Title: Prenatal and Postpartum Mental Health Care for Military
Servicemembers And Their Dependents

Description: Prenatal and postpartum depression are common complications
during pregnancy. As many as one in five women will experience prenatal
and postpartum depressions. On today's podcast, we talk with GAO's
Alyssa Hundrup about our work on one specific population - military
service members and their dependents, and the care they receive for
these conditions through TRICARE, which provides millions of people care
through both military facilities and private care providers.

Related GAO Work: GAO-22-105136, Defense Health Care: Prevalence of and
Efforts to Screen and Treat Mental Health Conditions in Prenatal and
Postpartum TRICARE Beneficiaries

Released: May 2022

[Alyssa Hundrup:] Mental health is a critical issue affecting many new
and expecting mothers in the military population.

[Music]

[Holly Hobbs:] Hi and welcome to GAO's Watchdog Report--your source for
news and information from the U.S. Government Accountability Office. I'm
your host, Holly Hobbs.
Prenatal and postpartum depression are common complications during
pregnancy. As many as one in five women will experience these mental
health conditions. And they can be serious. On today's podcast, we'll
look at one specific population--military service members and their
dependents--and the care they receive for these conditions through
TRICARE, which provides millions of people care through both military
facilities and private care providers. Joining us is Alyssa Hundrup, an
expert on public health issues and a director in our health care team.
Thanks for joining us.

[Alyssa Hundrup:] Thanks for having me.

[Holly Hobbs:] So, Alyssa, why did we specifically look at TRICARE
beneficiaries and postpartum/prenatal conditions?

[Alyssa Hundrup:]  Well, in the last few years, we've seen an increased
interest in maternal health issues, as well as mental health issues
generally. So, specific to the TRICARE population, families face an
additional unique risk, such as things like deployment of their spouses
for long lengths of time or living away from their extended families.
And increased risk for mental health, such as depression or anxiety. And
it was the intersecting interests of both maternal and mental health
that led to our study looking at the military population. Now, I do want
to note that when I say “TRICARE beneficiaries”, I'm including both
active duty service members as well as their families.

[Holly Hobbs:] So you mentioned that their lifestyle might contribute to
increased risk. Do we know if service members or their families were
more likely to suffer from these conditions than, say, the general U.S.
population?

[Alyssa Hundrup:]  So, unfortunately, we weren't able to directly
compare the military population with the general population because
there really isn't comprehensive data for the latter. Now, we did have
good information for TRICARE, and there we found that 36 out of 100
pregnant individuals included a mental health diagnosis either during
their pregnancy or up to one year postpartum. The research we did find
related to the general population showed that one in five or
approximately 20% suffered from depression. But our analysis was much
broader, including things like substance use disorders. So it's really
not possible to compare the two numbers.

[Holly Hobbs:]  So within the military, were there groups or
characteristics of people who were more likely to suffer from these
conditions?

[Alyssa Hundrup:]  Yes, there were. Our analysis showed that active duty
service members had a slightly higher prevalence of mental health
conditions than their dependents--so their spouses or their children. We
also found a higher prevalence of mental health conditions among junior
or lower ranked active duty service members versus senior officers. And
then unmarried beneficiaries as compared to married beneficiaries had a
higher rate. Lastly, I would note that across the services we found a
higher prevalence of mental health conditions among the Army, which came
in at around 43% compared to the other service branches.
[Holly Hobbs:]  And what can you tell us about the quality of care
military service members and their families received?

[Alyssa Hundrup:]  So in general, we found that the Department of
Defense encourages standard screening for all pregnant beneficiaries and
then would issue referrals for additional or specialty care depending on
the needs that are identified. However, I do want to note that we and
others have identified several barriers that can prevent pregnant women
from seeking or obtaining care. And examples that we identified include
stigma, limited availability of providers, difficulty getting
appointments, and then just a lack of knowledge about some mental health
issues, especially related to pregnancies. Now we did find that a
majority of beneficiaries, who had diagnoses, did get treatment and that
treatment consisted of medication, psychological services, or both. But
there's really no way to know the number of beneficiaries that may have
needed care but didn't reach out to seek it for whatever reason.

[MUSIC]

[Holly Hobbs:] So Alyssa just told us that military service members and
their families may be more likely to suffer from pregnancy-related
mental health conditions because of additional stressors in their
lives--such as being separated by deployment. And that while the DOD
encourages screens for these conditions, some may feel stigmatized and
not seek help.
So Alyssa, in our report, did we identify any leading practices or good
examples of care that we hoped TRICARE would make available more
broadly?

[Alyssa Hundrup:]  Yeah, we definitely heard about specific services
being offered at individual clinics. For example, at some military
facilities, they have mental health care integrated into their
obstetrics care. So that could mean either having an obstetric provider
that specialized in some of these mental health care issues; or they
have mental health providers physically located within the clinic. We
did hear that having a mental health integrated right in the practice
can reduce stigma because that way they're not seen going into a
separate mental health clinic. Now, it's really hard for us to know how
broadly these types of services are available because, across the
military health system, each medical treatment facility is responsible
for deciding how primary care and obstetric care are set up. But we
definitely hope that by highlighting some of these practices and
services that that will encourage the adoption of those services on a
broad scale basis.

[Holly Hobbs:]  And last question, what's the bottom line of this
report?

[Alyssa Hundrup:]  Well, as with so many segments of the population,
mental health is a critical issue affecting many new and expectant
mothers in the military population. As I mentioned, about 36 out of 100,
we found have a mental health condition, most common among them,
anxiety, depression or trauma or stressor disorders. Now, most are
receiving treatment, but it's critical that the Department of Defense
continue to really emphasize both screenings and availability of
treatment.

[Holly Hobbs:]  That was Alyssa Hundrup talking about GAO's recent
review of TRICARE and prenatal/postpartum treatments and screenings.
Thanks for your time, Alyssa.

[Alyssa Hundrup:]  Thank you, Holly.

[Holly Hobbs:]  And thank you for listening to the Watchdog report. To
hear more podcasts, subscribe to us on Apple Podcasts, Spotify or
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watchdog, the U.S. Government Accountability Office, visit us at GAO.gov