Postpartum Depression Can Persist Well Beyond a Child’s First Birthday – Medicaid Should Adjust Accordingly

Postpartum depression can last up to three years, new research from the National Institute of Health has found, and symptoms can often emerge well after the first months following delivery and get worse over time. The findings, published in the journal Pediatrics, suggest that providers, particularly pediatricians, should screen new mothers for depression through at least their child’s second year of life, and that Medicaid and CHIP coverage for pregnant women and new mothers should be better aligned to support access to care in the first years of their child’s life.

The study followed 5,000 mothers in New York State (excluding the five New York City boroughs) over three years, and found that most had some level of depression throughout the time period. One in four women had elevated depressive symptoms at some point in the three years after giving birth, with roughly half of the group experiencing major depressive episodes during the postpartum period. The rest of the women experienced low levels of depression throughout the time period.

Participants with gestational diabetes, of young age, without college education, and/or a history of mood disorder were all more likely to experience higher levels of depressive symptoms for the full three years, the researchers found.

The study findings show the importance of significantly broadening the length of time that new mothers should be screened for postpartum depression. Maternal depression screenings and referrals as part of a child’s early well-child visits are an effective state strategy that more states are adopting to reach more moms who may be depressed during the year following a birth. The American Academy of Pediatrics (AAP) recommends that pediatricians screen mothers for depression at the child’s one month, two month, four month, and six month well visits.

Most state Medicaid agencies allow, recommend, or require a mother’s depression screening under the child’s Medicaid ID during a well-child visit, recognizing the close link between maternal wellbeing and healthy child development. Moms experiencing depression have a harder time bonding with their children, and an AAP report found that children living with mothers with depression may “…show impaired social interactions and delays in development.”

This new study can inform policy changes aimed at more effectively serving a parent and child’s relationship through Medicaid and CHIP coverage during a critical period of child development when relationships with caregivers are key. For example, the study’s authors recommend that pediatricians assess mothers multiple times early and late in the postpartum period before a child turns three, recognizing that some mothers will show varying degrees of postpartum depression symptoms. State Medicaid agencies set periodicity schedules under EPSDT, so agencies could use these findings to allow payment for maternal depression screenings through a child’s 30-month check-up. It will be interesting to see how AAP may approach this new evidence in any future updates to its Bright Futures guidelines, which the majority of states use to set their Medicaid screening schedules.

Of course, screening alone won’t get mothers of young children the help they need, should they screen positive for depression.  Ensuring their health coverage also matters. With pregnancy Medicaid and CHIP coverage ending just 60 days after birth, many women do not have coverage for themselves, so a positive screening result at their child’s four and six month visits can lead to additional frustrations when attempting to get care. CLASP has documented the many challenges facing mothers in accessing treatment, who face even more of an uphill battle in the remaining 12 states that have not expanded Medicaid.

Extending coverage for one year or even longer would be another critical first step  to mitigate the emotional and economic stress facing many families. Already states are pursing extending pregnancy coverage for up to 12 months postpartum, and the U.S. House just passed a bill last month to give states the option to extend Medicaid and CHIP pregnancy coverage for one year after the end of the pregnancy while receiving federal matching funds.

Mothers’ mental health is critical to the healthy development of their children well beyond birth. Medicaid and CHIP policies can better support parent health alongside their children during their critical early years of life.