Week 4 - Postpartum Depression Flashcards
Define PPD:
PPD is a mood disorder that occurs within four weeks to one year following parturition.
How is PPD diagnosed in the DSM?
DSM-5 does not recognize PPD as a separate diagnosis from depression.
- DSM-5: major depressive episode, onset in pregnancy or within 4 weeks of delivery
- Major depressive episode: at least 5 symptoms from DSM-5 list (slide 8) for at least 2 weeks for most of nearly every day.
Baby blues:
- Onset
- Length of time
- Symptoms
- Level of impairment
Onset: Usually within 10 days postpartum (often 2-5 days)
Length: Usually improves over 2 weeks
Symptoms: Anxiety, teary, overwhelmed, fluctuation of positive/negative moods
Level of Impairment: Fluctuates, some good days, mood not low all day
PPD:
- Onset
- Length of time
- Symptoms
- Level of impairment
Onset: Within 4 weeks - 1 year postpartum
Length of Time: Incidence rises within 20 days; can last months/yrs
Symptoms: Low mood, severe anxiety, overwhelmed, changes in appetite/weight, sleep disruption/insomnia, fatigue/low energy
Level of Impairment: Feeling low most of the time, for most days
Postpartum Psychosis:
- Onset
- Length of time
- Symptoms
- Level of impairment
Onset: Acute onset; first 2-4 weeks postpartum
Length of time: Varies
Symptoms: Anxiety-vague, labile/ low/elevated mood, delusions & hallucinations, disorganized speech/ thoughts/behaviour & mood swings
Level of impairment: Can deteriorate rapidly, psychiatric emergency
Etiology of PPD:
- Biological
- Psychological
- Sociocultural
Biological
- Hormone (estrogen, progesterone, and cortisol) changes during/after pregnancy most likely
- Neurotransmitter dysfunction/dysregulation
- Genetic factors
Psychological
- History of depression and/or anxiety disorders or prior PPD diagnosis.
- (-) life experiences
- Stress
- Coping mechanisms
- Insomnia/ difficulty sleeping
Sociocultural
- Stigma
- Cultural & societal expectations
- Socio-economic factors
- Poor social support and/or relationship complications
Impact on:
- Mother?
The first few days after birth set the stage for a woman’s experience/introduction to motherhood, and sometimes PPD can be triggered in this stage.
- E.g., introduction to breastfeeding, societal + healthcare pressures: this example highlights the need for critical judgment on the part of nurses and other healthcare personnel when educating women on the many aspects of infant care post-discharge (breastfeeding support is encouraged but should be done in accordance with principles of the therapeutic relationship)
Impact on:
- Maternal-Infant Interaction
- Reduction in the quality of maternal-infant interaction
- Increase in infant stress levels, especially in preterm babies.
- Children are at increased risk of socio-emotional, cognitive developmental complications, and developing stress and anxiety in their older years.
Impact on:
- Father/Paternal Figure
- Fathers can experience paternal PPD for reasons not related to hormonal changes, but rather work- and financial-related burdens on top of their responsibility to support the mother through the changes of childbirth.
- Symptoms of paternal PPD mirror those of the maternal (50% correlation) and having a partner with PPD increases the risk of paternal PPD four-fold
Assessment:
- Nursing
- RNAO recommendations
Nursing:
1) History
- Family or personal history of mood disorders (esp. PPD)
- Changes in mood – anhedonia, mood swings
- Thoughts – worrying, difficulty concentrating
- Behaviour/Physical Health – diet, sleep pattern
- Social support
2) Screening Tests
- 2-question screen: (1) feelings of hopelessness? (2) loss of interest?
- Edinburgh Postnatal Depression Screen (EPDS): score of 12+, likely depression
RNAO:
- Screen for PPD at 1, 2, 4, 6 and 12-month visit
- Routinely screen for perinatal depression during/after pregnancy
- Recognize person’s informational and support needs, their readiness to be screened and integrate the person’s cultural background/practices.
- Conduct or facilitate access to a comprehensive perinatal depression assessment with persons who screen positive for perinatal depression
Interventions:
- Nursing
- RNAO Recommendations
Nursing:
- Psychological treatment – psychoeducation, CBT, psychodynamic therapy
- Pharmaceutical treatments ¬¬– SSRIs, SNRIs
- Other – hormone therapy
- Patient Education
(note: nurses may not be able to do all the listed activities, but may refer/facilitate access to these resources)
RNAO:
- Collaborate with clients and healthcare team to create a comprehensive, therapeutic person-centered plan
- Prevention strategies to reduce risk of progression
- Promote self-care strategies
- Provide/facilitate access to resources
- Ongoing education and reflection!
Stigma associated with PDD?
- Rates for help-seeking remain low, with stigma frequently cited as the most common deterrent to seeking professional help
- Incongruity between expectations and reality of motherhood lead to feelings of failure, shame, embarrassment, guilt, hopelessness, self-blame
- New mothers experience both self and social stigma associated with postpartum depression, often stemming from misinformation or ignorance and leading to discrimination
- Motherhood is often glamorized in the media, further contributing to unrealistic and unattainable comparisons for mothers
Cultural considerations?
Although the meaning and context may vary across cultures, studies have found comparable rates and risk factors of PPD despite cultural identity and beliefs
Because Canada is so diverse, it is especially important for nurses to be sensitive to other’s beliefs, while acting in a culturally safe manner
