Starting from Scratch on Detecting Maternal Depression
I recently came across an article in the Health section of the New York Times with the headline “Panel Calls for Depression Screenings During and After Pregnancy”. This headline immediately caught my interest as I was surprised that this was news. I guess it should not surprise me that government funding and public attention has not been focused on the topic of maternal mental health, mental health coverage in the United States is sparing and hardly common, however I was still quite taken aback. The article discusses a ‘novel’ idea, the suggestion of screening for maternal mental illness (Belluck, 2016). The article claims that new evidence has shown that maternal mental illness, specifically mood disorders, are more common than previously thought and may actually start during pregnancy as opposed to post-partum (previously assumed to be the case) (Belluck, 2016). This data has apparently alerted the United States Preventative Task Force to the significant impact of maternal mood disorders on child well-being (Belluck, 2016). My question, however, is why implement screening tests? Post-Partum depression and the significant impact of maternal depression on children is well documented and frequently discussed in psychology literature. The ability to accurately and comprehensively identify women in need of treatment is incredibly important, as addressing maternal depression may help not only the patient but her children to prevent negative psychological outcomes associated with maternal mental illness (Oyserman, Bybee &Mowbray, 2002). But the question remains, why not pick a psychometric test that will more thoroughly and rigorously identify those who need to be assessed and treated? There are highly effective treatments for post-partum depression such as cognitive behavioral therapy, non-directive counseling, and psychodynamic therapy that can alleviate symptoms and possibly prevent serious behavioral and emotional consequences for children (Cooper, Murray, Wilson & Romaniuk, 2003). Given that there is a successful available treatment, it seems that using an alternate form of psychological testing to perform the first step of treatment, identification, would be useful in order to facilitate treatment of those who really need it while avoiding treating those false positives that screening tests produce. Although a structured clinical interview or a lengthy diagnostic scale may cost more to administer and create, it seems to me that the misclassifications of screening tests may lead to use of treatment in situations where it is not required. In the long run, it may be advantageous to perform more precise assessments in the form of structured clinical interviewing or comprehensive diagnostic inventories. It seems to me that because this issue is so important, utilizing a method that will give the most accurate results would be the best path in order to efficiently identify at risk women. Screenings for maternal depression are a good place to start, in my opinion, as it identifies those who may need treatment and, by nature, casts a wide net. Given that almost nothing existed before the screenings, anything is an improvement. The screening tests being performed now will hopefully allow for the opportunity to treat those mothers who may not otherwise have been identified as needing help, and perhaps initiate the process of intervening in a cycle of mental illness and negative parenting behaviors (Oyserman, Bybee &Mowbray, 2002). However, in the very near future health professionals should consider switching from screening tests that produce misclassification to a more thorough way of identifying at risk women for post-partum depression.
Cooper, P. J., Murray, L., Wilson, A., & Romaniuk, H. (2003). Controlled trial of the short-and
long-term effect of psychological treatment of post-partum depression. The British Journal of Psychiatry, 182(5), 412–419.
Oyserman, D., Bybee, D., & Mowbray, C. (2002). Influences of
maternal mental illness on psychological outcomes for adolescent children. Journal of Adolescence, 25(6), 587–602.