Improving women's health during internatal periods: developing an evidenced-based approach to addressing maternal depression in pediatric settings.

The internatal period, the time between births of successive children, has become a focal point for risk assessment and health promotion in women's healthcare. This period represents a time when women are at high risk for a depressive disorder. The pediatric venue offers a unique opportunity for the identification and management of depression in the internatal period, as mothers who do not attend their own medical appointments are likely to accompany their child to pediatric visits. This paper discusses the role pediatric providers can undertake to improve women's health in the internatal period through the detection and management of maternal depression at well-child visits. Successful models of the management of depression in other primary care settings are explored for their potential for implementation in the pediatric venue. A specific model developed and implemented as part of a 3-year project is presented to highlight the feasibility of an evidenced-based approach to the management of maternal depression in the pediatric setting. We present evidence demonstrating that pediatric providers can successfully identify postpartum women with depression, monitor symptoms and treatment adherence, and communicate results to a woman's healthcare provider. Yet more investigation is needed to create preventive interventions for maternal depression that integrate evidenced-based practice standards for the treatment of depression in primary care venues into pediatric settings. Future programs and policies targeting maternal depression in the pediatric environment should address patient mental health literacy and stigma, the training and education of pediatric providers, and issues of privacy and reimbursement.