We are excited to bring you this guest post by ICH’s partner, Jessie Colbert. Jessie is the Executive Director of the Mass. PPD Fund, a nonprofit that is working to raise awareness of postpartum depression and other perinatal mental health challenges and to improve services for parents in Massachusetts.
Postpartum depression and other Perinatal Mood and Anxiety Disorders (PMADs) are the #1 complication of pregnancy. They impact over 575,000 moms, as well as hundreds of thousands of dads, in the US each year – with devastating, multigenerational public health consequences. PPD is a painful, isolating challenge, characterized by symptoms including sadness, anxiety, sleep disturbance, anger or irritability, feelings of guilt and hopelessness, and/or intrusive thoughts of harming oneself or one’s baby.
The issue made headlines recently with the FDA’s approval of Zulresso, an exciting but expensive new drug that can effectively treat PPD much more quickly than traditional antidepressants. This announcement has gone a long way toward getting people talking about the issue. But there is still tremendous stigma around PMADs, and a major lack of understanding and support for parents who go through them.
So, it’s fitting to focus on this issue in May, mental health awareness month. We need to raise awareness around PMADs in many ways. Most importantly, they are so common, impacting about 1 in 5 new moms (O’Hara & McCabe, 2013). Just knowing this can make a major dent in stigma and help us improve treatment resources. And, it’s not just “postpartum depression.” Many disorders can be flagged during pregnancy. And PMADs can present in many different ways, including anxiety, PTSD (often from birth trauma), and postpartum OCD. Much less common but still critical to recognize and treat is postpartum psychosis, which impacts about 1-2 women per 1,000 births.
We also need raise awareness that it doesn’t just happen to birth mothers. Dads, adoptive parents, non-birth moms – they can all be vulnerable to these challenges, and are sometimes at even greater risk (in the case of IVF, for example).
In addition, and critically, PMADs do not impact all families equally. Although PPD and other PMADs can hit moms with every advantage, like many other illnesses these challenges are significantly influenced by the social determinants of health. While rates of PMADs are about 15-20% generally, they are double that for women of color (Gress-Smith et. al, 2012), with other risk factors upping the ante (lack of social support, poverty, substance abuse, prior mental illness, immigrant or refugee status, marital discord, etc.). Our efforts at identification, prevention, and treatment MUST consider these statistics, and cultural humility is vital.
The other piece of awareness is good news, though: PMADs are treatable. With right help (therapy, dyadic treatment, support groups, and/or medication), parents can feel better, and family life can get back on track. Unfortunately, however, only about 17% of those with PMADs receive some kind of treatment (Carter, 2009; Smith, 2009; Marcus, 2003).
That’s why I founded the Mass. PPD Fund. Even here in Massachusetts, where we boast many programs that are national models on the issue – our state’s PPD Commission, the MCPAP for Moms consulting service for OB/GYNs, leading research institutions such as MGH’s Center for Women’s Mental Health – there are only services for about half of the moms who need them, and likely even less. Our Fund is working to better quantify this measure, with help from the Department of Public Health and the Boston University School of Public Health’s Maternal & Child Health Center for Excellence.
As we fine-tune this data – which also involves identifying where in the state, and for whom, services are most lacking – we are working to invest where we know there is a need, with ICH’s help. The Fund is pursuing projects in urban Boston, the Cape, several Gateway Cities, the state’s congregate family homeless shelters, and other sites, working to add support groups and train mental health providers on the issue. ICH will bring their expertise through focus groups and other evaluation methods, helping us learn as much as we can about effective interventions during our organization’s pilot phase. We are also working hard to raise the profile of the issue, and the need for more services – and for much better support for new families in general. So please share this post, and help us spread the word!