NR439 Evidence-Based Practice

Introduction

The article review in this study assesses the socio demographic factors which are associated with pregnancy period. They include factors such as psychosocial factors related to stress and depression affecting the mothers at the pregnancy period. Also the article will review factors such as medical, psychiatric illness, birth outcomes and pregnancy associated factors as a measure for developing postpartum depression. The assessment of these factors will be identified and will inform good health care practice for management of depression among pregnant women in order to build effective solid based evidence. The study conducted a prospective cohort study among pregnant women and studied them in coming up with the clear medical practice informed care.

Research problem in the article

Postpartum depression is a common problem affecting women in the pregnancy stage. According to the article, reviews studies have identified that 7%-13% of women will often experience these episodes. Effects of postpartum depression have been noted to have adverse impairment later in future. Associated factors of the post partum depression include the socio demographic factors in the social life; have been identified as risk factors. Other studies have linked up the post partum depression to be associated with hormonal, environmental, emotional and genetic factors that are beyond the control of the mothers, (Gavin et al., 2005). Also post partum depression has been associated with women on the lower socioeconomic status, thus it informs on the access on economic empowerment among women playing crucial role in reducing the risks of post partum depression, (Hallowell et al., 2010).

Research design adopted

The article adopted prospective cohort design to follow the mothers who were between 4-6 months pregnant, this followed with the use of patient health questionnaires for the mothers. Inclusion criteria for the article involved two men who had at least complete one survey and six weeks follow up, the patients included were those attending the obstetric clinic. The exclusion of participants was being below the age of 15 year and inability to fill the questionnaires were the parameters used. In research, this design is an effective tool, which compares the individuals displaying certain characteristics and follow up in a longitudinal study, (Bhandari, Joenson & Stuttgart, 2009). Critical care of needs to be considered as prospective cohort studies are vulnerable selection bias and confounding factors which affect the validity of the results. Advantages associated with this study design is, it allows clarity of associated factors and assess the study exposure outcome. The disadvantage of these study design is that follow up for a long time can lead to disappearance of the subjects and this differential loss can be source of biasness,

Sample size in the study

The participants of the study were women who were receiving prenatal care. All women who were receiving obstetrical care and completing at least one survey in second and third trimester were assessed. The study recruited patience who participated at the 4 and 8 month questionnaire, while it excluded those below the age of 15 and unable to complete survey. The selected a total of 1,423 women. This group was compared with control group in the study.  However at initial stages, 3,039 women were recruited in the study and upon screening and inclusion criteria, 1, 423 were recruited in the study. The participants of this study were adequate, in that it represented a large number which could have any negative effect on the research findings. The larger size is meant to cover up for loss to follow up. Small sample sizes will not provide precise and estimate reliable answers to assess the study hypothesis, (Jones, Craley and Harrison, 2003), however large sample size also makes it hard for the study to be manageable, thus need for justification of the sample size calculation, (Livingstone & Cassidy, 2005). Hence for this article the sample size calculated is effective in achieving a higher statistical power.

Data collection methods

The article adopted usage of questionnaires for collecting data among the women. Women participated in survey as part of the recruitment criteria in the study. Patient health questionnaire was utilised in assessing the depressive symptoms during the second and third trimesters and postpartum. The health questionnaire was used for assessing the depressive symptoms of post partum depression among the women. Self reported questionnaires were used in assessing anti depressant usage. Smoking occurrence was assessed using the smoking free family’s prenatal screening tool. Further to strengthen, computerised medical records were used in getting the vital characteristics f the women like age at birth, fatal death and offspring birth weight. Ethical protocols were assessed and complied with University of Washington Human Subjects Institutional review board.  Clinical staff assisted in the collection of data among the participants.

Limitations of the study

The geographical location of the participants lacked the use of structured psychiatric interviews for diagnoses of the depression and assessment of history of previous episodes and not assessing the BMI, Body Mass Index. In trying to adjust to this limitation, it used a validated patient health questionnaire. Expression of research limitations is important in giving more validity on the results of the study and asses the research process effectively. To overcome this study limitation there is need to have an effective tool that captures previous history of the patients.

Study results

The study assessed the women in the postpartum phase with prior 4-8 months Assesment for socio demographic factors. The prospective study compared the two women categories in the study especially those with significant postpartum depressions with those displaying the symptoms were significantly younger with a P<0.0001. Those showing the likelihood of being employed had a P value of 0.04, having pregnancy associated depressive conditions had P<0.0001. Those having psychosocial stress were more likely to be smokers at p<0.0001 and were highly likely to take antidepressants drugs and showed low likelihood of taking alcohol and more likely to have pregnancy related medication which include diabetes with p value of 0.002 and neurological disorders at p=0.02. The study findings are credible due to an effective data collection tolls used and employed in the study. With the large sample size utilised, it enhances on the reliability of the study findings, thus the findings support the study problem statement.

Summary

The article review has highlighted major themes in the paper with keen interest on the major sub headings like the research issue under investigation, research design sample size determination, data collection tools and the limitations of the study. The study article was assessing the role of the socio demographic health behaviours which affect women in port partum period with keen interest on birth outcomes as risk factors for postpartum disease. The study findings found out that women who faced unemployment often were associated with depressive symptom and psychological stress, and its side effects were the likelihood to engage in alcohol and smoking related behaviour and later development of medical illness like diabetes and neurology disease. With these study findings, it will inform the health care practice on the need for caring for post partum stress disorder. Thus younger age, unemployment, antenatal depressive symptoms and psychological stress were associated with development of post partum disease. Thus clinical assessment of these socio demographic factors will be crucial factors in clinical management of post partum depression among women.

References

Bhandari M, Joensson A. Stuttgart: Thieme Medical Publishers; 2009. The Prospective Cohort Study.Clinical Research for Surgeons

Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106(5):1071–1083

Hallowell N, Cooke S, Crawford G, Lucassen A, Parker M, Snowdon C (2010) An investigation of patients’ motivations for their participation in genetics-related research. J Med Ethics 36:37–45.

Jones, S., Carley, S., & Harrison, M. (2003). An introduction to power and sample size estimation. Emergency medicine journal: EMJ, 20(5), 453.

Livingston, E. H., & Cassidy, L. (2005). Statistical power and estimation of the number of required subjects for a study based on the t-test: a surgeon’s primer. Journal of Surgical Research, 126(2), 149-159.