Pregnant Women With Depression Not Getting Needed Treatment

More than half of pregnant women who were depressed didn’t get treatment for it, according to a study published in the June Psychiatric Services in Advance.

“Most pregnant women did not receive any treatment, despite current guidelines that call for health care providers to engage in close monitoring, evaluation, and assessment of mental health care needs of pregnant women,” said study author Maria X. Sanmartin, Ph.D., an assistant professor at Hofstra University in Hempstead, N.Y. Major depressive episodes are twice as common among women compared with men, with their initial onset peaking during women’s reproductive years. In fact, according to a recent APA position statement on the subject, as many as 1 in 7 pregnant women and 1 in 5 postpartum women develops depressive or anxiety disorders.

Sanmartin and colleagues studied mental health treatment utilization among 128,000 women from the 2011-2016 National Survey on Drug Use and Health, a nationally representative dataset. The women were asked whether there was a time during the past year when they needed mental health treatment or counseling but did not get it, which the researchers termed “unmet mental health care needs.”

Researchers also zeroed in on the 12,400 women of reproductive age (18 to 44 years) who during the past year reported symptoms of a major depressive episode, according to DSM-IV criteria. They then compared the responses from women in the sample who were pregnant with those who were not.

Researchers found that pregnant women with a major depressive episode were significantly less likely to get any mental health treatment than the nonpregnant women. In fact, 51% of pregnant women with a major depressive episode did not get any treatment for it, compared with 43% of nonpregnant women. Financial concerns, including the cost of the treatment, were cited by 22% of pregnant women and 18% of nonpregnant women as the primary reason for not receiving needed mental health care, researchers reported.

“It is surprising that 51% of pregnant women with a major depressive episode did not receive any mental health treatment,” Sanmartin told Psychiatric News. “OB-GYNs should ask patients about their mental health, raising their awareness about it, and at least offer patients the opportunity to receive mental health treatment.”

Additionally, significantly more pregnant women (40%) than nonpregnant women (34%) reported having an unmet need for mental health treatment, regardless of whether they had received any mental health treatment.

Other findings included the following:

• Women with a major depressive episode reported a high prevalence of past-month substance use, including alcohol use (23%), marijuana use (17%), and misuse of prescription pain relievers (6%).

• Pregnant women with a depressive episode were less likely to have a college degree and more likely to be low income and on public health insurance.

• Most pregnant women with a major depressive episode who reported an unmet need for mental health treatment were lower income, white (non-Hispanic), and unmarried; had children younger than 18 years old; and received public health insurance benefits.

Prescription medication was the most prevalent form of treatment among pregnant women (40%) compared with any other form of treatment, despite guidelines recommending evidence-based psychosocial interventions and contact with psychiatrists before initiating pharmacological treatment. Only about one-third of pregnant women with depression received any outpatient mental health services.

“While care and intervention prior to pregnancy would be ideal, greater barriers exist among pregnant women and warrant attention,” Sanmartin said. “We need to integrate a more holistic approach to treat major depressive episodes. For instance, integrated health care delivery models between primary health care and behavioral health, mental health screening during pregnancy, and telepsychiatry services are important tools to pursue in tackling this issue.”

This study did not report any outside funding. ■