Untreated Postpartum Depression and Anxiety Costs California Billions, Report Concludes

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Untreated mood and anxiety disorders associated with pregnancy are costing California billions of dollars in health care spending, social services expenses and productivity losses, according to a new report.

The study, conducted by the research firm Mathematica with funding from three foundations including the California Health Care Foundation, estimates the cost of untreated perinatal mood and anxiety disorders (PMADs) in California at $2.4 billion for all births in 2017. This includes costs incurred due to medical interventions, low-income health care, welfare payments, work absenteeism and lost productivity over a six-year period, from the mom’s pregnancy through the child’s first five years of life.

California’s burden accounts for about a sixth of the nationwide cost of not treating perinatal mood and anxiety disorders, which the researchers estimated at $14.2 billion.

“It’s clearly a significant financial burden in the state of California,” said Kara Zivin, a senior researcher at Mathematica and the study’s director. “This really is an important societal problem that we should do a better job of addressing through screening women during pregnancy and postpartum, and then making sure those people who need treatment get treatment.”

An estimated one in six California women suffer from PMADs, such as postpartum depression, during or after pregnancy. That’s higher than the national average of one in seven women, according to the report. Women living in poverty or who face other stressors such as domestic violence or lack of family support, as well as those who have a history of mental illness, are especially at risk for these disorders.  

Yet many women don’t get screened for postpartum depression and other perinatal mental health problems. A bill signed into law last year, which requires doctors working with pregnant women and new moms to conduct screenings, is expected to make a difference. Even so, lack of access to treatment is an ongoing concern, said Stephanie Teleki, director of learning and impact at the California Health Care Foundation.

Research shows only half of women diagnosed with perinatal depression get treated.

“When you talk to people about this issue and you talk about the human toll of it … the next question that quickly follows is, ‘Well, how much is it going to cost to (fix) this?’” Teleki said. “What we really wanted to show is that there is a cost to doing nothing.”

Both moms and children suffer when perinatal mood and anxiety disorders go untreated. Moms are at higher risk for suicide, labor complications and poor overall health, and they may be less productive at work or not be able to work at all. Untreated PMADs can also make it hard for moms to connect and care for their children. Kids whose moms suffer from disorders such as postpartum depression are more likely to have poor mental, emotional and physical health themselves.

All this amounts to nearly $35,000 in increased health care costs, lost income, reduced economic output and increased use of public services for each mother and child pair, the report found. About half of these costs occur within the first year, and are associated with pregnancy and birth complications, according to the study.

Ultimately, it’s employers and health insurers who bear the brunt of these costs, said Zivin. This includes Medi-Cal, the state’s health insurance plan for low-income people, which covers about a third of state residents.

Avoiding these costs will require increased emphasis on screening and follow-up care for women during and in the first year after pregnancy, along with improved access to treatment for perinatal mental health conditions, the report concludes.

“We hope that the release of these numbers will start making the folks who are the payers, who are actually purchasing care, to not be pennywise and pound foolish,” said Teleki, referring to employers who negotiate health insurance plans. “They are actually paying in a different way right now, and we could use those same dollars that were being wasted to actually solve the problem. In the meantime you’d be helping a very fundamental part of the fabric of our society, which is our families.”

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