Thesis (Ph. D.)--University of Hong Kong, 2007. / Title proper from title frame. Also available in printed format.

<p><strong>ABSTRACT</strong></p><p><strong>Background</strong></p><p>Postpartum depression (PPD) occurs in 10% of women who have recently given birth. Postpartum depression is treatable but unidentified and untreated it could lead to serious consequences. There are multiple instruments for screening available. The Edinburgh Postnatal Depression Scale is the most frequently used and is regarded as the best instrument.</p><p><strong> </strong><strong>Aim</strong></p><p>The aim of this study was to analyze to what extent and how midwifes and primary care nurses identify mothers with symptoms of depression respectively PPD. A further aim was to enquire if there are routines for follow up and if there is any collaboration among the professions?</p><p><strong>Method</strong></p><p>A descriptive and comparative design with collection of quantitative and qualitative data was chosen. Midwifes (n=20) and primary care nurses (n=26) at 9 primary care centres answered a questionnaire concerning PPD.</p><p><strong>Results</strong></p><p>Almost all of the primary care nurses reported that they used EPDS as a screening instrument. They also described signs of depression/PPD. Midwifes and primary care nurses had some education in PPD, but there was a need for more education. Even if there was some collaboration among the professions there still was a wish for an increase of co-working.</p><p><strong>Conclusion</strong></p><p>EPDS-screening and referrals to psychologist, physicians and psychiatrists are routines used to identify PPD and also for follow-ups. The midwifes have not received education and does not use EPDS-screening in the same extension as the primary care nurses.</p><p><strong> </strong></p><p><strong></strong></p>

ABSTRACT Background Postpartum depression (PPD) occurs in 10% of women who have recently given birth. Postpartum depression is treatable but unidentified and untreated it could lead to serious consequences. There are multiple instruments for screening available. The Edinburgh Postnatal Depression Scale is the most frequently used and is regarded as the best instrument. Aim The aim of this study was to analyze to what extent and how midwifes and primary care nurses identify mothers with symptoms of depression respectively PPD. A further aim was to enquire if there are routines for follow up and if there is any collaboration among the professions? Method A descriptive and comparative design with collection of quantitative and qualitative data was chosen. Midwifes (n=20) and primary care nurses (n=26) at 9 primary care centres answered a questionnaire concerning PPD. Results Almost all of the primary care nurses reported that they used EPDS as a screening instrument. They also described signs of depression/PPD. Midwifes and primary care nurses had some education in PPD, but there was a need for more education. Even if there was some collaboration among the professions there still was a wish for an increase of co-working. Conclusion EPDS-screening and referrals to psychologist, physicians and psychiatrists are routines used to identify PPD and also for follow-ups. The midwifes have not received education and does not use EPDS-screening in the same extension as the primary care nurses.

Postpartum Depression: Standardizing Motherhood? by Pamela J. Regus Under the Direction of Wendy S. Simonds ABSTRACT An expansion of the medicalization of Postpartum Depression (PPD) is evident in increased screening for maternal depression that begins in pregnancy and continues in the postpartum period, and in the growing number of medical professionals alerted to watch for signs of maternal distress. Although a definitive etiology ofPPDremains elusive, the scientific and medical fields – highly imbued with authority to create knowledge in Western society – promote essentialist views of motherhood that espouse “natural” attributes such as maternal instincts and tendencies to nurture. Mothers who struggle with these standards of motherhood are then defined as being ill and become patients under the care of the medical profession until they can perform adequately in their motherhood roles, or they face social condemnation and legal repercussions for being “bad” mothers. Because characteristics of the “normal” postpartum period are said to be similar to symptoms of general depression, how do some women come to identify their postpartum experiences as depression while others do not? Does the choice of traditional obstetrics or an alternative, such as midwifery, make a difference in the incidence of postpartum depression? And what changes in the social support network occur in a woman’s life as a result of a diagnosis ofPPD? Using Foucault’s theory of docility, critical constructionism, and postmodern feminism as the theoretical focus, and in-depth interviews as the research method, I compare the postpartum experiences of mothers who have been diagnosed with postpartum depression with mothers who have not been diagnosed. The sample includes mothers who gave birth with the assistance of obstetrics and mothers who gave birth with the assistance of certified nurse-midwives. In order to examine the differences in approaches to and treatment of postpartum depression, I also interview a sample of obstetricians and certified nurse-midwives. Findings show that medical professionals use gender-normative assessments, such as physical appearance, language, and nurturing tendencies to determine whether the mother is performing as expected; if not, she is defined as ill and treated with antidepressant medication. Although the majority of mothers in the sample experienced feelings of depression in the postpartum period, many resisted diagnosis and medication. Mothers found the greatest support in their peers, rather than those closest to them, citing the ability to talk candidly about the struggles they face in their motherhood roles as the way to avert or heal from PPD. This finding highlights the enforcement of normative motherhood within the social institutions of the family and medicine; thus, cultural change from ideological representations of motherhood may come about through peer relationships. INDEX WORDS: Postpartum depression, Motherhood, Medicalization, Expansion of medical control, Maternal behavior, Childbearing years, Normative motherhood

In this study, I conduct a multiple method content analysis of literature on postpartum depression (PPD) from two on-line sources, Medline and LexisNexis. The purpose of the study is to determine how the medical profession defines and frames PPD, and to consider the implications of its movement into the medical model. I use the theories of Foucault, Gramsci, critical constructionism, and postmodern feminism to examine the effect of the medicalization of PPD on women’s lives. Using both simple descriptive statistics and qualitative analysis, I show the expansion of medical control over women’s bodies in the childbearing years beyond the physical to include the emotional and psychological aspects as well, which results in standardized maternal behaviors and emotions that tighten the boundaries of motherhood.

Transition to parenthood is a major life event that affects both fathers and mothers. Being a potentially stressful period, it can predispose vulnerable individuals to mental health problems. Compared with maternal studies, there is a dearth of longitudinal research on the psychological impact of transition to fatherhood, particularly with anxiety problems. There are emerging studies demonstrating the adverse consequences of paternal postpartum depression on infant outcomes. It is important to investigate paternal postpartum depression and anxiety and address their relationships with poor infant outcomes which will contribute to the recognition of the problems and the development of early intervention. The current study aimed to contribute to greater knowledge on risk factors of paternal postpartum mental health problems, and their adverse impact on infants, as well as understanding the possible mediating mechanisms underlying such a relationship. A total of 654 couples completed self-report questionnaires at third trimester of pregnancy using validated self-report psychological instruments to evaluate fathers' prenatal mental health. Among them, 255 couples were examined longitudinally at six week postpartum for depression and anxiety symptoms, and fathers were also assessed for marital satisfaction, self-esteem, social support, and postpartum attachment with infants. At six months postpartum, 121couples were again surveyed to assess their infants’ temperament and development. According to established cut-offs, 12.0% and 13.1% of fathers experienced significant postpartum depression and anxiety. No demographic risk factors were found for postpartum depression or anxiety. Multiple regression analyses indicated that low martial satisfaction, low self-esteem, fathers having prenatal anxiety and depression, partners having postpartum depression predicted fathers’ postpartum depression. Low marital satisfaction, low self-esteem, poor social support and fathers having prenatal anxiety were significant risk factors for fathers’ postpartum anxiety. Depressed and anxious fathers reported having less patience and tolerance, pleasure in interaction, and affection and pride with their infants. Paternal postpartum depression was related to reduced infants’ falling reactivity, and poor social and total development in infants; while postpartum anxiety was associated with heightened infants’ distress to limitations, reduced failing reactivity and greater sadness. Baron and Kenny’s criteria was used to investigate whether poor paternal attachment with infants mediated these relationships. Pleasure in interaction partially mediated the relationship between paternal postpartum depression and social as well as total development in infants, whereas affection and pride mediated between fathers' postpartum depression and infants' falling reactivity as well as social development. Affection and pride also served as a partial mediator between fathers' postpartum anxiety and infants’ failing reactivity. Findings revealed that paternal postpartum depression and anxiety are significant mental health problems. Low marital satisfaction, low self-esteem, poor social support, prenatal depression and anxiety, and partners' postpartum depression could contribute to these problems. Postpartum depression and anxiety could reduce fathers' attachment with infants, which adversely impacted infants' temperament and development. The current study also addressed that risk factors for paternal postpartum depression and anxiety were different, and they had distinctive environmental pathways affecting infant outcomes. This provides significant implications for designing timely and effective interventions to improve fathers' well-being and proper father-infant interaction. (499 / published_or_final_version / Psychiatry / Master / Master of Philosophy

n-3 fettsyror har en avgörande roll som komponent av plasmamembranets fosfolipider och tillhör gruppen fleromättade fettsyror. n- 3 fettsyrorna har en inverkan på cellstruktur och funktion och viktiga fettsyror är dokosahexaensyra (DHA) och eikosapentaensyra (EPA). DHA och EPA bildas från Alfalinolensyra (ALA) som är essentiell, det vill säga att den måste tillföras via kosten därför att kroppen inte kan tillverka den själv. ALA måste därför tillföras antingen genom fisk-och skaldjursintag och då framförallt fet fisk eller genom kosttillskott. EPA och DHA finns främst i hjärnan som till 60 % består av fett. Förlossningsdepression är en åkomma som drabbar ungefär 10-20 % av barnafödande kvinnor. Det är en komplex åkomma som kan bero på olika miljöfaktorer, genetiska anlag men kan även bero på kosten. Förlossningsdepression kan bli allvarligt både för modern och för barnet. Syftet med den här studien var att genom vetenskapliga artiklar undersöka om n-3 fettsyror kan ha en inverkan vid förlossningsdepression och isåfall genom vilka mekanismer. Det finns idag inget konkret svar på om n-3 fettsyror kan hjälpa vid förlossningsdepression samtidigt som många studier inom området har gjorts. Denna studie hade därför som syfte att eventuellt kunna bidra med ytterligare kunskap om n-3 fettsyror och förlossningsdepression och om fettsyrorna verkligen hjälper. Resultaten från de sex artiklar i studien som undersöktes visade inte på någon tydlig koppling mellan halten av n-3 fettsyror och förlossningsdepression. I tre av de sex studierna kunde dock en liten effekt observeras. En studie visade också att en högre snarare än en lägre nivå av fettsyror kunde öka risken för depression. Det behövs fler studier inom området för att få ett konkret svar.

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Maternal psychological well-being is one of many factors that shape the interactions a woman has with her infant. According to Belsky's (1984) Determinants of Parenting Process Model, he suggests that maternal personality and psychological well-being play a significant role in the observation of parenting behaviors. This model was utilized as the overarching framework for this dissertation. The dissertation, in the form of three manuscripts, outlines important factors within the marital relationship that impact postpartum depression, then exploring the moderation of depression by knowledge of infant development in four behavioral scales observed during a mother-infant interaction. Finally, two maternal behaviors that impact child outcomes were utilized as predictors of infant social-emotional and cognitive outcome, while testing for moderation by infant age.Results. In study one, women were more likely to report postpartum depression when they experienced more arguments with family and lower relationship depth. The second study found that knowledge of infant development moderated maternal reports of postpartum depression, thus allowing women with higher knowledge to maintain positive behaviors compared to women with low or average knowledge. The third study indicated that verbal stimulation resulted in higher scores for infant social-emotional and cognitive development, whereas maternal sensitivity was the only variable impacting social-emotional development. The test of moderation by infant age found mothers of older infants did speak more to their older infants, but the differences were minimal.Conclusion. Marital relationships play a significant role in promoting healthy maternal psychological well-being during motherhood. When psychological well-being is compromised via postpartum depression, decreases in maternal behaviors result in lower scores during maternal-child interactions. Maternal sensitivity and verbal stimulation uniquely contributed to infant outcomes. In addition, infant age may impact the observance of these two maternal behaviors resulting in increased or decreased observances based on the infant's age.Thus, use of Belsky's Determinants of Parenting Process Model within this dissertation confirmed the importance of maternal personality and psychological well-being in parenting behaviors. Mothers impacted by postpartum depression suffered a reduction in parenting behaviors, though higher knowledge appeared to buffer these negative effects. Implications for interventions and future work are discussed within each study.