SOME QUICK FACTS Working with Families with Perinatal Depression - - PDF document

12/3/18 1

Working with Families with Perinatal Depression and Anxiety: Nurturing Families and Nurturing Yourself

Tracey Wingold, LCSW

Tracey Wingold, LCSW, LLC Online Mental Health Counseling (804) 316- 9694 traceywingold@itherapymail.com

SOME QUICK FACTS

§ PMADS (Perinatal Mood and Anxiety Disorders) are caused by a combination of biomedical, internal, and external factors § Moms are more at risk if they have a personal or 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!

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 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)

ANXIETY and DEPRESSION

Anxiety and/or depression affect up to 1 in 5 new or expectant mothers

SOME QUICK FACTS

§ PMADS (Perinatal Mood and Anxiety Disorders) are caused by a combination of biomedical, internal, and external factors § Moms are more at risk if they have a personal or 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!

12/3/18 2

Risks of Untreated PMADs

PREGNANCY

§ Pregnant women experiencing PMADs are more likely to have

– poor health habits – poor prenatal care – substance abuse

§ Increased risk of negative birth

• utcomes

– pre-term labor – premature delivery (<37 weeks) – low birth weight – small head circumference – low APGAR scores – NICU admissions

POSTPARTUM

§ Depressed mothers are more likely to have

– fewer positive interactions with their babies – decreased response to cues – breastfeeding issues

§ Increased risk for children to experience

– cognitive/developmental delays – emotional/behavioral problems – substance abuse – psychiatric disorders

Suicide

§ Although very rare, suicide is a leading cause of death among women of childbearing age (CDC) § One recent study in Canada found that most suicides occurred between 9-12 months postpartum.

Sources: https://www.cdc.gov/nchs/data/hestat/suicide/rates_1999_2014.htm https://www.seleni.org/advice-support/2018/3/16/what-we-can-do-to-prevent-maternal-suicide

PMADS and Minority Families

§ African American and Latina families are at higher risk of experiencing PMADs. § Factors include higher incidences of poverty, violence in relationships, and trauma, which are all risk factors for PMADs. § Healthcare disparities and discrimination in healthcare can also cause PMADs to be missed due to lack of screening § One study found that AA women describe depression more prevalent through physical symptoms

Source: https://www.seleni.org/advice-support/2018/3/16/pmads-such-as-ppd-and- anxiety-in-african-american-moms?rq=minorities

WHAT YOU MIGHT OBSERVE

Overwhelmed Guilty Miserable Sad Anxious Angry Irritable Increased sensitivity Poor concentration Tired but cannot sleep Intrusive thoughts Panic attacks Physical Symptoms Lack of attachment to baby

WHAT IS YOUR ROLE?

Home visitors have a unique opportunity to assist moms who are struggling, because of your proximity to the family. You have the opportunity to 1.Observe the signs 2.Educate (“You are not alone, you are not to blame, with help you will get well.”) 3.Screen (using the EPDS or other screening tool) 4.Refer for more help (OB, therapist, psychiatrist) 5.Provide Support (Listen, validate)

WHAT A HOME VISITOR’S ROLE IS NOT

Home visitors do not §Diagnose §Provide therapy §Give medical advice

(some exception for nurses!)

12/3/18 3

What Can You Do?

SUPPORT

§ Listen actively and without judgement § Encourage her; point out her strengths and efforts § Engage her social support system § Encourage, and help her plan for, her own self-care (eating, sleeping, exercise, time off)

What Should I Say and Do?

ASK

How are you feeling about being a new mother? How are you coping with the additional stress of a new baby? Are you able to sleep when the baby is sleeping? How is your appetite? Do you have enough energy to do the things you need to do? Do you find yourself crying a lot / all the time? Are you having any thoughts at are scaring you?

SHARE

FACT SHEETS INFORMATION CARDS PATH TO WELLNESS PSVA WEBSITE SUPPORT GROUPS

SAY

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.

Screening

Edinburgh Postnatal Depression Scale

§ Since 1987, FREE § 10 questions § Depression & anxiety § Question #10 § When

• During pregnancy
• At delivery
• First year postpartum

Anxiety /depression are so common that we should screen all new / expectant mothers

Treatment Options

Self-Care Social Support Talk Therapy Medication Hospitalization

Easy Cheap More Involved More Expensive

17

Self Care

TIME OFF

No other job is so challenging 24/7 Keeping another person alive

EXERCISE

Light exercise, Outdoors Vitamin D + fresh air + change

• f scenery + endorphins

SLEEP

4-5 hours uninterrupted

EAT

Every time baby eats High protein Calories for breastfeeding

Women need to recover from physical & emotional effects of pregnancy & childbirth

Mothering the mother Resources

Postpartum Support Virginia

Support for mothers and families § One-on-one support via phone / email § 20 FREE peer-led support groups § Facebook page Resources and information § Books, websites, doulas § 160+ Mental health professionals Outreach and education § Information cards, Fact Sheets, posters § Volunteer training sessions § Information and education sessions www.postpartumva.org

Postpartum Support Int’l postpartum.net Postpartum Progress postpartumprogress.com MGH Center for Women’s Mental Health www.womensmentalhealth.org

Books by Karen Kleiman. This Isn’t What I Expected: Overcoming Postpartum Depression

12/3/18 4

THE POWER OF REFERRAL

§ Know your community providers (therapists, prescribers, support groups). § Provide a WARM HANDOFF if possible. § FOLLOW UP to be sure that care is initiated. § Be mindful of confidentiality.

NOW, What About YOU?

Self Care and Compassion Fatigue

Self-care is any activity that we do deliberately in

• rder to take care of our mental, emotional, and

physical health. Compassion Fatigue is a state experienced by those helping people in distress. It is an extreme devotion to those being helped to the degree it can cause a secondary traumatic stress for the helper.

§Source: https://psychcentral.com/blog/what-self-care-is-and-what-it-isnt- 2/?ref=sssorganicgglunkwn&prid=sbseogglunkwn

Managing Compassion Fatigue

Rediscover that life is larger than the immediate situation, no matter how important it is. §Restart activities that you may have stopped doing as work demands intensified. §Try something different. §Talk about your feelings and needs with a professional, or a trusted friend or family member. §Take a vacation!

* Source – the Konterra Group Knowledge Library, http://www.konterragroup.net/compassion- fatigue-natural-happens-real/

Self Care Checklist

Self-inventory and goals

Closing Thoughts

§ This is often the first time a woman deals with mental illness § Women experiencing PMADs think they are 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.

12/3/18 5

Questions?

Thank you!!