Would you say that there’s an increase in Perinatal Mood and Anxiety Disorders?  

The rates of perinatal depression have increased but so, too, have the rates of informed clinicians resulting in greater screening of perinatal birthing people. There are multiple factors at play. Firstly, with greater awareness, comes greater comfort with asking for help. I applaud primary care, OB/GYN, and pediatric settings that have implemented universal depression screening. You are role models for the healthcare industry. Another factor in the increased rates of PMADs has been the impact of the Covid 19 pandemic. These past few years, an additional pandemic has spread: a mental health crisis. We have seen a rise in rates of depression, anxiety, and suicidality across the board. Suicide rates have skyrocketed in adolescents and older adults. A sense of hopelessness has been pervasive as well; our fears have contributed to extreme anxiety.  

We know the reproductive years are ones of great mental health vulnerability. So, with the pandemic, came major changes in healthcare. Prenatal care, doula services, and lactation support pivoted. Appointments were either attended by the pregnant person alone, or they shifted completely to online offerings. I witnessed that with these changes, increased rates of anxiety and OCD occurred. A third, “pandemic” (in my estimation) happened these past two years and that is one of social isolation. I believe that the phrase, “It takes a village to raise a child,” has merit. Parenting in America can be lonely, and I see loneliness to be like a “steroid” for depression. My treatment recommendations include for the new parent to seek community. This was either unavailable or completely virtual in the past two years. With all of this, however, we have learned a great deal. While Perinatal Mood and Anxiety Disorders are common and children and families are affected, these disorders are treatable. This knowledge can be galvanizing for providers to join in the effort to screen and refer. As well, running a virtual support group these past two years was illuminating. We are adaptable and can be flexible. While in person would have had its benefits, virtual allowed new parents to make friends regardless of geography! 

Do PMADs seem to be impacting a diverse group of birthing people or is it more predominant in certain populations?  

No one is immune to PMADs. While rates of depression and anxiety in the perinatal period are high across the board, BIPOC (Black, Indigenous, People of Color) struggle at higher rates. The reasons for this are complicated and rooted in historical trauma. Implicit bias and the racism that exists today and has been around for centuries. Modern gynecology is founded on research done on slave women. Stories like those of Henrietta Lacks contribute to distrust of the medical system. Women, and particularly women of color, often share that their symptoms and self-reports are dismissed or disregarded. These experiences can result in tragic outcomes (rates of Black maternal mortality in this country are 3x that of white women) and continue to perpetuate fear and mistrust of the medical system.  

Are partners afflicted at the same rate as the birthing person?  

Partners are also often overlooked. It has taken a long time for us to begin conversations that include fathers and partners. One in ten dads has perinatal depression, but would those numbers be higher if men were regularly screened? We have come a long way, but we have much longer to go. I hope that clinical providers work to rigorously review and assess themselves for implicit biases and implement practices that are inclusive. Materials should include images of parents that are relatable to all parents. There is a lot we can do to make a difference here.  

Are those with PMAD symptoms seeking help? Are they comfortable talking about what they are feeling?  

Stigma plays a big role in mental illness. Ask anyone what messages they got in their home about mental illness and you won’t be surprised to learn that there is a lot of fear, misinformation, and even denial out there. As a result, seeking support can be seen as shameful. We need to increase conversations in all communities, including faith-based communities, so that people feel more comfortable asking for help. I applaud celebrities who come forward with their experiences. Stories can be a way for us to normalize and feel we can relate to others: “If she went through it and got better, maybe I can too.” This connection is so empowering. I especially want to thank Brooke Shields. She was one of the first who was vulnerable about her postpartum depression journey, and so many others have followed suit. I believe “what is shareable is bearable.” In other words, if we can talk about it and find someone who will truly listen and care, we can truly heal.

What do you think could be done to increase PMADs awareness, reduce stigmas around PMADs, and normalize talking about perinatal mental health?  

Calling attention to perinatal mental health and educating the public is really important. Too often, media gets it wrong. When a baby dies at the hands of a parent, the press often decries that it was due to postpartum depression. But that is unlikely. Depression does not cause mothers to kill their babies. This messaging is extremely damaging.  If I am afraid to tell you that I am anxious or depressed because you will think I am going to harm my child, there is a good chance that I won’t tell you anything. We need to get out there and educate the public and providers. Events like May being Maternal Mental Health Awareness Month are great opportunities to spread the word. Talk to your friends about your experiences. Let them know that people who get the right help DO get better, and that it is good for the whole family. (Remember, “If mama ain’t happy…”) 

When is the best time to educate about PMADs? During pregnancy? Postpartum? Both?  

This is a great question, but I will say clearly, there is NO WRONG TIME TO EDUCATE ABOUT PERINATAL MOOD AND ANXIETY DISORDERS! Pre-pregnancy, during fertility treatment, throughout pregnancy, when a loss occurs (miscarriage or pregnancy loss, infant death), at delivery, postpartum, up until a year are all times of vulnerability to experiencing PMADs. In fact, if we educate at every opportunity, we are more likely to reduce stigma and increase early identification and intervention. Why should anyone suffer? Brochures, posters, support group announcements, personal stories, learning about signs and symptoms and education about self-care are all important in decreasing rates of PMADs. Remember, when creating informational materials, be inclusive in language and images. If we can “see ourselves” in the literature, we can imagine ourselves in those circumstances. It also does a lot to increase trust in our medical homes. 

InJoy resources that educate parents about PMADs:   

Understanding Postpartum Health & Baby Care 
Understanding Birth
Understanding Pregnancy 
Understanding Fatherhood  
Parenting BASICS 0-6 months, Self-Care for Moms  

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