A HIDDEN CRISIS: WOMEN'S POSTPARTUM MENTAL HEALTH

Although many people might consider sleep deprivation and changing dirty diapers to be the greatest struggles during the first year of having a baby, statistics show that women's postpartum mental health is of greatest concern. In fact, in the first year after a baby is born, "suicide is one of the top five leading causes of maternal death in the United States, accounting for approximately 20% of all maternal deaths" (Pratt et al., 2023, p. 1-2).

This statistic does not account for all the mental and physical challenges that arise during pregnancy and before birth. Other perinatal (i.e., the time period before and immediately after childbirth) and postnatal (i.e., a year after the birth otherwise known as 'postpartum') mental health disorders, including postpartum depression, postpartum anxiety, obsessive-compulsive disorder, posttraumatic stress disorder, bipolar disorder, and postpartum psychosis (Nguyen et al., 2023; Pratt et al., 2023), are rampant - affecting approximately 1 in 7 mothers in the United States (Nguyen et al., 2023). In addition to this severity and the serious nature of perinatal/postpartum mental health concerns, women are not often "treated to remission" meaning that treatment did not last long enough to fully address the mental health concern (Nguyen et al., 2023, p. 78). Further, these statistics may not capture the full extent of postpartum mental health challenges, as many women may have undiagnosed perinatal and postpartum disorders.

While the aforementioned statistics are at the national level, mental health challenges among postpartum military women are even more prevalent.

• Military mothers (i.e., active-duty, dependents, reservists, and retirees) experience mental health conditions almost 3 times more often than civilian mothers (United States Government Accountability Office, 2022; Maternal Mental Health Leadership Alliance, 2023).
• Statistics on pregnant women from 2017-2019 suggest that approximately 36% of TRICARE active-duty Service members and their dependents received a perinatal (i.e., prenatal and postnatal) mental health diagnosis (United States Government Accountability Office, 2022).
• Receiving a postpartum depression (PPD) diagnosis increased drastically from 2001 to 2018 such that in 2001 for every 1,000 Servicewomen, 1.96 were diagnosed with PPD whereas in 2018 29.95 Servicewomen were diagnosed with PPD (Nicholson et al., 2020).

Additionally, other research has found that although some Veteran mothers experience elevated symptoms of postnatal mental health disorders such as depressive disorder, PTSD, or pregnancy-related anxiety (Goger et al., 2022), they do not meet the established threshold to receive an official diagnosis, potentially limiting their access to resources and treatments needed to thrive during their postnatal period. Further, research suggests that compounding military-specific stressors such as combat deployment experiences, lack of access to maternity care through the Office of Veterans Affairs (VA), stigma around accessing mental health services, and the prevalence of military sexual assault may exacerbate perinatal and postpartum mental health challenges for military-connected women (Nguyen et al., 2023). Although the reality of the hidden crisis of women's perinatal and postpartum health is alarming, it is time to start bringing concerns about postpartum mental health to light, and so, we invite you to join us in a call to action.

One of the first steps in creating change is by spreading awareness that a crisis exists – we must talk about it! In addition to spreading awareness by talking about maternal mental health challenges, we need to:

1. Normalize that some changes in mood will occur during postpartum, but that major mental health challenges are abnormal and may need to be professionally addressed.
2. Stress the importance of new mothers asking for help, especially helping them understand what mental health symptoms or experiences may require professional support (see the WIC Works Resource System: Resources website as a place to start).
3. Share resources with parents (i.e., both the mother and her partner) to support their parenting journey.

All efforts that promote awareness of the maternal health crisis, no matter what size, are needed.

• Share this article with a friend to start a conversation.
• Learn how to talk to a new mother experiencing depression and listen to military moms share their birth stories to better understand their experiences.
• When talking with others about the mental health needs of postpartum women, emphasize the severity of the need and how rates of postpartum difficulties are increasing.
• Advocate for increased support for military families at your place of employment and in your community with this key fact sheet on Military Maternal Health.
• Contact your U.S. Representative and Senator and ask for more support for military mothers like increasing paid leave for military parents and to support bills like the Federal Moms Matter Act.
  • Find your U.S. Representative
  • Find your U.S. Senator

Thankfully there are supports and resources available to help Servicewomen and their families if postpartum difficulties arise (Herrick & Chai, 2023), but we need to do our part to make sure these resources get into the hands of those who need them the most.

• Postpartum Support International: Help for Military Families
• The National Maternal Mental Health Hotline can help. Call or text 1-833-TLC-MAMA (1-833-852-6262).
  • This hotline is for mothers as well as healthcare providers and those calling on behalf of someone.
• Veterans Crisis Line: 1-800-273-TALK (8255), PRESS 1. To chat, use their Crisis Chat. To text, send a text to 838255.
• Potential Signs of Postpartum Depression
• Depression in Pregnant Service Members: Three Things Providers Can Do to Help
• Postpartum depression and anxiety: How to start the conversation
• USDA Maternal Mental Health Resources
• NIH Moms' Mental Health Matters
• USDA Maternal Depression: Everyone can play a role to Help Families Thrive

Goger, P., Szpunar, M. J., Baca, S. A., Garstein, M. A., & Lang, A. J. (2022). Predictors of early postpartum maternal functioning among women veterans. Maternal and Child Health Journal, 26, 149-155 https://doi.org/10.1007/s10995-012-03241-0

Herrick, M. S. R., & Chai, W. (2023). Incidence of postpartum depression decreases after initial expansion of military maternity leave. Military Medicine. Article usad354. https://doi.org/10.1093/milmed/usad354

Maternal Mental Health Leadership Alliance. (2023, May 17). Military Mothers Experience Maternal Mental Health Conditions Almost 3 Times More than Civilians. MMHLA Takes Steps to Solve this Issue. Maternal Mental Health Leadership Alliance: MMHLA. https://www.mmhla.org/articles/military-mothers-experience-maternal-mental-health-conditions-almost-3-times-more-than-civilians-mmhla-takes-steps-to-solve-this-issue

Nguyen, M. H. (Theresa), Semino-Asaro, S., Reminick, A. M., Rukaj, A. T., & Connelly, C. D. (2023). Barriers to and facilitators of military spouses' recovery from perinatal mental health disorders: A qualitative study. Journal of Military, Veteran and Family Health. Advance online publication. https://doi.org/10.3138/jmvfh-2022-0067

Nicholson, J. H., Moore, B. A., Dondanville, K., Wheeler, B., & DeVoe, E. R. (2020). Examining the rates of postpartum depression in active duty US military servicewomen. Journal of Women's Health, 29(12), 1530-1539. https://doi.org/10.1089/jwh.2019.8172

Pratt, Alessandra A., Anne G. Sadler, Emily B. K. Thomas, Craig H. Syrop, Ginny L. Ryan, and Michelle A. Mengeling. “Incidence and Risk Factors for Postpartum Mood and Anxiety Disorders among Women Veterans.” General Hospital Psychiatry 84 (2023): 112–24. https://doi.org/10.1016/j.genhosppsych.2023.06.013

United States Government Accountability Office. (2022). Defense health care: Prevalence of and efforts to screen and treat mental health conditions in prenatal and postpartum TRICARE beneficiaries (Report to Congressional Committees GAO-22-105136; pp. 1–54). United States Government Accountability Office. https://www.gao.gov/assets/gao-22-105136.pdf