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NIMH Updates on Perinatal Mood Disorders: Research and Resources

NIMH Updates on Perinatal Mood Disorders: Research and Resources. Kathleen M. O’Leary, MSW Acting Chief, NIMH Women’s Program, NIH, HHS Office of Research on Disparities & Global Mental Health National Institute of Mental Health, National Institutes of Health, HHS

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NIMH Updates on Perinatal Mood Disorders: Research and Resources

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  1. NIMH Updates on Perinatal Mood Disorders: Research and Resources Kathleen M. O’Leary, MSW Acting Chief, NIMH Women’s Program, NIH, HHS Office of Research on Disparities & Global Mental Health National Institute of Mental Health, National Institutes of Health, HHS Healthy Women, Healthy Hoosiers October 7, 2011

  2. Background – NIH • The nation’s medical research agency, within Dept. of Health & Human Services • National Institutes of Health - 27 Institutes and Centers (ICs) • National Institute of Mental Health (NIMH) funds neuroscience research, along with other ICs • NIMH mission: To transform the understanding & treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure

  3. The Role of NIMH in Perinatal Mental Health • NIMH funds and also conducts research • Translational Research - “From Bench to Bedside…” Example: “Groundbreaking Research into Postpartum Depression” video http://www.nimh.nih.gov/media/video/postpartum-depression.shtml Many other videos on mental health topics available at http://www.nimh.nih.gov

  4. I. Brief Look at Research Issues In: • Surveillance, Risk & Screening • Intervention • Services II. Examples of Recent Research Findings III. Resources for Clinicians

  5. Surveillance, Risk & Screening Issues • Incidence rates – up to 14%(AHRQ Publication No. 05- E006-2. Rockville, MD: Agency for Healthcare Research and Quality. February 2005; CDC: http://www.cdc.gov/reproductivehealth/Depression/Publications.htm ) • Screening tools – e.g. Edinburgh, PHQ-9 (Patient Health Questionnaire) – use is dependent upon setting, population & resources • When to identify/ when to measure?(e.g. Grote 2009) • Paternal perinatal/postpartum depression – emerging significant issue(e.g. Paulson JF 2010; Dave2010) • What is known about risk?(e.g. Lancaster 2010; O'Hara M, 1996)

  6. Interventions Issues • Proven treatments • Psychotherapies • Medications (http://www.nimh.nih.gov/health/publications/depression/how-is-depression-detected-and-treated.shtml ) • Medication treatment • Side-effects • Reluctance of pregnant women • Psychotherapies • How to engage women and families? • How to sustain women in treatment?

  7. Services Issues • Screening can only be effective if there are referral routes • Challenges in engaging women in treatment (e.g. Flynn H 2010; O'Mahen 2008) • Research needed on capacity-building & access to care • Ongoing research in different services settings (primary care, pediatrics, mental health, others) • Type of health-care system and who pays the bills is key to service delivery

  8. Recent Research Findings of Note • Basic science is illuminating the brain mechanisms involved in mood disorders (e.g. Maguire & Mody 2008 on mouse model of postpartum depression) • New data on risk factors uncovered (e.g. Valentine2010 on intimate partner violence as predictor of postpartum depression) • Research on medication treatment costs & benefits(e.g. Wisner 2009 on neonatal outcomes of depressed & treated vs. depressed & untreated; Cohen 2006 on pregnancy not mood-protective) • Research on best ways to engage high-risk groups into treatment (Crockett 2008 on rural low-income minority women) • Research on sub-populations (Mattocks 2010 on female veterans who become pregnant)

  9. Next Steps & Promising Research Directions NIMH continues to fund research in perinatal mental health that spans basic – epi – pathophysiological – developmental - interventions – services • Genetic epidemiology • Translational studies • IPV & PPD (intimate partner violence & postpartum dep.) • Alternative treatments

  10. What can U.S. researchers learn from other nations and other fields? Re: Surveillance, Interventions & Services in Perinatal Depression Research • Routine screening practice (e.g. Scotland) • Use of task-shifting & paraprofessionals (e.g. Atif Rahman’s work in Pakistan) • Stepped care (U.K. & other countries) • Home visitation (e.g. Ammerman in U.S.; many programs globally) • HIV prevention and care

  11. Ex. of Additional Researchers to follow: • Caron Zlotnick • Zlotnick C, Capezza NM, Parker D. An interpersonally based intervention for low-income pregnant women with intimate partner violence: a pilot study. Arch WomensMent Health. 2010 Dec 11 • Zlotnick C, Miller IW, Pearlstein T, Howard M, Sweeney P. A preventive intervention for pregnant women on public assistance at risk for postpartum depression.Am J Psychiatry. 2006 Aug;163(8):1443-5. • Katherine Wisner, Kimberly Yonkers & Linda Chaudron • Sit DK, Flint C, Svidergol D, White J, Wimer M, Bish B, Wisner KL. Best practices: an emerging best practice model for perinatal depression care.Psychiatr Serv. 2009 Nov;60(11):1429-31. • Accuracy of depression screening tools for identifying postpartum depression among urban mothers.Chaudron LH, Szilagyi PG, Tang W, Anson E, Talbot NL, Wadkins HI, Tu X, Wisner KL. Pediatrics. 2010 Mar;125(3):e609-17. • Major depression and antidepressant treatment: impact on pregnancy and neonatal outcomes.Wisner KL, Sit DK, Hanusa BH, Moses-Kolko EL, Bogen DL, Hunker DF, Perel JM, Jones-Ivy S, Bodnar LM, Singer LT. Am J Psychiatry. 2009 May;166(5):557-66. • The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Yonkers KA, Wisner KL, Stewart DE, Oberlander TF, Dell DL, Stotland N, Ramin S, Chaudron L, Lockwood C. Gen Hosp Psychiatry. 2009 Sep-Oct;31(5):403-13. Review. • Atif Rahman: • Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Rahman A, Malik A, Sikander S, Roberts C, Creed F. Lancet. 2008 Sep 13;372(9642):902-9

  12. Resources for Clinicians and Consumers • NIMH materials for consumers • Video for consumers on postpartum depression • Director’s blog on postpartum depression http://www.nimh.nih.gov/about/director/2010/spotlight-on-postpartum-depression.shtml • General website material http://www.nimh.nih.gov/health/topics/women-and-mental-health/index.shtml . Scroll to “Related Information” • Website for providers, researchers & consumers, launched w/ NIMH grant: www.Mededppd.org

  13. Resources for Clinicians and Consumers • ACOG & APA: “Depression During Pregnancy: Treatment Recommendations” 2009 http://www.acog.org/from_home/publications/press_releases/nr08-21-09-1.cfm • AA Pediatrics Guidelines: “Incorporating Recognition & Management of Prenatal & Postpartum Depression into Pediatric Practice” 2010. http://pediatrics.aappublications.org/cgi/reprint/peds.2010-2348v1 • Advocacy groups’ websites – many useful materials

  14. Additional Sources of Govt. & Other Materials for Consumers: • HHS • http://www.womenshealth.gov/ • Text4baby http://www.womenshealth.gov/about-us/government-in-action/text4baby.cfm • Health Resources Services Administration http://mchb.hrsa.gov/pregnancyandbeyond/depression/index.html • Centers for Disease Control http://www.cdc.gov/reproductivehealth/Depression/ • National Library of Medicine http://www.nlm.nih.gov/medlineplus/postpartumdepression.html - some in various languages

  15. To follow Research Findings… • Research societies: e.g.The Marce Society http://www.marcesociety.com/ & North Amer. Society for Psychosocial Ob-Gyn – http://www.naspog.org • Updated frequently www.mededppd.org • “NIMH Update” from the Office of Constituency Relations & Public Liaison – 2x monthly newsletter http://www.nimh.nih.gov/outreach/public-involvement-at-nimh.shtml • NIMH “Science News” on homepage and NIH “News in Health” and “Research Matters” www.nimh.nih.govwww.nih.gov

  16. More detailed material on NIMH Perinatal MH Research NIMH web material on research • NIMH meeting summary: http://www.nimh.nih.gov/research-funding/scientific-meetings/2010/fresh-perspectives-in-perinatal-depression-research-psychosocial-interventions-and-mental-health-services.shtml . An expanded summary for publication is being prepared. • NIMH Program Announcements outlining research priorities & gaps: Women's Mental Health in Pregnancy and the Postpartum Period (PA-09-174 & 175) (R01) http://grants.nih.gov/grants/guide/pa-files/PA-09-174.html & (R21) http://grants.nih.gov/grants/guide/pa-files/PA-09-175.html expire May 8, 2012 • NIH Reporter search tool to see what NIH is funding by topic http://report.nih.gov/ - Categorical Spending

  17. Thanks to: • NIMH Office of Research on Disparities and Global Mental Health • NIMH Division of Services & Intervention Research Indiana Office of Women’s Health for this opportunity • NIMH grantees who continue to push forward the research in this area! olearyk@mail.nih.gov

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