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Postpartum depression (PPD) refers to the onset of depressive symptoms anytime within first year following the birth of a child. PPD affects approximately 10-20% of new mothers and often goes underdiagnosed and untreated. Left untreated, PPD can predispose women to more severe and frequent future depressive episodes. Literature suggests depression in mothers may have long-term negative effects on infants’ and children’s psychosocial development. The American Academy of Pediatrics (AAP) has identified pediatric primary care as the ideal location to screen and refer mothers possibly suffering from depression. Routinely assessing PPD in mothers during well-child checks is not only recommended, it is increasingly being considered a best practice standard. The AAP calls for further research to improve the feasibility of assessing and treating PPD in mothers in pediatric primary care. This paper is part of a larger study that will be evaluating the effectiveness of screening new mothers for PPD in pediatric primary care settings and providing a brief same day interventions. The current aims of this portion of the study will be to evaluate 1) referral results, and 2) mothers’ level of satisfaction with the protocol. Research assistants (RA) will approach mothers of infants, birth to 6 months of age in the waiting rooms of ETSU Pediatrics in Johnson City, TN. Mothers will be given a brief description of PPD, the study and will be asked to participate by signing a voluntary informed consent document. As part of the visit, nurses will distribute and score the Edinburg Postpartum Depression Scale (EPDS). Mothers scoring 9 or above will receive a brief educational brochure about PPD, a brief intervention and a one week follow-up phone call with an onsite behavioral health consultant (BCH) or social worker (SW). At mothers’ discretion, an appropriate outside referral to preferred provider will be made, if necessary. Approximately two weeks post- intervention, a satisfaction survey by phone will be administered by RAs. The survey will examine referral results (e.g., of high scores, what recommendations were made, did mothers follow through, treatments received, was there improvement in EPDS score) and the mothers’ level of satisfaction with the protocol (e.g., satisfaction with how protocol was handled by staff and how well mothers felt their needs were addressed). Satisfaction will be noted on a likert-scale ranging from 0 (no satisfaction) to 10 (very satisfied). Data is pending and collection will start during the first week of March showing EDPS uptake, referral results and mother satisfaction. Data is expected for approximately 60-100 new mothers.

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I provided an updated, comprehensive review of treatments for mothers diagnosed with postpartum depression. Studies included in this meta-analysis were single-group pre-posttest, non-randomized and randomized controlled studies published from 1986 to 2010 that included face-to-face psychotherapy and psychopharmacology as well as non-traditional methods such as exercise and nurse-assisted counseling. 53 published studies were analyzed. The randomized studies showed a moderate to large effects (d= 0.72 to 1.25, k= 9) when postpartum interventions were compared to a control condition, and smaller effects (d= 0.3 to 0.57, k = 13) to treatment as usual. When postpartum interventions were compared to each other there was small to no difference in effect sizes (k = 9). All of the non-randomized comparisons showed no significant difference, except when therapy was compared to treatment as usual (d= 0.55, k = 2). Pre-post studies showed large effect sizes for therapy (d= 0.95, k = 7) and medication treatments (d= 4.30, k = 5). Influence analyses suggest that two studies had a large effect on aggregate effect sizes and heterogeneity statistics. Moderator and multivariate analyses were largely underpowered. Publication bias was not significantly related to outcome. Clinical implications for postpartum depression treatments and directions for future research were identified.

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Objectives: To determine whether task-shifting the treatment of Postpartum depression (PPD) is effective in both treating mothers and mitigating the potential negative effects of PPD exposure on infant emotion regulation (ER). Methods: In Study 1, a randomized controlled trial (RCT) with a waitlist control group was used to examine whether a nine-week group Cognitive Behavioural Therapy (CBT) intervention delivered by peers can effectively treat PPD in mothers. Study 2 used data from this same RCT to determine if maternal PPD treatment with peer-delivered group CBT intervention would lead to adaptive change in markers of ER in their infants. Finally, Study 3 used data from a RCT with a treatment-as-usual control group to examine whether maternal treatment with a Public Health Nurse (PHN)-delivered group CBT intervention led to adaptive change in markers of infant ER. In both Studies 2 and 3, markers of infant ER included two neurophysiological measures and a maternal-report measure of infant temperament. Results: Study 1 found that peer-delivered group CBT led to significant improvements in symptoms of depression and anxiety in mothers and reductions in symptoms remained stable six months after treatment initiation. Study 2 found evidence of change in two neurophysiological measures of infant ER following maternal treatment with peer-delivered intervention, but not in the maternal-report measure of infant temperament. Finally, Study 3 found evidence of change in a single neurophysiological marker of infant ER following maternal treatment with the PHN-delivered intervention, but found no change following maternal treatment in a second neurophysiological marker and maternal-report measure of infant ER. Conclusions: The studies in this thesis highlight the potential of using task-shifting to fill a gap in the healthcare system’s treatment of PPD. This work suggests that interventions delivered by peers and PHNs may not only be effective in treating those with PPD, but may also benefit their infants by mitigating any PPD-related consequences on infant ER development. This thesis contributes to the evidence that suggests timely maternal treatment of PPD may disrupt the transmission of psychiatric risk from parent to infant. / Dissertation / Doctor of Philosophy (PhD) / Postpartum depression (PPD) is common and has consequences for both mothers and their infants. The negative impact of PPD exposure on infant emotion regulation (ER) is especially harmful because of its association with later psychopathology. As a result, the objectives of the present thesis were to i) determine whether task-shifting the treatment of PPD is effective in treating mothers while ii) mitigating the potential negative effects of PPD exposure on infant ER. The results of this thesis indicate that a task-shifted, peer-delivered treatment is effective in treating mothers with PPD and that treating mothers with a task-shifted treatment may also lead to adaptive changes in infant ER. This thesis indicates that task-shifting the treatment of PPD may improve outcomes for mothers, prevent PPD-related consequences on infant ER development, and ultimately, improve future outcomes for their infants.

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.

Infertility impacts numerous individuals during their reproductive journey. Yet, there is little research and information available that examines if having a history of infertility goes on to have further implications after an individual conceives and gives birth. Thus, the current study aimed to examine if infertility impacts the postpartum period, and if there were any particular risk or resiliency factors that contributed to this relationship. In this study, women aged 18 to 50, who had given birth within the last 12 months, participated in an online survey that assessed a variety of physical and mental health constructs. Overall, results largely exemplified that infertility does not go on to impact postpartum adjustment within in this particular sample of women who identified as having higher levels of education, perceived SES, and income. However, many of the covariates, such as SES, did correlate with postpartum outcomes. Findings highlight the resilience of this sample of women, despite previously experiencing stressful events.

Bakgrund: Rectus abdominis diastas (RAD) är en separation av magmuskler som drabbar två av tre kvinnor (66%) i tredje trimestern och mellan 30-60% av dessa har kvarstående problem efter förlossningen. Detta tillstånd kan leda till försvagad muskelfunktion, ländryggsbesvär, smärta och/eller besvär i abdominis, bäcken-instabilitet samt urogynekologiska symptom. För behandling rekommenderas först fysioterapi dock saknas kliniska riktlinjer. Syfte: Syftet var att sammanställa aktuella randomiserade kontrollerade studier (RCT) för fysioterapeutiska behandlingstekniker vid postpartum rectus abdominis diastas (RAD), samt deras effekt på RAD avstånd. Material och Metod: Litteratursökningen utfördes mellan juni och september 2022 i tre databaser, PubMed (Medline), SPORTDiscus och CINAHL. Sökningen gav 210 träffar varav 6 inkluderades. Kvalitetsbedömning gjordes enligt PEDro skalan. Resultat: De behandlingstekniker som användes var generell träning av bålmuskulaturen, neuromuskulär stimulering, stabiliserande träning av bålmuskulaturen och buk-stabiliserande bälte. Kombination av neuromuskulär stimulering med bålmuskelträning och stabiliserande bålmuskelträning hade en signifikant minskning av RAD. Bålmuskelträning är bättre än ingen behandling. Stabiliserande bälte är inte bättre än ingen behandling. Kvalitet av samtliga artiklarna rankades måttlig till bra kvalitet enligt PEDro skalan. Konklusion: Resultatet visade att majoriteten av de inkluderade studierna rapporterade en minskning av RAD-avståndet. Detta tyder på att fysioterapi är en viktig komponent i rehabiliteringsprocess vid postpartum RAD samt att den kan rekommenderas till kvinnor med RAD efter förlossningen. Behandlingstekniker med signifikant minskning av RAD-avstånd är kombinationen av neuromuskulär stimulering med träning av bålmuskulatur samt träning som fokuserar på stabiliserande bålmuskulaturen. Mer studier med hög bevisvärde efterfrågas.