Los Angeles County Maternal Mental Health Access (LAMMHA) is a five-year program funded by the California Health Care Foundation (CHCF) to support community health centers in identifying and treating perinatal mental disorders in primary and prenatal care. Depression is one of the most common complications of pregnancy and the postpartum period, affecting at least one in seven childbearing persons in the U.S. Early identification is essential to prevent suffering, reduce family impact, and improve outcomes for both parent and infant.
To reflect on the experience of depression screening and linkage to care, we spoke with Dr. Ian Bennett, a family physician providing prenatal, postpartum, and pediatric care in a community health center and Dr. Amritha Bhat, a perinatal psychiatrist and associate professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. Drs. Bennett and Bhat shared cases that highlight both the challenges and opportunities of case finding for depression in the perinatal period.
Clinical Case #1:
Dr. Lopez met the patient, a 26-year-old pregnant woman, during her second trimester prenatal visit. The clinic’s routine protocol included depression screening using the PHQ-9. The patient screened positive (PHQ-9 of 15) with symptoms of low mood, insomnia, and feelings of guilt. At the follow-up diagnostic interview, a diagnosis of Major Depressive Disorder was confirmed. The patient described a history of depression in adolescence but had never received formal treatment. She was motivated to stay healthy during her pregnancy, especially for her baby. Dr. Lopez discussed treatment options, including counseling and medication. The patient opted for therapy, and Dr. Lopez referred her to a behavioral health specialist through the clinic’s integrated care program.
After delivery, at the 6-week postpartum visit, the patient again screened positive, with worsening symptoms. She described difficulty bonding with the baby and persistent fatigue. This time, she agreed to try Sertraline, a medication with a strong safety profile in breastfeeding. Dr. Lopez provided close follow-up and coordinated with the therapist. Importantly, the patient was also seen regularly in the pediatric clinic for well-child visits. At the 2-month well-baby visit, the pediatrician repeated depression screening. The consistent use of screening across settings ensured continuity of care and flagged ongoing risk. At that point, the pediatrician facilitated enrollment in LAMMHA, which provided case management and streamlined access to mental health services. Over the next several months, the patient’s mood improved significantly. She remained engaged in therapy and medication management and expressed gratitude for the multiple opportunities to be “seen and heard” across her prenatal, postpartum, and pediatric visits.
Case #1 Highlighted Best Practices:
✓ Screen early and often. Routine depression screening at multiple points in pregnancy, postpartum, and pediatric care increases the chances of catching cases early.
✓ Follow positive screens with diagnosis. A validated tool is the first step, but structured clinical follow-up ensures accuracy.
✓ Normalize the process. When every patient is screened, stigma is reduced.
✓ Use every clinical touchpoint. Pediatric visits offer critical opportunities to re-screen and intervene.
✓ Link to programs like LAMMHA where enrollment ensures continuity, navigation, and follow-through, reducing the likelihood of patients falling through the cracks.
Clinical Case #2:
Maria, a 32-year-old woman in her third pregnancy presented for her first prenatal appointment in her second trimester, having transferred care after moving from another state. The medical assistant who roomed her noticed that she had marked 0 on all questions of the EPDS which had been handed to her. Following up on this she realized that Maria primarily spoke Spanish at home and although she understood English she was more comfortable communicating in Spanish. She was given the EPDS in Spanish to complete and her total score was 11.
At the follow up diagnostic interview, it was determined that she did not meet diagnostic criteria for Major Depression. However, her obstetrician explained to Maria that as she was experiencing some symptoms of depression, she would benefit from psychotherapy, both to address her current symptoms and to reduce her risk of postpartum depression. Mild to moderate symptoms of depression during pregnancy can affect maternal wellbeing, bonding, and infant outcomes. Maria was connected to LAMMHA and received brief behavioral intervention from the bilingual care manager, and was also followed closely by the LAMMHA team, monitoring for any worsening of symptoms. At her 6-week postpartum visit, Maria completed a Spanish language EPDS and scored 5, reporting that she now felt much more like herself and had a strong bond with her baby.
Case #2 Highlighted Best Practices:
✓ Ensure that validated translated screening questionnaires are available, suitable to the needs of the population served.
✓ Depressive symptoms should be identified and addressed even when mild to moderate, as untreated depressive symptoms in pregnancy are the strongest risk factor for postpartum depression.
✓ Integrated, culturally and linguistically concordant care improves identification, patient engagement, and treatment adherence.
✓ Link to programs like LAMMHA where enrollment ensures continuity, navigation, and follow-through, ensuring that patients with risk factors receive monitoring and needed preventive care.
Resources for Clinicians
- Screening tools: EPDS, PHQ-9
- Guidance: American College of Obstetricians and Gynecologists – Screening for Perinatal Depression: Implementing Perinatal Mental Health Screening | ACOG
- Training: MCPAP for Moms Toolkit – mcpapformoms.org/Toolkits
- Resources: LAMMHA Resources
During the two-year program, the participating LAMMHA clinics receive intensive on-going support and training to implement and sustain Collaborative Care. Please visit the CCALAC LAMMHA program page for more program information and previous LAMMHA blog posts. For more information and resources around maternal mental health in California, please visit the California Department of Public Health – Maternal Mental Health page.
LAMMHA program partners: Community Clinic Association of Los Angeles County (CCALAC), Elevation Health Partners (EHP), Maternal Mental Health Now (MMHN), Concert Health, University of Pennsylvania (UPenn), University of California, Los Angeles (UCLA) and the Department of Psychiatry and Behavioral Sciences at the University of Washington (UW).