New Mothers

Janet Chassman
Bureau of Public Education and Outreach
New York State Office of Mental Health

1. Findings

   There were 258,455 births in New York in 2000. While new mothers are not generally considered to be at high risk of suicide, serious postpartum mood disorders that require hospitalization are associated with death from natural and unnatural causes.

   1. Prevalence and Patterns
      • Postpartum depression (PPD) is the most common disorder after childbirth. More women develop depression following birth than at any other time.
      • PPD is a treatable illness, but it is often unidentified by health care professionals.
      • 50-80% of new mothers get the "baby blues," depressive symptoms which resolve within 12 days after birth. 20% of these women will develop PPD.
      • 10-15% of mothers - 22% of multiethnic inner city mothers - develop PPD.
      • .1%-.2% (one in 1,000 or 2 in 1,000) of new mothers develop postpartum psychosis, a serious disorder characterized by paranoia, mood shifts, and/or hallucinations or delusions. Immediate medical attention is required.
      • Besides the symptoms experienced by the mother, PPD may affect the mother-infant interaction and may lead to problems as the baby grows.
      • Like all health and mental health services, screening and treatment for PPD must be culturally appropriate to be effective.
   2. Risk Factors for PPD
      • Previous incidence of PPD (50% will re-develop PPD)
      • Previous depression (25% will develop PPD)
      • Previous bipolar disorder
      • Depression during pregnancy
      • Depression or bipolar disorder in the family
      • Previous significant premenstrual syndrome (PMS)
      • Stressful situations, including difficult childbirth, health problems in the baby or mother, marital discord, lack of assistance with baby care, and lack of emotional support
   3. Barriers to Identifying and Treating PPD
      • In general, those who screen for PPD (e.g. obstetricians) do not provide evaluation and treatment (e.g. mental health clinics). This makes access to appropriate care more complex.
      • Stigma of mental health treatment
      • Medical personnel receive little or no training in identifying PPD
      • Family members may fail to recognize PPD
      • Mothers may not seek treatment due to lack of energy caused by the illness, stigma and/or feeling guilty about being depressed when she is supposed to be "happy."
2. Current State Efforts
   • The Healthy Families New York (HFNY) program provides home visiting services by trained home visitors who work with expectant families and families with newborns who have certain risk factors that may lead to child abuse and neglect and poor health outcomes. Home Visitors provide weekly home visits until the child is at least six months old and may continue less frequently based on the needs of the family until the child is five years old or in school or Head Start. Visits are aimed at promoting positive parent-child interaction and optimal child health and development. Home visitors also assist in linkage to other services to increase the families self-sufficiency. The HFNY program is currently located in 28 sites serving high need areas across the state.
   • Association of Perinatal Networks of New York received a grant to create training programs and resources to increase awareness of PPD and increase service utilization.
   • Information on PPD has been added to the Maternity Information leaflet, disseminated to all obstetrical hospitals statewide, and to "Your Guide to a Healthy Birth," which is also available to pregnant women statewide.
   • The Pregnancy Risk Assessment Monitoring System (PRAMS), a national screening program, now includes a question on PPD.
   • A prenatal depression question was added to the Statewide Perinatal Data System.
3. Action Steps
   1. There are strong risk factors for post-partum depression (PPD), and prenatal/perinatal screening can help to identify those most likely to develop it as well as deliver services to them in the hospital with follow-up to start right after delivery. Obstetricians, pediatricians and other medical personnel in contact with new mothers should screen mothers for PPD during the child's first year.
   2. Home visiting services have been shown to be effective in improving outcomes for children. All at-risk new mothers should receive home visitations services and be screened for post-partum depression, including follow-up care for women who screen positive and an emergency protocol for women in a peri-suicidal state or homicidal state. Involvement of the new mother's partner or support person in their treatment is highly desirable.
   3. A media campaign that highlights the prevalence and risk factors for post-partum depression, linkages to service providers and training inevidence-based treatment for post-partum depression are necessary ingredients of a prevention program.

References

American Association of Health Plans: Current Issues Report, Approaches to Depression Care. Washington, DC; AAHP, 2000.
American College of Obstetricians and Gynecologists, Answers to Common Questions about PPD. January 2002. www.acog.org
Georgiapoulos, AM, Bryan, TL; Wollan, P; Yawn, BP. Routine Screening for PPD Journal of Family Practice, 50 (2), 2001.
Moline, ML; Kah, DA; Ross, RW; Altshuler, LL; Cohen, LW. PPD: A Guide for Patients and Families, Expert Consensus Guideline Series. A Postgraduate Medicine Special Report, March 2001, 112-113.
Sobey, WS, Barriers to PPD Prevention and Treatment: A Policy Analysis Journal of Midwifery & Womens Health, Vol.47, no.5, Sept/Oct. 2002, 331-336.