While pregnant with her fourth baby, Jerrika Massey felt depressed because her father died before he could meet his newest grandchild. He had always been there for her previous births.
Massey didn’t tell anyone she was struggling because “I thought it was something I could handle by myself,” she said.
But at a prenatal appointment earlier this year, Massey scored poorly on a depression screening and was flagged for extra attention through Washington University’s Perinatal Behavioral Health Services.
Until recently, mental health screenings were not standard for pregnant women and new mothers even though at least 20 percent will experience depression or anxiety that can be exacerbated by hormonal surges, lack of sleep and the demands of an infant.
The screenings can be lifesaving — as many as one in five deaths of women in the postpartum period is caused by suicide.
“As a practicing obstetrician, that’s not an uncommon event,” said Dr. Camaryn Chrisman Robbins of Washington University. “It’s been my patient. I have people in my mind playing on repeat that have struggled with depression and have taken their own lives.”
At Barnes-Jewish Hospital, postpartum nurses will alert the mental health team if they notice that a new mother doesn’t want to hold her baby or makes comments about feeling inadequate or overwhelmed.
“It can be terrifying, the process of going home when you know that you’re at high risk of going to a dark place, and now you have a baby who needs you,” Robbins said.
Savannah Helton, a social worker, visited Massey at Barnes-Jewish earlier this month after baby Steven was born. Pictures of Massey’s father decorated the hospital room.
“I want you to be aware of how you’re coping, what your moods are like,” Helton told Massey, adding that she needed to come back if she wasn’t feeling like herself in a few weeks.
Earlier this year, the American College of Obstetricians and Gynecologists issued new “fourth trimester” recommendations for women’s ongoing care after childbirth, including a full assessment of their emotional well-being. The American Academy of Pediatrics also recommends depression screenings for new mothers at all of the baby’s checkups during the first six months.
Although postpartum depression rarely leads to violence, it may have been a factor in an area murder-suicide, according to police and medical sources. Mary Jo Trokey, 32, shot and killed herself, husband Matthew Trokey, 33, and their 3-month-old daughter, Taylor Rose Trokey, in February in their home in St. Louis Hills.
A police source at the time said detectives were tracking Mary Jo Trokey’s purchase of a gun in the days before the shooting and investigating mental illness as a possible influence.
St. Louis police have declined to release their investigative report, citing “an active investigation due to outstanding lab results.”
Mary Jo’s mother, Polly Fick, described her daughter as calm and polished and said she did not display any signs or have a diagnosis of postpartum depression. She had just returned from maternity leave as a social worker with United Healthcare, Fick said.
“She thought she could handle it. She was on overload,” Fick said. “She and Matt loved that baby. Mary Jo wanted to be such a good mom.”
After their deaths, Fick has become an advocate for maternal mental health by training to be a volunteer with SSM Health’s postpartum depression hotline and raising money for support groups.
Matthew Trokey’s family members declined to be interviewed but hinted at a more complicated situation in a statement provided to the Post-Dispatch.
“We are unsure of the role that postpartum depression played in Mary Jo’s devastating actions and our family’s unimaginable grief. Regardless, we support the strides being made in this area and are comforted to know new moms are getting access to the resources they need,” Matt’s mother, Kathy Trokey, said.
The tragedy signaled the urgent need for better recognition and treatment of mental health disorders in new mothers, said Dr. Cynthia Rogers, a Washington University psychiatrist.
Rogers has found that only about half of new mothers disclose any symptoms of depression during a time “when the world tells you you should be joyful. Sometimes people are so ashamed that they use all of their energy and efforts in keeping it from their loved ones,” she said.
But new mothers should seek help for overwhelming sadness or scary thoughts the same as they would for chest pains or heavy bleeding, Rogers said.
“These symptoms are a brain dysfunction associated with pregnancy and not a character flaw or personal failure,” she said.
‘You will get well’
While area hospitals typically compete for patients, maternal mental health has become an “all hands on deck” situation, with hospitals referring women to each other’s support programs to reach as many women as possible, Rogers said.
In January, Mercy St. Louis launched its Mother Baby Intensive Outpatient Program, in which mothers spend three hours, three days a week for up to six weeks in group and individual therapy for postpartum depression and anxiety.
“We’re really trying to validate moms and normalize their experience,” said Erin Poniewaz, a therapist in the program. “This is a critical opportunity to have these difficult conversations and get women the help they need.”
Carrie Myers signed onto the Mercy program last February after hearing about Mary Jo Trokey and following the instinct to get help. Myers wasn’t bonding with her newborn, Sebastian. She would get angry when he cried and had fears of hurting him.
“You hear about baby blues, but this was totally different. I felt like he wasn’t my baby, like I was babysitting,” she said.
At the first therapy session, Sebastian would not stop crying. Myers decided to tell the other women every scary thought she had — and realized it was easier to talk to strangers than her loved ones.
That peer support is so critical in the postpartum period, Poniewaz said. Women are encouraged to bring their babies to the therapy sessions. They learn infant massage and other techniques to gain confidence in their parenting.
Myers said her recovery from postpartum depression was a three-step process — being honest with herself, taking advice and learning new skills, and getting over the feelings of guilt.
Now she and 9-month-old Sebastian are thriving. They still go on play dates with the other women and babies from the support group and remember the mantra they learned:
“You’re not alone, you’re not to blame and you will get well.”