New mothers’ hallucinations and paranoia: Postpartum psychosis signs, symptoms and treatment
New mothers’ hallucinations and paranoia: Postpartum psychosis signs, symptoms and treatment
RN, BScN, PNC(C), MScN, PMH-C
CPMHC Executive Director / Research Director
Jaime Charlebois is a mom of one who struggled through early parenting due to undiagnosed and untreated perinatal mental illness. She is the Co-founder, Executive Director, and Research Director of the Canadian Perinatal Mental Health Collaborative. Jaime has 23 years of clinical experience and is currently working as an Advanced Practice Nurse and Psychotherapist in perinatal mental health. She holds a Master of Science in Nursing, a Perinatal Nursing Certification from the Canadian Nurses Association and a Perinatal Mental Health certification from Postpartum Support International. Her work experience includes clinical nursing, higher education, and clinical leadership positions. She collaborates at the local, provincial, and national level with multiple organizations and committees.
CPMHC Executive Director / Communications Director
Patricia Tomasi is a mom of two who struggled to find help for perinatal mental illness. Her personal experience led her to seek others online in search of peer support while dealing with her own perinatal mental illness. In 2017, Patricia started a Facebook Postpartum Depression & Anxiety Support Group providing 24/7 support to thousands of women from around the world who flocked to join the private group. Shortly after, she co-founded the Canadian Perinatal Mental Health Collaborative, along with Jaime Charlebois. She is also the founder of the cheeky Maternal Mental Health Matters Blog where she shares her own triumphs and struggles with motherhood, mental health, advocacy and her cat. In 2021, Patricia released a comprehensive anthology, You Are Not Alone, a collection of 49 stories from across the 49th parallel chronicling the diverse mental health challenges parents experience as they embark on the stages of conception through parenthood. Prior to her advocacy work, Patricia spent a decade providing communications and media relations expertise for the Ontario government and in addition to HuffPost, she also worked as a reporter for CTV and CBC news in Vancouver, Toronto, Timmins, and Thunder Bay. Patricia is now a former-journalist-turned-fierce-advocate who went from writing about the state of perinatal mental health in Canada as a reporter for HuffPost to lobbying the federal government for a national perinatal mental health strategy. You can find her on Facebook, Twitter and Instagram.
MHA, Principal, Yasmin Tuff Health Care Consulting, BC
Yasmin is excited to join the board of the Canadian Perinatal Mental Health Collaborative to help advance a vision for healthy, vibrant women and their families. She looks forward to contributing to the development of strategic partnerships to foster and advocate for the improvement of perinatal mental services to support the complex needs of Canadian women and their families. Her background has involved both the planning and delivery of pediatric and perinatal services in BC. Most recently, she has supported provincial initiatives focused on system-level planning for mental health services for children and youth and pediatric emergency care. Part of this work has included the development of interdisciplinary, provincial guidelines to support pediatric mental health services in acute care environments. She has worked in BC healthcare for over 25 years and has experience in program planning, project management and operational leadership positions. She has a Bachelor of Science degree from the University of Victoria and a Master’s in Health Administration from the University of Ottawa. In her free time, she enjoys the many hiking trails on Vancouver Island and is grateful to be able to live, work and play within the traditional, ancestral and unceded territory of the lək̓ʷəŋən peoples.
she/her, Executive Director, Happy Roots Foundation, Ontario
Monique Moreau is thrilled to be joining the CPMHC’s board! Jaime and Patricia have single-handedly raised awareness and brought attention to the lack of perinatal mental health supports in Canada. As a (tired) mom of two, consistent perinatal mental health screening would have made such a difference to her after the birth of her first child, and she is so excited to be cheering them on as they continue this incredibly important work. As a policy wonk and all-around nerd (she’s fun at dinner parties, she promises!), she looks forward to working collaboratively with her board colleagues. Monique is keen to support the CPMHC with her previous board experience in governance and strategic planning, as well as with her background as a lawyer and government relations specialist. It is Monique’s sincere hope that, should her kiddos go on to have families of their own, the necessary screening and supports will be in place to help them if they need it. But it can’t take another generation! CPMHC has built up incredible momentum on this issue and she can’t wait to work together.
PMP, CLSSBB, Ontario
Anita Brisson is a Senior Consultant with over 20 years experience in managing teams and executing projects effectively and efficiently. Born and raised in Toronto, she moved to North Bay in 2008 for the love of the city and has been a community contributor ever since. Anita is a Project Management Professional (PMP) and a Certified Lean Six Sigma Black Belt who leads various mental health projects, continuous quality improvements, financial analysis, governance, and team developments across both the public sector and private corporations. She is excellent at facilitating meetings, encouraging team collaboration, breaking problems down into small manageable tasks, identifying strategic goals and measuring performance. Her strong leadership skills bring cohesiveness, clarity, and a mutual sense of purpose to any multi-discipline team, which is imperative for continued success within the CPMHC initiatives. With Anita’s involvement in various mental health projects and initiatives over the past 10 years, she is thrilled to join this team to help drive the national perinatal mental health strategy of leaving no one behind. Her expertise and drive will be a real contribution in implementing universal screening and timely access to treatment.
Certified Queer Expectant and New Parent Coach, at Queer Nest, she/they, Ontario
Naomi is the founder Queer Nest and host of Queer Nest Club www.queernestclub.com. They is so excited to be a part of a team of individuals who are coming together for such an incredible purpose, while always bringing Queer visibility to the table and the mission. Naomi has a voice and she’s excited to use it! In her picture, she’s holding up a CBC article she was interviewed for. She will make sure Queer and LGBTQIA+ issues are heard, represented, and accounted for. Their ultimate hope is for everyone growing their family in Canada to feel like their health care provider is looking out for their mental health and cares about their whole wellbeing in the family-growing process. Naomi wants mental health to be so integrated into care that it is routine, proactive, nobody bats an eyelash when discussing mental health (concerns), and that quality resources are readily available to all. She wants the public mental health resource access to be smooth, swift, simple, inclusive and inviting to all families, and free.
MSW, RSW, she/her, Nova Scotia
Meaghan is a social worker from the east coast. Born and raised in St. John’s, Newfoundland and Labrador, she is now settled in Halifax, Nova Scotia, working at IWK Health as well as in private clinical social work practice. She has spent time working in rural and remote parts of Northern Labrador, and gained valuable experience working with Indigenous communities. She completed her Master of Social Work at the University of Toronto, and has worked in children’s and adolescent mental health in Ontario. Meaghan brings with her experience as Chair of the Board of Directors for a local non-for-profit organization in Halifax, and is excited to be on the CPMHC’s Board to help govern an organization that will bring forth national guidance and change in perinatal mental health across the country. She hopes that the valuable work that the CPMHC does will help to broaden and increase perinatal mental health services available throughout Canada. Meaghan works from a trauma informed, intersectional, anti-oppressive-anti-racist feminsit lens, and hopes that her education, training and experience will help CPMHC to continue and excel in the work the organization is already doing. She is looking forward to working with folks from across the country who have similar goals and hopes for perinatal mental health in Canada.
Dr. Kristin Horsley holds a PhD in Clinical Health Psychology from McGill University and is currently a Postdoctoral Fellow in the Department of Obstetrics & Gynaecology at McMaster University and with The Society of Obstetricians & Gynaecologists of Canada. As a Board Member for the Canadian Perinatal Mental Health Collaborative, she is excited to be working closely with a passionate group of people toward our common goal of improving perinatal mental health care in Canada. Dr. Horsley brings to this position her research and clinical experience in understanding the barriers, and facilitators, to the integration of perinatal mental health screening, assessment, and services into our existing healthcare frameworks. She hopes to contribute to, and support, strategic planning and initiatives aligned with the mission of advocating for a national perinatal mental health strategy. As both a clinician and researcher, Dr. Horsley wants to see innovative models of psychological care being integrated into obstetrical settings so that we can ultimately understand how to best implement universal screening, assessment, and evidence-based treatment for perinatal mental illness.
Rochelle Maurice is a clinical and organizational ethicist based in Toronto, Ontario. She is also pursuing doctoral studies in social work at the intersection of equity and maternal-child care. As a result of her experiences in both social work and ethics, Rochelle has an interest in and passion for addressing issues that affect pregnant and postpartum women and non-binary people at the intersection of health and social care. Rochelle’s attention to the gaps in care that both directly and indirectly effect the mental health of pregnant and parenting people has motivated her to contribute to meaningful change in this area. She is happy to join the board to support CPMHC’s advocacy efforts for a national perinatal mental health strategy. She is also excited to contribute to CMPHC’s diversity, equity, and inclusion initiatives in perinatal mental health care. Rochelle hopes to employ her studies in social justice to support anti-racism initiatives in perinatal mental health and her ultimate hope is for accessible, timely, and inclusive supports for all pregnant and parenting people across Canada.
she/her, Network Manager, Women’s Health Research Cluster, BC
Katherine is a mental health advocate who aims to advance youth wellbeing across Canada. Working towards this goal, she has worked in the healthcare, education and public sectors on projects relating to health promotion, community engagement and research. Currently Katherine manages the Women’s Health Research Cluster, where she works alongside scientists, trainees, and stakeholders worldwide to improve women’s health outcomes through multidisciplinary research. In addition, Katherine sits on the Board of Directors for First Call: Child and Youth Advocacy Society as Vice-Chair and Signatory Officer, and advocates for policy change at the municipal level as a Youth Mental Health Sub-Committee Chair for the City of Vancouver Child, Youth and Family Advisory Committee. Katherine believes that supporting youth wellbeing starts with supporting parents—particularly mothers. That’s why she is honoured to work with the CPMHC to help people receive the mental health care they deserve. Katherine hopes to leverage her experience in fundraising, research, operational management, and strategic planning to bring the CPMHC into the next phase of their advocacy journey. Ultimately, Katherine wants the federal government to adopt a national perinatal mental healthcare strategy that ensures every mother receives culturally appropriate mental health support before, during and after their pregnancy.
Epidemiologist, Canadian Perinatal Nutrition Program, Nunavut
Dr. Mohandoss is delighted to be on the board of directors because the CPMHC is Canada’s first and only perinatal mental health advocacy organization. The founders, members of the national committee, and all volunteers are dedicatedly working toward one common outcome. The CPHMC’s approach and focus is universal and nationwide and our focus is ensuring individuals benefit from the same resources, treatment, support, and education irrespective of whether they live in major cities, or in rural, remote or isolated communities. As a holistic healthcare professional dealing with chronic diseases, Dr. Mohandoss believes and has been practicing in identifying the root cause in order to prescribe the right interventions at the right time rather than treating symptoms and prognosis. Dr. Mohandoss believes we need to look through the same lens when it comes to perinatal mental health. Working in a northern isolated community – overseeing the Canadian Prenatal Nutrition Program, he is not only going to contribute his expertise but also the voice and experience of mothers and infants who have shared the importance of perinatal mental health with him. Dr. Mohandoss has experience working in public health, homeopathy, medicine, and surgery. His ultimate hope is for every mother/individual and infant to have universal access to resources and educational materials to be able to make informed decisions. These meaningful and long lasting impacts will not only strengthen families, but in general as a community and as a nation. He looks forward to helping CPMHC continue to be a strong leader in perinatal mental health care in Canada and to advise on standards in advocacy, awareness, education, policy, funding, resource management, accessibility, affordability and inclusiveness.
Erin Gurr is first and foremost a proud mother to her daughter Lucie-Ivalu, who was born at the height of the first wave of the COVID-19 pandemic in Montreal, Quebec. Erin is Metis-Anishinaabe-Kwe, originally from the Red River Metis settlement in Winnipeg, Manitoba. She has spent the majority of her professional life in counselling working with children, youth and their families of Indigenous descent, with a special focus on improving individual and communal wellbeing for nonstatus, Metis and other underrepresented communities. She has research and clinical experience in the adaptation of common psychometric instruments for use with minority-language patients, and is particularly passionate about the design of culturally informed psychological assessments in the context of perinatal mental wellbeing. She is so honoured and excited to be chosen to serve on the first-ever board for the Canadian Perinatal Mental Health Collaborative. Erin hopes to use this opportunity to bring together her clinical research experiences and community psychology training to advance multifaceted and holistic psychological interventions which have been designed/co constructed with/in Indigenous communities to honor and represent the diverse belief systems and life experiences of Indigenous peoples across Canada; particularly as they pertain to the broader concepts of “wholeness” and community wellness.
Judy’s job is being a role model for her children. Her other name is Dr. Hagshi and she works at the Herzl Family Practice Centre in Montreal, Quebec providing perinatal care to new families. As a mom and physician, she tries to model an empathic and inquisitive outlook on life. At home, that means trying to look at things from someone else’s point of view. And at work, it means trying to meet the patient where they are in their health-wellness journey. In general, she loves to think of novel solutions to problems and always aims to pay it forward. Dr. Hagshi was honoured to have been selected for the CPMHC inaugural Board of Directors because this organization’s mandate is to fill the holes that currently exist in providing supportive care to new families. Many people struggle with mental health issues specifically around the time of having a new baby, but don’t have ready access to care. The access must be upfront and personal: People should not have to struggle to get help for their struggles. The consequences of not supporting these new families at this critical time creates an intergenerational legacy of mental health difficulties. Dr. Hagshi believes in building the village that raises the child.
B.S.W., R.S.W., Manitoba
Victoria Hampton is a Registered Social Worker with over a decade of experience providing services in the areas of mental health and family violence. She is thrilled to be part of the effort CPMHC is leading to address perinatal mental health concerns in our country. Victoria’s professional background as a social worker and personal history of severe maternal morbidity following childbirth affords her a unique perspective on the need for services across the many diverse communities in Canada. As a Specialized Near-Miss Coordinator with Postpartum Support International, she has an intimate understanding of the barriers facing those seeking services and a passion for ensuring that individuals have access to support for the challenges they are facing. Victoria’s hope is that efforts to raise the profile of perinatal mental health in Canada translates to increased awareness, funding, research, and resources for all who are impacted by this issue.
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.
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)
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
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.
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 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 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)
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.
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.
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.
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.
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 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.”