12/3/18 SOME QUICK FACTS Working with Families with Perinatal Depression and § PMADS (Perinatal Mood and Anxiety Disorders) are caused by a combination of biomedical, internal, Anxiety: Nurturing Families and external factors and Nurturing Yourself § Moms are more at risk if they have a personal or family history, had a traumatic pregnancy or birth, or have little social support Tracey Wingold, LCSW § PMADs don’t always look like depression! (Anxiety Tracey Wingold, LCSW, LLC is very common.) Online Mental Health Counseling (804) 316- 9694 § PMADs are COMMON and TREATABLE! traceywingold@itherapymail.com Disclaimers § Information from this presentation came from a variety of sources. Credit goes to Postpartum Support Virginia, for providing some of the slides, information, and handout § Additional information was obtained from The Seleni Institute, an organization that provides training for ANXIETY and DEPRESSION professionals around perinatal mental health. § Other sources are noted within the presentation. § The self-care checklist is being used with permission. It was created by “Shari’s berries” (www.berries.com) SOME QUICK FACTS § PMADS (Perinatal Mood and Anxiety Disorders) are Anxiety and/or depression caused by a combination of biomedical, internal, and external factors affect up to 1 in 5 § Moms are more at risk if they have a personal or new or expectant mothers family history, had a traumatic pregnancy or birth, or have little social support § PMADs don’t always look like depression! (Anxiety is very common.) § PMADs are COMMON and TREATABLE! 1
12/3/18 Risks of Untreated PMADs Suicide § Although very rare, suicide is a leading cause of PREGNANCY POSTPARTUM death among women of childbearing age (CDC) § Pregnant women experiencing § Depressed mothers are more PMADs are more likely to have likely to have – poor health habits – fewer positive interactions with – poor prenatal care their babies § One recent study in Canada found that most – substance abuse – decreased response to cues § Increased risk of negative birth suicides occurred between 9-12 months – breastfeeding issues outcomes postpartum. – pre-term labor § Increased risk for children to – premature delivery (<37 weeks) experience – low birth weight – small head circumference – cognitive/developmental delays Sources: – low APGAR scores – emotional/behavioral problems https://www.cdc.gov/nchs/data/hestat/suicide/rates_1999_2014.htm – NICU admissions – substance abuse https://www.seleni.org/advice-support/2018/3/16/what-we-can-do-to-prevent-maternal-suicide – psychiatric disorders PMADS and Minority Families WHAT YOU MIGHT OBSERVE § African American and Latina families are at higher risk of experiencing PMADs. Overwhelmed Increased sensitivity § Factors include higher incidences of poverty, violence in Guilty Poor concentration relationships, and trauma, which are all risk factors for PMADs. Miserable Tired but cannot sleep § Healthcare disparities and discrimination in healthcare can also Sad Intrusive thoughts cause PMADs to be missed due to lack of screening Anxious Panic attacks Angry Physical Symptoms § One study found that AA women describe depression more prevalent through physical symptoms Irritable Lack of attachment to baby Source: https://www.seleni.org/advice-support/2018/3/16/pmads-such-as-ppd-and- anxiety-in-african-american-moms?rq=minorities WHAT IS YOUR ROLE? WHAT A HOME VISITOR’S ROLE IS NOT Home visitors have a unique opportunity to assist Home visitors do not moms who are struggling, because of your proximity to the family. You have the opportunity to § Diagnose § Provide therapy 1.Observe the signs § Give medical advice 2.Educate (“You are not alone, you are not to blame, with help you will get well.”) (some exception for nurses!) 3.Screen (using the EPDS or other screening tool) 4.Refer for more help (OB, therapist, psychiatrist) 5.Provide Support (Listen, validate) 2
12/3/18 What Should I Say and Do? What Can You Do? ASK SHARE SUPPORT How are you feeling about being a new mother? FACT SHEETS § Listen actively and without judgement How are you coping with the additional stress of a new baby? INFORMATION CARDS Are you able to sleep when the baby is sleeping? PATH TO WELLNESS § Encourage her; point out her strengths and How is your appetite? PSVA WEBSITE Do you have enough energy to do the things you need to do? efforts Do you find yourself crying a lot / all the time? SUPPORT GROUPS § Engage her social support system Are you having any thoughts at are scaring you? § Encourage, and help her plan for, her own SAY self-care (eating, sleeping, exercise, time off) Validate : I’m sorry you are having a tough time. Normalize : Lots of new moms have these feelings. Offer hope : You are going to get well. Treatment Options Screening Edinburgh Postnatal Self-Care Easy Depression Scale Cheap § Since 1987, FREE Social Support § 10 questions § Depression & anxiety § Question #10 Talk Therapy § When o During pregnancy Medication o At delivery o First year postpartum Hospitalization More Involved Anxiety /depression are so common that we should screen all new / expectant More Expensive mothers Resources Self Care Postpartum Support Virginia EXERCISE SLEEP Women Support for mothers and families Postpartum Support Int’l need to § One-on-one support via phone / email postpartum.net Light exercise, Outdoors 4-5 hours recover from § 20 FREE peer-led support groups Vitamin D + fresh air + change uninterrupted Postpartum Progress physical & § Facebook page of scenery + endorphins postpartumprogress.com Resources and information emotional EAT TIME OFF § Books, websites, doulas effects of MGH Center for Women’s Mental Health § 160+ Mental health professionals pregnancy www.womensmentalhealth.org Every time baby eats No other job is so challenging Outreach and education & childbirth High protein 24/7 § Information cards, Fact Sheets, posters Calories for breastfeeding Keeping another person alive § Volunteer training sessions Books by Karen Kleiman. Information and education sessions § This Isn’t What I Expected: Overcoming Mothering the mother www.postpartumva.org Postpartum Depression 17 3
12/3/18 THE POWER OF REFERRAL NOW, What About § Know your community providers (therapists, prescribers, support groups). YOU? § Provide a WARM HANDOFF if possible. § FOLLOW UP to be sure that care is initiated. § Be mindful of confidentiality. Self Care and Managing Compassion Fatigue Compassion Fatigue Rediscover that life is larger than the immediate Self-care is any activity that we do deliberately in situation, no matter how important it is. order to take care of our mental, emotional, and § Restart activities that you may have stopped doing as physical health. work demands intensified. § Try something different. Compassion Fatigue is a state experienced by those § Talk about your feelings and needs with a helping people in distress. It is an extreme devotion to professional, or a trusted friend or family member. those being helped to the degree it can cause a § Take a vacation! secondary traumatic stress for the helper. * Source – the Konterra Group Knowledge Library, http://www.konterragroup.net/compassion- § Source: https://psychcentral.com/blog/what-self-care-is-and-what-it-isnt- fatigue-natural-happens-real/ 2/?ref=sssorganicgglunkwn&prid=sbseogglunkwn Closing Thoughts § This is often the first time a woman deals Self Care Checklist with mental illness § Women experiencing PMADs think they are Self-inventory and goals monsters § Dads / partners can also experience PMADs § Mothers, babies, families can recover § This work is hard for you too! It’s important to take care of yourself in order to be effective and stay healthy. 4
12/3/18 Questions? Thank you!! 5
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