If you ask people what they think the most common medical complication is during and after childbirth, you probably won’t hear mental health issues. Yet perinatal mood and anxiety disorders (PMADs)—including prenatal and postpartum depression and anxiety—top the list, affecting at least one in seven women. In addition to the substantial human toll of these conditions, they come with a hefty price tag, especially because women who have them often go untreated.
Mathematica’s analysis, released today in conjunction with national Maternal Mental Health Week, estimated the national economic costs of these disorders. When following the mother–child pair from pregnancy through five years postpartum, the estimated cost is $14.2 billion for births in 2017, or an average of $32,000 for every mother–child pair affected but not treated. The California Health Care Foundation, the Perigee Fund, and the Zoma Foundation funded this study. In addition to national results, state-specific details are available for California, Colorado, and Washington State.
To assess the economic impact of not treating these disorders, Mathematica calculated costs incurred over six years, which included pregnancy through five years after the birth of a child. A little more than half (53 percent) of the costs, or $7.5 billion, occur in the first year (conception through birth).
“We conducted the most comprehensive analysis yet of the economic burden of perinatal mood and anxiety disorders in the United States,” said Kara Zivin, a senior researcher at Mathematica and the study director. “In addition to health consequences for mothers and children, these conditions are particularly burdensome in terms of maternal productivity loss and increased social services costs.”
Of the $14.2 billion, about 60 percent of the costs relate to maternal outcomes, and the remaining 40 percent relate to child outcomes. The most costly components include productivity loss because of an increased likelihood of work presenteeism (that is, mothers might be less productive or more likely to make mistakes at work), absenteeism (that is, mothers missing work), and unemployment ($4.7 billion, or 33 percent of total costs); preterm birth ($3.3 billion, or 23 percent of total costs); and maternal health expenditures ($2.9 billion, or 20 percent of total costs).
When comparing only medical costs of other perinatal conditions, PMADs cost more than $17,000 per mother over six years, whereas postpartum hemorrhage (bleeding) and gestational diabetes (diabetes during pregnancy) each cost up to $3,300 per mother and take place only during pregnancy and childbirth.
“This is a call to action,” said Becca Graves, executive director of the Perigee Fund. “We must screen and treat pregnant women and new parents for these serious and incredibly common illnesses and prevent the onset where we can.”
Although treatment for them is effective and beneficial for mothers and children, PMADs are often ineffectively treated or not treated at all. In fact, according to the recent Listening to Mothers in California survey, only half of perinatal women diagnosed with depressive symptoms receive any treatment.
“Given how common and detrimental these conditions are, it is important for the health care system to consistently support mothers from pregnancy through the first five years postpartum, which will in turn improve the well-being of their children,” said Stephanie Teleki, director of learning and impact at the California Health Care Foundation.
Mothers with untreated PMADs are more likely to deliver preterm and have a cesarean delivery than those without these disorders, which increases health care costs for both delivery and care of premature infants and makes it harder for mothers to return to work. In addition, children of mothers with PMADs have a higher risk of behavioral and developmental disorders themselves, including attention-deficit/hyperactivity disorder, depression, anxiety, and behavioral or conduct disorders such as oppositional defiant disorder.
Professional organizations such as the American College of Obstetricians and Gynecologists; the American Academy of Pediatrics; the American Psychological Association; the Association of Women’s Health, Obstetric and Neonatal Nurses; and the U.S. Preventive Services Task Force recognize the need to act, including by consistently screening for and effectively treating PMADs.
“Helping women and their families access effective and affordable treatment for these disorders will ultimately lessen the overall burden and costs on society, and more importantly, support mothers and infants to thrive,” said Rebecca Alderfer, senior program consultant at the ZOMA Foundation.
Mathematica’s health experts are pioneers in advanced health services research, clinical quality improvement and measurement, data quality, analytics, and emerging methodologies—an expertise paired with a strong understanding of health care policy and adoption of technological advancements. Leading with clarifying questions, our close, collaborative approach adapts to evolving policy contexts and moves beyond process to deliver solutions that aim to improve health outcomes, quality, affordability, community well-being, and value.
The California Health Care Foundation is dedicated to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. We work to ensure that people have access to the care they need, when they need it, at a price they can afford.
The Perigee Fund is committed to strengthening the earliest relationships between infants and toddlers and their caregivers during the prenatal to age three period, a time that is critical in the development of social, emotional, and physical health. We invest in the fields of early childhood mental health and perinatal mental health. Perigee has a deep focus in Washington State and contributes to the work of practice and policy leaders across the country.
ZOMA Foundation, a Denver-based private foundation founded by Ben and Lucy Ana Walton, acts as the philanthropic arm of their family office, ZOMALAB. Through the foundation, the organization leverages philanthropy to support systems-level alignment and efficiencies as well as to pilot, incubate, and prove innovations. The areas of focus for the foundation include issues within Early Childhood Development such as perinatal mental health, parental supports, and child maltreatment prevention; Rural Community Economic Development; and catalytic tools and initiatives to support thriving and resilient communities in Colorado and Chile. For more information visit: www.zomalab.com.