Bakgrund: Förlossningsdepression (Post partum depression) är vanligt förekommande, cirka 13 procent av nyblivna mammor drabbas. Faktorer som påverkar uppkomsten är bland annat tidigare missfall, hormonella rubbningar, depression tidigare i livet eller att förlossningen varit komplicerad. Första symtomet som uppträder är ofta sömnstörningar och sedan följer oro, osäkerhet, hopplöshet, skam och gråt. Syfte: Litteraturstudiens syfte var att belysa kvinnors upplevelser att drabbas av post partum depression. Metod: Sökning av vetenskapliga artiklar gjordes i databaserna EBSCO (CINAHL och Academic search elite), PubMed och SveMed+. För analys av artiklar användes metasyntes och utifrån materialet skapades fem huvudkategorier och elva underkategorier. Resultat: Huvudkategorierna belyste kvinnors upplevelser av PPD, Behov av stöd från omgivning och anhörig, Personligt förhållningssätt, Känslomässiga reaktioner i samband med PPD, Krav från omgivning och Känsla av maktlöshet. Slutsats: Kvinnor som led av PPD upplevde rollen som mamma mycket påfrestande. De beskrev brist på stöd från omgivning och sjukvårdspersonal, samt att de inte blev tagna på allvar när hjälp söktes. Dålig information och kunskap om PPD bidrog till känsla av misslyckande och därför valde en del kvinnor att isolera sig.

Bakgrund: Post partum depression är den vanligaste psykiatriska störningen som kan uppstå efter en förlossning. Ungefär 13 % av alla nyblivna mammor drabbas eller visar tecken på en depression. Syftet: Syftet med studien var att beskriva BVC sköterskans reflektioner och erfarenheter av att stödja mammor med Post partum depression. Metod: Beskrivande design med kvalitativ ansats. Åtta BVC-sköterskor på fem hälsocentraler medverkade. Semistrukturerade intervjuer genomfördes och analyserades med kvalitativ innehållsanalys. Resultat: EPDS var en bra enkät för att hitta mammor med PPD och för att få ett bra samtal med mammorna. Svårigheter framkom då mamman inte kunde det svenska språket. Det var viktigt att se mamman, inte bara barnet och att ge tid för stöd och samtal. Mammorna följdes upp via telefon och täta besök på mottagningen vid behov. Det upplevdes svårt då mamman inte ville ta emot hjälp när BVC-sköterskan bedömde att hon behövde detta. BVC-sköterskorna beskrev att mammor som visat sig ha PPD hänvisades till en psykolog. BVC-sköterskan ansåg sig inte ha tillräckligt mycket kunskap för att ge behandlande samtal men kunde lyssna och ge stöd genom att finnas där för dem. Slutsats: EPDS-enkäten är ett bra verktyg för att tidigt fånga upp mammor med PPD, enkäten är också ett bra stöd i samtalet med mamman. Det är viktigt att fokusera på mamman och inte bara på barnet och att tillräckligt med tid för samtal avsätts för att ge stöd. Mer handledning och utbildning behövs inom ämnet PPD för att kunna ge bättre stöd till mammor men även papporna. / Introduction: Postpartum depression is the most common psychiatric disorders that may occur following childbirth. Approximately 13% of all new mothers suffer or shows signs of depression. The purpose: The purpose of this study was to describe the child health care nurse´s reflections and experiences to support mothers with post partum depression. Method: Descriptive design with a qualitative approach. Eight child health care nurses at five health-centers participated.  Semi-structured interviews were conducted and analyzed by qualitative content analysis. Results: EPDS was an adequate instrument in order to find mothers with PPD and to initiate positive conversations with mothers. Difficulties emerged when mothers didn’t speak Swedish. It was important to see the mother, not just the child and to give time for support and conversations. Mothers were followed-up by telephone made frequent visits to the clinic when necessary. It was difficult when mothers didn’t accept help even though the child health care nurse found it necessary. Mothers who had PPD symptoms were referred to a psychologist by the child health care nurse. The child health care nurse’s perceived deficient knowledge providing therapeutic conversations but could listen and provide support by being there for the mothers. Conclusion: EPDS is an adequate tool for early identification of mothers with PPD, the instrument is a good help when talking to the mother. It is important to focus on the mother and not just on the child and allow enough time for conversation aside providing support. More guidance and training is needed within the topic PPD for improved support to mothers, but also fathers.

Post partum depression (PPD) drabbar mellan 10 – 15 % av nyförlösta mödrar. Att drabbas av en PPD kan orsaka känslomässiga och kognitiva besvär för hela familjen. Kvinnan löper också en större risk att drabbas av en depression senare i livet, vilket är en faktor som kan påverka mammans relation till barnet och sin omgivning. En tidig korrekt behandling är viktig för mammans framtida välbefinnande. Bland möjliga orsaker till post partum depression nämns hormonförändring, förändrad nivå av neurotransmittorer, nutritionella orsaker och sömnbrist. Behandlingen av PPD är inriktad mot psykoterapi, antidepressiv behandling och elektrokonvulsiv behandling (ECT). Syftet med denna litteraturstudie var att titta på effekten av det antidepressiva läkemedlet serotoninåterupptagshämmare (SSRI). Studierna som granskades i detta arbete hämtades från Pubmed. Fem studier valdes och samtliga var randomiserade kliniska prövningar. Tre av studierna visade ingen signifikant skillnad mellan SSRI och placebo/psykoterapi/tricykliskt antidepressiva (Nortriptylin). I två av studierna hittades en signifikant skillnad, med en bättre effekt för SSRI i jämförelse med placebo respektive samtal. I studie 2 erhölls en signifikant skillnad med avseende på remission efter 8 veckor (p=0.04) och i studie 3 var det en signifikant skillnad mellan andelen som nådde behandlingsmålet <13 på Edinburgh Postnatal Depression Scale (EPDS) efter 4 veckor. Vad gäller förbättringen av den kliniska sjukdomsbilden nådde fler lägre poäng på mätskalorna i de grupper där SSRI var inkluderat. Samtliga behandlingar som inkluderades i studierna nådde goda resultat. Sammanfattningsvis är SSRI ett bra alternativ för behandling av PPD, men i den inledande fasen kan det dock inte ses som bättre än psykoterapi eller behandling med nortriptylin. I den framtida forskningen skulle det vara intressant att se fler och framförallt större studier för att klargöra effekten av SSRI vid PPD.

Sensitive and responsive parenting during early infancy is highly understudied, particularly in families with a low socioeconomic status. Longitudinal data from 41 mothers and their 4 to 16 week old infants found that accurate maternal knowledge of infant development positively affected parenting contemporaneously and over time while depression did not affect parenting in this sample. Implications for intervention and research are discussed.

Introdução: A depressão pós-parto tem sido tratada ao longo do tempo como um problema das mulheres e poucos estudos têm abordado as repercussões desse evento nas relações familiares. Objetivos: Compreender as vivências e significados da depressão pós-parto materna para a mulher e sua família; Desenvolver um modelo teórico representativo da experiência da mulher e da família diante da depressão pós-parto materna. Método: Estudo qualitativo teve como referencial teórico norteador o Interacionismo Simbólico e como referencial metodológico a Teoria Fundamentada nos Dados. Os participantes deste estudo foram mulheres que tiveram depressão pós-parto e seus familiares, recrutados através de Hospitais Públicos e Unidades Básicas de Saúde do município de Cuiabá-MT. Os dados foram coletados por meio de entrevistas em profundidade com a mulher e o familiar. O número de famílias participantes foi se configurando, de acordo com a análise e a teoria emergente, totalizando dez famílias. Resultados: A análise dos dados permitiu identificar o modelo teórico Oscilando entre o apoio e a necessidade de manter o controle que representa as percepções e estratégias presentes na experiência da mulher e da família visando à adaptação da vida familiar às circunstâncias da vida afetadas pela depressão. Três categorias estruturam a experiência estudada: Lutando com a maternidade, Perdendo-se no meio de sentimentos na luta com o desconhecido e Assumindo o controle. Conclusões: O estudo permitiu identificar um processo psicossocial, em que controle e apoio constituem os elementos simbólicos centrais de como a mulher com depressão pós-parto e a família manejam a experiência desde o início dos sintomas até a constatação do diagnóstico. O modelo teórico contribui para a compreensão dos significados construídos e as condições que afetam a mulher e a família, e orientam a organização e a comunicação familiar. / Introduction: Post-partum depression has been treated over time as a womens problem and few studies have addressed the impact of this event on family relationships. Objectives: To understand the experiences and meanings of maternal post-partum depression for the woman and her family; To develop a theoretical model representative of the woman and her familys experience when facing post-partum depression. Method: It is a qualitative study that had as a guiding theoretical referential the Symbolic Interactionism and as a methodological referential the Grounded Theory. The participants of this study were women who had post-partum depression and their families, recruited through public hospitals and basic health units in the municipality of Cuiabá-MT. The data were collected through in-depth interviews with the woman and family. The number of families who participated was being configured according to the analysis and the emergent theory, totalizing ten families. Results: The data analysis allowed the theoretical model to be identified Oscillating between the support and the need to maintain control which represents the perceptions and strategies present in the experience of the woman and her family aiming at adapting family life to the circumstances of life affected by depression. Three categories structure the experience under study: Struggling with maternity, Losing herself in the middle of feelings in the struggle with the unknow and Taking control. Conclusions: The study allowed identifying a psychosocial process in which the control and support constitute the core symbolic elements of how the woman with post-partum depression and her family deal with the experience from the onset of the symptoms until the results of the diagnosis. The theoretical model contributed to the understanding of the constructed meanings and the conditions that affect the woman and her family, and guide the family organization and communication.

Föräldraskapet innebär en stor livsförändring och medför både positiva och negativa upplevelser. Det är viktigt att föräldrar och barn får ett fungerande samspel för att ha möjlighet att utveckla en god anknytning. Bristande samspel har konsekvenser för barnets utveckling men även för hela familjen. Nyblivna föräldrar befinner sig i en sårbar period i livet och var tionde kvinna drabbas av en depression efter förlossningen. Familjen behöver stöd från omgivningen och BVC-sjuksköterskan har en viktig del i detta stöd. Syftet med studien är att beskriva BVC-sjuksköterskans erfarenheter av att stödja samspelet mellan mor och barn vid post partum depression. Sex BVC-sjuksköterskor intervjuades och materialet tolkades genom kvalitativ innehållsanalys. BVC-sjuksköterskorna beskrev att det är viktigt att tidigt se ett samspel mellan mor och barn och att uppmärksamma föräldrarnas välbefinnande. För att BVC-sjuksköterskan ska ha möjlighet att stödja familjen är en god vårdrelation nödvändig. Relationen bör bygga på respekt och tillit och BVC-sjuksköterskans roll är att vara lyhörd och vägledande. Vid hög arbetsbelastning samt vid ovilja till stöd från familjen upplevde sköterskan en känsla av otillräcklighet och maktlöshet. BVC-sjuksköterskan spelar en stor roll i det viktiga nätverket kring familjen och agerar som spindeln i nätet när hennes egna resurser inte räcker till. BVC-sjuksköterskorna beskrev en förändring i samhället vilket påverkar föräldraskapet samt Barnhälsovården idag. Studiens fynd diskuteras utifrån tidigare forskning och författarnas erfarenheter. / <p>Program: Specialistsjuksköterskeutbildning med inriktning mot distriktssköterska</p><p>Uppsatsnivå: D</p>

Introdução: A depressão pós-parto tem sido tratada ao longo do tempo como um problema das mulheres e poucos estudos têm abordado as repercussões desse evento nas relações familiares. Objetivos: Compreender as vivências e significados da depressão pós-parto materna para a mulher e sua família; Desenvolver um modelo teórico representativo da experiência da mulher e da família diante da depressão pós-parto materna. Método: Estudo qualitativo teve como referencial teórico norteador o Interacionismo Simbólico e como referencial metodológico a Teoria Fundamentada nos Dados. Os participantes deste estudo foram mulheres que tiveram depressão pós-parto e seus familiares, recrutados através de Hospitais Públicos e Unidades Básicas de Saúde do município de Cuiabá-MT. Os dados foram coletados por meio de entrevistas em profundidade com a mulher e o familiar. O número de famílias participantes foi se configurando, de acordo com a análise e a teoria emergente, totalizando dez famílias. Resultados: A análise dos dados permitiu identificar o modelo teórico Oscilando entre o apoio e a necessidade de manter o controle que representa as percepções e estratégias presentes na experiência da mulher e da família visando à adaptação da vida familiar às circunstâncias da vida afetadas pela depressão. Três categorias estruturam a experiência estudada: Lutando com a maternidade, Perdendo-se no meio de sentimentos na luta com o desconhecido e Assumindo o controle. Conclusões: O estudo permitiu identificar um processo psicossocial, em que controle e apoio constituem os elementos simbólicos centrais de como a mulher com depressão pós-parto e a família manejam a experiência desde o início dos sintomas até a constatação do diagnóstico. O modelo teórico contribui para a compreensão dos significados construídos e as condições que afetam a mulher e a família, e orientam a organização e a comunicação familiar. / Introduction: Post-partum depression has been treated over time as a womens problem and few studies have addressed the impact of this event on family relationships. Objectives: To understand the experiences and meanings of maternal post-partum depression for the woman and her family; To develop a theoretical model representative of the woman and her familys experience when facing post-partum depression. Method: It is a qualitative study that had as a guiding theoretical referential the Symbolic Interactionism and as a methodological referential the Grounded Theory. The participants of this study were women who had post-partum depression and their families, recruited through public hospitals and basic health units in the municipality of Cuiabá-MT. The data were collected through in-depth interviews with the woman and family. The number of families who participated was being configured according to the analysis and the emergent theory, totalizing ten families. Results: The data analysis allowed the theoretical model to be identified Oscillating between the support and the need to maintain control which represents the perceptions and strategies present in the experience of the woman and her family aiming at adapting family life to the circumstances of life affected by depression. Three categories structure the experience under study: Struggling with maternity, Losing herself in the middle of feelings in the struggle with the unknow and Taking control. Conclusions: The study allowed identifying a psychosocial process in which the control and support constitute the core symbolic elements of how the woman with post-partum depression and her family deal with the experience from the onset of the symptoms until the results of the diagnosis. The theoretical model contributed to the understanding of the constructed meanings and the conditions that affect the woman and her family, and guide the family organization and communication.

A gestação e os primeiros tempos da vida de um bebê são fundamentais para o estabelecimento do vínculo com seus pais; além de garantir sua sobrevivência, fornecem matéria-prima para as tramas de seu psiquismo, formando um solo no qual se desenvolverão suas relações ao longo da vida. Concomitante a essa construção, transcorre um processo análogo com os pais, que se vão construindo gradativamente nessa condição ao se relacionar com o filho. No entanto, esses primeiros tempos podem ter um forte impacto em quem gera e cuida do bebê. Assim, a finalidade deste estudo é iluminar as vivências psíquicas da mulher no pós- -parto e verificar que recursos desenvolve para lidar com o trabalho psíquico necessário para enfrentar os lutos e construir e exercitar a parentalidade. Por meio de uma pesquisa qualitativa balizada teoricamente pela psicanálise, estudaram-se cinco duplas mãe-bebê. Houve ao menos quatro encontros como cada dupla: pelo menos um na gestação e três após o parto (uma semana, um mês e dois meses). Os encontros gestacionais se deram num lugar escolhido pela participante e os no puerpério, em sua casa. Com o instrumental da psicanálise, fizeram-se entrevistas semidirigidas e observação da relação que a mãe estabelecia com o bebê e com a pesquisadora. Analisou-se cada caso em separado e se verificaram possíveis confluências entre eles. Tendo em conta a especificidade do funcionamento psíquico materno e o impacto das exigências de um filho para quem deve ajudá-lo a viver, a pesquisa revelou a importância de considerar a amplitude dos fenômenos de gestar e cuidar. Esse papel, que toda mãe deve exercer, foi vivido, ao menos num primeiro momento, como brutal e desorganizador não só pela mulher, mas por toda a família. As dificuldades de se metabolizarem essas vivências e as perdas inerentes ao processo por exemplo, o bebê ideal, a maternidade idealizada, o narcisismo, o ritmo anterior e a rotina, entre outras podem prejudicar a construção e o exercício da parentalidade e mesmo obstar a superação do baby blues, eventualmente desencadeando fenômenos depressivos (manifestos ou encobertos). Os ganhos reais decorrentes da chegada do bebê podem ser vividos a partir desse contato com as perdas e de sua elaboração. Concluiu-se também que se devem construir mecanismos de prevenção e cuidados para a família nesses primeiros tempos de vida do bebê, com a colaboração entre as várias disciplinas envolvidas e com políticas de saúde pública. Entre as questões levantadas a esse propósito, alerta-se para o risco de se negligenciarem ou, no outro extremo, patologizarem as dores inerentes à delicada construção da parentalidade / Gestation and the first times in a babys life are fundamental to the establishment of bonds with the parents; apart from guaranteeing their survival, it provides the basis for the webs of their psychism, forming the ground on which their relationships will develop throughout their life. Concomitant to this construction, the parents go through an analogue process, gradually building themselves in this condition as they relate to the child. However, these first times may have a strong impact on who generates and cares for the baby. Thus, the aim of this study is to enlighten the womans post-partum psychic experiences and to verify the resources developed to cope with the psychic work necessary to face the grieves and to build and exercise parenthood. Through a qualitative research theoretically bound by psychoanalysis, five mother-baby pairs were studied. There were a minimum of four encounters with each pair: at least one on gestation e three post-partum (one-week, one-month and two-month old). The gestational meetings took place at a location chose by the participant and the puerperium encounters, at her home. With psychoanalysis instrumental, semi-guided interviews and observation of the relationship established by the mother with the baby and with the researcher took place. Each case was separately analyzed and possible confluences between them were verified. Taking into account the specificity of the psychic maternal functioning and the impact of the demands of a child on who must help them live, the research revealed the importance of considering the amplitude of the carrying and caring phenomena. This role, that all mothers must play, was experienced, at least at first, as brutal and disorganizing not only by the woman, but by the whole family. The difficulties of metabolizing these experiences and the losses inherent to the process for instance, the ideal baby, idealized motherhood, narcissism, the previous rhythm and the routine, among others may damage the construction and the exercise of parenthood and even thwart the overcoming of the baby blues, eventually unfolding depressive phenomena (manifest or covered). The real gains resulting from the babys arrival may be lived from this contact with the losses and its elaboration. It was also concluded that prevention and care mechanisms for the family must be built in these first times of the baby\'s life, with collaboration between the various disciplines involved and with public health policies. Amongst the issues raised to this purpose, an alert is made to the risk of neglecting or, on the other end, pathologizing the pains inherent to the delicate construction of parenthood

Childbirth can be associated with short and long-term psychological morbidity including depression, anxiety and trauma symptoms. Some previous studies have used psychological interventions to reduce postpartum distress but have primarily focussed on attempting to relieve symptoms of depression with little recognition of trauma symptoms. Furthermore, the intervention used in these studies has generally been poorly documented. The first aim of the present study was to develop a counselling framework, suitable for use by midwives, to address psychological trauma following childbirth. Multiple methods were used to develop the intervention including focus groups with women and midwives. Both the women and midwives gave unequivocal support for postpartum debriefing. Themes that emerged from the focus groups with women included the need for opportunities to talk about their birth experience, an explanation of events, an exploration of alternative courses of action that may have resulted in a different birth experience, talking about their feelings such as loss, fear, anger and self-blame, discussing social support, and discussing possible future childbearing. There was a high level of agreement between the women's and midwives' views. These themes were synthesized with contemporary literature describing counselling interventions to assist in reconciling a distressing birth experience and a model for understanding women's distressing birth experiences to develop a counselling framework. The counselling intervention was then tested using a randomised controlled study involving 400 women recruited from antenatal clinics of three public hospitals. When interviewed within seventy-two hours of birth, 103 women reported a distressing birth experience and were then randomised into either the treatment or control group. Women in the intervention group had the opportunity to debrief at the initial postpartum interview (< 72 hours postpartum) and at four to six weeks postpartum. The prevalence of posttraumatic stress disorder was quite high; 9.6% of participants meeting the diagnostic criteria for acute PTSD at four to six weeks postpartum. Fewer participants (3.5%) met the diagnostic criteria for chronic PTSD at three months postpartum. As with previous research relating to childbearing women, few demographic factors or antenatal psychological factors were associated with the development of a PTSD symptom profile following childbirth. The development of PTSD symptom profile was strongly associated with obstetric intervention and a perception of poor care in labour. This finding is also consistent with previous research. Emotional distress was reduced for women in the intervention group in relation to the number of PTSD symptoms [t (101) = 2.144, p = .035], depression [c2 (1) = 9.188, p = .002], stress [c2 (1) = 4.478, p = .029] and feelings of self-blame [t (101) = -12.424, p <.001]. Confidence about a future pregnancy was higher for these women [t (101) = -9.096, p <.001]. Although there was not a statistically significant difference in the number of women with a PTSD symptom profile at three months postpartum, fewer women in the intervention group (n=3) than in the control group (n=9) met PTSD criteria. Likewise, there were fewer women in the intervention group (n=1) with anxiety levels above mild than in the control group (n=6). Importantly, this study found that offering women who have had a traumatic birth the opportunity for counselling using the framework documented in this dissertation was not harmful. This finding is in contrast to previous findings of other studies. The intervention was well received by participants. All the women in the intervention group found the counselling sessions helped them come to terms with their birth experience. Maternity service providers need to be cognizant of the prevalence of this debilitating condition and be able to identify women at risk for early intervention and referral to a mental health practitioner if appropriate. This research offers further support for the compelling need to implement changes to the provision of maternity services that reduce rates of obstetric intervention and humanise service delivery as a means of primary prevention of birth-related PTSD.

Bakgrund: En moder som lider av post partum depression har svårare att knyta an till sitt barn. Barnets kognitiva och känslomässiga utveckling kan då hämmas. Det är viktigt att tidigt upptäcka dessa mödrar för att på så vis kunna erbjuda stöd och förkorta moderns sjukdomstid. Syfte: Syftet var att belysa BVC-sjuksköterskors erfarenheter av att ge stöd till mödrar med post partum depression. Metod: Datamaterialet analyserades med kvalitativ innehållsanalys med induktiv ansats. Data insamlades genom intervjuer med åtta BVC-sjuksköterskor med specialistexamen som distriktssköterska verksamma inom barnhälsovård. Resultat: Ur analysen av datamaterialet framträdde sex kategorier så som; följsam till moderns behov, erbjuda råd och vägledning, bygga upp moderns insikt om post partum depression, initiera samarbete runt modern, känsla av egen otillräcklighet, kommunikationsproblem med 14 underkategorier. Konklusion: För att kunna erbjuda modern ett optimalt stöd behöver en relation byggd på förtroende skapas mellan BVC-sjuksköterskan och modern. Kommunikation är ett viktigt verktyg för att skapa tillit vilket är en förutsättning för relationen. / Background: A mother who is suffering from post partum depression has difficulties with the attachment to her child. As a result of this, the child’s cognitive and emotional development can be harmed. It is important to detect these mothers at an early stage, to offer support in order to shorten the time of suffering. Aim: The aim of this study was to illustrate child health care nurses’ experiences of giving support to mothers with postpartum depression. Method: The data were analyzed using qualitative content analysis technique with inductive approach. Eight interviews with child health care nurses’ who work with childrens’ health care were performed. Results: Six categories emerged from the analysis; Responsive to the needs of the mother, offer advice and guidance, build awareness of postpartum depression, initiate collaboration around the mother, sense of their own inadequacy, communication problem and 14 subcategories. Conclusion: In order to offer the mother optimal support needs a relationship between the child health care nurse and the mother be created, which is built on trust. Communication is an important tool to build trust, which is essential for the relationship.