Mothers' Mental Health Care Use After Screening for Postpartum Depression at Well-Child Visits

Abstract

Objective: The American Academy of Pediatrics recommends postpartum depression (PPD) screening. It is unknown whether pediatricians are effective in linking mothers to mental health services. The objectives of the current study are to determine 1) mental health care use among women with Medicaid insurance after a positive PPD screen and 2) maternal and infant factors that predict the likelihood of mental health care use.

Methods: Retrospective cohort design of mothers attending their infants' 2-month well child visit at 1 of 5 urban primary care practices between 2011 and 2014. A linked dataset of the child's electronic health records, maternal Medicaid claims, and birth certificates was used. The primary outcome was mental health care use within 6 months of a positive PPD screen. Multivariate logistic regression was used to estimate maternal and infant clinical and sociodemographic factors that predict service use.

Results: In total, 3052 mothers met study criteria, 1986 (65.1%) completed the PPD screen, and 263 (13.2%) screened positive for PPD, of whom 195 (74.1%%) were referred for services. Twenty-three women (11.8%) had at least 1 Medicaid claim for depression within 6 months of screening. In multivariate modeling, mothers with a history of depression in the previous year (odds ratio = 3.80, 1.20-12.11) were more likely to receive mental health services after a positive screen.

Conclusions: Few mothers who screened positive for PPD received mental health services. Mothers without a recent history of depression treatment may be especially at risk for inadequate care. Additional mechanisms to improve access to mental health services after PPD screening are needed.

Keywords: depression; postpartum; screening; well-child care.