Improving Access to Treatment for Women with Perinatal Depression

The sixth World Congress on Women’s Mental Health is meeting this week in Tokyo. Since the first congress met in 2001, we have witnessed an incredible — and even dizzying — explosion of activity in this field. What was once a small pond of inquiry is now an ocean. Over the last decade, public awareness of the mental health challenges women face has grown tremendously, and we can say with certainty that we have succeeded in putting this important topic firmly on the medical map.

Still, the field of women’s mental health faces important challenges. How can we best serve women and the clinicians who care for them as we move forward? There continues to be significant obstacles we must tackle in terms of diagnosis and treatment of psychiatric illness in women, and this continues to be particularly problematic for women who suffer from depression in the context of childbearing.

It is estimated that about 15% of women suffer from depression either during pregnancy or the postpartum period. Prior to the 1980s, most new mothers had never heard of postpartum depression.

Over the last few decades, however, we have made considerable progress in educating women about their risk for psychiatric illness during this vulnerable time, and women now have a much more sophisticated understanding of depression as a real, but treatable, illness. Still, most women with depression in this setting do not receive adequate treatment. 

In 2010, the American College of Obstetricians and Gynecologists recommended screening for depression in all pregnant and postpartum women. Many states have drafted legislation supporting or mandating universal screening for perinatal depression. What we see now is an increasing number of health care professionals who feel comfortable talking about and screening for depression in this vulnerable population. 

Sadly, it seems that this heightened vigilance has not necessarily translated into greater access to care for the women who need it most. Multiple studies have demonstrated that various screening instruments may be used to facilitate the identification of women with depression during pregnancy and the postpartum period. But only a handful of studies have examined the outcomes of women who were identified as being depressed using these screening techniques.

The results have been dismal, indicating that, while we are able to successfully identify women with depression, less than a third of these women end up getting any sort of treatment.