Maternal Mental Health Among Utah Women

Pregnancy, giving birth, and caring for a newborn are challenging. Most mothers naturally experience the “baby blues” during the first two weeks after delivery, when they report feeling anxious, irritable, overwhelmed, or weepy. Usually, these symptoms resolve on their own within two weeks. Some women, however, experience mental health concerns beyond the baby blues, such as postpartum depression or postpartum anxiety. It is estimated that one in eight women in the US report postpartum depression symptoms. Symptoms of depression interfere with daily life and can include feeling sadness, guilt, or hopelessness; loss of interest in activities; changes in energy, sleep, and appetite; irritability; difficulty concentrating; withdrawing from social relationships; and, sometimes, thoughts of hurting oneself or others.

Perinatal Mood and Anxiety Disorders (PMADs) is a term used to encompass a range of disorders that can occur during pregnancy or up to one year postpartum. Mood disorders include depression or bipolar disorder. Anxiety disorders include generalized anxiety and obsessive-compulsive disorder. Post-traumatic stress disorder may also occur. Combined, these disorders are common complications of pregnancy, affecting up to 20.0% of mothers.

This research snapshot summarizes data about PMADs in Utah, reviews relevant information for patients and healthcare providers, and aims to raise awareness about this issue so that more women receive appropriate screening and care. The snapshot is organized in the following areas:

1. Overview of US and Utah data,
2. Screening recommendations,
3. Treatment and resources, and
4. What Utahns can do.

Overview of US and Utah Data

• In a 2018 report about the Pregnancy Risk Assessment Monitory System survey (PRAMS), the national average of women experiencing depression symptoms after the birth of a baby was 13.0%; Utah’s average was similarly estimated to be 13.0–15.0%.
• The rate of postpartum depression symptoms was 15.0% for Hispanic/Latino mothers; 15.3% for White, non-Hispanic/Latino mothers; and 18.0% for other, non-Hispanic/Latino mothers.
• Younger mothers reported postpartum depression symptoms more than older mothers did.
• Similar to national data about risk factors, Utah data shows that PMAD risk factors include the mother being unmarried, living at or below 100.0% of the federal poverty level, being enrolled in Medicaid, having no college education, receiving WIC services during pregnancy, having an unintended pregnancy, or feeling ambivalence towards pregnancy.

Screening Recommendations

Overall, the data suggest that Utah screening rates need to improve, particularly as women seek healthcare prior to becoming pregnant. The American College of Obstetricians and Gynecologists (ACOG) recommends the following:

• Screening patients at least once during the perinatal period with a validated measure of mood and emotional well-being.
• Closely monitoring, evaluating, and assessing women with previous depression, anxiety, suicidal thoughts, or increased risk factors for PMADs.
• Referring patients to appropriate behavioral health resources or initiating medical therapy, or both.
• Ensuring systems are in place to confirm follow-up for diagnosis and treatment.

Treatment and Resources

Individuals who screen positive should be fully assessed for a diagnosis and then should discuss treatment options with their provider. Treatment is based on severity of illness and may include conservative measures, therapy, and/or medications. Conservative measures include sleep, exercise, and discussing social support. Patients and providers should use risk/benefit assessments to select treatment plans. For mothers who have several risk factors, the United States Preventative Task Force recommends preventative therapy and support groups.

Women concerned they are experiencing symptoms of PMADs should talk with their obstetrics provider if they are pregnant or within the first six weeks postpartum; they may also talk with their primary care provider for an evaluation and a discussion of treatment options. The obstetrics or primary care provider can screen, diagnose, and discuss treatment options. If needed, they may refer women to a specialist in maternal mental health.

What Utahns Can Do

Many play a role in supporting individuals experiencing PMADS and ensuring positive outcomes.

• Policymakers can remain informed about state statistics and support screening and treatment programs.
• Providers can implement strategies to improve their screening rates of mothers and also of partners if they are present.
• Women and partners can speak up and ask for help.
• Friends and extended family can understand symptoms, advocate for mothers, and offer emotional and practical support.

Conclusion

Given the high rates of perinatal mood and anxiety disorders, continued research is crucial to inform both policy and practice and to help new mothers most at risk. Through evidence-based policy adjustments, Utah can improve PMADs screening rates and access to quality care. As Utahns become educated about specific risk factors of PMADs, and as individuals seek appropriate care and treatment, more Utah mothers and their families will thrive.

To learn more about maternal health among Utah women, read the full snapshot.