Postpartum Depression is generally defined in the following context: “Specifier of nonpsychotic major depression that has its onset within 4 weeks after delivery” (Mehta and Sheth, 2006). In addition, the illness is often classified into the following categories: “Baby blues,” “nonpsychotic depression,” and “puerperal psychosis” (Mehta and Sheth, 2006). Therefore, the illness is complex in nature and is attributed to the emotions that are experienced after giving birth (Mehta and Sheth, 2006). It appears that there are no clear distinctions between first-time and experienced mothers facing postpartum depression, and that the state is potentially dependent upon hormonal imbalances (Mehta and Sheth, 2006). The state of postpartum depression is particularly difficult for its sufferers, as they are often unable to care for their newborn babies in the way that they desire, and this places a particularly difficult strain upon the family in these cases. The defining attributes of the illness are emotional in nature, and require further evaluation in order to establish a successful diagnosis and treatment strategy.
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For women facing the risk of postpartum depression, there are a number of common concerns that are well-defined and researched, including but not limited to stress, hormone imbalance, and alternative methods of conception. Therefore, those women facing postpartum depression often possess a number of risk factors that may be individual or combined. As a result, a diagnosis of this condition is often based upon several factors. However, these factors may also be attributed to other conditions and circumstances, so how they are identified and managed is of critical importance in addressing the condition directly. In general, “A meta-analysis of numerous studies found the average prevalence rate of postpartum depression to be 13 %…there is a three-fold increase in the risk of depression during the first months after delivery” (Joesfsson, 2003, p. 14). Therefore, it is important to note that postpartum depression is a common condition that requires further evaluation and treatment.
A case study is perhaps the most feasible opportunity to explore the variables involved in postpartum depression, as this will enable the evaluator to determine the extent to which the illness is based upon various factors, how it was derived, and how to best treat the condition effectively. Typically, a scale known as the Edinburgh Postnatal Depression Scale (EPDS) is widely used to identify the severity of postpartum depression episodes, as is useful in determining the course of treatment that will treat the condition without delay (Chokka, 2002).
One case to consider is that of using the EPDS to screen patients for postpartum depression, and if the condition is identified, to determine its severity (Joesfsson, 2003). This scale is used to convey a greater understanding of the epidemiology of the illness, and its contributing factors in those that suffer its symptoms (Joesfsson, 2003). The case study under consideration examines women facing postpartum symptoms of depression at several intervals, and explores a number of variables that are relevant in describing the condition and its potential outcomes for female patients (Joesfsson, 2003). There were a number of statistical requirements under consideration, as well as an opportunity to explore the ethical nature of the study and how it might impact postpartum women in a personal manner: “We questioned ourselves whether it would create increased anxiety to ask the eligible women personal questions about mental and physical health and later on about their children’s behavior. However, we concluded that the positive effects would outweigh the negative effects and that the attendance rate would reflect the women’s opinions in this matter. Verbal and written information was given to all participants and it was made clear that participation was voluntary” (Joesfsson, 2003, p. 33). From this perspective, it should be noted that the postpartum depression study served as a means of influencing the identification of risk factors, as well as the epidemiology behind such factors and subsequent treatment alternatives that would be useful in supporting patients of this nature (Joesfsson, 2003). In this manner, it was determined that the study was a safe and effective means of identifying various risk factors associated with postpartum depression.
The study results indicate that the EPDS is a highly useful tool in order to support the findings associated with postpartum depression (Joesffson, 2003). One of the key factors in this study that is not found in many other studies is as follows: “An advantage of this study is that all data were extracted from standardized medical records in which data were collected prior to knowledge of postpartum mood. This made it possible to minimize maternal recall bias. To our knowledge this is the only study that includes earlier medical, gynecologic and obstetric history” (Joesffson, 2003, p. 37). Therefore, the study indicates that there are significant opportunities to explore postpartum depression by using the EPDS scale, and that the results from this scale will continue to provide clinicians with the tools that are necessary to improve diagnosis and treatment methods for postpartum depression and its many complexities (Joesffson, 2003).
EPDS is also evaluated in a borderline case involving postpartum women from Chile, and it was determined that the scale is very useful in other settings as a screening and diagnostic tool (Jadresic et.al, 1995). Another borderline case involving subjects from Iran is also useful in determining the effectiveness of the EPDS tool (Montazeri et.al, 2007). A contrary case involves the detection of false negatives in using the EPDS, which is in stark contrast to many other cases that support the widespread use of this scale to identify postpartum depression (Guedeney et.al, 2000). A case invented for the research might demonstrate that EPDS is successful in diagnosing other types of depressive disorders or episodes that extend beyond postpartum depression. Finally, an illegitimate case involves an examination of symptoms that are depicted as postpartum depression with the EPDS, but are actually not related ( Jomeen and Martin, 2008).
Based upon the model case, the antecedent is the series of unusual behaviors that are generally associated with postpartum depression, such a perceived detachment from the child, as well as emotions, such as uncontrollable crying and fits of anger. As a result of these behaviors, it is generally believed that women suffering from postpartum depression face considerable emotional and psychological consequences until they are diagnosed and are treated for their condition in a successful manner.
In a related case study, EDHS is utilized in conjunction with the Patient Health Questionnaire (PHQ-9) in an effort to identify postpartum depression in a different light. In a general context, “Routine depression screening has been recommended for all adults using tools, such as the Patient Health Questionnaire (PHQ-9), that have been validated in primary care practices” (Yawn et.al, 2009, p. 483). From this perspective, it is known that postpartum depression is not commonly considered under this questionnaire, and requires further consideration as a potential tool for evaluation of this condition (Yawn et.al, 2009). The study considered both tools as an opportunity to identify postpartum depressive symptoms, and to also demonstrate that these studies might be useful together, while also recognizing the limitations of their use in conjunction with each other (Yawn et.al, 2009). These findings suggest that there are significant factors involved in identifying postpartum depression, particularly when a body of questions are asked of each study participant that might be uncomfortable to answer (Yawn et.al, 2009). Therefore, it is difficult to identify all of the possible implications of using both tools without further evaluation (Yawn et.al, 2009). Nonetheless, it is very important and relevant to consider how postpartum depression is diagnosed and treated under the most common conditions.
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Other studies also demonstrate that postpartum depression, when diagnosed by using the EPDS scale, is highly responsive to different forms of cognitive therapy, including individual and group counseling, amongst other methods (Moss et.al, 2009). However, studies do not go so far as to say that educational programs are a useful tool in supporting the prevention of postpartum depression, as this has yet to be identified as an effective alternative (Moss et.al, 2009). There continue to be critical factors that influence postpartum depression that have not been fully identified, and therefore, the EPDS is a very useful method of deciphering new problems and potential treatment solutions (Moss et.al, 2009).
Based upon the indicators provided in the discussion and case studies thus far, there are a number of empirical referents to consider when addressing the scope of postpartum depression, and how it is dramatically influenced by various factors, including but not limited to risk factors, symptoms, diagnosis and treatment. It is clear that there are a number of common risk factors associated with postpartum depression that are common in many identified cases, including but not limited to prior depressive episodes, hormone imbalances, and other related factors. These factors are typical contributors to the condition, even though their severity varies from one case to another. Nonetheless, when considering postpartum depression, these are typical concerns that must be evaluated on a consistent basis.
In one context, it is observed that postpartum depression may be associated with what is known as the “relinquishment of motherhood,” which is reflective of different circumstances, such as giving up a baby for adoption, as well as the challenges associated with postpartum depression (La Monica). In this context, “Relinquishment is usually done with a great deal of conflict, especially if done under compulsion. Consequences of relinquishment are (1) the obvious loss of a child, (2) a resulting role change; she is no longer functioning as a mother, and (3) the inevitable grief process to follow” (La Monica, p. 269). From this perspective, it is clear that postpartum depression also falls into this category, and possesses empirical consequences for a mother until a diagnosis and treatment plan is satisfied. It is important for a mother facing postpartum depression to consider how this might impact her child or children, and how to best approach the situation in a delicate yet assertive manner. However, since the judgment of the mother is often poor as a result of her condition and she may be unable to think clearly, it is necessary to consider how the condition might be identified by a clinical professional, and thus treated accordingly. It is important for family members and clinicians to be involved as early as possible, so that the symptoms do not become so severe that irreversible consequences are inevitable, as occurs in some cases.
In all cases of postpartum depression, it is critical to develop an understanding of the underlying factors, causes, and diagnosis methods that are most common, so that all possible ideas are explored without severe repercussions for patients. Therefore, it is expected that in all cases of postpartum depression, establishing a diagnosis using the EPDS and/or the PHQ are of critical relevance in order to determine the most feasible course of action for the patient in question. This is a general rule that applies to almost any diagnosis, and requires ongoing consideration in order to achieve the desired level of effectiveness. It is imperative that these methods are utilized consistently from one case to the next in order to establish effective patterns for treating postpartum depression and its underlying causes.
In order to identify the various principles that are associated with a diagnosis of postpartum depression, it is necessary to develop a greater understanding of various risk factors that are associated with the illness and its outcomes for new and experienced mothers. It is evident that there are a variety of concerns that are associated with postpartum depression, and that these require further consideration and evaluation. Therefore, various research studies to date indicate that there are a number of relevant tools that are often utilized in order to understand the overall concepts associated with postpartum depression, and how to best diagnose and treat this complex psychological condition with physical undertones. The most common tools used to identify the condition are the EPDS and the PHQ, which are utilized to identify severity of the condition under different circumstances. Patients suffering from this illness must be cooperative and supportive in seeking a diagnosis and treatment, even though this is often a very difficult concept to grasp. Therefore, it is important for clinicians to be heavily involved in this process, so that patients are provided with the best possible outcomes for their condition, regardless of its severity. This will provide the greatest level of support during diagnosis and treatment to improve the condition through regular treatment and ongoing intervention as necessary.
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