Findings from a study of women with lived experience of depression during and after pregnancy, specific to what is helpful, what are barriers and how to affect change

Allison, Jeroan J.

Biebel, Kathleen

Byatt, Nancy

Debordes-Jackson, Gifty

Friedman, Liz

Ziedonis, Douglas M.

English

eScholarship@UMMS

University of Massachusetts Medical School eScholarship@UMMS Implementation Science and Practice Advances Research Center Publications Psychiatry 2012 Relationships as Key to Recovery for Perinatal Women Living with Depression Kathleen Biebel University of Massachusetts Medical School Et al. Let us know how access to this document benefits you. Follow this and additional works at: https://escholarship.umassmed.edu/psych_cmhsr  Part of the Health Services Research Commons, Maternal and Child Health Commons, Obstetrics and Gynecology Commons, Psychiatric and Mental Health Commons, Psychiatry Commons, Psychiatry and Psychology Commons, and the Women's Health Commons Repository Citation Biebel K, Byatt N, Debordes-Jackson G, Friedman L, Allison JJ, Ziedonis DM. (2012). Relationships as Key to Recovery for Perinatal Women Living with Depression. Implementation Science and Practice Advances Research Center Publications. Retrieved from https://escholarship.umassmed.edu/psych_cmhsr/617 This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Implementation Science and Practice Advances Research Center Publications by an authorized administrator of eScholarship@UMMS. For more information, please contact Lisa.Palmer@umassmed.edu. Relationships as Key to Recovery for Perinatal Women Living with Depression  Kathleen Biebel, Nancy Byatt, Gifty Debordes-Jackson, Liz Friedman, Jeroan Allison, & Doug Ziedonis Goals • What we know about perinatal women living with depression • Our study  • Findings regarding relationships • Next steps    Terminology • Perinatal –  Traditionally, mid-pregnancy to 28 days after birth      • A continuum –  Include all of pregnancy and up to several years after birth  Impact of mental health challenges during the perinatal period • Affect parent, child, partner and family –  Attachment challenges –  Under-utilization of prenatal care –  Behavioral challenges with      children –  Difficulties with social interactions –  Poor health behaviors Prevalence of perinatal mental illness • 25% of women pregnant in past year met criteria for psychiatric diagnosis • 10-20% of mothers meet criteria after birth • 10-25% of fathers  Few seek treatment • 15-25% of women meeting     criteria receive treatment  Why limited treatment seeking? • Concerns of being judged as a mother • Concerns about losing parental rights • Lack of understanding by mothers and providers about medication during pregnancy and post delivery • Negative experiences in the mental health system Study and purpose • Study of women with lived experience of depression during and after pregnancy – Interested in experiences with providers  • what is helpful?  • what are barriers? • what can we do to affect change?  • Use findings to develop preliminary guidelines to engage women in depression  treatment  • Inform development of interventions to integrate depression treatment into provider settings Methods • Four focus groups with mothers (n=27) in Western Mass –  Self –identified as experienced perinatal depression  or emotional crisis – Probes targeted to identify barriers and facilitators to accessing care, and potential strategies for change  Characteristics of mothers • Mean age: 32 • Caucasian • 80% had 1 or 2 children • Income variability • 22% - less than 20K/year • 11% - more than 100K/year • All parenting with a partner • Mental health treatment • Pre-pregnancy – 70% • During pregnancy – 22% • After pregnancy – 67%  General findings  • Barriers to care – Fear – OB providers lack of knowledge re: mental health care • What would facilitate care – Flexible care options – Recognition of importance of perinatal mental health – Integrate prevention, detection, and management of depression into perinatal care   What mothers’ said about relationships • Value of relationships  • Relationships critical to wellness for mother, child and family  • How a “good” or “bad” relationships can influence if and how care is received by mothers     There are many “providers” in mothers’ lives • OB/GYNs • Mid-wives • Mental health professionals • Pediatricians • Partners, families and friends • Lactation consultants • Yoga instructors • Chiropractors • Support groups • Facebook, virtual environments  Focus on mothers AND babies “What would be helpful for me to hear from an OB is, ‘you know, we make this appointment to talk about the wellness of your child, but let’s take a few moments and talk about the wellness of you.  What do you want to tell me so far about this experience for you?’” Recognize the transition to parenthood “People are really good at forgetting there’s a primary caretaker for that baby who could use some attention…and I think it’s a hard transition for moms to go from being the sole, you know, person getting attention being pregnant, and that the second you deliver, it’s like you’re yesterday’s news.” Acknowledge physical and emotional experiences “It was really creepy actually, cause the doctors were focusing on the medical stuff.  And they were like, ‘oh, something’s really wrong.’  And then the midwives had no clue and they were saying, ‘How are you feeling? Your ankles look good.  Not a lot of swelling’….so there wasn’t any space in any of this for people to ask me how I was doing, how I was feeling, or any discussion of the emotional stuff.” Acknowledge the whole person, not just the illness  “Address everything that’s not depression.  You know, there’s exercise…nutrition, sleep, friendships.  Everything changes when you have a baby, and if there was some sort of way to encompass the whole self, that would be really cool.” Learn through authentic communication “You know, my pediatrician referred me there…he’s such an amazing person.  But it was such an organic conversation.  He was asking about her eating habits, which led to sleep and then about my eating habits.  And it didn’t feel like when I was screened six weeks postpartum and she went down the checklist and said, ‘have you laughed?  Do you feel good?’” Have a conversation about supports “When I delivered at Umass Memorial you have a nurse and you get these two booklets – one is on shaken baby and on one postpartum depression and psychosis.  And the nurse goes through each with you, and you both sign off that you’ve gone through and read the materials so you can kind of recognize…when you’re angry and have to put the baby down….That was really helpful, and I was surprised and happy they did that.” Validate experiences “Not, you know, joking and saying ‘Oh-no, all babies do that.’ You know, like, ‘No, actually can we just talk about what my baby’s doing right now and the fact that it’s upsetting me’…you know, I think the first time mom thing…people just take your stories as anecdotal…and just brush it off.” Summary • Focus on mothers and babies • Recognize the transition to parenthood • Acknowledge physical & emotional experiences • Acknowledge the whole person • Learn through authentic communication • Have a conversation about supports • Validate experiences Why think about relationships  Improved Outcomes  (daily functioning, parenting, well-being, quality of life, health, offspring health, relationships, family, prognosis) Symptom Improvement    Treatment Engagement Assessment Detection Next steps • Explore further what it is about these relationships and interactions that makes a difference • Examine how to fit with existing protocols, screens and constraints • Investigate strategies to encourage organizational and systems change • ALL INFORMED BY MOTHERS AND PROVIDERS   Contact Us • Kathleen Biebel – Kathleen.Biebel@umassmed.edu  • Nancy Byatt – Nancy.Byatt@umassmemorial.org 

Relationships as Key to Recovery for Perinatal Women Living with Depression

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Relationships as Key to Recovery for Perinatal Women Living with Depression

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