Postpartum Depression Essay Example
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Mood disorders are common amongst women in the postpartum period. There are three major categories of postpartum affective disorders: postpartum blues, postpartum depression, and postpartum psychosis (Brockington, 2004). An estimated 85% of all new mothers report experiencing some form of postpartum blues. Symptoms of postpartum blues are mild as compared to those of postpartum depression and include irritability, mood lability, and emotional hypersensitivity. The symptoms of postpartum blues occur within 2-4 days of delivery and resolve within days (World Health Organization (WHO), 2009). Postpartum psychosis is rare; it affects 1-2 women /1000 births. Its clinical onset is relatively fast as it occurs between the first and third days of delivery. Women with the condition fluctuate between periods of mania and depression and also have disorganized behavior, severe agitation, delusions, or hallucinations (Brockington, 2004). Postpartum depression which is the focus of this paper is less serious than postpartum psychosis. It is a research and clinical construct used to describe depression that arises after childbirth. Postpartum depression has attracted a lot of research interest over the preceding 4 decades especially in developed countries (WHO, 2009). These studies suggest that the condition affects 10 to 15% of women (Gavin et al., 2005). Postpartum depression has been selected as the focus of this paper due to the adverse effects it has on maternal confidence as well as the emotional, cognitive, and social development of infants (Nulman et al., 2012). If untreated, it can lead to chronic mental health problems and suicidal behaviors for the mother (Logsdon, Wisner, & Pinto-Foltz, 2006).
Symptoms of depression occurring after childbirth include feelings of despair, sadness, inadequacy, fatigue, anxiety, dependency, compulsive thoughts, and loss of libido (Guille, Newman, Fryml, Lifton, & Epperson (2013). It is not clear how long the postnatal period lasts. This lack of clarity affects the diagnosis of postpartum depression since it brings confusion with regards to the period during which depression occurring after childbirth should be considered as postpartum depression (WHO, 2009). There is also controversy over how long depression occurring after childbirth should be considered of postpartum onset (WHO, 2009). The Diagnostic and Statistical Manual of Mental Disorders (DSM IV) specifies a four week period after delivery for the onset of postpartum depression. Some researchers such as Nott (1987 as cited in WHO, 2009), however, reported postpartum depression cases occurring between 3 and 9 months post-delivery. The DSM-IV defines post-partum depression as a major depressive episode lasting 2 weeks or more coupled with daily presence of 5 or more of the following symptoms: sleep pattern changes, psychomotor agitation or retardation, significant weight gain or weight loss, decreased ability to think or concentrate, fatigue or loss of energy, feelings of hopelessness, worthlessness, or guilt, and recurrent suicidal thoughts (Sierra, 2008). Therefore, the diagnosis of postpartum depression is arrived at if a patient displays symptoms that meet the DSM-IV criteria. Notably, the American Psychiatric Association amended the name of postpartum depression to peripartum depression in its 2013 manual, the DSM-V. The new manual also stipulates that the disorder can start during pregnancy or within 4 weeks of delivery (American Psychiatric Association, 2013).
Substantial evidence suggests that a range of psychosocial, cultural, and economic factors contribute to postpartum depression. However, correlations between risk factors and postpartum depression should not be interpreted as causal links. The general view is that postpartum depression occurs as a result of an interaction between a number of protective and risk factors (WHO, 2009). Certain factors such as a personal history of an affect disorder, anxious or depressed mood in pregnancy, and prior psychiatric hospitalization have consistently been found to predict postpartum depression (Guille et al., 2013). Poor parental care especially neglect during childhood and a history of physical and sexual abuse during childhood have been associated with adult depression as well as postpartum mood disorders (WHO, 2009). A poor relationship between a mother and her partner is also a major predictor postpartum depression. Problems with such relationships are conceptualized as men providing little practical or emotional support, marital conflict, low satisfaction, inadequate involvement in infant care, unhappiness, and poor adjustment (WHO, 2009). Some authors have proposed that depressed women tend to be socially withdrawn and irritable which makes it difficult for their partners to relate with them and provide care. Although violence against women by intimate partners has been strongly linked to depression amongst women, its influence on postpartum depression has not been elucidated. This violence includes criticism, control, coercion, humiliation, physical, and verbal abuse (WHO, 2009).
Broader social factors have also been linked with postpartum depression. They include poor social support like having few confiding relationships or friends as well as lack of assistance in crisis. Depression after childbirth has also been found to be more prevalent amongst single or young mothers (Stewart, Robertson, Dennis, & Grace, 2004). Recent immigration or relocation and having the first child while >30 years’ old have also been associated with postpartum depression. Findings from international studies additionally suggest that lack of practical help from family and poor relationships with a partner’s family contribute to depression after childbirth (Stewart, Robertson, Dennis, & Grace, 2004). Adverse life events like serious financial hiccups and bereavement that coincide with childbirth also make the adjustment to parenthood difficult and stressful (WHO, 2009). Notably, the impact of socioeconomic status on postpartum depression has not been tested accurately. This is because it is hard to recruit and maintain young and poorly educated mothers from poor families in studies. Generally, the propensity to become depressed after childbirth seems to be influenced by factors that affect the transition process to parenthood (WHO, 2009).
The management of postpartum depression depends on its severity. Mild to moderate forms of the condition are managed using psychotherapy. Moderate to severe forms of the disorder are managed using psychotherapy and antidepressant medications (Guille et al., 2013). Cognitive behavioral therapy and interpersonal psychotherapy have the largest evidence based for acute treatment of postpartum depression. Both forms of treatment are time-limited treatments. They focus on current problems and encourage clients to reestablish control over their affect and functioning. The aim of IPT is to assist clients identify and change interpersonal difficulties. It does this by helping clients understand themselves, their current roles and relationships with other better (Guille et al., 2013). CBT, on the other hand, helps individuals recognize the interaction between emotions, behaviors, and thoughts. This helps clients to recognize faulty or maladaptive thinking patterns that lead to negative emotions and behaviors. Clients also participate in activities designed to improve their moods and thought patterns (Guille et al., 2013). Antidepressants balance mood-altering chemicals in the brain. They help to improve symptoms of depression such as loss of energy, appetite, sleep, irritability, insomnia, and lack of concentration (Fitelson, Kim, Baker, & Leight, 2011).
The specific nursing interventions for a client with post-partum depression would include assessing for signs of depression and encouraging a well-balanced diet. Other interventions include encouraging partner support, participation in an exercise program, family participation in the care of the infant, and periods of rest for the mother. The client’s partner and significant others also need to be offered support. In addition, they should be educated about the signs and symptoms they should report as well as the client’s medication dosages and schedules (Green, 2012). The mother should also be taught coping strategies and referred to support groups, community support programs, and specialized mental health treatment as appropriate. To assess the patient’s response to the above nursing interventions, a number of factors need to be evaluated. They include the client’s use of effective coping strategies, help seeking behaviors, self-reported fatigue, performance of self-care, feelings of well-being, and pleasure or engagement in infant care (Green, 2012).
In summary, this paper has described postpartum depression, its onset, symptoms, diagnosis, and management. Postpartum depression was selected because of the significant and potentially devastating lifetime implications it has on women and children. The onset of the condition can be during pregnancy or within four weeks of childbirth. Mothers with the condition are identified through screening and a concrete diagnosis made if the client meets the DSM-V criteria for the condition. Symptoms of the disease are subjective and objective in nature. Management of the condition depends on the severity of the disorder. The mainstay treatments are psychotherapy and antidepressant medications. These treatments help to improve a client’s mood and overall functioning.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Brockington, I. (2004). Diagnosis and management of post-partum disorders: A review. World Psychiatry, 3 (2), 89-95.
Gavin, N. I., Gaynes, B.N., Lohr, K.N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression FA systematic review of prevalence and incidence. Obstetr Gynecol., 106, 1071–1083
Green, C. (2012). Maternal newborn nursing care plans (3rd ed.). Sudbury, MA: Jones & Barlett Learning.
Guille, C., Newman, R., Fryml, L. D., Lifton, C. K., & Epperson, C. N. (2013). Management of postpartum depression. Journal of Midwifery and Women’s Health, 58(6), 643-653.
Fitelson, E., Kim, S., Baker, A. S., & Leight, K. (2011). Treatment of postpartum depression: Clinical, psychological, and pharmacological options. International Journal of Women’s Health, 3, 1-14.
Logsdon, M.C., Wisner, K.L., & Pinto-Foltz, M.D. (2006). The impact of peripartum depression on mothering. J Obst, Gyn, and Neo Nurs., 35, 652–658.
Sierra, J. (2008). Risk factors related to postpartum depression in low-income Latina Mothers. Ann Arbor, MI: ProQuest Information and Learning Company.
Stewart, D. E., Robertson, E., Dennis, C., & Grace, S. (2004). An evidence-based approach to post-partum depression. World Psychiatry, 3(2), 97-98.
World Health Organization (2009). Mental health aspects of women’s reproductive health: A global review of the literature. Geneva: WHO Press.
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