UIC PERINATAL MENTAL HEALTH PROJECT

Illinois

The Illinois Postpartum Depression Task Force has estimated that severe peripartum depression affects between 18,500 and 37,000 women annually statewide (Illinois Postpartum Depression Task Force, 2002). Statewide data demonstrate several factors that increase the risk of perinatal depression, and that increase barriers to treatment. A central risk factor is low socioeconomic status. Medicaid funds approximately 40% of live births in Illinois each year. For example, in 2001 (the most recent year for which full data are available), Illinois Medicaid covered 81,000 of the 184,022 births within the state, or 44.0% (Illinois Department of Public Aid, 2004). According to the 2001 Illinois Pregnancy Risk Assessment and Monitoring System (Illinois PRAMS), among women giving birth in Illinois, 27% noted difficulty paying bills, 15% experienced job loss, 14% had a spouse or partner who lost a job, and 7% were homeless. Another risk factor is youth. Illinois Medicaid covers approximately 18,000 births to teen mothers annually, which was 89% of all teen births in Illinois in 2001 (Illinois Department of Public Aid, 2004). A third key risk factor is unintended birth, which included 66% of Medicaid births in Illinois and 54% of total births in Illinois in 2001 (Illinois PRAMS, 2001).

Illinois Pregnancy Risk Assessment and Monitoring System (PRAMS) data also reveal high rates of perinatal risks known to be associated with untreated maternal depression. For example, in 2001, 13% of respondents reported low birth weight babies, and 12% reported premature births (Illinois PRAMS 2001). In Illinois in 2001, 5% of women giving birth reported drinking alcohol during pregnancy, and 13% reported smoking cigarettes during pregnancy (Illinois PRAMS 2001). About 5% of women giving birth in Illinois in 2001 reported being a victim of violence during a pregnancy (Illinois PRAMS 2001), the likelihood of which may be increased by depression (Adams Hillard 1985).

Widespread failure to identify lower-income women with perinatal depression is reflected in data from the Illinois Department of Public Aid (IDPA). For example, of the 81,000 women with Medicaid-funded deliveries in Illinois in 2001, only 607 received a diagnosis of depression (Illinois Department of Public Aid 2004). This is less than 1% of women giving birth. By the most conservative estimate, 7% of women in the general population would be expected to have a diagnosis of major depression postpartum, and in this high-risk population the rate would be expected to be considerably higher.

Another focus in Illinois has been on risks incurred by offspring whose mothers have untreated depression and comorbid addictive disorders. The Illinois Department of Children and Family Services (DCFS) systematically investigated risk factors for child maltreatment statewide, and found that the largest group of children entering the child welfare system were those of substance-abusing parents, many of whom had symptoms of depression. In the Intact Family Program, 49% of mothers used cocaine, 27% used heroin, 9% used alcohol, 4% used marijuana, and 2% used PCP, as their primary addictive substance (Kane 2004).

Information on Perinatal Depression
Approximately 7 – 20% of women giving birth develop major depression during late pregnancy and/or postpartum (Joseffson et al. 2001; Bennett et al. 2004). Peripartum psychiatric symptoms pose risks for offspring as well as for their mothers. Maternal depression during pregnancy can increase the risk of preterm labor (Dayan et al. 2002; Kelly et al. 2002; Orr et al. 2002), low birth weight (Kelly et al. 2002; Federenko and Wadhwa 2004), neonatal irritability (Zuckerman et al. 1990) and subsequent psychiatric problems in offspring (Jacobsen 1999). Untreated depression during pregnancy is also associated with increased use of addictive substances, which in turn increases rates of congenital anomalies, obstetric complications, and developmental problems in offspring (Zuckerman et al. 1989; Finnegan & Kandall 1997).

There is considerable evidence that peripartum depression is under-recognized and under-treated (Coates et al. 2004). Societal stigma associated with psychiatric diagnoses is one obstacle to recognizing symptoms and seeking treatment (Dinos et al. 2004). Another major contributory factor is insufficient training in the assessment and treatment of peripartum depression for primary health care providers. In a recent survey, for example, only 32% of obstetrician-gynecologists surveyed felt they had been adequately trained to treat depression (LaRocco-Cockburn et al. 2003). Administering antidepressant medication during pregnancy and breast feeding is a specialized skill that is not regularly included in medical school and residency training curricula (Spielvogel et al. 1995). Psychotropic medication pharmacokinetics are affected by pregnancy and lactation (Miller 2001), and medications differ in their relative risks during pregnancy and breast feeding (Altshuler et al. 2001). Psychotherapeutic techniques with proven efficacy for treating and preventing peripartum depression, such as interpersonal psychotherapy (O'Hara et al. 2000; Spinelli and Endicott 2003) are also not part of standard curricula for most health professionals.

In summary, despite the high prevalence of peripartum depression, and the substantial risks associated with untreated symptoms of peripartum depression, societal stigma and a paucity of specialized training for health care professionals pose formidable obstacles to the prompt recognition, diagnosis and treatment of depression in pregnant women and new mothers. The UIC Perinatal Mental Health Project aims to diminish those obstacles in Illinois.