What if we could prevent postpartum depression? I have yet to see a 100% surefire answer on how to do that, but we may be getting closer. The keyseems to beSUPPORTING NEW MOTHERS (!) closely and carefully in the first year.
Last year, I reported on a study conducted in Canada about the ability of peer support to either prevent or lessen the symptoms of postpartum depression. The study, conducted by Cindy-Lee Dennis at the University of Toronto, found that having trained volunteer mothers make regular phone calls to moms who have been identified as at-risk for PPD between 2 and 12 weeks postpartum reduced the number of women who developed symptoms requiring medical treatment.
Last week, another study conducted in the UK and published in the journal Psychological Medicine found that regular support from trained workers reduced the incidence of postpartum depression.New motherswere 30% less likely to develop PPD if they were attended to by a National Health Service health visitor who received specific training on screening for depression and on basic listening and cognitive behavioral therapy techniques. As reported in the Telegraph:
"The primary role of a health visitor is to check the progress of the new born and give advice on matters like breast feeding. However, they often provide invaluable friendly support for mothers in the months after birth.
Professor Terry Brugha, a psychiatrist at Leicester University, said: 'Up until now, it was thought that depression could only be treated when it is picked up by a GP or health visitor.
'But this study shows that women are less likely to become depressed in the year after childbirth if they are attended by an NHS health visitor who has undergone additional training in specific mental health assessment and in psychological approaches based on either cognitive behavioural or listening techniques.
'Women receiving usual care were significantly more likely to develop depression six months after childbirth.'"
What's more, Science Daily reported that such training was cost effective, even taking into account the costs of that extra training.
In Katherine's dream world of tomorrow, every single OB/GYN will take a complete social and medical history of newly pregnant patients. He or she will be aware of the variety of risk factors that exist for perinatal mood and anxiety disorders and will ask questions to identify whether a patient has any of them. Then, at-risk patients will receive specialized education on these illnesses,screenings,and extra attention throughout the first year postpartum from people who have been trained to provide emotional support. What a lovely world it will be.
How interesting, can't say I am surprised. Support was a main factor in my healing. Yes the medication and therapy was essential, I suffered from PPD and PPA with my daughter. With our next baby, yes I want to have another, my family and friends have already volunteered to be extra vigilant with recognizing signs and symptoms and being there for support and listening. And so has my OB, she said I will probably have more frequent PP appts, just to check in next time. If I could nominate my OB for some sort of award for the way she supported me through my PPD/PPA, I would. She went above and beyond, that's what it takes!
We live in the same dream world. I think one key thing out of this whole piece is that you mention in has been shown to be cost-effective. In a world ruled by insurance regulations and money, that definitely puts this sort of thing in a place where "the powers that be" may actually buy into such a thing. Great info – thank you!
Hi Katherine –
Interesting question. So many other questions pass through my mind. Is depression preventable? How can we strengthen people in order to help them cope with life events? I see pregnancy-related biopsychosocial challenges on a continuum with the woman's entire life of challenges.
New procedures such as having a new mother supported postpartum by a paraprofessional can help mitigate/screen women for postpartum symptoms. And those studies are so promising and it is fantastic. I tend to think, though, there are some people who come into pregnancy with prior psychological stressors, then adding the physical stressor of pregnancy and again the psychological stressor of mothering…this combination is a set-up for a perinatal mood disorder.
So, going into pregnancy, it is important that women are taking care of themselves, to be emotionally healthy, to recognize previous losses and life challenges. The ob/gyn is in a great position to do this type of screening, and have referrals handy for prenatal counseling.
Bravo for you for advocating for change and for more supportive care for women!
Kind regards, Kathy
And the dream world is becoming a reality our here in Western Mass!
In Franklin County, where there are about 500 births a years, this fall we will have every ob/gyn, midwife, family practice doc, pediatrician, obstetrical nurse, clinician, social worker and (soon!) the emergency service workers trained in how to identify and support women with emotional complications in pregnancy and postpartum. We are about to implement universal screening and we have an excellent Resource and Referral Guide. We have a MotherWoman Support Group, that the week it started had five women attend and has 8 – 10 mothers every week attending. The group is led by a clinical social worker and an ob nurse from the one hospital. It's very exciting to see a comprehensive campaign unfold in a rural county with a small city.
By the way, this is Rep. Ellen Story's general region. She's the woman who spearheaded the newly passed PPD Legislation in MA. (She understood the depth of the PPD crisis in our MotherWoman office two years ago.)
We are having fun at MotherWoman, this year!
And it's very exciting to be able to make Katherine's dreams come true!
I'm currently in a study that is being conducted at the University of Minnesota to test the impact of peer support on recovery from PPD. There were three groups -one assigned a postpartum doula for 24 hours (mine came for 2-3 hours at a time), another who received telephone peer support, and a random control group that received literature with resources about PPD. Dr. Dwenda Gjerdingen is conducting it. Not only did she put me in the study, but she actualy put in a call to a colleague that was not taking patients as the psychiatrist I was seeing was TERRIBLE and knew nothing about PPD. I'm really excited to see the results and owe a lot to Dr. Gjerdingen for helping me tremendously on my road to recovery.
I loved my OB and thought she was very attentive, but even though she asked me how I was feeling six weeks postpartum, that was it. There was no PPMD-specific followup, and since my PPD didn't develop until almost 8 months after my son's birth, I kind of fell under her radar. I think this kind of training would make every doctor a better, more sympathetic, and more qualified doctor.