Perinatal Mood Disorder Screening in Healthcare Settings

As Americans move to a more mindful and pro-mental health outlook, one of the of areas that needs some attention is new and pregnant mothers. The time period that a woman is pregnant, up to a year postpartum, is considered the perinatal period. Post-partum depression, anxiety, psychosis, and antepartum depression are all encompassed under the phrase ‘Perinatal Mood Disorders’ or PMD. More resources for the PMD population would, I believe, create positive outcomes that last long-term for mothers and their infants. PMD has been shown to cause long-term adverse birth outcomes when it goes untreated.1 Below, I will outline some surprising statistics as well as some outcomes, resources and possible solutions for providers of pregnant women and women with infants.

Research shows that 1 in every 5 to 7 women experience postpartum depression.3 Also, 1 in every 10 fathers or spouses experience postpartum depression.3 If a woman experiences PMD her partner is more likely to also experience PMD. Over 50% of women that are experiencing symptoms of perinatal mood disorder are not identified.1 This is a truly unfortunate statistic because research has also show that women are more likely to come into contact with a health provider during their prenatal period than any other time in their life. Even though women are coming in to contact with health care providers, they are not being screened, why?

A common reason why providers do not screen for mental health during the prenatal period is due to lack of resources. Providers do not want to dig for problems they cannot fix. However, I do believe this is just a lack of education, there is support out there, if you look. Providers also seem to focus on the medical aspect of a pregnancy. During this time women may be seeing an OBGYN who does not feel comfortable discussing mental health or does not view that as their scope. Research shows however the PMD for women is more prevalent then preeclampsia, breast cancer, and diabetes.1 Also, in 2015 the American Congress of Obstetricians and Gynecologists reamended that women be screened during their prenatal period at least one time.1 Physicians may not be aware of appropriate tools to screen (like the EPDS or PHQ 9). Aside from healthcare providers not screening for PMD, mothers are also hesitant to reach out for help. Despite how common PMD is in women, as a 2016 Lee Research Review points out, “few women seek professional advice due to physical and attitudinal barriers, long-waiting times for face-to-face psychotherapies, social stigma and uncertainties about the potential risks of pharmacological therapies during pregnancy”2

                  Adverse outcomes are a probable outcome of Perinatal Mood Disorder. Including a decreased attachment and stress on the fetus.  If you identify PMD early, it can change these outcomes and increase the infant-parent bond. Subsequently, women should be screened at least one time during their pregnancy and up to one-year post-partum. Research shows that the prevalence of depression typically peaks around 3 months postpartum. 2

                  What are some good resources for Perinatal Mood Disorder? I would encourage all new moms and especially anyone at risk to get adequate rest, exercise and nutrition. However, I know first-hand that is easier said than done. The first one that I would recommend is talking to your doctor about is. Getting some physician input on potentially starting medication or a therapist referral would be helpful. Physicians can help direct you to PMAD’s and treatment. The second thing I would recommend for mothers, is locating the Postpartum Support International (PSI) website. They have around the clock help and support available, as well as websites, blogs, etc. There is much more information on this topic that I will delve into piece by piece over the coming weeks. Including prevalence and resources.

As always, feel free to leave a comment! Is there something you learned or something you feel I left out? Drop a comment in the section below!

Take Away Points

  • 1 in 7 women are diagnosed with Perinatal Mood Disorder
  • There are many reasons, including stigma and lack of support, that women do not come forward with feelings of PMD.
  • Women should be screened prenatal and at pediatric appointments for PMD.
  • Resources : Local physician or community health partner; Social Worker for Women and Children; Therapist; Stress Reductions Techniques; Prenatal Massage: Prenatal Yoga; PSI; Online support groups; Telehealth and Teletherapy.
  • YOU ARE NOT ALONE

 

References

  1. Accortt, E., Wong, M., 2017. It Is Time for Routine Screenings for Perinatal Mood and Anxiety Disorders in Obstetrics and Gynecology Settings. Volume 72, Number 9.
  2. Lee, E., Denison, F., Hor, K., Reynolds, R. (2016). Web-based interventions for prevention and treatment of perinatal mood disorders: a systematic review. BMC Pregnancy and Childbirth 16:38 DOI 10.1186/s12884-016-0831-1
  3. Postpartum Support International; https://www.postpartum.net

Published by Traci Schank LCSW Counseling

Counseling Specializing In: Perinatal Mood Disorder Postpartum Anxiety, Depression, and Psychosis Infant Mental Health Relationships Attachment and Bonding Prenatal Stress PTSD Child and Infant Development

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