Panel urges screening: Universal Depression Screening
Published: January 27, 2016
Panel urges screening: Universal Depression Screening, The recommendation, expected to galvanize many more health providers to provide screening, comes in the wake of new evidence that maternal mental illness is more common than previously thought; that many cases of what has been called postpartum depression actually start during pregnancy; and that left untreated, these mood disorders can be detrimental to the well-being of children.
It also follows growing efforts by states, medical organizations and health advocates to help women having these symptoms – an estimated one in seven postpartum mothers, some experts say.
“There’s better evidence for identifying and treating women with depression” during and after pregnancy, said Dr. Michael Pignone, a professor of medicine at the University of North Carolina at Chapel Hill and an author of the recommendation, which was issued by the United States Preventive Services Task Force. As a result, he said, “we specifically called out the need for screening during this period.”
The recommendation was part of updated depression screening guidelines issued by the panel, an independent group of experts appointed by the Department of Health and Human Services. In 2009, the group said adults should be screened if clinicians had the staff to provide support and treatment; the new guidelines recommend adult screening even without such staff members, saying mental health support is now more widely available. The 2009 guidelines did not mention depression during or after pregnancy.
“It’s very significant that the task force is now putting forth a recommendation that’s specific to pregnant and postpartum women,” said Katy Kozhimannil, an associate professor of public health at the University of Minnesota. “Policy makers will pay attention to it. Increased screening and detection of depression is an enormous public health need.”
The panel gave its recommendation, which was published in the journal JAMA, a “B” rating, which means depression screening must be covered under the Affordable Care Act.
For years, obstetricians and other health care providers who saw women during and after pregnancy often felt ill equipped or reluctant to ask about problems like depression, anxiety and obsessive-compulsive disorder.
“OB-GYNs thought that if they identify something and don’t have resources to support it, it puts them at significant legal risk,” said Dr. Samantha Meltzer-Brody, the director of the perinatal psychiatry program at the University of North Carolina at Chapel Hill. “Pediatricians have the added caveat that the mom isn’t really their patient – the child is.”
And, she said, many women are reluctant to share symptoms with doctors on their own. If a mother is “feeling so anxious you’re going to come out of your skin or feeling that you’re going to harm your baby, you may think: ‘Oh, my God, I’m having these crazy feelings and nobody’s talking about it. I must be a terrible mother.’ ”
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