Alex Murra:

Hello, everyone. Welcome back to From the Front row, brought to you by the University of Iowa College of Public Health. My name is Alex Murra, and if this is your first time with us welcome. We are a student run podcast that talks about major issues in public health and how they are relevant to anyone, both in and out of the field of public health. Today we’ll be chatting with Dr. Stacey Pawlak. Dr. Pawlak is a clinical psychologist and clinical assistant professor of psychiatry at the University of Iowa Carver College of Medicine and the director of women’s wellness and counseling services in University of Iowa Hospitals and Clinics. Her clinical focus is on providing mental health services for perinatal women and infant fertility patients. Dr. Pawlak earned her PhD in clinical psychology at the University of Memphis and BA in psychology at University of Michigan. Today she is here with us to discuss current topics on women’s mental health and how the pandemic has impacted women’s mental health and wellness. Welcome to the show Dr. Pawlak.

Stacey Pawlak:

Hi Alex. Thank you. I’m really excited to be here.

Alex Murra:

Just to start us off can you tell us about your path to becoming a clinical psychologist and why you chose to specialize in women’s mental health?

Stacey Pawlak:

Sure. I think my path really started in elementary school believe it or not. I remember I have distinct memories of kind of seeing those kids on the playground who weren’t being chosen for the games or one sitting at lunch by themselves and really feeling this deep empathy for them and wanting to connect with them. But at that point in time I didn’t really know what a psychologist or a counselor even was. Then when I went to college during my first year I took that sort of like requisite intro psych class that everybody takes sort of like the easy A class. But I found that I was so excited about the work we were doing and I thought this is something I could see myself doing for the rest of my life. I started working with a social psychologist there at Michigan and worked with him to kind of doing research for a couple of years and he was sort of a mentor.

Stacey Pawlak:

And he said, “Because you really enjoy connecting with people clinical psychology might be the path for you.” So I went on to grad school and I kind of started off there with an interest in sex differences. Then I went onto my internship here at U of I at the counseling service and did a rotation here at the hospital and did work with perinatal women. That’s kind of where the root of that specific interest began. I took some time off though after internship and had kids. So that again I got that experience as being a mom and I really kind of understood what the joys and the complications of that can be. So when our clinic here, the women’s wellness and counseling service, started up in 2007 and I was asked to join that was the beginning of my career. And now I’ve been the director of that clinic for about three years.

Alex Murra:

That’s wonderful. I think it’s so cool first of all that you were kind of getting this like spark that started when you were a kid. And then, I love those intro classes in college, they can relate just like hook in and then it takes off from there. When we’re thinking about women’s mental health and specifically perinatal mental health, I think there’s so many conditions that people might think of or maybe symptoms that they can get confused or is this really a condition? Is this something I should go see someone for? Can you talk a little bit about what are the most common conditions or symptoms that women might experience during or after their pregnancy?

Stacey Pawlak:

One of the things I wanted to share with you before I kind of talk about some of the specific conditions and symptoms is the thought that the reality that pregnancy is such a major transition in a woman’s life and really parenthood as well in a man’s life too. But for any transition there’s so many challenges that come with it. Even the ones that we’re really excited about and that lead us somewhere where we want to go, there’s impacts to work, to career, to relationships, to partnerships, financial medical body image comes into play, identity. Because of that there’s often expectations. And sometimes those expectations just are unrealistic. They may not match what reality can bring us and that’s really challenging. Then also women can’t always conceive very easily. There could be infertility or perhaps pregnancy loss and these things all sort of compound that really significant life transition. And lots of mood issues comes up with transitions too. Just the upheaval that comes with those life changes.

Stacey Pawlak:

So some of the symptoms and what’s hard about pregnancy and postpartum is a lot of the symptoms that normally you’d be on the lookout for as signs of depression or anxiety are sort of a normal part of pregnancy. You don’t really get a lot of sleep when you’re pregnant or you have disruptive sleep. Same thing when you give birth, your baby needs your attention so you’re up all during the night caring for the baby. Eating often changes, obviously weight changes. There can be a lot of emotional liabilities sort of like ups and downs and sometimes a lot of irritability, fatigue, just worries about am I going to be able to do this thing. Those sorts of things come up. So now the specific mood symptoms that can be different than just normal kind of parts of pregnancy or the postpartum period, may be more linked to the baby itself or the pregnancy itself.

Stacey Pawlak:

So kind of like the stuff that I might not be able to bond with the baby or maybe I’m not even interested in the pregnancy or the baby. Sometimes women have these unrealistic fears that something will happen to the baby. And sometimes they worry that they’ll hurt the baby themselves. And one that often comes up and it links back to those expectations are this idea that I’m going to be a bad mom, that I won’t do the things. I don’t want be the mom I want to be or somehow I won’t meet my own expectations. So that comes up. So some of the different specific disorders that we kind of look for during the perinatal period include antenatal depression or anxiety. So that’s going to be present during pregnancy or postpartum depression or anxiety. And the anxiety can include more of like a generalized kind of anxiety where there’s just a lot of worry from day to day. You could have panic attacks where you’re having these intense bursts of anxious feelings. Or you could have obsessive compulsive disorder where you start thinking that maybe it links to that harm thing.

Stacey Pawlak:

Like something’s going to happen, you can’t stop thinking that your baby’s going to get hurt or die or you’re going to do something that might hurt the baby. Or germs or something like that. We also see antenatal and postpartum bipolar disorder. Usually that’s something that was existing prior to the pregnancy that kind of continues through it. We also are seeing and this ends up being kind of underdiagnosed as postpartum PTSD. We see a lot of women who have birth trauma or sometimes it’s not trauma necessarily during the birth, but let’s say a preterm birth and baby might end up in the NICU with some significant health issues. Those women often are having nightmares or intrusive thoughts or avoidance behaviors, things like that linked to that trauma. And then our most feared but actually least likely to occur diagnosis is postpartum psychosis. That really is rare, but it’s really a problem when it does occur. So usually less than 1% of women are going to experience that. But that’s a life-threatening scenario.

Alex Murra:

Thank you for that, that’s really interesting to kind of see the breadth of different conditions that you might see. A little followup question to that is one of the conditions you mentioned was postpartum depression. And then I think this also is linked to sometimes I hear this rhetoric around pregnant women and mental health. They’re just like, “Well you’re just hormonal.” I hear the baby blues. So maybe what’s the difference between postpartum depression and then baby blues [inaudible 00:08:00].

Stacey Pawlak:

Yeah. So that’s a really good question because one is really the baby blues is considered more like that’s likely very likely up to like 80% of women are going to experience that one. And it’s not as significant or severe. It may not require any sort of treatment whatsoever. Whereas postpartum depression, which is more like one in eight to 10 women experienced that one, that one is more severe. So the difference might be the level of severity of symptoms. So postpartum depression is going to be a clinical depression, just like major depressive disorder but during that postpartum period. It can start in pregnancy even and then continue through the postpartum. So it’s going to meet some very, very specific criteria and a timeframes as well. Like a certain amount of time. There has to be at least a two week period of time when you’re noticing these symptoms like low mood, loss of pleasure in normal activities.

Stacey Pawlak:

Usually there’s sleep changes, eating changes. There can be loss of self-esteem or self-worth, there’s often fatigue those sorts of things and it can include suicidal or just hopeless kind of feelings as well. Whereas baby blues really common and that I often think is more sort of linked to maybe some of those hormonal shifts which are real. It’s just like PMs, PMDD. Women have these hormonal shifts through our reproductive lives. The baby blues you’re probably going to be kind of tearful or maybe you just don’t feel like yourself. Maybe not crying, but you’re just kind of blah. It probably dissipates fairly easily like maybe it only lasts a few hours or a few days and you kind of enjoy stuff like you normally do or you’re trying to anyway. Whereas depression you may be trying very hard to do the things you normally do or meet up with people or talk to friends and you just aren’t feeling it. So it’s really a difference in functionality and severity of those symptoms and sometimes the timeframe as well.

Alex Murra:

Thank you for that clarification. I always think it’s important kind of to get the clinical background before we kind of delve into the public health aspect of things, which is kind of where we’re going right now. So when we’re thinking about conditions like postpartum depression or different anxiety disorders after pregnancy or during pregnancy, what are some factors that might increase the person’s risk and is anyone at higher risk for these conditions and who might that be?

Stacey Pawlak:

Absolutely. I think there’s a definite set of factors that we kind of look for. The first being any history of previous mental health conditions or issues at any point in that person’s life. So any mood issues, any anxiety, depression, eating issues, anything like that is going to be one thing we’re going to look for. Next, if they’ve had a child before or have been pregnant before, if they notice those symptoms during that perinatal period or during that pregnancy or postpartum period. So a previous history of what we call PMADs, which is perinatal mood and anxiety disorder. So previous history of that. Also we find that women who do have more of a history of those menstrual or hormonally linked syndromes like PMs or PMD, they also seem to have an increased likelihood of experiencing perinatal mood issues. So we look for that. And then the other big genetic piece or linkage heritability linkage might be with a family history.

Stacey Pawlak:

So if the woman has a family member, especially if it was a female family member, a mom or a sister, most likely who’s had anxiety or depression or PMADs, we’re going to look for that. So those are some of the markers. Now, these things don’t mean… If you have these things it doesn’t necessarily mean that you are going to for sure develop perinatal mood disorders. But we’re going to keep an eye on you just because it’s a greater possibility. So beyond that there’s a lot of psycho-social factors that play in as well. And some of the ones that you’d probably imagine not having a good support network, especially if there’s not a good partner support network. That doesn’t mean that a single mom is going to be depressed or anxious. It just means having a good support network of somebody is important. Partner violence, intimate partner violence, is definitely a risk factor.

Stacey Pawlak:

If that exists ahead of time, that’s problematic. We’re going to want to keep an eye on that. We find that younger moms who may lack some of the access to resources and they may not have that support network either are ones that may want to keep an eye on. Low SES and financial stress for anyone that’s a risk factor for mood issues or mental health issues. So definitely for moms. If there’s been changes or stressors in their environment, like maybe a recent move, a job loss, illness, obviously we’ve had a pandemic that’s a major stressor that has impacted perinatal mental health as well. Moms who have any history of medical concerns are going to be someone we’re going to watch too. Especially if those medical concerns may have been linked to perinatal care. So like preeclampsia, preterm birth, pregnancy complications, but other health concerns as well that may impact their wellbeing.

Stacey Pawlak:

And then finally, a couple others are like if their baby has ended up in the NICU or if their baby just has some health issues that need to be addressed, that’s a major stressor that can affect mood. And then a history of infertility or pregnancy loss or neonatal death. Those are also risk factors that we want to keep an eye on. Again, I want to stress just because someone has these factors does not mean that they will develop PMADs or any sort of issue like that. We just know that there’s a greater propensity to have that occur, especially if they have a number of those concerns on their in their list.

Alex Murra:

If someone suspects maybe that they’re higher risk or knows that they are a higher risk, what should they do? Especially maybe if they’re not able to go to regular post-pregnancy visits.

Stacey Pawlak:

That’s a really good question. I love to see women being proactive and I like their loved ones and family members and their care providers to be proactive as well. So when you notice that some of those risk factors might be present for yourself or for the person that you care about who’s going to give birth or has given birth, just really being proactive and kind of gathering the supports and the resources that that person might need. It’s really important for everyone, moms and anyone who cares about a mom to educate themselves about those warning signs about the risk factors, what kinds of symptoms you want to be on the lookout for? Just like we talked about baby blues, which may be not too worrisome versus full on postpartum depression or anxiety. So knowing some of those warning signs and then treatment options, that’s a good one too.

Stacey Pawlak:

So once you know there’s a problem, what do you do about it? Where do you go? Who do you talk to? What kinds of strategies maybe if you can’t see a care provider, what kind of strategies can you try on your own? We know that staying healthy is really important and that’s proactively preventatively you can stay healthy through exercise. A lot of people find that maintaining a daily routine of some sort is helpful. Mindfulness practices, that’s something that I always encourage. It’s just more of an idea of staying present focused instead of thinking like what has happened or what could happen. What if I’m not a good mom? That’s not really helpful. People are going to think that, but it’s not necessarily helpful and it’s not usually rooted in any evidence. And then obviously if you notice that there’s a problem, if you start seeing some of these warning signs and you think that you don’t feel well yourself seeking that care and care can include all sorts of different things.

Stacey Pawlak:

Obviously I’m a psychologist so I really like psychotherapy as a care option. Medication is good as well. And a lot of research shows that both of those two things put together have the greatest impact. And I always tell women… So I meet a lot of times with women who are planning to conceive. So they’re going through fertility care. And so they’re talking about I know I have a history of mood issues or I’m currently being treated for those. It’s really important to continue the treatments that work for you. It’s a misconception by a lot of women that they cannot take a medication, an antidepressant or antianxiety med or some other psychiatric medications during pregnancy. But the reality is that our psychiatrists feel if it’s helpful to you, if it helps you to be the best mom you can be, we’d like to figure out a way for you to continue that.

Stacey Pawlak:

So that’s something that I’ve really encourage women to think about. If after careful consideration that medication isn’t going to be a good option for you, that’s okay. There’s lots of other ones, but I think that one needs to be there for some women. Some of the things I encourage women to think about are just looking at their behaviors are they engaging in enough self-care? Are they taking care of themselves? What are their expectations like? Their thoughts? And really being flexible with their goals.

Stacey Pawlak:

So some of the things that can exacerbate or sometimes even cause some of those mental health conditions during pregnancy or postpartum is the goals that aren’t flexible or adaptable. So like with breastfeeding or feeding the baby that can come up where you really have this idea of what you want it to be like and then baby’s not cooperating, it’s just not going the way you want it to go. And it can be really, really challenging if you’re not able to sort of change the way you’re thinking about that and adapt and say, “You know what, maybe I’m not going to breastfeed or maybe I’ll not breastfeed as much.” Or whatever it might be.

Stacey Pawlak:

Also we see expectations and goals with back to work and weight loss, those things come up. So if you have a rigid sense of what you want to accomplish with those things, it can be really hard to let go of those things and it affects your mental health. And obviously if there’s any sense of hopelessness or any sorts of disordered thought that could indicate psychosis, obviously seek immediate care as much as going to the emergency department or even calling 911 if you feel like you might harm your baby or yourself.

Alex Murra:

We kind of touched on this a little bit, but sometimes women aren’t able to access care or maybe they’re afraid that if they do then people are going to perceive them as a bad mother like you said. When we’re thinking about barriers, whether that’s stigma barriers or healthcare access barriers, what really are those specific barriers for women seeking mental health care? And follow up, what can we as public health professionals or healthcare professionals do to advocate for these women?

Stacey Pawlak:

Yeah. It’s a really important question about the barriers and this isn’t just true for perinatal mental health care. It’s true for mental health care in general unfortunately. I mean, there’s always a cost for care, a cost of care that can be challenging. Luckily in my clinic we accept all the insurances that the hospital accepts, which is pretty much everything including state insurance, Medicaid and Medicare. But cost of care can be prohibitive to women who don’t have insurance or don’t have adequate insurance. Distance to care and transportation can be an issue. We’re in a state where so my clinic is really the only specialized clinic in the entire state that provides this type of care. Not that there aren’t other providers across the state that women can see, but right now we’re seeing wait lists, huge wait lists to get in to see people for therapy and for medication.

Stacey Pawlak:

So it’s difficult across the board. So women are having to travel. One of the good things that came out of the pandemic was the ability to use tele-health. And our clinic has been using that fairly extensively. So several women on my caseload right now are ones I never would have seen had we not had the option to do video sessions. Because they’re in Des Moines or 2, 3, 4 hours away from me, they would not be able to drive especially with a new baby. And finding childcare is difficult too. So we allow moms to bring babies in with them and their kids in with them, but that’s not always true for some appointments. You’re not really supposed to bring your kids in. So that’s a barrier to care right there. You may not be able to afford the childcare or find it.

Stacey Pawlak:

Sometimes there’s lack of support from the partner or the loved ones to seek out care unfortunately. Luckily as the stigma of mental health care lessens over time, I don’t think it’s ever going to be gone completely. But as it lessens, people are more accepting and understanding of seeking care. But there can be someone whose partner says you don’t need that or I’m not going to watch the baby while you go that’s stupid. Or just doesn’t support the changes that they’re trying to make through their mental healthcare treatment. Then there’s just like we mentioned before, the stigma. Luckily that’s decreasing I think a little bit. But a lot of women will wait, wait, wait, thinking I can manage this on my own. This is normal, me feeling this horrible must be normal. There’s something wrong with me. Everybody else is happy, but they just keep that to themselves not wanting to seek out the care.

Stacey Pawlak:

It feels like they’re admitting to being weak or just not being a good mother because they’re seeking out care or not just loving every second of motherhood. So as professionals, what we need to do is really gain an awareness of these barriers and really help to figure out work arounds for patients. Just like in our clinic when we say, “Go ahead and bring your baby with you if you need to.” It’s not always ideal to have a baby with you, but some moms are breastfeeding they need to bring the baby to feed it. So we’ll do that. We also need to be able to normalize the joys and the challenges of motherhood. I think this is one of the biggest things. Because when you see pictures of moms and babies and dads and babies are always happy, baby’s happy. Everything’s looks good, everybody’s clean, organized. That’s not real life.

Stacey Pawlak:

Real parenthood is messy. There’s a lot of tears. There’s probably a lot of smelly things going on. It’s just not that perfect image. And to be able to share with women it is a struggle, it makes them feel like okay, so there’s nothing, it’s not really something that’s wrong with me here. We also need to be able to screen women to find these symptoms, to hear what they’re saying. And this can be done by people who are not mental health care professionals too. It can be done by any healthcare worker, really anyone including like a partner or a friend. They can kind of be aware of some of these symptoms and do sort of an informal screening. But as professionals, we need to be able to screen women. And then we have to find a place to refer them to.

Stacey Pawlak:

That’s another big issue right now. Like I said, our clinic being really the only one in the whole state of Iowa where do we send these women to once we know they need help? Unfortunately there is often a wait to see someone. We try in my clinic to get people in within a few weeks. It can be hard especially recently with so many referrals, but that’s important. And then finally we really need to advocate for research in this area. We need to advocate for funding. We need to advocate for greater access to care in general. Also family leave.

Stacey Pawlak:

It is horrible when women get six weeks after delivering and then they need to return to work. It is such a huge tax on their mental health to just the logistics of arranging for daycare and the going back to work and that sort of stuff. Family leave is just dismal for moms and for dads. That’s something I’d love to see change. And just improved access as well to early childhood interventions for those kids who maybe do need extra help later on. That’s another thing we all as professionals need to be advocating for.

Alex Murra:

I love so many of the things that you brought up. I have this thing where I’ve been taking these maternal child health classes and we talked a lot about perinatal mental health and there’s so many barriers to care. But I’m also very excited now that we’ve been able to identify them. It’s like okay, well now we know what they are we got to charge forward and try and break down these barriers, make sure people get the care. And that’s where I think telehealth is really interesting too, because it’s got so much potential to reach these people who maybe were like you said were unreachable before. So switching to pandemic specifically. You mentioned that the COVID pandemic was obviously a large stressor in everyone’s lives. It’s also for a lot of people is very isolating. And you talked about support systems during this time, how important that is. So how has the pandemic really impacted women’s mental health?

Stacey Pawlak:

I think women have been affected disproportionately more significantly than men in a lot of ways. When we think about it women are often the ones who are staying home with kids, who needed to reduce or even eliminate their work time so that they could be home with kids who were no longer in school. Maybe they were doing schooling those kids or just childcare. If there were older relatives or things like that, women are usually the ones taking care of those ones. The in-laws or the parents who need help. During the pandemic women were engaging in a greater proportion of the household tasks and domestic activities around the house. And women just in general we know are working lower paying jobs. They’re less financially secure than men. That’s just sort of the way it is. And so when they lost those jobs or when they had to reduce their time, they were getting even less from what was already a lower base.

Stacey Pawlak:

And then we’ve just seen unfortunately an increase in gender-based violence. When women are stuck at home with their abuser, there’s just no avenue for escape, unfortunately. There was a survey that was done that it was actually across 64 different countries and it was almost 7,000 women it was reported in Plus One journal recently. It was done last spring, so about a year ago. And they really found highly elevated levels of post-traumatic stress, anxiety, depression and loneliness with women specifically during the pandemic. And when you look at perinatal population, there’s some very specific impacts as well. In addition to just the general impacts to women. So a lot of women who were let’s say going through fertility care or trying to conceive were concerned about how the coronavirus might impact their fertility or their pregnancy. That was really frightening. Clinics like the fertility clinic here shut down during the pandemic, which stopped IVF cycles that had been in the planning for sometimes maybe months, maybe even a year, everything stopped.

Stacey Pawlak:

And those timelines you don’t stop growing older when the clinic shuts down. So that affected so many things. That was very anxiety producing. And then finally when women were pregnant during the pandemic, most of the time at least at the very beginning, you couldn’t bring a partner with you or any support person to your appointments. So there was worries about then laboring and delivering without the partner. If you were diagnosed with the virus at delivery you were isolated from your baby, which is beyond anything I can imagine in terms of fearful. And also just after delivery most of the time you expect mom, sister, friends, someone to come and kind of help out around the house and stay with you. During the pandemic this just wasn’t happening. And even now, even at this point as we’re starting to see this change thank goodness out of sort of these pandemic conditions, there’s still concerns about the vaccine and its impact on pregnancy or on fertility. A lot of question marks are still out there. So it’s really still frightening for a lot of women who are in that perinatal period.

Alex Murra:

I’ve heard a lot of the vaccine concerns, especially with pertaining to breastfeeding. But yeah, it’s definitely been a challenging time. It’s very devastating to hear about the fertility clinic IVF stopping and all of that. As you kind of mentioned, restrictions are starting to ease up. People are slowly beginning to return to whatever sense of normalcy the new normal. But I think a lot of people are experiencing re-entry anxiety, especially with all the news that the Delta variant going on. I see headlines with that all the time. And I’ve heard a lot of people they’ll… I’ve had family members call me up like, “What should I do with this new variant? Is it safe to go outside?” Can you talk about what exactly is re-entry anxiety and what are some ways that people can cope with feelings as we’re trying to move forward?

Stacey Pawlak:

So I think at the beginning of the pandemic in March 2020, the most common question people had is when can we go back to what we were doing before? As time went on as weeks, days, weeks, months passed, we really started to get used to these new safety precautions that were protecting us and our loved ones from the potentially death, illness and death from this virus that we knew little about. So as time went on, we got used to these safety measures. And so now that we’re reversing even though most of us are really excited that we’re hopefully going back to this place that we used to be that less socialized isolation and sanitizer and masks and stuff. There’s still this association with those safety measures that they are good, they’re good to do.

Stacey Pawlak:

So as we remove them, it feels like, “Am I losing protection? Am I putting myself in danger by doing this?” So some people have a greater concern than others. And those people might be ones who were more deeply affected by the pandemic who experienced losses or loved ones did. And so they’re more sensitized to the dangers of stopping those procedures, those safety precautions. Other people who maybe already had a history of anxiety or mood issues are more likely to be a little concerned. People who have kids who are not vaccinated still have a lot of concerns about not wearing a mask or going out in big groups and stuff like that. So lots of people are still kind of needing to take it slow. When we adopted the safety precautions, it was like everybody needs to do this now. For everybody, everybody needs to do it, right?

Stacey Pawlak:

But when we’re reversing it, that’s not necessarily the case. You can still wear your mask. You can still socially distance yourself. You can still take it really slow and do what you personally need to do to feel okay. I would say that anybody who’s making steps toward that, that’s a positive thing. And sort of examining your thoughts as you go along the way. Because if you still have thoughts like I am going to get sick, I can’t leave the house, that’s problematic. But just feeling like, “I don’t think I want to go to that big gathering this weekend. I think I’m good staying home and reading a book.” That’s totally okay. Just like anything else everybody has different levels of comfort and with re-entry it’s the same sort of thing. And I think most places and most people, most employers are trying to be accommodating toward people who may not feel they want to go back to that, but they’re not quite ready to jump into it.

Alex Murra:

Yeah. I think it’s so important to be accommodating like you said, sensitive to the fact that people this impacted their lives in many ways and it’s not going to just happen overnight that we’re going to return to whatever normal life.

Stacey Pawlak:

Exactly.

Alex Murra:

To finish us off, one of the questions we like to ask everyone is, what is one thing that you thought you knew but were later wrong about?

Stacey Pawlak:

Yeah, that’s a really good question. I think that when I was starting out as student in my career as a psychologist and a therapist, I kind of had this idea that with enough education and experience I could at some point know it all and have all the answers. And there’s this craving to want to feel confident and knowledgeable and just really just better able to help people when they’re struggling. So I kind of had this idea that there’d be this end point in time. Like I’d be this expert and I would never doubt myself again. Right? And I see it in the students I work with too where it’s like trying to gather enough information and expertise to just feel like I can do this. What I have figured out though is that you just don’t stop learning and you continue to gather information and develop your skills.

Stacey Pawlak:

And it’s not going to end at any point in time. And that’s a good thing. And the awesome thing is, is that some of the best teachers that I have are the people who I work with in therapy. Those who they come to me for support and assistance, but I’m really humbled by their strength, their resilience, their hope in the face of the challenges in their lives. And really in the end, they helped me to grow. They helped me to become a better therapist and really a better person every single day. So no end to the learning and I’ll never be an expert, darn.

Alex Murra:

That’s a really good thing to end on. I think everyday the more I learn the more I realize I don’t know.

Stacey Pawlak:

Exactly.

Alex Murra:

Thank you so much Dr. Pawlak for coming on and talking with us and discussing women’s mental health. I think it was really interesting and a lot of people enjoyed this conversation.

Stacey Pawlak:

You’re welcome. It’s really been a pleasure, thank you.

Alex Murra:

That’s it for our episode this week. Big thanks to Dr. Stacey Pawlak for coming on today. This episode was hosted, written, edited and produced by Alex Murra. You can learn more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple podcasts and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues. Our team can be reached at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Stay happy, stay healthy and keep learning.