A pregnant woman in San Francisco uses the Ginger.io app to reflect on her mood and practice mental health coping strategies. (Mariya Campwala/Ginger.io)
A new baby usually ushers in a period of sleeplessness and joy in roughly equal measure, but sometimes pregnancy and birth also usher in a period of anxiety and depression.
An academic study of 10,000 mothers in Pittsburgh, the largest study on this topic to date, found 14 percent of them suffered from postpartum depression in the year after birth. For some women, the struggle actually starts to emerge while they are pregnant.
In fact, one study found mental health conditions tied with urinary tract infections as one of the top three types of maternal complications during pregnancy. Another study found postpartum depression is the most common complication of childbirth. And yet, a compilation of studies indicate that just 15 percent of women with perinatal mood disorders receive treatment.
Why do so few women get the help and support they need? The overwhelming reason is fear of being stigmatized as an “unhappy” or “bad” mother.
San Francisco-based Ginger.io is a mobile startup seeking to help women by connecting them with medical support when they need it. The perinatal depression app is intended to help users and health care providers identify the difference between normal mood fluctuations and anxieties, and times when intervention and/or treatment is needed.
The app collects sensor data and self-reported information for factors such as how much you move around, eat, sleep and talk with people. Then it creates a map of your behavior patterns. When it notices significant changes that indicate perinatal depression or anxiety, the app notifies your care provider who can then reach out with support. In addition, Ginger.io makes it easy for women who are pregnant or recently had a baby to create a log of their behavior and emotions, so they have tangible data to share with during doctor visits.
The company emerged out of the MIT Media Lab in 2010 with the broad goal of using smartphones to improve mental health care. It has since formed partnerships with more than 30 institutions across the country, including eight of the top academic medical centers in the U.S..
Ginger.io’s perinatal depression program is currently being piloted with three major health systems -- Novant Health in North Carolina, the University of Pennsylvania and a California system the company hasn’t named.
Identifying Perinatal Depression
“So often things fall through the cracks,” said Naomi Kincler, Ginger.io’s Head of Customer Success who helped implement the program at Novant. “Even in pregnancy, when you are coming in regularly for visits, a lot that can still happen in between, and the usual visit with a doctor is no more than 15 minutes.”
Kincler shared the story of a patient with a history of depression, who stopped taking her antidepressant for fear it would harm the baby. Ginger.io triggered an alert to her doctor, noting elevated symptoms of depression. Kincler says when the doctor reached out, the woman said she had no idea it would be so hard and she was done being pregnant.
Kincler said the doctor believed the woman was at risk for self-harm, and recommended she restart her antidepressants. But the following week, Ginger.io sent another alert. A triage nurse followed up and found the woman had not restarted her meds. The doctor then followed up again to reinforce the safety of taking the medication, and the woman was able to resume treatment and manage her symptoms.
“This story highlights the fact that visits alone don't always provide the best venue to have those discussions with the patients,” Kincler said. “The real power behind our tool is the ability to dig deep into issues, track improvement, and connect dots between visits.”
Nurse Birdie Gunyon Meyer backs that up.
“Many, many of our care providers are not asking women how they are doing emotionally,” said Meyer, coordinator of the Perinatal Mood Disorders Program at Indiana University Health, and the former President of Postpartum Support International. “They are so busy and only have so much time to see each patient. Most of our OB care providers’ offices still do not screen because it is time-consuming, and so women just don’t know where to go or who to call.”
However, Meyer is skeptical that an app would be able to bridge this communication gap.
“Care providers are very busy, and so while the app might provide great, useful information, I wonder if they would actually use it?” she said. “And many women may still be reluctant to tell the truth because they do not want to look bad to their OB/GYN. If the care provider usually doesn’t ask how they are doing, they may not feel safe saying anything. Even if they do, its important to make sure women are connected with proper social support, not just medication.”
The mental health of pregnant women and new moms is an extremely sensitive issue. Meyer said many women may feel uncomfortable sharing this kind of information with an app. What if the data fell into the wrong hands? Could this information be used in an unwarranted way, for example, to alert Child Protective Services, or to advertise pharmaceuticals?
Kincler said Ginger.io treats patient data like a medical record, encrypting it and sharing it only with care providers. Users can also ask Ginger.io to delete their data.
Being pregnant and having a newborn can be stressful. Feeling depressed or anxious can be stressful. Keeping secrets can be stressful. With perinatal mood disorders, all three of these stresses can coalesce into one, unbearable burden.
Meyer says a key part of alleviating this burden is sharing one simple message: You are not alone. You are not to blame. With help, you will be well.
It comes down to communication: If the app helps women express their experiences honestly, and if care providers respond quickly and effectively -- two big “ifs” -- then the app could be a tool to help get more women with perinatal mood disorders diagnosed and helped.
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