An Opportunity for State Action: Influential Panel Calls for Depression Screenings During and After Pregnancy

By Stephanie Schmit

Recently, the United States Preventive Services Task Force (USPSTF) called for universal depression screening and treatment for all adults, including pregnant and postpartum mothers. The recommendation is important because when the USPSTF speaks, health insurers and states have strong reasons to listen.  This recommendation is a B priority level.

When the USPSTF makes a recommendation at the A or B priority level (as in this case), based on a rigorous review of the research evidence, health insurers are required to cover the screening free, and state Medicaid programs may have the opportunity for an incentive payment if they do the same.  Currently, 11 states have committed to providing coverage for all A and B recommendations through Medicaid with no cost sharing to the patient, which allows them to receive a 1 percent increase in federal dollars to support the program.  Additionally, anti-poverty and early childhood stakeholders and advocates should applaud this decision, because implementing the recommendation can have a critical impact in countering the significant role that untreated depression among low-income mothers of young children plays in hindering parenting, placing children’s development at risk, and holding mothers back from their own educational and career goals. 

As outlined in a recent joint letter to the editor published in the New York Times, beyond screening, new provisions in the Affordable Care Act offer a crucial and large-scale opportunity to treat maternal depression—helping mothers and children escape poverty. One of these opportunities is with Medicaid expansion, which allows more women to receive maternal depression screening and treatment. A forthcoming brief from CLASP aims to help state policymakers, advocates, stakeholders, and community practitioners in the health, mental health, and early childhood worlds by providing them with a road map to identify systems barriers to screening and treatment and offering early and emerging insights about how to overcome them.

Thus, the USPSTF recommendation provides the opportunity for many fewer women to suffer from untreated depression.  Low-income women would have the most to gain from the screening, and treatment that may result from this recommendation.  Depression is widespread among low-income mothers, including mothers with young children. One in nine poor infants lives with a mother experiencing severe depression, and more than half live with a mother experiencing some level of depressive symptoms. While depression is highly treatable, many low-income mothers do not receive treatment—even for very severe levels of depression. Indeed, more than one-third of low-income mothers with major depressive disorder get no treatment at all. Unfortunately, untreated maternal depression is damaging to children, particularly young children, by placing at risk their safety and cognitive and behavioral development.

Depression screening and treatment can make an enormous difference in families’ lives. Treatment helps low-income mothers feel better, and research shows it also helps them do what they care about most—nurture and teach their young children—and move their family toward greater financial security through participation in education, job training, and employment.  The USPSTF’s recommendation underlines the urgency of these reforms.