Postpartum Mood Disorders

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Postpartum Mood Disorders

• Nurses Role in Identification Intervention

Van Gogh Mother Roulin 1888
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• Betty Bowles RNC, MSN
• Nelda Coleman RN, MSN
• Lauren Jansen RN, MSN
• Midwestern State University
• Wilson School of Nursing
• Wichita Falls, Texas

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• Postpartum mood disorders affect individuals,
  families, and communities. Untreated symptoms
  have resulted in baby blues, mild to severe
  depression, and psychosis. Outcomes of untreated
  mood disorders may lead to dysfunction within the
  family unit, delays in cognitive, psychosocial,
  and social development of the newborn, and may
  pose the risk of the individual either harming or
  murdering her children.

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Postpartum Mood DisordersImpact on Families

• Robs a mother of time spent with infant
• Affects marital relationships
• Hampers maternal-child bonding
• Inhibits normal cognitive and emotional
  development of children

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Postpartum Mood DisordersIncidence

• 12 women report moderate depression after
  childbirth (CDC)
• 6 women report severe depression after
  childbirth (CDC)
• 36,500 mothers in Texas suffer from postpartum
  mood disorders annually

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Postpartum Mood DisordersIncidence

• Postpartum mood disorders (PPD) is frequently
  seen in the first 3 months after delivery
• Episodes may last 6 months or more in 25-50 of
  mothers
• 80 of women experiencing PPD will have
  additional episodes
• Many women suffer covertly and are never
  diagnosed

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Postpartum Mood DisordersEducation Assessment
Recommendations

• The American Academy of Pediatrics and the
  American College of Obstetricians and
  Gynecologists (2002) recommend pregnant women
  should be educated about PPD in the third
  trimester and assessed for risk during the
  postpartum period

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Postpartum Mood DisordersBaby Blues

• Incidence
• Up to 80 women experience baby blues
• Occurs within the first week postpartum
• May persist for several hours to several weeks

• Symptoms
• Mood swings
• Crying
• Sadness
• Anxiety
• Dependency
• Impatience
• Irritability
• Restlessness
• Loneliness

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Postpartum Mood DisordersBaby Blues

• Causes
• Emotional letdown after birth
• Increased responsibilities of motherhood
• Fatigue or sleep deprivations
• Feelings of disappointment with the birth
  experience

• Treatment
• Rest
• Proper nutrition
• Help with infant and household responsibilities
• Family and friends support systems
• Avoidance of isolation

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Postpartum Mood DisordersPostpartum Depression

• Incidence
• May occur any time during the first year
  postpartum
• Onset may be rapid or gradual, with sadness and
  lack of joy in motherhood
• Affects 10-20 of mothers.

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Postpartum Mood DisordersPostpartum Depression
Symptoms

• Psychological
• Depressed mood
• Mood swings
• Hopelessness
• Persistent guilt
• Indecisiveness
• Lack of focus or concentration
• Social withdrawal
• Poor hygiene

• Physical
• Constipation
• Exhaustion
• Eating disturbances
• Weight fluctuations
• Sleep problems
• Vague pain
• Hyperventilation
• Heart palpitations

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Postpartum Mood DisordersPostpartum Depression

• Causes
• Thought to be related to hormonal changes within
  the body
• Possible effects on serotonin levels in the brain

• Treatment
• Requires assessment by a medical professional
• Medical care
• Counseling

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Postpartum Mood DisordersPostpartum Psychosis

• Incidence
• Occurs in 1 or 2/1000 postpartum women
• Onset can vary from 2-3 days to 3 months after
  childbirth
• 5 suicide rate
• 4 infanticide rate

• Symptoms
• Insomnia
• Eating disorders
• Extreme anxiety and agitation
• Visual or auditory hallucinations
• Delusion denying birth or about infants death
• Suicidal or homicidal thoughts
• Delirium
• Mania

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Postpartum Mood DisordersPostpartum Psychosis

• Causes
• Unknown
• Treatment
• A severe medical emergency
• Requires immediate assessment by a medical
  professional
• Hospitalization for medical and psychiatric
  treatment

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Postpartum Mood DisordersRisk Indicators

• Pre-pregnancy
• History of depression
• Substance abuse
• Severe PMS
• Premenstrual dysphoric disorder
• Mood instability while taking oral contraceptives
  or fertility medications
• Thyroid dysfunction
• Previous obstetric complications

• Pregnancy
• Unwanted pregnancy
• Increased number of somatic complaints during
  pregnancy
• Depression or anxiety during pregnancy

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Postpartum Mood DisordersRisk Indicators

• Postpartum
• Premature or post-mature birth
• Labor or birth complications
• Dissatisfaction with labor and/or delivery
• Separation from infant after delivery
• Early hospital discharge

• Newborn
• Difficult infant temperament
• Infants with medical, feeding and/or sleeping
  problems
• Abrupt weaning
• Bottle feeding

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Postpartum Mood DisordersRisk Indicators

• Family
• Family history of depression
• Perceptions of patients parents parenting
• Not living with ones spouse or significant other
• Marital dissatisfaction or discord
• Lack of support from family and friends
• Other children at home

• Other
• Adverse life events
• Life stresses
• Bereavement
• Acculturation

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Postpartum Mood DisordersPredictors (Beck, 1996)

• History of previous depression
• Prenatal anxiety
• Prenatal depression
• Maternity Blues
• Low marital satisfaction
• Low social support
• Difficult infant temperament
• Life stress
• Low self-esteem
• Single marital status
• Low socioeconomic status
• Unplanned / unwanted pregnancy

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Postpartum Mood DisordersEducational
Interventions

• Prenatal Classes
• Physician offices
• Health clinics
• Media blitzes
• Newspaper articles
• Womens health newsletters
• Community lectures
• Family involvement in the educational process
• Routine prenatal screening

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Postpartum Mood DisordersTexas Initiatives

• House Bill 341
• Requires physicians, midwives, hospitals and
  birthing centers to provide pregnant patients
  with a postpartum depression resource list
• Texas Department of Mental Health
• Provides healthcare providers and families with
  tips on dealing with depression through its
  website

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Postpartum Mood DisordersScreening Tools

• Edinburgh Postnatal Depression Scale (EPDS)
• High specificity and sensitivity in detecting
  minor and postpartum depression
• 10 item self-report scale
• May be administered during the antepartum or
  postpartum period
• Postpartum Depression Scale (PPDS)
• High specificity and sensitivity in detecting
  minor and postpartum depression
• May be administered during the antepartum or
  postpartum period
• Zung Scale
• Not specific to the postpartum period
• 20 item self-report scale
• May be used in the antepartum and postpartum
  periods

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Postpartum Mood DisordersReferral and Support

• Organizations
• Texas Department of Health and Human Services
• Post Partum Resource Center of Texas
• National Mental Health Association
• Family/Community
• Support groups
• Phone bank
• Online support groups sponsored by professionals