Maternal Depression

Postpartum depression is one of the most common complications of childbearing with an estimated prevalence of 19.2% in the first three months after delivery (1). Depressive episodes (major and mild) may be experienced by approximately half of women during the first postpartum year (1). Characterized by depressed mood, loss of pleasure or interest in daily activities, feelings of worthlessness and guilt, irritability, sleep and eating disturbances (2), its etiology is multi-faceted and complex (3;4).

Maternal mental health (MMH) disorders occurs in one out of 10 women during pregnancy and within the first year after birth (Maternal Health, 2016). Current law in California states no requirement for perinatal or postpartum screening. AB 244 proposes to create a pilot program to increase the healthcare providers capacity and training to manage MMH conditions to serve pregnant and postpartum women up to one year after delivery (California Legislative Information, 2017). The purpose of this paper is to increase management of MMH disorders, support of bill AB 244 and Assemblymember Cristina Garcia’s opinion, how a bill becomes a law, and how nurses can impact current law.

Segre, A. R. (n.d.). Perinatal Depression: A Review of U.S. Legislation and Law. Retrieved from www.ncbi.nlm.nih.gov: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725295/

During the last two decades, researchers have intensified their efforts to expand the findings about paternal perinatal depression. The study conducted by Goodman in 2004, has shown that the postpartum depression’s prevalence among fathers varied from 1.2% to 25% in the population sample. Furthermore, these percentages rose to achieve 24 to 50 per cent when the paternal postpartum depression was associated with maternal postpartum depression. The literature review and studies asserted the detrimental consequences of paternal perinatal depression on child wellbeing and development (Children, C. on D., Parenting Practices, and the Heaslthy Development of, Medicine, I. of, Education, D. of B. and S. S. and, & Council, N. R., 2009) such as hyperactivity, emotional deregulations, behavioral problems (Davis, Davis, Freed, & Clark, 2011, van den Berg et al., 2009). These studies outlined the importance of prevention and intervention to foster the paternal perinatal depression issue, through developing screening, diagnosis and management guidelines.

Postpartum psychiatric disorders, particularly depression, has become the most underdiagnosed complication in the United States. It can lead to increased costs of medical care, inappropriate medical care, child abuse and neglect, discontinuation of breastfeeding, and family dysfunction and adversely affects early brain development (Earls, 2010). Over 400,000 infants are born to mothers that are depressed. One of 7 new mothers (14.5%) experience depressive episodes that impair maternal role function. An episode of major or minor depression that occurs during pregnancy or the first 12 months after birth is called perinatal or postpartum depression (Wisner, Chambers & Sit, 2006). Mothers with postpartum depression experience feelings of extreme sadness, anxiety, and exhaustion that may make it difficult for them to complete daily care activities for themselves or for others (Postpartum Depression). The six stages of postpartum are denial, anger, bargaining, depression, acceptance and PTSD. These stages may affect any women regardless of age, race, ethnicity, or economic status. However only a physician can diagnose a woman with postpartum depression. It does not occur because of something a mother does or does not do, it’s a combination of physical and emotional factors. After childbirth, the levels of hormones in a woman’s body quickly drop; which may lead to chemical changes in her brain (Postpartum Depression). Unbalanced hormones may trigger mood swings.

Postpartum depression, which is the most prevalent of all maternal depressive disorders, is said to be the hidden epidemic of the 21st century. (1) Despite its high prevalence rate of 10-15% and increased incidence, postpartum depression often goes undetected, and thus untreated. (2) Nearly 50% of postpartum depression cases are untreated. As a result, these cases are put at a high risk of being exposed to the severe and progressive nature of their depressive disorder. (3) In other words, the health conditions of untreated postpartum depression cases worsen and progress to one of their utmost stages, and they are: postpartum obsessive compulsive disorder, postpartum panic disorder, postpartum post traumatic stress, and postpartum psychosis.

Postpartum depression (PPD) affects at least 10-20% of new mothers. However, the true incidence may be much higher due to the fact that screening is not considered to be a standard practice, leaving PPD undetected and untreated in many women (Schaar & Hall, 2014). Postpartum depression not only negatively affects the mother; it also has a negative impact on the infant. For this reason, it is important for the health care providers caring for pregnant and postpartum mothers to screen them for risk factors associated with PPD, as well as educate them on ways to lessen their chances of getting PPD. It is also important for the health care providers to screen for PPD with a standardized tool like the Edinburgh Postnatal Depression Scale (EPDS), and to take action in treating it when it is suspected or diagnosed.

As mental health in America is finally being addressed and more research is seen, it is important to look at the potential causes or correlations that lead to common diagnoses for patients. According to Brummelte and Galea (2010), “depression affects approximately 1 in 5 people, with the incidence being 2-3x higher in women than in men.” Postpartum depression (PPD), a subset of this debilitating disease, has an estimated prevalence rate of 13-19% with another estimated 50% that are undiagnosed (O’hara and McCabe, 2013). As a whole, it has the same symptoms as major depressive disorder but diagnosis occurs within 0-4 weeks of giving birth (American Psychiatric Association, 2013). Part of this lack of diagnosis is due to a multitude of healthcare

Depression is a common problem during and after pregnancy; about thirteen percent of pregnant women and new mothers have depression (Women’s Health, par. 2). According to the National Institute of Mental Health, postpartum depression is defined as a mood disorder that can affect women after childbirth (National Institute of Mental Health, par. 2). Even though the mothers that suffer from postpartum depression often think it is their fault, postpartum depression can happen to any mother. This is because it is a disorder that is out of their control, it is common among many mothers and it is usually caused by a hormonal imbalance.

Mental health has become an important factor in a persons well-being and is recognized as having the same importance as physical health. The mental health of a person can determine how they act in society. Their mood and behavior can be severely affected in ways that family or friends don’t understand. A mood disorder that has a significant affect on family members is called postpartum depression. Postpartum depression is a mood disorder that occurs in women who have given birth a few weeks prior. This mood disorder is diagnosed after two months or even longer, new mother can be continuously sad throughout the day and feel as though not having a connection with their baby. Doctors are not able to know which mother will have postpartum depression

According to two recent studies, 7-13% of all postpartum women suffer from depression. Even more alarming, the prevalence of postpartum depression (PPD) in mothers who have pre-term infants rises to 30-40% according to a recent review (Robertson E, Grace S, Wallington T, Stewart DE., 2004; Schmied V, Johnson M, Naidoo N, et al., 2013). Mood and anxiety disorders, specifically PPD, are severe, yet common complications in women of reproductive age. Undertreated depression in postpartum women is associated with health risks for both the mother and infant, making the goal of euthymia a top priority in the care of postpartum women. Current practice regarding PPD focuses on the triad approach of early detection and prevention, the use of pharmacotherapy, and the use of psychotherapy. However, the treatment of mental illness during pregnancy requires weighing the benefits of pharmacological treatment for the mother, to the risk of the medications on the growth and development of the fetus as well as the theoretical risks associated with undertreated depression. However, many studies are showing that the risks of postpartum depression to both the mother and infant significantly outweigh the risks of pharmacological treatment during pregnancy. Also, due to the ethical issues surrounding trials of pharmacotherapy during pregnancy, further research to determine evidenced-based methods of treatment are still necessary. The most important intervention to date is a

Depression is a major public health problem that is twice as common in women as men during the childbearing years. Postpartum depression is defined as an episode of non-psychotic depression according to standardized diagnostic criteria with onset within 1 year of childbirth (Stewart D., et. al, 2003, p. 4). For women aged 15 to 44 years around the world, Postpartum Depression is second to HIV/AIDS, in terms of total disability (World Health Organization, 2001). Depression has a profound impact on parameters of interpersonal behavior. Post-Partum depression

Postpartum depression is a mood disorder in females that is known to be present within the 4 to 6 weeks after childbirth (Battle et al). This condition is the most common complication after childbirth (Mosses-Kolko et al.,2009).Studies have shown predictors which lead to postpartum depression such as maternal childhood maltreatment and lifetime posttraumatic stress disorder (PTSD)in pregnancy (Seng 2013).A variety of factors exist among certain subgroups of women that may lead to postpartum depression. Postpartum depression affects approximately “one out of eight of the more than four million women who give birth in the United States every year”(Kruse et al. 2013a). The estimation of PPD in the US, UK, and Australia is from 7% to 20 % (Fitelson

Postpartum depression is the most common psychological complexity that occurs after childbirth (Bakhshizadeh, 2013). This form of depression has been reported to be as high as 20% (Asltoghiria, 2012). The mother will begin to experience postpartum depression between the birth of the infant and 6 to 8 weeks later (Bhati, 2015). Depending on the person, the typical length of postpartum depression ranges anywhere from two weeks to two years in length (Posmontier, 2010). It is thought that postpartum depression affects mothers of multiples at a greater incidence than mothers whom birth just one child, and the chance increases with the number of children in a multiple birth. Evidence shows that the older the mother’s age at the time of birth, shows there is no notable increase in the risk of being diagnosed with postpartum depression. Another factor that is thought to have an influence on the diagnosis of postpartum depression is income within the household. A study shows that as income goes down, the risk of having

A mother who struggles with depression post-partum is likely to expose her baby to more harmful effects. Gerhardt (2015) states that the baby of a depressed mother can find it difficult to cope with or get over stress, or they may be more fearful (p. 21). These babies also may respond to others with depression themselves, as their mother may be neglectful in their care (Gerhardt, 2015, p. 36). One of the reasons for this is because of their cortisol levels, which can fluctuate situationally. However, in infants this can affect their development (Gerhardt, 2015, p. 83) as well as their immune system (Gerhardt, 2015, p. 118), and is evidence that a mother with depression can have a significant impact on her child well beyond when the depression occurs. Additionally, Gerhardt (2015) notes that, “When they grow up, these babies of depressed mothers are highly at risk of succumbing to depression themselves.” (p.