Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression — United States, 2018

Abstract

Introduction: Perinatal depression is a complication of pregnancy that can result in adverse maternal and infant outcomes. Screening to identify pregnant and postpartum women with depressive symptoms is recommended to provide diagnosis, treatment, and follow-up care to reduce poor outcomes. Methods: CDC analyzed 2018 data from the Pregnancy Risk Assessment Monitoring System to describe postpartum depressive symptoms (PDS) among women with a recent live birth and to assess whether health care providers asked women about depression during prenatal and postpartum health care visits, by site and maternal and infant characteristics. Results: Among respondents from 31 sites, the prevalence of PDS was 13.2%, ranging from 9.7% in Illinois to 23.5% in Mississippi. The prevalence of PDS exceeded 20% among women who were aged ≤19 years, were American Indian/Alaska Native, smoked during or after pregnancy, experienced intimate partner violence before or during pregnancy, self-reported depression before or during pregnancy, or whose infant had died since birth. The prevalence of women reporting that a health care provider asked about depression during prenatal care visits was 79.1% overall, ranging from 51.3% in Puerto Rico to 90.7% in Alaska. The prevalence of women reporting that a provider asked about depression during postpartum visits was 87.4% overall, ranging from 50.7% in Puerto Rico to 96.2% in Vermont. Conclusions and Implications for Public Health Practice:The prevalence of self-reported PDS varied by site and maternal and infant characteristics. Whether providers asked women about perinatal depression was not consistent across sites. Provision of recommended screenings and appropriate referrals for diagnosis, treatment, and follow-up care can ensure early and effective management of depression to reduce adverse maternal and infant outcomes.

Perinatal Depression: Challenges and Opportunities

“…An analysis of 2018 data from the Pregnancy Risk Assessment Monitoring System found that the prevalence of self-reported PPD symptoms averaged 13.2% and was higher among American Indian/Alaska Native (22.0%), Asian/Pacific Islander (19.2%), and black women (18.2%) than among white women (11.4%). 8 However, PPD symptoms were measured with the Patient Health Questionnaire-2 (PHQ-9) instrument, AND symptoms were not measured, and only 31 states were included. Studies also point to increased PND prevalence among low-income women.…”

Social-ecological considerations for the sleep health of rural mothers

“…Poor sleep health is a hallmark of perinatal anxiety and depression and it is almost universally present among severe mood disorders and/or postpartum psychosis (Bhati and Richards 2015;Lawson et al 2015;Okun et al 2018). PPD is the most common post-childbirth complication, occurring in approximately 10-15% of US childbearing women (Bauman et al 2020;Bhati and Richards 2015;Chang et al 2012;Hasin and Grant 2015;Nidey et al 2020); it is associated with numerous negative physical and psychological health outcomes in mothers and infants (Slomian et al 2019). Although the literature regarding differences between rural and urban prevalence of sleep and anxiety/depression is mixed, the social context of rural life (e.g., geographic isolation, social stigma) translates to a greater impact on the lives of rural women and their families (Chang et al 2012).…”

“…Integrating behavioral health services into rural primary care can also be achieved through increased screening for behavioral health problems (Drake et al 2014) and provider-led discussions of mental health during perinatal appointments (Bauman et al 2020). Additionally, focusing on strengthening social support (Mersky et al 2020) and fostering strong alliances between patients and their health care providers can help improve mental health outcomes for mothers and their families (Batra 2019).…”

Healthcare resource utilization and costs associated with postpartum depression among commercially insured households

“…onset during pregnancy to up to 4 weeks postpartum reported by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5] 4 to any depressive disorder within the first postpartum year reported by the World Health Organization [WHO]) 1,[5][6][7][8] . The prevalence estimates for depression symptoms among women queried between 2 and 9 months postpartum were 9.7%-23.5% (average of 13.2%) based on an analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 31 sites by researchers at the Centers for Disease Control (CDC) 9 . Additionally, among 16 continuously reporting sites, a small but statistically significant increase in depression diagnosis (0.22%) was observed from 2012 to 2018.…”