Postpartum Depression Educational Program Results

Abstract

The paper focuses on the development of a project aimed at females of 18-35 years of age discharged from the hospital after child birth who participate in a nurse practitioner home visit educational and assessment program. Their results will be compared to non-participation in the nurse practitioner home visit educational and assessment program. The expected result is a decreased incidence of postpartum depression among these females within 90 days of hospital discharge.

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Childbirth is generally considered to be stressful both for mothers and infants. Frequently, it can cause postpartum depression that can take serious forms (Dennis & Dowswell, 2013). The problem is not new and has been a topic of research globally. For example, the study investigating physical health after birth and maternal depression of nulliparous women aimed to discover the relationship between maternal physical health problems and depressive symptoms in the first year after childbirth (Woolhouse, Gartland, Perlen, Donath, & Brown, 2014). Thus, there is a necessity to study possible outcomes and review nursing interventions that can be effective in reducing negative outcomes of separation after a woman with an infant is discharged from the hospital. This project involves educational and assessment interventions provided by nursing practitioners during home visits. PICOT Question for this project can be formulated in the following way.

PICOT Question organizer
P Population Females 18-35 years of age discharged from the hospital after child birth
I Intervention or
Issue of interest
who participate in a nurse practitioner home visit educational and assessment program
C Comparison as opposed to non-participation in the nurse practitioner home visit educational and assessment program
O Outcome have a decreased incidence of postpartum depression
T Time frame within 90 days of hospital discharge.

Evidence Review and Synthesis

Evidence for the project was obtained from the scholarly articles published after 2012. Studies published during 2012 or earlier were excluded from the review as outdated. On the whole, the studies reviewed in this project include population of women between 18 and 35-40 years old. Interventions in the selected works focus on depression/anxiety screening, education of mothers, counseling or psychotherapy. The majority of the interventions were home-based and provided by nursing professionals. The project compared the usual care provided in hospitals and individual intervention based on home-visiting that targets both at-risk and not-at-risk mothers that provides better results in maternal psychological well-being, resulting in increased self-efficacy and reduced risk of depression.

One of the studies indicates that biological interventions can be as effective as education and screening, although pharmacological treatment of mothers might increase health-related risk both for the mother and the infant. The expected outcome is that individual interventions that include depression screening, education, and social support are more likely to reduce postpartum depression rates among women. Individual interventions under consideration are led by professional nurses and can be provided together with routine care. In the reviewed studies, time administered for follow-ups differed. The most widely used time frames for follow-ups were one month, twelve weeks (three months) and six months. The effectiveness of the intervention was often measured during several follow-ups, which indicated the persistence of the impact.

The findings can be briefly synthetized in the following statements. Depression screening for postpartum women with or without other treatment supports (education, counseling) reduces the prevalence of depression among postpartum women and increases remission (O’Connor et al., 2016). The findings of the study by Werner, Miller, Osborne, Kuzava, and Monk (2015) revealed individual interventions that target at-risk populations showed more effectiveness than group-based interventions or no interventions in reducing depression. Another research concerning a nurse-home visiting program proved that it is applicable universally and can be used successfully and efficiently in communities to improve family’s community connections, the psychological well-being of parents and infant (Dodge et al., 2014).

Denis and Dowswell (2013) researching psychosocial and psychological interventions for preventing postpartum depression, came to a conclusion that individualized intensive interventions conducted by professional nurses, telephone-based peer support, and interpersonal therapy reduce the risk of developing postpartum depression among women; both individual and multiple-contact interventions were effective. Individualized sessions were intensive and person-centered. Finally, a randomized controlled trial of the effectiveness of a postnatal psychoeducation program on self‐efficacy, social support and postnatal depression by Shorey, Chan, Chong, and He (2015) showed that a psychoeducation program developed for first-time mothers by academic experts and nursing professionals can positive affect mothers’ self-efficacy and reduce the risk of postpartum depression if combined with routine care. Lower scores of postpartum depression were registered at 6 and 12 weeks postpartum. Still, some additional research is necessary to evaluate whether the intervention results would be the same if conducted among second-time mother, mother with lower income, or mother without education.

The obtained evidence supports the idea of efficiency and necessity of nursing interventions aimed at control and prevention of postpartum depression. Thus, a project including a nurse practitioner home visit educational and assessment program can be a necessary step to the solution of this problem.

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Purpose of the Project

The purpose of the project for a registered nurse is to implement a home visit educational and assessment program among females of 18-35 years of age discharged from the hospital after child birth and compare incidence of postpartum depression among this group and te group that does not participate in a program. As a registered nurse, I will improve my professional skills and contribute to the research of a significant health problem. Probably, the project can provide evidence for further research of postpartum depression within more specific population groups.

Methods/Implementation Plan

As the majority of studies include an intervention and a control group, subjects will be their own controls. Time is appropriate, as it indicates the effectiveness of the intervention during a specific period, i.e., three months = 90 days) after hospital discharge. The purpose of the paper is to evaluate five peer-reviewed studies related to the PICOT question to understand whether it is supported by research findings and evidence. The researcher will focus on studies that include individual interventions that target women (18 to 40 years old) and aim to affect or reduce postpartum depression rates among participants by using educational and psychological interventions provided by nursing professionals.

Specific attention is paid to the following factors: the age of women (no studies that include adolescents are used as such studies would interfere with the PICOT question), the prevalence of depression in women (several studies included and purposely targeted women at risk of developing depression), interventions provided to women (home-visiting, group counseling, CBT, interpersonal therapy were used in the selected studies, but all of them included professional, nurse-lead education and assessment either home-based or hospital based), and the improvement or prevention of depressive symptoms (with or without anxiety) in women who underwent proposed interventions.

Project Implementation

Educational and assessment interventions will be implemented on women aged 18-35 who are discharged from the hospital after child birth. These interventions will be home-based and provided by nursing professionals. Visits will be organized during three months after discharge from hospital. It is expected to be a useful intervention because the research proves that nurse home visits positively influence maternal-infant interaction and have impact on reduction of severity of postpartum depression (Horowitz et al., 2015).

Data Analysis

The effectiveness of the project can be assessed in the following way. First of all, it is necessary to define tools that will be applied. Previous researches have examples of using Postpartum Depression Screening Scale (PDSS) that is “a 35-item self-report instrument to identify women who are at high risk for postpartum depression” (Horowitz et al., 2015, p. 292). Another scale suggested by Horowits et al (2015) is Edinburgh Postnatal Depression Scale (EPDS). It was developed to reveal major symptoms of PPD and is broadly applied for PPD screening as an instrument in community-based population studies in the United States and other countries. Its 10-item version “consists of statements describing depressive symptoms with responses ranging from 1 (low) to 4 (high) according to severity or duration” (Horowitz et al., 2015, p. 293). Total scores on the EPDS range from 0–30. Finally, another method applicable to assess mother’s condition is diagnostic interview that is conducted and interpreted by a professional nurse. It will help to assess the results of the previous scales and obtain comments and impressions of the project participants. Such feedback can be useful for the project improvement because both advantages and disadvantages as evaluated by participants can be applied.

Evaluation Plan

  • Step 1: develop assessment criteria to apply to sample involved into the project.
  • Step 2: apply assessment criteria to the obtained results
  • Step 3: compare results of the usual care provided in hospitals to individual intervention based on home-visiting that is aimed at both at-risk and not-at-risk mothers.
  • Step 4: interpret the results and draw conclusions.
  • Step 5: outline perspectives for project improvement.

Dissemination of Results

After the project is implemented and then selected interventions prove to be effective, it is important to share the results with the interested colleagues. Dissemination of the project results can be provided in some ways. First of all, a presentation can be organized. It is a good method because it allows answering questions and sharing opinions in real time. Secondly, the results can be published on a web-resource and thus made available for a broader audience.

References

Dennis, C. L., & Dowswell, T. (2013). Psychosocial and psychological interventions for preventing postpartum depression. Web.

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Dodge, K. A., Goodman, W. B., Murphy, R. A., O’Donnell, K., Sato, J., & Guptill, S. (2014). Implementation and randomized controlled trial evaluation of universal postnatal nurse home visiting. American Journal of Public Health, 104(1), 136-143.

Horowitz, J., Murphy, C., Gregory, K., Wojcik, J., Pulcini, J., & Solon, L. (2013). Nurse Home Visits Improve Maternal/Infant Interaction and Decrease Severity of Postpartum Depression. Journal of Obstetric, Gynecologic & Neonatal Nursing, 42(3), 287-300. Web.

Moshki, M., Baloochi Beydokhti, T., & Cheravi, K. (2013). The effect of educational intervention on prevention of postpartum depression: an application of health locus of control. Journal of Clinical Nursing, 23(15-16), 2256-2263. Web.

O’Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U. (2016). Primary care screening for and treatment of depression in pregnant and postpartum women: Evidence report and systematic review for the US Preventive Services Task Force. JAMA, 315(4), 388-406.

O’Hara, M., & McCabe, J. (2013). Postpartum Depression: Current Status and Future Directions. Annual Review of Clinical Psychology, 9(1), 379-407. Web.

Paul, I., Downs, D., Schaefer, E., Beiler, J., & Weisman, C. (2013). Postpartum Anxiety and Maternal-Infant Health Outcomes. PEDIATRICS, 131(4), e1218-e1224. Web.

Shorey, S., Chan, S. W. C., Chong, Y. S., & He, H. G. (2015). A randomized controlled trial of the effectiveness of a postnatal psychoeducation programme on self‐efficacy, social support and postnatal depression among primiparas. Journal of Advanced Nursing, 71(6), 1260-1273.

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Werner, E., Miller, M., Osborne, L. M., Kuzava, S., & Monk, C. (2015). Preventing postpartum depression: Review and recommendations. Archives of Women’s Mental Health, 18(1), 41-60.

Woolhouse, H., Gartland, D., Perlen, S., Donath, S., & Brown, S. (2014). Physical health after childbirth and maternal depression in the first 12 months post partum: Results of an Australian nulliparous pregnancy cohort study. Midwifery, 30(3), 378-384. Web.

Appendices

Evidence Synthesis.

Google Scholar Study #1 Study #2 Study #3 Study #4 Study #5 Synthesis
(p) Population 18-year-old or older women Age not stated; no adolescent participants, thus 18 old or older Age not stated; no adolescent participants, thus 18 old or older Various; 18 years old or more Mean age: 26.8 years 18-year-old or older mothers up to 35-40 years
(i) Intervention Depression screening with or without additional treatment components Biological, psychological, and psychosocial interventions, including pharmacological treatment, individualized home-based interventions, CBT, interpersonal therapy Durham Connects (individualized 4-7 session intervention program that assesses parental and infant well-being, parental anxiety and depression, family connections) Individualized postpartum home visits, telephone-based support, interpersonal psychotherapy Postnatal psychoeducation program and routine care Individualized interventions that focus on depression/anxiety screening, education of mothers, counseling or psychotherapy. The majority of the interventions were home-based and provided by nursing professionals.
(c) Comparison Usual care provided to control group No biological interventions, group-based psychological interventions or no psychological interventions Families with the infants of the same age that did not participate in Durham Connects Standard care Routine care only Compared to the usual care provided in hospitals, individual intervention based on home-visiting that targets both at-risk and not-at-risk mothers provides better results in maternal psychological well-being, resulting in increased self-efficacy and reduced risk of depression. One of the studies indicates that biological interventions can be as effective as education and screening, although pharmacological treatment of mothers might increase health-related risk both for the mother and the infant
(o) Outcome Depression screening can reduce depression symptoms Individualized psychological interventions were partially more effective than group-based interventions Families that participated in Durham Connects reported lower rates of emergency care incidence, more community connections, lower rates of depression and anxiety. Women who participate in psychological or psychological interventions were less likely to develop postpartum depression Postnatal psychoeducation program is effective in improving maternal outcomes as it decreases depression rates and increases maternal self-efficiency Individual interventions that include depression screening, education, and social support are more likely to reduce postpartum depression rates among women. Individual interventions are led by professional nurses and can be provided together with routine care.
(t) Time Three-five months Not stated Divided into follow-ups: three weeks, twelve weeks, one month after Various, including three weeks, twelve weeks, and more, depending on the study Six and twelve weeks postpartum Time administered for follow-ups varied among the studies. The most widely used time frames for follow-ups were one month, twelve weeks (three months) and six months. The effectiveness of the intervention was often measured during several follow-ups, which indicated the persistence of the impact

Evaluation Table.

Citation Design Sample size: Adequate? Major variables: independent
dependent
Study findings: strengths and weaknesses Level of evidence Evidence synthesis
O’Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U. (2016). Primary care screening for and treatment of depression in pregnant and postpartum women: Evidence report and systematic review for the US Preventive Services Task Force. JAMA, 315(4), 388-406. Systematic review of randomized and nonrandomized clinical trials 11 869 women, 18 years old or older (O’Connor, Rossom, Henninger, Groom, & Burda, 2016). The sample size is large and adequate to provide generalizable results. Ind. Variable: Depression screening and intervention methods
Dep. Variable: Prevalence of depression at follow-up (3-5 months)
Study findings indicate that screening for depression with or without additional treatment-related supports reduces the prevalence of depression in postpartum women. Its strengths include the use of direct and indirect evidence, large sample size, and evaluation of methods. Its weaknesses are clinical trials with strict exclusion criteria, small sample sizes in some of the trials, no data on harm of conduced interventions Level I: systematic review of RCTs Depression screening for postpartum women with or without other treatment supports (education, counseling) reduces the prevalence of depression among postpartum women and increases remission
Werner, E., Miller, M., Osborne, L. M., Kuzava, S., & Monk, C. (2015). Preventing postpartum depression: Review and recommendations. Archives of Women’s Mental Health, 18(1), 41-60. Qualitative literature review of RCTs Exact numbers of participants not stated; 37 trials were used, which is an adequate number of studies for a literature review since it contains a generally large sample size Ind. Variable: Screening instruments and interventions (biological and psychological) Strengths: a variety of screening instruments and interventions (pharmacological, dieting, interpersonal therapy, home visits, CBT therapy, etc.) used, multiple databases for research, use of RTCs. Weaknesses: use of outdated studies, studies with possible biased results, studies with small sample sizes that could affect the validity of results Level II: multiple well-designed randomized control trials used Individual interventions that target at-risk populations showed more effectiveness than group-based interventions or no interventions in reducing depression (Werner, Miller, Osborne, Kuzava, & Monk, 2015)
Dodge, K. A., Goodman, W. B., Murphy, R. A., O’Donnell, K., Sato, J., & Guptill, S. (2014). Implementation and randomized controlled trial evaluation of universal postnatal nurse home visiting. American Journal of Public Health, 104(1), 136-143. RCT 531 mothers; an adequate sample for one RCTs that can be generalized Ind. Variable: Intervention control program Durham Connects (Dodge et al., 2014)
Dep. Variable: number of emergency care incidents, parental behavior, rates of anxiety and depression
Strengths: large sample size, findings applicable both universally and to individual family needs, affordability of intervention, six-month follow-up. Weaknesses: findings derived from one community, lack of subgroups Level II: a well-designed RTC A nurse-home visiting program that is applicable universally can be used successfully and efficiently in communities to improve family’s community connections, the psychological well-being of parents and infant.
Dennis, C. L., & Dowswell, T. (2013). Psychosocial and psychological interventions for preventing postpartum depression. Web. Systematic review of published and unpublished RCTs 28 trials, approx, 17.000 women (Dennis & Dowswell, 2013). An adequate sample size that is generalizable to different social groups Ind. Variable: Psychosocial or psychological interventions (individualized home visits, telephone support, interpersonal psychotherapy)
Dep. Variable: Risk of postpartum depression development
Strengths: Identification of specific interventions that might be effective (home visits, psychotherapy, etc.) based on quality and methodologically well-designed RCTs Weaknesses: Findings do not indicate whether interventions had any influence on maternal stress, perceived support, or relationships between the infant and the mother Level I: a systematic review of well-designed RCTs Individualized intensive interventions conducted by professional nurses, telephone-based peer support, and interpersonal therapy reduce the risk of developing postpartum depression among women; both individual and multiple-contact interventions were effective. Individualized sessions were intensive and person-cenetered
Shorey, S., Chan, S. W. C., Chong, Y. S., & He, H. G. (2015). A randomized controlled trial of the effectiveness of a postnatal psychoeducation programme on self‐efficacy, social support and postnatal depression among primiparas. Journal of Advanced Nursing, 71(6), 1260-1273. RCT 112 women, 61 in the intervention group, 61 in the control group. A small sample size that is difficult to generalize Ind. Variable: Postnatal psychoeducation program and routine care
Dep. Variables: maternal self-efficacy, social support, and postpartum depression
Strengths: findings are based on theory-based intervention program, identify several potential positive outcomes of the psychoeducation program (increased self-efficacy, decreased risk of depression, rates of social support) (Shorey, Chan, Chong, & He, 2015). Weaknesses: findings apply to English-speaking, well-educated mothers, not tested on other potential participants (e.g., non-English speaking, without education, etc.) Level II: findings obtained from a well-designed RCT A psychoeducation program developed for first-time mothers by academic experts and nursing professionals can positive affect mothers’ self-efficacy and reduce the risk of postpartum depression if combined with routine care. Lower scores of postpartum depression were registered at 6 and 12 weeks postpartum. Additional research is necessary to evaluate whether the intervention results would be the same if conducted among second-time mother, mother with lower income, or mother without education
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