Maternal Mental Health:
A National Health Care Crisis

Nancy Byatt

Care for Your Mind acknowledges and appreciates the collaboration of the National Network of Depression Centers in developing this series.

Maternal Mental Health: A National Health Care Crisis
Nancy Byatt, D.O., M.S., M.B.A., F.A.P.M.

Few issues are of more importance to our society than the psychological well-being of pregnant and postpartum women. They are the guardians of current and future generations — our mothers, partners, children, daughters, and sisters.

Tragically, America’s mothers are facing a mental health care crisis. One in seven women who are pregnant or have recently had a baby suffers from depression, making it more common than diabetes during pregnancy. This is an epidemic that affects all of us, impacting hospitals, homes, schools, and workplaces.

Depression is also the leading cause of disability worldwide among women of reproductive age, and maternal suicide accounts for 20% of postpartum deaths among depressed women.

Perinatal depression has negative effects on birth outcomes, infant attachment, and children’s behavior/development. Although depression is by far the most common mental health condition women experience, many others live also live with anxiety and frightening thoughts.

Maternal depression has staggering economic impacts. According to a Healthcare Cost and Utilization Project report, nearly $15 billion annually is spent on childbirth-related hospitalizations for women who suffer from depression during pregnancy. In addition, children of depressed mothers tend to visit medical offices and emergency departments more frequently and utilize more health services. One study found that the annual cost of not treating a mother with depression is $7,211. Apply that to 800,000 mothers per year in the U.S., and, that’s $5.7 billion dollars.

Sadly, most women who are struggling with depression, anxiety, or other mental health issues during or after their pregnancy are not recognized, heard, or supported by their medical providers. Not because providers don’t care (to the contrary—providers care deeply), but because there is no system in place to allow doctors to provide appropriate treatment. Because of a severe lack of resources and education, perinatal mental health has become a national public health crisis, and it’s time for reform.

I am a psychiatrist who works with pregnant and postpartum women and the medical director for the Massachusetts Child Psychiatry Access Project for Moms (MCPAP for Moms), which helps pregnant and postpartum women get the mental health support they need and deserve.

Women, children, and families need us to work together to bring depression and other mental health issues out of the shadows. Women need to know they live in a culture that supports them, listens to them, and remains with them as they take on an extraordinarily challenging role: motherhood. Providers need to feel comfortable broaching the subject with patients and following up with appropriate treatment and/or referral. It begins here.

The good news is this issue is gaining momentum. The Journal of the American Medical Association (JAMA) just released new recommendations from the US Preventive Services Task Force (USPSTF) related to depression screening. It recommended all adults be screened (including pregnant and postpartum women), and stressed the importance of having systems in place in order to accurately diagnose, provide effective treatment, and offer appropriate follow-up.

Through this series, we aim to continue that momentum, and spark a national conversation about mental health during pregnancy and the year after birth. Recently, U.S. Congresswoman Katherine Clark (MA-5) introduced first-of-its-kind legislation, the Bringing Postpartum Depression Out of the Shadows Act  (H.R. 3235/S. 2311 is the companion US Senate bill) that could change the national landscape for maternal mental health. As these bills await action in Congress, stakeholders on the front lines are joining forces for a series of stories about this immensely important topic.

Engage in this groundbreaking dialogue with us as we strive to inspire advocacy and bring about positive change.

Over the next few weeks, read our posts and share your comments, suggestions, and personal stories with us. You are as much a part of this effort as we are, and we look forward to hearing from you and creating a truly powerful tool for change. Please read next week’s post: Why Doctors Can’t Treat Their Patients: Barriers to Mental Health Care for Obstetricians and Pediatricians. Subscribe to CFYM to so that you automatically receive each week’s post in this series every Tuesday.

Your Turn

  • How has perinatal depression affected you or someone you know?
  • What do you think is important as we address maternal mental health?
  • What have you experienced or heard of that has been effective in identifying and treating postpartum depression?

Dr. Byatt is a perinatal psychiatrist focused on improving health care systems to promote maternal mental health. She is an Associate Professor at UMass Medical School in the Departments of Psychiatry and Obstetrics and Gynecology.  She is the Founding and Statewide Medical Director of MCPAP for Moms, a statewide program that addresses perinatal depression in Massachusetts by providing mental health consultation and care coordination for medical providers serving pregnant and postpartum women. Her research focuses on developing innovative ways to improve the implementation and adoption of evidence-based depression treatment for pregnant and postpartum women. She has received federal funding from the Center for Disease Control to test an intensive, low-cost program that aims to ensure that pregnant and postpartum women with depression receive optimal treatment. Her academic achievements have led to numerous peer-reviewed publications and national awards.

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