It is now the official recommendation of the US Preventive Task Force for all pregnant women and new mothers to receive screening for postpartum mood and anxiety disorders. We saw New York City mandate universal depression screening late last year and hoped for widespread change across the country. Now here we are, just barely into 2016, and things are looking up for new moms, babies, and families.
But wait. If you stop to read through any of the comments on either NPR or New York Times‘ articles, you’ll see a lot of negativity regarding this recommendation. It’s easy to get confused by the back and forth, fear-mongering, and general lack of knowledge about PPD and other mood and anxiety disorders. A lot of myths, stereotypes, and stigmas are being perpetuated by people who don’t know much about maternal health or should know better.
We decided to address a few of the myths and stereotypes to clear up the air.
Addressing Myths and Stereotypes on Depression Screening for Pregnant & New Moms
Why didn’t the US Preventive Task Force recommended depression screening for all adults instead of just pregnant women and new moms?
They did. They have now recommended screening for all US adults, they just included pregnant and new moms in their recommendation so that they can be screened for perinatal mood and anxiety disorders like postpartum depression.
What if moms just lie and answer no to the screening questions?
Some will. Some won’t. No depression screening system is perfect. But the more you ask, the more struggling moms you’ll be able to identify. Helping more mothers is better than helping few.
Meantime, Postpartum Progress and other organizations like the National Coalition of Maternal Mental Health will continue working to reduce stigma, raise awareness, and improve policy so that every mom will feel safe answering the questions truthfully. There is still a lot of work to be done.
Women with mental illness shouldn’t be having kids in the first place.
This is such an offensive line of thinking that it’s hard for us to even respond. If we didn’t have people with mental illness in the world, then the world would have never benefited from:
- President Abraham Lincoln
- Walt Disney
- Authors Charles Dickens, Leo Tolstoy, Ernest Hemingway, Virginia Woolf and JK Rowling
- Architect Frank Lloyd Wright
- Artists Georgia O’Keefe, Frida Kahlo, and Vincent Van Gogh
- Actors Robin Williams and Audrey Hepburn
- Florence Nightingale
- Singers Alicia Keys and Nina Simone
- Composer Ludwig Van Beethoven and Saxophonist Charlie “Bird” Parker
- Astronaut Buzz Aldrin
Of course people with mental illness are parents. And they may have kids who also have, among many characteristics, a mental illness. And all of them have something to contribute.
Isn’t it silly to say that screening will fix the problem of maternal mental illness?
No one has asserted that screening will fix the problem. It’s simply one part of the problem. We need to find the moms who need help so that we can give it to them. We need to increase access and reduce disparities. We need treatment options that are affordable. We need more research. We need to invest in peer support. But just because all the issues can’t be solved at once doesn’t mean we should attempt to solve one of them.
How will depression screening help if there’s no access to services? There aren’t enough providers.
It’s true that there is a shortage of professional mental health services and clinicians, both in the US and elsewhere, who understand how to treat perinatal mood and anxiety disorders. There are many places where, even if a mom’s screen shows that she may have postpartum depression, there’s no good place to send her for an official diagnosis and treatment. There are a lot of people working on this issue. Postpartum Support International, the Postpartum Stress Center, the California Maternal Mental Health Collaborative and the Seleni Institute, for instance, are all working to train providers. Postpartum Progress is working to train its massive community of maternal mental illness survivors to provide peer support, augment the work of clinicians and fill gaps. Everybody is working overtime on this, and to be honest we need to funding community to support our work so that we can meet the need.
This is about money. This will mainly just benefit drug companies.
The task force isn’t recommending the type of treatment moms should get, only that we should be asking pregnant and new moms how they are doing and checking for symptoms of depression or anxiety.
There are many ways to treat moms, and they depend on the mom, the severity of her symptoms, what works for her and what doesn’t, what she has access to, etc. Therapy is very effective for women with maternal mental illness. Medication is also effective. Group therapy can be effective. And mounting evidence shows that peer support is effective.
It’s certainly possible that drug companies will benefit from increased prescriptions, but that isn’t the point of these recommendations. Does anyone really believe that we should punish mothers and children by sentencing them to the lifelong effects of untreated maternal mental illness just so we can prevent drug companies or therapists from making money? We sure don’t.
What about underserved or minority women and others who distrust the system already and are worried they may lose their children if they answer screening questions honestly?
Health disparities are real. In most places, low-income mothers and mothers of color have less access to good services and have had more of the kinds of experiences that make them feel they may not be safe reaching out for help. It’s terrible, and every community has a lot of work to do to fix that. We need more trauma-informed training of providers and peer supporters. We need people who understand the wide variety of symptoms of perinatal mood and anxiety disorders and who know that the vast majority of mothers with these illnesses are not a danger to anyone. We need more treatment options for moms with limited access, finances, transportation, and childcare. We need more clinicians of color.
We’re not sure how this problem will be fixed unless more funding goes to ensure that affordable treatment options are available and that people who support low-income and minority mothers have received the kind of comprehensive training that ensures that moms who need help won’t be victimized.
What Patients Have to Say
One important place to start a conversation about universal screening for postpartum mood and anxiety disorders is with moms who are currently being treated or who have already been through treatment. We asked a group of our moms what they thought about the articles on NPR and the New York Times, the comments that followed, and the recommendation to screen all moms. They shared some of their personal stories, some of their excitement, some of their misgivings and fears for new moms. They bring an important voice to this discussion as they’re paving the way for how mothers should be treated.
“At my six week postpartum check-up, my doctor told me not to watch any sad movies and that I should be fine. I thought postpartum depression was “only” thoughts of hurting your baby or crying all the time, neither of which were part of my constellation of symptoms which were more related to anxiety than depression (i.e.: racing heart, migraines, inability to eat/sleep, numbness in my hands, etc.).It wasn’t until my twins (first pregnancy) were 12 weeks old that I was finally diagnosed. This after significant weight loss, dehydration, ER visits and inability to continue to breastfeed my tiny babies. Fortunately I had family supports and health insurance, but had it not been for those things, I don’t know what my outcome might have been. Screening during and after pregnancy, way beyond six weeks, for ALL perinatal mood disorders is crucial for moms, their babies, and their families.” -Amanda
“First of all, I am jumping up and down at this recommendation. If I had been a part of this, I firmly believe that my PPD/PPA/PPOCD would not have gotten to the point that it did. I want to address comments that I saw on the article about this being a way for them to “push more pills.” 1. Not all mothers who are diagnosed with Postpartum Depression require medication. 2. For those that do, it can literally save a life. Also to the person who commented “Any rational, underfinanced person bringing another human into this mess ought to be gripped with anxiety and tension.” I was a completely rational, well-financed, successful, and stable woman when I brought two humans into the world. And I was STILL gripped with anxiety, depression, tension, self-harm, and suicidal ideation. You don’t have to have “made a mistake” for these issues to hit you…and hit you hard.” -Rebecca S.
“This is such an important step in the right direction, and I’m very encouraged by this news. Let’s finally make this a standard of care! And I really hope more healthcare providers screen during pregnancy and then after birth as well, and not just one or the other, since the pregnancy period is just as vulnerable to mood disorders.” -Stephanie P
“Why does it have to be “recommended” in the first place? It should be something that just IS. Perinatal mood and anxiety disorders exist. Doctors know this. So screening for it should be just as common as checking your blood pressure.” -Jessica L
“I think this is a great step in the right direction, and I’m completely 100% on board. I was not screened at any of my appointments after either of my children. My concern is: Would women be completely honest during the screening? I wouldn’t have been prior to my postpartum psychosis crisis, because I didn’t want to be judged or thought of as a less-together mom. I have a feeling other moms wouldn’t be completely honest on screening tools either for the same reasons.” -KD
“Many women do not have the financial resources for therapy as a first defense. I firmly believe you can not get well without a combination of talk therapy as well as medications. But again, that is my personal opinion and not always an option. What would be super great would be a reform to mandate that all insurances, including Medicaid, paid for therapy and counseling services. Period. Without a timeline on when one should “be better.” While I am thankful that steps are being taken to help moms, I still think there is a lot of education and work to go!
“I think this is such an important step. However, I was screened by a visiting nurse. She asked me questions, and I answered the way I thought I should, not how I was truly feeling. I passed with flying colors. Yet, I was screaming inside, but terrified to let on. I cried for the two days we were at the hospital after my daughter’s birth, at every pediatrician visit, and new mom’s groups. I called our warm line and hung up because I was crying so hard that I couldn’t get words out. Yet, other than that first visiting nurse screening, nobody followed up or offered me help or even seemed to notice when I was screaming out for it.” -Sarah B
“I think this article is another step in the right direction towards bringing awareness. Moms should be screened during pregnancy and at well-child visits the first year. I knew to ask for help, but some moms are afraid to. The more this is discussed and normalized, the more we can help moms who suffer in silence. Healthy kids start with healthy moms!” -Joyce M.
“What concerns me in the comments to this article is the feeling like “big pharma” is behind all of the research and recommendations. I bet most, if not all of these people commenting have never had to deal with this personally. I told my OBGYNs multiple times that I knew I was more likely to have PPD because my mom is bi-polar and I had depression and anxiety in the past. That was it. I mentioned it and the doctors never talked to me about it. Crying at every single one of my son’s doctor appointments and just being told I am a good mom, not screening me, not thinking maybe this is a little more than being concerned for my baby. If I could have gotten through all of this without meds, by all means I would have. Big Pharma and Big Government have nothing to do with this and wanting to control people and their mental illness.” -Samantha K
“I will add [with reference to Big Pharma], not all moms choose medication. I was able to get well without it. I went the natural alternative route and at the end, added in talk therapy. World of difference.” -Audra B
While we know there’s a long road ahead in implementing change and getting all women screened for perinatal mood and anxiety disorders, we strongly agree with the US Preventive Task Force and their recommendations. This is not a cure all. This is not the magic fix to all of our problems. This is a step. And yet, every step we take forward is a good thing. Every barrier we get past may help us as we try to break the barriers that still remain.