The evidence base

Maternal Depression

Maternal depression is a mental health disorder that can have significant negative effects on the entire family. [1][2] Untreated maternal depression and anxiety affect parent-child relationships and the healthy development of young children. [3]

It is estimated 1 in 5 women in the United States will develop depression at some point.2 Studies suggest African American and Hispanic mothers have the highest rates of postpartum depression among all racial and ethnic groups but are less likely to receive treatment, due to lower screening rates and less successful referrals. [4] [5] [6] [7]

Efforts to effectively treat or prevent maternal depression help to ensure children will lead healthy and productive lives. This is why the American Academy of Pediatrics encourages surveillance and screening for maternal depression and why Healthy People 2030 includes a goal to increase postpartum depression screening rates.

How HealthySteps Supports Maternal Depression Screening and Treatment

HealthySteps ensures universal screening for maternal depression in pediatric primary care, creates more opportunities for prevention and encourages treatment by providing families with referrals and offering close follow-up and support to make sure services are accessed.

Research on HealthySteps demonstrates that HealthySteps mothers are more likely to disclose maternal depression symptoms, get referred for necessary services, and report fewer symptoms.

  • Mothers were significantly more likely to discuss their depressive symptoms with pediatric providers [8][9]
  • Pediatric providers were significantly more likely to discuss postpartum depression with mothers [10]
  • Mothers had significantly higher rates of maternal depression referrals and were more likely to have documented follow-up [11] [12]
  • Mothers with depressive symptoms reported significantly fewer symptoms three months after receiving HealthySteps [13]
  • Reported depressive symptoms decreased at a faster rate than among comparable mothers [14]

Findings from the HealthySteps Outcome Pilots Project add promising evidence related to HealthySteps’ ability to improve screening for maternal depression, increase referral follow-up, and reduce reported concerns and symptoms.

  • Maternal depression screening increased from 41% to 95% in just 19 weeks in one Outcome Pilot site and from 31% to 60% in just 11 weeks in another site.
  • In one Outcome Pilot site, maternal depression referral follow-up increased from 49% to 67%.
  • In one Outcome Pilot site, only 18% of HealthySteps mothers screened positive for maternal depression compared to higher rates of 40 to 60% reported for comparable populations of women with low incomes, suggesting HealthySteps may help mitigate maternal depression.[15] [16]

[1] Olin, S.C., Kerker, B., Stein, R.E., Weiss, D., Whitmyre, E.D., Hoagwood, K., Horwitz, S.M. (2016). Can postpartum depression be managed in pediatric primary care? Journal of Women’s Health 25(4):381-390.

[2] Santoro, K., Peabody, H. (2010). Identifying and treating maternal depression: Strategies and considerations for health plans. Washington, DC: National Institute of Health Care Management.

[3] Center on the Developing Child at Harvard University (2009). Maternal Depression Can Undermine the Development of Young Children: Working Paper No 8.

[4] Howell, E.A., Mora, P.A., Horowitz, C.R., Leventhanl, H. (2005). Racial and ethnic differences in factors associated with early postpartum depressive symptoms. Obstetrics and Gynecology, 105(6): 1442-1450.

[5] Kozhimannil, K.B., Trinacty, C.M., Busch, A.B., Huskamp, H.A., Adams, A.S. (2011). Racial and Ethnic Disparities in Postpartum Depression Care Among Low-Income Women. Journal of Psychiatric Services 62(6):619-625

[6] Sidebottom, A., Vacquier, M., LaRusso, E., Erickson, D., Hardeman, R. (2020). Perinatal depression screening practices in a large health system: identifying current state and assessing opportunities to provide more equitable care. Archives of Women’s Mental Health 24:133-144.

[7] Callister, L. C., Beckstrand, R. L., & Corbett, C. (2010). Postpartum depression and culture: Pesado corazon. The American Journal of Maternal/Child Nursing 35(5): 254–261.

[9] Johnston, B.D., Huebner, C.E., Anderson, M.L., Tyll, L.T., Thompson, R.S. (2006). Healthy Steps in an integrated delivery system: Child and parent outcomes at 30 months. Archives of Pediatrics & Adolescent Medicine 160(8):793–800.

[10] Buchholz, M., Talmi, A. (2012). What we talked about at the pediatrician’s office: Exploring differences between Healthy Steps and traditional pediatric primary care visits. Infant Mental Health Journal 33(4):430–436.

[11] Guyer, B., Barth, M., Bishai, D., Caughy, M., Clark, B., Burkom, D., Genevro, J., Grason, H., Hou, W., Keng-Yen, H., Hughart, N., Snow Jones, A., McLearn, K.T., Miller, T., Minkovitz, C., Scharfstein, D., Stacy, H., Strobino, D., Szanton, E., & Tang, C. (2003). Healthy Steps: The first three years: The Healthy Steps for Young Children Program National Evaluation.

[12] Beucke, N., Pauley, A., VonDras, S., Kryah, R. (2019). Postpartum Depression Screening, Referral, and Follow-Up in Pediatric Primary Care: The HealthySteps Effect. [Presentation] AAP National Conference, October 25-29, New Orleans, LA.

[13] Johnston, B.D., Huebner, C.E., Tyll, L.T., Barlow, W.E., Thompson, R.S. (2004). Expanding developmental and behavioral services for newborns in primary care: Effects on parental well-being, practice and satisfaction. American Journal of Preventive Medicine 26(4):356–366

[14] Kearns, M.A., Fischer, C., Buchholz, M., Talmi, A. (2016). More than the blues? Comparing changes in pregnancy related depression symptoms based on enrollment in Healthy Steps [Poster Session]. ZERO TO THREE Annual Conference, December 7-9, New Orleans, LA.

[15] Earls, M.F., Committee on Psychosocial Aspects of Child and Family Health. (2010). Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics 126(5):1032-1039.

[16] Ammerman, R.T., Putnam, F.W., Bosse, N.R., Teeters, A.R., Van Ginkel, J.B. (2010). Maternal depression in home visitation: A systematic review. Aggression and Violent Behavior 15(3):191-200.