Management Of Postpartum Depression Research Articles

Best Practice Guidelines for the Nurse Practitioner Regarding Screening, Prevention, and Management of Postpartum Depression

The purpose of this study was to design a means to educate the registered nurse or nurse practitioner on epidemiology, signs and symptoms, risk factors, screening tools, management, and complications that can occur with delayed diagnosis of postpartum depression. A decision tree was also developed to help the registered nurse or nurse practitioner understand the best clinical practice guidelines regarding the best screening tool to use, when the tool should be used, and management of patients identified with postpartum depression. Best practice guidelines were developed from the literature review.

Postpartum depression: an original survey of screening practices within a healthcare system

Objective. This study evaluated the strategies for postpartum depression (PPD) screening by surveying healthcare providers at a US academic medical centre.Methods. A 10-question survey was administered to 251 Obstetrics/Gynaecology, Paediatrics, and Family Practice physicians, nurses and other healthcare professionals in April–June 2007. It explored PPD screening methods and familiarity with selected screening instruments (EPDS, PDSS and PHQ-9). Familiarity scores were assigned based on Likert scale ratings, from 1 (not familiar at all) to 5 (using it all the time). Score mean values and standard deviations were calculated for each screening tool, overall and across specialty and training status. Pearson chi-square analyses with discrete and categorical variables and ANOVA with continuous variables were conducted, followed by Tukey post hoc analyses to identify significant mean differences.Results. There were 131 completed surveys. Respondents were largely unfamiliar with PPD screening instruments, although Ob/Gyn providers were significantly more aware of each tool than were Paediatrics members. Preferred screening methods were symptom review (83%) and physical examination/observation (65%). Sixty-three per cent of respondents used multiple methods. Timing of screening varied across specialties. Paediatric providers screened earliest (0–4 weeks) of all respondents.Conclusions. Healthcare providers typically screened for PPD using a combination of clinical methods and were less familiar with standardised instruments. Uniform screening protocols across specialties and targeted educational interventions are strongly recommended to promote better detection and collaborative management of PPD.

Web-based Training for Implementing Evidence-Based Management of Postpartum Depression

Postpartum depression (PPD) is a significant mental health problem that is common in primary care and often under-recognized and under-treated. We developed an educational website (www.step-ppd.com) to give primary care providers easy access to up-to-date information on PPD and evidence-based approaches for assessing and treating PPD. Three web-based modules include didactic information, case studies, interactive video clips, and links to additional resources. The Support and Training to Enhance Primary Care (STEP)-PPD website is a new and valuable resource for primary care providers that can be easily accessed online and provides accurate and current information on best practices for evidence-based management of PPD in primary care settings. The STEP-PPD website is publicly available and free of charge. To register for and view the program, visit www.step-ppd.com.

Stepped Care Treatment of Postpartum Depression: A Primary Care-Based Management Model

Postpartum depression (PPD), the most prevalent serious postpartum complication, is a devastating illness that negatively impacts not only the mother, but also her infant, other family members, and work performance. There is an extensive body of research addressing systems-based quality improvement efforts for treatment of depression in primary care populations; however, little of this research has been directed toward postpartum populations. This paper presents a health care systems-based quality improvement model for the treatment of PPD derived from research outcomes in general primary care populations. OVID/MEDLINE and PsychINFO searches were performed using the following terms: depression, postpartum depression, mass screening, collaborative care, stepped care, psychotherapy, cognitive-behavioral therapy, interpersonal therapy, and education as keywords. The PPD management model described herein includes screening and diagnosis, initiation of active treatment, and use of collaborative care, which includes primary care visits, case manager follow-up, and more intensive care, through specialty consultation or referral, for complicated or difficult cases. Stepped care, a form of collaborative depression treatment, is proposed as a practical, cost-effective method for improving PPD diagnosis and clinical outcomes.

Predictors of Postpartum Fatigue Between Early and Late Postpartum Period in Parturient Women: Divided by 3/4 Weeks of Postpartum Period

Purpose: The purpose of this study was to compare the predictors between the early and late postpartum period in parturient women. Methods: The Subjects were 399 healthy postpartum women who visited the obstetric clinic at 5 hospitals for a routine check up after childbirth. They were divided into two groups: one was in the early postpartum period, the first three weeks after childbirth (n=107), the other was in the late postpartum period, four to six weeks after childbirth (n=292). The data were collected by using a self-report questionnaire from July to September, 2006. The data were analyzed with the SPSS 12.0 Win program. Results: There were significant statistical differences in age and parity between the two groups. Postpartum fatigue was significantly predicted by postpartum depression and age in the early period, and postpartum depression, sleep satisfaction, and childcare stress in the late period. The mean scores of childcare stress and perceived infant difficulty in the late period were significantly higher than those of the early postpartum period. Conclusion: Postpartum depression was the most important predictor of postpartum fatigue regardless of the postpartum period. In addition, especially in the late period, sleep satisfaction and childcare stress were significant predictors of postpartum fatigue. Based on these results, primary nursing interventions for reducing postpartum fatigue should focus on postpartum depression management, and nursing interventions for increasing sleep satisfaction and decreasing childcare stress would be helpful for management of postpartum fatigue in parturient women in the late period.

The maternity blues in Western Nigerian women: Prevalence and risk factors

The study aims to investigate the prevalence of maternity blues and examine the risk factors involved in a group of Nigerian postpartum women. Five hundred and two postpartum women who had a normal vaginal delivery in 5 health centers in Ilesa Township were assessed with the Maternity Blues Scale daily for the first 10 days' postpartum. They also filled a structured questionnaire detailing their sociodemographic and obstetric histories. The prevalence of maternity blues was 31.3%, and the symptoms peaked at the fifth day postpartum. The predictors of maternity blues include significant mood change during the pregnancy (OR 3.17, 95% CI 1.42-6.11), past admission during the pregnancy (OR 3.21, 95% CI 1.78-5.39), female baby (OR 2.82, 95% CI 1.53-4.12), and single mothers (OR 3.35, 95% CI 2.26-5.64). The prevalence and the significant risk factors for maternity blues seem to differ across culture. Obstetricians and midwives have to consider this in strategies for prevention and management of postpartum depression in new mothers in this environment.

Screening postpartum depression with the Taiwanese version of the Edinburgh Postnatal Depression Scale

This study is intended to develop the Taiwanese version of the Edinburgh Postnatal Depression Scale (EPDS-T), to evaluate its validity, and to estimate the prevalence of postpartum depressive disorders (PPD) among Taiwanese women. A prospective cohort of 203 subjects who completed the EPDS-T, the Beck Depression Inventory (BDI-II), and postpartum questionnaire at 6 weeks after giving birth were assessed with the Mini-International Neuropsychiatric Interview (MINI) and DSM-IV to establish their psychiatric diagnoses. We tested the validity of EPDS-T against the clinical diagnoses and compared its applicability with BDI-II. We found that the Taiwanese version of EPDS-T had satisfactory sensitivity and better specificity than BDI-II, that the 12/13 cutoff point was the best for screening PPD, and that 10.3% of the study population suffered from depressive disorders at 6 weeks postpartum. Based on the findings of this study, we suggest that PPD prevalence among Taiwanese women is not lower than that among most Western populations and that the validated EPDS-T can be used for early detection and management of postpartum depression in Taiwan.

Postpartum depression in a maternity hospital in Nigeria

To explore the recognition and management of postpartum depression (PPD) by the obstetric team in a maternity hospital concomitantly, was to find the rate of PPD in the centre. A descriptive cross-sectional study. Island Maternity Hospital, Lagos, Nigeria; a moderately large obstetric facility with 68 beds and 42 paediatric cots. The medical staff including doctors and nurse midwives in the study centre. Concomitantly, a sample of women that delivered in the hospital during the study period. Seventy two (65.5%) of the total 110 obstetric staff in the hospital consented to the study; made up of 10 doctors and 62 midwives of varying cadres. 43.1% of them admitted their difficulty to recognise PPD with X2 of 25.8, while 19.4% expressed doubt in the obstetric team's ability to manage PPD. 86.1% would rather refer PPD cases to the psychiatrists, but saw stigma as a militating factor. Hence 77.8% with X2 of 65.3 would want consultation-liaison psychiatric services established in the centre. Concomitantly, of the 252 women assessed with EPDS, 23% were depressed with scores >12. It is concluded that there is need to update the obstetric team's knowledge on the management of PPD through Continuous Medical Education (CME) to which 97.2% of them agreed.

Integrating Services in the Recognition and Management of Postpartum Depression

Our study, completed in 1999, linking a mother-baby unit with Maternal and Child Health Nurses (MCHNs) with education, liaison and prioritised tertiary assessment and admission is presented, and issues of service delivery and satisfaction are highlighted. Two hundred and forty three women were recruited antenatally and followed to up to nine months postpartum, 133 forming the study group and 110 the control. MCHNs in the study group were offered an intensive education package, with ongoing six weekly liaison meetings. The intervention was welcomed and feedback positive. Women in the study and control group did not differ in their levels of depression throughout the study. Differences, however, in adjustment to motherhood emerged between women in well-supported affluent areas and those in under-resourced lower socioeconomic areas. MCHNs were seen by women in all areas as the key people to turn to. Those in the lower socioeconomic areas reported greater difficulties in providing a service, and women in these areas were less likely to access services external to their region. Implications for the development of further services and the linking of these supports are discussed.

Management of post-partum depression (PPD) in a special PPD clinic

Management of post-partum depression (PPD) in a special PPD clinic