Medical policymakers are increasingly urging aggressive screening and integrated care to help women with perinatal mood and anxiety disorders (PMADs), including postpartum depression.
According to the American Academy of Pediatrics, PMADs are the most common complication of childbirth in the U.S., affecting about 14 percent of women in their lifetimes and up to 50 percent in some specific populations.
PMADs can lead to a variety of adverse outcomes for both mothers and their babies, researchers say. These include less breastfeeding, poor maternal-infant bonding, less infant immunization and maternal suicides that account for up to 20 percent of postpartum deaths.
Although experts acknowledge that PMADs are a significant problem, finding a way to solve this issue is far from clear.
In a policy statement published December 2018 in the journal Pediatrics, the AAP recommended screening at well-child checkups throughout the first several weeks and months of infancy. The academy also recommended providers use community resources and make appropriate referrals to ensure women suffering with these disorders receive follow-up treatment.
But many believe that PMADs require a more comprehensive approach. Lenore Jarvis, M.D., MEd, an emergency medicine specialist at Children’s National Health System, believes women should receive integrated care at several levels, including individual, interpersonal, organizational, community and policy.
This approach has been implemented by Children’s National Health System and includes one-on-one screenings that take place in primary care clinics. Currently, all five of Children’s primary care clinics screen for mental health concerns at annual visits.
Mothers are also screened for PMADs during the 2-week, 1-, 2-, 4-, and 6-month visits via the Edinburgh Postnatal Depression Scale.
In addition, recent studies at Children’s neonatal intensive care unit (NICU) and emergency department (ED) suggest that performing PMAD screenings in these settings as well could help catch even more women with these disorders.
Indeed, practitioners discovered about 45 percent of parents had a positive screen for depression at NICU discharge, and about 27 percent of recent mothers had positive screens for PMADs in the ED.
To further these efforts, Children’s National recently started a Perinatal Mental Health Taskforce to promote multidisciplinary collaboration and open communication with providers among multiple hospital divisions.
This task force is working together to apply lessons learned from screening in primary care, the NICU and the ED to discuss best practices and develop hospital-wide recommendations. They’re also sharing their experiences with hospitals across the country to help them develop best practices for helping women with PMADs at their own institutions.
On a federal level, Jarvis and colleagues are seeking out more resources for PMAD screening, referral and treatment. They successfully advocated for Congress to fully fund the Screening and Treatment for Maternal Depression program, part of the 21st Century Cures Act. And locally, they provided testimony to help establish a task force to address PMADs in Washington.
Together, Jarvis said, these efforts are making a difference for women with PMADs and their families.
“All this work demonstrates that you can take a problem that is very personal, this individual experience with PMADS, and work together with a multidisciplinary team in collaboration to really have an impact and promote change across the board,” she said.