Postpartum Depression Detection & Treatment

"Dateline: September, 2001 - Youngstown resident, Jodi Kluchar found dead in her home at 5:00 this morning. Apparent cause of death is suicide. She leaves her husband, Matthew Kluchar, two year old son and one month old daughter..." What if the previous story was true? It may have been if I had not sought help for Postpartum Depression after the birth of my daughter in August, 2001. However, my therapist was not familiar with Postpartum Depression, and it took a very long time to customize a treatment plan that worked for me. Because of my experiences, I've created a peer support group in Mahoning County, and decided to get my bachelors degree in social work, and to specialize in counseling new mothers who are suffering from Postpartum Depression.

According to a recent study, up to 20% of women experience Postpartum Depression after childbirth. A significant number of those women are low-income, non-white, and/or single mothers , yet not enough attention is given to screening new mothers and providing preventative treatment. (Although I feel that statistic is low because of the cases that go unreported.) The mother is the nucleus of the family, and if the mother is not healthy, then the infant will be affected. However, many women do not seek help because of fear and the stigma attached to the disorder. A group of 118 women who belong to an online support group and have experienced Postpartum Depression was polled: 33 % have not sought professional help because of the feelings of failure and shame attached to their experiences; 55% chose not to have any more children due to fear of the depression returning after a subsequent childbirth; and 88% believe that treatment by a professional familiar with the disorder would be or would have been beneficial to their recovery . These results show that social workers need to be proactive in their communities in detecting and treating Postpartum Depression in new mothers, and educating health care providers about the warning signs.

Postpartum Depression can manifest itself in many forms, usually within the first year after giving birth. The "Baby Blues" effect 80% of new mothers, but usually subsides in two weeks. If the depression lasts longer than two weeks Postpartum Depression must be considered as a possible diagnosis, and it may last up to a year without treatment. Postpartum Depression can affect 15% to 20% of new mothers, and symptoms include depressed mood, changes in appetite, sleep disturbances, extreme and unexplained sadness, uncontrollable crying, fatigue, and feelings of worthlessness or hopelessness, lack of interest in normal activities, inability to bond with the new infant, fleeting thoughts about hurting the infant, feelings of fear and guilt, and suicidal thoughts. Postpartum Depression is often confused with Postpartum Psychosis which is characterized by delusions, paranoia, and hallucinations, and affects less than one percent of new mothers. However it is the most serious of Postpartum Mood Disorders because 4% to 5% of women with Postpartum Psychosis either commit suicide, infanticide or both, so it requires immediate hospitalization. Risk factors for developing Postpartum Depression consist of a personal or family history of depression, depression during pregnancy, low socioeconomic status, lack of family support, lack of a partner, being a victim of physical or sexual abuse, non-white cultural background, previous pregnancy loss, and the infant being a result of an unwanted pregnancy. Friends and family members can exacerbate the situation by saying things like, "You have a healthy infant, you should just be happy." This can increase feelings of guilt in the new mother, and prevent her from seeking treatment because she is "supposed to be happy." OB/GYN's often miss the signs of Postpartum Depression at the six-week follow-up visit either because they are so busy that they neglect to ask how the new mother is feeling, or they are simply unfamiliar with the symptoms of the disorder.

Social workers can provide treatment to women suffering from Postpartum Depression that includes group therapy and interpersonal therapy. Group therapy is useful in relieving the fear and isolation depressed mothers often feel, and can create lasting relationships. It is important for the leader of the group to have a list of physicians and treatment centers available for referral in case a woman attending needs addition treatment, such as medication. According to Grote, interpersonal therapy, which consists of three phases, is valuable in treating Postpartum Depression, and preventing a relapse or recurrence in the future. The first phase of interpersonal therapy is called the "acute phase," which begins when the new mother has her first depressive episode. This phase seeks an initial response to therapy. Once the mother has achieved partial or full remission from depression, continuation is the next and middle phase of treatment. The goal of the "continuation phase" is to prevent a relapse of depression long enough to achieve recovery from depression. The "maintenance phase" begins after the mother has recovered and is designed to prevent recurrence for as long as two to three years. Studies show that Postpartum Depression is a chronic illness and relapse is expected within the first two to six months after remission, while recurrence is expected within the first six to eight months after recovery. Because of this, therapy sessions are recommended bi-weekly during the continuation phase and monthly during the maintenance phase to help new mothers deal personal and social stress effectively . Education during therapy should emphasize that depression is common; it is not the woman's fault, and that by working with her therapist, she will begin to feel better.

A system of education led by social workers needs to be implemented into the community to educate health care providers and new mothers about the symptoms and risk factors of Postpartum Depression, screening and treatment options. That way OB/GYN's and Pediatricians will be able to spot the warning signs and more women will be diagnosed and treated. Social workers are involved with new mothers in a variety of settings yet often don't have access to medical history. So if other health care providers are aware of the symptoms and risk factors, a coordinated effort can be made to help the social worker identify high risk mothers, and get them the treatment they need. Since women of low socioeconomic status are more likely to experience Postpartum Depression, as stated above, Community Health Clinics are an excellent place to evaluate the emotional well being of mothers while her infant is getting a checkup. The Edinburgh Postnatal Depression Scale is an excellent, and usually state approved tool to assess depression in new mothers. Staff can ask the ten simple questions from this screening tool to determine whether or not the mother has symptoms of Postpartum Depression . Staff can also help by letting the new mother know that she is not alone and refer her to treatment. A therapist who is familiar with Postpartum Depression can help offset the fear of the new mother, and start her on a treatment plan that will speed her to wellness.

This is of monumental importance for the health and well-being of not only the mother, but the infant as well. Preterm birth and low birth weight are more prevalent if the mother experiences depression during pregnancy. Studies have also shown correlations between Postpartum Depression and development of the infant. Depressed mothers may become emotionally withdrawn and unresponsive to their new infant and this can lead to insecure attachment. The most severe form of insecure attachment is called Reactive Attachment Disorder, where the infant shows either unusual friendliness to strangers, or completely withdraws from social contact. Infantile depression can also occur, in which appetite and activity levels drop, vocalization and eye contact decline, and they can completely withdraw from social interaction. This can lead to a diagnosis of "Failure to Thrive," in which the infant falls below the fifth percentile on the growth charts. Mothers with Postpartum Depression are also more prone to neglect or abuse their infants, and in the worst cases of Postpartum Psychosis, even kill their infants . When these symptoms are present in an infant, it is a good indicator to the pediatrician that the mother may be experiencing Postpartum Depression, and then the pediatrician can refer her to the appropriate resources for detection and treatment.

If I had committed suicide in 2001, I would never have been able to see my children grow up. I would have never started a postpartum support group, and I would never be pursuing my bachelors degree in social work so I can help suffering women full time. I believe my experiences with Postpartum Depression have prepared me for this work; it is my passion and my calling in life. Along with counseling women, I plan on developing a community education program for health care professionals that will prepare them to look for the warning signs of Postpartum Depression in new mothers. I also believe that screening with the Edinburgh Postnatal Depression Scale should be mandatory for all new mothers released from the hospital, and again at their six-week follow up visit with their OB/GYN. This screening tool is already approved for use by the State of Ohio; we just need to start incorporating it into the model of care for new mothers. Only then will more mothers be diagnosed, especially those most at risk, and then be referred to the help they need, and less women will suffer in silence.

Abrams, Laura S. and Laura Curran. "Not Just a Middle Class Affliction: Crafting a Social Work Research Agenda on Postartum Depression." Health & Social Work 32.4 (2007): 289-296.

Dowd Stone, Susan and Alexis E. Menken. Perinatal and Postpartum Mood Disorders: Perspectives and Treatent Guide for the Health Care Practitioner. New York, NY: Springer Publishing Company, LLC, 2008.

Grote, Nancy K., et al. "Culturally Relevent Psychotherapy for Perinatal Depression in Low-Income OB/GYN Patients." Clinical Social Work Journal 32.3 (2004): 327-347.

Group, Members of the PTSD After Childbirth Yahoo. Postpartum Depression Survey Jodi Kluchar. 14 November 2008.

Gruen, Dawn S. "Postpartum Depression: a Debilitating Yet Often Unassessed Problem." Health & Social Work 15.4 (1990): 261-270.