Health teams must recog­nise de­pres­sion

A na­tional approach is planned to help women who don’t warm to their ba­bies the way so­ci­ety ex­pects. Kel­lie Bis­set re­ports

The Weekend Australian - Travel - - Health -

HOL­LIE Ca­vanagh was 29 when one night where she just wanted to die. Asleep in the nurs­ery was twom­onth-old Alex — a good baby who ate well, slept well and was easy on his par­ents. But Ca­vanagh just couldn’t warm to him, and things con­tin­ued to de­te­ri­o­rate un­til that night, when she woke her hus­band to tell him she was hav­ing sui­ci­dal thoughts.

‘‘ I ba­si­cally got to the point that if there was a but­ton to press to evap­o­rate from the planet, I would have pressed it,’’ Ca­vanagh says. ‘‘ Ev­ery time Alex cried or made noise or in­di­cated he needed me, I had a buzz of anx­i­ety in my tummy. Do­ing ev­ery­thing for him was a chore, not a joy in the be­gin­ning. I was not hon­est about the fact that I did not want to hug my child, or com­fort him.’’

Ca­vanagh was di­ag­nosed with post­na­tal de­pres­sion (PND), a de­bil­i­tat­ing con­di­tion that af­fects about 15 per cent of child­bear­ing women — and one which be­yond­blue, the na­tional de­pres­sion ini­tia­tive, is tak­ing very se­ri­ously with a na­tional ac­tion plan due to be com­pleted within the next few months.

Ca­vanagh was for­tu­nate that her child health nurse had kept a close eye on her, and in­sisted she see a GP with an in­ter­est in men­tal health. But it’s been a year-long road to re­cov­ery. With the help of coun­selling, a PND sup­port group, and an­tide­pres­sant med­i­ca­tion, Ca­vanagh is back to her old self — and is madly in love with her baby.

She’s now writ­ing a book on other women’s ex­pe­ri­ences of the con­di­tion in an ef­fort to make those who suf­fer from it feel a lit­tle less alone in their de­spair.

‘‘ It is a men­tal tor­ture,’’ Ca­vanagh says. ‘‘ You wake up and feel this dread of fac­ing the day and it pulls you down even more. You still have to try and get through the day and pre­tend you are fine. I wanted to read about women who came through it. Peo­ple said it would get bet­ter, but I did not be­lieve it. It would have helped to hear that from women them­selves.’’

Ca­vanagh is yet to find a pub­lisher, but she’s not aiming to make any money. Her goal is to dis­trib­ute her work to ma­ter­nal and child health nurses, who may be able to pass it on to their pa­tients.

And for those women, she can’t stress enough the im­por­tance of seek­ing help. ‘‘ The big­gest rea­son that I am still here is that I was hon­est about hav­ing sui­ci­dal thoughts. It is not some­thing you want to tell peo­ple.’’

Ca­vanagh had suf­fered sev­eral episodes of de­pres­sion in the past, and raised th­ese with her ob­ste­tri­cian dur­ing preg­nancy. He played the risk down. She was told PND was just an­other word for the adjustment phase fol­low­ing child­birth. In fact, 75 per cent of stud­ies show women who have ex­pe­ri­enced a pre­vi­ous de­pres­sive episode are more likely to suf­fer PND.

‘‘ If my ed­u­ca­tion had started back then, my ex­pe­ri­ence would have been very dif­fer­ent,’’ she says. ‘‘ I was even­tu­ally re­ferred to some­one who was de­scribed as a ‘ de­pres­sion­friendly’ doc­tor — but all doc­tors should be ‘ de­pres­sion-friendly’.’’

Train­ing health pro­fes­sion­als to recog­nise and man­age de­pres­sion in preg­nant women and new moth­ers is some­thing that has also caught the at­ten­tion of be­yond­blue. In launch­ing be­yond­blue’s na­tional ac­tion plan ear­lier this year, Par­lia­men­tary Sec­re­tary for Health Brett Ma­son said most women with this prob­lem re­mained uniden­ti­fied and un­treated.

This can have long-term con­se­quences, says pro­fes­sor Anne Buist, di­rec­tor of women’s men­tal health at the Univer­sity of Melbourne and con­sul­tant to the be­yond­blue pro­gram. ‘‘ With a de­pressed mum you don’t get as se­cure [mother-child] at­tach­ment, and in­se­cure at­tach­ments are as­so­ci­ated with de­pres­sion in later life,’’ Buist says. ‘‘ The chances of the child hav­ing anx­i­ety disor­ders, con­duct disor­ders and be­havioural disor­ders are sub­stan­tially in­creased. The rip­ple ef­fect from ma­ter­nal de­pres­sion is enor­mous.’’

Be­yond­blue’s ac­tion plan will in­clude rou­tine as­sess­ment for de­pres­sion and re­lated prob­lems dur­ing preg­nancy, and in the first post­na­tal year. Be­yond­blue says it will en­sure af­fected women re­ceive rel­e­vant in­for­ma­tion and prompt pro­fes­sional help — wher­ever they live, what­ever their cir­cum­stances. This may prove to be a tough ask. Psy­chi­a­try and psy­chol­ogy ser­vices are not al­ways read­ily avail­able, par­tic­u­larly in rural ar­eas where GPs are also un­der mas­sive work­force pres­sures.

Buist agrees the so­lu­tions are com­plex and that dif­fer­ent ar­eas may need dif­fer­ent mod­els of care. But at the core, she says, is ‘‘ the abil­ity to pick it up, the abil­ity to re­fer and the abil­ity to treat — we have to have all three’’.

Buist would par­tic­u­larly like to see more early post­grad­u­ate train­ing in peri­na­tal de­pres­sion, par­tic­u­larly for ob­ste­tri­cians and mid­wives. It’s not a mat­ter of teach­ing them to be psy­chi­a­trists, she says, but in­still­ing the im­por­tance of re­fer­ring women on — and do­ing it early.

The Royal Aus­tralian and New Zealand Col­lege of Ob­ste­tri­cians and Gy­nae­col­o­gists has also re­it­er­ated the need for its mem­bers to be aware of the con­di­tion. Last month it en­dorsed a pol­icy on post­na­tal/peri­na­tal de­pres­sion that stressed the need for all mem­bers of preg­nancy care teams to iden­tify clin­i­cal fea­tures that may pre­dis­pose to PND. It also said preg­nancy car­ers should ini­ti­ate a care plan that al­lowed for early recog­ni­tion and treat­ment.

As for ma­ter­nal and com­mu­nity child health nurses, they ap­pear to be the best trained, she ar­gues, and GPs are some­where in the mid­dle, al­though she agrees ed­u­ca­tion is not the to­tal an­swer.

Pro­fes­sor Jane Gunn is con­vinced it’s not the an­swer, par­tic­u­larly when it comes to gen­eral prac­tice. The chair of pri­mary care re­search in the Univer­sity of Melbourne’s de­part­ment of gen­eral prac­tice says she knows of no ev­i­dence that GPs are miss­ing PND.

‘‘ GPs don’t say they re­ally need help to iden­tify the prob­lem or don’t un­der­stand what it is,’’ Gunn says. ‘‘ The is­sue is, when you come across a wo­man with a big prob­lem, where do you send her? Women need child care, oc­ca­sional care, home help, moth­ers’ groups, ac­cess to coun­selling, cou­ple coun­selling for those ex­pe­ri­enc­ing part­ner vi­o­lence — as the GP in the com­mu­nity, th­ese ser­vices are not that easy to find. You are left with do­ing what you can.’’

An­other po­ten­tial hur­dle of any na­tional ac­tion plan is the idea of screen­ing women for PND. Gunn says this is a con­tro­ver­sial and vexed area, with some ex­perts hav­ing ques­tioned whether screen­ing could do more harm than good. In the UK, she says, rou­tine screen­ing has been stopped.

Di­rec­tor of the Cen­tre for Mother and Child Health Re­search at La Trobe Univer­sity, Pro­fes­sor Ju­dith Lum­ley, urges ex­treme cau­tion on any form of rou­tine screen­ing.

‘‘ We don’t know whether screen­ing is a good thing or not,’’ she says. ‘‘ Un­less we have tested what we want to do and shown it makes a dif­fer­ence, it is quite wrong to in­ter­vene. What does it take to change in or­der to make a real dif­fer­ence? We don’t know that.’’

Lum­ley says the in­ci­dence of PND ap­pears to be stable, but there is a huge range of sever­ity, from more milder forms to sit­u­a­tions where the mother is at real risk of harm­ing her baby — mak­ing treat­ment com­plex.

A for­mer chair­woman of the Royal Aus­tralian Col­lege of Gen­eral Prac­ti­tion­ers, Melbourne GP Leanne Rowe, says there is stigma at­tached to PND for many women and it can be dif­fi­cult for pa­tients to ac­cept the di­ag­no­sis.

Re­search in 2005 by Univer­sity of Ade­laide PhD stu­dent Vic­to­ria Wil­liamson backs this up. She found that PND suf­fer­ers of­ten wore a ‘‘ mask’’ to hide their true con­di­tion, afraid that their re­al­ity was so dif­fer­ent from im­age of su­per­mums.

Hol­lie Ca­vanagh can re­late to this, and she says ad­mis­sions from ‘‘ celebrity mums’’ such as news­reader Jes­sica Rowe that they have ex­pe­ri­enced PND are ex­tremely help­ful in com­bat­ing the ‘‘ new mum baby joy’’ sto­ries found in many women’s mag­a­zines.

In the end though, she mainly wants other women to know that there is hope they can emerge from the dark. ‘‘ I have seen the black­est holes and been at the bot­tom of them — and com­ing out is like be­ing re­born.’’

Through the black­ness: Hol­lie Ca­vanagh has known post-na­tal de­pres­sion and now wants to help oth­ers re­cover

Newspapers in English

Newspapers from Australia

© PressReader. All rights reserved.