Michael Silverman (’91) is an associate professor of psychiatry at the Icahn School of Medicine at Mount Sinai. Photo by Chris Sorensen
When women who’ve given birth at New York’s Mount Sinai Hospital return for their postpartum checkup, 99.5 percent of them are screened for postpartum depression—up from 58 percent a decade ago. The improvements owe much to the advocacy of Michael Silverman, an associate professor of psychiatry at the Icahn School of Medicine at Mount Sinai. And while he’s proud of this progress, Silverman (’91) is the first to admit these screenings alone are too little, too late.
“This whole idea of screening in the postpartum period, it’s great. But at that point, the women have already fallen apart,” he says. “Move it up.”
A body of research, including Silverman’s, shows that the women most likely to experience postpartum depression are those who’ve been depressed before. So why wait until after delivery to begin talking about the condition?
“Your obstetrician should be asking in that first-trimester appointment, ‘Do you have a history of depression?’ That’s what we want the practitioners to do,” Silverman says. “And that’s what my personal agenda has become.”
Silverman, who holds a master’s degree in rehabilitation counseling from Sargent College and a PhD in cognitive psychology from The New School for Social Research, New York, has studied postpartum depression for more than a decade. He also maintains a counseling practice in Manhattan and is the author of Unleash Your Dreams: Tame Your Hidden Fears and Live the Life You Were Meant to Live (Wiley, 2008). In 2007, he was the first to use functional magnetic resonance imaging (fMRI) to identify abnormal brain processes in women with postpartum depression. Since then, his research has branched out to include many aspects of the condition, including its prevalence and risk factors.
Warning women early about their risk for postpartum depression allows them to put a support system in place before their baby is born, according to Silverman. Waiting until the postpartum period to screen for depression not only delays treatment, he says, but also misses too many people who need help. Many women—especially those who are severely depressed—don’t return for standard follow-up care. Those who do rarely get the careful screening that Mount Sinai patients receive. That’s because obstetricians are often reluctant to delve into patients’ mental health, which is outside their expertise, Silverman says. And postpartum depression is hard to detect because so many of its symptoms—sleeplessness, fatigue, difficulty concentrating, anxiety—are symptoms nearly all new mothers experience to some degree.
To find participants for his early research, Silverman worked with obstetricians at Mount Sinai and implemented a postpartum mood screening at the hospital’s community clinic; doctors would ask patients to complete a standardized questionnaire and then tabulate their scores. At first, compliance rates were low. But when the clinic began using electronic health records in 2010, Silverman made a suggestion: program a “hard stop” into the postpartum medical record, requiring doctors to enter a patient’s mood score before her chart could be closed. Compliance rates shot up. The increase in screenings has helped Silverman improve postnatal care at Mount Sinai, provide a blueprint for other hospitals, and identify research subjects.
“Your obstetrician should be asking in that first-trimester appointment, ‘Do you have a history of depression?’ That’s what we want the practitioners to do.”–Michael Silverman (’91)
Silverman’s current focus is analyzing data from Sweden’s detailed national health registries to learn more about postpartum depression’s risk factors and its long-term effects on mothers and children. He published his first paper based on these analyses in 2016, reporting that gestational diabetes raises the risk of postpartum depression, especially in women with prior history of depression. The study, which was funded by the National Institutes of Health, also concluded that women with a previous diagnosis of depression are more than 20 times more likely to experience postpartum depression than other mothers.
These numbers have convinced Silverman that a history of depression is the main driver of postpartum depression, not simply a risk factor. To get this important message to obstetricians and their patients, he and his colleagues have spoken at medical conferences, met with legislators, and worked with foundations, community health clinics, and local parenting groups. Improving clinical practice patterns is a slow process, Silverman says, but—for the sake of women and their babies—he’s advancing it one screening at a time.