Depression in Parents, Parenting, and Children Opportunities to Improve Identification, Treatment, and Prevention (2009) / Chapter Skim
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5 Screening for Depression in Parents
5 Screening for Depression in Parents
Pages 183-204
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From page 183... ...
• Studies that have examined the mental health outcomes of adult depression screening in primary care settings rarely identify if the adult is a parent; have not addressed its impact on parental func tion; do not inquire about comorbid conditions (e.g., anxiety disor ders, substance use) ; rarely assess adult treatment preferences; and rarely consider barriers to utilization of services or the two-genera tion impact of depression.
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From page 184... ...
Finally, we consider promising approaches to parental depression screening and assessment in public health settings and with high-risk populations served by homeless, home visitation and substance use programs. In addressing the impact that depression has on children, the com
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From page 185... ...
Clinical studies are not available that use screening tools to address the issue of parental skills for children of multiple ages in the context of depression. PRIMARY CARE SETTINGS The substantial numbers of adults with depression who are untreated, along with the underrecognition of depression by primary care providers, has led to examination of the use of brief screening procedures for depressive symptoms to address this problem.
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From page 186... ...
. Although maternal depression is associated with child developmental and behavioral outcomes, as discussed in Chapter 4, these recommendations do not mention either screening for maternal depressive symptoms with developmental screening or screening mothers when developmental delays are found.
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From page 187... ...
It is important to remember that, although a positive screen reveals depressive symptoms that might influence parenting, the positive predictive value for major depression is 35 to 50 percent with these screeners when validated by psychiatric interview (Boyd, Le, and Somberg, 2005; Kroenke, Spitzer, and Williams, 2003)
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From page 188... ...
For positive Recommended that the physician screen ≥ 3 follow up with a more comprehensive screening tool. RAND Sensitivity = < 1 minute This is a three-item adaptation 3-question 1.00 Self-administered (Kemper and Babonis, 1992)
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From page 189... ...
The Centers for Disease Control and Prevention has recently completed a study of maternal recall of postpartum depressive symptoms at 6 months postpartum in 17 states during 2004–2005. The prevalence of self-reported postpartum depression ranged from 11.7 percent in Maine to 20.4 percent in New Mexico.
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From page 190... ...
The evidence thus far shows that, in the postpartum period targeted by many programs, depressive symptoms, but not major depression, are more prevalent than at other times of parenthood. Some public health programs have initiated comprehensive programs to address maternal depression.
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From page 191... ...
. Maternal depression screening in a disadvantaged, urban, pediatric, clinic setting during well-child visits for children under age 6 showed that 27 percent of mothers screened positive using a yes or no response for the PHQ-2, and 12 percent screened positive with the Beck Depression Inventory (BDI)
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From page 192... ...
SCREENING IN OTHER SETTINGS Parents, particularly women, with children who are at heightened risk for depression are served in other community programs that may provide the opportunity to screen for depression and offer further assessment and supports for treatment. Maternal depression is common among parents of Early Head Start programs, and depressive symptoms have been assessed as
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From page 193... ...
Among mothers, 83–88 percent screened positive for depressive symptoms at treatment entry (Conners et al., 2006; Lincoln et al., 2006)
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From page 194... ...
. The ASI, which is a required intake tool for substance abuse treatment programs in many states, is now used for screening patients for the need for further psychiatric assessment by the center psychiatrist.
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From page 195... ...
Based on these rates of depression in the home visiting literature, routine screening can be expected to reach many high-risk families and to identify a large number of clinical cases. Although no randomized clinical trial outcomes have been published for the strategy of screening all new mothers through home visitation, several state programs are conducting screening programs in which home visitors administer and score a standardized depression screen and then refer mothers (or fathers)
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From page 196... ...
CHALLENGES IN THE IMPLEMENTATION OF SCREENING FOR DEPRESSION For depression screening to be feasible in more primary care settings, more information about the details of implementing screening programs in different settings is needed for practices to plan for adequate time and support resources. For example, only one study provides information about the impact on the time spent by clinicians with routine depression screening (Olson et al., 2006)
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From page 197... ...
The major problem raised by routine screening is how to provide effective services for the large number of depressed parents who are likely to be identified. In addition to needing local capacity to treat these newly recognized cases, several studies indicate that home visitors as a group are not good at connecting families with community-based services for depression, domestic violence, and substance abuse (Hebbeler and Gerlach-Downie, 2002; Tandon et al., 2005)
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From page 198... ...
They should examine the impact of each step in the care process from screening, education, and parent engagement, through parent treatment preferences and choices made, to referrals made and completed, and to clinical outcomes. More research is needed to determine the optimal ways to integrate parental depression screening with the assessment of parenting and child developmental and behavioral status for all children but especially in highrisk populations (i.e., with substance use disorders, low-income status, at risk for abuse)
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From page 199... ...
Mothers with elevated depressive symptoms as well as cases of clinical depression have been successfully identified primarily through screening programs in perinatal health care settings and, to a limited extent, in other private and public primary care settings. Depression in fathers has not been the focus of screening programs.
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From page 200... ...
. Changes in depressive symptoms in first-time mothers in home visitation.
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From page 201... ...
. Pediatricians' attitudes about dis cussing maternal depression during a paediatric primary care visit.
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From page 202... ...
. Brief maternal depression screen ing at well-child visits.
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From page 203... ...
. Perinatal Maternal Depression and Child Devel opment: Strategies for Primary Care Providers.
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