Stigma, Inequity and Increasing Prevalence – How We Can Address the Most Pressing Priorities in Maternal Mental Health
Maternal anxiety and depression are the most common complications of childbirth. These complications can impact at least 1 in 5 women, yet they are not universally screened for, nor treated. The good news is that screening and treatment have each proven to be effective in lessening the impact of these disorders.
When it comes to the issue of perinatal depression, there are several priorities we must address. Below is a summary of the most pressing challenges.
Accommodating for the effects of COVID-19
The collective fatigue and isolation we’ve all experienced during the pandemic is likely compounding the effects of perinatal depression. A recent study examining the pandemic’s effect on moms in Europe showed that almost half (47.5%) of women with babies aged six months or younger met the threshold for postnatal depression during the first COVID-19 lockdown, more than double the average rates for Europe before the pandemic.
In the US, 42 percent of respondents to a CDC survey in December reported anxiety or depression symptoms, an increase of over 200 percent from the 2019 average. One survey by CARE International found that women have experienced mental health hardships at a rate of almost 3:1 compared with men during the pandemic.
As we move forward, we should anticipate an increase in demand for mental health support among expectant and new moms, and be proactive about addressing perinatal depression.
Effectively screening and identifying risk factors
Research suggests that 30 to 35 percent of women who struggle with perinatal depression have a history of depression, mood disorders, or anxiety disorders. Additionally, a woman with a previous history of postpartum depression is 10 to 50 percent more likely to experience depression in subsequent pregnancies. Almost half of women with postpartum depression begin experiencing symptoms of depression during pregnancy. So identifying moms earlier and intervening faster improves our ability to help lessen the impact of depression during and after pregnancy.
Based on a large, systematic review of multiple randomized controlled trials, a recent study showed that simply screening for depression during and after pregnancy can have a positive impact on prevalence within a patient population. ACOG reports that screenings alone can reduce risk of perinatal depression by as much as 9 percent.
Creating digital access to the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool can be an effective way to identify patients who need help. In a recent client analysis, we found that 46 percent of women who completed the survey on our platform were identified as possibly having minor or major postpartum depression.
Actively acknowledging and normalizing depression
One study estimates that seventy percent of women who are wrestling with their mental health during or after pregnancy either minimize their symptoms or actively hide them. Additional research from Thomas Jefferson University showed that screening and diagnosis for maternal mental health were not uniform and that less than 10 percent of mothers in need received treatment.
Shame, guilt and fear are all emotions driving continued stigma for maternal mental health needs. Stigma is specifically common among depressed mothers who have low support or who are unaware of available resources.
The more we can do to normalize mental health needs, specifically in pregnancy, the better our chances of making a positive impact. Too many women avoid treatment when they need it most. They suffer in silence. To address this, we must more consistently get educational information in the hands of both patients and providers, while encouraging moms to share their stories.
Ensuring equitable mental health support for all patients, including black, Indigenous and people of color (BiPOC) and LGBTQIA+
Addressing maternal mental health means addressing health equity for all. In the U.S., mental health care is not accessible to all who need it, and that access is complicated by bias, discrimination, and lack of representation in clinicians. Studies show differences in care initiated and received by Black and Latina women vs their white counterparts. LGBTQIA+ families are at higher risk for perinatal mood struggles for a variety of reasons, including discrimination and stigma, which they may also face when seeking mental health care.
These groups are often marginalized by the mental health system. They also experience vast discrepancies generally in terms of maternal health. This double dose of inequity creates additional risk for these groups. Focusing specifically on addressing their unique needs is mission critical as we think about maternal mental health.
Educating patients and making timely connections
We can’t place the entire burden of addressing maternal mental health on providers. We have to augment the care they deliver with tools that can extend their impact. Leveraging digital technologies, we can assess patients early and escalate those at high risk. We can serve up educational articles and specific action items. We can also help patients more easily navigate to nurse lines, support groups and other mental health resources, such as counseling. All of these efforts serve to reduce stigma, create more equitable access to mental health resources and provide much needed support between provider visits.
Even simple resources can have a powerful impact in this area. At Wildflower, we offer a robust set of educational articles, tools and simplified connections to care for moms and families. Far and away, one of the most popular features on our platform is something we call “Baby Boost.” This tool provides a moment of mindfulness and connection for a mom-to-be, promoting calm and stress reduction.
As we move further into virtual and value-based care within the OB setting, it’s important to keep maternal mental health front and center. We should consistently be evaluating how to comprehensively address screening and support. This includes filling gaps virtually for providers, who often are not resourced to manage evaluation and treatment. The goal is continued connectivity between patients and their providers in combination with more convenient access to mental health services. We must be there for mom throughout her pregnancy, while also surrounding her with support after her baby is born and at every age and stage.