By the Kansas Chapter of Postpartum Support International Board of Directors
The Kansas Chapter of Postpartum Support International (PSI-KS) is dedicated to improving awareness, support and treatment in Kansas for perinatal mood and anxiety disorders. Fifteen to 20 percent of mothers experience prenatal or postpartum depression, making this the most common complication of pregnancy and childbirth—above preterm delivery, gestational diabetes or hypertension.
According to the 2018 Kansas Pregnancy Risk Assessment Monitoring Systems (PRAMS) Surveillance Report, 18 percent of postpartum women in Kansas reported experiencing symptoms of depression in the first six months postpartum. Fathers are also at risk of increased anxiety and depression surrounding the birth of a child, at a 10 percent prevalence rate. In addition to depression and anxiety, perinatal mood and anxiety disorders include adjustment disorders, obsessive compulsive disorders, post-traumatic stress disorder, postpartum psychosis and bipolar disorders. The causes of perinatal mood and anxiety disorders are complex and multi-faceted, pointing to a combination of biological and psychosocial risk factors, ranging from hormonal changes to the stress of a major life transition and inadequate support. Although perinatal mood and anxiety disorders impact parents of all socioeconomic backgrounds, the rate of perinatal mood and anxiety disorders almost doubles among low-income parents and people of color.
Untreated perinatal mood and anxiety disorders can have lifelong negative impacts on child development, individual well-being and family function. There are potential neurological, behavioral and psychological adverse impacts for children whose parents suffer chronically untreated mental illness and in extreme cases can contribute to child abuse and infanticide. Perinatal mood and anxiety disorders may prevent secure attachment/bonding between parents and the infant. Untreated mental health complications in pregnancy impact pregnancy health and fetal development, increasing risk of preterm labor, low birth weight and NICU stays. Mothers with perinatal mood and anxiety disorders are also less likely to meet their breastfeeding goals. Suicide is also a risk of perinatal mood and anxiety disorders. While the U.S. does not currently report maternal suicide rates, suicide is a leading cause of maternal deaths in the U.S. and the second leading cause of death among women of reproductive age. Perinatal mood and anxiety disorders also increase marital distress and are associated with higher divorce rates. In the western culture, this transition to parenthood is typically a time in which most couples show a significant decline in relationship satisfaction. Rates for domestic violence spike during pregnancy and in the year following childbirth. Fortunately, effective evidence-based treatment is available and has been shown to mitigate the adverse impact of perinatal mood and anxiety disorders.
PSI-KS commends our state for recent efforts to expand screening for perinatal mood and anxiety disorders as well as perinatal substance use disorders through the Kansas Connecting Communities (KCC) collaborative efforts. The significant efforts of the KCC initiative is bridging gaps to increase screening, identification and treatment of perinatal mood and anxiety disorders. While this effort will undoubtedly improve perinatal mental health care for many mothers in Kansas, these efforts will not reach their full potential when too many parents cannot afford treatment due to lack of health insurance coverage. The postpartum appointment and well-child visits are key point for screening for these disorders, however, health care coverage by Medicaid for low-income mothers who qualified through pregnancy-based coverage ends following the six-week postpartum exam. Additionally, fathers do not qualify for this coverage at all and are often left without treatment options. Therefore, many parents cannot afford to follow up with psychiatric assessment or treatment after being identified through a screening as at risk. Even parents who qualify for sliding scale services often face difficult choices between paying for mental health care or paying their bills. In addition to cost, additional barriers include long wait times and lack of maternal mental health trained providers.
The struggle to access affordable health care is very real and experienced all too often by low-income parents in Kansas. In a recent dissertation study on perinatal mood and anxiety disorders in Kansas, one mother shared, “After the twins were born and after I was out of the hospital six weeks postpartum my insurance ended because I was getting it through [Medicaid]. So I didn’t have the money to continue going [to therapy]…. I thought about maybe trying another medication [but] I wouldn’t have been able to pay for it, so I didn’t want to start on it and then have to stop it because it can become worse if you suddenly stop the medicine.” This mother was still experiencing severe depression and anxiety three years after childbirth, which also impacted her ability to reenter the workforce. Another mother, who had an auto-immune condition in addition to her mental health symptoms reported, “If I run out of my prescriptions, if I don’t have my medicine, I’m not able to function. If I’m unable to function that means I’m not able to be productive and that means I’m not able to be a good mother, [a good] Christian, I mean, everything because I become a miserable person.”
The consequences of untreated perinatal mood and anxiety disorders are poor prenatal care in subsequent pregnancies, risk of medical/obstetrical complications, exacerbation of psychiatric illness beyond the postpartum period, self-medication/substance use, impaired bonding/attachment and adverse outcomes for the child or children. KanCare expansion is a family-friendly policy, as it allows access to affordable health care and has lifelong positive impacts on the well-being of parents and, in turn, the children they are raising. Therefore, PSI-KS advocates Medicaid expansion as key to our mission of supporting parents and improving access to effective health care for perinatal mood and anxiety disorders.
Authored by the PSI-KS Board of Directors: Melissa Hoffman, President; Taylor Ulrey, Vice President; Carrie Wendel-Hummell, Treasurer; Christy Schunn, Secretary; Anjali Kansal-Rill, Chapter Liaison; Taryn Zweygardt, Social Media Director