Perinatal mood and anxiety disorders, serious mental illness, and delivery-related health outcomes, United States, 2006–2015

Abstract

Background: National estimates of perinatal mood and anxiety disorders (PMAD) and serious mental illness (SMI) among delivering women over time, as well as associated outcomes and costs, are lacking. The prevalence of perinatal mood and anxiety disorders and serious mental illness from 2006 to 2015 were estimated as well as associated risk of adverse obstetric outcomes, including severe maternal morbidity and mortality (SMMM), and delivery costs. Methods: The study was a serial, cross-sectional analysis of National Inpatient Sample data. The prevalence of PMAD and SMI was estimated among delivering women as well as obstetric outcomes, healthcare utilization, and delivery costs using adjusted weighted logistic with predictive margins and generalized linear regression models, respectively. Results: The study included an estimated 39,025,974 delivery hospitalizations from 2006 to 2015 in the U.S. PMAD increased from 18.4 (95% CI 16.4-20.0) to 40.4 (95% CI 39.3-41.6) per 1000 deliveries. SMI also increased among delivering women over time, from 4.2 (95% CI 3.9-4.6) to 8.1 (95% CI 7.9-8.4) per 1000 deliveries. Medicaid covered 72% (95% CI 71.2-72.9) of deliveries complicated by SMI compared to 44% (95% CI 43.1-45.0) and 43.5% (95% CI 42.5-44.5) among PMAD and all other deliveries, respectively. Women with PMAD and SMI experienced higher incidence of SMMM, and increased hospital transfers, lengths of stay, and delivery-related costs compared to other deliveries (P < .001 for all). Conclusion: Over the past decade, the prevalence of both PMAD and SMI among delivering women increased substantially across the United States, and affected women had more adverse obstetric outcomes and deliveryrelated costs compared to other deliveries.

An Overview of Maternal Anxiety During Pregnancy and the Post-Partum Period

“…Elevated anxiety levels and the onset of anxiety disorders during pregnancy and in the post-partum period has been increasing and is highly prevalent 87 . Given the large degree of overlap and the frequent co-occurrence of depressive and anxiety disorders during pregnancy and in the post-partum period it is not always easy to differentiate these two disorders; continued research is needed to further parse the differences and similarities between them.…”

Protecting the infant-parent relationship: special emphasis on perinatal mood and anxiety disorder screening and treatment in neonatal intensive care unit parents

“…To improve, we first need to widen the scope of symptoms that are screened for. The umbrella term PMAD includes postpartum depression (PPD), but also anxiety, post-traumatic stress disorder (PTSD), obsessive compulsive disorder, and others [ 14 , 28 ]. While postpartum depression and anxiety remain the most common types of PMAD in NICU families, other types of PMAD are not infrequent.…”

“…Ideally, PMAD screening would start in the antepartum period for families anticipated to have a child admitted to the NICU [ 14 , 39 – 41 ]. With or without an antenatal meeting, NICU mental health support staff should meet with each NICU family in the first 72 hours of a child’s admission to (re)establish a working relationship, normalize emotional distress, and identify additional PMAD risk factors [ 42 ].…”

Human–Animal Interaction and Perinatal Mental Health: A Narrative Review of Selected Literature and Call for Research

“…PMADs have gained increasing recognition among clinicians and researchers due to their prevalence and significant morbidity during the perinatal period [ 40 , 41 ]. It is estimated that PMADs affect close to 20% of pregnant and postpartum women in the U.S., with rates increasing over the past decade [ 42 ], and more recently due to the impacts of chronic stress and social isolation associated with the COVID-19 pandemic [ 43 , 44 ]. Nationally representative data suggest that this rise in PMAD prevalence is likely a combination of genuinely increasing rates as well as enhanced awareness and screening in clinical and research settings [ 42 ].…”