Pediatricians' Attitudes and Practices on Postpartum Depression Screening: A Role for Social Workers

 

Background: In the first year after birth of a child, 6.5% to 12.9% of new mothers experience postpartum depression (PPD). PPD threatens the mother-child relationship and adversely affects infant's development if left untreated. Pediatricians can play a critical role in early detection of PPD. In 2010 The American Academy of Pediatrics made recommendations for PPD screening at well child visits yet little research is available regarding screening practices. The purpose of this study was to acquire information on attitudes, practices and perceived barriers to screening among pediatricians residing in a metropolitan city in Texas. The study also examined the effect of training and engagement of social workers on pediatricians' attitudes and practice of PPD screening.

Methods: SurveyMonkey was used to deliver a 20-item questionnaire covering PPD screening attitudes, practices and questions about receipt of training in how to screen and refer. The survey was sent out three times with the help from Chief Medical Officer over three months and yielded a 42% response rate (n=104).

MANOVA was applied to test the effect of training, engagement of social workers on pediatricians' attitudes towards PPD screening. Due to the small proportion of pediatricians receiving training or getting help from another professional, log-linear analysis failed to apply in this sample. Alternatively, Pearson's chi square test and fisher's exact test were adopted to explore the correlation between training, engagement of social workers and PPD screening practice among pediatricians.

Results: Sixty (57.7%) pediatricians reported that they screen in their practice and 69 (66.3%) pediatricians can recall the latest case in which they recognized a mother at risk of PPD. In total 23 (22.1%) pediatricians received training on PPD screening in the past year. Completion of training positively affected pediatricians' attitudes towards PPD screening (Pillai's trace V=0.125, F(6, 94)=2.231, p=.047). Separate univariate ANOVAs revealed significant effects of training on pediatricians' confidence in assessing PPD (F(1,99)=12.569, p=.001) and knowledge of diagnostic criteria of PPD (F(1,99)=8.534, p=.004). Pediatricians who received training are more like to screen PPD in their practice. (χ²(1,1)=7.224, p=.006)

When accounting for completion of PPD training, results showed that pediatricians who can access help from another professional, such as social workers, are more likely to screen PPD among new mothers (p=.040). Most pediatricians who received help from another professional cited social work as the most often used profession.

Most (83.8%) pediatricians perceived lack of time as the primary barrier to screen PPD among new mothers. Other barriers included being unfamiliar with mental health resources where they can refer new mothers (53.5%) and being unaware of next step after a positive screen for PPD symptoms (37.4%).

Implications: Lack of time and access to mental health referral are primary barriers of screening PPD in pediatric settings. Findings reveal that receipt of training on PPD screening boosts pediatricians' diagnostic knowledge, confidence of assessment and screening practice. The inter-professional collaboration also increases likelihood of PPD screening. Recommendations to engage social workers to train pediatricians and to provide mental health service to mothers with depressive symptoms are provided.