Maternal Mental Health Awareness – What are Perinatal Mood and Anxiety Disorders?

May is Maternal Mental Health Awareness Month and the first Wednesday of May has been designated as “World Maternal Mental Health Day”. This is noteworthy as in several countries, 1 in 5 new mothers experience a form of perinatal mood and anxiety disorders (“PMADs”). As with mental illness in general (where no one is immune, despite their circumstances), PMADs can affect women of all ages, income levels, cultures etc. Maternal Mental Health Day is important because it is meant to reduce the stigma of maternal mental illness.

What are perinatal mood and anxiety disorders?

Perinatal mood and anxiety disorders refer to mood and anxiety symptoms that occur during pregnancy or up to one-year post-partum (after pregnancy). According to UNC School of Medicine’s Center for Women’s Mood Disorders, there are many different types of PMADs including:

Depression During Pregnancy/Perinatal Depression

This refers to depression that occurs during pregnancy or within a year after delivery of the baby.

• It is thought that while “mild mood changes” during pregnancy are common, mood symptoms can sometimes become severe enough to require treatment and depression and anxiety during pregnancy can worsen and continue into the postpartum period.
• Factors that increase the probability of perinatal depression include if a woman has a previous history of depression or history of substance abuse, family history of mental illness, lack of support, marital or financial problems, anxiety, previous pregnancy issues.
• Symptoms include feeling sad, depressed, crying, diminished interest in becoming a mother, feelings of worthlessness or guilt, feeling restless or irritable, strong anxiety or tension concerning the baby, difficulties sleeping, suicidal ideation, low energy, weight changes.

Pregnancy Loss

This refers to miscarriage, which can occur at any point in pregnancy and cause physical and emotional pain and grief. Loss of pregnancy can lead to sadness, anger, guilt and depression.

Postpartum Depression

A variety of mood symptoms can occur after the delivery takes place.

• Postpartum depression is more severe than what is commonly termed, “Baby Blues” which lasts for a short period of time (i.e. 1-3 weeks post-delivery).
• Postpartum depression has a longer duration of symptoms and can occur at any point after delivery.
• Symptoms include increased crying, feelings of sadness, depression, intense anxiety, obsessions, loss of interest, feelings of guilt, worthlessness, fatigue, irritability, disturbed sleep, appetite changes, poor concentration, excessive worry, suicidal thoughts.

Postpartum Anxiety Disorders

These can include generalized anxiety disorder, panic disorder and obsessive compulsive disorder.

• Postpartum anxiety disorders might be as common as postpartum depression and can overlap with depression.
• Anxiety symptoms can include panic attacks, excessive worry, restless sleep, hyperventilation, and repeated thoughts or images of frightening things happening to the baby

Postpartum Psychosis

This is seen most often in women with mood disorders such as bipolar disorder or schizoaffective disorder.

• Symptoms of psychosis include delusions, hallucinations and disorganized thinking.
• Symptoms of depression and mania might also be experienced.
• This is seen most often in mothers who are having a severe episode of a mood disorder, for example a severe manic episode.

Can someone with a Perinatal Mood and Anxiety Disorder apply for Long-Term Disability Benefits?

Employees make applications for long-term disability benefits for a variety of reasons. When applying for any type of disability claim, it is always important to provide supportive medical evidence.

In terms of maternal health issues, one example would be if a woman who has experienced a miscarriage was unable to return to work due to the severity of her symptoms and how they affect her daily functioning, she might decide to apply for long-term disability benefits.

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In terms of long-term disability benefits and parental leaves, a long-term disability insurer will only cover the health-related portion of a maternity or parental leave. The insurance company determines which part of the leave is voluntary and which part is health-related.

What does an insurance company mean by the term, “health-related”? For a maternity leave, this refers to the period in which a woman is unable to work for health reasons specifically related to childbirth or recovery from childbirth. For example, due to post-partum depression or another type of perinatal mood and anxiety disorder. This must be substantiated with appropriate medical evidence.

What would appropriate medical evidence consist of? With any claim for a mental illness, aside from listing your symptoms, it is important to show evidence that you are seeking treatment, be it from a social worker, psychotherapist, psychologist, psychiatrist, hospital day program etc. If you are prescribed medication, the insurance company would be interested in knowing how your medication dosages have changed over time.

What if my claim is denied?

Many claims are denied because the insurance company feels that a person is not seeking appropriate treatment or medical care and a denial letter may say that your claim is denied due to “lack of objective medical evidence” and that there is no medical evidence to support your reported limitations and/or restrictions. A denial letter may also say that you are past the typical “recovery period” for your illness.

With any type of claim it is important to have your illness properly documented and to show you are attending regular doctor’s appointments and seeking reasonable and appropriate treatment. The insurance company is looking to see that you are making an effort to recover from your illness. When you seek regular medical attention, you can report your symptoms regularly and your treating physicians can document all new or worsening symptoms, how treatments are working or aren’t working and side effects of treatments. This information can be used to support your claim.

If your claim is denied, you can fight the insurance company’s decision. You should speak with a lawyer as soon as possible so that you understand what limitation period applies (so you know how long you have to start a lawsuit) and to know what your rights and obligations are as an insured person.

Sources:

• https://www.awarenessdays.com/awareness-days-calendar/world-maternal-mental-health-awareness-day-2018/
• https://www.med.unc.edu/psych/wmd/mood-disorders/perinatal