Last week’s blog encouraged providers to learn more about postpartum depression from a patient’s perspective. This blog will discuss how we, as providers in the Military Health System, can help patients address these symptoms.
Pregnancy, childbirth, and motherhood can bring a wealth of positive experiences and emotions to service members. While the host of physical, emotional, behavioral, and social changes that come with a baby can be exciting, new mothers also can experience sleep problems, fatigue, worries, and feelings of unhappiness. In fact, up to 80 percent of new mothers experience some form of these “baby blues,” according to the National Institute of Mental Health.
A much smaller percentage of women experience clinically significant levels of depression during pregnancy or the postpartum period. Between 3-6 percent of new mothers develop a major depressive episode during pregnancy or the four weeks following delivery (identified with the “peripartum onset” specifier in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). Peripartum depression can significantly affect the well-being of both mother and baby.
Fortunately, the Military Health System provides service members with a spectrum of treatment options tailored to match the intensity of symptoms, ranging from early intervention for mild “baby blues” to more intensive specialty interventions for severe peripartum mood symptoms. Within primary care, pregnant women and new mothers experiencing the ups and downs of this life change can meet with an Internal Behavioral Health Consultant (IBHC), a psychologist or social worker trained to work on interprofessional primary care teams providing focused biopsychosocial assessment and intervention.
An IBHC might work with a pregnant service member on strategies for decreasing worry about childbirth or parenthood, or improving sleep despite the physical changes and discomforts of pregnancy. An IBHC might assist a new mother with adjusting to the demands of balancing parenting with her active-duty responsibilities, learning cognitive strategies for managing periods of sadness or anxiety, or implementing goals for gradually increasing physical activity to improve mood and meet required fitness standards.
If the severity of symptoms is high, if the patient’s functioning is significantly impaired, or if symptoms don’t improve with a primary care behavioral health intervention, the IBHC can facilitate and coordinate a referral for specialty behavioral health care. This higher level of care can include specialty evaluation for psychotropic medication (if not prescribed by the primary care provider) or a full course of an evidence-based psychotherapy for depression, such as cognitive behavioral or interpersonal therapy.
Additional resources for primary care and mental health providers:
- U.S. Preventive Services Task Force (USPSTF): Primary Care Screening for and Treatment of Depression in Pregnant and Postpartum Women: Evidence Report and Systematic Review
- National Institute of Mental Health: Postpartum Depression Facts (patient education brochure)
- American Family Physician journal: Identification and Management of Peripartum Depression
- Deployment Health Clinical Center: Information on depression treatment options and resources
- Deployment Health Clinical Center: Information and resources for suicide risk in military populations
Capt. Anne Dobmeyer is a U.S. Public Health Service psychologist in the Primary Care Behavioral Health directorate at Deployment Health Clinical Center. She specializes in clinical health psychology and the integration of behavioral health services into primary care clinics within the Department of Defense.
The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.