Maternal Minds Matter

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September is National Suicide Prevention Month, and September 9-13 is Maternal Suicide Awareness Week, making it an important time to discuss the maternal mental health crisis in the United States.

Perinatal mood and anxiety disorders (PMADs) are the number-one complication of pregnancy, affecting an estimated 15-21 percent of mothers. PMADs can emerge anytime during pregnancy as well as up to a year postpartum. PMADs include not only postpartum depression but also anxiety, OCD, PTSD, bipolar disorder, and psychosis.

Signs and symptoms of PMADs include feeling sad, hopeless, depressed, irritable, anxious, experiencing low or excessive energy or motivation, having trouble concentrating, a loss of interest in things previously enjoyed, feelings of worthlessness or guilt, sleep and eating disturbances, intrusive thoughts, compulsive behaviors, flashbacks, nightmares, delusions, and thoughts of suicide and/or homicide.

Risk factors for PMADs include a prior mental health history, trauma history, reproductive challenges, pregnancy and infant loss, pregnancy and delivery complications, breastfeeding challenges, and other stressors, such as a lack of social support, financial stress, and relationship issues.

According to the Policy Center for Maternal Mental Health, the U.S. received an overall grade of D+ when it comes to addressing maternal mental health. Even more concerning, of all developed nations, the U.S. has the highest maternal mortality rate, with 25 percent of those deaths being mental health-related.

In fact, suicide is now one of the leading causes of maternal mortality. The risk of suicide is four times higher for black women, with black women being more likely to experience a PMAD compared to white women, as well as being less likely to receive help. As many as 75 percent of women, regardless of race or ethnicity, do not receive treatment.

There is much that can be done to address the maternal mental health crisis, including increased awareness and decreased stigmatization, increased screening and identification, the implementation of integrated mental health care, increased community supports, and policy changes in the U.S.

1. Increased awareness and decreased stigmatization

There is an ongoing lack of awareness of PMADs as well as an idealization of motherhood that can lead women who are experiencing mental health issues while pregnant and postpartum to blame themselves rather than reach out for help. For this reason, there needs to be more education on PMADs as a part of OB visits that help mothers understand they are experiencing symptoms rather than simply feeling as though they are failing.

2. Increased screening and identification

Because of the high incidence of PMADs during pregnancy as well as postpartum, women should be routinely screened at their OB appointments, as well as at their baby’s pediatrician’s office through the first year postpartum. This will help identify women who are endorsing symptoms of PMADs and allow for early intervention.

3. Implementation of integrated specialized mental health care

While screening for PMADs at OB and pediatrician visits is important, neither of these specialists is able to address maternal mental health issues. Additionally, there is often poor linkage of care. For this reason, mental health clinicians need to be integrated as a part of a collaborative, multidisciplinary team during pregnancy and through the first year postpartum.

Moreover, mental health clinicians need more specialized training in perinatal mental health as there are very few psychiatrists who are trained in reproductive psychiatry, and therapists do not routinely receive training in perinatal mental health.

4. Peer supports

In addition to improving access to clinical care, women need more community supports: for example, peer support groups that focus not just on the infant, as is typical of “mommy and me” groups, but the transition to motherhood, sometimes called matresence, that, like adolescence, involves not only physiological and hormonal changes but also a massive identity shift that makes it a psychologically vulnerable time. These kinds of community-based peer supports have been found effective in the prevention of PMADs.

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5. Policy changes

Addressing the maternal mental health crisis also necessitates the adoption of policy changes, such as paid family or medical leave, which has been shown to reduce the incidence of PMADs, and access to affordable, quality childcare, which can alleviate parenting stress and protect women against PMADs.

While significant work needs to be done to address the maternal mental health crisis, please know that there are resources currently available.

If you think you may be experiencing a PMAD, Postpartum Support International (PSI) has a helpline available at 1-800-944-4773 (4PPD). PSI also has free online support groups and a directory where you can find providers to work with individually in your area. The National Maternal Mental Health Hotline is available 24/7 at 1-833-852-6262. If you are experiencing thoughts of suicide, the Lifeline is available 24/7 at 988, as is the Crisis Text Line at 741741. In the event of an emergency, please call 911 or go to the nearest ER.

To find a therapist near you, visit the Psychology Today Therapy Directory.