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  • Postnatal Depression, Risk Factors,

    Assessment, Identification &

    Treatments

    Dr Patricia Leahy-Warren, PhD, MSc (Research), HDipPHN, BSc, RPHN, RM, RGN

    Presentation at the Emotional Wellbeing Education Conference

    May 10th 2014

  • Objectives

    • Background Literature

    • Postnatal Mental Health

    • Risk factors

    • Assessment and screening instruments

    • Importance of identification of PND

    • Treatments

    • Conclusion

    Emotional Wellbeing Educational

    Conference May 10th 2014

  • Emotional Wellbeing Educational

    Conference May 10th 2014

  • Postnatal Period

    • Time of transition

    • Major developmental change

    • Becoming a mother for first-time

    • Adaptation and coping

    • Learning infant care skills

    • Societal pressure ‘perfect mother’

    • ‘Poor relation’ of perinatal research

  • Postnatal Mental Health

    • Baby blues

    • Postnatal Psychosis

    • Postnatal depression

    • Postnatal posttraumatic stress disorder

    • Postpartum panic disorder

    • Postpartum anxiety

    Emotional Wellbeing Educational

    Conference May 10th 2014

  • Prevalence of risk of

    Postnatal Depression

    International rates:

    4.4% to 73.7%

    Irish rates: 11.4%-28.6%

    Recent Irish study

    At 6 weeks

    13.2% (95% CI: 9.8-16.6%)

    At 12 weeks

    9.8% (95% CI: 6.5-13.1%)

    Emotional Wellbeing Educational

    Conference May 10th 2014

  • Emotional Wellbeing Educational

    Conference May 10th 2014

    Triggers or Events

     Having a baby

     Accident

     Bereavement

     Marital breakdown

     Moving house

     Illness

     Traumatic experience

    Vulnerability or Risk factors

     Social isolation

     Domestic abuse

     Low self-esteem/efficacy

     Physical ill health or exhaustion

    Denial or

    refusal to

    face up to

    issues

    High

    expectations

    about being

    able to cope

    regardless

    History of depression

    or other mental health

    problems

    History of

    physical or

    sexual abuse

    Not living

    up to one

    self

    Always

    seeing the

    dark side

    Cited from Nicolson, P (1988) Postnatal Depression Facing the paradox of loss, happiness and motherhood p. 13 Sussex: Wiley

    Bio Psychosocial Model Explanation of Depression

  • Postnatal Depression

    Mothers’ experiences I felt I was a

    failure as

    a mother

    It was

    lonely…nobody to

    talk to…I never hit

    him…(but)

    grabbed

    him…ignored his

    crying

    It was terrible,

    like someone

    else taking over. I

    wasn’t the same

    person

    I felt ghastly …like a

    physical weight

    pulling me

    down…everything

    was an effort

    I liked my

    baby but I

    wasn’t

    interested

    in her

    Emotional Wellbeing Educational

    Conference May 10th 2014

  • Assessment & Identification

    Holistic nursing clinical assessment plus

    • Whooley questions:

    1. ‘During the last month, have you often

    been bothered by feeling down, depressed

    or hopeless?’

    2. ‘During the last month have you often

    been bothered by having little interest or

    pleasure in doing things?’ (NICE CG 45)

    Emotional Wellbeing Educational Conference May 10th 2014

  • Arroll follow on question

    • This is also supplemented with a third

    question if the answer to either of the first

    two is ‘Yes’:

    • 3. ‘Is this something with which you would

    like help?’ which has three possible

    responses: ‘No,’ ‘Yes, but not today,’ and

    ‘Yes.’ (Arroll, Goodyear-Smith, Kerse, N., et al.2005).

    Emotional Wellbeing Educational

    Conference May 10th 2014

  • Treatments • Antidepressants e.g. Selective serotonin

    reuptake inhibitors (SSRIs)

    • Cognitive Behavioural Therapy (CBT)

    • Cognitive Behavioural Counselling (CBC)

    • Interpersonal Therapy (IP)

    • Counselling e.g. non-directive in home

    visits

    • Support

    Emotional Wellbeing Educational

    Conference May 10th 2014

  • Social Support

    • Structural Social

    Support (Networks) • Persons

    – Formal (Health

    Professionals)

    – Informal

    (Family/Friends)

    • Functional Social

    Support • Informational

    • Instrumental

    • Emotional

    • Appraisal

    Emotional Wellbeing Educational

    Conference May 10th 2014

  • 0 10 20 30 40 50 60 70 80

    % c

    h a

    n g

    e s

    Partner Mother Neighbour Professional

    Structural social support

    Informational support- from birth to 6

    weeks

    Birth

    6 weeks

  • 0

    20

    40

    60

    80

    100

    % c

    h a n

    g e s

    Partner Mother Neighbour Professional

    Structural social support

    Instrumental support- from birth to 6

    weeks

    Birth

    6 weeks

  • 0

    20

    40

    60

    80

    100

    % c

    h a n

    g e s

    Partner Mother Neighbour Professional

    Structural social support

    Emotional support- from birth to 6

    weeks

    Birth

    6 weeks

  • 0

    20

    40

    60

    80

    100

    % c

    h a

    n g

    e s

    Partner Mother Neighbour Professional

    Structural social support

    Appraisal support- from birth to 6

    weeks

    Birth

    6 weeks

  • At 12 weeks • Mothers who received no formal support at birth

    had a significantly elevated risk of PND

    (Odds ratio = 3.33, p < 0.01, 95% CI = 1.36 – 8.19)

    • Mothers who received low levels of appraisal

    support at 12 weeks were at greatly increased

    risk of PND relative to those receiving high

    levels of support

    (Odds ratio = 6.42, p < 0.05, 95% CI = 1.44 – 28.7)

    (Leahy-Warren et al., 2005, 2007, 2011, 2012)

    Emotional Wellbeing Educational

    Conference May 10th 2014

  • Conclusion

    • PND serious Public health issue

    • Early identification of affected women in the

    community

    • Women’s preferences for effective treatments

    • Health of women’s partners

    • Significance of social support- structural and

    functional dimensions

    Emotional Wellbeing Educational

    Conference May 10th 2014

  • Recommendations

    • Universal screening for postnatal depression in the community

    • Greater emphasis on postnatal nursing care in the community

    • Choices of different models of care and treatments in the community

    • Partners and maternal mothers acknowledged as primary sources of support

    • Further research to enhance early detection in primary care

    • Further research on effective acceptable interventions in community

    Emotional Wellbeing Educational

    Conference May 10th 2014

  • Emotional Wellbeing Educational

    Conference May 10th 2014

    http://images.google.com/imgres?imgurl=http://www.citizensam.org/graphics/Thank-you-2.jpg&imgrefurl=http://www.citizensam.org/html/thankyous.html&usg=__2eLYgFirPsAE2rwFYdsEtm8CERU=&h=267&w=290&sz=11&hl=en&start=11&tbnid=buJuHfCSUKShyM:&tbnh=106&tbnw=115&prev=/images%3Fq%3Dthank%2Byou%26gbv%3D2%26hl%3Den%26sa%3DG

  • References Arroll, B., Goodyear-Smith, F., Kerse, N., et al. (2005) Effect of the addition of a ‘help’

    question to two screening questions on specificity for diagnosis of depression in general

    practice: diagnostic validity study. British Medical Journal, 331, 884

    Leahy-Warren, P., M. G., et al. (2011). Postnatal Depression in First-Time Mothers:

    Prevalence and Relationships between Functional and Structural Social Support at 6 And

    12 Weeks Postpartum. Archives of Psychiatric Nursing 25(3): 174-184.

    Leahy-Warren, P., G. McCarthy, et al. (2011). First-Time Mothers: Social Support,

    Maternal Parental Self-Efficacy and Postnatal Depression.Journal of Clinical Nursing DOI:

    10.1111/j.1365-2702.2011.03701.x

    Leahy-Warren, P. and G. McCarthy (2007). Postnatal depression: Prevalence, Mothers'

    perspectives, and treatments. Archives of Psychiatric Nursing 21(2): 91-100.

    Leahy-Warren, P. (2007). Social Support for First-Time Mothers: An Irish Study MCN,

    American Journal of Maternal Child Nursing 32(6): 368-374.

    Leahy-Warren, P. (2005). "First-time mothers: social support and confiden