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CHAPTER 34 Cheryl Tatano Beck 681

serious injury or death to the mother or her infant. postpartum depression follows a logical progression
The birthing woman experiences intense fear, help- specific to observations made in nursing practice. It is
lessness, loss of control, and horror” (Beck, 2004b, accessible empirically and theoretically. Importantly,
p. 28). Beck noted that women who actually had been concepts and definitions used for predicting a wom-
suffering from PTSD were misdiagnosed as having an’s risk for postpartum depression and concepts and
postpartum depression and were treated incorrectly definitions used to screen women for symptoms of
with antidepressant medications. She recommended postpartum depression are directly meaningful for
that postpartum mood disorders be changed to post- women, the lay public, and practitioners from nursing
partum mood and anxiety disorders (Beck, 2004b). and other related disciplines.
PTSD would then be differentiated as a distinct
diagnosis with different treatment approaches. Birth Generality
trauma, as a concept, will be examined empirically Beck has accounted for the complexity of postpartum
and included in predictor and screening instruments depression within the expansion of the concepts
as appropriate. Beck (2006c) examined women’s expe- within the theory. Generality issues relate to how
rience of the anniversary of their birth trauma, noting broadly the theory describes human experience, and
that the birthday of a woman’s child might represent this is supported by applicability of the theory in dif-
a time of reexperiencing the trauma all over again. ferent cultural contexts. Chinn and Kramer (2011)
Current research by Beck and co-investigator Carol note that generality refers to a theory’s ability to
Lammi-Keefe focuses on docasahexaenoic acid in remain conceptually simple, yet account for a broad
pregnancy and its effect on postpartum depression range of empirical experiences. Postpartum depression
(Judge & Beck, 2008). is a relatively narrow experience; however, its nature
Researchers utilized the PDSS to screen for postpar- and causation are especially complex. Importantly,
tum depression in a sample acquired on the Internet Beck (2007) has studied the experiences of many
compared with a community-based sample (Le, Perry, women and has also used research from numerous
& Sheng, 2008). Initial results suggested a high degree sources that address postpartum depression in various
of internal consistency and construct validity between geographical and cultural groups. Embracing findings
the two groups. Findings indicated that the Internet from these studies to compare and contrast with the
group included greater numbers of participation among extant theory has given new breadth to the theory and
Hispanic and Asian women, and the Internet group evi- significantly impacts its generality.
denced more risk factors for a postpartum depression
diagnosis. Future research focuses on ways to connect Accessibility
women in an Internet group with appropriate services The PDSS (Postpartum Depression Screening Scale)
for intervention for prevention and treatment. has been subjected to a rigorous statistical process for
development and standardization. Beck and Gable
Critique (2000) examined the psychometric properties of the
scale with regard to reliability of the measure within
Clarity developmental and diagnostic samples. Validity anal-
Beck’s theory evidences a semantic clarity as concepts yses were conducted with the two samples, as were
are defined clearly and consistently. Within and between procedures used to establish cutoff scores for clinical
research reports, Beck uses terms, ideas, definitions, and interpretations. These studies indicated that the
concepts in a way that reflects growth, yet they are PDSS is a reliable and valid screening instrument for
defined and easily understood. Her research and writ- detection of postpartum depression (Beck & Gable,
ings use both inductive and deductive language, and her 2000, 2001a, 2001b, 2001c, 2001d). The theory and
verbiage is economical and clear. the PDSS are relatively new and have therefore not
been critiqued empirically by a wide variety of schol-
Simplicity ars. Beck has two instruments: the PDSS, which
Postpartum depression is a complex phenomenon, is well established, and the Postpartum Depression
experientially and theoretically. Yet Beck’s theory of Prediction Inventory (PDPI), which has more recently