ISSUE : Maternal depression is a significant risk factor affecting the healthy development of babies, children and youth.

The relationship between maternal mental health and child health outcomes is well documented and research is continually demonstrating the importance of early detection and treatment of maternal mental illness in early childhood developments^1,2,3. Maternal depression can impair the maternal/child bond and result in delayed physical, social and cognitive development with long term implications for physical and mental wellbeing and related health outcomes^2,3,4. Mothers who are struggling with their own mental health concerns may find interaction with their child in this capacity more difficult and thus delay or impair this vital component of early brain development.

The World Health Organization (WHO) defines maternal mental health as “a state of well-being in which a mother realizes her own abilities, can cope with normal stresses of life, can work productively and fruitfully and is able to make a contribution to her community”². When confronted with mental illness, many women are unable to function in a way that allows them to contribute at a level that is consistent with WHO definitions. Maternal depression is the second leading cause of disability among women globally² and estimates suggest that up to one in five women will struggle with a mental health complication during the perinatal period.

It may surprise you to learn that:

● It is estimated that up to one in five perinatal women will suffer from a maternal mental illness. This prevalence makes mental illness the most common complication of the perinatal period, and a significant public health concern.

● Not only are women affected by poor mental health but impacts are felt directly by their partners, family, friends and community. When left untreated, mental illness can have a direct impact on early childhood development outcomes.

● Exposure to Adverse Childhood Experiences (ACEs), of which parental depression is one, can result in high levels of toxic stress on a child’s developing brain that can result in a greater likelihood of poor mental and physical health outcomes later in life⁵.

BACKGROUND

Many mothers experience a perinatal mood and anxiety disorder. In 2017, a study in the Canadian Medical association journal looked at suicide among new mothers and found that 1 in 19 maternal deaths in Ontario is attributed to suicide^6,7. Making suicide the fourth leading cause of death for perinatal women in Canada⁷. 1 in 19!!!

Because of stigma and leaving the onus on the mothers to reach out for help, only 15% of mothers who experience a perinatal mood or anxiety disorder (PMAD) receive professional treatment ⁸. Some countries, such as the UK, Australia, USA, all have a Maternal Mental Health Strategy & screening program in place. Canada instead leaves the responsibility on new mothers to reach out for help. They may not know to reach out for help if they do not know they are experiencing a PMAD, or they may be afraid of the stigma associated with a PMAD.

If we want to support children and youth, we must start with mothers and ensure that they are healthy. When moms thrive, babies thrive. If we want to turn the tide on some of our biggest challenges with children and youth we need to focus on preventing them by having a strategy for supporting Canadian mothers and increase maternal mental health.

CONSIDERATIONS

Based on research, current trends, and new knowledge, we need to act now and put a plan in place to screen mothers for PMADs to prevent the loss of life, lessen the effect on children and youth, and decrease the high economical costs for something that can be prevented by early detection, and simple interventions. We need a plan in place to identify the mothers who are at risk and get them into treatment whether that is peer based support groups, medication, counselling, or hospitalization.

Consider this:

• Maternal depression and anxiety is a stronger risk factor for child behavioral problems than smoking, binge drinking, and emotional or physical domestic abuse⁹.
  
  
• More women will suffer PMAD than there are new cases of breast cancer diagnosed annually ¹⁰.
  
  
• More women will suffer from Postpartum Anxiety and Depression in a year than the combined number of new cases for men and women of Tuberculosis, Leukemia, Multiple Sclerosis, Parkinson’s Disease, Alzheimer’s Disease, Lupus, and Epilepsy.
  
  
• Depression during pregnancy and the immediate postpartum period is the most concerning time and has the biggest effect on the developing brain⁵.
  
  
•  It has been estimated that the cost for untreated mother/child unit is up to $150,000 with 72% of the cost allocated to the child¹¹. 
  
  
• It is estimated 85% of mothers do not receive treatment, so the economic cost to Canada is approximately $11 billion dollars. This can be reduced to approximately $5,000 if we screen and treat.
  
  

This is an excerpt from the brief presented at the Great Canadian Health Care Debate at the National Health Leaders Conference, June 2018. See the full brief here.  

REFERENCES

1. Evans, J., Melotti, R., Heron, J., Ramchandani, P., Wiles, N., Murray, L. and Stein, A. (2011). The timing of maternal depressive symptoms and child cognitive development: a longitudinal study. Journal of Child Psychology and Psychiatry, 53(6), pp.632-640.

2. Rahman, A., Surkan, P., Cayetano, C., Rwagatare, P. and Dickson, K. (2013). Grand Challenges: Integrating Maternal Mental Health into Maternal and Child Health Programmes. PLoS Medicine, 10(5), p. e1001442.

3. Sohr-Preston, S.and Scaramella, L. (2006). Implications of Timing of Maternal Depressive Symptoms for Early Cognitive and Language Development. Clinical Child and Family Psychology Review, 9(1), pp.65-83.

4. Jones, C., Jomeen, J. and Hayter, M. (2014). The impact of peer support in the context of perinatal mental illness: A meta-ethnography. Midwifery, 30(5), pp.491-498.

5. Lebel, C., Walton, M., Letourneau, N., Giesbrecht, G., Kaplan, B. and Dewey, D. (2016). Prepartum and Postpartum Maternal Depressive Symptoms Are Related to Children’s Brain Structure in Preschool. Biological Psychiatry, 80(11), pp.859-868.

6. Nasser, S. (2017) 1 in 19: New study shines light on reality of suicide among new Ontario moms, moms-to-be. CBC news. http://www.cbc.ca/news/canada/toronto/mothers-suicide-ontario-study-1.4267417

7. Grigoriadis, S., Wilton, A. S., Kurdyak, P. A., Rhodes, A. E., VonderPorten, E. H., Levitt, A., … Vigod, S. N. (2017). Perinatal suicide in Ontario, Canada: a 15-year population-based study. CMAJ : Canadian Medical Association Journal = Journal de l’Association Medicale

8.  Patterns of Depression and Treatment in Pregnant and Postpartum Women Angela Bowen, RN, PhD1 ; Rudy Bowen, MD, CM, FRCP2 ; Peter Butt, MD, CCFP3 ; Kazi Rahman, MBBS, MS (PhD Candidate)4 ; Nazeem Muhajarine, PhD5, 2012

9. Knitzer, J., Theberge, S., & Johnson, K. (2008). Reducing Maternal Depression and Its Impact on Young Children. Retrieved from http://www.nccp.org/publications/pdf/text_791.pdf

10. Stone, K. (2010). How Many Women Get Postpartum Depression? The Statistics on PPD | POSTPARTUM PROGRESS. Retrieved May 17, 2018, from http://www.postpartumprogress.com/how-many-women-get-postpartum-depression-the-statistics-on-ppd

11. Bauer, A., Parsonage, M., Knapp, M., Iemmi, V., Adelaja, B., & Hogg, S. (2014). The costs of perinatal mental health problems. Centre for Mental Health. /doi.org/10.13140/2.1.4731.61