Mémoire de sage-femme : Médecine : Nancy 1 : 2009. / Titre provenant de l'écran-titre. Bibliogr.

Thesis (M.S.)--University of Missouri-Columbia, 2003. / Typescript. Includes bibliographical references (leaves 73-87). Also available on the Internet.

Thesis (M.S.)--University of Missouri-Columbia, 2003. / Typescript. Includes bibliographical references (leaves 73-87). Also available on the Internet.

Background Postnatal depression (PND) has become a world-wide public health problem. Maternal Child Health Centers (MCHCs) provide maternal and child healthcare with community-based Comprehensive Child Development Services (CCDS) aimed for early identification for provision of appropriate referral for intervention. There were 13.8% suspected PND cases in 2011(Department of Health PND Report, 2011). Antenatal Interpersonal Psychotherapy (IPT) has found efficacious for high depression risk (HDR) pregnant women. Evidence-based practice (EBP) antenatal IPT guideline best suited for MCHCs implementation. Purpose This dissertation intends to develop an effective EBP antenatal IPT guideline for HDR pregnant women, and to offer plans for implementation and evaluation. Methods Six electronic databases searched for updated relevant studies. Randomized controlled trails (RCTs) with antenatal IPT intervention for HDR pregnant women targeted. Evidence data related to EBP guideline development were extracted for critical appraisal. Program implementation potentials assessed for transferability, feasibility and cost-benefit ratio. Guideline with level of evidence and recommendation grading developed. Communication plan for different stakeholders and potential users were developed. Pilot test planned for process evaluation. Impact evaluation, outcome evaluation and economic evaluation planned to verify empirical evidences to initial changes in MCHCs. Results Eight RCTs studies, which compare group receiving antenatal IPT intervention with routine antenatal education group, were reviewed. Target population was HDR pregnant women. Antenatal IPT intervention found effective for HDR pregnant women with PND. The studies suggest antenatal IPT intervention give0.89 reductions in EPDS, improved psychological well-being, 0.77 reductions in GHQ and improved role competence2.43 increases in PSOC-E. After critical appraisal of reviewed studies, antenatal IPT guideline developed. Pregnant women should be screened between 20 to 32 gestation weeks. Those with EPDS≥13 scores should enrolled into two 2-hour antenatal IPT program educated by trained nurse educators in class size ≤10. Those refusing to join the program receive routine education. Three-point measurements of EPDS, GHQ and PSOC-E at baseline, postnatal 6 to 8 weeks and 3 to 6 months of both groups are conducted. Postnatal EPDS ≥13 participants referred for psychiatric services upon their consent. Program will propose implementation in MCHCs. Steering Committee is established and communicates with various stakeholders. Pilot test implement in one MCHC and reviewed for clinical applicability, feasibility and to obtain process evaluation for quality improvement. Program should have quasi-experimental non- equivalent pretest-posttest control group and analyze data with ‘two-sample t-test’, ‘paired t-tests’ and ‘chi-square test’. Target achievement should be: i. Primary outcomes: EPDS score reduced to0.89, GHQ reduced to0.77 and PSOC-E score increased to2.43; ii. Secondary outcomes: Reduction of PND incidence and PND management caseloads by 20%. Participants’ gestation ages, program attendance and satisfactory rates recorded. Economic evaluation indicates for every $1invested, the return is $8.45, program is a sound investment suggested. Conclusions Eight RCT studies provide evidence that antenatal IPT program is effective for HDR pregnant women in reducing PND, and in promoting higher maternal role efficacy level and psychological well-being. Implementation of this EBP program guideline can potentially help PND prevention and ease antenatal depression management of HDR pregnant women in MCHCs. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Postpartum depression is recognized as an important maternal and child health issue. Postpartum depression is the most common perinatal psychiatric disorder and one of the most common complications of childbirth. Studies show prevalence rates in women ranging from 10% to 25%. Postpartum depression affects the emotional wellbeing of mothers, infant behavior, mother-infant bonding, and marital relationships. However, the majority of women who experience postpartum depression do not seek care. The purpose of this analysis is to examine the demographic differences between women in Georgia who report symptoms of postpartum depression but do not seek care, versus women who report postpartum depression symptoms and seek care. Approximately 15% of respondents in this study reported postpartum depression. Of these women, approximately 80% did not seek care for their symptoms. This analysis found that women with the following characteristics were more likely to not seek care for depression: non-White and Hispanic women; women that were uninsured before their pregnancy; women that had their prenatal care paid for by Medicaid or the Military; and women who did not seek care for depression during their pregnancy. The results of this study may help to guide the implementation of public health interventions among postpartum women in Georgia.

No description available.

No description available.

Bakgrund: 10-15% av alla nyblivna svenska mödrar drabbas idag av postpartum depression, även kallat förlossningsdepression. Sjukdomen uppkommer i samband med barnets födelse och utvecklas oftast inom två månader efter förlossningen. Postpartum depression påverkar moderns självbild och kan skapa problematik i anknytningen mellan modern och det nyfödda barnet. Syfte: Belysa mödrars upplevelser i samband med postpartum depression. Metod: Studien är baserad på sex självbiografier och är genomförd utifrån en kvalitativ ansats där resultatet har bearbetats med stöd av en manifest innehållsanalys. Resultat: Det framkom fem huvudkategorier: Lycka blev en obekant känsla, Förväntningarna på moderskapet uppfylldes inte, En främling för sig själv fångad i negativa tankar, När bägaren rann över samt Ljusa stunder. Ett tydligt fynd är att mödrarna känner stor besvikelse över att förväntningarna på postpartum perioden inte överensstämmer med verkligheten samt oförståelse över sina negativa tankar som överrumplade dem. Slutsats(er): Resultatet påvisar att postpartum depression måste synligöras bättre för att fler mödrar som drabbats ska våga söka hjälp. En bredare kunskap inom vården kan möjliggöra att postpartum depression uppmärksammas bättre.  Även allmänsjuksköterskor bör lära sig att uppmärksamma sjukdomen för att kunna fånga upp dessa mödrar i ett tidigt skede.

Currently in Australia, 80% of women are employed during first pregnancy, and 40% resume employment in the postpartum. The first aim of this study was to identify which of a broad range of factors, including maternal preferences, maternal separation anxiety and maternity entitlements, contributed to maternal employment in the first 10 postpartum. The second aim was to identify the contribution of women’s satisfaction with employment arrangements to their psychological well-being. Participants were 165 employed pregnant women over 18 years of age and with sufficient English for completion of study materials, systematically recruited in the third trimester of pregnancy. Data were collected in pregnancy and at 3 and 10 months postpartum. Maternal preferences, not or no longer breastfeeding and lower maternal separation anxiety were associated with significantly increased likelihood of resuming postpartum employment when maternal age, educational attainment and occupational status were controlled for. A constellation of adverse employment conditions made independent contributions to measurably worse maternal mood including experiencing sexual discrimination in pregnancy, no maternity entitlements when known determinants of poorer maternal well-being were controlled in regression analyses. These findings provide evidence about the relevance of structural determinants to maternal well-being, and highlight the urgency of a national paid parental leave scheme in Australia.

Postnatal depression (PND) is a serious and debilitating condition that disrupts women's lives at a time when they are already under stress, adapting to the substantial demands having a baby creates. PND is linked with adverse effects on the development of the child and the family system, including poor marital adjustment and elevated levels of depression in male partners. Implications, not only for men's health, but also for the amount and quality of support men can provide for their partners and children are far-reaching. Preventative programmes for the treatment of PND have been widely advocated, but are rare in the literature. Even fewer, are treatment programmes that include male partners. This study compared the efficacy of a structured Cognitive Behavioural Therapy (CBT) programme for the treatment of PND, delivered in 3 different ways, within an Australian semi-rurallcoastal community. Thirty-nine women, diagnosed with PND, completed 10 weeks of either 'individual' (n=9), 'group women only' (n=16) or 'group partners involved' (n=14) intervention and were compared with a control support group (n=7). Pre-intervention, women in the study reported the presence of a number of psychosocial risk factors for PND and almost 20% of the men in this sample were also depressed according to the BDI-II. Partners of the women in the 'group partners involved' treatment completed a 6-week CBT group programme especially designed for men (n=13). Partners of the women involved in the other interventions acted as a control group (n=16). Depression, anxiety, parenting stress, relationship adjustment and social support measures were taken using standardized instruments at pre-intervention, post-test and at 3- and 6-month follow-up. Qualitative information about the experiences of PND and the intervention programme was obtained through focus group interviews. The intervention programme was evaluated by questionnaire by both participants and their general practitioners or allied health professionals who had referred them to the programme. Results indicated that, overall, the 10-week, structured CBT programme was far more effective in treating PND than attending a support group. Over time, group therapy outperformed individual therapy for depression and anxiety. Including partners in intervention meant significantly improved outcomes at 6-month follow-up for depression, anxiety and relationship adjustment for women. When male partners were included, women's social support levels were significantly higher at 3-month follow-up. Post-intervention men who participated in the men's group were significantly less depressed and stressed, and showed higher levels of social support than controls. The intervention programme was rated highly by both participants and referrers for effectiveness and acceptability, with the psychoeducational information and CBT strategies rated as the most useful components. Participants viewed the inclusion of male partners in PND treatment as fundamental and strongly recommended increased community and professional awareness of PND and its consequences. The important implications for clinical practice and resource allocation raised by this study are addressed.