Since implementing a postpartum screening program in 2006, New Jersey remains far ahead of the curve, and the state program continues to serve as a national model.

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Carolyn Beauchamp, president and CEO of the Mental Health Association in New Jersey, credits the awareness raised by Mary Jo Codey, wife of former acting New Jersey Gov. Richard Codey, about her personal battle with postpartum depression for prompting the law to be enacted a decade ago.

"They started out with education and early intervention at the point where the woman has the child and is in the facility, in a hospital or in a clinic or whatever, they have to be screened before they leave. Now probably, we should back that up, and people should be looking for depression earlier on," Beauchamp said.

Beauchamp said making the postpartum screening process a law, and not just a recommendation, was key.

"What it has offered as a law is that hospitals, which are very institutional structures and are hopefully going to follow the rules and do the right thing, are very busy screening people before they leave the hospital, and that's working up to 95 percent of the time from what I see in the different information I've gathered," Beauchamp said.. "So, we know that this is working. Women are being screened before they leave the hospital with their babies. The second part, which is also very concrete and very clear, is that you're supposed to be screened again when you go for your first baby visit or within the first three months."

Having clear markers and things that can be measured is what Beauchamp attributed to making the law easy to implement statewide in 2006, and for its continued success in detecting postpartum depression today.

No other state had done that, Beauchamp said. She added it was controversial at the time as to whether women should be forced to undergo a screening just because they were in a hospital having a child, regardless of income level or what hospital they were in.

"I think we've had a whole cultural shift in terms of trying to have more of handle on healthcare and providing better care, especially with the Affordable Care Act. So at this point, I think we see that as really being again, ahead of the curve, and providing something that perhaps wouldn't normally be provided, and that's a positive thing," said Beauchamp.

According to Beauchamp, what's being looked at now, is how to make sure that women are being screened routinely as they're pregnant.

"What we're finding, and I think in 2006 we weren't as clear that women were suffering depression even before they had the child. It was just postpartum. There were certainly plenty of instances where women were suffering from depression while they were pregnant. So if you could pick that up before they're in the hospital through their obstetrician or through their primary care doctor, you're really in a much better position to have them go through a much more comfortable birth, afterbirth, picking up on that depression and handling it much earlier. So we're really looking at intervening earlier and earlier, and giving people the education and the choices that they can make," Beauchamp said.

Beauchamp said a study done on female Medicaid recipients - who were considered to be the most vulnerable population - did not yield positive results.

"These are folks who really have to rely on their entitlement to get them that care that they need, which means that they have to have doctors who accept Medicaid, and in the state of New Jersey, that's pretty rare, and I think that is one of the enormous problems. Our Medicaid rates are so low, probably some of the lowest in the nation. We're hoping that will change. It has to change, because what we found was that even with the education and the early attempts at intervention when women came into a hospital to have the baby, the follow up and the change after the fact just wasn't happening," said Beauchamp. "It's very hard for women to get that kind of follow up care for many reasons, so I think we have to really look at that population very specifically and figure out with some research, why isn't this working, how do we make it work. We absolutely can't just leave that population out there."

At least 20 percent of new mothers experience postpartum depression, according to webmd.com. It's unknown exactly what causes postpartum depression, but physical and emotional issues could play a role, according to the mayoclinic.org. Hormonal changes after childbirth as well as in hormones produced by a woman's thyroid gland, sleep deprivation, and even anxiety or being overwhelmed, are possible contributing factors of postpartum depression. Treatment  for postpartum depression depends on the severity of it, and can involve medication and therapy.

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