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Post Partum Depression

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Shauna-Dean Jackson

on 27 January 2015

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Transcript of Post Partum Depression

American Psychiatric Nursing Foundation
Research Grant Proposal

Post Partum Depression
Research Question
Literature Review
Three scholarly articles were chosen to exhibit a that social support is a necessary component in the post partum period among ethnically diverse first time mothers. Each article highlighted repectfully Caucasian, Hispanic and African American/Black mothers and their social support or lack there of.

Article 1: First Time Mothers: Social Support, Maternal Parental Self Efficacy and Post Natal Depression

Article 2: Cuban American Mothers and Post Partum Cultural Support

Article 3: Postpartum Depression, Culture and African-American Women
Theoretical Conceptual Framework
The conceptual framework supporting the research is underpinned by the social support theory. The social support theory is a middle range theory that addresses structure and interactions in relationships.

Continuing research on social support interventions can provide nurses with knowledge about the most effective strategies for strengthening social support for clients, which contributes to an improved health status.

Data Management and Analysis
Presented by:
Lillian Dent
Shauna-Dean Jackson
Shannon Stanley

What is the influence of social support on postpartum depression in first time ethnically diverse mothers during the post natal period?
There is definitely a discernible problem that led to the study of the role that social support has on post-partum depression in ethically diverse mothers in the postnatal period. It is reported that in the U.S., there is an enormous amount postpartum women with depression who are not identified or treated despite that fact that they are at a higher risk for psychiatric disorders (Northwestern Medicine, 2013
There are many associated factors that are involved in the predisposition of post partum depression (PPD) in first time mothers. Not only the fact that these women are having babies for the first time, there are other identified factors that further expose these mothers to PPD. These factors include: An unexpected/unplanned pregnancy, the age of the woman, race/ethnicity, education, marital status, and poverty levels (Abbasi et al, 2013).
Intro Cont'd
This study will hopefully shed light on another variable that is overlooked considerably in the diagnosis of PPD, Social Support. Previous research has suggested that mothers in the postnatal period that have received help from their significant others, and other family members with household chores and infant care, reported a feeling of well-being (McCarthy, Leahy-Warren &Corcoran, 2011).
In addition, according to the author Katherine L. Wisner, M.D. of Northwestern,"It's a huge public health problem. A woman's mental health has a profound effect on fetal development as well as her child's physical and emotional development" (Northwestern Medicine, 2013).
Problem Statement
To examine the influence that social support has on post-partum depression in first time ethnically diverse mothers during the postnatal period. There as been a lack of studies that identified or examined the problem in relation to ethnically diverse populations of mothers that are at risk. Many of the studies done previously were limited to white Caucasian mothers.
Social support has been defined as an individual’s view of being cared for, loved, accepted within a network of family and the community. Positive social support is vital to the “mental and somatic health” as well as “prevention” of health problems (Social support, 2011).
Postpartum depression is a serious mental health problem that is marked by “prolonged period of emotional disturbance, occurring at a time of major life change and increased responsibilities in the care of a newborn infant. PPD can have significant consequences for both the new mother and family”(American Psychological Association, 2014).

The sampling group is based on the female population of West Palm Beach, FL to recruit postpartum mothers into three focus groups. All women who complete participation in a postpartum depression randomized trial and who agreed to be contacted within the next year for future studies were eligible to participate, stratified random sampling will be used as a presence or absence of depressive symptoms during the randomized trial.
“In stratified random sampling the population is first divided into two or more strata.As with quota sampling, the aim is to enhance representativeness (Polit& Beck, 2012).
Data Collection/Generation Techniques and Sources

The following data collection instruments were used during the study.

1. The Pregnancy Risk Assessment Monitoring System (PRAMS)

2. The Behavioral Acculturation Scale (BAS)

3. The Postpartum Semi-structured Cultural Component Interview (PSCCI)

4. The Social Support Theory Socio-Demographic Data Collection Tool
The researchers will garner the services of NOVA Research Company to facilitate Data Management and Analysis.

NOVA Research Company has more than 17 years of data collection, management and data analysis experience. Their data management team is experienced in developing data collection protocols; determining what methods and types of instruments are required for both process and quantitative data; and designing, developing, and testing those instruments.

They also perform reliability and validity testing of instruments, train interviewers, and enable a variety of modes of administration. NOVA's database programmers are skilled in performing every aspect of data management.
Sample Size and Configuration
Abbasi, S., Chuang, C. H., Dagher, R., Zhu, J., & Kjerulff, K. (2013). Unintended Pregnancy and Postpartum Depression among First-Time Mothers. Journal of Women's Health (15409996), 22(5), 412-416. doi:10.1089/jwh.2012.3926
American Psychological Association. (2014). Postpartum Depression.Retrieved from http://www.apa.org/pi/women/programs/depression/postpartum.aspx
Center for Disease Control and Prevention. (2008, April 11). Prevalence of self-reported postpartum depressive symptoms. Retrieved from http://www.cdc.gov/mmwR/preview/mmwrhtml/mm5714al.htm
Cox, J., Holden, M., Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10 item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry. 150, 782-786
Leahy-Warren, P., McCarthy, G., & Corcoran, P. (2012). First-time mothers: social support, maternal parental self-efficacy and postnatal depression. Journal of Clinical Nursing, 21(3/4), 388-397. doi:10.1111/j.1365-2702.2011.03701.x
Ozbay, F., Johnson, D., Dimoulas, E., Morgan, III, C.,Charney, D., Southwick, S. (2007, May).Social support and resilience stress: From neurobiology to clinical practice. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/
McCarthy, G., Leahy-Warren, P., Corcoran, P. (2011). First-time mothers: social support, maternal parental self-efficacy and postnatal depression. Journal of Clinical Nursing,21(21), 388-397.
Negron, R., Martin, A.,Almog, M., Balbierz, A., Howell, E. (2013, May).Social support during the postpartum period: Mothers’ views on needs, expectations, and mobilization of support.Maternal Child Health Journal. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518627
Northwestern University. (2013, March 14). Postpartum depression: Surprising rate of women depressed after baby. Science Daily. Retrieved from www.sciencedaily.com/releases/2013/03/130314124618.htm
Polit, D.F., & Beck, C.T. (2012). Nursing research: generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Lippincott, Williams & Wilkins.
Roux, G., Anderson, C., & Roan, C. (2002). Postpartum depression, marital dysfunction, and infant outcome: a longitudinal study. Journal of Perinatal Education, 11(4), 25-36.
Social Support. (2011). Perspectives (Pre-2012), 34(3), 4. Retrieved from http://search.proquest.com/docview/867846326?accountid=87314
Szapocznik, J., Scarpetta, M., Kurtines, W., & Arnalde, M., (1978). Theory and measurement of acculturation. Inter-American Journal of Psychology; 12, 113-130.
Ugarriza, D. (2006). Cuban American mothers and postpartum cultural support. Hispanic Health Care International, 4(4), 219-225.
Yun, K., Chesnokova, A., Matone, M., Xianqun, L., Localio, A., & Rubin, D. M. (2014). Effect of Maternal--Child Home Visitation on Pregnancy Spacing for First-Time Latina Mothers. American Journal of Public Health, 104(S1), S152-8. doi:10.2105/AJPH.2013.301505

To reduce bias and show awareness of their potential influence on the study and its participants the researcher did extensive literature review in relation to the research problem. The researcher also used appropriate research tools and theoretical framework that specifically addressed the research study to ensure validity.

The researcher also educated the participants on the purpose and procedures of the research. The consent was fully reviewed with the participant, any questions were answered and they were provided a copy. They were also educated on their rights to refuse to be in the study and to withdraw at any time. In addition, the institutional review board reviewed the proposal.

Implication to Nursing Practice
The implications for nursing are apparent, as postpartum depression is a serious healthcare problem that affects far too many women, their infants and families in general.

Understanding the different cultures and ethnic backgrounds is crucial in providing the appropriate care of the family as a whole and will lead to better patient outcomes and more cost effective healthcare.

Also, our primary goal is trying to emphasize the importance of social support in the post natal period and how important it is to all women regardless of race.
According to the CDC “post-partum depression affects 10-15% of mothers within the first year after giving birth” (CDC, 2008).
Couple this with other varying factors and the percentage increases exponentially. The research that is being undertaken here is done to shed light on the importance of social support in the post natal period for first time mothers.
Amankwaa, L. C. (2003). Postpartum Depression, Culture and African-American Women. Journal of Cultural Diversity. Vol. 10, No. 1
Hopefully this grant will allow us to bring a much needed awareness to those who can make a difference and hopefully assist us in decreasing the prevalence of Post Partum Depression.
The allowance for this research study is five thousand dollars. The principal investigator and two co-investigators of this study are agreeable to donating their time and efforts to the collection, analysis and dissemination of this research study. Stipend and expenses for sub-contracted foreign interviews: 168 interviews @ average of $10/interview for 12 months, totaling $1,680. One thousand dollars will be donated to St. Mary’s Hospital for facilities and personnel use.

Five hundred dollars will be donated to Hair Cuttery and five hundred dollars will be donated to Massage Envy for their donation of services at the Mommy’s Day Out. We are estimating $1000 dollars for food to be provided at the Mommy’s Day Out. One thousand dollars will be donated to the Palm Beach and Broward Sheriff’s Office for participating in the Mommy’s Day Out. Three hundred and twenty dollars will be used for printing materials and supplies such as copying and postage.
The sampling frame used was first time Caucasian, African-American and Hispanic mothers whose babies were born in the maternity ward at St. Mary’s Medical Center in West Palm Beach, Florida. Eligibility criteria for selection were: first-time mother, 18 years of age and older and Caucasian, African-American or Hispanic.

There was no English language requirement, as Spanish language materials were utilized also. In an effort to condense the study due to time and financial restraints, the sample group will be based on 2.5% of the 9% of all females expected to experience PPD within each ethnic group.
Palm Beach County female population size of 681,246

The Caucasian population is 502,616. Nine percent of that is 45,235 and 2.5% of that group is 56.5 (57)
The Hispanic population is 123,381 with 9% of that being 11,104 and 2.5% of that being 13.8 (14)
The African-American population is 119,139 with 9% being 10,722 and 2.5% being 13.4 (13).
Human Subjects
Reviewed by the human subjects review commitee

World Health Organization Consent Used
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