S.L.
N.,
It sounds like people have offered local resources for you and I hope that they help. For everyone reading this, I thought I'd send an article that just came out in the Chicago Tribune about postpartum mental health needs. In the article, it identifies more local resources and at the bottom of the article is an 800# for the Postpartum Support International Helpling. Best wishes. S.
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Psychosis hits 1 in 1,000 new moms, study says
Universal screening urged after childbirth
http://www.chicagotribune.com/news/nationworld/chi-###-##...
By Ronald Kotulak
Tribune science reporter
December 6, 2006
Within three months after giving birth for the first time, 1 out of 1,000 women suffered from schizophrenia, bipolar disorder, depression or another psychotic condition severe enough that she was hospitalized, Danish researchers found by examining hundreds of thousands of health records.
The results of their study provide startling evidence that truly debilitating postpartum psychoses occur more frequently than many people may suspect, putting mothers at risk of hurting themselves or their infants.
Reported in Wednesday's issue of the Journal of the American Medical Association, the research was accompanied by an editorial calling for universal screening programs that would check for mental problems in new mothers.
The results underscore the potential for danger after childbirth, when a sharp drop in levels of key hormones like estrogen and progesterone may trigger mental disorders in susceptible women.
"We've had a difficult time figuring out what causes postpartum psychiatric illnesses, and I see this study as really strongly supporting a biologic, hormonal or other physical basis," said Dr. Valerie Davis-Raskin, a former associate clinical professor at the University of Chicago who treats patients with postpartum depression.
"All women go through this massive hormonal change after delivering a baby," said Davis-Raskin, who was not involved in the study. "It's such a stressor on the mother's brain."
An estimated 70 to 80 percent of new mothers experience postpartum letdown, a mild mood disorder typically known as the "baby blues" that lasts one to two weeks. But 10 to 15 percent suffer postpartum depression, a more serious mental disorder that can last weeks to months.
In the journal editorial, Katherine Wisner of the University of Pittsburgh School of Medicine called postpartum depression a major public health problem that needs more attention.
Although effective therapies are available for depression and psychoses, maternal mental problems are often not recognized or treated, said Wisner, a professor of psychiatry and obstetrics, gynecology and reproductive sciences.
Maternal depression can harm a newborn's mental and motor development and is associated with poor impulse control, low self-esteem and behavior problems as the child develops, Wisner wrote.
New Jersey OKs screening law
This year New Jersey became the first state to pass a law requiring postpartum screening for all new mothers. The law, which took effect in October, also requires physicians to educate expectant mothers and their families about the signs of postpartum depression and to screen new mothers for the disorder. Physicians who fail to comply face state sanctions.
The law provides $4.5 million to educate physicians and to produce information aimed at the public. Doctors, who usually see new mothers when they bring their babies in for a two-week pediatric checkup, are advised to use the Edinburgh Postnatal Depression Scale, a list of 10 questions.
State Sen. Don Harmon (D-Oak Park) said he plans to introduce a similar bill in the legislative session starting in January and is studying the New Jersey law as well as proposals for screening in other states.
"These mental problems are much more common than folks know or are willing to talk about," he said. "We need to eliminate that stigma and help connect women to the appropriate mental health services."
630,000 women studied
The Danish study is the first in more than two decades to look at the problem of serious psychoses in women after childbirth. It is considered important because the health records of Danish citizens are carefully maintained, including psychiatric hospital admissions.
The study, headed by Trine Munk-Olsen of the University of Aarhus, involved 630,373 women and 547,431 men who became new parents between 1973 and 2005. The researchers found 1.03 women per 1,000 births suffered a mental disorder requiring hospital admission.
For new fathers, the rate of hospitalizations for mental illness was 0.37 per 1,000 births, a rate that did not differ from the general male population.
"This may indicate that the causes of postpartum mental disorders are more strongly linked to an altered physiological process related to pregnancy and childbirth than psychosocial aspects of motherhood," Munk-Olsen said.
Protection during pregnancy
During pregnancy, the rate of mental problems declines sharply, the study found, indicating that elevated estrogen and progesterone levels may be a protective factor. As these hormones drop off after childbirth, psychiatric illnesses jump.
"It supports what I see clinically," Davis-Raskin said. "If you go out and shovel snow and you have chest pain or a heart attack, the snow didn't cause it. It uncovered something that was there. I think that's what childbirth does for many women with mood disorders, particularly bipolar or a tendency for psychotic disorders."
Carol Blocker said the mental state of her daughter Melanie Stokes deteriorated almost from the instant she gave birth six years ago. Stokes went from being bright, happy and eager for the birth of her baby to a deep depression and eventually hallucinations.
"Everything she said from that point on was like, `Mommy, I have to die,'" Blocker said. "I said, `Melanie, whatever this is we're going to work through it.' And she said, `No, I don't think so, Mommy. I want you to go and buy yourself a real nice outfit to come to my funeral.'
"I took her from doctor to doctor and no one said, `OK, there's something called postpartum psychosis that affects new mothers and I think Melanie might have this and this is what we'll do,'" Blocker said.
Four months later, Stokes checked into a Lincoln Park hotel, asked for a room on the top floor, wrote notes to her mother and a few others, and jumped out the window to her death.
Dr. Katherine Marshall Moore, a Mayo Clinic psychiatrist, said screening new mothers for psychiatric disorders should become routine.
"Mothers don't realize that they are struggling," she said. "Others around them might not necessarily recognize it and there's stigma associated with treatment for mental health issues. That's what we really have to tackle--getting people aware of the problem, getting them to go for treatment and knowing that there are really effective treatments out there."
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ON THE INTERNET
Read about how two families worked through their tragedies and learn about the science behind postpartum depression at chicagotribune.com/postpartum
WHERE TO FIND HELP
Find information at postpartum.net or call Postpartum Support International's help line at 800-944-4PPD
Copyright © 2006, Chicago Tribune
