Education and screening are key to treating postpartum depression.
The CDC estimates that as many as 1 in 5 women suffer from a perinatal mental health disorder, including postpartum depression. But that figure may be just the tip of the iceberg—a recent North Carolina State University study found 21 percent of recent mothers experiencing symptoms of a perinatal mental health disorder did not disclose it to their health care providers. Whether that's out of guilt, fear or simply a lack of knowledge, it represents a significant number of mothers who are not receiving the help they need.
"Pulling this out of the shadows and making people understand how common it is—it's one of the main complications of pregnancy—is really important," says Cynthia Rogers, M.D., a child and adolescent psychiatrist at St. Louis Children's Hospital. "We've made some great strides in doing that, but there's a continued need."
The effect on children
Treating all mothers with postpartum depression is of vital importance to the health of their children. Rogers says studies have shown the functionality of the primary caregiver has a direct effect on the health of an infant, including:
- Diminished socialization: they don't vocalize as much, there's less cooing and eye contact
- Impaired cognitive development
- Increased likelihood of behavioral problems and lower academic achievement later in life
Screening is key
The key to identifying and ultimately treating women with pregnancy-related mental disorders is screening, according to Rogers. Though they are recommended by the American Academy of Pediatrics, she says perinatal mental health screenings are performed inconsistently. "We can't leave it up to a mom to report the symptoms, we must screen for them," Rogers says. "And screen everyone—don't make any assumptions about who might be experiencing symptoms because it can cut across all races, experiences and socioeconomic status."
At St. Louis Children's Hospital, the screening includes:
- A symptom questionnaire for the patient
- A thorough discussion about potential risk factors, including stressors that may be present in the mother's life at the time
- A review of her prior mental health history
Even if the screening reveals no signs of symptoms, Rogers says it's still important to continue to educate mothers about the disorder because the onset of postpartum depression can occur months after the baby's birth.
More work to do
Treatment options for postpartum depression are not unlike those for other types of depression. They range from supportive therapy and lifestyle interventions (exercise, rest and support from family and friends) for milder cases to psychiatric therapy and medications for more severe occurrences.
Overall, Rogers sees gradual improvements in the identification and treatment of perinatal mental disorders, buy she says more can be done:
- Education. Continuing to increase education and awareness "not only for women, but for society at large about how common these disorders are," she says.
- Training. Prioritizing education for medical providers on how to identify and treat perinatal mental disorders.
- Insurance. "A major issue is making sure insurance coverage is extended through the postpartum period, especially in states that don't have Medicaid expansion," Rogers says. "A lot of women are losing the Medicaid they received during pregnancy at a couple months postpartum, which is often when these disorders initiate."
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