This week a group of health industry experts has issued an update of their 2009 recommendation that all adults should be screened for depression to specifically include pregnant and postpartum women. The new recommendations come from the U.S. Preventative Services Task Force (USPSTF), an organization that routinely reviews current scientific literature in order to make policy suggestions based on their findings.
What’s new?
In addition to the targeted language to include depression screenings for all women during their childbearing years, the new guidance urges practitioners to specifically consider how current treatment resources might need to be enhanced and expanded to better meet the needs of pregnant and postpartum patients. Specifically the panel concluded that there is a further need for research “to assess barriers to establishing adequate systems of care and how these barriers can be addressed.”
Current screening methods often consist of a questionnaire administered during routine well-baby or primary care visits either by a physician or a nurse practitioner. The questionnaire asks patients to rank how often they have experienced a comprehensive list of negative emotions and how those emotions have affected their quality of life. If the respondents’ answers indicate possible depressive or other mental health concerns, treatment protocol can range wildly. The recent USPSTF report states a need for providers to begin working towards a standard of care for all patients that includes targeted follow-up opportunities for cognitive behavioral therapy (CBT) and/or pharmacological/SSRI therapy (selective serotonin reuptake inhibitors).
Depression, anxiety, panic – oh my!
For many women the birth of a baby can trigger an onslaught of difficult emotions. Oftentimes it can be challenging for mothers to find a forum to air these feelings, especially at a time when society at large sees birth only as a joyous event.
Historically these feelings have been called ‘baby blues’ – a term which describes the set of emotional symptoms that can be experienced after childbirth; mood swings, anxiety, irritability, sadness and overwhelm as well as appetite and sleep disturbances. Traditionally these symptoms were attributed to a combination of fluctuating hormonal levels coupled with the sleep deprivation that many women experience in the post-delivery period. Often the symptoms of ‘baby blues’ show up within two to four days after birth and then gradually taper off as these issues stabilize.
But for as many as 19% of women, according to Center for Disease Control (CDC), for whom the symptoms do not dissipate with time, the term becomes something of a misnomer. Especially when one takes into consideration the growing body of research and evidence that supports the idea that often a host of associated mental disorders such as generalized/social anxiety, obsessive compulsive disorder, adjustment disorder, and panic disorder are also positively correlated with a woman’s transition to motherhood and beyond.
Potential benefits of increased screening and treatment
Both the CDC and the World Health Organization (WHO) identify that women who enter into their childbearing and childrearing experiences with symptoms of depression or other mental health concerns have unique challenges that must be addressed not only for the health of the mother but also for the health of the baby. Women with depression are at a higher risk for substance abuse and chronic disease. Mothers who experience postpartum depression report higher incidences of negative, hostile or disengaged parenting behaviors. Babies born to mothers with depression are at a higher risk for adverse emotional development, more problematic sleep habits, lower cognitive functioning and even higher incidences of infant mortality.
The USPSTF report found a positive correlation between treatment and disease remission and also found no significant evidence of harmful or dangerous repercussions to mother or baby for treatment (either behavioral or pharmacological) or screening practices.
A healthier approach
Depression is an insidious disease that has profound economical, emotional and developmental effects for individuals, families and for our society as a whole. The willingness of the U.S. Preventative Services Task Force to place focused attention onto the mental health of mothers and babies, and to highlight the need for further development of resources to meet that need, signifies a changing paradigm in society at large, one in which the importance of attending to the mental health of our most vulnerable populations becomes tantamount to driving meaningful health reform for all.
Resources to reach out, inform and support
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