Legal and Ethical Considerations: Risks and Benefits of Postpartum Depression Screening at Well-Child Visits

Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York, United States
PEDIATRICS (Impact Factor: 5.47). 02/2007; 119(1):123-8. DOI: 10.1542/peds.2006-2122
Source: PubMed


Pediatric professionals are being asked to provide an increasing array of services during well-child visits, including screening for psychosocial and family issues that may directly or indirectly affect their pediatric patients. One such service is routine screening for postpartum depression at pediatric visits. Postpartum depression is an example of a parental condition that can have serious negative effects for the child. Because it is a maternal condition, it raises a host of ethical and legal questions about the boundaries of pediatric care and the pediatric provider's responsibility and liability. In this article we discuss the ethical and legal considerations of, and outline the risks of screening or not screening for, postpartum depression at pediatric visits. We make recommendations for pediatric provider education and for the roles of national professional organizations in guiding the process of defining the boundaries of pediatric care.

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    • "mothers of newborns (Chaudron et al. 2007; Horowitz and Cousins 2006). Because of these concerns, Kelsey–Seybold Clinic, which includes a large obstetrics practice in Houston, TX, instituted a program of systematic screening, referral, and monitoring for peripartum depression. "
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    ABSTRACT: This study was developed to evaluate the feasibility of implementing systematic depression screening in a large obstetric practice and to evaluate the degree that detection and referral led to linkage with behavioral healthcare. Depression screening was conducted using the Edinburgh Postnatal Depression Scale, administered at the initial pregnancy care appointment. Patients at or above a predetermined score of 14 were advised to seek further behavioral health assessment through the patient's behavioral healthcare coverage. Within 4 weeks of screening, those referred were contacted by telephone, by clinic staff, to determine whether they had pursued behavioral healthcare as recommended. Limited available data for newly established postdelivery screening were similarly evaluated. All 2,199 newly presenting pregnant women who were seen in our obstetric clinics from September 2008 to May 2009 were screened for depression, and 102 (4.6%) scored at or above an EPDS of 14. Follow-up calls revealed that none had pursued further behavioral health assessments. Of these 2,199, screening and follow-up data were available for 569 women at their 6-week postdelivery visit. Of these, 28 (4.9%) were above EPDS of 14, and 5 (17.9%) reported pursuit of further behavioral healthcare following screening and referral. Peripartum depression can be addressed with systematic screening, and the electronic medical record can readily be used to monitor results. Detection and referral at the beginning of pregnancy did not lead to intended linkage with behavioral healthcare, but detection and referral postdelivery had a modest influence. Barriers to pursuing behavioral healthcare need to be discovered and addressed.
    Archives of Women s Mental Health 03/2012; 15(2):115-20. DOI:10.1007/s00737-012-0262-6 · 2.16 Impact Factor
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    • "Identification of depression in the postpartum period may be complicated by some of the normal physical and emotional demands of new motherhood, including changes in energy and appetite, sleep deprivation, and heightened concern for the infant. Experts have recommended screening for PPD at the first postnatal obstetrical visit (usually 4–6 weeks after delivery),39 or in the family practice40 or pediatric setting,41 as these are the most widespread points of interaction with the health care system for new mothers within the first three months of delivery. The most commonly used screening tool for PPD is the Edinburgh Postnatal Depression Scale (EPDS),42 a 10-item self-report that emphasizes emotional and functional factors rather than somatic symptoms. "
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    ABSTRACT: Postpartum depression (PPD) is a common complication of childbearing, and has increasingly been identified as a major public health problem. Untreated maternal depression has multiple potential negative effects on maternal-infant attachment and child development. Screening for depression in the perinatal period is feasible in multiple primary care or obstetric settings, and can help identify depressed mothers earlier. However, there are multiple barriers to appropriate treatment, including concerns about medication effects in breastfeeding infants. This article reviews the literature and recommendations for the treatment of postpartum depression, with a focus on the range of pharmacological, psychotherapeutic, and other nonpharmacologic interventions.
    International Journal of Women's Health 12/2010; 3(1):1-14. DOI:10.2147/IJWH.S6938
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    • "The relationship between the perinatal period and maternal mental health disorders has received national attention (Gaynes et al. 2005). Two primary focal areas include improving the detection of perinatal depression by standardized use of validated screening tools (Chaudron et al. 2007; Olson et al. 2005) and evaluating the safety of antidepressants during pregnancy (Yonkers et al. 2009) and breastfeeding (Weissman et al. 2004). Despite the co-morbidity of mood and anxiety disorders and the use of similar treatments (antidepressants and cognitive behavioral therapy), little attention has been given to the experience of maternal anxiety during the perinatal period. "
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    ABSTRACT: This study aims to describe the phenomenology of obsessive-compulsive symptoms (OCS) and disorders (OCD) in perinatal women and to explore the relationship of OCS/OCD to postpartum depression. A prospective longitudinal study of 44 women screened with the Obsessive-Compulsive Inventory-Revised (OCI-R) and Edinburgh Postnatal Depression Scale (EPDS) between 30 and 37 weeks of pregnancy. Twenty-four women completed a diagnostic interview and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) before delivery and were contacted postpartum to repeat the EPDS and Y-BOCS. In the third trimester, 32% reported high levels of anxiety and/or depressive symptoms (EPDS ≥ 10 and/or OCI-R ≥ 15) and 29% of those who completed the diagnostic interview met criteria for OCD. At 1 month postpartum, 12.5% had new OCS (Y-BOCS ≥ 8) and 25% had new high levels of depressive symptoms (EPDS ≥ 10). OCS increased in intensity postpartum but did not change in character. OCD and OCS may be of greater prevalence during the perinatal period than previously recognized. The high rates provide new information and require replication in larger, more diverse populations. Research in the perinatal period must expand beyond the exploration of depression to include anxiety disorders and specifically OCD.
    Archives of Women s Mental Health 03/2010; 13(5):403-10. DOI:10.1007/s00737-010-0154-6 · 2.16 Impact Factor
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