Page 446 - Encyclopedia of Nursing Research

POSTPARTUM DePReSSION n 413

and Statistical Manual of Mental Disorders, major risk factors associated with the devel-
fourth edition, text revision (American opment of PPD. A range of risk factors have
Psychiatric Association, 2000), diagnostic been identified with the development of PPD, P
criteria specify onset within 4 weeks post- including a history of depression, difficult
partum. The most frequent symptoms are infant temperament, marital or partner rela-
feelings of inadequacy, sadness, fatigue, tionship problems, child care stress, low self-
anxiety, worry, compulsive thoughts, and esteem, and poor social support. Depressive
diminished functioning that can occur symptoms in mothers of prematurely born
from within 2 weeks postpartum to beyond infants were associated with the stress of
1 year. Women experiencing PPD can expe- their infants’ hospitalizations and maternal
rience symptoms severe enough to require role issues in postpartum (Miles, Holditch-
a combination of pharmacological inter- Davis, Schwartz, & Scher, 2007). Results
ventions and either short- or long-term from a national U.S. survey of 1,359 women
counseling and therapy and even hospital- conducted in 2002 (“listening to Mothers”)
ization. Concerns about the risks of medi- showed that younger women with less edu-
cation used to treat PPD have included the cation had the highest rates of moderate–
effects on breast milk and the developing severe depression symptoms as measured
infant, although a recent systematic review by the edinburgh Postnatal Depression Scale
of relevant studies to date has indicated (ePDS; Mayberry, Horowitz, & Declercq,
that this problem is dependent on the type 2007). Results from a recent large-scale
of drug used (DiScalea & Wisner, 2009). PPD screening initiative of more than 5,000
PPD is distinguished from commonly women showed that race/ethnicity identifi-
experienced “postpartum or maternity blues” cation other than Caucasian and having less
and postpartum psychosis. Postpartum than a high school education were associated
blues is characterized by onset during the with higher PPD scores (Horowitz, Murphy,
first 2 weeks after delivery, presence of mild Gregory, & Wojcik, 2009). Results from these
depressed symptoms with typically rapid two recent studies with large samples sug-
resolution, and prevalence as high as 80% gest that previous mixed results concerning
in the United States. In addition, postpar- demographic risk factors may have due to
tum blues wane without need for interven- small samples and limited diversity among
tion. Postpartum psychosis, in contrast, is samples. Thus, race/ethnicity identifica-
a rare (1–2 per 1,000) and severe disorder. tion other than Caucasian, very young age,
Symptoms may emerge as early as 1 month and low education may in fact increase the
before delivery, and rapid postpartum onset PPD risk.
within 4 weeks postpartum is characteris- The ePDS is the most widely used
tic. Hallucinations, delusions, and paranoia screening instrument in research conducted
are hallmarks and can be associated with worldwide (Gaynes et al., 2005), and many
suicidal and homicidal ideation. Therefore, single sample studies have been published
risk of harm to the infant is a major concern by nurse researchers from countries all
with psychosis and with severe PPD when over the world. One example of an interna-
cognitive distortions are present (American tional multisite study involved 892 women
Psychiatric Association, 2000). from nine countries, which was designed to
During the last two decades, a major shift compare differences in postpartum depres-
in research has occurred from an emphasis sive symptomatology across samples at 4 to
on treatment of PPD by psychiatrists and psy- 6 and 10 to 12 weeks postpartum (Affonso,
chologists, to a multidisciplinary approach, De, Horowitz, & Mayberry, 2000). Average
to research and treatments. Researchers depression scores for women from countries
have aimed specifically at determining the in which postpartum cultural traditions