PPD is similar to clinical depression.it is not only prevalent among women but also in men. sufferers are not alone and they can prevent this by talk, talk and talk.
5 charts on South Africa as a source country for international student recrui...
Postpartum depression
1. TOPIC:
POSTNATAL DEPRESSION
Presented by:
Mrs. Sukhbir Kaur
Associate Professor,
B.Sc.(N), PGDHM, M.Sc.(N) Ph.D. Scholar
Sri Guru Ram Das College of Nursing,
Sri Guru Ram Das university of Health Sciences.
“ BEYOND THE BLUES”
4. TERMINOLOGY
PERINATAL : means the period of time covering your
pregnancy and up to roughly a year after giving birth. It’s made
up of two parts:
• peri meaning ‘around’ and natal meaning ‘birth’.
POSTPARTUM : postnatal or postpartum meaning ‘after
birth’
DEPRESSION: it is major depressive disorder in which there
is low mood and aversion activity that can affect a person’s
thought, behavior, feelings and sense of well – being.
5. POSTNATAL BLUES or baby blues: Many women feel a
bit down, tearful or anxious in the first week after giving
birth. This is often called the "baby blues" and is so common
that it’s considered normal. The "baby blues" don’t last for
more than two weeks after giving birth.
6. Having a baby is a big life event, and it’s
natural to experience a range of emotions
and reactions during and after your
pregnancy. But if they start to have a big
impact on how you live your life, you
might be experiencing a mental health
problem.
7. INTRODUCTION
Depression is more common in women than men.
The report on Global Burden of Disease estimates
the point prevalence of
unipolar depressive episodes to be 1.9% for men
and 3.2% for women, and the one-
year prevalence has been estimated to be 5.8% for
men and 9.5% for women.
The incidence among women is twice that of men
and peaks between 18 to 44 years of age - the
childbearing years
8. DEPRESSION IN WOMEN
Women are at increased risk of mood disorders
during periods of hormonal fluctuation-
premenstrual
postpartum
Perimenopausal .
9. THE RANGE OF POST-DELIVERY MOOD
DISORDERS
50% to 80% of women
experience transient “baby
blues” within the first two
weeks following delivery
0.1% to 0.2% of women
experience postpartum
psychosis usually within the
first 4 weeks following
delivery
10. Around one in five
Women will experience
a mental health problem
during pregnancy
or in the year after giving birth.
Postnatal depression is common mental health
problem and is a type of depression that many
parents experience after having a baby
11. It's a common problem, affecting
more than 1 in every 10 women
within a year of giving birth. It
can also affect fathers and
partners, although this is less
common.
12. It's important to seek help as soon as
possible if you think you might be depressed,
as your symptoms could last months or get
worse and have a significant impact on you,
your baby and your family.
With the right support, which can include
self-help strategies and therapy, most women
make a full recovery.
13. 700 B.C.
• The earliest reports of women
experiencing emotional difficulties after
childbirth were found
1700
• Women often did not report their
symptoms for fear of being
institutionalized with the diagnosis of
neuroticism and insanity .
1850
• Postpartum depression is defined as
mental disorder and was referred to as
postpartum psychosis
1950
• Popular magazines and journals such as
vogue and ladies home journal begin
publishing articles that raised awareness
of postpartum depression
14. 1980
• The DSM- III was published and first
step towards treating the symptoms of
PPD were made
2000
• There is an increase in the amount of
reports of postpartum depression and
celebrities giving public testimonials
of their battle with PPD.
2014
• The treatment of this disorder calls
women to adapt to the role of
motherhood rather than adapting the
role of motherhood to fit the women
15. EPIDEMIOLOGY OF PPD
Postpartum
depression is
found across the
globe, with rates
varying from 11%
to 42%.
According to the
National Institutes
of Mental Health,
studies show that
the childbearing
years are when a
woman is most
likely to experience
depression in her
lifetime.
6.8% to 16.5% of
women experience
postpartum
depression (PPD)
also known as
postpartum major
depression (PMD)
16. More than 10 million cases per year in India.
It affects 20% of mothers in developing countries according to
WHO.
African American mothers have been shown to have the highest
risk of PPD at 25%, while Asians had the lowest at 11.5%
17. Among men, in particular
new fathers, the incidence of
postpartum depression has been
estimated to be between 1% and
25.5%. In the United States,
postpartum depression is one of
the leading causes of the murder
of the children less then one
year of age which occurs in
about 8 per 100,000 births
18. DEFINITION
Postpartum depression (PPD), also called postnatal depression or
maternal depression , is a type of clinical depression which can
affect both sexes after childbirth. Symptoms may include
sadness, low energy, changes in sleeping and eating patterns, reduced
desire for sex, crying episodes, anxiety, and irritability.
19. According the Mayo Clinic, Postpartum Depression may seem like
Baby Blues at first; however, the symptoms are more intense and
longer lasting, eventually impacting a mother’s ability to care for her
baby.
Maternal depression is the mood disorders with symptoms similar to
the “blues” that persist beyond 2 weeks. Symptoms can be mild to
severe.
20. Difference between Baby blues
and PPD
POST PARTUM BLUES
Onset at 3rd or 4th day
post- delivery and can
last from a few days
to a few weeks.
POST PARTUM
DEPRESSION (PPD)
Onset can be anytime
one year after delivery
and last more than 2
weeks
22. While many women experience self-
limited, mild symptoms postpartum,
postpartum depression should be
suspected when symptoms are severe
and have lasted over two weeks.
While the causes of PPD are not
understood, a number of factors have
been suggested to increase the risk:
23. Risk factors
Prenatal depression or anxiety
A personal or family history of depression
Moderate to severe premenstrual symptoms
Maternity blues
Birth-related psychological trauma
Birth-related physical trauma
Previous stillbirth or miscarriage
24. Formula-feeding rather than breast-feeding
Cigarette smoking
Low self-esteem
Childcare or life stress
Poor marital relationship or single marital status[
Low socioeconomic status and social support
Infant temperament problems/colic
Unplanned/unwanted pregnancy
Elevated prolactin levels
Oxytocin depletion
Violence against women
25. The cause of PPD is not well understood.
Hormonal changes, genetics, and major life
events have been hypothesized as potential
causes.
Evidence suggests that hormonal changes may
play a role.
Hormones which have been studied
include estrogen, progesterone, thyroid
hormone, testosterone, corticotrophin releasing
hormone, and cortisol.
Causes
26. After childbirth, a
dramatic drop in
estrogen and
progesterone may
contribute to
postpartum
depression
Decreased in thyroid
hormone .
-tired and depressed
feelings
- Changes in blood
pressure,
- immune systems and
metabolism can lead
to fatigue and mood
swings.
Emotional changes .
- sleep deprivation
- trouble handling
even minor problems.
- anxiety related to
ability to care for a
newborn.
- feel less attractive
- feel they have lost
control over their life.
27. S
Lifestyle influences can also be a cause of
Postpartum Depression. These include:
• A demanding baby
• Older siblings
• Difficulty breast-feeding
• Exhaustion
• Financial problems
• A lack of support from loved ones
Fathers, who are not undergoing profound
hormonal changes, can also have postpartum
depression. The cause may be distinct in males.
28. EMOTIONAL SYMPTOMS
Increased Crying
Irritability
Hopelessness
Loneliness
Sadness
Uncontrollable mood swings
Feeling overwhelmed
Guilt
Fear of hurting self or baby
Ideas of suicide
SIGN AND SYMPTOMS
29. BEHAVIORAL SYMPTOMS
Lack of, or too much,
interest in the baby
Poor self-care
Loss of interest in otherwise normally stimulating
activities
Social withdrawal and isolation
Poor concentration, confusion
31. MYTHS ABOUT POSTNATAL DEPRESSION
Postnatal depression is often misunderstood and there are many myths
surrounding it. These include:
Postnatal depression is less severe than other types of
depression.
Postnatal depression is entirely caused by hormonal changes.
Postnatal depression will soon pass.
Postnatal depression only affects women. Research has actually
found that up to 1 in 25 new fathers become depressed after having
a baby.
32. Diagnosis
Postpartum depression in the DSM-5 is known as "depressive
disorder with peripartum onset". Peripartum onset is defined as
starting anytime during pregnancy or within the four weeks following
delivery.
The criteria required for the diagnosis of PPD are the same as those
required to make a diagnosis of non-childbirth related major
depression or minor depression.
In ICD – 10 PPD is classified under F 53.0 as Mental and behavioral
disorders associated with puerperium, not elsewhere classified.
33. Screening
In the US, the American College of Obstetricians and Gynecologists
suggests healthcare providers consider depression screening for
perinatal women.
Additionally, the American Academy of Pediatrics recommends
pediatricians screen mothers for PPD at 1-month, 2-month and 4-month
visits.
However, many providers do not consistently provide screening and
appropriate follow-up. For example, in Canada, Alberta is the only
province with universal PPD screening. This screening is carried out by
Public Health nurses with the baby's immunization schedule.
34. The Edinburgh Postnatal Depression Scale , a
standardized self-reported questionnaire. If the new
mother scores 13 or more, she likely has PPD and
further assessment should follow.
In india Prime MD today questionnaire is used –
primary care evaluation for mental disorders
translated into 11 indian languages
35. Prevention
A 2013 Cochrane review found evidence that
psychosocial or psychological intervention
after childbirth helped reduce the risk of
postnatal depression, including home visits,
telephone-based peer support, and
interpersonal psychotherapy, as depressed
mothers commonly state that their feelings of
depression were brought on by "lack of
support" and "feeling isolated."[
36. Prevention
A major part of prevention is being informed
about the risk factors, and the medical
community can play a key role in identifying
and treating postpartum depression.
Women should be screened by their
physician to determine their risk for acquiring
postpartum depression.
Also, proper exercise and nutrition appear to
play a role in preventing postpartum,
and depressed mood in general.
37. TREATMENT
1. Psychological treatments : Talking treatment
Psychological therapies are usually the first treatment
recommended for women with postnatal depression.
The main types used are described below.
a. Guided self-help
b. Cognitive behavioral therapy
c. Interpersonal therapy
2. Antidepressants
38. A. guided help :
Guided self-help involves working through a
book or an online course on your own or with
some help from a therapist.
The course materials focus on the issues you
might be facing, with practical advice on how
to deal with them.
The courses typically last 9 to 12 weeks
39. Example, some women have unrealistic expectations
about what being a mum is like and feel they should
never make mistakes. As part of CBT, you'll be
encouraged to see that these thoughts are unhelpful
and discuss ways to think more positively.
CBT can be carried out either one-to-one with a
therapist or in a group. Treatment will often last three
to four months.
B. Cognitive behavioral therapy (CBT)
40. Interpersonal therapy
Interpersonal therapy (IPT) involves
talking to a therapist about the
problems you're experiencing.
It aims to identify problems in your
relationships with family, friends or
partners , marriage and how they
might relate to your feelings of
depression.
Treatment also usually lasts three to
four months.
41. 2. ANTI DEPRESSANTS usually need to
be taken for at least a week before the
benefit starts to be felt, so it's important to
keep taking them even if you don't notice
an improvement straight away. You'll
usually need to take them for around six
months after you start to feel better. If you
stop too early, your depression may
return.
Ex. SSRIs : fluoxetine, sertraline,
venlafaxine,
Newer drugs : Bupropion, Escitalopram
42. Alternative
remedies
St John's Wort
is a herbal
Cranial nerve
stimulation
Bright light
therapy
Folic acid
Omega 3 – fatty
acids : flax seeds,
fish, salmon
Vitamins B- 2 :
riboflavin
SAMe – S-
adenosyl
methionine
Acupuncture
Exercise
43. Adjunctive therapy as Hormone therapy
: ERP therapy can be given along with
antidepressants.
44. There are a number of things you can try yourself to improve your
symptoms and help you cope. These include:
talk to your partner, friends and family
don't try to be a "super mum"
make time for yourself
rest when you can
exercise regularly
eat regular, healthy meals and don't go for long periods
without eating
don't drink alcohol or take drugs, as this can make you feel
worse
Keep a daily diary of your emotions and thoughts
Give yourself a credit for things you accomplish
Give permission to yourself to feel overwhelmed
Join a support group
47. 1. Active- listen and identify client’s perceptions of
current situation.
2. Emphasize the need for continued communication
with the partner or a close friend who is available
3. Encourage verbalization of fears and anxieties and
expressions of feelings depression.
4. Discuss the realities of parenting and the fact that it
may be exhausting.
5. Point out infant cues and explain their meaning. This
helps her feel better about herself and her ability to
care for the infant.
6. Include the spouse in discussions about the woman’s
condition.
7. Emphasize the importance of the mother taking the
medication as ordered. Antidepressants are often used
for PPD and may be continued for 6months or more.
8. Assist the mother and her partner in identifying
people who are available to provide support.
48. RESEARCH STUDIES :
1. Shivalli S, Gururaj N (2015) conducted a study on
Postnatal Depression among Rural Women in South
India, in order to elicit socio-demographic,
obstetric and pregnancy outcome predictors of
Postnatal Depression (PND) in Karnataka state,
India. Hospital based analytical cross sectional
study design was taken and was conducted in rural
tertiary care hospital of Mandya District, Karnataka
state. PND prevalence based estimated sample of
102 women who came for postnatal follow up from
4th to 10th week of lactation was taken. The
Edinburgh Postnatal Depression Scale (EPDS) was
used to assess PPD.
49. Conclusion
Risk of PND among rural postnatal women was high
(31.4%). Birth of female baby, poverty and
complications in pregnancy or known medical illness
could predict the high risk of PND. PND screening
should be an integral part of postnatal care. Capacity
building of grass root level workers and feasibility
trials for screening PND by them are needed.
50. 2. Dr Prabha Chandra of the Department of Psychiatry, Nimhans, Bangalore
conducted a study titled 'Delusions related to infants and their association with
mother-infant interactions in postpartum psychotic disorders’. This study, done
on about 100 women, found that nearly 50% of them ended up developing
delusions in the postpartum period. These women were subsequently admitted
to Nimhans for treatment. The study also showed that 40% of the women with
postpartum depression had thoughts of killing their baby while nearly 36%
exhibited such behavior.
53. References
Antenatal and postnatal mental health: clinical management
and service guidance. NICE CG192 (2014) National Institute
for Health and Care Excellence: London.
Musters C, McDonald E, Jones L (2008) Management of
postnatal depression. British Medical Journal, 337, 399-403.
Dennis CL, Hodnett ED (2007) Psychosocial and psychological
interventions for treating postpartum depression. Cochrane
Database of Systematic Reviews. Oct. Issue 4.
Raj E.B . 2014. Debr’s Mental health psychiatric Nursing.
EmmesMedical publishers. Banglore. 133- 154.
Hinweis der Redaktion
Risk first time is 10% One episode risk increases to 20 % But chance of remaining well is still 80%
Self-care, stress reduction, quick assessment and treatment of new depression reduces risk and effects of illness