Mental health of postpartum depression
THE PURPOSE OF THE study was to collect pilot data on what appears to be a promising treatment for postpartum depressed mothers. The “Gruen” (1993) postpartum depression treatment program is a rationally derived group therapy treatment for women who suffer from postpartum depression. It is designed to target specific symptoms and problems of postpartum women. One of the well-known drawbacks of group therapy is that it takes place over a period of time when postpartum depressed mothers are overwhelmed with what they already “have to do” and are reluctant to take on more activities, even if those activities are or may be beneficial to them.
By doing a pilot study using the therapy as the treatment variable, we were able to identify the benefits of the therapy and the barriers to attending the therapy sessions. Treatment and control groups were used in the pilot. The mothers were all diagnosed with postpartum depression and referred to the group from nurse midwives in the Miami-Dade County area. The mothers were pre- and posttested for depression with the Beck Depression Inventory II (BDI II; Beck, Steer, & Brown, 1996). Lunch and child-care assistance were provided to the six mothers in the treatment group while they attended the group therapy treatment. A control group of eight mothers did not attend therapy but were screened for depression with the BDI II (Beck et al., 1996) at the same two times as the treatment group. The research question was: will mothers with postpartum depression experience a decrease in depression as a result of treatment with the “Gruen” (1993) postpartum depression group therapy model.
In addition to answering the research question, the researchers were able to identify the obstacles and the openings to treatment attendance. Because the therapy looked so promising the benefits of finding the manner in which to encourage and assist mothers to attend became a significant treatment breakthrough.
Literature review
There are at least three postpartum affective disorders. The first is postpartum “blues,” a self-limiting period of emotional instability experienced by most women after giving birth (Altshuler et al 2001 and O’Hara et al 1996). The second is postpartum psychosis, a severe psychotic disorder that requires biomedical intervention including hospitalization (Altshuler et al 2001 and Pariser et al 1997). The third is postpartum depression, a prolonged mood disorder characterized by tearfulness, guilt, and inability to cope (Altshuler et al 2001; Berggren-Clive 1998 and Nalepka et al l995). The focus of this study was postpartum depression only and did not address treatment issues of postpartum “blues” or psychosis, both of which are distinct clinical entities with accepted and effective biological and psychological treatment modalities.
Although it is a clearly defined syndrome, postpartum depression has an insidious onset, occurring from about two to six weeks after delivery. Close to 13% of postpartum women suffer from postpartum depression and go untreated because of poor detection (O’Hara et al 1991 and Seidman 1998). Postpartum depression is an atypical mood disorder characterized by the following symptoms: tearfulness, mood swings, despondency, feelings of inadequacy, inability to cope with the care of the baby, and increasing guilt about the birth and performance as a mother. Psychotic symptoms, such as severe delusions, are not present (Pariser et al., 1997). Postpartum depression can be present for varying lengths of time and can occur any time during the first year after giving birth, however, the condition usually arises from between 2 weeks and 3 months after giving birth. Symptoms have been known to be present for up to 1 year (Pariser et al., 1997).
Apparent subtypes of postpartum depression such as postpartum panic disorder and postpartum obsessive compulsive disorder have also been described. According to Beck (1998), postpartum panic disorder is characterized by physical symptoms such as chest pain, heart palpitations, shortness of breath, dizziness, tightening of the throat, and tingling in extremities.
According to Wisner, Peindl, Gigliotti, & Hanusa (1999), postpartum obsessive compulsive disorder is characterized by intrusive repetitive and persistent thoughts or mental pictures. Thoughts often are about hurting or killing the baby and an overwhelming sense of horror about these thoughts. Thoughts may be accompanied by behaviors to reduce the anxiety, such as hiding knives.
Most women do not seek help for the disorder (Stern et al 1983 and Ugarriza, D., 2002. Postpartum depressed women’s explanation of depression. In: Journal of NursingScholarship,Third Quarter, pp. 227–233. View Record in Scopus | Cited By in Scopus (16)Ugarriza 2002). Minimizing the symptoms, they typically ignore what is happening to them and find themselves quite uncomfortable for a long period of time. Some women do seek professional help but are often disappointed with their treatment options. Conflict over taking antidepressant medication and breastfeeding is an issue, as mothers are warned not to breastfeed while taking antidepressant medication (Ugarriza, 2002). In addition, the antidepressant medication is often ineffective for this particular affective disorder characterized by much milder symptoms than a major depression (Affonso et al 1992 and Ugarriza 2002).
Tags: Postpartum depression