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Saving Lives in New York Volume 2: Approaches and Special Populations • Stigma of mental health treatment • Medical personnel receive little or no training in identifying PPD • Family members may fail to recognize PPD • Mothers may not seek treatment due to lack of energy caused by the illness, stigma and/or feeling guilty about being depressed when she is supposed to be “happy.” II. Current State Efforts • The Healthy Families New York (HFNY) program provides home visiting services by trained home visitors who work with expectant families and families with newborns who have certain risk factors that may lead to child abuse and neglect and poor health outcomes. Home Visitors provide weekly home visits until the child is at least six months old and may continue less frequently based on the needs of the family until the child is five years old or in school or Head Start. Visits are aimed at promoting positive parent-child interaction and optimal child health and development. Home visitors also assist in linkage to other services to increase the families’ self-sufficiency. The HFNY program is currently located in 28 sites serving high need areas across the state. • Association of Perinatal Networks of New York received a grant to create training programs and resources to increase awareness of PPD and increase service utilization. • Information on PPD has been added to the Maternity Information leaflet, disseminated to all obstetrical hospitals statewide, and to “Your Guide to a Healthy Birth,” which is also available to pregnant women statewide. • The Pregnancy Risk Assessment Monitoring System (PRAMS), a national screening program, now includes a question on PPD. • A prenatal depression question was added to the Statewide Perinatal Data System. III. Action Steps 1. There are strong risk factors for postpartum depression (PPD), and prenatal/perinatal screening can help to identify those most likely to develop it as well as deliver services to them in the hospital with follow-up to start right after delivery. Obstetricians, pediatricians and other medical personnel in contact with new mothers should screen mothers for PPD during the child’s first year. 2. Home visiting services have been shown to be effective in improving outcomes for children. All at-risk new mothers should receive home visitations services and be screened for postpartum depression, including follow-up care for women who screen positive and an emergency protocol for women in a peri-suicidal state or homicidal state. Involvement of the new mother’s partner or support person in their treatment is highly desirable. 3. A media campaign that highlights the prevalence and risk factors for postpartum depression, linkages to service providers and training inevidencebased treatment for post-partum depression are necessary ingredients of a prevention program. References American Association of Health Plans: Current Issues Report, Approaches to Depression Care. Washington, DC; AAHP, 2000. American College of Obstetricians and Gynecologists, Answers to Common Questions about PPD. January 2002. www.acog.org Georgiapoulos, AM, Bryan, TL; Wollan, P; Yawn, BP. Routine Screening for PPD Journal of Family Practice, 50 (2), 2001. Moline, ML; Kah, DA; Ross, RW; Altshuler, LL; Cohen, LW. PPD: A Guide for Patients and Families, Expert Consensus Guideline Series. A Postgraduate Medicine Special Report, March 2001, 112-113. Sobey, WS, Barriers to PPD Prevention and Treatment: A Policy Analysis Journal of Midwifery & Women’s Health, Vol.47, no.5, Sept/Oct. 2002, 331-336. 90 New Mothers
Saving Lives in New York Volume 2: Approaches and Special Populations New York Men in the Middle Years Gary L. Spielmann, M.A., M.S. Director of Suicide Prevention New York State Office of Mental Health In late August, 2003, the 55 year old president and chief executive officer of a major bank in western New York, who was also chairman of a university board of trustees, went home from work and killed himself. It was the second suicide of a prominent local resident in less than three weeks. Colleagues and friends said both men were hard workers and high achievers who had been troubled recently by public embarrassments. While it is tempting to say that these upsetting circumstances caused the men’s suicides, experts warn, it’s not that simple. (Neville: 2003) It is not surprising that both victims were males. Men outrank women in all of the 15 leading causes of death, except one: Alzheimer’s disease. In fact, men’s death rates are at least twice as high as women’s for suicide, homicide, and cirrhosis of the liver. At every age, according to a study published in the May 2003 issue of the American Journal of Public Health, American males have poorer health and a higher risk of mortality than females. (DR Williams, The Health of Men: Structured Inequalities and Opportunities) More of them smoke (although women are catching up), drink heavily and are far more likely to engage in behaviors that put their health at risk, from abusing drugs to driving without a seat belt. Men also drive more rollover-prone SUVs and suffer more motorcycle fatalities. (Sanjay Gupta, M.D.: 2003) Another reason may be deeply rooted cultural belief: a “macho” world view that rewards men for taking risks and tackling danger head on. (Ibid.) In other words, males are praised for “being in control” of the situation, even when it is inherently dangerous or challenging. Could the suicide of these prominent western New Yorkers have been prompted by their sense of loss of control over a situation they were expected to master, but could not? Could they, like thousands of other successful people who die from suicide seemingly out of the blue, have actually suffered from depression? It’s likely to have been a contributing factor, if not the root cause, since mental disorders are involved in 90-95% of all suicides. According to Dr. Richard Carmona, Surgeon General of the United States, about 6 million men have clinical depression, but research shows they are less likely to seek treatment than women. Many men do not realize that some health symptoms may be caused by depression. For generations, men have been told that they have to act tough. As a result, men tend to self-medicate, and avoid going to see a physician, even when their symptoms are acute. The result: men are four times more likely to die from suicide as women in New York. Is it another manifestation of men wanting to control the situation that they typically use more lethal means to die, thereby leaving less to chance? Men in the Middle Years 91
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