Foundation seeks to prevent tragic effects of postpartum depression

PITTSBURGH – His family owned pizza shops. Hers owned McDonald’s franchises. In 2008, at a mutual friend’s birthday party in Miami, Alexis Joy Micale “walked in, and I knew that she was going to be my wife,” Steven D’Achille said.

Just a few months later, D’Achille was driving to New Jersey to move in with her, calling her father from the car on the way there to ask for his daughter’s hand in marriage.

They were married in the fall of 2009 and moved to Pittsburgh’s Bloomfield neighborhood after the wedding so that he could join his family’s business. She began a job she loved, selling houses with Ryan Homes, working with families “to build their dream homes,” D’Achille said.

The pair were thrilled to find out in late 2012 that they were expecting a child. “We got pregnant so easy, and the pregnancy was so easy,” D’Achille said. “It was too good to be true.”

Their daughter, Adriana, was born Aug. 30, 2013. Six weeks later, Alexis Joy D’Achille committed suicide. Despite “never a day in her life” having mental health problems before her daughter’s birth, the 30-year-old suffered severe postpartum depression, starting when her daughter was about 3 weeks old.

Steven D’Achille, sitting in the office of his lawyer, John Gismondi, declined to share details of his wife’s final weeks in anticipation of filing a lawsuit about her care.

Just weeks after her death, he began to raise money to promote awareness of the disease. From events as big as a gala at the Fairmont Hotel and as small as contributions from a moms’ group, donations poured in.

In its first 18 months, the Alexis Joy Foundation raised $250,000, giving $100,000 of that sum to Allegheny Health Network this spring as a planning grant for research, prevention and treatment of postpartum depression.

The ultimate goal, for D’Achille, is for the group “to one day be the leading perinatal mood disorder program in the country.”

AHN had already been thinking about ways to improve care for women with postpartum depression. “We’ve been talking about it for a long time,” said Deborah Linhart, vice president of women’s health initiatives. “His story resonated so much it became really a call to arms.”

An analysis of Highmark data that tracked 1,000 women from the start of their pregnancy over an 18-month period found that 22 percent had a diagnosis of depression. “The number sounds so high because people kept it to themselves,” Linhart said. “A part of it is destigmatizing this, making people aware that this really can happen.”

Postpartum depression, marked by symptoms such as confusion, sadness, hopelessness and guilt, can initially be difficult to distinguish from the “baby blues,” a short-lived condition that affects up to 70 percent of new mothers. While the baby blues generally clears within a week or two, postpartum depression persists. It is most common in the three months after birth, although symptoms could start showing up as long as a year later.

Although relatively few cases of postpartum depression are as severe as Alexis D’Achille’s, many more women could benefit from getting treatment, even for milder cases. “Not all postpartum depression ends in tragedy, but it’s a lot of pain and suffering that can be avoided, and it’s not good for the infant,” said P.V. Nickell, assistant chair for psychiatry at Allegheny Health Network.

Since starting to work with Steven D’Achille this spring, AHN has distributed about 5,000 copies of a brochure, “Alexis’ Story,” with information about signs of postpartum depression and resources for treatment. The brochure is being distributed at childbirth classes, obstetricians’ offices, hospital discharges and well-baby visits.

For D’Achille, the brochures will help reach people who might think they’re not at risk for the disease. His wife had a relentlessly sunny personality, with no history of depression before or during her pregnancy. “Alexis was the last person in the world that anyone could think this could happen to,” he said. “This kind of depression, it knows no bounds.”

The hospital system will also soon be piloting a triage program, using telemedicine to immediately assess women identified by their obstetrician or other doctor as having symptoms of postpartum depression. AHN has hired a dedicated psychologist and clinical social worker who will work with three OB-GYN practices participating in the trial. Women identified by the OB-GYNs will be immediately seen, while still in their doctors’ offices, via a video-conferencing program by the triage psychological staff. They will then be referred for treatment, whether it be medication, outpatient care or inpatient care.

Eventually, AHN is hoping to expand the screening and telemedicine to pediatricians’ offices as well, where new mothers often have more points of contact.

The team at AHN, including D’Achille, has also gone on site visits to leading programs nationally in treating postpartum depression. The group is particularly interested in treatment options that allow the mother to stay bonded to her baby. “We want to identify the problems that kept people, especially Alexis, from getting the care she needed in a timely manner,” Dr. Nickell said. “A mother might say, ‘I don’t want to leave my baby and go to this partial hospital program.’ We visited a program at Brown University that we’re going to try to reproduce here, a partial hospital for moms with young babies where they bring their baby with them - that’s on the drawing board.”

Only a handful of such programs exist in the U.S., he said, although allowing mothers to bring their babies with them to treatment facilities is more common in Europe.

D’Achille’s fundraising efforts will continue as well. As Adriana’s second birthday approaches, the foundation will hold the Run for Joy 5K and 1-mile fun run at an area boathouse on Saturday.

Adriana has inherited her mother’s “total spitfire” personality, he says, and she loves to swim. His wife, he said, was happiest when cigarette boating on the Jersey Shore.

The impact of program with AHN, he hopes, is something that will further connect mothers and daughters.

“Alexis, she excelled at everything she did,” D’Achille said. “I wanted something for Adriana to be proud of her mom for. Her mom will make a difference in so many women’s lives.”