Listening to Our Mothers: Using patient experience to understand the heterogeneity of perinatal mood and anxiety disorders
In January 2016, the US Preventative Services Task Force (USPSTF) released revised depression screening recommendations for the general population, and for the first time included pregnant and postpartum women unique cohort in need of particular attention from health care providers. These revised guidelines have resulted in increased attention to the screening process and tools used in practice with perinatal women however, there are significant concerns over the lack of effective referral infrastructure in place to adequately diagnose and treat women who develop a perinatal mood and/or anxiety disorder (PMAD), like postpartum depression. Affecting approximately 15 - 20% of women who have given birth, PMADs place a tremendous burden on women, families and communities, and represent one of the largest public health challenges in the United States and around the world. Shrouded in shame and stigma, PMADs directly challenge cultural notions of motherhood as being a natural and blissful state for all women; a time of joy, celebration and happiness.The symptoms of PMADs are not homogenous however, strong feelings of inadequacy, failure, sadness, and anger, accompanied by anxiety, insomnia, lack of appetite and loss of pleasure in activities once enjoyed are often associated with a PMAD diagnosis.
Equally problematic is the language used to described the wide range of PMADs that can occur, with the term “postpartum depression” being applied to a range of clinical diagnoses including postpartum psychosis, obsessive compulsive disorder, long term sub-clinical depression and an a major depressive disorder occurring in the perinatal period. This ambiguity is reinforced by the absence of a stand-alone postpartum depression diagnosis within the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, and commonly used as the main source of diagnostic criteria for mental illness.This lack of differentiation is common and arguably creates misunderstanding among women and their health care providers; it may greatly impact the type of treatment and follow up offered, patient compliance with treatment, and generally slow the recovery process. Through a discussion of the clinical symptoms of PMADs contrasted by the actual patient experience with individual diagnoses, we will illustrate the wide variety of PMADs that fall within what we suggest is a “postpartum depression spectrum”. Our panel members will speak to their individual experience with a PMAD diagnosis that may include perinatal depression, anxiety, obsessive compulsive disorder and psychosis. Highlighting the challenges of each diagnosis as it pertains to individual symptoms, compounded by the difficulties of pregnancy and mothering an infant while navigating a significant life transition, our patient panel will humanize the PMAD experience.