The Potential Cost of Honesty in Perinatal Screening

Fear of child separation can keep parents from disclosing mental health concerns.

Reviewed by Devon Frye

Key points

• Many new parents fear disclosing mental health struggles for fear of separation from their baby.
• Common screening processes for perinatal mood and anxiety disorders discourage honesty.
• A recent study found that only 36 percent of new parents answered mental health questions honestly.
• It’s time to rethink how we screen and support peripartum caregivers.

Imagine the weight of perinatal mood and anxiety disorders (PMADs) during pregnancy or postpartum. Now imagine recognizing that you need support, but choosing silence out of fear that speaking up might mean losing your baby. This is the haunting dilemma many caregivers face when they’re screened for perinatal mental health.

In our recent study, we surveyed over 1,000 caregivers around the world. One striking finding was that, of those who were screened for PMADs, only 36 percent reported answering honestly. The remaining caregivers admitted to concealing their true feelings, afraid that being forthright about their mental health struggles would label them “unstable” or “incompetent” and lead to them being separated from their baby. This choice to stay silent—while understandable—can deepen suffering and block the path to crucial support for caregivers and infants.

In interviews, caregivers spoke openly about their fears. One shared that her biggest fear was that "my child would be taken away from me if I was honest about how crazy I felt.” Another admitted, “I was afraid if anyone knew how I really felt, they would take my baby away from me, no matter how irrational that sounds.”

Unfortunately, we found that these weren’t isolated cases. Another mother shared, "No one prepared me for this and that was the hardest part. I felt so alone and scared for me and my baby, but also scared to seek help out of fear of my baby being taken away.” Many new parents feel torn between protecting their mental health and protecting their family unit.

The PMAD screening process itself can discourage honesty. Often, it’s a brief, standardized questionnaire (such as the Edinburgh Postnatal Depression Scale) at the hospital or an obstetrician’s or pediatrician’s office. This format is notoriously impersonal and can signal to caregivers that screening is merely a protocol for healthcare providers to avoid liability; it feels to many as anything but a genuine outreach effort to support them.

One mother explained, “The Edinburgh test feels incredibly shallow… I’d memorized which questions, and what score I needed to achieve to not raise eyebrows. It also lacks nuance, and never once did a doctor dive deeper into any of the answers. At best a nurse practitioner would glance at the sheet and sweep it up into her clipboard.” For her, the tool felt like “a trap instead of a tool to provide help.”

Another mother described the pressure to hide her anxiety and depression: “I was so anxious I was afraid if I was honest, they’d think I wasn’t a good mom, so I just checked all 4s with one or two 3s so it didn’t seem fake.”

What Needs to Change in Perinatal Mental Health Screening?

It’s time to rethink how we screen and support peripartum caregivers. Every interaction should be an opportunity to listen and provide real resources, not a moment that heightens shame or stokes fear. Caregivers should feel safe disclosing mental health struggles, confident that honesty will lead to compassion, not condemnation.

Addressing these barriers starts with acknowledging the flaws in our current systems that perpetuate a culture of fear rather than honest disclosure, which may only inhibit help-seeking behavior. Only then can we hope to create a culture in which peripartum caregivers are genuinely supported, without fearing the loss of the very connection that matters most: the bond with their child.