Perinatal Mental Health

Perinatal Mental Health  

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The transition to parenthood is a life changing experience with significant physical and psychological adjustments for the entire family. Many parents experience mood changes and feel overwhelmed during pregnancy and/or after the birth of their child. When these symptoms do not resolve on their own, worsen in severity and begin to affect a person’s quality of life, they may be experiencing a perinatal mental health disorder. While the term “Postpartum Depression” has been used in the past, perinatal mental health conditions are actually a spectrum of experiences that can affect individuals during pregnancy and/or postpartum that include postpartum depression as well as a variety of other conditions. Birthing individuals are not to blame or at fault for experiencing a perinatal mental health condition: it is not brought on by anything a person has or has not done. Perinatal mental health disorders occur in people of every culture, age, income level and ethnicity. Treating perinatal mental health conditions may help prevent long-term and adverse effects for parents, children and families.

The spectrum of perinatal mental health conditions includes:

  • Perinatal depression 

  • Perinatal anxiety and panic disorders

  • Obsessive compulsive disorder (OCD)

  • Post-traumatic stress disorder (PTSD)

  • Perinatal bipolar disorder and postpartum mania

  • Postpartum psychosis

  • Perinatal substance use

  • Parental suicide

  • Complicated grief after perinatal loss

Note: Pregnancy and parenting are not gender or sex exclusive. Throughout this webpage you will see language that leaves room for many different birth experiences and outcomes. Importantly, the language used in the “Perinatal Mental Health Statistics'' section of this page refers to the participant populations as identified by the researchers who conducted the studies. All people who identify with pregnancy and parenting can be affected by mental health conditions during the perinatal period regardless of gender, sex, or sexual orientation.

On this webpage, we provide basic information about  perinatal mental health conditions as well as a compilation of resources from the MHTTC and other reputable sources for the medical and mental health workforce. We also recognize that perinatal mental health conditions are expressed differently across different cultures. Where possible, we have included links and resources to culturally-relevant materials.


Perinatal Mental Health Findings

While exact rates of perinatal mental health conditions are not known, recent studies provide us with some information about their incidence and risk factors:

  • About 70-80% of new parents experience mood swings and feelings of being emotionally and physically overwhelmed after having a baby. These symptoms, sometimes called “baby blues,” usually resolve on their own after 1-2 weeks. On the other hand, perinatal mental health disorders are usually more persistent, of higher intensity, and require treatment.

  • Perinatal mental health symptoms are very common. 

    • Depression is considered the most common complication associated with childbirth. It affects at least 1 in 7 women during pregnancy and postpartum (Wisner et al., 2013).

    • Approximately 13–21% of women are affected by anxiety during pregnancy or the postpartum period (Fairbrother et al., 2015).

  • Although perinatal mental health symptoms are relatively prevalent, these conditions can be stigmatized, making it difficult for individuals to ask for help. Unfortunately, up to 50% of mothers will never seek treatment (CDC, 2008).

    • Stigma may hinder a person’s recognition of the presence of perinatal mental health distress and help-seeking behavior (O’Mahen & Flynn, 2008).

    • Women report that they feel ashamed that their perinatal mental health concerns and symptoms may be seen as signs of personal failure; they fear their social network will disapprove (Fonseca, Moura-Ramos, & Canavarro, 2018).

    • Stigma was the most important barrier to women’s help-seeking process (Silva (2015) as cited in Fonseca, Moura-Ramos, & Canavarro, 2018).

  • Pre-existing mental health conditions are a risk factor. At least 60% of women with perinatal depression have experienced a mental health condition in the past (Wisner et al., 2013).

  • While perinatal mental health conditions can affect individuals of all backgrounds, individuals of low socioeconomic status and of racial-ethnic minority may have a higher likelihood of developing one of these conditions. 

    • Individuals of Latinx heritage exhibit a higher prevalence of perinatal mental health disorder(s) and are less likely to be identified or receive adequate and culturally competent mental health care (Lara-Cinisomo, Clark, & Wood, 2018).   

    • Another study found that less than half as many low-SES African American women received counseling or medication in the six months after giving birth compared to white women of low SES. The African American women also had lower rates of follow-up and continued care (Kozhimannil, 2011).

    • A larger proportion of women of Native American and Alaska native or indigenous identity experience mental health symptoms during the perinatal period relative to the general population. More research is needed to better understand the nature and extent of perinatal distress within this group (Bowen et al., 2014). 

  • More than 10% of fathers experience depression and anxiety during the perinatal period (O’Brien et al., 2017).

  • Social support can buffer against the onset and severity of perinatal mental health conditions. Notably, these results do not differ by race/ethnicity, suggesting that social support is an important protective factor for individuals affected by depression during the perinatal period regardless of identity (Pao et al., 2019).

 

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MHTTC Products and Resources

Black Women and Postpartum Depression Fact Sheet | Central East MHTTC

Perinatal Depression | Mountain Plains MHTTC

Perinatal Mood and Anxiety Disorders: Supporting Latinx | National Hispanic and Latino MHTTC


Other Resources

Provider Resources

 
Clinical Guidelines- nationalperinatal.org  
Collaboration in Practice Implementing Team-Based Care  
COVID-19 | National Perinatal Association  
COVID-19 | Maternal Mental Health Leadership Alliance  
COVID-19 Perinatal Mental Health Resources | The International Marce Society for Perinatal Mental Health  
Depression in Mothers: More Than the Blues | SAMHSA Publications and Digital Products  
https://store.samhsa.gov/sites/default/files/d7/priv/pep12-recdef.pdf  
Information for MMH Advocates & Professionals  
MCPAP for Moms Toolkit  
Maternal Mental Health Leadership Allliance's Fact Sheets  
Mom's Mental Health Matters: Moms-to-be and Moms - NCMHEP  
Moms' Mental Health Matters: Action Plan for Depression and Anxiety Around Pregnancy (Tearpad)  
Moms' Mental Health Matters: Happiest Time (Poster)  
Moms' Mental Health Matters: Prepared for Anything (Poster) | NICHD  
Moms' Mental Health Matters: Talk About Depression and Anxiety Around Pregnancy (Postcard)  
Perinatal Mental Health Alliance for People of Color  
Perinatal Mood and Anxiety Disorders  
Perinatal Psychiatric Consult Line  
Psychologists in the NICU  
Resources for Providers — 2020 Mom  
Screening Protocol for Perinatal Mood and Anxiety Disorders for Primary Care Providers  
   

Trainings/Webinars

 
Certificate Training — 2020 Mom  
Certificate Trainings  
Educational Presentations - The International Marce Society for Perinatal Mental Health  
Free Intro to MMH — 2020 Mom  
Frontline Provider Trainings  
Maternal Mental Health 101- Free Online Webinar  
Online Staff Education  
Past Webinars — 2020 Mom  
PSI Webinar Series  
Webinars  
Webinars — 2020 Mom  
   

Resources for Individuals with Lived Experience

 
Awareness Materials- 2020 Mom  
Depression During and After Pregnancy (English)  
Mom's Mental Health Matters: Moms-to-be and Moms - NCMHEP  
   

Resources for Individuals Affected by Perinatal Loss

 
Babyloss - a home on the web  
Dealing with grief after the death of your baby  
Empty Arms Bereavement Support  
Nationalshare.org  
   

Resources for Individuals Affected by Infertility

 
Fertility and Mental Health - MGH - CWMH  
RESOLVE: The National Infertility Association: Homepage  
   

Resources for Addressing Perinatal Mental Health among Racial and Ethnic Minority Groups

 
Birthing Project USA: Underground Railroad for New Life  
Depression in Mothers: More Than the Blues--A Tool Kit for Family Service Providers (Spanish Version) | SAMHSA Publications and Digital Products  
Home | ourbwbj  
La salud mental de las mamás es muy importante: Habla sobre la depresión y la ansiedad durante el embarazo y despues del parto (tarjeta postal) | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development  
La salud mental de las mamás es muy importante: Momento más feliz (póster) | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development  
La salud mental de las mamás es muy importante: Plan de acción para combatir la depresión y la ansiedad relationadas con el embarazo | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development  
La salud mental de las mamás es muy importante: Usted está preparada para CASI cualquier cosa (póster) | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development  
Como Se Siente Ahora?  
National Association to Advance Black Birth: The NAABB  

 

Postpartum Support International Helpline: Call 1-800-944-4773 (#1 en Español or #2 in English)

 

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References

Bowen, A., Duncan, V., Peacock, S., Bowen, R., Schwartz, L., Campbell, D., &        Muhajarine, N. (2014). Mood and anxiety problems in perinatal indigenous women in Australia, New Zealand, Canada, and the United States: A critical review of the literature. Transcultural Psychiatry, 51(1), 93-111. doi:10.1177/1363461513501712

Centers for Disease Control (CDC). (2008). Prevalence of self-reported postpartum         depressive symptoms—17 states, 2004–2005. Morbidity and Mortality Weekly Report, 57(14), 361–366.

Fairbrother, N., Young, A. H., Janssen, P., Antony, M. M., & Tucker, E. (2015). Depression and anxiety during the perinatal period. BMC psychiatry, 15, 206. doi:10.1186/s12888-015-0526-6

Fonseca, A., Moura-Ramos, M., & Canavarro, M. (2018). Attachment and mental health-seeking in the perinatal period: The role of stigma. Community Mental Health Journal, 54(1), 92-101. doi:10.1007/s10597-017-0138-3.

Kozhimannil, K. B., Trinacty, C. M., Busch, A. B., Huskamp, H. A., & Adams, A. S. (2011). Racial and ethnic disparities in postpartum depression care among low-income women. Psychiatric Services, 62(6), 619-625. doi:10.1176/appi.ps.62.6.619

Lara-Cinisomo, S., Clark, C. T., & Wood, J. (2018). Increasing diagnosis and treatment of perinatal depression in Latinas and African American women: Addressing stigma is not enough. Women’s Health Issues, 28(3), 201-204. doi:10.1016/j.whi.2018.01.003

Miller, L. & LaRusso, E. (2011). Preventing postpartum depression. Psychiatric Clinics of North America, 34, 53-65. doi:10.1016/j.psc.2010.11.010

O'Brien, A. P., McNeil, K. A., Fletcher, R., Conrad, A., Wilson, A. J., Jones, D., & Chan, S. W. (2017). New Fathers' Perinatal Depression and Anxiety-Treatment Options: An Integrative Review. American Journal of Men's Health, 11(4), 863–876. doi:10.1177/1557988316669047

O’Mahen, H., & Flynn, H. (2008). Preferences and perceived barriers to treatment for depression during the perinatal period. Journal of Women’s Health, 17(8), 1301-1309. doi:10.1089/jwh.2007.0631

Pao, C., Giuntivano, J., Santos, H., & Meltzer-Brody, S. (2019). Postpartum depression and social support in a racially and ethnically diverse population of women. Archives of Women’s Mental Health, 22, 105-114. doi:10.1007/s00737-018-0882-6

Wisner, K. L., Sit, D. K. Y., McShea, M. C., Rizzo, D. M., Zoretich, R. A., Hughes, C. L., …, & Hanusa, B. H. (2013). Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings. JAMA Psychiatry, 70(5), 490–498. doi:10.1001/jamapsychiatry.2013.87

 


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