Appendix B

Leadership Guide to PPD 101

Major Justin Mastrangelo, USAFR

Postpartum depression (PPD) is a major depression disorder occurring within the first four weeks after childbirth. However, throughout clinical practice, a major depression disorder occurring within the first year of delivery is also considered PPD. Signs of PPD vary but may include disturbances in sleep, energy level, appetite, and libido. Studies have shown that nearly 20 percent of newborn mothers suffer from PPD.1 Positive screens of PPD have associated with increased rates of suicidal ideations.2

1. Military servicemembers’ families and home life provide the foundation and stability that the U.S. military and Joint force rely on. Not only does PPD affect mothers, but it can also impact the spouse and the development of the child. To ensure the readiness of the force, it is essential maintain the integrity of the family’s foundation.

2. Many stigmas exist in today’s society and military complex that may preclude mothers from seeking necessary treatment for PPD. These include social media, the Exceptional Family Military Program (EFMP), and mental health disorder stigmas within the Department of Defense (DOD). Military leaders should be familiar with DODI 6490.08, which addresses command notification requirements to dispel stigmas in providing mental health treatment to servicemembers.

3. The DOD healthcare system is well-equipped and staffed to provide the necessary treatment and support to families suffering from PPD. Military leaders, including commanders, senior enlisted leaders, and key spouses should be familiar with treatment options to educate servicemembers and their families on the avenues of PPD support.

4. PPD can be exacerbated by military service due to the negative stigmas associated with mental health treatment in the DOD. Leaders of all ranks should establish open communication channels with new mothers and families and discuss available treatment options. The path to preserving the family foundation lies in an education campaign and the ability to detect the signs and symptoms of PPD as early as possible. To remain an effective and cohesive unit free from disruptions in force readiness, the DOD should be informed about PPD, how to dispel stigmas, and effective assessments and treatment options for servicemembers and their families.


  1. Tai Do et al., “Depression and Suicidality during the Postpartum Period after First Time Deliveries, Active Component Service Women and Dependent Spouses, U.S. Armed Forces, 2007–2012,” Medical Surveillance Monthly Report 20, no. 9 (September 2013): 2–7.
  2. Molly M. Long et al., “A Systematic Review of Interventions for Healthcare Professionals to Improve Screening and Referral for Perinatal Mood and Anxiety Disorders,” Archives of Women’s Mental Health 22, no. 1 (February 2019): 25–36,



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Maj Justin Mastrangelo serves as a politico-military planner and branch chief at Western Europe and Balkans Division, Deputy Directorate (Europe/NATO/Russia), Strategy, Plans, and Policy Directorate (J5), Joint Staff, located at the Pentagon. He has served around the world within the special operations community as a U-28A Draco and Lockheed Martin MC-130J Commando II pilot. After spending 12 years on active duty in the U.S. Air Force, Mastrangelo joined the Air Force Reserve and began a career as a first officer for Delta Air Lines. He graduated from the Marine Corps Command and Staff College, where he wrote on postpartum depression (PPD) and its impacts on the Joint force. He lives in Northern Virginia with his wife, Lindsay, and two sons, Sam and Max.

The views expressed in this article are solely those of the author. They do not necessarily reflect the opinions of Marine Corps University, the U.S. Marine Corps, the Department of the Navy, or the U.S. government.

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