Anyone who has been pregnant or lived with someone who is pregnant knows the kaleidoscope of emotions that can lead up to delivery day and fill the weeks that follow. This major life transition can bring not only giddy excitement but also stress, anxiety and depression.
Now two researchers in Marquette’s Helen Way Klingler College of Arts and Sciences — Dr. Kimberly D’Anna-Hernandez, associate professor of psychology, and Dr. Sabirat Rubya, Northwestern Mutual Data Science Institute Assistant Professor — are working with colleagues across campus to develop new ways to support perinatal mental health.
Their community-oriented research projects are especially needed in Milwaukee, which struggles with wide racial and ethnic disparities in maternal and infant health outcomes. A parent’s mental health in pregnancy and beyond can affect a baby’s health in numerous ways.
“Women who experience depression in pregnancy are more likely to give birth to babies who are preterm and babies who are low birth weight. And those are the two biggest risk factors for disease — physical or mental,” explains D’Anna-Hernandez, who directs the Cultural Perinatal Health Laboratory at Marquette. “They’re obviously more likely to have postpartum depression as well, and it interferes with that mother-child bond.”
Bolstering prevention efforts for perinatal depression
D’Anna Hernandez and her collaborators are developing an interdisciplinary prevention program for perinatal depression with three aims: strengthen an existing intervention to make it more culturally responsive, expand the perinatal mental health workforce through training, and form a perinatal mental health collaborative to gather resources and make it easier for new and expecting parents to access support. The project is funded by the American Rescue Plan Act through a $250,000 grant administered by the Medical College of Wisconsin.
The project’s principal investigator is Dr. Kavitha Venkateswaran, clinical assistant professor of counseling education and counseling psychology in the College of Education. Dr. Lisa Edwards, professor and director of training for counseling psychology, and Dr. Karen Robinson, associate professor of nursing, are also collaborators.
“We’re all very interested in perinatal mental health, particularly in women of color and women from marginalized backgrounds,” says D’Anna-Hernandez, who brings expertise in behavioral neuroscience and perinatal mental health disparities in Milwaukee’s Latinx population.
Up to 80 percent of mothers develop what’s commonly known as the “baby blues” during the two weeks after childbirth, and 1 in 7 mothers have this condition progress to postpartum depression. Although it gets less attention, depression during pregnancy is common too, especially for women of color. D’Anna-Hernandez’s research has found that Mexican and Mexican-American women are three times more likely to experience depression during pregnancy compared with the general population.
Early intervention can be transformational for both expecting parents and babies. “After the baby comes, it’s much harder to develop skills and tools to start making changes in your life. Oftentimes, at that point, the stress is so high and folks are sleep deprived,” Venkateswaran notes. “If we can prevent or reduce mental health concerns during pregnancy, we’re likely going to start seeing some of those health outcomes improve as well, both for the mother and the child.”
The team plans to adapt and augment an existing perinatal prevention program — known as Reach Out, Stay Strong, Essentials for mothers of newborns, or ROSE — developed at Michigan State University. The evidence-based program can be delivered by any health care worker, not just mental health clinicians.
To make the program even more accessible, the Marquette researchers plan to add a telehealth option and make the content more culturally relevant for mothers from diverse backgrounds.
The team will involve a doula nurse and physical therapist. And the program will cover issues that can worsen mothers’ depression and anxiety — from breastfeeding to sleep deprivation to pelvic floor issues after childbirth. By making the program more comprehensive, researchers hope to reach more pregnant and expecting moms who may not traditionally think of themselves as needing mental health support.
After the team finishes developing program content, it will gather feedback from clinic partners and community members. Local clinics could use the intervention with expecting parents as early as next summer.
By working with partners from this broad, community-based collaborative, D’Anna-Hernandez says, “we can see what are their concerns, what are the things that they want to know and that we can help to support and amplify together as equal partners.”
Using technology to facilitate social support
In computer science, Rubya is working on a project that explores how new and expecting mothers turn to online communities for support. She started by reviewing the literature and interviewing pregnant people and those who had recently given birth.
“We learned that social support is really important. They need support from their spouse, their family and friends, and also other peers who have been through similar experiences,” says Rubya, co-director of Marquette’s Social and Ethical Computing Lab. “So, we also wanted to know: What are their sources of social support or what are the barriers?”
Online social support, especially when it’s anonymous, can feel safer for people from marginalized communities, she notes. Women expressed reluctance to seek support for mental health struggles through traditional channels, worrying that if their providers knew about these problems, their children would be taken away from them.
With the help of graduate student Farhat Tasnim Progga, Rubya explored online support communities devoted to postpartum depression on the Reddit, BabyCenter and What to Expect websites. She particularly noticed the power of storytelling, both in relating trauma and sharing successes. But existing online communities have their own challenges: misinformation or conflicting advice, toxic interactions and lack of timely response when someone is facing a mental health crisis.
Rubya plans to develop an app that will pair storytelling — using artificial intelligence to generate personas that resonate with users from different backgrounds — with educational content on topics such as babies’ sleep, breastfeeding and various potential stressors. Her goal is to create content that respects users’ privacy while delivering more trustworthy and timely support than one might find on a giant message board.
She hopes to have a prototype ready within six months and then will conduct an evaluative study, partnering with D’Anna-Hernandez to get feedback from new and expecting parents in Milwaukee. She’s grateful for that anticipated collaboration and for assistance from departmental colleagues who are experts in artificial intelligence. “Anytime I need help, I have those colleagues who can help me where I lack that expertise,” she says.
Eventually, Rubya would love to see her intervention reach beyond the United States. In her home country of Bangladesh, she notes, families often hide mental health issues instead of seeking treatment. “It’s a very sensitive topic there,” she says. “If I can even reduce the stigma even a little bit, that would be a big success.”
Partnering for greater impact
With an issue as complex as perinatal mental health, interdisciplinary approaches are valuable. That makes the Klingler College well-suited for this type of research, the faculty note. “I found the barriers between departments really low, so that makes it great for collaborating,” D’Anna-Hernandez says. “That spirit of really moving everybody forward and particularly doing things for the community — that has been a strong piece of what I’ve seen in my collaborators in Arts and Sciences.”
Rubya echoes that sentiment, and that spirit extends across colleges too. Venkateswaran sees cross-disciplinary-expertise “making our work stronger because we all have a different lens and can provide that diverse perspective.”
And that’s promising for the future of perinatal mental health in Milwaukee and beyond. Says D’Anna-Hernandez: “I really see this collaborative being just the beginning of … where we can go and take this work.”