Suicide and Overdose are the Leading Causes of Death for New Mothers; Screening Could Change This

This year has already seen the tragic loss of many new mothers due to suicide and overdose.

The media has covered stories about Ariana Sutton, and more recently, Dr. Krystal Cascetta, who both died by suicide in the postpartum period.

Hearing about these losses occasionally in the media can lead us to believe that these deaths are one-off tragedies, when in fact, these devastating losses are more common than we realize and are connected to a greater maternal mental health crisis in the United States.

Women and childbearing people are at the highest risk for developing perinatal mental health conditions between 3-6 months postpartum

Suicide and overdose are the leading causes of death in the first year postpartum, according to the Centers for Disease Control and Prevention.

The postpartum period is without question a vulnerable time of massive transition. Women and childbearing people are at the highest risk for developing perinatal mental health conditions between three to six months postpartum, and data shows that the peak incidence of suicide occurs between six to nine months postpartum.

Perinatal mental health conditions impact 1 in 5 pregnant and postpartum people (source 1, source 2). However, as with many issues with maternal mortality, individuals of color and individuals impacted by poverty are disproportionately impacted by these conditions, as they are more likely to experience these mental health challenges and less likely to have access to care.

Postpartum is a high-risk period, with a majority of suicides occurring between 6-9 months

Given this evidence of the heightened risk periods within the postpartum timeframe, several important questions naturally follow:

• Who is checking on the mental health of mothers and childbearing people during this high-risk period? 

• How are healthcare providers identifying, treating, and even preventing perinatal mental health conditions before they become life-threatening? 

• Do people know where to go for help?

To address this issue, we launched the Perinatal Mental Health Education and Screening Project

To address these questions, MMHLA launched the Perinatal Mental Health Education and Screening Project in September 2021 as a multi-year, multi-disciplinary effort to ensure that all pregnant and postpartum people are educated about and screened for mental health conditions during the two-year perinatal timeframe—from pregnancy to one year postpartum.

The first phase of the Screening Project began by exploring the current state of perinatal mental health screening and gathering evidence about barriers to screening. To gain these insights, we used traditional data-gathering processes in addition to convening 11 roundtable discussions with over 250 people representing diverse backgrounds and different sectors of the maternal health field, such as professional medical organizations, healthcare providers, and individuals who have lived experience with perinatal mental health conditions.

There is no standard or consistency of perinatal mental health patient education and screening in the U.S., causing disparities and inequities

We found that numerous national medical organizations and governing bodies have made recommendations for perinatal mental health screening. In addition, some states and health systems require screening for perinatal mental health conditions. However, there is no standard or consistency of perinatal mental health patient education and screening in our country, which has caused wide disparities and inequities in screening and treatment.

Essentially, whether or not a patient receives screening, timely detection, and treatment for perinatal mental health conditions that could potentially save their life comes down to where and when that patient happens to go for their health care—leaving their perinatal health and wellbeing completely up to chance.

Healthcare providers face several barriers to screening and educating their patients about perinatal mental health conditions

We also learned that there are several barriers that make it difficult for healthcare providers to screen their patients and provide education about these conditions. Many healthcare providers expressed that perinatal mental health is not a part of their formal training, making it difficult to recognize these conditions in their patients.

Others shared that they are not familiar with resources to connect their patients to for support. There was also the common issue that not all insurance companies reimburse providers for screening—or if they do, it is for a minimal amount. 

Participants of the Screening Project also noted that current screening tools do not adequately assess for the wide range of perinatal mental health disorders, for beliefs and attitudes that are grounded in culture and religion, or for physical symptoms, which Black and LatinX people often use to describe their feelings of depression.

Moreover, people of color and people with disabilities are more hesitant to discuss their mental health challenges with healthcare providers due to fear of being reported to Child Protective Services, undergoing unwanted interventions, or experiencing outright dismissal of their experiences.

In short, improving both the screening tools and the standardization and consistency in screening can lead to better health outcomes. However, achieving this ideal situation, as the research already shows, is not going to be simple or easy.

We have developed a framework that defines when to screen and educate a patient throughout pregnancy and postpartum

To tackle this complex issue, we separated the Screening Project into two phases. Phase I focused on developing a framework that defines WHEN to provide patient education and screening. We completed Phase I in January 2023, publishing a report and hosting a webinar to share the Framework and the details of our process. The Framework identifies 13 potential opportunities to provide screening and education, with all 13 of these touchpoints occurring during regularly scheduled obstetric and well-baby pediatric visits.

We are engaged in efforts to dismantle four major barriers to screening and education

Phase II of the Screening Project, which launched in Spring 2023, is focused on dismantling barriers to screening to make it easier for healthcare providers to screen and educate their patients. We are working on both short-term and long-term efforts to address four specific barriers to screening.

Supporting perinatal mental health education among healthcare providers

To support the education of healthcare providers, we are establishing a speakers bureau to send perinatal mental health educators to mental health, maternal health, and other relevant conferences throughout the United States to bring this education to the right people in the right setting. We are also creating an online database that providers can use to search for trainings on specific topics. Lastly, we are developing intentional partnerships with several leading organizations in maternal-child health and mental health to ensure that their members are educated and informed about available training resources. 

Ensuring healthcare providers know what resources are available

To help connect providers and patients with resources for support, we are continuing to curate our Resources Hub in addition to using our social media and newsletter to uplift effective resources such as Postpartum Support International, the National Maternal Mental Health Hotline, the Suicide & Crisis Lifeline, and many more sources of support.

Collaborating with experts to improve screening tools

In an effort to improve the issues found in a commonly used screening tool known as the Edinburgh Postnatal Depression Scale (EPDS), researchers at Virginia Commonwealth University (VCU) have created the EPDS-US, which is an adapted version of the EPDS that incorporates principles of trauma-informed care. These changes are designed to be supportive, clear, and respectful. We plan to assist the VCU team in any way we can to make the EPDS-US a success.

In addition, we have identified a team of researchers who are working to create and validate a screening tool that is more comprehensive, robust, and culturally and racially appropriate.

Working to make the insurance reimbursement process easier

We have been meeting with experts in the insurance industry to identify opportunities to ensure that frontline providers, such as obstetricians and pediatricians, are adequately and easily reimbursed for providing patient education and screening for perinatal mental health conditions.

Improving screening and education is not the sole solution, but it is critical and can save lives

Dismantling all of these barriers will take time, resources, and dedication, and we acknowledge that the complexities of the maternal mental health crisis will not be solved through improving screening and education alone. However, we know from evidence that talking about and screening for mental health conditions can reduce symptoms and stigma, thereby improving health outcomes.

Pregnancy and postpartum shouldn’t be a life-threatening battleground; systemic change is urgently needed

When mothers and childbearing people receive timely detection and treatment of perinatal mental health disorders, they get another chance at life—another chance at being there for their baby, their family, or just for themselves. Our nation’s mothers and childbearing people should not have to risk losing their lives due to a largely preventable cause of death.

Through collaboration, sheer determination, and systemic change, we can change the trajectory of this crisis and improve the mental health of all mothers and childbearing people in our country.