This dissertation is a mixed methods analysis investigating postpartum depression as it is experienced by self-reported depressed Mexican American adolescent and adult mothers. The qualitative portion of this study explores pregnancy and motherhood to better understand meanings attached to depression. Six adolescent and six adult mothers, were recruited from the Dallas/Fort-Worth area. Each was interviewed twice, using semi-structured interview guides. The quantitative phase utilizes a national sample of self-reported depressed Hispanic mothers to identify breastfeeding behavior and mothers' perceptions of the physical health of their babies. Specifically, a secondary analysis of the National Survey of Children's Health, 2003 was used to supplement the qualitative data. This study provides a theoretical framework of fragmented identity to explain socio-cultural factors contributing to postpartum depression among Mexican American adolescent and adult mothers. Common themes leading to a fragmented identify were indentified. Contributors to postpartum depression include: unplanned pregnancy, internal struggle between cultures, body image and family conflict. Stigma associated with teen motherhood also contributed to depression among adolescent mothers while the medicalization of childbirth was a contributing factor of depression among the adult mothers. Additionally, the duration of breastfeeding and mothers' perceptions of their babies' physical health were impacted by depression, but breastfeeding initiation was not.

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

Postpartum depression (PPD) is a common perinatal mental health disorder (CPMD) extensively linked to poor child health outcomes, including increased risk of illness, stunting and underweight. Rates of PPD and child malnutrition are consistently elevated in Sub-Saharan Africa compared to other regions of the world. This includes Northern Uganda, a region devastated by armed conflict and enduring poverty. While the link between PPD and adverse child health outcomes is firmly established, the mechanisms underlying this association remain poorly understood.The current study addresses this gap in the literature through investigating in a sample of Ugandan mothers of children 0 to 23 months how maternal behaviors promoting child health differ in the presence or absence of probable depression. This study also explores how perceived social support and women’s empowerment may moderate the relationship between PPD and mothers’ engagement in these health-promoting behaviors. The study is based on cross-sectional, baseline data collected for a project sponsored by Food for the Hungry Uganda, an international relief and development organization, and in partnership with the Global Mental Health Lab at Teachers College, Columbia University and World Vision International. The study’s sample included 1028 probably depressed and 284 nondepressed Ugandan mothers with at least one child under 24 months of age at the time of interviewing. The study’s findings yielded evidence to support the reliability and validity of the Patient Health Questionnaire-9 and Multidimensional Scale of Perceived Social Support for this sample. While as expected, probable depression was positively associated with child underweight, recent child illness, delayed care seeking for sick children and unsafe disposal of child feces, positive associations were also found between depression and important health-promoting behaviors, for which there is little evidence in the extant literature, including provision of the same amount or more food to a sick child, knowledge of danger signs of childhood illness, and some WASH behaviors. Perceived social support and women’s empowerment indicators were also found to moderate the association between probable depression and some IMCI, IYCF and WASH behaviors. Study limitations, clinical implications and recommendations for further research are discussed.

Bakgrund: Förlossningsdepression är en form av klinisk depression som kan drabba kvinnor efter barnafödandet. Symtom inkluderar ångest och anknytningssvårigheter mellan kvinnan och det nyfödda barnet. Förlossningsdepression screenas med hjälp av självskattningsskalan The Edinburgh Postnatal Depression Scale i kombination med en klinisk bedömning av symtomen. Behandlingar inkluderar antidepressiva läkemedel och psykologisk behandling. Syfte: Syftet var att beskriva kvinnors upplevelser av förlossningsdepression. Metod: En litteraturöversikt med induktiv ansats genomfördes. Informationssökningen genomfördes i de omvårdnadsbaserade databaserna CINAHL och PubMed. Resultat: I resultat framkom fyra kategorier; Att inte nå upp till det idealiserade moderskapet, utmaningar i samband med rollförändring, ensamhet och isolering och behov av stöd. Resultaten visade att övergången till moderskap upplevs vara utmanande av kvinnor med förlossningsdepression. Kvinnorna upplever även känslor av skuld och skam när de inte lever upp till de sociala normerna som är knutna till att vara en bra mamma. Konklusion: Litteraturstudiens resultat kan bidra till ökad förståelse av kvinnors upplevelser och behov vid förlossningsdepression. Studien konkluderar att utbildning av vårdpersonal avseende förlossningsdepression, dess symtom och hur personal möter och vårdar enskilda kvinnor är av stor vikt. / Background: Postpartum depression (PPD) is a form of clinical depression that can affect women after childbirth. Symptoms include anxiety and bonding difficulties between the woman and the baby. PPD is screened by using the The Edinburgh Postnatal Depression Scale in combination with a clinical assessment of the symptoms. Treatments include antidepressants and psychotherapy. Aim: The aim was to describe women's experiences of PPD. Method: A literature review with an inductive approach was conducted. Information retrieval was conducted in the nursing-based databases CINAHL and PubMed. Results: In the results, four categories emerged; Not reaching the idealized motherhood, challenges associated with role change, loneliness and isolation and need for support. The results showed that the transition to motherhood is perceived as challenging by women with PPD. The women also experience feelings of guilt and shame when they do not live up to the social norms associated with being a good mother. Conclusion: The results of the literature study can contribute to an increased understanding of women's experiences and needs in PPD. The study concludes that teaching health care professionals about PPD, its symptoms and how to meet and care for women is of great importance.

While major depression is a well-defined mental health condition, it's presentation can be vastly different across individuals and groups, and many factors impact one's vulnerability. A critical period of vulnerability to depression is the postpartum period. Despite the frequent assumption that postpartum conditions solely affect women, prevalence estimates of paternal postpartum depression (PPPD) are comparable with those of women. Similar to mothers, men experience significant biological and psychosocial changes following the birth of a child that contribute to the onset of postpartum depression. A growing body of research has identified many potential variables related to PPPD, yet there is no clear consensus as to which variables are the most impactful. Following PRISMA guidelines, we conducted a meta-analysis to aggregate the known findings and quantitatively determine the most salient predictors of PPPD. We hypothesized that the psychosocial factors of relationship satisfaction, social support, partner depression and history of depression would yield the strongest aggregate effect sizes. By searching databases using logical operations, as well as conducting backward and forward searches, we identified 129 articles that met inclusion/exclusion criteria with a total sample size of 114,712 participants (79,743 fathers). Trained independent coders extracted data directly from identified studies, including sample characteristics for descriptives and moderators, and demographic correlates. Correlates of primary interest include but are not limited to maternal depression, history of depression, relationship satisfaction, and social support. Effect sizes represented as Pearson correlations (or transformed to r using standard procedures) were calculated and compared using a random-effects model. In partial support of our hypothesis, fathers' reported history of depression had one of the largest effect sizes (r = .469, unbiased r = .368). The other primary psychosocial factors had relatively moderate effect sizes: social support, r = -.359 (unbiased r = -.398); relationship satisfaction, r = -.300 (unbiased r = -.266); and partner depression, r = .294 (unbiased r = .471). The correlates of PPPD with the strongest effect sizes were all factors associated with personal distress and stressful pregnancies. Demographic correlates (i.e., younger age, non-White ethnicity, lower education, unemployment, lower SES) generally had small though statistically significant effect sizes. This study helps provide a clearer picture of what predicts PPPD to more accurately screen for men at greatest risk and inform the development of diagnostic measures and treatments. It also lays the groundwork for future work in a more unified and productive direction. By researching and sharing better information, we can provide better access and better outcomes for postpartum couples.

Postpartumdepression drabbar uppskattningsvis 10-20% av kvinnor som föder barn i Sverige varje år. Majoriteten av de drabbade kvinnorna behöver söka vård själva då det inte uppmärksammas av vårdpersonal. Av denna anledningen är det viktigt att sjuksköterskan är medveten om symtom och kännetecken för postpartumdepression. Syftet med studien var att beskriva kvinnors upplevelse av postpartumdepression. Uppsatsen är en kvalitativ innehållsanalys med manifest ansats. För studien användes 17 artiklar som granskades och analyserades vilket genererade i fem kategorier vilket resultatet baserades på. Kategorierna var; “Att bli någon annan”, “Att känna sig ensam med övermäktiga krav”, “Att inte känna sig nära sitt barn”, “Att inte bli sedd och hörd” och “Att hitta strategier för att klara av den nya vardagen”. Studiens resultat kan bidra till att kunskap och förståelse om postpartumdepression ökar hos sjuksköterskan och vårdpersonal, vilket ökar kunskap i hur kvinnor med postpartumdepression ska hjälpas.

Bakgrund: Förlossningsdepression (PPD) drabbar 12 % kvinnor. Sjukdomen erhålls efter barnafödande och kommer vanligtvis inom fyra veckor. Idag förekommer det okunskap om psykisk ohälsa relaterat till förlossningsdepression. Dessutom finns det begränsad kunskap hos de nyblivna mödrarna om hur och var de ska söka vård. För att kunna erbjuda en god vård utifrån kvinnornas behov behövs mer kunskap om deras upplevelser.  Syfte: Att undersöka kvinnors upplevelser av förlossningsdepression samt vården i samband med detta.  Metod: Allmän litteraturstudie med deskriptiv design. Databaserna Pubmed, Psycinfo och CINAHL användes till litteratursökningen. Resultatet baserades på 11 originalartiklar med kvalitativ ansats, som var skrivna mellan 2008-2019. Artiklarnas kvalitet granskades.  Resultat: Vid sjukdomen upplevde flera mödrar känslan av misslyckande, hopplöshet och de påverkades av stigman runt sjukdomen att framstå som en dålig mamma. Isolering och ensamhet upplevdes av många mödrar. Stöd i form av bekräftelse och förståelse upplevdes vara en grund för återhämtning. Mödrarna upplevde också bristfällig kunskap om PPD. En del mödrar upplevde vården som stöttande och givande, medan en del upplevde den som bristfällig eftersom bland annat sjukvårdspersonal försökte normalisera känslorna.  Slutsats: Resultaten skulle kunna tolkas som att många upplevelser berodde på bristfällig kunskap om PPD hos kvinnor och hos olika yrkeskategorier inom vården. Eftersom PPD är en del av vårt samhälle bör ökad kunskap hos sjuksköterskor inom öppenvården främjas för att ge mödrar en bättre vård och hälsa. / Background: Postpartum depression (PPD) affects 12 % of women. PPD comes after childbirth and usually appears within four weeks. Today there is poor knowledge about mental ill related to PPD. Women have also limited knowledge about how and where to seek care. To be able to offer good care based on women’s needs, more knowledge about their experience is needed.  Purpose: To investigate the experiences of women with Postpartum Depression (PPD) and the healthcare in conjunction to this.  Method: General literature study with descriptive design. The Pubmed, Psykinfo and CINAHL databases were used for the literature search. The result was based on 11 original articles with a qualitative approach, written from 2008-2019. The quality of the articles were examined.    Result: During the PPD period, several mothers experienced the feeling of failure, hopelessness and felt affected by the stigma around the disease, to appear as a bad mother. Isolation and loneliness were experienced by many mothers. Therefore support in the form of affirmation and understanding was seen as a basis for recovery. Poor knowledge about PPD was a common experience. Some mothers perceived the care as supportive and rewarding, while some women felt that the care was not good because healthcare professionals tried to normalize their feelings.  Conclusion: The results of the study could be interpreted that many experiences from women depend on poor knowledge of PPD in both mothers with PPD and in different health care professionals. Since PPD is a part of our society, increased knowledge of nurses non-institutional care should be encouraged for the reason to give mothers with PPD better care and health.

Bakgrund: Depression är ett globalt hälsoproblem med allvarliga konsekvenser. Stora livsförändringar som till exempel barnafödande innebär ofta stora påfrestningar, vilket kan leda till psykisk ohälsa. Postpartumdepression (PPD) är ett sjukdomstillstånd som drabbar modern men även fadern och inte minst hela familjen.Syfte: Syftet med studien var att beskriva männens upplevelser när de drabbas av förlossningsdepression. Metod: En allmän litteraturstudie med induktiv ansats, niovetenskapliga artiklar användes för resultaten och kodades ner till teman och kategorier. Resultat: Resultatet i litteraturstudien delades in i tre teman och sexkategorier. Det första temat var fädernas upplevelser av stress. Fäderna upplevde stress genom att känna ansvar att bära upp hemmet ekonomiskt och av att inte få tillräckligt med sömn. Andra temat var fädernas upplevelser av otillräckligt stöd.Stödet från sjukvården visade stora brister, i form av otillräcklig information och avsaknad av stöd riktad till fäderna. Sista temat var påverkan i relationen. Fäderna upplevde i hög grad en bristfällig delaktighet vilket skapade utanförskap till både modern och barnet. Konklusion: PPD hos fäder är ett vanligt tillstånd med risker för allvarliga konsekvenser. Det saknas i stor utsträckning tillräckliga möjligheter att både upptäcka och behandla tillståndet. Om stödet är bristfälligt ökar risken för allvarliga konsekvenser som att barnens utveckling och relationen till partner försämras. / Background: Depression is a global health problem with serious consequences. Major life changes such as childbirth often involve great stress, which can lead to mental illness. Postpartum depression (PPD) is a disease that affects the mother but also the father and not least the whole family. Aim: The aim of this study was to describe men’s experiences when suffering of postpartum depression. Method: A general literature study with inductive approach including nine scientific articles were used for the results and coded down to themes and categories. Results: The results of the literature study were divided into three themes and six categories. The first theme was fathers' experiences of stress. The fathers experienced stress due to feelings of responsibility for the economy and due to lack of sleep. The second theme was fathers' experiences of insufficient support. The support given by the health caresystem was insufficient due to lack of information and support directed to the fathers.The last theme was impact in relationship. The fathers’ experiences include to a large extent a lack of participation which led to a sense of exclusion towards the mother and the child. Conclusion: Paternal PPD is a frequent condition with potential serious consequences. To a large extent there are lack of sufficient possibilities to detect and treat the condition. If the support is inadequate, the risk of serious consequences such as the children’s development and the relationship with the partner deteriorates.

Orientador: Olga Maria Piazentim Rolim Rodrigues / Banca: Maria Beatriz Linhares / Banca: Gimol Benzaquen Perosa / Resumo: O ciclo gravídico puerperal é marcado por alterações emocionais, características deste período, com possibilidade de desencadear transtornos psíquicos significativos, comprometendom a saúde materno-infantil. Entre os fatores psicológicos que, geralmente, implicam em complicação durante gestação, parto e puerpério estão o stress e a ansiedade vivenciados na gravidez e a depressão, no puerpério. Objetivo: Avaliar a ansiedade-estado e o stress de primagestas no terceiro trimestre de gestação e no pós-parto e averiguar ocorrência de depressão pós-parto associando-os com aspectos de gestação e cuidados com o bebê. Método: A pesquisa foi constituída de duas etapas. Na etapa 1 ocorreu a coleta de dados no terceiro trimestre de gestação e a etapa 2, ocorreu após 45 de nascimento do bebê. Na etapa 1 entrevistou-se 98 primagestas e aplicou-se os instrumentos IDATE (Inventário de Ansiedade Taco/Estaco), ISSL (Inventário de Sintomas de Stress de Lipp) e Entrevista Inicial. Destas, 64 também participaram da etapa 2, onde aplicou-se os instrumentos IDATE, ISSL, EPDS (Escala de Depressão Pós-parto de Edimburgo) e Questionário a respeito do parto, nascimento e rotina de cuidados com o bebê. Os dados foram analisados usando o programa SPSS for Windows, versão 17.0. Resultados: Os resultados da etapa 1 indicaram que 63% da primagestas apresentam ansiedade-estado controlada e 37% alta ansiedade-estado no terceiro trimestre. Quanto ao stress, 22% não o manifestaram e 78% manifestaram. Das participantes, 56% estavam na Fase de Resistência, 20% na Quase Exaustão e 2% na Exaustão. Delas, 11% manifestaram sintomas físicos, 86% psicológicos e 3% e psicológicos. Os resultados da etapa 2 indicam que 73% das puérperas manifestaram ansiedade-estado controlada e 27% alta ansiedade-estado. Observou-se diferença significativa entre a ansiedade-estado manifestada no terceiro... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The puerperal period is marked by emotional changes, typical of this period, with the possibility of triggering significant mental disorders, affecting the maternal and child health. Psychological factors that usually imply a complication during pregnancy, childbirth and are experienced stress and anxiety and depresssion in pregnancy, postpartum. Objective: To evaluate the state-ansiety and stress of primipara in the third trimester of pregnancy and postpartum and to investigate the occurence of postpartum depression by associating them with aspects of pregnancy and baby care. Method: The study considered of two steps. In step data collection occurred in the third trimester of pregnancy and step 2,45 occured after the baby's birth. In step 1 was interviewed 98 primiparous and applied the tools STAI Anxiety Inventory (Taco/State), Inventory (SSI Lipp Stress Symptoms) and the Initial Interview. Of these, 64 also participated in the second stage, where we applied the tools IDATE, SSI, EPDS (Edinburgh Postnatal Depression Scale) and the Questionnaire about labor, birth and care routine with the baby. Data were analyzed using SPSS for Windows, version 17.0. Results: The results of phase 1 indicated that 63% od primiparum have anxiety state-controlled and 37% high state anxiety in the third quarter. As for stress, not the 22% and 78% had expressed. Of participants, 56% were in Stage of Resistance, 20% in almost 2% at axhaustion. Of these, 11% had physical symptoms, 86% 3% psychological and physical and physichological. The results of step 2 indicate that 73% of the women expressed anxiety state-controlled and 27% high-anxiety state. There was a significant difference between state anxiety manifested in the third trimester of pregnancy and puerperium (t 2:36, p<0.05). Regarding the stress 37.5% had no symptoms of stress and 62.5% manifested. Of which indicated 80% were in Phase Resistance... (Complete abstract click electronic access below) / Mestre

Introduction: Research has shown that Postpartum Depression (PPD) occurs in 10-20% of new mothers. Symptoms of PPD include excessive sadness, increased anxiety, guilt, and possible suicidal ideation. PPD can increase a mother’s risk for health and psychological dysfunction including future psychiatric illnesses, substance abuse, and decrease her adaptive functioning. PDD can also have negative implications on child safety practices and a child’s psychosocial and developmental wellbeing. Treatments for PPD, such as medication and psychotherapy, have been shown to be effective at reducing the number and severity of a mother’s symptoms, and generally improving their lives and the lives of their families. Unfortunately, many mothers do not receive treatment due to fears of stigma, inadequate screening practices and an inability to access care. Thus, early detection and improved access to care is critical and literature suggests formal screening practices increases the rate of detection. Pediatrician’s offices serve as ideal locations to screen mothers and connect them to appropriate services because of frequent contact with the mother. Methods: Recognizing this public health concern, the American Academy of Pediatrics developed PPD screening guidelines. ETSU Pediatrics, a local pediatric primary care clinic, adhered to these guidelines, assembled an interdisciplinary health care team, and developed a stepped care protocol to not only screen all new mothers but connect them with immediate, onsite behavioral health services. The protocol consisted of four distinct phases: 1) distribution of the Edinburgh Postnatal Depression Scale (EPDS), an evidence- based tool screening for depression in new mothers, to every mother of infants 0 to 6 months at their well- child visit; 2) appropriate documentation of the EPDS score and plan of action noted within the electronic medical record (EHR); 3) brief behavioral health intervention conducted by the on-site behavioral health consultant, and/or referral to outside provider; 4) phone call follow up with mother and referred provider. The aim of the study is to evaluate components of intervention feasibility based upon the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), which stems from the Dissemination and Implementation Science field. This particular project extends past previous pilot studies to include EHR chart review from an entire year and evaluates the protocol’s feasibility by examining Adoption and Maintenance domains. Results: Results were collected from EHR and billing records of all patients, 0 to 6 months of age, seen at the clinic from February 26, 2014 to February 25, 2015 (n = 755) for their well-child visit (n = 2,459). Adoption will examine feasibility by noting the percentage of mothers who were administered the EPDS as well as the general trend in administration across the year. Maintenance will examine feasibility from a financial perspective and reveal the amount of reimbursement accrued by billing for the EPDS. Conclusions: The anticipated results will have implications on the