Perinatal Mental Illness - PowerPoint Presentation

Slide1

Perinatal Mental Illness

Florida’s largest reproductive health issue:

Lauren W. DePaola, MSW, LCSW

Florida Children & Youth Cabinet

May 4, 1016 Slide2

FIRST WEDNESDAY OF MAY

MAY 4, 2016

2Slide3

Disclosure

I have no financial disclosures.Slide4

Outline

Starting with a proposalPMAD: What is it?Risk factorsWhat are the outcomes?

CareCollaborative efforts for positive impactSlide5

Proposal to Strengthen Families of Florida

Establish and convene

a statewide perinatal mood and anxiety disorders task force to develop recommendations and educational materialsSuggested goals to begin with:

Annual proclamation of May recognizing perinatal mental health awareness

Dedicated piece of DCF website for

education, resources and provider clearinghouse (FSU)

on Perinatal Mental HealthSlide6

Perinatal Mood and Anxiety Disorders (PMAD)

Perinatal: any time during pregnancy and (ANY time in) postpartum; including loss

SPECTRUM of mood disordersPrenatal and postpartum depression and anxietyPostpartum panic disorderPerinatal Obsessive Compulsive Disorder

Postpartum Posttraumatic Stress DisorderPostpartum Bipolar DisorderPostpartum Psychosis

“The

reproductive years present increased probability for stress and emotional health complications

.”Stone, S. and Menken, A., (2008), Perinatal and Postpartum Mood Disorders, Perspectives and Treatment Guide for The Health Care Practitioner.Slide7

Can begin any time during or after pregnancy, including loss

Might merge with baby blues or start laterOnset any time in the first year postpartumCommon triggers for later onset

Hormonal TriggersRapid WeaningHormonal birth control

Increased family stressReturn to workIllness or hospitalization

Loss and griefSlide8

THE #1 HEALTH COMPLICATION RELATED TO

PREGNANCY AND BIRTH- YET, THE LEAST SCREENEDAND TREATEDSlide9

January 27, 2016 NY Times

U.S. Preventive Services Task Force

Women should be screened for depression during pregnancy and after giving birth -- an influential government-appointed health panel said Tuesday, the first time it has recommended screening for maternal mental illness.

Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement

JAMA

. 2016;315(4):380-387. doi:10.1001/jama.2015.18392

9Slide10

The numbers

1 in 7 women; 1 in 10 men (increases in low socioeconomic areas)

Prenatal Depression: 13.5%

Postpartum Depression (PPD) 13.6% in first month

19.2% in first year

PPD, Teen Moms: 26% - 60%

PPD, Moms of Multiples 25% PP Psychosis: .1 -.2

%

1 IN 4 PREGNANCIES END IN LOSS

Gaynes

BN, Gavin N (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes.

Evid

Reprod

Technol

Assess 119:1–8Slide11

Florida

2015 - Florida Maternal, Infant, & Early Childhood Home Visiting Program Maternal Depression Analysis1:4

women in the study reported PPDStress was the highest risk factor for depression, regardless of the mother’s sociodemographic factors, experience of childhood abuse or current/past substance abuse.

The Florida Pregnancy Risk Assessment Monitoring System (PRAMS) found that 58.8% of mothers experienced postpartum depression symptoms after giving birth (2010 report) Slide12

Risk Factors = many

PREDICTIVE RISK FACTORSMother/father is a minor (under age 18)

Depression or anxiety in pregnancyPersonal or family history of depression, anxiety, bipolar disorder, eating disorders or OCDPrevious PMAD symptoms in prior pregnancy/postpartumHistory of sensitivity to hormonal shifts (example: depression or anxiety at puberty, PMS, after pregnancy loss, mood sensitivity to birth control pills/fertility drugs)

Thyroid dysfunctionPoor social, familial or financial well-beingSlide13

More factors…

Exacerbating factors:Crisis related to health of baby or mother (during pregnancy, during birth or after birth); high needs infantUnplanned pregnancy

Recent loss/unresolved lossRecent move/ the feeling of isolation“Type A” personality; perfectionist; “superwoman syndrome”

Complications in pregnancy, birth; breastfeedingHistory of abuse and trauma

History of lack of foundational attachment as a child

Unresolved feeling about miscarriage, abortion, adoption or infant lossSlide14

And then there’s this…Slide15

Infant crying and increasing exhaustion can accumulate into a vicious circle and negatively affect family health (

Kurth et al., 2010).Slide16

Outcomes

Prenatal and childbirth:

Inadequate Prenatal CarePoor NutritionRisk of Substance AbusePregnancy Complications

Birth ComplicationsMiscarriageStress in utero and infancy Slide17

Maternal and family impacts

Impact on older childrenNegative maternal identity and self-esteemDisruptions in functioning

Negative coping and behaviorsSuicide/filicideIncreased Familial Conflicts/dissolution of families

Suicide is one of the three leading causes of maternal death

Oates, Br Med Bull. 2003 ;Stewart ,CMAJ 2006;

Marcus, et al., J Women’s Health 2003;

Orr, et al. Pediatric & Perinatal Epidemiology 2000Slide18

Outcomes for the CHILD

Temperament / behaviorLimited play and exploratory behaviors; less responsive to facial expressions; emotional lability; emotion regulation difficulty

Cognitive developmentLanguage delays; lower scores on McCarthy Scale of Children’s Abilities; poor school performanceMental / emotional health

Hyperactivity; defiance and disrespect; higher rates of depression in adolescence; increased adolescent substance abuse and behaviors leading to involvement in juvenile justice systemSlide19

Juvenile delinquency

“linking early life outcomes to later well-being, efforts to prevent and/or treat mental and addictive disorders in mothers and other women of childbearing age have the potential to improve outcomes of their children not only early in life, but throughout the life

cycle.”

Shader, Michael (2003), Risk Factors for Delinquency: An Overview; U.S. Department of Justice; Office of Juvenile Justice and Delinquency PreventionSlide20

Preventive health and parenting practicesShorter duration of breastfeeding; Improper sleep positioning; Less play and

reading; Less safety item use; Higher use of acute healthcare services; Delay in immunizationsMaternal-child interactionsDecreased reciprocity in interaction of infant; Decreased enjoyment of infant by mother; Lack of patience to soothe; Less active interactions;

Decreased bonding and attachmentPotential physical harm…death

Abuse / neglect; InfanticideSHAKEN BABY SYNDROME/Abusive Head TraumaSlide21

OICA.org

ADVERSE CHILDHOOD EXPERIENCESSlide22

There is no Health WITHOUT Mental Health

MENTAL HEALTH MUST BE INTEGRATED AT EACH POINT- AN INTEGRAL PIECE FOR STANDARD OF CARE.Slide23

Obstacles to Care

Provider Accessibility

Provider MisinformationCultural Taboos

Shame and Fear

Feldman

, et al. (2009) Maternal Depression and Anxiety Across the Postpartum Year

and Infant Social Engagement, Fear Regulation and Stress Reactivity. Jour of the American

Academy of Child and Adolescent Psychiatry, 48:919-927.

23Slide24

Primary Prevention Model

Risk Factors are knownPopulation is known and present

Feasible to identify high-risk mothersScreening is inexpensive

Screening is educational Many risk factors are amenable to change

Known, reliable, and effective treatments

24Slide25

Collaboration to Build on Existing Efforts

Protective factors approach must address PMAD

Strengthening Families Florida – multitude of agenciesFlorida Postpartum Support International (training for professionals/paraprofessionals; resources for communities and individuals)

Screening must be coupled with follow-up and treatmentEmotional support and education MUST start at preconceptionMental Health IS HealthSlide26

THANK YOU FOR YOUR CARE FOR THE HEALTH OF FLORIDA FAMILIES.