Postpartum DepressionPostpartum DepressionYounglee KIM, RN, PHN, MSNYounglee KIM, RN, PHN, MSN

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Today class objectivesToday class objectives

To understand importance To understand importance of PPD careof PPD care

To verbalize correct To verbalize correct symptoms of PPDsymptoms of PPD

To understand how to use To understand how to use the EPDS screening toolthe EPDS screening tool

IntroductionIntroduction

Over the centuries, normal thought is that the moment Over the centuries, normal thought is that the moment when a pregnant woman delivers her child that it will when a pregnant woman delivers her child that it will be a special and precious moment for her, but studies be a special and precious moment for her, but studies show that is not always so. show that is not always so.

Unfortunately, all of women have not felt joy and Unfortunately, all of women have not felt joy and feeling of pleasure normally associated with bring a feeling of pleasure normally associated with bring a new life into this world.new life into this world.

Many of women have reported Many of women have reported depressed mood, fatigue, and depressed mood, fatigue, and feeling of worthless or excessive.feeling of worthless or excessive.

Family members easily ignore Family members easily ignore mothers’ feelings of unhappiness mothers’ feelings of unhappiness and sandiness during postpartum and sandiness during postpartum periodperiod

Medical attention has tended to Medical attention has tended to ignore the seriousness of PPD, ignore the seriousness of PPD, too. too.

The broad meaning of depressionThe broad meaning of depression Depression is probably the most common Depression is probably the most common

psychiatric complaint, and it was called psychiatric complaint, and it was called melancholia. melancholia.

The course of the disorder is extremely The course of the disorder is extremely variable from persons to persons. variable from persons to persons.

It may be mild or severe, acute or chronic. It may be mild or severe, acute or chronic. In psycho logy, it is about feelings of low self In psycho logy, it is about feelings of low self

– worth or guilt and a reduced ability to enjoy – worth or guilt and a reduced ability to enjoy life.life.

Hormonal change decrease the levels of Hormonal change decrease the levels of

progesterone progesterone and and estrogenestrogen after placental after placental delivery cause a change in the neurotransmitter levels in delivery cause a change in the neurotransmitter levels in leading to symptoms of depression (Cohen & Nonacs, leading to symptoms of depression (Cohen & Nonacs, 2005)2005)

Three terms of depression during the postpartum period; Three terms of depression during the postpartum period;

postpartum blues (the baby blues), postpartum blues (the baby blues), postpartum depression (PPD), and postpartum depression (PPD), and postpartum psychosispostpartum psychosis..

Postpartum blues Postpartum blues (baby blues)(baby blues)

Incidence Incidence 50% -80%50% -80%

Onset Onset Day 2-5Day 2-5

Duration Duration Few daysFew days

Symptoms Symptoms Changed moodChanged mood

Episodic tearfulness Episodic tearfulness

Irritability, Anxiety Irritability, Anxiety

Overwhelming Overwhelming

Lost appetiteLost appetite

Sleeping problemSleeping problem

Postpartum depression (PPD)Postpartum depression (PPD)

Incidence Incidence 5-15%5-15% Onset Onset the first 2 weeks-3 monthsthe first 2 weeks-3 monthsDuration Duration Up to 1 yearUp to 1 year

Symptoms Symptoms Depressed mood,Depressed mood, Sleep changesSleep changes AnxietyAnxiety FatigueFatigue Feeling worthlessFeeling worthless Inability to concentrate Inability to concentrate Suicide plan or attemptSuicide plan or attempt

Postpartum psychosisPostpartum psychosisIncidence Incidence 0.1%0.1%Onset Onset the first 2 weeks-6 weeks the first 2 weeks-6 weeksDuration Duration Weeks to monthsWeeks to months

Symptoms Symptoms IrritabilityIrritability ConfusionConfusion Psychotic symptomsPsychotic symptoms DelusionDelusion HallucinationHallucination

The symptoms of PPDThe symptoms of PPD

1.1. Depressed mood. Depressed mood. 2.2. Loss of interest or pleasure in activities of life. Loss of interest or pleasure in activities of life. 3.3. Sleep changes. Sleep changes. 4.4. Agitation or retardation in movements.Agitation or retardation in movements.5.5. Fatigue or loss of energy. Fatigue or loss of energy. 6.6. Feeling worthless or excessive inappropriate guilt. Feeling worthless or excessive inappropriate guilt. 7.7. Inability to concentrate or think; being indecisive every day. Inability to concentrate or think; being indecisive every day. 8.8. Thought of death, suicidal ideation without a plan or a suicide Thought of death, suicidal ideation without a plan or a suicide

plan or attempt. plan or attempt. 9.9. Somatic symptoms, including headache, constipation, Somatic symptoms, including headache, constipation,

diarrhea and severe anxiety. diarrhea and severe anxiety. 10.10. Shame and low self-esteem.Shame and low self-esteem.

the American Psychiatric Association (APA)the American Psychiatric Association (APA)

The significant predicators of The significant predicators of PPDPPD

1.1. History of prenatal anxietyHistory of prenatal anxiety2.2. Occurrence of postpartum bluesOccurrence of postpartum blues3.3. Low self-esteemLow self-esteem4.4. A stressful life resulting in excessive demandsA stressful life resulting in excessive demands5.5. Lack of social support from family and friendsLack of social support from family and friends6.6. A strained material relationship A strained material relationship 7.7. The nature of the infant’s temperamentThe nature of the infant’s temperament8.8. Childcare stressChildcare stress

(Lintner & Gray, 2006)(Lintner & Gray, 2006)

Screening toolsScreening tools

Center of Epidemiological Studies-Depression Center of Epidemiological Studies-Depression Scale (CES-D)Scale (CES-D)

Edinburgh Postnatal Depression Scale (EPDS)Edinburgh Postnatal Depression Scale (EPDS) Postpartum Depression Screening Scale (PDSS) Postpartum Depression Screening Scale (PDSS) Beck Depression Inventory Second Edition (BDI-Beck Depression Inventory Second Edition (BDI-

II) II)

The CES-DThe CES-D ---The scale consists 20 items, with four responses ---The scale consists 20 items, with four responses ranging from “rarely” to “most of the time”, and measure ranging from “rarely” to “most of the time”, and measure depressive symptoms occurring during the past week depressive symptoms occurring during the past week

The PDSSThe PDSS --- It consists 35 items and assesses for dimensions --- It consists 35 items and assesses for dimensions of depression related to sleeping/ eating disturbances, anxiety/ of depression related to sleeping/ eating disturbances, anxiety/ insecurity, emotional liability, loss of self, guilty/ shame, insecurity, emotional liability, loss of self, guilty/ shame, cognitive impairment, contemplating harming oneself and cognitive impairment, contemplating harming oneself and thoughts of suicide. thoughts of suicide.

The BDI-II-The BDI-II--- -- It includes a 21 –items, multiple-choice It includes a 21 –items, multiple-choice screening tool that assesses for the presence of depression, as screening tool that assesses for the presence of depression, as well as the severity of depression, and corresponds well with well as the severity of depression, and corresponds well with DSM-IV-TR. DSM-IV-TR.

The EPDSThe EPDS

A commonly recommended screening tool of PPD. A commonly recommended screening tool of PPD. The question based on mother’s feelings over the past 7 daysThe question based on mother’s feelings over the past 7 days 10 items to detect prenatal and postnatal depression. 10 items to detect prenatal and postnatal depression. The English and Spanish versions The English and Spanish versions The total score is ranged from 0 to 30. The total score is ranged from 0 to 30. The bigger score means a more severely depressedThe bigger score means a more severely depressed Possible Depression: 10 or greaterPossible Depression: 10 or greater Severe condition: 13 or greaterSevere condition: 13 or greater Always look at item 10 (suicidal thoughts)Always look at item 10 (suicidal thoughts)

The practiceThe practice

Thank you!Thank you!