Symptoms of depression can develop at any time throughout life, but women are especially vulnerable to symptoms of depression during pregnancy and after giving birth.  After having a baby, many mothers feel sad, afraid, angry, or anxious, and may also feel guilty for having these negative feelings.  These feelings or “Baby Blues” are common and usually only last a few days.    

Feelings that last for more than two weeks or get worse could be signs of postpartum depression.  According to a Grantmakers in Health Bulletin article (Oct. 18, 2004), about 10-20 percent of new mothers are depressed – yet the diagnosis may go undetected.  The Journal of Women’s Health notes that 20 percent of women screened in obstetric clinic waiting rooms scored in the depression range – with fewer than 15 percent receiving treatment.

Screening for symptoms of depression is important, particularly for women of color.  Nearly 50 percent of Latina and black mothers reported depression symptoms compared to about 31 percent of white mothers, according to a national study supported by the Agency for Healthcare Research and Quality completed in June 2005.

The Maternal and Child Health Consortium, a community-based social services organization, works to improve access to high quality health care for women and children in Chester County, Penn.  The Consortium’s Healthy Start program is a prenatal home visiting program that provides women with a diverse array of supportive services.  In 2003, the Consortium began to screen Healthy Start participants for depression using the Edinburgh Postnatal Depression Screening.  Nationally, Healthy Start programs are providing depression screening, and programs use a variety of screening tools.  MCHC’s Healthy Start staff of Family Health Advocates receive training on perinatal depression, screening procedures and follow-up protocols, from trainers at the Health Federation of Philadelphia and a psychiatrist with extensive experience treating postpartum depression.

In order to determine if a woman is experiencing symptoms of depression, Healthy Start’s Advocates (most of whom are bilingual and bicultural) screen women at least twice during the perinatal period.  The first screening takes place during the home visit by the Advocate for the prenatal needs assessment.  The second screening takes place during the home visit for the postpartum needs assessment, one month after the baby is born.  Additional screenings may be done if the participant is experiencing a stressful life event such as separation from the baby’s father, loss of a job, domestic violence, etc. 

In addition to the survey, all Healthy Start moms receive information about the symptoms and treatment of depression as well as things new moms can do to feel better.  In cases where the survey shows a woman has symptoms of depression, Healthy Start staff will provide her with emotional support and connect her (where possible) with mental health professionals for further assessment and treatment.     

To help better meet the needs of participants experiencing depression, MCHC founded a pilot support group called “Mujeres Latinas Apoyandose” (Latina Women Supporting Each Other) in 2005 in collaboration with Family Service of Chester County.  The support group helps to address the unique issues that Latina women encounter in Chester County.  Many Latina women are isolated from the community and its services due to lack of transportation, and many do not speak English.  Often, husbands work long hours and are unavailable to their families.  The support group helped to reduce the feelings of isolation experienced by the women. 

In 2005, MCHC completed an Edinburgh Postnatal Depression Screening survey for 419 (84 percent) of all pregnant participants enrolled or giving birth during 2005.  Of these, 155 (37 percent) scored positive in the range for possible or probable depression.  Healthy Start staff assisted 51 (82 percent) of pregnant participants scoring 14 or higher on the survey with receiving further assessment and treatment from a mental health provider. 

MCHC also completed an Edinburgh Postnatal Depression Screening survey for 369 participants giving birth in 2005.  Of these, 86 (23 percent) scored positive in the range for possible or probable depression.  Healthy Start staff assisted 23 (85 percent) of interconceptional participants scoring 14 or higher on the survey with receiving further assessment and treatment from a mental health provider.  Barriers faced by Healthy Start participants on obtaining mental health services for depression included: lack of health insurance, child care, and transportation.  Additionally, Healthy Start participants feared that the county’s child welfare agency would take custody of their child/ren if they received mental health treatment.

Federal funding through Healthy Start and private funding through the Chester County Fund for Women and Girls supports this work.  For more information about Maternal and Child Health Consortium, please visit http://www.ccmchc.org.