Primary Care Pediatricians’ Roles and Perceived Responsibilities in the Identification and Management of Maternal Depression

By impeding emotional attachment and altering mother-child interactions, maternal depression may substantially impair a child's health. Depression also may alter a mother's expectations of parenting, lower her confidence,and compromise her parenting skills. Many have recommended that primary care clinicians become more involved in managing maternal depression. This national survey asked 888 randomly chosen US primary care pediatricians about their personal experience with maternal depression and their views about barriers to care and how to implement new strategies to improve care. The 508 respondents were 57% of those contacted. A majority of the pediatricians (57%) accepted a responsibility to recognize maternal depression, and they also were more likely to take an interest in other psychosocial issues of concern to the child and family. Perceived responsibility could not be related to particular attributes of the physicians or their practice patterns. The pediatricians tended to focus on the child's problems or the mother's behaviors and appearance rather than on the family history. Patients were not routinely asked about depressive symptoms. Those who felt responsible for recognizing maternal depression were the likeliest to evaluate the risk of suicide. One third of physicians reported using the term "depression" when talking with the mother, but even more discussed the problem without labeling it. A sizable proportion, 28%, did not discuss it at all. In addition to referrals, many pediatricians provided brief interventions. The most obvious perceived barriers to care were a lack of adequate time to take a history or provide counseling and insufficient training in and knowledge about how to diagnose and treat depression. Although many respondents felt confident about diagnosing maternal depression, very few were confident in their ability to treat it effectively. Nevertheless they did acknowledge having an educational role. In general, primary care physicians feel limited in their ability to recognize and treat maternal depression. Educational efforts and novel clinical approaches might best be directed to practitioners who accept a responsibility in this area and who are willing to change their approach.