Panel Calls for Mental Illness Screening During and After Pregnancy

The recommendation, released Tuesday, follows research pointing to the prevalence of postpartum depression, which is thought to affect one in seven women.

The recommendation, released Tuesday, follows research pointing to the prevalence of postpartum depression, which is thought to affect one in seven women. Shutterstock

Women should undergo screening for mental illness during pregnancy and after giving birth, one of the nation’s foremost health panels has recommended.

The recommendation, released Tuesday, follows research pointing to the prevalence of postpartum depression, which is thought to affect one in seven women. Left untreated, the disorder can harm women and their children, the United States Preventive Services Task Force panel indicated.

In issuing the guidelines, the panel, an independent group of experts appointed by the U.S. Department of Health and Human Services, found “convincing evidence” that screening for mental illness in primary care settings would benefit patients. It recommends that simple questionnaires be administered to all pregnant women.

“There’s better evidence for identifying and treating women with depression” during and after pregnancy, Dr. Michael Pignone, a professor of medicine at the University of North Carolina at Chapel Hill and an author of the recommendation, told the New York Times.

Consequently, he said, “We specifically called out the need for screening during this period.”

The recommendation was included in updated depression screening guidelines issued Tuesday by the panel.

Margy Hutchison, a certified nurse midwife and clinical professor at the University of California, San Francisco, said the recommendation would bring more attention to pregnancy-related depression by “systemizing” and normalizing the screening of all pregnant women.

Hutchison told Rewire in a phone interview that screening, until now, “hasn’t been seen as an important part of prenatal care. If you have a woman who is depressed, it’s not only affecting her health, it’s affecting the health of her fetus and child. It’s really about how do we systemize attention to something like depression.”

Calling for screening of maternal mental illness is a first for the influential panel. A 2009 recommendation by the task force called for doctors to screen for adult depression, but made no mention of depression screening during or after pregnancy.

Roughly 10 to 15 percent of recently pregnant people experience postpartum depression, said Dr. Pratima Gupta, reproductive health advocacy fellow with the New York-based Physicians for Reproductive Health. The rate of depression in non-childbearing women is comparable, Gupta said, suggesting that some individuals are going undiagnosed. And depression, she noted, affects women during pregnancy as well.

“A guideline like this is wonderful to encourage providers to screen women both during pregnancy and after pregnancy,” Gupta told RH Realty Check.

Routine screening, she added, would also help destigmatize pregnancy-related depression, which occurs during a life event that’s freighted with societal expectations.

“If women are experiencing any depressive symptoms, they’re hesitant to come forward because society expects them to be filled with joy and excitement,” Gupta said.

The recommendation, published in the Journal of the American Medical Association, comes with a “B” rating, which means the Affordable Care Act must cover depression screening as part of preventive care, as the Kaiser Family Foundation explains.

Mona Shattell, chair of the Department of Community, Systems, and Mental Health Nursing at Chicago’s Rush University, called the recommendation long overdue.
“Frankly, it’s unbelievable that screenings haven’t been part of usual care,” Shattell told Rewire in an email. “Even high profile cases in the past of women who have killed their children because of psychosis (stemming from depression) didn’t result in systematic changes in care. In many of those cases, the mothers or families were individually blamed, scapegoated, when in reality [this] was a system of care that failed them.”
A simple screening, Shattell continued, “could have prevented these tragedies. We need to implement more integrated care models, where mental health care and physical health care are provided concurrently in the same place.”