Introduction
Although pregnancy and parenthood are frequently viewed as joyful experiences, many women around the world have emotional difficulties that can have a serious negative impact on both their own and their children's health. Mental health conditions like anxiety and depression are common among pregnant and postpartum women worldwide, but obstetrics and gynecology (OBGYN) procedures at the moment do not adequately address these problems.
It’s considered the responsibility of OBGYNs to recognize and address mental health issues, but many of them lack the appropriate training and resources to do so effectively. Improving patient satisfaction, promoting a more all-encompassing approach to women's health, and improving health outcomes all depend on the integration of mental health services within OBGYN treatment. In this blog post, we’re going to look at both the science and the business case for incorporating mental health services into OBGYN practices, especially during pregnancy and postpartum.
Body
Firstly, let’s discuss the scientific aspect behind mental health in OBGYN care. There are many women around the world who experience mental health issues, both during and after childbirth. Postpartum depression, depression that comes within a year of delivering a baby, affects more than 1 in 10 women annually. In the U.S., postpartum depression, or PPD, is very common, affecting more than 3 million women across the country per year. (1) Women with postpartum depression often feel anxious and experience excess periods of lethargy, withdrawal, lack of interest in the outside world, difficulty with self-care, and overall sadness. Those who develop postpartum depression are also at a greater risk of developing major depression later on in their lives. (2)
So what can we do to ensure that these women receive the proper care and treatment that they deserve not just physically, but also on a mental and emotional scale? Some possible solutions include screening tests for mental health amongst pregnant and postpartum women, and business partnerships between OBGYN practices and mental health practitioners. But with this comes one major business aspect that can mess with the efficiency and integration of such solutions in hospitals - cost.
Screening examinations play a crucial role in the prevention and identification of possible mental health related issues for both pregnant women and postpartum women. One type of screening examination, the Perinatal Anxiety Screening Scale, or PASS, is used to assess the mental and emotional state of women both during the pregnancy and postpartum period. Specifically, it looks for different forms of anxiety, such as social anxiety, panic disorders, OCD, and PTSD, relating to fears and anxieties that may affect a pregnant or freshly new parent. (3)
In the case of postpartum depression, one of the most common yet effective questionnaires is the Edinburgh Postnatal Depression Scale (EPDS). This type of screening includes 10 questions about the mother’s moods and thoughts. She must underline the response that comes closest to how she has felt over the course of the previous week. (4) The test uses the information provided to assess the mother’s state of mind, and whether she may be at risk for postpartum depression or already have it. It was developed to help OBGYN practices in identifying and treating new mothers with mental health issues. By preventing the occurrence, the incidence of this type of depression can be lowered, and more patients can be found and treated as well. (5)
A few examples of questions on the EPDS questionnaire
But what good is it to diagnose a mother with PPD, but not have the resources or funding to treat her properly afterwards? Luckily, this isn’t the case. Most mental health screenings during pregnancy or the postpartum period have cost effectiveness ratios, or the difference in costs of a product divided by the difference in outcomes (in simpler words, how effective the cost of the product is in relation to the revenue of its results - “is it worth it?”), that are relatively up to mark. Take the Edinburgh Postnatal Depression Scale exam, for example. With the EPDS, the incremental cost effectiveness ratio was around $27,500 per QALY in 2022. (6)
To make this make more sense, cost effectiveness is measured with QALYS, a system that allows for the comparison of the efficiency of various health interventions that are used for various conditions, using the same units. In other words, the QALY measures the cost effectiveness for different products and is an outcome that can be compared across different types of interventions. (7) Overall, since, in the United States, medical interventions that cost less than $50,000 to $60,000 per QALY gained are deemed reasonably efficient, the EPDS, which falls under this criteria with a cost of around $27,500 per QALY, can be considered cost effective for hospitals and other places of care and treatment to incorporate into their mental health program structure. (8)
Conclusion
Incorporating mental health services into OBGYN care is more than necessary for tackling the emotional challenges faced by pregnant and postpartum women. With so many women around the globe experiencing disorders such as postpartum depression, screening tools like the Edinburgh Postpartum Depression Scale are not only crucial for the detection, identification, prevention, and treatment of such disorders, but are also cost-effective. By using such business strategies, making mental health a priority in OBGYN care and women's healthcare becomes easier and more favorable for everyone, ensuring that soon-to-be mothers and mothers receive the proper mental and emotional care they deserve during this huge moment of their lives.
Bibliography:
- Better Health Channel. (2022). Postnatal depression (PND). Vic.gov.au. https://www.betterhealth.vic.gov.au/health/healthyliving/postnatal-depression-pnd
- NHS. (2022, August 4). Postnatal Depression. NHS. https://www.nhs.uk/mental-health/conditions/post-natal-depression/overview/
- Screening Tools - PEACE for Moms. (2024, March 4). PEACE for Moms. https://www.peace4momsga.org/for-professionals/screening-tools/
- MedlinePlus. (2017a). Postpartum Depression Screening: MedlinePlus Lab Test Information. Medlineplus.gov. https://medlineplus.gov/lab-tests/postpartum-depression-screening/
- MedlinePlus. (2017b). Postpartum Depression Screening: MedlinePlus Lab Test Information. Medlineplus.gov. https://medlineplus.gov/lab-tests/postpartum-depression-screening/
- Heslin, M., Jin, H., Trevillion, K., Ling, X., Nath, S., Barrett, B., Demilew, J., Ryan, E. G., O’Connor, S., Sands, P., Milgrom, J., Bick, D., Stanley, N., Hunter, M. S., Howard, L. M., & Byford, S. (2022). Cost-effectiveness of screening tools for identifying depression in early pregnancy: a decision tree model. BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-08115-x
- Jacobs, J. (2016). HERC: Cost-Effectiveness Analysis. Va.gov. https://herc.research.va.gov/include/page.asp?id=cost-effectiveness-analysis
- Owens, D. K. (1998). Interpretation of cost-effectiveness analyses. Journal of General Internal Medicine, 13(10), 716–717. https://doi.org/10.1046/j.1525-1497.1998.00211.x
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