Women's Perspectives on Adequacy of Screening and Treatment for Postpartum Depression

126 Pages·2015·0.58 MB·English

Walden University
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Walden Dissertations and Doctoral Studies
Walden Dissertations and Doctoral Studies
Collection
2015
Women's Perspectives on Adequacy of Screening
and Treatment for Postpartum Depression
Gloria Marcia Watson
Walden University
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Walden University

College of Health Sciences

This is to certify that the doctoral dissertation by

Gloria Watson

has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.

Review Committee
Dr. Sandra Rasmussen, Committee Chairperson, Public Health Faculty
Dr. Amany Refaat, Committee Member, Public Health Faculty
Dr. Jacqueline Fraser, University Reviewer, Public Health Faculty

Chief Academic Officer
Eric Riedel, Ph.D.

Walden University
2015
Abstract
Women’s Perspectives on Adequacy of Screening and Treatment for Postpartum
Depression
by
Gloria M. Watson

MSN/MPH, Hunter College, 2003
BSN, Graceland University, 1999

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Community Health Promotion and Education

Walden University
November 2015
Abstract
Postpartum depression affects some 10% to 20% of mothers. Its impact on the health and
well-being of mothers and their infants is well documented. If not identified and
addressed early, it can result in emotional burden, costly hospitalization and treatment,
and, at worst, suicide and or infanticide. Empowerment theory was the conceptual
framework for this hermeneutic phenomenological study. The purpose was to understand
the lived experiences of the screening and treatment processes of 10 women from New
York City experiencing postpartum depression and their perceived adequacy of the
treatment received. In-depth interviews were used to investigate participants’ lived
experiences of the screening and treatment processes for their postpartum depression and
to explore the extent to which they percieved that their emotional needs were met. From
the responses to the interview questions, 6 themes emerged: crying and stress during and
after pregnancy, inadequate assessment, feeling bad or unlike oneself, lack of
understanding, needing to cope, and prayer was essential for recovery. Participants had
tearfulness that began during pregnancy and intensified during the postpartum period,
were ineffectively assessed, exhibited bizarre behaviors that could not be explained, had
little understanding of what they were experiencing, and were sometimes misunderstood
by others. Further, participants at times sought treatment on their own in order to cope.
Some reported that prayer was central to the restoration of their mental health. Insights
gained through this study can be utilized to foster positive social change by heightening
awareness and assisting health care providers in planning appropriate screening and
treatment to meet the individual needs of women with postpartum depression.
Women’s Perspectives on Adequacy of Screening and Treatment for Postpartum
Depression
by
Gloria M. Watson

MSN/MPH, Hunter College, 2003
BSN, Graceland University, 1999

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Community Health Promotion and Education

Walden University
November 2015
Table of Contents
Chapter 1: Introduction to the Study ....................................................................................1
Introduction ....................................................................................................................1
Background ....................................................................................................................2
Problem Statement .........................................................................................................4
Purpose of the Study ......................................................................................................5
Research Questions ........................................................................................................6
Conceptual Framework ..................................................................................................6
Nature of the Study ........................................................................................................7
Definitions......................................................................................................................7
Assumptions ...................................................................................................................9
Scope and Delimitations ................................................................................................9
Limitations ...................................................................................................................10
Significance..................................................................................................................11
Summary ......................................................................................................................14
Chapter 2: Literature Review .............................................................................................16
Introduction ..................................................................................................................16
Literature Search Strategy............................................................................................17
Conceptual Framework ................................................................................................18
Health Problem ............................................................................................................22
Postpartum Blues .................................................................................................. 23
Postpartum Depression ......................................................................................... 24
i
Postpartum Psychosis............................................................................................ 26
Effects of Postpartum Mood Disorder .........................................................................27
Mothers and Postpartum Depression .................................................................... 27
Fathers and Postpartum Depression ...................................................................... 32
Postpartum Depression and Infant Care ............................................................... 34
Screening......................................................................................................................39
Treatment Modalities ...................................................................................................44
Treatment Decisions ....................................................................................................49
Research Methodology ................................................................................................53
Summary and Conclusions ..........................................................................................57
Chapter 3: Research Method ..............................................................................................60
Introduction ..................................................................................................................60
Research Design and Rationale ...................................................................................61
Role of the Researcher .................................................................................................63
Methodology ................................................................................................................65
Analysis........................................................................................................................68
Issues of Trustworthiness .............................................................................................71
Summary ......................................................................................................................76
Chapter 4: Results ..............................................................................................................78
Introduction ..................................................................................................................78
Pilot Study ....................................................................................................................78
Demographics ..............................................................................................................79
ii
Data Analysis ...............................................................................................................81
Evidence of Trustworthiness........................................................................................83
Results ..........................................................................................................................84
Crying and Stress During and After Pregnancy .................................................... 84
Inadequate Assessment ......................................................................................... 86
Feelings Bad or Unlike Oneself ............................................................................ 88
Lack of Understanding .......................................................................................... 89
Needing to Cope ................................................................................................... 91
Prayer was Essential for Recovery ....................................................................... 93
Summary ......................................................................................................................94
Chapter 5: Discussion, Conclusions, and Recommendations ............................................95
Introduction ..................................................................................................................95
Interpretation of Findings ............................................................................................95
Limitations of the Study...............................................................................................98
Recommendations for Further Study ...........................................................................99
Implications for Social Change ..................................................................................100
Researcher’s Reflections ............................................................................................102
Conclusion .................................................................................................................104
References ........................................................................................................................106
Appendix A: Consent Form .............................................................................................115
Appendix B: Interview Questions ....................................................................................118
iii
1
Chapter 1: Introduction to the Study
Introduction
The birth of a child is often associated with much excitement and joy and the new
mother is expected to gladly welcome her new role. For many mothers, however, this
new role is far from an enjoyable experience because of postpartum depression. There are
three conditions that are generally termed postpartum depression: postpartum or “baby”
blues, postpartum depression or postpartum nonpsychotic depression, and postpartum
psychosis (Seyfried & Marcus, 2003). These three conditions are generally differentiated
by their duration and level of severity (Seyfried & Marcus, 2003).
The first condition, postpartum blues, occurs in as many as 50% of mothers, and
researchers have described it as a transient mood disturbance (Miller, 2002). The
symptoms of postpartum blues generally resolve within a few hours to a few days
(Advance in Neonatal Care, 2003) and no treatment is required (Seyfried & Marcus,
2003). Emotional lability and happiness are the predominant symptoms (Miller, 2002;
Seyfried & Marcus, 2003). Postpartum depression, the second condition, affects some
10% to 20% of mothers (Miller, 2002). Symptoms include insomnia, loss of appetite,
inability to concentrate, feelings of ineffectiveness as a mother, and thoughts of harming
the self or the infant (Miller, 2002). Symptoms generally persist for several weeks to
several months and treatment is necessary (Seyfried & Marcus, 2003). Left untreated,
postpartum depression can have long-term and devastating consequences (Dietz et al.,
2007; Miller, 2002). The third condition, postpartum psychosis, is a psychiatric
emergency. Symptoms include delusions, hallucinations, and suicidal and homicidal
2
thoughts (Miller, 2002). As Miller (2002) noted, women experiencing postpartum
psychosis are more likely to act on suicidal or homicidal thoughts than women
experiencing postpartum nonpsychotic depression. A more in-depth discussion of these
three conditions and their effects or consequences appears in Chapter 2.
Background
Mood disturbance during the postpartum period has been documented since the
days of Hippocrates (Miller, 2002). However, postpartum depression often goes
unrecognized or underrecognized and untreated or ineffectively treated. The Diagnostic
and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American
Psychological Association, 2000) defined postpartum depression as a major depressive
illness with onset within the first 4 weeks after childbirth. Miller (2002) observed that
scholars have proposed hormonal changes occurring within the first few weeks following
delivery as a predisposing factor for postpartum depression. Miller noted that tragic
familial events related to postpartum depression have resulted in increased public
awareness of the problem and possibly to misconceptions about the prevalence of the
disorder.
Dietz et al. (2007) evaluated the prevalence of maternal depression before,
during, and after pregnancy among 4,398 women, using data from the Kaiser Permanente
Northwest (KPNW) group practice health maintenance organization in Oregon and the
state of Washington. The researchers chose women enrolled in KPNW continuously 39
weeks before and 39 weeks after pregnancy. Among the women, 678 were depressed at
some point before, during, or after pregnancy. Mental health disorders specific to