Minnesota Title V MCH Needs Assessment Fact Sheets

Pregnant Women, Mothers and Infants

Promotion of Maternal & Infant Mental Health

Summer 2004

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Size of the Problem

Over 68,000 births occur annually in Minnesota and over 1,096,832 women of childbearing age (15 to 44 years) reside in the state [1].

Seriousness

Infants and mothers affected by mental health concerns
Although Minnesota has limited statewide statistics regarding the magnitude of perinatal depression or related mental health disorders, Minnesota data indicate that self-inflicted injury is the leading cause of hospital-treated injury among women of childbearing age. The National Institute of Mental Health estimates that approximately 70 to 80 percent of women experience some type of postpartum depression usually beginning about two to three days after birth. These “postpartum blues” usually resolve within 14 days but approximately 20 percent of these women will develop postpartum depression that can last up to one year or longer. An additional 10 percent of these women can develop postpartum psychosis, which can disrupt the mother’s ability to adequately nurture her child.

In addition to these estimates on the incidence of postpartum depression, a recent University of Michigan study concluded that 20 percent of the 3,472 pregnant women in the study showed signs of depression while pregnant and many were under-diagnosed and under-treated [2,3].

Children of depressed mothers are more likely than other children to have behavior, cognitive, socio-emotional problems, academic difficulties and health problems [4]. Among families receiving welfare, children of depressed mothers have, on average, lower scores on mathematical achievement tests than other children. Depression among mothers has also been linked to delays in cognitive and motor development among children ages 28 to 50 months [5,6].

Minnesota Pregnancy Risk Assessment-Emotional Health
and Depression Risk, 1998-2001
  Percentage
"Has felt sad or down for more than 2 weeks in the past year"
12.6%
"Has ever been or currently being treated for an emotional disturbance"
11.7%
"Has experienced physical, sexual, or emotional abuse"
14.1%
Source: DHS Mn Pregnancy Assessment Form, 1998-2001. 2003.
N= 54,309 pregnant women on medical assistance

The Department of Human Services report that for the years 1998-2001, representing 54,309 pregnancies, risk factors indicating perinatal mental health and related problems were noted in significant numbers as indicated by the adjacent table.

Data from Minnesota home visiting programs indicate that pregnant women and mothers requested assistance and referral to community agencies for their self-reported emotional and/or mood disorders.

  • In a universally offered home visiting program for new parents in six regions of Minnesota, 19% of the 955 new mothers served in 2000 needed or wanted follow-up related to emotions and depression [7].
  • In current statewide public health nursing family home visiting programs for low-income pregnant women and families with young children, there is anecdotal evidence that 35% of the mothers reported that they were dealing with mental health problems/issues [8].

The 2002 Minnesota Pregnancy Risk Assessment Monitoring System (PRAMS) survey conducted with mothers of newborns found that: 76% were asked by their provider about “baby blues”; 60% said they were “a little to very depressed” in the months after delivery; and 24% said that the time during pregnancy was “moderately to a very hard time.”

National data indicates that parents with higher levels of education (bachelor’s degree) are less likely to show symptoms of depression. Single parents had a higher rate (9%) of reported depression symptoms than parents who lived with a spouse or partner (3%) [9].

Disparities
Women of childbearing age are over-represented in Minnesota data on nonfatal, hospital-treated self-inflicted poisoning [10]. Disparities also exist regarding access to maternal and infant mental health promotion interventions in Minnesota’s rural communities and American Indian tribal reservations, as well as a shortage of providers proficient in culture-specific interventions.

Race-specific data on parents (who report two or more depressive symptoms during the past 30 days) was collected as a part of the national Health Interview Survey (2001) with the following findings [9].

  • White, non-Hispanic- 4.1%
  • Black, non-Hispanic- 5.4%
  • Hispanic- 5.5%
  • Other, non-Hispanic- 4.5%

Economic
No economic impact or cost effectiveness data is available for the impact of treating perinatal and infant mental health problems.

Interventions

Recommendations for interventions have been identified by the 2004 document, Healthy Minnesotan’s Strategies for Public Health, Volume 2 [11]. The document addressed three distinct interventions for perinatal depression and associated stigma:

1. Increase provider awareness about the signs, symptoms and treatment of depression during pregnancy and following birth.
2. Conduct public health nurse home visits to provide routine education and screening for depression during pregnancy and following birth.
3. Address the stigma associated with child and adult mental disorders and seeking mental health, substance abuse and suicide prevention services by educating the general public.

Minnesota does have a prenatal screening tool, called the Minnesota Pregnancy Assessment Form (MPAF), designed through collaborative efforts among the Managed Care Organizations, Minnesota Department of Human Services, Minnesota Department of Health, and perinatal providers.

The MPAF tool is an assessment tool with 39 medical and social risk factors that are related to poor pregnancy outcomes. The screening tool recommendations are: 1) Prenatal care providers are encouraged to screen pregnant women at the initial prenatal visit and at 28 wks of pregnancy; and 2) The screening forms are to be submitted to the Minnesota Department of Human Services for data collection and analysis purposes.

Effectiveness of Interventions
Studies of the impact of professional education show a relationship between improvements in provider performance and patient health outcomes where a variety of educational strategies were involved. A direct relationship with positive health outcomes is most apparent when reinforcing educational elements (case discussion and interactive learning opportunities) are used [12,13].

The NCAST (Nursing Child Assessment Satellite Training) Parent/Child Interaction program is designed to teach those who work with families about the competencies and capabilities of the newborn infant, their effect on caregiver-infant interaction, and ways to effectively translate these interactions. The NCAST scales have been shown to have predictive validity of caregiver total scores with later child cognitive tests, supporting the use of the tools to promote early infant brain development [14,15].

Status

Minnesota Resources
A brief training on a new NCAST/ University of Washington curriculum titled, “Promoting Maternal Mental Health During Pregnancy” was provided statewide by MDH to 250 home visitors in March of 2002 [16].

The training on this new NCAST curriculum was well accepted and some public health nurses and other home visitors are currently using it in their home visiting programs across the state. The Minnesota Department of Health has had numerous requests to provide more extensive training in the area of promotion of perinatal mental wellness, as well as training on screening for perinatal depression and related mental health problems.

Community Awareness
Public health nurses work with non-nursing home visitors, such as parent educators and community health workers, to deliver home-based services to pregnant women and mothers with young children. The public health nurses, and home visitors who partner with them, have identified the need for education in the area of screening, identification and referral for perinatal depression and related mental health problems.

References

1. MDH. Minnesota Center for Health Statistics.2002.
2. Journal of Women’s Health. 12(4). May 2003.
3. Developmental Psychopathology. 16(1):43-68. Winter 2004.
4. Ahluwalia, SK, McGroder, SM, Zaslow, M and Hair, EC. “Symptoms of depression among welfare recipients: A concern for two generations”. Child Trends Research Brief. December 2001. http://shop.childtrends.org/onlinecart/product.cfm?id=654 [Attn: Non-MDH Link]
5. Hair, EC, McGroder, SM, Zaslow, M, Ahluwalia, S., Moore, KA. “How do maternal risk factors affect children in low income families? Further evidence of two-generational implications.” J of Prevention and Intervention in the Community. 23(12):65-94. 2002.
6. Petterson, SM, Albers, AB. “Effects of poverty and maternal depression on early child development.” Child Development. 72(6):1794-1813. Nov/Dec. 2001.
www.srcd.org/subinfo.html [Attn: Non-MDH Link]
7. MDH. Minnesota Healthy Beginnings Report. 2001.
8. MDH. Minnesota Family Home Visiting Summary Report. 2003.
9. Parental Symptoms of Depression. Child Trends DataBank. National Health Interview Survey data, 1998-2001. 2002. www.childtrenddatabank.org [Attn: Non-MDH Link]
10. MDH. Injury and Violence Prevention Unit. 2004.
11. MDH, Healthy Minnesotan’s Strategies for Public Health, Volume2. 2004.
/strategies/mental.pdf
12. Heffron, M. Clarifying concepts of infant mental health-promotion, relationship-based preventive
intervention, and treatment. Infants and Young Children, 12(4), 14-21.2000
13. The Florida State University Center for Prevention and Early Intervention Policy for the Florida Developmental
Disabilities Council. Florida’s Strategic Plan for Infant Mental Health. Tallahassee, Florida. pp. 40-42. 2000.
14. Advisory Committee on Services for Families with Infants and Toddlers. September, The Statement of the Advisory Committee on Services for Families with Infants and Toddlers. Washington, DC: Department of Health and Human Services. 1994.
15. Solchany, JE., and Barnard, K. Is mom’s mind on her baby? Infant mental health in early Head Start. Zero to Three,(22)1, pp.39-47. 2001.
16. Solchany, J. Promoting Maternal Mental Health During Pregnancy. NCAST Publications, University of
Washington, Seattle. 2001.