In Pregnancy What Is the Effect of Anxiety on Postpartum Depression - Research Proposal Example

In Pregnancy What Is the Effect of Anxiety on Postpartum Depression September 5, II. Problem ment The association between postpartum depression and new parenting stress has long been established, effecting mother-child attachment and the child’s attachment to the caregiver. This stress can be defined as a disparity or lag between the resources available to meet demands. One study indicates that antenatal depression and anxiety have a direct impact on postpartum parenting stress, despite the type of antenatal treatment that is provided (Misri, Kendrik, Oberlander, Norris, Tomfohr, Zhang, Grunau, 2010). This postpartum depression and anxiety has consistently been linked with increased levels of parenting stress. Increased levels of parenting stress directly correlate to the occurrence of postpartum depression and the anxiety experienced during pregnancy. As symptoms of antenatal anxiety and depression became more severe levels of parenting stress increase. Antenatal depression and anxiety has been shown to impact the developing fetus as well as early child behavior. These babies spend more time crying and unhappy in appearance and demonstrate more stress related behaviors. They are often more difficult to console and appear to be more irritable. The relation between increased depression and anxiety during pregnancy even when controlling postpartum through therapy and other pharmacological means persist, despite this early intervention is strongly warranted. III. Literature Review A. Depression and Anxiety among Postpartum and Adoptive Mothers Research has increasingly addressed the comorbidity of anxiety with postpartum depression. Related factors that contribute are described as low self-esteem and maternal income and these are common predictors of prenatal anxiety (Mott, Schiller, Richards, O’Hara, & Stuart, 2011). Prenatal anxiety greatly increases a woman’s chances of anxiety and depression during the first seven months of the postpartum period. Data used for this study included a postpartum group selected from an existing data set who were enrolled in a previous study conducted through the University of Iowa. Women who participated in this study had delivered a baby in the prior 12 months and data was gathered through the use of questionnaires sent to those interested in participating in the study. There were 147 surveys or questionnaires returned that data was compiled from. Postpartum mothers most often reported the effects of anxiety included general depression, dysphoria, lassitude, insomnia, suicide ideation, appetite loss and gain, ill-temper, social anxiety, panic and traumatic intrusions. Results of this study concluded that adoptive women experienced fewer symptoms of anxiety and greater well-being than post-partum women. Biological mothers may have an increased sensitivity to hormones accompanying birth which are associated with anxiety and post-partum depression. Adoptive women experience fewer symptoms of anxiety and this is consistent with previous studies which demonstrate less psychopathology among adoptive mothers. This study is useful is establishing biological factors as a major contributing factor to the effects of anxiety on postpartum mothers. Strengths of the study include assessing current psychopathology using validated measures of anxiety and depression, a control group and the inclusion of social risk factors for depression. Limitations of the study are the self-reporting method used in the form of questionnaires to gather the data. B. High Risk Pregnancy: Effects on Post-Partum depression and Anxiety Four hundred post-partum women were divided into two study groups; aged 16-43. A high risk pregnancy group and a normal risk pregnancy group. The Beck depression inventory was used to measure symptoms of depression. To assess the symptoms of anxiety the Spielberger Standard test was used. Symptoms of depression and anxiety were much higher in those with high risk pregnancies, though anxiety was more prevalent in both groups. Results of this study closely matched those of the previous study in that anxiety was suffered most commonly in high risk pregnancies possibly due to maternal hormones and the stressors of higher risk factors. This study suggests that high risk pregnancy has more potential for post-partum anxiety. Severe and moderate levels of anxiety were measured. Factors found to increase risk of anxiety included in both groups age at pregnancy, gravida, interval between pregnancies, history of abortion, the fact of the child being wanted or unwanted, social support and unpleasant life events. Symptoms of anxiety and depression were more common in women with fewer children. This is possibly because these women have less experience with pregnancy and delivery. Programs need to consider the nature of psychological problems associated with high risk pregnancies especially (Zadeh, Khajehei, Sharif, & Hadzic, 2012). C. Women’s Mental Health Nursing: Depression, Anxiety and Stress During Pregnancy This study assessed depression, anxiety and stress of 59 pregnant women. Clinical interviews were used, self-reporting and estimated levels of the stress hormone cortisol from saliva samples. The study showed a high incidence of prenatal depression, anxiety and stress especially during the third trimester. Newborns and infants exposed to maternal anxiety exhibit irregularities. The incidence of anxiety was lower than that of depression on both the first and second maternal wellbeing visit. The results of this study support high incidences of maternal depression, stress and anxiety. Fewer symptoms were reported during self-report than in patient interviews by clinicians. More study needs to be done on the us e of psychotropic medications during pregnancy on fetal brain behavior and more research and testing should lead to alternative treatments methods with less effect on fetal growth and development (Parcells, 2010). D. Early Maternal Anxiety Predicts Cognitive and Behavioral Outcomes of VLBW Children at 24 Months Corrected Age 88 mothers were recruited in the NICU and 57 were followed at 24 months corrected age. Mothers completed self-report measures of anxiety and at 24 months mother and child interactions were videotaped. These observations were coded using Emotional Availability Scales. Maternal stress, depression and anxiety played critical roles in the outcomes of the infants. Stress was found to persist for two-three years following delivery of the infant. The mother’s symptoms of anxiety interfere with her ability to parent sensitively and respond appropriately to infant need cues. Anxious mothers are less sensitive and more intrusive in interactions with their infants. They were also seen to provide less structure during free play. Data is limited on the long term effects of early maternal anxiety and depression and more follow up studies need to be completed longitudinally. This study demonstrated that maternal anxiety and post-partum depression is associated with poor cognitive development and internalized behavior problems. The limitations of the study include the relatively small sample size and it is a factor that anxious mothers are least likely to enroll their child in programs that promote cognitive and social development. There is emphasis on the need for early detection of maternal anxiety and post-partum depression for the growth and development of the infant (Zelkowitz, Na, S., Wang, Bardin, & Papageorgiou, 2011). E. Anxiety and Depression in Women and Men from Early Pregnancy to 3-Months Post-Partum 260 Portuguese couples completed the State Anxiety Inventory and the Edin-burgh Post-natal depression scale at each trimester of pregnancy, childbirth and 3 months post-partum. Depression was more prevalent than high anxiety during pregnancy and the post-partum period. These results may tend towards being more cultural because of the population sample. Depression is also more common in women than in men. Anxiety in woman becomes prevalent in the third trimester and in childbirth. Limitations of this study include the voluntary nature and the fact that those who agreed to participate may be less anxious or depressed (Figueiredo, & Conde, 2011) IV. Theoretical Foundation Postpartum depression and maternal anxiety are obviously closely related and studies show that these problems may be more common than those self-reported. Because of the limitations of self-reporting studies should be redesigned in order to assess individuals less likely to voluntarily participate. These groups include those with severe or moderate anxiety who may be fearful of participating in studies. Post-partum depression affects mother-child bonding and the quality of all interactions. V. Methodology for Research Databases were searched such as PUBMED, MEDLINE, EBSCOHOST and CINAHL. Search terms that were used were as follows: Postpartum anxiety Pregnancy and anxiety Postpartum depression Antenatal anxiety Pregnancy mental health Effects of anxiety on postpartum depression Infant behavior as related to maternal anxiety A review of five journal articles peer reviewed was used in this study to gather related facts and statistics. Studies that were reviewed included, population study’s and statistically reported data, intervention studies and collective reviews of literature that has been published in peer review journals. My intervention of choice would be early detection and screening through a combination of self-reporting through questionnaires, practitioners evaluations of mental health status at certain intervals during the pregnancy and the use of standardized anxiety and depression scales for testing measures. To implement these interventions would mean state wide mandated testing measures which included in every plan of care for all pregnant women. The outcome of these measures would be earlier detection and treatment of anxiety related postpartum depression and possibly the prevention of postpartum depression that is related to anxiety. To measure the outcome of these interventions assessments should be done by clinicians at post-partum visits, self-reporting through questionnaires should be utilized once again and the infant pediatrician should also assess the mother’s mental wellbeing at the child’s first three pediatrician visits. These allow there to be a cohesive response to the problem among health care providers. Finding should be reported in a centralized database designed to gather the data from a large number of providers which will have more of an impact than smaller studies with few participants. VI. Plan and Implementation I believe the effects of anxiety are proven to contribute to post-partum depression as numerous studies have pointed out. This relates both to maternal hormonal changes, life stressors, and other factors such as high risk pregnancies, the number of births the mother has experienced and living circumstances. Post-partum depression also effects the interaction between the mother and infant and is shown in annual tests as well as self-reporting methods. These infants may be developmentally behind other infants. VII. Conclusion Studies and literature review consistently point out that there is a direct correlation between maternal anxiety and post-partum depression. Most of the studies reviewed used relatively small sample sizes and participants were either voluntary or self-reported. These limitations unfortunately allow the most serious cases to go unnoticed and unreported until childhood problems develop associated with maternal anxiety and post-partum depression. Larger sample sixes and double blind studies using similar groups with one group being voluntary and the control group being chosen at random may provide more accurate results. Despite these flaws the evidence is clear that the relationship between these factors is strong and persistent. VIII. References Figueiredo, B., & Conde, A. (2011). Anxiety and depression in women and men from early pregnancy to 3-months postpartum. Archives Of Womens Mental Health, 14(3), 247-255. doi:10.1007/s00737-011-0217-3 Misri, S., MD, FRCPC, Kendrik, K., BA, Oberlander, T., MD, FRCPC, Norris, S., MD, FRPCP, Tomfohr, L., BA, Zhang, H., MSc.MEng, & Grunau, R., PhD,Rpsych. (2010). Antenatal Depression and Anxiety Affect Postpartum Peranting Stress: A Longitudinal, Prospective Stduy. La Revue Canadienne De Psychiatrie, 55(4), 222-228. Retrieved September 5, 2012, from http://content.ebscohost.com/pdf23_24/pdf/2010/0WB/01Apr10/51017017.pdf?T=P&P=AN&K=51017017&S=R&D=aph&EbscoContent=dGJyMNXb4kSeprM40dvuOLCmr0qep7BSr6u4SrWWxWXS&ContentCustomer=dGJyMPGusE63rrdNuePfgeyx43zx Mott, S., Schiller, C., Richards, J., OHara, M., & Stuart, S. (2011). Depression and anxiety among postpartum and adoptive mothers. Archives of Womens Mental Health, 14(4), 335-343. Doi: 10.1007/s00737-011-0227-1 PARCELLS, D. (2010). Womens mental health nursing: depression, anxiety and stress during pregnancy. Journal Of Psychiatric & Mental Health Nursing, 17(9), 813-820. doi:10.1111/j.1365-2850.2010.01588.x Zadeh, M., Khajehei, M., Sharif, F., & Hadzic, M. (2012). High-risk pregnancy: Effects on postpartum depression and anxiety. British Journal Of Midwifery, 20(2), 104-113. Zelkowitz, P., Na, S., Wang, T., Bardin, C., & Papageorgiou, A. (2011). Early maternal anxiety predicts cognitive and behavioural outcomes of VLBW children at 24 months corrected age. Acta Paediatrica, 100(5), 700-704. doi:10.1111/j.1651-2227.2010.02128.x Read More