Saturday, October 10, 2020

In Her Words: Managing Mental Health

When mothers have depression, their children can be affected too.
Lilli Carré

By Corinne Purtill

“To this day, I come across physicians and ob-gyns who say, ‘Well, she doesn’t look depressed.’”

— Dr. Tiffany Moore Simas, chair of the department of obstetrics and gynecology at University of Massachusetts Medical School

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Over the course of her pregnancy, a woman receiving medical care in the United States can expect to be stuck with needles and prodded with ultrasound wands, to be asked to pee in countless cups and to gamely submit to any testing, measuring, monitoring or poking that might yield data on her body or the fetus.

When it comes to mental health, however, the medical care juggernaut comes to a screeching halt. In the United States, many expectant mothers get little more than a checklist of questions about their current mood or a cursory discussion with their provider.

The result is that emerging mental health problems often go unaddressed. Roughly one in seven women in the United States develop postpartum depression after delivering a child; an estimated 25 percent of those cases emerge during the pregnancy itself.

And when mothers have depression, their children can be affected too.

“There is a good bit of data showing that when women experience significant stress, depression and/or anxiety during pregnancy, their children are at greater risk for neurodevelopmental and mental health problems,” says Dr. Catherine Monk, a professor of medical psychology at Columbia University and Director of the Women’s Mental Health @Ob/Gyn service at NewYork-Presbyterian/Columbia University Irving Medical Center.

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Dr. Monk stressed that a majority of infants aren’t affected by maternal stress in pregnancy, and that maternal mental health is only one of many factors that influence fetal and infant development. But as with all preventive care, addressing maternal depression early can save a great deal of pain down the line.

Clinical depression is a medical condition that causes needless suffering, can alter a mother’s ability to respond to her baby’s needs and may prove fatal in severe cases. It’s a health problem that responds to treatment, from counseling and skills training to medication.

Despite the fact that mental health conditions are among the most common postpartum complications, generations of obstetricians received little to no formal training in how to identify or address them, said Dr. Tiffany Moore Simas, chair of the department of obstetrics and gynecology at University of Massachusetts Medical School in Worcester.

That’s improved in the past five years, but there’s still a long way to go. “To this day, I come across physicians and ob-gyns who say, ‘Well, she doesn’t look depressed’” as justification for not screening a patient for mental health issues, Dr. Moore Simas said. “For many years, women have fallen through the cracks.”

The 10 to 15 percent of women who exhibit symptoms of full-blown clinical depression during pregnancy often get treatment for it. It’s the additional 25 to 40 percent of women who have risk factors for depression, like stress at home or prior mental health issues, or who show signs of depressive behavior that doesn’t rise to the level of a full diagnosis, who tend to be overlooked.

For women with access to it, therapy is effective. But it’s expensive, and there simply aren’t enough trained therapists in the United States to provide one-on-one services to every pregnant woman who might need them. However, a 2019 report from the U.S. Preventive Services Task Force, pointed to two alternatives that offer measurable benefits to women at significantly less cost and which, under the Affordable Care Act, insurers must cover without requiring co-payments.

The first is a five-session program called “Reach Out, Stay Strong, Essentials for Mothers of Newborns,” or the ROSE Program. Developed by researchers at Michigan State and Brown universities, the ROSE Program trains expectant mothers in group classes on how roles and relationships change postpartum, and teaches assertiveness skills so expectant mothers can ask for the support that they need. It’s currently in place at dozens of prenatal clinics across the country that provide health care for low-income women.

The second is the Mothers and Babies Program, an online course derived from cognitive behavioral therapy that teaches expectant and new mothers how to identify harmful thoughts, cultivate support networks and seek out healthy mood-boosting activities.

Developed in the early 2000s by psychologists at the University of California, San Francisco, the program is now available in more than 20 American states and has been piloted in Kenya and Tanzania as well. Its organizers “like to think of Mothers and Babies as having a two-generation impact that improves the health and well-being of both mother and child,” said Darius Tandon, an associate professor and director of the Mothers and Babies Program at Northwestern University in Evanston, Ill.

Women who go through the course experience less stress and depression after childbirth, according to Dr. Tandon, and their children benefit from more responsive parenting and have better development outcomes.

When compared with a control group, both programs significantly reduced postpartum depression for participants. What those figures represent in real life are thousands of women whose children’s first months and years are not clouded by the pain of depression; who avoid the risk of suicide or self-harm; and who bond with their babies without depression’s warping interference.

Ricardo F. Muñoz, a clinical psychology professor at Palo Alto University in California and one of the original architects of the Mothers and Babies Program, has been working on depression prevention for the past 50 years. No opportunity excites him more than pregnancy intervention, where the work can benefit two generations at once.

“We know these things can work,” Dr. Muñoz said. “They don’t work 100 percent, but they reduce risk significantly. If we can do that for depression, we should be doing it.”

The Substance Abuse and Mental Health Services Administration National Helpline offers free and confidential information in English and Spanish on mental health treatment and services, 24 hours a day. Call (800) 662-4357 or TTY: (800) 487-4889.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or go to SpeakingOfSuicide.com/resources for a list of additional resources.

What else is happening

Here are three articles from The Times you may have missed.

“We were all thinking we were going to die,” the artist Amy Sillman said, “and spring was just carrying on.”Calla Kessler for The New York Times
  • “I made, literally, a titanic amount of work during the Covid period.” A walk through the artist Amy Sillman’s new show offers a master class in how abstraction can capture the fraught spirit of 2020. [Read the story]
  • “A simple chat with a stranger can make people feel great.” Laurie Santos, host of The Happiness Lab podcast says self-care doesn’t have to be selfish. [Read the story]
  • “After 68 years together, we couldn’t say goodbye.” In April, the loss of Mayya Gil’s husband was compounded by worries about meeting her basic needs. [Read the story]

In Her Words is edited by Francesca Donner. Our art director is Catherine Gilmore-Barnes, and our photo editor is Sandra Stevenson.

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On Politics: Trump, Lagging in Polls, Tries to Project Strength: This Week in the 2020 Race

President Trump returned to the White House this week after his hospitalization for coronavirus.

Welcome to our weekly analysis of the state of the 2020 campaign.

Joseph R. Biden Jr. at the Carpenters Local Union 1912 in Phoenix on Thursday.Hilary Swift for The New York Times

The week in numbers

  • The Biden campaign has now spent more than $500 million on ads this year. Over the last week, the Biden campaign spent $40.3 million on television and radio, while the Trump campaign spent about $23.3 million, slightly more than the previous week, according to the ad-tracking firm Advertising Analytics. The Trump campaign has closed the spending gap on Facebook, spending $5.2 million on the platform over the past week, while the Biden campaign spent $5.9 million in the same period.
  • The polling picture for President Trump grew particularly dark this week, as it became clear there was no sympathy bump after his positive coronavirus test. A CNN poll found him trailing Joe Biden by 16 points among likely voters nationwide — his worst result of any CNN survey this year.
  • The poll was conducted primarily after Mr. Trump received his virus diagnosis. Sixty-three percent of Americans in that survey said they thought the president had acted irresponsibly toward those around him in handling the threat of infection.
  • A pair of New York Times/Siena College polls out this week found Mr. Biden with a six-point lead in Nevada and a statistically insignificant one-point edge in Ohio, where Mr. Trump won handily four years ago.

Catch me up

With just three weeks to go before Election Day, and voting already underway in many states, President Trump’s support is falling far behind his opponent nationally, with his behavior alienating women, seniors and suburbanites, according to new polls. The president, eager to rejoin the campaign trail after being hospitalized with the coronavirus, secured a doctor’s note clearing him to return to “public engagements” as soon as Saturday. Mr. Trump is planning to host hundreds of people on the South Lawn of the White House that day; it would be his first in-person event since his positive coronavirus test. He has been eager to show that there is no cause for concern when it comes to his health, and no medical reason to hold him back. After the president refused to participate in a virtual debate on Oct. 15, which organizers had proposed as a safety precaution, the Commission on Presidential Debates officially canceled the event.

The problem for Mr. Trump is that his in-person return isn’t necessarily a plus for him, politically. In his aggressive attacks and interruptions during his debate with former Vice President Joseph R. Biden Jr. two weeks ago, the president appeared to only further alienate undecided voters, according to focus groups and polls. The president attempted to show his supporters that everything was fine in two phone interviews on Thursday. But, he called for his political enemies to be indicted and later sounded raspy when he called into Sean Hannity’s show Thursday night. He spent over two hours on the phone with right-wing radio host Rush Limbaugh on Friday, and he wasn’t the one to cut the session off.

His campaign, meanwhile, has become primarily a television ad-buying apparatus, though it is shrinking its television spending as it contends with cash flow issues, as it waits on the White House to figure out when and how the president will return to the trail.

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Mike Pence tried to recast Donald Trump at V.P. debate

Vice President Mike Pence during the vice presidential debate at the University of Utah in Salt Lake City.Erin Schaff/The New York Times

The first and only 2020 vice-presidential debate was an exercise in avoidance.

As Senator Kamala Harris of California pushed Vice President Mike Pence to defend the policies and tone of Mr. Trump, Mr. Pence sought to recast the president as someone different from the one who many American voters see. In Mr. Pence’s telling, Mr. Trump has taken the threat of the virus seriously from its outset. He ignored questions about how the president has cast doubt on the electoral process and, during the last presidential debate, refused to denounce white supremacy.

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The Trump campaign had hoped to capitalize on what they saw as a strong performance by the vice president. But less than 48 hours later, Mr. Trump had already moved the attention back onto himself.

Mr. Trump’s desire to hold campaign rallies next week and the administration’s refusal to answer basic questions about his health overshadowed Mr. Pence’s efforts to put a more empathetic spin on the administration’s coronavirus response.

Everyone got the virus, but no one went off message

A member of the White House cleaning staff sprayed a disinfectant chemical in the briefing room.Anna Moneymaker for The New York Times

In Trumpworld, testing positive for the coronavirus was no reason for the president’s top surrogates and spokesmen to halt their regular appearances on television, the key to relevancy in the president’s universe, or change their talking points about the administration’s response. Kayleigh McEnany, the White House press secretary, has been appearing on Fox News from her home, where she is isolating from the rest of her family.

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“This was a novel virus that came in from China,” Ms. McEnany told Mr. Hannity, the Fox News host, this week. “No one had seen it. There were no tests. There were no therapeutics. In short order, President Trump developed them.”

Ronna McDaniel, the chairwoman of the Republican National Committee, appeared on Fox News to criticize the debate commission for “not following the science” by deciding to hold a virtual debate. “The C.D.C. has said you’re not shedding live virus 10 days after diagnosis,” she said, speaking from her home where she, too, is recovering from the virus.

  • Appearing on TV while sick is a way to play down the virus: Surrogates who appear on television even after having tested positive were the living embodiment of the president’s edict, “don’t let it dominate your life.” By appearing on television, those surrogates were embodying the president’s false claim that Covid-19 was akin to contracting the flu.
  • Contracting the virus didn’t change anyone’s view of it: Even as the virus has infected many in the West Wing, the talking points have remained virtually unchanged. If anything, some Trump advisers worried that the president’s rhetoric about the virus had become more dangerous since his own diagnosis, as he has told people the virus was not something to fear. None of the newly infected appeared chastened by the experience of getting the virus, themselves. Even friends of Chris Christie, the former New Jersey governor who has been hospitalized for a week, said he was doing just fine, swatting away any questions about the state of his health.

Why won’t Biden or Harris answer about court packing?

Senator Kamala Harris during the vice-presidential debate.Erin Schaff/The New York Times

The overarching philosophy of Mr. Biden’s campaign has been to keep the focus on Mr. Trump, and specifically his handling of the pandemic. Because of this both Mr. Biden and his running mate are refusing to answer a basic policy question: are they in favor of adding seats to the Supreme Court?

The Democratic candidates have both said to answer the question would be a distraction during a time Republicans are seeking to push through the Supreme Court nomination of Judge Amy Coney Barrett. Mr. Biden went further this week, saying he intended to tell voters his view on the subject after the November election.

Here are three things you should know about the Democrats and the issue of court packing:

  • Mr. Biden rejected the idea in the primary: Mr. Biden is currently refusing to answer a question that he has already answered. Before the Iowa caucuses, in an interview with Iowa Starting Line, Mr. Biden said court packing would be mistake. “No, I’m not prepared to go on and try to pack the court, because we’ll live to rue that day,” he said at the time.
  • Ms. Harris expressed some openness: Ms. Harris, who did more to court the party’s progressive flank in the primary than Mr. Biden, has previously signaled that she was weighing the idea. When asked in March, Ms. Harris said “We have to take this challenge head on, and everything is on the table to do that.” Ms. Harris said there was a “crisis of confidence” on the court that Democrats have to address.
  • The politics are unclear: Some progressive groups have pushed elected officials to answer the question of expanding the courts but it is unclear whether the issue has permeated to the Democratic base. In the short term, Democrats are seeking to push back on Republican attempts to confirm Ms. Barrett for the seat once held by Justice Ruth Bader Ginsburg. Democrats want to correct what they feel was a “stolen” seat when President Barack Obama was blocked from filling the open seat after Justice Antonin Scalia died in 2016. Instead, it was filled by Mr. Trump who nominated Justice Neil Gorsuch. At this point, it is a Washington power play, not a clear electoral issue.

What you might have missed

A voter and her son cast her ballot on the first day of in-person voting in Des Moines.Kathryn Gamble for The New York Times
  • The R.N.C. invested $60 million in a digital get-out-the vote campaign this year. That’s a $57.1 million jump from 2016, emphasizing that the party recognizes mail-in voting is a necessary push even if the president doesn’t think so.
  • Mr. Trump has counted on veterans as well as active-duty service members as a key slice of his political base; in 2016, about 60 percent voted for him. But that support appears to have slipped. Mr. Trump’s comments this week suggesting Gold Star families were to blame for his coronavirus infection aren’t helping.
  • In an effort to avoid another 2016, when Facebook was used by Russian operatives to spread misinformation before the election, Mark Zuckerberg has spent more than $5.1 billion this year on the company’s “integrity” and security divisions, which identify and clamp down on interference. This is more than Facebook’s yearly revenue in 2012.
Nick Corasaniti, Isabella Grullón Paz and Giovanni Russonello contributed reporting.

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