by Brenda Stubbs, Triad Regional Coordinator & Jennifer Vickery, Western Regional Coordinator
When thinking about addressing mental health, it’s important to note that our minds and bodies are not separate systems and that often when the body experiences a mental health complication or disorder there are co-occurring physical symptoms as well. The “mind-body connection” is an often underestimated phenomena as even the language used to discuss health and wellness refers to the “mind” and “body” as distinct entities; however, a growing number of researchers are now finding that adverse health conditions such as diabetes, heart disease, and obesity can also be linked to depression. Depression can be the result of experiencing childhood trauma or adverse childhood experiences. We know through the Adverse Childhood Experiences (ACE) study that high ACE scores have a direct correlation with higher rates of depression, substance abuse, tobacco use, and obesity. In short, people who have high ACE scores may turn to self-medicating and/or risky behaviors to deal with their trauma. Often these are the very behaviors that can lead to adverse health conditions and adverse birth outcomes.
Using obesity as an example, clinicians and researchers have been aware for some time that victims of childhood abuse are twice as likely to experience depression as adults, and further, there is a strong correlation between depression and obesity. This does not necessarily mean that all obese adults experienced abuse in their childhood nor does it mean that all obese adults can be diagnosed with depression; however, it does begin to shed light on how certain lifestyle decisions that contribute to obesity such as overeating and a sedentary lifestyle can serve as coping mechanisms, much like drugs and alcohol, to deal with childhood trauma. Turning our focus to maternal obesity, according to the March of Dimes, entering pregnancy overweight or obese (or using drugs or tobacco) carries lifelong health complications for both mother and baby.
As mentioned previously, our minds and bodies function as an integral system and are not distinct entities; therefore, the statistics are even more alarming when discerning the impact of maternal mental and physical health on birth outcomes. In example, a recently published study in the Journal of Depression and Anxiety has shown that diabetes and postpartum depression are occurring more simultaneously than initially thought. The largest population-based study to date conducted by Michael E. Silverman, PhD, assistant professor of psychiatry at the Icahan School of Medicine at Mount Sinai in New York City, found that first time mothers that did not have a history of depression significantly increased their risk for developing postpartum depression if diagnosed with gestational diabetes. The mothers with a previous comorbid diagnosis of gestational diabetes and depression increased their risk for postpartum depression by an alarming 70%. Dr. Silverman states, “Most practitioners think of these as two isolated and very different conditions, but we now understand gestational diabetes and postpartum depression should be considered together.
Furthermore, there is also growing evidence that women who experience preconception gynecological morbidities such as endometriosis, dysmenorrhea (painful periods), and abnormal uterine bleeding have an increased risk for developing postpartum depression. A nationwide study in Japan conducted from 2011-2014 by the Japanese Environment and Children’s Study Group (JECS) found that women with endometriosis and menstrual problems were at increased risk of developing postpartum depression. This study suggests a perinatal mental health screening is needed for predisposed women.
According to Healthy People 2020’s leading indicators for maternal and child health, medical experts are seeing more and more that the mental, behavioral, and socio-economic conditions of the mother are having a huge impact on birth outcomes. It is these conditions, after all, that subsequently have a huge impact on the mother’s physical health. The bottom line is that when we are screening women of childbearing age for risk factors like smoking, diabetes, obesity, and hypertension, we also need to be assessing their mental health status. Doing so will help ensure healthier women, healthier babies, and healthier families.
Affect Disord. 2017 Aug 1;217:34-41. doi: 10.1016/j.jad.2017.03.049. Epub 2017 Mar 30. Preconception gynecological risk factors of postpartum depression among Japanese women: The Japanese Environment and Children’s Study (JECS)
Silverman, M.E. (2017) The risk factors for postpartum depression: A population based study. Depression and Anxiety, 34, 178-187. DOI: 10.1002/da.22597