Maternal Mental Illness: A Silent Crisis in America’s Maternity Care
In recent years, the United States has been grappling with a disturbing trend – an alarming rise in pregnancy-related deaths. While the maternal mortality rate in the US is already two to three times higher than in other high-income countries, a new evidence review published in the journal JAMA Psychiatry has shed light on a crucial factor contributing to this crisis: maternal mental illness. According to the review, mental health disorders, including suicide and opioid overdose, are responsible for nearly one in four maternal deaths in the US. This staggering statistic highlights the urgent need to prioritize mental health in national initiatives aimed at combating the issue.
The review examined 30 recent studies and 15 historical references, revealing the underrecognized role of mental illness in maternal mortality. Dr. Katherine Wisner, associate chief of perinatal mental health at Children’s National Hospital and co-author of the evidence review, emphasized the lack of awareness surrounding this issue. She stated, “The contribution of mental health conditions to the maternal morbidity and mortality crisis that we have in America is not widely recognized.” To address this crisis effectively, it is crucial to bring attention to the public and policymakers and demand action to address the mental health crisis that is claiming the lives of mothers across the nation.
One key finding from the review is that women are at a higher risk of developing new psychiatric disorders during and immediately after pregnancy. Depression, in particular, poses a significant threat, with approximately 14.5% of pregnant individuals experiencing a new episode of depression during pregnancy or within the first three months after birth. Shockingly, only 20% of women are screened for postpartum depression, indicating a significant gap in mental health support for new mothers. Dr. Wisner stressed the importance of universal screening and treatment, stating, “Given that this is a time that many mothers have contact with healthcare professionals, it’s critically important that all mothers are screened and offered treatment.”
However, access to comprehensive maternity care remains limited in many states, exacerbating the challenges faced by mothers. A study published in January 2023 revealed that over 400 maternity services nationwide closed between 2006 and 2020, leaving nearly six million people in “maternity care deserts” with little or no access to essential care. This lack of accessible maternity care not only creates stress for mothers who must travel long distances but also increases the risk of untreated health complications. The evidence review emphasizes the need for comprehensive and accessible maternity care to ensure the well-being of both mothers and their children.
Reproductive health care limitations, including restricted access to abortion, also have a significant impact on maternal mental health. The review highlighted a study that found a 6% higher annual rate of suicide in reproductive-age individuals due to the enforcement of targeted regulation of abortion providers (TRAP) laws, which lead to fewer abortion providers. This link between limited reproductive health care options and mental health issues further underscores the need for comprehensive support systems for women during the perinatal period.
Moreover, the review emphasized the role of social determinants of health in pregnancy outcomes. Maternal trauma, prenatal stress, economic stability, education, and environment all play crucial roles in shaping the well-being of mothers and their children. Members of racial and ethnic minority groups are particularly vulnerable to stressors due to systemic inequities. This is evident in the stark racial disparities in maternal death rates, with Black mothers experiencing a mortality rate 2.6 times higher than that of white mothers in 2021. Dr. Jessica Pineda, assistant professor of psychiatry and director of the Women’s Mental Health fellowship at Brown University, highlighted the racial disparities in maternal mental health treatment, stating, “Racial disparities that contribute to lack of treatment for mental health disorders likely also include barriers related to transportation, childcare, and cost, as well as distrust of the healthcare system.”
While national initiatives like the White House Blueprint for Addressing the Maternal Health Crisis have mobilized resources to combat maternal mortality, the review emphasizes the need to prioritize mental health within these efforts. The White House acknowledges the need to transform mental health beyond the healthcare system and address the determinants of behavioral health. This includes investing in community services, fostering a culture and environment that promotes mental wellness and recovery, and prioritizing mental health in maternal health initiatives.
To address the crisis effectively, the researchers recommend improving interdisciplinary training in obstetrics and mental health for healthcare professionals. They also advocate for universal maternal mental health screening and public education about family planning options. Additionally, the review highlights successful programs that have been developed to prevent postpartum depression and support access to perinatal mental health care, such as the US Preventative Health Services Task Force Rose Program and the Massachusetts Child Psychiatry Access Program for Moms.
As the US continues to grapple with the alarming rise in pregnancy-related deaths, it is crucial to recognize the significant role of maternal mental illness in this crisis. By prioritizing
