A better start: Building a brighter future for perinatal mental health at the Child Study CenterMay 12, 2022
April 25, 2022
The second in a new series of webinars, A better start: Building a brighter future for perinatal mental health at the Child Study Center was held via zoom on Monday, April 25, 2022 with YCSC faculty members Amanda Lowell, PhD; Kieran O’Donnell, PhD; and Helena Rutherford, PhD. The session involved a conversation about a new shared vision for the future of perinatal mental health at the YCSC and beyond.
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- 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.
- 01:04Amanda 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.
- 03:04Helena 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.
- 17:41how 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.
- 21:18thank 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,
- 23:21we 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.
- 26:03we 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?
- 28:19it gives us a chance to then feedback
- 28:21to clinicians like Doctor Lao to say,
- 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.
- 28:30we 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.
- 44:00The 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.