Predictors of Postpartum DepressionApril Peter Chamberlain College of NursingNR 439: Evidence Based PracticeDecember 2017  Predictors of Postpartum Depression             Childbirth is supposed to be awonderful and joyful occasion for those involved. Mothers often hear stories ofhow elated they will be when they see their newborn baby that they willcompletely forget about the tremendous pain they just went through. Not allmothers experience this feeling of excitement and elation. According to theCenters of Disease Control, 1 out of 9 women will experience postpartumdepression (cdc.

gov). There are some moms that will experience the “baby blues”after childbirth, these symptoms can cause anxiety, mood swings, unexpectedcrying spells, and insomnia, and can be expected due to the changes inhormones. However, some other moms will experience a more intense form of the”baby blues” that is longer lasting and this is known as postpartum depression.            The purpose of this research articlereview is to determine the predictors of postpartum depression.  The research was performed to see if differentfactors such as medical and psychiatric illness, depression, psychosocialstress, or pregnancy related illness, and birth outcomes increase thelikelihood of developing postpartum depression.

Research Question             The research question aims to see ifhealth risk behaviors, history of depression, sociodemographic factors, medicaland psychiatric illnesses, pregnancy related illnesses, and birth outcomes arerisk factors for developing postpartum depression. There have not been manystudies completed, or enough research done to show all of the possible causesand risk factors for postpartum depression. Some things that could haveaffected the research question would be if the clinical staff was unable to geta portion of the questionnaires completed, high-risk pregnancy trends due tothe nature of the clinics patient population and the point in pregnancy inwhich patients were seeking care at this clinic. Research Design             The research design of this study waspredictive and retrospective.

According to Houser, predictive research is usedto determine whether a certain risk factor will lead to a certain healthcondition and a retrospective study will use data that has already beencollected as part of an event or studies that has taken place (Houser, 2018).  The patients in the study were all receiving prenatalcare and had completed surveys during their second and third trimesters and inthe postpartum period. Information from these surveys as well as all thedemographic information, smoking history, and health history were all obtained forthe study.

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            A retrospective study relies on howwell documentation was taken.  An exampleof this within the study would be that the office staff was unable to completeall the questionnaires. This could be a disadvantage to the study.

Someadvantages or strengths of this type of study would be shorter timeframes andcost effectiveness. The Research Sample andData Collection             The participants in this study werewomen receiving prenatal care at the university obstetrical clinic between2004-2011 who delivered at the University of Washington Hospital (JOWH 2014).All women receiving care and who completed surveys during the second and thirdtrimester were eligible for the study. Exclusions in the study were women who were unable to complete thequestionnaire because of language barriers and mental capacity, or women lessthan 15 years of age at the time of delivery.

From this screening sample of3,039, 1423 women were included and compared to the 1,616 who were excluded(JOWH, 2014).  The sample size and numberof patients in this study was an adequate one, however inclusion of all pregnanciescould have given a better representation to the population of women who sufferfrom postpartum depression, not just the high-risk pregnancies from thissetting. Another gap recognized within this study was that not everyone fromthe sample completed their postpartum survey, and others did not complete bothsurveys at 4 and 8 months or did not provide data on birth outcomes.

            Data was collected by the clinicalstaff, the tools used were questionnaires and the questions coveredsociodemographic, medical, and behavioral information. The questionnaires wereimplemented as a QI initiative in January of 2004 and were completed by patientsin their second and third trimesters. They were then completed again at the6-week postpartum check. The Patient Health Questionnaire was used to assessdepressive symptoms and a continuous severity measure was used as a variable. Informationregarding the use of antidepressants was obtained via self-reporting. Patientsdiagnosed with gestational diabetes were selected based on their ICD-9 code.The PPPS scale, Prenatal Psychosocial Profile Stress scale, is an eleven itemself-report scale that measures perceived currently hassles or stressors. The TACEalcohol screen, abuse assessment screen, and CAGE questionnaire were obtainedthrough self-reporting surveys.

Gestational age, birth weight, birth outcomes,were all obtained by electronic medical record documentation. Ethicalconsiderations were not specifically recognized but exclusion criteria could beconsidered an ethical gap. Limitations             There are limits to this study thathave an effect on results. Such limitations are that the sample population is arepresentation of only one clinic in the United States. Studying a larger populationsample and providing more detail in the questionnaires about alcohol,postpartum depression history, psychiatric assessments, and social supportcould help overcome the limitations of the study. Knowing and recognizinglimitations is important to understanding the research results, and discussingthese limitations validates the research and puts them into a context that iseasy to understand.Findings            The findings in this study concludethat predictors of postpartum depression include: pre-pregnancy depression,patients taking antidepressants, young age, unemployed status, chronic illness,and smoking (JOWH, 2014).

         Thesefindings determined which factors would increase the likelihood of postpartumdepression. Credibility of the research should be assessed using the followingkey issues by Houser: 1.     Theauthor has appropriate clinical and educational credentials2.

     Determineif there is any conflict of interest that will being bias to the study3.     Isthe journal unbiased?4.     Isthe research peer reviewed?5.     Isthe research published in a reasonable timeframe? Thisresearch study is credible because the author has appropriate credentials,there is no conflict of interest, the journal is not biased, the research waspeer reviewed and it was published in a timely manner. Conclusion Knowing and understanding the predictorsthat increase the likelihood of developing postpartum depression are importantin the treatment of postpartum depression. Being able to identify thesepredictors helps practitioners use interventions that will result in bestpossible outcomes for the patients.

Examples of interventions include bettermanagement of chronic illness during pregnancy, management of depression inthose that have it prior to pregnancy, offering assistance with smoking andalcohol cessation, nutrition assistance, and promoting mental health wellness.This research study identified predictors that can increase postpartumdepression risk. Interventions and their implementation will requirecollaboration across all areas of the healthcare team.  References DepressionAmong Women.

(2017, February 15). Retrieved December 03, 2017, from  https://www.cdc.gov/reproductivehealth/depression/index.htm Houser, J. (2018).

 Nursing Research: Reading,Using and Creating Evidence, 4th Edition. BookshelfOnline. Retrievedfrom https://online.

vitalsource.com/#/books/9781284138887/ Katon, W., Russo, J., & Gavin,A. (2014).

Predictors of postpartum depression. Journal of Women’s Health(15409996), 23(9), 753-759. doi:10.1089/jwh.2014.

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