RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCE. KARNATAKA, BANGALORE.
SYNOPSIS FOR REGISTRATION OF TOPIC FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / DEEPA JOSEW/O VICTOR GEORGE, #648, KAVERI NILAYA,14TH B MAIN MATHIKERE, BANGALORE-54.
2. / NAME OF THE INSTITUTION / M.S.RAMAIAH INSTITUTE OF NURSING EDUCATION AND RESEARCH
M.S.R.I.T POST
BANGALORE-560054.
3. / COURSE OF STUDY AND SUBJECT / MSc NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
DISSERTATION PROTOCOL
4. / DATE OF ADMISSION TO COURSE / 04/06/2009
5. / TITLE OF THE STUDY:
COMPARISON OF POST PARTUM DEPRESSION AMONG PRIMI & MULTI PARA MOTHERS IN A VIEW TO DEVELOP SELF INSTRUCTIONAL MODULE FOR FAMILY MEMBERS ON PREVENTION OF POST PARTUM DEPRESSION.
6. BRIEF RESUME OF THE INTENDED WORK
Introduction
Post natal period is the period when the women readjusting physiologically and psychologically to motherhood.Emotional responses may be just as intense and powerful for experienced as well as for new mothers.1
Postpartum depression (PPD) is an intense and pervasive illness with severe & liable mood swings, and is more serious and persistent than postpartum blues. Depression occurs following child birth is called postpartum depression. 2
The onset of postpartum depression is gradual and the condition may last for 3-6 months. In some cases it will persist throughout the first year of the baby’s life. In United States, the reported incidence of postpartum depression has ranged from 3 to 30 % during the first 3 months after childbirth. However, postpartum depression is believed to be undiagnosed and underreported.3
Woman with a previous history of depression are at increased risk of experiencing postpartum depression. The various factors like history of severe premenstrual dysphoric disorder or premenstrual syndrome (PMS), the unplanned pregnancy and stressful events during pregnancy or birth, increase the odds of developing postpartum depression.3
Causes of postpartum depression are unknown. Hormones may challenge some threshold after birth in the psychologically vulnerable women.The rapid hormonal changes that accompany pregnancy and delivery may trigger depression. Woman who have just given birth and dealing with physical, emotional changes, lifestyle changes and who is often sleepdeprived are at risk. In addition, they may feel overwhelmed and anxious about their ability to properly care for their baby.4
A study on Post-partum depression in the rural community, in India, states that 26.3% were diagnosed to have post-partum depression. The various factors associated with post-partum depression were age less than 20 or over 30 years, schooling less than five years, thoughts of aborting current pregnancy, unhappy marriage, physical abuse during current pregnancy and after childbirth, husband's use of alcohol, girl child delivered in the absence of living boys and a preference for a boy, low birth weight, and a family history of depression.5
A study conducted in Bangladesh on the magnitude and contributory factors of postnatal depression shows that the prevalence of postnatal depression is 22% at 6-8 weeks post-partum. The prevalence is further high in low-income developing countries. Thepostnatal depression could be predicted by history of past mental illness, depression in current pregnancy, perinatal death, poor relationship with mother-in-law and either the husband or the wife leaving home after a domestic quarrel .6
Postpartum depression is a taboo subject in some social circles, which silences many women. Women may feel guilty, isolated and a failure at a time when they should feel victorious and contented to embrace the powerful role of motherhood. This is further compounded when some women and their partners may not be fully informed about the signs and symptoms of postpartum depression.
6.1 NEED FOR THE STUDY
Depression in postpartum period has been classified into three categories in ascending level of severity viz, maternity blues, postpartum depression and psychotic depression. Because the blues are self limiting and the florid postpartum psychosis obvious, the serious but more often under recognized middle category becomes an important subject of enquiry. 7
The prevalence of postpartum depression ranges from 10% to 15%, with screening rates of depressive symptoms as high as 35% in African American women.7Mothers with postpartum depression may experience lack of interest in their baby, negative feelings towards their baby, worrying about hurting their baby, lack of concern for themselves, loss of pleasure, lack of energy and motivation, feelings of worthlessness and guilt, changes in appetite or weight, sleeping more or less than usual and recurrent thoughts of death or suicide.8
Maternal depression is associated with adverse effects on infant development. Children of mothers with postpartum depression may have behavioural problems, delay in cognitive development, social problems, emotional problems and risk of depression early in life. 8
A study conducted on prevalence and risk factors of postpartum depression among Pakistani women in Norway in 2008 by the University of Oslo concluded that only 7.6% of the immigrant Pakistani women were depressed in postpartum. High scores on the life event scale, a history of prior depression, single marital status, a poor relationship to one's partner and an age of 30 years or more were found to be significant risk factors for postpartum depression. 9
A study was conducted to determine the incidence and risk factors for developing post-partum depression in a cohort of women living in ruralsouth India assessed 359 women in the last trimester of pregnancyand 6-12 weeks after delivery for depression and for putativerisk factors.The incidence of post-partum depression was 11%. The risk factors for the onset of post-partum depression were found to be low income, birth of a daughter when a son wasdesired, relationship difficulties with mother-in-law and parents,adverse life events during pregnancy and lack of physical help.10
Postpartum depression can disrupt relationships, especially with her partner, and her infant can present with attachment disorders and cognitive delays. Support has been found to be beneficial to pregnant and labouring women. A meaningful relationship with a supportive caregiver reinforces the concept that the woman matters to someone, increasing feelings of well-being, control, and positive effect.6
The left, untreated, postpartum depression cases can last for a significant length of time, even up to a year or more.The postpartum depression can interfere with woman’s ability to function, including woman’s ability to take care of herself and her child. Early detection helps to give awareness to the family.10The support from family and attention to post natal mother’sneedsmay help them to get back on to the healthy and happy motherhood.6
6.2 REVIEW OF LITERATURE
A studyconducted on women living in rural areas of Isfahan Province in Iran, have assessed 6627 women,between 2 to 12 months after delivery, for depression and putative risk factors. The main risk factors of postpartum depression were found to beunemployment, low education, mother’s young age, undesired gender of the child, unplanned pregnancy, low education and history of depression. 11
A study conducted to examine socio-demographic and obstetric risk factors for postnatal depressive symptoms in a Nigerian community,in Africa.They recruited876 women at 6 weeks postpartum.Depression was diagnosed in 14.6 % of the postpartum women. The predictors of Post natal depression included hospital admissions during the pregnancy, female sex of the baby, preterm delivery , instrumental delivery, Caesarean section , and being single . 8
A prospective cohort study carried outin Hunan, China tosee the association of antenatal and postnatal social support with postpartum depression (PPD) on 534 pregnant women .A total of 19.29% women had PPD. Women with low prenatal and postnatal social support had higher rates of PPD. They concluded that postnatal social support and PPD is much stronger than that of prenatal social support.12
A Cochrane database systematic reviewon psychosocial and psychological interventions for treating postpartum depression compared with usual postpartum care in the reduction of depressive symptomatology was conducted. The meta-analysis results suggest that psychosocial and psychological interventions are an effective treatment option for women suffering from postpartum depression compared to usual postpartum care.13
STATEMENT OF THE PROBLEM
A comparative study to assess postpartum depression among primi and multipara mothers in a view to develop self instructional module for family members on prevention of postpartum depression at selected community area, Bangalore.
6.3 OBJECTIVES:
To assess the postpartum depression among primi and multi para mothers.
To compare post partum depression among primi and multi para mothers.
To find the association between post partum depression and selected socio demographic variables.
To develop a self instructional module for family members on prevention of postpartum depression.
6.4 HYPOTHESES:
H01-There is no significant difference in the postpartum depression among primi and multi para mothers.
H02-There is no significant association between post partum depression and selected socio-demographic variables.
6.5 OPERATIONAL DEFINITION:
1. Postpartum depression: It is a postnatal complication characterized by an intense, depressive symptoms such as lack of interest in baby, negative feelings towards baby, lack of concern, lack of energy and motivation, feelings of worthlessness and guilt, anxiety, changes in appetite or weight, sleeping more or less than usual, loss of pleasure, recurrent thoughts of death or suicide as measured by modified Edinburgh postnatal depression scale (EPDS).
2. Primipara : women who have delivered for the first time and in her first 3 months period after delivery irrespective of the mode of delivery and outcome of labour.
3. Multipara: women who have delivered more than one time and in her first 3 months period after delivery irrespective of the mode of delivery and outcome of labour.
4.Self instructional module: it refers to systematically organized learning module prepared for the family members by the investigator and validated by experts containing information regarding meaning,risk factors, manifestations, prevention and management of postpartum depression.
5. Family members: refers to the any relative involved in care of post natal mothers.
6.Prevention: includes primary, secondary and tertiary preventive measures that should be undertaken by the family members involved in care of postnatal mother.
6.6 ASSUMPTIONS:
- Self instructional module may help to create awareness among family members on prevention of postpartum depression.
- Awareness of family members may help in all levels of prevention of postpartum depression among primi and multi para mothers.
6.7 DELIMITATIONS:
Study is delimited to
- primi and multipara mothers residing in selected areas ofBangalore.
- a period of 4 weeks of data collection.
7. MATERIALS AND METHODS:
7.1 Sources of data:
Primi and Multipara mothers.
7.2 Methods of data collection:
7.2.1 Type of study / Research approach:
Descriptive comparative study.
7.2.2 Research design:
Non experimental descriptive research design.
7.2.3 Variables:
Study variable: Post Partum depression.
Attribute variable: Age, Parity, Marital status, Relationship with spouse,
Educational status, Occupation, Religion, Individual income, Monthly
Incomeof the family, Type of family, Complications in pregnancy,
History ofpremenstrual syndrome, Planned or unplanned pregnancy,
Mode of delivery,Gender of the baby,preferred gender of the baby,
Family history of mental illness.
7.2.4. Sampling technique:
Nonprobability convenient sampling technique.
7.2.5. Sample and Sample size:
60 Postnatal mothers including 30 primi and 30 multipara mothers
whofulfilselection criteria will be selected.
7.2.6. Selection criteria:
Inclusion criteria: Primi and Multipara mothers
- who can read and understand Kannada or English .
- who are willing to participate in the study.
Exclusion criteria: Primi and Multipara mothers
- who are clinically diagnosed withPostpartum depression and are under treatment.
- who do not have any family members staying withthem.
7.2.7. Follow up:
As the study is a descriptive study there will not be any follow up done
by theinvestigator.
7.2.8. Comparison parameters:
Postpartum depression will be compared between primi and multipara
mothers.
7.2.9. Duration of study:
One month of data collection.
7.2.10.Instrument:
Section A: Socio demographic profile
Section B: Modified Edinburgh Postnatal depression Scale (EPDS).
7.2.11. Data collection procedure:
After obtaining permission from concerned authority, purpose of the
study willbe explained and written consent will be obtained from the participants and post partum depression will be assessed by using Modified Edinburgh Postnatal Depression Scale.Self instructional moduleon postpartumdepression will be prepared for the familymembers based on the findings of the study.
7.2.12. Statistical methods used:
Descriptive statistics:
- Frequency and percentage distribution for analysis ofsocio demographicvariables and postpartum depression.
- Mean, mean percentage and standard deviation will be used to assess postpartum depression.
Inferential statistics:
- Mann whitney U test will be used to compare postpartumdepression between Primi and multi para mothers.
- Chi Square test will be used to find the association between postpartumdepressionand selected socio demographic variables.
7.3. Does the study require any investigation or interventions to be
conducted on patients or other humans or animals? If so, please
describe briefly
Yes, the study assesses postpartum depression among primi and multi para
mothers by administering Modified Edinburgh Postnatal Depression Scale.
7.4. Has ethical clearance been obtained from your institution in
case of 7.3?
- Ethical clearance will be obtained from concerned authority and written consent will be obtained from post natal mothers.
8.LIST OF REFERENCES
- Diane M. Fraser, Margaret A, Cooper.Myles Textbook for midwives. 14thed. Edinburgh: Churchill Livingstone; 2003. p. 659.
- Wong, Hockenberry, Wilson, Perry, Lowdermilk.Maternal Child Nursing Care. 3rd ed. China: Mosby Elsevier; 2006. p.674.
- Gorrie,McKinney,Murray.Foundations of Maternal Newborn Nursing.USA: W. B. Saunders Company; 1994. p. 798.
- Postpartum Depression-Signs, Symptoms, and Help for New Moms [Online]. [cited2009Oct10];Availablefrom:URL:
- Savarimuthu RJ, Ezhilarasu P, Charles H, Antonisamy B, Kurian S, Jacob KS. Post-partum depression in the community: A qualitative study from rural south India. Int J Soc Psychiatry [serial on CD-ROM]. 2009 Nov 11.
- Gausia K, Fisher C, Ali M, Oosthuizen J. Magnitude and contributory factors of postnatal depression: a community-based cohort study from arural sub district of Bangladesh. Psychol Med [serial online] 2009 Jun [cited 2009 Oct 29]; 39(6) ): 999-1007. Available from: URL:
- Mamta Sood & A.K. Sood. Depression in Pregnancy and Postpartum Period Indian J Psychiatry2003;45(1):46-51.
- Adewuya AO, Fatoye FO, Ola BA, Ijaodola OR, Ibigbami SM. Sociodemographic and obstetric risk factors for postpartum depressive symptoms in Nigerian women. J Psychiatr Pract2005 Sep;11(5):353-8.
- Vangen. S, Nordhaqen R, Ytterdahi T, Maqnus p, Stray-Pedersen B.J.Postpartum depression among Pakistani women in Norway: prevalence andriskfactors. Matern Fetal Neonatal Med 2008 Dec;21(12):889-94.
10. ManiChandran, Prathap Tharyan, Jayaprakash Muliyil, Sulochana .Post-partum depression in a cohort of women from a rural area of Tamil Nadu, India, Incidence and risk factors. The Br J Psychiatry2002;181: 499-504.
11. Kheirabadi GR, Maracy MR, Barekatain M, Salehi M, Sadri GH, Kelishadi M, Cassy P.Risk factors of postpartum depression in rural areas of Isfahan ProvinceIran.Arch Iran Med2009 Sep;12(5):461-7.
12.Xie RH, He G, Koszycki D, Walker M, Wen SW. Prenatal social support, postnatal social support, and postpartum depression. Ann Epidemiol. 2009 Sep;19(9):637-43.
13.Dennis CL, Hodnett E.Psychosocial and psychological interventions for treating
Postpartum depression[Online] 2007 OctAvailable from: URL:
9. / SIGNATURE OF THE CANDIDATE10. / REMARKS OF THE GUIDE / Family plays major role in helping the postnatal mothers to adapt to her mothering role. Hence adequate knowledge is necessary for family members to assist postnatal mothers to successfully travel through this transition.
11.
11.1
11.2
11.3
11.4
11.5
11.6 / NAME AND DESIGNATION OF (in block letters)
GUIDE
SIGNATURE
CO-GUIDE(IF ANY)
SIGNATURE
HEAD OF THE DEPARTMENT
SIGNATURE / Ms. C.RAJESWARI
ASSOCIATE PROFESSOR
DEPT. OF OBG NURSING
M.S.R.I.N.E.R
Ms. C.RAJESWARI
ASSOCIATE PROFESSOR
DEPT. OF OBG NURSING
M.S.R.I.N.E.R
12.1
12.2 / REMARKS OF THE CHAIRMAN AND PRINCIPAL
SIGNATURE / Family support being the major contributory factor of postpartum depression, this study would be helpful in early detection as well as creating awareness in family members regarding prevention of postpartum depression