Postpartum depression is only one aspect of the mental health picture when it comes to birthing individuals and parents, according to Assistant Professor of Social Work Rebecca Rouland.
"If you go back a couple of decades, postpartum depression was kind of a catchall term," Rouland said. "In my work, I prefer the term perinatal mental health conditions (PMHCs), which is more encompassing and reflects all the spectrums of mental health changes around birth."
Rouland notes a range of mental health experiences among birthing individuals, from mood and anxiety disorders to psychosis-conditions that all fall under the PMHC umbrella. She is particularly focused on how diagnosis and treatment rates vary among different demographic groups, highlighting the influence of race and socioeconomic factors.
In her recent paper, "Perinatal mood disorders among low-income birthing persons living in urban areas in the United States," co-authored with Robert Keefe, an associate professor at the University at Buffalo, Rouland investigates the reasons for disparities in perinatal mood disorders (PMD). The paper examines the intersection of geographical location, race, ethnicity, and economic status. While previous studies have documented higher rates of perinatal mental health conditions in marginalized populations, Rouland and Keefe identified a gap: the lack of a comprehensive analysis explaining why these disparities persist.
"We were completing data analysis of interviews with low-income birthing persons of color," Rouland explained, "and while pulling the literature for that, we realized that there was no paper that united all the different factors. There was no paper we could cite that explained the complex, intersectional 'why' of these disparities."
Barriers to care
Rouland explains that low-income birthing persons of color often experience racism and systemic bias, including from health care providers. This is further compounded by a historical mistrust of the medical system. Practical challenges such as unreliable public transportation, lack of insurance, and limited childcare further restrict access to care.
Many low-income individuals may not recognize symptoms of depression or other mental health conditions, or may hesitate to seek help due to cultural or self-stigma. And while the recommended treatment for perinatal mood disorders combines therapy and medication, Rouland notes that many mothers are reluctant to use medication due to cost and potential side effects.
Rouland and Keefe also found that low-income mothers of color often prefer working with social workers or professionals who offer broader support beyond mental health. "If health care providers can provide tangible resources - such as formula or diapers - mothers are more likely to be open to receiving mental health care and treatment."
The need for universal screening
Universal screening for perinatal mental health is strongly recommended but not required in the United States, unlike in countries such as Australia. Typically, screenings are conducted six to eight weeks after birth using the Edinburgh Postnatal Depression Scale (EPDS), a well-researched and freely available tool.
However, Rouland points out that mental health challenges often peak three to six months postpartum, which means that many cases go undetected at the standard six-week screening. She advocates for ongoing screenings from birth through the first year for a more comprehensive approach.
Still, Rouland cautions that screening is just a first step. "Screening indicates when follow-up is needed," she says, "but it's not a diagnosis or a guarantee that treatment will be required."
