BHIPP Bulletin

Volume 10, Issue 11

May 2025

This month's BHIPP Bulletin is a contribution from

Rheanna Platt, MD, Associate Professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine and BHIPP Consultant.

Perinatal mood and anxiety disorders (PMADs) are the most common complication of pregnancy,¹ affecting approximately 20% of birthing individuals, and can affect individuals up to 12 months after delivery. Risk factors for PMADs include low social support, psychosocial stressors (e.g., poverty, relationship strain), and history of depression. In addition to impacting the health and functioning of the pregnant/postpartum individual, PMADs and other mental health conditions (e.g., perinatal substance use which affects an estimated 10%²) impacting parents can have significant effects on child health and development, particularly if they interfere with parenting and attachment. As a frequent point of contact for families in the postpartum period, pediatric primary care providers have a unique opportunity to identify, address, and promote parental mental health. In this newsletter, we will review screening, management, and resources related to maternal mental health. 

In the past decade, professional societies including the American Academy of Pediatrics,³ the American Academy of Family Physicians, and American College of Obstetricians and Gynecologists⁴ have recommended universal screening for maternal depressive symptoms, and the US Preventive Services Task Force (USPSTF) encourages maternal depression screening.⁵ Bright futures recommends screening for postpartum depression at 4 well-child visits in the first 6 months of infancy.⁶ However, screening remains far from universal, with barriers to screening including lack of time/competing demands, lack of comfort with management, and/or limited resources for those with positive screens.⁷  

Screening Instruments

The Edinburgh Postnatal Depression Scale (EPDS) is a 10-question survey that is freely available in multiple languages. The USPSTF has concluded that there is sufficient evidence to support its use for depression screening in pregnant and postpartum women. A benefit of the EPDS is that it includes a question about anxiety, which is often under-recognized in pregnancy and postpartum. The EPDS is included in the Survey of Well-Being of Young Children (SWYC), which is available in multiple languages and also includes questions on parental substance use.   

While the PHQ-9 is widely used as a screening instrument for perinatal depression, the USPSTF recently concluded that the data were insufficient for its specific use in postpartum depression screening, or for the shorter PHQ-2 as a standalone screener.⁸ 

Regardless of choices and/or practices related to screening, there are several universal interventions that may have benefits for parental mental health. For example, social support is broadly protective against a range of mental health conditions. Inquiring about social support and encouraging connections to others may be a powerful connection in and of itself. A number of organizations, including Postpartum Support International, offer a number of online support groups, including those targeting individuals with specific concerns. A national 24/7 maternal mental health hotline was recently established and is available for texting and calling at 1-833-TLC-MAMA in English and Spanish. Validating the challenges of parenthood can also be an important intervention for parents, particularly in the event of fussy babies as difficult infant temperament is a risk factor for postpartum depression. Additionally, poor sleep quality/sleep disturbance increases risk for perinatal mental health problems,⁹ thus inquiring about parental sleep, and making a plan to improve sleep to the highest degree possible (e.g., discussing naps, feeding schedules and responsibilities), can also be an important preventive intervention. Finally, providing education about parent mental health conditions and their warning signs (as well as freely available resources, some of which are listed below) can help families with early recognition of symptoms. 

Resources:

1. Pediatric Provider Toolkit to Assist in the Screening of New Patients during Well-Child Visits

2. Maternal Mental Health Hotline: 1-833-TLC-MAMA (Text or Call in English or Spanish, 24/7)

3. Maryland Addiction Consultation Service (MACS) for MOMs: Warmline (similar to BHIPP) for providers managing and addressing the needs of pregnant and postpartum patients with substance use disorders

4. Postpartum Support International: includes a helpline, provider directory, parent support, and more

As always, if you have questions about the behavioral health needs of your patients, we encourage you to call the BHIPP consultation line at 

855-MD-BHIPP (632-4477), open 9am-5pm Monday-Friday, for resource/referral networking or consultation support.

We will keep you informed about all our services and training events through our website (www.mdbhipp.org) and monthly e-newsletters. Additionally, BHIPP is on LinkedIn and Facebook. We invite you to follow us there to stay up-to-date on upcoming training events, pediatric mental health research, and resources for providers, families and children.

BHIPP Announcements

There is still time to register for tomorrow's BHIPP Webinar!

Register for the next BHIPP Webinar on May 28th at 12:00pm! BHIPP Webinars are a series of interactive, web-based learning sessions that are a virtual space for pediatric primary care, emergency medicine, and behavioral health providers to connect, learn and share about strategies, practices and resources to promote mental health and resilience among children and families as well as providers. Free CME and CEU credit is available for participation.

Sign up for an upcoming BHIPP Webinar!

Register for an upcoming BHIPP Webinar on June 12th at 12:00pm! BHIPP Webinars are a series of interactive, web-based learning sessions that are a virtual space for pediatric primary care, emergency medicine, and behavioral health providers to connect, learn and share about strategies, practices and resources to promote mental health and resilience among children and families as well as providers. Free CME and CEU credit is available for participation.