D.Cur. (Psychiatric Nursing Science) / The overall goal of this research study was to explore and describe strategies in order to promote the mental health of married couples throughout the ante- and postnatal period. The majority of research on the transition to parenthood has found that as couples become parents, there is a dramatic decrease in positive marital interchanges, a dramatic increase in marital conflict and a precipitous decline in marital satisfaction (Belsky & Kelly, 1994; Belsky & Pensky, 1988: 133-156; Belsky, Spanier & Rovine, 1983: 567-577). The transition to parenthood is viewed as instigating a shift in the marriage whereby most couples are expected to experience a qualitative change in their relationship that is relatively abrupt (Pancer, Pratt, Hunsberger & Gallant, 2000: 253-280). Becoming a new parent poses challenges for nearly every married couple (Curran, Hazen, Jacobvitz & Feldman, 2005: 189). Becoming a parent is a major developmental transition of adulthood (Harwood, McLean & Durkin, 2007: 1). Individuals often have optimistic expectations about parenthood, yet this transition also presents a number of challenges (Harwood et al, 2007: 1). The questions that arose was what are the stories of married couples throughout the ante- and postnatal period of their first child, and what can be done by an advanced psychiatric nursing practitioner to promote the mental health of married couples based on their story. The researcher utilised a qualitative, explorative, descriptive and contextual study design as described in Babbie (2010: 92). This research study was carried out in four phases. During the first phase of this research study, the researcher explored and described the stories of married couples throughout the ante- and postnatal period of their first child according to the quest narrative method described by Frank (1997: 115). The results were discussed within relevant literature. iv In the second phase of this research study the researcher developed a conceptual framework on the basis of the empirical data. The conceptual framework was developed according to the concepts as proposed by Dickoff, James and Wiedenbach (1968: 435). The researcher described strategies, to promote the mental health of married couples throughout the ante- and postnatal period of their first child, in the third phase of this research study. These strategies were described according to a relationship phase, a working phase and a termination phase as part of the facilitation process. These three phases were discussed as part of a proposed facilitation process that forms part of the developed conceptual framework. In the fourth phase of this research study, the developed strategies were subjected to expert assessment according to the criteria stated by Chinn and Kramer (2011: 196-205). The findings of the research study are applicable to psychiatric nursing practice, research and psychiatric nursing education.

No description available.

Thesis (MA (Psychology))--University of Stellenbosch, 2006. / This study aimed to determine whether low-income women residing in a rural community in South Africa experienced any significant difference in the prevalence rates of depressive symptoms postpartum as compared to depressive symptoms prepartum. Thirty women between the ages of 16 and 38 were recruited during pregnancy from the local community clinic in Kylemore, South Africa. The women where assessed for elevated levels of depressive symptomatology using the Beck Depression Inventory (BDI) during pregnancy and again at three and six months postpartum. It was found that 18 (60%) of the women reported elevated levels of depressive symptomatology during the prepartum assessment, with 11 (37.9%) and 12 (48%) women reporting elevated levels of depressive symptomatology at the three months and six month postpartum assessment respectively. It was further found that the sample from the current study did not experience any significant difference in the rate of depressive symptomatology from the prepartum assessment to either of the postpartum assessments. The results also suggests that a relationship exists between the levels of depressive symptomatology prepartum and the levels of depressive symptomatology postpartum, as those women who experienced high levels of depressive symptomatology during pregnancy continued to show high levels of depressive symptomatology at the postpartum assessments. The findings from the current study thus suggest that the classification of postpartum depression as a unique and separate entity, that differs from depression occurring in women at other times and from depression as experienced by men, may be misleading. The term suggests a depression that develops following childbirth, while in the current study it seemed that when depressive symptoms were reported postpartum, they were also already apparent during pregnancy. The findings from the current study therefore suggest that the existence of postpartum depression as a distinct diagnosis or illness is problematic – a suggestion that has frequently been suggested in the literature (Aderibigbe, Gureje, & Omigbodun, 1993; Chandran, Tharyan, Muliyil & Abraham, 2002; Cooper, Campbell, Day, Kennerly & Bond, 1988; Cox, Murray & Chapman, 1993; O’Hara, Zekoski, Phillips & Wright, 1990; Patel, Rodrigues, & DeSouza, 2002).

Thesis (MA)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The topic of perinatal depression (i.e. depression during and after pregnancy) remains a subject of continued research interest, as a broad literature body reports that a large proportion of women suffering from this mental disorder do not receive appropriate treatment. This is worrisome, firstly, because mental health treatment is often readily available to the public and at no cost. Secondly, untreated perinatal depression not only holds dangerous consequences for the mother but also for the infant and the rest of the family. It is therefore important to identify those factors that act as barriers to mental health care utilization for perinatal depression. Although this is a persistent problem within the South African context, to date, little is known about the barriers to the utilization of available mental health services experienced among pregnant South African women. For this reason, the Perinatal Mental Health Project (PMHP) aims to provide mental health services at the same location where women receive obstetric services. However, despite their efforts, the number of women who decline available treatment is still of great concern. The present study offers a unique perspective on counselling for perinatal depression appointment-keeping barriers as it provides a holistic view of these barriers that exist not only within the women but also in their multi-levelled environments. Secondly, it addresses the problem of nonattendance to mental health care treatment offered by the PMHP and consequently also addresses the gap in South African research on the topic. The sample for this study was selected from PMHP files of those patients who failed to attend scheduled counselling appointments. The participants included in this study were selected by means of purposeful sampling to participate in face-to-face and telephonic semi-structured interviews. Participants were assured of confidentiality and anonymity. The semi-structured interviews were audio-recorded and transcribed after which transcriptions were entered into MS Word for textual analysis. Transcriptions were thematically analysed. The main themes that emerged from the present study included individual-related barriers, social-related barriers, institution-related barriers, community-related barriers and poverty-related barriers. The results of the present study reflect the motivations for depressive pregnant women to decline available and free mental health services provided by the PMHP, according to five main themes. These themes were then discussed according to Bronfenbrenner’s (1977; 1979) Ecological Systems Theory, which categorised the main themes identified according to the different systems operating within the patient’s environment, i.e. the individual-, micro-, meso-, exo-, and macrosystem. The individual system comprised the individual-related barriers, which included poor mental health, and ambivalent feelings toward the pregnancy. The microsystem comprised the social-related barriers, which included low social support and self-help strategies. Community-related barriers were considered within the mesosystem of the patient’s ecological environment, with stigma and pity as sub-barrier. The exosystem comprised the institution-related barriers, including referral protocol barriers, lack of information provided by the nurses, and nurses’ attitudes as experienced by participants. Lastly, poverty-related barriers were considered within the macrosystem, with financial life hardship, constant child-care demands, and transportation barriers as sub-barriers. The significance of this study lies in the original perspective offered on mental health care appointment-keeping behaviour within the South African context. Future research could, in addition to conducting interviews with hospital patients, include health care professionals and focus groups as this will allow for triangulation of the perspectives of all significant players. Also, having identified the problems and concerns with regards to attending counselling appointments, future research direction may be aimed at creating interventions designed to reduce the identified barriers to mental health care service use. / AFRIKAANSE OPSOMMING: Perinatale depressie (d.w.s. depressie voor en na swangerskap) bly ʼn onderwerp van voortdurende navorsings belang, aangesien ʼn breë navorsingsveld aandui dat ʼn groot proporsie van vroue wat aan hierdie geestesversteuring lei, nie die gepaste behandeling ontvang nie. Dit is kommerwekkend, eerstens, aangesien behandeling vir geestesgesondheid meestal openlik verkrygbaar is aan almal sonder enige koste. Tweedens, onbehandelde perinatale depressie hou nie slegs gevaarlike gevolge vir die moeder in nie, maar ook vir die baba en die res van die gesin. Dit is daarom belangrik om daardie faktore te identifiseer wat as hindernisse optree tot geestesgesondheid sorg diensgebruik vir perinatale depressie. Alhoewel dit ʼn voortdurende probleem binne die Suid-Afrikaanse konteks is, is daar tot op hede geen navorsing wat hindernisse tot gebruik van beskikbare geestesgesondheidsdienste bekend gemaak nie, veral wat ervaar word onder swanger Suid-Afrikaanse vroue nie. Vir hierdie rede, beoog die Perinatal Geestesgesondheid Projek (Perinatal Mental Health Project - PMHP) om geestesgesondheidsdienste te lewer by dieselfde plek waar vroue verloskundige dienste kan ontvang. Nietemin, ten spyte van hul pogings, is die getal vroue wat beskikbare behandeling van die hand wys steeds van groot kommer. Dié studie bied ʼn unieke perspektief op hindernisse tot berading vir perinatale depressie afspraak-ooreenkoms gedrag, aangesien dit ʼn algehele uitkyk bied op hindernisse wat nie slegs binne die vroue bestaan nie, maar ook in hul veelvlakkige omgewings bestaan. Tweedens, spreek dit die probleem van nie-bywoning van geestesgesondheidsbehandelingsdienste wat aangebied word deur die PMHP aan en gevolglik ook die gaping wat binne Suid-Afrikaanse navorsing rakende dié onderwerp bestaan. Die steekproef vir die studie was gekies van PMHP lêers van daardie pasiënte wat nie hul geskeduleerde terapie afsprake bygewoon het nie. Die deelnemers ingesluit in die studie is deur middel van doelgerigte-steekproefneming geselekteer om aan aangesig-tot-aangesig of telefoniese semi-gestruktureerde onderhoude deel te neem. Deelnemers is van hul vertroulikheid en anonimiteit van die proses verseker. Die semi-gestruktureerde onderhoude was oudio-opgeneem en transkripsies is daarvan gemaak, waarna die transkripsies in MS Word gelaai is vir tekstuele analise. Transkripsies is tematies geanaliseer. Die hooftemas wat na vore gekom het, sluit in individuele-verwante hindernisse, sosiale-verwante hindernisse, institusie-verwante hindernisse, gemeenskapsverwante hindernisse en armoede-verwante hindernisse. Resultate van dié studie reflekteer die motiverings van depressiewe swanger vroue om beskikbare en gratis geestesgesondheidsdienste wat verskaf is deur die PMHP van die hand te wys, volgens die vyf hooftemas. Hierdie temas is toe volgens Bronfenbrenner (1972) se Ekologiese Sisteemteorie verdeel in die verskillende sisteme teenwoording in die pasiënt se omgewing, naamlik die individuele-, mikro-, meso-, ekso-, en makrosisteem. Die individuele sisteem het die individuele-verwante hindernisse ingesluit, wat swak geestesgesondheid, en teenstrydige gevoelens teenoor die swangerskap omvat het. Die mikrosisteem het die sosiale-verwante hindernisse ingesluit, wat swak sosiale ondersteuning, en self-help strategieë omvat het. Gemeenskapsverwante hindernisse is binne die mesosisteem van die pasiënt se ekologiese omgewing beskou, en het stigma en jammerte as sub-hindernisse ingesluit. Die eksosisteem het die institusie-verwante hindernisse ingesluit, wat verwysing protokol hindernisse, gebrek aan inligting verskaf deur die verpleegsters, en verpleegsters se houdings soos ervaar deur die deelnemers omvat het. Laastens is die armoede-verwante hindernisse binne die makrosisteem beskou, en het finansiële lewens swaarkry, konstante kindersorg eise, en vervoer-verwante struikelblokke as sub-hindernisse ingesluit het. Die belang van dié studie lê in die oorspronklike perspektief van geestesgesondheidsbehandeling dienste afspraak-ooreenkoms gedrag binne die Suid-Afrikaanse konteks, wat aangebied is. Toekomstige navorsing kan, bykomend tot die voer van onderhoude met hospitaal pasiënte, fokus daarop om gesondheidsorg kenners en fokus groepe in te sluit, aangesien dit die triangulasie van perspektiewe moontlik maak van al die belangrike rolspelers. Ook, aangesien die probleem en bekommernisse rakende bywoning van terapie afsprake reeds geïdentifiseer is, mag toekomstige navorsing in die rigting beweeg met die doel om intervensies te omskep wat beoog om die geïdentifiseerde hindernisse tot geestesgesondheidsorg diensgebruik te verminder.

Exclusive breastfeeding for at least 6 months provides numerous infant and maternal benefits. Yet mothers with risk factors, such as lower education, lower socioeconomic status, younger maternal age, planned cesarean birth, and anxiety and depression, are more likely to stop breastfeeding in the early postpartum period. Few studies have focused on perinatal depression as a risk factor for breastfeeding cessation. To tailor effective interventions, nurses must first understand the lived experience of breastfeeding for mothers at risk for perinatal depression. A descriptive phenomenological study was conducted to elucidate the experience of breastfeeding for mothers with perinatal depression. The study was grounded in Swanson’s middle-range theory of caring. After university Institutional Review Board approval, a purposive sample of 10 women was recruited from various organizations. Participants completed a demographic questionnaire and the Edinburgh Postnatal Depression Scale, and semistructured, audiorecorded face-to-face or telephonic interviews were conducted. The researcher transcribed the data which was transformed into constituents of the mothers’ lived experience by utilizing Giorgi’s descriptive phenomenological method. Five constituents emerged: choosing selflessness, harboring inadequacy, deliberate persevering, discerning meaning, and cherishing intimacy. The constituents embodied the essence of the mothers’ thoughts and feelings connected to breastfeeding. By daily choosing selflessness, mothers consciously decided to breastfeed despite physical or psychological struggles. They often were harboring inadequacy due to ongoing struggles which led to incessant thoughts of maternal incompetence. Yet they successfully breastfed for at least 2 weeks after birth by deliberate persevering. Through breastfeeding, they were discerning meaning to realize their value as mothers. Finally, they reveled in purposeful moments of togetherness with their babies through cherishing intimacy. The study findings inform recommendations for nursing education, practice, research, and policy. Nursing education must include basic breastfeeding and perinatal mental health knowledge in prelicensure curricula and up-to-date lactation management techniques and perinatal mental health awareness training in continuing education. Practicing maternal-child nurses must provide education and support to mothers about advantages and difficulties of breastfeeding throughout the perinatal period. Future research includes determination of support needs for women with perinatal depression with subsequent development and evaluation of therapeutic actions to promote breastfeeding success. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

Background: Throughout the COVID-19 pandemic, women carried, birthed, and cared for infants in a drastically changed world. For perinatal women, the sudden increase in stressors compounded an already vulnerable time where they are at an elevated risk of developing symptoms of psychopathology. Moreover, the pandemic exacerbated pre-existing racial health disparities and disproportionately impacted Black, Indigenous, and People of Color (BIPOC)— particularly perinatal BIPOC women, due to the intersection of their race and perinatal status. This study investigated the relationships between COVID-19-related stressors and postpartum psychopathology using network analysis. Network analysis is used as an alternative technique for investigating the activation and maintenance of psychopathology and is increasingly used to examine the influence of external variables (e.g., stressors) on network dynamics. The relationship between psychological symptoms and stressors is typically examined in a unilinear manner—that is, stress causes psychopathology or vice versa. By using network analysis, we were able to investigate the bidirectional relationship between COVID-19-related stressors and postpartum psychopathology to reveal new insights into the individual stressor-symptom interactions that may underlie the emergence of psychological disorders for the perinatal population during the pandemic. Methods: Participants (N=630) were recruited via social media and listservs and completed an online Qualtrics survey. Data quality measures were used to identify repeated, incomplete, and potentially fraudulent responses, which were removed prior to data analysis. Goldbricker, inter-item correlations, and variance inflation factor analyses were used to address topological overlap and identify statistically unique items to be included in the networks. A comorbidity symptom network was estimated to investigate the relationship between postpartum depression and anxiety symptoms in all participants. Bridge symptoms between the two conditions were identified using bridge analysis and clique percolation analysis. Next, an expanded model was estimated to investigate the relationship between postpartum symptoms and COVID-19-related stressors. Node-wise predictability and moderation analyses were used to investigate the effects of adding external variables (i.e., positive experiences, maternal functioning domains, and predictors of psychopathology) to the expanded model. Finally, moderated networks were estimated to investigate differences in the structure of the comorbidity network and the expanded network for mothers from different racial and ethnic groups. Results: Fear-based symptoms were central in both the comorbidity and expanded networks and bridged postpartum anxiety and depression symptoms in the comorbidity network. The Depressed Mood and two Home Stress domains were central in the expanded network. Additional bridge symptoms in the comorbidity network included feeling overwhelmed, concentration difficulties, and feeling disliked by others, and in the expanded network included the Postpartum Stress, Emotional Stress, and Difficulty Adjusting domains. Moderation analyses revealed that the more mothers felt competent and the less challenging they perceived their infant’s temperament, the weaker the node connections were in their expanded networks. Furthermore, mothers with a history of prenatal depression, prenatal anxiety, or baby blues had denser expanded networks (i.e., stronger and more unique edges) compared to mothers with no history of these conditions. Contrary to expectations, moderation analyses revealed that: 1) social support and engaging in positive experiences during the pandemic strengthened connections between stressors and symptoms; 2) middle-income mothers had denser networks compared to low- and high-income mothers. Finally, racial network comparisons revealed that Black mothers' comorbidity and expanded networks were denser compared to all other racial groups. Conclusions: Our findings highlight the influence of major contextual changes, such as the COVID-19 pandemic, on network dynamics—that is, previously established peripheral network nodes (e.g., fear) may shift to the center during large-scale events. Therefore, researchers cannot assume that previously identified central nodes will remain as the main drivers of psychopathology irrespective of changes in context, as this may lead to a misdirection of prevention and intervention efforts. Further, our findings underscore that people with multiple intersecting vulnerabilities may be disproportionately impacted by these major events.

published_or_final_version / abstract / Social Work and Social Administration / Doctoral / Doctor of Philosophy