REFLECTION ON PREDICTORS OF POSTPARTUM DEPRESSION
The research to be reviewed in this paper concerns the examination of the widespread variety of socio-demographic factors, health risk activities, history of depression, pre-pregnancy medical disease; pregnancy associated illness as well as the birth results as risk factors for Post- Partum depression. The study is interested in focusing on providing information involving the women who experience PPD whether they have a high level of risk of future depressive incidents together with subsequent functional impairment. According to the study, there are factors which relate moderately to high risk of PPD. The purpose of this paper is to review the article which is researched on the risk factors for Post-Partum depression. The paper will reflect on the literature review of different researchers who have reviewed the risk factors for the development of PPD. The paper will as well review the results from the research article and make a conclusion in relation to the nursing exercises.
The research question
The question of this research article is to examine the wide variety of socio-demographic factors, health threat behaviors, history of depression, pre-pregnancy medical and psychiatric infection, pregnancy associated illness and birth outcomes as risk factors for postpartum, depression. The research shows how the most women who are affected by the PPD have a high risk of future depressive episodes which results in functional impairment. Moreover, PPD has been indicated to badly affect the functioning of maternal which is a risk factor for bonding of unfortunate mother-infant, consequent hindered development of the child milestones as well as the child and teenage mental health conditions. However, the risk factors found to be related to moderate on a high risk of PPD is for instance depression or the anxiety at the time of pregnancy, stressful events in life, little support socially, previous depression history as well as the personality factor of neuroticism (Karton, 2014).
This question covers most of the factors which result to the risk factors of PPD. Covering of the identified factors in a wide range will manage all the risks associated with PPD with a lot of ease. It means that a number of reviews from various studies will be considered as there is no unique study that covers all the factors at the same time. The trend that could have affected the question is inefficient factors which are associated with the question. The irrelevant information would affect the question.
Study design
The study design which was used in this study was the systematic reviews and cohort study which examine risk factors for the creation of PPD. The risks factors found to be related to moderate to high risk of PPD. This type of research design summarizes the outcomes of the available carefully designed healthcare researchers and offers a high level of evidence on the effectiveness of healthcare interventions. This kind of study design enables the author to make a judgment concerning the evidence and inform recommendations for healthcare. Therefore, this study design provides a comprehensive review of every relevant research on a specific clinical or healthy related question. There are several benefits which are associated with this kind of research design and includes that it is not expensive to review prior research as compared to creating a new study, the exhaustive review of the current literature as well as other sources (Egger, Davey-Smith, & Altman, 2013). In addition, the outcomes can be generalized as well as extrapolated into the general population in a broader manner as compared to individual research. However, there is also limitation related to systematic review which is consuming time and may also be difficult to combine the studies. The author used the identified study design because it combines all the literature reviews in order to provide evidence on the research question on the risk factors developing the PPD.
Sample size
The selected study sample was from the whole screening sample. The sample size was 3,039 women where 1,423 women are whose data were included in the research and 1,616 women were excluded from the study due to the missing of the main information on baseline demographic as well as the clinical variable considering Fischer exact tests and t-tests. In line for the significant inclusion group differences, non-response propensity scores were developed using baseline variables for instance demographics, pregnancy variables, medical conditions depression as well as risk behaviors of health. However, the inverse of the probability of not responding was used to weight the regression analysis.
A sum of 3,039 women underwent screening either at four months or eight months’ time of pregnancy. A portion of this, 1,515 women was excluded because of lack of a postpartum assessment. 84 failed to be included because of filling only out the eight-month questionnaire which didn’t have any question on the history of medical and 17 were not included because of lack of information on birth results making the sample of the study to be 1,423. Univariate investigation associating the pregnancy information for those women who were as well as those who were not included in this research revealed significant team differences. The number of the sample was adequate as it was large enough for the study question.
Data collection
The University of Washington Hospital collected the data from the women who were being offered prenatal care at the University Obstetrics Clinic. Questionnaires were the tools used to collect information from the participants. Women who participated in answering the questionnaires are those at different trimesters of pregnancy. Some of the participants had only a single questionnaire complete while others had two during pregnancy. However, the Clinical professionals had the responsibility of screening the sick with the survey questionnaire and when finalized, finding record informed consent to connect medical information with research outcomes. Due to the busy nature of city obstetrics clinic, the workforce was not able to get a small proportion of questionnaires finished. The ethical considered was that no one would have completed the questionnaire in case the person was less than 15 years of age at the time of delivery. Thus the person was excluded and considered under age.
Limitation of the study
The limitation of the research involves the study of the population from single big university clinic in one geographical area of the United States. Another limitation was the lack of use of structured psychiatric interviews for diagnosis of depression as well as a history of prior depressive episodes and not evaluating mass of the body index or social support. In order to solve the limitations, it would be necessary to subdivide the population of the study and to ensure many geographical areas are involved. On the issue concerning the use of structure psychiatric diagnosis of depression, it is necessary to measure pre-pregnancy diabetes, hypertension as well as gestational diabetes which are related to pre-pregnancy BMI. It is essential to identify the limitation of study as it creates opportunities to make suggestions for more research. It also provides an opportunity to demonstrate that an individual has thought critically concerning the research problem and understood the associated literature.
Findings of the study
According to the findings and the analysis, a sum of 6.7% of women ha a PHQ-9 score of greater than 10 at the time of pregnancy and 5.8 percent has a range of greater than 10 at the postpartum check. As in the descriptive information, women with PPD indicated significantly more depressive symptoms at the time of pregnancy as compared to the women without PPD. Moreover, the women with PPD were significant of young age, a probability of those married was less as well as educated were significantly less and were unemployed as compared to the women without PPD. In the basis of medical status, women with PPD in comparison with women without PPD are recorded with high rates of diabetes, hypertension as well as neurological situations. In association to the pregnancy, the variables did not have a difference in odd ratio. Hence, there was an increase of 10% in the odds of reporting PPD for each one point increase in PHQ-9 range evaluate at the time of pregnancy. In relation to depression, women having PPD were significantly probable to be of young age, unemployed as well as have pre-pregnancy diabetes and neurological disorders (Florio, 2013).
Health associated behavior slightly reduces the odds to 1.10. The addition of the pregnancy-associated variables failed to change the odds ratio. Hence, there is a 10 percent increase in the odds of reporting PPD for each one point increase in PHQ-9 range evaluate at the time of pregnancy (Beck, 2013). A clinically significant five-point increase in PHQ range evaluates at the time of pregnancy resulted in a 70 percent increase in the odds of PPD. There is also 95 percent confidence interval for all the involved variables.
The findings answer the question of the research as it shows that younger age, joblessness, antenatal depressive syndromes, use of ADs, pre-pregnancy chronic physical disorders and psychosocial stressors were independent determinants of the development of PPD. In the findings, most of the variables were similar and thus making it reliable. The significance and odds ranges for every variable were the same for the propensity weighted.
Summary
PPD is a quite common illness which affects the functional impairment as well as raises the risk of infant bonding of poor mother and also delays the infant development. The information showed that depressive symptoms in pregnancy, use during the screening of pregnancy, unemployment, younger age, pre-pregnancy diabetes as well as neurologic illness, use of less alcohol at the time of pregnancy, smoking and the significant level of psychosocial stressors were independent factors of risk of PPD (Florio, 2013).
The findings emphasize that the most risk factors for PPD which is potentially modifiable are depressive symptoms in pregnancy. Therefore, it is essential to improve case finding of patients with depression using well validated tools for instance PHQ-9. Women living in socially disadvantaged condition are likely to have an excessive risk for both medical as well as psychiatric disorders which results in developing at younger ages as compared to the women growing up in less vulnerable circumstances.
Pre-pregnancy diabetes was related to a greater risk of PP. The disadvantaged socioeconomic condition, adversity in childhood and depression have been seen to be related to the great risk of pre-pregnancy abnormalities of metabolic and diabetes indicating that development of this illness early in the life of a woman might reflect psychological as well as exposures.
The benefits of the study involve large sample size, using tendency weights to allow the use of the entire screening sample as well as an addition to the entire range of forecasted variables. However, the limitation of the research was the study population from single large university clinic in one geographical area. It is clear that younger age, joblessness, antenatal depressive syndrome, using ADs, psychosocial stressors, a pre-pregnancy chronic physical disorder as well as smoking were independent predictors of the development of PPD. Care on the identified risk factors will assist in the main care and Ob-Gyn physicians’ emphasis depression case finding determinations.
References
Beck, C. T. (2013). Predictors of Postpartum Depression. Nursing Research, v50 n5, 275-285.
Egger, M., Davey-Smith, G., & Altman, D. (2013). Systematic Reviews in Health Care : Meta-Analysis in Context. Somerset: Wiley.
Florio, D. (2013). Perinatal episodes across the mood disorder spectrum. paris: JAMA Psychiatry.
Karton ,C.(2014). Predictors of Postpartum Depression. Journal of Women’s Health,v23 n9, 753-759.
