Mother Load
by Women’s Brain Health Initiative:
MATERNAL MENTAL HEALTH
Access to mental health care was a major issue long before COVID-19, but the pandemic placed new and extraordinary stresses on the system. Women suffering from postpartum depression were among those facing additional barriers. British Columbia’s Ministry of Health reported a surge in demand from new mothers for mental health care, along with a resultant increase in waitlists. An ongoing research study out of the University of Calgary suggests that more new mothers are struggling with postpartum anxiety and depression in the first three months after giving birth than prior to the pandemic.
In the wake of these troubling trends comes a research project that seeks to bring a readily accessible means of mental health support to new mothers and their children.
Dr. Catherine Lebel of the University of Calgary and her colleagues are testing a mobile application (or app) known as “BEAM” (Building Emotional Awareness and Mental Health), which takes women through a ten-week, structured program designed to help alleviate the symptoms of postpartum depression.
“What we’re hoping to find with the app is that actually there are relatively simple ways to support people through this transition period,” said Dr. Lebel, an Associate Professor of Radiology.
SMART PHONE OR TABLET-BASED APP
The BEAM app takes new mothers through a series of videos and connects them with a clinically trained coach with advice and strategies for dealing with the stresses of caring for a child. Those who exhibit signs of more serious depression or anxiety receive a referral for one-on-one therapy. The approach requires far fewer resources than typical clinical care and, crucially, can reach much more people.
“Because it’s delivered by an app, it means that it can be delivered anywhere,” Dr. Lebel told Mind Over Matter® in a phone interview from her Calgary office.
“It’s easier to deliver than a traditional therapy model. People are still getting access to evidence-based information and resources, and they’re connecting with people who’ve experienced postpartum depression as well and they’re led through it by a psychologist. But it’s not as resource intensive for either side as a traditional therapy model.”
Developed by Dr. Lianne Tomfohr-Madsen of the University of British Columbia and Dr. Leslie E. Roos of the University of Manitoba, the app has already been tested on a pilot basis in a couple of different studies.
Based on the feedback received, the research team is making some refinements to the app and plans to conduct a study within the next few months, funded by the Bell Let's Talk - Brain Canada Mental Health Research program, a pillar of Brain Canada's Mental Health Research Initiative, to test its efficacy. As part of the project, which is made possible through the Canada Brain Research Fund (CBRF), Brain Canada's partnership with the Government of Canada, the researchers will not only be observing the progress of the mothers, but also any behavioural changes in the children.
“Our hypothesis is that the program will improve the mother’s mental health, and by proxy will improve the kid’s behaviour and brain development,” said Dr. Lebel.
STUDYING PANDEMIC STRESSES
Dr. Lebel’s research focuses on many aspects of the mental health of mothers and their babies – both postpartum and during pregnancy. Coinciding with the development of the app is a study out of the University of Calgary involving approximately 10,000 women from across the country, which will explore how the stresses of the COVID-19 pandemic affected pregnant women and their children.
“We hope to study them as long as they’ll let us. We’ve seen massively increased stress during the pandemic. It will be interesting to see what we can learn about the long-term effects,” said Dr. Lebel.
IMPACTS OF PRENATAL DEPRESSION
The study builds upon Dr. Lebel’s earlier research of an area that is less studied than postpartum depression: the effects on children whose mothers suffer depression during pregnancy. While it had been well-established that alcohol and drug abuse during pregnancy can have serious long-term impacts on the baby, Dr. Lebel’s work revealed that prenatal depression also has an adverse effect.
“I think it has been underrecognized. I feel like moms don’t get as much care as they deserve when pregnant because of all the attention on the baby. But it’s a significant problem for a lot of reasons.”
Dr. Lebel scanned the brains of children of women who had symptoms of depression during pregnancy and found that they had a thinner cortex (the grey matter on the outside of the brain), which could affect children’s learning and behaviour. The research team also found that boys exposed to higher depression in utero had more hyperactive behaviour, which was related to altered brain connectivity. The observed brain changes may be one reason why children exposed to depression in utero are more likely to have depression themselves later in life.
“We can’t fully connect those dots yet,” said Dr. Lebel. “But it’s logical that the brain changes we see that seem to be a result of prenatal depression are likely to make children more vulnerable. Certainly not every person whose mother had depression in pregnancy is going to have depression as well, but these brain changes are probably making children more vulnerable.”
A question that remains is whether these impacts will be felt later in life in other ways, such as elevated risk of dementia. The participants are still children and will have to be observed over a much longer period of time to find those answers.
Dr. Lebel believes that this is an area worthy of further research. It is critical for mothers to be healthy and well, and we could do much more to help them, both during pregnancy and after the birth of their children.
“It would be really nice if mental health supports were more accessible. I think we could do a lot of good for women, for moms, for children, and
for families.”
The “Pregnancy During the Pandemic” study asks each participant to complete a questionnaire at various points during pregnancy, as well as after delivery and during the first few weeks of a child’s life. In optional follow-up studies, researchers will be collecting hair and saliva samples to learn more about the ways in which stress affects biological indicators of stress in pregnant women and their babies.
A 2019 Statistics Canada study indicated that nearly a quarter of women who had recently given birth reported feelings of postpartum depression or anxiety, with the rates higher among mothers under the age of 25.