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

Sarah Guth, MD • January 13, 2026

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:


  1. Trust in providers
  2. 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:


  1. Designate staff (nurses or medical assistants) who a patient knows already to administer screeners with a short preface about purpose and outcomes
  2. Add stress measures (e.g., Perceived Stress Scale or Everyday Discrimination Scale) to identify hidden distress
  3. 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


  1. Armstrong SJ, Small RE. The paradox of screening: rural women's views on screening for postnatal depression. BMC Public Health. 2010;10:744.
  2. 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.
  3. Dwarakanath M, et al. Barriers to Diagnosis of Postpartum Depression among Younger Black Mothers. Res Sq. 2023.
  4. Kannikeswaran AP, et al. Perinatal providers' attitudes towards culturally relevant infant mental health integration. Front Psychiatry. 2025;16:1644836.
  5. 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.
  6. Skoog M, et al. Screening immigrant mothers for postpartum depression: a qualitative systematic review. PLoS One. 2022;17(7):e0271318.
  7. 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.
  8. 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.