Perinatal Mental Health and Social Support

Perinatal Mental Health Overview

Untreated perinatal mental illness is an adverse childhood experience (ACE) that can have significant impact on a child’s development and impact health throughout the life course. Perinatal mental illness is a range of mental health disorders that include depression, anxiety and psychosis that occur during pregnancy and during the first year postpartum. Although many new parents experience postpartum blues which often resolves after a few weeks postpartum, some experience more enduring depression or anxiety that affects functioning and attachment with the new infant.

The most common type of perinatal mental illness is perinatal depression (PND), which is depression during pregnancy or in the first year after birth. About 12% of birthing parents experience depression during pregnancy or after childbirth. Depression during pregnancy has been linked to preterm birth and low birth weight. Left untreated, it can become chronic. Postpartum depression (PPD) is a subset of perinatal depression that occurs after childbirth. PPD causes complication for not only the birthing parent, but the entire family unit, and the parent-infant dyad. PPD has been linked to inappropriate medical treatment of infant, discontinuation of breastfeeding, family dysfunction, an increased risk of abuse and neglect and disruption in the parent-infant dyad attachment.

Regular contact with health care providers during the perinatal period makes it an ideal time to screen for perinatal mental illness. However, the disorders are under-diagnosed and therefore, under-treated. Pediatric health care providers are likely to interact with postpartum people and have a wide range of opportunities to screen for mental health during health supervision visits. This screening is for the direct benefit of the child and can be included in a child’s visit as a service to the child. The US Preventive Services Task Force recommends that clinicians screen for depression in pregnant and postpartum people and refer those at increased risk of perinatal depression to counseling interventions.

In addition, a 2016 Centers for Medicare and Medicaid Services (CMS) information bulletin recommends coverage of maternal depression screening as part of a health supervision visit and Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. When screening indicates that diagnostic and treatment services are indicated, CMS also indicates that coverage for dyadic therapy can be claimed as a direct service under the child’s Medicaid account. Pediatricians can take advantage of regular contact with postpartum people and play a vital role in screening, intervention and referral to treatment. The AAP Perinatal Depression Policy Statement provides additional information on the impact of perinatal depression on child health and pediatric providers’ role in providing support to the parent-infant dyad. In addition, the statement highlights brief intervention techniques that providers might use to engage parents after screening.

Physician Education and Training

National and Community Resources

Resources for Families

Additional AAP Resources