Tesi sul tema "Postpartum depression Pregnancy Depression in women"

Objective: Social support and religious commitment were examined in relation to antenatal and postpartum depressive symptoms in a prospective, longitudinal study to determine whether religious commitment explained variance in depression scores beyond that accounted for by social support. Background: Social support and religiosity are positively related to good mental/physical health, and depression is related to poor health outcomes in pregnancy and postpartum. It was hypothesised that social support and religious commitment would be inversely related to depressive symptoms, and that religious commitment would predict variance in depression scores over and above social support. Methods: In 106 mostly low SES Appalachian pregnant women, social support and religious commitment were measured during the first trimester. First and third trimester (Center for Epidemiological Studies Depression Scale – 10 item version), and 6 weeks and 6 months postpartum (Edinburgh Postnatal Depression Scale) depression symptoms were measured. Hierarchical regression examined relative contributions of social support (Prenatal Psychosocial Profile) and religious commitment (Religious Surrender and Attendance Scale – 3 Item Version) to depressive symptoms at each time point while controlling for education and marital status. Results: Regression results indicated that social support and religious commitment explained 10–18% and 0–3% of the variability in depression scores, respectively. Conclusion: Both social support (all time points) and religious commitment (only at 6 months postpartum) were inversely related to depression. Pregnant women low in social support and postpartum women low in social support or religious commitment may be at increased risk for depression.

Background: Young childbearing women have an increased risk of experiencing perinatal depression when compared to adult childbearing women. Perinatal depression has been associated with adverse life events in the literature and conceptually, in frameworks such as the Lifecycle Approach to Risk Factors for Mental Disorders Model. Purpose: The purpose of this manuscript-based thesis was to (1) determine the prevalence of: (i) adverse life events that have been associated with depression and (ii) depressive symptoms among the young pregnant and parenting women who access specialized services in an urban centre in Ontario, Canada; (2) determine which adverse life events are predictive of depression during the perinatal period, in this population; and (3) examine the psychometric properties of the Edinburgh Postnatal Depression Scale (EPDS) for use in a population of young childbearing women who access specialized services in an urban centre in Ontario, Canada. Methods: A survey was conducted with 102 young women from two agencies that provide specialized services to young parents. The interviewer-administered questionnaire included demographic questions, the Edinburgh Postnatal Depression Scale, the Antenatal Psychosocial Health Assessment, the Centers for Epidemologic Studies Depression Scale, Brown’s Support Behaviour Inventory. Results: 31.4% of the sample screened positive for perinatal depression. The only adverse life events found to predict perinatal depression were satisfaction with support from ‘others’ and intimate partner violence. Another predictor was very young maternal age (14 – 17 years). The EPDS was found to be psychometrically sound when used in this population of young childbearing women. Conclusion: In this study of young childbearing women in Ontario, Canada, we found a high prevalence rate of perinatal depression and adverse life events. Furthermore, we identified specific factors that predict the development of perinatal depression in this group. Nurses can use these findings to help prioritize perinatal screening efforts to identify this condition early on in order to lessen the adversities related to perinatal depression.

Introduction: Obesity is a growing global public health problem and is as prevalent among pregnant women as in the general population. It is well known that obese women have an increased risk for several complications during pregnancy and delivery and this is also true for the neonate. Excessive gestational weight gain among obese women seems to further increase these risks for adverse outcomes. It has not been known up to the time of this study whether a behavioral intervention program designed for obese pregnant women could result in a reduction of gestational weight gain. Aim: The overall aim of the present thesis was to study the effect of an intervention program designed to control weight gain among obese pregnant women during pregnancy and to then observe the outcomes of their pregnancies. In addition we wanted to learn if this behavioral intervention program could result in a weight gain of less than seven kilograms. Material and methods: The intervention group consisted of 155 obese (BMI >30 kg/m2) pregnant women at the antenatal care clinic (ANC) in Linköping; the control group consisted of 193 obese pregnant women in two other cities. The women in the intervention group were offered, in addition to regular care at the ANC, motivational interviewing in weekly visits to support them in making this behavioral change. They were also offered aqua aerobic class once or twice a week. The women in the control group attended the routine antenatal program in their respective ANCs. Outcome measures were: weight in kg, pregnancy-, delivery and neonatal outcomes, prevalence of anxiety- and depressive symptoms and attitudes and experiences of participating in an intervention program. Results: The women in the intervention group had a significantly lower gestational weight gain and also had a lower postnatal weight than the women in the control group. The percentage of women in the intervention group who gained <7 kg was greater than the percentage in the control group. There were no differences between the two groups in pregnancy-, delivery- and neonatal outcomes. In addition, there was no difference in prevalence of symptoms of anxiety and depressions between the intervention- and control group and the gestational weight gain did not have any effect on symptoms of depression or anxiety. The women in the intervention group with gestational weight gain <7 kg, weighed less at the two years follow-up than the women in the control group. Most of the women who participated in the intervention program expressed positive attitudes and were positive towards their experiences with the intervention program and their efforts to manage the gestational weight gain. Conclusion: The intervention program was effective in controlling weight gain during pregnan-cy and did not change the pregnancy, delivery or neonatal outcomes or the prevalence of anxie-ty- and depressive symptoms. The group with a gestational weight gain <7 kg showed the same distribution of complications as the group with a higher weight gain. The intervention program seems to influence the development of weight in a positive direction up to two years after childbirth. The women were also satisfied with their participation in the intervention program.

We sought to examine the concordance of two suicidal ideation items from the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS), to evaluate the prevalence of suicidal ideation among pregnant women, and to assess the co-occurrence of suicidal ideation with antepartum depressive symptoms. A cross-sectional study was conducted among 1,517 pregnant women attending prenatal care clinics in Lima, Peru. Item 9 of the PHQ-9 assesses suicidal ideation over the last 14 days while item 10 of the EPDS assesses suicidal ideation in the past 7 days. The two suicidal ideation items have a high concordance rate (84.2 %) but a moderate agreement (the Cohen's kappa = 0.42). Based on the PHQ-9 and the EPDS, 15.8 and 8.8 % of participants screened positive for suicidal ideation, respectively. Assessed by the PHQ-9, 51 % of participants with suicidal ideation had probable depression. In prenatal care clinics, screening for suicidal ideation is needed for women with and without depressive symptoms. Future studies are needed to identify additional predictors of antepartum suicidality, determine the appropriate duration of reporting period for suicidal ideation screening, and assess the percentage of individuals with positive responses to the two suicidal ideation items at high risk of planning and attempting suicide.
This research was supported by an award from the National Institutes of Health (NIH), the Eunice Kennedy Shriver Institute of Child Health and Human Development (R01-HD-059835). The NIH had no further role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The authors wish to thank the dedicated staff members of Asociacion Civil Proyectos en Salud (PROESA), Peru and Instituto Especializado Materno Perinatal, Peru for their expert technical assistance with this research. The authors would like to thank Kathy Brenner for her help with revising this manuscript.
Revisión por pares

Thesis (MA (Psychology))--University of Stellenbosch, 2006.
This study aimed to determine whether low-income women residing in a rural community in South Africa experienced any significant difference in the prevalence rates of depressive symptoms postpartum as compared to depressive symptoms prepartum. Thirty women between the ages of 16 and 38 were recruited during pregnancy from the local community clinic in Kylemore, South Africa. The women where assessed for elevated levels of depressive symptomatology using the Beck Depression Inventory (BDI) during pregnancy and again at three and six months postpartum. It was found that 18 (60%) of the women reported elevated levels of depressive symptomatology during the prepartum assessment, with 11 (37.9%) and 12 (48%) women reporting elevated levels of depressive symptomatology at the three months and six month postpartum assessment respectively. It was further found that the sample from the current study did not experience any significant difference in the rate of depressive symptomatology from the prepartum assessment to either of the postpartum assessments. The results also suggests that a relationship exists between the levels of depressive symptomatology prepartum and the levels of depressive symptomatology postpartum, as those women who experienced high levels of depressive symptomatology during pregnancy continued to show high levels of depressive symptomatology at the postpartum assessments. The findings from the current study thus suggest that the classification of postpartum depression as a unique and separate entity, that differs from depression occurring in women at other times and from depression as experienced by men, may be misleading. The term suggests a depression that develops following childbirth, while in the current study it seemed that when depressive symptoms were reported postpartum, they were also already apparent during pregnancy. The findings from the current study therefore suggest that the existence of postpartum depression as a distinct diagnosis or illness is problematic – a suggestion that has frequently been suggested in the literature (Aderibigbe, Gureje, & Omigbodun, 1993; Chandran, Tharyan, Muliyil & Abraham, 2002; Cooper, Campbell, Day, Kennerly & Bond, 1988; Cox, Murray & Chapman, 1993; O’Hara, Zekoski, Phillips & Wright, 1990; Patel, Rodrigues, & DeSouza, 2002).

Dissertação de Mestrado em Psicologia da Gravidez e da Parentalidade
A depressão pós-parto constitui uma situação de risco para a mãe, para o bebé, para o pai e restante família. Numa tentativa de amenizar os efeitos nefastos da depressão pós-parto, alguns investigadores debruçaram-se sobre a função do pai durante esse período. O companheiro de uma mulher com depressão pós-parto tanto pode ser um elemento desencadeador desta patologia, como parece ter um papel crucial para o seu desaparecimento, representando o membro com maior influência na alteração do comportamento da mãe e no seu restabelecimento. Perceber o que sentem, pensam e que comportamentos assumem face à depressão das companheiras e de que forma isso interfere na recuperação destas mulheres foi o objectivo desta revisão de literatura, com o propósito de nos permitir perceber os mecanismos da depressão pós-parto, e as repercussões e os comprometimentos que pode ter ao nível das dinâmicas familiares que se estabelecem entre os diferentes membros.

"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.

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: 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.

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.

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.

Purpose: The purpose of this study was to determine the prevalence of postpartum depression among Hispanic immigrant women seeking healthcare services at a community health clinic. Data Sources: Hispanic immigrant women were recruited. Out of 116 study participants, 96 women were in the final sample. Using the Beck PDSS-Spanish version, women were screened for symptoms of postpartum depression. Conclusions: The prevalence rate of significant symptoms of PPD was 54.2% for the entire sample of 96 women. Nearly 66% of women who screened positive for symptoms of PPD scored above the listed cutoff score for suicidal thoughts. Women were divided into four postpartum age groups from 2 to 48 weeks; prevalence rates of symptoms of PPD ranged from 50% to 60.9% among the different groups. There were no statistically significant demographic predictors for PPD. Implications for Practice: Given the high rates of symptoms of PPD in this population, it is strongly recommended healthcare providers implement universal screening for all Hispanic women in pregnancy and across the first postpartum year to ensure prompt diagnosis and culturally appropriate treatment. Further research is needed to assess the cultural components of postpartum depression and to determine if the prevalence is consistent in other community settings.

Researchers have found that postpartum depression (PPD) affects 10 to 15% of new mothers in the U.S. and minority groups experience more depressive symptoms than most of the U.S. population. In Maricopa County, Arizona, research studies of PPD suggested that Mexican women had the highest PPD rate when compared to African-American, Cuban, and Puerto-Rican women. The purpose of this qualitative interpretive descriptive study was to explore what experiences Mexican women in Maricopa County had with PPD, their perceptions of factors such as low-income, cultural beliefs, intimate partner violence, social support, and healthcare services, and to explore barriers that may prevent Mexican women in Maricopa County from receiving diagnostic care for PPD. The theoretical basis for this study was Engel's biopsychosocial model of perinatal mood. Ten Mexican women living in Maricopa County with PPD were interviewed to help gain a deeper understanding of past experience with PPD. The key findings in this study were that socioeconomic status, social support, cultural beliefs, and intimate partner violence were associated with PPD in Mexican women before and after childbearing. The participants in this study stated that lack of public transportation, illegal status, and spouse deportation to Mexico were associated with their PPD. A better understanding of these experiences with PPD could lead to policies and practices that address those women at greater risk of PPD. A social change implication of this study could be the implementation of early diagnostic testing for PPD prevention for Mexican women in Maricopa County.

Thesis (MA)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: The topic of perinatal depression (i.e. depression during and after pregnancy) remains a subject of continued research interest, as a broad literature body reports that a large proportion of women suffering from this mental disorder do not receive appropriate treatment. This is worrisome, firstly, because mental health treatment is often readily available to the public and at no cost. Secondly, untreated perinatal depression not only holds dangerous consequences for the mother but also for the infant and the rest of the family. It is therefore important to identify those factors that act as barriers to mental health care utilization for perinatal depression. Although this is a persistent problem within the South African context, to date, little is known about the barriers to the utilization of available mental health services experienced among pregnant South African women. For this reason, the Perinatal Mental Health Project (PMHP) aims to provide mental health services at the same location where women receive obstetric services. However, despite their efforts, the number of women who decline available treatment is still of great concern. The present study offers a unique perspective on counselling for perinatal depression appointment-keeping barriers as it provides a holistic view of these barriers that exist not only within the women but also in their multi-levelled environments. Secondly, it addresses the problem of nonattendance to mental health care treatment offered by the PMHP and consequently also addresses the gap in South African research on the topic. The sample for this study was selected from PMHP files of those patients who failed to attend scheduled counselling appointments. The participants included in this study were selected by means of purposeful sampling to participate in face-to-face and telephonic semi-structured interviews. Participants were assured of confidentiality and anonymity. The semi-structured interviews were audio-recorded and transcribed after which transcriptions were entered into MS Word for textual analysis. Transcriptions were thematically analysed. The main themes that emerged from the present study included individual-related barriers, social-related barriers, institution-related barriers, community-related barriers and poverty-related barriers. The results of the present study reflect the motivations for depressive pregnant women to decline available and free mental health services provided by the PMHP, according to five main themes. These themes were then discussed according to Bronfenbrenner’s (1977; 1979) Ecological Systems Theory, which categorised the main themes identified according to the different systems operating within the patient’s environment, i.e. the individual-, micro-, meso-, exo-, and macrosystem. The individual system comprised the individual-related barriers, which included poor mental health, and ambivalent feelings toward the pregnancy. The microsystem comprised the social-related barriers, which included low social support and self-help strategies. Community-related barriers were considered within the mesosystem of the patient’s ecological environment, with stigma and pity as sub-barrier. The exosystem comprised the institution-related barriers, including referral protocol barriers, lack of information provided by the nurses, and nurses’ attitudes as experienced by participants. Lastly, poverty-related barriers were considered within the macrosystem, with financial life hardship, constant child-care demands, and transportation barriers as sub-barriers. The significance of this study lies in the original perspective offered on mental health care appointment-keeping behaviour within the South African context. Future research could, in addition to conducting interviews with hospital patients, include health care professionals and focus groups as this will allow for triangulation of the perspectives of all significant players. Also, having identified the problems and concerns with regards to attending counselling appointments, future research direction may be aimed at creating interventions designed to reduce the identified barriers to mental health care service use.
AFRIKAANSE OPSOMMING: Perinatale depressie (d.w.s. depressie voor en na swangerskap) bly ʼn onderwerp van voortdurende navorsings belang, aangesien ʼn breë navorsingsveld aandui dat ʼn groot proporsie van vroue wat aan hierdie geestesversteuring lei, nie die gepaste behandeling ontvang nie. Dit is kommerwekkend, eerstens, aangesien behandeling vir geestesgesondheid meestal openlik verkrygbaar is aan almal sonder enige koste. Tweedens, onbehandelde perinatale depressie hou nie slegs gevaarlike gevolge vir die moeder in nie, maar ook vir die baba en die res van die gesin. Dit is daarom belangrik om daardie faktore te identifiseer wat as hindernisse optree tot geestesgesondheid sorg diensgebruik vir perinatale depressie. Alhoewel dit ʼn voortdurende probleem binne die Suid-Afrikaanse konteks is, is daar tot op hede geen navorsing wat hindernisse tot gebruik van beskikbare geestesgesondheidsdienste bekend gemaak nie, veral wat ervaar word onder swanger Suid-Afrikaanse vroue nie. Vir hierdie rede, beoog die Perinatal Geestesgesondheid Projek (Perinatal Mental Health Project - PMHP) om geestesgesondheidsdienste te lewer by dieselfde plek waar vroue verloskundige dienste kan ontvang. Nietemin, ten spyte van hul pogings, is die getal vroue wat beskikbare behandeling van die hand wys steeds van groot kommer. Dié studie bied ʼn unieke perspektief op hindernisse tot berading vir perinatale depressie afspraak-ooreenkoms gedrag, aangesien dit ʼn algehele uitkyk bied op hindernisse wat nie slegs binne die vroue bestaan nie, maar ook in hul veelvlakkige omgewings bestaan. Tweedens, spreek dit die probleem van nie-bywoning van geestesgesondheidsbehandelingsdienste wat aangebied word deur die PMHP aan en gevolglik ook die gaping wat binne Suid-Afrikaanse navorsing rakende dié onderwerp bestaan. Die steekproef vir die studie was gekies van PMHP lêers van daardie pasiënte wat nie hul geskeduleerde terapie afsprake bygewoon het nie. Die deelnemers ingesluit in die studie is deur middel van doelgerigte-steekproefneming geselekteer om aan aangesig-tot-aangesig of telefoniese semi-gestruktureerde onderhoude deel te neem. Deelnemers is van hul vertroulikheid en anonimiteit van die proses verseker. Die semi-gestruktureerde onderhoude was oudio-opgeneem en transkripsies is daarvan gemaak, waarna die transkripsies in MS Word gelaai is vir tekstuele analise. Transkripsies is tematies geanaliseer. Die hooftemas wat na vore gekom het, sluit in individuele-verwante hindernisse, sosiale-verwante hindernisse, institusie-verwante hindernisse, gemeenskapsverwante hindernisse en armoede-verwante hindernisse. Resultate van dié studie reflekteer die motiverings van depressiewe swanger vroue om beskikbare en gratis geestesgesondheidsdienste wat verskaf is deur die PMHP van die hand te wys, volgens die vyf hooftemas. Hierdie temas is toe volgens Bronfenbrenner (1972) se Ekologiese Sisteemteorie verdeel in die verskillende sisteme teenwoording in die pasiënt se omgewing, naamlik die individuele-, mikro-, meso-, ekso-, en makrosisteem. Die individuele sisteem het die individuele-verwante hindernisse ingesluit, wat swak geestesgesondheid, en teenstrydige gevoelens teenoor die swangerskap omvat het. Die mikrosisteem het die sosiale-verwante hindernisse ingesluit, wat swak sosiale ondersteuning, en self-help strategieë omvat het. Gemeenskapsverwante hindernisse is binne die mesosisteem van die pasiënt se ekologiese omgewing beskou, en het stigma en jammerte as sub-hindernisse ingesluit. Die eksosisteem het die institusie-verwante hindernisse ingesluit, wat verwysing protokol hindernisse, gebrek aan inligting verskaf deur die verpleegsters, en verpleegsters se houdings soos ervaar deur die deelnemers omvat het. Laastens is die armoede-verwante hindernisse binne die makrosisteem beskou, en het finansiële lewens swaarkry, konstante kindersorg eise, en vervoer-verwante struikelblokke as sub-hindernisse ingesluit het. Die belang van dié studie lê in die oorspronklike perspektief van geestesgesondheidsbehandeling dienste afspraak-ooreenkoms gedrag binne die Suid-Afrikaanse konteks, wat aangebied is. Toekomstige navorsing kan, bykomend tot die voer van onderhoude met hospitaal pasiënte, fokus daarop om gesondheidsorg kenners en fokus groepe in te sluit, aangesien dit die triangulasie van perspektiewe moontlik maak van al die belangrike rolspelers. Ook, aangesien die probleem en bekommernisse rakende bywoning van terapie afsprake reeds geïdentifiseer is, mag toekomstige navorsing in die rigting beweeg met die doel om intervensies te omskep wat beoog om die geïdentifiseerde hindernisse tot geestesgesondheidsorg diensgebruik te verminder.

Thesis (M.A.)--Georgia State University, 2009.
Title from file title page. Wendy Simonds, committee chair; Elisabeth O. Burgess, Dawn M. Baunach, committee member. Description based on contents viewed Sept. 28, 2009. Includes bibliographical references (p. 71-76).

Purpose: This study was initiated to verify whether a remarkably high rate of postpartum depression (PPD), previously found in immigrant Hispanic women receiving health care at a community clinic, would also be found in a community sample with a similar demographic. Data Sources: Sixty immigrant Hispanic women who had recently given birth were recruited from local community settings. The Beck Postpartum Depression Screening Scale-Spanish version (PPDS-S) and the General Acculturation Index (GAI) were used to screen for PPD symptoms and to collect demographic data. These data were then compared with previously published data from the community clinic sample. Conclusions: Sixty percent of the immigrant Hispanic women in our community sample showed significant PPD symptoms as scored on the Beck PPDS-S. There was no significant difference found in demographics or in types of PPD symptoms between the clinic sample and the community sample. Of all the demographic data, the only statistically significant positive predictive factor for increased PPD symptoms was having a previous history of depression. In addition, 54% of the sample had an elevated symptom content profile score for suicidal thinking. Implications for Practice: Health practitioners should be aware of a potentially high rate of PPD in this population, especially in light of previously studied increased rates of suicide attempts in Latinas. If a prior history of depression is predictive of PPD, it is possible that many of the mothers in our sample suffered from depression prior to the postpartum period, but were not appropriately diagnosed or treated. Recommendations for outreach and further research are discussed. In particular, further research regarding the prenatal prevalence of depression in immigrant Hispanic women is recommended in order to further understand the high incidence of PPD.

A growing body of research has emerged about effective treatments for postpartum depression, specifically how the internet could become a pivotal and vital option for women with postpartum symptoms. With that in mind, the purpose of this quantitative study was to investigate whether women suffering from postpartum depression preferred traditional therapy treatment or internet therapy treatment. The nonexperimental survey design was used to assess differences between groups related to stigma, satisfaction with treatment, and perceived quality of treatment received. Data collected from a sample of 78 adult females, who had previously received postpartum depression therapy treatment, indicated there was no difference experienced between the treatment modalities. Results were calculated using an independent sample t-test, noninferiority design, and it was determined that participants perceived no difference in their experience of stigma, treatment satisfaction, and perception of credibility and quality between the two therapy modalities. This study adds to the growing body of literature that suggests internet therapy may be a viable option for some women. The results encourage positive social change in that psychologists may advance clinical practice through incorporating technology into their treatment plans, thereby benefiting women who suffer from this condition and who may not be able to readily access a therapist's office on a weekly basis.

An analysis was conducted to examine the prevalence and risk factors for depressive symptoms and the factors associated with accessing healthcare among 2 groups of immigrant postnatal Mexican women living in California less than 10 years. Using Andersen's Behavioral Model for Health Care Utilization, this study's findings are consistent with prior research. The demographic variables of the women who lived in the United States less than 5 years and women who lived in the United States less than 10 years did not differ. Recent immigrants were more likely to see the doctor more frequently or wait less time between visits. Over 90% of participants experienced limited English proficiency. The percentage of women experiencing depression symptoms was 12.6%. The fmdings underscore the need for social workers to assess the risk factors associated with postpartum depression and evaluate the predisposing, enabling and need factors of Mexican immigrant women associated with accessing care.

The overarching purpose of this collected papers dissertation was to explore the best practices used by Human Resource Development (HRD) professionals to help working mothers who are experiencing postpartum depression symptoms after maternity leave. The first paper in this dissertation was an integrative literature review. The second paper in this dissertation investigated whether participation in online support groups served to moderate the effect of postpartum depression symptoms on work impairment (measured in terms of absenteeism and presenteeism). Both studies were undergirded by the stress-buffering hypothesis, which posits that social support can moderate the effect of experiencing a stressful event. Study #2 also included the self-labeling theory, which explains how a person with mental illness seeks voluntary support. Study #1 reviews studies that examine how to support women experiencing postpartum depression symptoms in the workplace. No studies were found in HRD literature. The stress-buffering hypothesis held weight in informing HRD professionals to help women experiencing postpartum depression symptoms. The majority of the studies pointed to social support, especially from coworkers and supervisors, as having a positive effect on postpartum depression symptom scores. Study #2 explores the effect of participation in online support groups on the work impairment of women experiencing postpartum depression symptoms. This study surveyed working mothers with children under the age of one from online support groups. The survey consisted of three measures: The Edinburg Postnatal Depression Scale (Cox, Holden, & Sagovsky, 1987); the Work Productivity and Activity Impairment (WPAI; Reilly, Zbrozek, & Dukes, 1993); and the Online Social Support for Smoking Cessation survey (OS4; Graham, Papandonatos, Kang, Moreno, & Abrams, 2011). This study did not support the hypothesis that online support group participation would moderate the effect of postpartum depression symptoms on work impairment. Overall, the findings of these studies are entry points into the HRD literature about how working women who are experiencing postpartum depression symptoms can be supported by their employers. Further research is necessary to examine the type of social support that is effective at helping working mothers.

Background: : Few investigators have evaluated the association between early pregnancy social support and depression; however, increased social support may improve mental health during pregnancy. Our objective is to examine whether in early pregnancy there is an association between social support and maternal depression among women in Peru. Methods: : 2,062 pregnant women participated in structured interviews. Early pregnancy social support was measured using the Social Support Questionnaire (SSQ-6). We evaluated the number of individuals that participants could turn to in different situations (Social Support Number Score; SSQN) and their satisfaction with support received (Social Support Satisfaction Score; SSQS). Median SSQN and SSQS characterized participants according to high and low levels of support. SSQN family vs. non-family support were also evaluated separately. Antepartum depression was assessed using the Patient Health Questionnaire-9. Multivariable logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: : 39.6% of women reported high SSQN and 45.5% reported high SSQS. Approximately 25% had antepartum depression. Women with high SSQN had 22% lower odds of antepartum depression (OR = 0.78; 95%CI: 0.63–0.97). Similarly, women with high SSQS scores had 45% lower odds of antepartum depression (OR = 0.55; 95%CI: 0.45–0.68). Women with high SSQN non-family scores had 30% lower odds antepartum depression compared to those with low SSQN non-family scores (OR = 0.70; 95%CI: 0.57–0.86). The association between SSQN family scores and antepartum depression did not reach statistical significance. Conclusion: : Increased social support may improve maternal mental health during pregnancy and this association should be assessed in longitudinal studies.
This research was supported by awards from the National Institutes of Health ( NIH ), National Institute of Minority Health and Health Disparities ( T37-MD-001449 ) and Eunice Kennedy Shriver National Institute of Child Health and Human Development ( R01-HD-059835 ). The NIH had no further role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
Revisión por pares

Postpartum depression (PPD) is linked to diminished maternal, pediatric, and family health outcomes and is designated as the most common childbirth complication. PPD is an international public health concern and found in most populations. Studies suggest that American Indian/Alaska Native (AI/AN) women suffer higher PPD prevalence (14% to 29%) than other United States' women, revealing a racial/ethnic disparity. Health disparities research is a national public health priority and substantiates the need to explore PPD in AI/AN women. Clinicians define PPD as an episode of major depressive disorder with a "peripartum onset" specifier that occurs within the first year after delivery.

This dissertation work explored and synthesized PPD research about AI/AN women, where there remains considerable mystery surrounding the causes and consequences of PPD. Even with federal regulations in place requiring the inclusion of minorities and women and other underrepresented groups in research, AI/AN women have been mostly excluded, as evidenced by few studies and small sample compositions that include AI/AN women in PPD research.

Using a comparative analysis approach, validation studies of the EPDS and the PHQ-9 were examined. While possessing excellent concurrent validity, the low predictive accuracy of both tools in non-Western samples suggests cultural bias. No PPD screening instrument has been validated in samples of AI/AN women. Cross-cultural adaptation advances the science of comparative effectiveness research, and is therefore a logical next step. Using a phenomenological methodology with a community-based participatory approach, AI/AN women's "lived" PPD experiences were described. AI/AN women who experienced PPD now or in the past were interviewed using a semi-structured interview guide. De-identified demographic data were collected. Thematic analysis guided by Moustakas' (1994) procedure followed and seven major themes emerged.

This dissertation has advanced nursing science by providing an understanding of PPD in AI/AN women. Future research for AI/AN women with PPD should focus on: 1) their access to and use of PPD services; 2) the cross-cultural adaptation for PPD screening; 3) the possible relationship between PPD and intimate partner violence; 4) their preferences for PPD treatment; and 5) the possible relationship between PPD and acculturation.

Postpartum depression affects between 10 - 15% of all mothers within the first year after giving birth (Dietz, 2007; Epperson, 1999).  Studies that have focused on women\'s experiences of postpartum depression have found similar in experience of contrast between women\'s expectations of motherhood, and their actual experiences (Beck, 2002; Knudson-Martin & Silverstein, 2009; Mauthner, 1999).  Using a phenomenological approach, this study sought to explore women\'s experiences of contrast, understand how this experience contributed to their social construction of what motherhood meant, and ask if and how women might change the messages that they receive regarding being a mother.  
Seven women were recruited from a postpartum depression support group and interviewed in a focus-group setting.  Respondents noted that they experienced a great contrast between their expectations of motherhood and what they actually experienced.  These expectations, however, seemed ambiguous and generic.  Women reported that they were surprised by the amount of judgment and pressure they felt surrounding being a mother.  Participants seemed to challenge their preconceptions about being a mother by focusing on making choices that were best for them and their children and by allowing unhappy feelings to be compatible with their definition of a good mother.  Women in the study described wanting to hear messages that were honest and open about the realities of motherhood, both from the media and in their interactions with other women and loved ones.  Participants also seemed to feel strongly that more efforts should be made to reach out to new mothers.

Master of Science

Purpose: The purpose of this interpretive phenomenological study is to explore the lived experience of Haitian immigrant women living in Massachusetts with PPD. Specific Aims: Aim 1: To explore the lived experience of PPD among Haitian immigrant women. Aim 2: To explore how the experience of being Haitian influences Haitian immigrant women in their response to PPD. Framework: Leininger's Theory of Cultural Care (1988) guided the phenomenological approach and data collection. The Transcultural Care Decision & Action model contains three predictive modes for guiding nursing care judgments, decisions, or actions to provide care. Design: Interpretive phenomenology guided this qualitative study. Individual face-to-face interviews were conducted. The data from each interview were transcribed into a written document and analyzed using the Crist and Tanner five-step process. Results: This study yielded two themes; each theme has three dimensions. The first theme is “Feeling Disconnected” with three dimensions: (a) lack of support; (b) partner conflict; and, (c) nostalgia of Haiti. The second theme is “Feeling Reconnected” with three dimensions: (a) realization of needed help; (b) spirituality; and, (c) resilience. Conclusion: This study provides insight into the lived experience of Haitian women with PPD. Awareness of Haitian women’s actual experiences with PPD will help health care providers to identify and provide culturally appropriate care to this population.

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.

SAMMANFATTNING Bakgrund: Postpartumdepression (PPD) är en depression som uppkommer omkring fyra veckor efter förlossningen och drabbar cirka 10 - 15 % av kvinnorna. Det finns många olika faktorer som bidrar till att PPD utvecklas som t.ex. prenatal depression, premenstruella spänningar, ångest, instabilt partnerskap, låg inkomst, stressad livssituation, lågutbildade, arbetslöshet och brist på socialt stöd. Syfte: Syftet med denna studie var att utforska kvinnors upplevelser av att ha drabbats av postpartumdepression. Metod: En litteraturstudie av tio kvalitativa studier som granskat kvinnors upplevelser av postpartumdepression genomfördes. Resultaten har sammanställts efter att studierna kvalitetsgranskats och analyserats. Samtliga artiklar hade kvalitativ ansats och söktes i databaserna PubMed och PsychINFO. Som teoretisk referensram användes Joyce Travelbees omvårdnadsteori. Resultat: Tre övergripande kategorier av kvinnors upplevelser framkom vid granskningen av artiklarnas resultat: Upplevelser av förändringar, Upplevelser av stigmatisering och Upplevelser av återhämtning. Kvinnors berättelser beskriver deras individuella känslor och förväntningar över att bli föräldrar och när verkligheten inte stämmer överens med förväntningarna uppstår känslor som skuld och skam. Det finns en stigmatisering runt PPD som är svår för kvinnor att komma över. De upplever att det är svårt att söka vård för psykiatrisk sjukdom och det finns en rädsla och oro över att uppfattas som en dålig förälder. Omgivningen och partnern spelar en stor roll när det kommer till att identifiera symtomen och att ta första steget mot tillfrisknande genom att de har möjligheten att uppmärksamma och uppmuntra kvinnor till att söka hjälp och får det stöd som är nödvändigt. Slutsats: PPD upplevs av många kvinnor som ett stigma. Kvinnor kan uppleva sig misslyckade och känna skam och skuld när tiden efter förlossningen inte blev som de förväntat sig. Att uppmärksamma dessa kvinnor i ett tidigt stadie är en av sjuksköterskans många ansvarsområden. För att kunna göra det krävs det att sjuksköterskan har en förståelse för och kunskap om PPD.
ABSTRACT  Background: Postpartumdepression (PPD) is a mental disorder that occurs in about four weeks after delivery and affects approximately 10 - 15% of the new mothers. There are many different factors that contribute to develop PPD such as prenatal depression, premenstrual tension, anxiety, unstable partnerships, low income, stressful life situation, unskilled, unemployment and lack of social support. Aim: The aim of this study was to explore women's experiences of having suffered from postpartumdepression. Method: A literature review was conducted on ten qualitative studies that examined women's experiences of postpartumdepression. The results were compiled after the studies had been qualityreviewed and analyzed. All reviewed articles had a qualitative approach and was searched in the databases PubMed and PsychINFO. Joyce Travelbee's nursing theory was used as a theoretical framework. Results: Three categories of women’s experiences emerged after analysis: Experiences of changes, Experiences of stigma and Experiences of recovery. The women's stories describe individual feelings and expectations related to becoming a parent, and when reality does not match expectations feelings of guilt and shame arise. There is a stigma associated with the PPD that is difficult for women to handle. They may experience difficulties to seek treatment for mental illness and there is a fear and concern about being perceived as an insufficient parent. The environment and the partner plays an important role when it comes to identifying the symptoms and to take the first step toward recovery by having the ability to recognize and encourage women to seek help and get necessary support. Conclusion: PPD is experienced by many women as a stigma. Women see themselves as failures and feel shame and guilt when the time after childbirth did not turn out as expected. Paying attention to these women at an early stage is a nursing responsibility. To do so requires that nurses have an understanding and knowledge of PPD.

Thesis (M.A.)--Georgia State University, 2007.
Title from file title page. Wendy Simonds, committee chair; Ralph LaRossa, Phil Davis, committee members. Electronic text (101 p. : col. ill.) : digital, PDF file. Description based on contents viewed Nov. 5, 2007. Includes bibliographical references.

Background Postnatal depression (PND) has become a world-wide public health problem. Maternal Child Health Centers (MCHCs) provide maternal and child healthcare with community-based Comprehensive Child Development Services (CCDS) aimed for early identification for provision of appropriate referral for intervention. There were 13.8% suspected PND cases in 2011(Department of Health PND Report, 2011). Antenatal Interpersonal Psychotherapy (IPT) has found efficacious for high depression risk (HDR) pregnant women. Evidence-based practice (EBP) antenatal IPT guideline best suited for MCHCs implementation. Purpose This dissertation intends to develop an effective EBP antenatal IPT guideline for HDR pregnant women, and to offer plans for implementation and evaluation. Methods Six electronic databases searched for updated relevant studies. Randomized controlled trails (RCTs) with antenatal IPT intervention for HDR pregnant women targeted. Evidence data related to EBP guideline development were extracted for critical appraisal. Program implementation potentials assessed for transferability, feasibility and cost-benefit ratio. Guideline with level of evidence and recommendation grading developed. Communication plan for different stakeholders and potential users were developed. Pilot test planned for process evaluation. Impact evaluation, outcome evaluation and economic evaluation planned to verify empirical evidences to initial changes in MCHCs. Results Eight RCTs studies, which compare group receiving antenatal IPT intervention with routine antenatal education group, were reviewed. Target population was HDR pregnant women. Antenatal IPT intervention found effective for HDR pregnant women with PND. The studies suggest antenatal IPT intervention give0.89 reductions in EPDS, improved psychological well-being, 0.77 reductions in GHQ and improved role competence2.43 increases in PSOC-E. After critical appraisal of reviewed studies, antenatal IPT guideline developed. Pregnant women should be screened between 20 to 32 gestation weeks. Those with EPDS≥13 scores should enrolled into two 2-hour antenatal IPT program educated by trained nurse educators in class size ≤10. Those refusing to join the program receive routine education. Three-point measurements of EPDS, GHQ and PSOC-E at baseline, postnatal 6 to 8 weeks and 3 to 6 months of both groups are conducted. Postnatal EPDS ≥13 participants referred for psychiatric services upon their consent. Program will propose implementation in MCHCs. Steering Committee is established and communicates with various stakeholders. Pilot test implement in one MCHC and reviewed for clinical applicability, feasibility and to obtain process evaluation for quality improvement. Program should have quasi-experimental non- equivalent pretest-posttest control group and analyze data with ‘two-sample t-test’, ‘paired t-tests’ and ‘chi-square test’. Target achievement should be: i. Primary outcomes: EPDS score reduced to0.89, GHQ reduced to0.77 and PSOC-E score increased to2.43; ii. Secondary outcomes: Reduction of PND incidence and PND management caseloads by 20%. Participants’ gestation ages, program attendance and satisfactory rates recorded. Economic evaluation indicates for every $1invested, the return is $8.45, program is a sound investment suggested. Conclusions Eight RCT studies provide evidence that antenatal IPT program is effective for HDR pregnant women in reducing PND, and in promoting higher maternal role efficacy level and psychological well-being. Implementation of this EBP program guideline can potentially help PND prevention and ease antenatal depression management of HDR pregnant women in MCHCs.
published_or_final_version
Nursing Studies
Master
Master of Nursing

Postpartum depression (PPD) is internationally recognized as one of the most prevalent and severe but neglected maternal mental health complications of childbirth. Previous studies have indicated that there is a high burden of disease associated with PPD in both developed and developing countries. However, there remain gaps in the current literature regarding the recognition and management of PPD in remote parts of the developing world. Therefore, the purpose of this study was to understand the perceptions, attitudes, and beliefs of health professionals towards PPD and examine the factors that either facilitated or hindered its recognition and management in a remote setting in Nigeria. The pen-3 cultural model was the conceptual framework used in this study. The study focused specifically on professionals with regard to the recognition and management of PPD in a rural hospital in Nigeria. Ten semi structured qualitative interviews were conducted with doctors and nurses from a rural hospital in Nigeria. Data were analyzed via phenomenological interpretative analysis. Results from the study revealed that health professionals in a remote setting in Nigeria have a working knowledge of PPD and perceived the condition as a serious public health concern, but were faced with numerous barriers from the institutional, organizational, and community level that hindered their ability to recognize and manage PPD in a timely manner. These results make an important contribution to the existing literature and can enhance social change initiatives through the enhancement of awareness of PPD, and the need for improvement of policies on comprehensive maternal mental health in remote parts of Nigeria.

Background: Postnatal depression (PND) is one of the most common maternal mental health problems for women worldwide. Yet the wide range of reported rates of PND in different countries raises questions about how PND is experienced by women in different cultures and whether interventions developed in western cultures are appropriate in very different settings. It is important to establish how PND is defined, experienced and managed in different cultures in order to create culturally relevant interventions. No previous studies of experience of PND and its management have been conducted in Malaysia. The aim of this study was to explore women’s experiences and healthcare practitioners’ (HCPs) perspectives of PND in a multicultural country, Malaysia. Methods: This was a qualitative study informed by a critical realist approach. Semi-structured interviews were carried out with 33 women (from three different cultural backgrounds) attending for child or postnatal care and 18 HCPs in six purposively selected maternal and child health (MCH) clinics and a female psychiatric ward in Kuala Lumpur, Malaysia. Data were analysed using framework analysis. Findings: There were some differences in the women’s perceptions of PND experience across three different cultural backgrounds in Malaysia. Malay women were more likely to describe the symptoms of PND based on a combination of emotional and behavioural changes, whereas Chinese and Indian women talked more about emotional changes. Traditional postnatal practices were described as contributing to PND by some Malay women but were accepted as promoting maternal and infant well-being by the majority of Indian women. Religious activities were reported as an effective strategy for the Malay women but were not seen as helpful by the majority of Chinese women. Considering HCPs, it appeared that the absence of a clear and specific policy and guideline in the management of PND within the Malaysian healthcare system has resulted in a lack of professional ownership in the management of PND, especially among HCPs in MCH clinics. Conclusion: The women and the HCPs had distinct ways of conceptualising PND experiences, although they agreed on several symptoms and causal explanations. This study calls for a system-based enhanced PND care with an initiation of culturally appropriate care for PND within the healthcare system.

The association between pain and depression is well documented across various populations, but not in puerperal women. This study examined the association of childbirth pain with postpartum depression (PPD) in a nationally representative sample of Canadian women. Data from the Canadian Maternity Experiences Survey (n=6421) was used. Multivariate logistic regressions and partial proportional odds models were fitted and included socio-demographic, obstetric, health, psychological, and psychosocial factors. Chronic pain sufferers at mean 7.3 months postpartum had adjusted odds of PPD of 2.4 (95% CI: 1.6, 3.6) compared to women without pain. Adjusted odds of PPD increased with the number of areas of chronic pain, reaching 4.2 (95% C.I.: 0.7, 25.0) for 3 or more areas. Immigration, obesity, cesarean section and social support increased the strength of the association while smoking and the use of pain relief were protective effect modifiers. Persistent postpartum pain is a major risk factor for PPD.

Thesis (PhD)--University of Stellenbosch, 2011.
ENGLISH ABSTRACT: Pregnancy is a vulnerable time in settings such as sub-Saharan Africa, and is associated with exposure to a multitude of physiological, social and psychological risks. High HIV prevalence, and the fact that many women will test for HIV for the first time during their pregnancy, has raised concern about women‘s psychological health during pregnancy. Depression during the antenatal period is of public health concern as it has been shown to be associated with poorer foetal and delivery outcomes, risky behaviours, and poorer uptake of antenatal care. Antenatal depression is a predictor of postnatal depression, and postnatal depression has been associated with poor maternal sensitivity and attachment in mothers which is known to result in increased behavioural and developmental difficulties in children. The aim of this research was to provide a clear, in depth and culturally sensitive understanding of the manifestation of depression in pregnant women in a rural area with high HIV prevalence in South Africa. The research method included a diagnostic assessment of depression in 109 women in their third trimester of pregnancy, and an in-depth qualitative examination of the contextual framework within which HIV testing and depression are experienced with a sub-sample of 56 women. The quantitative results demonstrated that the prevalence of antenatal depression was high (46.7%), with close to half of the women being diagnosed with depression. Presentations of depression most frequently included disturbances in mood, loss of interest and suicide ideation. Symptoms which overlap with common side effects of pregnancy such as loss of energy and weight change did not result in an overestimation of depression. Likewise, very little evidence of the somatisation of depression, or particular cultural barriers to the diagnosis of depression based on DSM-IV criteria was found. Rates of suicide ideation were high and equally common among HIV positive as HIV negative women. Factors significantly associated with depression included living within a family homestead, access to a regular source of income and practical support from a partner. Both income and partner support had a negative association with depression. Living away from a family or parental home had a positive association with depression. The results showed that the Edinburgh Postnatal Depression Scale (EPDS) was effective in identifying depression and that a shorter three item version was as effective as longer versions. A positive score for depressed mood on the EPDS was significantly associated with HIV, suggesting that the EPDS is a good screening tool for elevated psychological risks among HIV positive women post HIV testing. Qualitative results showed that having an unsupportive partner and the occurrence of relationship or familial conflict played an important role in the development of emotional distress during pregnancy and resulted in a high number of unwanted pregnancies. Partner and familial conflict was intertwined with cultural practices which govern the acceptability of childbearing among unmarried women and the social recognition of partnerships and paternal responsibilities. Testing for HIV was considered a stressful life event for all women regardless of their HIV status and was a particularly negative life event for women who tested HIV positive or for women who had concerns over partner infidelity. Disclosure among HIV positive women frequently lead to increased partnership conflict. Qualitative findings suggested that depression and emotional distress after HIV testing did interfere with women‘s ability to engage with prevention messages. Women who were coping well with learning their HIV positive status had high levels of family disclosure and subsequent family support in common. The implication of this research is that it is important that public health programmes screen for depression among childbearing women. These data suggests that a shorter three item version of the EPDS along with screening for partner and family support or conflict would effectively detect most women at high risk for depression. Likewise, public health interventions for women with depression which are implemented in primary health care facilities and in isolation of the partnership and familial context within which depression occurs are not likely to be effective. Further research is needed to establish the precise prevalence of antenatal and postnatal depression in women at high risk for HIV; to validate the effectiveness of a shorter screening tool in resource limited settings; and to establish risk and protective factors, and trimester specific risks which could inform the design of cost effective interventions in poorly resourced settings.
AFRIKAANSE OPSOMMING: Swangerskap in Afrika, suid van die Sahara, is ʼn kwesbare tydperk met blootstelling aan ʼn menigte fisiologiese, sosiale en sielkundige risiko‘s. Die hoë voorkoms van HIV en die feit dat baie vrouens gedurende swangerskap vir die eerste keer vir HIV wil toets, het ‗n besorgdheid oor vrouens se sielkundige gesondheid gedurende swangerskap laat ontstaan. Depressie gedurende die voorgeboortelike periode is van belang vir publieke gesondheid, want daar is bewyse wat dui op ‗n verband tussen depressie en swakker fetale en geboorte resultate, riskante gedrag en verminderde gebruik van voorgeboortelike sorg . Voorgeboortelike depressie is ʼn indikasie van moontlike nageboortelike depressie en nageboortelike depressie word geassosieer met swak moederlike sensitiwiteit en die gebrekkige vorming van ‗n band tussen moeder en kind; wat reeds bewys is om te lei tot verhoogde gedrags- en ontwikkelingsprobleme in kinders. Die doel van hierdie navorsing was om ʼn duidelike, indiepte en kulturele-sensitiewe begrip van die manifestasie van depressie in swanger vroue in ʼn landelike omgewing met hoë HIV voorkoms in Suid Afrika te verkry. Die navorsingsmetode sluit in ʼn simptomatiese beraming van depressie by 109 vroue in hul derde trimester van swangerskap en ʼn indiepte kwalitatiewe ondersoek na die kontekstuele raamwerk waarbinne HIV toetse en depressie ondervind word met ʼn sub-steekproef van 56 vrouens. Die bevinding was dat die voorkoms van voorgeboortelike depressie hoog was, 46.7 %, met feitlik die helfte van die vrouens wat met depressie gediagnoseer is. In die meeste gevalle het die voorkoms van depressie gepaard gegaan met ʼn verandering in gemoedstoestand, ʼn verlies aan belangstelling en selfmoordgedagtes. Simptome wat ooreenstem met algemene newe-effekte van swangerskap, soos verlies aan energie en verandering in gewig, het nie bygedra tot ʼn oorberekening van depressie nie. Soortgelyk is baie min bewyse gevind dat somatosasie van depressie, of spesifieke kulturele grense, tot die diagnose van depressie gebaseer op DSM-IVkriteria bydra. Die oorweging van selfmoord was hoog en algemeen tussen beide HIV-positiewe en HIV-negatiewe vouens. Faktore wat aansienlik met depressie geassosieer word, sluit in om in ʼn familiegroep te bly, toegang tot ʼn vaste bron van inkomste en die praktiese ondersteuning van ʼn lewensmaat. Beide inkomste en die ondersteuning van ʼn lewensmaat het ʼn negatiewe verbintenis met depressive. Om nie by familie of in ʼn ouerhuis te bly nie het ʼn positiewe assosiasie met depressive. Alhoewel HIV-status verband hou met depressie, was dit nie uitermate die geval nie, alhoewel daar ʼn gebrek aan statistiese kragdoeltreffendheid was om die effek van HIV vas te stel, gegee die beperkte grootte van die steekproef. Die resultate het getoon dat die EPDS graderingsinstrument effektief was om depressie te identifiseer en dat ʼn korter driepunt weergawe daarvan net so effektief was soos die langer weergawe. ʼn Positiewe telling vir ʼn depressiewe gemoedstoestand op die EPDS het ʼn betekenisvolle assosiasie met HIV en dui daarop dat die EPDS ʼn goeie graderingsinstrument is vir verhoogde sielkundige risiko by HIV-positiewe vrouens, selfs al is HIV-positiewe vrouens in dié steekproef statistieksgewys nie meer geneig tot depressie as HIV-negatiewe vrouens nie. Kwalitatiewe resultate toon dat ʼn lewensmaat wat nie ondersteunend is nie en die voorkoms van verhoudings- of familiekonflik ʼn belangrike rol speel in die ontwikkeling van emosionele angs gedurende swangerskap en dit het gelei tot ʼn groot aantal ongewenste swangerskappe. Konflik met ʼn lewensmaat en met familie was verweefd met kulturele gebruike wat die aanvaarbaarheid van geboortes onder ongetroude vrouens beheer en die sosiale erkenning van verhoudings en die vader se verantwoordelikhede. ʼn HIV-toets is as ʼn stresvolle lewensgebeurtenis beskou deur alle vroue, ongeag van hulle HIV-status en was ʼn besondere negatiewe lewensgebeurtenis vir vroue wat HIV-positief getoets het of vir vroue wat bekommerd was oor hulle lewensmaats se getrouheid. Onthulling van die HIV-status van positiewe vrouens het gereeld tot verhoogde konflik in verhoudings gelei. Kwalitatiewe bevindings dui daarop dat depressie en emosionele angs na ʼn HIV-toets inmeng met ʼn vrou se vermoë om ag te slaan op voorkomingsboodskappe. Vroue wat die kennis van hulle HIV-positiewe status goed hanteer het, het hoë vlakke van bekendmaking van hulle status en die ondersteuning van hulle familie in gemeen. Die implikasie van die navorsing is dat dit belangrik is vir publieke gesondheidsorgprogramme om te toets vir depressie onder swanger vroue. Die resultate dui daarop dat ʼn korter driepunt weergawe van die EPDS, saam met ʼn ondersoek na die ondersteuning van of konflik met ʼn lewensmaat en familie, effektief kan wees om vroue met ʼn hoë risiko vir depressie te identifiseer. Soortgelyk, publieke gesondheidsingryping in primêre gesondheidsorg fasiliteite vir vroue met depressie wat in isolasie van die lewensmaat en familie konteks, waar depressie voorkom geadministreer word, is onwaarskynlik om te slaag. Bevindings onderskryf die belangrikheid van ondersteuning vir die familie om effektief te kan reageer en herstel van stresvolle faktore soos onbeplande swangerskappe en HIV-diagnose, in ʼn konteks wat swaar deur HIV geaffekteer word, aangesien dit ʼn voorkomende effek op depressie kan hê. Verdere navorsing is nodig om die presiese voorkoms van voorgeboortelike en nageboortelike depressie in vrouens met ʼn hoë blootstelling aan HIV vas te stel; om die sukses van ʼn korter graderingsinstrument in arm omgewings te staaf; en om die risiko en beskermende faktore vas te stel en trimester spesifieke risiko‘s wat die ontwerp van ʼn koste-effektiewe ingryping in gebiede met ontoereikende hulpbronne kan beïnvloed.

This thesis is an ethnography of the postnatal experiences of South Asian migrant women in Perth, Western Australia. I examine cultural differences relating to mothering and argue that the South Asian culture in which these migrant women were socialized can impact greatly on how they experience the feelings of what is called “postnatal depression” in the Western medical arena. I carried out ethnographic research among the members of the Bangladeshi and Indian communities in Perth. The main focus group of this study is first time mothers who gave birth in Australia, but I also worked with other women who had grown up children. Due to migration the South Asian women and their families experienced social isolation, cultural differences, language difficulties, economic hardship and low job satisfaction. Moreover, when these women gave birth in Perth they were faced with a lack of physical and emotional support, and also distress at not being able to perform their traditional birth rituals. Their difficult situations led the women to cry, feel despondent, to suffer and to experience a sense of hopelessness. Their painful postnatal feelings can be defined as an illness - depression - by the Western medicine. However, I found these women did not perceive their negative postnatal feelings as an illness, but accepted them as a part of life. I analysed these women’s postnatal psychological understandings about “postnatal depression” by examining the South Asian convention of female virtue which is practiced through restrictions on female behaviour. The migrant women in my study, having internalizing the South Asian cultural schema of womanhood, articulate their negative postnatal feelings as a prerequisite of motherhood. In this thesis I argue that feelings are not the totality of experience, rather, experience is also formulated by the particular sociocultural perspective of the individual who is having the experience. The culture a person belongs to, defines how that person will experience his or her feelings. I also suggest that it is possible to modify dysphoric affect by altering the meaning of feelings