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Symposium slide presentation

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Symposium slide presentation

  1. 1. Postpartum Depression: A Brief Overview
  2. 2. Objectives: <ul><li>Recognize the signs and symptoms of Perinatal Mood Disorders, especially PPD </li></ul><ul><li>Understand the effects of PPD on the mother, infant, family, and friends </li></ul><ul><li>Identify and access appropriate referral sources </li></ul>
  3. 3. The Postpartum Depression screening legislation in New Jersey, N.J.S.A. 26: 2-175 et seq., <ul><li>The legislation took effect on October 10, 2006 . </li></ul><ul><li>The act requires that : </li></ul><ul><li>health care professionals providing prenatal care will educate women and their families about Postpartum Depression (PPD) </li></ul><ul><li>all birthing facilities provide information and screening for PPD to departing new mothers and other family members </li></ul><ul><li>obstetricians, pediatricians, nurse midwives and nurses from private practices and clinics screen women within the first few postnatal check-up visits </li></ul>(Source: NJ Dept. of Health and Senior Services)
  4. 4. Postpartum Mood Disorders Maternity blues Adjustment Disorder Postpartum Depression Postpartum Psychosis/ Mania Disorder 26 to 85% About 20% 10 to 20% 0.2% Incidence Support and reassurance Support/reassurance psychotherapy Antidepressants, mood stabilizers & psychotherapy Hospitalization; antipsychotics; mood stabilizers; benzodiazepines; antidepressants; ECT Treatment 80% resolve by week 2; 20% evolve to PPD Excessive difficulties adjusting to motherhood Onset within 1 year Agitated Major depression often with obsessions. Onset after PP day 3. Mixed/rapid cycling. Risk of infanticide. Presentation
  5. 5. Could you have postpartum depression (PPD)? <ul><li>Have you recently been pregnant or had a baby? </li></ul><ul><li>Do you feel sad, anxious, or like you can’t handle things? </li></ul><ul><li>Have you thought about hurting yourself, your baby, or others? </li></ul>
  6. 6. If you answered yes, you are not alone… <ul><li>PPD affects between 11,000 and 16,000 women in New Jersey each year. </li></ul><ul><li>PPD is REAL. And there is REAL help for you. </li></ul><ul><li>PPD will not last forever and it can be treated. </li></ul>
  7. 7. What you need to know about PPD: <ul><li>Is pregnant </li></ul><ul><li>Recently had a baby </li></ul><ul><li>Had a miscarriage </li></ul><ul><li>Ended a pregnancy </li></ul><ul><li>Stopped breastfeeding </li></ul>PPD can affect any woman who:
  8. 8. Postpartum Depression Risk Factors <ul><li>Prenatal depression / history of depression </li></ul><ul><li>Prenatal anxiety / history of anxiety </li></ul><ul><li>Experiencing stress in life </li></ul><ul><li>Sudden changes in home or work routines </li></ul><ul><li>Teen pregnancy </li></ul><ul><li>Lack of social support </li></ul><ul><li>Socioeconomic factors </li></ul><ul><li>Complications during or after pregnancy </li></ul>
  9. 9. Social Isolation, Contributing Factor <ul><li>Woman perceives herself as not supported; has low self esteem </li></ul><ul><li>Family lives at a distance, physically unavailable or culturally in conflict </li></ul><ul><li>Cut off from friends </li></ul><ul><li>Relationship discord, including emotional or physical abuse; desertion of spouse or significant other </li></ul><ul><li>History of childhood sexual abuse </li></ul>Bulst & Janson, 2001 Crockenberg & Leerkes, 2003
  10. 10. Not Risk Factors <ul><li>Maternal age (beyond 18) </li></ul><ul><li>Level of education </li></ul><ul><li>Number of children </li></ul><ul><li>Length of relationship with partner </li></ul><ul><li>Gender of child </li></ul>Robertson, Grace, et al GenHospPsych 26(2004)289-295
  11. 11. Know the warning signs: <ul><li>Trouble sleeping or sleeping too much </li></ul><ul><li>Feeling irritable, angry, nervous, or exhausted </li></ul><ul><li>Lack of interest in baby, friends and family </li></ul><ul><li>Feeling guilty, worthless, or hopeless </li></ul><ul><li>Feelings of being a bad mother </li></ul><ul><li>Low energy or trouble concentrating </li></ul><ul><li>Thoughts of hurting the baby, yourself, or others. </li></ul>
  12. 12. Postpartum Psychosis or Mania Common Symptoms <ul><li>Psychosis </li></ul><ul><ul><li>Delusions </li></ul></ul><ul><ul><li>Hallucinations </li></ul></ul><ul><ul><li>Disorganized speech </li></ul></ul><ul><ul><li>Disorganized behavior </li></ul></ul><ul><li>Symptoms are typically related to the infant, often with a religious flavor </li></ul><ul><li>Marked lability of moods </li></ul><ul><li>Mania </li></ul><ul><ul><li>Euphoria </li></ul></ul><ul><ul><li>Decreased need for sleep </li></ul></ul><ul><ul><li>More talkative </li></ul></ul><ul><ul><li>Racing thoughts </li></ul></ul><ul><ul><li>Distractibility </li></ul></ul><ul><ul><li>Increased involvement in activities </li></ul></ul><ul><ul><li>Excessive involvement in pleasurable but risky activities </li></ul></ul>Adapted from DSM IV-TR, Washington, D.C.: American Psychiatric Association; 2000.
  13. 13. Potential Effects Of Postpartum Mood Disorders <ul><li>Negative Mother/Infant Relationship </li></ul><ul><li>Delayed Child Development </li></ul><ul><li>Altered Partner Relationship </li></ul>
  14. 14. PPD affects the whole family… <ul><li>As a family member or friend, you may: </li></ul><ul><li>Feel confused or worried by mood changes in a woman who has had a baby or been pregnant. </li></ul><ul><li>You may even notice a change in behavior before she does. </li></ul><ul><li>You can help. Lend your patience and support to your loved ones in this difficult time. </li></ul><ul><li>However, if symptoms persist BEYOND TWO WEEKS, seek help… </li></ul>
  15. 15. Postpartum Depression Screening <ul><li>Postpartum Depression Screening is taking place, “prior to discharge from the birthing facility and at the first few postnatal checkup visits.” </li></ul><ul><li>A specific screening tool called the Edinburgh Postnatal Depression Scale is the state recommended tool of choice. </li></ul><ul><li>This screening tool is to be administered by qualified healthcare professionals. </li></ul>
  16. 16. <ul><li>Taken from the British Journal of Psychiatry </li></ul><ul><li>June, 1987, Vol. 150 by J.L. Cox, J.M. Holden, R. Sagovsky </li></ul><ul><li>Instructions </li></ul><ul><li>The mother is asked to underline the response that comes closest to how she has been feeling in the previous 7 days. </li></ul><ul><li>All ten items must be completed. </li></ul><ul><li>Care should be taken to avoid the possibility of the mother discussing her answers with others. </li></ul><ul><li>The mother should complete the scale herself, unless she has limited English or has difficulty with reading. </li></ul>Edinburgh Postnatal Depression Scale
  17. 17. Using the Edinburgh Postnatal Depression Scale (EPDS)
  18. 18. Guidelines for Evaluation: <ul><li>Response categories are scored 0, 1, 2, and 3 according to increased severity of the symptom. Questions 3, 5, 6, 7, 8, 9, 10 are reverse scored (i.e., 3, 2, 1, 0). </li></ul><ul><li>Individual items are totaled to give an overall score. A score of 10+ indicates the likelihood of depression, but not its severity. The EPDS Score is designed to assist, not replace, clinical judgment. Women should be further assessed before deciding on treatment. </li></ul><ul><li>This scale may be reproduced by users without further permission providing they respect copyright by quoting the names of the authors, the title and the source of the paper in all reproduced copies. </li></ul>
  19. 19. <ul><li>The thought of harming myself has occurred to me. </li></ul><ul><li>Yes, quite often </li></ul><ul><li>Sometimes </li></ul><ul><li>Hardly ever </li></ul><ul><li>Never </li></ul>Question 10
  20. 20. <ul><li>Inaccurate self-report </li></ul><ul><ul><li>Undiagnosed mood disorders </li></ul></ul><ul><ul><li>Denial of illness </li></ul></ul><ul><li>Fear of involvement of child protection agencies </li></ul><ul><li>Ability to mask symptoms especially if highly functional </li></ul><ul><li>Motherhood myth </li></ul>False Negatives Despite Screening
  21. 21. Family & Friends: How you can help… <ul><li>Help with daily activities before she asks </li></ul><ul><li>Encourage her to be open about her feelings </li></ul><ul><li>Be alert to signs of depression </li></ul><ul><li>Be patient and supportive </li></ul><ul><li>Help care for the baby </li></ul><ul><li>Encourage the mother to visit a doctor </li></ul><ul><li>Create a safe, loving, and accepting environment </li></ul>
  22. 22. How You Can Help: <ul><li>Learn more, visit the website: www.njspeakup.gov </li></ul><ul><li>Use the 1-800 # line: 1-800-328-3838 </li></ul><ul><li>Provide educational brochures to moms & family members </li></ul><ul><li>Provide info about resources available in NJ as well as in Monmouth & Ocean Counties </li></ul><ul><li>Refer mom to a self-help support group </li></ul><ul><li>Consider establishing a support group through your organization </li></ul>
  23. 23. 1-800-328-3838……. How It Works <ul><li>The 1-800-328-3838 is available for anyone to call who wants information or who wants to speak to a clinician </li></ul><ul><li>The potential benefit of a referral through the NJDHSS 800#/UBHC(University Behavioral Health Care) process: </li></ul><ul><li>Will be referred for emergent clinical response to the Screening Center in the county where the client resides. </li></ul><ul><li>The client will potentially be seen in 5 business days </li></ul><ul><li>A client who is uninsured or underinsured can be covered up to 12 visits under this PPD clinical services program </li></ul><ul><li>A client’s primary health insurance will be taken into account when clinical services are being arranged </li></ul>
  24. 24. The Medication Question: To nurse or not to nurse? <ul><li>Nursing is a totally personal choice; one that should be respected regardless if the mother chooses to nurse or not. </li></ul><ul><li>Should medication be needed to treat PPD, one should understand that it is NOT 100% necessary to stop nursing one’s baby if mom is medicated. There are acceptable medications that can be used and practices that can be modified. </li></ul><ul><li>However, should the mother decide that she wants to stop nursing, she needs to be supported with this decision and not be made to feel guilty. </li></ul>
  25. 25. You can feel better! <ul><li>PPD is no one’s fault and will not last forever. </li></ul><ul><li>No matter how bad you feel today, there is hope for a brighter tomorrow. </li></ul><ul><li>You can beat the symptoms of PPD. </li></ul><ul><li>Treatment can help…But you have to speak up when you’re down! </li></ul>

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