AT THE PAS ANNUAL MEETING
SAN DIEGO (FRONTLINE MEDICAL NEWS) – Infant hospitalizations provide an untapped opportunity to screen for maternal postpartum depression, according to Dr. Margaret Trost.
“A hospital setting places a mother at the bedside with her infant for much of the day, which may provide time for screening and counseling,” noted Dr. Trost, a pediatric hospitalist at Children’s Hospital Los Angeles and the University of Southern California in Los Angeles.
The American Academy of Pediatrics recommends screening mothers for postpartum depression during an infant’s routine office visits. Realistically, that often doesn’t happen, because of time constraints, because of physician discomfort with diagnosing the illness, or because an infant with prolonged hospitalization for severe illness misses the scheduled office visits, she said at the annual meeting of the Pediatric Academic Societies.
Dr. Trost presented what she believes is the first-ever formal study of screening for maternal postpartum depression during infant hospitalization. The results demonstrated that this approach is readily accomplished and captures large numbers of previously unscreened mothers. Moreover, women who initially screened positive and followed staff advice to discuss postpartum depression with their own physician or a recommended mental health referral resource had lower postpartum depression scores upon repeat screening at 3 and/or 6 months of follow-up.
Maternal postpartum depression is a depressive episode occurring within 1 year of childbirth. It affects an estimated 10% of mothers, with markedly higher rates in high-risk populations, including teenage or low-income mothers. In addition to the harmful effects on the mother, postpartum depression can harm an infant’s cognitive development and contribute to behavioral and emotional problems, Dr. Trost noted.
She reported on 310 mothers screened for postpartum depression 24-48 hours after their infant was admitted to Children’s Hospital Los Angeles. All infants had to be at least 2 weeks of age, because maternal depressive symptoms within the first 2 weeks after childbirth are classified as “baby blues” rather than postpartum depression. Study eligibility was restricted to the mothers of infants who were not admitted to an intensive care unit.
The screening tool utilized in the study was the Edinburgh Postpartum Depression Scale (EPDS), a validated 10-question instrument that probes a mother’s feelings, including energy, mood, and suicidality, within the past 7 days. A score of 10 or more out of a possible 30 identifies an at-risk mother.
All participants also were assessed using the Maternal-Infant Bonding Tool. In addition, information was collected on maternal demographics, social isolation, and history of previous psychiatric illness, as well as the infants’ comorbid conditions.
Based upon EPDS results, 28% of the mothers were deemed at risk for postpartum depression. They received counseling from both a physician and a social worker, got a handout on local and national mental health resources, and were advised to discuss their screening results with their personal physician or someone on the mental health referral list.
Of note, a mere 18% of study participants reported that they had been screened for postpartum depression since their most recent childbirth, underscoring the point that this important task doesn’t consistently get done in the outpatient setting, Dr. Trost said.
In this study, the higher a mother’s score on the EPDS, the worse her maternal-infant bonding score.
In a logistic regression analysis, Hispanic mothers were significantly less likely to have postpartum depression symptoms than non-Hispanics, with an odds ratio of 0.46.
Several risk factors for postpartum depression were identified in the study. Women who reported having low or no social support were 3.5 times more likely to have an at-risk EPDS score than those with self-described good social support. Those with a history of psychiatric illness were at 5.1-fold increased risk.
Those maternal risk factors for postpartum depression were consistent with the results of previous studies. A novel finding in this study was the identification of an infant risk factor: neurodevelopmental disorders. The 22 mothers of infants with a neurodevelopmental abnormality – cerebral palsy, mental retardation, hydrocephalus, seizures, a ventriculoperitoneal shunt, or craniosynostosis – had a 3.4-fold increased risk of a positive screen for postpartum depression. Moreover, in a multivariate logistic regression analysis controlled for race, social support, and history of psychiatric diagnosis, having an infant with a neurodevelopmental problem still remained associated with a threefold increased risk of maternal postpartum depression.
Attempts to follow up with all study participants by phone 3 and 6 months later met with only limited success. Of 87 mothers who screened positive by the EPDS, 21 completed follow-up phone interviews involving repeat screening, at which point 11 women still screened positive while 10 screened negative.
Follow-up interviews also were completed with 76 of the 223 mothers who initially screened negative. Of note, 6 women, or 8%, screened positive at follow-up.
Among the 21 mothers with an at-risk EPDS score at the initial screening during their infant’s hospitalization, 8 (38%) women took the advice to have a follow-up discussion about their risk for postpartum depression. This was typically with their personal physician, presumably because they felt more comfortable talking about the problem with a professional with whom there was already an established relationship, Dr. Trost said. On follow-up EPDS screening, those women showed a significant reduction from their baseline scores down to levels below the threshold for concern. In contrast, the change over time in EPDS scores in the 13 women who didn’t seek help was unimpressive, although the small sample size – just 21 mothers – must be noted, she said.
One audience member suggested that the intervention part of the program would be much more effective – and the follow-up rate higher – if the mental health referral resources could be incorporated into the initial infant hospitalization. Dr. Trost agreed, adding that she is looking into bringing in on-site small-group sessions.
She reported having no financial conflicts regarding this study, which was conducted free of commercial support.