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Pregnancy Related Depression Resource Guide

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by

Cary Thomas

on 13 May 2014

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Transcript of Pregnancy Related Depression Resource Guide

Public Health Wheel:
Communication

Resources available:
pamphlets, brochures, local support groups, websites, crisis hotlines, family and spouse support groups

Barriers:
information is overwhelming, out-of-date, inconsistent

Resource Accessibility:
Majority of women in WIC have access to at least one of the following:
Telephone, internet, transportation

Language:
Jefferson County WIC participants are mostly English speaking with a small percentage of Spanish speaking

Pregnancy Related Depression Resource Guide

Risk Factors for Depression
Major Health Concerns: Problem Areas
Maternal-Infant Attachment Issues
Rejecting, unresponsive, inconsistent care of infant
(Meltzer-Brody, 2011, p 90)

Infant Health & Safety
Greater child insecurity and psychiatric disturbances
(American Pregnancy Association, 2013)
Decreased nutrition leading to decreased growth and development
(Rahman et al., 2004, p 951)

Maternal Morbidity
Maternal suicide is 20 percent of postpartum deaths
(Meltzer-Brody, 2011, p 90)
The Root of the Problem
• Pregnancy Related Depression (PRD) is a serious health concern for women of Jefferson County, Colorado. Between 14 - 23 percent of women will struggle with symptoms of depression during pregnancy (American Pregnancy Association, 2014).

• "Depression in pregnancy is an illness that can be treated and managed but the first step, seeking out help and support is the most important" (American Pregnancy Association, 2014).

• In the state of Colorado, nearly 97,000 women accessed WIC services in 2013 (United States Department of Agriculture, 2014).

We created a wallet-sized guide of resources regarding pregnancy related depression.
Location:
Lakewood WIC office is located off of U.S. Highway 6.
Parking is free

RTD bus line Kipling Street 100 runs 30 minutes



Personal or family history of depression and/or other mental illness
A lack of social support
Anxiety or negative feelings about the pregnancy
Inability to breastfeed
Public Health Wheel:
PEOPLE
Public Health Wheel: ECONOMICS

WIC Eligibility:
Income requirement of less than 185% of poverty level
Many receive SNAP benefits
Majority are on Medicaid and/or TANF

Prevalence of PPD symptoms:
Women with Medicaid: 14.3 percent
Women with Employer-based Insurance : 9.7 percent


Public Health Wheel:
HEALTH & HUMAN SERVICES


Women, Infants and Children (WIC)
• http://jeffco.us/public-health/healthy-families/women-infants-and-children/

Nurse Family Partnership
• http://jeffco.us/public-health/home-visitations/nurse-family-partnership/

Prenatal Plus
• http://jeffco.us/public-health/home-visitations/prenatal-plus/
Jefferson County Mental Health

Jefferson Center for Mental Health
• http://www.jeffersonmentalhealth.org/about/Aboutmain.cfm
Existing Public Health Program:
Partial Hospitalization Program at
Pine Rest Christian Mental Health Services

Public Health Wheel: Transportation
References
American Pregnancy Association. (2013). Depression during Pregnancy. Retrieved April 20, 2014,
from http://americanpregnancy.org/pregnancyhealth/depressionduringpregnancy.html
Colorado Department of Public Health and Environment (CDPHE). (2011). Pregnancy Risk
Assessment Monitoring System (PRAMS). Retrieved April 23, 2014, from http://www.chd.dphe.state.co.us/cohid/topics.aspx?q=Pregnancy_Risk_Assessment_Data
Colorado Department of Public Health and Environment (CDPHE). (2012). Pregnancy-related
Depression Webinar now available online! Retrieved April 20, 2014, from http://www.coprevent.org/2012/09/pregnancy-related-depression-webinar.html
Evan, M., Donelle, L., & Hume-Loveland, L. (2012). Social support and online postpartum
depression discussion groups: A content analysis. Patient Education and Counseling, 87(3), 405-410. doi: 10.1016/j.pec.2011.09.011
Gjerdingen, D. K., McGovern, P., Pratt, R., Johnson, L., & Crow, S. (2012). Postpartum Doula and
Peer Telephone Support for Postpartum Depression: A Pilot Randomized Controlled Trial. Journal of Primary Care & Community Health, 4(1), 36-43. doi: 10.1177/2150131912451598
Jefferson Center for Mental Health. About Us. Retrieved April 25, 2014, from
http://www.jeffersonmentalhealth.org/about/Aboutmain.cfm
Jefferson County, CO. (2013a). Nurse Family Partnership. Retrieved April 24, 2014, from
http://jeffco.us/public-health/home-visitations/nurse-family-partnership/
Jefferson County, CO. (2013b). Prenatal Plus. Retrieved April 24, 2014, from
http://jeffco.us/public-health/home-visitations/prenatal-plus/

Key Informants
Multiple key informants addressed PRD as a public health concern for women in Jefferson County.
Currently, grant work is being conducted to improve the screening process for PRD and to improve utilization of resources.

C.K.

(Public Health Nurse)
"I would say around 50 percent of the clients I see through Prenatal Plus show signs of pregnancy related depression" (personal communication, 2014).

M.S.

(Customer Service Representative in Presumptive Eligibility)
"Often, clients complain that the provided resource guides are out of date" (personal communication, 2014)


"Awareness of the term PPD does not necessarily imply awareness of its symptoms or sources of assistance. Therefore, new mothers and their social support networks may be vulnerable, due to the inability to recognize the symptoms and seek assistance. Nurses can play a pivotal role in educating perinatal women, their social support networks and the public with respect to PPD" (Sealy, Fraser, Simpson, Evans & Hartford, 2009).

Wallet Resource Guide:
Discrete resource guide with a listing of up-to-date local, in-person, online and international resources regarding pregnancy related depression
Additional resources listed for family members and Spanish speaking clients
Provided to all WIC participants in Jefferson County as a component of the enrollment packet
Readability assessed at 7.2 according to SMOG evaluation

Resources Required:
Printing capabilities and funding
WIC counselors and office staff participation






Evaluation
Program Plan
Plan: Objectives

Long-term Goal:
Women enrolled in the WIC program in Jefferson County will report
decreased symptoms of depression as a result of utilization of the resources available on the provided guide.

Measurable Objective One
: 85 percent of women who access resources at Jefferson County WIC office will report they received the resource guide regarding pregnancy related depression within their WIC registration packet at the standard three month follow up appointment.

Measurable Objective Two
: 75 percent of Jefferson County WIC office clients who are experiencing pregnancy related depression will utilize the resources available on the resource guide, as reported at the three and six month standard follow up appointments.


DEMOGRAPHICS
18.1% of pregnant women in JeffCo were on WIC during pregnancy (PRAMS, 2011).

20.6% women in JeffCo were covered by Medicaid for prenatal care (PRAMS, 2011).

WIC Eligibility:
Income requirement of less than 185% of poverty level
Many receive SNAP benefits
Majority are on Medicaid and/or TANF
This program is located in Grand Rapids, Michigan and is offered to mothers who are experiencing symptoms of PRD. It is a 5 day intensive program, and is second of its kind nationwide.

This program would not work for our population due to many barriers including: transportation, need to work, cost and family obligations.

This program also requires a referral from a primary physician for Medicaid participants.



"Women suffering from PPDS who did not seek help were more likely to be younger, less educated, nonwhite, Hispanic, and enrolled in WIC during pregnancy"
(McGarry, Kim, Sheng, Egger & Baksh, 2009).


"...public health professionals should raise awareness of PPD through media campaigns and the distribution of educational materials among all women, and especially high risk groups" (McGarry, Kim, Sheng, Egger & Baksh, 2009).
Values for the State of Colorado, PRAMS 2010
1 out of 9 Colorado moms experience symptoms of depression after giving birth.
(www.coprevent.org/2012/09/pregnancy-related-depression-webinar.html)
(U.S. Census, 2012)
Available Prevention and Educational Programs:
(http://www.rtd-denver.com/)
Charge is $2.25 each way per rider.
Children age 5 and under ride free when accompanied by a fare paying adult.
("Depression during and after pregnancy fact sheet," n.d.)

(https://www.womenshealth.gov/publications/our-publications/fact-sheet/depression-pregnancy.html)
Literature Review
http://www.pinerest.org/mother-baby-postpartum-depression-treatment
2012 Census: Jefferson County Values
100,708 (ages 15-45) women in Jefferson County
Women who have given birth in the past 12 months: 5, 864
20.6% women in JeffCo access WIC resources







Brief survey at three and six month appointments by WIC counselors to address the following questions:
1. Did you receive the PRD resource guide?
2. Have you or are you experiencing any symptoms of depression?
3. Have you utilized any of the resources available on the guide?
If client answers "yes" to number 3, they will be asked to complete the Likert scale to evaluate the effectiveness of the resource guide.
Resource Satisfaction Survey: Likert Scale
Client will be asked to complete the Resource Satisfaction survey if they answered "yes" to number 3 on the brief survey.
Pregnancy Related Depression Resource
Guide

Jefferson County Public Health Department Group A
Spring 2014
Complications with a previous pregnancy or birth
Relationship conflict
Financial problems
Stressful life events
Young age
Substance abuse
Unintentional pregnancy
Jefferson County, CO. (2013c). Women, Infants and Children (WIC). Retrieved April 24, 2014, from
http://jeffco.us/public-health/healthy-families/women-infants-and-children/
McGarry, J., Kim, H., Sheng, X., Egger, M., & Baksh, L. (2009). Postpartum depression and help-seeking behavior. Journal
of Midwifery and Women's Health, 54(1), 50-56. doi: 10.1016/j.jmwh.2008.07.003
Meltzer-Brody, S. (2011). New insights into perinatal depression: pathogenesis and treatment during pregnancy and
postpartum. Dialogues in Clinical Neurosciences, 13(1), 89-100.
Pine Rest Christian Mental Health Services. (2014). Mother & Baby Postpartum Depression Treatment. Retrieved April 30,
2014, from http://www.pinerest.org/mother-baby-postpartum-depression-treatment
Postpartum Support International (PSI). (2014). Retrieved April 18, 2014, from http://www.postpartum.net/
Regional Transportation District (RTD). (2014). Route 100: Kipling St. Retrieved April 27, 2014, from
http://www3.rtd-denver.com/schedules/getSchedule.action runboardId=141&routeType=
1&routeId=100&serviceType=3
Sealy, P. A., Fraser, J., Simpson, J. P., Evans, M., & Hartford, A. (2009). Community awareness of postpartum depression.
Journal of Obstetric, Gynecologic, and Neonatal Nursing, 38(2), 121-133. doi: 10.1111/j.1552-6909.2009.01001.x
United States Census Bureau. (2012). American Fact Finder. Retrieved April 20, 2014, from http://factfinder2.census.gov/
faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_12_1YR_B01001&prodType=table
United States Department of Agriculture. (2014). WIC Program. Retrieved April 20, 2014, from
http://www.fns.usda.gov/pd/wic-program
United States Department of Health and Human Services. Office of Women’s Health. (2014). Depression during and after
pregnancy fact sheet. Retrieved April 22, 2014, from https://www.womenshealth.gov
More References
Evaluation of Goals:
Full transcript