4. Depression: risk factors
• Stressful life events
• Recent death of a loved one
• Family history
• History of abuse or trauma
• Exposure to traumatic events
• Intimate partner violence
• A serious or chronic medical condition
• Alcohol or drug abuse
• Prior episodes of depression
5. Major depression: symptoms
• Depressed mood + anhedonia+ any 3 of the
following:
• Sleep disorders
• Interest deficit or lack of feeling pleasure
• Guilt
• Energy deficit
• Concentration deficit
• Appetite disorder
• Psychomotor retardation or agitation
• Suicidality
6. Dysthymia ( American Psychiatric
Association)
• Depressed mood for most of the day* 2years
• Presence of 2 or more of the symptoms listed
under major depression
• Never any mania/hypomania
10. • Change in functioning
• Not severe to cause marked impairment in social
or occupational functioning
• No psychosis
11. Screening for depression
• Patient health questionnaire-2
• Patient health questionnaire-9
• Beck depression inventory
• The centre for epidemiologic studies- depression
scale
12. Treatment
• Cognitive behavioural therapy
• Counselling
• Faith based therapy
• Group therapy
• Psychotropic medications
• Yoga and acupuncture
16. Nursing management
• Disturbed self esteem related to lack of positive
reinforcement of one’s values and worth
• Hopelessness r/t lack of energy to mobilize
resources
• Risk for fetal injury related to lack of interest in
self care
17. • Disturbed sleep pattern r/t internal stress
• Social isolation r/t inability to engage in
satisfying personal relationships
• Powerlessness related to lack of inability to exert
control
18. Mania
• Antipsychotics: EPS in neonates
• Lithium: CVS defects, neonatal cyanosis, lethargy,
flaccidity, and non toxic goiter: contraindicated for
1st 3 months
• Benzodiazepiines: oral clefts
• Carbamazepine and valproate: NTDs
• ECT: safest
27. Risks of untreated depression and
anxiety during pregnancy
• Burden of disability
• Prematurity/IUGR
• Risk for postpartum depression/ postpartum
psychosis, postpartum OCD/ suicide or
infanticide
42. Etiology
• Endocrinal changes
• Change in body image
• Activation of unconscious psychological conflicts
• Intrapsychic recognition of becoming a mother
45. Social and interpersonal factors
• Society’s attitudes
• Husband’s support
• low social class
• Unmarried status
• Early sexual and marital problems
• Previous abortions
• Unstable, unsupportive husband
51. 5 of the symptoms* 2 weeks
• Depressed mood
• Significant change in weight
• Sleep disorders
• Psychomotor agitation or retardation
• Fatigue
• Inappropriate feelings of guilt or worthlessness
• Impaired concentration
• Recurrent suicidal thoughts
52. Strong Risk factors
• Anxiety during pregnancy
• Depression during pregnancy
• Stressful life events during pregnancy
• Low level of social support; single marital status
• History of depression
• Postpartum depression after a prior pregnancy
53. Additional risk factors
• Biologic vulnerability
• Family history
• Unplanned pregnancy
• Young maternal age
• Lower socioeconomic status
• History of interpersonal violence
• Thyroid dysfunction
54. Screening for postpartum depression
• The Edinburgh postnatal depression scale
>12: require evaluation and possible referral to a
mental health specialist
10-12: presence of symptoms of distress
Repeat test in 1-2 week
Consider referral
0-9: if symptoms persist for more tha 1-2 weeks,
further evaluation
56. Early predictive signs of postnatal
depression
• No visitors, not sharing news about birth with
relatives
• Unsupportive family
• Maternal rejection or ambivalence to pregnancy,
child birth or newborn
• Aggressiveness to newborn
• Sleep disturbance or severe nightmares
• Lack of interest in newborn care
• Intense feelings of loss
• Extreme feelings of sadness, anxiety, guilt and anger
57. Nursing diagnoses
• Ineffective individual coping r/t stress of child
birth, negative self concept
• Impaired social interaction r/t severe depression
• Impaired family processes r/t post partum
psychosis
• Impaired parenting r/t postpartum blues
,feelings of inadequacy
• Risk for injury r/t postpartum psychosis
• Ineffective family coping r/t maternal
depression
63. Risk factors
• Childhood trauma
• Sexual abuse
• Depression
• PTSD preceding the pregnancy
• Depression , anxiety or a fear of child birth
• Lack of support from care providers or partner
64. Treatment
• Debriefing and counselling
• Cognitive behavioural therapy
• Eye movement desensitization and reprocessing
