Depression in Postnatal Women - Coursework Example

Depression in Postnatal Women Student Name: Student Number: HSNS 205: Introduction to Mental Health Nursing Lecturer: Length: 2501 Introduction Depression is a mood state that causes a constant feeling of sadness and lack of interest. Postnatal depression in women is a common mood disorder associated with childbirth and affects 12-15% of all childbearing women in Australia (Edward et al., 2011). The signs of depression set in during the first few weeks after childbirth. When postnatal depression goes untreated, it may last for months or even years. Early identification of postnatal depression, evaluation of the contribution of risk factors to postnatal depression, timely treatment and use of cost-effective prevention programs with universal strategies that target childbearing women may help lower incidences of postnatal depression in Australia (Chojenta et al., 2012). This paper presents a discussion of depression in postnatal women and argues that women who have or are vulnerable to postnatal depression can be identified and assisted to mitigate the problems associated with this disorder. Furthermore, the paper applies previous studies on the identification and management of depression in postnatal women. Incidence and prevalence of PND In Australia, the incidence of postnatal depression has been studied and reported since 1858. Satisfactory prospective research has been published that applies comparable and well-authenticated psychometric rating scales (Perese, 2012, p. 5). The literature documenting the causes, incidence, prevalence, effects and management of postnatal depression is reviewed in this research to explain the opportunities and challenges presented to healthcare providers by this disorder. Recent research on depression in postnatal women has claimed that postnatal depression is normally present between the period of baby blues and puerperal psychosis. Postnatal depression affects 12-15% of all childbearing women in Australia, the signs setting in during the first few weeks after childbirth. According to Usher et al. (2008), depression is detectable in the mothers when the baby is between four and six months old. Research has shown that the earlier depression in postnatal women is identified, diagnosed and treated, the quicker the new mother recovers. In Australia, depression in postnatal women normally affects one in every ten new mothers, beginning as baby blues and gradually developing into a medical condition (Horwitz et al., 2009). On average, 40-70% of postnatal depression occurs within the first three months following childbirth; however, postnatal depression may persist for many months, with estimates that 25-60% of cases remit within three to six months and a further 15-25% of cases remitting within one year (Horwitz et al., 2009). A small proportion of cases of postnatal depression continue for more than one year. Pathophysiology of PND As mentioned in the introduction, PND is a complex disorder and if left unattended, can act as a platform for future mental health conditions. This is because the disease is a combination of biological, social and psychological factors (Westall & Liamputtong, 2011). The disorder manifests via a number of symptoms, including difficulty sleeping, changes in appetite, sadness, difficulty coping, irritability, anxiety, negative thoughts, fear of being alone, loss of memory or confusion, feelings of guilt, loss of self-esteem and self injury, among others. It is generally accepted that these symptoms can set in anytime during the first year after childbirth. PND has many symptoms; however, a large number of individuals with the disorder remain unattended due to the similarity of symptoms with those commonly experienced after childbirth. Childbirth is a physically and emotionally challenging experience, and sleep deprivation, sheer exhaustion, hormonal changes and changes in roles and responsibilities are naturally experienced by all mothers (Mazza, 2011). For this reason, many women suffer decreased libido, lethargy and irritability without necessarily suffering from PND. The disorder thus easily remains undetected as in addition to the above, feelings of guilt, which are a symptom of PND, prevent mothers from seeking help. In addition to the mothers, PND affects close relations of the mother, including spouse, family and friends (Nicolson, 2001). Studies have indicated that male partners of women suffering from PND often develop depression (Westall & Liamputtong, 2011). Due to cultural influence, men are less likely to succumb to grief and sadness in public; for this reason, the incidence of male depression related to PND is largely unreported. This is a point of concern as it has been observed that one of the main causes of suicide among men is unattended depression (Westall & Liamputtong, 2011). Prenatal and Postnatal Treatment Strategies for PND PND is an umbrella term that covers a number of common postpartum disorders beginning after childbirth and persisting for as long as 14 months after the onset. Some of these disorders common in PND are anxiety, feeling of sadness, fatigue , reduced libido experiencing changes in sleeping patterns, loss of appetite and irritability. PND’s manifestation is very similar to the normal complications that follow childbirth; for this reason, it can quite easily remain undetected. In light of this problem, practitioners have developed a variety of tools that can be used to identify incidence of the disease and initiate necessary action. The two approaches commonly used include screening using designed measurement instruments and clinical evaluation. In many cases, appropriate screening tools consist of a set of questions reflective of postpartum depressive symptoms. The respondents complete the screening tool by providing a suitable rating, e.g. 0-3, indicating the degree to which they are affected by the specific symptom. The lower number (0) represents the lowest frequency and the highest number represents the highest frequency (3). An example of a PND screening tool is the Edinburgh Postnatal Depression Scale (EPDS) (Murray et al., 2010). Another method for diagnosing PND is to perform a comprehensive clinical examination. It is recommended that this evaluation take place around six weeks after delivery (Murray et al., 2010). The examination typically involves exploration of symptoms and their impact on the woman in relation to her personality and circumstances. It is also important to investigate the woman’s relationship with her partner, baby and other children in order to establish the amount of support she has available. In addition, the practitioner will review the events of the pregnancy and delivery, feeding habits and any physical challenges. The diagnosis of PND using this approach is not difficult; however, in practice the method is often unused as women experiencing symptoms already feel shame and are less likely to seek help. This position is supported by the findings of a study that compared response to clinical evaluation and screening; though both tools were effective at diagnosing PND, the screening tool was more successful as it was easily administered and completed and led to greater help-seeking behavior due to knowledge of risk factors (Usher et al., 2009). Diagnosis of PND While the previous section indicates that screening tools like EPDS and a comprehensive mental examination are the primary methods for diagnosing PND, it should be noted that the EPDS alone cannot replace the validity of mental examinations (Usher et al., 2009). However, given its success in the evaluation of PND and its ease of administration, EPDS remains a valid and useful tool for diagnosing PND. For this reason, this section will provide evidence in support of the selection of EPDS for preliminary evaluation and stipulate guidelines for its use. Among the criteria cited by medical personnel for its use in diagnosis is the fact that EPDS can provide a sample of the criteria used to evaluate PND and create a useful reference point (medical health officers require a repository of valid mental health data to aid in effective diagnosis and treatment). The EPDS is useful in determining the percentages of women with low mood, investigating correlates of low mood and first-stage screening to propose clinical intervention (Hussain, 2010). Another valid criterion used by medical officers in support of this evaluation tool is the ease of administration. It has already been established that many postnatal mothers skip clinical examinations owing to fatigue, pregnancy-related complications or feelings of shame typical of sufferers of PND. For this reason, a home-administered EPDS screening is a better approach to ensure that all suffering mothers are identified and referred to relevant medical facilities for further examination and intervention. In addition to the above criteria in support of EPDS for diagnosis, it should be noted that the tool is best used during postnatal checkups at about six weeks (Usher et al., 2009). This allows for early detection and intervention as clinical examination often takes places almost 12 weeks after delivery. The tools should be administered by trained medical health officers and respondents should be allocated a peaceful place to complete the test without pressure. In cases where mothers have to resume work early, the test may be posted with an explanatory note or administered during a home visit by a health officer. The above criteria and tools are well suited for appropriate diagnosis and intervention of PND cases (Usher et al., 2009). Treatment Due to the implications of childbirth, women are at an increasingly high risk of developing a major depressive disorder during their childbearing years (Usher et al., 2009). The treatment of any major depressive disorder (MDD) presents significant challenges during pregnancy as drugs are often absorbed by the placenta and then transferred to the developing foetus. According to Fitelson et al., (2011), a study of structural and developmental results of children of mothers suffering MDD exposed to SSRIs during pregnancy found that selective serotonin reuptake inhibitors (SSRIs), and other antidepressants, showed that the risk to the foetus was found to be minimal.The study included a sample of children exposed to SSRIs in utero and a sample not exposed to SSRIs in utero. The study carried out postnatal neuro-developmental analysis on the children from the age of three and a half years to six years. The results of this investigation established that children exposed to SSRIs in utero did not indicate any significant neuro-developmental variations compared to those not exposed to such MDD medication during gestation (Fitelson et al., 2011). However, immediately after childbirth (1-5 min), those exposed to medication such as SSRIs for treatment of MDD had slightly lower heart rate and breathing rate after the neuro development analysis. It should be noted that the neuro-developmental analysis performed was comprehensive and included monitoring of attention arousal, orientation, emotional regulation, motor quality and several other motor quality factors. Similar findings have been reported in relation to antidepressant drugs used for treatment of PND in newly-delivered mothers.The study revealed that upon acquiring information on the relative safety of breast milk while using antidepressants, the majority of participants found it acceptable to continue use of antidepressants while breastfeeding (Fitelson et al., 2011). However, it should be noted that many participants still preferred psychotherapy as the safest treatment for PND. Supportive Care Options for PND Depression in postnatal women has long-term consequences for their partners, infants and other children. Recent studies have confirmed that there exists a defined relationship between postnatal depression and marital relationship; the infant’s cognitive and emotional development and the partner’s level of depression (Christopher & Benjamin, 2013). This is caused by the added responsibilities, consequences in relationships, personal disruption and other material circumstances. Family members, communities and health professionals should assist in determining difficult marital and parenting adjustments in the early postnatal period and the symptoms of postnatal depression (Hussain, 2010). Offering professional help, such as informational materials, would also reduce postnatal depression among childbearing women. Postnatal depression can be reduced by conducting postnatal depression evaluations. This can be achieved via a two-stage process whereby women with high scores on self-report measures are subsequently reviewed with standardised diagnostic interviews, general depression inventories, general health questionnaires and the EPDS. The treatment of postnatal depression is a multifactorial process that addresses both psychological and biological factors; these involve individual and group treatment and biological interventions, such as hormonal treatments, antidepressants and electroconvulsive therapy (Christopher & Benjamin, 2013). Research Question Do women know enough about PND before they have babies? Can we increase our education efforts so that they are more empowered to identify the warning signs themselves? Further Research There are core gaps within the management literature on postnatal depression in women - a lot of the information provided remains unclear as no single mechanism exists by which females develop postpartum depression. Hence, it is greatly implausible that a particular modality of treatment will be effective for every woman. Clatworthy (2012) argued that a multifactorial treatment approach incorporating the contributions of biological and psychological factors would be very beneficial due to its ability to address the compound origins of the symptoms of postnatal depression. Further research is required to identify definite interventions that decrease the incidence of depression linked to childbirth and to suggest adaptable, practical and cost-effective approaches. Through enhancement of collaborative measures, primary care and mental health teams can develop particular skills and training to improve the recognition of psychological morbidity in the course of the first postpartum year and precise prediction practices to assess risk among their client populace (Usher et al., 2008). When there is evidence of effective preventive measures, these should be endorsed and receive proper support from the family, health sector and government. Additionally, preventive measures will need support from broad specialist mental health services comprising completely resourced multidisciplinary members with connections to community-based and primary care services. Conclusion This paper has discussed depression in postnatal women within Australia and has highlighted that women who have postnatal depression appear to experience more than just regular postnatal tiredness and tension. Therefore, both health practitioners and the population need to be more conscious of women in the pre- and postnatal period. Since postpartum depression has a compound origin, no particular intervention is guaranteed to succeed; hence, a combination of both biological and psychological interventions is required. Lack of self-reporting and non-compliance with management and intervention are thought to be major obstacles to achieving effective care in cases of postnatal depression. Mothers who receive organised care during the antenatal phase are likely to identify as at risk for postnatal depression; as a result, proper management can be planned for these women. Additionally, the inability of health professionals to detect PND has further worsened this condition since it makes women with prenatal depression hesitant to seek a medical approach for fear of victimisation and stigma. More research should be done to come up with better assessment tools, preventive strategies and supportive measures that are effective in treating PND in Australia. References Austin, M.P., Frilingos, M., Lumley, J., Hadzi-Pavlovic, D., Roncolato, W., Acland, S., Saint, K., & Parker, G. (2008). Brief antenatal cognitive behaviour therapy group intervention for the prevention of postnatal depression and anxiety: A randomised controlled trial. Journal of Affective Disorders, 105, 1-3. Chojenta, C., Loxton, D., & Lucke, J. (2012). How do previous mental health, social support, and stressful life events contribute to postnatal depression in a representative sample of Australian women? Journal of Midwifery & Women's Health, 57(2), 145. Clatworthy, J. (2012). The effectiveness of antenatal interventions to prevent postnatal depression in high-risk women. Journal of Affective Disorders, 137, 25-34. Dennis, C.L., Hodnett, E., Kenton, L., Weston, J., Zupancic, J., Stewart, D.E., & Kiss, A. (2009). Effect of peer support on prevention of postnatal depression among high risk women: Multisite randomised controlled trial. British Medical Journal (Clinical Research Edition), 338(7689), 280-284. Edward, K.L., Munro, I., Robbins, A., & Welch, A. (2011). Mental health nursing: Dimensions of praxis. New York: Oxford University Press Australia. Fitelson, E., Kim, S., Backer, A.S., & Leight, K. (2011). Treatment of postpartum depression: Clinical, psychological and pharmacological options. International Journal of Women’s Health, 3, 1-14. doi:10.2147/IJWH.S6938. Hanington L., Heron, J., Stein, A., & Ramchandi, P. (2011). Parental depression and child outcomes: Is marital conflict the missing link? Oxford: Oxford University Press. Horwitz, S., Bell, J., & Grusky, R. (2009) Persistence of maternal depressive symptoms through the early years of childhood. Journal of Women’s Health , 18(5): 637–645. Hussain, I. (2010). Women and depression. Newcastle, UK: Cambridge Scholars. Kohen, D. (2010). Oxford textbook of women and mental health. Oxford: Oxford University Press. Murgatroyd, C.A., & Nephew, B.C. (2013) Effects of early life social stress on maternal behavior and neuroendocrinology. Psychoneuroroendocrinology.38, ( 2) 219–228. Murray, L., Halligan, S., & Copper, P. (2010) Effects of postnatal depression on mother-infant interaction and child development. New York: Guilford Press. Perese, E.F. (2012). Psychiatric advanced practice nursing: A biopsychosocial foundation for practice. Philadelphia, PA: F.A. Davis Co. Turner, K.M., Sharp, D., Folkes, L., & Chew-Graham, C. (2008). Women’s views and experiences of antidepressants as a treatment for postnatal depression: A qualitative study. Family Practice, 25(6), 450-455. doi:10.1093/fampra/cmn056 Usher, K., Foster, K., & Bullock, S. (2008). Psychopharmacology for health professionals. New York: Elsevier Australia. Woolcock, K. (2011). Postnatal depression. Australian Pharmacist, 30(9), 750-752, 754-755. Read More