Maternal mental health disorders affect 20% of new mothers in the United States, making them among the leading complications of childbirth ahead of high blood pressure, gestational diabetes and preeclampsia.
Eva Johnson, MD, clinical associate professor with the Texas A&M University Naresh K. Vashisht College of Medicine at Texas A&M Health, is a practicing psychiatrist with additional training in reproductive psychiatry. She said perinatal and postpartum mental health experiences, which begin or worsen during pregnancy or within a year or so after childbirth, can be more complicated than a standard anxiety or depression diagnosis due to pregnancy-related physiological changes.
“Mental health disorders related to pregnancy and outside of that period differ mainly in terms of how we are diagnosing using DSM criteria, the manual professionals use to diagnose mental health conditions,” Johnson said. “Sometimes during the perinatal period, there may be symptoms that take on unique characteristics that are more specific to the maternal experience. For example, guilt, negative self-image or depression that is more focused on how she views herself as a mom.”
Postpartum depression
Postpartum depression (PPD)—officially diagnosed in the DSM-5 as major depressive disorder with peripartum onset—is widely depicted in media and often, incorrectly, used interchangeably with other perinatal mental health conditions. PPD affects one in seven women, according to Johnson.
Depression is a condition that is characterized by low mood or decreased interest or pleasure in activities. It may affect eating and sleeping patterns, and patients can experience low energy or difficulty concentrating. Depression can also come with guilt or feelings of worthlessness and negative self-image, Johnson said. In severe cases, patients may have thoughts of death or suicidal ideation. Any symptoms lasting longer than two weeks during the perinatal period is considered postpartum depression and can last up to a year, she added.
The good news, Johnson said, is that symptoms tend to improve quickly with treatment. Tell your provider about any symptoms you’re experiencing, so they can provide the proper treatment and get you the help you need.
A much less severe state following childbirth is commonly known as “baby blues,” which impacts around 80% of women who have just given birth. Symptoms, thought to be brought on by the rapid decrease in hormones after childbirth, typically start shortly after birth and last less than two weeks. They may include some mood changes, irritability, anxiety or sadness. The baby blues are not typically impairing—any symptoms that impede daily activities should be mentioned to a provider.
Postpartum anxiety
Globally, anxiety disorders are the most commonly diagnosed mental health conditions, and maternal mental health is no exception. Approximately one in five mothers experiences perinatal anxiety, Johnson said.
Like other anxiety disorders, perinatal anxiety exists on a spectrum, encompassing generalized anxiety, social anxiety, panic disorder and more. Obsessive-compulsive symptoms, including intrusive thoughts and compulsions, are also often included in screening when a patient presents with perinatal anxiety.
Typical anxiety symptoms involve persistent, uncontrollable and impairing fears or worries. Some symptoms may overlap with those of depression, such as trouble concentrating, difficulty sleeping or irritability, Johnson said. Physical symptoms like a racing heart, shortness of breath and muscle tension are also common. However, in maternal mental health conditions, the symptoms frequently center around concerns for the baby, she added.
“During the perinatal period, oftentimes these fears or worries may be related to the baby but also can encompass a wide range of fears such as occupational or medical worries. So, maybe fears or concerns about how baby is doing or their own wellbeing or how their partner is doing,” Johnson said. “In relation to OCD, which is in the anxiety spectrum, someone may have intrusive thoughts like, ‘Did my baby stop breathing?’ So, they may develop compulsions or associated behaviors to relieve that fear, like going back and constantly checking to see if baby is breathing.”
While some worry is normal for someone who is recently postpartum, Johnson said, difficulty controlling these worries and a functional impairment from your symptoms could signal a bigger problem. If you suspect anxiety, and it is interfering with your daily life or the ability to care for yourself or your child(ren), you should speak to a provider about your symptoms, she said.
Postpartum psychosis
Postpartum psychosis is the rarest maternal mental health incidence—only occurring in one to two out of every 1,000 women—and is considered a mental health emergency, Johnson said.
About 4% of postpartum psychosis cases result in infanticide and about 5% result in suicide. Onset is usually rapid during early postpartum, but some cases have been documented to occur later.
Interestingly, postpartum psychosis—though it has been well documented in scientific literature—is not an official diagnosis in the DSM, Johnson said. Groups of reproductive psychiatry experts have been advocating to change that, aiming to promote visibility and provide clear guidelines for diagnosis, in addition to opening options for treatment and insurance coverage.
Symptoms of postpartum psychosis include delusions—usually centered around the newborn or childbirth—or false beliefs, bizarre or disorganized behavior, or hallucinations. There can also be distinct or rapid changes in demeanor, like unusually elevated mood or depressed mood and irritability. Patients may be confused or feel detached from their body. Insomnia is common as well.
The condition may fluctuate and can rapidly worsen or improve, and symptoms sometimes overlap with bipolar disorder, Johnson said. Postpartum psychosis symptoms can sometimes be hard to see from the outside without doing regular check-ins with the new mom, especially since some women might not disclose symptoms due to stigma.
If you suspect postpartum psychosis for yourself or a loved one, get to the nearest emergency room as soon as possible. If you believe your loved one may be a danger to themselves or others, seek professional help immediately. The Suicide and Crisis Lifeline operates 24/7 and can be reached by calling 988 in the United States.
How to support mothers
While mental health conditions encompass a wide variety of diagnoses, symptoms, duration and severity, the bottom line remains the same: New mothers need help and shouldn’t be ashamed or afraid to ask for it. And community support is a critical element in mothers’ support networks.
Risk factors for developing a perinatal mental health condition include family history or a personal previous history of mental health concerns—both in and out of pregnancy—but all new mothers are susceptible and having a support system can mitigate some of the risk.
Johnson recommends loved ones check in with new moms regularly before and after birth. She also suggests partners and pregnant women have conversations with each other and with a provider prior to giving birth about what behaviors are normal, what is concerning and when to take action.
The National Maternal Mental Health Hotline is available at 833-852-6262 for immediate support—for mothers or a concerned loved one—to receive mental health support and resources from a licensed professional.
For ongoing support, Johnson recommends checking the Postpartum Support International directory to find a provider in your area that is equipped to provide perinatal mental health support.
There is support for perinatal providers as well. Providers of perinatal women can call the Perinatal Psychiatry Access Network (PeriPan) hotline at 888-901-2726 to speak to a behavioral health specialist, consult with a reproductive psychiatrist and get connected with resources.
It’s important not to wait, Johnson emphasized. As soon as symptoms start appearing, a provider can begin treatment and help you start feeling better as soon as possible.
“I think it’s important for moms to recognize that they matter, too,” Johnson said. “The postpartum period can feel like a bubble. And I think if more women knew how common it is, it might make it a little bit easier to ask for help.”
ABOUT TEXAS A&M HEALTH
Texas A&M University Health Science Center (Texas A&M Health) comprises five colleges and schools (dentistry, medicine, nursing, pharmacy and public health), integrated University Health Services, several research centers and institutes, and numerous outpatient clinics with a shared mission of advancing health care for all. We serve the state and beyond with campuses and locations in Bryan-College Station, Dallas, Houston, Round Rock, Kingsville, Corpus Christi, McAllen and Navasota. Learn more at health.tamu.edu or follow @TAMUHealth on X (née Twitter).
.jpg)
.jpg)
