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Project Synopsis Submitted to IGNOU for the program of Master of Arts Degree in PSYCHOLOGY BY ENROLMENT NUMBER: UNDER THE SUPERVISION OF PROGRAMME COORDINATOR (MAPC) DISCIPLINE OF PSYCHOLOGY, SOSS, INDIRA GANDHI NATIONAL OPEN UNIVERSITY, MAIDAN GARHI, NEW DELHI - 110068
Its symptoms are very common. Such as mood swings, sadness, irritability, desire to cry and worry about whether the child will be able to handle it. This change in behavior gets resolved automatically after some time. There is no need of medicines for this. However, if symptoms increase then treatment becomes necessary. As the disease progresses, one does not feel sleepy, does not feel hungry, the patient is lost in himself and he gets the idea of suicide. This is the next stage of the disease and it is called postpartum depression. In this, many times the woman even gives up her child. It also proves dangerous for the child. However, this happens in very few cases. Gynecologist Bhanupriya at GB Pant Hospital in Delhi says that mental problems after delivery can be of any kind. As such, another part of it is postpartum anxiety. In this, the woman is very scared for her child. He starts feeling threatened in everything. Many times she does not even let the child put her hands up. What are the causes of postpartum depression? Dr. Praveen Tripathi says that there can be many reasons for the change in behavior of the mother. Some of which are as follows-
Women with histories of mood disorders appear to be more vulnerable to relapse during the postpartum period. Gold (2002) states women with a history of postpartum depression are at a 50% higher risk for recurrent episodes following subsequent pregnancies. The risk of postpartum depression in women with a history of depression is as high as 25% to 30% (Gold, 2002). According to Choi et al. (2009), woman with a history of depressive symptoms are nearly twice as likely to need counseling for depressive symptoms postpartum. Inandi et al. (2005) also confirmed that women with past psychiatric history had an increase in depressive symptoms. Furthermore, studies have shown that having a history of mental illness increases the odds of postpartum depression. In the current study, participants with a history of mental illness including depression were excluded from participation. According to Chen (2008), mothers of multiple births are at an increased risk for numerous complications. A study was conducted by Sheard, Cox, Oates, Ndukwe, and Glazebrook (2007) which compared psychological outcomes in first time parents conceiving one or more children through in-vitro fertilization (IVF). Using the Edinburgh postnatal depression scale (EPDS), their study showed higher levels of stress and anxiety during the second and third trimester. Stress during pregnancy is a risk factor for postpartum depression (Choi et al., 2009). Glazebrook, et al. (1999) conducted an ongoing study on physiological adjustment during pregnancy and postpartum in in-vitro fertilization births. The results suggested that couples with multiple births (as a result of IVF treatment) experience higher levels of anxiety during the second and third trimesters of pregnancy. According to Choi et al., (2009), there is an increased risk for complications with multiple gestations which leads to higher parental stress. According to Choi et al., parental stress is a risk factor for postpartum depression.
Flaherty & Damato (2009) found that mothers of twins sleep an average of 5.4 hours in a 24 hour period, compared to the recommended 7-8 hours of sleep per night. According to Haddon (2005), 76 % of mothers of multiples felt constantly exhausted as compared to 8% of mothers of singletons. Haddon’s findings showed poor sleep quality and quantity leads to increased risk for postpartum depression. According to Inandi, et al., (2005) women who have a supportive family or a significant other are less likely to suffer from postpartum depression. Their study involved 1,350 women during their first postnatal year, and aimed to identify risk factors. for depression. Higher EPDS scores were identified in women who were married and younger than twenty-five, who had poor family support or lack a close friend, and insufficient support during pregnancy. Risks were associated with poor relationships both in childhood and with their current family and relationships. Skari et al. (2002) conducted a prospective, population based cohort study comparing levels of psychological stress after childbirth. Childbirth itself was not found to be a psychological distress to most parents. Maternal distress was predicted by being a single parent. The author concluded that less social support increased the likelihood of increased acute stress response, and thereby PPD. Abrams & Curran’s (2009) research showed there is a relationship between low income status and postpartum depression. The average annual cost of housing, food, transportation, clothing, healthcare, and childcare per child (in a two child, husband and wife home) is between $8, and $9,450 (Lino, 2010). Inandi et al. (2005) found that high income protected women against depressive symptoms. The meta-analysis by Beck (2001) showed a depression rate of 24.35% for incomes under $10,000. The rate for PPD decreased as the income increased. Beck’s study
disturbance, fatigue or loss of energy, difficulty concentrating, feelings of worthlessness or guilt, and recurrent thoughts of death. The onset of symptoms is within four weeks of delivery (American Psychological Association, 2000). The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for diagnosing major depression is often used to diagnose PPD. According to the DSM-IV, symptoms of major depression include: depressed mood, lack of pleasure or interest, sleep disturbances, weight loss, loss of energy, agitation, feelings of worthlessness, diminished concentration, and frequents thoughts of death or suicide.
Beck (2000) began researching perinatal issues as early as 1972. The concepts and definitions used to describe Beck’s PPD theory have been refined as her research on postpartum depression has developed over the years. The purpose of this theory was to provide insight into the experience of postpartum depression. Gold (2002) states women with a history of postpartum depression are at a 50% higher risk for recurrent episodes following subsequent pregnancies. The risk of postpartum depression in women with a history of depression is as high as 25% to 30% Choi et al. (2009), woman with a history of depressive symptoms are nearly twice as likely to need counseling for depressive symptoms postpartum.
Inandi et al. (2005) also confirmed that women with past psychiatric history had an increase in depressive symptoms. Furthermore, studies have shown that having a history of mental illness increases the odds of postpartum depression. In the current study, participants with a history of mental illness including depression were excluded from participation. According to Chen (2008), mothers of multiple births are at an increased risk for numerous complications. A study was conducted by Sheard, Cox, Oates, Ndukwe, and Glazebrook (2007) which compared psychological outcomes in first time parents conceiving one or more children through in-vitro fertilization (IVF). Using the Edinburgh postnatal depression scale (EPDS), their study showed higher levels of stress and anxiety during the second and third trimester. Stress during pregnancy is a risk factor for postpartum depression. Glazebrook, et al. (1999) conducted an ongoing study on physiological adjustment during pregnancy and postpartum in in-vitro fertilization births. The results suggested that couples with multiple births (as a result of IVF treatment) experience higher levels of anxiety during the second and third trimesters of pregnancy. According to Choi et al., (2009), there is an increased risk for complications with multiple gestations which leads to higher parental stress. According to Choi et al., parental stress is a risk factor for postpartum depression. Flaherty & Damato (2009) found that mothers of twins sleep an average of 5.4 hours in a 24 hour period, compared to the recommended 7-8 hours of sleep per night. According to Haddon (2005), 76 % of mothers of multiples felt constantly exhausted as compared to 8% of mothers of
Beeghly, et al., (2003) focused on PPD and African American mothers of healthy full term infants. Using the Center for Epidemiological Studies-Depression Scale (CES- D), three socio- demographic risk factors were found to be closely associated with depressive symptoms. These included, single marital status, low-income status, and negative maternal perception of the adequacy of income for meeting familial needs. Choi et al. (2009) documented that African American women are at an increased risk for PPD, with African American mothers having a 27% greater risk of PPD than Caucasian mothers. Gao, Chan, You, and Li (2009) studied Chinese culture and the incidence of PPD. Their results indicated a strong correlation between increased stress, unhappiness, and depressive symptoms solely related to their cultural norm. Choi et al., (2009) conducted a study exploring demographic factors and its relationship to PPD. The authors used data from the Early Childhood Longitudinal Study- Birth Cohort, a nationally represented sample of children born in 2001. They measured depressive symptoms in mothers using a version of the Center for Epidemiologic Studies Depression (CES-D) scale. The sample comprised 776 participants who had given birth to multiples, and 7,293 participants who had given birth to one child. Sheard et al. (2007) conducted a longitudinal study assessing the psychological adjustment during the postpartum period in mothers of single and multiple in-vitro fertilization (IVF) births. Two questionnaires were mailed out, once during pregnancy and once after pregnancy. A telephone interview was also conducted at six weeks.
Flaherty & Damato (2009) found that mothers of twins sleep an average of 5.4 hours in a 24 hour period, compared to the recommended 7-8 hours of sleep per night. According to Haddon (2005), 76 % of mothers of newborn twins felt constantly exhausted compared to 8% of mothers of singletons. Flaherty & Damato conducted a descriptive longitudinal design study on the relationships between sleep duration, sleep quality, fatigue, and depression in fathers of twins. Inandi et al. (2005) found that poor relationships with family members were an important risk factor for depression. Specifically, poor relationships with the father were closely linked with depressive symptoms. Women with no friends had an increased chance of depression, along with mothers who lacked support from their husband. Skari et al. (2002) conducted a prospective, population based cohort study on 127 mothers and 122 fathers comparing levels of psychological stress after childbirth. Participants were asked to complete the General Health Questionaire-28 (GHQ-28), States of Anxiety, and Impact of Event Scale at zero and four days after birth, and again at six weeks and six months after birth. Childbirth itself was not found to be a psychological distress to most parents. Maternal distress was predicted by being a single parent. The authors concluded that less social support increased the likelihood of an acute stress response. Abrams & Curran (2009) investigated the experiences of low- income mothers. The researchers field work and in-depth interviews on low income mothers’ experiences with postpartum depression identified five core symptoms: Ambivalence (feeling like they were not prepared for having a baby), caregiver overload (feeling like the baby will never stop crying and
demographic risk factors were found to be closely associated with depressive symptoms. The researchers focused on prevalence, stability, and sociodemographic factors correlating with depressive symptoms in black mothers during the first eighteen weeks after delivery. Mothers were also assessed by marital status, income, age, education, infant weight, gender, gestational age, maternal employment status, and number of hours infant was in daycare. Results of this study indicated that in the United States African American mothers typically came from a low socio-economic status, which was directly related to higher CES-D scores. Bowers, N. (2001). is a 35-item Likert scale questionnaire with seven different subscales: sleeping/eating disturbances, anxiety/insecurity, emotional lability, cognitive impairment, and loss of self, guilt/shame, and contemplating harm to ones’ self. The scale is used to assess women for PPD two weeks after delivery. It was specifically developed to measure postpartum depression based on the qualitative studies by Beck and Gable. The alpha reliability for the PDSS is .95 (Beck & Gable, 2000). The sensitivity of the PDSS is 94%, with a specificity of 98%, for major depressive disorder. It has not been tested in adolescents, but has been deemed reliable through research in postpartum women 18-46 years of age. OPERATIONAL DEFINITION Postpartum depression: Maternal depression occurring anytime from two weeks to 2-years postpartum, as measured by the Postpartum Depression Screening Scale (Beck, 2001).
Primiparous woman of a singleton: A woman between the ages of 18 and 45, residing in the Midwest, who gave birth to no more than one live infant for the first time within the past two years. Primiparous woman of multiples: A woman between the ages 18 and 45, residing in the Midwest, who gave birth to two or more infants for the first time within the past two years. Demographic factors: In this study, factors included: complications with pregnancy or delivery, marital status, social support, socioeconomic status, educational status, and ethnicity. RATIONALE OF STUDY The purpose of this study is to investigate the difference in postpartum depression between primiparous mothers of singletons versus primiparous mothers of multiples. According to Beck (2001) factors such as sleep deprivation, life stress (i.e. complications), social support, socioeconomic status, and ethnicity are significant risk factors for postpartum depression. To investigate the differences in postpartum depression between primiparous mothers of singletons versus multiples. Advanced practice nurses (APN) are often the only provider’s mothers see during their postpartum period (Gold, 2002). It is necessary for APN is to be aware of the different experiences of mothers in order to adequately assess, educate, and implement a plan to prevent and treat postpartum depression.
versus those who give birth many times more. Demographic factors for each group will be also compared, as research has shown that certain demographic factors such as single marital status and low income increase the risk of postnatal depression. From any resulting difference of postnatal depression to ascertain whether a woman gives birth to multiple children versus a single child, the researcher will ensure that other demographic factors were similar. SAMPLE The target population for this study would be women of childbearing age. The accessible population would be single and multiple-gestation primitive women from maternity clinics and support groups in Delhi. The sample will have at least 30 primitive women (15 mothers of multiple-gestation births and 15 mothers of single-gestation births). The inclusion criteria will be:
DATA COLLECTION Prior to commencing data collection, participants will be informed that it is implied by consent to return the completed survey. The researcher will distribute informational packets about current studies to maternity and gynecology offices in maternity clinics, and to mothers of multiples support groups located in the residential areas. Instructions to return all completed surveys to the researcher will be included. The information packet will include the purpose of the study, eligibility criteria, informed consent and two questionnaires. Tools for data collection will be sent to participants with the researcher's contact information. TOOLS USED Two instruments will be used for data collection: A demographic survey that will be developed by the researcher, and Beck’s Postpartum Depression Screening Scale (Beck and Gable, 2000). The demographic survey will include age, marital status, educational level, occupation, household income, and history of depression. The second instrument, Beck’s Postpartum Depression Screening Scale (PDSS), has been accepted as a reliable measurement tool for postpartum depression. The 35 item scale is written at a third grade reading level and uses a rating of one (strongly disagree) to five
