But finding a way to integrate both screening and treatment into an already tenuous health care environment can be challenging. "We should be bringing this stuff right into pediatrics," Weitzman says. They have found that a simple screening, whether it is via a paper survey or simple questions from a pediatrician, is feasible to incorporate into a standard well-child visit. It will help, she notes, if pediatricians are aware of some of the red flags, such as infrequent (or overly frequent) doctor visits, negative description of young children or other behavioral signals. But once doctors recognize signs of depression, there are often few resources—especially for disadvantaged families—to recommend and even fewer on-site cognitive behavior therapy programs like the one in the study. And even in their study, Weitzman notes, there were high dropout rates, which emphasize the need for treatments that are easy for families.
Beyond the challenge of providing sessions and making sure those who need treatment get it, the cost of these programs can be prohibitive. Finding a way to establish screening and treatment protocols so they are not only convenient for families and practitioners but also integrated into the reimbursement structure is likely to be difficult. Because many programs address postpartum depression through six months, it can be hard to find reimbursable programs that will address maternal and parent-child bonding in treatment, Cooper notes.
As with other diseases, however, treating it is likely to pay off in the long run. Depressed adults often miss work or have trouble retaining consistent employment, resulting in lost productivity. "We know that depression is a huge cost to our society," Cooper says. And beyond the individual, improving parental state of mind pays long-term dividends for improved child development, she notes, adding that any booster to "foster those bonds and make sure those children have the most quality early childhood experience" is a solid investment. Citing a frequently used figure for cost-benefit analysis, Cooper notes that, "for every $1 invested in early childhood, we save $8.… If you think of it in terms of prevention, this is a huge benefit to society."
First, however, the concept surrounding maternal depression needs to change, Weitzman notes. "Depression is a chronic disorder—it waxes and it wanes," she says. "We just need to expand and broaden our thinking [from the idea] that there's this short time after the birth of a baby that someone can be depressed."