Postnatal Depression

In the United Kingdom, 1 in 10 women experience postnatal depression following childbirth (Lewis, 2004). Postnatal depression has profound effects on quality of life, social functioning and economic productivity (Chisholm et al, 2003). The health consequences could also lead to adverse long-term emotional and physical development of the infant (Miles, 1993; Jones, 1994; Boath et al, 1998). Postnatal depression is also predictive of child cognitive and behavioural disturbances at the age of 3 years (Campbell et al, 1995; Murray et al, 1996). Moreover, failure to identify these women often leads to safeguarding concerns for both mothers and infants (Warrington et al, 2001). Health visitors play a vital role in identifying and supporting women who experience postnatal depression. Their role includes supporting families from birth to five, thus giving opportunity to provide a prolonged period of contact and support to women  affected by the disorder. However, evidence suggests that most vulnerable women including Black Minority Ethnic groups do not always receive this vital care.

What is the current state of play with this issue?

Postnatal depression can affect men too. The birth of a new baby can be stressful for both parents and some fathers feel unable to cope, or feel they are not giving their partner the support she needs. It usually develops in the first four to six weeks after childbirth, although in some cases it may not develop for several months. There are many symptoms of postnatal depression, such as low mood, feeling unable to cope and difficulty sleeping, but many women are not aware they have the condition. It’s common to experience mood changes, irritability and episodes of tearfulness after birth the so called baby blues. These normally clear up within a few weeks. But if a woman experiences persistent symptoms, it could well be the result of postnatal depression. It is important for partners, family and friends to recognise signs of postnatal depression as early as possible and seek professional advice. Postnatal depression can be lonely, distressing and frightening, but there are many treatments available. As long as postnatal depression is recognised and treated, it is a temporary condition you can recover from. It is very important to seek treatment if you think you or your partner have postnatal depression. The condition is unlikely to get better by itself quickly and it could impact on the care of the baby.

Treatment for postnatal depression includes:

Self help advice

Talking therapies such as cognitive behavioural therapy

Antidepressant medication

The cause of postnatal depression

The main causes are not clear, but it’s thought to be the result of several things rather than a single cause.

These may include:

The physical and emotional stress of looking after a newborn baby hormonal changes that occur shortly after pregnancy; it is thought some women may be more sensitive to hormones than others individual social circumstances such as money worries, poor social support or relationship problems.

Women might be more at risk of developing post natal depression if they:

Have a previous history of depression or other mood disorders such as bipolar disorder

Have a previous history of postnatal depression

Experience depression or anxiety during pregnancy

Postnatal depression is more common than many people realise and cases can often go undiagnosed. It is estimated around one in seven women experience some level of depression in the first three months after giving birth. Rates of postnatal depression are highest in teenage mothers and is thought to affect all ethnic groups equally.

Aims and objectives

Depression affects 5-22% of women after childbirth. Some women with postnatal depression will experience a prolonged or relapsing illness that may last until their children enter school. It has adverse effects upon the coping abilities of women, their relationships with their infants, partners and social networks and may adversely affect the educational attainment and behaviour of their children. Since many more women are now active in the workforce, the effects of postnatal depression have obvious economic consequences both for their families and their employers.

The researcher will find out themian causes of postnatal depression among the moothers

The researcher want to know the impact of postnatal depression on the motehrs

The researcher want to know about the treatment of postnatal depression

The researcher is intersted in finding out the main causes of postnatal depression

The researcher will find out the darkside and its bad effects on mother’s health

The researcher will develop the positive suggestions and recommendations for the mothers to

reduce the chances of postnatal depression.

The researcher will find out the risk of postnatal depression associated with human lives

The researcher will find out its percentage and the age in which the people become its victom

Review of literature

The postnatal period is the period following the birth of a baby (Omar & Fattah, 1998) extending up to one year after delivery. For the majority of women this marks a relatively healthy period in their lives. However, it is estimated that a significant number of families areaffected by postnatal depression with 15% of women diagnosed with this disorder (Leverton & Elliott, 2000; Lewis, 2004). Despite the widespread nature of the problem the current process of diagnosis and treatment is not standardised, is often chaotic and may result in inappropriate care and treatment (Clifford et al, 1999). Postnatal depression is defined as an affective mood disorder often occurring in women up to one year after child birth (Gibson et al, 2009). This disorder is often characterised by feelings of loss and sadness and sometimes the loss of self-esteem (Olshansky, 2003). The depressive scale of this disorder and its presentation ranges from mild depression requiring minimal intervention to puerperal psychosis which often requires multi-therapy intervention, hospitalisation and long term support (Williamson & McCutcheon, 2004). Depression accounts for the greatest burden of

disease among all mental health problems, and it is expected to become the secondhighest among all general health problems by 2020 (Murray & Lopez, 1996). Minority ethnic groups represent 29% of the population in Greenwich with an estimated increase to over 33% by 2011 (Whiteman & Guite, 2008).

Evidance

A qualitative study by Amankwaa in 2003 looked at 12 women who have experienced postnatal depression in the past and noted that these African women believed that only white women get postnatal depression. This was considered a sign of weakness that did not represent a legitimate illness (Cox, 1999). In 2004, in a rural area of Ethiopia, Hanlon et al, (2009) conducted 25 in-depth interviews and five focus groups with purposely-selected participants. The participants included pre-natal women, fathers, grandmother, traditional and religious leaders, birth attendants and community leaders. The aim of the study was to determine societal recognition of problematic distress states in the postnatal period. The problematic distress state was defined to include both spiritual and mental disturbance. Hanlon et al, (2009) study identified salient themes that respondents spontaneously describe as culturally problematic distress occurring in the postnatalperiod, but they did not consider it to be an illness. This bears similarities to the current study where women exhibited symptoms of postnatal depression but did not regard it as an illness. The implication for practice suggests that lack of identification could be a contributory factor in naming the presenting phenomenon of postnatal depression. The overall findings suggest that black Caribbean women often have difficulties conceptualising postnatal depression, due to their tendency to minimise stress and their health seeking behaviour. However, current standardised tools such as the EPDS do not reflect the understanding and perception of women from BME groupsas demonstrated by Clifford et al, (1999). Edge, (2004) focus on ethnic groups offers greater understanding into the efficacy of the use of the EPDS. Although the findings from these studies were from Caribbean women, the overall evidence suggests that using the EPDS alone may not be the most effective method for assessing women from different cultural background. Oates et al, (2004) looked at postnat tal depression across countries and cultures and compared the emerging themes across different centres. This study found morbid unhappiness after child birth comparable to postnatal depression but not all saw this as an illness remediable by medication. This cultural approach also helps to understand why boys, who are most valued in Asian and African societies, in western society are most at risk of insecure attachment, cognitive difficulties and behavioural problems if their mothers had postnatal depression (Sharp et al, 1995). The consequences of this delayed effect of postnatal depression for the subsequent generations could be substantial (Chisholm et al, 2003). However, it is difficult to generalise the validity of the outcome due to lack of clarity in data collection. Moreover, the homogeneity in data collection could not be compared because participants remained in their cultural environment. The findings therefore cannot be directly compared to the present study which looked at African women living in Greenwich, UK, whose thinking and perception might be different in the way they respond to postnatal depression (Cox, 1999). Two anthropological studies, by Clifford et al, (1999), and Oates et al, (2004), in postnatal disorder, confirm the value of cultural education and training to assist with the understanding of the pathways to care and prevention of postnatal depression.

Research methodology

The researcher will use a focus group method to collect data from participants. Focus group

is an in depth, open ended group discussion that enables exploration of specific issues on predefined and limited topics (Krueger, 1988). The purpose of the focus group was to elicit and validate collective testimonies and group resistance narratives. These testimonies and narratives have been used by women and could be used by any subjugated group ‘to unveil specific and little-researched aspects of women’s daily existences, their feelings, attitudes, hopes, and dreams (Madriz, 2000). Focus groups can facilitate the identification of cultural values and they are said to be valuable when researching ethnic minority groups (Wilkins et al 2002). Forthis current study, participants felt very comfortable within the groups knowing they were not alone in the way they felt during and after pregnancy. They were also able to share their experiences with their mother-in-law knowing others have the same experiences.

Despite the positive attributes of using focus groups, I was also aware of the potential influence of dominant group members. This means supporting unassertive participants to articulate their views. I was also aware that not everyone would be open about discussing deeply personal and sensitive issues in a group setting. One of the difficulties centres on recording data during the discussion whilst manipulating recording equipment and being attentive to detailed information. These difficulties were managed with a co-facilitator who assisted with field note-taking, verbatim transcribing as well as voice tape recordings.

Ethical Approval

Ethics approval was obtained from South London Research and Ethics Committee before approaching the women. An application was made through the Integrated Research Application System and a review of the process was made before the panel of the Ethics Committee. The Trust also gave Research and Development approval before commencing the study.

Population and Sample size

Twenty six women of African background aged between 16-45 years old, were purposively selected from the health visitors’ list all of whom were African women who had migrated and are settled in the UK. This age group wasselected as it represents the reproductive and fertile record of a woman’s life. Women under the age of 16 were excluded due to the complex and sensitive nature of the topic. Participants were asked about their marital status and the kind of support network they have at home, as studies have shown that women’s marital status and the kind of support network they have are significant risk factors that may predispose a woman to postnatal depression (Patel et al, 2002). Similarly, their educational background or employment status may also affect their perception and the way they describe postnatal depression. Letters were sent to all the stakeholders such as the health visiting teams, the homeless liaison team, the safeguarding team and the clinical psychologist team, after receiving ethics and R&D approval.

Recruitment

Recruitment of participants was made easy by colleagues who supported the course of the study. Out of the 26 women invited, 22 confirmed attendances but only 17 participated in the study. Eight attended for Group 1 and 9 attended Group 2. The groups were seen on two separate days. An information leaflet outlining the study (see Appendix 3), was sent to all

participants followed by a ‘phone call a week later. Transport was organised to take the participants to and from the focus group meeting. They were all given a gift voucher to thank them for participating in the focus group. Each focus group lasted for two hours with 15 minutes break. Focus groups were held in the Children Centre which is a familiar environment for participants. The benefit of having a co-facilitator meant the researcher was able to facilitate the discussion, while the co-facilitator was free to take notes and assist with the subsequent transcription of the data collected (Krueger, 1988).

Criteria

It was difficult to develop a strict inclusion criterion due to limitation in numbers, but the following were essential to gather useful information for the study:

• Women in the postnatal period who have delivered a baby up to a year ago.

• Must be from African descent and between the ages of 16 and 45 years.

• Must be able to speak and understand the English language.

• Must have a live baby.

Data Gathering

Women were given the consent form to sign to agree to participate in the group. A focus group schedule which focused on how women felt when they became pregnant, was used. The focus of this schedule was asking them to describe their emotional feelings and the concerns they may have had during pregnancy and after having the baby. All participants were given codes, all conversations were tape recorded and stored in a locked cabinet on NHS premises, accessible only to the facilitator. The two transcripts were read several times to understand the data. Initial coding of the transcripts was then performed. Codes will made to capture the descriptive language used by the participants. Once the data will sorted, the facilitator grouped the data into themes, and examined all the cases in the study to make sure that the description of each theme was captured (Pope et al, 2006).  Triangulation will be used to improve the reliability and validity of the data. The key findings will be presented back to the participants through follow-up phone calls. There will general agreement about the information collected. The tape recorded data will also play back to check for clarity and confirmation of their descriptions and compared with the field notes.

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