‘Healing is possible’: Addressing stigma, sharing resources for postpartum depression
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Key takeaways:
- Experts highlighted the signs and symptoms of postpartum depression and the importance of support from family and friends.
- There are many free resources available to help women and families seeking support.
Women struggling with their mental health during and after pregnancy often hesitate to ask for support, an issue compounded by a need for more resources and provider education on the signs and symptoms of postpartum depression.
The common symptoms of perinatal and postpartum depression may be easy to miss during the chaotic days, weeks and months after delivery, Emily Miller, MD, associate professor of obstetrics and gynecology and division director of maternal-fetal medicine at the Warren Alpert Medical School of Brown University and Women and Infants Hospital, said during a webinar hosted by the Office on Women’s Health, part of HHS. The “Shining a Light on Maternal Mental Health: Signs, Symptoms and Support for Postpartum Depression” webinar highlighted the signs and symptoms of postpartum depression, disparities in maternal mental health care for underserved communities and resources for women and families looking for support.
For women struggling with postpartum depression, the symptoms most frequently experienced can be feeling sad or “blue” most days and not enjoying doing things they used to, Miller said.
“For the things you used to really love, if you start to feel blunted, those are symptoms that really deserve evaluation,” Miller said.
According to HHS, an estimated one in five people are impacted by mental health conditions, including mood disorders, anxiety disorders, trauma-related disorders, obsessive-compulsive disorder and postpartum psychosis, during pregnancy and the postpartum period. These conditions also disproportionately affect Black and American Indian/Alaska Native women and others in under-resourced communities.
In May, HHS announced the release of a national strategy to address the public health crisis of maternal mental health and substance use issues. The National Strategy to Improve Maternal Mental Health Care is part of broader federal efforts to address women’s overall health, and maternal health in particular, consistent with the White House Blueprint for Addressing the Maternal Health Crisis.
Signs, symptoms of postpartum depression
Some of the symptom patterns are different for postpartum depression or perinatal depression compared with depression at another time of life, according to Laura J. Miller, MD, medical director of reproductive mental health in the Office of Mental Health and Suicide Prevention at the Veterans Health Administration and professor of psychiatry at Loyola University Stritch School of Medicine.
“Anxiety is very common, along with depressed mood, postpartum — more so than at other times when a person could be depressed,” Laura Miller said. “Also, a sense of restlessness or feeling agitated can become more common at that time, along with being very indecisive with difficulty concentrating ... way beyond the usual.”
Additionally, symptoms of obsessive-compulsive disorder could manifest during the perinatal or postpartum period, even without a formal diagnosis of obsessive-compulsive disorder, Laura Miller said.
“[The thoughts] keep coming, even though you do not want to think about them,” Laura Miller said. “What is very common during [postpartum depression] is those thoughts are about harm and can be about harming the baby. That does not mean the baby is at increased risk — that has been clearly proven. But the thoughts are very distressing and it is really hard to share with anyone that you are having those thoughts because it is so frightening to imagine how people will react.”
For women from underrepresented populations, signs and symptoms of postpartum depression may present differently, according to Andrea Clark Horton, JD, MDiv, director of the Perinatal Mental Health Alliance for People of Color (The Alliance) at Postpartum Support International.
“For women of color, symptomology can actually be somatic,” said Clark Hortin, also an attorney and ordained minister. “It might manifest as headaches, stomachaches, pains in the body. Sometimes women have a hard time distinguishing that because your body is readjusting [after delivery]. Some of the cultural stigma in communities of color around mental health care — not just because of systemic inequities but because of what we believe generally as a society about mental health care — may lead some to see these things as a sign of weakness. I tell my clients all the time, the feelings you keep in, they have to have somewhere to go. Eventually, they will come out in these other ways, as pain in the body, excessive tiredness, snapping for ‘no reason,’ overeating or no appetite at all.”
Help extends to friends and family
Friends, family and other support people, including the non-birthing parent, can play an important role in helping women who may be struggling with perinatal or postpartum mental health, or may need support themselves. That is why it is just as important to include support people in any care plan and in postpartum monitoring at large, Emily Miller said.
“It’s about educating around signs to look out for,” Emily Miller said. “Most people with [postpartum depression] are not going to come in [to a clinic appointment] and say, ‘For most days of the week I am in a depressed mood with anhedonia and here is my checklist.’ It is not that obvious. But you might notice your loved one is withdrawn or starting to isolate themselves, or not really interested in something you both used to love to do.”
Family and friends who notice such changes may need guidance on how to start and nurture a conversation about postpartum depression signs and symptoms, Emily Miller said.
“How do you approach it in a loving and supportive way?” Emily Miller said. “We can do a better job of educating the support community around birthing people.”
Clark Horton said available supports, such as the Postpartum Support International (PSI) HelpLine, are open to anyone, including support people. PSI also offers a provider directory listed by state, with information about more than 30 free virtual support groups, including for military and LGBTQIA+ families.
“If you do not know what to do and feel like someone in your life is struggling postpartum or during the perinatal period, those helplines and resources are not only for the birthing person,” Clark Horton said. “They are also for friends and family as well. That can be part of an effort to connect your loved ones to those services, but also to talk through the stress that you have.”
Offer support, treatment options
In addition to PSI, the federal government has resources for new parents or pregnant women who need help or have questions. The National Maternal Mental Health Hotline at 1-833-TLC-MAMA, supported by HHS, is free and confidential, offering trained counselors in English and Spanish 24/7.
“[The hotline] should be included with the positive pregnancy test,” Emily Miller said. “Everyone needs to know that this exists.”
Panelists acknowledged that many patients still struggle to get the mental health care they need, and resources continue to grow to meet demand.
“OB/GYNS, we are building capacity,” Emily Miller said. “Some but not all perinatal folks see their OB/GYN as the primary point of care or as their clinician during the whole perinatal period. We have not historically had a lot of training or education on the diagnosis or management of perinatal mental health conditions. There has been a huge push to educate people who are in practice but also start with trainees ... to make sure the future generation of folks is more prepared.”
In the meantime, another resource clinicians can offer patients is perinatal psychiatry access programs, Emily Miller said.
“If you are in your office and there is a [situation] where you do not know what to do, your state may have a perinatal access program where you can call and have a clinician-to-clinician consultation to help guide you,” Emily Miller said. “If you do not have a state-specific resource, PSI has a number you can call. All OB/GYNs need to know that they have that access.”
There are also ample resources available for women veterans through the VA, according to Laura Miller. Each VA hospital has an officially designated women’s mental health champion, as well as designated maternity care coordinators. Both are available to provide any needed resource and help a clinician engaged in diagnostic evaluation and treatment.
“There are a lot of ways to structure prenatal and postpartum care that can comprehensively and equitably include mental health,” Emily Miller said. “One such model is the collaborative care model. Ask your clinic, ‘Do you have this?’ If they do not know what it is, ask, ‘Why not?’ As a consumer, you have power to try and move the needle.”
In addition to obstetric care providers, there are a range of people who can meet the various needs of people who struggle with mental health challenges during or after pregnancy, Laura Miller said.
“For those who need formal psychotherapy but not medication, there are social workers, psychologists, marriage and family therapists,” Laura Miller said. “For those who do not need any of that but need supportive interventions like mindfulness and peer support, there are doulas, peer specialists and mindfulness coaches. Sometimes it is helpful to think outside the box and look for a whole array of possible people who can help,” Laura Miller said.
For many women, just knowing there is someone to listen and offer support can change everything, Clark Horton said.
“Healing starts with getting help and healing is possible,” Clark Horton said.
Resources:
- National Maternal Mental Health Hotline. Available at https://mchb.hrsa.gov/programs-impact/national-maternal-mental-health-hotline. Accessed May 20, 2024.
- Postpartum Support International. Available at https://www.postpartum.net/. Accessed May 20, 2024.
- White House Blueprint for Addressing the Maternal Mental Health Crisis. Available at Maternal-Health-Blueprint.pdf (whitehouse.gov). Accessed May 20, 2024.