Barriers to postpartum depression prevention and treatment: a policy analysis.

Public policy erects two barriers to adequate prevention and treatment of postpartum depression (PPD) in the United States: 1) the lack of parity between insurance coverage for mental and physical illness decreases access to care and 2) the current model of postpartum care fails to incorporate screening and follow-up. Treatment for PPD falls into the insurance category of mental health. But many insurance companies either do not cover mental illness at all or provide coverage that is far below that for physical ailments. Because cost-benefit analyses have shown the benefits of parity laws, legislation to achieve parity between mental and physical health insurance is crucial in addressing this problem. Meanwhile, the U.S. model of post-partum care should follow the example of care provided in the United Kingdom where nurse-midwives visit new mothers at home to check on their physical and emotional status. In one program that produced positive psychological health outcomes, midwifery visits were tailored to individual needs and extended to 10-12 weeks postpartum. Encouraging developments in the United States include 1) an effective program that screens new mothers with signs of PPD and provides telephone follow-up and rapid treatment referral and 2) proposed legislation to fund organizations working to reduce the incidence of PPD.