Maternal Depression is on the Radar
But Will it Make a Difference?
A Letter to the San Diego Union Tribune
San Diego Postpartum Health Alliance
Task Force Recommendation’s Impact on San Diego Will Depend on the System Response
This week, the US Preventive Services Task Force (USPSTF) captured national headlines, calling for all pregnant and postpartum women to be screened for depression. The maternal mental health community widely celebrated the news, recognizing it as a monumental step forward to improve the lives of mothers, children and families throughout the US. One in seven women experience depression during or after pregnancy, with higher rates occurring among specific populations such as those affected by military deployment, immigration, or poverty. In San Diego County, where the annual birth rate is approximately 40,000, universal implementation of this recommendation would potentially impact thousands of women and their families.
The Task Force recommendations are based on the growing body of research that confirms that maternal depression during and after pregnancy routinely goes unidentified and untreated. Furthermore, untreated depression presents a significant potential risk to both the baby and the mother. Maternal depression is associated with pre-term birth, low birth weight, lower academic achievement, and an increased risk of mood and anxiety disorders across the child’s lifetime. On the whole, untreated maternal depression is incredibly costly to families as well as society as a whole.
Universal depression screening for pregnant and postpartum women will result in a greater percentage of women being diagnosed early in the course of the illness and potentially decreasing the otherwise harmful impacts to a child’s social-emotional and cognitive development that maternal depression can have. However, the recommendation will only deliver substantial benefits if an adequate and informed system of care is built to address the problem.
A critical component of the task force’s recommendations is the concurrent necessity of having systems in place to link women to appropriate treatment and care once they have been positively screened and identified. San Diego Postpartum Health Alliance (PHA) is a valuable resource for families and providers in the region. PHA’s Warmline volunteers are available to respond to callers within 24 hours to answer questions related to mood or anxiety symptoms during pregnancy or after birth. Volunteers are trained to screen, assess risk, and support callers in locating appropriate resources, including qualified providers to conduct medication evaluations, support groups, therapy, or home based supports for the infant or new parents. PHA also trains providers in how to screen, assess and treat maternal depression.
Frequently, women report profound confusion and pain from living with the illness for longer than need be, because a health professional inaccurately minimized or misdiagnosed their symptoms. Furthermore, women often report being told that depression in pregnancy or postpartum is no different than depression at any other time in one’s life, so it requires no difference in care. Those who work closely with this issue know that this is not the case. The sorrow and pain of maternal depression is distinctly different from other episodes of depression that can occur across one’s lifespan. This is because it arrives in the context of caring for one of the most, if not the most precious and vulnerable being in that woman’s life. Feeling incapable of providing that care, or feeling numb and disconnected from your infant or young child, or in the worst case, having thoughts of harming your child can be devastating and debilitating. The pain and confusion are only compounded by the conflict and discord that often arises between the parents as a result of the illness and its debilitating symptoms.
Effectively treating maternal depression requires that professionals look through a finely focused lens in order to understand the woman’s experience in the context of her life role. It requires the capacity to speak to her compassionately, without judgement, in order to guide her through to recovery. Under the weight of maternal depression, marriages often fall apart, careers are interrupted and financial stability is threatened. Maternal depression is not the same as depression during any other time of life. Therefore, effective screening, assessment and treatment requires qualified and informed providers to ensure that mothers and fathers (1 in 10 dads experience depression during the mother’s pregnancy or postpartum period) benefit from care. In the eyes of child and family health advocates, the Task Force recommendations are indeed a step forward. Exactly how big of a step will depend entirely on whether San Diego can build a comprehensive system of care to respond.
For more information about Postpartum Health Alliance (PHA), to schedule a training or to become a member, email: email@example.com or visit www.postpartumhealthalliance.org.