Dissertations / Theses on the topic 'Depressione postparto'

2012/2013
Sotto studio 1°. Screening dei sintomi depressivi nel postparto in alcuni Punti Nascita del Friuli Venezia Giulia. Prevalenza e identificazione precoce Introduzione. Il tasso di prevalenza dei sintomi depressivi variano dal 10% al 15% delle donne dopo il parto. Le severe conseguenze di questo disturbo sulla madre, sulla relazione madre-figlio, sulla relazione di coppia e sulla famiglia rendono indispensabile identificare precocemente le madri a rischio, per suggerire strumenti preventivi di screening e aiuti sanitari per madri a rischio. Diversi studi utilizzando l’EPDS come baseline nei primi 2 o 3 giorni dopo il parto, durante la degenza ospedaliera, hanno mostrato che il maternity blues si associa ad un aumentato rischio di depressione maggiore e di disturbi d’ansia nei tre mesi dal parto. Obiettivo. Conoscere la prevalenza del fenomeno della DPP in Friuli Venezia Giulia, considerato che non esistono dati in tal senso, attraverso una rilevazione in alcuni Punti Nascita della regione, anche in rapporto al ruolo di fattori demografici e psicosociali. Verificare se possibile identificare durante la degenza ospedaliera, madri a rischio di DPP nel post-parto successivo. Metodo. A un campione di 1110 puerpere, raccolto in 6 Punti Nascita del FVG, 2,3 giorno dopo il parto, durante la degenza ospedaliera (T0), sono stati somministrati l’EPDS (cut-off≥9) (Cox et al.1987; Carpiniello et al. 1999), per rilevare l’umore materno e una scheda sociodemografica; durante il follow-up telefonico a tre mesi dal parto (T1) proposti l’EPDS e alcune domande per cogliere eventuali fattori di rischio. Risultati. A T0: la prevalenza EPDS è 16.7% (media è 4.58, s.d.=4.02, range 0-22); a T1 è 14.3% (media 4.59, s.d.=3.62, range 0-23). A T1 sono non cliniche (EPDS<9) il 90% delle donne non cliniche a T0 e sono cliniche il 35% di quelle cliniche a T0 (OR=4.93, Wald Chi Quadrato=66.307, p=0.00). La regressione logistica mostra che l’EPDS ≥ 9 si associa a T0 con: tipo di parto (Wald Chi quadrato=8.1, p=0.004; OR= 1,76), livello economico (Wald Chi quadrato=9.54, p=0.002, OR= 3,04); life events (Wald Chi quadrato=8,80, p=0.003, OR= 2,03); stress per la cura del bambino (Wald Chi quadrato=6,01, p=0.014, OR= 1,76); a T1 con: eventi di stress (Wald Chi quadrato=43.7, p=0.00, OR= 5,21), stress nella cura del bambino (Wald Chi quadrato=24.03, p=0.00, OR=3,5), aiuti dal marito (Wald Chi quadrato=4.0, p=0.045, OR=2,03), problemi nell’allattamento (Wald Chi quadrato=5.57, p=0.02, OR=1,96). L’ansia (items EPDS 3+4+5: cut-off >4) a T0 è 18.5% (media: 2.44,ds=2.1), a T1: 14.3% (media 2.39,ds=1.9). Discussione. La prevalenza di sintomi depressivi si attesta sui valori individuati da altri studi; la gran parte delle donne depresse ha comorbilità con sintomi ansiosi. Il maternity blues a T0 ha una probabilità di mantenenimento cinque volte maggiore e circa un terzo/metà delle donne rilevate resta clinica a T1; si associa con: parto cesareo, life events, stress nella cura del neonato, problemi di allattamento. A T1 i sintomi depressivi si associano a: life events, carenza di supporto, da parte del partner e/o dai familiari, difficoltà di allattamento e stress nella gestione del neonato. Fattori protettivi risultano: alta scolarità e livello economico medio-alto/alto. Conclusione. I risultati indicano l’utilità di effettuare screening di routine dell’umore materno già durante la degenza post-parto, per individuare precocemente donne a rischio di DPP e avviare percorsi di aiuto. Sotto-Studio n°2 Titolo. Ruolo di varianti geniche (geni OXTR, SLC6A4, BDF) e dello stile di attaccamento materno nella predisposizione alla depressione postparto Introduzione. Il modello interpretativo della DPP, che la considera come un disturbo a origine multifattoriale, vede interazioni tra genetica, aspetti psicologico-relazionali e aspetti socio-ambientali. Fino ad oggi numerose sono le ricerche che si sono focalizzate prevalentemente sui fattori psicosociali che possono contribuire alla DPP, mentre restano relativamente scarse le conoscenze su vulnerabilità predisponenti, sia circa le basi genetiche, che lo stile di attaccamento insicuro, fattore di rischio ormai ampiamente validato per la depressione maggiore. Obiettivo. Approfondire alcuni fattori di predisposizione nello sviluppo della DPP, di tipo psicologico-relazionale e di tipo biologico-genetico. Si vuole indagare, se uno stile di attaccamento materno insicuro (legame parentale precoce, stile di attaccamento adulto e sentimentale) sia fattore di vulnerabilità dell’umore materno nel puerperio. Il sotto studio di genetica vuole indagare se nell’etiologia della DPP possano essere implicati aspetti genetici, connessi al genotipo del polimorfismo 5-HTT del gene SLC6A4, trasportatore della serotonina; del polimorfismo Val66Met del gene BDNF; del polimorfismo SNP rs53576 del gene OXTR. Metodo. A un campione di 251 madri, a 2,3 giorni post-parto (T0) sono proposti: scheda socio-demografica; EPDS e BDI-II; PBI; ASQ, ECR, Ca-Mir per rilevare lo stile di attaccamento e sentimentale. E’ stato fatto prelievo per la genetica. Al follow-up a tre mesi (T1) proposti EPDS, BDI-II e alcune domande per fattori di rischio. Risultati. A TO i punteggi EPDS si associano significativamente con i punteggi a T1 (p=0.00, OR 7.26); il BDI-II si associa significativamente con EPDS a T0 (p 7=0.00; OR= 17.9) e a T1 (p=0.00, OR=80.42) e con BDI-II a T1(p=0.00, OR 15.73). I sintomi depressivi (EPDS≥9) si associano significativamente a T0 con PBI padre (p=0.012, OR= 3.9) e cura paterna (p=0.001, OR=5); con ASQ: evitamento (p=0.023, OR=5.7), fiducia (p=0,007, OR=0,02), disagio nell’intimità (p=0.04, OR= 4), secondarietà delle relazioni (p=0,04, OR=4,7), bisogno di approvazione (p=0.001,OR= 12); con ECR: ansia (=0.001, OR =10.1). Il BDI-II a T0 si associa altresì con PBI tipo di legame materno (p=0.031, OR= 3.6) e cura materna (p=0.031, OR= 2.86), con ASQ ansia (p=0,004, OR=31), preoccupazione nelle relazioni (p= 0,025, OR=7,6), con ECR evitamento (p,003, OR=6,7). A T1 l’EPDS≥9 si associa con PBI madre bassa cura (p=0,011, =R=3,3), con PBI padre legame insicuro (p=0,034, OR 2,6) e bassa cura (p=0,014, =R=3,3), con ASQ: bisogno di preoccupazione (p=0,05, OR=12,8); con ECR ansia (p=0,05, OR=3,9). A T1 il BDI-II: con PBI bassi livelli di cura materna (p=0,031, =R=3,3) e paterna (p=0,014, OR=3,6); con ASQ: bisogno di approvazione (p=0,01) e preoccupazione per le relazioni (0,05, OR=5); con ECR ansia (p=0,01, OR=7,5). L’analisi di regressione logistica evidenzia associazione tra EPDS e PBI cura paterna (p.005) e con ECR Ansia (p.013). A T1 con ASQ Disagio Intimità (p.017), Bisogno Di Approvazione (p.013) e ECR Ansia (p.001). Le difficoltà di allattamento associano ai sintomi depressivi a T0 (EPDS: OR=3.62; BDI-II: OR= 5.2) e a T1 (EPDS: OR=3.5; BDI-II: OR= 4.7) Discussione. I sintomi depressivi a T0 associano con storia di scarsa cura e di legame paterno precoce carente; con evitamento e disagio nell’intimità, scarsa fiducia negli altri e nell’importanza delle relazioni interpersonali; necessità di approvazione; con legame di coppia insicuro-ansioso. La diagnosi formale di DPP aggiunge: scarsa cura materna nell’infanzia, relazioni in età adulta evitanti e ansiose, necessità di approvazione e preoccupazione per le relazioni stesse. A T1 con storia di scarsa attenzione sia materna che paterna, bisogno di approvazione nelle relazioni, legame di coppia ansioso-preoccupato. Nell’accudimento del piccolo si associa con difficoltà nell’allattamento e alto stress nella gestione del figlio. Conclusione. Nella comparsa di sintomi depressivi nel post-parto si conferma il ruolo predisponente di vulnerabilità di relazioni genitoriali infantili insicure, di stili di attaccamento e di coppia ansiosi. Sotto studio di genetica3°. Analisi di varianti geniche nella predisposizione allo sviluppo di depressione post-partum Risultati. Pur evidenziandosi differenze tra i punteggi statistici totalizzati, emerge assenza di differenze statisticamente significative tra casi e controlli per le variazioni di frequenza allelica (p =SLC6A4: 0.3429, BDNF:0.2027, OXTR:0.3787) e di frequenza genotipica (p=SLC6A4: 0.1639, BDNF:0.3307, OXTR: 0.5758). Discussione. L’analisi di fattori genetici predisponenti a sintomi depressivi nel post-parto esclude il coinvolgimento dei polimorfismi 5-HTT del gene SLC6A4, Val66Met del gene BDNF; SNP rs53576 del gene OXTR nella vulnerabilità per depressione post-parto. Conclusione. L’assenza di differenze significative non esclude l’eventuale predisposizione genetica verso la depressione post-parto, dovuta presumibilmente a geni che non sono stati analizzati nella presente ricerca. sotto-Studio n°4. Titolo. Ruolo di fattori psicosociali di rischio dei sintomi depressivi nell’ ante-postparto Introduzione. Come per molti altri disturbi psichiatrici, anche per l’eziologia della DPP la letteratura sostiene la presenza di più variabili co-causative, che agiscono non solo dopo la nascita del figlio, ma già in gravidanza, con la comparsa di sintomi depressivi, che possono condizionare la formazione del legame materno-fetale. Obiettivo. L’obiettivo è di indagare la relazione tra alcune variabili psicosociali e la comparsa di sintomi depressivi in gravidanza e dopo il parto, per verificare l’andamento dell’umore ed evidenziare il ruolo dei fattori di rischio, anche nello sviluppo del legame materno-fetale. Metodo. A un campione di quarantasei gravide, al terzo trimestre di gravidanza (T1), sono stati somministrati l’EPDS (Cox et al.1987; Carpiniello et al. 1999), per rilevare l’umore materno; la scheda dei fattori di rischio psicosociale; il PBI (Parker et al.1979), per rilevare il legame precoce di attaccamento; il PAI (Muller 1993), per misurare il legame materno-fetale. A una settimana dal parto (T2) e a tre mesi (T3) sono stati effettuati i follow-up telefonici e riproposto l’EPDS, per verificare la comparsa di sintomi depressivi Risultati. La percentuale di EPDS ≥9 aT1:17,8% (media: 5.09, d.s..=4.18, range=0-21); aT2: 20,5%,(media: 6.07, d.s.=4.62, range=0-23); a T3: 18,2% (media 5.21, d.s.=3.74, range=0-14). L’EPDS ≥9 si associa con: basso sostegno a T1 e a T2 (p=0.04, OR = 6.04; p = 0.04, OR = 5.85); scarso aiuto a T1 e a T3 (p = 0.059, OR = 6.37, p = 0.06, OR = 6.19), sindrome premestruale a T2 (p = 0.02, OR = 15.37); minore soddisfazione di coppia a T1, T2 e T3 (T1: p = 0.02, OR = 0.15, T2:p = 0.001, OR = 0.07, T3:p = 0.04, OR = 0.18); eventi di stress prima della gravidanza a T1 e T2 (p = 0.05, OR = 5.74; p = 0.02, OR = 6.96); ansia prima della gravidanza a T1, T2 e T3 (p = 0.015, OR = 0.13) e durante la gravidanza a T1 (p = 0.06, OR = 0.21), bassa autostima a T3 (p = 0.015, OR = 18.62); istruzione a T1 e T3 (p = 0.034, OR = 0.19). Alti punteggi al PAI (media 61,65; d.s.8,22 ) si associano con età minore di 35 anni (t=3.01, p=0.007) ed essere primipare (t=2.090, p=0.046). Discussione. I fattori psicosociali di rischio, associati ai sintomi depressivi in gravidanza sono: eventi di vita stressanti; ansia in gravidanza; basso sostegno pratico ed emozionale; una settimana dopo il parto: eventi di vita stressanti; sindrome premestruale; tre mesi dopo il parto: bassa autostima; scarso sostegno e aiuto; disordini d’ansia prima e in gravidanza. Fattori protettivi sono risultati: scolarità avanzata (universitaria), buona soddisfazione di coppia. L’attaccamento materno-fetale è risultato più intenso con più bassa età e nelle primipare e tra coloro con cura materna adeguata nell’infanzia. Conclusione. I risultati individuati confermano il ruolo centrale che alcuni fattori psicosociali di rischio hanno nella comparsa di sintomi depressivi già in gravidanza e poi nel post-parto.
XXV Ciclo
1957

Att bli förälder är en viktig händelse för alla kvinnor liksom deras män. Men några kan känna sig oförberedda, känslomässigt labil, oroliga och osäkra under den första tiden efter förlossningen. Nya åtaganden och ansvar som medföljer föräldraskapet kan påverka det psykiska välbefinnandet och kan utvecklas till en postpartum depression (PPD). PPD drabbar cirka 13 procent av alla kvinnor som har fött barn. Det som kännetecknar PPD är nedstämdhet, irritabilitet, känsla av hopplöshet, orkeslöshet, sömnproblem, koncentrationssvårigheter, ångest attacker, osäkerhet, likgiltighet och suicidtankar. Litteraturstudiens syfte var att undersöka vikten av en tidig upptäckt av PPD hos kvinnor och skapa kunskap i syfte att förbättra omvårdnaden. Blivande föräldrar behöver inte bara information om själva förlossningen utan också de förändringar som sker tiden efter partus.

Databassökningen gjordes i Cinahl, PubMed, och PsycInfo. Sjutton vetenskapliga artiklar inkluderades och granskades med hjälp av SBU-granskningsmall. Analysen resulterade i tre kategorier, vikten av tidig upptäckt, hur familjens hälsa påverkas och hur vårdpersonal kan hjälpa. PPD har negativa effekter, inte bara på kvinnan själv, utan även på hela familjen. Det framkom tydligt hur viktigt kunskapsutvecklingen hos vårdpersonalen är för att kunna bryta PPD i ett tidigt skede. PPD är fortfarande ett relativt ”bortglömt tillstånd” då den nyförlösta kvinnan behöver kunnig vårdpersonal för att identifiera och förstå svårigheterna vid PPD.

Postpartum Depression: Standardizing Motherhood? by Pamela J. Regus Under the Direction of Wendy S. Simonds ABSTRACT An expansion of the medicalization of Postpartum Depression (PPD) is evident in increased screening for maternal depression that begins in pregnancy and continues in the postpartum period, and in the growing number of medical professionals alerted to watch for signs of maternal distress. Although a definitive etiology ofPPDremains elusive, the scientific and medical fields – highly imbued with authority to create knowledge in Western society – promote essentialist views of motherhood that espouse “natural” attributes such as maternal instincts and tendencies to nurture. Mothers who struggle with these standards of motherhood are then defined as being ill and become patients under the care of the medical profession until they can perform adequately in their motherhood roles, or they face social condemnation and legal repercussions for being “bad” mothers. Because characteristics of the “normal” postpartum period are said to be similar to symptoms of general depression, how do some women come to identify their postpartum experiences as depression while others do not? Does the choice of traditional obstetrics or an alternative, such as midwifery, make a difference in the incidence of postpartum depression? And what changes in the social support network occur in a woman’s life as a result of a diagnosis ofPPD? Using Foucault’s theory of docility, critical constructionism, and postmodern feminism as the theoretical focus, and in-depth interviews as the research method, I compare the postpartum experiences of mothers who have been diagnosed with postpartum depression with mothers who have not been diagnosed. The sample includes mothers who gave birth with the assistance of obstetrics and mothers who gave birth with the assistance of certified nurse-midwives. In order to examine the differences in approaches to and treatment of postpartum depression, I also interview a sample of obstetricians and certified nurse-midwives. Findings show that medical professionals use gender-normative assessments, such as physical appearance, language, and nurturing tendencies to determine whether the mother is performing as expected; if not, she is defined as ill and treated with antidepressant medication. Although the majority of mothers in the sample experienced feelings of depression in the postpartum period, many resisted diagnosis and medication. Mothers found the greatest support in their peers, rather than those closest to them, citing the ability to talk candidly about the struggles they face in their motherhood roles as the way to avert or heal from PPD. This finding highlights the enforcement of normative motherhood within the social institutions of the family and medicine; thus, cultural change from ideological representations of motherhood may come about through peer relationships. INDEX WORDS: Postpartum depression, Motherhood, Medicalization, Expansion of medical control, Maternal behavior, Childbearing years, Normative motherhood

Flera studier visar amningens fysiska och psykiska hälsofördelar för mor och barn, dock avvänjer kvinnor som lider av postpartum depression amning tidigt om de presenteras med utmaningar under amningen. Syfte med denna studie är därför att beskriva hur kvinnor som lider av postpartum depression upplever amning. Nio kvinnor deltog i studien, fem förstföderskor och fyra omföderskor, varav 5 intervjuades och 4 erhöll semistrukturerade frågeformulär med öppna svarsalternativ. En reflekterande livsvärldsansats som baserar på fenomenologi användes under datainsamling och dataanalys. Resultatet visar att amningen som fenomen är komplex och innebär en utmaning för kvinnan. Den essentiella innebörden av fenomenet beskrivs som ”amning som en kraftkälla, där den har potential att vara både kraftgivande och stärkande samt riskerar vara kraftdränerande”. Detta beskrivs vidare utifrån fyra innebördselement: ”att knyta kontakt med och lära känna sitt barn”, amning som återhämtning”, ”amning som energikrävande” och ”att känna sig ömtålig och utsatt”. Vårdande av kvinnor som lider av postpartum depression under amning innebär att assistera kvinna att möta sin osäkerhet och stärka hennes förtroende för att lita på sin förmåga att amma sitt barn. När amningen fungerar bra har den potentialen att inge kraft och stärka kvinnan i moderskapet. Fungerar amningen däremot inte bra riskerar den att dränera kraft och strävan efter samhörighet och bekräftelse sätts på spel vilket späder på kvinnans redan sköra situation och gör henne ännu mer sårbar i förhållande till barnet och sig själv.

Sebbene il rapporto tra disturbi dell’umore e puerperio fosse noto fin dai tempi di Ippocrate, molti casi di depressione post parto (DPP) non sono adeguatamente diagnosticati. Per cui le ricerche hanno tentato di identificare un marker precoce di DPP, onde poter identificare per tempo le donne a rischio. Nel complesso intreccio dei fattori eziopatogenetici, sicuramente la tiroide occupa un posto importante, sebbene non prioritario. Nella nostra ricerca abbiamo indagato sul ruolo degli anticorpi antiperossidasi (anti TPO) in gravidanza, come fattore di rischio indipendente per lo sviluppo di sintomi depressivi in puerperio. Lo studio, di tipo osservazionale prospettico, è stato condotto su un campione di 162 donne sane in gravidanza. Sono state escluse le donne con anamnesi positiva per depressione e disturbi psichiatrici. Durante la visita eseguita nel I trimestre di gravidanza, oltre ad una accurata anamnesi, è stato eseguito un prelievo ematico per il dosaggio di fT4, TSH, anti TPO; nella stessa occasione le donne hanno compilato dei questionari per la valutazione di sintomi ansiosi (STAI) e depressivi (BECK DI). Le donne sono state poi rivalutate per sintomatologia depressiva a 7 giorni dopo il parto e nuovamente a 30 giorni dopo il parto, tramite il questionario di Edinburgo (EPDS). Mediante l’analisi di regressione multipla lineare abbiamo cercato di individuare i fattori di rischio indipendenti per DPP. L’analisi statistica dei risultati ha evidenziato come la presenza di anti TPO durante il I trimestre di gravidanza, sia un fattore di rischio indipendente per elevati sintomi depressivi a 7 e a 30 giorni dopo il parto. Le gestanti positive agli anti TPO sembrano presentare un rischio aumentato di DPP, indipendentemente dalla funzionalità tiroidea. La correlazione tra umore depresso e malattie autoimmunitarie non è stata ancora ben chiarita. La depressione nelle donne con anti TPO potrebbe essere legata allo stato generale associato con la condizione di autoimmunità o ad alterazioni tiroidee subcliniche. I risultati del nostro studio suggeriscono che la presenza di anti TPO in gravidanza possa essere considerata come un marker precoce e indipendente di rischio aumentato per DPP. In tal modo il ginecologo potrebbe avere a disposizione uno strumento per l’identificazione di donne a rischio aumentato, da valutare insieme ad altri noti fattori di rischio anamnestici.
Yet even though the relationship between depressive mood and the puerperium has been documented since the time of Hippocrates, fewer than half of all the cases of postpartum depression are adequately diagnosed. Therefore the question arises as to whether markers exists for PPD; in other words, can we identify women at higher risk? The thyroid is surely not the primary cause of PPD, but evidences suggests that thyroid hormones cannot be ignored as important factors in the cascade of biological events leading to the onset of PPD. In this work we investigated whether the presence of thyroperoxidase antibodies (TPO Abs) during pregnancy could be a marker for an increased risk for postpartum depression. In this prospective observational work a sample of 162 healthful pregnant women was studied. We excluded women with a personal history of depression and psychiatric disorders. During the first trimester TSH, free thyroxine and TPO Abs testing was performed; in the same period the women also completed the State Trait Anxiety Inventory and the Beck Depression Inventory. In the post partum period, at 7/10 and 30 days after delivery, the women completed the Edinburgh Post Partum Depression Scale (EPDS). Multiple logistic regression was performed to determine independent risk factors for post partum depression. The statistical analysis showed that the presence of TPOAbs at the first trimester of pregnancy is significantly associated with depressive symptoms at 7 and 30 postpartum day. Women who are positive to TPOAbs in early gestation are prone to postpartum depression, independently of thyroid dysfunction. The relationship between autoimmune thyroid disease and depressive mood remains undecided. The depression may be related to the general malaise associated with an autoimmune condition (positive thyroid antibody status) or to subtle fluctuations in thyroid hormones. This study suggests that the presence of TPOAbs during gestation could be regarded as an indipendent marker for the occurrence of PPD. This finding may helps the gynaecologist to identify women at risk for PPD, in the context of other well known risk factors.

Syfte: Syftet med föreliggande studie har varit att beskriva kvinnors upplevelse av att drabbas av en postpartum depression(PPD). Metod: Examensarbetet som föreligger gjordes som en litteraturstudie med deskriptiv design. Studien baserar sig på resultatet av 12 vetenskapliga artiklar. De 12 valda artiklarna hämtades från PubMed och CINAHL. Huvudresultat: Det som visade sig vara utmärkande för en PPD var att kvinnorna kände sig kluvna inför moderskapet. De hamnade i en gråzon mellan vad de hade förväntat sig och hur verkligheten såg ut. Det visade sig att många kvinnor känner allt annat än lycka som nybliven förälder. Det handlade om känslor som misslyckande, sorg, förlust, rädsla, ensamhet och skam. Många ansåg att informationen om tillståndet i föräldrautbildningen var alldeles för liten. Känslorna pendlade mellan kärlek och hat gentemot det lilla spädbarnet. En rad kvinnor beskrev tankar de haft som gick ut på att faktiskt skada det lilla spädbarnet. Många ansåg däremot att när de väl fick adekvat hjälp kändes det som en lättnad. Det blev då mer legitimt för dem att vara ledsna och att slippa eftersträva bilden av den perfekta mamman. En annan viktig faktor för dessa kvinnor visade sig vara det sociala stödet men även förståelse från de närmsta anhöriga. Det framkom även att det fanns väldigt många kvinnor som led i tysthet.

This study examined 214 New Zealand women, both during pregnancy and in the postpartum, in order to determine the influence of infant-related stressors, unplanned pregnancy, social support and the role of the marital relationship in the development of postpartum depression. The relationship of demographic factors, the woman's feelings about having a new baby in the family and previous history of depression were also analyzed. The prevalence of depressive symptomatology was 30.8% during pregnancy and 39.7% in the postpartum. Postpartum depression was predicted by depression during pregnancy, by poorer postpartum marital adjustment and by lower levels of postpartum social support. The strongest predictor of the change in depression scores over time was depression during pregnancy. The important role of depression during pregnancy in the etiology of postpartum depression, suggests that postpartum depression is a continuation of depression during pregnancy. Women who were more depressed during pregnancy tended to be younger, of lower socio-economic status, and to have a reported history of depressive episodes prior to their pregnancies. Higher levels of prepartum depression were also related to women's feelings of being unhappier about having a new baby in the family, to poorer marital adjustment, and to lower levels of social support during pregnancy. Depression during pregnancy was found to be more likely to have a negative effect on marital adjustment than poor marital adjustment on depression. Similarly, depression during pregnancy was found to be more likely to have a negative effect on social support, than vice versa. However, further regression analyses, showed that postpartum marital adjustment and postpartum social support had a strong relation to postpartum depression, irrespective of the levels of prepartum marital adjustment, prepartum social support, and prepartum depression. Contrary to predictions, neither infant temperament, nor infant risk were related to postpartum depression.

Bakgrund: Föräldraskapet förknippas med glädje, självförverkligande och hopp om framtiden. Ibland blir inte den första tiden med barnet vad den nyblivna modern tänkt sig, en del kvinnor känner sig nedstämda medan andra upplever att de inte är förberedda för allt vad föräldraskapet innebär. Kvinnan kan bli rädd för att inte behärska den nya rollen som mor. I Sverige drabbas varje år cirka 10000 kvinnor av depression de första månaderna efter barnets födelse. Symtomen är nedstämdhet, känsla av att vara värdelös, oro, trötthet, svårt att känna glädje för sitt barn och tankar på att skada barnet. Inom hälso- och sjukvården har barnmorskan en viktig roll att screena för postpartum depression, mot bakgrund av att av psykosociala eller psykologiska insatser kort efter förlossningen kan förebygga depression. Postpartum depression påverkar inte bara kvinnan utan även barnet och kvinnans partner. Syfte: Syftet var att belysa mödrars upplevelser av en postpartum depression. Metod: Metoden som användes var en litteraturöversikt. Sexton kvalitativa vetenskapliga artiklar inkluderades och analyserades genom en beskrivande metasyntes som metod. Resultat: I resultatet identifierades fem teman omställning till föräldraskap, de upplevda symtomen, relationen till barnet, upplevelse av stöd, att komma tillbaka. Resultatet visade att tiden som nybliven mor innebar förändringar som kvinnorna inte kände sig förberedda på. Tiden efter barnets födelse präglades av oro inför att skada sitt barn, saknat självförtroende och känslor av att tappa bort sig själva. Kvinnorna upplevde avsaknad av stöd och rädsla inför att anförtro sig till sjukvården med konsekvensen att ses som en inkompetent mor och bli fråntagen sitt barn.

Bakgrund: 13 procent av alla kvinnor drabbas av postpartum depression (PPD) efter förlossningen. PPD påverkar inte bara modern som individ utan även barnet och resten av familjen. Syfte: Syftet med denna litteraturstudie var att belysa sjuksköterskans roll i omvårdnadsarbetet med familjer som drabbats av postpartum depression. Metod: Litteraturstudie. Databaserna Pubmed och Cinahl har använts i studien. Tre kvantitativa artiklar har använts och tolv kvalitativa. Resultat: Första mötet mellan sjuksköterskan och kvinnan med PPD har stor betydelse. Mödrarna känner sig trygga och vågar öppna sig mer om de har en bra relation med sjuksköterskan. Mödrarna anser att det är lättare att ta emot råd från en sjuksköterska de har god relation med. Diskussion/Slutsats: God kommunikation, information och kontinuitet bör förbättras i vården. Sjuksköterskorna behöver mer kunskap om PPD för att kunna ge familjerna bästa tänkbara vård. Har sjuksköterskorna god kunskap kommer även relationen med familjen att stärkas.

Background: Every year 8-15% of Swedish women is diagnosed with a postpartum depression after giving birth, this translates to 10 000 women every year. These depressions can continue for weeks up to years and does not only affect the well-being of the mother but also the development of the child due to lack of bonding between the mother and the child. Aim: The aim of this study is to investigate if there is any evidence based nursing that can be given during the postpartum depression and if there is; compile current research of what evidence based nursing that can be given to women during postpartum depression. Method: A review design was used where ten articles were analyzed. The articles were found in the CINAHL and PubMed database. Results: Primarily the study showed that there is evidence that healthcare personnel provided with an extended mental health education was more effective at giving care to women with low risk of PPD. There is no evidence that higher rates of nursing would help women with low risk of PPD develop PPD. There is also evidence that women who had an initial high EPDS score received a lower EPDS score over time if they received either help with group therapy or home visits by mental health professionals. Evidence also show that it helps with telephone support by peers who at some point in there life have had an experience with postpartumdepression. The training given to the staff showed how to use the EPDS scale, basic principles in person-centered care, cognitive behavior and identification of various risk factors and symptoms. Conclusion: There is some research concerning care for postpartum depression. The research shows that care given by healthcare personnel with an extended training in mental health care gives the best results. There is one study that also shows that telefone based peer support given by people with self experienced postpartumdepression also helps. Some findings also indicate that the frequency of meeting with healthcare workers does not affect the wellbeing of the mother.

"31 May 2002" Bibliography: leaves 232-255. Using cross-sectional and longitudinal analysis to compare childbearing women with matched controls, this study aimed to identify whether depression in postpartum women differed quantitavely or qualitatively to depression experienced at other times. Postpartum women were not found to be at increased risk of depression. However, a consistent but insignificant peak, which was not evident in control group responses, was noted in levels of nonsomatic depression, anxiety and stress in the early postpartum months.

Postpartum depression affects 7 to 20% of women in the first year after giving birth. Unfortunately, over 50% of women experiencing postpartum depression go untreated due to lack of detection, placing the woman and child at risk for detrimental consequences. One of the most common barriers in detecting and treating postpartum depression is the low incidence of screening performed at primary care and obstetrical visits during the postpartum period. Efforts have focused on improving identification of postpartum depression through the use of a valid screening tool performed throughout the first year. The purpose of the practice improvement project is to implement routine screening using the Patient Health Questionaire-2 (PHQ-2) at the four-to-six week and six month postpartum visits at a Community Clinic in a Midwestern City. The two question tool, assesses both sad mood and inability to experience pleasure from activities usually found enjoyable. If a patient answers yes to one or both of the questions, further clinical assessment should be performed to consider diagnosis. Once a patient is diagnosed, treatment through mental health counseling and/or medication should be ordered and consistent follow-up should be provided through phone calls and office visits. The practice improvement project was implemented in September, 2014 and evaluation took place three months post-implementation. Evaluation consisted of data collection, through chart audit and review, of all postpartum women, ages 18-49 years, who were seen by one of the three OB/GYN providers in the past year. The chart audits identified how many patients were seen overall, including demographic information. Chart audits also identified patients who were diagnosed with depression three months prior to implementation and three months post-implementation to determine a difference. Chart reviews further analyzed treatment and follow-up methods performed. Results of the project found an increase of postpartum depression detection from 8% to 15% and an increase in treatment methods. Inconsistency with follow-up methods were found and recommendations were made to address them. It was concluded that routine screening for postpartum depression, using the PHQ-2, provided a means to identify and treat postpartum depression in the primary care setting.

Approximately 500,000 women in the US suffer from postpartum depression (PPD) every year. Yet only half of women affected seek treatment. PPD affects the entire family unit, altering parenting behaviors and increasing prevalence of depression among male partners of women suffering from PPD. In addition, infants whose mothers suffer from PPD have a higher risk of Sudden Infant Death Syndrome (SIDS) and more frequent hospitalization as well as cognitive and behavioral delays. Despite the significance of PPD to the health of women and families, most research has focused on the identification and treatment of PPD. Research pertaining to intrapartum events as possible risk factors for PPD has been contradictory and variable in quality. The purpose of this study is to examine possible relationships between intrapartum events and subsequent incidence of postpartum depression.The Diathesis-Stress Model provides the foundation for this proposed research, in which a combination of vulnerability factors (diatheses) in the context of life events (stress) results in psychopathology (PPD). Vulnerability factors such as previous history of depression, prenatal anxiety, or low self esteem may interact with intrapartum stressors such as cesarean section, induction of labor, or use of pain medication to increase PPD symptomatology. This study will examine the stress component of the Diathesis-Stress Model.The study design was a retrospective descriptive design aimed at identifying relationships between intrapartum events and PPD. A chart review was performed to identify intrapartum events and scores on the Edinburgh Postnatal Depression Scale (EPDS) at two- and six- weeks postpartum. The sample consisted of 102 women who delivered at a specified rural New England birthing center during 2007.Nurses commonly interface with women in health care settings and are uniquely poised to educate them about PPD. Nurses have the unique opportunity to alert women to the potential risk for PPD and encourage them to report signs and symptoms early. Increased reporting of symptoms can reduce the number of unidentified cases and promote interventions that avert some of the devastating emotional, physical, and economic consequences.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
Background: In the United States, the prevalence of postpartum depression is 10-15%. There is limited study on the appropriate postpartum screening tool for Burmese refugees in the United States. Hypothesis: The Burmese and Karenni versions of Edinburgh Postnatal Depression Scale (EPDS) are appropriate to use as a tool for screening postpartum depression in Burmese refugees. Aims: This study examines the views of Burmese refugees on the questions of Edinburgh Postnatal Depression Scale as a routine screening for postnatal depression and their opinion and experiences on postpartum depression. Methods: A qualitative approach was chosen to complete this study. A medical student and a Burmese interpreter participated in a one-on-one interview with 30 Burmese women sharing their views and opinions on translated EPDS and postpartum depression. Results: Thirty Burmese women were interviewed in the Phoenix area. The qualitative analysis indicate that the EPDS screening turned out to be a useful and culturally appropriate tool for the Burmese refugees to screen postpartum depression in this specific population. Conclusions: Without consistent and culturally appropriate screening for Burmese women, it would be hard to treat Burmese women for postpartum depression. Our study shows that acceptability for routine screening with a translated EPDS amongst health visitors is possible to achieve. Using the Edinburgh Postnatal Depression Scale in Burmese and Karenni language should be considered when seeing Burmese refugees in the clinic.

Bakgrund: Postpartum depressioner (PPD), en förlossningsdepression, drabbar kvinnor i hela världen. En långvarig postpartum depression hos kvinnan kan ha avgörande konsekvenser för utvecklingen av hennes barn och relationen till hennes partner. Många kvinnor lider i tystnad då de inte vet att det finns en förklaring till känslorna de genomgår eller att de skäms för att inte klara av att leva upp till bilden av den ”perfekta mamman”. Syfte: Att beskriva upplevelser av postpartum depression hos vuxna kvinnor diagnostiserade med PPD.

Metod: Sju vetenskapliga artiklar användes för att genomföra denna systematiska litteraturstudier med en induktiv ansats. Resultat: Utifrån frågan ”vilka gemensamma upplevelser genomgår kvinnor med PPD”? Framkom sju teman: misslyckande, stress, ensamhet, inre strid, förlust av kontroll, rädsla och skam. Slutsats: Hälso- och sjukvårdspersonal inom MHV (Mödrahälsovård) och BHV (Barnahälsovård) kan lättare upptäcka tidiga symtom och tecken hos nyblivna mammor med postpartum depression genom att förstå deras upplevelser av PPD, och därmed förhindra en långvarig depression.

 

 

 

 

 

 

 

 

 

 

 

Postpartum depression (PPD) is one of the most common complications of childbirth around the world. Despite several studies on the underlying mechanisms, the pathophysiology remains elusive. The aims of this thesis were to assess possible associations between the risk for self reported PPD and serum levels of leptin, the season of delivery, the gender of the newborn, and the history of premenstrual symptoms, respectively. A population based cohort of 2318 newly delivered women in Sweden were screened five days, six weeks and six months postpartum, using the Edinburgh Postnatal Depression Scale. This cohort comprised 60% of the total population, and the prevalence of self reported PPD was 11.1% six weeks after the delivery. A negative association between leptin levels at delivery and self reported PPD at six weeks and six months postpartum was evident, even after adjusting for confounding factors.  An increased risk for self reported PPD was noted among women delivering during the last three months of the year, compared to those giving birth in April through June. This is of clinical importance, since women delivering at the end of the year could benefit from a closer follow-up after delivery.  Despite previous varying findings – depending on study population and consequently different cultural settings – in our study, no association between infant gender and self reported PPD could be detected at six weeks or six months postpartum. However, women giving birth to baby boys had a higher risk for postpartum blues.   Lastly, an increased risk for self reported PPD among women with a history of premenstrual symptoms was noted. Interestingly, after stratification for parity, the association between PPD and premenstrual symptoms remained only among multiparas. The association between PPD and premenstrual symptoms might shed light on the many possible routes by which hormonal changes may influence mood in women. In conclusion, this population based study strengthens the notion that PPD is a complex multifactorial disorder, with biological, social and psychological parameters shaping each individual’s risk.  Further research is needed in this field, in order to investigate underlying pathophysiological mechanisms, propose more effective diagnostic tests and assess therapeutic interventions.
UPPSAT

Postpartum depression (PPD) är ett begrepp som används vid depressioner upp till ett år efter förlossningen. Syftet med studien var att beskriva mödrars upplevelse av PPD. Examensarbetet är en litteraturstudie med deskriptiv design. De 15 kvalitativa vetenskapliga artiklarna som ligger till grund för resultatet är hämtade ur databaserna PubMed samt CINAHL. Känslor vid PPD kan förklaras i termer av lidande, förluster och förändringar. Många drabbade var rädda att anses som olämpliga mödrar. De betraktade sig vara fångade i klyftan mellan verkligheten och förväntningarna. Mödrarna anklagade sig själva då dessa inte uppfylldes. Upplevelse av ensamhet var vanligt samt att de inte visste var och till vem de skulle vända sig för att få hjälp. Förtroendet för sjuksköterskan är viktigt för att modern ska våga söka hjälp. Flera kvinnor upplevde ångest och beskrev att känslorna för barnet varierade mellan kärlek och hat. En del kvinnor såg ingen annan utväg än självmord och/eller barnamord, tankar som dessa uppkom särskilt i samband med att ångesten blev för övermäktig att hantera. Det är viktigt att förstå komplexiteten av PPD eftersom symptomen tenderar att hållas dolda. Ett lidande då förväntningarna inte uppfylldes tog sig uttryck i form av känslor av misslyckanden och att känna sig som en oduglig mor.
Postpartum depression (PPD) is a term used for depression up to one year after childbirth. The aim with the study was to describe mothers' experience of PPD. The thesis is a literature review with a descriptive design. The 15 qualitative scientific articles that form the basis of the results are taken from PubMed and CINAHL. Emotions from PPD can be explained in terms of suffering, losses and changes. Many affected were afraid to be regarded as unfit mothers. They considered themselves to be trapped in the gap between reality and expectations. Mothers accused themselves when expectations were not met. Experiences of loneliness were common and they did not know where and who to turn to for help. The mother’s confidence for the nurses was important to dare to seek help. Several women experienced anxiety and described that the feelings for the child varied between love and hate. Some women saw no alternative but suicide and / or infanticide, these thoughts arose particularly in connection with when anxiety became too overwhelming to handle. It is important to understand the complexity of PPD as the symptoms tend to be kept hidden. Suffering when expectations were not met was expressed in form of feelings of failure and feeling like a unfit mother

Bakgrund: 13 procent av alla kvinnor drabbas av postpartum depression (PPD). PPD påverkar inte bara kvinnan som individ utan även barnet och resten av familjen. Syfte: Att belysa de faktorer som på olika sätt har betydelse vid postpartum depression. Metod: Litteraturstudie. Artiklar har sökts i databaserna Cinahl, PsychInfo och PubMed. Arton kvantitativa artiklar har använts i studien. Resultat: Visade att kvinnor med tidigare depressions- och ångestsjukdomar löpte störst risk att drabbas av PPD. Mätinstrumenten som prövats för att förutse PPD under graviditet visade sig ha en känslighet för upptäckt på mellan 40-78%. Det visade sig även att förebyggande insatser för kvinnor i riskzonen inte hade någon effekt på utvecklandet av depressionssymtom postnatalt. Slutsats: Även om vi inte kan förhindra uppkomsten av PPD så är det ändå av vikt att vara medveten om de riskfaktorer som finns. Med den kunskapen kan vi tidigt upptäcka dessa kvinnor. Det ger möjlighet till ett ökat stöd och adekvata hjälpinsatser vilket kan begränsa omfattningen av sjukdomen.

Postpartum depression är vanligast hos mödrar men även pappor kan drabbas. Studiens syfte var att identifiera riskfaktorer för pappan att drabbas av depression postpartum. Metoden var en strukturerad litteraturstudie med en integrativ ansats. Resultatet visade att sociodemografiska faktorer så som arbetslöshet, tillfällig anställning, oro över ekonomi och låg utbildning var riskfaktorer för depression postpartum hos pappor. Förändringar och försämring i relationen till partnern och upplevelsen av att ha ett besvärligt barn påverkade papporna. Barn med tillväxtproblematik, sjukdomsfall hos barnet och barn som sov dåligt var faktorer som spelade in. Att pappan känner ett utanförskap eller brist på sammanhang och brist på stöd kunde vara riskfaktorer men en del män ville trots tillgång till stöd inte nyttja detta. Konklusionen blev att distriktssköterskan bör vara medveten om riskfaktorer för pappan att drabbas av depression postpartum då en generell screening inte utförs i dagsläget. Mer forskning kring vad som kan leda till depression hos pappor samt vilket slags stöd pappor med depressiva symtom behöver av distriktssköterskan på barnavårdscentralen vore fördelaktigt.
To suffer from postpartum depression is most common in mothers but it can also happen to fathers. The aim of the study was to identify risk factors for fathers to suffer from postpartum depression. The method used was a structured literature study with an integrative approach. The results showed that socio-demographic factors such as unemployment, temporary employment, concern about economics and low education were risk factors for depression postpartum in fathers. Changes and deterioration in the relationship with the partner and the experience of having a difficult child affected the dads. Children with growth problems, illnesses in the child and children who slept poorly were factors that were shown. Feeling of isolation or lack of coherence and lack of support could be risk factors, but some men, despite access to support, would not use this. The conclusion was that the district nurse should be aware of the risk factors for the father to suffer from postpartum depression when screening for depression in fathers is not usually performed. More research on risk factors for depression in fathers and what kind of support depressed fathers needs from the nurse at the child welfare center would be beneficial.

Postpartum depression (PPD) is a social problem that affects as many as 1 out of 8 women in the United States. Though this mental illness is not a cause and effect phenomena, there are risk factors that increase the likelihood of a mother experiencing PPD. Some risks include hormonal fluctuations, family history of mental health conditions, sleeping patterns, and birth experience. This mental health condition can be an isolating experience due to the stigma associated with maternal depression. Due to this, it is essential to develop a PPD support group to help decrease PPD symptoms, increase coping skills, and expand social support networks. With funds provided by Hearst Foundation, the objective of this grant proposal was to provide an evidence-based support group at Presbyterian Intercommunity Hospital Health for prenatal and within a year postpartum women experiencing PPD. The actual submission and funding of this grant were not required for the successful completion of the project.

Abstract Postpartum depression (PPD) has been identified as a mental health condition that impacts women, men, and families. PPD has been shown to be prevalent in both women and men following the birth of a child; it has been associated with marital conflict, insecure attachment, and poor infant-child outcomes. While PPD has been studied extensively in women, paternal PPD often goes understudied, undetected, and untreated. The purpose of the present research was to explore the lived experiences of men who have experienced PPD through the lens of self-perception theory using a qualitative phenomenological study. Six men who have experienced PPD shared their lived experiences with PPD, including how they recognized they had a problem and what alerted them to get help. Data were analyzed using coding and the development of themes; the findings for this study showed that men's lived experiences with PPD included feelings of sadness, anger, fear, confusion, and being in denial. The men tended to not seek help for their experiences of PPD, and they were not previously informed about the disorder of paternal PPD. The present study provides a better understanding of PPD for fathers, information for healthcare providers who deal with expectant fathers, and significant others such as mothers of the child, and other family members and coworkers regarding how to respond to paternal PPD. Better understanding of PPD will provide fathers with more of the support they need to successfully make the journey through PPD.

The suffering associated with postpartum depression (PPD) has been well documented in both quantitative and qualitative literature. Inquiry into the experience of PPD as transformational or producing personal growth does not exist. The objective of this grounded theory study was to explain and describe the nature of transformation through PPD. Methods included 1 to 1.5 hour interviews with a theoretical sample of 20 women self-identifying as (a) having had PPD, and (b) considered the experience transformational. No definition of transformation was given to intentionally avoid bias. A total of 328 pages of transcribed interviews were coded in open, axial, and selective order using iterative constant comparison, and reflective coding matrices. Four core categories of transformation through PPD emerged: (a) Before / I was unprepared, (b) During / I was shattered, (c) After / I am a different person, and (d) Beyond / I was meant to have PPD. Women were unprepared for the onset of symptoms, shattered by the physical and psychological symptoms during PPD, including suicidal ideation. Despite care provider failure to screen, women acted as agents in accessing their own care. After cessation of symptoms women experienced increased self-confidence, compassion for others, and enhanced relationships. All women reported achieving new professional or vocational goals such as authoring books, returning to school, or changing careers. Women reported increased sense of purpose and meaning to life as a result of their experience of struggling to survive PPD. The theory discovered was that PPD can be experienced as a traumatic life event, through which post-traumatic growth can occur. Future research into the experience of a perinatal mood or anxiety disorder as a traumatic life event expands the understanding of the mechanisms of human potential through suffering and provides insight into treatment, assessment, and prevention.

There has been little research on postpartum depression (PPD) in the southeastern region of Montana. In the clinical experience of this researcher, relatively few health care providers perform a thorough assessment for PPD as part of postpartum care. Health care providers tend to underestimate both the incidence and effects of PPD. This study surveyed 16 women in southeastern Montana at their 4 to 6 week postpartum health care visit, using a standardized Postpartum Depression Screening Scale (PDSS). Surveys were scored while participants were at the clinic, and results were made available to the participants' health care providers. Women were surveyed at a physician-run OB/GYN practice. Fifteen of the women were married and one woman was single. One woman had only a high school education, 7 had some college, and 8 had 4-year college degrees. All of the women had health care insurance. Of the 16 women surveyed, 8 had PDSS scores consistent with normal adjustment. Five had PDSS scores consistent with significant symptoms of postpartum depression, and 3 women had PDSS scores that indicated a positive screen for postpartum depression. While the results fall within the prevalence rates indicated in the review of literature, they are not statistically significant and cannot be generalized to all women in southeastern Montana or to other populations. This study should be replicated with a larger sample size.

The peripartum period is a potentially difficult time in a woman's life, a time when up to 70% of women experience transient mood symptoms and approximately 15% will suffer from a severe mood event which impacts not just her, but her family as well. The symptoms and clinical features of the mood symptoms are linked to Major Depressive Disorder (MDD) and Bipolar Disorder (BD). Appropriate diagnosis as early as possible has a critical impact on the immediate and long-term health of the peripartum woman, especially in those with a bipolar diathesis. While treatment for BD versus MDD may be markedly different, it can be difficult to distinguish between the two, especially during a depressed episode, with postpartum onset. To date, no study has evaluated the Edinburgh Postnatal Depression Scale (EPDS) for its value as a screening measure for the differentiation of BD versus MDD in the postpartum period.

This study sought to: 1) to describe the demographic differences between women diagnosed with BD versus MDD seeking treatment for a major depressive episode, with postpartum onset; 2) to characterize the features of the major depressive episode; with postpartum onset in women diagnosed with BD versus MDD; and 3) to examine scale characteristics of the EPDS as a predictor of the diagnosis of BD versus MDD.

Results revealed that postpartum depressed women diagnosed with BD reported a) an earlier age of onset, b) a greater number of prior mood episodes, c) greater incidence of psychotic symptoms in the current depressive episode, and d) lower overall scores on the EPDS versus postpartum depressed women diagnosed with MDD. There were no reliable differences between the groups on family history of a) mood disorders; b) number of generations; c) weeks postpartum at symptom onset; d) scores on a 4-item subscale of the EPDS; e) suicidal/homicidal ideation; nor the incidence of symptoms of f) atypical depression, g) generalized anxiety disorder, or h) obsessive-compulsive disorder. The findings support the use of a thorough clinical and demographic history when evaluating postpartum depressed women and the use of a measure in place of or in addition to the EPDS to ensure the appropriate differentiation of BD versus MDD.

While major depression is a well-defined mental health condition, it's presentation can be vastly different across individuals and groups, and many factors impact one's vulnerability. A critical period of vulnerability to depression is the postpartum period. Despite the frequent assumption that postpartum conditions solely affect women, prevalence estimates of paternal postpartum depression (PPPD) are comparable with those of women. Similar to mothers, men experience significant biological and psychosocial changes following the birth of a child that contribute to the onset of postpartum depression. A growing body of research has identified many potential variables related to PPPD, yet there is no clear consensus as to which variables are the most impactful. Following PRISMA guidelines, we conducted a meta-analysis to aggregate the known findings and quantitatively determine the most salient predictors of PPPD. We hypothesized that the psychosocial factors of relationship satisfaction, social support, partner depression and history of depression would yield the strongest aggregate effect sizes. By searching databases using logical operations, as well as conducting backward and forward searches, we identified 129 articles that met inclusion/exclusion criteria with a total sample size of 114,712 participants (79,743 fathers). Trained independent coders extracted data directly from identified studies, including sample characteristics for descriptives and moderators, and demographic correlates. Correlates of primary interest include but are not limited to maternal depression, history of depression, relationship satisfaction, and social support. Effect sizes represented as Pearson correlations (or transformed to r using standard procedures) were calculated and compared using a random-effects model. In partial support of our hypothesis, fathers' reported history of depression had one of the largest effect sizes (r = .469, unbiased r = .368). The other primary psychosocial factors had relatively moderate effect sizes: social support, r = -.359 (unbiased r = -.398); relationship satisfaction, r = -.300 (unbiased r = -.266); and partner depression, r = .294 (unbiased r = .471). The correlates of PPPD with the strongest effect sizes were all factors associated with personal distress and stressful pregnancies. Demographic correlates (i.e., younger age, non-White ethnicity, lower education, unemployment, lower SES) generally had small though statistically significant effect sizes. This study helps provide a clearer picture of what predicts PPPD to more accurately screen for men at greatest risk and inform the development of diagnostic measures and treatments. It also lays the groundwork for future work in a more unified and productive direction. By researching and sharing better information, we can provide better access and better outcomes for postpartum couples.

Introduction: Financial incentives increase smoking abstinence among pregnant and postpartum women. They have also been reported to reduce psychological symptoms using the Beck Depression Inventory (BDI) and Brief Symptom Inventory (BSI) in women at risk for perinatal depression. This prospective study aims to replicate and extend these findings using the BDI and Edinburgh Postpartum Depression Scale (EPDS). Methods: Participants were 169 pregnant cigarette smokers who were assigned to one of two treatment conditions: Best Practices only (n=88), which entails brief counseling and a referral to a pregnancy-specific quit-line, or Best Practices + Incentives (n=81). Participants were categorized as at increased risk (Dep+; n= 91) or lower risk (Dep-; n= 76) for depression based on history of depressive symptoms and baseline symptom scores. Treatment effects on smoking status and BDI/EPDS scores were examined across nine perinatal assessments using repeated measures analyses of covariance. Results: Financial incentives increased rates of biochemically-verified abstinence through 12-weeks postpartum independent of depression risk (ps ≤ .01) but did not differentially decrease BDI or EPDS scores (ps > .05). Scores decreased with both interventions for the Dep+ women (p = .001). Conclusions: These results replicate earlier evidence that financial incentives increase perinatal smoking abstinence in Dep+ women but not their efficacy in differentially reducing depressive symptoms at levels greater than Best Practices. The failure to replicate effects on depressive symptoms may be due to use of different control conditions in the current and prior study or increased screening and intervention for perinatal mental health during routine obstetrical care.

Breastfeeding is well known to be beneficial to both the mother and the baby. To the baby, it is associated with decreased short-term health problems such as diarrhea and respiratory infections, as well as decreased long-term health consequences such as type 2 diabetes, obesity, and raised blood cholesterol levels. To the mother, it is suggested to reduce type 2 diabetes, breast cancer, as well as ovarian cancer. Increasing exclusive breastfeeding rate, in which higher proportion of infants are given breast milk only, could also benefit the society as a whole. It is shown to reduce health care cost and premature deaths. Despite the gradual elevation of ever breastfeeding rate in Hong Kong up to 83% in 2013, the exclusive breastfeeding rate at 2 months postpartum remained relatively low at 21.7%. On the other hand, postpartum depression is a debilitating condition to both the mother and the baby. The prevalence was about 10-15%. And it could lead to deteriorated quality of life to the mother and increased maternal suicidal rate. It could also affect the long-term development of the baby. Previous studies showed controversial results on the association between breastfeeding and postpartum depression. Some suggested breastfeeding being protective against postpartum depression, while other studies did not show significant results. However, there was still no formal study in the local Chinese population about the issue. In view of that, the current study aimed at assessing the association between breastfeeding and postpartum depressive symptoms in the local Chinese population. This was a cross-sectional study which included 600 mothers with data retrieved from MCHCs’ database. Demographic data and breastfeeding status were included in binary logistic regression analysis with Edinburgh Postnatal Depression Scale (EPDS) result of either screened positive or negative as the outcome. The odds ratio of being screened positive in EPDS with more depressive symptoms for mothers with exclusive breastfeeding, compared with mothers not on breastfeeding (OR=0.42, 95% CI=0.19, 0.93) and mothers with non-exclusive breastfeeding (OR=0.40, 95% CI=0.19, 0.85) were both statistically significant after adjusted for the demographic data. Subgroup analysis on those intended for exclusive breastfeeding shortly after delivery also showed significant results. Those who succeeded in maintaining exclusive breastfeeding at 6-8 weeks postpartum were significantly less likely to be screened positive in EPDS (OR=0.07, 95% CI=0.01, 0.41) compared to those who could not maintain exclusive breastfeeding. This study proposed to assess whether there is an association between breastfeeding and decreased maternal postpartum depressive symptoms in local Chinese population. The results reiterated the advantages of breastfeeding and warranted more intense efforts in promoting and protecting breastfeeding. The large effect shown in the subgroup analysis highlighted the importance of maintaining exclusive breastfeeding. Since this study could only establish association, the results could not show causation and future studies should focus on establishing the temporality of causation between breastfeeding and decreased maternal postpartum depressive symptoms. Stricter adjustment for potential confounders should also be achieved with a prospective study better designed to control for temporality and time-varying confounders in the future.
published_or_final_version
Public Health
Master
Master of Public Health

Postnatal depression (PND) is a serious and debilitating condition that disrupts women's lives at a time when they are already under stress, adapting to the substantial demands having a baby creates. PND is linked with adverse effects on the development of the child and the family system, including poor marital adjustment and elevated levels of depression in male partners. Implications, not only for men's health, but also for the amount and quality of support men can provide for their partners and children are far-reaching. Preventative programmes for the treatment of PND have been widely advocated, but are rare in the literature. Even fewer, are treatment programmes that include male partners. This study compared the efficacy of a structured Cognitive Behavioural Therapy (CBT) programme for the treatment of PND, delivered in 3 different ways, within an Australian semi-rurallcoastal community. Thirty-nine women, diagnosed with PND, completed 10 weeks of either 'individual' (n=9), 'group women only' (n=16) or 'group partners involved' (n=14) intervention and were compared with a control support group (n=7). Pre-intervention, women in the study reported the presence of a number of psychosocial risk factors for PND and almost 20% of the men in this sample were also depressed according to the BDI-II. Partners of the women in the 'group partners involved' treatment completed a 6-week CBT group programme especially designed for men (n=13). Partners of the women involved in the other interventions acted as a control group (n=16). Depression, anxiety, parenting stress, relationship adjustment and social support measures were taken using standardized instruments at pre-intervention, post-test and at 3- and 6-month follow-up. Qualitative information about the experiences of PND and the intervention programme was obtained through focus group interviews. The intervention programme was evaluated by questionnaire by both participants and their general practitioners or allied health professionals who had referred them to the programme. Results indicated that, overall, the 10-week, structured CBT programme was far more effective in treating PND than attending a support group. Over time, group therapy outperformed individual therapy for depression and anxiety. Including partners in intervention meant significantly improved outcomes at 6-month follow-up for depression, anxiety and relationship adjustment for women. When male partners were included, women's social support levels were significantly higher at 3-month follow-up. Post-intervention men who participated in the men's group were significantly less depressed and stressed, and showed higher levels of social support than controls. The intervention programme was rated highly by both participants and referrers for effectiveness and acceptability, with the psychoeducational information and CBT strategies rated as the most useful components. Participants viewed the inclusion of male partners in PND treatment as fundamental and strongly recommended increased community and professional awareness of PND and its consequences. The important implications for clinical practice and resource allocation raised by this study are addressed.

Postnatal depression (PND) is a serious and debilitating condition that disrupts women's lives at a time when they are already under stress, adapting to the substantial demands having a baby creates. PND is linked with adverse effects on the development of the child and the family system, including poor marital adjustment and elevated levels of depression in male partners. Implications, not only for men's health, but also for the amount and quality of support men can provide for their partners and children are far-reaching. Preventative programmes for the treatment of PND have been widely advocated, but are rare in the literature. Even fewer, are treatment programmes that include male partners. This study compared the efficacy of a structured Cognitive Behavioural Therapy (CBT) programme for the treatment of PND, delivered in 3 different ways, within an Australian semi-rurallcoastal community. Thirty-nine women, diagnosed with PND, completed 10 weeks of either 'individual' (n=9), 'group women only' (n=16) or 'group partners involved' (n=14) intervention and were compared with a control support group (n=7). Pre-intervention, women in the study reported the presence of a number of psychosocial risk factors for PND and almost 20% of the men in this sample were also depressed according to the BDI-II. Partners of the women in the 'group partners involved' treatment completed a 6-week CBT group programme especially designed for men (n=13). Partners of the women involved in the other interventions acted as a control group (n=16). Depression, anxiety, parenting stress, relationship adjustment and social support measures were taken using standardized instruments at pre-intervention, post-test and at 3- and 6-month follow-up. Qualitative information about the experiences of PND and the intervention programme was obtained through focus group interviews. The intervention programme was evaluated by questionnaire by both participants and their general practitioners or allied health professionals who had referred them to the programme. Results indicated that, overall, the 10-week, structured CBT programme was far more effective in treating PND than attending a support group. Over time, group therapy outperformed individual therapy for depression and anxiety. Including partners in intervention meant significantly improved outcomes at 6-month follow-up for depression, anxiety and relationship adjustment for women. When male partners were included, women's social support levels were significantly higher at 3-month follow-up. Post-intervention men who participated in the men's group were significantly less depressed and stressed, and showed higher levels of social support than controls. The intervention programme was rated highly by both participants and referrers for effectiveness and acceptability, with the psychoeducational information and CBT strategies rated as the most useful components. Participants viewed the inclusion of male partners in PND treatment as fundamental and strongly recommended increased community and professional awareness of PND and its consequences. The important implications for clinical practice and resource allocation raised by this study are addressed.

Background. Because there have been few studies examining resilience associated with postnatal (PN) depression, this study aimed at formulating and testing a theory-based model integrating both traditional resilience paradigms and non-traditional factors including existential beliefs about life, motherhood and religion. Method. Study hypotheses addressed prediction of PN depression, stress and resilience, and the confounding influence of negative affectivity (neuroticism). Study variables included PN depression (Edinburgh PN Depression Scale, EPDS), stress, neuroticism, self-esteem, mother's distress and ambivalence, purpose/meaning, religious belief, parity, age, marital and social status. They were assessed with standardized self-report instruments and, following a pilot, administered to a probability sample of women four months postpartum in a one-wave, community, postal survey. Because the overall response rate was so low (49%) only the Europeans were included in the study (N = 225; response-rate = 78%). Statistical hypothesis-testing included linear and logistical multivariate model-twilding techniques, and principal components analysis. Results. Sixteen percent scored in the major depression range (EPDS > 12), and 14% in the minor depression range. Depression was associated with stress, neuroticism, purpose/meaning, mother's distress and (marginally) religious belief, but not with self-esteem, mother's ambivalence, age, parity or social class. Although neuroticism was strongly associated with depression, and also overlapped with most psycho-social variables, nonetheless stress, purpose/meaning, and mother's distress maintained significant relationships with depression after neuroticism was statistically controlled. Stress was associated in part with the perception of losing one's freedom in the motherhood role (neuroticism controlled). When resilience was defined as high stress coupled with low depression, it was associated with low levels of neuroticism and mother's distress. When resilience was defined in terms of high levels of maternal satisfaction, it was associated with high purpose and low ambivalence. Principal components analyses revealed that (1) stress scores reflected two dimensions suggestive of distress and self-efficacy; and (2) depression, stress, neuroticism, self-esteem and purpose were markers for the same underlying component, whereas mother's distress and ambivalence were markers for another (unrelated) component. Conclusion. This study underlines the relevance of temperament, self-efficacy, self-transcendence, existential beliefs and motherhood-related cogniitions to the understanding of PN depression and stress.
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After careful review of the literature, a gap exists regarding the prevalence of postpartum depression in the military population compared with the civilian population. It is currently estimated that postpartum depression affects 13% of the childbearing population and over 50% of cases go unnoticed. The purpose of this study was to determine if a higher prevalence of postpartum depression exists in women married to active duty military members compared with women married to members of the general population in rural northwestern Montana. A sample population of 27 women from rural northwestern Montana completed the Postpartum Depression Screening Scale (PDSS) and their results were compared with those from a comparative population of 54 women married to active duty military members from southern Georgia. The PDSS short form was used and consists of seven questions with a Likert type scoring. The possible scores ranged from seven to 35 and a score of greater than 14 indicated that the woman had symptoms of depression. Data were analyzed and the average score and the prevalence rate were determined for each population. The average score for the civilian population was 16.85 with a prevalence rate of 62.96% compared with the military population's average score of 13.7 and prevalence rate of 50%. Demographic data was also collected and analyzed. The prevalence rate for the civilian population from rural northwestern Montana was greater than for the population of women married to active duty military members. Both populations had a greater than average prevalence rate. Possible limitations to the study include a small sample size, the data were collected from different time periods and different geographic areas, economic instability was increasing for the sampling of rural women, rural women were screened in the winter months, and there is limited research regarding the rural woman and postpartum depression.

Postpartum depression (PPD) is a well- recognized public health problem with a predictable onset beginning after childbirth and lasting from 3 to 14 months. Studies consistently report that cases of PPD are not identified and treated which results in serious personal, family, and social consequences (Webster et al., 2000). Therefore, it is of great importance that this disorder be diagnosed and treated early to prevent these deleterious consequences. The reported prevalence for PPD ranges from 3.5% to 33% depending upon assessment criteria used (Whifen as cited in Evins et al., 2000). The purpose of this clinical project was to review the literature in order to identify those factors that prevent postpartum depression from being identified and treated. A critique of the literature led to assessing one commonly used screening tool and to proposing strategies to increase early diagnosis and treatment. Not a single article reported PPD as being identified and treated, and this resulted in the development of an education module for health care providers. A suggestion for future educational modules includes targeting women in their reproductive years, as well as the community. The goal of these educational modules would be to is increase awareness of PPD risk factors, screening, and treatment strategies to avoid women and their families from suffering from PPD sequelae.

Background: Postpartum depression is a common complication after birth and affects approximately 13-19% of women each year. Many women currently have antidepressant drugs prescribed and would therefore benefit from a treatment option without adverse side effects, in this case physical activity. Physical activity is considered to have an effect on mental health in general as exercise breaks down the destructive and negative thoughts you have by distracting. Aim: The aim of this study was to determine whether physical activity can affect the mental well-being of women with postpartum depression. Method: A descriptive literature study based on 10 quantitative original articles with different study designs. Nine out of the 10 articles included were intervention studies. The databases Pubmed, CINAHL, Google Scholar and psycINFO were used to gather information for this literature study. Quality review was carried out using review templates. Results: Eight out of ten articles showed that physical activity had a positive effect and reduced depressive postpartum symptoms. What kind of physical activity the different studies chose for their intervention were varied, as well as the measuring instruments used to measure depression symptoms in postpartum women. The result was divided and presented in three categories; group training, home-based training and group training with home-based training as a complement. Conclusion: The result of our study show that physical activity has an effect on the mental well-being of women with postpartum depression. The degree of depression decreases in points and one could also see an elevated quality of life after interventions in the form of physical activity. However, to strengthen this result and to get enough evidence, more research is needed on the subject.
Bakgrund: Postpartum depression är en vanlig komplikation och drabbar cirka 13-19% av kvinnor som föder barn varje år. Många kvinnor får i nuläget antidepressiva mediciner utskrivet och skulle därmed gynnas av ett behandlingsalternativ utan negativa biverkningar, i det här fallet fysisk aktivitet. Fysisk aktivitet anses ha effekt på psykisk ohälsa generellt i och med att motion bryter ner de destruktiva och negativa tankarna man har genom att man blir distraherad.  Syfte: Syftet var attundersöka om fysisk aktivitet kan påverka det psykiska välmåendet hos kvinnor med postpartum depression.  Metod: En deskriptiv litteraturstudie baserad på 10 kvantitativa originalartiklar med olika studiedesign. Nio av de 10 artiklarna som inkluderades var interventionsstudier. Databaserna Pubmed, CINAHL, Google Scholar och psycINFO användes för att samla information för denna litteraturstudie. Kvalitetsgranskning gjordes med hjälp av granskningsmallar.  Resultat: Åtta avtio artiklar visade att fysisk aktivitet hade en positiv effekt och reducerade depressiva postpartum symptom. Vilken fysisk aktivitet som de olika studierna valt att använda sig av var varierande, samt vilka mätningsinstrument som användes för att mäta depressionssymtom hos postpartum kvinnorna. Resultatet delades upp och presenterades i tre kategorier; gruppträning, hembaserad träning och gruppträning med hembaserad träning som komplement.  Slutsats: Resultatet av litteraturstudien visar att fysisk aktivitet har påverkan på det psykiska välmåendet hos kvinnor med postpartum depression. Graden av depression minskades i poäng och man kunde även se en förhöjd livskvalité efter interventioner i form av fysisk aktivitet. För att styrka detta resultat och få tillräckligt med evidens behövs dock mer forskning kring ämnet.