LA JOLLA, CALIF. – An estimated one in five pregnant and postpartum women have significant mental health problems, yet few seek help, Pec Indman, Ed.D., M.F.T., said at the annual meeting of the Anxiety and Depression Association of America.
"Many things get in the way of women getting the help they need, including the cost of treatment," said Dr. Indman, a women’s mental health counselor who practices in San Jose, Calif. "They wonder how they’re going to pay for it. Many people don’t think that health insurance will cover mental health, particularly something related to pregnancy or postpartum. Usually there is coverage."
Dr. Pec Indman
Limited time is another perceived barrier. With a new baby in your life, "who has time if you’re working or if you have other children in the home?" she said. "There’s also the potential loss of pay from work. How can you miss work to get the help you need if you go back to work after your maternity leave?"
Then there’s the concern about child care coverage. "I can’t tell you how many women are relieved when I say, ‘If you need to bring the baby [to your next treatment session], you’re welcome to,’ " Dr. Indman said. "The assumption that they can’t bring their baby to treatment really gets in the way of their ability to take the next steps."
Lack of clinician knowledge about prenatal and postpartum depression and anxiety is another big obstacle to treatment. During her own training, Dr. Indman said, "no one ever mentioned anything related to pregnancy or postpartum mental health issues. One of the things we’re working to do is train providers in this very specific field." Organizations such as Postpartum Support International provide resources for social support and professional education.
Psychological barriers also affect a woman’s ability to seek help. "The illness itself gets in the way," noted Dr. Indman, director of women’s health for RegroupTherapy.com, which offers online video support groups and psychotherapy. "The nature of depressive thinking is that ‘I’m helpless. There is no hope for me. I’m doomed.’ There’s also a certain social stigma about postpartum depression and the fear of admitting you’re having a hard time, the fear of not knowing what to expect with psychotherapy or with [seeing] a psychiatrist. Often there is a lack of support and opposition to treatment, including medication. I have had [clients] kicked out of community organizations and churches for seeking treatment."
In Dr. Indman’s opinion, telemedicine holds great promise as a way to assist women with mental health issues by "helping them understand that they’re not alone" in their struggles. She pointed to a Veterans Affairs study that tracked the impact of telemental health services among 98,609 patients between 2006 and 2010 (Psychiatr. Serv. 2012;63:383-5). It found that the use of telemedicine reduced the psychiatric admissions by an average of 24% and the number of hospitalization days by an average of 27%.
"Improving access to health care really makes a difference," she said of her experience facilitating treatment sessions via RegroupTherapy.com. "I have found that you can do therapy quite effectively, including group therapy."
Dr. Indman said she had no relevant financial conflicts to disclose.