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Publications

Platform Proposal to Each Political Party of Canada

August 2021

CPMHC went to work as soon as the federal election was called in August 2021. We submitted our platform proposal to each party calling for support for a National Perinatal Mental Health Strategy

National Report: Time For Action – Why Canada Needs A National Perinatal Mental Health Strategy Now

May 2021

On May 5th, the day our Report was released, MP Heather McPherson presented a Motion in the House of Commons asking for support for a National Perinatal Mental Health Strategy and to delcare the first Wednesday of May annually as World Maternal Mental Health Day which the Government of Canada and all parties agreed to UNANIMOUSLY!

While it’s not binding, meaning the government doesn’t have to act on the motion, it is an extremely positive step in the right direction! BUT… there’s still a lot of work to do so please JOIN THE FIGHT and participate in our Email Letter-Writing Campaign to hold all MPs accountable for their support for the Motion!

You Are Not Alone: An Anthology Of Perinatal Mental Health Stories From Conception To Postpartum

Book

This anthology is about more than postpartum depression. It’s about preconception and pregnancy, too. This book contains stories that span the spectrum of perinatal mental illness including infertility, miscarriage, disability, tokophobia, stillbirth, prenatal and postpartum anxiety, obsessive-compulsive disorder, bipolar disorder, and psychosis, along with what it’s like to struggle with a perinatal mental illness during an unprecedented global pandemic. This anthology is filled with 49 stories for people across the 49th parallel—and beyond.

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Daisy Singla

Current REB-Approved Grants

October 22, 2020

June 2019-May 2024Scaling up psychological treatments for perinatal depression and anxiety via telemedicine

Role: Principal Investigator

Patient Centered Outcomes Research Institute (PCORI).
Grant: Pragmatic Clinical Study

Co-Principal Investigator: Samantha Meltzer-Brody

Collaborators: Cindy-Lee Dennis, Ariel Dalfen, Simone Vigod, Alex Kiss, Andrea Lawson, Paula Ravitz, Allison Stuebe, Bradley Gaynes, Crystal Schiller, John Naslund, Jo Kim, Laura LaPorte, Richard Silver, Steven D. Hollon, and Vikram Patel

Amount: $ 13,153,426.00 USD; Awarded December 11 2018

April 2019-March 2021The development and evaluation of a digital training platform for interpersonal psychotherapy.

Role: Co-Principal Investigator, AFP

Grant MSH-UHN AMO Innovation Funding: Paula Ravitz
Collaborators: Andrea Lawson, Simone Vigod, Sophie Grigoriadias, Sophia Soklaridis

Amount: $189,444.59 CAD Awarded March 2019

June 2018-May 2020Enabling translation to Science to Service to Enhance Depression CarE (ESSENCE) Administrative Supplement.

Role: Co-Investigator.

Supplement Award. National Institutes of Mental Health.
Grant: U19MH113211-S1. Principal Investigator: Patel, Vikram
Collaborators: John Nasland, Zafra Cooper
Amount: $155,247.00 USD

Jul 2019-Jun 2024IMPlementation of evidence-based facility and community interventions to REduce the treatment gap for depreSSion (IMPRESS)
Role: Co-Investigator.

R01. National Institutes of Mental Health.
Principal Investigators: Vikram Patel; Abhijit Nadkarni.
Collaborators: Chunling Yu, Pim Cuijpers, Richard Velleman, Helen Weiss, Rahul Shidhaye;
Amount: $3,500,000.00 USD

April 2019-Mar 2021 Web Cameras

Role: Co-Investigator.

Post Graduate Innovations Award.
Grant Post Graduate Innovations Award. Principal Investigator: Mark Halman.
Collaborators: Andrea Lawson, Lesley Wiesenfeld.
Amount: $10,000.00 CAD

Aug 2017-Jul 2022Testing Means to Scale Early Childhood Development Interventions in Rural Kenya.

Role: Co-Investigator.

R01. National Institutes of Child Health and Development.
Grant No.: R01HD090045. Principal Investigator: Luoto, Jill.
Collaborators: Italo Lopez Garcia, Lia Fernald, Frances Aboud, Alie Eleveld, James P. Smith.
Amount: $3,924,255.00 USD

Dr. Leslie Roos

Dr. Leslie E. Roos is an Assistant Professor at the University of Manitoba, with appointments in Psychology and Pediatrics. She aims to prevent the intergenerational transmission of stress-linked health inequities by developing scalable programs that promote parent mental health and family relationships. In her basic science research, Dr. Roos takes a multi-modal approach across neurobiology, cognitive function, and parent-child observation methods to identify opportunities to improve program efficacy. Dr. Roos also consults on program evaluation with local agencies and international teams to advance community-sourced solutions for stress-exposed families, starting in the prenatal period.

Current REB approved research:The Building Regulation in Dual Generations program (BRIDGE) : The BRIDGE program is designed to promote intergenerational self-regulation, the effortful control of emotions and behaviour. BRIDGE brings together best-practice therapeutic approaches for building skills in emotional understanding, mindfulness, distress tolerance, and communication for mothers and young children.

Parenting During the Pandemic: Families are facing unprecedented challenges related to coping with a pandemic outbreak. The Parenting During the Pandemic Study aims to develop an understanding of the impact that the pandemic is having on parent’s reported stress, mental health, and support needs with the ultimate goal of informing programming and policies to better meet family needs.
Indigenous Child Wellness Project: In collaboration with the Indigenous Advisory Committee of The Until the Last Child Foundation, Indigenous student mentees are undertaking a project with the goal of developing a measure to assess the wellness of Indigenous children and families. We are ensuring that this work is done in a way that respects cultural protocols by consulting with knowledgeable people in the community, involving Elders, and inviting families to contribute.

Dr. Nichole Fairbrother

Dr. Nichole Fairbrother is a registered psychologist and Clinical Associate Professor with the UBC Department of Psychiatry and the Island Medical Program. She received her Ph.D. in clinical psychology from the University of British Columbia in 2002, and subsequently completed a post-doctoral fellowship in women’s reproductive health through the Child and Family Research Institute and the UBC Department of Health Care and Epidemiology.

Dr. Fairbrother’s research is in the area of perinatal anxiety disorders and epidemiology, with a focus on new mothers’ thoughts of infant-related harm and perinatal obsessive-compulsive disorder (OCD). Current research activities include a large-scale study of maternal thoughts of infant-related harm and their relation to postpartum OCD and child harm, and several inter-connected studies of fear of childbirth. She is currently in the planning stages for a study of perinatal anxiety disorder screening and two randomized controlled trials of online CBT for fear of childbirth, and postpartum OCD.

Here are the projects Dr. Fairbrother is currently working on:

Perinatal anxiety disorders screening study

Canadian Institues of Health Research, Project Grant Competition, Bridge funding award from the CIHR Institute of Neurosciences, Mental Health and Addiction (INMHA) Priority Announcement. Nichole Fairbrother (PI); Martin Antony, Sarah Norris, Arianne Albert, Patricia Janssen, Fanie Collardeau, & Benicio Frey (Co-Is)

Unwanted intrusive thoughts in new parents: Development of a psychoeducational video

Canadian Institues of Health Research, Planning and Dissemination Grant Competition. Nichole Fairbrother (PI); Fiona Challacombe, Jonathon Abramowitz, Maria Bavetta, Diane Wilson, & Alissa Antle (Co-Is)

Pregnancy Specific Anxiety Scale (PSAS): Instrument development and psychometric testing.

Canadian Institutes of Health Research, Hamideh Bayrampour (PI); Patricia Janssen, Rollin Brant, Michelle Butler, Nichole Fairbrother, & K.S. Joseph (Co-Is)

Dr. Ryan Van Lieshout, MD, PhD, FRCP(C)

Canada Research Chair in the Perinatal Programming of Mental Disorders

Albert Einstein/Irving Zucker Chair in Neuroscience

Associate Professor, Department of Psychiatry and Behavioural Neurosciences

Director, MD/PhD Program McMaster University

Dr. Ryan Van Lieshout is a perinatal psychiatrist at McMaster University interested in developing interventions aimed at increasing access to treatment for women with depression during pregnancy and the postpartum period. As the Canada Research Chair in the Perinatal Programming of Mental Disorders and the Albert Einstein/Irving Zucker Chair in Neuroscience, his research also examines the effects of evidence-based treatments for perinatal depression on offspring with a focus on disrupting the intergenerational transmission of mental health problems from mothers to their infants.

Here are the projects Dr. Lieshout is currently working on:

Online 1-Day Cognitive Behavioural Therapy (CBT)-Based Workshops for Postpartum Depression

Rationale: Even though PPD is one of the most common complications of childbirth, very few women are able to access evidence-based treatment. To overcome the substantial barriers facing new mothers with depression, we have developed a 1-Day CBT-Based Workshop aimed at treating PPD. These workshops are designed to be easily accessible, provide skills that can be used both in the short and long-term and delivered in large groups to maximize efficiency and network building.

Objectives: The objectives of this randomized controlled trial are to determine if these workshops: (1) can effectively reduce maternal depression, (2) are cost-effective, and (3) can reduce the impact of common comorbidities and complications of PPD.

Eligibility Criteria: Women who have had an infant in the past 12 months and who score ≥10 on the Edinburgh Postnatal Depression Scale are potentially eligible.

Study Details: Participants will be assigned to receive treatment immediately (experimental group) or 12 weeks later (waitlist control group). They provide data at baseline, 12 weeks later (immediately before the waitlist control workshop), and 12 weeks after that. Mothers will rate levels of symptoms of depression and anxiety, as well as social support, quality of life, service utilization, mother-infant bonding, and infant temperament at all three timepoints.

Future Implications: 1-Day CBT-Based Workshops for PPD have the potential to revolutionize how PPD is treated in Canada and beyond. With the promise of cost-effectiveness and broad uptake, they could provide public health departments with the tools they need to deliver on their promise of successful approaches to mental disorders.

How to sign-up: If you are interested in learning more or would like to register to participate in the study, send us an email at 1daycbtworkshops@gmail.com or fill out our sign-up form.

Online Public Health Nurse Delivered Group Cognitive Behavioural Therapy (CBT) for Postpartum Depression

Rationale: Since public health nurses (PHN) are often a first point of contact and support for women with PPD, it is critically important that they have the skills required to address the mental health needs of these women. We recently trained a group of PHNs (in Niagara Region) to deliver a 9-week group Cognitive Behavioural Therapy program for PPD online.

Objectives: The objectives of this randomized controlled trial is to determine if PHNs can be trained to deliver group CBT for PPD that is superior to usual postnatal care in (1) acutely treating PPD, (2) reducing relapse and recurrence, (3) improving mother-infant attachment and parenting, and (4) optimizing infant emotional functioning.

Eligibility: Women who have had an infant in the past 12 months and who score ≥10 on the Edinburgh Postnatal Depression Scale will be randomized to receive either PHN-delivered CBT for PPD online in addition to care as usual or care as usual from their usual healthcare providers.

Study Details: Participants will provide information at baseline, 9-weeks, and 6 months post-baseline. Mothers will rate levels of depression and anxiety, as well as social support, quality of life, service utilization, mother-infant bonding, and infant temperament at all three timepoints. When in-person is again permitted, they will also attend a study visit where measures of mother and infant neurophysiology (electrocardiogram, heart rate variability, salivary cortisol) will be collected.

Future Implications: Given Public Health Ontario’s commitment to improving maternal perinatal mental health and the presence of public health units and PHNs in both urban and rural areas, this intervention has the potential to be disseminated to Public Health Units across Ontario and to improve the health of women and their families both in the short and long term.

How to sign-up: If you are interested in learning more or would like to register to participate in the study, send us an email at niagaracbt@gmail.com or fill out our sign-up form.

Online Peer-Delivered Group Cognitive Behavioural Therapy for Postpartum Depression

Rationale: COVID-19 has exposed vulnerabilities in social and economic systems that lead to significant health inequalities for mothers and their children. Not only have women’s exposure to factors that exacerbate PPD (e.g., more stress and work, partner conflict, job loss and food insecurity) increased, but social distancing measures have reduced access to protective factors like social support and medical care. Peer-administered interventions, those delivered by recovered former sufferers, are increasingly recognized as effective alternatives to traditional mental healthcare services and could help overcome many barriers to treatment faced by women during COVID-19. Given the large supply of potential peers, women’s desire to help others recover from PPD, and the potential for peers to deliver psychotherapy as effectively as trained professionals, task-shifting the treatment of PPD to peers in an onlinegroup format offers a safe, accessible, and cost-effective way to improve PPD rapidly.

Objectives: To determine whether a 9-week Online Peer- Delivered Group Cognitive Behavioural Therapy (CBT) for PPD can effectively treat PPD and its common complications (anxiety, social isolation, mother-infant relationship problems, and infant temperament).

Eligibility Criteria: Women who have had an infant in the past 12 months and who score ≥10 on the Edinburgh Postnatal Depression Scale are potentially eligible.

Study Design: A randomized-controlled trial where women are randomly assigned to receive treatment immediately or after a 9-week waitlist period. Data will be collected at two time points: (1) before treatment (at study enrollment for the waitlist group) and (2) after treatment (before treatment for the waitlist group).

Anticipated Outcomes: If this 9-week online group CBT is proven to be effective, it will provide the healthcare system with an innovative approach to addressing PPD need in Canada that matches women’s preferences for treatment, reduces barriers, and increases treatment rates beyond the COVID-19 pandemic.

How to sign-up: If you are interested in learning more or would like to register to participate in the study, send us an email at brantpeercbt@gmail.com or fill out our sign-up form.

Dr. Simone Vigod, MD, MSc, FRCPC

Chief, Department of Psychiatry, Women’s College Hospital

Shirley A. Brown Memorial Chair in Women’s Mental Health Research, Women’s College Research Institute

Associate Professor & Director of the Division of Equity, Gender and Population, Department of Psychiatry University of Toronto

Adjunct Scientist, ICES, Toronto, Ontario

Dr. Simone Vigod is an Associate Professor in the Department of Psychiatry at the University of Toronto, and Chief, Department of Psychiatry at Women’s College Hospital. Her background includes an Honours BSc in Psychology from McGill University (1999), MD from the University of Toronto, UofT (2003) and psychiatric residency at UofT (FRCPC, 2009) and a Masters of Science in Clinical Epidemiology from the UofT Institute for Health Policy, Management and Evaluation (IHPME) (2011). Dr. Vigod’s research addresses disparities in health and health care for individuals with psychiatric disorders, with a specific focus on women across the lifespan and on equity in access to treatment for diverse populations. She is an Adjunct Scientist at ICES in Toronto, Ontario where she conducts her population-based epidemiological research focused on the health of women with mental illness and their children. In 2018, she obtained the Shirley A. Brown Memorial Chair in Women’s Mental Health Research at Women’s College Research Institute at Women’s College Hospital where she runs a clinical research program that focuses on novel health system interventions to improve access to and uptake of care for women with mental illness.

Here are the projects Dr. Vigod is currently working on:

2018-2023 An electronic patient decision aid for antidepressant drug use in pregnancy: A randomized controlled trial. Canadian Institutes of Health Research (CIHR), Project Grant. PI: Vigod, SN. Co-Is: Dennis CL, Grigoriadis S, Metcalfe K, Oberlander T, Stewart DE, Thorpe K, Parsons J, DeOliveira C. Major depressive disorder is a debilitating and often chronic mental illness that affects 1 in 5 women over the lifespan. When depression is not treated effectively during pregnancy, the mother’s and her child’s health is at risk. Antidepressants are a mainstay of treatment for women whose depression is severe, or not adequately responsive to psychotherapy. Yet, it is very hard to determine when risks for relapse/ongoing depression definitely outweigh the small, but still uncertain risks of antidepressants. So, treatment decisions regarding antidepressant use in pregnancy must be guided not only by evidence about harms and benefits, but also by: (1) how a woman values the potential benefits and harms of the treatment options; (2) which option she prefers; and (3) the extent to which she wants to be involved in the treatment decision. Women have significant difficulty making this decision, but want to be active in decision-making. We designed an interactive electronic PDA to help women with depression make decisions about whether or not to use antidepressant medication in pregnancy, and successfully pilot-tested it with women across Canada. We are not conducting a randomized controlled trial to determine the efficacy of the online PDA in women with depression who are pregnancy-planning or in the early stages of pregnancy and facing decisions about use of antidepressants in pregnancy. The primary focus of the trial will be on whether the PDA can optimize decision-making effectively, as measured by the prevention of postpartum depression (PPD) since this clinical outcome is most directly linked to both ineffective management of depression in pregnancy, and to long-term negative impact for mothers and children. LINK TO STUDY FOR WOMEN TO PARTICIPATE: https://www.womensresearch.ca/research-areas/mental-health/pda-for-antidepressant-use-in-pregnancy

2018-2021 Schizophrenia Understood in the Perinatal period: Psychiatric Outcomes and Reproductive Trajectories (SUPPORT) – Part 3: Child Health. Canadian Institutes of Health Research (CIHR). Project Grant. PI: Vigod, SN. Co-Is: Brown H, Dennis CL, Cohen A, Saunders N, Tu K, Holloway A, Morrison K, Ray JG, Oberlander T, Hanley G, Berard A, Kiss A. More than 50% of women with schizophrenia become pregnant, and birth rates have been steadily rising since the early 1990s. With appropriate supports and services, women with schizophrenia are often able to retain custody of their children, and maintain meaningful parenting capacity. Yet, early developmental exposures may put these children at risk for chronic health problems across the lifespan, including physical health and mental health problems. Such risk factors may include poverty, prenatal maternal health status including chronic cardio-metabolic diseases, and pregnancy-related exposures such as smoking, substance use and medications used for psychiatric illness. We previously showed that maternal schizophrenia is associated with a high risk of pregnancy complications and for infants being born preterm, too small and/or too large, and with serious neonatal medical problems, all implicated as markers for chronic disease across the lifespan. We propose the first comprehensive study of the long-term health of children born to women with schizophrenia by studying a sample of over 7000 such children born in Ontario, and focusing on their risk for developing chronic diseases up to age 19.

2018-2020 Postpartum depression Action toward Causes and Treatment (PACT)- Canada: Predictive Analytic Models of Postpartum Depression Risk. Canadian Institutes of Health Research (CIHR). PI: Vigod, SN. Co-Is: Brown HK, Dennis CL, Gruneir A, Thombs B, Walker M. Postpartum depression (PPD) is the most common complication of childbirth, affecting up to 1 in 5 women in the year after delivery. It is associated with long-term maternal morbidity, child emotional, cognitive and behavioural difficulties, and even maternal and child mortality. The long-term cost of PPD and related perinatal mental illnesses is estimated at ~1.4 billion Canadian dollars per one-year cohort of children. Prevention of postpartum depression could avert a significant amount of this burden. Specific psychosocial and psychological interventions can prevent PPD, especially when delivered in the early postpartum (as opposed to in pregnancy) and in high-risk women. Yet, there is no evidence-based tool in common practice that can accurately predict the level of risk for PPD in an individual woman. The aim of this catalyst grant is to create a clinical risk index, to be used around the time of delivery, for determining the probability that a woman will develop depression in the first year postpartum. We will harmonize and analyze linked population-based clinical and health administrative datasets comprising key PPD risk factors in ~400,000 Ontario women, create a statistical model that predicts who will develop PPD, and convert the final model into a clinical tool that can estimate a woman’s PPD risk. Stakeholders, including women with lived experience, public health nurses, primary care and antenatal care providers will help create a clinically useful tool to optimize future integration into the health care system. To our knowledge, this will be the first research in Canada, and the largest and most comprehensive worldwide, that attempts to create a personalized tool for determining PPD risk, thereby making a significant contribution to knowledge and practice.

2018-2020 Automated screening, triage, and follow-up to facilitate proactive, personalized postpartum mental health treatment for new parents. Canadian Institutes of Health Research (CIHR). Catalyst Grant: Personalized Health. Co-PIs: Ivers N, Aggarwal P, Dennis CL, Vigod SN. Co-Is: Sacha Bhatia, Laura Desveaux, Janessa Griffith, Trevor Jamieson, Holly Witteman. Mental health symptoms – especially depression and anxiety – are very common in new parents, affecting close to 20% of mothers and at least 10% of fathers. When such symptoms progress to severe levels, they can be more difficult to treat. Early identification of symptoms and prompt treatment are ideal. Despite broad awareness that mental health symptoms in new parents are common, few systems are in place to automatically assess and monitor such symptoms. Evidence-based symptom surveys that can identify parents at risk for postpartum mental health disorders exist, and effective medication and non-medication treatment options are available. Yet, most primary care settings do not have systems in place to ensure that parents with mental health problems (and especially fathers) are identified and treated. This study will use a digital app with tablet computers and email integration to engage parents in assessing their mental health symptoms within weeks of the birth of their new baby. Electronic symptom surveys, sent on behalf of the family doctor, will be used to support proactive, personalized postpartum mental healthcare (P3MH). Responses will be used to enable a tailored care plan for the patient, including advice about options for referrals, treatment, and local community-based psycho-educational and/or social supports. This eHealth intervention includes a web-based application for parents and seamless integration in the electronic medical record, so that when the family doctor sees the patient in clinic, relevant information is ready to be discussed. In this study, we will carry a co-design process with patients and health professionals to refine this eHealth intervention, and determine the usability, user experience, and perceived value of this process in terms of whether it enables mental health symptoms to be caught early and managed in the best way possible for each parent. We will also pilot the procedures for a future large-scale evaluation.

2019-2020 Sexual health intervention for women with first-episode psychosis. PI: Vigod, SN. Co-Is: Gupta R, Zaheer J, Voineskos A, Dunn S, Dmytryshyn R, Barker L and Berkhout S. MOHLTC. AFP Innovation Fund. The World Health Organization (WHO) defines sexual health as a state of well-being in relation to sexuality that requires a positive and respectful approach to sexuality and sexual relationships, and safe sexual experiences. Sexual health promotion activities have been instituted globally in pursuit of sexual health for all, often with a focus on vulnerable populations. Schizophrenia is a complex chronic illness that is associated with significant disability for the 300,000 Canadians – and many more around the world – affected by it. While most women develop schizophrenia in their late teens or early 20s, a time when sexual health promotion is arguably of greatest importance, sexual health has not been systematically integrated into their care. This is a significant gap. Women with schizophrenia report negative subjective experiences around sex, and have high rates of adverse sexual health outcomes (e.g. sexually transmitted infections, unplanned pregnancy). We aim to develop and evaluate the user acceptability of a sexual health intervention for young women with schizophrenia that can ultimately be integrated into standard early psychosis care, and evaluated for its impact on improving their long-term sexual health trajectories.

Hilary Brown

Traumatic brain injury and perinatal mental illness

In Canada, 2% of the population lives with a traumatic brain injury (TBI), and there are 18,000 hospitalizations for TBI each year. One-third of persons with TBI are women, and TBI is common in young women entering their childbearing years. Women with TBI are more likely than men to have mental health problems post-injury. Yet, little is known about their mental health around the time of pregnancy. This is an important issue because women with TBI may be uniquely at risk for new or worsening mental illness in pregnancy and the postpartum period because of stressors related to sleep deprivation and sensory issues, and the impact of hormonal changes on a vulnerable brain. Our goals are to examine the burden of mental illness among women with TBI before, during, and after pregnancy and the risks of medical problems in the mother and baby during and after pregnancy among women with co-occurring TBI and perinatal mental illness. Evidence of an association between TBI and mental illness around the time of pregnancy will lead to the development of health care services that address the unique mental health needs of women with TBI. Given that TBI is a leading cause of disability worldwide, these efforts will result in better outcomes for mothers, infants, and families by providing more responsive support to women with TBI.

Funding: “Traumatic brain injury and perinatal mental health outcomes”. Canadian Institutes of Health Research Project Scheme Grant. Nominated Principal Investigator: Brown HK. Co-Principal Investigator: Vigod SN. Co-Investigators: Cohen E, Colantonio A, Chan V, Mollayeva T, Ray J, Saunders N, Sutradhar R.

Chronic medical conditions and perinatal mental illnessPerinatal mental illness includes mood, anxiety, and psychotic disorders that occur in pregnancy or in the first 12 months after delivery. Affecting 20% of women, perinatal mental illness has serious negative consequences for mothers, infants, and families. Women at high risk for perinatal mental illness need to be identified early to avoid negative outcomes. Previous history of mental illness, stress, and lack of support are known to predict perinatal mental illness. Outside of the perinatal period, chronic medical conditions may be risk factors for mental illness. However, although 1 in 5 pregnant women have a chronic medical condition, the association between chronic medical conditions and perinatal mental illness is not fully understood. Our aim is to examine the impact of chronic medical conditions on the risk for mental illness during pregnancy or postpartum. Our findings will improve the health care delivery system: If there is an association between chronic medical conditions and perinatal mental illness, we will provide evidence needed to prioritize including mental health resources in obstetrical services. Because many pregnant women have chronic medical conditions, our research has the potential to make a substantial positive impact on the health of Canadian mothers, infants, and families.

Funding: “Chronic medical conditions and perinatal mental illness”. Canadian Institutes of Health Research Project Scheme Grant. Principal Investigator: Brown HK. Co-Investigators: Dennis CL, Guttmann A, Vigod S, Ray J.

Disability and maternal and infant outcomes

In Canada, one in 8 women of childbearing age has a disability. Disabilities can be categorized as physical (e.g., spinal cord injuries), sensory (e.g., vision and hearing impairments), and intellectual and developmental (e.g., fetal alcohol syndrome). Until recently, childbearing rates among women with disabilities were low. With medical advances and better integration of persons with disabilities in the community, more women with disabilities are starting families. Women with disabilities experience high rates of poverty and poor health, and research is beginning to show that these factors increase their risk for poor pregnancy and later child outcomes. However, there is little research examining the health of their infants. Our aim is to compare perinatal health and mental health outcomes, and infant health and health care access, among women with and without disabilities. Our findings will improve the health care delivery system: Evidence of increased risk for poor outcomes among women with disabilities will provide information needed to create specialized supports for women with disabilities and their infants. Because women with disabilities represent a growing maternal population, our research could have a significant impact on the health of Canadian mothers and infants.

Funding: “Pregnancy in women with disabilities: Using novel methods to characterize risk”. National Institutes of Health R01. Nominated Principal Investigator: Brown HK. Co-Principal Investigator: Lunsky Y. Co-Investigators: Guttmann A, Havercamp S, Parish S, Ray J, Vigod S. and “Infants born to women with disabilities: Health and health care”. Canadian Institutes of Health Research New Investigator Grant in Maternal, Reproductive, Child and Youth Health. Principal Investigator: Brown HK. Co-Investigators: Guttmann A, Lunsky Y, Ray J, Vigod S.

Catriona Hippman

Catriona Hippman is a Research Fellow with the Reproductive and Infant Psychiatry programs at BC Children’s and Women’s Hospitals. She completed her PhD in 2020 in the UBC Interdisciplinary Studies program, co-supervised by Dr. Jehannine Austin and Dr. Lynda Balneaves. She is also trained clinically as a genetic counsellor, certified since 2009, and is a Clinical Assistant Professor in the UBC Department of Psychiatry.

Summary of REB approved research including future implications:

“My doctoral work focused on how we can better support women who are trying to decide whether to take antidepressants during pregnancy. I did this through two studies. In one, I interviewed 31 women about their experience of deciding whether to take antidepressants during pregnancy and then developed a theoretical model of decision making from women’s stories. In the other, I did genetic testing for 83 women who were taking antidepressants during pregnancy, and compared levels of depression symptoms for women grouped by variations they had in two genes that are responsible for enzymes that are involved in metabolizing antidepressants. My research can be used by clinicians and patients to support decisions regarding depression treatment during pregnancy.

Depression is very common, affecting 10-15% of pregnant women. Over the years, prescriptions for antidepressants have increased, particularly for women of childbearing age. There is a great deal of societal pressure on women during pregnancy, and intense stigma against taking antidepressants during pregnancy – there is stigma not only towards mental illness generally, but also the perception that ‘good mothers’ don’t take medication. The media often fans the flames of women’s fears with headlines such as “Taking antidepressants during pregnancy increases risk of autism by 87 percent” – Dec. 14, 2015. Without medication, however, many women are not able to control their depression symptoms, and this can also have consequences for both mother and baby – in the most extreme cases, causing loss of life for both through the mother completing suicide.
My work challenges the assumption that living without medication is necessarily best, and my hope is to co-construct a new narrative that choosing to take antidepressants during pregnancy can be the choice of a responsible mother.

My vision is for all women to feel empowered to care for their mental health, and my mission is to improve women’s reproductive mental health through translational research.”

Publications

Platform Proposal to Each Political Party of Canada

National Report: Time For Action – Why Canada Needs A National Perinatal Mental Health Strategy Now

You Are Not Alone: An Anthology Of Perinatal Mental Health Stories From Conception To Postpartum

Jaime Charlebois

Patricia Tomasi BJourn

Yasmin Tuff

Monique Moreau

Anita Brisson

Naomi Mendes-Pouget

Meaghan Norris

Dr. Kristin Horsley

Rochelle Maurice

Katherine Moore

Dr. Arvind Mohandoss

Erin Gurr

Dr. Judy Hagshi

Victoria Hampton

Daisy Singla​

Dr. Leslie Roos​

Dr. Nichole Fairbrother

Dr. Ryan Van Lieshout, MD, PhD, FRCP(C)

Dr. Simone Vigod, MD, MSc, FRCPC

Hilary Brown

Catriona Hippman

Daisy Singla

Dr. Leslie Roos