A new study published by Nested looked at forging new understandings as to how caregivers actually experience perinatal mood and anxiety disorders (PMADs).
“We looked closely at systemic gaps in screening, treatment, and follow-up, as well as how supported new parents felt by their partners, healthcare providers, and workplaces,” study author Erin O’Connor told us. “In addition to documenting these experiences, we aimed to provide evidence-based recommendations for healthcare providers, workplaces, and policymakers so perinatal mental health care can actually meet families where they are.”
O’Connor explained that this work builds on decades of maternal mental health research, so the researchers knew gaps in care would show up. The research team also approached it from a family systems perspective. If one person is struggling, the entire family feels the ripple effects. That’s why, in addition to birthing parents, the team wanted to understand what nonbirthing caregivers were experiencing
“On a professional level, caregiver mental health shapes family well-being,” O’Connor told us. « If it’s ignored, the whole system suffers. On a personal level, I experienced PMADs with both the birth of my eldest daughter and the adoption of my younger daughter. I felt uncomfortable sharing my struggles and unsure where to turn for support. Even though my work told me I wasn’t alone, I could see how many families were quietly enduring the same thing. I wanted to help fill those gaps in both research and practice.”
The research team distributed a survey to thousands of primarily birthing caregivers, incorporating items from the Edinburgh Postnatal Depression Scale (EPDS) along with additional items on anxiety, support systems, and care experiences. To go deeper, the researchers conducted 17 in-depth, two-hour interviews with parents. Their analysis used a mixed-methods design with multivariate statistical models to identify patterns, alongside qualitative coding to capture the texture of caregivers’ lived experiences.
“We obtained 4 main results,” O’Connor told us. “With regards to screening gaps, nearly 40% of caregivers with PMADs were never screened at follow-up appointments and 98% of non-birthing caregivers (fathers, adoptive parents, same-sex partners) were never screened.”
Regarding stigma and fear, O’Connor explained that almost half of caregivers felt unable to answer screening questions due to fear of judgment or custody loss. They felt like screening was a trap rather than a path to support.
“Only approximately 25% of birthing parents felt comfortable talking to a partner or medical professional about their feelings,” O’Connor told us. “With regards to systemic risk factors, NICU parents were 74% more likely to experience PMADs, lack of paid leave strongly increased PMAD risk and job loss, and families described PMADs as affecting the entire system, not just the birthing parents.”
Concerning provider gaps, only 24% of caregivers felt comfortable raising mental health concerns with providers and many pediatricians and OB/GYNs lack training in PMAD-specific care.
“Overall, the findings confirmed what we suspected about systemic gaps,” O’Connor told us. “But we were surprised by a couple of things. First, how many caregivers said they couldn’t even open up to their partners about their struggles. Second, how often grandparents came up as a key support. This highlighted the possibility of ‘grandternity leave’, which would recognize how workplace policies like paid leave can respond to the evolving role of caregivers.”
There are several call to actions that came out of the study. One is to expand provider training so that PMADs (including symptoms beyond depression like anxiety, OCD, and trauma) are recognized and addressed. Another call to action is to guarantee equitable access to telehealth and peer-support networks as well as implement inclusive screening for all caregivers, including non-birthing caregivers.
“Another call to action is to advocate for extended, inclusive paid leave policies, including for grandparents,” O’Connor told us. “And improve workplace culture by promoting flexible, supportive return-to-work policies, as well as expand education for OB/GYNs and pediatricians so every frontline provider knows how to respond and connect patients to mental health support.”
Lastly, the study invokes a call to action to encourage collaborative care models that connect OBs, primary care, mental health specialists, doulas, PTs, and OTs into a holistic team approach.
“Screening should never feel like a trap,” O’Connor told us. “It should be an entry point to care, with clear, compassionate next steps. The fixes are achievable, but they require shifting from individual responsibility to system-wide accountability. Every caregiver’s mental health matters, and it’s time our policies and practices reflected that.”