Data Gaps in Postpartum Depression

Karan

Postpartum Depression is experienced by 10 to 20% of mothers globally. We are working through a prize design that may incentivize teams to collect data for postpartum depression.

We want to learn from you:

• What types of data would you prioritize?
• What types of missing data in this focus area will help practitioners better understand, predict, and treat postpartum depression?

mhackett

In an ideal world, self-completed data assessing frequency and severity of PPD. We will get limited data if we rely only on routinely collected information.

We likely need much better safety data for all prescribed antidepressants postpartum - proper/explicit recording of adverse effects. And better information on drug distribution, supply, accessibility and cost/affordability in LMIC.

We have little understanding of the types of talking therapies provided and who provides them - if at all - especially in LMIC. There is likely a fair amount of informal provision - would be good to capture that in some way.

And in many LMIC, health systems are designed by men usually without women in mind, many women do not use the health care system because it is not safe for them (culturally or otherwise) or they are discouraged or disallowed from attending by family/partners. So understanding why women don't use formal services, and what they receive when they do use them would also be helpful.

It is difficult to predict things when we can't find/don't see the women who experience them.

boblf029

I agree with some of mhackett's observations but not all of them, at least not completely. Yes, the health care system leaders in many if not all countries are men and yes the women do get less than adequate care for certain problems. This is not uncommon here in the United States, let alone in the developing nations of the world. But the picture is complicated because non-western medicine is very different from western(allop[athic) medicine. And sometimes the non-western medicine is better than the western medicine. A lot of non-western medicine is intended for psychological health, the traditional healers may speak of making the gods happy or putting the person in harmony with the spirits etc. And it may well work in some cases for whatever reason including the famous placebo effect. What we want to do is offer a solution when the folk medicine is unavailable or not satisfactory to the women and her family. This is more likely to be acceptable to them. And by offering a service that is consistent with the cultural beliefs of the society I think we can start creating a health data bank including data on post partum depression in some of these societies.

The data bank must collect data that is specific to the society rather than to western medicine unless they are the same. The way in which symptoms are described will reflect the way the society sees the world as these concepts are influenced by the language and translation from one language to another is an art form rather than a precise science. It is going to be very challenging and time consuming to get the sorts of data that western medicine wants for diagnostic and prognosis purposes. .

Shashi

@mhackett - Thanks Maree for sharing your thoughts across all the active discussions. All good points. We have taken a note of all the points mentioned.

Thanks @boblf029 for sharing your thoughts on this discussion.

Hello @fran, @brunowsky, @saaronson, @ktabb, @Tapman - Please join the discussion to share your thoughts on what type of data is essential to identify postpartum depression. Thanks.

Shashi

Hi @Suneetharani, @panderekha, @sarahkhenry, @stellunak, @Tapman, @Mohammadimr - What do you think, what type of data is essential to understand, predict, and treat postpartum depression? Please share your thoughts. Thanks.

Kathleen_Hamrick

@mhackett thank you for sharing your thoughts with us here.

mhackett wrote: »

In an ideal world, self-completed data assessing frequency and severity of PPD. We will get limited data if we rely only on routinely collected information.

We likely need much better safety data for all prescribed antidepressants postpartum - proper/explicit recording of adverse effects. And better information on drug distribution, supply, accessibility and cost/affordability in LMIC.

We have little understanding of the types of talking therapies provided and who provides them - if at all - especially in LMIC. There is likely a fair amount of informal provision - would be good to capture that in some way.

And in many LMIC, health systems are designed by men usually without women in mind, many women do not use the health care system because it is not safe for them (culturally or otherwise) or they are discouraged or disallowed from attending by family/partners. So understanding why women don't use formal services, and what they receive when they do use them would also be helpful.

It is difficult to predict things when we can't find/don't see the women who experience them.

How might technology be leveraged to collect this much needed, missing self-completed data?

With regards to collecting this information, what locations around the world would you recommend be prioritized first, and why?

mhackett

@Kathleen_Hamrick - Many people have access to smart phones and mobile phones so that seems the most logical way. Alternatively, provide community health workers, healers, elders with devices (tablet/iPad etc) and data and they can help with collection of same via surveys, door knocking or during routine visits. With voice to text and voice recognition, literacy need not be a problem.

It's not so much locations - so much as the disparity in so many locations. It's finding those who live with disadvantage - urban and rural slums, remote/tribal communities, homeless, women (especially women in any countries where they may be overlooked and who have little or no opportunity to improve their situation due to being prevented from education or undertaking paid work). I wouldn't limit this to a country or countries - there are people living with extreme disadvantage in the most privileged of countries.

Shashi

Thanks Maree for sharing your thoughts.

Hello @ktabb, @MarianneSeney, @KateH, @AnnalijnUBC, @nickarora3 - please let us know your thoughts on what type of data will help practitioners better understand, predict, and treat postpartum depression?

Shashi

Hi @sshinde, @nrasgon, @WD_Research, @mrchildren, @lmo17 - It would be great to hear your thoughts on type of data essential to predict postpartum depression. Thanks.

stellunak

Shashi wrote: »

Hi @Suneetharani, @panderekha, @sarahkhenry, @stellunak, @Tapman, @Mohammadimr - What do you think, what type of data is essential to understand, predict, and treat postpartum depression? Please share your thoughts. Thanks.

In my experience, there are 3 main indicators that predict post-partum depression (and probably depression around other major life events and changes): 1. past trauma, especially related to the child-mother bond and or sexual violence, 2. personality patterns that center on control, very fixed identity structures etc. The transition to motherhood is more than anything an act of relinquishing control and the lack of social-emotional skills or other resources that would allow the mother to navigate uncertainty seems to be a major cause of depression 3. lack of support networks in which the woman/mother can develop authentic, vulnerable, non-judgemental bonds.

It is not yet clear to me what sort of data could be used as sources of information on the above, but I am sure that many of you may already have ideas around this.