The Hidden Risks of Maternal Depression

An estimated 1 in 7 pregnant or new moms experience depression at some point. But most go unrecognized and untreated -- despite the fact that suicide is a leading cause of maternal mortality. Scarcity of services is one reason, said panelists in a recent presentation jointly hosted by Boston and Harvard universities.  ​
An estimated 1 in 7 pregnant or new moms experience depression at some point. But most go unrecognized and untreated -- despite the fact that suicide is a leading cause of maternal mortality. Scarcity of services is one reason, said panelists in a recent presentation jointly hosted by Boston and Harvard universities.

 

While it's well-known that the "Baby Blues" are common, many psychiatrists are uncomfortable treating mothers in distress, and obstetricians are often unfamiliar with how best to intervene -- especially in rural areas where care is scarce -- experts at a recent webinar reported.

"Even if a woman tests positive for depression, less than a quarter of those women are going to get to even an initial mental health appointment," reported Dr. Nancy Byatt. "And far less than that will actually engage in ongoing treatment."

Dr. Nancy ByattByatt is a leading authority on maternal mental health at the University of Massachusetts Medical School, and executive director of the state's model Lifeline4Moms program.

On the heels of HRSA's Maternal Mortality Summit last summer – which highlighted the importance of access to mental health services during pregnancy and up to a year after birth – Byatt said that adoption of routine screening protocols for new and expectant moms is increasing.

"But the question remains, once someone screens positive, what do we do about that?"

HRSA recently awarded five-year grants to seven states to devise ways of bridging the gap between screening and treatment for new and expectant moms. Modeled after the Massachusetts Child Psychiatry Access Program – which 32 states have adopted for the treatment of kids – Byatt has been instrumental in extending the service to mothers in the state as well.

If a woman tests positive for diabetes – another common maternal malady – obstetrics departments have very clear treatment and referral plans, Byatt explained.

But few obstetric and pediatric clinicians are trained to recognize and help manage maternal depression. Two-thirds of women who screen positive go on to develop depression before the baby is born. The Massachusetts model aims to get women into treatment faster and earlier, mindful that the U.S. has one of the highest rates of maternal suicide in the developed world.

Dr. Deborah CowleyDr. Deborah Cowley, professor of psychiatry at the University of Washington, noted that only about 20 percent of pregnant and post-partum women receive mental health care services in the normal course of pregnancy.

"Eighteen of our 39 counties actually have no psychiatrist," she observed. "Most of these 18 counties have no mental health providers of any kind – and our perinatal psychiatrists are focused pretty much in Seattle … maybe 4-5 hours drive away.

"It's very difficult to find local mental health providers" to whom clinicians can refer stressed out moms.

What's needed, Cowley said, is local programs focused on making mental health a part of obstetric care, similar to diabetes. Byatt stressed that collaboration between obstetrics and mental health should go hand-in-hand.

"We're not trying to turn the OB into a psychiatrist," she added, "because we know when we try … that it doesn't work."

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Date Last Reviewed:  February 2019