Submitted by: Kansas Connecting Communities
Perinatal Mood and Anxiety Disorders (PMADs) are the most common complication of the perinatal period, impacting an estimated 1 in 5 individuals during pregnancy and the year following pregnancy. Mathematica Policy Research estimates the societal costs of untreated PMADs is approximately $32,000 per mother-child pair from pregnancy through five years postpartum . More than half of these costs and adverse outcomes occur during the first year postpartum. Children of mothers experiencing PMADs are at increased risk for delayed developmental milestones, behavior problems, and difficulties with literacy and learning .
In Kansas, data released through the Pregnancy Risk Assessment and Monitoring System (PRAMS) from 2019 indicate that 13.8% of mothers report not accessing treatment for depression after birth, despite a perceived need . Reasons for not accessing treatment include it seeming too difficult or overwhelming (82.5%), lack of time due to work, lack of childcare, or other commitments (57%), and worries about the cost (54.1%). The COVID-19 pandemic has created unprecedented stress and isolation for perinatal individuals leading to elevated rates of depression and anxiety compared to previously reported population rates . Increasing prevalence rates highlight the urgency for timely and effective identification and intervention processes to prevent long term impacts on family wellbeing and child development.
With adequate systems of care in place for referral and treatment, universal screening is an optimal approach for identifying pregnant and postpartum mothers who are experiencing symptoms of PMADs. Screening all perinatal women using a universal and validated screening tool increases identification rates and facilitates treatment planning [5,6]. The 2016-2018 Kansas Maternal Mortality Report identifies screening for mental health conditions, including postpartum anxiety and depression, as a key action for improving maternal outcomes in Kansas .
Current recommendations from the US Preventative Services Task Force omit previous recommendations around “selective screening” and now promote universal screening during the perinatal period . Universal screening can be implemented efficiently and effectively during routine healthcare visits. The American Academy of Pediatrics recommends screening for postpartum depression at the 1-, 2-, 4-, and 6-month well-child visits .
The Edinburgh Postnatal Depression Scale (EPDS) is the most frequently used screening tool for depression and anxiety during pregnancy and the postpartum period, typically taking less than 5 minutes for patients to complete and available in 50 languages . In addition to depression, the EPDS measures anxiety symptoms and includes a question on suicidal ideation. The EPDS has demonstrated acceptable sensitivity and positive predictive value for detecting major depressive disorder during pregnancy and postpartum [6, 11].
Medicaid Reimbursement Update
Recognizing the importance of universal screening for mothers and families, Kansas Medicaid adopted a maternal depression screening policy effective January 1, 2021. In addition to supporting reimbursement for up to 3 screening during the prenatal period under the mother’s Medicaid ID, the KanCare Maternal Depression Screening policy also allows reimbursement for up to 5 maternal depression screenings during the 12-month postpartum period under the child’s Medicaid ID as part of a pediatric visit. Updated guidance around utilizing this policy is available here.
Implementation and Treatment Planning Support
KAAP released Clinical Guidelines for Implementing Universal Postpartum Depression and Screening in Well Child Checks to support members with screening implementation and billing procedures. Expert implementation assistance is also available at no cost to providers through the Kansas Provider Consultation Line for Perinatal Behavioral Health at 833-765-2004. Services include support connecting patients to perinatal specific resources, screening and billing guidance, and case consultations with psychiatry staff who specialize in perinatal mental health and substance use.
- Luca DL, Garlow N, Staatz C, Margiotta C, Zivin K. Societal Costs of Untreated Perinatal Mood and Anxiety Disorders in the United States. Mathematica Policy Research. https://www.mathematica.org/our-publications-and-findings/publications/societal-costs-of-untreated-perinatal-mood-and-anxiety-disorders-in-the-united-states. Published April 2019.
- Center on the Developing Child at Harvard University. Maternal Depression Can Undermine the Development of Young Children: Working Paper No. 8 (2009). www.developingchild.harvard.edu
- Kansas Pregnancy Risk Assessment Monitoring System (PRAMS) 2019 Surveillance Report. Kansas Department of Health and Environment (KDHE), Division of Public Health. https://www.kdheks.gov/prams/reports.htm. Published April 2021.
- Davenport, MH, et al. Moms are Not Ok: COVID-19 and Maternal Mental Health. Frontiers in Global Women’s Health (2020). doi:10.3389/fgwh.2020.00001
- Avalos LA, Raine-Bennett T, Chen H, Adams AS, Flanagan T. Improved Perinatal Depression Screening, Treatment, and Outcomes With a Universal Obstetric Program. Obstet Gynecol. 2016;127(5):917-925; doi:10.1097/AOG.0000000000001403
- O’Connor E, Rossom RC, Henninger M, Groom HC, Burda BU, Henderson JT, Bigler KD, Whitlock EP. Screening for Depression in Adults: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Jan. Report No.: 14-05208-EF-1. PMID: 26937538.
- Kansas Maternal Mortality Report 2016-2018. Kansas Maternal Mortality Review Committee. https://kmmrc.org/reports/ Published December 2020.
- Siu A, US Preventive Services Task Force. Screening for Depression in Adults US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(4):380-387. doi:10.1001/jama.2015.18392
- Earls M, Yogman M, Mattson, G, Rafferty J. Incorporating Recognition and Management of Perinatal Depression into Pediatric Practice. Committee on Psychosocial Aspects of Child and Family Health. Pediatrics. Jan 2019, 143 (1) e20183259. doi:10.1542/peds.2018-3259
- Committee Opinion: Screening for Perinatal Depression. American College of Obstetricians and Gynecologists. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/11/screening-for-perinatal-depression Published November 2018.
Levis B, Negeri Z, Sun Y, Benedetti A, Thombs BD. Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data. BMJ. 2020