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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.

This thesis is an ethnography of the postnatal experiences of South Asian migrant women in Perth, Western Australia. I examine cultural differences relating to mothering and argue that the South Asian culture in which these migrant women were socialized can impact greatly on how they experience the feelings of what is called “postnatal depression” in the Western medical arena. I carried out ethnographic research among the members of the Bangladeshi and Indian communities in Perth. The main focus group of this study is first time mothers who gave birth in Australia, but I also worked with other women who had grown up children. Due to migration the South Asian women and their families experienced social isolation, cultural differences, language difficulties, economic hardship and low job satisfaction. Moreover, when these women gave birth in Perth they were faced with a lack of physical and emotional support, and also distress at not being able to perform their traditional birth rituals. Their difficult situations led the women to cry, feel despondent, to suffer and to experience a sense of hopelessness. Their painful postnatal feelings can be defined as an illness - depression - by the Western medicine. However, I found these women did not perceive their negative postnatal feelings as an illness, but accepted them as a part of life. I analysed these women’s postnatal psychological understandings about “postnatal depression” by examining the South Asian convention of female virtue which is practiced through restrictions on female behaviour. The migrant women in my study, having internalizing the South Asian cultural schema of womanhood, articulate their negative postnatal feelings as a prerequisite of motherhood. In this thesis I argue that feelings are not the totality of experience, rather, experience is also formulated by the particular sociocultural perspective of the individual who is having the experience. The culture a person belongs to, defines how that person will experience his or her feelings. I also suggest that it is possible to modify dysphoric affect by altering the meaning of feelings

Paper one is a metasynthesis of studies exploring mothers' experiences of recovery from postnatal mental illness. Four databases were systematically searched using key words and index terms to identify the qualitative literature exploring mothers' experiences of recovery from postnatal mental illness. Fourteen studies met the inclusion criteria and were critically appraised and synthesised. These papers reported the views of 395 women's experiences of recovery from postnatal mental illness. Five core themes emerged from the synthesis to describe four key processes that facilitate recovery. This experience begins with recognising the problem through crisis and relational distress. Women then go through the process of seeking help which consists of subthemes of accepting help and help to access help. The next process in the in the journey is achieving recovery which includes subthemes of sharing with others like me, coping strategies and noticing recovery. The final process of maintaining recovery consists of incorporating coping strategies into daily life; acquiring a different model of motherhood and processing the experience. The role of the family was interwoven through each stage of recovery. Recommendations were made for professionals who come into contact with this group of women and their families. The review highlighted gaps in the existing evidence and made recommendations for future research. The findings and limitations were discussed with reference to the existing literature. Paper two explored the role of the baby in 12 mothers' experiences of recovery from psychosis after childbirth. A thematic analysis of the data identified three core themes that described the role of the baby in the mothers' recovery. Findings revealed that the baby was central to women's recovery and could be experienced as both helpful and unhelpful. The baby interacted with the mother; increasing self efficacy and reducing emotional distress. The baby could act as a barrier to recovery by increasing the women's emotional distress and hindering access to help and self care. The findings recommended that women receive specialist treatment in mother and baby units where they can access interventions that support parent-infant interactions. The findings of the study add to the existing evidence base on recovery from psychosis after childbirth and highlighted areas for future research. Paper three is a critique of the research carried out in Papers one and two. This paper discussed the rationale for the research design in both papers. Approaches to data sampling and data analysis are reviewed with reference to researcher reflexivity. The search strategy and critical appraisal of techniques of the metasynthesis are also critiqued. Paper three closes with personal reflections and conclusions drawn from both papers.

Abstract A longitudinal follow-up study of postnatal depression was performed in the years 1995-2000 in the University of Oulu. A volunteer, ramdomly selected group of 187 mothers from maternal wards of the University Hospital of Oulu were studied with different questionnaires in the first postpartum week. Depressive symptoms were re-assessed with Edinburgh Postnatal Depression Scale four months postpartum when paternal depression was evaluated with Beck Depression Inventory. 16.2% of the women were immediately after delivery screened as being depressed. Four months postpartum 13.0% of the mothers were depressed whereas 5.1 % of the fathers were having depressive symptoms. The cumulative incidence of maternal postnatal depression within the first four months was 22.2%. These mothers who immediately showed depressive symptoms were at a higher risk to be depressed later. Maternal age 30 years or less predicted postnatal depression. The occurrence of maternal postnatal depression varied slightly during different seasons; during dark time immediate depressive symptoms increased and the spring seemed to protect from later postnatal depression. Analgesia during vaginal delivery, e.g. nitrous oxide, epidural analgesia or paracervical blockade, protected from postnatal depression as well. Caesarean section, either elective or emergency, did not predict postpartum mental well-being. Scores from the GHQ and the EPDS were strongly interrelated. Seven (5%) fathers were depressed four moths postpartum. They all were men whose partners also scored high in the EPDS. Those mothers who were depressed interpreted infant facial signals differently, seeing less joy, disgust and anger, but more sadness in the infant facial pictures. Cultural variability was found in complex blended facial features of emotions, e.g. distress, in the Infant Facial Expression from Looking at Picture scale, although remarkable agreement was achieved and reinforced. In the videotaped early mother-infant interaction small, but essential, changes were observed at 10 months postpartum. Overall, mothers who had had persistent depressive symptoms showed less negative expressions and had less anger and anxiety in their interaction. Their children were slightly less impulsive and seemed to have less visual and communicative contact with their mothers. The dyad was characterised by short periods of uninvolvement between the mother and the infant; e.g. the moments of reciprocity were less frequent than in the non-depressed mothers. At 42 months postpartum, the children of the persistently depressed mothers scored lower on the Expressive language scale than the children of the mothers who were depressed in one measurement or never.

Yes / Vulnerable migrant women are at an increased risk of developing postnatal depression, compared with the general population. Although some symptoms are the same as in other pregnant women, there are specific reasons why vulnerable migrant women may present differently, or may not recognise symptoms themselves. Factors associated with migration may affect a woman’s mental health, particularly considering forced migration, where a woman may have faced violence or trauma, both in her home country and on the journey to the UK. Vulnerable migrant women engage less with maternity care than the average woman for reasons including a lack of knowledge of the UK healthcare system, fear of being charged for care, or fear that contact with clinicians will negatively affect their immigration status. This article explores the issues surrounding vulnerable migrant women that increase their risk of developing postnatal depression and presents reasons why this may go unrecognised by health professionals such as midwives.

One of the most common complications for mothers after childbirth is postpartum depression (PPD). This illness can occur in women who have given birth, who have miscarried or who have had a stillbirth. The American College of Obstetricians and Gynecologists (2010) indicate that PPD affects 1 in 8 women. These statistics are disturbing especially when 51 % of women may not be willing to seek treatment for PPD (Beck & Gable, 2001 ). Therefore, the number of women who are experiencing PPD is of national concern. The literature reveals that there is not a standard or protocol for the assessment of PPD symptoms, education delivery, or referral and treatment. With an absence of a standard or protocol, this devastating disorder will continue to go undiagnosed in thousands of women affecting not only their wellbeing but the wellbeing of their families. Nurses are in an optimal position to help prevent and identify women suffering from PPD. Establishing the nurse's role in assessing, educating and referring women and families suffering from PPD will assist in reducing the prevalence of this illness and identifying afflicted women for early intervention. Implementing a standard of practice in PPD assessment, education, and referral will assist healthcare providers in achieving the Healthy People 2010 objective of reducing mental illness and complications due to pregnancy.

Bakgrund: Under graviditeten och efter förlossningen genomgår kvinnan en period som innebär en stor förändring i hennes liv och det är vanligt att uppleva ett brett spektrum av olika känslor. Den första tiden efter förlossningen kan symtom på allvarliga psykiska hälsoproblem utlösas, såsom en depression. Depression hos nyblivna mödrar, en så kallad postpartumdepression, har sedan 1990-talet ökat i intresse inom hälso- och sjukvården, inom omvårdnadsforskningen samt bland föräldrar.   Syfte: Syftet med denna studie var att belysa BVC-sköterskors upplevelser av att möta mödrar med symtom på postpartumdepression.   Metod: En induktiv ansats användes där datamaterialet analyserades med kvalitativ innehållsanalys. Datamaterialet utgjordes av intervjuer och åtta BVC-sköterskor intervjuades.   Resultat: Ur analysen av datamaterialet framkom fyra kategorier: etablera ett gott samarbete, ge råd och vägledning, att använda instrument som underlättar och kommunikativa hinder i arbetat samt tillhörande underkategorier.   Konklusion: För att kunna möta mödrar med symtom på postpartumdepression bör BVC-sköterskorna etablera ett bra samarbeta. Det första hembesöket var också betydelsefullt för att kunna etablera ett bra samarbete mellan BVC-sköterskorna och mödrarna. Att använda instrument såsom EPDS-formuläret, underlättade samtalet och var ett viktigt verktyg för BVC-sköterskorna. / Background:  During pregnancy and after childbirth the woman go through a period that represents a major change in her life and it´s common to experience a wide range of different emotions. The first time after birth, symptoms of serious mental health problems can be triggered, such as depression. Depression in new mothers, known as postpartum depression, has increased in interest since the 1990s in health care, nursing research and among parents.   Aim: The aim of the study was to illustrate Child health care nurses’ experiences of encounting mothers’ with symptoms of postpartum depression.   Method: Qualitative content analysis with inductive approach was used and data were collected through interviews. Eight Child health care nurses’, CHCN, were interviewed.   Results: Four categories emerged from the analysis: establish a good collaboration, provide advice and guidance, to use instruments that facilitate and communicative barriers at work and associated subcategorys.     Conclusion: In order to meet mothers with symptoms of postpartum depression CHCN need to establish a good collaboration. The first home visit was also important to establish a good collaboration between CHCN and mothers. The use of instruments such as EPDS, facilitate the conversation and was an important tool for the CHCN.

Bakgrund: Postpartumdepression (PPD) är en depression som debuterar efter förlossningen och kan drabba både män och kvinnor i all ålder och i all kultur. Postpartumdepressionen för med sig särskilda risker som kan innebära allvarliga konsekvenser för familjer. Forskning om PPD fokuserar i huvudsak på mödrars upplevelser och påverkan på barnet och familjen. Medan fäderna upplevelser har saknats. PPD kan drabba fäderna i lika stor utsträckning som mödrar men fortfarande ett dolt problem. Syfte: Postpartumdepression (PPD) är en depression som debuterar efter förlossningen och kan drabba både män och kvinnor i all ålder och i all kultur. Postpartumdepressionen för med sig särskilda risker som kan innebära allvarliga konsekvenser för familjer. Forskning om PPD fokuserar i huvudsak på mödrars upplevelser och påverkan på barnet och familjen. Medan fäderna upplevelser har saknats. PPD kan drabba fäderna i lika stor utsträckning som mödrar men fortfarande ett dolt problem. Metod: En litteraturöversikt utfördes med tio kvalitativa studier om föräldrarnas upplevelser av PPD. Artiklarnas olika tema identifierades, jämfördes, analyserades för att sedan kategoriseras i de slutgiltiga teman som presenterades i detta arbete. Resultat: Tre huvudteman redovisades: Postpartumdepressionens inverkan på det känslomässiga livet och självbilden, Postpartumdepressionens inverkan på attityder och sist Postpartumdepressionens inverkan på förmågan att söka stöd. Diskussion:  Föräldrarna upplever att postpartumdepression har stor inverkan i deras liv. Sjukdomens okunskap och stigma hindrar de att söka stöd. Fäderna upplever att de nonchaleras. Allmänsjukvårdspersonal bör söka sig kunskapen om vilken inverkan postpartumdepression har på föräldrars liv och hur föräldrarna upplever postpartumdepression. Detta skulle bidra till att bemötande förbättras som i sin tur skulle leda till att mer föräldrar söker vård för postpartumdepression / Background: Postpartum depression (PPD) is a depression that debuts after childbirth and can affect both men and women of all ages and in all cultures. Postpartum depression brings with it particular risks that can have serious consequences for families. Research on postpartum depression mainly focuses on maternal experiences and the influence on the child and the family while researches on father`s experiences have been lacking. Postpartum depression can affect fathers to the same extent as mothers but still a hidden problem. Aim: The aim was to highlight parents´ experiences of postpartum depression. Method: A literature review was conducted with ten qualitative studies of the parents' experiences of postpartum depression. The different topics were identified, compared, analyzed and then categorized into the final themes presented in this paper. Results: Three main themes were reported: Postpartum depression impact on emotional life and self-image, Postpartum depression impact on attitudes and last Postpartum depression impact on the ability to seek support. Discussion: Postpartum depression has a major impact on parents’ lives. The lack of knowledge on the disease and the stigma upon it prevents parents from seeking support. Fathers rapports that they are left by side. General healthcare professionals should seek knowledge about the effect of postpartum depression on parents' lives and how they themselves experience the disease. This would help improve treatment, which would in turn lead to more parents seek help for postpartum depression.

Purpose: Postnatal depression has significant negative outcomes for both mother and baby. Cognitive-behavioural interventions have proven promising in its treatment, but there are a number of barriers, specific to the postnatal period, which lead to low take-up of treatment. Online interventions may circumvent some of these barriers. However, evidence of long-term follow-up is sparse, in spite of the importance of knowing how such treatments work over the longer-term. Methods: Long-term follow-up of postnatal women participating in a feasibility randomised controlled trial of NetmumsHWD, an online behavioural activation treatment with telephone support. Results: Retention rates of over 70 percent were obtained. There were small but non-significant effects of treatment on depressive symptomology and behavioural activation scores at 16 months post-randomisation. Baseline depression and behavioural activation scores predicted attrition prior to the implementation of outreach strategies for data collection; these systematic differences in attrition disappeared post-implementation. Measures of treatment adherence were not related to outcome. Conclusions: Collection of long-term follow-up data from postnatal women appears feasible. The findings demonstrate the importance of outreach in maximising retention, especially in relation to the generalizability of results. Future research should consider ways to assess treatment engagement and its relationship with outcome.