Thesis (MCur)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Mental health is still the step-child of Health Services, although many studies show the serious negative impact it has on the mother, baby and the family. Knowledge about Postnatal Depression (PND) and associated risk factors which influence the development of PND is vital for early detection and intervention. Worldwide PND affects on average 10-15% of women after giving birth regardless of socio-economic status, race or education. Studies also reveal that the prevalence of PND is as high as 40-60% amongst women after giving birth. The goal of the study was to investigate the prevalence and factors influencing PND in a rural setting, in the Witzenberg Sub-district. The objectives included determining the prevalence of PND and identifying the contributing risk factors associated with PND. A descriptive explorative research design with a quantitative approach was applied. The target population was (N=1605) mothers, 18 years and older who gave birth in this Sub-district in one year, a convenience sampling method was used to select the study sample of (n=159/10%) participants who met the criteria and who gave voluntary permission to take part in the study. Validity and reliability was supported through the use of validated questionnaires EPDS and BDI including a questionnaire based on demographical, psychosocial and obstetrical data. In addition experts in statistics, nursing and psychiatry were consulted including language experts who validated the correctness of the Afrikaans and Xhosa translated questionnaires. A pilot study was conducted to test the feasibility of the study and all data was collected personally by the researcher with the support of two trained field workers. Ethics approval was obtained from Stellenbosch University and permission from the Department of Health, Provincial Government of the Western Cape, including informed written consent from each participant. The data was analysed with the assistance of a statistician and are presented with histograms and frequency tables. The relationship between continuous response variables and nominal input variables was analysed using analysis of variance (ANOVA). Various statistical tests were applied to determine statistical associations between variables such as the chi-square tests using a 95% confidence interval. Non-parametric tests such as the Mann-Whitney U–test or Kruskal-Wallis test were used for randomised design. Levene’s test was used for Homogeneity of Variance and the Bonferonni test of probability. The study revealed that 50.3% of the mothers, who participated in the study, had PND. Various risk factors were determined in this study that influences the development of PND. Results include statistical associations between PND and the following: - unplanned babies and unwelcome babies (p=<0,01) - life events (p=0.01) - partner relationship (p=<0.01) - family and social support (p=<0.1) Furthermore, the majority of the participants (53.8%) with PND (n=80) had a history of a psychiatric illness which was shown with significance (p=<0.01), the majority of the participants (63.5%) were unmarried and 23.8% were teenagers who suffered from PND. Recommendations include promoting healthy lifestyles, empowerment of women, prevention of teenage pregnancies, early and holistic assessment for symptoms of PND and approriate referral. In conclusion the prevention and promotive measures, early detection of PND and appropriate referrals and treatment are critical in managing maternal, child and family well being. / AFRIKAANSE OPSOMMING: Geestesgesondheid blyk die stiefkind van gesondheidsdienste te wees, ten spyte daarvan dat navorsing die negatiewe impak wat dit op moeder, baba en die gesin het bevestig. Kennis van postnatale depressie (PDN) en verwante risiko faktore wat die ontwikkeling van PND beïnvloed is van uiterste belang vir die vroeë opsporing en ingryping daarvan. PND affekteer gemiddeld 10%-15% van vroue wêreldwyd wat dit ervaar nadat hulle geboorte geskenk het, ongeag sosio-ekonomiese status, ras of opleiding. Navorsing dui daarop dat die voorkoms van PND so hoog is soos 40%-60% onder vrouens nadat hulle geboorte geskenk het. Die doel van hierdie studie was om die prevalensie van PND en die faktore wat PND beïnvloed in ’n landelike nedersetting in die Witzenberg Subdistrik te ondersoek. Die doelwitte sluit die bepaling van die prevalensie van PND in en die identifisering van die risiko faktore wat daartoe aanleiding gegee het. ’n Beskrywende verkennende navorsingsontwerp met ’n kwantitatiewe benadering is toegepas. Die teikengroep was (N=1605) moeders, 18 jaar en ouer wat geboorte geskenk het in hierdie subdistrik binne een jaar. ’n Gerieflikheidssteekproef metode is gebruik om die deelnemers (n=159/10%) te selekteer wat aan die kriteria voldoen het en vrywillig toestemming gegee het om aan die studie deel te neem. Geldigheid en betroubaarheid is gerugsteun deur die gebruik van geldige vraelyste, naamlik EPDS en BDI wat ’n vraelys insluit wat gebaseer is op demografiese, psigososiale en verloskundige data. Hierbenewens is deskundiges in statistiek, verpleegkunde en psigiatrie geraadpleeg, asook taalkundiges wat die taalkorrektheid van Afrikaans en Xhosa vertaalde vraelyste nagegaan het. ’n Loodsondersoek is uitgevoer om die haalbaarheid van die navorsing te toets en alle data is persoonlik deur die navorser met die hulp van ’n opgeleide veldwerker ingesamel. Etiese goedkeuring is verkry van die Universiteit van Stellenbosch en toestemming van die Departement Gesondheid, die Provinsiale Regering van die Wes-Kaap, asook skriftelike toestemming van elke deelnemer. Die data is ontleed met die bystand van ’n statistikus en is deur frekwensie tabelle aangebied. Die verhouding tussen volgehoue/aaneenlopende respons veranderlikes en nominale inset/invoer veranderlikes is ontleed deur gebruik te maak van die analise van variansie (ANOVA). Verskeie statistiese toetse is toegepas om die statistiese assosiasies tussen veranderlikes vas te stel soos die chi-kwadraat toetse deur ’n 95% betroubaarheidsinterval te gebruik. Nie-parametriese toetse soos die Mann-Whitney U-toets of Kriskal-Wallis toets is gebruik vir ewekansige ontwerp. Levene se toets is gebruik vir homogeniteit van variansie en die Bonferonni toets vir waarskynlikheid. Die toets het bewys dat 50.3% van die moeders wat aan die studie deelgeneem het, het PND. Verskeie risiko faktore is in hierdie studie vasgestel wat die ontwikkeling van PND beïnvloed. Resultate sluit statistiese assosiasie tussen PND en die volgende in: - onbeplande babas en onwelkome babas (p=<0,01) - lewensgebeure (p=0.01) - lewensmaat verhoudings (p=<0.01) - familie en maatskaplike ondersteuning (p=<0.1) Vervolgens het die meeste van die deelnemers (53.8%) met PND (n=80) ’n geskiedenis van ’n psigiatriese siekte met ’n beduidenis (p=<0.01), die meeste van die deelnemers (63.5%) is ongetroud en 23.8% is tieners wat aan PND ly. Aanbevelings sluit die bevordering van gesonde leefstyle, die bemagtiging van vrouens, voorkoming van tienerswangerskappe, vroeë en holistiese assessering van simptome van PND in en die aangewese verwysing. Daar kan tot die slotsom gekom word dat voorkoming- en bevorderingsmaatstawwe, vroeë opsporing van PND en aangewese verwysings en behandeling, krities is in die hantering van moeder-, kind- en gesinswelstand.

Background: The present study considers some of the underlying mechanisms that may be acting in postnatal depression (PND). It has been suggested that rumination predicts problem solving ability and that child temperament and maternal attributions predict mother-infant bonding. This study aims to investigate the role that brooding and reflective rumination may play in predicting and mediating these relationships in postnatal women. Methods: Postnatal women were recruited to complete an online survey.190 women responded and completed the Edinburgh Postnatal Depression Scale (EPDS), Maternal Attribution Scale (MAS), Postpartum Bonding Questionnaire (PBQ), Parental Problem Solving Task (PPST), Rumination Response Scale (RRS), Infant Behaviour Questionnaire (IBQ) and a confidence in problem solving using a Visual Analogue Scale (VAS). Results: Analyses showed that reflective rumination mediated the relationship between low infant soothability and high negative attributions, on maternal problem solving. Reflective and Brooding Rumination also predicted confidence in problem solving and mother-infant bonding. Analyses showed that infant temperament (soothability and distress) and maternal attributions (positive and negative) predicted confidence in problem solving and mother-infant bonding Limitations: This study employed a correlational design and therefore all inferences regarding possible causal pathways are tentative. Limitations include the use of self report measures to assess mother-infant bonding and infant temperament. Additionally the PPST is a new measure which needs further validation. Conclusions: Reflective rumination may act as an adaptive strategy for women in the postnatal period when faced with difficult child temperaments, and for those employing negative attributions, when faced with parent specific problem solving tasks. In addition, Brooding and Reflective Rumination may be important in predicting difficulties in mother-infant bonding. Difficult Infant temperaments and less positive or more negative maternal attributions, may affect problem solving, confidence in problem solving and mother-infant bonding in the postnatal period. Future research should look to replicate these findings and explicate possible causal relationships within a postnatal population.

Following decades of research on stress and its impact on behaviour, it is now widely accepted that selective psycho-pathologies, in particular clinical depression are more prevalent in humans with prior history of life-stress events. Interest in stress has led to questions about how it might affect the physiology and behaviour of animals exposed indirectly during gestational development. Not unexpectedly gestational stress has been shown to affect the offspring in several ways: endocrine responses to stress are elevated, fear, arousal and affective disturbances are all subject to vary if the pregnant animal is subjected to periods of aversive stimulation. Beginning in 1997, Michael Meaney of McGill University produced a series of publications suggesting that peri-natal events influence offspring and infant development, not via physical discomfort or physiological disturbance, but does so through modifications of maternal behaviour. Highly nurturant mothers (those who engage in active arched-back nursing (ABN), and spend more time licking and grooming (L/G) their pups), programme their offspring with improved cognitive abilities, decreased anxiety and fear, and reduced HPA axis hormone secretion. Low-nurturant mothers, who engage in less ABN and less L/G, tend to programme the opposite responses in their offspring. Our initial foray into this field was to investigate if gestational stress might also produce responses in the offspring via changes in maternal behaviour, and indeed ABN and L/G were reduced in dams which were subjected to gestational stress. We queried why stressed Dams would be less maternal towards their infants, and tested gestationally-stressed Dams in the Porsolt test for depressive-like behaviour. Our results suggested that these stressed Dams were actually depressed and this resulted in less maternal behaviour. Human mothers with depression are also less maternal and have been shown to divest themselves of infant care much like our prenatally-stressed Dams. On this basis we have proposed that gestational stress induced decrements in maternal behaviour represent a novel rat model for postnatal depression with face and construct validities. In the present work we have attempted to replicate the findings of Smythe's group (Smith et al., 2004), and have investigated the potential for antidepressants to alter the influence of gestational stress on maternal behaviours and depressive-like response, and whether or not the offspring are modified by maternal treatment with ant-depressants. Approximately 140 time-mated, lister hooded rats were generated in house, and subjected to gestational stress on days 10-20 (1hr restraint/day) or remained undisturbed in their home cages. Following birth, cohorts of control and stressed Dams were administered vehicle or an antidepressant (imipramine 15mg/kg; or sertraline 10mg/kg) once daily until postnatal day 10. We assessed maternal Porsolt activity, nurturance (ABN, L/G, nest building) and anxiety-like behaviour in the elevated plus maze (EPM). Representative offspring of each Dam's treatment conditions were maintained post weaning and assessed in the Porsolt and EPM to determine if any changes in maternal behaviour elicited by the antidepressants altered their behavioural programming. Our findings confirm that Dams show depressive-like symptoms following gestational stress, and that administration of antidepressants to the Dams reduces depressive-like behaviour and increased maternal care. We propose that rat gestational stress is a putative model for human postnatal depression. Prenatal stress effects on maternal behaviour in the rat Dam represent a novel, and innovative model for human postnatal depression.

Background: Postnatal depression (PND) is a global problem and an important public health issue. It is estimated that approximately 15% of women experience depression during the first postnatal year but there are problems in recognition because its clinical assessment can be complex. The incidence of postnatal depression continues to rise resulting in serious consequences for the mother, her child and the extended family and a risk of suicide (the leading cause of maternal death in England and Wales) and infanticide in some severely depressed mothers. Treatment programmes vary considerably but many studies are suggesting that psychological interventions can be as equally, if not more, clinically effective in the management of depression as routine care from a general practitioner or anti-depressants in the short term – and may be more cost effective. Method: The aim of this exploratory pilot study is to identify whether the support, on a one to one basis, from a Peer Support Worker (PSW) would assist in the reduction of PND in new mothers. Eight PSW’s were recruited. Each PSW had previously suffered from mild to moderate postnatal depression but had recovered and were not currently receiving any form of psychological support or taking any medication. They were employed, on a six month contract, by the local NHS Trust. References and enhanced criminal records clearance were obtained. A confidentiality statement was also signed by the PSW. Thirty mothers were recruited by their own Health Visitor. This was carried out using the Edinburgh Postnatal Depression Scoring documentation (EPDS) alongside a clinical assessment. The cut off score, as agreed by both the lead researcher and the Health Visitors involved in the study, was 11. Fully informed consent was obtained and participant information sheets given. The mothers were allocated into either a Control group or an Intervention group using number alternating. The PSW’s received formal training about child protection procedures/safeguarding children in addition to the relevance and importance of confidentiality. However, apart from this, a structured training programme was not adhered to. The PSW’s strongly felt, as a combined group, that they wanted to provide the intervention simply as a ‘fellow mum who had survived the rollercoaster journey of PND’. Each PSW wanted to identify the nature of the problem, find a possible solution, and design their own proposed ‘support package’ – from the outset of the study. The PSW visited the mother in their home environment, or a location of their choice, for a period of six weeks on a once weekly basis (intervention group). This was then compared to a number of mothers who received support from their family Health Visitor (HV) alone (control group). Data collected was both qualitative and quantitative. The PSW's and the mothers from both the control group and the intervention group were asked to maintain a log book reflecting upon their feelings and thoughts after each visit (either from their PSW or their HV). Individual and group supervisory sessions were also offered by the lead researcher to both the mothers within the intervention group, and the control group, in addition to the PSW’s. A number of the participants were interviewed on a one to one basis when their infant was six months old. Data from the interviews was subsequently transcribed, coded and categorised, and key themes identified. Quantitative data was collated in the form of an Edinburgh Postnatal Depression Score (EPDS) – an assessment tool which is routinely used to identify mothers at risk or suffering from postnatal depression. The EPDS score was recorded prior to the support commencing by either a PSW or the Health Visitor, after completion of all six visits, and when the infant was six months old. Analysis: The EPDS scores recorded at 6 weeks, 12 weeks, and again when the infant was six months old, were analysed and summarised using graphs and charts. Non parametric analysis using Friedman’s Anova and the Wilcoxon paired test was carried out. A Mann Whitney test, Kolmogorov-Smirrov test and a Shapiro-Wilk test were also performed. A constant comparative method was used as a means of analysing the qualitative data collected from both log books and interview transcript (Denscombe 2008). The lead researcher consistently read and re-read text data, compared new codes and categories as they emerged and repeatedly compared them against existing versions. This process enabled the researcher to refine and improve the explanatory power of the concepts and theories generated from the data. Similarities and differences were highlighted and categories and codes were identified. On completion of this analysis, all participants were contacted to ensure validity of the findings and that each participant agreed with the researchers interpretation of the data collected. Results: Qualitative and quantitative findings from this study suggest that the input from a PSW does assist in the reduction of PND in new mothers. This is demonstrated in both the analysis of the quantitative data and the qualitative. The EPDS scores demonstrated little difference between the participants at 6 weeks but the statistics started to diverge at 12 weeks – the mean at 12 weeks for the control group is recorded at 12.46 and the intervention group is 10.33 – a difference of 2.13. The EPDS at six months demonstrates a difference between the two scores as 2.67 (the control group mean recording is 11.60 compared with the intervention mean which is 8.93). The key themes identified were the immeasurable value of ‘social support’ and ‘shared experiences’. The resounding factor that appears repeatedly throughout the analysis of data is the fact that the mothers could ‘truly relate to their Worker.’ Their PSW gave them ‘hope’, made them feel as if they were ‘not a failure’ and gave them an overwhelming ‘sense of normality’. This, in turn, increased their self-esteem, their positivity towards their parenting role, and their ability to therefore be ‘a good mother.’ A major strength of the work was the involvement of the PSW’s in both the planning and the implementing of the intervention. It was their design, their creation, and their feelings about what may really help their mother. A number of other themes were also identified that were, interestingly, commonalities across the entire data set (participants and PSW’s). These included recognition of their own changing perspective – a realisation that there simply is no ‘quick fix’ solution, that both time and support are required. The PSW’s described feelings of ‘personal benefit’, ‘self-awareness’ and the ‘provision of closure’ for themselves. The intervention group also talked, at length, about their ‘personal benefit’ from the PSW, and their own self-awareness about how they truly felt, their emotions and, in some instances, why they felt this way. The control group recognised the huge advantage from talking to other mothers and, although they did not have the formal support sessions from a PSW, they embraced the opportunity of sharing their thoughts and feelings with ‘fellow mums’. Each participant, and PSW, discussed the sharing of experiences, empathy, the feeling of ‘release’ and, particularly on the mothers’ part, the importance of knowing that, actually, they are not ‘alone’. Conclusion: The aim of this study was to provide early intervention to mothers who were classed as ‘at risk’ of suffering from PND, and, indeed, the support from the PSW’s did appear to have a positive impact upon the mothers’ mental health and wellbeing. However, this was a small scale, pilot study over a relatively short period of time. Larger, more longitudinal studies are certainly required. The importance of the pilot study presented here lies in its usefulness in shaping research to investigate and explore further whether there are indeed beneficial factors to post-natally depressed mothers who receive one to one support from a PSW. The positive results from this study can, potentially, have a huge impact within practice and, most importantly, upon the lives of those affected by postnatal depression.

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2017-04-24T14:36:33Z No. of bitstreams: 1 Clarissa Martins.pdf: 1616707 bytes, checksum: 7d6ba6c5f2c247d0a5ccd351abde1ebe (MD5) / Made available in DSpace on 2017-04-24T14:36:33Z (GMT). No. of bitstreams: 1 Clarissa Martins.pdf: 1616707 bytes, checksum: 7d6ba6c5f2c247d0a5ccd351abde1ebe (MD5) Previous issue date: 2014-10-28 / This dissertation refers to an epidemiological study of screening scales for depression in pregnant adolescents. The main objective of the research was to adjust the cutoff scales for screening for depression, Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory (BDI), for pregnant teenagers. It is a cross-sectional, population-based study carried out with pregnant adolescents (10-19 years old), which consulted the service prenatal Unified Health System (SUS) of Pelotas. Was carried out from October 2009 to March 2011. The sample was composed based on the SIS-Prenatal program records along the municipal health department and the Basic Health Units, and specialized clinics in the urban area of Pelotas / RS. The women answered a questionnaire with socio demographic and obstetric data, besides the two scales for screening for depression during pregnancy. Also participated in a structured clinical interview Mini International Neuropsychiatric Interview 5.0 (MINI) for the clinical diagnosis of depression. Demographic, obstetric and psychiatric social variables were assessed according to the WHO questionnaire. The accuracy of the scales was calculated by their Area under the curve (AUC) of ROC, as well as their respective sensitivity, specificity and predictive values. The best cutoff (PC) found for this sample was ≥10 EPDS scale, with sensitivity 81.1% and specificity 82.7% and AUC of 0.899. BDI for the best cutoff point was ≥11, sensitivity 81.1%, sensitivity 76.8% and an AUC of 0.869. Since the difference between the two AUC were statistically significant (p = 0, 0215). Based on the results, it is concluded that the EPDS scale has become more predictive and sensitive in screening for depression in pregnant adolescents, with respect to BDI. / A presente dissertação refere-se a um estudo epidemiológico sobre escalas de rastreamento para depressão em gestantes adolescentes. O objetivo principal da pesquisa foi verificar os pontos de corte das escalas para rastreamento da depressão Edinburgh Postnatal Depression Scale (EPDS) e Beck Depression Inventory (BDI), em gestantes adolescentes. Trata-se de um estudo transversal, de base populacional, realizado com gestantes adolescentes (10 a 19 anos de idade), as quais consultaram o serviço de pré-natal do Sistema Único de Saúde (SUS) de Pelotas-RS. Desenvolvido no período de outubro de 2009 a março de 2011. A amostra foi composta com base nos registros do programa SIS-Pré-Natal, junto a secretaria municipal de saúde e nas Unidades Básicas de Saúde, além de ambulatórios especializados na zona urbana de Pelotas/RS. As gestantes responderam a um questionário com dados sócio demográfico e obstétricos, além das duas escalas para o rastreamento da depressão durante a gestação. Também participaram de uma entrevista clínica estruturada Mini Internacional Neuropsychiatric Interview 5.0 (MINI) para o diagnóstico clínico da depressão. As variáveis sócio demográficas, obstétricas e psiquiátricas foram avaliadas nos domínios do questionário da OMS. A precisão das escalas foi calculada através de suas Áreas sob a curva (AUC) de ROC, assim como suas respectivas sensibilidade, especificidade e valores preditivos. O melhor ponto de corte (PC) encontrado para esta amostra na escala EPDS foi ≥10, com sensibilidade 81,1% e especificidade 82,7% e AUC de 0,899. Para a escala BDI o melhor ponto de corte foi ≥11, sensibilidade 81,1%, sensibilidade 76,8% e uma AUC de 0,869. Sendo que a diferença entre as duas AUC mostraram-se estatisticamente significativas (p=0,0215). Com base nos resultados, conclui-se que a escala EPDS apresenta-se mais preditiva e sensível no rastreamento para depressão em gestantes adolescentes, quando contrastada com a escala BDI.

La dépression postnatale (DPN) est un facteur de risque de trouble des interactions précoces mère-enfant et de troubles de santé mentale de l’enfant. Si les programmes de visites à domicile (VAD) en périnatalité ciblent souvent la prévention de la DPN, les résultats sont peu probants.CAPEDP est la première étude contrôlée randomisée de VAD destinée à des familles multirisques d’une telle ampleur menée en France. Ce travail en décrit les résultats sur la DPN. 440 femmes sont recrutées et randomisées en deux groupes : primipares, âgées de moins de 26 ans, et au moins un facteur de risque parmi : un faible niveau d’éducation, des revenus faibles et/ou être isolées. Le groupe intervention bénéficie de VAD menées par des psychologues du troisième trimestre de grossesse aux deux ans de l’enfant. La symptomatologie de la DPN est évaluée à l’inclusion et 3 mois après la naissance avec l’Edinburgh Postnatal Depression Scale (EPDS). A 3 mois post-partum, les scores moyens à l’EPDS sont respectivement de 9.4 (5.4) pour le groupe contrôle et de 8.6 (5.4) pour le groupe intervention (p = 0.18). Pour certains sous-groupes de femmes ayant bénéficié de l’intervention les scores EPDS sont plus faibles que le groupe contrôle : celles avec peu de symptômes dépressifs en prénatal (EPDS<8), celles qui pensent être avec le père pour élever leur enfant, et celles avec un niveau d’éducation supérieur au BEPC. CAPEDP n’a pas démontré d’efficacité pour prévenir la DPN. Les analyses post hoc montrent que l’intervention peut être efficace pour des femmes sans certains facteurs de risque. Il serait utile de développer des recherches plus intégrées dans le dispositif de droit commun. / Postnatal maternal depression (PND) is a significant risk factor for infant mental health. Although often targeted in perinatal home-visiting programs with vulnerable families, little impact on PND has been observed. CAPEDP is the first French randomized controlled trial for multi-risk families evaluating the impact on PND symptomatology of a home-visiting intervention using psychologists in a sample of women presenting risk factors.440 women were recruited at their seventh month of pregnancy. All were first-time mothers, under 26, with at least one of three additional psychosocial risk factors: low educational level, low income, or planning to raise the child without the father. Participants were randomized into either the intervention or the control group. The intervention consisted of intensive multifocal home visits through to the child’s second birthday. The control group received care as usual. PND symptomatology was assessed at baseline and three months after birth using the Edinburgh Postnatal Depression Scale (EPDS).At three months postpartum, mean EPDS scores were 9.4 (5.4) for the control group and 8.6 (5.4) for the intervention group (p = 0.18). The intervention group had significantly lower EPDS scores than controls in certain subgroups of women: with few depressive symptoms at inclusion (EPDS<8), who were planning to raise the child with the child’s father, with a higher educational level.CAPEDP failed to demonstrate an overall impact on PND. However, post-hoc analysis reveals the intervention was effective in subgroups of women without certain risk factors. Effective overall reduction of PND symptomatology may require more tailored interventions.

Becoming a mother is a challenging time and for some women the lifestyle adjustment can be very stressful. In combination with the changes in family structure mothers are increasingly seeking professional support and assistance in the care of their infants and children. Child and family health services in NSW offer varying levels of professional support and education, including 24-hour residential care. The purpose of this study is to explore and describe the mothers' perceptions and experiences of residential admission to a Child and Family Health Unit - Karitane. This study is descriptive in nature. Sixteen English speaking mothers admitted to Karitane in 1998 took part in the study. Focus groups were the main source of data for the study. The focus groups were undirected, conversations recorded and written notes taken. Additional data were collected by a questionnaire to determine the demographic characteristics of the mothers. The mothers' indicators of depression were scored using the Edinburgh Postnatal Depression Scale (EPDS). Each mother completed the EPDS during the admission period and at the time of the focus and respective comparison was made. Data analysis revealed that the mothers' EDPS scores had decreased significantly at the time of the focus group meeting. The key concepts that emerged in the mothers' descriptions of their experiences were the importance of the development of the professional relationship, equity and access to parenting services, particularly for the partner, and the need for services to promote and provide realistic parenting education with an early intervention focus. The implications of the findings lend support to health care professionals in lobbying government for the necessary funds, in providing increased access to quality parenting services. / Master of Nursing (Hons)

The purpose of the research project was to examine the effects of exercise and social support for postnatal women who reported experiencing Postnatal Depression (PND). PND is a serious condition that affects up to 10%-15% of women (O'Hara & Swain, 1996). Many previous studies have reported an improvement of depressive symptomatology following a pram walking intervention. However, no published research exists which assesses postnatal women who report experiencing PND. A randomised controlled trial was used, where pre-test data were compared to post-test effects. Two studies were conducted. In study 1 (n= 20) a multi-intervention group (exercise and social support) was compared to a control group who received no intervention. Study 2 (n= 19) was conducted 20 months later on a different group of women and involved a pram walking intervention group and a comparison social support group. Structured questionnaires assessing depressive symptomatology, general health and levels of social support were administered at pre-test phase, week 6 and 12. A sub-maximal fitness test was conducted the week before the program started and at week 12. The chief investigator was present at all sessions to guide the participants. Study 1 (S1): The multi-intervention group attended 3 pram walking sessions per week. After the exercise session the group met for refreshments in a local hall. The control group was only required to perform the fitness tests and answer the questionnaires. A 6-week alternative program of exercise and social support was offered to all the women at the completion of the intervention period. Study 2 (S2): The pram walking group met for 2 exercise sessions and were required to make up the third session independently. The comparison social support group met once per week for morning tea with the children. The samples for both studies were drawn from the Gold Coast region in Australia. Women of childbearing age who were experiencing depressive symptoms were recruited. For S1 their child had to be less than or equal to 12 months and for S2 the age cut off was increased to less than or equal to 18 months. The participants were screened to ensure that they did not have a medical condition that would prevent regular aerobic exercise and they were also excluded if they had a previous history of mental illness or could not speak English. Demographic data were obtained from each participant and details such as height, weight and age were collected for use in analysing fitness levels. The data for each study were collected across three time points (pre, week 6 and week 12) using widely tested instruments. Some additional questions relating to the participants experiences were collected at the completion of the study from the women allocated to the intervention groups. Data were also collected on fitness levels (pre and week 12) and the instrument was tested for its reliability. Both pram walking intervention groups were required to complete a weekly exercise diary. For each study, to test for the effect of the intervention over time, a two-way analysis of variance was conducted on the major outcome variables. Group (intervention versus control) was the between subject factor and time (pre-test, week 6, week 12) was the within subject factor or repeated measures factor. Due to the small sample size, further tests were conducted to check the assumptions of the statistical test to be used. The results showed that using Mauchly's Test, the Sphericity assumptions of repeated measures for ANOVA were met. Further, tests of homogeneity of variance assumptions also confirmed that this assumption was met. Data analysis was conducted using the software package SPSS for Windows Release 10.0. (Norusis, 2000). Overall, the findings from both S1 and S2 showed that the groups who received the pram walking intervention improved their depressive symptomatology and fitness levels when compared to those of the control (S1) and social support group (S2). Social support levels did not alter for either group from both studies. These results are encouraging and suggest that a pram walking program is an effective form of intervention for postnatal women experiencing depressive symptomatology.

Paternal postnatal depression has begun to receive attention during the last decade. Studies have shown that the consequences of paternal and maternal postnatal depression are equally serious. There are currently no validated instrument for screening of paternal postnatal depression. In this cross-sectional study a self-report questionnaire, the Edinburgh Gotland Depression Scale (EGDS) is validated against the clinical interview SCID-CV as gold standard, and is further developed. A convenience sample of Swedish fathers (N = 95) who had children in the past year, answered an online questionnaire and a subsample (n = 52) of them were later interviewed with the SCID-CV. The revised EGDS showed improved criterion-related validity, sensitivity and specificity. The scale has problems disciminating between mildly and non-depressed fathers. A cut-off score of ≥8 on the revised EGDS results in sensitivity of 91.7 per cent and specificity of 85.0 per cent. This study should be replicated and cross-validated to provide further evidence of validity. / Postnatal depression hos fäder har börjat uppmärksammas under det senaste decenniet. Studier har visat att konsekvenserna av postnatal depression hos fäder och mödrar är lika allvarliga. Det finns för närvarande inga validerade instrument för screening av postnatal depression hos fäder. I denna tvärsnittsstudie har självskattningsformuläret, Edinburgh Gotland Depression Scale (EGDS) valideras mot den kliniska intervjun SCID-CV som gold standard, och vidareutvecklas. Ett bekvämlighetsurval av svenska fäder (N = 95) som fått barn under det senaste året, besvarade en webbenkät och en undergrupp (n = 52) av dem blev senare intervjuade med SCID-CV. Det reviderade EGDS visade förbättrad kriteriumrelaterad validitet, sensitivitet och specificitet. Skalan har problem med att diskriminera mellan milt och icke-deprimerade pappor. En cut-off poäng ≥8 för den reviderade EGDS resulterar i sensitivitet på 91,7 procent och specificitet på 85,0 procent. Denna studie bör replikeras och korsvalideras för att ge ytterligare belägg för validiteten.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Introduction : The health status of women in peri-urban areas has been influence by the South African political transition. Despite some progress, maternal and child mortality rates are still unacceptably high. A mother’s nutritional status is one of the most important determinants of maternal and birth outcomes. The Institute of Medicine’s pre-pregnancy Body Mass Index (BMI) method is not always appropriate to use in a peri-urban setting as many women attend their first antenatal clinic later on in their pregnancy. Two alternative methods, the gestational BMI (GBMI) and the gestational risk score (GRS), have been used elsewhere to screen for at risk pregnancies, but have not been used in a South African peri-urban setting. Furthermore, examining socio-economic variables (SEV) aids in the explanation of the impact of social structures on an individual. Risk factors can then be established and pregnant women in these higher risk groups can be identified and given additional antenatal clinic appointments and priority during labour. Aim: The first aim was to investigate the strength of the GBMI and GRS methods for predicting birth outcomes and maternal morbidities. The second aim was to investigate the relationships between SEV, GBMI and maternal morbidities. Methods: This was a sub-study of the Philani Mentor Mothers Study. A sample of 103 and 205 were selected for investigating the prediction methods and SEV respectively. Maternal anthropometry, gestational weeks and SEV were obtained during interviews before birth. Information obtained was used to calculate GBMI and GRS and to assess the SEV. Birth outcomes were obtained from the infant’s clinic cards and maternal morbidities were obtained from interviews two days after the birth. Results No significant association was found between GBMI and birth outcomes and maternal morbidities. A significant positive association was found between GRS and birth head circumference percentile (r=0.22, p<0.05). The higher the GRS, the higher the risk of an infant spending longer time in the hospital (Kruskal Wallis X2 = 4, p<0.05). A significant positive association was found between GBMI and the following SEV factors; age (r=0.33, p<0.05), height (r=0.15, p<0.05), parity (r=0.23, p<0.05), income (r=0.2, p<0.05), marital status (X2 = 9.35, p<0.05), employment (U=2.9, p<0.05) and HIV status (U=2.54, p<0.05). No statistically significant relationships were found between gestational hypertension and gestational diabetes mellitus and SEV. Conclusion: From the findings of this sub-study there were some promising results, however it is still unclear as to which method is the most appropriate to predict adverse birth outcomes and maternal morbidity. It is recommended that the GBMI and GRS once-off methods be repeated in a larger population to see if there are more parameters that could be predicted. Women who were older, shorter, married, had more pregnancies, HIV negative and had a higher socioeconomic status tended to have a greater GBMI. This can lead to adverse birth outcomes and increases the risk of women developing maternal morbidities and other chronic diseases later in their life. Optimal nutrition and health promotion strategies targeting women before conception should be implemented. / AFRIKAANSE OPSOMMING: Inleiding: Die gesondheidstatus van vroue in semi-stedelike areas is beïnvloed deur die Suid-Afrikaanse politiese oorgang. Ten spyte van ’n mate van vooruitgang is die sterftesyfers vir moeders en kinders steeds onaanvaarbaar hoog. ‘n Moeder se voedingstatus is een van die mees belangrike bepalende faktore van moeder- en geboorteuitkomste. Die Instituut van Geneeskunde se voorswangerskap Liggaamsmassa Indeks (LMI) metode is nie altyd toepaslik om te gebruik in ‘n semi-stedelike opset nie aangesien baie vroue hul eerste voorgeboorte-kliniek eers later in hul swangerskap bywoon. Twee alternatiewe metodes, die swangerskap LMI (SLMI) en die swangerskap risiko telling (SRT) is al elders gebruik as sifting vir hoë risiko swangerskappe, maar is nog nie gebruik in ‘n Suid-Afrikaanse semi-stedelike opset nie. Vervolgens kan ‘n ondersoek na sosio-ekonomiese veranderlikes (SEV) help om die impak van maatskaplike strukture op ‘n individu te verduidelik. Risiko faktore kan dan vasgestel word en swanger vroue wat in hierdie hoër risiko groepe val kan geïdentifiseer word. Dié vroue kan addisionele voorgeboorte-kliniek afsprake ontvang asook voorkeurbehandeling tydens die geboorteproses. Doelstellings: Die eerste doelstelling was om die sterkte van die SLMI en SRT metodes te ondersoek as voorspellers van geboorte uitkomste en moeder-morbiditeite. Die tweede doelstelling was om die verhoudings tussen SEV, SLMI en moeder-morbiditeite te ondersoek. Metodes: Hierdie projek was ‘n sub-studie van die Philani Mentor Moeders Studie. ‘n Steekproefgrootte van 103 en 205 was geselekteer om onderskeidelik die voorspeller metodes en SEV te ondersoek. Die moeder se antropometrie, swangerskap weke en SEV was verkry gedurende onderhoude voor geboorte. Informasie ingewin was gebruik om die SLMI en SRT te bereken en om die SEV te ondersoek. Geboorteuitkomste was verkry vanaf die babas se kliniekkaarte en moeder-morbiditeite was verkry tydens onderhoude twee dae na die geboorte. Resultate: Geen betekenisvolle assosiasie was gevind tussen SLMI, geboorteuitkomste en moeder-morbiditeite nie. ‘n Betekenisvolle positiewe assosiasie was gevind tussen SRT en die geboorte kopomtrek persentiel (r=0.22, p<0.05). Hoe hoër die SRT, hoe hoër die risiko dat ‘n baba langer in die hospitaal sou bly (Kruskal Wallis X2=4, p<0.05). ‘n Betekenisvolle positiewe assosiasie was gevind tussen SLMI en die volgende SEV faktore: ouderdom (r=0.33, p<0.05), lengte (r=0.15, p<0.05), pariteit (r=0.23, p<0.05), inkomste (r=0.2, p<0.05), huwelikstatus (X2=9.35, p<0.05), besit van ‘n identiteitsdokument (U=1.75, p<0.05), werkstatus (U=2.9, p<0.05) en MIV status (U=2.54, p<0.05). Geen statisties beduidende verhoudings was gevind tussen swangerskap hipertensie, swangerskap diabetes mellitus en SEV nie. Gevolgtrekking Sommige bevindinge van hierdie sub-studie dui op belowende resultate, alhoewel dit steeds nie duidelik is watter metode die mees toepaslike is om ongewenste geboorteuitkomste en moeder-morbiditeit te voorspel nie. Dit word aanbeveel dat die SLMI en SRT eenmalige metodes herhaal word in ‘n groter populasie om te sien of daar meer parameters is wat voorspel kan word. Vroue wat ouer, korter, getroud, meer swangerskappe, MIV negatief en ‘n hoër sosio-ekonomiese status gehad het was geneig om ‘n hoër SLMI te hê. Dit kan lei tot ongewenste geboorteuitkomste en verhoogde risiko om moeder-morbiditeite en ander chroniese siektes later in hul lewe te ontwikkel. Optimale voeding en gesondheidsbevordering strategieë wat vroue teiken voor bevrugting behoort geïmplementeer te word.