Postpartum Depression Screening of Women Veterans in Alaska Quality Improvement Project

A Project Submitted in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCE in Nursing SciencePostpartum depression screening guidelines were updated by the American College of Obstetricians and Gynecologists and the United States Preventive Services Task Force in 2015 and 2016, respectively. Universal postpartum depression screening is recommended where previously it was not. Postpartum depression screening is relevant to the rapidly growing population of women Veterans served by the Veterans Health Administration (VA) as part of their comprehensive health care benefits. Little information was available on the postpartum depression screening practices within the Alaska VA Healthcare System. Using a quality improvement methodology, the author identified postpartum depression screening as a topic of interest. Current practice was assessed through a retrospective chart audit of all maternity consults placed during the fiscal year 2014. The chart audit revealed an 81% postpartum depression screening rate. Incomplete data limited a full statistical analysis; however, all women who returned to an Alaska VA clinic, received screening and treatment. An informational brochure was developed for women and their health care providers highlighting postpartum depression screening and treatment resources.Title Page / Abstract / Table of Contents / List of Tables / List of Appendices / Introduction / Purpose / Literature Review / Implications for Nursing Practice / Methods / Results / Discussion / Conclusion / References / Appendice

Heterogeneity of postpartum depression: a latent class analysis

Background—Maternal depression in the postpartum period confers substantial morbidity and mortality, but the definition of postpartum depression remains controversial. We investigated the heterogeneity of symptoms with the aim of identifying clinical subtypes of postpartum depression. Methods—Data were aggregated from the international perinatal psychiatry consortium Postpartum Depression: Action Towards Causes and Treatment, which represents 19 institutions in seven countries. 17 912 unique subject records with phenotypic data were submitted. We applied latent class analyses in a two-tiered approach to assess the validity of empirically defined subtypes of postpartum depression. Tier one assessed heterogeneity in women with complete data on the Edinburgh postnatal depression scale (EPDS) and tier two in those with postpartum depression case status. Findings—6556 individuals were assessed in tier one and 4245 in tier two. A final model with three latent classes was optimum for both tiers. The most striking characteristics associated with postpartum depression were severity, timing of onset, comorbid anxiety, and suicidal ideation. Women in class 1 had the least severe symptoms (mean EPDS score 10·5), followed by those in class 2 (mean EPDS score 14·8) and those in class 3 (mean EPDS score 20·1). The most severe symptoms of postpartum depression were significantly associated with poor mood (mean EPDS score 20·1), increased anxiety, onset of symptoms during pregnancy, obstetric complications, and suicidal ideation. In class 2, most women (62%) reported symptom onset within 4 weeks postpartum and had more pregnancy complications than in other two classes (69% vs 67% in class 1 and 29% in class 3). Interpretation—PPD seems to have several distinct phenotypes. Further assessment of PPD heterogeneity to identify more precise phenotypes will be important for future biological and genetic investigations

Improving Postpartum Depression Literacy: A Quality Improvement Initiative

Background: Postpartum depression (PPD) is associated with increased healthcare costs, decreased levels of productivity, and negative patient outcomes, collectively affecting babies, women, and society. Women are at an increased risk for mortality and morbidity if postpartum depression is left untreated. Postpartum depression literacy improves patient outcomes. Problem: Women may fail to effectively recognize the signs and symptoms of postpartum depression, due to inadequate postpartum education and lower health literacy levels. Methods: A formalized postpartum depression education program was implemented online to mothers attending a postpartum adjustment support group in the spring of 2022 and compared to usual postpartum depression education. A structured or formalized postpartum depression education program consists of the implementation of a premeditated plan, in which the topics of postpartum depression, self-care, and social support are discussed in an effective and timely manner. Intervention: Three PPD education sessions were presented by the project leader and were repeated once, in which participants needed to attend three out of the six sessions. Results: After completion of educational sessions, there was a statistically significant difference in pre-and and post-test postpartum depression literacy scores (Mdn=150 vs. 126, respectively, p= .018). Conclusion: This project resulted in an increase in postpartum depression literacy scores, which reinforces the recommendation for the implementation of a formalized postpartum depression education program

How Breastfeeding Affects Postpartum Depression

According to the 2008 CDC report, nearly one out of every eight women are affected by postpartum depression at one point or another in their lives. The purpose of my research was to study the potential effects of breastfeeding on postpartum depression. The objective was to study how breastfeeding affects the occurrence of postpartum depression in mothers in the United States. To understand the relationship between postpartum depression and breastfeeding, I read science journal articles describing the biological background behind breastfeeding and postpartum depression. I read psychology and biology journal articles dealing with possible forms of treatment for postpartum depression and how they may be affected by breastfeeding. Also, I read science journal articles dealing with the cause and effect relationship between the two. From my research, I came to multiple conclusions. First, breastfeeding does help to prevent and reduce the occurrence of postpartum depression. Although this is true, the cause and effect relationship between postpartum depression and breastfeeding depends on the situation. For example, for some individuals, lack of breastfeeding may cause the occurrence of postpartum depression. In other cases postpartum depression may cause the early cessation of breastfeeding. There is no definitive answer. After gathering all my research, there is still much research that needs to be conducted in this field.https://scholarscompass.vcu.edu/uresposters/1156/thumbnail.jp

Systematic Review: The Relationship of Spouses’ Support and Postpartum Depression

Postpartum depression is a mental health problem experienced by mothers at 4 weeks after giving birth which is characterized by feelings of sadness, decreased mood, feelings of failure or guilt, and even suicidal ideation, one of which is due to lack of husband support. To analyze the incidence of postpartum depression, the provision of husband support, and the relationship between providing husband support to the incidence of postpartum depression. This study used a systematic review design by tracing journal articles through the database like as Proquest, Garuda Portal, PubMed, and Science Direct with the publication year from January 2012 - January 2022 and discussing husband support and the incidence of postpartum depression, and using Indonesian and English. The keywords used in national journal were "husband's support" and "postpartum depression" or "postpartum depression", for international journal articles used "spousal support" or "partner support" or "husband's support" and "postpartum depression. The results showed that 10 journal articles met the inclusion criteria with all journal articles stating that there was a relationship between husband support and the incidence of postpartum depression. Most postpartum mothers do not experience postpartum depression and receive husband's support. There was a relationship between providing husband's support and the incidence of postpartum depression, where the higher the husband's support, the lower postpartum depression that occurs in postpartum mothers. The results of the study found 10 journal articles that met the inclusion criteria with all journal articles stating that there was a relationship between the provision of husband support and the incidence of postpartum depression

Postpartum depression: Prevention and multimodal therapy

A woman goes through many biological (hormonal, physical), psychological (emotional), and socio-cultural changes during pregnancy. Furthermore, changes also occur in the mother\u27s familial and interpersonal world after childbirth. While some mothers have positive emotions at birth, such as joy and pleasure, others complain of negative experiences varying from sadness and depression to psychosis. Thus, the risk of depression is higher for women during the postpartum period, having a tendency to decrease in most cases over the first 2 weeks after delivery. Unfortunately, this favorable evolution does not happen in about 1 in 4-7 women, who develops postpartum depression. Postpartum depression has generally the same features as any common depressive episode encountered at any other time in life. However, assessment of depressive symptoms in the parental period implies not only general tools (such as the Depression Scale of the Center for Epidemiological Studies or the Beck Depression Inventory), but also a specific evaluation using the Edinburgh Postnatal Depression Scale. Taking into account all changes that occur during the peripartum period, a multimodal approach for postpartum depression would be recommended, including an appropriate lifestyle (walks, ambient environments), counseling, cognitive-behavioral therapy, and finally antidepressant medication when required. As a conclusion, postpartum depression may range from a mild and reversible episode to a severe and persistent form. Antepartum and postpartum screening, an early diagnosis, and a tailored approach to depression are essential for better results and prognosis related to both mother and child

Pediatric Primary Care Providers and Postpartum Depression: Educating Providers About the Importance of Regular Screening, Referrals and Follow-up

Postpartum depression affects approximately 10-20% of women in the first year after giving birth. Postpartum depression can be difficult to assess, as many symptoms mimic that of “normal” postpartum activity, including insomnia, changes in appetite and anxiety. Lack of education about postpartum depression, or fear of discussing these concerns with their providers, can cause postpartum depression to go undiagnosed and untreated. Additionally, women who are diagnosed with some level of postpartum depression may not ever receive treatment for it. Undiagnosed and untreated postpartum depression can have serious health implications for mothers and their babies, causing permanent effects on child developmental. Pediatric primary care providers have the most access to new mothers after delivery, and are in a unique position to educate about and screen for postpartum depression during the numerous newborn/infant well exams; they are also capable of facilitating any necessary care for mothers who screen positive via referrals and following up, which is crucial for improving outcomes. Not all pediatric primary care providers screen for post postpartum depression; some screen but do not refer or assist with follow up, for reasons that include lack of education and lack of awareness. This quality improvement project aimed to educate pediatric providers about the importance of screening regularly and how to facilitate follow-up care for those who screen positive for postpartum depression. Outcomes, as measured by self-report Likert survey showed that 88% of participants reported more awareness of available resources for women with postpartum depression and 44% reported improved sense of responsibility for screening for postpartum depression in the pediatric setting

The functions of postpartum depression

Evolutionary approaches to parental care suggest that parents will not automatically invest in all offspring, and should reduce or eliminate investment in their children if the costs outweigh the benefits. Lack of paternal or social support will increase the costs born by mothers, whereas infant health problems will reduce the evolutionary benefits to be gained. Numerous studies support the correlation between postpartum depression (PPD) and lack of social support or indicators of possible infant health and development problems. PPD may be an adaptation that informs mothers that they are suffering or have suffered a fitness cost, that motivates them to reduce or eliminate investment in offspring under certain circumstances, and that may help them negotiate greater levels of investment from others. PPD also appears to be a good model for depression in general

Screening of Postpartum Depression Among Chinese Immigrants

Postpartum depression among the Chinese population in the United States has been understudied even though the Chinese community continues to rapidly increase in numbers. The purpose of this study is to investigate the prevalence of postpartum depression among Chinese immigrants using the Edinburgh Postnatal Depression Scale, a self-report questionnaire. This study also reports demographics obtained from participants and explores the practice of zuo ye zi among Chinese immigrants. In the spring of 2005, twenty-eight postpartum Chinese women, all first generation immigrants, were asked to participate in this study during home visits conducted by public health nurses in Alameda County, CA. The overall prevalence of postpartum depression in the study was found to be 14.3%, with 10.7% showing signs of mild depression, and 3.6% showing signs of severe depression. All of the depressed subjects refused referral to a mental health specialist. Instead, they preferred to continue to discuss issues with social workers at the clinic where they had previously established relationships. The majority (96%) of the subjects practiced zuo ye zi, a common postpartum custom in the Chinese community, and 39% of the subjects were helped by their husbands. The majority of the subjects (89%) qualified for MediCal. Lack of social support and low socioeconomic status may be contributing factors in postpartum depression among Chinese immigrants. The self-administered depression tool used in this study was found to be helpful in getting Chinese women to express symptoms related to depression, and was thus useful in screening mental health problems