Hormonal changes during and after pregnancy may trigger depression in some women. In fact, between 10 and 15 percent of pregnant women and new mothers may experience some symptoms of depression. But their condition can be far more than simply feeling “blue” or “down.” For many, it can have a debilitating effect on their health, their family, their careers and their relationships.
To address the need for earlier screening and treatment of maternal depression, the Texas Children’s Pavilion for Women launched a pilot program in May to screen patients multiple times throughout their pregnancy and postpartum period. The effort is part of the Women’s Mental Health Delivery System Reform Incentive Payments (DSRIP) program, focusing on expanded access to health care services.
“Our goal is to identify women with maternal depression as soon as possible and get them into care because maternal depression is treatable,” said Dr. Lucy Puryear, medical director of The Women’s Place – Center for Reproductive Psychiatry and Baylor College of Medicine psychiatrist, who oversees the program. “How we deal with this can have a profound impact not only on the physical and emotional well-being of the mother, but on the life of the child and the family overall.”
As part of the program, women are screened for maternal depression using the Edinburgh Postnatal Depression Scale multiple times throughout their pregnancy (during the first and third trimesters) and postpartum (at two weeks in the pediatrician’s office and at six weeks by their obstetrician), and those requiring follow-up mental health services are referred for care.
“Our overriding goal is to learn from the patients we’re currently screening in order to develop a model for the early diagnosis and treatment of maternal depression using several combined strategies,” said Dr. Puryear. “Texas Children’s Pavilion for Women is uniquely positioned to oversee this project because of the unique Reproductive Psychiatry program and faculty at Baylor College of Medicine.”
Dr. Lisa Valentine, a Baylor College of Medicine psychiatrist hired to treat patients as part of this program, practices at The Women’s Place at the Pavilion for Women, The Center for Children and Women at Greenspoint and at Pearland Ob-Gyn. Two Texas Children’s Pediatrics practices, Pearland and Shadow Creek Ranch, are serving as pilot sites for the project. Providers and staff at these pilot sites have been trained to implement standardized screening and referral.
At Texas Children’s Pediatrics Pearland, every new mother is screened for postpartum depression at the initial well-child visit, which occurs approximately two weeks postpartum, referring those needing services. Referrals are processed quickly and most patients are seen within seven days of being screened. Select providers at Texas Children’s Pediatrics Shadow Creek Ranch have also begun standardized screening.
Future plans focus on educating and training staff at obstetric clinics and additional pediatric clinics to implement standardized screening and referral; adding additional providers, including a psychiatrist, therapist and social worker; and expanding to additional sites with the intent of integrating maternal mental health services where women are already seeking treatment.