Policy changes needed to improve maternal mental health in US

Key takeaways:

• Strategies aim to reduce risk for maternal mental health disorders.
• Areas of improvement include psychiatric deserts, provider curriculums, paid parental leave and behavioral health care integration.

U.S. policy changes are needed to reduce perinatal mental health deserts, standardize social determinants of health data, improve psychiatric curriculums and establish paid parental leave, researchers reported in JAMA Psychiatry.

“Compared with white and more affluent peers, mothers of racial and ethnic minority groups and low-income individuals are more likely to enter the perinatal period with numerous social determinants of health stressors because of systemic inequities,” Katherine L. Wisner, MD, MS, adjunct professor at the Developing Brain Institute, Children’s National Hospital in Washington, D.C., and colleagues wrote. “The health impacts of structural and interpersonal racism accumulate over generations. Racial and ethnic minority mothers experience additional systemic mistreatment in access to high-quality perinatal care.”

Wisner and colleagues evaluated publications from the past 3 years regarding the impact of mental illness on maternal mortality. Publications were extracted from PubMed, Ovid, direct data from government websites and health policy sources like the Policy Center for Maternal Mental Health. Researchers then developed an outline of challenges in perinatal mental conditions and mortality rate measurements, contributions of social determinants of health to mental conditions and mortality, characterizations of perinatal psychiatric disorders, increased mortality with maternal mental illness, limitations in access and care, prenatal stress and its impact on reproductive outcomes, clinician expertise improvement through cross-disciplinary education and mental health interventions.

After reviewing the publications, researchers developed the following recommendations:

• Include perinatal treatment instructions in certification programs for buprenorphine and addictions fellowships to increase mental health prescribers.
• Develop interdisciplinary health system strategies to provide a continuum of integrated perinatal and behavioral health care.
• Conduct epidemiologic studies of self-harm and completed suicide rates since Dobbs to clarify the association and potentially identify risk factors for preventive intervention.
• Develop interventions to prevent and reduce maternal and neonatal stress.
• Develop trauma-informed maternity programs that support prevention and recovery during and after pregnancy.
• Standardize, incorporate and promote preconception health indicators that can be consistently measured and evaluated to address health and wellness prior to pregnancy.
• Develop family interventions to improve mental health and coping skills in the early postpartum period, particularly for parents of infants in the NICU, to address pediatric, obstetric and psychiatric needs for these families.
• Standardize data collection across large health care databases to define specific social determinants of health with the greatest impact on maternal-infant outcomes.
• Screen for social determinants of health to identify and connect pregnant women with resources to improve their outcomes.

According to the researchers, offering paid parental leave of at least 2 to 3 months may be a strategy to decrease risks for maternal mental health disorders.

“A shift in conceptual frameworks must be achieved to reduce maternal morbidity and mortality as the public health crisis that it represents,” the researchers wrote. “Maternal mental health must be prioritized to improve health through policy changes that can be tracked and monitored.”