Immigrant women are at greater risk for postpartum depression (PPD) compared to non-immigrant women and experience multiple barriers to accessing health services to address their needs. This mixed method study explored the multi-level factors that contribute to the postpartum mental health of immigrant women in Canada and their ability to access requisite health services. In the quantitative phase, data from a longitudinal prospective cohort survey of women were used to examine predictors of PPD over the first postpartum year for a sample of women who delivered at two hospitals in Toronto, Ontario. In the qualitative phase, an interpretive descriptive design shaped by an integrated knowledge translation approach was used to understand the factors immigrant women living in Scarborough, Ontario (a region of Toronto) perceive as contributing to their postpartum emotional health and the factors immigrant women and care providers perceive as influencing access to health services. Across quantitative and qualitative findings, factors contributing to PPD among immigrant women included a lack of social support, individual and community-level challenges faced in terms of the social health determinants, physical health status, and client-provider relationships. Factors contributing to reduced access to health services included: lack of system knowledge, social health determinants, organizational and system barriers, limited access to treatment, and a need for service integration and system navigation support. Immigrant women in Canada experience numerous health inequities that increase their risk for PPD and v prevent them from accessing service supports to address PPD concerns. The Canadian health care system needs to be responsive to individual needs in order to facilitate equitable access and address the health needs of Canadian immigrant women and their families. The diversity and proportion of immigrants in Canada calls for a linguistically and culturally supportive health care system with a strategic approach to enhancing accessibility to address health inequities. / Dissertation / Doctor of Philosophy (PhD) / Immigrant women have a 2-3 times higher risk for postpartum depression (PPD) than native-born women. This study explored the factors that contribute to PPD among immigrant women in Canada and how health services can help them get the care they need, from the perspective of immigrant women and care providers. This study found increased PPD risk when women lacked social support, had physical health issues, and faced challenges such as low income and lack of English language skills. Working with care providers could help address these challenges or make it more difficult to get care. Immigrant women had more difficulty getting services when they lacked knowledge about the health care system, faced social, financial, and language-based barriers to care, and experienced barriers when using available services. The findings from this research can inform the design and delivery of health care to best meet the needs of immigrant women with PPD.

Bakgrund: Psykisk ohälsa är ett globalt växande folkhälsoproblem, där depression är den vanligaste diagnosen. En typ av depression är postpartumdepression, som drabbar kvinnor i nära anslutning till förlossningen av barn. Uppskattningsvis drabbas ca tio procent av alla kvinnor som föder barn världen över av postpartumdepression. Symtomen för postpartumdepression liknar symtomen vid depression men riktar sig ofta mot delar av moderskapet. Dessutom förekommer vissa fysiska symtom och en del upplever suicidala tankar. Sjuksköterskan har en viktig roll för att fånga upp kvinnor som drabbats eftersom de ofta söker vård för andra problem. Kontinuerliga samtal och mentalt stöd är en viktig del i behandlingen. Syfte: Syftet var att beskriva kvinnors erfarenheter av att leva med postpartumdepression. Metod: Litteraturöversikt gjord utifrån tio vetenskapliga artiklar som hämtats från Cinahl Complete och PubMed. Resultat: Resultatet presenteras under fyra huvudteman: ohälsa hos mammor efter förlossning, erfarenheter av stöd och relationer, känsla av skam och rädsla inför vårdkontakt och förhållningssätt till sjukdom och behandling. Slutsats: Resultaten i de olika artiklarna skiljer sig åt beroende på kvinnornas tidigare erfarenheter och vart de kommer ifrån. Kvinnornas kulturella arv, traditioner och religion kunde påverka sättet deltagarna såg på postpartumdepression och hur de hanterade det. En aspekt som lyftes upp av många kvinnor var behovet av stöd från partner, vård och omgivning. / Background: Mental illness is a globally growing public health problem where depression is the most common diagnose. One type of depression is postpartum depression, it affects women in close proximity to childbirth. Approximately ten percent of all women globally who give birth suffers from postpartum depression. The symptoms for postpartum depression resembles the symptoms for depression but often turns toward parts of the motherhood. Physical symptoms also occur and some experience suicidal thoughts. The nurse play an important role in noticing women affected since they often seek healthcare for other problems. Continuously having conversations and mental support is a crucial part of treatment. Aim: The aim was to describe womens experiences of living with postpartum depression. Method: Literature review based on ten scientific articles retrieved from Cinahl Complete and PubMed. ​Results: The results are presented under four main themes: illness in mothers after childbirth, experiences of support and relationships, feelings of shame and fear before healthcare contact and attitudes to illness and treatment. ​Conclusions: The results from the different articles differs depending on where the women come from and their different experiences. The womens cultural heritage, traditions and religion could affect the way participants viewed postpartum depression and how they handled it. One aspect many women mentioned was the need of support from a partner, health care and their surrounding.

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Introduction: In Major Depressive (MDD) and Bipolar Disorders (BD), there are well-documented changes in sleep and biological rhythms. However, how sleep and biological rhythm disruptions impact functioning and quality of life (QOL) in these populations, and how these disruptions affect perinatal mood and anxiety remains little-known. In this thesis, we aimed to compare sleep and biological rhythms in individuals with and without mood disorders, and to investigate whether these measures can account for worsened functional impairment and QOL in these populations. We investigated whether clinical variables combined with sleep and biological rhythms during pregnancy can be used to predict depressive and anxiety symptom severity postpartum. Finally, we investigated longitudinal changes in sleep, and biological rhythms over the perinatal period. Results: Subjective and objective sleep and biological rhythm disruptions, and light exposure differences are wide-spread in MDD and BD. Regression analyses showed that subjective and objective sleep and biological rhythm disruptions can explain 43% of variance in QOL scores, and 52% of variance in functional impairment in MDD, BD and healthy controls. Clinical and demographic variables, objective and subjective sleep and biological rhythm measures collected during pregnancy accounted for 50% of postpartum depression and 49% of postpartum anxiety symptom severity variance, in regression analyses. Numerous sleep and biological rhythm changes occurred across multiple domains from pregnancy to postpartum. Conclusion: Results suggest that sleep and biological rhythm disruptions occur across many domains in mood disorders, including sleep, light exposure, daily activity rhythms and melatonin. These disruptions are associated with worse QOL and functioning in BD, MDD and healthy controls. Biological rhythms and sleep changes across the perinatal period can be used to predict severity of postpartum depressive and anxiety symptoms. This work highlights the importance of sleep and biological rhythms as intervention targets across different outcomes, and across different mood diagnoses. / Thesis / Doctor of Philosophy (PhD) / Sleep and biological rhythms are often disrupted in individuals with depression and bipolar disorder. In this thesis, we aimed to compare sleep and biological rhythms in individuals with depression or bipolar disorder, against individuals without these disorders. We investigated whether sleep and biological rhythms contribute to functioning and quality of life in these individuals. As sleep and biological rhythms are disrupted in pregnancy and following childbirth, we assessed whether sleep and biological rhythms during pregnancy can be used to predict postpartum depression and anxiety severity. Finally, we investigated changes in sleep, biological rhythms and light exposure from pregnancy to postpartum. Results indicate that disruptions in sleep, biological rhythms, and changes in light exposure are widespread in mood disorders. These disruptions are linked to worse quality of life and functioning. Sleep and biological rhythms change from pregnancy to postpartum, and can be used to predict severity of postpartum depression and anxiety.

This study examined pregnancy risk and protective factors for developing postpartum depression from a structural family theory lens. The purpose of this study was to (1) examine previously identified pregnancy stressors to learn which stressors put women more at risk for postpartum depression and (2) to identify possible buffers for women who are at risk for developing postpartum depression. In this paper, two analyses were proposed. Analysis I, uses a hierarchal regression analysis to examine the impact of couple related stress on postpartum depression. Analysis II uses moderated multiple regression to test factors during pregnancy which may protect at-risk women from postpartum depression symptoms. Three post-hoc exploratory analyses were conducted following the originally proposed analyses. Secondary data was used in this study. The data was collected in four large urban hospitals in Utah from 2005-2007 and included 1568 women. The results of these analyses illustrate the importance of conceptualizing postpartum depression from a family systems perceptive. Specifically, this study shows that a couple’s relationship, depending on the stress level experienced in the relationship, can be both a risk and protective factor for pregnant women. / Ph. D.

Introduktion: Mellan åtta och femton procent av nyförlösta kvinnor i Sverige drabbas av Postpartum depression (PPD). Många vet inte om att de är sjuka och söker inte vård. Hälso- och sjukvården ska tidigt uppmärksamma symtom, samt ha kunskap om vilka faktorer som kan bidra till PPD för att ge vård, hjälp och stöd. Syfte: Syftet var att utforska kvinnors upplevelse av förlossningsdepression samt stöd från vårdpersonal. Metod: En systematisk deskriptiv litteraturöversikt baserad på elva originalartiklar med kvalitativ design utfördes. Resultat: Resultatanalysen visade att kvinnorna upplevde fysiska och psykiska symtom, kände rädsla och hade svårigheter att prata om sina känslor vilket bidrog till isolering. En del kvinnor hade anknytningsproblem till barnet och vissa påverkades i sin relation till partnern. Kvinnor hade suicidtankar eller tankar på att skada sig själva eller sitt barn. Positiva eller negativa egenskaper hos vårdpersonalen var avgörande för mödrarnas önskan om stöd. När stödet i vården var bristande eller otillräckligt upplevdes fysisk aktivitet vara hjälpande faktorer. Slutsats: Kvinnor med PPD upplever ett onödigt lidande och känner skuld och skam. I många fall skulle dessa individer kunna upptäckas och få behandling tidigare genom att sjukvården arbetar proaktivt och ger kvinnor information i ett tidigt stadium. Det kan hjälpa kvinnor att uppmärksamma symtom själva och att söka vård i tid. Att göra information och vård lättillgängligt, att öka kunskapen i samhället och bland professionerna i vården samt att normalisera och bryta stigmat skulle kunna underlätta för många drabbade. / Introduction: Between eight and fifteen percent of women who have just given birth in Sweden suffer from postpartum depression (PPD). Many do not know that they are ill and do not seek treatment. The healthcare system must pay attention to symptoms early on, and have knowledge of which factors can contribute to PPD in order to provide care, help and support. Purpose: The purpose was to explore women's experience of postpartum depression and support provided by healthcare professionals. Method: A systematic descriptive literature review based on eleven original articles with a qualitative design was performed. Result: The results analysis showed that the women experienced physical and psychological symptoms, felt fear and had difficulty talking about their feelings, which contributed to isolation. Some women had attachment problems with the child and some were affected in their relationship with the partner. Women had suicidal thoughts or thoughts of harming themselves or their child. Positive or negative characteristics of the healthcare professionals were decisive for the mothers' desire for support. When support in care was lacking or insufficient, physical activity was perceived to be a helping factor. Conclusion: Women with PPD experience unnecessary suffering and feel guilt and shame. In many cases, these individuals could be detected and treated earlier by the healthcare system working proactively and providing women with information at an early stage. It can help women to notice symptoms themselves and to seek care in time. Making information and care easily accessible, increasing knowledge in society and among the healthcare professions, and normalizing and breaking the stigma could make things easier for many sufferers.

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: Postpartum depression har länge förknippats med moderskap, men drygt 10 % av papporna drabbas också av depression efter barnets födelse. Syfte. Belysa begreppet postpartum depression hos fäder. Metod: Systematisk litteraturstudie som bearbetat och analyserat kvantitativ samt kvalitativ forskning genom en innehållsanalys. Resultat: Orsakerna till postpartum depression hos fäder var främst psykologiska och sociala faktorer där mammans eventuella depression, pappans arbetslöshet och en ansträngd ekonomi samt pappans upplevelse av bristande socialt stöd utgjorde de viktigaste orsakerna. Depressionen påverkade pappans anknytning till barnet, hela familjen och föräldraskapet samt barnets emotionella, kognitiva och sociala utveckling negativt. Slutsats: Postpartum depression hos pappan orsakas av sociodemografiska, psykiska och sociala faktorer. Depressionen påverkar familjen, parrelationen, föräldraskapet samt barnets kognitiva och sociala utveckling negativt. Den kunskap litteraturstudien bidrar till ger ökade möjligheter att uppmärksamma postpartum depression hos pappan, stödja familjen samt bidra till en fördelaktig utveckling för barnet. Framtida forskning bör ske med syfte att hitta lämpliga metoder och bedömningsinstrument utformade för att identifiera pappor med risk att utveckla en depression. / Background: Postpartum depression have for a long time been associated with motherhood, but more than 10 % of fathers also get a depression after their child's birth. Aim: Elucidate the concept of paternal postpartum depression. Method: A systematic literature study who processed both quantitative and qualitative research, analyzed with a content analysis. Results: The causes of paternal postpartum depression where mostly psychological and social factors were the mother´s depression, the father’s unemployment and a strained economy together with the father´s experience of lack of social support seemed to be the most important risk factors. Paternal postpartum depression affected the father’s attachment to his child, family, parenthood and the child's emotional, cognitive and social development negatively. Conclusion: Paternal postpartum depressions are caused of socio-demographic, psychological and social factors. The depression affects the whole family, partners, parenting and the child's cognitive and social development negatively. The literature study increases the knowledge and opportunities to identify postpartum depression in fathers, support the family and to contribute to a favorable development for the child. Future research should be done in order to find appropriate methods and assessment instruments designed to find the fathers at risk for developing depression.

Bakgrund: Postpartum depression drabbar 13-19% av nyblivna mammor och konsekvenserna av att behandling inte sätts in i tid kan få bestående effekter för såväl mamman som barnet. Syfte: Att beskriva faktorer som påverkar hjälpsökande beteenden hos nyblivna mammor med symptom på postpartum depression. Metod: En allmän litteraturstudie genomfördes där tio kvalitativa artiklar granskades, analyserades och sammanställdes. Resultat: Ur litteraturstudiens resultat framkom temana: hälso-och sjukvårdens påverkan, familj och närståendes betydelse, kunskapsnivån kring postpartum depression, kulturens betydelse och förväntningar kring moderskapet. Hälso-och sjukvården samt familj och närstående beskrevs vara faktorer som främjade kvinnors hjälpsökande beteenden samtidigt som kultur, okunskap, informationsbrist och förväntningar kring moderskapet var framträdande hinder på vägen till att söka hjälp. Slutsats: Studien visade på ett antal faktorer som påverkade det hjälpsökande beteendet. För att kunna minska stigmatiseringen kring diagnosen och istället öka kunskaperna behövs det mer omfattande informationsåtgärder. Sjuksköterskor behöver ha god kunskap om postpartum depressionen för att förstå kvinnornas hjälpsökande beteenden och vidare forskning kring upplevelsen av hälso-och sjukvården som en hindrande faktor är önskvärt för att denna faktor i framtiden endast ska vara främjande. / Background: Postpartum depression affects 13-19% of new mothers, and the consequences when treatment is not introduced in time can have permanent effects for both the mother and the child. Purpose: To describe factors that affect help seeking behaviors in new mothers with symptoms of postpartum depression. Method: A general literature study was conducted where ten qualitative articles were examined, analyzed and compiled. Results: The results of the literature study featured the themes: the impact of healthcare, the meaning of family and close relatives, the level of knowledge regarding postpartum depression, the significance of culture and expectations about maternity. Healthcare and family were described as promotive factors in women's help seeking behavior while culture, ignorance, lack of information and expectations about motherhood were prominent barriers in help seeking. Conclusion: The study showed several factors that influenced the help seeking behavior. In order to reduce stigmatization around the diagnosis and instead increase knowledge, more comprehensive information measures are needed. Nurses need to have knowledge of postpartum depression in order to understand women's help seeking behaviors and further research on the health care experience as a barrier is desirable for this only be a promotive factor in the future.