Women’s History Month: The Rise of Reproductive Psychiatry
During Women’s History Month, we invite you to reflect on the history of women’s mental health and the rapid advancement of the field of reproductive psychiatry over the past several decades. While our understanding of women’s mental health has thankfully progressed from Hippocrates’ attribution of psychological distress to a “wandering uterus,” much of this development has been surprisingly recent.
In 1980, when hysteria was removed from the DSM*, only 20 research papers in total using the terminology postpartum, postnatal, or perinatal depression had ever been contributed to the scientific literature. In 1987, one such publication introduced the Edinburgh Postnatal Depression Scale (EPDS), a scale developed in England for perinatal depression screening that is now widely used both in research and clinics. Establishing a scale for postpartum depression provided recognition for perinatal depression as a condition with its own phenomenology, worthy of study.
In the same year, Postpartum Support International was founded as a non-profit organization in California with the mission of promoting “awareness, prevention and treatment of mental health issues related to childbearing in every country worldwide.” At that time, no women’s mental health clinical fellowships existed, and women were often excluded from research study designs addressing mental health. In 1993 the inclusion of women in National Institutes of Health-funded research was mandated, and the number of new publications on postpartum depression each year has grown by three orders of magnitude since the 1980s. The 2000s were notable for the establishment of the first psychiatry subspecialty fellowship in women’s mental health by the University of Illinois at Chicago in 2002, and the fellowship stood alone for years until it was joined by Brigham and Women’s Hospital and Columbia University in 2008.
The past fifteen years have been particularly transformative for the field. The number of fellowship programs went from three in 2008 to 16 today. Several professional groups for reproductive mental health, including Marcè of North America and the APA Committee on Women’s Mental Health, were established during this time span. Additionally, educational opportunities in the field have proliferated in the past five years, with the launch of the open access National Curriculum in Reproductive Psychiatry in 2018, the creation of a National Trainee Interest Group in Reproductive Psychiatry in 2021, and the publication of the Textbook of Women’s Reproductive Mental Health by the APA Publishing in 2022.
Clinically, in 2019, the U.S. Food and Drug Administration (FDA) approved brexanolone, the first treatment specifically for postpartum depression and additional approvals appear to be on the horizon. Public policy has begun to reflect the advances of the field, and the Maternal Mental Health Leadership Alliance was founded in 2019 to advocate for maternal mental health policy changes.
Recent legislative successes include the 21st Century Cures Act, which included support for identification and treatment of maternal depression, and the TRIUMPH for new moms act of 2021 which established a Task Force on Maternal Mental Health and the National Maternal Mental Health Hotline.
Though the field of reproductive psychiatry may be relatively new, we believe that the need for it has long existed as one in five women will experience a mental health condition or substance use disorder during pregnancy or postpartum. We look forward to continued recognition of the importance of women’s mental health and to many future additions to this timeline.
*Diagnostic and Statistical Manual of Mental Disorders, Third Edition, 1980. American Psychiatric Association.
Resources on Maternal Mental Health
- Peripartum Depression (formerly Postpartum) (APA)
- National Maternal Mental Health Hotline – 1-833-943-5746 (1-833-9-HELP4MOMS)
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- Postpartum Support International
- Moms’ Mental Health Matters – National Institutes of Health