Postpartum depression issue

Postpartum depression is defined as significant depressive episodes experienced by women who have recently given birth within the last 6 weeks, but can last for several weeks or months. It is a high-risk phase, and women who suffer postpartum depression are more likely to have recurrent depressive episodes, resulting in functional impairment.

Postpartum depression, in theory, has an impact on maternal functioning and is a key risk factor for poor mother-infant bonding as well as delayed child developmental milestones.

This study essentially answers the various questions that arise during the postpartum time.

It provides ways of how to deal with ppd professionally thus avoiding major fatal health consequences that would otherwise arise in the event of an unprofessional intervention. This research sample seeks to give solutions and predict sign and symptoms of postpartum depression.

It examines socio-demographic factors, pregnancy-associated psychosocial stress and depression, health risk behaviors, prepregnancy medical and psychiatric illness, and pregnancy-related illness and birth outcomes as risk factors for postpartum depression.

The research uses a prospective cohort study and hierarchical logistic regression analysis to examine predictors of postpartum depression.

The study sample includes only pregnant women receiving prenatal care at the University Obstetric Clinic, who delivered at the University Of Washington Hospital.

A Patient Health Questionnaire-9 (PHQ-9) was used to determine depressive symptoms of postpartum during the second or third trimester.

b) The Purpose of this paper relating to the given research article and implications based on nursing experience.

The main purpose was to examine socio-demographic factors such as age, marital status which were collected during the third and second trimesters. In addition, pregnancy associated psychosocial stress and depression, health risk behaviors, prepregnancy medical and psychical illness, pregnancy related illness and birth outcomes were identified as risk factors for postpartum depression.

Implications based on nursing experience

Helped the clinical staff gain easy access of depressive symptoms during the second or third trimester and postpartum.

Assisted the research team to understand the severity of postpartum depression effects and other premedical conditions during pregnancy.

.The research team was able to come to conclusion of when postpartum depression is more severe among young pregnant women and married women.

c) Summary and Analysis

The research gives more insight on various predictors of postpartum depression and therefore helps clinical experts have a proper diagnosis and management of a postpartum crisis. This eliminates misdiagnosis and outcome failures in the management.

4. Description of research question on this study

Research question in greater deal

The research question aims at identifying or quick diagnosis of postpartum depression during the screening at the outpatient and inpatient clinic. These predictors can help score a patient risk to postpartum depression and hence adequate management. Risk factors found to be associated with moderate to high risk of PPD include depression or anxiety during pregnancy, stressful life events, low levels of social support, previous history of depression, and the personality factor of neuroticism. Pregnancy-related complications such as preeclampsia, premature labor, and other labor-related complications were associated with significant but lower level of risk in most studies.1 Markers of lower socioeconomic status such as unemployment and lower educational attainment have also been associated with significant but lower risk of PPD.

The research was done on women receiving prenatal care at the Obstetrics University Clinic between January 2004 and June 2011, who delivered at Washington University Hospital. All of the women under the research program receiving obstetrical care and completing it.

At least one survey during their second or third trimester as well as 6-week postpartum follow-up was suitable for the study. The Patient Health Questionnaire-9 (PHQ-9) was used to evaluate depressive symptoms of postpartum during the second or third trimester and postpartum. A mean between the 4th and 8th months of PHQ-9 was used based on the questionnaires to determine the depressive symptoms during postpartum visits which ended up in finding that a PHQ-9 of +10 found in obstetrics and gynecology (Ob-Gyn) patients had the highest of 73% and specificity of 98%, compared to a structured psychiatric interview diagnosis of major depression. Socio-demographic information including general Health history, health risk behaviors, social history and psychosocial stressors were also collected during either the second or third trimester to help provide a better research basis on postpartum period.

b) Observations

From the 1st model that shows women with and without postpartum depression, a total of 6.7% of women had a PHQ-9 score of greater than or equal to 10 during pregnancy while 5.8% had a score of greater than or equal to 10 during the postpartum check. Women with Postpartum depression reported significantly higher depressive symptoms during pregnancy as compared to women without PPD. Presumably, women with PPD were younger, less educated, less likely to be married and probably to be unemployed than women without PPD.

Women who experience PPD have an increased risk of future depressive episodes resulting into mental functional impairment. From table 2, the unadjusted odds ratio for the PHQ-9 scores analysed during pregnancy was 1.25 having a data allocation of (95% confidence gap [95%CI] = 1.21–1.29). Addition of medical conditions and demographic variables did little to change this result.

c) Events and trends that affect this question

Most of the events that affected this research were mainly demographic factors. The various variables included;

Age

Race

Marriage

Unemployment

Asthma

Diabetes

GI disorder

Heart conditions

Hypertension

Migraine

Neurological conditions

Thyroid problems

d) Summary and analysis of article using own words

A postpartum depression is affected by events and trends otherwise known as predictors and is outline as variables in this research.

5. Research design of this study and discuss using own words

a) Research design of the study

The design used is known as Cohort study.

b) Strengths and weaknesses of type of design and hypothesis why the author used the design and not others

The Strength of the design:

A large sample size can be taken

Full screening sample can be done using preference weights

Variables that are full predicting over a whole range can be used during postpartum analysis.

Weaknesses of the design

It may prove difficult to interpret data due to the large sample size

There was no use of structured psychiatric assessment for diagnosis of depression and history of earlier depressive episodes and no assessment of body mass index.

Hypothesis why the author chose the design:

The author chose this design sample as it provided a big range of possible causes and solutions to

Postpartum depression. The design sample compared younger women to married women and used questionnaires to explain who was likely to be affected by postpartum.

c) Summary of the article

Two of the commonly used designs were cohort and coherent. Of the two designs cohort was the most suitable design for this research due to its capability of using a larger sample size and numerous variability.

6. Sample

a) Sample size used

N= 1423

b) Was the sample adequate?

The sample was large enough and hence adequate, the sample size had all the risk factors for postpartum depression included and hence the variable left out was only 2.7%.

c) Describe the number of participants and if the number was adequate

Three thousand and thirty-nine women participated either at four months or eight months (or both time periods). Of the total figure, 1515 were separated due to lack of postpartum assessment. This was a common hindrance during the study.

Eighty-four of the women were excluded due to filling in the 8 eight month questionnaire which had no questions on medical history.

Seventeen of the women under the program were eliminated due to lack of data on birth outcome (preterm labor or low birth weight)

Study sample, therefore left to only 1423 women.

d) Are the number of participants adequate?

Yes, the number of participants was adequate enough to carry out an efficient research sample on postpartum depression.

e) Summary of the article

The research included almost all variable predictors for postpartum depression and sampled largely enough persons for a true reflection of the actual research question. From the data acquired a total of 6.7% of women had a PHQ-9 score of greater than or equal to 10 during pregnancy whereas 5.8% had a score of greater than or equal to 10 at the time of postpartum check. In relation to medical conditions, women with postpartum depression reported higher rates of migraines, diabetes and a trend (p = 0.06) for hypertension and neurological conditions of (0.07) compared to women without postpartum depression.

7. Data collection methods

Data collection methods for PPD were the use of:

Questionnaires

Clinical records

b) Tools used

PHQ-9

Fisher´s exact test

Hierarchical logistic regression

c) Ethical considerations addressed and gaps identified

Women ˂15 years of age at the time of delivery were excluded

Mental incapacity women excluded

Single women were not included

Gaps identified:

Few types of research included the wide range of risk factors such as socio-demographic etc

Participants came from only one geographical location hence limitation to address the entire population

Limited tools for research due to ethical consideration and information sensitivity

d) Summary

While collecting data, ethical consideration needs attention ant this may limit data collection. The researcher should also try bridge the gaps identified to almost nil for a credible research.

8. Limitations of the study

Study of the population from one large University Clinic in one geographical region of USA.

Lack of the use of structured psychiatric interviews for diagnosis of depression.

Staff was unable to get a small percentage of the completed questionnaires.

b) How to overcome the limitations

Increasing the geographical location of the study population.

Clinical staff to train juniors who would not be extremely busy to get the questionnaires completed.

Try in cooperating both PHQ-9 and structural psychiatric interview for diagnosis depression for data accuracy.

c) Why limitations are important to list and discuss

Help future researchers simplify data collection and formulate other tools.

Improve the whole process of researching.

To produce credible and reliable researchers in future.

d) Summary

The Research has its own shortcomings regardless of how small it is. One should recognize these limitations to improve subsequent research.

9. Findings in the study

Women that are young and unemployed, psychosocially stressed women having adverse health habits such as smoking and development of medical disorders and depressive disorders in early adulthood are vulnerable to postpartum depression.

Prepregnancy diabetes was associated with higher risk of postpartum depression.

Antidepressant use is likely a marker of depressive episodes that occurred prior to pregnancy.

A higher rate of probable major depression based on PHQ-9 score of ≥ 10 during pregnancy.

b) If findings answered the research.

Yes, the findings provided detailed information on the research.

c) Credibility of the findings

All procedures were approved by the University of Washington Human Subjects Institutional Review Board.

d) Summary and Analysis

Findings (predictors) stated above are directly proportional to postpartum depression. A score equal to or above 10 points indicating a major risk to postpartum depression

Summary

Depressive symptoms in pregnancy were found to be the highest risk factor of postpartum. From the data acquired it was found that for each 1 point change in depressive symptoms there was a partial 10% risk of PPD. A five-point clinical increase on the PHQ-9 was associated with an approximate of 70% increased risk of postpartum depression. The PHQ-9 was found to be a proper validating tool of finding patients with depression. However, screening of depression wasn’t enough as data showed that almost half of patients with depression did not pass through primary care referrals to health specialists. Prepregnancy diabetes was also found to increase the risk to PPD. Antidepressant prescriptions were found to be correlated with severe and consistent episodes of depression that would have been otherwise treated earlier but are not.

Reduced alcohol use at the time of pregnancy increased the chances of having postpartum depression. From a different study carried out it was also noted that most postpartum episodes began within the first postpartum month.

Attention to these risk factors may help primary care and obstetric gynecology physicians focus depression case–finding efforts.

A postpartum depression prediction is directly proportional to depression during pregnancy, hypertension, and diabetes thus directly related to the findings.

c) The Probability of implementation into practice was not that high enough as most of the women were not able to undergo early assessments when they started experiencing depression. Is the evidence strong enough to suggest a change to practice? Yes

The evidence provided by the findings dim it efficient to implement into the practice as it also provided ways on how to tackle postpartum depression.

d) Concluding statement

Attention to these risk factors may help primary care and obstetric gynecology physicians focus on depression case-finding efforts. From the data acquired in the research, it was noted that women suffering from PPD were notably to be younger, unemployed and having prepregnancy diabetes. Furthermore, in relation to neurology, most of the patients were reported to be frequent smokers who alternatively used Antidepressants. No or less alcohol use during pregnancy is vital as it helps avoid fetal problems such as low baby weight after delivery.

A woman with postpartum depression will report more depressive symptoms during pregnancy as compared to a woman without postpartum depression.

References

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