Postnatal depression in the Year of the Dragon

Women are more likely to develop emotional problems after childbirth than at any other time in their lives and the life time prevalence of major depression in women is almost twice that of men (Kohen, 2001). According to Lumley et al. (2004), one out of every six women experiences a depressive illness in the first year after giving birth. Thirty per cent of those women will still be depressed when their child is two years old. Of those women, 94% report experiencing a related health problem. Women who experience problems in the early stages of motherhood also report problems with their relationships, their own physical health and well-being. Women report that a lack of support, isolation, and exhaustion are common experiences.

Several years ago I was approached to develop a new brochure about Women’s perinatal mental health (given my expertise as as a clinician and educator in maternal mental health) for the New Zealand Mental Health Foundation who were partnering with EGG maternity a New Zealand company specialising in maternity wear. In developing the brochure, my partner and I consulted widely with consumer groups, mothers, fathers, health professionals in order to ascertain what would be the most important and clear information we could put inside the brochure. This was the end result:

The PND brochure has become widely available, it is included in information packs given to new mothers by Plunket, available from the resource centre at the Mental Health Foundation, the Foundation website and EGG maternity boutiques in New Zealand.  It has been one of the most requested brochures ever with 33,800 sent out in 2011 alone.

Women who have a baby in a new country and are separated from their support networks and special perinatal customs (including special foods, nurturing, rest and household help) through migration can experience isolation and postnatal depression.

For the Year of the Dragon this brochure has been translated into Chinese by Kai Xin Xing Dong -a public education programme aimed at reducing the stigma and discrimination faced by Chinese people who experience mental illness. Funded by the Ministry of Health, the project aims to raise mental health awareness in the Chinese community and to counter stigma and discrimination.

See here for other PND resources

Gambling: Causing more harm than good

First published in the Goanet Reader Tue, 26 Sep 2006
I read with dismay about the establishment of ten new offshore casinos in Goa in an item in the latest Goan Voice UK and thought I would share my thoughts. I’ve just spent the entire week facilitating an annual International Gambling Think Tank and a follow up International Conference on Gambling examining the impacts of gambling in particular perspectives from practice, policy and research.

The Think Tank saw the world’s leading authorities on problem gambling examining current international developments in gambling research and practice. It was co-hosted by the New Zealand’s Gambling Helpline and AUT University where I work.

The helpline has 18,000 contacts each year and is a world leading resource for problem gamblers. While the conference was hosted by AUT University and the Problem Gambling Foundation of New Zealand.

About 50,000 New Zealanders or 1.2% of the population have a gambling problem (defined as patterns of gambling that disrupt personal, family, or vocational pursuits) and research shows that the poor, Maori and Pacific Island people are hardest hit.

Quite often gambling and social inequality are linked and with many migrants and indigenous communities being found in the lower social strata of communities, they are at risk.

Maori experience high rates of problem gambling and are more likely than NZ Europeans to be worried about their gambling behaviour and more likely to want immediate help. There are sub-groups at risk for problem gambling such as youth, women, elderly Maori and those with mental illnesses or other addictions.

Pacific peoples living in New Zealand experience socio-demographic risk factors that are associated with developing problem gambling, such as low socio-economic status, being young, living in in urban areas and having low educational and low occupational status.

Studies show that adult Pacific peoples were most at-risk of all ethnic groups for developing problem or pathological gambling behaviour. They are thought to be six times greater at risk of problem gambling than New Zealand Europeans.

Increasingly high rates of gambling have been noted among Chinese communities, particularly new migrants and restaurant workers. It is thought that this is precipitated by loneliness, isolation, cultural and language barriers.

International Asian students are also vulnerable groups as in addition to the factors mentioned earlier they can also have access to considerable amounts of cash. Migrants are thought to be at risk of gambling problems because of acculturation which makes them more likely to be conditioned to the dominant practices of the receiving community or because they are struggling with the acculturation process.

The historical gender imbalance in men being the key users of problem gambling services has changed since the introduction of electronic gaming machines which have made gambling more accessible and acceptable, leading to an equal if not greater number of women presenting to problem gambling services for help.

Not only is the gambler affected but Australian research has found that each problem gambler is likely to directly affect at least seven other people including children through family dysfunction, problems at work or crime. Problem gambling also has economic and social costs to families and communities.

Problem gamblers are more likely to experience other problems as a result or in combination with issues such as relationship issues, isolation, poor physical and psychological health, and be hazardous drinkers.

So what are communities doing about gambling? Responses are mixed. Some view gambling as criminal, while others view it as a social activity and for some governments and communities it is a source of funding.

In New Zealand the Gambling Act of 2003, includes a focus on preventing and minimising of harm caused by gambling, including problem gambling. The Act has an integrated public health approach and sets out a number of obligations for gambling operators in prevention and minimisation of harm.

Under the Act, gambling venues are penalised if they allow people who have self-excluded into their venues and the notion of host responsibility and duty of care are paramount.

The government views gambling as a source of economic development, revenue generation and a source of funding for community initiatives and programmes. The industry view is that gambling is entertainment and that people are free to choose. However, in 2004/05 gamblers lost more than $2.02 billion on gambling activity in New Zealand and that this was derived disproportionately from those living in high deprivation communities.

Psychological aspects: Though many participate in gambling as a form of recreation or even as a means to gain an income, gambling, like any behavior which involves variation in brain chemistry, can become a psychologically addictive and harmful behavior in some people. Reinforcement phenomena may also make gamblers persist in gambling even after repeated losses. Because of the negative connotations of the word “gambling”, casinos and race tracks often use the euphemism “gaming” to describe the recreational gambling activities they offer.

The harms that gambling causes are not incidental harms, they are grave harms that result in domestic violence, crime, incapacity, and children going without food. Industry operators rely on harm causing losses and are casual agents of harm

So I conclude this diatribe with some questions: Can Goa afford to have ten new offshore casinos? Does it need to be a “gambler’s paradise”? Will these casinos create wealth for Goans and Indians or will they cause more harm? Can industry operators provide a safe product? If not is it better to not have casinos at all? Will more casinos lead the way to the installation of electronic gaming machines?

These are issues that need healthy debate; it is hard to put the genie in the bottle when it has already been unleashed. As James Doughney said in his presentation today: “The harm is more unjust, more unconscionable because governments have a duty to protect.”