Tag Archives: postpartum depression

Breast Cancer, Diabetes screening worth it; Postpartum Depression screening not

Leave a reply

Earlier this week, I wrote about UK researchers concluding that Postpartum Depression screening was just not cost effective.

Since then, a couple of other studies regarding screening for other conditions have been released.

It seems that screening for Diabetes in primary care qualifies as cost-effective.

And screening for Breast Cancer saves lives despite the habitual over-diagnosis. For every misdiagnosed case, two lives are saved. In fact, the researchers for this study state that approximately 6 women are misdiagnosed and undergo unnecessary treatment for cancer they may never have developed as a result of a false positive at the screening level. In case you were wondering, these researchers are UK based as well.

Hey. Wait.

The researchers from the UK cited over-diagnosis  as one of the reasons formal screening for Postpartum Depression was not cost effective.

And being misdiagnosed with Postpartum Depression does not lead to expensive radiation treatment or other damaging exposures including surgery. At very worst, you may receive a script for an anti-depressant or a referral to a counselor for some talk therapy.

What the….

So lemme get this straight.

Pumping a woman full of radiation and chemotherapy is hunky dory and cost effective EVEN if she doesn’t need it.

But a quick questionnaire to check on mom’s mental health is NOT?

On what planet does this even BEGIN to make sense??

Let’s also discuss this little nugget. For both the Diabetes and Breast Cancer studies, ACTUAL records were used. The Postpartum Study was compromised of 92 “hypothetical” cases.

When did we stop rating the study of actual records? When did researchers stop including the actual risks and ripples of Postpartum Depression? A woman without Postpartum Depression or who is successfully diagnosed, treated, and recovering is more likely to breastfeed in my opinion. And if she’s nursing, she’s protecting herself and her child from – guess what – Diabetes AND Cancer.

So you really want to practice cost-effective healthcare?

SCREEN women after birth. Ensure their stability, support, and positive outcome with life as a new mom. Encourage them to participate in health practices for themselves and their children. Enabling women to make healthier choices reduces the risk of other issues down the road. Screening saves lives when it comes to Postpartum Mood Disorders. It saves mothers, children, and families. It’s not something you skip over because it’s simply not “cost-effective.” Skip screening and cost will simply shift elsewhere – to diabetes care, cancer care, future mental health care for mom or kids, broken families, etc.

It is simply not acceptable to allow new mothers to continue to suffer. Not acceptable at all.

Just Talkin’ Tuesday 03.30.10: Symbols of Recovery

Leave a reply

“Cool ring,” she said, catching me completely off-guard.

I managed to mumble a thank you once I realized it wasn’t my plain gold band about which she was talking.

On my left hand, I wear a silver butterfly ring. It’s a symbol of how far I have come. I know in my heart I’m recovered. But it’s nice to have a symbol.

I also have an African Violet plant in my kitchen given to me by my brother and sister in law on the Mother’s Day shortly before my hospitalization. Back then I did not really want to take care of it, much like I did not want to take care of myself, my family, anything. But now? Now we are all thriving and it is too. I recently replanted it, actually. The thing is monstrous!

Much like holidays have their own symbolism, each one of us may have a symbol we have come to associate with recovery or our journey toward wellness.

What’s yours? What are you holding on to when nothing else seems to help? Is there a story behind it? Share it with us.

Postpartum Depression formal screening not worth the cost, BMJ study says

Leave a reply

According to a recently published study in the British Medical Journal (BMJ), Postpartum Depression Screening is not…. brace yourselves. Worth the cost.

That’s right.

NOT.WORTH.THE.COST.

In their cost effective analysis, the researchers used “A hypothetical population of women assessed for postnatal depression either via routine care only or supplemented by use of formal identification methods six weeks postnatally, as recommended in recent guidelines.”

The conclusion was that overall not using a formal screening method was much more cost effective as it eliminated false positives.

So the mental health of a woman which will then affect her child, her family, her community, the world at large, are just not worth it to the National Health System of the UK. The EPDS scored out at about $67,000 per quality adjusted life years while no screening method scored at a price tag of just $20 – $30,000. No value for the money was found to exist when using the formal identification methods.

Did these researchers not read Murray & Cooper’s Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression which explores the effects of postpartum depression treatments on children?

There is SO much more at stake here than the dollar value to the National Health System.

There’s the potential for broken families. The potential for children growing into their own mental health issues, the potential for continued need for mental health treatment due to an undiagnosed episode of postpartum depression, potential for increased incarcerations due to untreated mental illness, continued sadness, the continued stigma, continued and perpetuated lack of education on the part of physicians in regards to Postpartum Mood Disorders.

The most interesting aspect of this study is that it focused on screening for Postpartum Depression in the Primary Care setting. Primary care physicians are not always comfortable or knowledgeable in screening for mental health issues. If a patient were to screen positive, that physician is then morally responsible for referring them to a specialist. Often times, at least here in the states, a Primary Care physician is unaware of where to refer a patient for help with a Postpartum Depression Disorder. Therefore, they become afraid of screening because they fear what will happen if a positive were to occur. What would they do with the patient? Where would they send them? How would they respond? Are they familiar enough with Postpartum Mood Disorders to recognize a false positive?

I think the key to the results of this study is not so much in blaming the high percentage of false positives but in urging that Primary Care physicians receive more training to enable them to recognize a false positive through more in depth questions after a positive is scored via the Edinburgh Postnatal Depression Scale.

original photo/graphic "Hand holding necklace" by K.Sawyer @flickr

A stronger safety net involving a stronger communication between midwives, Obstetricians, Pediatricians, and General Practitioners is so desperately needed to keep women from falling through the very big cracks which currently exist in the system.

Let’s think about this for a moment, shall we?

A woman gets pregnant. She sees a medical physician to get the pregnancy confirmed. Most mothers seek OB or midwife care for their entire pregnancy. Unless they’re depressed – depressed and mentally ill mothers are less likely to take good care of themselves during a pregnancy, making specialized care even more important even when baby is still in utero. Once mothers give birth, they are then shuttled off to the pediatrician’s office for the bulk of their medical contact. One six week or eight week visit to the midwife or OB to ensure mom is healing properly then an annual PAP visit unless something arises in between. Many Pediatricians focus on babies and not mother. But the tide is changing as more and more Pediatricians are taking into account the family lifestyle and well-being. My own Pediatrician does this and I absolutely adore her for it.

But overall, there is typically no continuity of care, no communication between physicians throughout the birth process. There should be. There needs to be. A woman deserves a team of support. She deserves to thrive. So do her children.

No matter what the cost.

Because once you fail woman and her children, you fail society.

Fail society and we fail to exist.

If we fail to exist….

Just Talkin’ Tuesday 03.23.10: How did you find your therapist?

Leave a reply

Original photo: "Everyday Use Items: a couch" by @foka_kytutr @ flickr.com

Congratulations!

You have broken through the fear to make the call for help.

But now what?

Unless you have a therapist tucked away with the burp cloths or shoved in a random diaper bag pocket, chances are you’ll be scrambling to find one after diagnosis with Postpartum Mood Disorder.

There are a lot of questions to be considered when searching for a therapist. Some are financial, some regarding training, and others regarding how experienced the therapist is with your specific diagnosis.

Just as you wouldn’t see an Oncologist for a Pulmonary Embolism, you wouldn’t visit a Substance abuse therapist for a Postpartum Mood Disorder.

But when you are in the throes of Postpartum Mood Disorder, you don’t necessarily have the wherewithal to be going down a checklist of requirements for a Therapist. (That is, unless you get lucky like me and develop Postpartum OCD. Then lists and keeping certain things in a very particular order becomes very very important to you.)

So how can you tell your therapist is going to be a good match or is trained in dealing with Postpartum Mood Disorders?

The first thing you need to know is what degrees to look for when ensuring the therapist you are considering is professionally and properly trained. A therapist will primarily hold a Masters level degree and be either a Licensed Social Worker or Counselor/Therapist depending on your state’s licensing office. A solid counselor should not hesitate to provide evidence of his/her training and current license status if requested. You may also see a Psychologist, who will hold either a Ph.D (research) or a Psy.D (Professional) for therapy.

The second thing to consider is specialized training in Postpartum Mood Disorders. If the therapist is truly focused/familiar with Postpartum Mood Disorder patients, he or she will be aware of Postpartum Support International, Karen Kleiman’s Clinician Training at the Postpartum Stress Center, or Pec Indman’s two day training via Postpartum Support International. If your therapist claims to be intimately involved with treating Postpartum Mood Disorder clients yet has no earthly idea who these people or organizations are, be wary. Ask what specialized training they have completed in the area of Postpartum Mood Disorders (if any) and how long they’ve been treating patients with similar diagnoses to yours.

Third, while your therapist is not meant to be your best friend, you should feel somewhat at ease during the appointment. If you feel uncomfortable or on edge during therapy, you’ll be less likely to disclose as much and therefore hinder your own journey toward wellness. It’s worth the search to find a therapist with philosophies similar to yours.

Do not be afraid to ask what their policy is on admitting to Intrusive thoughts. Many many women worry that if they admit they have thoughts of doing horrible things to their children, the children will be taken away from them. I faced this very same issue and asked my therapist this question before I admitted some pretty dark thoughts to her. Her response was that yes, she was required to report situations which indicated imminent harm to oneself or others but that she understood intrusive thoughts and their involvement in my particular diagnosis. This particular concern goes back to finding out what experience the therapist you are considering has with Postpartum Mood Disorders.

Dr. John Grohol over at PsychCentral has some good advice on how to tell a good therapist from a bad one. I would highly recommend you read it and keep these tips in mind.

Another great link to keep tucked away is “Tips for talking with your doctor” by Karen Kleiman over at the Postpartum Stress Center. She suggests starting with the doctor you feel most at ease with even if it’s your primary care physician. He or she can always refer you to specialists once a consensus is made that further help is indeed needed.

I now hand this post over to you, the reader.

What did you do to find your Postpartum Therapist? Any tips? Suggestions? What to look for? What to avoid?

Let’s get to just talking here!

(Tomorrow we’ll be discussing different types of therapy available for the Postpartum Woman. Stay tuned!)


The reprehensible spammification of Postpartum Mood Disorders

Leave a reply

Something is afoot.

Something strange, disturbing, and downright irresponsible.

Sadly, I am not surprised at this recent development given what a hot topic Postpartum Mood Disorders has become of late in relation to recently (passed!) legislation and the courage of more and more mothers speaking out about their own difficult experiences after the birth of a child.

More and more, I have been receiving very odd links in my Google Alerts for several Postpartum Mood Disorder related search terms. These links lead to websites that have absolutely nothing to do with anything maternal, postpartum, baby, family, or any other related topics. And the information included therein is anything but accurate or reliable.

Even worse, I’ve been seeing a lot of new websites crop up with blanket promises of “Curing” postpartum depression for one low price. (One website even includes a friends and family “coupon” which cuts the price in half just for you!)

My stomach has been churning at the very thought of at-risk women and well-meaning family members finding these sites.

Oh yes, ladies and gentleman, I’m talking about the spammification of Postpartum Mood Disorders.

I can tell the difference between a reliable website and an unreliable website.

Women who blog with me, survivors, experts, and others intimately familiar with the topic can tell the difference.

But what about women and families currently being tossed about on the big nasty Postpartum Sea? Can THEY tell the difference or will they fall prey to these deceptive tactics masquerading as effective life preservers in a hopelessly churlish sea?

Spamming is a disgusting and contemptuous act which has been going on for years. Many of our in-boxes sit full of spam. Some of it makes it through from the spam folder into our in-box making it seem even more reliable. And if one of these links were to make it into the in-box of an at-risk woman or a well-meaning but uninformed family member of a woman struggling with a Postpartum Mood Disorder, the results may prove ghastly.

So what are we to do?

How do we get educated and knowledgeable when it comes to dissecting the authority and reliability of a website?

There are a few steps you can take.

First, is the site’s URL address directly related to the topic you’ve researched?

Chances are that if you’ve researched Postpartum Mood Disorders or Depression and end up on a website for air conditioners, furniture, auto repair, or turf builder, you’re not at a reputable website.

Second, let’s say that the website you’re at DOES correlate to the topic you’ve researched and the word postpartum is in the URL address. That’s gotta be good, right? Well, yes, and no.

Does this website link to known organizations specializing in helping women with this issue? (Think Postpartum Support International) What’s their google page rank? Are they HON Code certified? (Think Postpartum Progress) What’s the story behind the person who put the website together? Are they clear about their training? Do they let you know they’re a Mom/peer supporter, a doctor, provide confirmable evidence of education/degrees/certifications? Can you find anything about them elsewhere? Have other bloggers or websites linked to them and endorsed them or mentioned them? Or are they only published at their specific website and other unreliable websites? (I don’t have a high Google Page Rank or an HONcode certification but I am working to improve my page rank and also toward an HONcode certification as well. I also over-research everything I put up here which is why sometimes I’m a little behind on posting about a hot topic. I’d rather get it right than have it up as soon as it happens)

Third – is the website trying to sell you something? Does the website promise a cure? Are they dismissive of an entire approach to treating Postpartum Mood Disorders?

If the website is really trying to get you to buy something without describing in detail what it is, you need to be wary. There is no one size fits all treatment. There is NO overnight cure for Postpartum Mood Disorders. Just as with all women, all pregnancies, and all deliveries, there are many different types of Postpartum Mood Disorders and they are rooted in different issues dependent on the history of the woman, the type of birth she experienced, her thyroid levels, anemia levels, etc. There are SO many different layers to uncover when it comes to a Postpartum Mood Disorder. It is dangerous to buy into a one size fits all approach. Just as labor is a fluid process subject to change at any moment given any circumstances, so is postpartum recovery. We all approach life with our own individualized chemistry and baggage. Matching sets don’t commonly occur out here in the real world.

The practice of Quackery has been around for eons and will unfortunately continue to exist as long as people are willing to grasp at any answers that may save them from their current condition. That being said, there are legitimate complementary treatments and alternative approaches available for treating postpartum mood disorders. Anyone worth their salt in dedication to helping women with Postpartum Mood Disorder will be open to supporting whatever path you choose to take toward wellness regardless of what type of methods you choose. In the same vein, anyone worth their salt will also strongly encourage you to work with medical professionals as you work toward wellness. Anyone worth their salt will also openly share their training, education, and base of knowledge with you as well. There should be no hidden cloak, no Wizard of Oz mumbo jumbo going on during your journey to wellness with a good provider.

Here are a couple additional links that may help you navigate your way through the 102,000 results you’ll get via Google in .20 seconds for Postpartum Mood Disorders:

Tips on Identifying Reliable Health Information on the Internet

Quackwatch.org

What can you do if you fall victim to one of these websites? First, you can file with the FTC. And if you’ve lost money and care to pursue legal action, you are entitled to do so under something called the Lanham Act. You can also contact the Better Business Bureau’s Online department by clicking here. You can also click here for seven tips on how to keep your email address from getting added to the growing number of spam lists out there.

As more and more voices speak up about their experience with Postpartum Depression, more and more Snake Oil salesmen will crop up to take advantage of the growing searches occurring on the Internet for information. It’s sad and blasphemously tragic but such has been the way for ages with many medical conditions.

Bottom line: If in doubt, throw it OUT. That phrase is handy in the restaurant industry and certainly handy here too. If a link promises too much too fast or reeks of a foul distrusting odor, throw it out.

Tread carefully. Think it through. Talk to a professional. Take care of you.

Tomorrow we’ll be sharing tips on how to tell a good doctor/therapist from a bad doctor/therapist.

Have any tips or insights to share on this? Email me at ppdacceptance(@)gmail.com.

Be sure to check back to see if your tips/experiences were included!