Perinatal mood disorders such as postpartum depression and postpartum posttraumatic stress disorder are an area of growing concern. There have been few studies regarding ways to identify women at risk of developing these disorders in the antepartum period. During the antepartum period, women attend prenatal appointments with their provider to assess the health of their pregnancy. This period is ideal to administer emotional health questionnaires to identify if patients may be at risk of developing postpartum mood disorders. The aim of this study was to identify if there are differences on antepartum emotional health questionnaire scores between women who have postpartum mood disorders, and those who do not. The data come from 19 women undergoing scheduled cesarean deliveries at Boston Medical Center. The questionnaires collected information about stress, depression, anxiety, and symptoms of postpartum depression and posttraumatic stress disorder. We compared the scores of the women who had postpartum depression and postpartum posttraumatic stress disorder to the women who did not, to examine if the scores in the antepartum period correlated with postpartum mood disorders. We did not find any differences between the postpartum depression group, but did find a difference on one questionnaire between the postpartum posttraumatic stress disorder group. Within our cohort, we found similar incidences of postpartum depression, postpartum posttraumatic stress disorder, and self-harm/suicidal ideations compared to national incidences. Future studies should include more participants and a more heterogenous cohort as it pertains to cesarean delivery type, indication for cesarean delivery, intrapartum events, and histories of depression, anxiety, posttraumatic stress disorder, and other mood disorders. Although we only found a difference on one questionnaire for one of the postpartum mood disorders, future studies should prioritize the antepartum period as a time to identify and address concerns of postpartum mood disorders.

Bakgrund: Att bli förälder är en omvälvande och stor förändring i livet och det är vanligt att bli nedstämd den första tiden som förälder. Oftast går det över ganska snabbt efter förloss-ningen men 10-20 procent av alla nyblivna mödrar mår fortsatt dåligt en längre tid och drab-bas av en förlossningsdepression. På grund av känslor som skam och skuld undviker många mödrar att söka vård och därför blir förlossningsdepression ofta oupptäckt och odiagnostise-rat.Syfte: Att beskriva mödrars upplevelser vid förlossningsdepression samt att beskriva upple-velsen av stödet från sjuksköterskan. Syftet var vidare att beskriva de inkluderade artiklarnas urvalsmetod och undersökningsgrupp.Metod: En beskrivande litteraturstudie baserad på 15 vetenskapliga artiklar med kvalitativ ansats. Databaserna PsycINFO och Cinahl användes till litteratursökningen.Huvudresultat: Vanliga upplevelser hos mödrar med förlossningsdepression var rädsla, skuld och ökad sårbarhet för att hantera förändringar. Mödrarna beskrev en frustration kring stödet och rådgivningen som gavs från sjuksköterskan samt deras attityder. Mödrarna beskrev en önskan om att sjuksköterskan skulle lyfta fram och synliggöra förlossningsdepression.Slutsats: Mödrar med förlossningsdepression lever i en känslomässig berg- och dalbana. På grund av skam och dåligt bemötande från sjuksköterskan undviker många mödrar att söka hjälp och de som försöker söka hjälp vet oftast inte var de kan vända sig. Sjuksköterskan ska enligt mödrarna ha ett empatiskt bemötande och vårda relationen mellan dem för att skapa trygghet i vården. / Background: Becoming a parent is revolutionary and a huge change in life and it is normal to become depressed the first time as a parent. The feelings often disappear after giving birth, but 10-20 percent of all new mothers continues to feel depressed for a long time and can result in a postpartum depression. Because of feelings such as shame and guilt many mothers avoid seeking care and therefore postpartum depression often become undiscovered and under-diagnosed. Aim: To describe mothers' experiences at postpartum depression and to describe the experi-ence of support from the nurse. The aim was also to describe the included articles selection method and study group. Method: A descriptive literature study based on 15 scientific articles with qualitative approach. The databases PsycInfo and Cinahl were used for the literature research. Main Results: The most common experiences of mothers with postpartum depression were fear, sense of guilt, increased vulnerability to manage change. The mothers described the frus-tration surrounding the support and advice given by the nurse. What created the most frustra-tion were the poor availability and the nurse's condescending attitude. The mothers described a desire that the nurse would highlight and make postpartum depression more visible. Conclusion: Mothers with postpartum depression lives in an emotional rollercoaster. Because of the feeling of shame and poor treatment from the nurse many mothers avoid to seek help and those who try to seek help often do not know where to turn. According to the mothers the nurse should have an empathetic approach and cherish the relationship between them to create safety in care.

Research shows that maternal depression has adverse effects on mother-infant attachment and subsequent infant development (Cogill, Caplan, Alexandra, Robson & Kumar, 1986). The mechanisms through which this comes about are unclear. Murray & Cooper (1997) suggest an impaired pattern of mother-infant communication is responsible. Within this, Murray proposes that maternal speech may be a key factor. This study constitutes a preliminary exploration into the mechanisms through which maternal depression effects mother-infant interaction in South Africa. 147 predominantly Xhosa-speaking mother-infant dyads that took part in a broader epidemiological study on post-partum depression in Khayelitsha (Cooper, Tomlinson, Swartz, Woolgar, Murray & Molteno, 1999) made up the subjects. Maternal depression was assessed according to the Structured Clinical Interview for DSMIV (SCID). Maternal speech recorded from standard, five-minute, face-to -face mother-infant interactions was translated and analysed according to a coding system developed by Murray (Murray, Kempton, Woolgar & Hooper, 1993). The speech of depressed mothers to their two month old infants was compared to the speech of non-depressed mothers on dimensions of focus, affect and agency, and the role of infant gender was assessed. Results revealed no significant group differences for depression. Maternal speech to male infants was found to hold significantly less ascription of agency than to female infants. Findings suggest that maternal speech may be too narrow a marker of maternal depression in this context and that broader indices are needed. It is recommended that future research control for measures of social adversity, factor in cultural and language particularities, and consider contextual aspects of mother-infant interaction / attachment processes, in investigating the mechanisms through which post-partum depression leads to negative infant outcome in the developing world.

Bakgrund: I Sverige drabbas cirka 10 000 nyblivna mödrar av postpartum depression (PPD) varje år. Att bli förälder är någonting som förknippas med en glädjefylld händelse men denna bild kan ibland stå i stark kontrast till verkligheten. Det är en omställning att bli förälder och i vissa fall kan det vara svårt att anpassa sig till livets nya riktning. Tiden efter förlossningen är en period av ökad sårbarhet både psykologiskt och biologiskt. Sårbarheten för depression varierar beroende på psykologiska och/eller biologiska faktorer vilket får till följd att olika individer kan reagera olika på samma påfrestning. Symtomen kan komma allt från någon vecka efter förlossningen men det kan också dröja upp till ett år. Det är viktigt att den som drabbats av PPD får en diagnos i ett tidigt skede då det ger en bättre förutsättning för ett tidigt tillfrisknande och mindre risk för att barnet ska ta skada. En del kvinnor som drabbats av PPD söker inte vård då de skäms över sina känslor och är rädda för att bli stigmatiserade vilket i slutändan kan leda till allvarliga och oönskade konsekvenser. Syfte: Syftet med detta arbete var att belysa hur biologiska och psykosociala faktorer påverkar risken för att utveckla PPD. Metod: Metoden som användes var en litteraturöversikt där sammanlagt 15 vetenskapliga artiklar inkluderades. Artiklarna var högst tio år gamla, peer reviewed, svarade på syftet och etiskt granskade. Artikelsökningen genomfördes i databaserna PubMed, CINAHL och PsycINFO. Även manuella sökningar förekom. Författaren klassificerade och utförde kvalitetsbedömning på samtliga artiklar. Resultat: De biologiska faktorerna som ingick i de genomgångna artiklarna i litteraturöversikten var hormoner, sömn och barnets temperament. De psykosociala faktorerna som ingick var socioekonomiska faktorer och socialt stöd. Det sammanställda resultatet visade på att dessa faktorer kan öka risken för att drabbas av PPD. Slutsats: Resultatet i föreliggande studie pekar på att hormonella faktorer, sömn, barnets temperament, socio-ekonomiska faktorer och brist på socialt stöd är riskfaktorer för att utveckla PPD. Det är därmed av stor vikt att vårdpersonal på mödravård, förlossning och BVC är uppmärksamma på dessa riskfaktorer samt tidiga symtom. Det är också viktigt att den gravida kvinnan/ nyblivna mamman, partnern och anhöriga känner till både riskfaktorer och symtom för att få hjälp i ett tidigt skede.

Bakgrund: Postpartumdepression är ett globalt förekommande fenomen, ungefär 20 procent av immigranter lider av sjukdomen. Det behövs mer kunskap kring postpartumdepression hos immigranter. Syfte: Syftet med denna litteraturöversikt var att syntetisera kvalitativ forskning om hur immigranter upplever sin livssituation och behov av stöd från vården i samband med en postpartumdepression. Metod: Kvalitativ litteraturöversikt med tematisk analys. Resultat: Fyra teman identifierades. De var rädsla för stigma, uppfattningen om postpartumdepression, upplevelsen av vårdsammanhang samt behov av stöd. Resultatet visade att immigranter hade brist på kunskap för postpartumdepression och upplevde att de inte får tillräckligt med stöd varken från familj och sjukvård. Slutsats: Det finns fortfarande en stigmatisering hos immigranter att hantera psykisk ohälsa. Känslor som skuld och skam är ofta orsaker att inte våga träda fram eftersom att bli mamma är förknippat med lycka. Det leder till utmaningar att fånga upp dem med symtom som tyder på postpartumdepression. Sjukvården behöver mer kompetens att ge personcentrerad vård till patienter med olika kulturella bakgrunder. Mer forskning om effekten av hembesök skulle förbättra immigranters hälsa och upptäcka postpartumdepression i tid. / Background: Postpartum depression is a global occurring phenomenon, where approximately 20 percent of immigrants suffer from it. More knowledge is needed about postpartum depression in immigrants.  Purpose: The aim of this literature review was to synthesize qualitative research on how immigrants’ experience their life situation and need for support from healthcare in association with postpartum depression. Methods: A qualitative literature review with thematic analysis.  Results: Four themes were identified. These were fear of stigma, the perception of postpartum depression, the experience of care context and need of support. Result shows that immigrants don’t have enough knowledge about postpartum depression. Furthermore, they lack support from both family and healthcare.  Conclusions: There is still a stigma among immigrants’ dealing with mental illness. Emotions such as guilt and shame are often reasons for not coming forward because becoming a mother is associated with happiness. These factors lead to challenges identify those symptoms that indicates postpartum depression. The healthcare needs more education to provide individual care to patients with different cultural backgrounds. More research on the effect of home visits can improve immigrants' health to detect postpartum depression in time.

Bakgrund: Postpartumdepression (PPD) drabbar mellan 8-15% av alla kvinnor som föder barn och innebär stora påfrestningar för både modern, partnern och spädbarnet. Utvecklandet av PPD har multifaktoriella orsaker som tidigare psykiatrisk sjukdom, dåligt parförhållande och brist på socialt stöd. Syfte: Studiens syfte var att undersöka kvinnors upplevelser av postpartumdepression. Metod: Studien är en litteraturöversikt där vetenskapliga artiklar motsvarande studiens syfte granskades. Samtliga artiklar hade kvalitativ ansats och söktes i databaserna Cinahl och Pubmed. Resultat: Studiens resultat indelades i tre övergripande teman: moderskap, diagnostisering - samt stöd. Kvinnor som drabbas av PPD uppfattar sig vara misslyckade mödrar samt upplever känslor av hopplöshet och utmattning. Stigmatiseringen kring PPD samt att bli diagnostiserad med psykiatrisk sjukdom, och rädslan av att bli uppfattad som en otillräcklig mor, leder till motvilja att uppsöka vård. Vårdpersonalen uppfattas ofta normalisera kvinnornas depressionssymptom vilket leder till att dessa kvinnor tappar förtroende för vården och inte känner sig sedda eller tagna på allvar. Partnerns och den närmaste omgivningens stöd spelar en betydande roll för att identifiera symptom, söka hjälp och tillfriskna. Slutsats: PPD upplevs av drabbade kvinnor både som ett personligt och socialt stigma, där den egna förmågan till moderskap och lämplighet ifrågasätts. Resultaten indikerar behov av förbättrat bemötande från vården, samt nytänkande inom tillgänglighet och prevention. / Background: Postpartum depression (PPD) affects between 8-15% of all women who give birth to children and poses major new challenges for the mother, partner and baby. The causes behind the development of postpartum depression are multifactorial; a previous psychiatric illness, poor partner relationship and a lack of social support. Aim: The aim of the study was to explore women's experiences of postpartum depression. Method: The study is a literature review in which scientific papers corresponding to the study's aim were reviewed. All reviewed articles had a qualitative approach and was searched in the databases CINAHL and Pubmed. Results: The results of the study were divided into three overarching themes: maternity, diagnosis and support. Women who suffer from PPD perceive themselves to be a failure as mothers and experience feelings of hopelessness and exhaustion. The stigma surrounding PPD and beeing diagnosed with a mental illness, as well as the fear of being perceived as an inadequate mother, are leading to reluctance to seek care. Health care workers are often perceived to normalize women's depressive symptoms which leads to that these women lose trust in the health care system and do not feel they are seen or taken seriously. Support from partner and the immediate surrounding plays a significant role in identifying symptoms, helpseeking and the process of recovery. Conclusion: PPD was experienced by the affected women as both a personal and a social stigma, where their ability to motherhood and suitability was questioned. The results indicate the need for improved treatment of health care, as well as innovation in availability and prevention.

Adolescent pregnancy has been of longstanding societal concern primarily because of the inability of most young mothers to provide adequately for their infants. Depression often results in disengagement from mother-child interaction. Adolescent mothers identified as depressed are at increased risk of future psychopathology, with additional deleterious effects on their infants&rsquo / lives. The purpose of this study was to explore adolescent mothers&rsquo / experiences of motherhood and memories of feeling depressed during or after the birth of their babies. The first aim was to explore the young women&rsquo / s experiences of mothering, by focusing upon the practice of being a mother. The second aim was to explore the young women&rsquo / s experiences of depression, by focusing on their physical behaviour and emotional experiences. The third aim was to explore their perceptions of the causes of their depression. The rationale for this study was that these issues will further enhance the body of knowledge available to practitioners working with adolescent mothers. It will also provide a source of insights and hypotheses for preventive intervention research. The study was located within a feminist standpoint framework that begins from the perspective of women with the aim to explore women&rsquo / s accounts of their experiences in relation to depression as an important source of knowledge. A qualitative research design and methodology was employed in the region of the Western Cape. Eight adolescent mothers between the ages of 16 and 19 were recruited and interviewed. The interviews were semi-structured and consisted out of open-ended questions. Interviews were recorded, transcribed verbatim and thematic analysis of data was carried out. The findings of this research yielded some interesting areas for future research and implications for treatment and intervention with first-time adolescent mothers. The adolescent mothers in this study experienced similar depressive symptoms to adult mothers in previous research. All the participants revealed that they feared their parents&rsquo / disappointment in them for being pregnant. This factor contributed to their depression, because they received very little (if any) support from their parents or the father of their baby. The participants discussed that their pregnancy or giving birth was linked to various aspects of themselves that they had lost as an adolescent. Before they received counselling, none of the participants understood why they experienced depressive symptoms or what was happening to them at the time after their pregnancies.

Background: To this date most studies have been focused on the influence of clinical depression and psychotic reactions during the postnatal period on mother-infant interaction, therefore this study examined the effects of maternal depressive mood in the postnatal period on mother-infant verbal and non-verbal communication. Method: Seventy two mother-infant dyads participated in the study. Eighteen infants of mothers with depressive mood and 18 controls were seen when they were 6 months old; and eighteen infants of mothers with depressive mood and 18 controls were seen when they were 10 months old. The Edinburgh Postnatal Depression Scale (EPDS) was used as a mean to assess maternal depressive mood. Tactile, verbal, and gaze behaviours of mothers and their infants when playing face-to-face during pleasure- and surprise-eliciting situations were coded using micro-analytic techniques. The behaviours of infants of mothers with symptoms of depression were also coded during interactions with a female unfamiliar adult (stranger) during a pleasure-eliciting situation. Results: The patterns of communication in non-depressed mother-infant dyads were appropriate to infants’ developmental age. However, maternal symptoms of depression as outlined by the EPDS appeared to somewhat hinder mothers’ ability to attend to infants’ developmental needs and communicate appropriately through touch, speech, and gaze; as well as infants’ capacity for positive emotional regulation, exploration of the toy, and gaze directed to their mothers during play interactions. Conclusions: These results suggest that maternal depressive mood is potentially a risk factor for difficulties in mother-infant communication during the first year postpartum. The mothers’ mood state and their infants’ age influence the type, frequency, and duration of touch, speech, and gaze during early interactions. Such findings are discussed considering a bi-directional influence in the development of communicative responses between mothers and infants across time.

Postpartum depression är psykisk ohälsa som drabbar mer än var tionde kvinna i Sverige. Tidigare studier har även visat att distriktsköterskans vårdmöten med nyblivna mammor på barnavårdscentralen är betydande. Låg bemanning inom barnhälsovården har rapporterats. Syftet med studien är att beskriva distriktsköterskans vårdmöte med nyblivna mammor på barnavårdscentralen och i hemmet för att kunna bedöma risken för postpartum depression. För att genomföra studien har en kvalitativ intervjustudie genomförts. Sju distriktssköterskor med varierande erfarenhet ingår. Datamaterialet har analyserats med innehållsanalys som resulterade i följande fyra generiska kategorier: Fokus på familjen, Arbeta förebyggande, Öppet förhållningsätt och Tvärprofessionellt arbete. Huvudkategorin beskrivs som Ett försiktigt förhållningssätt som inkluderar hela familjen och bygger på tvärprofessionell samverkan. För att uppmärksamma små och tidiga tecken på ohälsa hos mammor i riskzonen för postpartum depression krävs ett vårdande förhållningssätt som karaktäriseras av försiktighet och varsamhet i vårdmötet. Hela familjen inkluderas på ett naturligt sätt från första mötet på barnavårdscentralen eller i hemmet. Förhållningssättet bygger på tvärprofessionell samverkan där distriktssköterskan samarbetar med kollegor som representerar olika specialistkompetenser och beslut tas i samförstånd. Centralt är att skapa en inbjudande miljö för att möjliggöra ett vårdande möte. Slutsatsen är att distriktsköterskans möte med mammor i riskzonen för postpartum depression kräver kollegialt stöd för avgörande beslut. Stress och en tung arbetsbörda i kombination med oro för att missa tecken på psykisk ohälsa hos mammor i riskzonen har synliggjorts.

O consumo de álcool durante a gestação tem sido associado na literatura científica a uma maior intensidade de sofrimento psiquiátrico durante a gestação e no pós-parto. Este estudo teve como objetivo principal verificar se o consumo de álcool em gestantes está relacionado a um aumento de sintomas depressivos e/ou ao diagnóstico de depressão no pós-parto. Para tal foi realizado um estudo prospectivo, com dois tempos de coleta de dados. Foram convidadas a participar gestantes da rede pública de saúde da cidade de Juiz de Fora/MG. Inicialmente foram entrevistadas 260 mulheres no terceiro trimestre gestacional, das quais 177 foram entrevistadas entre 15 dias a 3 meses após o parto. Para avaliação do uso de álcool durante a gestação foram utilizados os instrumentos T-ACE (Tolerance, Annoyed, Cut down, Eye opener) e AUDIT C (Alcohol Use Disorders Identification Test C), além do relato das gestantes sobre a quantidade de álcool ingerida durante toda a gestação. Para avaliação de sintomas depressivos no pós-parto foi utilizado o instrumento EPDS (Edinburgh Postnatal Depression Scale) e para o diagnóstico de Episódio Depressivo Maior foi utilizada a entrevista diagnóstica MINI (Mini International Neuropsychiatric Interview). Os resultados obtidos apontaram para um aumento de sintomas depressivos no pós-parto proporcional ao aumento do consumo de álcool durante a gestação medido pelo total do AUDIT C (Spearman Correlation, r=0,251; p<0,001) e pelo total em gramas de álcool consumido durante toda a gestação (Spearman Correlation, r=0,185; p=0,01). Além disso, foi observado uma maior prevalência de depressão pós-parto entre as mulheres que tiveram pelo menos um binge alcoólico durante a gestação (Non-parametric Chi-Square, value=88,28, p< 0,001). Os dados apresentados permitem concluir que existe um aumento de sintomatologia depressiva no pós-parto à medida que aumenta o consumo de álcool na gestação e aumento de diagnóstico para aquelas que tiveram pelo menos um binge alcoólico durante a gestação. / Alcohol consumption during pregnancy, according to the scientific literature, has been associated to a higher intensity of psychiatric problems during the gestational period as well in the postpartum period. This study aimed to verify whether alcohol consumption in pregnancy is related to an increase of depressive symptoms and/or the diagnosis of depression in the postpartum period. For this purpose a prospective study was carried out, with two phases of data collection. Pregnant women assisted by public health services of the city of Juiz de Fora /MG were invited to participate. Initially 260 women in the third gestational trimester have been interviewed. For the second phase 177 were interviewed between 15 days to three months after childbirth. To assess alcohol use during the gestational period the research instruments T-ACE (Tolerance, Annoyed, Cut down, Eye-opener) and AUDIT C (Alcohol Use Disorders Identification Test C) have been used, besides of direct reports of the pregnant women about the amount of alcohol ingested during all the gestation. To evaluate postpartum depressive symptoms the instrument EPDS (Edinburgh Postnatal Depression Scale) was used and to determine the presence of a diagnosis of Major Depressive Episode the diagnostic interview MINI (Mini International Neuropsychiatric Interview) was used. The results pointed out to an increase of postpartum depressive symptoms proportional to the increase of alcohol consumption during the gestation measured by the total score of the AUDIT C (Spearman Correlation, r=0,251; p<0,001) and by the total amount (in grams) of alcohol ingested during all the gestational period (Spearman Correlation, r=0,185; p=0,01). Further, a higher prevalence of postpartum depression was found among the pregnant women who reported at least once a binge episode during the gestational period (Nonparametric Chi-Square, value=88,28; p< 0,001). The presented data allow concluding about the occurrence of an increase of depressive symptoms in the postpartum period related to higher alcohol consumption in pregnancy as well an increase of diagnosis among those pregnant women who have had at least one binge episode during all the gestational period.