Bakgrund: 10-15% av alla nyblivna svenska mödrar drabbas idag av postpartum depression, även kallat förlossningsdepression. Sjukdomen uppkommer i samband med barnets födelse och utvecklas oftast inom två månader efter förlossningen. Postpartum depression påverkar moderns självbild och kan skapa problematik i anknytningen mellan modern och det nyfödda barnet. Syfte: Belysa mödrars upplevelser i samband med postpartum depression. Metod: Studien är baserad på sex självbiografier och är genomförd utifrån en kvalitativ ansats där resultatet har bearbetats med stöd av en manifest innehållsanalys. Resultat: Det framkom fem huvudkategorier: Lycka blev en obekant känsla, Förväntningarna på moderskapet uppfylldes inte, En främling för sig själv fångad i negativa tankar, När bägaren rann över samt Ljusa stunder. Ett tydligt fynd är att mödrarna känner stor besvikelse över att förväntningarna på postpartum perioden inte överensstämmer med verkligheten samt oförståelse över sina negativa tankar som överrumplade dem. Slutsats(er): Resultatet påvisar att postpartum depression måste synligöras bättre för att fler mödrar som drabbats ska våga söka hjälp. En bredare kunskap inom vården kan möjliggöra att postpartum depression uppmärksammas bättre.  Även allmänsjuksköterskor bör lära sig att uppmärksamma sjukdomen för att kunna fånga upp dessa mödrar i ett tidigt skede.

Yes / Poor perinatal mental health, in particular depression, affects at least 10% of new mothers in the UK. Current best practice recommends the use of talking therapies or medication, however, many women choose not to use medication or are deterred from accessing NHS services for example due to immigration status. Those who can access NHS treatment often face a long waiting list to see a clinician or therapist. Untreated perinatal depression impacts on the health and wellbeing of mothers and babies, consequently it is essential that alternative psychosocial interventions delivered by non-clinicians are considered. A systematic review was conducted on seven quantitative studies examining the effect of psychosocial interventions in reducing maternal symptoms of depression. Interventions focused either on physical activity or peer support, measuring depression scores on a validated screening tool. The review concludes that antenatal group peer support may benefit women in the antenatal period and that postnatal peer telephone support may be helpful for primiparous women but further large scale research is required.

<p><strong>ABSTRACT</strong></p><p><strong>Background</strong></p><p>Postpartum depression (PPD) occurs in 10% of women who have recently given birth. Postpartum depression is treatable but unidentified and untreated it could lead to serious consequences. There are multiple instruments for screening available. The Edinburgh Postnatal Depression Scale is the most frequently used and is regarded as the best instrument.</p><p><strong> </strong><strong>Aim</strong></p><p>The aim of this study was to analyze to what extent and how midwifes and primary care nurses identify mothers with symptoms of depression respectively PPD. A further aim was to enquire if there are routines for follow up and if there is any collaboration among the professions?</p><p><strong>Method</strong></p><p>A descriptive and comparative design with collection of quantitative and qualitative data was chosen. Midwifes (n=20) and primary care nurses (n=26) at 9 primary care centres answered a questionnaire concerning PPD.</p><p><strong>Results</strong></p><p>Almost all of the primary care nurses reported that they used EPDS as a screening instrument. They also described signs of depression/PPD. Midwifes and primary care nurses had some education in PPD, but there was a need for more education. Even if there was some collaboration among the professions there still was a wish for an increase of co-working.</p><p><strong>Conclusion</strong></p><p>EPDS-screening and referrals to psychologist, physicians and psychiatrists are routines used to identify PPD and also for follow-ups. The midwifes have not received education and does not use EPDS-screening in the same extension as the primary care nurses.</p><p><strong> </strong></p><p><strong></strong></p>

ABSTRACT Background Postpartum depression (PPD) occurs in 10% of women who have recently given birth. Postpartum depression is treatable but unidentified and untreated it could lead to serious consequences. There are multiple instruments for screening available. The Edinburgh Postnatal Depression Scale is the most frequently used and is regarded as the best instrument. Aim The aim of this study was to analyze to what extent and how midwifes and primary care nurses identify mothers with symptoms of depression respectively PPD. A further aim was to enquire if there are routines for follow up and if there is any collaboration among the professions? Method A descriptive and comparative design with collection of quantitative and qualitative data was chosen. Midwifes (n=20) and primary care nurses (n=26) at 9 primary care centres answered a questionnaire concerning PPD. Results Almost all of the primary care nurses reported that they used EPDS as a screening instrument. They also described signs of depression/PPD. Midwifes and primary care nurses had some education in PPD, but there was a need for more education. Even if there was some collaboration among the professions there still was a wish for an increase of co-working. Conclusion EPDS-screening and referrals to psychologist, physicians and psychiatrists are routines used to identify PPD and also for follow-ups. The midwifes have not received education and does not use EPDS-screening in the same extension as the primary care nurses.

Magister Public Health - MPH / Common perinatal mental disorders (CPMDs) are increasingly being recognised as an important public health issue including depression and anxiety. In low and middle income countries such as Rwanda, CPMDs are prevalent among women in perinatal period. In Africa, the estimated prevalence rates of depression are 11.3% and 18.3% during ante-postnatal respectively, while ante-postnatal anxiety rates are 14.8% and 14% respectively. However, in Rwanda there is limited literature on CPMDs. This study was aimed at determining the occurrence of CPMDs in a selected district hospital of the Eastern Province in Rwanda as well as the factors associated with CPMDs in the selected study area. A descriptive quantitative cross-sectional survey was conducted with a sample of one hundred and sixty five mothers in perinatal period, who were selected systematically. Demographic data and factors associated with CPMDs were determined using structured questionnaire and combined screening tools such as Zungu Self-rating anxiety scale (SAS) and Edinburgh Postnatal Depression Scale (EPDS). The Cronbach alpha values were 0.87 and 0.89 for SAS and EPDS respectively. SPSS Version 21 was utilized to analyse data. Univariate, bivariate correlational and multivariate analyses were performed. Most of the respondents (38.2%) were aged 25-29 years; Protestants (77.6%); married (44.8%); unemployed (77%) and had a primary school level of education (60.6%). With respect to participants in antenatal period (51.5%); 14.5% had a clinical level of anxiety and 19.4% had depression. In terms of participants in postnatal period (46.7%); 22.5% had a clinical level of anxiety and 29.7% had depression. However, participants in both periods (1.8%) all had a normal level of anxiety and 1.2% had depression.

Bakgrund: En postpartumdepression uppstår i samband med förlossningen och drabbar mellan 8–15 procent av alla nyförlösta kvinnor varje år bara i Sverige. Någon enskild orsak till tillståndet finns inte men sociala och psykologiska, socioekonomiska, traumatiska och stressrelaterade händelser, brist på socialt stöd och en tidigare historik av depression har påvisats vara betydande riskfaktorer för utvecklingen av tillståndet. Att drabbas av en postpartumdepression innebär ett stort lidande hos den drabbade kvinnan men påverkar även hela familjen. Det är av betydande vikt att tidigt kunna ställa en diagnos för att minska negativa konsekvenser i familjen. Syfte: Syftet var att belysa kvinnors upplevelser av postpartumdepression. Metod: En litteraturöversikt med grund från tio vetenskapliga artiklar av kvalitativ metod utfördes. Artiklarnas olika tema identifierades, jämfördes och analyserades för att sedan kategoriseras i de slutgiltiga teman som presenterades i detta arbete. Resultat: Resultatet består av två huvudsakliga teman och fem subteman; Att leva med postpartumdepression med subteman det förväntade moderskapet och stigmatisering och dess påverkan; Barriärer i vården med subteman behov av stöd, svårigheter att söka hjälp och normalisering i vården. Många kvinnor upplevde en bristande information och kunskap kring tillståndet. I resultatet framkom det att stigmatiseringen kring psykisk ohälsa och postpartumdepression resulterade i en rädsla att mötas av oförstående och fördomsfullhet. Vidare framkom det avgörande faktorer för hur kvinnorna upplevde svårigheter i sin kontakt med vården. Diskussion: Författaren diskuterar valda delar ur det framkomna resultatet i litteraturöversikten utifrån aktuell forskning, egna reflektioner och Phil Barkers tidvattenmodell. / Background: Postpartum depression is a serious form of depression that affects between 8-15 percent of all women just in Sweden every year. No individual cause of the condition exists, but social and psychological, socio-economic, traumatic and stress-related events, lack of social support and a previous history of depression have been shown to be significant risk factors for the development of the condition. Suffering from a postpartum depression means a great suffering for the affected women but it also affects the whole family. An early diagnosis is important in order to reduce negative consequences regarding family. Aim: The aim of this study was to explore women's experiences of postpartum depression. Method: A literature review based on ten scientific articles of qualitative method was conducted. The different themes of the articles were identified, compared and analyzed and then categorized into the final themes presented in this work. Results: The result consisted of two main themes and five subthemes; To live with postpartum depression with the subthemes the expected motherhood and stigmatization and it´s impact; Barriers in health care with the subthemes need for support and difficulties in seeking help and normalization in health care. Many women experienced a lack of information and knowledge about the condition. The result showed that the stigma surrounding mental illness and postpartum depression resulted in a fear of being confronted by ignorance and prejudice. Decisive factors emerged as to how women experienced difficulties in their contact with health care.  Discussion: The author discusses selected parts of the result obtained in the literature review based on current research, own reflections and Phil Barker´s The Tidal Model

The aim of this thesis was to increase understanding of how rumination, defined as the behaviours and thoughts that focus an individual’s attention on their depressive symptoms and on the implications of these symptoms (Nolen-Hoeksema, 1991), affects the relationship between postnatal depressive symptoms and maternal sensitivity. Study 1 examined the impact of self-reported maternal rumination on perceived maternal attunement and mood, and the role of perceived social support and infant temperament in this relationship in a community sample of mothers (N = 203). Rumination mediated the relationship between maternal depressive symptoms and maternal responsiveness when infant negative affect was low but not high. Contrary to predictions, rumination did not mediate the relationship between social support and maternal attunement. Study 2 incorporated a second assessment point approximately six months later with the same sample. Prospective analyses were undertaken to examine the directional relationship between rumination and maternal attunement in the context of depressive symptoms. Unexpectedly, analyses revealed that maternal bonding prospectively predicted rumination at six months, after controlling for rumination at baseline. The converse relationship was not significant. This was contrary to the thesis hypothesis that increased rumination would predict impaired attunement at six months. Partially consistent with the thesis hypotheses, the relationship between rumination and maternal attunement was moderated by depressive symptoms at baseline; such that mothers who were low in depressive symptoms and had lower bonding at baseline reported higher levels of rumination at 6 months. Study 3 also explored the directional relationships between maternal mood, rumination and maternal attunement at a state level in a daily diary study with a community sample of mothers (N = 94) with infants aged between 3 and 14 months. Consistent with the findings of study 2, state maternal bonding at Time 1 predicted both state maternal rumination and state maternal mood at Time 2, and state rumination at Time 2 mediated the relationship between state bonding at Time 1 and state mood at Time 2. In the final study, the causal relationships between an experimentally induced state of ruminative thinking and observed maternal behaviours in a mother-infant interaction task were examined in a sample of dysphoric and non-dysphoric mothers (N = 79) and their infants. The analyses examined change in mother-infant interaction quality from baseline to post rumination induction, and subsequent change following an infant stressor task. Findings revealed a significant reduction in maternal sensitivity and mother-infant dyadic synchrony in the rumination group, but not the control group. For maternal sensitivity, the effect of rumination was exacerbated following the stressor task. Contrary to predictions, this relationship was not moderated by dysphoric symptoms. The findings of this thesis indicate that ruminative thinking directly impairs observed maternal behaviours, but that perceived poorer maternal attunement also increases self-reported ruminative thinking. The significance of these findings for theoretical explanations of rumination in a postnatal context are considered, and the clinical implications for parenting programmes and interventions for both mothers in the community as well as those considered at risk are discussed.

Purpose: Postnatal depression (PND) has significant negative outcomes for both mother and baby. The literature indicates that cognitive behavioural interventions can be effective and efficacious treatments, less is known about what mechanisms underpin change in such interventions. The present study aimed to explore severity of depression as a moderator and Behavioural Activation (BA) as a possible mediator of treatment outcome in an online BA intervention for PND. Methods: Follow-up of postnatal women participating in a feasibility Randomised Controlled Trial (RCT) of Netmums, an online BA treatment with telephone support. Results: There was no evidence to support the hypothesis that severity of depression acted as a moderator for treatment outcome. No mediation effects for BA were found. Rumination and avoidance did predict treatment outcome, but this did not differ between the treatment and control group. Post Hoc sudden gains analysis revealed that 48.90% of the treatment group sample experienced a sudden gain. Those who experienced a sudden gain had better post intervention outcomes. Conclusions: The findings have important implications for both theory and the design of future interventions. Future research should consider collecting weekly measures from both treatment and control groups.

Paper one is a systematic review aimed at improving our understanding of the culturally determined risk factors of postnatal depression (PND) within 'Sub-Saharan Africa', by integrating evidence from quantitative and qualitative studies. A mixed-method systematic review approach was employed, nine quantitative and three qualitative studies were quality assessed, synthesised, and integrated. Stressful life events, adhering to cultural values and traditions, the effects of negative cultural perceptions and difficulties within the African extended family system were found to be risk factors for the development and maintenance of PND in Sub-Saharan Africa. The objective of paper two was to explore the lived experience of postnatal depression in West African mothers living in the UK. A qualitative design using semi-structured interviews with six West African mothers (Nigeria = 3; Ghana = 3) who were experiencing low mood in the postnatal period was undertaken. Participants were recruited from mother and baby groups within the National Health Service. Interpretative Phenomenological Analysis was used to explore and analyse the data. Five overarching themes emerged: (1) conceptualiszing PND, (2) isolation, (3) loss of identity, (4) issues of trust and (5) relationships as a protective factor. Each theme consisted of a number of subthemes. Women exhibited symptoms of PND but did not regard it as an illness, with the name 'depression'. They viewed their emotional distress as a result of social stress, and described feelings of isolation, loss of identity and relationship difficulties. Women's cultural background influenced their help-seeking behaviour; participants often avoided talking about their feelings and kept their distress to themselves. The findings have clinical implications in how services should be designed to meet the needs of African communities. Paper three reflects on the process of developing culturally competent research through the development of the current thesis. Suggestions for future research and reflections on the strengths and limitations of the research process are embedded throughout. Clinical implications are discussed with reference to a community psychology model.

Omega-3 fatty acids are increasingly recognised as playing an important role in human brain development and mental health. The polyunsaturated fatty acids (PUFAs) include omega-3 and omega-6 fats which are essential fatty acids (EFAs), consumed via the diet. Omega-3 fatty acids are particularly abundant in fish oils. The omega-3 fatty acids are being focused on for their role in depression, the main types being docosahexaenoic acid (DHA), which is abundant in neural tissue, and also eicosapentaenoic acid (EPA) which is biologically very active. There is an emerging literature in relation to omega-3 fatty acid blood levels in depression and the effects of treatment with omega-3. Strong epidemiological evidence has also been published indicating an association between a population's fish intake and depression rates. A specific research focus on omega-3 as a treatment for depression in the perinatal period is also starting to emerge. The importance of this particular area is enhanced by the knowledge that omega-3 depletion occurs during the perinatal period due to fetal diversion for neurodevelopment. In view of the lay public promotion of omega-3 and its appeal to women as a 'natural therapy', there is a need to scientifically evaluate its effectiveness to treat depression in the perinatal period. It is also important to investigate omega-3 as an alternative to antidepressants given the ongoing uncertainties regarding their safety in pregnancy. In this thesis a literature review presents current research relating to this field. This is followed by a description of the methodology and results for the two trials conducted. The results of the double-blind randomised placebo controlled trial of omega-3 as a treatment for depression in the perinatal period were essentially negative. However this result is limited by the small sample size in the study and therefore it may be unwise to interpret the result as conclusive. The case-control study confirmed the hypothesis that omega-3 levels were more depleted in depressed women compared to non-depressed women. A discussion of the results and trial limitations then follows in the thesis. It is concluded that further larger studies are warranted in this area.