Background: Postpartum Depression (PPD) affects up to one in five mothers. While psychotherapy can effectively reduce symptoms of PPD, it is unclear how PPD treatment affects maternal psychophysiology. Determining physiological changes in response to cognitive behavioural therapy (CBT) could provide insights into the mechanisms underlying effective treatment and/or help predict treatment outcomes. This study examined if treating PPD with CBT led to changes in frontal cortical activity and heart rate variability, two markers of maternal emotion regulatory capacity. Methods: Community-dwelling mothers with PPD (Edinburgh Postnatal Depression Scores ≥10) were randomized to receive nine weeks of group CBT delivered by recovered peers (i.e., those who had previously recovered from PPD) (n=26) or be put on a waitlist to receive the intervention nine weeks later (n=24). Electroencephalographic (frontal alpha asymmetry), electrocardiographic (heart rate variability), and clinical (depression, anxiety) data were collected at baseline and nine weeks later. Results: Participants in both the immediate treatment and waitlist control groups reported moderate levels of depression and anxiety at baseline. After treatment, mothers in the treatment group showed greater improvements in depression (p<0.01, Cohen d=1.22), and anxiety (p<0.005, Cohen d = 1.48), and high-frequency heart rate variability (p<0.05, Cohen d=0.70), but not frontal alpha asymmetry, compared to the waitlist control group. Conclusion: Group CBT for PPD can improve symptoms of depression and anxiety and parasympathetic nervous system function. Future research should attempt to replicate and extend these findings using larger samples, additional biomarkers, and longer periods of follow up. Examining how evidence-based treatments for PPD affect maternal psychophysiology can improve our understanding and potentially predict treatment effects. / Thesis / Master of Science (MSc) / Postpartum depression affects up to one in five mothers in the first year after delivery. When treated promptly with talking therapies (i.e., psychotherapy) such as cognitive behavioural therapy (CBT), many experience significant improvements in their symptoms. However, the changes occurring in the brain and the remainder of the nervous system occurring in response to psychotherapy is not well known. It is important that this is understood so that we can develop more effective treatments and better predict who will respond to different types of treatments. In particular, the role of the frontal lobe of the brain, and the body’s parasympathetic system is poorly understood in the context of PPD. This thesis aimed to examine the impact of CBT on women’s frontal lobe functioning using a measure called frontal alpha asymmetry (FAA) measured via electroencephalography (EEG), and parasympathetic nervous system-based heart rate variability (HRV) using electrocardiography (ECG). In this study, we compared mothers with PPD treated with CBT to those who did not receive this treatment. We found that HRV responded in mothers who received CBT compared to women who were in the control group. No significant changes were found for FAA after treatment. These results suggest that HRV may be explored further as a valid treatment outcome for CBT when provided to women with PPD.

Background: Post partum depression affects around 13 percent of all new mothers. Riskfactors for developing this condition can include previous history of depressions or a lack ofsupport from those around you. Treatment options may include therapy, medication or so-called support groups. Postpartum depression can negatively impact the mother-childattachment, leading to long-term physical and mental health consequences for both the motherand child. Aim: The aim was to describe mothers' experiences of suffering from postpartum depression. Method: A meta-synthesis based on ten qualitative articles that were analyzed using aninductive approach. The searches were conducted in three databases: PubMed, CINAHL andPsychInfo. Results: Four categories emerged: 1. The mothers' experience of not being able to live up totheir own and others' expectations. The mothers describe their experience of postpartumdepression and how they felt a lost sense of identity and a feeling of not being a good mother.2. The mothers' experience of negative consequences in life. They described guilt and shamerelated to their postpartum depression. They experienced of a lack of support from family andpartners. 3. The mothers' experiences of barriers to seeking help. There was a fear of stigmaand previous negative experiences with healthcare that could prevent them from seeking help.4. Different strategies for managing their situation. They described various strategies theyhad to feel better and their experiences of what has helped and could help them. Conclusion: The mothers experienced suffering related to their postpartum depression and itsconsequences. The mothers highlighted that the healthcare professionals' approach andsociety's perception of the diagnosis impacted their willingness to seek help. They felt thatsupport from the healthcare system and from the community could have helped them / Bakgrund: Av alla nyblivna mammor drabbas cirka 13 procent av förlossningsdepression.Riskfaktorer för att drabbas kan vara tidigare depressioner eller bristande stöd frånomgivningen. Behandlingen kan innefatta terapi, läkemedel eller så kallade stödgrupper.Förlossningsdepressionen kan påverka anknytningen till barnet negativt vilket på sikt kan geen försämrad fysisk och psykisk hälsa hos både mamma och barn. Syfte: Syftet var att beskriva mammors upplevelse av att drabbas av förlossningsdepression. Metod: En metasyntes baserad på tio kvalitativa artiklar som analyserades med induktivansats. Sökningarna genomfördes i tre databaser: PubMed, CINAHL och PsychInfo. Resultat: Det framkom fyra kategorier: 1. Mammornas upplevelse av att inte kunna leva upptill sina egna och andras krav. Mammorna beskriver sin upplevelse av sinförlossningsdepression och hur de upplevde en förlorad identitet och en känsla av att inte varaen bra mamma. 2. Mammornas upplevelse av negativa konsekvenser i livet. De beskrev enskuld och skam relaterat till sin förlossningsdepression. Det fanns upplevelser av brist på stödfrån familj och partner. 3. Mammornas upplevelser av hindrande faktorer för att söka hjälp.Det fanns en rädsla för stigma och tidigare dåliga erfarenheter av vården som kunde leda tillatt de inte sökte hjälp. 4. Olika strategier för att hantera sin situation. De beskrev olikastrategier som de hade för att må bättre och sina upplevelser av vad som hjälpt och skullekunna hjälpa dem. Slutsats: Mammorna upplevde ett lidande kopplat till sin förlossningsdepression ochkonsekvenserna av den. Mammorna lyfte att vårdpersonalens bemötande och hur samhälletser på diagnosen påverkade om de söker hjälp. De upplevde att stöd från sjukvården och frånomgivningen hade kunnat hjälpa dem

The aim of this presentation is to describe the development, implementation, and one-year outcomes of a team-delivered, evidence-based protocol to identify and address postpartum depression in a pediatric primary care clinic. The presentation will include: 1) a description of the development process based on implementation science, 2) engaging activities for the audience such as a video illustration of the protocol itself, and providing an opportunity to learn and practice administering the Ecomap, an evidence-based assessment for social determinants of health, and 3) data from a records review showing outcomes. Additionally, this presentation will illuminate barriers and facilitators at varying levels to team-based healthcare in general and within this specific clinic. At the conclusion of this presentation, participants will be able to: Explain the inception and development of a stepped-care protocol set within a pediatric primary care clinic as conceptualized by the Consolidated Framework for Implementation Research. Describe the function and utility of an Ecomap to understand a family's social determinants of health. Apply the RE-AIM model to evaluate a clinical intervention implemented within an interdisciplinary pediatric primary care clinic.

The birth of a child can be a stressful time accompanied by an array of emotions including depression. Postpartum depression (PPD) affects approximately 1 out of 7 new mothers. It can affect a new mother’s sleep, appetite, mood, and bond with her baby, as well as impact child development and well-being, if left untreated. Beginning in March, 2013, ETSU Pediatrics deployed an evidence based screening tool, the Edinburgh Postpartum Depression Scale (EPDS), to identify mothers of newborns with PPD. Mothers attending well-visits with their baby from birth to six months of age who score above an eight on the screener are provided with education about PPD, referrals, brief on-site counseling, and phone-call follow- up. Many of these mothers express concerns about resources and social factors that impact their health and mood. An Ecomap is a visual representation of strengths and stressors of a patient’s relationship with their environment, social supports, and resources. The awareness of a patient’s relationships and support within their environment can be useful for assessment of needs and intervention on their behalf. The objective of this study is to pilot the utility of the Ecomap to illuminate common stressors of the social determinants contributing to or exacerbating symptoms of PPD, in order to provide brief solution-focused interventions and referrals to alleviate the stressors. Although Ecomaps have been utilized in clinic settings, there is a lack of research on their effectiveness in identifying social determinants of mothers with PPD. We hypothesized that implementing the Ecomap with mothers that present with an elevated EPDS score will identify a significant number of social determinates that are actionable by social workers on staff. When a mother presented with a score of eight or above on the EPDS administered during a well-child check, the social work staff completed an Ecomap with mothers via a warm handoff. The social determinants identified on the Ecomaps were then categorized and counted to determine biggest social needs of mothers at the ETSU Pediatric clinic from 11/13/2015 through 02/28/2016. The clinic completed 27 ecomaps with mothers who scored 7 or above at well child checks. Transportation and mental health services presented as the most common domains that social work was able to effectively act to rectify. Overall, the utilization of the Ecomap was successful in identifying social determinants contributing to or exacerbating symptoms of PPD. Addressing these stressors through resource allocation and brief solution-focused therapies may contribute to a reduction of PPD symptoms. Future research, therefore, should examine whether addressing these social stressors reduces symptoms of PPD above and beyond targeting depressive symptoms alone in mothers presenting at pediatric clinics.

No description available.

Postpartum Depression (PPD) occurs in 10-20% of new mothers. PPD can lead to serious health risks to both the mother and infant, increase the risk of complications during birth, and cause lasting effects on the development and wellbeing of the child. Many mothers suffering from PPD do not receive treatment due to fear of being stigmatized, lack of education, or not being able to access mental health services. High prevalence of PPD, along with the negative and lasting effects it can cause point to the importance of developing an effective and feasible method of assessing and treating this disorder. A pediatric primary care office may be an opportune setting to screen for PPD since mothers often accompany their children to regularly scheduled well child visits. While some studies have examined PPD screening within the pediatric primary care setting, few have explored the addition of an on-site Behavioral Health Consultant to provide brief interventions for depressed mothers as part of a stepped care model. The primary aim of the current study is assess the feasibility of implementing a stepped care protocol that assesses PPD and provides brief interventions and referrals for depressed mothers within a pediatric primary care clinic. The protocol consists of several phases including: 1) distribution of the Edinburgh Postpartum Depression Screener to every mother arriving for a well child visit during the first six months of their child’s life; 2) appropriate documentation in the clinic’s electronic health record (EHR) of the Edinburgh score and resulting plan of action; 3) a brief same day intervention by the on-site Behavioral Health Consultant and referral to outside provider, if applicable; and 4) phone call follow up with the mother and referred provider, if applicable. Research assistants will monitor the EHR to determine the clinic’s fidelity to the protocol (e.g., if the Edinburgh is being administered properly). Data will also be collected from the EHR to determine if a correlation exists between Edinburgh scores and number of Emergency Room visits made by the child, immunizations administered to the child, and number of well child checks the child attended. Data collected throughout the month of March showing the Edinburgh uptake, consistency with protocol, and any correlation between Edinburgh scores and other variables will be presented.

Abstract available through the Annals of Behavioral Medicine.

Postpartum depression (PPD) is a prevalent, complex illness impacting 10% to 20% of mothers and their families. Treatments for PPD, such as medication and psychotherapy, are effective at reducing the severity of symptoms and generally improving quality of life for new mothers and their families. Unfortunately, many mothers with PPD go unrecognized due to a lack of standardized screening methods. Further, mothers regularly encounter barriers to accessible, evidence-based follow-up care to treatment even when symptoms of PPD are detected. The use of a stepped care protocol, set in a pediatric primary care clinic, is one proposed strategy to address the insufficient rates of screening, detection, and maternal contact with treatment. This study examines the feasibility of implementing a stepped care protocol to screen and provide brief therapeutic treatment to mothers reporting symptoms of PPD in one pediatric primary care clinic. The RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework was used to evaluate implementation outcomes. Results suggest this stepped care protocol was feasibly implemented in one pediatric primary care clinic. The protocol was largely successful in screening mothers at a majority of well child checks (83.76%) for PPD and connecting them with resources based on the severity of symptoms reported. Future studies should further evaluate the impact brief onsite mental health treatments have on reports of PPD symptoms, longitudinal maternal and child outcomes as a result of the protocol, as well as the protocol’s replicability to pediatric practices elsewhere.

Postpartumdepression drabbar cirka 12–13 procent av alla nyblivna mammor runt om i världen. Symtom på postpartumdepression kan finnas redan under graviditeten eller uppträda efter det att barnet fötts. Relationen mellan mamman och barnet, partner och övriga familjemedlemmar kan påverkas negativt om mamman drabbas av en postpartumdepression. Det är viktigt att som barnmorska ha kännedom om tillståndet för att kunna identifiera symtom samt veta vilka insatser som ska sättas in. För att kunna bidra till en god vård utifrån kvinnornas behov behövs kunskap om kvinnornas upplevelser av att genomgå en postpartumdepression. Studiens syfte var att belysa kvinnors upplevelser av att genomgå en postpartumdepression. Metoden som tillämpades var en litteraturöversikt med systematisk design. Sökningar genomfördes i databaserna PubMed och CINAHL, som resulterade i 15 kvalitativa artiklar. En integrerad analys genomfördes. Resultatet sammanställdes i fyra huvudkategorier: En känslomässig berg- och dalbana, en identitet i förändring, påverkan på relationer och att hitta vägen tillbaka. Att genomgå en postpartumdepression bidrar till upplevelser av identitetsförlust och känslor av ett misslyckande i moderskapet. Kvinnor beskriver en stigmatisering runt postpartumdepression. Problem i anknytning till barnet och med amning påverkar kvinnornas mående. Kvinnorna upplever en mängd olika känslor och vissa mår så pass dåligt att det bidrar till att de har tankar på att skada sig själva eller sitt barn. Brist och betydelsen av stöd visade sig påverka kvinnornas upplevelse av en postpartumdepression. Slutsatsen var att genomgå en postpartumdepression kan drabba vilka kvinnor som helst och då inte bara kvinnan utan påverkar hela hennes familj. Bristen och betydelsen av stöd, både från kvinnans anhöriga samt hälso- och sjukvården är till stora delar kopplade till kvinnans upplevelse av en postpartumdepression. Ett gott socialt och professionellt stöd visade sig vara en grund för återhämtning. Således är både barnmorskans förebyggande arbete och tidiga upptäckt av tillståndet av betydelse för att främja god hälsa. / Postpartum depression affects approximately 12-13 percent of all new mothers worldwide. Symptoms of postpartum depression may become present during pregnancy or after birth. The relationship between the mother and the child, partner, or other family members can be negatively affected if the mother experiences postpartum depression. It is important for midwives to be aware of this condition to be able to identify the symptoms and implement the right interventions. In order to provide quality care based on women's needs, it is necessary to have knowledge of women's experiences of postpartum depression. The aim of the study was to highlight women's experiences of going through postpartum depression. The method applied was a literature review with a systematic approach. Searches were conducted in the PubMed and CINAHL databases, resulting in 15 qualitative articles. An integrated analysis was performed. The results were compiled into four main categories: an emotional roller coaster, a changing identity, impact on relationships, and finding a way back. Going through postpartum depression contributes to experiences of loss of identity and feelings of failure in motherhood. Women describe a stigma surrounding postpartum depression. Problems with attachment to the child and breastfeeding affect women's well-being. Women experience a range of different emotions, and some are so affected that they have thoughts of harming themselves or their child. The significance of support and the lack thereof, were found to affect women's experience of postpartum depression. In conclusion, the study shows that experiencing postpartum depression can affect any woman and not just the woman herself but her entire family. The significance of support and that the lack thereof, both from the woman's relatives and the healthcare system, are closely related to the woman's experience of postpartum depression. Adequate social and professional support was found to be fundamental for recovery. Therefore, midwives’ preventive work as well as early detection of the condition are of importance in promoting good outcomes.

As If It Were One Day is a multimedia art installation that chronicles patterns of light, movement, and sound, channeling the fluidity of time within the newborn phase of familial living. After giving birth to my daughter, I spent the next seven weeks observing these elements and recording them via video. The resulting art installation acknowledges my efforts to navigate my current life as an artist and a mother, my past battle with postpartum depression, and my consequent gravitation toward light.