Mental Health; Your Pregnancy Matters

Risk of anxiety, depression doubles in hospitalized pregnant patients

Mental Health; Your Pregnancy Matters

Dr. Doty on her pregnancy complications: 'Looking back, the whole situation feels surreal. I’m a psychiatrist, and I have worked with high-risk pregnancy patients for eight years. And there I was, anxious, depressed, and showing a level of vulnerability I’d never experienced before.'

I had my daughter six weeks early due to placenta previa, which is when the placenta covers the cervix. My Ob/Gyn said that if I noticed any spotting, I should come to the hospital to be monitored for 24 hours.

I did as I was told, and the doctor said if I started bleeding again, I’d need an emergency cesarean section (C-section). No more bleeding, and I could go home. That last part was all I heard – in my mind I had no room for anything but a positive outcome. So, during my stay, I didn’t ask my Ob/Gyn any questions and I didn’t look up any information.

When the bleeding returned later that night and the reality sank in, I fell apart. At midnight, I called my sister and told her: “Go get mom. I need her with me.” My sister drove all night to bring Mom back from Oklahoma.

Looking back, the whole situation feels surreal. I’m a psychiatrist, and at the time I had been working with high-risk pregnancy patients for six years. And there I was, anxious, depressed, and showing a level of vulnerability I’d never experienced before.

Unfortunately, my story is not unique

Many people struggle with anxiety and depression, and more doctors will soon be asking their patients about their mental health during routine visits.

In June 2020, the Women’s Preventive Services Initiative (WPSI) recommended that teens and women age 13 and older should receive anxiety screenings. And in September 2022, the U.S. Preventative Services Taskforce recommended that all adults younger than 65 be screened for anxiety, including pregnant and postpartum patients.

These recommendations indicate the effects of increased stress levels during the pandemic, and offer touch points to reveal mental health disorders that might otherwise go untreated.

Anxiety and depression are even more common among pregnant women who experience pregnancy complications. A 2021 study in Obstetrics & Gynecology found that one in three women who are hospitalized with obstetric complications experience anxiety or depression symptoms. That’s double the rate of the general population.

Patients in the study reported that their anxiety generally decreased as they adjusted to being in the hospital, while depression ebbed and flowed in intensity. We see this same trend in our patients, and it varies depending on their individual health, the gravity of their situation, and their ability to cope with stress and change.

Women are already the largest group of patients with anxiety and depression. Pregnancy may be the first hospitalization many women experience, and obstetric complications often occur suddenly, generating high emotions.

Patients with existing mental health conditions are at increased risk of worsening symptoms when they’re hospitalized due to fetal or maternal complications. But women with no existing mental health problems are not immune. Symptoms can arise even in the healthiest patients.

Related reading: Diagnosing depression and anxiety during pregnancy

Services such as psychotherapy can help comfort women hospitalized with pregnancy complications.

Mental health concerns we see in hospitalized moms

Amidst the stress of worrying about your pregnancy, your health, and older children, new or worsening symptoms and conditions such as these commonly occur:

  • Adjustment disorder: Sometimes called situational depression, this condition involves heightened symptoms that are not severe enough to be classified as anxiety or depression.
  • Discouragement: Women with previous high-risk or complicated pregnancies may worry about experiencing another trauma.
  • Loneliness: Patients with limited social or family support, those who live far from the hospital, or those with weeks-long hospitalizations may feel isolated.
  • Triggers of past trauma: Patients who have survived domestic violence or childhood abuse may be trigged by the sights, sounds, and constant monitoring in the hospital.
  • Unwillingness to take their medication: Many anxiety and depression medications are safe to take during pregnancy. However, some patients stop taking them to avoid perceived risk to the baby. These medications take time to work and stopping unnecessarily may result in a gap in stability once you are home with your newborn.
  • Refusal to stay in the hospital: Patients with older children or aging parents at home sometimes leave the hospital against medical advice, which can add anxiety and depression to an already stressful situation.

Related reading: Pregnancy, anxiety, and the pandemic: 4 ways to manage symptoms

Treatment and support options

UT Southwestern and Parkland Hospital are trained to identify and advocate for expectant and new moms with mental health concerns. While many hospitals rely on virtual psychology and psychiatry support, we staff full in-house teams at both hospitals. We will come to you when you are hospitalized with obstetric complications.

Depending on your length of stay and needs, we can initiate psychotherapy, prescribe medication, and arrange follow-up behavioral health care after you are released from the hospital.

Dedicated case managers and social workers will help you facilitate access to resources here and at home, including:

Christina Stock provides music therapy at UT Southwestern's Clements University Hospital.
  • Childcare for your other children: Parkland recently partnered with Annie’s Place, a local daycare center, to hold drop-in hours for families of hospitalized patients and individuals who need to attend doctor visits.
  • Help with self-care or newborn care after you go home.
  • Setting up follow-up mental health care appointments.

UT Southwestern also offers many supplemental therapies and support services to help comfort and relax you during your stay, including:

  • Spiritual care from an in-house or external chaplain
  • Guided yoga or meditation
  • Music therapy
  • Pet therapy
  • Aromatherapy

Take care of yourself, and each other

In the best circumstances, women who have or are at risk for anxiety or depression optimize their mental health care prior to becoming pregnant. However, approximately half of U.S. pregnancies are unplanned, and many women don’t get that opportunity.

If you are taking anxiety or depression medication, or if you are currently going to therapy, we recommend continuing treatment unless your doctors recommend otherwise. Your Ob/Gyn and mental health care provider will work closely with you to find a treatment plan that controls your symptoms and makes you comfortable.

If you need mental health support in the hospital, we are here for you. Your Ob/Gyn does much more than just deliver your baby – they can connect you right away to emotional or mental health support.

If a loved one is showing signs of anxiety or depression – either while she is hospitalized or after she goes home – check in with her regularly and offer support. Many women have ample support in the first few weeks after delivery. But the following months can be more challenging.

Show your support by making specific, affirming statements. Asking open-ended questions such as, “How can I help?” will result in a passive (and often false), “I’m fine.” Instead, show that you have her back and are planning to help:

  • “What time can I bring over dinner?”
  • “When can I keep the older kids overnight for you?”
  • “Can I babysit Saturday so you can have some ‘me time’?”

Call for medical help right away if your loved one says or acts as if she might harm herself or the baby. She may be suffering from postpartum depression – a serious mental health condition that can have dire consequences if left untreated.

Women are sometimes reluctant to ask for help. We don’t want to appear weak or bother anyone. But none of us is Superwoman, and all of us – particularly when we are pregnant – need support.

To talk with an Ob/Gyn or mental health care provider, call 214-645-8300 or request an appointment online.