Screening for perinatal mental health disorders

Transcript:

Cynthia Chew, DNP, CPNP-PC, IBCLC:

Hi, I'm Cynthia Chew, I'm a pediatric primary care nurse practitioner. I practice at Pediatric Associates of Westmoreland, I'm also a lactation consultant there. I am also faculty at the School of Nursing at the University of Pittsburgh and coordinate the nurse practitioner programs within the school.

Contemporary Pediatrics:

Can you tell us about your session, "The Why and How of Screening for Perinatal Mental Health Disorders in Pediatric Primary Care," presented at NAPNAP 2024?

Chew:

My talk was about perinatal mood and anxiety disorders or PMADS, and these are the mental health conditions that birthing parents face during pregnancy and in the postpartum period. Specifically, I talked a little bit about the different variations of those disorders, including perinatal depression and perinatal anxiety, which includes perinatal OCD, bipolar and psychosis, and the impact that that has on children and families and why we should be screening for it in pediatric primary care. I think that the most important things to know are that PMADs are the leading cause of maternal mortality in the United States and they're responsible for about 20% of maternal deaths. I think that we often think about other complications of pregnancy as being more at the forefront, you know, things related to actual complications with birth, and not these mental health issues. The thing that's so sad about this is that they're largely preventable or modifiable. We can reduce the risks if we are working with our families and have good screening and take good histories of both our pediatric patients, but also of their parents and their caregivers. In addition to that, it cost the healthcare system a whole lot. I think we all know, as pediatric providers that we can't have good care for a child if the caregiver isn't well. So it's really important that as providers, we're not only asking about how the baby's sleeping, and peeing and pooping and eating, but how are the parents coping with that, and are things going okay, and is there some support that we can offer? I think luckily, our professional organizations have recognized that this is important and so they allow us the opportunity to provide screenings to parents, and bill for them, so these are reimbursable screenings that we can do, even though they're not technically for our patient, because they directly affect the health of our patient. You can use these evidence-based tools to screen for particularly depression and anxiety. I would say the most common one is the Edinburgh Postnatal Depression Scale. Another key takeaway from that is, you can actually use it as an anxiety screener because items 3, 4 and 5 directly relate to anxiety. So you can get, double your effort for doing 1 screening by scoring those 3 items, and if a patient scores more than 5, they're likely also suffering from postpartum anxiety.

Contemporary Pediatrics:

What are the next steps for a pediatric provider after a screening has been given to the parent?

Chew:

I think that's one of the biggest barriers that providers face in "this isn't my patient, what's my responsibility?" We cannot obviously prescribe medications or provide therapy to these families, but there's lots of creative ways that we can provide support, and we can coordinate with the birthing parents, caregiver, their health care provider, we can make sure that they're aware and help with referrals to community resources. There's other things that we can do to support the family. A lot of the triggers for anxiety and depression have to do with stress related to caring for a newborn. So if we can highlight the strengths that the family has and lean on the supports that they have in place, and then also see where they might have deficits in their care, we can help to identify what resources are going to help them the most. One thing that we can do in most states is refer to early intervention whenever parents are suffering from mental health disorders, because they can actually help provide some therapy and some work with the child-parent dyad to help support right within the home, and then there's other resources that every community has that are unique. Parent support groups, postpartum doula services, lactation support groups. So knowing your resources within your community and, kind of digging in a little deeper after that screening to see what resources might benefit that family the most.

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