Counseling helps women with common, sometimes life-threatening, condition
The birth of a child can be one of life’s greatest joys, but for 10 to 20 percent of all mothers, it can trigger an unexpected – and potentially serious – condition known as postpartum depression (PPD). The emotional state can range from a mild case of “baby blues” after childbirth to severe and long-lasting depression, or even postpartum psychosis.
According to Jacqualene Stephens, PhD, LMFT, Director of Behavioral Health and Social Services at Parkland Health & Hospital System’s Community Oriented Primary Care health centers, Parkland sees more than 10,000 female obstetrical patients each year in its Women’s Health Centers.
“Based on statistical probabilities, 1,000 to 2,000 Parkland patients annually may experience PPD,” Dr. Stephens said. “These patients need mental health services. Early intervention is important because it can prevent a series of damaging behavioral, medical and social problems for women and their family members. But unfortunately, access to mental health services for Dallas-area women with symptoms of PPD has been limited.”
To meet the need, Parkland recently launched a new Postpartum Depression Program funded by the state’s 1115 waiver that integrates behavioral health services into outpatient obstetrics settings to provide increased access to mental health services. Launched in October 2014, the program currently employs three clinical social workers. When fully implemented, the program will deploy an additional seven counselors, providing the service in eight of Parkland’s 10 Women’s Health Centers in Dallas County.
The causes of PPD are not well understood, but hormonal changes are believed to play a strong role. After childbirth, a dramatic drop in the hormones estrogen and progesterone may contribute to PPD. Changes in metabolism, sleep deprivation and lifestyle influences such as a demanding baby, other children, financial pressures and lack of support from one’s partner or loved ones also play a role.
Symptoms may include sadness, anxiety, episodes of crying, mood swings, feelings of shame or guilt, insomnia, changes in eating patterns and withdrawal from friends and family. In severe cases, there is a risk of maternal suicide and infant harm or death.
“If untreated, postpartum depression can last for months or even longer, and can become a chronic depressive disorder,” Jacqueline Juarez, MSW, LCSW, a counselor at Parkland’s Oak West Women’s Health Center said. “PPD can also have very negative consequences for the infant as well as the mother.”
Children of mothers with postpartum depression can become withdrawn, irritable or inconsolable; display insecure attachment and behavioral problems; experience problems in cognitive, social and emotional development; and have a higher risk of anxiety disorders and major depression in childhood.
Treatment for PPD can include individual or group counseling, medications, referral to a Parkland psychiatrist and hospitalization for extreme cases. PPD counselors coordinate care with the Parkland Psychiatry Clinic and provide phone follow-up and referrals to other resources, such as domestic violence counseling, parenting skills training or substance abuse counseling.
“It helps many women with milder symptoms of PPD to work out how they’re feeling by talking to someone trained to help them,” Juarez said. “They need to be reassured that they will feel normal again.”
Women and their partners need to be educated about PPD, Juarez added, because many may feel stigmatized for seeking psychiatric services.
“They don’t want to be seen as crazy,” she said. “But we can help them develop coping skills as well as provide medications and psychiatric counseling if appropriate.”
At Parkland, all women are screened for symptoms of PPD at their routine postpartum two-week check-up using the Edinburgh postpartum Depression Scale (EPDS), a questionnaire widely used to identify women with PPD. Further assessments can include substance abuse screening, a psychiatric/social history and discussion of symptoms, with same-day referral to a Parkland psychiatrist if necessary.
For more information about the Parkland Postpartum Depression Program, please contact Dr. Jacqualene Stephens at 214.266.1222. To find a Parkland Women’s Health Center near you, visit www.parklandhospital.com/womens-health-locations.