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Mothers' Mental Health Care Utilization After Screening for Postpartum Depression at Well Child Visits

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OBJECTIVES: The American Academy of Pediatrics recommends postpartum depression (PPD) screening. It is unknown if pediatricians are effective in linking mothers to mental health services. The objectives of the current study are to determine: 1) mental health care utilization among women with Medicaid insurance after a positive PPD screen and 2) maternal and infant factors that predict the likelihood of mental health care utilization. METHODS: Retrospective cohort design of mothers attending their infants' 2-month well child visit at one of five urban primary care practices between 2011-2014. A linked dataset of the child's electronic health records, maternal Medicaid claims, and birth certificates was used. The primary outcome was mental health care utilization within six months of a positive PPD screen. Multivariate logistic regression was used to estimate maternal and infant clinical and sociodemographic factors that predict service use. RESULTS: 3,052 mothers met study criteria, 1,986 (65.1%) completed the PPD screen, and 263 (13.2%) screened positive for PPD of whom 195 (74.1%%) were referred for services. Twenty-three women (11.8%) had at least one Medicaid claim for depression within six months of screening. In multivariate modeling, mothers with a history of depression in the prior year (OR=3.80, 1.20-12.11) were more likely to receive mental health services after a positive screen. CONCLUSIONS: Few mothers who screened positive for PPD received mental health services. Mothers without a recent history of depression treatment may be especially at risk for inadequate care. Additional mechanisms to improve access to mental health services following PPD screening are needed.


Kallem S, Matone M, Boyd RC, Guevara JP