Maternal Depression Screening

The percentage of children who turned 6 months of age during the measurement year, who had a face-to-face visit between the clinician and the child during child's first 6 months, and who had a maternal depression screening for the mother at least once between 0 and 6 months of life

This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA) with support from The Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy. The views presented here are those of the author and not necessarily those of The Commonwealth Fund, its directors, officers, or staff. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses must be approved by NCQA and are subject to a license at the discretion of NCQA. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. (C) 2009-2019 National Committee for Quality Assurance. All Rights Reserved. 

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Maternal depression is a common condition with potentially serious and far-reaching consequences. Rates of depression for pregnant and/or postpartum women range from 12-15%, with postpartum depression rates in some U.S. areas estimated to be as high as 20% (Ko et al., 2017; Gaynes et al., 2005; Bennett et al., 2004). Depression has significant consequences for women, their infants and families. Women with untreated depression during pregnancy are at risk of developing severe postpartum depression and suicidality, and of delivering premature or low birthweight babies (Chan et al., 2014). Postpartum depression hinders infant attachment and bonding and can lead to developmental disorders that last into adolescence (Field, 2010; Kingston, Tough, & Whitfield, 2012; Dawson et al., 1999). During infancy, important caregiving activities such as breastfeeding, sleep, adherence to well-child visits and vaccine schedules can be compromised in depressed mothers (Kingston et al., 2012; Gregory et al., 2015; Minkovitz et al., 2005). 

Clinical guidelines recommend that maternal screenings for depression should occur where there are adequate systems in place (Siu & USPSTF, 2016; American College of Obstetricians and Gynecologists, 2015; Yonkers et al., 2009). Adequate systems in place means having the appropriate systems and clinical staff to ensure that patients are screened and, if screened positive, are appropriately diagnosed and treated with evidence-based care or referred to a setting that can provide the necessary care (Siu & USPSTF, 2016). Guidelines also recommend that providers maintain regular follow-up with patients diagnosed with depression and use a standardized tool to track symptoms (Mitchell et al., 2013). Standardized instruments are useful in identifying meaningful change in clinical outcomes over time. Despite these clinical recommendations, maternal depression is often underdiagnosed and untreated. Nearly 60% of women with depressive symptoms do not receive a clinical diagnosis, and 50% of women with a diagnosis do not receive any treatment (Ko et al., 2012). This measure encourages clinicians to screen new mothers for depression.

U.S. Preventive Services Task Force (USPSTF) et al. (2016)
The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.
Grade: B Recommendation

Bright Futures (Hagan et al., 2017)

Mothers of one month old infants: Maternal depression screen

Mothers of two month old infants: Maternal depression screen
Grade: Expert Consensus

American College of Obstetricians and Gynecologists (2015)
The American College of Obstetricians and Gynecologists recommends that clinicians screen patients at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool. Although screening is important for detecting perinatal depression, screening by itself is insufficient to improve clinical outcomes and must be coupled with appropriate follow-up and treatment when indicated. Systems should be in place to ensure follow-up for diagnosis and treatment.
Grade: Expert Consensus

Higher score indicates better quality

.American College of Obstetrics and Gynecologists. (2015). Screening for perinatal depression: Committee Opinion No. 630. Obstetrics & Gynecology, 125(5), 1268-1271.

Bennett, H. A., Einarson, A., Taddio, A., et al. (2004, April). Prevalence of depression during pregnancy: systematic review. Obstetrics & Gynecology, 103(4), 698-709.

Chan, J., Natekar, A., Einarson, A., et al. and Koren G. (2014, March). Risks of untreated depression in pregnancy. Canadian Family Physician,. 2014 Mar; 60(3),: 242-243.

Dawson, G., Frey, K., Panagiotides, H., et al. (1999). Infants of depressed mothers exhibit atypical frontal electrical brain activity during interactions with mother and with a familiar, nondepressed adult. Child Development, 70(5), 1058-1066.

Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: A review. Infant Behavior and Development. 2010;, 33(1), :1-6.

Gaynes, B. N., Gavin, N., Meltzer-Brody, S., et al. (2005, February). Perinatal depression: Prevalence, screening accuracy, and screening outcomes—Summary (Evidence Report/Technology Assessment No. 119; AHRQ Publication No. 05-E006-1). Rockville, MD: Agency for Healthcare Research and Quality. 

Gregory, E. F., Butz, A. M., Ghazarian, S. R., et al. (2015). Are unmet breastfeeding expectations associated with maternal depressive symptoms? Academic Pediatrics, 15(3), 319-325.

Hagan, J. F., Shaw, J. S., Duncan, P. M. (eds.). (2017). Bright Futures: Guidelines for health supervision of infants, children, and adolescents. 4th edition. Elk Grove, IL: American Academy of Pediatrics. 

Kingston, D., Tough, S., & Whitfield, H. (2012). Prenatal and postpartum maternal psychological distress and infant development: A systematic review. Child Psychiatry & Human Development. 2012, ;43(5), :683-714.

Ko, J. Y., Farr, S. L., Dietz, P. M., et al. (2012). Depression and treatment among U.S. pregnant and nonpregnant women of reproductive age, 2005-2009. Journal of Women’s Health (Larchmont), 21(8), 830-836.

Ko, J. Y., Rockhill, K. M., Tong, V. T., et al. (2017). Trends in postpartum depressive symptoms—27 states, 2004, 2008, and 2012. Morbidity and Mortality Weekly Report, 66(6), 153-158. doi: http://dx.doi.org/10.15585/mmwr.mm6606a1

Minkovitz, C. S., Strobino, D., Scharfstein, D., et al. (2005). Maternal depressive symptoms and children’s receipt of health care in the first 3 years of life. Pediatrics, 115(2), 306-314.

Mitchell, J., Trangle, M., Degnan, B., et al. (2013, September). Adult depression in primary care. Bloomington, MN: Institute for Clinical Systems Improvement. 

Siu, A. L., & USPSTF. (2016). Screening for depression in adults: U.S. Preventive Services Task Force recommendation statement. JAMA, 315(4), 380-387. 

US Preventive Services Task Force, Siu, A. L., Bibbins-Domingo, K., et al. (2016, January 26). Screening for depression in adults: U.S. Preventive Services Task Force recommendation statement. JAMA, 315(4), 380-387. doi: 10.1001/jama.2015.18392

Yonkers, K. A., Wisner, K. L., Stewart, D. E., et al. (2009). The management of depression during pregnancy: A report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. General Hospital Psychiatry, 31(5), 403-413.

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The eMeasure specifies only patient's (baby) chart, looking for the newly allocated SNOMED codes that allow providers to record the screening and treatment of the mother, but the endorsed measure relies on notes from the patient's and mother's charts. Information for the measure can be obtained from either the mother's or the baby's chart.

TBD

Children with a visit who turned 6 months of age in the measurement period

Equals Initial Population

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Children with documentation of maternal screening or treatment for postpartum depression for the mother

Not Applicable

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For every patient evaluated by this measure also identify payer, race, ethnicity and sex

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