Prioritize maternal mental health when addressing morbidity and mortality Importance The maternal mortality rate in the United States is 2 to 3 times higher than that of other high-income countries. While many national initiatives have been developed to combat maternal mortality, these efforts often do not include mental illness. Aim Highlight the little-recognized contribution of mental illness to maternal mortality, which is almost double that of postpartum hemorrhage. Review of the evidence A thematic outline was developed to include challenges in measuring perinatal mental conditions and mortality rates; contributions of social determinants of health to mental conditions and mortality; characterization of perinatal psychiatric disorder; mechanisms by which maternal mental illness increases mortality, specifically suicide and addictive disorders; access limitations and care “deserts”; prenatal stress and its impact on reproductive outcomes; increase physician expertise through interdisciplinary education; intervention sites and models; and affirm that mental health is essential for maternal health. Publications from the last 3 years were prioritized, particularly those related to policy. References were selected by consensus. Sources were PubMed, Ovid, direct data published on government websites, and health policy sources such as the Maternal Mental Health Policy Center. Findings Priority was given to recent sources. The 2022-2023 citations were 26; in the last 5 years, 14; and historical references, 15. Recommendations for addressing each topic area serve as concluding statements for each section. To mitigate the contributions of mental illness to maternal mortality risk, a coordinated effort across professional and governmental organizations is required. Conclusions and relevance Concrete programmatic and policy changes are needed to reduce perinatal stress and address trauma, standardize data collection on social determinants of health among perinatal patients, increase access to reproductive psychiatry curricula among prescribers, reduce obstetric and perinatal mental health deserts, institute paid parental leave programs, and support the seamless integration of perinatal and behavioral health care. Furthermore, rather than focusing on a relatively smaller portion of the health contributors targeted by current medical practice, strengthening the social foundation strengthens families’ health prospects for our current and future generations. |
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Policy changes and resources essential to reverse the public health crisis caused by the “death of mothers”
A research team led by Children’s National Hospital sifted through years of data showing that maternal mental illness is an underrecognized factor contributing to the deaths of new mothers. They call for urgent action to address this public health crisis in the latest issue of JAMA Psychiatry .
Backed by dozens of peer-reviewed studies and health policy sources, the journal’s special communication comes as maternal mortality soars in the United States to three times the rate in other high-income countries .
"The contribution of mental health conditions to the maternal morbidity and mortality crisis we have in the United States is not widely recognized," said Katherine L. Wisner, MD, associate chief of Perinatal Mental Health and member of the Center for Prenatal Care, Neonatal and Maternal. Health research at Children’s National. "We need to bring this to the attention of the public and policymakers to demand action to address the mental health crisis that is contributing to missing mothers in America."
The evidence review exposed the risks facing new mothers: More than 80% of maternal deaths in the United States are preventable, particularly nearly 1 in 4 maternal deaths that are attributable to mental health disorders. Overdoses and other maternal mental health conditions are claiming the lives of more than twice as many women as postpartum hemorrhage , the second leading cause of maternal death. For non-Hispanic black mothers, the death rate is a staggering 2.6 times that of non-Hispanic white mothers.
However, the research team found that recent national efforts to combat maternal mortality have failed to address maternal mental health as "the public health crisis it represents." Even methodologies for measuring maternal health statistics are inconsistent, challenging efforts to shape health policy.
Examining 30 recent studies and 15 other historical references, the team, which included Caitlin Murphy, MPA, PNP, a research scientist at the George Washington University Milken School of Public Health, and Megan Thomas, MD, FACOG, an obstetrician at the University of Kansas School of Medicine: Found extensive data supporting the need to elevate maternal mental health as a priority. Some examples:
Multiple studies show that the perinatal period puts women at increased risk for new and recurrent psychiatric disorders: 14.5% of pregnant mothers have a new episode of depression and another 14.5% develop an episode three months after the birth. birth.
Nationwide, more than 400 maternity care centers closed between 2006 and 2020, creating “maternity care deserts” that left nearly 6 million women with limited or no access to maternity care.
Mental health conditions, such as suicide or opioid overdoses , are to blame for nearly 23% of maternal deaths in the United States, according to reports from three dozen Maternal Morbidity and Mortality Review Committees, which are state organizations. that review each maternal death within the following year. the pregnancy. This is followed by bleeding (13.7%), heart conditions (12.8%) and infection (9.2%).
Even with these sobering statistics, Dr. Wisner says only 20 percent of women are screened for postpartum depression. "As this is a time when many mothers have contact with health professionals, it is vitally important that all mothers are screened and offered treatment," she said. "Mental health is essential for the health of the mother, the child and the entire family."
