A better start: Building a brighter future for perinatal mental health at the Child Study Center

Transcript

• 00:00And thanks everyone for joining.
• 00:02We may have a couple of others hop on.
• 00:06This is the wonderful advantage of zoom.
• 00:09Umm? So just in case people
• 00:12are on the don't we know me?
• 00:14I'm Linda Mays from the Child Study
• 00:16Center and it's just really a great
• 00:19pleasure to have colleagues joining
• 00:21us in this virtual way for another
• 00:23of our fireside fireside chances.
• 00:26Karen points out for the White
• 00:27House announcement on Friday.
• 00:28We had no idea how historically
• 00:31appropriate that metaphor would be.
• 00:34I especially also like having it be a
• 00:37fireside chat in a virtual environment,
• 00:40but today.
• 00:41Now we have a real pleasure to introduce
• 00:44you to work in perinatal mental health.
• 00:46That's going on in the Child
• 00:48Study Center and as you'll hear,
• 00:50you'll hear about our commitment
• 00:52to not only helping children but
• 00:55helping families and parents
• 00:57and thinking across generations.
• 00:59So again,
• 01:00thank you for being here and I I want
• 01:02to turn it over to my colleagues.
• 01:03Karen,
• 01:04Amanda and Helena for their chat together.
• 01:09Good afternoon everyone.
• 01:10It's such a pleasure to be able
• 01:12to spend some time together.
• 01:13I'm Kieran O'Donnell and I joined the
• 01:16Child Study Center in September 2020,
• 01:19where I have a joint appointment
• 01:20in the Department of Obstetrics,
• 01:21Gynecology and Reproductive Sciences
• 01:23and I'm really fascinated with trying
• 01:26to understand how and why what happens
• 01:28in the womb can last a lifetime
• 01:31trying to unpack the biological
• 01:33mechanisms that allow communication
• 01:35between the mother and the fetus,
• 01:37which then can influence.
• 01:39Mental health trajectories across
• 01:41the lifespan and of course
• 01:43within that research program.
• 01:45It's critically important that we
• 01:47try to understand the drivers or the
• 01:50causes of maternal mental health and
• 01:52maternal mental illness really to try
• 01:55and realize targeted prevention efforts,
• 01:58and I'll pass you over onto
• 01:59my colleague Dr role.
• 02:04Hi good afternoon so my name is Amanda
• 02:06Lowell and I am a licensed clinical
• 02:09psychologist at the Child Study Center.
• 02:12I came in 2016 for my pre doctoral
• 02:15internship and have stayed for fellowship
• 02:18training and I'm now on the faculty where
• 02:22I provide clinical services and the
• 02:24parent and Family development program to
• 02:26mothers and fathers who are experiencing
• 02:29their own mental health challenges
• 02:31and are in need of parenting support.
• 02:33And then I try to take what I learned
• 02:37from my clinical work and apply it to
• 02:41research questions that we can better
• 02:43inform interventions and scale them.
• 02:45Make them work for the individual
• 02:48that really needs them,
• 02:49not just for large groups,
• 02:52but you know the person sitting
• 02:53in front of us and what they need.
• 02:56And I think that that really ties into what
• 02:59Helena has to say about her approach too.
• 03:02Hi good afternoon everybody.
• 03:04I'm
• 03:04Helena Rutherford and I'm an associate
• 03:06professor in the Child Study Centre
• 03:08and I directed before and after baby
• 03:10lab or the bubble as we like to call
• 03:12it where we're really interested in
• 03:14understanding how the mind and the brain
• 03:17changes when individuals become parents.
• 03:19In particular, we think about this time as
• 03:21being a period of development and adulthood
• 03:23that the brain doesn't stop developing.
• 03:26Once we hit adolescence and young adulthood.
• 03:28But really that there's times of plasticity
• 03:30of the brain across the adult span as well,
• 03:33and so we think about adult
• 03:35development during the perinatal
• 03:36period for men as well as women,
• 03:37and we're particularly excited to understand
• 03:40what that brain plasticity looks like,
• 03:42not only in terms of our
• 03:44understanding of parenting,
• 03:44but also where we can help identify parents
• 03:47who may be at risk from from challenges.
• 03:49In the passing period.
• 03:50So we use a lot of neuroimaging measures
• 03:52to look at how the brain works and
• 03:55during pregnancy in the 1st place and
• 03:57period to help inform us and refines,
• 03:59move our research questions and
• 04:00then hopefully feed that back
• 04:02then to some of the clinical work
• 04:04that you'll hear about as well.
• 04:05So I'm really excited for this conversation
• 04:07today I'm going to pass it back to Kieran.
• 04:10And you know, we really are hoping that
• 04:12this will be a conversation today,
• 04:13so please do feel free to jump in
• 04:15with any questions priska you really
• 04:17set the bar high with telling us that
• 04:19you're expecting your grandchild,
• 04:21so we will try to answer any
• 04:23questions that you do have for us,
• 04:26but we thought that we'd start
• 04:27as we look forward to the future,
• 04:30and I hope you'll agree at the
• 04:31end of the conversation.
• 04:32That is a particularly bright future
• 04:34for perinatal mental healthcare.
• 04:35Here at the Child Study Centre.
• 04:37But as we look forward to the
• 04:39future and plan for the future,
• 04:40we thought it's important.
• 04:41Think about the present and the
• 04:44current state of the science
• 04:46and the state of epidemiology.
• 04:48When it comes to perinatal
• 04:50mental illness and so why now?
• 04:53Why are we having this conversation today?
• 04:55Well, we we couldn't have timed
• 04:57it better with the announcement
• 04:58from the White House last week,
• 05:00but I think we were particularly
• 05:02interested in having this conversation
• 05:04just because of the compelling
• 05:05and overwhelming need for an
• 05:07increased services and investment
• 05:09in perinatal mental health.
• 05:11And you know?
• 05:12If we were having this
• 05:13conversation a couple of years ago,
• 05:15I would have said that
• 05:16approximately one in six,
• 05:18maybe one in five women,
• 05:19struggle with their mental health
• 05:21in and around pregnancy and using
• 05:23a large court in the United Kingdom
• 05:25of over 15,000 pregnancies where we
• 05:28have two generations of pregnancies,
• 05:30so women and then their daughters
• 05:32and looking at their mental health
• 05:34needs and their own pregnancies.
• 05:35We've seen a generational increase,
• 05:37so approximately one in four women are
• 05:40struggling with their mental health in.
• 05:42And around pregnancy,
• 05:44and that statistic predates
• 05:46the ongoing global pandemic,
• 05:48and so in the most recent systematic
• 05:50review of studies published
• 05:52during the pandemic,
• 05:54we're actually seeing that number
• 05:55increasing to as many as one in three.
• 05:57So a recent survey of over 1000
• 06:00women across the United States
• 06:02and 36% of pregnant individuals
• 06:04struggling with their mental health
• 06:06in or shortly after pregnancy.
• 06:09So not only have we seen
• 06:11this generational increase.
• 06:12And perinatal mood and anxiety
• 06:15disorders that obviously has then
• 06:17been exacerbated by the ongoing
• 06:20and COVID pandemic.
• 06:21So what do we think about in
• 06:23terms of the impact at the level
• 06:25of the individual will sadly,
• 06:26and death by suicide and overdose
• 06:28remains one of the leading causes
• 06:31of death for women in the perinatal
• 06:34period and in the context of the
• 06:37adverse effects on the next generation.
• 06:39So research from my own group and
• 06:41others have shown that children.
• 06:43Point to women who struggle with
• 06:45their mental health in pregnancy
• 06:47have approximately doubled their
• 06:48risk for developing emotional
• 06:50and behavioral problems,
• 06:52and we see these effects as
• 06:53early as age 4 years of age,
• 06:56and they persist until early adulthood.
• 06:59So really,
• 07:00what we think we're seeing is
• 07:02the start of the trajectory that
• 07:04is influenced by mental health
• 07:07in and around pregnancy,
• 07:09and so if we scale up,
• 07:11what is the impact at the societal level?
• 07:14Well, the most recent cost
• 07:16analysis from the United States has
• 07:19indicated a cost of 18 billion U.S.
• 07:21dollars per year for the cost associated
• 07:25with untreated mood and anxiety disorders,
• 07:28and in a recent analysis,
• 07:30approximately 70% of those costs were due
• 07:33to the adverse effects of untreated mood
• 07:36and anxiety disorders on child outcomes.
• 07:38So that was a lot of numbers.
• 07:40I know we talked about the one in three women
• 07:42that struggle with their mood or anxiety.
• 07:44Disorders in and around pregnancy.
• 07:46We talked about the 18 billion U.S.
• 07:49dollars, the cost to the economy.
• 07:52We talked about the increase,
• 07:54the doubling of risk for
• 07:56emotional behavioral problems,
• 07:57and trillion born to women who
• 08:00experience mood or anxiety disorders
• 08:02or high levels of anxiety or
• 08:04depression in and around pregnancy.
• 08:06But you know,
• 08:07I I want to emphasize that, you know,
• 08:10there are things that can be done and
• 08:12we do have tools that can help us.
• 08:15Identify individuals that have a higher
• 08:17level of need in the context of their
• 08:20mental health in and around pregnancy.
• 08:22Some of those tools are somewhat
• 08:24dated and we can talk about some more
• 08:27innovative approaches and how we may be
• 08:30able to better identify individuals that
• 08:32struggle with mood or anxiety disorders.
• 08:36But we can ask the question
• 08:39about who is struggling,
• 08:40and in fact the American
• 08:42College of Obstetricians and
• 08:43Gynecologists recommends screening.
• 08:45At least once in the perinatal period and
• 08:48here in the Yale New Haven Hospital system,
• 08:50we seem to be doing that pretty well,
• 08:52so we screen approximately 56% of
• 08:56individuals in the postpartum period.
• 08:59But you know, being at Yale,
• 09:01I think we can always do better
• 09:03and we should do better.
• 09:05And in fact,
• 09:06in some countries there is recommendations
• 09:08for screening early in pregnancy,
• 09:10and so I think that that is one of
• 09:12the opportunities that we have here
• 09:14to exceed the American College of
• 09:16Obstetricians and Gynecologists.
• 09:17Recommendations to really realize
• 09:20universal screening early in pregnancy,
• 09:22and that's so critically important when
• 09:25we think about being able to provide
• 09:28treatment for these individuals that
• 09:30are struggling with their mental health,
• 09:32and as we'll hear from Amanda,
• 09:35you know we were experiencing
• 09:37a behavioral health surge.
• 09:38There is a real level of need,
• 09:39and even for our parent and family
• 09:42development program where we can
• 09:43target and bolster the health of
• 09:45pregnant individuals and their families
• 09:47is approximately a three month.
• 09:48Waiting list now if you have to
• 09:50wait for that three months when you
• 09:52have a young neonate or infant,
• 09:55you're just setting that individual
• 09:56back from being able to improve
• 09:59their mental health,
• 10:00and indeed potentially influence
• 10:01their at the level of care they
• 10:04can give to their children.
• 10:05And you know,
• 10:06as we transitioned to Doctor Lowell,
• 10:09just also mentioned that there
• 10:10are effective treatments,
• 10:11so an expert task force the
• 10:14US Preventive Services Task
• 10:16Force has. Provided guidance
• 10:19indicating that there are now
• 10:21multiple treatments that can actually
• 10:24prevent perinatal depression.
• 10:25So despite the increased level of need,
• 10:28there are things that we can do,
• 10:30and now I'd like to pass you over
• 10:32to Doctor Lowell to hear a little
• 10:34bit about what it is we can do.
• 10:38All right, thank you.
• 10:41I thought that it would be interesting
• 10:44to kind of share with folks a
• 10:47vignette of of a mother that I've
• 10:49worked with in the perinatal period
• 10:51just to kind of bring it to life.
• 10:54Think that Doctor O'Donnell shares
• 10:57some really staggering statistics,
• 10:59and they're pretty hard to
• 11:01wrap our minds around it.
• 11:03I mean, we, we recognize that.
• 11:07We're up against a really big problem and
• 11:11and we can think a lot about ways that.
• 11:15We can address that,
• 11:16but to put a face or or a
• 11:19person to what that looks like,
• 11:21I think can be really valuable.
• 11:23And so today I want to speak with
• 11:27you about a woman named Aubrey.
• 11:29So what we'll call her today?
• 11:32Actually met Aubrey in 2016 when
• 11:35I first came to Yale as a trainee,
• 11:38and at the time she was a 29 year old
• 11:42single mother who had a four year
• 11:45old son and they initially came to
• 11:47the youth clinic at the Yale Child
• 11:50Study Center because her son was
• 11:53experiencing some really significant
• 11:55emotional and behavioral problems
• 11:57that we're looking at bit like ADHD.
• 12:02A bit like oppositionality,
• 12:04so she came to the clinic and as
• 12:07I was getting to know her and her
• 12:10family for the sake of this child.
• 12:13Recognize that this is a family that's
• 12:16been through an incredible amount of trauma.
• 12:19The Speaking of treatments that work
• 12:22I conducted and provided an evidence
• 12:24based treatment for early childhood
• 12:27trauma called child parent psychotherapy,
• 12:30and so this is a dyadic treatment
• 12:32that I had both mother and child
• 12:34in the room and we really worked on
• 12:37processing their shared trauma and
• 12:40this trauma was in relation to the
• 12:44the families experience of the child's
• 12:48fathers mental illness of his own.
• 12:51So we completed child parent therapy.
• 12:53But what I really want to speak
• 12:55with you about is the fact that
• 12:57after we said goodbye for a time,
• 12:59she resurfaced in 2020.
• 13:01So right as the pandemic was hitting,
• 13:04I heard from Aubrey and she reached
• 13:07out to me and indicated that she
• 13:10was pregnant and that she was
• 13:13really struggling and she didn't
• 13:15know where else to go.
• 13:16She didn't know who else to speak to or
• 13:18what else to do, but remembered that.
• 13:20Had been helpful.
• 13:23It was serendipitous because I had
• 13:25transitioned from working in the
• 13:27youth side of the clinic to the
• 13:29parent side of the clinic or the
• 13:31parent and Family Development program,
• 13:33and my main interest has been
• 13:35perinatal and parental mental health,
• 13:37so this was a perfect opportunity for
• 13:40me to really support this mom and
• 13:42it really kind of worked out nicely,
• 13:44but what struck me was that she really
• 13:46didn't know where else to turn and
• 13:48this was right at the very beginnings
• 13:50of this mental health crisis and this.
• 13:53Federal health surge that we're
• 13:55now continuing to experience.
• 13:57So she had approached me.
• 13:59She was experiencing severe depression.
• 14:01She was extremely tearful.
• 14:03She's hopeless and she was really
• 14:06down most of the day,
• 14:08and she struggled in her daily
• 14:10activities and she was able to get
• 14:12to work and she was able to get
• 14:14her son to school.
• 14:15But if she wasn't engaged in really
• 14:17either of those two activities,
• 14:18she was crying and she was really
• 14:21busy ruminating and wondering about.
• 14:23And questioning about whether
• 14:25she was a good mother or not,
• 14:28she was questioning her own worth,
• 14:30and this all seemed to be secondary
• 14:33to domestic violence that she was
• 14:35experiencing with a new partner of hers
• 14:38that she was expecting a child with.
• 14:40And she was expecting the child
• 14:42later that summer.
• 14:42And this was about March April
• 14:44that I was speaking with her.
• 14:45So there were a few months during
• 14:47which time she was pregnant.
• 14:49And I finally kind of got in there
• 14:51and and was able to work with her.
• 14:54As it turns out,
• 14:56she had actually sought support elsewhere
• 14:58in the community before she found me,
• 15:00and that's when she finally reached
• 15:02out to me and was like Amanda,
• 15:03I really need your help.
• 15:07So she had reached out also in the community,
• 15:09and none of that really was
• 15:11the right fit for her.
• 15:13So on top of the weight lists
• 15:17that were announced,
• 15:17seeing the treatments and the approaches
• 15:21themselves were not quite what she
• 15:23needed and what she felt like she needed,
• 15:27which was to be held in her role as
• 15:29both an individual and as a mother,
• 15:32and so many of the clinics that
• 15:35are out there in the community.
• 15:37Provide parenting support or skills
• 15:40or mental health treatment to adults
• 15:43and what she needed was really the
• 15:46intersection of the two because
• 15:48she was depressed as a mother and.
• 15:51And so I really worked hard to help
• 15:55her think about the intersection
• 15:57of those two identities.
• 16:00And we participated our our eye
• 16:03facilitated comparative behavioral
• 16:05therapy for depression with her
• 16:07entirely through telehealth.
• 16:10And this really worked out well,
• 16:12because I had a pre-existing
• 16:14relationship with her,
• 16:15but I think that the flexibility
• 16:17that telehealth offered was really,
• 16:19really vital to her continued
• 16:23participation during a time where we
• 16:25often see a lot of barriers to care
• 16:28when when a mother is depressed and is,
• 16:31I mean,
• 16:31depression itself makes it
• 16:32hard to engage in
• 16:33treatment. But then,
• 16:34being pregnant and having limited
• 16:36resources and having to get to lots
• 16:38of other doctors appointments can be
• 16:40really challenging. We're engaged,
• 16:41so telehealth was a real benefit.
• 16:44But we got to see throughout
• 16:46the COVID period.
• 16:48But during our treatment I
• 16:49worked really hard with her to
• 16:51challenge and or to identify first.
• 16:53Her really unhelpful thoughts that
• 16:55she was having about her own worth as
• 16:57a mother and her own capacities as
• 16:59a mother and as a partner as well.
• 17:02It was tough because she was
• 17:05experiencing a lot of emotional
• 17:07abuse with her partner at the time.
• 17:11And so we had to do a lot of
• 17:13thinking with her about what the
• 17:15reality of the situation was,
• 17:17and that also had to include an
• 17:19emphasis on thinking about her own
• 17:22experiences and relationships that
• 17:24maybe made her vulnerable to the
• 17:26things that that her partner was saying.
• 17:30That really touched on her nerves
• 17:31and really got her doubting herself.
• 17:34So to kind of harken back to
• 17:36what was said earlier.
• 17:37I mean there's this real.
• 17:39We're doing some real thinking about.
• 17:41Uhm,
• 17:41how her experiences in in her own
• 17:45childhood are now influencing how she's.
• 17:49Potentially about to parent a
• 17:51new a new child here.
• 17:54So in addition to really reflecting
• 17:56and developing some insight about her,
• 17:58her experiences and relationships and
• 18:00what was true and what wasn't maybe
• 18:03true about herself and those relationships,
• 18:05we had to focus on the emotional
• 18:08piece of why challenging these
• 18:10thoughts was really difficult for her.
• 18:12And then we just had to give her
• 18:14some concrete skills as well.
• 18:15For here's how to talk to someone.
• 18:17And here are the things to do when
• 18:20someone is really unkind to you.
• 18:22And here is. Here are the ways that you.
• 18:24Should or shouldn't engage with
• 18:26that behavior that are going to
• 18:28help you be healthy.
• 18:29So we talked a lot about it in
• 18:30terms of what's going to be healthy
• 18:32for you and what's going to be
• 18:34healthy for your child.
• 18:34And so it wasn't really until she had
• 18:37the opportunity to be held in her
• 18:39role as a as a woman and as a person.
• 18:41But then she could think about
• 18:44her child's experience.
• 18:46So one example that I'll share with
• 18:48you is is that now flash forward.
• 18:51She's had her baby, and they're doing well.
• 18:55And one of the really stark
• 18:57differences that I'm noticing is
• 19:00that she in her with her older child
• 19:03who remember I met many years prior.
• 19:07He was exposed to significant trauma
• 19:10because of his own father's mental illness,
• 19:12and that really came from Moms Aubrey's
• 19:14own urge and wished for her son to
• 19:17have a relationship with his father.
• 19:19Even though it wasn't the
• 19:20healthy thing to do.
• 19:21But it felt really important to
• 19:23mom and so now she has an infant
• 19:26daughter and she felt pulled and
• 19:29compelled to do the same thing.
• 19:31It was.
• 19:31My daughter needs to have a relationship with
• 19:34her father but we were able to
• 19:36really slow down and think about.
• 19:38Why that was important to her?
• 19:40How it turned out in her other child
• 19:42and his relationship with his father
• 19:44and what this child may need versus
• 19:47what it is that she wishes for
• 19:49and how those two things might be
• 19:52similar and also pretty different.
• 19:54So again, after having held mom in that
• 19:57she's much more able to hold her child,
• 20:00which I think really speaks
• 20:03to kind of almost.
• 20:05Where we put our our energy and our effort,
• 20:08if we're able to treat kind of one parent,
• 20:10it has a ripple effect to impact.
• 20:13However many children that they have,
• 20:15and so it's been a really beautiful
• 20:18experience to get to work with this mom.
• 20:21But I think what what's really important
• 20:24to be thinking about is that there's a
• 20:26real need to scale this type of support.
• 20:29We really need to be thinking
• 20:31about how do we help providers?
• 20:33Think holistically about parents,
• 20:34parental mental health or
• 20:36perinatal mental health.
• 20:37For you know,
• 20:38the intersection of an individual.
• 20:40Plus as as a parent or as a birthing person,
• 20:43or as someone who's expecting a new child.
• 20:47And then I think not only do we need
• 20:49to generally train folks on that,
• 20:51but then think about taking evidence
• 20:54based treatments and having them
• 20:56work for individuals and and how do
• 20:58we customize them and tailor them
• 21:00and make sure that we match them
• 21:02to the right folks and then get
• 21:04them into into the right hands.
• 21:07We have to do in order to do that,
• 21:09we need to understand the
• 21:10mechanisms underlying treatment.
• 21:111st and I think that that's
• 21:15where Helena comes in.
• 21:18Great
• 21:18thank you Amanda and I think it
• 21:20was just a beautiful segue in terms
• 21:22of thinking about how the research
• 21:24side of things we need to work and
• 21:26partner with clinicians who are
• 21:27directly working with families in
• 21:28order to really make sure that the
• 21:30research is as effective as it could
• 21:32be in targeting and in supporting
• 21:33the women who really need it more.
• 21:37Research lens my labs.
• 21:39Looking at and interested in
• 21:41mechanisms that may confer risk
• 21:43in the perinatal period and
• 21:45forming caring for their children.
• 21:47And so we really started off
• 21:48looking in the postpartum period and
• 21:50thinking about challenges to mental
• 21:52health and the post Natal period.
• 21:54Starting to identify mechanisms then
• 21:55and then moving backwards and looking
• 21:58at seeing those mechanisms are there
• 21:59and present in the prenatal period too.
• 22:02The advantage being is if we can work
• 22:04with women when they're pregnant that
• 22:06that that the generally easier to access.
• 22:08That they don't necessarily have
• 22:10the childbearing demands that
• 22:11they would have postnatally,
• 22:13but more generally,
• 22:13thinking about the earlier,
• 22:14we can intervene the better.
• 22:16So why wait to baby the baby to arrive
• 22:18to identify risk when we could be
• 22:20identifying that risk much earlier?
• 22:21So there's a big drive in the lab now
• 22:23to be thinking about mechanisms across
• 22:25the perinatal period and as early
• 22:27as those mechanisms might manifest,
• 22:29the faster we can jump on them and always
• 22:31be able to start characterizing who
• 22:33may or may not be at risk in that way.
• 22:36So I wanted to give a specific example.
• 22:38As a way of illustrating how we've
• 22:41worked with clinicians to think about
• 22:43mechanisms and how those mechanisms
• 22:44can then transition back into thinking
• 22:47about clinical work that way,
• 22:49so a lot of work that we do in the lab
• 22:51focuses on maternal substance use disorders,
• 22:53and so this is a an area that Doctor
• 22:55Lowell has a lot of expertise in
• 22:57in terms of working with mothers
• 22:59through pregnancy and the post
• 23:00Natal period who have a host of
• 23:03different substance use disorders,
• 23:04but we really got interested in this.
• 23:06As I said in the past night
• 23:08period to begin with.
• 23:09Primarily because what we
• 23:10were hearing from clinicians,
• 23:11but also what we were seeing,
• 23:12being published in the literature,
• 23:13is that many mothers who have substance
• 23:15use disorders also have significant
• 23:17challenges in caring for their children.
• 23:19And it really made us think about,
• 23:21well,
• 23:21we don't want this.
• 23:23One size fits all approach at
• 23:24mothers with substance use disorders
• 23:25are all going to have challenges.
• 23:27Caregiving clearly they're going
• 23:28to be protective effects.
• 23:29It's not all mums who are
• 23:31having these challenges,
• 23:31but what is it that makes it particularly
• 23:33challenging for mothers of substance
• 23:35use disorders that we can you know,
• 23:37potentially work with it
• 23:38and try and understand.
• 23:39In order to help develop and
• 23:42refine intervention programs.
• 23:44So we came at this through
• 23:46a neurobiological lens,
• 23:47primarily because we wanted to get
• 23:48into this idea around mechanisms,
• 23:50and are there biological mechanisms
• 23:52that might under score what we're
• 23:54observing in mothers with substance
• 23:55use disorders that we can then
• 23:57feed back to the clinicians and
• 23:59to help them refine what you know
• 24:01the work they're doing?
• 24:02And then we have this iterative
• 24:04discussion back and forth to help them
• 24:06inform research wise what we're doing.
• 24:08And so we started off at a very basic level
• 24:10in terms of just looking at a
• 24:12whole host of research that.
• 24:14Listed primarily in animal studies and
• 24:16with far fewer studies of human mums,
• 24:18but you know where we've started to see
• 24:20you know what the neural mechanisms
• 24:22that might be implicated in caregiving.
• 24:24But also what are those neural mechanisms
• 24:26that are implicated in addiction and
• 24:28we've learned in the past ten years
• 24:30how much plasticity there is no in the
• 24:33human maternal brain that there's so
• 24:35much change that's happening during
• 24:36pregnancy and the post Natal period?
• 24:38This seems to be driving towards helping
• 24:41mom think execute maternal behaviors.
• 24:44Caregiving and raising her child in the
• 24:47post Natal period and so we wanted to
• 24:49think about what that plasticity is there,
• 24:50how my addiction be interrupting that
• 24:52and when we looked at the literature of
• 24:55the first thing that became very apparent
• 24:57is that in in the human studies and in
• 24:59the animal studies there are there are
• 25:01two sets of neural circuits that were
• 25:03really being heavily impacted by addiction.
• 25:06There was neurosecretory.
• 25:07They're implicated in
• 25:08stress so how individuals,
• 25:10irrespective of addiction,
• 25:11that how individuals regulate and
• 25:13respond to stressful situations?
• 25:15And the presence of addiction.
• 25:16And we can think about addiction as
• 25:19a stress dysregulation disorder.
• 25:20These individuals just really have a hard
• 25:22time in terms of regulating their stress,
• 25:25but we also know being a new
• 25:27parent is stressful.
• 25:28Again, in the absence of addiction.
• 25:30But also in the presence of addiction.
• 25:31Caring for a child across development
• 25:34is just inherently stressful too,
• 25:36and so we saw you know to begin with.
• 25:38While if there's this neurobiology
• 25:40of parenting that focuses on stress,
• 25:42but also we know those stress systems
• 25:44are compromised by addiction.
• 25:45This might give us a neurobiological pathway
• 25:47through which to understand where some of
• 25:50these challenges parents may be experiencing.
• 25:52If they're managing an addiction
• 25:53on top of caring for their child.
• 25:56A second, your second.
• 25:57We also lived here,
• 25:58and you're a second that are involved
• 26:00in reward or how we experience
• 26:01and understand pleasure.
• 26:03Again,
• 26:03we see that those neural circuits
• 26:05are compromised in addiction that
• 26:07individuals with addiction tend to
• 26:09find stimuli or information just
• 26:11less pleasurable and less enjoyable
• 26:13in comparison to the substance that
• 26:15they may be using and abusing.
• 26:17But we also know that reward is
• 26:19somewhat important and and pleasure
• 26:20so much important has so much
• 26:22importance of caring for the child to
• 26:24inherently we talk about parenting.
• 26:26General as being this balance of
• 26:27stress and reward that there's
• 26:29a joys of being a parent,
• 26:30but there's also the challenges
• 26:31of being a parent too,
• 26:33so it started to give us another
• 26:35neurobiological mechanism that
• 26:36we can think through again in
• 26:38the presence of addiction.
• 26:39Whether it's reward circuits would
• 26:41typically be responsive to baby,
• 26:43that in when addiction is present,
• 26:45they may be less responsive,
• 26:47and so we started having these
• 26:49these discussions around.
• 26:49While we've seen this,
• 26:51but we've not really tested that hypothesis,
• 26:53and so we want we wanted to look at was to
• 26:55see what is there any evidence in human?
• 26:57Those with addiction that they have
• 26:59this more stress reactive response
• 27:01and less rewarding response when
• 27:04engaging with their children.
• 27:05And so the way we went about testing
• 27:07that was to begin again personally.
• 27:09And we recruited mothers from the local
• 27:12community and just to view photographs
• 27:13of infant faces or to listen to infant
• 27:16cries so our infant cries being the
• 27:18stressful cries that we hear you kind of
• 27:20very early on in the first night period,
• 27:22but also having photographs
• 27:24of baby smiling, you know,
• 27:25especially if it's own baby smiling at them.
• 27:27You know, some would argue that that's the
• 27:29most rewarding stimulus you could show mum,
• 27:31and especially kind of those
• 27:33first few months postpartum.
• 27:34So we had mothers view those
• 27:36photographs and also listen to those
• 27:37infant cries and what we saw was
• 27:39consistent with our hypotheses.
• 27:40We saw that you know,
• 27:41particularly when mums were
• 27:43looking at these very positive.
• 27:44These very rewarding and for faces that
• 27:46they not only showed a decreased neural
• 27:49response and their reward neurosecretory,
• 27:51but there was also a delayed neural
• 27:53response in their same neuro seconds in
• 27:55comparison to women without substance use.
• 27:57Disorders and importantly,
• 27:58we looked at this in the context
• 28:01of nicotine addiction,
• 28:02as well as polysubstance use,
• 28:04and we saw very comparable findings,
• 28:06so we don't think this is about
• 28:08addiction to one specific drug,
• 28:09but we think it's about substance
• 28:11use and substance abuse.
• 28:12More generally,
• 28:13just regulating these key neural circuits
• 28:15that we know are important for parenting.
• 28:17So why is this helpful to know?
• 28:19Well,
• 28:19it gives us a chance to then feedback
• 28:21to clinicians like Doctor Lao to say,
• 28:23well,
• 28:23we think that there's a neurobiological
• 28:24basis and many of the challenges that
• 28:26these mothers are experiencing whilst
• 28:28they're caring for their children price.
• 28:29Lately,
• 28:30we think that there's this
• 28:31increased reactivity to stress,
• 28:33but also this decreased reactivity to
• 28:35what would be considered more rewarding,
• 28:38and so that allows mechanisms and money
• 28:40for clinicians to be thinking about.
• 28:42Well, how can we start targeting stress?
• 28:43How can we start targeting stress regulation
• 28:46and thinking about that as a skill?
• 28:47That we can work with with mums,
• 28:49but also how can we think about
• 28:51ways that mums can really take a
• 28:52moment really just pause and think
• 28:53about the enjoyment and pleasure
• 28:55that they're experiencing while
• 28:56they're engaging with children,
• 28:57so it allows us to very robustly
• 29:00think about mechanisms in terms of
• 29:01what we can feedback from clinicians.
• 29:04But also,
• 29:04it gives clinicians something that
• 29:05they can tell mothers to that this
• 29:07isn't something that ambiguous
• 29:08or cloudy that it really gives
• 29:10them an opportunity to say.
• 29:11And we think that there's a
• 29:13neurobiological basis to the
• 29:14experiences that you're you're
• 29:15managing managing right now,
• 29:16that it gives you know.
• 29:17Like something very concrete
• 29:19to be working with in that
• 29:21way, so that's what we really hope.
• 29:22This partnership between clinicians
• 29:24and researchers can go forwards.
• 29:26And I think the other piece,
• 29:28just to echo what Doctor Lou was
• 29:30saying at the end and how scalability.
• 29:32But it's also about important to recognize
• 29:34individual differences here as well.
• 29:36And and we really try and think
• 29:37about this as not as a group of
• 29:39mums with substance use disorders.
• 29:40Best is out.
• 29:41Or mums with depression or with anxiety.
• 29:43Besses starts with without but
• 29:44really thinking about all months
• 29:46and thinking about how that varies.
• 29:48And every mom comes to their parenting
• 29:50situation with a different background,
• 29:51a different history,
• 29:52their own experience of being parented,
• 29:54their own experience and decision
• 29:56making about how they want to.
• 29:58Present themselves,
• 29:58but these are all factors that we
• 30:00have to take into consideration too
• 30:02that that it's too superficial to say,
• 30:04OK, let's put all these mums into
• 30:05one camp and compare them to a
• 30:07group of mums in a different camp.
• 30:08But the individual differences approach
• 30:10to this idea that that we need to scale,
• 30:13but we need to be mindful of the nuance
• 30:15of the maternal experience is really
• 30:18important in this situation as well.
• 30:20So that's why I wanted to to share
• 30:22with you about research and trying
• 30:23to make that bridge then with what
• 30:24you're hearing from Doctor Lowell.
• 30:27That's wonderful, thank you so much.
• 30:28Doctor Rutherford. I you know,
• 30:30just just extending that then to thinking
• 30:33about the impacts on the child you
• 30:35touched on a topic that is very near and
• 30:38dear to my heart and research program.
• 30:40Thinking about how we can better
• 30:42understand individual differences
• 30:43and the impact of perinatal anxiety
• 30:46and depression on child outcomes.
• 30:47And that's really a public health challenge,
• 30:50but it's a scientifically
• 30:52fascinating question.
• 30:53You know, trying to understand the
• 30:55embedding of that university and.
• 30:57Trying to determine whether or not we can
• 31:00mobilize information about biological
• 31:01embedding to better understand and
• 31:03identify children at greatest risk
• 31:05and one of the tools that my team
• 31:07has been involved in developing is
• 31:10a measure of biological age that we
• 31:13can derive from simple cheek swabs.
• 31:15So we just collect eucalypt athelia
• 31:17cells or cheek swabs from neonates
• 31:19from infants from children.
• 31:21It's very well tolerated and we can
• 31:23estimate a child's biological age, and,
• 31:26in a very recent study, we examined.
• 31:29Biological aging in children at 6 and 10
• 31:33years of age and then at three months,
• 31:35nine months and 24 months of age
• 31:38and two independent cohorts,
• 31:39and what we found was that
• 31:42maternal prenatal anxiety,
• 31:43accelerated biological aging or epigenetic
• 31:46aging with marked individual differences,
• 31:50suggesting that not all
• 31:51children were affected,
• 31:52and indeed that's one of the outcomes
• 31:54that we are one of the findings
• 31:56that we see in multiple studies is
• 31:58that not all children are affected.
• 32:00And that's an important public
• 32:01health message to get across.
• 32:03Most children,
• 32:03even if they're exposed to anxiety,
• 32:05depression will do just fine,
• 32:07and that's the the the reassurance
• 32:09that we can provide to anyone
• 32:10that may be pregnant or no.
• 32:11People who are pregnant.
• 32:13But of course,
• 32:14the question is why is it that
• 32:16those children that are affected are
• 32:17affected in the way that they are?
• 32:19And that's where we're hoping that some
• 32:22of these biological tools might be
• 32:24able to help us identify individuals
• 32:26that are at greatest risk following
• 32:29exposure to perinatal anxiety.
• 32:31Or depression,
• 32:31now we've switched on a lot of
• 32:34topics right now,
• 32:35and you know doctor Little
• 32:36you mentioned about,
• 32:38you know the the the critical
• 32:40importance of partner support and you
• 32:42know they you know kind of shocking
• 32:44and levels of domestic violence that
• 32:47actually increase during pregnancy
• 32:49and indeed another leading cause of
• 32:52maternal mortalities is homicide.
• 32:54And you know,
• 32:55and doctor Ruthford you talked
• 32:57about really elegant neurobiological
• 32:58research trying to understand individual.
• 33:01Differences and maternal behavior.
• 33:03So I just wanted to to pause for
• 33:05a moment to see if anyone had any
• 33:07thoughts or questions or clarifications
• 33:09about anything that we've touched
• 33:12on and so far before we talk a
• 33:13little bit about some of our future
• 33:16plans within the center.
• 33:28Just looking from just looking
• 33:30for anyone raising their hand
• 33:31or putting things in the chat.
• 33:34Alright, well I have I'm too slow to
• 33:37raise my hand just a moment here and
• 33:39I'll there look there we go. So so.
• 33:44Is your substance use disorder?
• 33:48Work all done on an outpatient basis.
• 33:52And if so, how are they?
• 33:55How are these folks finding their
• 33:56with mothers finding their way to you?
• 34:02Yeah, that's a great question,
• 34:04and so yes, so we primarily been
• 34:06working with outpatient mothers
• 34:08with substance use disorders,
• 34:09and so there's been two real approaches that
• 34:12we've been able to recruit these women.
• 34:14One is through partnerships with clinics,
• 34:16and so we're at clinics who are
• 34:19seeing mothers for whether it's
• 34:21counselling or CBT based treatments,
• 34:24but also through medicated assistant
• 34:27Medicaid therapeutic approaches.
• 34:28For instance, methadone maintenance.
• 34:30So you've been working with clinics.
• 34:32That we found that the vast majority
• 34:34of our mothers have come through
• 34:35word of mouth and through Flyers
• 34:37and Community efforts that we have
• 34:38in the local New Haven area.
• 34:40So we have a dedicated recruitment
• 34:43coordinator who's a mum who lives in
• 34:45New Haven is a well recognized mom in
• 34:48the New Haven area and so she spends
• 34:50a lot of times in our grocery stores
• 34:52and our libraries and then around
• 34:55family areas in the New Haven area.
• 34:57And it's got a lot of report in
• 34:59the community and so we're not
• 35:00always specifically recruiting for
• 35:02mothers with substance use.
• 35:03So it is what we find is that when
• 35:05we're cutting broadly from others,
• 35:06a significant proportion of them
• 35:08have substance use disorders,
• 35:09and I think that that's been very
• 35:11striking for us when we look at
• 35:13our Community samples that you
• 35:15know their community samples with
• 35:16elevated levels of substance,
• 35:18use of a number of meeting criteria
• 35:20for substance use disorders.
• 35:21So that's kind of been our
• 35:23main recruitment approach.
• 35:27So I have a question.
• 35:28I have a question. This is priska,
• 35:30so the data is very striking that
• 35:33it's one in four women who are
• 35:35pregnant who feel depression or I.
• 35:38I can't remember what the terminology is,
• 35:40but I'm and it's possibly now one
• 35:42in three and I was wondering this
• 35:44is data hold up industrialized
• 35:46countries and also any speculation
• 35:49you know like and also within the US.
• 35:52Is it skew social economically?
• 35:54And any speculation as to why?
• 35:57This is going up.
• 35:59Yeah, that's that's a wonderful
• 36:00question and you know.
• 36:02And if I if I had been
• 36:03speaking to you a year ago,
• 36:04I would say you know in
• 36:06high income countries we're
• 36:07thinking you know one in five,
• 36:08perhaps one in four with
• 36:10this generational increase,
• 36:11and in some low and middle income countries
• 36:13the number would have been one in three.
• 36:15So for example,
• 36:17we're working with a run early
• 36:20intervention project in rural
• 36:21Vietnam and we see more than 30%
• 36:24of pregnant individuals struggling
• 36:25with their mental health.
• 36:27And so in in resource constrained
• 36:29environments or in low and
• 36:30middle income countries,
• 36:31there can be a higher level of need.
• 36:35But now, with the ongoing pandemic,
• 36:37we're seeing that the the rates
• 36:39the prevalence rates in the
• 36:40United States are even comparable
• 36:42to those rates observed in in
• 36:44resource constrained environments.
• 36:46Now obviously the the drivers may
• 36:48be slightly different across those
• 36:51different contexts, but you know,
• 36:53I think common risk factor is,
• 36:55you know, poverty, early stressful.
• 36:57Events reduced or low partner support.
• 37:00There's a critical role for the
• 37:03partner in supporting perinatal
• 37:05mental health and so I think that
• 37:08that is seen universally that partner
• 37:10support is one of those either
• 37:12protective factors or we flip it on its head.
• 37:15It's a risk factor,
• 37:16and with the absence of of partner support,
• 37:19and so you know the one in three is
• 37:21is what we would have thought of that
• 37:22for low and middle income countries
• 37:24and some low and middle income countries.
• 37:26But now we're seeing that
• 37:28in the United States.
• 37:29And again,
• 37:30that is that will depend also on
• 37:31the Community and Community level,
• 37:33risk factors and so that that number
• 37:35will will depend on contextual factors.
• 37:48Why don't you talk about your
• 37:49future future plans? Well,
• 37:52you know I think what what we hope you've
• 37:54seen today is that there's there's
• 37:56concentrated expertise in perinatal
• 37:58mental health here in the Child Study
• 38:01Center and ranging from basic research
• 38:03through to clinical practice and really,
• 38:08a placing an emphasis.
• 38:09Then on educating the next generation
• 38:12of clinicians and what we are,
• 38:14what are what the but the future of the CHILD
• 38:16Study Center in perinatal mental health?
• 38:17The child study?
• 38:18Center and we hope to capitalize on our
• 38:21relationships with obstetrics and gynecology
• 38:24and reproductive sciences and Pediatrics.
• 38:26To really create a coordinated approach
• 38:28to support mental health of pregnant
• 38:31individuals and their children,
• 38:33and so that would take three main forms.
• 38:38One would be realizing improved or
• 38:41universal screening in pregnancy
• 38:43or pregnant individuals.
• 38:45As I mentioned to you at the
• 38:47start of our conversation.
• 38:48The screening tool that's most
• 38:50commonly used was developed in the 80s,
• 38:52and it doesn't ask about substance use.
• 38:55It doesn't ask about partner support.
• 38:58There are key aspects of
• 39:00pregnant individuals,
• 39:01experience and risk factors for
• 39:03perinatal mood and anxiety disorders
• 39:05that are not captured in some of
• 39:08these older screening assessments,
• 39:09and we know that 95% of women of
• 39:13childbearing years and when a smartphone,
• 39:15for example and one of the studies that
• 39:17we're involved with at the moment.
• 39:19Is trying to determine whether we
• 39:21can develop digital biomarkers so
• 39:23biomarkers related to social support
• 39:25from a pregnant woman's use of
• 39:28her cell phone,
• 39:28so really trying to explore new
• 39:32approaches to achieve greater coverage,
• 39:35greater screening of pregnant
• 39:37individuals in pregnancy,
• 39:39and so approximately 7% of pregnant
• 39:41individuals are screened in pregnancy
• 39:43and in the postpartum and in in
• 39:45the Yale New Haven Hospital system
• 39:48and we really want to.
• 39:49Exceed those American College of
• 39:52Obstetricians and gynecologists
• 39:53recommendations and really move
• 39:55that number up.
• 39:56I think one of the biggest questions
• 39:58that then remains for in the field is
• 40:01whether or not we can improve child outcomes.
• 40:04If we improve maternal anxiety
• 40:06or depression in pregnancy.
• 40:09And So what we're lacking in that
• 40:11context is a very large scale where
• 40:14bus study of interventions that can to
• 40:17whether we can determine if we can.
• 40:19Move the needle on emotional behavioral
• 40:22problems in children and following
• 40:25treatment of maternal anxiety and
• 40:27depression and thinking about how we
• 40:30can develop this cross fertilization as
• 40:33as Doctor Rutherford and Lowell mentioned,
• 40:35this is already going on in the CHILD
• 40:37Study Center where you have research,
• 40:39informing practice and practice
• 40:41informing research and we want
• 40:43to bring that to scale to really
• 40:45develop increased access to evidence
• 40:48based treatments and improved.
• 40:50Treatments for perinatal mood and
• 40:52anxiety disorders and doctor Lowell
• 40:54touched on this a little bit.
• 40:56Is that you know,
• 40:58not all treatments will work for
• 41:00an individual.
• 41:00We need to develop a way of targeting
• 41:04these treatments more effectively.
• 41:06So in on in oncology we talk a lot about
• 41:08precision medicine or personalized
• 41:10approaches and what we want to
• 41:12do is really realize the full
• 41:15potential of personalized perinatal
• 41:16mental healthcare and then the
• 41:18final pillar of this strategy.
• 41:20Is really to try and ensure that
• 41:22there's an emphasis placed on
• 41:24training and education for the
• 41:26future generation of clinicians
• 41:28and scientists and so that there
• 41:30we can break down those silos and
• 41:33between disciplines to ensure that
• 41:36we're really trying to develop a
• 41:39holistic approach to improving
• 41:41perinatal mood and anxiety disorders.
• 41:46So that's the future we're working towards,
• 41:48and we're excited to share that vision
• 41:50with you and and welcome any feedback
• 41:52that you would have on our as we as
• 41:55we embark on this exciting journey.
• 42:07Amanda, there's a question
• 42:09that I think perhaps also
• 42:12touches on thinking about it.
• 42:13Learning ahead. As you think about
• 42:16your clinical work with parents.
• 42:19Are there particular research
• 42:20questions that you would want to have?
• 42:23Karen Helena? Really,
• 42:24the three of you think about.
• 42:28Has that absolutely. I mean, that's.
• 42:35And because I think that that really
• 42:37closes the feedback loop as well.
• 42:41So my biggest wish for questions
• 42:46that research can answer are. How?
• 42:50How does treatment you know with
• 42:53helenas example in particular right?
• 42:59She speaks to the ways in which.
• 43:05The brain responds differently when
• 43:06addiction is part of the picture,
• 43:09and so I will come.
• 43:10And I'll train clinicians and I'll say
• 43:12that this is the case, and then the
• 43:15first question that gets asked is OK.
• 43:17So when we give them the treatment that
• 43:19you're training us to do, does that fix it?
• 43:21Does that and so that becomes.
• 43:23Then we know that there are these
• 43:26neural circuits that are disregulated.
• 43:30For substance use in particular,
• 43:32but Doctor Rutherford,
• 43:34you've done research on anxiety
• 43:36and depression as well, right?
• 43:39And so I think that this is kind
• 43:41of a broad question, but it is.
• 43:44When we then put the intervention into place.
• 43:48Then what?
• 43:50That's that's the $1,000,000 question.
• 43:54For for myself as well as,
• 43:55then the clinicians that
• 43:58I that I'm also training.
• 44:00And.
• 44:00The other layer to that is sometimes
• 44:03when I'm training clinicians I'm.
• 44:05I'm also in my in the audience and
• 44:08includes folks like peer recovery coaches,
• 44:11so these are individuals mothers with
• 44:14lived experience of addiction themselves,
• 44:17and they so they're experiencing
• 44:19this information on multiple levels,
• 44:21and that question becomes even more
• 44:23like the answer to that question
• 44:24becomes even more important to
• 44:26them because it matters to them
• 44:28professionally as well as personally.
• 44:30So I would love to have an answer to that.
• 44:33To that question.
• 44:36So I have so I have another question.
• 44:38This is priska sorry I I said I was
• 44:41going to ask a lot of questions.
• 44:43I'm not clear as to how you define addiction.
• 44:47So is it like?
• 44:48People who can't get through
• 44:51the day or is it?
• 44:53So I just I don't know anything about
• 44:56addiction and I do know that marijuana
• 44:59use is now being legalized across
• 45:01many States and I was wondering,
• 45:04does that count?
• 45:05Is that considered an addictive?
• 45:08Is that something that will fall
• 45:09or do people do fine with that?
• 45:11And so I just like to be clear
• 45:13to what makes how do you classify
• 45:16someone as as as being an addict?
• 45:21I'm going to actually. Yeah,
• 45:24I'm going to. I'm going to let either.
• 45:27I see Doctor Rutherford nothing. Yeah,
• 45:29I didn't know if you wanted to
• 45:31start the flow and then I can.
• 45:32I can tell you how we do
• 45:34it through research lens,
• 45:34but I don't know if you wanted to
• 45:36speak to you. Sure, sure,
• 45:37because I I I have a feeling that I know
• 45:40what you might say from the research
• 45:41lens and I think that you're taking
• 45:43it in a really exciting direction
• 45:45because to to spoil that actually,
• 45:49you know it becomes less of
• 45:51a categorization I think,
• 45:52and more of a of a question
• 45:55about degree of substance use and
• 45:57severity of of substance use and.
• 46:00Anyway, so I'll I'll let Doctor
• 46:02Rutherford explain a little bit
• 46:04about that but addiction, you know,
• 46:07I think clinically we're thinking
• 46:08about it in terms of physical
• 46:10dependence on the substance,
• 46:12and so the need to use the substance
• 46:15in order to remain at homeostasis.
• 46:19And then when you have not used
• 46:21that substance in some time,
• 46:22your body begins to go into
• 46:24withdrawal symptoms.
• 46:24And that's a pretty clear cut
• 46:28definition of what addiction?
• 46:30Might be,
• 46:30but I think it's much more complex than that,
• 46:33and that's where I'll let Doctor
• 46:35Weatherford speak about it.
• 46:39Q So the only piece I would add then is that
• 46:41we're trying to move away from this
• 46:43categorical present or absent distinction.
• 46:45That's usually the case in research
• 46:47studies and that you have your criteria,
• 46:50whether it's an interview that
• 46:51the individuals complete,
• 46:52or whether it's a checklist of symptoms,
• 46:55and so we're trying to move it into
• 46:57more of what we call continue as
• 46:58approach to thinking about the frequency
• 47:00or the severity of the substance.
• 47:02Use has two advantages.
• 47:04One is that we move away from this time.
• 47:09And then you know it's just
• 47:11one category of individuals,
• 47:12whether their mums or otherwise
• 47:13going into that group.
• 47:14But it also gives us as a second piece
• 47:17an opportunity to look more broadly,
• 47:19so to look across mothers everywhere
• 47:22in the context of our research,
• 47:23that we don't necessarily think about,
• 47:24then only mothers who meet
• 47:26these particular criteria.
• 47:27But we can include mothers who may
• 47:29be smoking cannabis regularly but
• 47:31aren't dependent upon it in the way
• 47:33that Amanda was describing in terms of
• 47:35needing to maintain that homeostatic,
• 47:37or that that.
• 47:38Physiological balance in their body,
• 47:40and so it really allows us to think more
• 47:42about what the substance use represents,
• 47:44how it's being used,
• 47:45rather than the physical dependency.
• 47:47And that's going to that,
• 47:48you know,
• 47:49we think that that's going to vary a lot.
• 47:50Kind of parent by parent in terms of why
• 47:52that substance is being used to begin with.
• 47:54So we we've just have a paper under
• 47:56review where we've replicated all
• 47:57the categorical findings with
• 47:59this new continuous approach.
• 48:00So we're really excited that
• 48:02that's going to be coming out soon.
• 48:03And now we're trying to push that
• 48:05a bit further to say, OK,
• 48:06how does this then these brain substance use?
• 48:09Associations now then linked to
• 48:11behavior and behavior that we
• 48:13can observe in parents too.
• 48:15So thank you for setting that up, Doctor.
• 48:19Risk of the set help.
• 48:26Yes, yes it does. Yes it does.
• 48:28I knew it's kind of a broad question.
• 48:30A little off topic, but as you were talking
• 48:33I realized I didn't have a great appreciation
• 48:35of how addiction is defined. So thank you.
• 48:39And I would just add I don't
• 48:41know that it's so much.
• 48:42It's actually not all topic and I
• 48:43don't know if Doctor Rutherford
• 48:45wants to speak more to this,
• 48:46but we because you did touch on it.
• 48:48Helena that we think about how
• 48:50addiction and reward systems come
• 48:52together and how parenting and
• 48:54reward systems come together.
• 48:56Do you want to?
• 48:58It's not saying that parents
• 48:59are addicted, but
• 49:01yeah, although early on in the kind
• 49:03of the literature that that language
• 49:04is being used to describe how
• 49:06parents respond to their children,
• 49:07they do become addicted that it is
• 49:09this your complete preoccupation
• 49:10with a child and that very much
• 49:12you're if you look at just the
• 49:15behavioral description of how mothers
• 49:16were talking about their children
• 49:17and thinking about their children,
• 49:19that it paralleled and addictive state too.
• 49:21So there's some history there in terms of
• 49:24thinking and that about it in that way.
• 49:26So I think that that's where.
• 49:28That there's a lot of overlap here in
• 49:30terms of these neural circuits and
• 49:31neural circuits are implicated in
• 49:33attachment behaviour and parenting behaviour,
• 49:35but also an addiction to the other piece.
• 49:37If it's just a right to add on quickly
• 49:39to what Doctor Laura was saying too,
• 49:41was that you know she and I had
• 49:43shared a bit about addiction and and
• 49:45Doctor O'Donnell had talked about
• 49:46depression anxiety,
• 49:47and I think one of the areas that
• 49:49we all want to see grow is the ideas
• 49:51of biomarkers not being specific
• 49:53to 1 clinical disorder,
• 49:54but how they may be transdiagnostic too,
• 49:56and I think it's really important
• 49:58to recognize.
• 49:58At the fundamental level of
• 50:00Eminem is caring for a child.
• 50:02That child stimulus is exactly the
• 50:04same across all these parents.
• 50:05In terms of there's a dependent there,
• 50:07there's a child there that's pulling
• 50:08for mum's attention and mum is trying
• 50:10to put off for their attention and
• 50:12what we're interesting is trying to
• 50:14to understand the Intersect in biology
• 50:16and psychology here to to figure out
• 50:18is this all going to be specific to
• 50:201 clinical disorder or are we going
• 50:23to see commonalities across depression,
• 50:24anxiety and substance use?
• 50:26Especially so many of these that
• 50:27comorbid of each other too.
• 50:30Lynn, you had a question.
• 50:33Yeah. Kind of a comment and a question,
• 50:37so I'm in Minneapolis, also
• 50:39known as the treatment capital of the country
• 50:43and. I recently learned that we
• 50:47have two programs here that take.
• 50:51For inpatient substance abuse treatment.
• 50:54That allow mothers to bring children.
• 50:58Is that common? Do you?
• 51:00Do you have that and and?
• 51:02And why don't?
• 51:02Why don't we see more of that
• 51:04for inpatient mental health?
• 51:09Because I would, I would imagine that
• 51:11it would overcome some resistance
• 51:14towards attending treatment.
• 51:16If you could bring your.
• 51:18Your kid. Absolutely.
• 51:21Amanda, you were nodding.
• 51:23Do you want to start that?
• 51:25I would say that it's not uncommon for
• 51:30this to be the case for residential
• 51:34substance use treatment. Umm?
• 51:37At least in the communities that I've served,
• 51:41and that I've worked in.
• 51:44And it's not an uncommon model
• 51:48and and I think that.
• 51:52The neurobiology research becomes
• 51:54so important when we're thinking
• 51:57about if we're trying to kind of.
• 51:59Reverse. The circuitry and
• 52:03make parenting more rewarding,
• 52:06like at the child's presence
• 52:09becomes very important.
• 52:10I'm not sure the answer as to why
• 52:13that's not extremely common for mental
• 52:15health treatment I I actually am
• 52:17racking my brain and can't think of.
• 52:20Personally, any settings where that occurs.
• 52:24I don't know if others are familiar
• 52:26with that kind of model, yeah?
• 52:31In the UK, actually it's a very common
• 52:33model for mother and baby units,
• 52:35and so we're pregnant individuals
• 52:37or individuals with neonates and
• 52:40can be admitted on to award,
• 52:42and actually a large systematic
• 52:44review hasn't found clearly convincing
• 52:47evidence for clinical benefits,
• 52:50but certainly benefits in the context of
• 52:53patient reported and kind of perception
• 52:56of the care that they've experienced.
• 52:58I do know, anecdotally.
• 53:00That a mother and baby that was
• 53:02set up one of the first to be set
• 53:05up here in the United States and
• 53:07that was found it challenging to
• 53:10actually have insurers and reimburse
• 53:13for the stay of healthy neonates.
• 53:16So there was no justification for
• 53:19the hospitalization of the neonate,
• 53:21and so the neonate could stay with
• 53:23the mother during visiting hours.
• 53:25And during the day,
• 53:26but then couldn't stay overnight in
• 53:28that particular mother and baby unit.
• 53:31So it is a it is a model of care.
• 53:33And but it's there.
• 53:34May be contextual factors here that
• 53:36that limit its widespread availability.
• 53:44I wonder too. Also, if there are factors
• 53:47around how often times child and adult
• 53:50services go by different tracks and.
• 53:55Right, right? I mean that's a really big
• 53:58implementation question that we have at
• 54:01this moment when it comes to delivering
• 54:03evidence based parenting support to mothers
• 54:05with the with addictions in particular.
• 54:08So those in treatment for for opioid use
• 54:12disorder who need parenting to support,
• 54:14where do they get that?
• 54:15Is that meant to be delivered at
• 54:17in the substance?
• 54:17Use treatment setting?
• 54:19Or is it meant to be delivered by
• 54:22in the child development setting?
• 54:25And it it's it's a question around insurance,
• 54:28but it's also around a question
• 54:30around expertise because there's not
• 54:33much cross pollination among these
• 54:35two worlds or expertise of folks who
• 54:38know about addiction and parenting.
• 54:41And oftentimes, which I just
• 54:42underscores what the three of you are
• 54:45highlighting around the perinatal.
• 54:47That type program in perinatal
• 54:50behavioral health would be in a child
• 54:53study center as we're really trying
• 54:56to blend expertise across disciplines.
• 54:58Obstetrics Pediatrics,
• 55:00adult psychiatry, child psychiatry.
• 55:05I think we have time for one more question.
• 55:09Turning to the turning to the group.
• 55:15And Krista has put a A in the chat.
• 55:18Has put about the feedback.
• 55:26So let me just say to the three
• 55:28of you I know we've spoken about
• 55:31the the great opportunities.
• 55:33Are there any challenges that we might
• 55:36still also frame as opportunities
• 55:38that you'd want to to highlight?
• 55:41Or any concluding remarks that
• 55:43you'd want to have for us.
• 55:48I think that we've made progress on stigma,
• 55:51but I think stigma surrounding
• 55:53perinatal mental health still remains.
• 55:56I think that is a challenge both
• 55:58when thinking about screening,
• 56:00you know whether or not people are likely
• 56:02to disclose and their their their struggles,
• 56:04particularly if we think about
• 56:07minoritized populations,
• 56:08and I think they're you know has been,
• 56:11you know, kind of challenges in the
• 56:13past with with those families getting
• 56:15victimized by Child Protective Services.
• 56:17And so I think that we need to be aware.
• 56:19Of issues and barriers to people being
• 56:21able to disclose how they're feeling,
• 56:23perhaps you know,
• 56:24the generational increase that
• 56:26we're seeing in rates of mood and
• 56:29anxiety disorders actually reflects
• 56:31maybe a greater openness to discuss
• 56:34and individuals mental health,
• 56:36but I think that stigma does
• 56:37remain a challenge, and, you know,
• 56:39I'm aware that this is a heavy topic.
• 56:40We're aware that this is a heavy topic,
• 56:42and it's heavy because it's it's important,
• 56:44but what we've really tried to
• 56:46emphasize today is that there
• 56:47are there is hope there is.
• 56:49There are.
• 56:49You know,
• 56:50kind of research breakthroughs that
• 56:51Doctor Ruth but has been talking about.
• 56:53You know Doctor Lowell has talked about
• 56:55really advances in our ability to
• 56:57treat and move the needle on improving
• 56:59and mood and anxiety disorders,
• 57:01so we don't.
• 57:02We do want you to leave you on
• 57:04a hopeful note that,
• 57:05and really,
• 57:05the future is bright in the
• 57:07context of perinatal mental health
• 57:09care at the Child Study Center,
• 57:11and that we really are standing on
• 57:12the on the shoulders of giants here
• 57:14in the CHILD Study Center as we try
• 57:17in advance and perinatal mental health.
• 57:20Thanks so much to everyone for joining
• 57:23and thank you for the three of you for.
• 57:25Bringing us all into this this area,
• 57:29so thanks again and please stay tuned for
• 57:34another fireside chat. Thanks everyone.