Studying Perinatal Well-being with Dr. Jennifer Payne, MD (Offered in English)

Listen to this month’s Studying Perinatal Well-being interview with Dr. Payne, the Vice Chair of Research in the Psychiatry Department and Professor of Psychiatry and Neurobehavioral Sciences at the University of Virginia. Dr. Payne established the Reproductive Psychiatry Research Program at the University of Virginia. Dr. Payne is the current MONA and Marcé Society for Perinatal Mental Health president. In this month’s episode, Dr. Payne shares cutting-edge findings on epigenetic biomarkers for postpartum depression. She also discusses plans for the 2023 Marcé of North America biennial conference and the 2024 International Marcé Society for Perinatal Mental Health biennial conference in Spain.

Transcript

Host (Dr. Lara-Cinisomo) [00:00:04] Welcome to Studying Perinatal Wellbeing, the podcast of the Marcé  of North America. This bilingual monthly podcast will allow new and experienced researchers, practitioners, students, and community members to hear about the latest research and community actions on perinatal well-being. I'm Dr. Sandraluz Lara-Cinisomo your host. Today’s guest is Dr. Jennifer Payne MD., an expert in reproductive psychiatry. Dr. Payne received her bachelor’s in biology at Davidson College in Davidson, North Carolina. And her medical degree from Washington University Medical school in St. Louis, Missouri. She completed her residency in psychiatry at the Johns Hopkins Hospital and then completed a fellowship in mood disorders through the mood and anxiety disorders program at the National Institute of Mental Health. Until recently, she was a social professor at the Johns Hopkins Medical School where she founded and directed the Women’s Mood Disorders Center. Currently, Dr. Payne is the Vice Chair of research in the psychiatry department, and professor of psychiatry in Neurobehavior sciences at the University of Virginia. Where she has established the reproductive psychiatry research program. She has an extensive publication and funding record, some of which we’ll hear about today. Thank you so much for joining us today. We're so glad to have you here. So, I like to begin by asking our guests, how did you become interested in perinatal mental health? 

Dr. Payne [00:00:42] Well, that that is a great question. And it goes back a long time ago. So after I completed residency, I went to the National Institutes of Health and did a fellowship and doing clinical research and mood disorders. And as part of that fellowship, we kind of had a brainstorming session every week or so in which we would kind of throw ideas around about how are we going to get to the underlying biology for a major depression and bipolar disorder. And I literally had an epiphany at one of these brainstorming sessions where I realized that postpartum depression was the perfect type of depression to study because you could predict when it would occur. As you know, if you take 100 pregnant women from the general population, about 15 of them get ill in the postpartum time period. And if you take women with preexisting mood disorders, about 40 or so will get ill. You know, compare that to watching 100 men for a year, none of them might get ill. And so it's really this natural experiment where you can measure all kinds of things beforehand and then look to see who gets depressed. And even when they get depressed and start to really try to understand what the underlying biology is. So that's how I kind of backed into  postpartum depression. I also happened to love taking care of women through pregnancy and into the postpartum time period. So clinically, that was a good choice as well. 

Host (Dr. Lara-Cinisomo)  [00:02:15] Wonderful. I appreciate you taking us to the start of your process. And so you are deeply engaged in research and clinical care and now administrative work. And we'll talk about that in a moment. But I'm sure our listeners are interested in learning how you manage all of that. How do you decide which research questions to ask and explore? 

Dr. Payne [00:02:38] Yeah, So, you know, I think research questions really require have taken some time to really think about them. And what's funny is it takes a long time to get research projects going and it takes a long time to get grants and you often have to resubmit them. And so when you get funding, you then spend a lot of time setting the research project up. So you really spend a lot more time getting that part done than you do thinking. And so one of my favorite things to do is to talk about ideas, kind of like what I was talking about back when I was doing my fellowship, just spending some time with other researchers and preferably some young people who are interested in research and, you know, batting around ideas about what might be happening, what might not be happening, how would we answer this question? And those brainstorming sessions usually give me several years of work to follow through on the research questions. 

Host (Dr. Lara-Cinisomo)  [00:03:45] Yes, that's really helpful to learn a little bit about your process before you even start the writing of a grant proposal or a manuscript or looking at data. I know you've published on many, many topics and one of them is worry and its predictive effect on postpartum depression. What can you tell us about worry and what is it about worry that is a risk factor for postpartum depression? 

Dr. Payne [00:04:10] Well, I think I think it's going to be hard to say why exactly. It's a it's a risk factor for postpartum depression. But one thing that we know is that a lot of women with postpartum depression are also anxious. So kind of the classic picture is, you know, a baby being sound asleep and mom wringing her hands over the the baby's cradle, checking to see if the baby's breathing. And so I think anxiety really goes along with a lot of cases of postpartum depression. And what we found was that there was a questionnaire that we used during pregnancy that measured the amount of worry a woman was experiencing, and it was predictive of the later development of postpartum depression. And I think what that means is that there are early symptoms that occur during pregnancy and worry can be one of those. 

Host (Dr. Lara-Cinisomo)  [00:05:05] Yeah. So what advice or suggestions do you have to the clinician working with a pregnant person or to that pregnant person who expresses worry? I know you're a clinician in addition to a researcher and administrator. What kind of tips can you provide? 

Dr. Payne [00:05:22] Yeah, so, you know, I actually just saw a pregnant woman today with generalized anxiety disorder. I think that there are a couple of things that you want to. Say other than, you know, thinking about using medication for significant symptoms. And one of those is get a psychotherapist and preferably focus on cognitive behavioral therapy, which can be really helpful with anxious thoughts. The other thing I usually recommend is doing some sort of meditative practice, whether that's actual meditation. I personally think yoga is, you know, the bee's knees and helps everybody. And, you know, there are a lot of short videos that people can do even online. They don't have to join a class or pay for a class. And those kinds of active things that can help reduce anxiety can be really helpful. Most women find that some sort of exercise, whether that's yoga or walking around the block, is also helpful. 

Host (Dr. Lara-Cinisomo)  [00:06:23] Wonderful. We talked a little bit about the predictive effect of worry and determining risk for postpartum depression. I know you're also exploring a really exciting line of research, looking at biomarkers. Do you want to talk a little bit about that line of work? 

Dr. Payne [00:06:38] Sure. So this this project has been going on for 12 years now, which is kind of hard to believe. And to make a long story short, we've identified two epigenetic biomarkers that are predictive of who's going to develop postpartum depression with about 80% accuracy. And we've now replicated these biomarkers in about six cohorts. And so I'm finally believing that these biomarkers may actually be real. And so we can take blood during the third trimester and look at the methylation patterns at a couple of specific genes. And those methylation patterns are predictive of whether someone's at high risk or low risk of postpartum depression. So now I'm actually working with a company, I'm working with NIH,  NIH has a competition. It's called a RADX Prize, and we're in the third round of that competition. And their whole goal is to help scientists take their research to market so that we can actually do something to improve the lives of others with our research. So I'm hopeful that eventually we'll get these to be available. And my hope is that we'll be able to change the standard of care so that every woman would get a blood draw IN their third trimester and those that are found to be at elevated risk will make some sort of plan with their doctor about how to try to prevent postpartum depression. And I’d love the incidence of postpartum depression to shrink over time. 

Host (Dr. Lara-Cinisomo)  [00:08:15] Yeah, that sounds really exciting and promising. And good luck with that competition. Yes. So you talked about the epigenetics of it, are there environmental contextual factors that might be of some important characteristics to consider when we're thinking about these biomarkers? 

Dr. Payne [00:08:34] Sure. So the way we identified the biomarkers was actually we started with the mouse model and Zach Kominski, who's my partner in this, and I both thought that the hormonal changes that women experience and the process of being pregnant might change certain gene epigenetic signatures. And so we exposed mice to estrogen. I did not physically do this because I'm allergic, but we exposed mice to estrogen. And then we looked specifically at the hippocampus to see what genes were changed with the epigenetic methylation patterns. And then we cross-referenced those genes that changed from blood samples from women who I carefully characterized. And so the initial sample was in women who were well during pregnancy and got depressed postpartum, or who did not become depressed postpartum. And when we cross-referenced those genes, we found that two genes were specifically methylated and a particular pattern every time a woman was depressed in the postpartum time period. And so over the years, we replicated these findings and our samples that we've collected and in samples that other people have collected. And it's about 80% accurate every time we look at it. So it's interesting because we think the quote unquote, environmental exposure to estrogen is part of what's driving these biomarkers. 

Host (Dr. Lara-Cinisomo)  [00:10:06] Yeah. So the the individual is the context? 

Dr. Payne [00:10:10] Correct, exactly. 

Speaker 1 [00:10:10] Yeah, that's interesting because we look outside of the individual many times looking at some psychosocial stressors. Maybe there was a traumatic event, but this is a hormonal change that happens in pregnant people. And for some people, this response, a sensitivity to this hormone, could trigger this event postpartum. 

Dr. Payne [00:10:31] Exactly. Exactly. 

Host (Dr. Lara-Cinisomo)  [00:10:34] That's really interesting. It's a really exciting line of research. So in thinking about large scale or scaling it out and thinking about making it a standard of care could be part of this prenatal assessment that every birthing person is going to be exposed to. 

Dr. Payne [00:10:52] Exactly. One of the things that worries me about postpartum depression is that even though we can screen for it pretty easily, that, you know, the Edinburg is a self rated scale, it's pretty easy to give people a piece of paper. But, you know, less than 50% are screened for postpartum depression today. And part of that is because we do not have the resources, the psychiatric and the mental health resources to handle everybody that would screen positive. And so what is exciting about the biomarkers is that they're predictive. So it's before symptoms so that we can intervene to prevent the disaster that post-partum depression can be. 

Host (Dr. Lara-Cinisomo)  [00:11:33] Yeah. And so we have to develop a workforce who can draw the blood, do the testing, do the interventions, do the referrals. As president of the Marcé of North America. One of the goals, I believe, is really to help the next generation and current researchers, clinicians and community members. And that includes students, of course. And so we have the conference coming up in October of 2023. What are your goals for that conference? The topic is equity and innovation in perinatal mental health. And your research definitely fits that criteria work. What can you tell us about your goals or hopes for that conference? 

Dr. Payne [00:12:14] I'm hoping that it's a really successful conference. We've got a lineup of keynotes that I think are both diverse and have diverse topics and topics that we're going to want to hear about. We have a great set of pre-conference workshops and right now, you know, the abstracts right now as we're speaking is still open. And so we're hoping to put on a really great scientific conference. The abstract committee this year decided to emphasize younger speakers, and so older, more established investigators are really only allowed to present symposiums so that we can have the younger generation presenting for the oral abstracts. And I think that's a wonderful idea and a real way to get, you know, young people A. involved in research, B. involved in the conference, but also inspire them to do more for the next time around. 

Host (Dr. Lara-Cinisomo)  [00:13:16] Yeah, that's a really innovative approach, definitely to a conference format, leveraging the experience of the next generation in a venue where there will be people that they can collaborate with who are more established. 

Dr. Payne [00:13:31] Exactly, Exactly. And one of the other things Mona has done this year, we started a research task force or committee. And the way we're running is we're having a meeting about once a month. And I'm inviting anybody who's interested in research to A. come to the meeting but B. present ideas. So present specific aims, get feedback on your paper, bring a figure that you're struggling with, and let's have the group think together about how to help that person or really hone that research question. I think that'll be a great way to really promote research in this society. 

Host (Dr. Lara-Cinisomo)  [00:14:12] Sign me up. Sounds really productive. 

Dr. Payne [00:14:16] Absolutely. 

Host (Dr. Lara-Cinisomo)  [00:14:17] Yeah, it sounds really productive. And speaking of being productive, you are very busy now. You're also the president of the International Marcé Society for Perinatal Mental Health. 

Dr. Payne [00:14:26] I figured that doing the conference for Mona would be good training for doing the conference for international. And so I said, sure, I’d do it. It has been a lot to juggle, I will admit that. 

Host (Dr. Lara-Cinisomo)  [00:14:46] Yeah, it’s great that you’re open about the amount of work that this may bring to your life, given your relatively new role as an administrator, which we’ll come back to. But this next international conference, which will be next fall 2024, will be in Barcelona, Spain. Can you tell us why you chose that as the conference venue? 

Dr. Payne [00:15:11] Sure. So the international conference has a very strong English and English speaking base, but we have regional groups from other non-English speaking countries. And I felt that when I became president that I would really like to take the international Marcé into even more international waters, if you will. And so I felt that we should have the conference in a non-English speaking country. And I happened to be married to a Latino. And he took me to Barcelona for the first time 26 years ago. And I love Barcelona, so I thought that would be a beautiful city to have the conference in. In addition, the regional group, the Spanish regional group, is very strong and very excited and they are working really hard to help make this happen. One of my other ideas for International is to have the regional groups actually do symposia in their native language. So we're going to have a virtual portion of the international conference and when we do that, we can actually translate, you know, these symposia into English and perhaps other languages and therefore really make it a much more international conference. So I really wanted to be more diverse and inclusive. And so that's why I decided Barcelona was going to be a good idea. 

Host (Dr. Lara-Cinisomo)  [00:16:45] What a fantastic idea to make it more accessible to people who perhaps can not make the trip to Barcelona for whatever reason. And then also as an international organization of a sort, Marcé of North America includes Mexico and Spain, where other languages are spoken other than English. And so making the international conference accessible to other groups I think is really fantastic and innovative approach. 

Dr. Payne [00:17:13] Well, I'm hoping I'm hoping that it works out well. And so cross your fingers for me. 

Host (Dr. Lara-Cinisomo)  [00:17:18] I'm excited about it. Another recent role you've taken on as vice chair of Research and the Department of Psychiatry and Neuro Behavioral Sciences at the University of Virginia. I want to note that you're one of a small number of female leaders in a similar role. Congratulations. Can you tell us how you manage administrative duties with your research and in patient care? 

Dr. Payne [00:17:44] Well, it's it's an exciting day every day. I decided to come to the University of Virginia and be vice chair of research because it offered me a chance that I was really ready for, which was to concentrate more on research. And I still do clinical work, but to have that be a smaller part of my plate. And what's kind of neat about my duties as vice chair of research is that it really falls in line with my other goals. So it's really about mentoring and developing programs that allow mentoring and get younger people interested in research and the entire department aware of what research is going on and how they might add research to their academic profile. And to me, that goes hand in hand with doing good research if you're a clinical researcher and you're not mentoring younger people, you're not doing your job. Right. And and so I just have this on a little bit of a bigger scale, which means I have more resources to offer people. So, for instance, today we announced the results of what we're calling the launch program, which is a small grants for junior faculty who would like to do a particular research project or block their time so that they can do research. And we had three winners that we announced today, and I'm very excited because I'm going to get the chance to work with them over the next year on their projects. 

Host (Dr. Lara-Cinisomo)  [00:19:18] Wow. That's great. That's congratulations to the winners. So would you say that your administrative responsibilities continue to inform your research and patient care? 

Dr. Payne [00:19:29] Yes. Yes, I would. So, you know, somebody said to me once, you know, come up with your mission statement and I don't have a specific mission statement, but I do think that my mission is around perinatal mental health. And right now, a majority of what I do is all around that. So we've started a perinatal mental health clinic here at UVA, just like I did at Hopkins so many years ago. You know, my research has to do with perinatal mental health. My mentorship generally has to do with perinatal mental health or about research more generally. So really aligning everything with a particular mission or goal makes it easier. 

 Host (Dr. Lara-Cinisomo)  [00:20:11] Wonderful. So our listeners include students at multiple levels, whether it's undergraduate, graduate, residency, medical school and community members who may be interested in engaging in research. What recommendations or advice do you have for those aspiring to engage in an investigation or a research project related to perinatal mental health? 

Dr. Payne [00:20:34] Well, first of all, get mentorship. So science is a team sport and it is best done in groups. And and the best research projects really do come out of groups getting together and thinking about a problem. That's why we have the grant review process we have through NIH. Although sometimes reviews can be annoying when someone doesn't like your grant, I really am convinced that the reviews generally make your grant better and stronger. So getting with a group, finding mentorship and and going from there is the place I would start. 

Host (Dr. Lara-Cinisomo)  [00:21:11] Yeah. So what should someone look for in a mentor? 

Dr. Payne [00:21:14] I think it depends on what your goals are and really there's never just one mentor really should be a mentorship team and you may get different things from different people. So you might have one mentor for writing papers and another for writing grants or one for how to balance share your work and home life. So you should definitely be looking for a team of mentors based on the needs that you think you need some help with. 

Host (Dr. Lara-Cinisomo)  [00:21:43] Yes, I think the saying is there is no mentor guru. There is no one mentor who will give it all. Yeah. And what should a mentor look for in a mentee? 

Dr. Payne [00:21:54] Well, as a mentor, I look for someone who organizes my meetings with them. So who comes to me with a clear agenda and has specific things that they want to get my advice or my thoughts on. I meet with the younger person and we and they really don't have an agenda. They just kind of want to spend time with me on a regular basis while I enjoy those relationships. That's really not mentorship in the way that I think about it. I think it's much better when the mentee kind of drives the relationship. You can have freewheeling conversations, but having some specific things that you'd like mentorship on or that you have questions on is really very helpful. 

Host (Dr. Lara-Cinisomo)  [00:22:39] Yeah, that's really wonderful advice. Having a plan sounds like both for the mentor and the mentee is important. 

Dr. Payne [00:22:45] Absolutely. 

Host (Dr. Lara-Cinisomo)  [00:22:46] That's wonderful. And in thinking about plans, we can look forward to the upcoming conference. This podcast will air before the October 2023 conference and definitely before the October or fall 2024. I don't know if the Barcelona conference has been scheduled yet. 

Dr. Payne [00:23:03] We are looking at dates and I'm hoping to have that settled soon. 

Host (Dr. Lara-Cinisomo)  [00:23:08] Well, we look forward to it. We will definitely put information about the conferences on the Marcé of North America website and make that accessible to everyone. Thank you so much, Dr. Payne, for meeting with us today. It's been a delight. 

Dr. Payne [00:23:21] Thank you. I really enjoyed this. 

Host (Dr. Lara-Cinisomo)  [00:23:24] Thank you for joining us at studying perinatal well-being. Please see our show notes on the Mona Podcast website for more information about today's guest. We always look for great perinatal well-being students, community members, researchers and practitioners to intervene. So please email your suggestions to monapodcast@marcenortham.com. Until next time, practice compassion for yourself and others.