Screening for postpartum depression and anxiety: Tips for pediatric providers

Dr. Alicia Pointer May 3, 2026 11:56:28 AM

Why screen for postpartum mood disorders?

About 1 in 5-10 women will experience perinatal depression. Untreated perinatal depression and anxiety can harm mothers’ long-term health, relationships with their family, their children’s health, and their children’s development. Early identification and treatment can prevent many of these negative consequences.

The US Preventative Services Task Force, American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and American College of Obstetricians and Gynecologists (ACOG) all recommend that women be screened for depression during the perinatal period with systems in place for treatment and follow-up. The AAP recommends that birth parents be screened for depression at the 1, 2, 4, and 6-month well child visits. But less than half of pediatricians screen for postpartum mood disorders. (While perinatal mood disorders can occur anytime in the perinatal period, most pediatricians see parents in the postpartum period after the baby is born.)

How to screen effectively

Without formal universal screening, it’s very easy to miss a diagnosis. Postpartum depression may initially present not with feelings of sadness but with insomnia, irritability, or anxiety. Mood changes may be dismissed as “baby blues,” “just hormones,” or typical of new parenthood. While there are risk factors for postpartum depression, there is no way to predict which individual person will develop it. Even experienced parents with strong support and no prior history of depression or anxiety may suffer from perinatal mood disorders. Screening ALL mothers during the postpartum period with a validated screening tool provides the best chance for identification and treatment.

Before implementing in-office screening, develop a plan that includes when and how parents will be screened, how screening tools will be scored and documented, how positive scores will be addressed, and what follow-up is needed after the initial visit. This workflow should be evaluated and adjusted regularly. There is no one recommended screener for perinatal depression or anxiety. It’s important to choose the screening tool that 1) will be used consistently, 2) can be efficiently and accurately scored and interpreted, and 3) is relevant to your intended population (e.g. primary language, literacy level, cultural background). Below are some of the most common screening tools available.

Patient Health Questionnaire (PHQ-9/PHQ-2)

The PHQ-9 is 9-question depression screen for all age groups including perinatal women that takes 5-10 minutes to complete. It can also be used to monitor symptom severity during treatment. It is free and available in many languages. Offices that are already familiar with using and scoring the PHQ-9 may feel most comfortable using the same scale for postpartum screening.

The PHQ-2 is a 2-question initial screener, can be self-completed or asked by a provider, and takes less than a minute to complete. A positive PHQ-2 needs to be followed up by a more comprehensive depression screening such as the PHQ-9 or EPDS.

Edinburgh Postnatal Depression Scale (EPDS)

The Edinburgh is a validated 10-item scale that takes about 5 minutes to complete. It was developed specifically to detect postpartum depression in primary care offices. Because it’s designed for the postpartum period, it may be more relevant and less likely to produce false positives than screens that ask questions about difficulty sleeping or feeling tired, for example. It is free and available in many languages.

A subscale of the EPDS consisting of questions 3, 4, and 5 (EPDS-3A) can be used to screen for perinatal anxiety disorders. A score of 5 or higher on the subscale may identify additional anxiety orders that could be missed with the total scale.

Generalized Anxiety Disorder (GAD-7)

The GAD-7 is a brief 7-item screen that takes less than 5 minutes to complete. It is not designed specifically for perinatal anxiety but has high sensitivity and specificity in the perinatal population. Similar to the PHQ-9, many offices are already familiar with the GAD-7 for their general patient population. It is free and available in many languages. It can also be used to assess the severity of anxiety over time or in response to treatment.

Perinatal Anxiety Screening Scale (PASS)

The PASS is a 31-item self-reported screening that takes about 5-10 minutes to complete. It is designed to assess the presence of and severity of anxiety specifically in the perinatal and postpartum period. The scale includes four categories of anxiety: acute anxiety and adjustment; general worry and specific fears; perfectionism, control and trauma; and social anxiety. Some providers will use the PASS to get more detailed information after a positive GAD-7 or EPDS-3A subscale.

Normalizing questions

Whether the screening questions are positive or negative, providers should do informal check-ins with new parents during regular visits. These brief conversations are important to assess for potential mood changes, determine parents’ needs for resources or support, and build parent confidence and trust. Screeners can miss families who are high risk for mood disorders but don’t yet meet symptom criteria and they tend to do a poor job assessing families’ strengths.

To build rapport and strengthen family resilience, it always helps to first discuss something positive you’ve noticed about the baby or their parenting. (And personally, watching parents become enamored with their children and develop confidence in their own parenting is one of my favorite parts of being a pediatrician!) Then start with questions that are supportive, open-ended, and nonjudgmental. Here are some examples that I use but find something that feels comfortable in your own voice.

This stage can be really overwhelming. What kind of support do you have?
What’s the best part of having a new baby? What about the hardest part?
The lack of sleep can take a huge toll on parents. How is it impacting you?

Follow-up

What comes after the screening is usually the most important part. Before the office starts screening, there should be a clear plan for how to manage positive screens and families who screen negative but have risk factors or need extra support. Having a close relationship with local mental health providers and obstetricians is very helpful in these situations.

The first priority is to assess for safety of the mother and baby. If there’s a concern for suicidality, self-harm, child harm or neglect, postpartum psychosis, or other danger signs, immediate emergency intervention is necessary. This may include an evaluation by co-located mental health, mobile mental health/crisis intervention, or the Emergency Department.

If a screening suggests postpartum depression or anxiety and families are safe, parents should leave the office knowing at least 4 things: 1) Results of the screening and what it means, 2) Postpartum mood disorders are common and are not anybody’s fault, 3) Postpartum mood disorders are treatable, and 4) Next steps and what they can expect. Here’s one example for a patient who screened positive for mild-moderate depression:

“Your answers on this questionnaire show you may have postpartum depression, a kind of depression that can happen after you have a baby. There’s no one cause, but it’s very common and can happen to anybody. I’m glad you filled out the form because this is an important part of your health and there are treatments that can help. Here’s some info including a local support group, and a referral for a therapist. We’ll follow up in 2 weeks, but here’s a number to call if things get worse, you have scary thoughts, or have a hard time taking care of the baby. What questions do you have about the screening and results? How do you feel about that plan?”

Resources for families

Referrals, treatment, and follow-up will vary depending on families’ needs and what resources are available in the office and community. When developing treatment plans and collating resources, remember to consider: assistance with basic needs, social supports, mental health providers, and how to access immediate help if needed.

Some pediatric practices have embedded social work, counselors, or care coordinators on-site who can provide immediate support with closed-loop communication. This is an excellent resource for providers and families, but many offices aren’t that lucky. Even more challenging, many areas have a shortage of mental health providers or long wait lists for appointments.

If your office is looking to improve postpartum mood screening and referrals, there are several resources that may be available for you and your families.

Project TEACH. This is the perinatal access program for New York. In addition to provider resources on maternal mental health, Project TEACH provides 1-on-1 consultations for prescribers to talk directly with a perinatal psychiatrist.
Home visiting programs. In NYS, this includes the Nurse-Family Partnership, Healthy Families, and others. Find out what home visiting programs are available near you and how to refer.
Perinatal and Infant Community Health Collaboratives. Local PICHC projects are community-based initiatives to improve health outcomes for birthing people and their families. They may offer community health workers, home-visiting, care coordination, or community partnerships that support maternal mental health.
Postpartum Resource Center of NY. They offer a statewide helpline, peer support program, and resource directory.
County departments of Mental Health or Social Services. They can guide you to additional local resources that you may not be aware of.
Parent support groups. Community centers, libraries, or birthing hospitals may offer in-person parent support groups. There are also many online support groups both for general support and for parents experiencing specific challenges.
Postpartum Support International offers support groups, a helpline, and a provider directory for patients, and resources and consultations for providers.
Basic needs assistance: Consider 2-1-1, findhelp.org, local nonprofits, religious organizations, or your county social services department.