Perinatal mental health conditions impact more than 1 in 5 individuals during the perinatal period, which includes pregnancy to 12 months after birth. Perinatal depression is the most prevalent complication of pregnancy in the United States, negatively affecting not only the birthing person, but also the child and family unit.

Despite recommendations from the American College of Obstetricians and Gynecologists (ACOG) for universal depression screening during and after pregnancy, there exists significant gaps in implementation (ACOG, 2023). Current screening is complicated by a lack of standardization and coordination between pre- and post-natal care providers and variation among clinic practices, leading to a staggering 50% of this population remaining undiagnosed and untreated (Rafferty et al., 2019). 

The landscape of mental health screening around pregnancy reveals stark disparities. Although there is increased prevalence of peripartum depression in Latine and Black birthing parents, non-white women are less likely to be screened compared to white women (Robidoux et al., 2023). Adding to the complexity, individuals covered by Medicaid, often associated with lower income, are also less likely to undergo screening, despite ACOG recognizing both as risk factors (ACOG, 2023; ACOG, 2018). This presents a glaring public health challenge, demanding immediate attention and a collective obligation to do better.

Current Barriers and the Devaluing of Mental Health

Genetic counselors are well-positioned within the perinatal care team to advocate for and champion perinatal mental health. Despite the potential for positive impact, a concerning 35.5% of genetic counselors "rarely" or "never" ask about personal or family history of psychiatric disorders while taking a family history (Booke et al., 2020). Ignoring mental health discussions in perinatal populations denies us a critical opportunity to provide education, normalize conversations about mental health, and comprehensively assess our patients' overall health. 

The lack of training and discomfort genetic counselors feel when discussing mental health history result from a larger stigmatization of mental health. Last year, the Adapt clinic, the first psychiatric genetic counseling clinic, closed after over a decade of critical work. The hospital’s decision to close the clinic is evidence of deprioritization of mental health at large and reflects the values of our profession and the healthcare system as a whole, emphasizing the need to invest in structures that protect and nurture the mental health of our patients. Training in psychosocial topics is what sets us apart from other medical colleagues. As a genetic counseling student, I question what the future of our profession, and our relevance, will be if we continue to devalue this work. 

The Role of Genetic Counselors in Perinatal Mental Health 

Common genetic counseling practices overlook opportunities to discuss and address mental health. As genetic counselors, we are in a key position to provide education of psychiatric conditions and genetics, and gather pertinent information, such as personal or familial history of depression. In addition, due to the correlation between health conditions in babies and increased risk of perinatal depression in parents, we are likely to evaluate parents and families who are at greater risk for perinatal mental health conditions. Genetic counseling, proven to enhance patients’ sense of control, promote help-seeking behavior, and positively impact understanding and empowerment, has the potential for significant positive influence for patients with mental health conditions (Inglis et al., 2017). 

Beyond engaging as individual clinicians, genetic counselors have a crucial opportunity to examine the structure of supports within their clinic. I challenge you to evaluate your clinic’s screening procedure, ensure the patients you see have received the screening they need, and work to build pipelines that support patient mental wellbeing. Genetic counselors have a duty to fulfill our code of ethics commitment to safeguard and promote patient welfare. By taking a critical look at our current practice, assessing the gaps in screening and support for perinatal mental health conditions, we can get one step closer to achieving this mission.

So, how can genetic counselors elevate our approach? 

• Incorporate mental health into genetic counseling sessions: Integrate mental health wellness into standard medical history and pedigree collection, especially when working with perinatal populations. Take time to correct any misconceptions about perinatal mental health and consider making a preemptive care plan with patients (if symptoms are recognized, where can they seek help, a safe place to bring their children, etc).  
• Amplify training and education: Bolster the confidence and skillset of genetic counselors by intensifying training activities and education on mental health and trauma-informed care. Equipping genetic counselors and trainees with comprehensive understanding strengthens their ability to navigate perinatal mental health concerns. 
• Have a plan in place with your clinic: Understand the current screening workflow at your clinic and strategize with your team about how you approach and triage mental health and psychiatric illness in clinical settings. What supports are available (social work, community resources, etc.) for patients at risk for or experiencing mental health crises, and how do patients access them? 
• Advocate for equitable screening: Assess and address any gaps in screening to prioritize equitable implementation and reach all individuals in need. Champion and standardize perinatal mental health screening across prenatal and postnatal care teams.

Addressing the challenge of undiagnosed and untreated individuals with perinatal mental health conditions requires a profound re-prioritization of mental health within appointments and at large. Engagement, assessment, and treatment should be embraced in a team-based and culturally responsive approach, a method genetic counselors are adept to coordinate. Together, genetic counselors can promote a future where mental health is a cornerstone of perinatal care.

References

American College of Obstetricians and Gynecologists. (2018). ACOG Committee Opinion No. 757: screening for perinatal depression. Obstetrics & Gynecology, 132(5), e208-e212.

American College of Obstetricians and Gynecologists. (2023). Screening and diagnosis of mental health conditions during pregnancy and postpartum (Clinical Practice Guideline No. 4). Obstetrics & Gynecology, 141(6), 1232-1261.

Booke, S., Austin, J., Calderwood, L., & Campion, M. (2020). Genetic counselors’ attitudes toward and practice related to psychiatric genetic counseling. Journal of Genetic Counseling, 29(1), 25-34.
Inglis, A., Morris, E., & Austin, J. (2017). Prenatal genetic counselling for psychiatric disorders. Prenatal diagnosis, 37(1), 6-13.

Rafferty, J., Mattson, G., Earls, M. F., Yogman, M. W., & Committee on Psychosocial Aspects of Child and Family Health (2019). Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice. Pediatrics, 143(1).

Robidoux, H., Williams, A., Cormack, C., & Johnson, E. (2023). Maternal Postpartum Depression Screening and Referral in a Latinx Immigrant Population: A Quality Improvement Study. Journal of Immigrant and Minority Health, 1-9.
 

Caitlyn Ark (she/her) is a first-year genetic counseling student at Boston University Chobanian & Avedisian School of Medicine. She has previous experience with social work and program evaluation, and hopes to increase health empowerment of patients through enhancing healthcare and public health systems.