Primary care pediatricians' roles and perceived responsibilities in the identification and management of maternal depression.

Objective: To describe the attitudes and approaches of primary care pediatricians in the identification and management of postpartum and other maternal depression.

Methods: A national survey of randomly selected primary care pediatricians reported their management of the last recalled case of postpartum or other maternal depression, barriers to care, their attitudes about recognition and management, confidence in skills, and their willingness to implement new strategies to improve care.

Results: Of 888 eligible primary care pediatricians, 508 (57%) completed surveys. Of these pediatricians, 57% felt responsible for recognizing maternal depression. In their last recalled case, respondents used an unstructured approach for identification based primarily on maternal appearance or complaints. When maternal depression was suspected, additional assessment of any kind was done by 48% of pediatricians. Although 7% perceived themselves to be responsible for treating maternal depression, pediatricians indicated they had an active role in 66% of cases in which they provided 1 or more brief interventions. The major barriers that were believed to limit their diagnosis or management were insufficient time for adequate history (70%) or education/counseling (73%) and insufficient training/knowledge to diagnose/counsel (64%) or treat (48%). Responses with cases involving maternal depression and the specific situation of postpartum depression were very similar. Forty-five percent were confident in their ability to diagnose maternal depression, whereas 32% were confident in their ability to diagnose postpartum depression. Nearly one fourth of pediatricians were willing to change their approach to identification. Pediatricians who felt responsible for recognizing maternal depression were more likely to assess more completely and intervene in cases as well as consider implementing change in their practice.

Conclusion: Pediatricians' current attitudes and skills that are relevant to maternal depression limit their ability to play an effective role in recognition and management. Future interventions need to address each of these issues. Educational efforts and new clinical approaches may be more effective with those who feel responsible and willing to change their approach to maternal depression.