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Physicians discuss improving postpartum depression screening, addressing cultural barriers, and enhancing access to care for diverse patient groups.

As many as 75% of people who deliver a baby experience baby blues, and up to 15% of these patients also develop postpartum depression (PPD). PPD can significantly impact a patient’s well-being and ability to care for their child.

In an interview with Physician’s Weekly, Eruwama Sackey, MD, and Jason James, MD, shared how physicians can improve PPD screening and management.

PW: What factors contribute to under-screening of postpartum depression (PPD) during routine prenatal and postpartum visits?

Dr. Sackey: Many people don’t do screenings for PPD because they don’t know which tools to use. We use the Edinburgh Postnatal Depression Scale (EPDS), or we can even use the Patient Health Questionnaire-9. There aren’t always places to refer people when you have positive screenings.

Additionally, patients say, “When I fill these things out, I don’t always answer honestly because I am scared that someone is going to call child services and take my children away.”

Dr. James: I believe the number one factor is a lack of training. Historically, OB/GYNs receive very little training on the mental health aspects of caring for pregnant women.

Number two is the lack of reimbursement. We’re supposed to be screening for many things: domestic violence, substance abuse, teratogenic medication exposure, seatbelts, etc. While PPD is extraordinarily important, sometimes it gets lost.

How do you talk with patients about the emotional and psychological changes they may experience during pregnancy and after childbirth?

Dr. James: When I see patients at the beginning of their pregnancy, I’ll often say that I become their obstetrician, gynecologist, primary care physician, and psychologist because a huge component of what we do is mental health.

I let patients know that discussions about mental health or psychological issues are the norm in prenatal care. I make them comfortable by starting with an open-ended question: “How are you feeling? Are you doing well? Are you happy? What are your concerns?”

Dr. Sackey: Perinatal mood and anxiety disorders are the number one complication of pregnancy and, in the postpartum period, suicide. Postnatal suicide and substance use are the top causes of death after a pregnancy.

Dr. James: Parents need to know that pregnancies and childbirth are marked by significant degrees of unexpected outcomes. Patients who experience a situation they weren’t expecting tend to have the most difficult issues with mental health.

What are some strategies to improve access to PPD care for Black and Hispanic patients?

Dr. Sackey: As clinicians, we must start looking at risk factors for perinatal mood anxiety disorders like being a woman of color, experiencing trauma, and having depression or anxiety before giving birth.

We know that Black and Brown women are more likely to experience trauma throughout their lives, which could be racial trauma, sexual trauma, or trauma from being of different socioeconomic statuses. They are more likely to experience medical issues due to medical racism, like gestational diabetes, gestational hypertension, pre-eclampsia, C-sections, and birth trauma.

Some studies have said that we should have lower EPDS cutoff scores for women of color. Talk to patients, give them referrals, and let them know we’re not going to call child services unless there’s child abuse or neglect.

Dr. James: My patient population is about 75% to 80% Hispanic. We have a checklist of risk factors on the hospital chart for every patient so that we can identify and address them.

The other important thing is recognizing cultural differences within specific ethnic groups. Hispanic patients have different ways of dealing with mental health issues than non-Hispanic patients. We must ensure that we are implementing cultural sensitivity into medical training.

Dr. Sackey: Sometimes our patients say, “I would go to this service or this group, but I don’t know if I feel comfortable being the only person who looks like me.” Having professionals that are similar to patients can eliminate social barriers.

How can clinicians ensure they catch PPD?

Dr. Sackey: We must think outside of the box and offer patients different resources. We can educate family members on PPD and anxiety so they can identify symptoms and help the patient get care when they need it.

Talk to patients early, before they exhibit symptoms. Let them know that it is possible to take medications during pregnancy and while breastfeeding. Talk to them about the risk for being on meds versus not.

Dr. James: Whether you’re a physician, midwife, or nurse practitioner, we all must take ownership of this situation. The differences that we can make in our patient population are immense.