vtcpap

Can We Create Safer and More Thorough PMAD Screening in Vermont?

Tue, 13 Jan 2026 20:59:11 GMT

Perinatal Mood and Anxiety Disorders (PMADs) affect birthing individuals across Vermont—but our data suggest that BIPOC birthing individuals may be under-identified and under-supported .

At VTCPAP, our perinatal service is aiming in 2026 to work with providers to understand barriers and provide evidence-based strategies to improve detection and care for all Vermonters.

What the Data Shows

Vermont Department of Health: 7–10% of Vermonters identify as non-white
VTCPAP consultations (past year): 4 out of 120 involved non-white patients
Research: Non-majority individuals may experience postpartum depression and anxiety at twice the rate of white individuals

The gap: We should be seeing more consultations for BIPOC patients—but the data show otherwise.

Why Are Screenings Missing BIPOC Patients?

Research points to two main factors :

Trust in providers
Limitations in screening tools

1. Trust Matters

Patients are more honest on the Edinburgh Postnatal Depression Survey (EPDS) when they:

Have a trusted relationship with the provider
Receive a clear explanation of the purpose and use of the screening
Are assured the screen is not used to judge parenting competence or reported to DCF

Why this matters for BIPOC patients:

Studies show BIPOC and immigrant birthing individuals may have less implicit trust in their providers , especially in predominantly white healthcare settings
Fear of being seen as “unfit” can reduce honesty on screenings

Best practice:

Build consistent provider relationships before administering screenings; It is most effective if the MA, RN or MD who administers the screening knows the patient
Preface the screening with supportive language about how the results will be used to support them, not judge them, and what will this look like?

2. Screening Tools May Miss Stress-Related Distress

The EPDS may not fully capture stress experienced by BIPOC patients. There may be stigma around mental health conditions, where people don't readily identify with mental health symptoms, but they may identify as having high stress. Research shows:

High stress levels can be as harmful as depression/anxiety
Tools like the Perceived Stress Scale or Everyday Discrimination Scale can complement the EPDS
Stress scores can trigger interventions similar to positive EPDS screens

Key insight: Stress may reflect unrecognized depression/anxiety or distress not captured due to cultural or systemic barriers.

Strategies for Safer, More Equitable Screening

Small changes can make a big difference:

Designate staff (nurses or medical assistants) who a patient knows already to administer screeners with a short preface about purpose and outcomes
Add stress measures (e.g., Perceived Stress Scale or Everyday Discrimination Scale) to identify hidden distress
Engage VTCPAP for consultation:

Dr. Guth can work with your practice to design a tailored plan
Look out for a virtual education session in early 2026

Goal: Improve detection and care for all Vermont birthing people , especially those historically under-identified.

Action Steps for Providers

Introduce screenings after establishing trust with patients
Explain why the screening is happening and how results are used
Consider adding a stress-focused measure alongside the EPDS
Reach out to VTCPAP for consultation or attend upcoming virtual education sessions

References

Armstrong SJ, Small RE. The paradox of screening: rural women's views on screening for postnatal depression . BMC Public Health. 2010;10:744.
Bauman BL, et al. Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression . MMWR Morb Mortal Wkly Rep. 2020;69(19):575–581.
Dwarakanath M, et al. Barriers to Diagnosis of Postpartum Depression among Younger Black Mothers . Res Sq. 2023.
Kannikeswaran AP, et al. Perinatal providers' attitudes towards culturally relevant infant mental health integration . Front Psychiatry. 2025;16:1644836.
O’Mahony J, Donnelly T. Immigrant and refugee women's postpartum depression help-seeking experiences . J Psychiatr Ment Health Nurs. 2010;17(10):917–928.
Skoog M, et al. Screening immigrant mothers for postpartum depression: a qualitative systematic review . PLoS One. 2022;17(7):e0271318.
Sroka AW, et al. Depression screening may not capture significant sources of prenatal stress for Black women . Arch Womens Ment Health. 2023;26(2):211–217.
Tobin C, et al. Recognition of risk factors for postpartum depression in refugee and immigrant women . J Immigr Minor Health. 2015;17(4):1019–1024.

Perinatal OCD Training: July 1, 2026 Register Today!

Tue, 13 Jan 2026 20:59:08 GMT

Perinatal Mental Health: Key Takeaways for Providers

Tue, 13 Jan 2026 20:59:06 GMT

Perinatal mental health challenge are the most common complication of birth in the US, affecting 1 in 5 birthing parents and 1 in 10 partners or fathers nationally, with even high rates in Vermont: up to a quarter of Vermont families are impacted. Symptoms can begin during pregnancy and onset any time within the first year postpartum. These complications can also impact families that grow by adoption or surrogacy. While hormone shifts play a part, individual histories play an important role. Left untreated, postpartum mood complications can lead to lifelong challenges with depression, anxiety and bonding or attachment cycles, which can lead to more challenges for the entire family later on.

Any provider interfacing with pregnant or postpartum parents should watch for symptoms of mood complications, understanding that at times they will be quite obvious (such as psychosis or profound depression), while other times they may be more mild cases that are still very much in need of treatment intervention. Symptoms can be identified using screening tools such as the Edinburgh Postnatal Depression Scale (EDPS), but this cannot be all that we rely on. Often, mood challenges go un- or under-reported for a host of well-researched reasons. Therefore, it’s up to providers to offer an array of support tools, including ones parents can access on their own if they choose. Offering an informational handout with a list of resources to all perinatal patients as a standard of care is a strong first step. And for physicians and providers who are using screening tools, comprehensive follow up for positive screens is critical. We cannot continue to screen if we are unable or unwilling to follow up on positive results in a comprehensive way.

While the landscape for referrals and support in Vermont may seem barren on the surface, Vermont actually scores amongst the higher ranks in the country for perinatal support according to the Policy Center for Maternal Mental Health 2025 Report Cards. Vermont has made commendable efforts to enhance perinatal support and continues to do so with the recent Maternal Health Innovation grant. While the system isn’t perfect, it’s a strong, forward-moving collaborative effort.

For clinicians practicing in Vermont, there are several state and national resources available to families and providers alike. These include:

Postpartum Support International (PSI) provides provider training, a local provider directory, and free peer support resources. The local Vermont chapter is active so don’t hesitate to reach out to psivt@postpartum.net with questions or referrals.

The Vermont Consultation & Psychiatry Access Program (VTCPAP) perinatal service equips perinatal providers with real-time consultation from perinatal psychiatrists, screening resources, and referral support.

Through to Thrive has a variety of books and online classes for parents who do well with individual, self-paced learning as well as training tools for providers. CEUs are available and training tools include concrete resources and can include consultation for individuals and teams.

References