Postnatal Depression, Risk Factors, Assessment ......Postnatal Depression, Risk Factors, Assessment,...
Transcript of Postnatal Depression, Risk Factors, Assessment ......Postnatal Depression, Risk Factors, Assessment,...
Postnatal Depression, Risk Factors,
Assessment, Identification &
Treatments
Dr Patricia Leahy-Warren, PhD, MSc (Research), HDipPHN, BSc, RPHN, RM, RGN
Presentation at the Emotional Wellbeing Education Conference
May 10th 2014
Objectives
• Background Literature
• Postnatal Mental Health
• Risk factors
• Assessment and screening instruments
• Importance of identification of PND
• Treatments
• Conclusion
Emotional Wellbeing Educational
Conference May 10th 2014
Emotional Wellbeing Educational
Conference May 10th 2014
Postnatal Period
• Time of transition
• Major developmental change
• Becoming a mother for first-time
• Adaptation and coping
• Learning infant care skills
• Societal pressure ‘perfect mother’
• ‘Poor relation’ of perinatal research
Postnatal Mental Health
• Baby blues
• Postnatal Psychosis
• Postnatal depression
• Postnatal posttraumatic stress disorder
• Postpartum panic disorder
• Postpartum anxiety
Emotional Wellbeing Educational
Conference May 10th 2014
Prevalence of risk of
Postnatal Depression
International rates:
4.4% to 73.7%
Irish rates: 11.4%-28.6%
Recent Irish study
At 6 weeks
13.2% (95% CI: 9.8-16.6%)
At 12 weeks
9.8% (95% CI: 6.5-13.1%)
Emotional Wellbeing Educational
Conference May 10th 2014
Emotional Wellbeing Educational
Conference May 10th 2014
Triggers or Events
Having a baby
Accident
Bereavement
Marital breakdown
Moving house
Illness
Traumatic experience
Vulnerability or Risk factors
Social isolation
Domestic abuse
Low self-esteem/efficacy
Physical ill health or exhaustion
Denial or
refusal to
face up to
issues
High
expectations
about being
able to cope
regardless
History of depression
or other mental health
problems
History of
physical or
sexual abuse
Not living
up to one
self
Always
seeing the
dark side
Cited from Nicolson, P (1988) Postnatal Depression Facing the paradox of loss, happiness and motherhood p. 13 Sussex: Wiley
Bio Psychosocial Model Explanation of Depression
Postnatal Depression
Mothers’ experiences I felt I was a
failure as
a mother
It was
lonely…nobody to
talk to…I never hit
him…(but)
grabbed
him…ignored his
crying
It was terrible,
like someone
else taking over. I
wasn’t the same
person
I felt ghastly …like a
physical weight
pulling me
down…everything
was an effort
I liked my
baby but I
wasn’t
interested
in her
Emotional Wellbeing Educational
Conference May 10th 2014
Assessment & Identification
Holistic nursing clinical assessment plus
• Whooley questions:
1. ‘During the last month, have you often
been bothered by feeling down, depressed
or hopeless?’
2. ‘During the last month have you often
been bothered by having little interest or
pleasure in doing things?’ (NICE CG 45)
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Conference May 10th 2014
Arroll follow on question
• This is also supplemented with a third
question if the answer to either of the first
two is ‘Yes’:
• 3. ‘Is this something with which you would
like help?’ which has three possible
responses: ‘No,’ ‘Yes, but not today,’ and
‘Yes.’ (Arroll, Goodyear-Smith, Kerse, N., et al.2005).
Emotional Wellbeing Educational
Conference May 10th 2014
Treatments • Antidepressants e.g. Selective serotonin
reuptake inhibitors (SSRIs)
• Cognitive Behavioural Therapy (CBT)
• Cognitive Behavioural Counselling (CBC)
• Interpersonal Therapy (IP)
• Counselling e.g. non-directive in home
visits
• Support
Emotional Wellbeing Educational
Conference May 10th 2014
Social Support
• Structural Social
Support (Networks) • Persons
– Formal (Health
Professionals)
– Informal
(Family/Friends)
• Functional Social
Support • Informational
• Instrumental
• Emotional
• Appraisal
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Conference May 10th 2014
01020304050607080
% c
ha
ng
es
Partner Mother Neighbour Professional
Structural social support
Informational support- from birth to 6
weeks
Birth
6 weeks
0
20
40
60
80
100
% c
han
ges
Partner Mother Neighbour Professional
Structural social support
Instrumental support- from birth to 6
weeks
Birth
6 weeks
0
20
40
60
80
100
% c
han
ges
Partner Mother Neighbour Professional
Structural social support
Emotional support- from birth to 6
weeks
Birth
6 weeks
0
20
40
60
80
100
% c
ha
ng
es
Partner Mother Neighbour Professional
Structural social support
Appraisal support- from birth to 6
weeks
Birth
6 weeks
At 12 weeks • Mothers who received no formal support at birth
had a significantly elevated risk of PND
(Odds ratio = 3.33, p < 0.01, 95% CI = 1.36 – 8.19)
• Mothers who received low levels of appraisal
support at 12 weeks were at greatly increased
risk of PND relative to those receiving high
levels of support
(Odds ratio = 6.42, p < 0.05, 95% CI = 1.44 – 28.7)
(Leahy-Warren et al., 2005, 2007, 2011, 2012)
Emotional Wellbeing Educational
Conference May 10th 2014
Conclusion
• PND serious Public health issue
• Early identification of affected women in the
community
• Women’s preferences for effective treatments
• Health of women’s partners
• Significance of social support- structural and
functional dimensions
Emotional Wellbeing Educational
Conference May 10th 2014
Recommendations
• Universal screening for postnatal depression in the community
• Greater emphasis on postnatal nursing care in the community
• Choices of different models of care and treatments in the community
• Partners and maternal mothers acknowledged as primary sources of support
• Further research to enhance early detection in primary care
• Further research on effective acceptable interventions in community
Emotional Wellbeing Educational
Conference May 10th 2014
Emotional Wellbeing Educational
Conference May 10th 2014
References Arroll, B., Goodyear-Smith, F., Kerse, N., et al. (2005) Effect of the addition of a ‘help’
question to two screening questions on specificity for diagnosis of depression in general
practice: diagnostic validity study. British Medical Journal, 331, 884
Leahy-Warren, P., M. G., et al. (2011). Postnatal Depression in First-Time Mothers:
Prevalence and Relationships between Functional and Structural Social Support at 6 And
12 Weeks Postpartum. Archives of Psychiatric Nursing 25(3): 174-184.
Leahy-Warren, P., G. McCarthy, et al. (2011). First-Time Mothers: Social Support,
Maternal Parental Self-Efficacy and Postnatal Depression.Journal of Clinical Nursing DOI:
10.1111/j.1365-2702.2011.03701.x
Leahy-Warren, P. and G. McCarthy (2007). Postnatal depression: Prevalence, Mothers'
perspectives, and treatments. Archives of Psychiatric Nursing 21(2): 91-100.
Leahy-Warren, P. (2007). Social Support for First-Time Mothers: An Irish Study MCN,
American Journal of Maternal Child Nursing 32(6): 368-374.
Leahy-Warren, P. (2005). "First-time mothers: social support and confidence in infant care
Journal of Advanced Nursing 50: 479-488.
National Institute for Health and Clinical Excellence (2007) Antenatal and postnatal mental
health: clinical management and service guidance (NICE CG 45) (para 5.4.3 p116).
Whooley, M. A., Avins, A. L., Miranda, J., et al. (1997) Case-finding instruments for
depression. Two questions are as good as many. Journal of General Internal Medicine,
12; 439–445