Study finds large, unmet need for mental health treatment in parents of multiples

Parents of twins and other multiple-birth children experience higher than average rates of depression, anxiety and other mental health issues, particularly during the first three months, according to a survey study in the May issue of Journal of Psychiatric Practice. The journal is published by Wolters Kluwer.

About half of parents of multiples say they could have benefited from treatment for symptoms of mental health problems – but less than ten percent received such care, reports the study by Susan J. Wenze, PhD, of Lafayette College, Easton, Pa., and Cynthia L. Battle, PhD, of Warren Alpert Medical School of Brown University, Providence, R.I. They write, "There is a large, unmet need for mental health treatment in parents of multiples in the perinatal period, especially the early postpartum months."

High Impact of Mental Health Issues for Parents of Multiples

Two hundred forty-one parents of multiples completed survey questionnaires, in person or online. Of these, 197 were mothers and 44 were spouses/partners. About 20 percent of multiples were conceived via fertility treatment.

Forty-eight percent of the parents said they would have been interested in some type of mental health treatment during pregnancy or the first year after their children were born. Participants cited a wide range of concerns, including symptoms of depression or anxiety, elevated stress, relationship issues, and "managing having multiples."

But less than ten percent of parents received any mental health treatment. Of those who sought care, more than three-fourths were treated for depression symptoms. The treatment rate was higher, 58 percent, for parents whose children were younger (five or under) at the time of the survey.

Most parents said that the most difficult time was between birth and age three months. Although most reported relatively mild symptoms, some parents had more severe symptoms consistent with generalized anxiety disorder (25 percent) or major depressive disorder (14 percent). These rates were higher for parents of younger multiples. Unmarried parents, those with low incomes, and those whose babies were premature had more severe depression and anxiety symptoms.

Lack of time was the most commonly reported obstacle to mental health care. Nearly two-thirds of participants said that no healthcare provider talked to them during pregnancy about mental health issues that might arise after their multiples were born. Sleep quality was poor for all participants – especially mothers – and poor sleep quality was strongly related to more severe depression and anxiety symptoms.

Parents said they would be interested in both traditional and electronic (eHealth) approaches to mental health care. Younger parents had especially high rates of internet/smartphone use to seek information and support related to raising multiples.

Partly due to the use of fertility treatments, multiple births have increased dramatically over the years. The new study adds to previous evidence that parents of multiples experience elevated mental health symptoms.

While many parents of multiples express interest in mental health care – especially during the very challenging first three months – few receive treatment. The new findings suggest that eHealth strategies might be an acceptable option for these parents, while overcoming lack of time and other barriers to mental health care.

Most parents say that they received no prenatal counseling about the mental health issues associated with multiple births. Drs. Wenze and Battle write, "We recommend that healthcare providers attend carefully to parents of multiples' mental health during pregnancy and the early postpartum periods, and proactively integrate discussion of perinatal mental health concerns into their prenatal care regimens."​​