Perinatal depression: The role of State and local Maternal, Adolescent and Child Health (MCAH) programs

Background: Perinatal depression, a term used to include both minor and major depression, can occur from the time of conception up to 1 year after childbirth. Prevalence estimates range between 5% and over 50% with estimates of major depression between 6 and 13%. The highest risk for the first episode of major depression is during the childbearing age. Prenatal depression may affect how a woman cares for herself and may increase the risk of delivering a premature or low birth weight baby. Postpartum depression negatively affects the mother and the family and may result in infant detachment disorder and have a negative impact on infant cognitive and emotional development. Objective: To define the problem, its prevalence and risk factors, discuss issues of definition, summarize best practices and intervention issues and provide recommendations for State and local MCAH programs. Methods: Review of literature and use of a logic model to illustrate key MCAH policy and program level intervention points. Results and Conclusions: Perinatal depression is a significant health issue which is frequently overlooked or minimized in clinical care and heath promotion efforts. MCAH agencies and programs should take a key public health role in addressing stigma, educating about depression through provider and public education, developing linkages and building referral networks with mental health, addressing depression in preconception care, and promoting primary care and community based screening (i.e. at a WIC program), assessment and referral using standardized tools. Successful policy and program interventions will be shown and gaps in research discussed.