"Childbirth educators are crucial front-line professionals in providing information to women about their risks for medical complications related to pregnancy and birth, and postpartum depression is a common problem." - Dr. Katherine L Wisner

Katherine L. Wisner, M.D., M.S., has been involved in clinical work and research since the mid-1980's. Prior to her medical training, she achieved a Master's Degree in Nutrition. Dr. Wisner did a pediatrics internship, is board-certified in both adult and child psychiatry, and completed a 3-year postdoctoral training program (NIAAA-funded) in epidemiology. Her major interest area is women's health across the life cycle with a particular focus on childbearing. In January 2011, Dr. Wisner was chosen as the recipient of AMWA's Women in Science Award for the year 2011. Dr. Wisner is a Norman and Helen Asher Professor of Psychiatry and Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine.

Most recently, Dr. Wisner and colleagues (2013) published the largest American study to date (N = 10,000) investigating the value of screening for depression in postpartum period (4 to 6 weeks) using the Edinburgh Postnatal Depression Scale (EPDS)1.

I know I speak for all in welcoming Dr. Wisner to Science and Sensibility.

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Walker Karraa: Congratulations to you and your colleagues on this most recent JAMA Psychiatry study. The findings have significant implications regarding the value of screening for postpartum mood and anxiety disorders. What role do you think childbirth education has in the area of perinatal mental health?

Dr. Wisner: Childbirth educators are crucial front-line professionals in providing information to women about their risks for medical complications related to pregnancy and birth, and postpartum depression is a common problem.

WK: Should childbirth educators and doulas be trained to screen for PMADs?

Dr. Wisner: My answer would be yes, but the controversy in the field is about routine screening - that women with depression can be identified, but getting them to mental health treatment if it exists outside the obstetrical care setting is difficult. So the counterpoint is- why screen if we don't have on-site, accessible, acceptable services for mental health? My opinion is that we ought to work toward this model of integrated care rather than decide not to screen! I certainly think childbirth educators and doulas can increase education and awareness and are often the first professionals that women call for help, so that group of women who want to and can access care can get the help they need.

WK: How could childbirth education organizations use this study to inform their practices and curriculum?

Dr. Wisner:The study provides evidence that the prevalence of depression is high both during and after pregnancy and evidence that screening is effective in identifying women with major mood disorders. Women with psychiatric episodes certainly can be assured that they are not alone, which is a common belief of pregnant women and new mothers.

WK: Due to the prevalence of self-harm ideation in postpartum period found in your study and other studies supporting this alarming rate, and the fact that suicide is the second leading cause of maternal death, how might childbirth education organizations and professionals address this critical problem?

Dr. Wisner:Screening with the EPDS, which has the item 10 self-harm assessment questions, and sensitive exploration of self-harm and suicidal ideation is the primary approach to suicide prevention. It has to be identified before intervention can occur.

WK: A remarkable finding in your study was the rate of bipolar disorder among women who had screened positive (10 or higher) on the EPDS. Additionally, among those with unipolar depression, there was high comorbidity for anxiety disorders. What are your thoughts as to how childbirth education might begin to help childbearing women unpack and understand the symptoms of anxiety in prenatal education?

Dr. Wisner: In our study we found that women with depression usually had an anxiety disorder that pre-dated the depressive episodes-this observation is true for women who are not childbearing as well. Having anxiety or depression as a child or adolescent increases the risk for peripartum episodes. There are excellent pamphlets and websites about perinatal depression (www.womensmentalhealth.org; www.postpartum.net) which can be used to frame a brief discussion and give to the patient for reference. This also gives the message that talking about mental health before and during childbearing is an important topic, just like surgical births, anesthesia etc.

WK: The data you have contributed to science are unsurpassed, yet early in your career many questioned whether postpartum depression was real, and doubted if you would be able to pursue a research career in postpartum mood disorders.

Dr. Wisner: Indeed!

WK: How did you persevere-and particularly in a male-dominated field?

Dr. Wisner: I got angry that so few data were available to drive care for pregnant and postpartum women and never let go of the importance of obtaining that information. That motivation was coupled with a real joy in taking care of perinatal women and their beautiful babies!

WK: Do you think there is still an underlying doubt as to whether postpartum depression (or perinatal mood/anxiety disorders) is real?

Dr. Wisner: Not in academic medicine, and I have not heard anyone say this in about a decade (thankfully!).

WK: What is your favorite part of the research? Data collection, analysis, or interpretation?

Dr. Wisner: Publishing findings that make a difference in women's lives, and holding the babies.

WK: What new trends do you see in research as hopeful signs of progress?

Dr. Wisner: The incredible number of young clinicians and investigators who are interested in perinatal mental health. Also, our field has been so accepting of interdisciplinary enrichment of research questions.

WK: What advice would you share with women in research today?

Dr. Wisner: Network with your colleagues inside and outside your organization frequently, attend perinatal mental health meetings and don't ever give up!

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What are your thoughts regarding Dr. Wisner's expert opinion? How do you currently address postpartum depression and anxiety in your childbirth classes? After reading this interview and taking at look at Dr. Wisner's just published research, might you reconsider how you teach about this important topic or change your approach? Let us know in the comments section below- Sharon Muza, Community Manager

More about Dr. Wisner

Marce International Society for the study of Childbearing Related Disorders.

Her major interest area is women's health across the life cycle with a particular focus on childbearing. She is a pioneer in the development of strategies to distinguish the effects (during pregnancy) of mental illness from medications used to treat it (Wisner et al,JAMA 282:1264-1269, 1999; MHR01-60335, Antidepressant Use During Pregnancy).

In recognition of her work, she was a participant in activities related to the FDA Committee to Revise Drug Labeling in Pregnancy and Lactation, a committee member for the National Children's Study (Stress in Pregnancy), a consultant to the CDC Safe Motherhood Initiative and the Agency for Healthcare Research and Quality Report Perinatal Depression: Prevalence, Screening Accuracy and Screening Outcomes.

Dr. Wisner was elected to membership in the American College of Neuropsychopharmacology in 2005. She received the Dr. Robert L. Thompson Award for Community Service from Healthy Start, Inc., of Pittsburgh in 2006 and the Pennsylvania Perinatal Partnership Service Award in 2007 from the State of Pennsylvania.

Dr. Wisner was the first American psychiatrist to collect serum from mothers and their breastfed infants for antidepressant quantitation as a technique to monitor possible infant toxicity. She published the only two placebo-controlled randomized drug trials for the prevention of recurrent postpartum depression and showed that a serotonin selective reuptake inhibitor was efficacious.

References

1.Wisner, K.L., Sit, D., McShea, M. C., Rizzo, D.M., Zoretich, R.A., Hughes, C.L., Eng, H.F., Luther, J.F., Wisneiweski, S. R., Costantino, M.L., Confer, A.L., Moses-Kolko, E.L., Famy, C. S., & Hanusa, B.H. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, Published online March 13, 2013. Doi: 10.1001/jamapsychiatry.2013.87

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