The US faces a deadly maternal mental health crisis

(The Hill) – Pregnant women and new mothers are facing a deadly mental health crisis across the United States.

Mental health conditions, the leading underlying cause of pregnancy-related deaths in the country, are driving an alarming increase in maternal mortality rates, which increased by approximately 60 percent between 2019 and 2021, according to the Centers for Disease Control and Prevention (CDC ).

Suicides and overdoses account for nearly a quarter of those deaths, according to the CDC.

Rates of substance use, depression, anxiety and other serious mental health conditions – such as suicidal ideation and postpartum psychosis – appear to be rising among pregnant women and new mothers.

“I’m very concerned,” said Ludmila De Faria, chairwoman of the American Psychological Association’s committee on women’s mental health.

The CDC recently released data showing that maternal deaths decreased in 2022 and reported that 817 women died of maternal causes that year. While the drop in deaths is a step in the right direction, doctors warn that more data is needed to see if maternal mortality is really falling.

The agency has not released detailed data on the causes of these deaths, so it remains unclear how many maternal deaths in 2022 resulted from mental health conditions.

It is difficult to measure how much maternal mental health is deteriorating in the US given the limited data available.

While suicide rates appear to be rising among pregnant and postpartum women, for example, Christine Yu Moutier, chief medical officer at the American Foundation for Suicide Prevention, warns that this may be due in part to better collection of data on maternal mortality rather than a true increase. .

She specifically points to the Maternal Deaths Prevention Act, which Congress passed in 2018, as a reason for the improved data.

But even considering the still limited data on the subject, some research suggests that maternal mental health is deteriorating.

A 2020 study found that suicide, meaning either suicidal thoughts or suicide attempts, increased in the decade before the start of the COVID-19 pandemic.

Researchers at the University of Michigan, examining suicide rates among pregnant women with private health insurance between 2006 and 2017, found that the number of women who thought about suicide or self-harm tripled during those years.

Health experts also believe that rates of mental health conditions such as anxiety and depression have increased among pregnant women because they have become more prevalent in the population as a whole, according to De Faria.

As of 2020, global rates of depression and anxiety have increased by 25 percent, according to the World Health Organization.

In the US, depression rates hit an all-time high last year, according to a Gallup poll; 29 percent of American adults admitted to the survey that they had been diagnosed with the disease at some point in their lives — up 10 percentage points from 2015.

The same survey found that far more women than men have experienced depression: About 36 percent of women reported being diagnosed with depression at some point in their lives, compared to about 20 percent of men.

And that disparity is growing as women see a particularly sharp rise in depression. Rates have risen almost twice as much for women as for men since 2017, the survey shows.

The suicide rate among young women in the US is also on the rise. Deaths by suicide increased 4 percent from 2021 to 2022 among women ages 25 to 34, according to the most recent CDC data.

Some experts, like Moutier, worry that maternal mental health may have worsened due to decreased access to mental health care.

The U.S. is experiencing a shortage of mental health providers, with about 47 percent of Americans, or 158 million people, living in a mental health workforce shortage area as of this year, according to the health policy research group KFF.

Additionally, many physicians who treat pregnant or postpartum women, such as primary care physicians or obstetrician-gynecologists, do not screen for mental health despite professional organizations recommending that they do so.

Angelina Spicer told The Hill that when she visited her gynecologist for a six-week postpartum checkup after her daughter was born eight years ago, the doctor simply made sure “she was clear to have sex again” and not never asked him how he was treating her. life with the new baby.

Spicer, a stand-up comedian, experienced severe anxiety and depression after the birth of her daughter.

But she said the conversation with her doctor during the checkup focused on Spicer’s weight. The doctor commented how she “looked amazing” and “just like she did before the baby,” Spicer recalled.

“I was like, why are we talking about how I look? And why doesn’t anyone ask me why I feel like I’m drowning?” she said.

Fewer than 20 percent of pregnant and postpartum women on Medicaid receive a mental health screening, according to the Maternal Mental Health Policy Center.

Screening rates are even lower for women with private insurance, the organization found. Only 9 percent of pregnant women and 11 percent of postpartum women with private insurance undergo a mental health screening.

Partly due to a lack of screening, while about 1 in 8 women will experience postpartum depression in the year after giving birth, roughly half of those cases will go undiagnosed, a 2019 study found.

Even when cases of depression are detected, many women do not seek care. A study published in 2015 found that only 22 percent of perinatal women who tested positive for depression received treatment.

“The impact this has on women who don’t get treatment and the impact on families is huge,” said Elizabeth Cherot, president and chief executive officer of the March of Dimes.

“Think about how if left untreated like [poor maternal mental health] it affects parents, babies, families and our entire society.”

Mood disorders during or immediately after pregnancy can damage the mother’s relationship with her child and her partner.

“Emotional distress can hinder a mother’s ability to form a strong, nurturing bond with her baby, impairing her ability to provide the responsive care essential to the baby’s healthy development,” according to a 2023 study .

“Tense emotional states can reverberate in the mother’s partnership causing communication breakdowns and emotional distance.”

Beyond the scope of treatment, or lack thereof, health experts also worry the changing landscape of reproductive laws after the Supreme Court’s 2022 decision overturning Roe v. Wade could have a negative impact on maternal mental health.

After this decision, “what you have is potentially a significant increase in the number of unplanned pregnancies,” De Faria told The Hill.

In the year after the Women’s Health Organization’s Dobbs v. Jackson decision, states with abortion bans had an average fertility rate 2.3 percent higher than states without them, according to a 2023 analysis.

This increased birth rate led to approximately 32,000 more births than expected, according to the analysis. It is not clear how many of those pregnancies were planned.

Having an unplanned pregnancy can be “a huge stress” for someone with or without an existing psychiatric illness, De Faria said.

Numerous studies show a link between unplanned pregnancies and higher rates of perinatal depression.

One conducted in Brazil in 2017 found that women with unplanned pregnancies were 2.5 times more likely to suffer from depression during pregnancy and in the months after birth, compared to women with planned pregnancies.

Although experts have concerns about the future of maternal mental health, they also agree that there may be some light in the darkness.

“What gives me hope is the attention it’s getting,” Caitlin Murphy, a research scientist at the Milken Institute’s School of Public Health, said of the nation’s poor maternal mental health and screening rates.

“Once the information gets out, people start doing something about it.”