Introduction:
Perinatal Mental Health (PMH) conditions, previously referred to as Perinatal Mood and Anxiety Disorders (PMAD), can occur at any time during the perinatal period (that is, during pregnancy, post-loss, and/or postpartum), and can affect not only the pregnant or postpartum person, but also fathers and partners. PMH conditions include:
- Perinatal depression
- Perinatal anxiety
- Perinatal obsessive compulsive disorder (OCD)
- Perinatal post-traumatic stress disorder (PTSD)
- Bipolar mood disorders
- Perinatal/Postpartum psychosis
Many women experience some mild mood changes during or after the birth of a child, including postpartum “blues,” which occur in 50 - 80% of women. However, 15 - 20% of women experience more significant symptoms of depression or anxiety. Fathers can also experience postpartum depression (PPD) or anxiety, with approximately 10% affected.
Women of every culture, age, income level and race can develop perinatal mental health conditions. Symptoms can appear at any time during pregnancy and the first 12 months after childbirth or loss. Risk is higher with parents facing financial hardship, poor social support, teen pregnancy, and mothers of infants in the neonatal intensive care unit (NICU). Fathers are at significantly higher risk of development of postpartum depression when their partners also experience the condition. While many PMH conditions are underdiagnosed, there are effective and well-researched treatment options (including counseling, support groups, and medications) to help women recover. Untreated maternal mental health conditions can have lasting effects on mothers, infants, and families; and can impact child development and well-being.
Periodic psychosocial and mental health screening is recommended by the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Family Physicians (AAFP), and the American Academy of Pediatrics (AAP). Screening for depression and anxiety using standardized, validated instruments should occur:
- At the initial prenatal visit
- Later in pregnancy
- At postpartum visits
Widely used, validated, screening tools are available online at no charge:
- EPDS (Edinburgh Postnatal Depression Scale)
- GAD-7 (Generalized Anxiety Disorders):
- PHQ (Patient Health Questionnaire; PHQ-4, PHQ-9, PHQ-A [Adolescent])
The Perinatal Mental Health Screening and Care Pathway was developed to assist health care providers in Orange County with incorporating routine perinatal mental health screening into clinical practice. The Orange County Perinatal Council (OCPC) anticipates that improved perinatal mental health screening accompanied by early referral to community mental health services will result in better maternal and infant outcomes.
The Perinatal Mental Health Screening and Care Pathway was developed as part of the Orange County Perinatal and Infant Mental Health and Substance Use Provider Toolkit by the Orange County Perinatal Mood and Anxiety Disorders (OC PMAD) Collaborative, later renamed the SEEDS (Services, Education, Emotional & Developmental Support) for Thriving Families Coalition, a subcommittee of the OCPC, to build the foundation for a perinatal mental health system of support. The toolkit contains local resources, evidence-based tools, and recommendations to assist healthcare and service providers in offering education, preventive interventions, screening, referral, and treatment for new and expecting parents. Updates to this toolkit will be made periodically as needed. For specific inquiries regarding mental health services and treatment programs for non-perinatal adults and children, contact 1-855-OC-LINKS (1-855-625-4657).
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