The mental health profession faces significant and as yet unmet challenges in treating postpartum depression (PPD) and psychosis among women of color, APA Assembly Speaker Nada L. Stotland, M.D., M.P.H., told those attending a panel discussion at last month’s Congressional Black Caucus Legislative Conference in Washington, D.C.
Stotland’s remarks underscored the importance of passing legislation, introduced last summer by Rep. Bobby L. Rush (D-Ill.), that seeks to expand and intensify research on PPD.
"Postpartum depression is a real and devastating disease," explained Stotland, a professor of psychiatry and obstetrics/gynecology at Rush Medical College in Chicago. She discussed the symptoms and effects of PPD at a forum titled "Postpartum Depression and the African-American Mother: It Ain’t Just the Baby Blues." The forum was sponsored by Rush, chair of the Congressional Black Caucus.
PPD affects about 10 percent of all new mothers, according to Stotland. "It is different from both the ‘baby blues’ and from postpartum psychosis," she told Psychiatric News.
Baby blues, Stotland explained, is a state of heightened emotions that sets in within a few days after childbirth and goes away within a few more days or a week all by itself. Postpartum psychosis, which affects fewer than one-tenth of 1 percent of new mothers, causes a women to lose touch with reality and become increasingly disoriented and confused.
"She hears voices and develops bizarre beliefs," Stotland explained. "For example, she may believe that her baby is Satan or that she is poisoning the baby. Postpartum psychosis is a medical emergency."
PPD, Stotland said, is often insidious, being underdiagnosed and, therefore, undertreated. Symptoms may appear any time within six to 12 months following birth. Without treatment, it may last up to nine to 12 months, leaving lifelong emotional scars for both the mother and her baby.
Effective treatment, according to Stotland, may involve antidepressant medications, psychotherapy, or both.
"There is increasing evidence that antidepressant medication does not harm the infants of nursing mothers," she told the caucus panel. "The possible negative effects of medication must always be weighed against the dangers of depression—a real and cruel disease."
"It’s especially cruel," Stotland later told Psychiatric News, "that many people will unknowingly say to a depressed postpartum woman, ‘This should be the happiest time of your life,’ or that [she] should be ‘extra grateful since you have a healthy, happy baby.’ Depression is a disease; you don’t have it because you’re not grateful or mindful of how lucky you might be."
"While similar rates of PPD occur in women of all racial and ethnic backgrounds," Rush told the panel audience, "African-American mothers have particular reasons for concern due to their cultural views regarding mental illness."
Rush explained that due to the stigma associated with mental illness within the African-American community, many African-American mothers may not seek treatment until symptoms are so severe that treatment is much more difficult.
"The loss of this precious time can turn an otherwise treatable disease into a life-threatening illness," Rush said.
Women at high risk for PPD, said Stotland, are those who have poor social-support systems, have had depressions in the past, and suffer complications of childbirth. This is especially true, she said, in the African-American community, where women may be socioeconomically disadvantaged, are more likely to be single mothers, and have higher incidences of complications at birth, largely due to inadequate health care overall.
Rush agreed, telling the audience that "those in the African-American community who do have access to a health care provider may not have access to a culturally competent health care provider, to assure that the birth of their child is a wonderful time for a new mother and her family."
"These very questions being addressed by this panel," Stotland told Rush, "are prying questions that have not been answered. I’m proud to say that I recognized the deficits quite some time ago, but I can’t say that I was able to do anything about them."
The panel and audience agreed with Stotland that the lack of culturally competent postpartum care for African-American mothers is a "systems question; it’s a perception problem; and, indeed, it may well be a prejudice problem."
Rush introduced the Melanie Stokes Postpartum Depression Research and Care Act of 2001 in the U.S. House of Representatives (HR 2380) on June 28. The bill is named after one of four women who took their own lives in Rush’s home district of the Chicago metropolitan area last summer while battling PPD.
The bill seeks to require the directors of the National Institutes of Health and National Institute of Mental Health to expand and intensify research on PPD. Under the proposed law, research would be geared toward finding the etiologies of PPD and focus on the development of improved diagnostic techniques and treatments.
The bill would also grant funds to state and local governments, public or nonprofit hospitals, and community-based organizations for delivery of essential services to individuals with PPD or postpartum psychosis and their families. Services available would include case management, screening, and comprehensive treatment and support services. Rush currently has more than 35 cosponsors of the measure.
The text of HR 2380 can be accessed on the Web at thomas.loc.gov by searching on "HR 2380." ▪