Parental Depression Screening Beyond the First Birthday: Can Pediatricians Make a Difference?

In a recently released article in Pediatrics, Ava Marie Hunt et al conducted a scoping review to understand the literature on parental depression screening beyond the postpartum period, specifically beyond the child’s 1st birthday, and to identify relevant knowledge gaps (10.1542/peds.2021-055804). For those unfamiliar, a scoping review is similar in concept to a systematic review or meta-analysis, in that it looks at the literature on a specific topic, but its goal is to map the volume, type, and characteristics of primary research studies; it is particularly useful when the literature is either heterogeneous, complex, or previously unexamined.¹ In comparison, a systematic review aims to answer a specific question by gathering all available evidence in a defined and methodical way; a meta-analysis is the statistical process used to combine and analyze results from studies that are similar enough to be examined together.² While there is a relatively large body of information on maternal postpartum depression screening in pediatric offices and clear recommendations,² depression screening for both mothers and fathers/partners and screening beyond the 1st year of life, are relatively less explored, and a scoping review is the optimal way to proceed. The authors found 41 articles that met their search criteria: the study criteria included screening by a pediatric clinician in a pediatric healthcare setting for either maternal or paternal depression or mood disorder after the child’s first birthday, and the study was published in English.

The 41 articles included more than 32,000 parents and caregivers. Studies were mainly observational (35/41, 85%) and from primary care settings (21/41, 51%); most included mothers only (28/41, 68%), although 8 (20%) enrolled both mothers and fathers. The most frequently used screening tool was the Beck Depression Inventory (20%). Parental depression was associated with negative mental and physical child health outcomes, but for me the real eye-opener was that the studies included in this scoping review reported an overall mean positive screening rate for depressive symptoms of 25.5%. This means that parental depression beyond the postpartum period is neither a small nor insignificant issue.

This article is a must-read for clinicians, and a call to action for ongoing parental depression screening in our offices beyond the first year of life. Currently, the Bright Futures/AAP Periodicity Schedule recommends screening for maternal depression at the 1-, 2-, 4-, and 6-month health supervision visits, and for paternal/partner depression at the 6-month visit.³ We can do more, and this review convinces me that we should. As the authors note, screening requires selecting a tool(s),^4,5 instituting provider and staff training, and ideally having a robust system for referral to resources and follow up. Given the consequences for child health of untreated parental depression, this endeavor is clearly worth our efforts.  Let us know what you are doing in your office!

References:

1. Pham MT, Rajić A, Greig JD, Sargeant JM, Papadopoulos A, McEwen SA. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Res Synth Methods. 2014;5(4):371-385. doi:10.1002/jrsm.1123
2. Ahn E, Kang H. Introduction to systematic review and meta-analysis. Korean J Anesthesiol. 2018;71(2):103-112. doi:10.4097/kjae.2018.71.2.103
3. Rafferty J, Mattson G, Earls MF, Yogman MW; COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH. Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice. Pediatrics. 2019 Jan;143(1):e20183260. doi: 10.1542/peds.2018-3260. PMID: 30559118
4. Infancy Visits- Bright Futures- American Academy of Pediatrics. (BF4_InfancyVisits). https://brightfutures.aap.org/Bright%20Futures%20Documents/BF4_InfancyVisits.pdf (accessed 5/25/2022).
5. National Research Council (US) and Institute of Medicine (US) Committee on Depression, Parenting Practices, and the Healthy Development of Children; England MJ, Sim LJ, editors. Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention. Washington (DC): National Academies Press (US); 2009. 5, Screening for Depression in Parents.Available from: https://www.ncbi.nlm.nih.gov/books/NBK215108/
6. Kennedy E, Munyan K. Sensitivity and reliability of screening measures for paternal postpartum depression: an integrative review. J Perinatol. 2021 Dec;41(12):2713-2721. doi: 10.1038/s41372-021-01265-6. Epub 2022 Jan 1. PMID: 34974537; PMCID: PMC8752439