Reduced therapy attendance near childbirth reported among US military service members

Among US military service members, therapy attendance decreases around the time of childbirth, according to a recent study in JAMA Network Open.¹

Takeaways

Both mothers and fathers in the US military significantly reduce their mental health therapy sessions around the time of childbirth, with the most notable drop occurring in the month before and after birth.
Approximately 20% of mothers experience depressive episodes and anxiety within 3 months postpartum, underlining the vulnerability of this period for parents' mental health.
Despite the high risk of mental health disorders during pregnancy and postpartum, only one-third of recent-birthing mothers with diagnosable conditions utilize mental health services.
Interventions such as cognitive behavioral therapy have shown significant effectiveness, with an 81% reduction in postpartum anxiety and depression among treated patients, emphasizing the importance of mental health support.
The study suggests increasing accessibility to mental health services through methods such as home visits or telehealth appointments to address the decline in therapy attendance among new military parents.

A depressive episode within 3 months postpartum is reported among approximately 20% of mothers, making the pregnancy and postpartum periods vulnerable for parents’ mental health. Anxiety during pregnancy is also reported among approximately 20% of mothers, and the risk of anxiety continues during the postpartum period.

Other severe mental health disorders with increased risk during pregnancy and postpartum include affective psychosis, bipolar disorder, and schizophrenia. However, parental use of mental health services remains low, with only 1 in 3 recent-birthing mothers with a diagnosable mental health disorder using mental health services during pregnancy.

Data has indicated efficacy from interventions in the treatment of postpartum depression.² A study from the National Institutes of Health found that postpartum anxiety and depression was reduced by 81% among patients receiving cognitive behavioral therapy. Therefore, mental health service use may be vital to manage patients’ mental health.

Investigators conducted a cohort study to evaluate mental health treatment during pregnancy and postpartum among US military patients.¹ Mental health treatment was compared between parents and nonparents monthly.

Participants included US Army and Navy service members on active duty sometime between January 1, 2013, and December 31, 2019. Data collected included sex, race, ethnicity, age, education level, Armed Forces Qualification Test score, time in service, rank, branch of service, sex, date of birth, and spouse military status.

At least 12 months before birth and 24 months after birth of data was necessary for parents to be included, while 36 continuous months of data was necessary for nonparents. Weekly data was also obtained, including 12 months before birth and 6 months after birth for parents and 18 continuous weeks for nonparents.

The transition to parenthood was the exposure evaluated, determined by gaining a new dependent aged under 1 year among patients without prior children, as well as mothers having an inpatient birth related hospital visit near the time of birth. Mental health therapy sessions per month and per week were the primary outcomes of the analysis.

There were 15,554,193 person-month observations in the final analysis, encompassing 10,193 mothers aged a mean 25 years and 50,865 nonmother matches. Additionally, 43,365 fathers and 216,777 nonfather matches were included in the analysis.

Of patients, 19.1% were Black, 80.9% races other than Black, 14.6% Hispanic, and 85.4% non-Hispanic. For the weekly sample, these rates were 31.9%, 68.1%, 17.4%, and 62.6%, respectively. Demographic, job, and dependent characteristics were similar between parents and nonparents.

Mental health treatment use was similar between parents and nonparents until a few months before birth. During this time, a reduction in therapy sessions attended was observed among mothers and fathers.

For mothers, a statistically significant reduction in therapy sessions attended was observed starting at 4 months before birth, with a reduction of 0.0161 sessions. For fathers, a statistically significant reduction of 0.0041 was observed at 7 months before birth.

The period close to birth had the most significant reductions, with a reduction of -76.7% at 1 month postpartum vs 10 months before birth for mothers and -47.5% in the birth month vs 10 months before birth for fathers. However, therapy use stabilized by 4 months postpartum, at similar rates compared to nonparents.

Patients with a prior need for mental health services experienced a more significant decrease in treatment during pregnancy, with a decrease of -77.4% reported among mothers with 2 or more mental health sessions before pregnancy and -73.1% among fathers.

The prevalence of therapy session utilization was increased among parents returning to work after parental leave. Attending a therapy session was reported among 1.08% of mothers in the last week of leave, with an increase of 51.3% at week 7 among mothers under a 6-week parental leave policy.

These results indicated reduced therapy attendance near childbirth among US military service parents. Investigators concluded there is a need for more accessible treatment options including home visits or telehealth appointments.