Depression is one of the most widespread and disabling mental health disorders affecting adults worldwide, and Black women bear a disproportionate burden of this disorder. With its varied symptom presentation, depression can be difficult to diagnose. In addition, Black women may be less likely to report symptoms due to cultural stigma. The purpose of this dissertation is to examine the associations between social determinants of health and depressive symptoms using DNA methylation data and machine learning to predict depressive symptoms in Black women. Chapter 2 contains two comprehensive literature reviews: a scoping review of machine learning methods used to analyze omics data to classify depressed cases and healthy controls and a concept analysis of depression in Black mothers. Chapter 3 examines associations between social determinants of health, depressive symptoms, and DNA methylation. Chapter 3A focuses on socioeconomic deprivation; Chapter 3B focuses on perceived income inadequacy; and Chapter 3C identifies differential methylation associated with depressive symptoms. Chapter 4 utilizes supervised machine learning algorithms to predict depressive symptoms and perform feature selection. These chapters show the harmful effects that perceived discrimination can have on the mental health of Black women. Additionally, the results indicate that DNA methylation is associated with depressive symptoms, an area which requires further research.

Certain sport environments may contribute to the development of disordered eating and those that heavily emphasize weight and/or body shape can be particularly damaging to an athlete's body image, self-concept, and eating behaviors. In particular, female athletes in collegiate sports are at a greater risk for engaging in unhealthy behaviors because they face both societal pressures from Western culture to be thin, in addition to sport pressures that focus on performance and appearance. According to the American Medical Association almost half of American women are trying to lose weight, illustrating that societal pressures alone to be thin and attractive can influence the development of disordered eating. Athletes are exposed to the same sociocultural pressures as their nonathlete counterparts, and would be expected to have similar feelings about their bodies as women in general. Add subsequent pressures like team "weigh-ins," coaches' body comp preferences, judges' critiques, revealing attire, and endurance/strength demands, and the stage is set for the development of disordered eating. In the current study, participants were 414 Division-I female gymnasts, swimmers/divers, and they completed self-report measures assessing sport pressures, body satisfaction and disordered eating behavior to test Petrie & Greenleaf's etiological model. Results indicate that sport pressures do lead directly to dietary restraint, a precursor to disordered eating, and are not always mediated through internalization and body dissatisfaction. These findings suggest that decreasing and intervening with perceived sport pressures may lessen the risk of female athletes developing an eating disorder.

A qualitative, descriptive, explorative, and contextual research design was selected for this study. The purpose was to explore the phenomenon of mass hysteria among the Basotho in Lesotho and to develop guidelines which may facilitate early intervention and better management and control of mass hysteria outbreaks. The study area covered four of the ten districts in Lesotho. Four high schools where recent outbreaks of mass hysteria have been reported were included in the study. Semi-structured individual interviews and focus group interviews were conducted to collect the data. Purposive sampling was used to select young women in high schools who experienced mass hysteria; teachers who were present during mass hysteria episodes; a parent; and traditional healers and religious leaders who were involved in treating the affected.Thirteen individual interviews were held respectively with one victim of mass hysteria from a rural area, four school principals,a parent,five traditional healers, a priest and apastor. Three focus group interviews were conducted with thirty affected young women from three different high schools and two focus group interviews were held with twenty teachers from two different high schools.The data were transcribed verbatim and content analysis was done using open and axial coding. Four themes emerged from the findings, namely: manifestations of mass hysteria among the Basotho; interventions used by the Basotho to alleviate mass hysteria; Basotho’s views about the phenomenon of mass hysteria; and effects of mass hysteria onthe Basotho. The findings show that young women in Lesotho experience both physical and psychological symptoms during mass hysteria episodes and that it has a contagious effect. The interventions used by the Basotho to alleviate mass hysteria include traditional healing, herbal remedies, exorcism and prayer.The Basotho have different views about mass hysteria attributing it to either supernatural forces or natural illness. Episodes of mass hysteria have a negative impact on the victims,their families, and those who witnessed the episodes, causing confusion, fear and anxiety. Guidelines were compiled to assist teachersand health workers to improve the management and control of mass hysteria episodes in Lesotho. / Health Studies / D. Litt. et Phil. (Health Studies)

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.

Assertive training was investigated to determine its usefulness in teaching mildly retarded women to become more assertive. The 10 subjects (ages 18-35, WAIS VIQ 50-75) were randomly assigned to either the assertive training or the control group. Experimental subjects received 5 weeks of daily assertive training sessions which employed modeling, behavior rehearsal, and focused instructions in a group setting. Specific components of assertive behavior were taught in the following order: (a) assertive refusals, (b) assertive requests, (c) posture, (d) eye contact, and (e) loudness, Results of a behavioral role-playing task administered to both groups before and after treatment revealed that assertaive training subjects made significantly greater improvement than controls in their assertive content, Additionally, these subjects manifested significantly more improvement than control subjects on a global assertiveness measure.

O objetivo desse estudo foi investigar como as mulheres com deficiência são recebidas nos serviços de atenção primária e como essas mulheres e os/as profissionais que lhes assistem dão sentidos às práticas desenvolvidas. As mulheres com deficiência ainda contam com ações inexpressivas voltadas para as suas necessidades nos serviços de atenção primária em saúde, que embora privilegie a clientela feminina, pouco reconhecem as especificidades desse segmento, como por exemplo, aspectos relativos aos seus direitos sexuais e reprodutivos. Trata-se de pesquisa qualitativa que entrevistou 39 profissionais de três serviços de atenção primária de uma região da cidade de São Paulo, bem como 15 mulheres com variados tipos e graus de deficiência, na idade reprodutiva, usuárias destes serviços. Sete dessas mulheres são mães de mais de um filho, e três tiveram filhos após a aquisição da deficiência, o que corrobora o fato de parcela significativa de mulheres com deficiência ter vida sexual ativa e necessitar de atenção relativa à sua saúde sexual e reprodutiva. Os profissionais afirmam que a presença de mulheres com deficiência na idade reprodutiva em geral é rara, e apontam que suas necessidades de saúde são mais determinadas pelo tipo e grau da deficiência do que por determinantes socioculturais de gênero. Reconhecem lacunas em sua formação para abordarem deficiências e questões de gênero - o que se revela no predomínio de concepções baseadas no senso comum - e apontam a necessidade de os serviços investirem na acessibilidade física, comunicacional e de atitudes. Já as usuárias relatam dificuldades de acesso aos serviços, que inclui falta de transporte, barreiras arquitetônicas, barreiras na comunicação, atitudes preconceituosas e pouco acolhedoras de alguns profissionais. Avaliam como positivo a oferta de cuidado no domicílio para aquelas que não conseguem ir ao serviço / This study aimed to investigate how women with disabilities are received in primary health care facilities and how these women and primary care providers who assist them give meaning to the practices developed. Women with disabilities still have few actions aimed at their needs in primary health care services. Despite the attention given to the female population in primary health care facilities, they still dont recognize specificities of women with disabilities, such as issues related to their sexual and reproductive rights. Through a qualitative research 39 providers were interviewed in three primary health care facilities in a region of São Paulo city, and also 15 women with different types and degrees of disability, reproductive age, users of these services. Seven of these women are mothers of more than one child, and three of them had children after the acquisition of disability, which corroborates the fact that a significant portion of women with disabilities are sexually active and need attention on sexual and reproductive health. The providers said that the presence of disabled women of reproductive age in general was scarce, and reported that their health needs were more determined by the type and degree of disability than by socio-cultural determinants of gender. They recognized gaps in their training to address disability and gender - which reveals the predominance of concepts, based on common sense - and highlighted the need for services to invest in physical accessibility, communication and attitudes. For the other side, the users have reported difficulties in accessing services, which included lack of transportation, physical and communication barriers, prejudice and unwelcoming attitudes of some providers. They evaluated as positive the provision of home care for those who couldn´t go to the service

Este é um estudo quanti-qualitativo que teve como objeto os limites e as possibilidades de atuação dos integrantes das equipes de saúde da família na violência doméstica vivenciada pelas mulheres no sentido de dar visibilidade a este problema no âmbito dos serviços de saúde. Seus objetivos específicos foram: identificar as concepções de violência de mulheres que vivenciaram situações violentas no espaço doméstico, apreender qual a expectativa das mulheres ao buscarem o serviço de saúde quando vivenciam situações de violência doméstica, identificar os limites de atuação dos profissionais de saúde frente à violência doméstica vivenciada pelas mulheres e analisar à luz de gênero o posicionamento dos profissionais de saúde em relação à violência doméstica contra a mulher. Neste estudo utilizaram-se como referencial teórico-metodológico as categorias gênero e violência de gênero enquanto constructos sociais. Para o tratamento dos dados foi utilizada a metodologia da análise de conteúdo proposta por Bardin e Minayo e as recomendações de Bourdieu para a construção das histórias das mulheres. Foi desenvolvido em duas etapas. A primeira teve como sujeitos de pesquisa as gestantes atendidas no Centro de Saúde Padre Fernando de Melo no município de Belo Horizonte, realizada através da observação participante, da aplicação de 64 questionários fechados e 12 entrevistas semi-estruturadas. As informações obtidas subsidiaram o desenvolvimento da segunda etapa da pesquisa. A segunda etapa foi desenvolvida através de uma Oficina de trabalho realizada com quinze profissionais das equipes de saúde da família do referido centro de saúde tendo como tema o posicionamento dos profissionais das equipes de saúde em situações de violência doméstica contra as mulheres. Nesta oficina foram coletadas informações sobre os limites e possibilidades de abordagem da violência doméstica nos serviços de saúde. Os resultados mostram que mulheres e profissionais de saúde ao não reconhecerem a violência doméstica contribuem para que se mantenha como um problema presente e recorrente, porém, não abordado nos serviços de saúde. Mostram ainda a potencialidade das Oficinas na coleta de dados de pesquisa articulada à reflexão crítica e na abordagem da violência doméstica nos serviços de saúde / This is a quanti-qualitative study that had as purpose to understand the limits and the possibilities of action by integrants of family health teams on domestic violence against women in search of appropriate ways to give visibility to this problem in the scope of the health services. Its specific objectives were: to identify the conceptions of violence by women who had lived in violent situations in the domestic space, to apprehend which could be the expectation of the women when searching the health service after suffering domestic violence, identify the limits of action of the health professionals dealing with women under domestic violence, and to analyze the gender´s view and the perception of the family health team in relation to the domestic violence against the woman. In this study the categories gender and type of violence were used as theoretical and methodological referential for the social constructs. For the data analysis it was used the methodology proposed by Bardin and Minayo and the recommendations of Bourdieu for the construction of the histories of the women. The research was developed in two stages. The first one had as subjects pregnant women attended in the Centro de Saúde Padre Fernando de Melo in the city of Belo Horizonte, evaluated through the observation, the application of a closed questionnaire with 64 questions and 12 half-structuralized interviews. The information obtained subsidized the development of the second stage of the research. The second stage was developed through a workshop with fifteen professionals of the family health team above mentioned having as the purpose the perception and positioning of the professionals dealing with situations of domestic violence against the women. In this workshop information on the limits and possibilities of approaching the domestic violence in the health services were collected. The results show that women and health professionals when do not recognize the domestic violence do not contribute to prevent it, what then becomes a present and recurrent problem in the health services. The results also show the potentiality of the workshops in the collection of data for research, articulated to the critical analysis and approach of the domestic violence in health services facilities and programs

Introdução: No Brasil, o uso de métodos contraceptivos está centrado na pílula anticoncepcional oral, na laqueadura e na camisinha masculina. Métodos contraceptivos reversíveis de longa duração, como o dispositivo intrauterino, são pouco usados, ao contrário do que ocorre no contexto internacional. A literatura mostra que há várias razões para essa subutilização, dentre as quais destaca-se o escasso conhecimento das mulheres sobre o mesmo que, por sua vez, promove atitudes negativas e concepções equivocadas em relação ao método e dificulta que as mulheres optem por ele. Objetivo: Analisar o conhecimento, as atitudes e as práticas de mulheres usuárias de Unidades Básicas de Saúde sobre o dispositivo intrauterino. Método: Estudo quantitativo transversal, em que amostra probabilística de 1.026 mulheres, de 18 a 49 anos de idade, usuárias de 38 Unidades Básicas de Saúde da cidade de São Paulo, foi entrevistada por meio de um instrumento estruturado. O nível de conhecimento sobre o método foi analisado por meio de uma escala composta por sete itens, preparada por meio Teoria de Resposta ao Item e análise fatorial. As atitudes foram analisadas em função das razões relatadas pelas mulheres para usar/não usar o DIU. As práticas foram analisadas considerando o uso anterior e o uso atual. Modelos de regressão logística múltipla foram conduzidos para identificar as características sociodemográficas e da história reprodutiva associadas ao conhecimento, uso e desejo de usar o dispositivo intrauterino. Resultados: Apenas 4,5% das mulheres alcançaram o escore máximo da escala do nível de conhecimento, ao passo que 13,1% obtiveram escore zero. As mulheres mais escolarizadas, de grupo socioeconômico mais elevado, que possuíam mais de um filho e que usavam ou já haviam usado o dispositivo intrauterino mostraram maior nível de conhecimento. A maioria das entrevistadas referiu não ter o desejo de usar o dispositivo intrauterino no futuro, principalmente porque estavam satisfeitas com o método em uso e por conta dos efeitos colaterais, tal e qual mulheres que nunca usaram o método. Aquelas que usavam, que já haviam usado e que gostariam de usar o dispositivo intrauterino apresentaram maior nível de conhecimento sobre o mesmo. Conclusão: O nível de conhecimento sobre o dispositivo intrauterino é baixo e influencia as atitudes e as práticas das mulheres. Aparentemente, conhecimento, atitudes e práticas sobre o dispositivo uterino são interconectados. / Introduction: In Brazil, the use of contraceptive methods is focused on the oral pill, tubal ligation and male condom. Different from the international context, long-term reversible contraceptive methods, such as the intrauterine device, are rarely used. According to the literature, there are several reasons for this underutilization, among them, stands out the lack of women´s knowledge, which in turn promotes negative attitudes and misconceptions about the method and, consequently, makes the choose to use it more difficult. Objective: To analyze the knowledge, attitudes and practices of women users of primary health care facilities about the intrauterine device. Method: A cross-sectional quantitative study was conducted among a probability sample of 1,026 women aged 1849, who were users of 38 primary health care facilities of Sao Paulo City. All participants were interviewed through a structured instrument. The level of knowledge about the method was analyzed through a seven-item scale, developed through Item Response Theory and factorial analysis. The attitudes were analyzed according to the reasons reported by the women to use/not to use the intrauterine device. The practices were analyzed considering the previous use and the current use. Multiple logistic regression models were conducted to identify sociodemographic and reproductive history characteristics associated with the knowledge, use, and desire to use the intrauterine device. Results: Only 4,5% of the women achieved the maximum score on the knowledge level scale, while 13,1% scored zero. Women with more educational level, belonging to higher socioeconomic group, who had more than one child, and who used or had already used the intrauterine device showed a higher level of knowledge. Most of the interviewees reported not having the desire to use the IUD in the future, mainly because they were satisfied with the contraceptive method in use and because of the side effects; similar to women who never used the method. Those who used, who had already used and would like to use the intrauterine device had a higher level of knowledge about it. Conclusion: The level of knowledge about the intrauterine device is low and influences women\'s attitudes and practices. Apparently, knowledge, attitudes and practices about the uterine device are interconnected.

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