 Good morning ladies and gentlemen and welcome to our third in the series of not all wounds are visible a community Conversation we're here this morning to talk about Anxiety and depression Particularly as it relates to women children and the family. This is in part a two-part series The second portion will be on November 28th, and that will be a focus on men Elders and the impacts of chronic disease on depression and anxiety We have quite a great program plan for you this morning I want to advise everyone that you can go on the website and obtain all of the presentations Which is ums.org? Slash community health in your packets today There is a page summary for each of those presentations and on the back of the event schedule You will see the biographies for each of our speakers So we may as well get started and we let me first tell you what the topics are for today Just as a refresher depression and anxiety as social cultural perspective Followed by childbirth parenting and depression After a short break we'll come back to growing up in fear the impact of community violence and police interaction and then we have a special presentation entitled one woman's story and this will be a Dialogue with one of our Employees here within the medical system who has graciously agreed to share her Journey with depression over the last 30 years and then we'll follow and end with Resilience and recovery. I also want to encourage you to visit some of the exhibitors in the hallway who are direct service Providers that are happy to speak with you So the first presentation this morning will be depression and anxiety a socio-cultural Perspective and that will be presented by dr. Jacqueline do vol Harvey who is The deputy health officer for the Department of Health in Prince George's County. Welcome, dr. Harvey Good morning, everyone So I hope this will be an interactive presentation My plan is to go over some basic information so that people who are not necessarily Familiar with mental health or the history of psychology and psychiatry will have some context But we're gonna try to get through those very quickly And then we're gonna talk about the vignettes because I'm hoping that those will make it real in terms of Understanding what mental illness looks like in everyday life now clearly we're not gonna use real people as you see from the summary We've used characters from television and of course because we're focusing on women I Particularly chose these characters because they are these central characters in the series And everyone else is a backdrop in terms of the men the children and everyone else so I think it's important and there's a significant diversity in The portrayal in the issues that these women experience and so I think this will be a really good opportunity For us to be able to talk about it. Hopefully you know these characters If not we can fill in and those in the audience who do have information can talk a little bit more about what they know So as we go along because we are all adult learners you have the summary sheet You can start jotting down Some of the questions that we have in terms of what trauma or issues these characters have experienced and what you think about their coping But we'll focus on that towards the end so generally again because you know We are in a university setting. We want to make sure people understand what we're gonna be focusing on So we're gonna talk about the social and cultural context of trauma of depression and anxiety and the impact of that on emotional development and I'm not gonna focus on this because we have another present Presentation on coping and strengths and resources, but we want to just generally highlight that to have a full context And we'll talk about how depression and anxiety manifest in daily life now. I'll just tell you I Think whatever happens to us on a daily basis What is driving some of our? Challenges is really about us either being depressed or being anxious We know that from a prevalence point of view Anxiety and depression are the most common Obviously, there's an issue of severity and there's an issue of coping in terms of how those things become more serious But on a daily basis we will experience some anxiety and some depression in our daily lives I Might feel extremely anxious standing in front of you and if this was my daily job I would certainly have to get some help to make sure that I can do this Well, it's not so I can manage doing it on an occasional basis. I Might I might have something stressful going in my life. We all have lost we have all kinds of things that happen So depression is not something that necessarily is something that may result in a suicide But if we're not paying attention to things as they start up more slowly Sometimes those things can escalate and so the impact of those issues even though they may start off in a fairly benign way Sometimes we need to pay attention to them in terms of looking at the longevity of the symptoms whether we are coping well whether we are struggling to do what we do in a daily life situation and so again There's severity and there's impact on one's life when we're thinking about Whether one needs to get help or not and part of the presentation today and the reason I'm here is because We know this is mental health awareness month and we think these kinds of Opportunities are what we need to do to make mental health understandable to the public and not the scary hide in you know in the back room Maniacal images that you see on television none of that It is a normal experience that people have throughout their lives again Depending on the severity and the support structure. It can become more debilitating But help is available and treatment works Bottom line if you take nothing out of this presentation understand the treatment good treatment is available and treatment does work Early identification and prevention obviously is the best route, but we have treatments that are effective and you can get help So let's move on I'm gonna focus on women, but I need to talk about one man and that man for those in the field is Sigmund Freud Now a lot of people don't really give a lot of credit to Freud But quite frankly, I think if Freud were alive today and working in the field today He would be saying a lot what I'm saying today because the fact of the matter is Freud was the one who understood that what was happening in in his culture Was treatable that there was something going on that needed to be understood And so he had some ideas as it as a neurologist that he needed to understand it and help people get over it So later on in the presentation, you'll see what I think is the translation of Freud's neuroses And all of the unconscious thought and that's basically what we refer to now as trauma Okay, sometimes we're not aware of the impact of a traumatic event on us so that can be unconscious and Sometimes that may not affect us. And so that's okay But again, if it's something that's recurring as an issue and preventing us from doing something that we want to do in our daily lives Then we need to understand it and in Freud's term. We need to make what is Unconscious conscious and that's basically the foundation of most of our talking therapies Someone helping you to see things that you're not able to necessarily see or understand Because they're observing so we've got to give Freud some credit and I just wanted to make sure I put him up there by the way the picture That is actually the couch That sort of became the tradition in psychotherapy where you know the client needs to lay down and all of that So if you wanted to know what it looks like, that's what it looks like So I'm suggesting though a broader perspective and that's the ecological model and Essentially, we can move quickly through this because all it's talks about is the importance of a social and physical environment In terms of how things impact us and that makes sense, right? So we're not in a vacuum. We're not living in a bubble We have a context in terms of environment. We interact with people Some of those interactions can be positive some can be negative. We have families. We want to do things We have goals objectives all of that within our daily living can potentially be stressful or not, but again, we are not We cannot live in a world where we have no impact for my environment We are interactive beings Isolation is probably one of the hardest things for us to deal with as human beings So we crave that human contact. We need it. It's important and vital to our existence And so sometimes unfortunately those interactions can be negative And so we need to understand that context both for the positive and the negative implications that it comes with and I'm doing essentially at the health department. We focus on public health So you can see the application of that concept within the public health arena where we know for example That your genetic code is now less important in terms of how you live your life successfully Than your zip code, right? So that's clearly a contextual impact on individuals well-being and and life experience. So again, we've got to broaden the context not just from whatever the individual is in in Freud's word not making conscious But also what the environmental impact is on an individual in their daily living and so some of the characters We're going to talk about was to demonstrate that This is the model that is the standard model if you you know go through to a side class You should see this and it just talks about the layers of impact that we we have in that ecological systems model And so later on well, there'll be presentations talking about children But clearly we know that this starts as early as prenatal a healthy mom is likely to have a healthy mom and Healthy dad is likely to have greater odds of having a healthy child And then we know about prenatal can we know all those things so that context in which a child is even conceived of in terms of being wanted by parents how they handle that period of Pregnancy and how they handle it when the child is born and all of those other things are clearly important And you'll have a little bit about that in the other presentation, but I wanted to start with our babies And across the lifespan we know that their implications And so this slide is just meant to give you a sense of some data about the fact that you know We can see manifestations of need very early on Unfortunately, most people do not get help. I think I just saw a statistic recently that while in one in sort of I think it's one in 25 individuals nationally are living with some mental illness 60% of those individuals are not getting any care or treatment Okay, that is not a full of fulfilling life That is not what we want people to do We want people to know that there is help available and help can be effective I'm going to digress for a second in Prince George's County for mental health awareness month Our team what our motto was go big or go home And so we launched in addition to all of the standard things that we do We launched an anti-stigma campaign because stigma is the single most important thing for us to address in terms of people accessing care And we've got to do that in a number of this one different ways This kind of a presentation is exactly the type of thing we need to do to bring this to Ordinary everyday people and help them understand it in that context So just in case we I'm gonna do this and hopefully the other presenters will have more time So they won't have to go through this but I wanted to make sure we were all having a frame of reference in terms of some definitions So there's a definition for mental health disorder and you know that this that speaks to alterations in thinking in mood and behavior substance use disorders dependence on or abuse of alcohol or the drugs and Generically we talk about those two areas as behavioral health the positive about behavioral health It also helps us focus on what's really important how will all of those things affecting you in your interactions your daily? Activities with other people and the things you want for your life. So we don't care if it's a mind disease We don't care if it's an issue that is being managed by medication talk therapy relaxation Mindfulness activities doesn't matter all of those things helping you Do the thing you want to do every day be successful Achieve what you want decide to go to school be willing to change jobs Stand up in front of an audience and speak because you're not afraid anymore any of those things We want you to be able to do those things and that's what we want to make sure we focus on the behavior part because at the end Of the day if there's no change in your behavior if you're not able to do anything else that you wanted to do the treatment Is not effective right so that's the goal and that's the integration of both substance use and mental health Is why we have the general term because we want those two to be integrated because you're one person Sadly though, it's still gonna be a bit of a challenge around that integration because There's essentially the training for Professionals in the field is very different Substance abuse treatment has actually always been one that has been peer supported Most of you will know about a a alcoholics anonymous, right? And so there's always been an sense that you can help someone if you've had that experience But fundamentally what is under that philosophy is the issue of acceptance of what that person is experiencing right because Oftentimes it is difficult not to blame someone for example if someone is addicted to a substance To not blame them because I well, you know you had a choice You didn't have to do that and look at all of the terrible things you're doing now that's hurting our family So there's a blaming that happens and a shaming that comes Unfortunately while that does happen and that's a natural response Shaming and blaming doesn't help the person get better. In fact, it makes it worse Because folks who are using substances unhappy that they're using them. I'm proud of what they're doing Don't think it's a good thing, but they have an addiction and there's a brain chemistry change And so whether they wanted to or not without help They simply will not be able to change the behaviors that are causing problems in the family so shaming and blaming is not working and in Peer-supported groups. There is none of that there is the acceptance that recovery is a process and During recovery there'll be moments where people are Not able to sustain that recovery and understanding that is a supportive experience But ultimately people make progress and they do get better and they not only recover, but in some cases thrive Mental health however has focused on understanding the nature of the illness The field has not been led by peer-supported Activities it's been more of a professional Licensure academic process with training and so joining those two philosophies of peer support and rigorous academic preparation is really where behavioral health is is it's seeing its best work happen So in conjunction with licensed professionals Most treatment involves some peer-supported activity, which is really essential for individuals to know that there's a group of people That understands that experience I don't believe that it is necessary to understand that experience firsthand to be helpful But I understand the value of having that for people and so again for look philosophically you can make your own decisions But their evidence shows the peer support in conjunction with Traditional treatments is really the most effective. So I just wanted to put that out there So new concept for us it was not we didn't talk about trauma We talked about trauma in medical settings that that that was a standard term. We have you know, we have shock trauma here but we're applying that term now to Anything that creates difficulty for an individual not just related only to physical injury And this is the SAMHSA definition of trauma and the green areas are highlighted You probably can't see it as well as I'd like but they are the ones that start with all of the ease and It speaks to An event or a series of events or circumstances that is experienced by an individual So again, it is the individual who determines whether something is traumatic for them But the impact can be either physical or emotionally harmful or life-threatening and it has to have a lasting adverse effect Okay, so I may have the same experience Donna has I May respond to that experience in a very different way from us because of who we are What our resources are how I perceive that event how I cope with it So we can't everybody is not impacted in the same way and some people Thrive even in negative situations. They do well. They overcome adversity. They there's no residual effect So it's not a one-size-fits-all Approach in terms of thinking of mental health what trauma allows us to do is broaden that context to make sure again We understand that sociocultural environment and understand how a particular issue can impact a person what was also very Positive about this definition is the last three words Where what was brought in was impact on spiritual well-being So this is the first time Psychology and many feels actually put Religion if you will in that context and I'm not just talking religion as in an organization But essentially how one copes and with those kinds of mechanisms. So your own spiritual well-being So it doesn't matter if there's no physical injury or any of these other things if you your own spirit feels like Something is wrong. That's enough because you define your experience You define whether there's a trauma and hopefully if you recognize it as that you reach out in whatever way That's appropriate for you and you get some help, right? Because we want you to recognize it, but we want you to do something about it if it's having a negative effect, okay? So I'm gonna skip through those because these are again standard SAMHSA slides Hopefully you've seen them if you haven't I know there are lots of places who do trauma training and talk about trauma informed care And that's where the field is moving, but I wanted to make sure you had them so that in the Powerpoint when you get it you will have some sort some reference documents that you can follow up on So that's all for the academic intellectual Stuff we're gonna have some fun now because I think the other thing we have to do mental health is actually Be relaxed and have some fun when we talk about these things It doesn't have to be these dire negative circumstances that are scary and you know worrisome So I think Shonda Rhimes is the new Freud But better than Freud especially for women she has done remarkable things in terms of Portrails of stress and coping on television and If you followed her from the beginning and I'll show some more slides you've seen those characters evolve You've seen this severity and the impact of traumatic events broaden and She's tackled issues that What weren't really tackled at all you'll also see some socioeconomic and some some some Racial differences in how things are handled which again talks about that broader context So for those of you who don't know just is just a quick tutorial for those who are not familiar and How many people know the Shonda Rhimes shows Grey's and that okay wonderful good and in the audience in the other sites I'm sure you all know them as well If not, you're gonna have to you know get get some old copies and learn all about it So these are the three primary characters in the three series On Thursday night starting at 8 o'clock. So Grey's Anatomy is on at 8 scandal is on at 9 and how to get away with murder is on at 10 and As I said the issues get more and more colorful more and more dramatic and more and more intense as you watch And then there's a new show on BBC that I'm gonna talk about that's kind of related to Shonda Rhimes and You know we went way over in this particular one, but I think it's also important that the old sort of well women are just the people who get depressed and somewhat neurotic These characters this is showing that women are Capable people all of the characters are talented strong dynamic Can I say the word badass women yeah, I can say that I can say that right and and that's what's really great about this They don't show a Segment that's you know Having all kinds of negative experiences had no option. It's not about that. It's about showing that even the brightest most talented most capable Have moments right and have things that go on in their life and the portrayal of all of that is really what I think is helpful To people to know that you know, it's just it's not just them so these are the the prime characters and a little bit of history on Grey's Anatomy All this of the series the first one and it started in 2005 And so this is what the characters look like In that time and they've actually evolved over over over the over the years and so it's pretty interesting So for those of you who know the show This is a moment where you can actually jot down some of the things that you know where the traumatic events because we're gonna talk about that now And we're gonna talk about that and identify three of those characters Meredith Gray who is The gray that the story the whole series is about Maggie Pierce who actually is her I Guess in the we call it a half sister and Miranda Bailey who's also a physician at the hospital And from a Capabilities from a training from a skill point of view Meredith and Maggie are basically the same character powerful Extremely knowledgeable Very talented very dynamic, you know, they go in and save lives when you know There's absolutely no hope they're the you know, they're the folks that just make things happen, right? No doubt of any talent in this group. These are the women, right and so Each of them faces different things Richard who's the next person here is Let me see if I remember correctly. This is Meredith father Maggie's father and his relationship to thank you Okay, good audience participation. Thank you So going back to those two though. So generally equal in terms of life experiences, right? Preparation academic learning scales and all of that Meredith and y'all can chime in has had Practically every negative life experience happened to her, right? There was Some heinous situation in the hospital People with guns, you know, there was lockdown. She lost her husband Join in Yes, McDreamy was what he was called She has had every possible thing and what happens Meredith bounces back now. Why does Meredith bounce back? Because this is your coping part. Why does she mark? Why is she able to bounce back? Because she had a lot of resources right Meredith was wealthy Meredith was well it was talented. She was at the top of her game professionally She had lots of good friends. She had a supportive network Richard was there her mother died. She actually had I believe she was the one who found him But I think her mother committed suicide, right? So she's had stuff happen. That's bad But she had lots of coping lots of support and lots of resources Maggie similarly Maggie didn't have necessarily the same upbringing But Maggie's we don't really know much about Maggie's history because she's a relatively new character But Maggie has been resilient and the few times we do have seen her family They seem to be extremely supportive and we've seen nothing that suggests Maggie hasn't had a wonderful childhood, a wonderful person. So these are very much parallel characters except that Meredith has we've known all about her trauma and we've known that she can cope I think there was remember there was a plane crash and Horrific things happen. They will you know, they were stranded but Meredith bounces back Okay, so bouncing back is possible, but What about those of us who don't have all of those wonderful positive strengths, right? Because that's this average This is not the average life by any means so I want to talk about Miranda Miranda is now I think the chief of surgery Um, Miranda is the only character on the show that is probably not a size four Okay, she's also not tall So she's short and a regular sized woman She's regular sized. I'll show you a picture of her later But she's short and she is regular sized and but she's talented as well And we didn't know anything about Miranda's family until very recently But there was one episode of Grey's Anatomy Where Miranda wanted to apply for a position She believed she was capable. She believed she could do very well but A new person entered the picture. This was a woman who wanted to interview for that same job Ironically, she was coming from Johns Hopkins. So I kind of chuckled about that And she was tall and blonde and white So Miranda short regular sized African-American tall blonde white And now nowhere did we ever see insecurities from Miranda up until this point but The woman from popkins comes in and you know, she's touring the place as as these things work And she's meeting people and she's talking about all the wonderful things She does and everybody's impressed and how wonderful that is and oh great And Miranda starts to feel oh wow Look at all this stuff. She's done Wow, they're responding to I've just been here for 10 years I've not really left and gone and done anything. Yeah, I did some good things But she's done this and she's done that And Miranda actually decides that she's no longer going to apply for the job Just the presence of that person and the response of her peers and colleagues Gives her so much self-doubt that she decides not to apply Fortunately and I'm gonna come back to the man next to her and that's why he's up there because this was focused on women But we have some men some time to do what they need to do Her husband sat her down and said listen girl uh-uh And he sat with her and helped her understand all that she brought To the table and yes, this was a shiny new penny And that was great, but she had a history of that organization. She knew the people She knew the issues. She was talented She was all of those things that he sat and told her about and she applied and she got the job Now this was not a re-character This is still a character on par with meredith gray in terms of talent and ability But those moments of self-doubt come even when we have those resources And sometimes having that supportive person who reminds us of who we are Beyond the doubt beyond the worry beyond the the fear that will fail because even if she had doubts She could have said i'm gonna try anyway, right, but she actually took herself out of the race So she made it possible that she would not even know if she was good enough in her own mind Which would have then potentially been something that she would have you know That would have been the beginning of not trying which is something a lot of us do Opportunities come up We're not quite sure we have all of the skills And we don't say well, you know what I'll learn some of those things because I think I have enough to do this job Well, we say you know what? No, I'm not going to do it And then somebody sometimes with less skill than us gets it and then we're mad But you got so you got to put your you got to put your hat in the ring Even when you have doubt, but sometimes we worry so i'm gonna keep moving on because we want to talk about I have some other slides to show you and i'm running out of time This is what miranda actually looks like Not frumpy not overweight Not short or she's wearing high heels obviously, but still okay So again image self doubt a lot of a lot of things kind of can take away from Us feeling good about ourselves, but in reality that's not the case Okay Scandal olivia pope. I personally have my white jacket. I didn't wear it today because I didn't want you know y'all to know about that But this is again dynamic The fixer the woman in charge, but she has some negative stuff in her family father Stone cold killer. Let's just just call it that Her mother equally bad right So the series chronicles how she copes And that's by being better than a lot of folks Making some life decisions about who she spends time with or doesn't spend time with And we see her primarily as alona A person who really doesn't feel she needs people Occasionally she'll want somebody and usually it's a sexual relationship. So no long-term commitments She'll you know, she'll pick and choose when she needs that but for the most part. She's a loner and I don't know This is not said in any of the story, but again, you kind of see if you know the characters of her family Where that comes from right? um one character in her life who is The personification of all things evil doing Is this character named hawk who literally? After a very traumatic event in terms of losing his family became a very evil person And the person who carried out all bad deeds So in hawk again, this is men without talking about men today, but I'm just gonna do a little side note What can happen when people lose family and lose that support and lose that love and connection? Again, it was shown in an example of a man And so on your sheets, you can kind of talk about it because there was actually a specific Traumatic event that we know about with Olivia Pope I'm not going to say most of you who see the show know it But the picture is there and you see the contrast between who she was And what happened and throughout the series after that for a long time. We see the post-traumatic stress Um syndrome playing out in her memories of those that event and all of that And then finally how to get we get away with murder and that title alone is provocative And so this character Shows the full gamut and and we really got the richest knowledge of family Support system friends Varied coping mechanisms Just was just flagrant and and very rich with a lot of information Some of the characters, um a young man who may or may not be her son She lost her child and we know about child loss and the impact of that Um a faithful friend Back and forth around lesbian relationships and um the lead character Is very sexually active That's one of her coping mechanism and also uses alcohol a lot again as a coping mechanism Both of which in an unhealthy way, obviously Has various people who do her bidding and take care of her and do dirty deeds And so what is really really and and lots of negative experiences lots of potentially traumatic events and some of them We understand are still having an impact on her What this show does though is it it talks about some things that we've not talked about that much And the first thing is i'm sorry. You can see very well. This is an image of her with her husband Her husband is a psychiatrist And she eventually He eventually marries her And so it shows what can happen when you have an impaired caregiver in terms of us of a helping professional Who's not aware of his own needs and his own issues and it and eventually they develop a relationship Which is extremely unhealthy because he was impaired She was clearly needed because she was his his client And it evolved in a way that is unethical and lots of negative things happened as a result Cicely Tyson plays her mother and the portrayal of cicely tyson and what she Her function in this series is to show Coping in a Cultural context one of the experiences. This is loss of her child That has been an issue that has plagued her throughout the story lines Eventually when it so overwhelms her she goes home and her mother takes her through a ritual of literally digging a hole in the ground And putting something that belonged to that baby and then covering it up And that process allows her to let go of what she had been holding on So therapy and treatment is not necessarily only sort of standard textbook stuff There are rituals and practices within cultures that are effective. She's experienced pretty much everything Um And so that kind of a street treatment strategy from a mother is there to point out The importance of recognizing culture and having those conversations with people about what is useful within their own culture To augment whatever you're doing in terms of your intervention Um, and so that's it. Let me just quickly show this last slide New series called killing eve Character who is a killer for hire And she is merciless Uh gets very close up favorite thing is to stab people with sharp objects in their eye up close And then there's the contrast of her being very childish She organizes birthday parties when there's no reason for it. So the psychological makeup of this character is extremely interesting And the lead character who she's now fixated with is um, sondra o who was meredith graze Best friend So I just had to tie that back into sondra rides. So that's it If you don't ask any, I will Did you think of these characters in this way in terms of looking at their coping? Looking at the diversity that they have in terms of how they portray Yes No, some people had not thought about it. Yeah I think one of the important class questions to ask particularly when you do an assessment early Is to ask people what they watch What do you watch on tv? First of all, they're nervous. They don't know what this is all about You want them to relax a little bit? So you say tell me what you watch on tv? I think what people watch is interesting and it kind of tells you a little bit about who they are Um, I talk when I do other talks one of the series I use is the um real housewives series That I need about two days to do But again, what people watch kind of gives you a sense and and you can and if you understand or know what they're watching It's helpful to sort of bridge the gap And because you can make a reference to well remember when so and so did this That was an example of what you were talking about and you saw how she coped and you recognized that as coping So can you try that? So that's I think one of the ways clinically we can have some conversations that are not scary to people or far into people and so on Yes, sir Mm-hmm. Yes, absolutely It wasn't part of the slide because I was focusing on generally on trauma, but it absolutely is when we the impact of trauma is The impact will depend on those things The slides have more details, which I didn't go over at all Where the who will be talked about and and the who generally is if this individual is a Known person as opposed to a stranger That has more impact if they're known to be family or friend of family of your family than if this is an stranger Okay, good substance use excellent So you're a great example of integrated behavioral health fabulous excellent other questions Okay, so I hope it was helpful I hope it challenged sort of the way we think about how we work with people Um, and I hope you got something out of this in terms of something that you hadn't thought about or wasn't aware of before So thank you for your participation Dr. Deval Harvey that certainly Brings home to real life What we see every day it really makes it real. Thank you very much So I'd like to introduce our next two speakers that are the focus will be childbirth parenting and depression Our two speakers will be dr. Sarah edwards and dr. Patricia woodruff Dr. Edwards is a board certified child and adolescent psychiatrist with specialized expertise in early childhood mental health and treatment of complex Trauma related disorders. She's the medical director of our child and adolescent Psychiatry clinical service at the university of maryland medical center, which also includes child inpatient partial hospitalization pediatric consultation and other subspecialty services Dr. Woodruff Is a clinical assistant professor at the university of maryland in the department of psychiatry She's the associate director of the university of maryland women's Mental health program actually she she was promoted to the director I correct that and has over 15 years of experience in reproductive psychiatry with a focus on perinatal psychiatric disorders She's practiced in clinical academic and private settings Uh providing psychiatric consultation evaluation and treatment to women during pregnancy and in the postpartum period She also provides education to obstetrics pediatricians and other psychiatrists regarding mental health issues In psychiatry, please welcome doctors edward and woodruff So i'm going to start uh i'm pat woodruff And thank you for that introduction jill So i have to say i've already learned something about myself. Um, dr. Deval Harvey. I did not realize That the shows I watch are such a reflection of who I am. I'm watching call the midwife right now and as dr. Rock basal Said I focus on the period before during and after pregnancy in terms of of treating women's mental health and that's A lot of what goes on and call the midwife Hadn't thought about that before So we're going to start So now that we know a little bit about stress trauma coping mechanisms Adaptive and maladaptive ones We're going to talk a little bit about one of the biggest Stresses that can happen in a woman's life. Sometimes it can be traumatic And that is childbirth getting pregnant having a Pregnancy maybe losing a pregnancy Having a baby raising a baby and one of the One of the things that can happen during any of that time is a woman can develop Problems with depression or anxiety and it's often overlooked Dr. Edwards, and I wanted to start with A video of some women who have actually experienced postpartum mood and anxiety disorders to kind of give us A flavor for what what people Think about after they've been treated for it and diagnosed and can talk a little bit about what the experience was like for them Everyone I knew I felt like had the most wonderful Experience after they had their baby, but I didn't know how to say like I am freaking out postpartum depression to me is The disconnect you have with Your baby an overwhelming uncontrollable sense of anxiety one of many mental illnesses that can affect mothers When I got pregnant I was instantly in a bad mood in addition to that I had fibroids which are tumors that grow in your uterus and it was really scary I knew I had postpartum depression from the first time when I went to go and pump my breast milk at work And I just broke down crying. I actually remember saying to my husband You know people kept saying I'd be so emotional and I feel fine And the reality of the situation was that I was completely emotionally numb right after I had the baby It was my husband's birthday So I baked a macaque and I invited people over and people were like what are you doing? But I felt like it was my duty to celebrate his birthday to Try to nurse and then come back and put on a happy face I believed that every parent around me knew what they were doing and that I was this Devastating failure when my son was four months old and I remember Breastfeeding him, but he wouldn't stop crying and I got face to face with him and I screamed Stop crying. That was probably the moment. I realized I needed help It's a really defeating feeling knowing that this is something you have no control over I thought after that moment. I just need to hold my baby I don't ever want this to happen again And something has to change being a stay-at-home mom was really isolating But I felt like I kind of came out of it when I started exercising and hanging out with other moms I started feeling better when I could wake up to my baby every morning And he just makes everything better and everything worthwhile To all the mothers going through this surround yourself with people who get it because you're not alone I know there's so much pressure right now to be like a perfect mom You have to be honest You have to let people in and let them know what you're going through if you are out there and you are struggling I want you to know that it is going to get better I'm a mother and I am vulnerable That I am capable and I am fighting every day and I'm doing the best that I can And struggling with postpartum depression Didn't make me weak, but becoming victorious over it That's what made me strong. We have lost way too many moms So please stay with us Find yourself a community And keep fighting one had any any immediate thoughts about the videos about the the women who spoke About their own experiences anything that they'd Any reactions? We'll have a chance to talk a little bit more as we go along Yes They had two different nurses in the nicu And I didn't get any sleep for three days straight because one of them was always up And I just got to a point. I just sat there and I just cried and cried and I thought I was a horrible person that I didn't know how to take care of my own children But um, luckily I had family support and I had an older sister that had children and And they helped me get through it. But if I hadn't had that support system I could have seen my own self, you know going Kind of going to a dark place because I was really scared I had I I got I was going through a divorce when I found out I was pregnant So I didn't have his support and It was it was rough. But thank god for peer support And people who care about you that can help talk you through this And that's what we have to do as women. We have to Know to share our stories in the stop We're we know for putting on this brave face And smiling and we're broken inside But we have to learn to tell others and to speak up and just tell somebody something is wrong I need help and that goes back to the whole idea of what dr. Deval Harvey was talking about the context And the stigma of mental illness So let's talk a little bit more about How do you know if you have depression or anxiety during pregnancy or after delivery? And these are just some of the questions that that we use when we're evaluating women to try to figure out Where on the spectrum of having anxiety or depression they are and one of the things I think that the women in the videos demonstrated very nicely is that there is a wide range of experiences from just feeling Really emotional and easily angry to feeling numb and anything in between So having any of these answering yes to any of these questions doesn't necessarily mean that you have A mood or anxiety disorder during or after pregnancy But that it's a possibility And today we're hoping to spread the word that depression and anxiety during pregnancy and after pregnancy can be serious And that it can affect your baby That it can be treated and that's not your fault This is a graphic from the post-partum support international website Which is a wonderful resource for moms and moms to be and people who are living with moms Who might be having problems with depression or anxiety Um, they have lots of phone and text lines and resources for anyone providers Women experiencing Or wondering if they're having a postpartum mood or anxiety disorder to reach out with questions or concerns and find out more about What's available to help you So what if you think you have a postpartum or uh during pregnancy mood or anxiety disorder? Number one keep in mind. You're not alone as many as 15 to 20 percent of women Have significant anxiety or depression during or after pregnancy. That's a lot and You know if if I ask people who've had kids to raise their hands We'd probably come up with that number about one in five one and six Untreated depression or anxiety can affect the entire family Again going back to that idea of context that dr. Deval Harvey talked about None of what we do happens in a vacuum and certainly a mom with depression or anxiety is is Going to have an impact on her children and other people in the home Untreated depression anxiety are never something that you just need to get over And if anyone says that we can just turn around and walk away because that is not helpful It's important to ask for help and where you get that help Can be as variable as the people in this room You can ask your partner your family members your doctor midwife a neighbor Or call one of the hotlines or the warm lines to find someone to help you And to keep in mind for those of us who work with women in the perinatal period that no one knows how a woman is feeling until you ask And as a woman experiencing any of these no one knows how you're feeling until you tell them And I think this is an amazing graphic because many of us Have felt this that all you can say when someone asks how are you doing is I'm fine And fine is not a word that I ever accept at face value when someone tells me that's how they're feeling You can't tell by looking at someone if they're doing okay or not If you know someone either as a provider or a neighbor Or a mom yourself who is having any thoughts or worries about hurting themselves or their babies It's critical to tell someone who cares about you and call for help and these are just some of the resources Locally we're lucky to have the baltimore crisis line. There's suicide hotlines And you know again this all these resources are available Uh with the rest of the presentation One of the organ the postpartum support organization sponsors An event called climb out of the darkness many of the women experiencing Perinatal mood or anxiety disorders feel like they're Under a mountain that they're they're they can't find their way out And this this graphic and this annual event represents what it feels like for those women to get the help that they need For us to raise the awareness Reduce the stigma associated with these And again, dr. Deval Harvey suggested Told us that there are treatments. There are effective treatments and there's a whole variety of them ranging from peer support to counseling talk therapy with professional medications Changes in what's going on I mean again You gave us a perfect example of how pulling in other people to help once you realize you're overwhelmed sometimes It just takes getting regular sleep Getting out being around people Accepting the fact that you need help Often more than one type of treatment is needed and if if just reaching out and asking your family for help isn't enough Then you might need to ask someone else for help to move kind of along until you find the thing that that makes you feel better Sometimes the perinatal mood or anxiety disorder resolves on its own, but we can't count on that We absolutely can't waiting for it to just go away Is is not going to be Often not going to be a good outcome Some of the things that are easy to do like we mentioned getting enough sleep Finding time to exercise eating regularly Watching what you eat even though the bag of potato chips sounds really tempting It's not the best thing to get your mood or your anxiety under better control I'm asking people just to give me an hour of babysitting so that I can Get out and do something for myself and that's not being selfish because again There's a piece of what the mom's going through Is going to have an effect on the baby so for the baby to be healthy and to develop well The mom needs to be healthy and develop well I'm going to hand this over to dr. Edwards now who's going to talk more about the depression and parenting Thank you so much before we Completely transition to parenting and the effect of maternal depression Does anybody have any questions or comments regarding the first section Talking about perinatal depression anxiety postpartum depression and anxiety. Thank you so much for sharing We were really hoping that this would be interactive. Yes. Wonderful Yes, we're gonna hold on. We'll give you one second. I had it on pause there. There you go I just wanted to ask a question about the postpartum depression and Is it a timeline? Like, you know, people always say, um, they had the depression right after they had the baby But what about when the child gets a little older? Is it still considered postpartum depression and Can it happen when they five or six? Thank you. That's a that's a very good question. Um And I'll answer it with two parts. The first part is that about 30 percent of postpartum depression actually starts during pregnancy And so it's not really postpartum depression The other piece is that untreated depression whenever it occurs in the first year postpartum Will likely continue and so it may not get bad enough or you may not Know Right away and it may be five years out when you have a child going to kindergarten that you've been depressed all along so If we if you were to come to me and say my child's five How is this postpartum depression and we looked back to Six months after the baby being born. We would probably be able to identify some depression at that point that Just progressed because it wasn't treated Are there other questions? Mine is not really so much about questions. It is a comment um, I know this section is about the postpartum depression, but with this One line that you all put out there I will I personally put myself out there. I've used them many times And found them very problematic And so I'm not going to get too deep in this because maybe there's another section Where y'all go more into it. I just feel like Just me even as a woman going through whatever That I've had a lot of problems with them. They're not always helpful And just wishing that yeah as far as like the warm lines I put up there The hotline No, there was another one that y'all were saying. Yeah, I mentioned like the bottom or like whatever so I'm not going to get too deep in that but You know, it would be nice if maybe y'all collaborate or somebody collaborate more on that later about And and one thing I think I alluded to is that just like if one treatment doesn't work You have to move on to another treatment and keep trying until you figure out what works One warm line might not work for everybody And there are lots of different resources postpartum perinatal mood and anxiety disorders are Fortunately kind of a hot topic and so there's more and more out there And if you bump up against a wall something that doesn't work for you something that's making you feel worse about yourself You know, again, I say move away from that and try something else And if if you keep running into those walls To to find someone who cares about you to help you and again, whether that's a family member You know someone in church someone in your In your school wherever you are that you you have someone that you can count on So you're right not every line works for everybody I just wanted to piggyback on that. I think that's a great example of Comments that we hear frequently about all types of treatment and It's really important to listen to yourself and if you think that it just doesn't fit or feel right Or as dr. Woodrow was saying it even makes you feel worse to move along There are lots of different types of treatment lots of different support systems out there And sometimes it does take just trying a couple other ones, but please never give up hope It's so important. We are a community around that has lots We have a lot to give and there's lots of different types of treatment So I know I work with some families where it's really important that they have Their church involvement that they have other family members with them Sometimes when they're at different treatment appointments and that's great if that's important and works for you That's what we need to do Other people Might not like that and want to have something Just talking on a phone and not seeing another person that can be very helpful So there's not a one-stop shopping not everything always fits But we do have to kind of keep pushing forward to find what fits for you So thank you so much for bringing that up because we hear that frequently And when the last thing we want is for you know for somebody to get turned off and say that's it I don't treatment's not going to work because we do know that it does I saw another hand over there Don't mean to be negative. However I have noticed And I'm saying I have noticed that I have a relative who Has the disorder But I've also have been noticing in her treatment There's some professionals in my opinion are not professionally sound Because sometimes their character their demeanor their personality. It doesn't fit the position And it shows Because I can tell when you're professional about the comments they make How are they the out-of-contact with the individual that can affect it sometimes? Oh, I can tell how we bother her or you come into the office to be seen And they give a friend a home over here. She comes That's not professional I've seen a lot of that in my walk You know, I'm just saying that can affect the relationship Absolutely. Well people with disorders just one word one wrong word Of one particular approach can mess the whole relationship I'm I'll just say to that a big part of what we are dedicated to is educating providers As well to to talk to obgyns and pediatricians and psychiatrists and counselors and social workers and make sure people understand How important every single word is and every single Interaction with someone who's already feeling so fragile and overwhelmed This could maybe be addressed in the second part too, but I think from the video. We also saw that often Until someone is able to admit that they might be experiencing something That's when the help starts and so I guess are there Um strategies for friends or family members to start the conversations early because I think even In general asking someone oh, how's your mental health? That's not something that commonly happens and so And you know someone might think oh, well, why are you asking me that and So what are some strategies for starting that conversations with pregnant women or new moms? So one of the things that that we do in all of the perinatal Programs that we have at university of mariland and it is recommended that there be universal screening during pregnancy and the postpartum For exactly these things so that it's only 10 simple questions But it's very helpful in identifying Women who may not Have thought you know that that this is That I have this But that becomes a starting point So I would see someone who scored Whatever on this screening tool and I would say this really suggests that you're you're maybe struggling more than you're aware of Or did you know that that this was That you were gonna whatever that I don't even know how to say Did you know that you you were having a hard time? Have you talked to anybody about it? You know to just kind of open the door So that is becoming more and more standard And again the big part of what we do is provide Education to clinicians as well to make sure people are comfortable asking the questions Looking for not just accepting fine as an answer when they ask a new mom I think we're gonna have to Dr. Widger We also have one question from a remote site for you The question is my son went to Vermont to college. I cried the whole way home to Maryland. Is that depression? If if the crying stopped After a few days after he got home, I would say it's a normal grief reaction Mostly these diagnoses are based on not just a single symptom like crying for a few hours or even a few days But how impaired your functioning is as you you go on from a particular event So we're going to get back to our talk and look at the parenting. We'll have lots of more time for questions Well, thank you So now we're going to turn a little bit Towards the child and the family as a whole unit and try to talk about how maternal depression does impact parenting and the child So why is this important? Well, as we've already discussed maternal depression is very common It's common during these childbearing years and it impacts the entire family And children of all ages not just the babies So when a parent is depressed when a mother's depressed If you think about it, you're not it's it impacts your entire being everything that you do on a daily basis So how you eat sleep interact, you don't have the energy And it really can compromise Your ability to respond in a very warm and nurturing manner to your child And that impacts their development We what we've learned about child development and the brain is really amazing We know that during the first several years of life Everyone's second a million neural connections are formed I mean, that's incredible for me to even think about I've sat here and talked for several seconds And that's millions and millions of connections And it's so important because these connections are formed We're all born and we have genes But as Dr. Duval Harvey had mentioned We're human social beings. It's these interactions that we have So it's a combination of the genes that somebody's born with But most importantly the interactions with the environment and that parent That then forms all of these connections We know that these connections are it's the foundation that later really allow All Later learning development How we deal with stress Does anybody have any thoughts about that? I mean, that's pretty incredible to think that just in the first several years of life That lays your future foundation and we know that I see a little bit of some head shaking. Yes How I mean, it's kind of like not something that's proven a disproven kind of thing But it's something that I think is very interesting and I don't know just bring me back to that that kind of concept. So yeah That's right. It's it's that it's not an either or it's that combination and how important all caregivers are And so when you're able to be functioning well And uh able to take care of yourself Which kind of piggybacks on your other comment about how do you start to Bring up topics if you're worried about somebody who might be suffering I sometimes like to put it in context of you know You need to be able to take care of yourself in order to take care of your children and families And so to check in and and to frame it not so much as there's a problem But how do we make sure that you're well and feeling well and have as much energy and support as necessary So then let me flip uh flip the slide here So these are some possible negative outcomes That happen to both young children and I'll show you through the ages if we are not able to help treat Uh maternal depression and I I say maternal but it's the same within the context of the family So it's also the moms and the dads But maternal depression so in babies If you're not able to be there And you can't really respond in that nurturing way You frequently can have problems with the baby feeding They might not grow well then They might you might be too tired to get them to their well care appointments Might be too stressful So then those children might not have all their shots that they need and they can become sick It's really important that when we're interacting with children Again, we develop based on these interactions and we call that like a serve and return Uh in return interaction So if you think about a baby cries and the mother comes up and nurtures Goes ahead and helps to soothe the baby Maybe the infant then starts to coo and the mother, you know responds in delight It's that back and forth communication That helps to make all of those good brain connections We know interestingly that Children right from the beginning need to hear lots of words So we actually coach parents to kind of be like a sports broadcaster and describe everything that you're doing So you have a baby right there in the kitchen and it's the morning time and you'd want to be able to say like Okay, mommy's now going to make some breakfast. I'm pouring myself cereal. Oh, look at this big red box of cereal Look how colorful the fruit loops are and you have to describe and you describe what it sounds like and tastes like And that baby is taking this all in and it's so amazing that our brains are making these connections If you are tired exhausted depressed anxious, you're really not able to do that And so you're not going to be talking as much and then that impacts their speech and language delays Oh, sorry That impacts how there's How their language is starting to form and what happens if you don't have good language skills? Well, it can lead to behavioral problems If you can't communicate and get your needs expressed and your needs met You become frustrated as a young child and so these children are going to have more likely have problems with behaviors Um, then you don't have as much success in preschool kindergarten and then it starts to leak into elementary school So you don't have that same level of academic success potentially And then when we start getting older and to add a lessons You can have the children themselves then start to have more mood and anxiety problems Maybe they don't finish school And that puts you at risk for you know being around friends that might not have the best influence So then you can make choices with substance use And so it kind of has this big Overall effect and it's hard to think that just maybe how you're feeling and interacting right when that baby is first born Could trickle down and have such long lasting effects, but it's possible And so that's why we really want to bring awareness to this I love this slide here because it highlights that depression and anxiety during and After birth are really associated with all of the negative intergenerational consequences for parents infants and really society so if you look at The beginning of the cycle here you have the parental depression And then you're not able to have that warm nurturing Caregiving from the beginning and you have poor bonding with a child Does anybody ever heard the term like attachment? bonding or attachment I heard before one of the best descriptions of that and attachment is kind of like Our own emotional Immune system so we have an immune system that helps us so when we get Exposed to germs and illnesses later on we're able to fight them off Well that attachment that you have with your parent or your caregiver Sets you up so that you can handle stress Later on in life that you can handle regulating your emotions And your actions So without that it makes it really difficult So we talked a little bit about some of the negative childhood outcomes And then we know that if You don't have the same level of school achievement and you've had stress And you could have more traumatic experiences Then unfortunately does put you at risk for increased future health problems Heart problems obesity diabetes Things like that Then those genes are then passed on to the next generation And it can be this cycle But I don't want anybody to lose hope there's hope because we know that treatment is there and it does work Many people have brought about Raised the issue of how it can be hard to find treatment that you feel is supportive and fits for you But it's out there. So I keep on encouraging people That sometimes it just takes trying to figure out what works for you We know with young children and infants There's many types of Treatment we can do the parent-child treatment that works and you have groups and it can help build and strengthen that attachment And that bond There's different family groups. There's individual treatment Many different types and it's out there So on that note, I'd like to again try to involve some Participation and see what sort of questions or thoughts or comments We got some great Thank you basically this part You answered Some of the questions the one question that I did have which was um, I wanted to know what was the probable cause of if the parent Or the child did not receive help if she went, you know When you go through that time period of that post-partum depression And you never receive help And the child never receives help But part of that was answered in this slide right here, but the other part wasn't for the child But not for the parent So what happens if the parent doesn't receive help? Absolutely, unfortunately does exist and so If I go back to this slide We know that untreated depression Anxiety can lead to many different different types of problems You're also going to be able to struggle with puts you at risk for future health problems, right? So problems with your heart your blood pressure Diabetes Puts you at risk for substance use issues because if you're not feeling well and are stressed and maybe aren't able to Handle other types of stress in a different way. You could choose things like substance use So it puts you at risk for many of those problems as well. So for the child Again, it's not a guarantee, but we know that untreated illness does lead to those potentially poor outcomes Same thing for the parents You know, you're not likely to have the same amount of fulfillment in your life as far as Doing the job that you want to do and being happy and being available to the rest of your family and for you to feel fulfilled So that's that's a great question Yes I'm just gonna ask you to get really close because we have remote sites my six week follow-up. So My question is about the expansion to access to screenings. Sure the question is if We are working on Increasing the amount of screening done on moms who are pregnant and postpartum because the person asking the question was screened immediately after birth and At six weeks postpartum. So the answer is yes When I see women in the the OB program here at University of Maryland They are routinely screened at their postpartum visit, which is anywhere between two and six weeks Um, they are also screened in both pediatrics with every well-baby visit and in family medicine if they bring their child there Um, and if I am seeing someone and treating them myself, I will I will reassess that same screen every time to kind of Just get Another piece of information about how they're doing. So again in terms of provider education that is a big part of what we are devoted to is to to help You know to to make sure everyone knows whether it's you know a nikkyu social worker or a family practice doc Who's doing well, baby visits or our mothers one year postpartum exam is that those are all reasonable times to Screen and you just can't screen too much. Um, it gets a little silly if it's every week, but Um We don't want to miss the woman who's been depressed for five years and doesn't realize that until she's taken her her son to school For kindergarten. So yes, we are working on that We have a question remotely, but I think you may have just answered it The question is how much emphasis is placed on pre-partum? Well pre-partum depression. How is this assessed and at what point in the pregnancy? So actually before delivery So that varies somewhat from practice to practice the american college of obstetrics and gynecology does not have specific guidelines at this point Or specific recommendations about when that screening should happen. They are starting to get on board with that Um, and so hopefully in the not too distant future. We will have routine screening My personal recommendation my professional recommendation is uh at a first pregnancy visit first Um, and then again in the third trimester at the very least and then again postpartum And if you get three screens and everything's good, then That's that's a good start We have a fabulous questions from st. Joe's medical center. Um Do men experience postpartum depression? They do not physically carry a baby but experience the same new parent emotions Are there resources for healthy new dads? Can dads carry this depression into further years like the mom? Take it away Absolutely. So I I scrolled back to this one slide where it does mention here that four percent of fathers are depressed during their child's first year of life So absolutely. It's a huge Can you hear me? It's a huge change When a child is born. It's wonderful. It's joyous, but it brings a different dynamic to any Relationship as well as it's stressful. And so absolutely fathers can experience and do experience Um depression and anxiety So this says up to four this says four percent, but my feeling would be that that's probably lower than it really is Um, I think men sometimes aren't Um as willing to seek help So I bet that numbers based on individuals who are seeking help Or admitting to it on some questionnaires and that's some of the ways in which we gather that data Just as an example of one resource for dads having Depression in the postpartum period is postpartum support international does have a whole section dedicated to that and they they do Presentations, uh, I'm not sure with what frequency but if you were to go to the postpartum support international website, you could see Um information about that There's another question Based on what you stated about genetics is depression hereditary I noticed signs of depression in my father. He was never diagnosed My brother was clinically depressed in his 20s and 30s and my daughter was diagnosed last year at 16 with depression and anxiety So again, the question is is it hereditary? Sure, um, we absolutely know that a lot of different types of mental illness like depression and anxiety Is hereditary that there's a greater likelihood part of that is because of genes And sometimes part of that is because of the environment So if you're raising a child in a similar environment to which you were raised But yes, we do know that there's a strong genetic component and some mental illness Specifically things like schizophrenia adhd Those have very high heritable Um Numbers or values that we we are able to determine how likely you are to pass that gene Do you want to add anything to that? Again to go back to dr. Duval Harvey's Discussion about context and sociocultural influences If if you you have a 10 component of depression that is genetic and you are raised in an environment that is not Providing you with the support and the resilience to Develop as positively as you can then that kind of magnifies the risk of developing depression So we also think about the heritability of How you how you live, uh, we talk about Intragenerational transmission of trauma So that if if you as a mom experience traumatic events and experiences and have Difficulty forming the bonds you need to form with your children Those children are more likely to experience those same kinds of symptoms And so we really look at intervening as early as we can in pregnancy to try to Help every mom be as well as she can when the baby is born Um, and if not during pregnancy after pregnancy if not after pregnancy when they're two or three or the The kid goes to daycare and starts having some problems that hadn't been identified before Those are all points at which we can intervene and so the genetics is a small piece of it But then there's a whole nurture piece that that also comes into play And so here are some additional resources Our university of oh my gosh, that's a wrong phone number The women's mental health program is 328 609 one Oh, that is oh, okay. Yeah. Yeah. Yeah, that's fine. That's fine But there's also more information on our programs outside. Thank you very much Thank you. Dr. Widra and dr. Edwards. That was great. Um, I want to thank our remote sites for sending a questions That's uh, great. We're going to take a 15 minute break Uh, the restrooms are around the corner. There's refreshments in the back of the room and we'll convene reconvene in 15 minutes Thank you