Postpartum Depression: Womens Perspectives of their Support Needs

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Postpartum Depression Womens Perspectives of
their Support Needs

• N. Letourneau PhD RN
• L. Duffett-Leger MN(C) RN

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Co-Investigators

• M. Stewart PhD
• C.-L.Dennis PhD RN
• K. Hegadoren PhD RN
• C. Rinaldi PhD CPsych
• J. Stoppard PhD CPsych

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Overview

• Background
• Study Description
• Research Findings
• Next Steps

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• 1. Background

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Causes of PPD

• Hormonal Changes
• Dopamine sensitivity
• Thyroid Dysfunction
• Negative Life Events
• Marital conflict, lack of support from friends,
  family or partner, social isolation

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What is PPD?

• persistent negative mood
• anxiety
• irritability
• sleep disturbance
• lack of energy
• lack of enthusiasm
• feelings of worthlessness
• loss of pleasure

• poor appetite
• inability to cope with daily activities (e.g.
  look after child)
• poor concentration
• poor memory
• suicidal ideation
• unreasonable fears

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Duration and Function

• Symptoms lasting longer than 1 week
• Symptoms affect functional ability to look after
  self or child

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Who is affected?

• Depression following childbirth affects up to 25
  of new mothers.
• PPD has serious implications for
• womens health
• family functioning
• health and development of children.

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When?

• PPD symptoms begin within first 12 weeks after
  birth. Duration depends on the time taken to
  access treatment.
• 50 of women remain clinically depressed at 6
  months postpartum.
• 25 of untreated women remain clinically
  depressed for over a year after the birth of
  their child.

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Need for the Study

• 50 of women decline support from a professional
  even when it is available.
• 50 of women with PPD decline medication.
• Available health services may not be sufficient
  to meet womens needs.

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Need for the Study

• For many, medication is insufficient to fully
  address PPD symptoms.
• Multiple causes of PPD suggests multiple
  interventions are needed.
• Current research has not addressed womens
  perspectives of their needs and preferences for
  support interventions.

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• 1. Study Description

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Research Questions

• For women with PPD, what are their
• Support needs
• Available resources
• Barriers to accessing resources
• Preferences for support interventions

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Research Design

• Multi-site exploratory, descriptive study
  conducted in Edmonton, Alberta (urban) and New
  Brunswick (rural).

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Sample Setting

• Eligible mothers gt18 years of age, had a baby and
  experienced PPD within the past 24 months for gt1
  week
• Mothers at both sites (AB 24, NB 18)
  participated in individual interviews
• Group interviews were conducted with mothers (AB
  5, NB 6) and service providers (AB 14, NB 18)

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Description of Sample
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Description of Sample
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• 2. Findings

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Findings

• 71 reported symptoms of depression in the last 2
  weeks
• 64 of the women reported a difficult pregnancy/
  delivery
• 83 of sought professional help for PPD from
  service providers (i.e., public health services).

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PPD Symptoms
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Provincial Differences
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Provincial Differences
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Support Needs

• Women identified a number of support needs in 3
  distinct categories
• Instrumental
• Emotional/Affirmational
• Informational

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Support Needs

• Instrumental
• In-home
• Spousal

A new mom coming to help me, to show me how easy
it is to take a baby out to go out with the car
seat, to show me how to breastfeed in a mall, or
just to be more mobile. (PPD_3)
He fully supported me. I think pause the only
reason I think he couldnt have helped me more is
he wasnt sure how to. (PPD_16)
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Support Needs

• Instrumental
• Family/Friends

My Mother-in-law helped my situation Just
having someone here all the time, who you could
just say its O.K.and she would take the baby
and you wouldnt have to worry about it (PPD_1)
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Support Needs

• Emotional/Affirmational

Getting somebody to talk with, and getting the
validation, and getting the understanding,
getting a sense of were here to help. (PPD_12)
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Support Needs

• Informational
• Knowledge for self (baby care, normal child
  development, PPD)
• As I tell everybody, you know that thing that
  comes out after the baby is a placenta, not a
  manual. We dont know any more than they do, but
  were expected to. (AB Group Interview)

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Support Needs

• Informational
• Knowledge for others (understanding
  identification of PPD)
• I want them husbands to go to a class thats
  called What the Hells Wrong With My Wife?
  laughter Explain it to them. Because they have
  no idea. They just see all of a sudden, their
  wife is different. (AB Group Interview)
• You know, you have to take counseling to get
  married, well in my religion anyways, theres
  marriage preparation courses, where are the
  children preparation courses? Where do they tell
  you to prepare for no rest, the conflicts between
  husband and wife? (PPD_33).

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Support Resources

• Mothers in New Brunswick and Alberta identified
  the need for both informal and formal supports.

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Informal Resources

• Self
• Partner
• Family and friends

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Informal Resources

• Self
• I have learned through this that you have to be
  your own advocate and you have to trust in
  yourself because, if you dont, nobody else will
  fight for you (PPD_35).
• Partner
• Id just sit there and get right quiet and Id
  look like I was going to start bawling at any
  minute and hed just come over and give me a hug
  and make me feel better PPD_36).

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Informal Resources

• Family
• One time I was feeding the baby in the kitchen
  and I just said- I have to go. So I called my mom
  and I said- mom I need you to come over with the
  kids and I have to go. I need to get some help.
  But just talking to my mom made me feel better
  (PPD_38).
• Friends
• And I have a friend who lives in the building.
  I go talk to her. If Im stressed out and just
  need a minute to get out, I just go and see her
  for a few minutes and then I come back (PPD_36).

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Formal Resources

• Medical/mental health providers
• Moms Groups, Breastfeeding Support Groups
• In-home support
• Telephone Support Lines
• Church/Spiritual Support

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Formal Resources

• Medical/Mental Health Providers
• The nurse was incredible public health. She
  talked to me, and she would phone and check on
  me, and if I was down she showed up. So she was
  really good. And my physician listened when I
  said No pills(PPD_7).
• I had a psychiatrist that was involved with my
  first pregnancy, and I got reacquainted with her
  due to the state of depression that set in during
  pregnancy. She helped me monitor things and keep
  them in a proper light as opposed to letting
  things get blown out of proportion like they
  sometimes do.(PPD_35).

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Formal Resources

• Moms groups
• Ive been meeting new moms, and that was the
  big thing, because I dont have any friends that
  really have any kids, so just to meet some new
  moms was good (PPD_15).
• In-home support
• They name of program will come and watch your
  other kid, or if you have a pile of dishes,
  theyll do dishes. If you need vacuuming, theyll
  do that. If you want to, theyll just sit down
  and talk with you and have a coffee (PPD_16).

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Formal Supports

• Telephone Support Lines
• The Mother-Baby Hotline. The twenty-four hour
  hotline, that really helped (PPD_33).
• Spiritual Support
• I think in the spiritual sense, theyre very
  supportive. Like, they cant help you personally,
  but they say they will pray for you, and if you
  need help, by all means, just ask. But I never
  asked them. Its just support in a spiritual
  sense (PPD_21).

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Barriers to Support

• Mothers with PPD identified themselves as the
  most common barrier to accessing support

You know deep down inside that you really do
need this, and you really do want it, but what
comes out of your mouth is, No, I dont need any
help even though inside, youre screaming, and
saying, Yes, for Gods sake, help me. (AB
Group Interview)
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Barriers to Support

• Self shame/stigma/denial/fear
• ? energy to make appointments, leave house, seek
  help
• Family friends minimizing symptoms
• Fear of taking anti-depressants (while
  breastfeeding)
• Lack of services or services do not meet needs
• Financial constraints
• Early maternal discharge
• Inconsistent messages difficulty developing
  rapport with service providers.

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Barriers to Support

• Self
• It was just my being worried about what people
  were going to think if I felt that way. And I
  didnt want to be given any kind of prescription
  drugs for how I was feeling. Looking back now, I
  know that I should have opened up way earlier
  (PPD_31).
• I didnt want to seem like a bad mom. My
  overriding fear was that somebody would think
  that I was being terrible and take (babies name)
  (PPD_32).
• And I think when you have suffered from
  depression before you always think that you are
  the one that cant handle situations like others
  can. And so there is a certain stigma about that.
  Obviously the word depression. I didnt want to
  be labeled that (PPD_42)

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Barriers to Support

• No Energy
• The thought of going out of my house... to
  dress that baby up and go out in public? No, I
  couldnt even think about it. No. Because that
  was just one more thing to have to do (PPD_33).
• Finances
• More finances would have helped me to go to the
  psychologist. That definitely stopped me from
  getting as much help as I needed. (PPD_31).

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Barriers to Support

• Services
• I wish there would have been more support
  groups. Because I didnt have anybody that I
  could say, Hey, you went through the same thing
  I did. Well, how do I get through this? I had
  nobody around to really talk to about that
  (PPD_36).
• Well, lack of resources. There is nothing in my
  face saying- if you are depressed call this
  number. I mean, its non-existent and just my
  own need to do it all like a good little mother,
  good little wife. And not breastfeeding Yeah,
  all the groups it seemed that were for
  breastfeeding mothers or abusive mothers or
  mothers that didnt have money, you know what I
  mean. (PPD_41).

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Preferences for Support

• Women described several preferences for
• One-on-one support
• Group support and,
• Greater public awareness about PPD

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One-on-One Support

• Instrumental and informational support
• Its that initial stage you come and you take
  some control here. You say, You dont look good.
  Go to bed. Im here, Im handling this. Dont
  even get up. Just go to bed. Were here. You
  want a mom, but not your mom. (AB Group
  Interview)
• Like teaching the mother- and this sounds so
  simple but it is necessary- teaching the mother
  to enjoy the childs toes. Teaching the mother
  how to interact with the baby and how to coo and
  how to talk to the baby, and that the baby knows
  you and loves you right away and knows your
  voice. Some mothers may not know that. Teaching
  how to deal with stress so that you are not
  freaking out at the baby because sometimes you
  are crying and yelling (PPD_41).

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One-on-One Support

• Emotional and affirmational support
• Once youve got your routines down and you know
  how to change a diaper, you know how to bathe the
  baby, you know how to get the meals on time, you
  know how to youre on top of that game, then you
  need the mental working-out, then you need the
  counseling (AB Group Interview)
• I think to be able to approach it with
  compassion and to develop a rapport you need to
  see the same person over and over again. (AB
  Group Interview)

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Group Support

• Members would include mothers with similar
  symptoms and those who have recovered.
• I would want to talk to someoneI have a group
  right now. We meet, theres four women, we meet
  every week. And I would want to talk to someone
  who has already been through postpartum
  depression, who doesnt pretend that its
  perfect, that its just a natural, earthy,
  wonderful experience. Someone whos very real,
  that I could talk to about the real side
  (PPD_33).
• Shared experience is good. Like if they are
  going through a similar experience or they are
  having similar problems. I just took a lot of
  comfort when someone would say- oh I had a
  terrible time and that was so terrible- just
  hearing other peoples stories. I dont know why
  but you take such great comfort in that- I guess
  its because you dont feel alone. You know, you
  dont feel like you are crazy (PPD_38).

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Group Support

• Group would provide a safe place where mothers
  feelings are validated.
• For me, I would have had to start in a group,
  cause theres safety in that, and kind of the
  admission that Im not okay, that theres a
  safety in the group. And then maybe, if you get,
  like, a mentor person, and then you go with
  one-on-one, once youve established kind of that
  safety. (AB Group)

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Group Support

• Group would provide an avenue for mothers to
  socialize with other mothers in similar
  situations.
• I need a group where I can feel like theres a
  safe place to say This isnt the greatest time
  of my life, and I wont be judged. And just
  getting some support around, and also just
  getting some support that you are a good mom, and
  that your baby does feel loved, even though
  youre not, like, jumping up and down for joy.
  pause And that it will get better. (PPD_12)

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Group Support

• Most women felt the group should be facilitated
  by a professional or paraprofessional with group
  facilitation skills and experience with PPD.
• I think someone that has definitely been through
  postpartum depression would be best to facilitate
  something like that because theyd have their own
  experiences that they could relate with you.
  Then youd understand that, ok, they do
  understand where Im coming from (PPD_31).

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Preferences for Support

• Public Awareness
• Women identified a need for increased public
  awareness of PPD.
• If better understood/less stigmatized, it would
  be easier for the mothers and their loved ones to
  recognize the symptoms and get help.

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Public Awareness

• I think people in general need to be more
  aware. Some people might not see it until their
  partner or their friend or their sister or
  somebody says, Youre not yourself. Other
  people around you need to know, Okay, this is a
  possibility and these are the things you look for
  and this is what you can do. (PPD_41)

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Recommendations

• Variety of intervention options
• One-on-one support early (including family,
  friends, professional)
• Group support later
• Increased public awareness about PPD

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4. Next Step
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March of Dimes Study

• One-on-one support for mothers with PPD
• Support provided by mothers who had PPD, but
  recovered
• 12 weeks of one-on-one in-home support will be
  offered
• Assess impact on PPD, maternal-child
  relationships, child development

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Acknowledgements

• S. Lavoie, N. Doiron, R. McNeil, K. Young (UNB)
  J. MacDonald, R. French, A. Bankowski, G. Lasiuk
  (U of A)
• Canadian Institute for Health Research (CIHR) -
  Institute of Neurosciences, Mental Health and
  Addiction NBIF UNB Research Fund UNB
  Work-Study Program

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The End