Postnatal depression

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Introduction

The biopsychosocial model can be termed as a broad view attributing a disease outcome to the intricate, variable interaction of some biological factors like genetic and biochemical, psychological factors like personality as well as social factors like socioeconomic or familial factors. Biopsychosocial model mainly counters the biomedical model that mainly attributes diseases to only biological factors like genes, viruses and somatic abnormalities (Gutierrez-Galve et al., 2015). On the other hand, postnatal depression is a problem affecting more than one in every ten women within a year of giving birth. The problem can also affect partners and fathers although this case is less common. According to different research work, biopsychosocial model is the best method for diagnosing and managing patients when compared to the traditional biomedical model. The approach maintains that diseases and illnesses result from some interacting systems within the cellular, organism, tissue as well as environmental levels. Different physicians can integrate the model into their practice through lifestyle and dietary factors, social support, the role of stress, the patients coping mechanisms as well as life traumas like abuse history.

Biopsychosocial assessment emphasizes the importance of a systematic view of a person as well as an integration of psychological, biological and socio-cultural factors on human functioning and development. The model has been used to assess various disorders like depression, addiction, anxiety, and chronic medical disorders (Mah et al., 2017). It is also considered an important part of mental health training programs for many years. In this case, the biopsychosocial model will be used by physicians to evaluate factors like the role of stress, life trauma, social support and the patients coping mechanism during the postnatal period. When it comes to treatment, there is a need to focus on the severity of the condition, the psychological and biological factors that influence the nature of the symptoms.

The biopsychological assessment is based on the perspective that individual is inherently biopsychosocial organism where psychological, biological and social dimensions are inextricable. For instance, Dorothy is affected by some life factors, which led to the postnatal depression like being stressed up and lack of stress management strategies.

Biopsychosocial Factors Influencing the Development of Postnatal Depression

Some of the factors leading to postnatal depression include poor quality of life as well as functional capacity for the affected person. Poor maternal health also highly contributes to postnatal depression (Barry et al., 2015). Additionally, research has indicated that poor partner relationship also leads to postnatal depression. Most researchers believe that postnatal depression results from a combination of different factors. To start with, the hormonal changes happening after having a child affects some women more than others. When

Various factors may lead to the diagnosis of mental health issues. Various factors have been identified and analyzed in various selected studies and can be grouped into various categories. The risk factors associated with postnatal depression include the following

Demographic factors

Various factors have shown significant association with postnatal depression that includes the age of the mother during the time of childbirth and her old age at marriage. Additionally, if a mother is an immigrant and she is giving birth to a child overseas, it has also been mentioned as a risk factor for postnatal (Barry et al., 2015). For instance, this is depicted in a study that examined Japanese women who happened to born and raised in Japan who did give their birth to their children in Hawaii. Half of these participants experienced an emotional dysfunction during their pregnancy. All those primipara females experienced postnatal depression, and this included the participants who had maternity blue.

There is also a problem in different health care attitudes in various cultures and distance from a family that has been cited to lead to homesickness, which can be a causative agent of postnatal depression. This is evident in Dorothy’s case as her parents became estranged after she met Alan. In addition, her parents cannot visit her freely and she hopes that being in hospital will help her meet her parents away from the controlling nature of her husband and his mother. There is no any consistent association found between postnatal depressions that have been seen with the maternal education (Milgrom & Holt, 2014).There is also the problem of lower socio economic status that has been categorized to be factors that have been associated with postnatal depression. Although pregnancy and childbirth have been considered a time of joy and pleasure in various families, they implicate high burdens to the families and especially to those families low-income families where the man is the only breadwinner can be a cause of depression to the new mothers. Dorothy and her husband live in a low socio-economic working class suburb of Brisbane showing that they are low-income family and this could add to the depression.

Clinical factors

This is considered a major factor that leads to postnatal, and it is parity. There are various observations that show that the frequency of primiparity is higher than in those women who have postnatal depression. Dorothy had a previous miscarriage and had not been able to get pregnant for a period of 5 years. The condition of women having five or more children has been seen to be responsible for the persistence of prenatal depression beyond the few postnatal months (Milgrom & Holt, 2014).There is another significant factor which is unwanted or negative attitude seen towards pregnancy. There are negative attitudes that have been seen towards pregnancy, which happens to double the risk of postnatal depression. There is pre marital pregnancy, which is considered another risk factor for postnatal depression to many women. There are various cultures, which consider premarital pregnancy as highly unacceptable especially those cultures that have a highly conservative attitude towards sex. Getting pregnant before one is married reflects that the woman experienced premarital sex intercourse which is seen as a shame or taboo in various societies. This is a causative agent to postnatal depression.

Premenstrual symptoms history, previous depression, or experiencing depression when one is pregnant, the high prenatal anxiety, maternity blues, history of postnatal have all be seen as putative risk factors for postnatal depression. Various studies which have examined these factors and gave a provision of the preliminary evidence that various phenomena that are hormone related to those occurrences of postnatal depression (Zhao et al 2015).The result in a way supports the notion that the etiology of postnatal depression is connected to differential hormonal sensitivity. These risk factors ought to be carefully assessed and evaluated clinically into detail while one is dealing with a woman of postnatal depression. Other factors are inclusive of ill health, the complications when one is pregnant or the perceptions of women having complications when they are pregnant history of pregnancy loss and preterm delivery

Psychosocial factors

There are some factors which were found to be associated with postnatal depression which includes living in influences of cultures including poor accommodation, lack of instrumental support, lack of social support, the stressful life events during pregnancy and conflicts by either in laws or relatives over the issue of child care (Murray, Fearon & Cooper, 2015). Dorothy feels that her husband, siblings, her husband’s mother who they stay with and her parents are not supportive of her and this increases the stress she is facing. Conflicts between the daughter and mother in law are common in various places, and these have resulted to many wedded women having the postnatal depression. There is an evident conflict between Dorothy and her mother in-law. Dorothy feels her mother is controlling. Dorothy lost contact with her friends when she met Alan and feels that she is alone and has no one to support her. Dorothy is also in an abuse marriage with Alan and this has contributed to the depression she is facing and possibly her dislike of the child.

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Child related factors

On the issues of child related factors, health problems of the child, dissatisfaction with the gender of the child, the child birth defects,  the feeding difficulties of the child, stress with child care and only short period of either rest or exhaustion after childbirth include all factors that are associated with postnatal depression. Dorothy had a difficult and painful childbirth and this is one of the reasons she has no emotional attachment and affection towards her child. Some studies have shown that there is dissatisfaction created on the mothers seen due to the gender of the child. Some communities require every homestead to have at least one son, and if a boy is not seen in those homesteads, the women in there are considered incapable which result to serious problems in their marriages (Cooper et al., 2015).This has implied a significance of infant gender in many families. Logically there are variables which relate to a child can be measured postnatal only. There are findings that those mother suffering from postnatal depression have shown more descriptions of their children that are negative than the control mothers and they do report more behavioral problems in their children. Dorothy dislikes, shows no emotional affection or attachment and does not want to breastfeed of get close to her child, which show signs of postnatal depression. Therefore, the symptoms of the mothers are a source of bias in reporting the characteristics of the child and the results of such studies those factors that are child related ought to be viewed with caution.

Management

Postnatal period is a very critical time to deliver intervention and failure to do so leads to adverse effects when it comes to the survival and future health of both the mother and the child. Research has indicated that many women die following complications during and after birth (O’Higgins et al., 2013). The benefit of breastfeeding are well documented, however when to start breastfeeding is very important. This is mainly because studies have suggested many benefits of early VS late breast-feeding. To a person like Dorothy who refuses to breastfeed her daughter and has no connection, affection or connection with the physician should insist on the need for breastfeeding, which will help in reducing the postnatal depression.

The main care plan for a woman suffering from postnatal depression is compliance of her medicine as well as the interventions from the physician. The physician intervention includes counseling that will allow Dorothy to express her feelings, which will result in psychological restoration; and antidepressant therapy, which is prescribed by the physician after a diagnosis of the postnatal depression.

When it comes to nursing management, the nurse has to be alert in sensing the current psychological state of the patient. The nurse should also offer precise information concerning the well-being of the patient that will give way to a more accurate care plan for the patient with postnatal depression (Pearson et al., 2013). Regarding assessment, the nurse should have assessed Dorothy’s psychological health before delivery that would have included an assessment of her illness history to determine whether she requires any counseling before the delivery to avoid the depression.

Regarding nursing intervention, the nurse should assist Dorothy to plan her daily activities like her nutrition, sleep and exercise programs. The nurse should also recommend supporting groups to Dorothy with aims of ensuring that she has a system where she can share her feelings with other people. Additionally, there is a need to advise Dorothy to take some time for herself to have a break from her regular baby care (Mah et al., 2017). Lastly, Dorothy should be advised to keep in touch with her social circle because in most cases they serve as a support system.

Research has indicated that women suffering from postnatal depression need understanding from friends and families. Understanding and acceptance by friends and family will be important for Dorothy to start to believe in her again. However, the best understanding will always come from the people who have experienced the same condition (Milgrom, Martin & Negri, 2015). Additionally, Dorothy needs some physical exercises to improve her brain functions as well as the sense of well-being. This requires a realistic program that will involve small steps to increase her activity. Friends and family can assist with short walks.

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Ethical Implications for the Selected Case Study

The ethical implications for the selected case study are linked to issues of autonomy, justice and privacy. Here issues of beneficence, non-malfeasance, respect for justice and autonomy all arise. Dorothy is a human being who deserves to be treated without extreme judgment, blame or lack of understanding. From her point of view and indeed her present circumstance, there is no one close to her, for instance her husband, siblings, parents and her mother in law who are supportive of her. Most of them seem to blame her for her plight and only care for the baby. This is unethical because she should also be recognized and be encouraged to get well and out of the situation.

At this stage, Dorothy needs understanding and support from her family members and the healthcare professionals because this marks the beginning of her recovery if she is to be emotionally attached to her baby and start getting close. In her current state, there is no one who respects her or seems to care for her just treatment because her family blames her for her plight and the baby’s dilemma as well. The healthcare professionals such as nurses, physicians and counselors should encourage her family members to show support instead of being critical of her. They should be encouraged to treat her with fairness, love, and consider her as an autonomous person and not in relation to Alan and the baby. Adding this to professional counsel, medical and healthcare treatment, Dorothy will recuperate and manage her condition.

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  1. Barry, T. J., Murray, L., Fearon, R. P., Moutsiana, C., Cooper, P., Goodyer, I. M., & Halligan, S. L. (2015). Maternal postnatal depression predicts altered offspring biological stress reactivity in adulthood. Psychoneuroendocrinology52, 251-260.
  2. Cooper, P. J., De Pascalis, L., Woolgar, M., Romaniuk, H., & Murray, L. (2015). Attempting to prevent postnatal depression by targeting the mother–infant relationship: a randomised controlled trial. Primary health care research & development16(4), 383-397.
  3. Gutierrez-Galve, L., Stein, A., Hanington, L., Heron, J., & Ramchandani, P. (2015). Paternal depression in the postnatal period and child development: mediators and moderators. Pediatrics135(2), e339-e347.
  4. Mah, B. L., Van Ijzendoorn, M. H., Out, D., Smith, R., & Bakermans-Kranenburg, M. J. (2017). The effects of intranasal oxytocin administration on sensitive caregiving in mothers with postnatal depression. Child Psychiatry & Human Development48(2), 308-315.
  5. Murray, L., Fearon, P., & Cooper, P. (2015). Postnatal depression, mother–infant interactions, and child development. Identifying Perinatal Depression and Anxiety: Evidence-Based Practice in Screening, Psychosocial Assessment, and Management, 139-164.
  6. Milgrom, J., & Holt, C. (2014). Early intervention to protect the mother-infant relationship following postnatal depression: study protocol for a randomised controlled trial. Trials15(1), 385.
  7. Milgrom, J., Martin, P. R., & Negri, L. M. (2015). Treating postnatal depression. John Wiley & Sons.
  8. O’Higgins, M., Roberts, I. S. J., Glover, V., & Taylor, A. (2013). Mother-child bonding at 1 year; associations with symptoms of postnatal depression and bonding in the first few weeks. Archives of women’s mental health16(5), 381-389.
  9. Pearson, R. M., Evans, J., Kounali, D., Lewis, G., Heron, J., Ramchandani, P. G., & Stein, A. (2013). Maternal depression during pregnancy and the postnatal period: risks and possible mechanisms for offspring depression at age 18 years. JAMA psychiatry70(12), 1312-1319.
  10. Zhao, Y., Kane, I., Wang, J., Shen, B., Luo, J., & Shi, S. (2015). Combined use of the Postpartum Depression Screening Scale (PDSS) and Edinburgh Postnatal Depression Scale (EPDS) to identify antenatal depression among Chinese pregnant women with obstetric complications. Psychiatry research226(1), 113-119.
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