{"id":1080,"date":"2009-07-17T10:37:07","date_gmt":"2009-07-17T10:37:07","guid":{"rendered":"http:\/\/blog.beliefnet.com\/theirbadmother\/2009\/07\/dear-time-magazine-and-your-problem-with-women-struggling-with-ppd-is-what-exactly.html"},"modified":"2009-07-17T10:37:07","modified_gmt":"2009-07-17T10:37:07","slug":"dear-time-magazine-and-your-problem-with-women-struggling-with-ppd-is-what-exactly","status":"publish","type":"post","link":"https:\/\/www.beliefnet.com\/columnists\/theirbadmother\/2009\/07\/dear-time-magazine-and-your-problem-with-women-struggling-with-ppd-is-what-exactly.html","title":{"rendered":"Dear Time Magazine: And Your Problem With Women Struggling With PPD Is What, Exactly?"},"content":{"rendered":"

I kinda thought that debates about the reality and severity of post-partum depression were settled well before Tom Cruise made an ass of himself prattling on about exercise and vitamins, but apparently not. <\/p>\n

Time Magazine published an article last week<\/a> that questions the seriousness of post-partum depression and questions the utility and good of the Mothers Act, a piece of legislation that would systematize support and services for women struggling with PPD across the US. <\/span>Which, I suppose, might be explained by citing the need for dialogue and debate yadda yadda, but seriously: how is dialogue about PPD furthered by questioning its seriousness and by questioning – doubting – the women who struggle or have struggled with it (not to mention, getting the facts wrong<\/a>)? We can’t have constructive discussion about PPD and its effects when such conversations proceed from assumptions that women exaggerate the seriousness of their experience or that much of PPD is simply ‘baby blues’ or that efforts to help women lead inevitably and problematically to pharmaceuticals, because such assumptions shame PPD-sufferers and mothers who have depended upon medication to get through what is one of the most difficult periods of their lives.<\/p>\n

Doubting and shaming women who do struggle or have struggled with PPD serves no-one. Time should know better<\/a>. Better than Tom Cruise, anyway.<\/p>\n

Below, the text of an open letter to Time to which I, along with scores of other women who have personal and professional interests in discussions about PPD, was a signatory:<\/p>\n


<\/i><\/p>\n

An Open Letter to the Editors of Time<\/a>:<\/span><\/i><\/p>\n

Time<\/em> has done a great disservice to all mothers who are suffering and will suffer from postpartum depression (PPD).  <\/span>In
\nan article called “The Melancholy of Motherhood” journalist Catherine
\nElton writes a distorted story that no doubt has already begun to
\nconfuse and stigmatize women with PPD.  <\/span> <\/span><\/span><\/font><\/i><\/p>\n

We cannot understand why Time<\/em>
\nwould choose to sensationalize what is a very serious medical issue for
\nhundreds of thousands of women in the United States each year, and to
\ncreate controversy around the MOTHERS Act, the one and only piece of
\nlegislation that would help to systematize support and services that
\nare sorely lacking in so many places throughout our country.<\/span>
<\/i><\/p>\n

There are several points in the article that concern us: <\/span><\/i><\/p>\n

1.<\/span>The MOTHERS Act is not “dividing psychologists” as Elton opines.  <\/span>The
\nAmerican Psychological Association, the American Psychiatric
\nAssociation and the National Association of Social Workers
\nwholeheartedly endorse the MOTHERS Act.  <\/span>  <\/span>In fact, you neglect to mention that much of the medical community supports the bill.  <\/span>It
\nhas been publicly endorsed by the March of Dimes, the American College
\nof Obstetricians and Gynecologists, the American College of Nurse
\nMidwives, the National Healthy Mothers Healthy Babies Coalition, and
\nthe Association of Women’s Health, Obstetric and Neonatal Nurses, among
\nmany others.  <\/span>You didn’t represent any of them in
\nyour piece, all of which are highly regarded organizations which have a
\nlong record of dedication to the health of both mothers and babies.<\/span><\/span><\/i><\/p>\n

2. <\/span>Elton calls screening controversial and infers it may not even work.<\/span> <\/span>Many
\nwomen will tell you that screening saved their lives, and others who
\nwere not screened wish they had been so they could have received
\ntreatment sooner.  <\/span>In fact, Elton interviewed at least two such women but they were not represented in the article.  <\/span>Screening for PPD is an effective way to identify women who may have it.   <\/span>Both
\nthe sensitivity (misses few sufferers) and specificity (some, but not
\ntoo many false positives) of the widely-used and validated Edinburgh
\nPostnatal Depression Scale, for instance, is very well-established.  <\/span>We’d be happy to send you multiple, contemporary, highly-regarded studies that support this.  <\/span>  <\/span><\/span><\/font><\/span><\/i><\/p>\n

3. Elton states that “… increased screening could lead to an increase in mothers being prescribed psychiatric medication unnecessarily.”  <\/span>First, the MOTHERS Act does not require screening.  <\/span>Second, n<\/span>one
\nof the screening tools for depression were designed to take the place
\nof evaluation by health care professionals, so it is manipulation to
\nsuggest that screening alone will yield treatment of any kind or
\nspecifically treatment via medication.  <\/span>In a
\nstudy of large scale universal screening efforts of more than 1000
\npregnant and postpartum women, screening for depression did not lead to
\ngreater rates of treatment (Yonkers et al., Psychiatric Services<\/em>, 2009).  <\/span>This is because there are many barriers to treatment, regardless of a positive screen.  <\/span>Additionally,
\nfor those who are able and choose to be treated, many women elect
\nmethods that don’t include medication (Pearlstein et al., Archives of Women’s Mental Health<\/em>, 2006).  <\/span><\/span><\/font><\/i><\/p>\n

<\/span><\/span><\/span> <\/i><\/p>\n

4. <\/span><\/span><\/font>Time<\/em> should be more careful when discussing the causes of PPD.  <\/span>We
\nwere surprised to see such a well-regarded publication misrepresent the
\nresults of a small research study that provided evidence to support the
\nidea that a subset of women are more susceptible to hormonal changes as
\na trigger for depression, such as PPD, by prefacing the results with
\nthe unsubstantiated statement that “pregnancy hormones … have little to
\ndo with PPD in most cases.”  <\/span>This study showed
\nthat for those with a known history of depression, the hormonal changes
\nthat occur following delivery may increase one’s risk for developing
\nsymptoms during the postpartum period.  <\/span>Yet Elton
\nattempts to use these results to support Michael O’Hara’s
\novergeneralization that women without prior history of “lots of anxiety
\nand depressive symptoms” (what does this even mean objectively?!) “are
\nunlikely to have problems in the postpartum period – not even close to
\nlikely.”  <\/span>Reporting results out of context to support the opinions of a source is appalling.  <\/span><\/font><\/span><\/i><\/p>\n

<\/span><\/span> <\/i><\/p>\n

The
\nfact that women who have had depression or anxiety in the past are more
\nlikely to experience PPD is nothing new.  This is only one<\/em> of
\nmany risk factors that have been identified.  Your article, however,
\nattempted to make a previous history of depression or anxiety the
\nsingle key to identifying PPD.  This will lead women who are ill but
\nwho have never been clinically diagnosed or treated for a mental
\nillness to believe they must not have PPD.  Many women who suffer will
\ntell you it was the first time they were ever treated for a mental
\nillness and the first time they came to realize they may have suffered
\nfrom depression or anxiety in the past.  You also leave out women who
\nhave no history of depression or anxiety but ended up with PPD for
\nother reasons.  Perhaps you were not aware, for instance, that diabetes
\nis a risk factor for PPD (Kozhimannil et al., JAMA<\/em>, 2009), as
\nis thyroiditis.  Women who deliver multiples or have babies born with
\nserious health problems also have a higher risk of getting PPD.<\/span><\/span><\/i><\/p>\n

<\/span> <\/i><\/p>\n

5.  The language used in the article frustratingly minimizes the devastation that PPD can cause.  <\/span>Such
\nphrases as “the melancholy of motherhood” and “still, there is no
\ndenying that the postpartum period is a difficult one for many women”
\nalmost brush PPD off as a blue funk or a trying transition time for new
\nmoms.  <\/span>This signifies a clear lack of
\nunderstanding about the seriousness of this illness that somewhere
\nbetween 10 and 20% of women around the world suffer.  <\/span>PPD impacts a mother’s ability to function on a daily basis.  <\/span>It is not<\/em> a difficult period.  <\/span>Elton asks, “<\/span>Does
\nPPD screening identify cases of real depression or simply contribute to
\nthe potentially dangerous medicalization of motherhood?”  <\/span>It
\nis no more medicalizing motherhood to identify and treat PPD than it is
\nto identify and treat gestational diabetes, which is universally
\nscreened for and occurs in only 3.5% of mothers.<\/span><\/span><\/font><\/i><\/p>\n

<\/span><\/span><\/font> <\/i><\/p>\n

As Time<\/em>
\nreported in June, the National Academies fully endorses screening for
\nparental depression and believes it is crucial, while also emphasizing
\nthat screening is not helpful unless there is effective follow up and
\ntreatment tied to it.  <\/span>Supporters of the MOTHERS Act share that belief.  <\/span>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<\/em>, 2007).  <\/span>Even fewer of those women ever receive treatment of any kind.<\/span><\/span><\/font><\/i><\/p>\n

We
\nare terribly sorry about the experience of the one mother quoted in
\nyour article, which happens on rare occasions, but we believe that the
\nMOTHERS Act would actually go a long way to prevent what happened to
\nher.  <\/span> <\/span>What this bill actually funds is research, education and awareness.  <\/span>If
\nthese pieces are put in place, women, families and medical
\nprofessionals will be better educated to prevent false positives from
\nscreening.  <\/span>A well-trained and educated physician
\nwill know to refer the patient on to a specialist who can inform her of
\nvarious treatment options and monitor her to ensure the treatment she
\nchooses is effective.  <\/span> <\/span>A
\nwoman who has been made fully aware of the kind of services she should
\nreceive and the risks and benefits of the treatments available to her
\nwill be able to make the best choice for herself and her family.<\/span><\/i><\/p>\n

Time<\/span><\/em>
\nfocused on one potential but unlikely consequence of the MOTHERS Act
\nrather than the actual content of the bill and why it is so sorely
\nneeded. <\/span> <\/span>We are deeply disappointed.<\/span><\/font><\/i><\/p>\n

Sincerely,
<\/span><\/i><\/p>\n

Concerned Women<\/span><\/i><\/p>\n

(Full list of signatories can be found HERE<\/a>.)<\/span><\/p>\n

(Pass it on.)<\/span><\/p>\n


<\/span><\/p>\n

\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

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