Dartmouth Medical School

For Release: June 13, 2005
Contact: MedNews Office (603) 650-1492

Well-Child Visits Can Uncover Maternal Depression

HANOVER, NH -- Well-child visits are often missed opportunities to uncover maternal depression. However, two simple, specific questions allow busy pediatricians to pinpoint at-risk mothers, according to a new study in the June issue of the journal Developmental and Behavioral Pediatrics.

The study found that screening revealed mental health issues that could influence the child's health in 8.8 percent of well-child visits, and mothers who answered the questions on paper were four times more likely to reveal depression than those who were interviewed face to face.

"Mothers of young children are likely to have more contact with a pediatrician than any other health care provider," according to lead researcher Ardis Olson, M.D., associate professor of pediatrics at Dartmouth Medical School, and colleagues.

Detecting parents at high-risk for depression is not a traditional function of pediatricians. Nevertheless, says Olson, "Our doctors are interested, because of how much mothers' mental health affects children." Children of depressive parents have higher risks of mental health problems as adolescents, Olson says.

"Mothers who are depressed may lack the energy to be consistent," Olson says. "They vary between being withdrawn, just not available and being overly obtrusive. Kids don't know where Mom is today."

For the study, pediatricians in four practices in small rural communities in New Hampshire and Maine were trained in screening approaches, which they used with a total of 473 mothers during well-child visits. Children ranged in age from 2 weeks to 16 years.

The number of fathers attending visits was so small that their screening data were not reported.

The researchers compared two screening methods: a face-to-face interview or paper questionnaire. Both asked the following:

--"In the past couple of weeks, have you been in a depressed mood most of the time?"

--"During the past couple weeks, have you often had little interest or pleasure in doing things?"

In the 223 women who filled out questionnaires, researchers found "either depressive symptoms or other maternal mental health issues that could influence the child's health" in 27 percent of well-child visits.

Of 250 mothers who were interviewed, 5.7 percent indicated mental health issues. Mothers of children younger than 1 year were less likely to screen positive than those with older children.

The interview script included the two-question screen and took less than one minute to administer. According to Olson, standard depression measures take 5 to 15 minutes to administer and score. "Even 5 minutes is long for a visit," she says. "It's challenging finding time [to screen]."

In a few visits, pediatricians who failed to screen mothers reported being too rushed, feeling uncomfortable asking or being distracted by very active children.

How did pediatricians react to the results? "All were surprised that interview questions were not as effective as the paper screen," Olson says. "These were experienced doctors who knew the families."

Either type of screening was more effective than the pediatrician simply observing that a mother had a depressed affect, which missed 54 percent of the mothers who had a positive depression screen. Nor was a general conversation about mood as effective as asking the two key questions.

Before initiating the screening, physicians and office staff planned their response to positive screens, including referral sources, educational materials about depression, and handouts about self-help approaches like exercise.

"A pediatrician can be a source of help for a mom who is struggling," Olson says.

For more information, contact Health Behavior News Service: (202) 387-2829 or www.hbns.org.