Why this matters:

• One in eight new mothers experiences postpartum depression
• One untreated case of postpartum depression costs around $33,000 on average
• It has been proven that postpartum depression is preventable, not just treatable, so research efforts focused on prevention could have big impact

Imagine you’re a new mom, sleep-deprived and home alone with your baby. It’s been over a month since you gave birth and you thought you would start to feel better by now: not just physically, but mentally.

Your relationships with your partner, family, and friends have shifted since the baby arrived and you’re not sure who to ask for help. If you needed help, it would be offered, right? The lack of help probably means you should have it covered on your own.

You continue to cycle through endless days of feeding and changing the baby with little sleep, sinking into a reality tinged with fogginess and isolation. You love your baby, but you don’t feel as connected as you imagined you’d be.

Some days you wonder what the point of it all is. You would say it’s hard to get out of bed in the morning, but you’re never really in bed anyways. Your baby is crying again. Robotically, you comfort the baby and try to remember what your life was like before this.

You have postpartum depression.

Nearly one in eight women experience postpartum depression, or PPD, after giving birth in the United States. PPD contributes to higher rates of postpartum substance abuse, domestic violence, infant mortality, and even psychosis or suicide.

Recent research demonstrates that there is a cost-effective way to decrease the rate of PPD by a staggering 50%, but the funding cuts looming over the National Institutes of Health, or NIH, could bring this breakthrough to a screeching halt.

Preventing PPD is not only important on an individual level, but for the health care system as a whole: a single case of untreated PPD costs $33,484 on average. These costs can be even higher in rural or underserved areas of the country. That’s why the National Institute of Mental Health has dedicated a portion of its funding to improving maternal mental health.

As a result, the Reach Out, Stay Strong Essentials, or ROSE, program has emerged as an affordable way to prevent PPD. The program prepares women for the postpartum period with a series of four educational sessions during pregnancy. The sessions focus on mental health, interpersonal relationships and community resources. Five randomized clinical studies have demonstrated that the ROSE program prevents half of cases of postpartum depression, a remarkable feat.

“Because of the ROSE [program]… I knew the ‘baby blues’ is pretty normal and pretty frequent… but I talked to my OB at the two-week [checkup] because I was not feeling right,” reported one participant who received early and successful treatment for PPD thanks to her knowledge from ROSE.

 

For researcher Jennifer Johnson, wider use of the ROSE program is an obvious next step when the success rate is so high. While the first phase of ROSE focused on proving that the content helps prevent PPD in at-risk populations, the second phase of ROSE aims to bring PPD prevention to every expecting mom in the United States.

As founding chair of the Charles Stewart Mott Department of Public Health at Michigan State University College of Human Medicine, Johnson brings her clinical psychology background to her work as an implementation scientist. She investigates how to bring proven interventions to the people who need them, a key component of making good on the financial support research requires.

Along with her longtime research partner Caron Zlotnick of Brown University, Johnson determined that instead of wasting time and resources on identifying who would most benefit from the ROSE program, every pregnant woman should have access to the content because the program is so affordable. Their current study aims to show that everyone can benefit from ROSE and that offering ROSE to everyone during pregnancy saves money.

In fact, it only costs between $2,000 and $4,000 in staff time to set the ROSE program up at an entire clinic or agency. That’s a savings of around $30,000 per PPD treatment. Part of the reason for this low implementation cost is the program’s adaptability. The content is crucial, but the format is flexible. Four distinct sessions need to occur throughout a woman’s pregnancy along with a postpartum “booster” review to be effective, but how the information is delivered is completely customizable.

Johnson knows that many clinics and public health agencies are already stretched to their limits to provide perinatal care, so it is vital that an additional program like ROSE can simply be added to a task that is already occurring.

“I was shocked at the level of stress clinics and agencies providing prenatal and postnatal care are under and how not well they are supported structurally,” Johnson said. “They’re trying to do so much with so little; they’re very committed.” Even clinics that struggled to implement the program at first often found success when they were supported by monthly check-ins from the ROSE research team.

“I really enjoy being a facilitator for the ROSE program,” reported Rachael Norwood, a facilitator at Henry Ford Health in Michigan. “I get to see pregnant people develop their support systems and advocacy skills. Even if they end up developing postpartum depression, at no fault of their own, I hear their stories on how they have felt more confident to ask for help when they need it.”

 

The NIH funding cuts could have devastating consequences for efforts to scale up the ROSE program and other maternal health efforts around the country. It’s frustrating, Johnson shared, that such significant research could be threatened under the guise of saving money when the ROSE program would save Americans millions of dollars annually. “Even if you give [the clinics and agencies] the most intensive technical support over time, and you prevent just one case of PPD, you come out ahead financially,” said Johnson.

The fact that PPD can be prevented, not just screened for or treated, is something Johnson wants everyone to know. Bringing this lifeline to every expectant mother in the United States would be a win-win situation, empowering moms while saving money. But with the precarious state of NIH funding in general, there is no guarantee that ROSE will be able to meet its potential.

Pregnant people interested in participating in the nationwide, at-home ROSE study can find more information at rosemom.org.

This story was originally posted on the College of Human Medicine website.