Postpartum depression (PPD) is a form of depression specifically linked to childbirth, and can lead to prolonged feelings of sadness, hopelessness, and difficulty bonding with the baby. Having thoughts about harming yourself or your baby, having no energy or motivation, crying a lot, withdrawing from loved ones, and losing interest in things you used to love are all signs of PPD. And according to new statistics, these feelings are becoming more common among new mothers.
A recent report by Blue Cross Blue Shield (BCBS) examined 1.8 million pregnancies between 2014 and 2018, and found that the number of women being diagnosed with postpartum depression increased by nearly 30 percent during that time period—from 73.6 diagnoses per 1,000 people in 2014 to 94.6 diagnoses per 1,000 people in 2018. And experts fear those numbers will only increase due to the COVID-19 pandemic. Motherfigure, a resource for pregnant and new moms, conducted a report of maternal care during the pandemic and found that 71 percent of mental health providers who focused on serving the perinatal population reported an increase in severity of perinatal mood and anxiety disorders compared to what they typically see in their practices. Additionally, the report found that 76 percent of the women it surveyed who had given birth during the pandemic self-reported symptoms of anxiety and depression.
These numbers feel disheartening, especially considering how much more awareness (and in many cases, acceptance) there is of PPD now compared to a decade ago. What's driving these increases? And what needs to be done to turn these statistics around—and better support the mental health needs of new parents?
Why is postpartum depression on the rise?
While the statistics about the rise in PPD are alarming, Joseph Cunningham, MD, the president of Blue Cross Blue Shield of Oklahoma and a board-certified OB/GYN, says it's important to note that PPD is being screened for and diagnosed more often—and that's a good thing. In other words, it was likely under-diagnosed in the past. But even taking this into account, he still maintains that the rates have increased more than expected.
One of the potential factors affecting PPD rates is the fact that more people are entering pregnancy with pre-existing physical and/or mental health conditions. In its report, BCBS found that the number of pregnant women with hypertension or Type 2 diabetes had increased by 31 percent and 28 percent, respectively, in the four-year period of the study. Past research has associated certain pre-existing medical conditions like high blood pressure and diabetes with an increased likelihood of complications during childbirth such as preeclampsia (uncontrolled high blood pressure before or after birth). And complications during childbirth have been shown to increase the risk for PPD.
There's also been a 35 percent increase in the number of pregnant women with diagnosed depression, and a 23 percent increase in anxiety, according to the BCBS report. Dr. Cunningham says people who have a history of depression or anxiety before pregnancy are more at risk for PPD.
Many of these rising health issues are compounded by health disparities in specific communities. "Women of a lower socioeconomic status have a higher risk for PPD and this is [often] because they are less likely to have a good support system and more likely to feel isolated," Dr. Cunningham says. Compounding the problem is the reality that only 9 percent of workers in the bottom 25 percent wage bracket in the United States have access to paid family leave, and research has linked inadequate maternity leave with an increased risk of PPD.
Lack of access to health care is another contributing factor. "As we look at racial disparities, socioeconomic disparities, and even regional disparities, [many] women live in maternity care deserts where they have to drive long distances to see a doctor or therapist," Sarah Levine-Miles, LCSW, a clinical social worker familiar with the Motherfigure study says. "These women are less likely to have access to child care or transportation to get to these appointments." Certain populations (particularly Black women) are also more likely to have pre-existing health conditions and childbirth complications due to larger health disparities—which puts them at a greater risk for PPD.
These existing problems have been compounded by the pandemic, experts say, thanks to historic rates of unemployment affecting people's incomes and insurance coverage, increased rates of anxiety and depression nationally, and social distancing making social connections even harder to maintain. "One of the challenges of COVID-19 is that it exacerbates the problem of not having enough hands-on support," Motherfigure founder Chelsea Allison says. She explains that when you're an exhausted new parent, it can make a world of difference to have family and friends help cook, wash dishes, or watch the baby so you can rest. But right now, many new parents aren't able to see loved ones in real life, which can lead to feeling even more isolated and overwhelmed.
Underlying everything, Levine-Miles says, is the enduring, unfair stigma that prevents many people with PPD symptoms from speaking up. There's still an unwritten expectation that people should be blissfully happy once they become parents. "There should never be a stigma to have PPD," Dr. Cunningham says. "You are not a failure [if you have PPD]."
How to turn the stats around
There's a lot that needs to be done in order to mitigate the growing rates of postpartum depression. "We need both sides, the patient and the physician, to open up because early diagnosis and early recognition significantly improves outcomes. And it shortens the course of any kind of illness," Dr. Cunningham says. He emphasizes the importance of keeping your doctor informed—both during pregnancy and after—about how you're feeling mentally because your doctor can help provide solutions, which can come in the form of therapy, support groups, and medication.
Allison says that she hopes the recent rise in telemedicine services is here to stay, as it's made connecting with doctors and therapists easier in many ways since there is, depending on the specific circumstances, less need to arrange childcare or carve out time to commute. "Many insurers have made coverage and reimbursements for telemedicine services more widely available, leading to decades of progress virtually overnight," she says. "COVID-19 introduced the opportunity for more creative solutions that meet people's needs [when and] where it's truly needed." New research in the journal Psychiatry shows that telemedicine has been vital specifically for providing new parents with mental health consultations, group therapy, support groups, and targeted parent webinars during the pandemic. While the long-term gains look promising, it's important to note that for low-income parents or parents in rural areas, reliable internet access presents a barrier to telemedicine that makes it not quite yet fully accessible.
Levine-Miles is optimistic about telemedicine's potential for helping postpartum parents, but maintains that "because of the unwarranted stigma still attached to PPD, it's important that [people] have a safe space in their homes to open up about how they're feeling" without fear of being judged by their partner or others they are quarantining with. "I have a lot of clients call me from the car," she says, indicating one way people have made their therapy sessions private.
She also underlines the importance of having support systems in place for new parents, which may look a little differently than it would if we were not in a global pandemic. It's important resources are given to everyone, especially those of a lower socioeconomic status. Women of a low monthly income are 11 times more likely to experience PPD at three months postpartum, according to a report published in Women's Health Journal. This shows just how critical policies like paid maternity leave and affordable access to mental health professionals are.
It's also important to address the reasons why more people are entering pregnancy with pre-existing physical and mental health issues. Unless these deep-rooted societal health disparities are addressed with systemic changes, there will continue to be more people entering pregnancy with health issues, putting them are greater risk for PPD and other poor health outcomes.
On a micro level, someone can support a new parent by arranging for meals to be delivered, dropping off some goodies that make them feel cared for, and regularly checking in virtually. If you're a new parent yourself, joining a virtual support group—whether it's one that meets regularly via video or a forum or Facebook group—is also a way to feel less isolated.
Postpartum depression is lonely in its essence, but the truth is, if you're experiencing it, you're far from alone. Hopefully, as we bridge the gap between those in need and the solutions that exist, these stats can turn around.
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