1. ESSENTIAL MENTAL HEALTH TOOLKIT FOR HEALTH CARE PROVIDERS CARING FOR PERINATAL WOMEN Valerie M. Kading, DNP Candidate 520-591-3117 vkading@nsmsu.edu vkading@gmail.com

2. DEPRESSION Global health burden Risks for women Prevalence 10-15%

3. PREGNANCY & DEPRESSION Perinatal Depression  Major Depressive Disorder  During pregnancy  Within 6 months after deliver Postpartum Depression  Major Depressive Disorder  Between deliver & up to 1 yr

4. WHY CARE? Depression during pregnancy  Poor maternal & birth outcomes  Inadequate fetal growth  Neurological development Postpartum Depression  Impaired social skills  Paternal depression  Marital and family relationship

5. WHY CARE? Compromised parent-child relationships Unsafe parenting Poor prenatal care

6. WHAT CAN YOU DO? Screen Know treatment guidelines Resources Referrals

7. SCREEN Edinburgh Postnatal Depression Scale (EPDS)  Cox et al. (1987)  10 item test  Valid  Outpatient, home visit  During and postpartum  Scoring  http://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf

8. ORGANIZATIONAL GUIDELINES OF TREATMENT ACOG  http://www.acog.org/About-ACOG/News-Room/News-Releases/2009/Depression-During-Pregnancy http://www.acog.org/About-ACOG/News-Room/News-Releases/2009/Depression-During-Pregnancy  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3103063/pdf/nihms293836.pdf http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3103063/pdf/nihms293836.pdf US Preventive Services Task Force  http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/depre ssion-in-adults-screening1 http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/depre ssion-in-adults-screening1 National Institute for Health Care Management  http://www.nihcm.org/pdf/FINAL_MaternalDepression6-7.pdf

9. RESOURCES~LACTMED (HTTP://TOXNET.NLM.NIH.GOV/NEWTOXNET/LACTMED.HTM)

10. RESOURCES~LACTMED

11. RESOURCES~ ARIZONA PREGNANCY RISK LINE http://www.pharmacy.arizona.edu/centers/pregnancy-riskline Meds during pregnancy Breastfeeding Phone: (520) 626-3410 Phone (888) 285-3410

12. RESOURCES~BOOKS & WEBSITES Hale, T. (2012). Medications and Mother’s Milk. Briggs, G. & Freeman, R. (2014). Drugs in Pregnancy & Lactation: A Reference Guide to Fetal and Neonatal Risk 10 th edition  http://infantrisk.com/ http://infantrisk.com/ Support and Training to Enhance Primary Care for Postpartum Depression (STEP-PPD)  http://step-ppd.com/step-ppd/home.aspx Center for Women’s Mental Health-Massachusett’s General Hospital  https://womensmentalhealth.org/ Postpartum International  http://www.postpartum.net/ http://www.postpartum.net/

13. RESOURCES FOR THE PERINATAL WOMAN Tucson Postpartum Depression Coalition  http://tucsonpostpartum.com http://tucsonpostpartum.com Center for Women’s Mental Health-Massachusett’s General Hospital  https://womensmentalhealth.org/ Postpartum International  http://www.postpartum.net/ http://www.postpartum.net/

14. WHO CAN I REFER TO? CODAC Serafina Women’s Services  (520) 202-1987 TPDS support groups  Wednesday 6:00-7:30pm: St. Joseph’s Hospital-Women’s Care Pavilion, Agave Room (520) 873-6858  Wednesday 10-11:30am: Northwest Medical Center, 6060 N. Fountain Plaza Drive, Suite 130, (520)877-4149  Wednesdays 5:00-6:00PM: Serafina Women’s Center, 502 N. Silverbell, (520) 202-1716

15. WHO CAN I REFER TO? Arizona Warm Line: 1-888-434-MOMS Emergent/Crisis mental health situation: 520-622-6000

16. REFERENCES Agency for Healthcare Research & Quality. (2015). Depression screening why is this important? Retrieved from http://www.ahrq.gov/professionals/prevention-chronic-care/healthier-pregnancy/preventive/depression.html#care http://www.ahrq.gov/professionals/prevention-chronic-care/healthier-pregnancy/preventive/depression.html#care Centers for Disease Control. (2012). QuickStats: Prevalence of Current Depression* Among Persons Aged ≥12 Years, by Age Group and Sex — United States, National Health and Nutrition Examination Survey, 2007–2010. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6051a7.htm?s_cid=mm6051a7_w#x2013;%20United%20States,%20National%20Healt h%20and%20Nutrition%20Examination%20Survey,%202007-2010%3C/a%3E Field, B., Booth, A., Ilott, I, & Gerrish, K. (2014). Using the knowledge to action framework in practice: a citation analysis and systematic review. Implementation Science, 9(142), 1-14. Retrieved from http://www.implementationscience.com/content/9/1/172. Flynn, H., Blow, F., & Marcus, S. (2006). Rates and predictors of depression treatment among pregnant women in hospital-affiliated obstetrics practices. General Hospital Psychiatry, 28, 289-295. Kersten-Alvarez, L., Hosman, C., Riksen-Walraven, J., van Doesum, K., Smeekens, S., Hoefnagels, C. (2012). Early school outcomes for children of postpartum depressed mothers: comparison with a community sample. Child Psychiatry Human Development, 43, 201-218. doi:10.1007/s10578-011-0257-y. Kingston, D., Tough, S., & Whitfield, H. (2012). Prenatal and postpartum maternal psychological distress and infant development: a systematic review. Child Psychiatry Human Development, 43, 6830714. doi:10.1007/s10578-012-0291-4. Le Strat, Y., Dubertret, C., & Le Foll, B. (2011). Prevalence and correlates of major depressive episodes in pregnant and postpartum women in the United States. Journal of Affective Disorders, 135, 128-138. doi:10.1016/j.jad.2011.07.004

17. REFERENCES Letourneau, N., Dennis, C., Benzies, K., Duffett-Leger, L., Stewart, M., Tryphonopoulos, P.,... Watson, W. (2012). Postpartum depression is a family affair: addressing the impact on mothers, fathers, and children. Issues in Mental Health Nursing, 33, 445-457. doi:10.3109/01612840.2012.673054. Melville, J., Gavin, A., Guo, Y., Fan, M., & Katon, W. (2010). Depressive disorders during pregnancy. Obstetrics & Gynecology, 116(5), 1064- 1070. Muzik, M., & Borovska, S. (2010). Perinatal depression: implications for child mental health. Mental Health in Family Medicine, 7, 239-247. Stein, A., Malmberg, L., Sylva, K., Barnes, J., Leach, P. & FCCC team. (2008). The influence of maternal depression, caregiving, and socioeconomic status in the post-natal year on children’s language development. Child: care, health, and development, 34(5), 603-612. doi:10.10.1111/j.1365-2114.2008.00837.x World Health Organization (WHO). (2012b). Prevalence and determinants of common perinatal mental disorders in women in low- and lower- middle-income countries: a systematic review. Retrieved from http://www.who.int/bulletin/volumes/90/2/11-091850/en/http://www.who.int/bulletin/volumes/90/2/11-091850/en/ Wu, Y., Selig, J., Roberts, M., & Steele, R., (2011). Trajectories of postpartum maternal depressive symptoms and children’s social skills. Journal of Child Family Studies, 20, 414-423. doi:10.1007/s10826-010-9407-2.