Postpartum depression (PPD) is a mood disorder affecting approximately 20% of women within 6 months of delivery. Untreated PPD diminishes a woman's functioning and may result in short and long-term consequences for her infant. Screening with evidence-based tools can identify prenatal and postpartum women at risk for PPD, ensure early treatment, and limit adverse maternal and infant effects. Using Rosswurm and Larrabee's evidence-based practice model, a multidisciplinary team of 7 key stakeholders, including directors and a nurse from the departments of OB/GYN, Pediatrics, and Primary Care, a psychiatrist specializing in women's health, and a member of nursing leadership, formed to guide the project. The purpose of the project was to develop a quality improvement initiative to promote antenatal and postnatal screening for PPD in the practice setting that lacked an evidence-based tool. As a federally qualified health center, the practice setting serves an ethnically and racially diverse population, particularly at risk for PPD. Project team members evaluated and graded current literature using the Johns Hopkins Evidence-Based Practice Rating Scale. The Edinburgh Postnatal Depression Scale (EPDS) was introduced and a policy and procedure developed to guide PPD screening. A formative evaluation of the policy and procedure using the AGREE instrument validated development. Project team members strongly agreed to use the EPDS as a PPD screening tool in the clinic population. A summative evaluation supported DNP student leadership of the project. The project has increased awareness of PPD and screening in the practice setting and, focused on improvements in the lives of women, infants, and their families.

This study explores the impact Social media has on the postpartum depression experience. To date, no work has examined the association between social media and postpartum depression. This research is an exploration into the use and impact of social media on individuals with postpartum depression. One hundred and three participants provided information about their demographics, experience with depression, treatment options, use of social media and preferred method of support. This information was gathered and analyzed via a web-based survey instrument. Descriptive statistics was used to compare responses on the internet based questionnaire. The study findings show that Social Media has a positive impact on individual that experience postpartum depression. Most participants indicted that social media assisted in offering emotional, informational and appraisal support through social media. In addition, it appears that a majority of study participants had a positive experience with social media. The greatest use through social networking and social knowledge sites.

Despite medical technology and research advances postpartum hemorrhages (PPH) continue to be a leading cause of morbidity and mortality for pregnant women, even in developed countries. One possible explanation for PPHs continuing to be a leading cause of maternal death is inconsistent recognition and timely treatment of women experiencing a PPH. This doctor of nursing practice project attempts to improve labor and delivery nurse knowledge through an educational intervention which will contribute to rapid identification and treatment of PPH. Knowledge change was demonstrated though change in pretest and posttest scores. The educational information and process was guided by adult learning theory and content was based on current research and evidence-based practice guidelines on PPH. Ninety six participants were assessed using a PPH pretest posttest design. The tests consisted of 15 questions. Correct scores were added and a percent correct score was calculated. The data demonstrated that 63% of the participants passed the pretest with an 80% or higher and 90% of the participants passed the posttest with an 80% or higher. The difference was statistically significant, indicating there was an increase in knowledge after the educational materials were presented. This DNP project contributes to social change by ensuring women receive excellent and timely PPH care by nurses who have a strong understanding of PPH and can apply that knowledge through rapid identification and treatment.

A growing body of research has emerged about effective treatments for postpartum depression, specifically how the internet could become a pivotal and vital option for women with postpartum symptoms. With that in mind, the purpose of this quantitative study was to investigate whether women suffering from postpartum depression preferred traditional therapy treatment or internet therapy treatment. The nonexperimental survey design was used to assess differences between groups related to stigma, satisfaction with treatment, and perceived quality of treatment received. Data collected from a sample of 78 adult females, who had previously received postpartum depression therapy treatment, indicated there was no difference experienced between the treatment modalities. Results were calculated using an independent sample t-test, noninferiority design, and it was determined that participants perceived no difference in their experience of stigma, treatment satisfaction, and perception of credibility and quality between the two therapy modalities. This study adds to the growing body of literature that suggests internet therapy may be a viable option for some women. The results encourage positive social change in that psychologists may advance clinical practice through incorporating technology into their treatment plans, thereby benefiting women who suffer from this condition and who may not be able to readily access a therapist's office on a weekly basis.

Existing research suggests that childbirth may be a significant trigger of posttraumatic stress disorder (PTSD) in the postpartum period. While literature presents important results regarding the prevalence and risk factors of postpartum PTSD, several gaps remain. The current study examined the factor structure of perinatal PTSD by comparing two supported structures of PTSD. Additionally, structural equation modeling (SEM) was used to examine whether subjective birthing experiences and objective childbirth characteristics mediated the relationship between psychosocial variables (history of trauma, fear of childbirth, and social support) and postpartum PTSD. Women were recruited during pregnancy from the University of Iowa Hospitals and Clinics. Symptoms of PTSD, OCD, and depression, as well as risk factors for postpartum PTSD were measured at pregnancy, 4, 8, and 12 weeks postpartum. Additionally, structured clinical interviews were conducted to assess for depression, PTSD, OCD, and mania. Five factor structures were examined using confirmatory factor analysis, including two four factor models with correlated latent factors, two four factor hierarchical models, and a unidimensional model. All models resulted in adequate global fit and excellent component fit. The most parsimonious model, the unidimensional model was retained. The SEM showed that subjective perceptions of childbirth mediated the relationship between fear of childbirth and postpartum PTSD at 4 weeks postpartum. At 8 weeks postpartum, objective childbirth characteristics mediated the relationship between fear of childbirth and postpartum PTSD and there was a direct relationship between fear of childbirth and postpartum PTSD. The current study supports a hierarchical or unidimensional structure of PTSD in perinatal samples emphasizing the importance of a higher-order, shared dimension of PTSD symptoms. It further emphasizes the importance of fear of childbirth and both subjective and objective birthing experiences in predicting postpartum psychopathology. Future research should examine these symptoms and risk factors in a more diverse and at-risk sample. Additionally, accurate assessments, and influential interventions for postpartum PTSD should be further examined.

In comparison to the vast literature on postnatal depression, there exists a paucity of studies that examine anxiety and stress in postnatal populations. This thesis drew from the cognitive vulnerability-stress theories of depression, anxiety, and stress to form its theoretical basis. The underlying premise was that stressful life events have the potential to interact with cognitive vulnerability or characteristic ways of thinking to result in distress for some individuals. New motherhood was therefore conceptualized as a life event that can trigger not only depression, but anxiety and stress in vulnerable women. A major aim of this thesis was to assess the prevalence of postnatal distress using the Edinburgh Postnatal Depression Scale (EPDS) and the Depression Anxiety Stress Scales (DASS-21). The sample comprised 325 primiparous mothers who ranged in age from 18 to 44 years (M=32 years), whose babies were aged between 6 weeks and 6 months. Women were recruited through mother's groups and health centres in Melbourne. Results revealed that over and above the 61 women (19%) who were classified by the DASS-21 as depressed, a further 33 women (10%) showed symptoms of anxiety or stress without depression. This finding supports the assertions that postnatal women need to be assessed for broader indicators of psychological morbidity than that of depression alone. Moreover, 7% of the sample were both anxious and depressed, and had significantly higher mean scores on the EPDS and DASS-depression scales than their depressed-only counterparts. This sub-group also had significantly lower levels of maternal role satisfaction and general life satisfaction than depressed-only women. Other significant findings in relation to the anxious-depressed sub-group, point to the importance of assessing the comorbidity of anxious and depressive symtomatology, and of recognizing the extent to which these women may be at heightened risk compared to depressed-only women. This thesis adapted the biopsychosocial model of postnatal depression proposed by Milgrom, Martin, and Negri (1999) as a research framework for examining a number of unique predictors of postnatal distress. Drawing from an extensive literature on control, two control-related scales were developed (the Perception of Control and Order Scale, and the General Desire for Control and Order Scale). These scales, along with several other cognitive measures, were found to significantly differ in ratings between distressed and non-distressed women. The findings substantiated a role for both controlIII related perceptions (perceptions of control and order, self-efficacy, and perceived control of internal states) and individual characteristics (perfectionism and fear of negative evaluation) in the postpartum. In a final analysis of the cognitive vulnerability-stress model, factors that remained significant that made a unique contribution to the postnatal literature were perceptions of control and order, perceived control of internal states, fear of negative evaluation, and perceived criticism/judgement from women's mothers.

The purpose of this ethnonursing study was to discover, understand, describe, and explicate the emic expressions, meanings, beliefs, practices, and experiences of postpartum Mexican American women living in a Passaic, New Jersey, community and to gain an understanding of any phenomena in the postpartum period. Leininger's culture care diversity and universality theory was utilized as the undergirding framework for this study. Eight key and 15 general informants participated in this study. The ethnodemographic interview guide, a qualitative enabler, was used to assist with the collection and analysis of data. NVivo 8.0, a qualitative software program, was used to assist with data management and organization. The data were analyzed and interpreted into categories, patterns, and themes that were confirmed through multiple interviews. Through face-to-face interviews and field notes, the researcher discovered, understood, described, explicated, and analyzed the cultural expressions, meanings, beliefs, practices, and experiences of Mexican American women during the postpartum period. The findings from this study focus first on nursing knowledge development, pointing the direction for future research to determine effective nursing care actions. Early interventions assist in providing culturally congruent care to postpartum Mexican American women. Implications for nursing research, theory, education, and practice are offered. / School of Nursing / Nursing / PhD / Dissertation

Postpartum depression (PPD) is one of the most common complications of childbirth around the world. Despite several studies on the underlying mechanisms, the pathophysiology remains elusive. The aims of this thesis were to assess possible associations between the risk for self reported PPD and serum levels of leptin, the season of delivery, the gender of the newborn, and the history of premenstrual symptoms, respectively. A population based cohort of 2318 newly delivered women in Sweden were screened five days, six weeks and six months postpartum, using the Edinburgh Postnatal Depression Scale. This cohort comprised 60% of the total population, and the prevalence of self reported PPD was 11.1% six weeks after the delivery. A negative association between leptin levels at delivery and self reported PPD at six weeks and six months postpartum was evident, even after adjusting for confounding factors.  An increased risk for self reported PPD was noted among women delivering during the last three months of the year, compared to those giving birth in April through June. This is of clinical importance, since women delivering at the end of the year could benefit from a closer follow-up after delivery.  Despite previous varying findings – depending on study population and consequently different cultural settings – in our study, no association between infant gender and self reported PPD could be detected at six weeks or six months postpartum. However, women giving birth to baby boys had a higher risk for postpartum blues.   Lastly, an increased risk for self reported PPD among women with a history of premenstrual symptoms was noted. Interestingly, after stratification for parity, the association between PPD and premenstrual symptoms remained only among multiparas. The association between PPD and premenstrual symptoms might shed light on the many possible routes by which hormonal changes may influence mood in women. In conclusion, this population based study strengthens the notion that PPD is a complex multifactorial disorder, with biological, social and psychological parameters shaping each individual’s risk.  Further research is needed in this field, in order to investigate underlying pathophysiological mechanisms, propose more effective diagnostic tests and assess therapeutic interventions. / UPPSAT

With an increasing amount of attention being paid to maternal mental health and the knowledge that maternal depression has the potential to adversely affect the breastfeeding relationship, the demand for appropriate breastfeeding support for mothers struggling with postpartum depression is on the rise. Using a hermeneutic phenomenological approach, the objective of this thesis research was to explore the lived experience of breastfeeding in women with postpartum depression to enhance understanding of what it means for these women to feel supported by registered nurses. After obtaining ethical and operational approval, recruitment began in September 2011 via the Saskatoon Postpartum Depression Support Program, a community wellness program offered by the Saskatoon Health Region. The researcher conducted in-depth, conversation-style interviews with five postpartum mothers. Interviews were transcribed verbatim and were analyzed according to emerging themes. The lived experience of breastfeeding with postpartum depression presented itself across interviews as overarching patterns, which are expressed by the following four themes: making the decision to breastfeed and having great expectations; learning the moves and wanting reassurance (establishing the breastfeeding relationship); breastfeeding in the dark (maintaining the breastfeeding relationship while trying to manage the symptoms of depression); keeping it under wraps and waiting it out (the issue of support). The mothers in this study valued the breastfeeding relationship when it went well; however, breastfeeding difficulties intensified symptoms of depression. Mothers who made the decision to breastfeed their infants needed ongoing support from healthcare professionals and loved ones to continue to breastfeed when faced with the debilitating symptoms of postpartum depression. This research concluded that women need increased anticipatory guidance to be prepared for the demands of motherhood. Women who are at risk for postpartum depression need appropriate treatment throughout the perinatal period and beyond. To these ends nurses must enhance their role as breastfeeding and postpartum depression educators across an extended perinatal period. Nurses should work along with other healthcare providers (midwives, social workers, physicians) to assess the effectiveness and appropriateness of prenatal classes as they are currently offered. Increased emphasis should be focused on newborn feeding and care for mother and baby postnatally in conjunction with prenatal preparation for birth itself. The issue of professional nursing support for breastfeeding must be explored from a sociopolitical context in order to determine if nurses have the cultural and institutional support they need to provide responsive care to mothers and babies. Enhanced support for breastfeeding certification among frontline staff is recommended. It is also recommended that staffing guidelines to decrease nurse-to-client ratios be implemented in order to give nurses the time needed to support mothers as they work through breastfeeding challenges (especially those mothers at risk for postpartum depression). Further, nurses need to enhance efforts to engage mothers and their families in a participatory manner so that knowledge gleaned results in responsive interventions.

Bakgrund: 13 procent av alla kvinnor drabbas av postpartum depression (PPD). PPD påverkar inte bara kvinnan som individ utan även barnet och resten av familjen. Syfte: Att belysa de faktorer som på olika sätt har betydelse vid postpartum depression. Metod: Litteraturstudie. Artiklar har sökts i databaserna Cinahl, PsychInfo och PubMed. Arton kvantitativa artiklar har använts i studien. Resultat: Visade att kvinnor med tidigare depressions- och ångestsjukdomar löpte störst risk att drabbas av PPD. Mätinstrumenten som prövats för att förutse PPD under graviditet visade sig ha en känslighet för upptäckt på mellan 40-78%. Det visade sig även att förebyggande insatser för kvinnor i riskzonen inte hade någon effekt på utvecklandet av depressionssymtom postnatalt. Slutsats: Även om vi inte kan förhindra uppkomsten av PPD så är det ändå av vikt att vara medveten om de riskfaktorer som finns. Med den kunskapen kan vi tidigt upptäcka dessa kvinnor. Det ger möjlighet till ett ökat stöd och adekvata hjälpinsatser vilket kan begränsa omfattningen av sjukdomen.