Causes of Post-Partum Depression
Abstract
Postpartum depression is a psychological condition known to affect childbearing women negatively and has been highly prevalent. This paper will assess studies concerning significant causes of postpartum depression, focusing on financial status, family support, and lack of knowledge for first-time mothers. In this research paper, studies that were reviewed had a focus on the causes of postpartum depression. The database that was mostly used came from PubMed and ScienceDirect, and the timeframe was from 2015 to 2020. Searches were conducted using keywords such as risk factors, social, economic, and nulliparous factors in postpartum depression. Information from this paper can be useful when coming up with tools to screen pregnant women at risk and also formulating prevention strategies.
Introduction
Leading causes of postpartum depression are lack of family support, financial problems, and insufficient knowledge because of being first-time mothers. Research studies have been consistent in showing that these risk factors are significant contributors to the high postpartum depression prevalence. Decisions informed by evidence are essential in designing screening tools that have sensitivity, sensitivity, cultural acceptability, and easily compatible with current practice. This discussion will highlight the three factors and look at how they are connected to postpartum depression.
Lack of Family Support
Social support from family members has shown to have a positive impact on health and can be useful in disease prevention (Ghaedrahmat et al., 2017). Studies conducted in the past fifty years have been consistent in showing that more significant family support translates to better health when compared to individuals who lack social support. Research has shown that family support reduces the risk of getting into depression when pregnant(Ghaedrahmat et al., 2017)Family social support during pregnancy for mothers below twenty years differ from those for mothers above twenty years. Mothers below twenty years receive relatively less social support from family and friends since they are not good at maintaining relationships with others (Kim et al., 2015). Unlike adult mothers, younger mothers are less educated, have a lower social status, and have a higher probability of not having a spouse. Several research studies have shown that mothers who had a family support system when pregnant and after giving birth had a reduced risk of experiencing postpartum depression. Surveys on maternity experiences analyzed postpartum depression as a function of the outcome. Examining maternity experiences and behaviors of adolescents, young adults, and adult mothers revealed that adolescent mothers had a higher chance of suffering from postpartum depression. The study was by Kingston, Heaman, Fell, and Chalmers (Kim et al., 2015).
In a study looking at relational measures, an assessment was done to determine the quality of their immediate network of relationship whereby the parents and spouses were considered. By use of parental Bonding instrument, it was possible to assess the mother’s relationship with their parents. For bonds with spouses, the assessment was by use of the Romance Qualities Scale (Smorti et al., 2019). Factors considered by this scale include disagreements, assistance, and level of closeness. In assessing how the mothers were attached with their children during pregnancy, The Parental Attachment Inventory was the tool. This study showed that the quality of parental attachment to children and love relationships have an impact on postpartum depression (Smorti et al., 2019).
Evidence revealed that the quality of a relationship matters more than the relationship’s length for a nulliparous mother. If there is a quality relationship between two spouses, there is more security and care between the partners, and this strong relationship becomes vital in times during and after childbirth. When couples transition into becoming parents, their relationship may deteriorate due to pregnancy since getting their first child involves a restructuring of the family and taking up new roles. This development can result in reduced relationship quality (Smorti et al., 2019). Therefore, the quality in a romantic relationship is determined by protection, whereas a relationship with low quality is characterized by a high risk of developing psychological conditions.
The nature of the mother with her parents also has an impact on the probability of developing PPD (Smorti et al., 2019). The quality of attachment between a pregnant woman and her mother greatly influences the woman’s mental health upon giving birth. The relationship between the pregnant woman and her mother affects how the new mother will relate with her newborn. A woman that experienced a quality relationship with her mother will be concerned about the child’s needs and be more attached to her child (Smorti et al., 2019). Such women with a strong motherly instinct influenced by their parents have shown a lower risk of developing postpartum depression. The good parental relationship is meaningful during first-time pregnancy as it affects the woman’s behavior when transitioning into motherhood.
Financial Problems
According to the Financial Health Institute, financial problems can result in financial stress, which can cause anxiety, being worried, being scared, and can also lead to psychological stress. American Psychological Association report indicates that approximately 72% of grown-ups feel stressed sometimes due to financial problems, and about 22% feel extremely stressed (Hill & Hettinger, 2019). Social, economic status, insufficient social resources, and the inability to accessing therapy have been identified as significant predictors of a mother suffering from postpartum depression. Healthcare professionals are advised to connect expectant mothers to resources to counter the negative implications of financial stressors on the overall health and reduce stigmatization, which usually accompanies these financial stress (Hill & Hettinger, 2019). The financial strain increases the risk of postpartum depression development. Therefore, mothers should feel that they are in control or have a strategy to improve their economic status and minimize the negative impact on their maternal health. (Hill & Hettinger, 2019)
A study conducted among Mississippi mothers who had given birth, researchers identified financial stress as the primary source of stress (Quaid et al., 2016). Mothers who had minimal levels of major stress forms exhibited the lowest postpartum depression level and was used as the reference. According to this study, mothers with high relationship-related stress and trauma but low financial pressure had a reduced risk of developing PPD (Qobadi et al., 2016). Mothers with anxiety linked to relationships, finances, and trauma had low postpartum depression prevalence, mothers with reduced levels of all the two types of stress, but a high financial burden showed reduced prevalence of PPD. These results conflicted with those from a study by Liu and Tronicks (Qobadi et al., 2016). This disparity could have been due to differences in perceptions about financial stress owing to the differences in contexts both socially and economically (Qobadi et al., 2016). For instance, the income for households in New York is higher compared to Mississippi. Evidence indicates that high household income increase the likelihood of perceived high financial stress. High household income increases the accessibility to finances from, for example, credit and loans. Having debts results in higher perceived stresses related to economic status.
Researchers also pointed out that having reduced levels of relational stress accompanied by high levels of finance-related stress results in a higher probability of PPD development. Therefore, it is clear that relational support alone is not enough to protect against PPD when other forms of stress are present. There is a complicated relationship between the risk factors that impact the overall well-being of a mother (Roomruangwong et al., 2016). Having many stressors can change how people perceive the extent of the stressors’ impact and can negatively affect the ability to cope with stress.
Being a First Time Mum
Having no prior experience as a mother for nulliparous women makes it difficult to have an interaction with their newborns. Studies indicate that nulliparous women have a higher risk of suffering from depression than multiparous women (Smorti et al., 2019). Not only are nulliparous women at risk getting depression, but they are also at risk of suffering from anxiety, which contributes to high co-morbidity (Dennis et al., 2017). Being a first-time mother makes women have feelings of uncertainties, and they may lack confidence in assuming the parenting role. Reduced self-confidence can contribute to PPD development (Smorti et al., 2019). In a study predicting PPD in nulliparous women, 205 nulliparous women who had been admitted by health providers in Kerman during the year 2016 were examined. A total of 102 nulliparous mothers had developed varying degrees of PPD. Some of the factors that seemed to have caused this postpartum depression were inadequate informational support and a lack of emotional support (Pourkhaleghi, Askarizadeh, & Fazilat-Pour, 2017).
Being afraid of giving birth is common among expectant women when it is their first time, and this fear has an association with dangers like miscarriages and abortions (Gosselin et al., 2016). Among nulliparous women, 20% of them have shown mild to moderate levels of fear, while about 6% of them exhibit extreme fear and can result in postpartum depression. A study looked at the connection between being afraid and giving birth, how pain is perceived PPD and PTS. Particular focus was on determining whether being fearful of giving birth has any association with PPD negative consequences (Gosselin et al., 2016)
The fear associated with child delivery is related to perceived pain during birth by women going through the process for the first time when anesthesia is not used. It is also associated with signs and symptoms of PPD and PTS and can occur where anesthesia was or wasn’t used. This fear has been reported to have a stronger association with PTS in women who go through a cesarean section, which had not been planned. Postpartum PTS symptoms can mediate in the connection between fear and giving birth and postpartum depression. These findings show how it is relevant to take into account the factor of women being afraid and perceived pain concerning symptoms of PTS and postpartum depression. Cesarean sections that had not been planned are vital factors that need consideration when studying the association between PTS symptoms and fear. Fear of giving birth can make the childbearing experience more detrimental and facilitate the development of PTS and PPD. Being psychologically vulnerable can also be a contributing factor which should be considered when analyzing these links (Gosselin et al., 2016)
Health literacy can be defined as an individual’s ability and capacity to get and comprehend information concerning health to facilitate the maintenance of health promotion behaviors (Khoei et al., 2017). Another study was carried out in Karaj hospitals in Iran to assess how health literacy is related to PPD among nulliparous expectant women. Health literacy level and depression levels were determined using the recommended measurement tools (Khoei et al., 2017). All the nulliparous women were assessed, and the findings indicated that 39.6% of the women had insufficient knowledge. The results also revealed that health literacy was significantly connected with the risk of developing PPD (Khoei et al., 2017). Therefore, it is evident that women who experience their first childbirth without adequate knowledge can easily get depressed.
Conclusion
Investigating the causes of postpartum depression is vital in strategizing how to reduce the adverse impact of this disorder on the mother and infant relationship and early development stages of a child. This field needs to expand its scope since it is multifaceted and needs to be addressed from all angles. Inadequate family support, economic instability, and going through the experience for the first time are the major causes of this disease, but other contributing factors are also important
References
Dennis, C., Falah-Hassani, K., & Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. British Journal of Psychiatry, 210(5), 315-323. https://doi.org/10.1192/bjp.bp.116.187179
Ghaedrahmat, M., Kazem, A., Kheirabadi, G., Ebrahimi, A., & Bahrami, M. (2017). Postpartum depression risk factors: A narrative review. Journal of Education and Health Promotion, 60(6). https://doi 10.4103/jehp.jehp_9_16
Gosselin P, Chabot K, Béland M, Goulet-Gervais L, &Morin AJ. (2016). Fear of Childbirth among Nulliparous Women: Relations with Pain during Delivery, Post-traumatic Stress Symptoms, and Postpartum Depressive Symptoms. L’encephale. 42(2):191-196. https://doi 10.1016/j.encep.2016.01.007.
Hill, A., & Hettinger, C. (2019). The Intersectionality of Race, Postpartum Depression, and Financial Stress. Concordia University, St. Paul Online. Retrieved 22 June 2020, from https://online.csp.edu/blog/forensic-scholars-today/race-postpartum-depression-ppd-financial-stress
Kim, T., Connolly, J., & Tamim, H. (2015). The effect of social support around pregnancy on postpartum depression among Canadian teen mothers and adult mothers in the maternity experiences survey. BMC Pregnancy and Childbirth, 14(1). https://doi.org/10.1186/1471-2393-14-162
Kohen, M., Lamyaian, M., Lotfi, R., & Montazeri, A. (2017). The Relationship between Postpartum Depression and Health Literacy among Nulliparous Women. Payesh, 16(6), 797-805. Retrieved 22 June 2020, from http://payeshjournal.ir/article-1-77-en.html
Pourkhaleghi N, Askarizadeh G, Fazilat-Pour M. (2017) Predicting Post-Partum Depression of Nulliparous Women: Role of Social Support and Delivery Type. JHC.; 19 (1) :18-29
Qobadi, M., Collier, C., & Zhang, L. (2016). The Effect of Stressful Life Events on Postpartum Depression: Findings from the 2009–2011 Mississippi Pregnancy Risk Assessment Monitoring System. Maternal and Child Health Journal, 20(S1), 164-172. https://doi.org/10.1007/s10995-016-2028-7
Roomruangwong, C., Withayavanitchai, S., & Maes, M. (2016). Antenatal and postnatal risk factors of postpartum depression symptoms in Thai women: A case-control study. Sexual & Reproductive Healthcare, 10, 25-31. https://doi.org/10.1016/j.srhc.2016.03.001
Smarty, M., Ponti, L., & Pancetti, F. (2019). A Comprehensive Analysis of Post-partum Depression Risk Factors: The Role of Socio-Demographic, Individual, Relational, and Delivery Characteristics. Frontiers in Public Health, 7. https://doi.org/10.3389/fpubh.2019.00295
.
.