ED Screenings Find High Prevalence of Maternal Depression
Faculty Profile: Jacqueline Grupp-Phelan, MD, MPH, Emergency Medicine
Depression afflicts approximately one in five mothers who bring their children to a pediatric emergency department (ED) or well-child clinic for care of non-urgent complaints, according to new research published by Jacqueline Grupp-Phelan, MD, MPH, of the Cincinnati Children's Division of Emergency Medicine.
In the nation's first exploration of maternal mental illness in the ED setting, 76 percent of those who screened positive for depression reported that their depression made it difficult to care for their children. In addition, 30 percent of mothers in the study screened positive for one of four mental health problems: depression, anxiety disorder, panic disorder or somatic complaints.
Dr. Grupp-Phelan's research found that 75 percent of children whose mothers brought them to a pediatric emergency department for non-urgent complaints screened positive for unrecognized mental illness -- meaning that they are at high risk of developing serious mental health issues.
The pediatric ED may be the only interaction some mothers and children have with a health care provider, particularly when the ED is used for non-urgent care. So Dr. Grupp-Phelan believes that the ED visit can prove valuable as a way to identify and treat families with mental health problems who otherwise may receive no mental health care.
Currently, only 3 to 6 percent of visits to pediatric EDs in the United States are specifically for recognized mental health issues, but that number is rising. With approximately 60 percent of all pediatric ED visits for primary care issues, Dr. Grupp-Phelan sees an opportunity for brief mental health interventions in the emergency setting. These interventions would be similar to programs at the Cincinnati Children's ED where physicians screen for suspected physical and sexual abuse and facilitate follow-up for families screening positive.
Dr. Grupp-Phelan and her colleagues continue to refine screening methods and target populations with funding from the NIH. She has found that mothers who bring children for non-urgent complaints accept the screenings and believe that screenings help physicians provide better care for their children. As the research moves to families visiting the ED for urgent problems, Dr. Grupp-Phelan and her colleagues are curious to see if receptivity to screening changes. They expect that the demographics of the subjects may change, but they do not anticipate a variation in the incidence of mental illness.
Upcoming research will explore the most effective ways to link families with mental health services through interdisciplinary interventions in the ED.
