Sarah Passey and Dr. Ana Birkhead, College of Nursing
Postpartum depression (PPD) is a subtype of major depression affecting 10-20% of new mothers around the world, with onset within 6 months after childbirth (Norman, Sherburn, Osborne, & Galea, 2010; Xie, He, Koszycki, Walker, & Wen, 2009). “It is a serious problem that affects a woman’s health and well-being, marital relationship, as well as the offspring’s health and wellbeing” (Xie et al., 2009, p.1). The mother’s feelings of hopelessness can lead to isolation and a lack of maternal/infant bonding and attachment. It is believed that the duration of this debilitating depression is determined, in part, by the accessibility of support and local services to the new mother (Norman et al., 2010). Many women, especially those that are breastfeeding, are often concerned about using prescription medications and end up suffering in silence.
“Psychosocial studies suggest that lack of social support is an important risk factor for postpartum depression” and propose that intervening with social support in the pre- and postnatal time periods may have important implication for the prevention and treatment of postpartum depression (Xie et al., 2009, p.1). In Baldwin’s (2006) research, he found that women who attend the CenteringPregnancy (Rising, 1998) support groups report increased perceived social support. This information inspired the development of my ORCA project. Our research team developed an evidence-based social support program to use as an intervention in treating mild to moderate PPD. No social support resources existed for women suffering from PPD in Utah County. Our program, implemented through the Utah County Health Department, is the first to offer this population of women a non-pharmacological and educational option to overcome their depression. This group, titled SOS4Women, has cycled through three, eight-week sessions starting in February 2011.
SOS4Women was formatted similarly to the CenteringPregnancy model developed by Sharon Rising (1998). The group was held with the same participants for the full eight weeks to increase continuity and feelings of trust within the group. The class took place every Wednesday for 90 minutes at the Utah County Health Department. Each week a mini-lesson was taught by a member of the research team. Topics for these lessons included: holistic approaches to PPD, medication options for PPD, stress of new baby on mother and family, a healthy body, and family planning. Although these lessons guided discussion for each group, time was focused on individual expression and group cohesion through sharing of personal experiences. Participants were collected with the assistance of the Welcome Baby program. Welcome Baby nurses would administer an Edinburgh postnatal depression screening (EDPS) to new mothers. If the mothers scored in the mild-moderate range for PPD, they were given information about our program and encouraged to attend. We also used this population to collect a control group for comparison.
My unique part of the project was to perform an extensive review of the literature, using at least ten references, focusing on the CenteringPregnancy social support model. I assessed its potential effectiveness with women suffering from PPD, and used the information to contribute to the formation of the larger project. I found that women suffering from PPD generally had a lack of social support or a perceived lack of support, and that women who participated in CenteringPregnancy felt a significant increase in social support. I presented my findings to the research team and this information was used to develop the group format. Our overall goal was to determine if the CenteringPregnancy model is effective in treating women with PPD.
To date, we have completed three, eight-week sessions and plan to do one more before publishing our results in the spring of 2012. We intend to publish in maternal/child health journals such as the Journal of Women’s Health and the American Journal of Maternal Child Health Nursing (MCN). We were able to present our research at the October 2011 Nursing Research Conference held at Brigham Young University. We have also discussed our work with other students and our group has been listed as a resource in community resource handouts given to new mothers in hospitals and clinics. I also wrote a letter to the county representative requesting funding for the continuation of this intervention. The nurses at the Utah County Health Department have requested continuing this program after the research is complete. Our hypothesis predicted that this group would be an effective intervention to decrease PPD in new mothers. We used the same scale (EDPS) to measure depression before and after the eightweek intervention as well as an individual interview. Women reported learning valuable skills to help overcome depression. They shared how important it was for them to have a safe place to share their feelings. They also reported developing trusting and therapeutic relationships with group members and the research team. Four women began the program on antidepressants and were able to wean off throughout the course of the program. An overall decrease in depression scores were recorded from beginning to end of the program.
This project, however, did not come without frustrations. Our largest difficulty orbited around attendance. Once women came, they would typically finish. However, getting women to the sessions proved very difficult. It is a problem that will need to be more carefully addressed in future studies. Depressed mothers often struggle getting out of the house. The idea of getting their infant ready and leaving to interact with others is an overwhelming thought. We found it very difficult to increase our attendance to the desired 8-12 women a session, usually landing around 3 women. However, we had one session with only one member. The lack of participants makes it very difficult to incorporate the “social support” aspect of this intervention. Although several dozen depressed mothers were screened, we only had a total of ten attend the course. This delays our anticipated publication date because we need more data for our pilot study.
Overall, this was and will continue to be an invaluable learning experience for me. I plan to continue working on this project with my mentor until we publish our results. I have just graduated from BYU with a BS degree in Nursing and have been hired in an Emergency Department. The skills I have gained in research will be priceless as I continue to research for my profession in order to provide the most up-to-date care. This project has also helped me understand the connection between hospital and community health, a connection that will help my future patients. I have been very grateful for this opportunity and support from Brigham Young University.
Scholarly Sources
- Baldwin, K. (2006). Comparison of selected outcomes of CenteringPregnancy versus traditional prenatal care. Journal Of Midwifery & Women’s Health, 51(4), 266-272.
- Halligan, S. L., Herbert, J., Goodyear, I.M., & Murray, L. (2004). Exposure to postnatal depression predicts elevated cortisol in adolescent offspring. Biological Psychiatry, 55,376-381.
- Ickovics, J., Kershaw, T., Westdahl, C., Rising, S., Klima, C., Reynolds, H., et al. (2003). Group prenatal care and preterm birth weight: results from a matched cohort study at public clinics. Obstetrics And Gynecology, 102(5 Pt 1), 1051-1057.
- Norman, E., Sherburn, M., Osborne, R., & Galea, M. (2010). An exercise and education program improves well-being of new mothers: a randomized controlled trial. Physical Therapy, 90(3), 348-355.
- Rising, S. (1998). Centering pregnancy. An interdisciplinary model of empowerment. Journal Of Nurse-Midwifery, 43(1), 46-54.
- Xie, R., He, G., Koszycki, D., Walker, M., & Wen, S. (2009). Prenatal social support, postnatal social support, and postpartum depression. Annals Of Epidemiology, 19(9), 637-643.