Perinatal Mental Health Care In The United States: An Overview Of Policies And Programs

Griffen, Adrienne; McIntyre, Lynne; Belsito, Jamie Zahlaway; Burkhard, Joy; Kimmel, Mary; Stuebe, Alison M.; Clark, Crystal T.; Meltzer‐Brody, Samantha

doi:10.1377/hlthaff.2021.00796

Cited by 28 publications

(23 citation statements)

References 31 publications

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“…The comparisons were made with very different population groups, as studies with PMHQ were not identi ed in pregnant women. It is recommended that governmental and non-governmental health entities include mental health evaluation in prenatal care from a PMH perspective and intervene in those who do not ourish [1,2,3,4,5,18]. It is emphasized to professionals who care for pregnant women, including midwives and nurses, that the absence of pathological psychiatric symptoms does not necessarily indicate good mental health [5,7,8,9].…”

Section: Strengths Limitations and Recommendationsmentioning

confidence: 99%

Levels of Interpretation of Positive Maternal Mental Health and Its Association With Obstetric and Psychosocial Factors: a Cross-sectional Study

Monterrosa-Castro

Romero-Martínez

Monterrosa-Blanco

2023

Preprint

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Objective: to estimate the frequency of Positive Maternal Mental Health (PMMH) interpretation levels in pregnant women who attended prenatal consultation and to identify their association with obstetric and psychosocial factors. Methods: a cross-sectional study that included pregnant women who attended prenatal care at 12 or more weeks of gestation. The following scales were applied: Positive Mental Health Questionnaire (PMHQ), Goldberg Anxiety and Depression Scale, and Jong Gierveld Loneliness Scale. Results: 702 pregnant women were evaluated; 634 (90.3%) had flourishing PMMH, and 68 (9.7%) had non-flourishing PMMH. Among the latter, all were at an intermediate level, and none were languishing. Flourishing PMMH was more frequent in adults (91.2%) than in adolescents (75.0%) and those with higher education (93.0%) than in those with basic education (83.9%). The PMHQ factors and global score correlated positively with maternal age and negatively with anxiety, depression, emotional, social, and general loneliness. Associated with a higher frequency of non-flourishing PMMH were: general loneliness OR:6.32[CI95%:3.38-11.82], social loneliness OR:5.98[CI95%:3.42-10.42], adolescence OR:3.47[CI95%:1.61-7.45], emotional loneliness OR:3.12[1.83-5.32], anxiety OR:2.14[CI95%:1.27-3.60], and depression OR:1.88[CI95%:1.09-3.25]. Less frequently: work occupation outside the home OR:0.41[CI95%:0.24-0.68], technical/technological studies OR:0.22[CI95%:0.08-0.60] and university OR:0.27[CI95%:0.10-0.71]. Preconception consultation, desired pregnancy, cesarean section, and fetal or neonatal death were not associated. In the adjusted model: general loneliness OR:3.02[CI95%:1.10-8.31], social loneliness OR:2.82[CI95%:1.38-5.79] and anxiety OR:1.93[CI95%:1.02-3.67], retained statistical significance. Conclusion: nine out of ten pregnant women had flourishing PMMH, and none had languishing PMMH. None of the obstetric factors were associated with non-flourishing PMMH, but they were associated with general loneliness, social loneliness, and anxiety.

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Section: Strengths Limitations and Recommendationsmentioning

confidence: 99%

Levels of Interpretation of Positive Maternal Mental Health and Its Association With Obstetric and Psychosocial Factors: a Cross-sectional Study

Monterrosa-Castro

Romero-Martínez

Monterrosa-Blanco

2023

Preprint

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“…Treating women at risk for perinatal depression may avert the long reach of negative consequences on maternal and child health and well-being [ 9 ••]. Despite calls for screening for perinatal depression from organizations such as ACOG and the United States Preventive Services Task Force (USPSTF), perinatal depression screening is done about 40% of the time compared to a 96% screening rate for gestational diabetes with barriers to screening including time constraints, lack of training, lack of knowledge of diagnostic criteria, and lack of systems of care-promoting screening initiatives [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…A common model used in low-income countries, this model has also gained preliminary support in the USA, with midwives, nurses, and peers delivering evidence-based treatments (i.e., cognitive behavioral therapy (CBT), interpersonal psychotherapy, behavioral activation) in primary care settings being the most common and efficacious [ 48 ]. Preventive treatment strategies are also now validated by research evidence, with programs such as Mothers and Babies; Reach Out, Stay Strong, Essentials for Mothers of Newborns (ROSE); and Practical Resources for Effective Postpartum Parenting (PREPP) demonstrating some effectiveness in preventing perinatal mental health conditions while leveraging community health structures [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…A 2022 review article investigating predictive modeling in this area found such risk factors as anxiety and depression during pregnancy, psychiatric diagnosis, pregnancy complications, stressful life events, and lifetime antidepressant use as areas to consider in identifying high-risk patients [ 66 ]. Advanced technology such as machine learning can be utilized to predict postpartum depression [ 66 ]; despite this, screening even for active symptoms lags behind physical health conditions such as gestation diabetes mellitus [ 6 ]. Infrastructural changes would be needed to utilize technology initiatives to screen for risk factors.…”

Section: Introductionmentioning

confidence: 99%

“…Health care shortages and gaps in research funding for perinatal mental health conditions have created an environment for suboptimal care for peripartum mental health This article is part of the Topical Collection on Reproductive Psychiatry and Women's Health conditions though legislative changes have raised focus to these areas, with 2021 federal funding of a dedicated maternal mental health hotline and with several states expanding Medicaid coverage to a full year postpartum [6].…”

Section: Introductionmentioning

confidence: 99%

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Postpartum Depression—Identifying Risk and Access to Intervention

Gopalan

Spada

Shenai

et al. 2022

Curr Psychiatry Rep

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Purpose of Review As maternal mortality climbs in the USA with mental health conditions driving these preventable deaths, the field of reproductive psychiatry must shift towards identification of women and other birthing individuals at risk and facilitating access. This review brings together recent studies regarding risk of perinatal depression and highlights important comorbidities that place individuals at higher vulnerability to poor perinatal outcomes. Recent Findings Recent research suggests that identifying risk for perinatal depression including historical diagnoses of depression, anxiety, trauma, and comorbid substance use and intimate partner violence may move the field to focus on preventive care in peripartum populations. Emerging data shows stark health inequities in racial and ethnic minority populations historically marginalized by the health system and in other vulnerable groups such as LGBTQ+ individuals and those with severe mental illness. Summary Innovative models of care using systems-level approaches can provide opportunities for identification and risk analyses of vulnerable peripartum patients and facilitate access to therapeutic or preventive interventions. Utilizing intergenerational approaches and leveraging multidisciplinary teams that thoughtfully target high-risk women and other birthing individuals could promote significant changes to population-level care in maternal health.

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Association of Medicaid Expansion With Postpartum Depression Treatment in Arkansas

Steenland

Trivedi

2023

JAMA Health Forum

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ImportancePostpartum depression affects approximately 1 in every 8 postpartum individuals in the US. Antidepressant medication can effectively treat postpartum depression. However, gaps in postpartum insurance coverage after the end of Medicaid pregnancy coverage at 60 days postpartum may limit treatment uptake and decrease continuity of postpartum depression treatment.ObjectiveTo examine the association of Medicaid expansion in Arkansas with postpartum antidepressant prescription fills and antidepressant continuation and supply during the first 6 months postpartum.Design, Setting, and ParticipantsCohort study with a difference-in-differences analysis comparing persons with Medicaid and commercially financed childbirth using Arkansas’ All-Payer Claims Database (2013-2016). Analysis was completed between July 2021 and June 2022.ExposuresMedicaid-paid childbirth after January 1, 2014.Main Outcomes and MeasuresAntidepressant medication prescription fills and the number of days of antidepressant supply in the early (first 60 days after childbirth) and the late (61 days to 6 months after childbirth) postpartum periods.ResultsIn this cohort study with a difference-in-differences analysis of 60 990 childbirths (mean [SD] birthing parent’s age, 27 [5.3] years; 22% Black, 7% Hispanic, 67% White individuals), 72% of births were paid for by Medicaid and 28% were paid for by a commercial payer. Before expansion, 4.2% of people with a Medicaid-paid birth filled an antidepressant prescription in the later postpartum period. Medicaid expansion was associated with a 4.6 percentage point (95% CI, 2.9-6.3) increase in the likelihood, or a relative change of 110%, in this outcome. Before expansion, among people with postpartum depression in the early postpartum period with a Medicaid-paid birth, 32.7% filled an antidepressant prescription in the later postpartum period, and had an average of 23 days of antidepressant prescription supply during the later postpartum period. Among people with early postpartum depression, Medicaid expansion increased the continuity of antidepressant treatment by 20.5 percentage points (95% CI, 14.1-26.9) and the number of days with antidepressant supply in the later postpartum period by 14.1 days (95% CI, 7.2-20.9).Conclusions and RelevanceMedicaid expansion in Arkansas was associated with an increase in postpartum antidepressant prescription fills, and an increase in antidepressant treatment continuity and medication supply in the period after Medicaid pregnancy-related eligibility ended.

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Perinatal Mental Health Care In The United States: An Overview Of Policies And Programs

Cited by 28 publications

References 31 publications

Levels of Interpretation of Positive Maternal Mental Health and Its Association With Obstetric and Psychosocial Factors: a Cross-sectional Study

Levels of Interpretation of Positive Maternal Mental Health and Its Association With Obstetric and Psychosocial Factors: a Cross-sectional Study

Postpartum Depression—Identifying Risk and Access to Intervention

Association of Medicaid Expansion With Postpartum Depression Treatment in Arkansas

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