DEPRESSION TREATMENT IMPROVEMENTS FOR MOTHER AND INFANT

Anna Henning

Many agree that the birth of a baby is a joyous occasion full of celebration and adoration–except sometimes it’s not. Postpartum depression (PPD) has the potential to affect a mother for up to a year after the birth of her child, and access to appropriate maternal mental health care is vital for the ongoing health of the mother and her infant (Hansotte et al. 2). Mothers suffering with PPD have a more difficult time caring for themselves, and in turn caring for their infant; infants of mothers suffering with PPD are “at increased risk for long-term health and developmental problems… and behavioral issues” (Hansotte et al. 2). Mothers suffering with PPD are at an increased risk for suicide as well (Hansotte et al. 2). Unfortunately many suffering mothers don’t receive necessary treatment for their PPD, contributing to the health problems of mother and infant. There is a necessity for the reformation of the current maternal mental healthcare system, as the treatment of postpartum depression is a public healthcare concern, wherein treatment for PPD would be improved with mandatory screening, in-home treatment, and advances in quality of care offered for mothers looking to obtain services.

Mandatory postpartum depression (PPD) screenings would aid in improving the health of mothers and their infants by evaluating mothers for possible illness.

With an introduction of mandatory PPD screening, the social stigma often associated with PPD screening and diagnosis could be eliminated. According to the article “Postpartum Depression: The Worst Kept Secret” from Harvard.edu, “Screening is very important because studies have shown that many women with postpartum depression are ashamed of their symptoms and are afraid of the social stigma associated with the diagnosis” (Chisolm). Because many mothers avoid requesting a PPD screening due to fear of associated social repercussions and stigma, mandatory screenings would eliminate this fear and offer help to those who potentially need it, leading to more women being accurately screened and therefore treated for PPD.

Mandatory PPD screening would also assist populations of mothers less inclined to seek professional help for their illness. An article titled “How Much Does Low Socioeconomic Status Increase the Risk of Prenatal and Postpartum Depressive Symptoms in FirstTime Mothers?” from Women’s Health Issues states that “women with lower incomes are less likely to have adequate access to mental health services and are least likely to report symptoms of depression to healthcare professionals,” further discussing a study finding that women of lower socioeconomic status with “low education, low income, being unmarried, and being unemployed” were at an increased risk of developing PPD and “were 11 times more likely than women with no socioeconomic risk factors to” develop PPD (Goyal et al. 97). Mothers of lower socioeconomic status (SES) seem to be less likely to request help and most likely to need it, but if PPD screening is made mandatory, mothers of lower SES won’t have to ask for help; it will be offered to them during their prenatal and postnatal physicians visits. If PPD screening was made mandatory, it would lead to early detection of illness, helping mothers to obtain treatment they may not have known they needed. The same Havard. edu article discussed as earlier explains “The key to the prevention and successful treatment of postpartum depression is early intervention. Women may not realize they are depressed after having a baby, or may realize they are struggling but feel too embarrassed to seek help. This is why it is very important to screen all new mothers” (Chisolm). Mandatory screening for all mothers during their prenatal and postnatal period would assist them in obtaining treatment they may not otherwise have recognized that they need, eventually allowing a mother to heal from an illness she didn’t realize she was suffering with. Mandatory screenings for PPD would benefit mothers and their infants, providing mothers with insight into their emotional state so that they may appropriately treat their illness if necessary.

In-home PPD treatment for mothers benefits the health of the mother and her child, and should be more widely offered. Treating PPD with in-home treatment is beneficial because it removes associated social stigma. An article from Public Health Reviews titled “Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review” states that “A woman may … feel freer to talk about her feelings in her home without the fear of being stigmatized,” and “Mothers in many studies … did not seek PPD care because of the stigma attached to it. Some reported not wanting to be seen as ‘crazy’ or to have a ‘real’ mental illness” (Hansotte, et al).

Often mothers avoid seeking PPD treatment out of fear of social stigma and retaliation, but with in-home treatment mothers can express the symptoms they’re experiencing more honestly and vulnerably without fear, allowing mothers to receive appropriate and accurate treatment. In-home PPD treatment furthermore provides much needed social support within the home. One journal article from the International Journal of Preventive Medicine called “Effect of Health Care as the “Home Visiting” on Postpartum Depression: A Controlled Clinical Trial” explains “many studies showed that the lack of social support is one of the most important risk factors for postpartum depression, … and health-care services by home visiting after delivery are an appropriate way for improving social support” (Milani, et al.). In-home treatment brings social support into the picture, erasing a common stressor mothers experience, and improving the overall PPD experience and health of mother and infant. Additionally, bringing PPD treatment into the home can alleviate many financial barriers a mother may experience when seeking treatment, making treatment more accessible. According to the article “Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review” in Public Health Reviews, “financial barriers were a main reason that women did not seek treatment for PPD. Financial barriers were broader than not merely being able to pay for treatment; women with children could not afford to pay someone to watch the child(ren) during treatment, could not afford transportation to go for treatment, or had insurance issues that impeded getting treatment.” (Hansotte et al.)

In-home PPD treatment erases certain financial stressors that warrants treatment otherwise inaccessible, allowing mothers to obtain the help they need. In-home treatment eliminates concerns associated with a mother’s opposition to receiving treatment, allowing mothers to receive treatment for their PPD, benefiting the health of the mother and her child.

Advances in quality of care offered to mothers for PPD treatment would benefit the health of mothers and their infants. Many mothers avoid seeking PPD treatment because their medical insurance coverage doesn’t accommodate their needs. An NPR article titled “Lawmakers Weigh Pros And Cons Of Mandatory Screening For Postpartum Depression” Dr. Laura Sirott comments that “her patients give a range of reasons why they don’t take her up on a referral [for PPD treatment] to a psychologist: “‘Oh, they don’t take my insurance.’ Or ‘my insurance pays for three visits.’ … ‘It’s a three-month wait to get into that person’” (Dembosky). Medical insurance coverage requires change within itself, as mothers suffering with PPD often avoid treatment because their insurance isn’t covering their needs in a cost-effective manner; with a change in medical insurance coverage, mothers’ access to treatment can be more available, assisting mothers’ and infants’ health. When a mother suffering with PPD is seeking treatment, doctors often don’t understand the intricacies of prescribing antidepressants to pregnant and breastfeeding mothers. Dr. Sirott from the aforementioned NPR article comments on this issue as well “it’s also hard to find a psychiatrist who is trained in the complexities of prescribing medications to pregnant or breastfeeding women, and who is willing to treat them” (Dembosky). Because many doctors don’t understand how to treat mothers with medication, emphasis and attention needs to be placed upon proper and accurate treatment of mothers by means of prescription therapy within the medical field, so that proper treatment for PPD may be made accessible to benefit the health of mothers and their infants. Only one PPD-specific antidepressant is available for mothers’ treatment, and it’s not very attainable, requiring thousands of dollars to use. In another article by NPR titled “Women

Say California Insurer Makes It Too Hard To Get Drug For Postpartum Depression”

this drug is explained: “It’s the first and only drug approved by the FDA specifically to treat postpartum depression … brexanolone replenishes a hormone metabolite that gets depleted after childbirth — allopregnanolone … Brexanolone is a synthetic version of allopregnanolone, delivered through an IV infusion over the course of 60 hours. It costs

$34,000,” as well as requires a three-day overnight hospital stay and demands that mothers must be under 6 months postpartum to be able to undergo brexanolone treatment (Demobosky). With these stipulations, a potentially life saving drug is made inaccessible to mothers who can’t afford the IV 60 hour treatment and 3-day overnight hospital stay, can’t afford to be away from their children for three days, and can’t afford to identify and express their symptoms to a healthcare professional in a timely manner; if brexanolone was made more readily available and affordable, the health of suffering mothers and their infants could improve. It is vital that advancements are made in the quality of care offered to mothers requiring PPD treatment, as improvement would vastly enhance the health of mothers and their infants.

Doctor Laura Sirott contends that mandatory screening for postpartum depression might not be as beneficial to the health of the mother and her child as previously mentioned. In an earlier discussed NPR article titled “Lawmakers Weigh Pros And Cons Of Mandatory Screening For Postpartum Depression,” the article explains “Many obstetricians and pediatricians say they are afraid to screen new moms for depression and anxiety,” with Dr. Sirott commenting “What are you going to do with those people who screen positive? … Some providers have nowhere to send them” (Dembosky). While physicians’ fears are valid and can be taken into consideration, physicians’ reluctance to screen eliminates a resource many suffering mothers may need and not otherwise have access to. Another physician by the name of Dr. Nirmaljit Dhami is interviewed in the same article, with the article stating “Supporters of California’s proposed bill, however, say doctors need to start somewhere,” before explaining Dr. Dhami believes “Screening is the first step in recognizing the full scope of the problem … Women should be screened on an ongoing basis throughout pregnancy and for a year after birth … not just once or twice as the bill requires … I often tell doctors that if you don’t know that somebody is suicidal it doesn’t mean that their suicidality will go away … If you don’t ask, the risk is the same”

(Dembrosky). As discussed, often mothers may not realize they need help or may not feel safe asking for it, and if PPD screening isn’t conducted, many struggling mothers and their children will suffer the repercussions of lack of treatment. Screening for PPD within our current healthcare system may seem daunting to some providers, but the screening is necessary to ensure that PPD is detected as early as possible to ensure the health of mothers and their infants.

A report conducted by the National Home Visiting Resource Center argues that PPD inhome treatment is subject for improvement due to home-visitors needing more training. It is explained in the report titled “Addressing Maternal Depression in the Context of Home Visiting: Opportunities and Challenges” that “Home visitors need specialized training to address maternal depression effectively … many home visitors report low levels of knowledge, training, and self-efficacy related to addressing depression with participants. A … study found that 44 percent of home visitors felt that they had not received sufficient training to help support families with mental health problems, including maternal depression” (NHVRC). While home visitors may feel underprepared for the roles they take on, it is shown that their presence is beneficial to the home environment nonetheless, as well as to mothers suffering with PPD. An earlier mentioned review titled “Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review” discusses a study conducted on two groups of mothers suffering with PPD and the in-home visitors effects on mother’s PPD status stating “the intervention group with the home visitor showed lower depression scores at follow-up than the control group. The subjects … agreed that in-home support would be a preferred treatment method for PPD” (Hansotte, et al.). In-home visitors provide documented relief to a mother’s PPD. “Effect of Health Care as the “Home Visiting” on Postpartum Depression: A Controlled Clinical Trial” states that in-home visits “after delivery [are] one of the best ways for family supportive and educative needs [to be met]… and due to problems of transportation for mothers and infants in early days after delivery, it is better to provide health-care services at home” (Milani, et al.). In-home visits provide many means of support to a mother, both socially and financially. While there are advancements to be made in in-home visiting for PPD treatment, there are advancements to be made in all healthcare fields, and to discount the advantages that inhome treatment provides to mothers based on need for improvement would be disingenuous.

It is important to the health of mother and child that the current maternal mental healthcare system is reformed, in which access to PPD treatment would be enhanced with mandatory screening, in-home treatment, and advances in quality of care available to mothers looking for treatment. An advancement in our current maternal mental healthcare system would provide an improvement in the health of mothers, their infants, their families, and the direct population. Postpartum depression affects virtually everyone; consider all of the women in your life capable of conceiving a child, and then realize that anyone capable of conceiving and carrying a child is capable of conceiving and carrying postpartum depression as well. When election time comes, consider voting for officials who value the passing of bills regarding maternal mental healthcare advancement. Speak with mothers around you and understand how common and how difficult suffering with PPD can be; an open conversation surrounding such topics can only diminish associated stigma and encourage those suffering to seek treatment when needed.

Works Cited https://www.nhvrc.org/wp-content/uploads/NHVRCBrief-081318_FINAL.pdf. Accessed 7 May 2022.

“Addressing Maternal Depression in the Context of Home Visiting: Opportunities and Challenges.” National Home Visiting Resource Center, Aug. 2018, pp. 1-13.

Works Cited Continued

Chisholm, Andrea. “Postpartum depression: The worst kept secret.” Harvard Health Publishing: Harvard Medical School, 8 Feb. 2017, https://www.health. harvard.edu/blog/postpartum-depression-worst-keptsecret-2017020811008. Accessed 7 May 2022.

Dembosky, April. “Lawmakers Weigh Pros And Cons Of Mandatory Screening For Postpartum Depression.” NPR, 19 Mar. 2018, https://www.npr.org/sections/ health-shots/2018/03/19/592225598/lawmakersweigh-pros-and-cons-of-mandatory-screening-forpostpartum-depression. Accessed 7 May 2022.

Dembosky, April. “Women Say California Insurer Makes It Too Hard To Get Drug For Postpartum Depression.” NPR, 13 Jul. 2021, https://www.npr.org/sections/ health-shots/2021/07/13/1011757615/women-saycalifornia-insurer-makes-it-too-hard-to-get-drugfor-postpartum-depres. Accessed 7 May 2022.

Goyal, Deepika, et al. “How Much Does Low Socioeconomic Status Increase the Risk of Prenatal and Postpartum Depressive Symptoms in First-Time Mothers?” Women’s Health Issues, vol. 20, no. 2, Apr. 2010, pp. 96-104. ELSEVIER, doi:10.1016/j.whi.2009.11.003. Accessed 7 May 2022.

Hansotte, Elinor, et al. “Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review.” Public Health Review, vol. 38, no. 3, 31 Jan. 2017, pp. 1-17. PubMed Central, doi:10.1186/s40985-017-0050-y. Accessed 7 May 2022.

Milani, Hourieh Shamshiri, et al. “Effect of Health Care as the “Home Visiting” on Postpartum Depression: A Controlled Clinical Trial.” International Journal of Preventive Medicine, vol. 8, no. 20, 6 Apr. 2017, pp. 1-6. PubMed Central, doi:10.4103/2008-7802.204003. Accessed 7 May 2022.