New Jersey Postpartum Screening Policy Offers Roadmap for Other States

Lilo H. Stainton | February 2, 2016 | Health Care
Access to care after diagnosis still prompts concerns for women in NJ and in other states

postpartum depression
The national recommendation to screen pregnant women and new mothers for signs of postpartum depression will help protect millions of American families, experts agree, since as many as 20 percent of new mothers suffer from the debilitating condition. And if history is any guide, the screening process New Jersey developed nearly a decade ago could continue to serve as a roadmap for communities nationwide.

Depression is the most common disability in the nation, according to the report that received widespread attention when issued last week by the United States Preventative Services Task Force, an independent panel of primary care physicians appointed by the federal Department of Health and Human Services. Panelists review various treatments and make a group recommendation on key issues to medical professionals nationwide.

But depression among pregnant women and new mothers is particularly worrisome, since it directly impacts both mother and baby, the group noted. With early diagnosis, appropriate treatment and follow-up care, mother and child can recover and thrive, it added.

The Garden State is far ahead of the curve. Thanks largely to a public campaign led by former first lady Mary Jo Codey, who experienced postpartum depression several times, the state launched a public awareness campaign – “Speak Up When You’re Down” – about the disease in 2005, when her husband, Sen. Richard Codey (D-Essex), served as acting governor.

A year later New Jersey enacted the nation’s first statewide screening process, requiring doctors to discuss postpartum depression with their pregnant patients and also to screen new mothers for the disease before they leave the hospital and at the baby’s first few check-up visits. The state now maintains a trove of information online on what it calls Perinatal Mood Disorders that includes resources for physicians, public materials in English and Spanish and a 24-hour hotline (1-800-328-3838) for families in crisis.

“I know that New Jersey was way ahead of everybody,” Mary Jo Codey recalled on Saturday, describing how she has been speaking out about the disease at events around the nation for the past decade. “If physicians don’t learn about it, women fall through the cracks.”

Since that beginning a decade ago nearly a dozen organizations from around the country have contacted New Jersey’s Department of Health for guidance or materials related to the state’s postpartum depression screening program. The list includes a healthcare coalition in Southern Oregon, a county health department in California, officials from Plano, TX, and representatives from Tufts Medical Center, in Boston, spokeswoman Donna Leusner said. The Alabama Women’s Coalition now includes a direct link to New Jersey’s “Speak Up” program on its homepage.

“That’s because of my wife. Her speaking out as first lady carried a lot of weight,” Sen. Codey added. “Thirty years ago, we’d never heard of it. We’ve come a long way.”

But other barriers to care remain, the Codeys and others agree, like a lack of doctors to treat all the postpartum patients diagnosed. “There’s nowhere to go. I’ve been worried about that for years. Women come to me and tell me they have it and where do they go,” Mary Jo Codey said.

Thanks to the New Jersey’s aggressive screening protocol — which health officials said reached 93 percent of mothers with hospital births during 2014 — hundreds of thousands of women have been checked for the disease. The Family Health hotline has received more than 13,000 calls since it started in 2005, state officials said. Roughly half of these callers were referred to the University Behavioral Health Center, at Rutgers University, for a telephone assessment to determine if they needed additional treatment.

Carolyn Beauchamp, president and CEO of the Mental Health Association in New Jersey, praised the Codeys and other state officials for their early initiative to address postpartum depression. “Nobody was really thinking about this at the time,” she said, adding that her organization would like to see all patients receive basic screening for depression as part of their regular physical check up. “We need to integrate this into physical care in a very ongoing way.”

Data on New Jersey’s postpartum program shows that the state has been quite successful in screening women while they are in the hospital giving birth, but Beauchamp said it is less clear that they are receiving the mental-health assessment that is required at the time of the baby’s first checkup, some weeks later.

“We don’t have good data on how that’s going or if that’s going,” Beauchamp said. A January 2014 newsletter from the Pregnancy Risk Assessment Monitoring System, a joint project from the state DOH and the federal Centers for Disease Control and Prevention, even noted that while all relevant hospitals comply with the screening requirement, “Later re-sceening is hard to document.”

Beauchamp and other mental-health advocates also point out that a diagnosis doesn’t guarantee treatment. In a 2014 study, MHANJ found that nearly half of the state’s licensed psychiatrists were not taking new patients. The result, Beauchamp said, is that most women end up going to their primary-care doctor who prescribes an antidepressant; while this can help, she said a combination of pharmaceutical treatment and counseling often works best. “We really do have to have options,” she said. “It’s very scary for new moms.”

While as many as eight in 10 woman experience some kind of “baby blues” in the days and weeks after giving birth, experts believe the far more severe postpartum depression affects one in seven new mothers. Symptoms include severe mood swings, appetite changes, insomnia, serious fatigue, excessive crying, intense anger and irritability, panic attacks, lack of concentration, feelings of worthlessness, shame or guilt, even thoughts of harming your baby or yourself, according to the Mayo Clinic. While the exact causes are not known, the disease seems to be triggered by a mix of hormonal changes and enormous stress.

“The emotional wellbeing of the mother can have a significant impact on the overall health of her newborn,” New Jersey Deputy Health Commissioner Dr. Arturo Brito, a pediatrician, said in an email. “Identifying and addressing postpartum depression early in its course is critical to ensuring positive a bond between mother and infant that can last a lifetime.”