Uncovering the urgent need for postpartum mental health care in Canada
Well-being during the first year after childbirth can have long-term effects on mothers and children alike. It’s also a period when mothers are at higher risk of developing mental illness, and the pandemic has only exacerbated those risks. Dr. Simone Vigod and her team are studying postpartum mental health care in Canada, and what we can do to ensure help is available during the pandemic and beyond.
What is Postpartum mental illness?SV: The postpartum period, generally thought of as the year following childbirth, is a high-risk time for new-onset and recurring mental illnesses. Common mental illnesses that occur postpartum include depression, and anxiety and related disorders. Bipolar disorder and psychosis can also occur, with the weeks following delivery being a particularly high-risk time. Postpartum mental illness poses unique risks to both mothers and children at a critical time. Untreated or undertreated mental illness in the postpartum period is linked to short and long-term problems with health and well-being for mothers – and to socioemotional and developmental difficulties in their children.
What motivated this research?
SV: The COVID-19 pandemic has created stress for many individuals and communities, related to illness and loss, as well as to financial and social burdens. Postpartum people in particular have been disconnected from the extended social support networks and key community programs that protect against mental illness, such as home visits from public health nurses, breastfeeding clinics, and support groups, owing to public health containment measures. National surveys suggested increased levels of distress around the time of pregnancy during the pandemic – but whether this distress was translating into an increased need or demand for health care for postpartum mental illness was not known.
What was the most important finding of this study, in your opinion?
SV: Our results showed that from April to November 2020 the use of health care services for postpartum mental illness was consistently about 25-30% greater than what would have been expected based on pre-covid patterns. This suggests that the distress observed in population surveys was translating into more service utilization. That being said, some populations that we might have expected to need more care did not increase their service use. This raises concerns about whether – even with the increased utilization – there was unmet need for care.
How does this change treatment for postpartum people in the future?
SV: With about 400,000 births in Canada each year, if even 10% of postpartum individuals experience mental illness, that means that more than 40,000 children and families are affected annually. As such, even small improvements in care delivery can have a large public health impact over generations. The results from this study demonstrate that ensuring timely, equitable access to evidence-based treatments for postpartum mental illness is even more urgently needed than in years past – and I hope that our decision-makers will invest in the supports and services needed to ensure the best outcomes in this important population. Health systems should focus proactively on patients from high-risk groups, monitor waiting lists for care, and explore creative solutions to expand system capacity, with special attention to postpartum patients who may be experiencing barriers to care.
Any next steps?
SV: Now that we have identified need, it is important to intervene to be able to identify, assess, and provide treatment for individuals in need. We are working on several research projects designed to ensure that postpartum individuals can easily access the right kind of care to meet their needs. At Women’s College Hospital, we have recently launched a virtual platform called rMOVIN – the Reproductive Mental health of Ontario Virtual Intervention Network . Individuals up to 12 months postpartum can participate in our trial of this comprehensive virtual platform that includes live chats with a care coordinator and connections to virtual care options including psychological services and specialized reproductive psychiatrists as needed. We have about 50 spaces left in our initial trial, and if successful, will increase the size of the program in Fall 2021.
What is the major take home message for the public?
SV: Postpartum mental health needs are important to address during and after this pandemic, to support the well-being of mothers, children and families across generations.
Vigod SN, Brown HK, Huang A, Fung K, Barker LC, Hussain-Shamsy N, Wright E, Dennis CL, Grigoriadis S, Gozdyra P, Corsi D, Walker M, Moineddin R. Postpartum mental illness during the COVID-19 pandemic: a population-based, repeated cross-sectional study. CMAJ. 2021 Jun 7;193(23):E835-E843. doi: 10.1503/cmaj.210151.