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The National Healthy Mothers,Healthy Babies Coalition

in celebration with U.S. Department of Health and Human Services,

Office of Women’s Health presents

Paying Attention to Maternal Mental Health Before, During and After

PregnancySusan Dowd Stone, MSW, LCSW

May 16, 2012

Additional Resources

• Organization of Teratology Information Specialists

• https://www.otispregnancy.org/forms/otis_referral-f115

• 1-866-626-6847

Postpartum Partners

• Monday night chat with the Experts for men www.postpartum.net

• Dr. Will Courtenay’s website• http://www.mensdoc.com/

Challenges to Perinatal Mental Health

• Economic impact on women• Lack of Awareness/Resources• Financial barriers• Education of providers• Establishing networks• Starting the conversation too late!

Environmental Influences with direct impact on women’s mental health

Global

National

Community

Personal

Global Impacts

• “Unipolar Depression, predicted to be the second leading cause of global disability burden by 2020, is twice as common in women”. World Health Organization, Gender and Women’s Mental Health

Susan Dowd Stone, LCSW 2012


In many developing societies, women bear the brunt of the adversities associated with poverty: less access to school, physical abuse from husbands, forced marriages, sexual trafficking, fewer job opportunities and, in some societies, limitation of their participation in activities outside the home.” Patal, V, & Kleinman, A. (2003). Poverty and Common Mental Disorders in Developing Countries.Bulletin of the World Health Organization 2003;81:609-615

• “Apart from the possible role of biological factors, which may explain why there is a consistent sex difference in risks for common mental disorders in all societies, it is plausible that gender factors — the considerable stresses faced by women— may also play a role”.

•• Patal, V, & Kleinman, A. (2003).

Poverty and Common Mental Disorders in Developing Countries.Bulletin of the World Health Organization 2003;81:609-615.


National Impact

• “Economic policies that cause sudden, disruptive and severe changes to income, employment and social capital that cannot be controlled or avoided, significantly increase gender inequality and the rate of common mental disorders” World Health Organization, Gender and Women’s Mental Health, 2012


Income Disparities

• Women, when they are able to find work, make only 91% (District of Columbia) to 63% (Wyoming) of what men make for the same position.

• National Women’s Law Center, 2008


Poverty and Women in the United States

• Record numbers of women were living in poverty — and extreme poverty — according to an analysis of 2010 Census data by the National Women's Law Center (NWLC). The poverty rate among women climbed to 14.5 percent in 2010 from 13.9 percent in 2009, the highest in 17 years.

• The extreme poverty rate among women climbed to 6.3 percent in 2010 from 5.9 percent in 2009, the highest rate ever recorded. Over 17 million women lived in poverty in 2010, including more than 7.5 million in extreme poverty, with an income below half of the federal poverty line.


Personal Impact Factors

E

E

E

EBP

BP

BP

BP


Personal Impact Factors

• Access to mental health services• Awareness• Partner support• Financial difficulties• Stigma• Ambiguous, confusing messaging

Advances in Maternal Mental Health

• Legislative• Research• Treatment• Awareness

Legislative Advances

• The Melanie Blocker Stokes MOTHERS Act S. 324 Now included in the Patient Protection and Affordable Care Act

• Watch videos and updates regarding legislation at

• http://www.perinatalpro.com/pmadmedialibrary.html

Susan Dowd Stone, MSW, LCSW, 2011

The Good News, the Bad News

• This work on every level has increased awareness and introduced maternal mental health on a local/national/federal level –

• BUT - Where’s the money?


Advances in Research

• From 1800 to 1970 – 11 articles in Psychinfodescribing “insanity of pregnancy”.

• For 2012 alone (at press) 48 major peer-reviewed studies/articles in established journals.

Advances in Research (cont)

• Current NIMH funding for mental health includes six ongoing clinical trials for postpartum depression ranked in the top ten.

• http://www.clinicaltrials.gov/ct2/results?term=depression+OR+mood+disorders+OR+depressive+disorder+OR+bipolar+depression+OR+postpartum+depression+OR+child+depression+OR+adolescent+depression+OR+geriatric+depression+OR+psychotic+depression+OR+anhedonia+OR+dysphoria+OR+minor+depression&recr=Open&rslt=&type=&cond=&intr=&outc=&lead=&spons=&id=&state1=&cntry1=&state2=&cntry2=&state3=&cntry3=&locn=&gndr=&fund=0&rcv_s=&rcv_e=&lup_s=&lup_e=

Awareness

• National, Regional and Local Campaigns• Responsible network/cable presentations• Print publications• Online resources• Bloggers


The Good News, The Bad News“Awareness of the term postpartum depression

does not necessarily imply awareness of its symptoms or sources of assistance. Public education is needed to address this fact in order to provide social support and encourage treatment for symptomatic women and their families.”

Sealy, P. A., Fraser, J., Simpson, J. P., Evans, M., & Hartford, A. (2009). Community awareness of postpartum depression. Journal of Obstetric, Gynecologic, & Neonatal Nursing: Clinical Scholarship for the Care of Women, Childbearing Families, & Newborns, 38(2), 121-133.


PRIMARY PREVENTION

Moving the Bar

Before pregnancy

After delivery

Insisting on Evidenced Based Treatment

BioDBT

PsychoPsychodynamic

CBT, IPT

SocialIPT


Establishing Community Networks

Obstetrical

Pediatric

PsychologicalBirth Centers

Community Resources

Social Support Across the perinatal period

Concrete Services

Asks Questions

Peer Support

Encourage self‐care

Concrete Services

• Meal preparation• Transportation• Childcare• Housecleaning• Organizing

Ask Questions!

• Gentle approach• Give permission to discuss• Keep it simple• Awareness• Psychoeducation

Peer Support

• New Moms Support Groups• Telephonic Support• Reduction of Isolation

Encourage Self-Care

• SLEEP

• Recreation

• Pampering

Removing Financial Barriers to Help

• Postpartum Support International

• www.postpartum.net• Coordinators and state by

state listings of resources• Free Chat with the

Experts telephone sessions

• Toll-free warm line• 1-800-944-4773

Removing Financial Barriers to Help

• Postpartum Progress most widely read blog on PPD!

• Huge, reliable resource of information for mothers, healthcare professionals !

• www.postpartumprogress.com• Katherine Stone, author,

survivor, advocate

MedEd.PPD

• Comprehensive online resource focused on research updates and events

• Available in English and Spanish

• Portal for providers and consumers

• Registry of mental health professionals who have had training in PPD

• www.mededppd.org

• MediSpin accorded multiple NIMH grants for their work

Mainstreaming Maternal Mental Health into Maternal Healthcare

• Encouraging national maternal child health organizations to emphasize maternal mental health from contemplation of pregnancy through one year postpartum

• The National Healthy Mothers, Healthy Babies Coalition


National Healthy Mothers, Healthy Babies Coalition

Get involved in HMHB programs such as:• Text4baby – www.text4baby.org or

www.facebook.com/text4baby

• National Premature Infant Health Coalition –www.facebook.com/NPIHC and www.NPIHC.org (coming this summer!)

National Healthy Mothers, Healthy Babies Coalition

• Find archived webinars and interviews with experts online at –www.hmhb.org

• Sign up for the Monday Morning Memo at [email protected] to get the latest news and resources in maternal and child health.

• “Like” HMHB on Facebook and Twitter! www.facebook.com/HMHBCoalition & @HMHBCoalition


• http://www.nimh.nih.gov/health/publications/women‐and‐depression‐discovering‐hope/what‐causes‐depression‐in‐women.shtml

• http://www.mayoclinic.com/health/postpartum‐depression/DS00546

• http://www.psychiatry.unc.edu/wmd


• http://www.womenandinfants.org/womenshealth/behavioralhealth/index.cfm

• http://www.massgeneral.org/psychiatry/services/treatmentprograms.aspx?id=1271

• www.perinatalpro.com

Susan Dowd Stone, MSW, LCSW

• www.perinatalpro.com• Co-editor Perinatal and Postpartum Mood

Disorders: Perspectives and Treatment Guide for the Healthcare Professional (Springer)

• Practice: Blue Skye Consulting, LLC, Englewood Cliffs, NJ

• 201-567-5596• [email protected]

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