Perinatal Mental Health Disorders

Perinatal Mental Health (PMH) disorders include a range of disorders and symptoms, including but not limited to depression, anxiety and psychosis. These disorders and symptoms can occur during pregnancy and/or the postpartum period (together often referred to as the perinatal period).

When left untreated these disorders can cause devastating consequences for the individual, the baby, their family and society.

These illnesses can be caused by a combination of biological, psychological and social stressors, such as lack of support, a family history, or a previous experience with these disorders.

Perinatal anxiety and depression are the most common complications of childbirth, impacting up to 1 in 5. , yet they are not universally screened for, nor treated.

The good news is that risk for both depression and anxiety can be reduced and sometimes prevented, and with treatment those impacted can recover.

Overview of Maternal Mental Health Conditions

 

The Baby Blues - Up to 85% of women will experience the “baby blues” after giving birth, tied to sudden shifts in hormones.

  • Women who experience the baby blues may feel sad, have mood swings and crying episodes.
  • The Blues are not considered a disorder as the symptoms often resolve within a few days. If symptoms persist, beyond two weeks, it’s likely the mother is suffering from depression.

Norhayati, M. N., Nik Hazlina, N. H., Asrenee, A. R., & Wan Emilin, W. M. A. (2015). Magnitude and risk factors for postpartum symptoms: A literature review. Journal of Affective Disorders, 175, 34–52. https://doi.org/10.1016/j.jad.2014.12.041

 

Pregnancy and Postpartum Depression - Approximately 20 % of women experience clinical depression during and/or after pregnancy.

  • Depression is treatable during pregnancy and postpartum.
  • Symptoms can range from mild to severe and, mothers with pre-existing depression prior to or during pregnancy are more likely to experience postpartum depression.
  • Pregnancy and postpartum depression are treatable and risk can also be mitigated.
  • Symptoms generally include sadness, trouble concentrating, difficulty finding joy in activities once enjoyed, and difficulty bonding with the baby.

Van Niel, M. S., & Payne, J. L. (2020). Perinatal depression: A review. Cleveland Clinic Journal of Medicine, 87(5), 273–277. https://doi.org/10.3949/ccjm.87a.19054

Wisner, K. L., Sit, D. K., McShea, M. C., Rizzo, D. M., Zoretich, R. A., Hughes, C. L., Eng, H. F., Luther, J. F., Wisniewski, S. R., Costantino, M. L., Confer, A. L., Moses-Kolko, E. L., Famy, C. S., & Hanusa, B. H. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70(5), 490–498 . https://doi.org/10.1001/jamapsychiatry.2013.87

 

Pregnancy and Postpartum General Anxiety - Approximately 20% of women develop an anxiety disorder during pregnancy or after childbirth.

  • Anxiety is treatable during pregnancy and postpartum.
  • Symptoms often include restlessness, racing heartbeat, inability to sleep, extreme worry about the “what ifs” - like what if my baby experiences SIDS, what if my baby falls, what if my baby has autism, etc.; extreme worry about not being a good parent/being able to provide for her family.

Fawcett, E. J., Fairbrother, N., Cox, M. L., White, I. R., & Fawcett, J. M. (2019). The prevalence of anxiety disorders during pregnancy and the postpartum period. The Journal of Clinical Psychiatry, 80(4). https://doi.org/10.4088/jcp.18r12527

 

Pregnancy and Postpartum OCD - The prevalence of maternal Obsessive Compulsive Disorder (OCD) ranges from 7.8% during pregnancy to 16.9% during the postpartum period.

  • OCD includes obsessions (an unwanted thought or feeling) that a person has an urge to relieve through an action or a “compulsion.”
  • OCD “obsessions” can include intrusive thoughts (see below for more information about intrusive thoughts).
  • About 50% of women with OCD have intrusive/unwanted thoughts about intentionally harming their infant (e.g., throwing the baby).6
  • It is important to note that although obsessions often contain alarming content they do not represent a psychotic process, where mothers are at a higher risk of harming themselves or their infants/children.

Fairbrother, N., Collardeau, F., Albert, A. Y., Challacombe, F. L., Thordarson, D. S., Woody, S. R., & Janssen, P. A. (2021). High prevalence and incidence of obsessive-compulsive disorder among women across pregnancy and the postpartum. The Journal of Clinical Psychiatry, 82(2). https://doi.org/10.4088/jcp.20m13398

 

Birth Related PTSD - The prevalence of postpartum PTSD is approximately 3% but increases for at-risk mothers to 15%.

  • These women are plagued with intrusive memories and flashbacks of the event.

Grekin, R., & O’Hara, M. W. (2014). Prevalence and risk factors of postpartum posttraumatic stress disorder: A meta-analysis. Clinical Psychology Review, 34(5), 389–401. https://doi.org/10.1016/j.cpr.2014.05.003


Perinatal Mental Health Questionnaires

Questionnaires called “screening tools” are used to determine if someone may be suffering from a perinatal mental health disorder. Being your own advocate is okay and you deserve to be well. Download/fill out the PSI discussion tool and bring it with you to your provider.


Other Features and Factors:

 

Birth Loss and Grief

  • Miscarriage and perinatal loss are associated with increased risk of depression, anxiety, and PTSD symptoms.

  • Approximately 60% of parents experiencing perinatal loss present with depression, anxiety, and PTSD symptoms.

Hunter, A., Tussis, L., & MacBeth, A. (2017). The presence of anxiety, depression and stress in women and their partners during pregnancies following perinatal loss: A meta-analysis. Journal of Affective Disorders, 223, 153–164. https://doi.org/10.1016/j.jad.2017.07.004 

Berry, S. N. (2022). The trauma of perinatal loss: A scoping review. Trauma Care, 2(3), 392–407. https://doi.org/10.3390/traumacare2030032

 

Postpartum Psychosis

  • Postpartum psychosis occurs in approximately 1 to 2 out of every 1,000 deliveries.
  • The onset is usually sudden, most often within the first 2 weeks postpartum.
  • The most significant risk factors for postpartum psychosis are a personal or family history of bipolar disorder, or a previous psychotic episode.
  • Postpartum Psychosis is considered a medical emergency due to the potential for a mom to harm herself or her baby.

Friedman, S. H., Reed, E., & Ross, N. E. (2023). Postpartum psychosis. Current Psychiatry Reports, 25(2), 65–72. https://doi.org/10.1007/s11920-022-01406-4

 

Intrusive Thoughts

  • Up to 100% of women (and their partners) have “intrusive” thoughts surrounding childbirth/ the postpartum period.

  • These thoughts may include thoughts of infant harm (e.g., dropping the baby or a woman herself harming her baby). These thoughts are unwanted (ego-dystonic) and recognized by the woman as inappropriate and concerning, (which is why these thoughts alone are not cause for alarm).

  • It is important to note that although obsessions often contain alarming content they do not represent a psychotic process, where mothers are at a higher risk of harming themselves or their infants/children.

  • Intrusive thoughts are not considered a “disorder.” When symptoms become persistent and are disabling, they are generally thought to be tied to OCD.

Brok, E. C., Lok, P., Oosterbaan, D. B., Schene, A. H., Tendolkar, I., & van Eijndhoven, P. F. (2017). Infant-related intrusive thoughts of harm in the postpartum period. The Journal of Clinical Psychiatry, 78(8). https://doi.org/10.4088/jcp.16r11083

Collardeau, F., Corbyn, B., Abramowitz, J., Janssen, P. A., Woody, S., & Fairbrother, N. (2019). Maternal unwanted and intrusive thoughts of infant-related harm, obsessive-compulsive disorder and depression in the perinatal period: Study protocol. BMC Psychiatry, 19(1). https://doi.org/10.1186/s12888-019-2067-x


National Maternal Mental Health Hotline:

National Maternal Mental health hotline HRSA

Health Resources & Services Administration

  • Free, 24/7, confidential support, resources and referrals to any pregnant and postpartum mothers facing mental health challenges and their loved ones.

  • The National Maternal Mental Health Hotline’s counselors provide real-time emotional support, encouragement, information, and referrals. Pregnant and postpartum women can get the help and resources they need, when they need it.

  • Call or text, 1-833-9-HELP4MOMS (1-833-943-5746) to connect with counselors at the National Maternal Mental Health Hotline. Learn more at www.MCHB.HRSA.gov/national-maternal-mental-health-hotline


Support for Those Not in Crisis:

PSI

Postpartum Support International

  • Volunteers offer encouragement, information, and treatment resources in your community. The HelpLine can be reached at 1-800-944-4773.

    • #1 En Español or #2 English

  • Those in need can also send a text.

    • Text “Help” to 800-944-4773 (EN)
      Text en Español: 971-203-7773

NOTE: The PSI HelpLine does not handle emergencies.
HelpLine hours are 8am-11pm EST
Services are in English and Spanish
People in crisis should call their local emergency number or the Suicide & Crisis Lifeline at 988.


Support for those Who Are Suicidal or in Severe Distress:

988 Suicide & Crisis Lifeline

The National 988 Suicide & Crisis Lifeline

The 988 Suicide & Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) provides free and confidential emotional support to people in suicidal crisis or emotional distress 24/7, across the United States. The Lifeline is comprised of a national network of over 200 local crisis centers, combining custom local care and resources with national standards and best practices.

If you need immediate help, please call or text 988 to talk with a trained counselor. A chat feature is available on the website: 988lifeline.org

People call to talk about lots of things: substance abuse, economic worries, relationships, sexual identity, getting over abuse, depression, mental and physical illness, and loneliness, to name a few.

  • The line is available to anyone in suicidal crisis or emotional distress.

  • Callers are routed to their nearest crisis center to receive immediate counseling and local mental health referrals.

  • The lifeline supports people who call for themselves or someone they care about.

Línea de Prevención del Suicidio y Crisis
1-888-628-9454

Lifeline Options For Deaf + Hard of Hearing
For TTY Users: Use your preferred relay service or dial 711 then 988.