Pediatricians Call for Expanded Screening at Well-Child Visits

In 2010, the American College of Obstetricians and Gynecologists (ACOG) recommended screening for depression in all pregnant and postpartum women. Many states have since drafted legislation supporting or mandating universal screening for perinatal depression in obstetric settings.  More recently, organizations dedicated to the care of children, including the American Academy of Pediatrics, have pushed for a greater focus on maternal mental health as a means of improving outcomes in children and have also recommended screening mothers for depression during the first six months of a child’s life. 

Fathers, however, have been left out of the picture. Given that fathers may also suffer from perinatal depression and that paternal depression, just like maternal depression, can have negative effects on the child’s well-being, this oversight may have significant consequences.  Addressing the issue of depression in fathers, a group of pediatricians had advocated for screening fathers, as well as mothers, for depression:

The new recommendations do not go far enough and risk being out of touch with contemporary American families. The US Preventive Services Task Force evidence review and recommendations are focused exclusively on interventions to prevent maternal depression. The AAP statement acknowledged paternal postpartum depression (PPD) as an established clinical problem yet called for pediatricians to screen solely mothers at the 1-, 2-, 4-, and 6-month well-child visits and “consider screening the partner as well” at the 6-month visit. We believe it is inadequate to treat the recognition and management of paternal depression as extra or optional. To promote optimal outcomes for children, pediatric providers must assess the mental health and adjustment to parenting of all new parents, regardless of gender or marital status, and make appropriate referrals for needed care.

This is especially important, they note, as fathers are less likely than mothers to seek help for depression.  While we have made progress in educating the public about depression in new and expecting mothers, it is likely that fathers are not aware of their own vulnerability to depression in this setting.  And this lack of awareness of paternal depression represents a barrier to seeking treatment. Thus, properly educating fathers about their risk for depression and helping them to know when and how to seek help is essential.  

Screening fathers for depression at well-child visits may be a bit more challenging than screening mothers.  The authors note that most fathers attend at least one well-child visit during the first year; however, it may be difficult to carry out screening across a longer interval of time. In addition, we do not yet have validated screening tools for paternal postpartum depression.  

Early identification and intervention are essential.  Addressing depression in either parent increases the capacity for emotionally sensitive and responsive parenting and the likelihood of strong attachment.  The authors note that “there is still much to learn about how best to engage fathers and treat paternal PPD, existing evidence suggests the benefits of pharmacologic or psychological therapies.” 

Ruta Nonacs, MD PhD

Walsh TB, Davis RN, Garfield C.  A Call to Action: Screening Fathers for Perinatal Depression.  Pediatrics. 2020 Jan;145(1).