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INTRODUCTION TO POSTPARTUM DEPRESSION

2. HISTORICAL PERSPECTIVE. Jean-Etienne Dominique Esquirol In 1838 in France, Esquirol was the first physician to report the systematic study of mental illness related to childbirth.. 3.

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INTRODUCTION TO POSTPARTUM DEPRESSION

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    1. 1 INTRODUCTION TO POSTPARTUM DEPRESSION

    2. 2 HISTORICAL PERSPECTIVE Jean-Etienne Dominique Esquirol In 1838 in France, Esquirol was the first physician to report the systematic study of mental illness related to childbirth.

    3. 3 “The more a mother has idealized motherhood, the more likely she may be to feel disappointed, disillusioned, and depressed as she faces the reality of day to day mothering.” A quote from Elizabeth Hormann, Editor of Mothering Magazine

    4. 4 The first 3 months after birth are recognized as the most vulnerable emotional period for mothers.

    5. 5 CLASSIFICATIONS OF POSTPARTUM PSYCHIATRIC DISORDERS 1. Adjustment reaction with depressed mood. 2. Postpartum major mood disorders. 3. Postpartum psychosis. Source: DSM IV TR

    6. 6 ADJUSTMENT REACTION WITH DEPRESSED MOOD “Postpartum Blues” AKA “Baby Blues” Definition: Exhibits depressed mood with physiologic abrupt withdrawal of hormones, estrogen, progesterone, and cortisol. Incidence: Affects 75-80% of population. Occurance: Peaks at PP days 3 – 5. May experience for a few hours, days, to 2 weeks. Usually self- limiting, generally resolves.

    7. 7 Baby Blues: Signs and Symptoms Crying Loneliness Anxiety Exhaustion Insomnia Restlessness Irritability Difficulty concentrating Feeling overwhelmed

    8. 8 Factors Contributing to “Baby Blues” Emotional let-down that follows labor + birth. Physical discomfort in early postpartum. Fatigue, sleep disruption / deprivation. Anxiety about caring for newborn. Concerns about her physical appearance.

    9. 9 Risk Factors for PP Blues Hormonal fluctuations- Decreased estrogen, progesterone, and thyroid. Increased prolactin. Sudden loss of circulating volume, weight, internal organ rearrangement. Stress, isolation, lack of social support. Sleep disruption. Low self esteem, preterm birth, problems with newborn, hx of infertility. Feelings of loss – identity, freedom, control. Concurrent losses – absent FOB, Incarcerated FOB, family death, job loss, relocation.

    10. 10 Postpartum Major Mood Disorders Postpartum Depression Definition: May start out as “Baby Blues” but progresses – 2-6 months or longer with additional symptoms. Incidence: up to 20-30% of population Occurrence: Extension and progression of “Baby Blues”. Greatest risk occurs during the fourth week postpartum, but encompasses anytime during the first year after childbirth.

    11. 11 Postpartum Depression: Signs and Symptoms Decreased appetite Insomnia Fatigue Inability to concentrate Confusion and high anxiety Excessive fears- NB health/ safety Hopelessness and despair Guilt, negativity Suicidal thoughts Infant neglect or abuse Unable to complete tasks

    12. 12 Risk Factors: Postpartum Depression Undesired/ unplanned pregnancy Hx of depression or previous PPD Lack of social support Recent major life change: family death, financial stress, job loss, relocation, marital discord, homelessness.

    13. 13 Additional Research findings: Robertson et al. (2004) confirmed that the strongest predictors were prenatal depression, prenatal anxiety, stressful life events, lack of social support, and previous history of depression. Beck (2003) reported that mothers of preterm infants and mothers of multiples experience a higher rate of PPD than mothers of healthy, full-term infants.

    14. 14 Research studies continued: Taveras et al. (2003) found that cessation of breastfeeding at 12 weeks postpartum was associated with higher levels of depressive symptoms. Righetti-Veltema et al. (2003) cited that toddlers of mothers who had experienced PPD displayed more insecure attachment to their mothers compared with toddlers of nondepressed mothers.

    15. 15 Transcultural Perspective: Over two decades of transcultural research has indicated that the prevalence of postpartum depression is fairly consistent throughout the world.

    16. 16 Beck: Grounded Theory “Teetering on the Edge” Stage 1. Encountering Terror Stage 2. Dying of Self Stage 3. Struggling to Survive Stage 4. Regaining Control

    17. 17 Beck’s Classic Study: Prevalent Themes in PPD NB perceived as demanding, cranky, colicky. Felt inept at mothering as a role. Presented a façade of normalcy. Obsessive thoughts. Felt guilty and angry. Panic attacks Felt isolated. Suicidal thoughts or attempts.

    18. 18 Health Care Providers Interventions: Prioritize the need for universal screening of all mothers. Utilize a universal screening tool. Be alert to high risk factors such as: Prenatal anxiety Extreme ambivalence, Hx. of depression, voiced personal dissatisfactions, Lack of social support, Concurrent life stressers, Unstable relationships Low socioeconomic status

    19. 19 HCP Interventions continued: Provide realistic childbirth and parenting education. Conduct patient teaching on Baby Blues, Postpartum Depression and Postpartum Psychosis. Include patient / client teaching on infant states, interpreting infant cues, and infant care. Ask specific questions about depression symptoms Establish an atmosphere of trust / comfort that concerns about parenting adequacy can be discussed. Assist and encourage women in locating community resources/ therapists/ support groups.

    20. 20 Ending words from a survivor of postpartum depression: “I do remember, however, a dear friend who came to visit me in the hospital. She stood at the end of my bed and I heard her say, ‘The most horrific and intense battlefield is the battlefield of the mind, but there is always light at the end of the tunnel.’ As a veteran who carries many invisible wounds from a war for which I will receive no medals, I know what she means.”

    21. 21 BIBLIOGRAPHY Beck, C.T. (2007). Exemplar: Teetering on the Edge: A continuing emerging theory of postpartum depression. In P.L.Munhall (Ed.), Nursing Research (4th ed., pp. 273-292). Sudbury, MA: Jones & Bartlett Publishers. Beck, C.T. (2001). Predictors of postpartum depression: An Update. Nursing Research, 50, 275-285. Beck, C.T. (2006). Further development of the Postpartum Depression Predictors Inventory-Revised. Journal of Obstetric, Gynecologic and Neonatal nursing, 35, 735-745. Cox, J., Holden, J.M. & Sagovsky, R. (1987). Detection of postpartum depression: Development of the 10 item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786. Oates, M.R., Cox, J.L., Neema, S., Asten, P., et al. (2004). Postnatal depression across countries and cultures: A qualitative study. British Journal of Psychiatry Supplement, 46, S10-S16.

    22. 22 Righetti-Veltema, M., Bousquet, A., & Manzano, J. (2003). Impact of postpartum depression symptoms on mother and her 18-month old infant. European Child and Adolescent Psychiatry, 12. 75-83. Stowe, Z.N., Hostetter, A.L., & Newport, D.J. (2005). The onset of postpartum depression: Implications for clinical screening in obstetrical and primary care. American Journal of Obstetrics and Gynecology, 192, 522-526. Traveras, E.M., Capra, A.M., Braveman, P.A., et al. (2003). Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics, 112 (Pt. 1), 108-115. Wood, A.F., Thomas, S.P., Droppleman, P.G., & Meighan, M. (1997). The downward spiral of postpartum depression. Maternal-Child Nursing Journal, 22, 308-317. Beck, C.T. (2008). Postpartum mood and anxiety disorders: Case studies, research, and nursing care. AWHONN.

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