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Identifying and Treating Post-Partum Depression (PPD)
Post-Partum Depression (PPD), also called postnatal depression, is a serious health concern characterized by anxiety, extreme sadness, mood swings, suicidal thoughts, and the lack of interest in oneself and an infant (NIH, 2017). PPD affects approximately one in seven women and has implications for both mothers and babies. Thus, it reduces women’s emotional attachment to babies and limits their ability to provide proper care (Leigh & Streltzer, 2014; Stone & Menken, 2008). At the same time, PPD can adversely affect a child because the lack of emotional and physical connectedness to a mother causes cognitive dysfunctions and developmental problems. However, despite adverse effects of PPD and its prevalence among new mothers, health care providers lack the necessary training and awareness to assess and treat this disorder effectively. The present research paper throws light on these problems and analyzes advanced approaches for timely identification and treatment of PPD.
During the past decade, empirical research has expanded our knowledge of PPD pathophysiology, risk factors, and consequences. Studies have demonstrated that risk factors for developing PPD include the previous history of depression or PPD; child illnesses and medically complicated pregnancy or delivery (McGarry & Tong, 2007), unplanned pregnancy, limited social and family support, and hormonal dysfunctions (Pearlstein et al., 2009). Women having PPD experience a variety of different symptoms varying from the mild ones (e.g. irritability, sadness, anxiety, reduced concentration, sleeping and appetite problems) to severe ones (e.g. excessive fatigue and anxiety, fear and suicide thoughts, panic attacks, etc.) (Mayo Clinic, 2015). In rare cases, a woman can develop postpartum psychosis, which manifests itself with hallucinations, paranoia, suicide attempts, etc. Naturally, the consequences of all these symptoms can be damaging, as they lead to decreased quality of life in women and developmental, behavioral, and language problems in babies (Mayo Clinic, 2015).
Despite the fact that postpartum depression has been studied extensively for the past decade, experts believe it is still not being diagnosed and treated properly. Statistics shows that PPD is still prevalent among American mothers. Recent data provided by the Centers for Disease Control and Prevention (2015) indicates that approximately 11-20% of new mothers have this condition, which accounts for 600,000 women annually. In reality, however, the actual number of women with PPD may reach a million because many cases are not diagnosed. In other words, thousands of women suffer silently and put themselves and their children at risk because health care providers do not have the necessary resources and training to deliver quality postpartum care (Corrigan, Kwasky, & Groh, 2015).
Several problems account for the high prevalence and underdiagnosis of PPD in the United States. First, healthcare providers fail to recognize the importance of ongoing assessment of mothers in the weeks following childbirth (Corrigan, Kwasky, & Groh, 2015). As a result, mothers are not educated properly on how they should take care of their children, which in turn creates emotional pressure and anxiety. New mothers are unaware of the multiple problems they may face soon after giving birth and are not ready to handle the pressure. Second, many health care providers do not take advantage of evidence-based screening tools, such as Patient Health Questionnaire (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) (Zhong et al., 2014). They lack knowledge on how to distinguish PPD from similar depressive disorders and cannot select and employ relevant screening tools (Boyd et al., 2011). Moreover, some health care providers perceive PPD as a natural response to giving birth and believe that no treatment is required (Rosenfield, 2007).
Therefore, given the barriers to PPD screening mentioned above, it is critical for health care providers to know what tools and algorithms they can use when suspecting postpartum depression. For now, PHQ-9 and EPDS are the most accurate tools for detecting PPD, and they can be adjusted to different clinical settings and situations (Yawn et al., 2015). EPDS is a brief self-report questionnaire consisting of ten statements, which are aimed at assessing a woman’s emotional and mental health condition for the past week (Alden et al., 2014). Women scoring higher than 12 possibly have PPD and should undergo further diagnostic evaluation by a qualified clinician. PHQ-9 can be used as an additional tool for identifying depression, which should then be confirmed by a more detailed assessment (Davidson, 2012). Additionally, health care providers may use numerous guidelines, recommendations, and manuals on PPD screening (Agency for Healthcare Research and Quality, 2012).
Only after the accurate screening and examination performed in line with evidence-based practice, as well as the elimination of other disorders with similar symptoms, healthcare providers can proceed to PPD treatment. Traditionally, PPD treatment includes psychotherapy and antidepressants; however, the latter should be prescribed in severe cases when mental health support does not bring visible improvement (Mayo Clinic, 2015). Sometimes, support groups can help mothers voice their concerns and look at their problem from a positive perspective. The overwhelming majority of women respond well to treatment and report improved well-being in several weeks after its initiation (WebMD, 2017).
To summarize the evidence provided in this paper, one may conclude that health care providers need to be educated and trained on PPD screening and treatment. This disorder has adverse implications both for mothers and children, so more efforts should be made to deliver timely and effective care. Health care providers need to be aware of available screening tools and guidelines to detect PPD at early stages and initiate treatment. Ultimately, their competence will determine the health and well-being of infants, their mothers, and the community in general.