NR439 Evidence Based Practice

Answer

Predictors of Postpartum Depression

Introduction

Post-partum depression (PPD) occurs in 7% to 13% of postnatal mothers, which occurs between the first day of delivery and the 6^th week.  Women go through periods of mind disturbance, thought disorder, worrying too much about the newborn, troubled sleep sessions and loss of appetite and severe stomach cramps.  These may result in the limited mother to baby bonding, and moments of depression as well as malfunctioning of minds in future. It is also known to be a primary reason for the slow development of babies commonly referred to as milestone delays and disorders during adolescence. The purpose of this paper is to analyze various risk factors associated with PPD and finding solutions to these problems (Dennis & Hodnett, 2007). These include; periods of anxiety and depression while pregnant and in mother’s history, stress passed through in the past and reduced social support. Complications associated with labor including immature labor and preeclampsia appears to be significant but take little part in PPD (Verreault et al., 2015).

Research question

The primary research question emerging from this article is; what are the main precursors of PPD and how can they be eliminated? Basing the research on this issue on a broader perspective, the view of risk factors associated with the growth and development of infants born to mothers who suffered PPD can be analyzed. Also, it is less difficult to come up with a percentage, or a rough estimate of the number of mothers suffering from PPD according to Patient Health Questionaire-9 (PHQ-9) is possible. These questions tend to be the blueprint of this study and helps in coming up with a clear view of the condition of PPD.

Research Design

Depressive symptoms have been analyzed in a model of Patient Health Questionaire-9 (PHQ-9) done in second, and third trimesters and also during postpartum periods. The respondents had to be above fifteen years and above of age in childbirth, mentally fit and ability to understand the language being used. The independent variable is taken to be PHQ-9 series severity measure. Average PHQ-9 obtained after attempting the questionnaire have been used, and the value ‡ ten have been adopted to measure the primary symptom of PPD. This value has been found in gynecologists together with the obstetrics patients hence have the largest sensitivity of 73% and 98% specificity as compared to systematic psychiatrist interview.

Sample size

The analysis of data was done, where total (N) was 3,039. The information from 1423 women was tested and a comparison done with the excluded data from 1616 mothers who missed some valuable data. T-test and the Fischer Exact test were carried out. The baseline variables included medical condition, health risks, demographics, variation in pregnancies, and depression. The results of mothers with PPD and those without were analyzed. The large sample size used gave this research article some strength, although was wanting because more data was excluded than the regarded by basing on the fact that there was missing information in the questionnaires.

Method

Those who have been taken into consideration are women receiving antenatal care in the obstetrics and gynecology clinic at the University of Washington hospital in the period of January 2004 and June 2011. Questionnaires were centered on the patient’s mood, socio-demographic, health, and the behavior of mothers with PPD. Mothers who were eligible for the participation were those in second and third trimesters and those at six weeks of postnatal care (McLearn et al., 2006). The challenge experienced is that mothers at second trimester had to fill one questionnaire, those at third filled two while the ones at the six weeks postpartum took three questionnaires, hence uneven participation. The choice of this method was based on the fact that the people responsible for the patients screening with the research queries were the clinical attendants and when complete, they got the informed consent which was written to bridge the health and research made.

Findings

Due to various reasons, 1,515 mothers were not included in the research, and this gave 1,423 as research sample.  The p-value obtained in different groups not covered in the study sample was <0.001, including in younger women who were not given a chance to participate, those likely lacking college education, likely single mothers, African Americans, and lastly unemployed. P<0.003 were women who appeared to be slightly depressed while baby death was reported to be in the probability of 0.01. Women who were somewhat capable of having GDM gave p<0.006 and for preeclampsia is p<0.02. The latter were not included in the analysis. In the analysis, the following factors such as socio-demographic factors including mother’s age, education background, race, marriage status, and employment were considered. Also, medical conditions such as diabetes, heart and neurological diseases, hypertension, and gastrointestinal infections were also taken into consideration. Behaviors of a mother during pregnancy is also identified, an example being domestic violence, smoking, use of antidepressant, alcoholism, and stress moments (Berger et al., 2015). The results were valid and credible where only four variables were non-significant which included alcoholism during pregnancy (p=0.18), neurological conditions (p=0.31), non-employed (p=0.37), and lastly asthma with a probability of 0.41. All the other variables were similar and gave a significant result (Katon & Gavin, 2014).

Limitations of the study

The study concentrated in one large clinic within the University of Washington, particularly in one geographical location in the US. This could have brought about the similarity in the data obtained. Also, the research did not have structured interviews by the psychiatrist to identify previous periods of depressions. On the contrary, the study was conducted by considering the body mass index (BMI) and socio-demographic status. And finally, although the use of PHQ-9 is widely embraced, it gave a slightly lower rate of basing the risks leading to PPD (6.7% during pregnancy and 5.8% postpartum periods) as compared to other surveys which have been carried out (Katon & Gavin, 2014).

References

Berger, E., Wu, A., Smulian, E. A., Quiñones, J. N., Curet, S., Marraccini, R. L., & Smulian, J. C. (2015). Universal versus risk factor-targeted early inpatient postpartum depression screening. The Journal of Maternal-Fetal & Neonatal Medicine, 28(7), 739-744.

Dennis, C. L., & Hodnett, E. D. (2007). Psychosocial and psychological interventions for treating postpartum depression. The Cochrane Library.

Karraa, W. Postpartum Psychosis: Review and Resources Plus Additional PPMAD Resources.

Katon, W., Russo, J., & Gavin, A. (2014). Predictors of postpartum depression. Journal of women’s health, 23(9), 753-759.

McLearn, K. T., Minkovitz, C. S., Strobino, D. M., Marks, E., & Hou, W. (2006). Maternal depressive symptoms at 2 to 4 months post partum and early parenting practices. Archives of pediatrics & adolescent medicine, 160(3), 279-284.

Verreault, N., Da Costa, D., Marchand, A., Ireland, K., Dritsa, M., & Khalifé, S. (2014). Rates and risk factors associated with depressive symptoms during pregnancy and with postpartum onset. Journal of psychosomatic obstetrics & gynecology, 35(3), 84-91.