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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.

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Presentation on theme: "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."— Presentation transcript:

1 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 NIMH Updates on Perinatal Mood Disorders: Research and Resources

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.govhttp://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 ) 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; Dave 2010) 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 )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. Valentine 2010 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 Womens Ment Health. 2010 Dec 11An interpersonally based intervention for low- income pregnant women with intimate partner violence: a pilot study. 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.A preventive intervention for pregnant women on public assistance at risk for postpartum depression. 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.Best practices: an emerging best practice model for perinatal depression care. 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. Accuracy of depression screening tools for identifying postpartum depression among urban mothers. 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. Major depression and antidepressant treatment: impact on pregnancy and neonatal outcomes. 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. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. 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 Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial.

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/spot light-on-postpartum-depression.shtml http://www.nimh.nih.gov/about/director/2010/spot light-on-postpartum-depression.shtml General website material http://www.nimh.nih.gov/health/topics/women- and-mental-health/index.shtml. Scroll to “Related Information” http://www.nimh.nih.gov/health/topics/women- and-mental-health/index.shtml Website for providers, researchers & consumers, launched w/ NIMH grant: www.Mededppd.orgwww.Mededppd.org

13 Resources for Clinicians and Consumers ACOG & APA: “Depression During Pregnancy: Treatment Recommendations” 2009 http://www.acog.org/from_home/publications/press_releas es/nr08-21-09-1.cfm http://www.acog.org/from_home/publications/press_releas es/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 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.cfmhttp://www.womenshealth.gov/about- us/government-in-action/text4baby.cfm Health Resources Services Administration http://mchb.hrsa.gov/pregnancyandbeyond/depressio n/index.html http://mchb.hrsa.gov/pregnancyandbeyond/depressio n/index.html Centers for Disease Control http://www.cdc.gov/reproductivehealth/Depression/ National Library of Medicine http://www.nlm.nih.gov/medlineplus/postpartumdep ression.htmlhttp://www.nlm.nih.gov/medlineplus/postpartumdep ression.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 http://www.marcesociety.com/ http://www.naspog.org Updated frequently www.mededppd.orgwww.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 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.gov www.nih.govwww.nimh.nih.gov www.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. http://www.nimh.nih.gov/research-funding/scientific- meetings/2010/fresh-perspectives-in-perinatal- depression-research-psychosocial-interventions-and- mental-health-services.shtml 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 http://grants.nih.gov/grants/guide/pa-files/PA-09- 174.html http://grants.nih.gov/grants/guide/pa-files/PA-09- 175.html NIH Reporter search tool to see what NIH is funding by topic http://report.nih.gov/ - Categorical Spendinghttp://report.nih.gov/

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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