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Perinatal mood & anxiety disorders (PMADs): Resources for healthcare providers

Find resources about perinatal mood and anxiety disorders for healthcare providers.
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How do PMADs impact my patients, including parents, caregivers, and infants?

Perinatal mood and anxiety disorders (PMADs) can impact parents, caregivers, and infants in many ways including:

  • Less participation in prenatal, postpartum, and primary care visits
  • Increased risk of smoking and substance use
  • Increased risk for obstetric complications
  • Challenges with bonding and attachment
  • Increased use of infant emergency department, leading to higher costs
  • Negative impact on sustained breastfeeding
  • Lower likelihood of:​
    • Attending well-child visits​
    • Completing immunizations​
    • Using home safety devices​
    • Placing infant in recommended sleeping position​

In addition, extensive research suggests that untreated PMADs is can have adverse effects on an infant’s development, including behavioral, cognitive, and health-related issues.

Importance of screening for PMADs

Health care providers serving pregnant and postpartum people have a unique and valuable position in screening for mental health disorders early and referring them to appropriate treatment. Universal screening for PMADs is essential for early identification and improving outcomes for parents, infants, and families. While obstetric and pediatric professions are typically associated with this care, there are many other health professionals that also serve people who are pregnant or given birth in the past year. Pregnant and birthing people may seek help for various concerns or symptoms, so it’s important for all health care providers to be aware of the options for screening and referrals for PMADs

Several national organizations have recommended universal screening:

Screening tools

Screening for perinatal mood and anxiety disorders with a standardized, validated screening tool allows healthcare providers to gain insights about a family’s situation and their current stressors. Screenings can help reduce stigma, create trust between the patient and healthcare provider, and identify barriers that may interfere with a family reaching their goals.

Validated screening tools for perinatal mood and anxiety disorders include:

Perinatal mood and anxiety disorderScreening tool/description
Postpartum depression (PPD)DPH-approved validated PPD screening tools
Perinatal anxietyGeneralized Anxiety Disorder 7-item (GAD-7) scale
Bipolar spectrum disorderMood Disorder Questionnaire
Obsessive compulsive disorder (OCD)Yale Brown Obsessive Compulsive Scale
Posttraumatic stress disorder (PTSD)Primary Care PTSD Screen for DSM-5 (PC-PTSD-5)
Postpartum psychosisCurrently, there is no validated screening tool specific to postpartum psychosis. A diagnosis must be made by a healthcare provider based on the patient’s presenting symptoms. Healthcare providers can reference the National Institute of Health’s publication on Treatment for Major Depression with Psychotic Features for more information.

What do I say to a parent or caregiver who may be experiencing a PMAD?

It’s important to normalize perinatal mood and anxiety disorders by using nonjudgmental and supportive language when screening your patients. Here are examples of phrases you can use when talking to your patients:

  • “Being a new parent or caregiver can be an incredibly wonderful and incredibly overwhelming experience, and it is normal to feel both.”
  • “We know that PMADs are common in many people after giving birth, so I talk to all the families I work with about this.”
  • If your patient’s screening is negative, you could say “I’m glad nothing like this is going on for you. Since many parents experience depression, we would like to share this brochure to help you support a friend or family member who might be going through something like this.”
  • If your patient’s screening is positive, you can remind them that PMADs are treatable and that you will connect them with the support and resources they need.

You can also use the recommendations below to have supportive conversations with your patients about PMADs:

  • Provide positive reinforcement whenever appropriate
  • Strengthen parental coping skills
  • It is important to note that in many cultures, PMADs are associated with stigma, shame, and misinformation. Approach your patient with cultural humility to foster open discussions and a better understanding about mental health and parenting or caregiving.
  • Create opportunities to strengthen and expand social support networks and connections for caregivers
  • Refer families to resources and services that address poverty, housing instability, food insecurity, violence prevention and support, substance use treatment, and other significant stressors that become more acute in pregnancy and postpartum
  • Remind families that screening, diagnosis, and therapeutic support for PMADs do not make them a bad person

What treatment options can I refer to my patients?

Counseling and therapy

Both counseling and therapy can be effective ways to help parents address their feelings, thoughts, and actions. Parents and caregivers struggling with PMADs can benefit from therapy by learning new ways to cope with stress and manage their feelings. Including significant others such as partners, spouses, and other family members in treatment can also help improve communication and gain their support during difficult times. Counseling can be tailored to meet the patient’s individual needs. Counseling sessions can be held in person or virtually, either through one-on-one sessions or a formal group therapy program, depending on what works best for the patient.

Medication

Psychiatric medications can be effective in treating PMADs. If you believe your patient might benefit from medication, health care providers can call MCPAP for Moms to help find an appropriate medication and/or a therapist for your patient.

Support groups

Support groups can be helpful in a variety of ways, including:

  • Helping parents make connections with other parents struggling with PMADs
  • Learning helpful and practical coping skills from other parents
  • Reduces a sense of isolation

You can use the resources below to find a support group for your patient:

Additional strategies & resources

In addition to therapy, support groups, and medication, many parents benefit from other resources including breastfeeding supports, home visiting services, or doula services. Other activities such as yoga, exercise, or meditation can also help reduce stress and improve overall well-being. You can check your local hospitals or clinics, libraries, community centers, and other community resources that host parent support groups to refer your patients. 

How can I find a clinician or a prescriber for my patient?

MCPAP for Moms supports providers serving pregnant and postpartum parents and their children up to one year after delivery to effectively prevent, identify, and manage mental health and substance use concerns.

Providers working with a perinatal person can call MCPAP for Moms at 855-Mom-MCPAP (855-666-6272) to request real-time phone consultation and referral to resources, Monday to Friday, 9:00am–5:00pm. A care coordinator will work with you to determine the patients’ needs such as consultation for psychiatric care, local perinatal counselors, community care coordination, and more.

Providers can also enroll their practice into MCPAP for Moms to gain access to:

  • Trainings and toolkits
  • Real-time psychiatric consultation
  • Linkages with community-based resources customized to your patients (e.g., insurance, language preference, geography)
  • Newsletters
  • Quarterly webinars

Regulation on postpartum depression (PPD) screening reporting requirements

Refer to the documents below for the screening and reporting regulations for postpartum depression or contact ppd.regulations@mass.gov for more information:

Resources

Helplines & services for parents and caregivers

  • Massachusetts Postpartum Support International (PSI)
    A toll-free and confidential warm line that provides support, listings of local counselors, support groups, and information in Massachusetts. Leave a message and a trained volunteer or staff person will return your call within 24 hours.​ Available in Spanish.
    Phone: (866) 472-1897
    Email: psiofmass@gmail.com
  • National Maternal Mental Health Hotline
    24/7, free, confidential hotline for pregnant and new parents. Available in English and Spanish​.
    Phone: 1-833-TLC-MAMA (1-833-852-6262)​
  • Massachusetts Behavioral Health Help Line
    Call or text 833-773-2445
    Available 24/7, including holidays. Free, confidential, and no health insurance is required.​ Real-time interpretation in 200+ languages.​
  • The Day Hospital at Women & Infants Hospital
    Offers short term, intensive mental health treatment in a day treatment facility for pregnant and postpartum people experiencing PMADs. This facility is in Providence, Rhode Island and accepts MassHealth.
  • Community Behavioral Health Centers (CBHCs)
    Offers a wide range of mental health and substance use services and treatment. Crisis services are available 24/7 for anyone in Massachusetts who feels they may be experiencing a mental health crisis, whether or not they have health insurance.

Clinical recommendations & support

Additional resources

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