Page 447 - Encyclopedia of Nursing Research

414 n POSTPARTUM DePReSSION

are practiced were significantly higher than deliver personalized behaviorally targeted
depression scores for women from europe, interventions to promote sensitive, respon-
P Australia, and the United States—“Western” sive maternal–infant interaction is challeng-
industrialized countries without such wide- ing but is supported by the current research
spread rituals. In focus groups conducted (Horowitz et al., 2009). Thus, researchers
in each of the countries, similar patterns are challenged to test additional interven-
of symptoms were described (Horowitz, tions and cost-effective approaches to deliv-
Chang, Das, & Hayes, 2001). Fatigue and pain ering behaviorally based maternal–infant
were common physical symptoms, with irri- interventions,
tability, anxiety, loneliness, worrying, inde- Nurse investigators are also involved in
cisiveness, and poor concentration being developing and testing alternative screen-
emotional and cognitive symptoms. Role and ing tools for early detection of depression
relationship conflicts were described within symptoms as one step toward preventing
the context of cultural variations. These find- illness severity. The Postpartum Depression
ings demonstrate that additional research is Screening Scale (PDSS) (Beck & Gable, 2001)
needed to explore postpartum cross-cultural is the most promising, 35-item self-report
adjustment problems and to test strategies for instrument to identify women who are at
relieving distressing symptoms. In addition, high risk for PPD. However, although both
a gap in PPD research for immigrant women the PDSS and ePDS are well-tested and
in North America has been identified (Fung available, a major hurdle has been the pro-
& Dennis, 2010). vision of universal depression symptom
Convincing research findings indicate screening of women postdelivery. In the
that a major problem associated with PPD “listening to Mothers II” U.S. national sur-
is disturbances in maternal–infant interac- vey, only 58% of 1573 postpartum mothers
tions. Intrusive or withdrawn patterns of interviewed by telephone or Internet, were
behavior have been linked to delays in infant asked by their caregiver if they had experi-
cognitive and emotional development (Field, enced feelings of depression in the weeks fol-
2010). Dunst and Kassow (2008) concluded lowing childbirth (DeClercq, Sakala, Corry, &
that efforts to modify caregiver sensitivity to Applebaum, 2006). In a nurse researcher-led
their children’s behavior using behaviorally study of 674 mothers who actually screened
based interventions that focused on changes positively for depression symptoms with the
in caregiver contingent social respon- ePDS, 26% were not asked about their emo-
siveness were most effective. In response to tional state by clinicians (Horowitz, Murphy,
this growing evidence, nurse investigators Gregory, & Wojcik, 2009). Because one of the
have studied the efficacy of an interactive interferences with adopting screening pro-
coaching approach delivered by a trained tocols is the lack of adequate information,
home visiting nurse that produced promis- Best practice guidelines and Internet educa-
ing findings in terms of a positive effect on tion programs have recently been developed
maternal infant responsiveness (Horowitz for both health professionals and women
et al., 2001). Until PPD screening is a uni- (Neiman, Carter, van Sell, & Kindred, 2010;
versal practice, identification of mothers at Wisner, logsdon, & Shanahan, 2008),
risk for PPD remains a major challenge to Recommendations for the conduct of
this work. Many mothers decline to partic- future research include studies to exam-
ipate in follow-up services (Horowitz et al., ine: (a) short- and long-term effects of both
2001, 2009). Moreover, delivery of personal- in-person and Internet-based early PPD
ized mother–infant coaching interventions symptom screening procedures and pro-
is labor intensive, for example, via home grams; (b) RCT designs to test the efficacy
visits (Horowitz et al., 2001). Testing ways to of nonpharmacological treatments and