By Brenda Campbell, LICSW
Oct. 15, 2019

Air Force photo by Benjamin Faske

October is designated as Depression Awareness Month. This provides an opportunity to discuss depression and how it can uniquely impact service members who are pregnant. While most of us are aware of postpartum depression, fewer may know that depression can occur throughout pregnancy. This blog will highlight a few key things for providers to keep in mind as they’re working with pregnant service members.

1. It's not just postpartum depression.

Depressive disorder with peripartum onset can occur during pregnancy and up to four weeks after delivery. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), 50 percent of postpartum major depressive episodes actually begin prior to delivery. Pregnancy can be a very exciting time for service members, but it can also be an emotional time with many hormonal and physical changes taking place.

Because society in general is less aware of depression during pregnancy, it is a good idea to educate your patients about signs of depression in the first prenatal visit, and conduct a depression screening. The VA/DOD Clinical Practice Guideline for the Management of Pregnancy strongly recommends depression screening for pregnant patients periodically throughout pregnancy. The guideline recommends using a standardized tool such as the Edinburgh Postnatal Depression Scale with pregnant service members throughout their pregnancy.

2. According to the pregnancy guideline, female service members are more likely than their civilian counterparts to suffer from depression.

This may be due to unique stressors female service members may encounter including routine military stressors, differences in unit cohesion for women than for men, and issues such as sexual harassment.

In addition to involving your patient in decisions about the pregnancy and childbirth, be aware of the presence or absence of family and other support. Consider recommending a support group for pregnant patients to help alleviate any social isolation they may be experiencing.

Another great resource for pregnant service members is Pregnancy & Childbirth: A Goal Oriented Guide to Prenatal Care. Commonly known as the "Purple Book", the latest version, updated in March 2019, walks service members through their pregnancy step by step. It provides invaluable information and resources to use throughout pregnancy and in the weeks following the birth of their child.

You may also recommend DOD’s New Parent Support Program. This program helps military families transition into parenthood by offering support and resources.

3. Information sharing and shared decision making is key.

It is beneficial for your patients to take an active and collaborative role in making decisions throughout their pregnancy. As a provider, offer information in a timely fashion to allow time for shared decision making. Active involvement in decisions throughout the pregnancy will help patients stay involved, connected, and self-aware, all of which will contribute to a healthy mood and a healthy pregnancy.

Ms. Campbell is a contracted licensed independent clinical social worker on the evidence-based practice team at the Psychological Health Center of Excellence. She has a master's in social work and has been working with service members, veterans, and their families for nearly a decade.