Maternal Depression - Thesis Proposal Example

How do women experiencing maternal depression communicate with their doctors while making decisions about antidepressants and breast-feeding? Maternal depression is fast gaining wide spread recognition as one of the most significant health issues. The wide amount of research conducted in the past, suggest that almost 10-20% of women suffer from depression either during or within the first twelve months of their pregnancies (also known as post partum depression). Such maternal depression can give rise to serious negative health consequences posing substantial risk to the lives of both the mother as well as the child. However, regardless of the mounting evidence stating the prevalence of maternal depression among women, the health care available to address their concerns is largely neglected. This could be mainly on attributed to the fact that most women suffering from maternal depression hesitate to share their grievances with their health care providers or on account of lack of adequate knowledge regarding the same (Castle et al., 2006). However, over the past decade the awareness and significance of addressing such mental health concerns of women has risen substantially, resulting in positive approaches developed by care givers to support and offer effective treatment to such women. This paper attempts to discuss the various issues related to communication between physicians or primary care givers and their patients i.e. women suffering from maternal depression, discuss theories related to communication patterns, assess the prescription of antidepressants and advice related to breast feeding given by the physicians to the women with maternal depression and lastly suggest ways in which the communication channels can be smoothened and improved to ensure optimum provision of health care to such women. Maternal depression: meaning and definition: The term maternal depression, in its most basic form refers to a range of depressive conditions of women prior to, during or post pregnancies. These depressive conditions include prenatal depression, postpartum depression and postpartum psychosis. Such mental health setbacks in the absence of timely treatment and care may result in serious deterioration of the womens mental health posing substantial threat to their lives as well as to those of their child (Shaw et al., 2009). Significance and role of communication between physicians and women with maternal depression: Women play a central role in parenting and hence are more responsible for facilitating and coordinating conversations with their physicians regarding their personal health issues. They are hence far more likely to communicate with their physicians as compared to their family members. The General Practitioners (GPs) are posed with a challenging issue to deal with - that of communicating with women suffering from maternal depression. In a general clinical setting issues related to maternal depression and other anxiety related problems are largely handled in primary care by the GPs and their team which includes psychiatrists, counselors, psychologists as well as other mental health workers. However, it has also been observed through research that the communication between primary and secondary care is not effective enough resulting in various miscommunication issues (Jones, 2004). The physicians and primary health care workers in general are entrusted with the responsibility to act as the key facilitator and assist the patient through effective communication. Communication plays a key role in eliminating and addressing mental health issues and hence efforts must be made to establish robust channels of communication between the physicians, health care workers as well as the women patients, in order to enable the health care providers an opportunity of early detection of any mental health problems. Effective communication can help in early and timely detection of such mental health problems and take initiatives in treatment and care (Patel, Woodward, and Feigin, 2010). There has been a wide amount of research stating the differences in communication styles of male and female physicians with their women patients. Such research state that the female physicians are largely found to be far more patient-centered in their approach and communication styles as compared to their male counterparts, in the sense that they are relatively more caring, and encourage sharing of information by asking relevant questions to their patients. The female physicians are known to be better communicators when dealing with psychosocial and mental health issues. The outcomes of most of these studies are the same in case of clinical and non-clinical settings (Gielen et al., 2004; Aries, 1996; Bertakis et al., 2003). The female physicians have been largely observed to be more emotionally supportive, responsive and tactful while communicating with the women patients as compared to their male counterparts. The male physicians on the other hand are direct, aggressive and emotionally non-expressive as compared to the female physicians. Thus the women patients are shown to have better co-ordination with are generally more responsive while interacting with the female physicians. In a study conducted by Hall and Roter (2002) it was observed that there were remarkable differences in interaction of women patients with their physicians based on the gender of their physicians or care givers. The women patients were observed to be communicating effortlessly with the female physicians, and disclosed more psychosocial and biomedical information to the women physicians as opposed to that shared with the male physicians. However such an observation was countered by claims made by another set of researches, stating that these differences in communication styles are also highly influenced by the diverse cultural backgrounds of the physicians and their personal norms and values, apart from their gender differences (van der Brink-Muinen, van Dulmen, Messerli-Rorback, & Bensing, 2002 in Gielen et al., 2004). Effective and respectful communication between physican and the patients ensures optimum maternity care and includes all features of a woman-centric method of communication i.e., responding sensitively to the patients, taking into consideration their diverse backgrounds i.e. cultural, social and ethnic, understanding their belief systems and expectations with regard to the consultation session. Such a communication guarantees high level of care and enhanced experience on the part of the patients resulting in reduced incidences of complications during pregnancy (Shields, Candib, 2010). The various communication styles and the differences between the same can be explained with the help of various theories discussed in the following section. These theories provide greater insight into the manner in which communication between doctors and patients in a clinical setting influence the treatment of critical illnesses. Theories of communication: Symbolic interactionism: This theory posits that symbolic interactionism enables the development of an identity of the individuals involved in communication, via interaction with each other. With regard to a clinical setting, this theory of communication states that practitioners as well as patients, in a communication tend to form an identity and create impressions of themselves during social interaction with the patients. This interaction between the physician and the patient is referred to as symbolic interactionism. According to Byrne & Long (1976) the interaction between physicians and patients could either be patient centric or physician centric in nature. According to Stewart and Roter (1989 in Stewart, 2003) most of the interaction / communication between patients and their physicians are doctor-centric in nature, where the power of communication is vested in the physicians, rather than the patients. According to Morgan (1997) the relationship between the patient and their physician changes in accordance with the styles of communication, at various stages of their illness. For instance if their illness is severe then the power of communication will be titled towards the doctor who will be in charge of the conversation and dominate the discussion and interactions with the patients, thus symbolizing a strong paternalism over their clients. While in case of the illness being not so severe, the patients can be encouraged to participate more actively in conversation and share information or grievances regarding their health, thus making the conversation patient-centric in nature. Doctor-patient interaction in a clinical setting: Communication is a fundamental and imperative clinical skill which can be learned and acquired through training or through experience. The interaction between physicians and their patients ascertain the overall health of the patients, apart from other factors. According to Raffler-Engel (1990) there are four key phases of communication between a doctor and the patient within a clinical setting. These stages include: encounter, exchange, influence and adaptation and control. The encounter phase refers to the process by which the doctors and patients come into contact with each other and interact, to share information regarding their health. The exchange phase indicates the flow of information from both the parties concerned. The influence phase refers to the psychological and behavioral impact of such an interaction while the adaptation and control stage indicates the effectiveness and accuracy of the information exchanged as well as feedback. Each of these stages mentioned above, are observed in an interaction between doctor and patient within a clinical setting whereby each stage plays a vital role in exchange of information. The clinical interview is conducted in order to diagnose the patients health, assess their health needs, and treatment required and prescribes medication based on the interview and examination. In order for the diagnosis to be accurate, the communication needs to be effortless and flawless. One of the fundamental roles of the physicians or health care providers is to ensure accurate assessment of the patients health needs and issues faced by them. Regardless of the type and stage of the illness (i.e. mild to acute) the patient must be analyzed and examined accurately, and must not suffer from unresolved concerns. Eliciting appropriate information from the patient requires skillful communication on the part of the doctors. One of the key goals of palliative care is to meet the needs of families and patients with acute health issues. Good communication hence is the only key to successful analysis of the patients’ health, and meets their goals effortlessly (Cassel, 2003). More often than not, the physicians often encounter difficulties in interacting with patients who suffer from mental / psychological issues. This makes communication with them all the more difficult as such patients tend to suffer from bouts of anger, guilt, frustration, sadness or fear. Often times the patients are so overcome with emotion that comprehending the information given out by them becomes a difficult task for the physicians. Research state that emotion or feelings of the patient are often ignored or not given due importance while assessing the patients health status, thus leading to misinformed decisions and treatment (Cassel, 2003). Attitudes of physicians towards medication use in breastfeeding: A significant proportion of breastfeeding women are required to take medications, however information made available through research suggest that several of these women lack adequate knowledge regarding the same. This lack of information can be attributed to the failure of general practitioners / physicians to communicate effectively the significance of medication, to breastfeeding women. Also, several women studied by way of research expressed their dissatisfaction with regard to the advice received from their physicians and many even failed to initiate proper measures to avoid infection or similar other illnesses. A large number of studies centered on the subject (i.e. the attitudes and communication styles of physicians with regard to prescribing antidepressants to breastfeeding women) focused on the GPs, since they play a key role in influencing decision making, and are wholly responsible in terms of interacting with women suffering from maternal depression (Amir et al., 2009; Amir et al., 2010; Jayawickrama et al., 2010; Jones & Brown, 2000; Jones & Brown, 2003). Although according to various studies, the GPs have been found to be largely supportive in recommending antidepressant medication to breastfeeding women (Amir et al., 2010; Jayawickrama, 2010; Lee et al., 2000) some others advised the female patients to abruptly cease medication, either temporarily for a brief period of time or permanently (Brown, 2000; 2003) taking into consideration the potential health hazards of such medication as opposed to their benefits (Brown, 2003). Furthermore a significant percentage of physicians studied, even advised to completely cease breastfeeding while on medication (Lee et al., 2000). Such abrupt decision making on the part of the physicians, in the face of stark and opposing studies stating the fatal effects on the child, raise serious doubts regarding the communication or lack of the same thereof between the patient and their physicians (Brown, 2003; Lee, 2000; Illett, 1997). The use of medications such as antidepressants, according to research, was mostly prescribed by the physicians after extensive communication and interaction with their patients, and conclusion of a risk benefit analysis (Brown, 2003; Illett, 1997). The decision to prescribe antidepressants is based on various factors, the state of the female patients, and other details related to their physical and mental health. However detailed information regarding their health status can only be gained through effective interaction with the patients, but most of the survey results stated that the opinion or consent of the female patients was taken into consideration (Brown, 2000) and that the female patients were largely allowed to make an informed choice. Conclusion: In conclusion, the physician and patient interaction within a medical (as well as non-medical) setting is one of the significant issues in the field of health and medicine, and the same must be dealt with, in an effective manner. There are wide ranging debates surrounding the gender of the physician and its impact on facilitating effective communication and interaction with the women patients suffering from maternal depression. However, despite the evidence there are studies which state that other factors such as peer influences, cultural values and background of the physicians, experience etc also play an equally important role in ascertaining their communication and interaction skills. The key to effective doctor-patient communication is pursuing patient-centered care, so as to ensure optimum provision of health care services to the patients and ascertain that all their health needs are effectively addressed and resolved. Effective communication in the field of medicine offers higher benefits in terms of enhanced provision of care to the patients; accurate analysis of the patients health needs; greater efficiency in handling their unmet needs, greater supportiveness and reduced conflicts and grievances on the part of the patients. It also ensures improved outcomes in terms of enhanced patient satisfaction, and commitment on the part of the patients by way of strict adherence to the treatment plan. As discussed in the previous sections, although there is substantial amount of research which suggests that female physicians are more apt at interacting with women suffering from maternal depression in particular and patients in general, the adherence to effective communication plans on the part of the doctors can go a long way in eliminating such gender barriers and result in increased outcomes for the patients. References: Amir L. H, Pirotta, M. V., (2009). Medicines for breastfeeding women: a postal survey of general practitioners in Victoria. The Medical Journal of Australia, 191(2): pp. 126. Amir L. H, Pirotta, M. V., (2009). Medicines for breastfeeding women: a postal survey of knowledge, attitudes and practices of general practitioners in Victoria, Australia. La Trobe University: Melbourne; 2010 Aries, E., (1996). Men and Women in Interaction: Reconsidering the Differences. New York: Oxford University Press. Bertakis, K. D., Franks, P., and Rahman, A., (2003). Effects of Physician Gender on Patient Satisfaction. Journal of the American Medical Women’s Association, 58(2), Spring 2003. Byrne, P. S., Long, B. E. L., (1976). Doctors talking to patients, RCGP Publications, London Castle, D., Kulkarni, J., Abel, K., (2006). Mood and anxiety disorders in women, Cambridge University Press, Pp. 126-128 Cassel, C. K., (2003). Geriatric medicine: an evidence based approach, Springer Publication, Pp. 287-290 Gielen, U. P., Fish, J. M., Draguns, J. G., (2004). Handbook of culture, therapy and healing, Routledge Publication, Pp. 184-186 Hall, J. A., Roter, D. L., (2002). Do patients talk differently to male and female physicians? Department of Psychology, North Eastern University, Boston, MA Ilett K. F., (1997). Drug distribution in human milk. Australian Prescriber 1997, 20: pp. 35-40. Jayawickrama H. S., Amir, L. H., Pirotta, M. V., (2010). GPs’ decision-making when prescribing medicines for breastfeeding women: Content analysis of a survey. 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