By: Autumn Triêu & Nai-Fen Su

POSTPARTUM DEPRESSION

During Pregnancy

•Women that show anxiety and mood symptoms during their pregnancy are at increased risk for the “baby blues,” which can turn into postpartum if lingers.•“baby blues,” affect 70% of women for a shorter time period after labor.•Do not impair functioning

What is Postpartum Depression?

•Postpartum depression happens after a female gives birth or up to a year after•Most of the time three months after delivery •Postpartum depression is moderate to severe depression in a woman after she has given birth•about 85% of women experience a type of mood disturbance•but only 10-15% develop significant symptoms.

but rather a type of mood disorder categorized by a major depressive episode.

THE DSM DOES NOT CONSIDER POSTPARTUM DEPRESSION A SEPARATE DISORDER,

Postpartum depression can accompany mood disorder criteria like,

Major depressive disorder, bi-polar I/II, and psychotic disorder

Symptoms of Postpartum

•Like most other diagnoses it has to interfere with daily functioning•Fluctuation in mood, mood lability, and preoccupation with infant well-being. •Ranges from over concern to frank delusion•The presence of severe ruminations or delusional thoughts about the infant is associated with a significantly increased risk of harm to the infant. •Women often have severe anxiety and panic attacks

Symptoms cont…

•Agitation •Changes in appetite •Feelings of worthlessness or guilt•Feeling withdrawn or unconnected •Lack of pleasure or interest in most or all activities •Loss of concentration •Loss of energy•Problems staying on task•Thoughts of death or suicide •Trouble sleeping

Extreme Cases of Postpartum•http://www.kdvr.com/news/kdvr-mother-arrest-death-infant,0,4178508.story•Psychotic episodes are characterized by command hallucination to kill the infant or delusions that the infant is possessed•Women with a history of mood disorders especially Bi-Polar 1 disorder have increased chance•30-50% of women have a chance of reoccurrence with another birth •Even if a woman does not have a mood disorder, family linkage with a mood disorder can result in PPD

Causes

•Neurotransmitters associated with depression • Interleukin-1 Beta entering bloodstream •Monoamine oxides' are too high •Fluctuating hormone levels

•Socio-economic status•How can I afford a baby?•Financial support •Cultural differences• In Asian cultures women are expected to stay home for 2 months nurturing the baby

BiologicalSocial Constructs and Contextual Factors

First time Fathers• Life style change • Role with partner and child• Sharing attention can lead to D&A use, social behavior and increased risk taking, and sexually deviant behavior • Stress at work (working longer hours) b/c wife is on maternity leave

• Feeling physically separated• Emotional attachment during and after pregnancy • Planned or unplanned pregnancy• 10% of American fathers had symptoms of depression

• Scarton, 2008

Affect on Child• It is suggested that child’s social and learning ability and cognition will be affected•Fathers with depression is thought to increase the likelihood that his children will act out or behave destructively•Mothers with depression is associated with decreased overall health and learning problems with a greater risk of depression

Edinbrough Postnatal Depression Scale •10- item questionnaire that may be used to identify women who have PPD•A score of 12 or greater or an affirmative answer on question 10 (suicidal ideation) raise concern and indicate a need for more through evaluation

Treatments •Cognitive- Behavorial Therapy• Interpersonal Therapies •Electroconvulsive Therapy (Severe cases)•Anti-Depressants and other Mood regulators •Some women refuse to use pharmacological interventions because of breast feeding

Recommendations •Clinical evaluation for postpartum mood and anxiety disorders•Medication management •Consultation regarding breastfeeding and psychotropic medication •Recommendations using non- pharmacological treatments •Referral to support services within the community.

References• Chin, R., Daiches, A., & Hall, P. (2011). A qualitative exploration of first-time fathers'

experiences of becoming a father. Community Practitioner, 84(7), 19-19-23. Retrieved fromhttp://search.proquest.com/docview/875531139?accountid=13158

• Whisman, M. A., Davila, J., & Goodman, S. H. (2011). Relationship adjustment, depression, and anxiety during pregnancy and the postpartum period. Journal of Family Psychology, 25(3), 375-375-383. doi:10.1037/a0023790

• Cramp, A. G., & Bray, S. R. (2011). Understanding Exercise Self-Efficacy and Barriers to Leisure-Time Physical Activity Among Postnatal Women. Maternal and Child Health Journal, 15(5), 642-651. doi:10.1007/s10995-010-0617-4

• Dana Scarton. (2008, May 21). Postpartum Depression Strikes New Fathers, Too. US News and World Report. Retrieved July 27, 2011, fromhttp://health.usnews.com/health-news/family-health/sexual-and-reproductive-health/articles/2008/05/21/postpartum-depression-strikes-new-fathers-too

• David B. Merrill, & David Zieve. (2010, September 4). Postpartum depression.. Text, . Retrieved July 27, 2011, fromhttp://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004481/

• Davidson, J., Zhang, W., Connor, K., Ji, J., Jobson, K., Lecrubier, Y., McFarlane, A., et al. (2010). Review: A psychopharmacological treatment algorithm for generalised anxiety disorder (GAD). Journal of Psychopharmacology, 24(1), 3 -26. doi:10.1177/0269881108096505

• MGH Center for Women’s Mental Health. (n.d.). Postpartum Psychiatric Disorders. Retrieved July 27, 2011, fromhttp://www.womensmentalhealth.org/specialty-clinics/postpartum-psychiatric-disorders/

• Rees, B. L. (1995). Effect of Relaxation with Guided Imagery on Anxiety, Depression, and Self-Esteem in Primiparas. Journal of Holistic Nursing, 13(3), 255 -267. doi:10.1177/089801019501300307

• Sumner, L. A., Wong, L., Schetter, C. D., Myers, H. F., & Rodriguez, M. (2011). Predictors of posttraumatic stress disorder symptoms among low-income Latinas during pregnancy and postpartum. doi:10.1037/a0023538

• Whisman, Mark A, Davila, Joanne, & Goodman, Sherryl H. (2011). Relationship adjustment, depression, and anxiety during pregnancy and the postpartum period. Journal of Family Psychology, 25(3), 375-383.