Stress in Women with Postpartum Depression - Essay Example

Introduction The following research article is based upon a critical framework structure to critique a qualitative piece of research en d “Stressin Women with Postpartum Depression: A Phenomenological Study” (Leung et al, 2005). According to Cormack (2000), the purpose of a research critique is not just to provide a review or summary of the work but to carefully examine all aspects of the work. Critiques of research are typically conducted as a means of verifying the conclusions that have been reached, determining their validity and assessing whether empirical evidence discovered are a logical and sequential consequence of the applications performed in the study. This stance regarding the purpose of the research critique is further supported by the comments of Holloway and Wheeler (1996), who indicate that a proper critique will judge the study’s strengths, limitations, meaning and significance. Aspects of the design that must be included in the critique include the design of the study, the methodology used, the sampling selection of participants and any ethical issues that may be related to this approach. Other concerns revolve around whether the data was interpreted empirically and finally whether the conclusions are valid based on the study presented. With this in mind, the following paper will first summarize the study under question and then provide a full critique through the identification of the study’s strengths and weaknesses. For the purposes of this report, the critical framework proposed by Polit and Beck (2004) will be used as a tool to assist in the critique process. This framework presents a step-by-step process to follow in the critiquing of medical research particularly. The use of the provided headings will provide a significant aid in the critique just as additional frameworks, illustrated throughout the work of Polit and Beck (2004) may provide additional supporting evidence. Article Summary Introduction The article introduces the concept that postpartum depression is actually a wordwide problem rather than a unique condition of the civilized world. The condition is believed to be brought on by the stress a woman experiences following the birth of her child and attempts to adjust to the sudden changes this brings about on a physical, psychological, cultural and social level. These findings are supported by the medical observations that women exposed to high levels of stress during their pregnancy experience higher levels of depressive symptoms leading to and following the birth. As might be expected, several things can help to reduce this postpartum stress of the mother, such as specific cultural customs and rituals or ideas concerning the roles of family members who come in to help. The literature review indicates that there have been several different quantitative approaches taken in trying to identify the effects of postpartum stress. Despite this, there remains a great deal of space for further research to be conducted, as the relationship between postpartum stress and postpartum depression as a condition have yet to be fully understood. It is the listed purpose of the study under review to delve into this issue regarding the specific relationship between stress and postpartum depression. Background The report indicated that there were a number of stress factors and stress events that could be directly associated with postpartum depression. The four major types of stress that could have some relationship with postpartum depression were listed as stress associated with a person’s perceived role in life, stress associated with the various tasks she was expected to complete, stress relating to her relationship with others and stress brought about by a lack of sufficient resources. Stressful events could occur during or following pregnancy and still have significant effect. In relation to postpartum depression, there were an additional five major stress events that continued to appear in the literature. These were identified as caring for a sick baby, experiencing a difficult or lengthy delivery, the additional trauma of a caesarean section delivery, elevated concerns regarding the baby’s appearance and stress regarding the baby’s welfare regardless of external circumstances. While much of these studies seemed to provide valid and complete data, the report under review indicated all of the studies that had been conducted in the past had been based on quantitative data analysis, so a qualitative approach to the question was justified. The Study The specific purpose of the study under review was to describe the actual lived experiences of Chinese mothers in Hong Kong as they suffered through the symptoms of postpartum depression. Participants The study was based upon a sampling of 11 women extracted from a larger study, providing only a purposive study group. Screening to determine whether the women were actually suffering postpartum depression was conducted at the sixth week following birth using the Edinburgh Postnatal Depression Scale (EPDS). Data Collection Lengthy interviews were conducted in the setting and time of the participants’ choice as a means of collecting the data needed for the study. This choice of setting and time was providing the participants as a means of reducing any undue stress caused explicitly by the study process. The in-depth interview with each study participant utilized open-ended questions for initial data collection followed up by various prompts as needed. Data was collected by in-depth interview conducted using open-ended questions supported by prompts. The data was collected by the same researcher who had tracked the women throughout their pregnancies for the larger study and the interviews were followed up by debriefing sessions designed to offer any remedial actions deemed necessary. While the report indicates that further measures were taken to ensure the validity of the data that was collected, no detail is provided as to what these measures might have been. Ethical consideration Ethical questions were approached from a variety of angles. To begin with, the women were able to select the environment and time period that was most convenient and comfortable to them, thereby reducing the levels of stress they might feel from the study itself. In addition, the researchers sought approval for the study design prior to the administration of the interviews from professionals at the university and associated hospitals. Finally, written consent to conduct the study was obtained from the participants themselves. Data Analysis The data was analyzed based upon the transcripted copies made from the recorded interviews. To ensure validity, these transcripts were made verbatim from the recordings, with no paraphrasing or interjected material permitted. To ensure consistency, all three researchers involved in the study held regular meetings to review the data. Colaizzi’s method was used for the final data analysis. Findings The data analysis revealed five common themes among the women interviewed. These themes were labelled parenting competence, the expectation-experience gap, baby-minder arrangements, childcare demands and conflicts with the culture or tradition. To help illustrate just what was meant by these distinctions, detailed descriptions were provided of the women’s experiences in each designated theme. This was accompanied by a detailed description of the women that participated in the study, an aspect of the study that was felt to have belonged to an earlier heading, primarily under the heading of Participants. Discussion The study provides some good discussion relating the five themes discovered in this study with themes discovered in other studies, particularly as they compare or contrast with the findings of other studies. Throughout this discussion, the authors also included additional useful data regarding how these participants dealt with their symptoms as they tracked through each of the identified problem areas. This was particularly enlightening regarding how the issues experienced within these themes developed into the stressful events that have been identified in other studies, cited earlier in the literature review. Conclusion Following this research, the authors of this study concluded that a great deal of the stress experienced by the women who participated was the direct cause of the conflicting social environment in which they found themselves. Hong Kong is recognized as a city undergoing tremendous transition and change, presenting a conflicting culture group as the gateway between the East and the West. This creates overwhelming dynamics of cultural conflicts, conflicting advice and often opposing lifestyles and values. One of the most major causes of stress in these women revolved around the primary issue of appropriate child care for their children as the Chinese tradition is in almost direct opposition to the view of the modern world. For this reason, it was recommended that medical care staff assist new mothers in adopting a flexible view of child care options that would enable a unique blend of traditional customs as well as modern thinking that most closely meshed with the concepts of the family. The results of this study suggested a possible strong correlation with the experiences of migrant groups in other parts of the world as these types of groups are similarly characterized by fast changes and dynamic mixing of cultures. The limited nature and sampling size used for this study coupled with the enlightening results encouraged the authors to recommend further study in this area. Critique Phenomenological Approach One of the first major problems discovered with this study was its classification as a phenomenological study. If this were the case, there should be a great deal of discussion illustrating the various details of the phenomenological methodology employed. However, the definitions that are provided within the literature remain unspecific and insufficient to establish the study to anything more in-depth than simple observational techniques. According to Denzin & Lincoln (2000: 3), “qualitative researchers study things in their natural settings, attempting to make sense of or interpret phenomenon in terms of the meanings people bring to them.” As this definition indicates, the observation of people in their natural settings does not provide any additional information that might help to illustrate the more in-depth data analyses and inferences that are necessary in attempting to identify the root causes of postpartum depression. While phenomenological studies have been popular because of the high degree of specific, case-by-case information that can be obtained, the ‘richness’ of this data, it is difficult to sort through the interconnections or lack of them that can emerge as a result of this method of research. There are several disadvantages to this approach to research, including time consuming data collection methods, difficulty of data analysis, the inherent uncertainty that clear patterns may or may not emerge and the method is generally perceived as less credible (Smith, 1975). However, its validity is illustrated in other works. “As an approach within sociology, phenomenology seeks to reveal how human awareness is implicated in the production of social action, social situations and social worlds” (Natanson 1970). The research method was initially developed by Husserl, who felt that a close examination of a person’s perception of objects could lead to an intuitive perception of the essence of the realities thus presented. In proposing the phenomenological method, Husserl felt it would be especially useful as an initial inquiry to identify the major objectives of further study. These insights into the phenomenological method indicate this form of research could be appropriate for any study in which the primary data collection method is based upon observation, especially when only small sample sizes are available. For example, Susan Jackson (1998) used this method of research for a study of ten gifted adolescents experiencing depression. Here where the subject is only a small number of young people, the specific issues faced by these adolescents could be identified and needs determined through close observation. One issue not compensated for in the present study was the fallibility of recall or accurate reporting as depressive behaviours were not observed but rather described at a later date or perhaps following counselling. A concerning point in this case is how the researcher would deal with disparities between direct observation and participant response – for example, the participant indicates she is not feeling depressed at the moment but the researcher observes tears in her eyes. Interpretations of the actions and behaviours of the depressed subject are not always easy, especially when working with orally related accounts of past feelings rather than direct observations. Complicating the matter even further, manifestations of depression do not always take on the same characteristics and depth of emotion is difficult for the observer to evaluate. Like the Jackson report, there are plenty of examples within the literature that indicate interviews such as those carried out in the presently reviewed work are capable of producing data sufficient for successful phenomenological study. The primary reason for this is because the purpose of phenomenological study is not necessarily to find the one general shared condition that leads to all incidents of the same phenomena, but rather to investigate the specific case to make general assumptions about how individuals in similar circumstances might react (Lester, 1999). In order to provide the most accurate means of application of findings, it is necessary to gather what is often referred to as ‘deep’ information which can only be gathered through the unique inductive and qualitative methods inherent in the interview format. Other means of gathering this type of data can be found in discussions and participant observations. As is evident in the literature, the primary goal of phenomenology is to gain the perspective of the individual as they interact with their social environment. These perceptions are typically taken for granted as a part of their cultural or social upbringing and therefore require a great deal of time and effort to uncover. The nature of the study means that personal knowledge and subjectivity cannot be separated from the information gathered and personal interpretations must be included in the data if it is to be valid. It is precisely because of this difference in the phenomenological approach as opposed to some other approaches that this mode of study is able to provide additional insight into the subjective experiences of individuals, leading to a greater understanding of motivations and behaviours while increasing understanding of everyday assumptions and cultural wisdom. The literature regarding the specific strengths and weaknesses of phenomenological research, specifically regarding the types of information and data it is designed to collect and the purposes to which this information is put, indicate that this was an appropriate method of study for the purposes of the study. Ethical Aspects The participants did not seem to be placed in any harm at all as a result of this study. Each participant was selected based on similar criteria regarding family structure and ethnic affiliations. They were all classified as Chinese women living in Hong Kong during the course of their pre- and post-natal treatments. They all lived with the baby’s father after delivery of the baby and were all classified as depressed under the definition of the EPDS. In addition, efforts were made to ensure the comfort and relaxation of the women during the interview process. Further, since the participants were selected from a larger study and given separate consent forms to sign, there is no sign that any of the participants were coerced in any way to participate in the present study. Ethical approval given by the university and the hospitals under whose care the participants fell further indicates no ethical concerns involved in this study. While the benefits of the research findings may not directly affect the participants in a positive, meaningful way, the information gained from this study could have significant affects upon the ways and means in which future patients suffering post-partum depression are treated. Literature Review The study under review made little to no direct reference to a literature review, instead including a section headed ‘Background’ in which previous studies were mentioned. For this reason, it seems as if the concept of a literature review was, at best, an afterthought to the overall study. In addition, this improperly labelled segment of the study only includes four true references to studies dealing with the subject matter at hand. This is a clear lack of regard for the significance of the work that has been done before and indicates a lack of prior research. It is impossible from this section to determine what the various points of view are in the field regardless of whether they supported or refuted the conclusions found through the study. The literature review is intended to provide significant background and purpose to the study underway, educating the reader regarding the significant points of interest, major points of view and conflicting opinions. It gives the reader a chance to understand the work that has already been done and the gaps in the research that the current study is intended to fill. It is not intended to be a short bibliography nor to summarize work that is only peripherally related to the topic, but this study provides neither of these inferior approaches either. There are other places within the study in which other literature is discussed, including the discussion and findings, there is not sufficient discussion to provide an accurate or acceptable literature review. Hypotheses There is no stated hypothesis to this paper. Instead, the study offers a purpose statement, mirroring some other studies in which the purpose takes the upper hand. Often, though, these types of papers include a hypothesis as the result of the research and offer suggestions for further research. This is the pattern into which this study falls, reducing its effectiveness and again presenting the impression that it was not well researched and organized. Design Further supporting the concept that the study was not well-planned, the format of the paper and the design of the study do not reflect professional formatting or description. While the authors indicated that the design was based upon a qualitative empirical type, little to no explanation is provided as to how the study would be conducted or how it was formulated. Many of the classical subheadings are missing from the paper entirely just as some of the major headings are missing – i.e. Literature Review, Method. The present format indicates a study that follows the format of a literature review research study rather than a qualitative design, but there is not enough literature cited to constitute this approach either. Method Like the Literature Review section, the Method section is mis-titled in the present study, instead labelled with the heading Data Analysis. However, under this heading, the approach to gathering data and analyzing it appropriately is addressed. The authors describe how the data is to be gathered and how the subjects were selected. The small size of the sample used in the study is appropriate for a phenomenological study, which is appropriate for a group even as small as a single individual. The method of data collection differs depending upon the size of the group involved (Lester, 1999). In the present study, the data collection method is listed as interviews, conversations, participant observation, action research, focus meetings and analysis of personal texts. In terms of small group studies, the size of the group is required to be small as a more effective means of making positive inferences. According to Lester (1999) inferences can be made much quicker as factors begin to recur through the group. This introduces a high degree of qualitative validity, but little advantage in introducing statistical validity in terms of relating to the population at large. It is difficult to analyze the validity of the data collection method as few indications were provided to detail the types of questions that were asked and all data collection was limited to these interviews. The analysis of the data is inherently difficult as is the presentation of the data collected as it was done through interview recordings. The study doesn’t indicate that any significant problems were encountered, but it is an inherent problem with this form of research that a large proportion of notes are generated that present an analytical nightmare (Lester, 1999). The analysis can therefore become tremendously complicated, requiring specific analysis methods to assist with the final analysis. Findings The findings of the study were correctly identified and described. According to the authors, the EPDS scores for the participants were used and five major themes were identified as a result. Assuming that the study was designed according to appropriate methods, which weren’t described, and that the phenomenological approach was appropriately applied, this study is successful in identifying the themes of stress associated with postpartum depression and therefore fulfilling its purpose. Despite the limitations already mentioned regarding the format of the written study and the detriments in literature review and other details, the study under review was successful in a general sense. This review has illustrated the importance of conducting research upon which evidence-based practice can be based. The use of frameworks in designing and conducting this research assists in producing reputable results that are easy for a reader to understand and critique. By conducting this critique, the author has gained significant knowledge regarding not only the research process, but the methods by which various types of research are conducted, the most appropriate situation in which the phenomenological approach might be applied and the skills and knowledge needed to appropriately read and critique a research study. At the same time, the subject of the study under review was informative regarding the specific issues, specifically stresses, experienced by women following the birth of their child and the ways in which these stresses might contribute to their experience of postpartum depression. References Bates P.S., Spencer J.C., Young M.E. & Rintala D.H. (1993). Assistive technology and the newly disabled adult: adaptation to wheelchair use. The American Journal of Occupational Therapy, 47, 1014-1021. Boutin-Lester, P. & Gibson, R. (2002). Patients perceptions of home health occupational therapy. 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