Perinatal Mental Distress in Rhode Island: Data to Guide Decision-Making.

Rhode Island stakeholders in maternal health consistently identify mental health as a priority area. It is probable that the hormonal and biochemical changes associated with pregnancy and delivery contribute to perinatal mental and emotional difficulties. However, modifiable social factors are also strongly associated with perinatal mental distress.1 We analyzed data on stressors and adverse circumstances from the Centers for Disease Control and Prevention (CDC)’s Pregnancy Risk Assessment and Monitoring System (PRAMS) to help stakeholders identify opportunities for interventions to reduce the scale of perinatal mental distress in the state. Most discussion of perinatal mental health focuses on postpartum depression, but this captures only part of the range of perinatal mental distress,2 missing other conditions like anxiety and stress.3 Likewise, estimates based solely on clinical diagnoses rather than symptomology more broadly may underestimate the scale of the problem.3,4 Previous studies have provided inconsistent results about the demographic distribution of mental distress, and there have been varied approaches to analyzing the role of stressors or adverse circumstances, e.g. clustering into categories or providing counts.2,4-9 However, simply counting stressors provides little guidance to stakeholders trying to understand what exactly should be addressed for maximal public health impact. We analyzed the potential population impact of targeting specific stressors, with the goal of providing calculations to stakeholders trying to select among multiple social factors to address. Since women generally have more provider contact during the perinatal period than any other time in their lives,10 these contacts are also an important opportunity to address mental distress well beyond the perinatal period, especially in light of the ACA’s expansion of the range of care for both childbearing women and mental health in general.