Submitted by Haroudo Xavier Filho (haroudo.xavierfo@ufpe.br) on 2016-03-01T19:18:54Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação Mestrado.pdf: 2528294 bytes, checksum: 69ec2d4350eed1f6344f027d79b47ebb (MD5) / Made available in DSpace on 2016-03-01T19:18:54Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação Mestrado.pdf: 2528294 bytes, checksum: 69ec2d4350eed1f6344f027d79b47ebb (MD5) Previous issue date: 2015-05-25 / Os períodos de gestação e puerpério nem sempre são marcados por alegrias e realizações. É exatamente nesta fase que muitas mulheres experimentam alterações importantes do humor e/ou ansiedade, sendo o pós-parto o período de maior vulnerabilidade para o aparecimento de transtornos psiquiátricos. Apesar de ser hoje uma das condições clínicas mais estudadas da psiquiatria e de ser bastante conhecida na prática clínica, a depressão pós-parto ainda não apresenta consensos conceituais e metodológicos importantes para um maior grau de confiabilidade no diagnóstico e na comparação de dados de pesquisas. Assim, esta pesquisa busca minimizar a carência de uniformização e consenso a respeito deste tema tão relevante. Este estudo corresponde a uma revisão sistemática descritiva, no qual foram utilizados três bancos de dados: PubMed/MEDLINE, Scientific Electronic Library Online (SciELO) e Literatura Latino-americana e do Caribe em ciências da saúde (LILACS) e foram incluídos os artigos originais em língua inglesa, nos últimos 5 anos até 30 de junho de 2014, em humanos do sexo feminino. Foram excluídos os artigos não originais, os artigos de revisão e os relatos ou séries de casos. Após a exclusão dos artigos não pertinentes, restaram 356 que foram avaliados por dois revisores e apenas 154 artigos preencheram os critérios de inclusão. O resultado evidencia uma grande heterogeneidade nos instrumentos de pesquisa, com 38 instrumentos de triagem, diagnóstico e avaliação distintos. A verificação do instrumento principal dos estudos, registra uma predominância do Edimburg Depression Postpatum Scale (EPDS) em cerca de 65% dos artigos, apresentando pontos de corte com uma variação total de 7 a 20 e predominância entre 12 e 13. Quanto ao tempo, verifica-se que a maior parte das aferições dos instrumentos foram realizadas no primeiro trimestre do puerpério (45%), contudo foram grandes os percentuais de registros fora deste período, 43% acima de 3 meses do puerpério e 12% durante a gestação. Em relação aos períodos com maior prevalência de casos após o nascimento, constata-se que 65% encontra-se nos primeiros 3 meses após o parto e 35% após os 3 meses. Desta forma, apesar de se averiguar uma heterogeneidade significativa entre os estudos, há uma predominância do EPDS como método de triagem mais utilizado. Já em relação ao tempo, os resultados indicam que ele está muito além do que atualmente é preconizado nos manuais diagnósticos, com episódios depressivos desde a gestação até o período de um ano após o parto, relacionando-se ao nascimento do filho. Os resultados deste estudo ajudam a diminuir as discordâncias metodológicas e conceituais sobre as depressões relacionadas ao parto e podem embasar políticas em saúde para melhorar as estratégias na busca de um diagnóstico mais preciso e precoce e, desta forma, ajudar na prevenção e assistência às mães acometidas por essa enfermidade. / Periods of pregnancy and postpartum are not always marked by joys and achievements. It is precisely at this stage that many women experience major changes of mood and / or anxiety, and the postpartum period has the greatest vulnerability to the onset of psychiatric disorders. Although it is now one of the most studied clinical conditions of psychiatry and being well known in clinical practice, the postpartum depression still does not present conceptual and methodological consensus important for a greater degree of reliability in the diagnosis and the data comparison of survey. Therefore, this research seeks to minimize the lack of standardization and consensus on this issue as relevant. This study represents a descriptive systematic review, in which was used three databases: PubMed / MEDLINE, Scientific Electronic Library Online (SciELO) and Latin American and Caribbean Literature in Health Sciences (LILACS) and original articles were included in English in the last five years until June 30, 2014, in human females. Non-original articles, review articles and reports or case series were excluded. After exclusion of irrelevant articles, remaining 356 that were evaluated by two reviewers and only 154 articles met the inclusion criteria. The result shows a great heterogeneity in research tools, with 38 screening tools, diagnostic and distinct evaluation. Verification of the main instrument of the studies, reports a prevalence of Edimburg Depression Postpatum Scale (EPDS) in about 65% of the articles, with cutoff points with a total variation 7-20 and prevalence between 12 and 13. As for the time, it appears that most of the instruments measurements were carried out in the first quarter of the puerperium (45%), however, were large percentage of the records outside of this period, 43% over 3 months postpartum and 12% during pregnancy. For periods with higher prevalence of cases after birth, it appears that 65% is the first 3 months after delivery and 35% after 3 months. Thus, although to ascertain significant heterogeneity between studies, there is a predominance of the EPDS as the most used screening method. In relation to time, the results indicate that it is far beyond what is currently recommended in the diagnostic manual, with depressive episodes from pregnancy to one year after delivery, relating to the birth of the child. The results of this study help to decrease the methodological and conceptual disagreements over the depressions related to childbirth and can to base health policies to improve the strategies in the search for a more accurate diagnosis and early and thus help prevent and assistance to affected mothers by this disease.

Submitted by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2018-09-19T13:10:59Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) FICHA CATOLOGRAFICA MARCIA FARIAS DE AMORIM (2).pdf: 710614 bytes, checksum: 12c5d565347cd059f7347fd6e178713e (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2018-09-19T13:11:16Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) FICHA CATOLOGRAFICA MARCIA FARIAS DE AMORIM (2).pdf: 710614 bytes, checksum: 12c5d565347cd059f7347fd6e178713e (MD5) / Made available in DSpace on 2018-09-19T13:11:16Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) FICHA CATOLOGRAFICA MARCIA FARIAS DE AMORIM (2).pdf: 710614 bytes, checksum: 12c5d565347cd059f7347fd6e178713e (MD5) Previous issue date: 2018-02-26 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The symptoms of depressive disorders affect most women between four to six weeks after delivery, being frequent in the postpartum period due to the various transformations that the woman passes this stage, but it is possible to identify depressive symptoms for periods less than four weeks and this relates to the Quality of Life that involves meanings that reflect in diverse dimensions of the human being, covering their experiences, knowledge, individual and collective values. Objective: To identify the depressive symptomatology and its association with the quality of life of women in the postpartum period. Method: Application of Edinburgh Postpartum Depression Scale (EPDS), the Quality of Life Index (QLI) Ferrans & Powers, version adapted to the postpartum period, as well as a form to identify the sociodemographic and obstetric profile of mothers. This is a descriptive, cross-sectional, quantitative approach. Analyzed quantitative of 134 mothers from December / 2017 to April / 2018 who had their births attended in the maternity Ana Braga, located in the East Zone of the city of Manaus. Results: There was a prevalence of 17.2% postpartum depression signals from depressive symptoms identified by the application EPDS and association between postpartum depression symptoms and quality of life. Conclusion: The prevalence of depressive symptoms in the puerperium is high, suggesting postpartum depression. Factors such as low socioeconomic status are risk for the development of symptoms, but compared to the areas of QLI, the socio-economic domain is negligible in evaluating the quality of life. / Os sintomas de transtornos depressivos acometem a maioria das mulheres entre quatro a seis semanas após o parto, sendo frequentes no período puerperal devido às diversas transformações pelas quais a mulher passa nesta fase, porém, é possível identificar sintomatologia depressiva em períodos menores que quatro semanas e com isso relaciona-se a Qualidade de Vida que envolve significados que refletem em diversas dimensões do ser humano, abrangendo suas experiências, conhecimentos, valores individuais e coletivos. Objetivo: Identificar a sintomatologia depressiva e sua associação com qualidade de vida de mulheres no puerpério mediato. Método: aplicação da Escala de Depressão Pós-parto de Edimburgo (EDPE), o Índice de Qualidade de Vida (IQV) de Ferrans & Powers, uma versão adaptada para o puerpério, além de um formulário para identificação do perfil sociodemográfico e obstétrico das puérperas. Trata-se de uma pesquisa descritiva, transversal, de abordagem quantitativa. Analisou-se um quantitativo de 134 puérperas no período de dezembro/2017 a abril/2018 que tiveram seus partos assistidos na Maternidade Ana Braga, localizada na Zona Leste da cidade de Manaus. Resultados: Foi identificada prevalência de 17,2% de sinais de depressão pós-parto a partir de sintomas depressivos identificados pela aplicação da EDPE, e associação entre a sintomatologia depressiva no puerpério e a qualidade de vida. Conclusão: É alta a prevalência de sintomas depressivos no puerpério, que sugerem estado de depressão pós-parto. Fatores como a baixa condição socioeconômica representam risco para desenvolvimento dos sintomas, mas em comparação aos domínios do IQV, o domínio socioeconômico é pouco significativo na avaliação da qualidade de vida.

Introdução: Os transtornos depressivos pós-parto podem afetar a mãe, o bebê e outros membros da família. A depressão pós-parto costuma iniciar na quarta semana e evolui lentamente por várias semanas. Objetivos: Identificar a ocorrência de sintomas depressivos em mulheres no pós-parto e verificar a associação entre sintomas depressivos e as variáveis sociodemográficas e obstétricas. Método: Estudo transversal realizado com 302 mulheres que se encontravam entre 42 e 56 dias após o parto, residentes no município de Lavras (MG). Os dados foram obtidos no período de agosto de 2011 a janeiro de 2012, por meio de entrevista para obtenção da caracterização da puérpera e aplicação da Edinburgh Postnatal Depression Scale (EPDS), para rastrear a depressão após a gestação. O ponto de corte 13 pontos na EPDS foi adotado para indicar a presença de episódio depressivo. A associação de sintomas depressivos com algumas variáveis maternas foi analisada pelo teste do Qui-Quadrado e regressão logística. O projeto foi aprovado pelos Comitês de Ética em Pesquisa da Escola de Enfermagem da Universidade de São Paulo Processo nº 1059/2011/CEP-EEUSP e do Centro Universitário de Lavras - Protocolo nº 1059/2011. Resultados: As mulheres tinham em média 27,04 (±6,12) anos de idade; 49,3% eram de cor branca; média de 10,44 (±2,12) anos de estudo, 85,8% com parceiro. O coeficiente Alpha de Cronbach verificado foi 0,85. A prevalência de sintomas depressivos foi de 11,9%. Houve diferença significativa no nível de etnia (p=0,032), escolaridade (p<0,001); situação conjugal (p<0,001); número de gestação (p=0,004); paridade (p<0,001); descanso (p=0,004); fumo (p<0,001); drogas (p=0,004); planejamento da gestação (p<0,001); aceitação da gestação (p<0,001); gestação desejada (p<0,001); experiência pré-natal (p=0,007); experiência no parto (p=0012); violência antes da gestação (p<0,001); violência na gestação (p<0,001); problema psicológico antes da gestação (p<0,001); problema psicológico na gestação (p<0,001); amamentação (p=0,006) e bebê com problema de saúde (p<0,001). As variáveis associadas ter parceiro, estar amamentado e ter mais filhos foram consideradas fatores de proteção para sintomas depressivos no pós-parto e as variáveis associadas ser negra/parda, fumantes e ter sofrido violência, fatores de risco. Conclusões: A prevalência de sintomas depressivos (11,9%) em mulheres no pós-parto no município de Lavras (MG) está compatível com as da literatura nacional e internacional que se referem como 10% e 20%. O conhecimento das variáveis maternas que podem influenciar a ocorrência de depressão pós-parto é de fundamental importância, para que a equipe de saúde possa intervir de forma precoce e adequada no tratamento das mulheres. / The study objectives were to identify the occurrence of depressive symptoms in postpartum women and the association between depressive symptoms and sociodemographic and obstetric variables. This is a cross-sectional study on 302 women who were between 42 to 56 days after delivery, residents in Lavras (MG). Data were collected from August 2011 to January 2012, through an interview and application of Edinburgh Postnatal Depression Scale (EPDS). The EPDS is a self-assessment to track depression after pregnancy, which contains 10 statements, each item has a score ranging from 0 to 3, reaching a maximum score of 30. We adopted a cutoff 13 points in EPDS, 59.5% sensitivity, 88.4% specificity in the Brazilian population, to detect depressive symptoms. The reliability was assessed by Cronbach\'s Alpha coefficient and the association of depressive symptoms with some maternal variables were analyzed by chi-square. The project was approved by the Research Ethics Committee of the School of Nursing, University of São Paulo under Opinion No 1059/2011 and the University Center Lavras. The women had an average of 27.04 (± 6.12) years of age; 49.3% white, mean 10.44 (± 2.12) years of education, 85.8% with partner. The Cronbach\'s Alpha coefficient was 0.85 verified. The prevalence of depressive symptoms was 11.9%. There were significant differences in the level of ethnicity (p = 0.032), education (p <0.001), marital status (p <0.001), number of pregnancy (p = 0.004), parity (p <0.001) and resting (p = 0.004) , smoking (p <0.001), drug (p = 0.004); planning pregnancy (p <0.001); acceptance of gestation (p <0.001); desired pregnancy (p <0.001); experience prenatal care (p = 0.007); experience in childbirth (p = 0012); violence before pregnancy (p <0.001); violence during pregnancy (p <0.001); psychological problem before pregnancy (p <0.001); psychological problem during pregnancy (p <0.001); breastfeeding (p = 0.006) and baby with health problems (p <0.001). The prevalence of depressive symptoms (11,9%) in postpartum women in Lavras (MG) is compatible with the national and international literature that refer as 10% to 20%. Knowledge of maternal variables that may influence the occurrence of postpartum depression is critical for the health team can intervene early and appropriate treatment of women.

Il presente studio intervento randomizzato è stato condotto su 140 donne assegnate - a seguito del parto - alla condizione di scrittura espressiva (EW) o alla condizione di scrittura neutra non-emotiva (NW). L’obiettivo era indagare gli effetti della scrittura espressiva sull’esperienza del parto sia sul funzionamento psicologico – sintomi depressivi e postraumatici da stress- (Studio 1a), sia sul funzionamento genitoriale - stress che la madre incontra nell’esercizio del suo ruolo e nell’interazione con il bambino – (Studio 2) al follow-up a tre mesi dal parto. Inoltre, sono state indagate le differenze individuali (moderatori) e i meccanismi psicologici- linguistici (mediatori) associati al cambiamento positivo a seguito della scrittura espressiva (Studio 1b). Gli studi hanno evidenziato che i sintomi depressivi e di intrusione connessi al trauma si riducevano nelle donne assegnate alla condizione EW nel confronto con la condizione NW e che a beneficiare dell’intervento erano le donne con sintomi acuti post-partum (Studio 1a). L’elaborazione cognitiva dell’esperienza stressante del parto attraverso le sessioni di scrittura è stata identificata come il meccanismo chiave, responsabile degli effetti benefici sulla sintomatologia depressiva postnatale (Studio 1b). Infine, il terzo studio ha identificato un effetto positivo della scrittura espressiva sulla qualità dell’interazione madre-bambino moderato da alcune caratteristiche individuali. / One hundred forty women participated in the present randomized intervention study. Right after giving birth women were assigned to the Expressive Writing (EW) intervention group or to the non-emotional neutral writing (NW) condition. The aim was to investigate the effects in the childbirth experience of expressive writing both on psychological functioning - depression and post-partum traumatic stress symptoms - (Study 1a), and on parental functioning - the stress experienced by mothers in their parental role and in the interaction with the newborn - (Study 2) at a three-month follow-up after delivery. Individual differences were investigated as moderators and psycholinguistic mechanisms as mediators associated with positive changes following expressive writing (Study 1b). Results indicate that depression and intrusive symptoms related to the trauma decreased in EW women compared to NW women, and that acute post-partum symptom women benefited the most (Study 1a). Cognitive elaboration of the childbirth traumatic experience taking place during writing sessions is the key mechanism responsible for the beneficial effects on postnatal depression symptoms (Study 1b). Finally, the third study indicated a positive effect of expressive writing on the quality of mother-child interaction. The effect resulted moderated by some individual characteristics.

Background: Postnatal depression (PND) is one of the most common maternal mental health problems for women worldwide. Yet the wide range of reported rates of PND in different countries raises questions about how PND is experienced by women in different cultures and whether interventions developed in western cultures are appropriate in very different settings. It is important to establish how PND is defined, experienced and managed in different cultures in order to create culturally relevant interventions. No previous studies of experience of PND and its management have been conducted in Malaysia. The aim of this study was to explore women’s experiences and healthcare practitioners’ (HCPs) perspectives of PND in a multicultural country, Malaysia. Methods: This was a qualitative study informed by a critical realist approach. Semi-structured interviews were carried out with 33 women (from three different cultural backgrounds) attending for child or postnatal care and 18 HCPs in six purposively selected maternal and child health (MCH) clinics and a female psychiatric ward in Kuala Lumpur, Malaysia. Data were analysed using framework analysis. Findings: There were some differences in the women’s perceptions of PND experience across three different cultural backgrounds in Malaysia. Malay women were more likely to describe the symptoms of PND based on a combination of emotional and behavioural changes, whereas Chinese and Indian women talked more about emotional changes. Traditional postnatal practices were described as contributing to PND by some Malay women but were accepted as promoting maternal and infant well-being by the majority of Indian women. Religious activities were reported as an effective strategy for the Malay women but were not seen as helpful by the majority of Chinese women. Considering HCPs, it appeared that the absence of a clear and specific policy and guideline in the management of PND within the Malaysian healthcare system has resulted in a lack of professional ownership in the management of PND, especially among HCPs in MCH clinics. Conclusion: The women and the HCPs had distinct ways of conceptualising PND experiences, although they agreed on several symptoms and causal explanations. This study calls for a system-based enhanced PND care with an initiation of culturally appropriate care for PND within the healthcare system.

Introdução: Os transtornos depressivos pós-parto podem afetar a mãe, o bebê e outros membros da família. A depressão pós-parto costuma iniciar na quarta semana e evolui lentamente por várias semanas. Objetivos: Identificar a ocorrência de sintomas depressivos em mulheres no pós-parto e verificar a associação entre sintomas depressivos e as variáveis sociodemográficas e obstétricas. Método: Estudo transversal realizado com 302 mulheres que se encontravam entre 42 e 56 dias após o parto, residentes no município de Lavras (MG). Os dados foram obtidos no período de agosto de 2011 a janeiro de 2012, por meio de entrevista para obtenção da caracterização da puérpera e aplicação da Edinburgh Postnatal Depression Scale (EPDS), para rastrear a depressão após a gestação. O ponto de corte 13 pontos na EPDS foi adotado para indicar a presença de episódio depressivo. A associação de sintomas depressivos com algumas variáveis maternas foi analisada pelo teste do Qui-Quadrado e regressão logística. O projeto foi aprovado pelos Comitês de Ética em Pesquisa da Escola de Enfermagem da Universidade de São Paulo Processo nº 1059/2011/CEP-EEUSP e do Centro Universitário de Lavras - Protocolo nº 1059/2011. Resultados: As mulheres tinham em média 27,04 (±6,12) anos de idade; 49,3% eram de cor branca; média de 10,44 (±2,12) anos de estudo, 85,8% com parceiro. O coeficiente Alpha de Cronbach verificado foi 0,85. A prevalência de sintomas depressivos foi de 11,9%. Houve diferença significativa no nível de etnia (p=0,032), escolaridade (p<0,001); situação conjugal (p<0,001); número de gestação (p=0,004); paridade (p<0,001); descanso (p=0,004); fumo (p<0,001); drogas (p=0,004); planejamento da gestação (p<0,001); aceitação da gestação (p<0,001); gestação desejada (p<0,001); experiência pré-natal (p=0,007); experiência no parto (p=0012); violência antes da gestação (p<0,001); violência na gestação (p<0,001); problema psicológico antes da gestação (p<0,001); problema psicológico na gestação (p<0,001); amamentação (p=0,006) e bebê com problema de saúde (p<0,001). As variáveis associadas ter parceiro, estar amamentado e ter mais filhos foram consideradas fatores de proteção para sintomas depressivos no pós-parto e as variáveis associadas ser negra/parda, fumantes e ter sofrido violência, fatores de risco. Conclusões: A prevalência de sintomas depressivos (11,9%) em mulheres no pós-parto no município de Lavras (MG) está compatível com as da literatura nacional e internacional que se referem como 10% e 20%. O conhecimento das variáveis maternas que podem influenciar a ocorrência de depressão pós-parto é de fundamental importância, para que a equipe de saúde possa intervir de forma precoce e adequada no tratamento das mulheres. / The study objectives were to identify the occurrence of depressive symptoms in postpartum women and the association between depressive symptoms and sociodemographic and obstetric variables. This is a cross-sectional study on 302 women who were between 42 to 56 days after delivery, residents in Lavras (MG). Data were collected from August 2011 to January 2012, through an interview and application of Edinburgh Postnatal Depression Scale (EPDS). The EPDS is a self-assessment to track depression after pregnancy, which contains 10 statements, each item has a score ranging from 0 to 3, reaching a maximum score of 30. We adopted a cutoff 13 points in EPDS, 59.5% sensitivity, 88.4% specificity in the Brazilian population, to detect depressive symptoms. The reliability was assessed by Cronbach\'s Alpha coefficient and the association of depressive symptoms with some maternal variables were analyzed by chi-square. The project was approved by the Research Ethics Committee of the School of Nursing, University of São Paulo under Opinion No 1059/2011 and the University Center Lavras. The women had an average of 27.04 (± 6.12) years of age; 49.3% white, mean 10.44 (± 2.12) years of education, 85.8% with partner. The Cronbach\'s Alpha coefficient was 0.85 verified. The prevalence of depressive symptoms was 11.9%. There were significant differences in the level of ethnicity (p = 0.032), education (p <0.001), marital status (p <0.001), number of pregnancy (p = 0.004), parity (p <0.001) and resting (p = 0.004) , smoking (p <0.001), drug (p = 0.004); planning pregnancy (p <0.001); acceptance of gestation (p <0.001); desired pregnancy (p <0.001); experience prenatal care (p = 0.007); experience in childbirth (p = 0012); violence before pregnancy (p <0.001); violence during pregnancy (p <0.001); psychological problem before pregnancy (p <0.001); psychological problem during pregnancy (p <0.001); breastfeeding (p = 0.006) and baby with health problems (p <0.001). The prevalence of depressive symptoms (11,9%) in postpartum women in Lavras (MG) is compatible with the national and international literature that refer as 10% to 20%. Knowledge of maternal variables that may influence the occurrence of postpartum depression is critical for the health team can intervene early and appropriate treatment of women.

The aim of this study is to give an in-depth understanding of the representations of a depressed woman who killed her baby. The representations under study is based on “The motherhood constellation” by Stern (1995) and focus on the woman’s representation of her mother as mother-of-herself-as-child, herself-as-mother and her representations of her children. Pregnancy is an important phase in a woman’s life. Parent-infant psychotherapies are a rapidly growing field of infant mental health as many psychological problems have their roots in infancy. Neglect, trauma and abuse and prolonged maternal depression can cause a child to develop a range of problems. The work of Winnicott (1965a) and Bion (1988) put the mother’s fantasy life about her infant as one of the major building blocks of the infant’s construction of a sense of identity (Stern, 1995). Fraiberg (Fraiberg, Adelson&Shapiro, 1980) with her “ghosts in the nursery” revolutionised this perception by placing the maternal representation at the core of the parent-infant clinical situation (Stern, 1995). The way the research developed and the nature of the research problem necessitated a pure qualitative mode of enquiry. A single case study was done about the representations (of self-as-mother, mother-as –mother–of–self-as-child- and of the children) in an extreme case where the mother’s depression led to her murdering her baby. Data collection was done through semi-structured interviews and documents from the psychiatric hospitals she attended. Data was also obtained from field notes, before and after the interviews and also while transcribing the audio-taped interviews. Data analysis was done by the procedures of data reduction and organising it into categories on the basis of themes as described by Neuman (2000). Coding and analytic memo writing were done. The relationships between concepts were examined and linked to each other and interweaved into theoretical statements. The researcher argues that not enough is done to enhance the relationship between a mother and her foetus, and later her baby. The concept of maternal representations is the only approach that opens the possibility to start working at the earliest point of prevention, because intervention can start during pregnancy. Intervention during pregnancy is ideal because defence mechanisms are less rigid during pregnancy and women are more in touch with their entire life cycle and the whole system is more open for change. The ghosts can be chased out of the nursery by helping the mother to see the repetition of the past in the present. The affective link, recognising and remembering the feelings help a parent not to repeat the past in the present - “…it is the parent who cannot remember his childhood feelings of pain and anxiety who will need to inflict his pain upon his child” (Fraiberg, Adelson&Shapiro, 1980, p. 182). / Thesis (PhD (Psychotherapy))--University of Pretoria, 2006. / Psychology / unrestricted

Over the past two decades, India has become an international hub of cross-border surrogacy. The extreme economic and cultural differences between international couples seeking surrogacy and the surrogates themselves, clinics compromising health of surrogates for profit, the stigmatisation of surrogacy in India, and the constant surveillance of these women living in a ‘surrogate house’, have raised concerns regarding the potentially negative psychological impact of surrogacy on Indian surrogates. The primary aims of the thesis were (i) to conduct a longitudinal assessment of surrogates’ psychological problems (anxiety, depression and stress) from pregnancy until several months after relinquishing the baby to the intended parents, (ii) to examine the nature of the bond formed between surrogates and the unborn baby and establish whether this prenatal bond contributes to their psychological problems, and (iii) to explore the experiences of surrogates during and post-surrogacy. Fifty surrogates were compared with a matched group of 69 expectant mothers during pregnancy. Of these, 45 surrogates and 49 compairson group of mothers were followed up 4-6 months after the birth. All surrogates were hosting pregnancies for international intended parents and had at least one child of their own. Data were obtained using standardised questionnaires and in-depth interviews and were analysed using quantitative and qualitative methods. Indian surrogates were found to be more depressed than the comparison group of mothers, both during pregnancy and after the birth. However, giving up the newborn did not appear to add to surrogates’ levels of depression. There were no differences between the surrogates and the expectant mothers in anxiety or stress during either phase of the study. The examination of risk factors for psychological problems among the surrogates showed that anticipation of stigma, experiences of social humiliation and receiving insufficient support during pregnancy were associated with higher levels of depression following the birth. With respect to bonding with the unborn child, surrogates experienced lower levels of emotional bonding (e.g. they interacted less, and wondered less about, the foetus), but exhibited higher levels of instrumental bonding (e.g. they adopted better eating habits and avoided unhealthy practices during pregnancy), than women who were carrying their own babies. Contrary to concerns, greater bonding with the unborn child was not associated with increased psychological problems post-relinquishment. All surrogates were able to give up the child. Meeting the intended parents after the birth positively contributed towards surrogates’ satisfaction with relinquishment whereas meeting the baby did not. The qualitative findings on surrogates’ experiences showed that the majority lacked basic medical information regarding surrogacy pregnancy; hid surrogacy from most people; felt positive and supported at the surrogate house; lived in uncertainty regarding whether or not they would be allowed to meet the intended parents and the baby; and did not actually get to meet them. These findings have important implications for policy and practice on surrogacy in the Global South.

Postpartum depression is an illness that is frequently unreported and undetected for a variety of reasons and may be potentially devastating for the mother affected as well as her family. Routine screening of postpartum women enables health practitioners to detect symptoms of PPD early and provides an opportunity for early intervention which may improve the outcome and increase the mother’s chances of an earlier recovery. It is therefore important that reliable and convenient screening tools are available to health practitioners who have contact with postpartum women. The primary objective of this research was to make an Afrikaans version of an existing screening scale available – the Postpartum Depression Screening Scale (PDSS), designed specifically to encompass the multifaceted phenomenon of PPD. In accordance with this objective, the validity and reliability of the PDSS and its Afrikaans version was investigated in English- and Afrikaans-speaking South African mothers. A further objective of this study was to compare the performance of the PDSS with the Edinburgh Postnatal Depression Scale (EPDS) and the Quick Inventory of Depressive Symptomatology (QIDS-SR16). Various factors have been reported to be associated with the development of PPD. The final objective of this study was to explore the relationship between known risk factors for PPD and high scores on the PDSS amongst women in South African. A total of 365 South African mothers, between 4 and 16 weeks postpartum participated in this study. English-speaking mothers (n = 187) completed the PDSS, EPDS, QIDS, and a demographic and psychosocial questionnaire, while Afrikaans speaking mothers (n = 178) completed the respective Afrikaans versions of these questionnaires. A multiple translation method – Brislin’s back-translation method and the committee approach – was used to translate the PDSS and the QIDS into Afrikaans. An item response theory (IRT), Rasch analysis, was used to examine dimensionality, item difficulty, differential item functioning, and category functioning of the PDSS and the Afrikaans PDSS. Results reveal excellent person reliability estimates for the Afrikaans PDSS as well as for the PDSS in a South African sample. Both language versions performed reasonably well and the majority of items in the PDSS dimensions and the Afrikaans PDSS dimensions demonstrated fit statistics that supported the underlying constructs of each dimension. Some items were identified as problematic, namely Item 2, Item 25, Item 28, and Item 30. The item person construct maps show reasonably good spread of items. There were, however, persons that scored higher than the items could measure and an overrepresentation of items at the mean level. The Likert response categories proved to be effective for all the Afrikaans PDSS items and almost all the PDSS items. Results indicate that 49.7% of mothers screened positive for major PPD using the PDSS. A further 17.3% of mothers obtained scores indicating the presence of significant symptoms of PPD. Statistically significant correlations were obtained between total scores on the PDSS, the EPDS, and the QIDS-SR16. Stepwise multiple regression analysis identified 11 variables that were significantly associated with a high PDSS total score. These were a history of psychiatric illness, postpartum blues, feeling negative or ambivalent about expecting this baby, fearful of childbirth, infant temperament, antenatal depression in recent pregnancy, lack of support from the baby’s father, concern about health related issues regarding the infant, lack of support from friends, difficulty conceiving, and life stress. / Thesis (PhD)--University of Pretoria, 2012. / Psychology / unrestricted

The aim of this research was to support new mothers in groups, so that they can function optimally as educators. During the research mothers with babies up to three months of age were used by means of a support group. This research project was done after it became evident from a literature study that new mothers suffered with unique problems during this adaption phase. In the empirical survey the researcher gave attention to the new mothers' specific needs and problems during this trimester. The researcher aimed to explore the experiences of the new mother as educator through weekly group sessions. From the results it was clear that there was a need of support from other mothers that is going through the same experiences. In this way new mothers could receive emotional support and obtain knowledge regarding relevant issues experienced during this unique life phase. / Educational Studies / M. Ed. (Guidance and Counselling)