Ensure perinatal and postpartum mental health screenings
Recommendation
The Substance Abuse and Mental Health Services Administration (SAMHSA) and the United States Preventive Services Task Force (USPSTF) should issue recommendations on screening for suicide risk in depression screeners for perinatal and postpartum periods. The Health Resources and Services Administration (HRSA) should update its Women’s Preventive Service Guidelines to incorporate maternal mental health screening and intervention.
Background/summary
Pregnant and postpartum women have alarming rates of depression and anxiety. Over 15 percent experience anxiety or depression in the perinatal period, and 20 percent do during the postpartum period.[1] In the United States, the estimated prevalence of major depressive disorder in the postpartum period ranges from 9 percent among pregnant women to 37 percent at any point in the first year postpartum.[2] Perinatal mental health disorders are the most common comorbidity of pregnancy, and suicide is the leading cause of death among pregnant and postpartum women.[3] Yet, mental health disorders are the most underdiagnosed obstetric complication.[4]
The American College of Obstetricians and Gynecologists recommends postpartum follow-up care, including screening for depression and anxiety, for all postpartum women.[5] However, no major federal agency has done the same.
HRSA established the Women’s Preventive Services Guidelines in 2011 based on recommendations from a study by the Institute of Medicine that was commissioned by the Department of Health and Human Services. In 2016 and again in 2021, HRSA awarded the American College of Obstetricians and Gynecologists a cooperative agreement, the Women’s Preventive Services Initiative (WPSI), to convene clinicians, academic researchers, and consumer health professional organizations to develop recommendations for updated guidelines. Currently, the WPSI recommends screening for anxiety in adolescent and adult women, including pregnant and postpartum women but does not detail optimal screening intervals, and it does not recommend mental health screening for depression.[6] Additionally, the USPSTF recommends clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions but does not recommend screening for all pregnant and postpartum people.[7] Under the Affordable Care Act, USPSTF recommendations that receive an “A” or “B” must be covered without patient cost-sharing, which increases access to these services.
These guidelines should be updated to incorporate maternal health screeners for depression and suicidality in the perinatal and postpartum period.
citations
1. Waqas, Ahmed, Ahmreen Koukab, Hafsa Meraj, Tarun Dua, Neerja Chowdhary, Batool Fatima, and Atif Rahman. 2022. “Screening Programs for Common Maternal Mental Health Disorders among Perinatal Women: Report of the Systematic Review of Evidence.” BMC Psychiatry. 22 (1). Last Accessed January 24, 2022.
2. Norhayati, M.N., N.H. Nik Hazlina, A.R. Asrenee, and W.M.A. Wan Emilin. 2015. “Magnitude and Risk Factors for Postpartum Symptoms: A Literature Review.” Journal of Affective Disorders. 175 (April): 34–52. Last Accessed April 1, 2015
3. Jones, Ian, Prabha S Chandra, Paola Dazzan, and Louise M Howard. 2014. “Bipolar Disorder, Affective Psychosis, and Schizophrenia in Pregnancy and the Post-Partum Period.” The Lancet. 384 (9956): 1789–99. Last Accessed November 15, 2014.
4. Earls, Marian F. 2010. “Incorporating Recognition and Management of Perinatal and Postpartum Depression into Pediatric Practice.” American Academy of Pediatrics. 126 (5): 1032–39. Last Accessed November 1, 2010.
5. The American College of Obstetricians and Gynecologists Committee. 2015. “Committee Opinion No. 630.” Obstetrics & Gynecology. 125 (5): 1268–71. Last Accessed May 2015.
6. U.S. Department of Health and Human Services, Health Resources & Services Administration. Women’s Preventive Services Guidelines. Last Accessed December 2022.
7. U.S. Preventive Services Task Force. Recommendation: Perinatal Depression: Preventive Interventions | United States Preventive Services Taskforce. Last Updated May 25, 2023.