Good news for adults struggling with depression everywhere, but particularly pregnant and postpartum women fighting the baby blues and beyond: The U.S. Preventive Services Task Force (USPSTF), a government-appointed panel of health experts, has just recommended universal depression screening at the primary care level for all adults, including pregnant and postpartum women.
The recommendation comes after the panel found evidence that the screening is helpful when paired with treatment, and poses little to no risk. The news also comes after new research that shows maternal depression has long been misunderstood.
While medical professionals all the way back to Hippocrates have known that sometimes new mothers get depressed, they’ve often missed how early in the pregnancy it can occur, and to what extent women are plagued by it during and after. The postpartum depression nonprofit and support community has endorsed universal depression screening as a hopeful step forward.
“We actually think it’s very positive, and the reason is one in seven mothers experience depression or anxiety either during pregnancy, or in the postpartum period,” said Sharon Gerdes, vice president of Postpartum Support International, whose website offers resources in every state for women suffering from perinatal or postpartum depression. “Postpartum depression comes in many shades of blue, and we feel screening is a way to identify those women and get them the help they need to be well.”
While women with a history of depression or mental illness are particularly vulnerable, research from 2014 shows that such symptoms can appear without warning in those even without a history, which makes screening a critical tool in identifying mothers who would not otherwise be prone to interpret their own symptoms as depression, or as likely to speak up in a medical setting.
Postpartum depression is most common in the first year after giving birth, and some 20 percent of women who experience it have suicidal thoughts, according to the American Psychological Association. The other symptoms of postpartum depression can be wide-ranging, examples include struggling to nurse, discontinuing nursing, family conflict, and child abuse or neglect. The highly publicized cases of postpartum psychosis, which tend to get more attention for their extreme manifestations, occur in only some .1 percent of postpartum women.
More common is experiencing anxiety, sadness, an inability to connect with your newborn, or a range of intrusive thoughts about harming your baby that make getting through the simplest aspects of early parenting difficult or impossible. In the Timeslook at research from 2014 on maternal illness, they chronicle stories from women who describe some of those disturbing thoughts, which include visions of suffocating an infant, slamming them against a wall, racing thoughts or voices saying a child will be stolen. Others admit to fantasizing about abandoning their child, sometimes stopping just short of harming them during feedings or baths.
It’s important to understand that these women are not likely to follow through on such thoughts, rather, they’re more likely to go to what Wendy N. Davis, the executive director of Postpartum Support International, told the Times are “extreme measures” to prevent themselves from harming their children. One woman “scooched downstairs on her butt for months because she’d imagined throwing her baby downstairs,” said Davis.
Dr. Katherine L. Wisner, a professor of psychiatry and obstetrics at Northwestern University who was part of the largest maternal depression screening research in 2013, told the Times that symptoms of depression are not always easy for health providers to detect, because lack of sleep and feeling moody are also part and parcel of being pregnant. Plus, doctors have long been told that “women don’t get depressed during pregnancy because they are happy.”
Those misconceptions make it incredibly difficult for women to distinguish between the normal baby blues, postpartum depression, or something more serious, given that the hormone crashes and intense feelings are considered a given part of pregnancy and recovery from childbirth. Further, the cultural depiction of the serene, glowing pregnant woman pressures women to outwardly project the same image, no matter how much they’re struggling inside.
Other barriers to women getting help during pregnancy for depression come not from the women but their providers, and are bleak reminders of the sometimes fearful litigious medical climate. “Ob-gyns thought that if they identify something and don’t have resources to support it, it puts them at significant legal risk,” Dr. Samantha Meltzer-Brody, the director of the perinatal psychiatry program at the University of North Carolina at Chapel Hill, told the Times. Furthermore, pediatricians may notice a struggling mother, but feel their patient is the child and not the mother, she added.
While a dozen states currently have recommendations for screenings in place—Texas, Virginia, Illinois, New York among them—only New Jersey legally requires them. But their experience may be a somewhat cautionary tale, as New Jersey reports that without enough treatment options, the screening alone isn’t enough, and still fails the many women who sought treatment on Medicaid.
And that’s the other crucial half of this process. The USPSTF recommends that primary care physicians start with this depression screening questionnaire, but that’s just the beginning.
“This is not a cure all,” Katherine Stone writes at Atlanta nonprofit Postpartum Progress, which pairs women with resources for dealing with postpartum anxiety and depression, and also endorses the universal screening recommendation. “This is not the magic fix to all of our problems. This is a step. And yet, every step we take forward is a good thing. Every barrier we get past may help us as we try to break the barriers that still remain.”
Beyond this, the screening simply helps raise awareness and reduces the stigma still associated with perinatal illness. Gerdes says Postpartum International is part of an international task force currently creating the first ever World Maternal Mental Health Awareness Day. It’s slated for May 4, 2016.
“So we are really pleased not only in the United States, but around the world, that people are realizing that screening and health is important for new mothers,” Gerdes added. “It is part of our universal message to new mothers: You are not alone, you are not to blame, and we can help you be well.”