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Parents experience multiple challenges with the birth of a new baby, including difficulties in managing infant behaviours, emotional adjustment, and even relationship issues, which are exacerbated by numerous risk factors. Postpartum depression (PPD) is defined as the common complication of pregnancy and childbirth which is associated with significant negative effects to mother and the whole family (“Postpartum Depression,” 2018). According to the DSM 5 criteria, Postpartum Depression (PPD) is considered as part of the major depressive disorders with a postpartum onset (Stewart & Vigod, 2016). PPD and its associated symptoms such as fatigue, loss of motivation, and cognitive impairment make it difficult for parents to respond to the needs of the infant and significant others. Necessarily, postpartum depression (PPD) increases resentment and hostility in individuals, hampering effective communication and diminishing emotional involvement. The estimated prevalence of PPD ranges from about 6.5% to 12.9% in women after birth and is even higher in low and middle-income households. Although some cases of PPD can be resolved spontaneously at their onset, approximately 20% of women still struggle with the condition beyond one year after delivery and have a 40% probability of relapse in subsequent pregnancies (Stewart & Vigod, 2016). This topic’s significance is embedded in the quest to foster better mental health for women, infants, and families because the repercussions of PPD affect the whole unit. Further, the discussion of this subject matter improves the recognition of the disorder among women and improves clinical outcomes.
Risk Factors and Health Promotion
Primarily, women with a family or personal history of PPD, bipolar disorder, or anxiety are at risk. Other risk factors include environmental or financial and other stressful life occurrences, social isolation, the burden of caring for infants, and lack of social support. Moderate PPD predictors include maternal neuroticism, low self-esteem, and childcare stress, while smaller predictors are associated with pregnancy and obstetric complications, lower socioeconomic status, and pessimistic cognitive attributions (Stewart & Vigod, 2016). Health promotion for PPD is done through various interventions and treatments. Some of these include counselling for psychiatric treatments and antidepressant medication whenever necessary. In this, some of the resources that PPD patients can take part in, recommended by the healthcare team includes finding supportive groups or networks, which offer practical and emotional support through shared experiences. These professionals may also recommend referrals to support groups for breastfeeding, lactation consultants, and peer groups for new mothers.
Screening and Diagnostics
Postpartum depression remains underdiagnosed and undertreated among a majority of the population. The screening efforts are quite challenging because the various somatic symptoms associated with having a new born, such as appetite and sleep disturbance, are also apparent for other disorders such as major depression. According to Gillis & Parish (2019), the best screening methods for PPD are still controversial, with different researchers advocating for various available types such as the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9). Necessarily, all postpartum women are screened for anxiety and mood disorders using evidence-based measurements. The recommended screening intervals include the first prenatal visits, and at least once during every trimester in pregnancy. After delivery, screening should be done on the first postpartum visits and at six and twelve months. In this process, the decline or stability in mood s and suicidal ideation are examined, and nurses can take appropriate in patients’ evaluation and treatment action.
Access to Healthcare and Legislation
In the U.S., although there are no explicit policies on postpartum depression screening, various states have adopted legislation to foster awareness and encourage the best outcomes for those with PPD, including New Jersey, Illinois, and West Virginia. Such law gives guidelines for education and screening and evaluation of a history of depression. Others require the development of educational programs by healthcare centres for women and their families and provide questionnaires for use in child healthcare and prenatal visits (Kazemeyni, Bakhtiari & Nouri, 2018). In terms of access, the rates of uninsured women often increase during pregnancy to the first PPD visits, hampering access to care for the disorder, and mental wellbeing for mothers and their families.
Additionally, access to mental care is influenced by various socioeconomic factors, which hinder patient access. Most refugee and immigrant populations have unique barriers to postpartum care, including low-income and undocumented status. Principally, white women are more likely to get a PPD diagnosis and treatment than racial minorities, who may also experience language barriers. Arguably, some physical obstacles to PPD care include lack of financial resources and transportation and housing issues. Women tend to seek social support and reliance from different close social contacts instead of seeking professional care, hampering access to adequate care. Among vulnerable populations, women tend to shy away from seeking PPD care because of the stigma associated with its categorization as a mental illness, making it not seem worthwhile to seek help (Kazemeyni, Bakhtiari & Nouri, 2018). Some of these individuals do not recognize PPD, and if they do, they do not know how to get treatment. Cultural perceptions of how mothers should act and feel after delivery also hamper access to PPD care.
Upcoming Research and Current Treatments and Management of Postpartum Disorder
A combination of mood stabilizers and antidepressants with various psychotherapy interventions are employed. Some of these interventions include family, individual, and group therapies. Arguably, this combination is usually associated with positive results, especially among women with moderate and mild PPD. Psychotherapy options help to restore the mental health of mothers and their families. Pharmacologic treatments are carefully administered since mothers may still be breastfeeding. Individual therapy mainly involves one-on-one talks with a healthcare professional to find better ways of coping with feelings, responding to different situations, and problem-solving. Interpersonal therapy explores the various causes of PPD and its contributory factors, thereby helping to relieve associated symptoms. This therapy helps build women’s confidence and improve communication with others (Gillis & Parish, 2019). Eye Movement Desensitization and Reprocessing (EMDR) is used to address traumatic experiences associated with postpartum depression and is useful for women who may have experienced traumatic circumstances during childbirth. In turn, family therapy helps women identify ways of dealing with the disorder in their families, to correct symptoms and restore emotional connections. However, various studies argue that some interventions are more effective compared to others.
Gillis & Parish (2019) suggest that group-based therapy is more effective than single ones and positively influences women’s recovery from PPD. Necessarily, a group environment fosters a feeling of acceptance and understanding, acting as a foundation for these individuals to share their PPD experiences. In these settings, wisdom, guidance, and challenges faced are shared, fostering positive outcomes associated with empowerment, validation, and improvement in the depressive symptoms. Group modality has been successful as a treatment method for emotional disorders and depressive symptoms, helping individuals maximize their health outcomes. Further, this type of therapy is also useful as an adjunct to biomedical and psychopharmacology treatments. Still, its impact on self-help is essential, as it improves the overall quality of life of mothers and their families. Group therapy provides an environment where individuals can share personal experiences without being ridiculed or belittled. In essence, this intervention helps address the identified risk factors for PPD, such as negative thought patterns, lack of social support, and poor interpersonal relations. The group modality takes place in different phases, encompassing information dissemination and education of women, techniques for stress reduction, and strategies for developing support systems and cognitive restructuring. This treatment also focuses on grief work, especially on the unmet expectations of parenting and birth, and fosters reconciliation and acceptance of feelings (Gillis & Parish, 2019). These merits associated with the group therapy intervention make it among the best forms of treatment for PPD. Whenever deemed appropriate by healthcare professionals, group therapy can be utilized in combination with medications, resulting in better mental health for women diagnosed with PPD.
Role of the Nurse as an Advocate for Women’s Health Issues
The foundation of nursing professionals’ roles in advocacy is embedded in the fundamental concern for the emotional, social, and physical needs of the disadvantaged and needy. In terms of women’s health issues, nurses should foster policies and legislation that promotes better health outcomes, especially on matters regarding maternal healthcare. Nurses have a role in addressing the social determinants of health that form the nexus between social inequalities, injustice, and poor health. By working one-on-one with women, nurses can extend advocacy efforts to enhance the latter’s wellbeing in the family unit and society (Kazemeyni, Bakhtiari & Nouri, 2018). In terms of awareness levels, although a significant part of the global population is aware of PPD, most do not understand its impact, symptoms, and areas of getting assistance.
Healthcare as a Business
In the nursing discipline, it is integral to meet the demands of patients as consumers. Nursing practice influences this through the core competencies in nursing, which foster better care for patients and ensures effective practice. Principally, nurses disseminate patient-centered care, respecting their differences and preferences. Consequently, their professionals work in interdisciplinary teams that foster collaboration and continuous learning, leading to the best outcomes. Nursing also affects patients’ demand as consumers through quality improvement, promoting prompt identification of potential errors in practice, mitigating them, and utilizing informatics.
Conclusion and Recommendations
Nursing professionals should impart knowledge on the signs and symptoms of postpartum depression during the antepartum period and educate women and their partners on the disorder and how to handle it effectively. There is a need for more awareness in society on PPD, and healthcare providers must utilize their advocacy roles to ensure the wellbeing of vulnerable populations. Also, group-based interventions should be used in the treatment for better mental health outcomes. Overall, postpartum depression remains underdiagnosed and undertreated, requiring efforts towards better interventions among all stakeholders, including health professionals at the policy level, patients, and the general public.
Gillis, B. D., & Parish, A. L. (2019). Group-based interventions for postpartum depression: An integrative review and conceptual model. Archives of psychiatric nursing, 33(3), 290-298.
Kazemeyni, M., Bakhtiari, M., & Nouri, M. (2018). Effectiveness of acceptance and commitment group therapy on postpartum depression and psychological flexibility. Journal of Clinical Nursing and Midwifer, 4(3).
Stewart, D. E., & Vigod, S. (2016). Postpartum depression. New England Journal of Medicine, 375(22), 2177-2186.
The Postpartum Depression (PPD) Patient Journey: Payer Considerations. (2018). P&T: A Peer-Reviewed Journal for managed care & Formulary Management, 1-18.