In honour of World Mental Health Day 2019 we interviewed Dr. Nichole Fairbrother about what fuels her research and how we can make a difference for women in the postpartum period.
What is your background?
I am a Clinical Associate Professor with the UBC Department of Psychiatry and the Island Medical Program. I received my Ph.D. in clinical psychology from the University of British Columbia in 2002.My doctoral work was in the area of women’s sexual assault and cognitive behavioural theories of post-traumatic stress disorder. Following my PhD, I 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. During that time, I began my current program of research in the area of women’s perinatal mental health with a focus on perinatal anxiety and related conditions and epidemiology.
In addition to the above, I hold the following, appointments: Associate member of the UBC School of Public and Population Health, Maternal-Child Health theme and the University of Victoria’s Faculty of Graduate Studies; Adjunct appointment with the University of Victoria’s Department of Psychology; and an Affiliate faculty appointment with the University of Victoria, Division of Medical Sciences. I am also an active member of the Women’s Health Research Institute.
Can you tell us a bit about your research with the Perinatal Anxiety Research Lab?
My program of research is primarily in the area of perinatal anxiety and related disorders and epidemiology, with an emphasis on prevalence, screening and access to evidence-based psychosocial interventions. At the moment, I am studying new mothers’ thoughts of infant-related harm and their relationship with obsessive-compulsive disorder (OCD) and parenting, fear of childbirth, perinatal anxiety screening tool development and evaluation, and therapist-supported, internet-based therapy for perinatal anxiety and related disorders (AD).
What impact do you hope to make with this work?
Pregnant and postpartum women represent a vulnerable group in society, with unique needs and mental health concerns. Historically, among perinatal women, depression and psychosis are the mental health disorders which have received the most attention. More recently, maternal, perinatal AD have received increasing attention. This is due, in part, to recent evidence that 20% of pregnant and postpartum women report symptoms meeting criteria for one or more AD.
My motivation for working in this topic area is fueled by a desire to improve our understanding of perinatal AD and to improve access to evidence-based treatment for these disorders.
For most of the AD, psychosocial interventions, in particular cognitive behaviour therapy (CBT), are considered first line treatments. CBT typically results in equivalent or superior outcomes to medication, with additional protection against relapse. Despite the superiority of CBT, medication is typically used to treat AD. Of significant concern is the fact that the medications used to treat AD, when taken by pregnant and breastfeeding women, carry non-trivial risks for the developing fetus and infant. Because of these risks, pregnant and breastfeeding women represent a group particularly in need of evidence-based, non-medication approaches to treatment. However, at present, CBT is only minimally publicly funded, and consequently access is limited largely to those with extended health benefits or the means to pay high out-of-pocket costs. As a result, access to evidence-based treatment for mental health conditions in Canada, and in particular for perinatal women, is an issue of financial privilege and heath inequity.
October 10th is World Mental Health Day. What type of action can researchers and healthcare providers take today – and throughout the year – to help improve women’s mental health?
When I think about pregnant women and new mothers, I guess I think about how important it is to reach out and connect. Early mothering can be a socially isolating experience. It’s also really important to normalize the experience. It is normal to be a little bit anxious, to worry about one’s baby, one’s body and how one’s life is going to change. Beyond this, we know that women continue to provide a disproportionate proportion of the domestic work in families, including large amounts of invisible work (making 25 phone calls to find a new day care, planning ahead for family birthdays, making grocery lists, etc.). Think about ways you have lift a little bit of that burden so maybe she gets a few minutes extra sleep, or just gets 10 minutes to drink a cup of tea and watch the rain.
What is the most interesting thing about the work you do?
I think the most interesting aspect of my research is the work I do regarding new mothers’ unwanted, intrusive thoughts (UITs) of infant-related harm, in particular the UITs of hurting one’s baby on purpose. We now know that 100% of new mothers report UITs of accidental harm to their baby, and a full 50% of new mothers report UITs of harming their infant on purpose. Further, there is good evidence that, among psychologically vulnerable women, these kinds of thoughts may lead to the development of OCD – an anxiety-related disorder characterized by recurrent and distressing UITs and repetitive behavioural responses to them (e.g., checking on the safety of one’s loved ones or washing one’s hands over and over). We now also know that UITs of intentional, infant-related harm are not associated with an increased risk of maternal violence towards the infant. We have recently applied for a small amount of money to create an animated, psycho-educational video about new mothers UITs of infant-related harm and their relationship with OCD and parenting.