Many of these deaths may be preventable, said Adrienne Griffen, who has a master’s degree in public policy and is executive director of the Maternal #MentalHealth Leadership Alliance.
Griffen discussed these findings and ways health care providers may be able to help at the 2021 virtual meeting of the #American College of Obstetricians and Gynecologists.
#Women “visit a health care provider an average of 25 times during a healthy pregnancy and first year of baby’s life,” she said. “Obstetric and primary care providers who serve pregnant and postpartum #women are uniquely positioned to intervene effectively to screen and assess #women for #mentalhealthdisorders.”
To that end, #doctors and other #healthcareprofessionals should discuss #mentalhealth “early and often,” Griffen said.
“Asking about #mentalhealthissues and #suicide will not cause #women to think these thoughts,” she said.
“We cannot wait for #women to raise their hand and ask for help because by the time they do that, they needed help many weeks ago.
Obstetric providers can explain to #patients that they will check on their #mentalhealth every visit, just as they do with their weight and blood pressure, Griffen said.
For example, a #doctor might tell a #patient: “Your #mentalhealth is just as important as your physical health, and #anxiety and #depression are the most common complications of pregnancy and childbirth,”
Griffen suggested. “Every time I see you, I’m going to ask you how you are doing, and we’ll do a formal screening assessment periodically over the course of the pregnancy. … Your job is to answer us honestly so that we can connect you with resources as soon as possible to minimize the impact on you and your baby.”
Although the OB-GYN should introduce this topic, a #nurse, lactation consultant, or social worker may conduct screenings and help #patients who are experiencing distress, she said.
During the past decade, several medical associations issued new guidance around screening new mothers for #anxiety and #depression. One recent ACOG committee opinion recommends screening for #depression at least once during pregnancy and once after birth, and encourages #doctors to initiate medical therapy if possible and provide resources and referrals.
Another committee opinion suggests that #doctors should have contact with a #patient between 2 and 3 weeks after birth, primarily to assess for #mentalhealth
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Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
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In discussing maternal #suicide statistics, Griffen focused on data from Maternal Mortality Review
Committees, which are state-based and include experts from different fields who study all deaths among #women within one year after they give birth.
Symptoms of fear and guilt sometimes appear months after your baby is born. See what else could point to this kind of #depression.
Two other sources of data about maternal mortality – the National Vital Statistics System and the Pregnancy Mortality Surveillance System – do not include information about #suicide, which may be a reason this cause of death is not discussed more often, Griffen noted.
Mortality review committees, on the other hand, include information about #suicide and self-harm. About half of the states in the #UnitedStates have these multidisciplinary committees. Members consider a range of clinical and nonclinical data, including reports from social services and #police, to try to understand the circumstances of each death.
A 2019 report that examined pregnancy-related deaths using data from 14 U.S. states between 2008 and 2017 showed that #mentalhealthconditions were the leading cause of death for non-#Hispanic white #women. In all, 34% of pregnancy-related #suicide deaths had a documented prior #suicide attempt, and the majority of #suicides happened in the late postpartum time frame (43-365 days after giving birth).
Some #doctors point to a lack of education, time, reimbursement, or referral resources as barriers to maternal #mentalhealth screening and treatment, but there may be useful options available, Griffen said. Postpartum Support International provides resources for #doctors , as well as mothers. The National Curriculum in Reproductive Psychiatry and the Seleni Institute also have educational resources.
Some states have #mentalhealthprograms, where psychiatrists educate obstetricians, #family #doctors, and #pediatricians about how to assess for and treat maternal #mentalhealthissues, Griffen said.
Self-care, social support, and talk therapy may help #patients. “Sometimes medication is needed, but a combination of all of these things … can help women recover from maternal #mentalhealthconditions,” Griffen said.
Need to intervene
Although medical societies have emphasized the importance of maternal #mentalhealth screening and treatment in recent years, the risk of self-harm has been a concern for obstetricians and gynecologists long before then, said Marc Alan Landsberg, MD, a member of the meeting’s scientific committee who moderated the session.
“We have been talking about this at ACOG for a long time,” Landsberg said in an interview.
The presentation highlighted why obstetricians, gynecologists, and other doctors who deliver babies and care for #women after birth “have got to screen these people,” he said. The finding that 34% of regnancy-related #suicide deaths had a prior #suicide attempt indicates that #doctors may be able to identify these #patients, Landsberg said. Suicide and overdose are leading causes of death in the first year after delivery and “probably 100% of these are preventable,” he said.
As a first step, screening may be relatively simple. The Edinburgh Postnatal #Depression Scale, highlighted during the talk, is an easy and quick tool to use, Landsberg said. It contains 10 items and assesses for #anxiety and #depression. It also specifically asks about #suicide.