Half of all pregnant women who experience depression do not get any treatment, and some may turn to alcohol, marijuana, and opioids to self-medicate, a study of national data found.
The research, which was published this month in Psychiatric Services in Advance, involved responses from 12,360 women to the National Survey on Drug Use and Health between 2011 and 2016. Researchers compared responses for pregnant and nonpregnant women between the ages of 18 and 44, all of whom had an episode of major depression.
They found 51 percent of pregnant women and 43 percent of nonpregnant women did not get any treatment for depression.
“In general, treatment rates are very, very low,” said Maria X. Sanmartin, a coauthor of the study and assistant professor of health professions at Hofstra University.
But pregnant women seem to be particularly underserved. Even among those who did get some treatment, pregnant women were significantly more likely to say it was not enough to meet their needs.
“What we would expect is that pregnant women are visiting the ob-gyn more and they should have more opportunities to see a psychologist or psychiatrist,” Sanmartin said. “But that is not what we found.”
Guidelines from both the U.S. Preventive Services Task Force and the American College of Obstetricians and Gynecologists recommend doctors screen all pregnant women for depression and refer those at risk to counseling.
The study didn’t ask women if they were screened, but maternal-health experts say depression in pregnant and postpartum women is consistently underdiagnosed. Many women are not asked about depression symptoms, and even those who are may feel too ashamed to answer truthfully.
For women of color, an added fear of child welfare services deeming them unfit can keep women from admitting symptoms and seeking care.
When mental illnesses go untreated, there can be serious consequences, research shows — from deteriorating physical health for the mother to developmental delays for the baby. People with untreated mental illness are also at higher risk for substance use.
The study found that in the month before women took the survey, 23 percent of pregnant women reported using alcohol, 17 percent used marijuana, and 6 percent used opioids. That indicates a significant health concern for mother and child, Sanmartin said.
In Pennsylvania, more than 3,000 drug-exposed newborns were born in 2017 — a number that has soared over the last decade as the opioid crisis grows. Experts suggest getting women proper mental-health and substance-use treatment could lower these numbers.
But what should treatment look like?
Maternal mental-health guidelines suggest therapy and consultations with a psychiatrist should be the first option. Yet the study found prescription medication was the most prevalent form of treatment among pregnant women.
“The easiest way to cope with these things is to just give medication,” Sanmartin said. “But medication alone might not be what would help the patient.”
The American Psychiatric Association says there is growing evidence that it’s safe for pregnant women to use antidepressants, and they can be helpful for some. But combining medication with therapy helps people address environmental and social factors that influence their mental health too.
Often, cost gets in the way, Sanmartin said.
The study found both pregnant and nonpregnant women cited financial concerns as the main barrier that kept them from getting treatment. More than three-quarters of the women in the study had insurance, but some had high deductibles or could not afford the copay.
Under the Affordable Care Act, all insurance plans are required to cover mental health and substance use treatment. But that doesn’t necessarily make accessing care easy or affordable.
Studies have shown many insurance plans have few in-network mental-health providers, forcing people to pay high fees for an out-of-network provider or skip treatment altogether. Add to that the shortage of psychiatrists across the nation and wait times for appointments that can stretch weeks, and the obstacles can be insurmountable for some.
Sanmartin said it would help to have doctors work in teams — an ob-gyn with a psychiatrist, for example — to detect depression in pregnant women and improve treatment rates.
It’s also crucial to improve patient education, she said. Doctors need to let women know about the possibility of experiencing depression during pregnancy and that there are treatment options. “Otherwise women might not know it’s not normal what they’re feeling,” she said.