I admire my friend and fellow blogger Katherine Stone for being such a warrior in the fight to understand postpartum depression. Whenever controversy surfaces in the media, my first inclination is to run and hide, whereas hers is to get in there and start fighting. She gathered a number of mental health bloggers and advocates to sign the following letter to Time Magazine regarding a recent article called “The Melancholy of Motherhood,” which wasn’t a fair snapshot of postpartum depression. Not according to John Grohol of Psych Central, and not according to the list of other professionals Stone called on to counter this article.
An Open Letter to the Editors of Time:
Time has done a great disservice to all mothers who are suffering and will suffer from postpartum depression (PPD). In an article called “The Melancholy of Motherhood” journalist Catherine Elton writes a distorted story that no doubt has already begun to confuse and stigmatize women with PPD.
We cannot understand why Time would choose to sensationalize what is a very serious medical issue for hundreds of thousands of women in the United States each year, and to create controversy around the MOTHERS Act, the one and only piece of legislation that would help to systematize support and services that are sorely lacking in so many places throughout our country.
There are several points in the article that concern us:
1.The MOTHERS Act is not “dividing psychologists” as Elton opines. The American Psychological Association, the American Psychiatric Association and the National Association of Social Workers wholeheartedly endorse the MOTHERS Act. In fact, you neglect to mention that much of the medical community supports the bill. It has been publicly endorsed by the March of Dimes, the American College of Obstetricians and Gynecologists, the American College of Nurse Midwives, the National Healthy Mothers Healthy Babies Coalition, and the Association of Women’s Health, Obstetric and Neonatal Nurses, among many others. You didn’t represent any of them in your piece, all of which are highly regarded organizations which have a long record of dedication to the health of both mothers and babies.
2. Elton calls screening controversial and infers it may not even work. Many women will tell you that screening saved their lives, and others who were not screened wish they had been so they could have received treatment sooner. In fact, Elton interviewed at least two such women but they were not represented in the article. Screening for PPD is an effective way to identify women who may have it. Both the sensitivity (misses few sufferers) and specificity (some, but not too many false positives) of the widely-used and validated Edinburgh Postnatal Depression Scale, for instance, is very well-established. We’d be happy to send you multiple, contemporary, highly-regarded studies that support this.
3. Elton states that “… increased screening could lead to an increase in mothers being prescribed psychiatric medication unnecessarily.” First, the MOTHERS Act does not require screening. Second, none of the screening tools for depression were designed to take the place of evaluation by health care professionals, so it is manipulation to suggest that screening alone will yield treatment of any kind or specifically treatment via medication. In a study of large scale universal screening efforts of more than 1000 pregnant and postpartum women, screening for depression did not lead to greater rates of treatment (Yonkers et al., Psychiatric Services, 2009). This is because there are many barriers to treatment, regardless of a positive screen. Additionally, for those who are able and choose to be treated, many women elect methods that don’t include medication (Pearlstein et al., Archives of Women’s Mental Health, 2006).
4. Time should be more careful when discussing the causes of PPD. We were surprised to see such a well-regarded publication misrepresent the results of a small research study that provided evidence to support the idea that a subset of women are more susceptible to hormonal changes as a trigger for depression, such as PPD, by prefacing the results with the unsubstantiated statement that “pregnancy hormones … have little to do with PPD in most cases.” This study showed that for those with a known history of depression, the hormonal changes that occur following delivery may increase one’s risk for developing symptoms during the postpartum period. Yet Elton attempts to use these results to support Michael O’Hara’s overgeneralization that women without prior history of “lots of anxiety and depressive symptoms” (what does this even mean objectively?!) “are unlikely to have problems in the postpartum period – not even close to likely.” Reporting results out of context to support the opinions of a source is appalling.
The fact that women who have had depression or anxiety in the past are more likely to experience PPD is nothing new. This is only one of many risk factors that have been identified. Your article, however, attempted to make a previous history of depression or anxiety the single key to identifying PPD. This will lead women who are ill but who have never been clinically diagnosed or treated for a mental illness to believe they must not have PPD. Many women who suffer will tell you it was the first time they were ever treated for a mental illness and the first time they came to realize they may have suffered from depression or anxiety in the past. You also leave out women who have no history of depression or anxiety but ended up with PPD for other reasons. Perhaps you were not aware, for instance, that diabetes is a risk factor for PPD (Kozhimannil et al., JAMA, 2009), as is thyroiditis. Women who deliver multiples or have babies born with serious health problems also have a higher risk of getting PPD.
5. The language used in the article frustratingly minimizes the devastation that PPD can cause. Such phrases as “the melancholy of motherhood” and “still, there is no denying that the postpartum period is a difficult one for many women” almost brush PPD off as a blue funk or a trying transition time for new moms. This signifies a clear lack of understanding about the seriousness of this illness that somewhere between 10 and 20% of women around the world suffer. PPD impacts a mother’s ability to function on a daily basis. It is not a difficult period. Elton asks, “Does PPD screening identify cases of real depression or simply contribute to the potentially dangerous medicalization of motherhood?” It is no more medicalizing motherhood to identify and treat PPD than it is to identify and treat gestational diabetes, which is universally screened for and occurs in only 3.5% of mothers.
As Time reported in June, the National Academies fully endorses screening for parental depression and believes it is crucial, while also emphasizing that screening is not helpful unless there is effective follow up and treatment tied to it. Supporters of the MOTHERS Act share that belief. Although effective treatment is available, fewer than half of cases of postpartum depression are recognized (Gjerdingen et al., Journal of the American Board of Family Medicine, 2007). Even fewer of those women ever receive treatment of any kind.
We are terribly sorry about the experience of the one mother quoted in your article, which happens on rare occasions, but we believe that the MOTHERS Act would actually go a long way to prevent what happened to her. What this bill actually funds is research, education and awareness. If these pieces are put in place, women, families and medical professionals will be better educated to prevent false positives from screening. A well-trained and educated physician will know to refer the patient on to a specialist who can inform her of various treatment options and monitor her to ensure the treatment she chooses is effective. A woman who has been made fully aware of the kind of services she should receive and the risks and benefits of the treatments available to her will be able to make the best choice for herself and her family.
Time focused on one potential but unlikely consequence of the MOTHERS Act rather than the actual content of the bill and why it is so sorely needed. We are deeply disappointed.
Mary Jo Codey, mother of 2, former first Lady of New Jersey, kindergarten teacher, New Jersey
Carol Blocker, mother of Melanie Blocker Stokes, Illinois
Sonia Murdock, co-founder and executive director of the Postpartum Resource Center of New York, past president of PSI, New York
Cheryl Beck, DNSc, CNM, FAAN, mother of 2, Board of Trustees Distinguished Professor at the University of Connecticut School of Nursing, co-author of the American Journal of Nursing 2006 Book of the Year award, Postpartum Mood and Anxiety Disorders: A Clinician’s Guide, Connecticut
Amy D. Gagliardi, mother of 4, Director of a Perinatal Health Clinic at a Federally Qualified Health Center, writer, researcher and chair of the Woman’s Health Sub-Committee of Connecticut’s Medicaid Managed Care Council, Connecticut
Valerie Plame Wilson, mother of 2, author of Fair Game, New Mexico
Adrienne Griffen, mother of 3, founder of Postpartum Support Virginia, and mid-Atlantic regional coordinator for Postpartum Support International, Virginia
Heidi Koss-Nobel, MA, mother, psychotherapist, Chairperson of Postpartum Support International of Washington, Washington
George J. Parnham, Attorney at Law, co-founder of the Yates Children Memorial Fund, Texas
Ann Dunnewold, Ph.D., mother of 2, licensed psychologist, author of Even June Cleaver Would Forget the Juice Box, past president of Postpartum Support International, Texas
Diane G. Sanford, Ph.D., internationally-recognized expert on pregnancy and postpartum emotional health, medical advisory board member on Babycenter.com, adjunct associate professor at the St. Louis University School of Public Health, Missouri
Catherine Connors, mother, author of the Her Bad Motherblog, featured parenting blogger at Beliefnet.com, Maternal Health Editor at BlogHer.com and Partner/Managing Editor at Mamapop.com, Canada
Tonya Fulwider, mother of 2, executive director of Perinatal Outreach & Encouragement, regional coordinator for Postpartum Support International, Ohio
Adrienne Martini, mother of 2, author of Hillbilly Gothic: A Memoir of Madness & Motherhood, New York
Katherine Stone, mother of 2, author of Postpartum Progress, the most widely-read blog in the US on postpartum depression, WebMD 2008 Health Hero, Georgia
Erin Reilly, co-founder of Sound of Silence, Friends of the Postpartum Resource Centerof New York, New York
Jen Stoll, mother of 2, executive director of The Postpartum Resource Center of Kansas, Kansas
Erika Krull, MS, LMHP, mother of 3, mental health counselor, author of the Family Mental Health blog on Psych Central, Nebraska
Wendy N. Davis, Ph.D., mother of 2, psychotherapist & perinatal mood disorders consultant, founding director of Baby Blues Connection, PSI Volunteer Coordinator, Oregon
Therese Borchard, mother of 2, author of the Beyond Blue blog on Beliefnet, author of several books including The Imperfect Mom: Candid Confessions of Mothers Living in the Real World, Maryland
Carol Peindl, RN, MSN, CNS, psychotherapist/nurse for the Prenatal and Postpartum Center of the Carolinas, PSI coordinator for the state of North Carolina, North Carolina
Diana Lynn Barnes, Ph.D., mother of 2, award-winning psychotherapist, past president of Postpartum Support International, California
Lauren Hale, mother of 3, author of Sharing the Journeyblog, iVillage Community Leader for Postpartum Depression and Pregnancy & Depression/Mental Illness Message Boards, Georgia
Pec Indman, PA, EdD, MFT, mother of 2, psychotherapist, co-author of Beyond the Blues, A Guide to Understanding and Treating Prenatal and Postpartum Depression, Education and Training Chair of Postpartum Support International, expert panelist for the Maternal and Child Health Bureau/HRSA, California
Tara Mock, mother of 2, author of the Out of the Valley blog for Christian postpartum depression support
Ivy Shih Leung, mother of 1, author of Ivy’s PPD Blog, New Jersey
Helen Ferguson Crawford, mother of 2, architect, Georgia
Karen Kleiman, MSW, founder and director of The Postpartum Stress Center, author of several books on postpartum depression, Pennsylvania
Joan Mudd, mother, founder of the Jennifer Mudd Houghtaling Postpartum Depression Foundation, Illinois
Susan Dowd Stone, MSW, LCSW, mother of 1, NJHSS Certified Perinatal Mood Disorders Instructor, Public Reviewer for the National Institutes of Mental Health, author and Adjunct Lecturer at the Silver School of Social Work at New York University, New Jersey
Marcie Ramirez, mother, co-founder of the Maternal Mental Health Task Force of Middle Tennessee, PSI Coordinator of Middle Tennessee, Tennessee
Amber Koter-Puline, mother of 1, author of the Beyond Postpartum blogand Atlanta support group facilitator, Georgia
Amy Tobias, mother, Indiana
Kimmelin Hull, PA-C, LCCE, mother of three, director of Pregnancy to Parenthood and author of A Dozen Invisible Pieces and Other Confessions of Motherhood, Montana
Sylvia Lasalandra-Frodella, mother of 1, Constituent Relations for the former First Lady of New Jersey Mary Jo Codey, author of A Daughter’s Touch, New Jersey
Lisa Jeli, mother of 1, California
Susan McRoberts, mother of 3, author of The Lifter of My Head: How God Sustained Me Through Postpartum Depression
Sara Pollard, RN, BS, Clarian Women’s Health Services, Indiana
Amy Burt, MA, mother of 3, director of operations, Perinatal Outreach & Encouragement for Moms, Ohio Coordinator for Postpartum Support International, Ohio
Diane Ashton, MSW, mother of 2, founder of PPD Support Hawaii, Hawaii
Laurel R. Spence, MS, PA-C, mother of 3, Assistant Professor, Baylor College of Medicine, clinical physician assistant, Women’s Specialists of Houston, Yates’ Children Memorial Fund/Women’s Mental Health Initiative advisory council member, speaker’s bureau Mental Health America – Houston and Postpartum Support International member, Texas
Sara Binkley-Tow, MA, CIMI, CHBE, PCD (DONA), executive director of Moms Bloom, Michigan
Sarah Pond, mother of 1, founder of Mama2Mama and early childhood development facilitator, Canada
Birdie Meyer, mother, president of Postpartum Support International
Della Palacios, mother of 2, Florida
Kimberly Wong, founder and chair of the Perinatal Mental Health Task Force of Los Angeles, California