Depression is a plague of the present time. It is twice as common in women as it is in men. Postpartum depression is one of the most common complications of childbirth (Glasser, et al., 2013). Postpartum depression is a non-psychotic depression, which manifests and progresses within one year after childbirth; it needs correct diagnosis, identification, and adequate treatment. The birth of a baby may happen to be a rather stressful occasion, it may appear not a lovely fairy-tale, but a cruel surprise with anger, sadness, inability to sleep, to eat, etc. Postpartum depression is harmful not only for a woman herself; it also selectively negatively influences on mother-child relations and so on emotional, physical, and cognitive development of a child as well (Letourneau et al., 2012). Cognitive, interpersonal, and behavioral problems were described in children of mothers with postpartum depression. Postpartum depression is a cross-cultural form of major depressive disorder that affects some 13% of women after childbirth and can have serious consequences for the mother, her child, her partner, and family in general. The diagnosis and treatment of postpartum depression are important and essential affairs. The problem of postpartum depression is an actual one, because of postpartum depression prevalence, its negative social consequences, and its negative influence on the child development. Postpartum depression is a serious social problem of nowadays and it has to be solved.
The aim of the paper is to reveal and discuss risk factors of postpartum depression, to discuss its influence on the health of the whole family and on the development of a child.
Postpartum Depression and the Family
Postpartum depression is a great social problem, because it destroys not only woman herself, but it also aggravates relations between the mother and all the members of the family, and may lead even to divorce, to child neglect, etc. The severity of postpartum depression may be complicated by the relationship with women’s partner (Letourneau et al., 2012). Mother’s postpartum depression deeply influences on emotional, cognitive, and social development of a child. Even in the case of mother’s mood improvement, the processes in the child are nearly irreversible. Children of mothers with postpartum depression usually have problems with sleep; they cry for a long time, they are irritable on one hand and more inactive on another. They are less responsive to the facial and vocal expression (Letourneau et al., 2012). The level of stress hormones is increased in such babies.
Diagnosis of Postpartum Depression
Some slight residual symptoms of depression or blue mood are typical in women within a year after childbirth. In 50-80% of deliveries “postpartum blues” may take place. They last for several days and are non-psychotic. In 10-20% of deliveries episodes of depression take place, they last for weeks and months. Psychotic episodes are identified in 0,1-0,2% of deliveries (Glasser, et al., 2013). The risk of postpartum depression development is highest within first three months after childbirth; it slightly decreases during the next four months up to the seventh month postpartum (Glavin, 2012). It is very important not to miss signs of postpartum depression in order to give the women adequate and professional help, because postpartum depression is usually undiagnosed; therefore, untreated even in patients with multiple visits to healthcare providers.
Several questionnaires are used for revealing postpartum depression. Among them there is a screening tool “General Health Questionnaire (GHQ)”, which was developed for revealing those at a high risk of development of any psychotic disorder. This questionnaire is available in different versions; the most widely used is a 28-item version. The other questionnaire is the Beck’s Depression Inventory (BDI), which is used for measuring the rate of severity of depression. The next questionnaire is the Postpartum Depression Screening Scale, which was developed especially for new mothers. This screening tool is effective for revealing major and minor depressions; it may provide a quick, accurate, and overall level of postpartum depression signs (Glavin, 2012). The Edinburgh Postnatal Depression Scale (EPDS) is used for identification and diagnosis of postpartum depression. This scale consists of ten questions with four variants of answer ranked from 0 to 3, for a scoring range of 0-30; a higher score is typical for severe signs of depression. This scale is ideal for obstetricians, who have no extensive experience with psychiatric tests, because it takes about not more than 5 minutes to complete the form and it is easy to score. The EPDS is a rather simple, convenient, and easy to use not only for mothers, but for the nurses as well. EPDS was translated into several languages and it is used all over the world. The EPDS is mainly focused not on the somatic features of the depression, but on the cognitive and affective symptoms. The EPDS is used as a helpful screening device to identify possible depression; it cannot confirm the diagnosis of depression. The EPDS increased the rate of postpartum depression diagnosis (Glavin, 2012). Screening for postpartum depression is necessary during 6-8 weeks after childbirth.
Postpartum depression may have a variety of etiologic factors. The main groups of etiologic factors are inherited predisposition for affective disorders, biological factors, including physical and physiological changes after delivery, social factors, and psychological ones. It is possible to mention changes in concentration of plasma estrogen and progesterone and placental steroids, autoimmune disorders of mother, sleep deprivation, and circadian rhythms disorders. Among social risk factors it is possible to define poverty, young maternal age, lack of social support, sexual abuse, unwanted pregnancy, conflict with a partner, etc. Among psychological risk factors the most important are Major Depressive Disorders (MDD) and anxiety during pregnancy, premenstrual dysphoric disorder, undue life stress during pregnancy, marital difficulties, and operative delivery (Zimmerman et al., 2013). Among psychological risk factors of postpartum depression some newborn’s troubles are identified: premature baby, congenital malformations or any other congenital pathology, and severe perinatal trauma. Early discharge from hospital may also influence both the mother and baby in a negative way (Glavin, 2012).
The symptoms of postpartum depression are similar to the other ones, typical for any other kind of depression. Among them are such symptoms as sleep disorders, anhedonia, agitation, anxiety, excessive guilt, etc. Postpartum depression is diagnosed according to the criteria of Diagnostic and Statistical manual IV for MDD. At least five of nine symptoms must be present for the period of not less than two weeks. One of these symptoms must be anhedonia or sadness; the other ones include low energy, changes in sleep patterns, changes in appetite, suicidal thoughts, difficulty conceptuality, psychomotor retardation, or agitation (McCoy, 2011).
Preventing and Treatment of Postpartum Depression
Preventing measures of postpartum depression have to be provided during the pregnancy. They have to include consulting sessions for future parents, or so-called schools for future mothers. The focus of these measurements is to form the idea of future parenthood with all possible troubles and happiness. They also work like special trainings for the process of delivery itself, and pay attention to the importance of personal maturity of the woman. Intervention by community health nurses during pregnancy may decrease the rate of postpartum depression. According to Glasser (2013), the risk of postpartum depression development was moderated in the pregnant women, who undergone early intervention by nurses (Glasser, 2013). Use of the EPDS during pregnancy pays attention to the emotional needs of a pregnant woman/a future mother and helps to initiate supportive intervention when necessary.
Standard treatment of postpartum depression includes psychotherapy, massage, reflex-therapy, and acupuncturing (McCoy, 2011). Usage of antidepressants is an issue of argue, because they can pass through the hemato-placental barrier and cause negative influence on the baby’s development. Among the methods of psychotherapy cognitive-behavioral and suggestive method are usually used. One of the main requests of psychotherapy is work with baby’s father and other members of the family, because postpartum depression is a family affair and it needs to deal with all the members of it in order to restore and improve relations not only between the mother and the baby, but also between the woman and her partner, between the father and the baby (Letourneau et al., 2012). Baby-aquatics and baby-Yoga also help to form healthy relations between the mother and the baby.
Role of Nurses in Identification and Treatment of Postpartum Depression
Nurses play an important role in identifying and treating women with postpartum depression. Their aim is to reveal the first signs of postpartum depression and to establish the offers of help. Nurses must have a guarded look at possible postpartum depression development. They have to provide consulting work with women after delivery, to inform depressed women about treatment measurements, to make recommendations, and to provide referrals (Glavin, 2012). Nurses must be able to use EPDS in order to identify mothers with postnatal depression. Well-child care visits are also a universal screening tool for revealing postpartum depression; they help to increase detection of postpartum depression. Regular home visits by nurses to the families with newborns during the first year after childbirth help to prevent emotional and developmental problems of a child, as well as child neglect and child abuse.
The postpartum depression is a broad and heterogeneous disease with a broad spectrum of psychiatric disorders, which take place within the first year after childbirth. The symptoms vary from postpartum blues up to psychotic episodes. Elaborations of a good profound organization programs for preventing and treating postpartum depressions and comprehensive screening programs are still of great importance. A guarded look at possible postpartum depression development has to be common for all the medical specialists dealing with the deliveries. The Edinburgh Postnatal Depression Scale is one of the most successful questionnaires for early diagnosis of postpartum depression, because of its convenience as for the mothers to complete and for the nurses to score. Community health nurses are the main soldiers in the battle for preventing, early revealing, and treating postpartum depression.