On Tuesday, an influential health panel, the United States Preventive Services Task Force, issued new recommendations for depression screening, explicitly saying that women should be screened during pregnancy and after childbirth. Here are answers to some questions about depression screening and maternal mental illness.
Q: What is maternal mental illness? A: Maternal mental illness can include what is commonly known as postpartum depression, but can also take the form of anxiety, bipolar disorder, obsessive-compulsive disorder or, in rarer cases, psychosis. Several of these disorders may be experienced at once, and symptoms can vary from mild depression to thoughts of suicide, or from intense worry to terrifying visions of causing harm to the baby. Most women never hurt their babies, but their stress can undermine their ability to care for their children, and can affect children's emotional well-being, social behavior and cognitive skills.
Q: When does maternal mental illness occur? A: Doctors used to say that these disorders began within a few weeks after childbirth, but new findings show that as many as half of cases actually begin during pregnancy and that symptoms can arise any time within a year after a baby is born. Some women experience symptoms only with their first child, some only with a subsequent birth and some with every pregnancy.
Q: How common is it? A: Studies suggest that during or after pregnancy at least 1 in 8, and as many as 1 in 5, women develop symptoms of depression, anxiety, bipolar disorder, obsessive-compulsive disorder or a combination.
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Q: What causes it? A: Scientists say the likely cause is an interplay of genes, stress and the hormones that surge during pregnancy and plummet right after childbirth. Some women are genetically predisposed to react more strongly to the hormonal fluctuations and some are more sensitive to stress involving their families, finances, work and other circumstances. Women with a personal or family history of depression or other psychiatric disorders are considered at greater risk.
Q: Who can do the screening? A: Screening can be done by any trained health provider, including obstetricians and pediatricians, the doctors who tend to see women most often during and after pregnancy. Providers who screen should also have the ability to provide diagnosis and treatment for women, or to refer women to places where they can receive a diagnosis and be treated.
Q: How is the screening done? A: The most common screening method is the 10-question Edinburgh Postnatal Depression Scale. It asks about feelings of sadness, worry, panic and fear, as well as whether a woman has been crying frequently, having trouble sleeping or experiencing thoughts of self-harm. Women who score 10 points or higher out of a possible 30 are considered at risk for depression, and a score of 13 or higher is usually considered serious depression. The screening test has been translated into dozens of languages.
Q: Will screening be covered by insurance? A: Yes. The federal Affordable Care Act included an amendment to encourage screening, diagnosis and treatment of maternal mental illness, and the new recommendation makes coverage even clearer. The task force gave its recommendation a "B" rating, indicating that screening should be done because it is probably beneficial; services that receive "A" or "B" ratings are covered under the health law.
Q: Is maternal mental illness treatable? A: Depression and other psychiatric disorders can be treated. Treatments vary and should be individually tailored. The task force reported that evidence appears strongest for cognitive behavioral therapy, a form of talk therapy, but some patients find that medication or other types of talk therapy are effective. The task force weighed in on the controversial question of whether women should take antidepressants during pregnancy. It said that some antidepressants could cause "potential serious fetal harms," but that "the likelihood of these serious harms is low." Q: Where can women go for help? A: Seek help from mental health professionals experienced in treating maternal mental illness. Primary care physicians and other providers can also help. Many women find that support groups are extremely beneficial. Postpartum Support International is one organization with extensive nationwide resources to link women up with providers, experts and support groups in their area.