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PMADS: Perinatal Depression: Signs and Where to Get Support By Kirsten Ellingsen, PhD, PMH-C

5/27/2022

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May is Mental Health Awareness month. One area that is now recognized globally during this month is Maternal Mental Health (World Maternal Mental Health Day https://wmmhday.postpartum.net).
 
During pregnancy and postpartum women are particularly vulnerable to anxiety and depression.  The perinatal period (conception-1 year delivery) is a time of significant hormone and identity change. While worry and anxiety is common; significant anxiety during pregnancy is related to higher rates of postpartum depression and comes with some lasting effects for mothers, infants, and families.
 
Pre-pandemic rates of a women experiencing a PMAD (Perinatal Mood and Anxiety Disorder) was estimated at about 1 in 5. However, research during the pandemic has find much higher rates. Rates of anxiety and depression during pregnancy have been found to more than double in the COVID-19 pandemic.
 
A study by Sandford University found rates of depression during pregnancy almost doubled https://news.stanford.edu/2021/06/01/stress-pregnancy-doubled-pandemic/. More than half of the pregnant women in the study reported high depression symptoms (51%) compared to a matched pre-pandemic group who had 25% rate. Another study conducted in the UK found that rates of depression for pregnant women went from 17% to 47% and anxiety jumped from 37% to 60% (https://www.sciencedaily.com/releases/2022/01/220131110457.htm). 
 
With approximately half of pregnant women now found to be experiencing high anxiety and depression symptoms, it is important to help increase awareness of signs and spread the word about available resources.
 
Why is this so important?
 
Depression in pregnancy or during the first 12 months after delivery is one of the most common medical complications for mothers. Postpartum depression has even been identified as the most underdiagnosed obstetric complication in the United States.
 
Many women do not recognize the signs and symptoms of a PMAD. Relatively few women get screened for anxiety or depression during pregnancy and receive adequate support during this time. Yet, there are potential serious negative outcomes for women, infants, and families when perinatal anxiety and depression is left untreated. AND. There are evidence based-research supported therapeutic services that can successfully reduce and help effective manage symptoms for depression and anxiety.
 
 
 
What are Risk Factors for Perinatal Depression? Risk factors for anxiety during pregnancy include financial challenges, low social support and poor support from a partner / spouse. A history of anxiety or depression also increases the chance that a mother will experience anxiety during the perinatal period. See the list of risk factors below: (From https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/11/screening-for-perinatal-depression)
 
Depression during pregnancy:
  •  Maternal anxiety
  •  Life stress
  •  History of depression
  •  Lack of social support
  •  Unintended pregnancy
  •  Medicaid insurance
  •  Domestic violence
  •  Lower income
  •  Lower education
  •  Smoking
  •  Single status
  •  Poor relationship quality
Postpartum depression:
  •  Depression during pregnancy
  •  Anxiety during pregnancy
  •     Experiencing stressful life events during pregnancy or the early postpartum period
  •  Traumatic birth experience
  •  Preterm birth/infant admission to neonatal intensive care
  •  Low levels of social support
  •  Previous history of depression
  •  Breastfeeding problems
 
Signs of Perinatal PMADS: A PMAD is not the commonly experienced “baby blues”. While approximately 60% of new mothers experience the “baby blues” the first few weeks after giving birth, a PMAD lasts longer and can significantly negatively affect functioning in daily life.
 
“Baby Blues”
 
According to the Children’s Hospital of Philadelphia (CHOP) signs of “baby blues” include the following: (https://www.chop.edu/conditions-diseases/perinatal-or-postpartum-mood-and-anxiety-disorders)
  • Crying often and not always for a reason
  • Feeling very tired
  • Having trouble falling asleep
  • Having trouble staying asleep
  • Having trouble thinking clearly, or feeling out of touch
  • Feeling very nervous around the baby
  • Becoming easily annoyed and/or angry and not understanding why
  • Feeling that nothing will ever be the same
  • Not feeling like yourself
 
Perinatal Depression
 
The University of North Carolina, Chapel Hill School of Medicine identified the following symptoms of depression during pregnancy and during the postpartum period: (https://www.med.unc.edu/psych/wmd/resources/mood-disorders/perinatal/)
 
Symptoms of Depression in Pregnancy:
  • Feeling sad, depressed, and/or crying a lot
  • Diminished interest in becoming a mother
  • Feeling worthless or guilty, especially about not being a good mother
  • Strong anxiety, tension, and/or fear either about your future child or other things
  • Sleep problems (not being able to sleep despite feeling very tired or sleeping more than usual but not feeling rested)
  • Thoughts of wanting to be dead or wanting to kill yourself
  • Having low energy
  • Loss of or increase in appetite or weight
  • Trouble focusing, remembering things, or making decisions
  • Feeling restless or irritable
  • Having headaches, chest pains, heart palpitations, numbness, or hyperventilation
Symptoms of Postpartum Depression:
  • Feeling sad, depressed, and/or crying a lot
  • Intense anxiety; rumination, obsessions (See Postpartum Anxiety Disorders below)
  • Loss of interest in usual activities
  • Feelings of guilt, worthlessness or incompetence
  • Fatigue, irritability, sleep disturbance
  • Change in appetite
  • Poor concentration
  • Feeling inadequate to cope with new infant
  • Excessive worry about baby’s health
  • Suicidal thoughts
Where to Find Support
 
If you or someone you know is experiencing depression symptoms or wants additional support during pregnancy or after delivery, please talk with a physician or trained therapist. There are free screening instruments that can be completed and shared with an OBGYN, Primary Care Physician or Therapist. (See https://psychology-tools.com/epds/  for a free downloadable  Edinburgh Postnatal Depression Screen (EPDS).
 
To find Providers in the US: Providers in Florida:
 
The Postpartum Support International (PSI) provider directory can be found at https://www.postpartum.net/get-help/provider-directory/
In Florida you can also search trained providers at: https://flmomsmhresources.org



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Teen Dating Violence Part 2: How to prevent it and respond to it By Rachel Funnell, LMFT

5/16/2022

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As a parent or caregiver to a teen, you’re a vital part of helping them develop healthy relationships and build up their confidence in order to leave unhealthy ones. During the pre-teem and teen years, it’s important to help your child learn the skills needed to create and maintain healthy relationships. This includes learning how to communicate and manage feelings in a healthy and appropriate way. As a parent or caregiver, you want to start conversations with your child. You want to include the basic, healthy elements of a relationship in the conversation, i.e.: respect, communication, trust, boundaries, honesty and equality. 

Discussion points for pre-teen and teens prior to dating:
  • Teach about consent:
    • Consent means asking for permission to do something and accepting the answer. 
    • Give examples of consent that are relatable to them. 
    • Help your child practice asking for consent and accepting rejection in everyday ways
    • Teach them how to ask for consent
    • Model asking for consent
  • Talk Openly 
    • Children get a lot of different messages about relationships from TV shows, movies, social media and friends. Be involved, as much as you can, with the different shows they watch or the people they follow. Use moments from the shows and who they follow, to have a conversation about what they think about what happened in it or what that person did.
    • Let your child know that they can come to you with questions about relationships.
    • Answer their questions honestly and encourage them to continue to have conversations about respect and safety.  
  • Talk about dating
    • Ask, “what do you look for in a dating partner?” 
      • Treats you with respect
      • Understand your needs and individual goals in life
    • Discuss how it’s okay to disagree in relationships as long as they feel they can have an open and honest conversation about their feelings.
    • Discuss the need for them to be able to freely express themselves, share their opinions and make decisions that are best for them. 
    • Discuss how a partner will respect what they wear, who they see and where they go. 
    • Discuss how they would feel and what they would think if the person they are dating asked them to stop doing something that they loved. 
      • Discuss how in a healthy relationship a partner will support their hobbies, friendships, family and coworkers. 
      • Give examples of what an unsupportive partner would look like. I.e.: make you stop a sport or club, tell you to stop seeing friends or family, or pressure you to skip class or work. 
    • Discuss boundaries around money.
      • Who should pay for things?
      • How often do you pay for things?
      • Do you feel pressured to pay for or buy things?
    • Discuss boundaries in general
      • How often should you call/text/contact your partner?
      • What do you do if your partner wants space?
      • What do you do if your partner isn’t respecting your boundaries?
      • Discuss not only physical boundaries but also emotional and digital boundaries. 

If you suspect that your pre-teen or teen is currently involved in an unhealthy relationship it’s important to know how to start the conversation and support them. Starting the conversation is one of the best ways to help create a safe space for your child to share their experiences and ask for support. Important points to keep in mind when having the conversation include:
  • Give support: Teens fear that their parents will overreact, blame them or be angry. It’s important to be supportive and non-accusatory or judgmental about the relationship. You can ask your child how they want to be supported and how you can help. 
  • Validate, empathize and create a space where they feel safe: If your teen tells you they feel like their partner is pressuring them to do things they don’t want to do, you can respond by saying “That sounds like a really hard thing to go through. Feeling like you're not being respected and forced to do something can bring up all kinds of difficult emotions. What happens when you try to talk to them about it?” 
    • Let them know that their feelings are valid, boundaries are healthy, and respect is important in a relationship. 
  • Accept what they are telling you: It’s important to believe them, even if what they are telling you is hard to hear. If you show skepticism or disbelief, it can make them feel unsupported and isolated. Tell them, “thank you for being honest. I believe you and what you’re describing sounds like unhealthy behavior which could lead to abuse - what you are feeling is valid.” 
  • Talk and focus on the behaviors, not the person involved: Remember that your teen may still have feelings of love, connection or compassion for their partner and this is normal. Instead of saying, “Your partner is controlling you”, say “The behaviors you’re describing sound very unhealthy.” 
  • Avoid ultimatums: Resist the urge to tell them to break up with their partner. This will only cut them off from support and they may be less likely to trust that you’re a safe person to talk to in the future. 
  • Decide on the next steps together: Ask them what they feel comfortable doing next, what can you do to support them and what would be helpful. 
  • If you believe that there is a need to take immediate action due to safety, you reach out to create a safety plan and speak with advocates www.loveisrespect.org/personal-safety/create-a-safety-plan/. 

https://www.loveisrespect.org/supporting-others-dating-abuse/

www.cdc.gov/violenceprevention/intimatepartnerviolence/teendatingviolence/fastfact.html






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Stop Asking Questions! The Top Tip for Getting Your Kids to Share More Information by Tara Motzenbecker, LMHC, NCSP

5/6/2022

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    Parent and Child Psychological Services is a private practice serving children and families in the Sarasota, Florida area. The practice is owned and operated by Dr. Gibson, a Licensed Psychologist who is Board Certified in Clinical Child and Adolescent Psychology. ​

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