Perinatal Depression

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Perinatal Depression

• MCH Federal/State Partnership Meeting
• Alexandria, VA
• October 17, 2007
• Diana Cheng, M.D.
• Medical Director, Womens Health
• Maryland Department of Health and Mental Hygiene

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Causes of Depression
hormones
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Depression Across the Female Lifespan
Pregnancy/Postpartum
Premenstrual
Peri-menopause
Birth
Death
Menopause
Menarche
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Postpartum Depression

• Affects 1 out of every 8 postpartum women
• Begins 2 weeks 1 year postpartum
• Symptoms
• Depression, anhedonia
• Emotional stress, helplessness, irritability,
  anger
• Inability to do normal everyday tasks
• Appetite changes, sleeping too much/ too little
• Thoughts of self-harm or suicide
• Overly intense worries about baby
• Lack of interest or fear of harming baby

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Depression During Pregnancy

• Pregnancy is not protective against depression
• Affects 10-15 of pregnant women
• Begins any trimester
• Symptoms

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Percentage of Mothers Who Reported Being at Least
Moderately Depressed in the Postpartum Period,
Maryland PRAMS 2001-2003
Annual household income
Age
Marital status
Race and ethnicity
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Risk Factors for Maternal Depression

• Prior depression (30)
• Prior postpartum depression (50) or psychosis
  (70)
• Depression during pregnancy
• Prior PMDD (premenstrual dysphoric disorder)
• Family history of depression or bipolar disorder
• ?Teens, not married, low income
• Recent stressful events
• marital/partner discord, loss of loved one,
  family illness, premature birth

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Edinburgh Postnatal Depression Scale

• Created for postpartum women
• Can also be used during pregnancy
• Less emphasis on physical symptoms
• Takes lt 5 minutes to complete
• Self-administered
• Validated screening tool
• Useful in primary care settings
• Rates intensity of depressive symptoms
• 10 questions, each worth 0-3 points
• Score gt12 (out of 30) indicates likely depression

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Treatment for Depression

• Support
• Support groups (facilitated), family, friends,
  help lines
• Counseling
• Cognitive behavioral / interpersonal therapy
• Other treatments
• light, alternative medicines
• ECT
• Antidepressants

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Maternal DepressionGetting Help
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Maternal Depression Effects on Infant and Child

• Poor pregnancy outcomes
• PTL, LBW, SGA, RDS, ?PIH ?SAb
• Poor mother-infant attachment
• Irritable, lethargic, poor sleep
• Language delays
• Behavioral difficulties
• Lower cognitive performance
• Mental health disorders
• Attention problems

Kahn, et al. AJPH 2002921312-1318 Bonari et al.
Can J Psychiatry 200449726-735

• Infant Behav Dev 200427216-229
• Psychiatry 20046763-80

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Maternal Effects of Untreated Depression

• Poor prenatal behaviors
• Nutrition, prenatal care, substance abuse
• Poor parenting behaviors
• Longer persistence of symptoms
• Increased risk of postpartum depression
• Increased risk of relapse
• Suicide

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Maryland Program DepressionDATA to Action
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Data ACTION

• Maternal Depression Team (multidisciplinary)
• Providers (ob,ped, CNM, FP, psych, nursing,
  social work, public health)
• Health care coverage (Insurance/medicaid)
• Organizations (WIC, March of Dimes,
  academic/community, womens health, daycares,
  churches)
• Legislation 2004 Maryland General Assembly
• Grants

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• 1-800-PPD-MOMS Helpline
• Website (www.healthynewmoms.org)
• Media messages
• Posters, Video PSAs, Radio Ads
• Local partnership grants
• Provider training
• Information Packets
• Provider CMEs, screening scale, brochure,
  resource list
• Education

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www.healthynewmoms.org
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Available in English, Spanish, Chinese, Korean,
Vietnamese, Russian, French
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WELL ProjectWomen Enjoying Life Longer A
Womens Health Program in 3 Title X Baltimore
County Family Planning Sites
Eastern Family Resource Center
Dundalk Health Center
Essex Health Center
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Maternal Depression

• Common Disorder
• Under-diagnosed, under-treated
• Adverse effects
• mother, fetus, infant, family
• Validated screening tools
• Effective treatment
• Universal Screening
• Capacity, advocacy, research, education