Assessing

Maternal Depression
Sandra Smith, MPH, PhD

You may have witnessed the devastating

effects depression can have for a new

mother, her children and family. All women
of childbearing age are at high risk for
depression, especially during pregnancy and
the first year or two after giving
birth. Maternal depression (also called
perinatal or postpartum depression)
occurs during pregnancy or within the
child's first year. Fairly accurate and
easy-to-use screening measures are
available. Still, the extent of maternal
depression among US women is uncertain;
reports range from 5 to 25%.
Best estimates based on surprisingly
scanty available data are that 14.5% of all
pregnant women in the USA have a new
episode of depression during pregnancy.
The same proportion experience
depression in the first 3 months after
birth. Higher rates of depression (1729%) have been found among mothers with
low income, low education, unmarried
status and African American ethnicity.
Estimates for teens run 6 to 36%.

Depression & Home Visitation

For mothers enrolled in home visiting

programs risks of depression and barriers
to care are high. Reported rates at
enrollment range from 28.5 up to 61% with
cutoffs exceeding clinical guidelines for
major depression. Even higher rates show
up when repeated measures reveal
depression that develops during service
and often extends beyond the first year.
You probably have experienced some of
the challenges maternal depression
presents for home visitors and home
visitation; it impacts service delivery and
negatively affects outcomes.
References below

Depression & Your Program

Home visiting offers unique opportunities to identify

& intervene for maternal mental health. But most
program evaluations have shown little effect on
depression. Still, there are exceptions. And at least
1 study suggests positive effects may be
delayed. Much remains to be learned to define best
practices for addressing depression in home visits.

Explore & Learn with me and your fellow visitors.

We'll start with a short survey to get a clearer idea

of the scope of maternal depression in families you

serve. Next issue, I will report your responses. Then
we will consider the challenges of addressing
maternal depression.

Maternal Depression
Survey #1 Take it Now

Beginnings Pregnancy Guide on "Baby

Blues" & Depression

Overall, pregnant women and

new moms are as likely to be
depressed as other women of similar
age. But some evidence
suggests that, in the first 5 weeks
after birth, new mothers are 3 times
more likely to experience
depression. Often depressive
symptoms are overlooked or
dismissed as the "baby blues", a
normal hormonal response to the
stress of labor and birth. But baby
blues last only about two weeks.
When symptoms persist longer or
start later, it's time to screen for
depression.

Beginnings Pregnancy Guide addresses depression

in Booklet #6 First Weeks at Home. You can use the
text on pages 83-84 and the Warning Signs on the
back cover to begin a reflective conversation about
depression and care. Take a look.

Practice Development Inc 2010

References:
Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G, Brody S, Miller WC. Perinatal (February
2005). Depression: Prevalence, Screening Accuracy, and Screening Outcomes. Evidence Report/Technology
Assessment No. 119. (Prepared by the RTI-University of North Carolina Evidence-based Practice Center, under
Contract No. 290-02-0016.) AHRQ Publication No. 05- E006-2. Rockville, MD: Agency for Healthcare Research
and Quality.
Ammerman, R.T., Putman, F.W., Bosse, N.R., Teeters, A.R. & Ginkel, J.B. (2010). Maternal depression in home
visitation: A systematic review. Agression and Violent Behavior 15, 191-200.
Ramos-Marcuse, F., Oberlander, S.E., Papas, M.A., McNary, S.W., Hurley, K.M. & Black, M.M. (2010). Stability of
maternal depressive symptoms among urban, low-income, African-American adolescent mothers. Journal of
Affective Disorders 122, 68-75.
Feinberg, E., Smith, M.V., Morales, M.J., Claussen, A.H., Smith, D.C., & Perou, R. (2006). Improving Womens Health
during Internatal Periods: Developing an Evidence-Based Approach to Addressing Maternal Depression in
Pediatric Settings. Journal of Womens Health 15(6), 692-703.

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