Plan for primary care intervention for perinatal depression

When a perinatal depression screen generates a positive result, pediatricians can implement appropriate and at least 1 primary care intervention. The urgency and level of the intervention is informed by the concerns and symptoms identified, and range from psychobehavioral therapy to therapy plus medication, emergency mental health services, hospitalization, or office-based support, if available. Some components of office-based interventions include.

• Open dialogue with the family/birth parent about the specific mental health concerns and symptoms/concerns identified, to help reduce stigma and normalize the need for mental health support resulting from stress, adjusting to pregnancy, or having a new child, etc. 
• Communication about the potential impact on the infant and need for more frequent office visits for infant screenings and surveillance.
• Initial and ongoing support including validation and empathy for the mother’s experiences, building a therapeutic alliance, using strength-based care strategies, and identifying community resources that promote recovery and family wellness.
• Referrals to evidence-based treatment programs, such as, adult primary care, addiction specialist, MOUD provider, lactation support, home visiting, etc.

Brief intervention components as listed in the AAP policy statement, Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice are

• Promote the strength of the mother-infant relationship.
• Encourage the mother and reassure her regarding any concerns about breastfeeding.
• Encourage understanding and responding to the infant’s cues.
• Encourage reading and talking to the infant.
• Encourage routines for predictability and security, sleep, diet, exercise, and stress relief.
• Promote realistic expectations and prioritize important things.
• Encourage social connections.

For a comprehensive description of screening, identification, and management of perinatal depression concerns, see the AAP technical report, Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice.