Depression in women

Personality Traits and Postnatal Depression: The Mediated Role of Postnatal Anxiety and Moderated Role of Type of Birth

This study investigated how personality traits are related to postnatal depression 2 weeks after giving birth and whether these relations are mediated by postnatal anxiety, measured after 3–4 days after giving birth and moderated by the type of birth. New mothers (N = 672, Mage = 29.33) completed scales assessing their personality traits, postnatal anxiety, and postnatal depression 3 or 4 days after giving birth (T1). They also reported postnatal depression 2 weeks after giving birth (T2). Path analysis indicated that postnatal anxiety explained the link between personality traits (i.e., neuroticism) and postnatal depression 2 weeks after childbirth. The type of birth moderated the relation among, personality traits, postnatal anxiety and depression. Neuroticism and consciousness, in the natural birth’s group, and neuroticism and agreeableness, in the cesarean birth’s group, were associated with postnatal depression. Further, anxiety explained the relation between neuroticism and postnatal depression in both natural and cesarean birth groups. In addition, postnatal anxiety mediated the relation between extraversion and postnatal depression in the cesarean birth group. Our findings highlight that postnatal anxiety is a potential mechanism explaining how personality traits (i.e., neuroticism, extraversion) are related to postnatal depression, and that these relations may depend on the type of childbirth.

Pathophysiology of depression and mechanisms of treatment

Major depression is a serious disorder of enormous sociological and clinical relevance. The discovery of antidepressant drugs in the 1950s led to the first biochemical hypothesis of depression, which suggested that an impairment in central monoaminergic function was the major lesion underlying the disorder. Basic research in all fields of neuroscience (including genetics) and the discovery of new antidepressant drugs have revolutionized our understanding of the mechanisms underlying depression and drug action. There is no doubt that the monoaminergic system is one of the cornerstones of these mechanisms, but multiple interactions with other brain systems and the regulation of central nervous system function must also be taken into account In spite of all the progress achieved so far, we must be aware that many open questions remain to be resolved in the future.

Factors associated with depressive symptoms among older adults living alone: an analysis of sex difference

OBJECTIVES

The aim of this study was to explore the prevalence of depressive symptoms and the risk factors that correlated with depressive symptoms among elders living alone.

METHODS

A cross-sectional design was implemented. The sample consisted of 117 women and 75 men aged 65 and older who living alone in Tainan, Taiwan. The Chinese version of Center for Epidemiological Studies Depressive Symptoms Scale was adopted to assess depressive symptoms. Logistic regression analyses were employed to determine the risk factors of depressive symptoms in the elderly women and men living alone.

RESULTS

Results of this study showed that the elderly women had a 1.6-fold greater prevalence of depressive symptoms than did men. Women who were aged 85 and above, and less social support, had a significantly higher occurrence rate of depressive symptoms. The risk factors for depressive symptoms in elderly men living alone included educational level, religious beliefs, self-rated health status, number of chronic illnesses, and social support.

CONCLUSIONS

Healthcare providers should reflect the sex difference on risk factors of depressive symptoms when planning mental health services for the elderly population.

Barriers to seeking help and treatment suggestions for prenatal depressive symptoms: focus groups with rural low-income women

Interviews were conducted with 21 pregnant or recently pregnant African American and Caucasian low-income women living in a rural southeastern community to elicit perceived barriers to seeking help for depressive symptoms in pregnancy and ways to overcome these barriers, as well as intervention suggestions. Participants identified themes regarding barriers to seeking help. These were: (1) lack of trust, (2) judgment/stigma, (3) dissatisfaction with the health care system, and (4) not wanting help. Themes identified regarding overcoming barriers were: (1) facilitating trust and (2) offering support and help. These and other findings point to the importance of integrating women's ideas into culturally sensitive interventions for women with depressive symptoms or depression in pregnancy that can be provided by a psychiatric nurse-practitioner or other mental health provider.

Postpartum depression screening by family nurse practitioners

PURPOSE

The purpose of the study was to identify whether and how nurse practitioners (NPs) screen for postpartum depression, as well as to identify factors affecting such screening.

DATA SOURCES

Self-report data were gathered from 159 questionnaires completed by a convenience sample of family NPs (FNPs) in Illinois and Wisconsin during July 2002.

CONCLUSIONS

Despite the fact that 84% of FNP respondents saw at least one postpartum woman yearly, 42% never screened for postpartum depression in any way. The subjects' confidence in their knowledge of how to use a screening tool was the single best predictor of screening behavior (r= .487). NPs tend to follow clinical practice guidelines, but no guidelines exist to address postpartum depression specifically. Screening for postpartum depression is not universal, making it likely that prevailing estimates of the incidence of this disease are low.

IMPLICATIONS FOR PRACTICE

If the number of NPs who screen for postpartum depression could be increased, many postpartum patients and families could be positively affected. Advanced practice nursing education should adequately prepare graduates to screen at-risk patients. The development of graduate curricula including thorough units on postpartum depression, as well as formulation of clinical practice guidelines for postpartum depression, could make great strides toward more and better screening, prompt diagnosis, and treatment.

Life story of and depression in an HIV-positive pregnant Thai woman who was a former sex worker: case study

We describe the life story of an HIV-positive pregnant Thai woman--part of a larger action research study--with a case study methodology. The participant was chosen because of her unique and complex life story involving HIV infection, pregnancy, and former sex work. Bua (pseudonym), interviewed five times during 2001-2002, was a former sex worker who got married and later became infected with HIV through a sexual relationship with a man other than her husband. The significant events in Bua's life are outlined chronologically, and the social and cultural dimensions contributing to her depression are described.

Depression in Pregnancy

Women who are already predisposed to depression are at increased risks during pregnancy because of endocrine changes; untreated depression in pregnant women might lead to adverse effects for both mothers and infants. This article examines outcomes associated with the use of antidepressants during pregnancy and identifies how nurses can help depressed pregnant women. It is recommended that pregnant women who have mild depression be treated with nonpharmacologic therapy, such as counseling, cognitive-behavioral therapy, or interpersonal psychotherapy. Current appropriate treatment for pregnant women with moderate and severe depression is antidepressant medication, although there is no consensus on the best antidepressants for use in pregnancy. Thus, the psychotropic drug must be chosen carefully to minimize negative effects on infants and mothers, for some studies have demonstrated deleterious effects on infants. Nurses in multiple settings who interact with pregnant women should be aware of the necessity of screening for depression. Nurses in antenatal care settings can refer appropriately screened women to mental health specialists; psychiatric nurse practitioners can identify suitable interventions based on potential risks and benefits to maternal and infant health.

Depression screening attitudes and practices among obstetrician-gynecologists

OBJECTIVE

To assess obstetrician-gynecologists' attitudes and practices related to depression screening.

METHOD

A total of 282 obstetrician-gynecologists completed a 36-question mail survey that assessed attitudes regarding depression screening, training to treat depression, psychosocial concern, professional influence, and ease of screening.

RESULT

Depression screening (employed regardless of signs or symptoms) was reported by 44% of physicians. Positive attitudes toward depression screening, high psychosocial concern, high ease of screening, and adequate training to treat depression were significant independent predictors of depression screening practices.

CONCLUSION

The majority of obstetrician-gynecologists are concerned about depression, believe depression screening is effective, and perform some degree of depression screening with their patients. However, they perceive depression screening as difficult to carry out in everyday practice, and some question whether screening improves outcomes.

How to diagnose and treat depression

Depression remains the most common problem in primary care; however, it's gravely underdiagnosed and undertreated. This article details how to diagnose and treat depression in adults and in special populations, including postpartum women, children and adolescents, the medically ill, and the elderly.

Sociodemographic factors of families related to postnatal depressive symptoms of mothers

Postnatal depression in mothers is commonplace as it affects 10-15% of recent mothers. Postnatal depression is still an under-diagnosed illness and if unidentified, is often left untreated. If left untreated, the depression can have an adverse effect not only on the mother, but also on the child's development and on the well-being of the whole family. The aim of this survey was to investigate the prevalence of postnatal depressive symptoms among Finnish mothers and to ascertain the relationship with sociodemographic factors in mothers. A sample of 1000 families at 2 months postnatal was studied by mailing the Edinburgh Postnatal Depression Scale to mothers and a questionnaire on demographic characteristics to mothers and fathers. The response rate was 39%. The data were examined by means of frequency and percentage distributions. Connections were examined using Spearman correlation coefficient and analysis of variance. In all, 373 mothers and 314 fathers took part in the study. Fifty-five (13%) mothers had depressive symptoms. Results show that the number of pregnancies, deliveries or children, the mode of delivery or the mother's age were not associated with depressive symptoms. However, mothers who had depressive symptoms had fewer years of education, shorter duration of breast-feeding and were more dissatisfied with family life compared with mothers who exhibited no depressive symptomatology. The families of mothers with depressive symptoms had also experienced more problems and changes having a profound impact on the family compared with other mothers.