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Postnatal depression poster @00369683

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Postnatal depression poster @00369683

  1. 1. Postnatal depression (PND) is a type of depression some women experience after having a baby. Becoming a mother impacts a woman physically, socially, economically and emotionally. The ways in which motherhood affects a woman ultimately affects the lives of her baby, the baby’s father, her family and friends. When a woman fails to adapt to the role of mothering an infant, she is identified as having PND (Nicolson, 2001). The postnatal period is a time when joy is the expectation and so women are reluctant to admit to mood symptoms because they feel embarrassed, stigmatised or may worry about the child being taken into care (Boots Family Trust, 2013). Overview of PND Causes Effects Symptoms can start soon after giving birth and last for months or, in severe cases, they can persist for more than a year. Symptoms include: • A persistent feeling of sadness and low mood • Feelings of hopelessness • Feelings of guilt • Low self-confidence • Anxiety • Insomnia • Thoughts of self harm or suicide (Kendall-Tackett & Kantor, 1993; NHS, 2015). Mothers may be reluctant to address these issues on their own so the Edinburgh Postnatal Depression Scale (EPDS; Cox, Holden & Sagovsky, 1987) is a useful tool in revealing depression. Symptoms PND is caused by a combination of physiological, psychological and social factors. Physiological factors: women undergo changes in hormonal levels in the postnatal period. Depression is likely to occur if oestrogen and progesterone levels are low and there is a large drop in these after a woman has given birth Psychological factors: a woman’s expectations of motherhood; her self-esteem; and prior vulnerability factors such as having a dysfunctional family history. Social factors: amount of help the mother has with the baby; amount of emotional support she receives; demographic characteristics; and her exposure to stressful life events (Kendall-Tackett & Kantor, 1993). For mothers, effects of PND can include failure to bond with their baby, a broken relationship with the father and suicide attempts (Cantwell, Clutton- Brock, Cooper et al., 2011). Effects can also include reduced maternal caregiving activities (e.g., breastfeeding, sleep routines vaccinations), maladaptive parenting behaviour, and behavioural problems and cognitive and linguistic delays in children (Field, 2010; Grace, Evindar, & Stewart, 2003; Reck et al., 2004). Types of treatment available to PND sufferers Postnatal Depression: considering the types of treatment available • Directive therapy – cognitive-behavioural therapy (CBT) and cognitive-analytic therapy (CAT) These therapies focus on ‘cognitions’ and changing the way a person thinks about themself and the world around them. Research identifies resolving past difficulties can resolve PND (Nicholson 1999; Mauthner 2002). Nicolson (1999) suggested women gained strength when past difficulties were managed successfully. Mauthner (2002) stated women who resolved past issues and conflicts were more satisfied with their role as mothers. • Non-directive counselling – person-centered counselling This type of counseling, introduced by Carl Rogers, does not offer direct advice, but rather allows the patient to hear themselves discuss their own options out loud to come to a decision. Glavin, Smith, Sørum & Ellefsen (2010) examined the effect of supportive counselling by public health nurses on PND and suggested the non-directive counselling method is an effective treatment method. • Routine primary care – visits from health nurses Health nurses visiting the mother know her health history and are her best resource for making sure she gets the right care. Wickberg & Hwang (1996) study on the effectiveness of counselling on Swedish women with PND found 80% of women with depression in the study group fully recovered after counselling compared to 25% of women in the control group who did not receive counselling. They suggested counselling by health nurses is helpful in managing postnatal depression. However, Cooper, Murray, Wilson & Romaniuk (2003) compared different psychotherapeutic approaches for PND and found little benefit at nine months after birth. In the study, 93 women with PND were randomised to CBT, non-directive counselling, routine primary care or psychodynamic therapy. Only the psychodynamic therapy produced significant reduction in depression in comparison to the control group at 4.5 months, and by nine months none of the treatments seemed superior to the control group. The study highlights the importance of further research comparing alternative treatment approaches for PND. • Complementary therapies – aromatherapy and exercise Perrya, Thurstona & Osbornb’s (2008) study on the arts as therapy in PND found some women become and remained more confident, but many expressed that after therapy had ended they returned to their low feelings. Thus longer-term support is needed. • Antidepressants – pills Antidepressants balance mood-altering chemicals in the brain, reducing symptoms and allowing normal functioning. Appleby, Warner, Whitton & Faragher (1997) evaluated the pharmacological treatment of PND. The study compared four treatment groups: fluoxetine plus a single session of CBT; placebo plus a single session of CBT; fluoxetine plus six sessions of CBT; and placebo plus six sessions of CBT. After four weeks of treatment, similar improvements occurred among women receiving either six sessions of CBT, or fluoxetine plus one session of CBT. The study shows women's choice of treatment may be guided by their preference of pharmacological or non-pharmacological approaches as both seem effective. However, fluoxetine has been linked with irritability, sleep disturbance, and poor feeding in some infants exposed to it in breast milk. Although the data regarding antidepressants during breast feeding are generally favourable, little is known about the long term effects of exposure to antidepressants on the child's developing brain. Many new mothers remain reluctant to take such medications while nursing (Burt, Suri, Altshuler, Stowe, Hendrick & Muntean, 2001).
  2. 2. References Appleby, L., Warner, R., Whitton, A. & Faragher, B. (1997). A controlled study of fluoxetine and cognitive-behavioural counseling in the treatment of postnatal depression. BMJ, 314, 932–936. Boots Family Trust. (2013). Perinatal mental health experiences of women and health professionals. Retrieved from http://www.tommys.org/file/Perinatal_Mental_Health_2013.pdf Burt, V, K., Suri, R., Altshuler, L, L., Stowe, Z, N., Hendrick, V. & Muntean, E. (2001). The use of psychotropic medications during breast-feeding. Am J Psychiatry, 158, 1001–1009. Cantwell, R., Clutton-Brock, T., Cooper, G. et al. (2011). Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. An international journal of obstetrics and gynaecology. 118(Suppl 1), 1-203. Cooper, P. J., Murray, L., Wilson, A. & Romaniuk, H. (2003). Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression. 1. Impact on maternal mood. The British Journal of Psychiatry, 182(5), 412-419. Cox, J. L., Holden, J. M. & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786. Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: A review. Infant Behavior & Development, 33(1), 1–6. Glavin K., Smith L., Sørum R. & Ellefsen B. (2010) Supportive counselling by public health nurses for women with postpartum depression. Journal of Advanced Nursing 66(6), 1317–1327. Grace, S. L., Evindar, A. & Stewart, D. E. (2003). The effect of postpartum depression on child cognitive development and behavior: A review and critical analysis of the literature. Archives of Women’s Mental Health, 6, 263–274. Jones, I. & Shakespeare, J. (2014). Postnatal depression. BMJ (Clinical research ed.). 349, 4500. Kendall-Tackett, K. A. & Kantor, G. (1993). Postpartum Depression. A Comprehensive Approach for Nurses. Newbury Park; London; New Delhi: Sage. p15-60. Mauthner, N. S. (2002). The darkest days of my life. Stories of postpartum depression. Cambridge: Harvard University Press. Nicolson, P. (1999). Loss, happiness and postpartum depression: The ultimate paradox. Canadian Psychology, 40(2), 162-178. Nicolson, P. (2001). Postnatal depression facing the paradox of loss, happiness and motherhood. New York: Wiley. NHS UK. (2015). Postnatal depression. Retrieved 22nd February, 2015 from http://www.nhs.uk/Conditions/Postnataldepression/Pages/Symptoms.aspx Perry, C., Thurston, M. & Osborn, T. (2008). Time for Me: The arts as therapy in postnatal depression. Complementary Therapies in Clinical Practice, 14(1), 38-45. Powell, S. (2013). A Mother’s Anonymous Confessions: Post Partum Depression. Retrieved from http://mommynoire.com/6048/a-mothers-anonymous-confessions-post-partum-depression/ Reck, C., Hunt, A., Fuchs, T., Weiss, R., Noon, A., Moehler, E. & Mundt, C. (2004). Interactive regulation of affect in postpartum depressed mothers and their infants: An overview. Psychopathology, 37, 272–280. Revolutionary Mom. (2014). Free Counseling Session For All Postpartum Depression Mothers. Retrieved from http://revolutionarymom.com/free-counseling-session-postpartum-depression-mothers/ Shaw, M. (2014). Why Postpartum Depression Is a Feminist Issue. Retrieved from http://www.huffingtonpost.com/maureen- shaw/why-postpartum-depression_b_5980276.html?utm_hp_ref=postpartum-depression Wickberg, B,. & Hwang, P. (1996). Counselling of postnatal depression: a controlled study on a population based Swedish sample. Journal of Affective Disorders, 39, 209-216.

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