Postpartum Depression Screening
Overview
Coding for Postpartum Depression
ICD-10-CM Codes
- Z00.1*- Well-child check/Encounter for newborn,
infant and child health examinations, including routine
developmental screening. Z00.1* health exam is always
listed first, as the primary reason for the visit.
- Z00.129 - well-child visits >28 days, without abnormal findings
- Z00.121 - well-child visits >28 days, with abnormal findings
- Z13.32 Encounter for screening for maternal depression (this can be coded in the mother’s chart but not the infant’s).
Current Procedural Terminology (CPT) Codes
- 96161* Administration of caregiver-focused health risk assessment instrument (e.g., depression inventory) for the benefit of the patient.
Practice Guidelines
Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice.
Pediatrics. 2019;143(1). PubMed abstract [Earls: 2019]
Postpartum Psychiatric Illness
Postpartum Depression
Early Signs
- Depressed mood or irritability
- Lack of enjoyment of usual activities
- Changes in sleep patterns (insomnia or hypersomnia)
- Worthlessness or guilt
- Tearfulness
- Self-doubt, often about her ability as a mother
- Changes in weight or appetite
- Avoidance of social interactions or responsibilities
- Neglect or loss of interest in the newborn infant or other children
- Fatigue or lack of energy
- Changes in appetite
- Poor concentration
- Recurrent thoughts of suicide, death, or running away
- Ruminations, or sometimes worries that she may harm the baby
- Delusions or hallucinations
Postpartum Anxiety
Postpartum Psychosis
Pearls & Alerts
- Dial 911 for an emergency.
- Call the toll-free National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), 24 hours a day, 7 days a week. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are confidential.
- Contact the Crisis Text Line 24 hours a day, 7 days a week, by texting HELLO to 741741 (US, Canada, UK).
Screening for Postpartum Depression
Edinburgh Postnatal Depresion Scale - EPDS (English & Spanish)


Patient Health Questionnaire Screeners (PHQ-9 & PHQ-2)
- The Patient Health Questionnaire (PHQ) Screeners PHQ-9 or PHQ-2: These free, well-known depression screens offer a 9-question and 2-question version, respectively, and can be used as brief caregiver depression screens.
The Survey of Well-Being of Young Children (SWYC)
Response to a Positive Screen for Postpatum Depression
- Evaluate the infant for poor feeding, growth, behavioral issues, and developmental concerns.
- Discuss the positive screen with the mother/primary caregiver to determine the severity of depression. The PHQ-9 can help rate the severity of the depression as well if additional tools are needed.
- Refer the parent to a mental health professional (psychiatrist, psychiatric nurse practitioner, psychologist, or social worker) for further assessment and evaluation for further behavioral health assessment and intervention.
- With the parent’s consent, consider discussing the positive screen with the parent’s primary health provider as well. Often, the caregiver’s own family doctor, obstetrician, midwife, internist, obstetrician, internist, psychiatric nurse practitioner, or psychiatrist may work with the parent to devise a medication management plan, if necessary
- If the parent or child’s immediate safety is at risk, refer to the nearest Emergency Room for a psychiatric evaluation. Do not leave the parent and baby alone.
Treatment of Postpartum Depression
Resources
Information & Support
For Professionals
MCPAP for Moms Toolkit for Pediatric Provider
A perinatal psychiatrist provides real-time consultation via the telephone to clinicians. The consultation may involve diagnostic
support, guidance in regards to medication treatment (when indicated), psychotherapy and community support needs, treatment
planning, and medication concerns regarding preconception, pregnancy, and lactation. A resource team works with providers
in arranging outpatient mental health and/or substance use support for patients; Massachusetts Child Psychiatry Access Program.
Postpartum Support International’s Perinatal Psychiatric Consultation Line for Clinicians
A service provided at no cost to assist clinicians with questions related to diagnosis and treatment for patients by calling
1-800-944-4773, ext 4.
Maternal Depression Poster ( 90 KB)
Encourages new mothers to speak with their doctor if they answered "yes" to either of the 2 questions on this poster.
American College of Obstetricians and Gynecologists
Clinical information about postpartum depression and other issues.
For Parents and Patients
Support
Postpartum Support International
Support for women and their partners who are dealing with post-partum depression. Includes professional assessment tools and
access to a volunteer network of local service providers and resources.
General
Postpartum Disorders (MGH)
General information about the various forms of postpartum depression; Massachusetts General Hospital.
Depression During & After Pregnancy: A Resource for Women, their Family, & Friends (HRSA) ( 20 KB)
Information for the woman and/or her family about the definition and symptoms of postpartum depression and when to seek treatment.
Includes a perinatal depression booklet in English and Spanish; Department of Health & Human Services.
Postpartum Depression & Breastfeeding (healthychildren.org)
Discusses how postpartum depression affects the baby, when to seek help, how to preserve breastfeeding goals, and the effects
of antidepressant medications and breastfeeding; from the American Academy of Pediatrics.
Tools
Edinburgh Postnatal Depression Scale (English) ( 120 KB)
A self-administered, 10-question, 5-minute screen for maternal depression with scoring instructions. Free, may be printed
without permission.
Edinburgh Postnatal Depression Scale (Spanish) ( 54 KB)
A Spanish, self-administered, 10-question, 5-minute screen for maternal depression with scoring instructions. Free, may be
printed without permission.
Screening Time (AAP)
An extensive list of screening tools organized by title, topics covered, number of items on the screen, parent completion
time, cost, and validation information. Topics can be filtered for specific results; American Academy of Pediatrics.
Services for Patients & Families in Nevada (NV)
Service Categories | # of providers* in: | NV | NW | Other states (4) (show) | | MT | NM | RI | UT |
---|---|---|---|---|---|---|---|---|---|
Crisis Mental Health Care | 37 | 4 | 8 | 4 | 7 | 25 | |||
Family Counseling | 43 | 21 | 27 | 74 | |||||
Family Support Services | 82 | 14 | 39 | 165 | 44 | 39 | |||
General Counseling Services | 206 | 1 | 147 | 41 | 31 | 373 | |||
Outpatient Mental Health Care | 50 | 16 | 40 | 12 | 256 | ||||
Social Workers | 7 | 10 | 10 |
For services not listed above, browse our Services categories or search our database.
* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.
Studies
Maternal Depression (clinicaltrials.gov)
Studies looking at better understanding, diagnosing, and treating this condition; from the National Library of Medicine.
Helpful Articles
PubMed search for articles about postpartum depression within the last 5 years
O'Connor E, Rossom RC, Henninger M, Groom HC, Burda BU.
Primary Care Screening for and Treatment of Depression in Pregnant and Postpartum Women: Evidence Report and Systematic Review
for the US Preventive Services Task Force.
JAMA.
2016;315(4):388-406.
PubMed abstract
Murray L, Cooper P.
Effects of postnatal depression on infant development.
Arch Dis Child.
1997;77(2):99-101.
PubMed abstract / Full Text
Discusses early maternal depression and adverse cognitive and emotional infant development.
Lesesne CA, Visser SN, White CP.
Attention-deficit/hyperactivity disorder in school-aged children: association with maternal mental health and use of health
care resources.
Pediatrics.
2003;111(5 Pt 2):1232-7.
PubMed abstract / Full Text
Investigates the association between the mental health status of mothers and attention-deficit/hyperactivity disorder (ADHD)
in their school-aged children and characterizes the health care access and utilization of families affected by ADHD.
Onunaku, Ngozi.
Improving maternal and infant mental health: focus on maternal depression.
National Center for Infant and Early Childhood Health Policy at UCLA.
July 2005.
/ https://www.hrsa.gov/archive/mchb/dataspeak/pastevent/june2005/files/i...
Discusses the impact of maternal depression on the social and emotional health of
young children. Recommends specific steps that early childhood program and public health administrators can take to address
the unmet mental health needs of mothers ultimately promoting the social and emotional health, school readiness, and future
functioning of very young children.
Page Bibliography
American Psychiatric Association.
Diagnostic and Statistical Manual of Mental Disorders, DSM-5.
Fifth ed. Arlington, VA: American Psychiatric Association;
2013.
978-0-89042-554-1
Burt VK, Quezada V.
Mood disorders in women: focus on reproductive psychiatry in the 21st century--Motherisk update 2008.
Can J Clin Pharmacol.
2009;16(1):e6-e14.
PubMed abstract
Review of the significant negative impact of maternal depression on maternal and child health and psychological well-being
and other possible consequences of chronic depression.
Cadzow SP, Armstrong KL, Fraser JA.
Stressed parents with infants: reassessing physical abuse risk factors.
Child Abuse Negl.
1999;23(9):845-53.
PubMed abstract / Full Text
Examines the relationship among potentially adverse psychosocial and demographic characteristics identified in the immediate
postpartum period and child physical abuse potential at 7 months.
Earls MF, Yogman MW, Mattson G, Rafferty J.
Incorporating recognition and management of perinatal and postpartum depression into pediatric practice.
Pediatrics.
2019.
PubMed abstract / Full Text
Field T, Diego M, Hernandez-Reif M.
Prenatal depression effects and interventions: a review.
Infant Behav Dev.
2010;33(4):409-18.
PubMed abstract / Full Text
Research on the negative effects of prenatal depression and cortisol on fetal growth, prematurity, and low birth weight.
Hay DF, Pawlby S, Sharp D, Asten P, Mills A, Kumar R.
Intellectual problems shown by 11-year-old children whose mothers had postnatal depression.
J Child Psychol Psychiatry.
2001;42(7):871-89.
PubMed abstract
Examines long-term sequelae in the children of mothers who were depressed at 3 months postpartum.
Monzon, C. M.D., Lanza di Scales, T. MD, Pearlstein, T. MD.
Postpartum psychosis: updates and clinical issues.
Psychiatric Times; (2014)
http://www.psychiatrictimes.com/special-reports/postpartum-psychosis-u.... Accessed on 4/28/2020.
In preparation for DSM-5, evidence of the onset of symptoms in postpartum disorders was examined. Study findings suggest that
50% of major depressive episodes that present postpartum actually began during pregnancy.
Müller MJ, Preuß C, Paul T, Streit F, Brandhorst G, Seeliger S.
Serotonergic overstimulation in a preterm infant after sertraline intake via breastmilk.
Breastfeed Med.
2013;8(3):327-9.
PubMed abstract / Full Text
Case study of a preterm infant who was exposed to sertraline and its main metabolite desmethylsertraline in utero and via
breastmilk.
Osborne LM.
Recognizing and Managing Postpartum Psychosis: A Clinical Guide for Obstetric Providers.
Obstet Gynecol Clin North Am.
2018;45(3):455-468.
PubMed abstract / Full Text
Quevedo LA, Silva RA, Godoy R, Jansen K, Matos MB, Tavares Pinheiro KA, Pinheiro RT.
The impact of maternal post-partum depression on the language development of children at 12 months.
Child Care Health Dev.
2012;38(3):420-4.
PubMed abstract / Full Text
Analyses the effect of the duration of the mother's depression on the language development of children at 12 months old.
Sellers R, Harold GT, Elam K, Rhoades KA, Potter R, Mars B, Craddock N, Thapar A, Collishaw S.
Maternal depression and co-occurring antisocial behaviour: testing maternal hostility and warmth as mediators of risk for
offspring psychopathology.
J Child Psychol Psychiatry.
2014;55(2):112-20.
PubMed abstract / Full Text
Using a longitudinal study of offspring of mothers with recurrent depression, the study tests whether maternal warmth/hostility
mediated links between maternal depression severity and child outcomes, and how far direct and indirect pathways were robust
to controls for co-occurring maternal antisocial behaviour.
Silver EJ, Heneghan AM, Bauman LJ, Stein RE.
The relationship of depressive symptoms to parenting competence and social support in inner-city mothers of young children.
Matern Child Health J.
2006;10(1):105-12.
PubMed abstract
Discusses how negative ratings of parenting competence, low perceived social support, and presence of health-related activity
restrictions can be useful markers of likely depression among inner-city mothers of young children.
Weissman AM, Levy BT, Hartz AJ, Bentler S, Donohue M, Ellingrod VL, Wisner KL.
Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants.
Am J Psychiatry.
2004;161(6):1066-78.
PubMed abstract
Analysis of available data on antidepressant levels in nursing infants to calculate average infant drug levels and determine
what factors influence plasma drug levels in breast-feeding infants of mothers treated with antidepressants.