Depression, an illness characterized by periods of low mood, fatigue, and changes in appetite, body weight and sleeping patterns, is a leading cause of disability, particularly among women.[1
] An estimated 19 percent of new mothers experience depression during the first three months following childbirth.[2
] Low-income women enrolled in state Medicaid programs may be at increased risk for developing postpartum depression, which can occur up to a year after giving birth.[3
Screening helps to detect postpartum depression, and efficacious treatments such as psychotherapies and antidepressant medications are available.[7
] Left untreated, postpartum depression can have severe negative affects on the mother’s health and well-being; her relationships with family members; the baby’s subsequent cognitive, behavioral, and emotional development; and greater long-term health care and social costs.[16
] The health effects and potential costs of untreated postpartum depression underscore the need for evidence-based policy.
Recent national and state legislative efforts aim to improve detection of and treatment for postpartum depression. The Affordable Care Act contains two sections with implications for postpartum depression. The first, pertaining to women’s preventive services, requires all new health plans to cover comprehensive women’s preventive care, including screening for postpartum depression.[CITATION 21 HERE] The second section of the health reform law previously introduced as the Melanie Blocker Stokes MOTHERS Act [22A
], authorizes $3 million annually to support a national public awareness campaign on postpartum mental health as well as research into maternal mental health, postpartum depression, and the benefits of postpartum depression screening.
The research provides an important opportunity to build on the existing evidence base to inform policy making at the state level, which is already moving forward. As of late December 2010, ten states had active legislation related to postpartum depression; another two states had legislation pending. Key provisions of the MOTHERS Act and the state-level efforts are described in detail in the Appendix.[22
Portions of both enacted legislation and additional proposals are modeled on seminal efforts by the state of New Jersey. These have unfolded in several stages.
First, the New Jersey Postpartum Wellness Initiative was established in July 2005 by Governor Richard Codey to raise awareness about postpartum depression and to increase access to appropriate clinical services. This continuing initiative targets health care providers and the public, and provides information about symptoms, screening, diagnosis, and treatment.[23
] Outreach to women and their families consists of a toll-free hotline, brochures, and online resources, coupled with state-sponsored television commercials and public service announcements.[25
During the program’s initial scale-up (July 2005 through April 2006), the Postpartum Wellness Initiative trained more than 4,500 clinicians to provide screening, referrals, and treatment for postpartum depression. These early efforts reached approximately 58 percent of obstetricians, 13 percent of pediatricians, and up to 12 percent of internal medicine and family practice providers in the state.[24
] Targeted trainings continue to take place in hospitals, clinicians’ offices, conferences, and continuing medical education programs, with the goal of reaching all clinicians who may be able to identify or treat women who suffer from postpartum depression.[−24]
Second, on October 10, 2006, New Jersey also became the first state to require postpartum depression screening of women who had recently given birth. The New Jersey Postpartum Depression Act requires that health care professionals educate women and their families about postpartum depression, both before and after delivery. The law also instructs all licensed health care professionals providing postnatal care including physicians and midwives, to screen women for symptoms before they are discharged from the hospital, and again at “the first few” postpartum follow-up visits.[26
Although clinicians are charged with screening, there are no specified consequences for failure to do so. Furthermore, the law stipulates no specific mechanisms for monitoring or enforcing clinician compliance, or to cover the cost of screening services.
The purpose of this study was to measure the effects of New Jersey’s outreach and education campaign, as well as its law requiring postpartum depression screening, on post-delivery use of mental health services in a particularly vulnerable group: Medicaid enrollees.