Tag: depression

The Inexpensive Way to Lift New Moms Out of Postpartum Depression

Posted on by robbie

Judy’s first pregnancy was planned, and she was looking forward to having a baby. Yet, halfway through the pregnancy, something changed. She began to feel down and bad about herself. She had less energy and struggled to concentrate. Thinking this was a normal part of pregnancy, she ignored it.
After she delivered her son, it all got worse. She felt as if she was in a black hole of sadness. She often gave her son to her mother, thinking he was better off without her. It wasn’t until a year and a half later, when she came out of the depression on her own, that she realized that she had not been herself.
Judy is a composite figure, based on the thousands of women for whom we have cared for or met during our clinical work and research. Her story demonstrates the profound impact that depression can have on mothers and their children.
Having a baby can be extraordinarily challenging. Women are extremely vulnerable to emotional changes during pregnancy and the year after delivery. In fact, depression is the most common complication of pregnancy. But women often have absolutely no idea they have depression, nor do anyone in their circle of influence, including their medical providers.
We believe there’s a missed opportunity to address depression in obstetric and pediatric settings: settings in which women are seen often during pregnancy and the year after birth. Women like Judy often drown in their illness, without anyone ever speaking to them about the possibility of depression. How and why does the health care system let this happen?

THE COSTS OF UNTREATED DEPRESSION

One in seven women experience depression during pregnancy and after birth. Depression negatively impacts mothers, children and families. It can affect birth outcomes, the way moms bond with their baby and children’s mental health later in life.
When untreated, depression can also lead to tragic outcomes, including suicide or infanticide. In fact, suicide is the leading cause of death among postpartum women with depression.
This illness is also costly. One case of untreated depression is estimated to cost over $22,000 annually per mother and baby pair.
Despite being a common illness with profound negative effects, most depression among pregnant and postpartum women goes unrecognized and untreated. Of the 4 million women who give birth in the U.S. every year, about 14 percent will experience depression. At least 80 percent will not generally get treatment.
There’s historically been no system in place to detect depression or help women get care. But professional societies and policymakers are starting to recommend screenings, while medical practices are beginning to integrate depression into obstetric and pediatric care.
This is a great first step. However, screening is not enough. After screening, the health system must ensure women get appropriately diagnosed and treated. Unfortunately, many providers aren’t trained or equipped with the proper resources to help women with depression, or may be reluctant to do so.

HELPING PROVIDERS HELP MOMS

In response to this need, our team is working on integrating depression into obstetric care in our state.
Our Massachusetts Child Psychiatry Access Program for Moms, launched in July 2014, helps frontline medical providers screen for and treat depression and other mental health concerns among pregnant and postpartum women.
MCPAP for Moms provides training and toolkits for providers, as well as telephone and face-to-face psychiatric consultation. For example, Judy’s obstetric provider could call MCPAP for Moms and talk to a psychiatrist to get guidance on how to treat, and with consultation, decide on a treatment plan that would include therapy. MCPAP for Moms also offers resources directly to women with ongoing mental health care.
Every provider in Massachusetts can access our services free of charge. MCPAP for Moms is funded through the MA Department of Mental Health. It also offers access to mental health care to pregnant and postpartum women in Massachusetts for less than $1 per month per woman. We are now evaluating how the program has affected outcomes for the more than 4,000 patients directly served since launch.
The ConversationTwo other states, Washington and Wisconsin, are starting programs like MCPAP for Moms, and 17 others are seeking funding. Especially exciting, next year’s federal budget includes grant money for other states to establish such programs. We envision a health care system where all providers caring for pregnant and postpartum women are armed with the resources they need to support women with depression.

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Tiffany Moore Simas is an associate professor of obstetrics-gynecology and pediatrics, and Nancy Byatt is an associate professor of psychiatry and obstetrics-gynecology, both at the University of Massachusetts Medical School. This article was originally published on The Conversation. 

How to Talk to Teenagers About Suicide

Posted on by robbie

In the aftermath of two high-profile suicides and a Centers for Disease Control and Prevention report that showed suicide rates have risen 25 percent since 1999, the question is more urgent than ever: How do you talk about suicide with someone who is severely depressed?
The problem is particularly pronounced among young people, with suicide the second leading cause of death in 2015 for those between the ages of 10 and 24. A recent study published by the Journal of Pediatrics found that one in five California teens actively think about killing themselves, leading public health professionals to advocate treating suicide as a systemic problem rather than a personal one.  
“Instead of changing individuals, we have the ability to take a public health approach and treat settings by bringing fixes and resources to groups,” says study co-author Ron Avi Astor, a professor at University of Southern California’s School of Social Work. He found that the percentage of students who thought about suicide ranged from the low single digits to upward of 70 percent, and depended largely on the school setting.  
Until there’s a greater societal shift, however, what’s the best way to reach someone who’s thinking of suicide? We asked Astor for advice on identifying, and confronting, young people who may be harboring suicidal thoughts.

DON’T BE AFRAID TO SAY THE ‘S’ WORD

A big myth is that by talking about suicide with someone, you are planting the seed or promoting the action. That’s false.
“It’s important to know you can’t trigger suicidal thinking just by asking about it,” Allen Doederlein of the Depression and Bipolar Support Alliance, recently told The New York Times.
Astor agrees — especially when it comes to teenagers, who are remarkably open, he says. He notes that teens who have thought about suicide will likely be honest about it. Specifically, he says, “you want to know if they’ve thought about how to do it — if they haven’t given much thought about it versus thinking about … a time and a place.”
The more detailed they are, the more urgent it is to get them help.
“It’s very difficult to ask, but if the person has made attempts — even if they’re not strong attempts — all those factors bump it up.”

DON’T GUILT THEM INTO LIVING

When trying to convince someone not to take their life, a common go-to is to mention all the people they’d be leaving behind. “Just think of your family,” you might be tempted to say. But try to resist that urge.
“It’s important not to make someone’s suicidality about yourself or others. They’re the person who’s hurting, so the focus needs to be on their feelings, their thoughts, and finding them help,” wrote suicide survivor Sian Ferguson.
Guilting people by mentioning who would miss them only exacerbates the problem. Instead, experts recommend simply telling them how much you care about them and showing empathy by acknowledging the truth of their situation. Express to them that, yes, right now sucks, and what they’re feeling is real.

REACH OUT TO THEIR FRIENDS, TOO

In his research, Astor found that someone’s friends often have a better idea of what is going on with them than their parents or teachers do.
To that end, Astor suggests speaking with the friends of someone you think might be at risk. Oftentimes, he says, they are also harboring suicidal ideation in a type of groupthink and can help shed light on underlying issues.

HELP THEM GET HELP

If you know a teenager is, in fact, having suicidal thoughts, seek help immediately.
The Society for Prevention of Teen Suicide recommends first seeing a pediatrician, who can refer you to a mental health professional, and the American Academy of Pediatrics notes that “pediatricians are, and will continue to be, an important first source for parents who are worried about their child’s behavioral problems.”
When trying to get someone to agree to see a therapist or psychiatrist, don’t try and force them, say experts. But that doesn’t mean you shouldn’t be blunt and level with them.
“Try to make the optimistic assumption that if you could speak directly, though tactfully, and with care, then that might bring relief,” said Stephen Seligman, a clinical psychiatry professor at the University of California.

SHOW UP AND BE PRESENT

The best advice many experts give, though, is just to show up, ask questions and listen carefully to their response.
There is a lot to say about opening up the conversation and letting someone else — even angsty teens — know that things can get better with the right help.

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For more information on how to help your teen or to speak to a specialist, visit the National Suicide Prevention Lifeline or call 1-800-273-8255. For more tips on speaking to your teen about suicide, visit the Society for the Prevention of Teen Suicide.

Confiding Isn’t Scary; It’s the Key to Feeling Safe for These Students

Posted on by robbie

“If you really knew me, this is what you’d know.”
At the Freire Charter School in Philadelphia, that was the prompt given to two dozen students as they stood before 500 peers, sharing personal stories and intimate details about their lives. The concept sounds intimidating, but it is how Freire school officials create a campus environment of empathy and community among its students and prevent future violence and tragedy.
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“When a community can come together and celebrate the humanity in each of our kids,” said school head Kelly Davenport, “that gives each and every one of our students the right just to be who they are, and to make that OK.”

Violent outbursts often stem from feeling isolated, Davenport explains, and creating a public forum such as this lets students know they’re not alone in their struggles. The goal of these sharing assemblies is to give students a means of expressing themselves without feeling judged or criticized, school organizer Dave Shahriari told NPR.

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“Kids have a lot to say, and I thought it could be really humanizing and helpful for the school as a community if they could say it in a safe space in front of each other,” he adds.

Elijah, a tenth-grader, was among the dozen students to share his story at the nearby Unitarian church (the school does not have an auditorium large enough to accommodate its students). He explained he was fortunate to have a support network of friends and a good relationship with his grandmother — but that he is often troubled with depression and has thoughts of suicide.

Upon his confession, Elijah implored his classmates who really care about him and his issues to stand up. The church roared with a standing ovation. Weeks later, Elijah still feels the love.

“They hug me or they give me a handshake, and then they was telling me stories like, ‘Yeah, I know what you was dealing with. I went through the same thing,'” he said.

Another tenth-grader, Tyshierra, revealed that behind her humor and lighthearted personality, there’s a story of loss and hurt. The West Philly native confessed to classmates that her mother was a drug dealer and was allegedly strangled to death by her boyfriend.

Shortly thereafter, Tyshierra’s father passed away of liver cancer. After a whirlwind of meetings with child protection caseworkers and participating in counseling programs, she and her siblings were finally taken in by their aunt.

“Losing my mother was my biggest fear,” she said. “Since that has already happened, I fear nothing and no one. Ya’ll see me as goofy, funny or whatever else, but deep down inside, I’m hurting for the way my life is.”

But even Tyshierra has felt the powerful effects of the brave choice to share her story with her peers.

Before the assembly, “everybody just was like, ‘OK, we at school,’ ” Tyshierra said. “But now, it’s like we feel like a family, like we know all that about each other.”

Perhaps it helped that the students divulged their secrets in the calm sanctuary of a church. But regardless of the location, it’s empowering to see a school that’s making its students feel safe with something other than added security or more metal detectors.

This Incredible Man Walked 34,000 Miles to Raise Awareness About Depression and Suicide

Posted on by robbie

For Steve Fugate, life is all about the journey — literally.
Walking more than 34,000 miles, Fugate has successfully crossed the continental United States seven times to raise awareness about depression and suicide. The 67-year-old’s message is simple, and it’s scrawled across a sign he always carries with him: LOVE LIFE.
That’s the message he wishes he could have imparted on his children. His son committed suicide in 1999. His daughter, who suffered from MS, succumbed to an accidental drug overdose just a few years later. “When I lost my son, I forgot about all other plans I had,” Fugate said in a short film for Korduroy TV. “So I walk.”
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Fugate’s LOVE LIFE Walk started shortly after his son’s death. During each cross-country trek, he tells himself that this is the last one. Yet, he keeps going. Last March, he left his hometown of Vero Beach, Florida, on his eighth adventure. His fans — thousands of them — keep up with his journey via Facebook. “I love Facebook. I go on there and it’s a way for me to get to more than just who I meet on the road,” Fugate says. “And it’s also a way for me to let people know that life is not what these newscasters have grabbed from all over the world to scare the living crap out of you. It’s a way for me to show people that random acts of kindness to happen to me on a daily basis — sometimes numerous in one day.”
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Indeed, it’s the kindness of others and the desire to find what he’s looking for (whatever that may be) — “I’ll know when I get it,” he says — that persuades him to keep walking. He’s walked through rain, hail, snow and sleet. He’s climbed mountains and been stalked by a mountain lion. He’s set up camp near tracks left by a grizzly bear. Five times, he’s struggled to cross the desert, each time proclaiming that he will never do it again. Yet he keeps going. “My creed is to mend the broken heart while still beating,” Fugate says. “I’m forced to keep walking with this LOVE LIFE sign because every once in awhile someone stops and they need it.”
But he’s not just healing others through his walks. He’s healing himself, as well. “I call what I do trail therapy,” he says. “It’s just like every other trail. It goes both ways. This isn’t just for others. This is for me too.”
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ManTherapy: Confronting Suicide With a Little Manly Humor

Posted on by robbie

The poster on the door to the office of Colorado’s suicide prevention chief reads, “Give your mind the same attention you give your penis.”
For most men, that’s a lot of attention.
For Jarrod Hindman, it could be the answer to a serious problem that has for years nagged Colorado and many western states, where mental health services are scarce: What’s the best way to help suicidal men get the mental health care they need? Hindman is hoping the key lies in something almost never associated with suicide — jokes
Hindman took over the state’s suicide prevention office in 2006. He noticed that it wasn’t spending much time, money or marketing on the problem of men and suicide. And yet the statistics were troubling: Men are nearly four times as likely to commit suicide as women. In 2009, men made up 79 percent of the nearly 40,000 people who died by suicide in the United States, according to the Centers for Disease Control and Prevention.
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In Colorado especially — along with the rest of the so-called “Suicide Belt” of the American West — the problem of suicide is dire. In 2012, the rate reached an all-time high of 19.7 suicides per 100,000 people in Colorado, a nearly 16 percent increase over the year before, according to the state’s Department of Public Health and Environment. Compare that with the rate for the U.S. overall: 12.4 suicides per 100,000 people. Among men in Colorado, the rate was higher still, at 30.62 suicides per 100,000 people.
Hindman was struck by another jarring statistic: Compared with women, men have far lower rates of depression, a major risk factor for suicide.
But that fact, he realized, didn’t mean fewer men than women were depressed. Data has repeatedly suggested that men are just as vulnerable as women to depression. So because fewer men were being diagnosed as depressed, it likely meant that they were not going to mental health professionals to get the diagnosis.
A few years later, Hindman met the founder of a marketing firm at a symposium. They arranged a meeting and hatched the idea for what would become “ManTherapy” — a website that brings therapy to men who wouldn’t seek it otherwise, and in the process, makes jokes about testicles.
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Go to the ManTherapy.org homepage and a video of a thickly mustached Dr. Rich Mahogany, man therapist (“not a real therapist”), greets you with one of a few random greetings. “Did you know that men have feelings too?” he might say. “No, not just the hippies.”
Dr. Mahogany addresses visitors from a wood-paneled office befitting Ron Swanson, complete with a moosehead on the wall and a sign for a music group called Richard and the Balls. On the site, there’s a primer on depression, anxiety and other mental health issues, titled Gentlemental Health 101: Kryptonite for the Manliest of Male Minds, plus lots of resources to connect men with therapy (“Because contrary to popular belief, men can’t fix everything themselves”), support groups (“You don’t need to go it alone, cowboy”) and the like.
ManTherapy.org ran into some opposition at first. For obvious reasons, suicide is a sensitive subject, and it’s not easy to joke about it. Some of the mental health professionals partnering with the state bristled, worried that the site would steer men away from their services. If even more depressed men went without treatment, it could lead to more suicide, they said, and increase the rate of other depression-related problems like weakened relationships, poor job performance, alcoholism, insomnia, heart disease and dementia.
The skeptics found that their fears were mostly unfounded. Since July 2012, when the website launched, 300,000 people have visited it. And some of the men who have been helped by the site have let the state know; hundreds of anonymous users have emailed positive comments, which Hindman shared with NationSwell. One visitor to ManTherapy wrote that “it was a safe place to me.” Another said that it “helps me see I’m not the only one going through my problems and I’m not less of a man for getting help and lets me know there is a life after this.”
Dr. Alan Berman, the director of the American Association of Suicidology in Washington, D.C., says men are “socialized” to be strong rather than emotional, and not to seek help or admit they have a problem. “It’s a tremendous barrier to overcome,” he says.
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There won’t be a way to determine the true impact of ManTherapy on suicide rates until this year’s statistics are released in Colorado. But in a hopeful sign, other states are signing on. Wisconsin is working on a licensing agreement with Colorado’s suicide prevention office to bring the droll Dr. Mahogany to its state with specific resources added to the website for those residents. Talks are also ongoing with North and South Carolina, and a handful of western states like Arizona, New Mexico and California. Even Australia started its own national version of the site.
The western U.S. states carry a particularly heavy burden of suicide; their rates are far higher than that of the rest of the country. The reasons are complex and difficult to tease out precisely. But it doesn’t help that: a) mental health resources in rural areas are harder to come by; b) Western Americans have more of a frontier mentality about dealing with their own troubles; and c) there’s a deep-rooted gun culture in the region, increasing the potential for self-harm.
These were the factors that prompted Hindman to start ManTherapy — to bring mental health help right to the computer screen of John Wayne. Since the days when Hindman first began, things have changed quite a bit. Last year ManTherapy.org, which is funded in part by the nonprofit Carson J Spencer Foundation, was honored with a public health award for its innovation. And last July, Colorado Gov. John Hickenlooper sent Hindman a note to congratulate him. Underneath the typed text, the governor scribbled: “WAY TO GO and keep up the GREAT work!”
Hindman is pleased, but knows he has work to do. One of his intermediate goals is, counterintuitively, to see reported rates of male depression rise, particularly in the 25-to-54 age group targeted by ManTherapy. “That means that men are getting off their ass and going to see a professional,” he says.
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