Health Insider Update


A Call to Screen all Pregnant Women for Depression

A Call to Screen all Pregnant Women for Depression
March 24
15:54 2016

Did you know that postpartum depression (PPD) is the most common childbirth complication? According to the US Preventive Services Task Force, all new and soon-to-be mothers need and deserve considerably more attention and care when it comes to depression.

It is estimated that the percentage of women who experience PPD symptoms is as high as 25% in some areas. If we dial that number down to 15%, that’s still about 600,000 women in the United States every single year. That number climbs to 900,000 when you take into account the women who experience PPD after miscarriage or stillbirth.

Currently, only 15% of those women receive treatment. This means that approximately 765,000 women are dealing with the disorder without help. Part of the reason for this disparity is a lack of screening.

4bd69fe1_42-53824012.xxxlarge_2xSymptoms of postpartum depression include:

• Low libido
• Crying episodes
• Anxiety
• Irritability
• Sadness
• Low energy
• Changes in eating/sleeping

What’s the big deal about anxiety and bad mood after birth?

Postpartum depression affects not only the mother, but the infant as well. Not only will the child have an increased risk of future psychiatric illness, but depressed mothers rarely bond properly with their children. While the mother is more likely to turn to alcohol and drugs, the child grows up with an increased risk for sleeping difficulties and is less likely to interact with others.

In some cases, PPD evolves into chronic or lifelong anxiety or depression and in rare cases leads to postpartum psychosis. PPD is one of the leading cases of infant murder (occurs in 8 out of 100,000 births).

What causes Postpartum Depression?

pregnantAlthough PPD is not fully understood, the following factors are believed to contribute:

• Sleep deprivation
• Anxiety regarding a mother’s new responsibilities as parent
• Identity crisis
• The feeling of losing control
• Anxiety due to lack of support from the father

The US Preventive Services Task Force has advocated for years that everyone be screened for depression. The panel’s focus on pregnant women is a new addition to the familiar recommendation.

New mothers need special care, says the task force, especially because evidence shows that PPD can be successfully diagnosed and treated. Recovery is especially important because PPD affects not only the mother, but the infant as well.

Depression is actually the word’s biggest cause of disease-related disability in women. It is estimated that 9% of pregnant women and 10% of new mothers will experience a major depressive episode.

A bill introduced last summer might change these disheartening statistics. The legislation would give the federal government authorization to fund depression screening and treatment for pregnant women and new mothers.

Health insurers have heard the task force’s call and are asking questions about the best tests for depression screening.

“Historically, depression in these populations has been under-recognized and under-treated,” says clinical psychologist Evette Ludman. Access to effective care is vital to recovery, she explains.

Consider the following example: 

Heidi Koss was not screened for depression during pregnancy, not even when she mentioned symptoms to her obstetrician. He told her that her feelings were “typical” and said, “perhaps you should get out more, maybe buy a new dress.”

“It just added to a sense of helplessness, hopelessness, and isolation,” said Heidi as she told her story to NPR 20 years later. She admitted that she tried to kill herself multiple times before finding a sympathetic counselor about a year after the birth of her first child.

“Pregnancy is not from the neck down,” says Heidi. She cited a British study from the 90’s that found psychiatric disorders such as suicide to be the leading cause of maternal death.

The biggest challenge regarding treatment is that many women don’t look for it.  

“Because hopelessness and inertia are often part and parcel of depression, it can be challenging for persons living with depression to keep at it until finding the treatment that is right for them,” says Ludman.

The task force recommends cognitive behavioral therapy and counseling for depressed mothers. The panel’s full recommendations for post-term and pre-term mothers can be found in the latest issue of the Journal of the American Medical Association (JAMA).


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April Kuhlman

April Kuhlman

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