A recently published article in the American Journal of Public Health has attributed a substantial financial cost to untreated perinatal mood and anxiety disorders among mothers. The study, conducted by researchers with the think tank and public policy firm Mathematica, found that the cost of untreated perinatal mood and anxiety disorders (PMADs) for the 2017 birth cohort totalled $14 billion USD, with an average cost of $31,800 per mother-child pair with postpartum illness.

The researchers used a cost-of-illness model to consider the major sources of costs related to perinatal mood and anxiety disorders among persons giving birth in 2017. First, the researchers considered the effects of PMAD on labor force participation and reduced maternal productivity. Second, the model included the economic effect of increased use of safety net services, including Medicaid, among those with untreated PMADs. And finally, the worsened maternal and child health outcomes associated with untreated PMADs were accounted for. While not exhaustive, this model allowed researchers to consider a range of costs, from the individual costs of suboptimal breastfeeding to the societal cost of maternal suicide.

After determining estimates for all costs therein, and using CDC data to establish the prevalence of treated and untreated PMADs in the US, the researchers proceeded to project this model over a period of 5 years postpartum in order to establish a population-wide estimate for these costs. At the individual level, the researchers established that within the timeframe of pregnancy and 5-years postpartum, the highest costs associated with untreated PMADs were productivity losses and healthcare expenditures incurred by mothers, and costs associated with the high risk of preterm birth and behavioral and developmental disorders among children. Furthermore, the majority of these costs occurred between the period of conception to delivery, and two-thirds of the costs were attributable to the mother. The total sum of all costs amounted to $31,800 per mother-child pair, and $14 billion for the US as a whole (although models using a range of low- and high-end estimates for individual costs produced a range of cost estimates between $2.5 and $63.4 billion). 

One clear limitation of the study was the restriction of the model to the 5 year postpartum period. The researchers were intentional in selecting this age cut-off, as they predict that the under-5 population is of high interest to lawmakers. The researchers do acknowledge that this limitation produces an underestimate compared to the total lifetime cost of untreated maternal PMAD within the child. 

According to the authors of the study, the policy and healthcare implications of this study further underscore the critical importance of screening for mood and anxiety disorders during the perinatal period. A further extrapolation of this finding is the need not only for improved screening, but also increased access to PMAD treatment through reductions in social stigma, financial cost, and other barriers to care. Previous studies of all non-communicable diseases have estimated that untreated non-communicable diseases could result in a global economic cost of over $47 trillion; this study narrows in on the critical importance of addressing PMADs as a matter of public health. 

Heather Anne Harmon, MPH

Luca, D. L., Margiotta, C., Staatz, C., Garlow, E., Christensen, A., & Zivin, K. (2020). Financial Toll of Untreated Perinatal Mood and Anxiety Disorders Among 2017 Births in the United States. American Journal of Public Health, (0), e1-e9. https://www.ncbi.nlm.nih.gov/pubmed/32298167

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