Rozprawy doktorskie na temat „Post-natal depression”

It is gradually becoming acknowledged that fathers do suffer from post-natal depression, but very little is known about their experience or how many fathers are actually affected. The factors that may increase a father's susceptibility to post-natal depression, or those that might indeed protect him, have also been given little consideration in research to date. This study examined the prevalence and comorbidity of post-natal depression in 100 first time parents, using the Edinburgh Post-natal Depression Scale (EPDS). The psychological factors of infant temperament, perception of own parenting and social support were investigated in a smaller sample of 30 fathers subsequently interviewed. These were measured using the Neonatal Perception Inventory (NPI), the Parental Bonding Instrument (PBI) and the Significant Others Scale (SOS) respectively. The findings suggest that approximately 12 per cent of first time fathers may suffer from post-natal depression and fathers are significantly more likely to experience this if their partner is also depressed. Depression amongst fathers was found to be associated with having little social support, perceiving one's own baby as more difficult than the average baby and perceiving one's own father as having been uncaring. The findings are discussed together with their clinical implications and areas for future research.

The aim of this thesis has been to reconceptualize 'post natal depression' and challenge the 'clinical' and 'social science' models of explanation. It has focussed on a) whether 'post natal depression' is an objective phenomenon, and b) whether the experience of 'post natal depression' is the same for every women, and C) whether there are any common features of the experience of childbirth and early mothering which enable the construction of 'normal' experience. It begins by suggesting that the 'clinical' and 'social science' models are problematic in that they are based on ideological assumptions and not scientific evidence about what is 'normal' following childbirth. This is explored by examining the previous literature and by using a pre-validated measure of 'post natal depression' in the pilot work alongside semi-structured interviews. The literature demonstrates a history of weak conceptualization and associated poor methodology, with explicit and implicit assumptions about the psychology of women, childbirth and the motherhood role. This thesis therefore sets out to re-examine and re-define 'post natal depression' by analysing detailed accounts of pregnancy, childbirth and early motherhood within a framework suggested by Gidden's stratification model of knowledge and other frameworks which take human reflexiveness into account.. The research comprised a small-scale longitiudinal study in which 24 women were interviewed up to four times; during pregnancy, and one, three and six months after delivery. The data comprised indepth verbatim transcriptions (from tape recorded interviews) which were analyzed to consider the meaning of the experience of childbirth, depression and early mothering to the individual respondent, and also to review the common features of the experience in order to suggest a construction of what is 'normal' here. The conclusion identifies certain elements of experience which are likely to lead to 'depression' at various stages after childbirth. These are concerned with physical stress, initial ibsecurities and lack of effective support and loss of former identity. They are not co-terminus with the 'stressors' of the 'social science' model in that their effect is totally subject to the meaning attributed to the events by each woman within the context of her biography.

van de Rijt-Plooij & Plooij (1992) have found periods of 'regressive behaviour' (Regression Periods), which accompany developmental transitions in infancy. In fullterm normal infants these periods occur at specific ages. The present study had two central aims. Firstly, to see if the Plooijs' finding of Regression Periods at 12, 17 and 26 weeks postpartum could be replicated. Secondly, to investigate the relationship between the length of Regression Periods for a control group of participants and a group of participants at heightened risk of developing insecure mother-infant attachment: mothers presenting with symptoms of post-natal depression. Forty-five mother-infant dyads participated in this prospective, longitudinal study. After seeing mothers at home, they were interviewed weekly, for approximately 15 weeks, about specific infant behaviours and their reactions to their infant. Following two types of manipulation of the data, Regression Periods for control group participants were detected at weeks 12, 16,20 and 24, whereas for participants in the post-natal depression group, Regression Periods were detected at weeks 14, 17 and 25, supporting the Plooijs' findings. Regression Periods were longer in the post-natal depression group. Depressed mothers were also less flexible in their mothering style, measured on the Facilitators & Regulators questionnaire. Based on the findings of this study, the development of insecure attachment is discussed. A clinical implication of this work is that information about Regression Periods could be made available to new-mothers, using Regression Period knowledge to focus on the prevention of insecure attachment.

The research question “What does it mean for a woman to be diagnosed with postnatal depression?” indicates three main overlapping areas of investigation: women, including issues of gender, discourses around womanhood and the roles and expectations being a woman carries; diagnosis, which is the categorising of experiences deemed to be outside of what is considered normal and includes discourses around mental health and mental illness; and mothers, including expectations of mothers and motherhood. All of these areas interlink and are arguably socially and culturally specific. There is also an underlying concept of identity as a woman, a mother and a mentally ill person, both separately and as an intersection of the three. It is therefore an important area of investigation within counselling psychology, a discipline that concerns itself with subjective experience and is therefore well placed to interrogate the process of medicalised diagnoses. The social and cultural influence also suggests Charmaz’s constructivist grounded theory as the appropriate method as it uses ideas of social constructionism. In this study semistructured interviews were carried out with eight women who believed they had been given a diagnosis of postnatal depression. They were asked about the circumstances leading up to their diagnosis and what they felt the impact was. These interviews were transcribed and analysed using a Grounded Theory methodology (Charmaz, e.g. 2006). A theory of how women view their experience of being diagnosed with postnatal depression, as well as how social factors influence the way the women make sense of this experience, is proposed. This theory takes the form of a process in which women described a dissonance between their expectations of motherhood and their lived experience. They understood this as a lack in themselves and as a result hid their struggles to a point at which they felt they could no longer avoid seeking professional help. The subsequent diagnosis of postnatal depression led to an opening of a dialogue around the difficulties they were experiencing as well as options of possible treatments. The implications of this process are discussed.

The overall objective of this research project was to explore the combination of a traditional treatment for postnatal depression (PND), such as cognitive behavioral therapy (CBT), with the use of virtual reality (VR) technology. This project set out to respond to five objectives 1) to study which treatments were the most effective and frequent for the treatment of PND, 2) to identify which components of CBT were used most frequently for the treatment of PND, 3) to identify whether VR had ever been used for the treatment of PND, and whether VR could be combined with traditional therapy and implemented in a clinical setting, 4) to study the feasibility and acceptance of this CBT plus VR intervention protocol 5) to explore the preliminary efficacy of the combination of CBT with VR for the treatment of PND.
El objetivo general de este proyecto de investigación era explorar la combinación de un tratamiento tradicional para la depresión postnatal (DPN), como la terapia cognitivo-conductual (TCC), con el uso de la tecnología de realidad virtual (RV). Este proyecto se propuso responder a cinco objetivos. 1) estudiar qué tratamientos eran los más eficaces y frecuentes para el tratamiento del DPN. 2) para identificar qué componentes de la TCC se utilizaban con más frecuencia para el tratamiento del DPN. 3) para identificar si la RV se había utilizado alguna vez para el tratamiento del DPN, y si la RV podía combinarse con una terapia tradicional e implementarse en un entorno clínico. 4) estudiar la viabilidad y aceptación de este protocolo de intervención de CBT más RV, es decir, identificar si la combinación de la TCC con la tecnología de RV era factible y aceptable. 5) explorar la eficacia preliminar de la combinación de la TCC con la RV para el tratamiento del DPN.
Programa de Doctorat en Psicologia

Childbirth can be associated with short and long-term psychological morbidity including depression, anxiety and trauma symptoms. Some previous studies have used psychological interventions to reduce postpartum distress but have primarily focussed on attempting to relieve symptoms of depression with little recognition of trauma symptoms. Furthermore, the intervention used in these studies has generally been poorly documented. The first aim of the present study was to develop a counselling framework, suitable for use by midwives, to address psychological trauma following childbirth. Multiple methods were used to develop the intervention including focus groups with women and midwives. Both the women and midwives gave unequivocal support for postpartum debriefing. Themes that emerged from the focus groups with women included the need for opportunities to talk about their birth experience, an explanation of events, an exploration of alternative courses of action that may have resulted in a different birth experience, talking about their feelings such as loss, fear, anger and self-blame, discussing social support, and discussing possible future childbearing. There was a high level of agreement between the women's and midwives' views. These themes were synthesized with contemporary literature describing counselling interventions to assist in reconciling a distressing birth experience and a model for understanding women's distressing birth experiences to develop a counselling framework. The counselling intervention was then tested using a randomised controlled study involving 400 women recruited from antenatal clinics of three public hospitals. When interviewed within seventy-two hours of birth, 103 women reported a distressing birth experience and were then randomised into either the treatment or control group. Women in the intervention group had the opportunity to debrief at the initial postpartum interview (< 72 hours postpartum) and at four to six weeks postpartum. The prevalence of posttraumatic stress disorder was quite high; 9.6% of participants meeting the diagnostic criteria for acute PTSD at four to six weeks postpartum. Fewer participants (3.5%) met the diagnostic criteria for chronic PTSD at three months postpartum. As with previous research relating to childbearing women, few demographic factors or antenatal psychological factors were associated with the development of a PTSD symptom profile following childbirth. The development of PTSD symptom profile was strongly associated with obstetric intervention and a perception of poor care in labour. This finding is also consistent with previous research. Emotional distress was reduced for women in the intervention group in relation to the number of PTSD symptoms [t (101) = 2.144, p = .035], depression [c2 (1) = 9.188, p = .002], stress [c2 (1) = 4.478, p = .029] and feelings of self-blame [t (101) = -12.424, p <.001]. Confidence about a future pregnancy was higher for these women [t (101) = -9.096, p <.001]. Although there was not a statistically significant difference in the number of women with a PTSD symptom profile at three months postpartum, fewer women in the intervention group (n=3) than in the control group (n=9) met PTSD criteria. Likewise, there were fewer women in the intervention group (n=1) with anxiety levels above mild than in the control group (n=6). Importantly, this study found that offering women who have had a traumatic birth the opportunity for counselling using the framework documented in this dissertation was not harmful. This finding is in contrast to previous findings of other studies. The intervention was well received by participants. All the women in the intervention group found the counselling sessions helped them come to terms with their birth experience. Maternity service providers need to be cognizant of the prevalence of this debilitating condition and be able to identify women at risk for early intervention and referral to a mental health practitioner if appropriate. This research offers further support for the compelling need to implement changes to the provision of maternity services that reduce rates of obstetric intervention and humanise service delivery as a means of primary prevention of birth-related PTSD.

Childbirth can be associated with short and long-term psychological morbidity including depression, anxiety and trauma symptoms. Some previous studies have used psychological interventions to reduce postpartum distress but have primarily focussed on attempting to relieve symptoms of depression with little recognition of trauma symptoms. Furthermore, the intervention used in these studies has generally been poorly documented. The first aim of the present study was to develop a counselling framework, suitable for use by midwives, to address psychological trauma following childbirth. Multiple methods were used to develop the intervention including focus groups with women and midwives. Both the women and midwives gave unequivocal support for postpartum debriefing. Themes that emerged from the focus groups with women included the need for opportunities to talk about their birth experience, an explanation of events, an exploration of alternative courses of action that may have resulted in a different birth experience, talking about their feelings such as loss, fear, anger and self-blame, discussing social support, and discussing possible future childbearing. There was a high level of agreement between the women's and midwives' views. These themes were synthesized with contemporary literature describing counselling interventions to assist in reconciling a distressing birth experience and a model for understanding women's distressing birth experiences to develop a counselling framework. The counselling intervention was then tested using a randomised controlled study involving 400 women recruited from antenatal clinics of three public hospitals. When interviewed within seventy-two hours of birth, 103 women reported a distressing birth experience and were then randomised into either the treatment or control group. Women in the intervention group had the opportunity to debrief at the initial postpartum interview (< 72 hours postpartum) and at four to six weeks postpartum. The prevalence of posttraumatic stress disorder was quite high; 9.6% of participants meeting the diagnostic criteria for acute PTSD at four to six weeks postpartum. Fewer participants (3.5%) met the diagnostic criteria for chronic PTSD at three months postpartum. As with previous research relating to childbearing women, few demographic factors or antenatal psychological factors were associated with the development of a PTSD symptom profile following childbirth. The development of PTSD symptom profile was strongly associated with obstetric intervention and a perception of poor care in labour. This finding is also consistent with previous research. Emotional distress was reduced for women in the intervention group in relation to the number of PTSD symptoms [t (101) = 2.144, p = .035], depression [c2 (1) = 9.188, p = .002], stress [c2 (1) = 4.478, p = .029] and feelings of self-blame [t (101) = -12.424, p <.001]. Confidence about a future pregnancy was higher for these women [t (101) = -9.096, p <.001]. Although there was not a statistically significant difference in the number of women with a PTSD symptom profile at three months postpartum, fewer women in the intervention group (n=3) than in the control group (n=9) met PTSD criteria. Likewise, there were fewer women in the intervention group (n=1) with anxiety levels above mild than in the control group (n=6). Importantly, this study found that offering women who have had a traumatic birth the opportunity for counselling using the framework documented in this dissertation was not harmful. This finding is in contrast to previous findings of other studies. The intervention was well received by participants. All the women in the intervention group found the counselling sessions helped them come to terms with their birth experience. Maternity service providers need to be cognizant of the prevalence of this debilitating condition and be able to identify women at risk for early intervention and referral to a mental health practitioner if appropriate. This research offers further support for the compelling need to implement changes to the provision of maternity services that reduce rates of obstetric intervention and humanise service delivery as a means of primary prevention of birth-related PTSD.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing
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An examination of parental leave and sense of parenting competence as risk factors for paternal post-natal depression. Post-natal depression has been well researched in mothers and has been found to have profound negative effects on both parents and the family unit. Recent findings have also shown that fathers experience postnatal depression at a similar rate to mothers, and this also has negative impacts on the family. Despite this, few studies have investigated factors contributing to the risk of postnatal depression among fathers. Parental leave has been shown to reduce the incidence of depression in both mothers and fathers, although fewer studies of the impact on fathers have been conducted. The aim of the present study was to examine the role of parental leave and sense of parenting competence in depression for first time fathers of a new baby. Fathers whose first child was aged under two years (N=102) completed an online survey comprising of questions about the timing and length of leave taken following the birth of their child, along with measures of depression and sense of parenting competence from the Parenting Stress Index. The data showed that depression was negatively associated with sense of parenting competence. No significant association was shown between leave taken and sense of parenting competence or between depression and leave taken, and no evidence for an indirect association between leave and depression through parenting competence was shown. These findings do not support research in other countries that found an association between increased parental leave and depression. It is possible that the impact of the Covid-19 pandemic influenced these findings.
Thesis (B.PsychSc(Hons)) -- University of Adelaide, School of Psychology, 2021

This study investigated the experiences and post-natal depression rates in women experiencing problems in establishing and maintaining a successful breastfeeding process with their babies. There were two phases in the project. Phase 1 gathered categorical data about this client group, their partner and baby, the breastfeeding problems experienced and screened the women for post-natal depression. Phase 2 involved semi-structured, in-depth interviews with ten of the women involved in Phase 1. The interviews explored women’s physical and emotional experiences of the breastfeeding problem(s); how this/these impacted on their relationship with their baby and partner; sought to elicit and evaluate the professional assistance they have received to remedy the problem(s); examined the amount and quality of family and social support received by the women; and invited participants to provide suggestions as to how other women in the same situation could be assisted. The results obtained found that this sample group had a higher level of PND than found by most previous researchers; that breastfeeding problems had a considerable physical and emotional impact on the women; they supported previous findings that professional, family and social supports are very important to new mothers; and that professional assistance and support to these women could be improved. It is recommended that further investigation is warranted – with a larger and more representative sample - to explore whether breastfeeding problems contribute to the aetiology and exacerbation of post-natal depression.