Four out of ten low-income Vermont women who gave birth in the last year, had depression during the 3 months before pregnancy, compared to 12.3% of all mothers. This is according to the Pregnancy Risk Monitoring System, a survey of women who recently gave birth that asks about their experiences, behaviors and healthcare utilization before, during and shortly after their pregnancy. Vermont mothers reported significantly higher rates of depression before and during pregnancy but did not report a higher rate of postpartum depressive symptoms. Among Vermont mothers, rates of depression before and during pregnancy were higher among younger women, women without any college education, and those enrolled in WIC during pregnancy. WIC enrollees were also significantly more likely to report postpartum depressive symptoms.

As many as one in five women suffer from symptoms of depression and anxiety before, during or after pregnancy, making this one of the most common complications of pregnancy. Depression and anxiety before, during, and after pregnancy — also known as perinatal mood and anxiety disorders — can have serious impacts on maternal health and well-being, and long-lasting impacts on children’s cognitive, behavioral, and academic development.

New findings contradict the longstanding view that symptoms begin only within a few weeks after childbirth. In fact, depression often begins during pregnancy and can develop any time in the first year after a baby is born. Recent studies also show that the range of disorders women face is wider than previously thought.

Studies indicate that maternal stress may undermine women’s ability to bond with or care for their children, and that children’s emotional and cognitive health may suffer as a result. Depression and anxiety can impact children from birth into adolescence and beyond, affecting:

• Birth outcomes (poor nutrition, preterm birth, low birth weight, spontaneous abortion)
• Cognitive development and behavioral challenges in infancy, toddler, and school age children
• Academic problems in adolescence

Low-income women are at greater risks for depression and the impacts of depression and have less resources and services available to them.

• Vermont Department of Health
• Department of Mental Health
• Blueprint for Health/Women’s Health Initiative
• Children’s Integrated Services
• Vermont Child Health Improvement Program
• Designated mental health agencies
• Women’s health and pediatric health care providers
• Community organizations

This topic demands a multi-tiered approach that includes the coordination and integration of primary care (adult and pediatric), obstetrics, mental health, community-based services, and education and information to pregnant and parenting women, their families, and circles of support.

Vermont is one of seven recipients of the Health Resources Service Administration (HRSA)-funded cooperative agreement: Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program. This agreement is for $627,000 a year for five years, and officially began on October 1, 2018.

This program is a partnership between the Vermont Department of Health, Department of Mental Health, Blueprint for Health/Women’s Health Initiative, Children’s Integrated Services, Vermont Child Health Improvement Program, the designated mental health agencies, women’s health and pediatric health care providers, and community organizations.

Vermont’s team has identified the following objectives for the five-year grant program, now called Screening, Treatment & Access for Mothers & Perinatal Partners (STAMPP):

1. assess resources, gaps and opportunities in our existing system of care;
2. increase the capacity of Vermont’s health care providers to educate, screen, diagnose, prevent, and treat maternal depression and other related behavioral disorders;
3. increase the capacity of Vermont’s mental health system to diagnose, and treat maternal depression and other related behavioral disorders, including the exploration and implementation of telemedicine and technology innovations;
4. increase the capacity of the human service workforce to screen and support women at-risk for maternal depression and other related behavioral disorders;
5. identify and support innovative financing options to support the screening, diagnosis, and treatment of maternal depression and other related behavioral disorders;
6. ensure access to comprehensive maternal depression and educational information and support and treatment options;
7. develop up-to-date, real-time referral resources at the community level; and
8. conduct a comprehensive evaluation.

Data is updated as it becomes available and timing may vary by data source.

The PRAMS sample of women who have had a recent live birth is drawn from the state's birth certificate file. Each participating state samples between 1,300 and 3,400 women per year. Women from some groups are sampled at a higher rate to ensure adequate data are available in smaller but higher risk populations. Selected women are first contacted by mail. If there is no response to repeated mailings, women are contacted and interviewed by telephone. Data collection procedures and instruments are standardized to allow comparisons between states.