Postpartum Depression Issues - Case Study Example

Postpartum Depression” is an issue that is quite common and despite the awareness of it being centuries old; it is still not sometimes given due consideration as a proper illness. According to research 10% to 16% of parous women have issues related to postpartum depression (Zlotnick et al, 2001). It has recently started getting recognized with the advent of pregnancy issues being taken seriously, in terms of mental as well as emotional problems that women have to go through in such a challenging phase of their lives. The aim of this paper is to scrutinize the researches being carried out in context with the evaluation of the effectiveness of the behaviourally-based interventions the treatment of postpartum depression. For the purpose of analyzing the key factors and findings of the studies related to the psychological interventions in relation to the postpartum depression we have taken into consideration a few studies; a brief overview of which is given as follows: Postpartum depression in women receiving public assistance: Pilot study of an interpersonal therapy oriented group intervention. (Zlotnick et al, 2001) This study was conducted on a rather small scale and is included in the American Journal of Psychiatry (2001). The purpose of this study was to determine the effectiveness of behavioural interventions in reducing the risk of postpartum depression. Thirty-seven pregnant women with at least one risk factors of postpartum depression, receiving public assistance were assigned four session group therapy intervention. Thirty-five of the women took part in the study. Later on structured interviews were carried out for the analysis of postpartum major depression (Zlotnick et al, 2001). The survey conducted by this study actually comprised of financially disadvantaged women that were of 20-32 weeks gestation, with the average age of 23, for the assessment of major postpartum risks, such as depressive symptoms or adverse social conditions (Zlotnick et al, 2001). The ones showing symptoms of depression were categorized and selected for the intervention. The intervention was based on interpersonal therapy. After that they were made to complete the Beck Depression Inventory to assess the degree of symptoms. The intervention that the new mothers received comprised of four group sessions over a period of four weeks. The results of this study showed that the four session group therapy was effective in preventing a major extent of postpartum depression in a period of three months when the women are most prone to it (Zlotnick et al, 2001). In terms of the statistics of the 35 women taken for study belonging to different groups 16 were Caucasian, 27 were single and 27 had completed high school. There were no significant differences in the two groups taken into consideration that were of those receiving the interventions and those receiving the usual treatment. The results of the Beck Depression inventory of the women receiving the interventions were relatively higher than the women receiving the usual treatments. The result of this study cannot be verified with full confidence though, because of the fact that it has been done on a very small scale and only constitutes women that have financial issues. While it is quite obvious that the issue of postpartum depression might have more pressing other factors influencing it and any study cannot just be verified by considering just one aspect of it. The diversity of the women taken as the subject matter is also not sufficient in this case. On the other hand, it proves the validity of the effectiveness of the therapy intervention on the postpartum depression but the results of it might vary on a larger scale (Zlotnick, 2001). Efficacy of interpersonal psychotherapy for postpartum depression (Stuart et al, 2000) For the verification of the influence of psychotherapy interventions on postpartum depression we can also consider this study included in the Archives of General Psychiatry (2000) in which 120 postpartum women were analyzed out of which 99 were present throughout the course of the study. These were the ones meeting the depression criteria and were assigned to a treatment pattern of 12 weeks of interpersonal therapy and were assessed every 4 weeks using various assessment tools (Stuart et al, 2000). Ten experienced therapists in private sector were recruited for the analysis and interpersonal psychotherapy sessions were carried out in 12 hour long individual session during the 12 week period. The review of the interview assessment, self-report assessments and statistical analysis was made use of for the deduction of the results (Stuart et al, 2000). The results show that after the therapy over 12 weeks, the women were observed as having recovered from depressive episode (Stuart et al, 2000). Interpersonal psychotherapy was able to show quite a significant improvement in the depressive symptoms in the women. The long duration of all the episodes that the women had to go through did show the importance of dealing with the women suffering from depression as soon as possible. The study did also show a greater ability of women taking interpersonal therapy in case of marital adjustment but the though the proof was not so statistically significant. During the course of the treatment clinical evaluators were used that did know the status of the patient (Stuart et al, 2000). There can be an issue with the relevancy of this study in terms of its small scale as even a minor number of drop outs can affect its validity. Moreover the subject’s clinical status was not kept secret from the clinical evaluators (Stuart et al, 2000) and though measures were taken to keep everything technical, it still left a loop hole for biasness. This study also lacks diversity in its subject matter as the women evaluated were mostly in a stable relationship and relatively well educated (Stuart et al, 2000). Controlled trial of the short and long term effect of psychological treatment of postpartum depression (Murray & Cooper, 2003) This is another one of those studies that has assessed the efficacy of the behavioural based interventions for the treatment of postpartum depression. For this study a community sample of major depressive women were identified and then considered for the study. This study was carried out by assigning the women suffering from postpartum depression to routine primary care, counselling, psychodynamic and cognitive behaviour therapy. After the implementation of these treatments assessments were made before as well as 4.5 and 18 months and later on after 5 years postpartum (Murray & Cooper, 2003). The analysis done over the period of the 4.5 and months and later on after 5 years of postpartum took into consideration factors such as early maternal management of infant behaviour, mother infant interactions, infant emotional and behavioural problems, infant attachment and infant cognitive development (Murray & Cooper, 2003). General linear models were used to analyze the measures of mother-infant relationship. After the controlling the potentially relevant baseline covariates such as social adversities, maternal age etc; further models were fitted to explore the effect of treatment (Murray & Cooper, 2003). Along with that the interactions between treatments and these baseline covariates was also kept into consideration. Statistical analysis was carried out by making that use of linear regression, logistic regression and binary variables (Murray & Cooper, 2003). The results of this study showed that in the first stage of analysis that was in the four month period the treatment effects were insignificant, though all the three treatments were found to reduce the risk of moderate or marked relationship issues. The analysis of the 18 month period showed that the rates of secure and insecure attachment were similar in the treated groups and the control condition. In addition to that scores on the measure of child cognitive development were also similar. In the 5 year period analysis the infants of the mothers having received the treatments had lower score as compared to the infants of control mothers. The figures of the cognitive development at this stage were also insignificant (Murray & Cooper, 2003). The whole study was able to show a short term benefits in terms of the mother-child relationship and child outcome. It also showed numerous negative findings such as no effect of the interventions on infant attachment or the infant and child cognitive development and behavioural issues (Murray & Cooper, 2003). Although this study has been carried out quite comprehensively there are still some limitations such as the ambiguity in detecting the differences between the treatment groups and also the absence of multiparous women for the sample. Although this study does show some efficacy of the behavioural interventions, effectiveness studies such as this one should be able to establish whether benefits would be obtained in routine practice. Intervening to reduce depression after birth: a systematic review of randomized trials (Lumley et al, 2004) This is another study that evaluates the effectiveness of non-pharmacological and non-hormonal interventions for postpartum depression. It took into consideration studies related to development and process evaluation of the interventions along with other studies related to women in labour, pregnant women and women in the year after birth. In addition to that it also analyzes studies that assessed depression using standard measures on validated depression scales, reporting changes from pre to post intervention. Validity assessment and data extraction were used by the authors for the selection of the studies which were grouped based on timing of the information and the population target (Lumley et al, 2004). In terms of universal antenatal no significant results were found of the interventions. There was also little effect found of the interventions in relation to selective and indicated antenatal interventions and interventions during labour. In relation to the postpartum depression the analysis of the studies was able to find that only the indicative postnatal interventions are able to reduce postpartum depression (Lumley et al, 2004). The study includes quite a valid selection of the studies for the review and analysis but as only one reviewer extracted the data it may have led to some errors. The distinction between the randomized and the quasi randomized studies is not so clear either. The fluency and clarity of the analysis felt to be seen lost in some parts of the paper. There is enough evidence to support author’s conclusions but there is a lack of systematic assessment of study quality. Discussion: The four studies considered were primarily chosen based on the fact that they cover different aspects of postpartum depression and opt for different approaches in terms of its treatment through non-medical approaches. The first two studies took into consideration, a relatively small sample of women for the analysis, while the later two constitute a greater number of women for analysis. In terms of their comparison, we see that the studies cover different types of women in terms of their status; for example, the first one comprises of women that are financially disadvantaged and receiving public assistance, the second one takes a general sample of women having depressive symptoms, while the third one consists of women that meet the major depressive criteria. The fourth study, however, takes a different approach for the analysis at hand and goes for the assessment of different studies and their results in terms of depressive parous women. The studies also differ on the grounds of their approach taken for the analysis; the first two studies opt for the interpersonal therapy procedures as the intervention for the control of the depressive symptoms, while the third one goes for the cognitive behaviour therapy for the treatment of depressive women going through the postpartum phase. In terms of the outcomes of the studies, we see that the studies that opted for interpersonal therapies for the treatment of postpartum depression were more effective, having shown positive results on different levels and aspects of the women under consideration. On the other hand the study that opted for the cognitive behaviour therapy showed mixed results that were mostly insignificant in nature, showing what little effects the cognitive behaviour therapy makes in terms of postpartum depression. We were also able to verify, through the studies under consideration, that the antenatal interventions had little effect on the level of postpartum depression and the interventions aiming for the postpartum period were relatively more effective. In terms of the treatment duration and intensity of the interventions we see that the interventions aimed at the first 3 month postpartum period were most effective as compared to the interventions and analysis aimed at a longer period of time that inculcated a higher intensity of interventions keeping aside the approach taken for the treatment. Though this aspect of the studies cannot be verified with full conviction because the primary factor in all the studies is the intervention used and the influence of such factors cannot be identified with full viability. Similarly, in terms of the settings used for the analysis and the interventions, their implications cannot be said to have much of an influence on the treatment procedures because as mentioned before the primary aspect of these treatments was primarily the therapy being used. Conclusion: Though there are various studies being carried out in this subject matter, but there is still a level of ambiguity that needs to be dealt with in order to come up with some hard facts that are not just applicable to some specific population category but that can actually be used as a platform for reference. The factors that show a tendency of influencing the mental stability of the women in terms of postpartum depression should be kept under radar for all the pregnant women from the start for their timely diagnosis and evaluation. Keeping in view the various studies being carried out, a specific treatment plan should be developed using the various overlapping aspects of those studies and their validity should be tested time and again on varying subjects in order to reach a general consensus. In view of the given results, one could suggest that while considering the non-medical interventions for the postpartum depression, the preferable approach would be of interpersonal therapy sessions and the treatment should be aimed at the postnatal period when women are most prone to depression. Overall we see a general agreement in various studies of the non-medical interventions as having a positive influence on the postpartum depression, but there is still a need for the development of a specific roadmap that has to be taken to deal with it. The subject matter of postpartum depression, being as common issue as it is, should be considered separately and should not be confused with other issues and should not be taken lightly because the health and stability of the mother is crucial not just for her stability but also for the stability of the whole family. References Zlotnick, C., Johnson, S. L., Miller, I. W., Pearlstein, T., Howard, M. (2001). Postpartum depression in women receiving public assistance: Pilot study of an interpersonal therapy oriented group intervention. The American Journal of Psychiatry. 158, 638-640. Stuart, S., W. O’Hara, M., Gorman, L. L., Wenzel, A. (2000). Efficacy of interpersonal psychotherapy for postpartum depression. Archives of General Psychiatry. 57 (11), 1039-1045. Lumley. J., Austin. M. P., Mitchel. C. (2004). Intervening to reduce depression after birth: a systematic review of the randomized trials. International Journal of Techonology Assesment in Health Care. 20 (2), 128-44. Murray. L., Cooper. P. (2003). Controlled trial of the short and the long term effect of psychological treatment of postpartum depression.the British Journal of Psychiatry. 122. 422-427 Read More