Diagnosis and treatment of perinatal mental health problems surges

Mental health problems during pregnancy or the first year of parenting are much more likely to be detected and treated today than just 10 years ago, three new studies suggest. ing.

However, the increase in diagnosis and care has not occurred evenly across different groups or states, and some pregnant or postpartum people are unable to receive treatment-friendly treatments that can put themselves and their newborns at risk. You are more likely to suffer from symptoms.

In general, studies show that diagnoses of anxiety, depression, and post-traumatic stress disorder increased during pregnancy and in the first year after giving birth among Americans with private insurance from 2008 to 2020. It has been shown that Treatment with both psychotherapy and pharmacotherapy has also increased during this period. population.

The findings were published in three papers in the April issue of the journal. health problemsfrom a team at the University of Michigan that studies perinatal mental health.

Their analysis grouped multiple conditions diagnosed during this period under the label PMAD, which stands for perinatal mood and anxiety disorders. PMADs generally include depression and anxiety disorders that occur during pregnancy and the postpartum period.

Key findings for privately insured persons aged 15 to 44 from 2008 to 2020:

• Perinatal PTSD diagnosis rates increased fourfold, reaching nearly 2% of all prenatal or postnatal cases in 2020. Most of the increase was in those diagnosed with PMAD. PTSD is thought to be an anxiety disorder that occurs as a response to trauma.
• The rate of PMAD diagnoses has nearly doubled, marking the largest increase since 2015. By 2020, 28% of pregnant or postpartum people were diagnosed with PMAD.
• Overall rates of suicidal thoughts or actions more than doubled among pregnant women and those who recently gave birth, according to information reported to insurance companies. However, the rate decreased among all people diagnosed with PMAD.
• The rate of pregnant or postpartum patients receiving psychotherapy (any form of talk therapy paid for by private insurance) has more than doubled. The proportion of people diagnosed with a PMAD condition receiving psychotherapy increased by 16% over the study period, with a clear increase from 2014 onwards.
• Antidepressant prescription rates during pregnancy and the postpartum period increased overall, but rates rose fastest among patients diagnosed with a PMAD during pregnancy. Antidepressant prescription rates rose particularly sharply after the release of multiple guidelines for clinicians treating PMADs in 2015 and 2016. By 2020, just under half of people diagnosed with PMAD were prescribed antidepressants.

Taken together, these studies point to major movements in maternal mental health. The situation is different, at least when it comes to the ability of our health systems to understand conditions and help people get treatment. ”

Dr. Stephanie Hall, Postdoctoral Fellow, Department of Psychiatry, UM School of Medicine

Hall is lead author of a new paper on PTSD diagnosis and perinatal antidepressant prescription, and co-author of a paper on PMAD diagnosis.

“If anything, the rates we are recording for diagnosis and treatment are a lower bound rather than an upper bound based on what other studies have suggested about who is experiencing these symptoms.” said Dr. Kara Zibin, a professor at the university. He is a graduate of the School of Medicine and the School of Public Health, and has also held positions at the VA Ann Arbor Healthcare System and Mathematica. “It’s important that people who are struggling get help, because not having access to care has consequences.”

Jibin has spoken and written publicly about her own experience with a mental health crisis during her pregnancy. health issues.

Impact of policy and guideline changes

Researchers believe that many of the changes in diagnosis and care are due to expanded insurance coverage through the Mental Health Parity Act and the Affordable Care Act, and updated guidelines for clinicians that have led to increased use of screening, psychotherapy, and medication. The researchers say this suggests that this happened after the stress was raised.

Relevant guidelines include those published by the American College of Obstetricians and Gynecologists and the U.S. Preventive Services Task Force.

But they also point out that increased public awareness and acceptance of mental health conditions and care likely contributed to the trends seen in the new findings.

Another factor that could explain changes in diagnosis and treatment is the rise of collaborative care models, where psychiatrists can provide expert consultation and resources to primary care teams caring for people of all ages with mental health conditions. be.

For example, since 2013, clinicians treating pregnant and recently given births anywhere in Michigan have been able to use the MC3 program, which is funded by the state of Michigan and run by Michigan Medicine, UM's academic medical center. You can receive support from

Because the study used data from private insurance companies, it did not include low-income people covered by Medicaid, which covers about 40% of U.S. births each year.

The data source also excludes people with other forms of government-funded insurance, those who are uninsured, and those who have had private insurance for less than two years.

As such, the findings of this study primarily apply to individuals who have insurance through their employer (their own or someone else's insurance that can cover their employer), including after federal and state market launch under the ACA. This applies to those who have purchased private insurance. . The first Marketplace plans offered coverage starting in 2014.

The study included data from the first nine months of the pandemic, and the researchers hope to include more recent data in future studies.

Disparities in diagnosis and care

All studies show differences between groups of individuals in diagnosis and treatment rates.

For example, white people with PMADs were much more likely to receive an antidepressant prescription during pregnancy than people of black, Hispanic, or Asian descent. Additionally, he is more likely to be diagnosed with PTSD throughout the perinatal period, even though other studies have shown that the actual incidence of PTSD during the perinatal period is higher for people of color. was high.

Meanwhile, Blacks as a group had the largest increase in PMAD diagnoses over the study period.

Among all age groups, the youngest group (15–24 years) had the greatest increase in both PMAD diagnoses and antidepressant prescriptions over the study period. People between the ages of 15 and 26 were more likely to be diagnosed with PTSD than people in older age groups.

PMAD diagnosis studies also show wide variation across states in the proportion of people diagnosed with PMADs after the Affordable Care Act compared to before.

The research team plans to continue its state-level analysis with new funding to accelerate the study of data from the Perinatal Individual Mental Health Survey. Their new research examines changes in abortion-related policies over time in states that have enacted reproductive health policies in recent years, including changes in abortion-related policies since Dobbs v. Jackson, the Supreme Court case that overturned Roe v. Wade. We plan to investigate the changes. June 2022 Women's Health Organization Case.

Researchers also plan to study the potential impact of other policy and clinical guideline changes.

They say the impact of telehealth-based perinatal mental health care in 2020 and beyond, especially for people living in areas with a shortage of mental health providers, is another important area to study. To tell.

“Perinatal mental health has far-reaching effects on babies and families,” says Zibin. “The changes we document in these studies will have ripple effects for years to come.”

In addition to Hall and Zibin, the paper's authors include members of the UM Perinatal Mental Health Services and Policy Program and UM faculty members Lindsey Admon, MD, MS, Sarah Bell MPH, and Anna Courant , MSN, Vanessa. K. Dalton, MD, MPH, Andrea Pangoli, MS, Amy Schroeder, MS, Anka Tilea MPH, Xiaosong Zhang, Ashley Vance, PhD, Henry Ford Health System, Karen M. Tabb, University of Illinois at Urbana-Champaign PhD, MSW.

Zivin, Admon, and Dalton are members of the UM Institute for Health Policy Innovation.

This study was funded by the National Institute of Mental Health (MH120124), part of the National Institutes of Health, and the National Institute on Minority Health and Health Disparities (MD014958).