Seleni is thrilled to announce our 2017 Travel Awardees who will present important research in the field of perinatal mental health at the 3rd Biennial Perinatal Mental Health Conference in Chicago in November.
These five women are committed to improving the emotional and physical health of women and infants through research into epigenetics, family psychiatric history, and the emotional interactions of moms and their babies. Another area of research focuses on how a mother's childhood experiences affect her child's stress response and her own chance of developing a perinatal mood or anxiety disorder (PMAD).
One common theme is an interest in integrated care settings where professionals from the disciplines of mental health and primary care work together to support moms and babies in a holistic way.
At Seleni, we are inspired by their passion for their work and their innovative approaches to emotional wellness.
Anna Bauer, PhD, postdoctoral research associate, department of psychiatry at the University of North Carolina School of Medicine
Background: Anna Bauer first became committed to women's health while in the Peace Corps, working as a girls' education volunteer with the Ministry of Women's Affairs in Mauritania. Afterward, she applied to the University of North Carolina at Chapel Hill to begin a master's program in public health, focusing on maternal and child health.
When she was pregnant with her first child, she had her "first wake-up call [about] the lack of emphasis we place on moms' emotions." After having genetic testing during pregnancy with almost no discussion with her OB, Bauer realized "there wasn't any concern over how the mom feels. That's why I wrote my master's thesis on prenatal screening programs and decision-making." Bauer went on to complete a PhD in epidemiology, focusing on the connection between preeclampsia and genetics.
Bauer also had mental health issues after her first child was born and realized how common PMADs are after talking with friends who had similar experiences. She decided to combine her work in epidemiology and genetics with maternal mental health and began work with Samantha Meltzer-Brody, director of the perinatal psychiatry program at the UNC Center for Women's Mood Disorders. There she researched the genetics and biomarkers of PMADs.
Conference presentation: Bauer will present research demonstrating that family history of a mood disorder, particularly bipolar disorder, in first degree relatives is a significant risk factor for developing a postpartum mood disorder. "Family psychiatric history can provide valuable information about risk and should be included in clinical screening guidelines," says Bauer. She is "excited to connect with clinicians at the conference to make my research translatable and effect change in the field of mental health."
What's next: "I am working on integrating the maternal mental health aspect of my research with preeclampsia, among other conditions, and birth outcomes to see how everything is connected."
Kisha Clune, MD, resident physician at the University of Washington
Background: When Kisha Clune, MD, began studying medicine, she knew she wanted to work with women and considered completing an ob-gyn residency. But then she "fell in love with psychiatry" and started getting involved in Columbia College of Physicians and Surgeon’s department for women’s mental health. "Historically, women have been such an underserved population, [and have] even been harmed by the field of psychiatry," says Dr. Clune.
After working with professor Catherine Monk, PhD, at Columbia, Dr. Clune began her psychiatric residency at the University of Washington, where she is now completing a fellowship subspecializing in women's mental health.
Conference presentation: Dr. Clune will present a poster on the perinatal epigenetics research she conducted in Dr. Monk's lab. "We understand a lot about how nurturing and the environment in which you raise a child can inform a lot of their behaviors and psychology as well as the interplay between how things can be heritable and how the environment influences heritability," says Dr. Clune. "But we don't have a good explanation for how it does that. Epigenetics can be the missing link."
Dr. Clune studied women with a history of trauma to see how it impacted their epigenome during the perinatal period. Dr. Clune was specifically studying gene methylation, a process that typically limits the expression of a gene. "In essence, it can quiet what the gene is doing," says Dr. Clune.
"We were able to see that both high stress in pregnancy and a history of childhood trauma was associated with higher methylation of the serotonin transporter gene postpartum. And methylation of the serotonin transporter gene has been linked to mental illnes, so this work could present helpful markers for at risk populations.”
What's next: "I would like to continue working in the field of perinatal mental health," says Dr. Clune. "It is so rewarding and has been so sadly neglected." Dr. Clune is most interested in exploring the "integrative model" in which a psychiatrist acts as a consultant embedded in a primary care setting, such as an ob-gyn office or even in a labor and delivery unit. This model can lower stigma, reduce the need for multiple appointments, and address the shortage of mental healthcare providers.
"I think there's a huge need for the subspecialty of perinatal mental health," says Dr. Clune, "because there is so much misunderstanding among healthcare professionals about how mental health affects a fetus and a woman's health in pregnancy."
Elena Goetz Davis, PhD, postdoctoral fellow, department of psychiatry and behavioral sciences at Stanford University
Background: Elena Goetz Davis began her research career at Harvard University and Duke University by studying the neurobiology of depression using neuroimaging and genetics research to understand who might be more vulnerable to depression.
Then she completed an internship with Margaret Howard, PhD, at the Women & Infant's Hospital in Providence, Rhode Island, where she did individual and group-based interventions for the perinatal population through The Day Hospital, the nation's first perinatal hospital program treating pregnant women and new moms with depression and other mood disorders. "I loved working with those women," says Davis. "It felt like this was such a critical time in their lives. It was such an important and impactful time to intervene."
Davis is currently doing postdoctoral research at Stanford University, where she continues to study depression as well as the additional component of infant mental health. She and her collaborators are investigating the connection between a mother's brain response, caregiving behavior, and infant neurodevelopment by neuroimaging both infants' brains and mothers' brains as each mother reacts to her infant's emotional signals.
Conference presentation: "I will be presenting some preliminary data that shows a mother's own attachment insecurity can predict vulnerability to postpartum depression," says Davis. "Statistically, the relationship between attachment insecurity and depression seems to be explained, at least in part, by difficulties with emotion regulation."
That finding suggests that one point of intervention would be emotion regulation, or how people are aware of and affected by their own emotions and whether they can apply skills to change their emotional state. Davis hopes her work could lead to potential interventions during pregnancy that could help women with emotion regulation when they become mothers. She is eager to talk to conference participants from different disciplines to see whether there is interest in developing these kinds of interventions.
What's next: Davis was inspired by the integrated nature of the treatment team at Women & Infants Hospital. "Psychiatrists, nurse practitioners, midwives, people in the nursery – so many people were observing the mother-infant dyad at a vulnerable time," says Davis who would like to do research in a similarly integrated environment. "We would hope that the woman would have remission from her depression, and we also want to help her meet her caregiving goals more effectively."
Jenny Fairthorne, PhD, postdoctoral research fellow in perinatal mental health and child development at the University of British Columbia
Background: Dr. Fairthorne completed her doctorate in maternal health and child disability at the University of Western Australia. Psychiatric disorders in the mothers of children with developmental disabilities was the major focus of Dr. Fairthorne's PhD research, and she used routinely collected health registry information (such as hospital admissions, health history and birth information). Information from multiple sites can be linked using a unique de-identified number, allowing researchers to investigate the person's health history retrospectively.
She then pursued a postdoctoral fellowship at the University of British Columbia, where she investigated the relationship between socioeconomic status (SES), perinatal mental health, prenatal medication use, and infant outcomes, also using linked data.
Conference presentation: Dr. Fairthorne will report her findings from linking data such as pharmaceutical prescription, hospitalization, and filed taxes to investigate the effect of antidepressant use on maternal hospitalizations associated with depression by socioeconomic status during the years surrounding a birth.
Compared to mothers of middle SES, she and her colleagues found that greater economic security meant a woman was less likely to have been hospitalized for untreated depression. These results provide preliminary evidence that barriers to pharmacological treatment for depression in disadvantaged mothers might contribute to their increased risk of nonpharmacologically treated depression.
What's next: Next year Dr. Fairthorne will begin a research fellowship at the University of York in the United Kingdom, where she will explore the effects of various health interventions using linked data. Her first project will involve assessing a health intervention for children with acute asthma to see the effect of having a child see an asthma nurse specialist rather than admitting the child to the hospital. Dr. Fairthorne plans to focus her career on independent research into maternal mental health and infant/child outcomes.
Liisa Hantsoo, PhD, instructor in the department of psychiatry at the University of Pennsylvania Perelman School of Medicine
Background: Dr. Hantsoo was drawn to women's health in graduate school at The Ohio State University when she conducted research on the effects of chronic stress on immune function and rates of depression. "I was particularly interested in how women were impacted because there is a much higher rate of depression in women compared to men," says Dr. Hantsoo. She also became interested in the potential impact of childhood adversity on mental health later in life.
Dr. Hantsoo went on to complete a postdoctoral fellowship at the University of Pennsylvania, where she worked in the lab of C. Neill Epperson researching the roles of stress and hormones in premenstrual dysphoric disorder and perinatal depression.
Conference presentation: In Chicago, Dr. Hantsoo will discuss her research into the interplay of childhood adversity (such as physical or verbal abuse or another kind of chronic stress), the development of perinatal depression, and potential impacts on the offspring of women who are affected by both. "We were interested in looking at the physiological stress response and mental health outcomes in women who had experienced adversity or stress during childhood, and we were also interested in seeing if their offspring experienced stress differently," says Dr. Hantsoo.
Using ultrasounds during pregnancy, the research team measured fetal adrenal glands. The adrenal glands secrete stress hormones, such as cortisol, playing a role in stress response and regulation. Researchers followed up with the children at 6 months old, exposing them to some mild stressors and measuring their cortisol (stress hormone) response. "We found that the offspring of moms who had childhood adversity had altered adrenal glands, especially the males," says Dr. Hantsoo. "And at 6 months, the babies had a blunted cortisol response, particularly in female offspring."
"Often it is assumed that high cortisol must be bad, but that's not necessarily the case," says Dr. Hantsoo. "Certainly if you have high cortisol over extended periods, it's not good. On the other hand you have a cortisol response for a reason. If your body is releasing cortisol, it is helping you to deal with a stressor. If the brain and nervous system were developing in a high stress environment, a blunted cortisol response could be adaptive." The data also suggest that there may be sex differences in how male or female offspring are impacted by maternal stress exposure, but more work needs to be done to clarify this.
What's next: "Following these individuals through their childhood to see if they continue to have an altered stress response and whether it is associated with any detrimental health outcomes."