In the Moment: Attitudinal Measure of Pediatrician Management of Maternal Depression Elyse R. Park, PhD; Amy Storfer-Isser, MS; Kelly J. Kelleher, MD, MPH; Ruth E. K. Stein, MD; Amy M. Heneghan, MD; Linda Chaudron, MD; Kimberly Eaton Hoagwood, PhD; Karen G. O’Connor, BS; Sarah McCue Horwitz, PhD Objective.—Pediatricians are in a good position to identify women who struggle with depression, but studies show low rates of pediatrician identification and management. It is likely that pediatricians’ management of maternal depression may vary on the basis of their attitudes, but no instrument has been developed to measure these attitudes. We sought to develop a measure of pediatricians’ attitudes about managing maternal depression and to identify characteristics associated with pediatricians’ attitudes about managing maternal depression. Methods.—We conducted a cross-sectional analysis of data pro- vided by 651 practicing, nontrainee pediatricians (response rate 57.5%) surveyed through an American Academy of Pediatrics 2004 Periodic Survey. An exploratory principal components analysis was used to investigate the interrelationships among the attitudinal items. Multivariable linear regression was used to assess the adjusted associations between physician and practice characteristics and attitudes. Results.—The attitudinal measure consisted of 3 subscales: ac- knowledging maternal depression, perceptions of mothers’ be- liefs, and treating maternal depression. Clinical approaches (eg, interest in further education on identifying or treating maternal depression) and training and work characteristics were signifi- cantly related to pediatricians’ attitudes; patient characteristics (eg, type of insurance and ethnicity/race) were not significantly associated with pediatricians’ attitudes. Conclusions.—We developed a measure to assess pediatricians’ attitudes about managing maternal depression. The findings from this study can be used to develop and assess interventions that improve pediatricians’ attitudes about acknowledging maternal depression, perceptions of mothers’ beliefs, and treating maternal depression. KEY WORDS: attitudes; maternal depression; survey Ambulatory Pediatrics 2007;7:239 –246 M aternal depression can have negative conse- quences for mothers as well as adverse emo- tional, behavioral, and developmental effects on children. 1–5 However, detection of maternal depression by pediatricians remains low, 6 despite research indicating that most mothers would feel favorably about pediatricians’ inquiries about their mood. 7 Furthermore, recommenda- tions from American Academy of Pediatrics’ Task Force on the Family to provide family-oriented care supports identifying and initiating referrals for maternal depres- sion. 8 Although systemic barriers to identification of maternal depression in primary care are certainly important, little is known about pediatricians’ attitudes regarding managing maternal depression. A study by Olson and colleagues 1 found that over half of pediatricians (57%) thought it was their role to identify maternal depression, but only 7% expressed being either responsible or confident about treating maternal depression. In this study, pediatricians who felt more responsible were more likely to be confident in their skills to recognize maternal depression. Gerrity and colleagues 9 developed a 4-item Perceived Self-Efficacy in Diagnosing and Treating Depression scale for primary care physicians, which also revealed that few pediatricians (3%) were very confident about caring for maternal de- pression (P .001). Behavior change models suggest that attitudes influence physicians’ behaviors. 10,11 These models posit that a “cue to action” (eg, a mother with signs of depression) would trigger cognitive constructs or attitudes (eg, confidence in ability to treat, perceived benefits of addressing depres- sion) that would precede intentions and actual behavior (diagnosing, referring, or treating maternal depres- sion). 12,13 These attitudes are influenced by sociodemo- graphic and environmental factors (eg, physician and practice characteristics). For example, pediatricians who are ambivalent about managing maternal depression would benefit from an “attitudinal intervention,” one that From the Departments of Psychiatry/Institute for Health Policy, Mas- sachusetts General Hospital/Harvard Medical School, Boston, Mass (Dr Park); Departments of Epidemiology and Biostatistics (Ms Storfer-Isser and Dr Horwitz) and Department of Pediatrics (Dr Heneghan), School of Medicine, Case Western Reserve, Cleveland, Ohio; Department of Pe- diatrics, College of Medicine and Public Health, Ohio State University, Columbus, Ohio (Dr Kelleher); Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (Dr Stein); Departments of Psychiatry, Pediatrics and Obstetrics and Gyne- cology, University of Rochester, Rochester, NY (Dr Chaudron); Depart- ment of Psychiatry, Columbia University, New York, NY (Dr Hoagwood); and Department of Research, American Academy of Pedi- atrics, Elk Grove Village, Ill (Ms O’Connor). Address correspondence to Elyse R. Park, PhD, Massachusetts Gen- eral Hospital/ Harvard Medical School, 50 Staniford St, 9th Floor, Boston, MA 02114 (e-mail: epark@partners.org). Received for publication January 2, 2006; accepted March 11, 2007. AMBULATORY PEDIATRICS Volume 7, Number 3 Copyright © 2007 by Ambulatory Pediatric Association May–June 2007 239