Dr Beth Mah Aboriginal mum and bub mental health Loretta Weatherall - PowerPoint Presentation

Dr Beth Mah Aboriginal mum and bub mental health

Loretta Weatherall, Lyniece Keogh, Auntie Pearl Slater, Kym Rae and Roger SmithGomeroi gaaynggal team

150 pregnant women of Aboriginal or Torres Strait Islander descent recruitedTamworth has 60,000 residents with approximately 10% identifying as Aboriginal or Torres Strait Islanders. Walgett has 2,000 residents with over 50% identifying as Aboriginal or Torres Strait Islander. Indigenous research staff involved in recruitment at antenatal clinics, survey administration and interpretation of resultsGomeroi gaaynggal steering committee- review and endorsement  Our study

Maternal age- 14.02 to 40.91 years (M= 25.88, SD=5.73). 4.8% of participants became parents younger than age 18.20% were under the age of 2152% were under 25 40.7% of our cohort were smokersThose under the age of 20 years- only 33% smoked. 41.5% of infants were female Gestational age at birth- 29.4 to 43.2 weeks ( M = 38.65, SD = 2.23). Birth weight- 910 to 5430g (M = 3,254.5g, SD = 687.64). 18% infants needed NICU or special care nursery. There were 5 sets of twins. The mums and bubs

  Trimester 1n Trimester 2n Trimester 3 n Total pregnancy incidence Number of participants 100 53 11   Number of life events    053227 129254 21750 3010 4100  Individual life event: % % % %Death of close friend or family member1435.6049.6Overcrowding at home9.415.411.135.9Unable to get a job13.88.111.133Mental illness10.67.711.129.4Divorce or separation9.42.7012.1Member of your family sent to jail/ currently in jail5.910.5016.4Became redundant3.65.409.0Serious illness2.42.805.2Alcohol related problem2.4002.4Serious accident1.22.804.0Witness to violence1.22.804.0Abuse or violent crime perpetrated upon1.2001.2Trouble with the police0012.512.5Gambling problem1.2001.2Pressure to fulfil cultural responsibilities1.2001.2Treated badly because you are an Aboriginal person1.2001.2Drug related problem0000Serious disability0000 Stressful life events

    Original   Revised Trimester Number of participants   Mean Standard deviation Scored >34 (%)  MeanStandard deviation1147 10.814.7110.2 33.3814.37286 10.0615.289.3 32.7315.23332 7.7512.253.1 30.0611.74Impact of Life EventsOriginal 0-4, Revised 1-5

PTSD symptoms explored in almost 2,000 Norwegian women as a result of labour pain and birth experience. The mean original IOE scale value was 6.73 (SD = 8.1);  our pregnant sample reported a mean original scale score of 10.8 (SD = 14.71). The Norwegian study found 1.9% scored greater than 34 (severe PTSD). In our study 10.2% scored >34 in the first trimester.   Garthus-Niegel S, Knoph C, von Soest T, et al. (2014) The Role of Labor Pain and Overall Birth Experience in the Deveopment of Posttraumatic Stress Symptoms: A Longitudinal Cohort Study. Birth, 41: 108-115.Norwegian birth study to compare

Study of over 1,000 European participants after exposure to a crisis such as terrorist attack or earthquake. IOE- R score was 20.6 (SD = 18.5) which is much lower than our pregnant cohort during their initial trimester- 33.38 (SD = 14.37) Feuerherd M, Knuth D, Meuhlan H, et al. (2014) Differential Item Functioning (DIF) Analyses of the Impact of Event Scale- Revised (IES-R): Results From a Large European Study on People With Disaster Experiences. Traumatology 20: 313-320. European study

Trimester Number of participantsNil (1-19) % Mild (20-24) % Moderate (25-29) % Severe (30-50) % ≥22 (%) 1147691251427.22866911.5811.525.6332889039.4Kessler-10 Scale

Urban pregnant women: 7.3% were depressed Rural pregnant women: 8.8% Indigenous pregnant women: 12.6%Our study 27% were depressedMilgrom J, Gemmill A, Bilszta J, et al. (2008) Antenatal risk factors for postnatal depression: a large prospective study. Journal of Affective Disorders 108: 147-157.Milgrom study using EPNDS

What does this mean for bub?

If Mum has PTSD or other anxiety it has been found that bub is at risk of higher rates of childhood anxiety, ADHD and learning problems Talge , N.M., Neal, C. and Glover, V., 2007. Antenatal maternal stress and long‐term effects on child neurodevelopment: how and why?. Journal of Child Psychology and Psychiatry, 48(3‐4), pp.245-261.PTSD in mum

Depression leads to a higher rate of bonding problems and negative developmental consequences (Misri and Kendrick, 2008). Mothers with depression showed less positive engagement and more negative behaviours with their infant compared to non-depressed controls (Campbell et al., 1992). In families with a depressed mother, mothers and fathers were found to have less optimal interaction with their infants ( Goodman, 2008 ). Depressed mothers are less likely to touch their infant, and use less attuned and informative speech (Herrera et al., 2004). Misri S and Kendrick K. (2008) Perinatal depression, fetal bonding, and mother-child attachment: a review of the literature. Current Pediatric Reviews 4: 66-70.Campbell S, Cohn J, Flanagan C, et al. (1992) Course and correlates of postpartum depression during the transition to parenthood. Development & Psychopathology 4: 29-47.Goodman J. (2008) Influences of maternal postpartum depression on fathers and father-to-father interaction. Infant Mental Health Journal 29: 624-643.Herrera E, Reissland N and Shepherd J. (2004) Maternal touch and maternal child directed speech: effects of depressed mood in the postnatal period. Journal of Affective Disorders 81: 29-39.Depression in mum

Assessment of depression and anxietyAssessment of the quality of the mother infant dyadInterventions for difficulty bondingAre any of these approaches culturally acceptable?What do we need to do to find out? Western approaches

beth.mah@health.nsw.gov.auPlease contact me