- Press Release Distribution

Rapid rise seen in mental health diagnosis and care during and after pregnancy

From depression and anxiety to PTSD, pre-pandemic decade saw increased diagnosis and treatment during perinatal period in those with private insurance

( Mental health issues during pregnancy or the first year of parenthood have a much greater chance of getting detected and treated now than just over a decade ago, a trio of new studies suggests.

But the rise in diagnosis and care hasn’t happened equally across different groups and states, leaving some pregnant or postpartum individuals more likely to suffer through treatable symptoms that can put themselves and their newborn at risk.

In general, the studies show rises in diagnoses of anxiety, depression and post-traumatic stress disorder during pregnancy and the first year after giving birth in Americans with private insurance from 2008 to 2020. Treatment – both with psychotherapy and medications – also rose in this population.

The findings, published in three papers in the April issue of the journal Health Affairs, come from a team at the University of Michigan who study mental health in the perinatal period.

Their analysis groups multiple conditions diagnosed during this period under the label PMAD, short for perinatal mood and anxiety disorders. In general, PMAD includes depressive and anxiety disorders that occur any time during pregnancy and the postpartum year.

Key findings from 2008 to 2020 in privately insured people age 15 to 44:

The rate of perinatal PTSD diagnosis quadrupled, to nearly 2% of all those pregnant or postpartum in 2020. Most of the rise was among those also diagnosed with PMAD; PTSD is considered an anxiety disorder in reaction to trauma. The rate of PMAD diagnoses nearly doubled, with the greatest increases seen since 2015. By 2020, 28% of those pregnant or postpartum received a PMAD diagnosis. The rate of suicidal thoughts or acts among pregnant and recently delivered people more than doubled overall, based on information reported to insurance companies. But the rate dropped among all those who had received a PMAD diagnosis. The rate at which patients who were pregnant or postpartum received psychotherapy – any form of talk therapy paid for by their private insurance – more than doubled. The rate of psychotherapy among those diagnosed with a PMAD condition increased 16% across the entire study period, with a clear increase after 2014. The rate of antidepressant medication prescriptions during pregnancy and the postpartum period rose overall, but the rate rose fastest among those diagnosed with a PMAD during pregnancy. The rate of antidepressant prescribing rose especially sharply after multiple guidelines for clinicians treating PMAD came out in 2015 and 2016. By 2020, just under half of those diagnosed with a PMAD received a prescription for an antidepressant. “Taken together, these studies show a lot of movement in maternal mental health,” said Stephanie Hall, Ph.D., a postdoctoral research fellow at the U-M Medical School Department of Psychiatry. “The landscape is different, at least as far as our health care system’s ability to pick up on conditions and help people get treatment for them.” Hall is first author of the new papers on PTSD diagnosis and antidepressant prescribing in the perinatal period, and a co-author on the paper on PMAD diagnosis.

“If anything, the rates we’re documenting for diagnosis and treatment are a floor, not a ceiling, based on what other studies have suggested about who is experiencing these symptoms,” said Kara Zivin, Ph.D., a professor in the Medical School and School of Public Health who also holds positions with the VA Ann Arbor Healthcare System and Mathematica. “It’s important that those who are struggling get help, because not getting care has consequences.”

Zivin has spoken and written publicly about her own experience with a mental health crisis during pregnancy, including in Health Affairs.

Impacts of policy and guideline changes

The researchers say their findings suggest that many of the changes in diagnosis and care happened after increased insurance coverage through mental health parity laws and the Affordable Care Act, and after updated guidelines for clinicians emphasized increased use of screening, psychotherapy and medication.

Relevant guidelines include those issued by the American College of Obstetrics and Gynecology and the U.S. Preventive Services Task Force.

But they also note that increased societal awareness and acceptance of mental health conditions and care likely contributed to the trends seen in the new findings.

Another factor that could explain changes in diagnosis and treatment: the rise of collaborative care models, under which psychiatrists can offer expert consultations and resources to primary care teams caring for people of all ages with mental health conditions.

Since 2013, for instance, clinicians caring for pregnant and recently delivered individuals anywhere in Michigan can get assistance from the MC3 program run by Michigan Medicine, U-M’s academic medical center with funding from the state of Michigan.

The studies used data from private insurance companies, so they do not include people with low incomes covered by Medicaid, which covers about 40% of all births in the United States each year.

The data source also does not include those with other forms of government-funded insurance, those without insurance, and those with coverage by private insurance for less than two years.

So, the study findings mainly apply to those who have insurance through an employer (their own or that of another person who can cover them), and to those who bought private insurance individually, including after the launch of federal and state marketplaces under the ACA. The first marketplace plans offered coverage starting in 2014. 

The studies include data for the first nine months of the pandemic, and the researchers hope to include more recent data in future studies.

Disparities in diagnosis and care

All of the studies show differences between groups of individuals in rates of diagnosis and treatment.

For instance, white individuals with PMAD were much more likely to receive antidepressant prescriptions during pregnancy than those of Black, Hispanic or Asian heritage. They were also more likely to be diagnosed with PTSD during the entire perinatal period, even though other research has shown that actual incidence of PTSD during the perinatal period is higher in people of color.

On the other hand, Black individuals as a group had the largest increase in PMAD diagnosis in the study period.

Of all age groups, people in the youngest group (15 to 24) had the largest increases in both PMAD diagnoses and antidepressant prescriptions during the study period. Those aged 15 to 26 were more likely to be diagnosed with PTSD than members of older age groups.

The PMAD diagnosis study also shows wide variation between states in the rate of individuals diagnosed with PMAD after the Affordable Care Act, compared with before.

The team plans to continue their state-level analysis, with new funding that will fuel studies of data from mental health surveys of individuals during the perinatal period. Their new research will look at changes over time in states where policies regarding reproductive care have gone into effect in recent years, including changes in abortion-related policies since the Supreme Court case that overturned the Roe vs. Wade decision in the Dobbs v. Jackson Women’s Health Organization case in June 2022.

The researchers also plan to study the potential impact of other policy and clinical guideline changes.

The impact of telehealth-based perinatal mental health care since 2020, especially for those living in areas with shortages of mental health providers, also represents another important area to study, they say.

“Perinatal mental health has broad implications for babies and families,” said Zivin. “The changes we’ve documented in these studies will have ripple effects for years to come.”

In addition to Hall and Zivin, the papers’ authors are fellow members of the U-M Perinatal Mental Health Services and Policy Program including U-M faculty and staff Lindsay Admon, M.D., M.Sc., Sarah Bell, M.P.H., Anna Courant, M.S.N., Vanessa K. Dalton, M.D., M.P.H., Andrea Pangori, M.S., Amy Schroeder, M.A., Anca Tilea, M.P.H., and Xiaosong Zhang, as well as Ashlee Vance, Ph.D., of Henry Ford Health System, and Karen M. Tabb, Ph.D., M.S.W., of University of Illinois at Urbana-Champaign.

Zivin, Admon and Dalton are members of the U-M Institute for Healthcare Policy and Innovation.

The research was funded by the National Institute of Mental Health (MH120124) and the National Institute on Minority Health and Health Disparities (MD014958), both part of the National Institutes of Health.


Papers cited:

Perinatal Posttraumatic Stress Disorder Diagnoses Among Commercially Insured People Increased, 2008–20, Health Affairs, doi:10.1377/hlthaff.2023.01447 

Antidepressant Prescriptions Increased For Privately Insured People With Perinatal Mood And Anxiety Disorder, 2008–20, Health Affairs, doi:10.1377/hlthaff.2023.01448

Perinatal Mood And Anxiety Disorders Rose Among Privately Insured People, 2008–20, Health Affairs,  doi:10.1377/hlthaff.2023.01437  



New research highlights inequities in treatment of postpartum depressive symptoms

Pregnancy and childbirth can be significant stressors on mental health. Nearly one in eight people who have given birth develop postpartum depression, according to the Centers for Disease Control and Prevention. More than just the “baby blues,” postpartum depressive symptoms can lead to adverse outcomes for birthing people and families, and treatment requires effective screening, diagnosis and management. New research from the UNC Gillings School of Global Public Health and the Columbia University Mailman ...

Ochsner Health nurses honored by the Louisiana State Nursing Association

NEW ORLEANS, La – Ten Ochsner Health nurses have been named to Louisiana State Nursing Association’s (LSNA) inaugural “40 under 40” list. This award recognizes future leaders of nursing in Louisiana. LSNA selected 40 outstanding nurse leaders 40 years of age and under who exemplify dedication to the nursing profession and demonstrate the qualities of a good leader. "Nurses provide an indispensable role in delivering high quality healthcare to our communities. This recognition is well-deserved and a testament to each nurse’s commitment to excellence in administering compassionate care to their patients. At Ochsner, we applaud this achievement and extend ...

Golfers’ risk from pesticides used on turfgrass is likely low, studies find

Golfers’ risk from pesticides used on turfgrass is likely low, studies find
For many, spring heralds fresh air and exercise on the golf course. But do players risk exposure to unsafe levels of pesticides used to beautify and maintain a golf course’s green grass? To find out, researchers asked volunteers to play 18 holes on a simulated course sprayed with common pesticides. They report the results in ACS Agricultural Science & Technology, saying there is likely limited cause for concern over toxic exposure from pesticide-treated turf. There are plenty of studies on pesticide exposure among people who tend ...

Dr. Boris Zelle earns 2024 Diversity Award from the American Academy of Orthopaedic Surgeons

SAN ANTONIO, April 1, 2024 – Boris A. Zelle, MD, FAAOS, FAOA, professor, vice-chair of research and chief of orthopaedic trauma in the Department of Orthopaedics at The University of Texas Health Science Center at San Antonio (UT Health San Antonio), recently received the American Academy of Orthopaedic Surgeons 2024 Diversity Award, recognizing outstanding contributions to advancing diversity in the field. With more than 39,000 members, the AAOS is the world’s largest medical association of musculoskeletal specialists. “Receiving the AAOS Diversity Award means a lot to me,” Zelle told the AAOS. “I have practiced academic ...

Georgia Tech researchers develop more broadly protective coronavirus vaccine

Scientists have been searching for the optimal coronavirus vaccine since the Covid-19 pandemic started. The mRNA vaccines developed through the federal government's "Operation Warp Speed" program were a massive innovation; however, annually updating those boosters for specific SARS-CoV-2 variants is inefficient for scientists and patients. SARS-CoV-2 is just one member of the Sarbecovirus (SARS Betacoronavirus) subfamily (others  include SARS-CoV-1, which caused the 2002 SARS outbreak, as well as other viruses circulating in bats that could cause future pandemics). Researchers at the Georgia Institute of ...

Mayo Clinic scientists pioneer immunotherapy technique for autoimmune diseases

ROCHESTER, Minn. — Mayo Clinic scientists have developed an immunotherapy strategy that potentially lays the groundwork for treating a spectrum of autoimmune diseases.  The new technique, detailed in a preclinical study published in Nature Biomedical Engineering, involves combining chimeric antigen receptors (CAR) with mesenchymal stromal cells (MSC), resulting in engineered stem cells known as CAR-MSCs.  “The pioneering approach shows potential in targeting inflammatory disease sites more precisely and improving immunosuppression and healing outcomes,” says Saad Kenderian, M.B., ...

We’ve had bird evolution all wrong

We’ve had bird evolution all wrong
An enormous meteor spelled doom for most dinosaurs 65 million years ago. But not all. In the aftermath of the extinction event, birds — technically dinosaurs themselves — flourished.  Scientists have spent centuries trying to organize and sort some 10,000 species of birds into one clear family tree to understand how the last surviving dinosaurs filled the skies. Cheap DNA sequencing should have made this simple, as it has for countless other species. But birds were prepared to deceive us. In a pair of new research papers ...

New method reveals hidden activity of life below ground

New method reveals hidden activity of life below ground
A team of scientists led by researchers at Bigelow Laboratory for Ocean Sciences have developed an innovative method to link the genetics and function of individual microbes living without oxygen deep below Earth’s surface. Measuring both of these attributes — and, more importantly, linking them together — has long been a challenge in microbiology but is critical for understanding the role of microbial communities in global processes like the carbon cycle.  The new approach, developed at Bigelow Laboratory’s Single Cell Genomics Center, enabled researchers to discover that one species of sulfate-consuming ...

New antibiotic class effective against multidrug-resistant bacteria

Scientists at Uppsala University have discovered a new class of antibiotics with potent activity against multi-drug resistant bacteria, and have shown that it cures bloodstream infections in mice. The new antibiotic class is described in an article in the scientific journal PNAS. Antibiotics are the foundation of modern medicine and over the last century have dramatically improved the lives of people around the world. Nowadays we tend to take antibiotics for granted and rely heavily on them to treat or prevent ...

A new family tree revises our understanding of bird evolution

A new family tree revises our understanding of bird evolution
Birds are the only dinosaur lineage that survived until today. About 66 million years ago at the Cretaceous–Paleogene (K–Pg) boundary, a mass extinction event destroyed all non-avian dinosaurs, providing an opportunity for birds to diversify rapidly and occupy a wide range of ecological niches. Neoaves, a diverse group comprising approximately 95% of all bird species today, emerged from this radiation. From the towering condors of the Andes to the diminutive hummingbirds flitting through tropical forests, Neoaves encompass a stunning ...


European Hormone Day 2024: Endocrine community unites to raise public awareness and push for policy action on hormone health

Good heart health in middle age may preserve brain function among Black women as they age

The negative effects of racism impact sleep in adolescents

Study uses wearable devices to examine 3- to 6-year-olds’ impulsivity, inattentiveness

Will future hurricanes compromise New England forests’ ability to store and sequester carbon?

Longest study to date assesses cognitive impairment over time in adults with essential tremor

Does a woman’s heart health affect cognition in midlife?

Unveiling the mysteries of cell division in embryos with timelapse photography

Survey finds loneliness epidemic runs deep among parents

Researchers develop high-energy-density aqueous battery based on halogen multi-electron transfer

Towards sustainable food systems: global initiatives and innovations

Coral identified as oldest bioluminescent organism, suggesting a new model of ancient ecology

SRI chosen by DARPA to develop next-generation computational design of metallic parts and intelligent testing of alloys

NJIT engineers muffle invading pathogens with a 'molecular mask'

Perinatal transmission of HIV can lead to cognitive deficits

The consumption of certain food additive emulsifiers could be associated with the risk of developing type 2 diabetes

New cancer research made possible as Surrey scientists study lipids cell by cell 

Bioluminescence first evolved in animals at least 540 million years ago

Squids’ birthday influences mating

Star bars show Universe’s early galaxies evolved much faster than previously thought

Critical minerals recovery from electronic waste

The move by Apple Memories to block potentially upsetting content illustrates Big Tech’s reach and limits, writes Chrys Vilvang

Chemical tool illuminates pathways used by dopamine, opioids and other neuronal signals

Asian monsoon lofts ozone-depleting substances to stratosphere

PET scans reveal ‘smoldering’ inflammation in patients with multiple sclerosis

Genetics predict type 2 diabetes risk and disparities in childhood cancer survivors

Health information on TikTok: The good, the bad and the ugly

New study points to racial and social barriers that block treatment for multiple myeloma

Rensselaer researcher finds that frog species evolved rapidly in response to road salts

A new chapter in quantum vortices: Customizing electron vortex beams

[] Rapid rise seen in mental health diagnosis and care during and after pregnancy
From depression and anxiety to PTSD, pre-pandemic decade saw increased diagnosis and treatment during perinatal period in those with private insurance