Intranatal And Postnatal Period: Understanding Postnatal Depression

In recent years, PND is a broad spectrum comprising of depression in antenatal, intra-natal and postnatal period affecting postnatal women throughout pregnancy to 12 months after delivery (APA, 2013). In Singapore, 80% of postnatal mothers have minor disorders- baby blues and 1 in 12 having PND (Mama, 2015). PND is serious but treatable. Yet, most of them don’t seek help in Singapore because mental disorder is a great stigma and societal attitudes affect them in expressing their illness. Singhealth (2014) states that 10-15% of postnatal women experience PND in Singapore with 3-5% having moderate/severe depression. PND affects the health of mother, child and family. In 2016, SAMH states that 8% of new mothers develop PND in Singapore and medical professionals add that many of the PND remain undiagnosed. Even outside Singapore, New York Times published that 1 in 5 postnatal mothers experience depressive, anxiety, obsessive-compulsive disorder, mood disorder or in combinations. PND is a major health issue in the world as it negatively impacts a person’s life. Post natal depression may lead to very serious health related problems in the world. It may cause an irreversible change in mother and children requiring prompt treatment. All these statistics indicates that research shows that research on PND is needed.   

Three aims have been developed by the researcher to examine the experiences of PND by Hong Kong- Chinese women. The goals of this study are clearly, specifically and concisely stated. They are easily achievable by adopting prompt research method. The study shows that they have evaluated the PND experience of postnatal women and stated that they were tired, confused, hopeless, helpless and loss of ability to control their emotions (APA, 2013). They have also observed absence of self-confidence and self-esteem with poor coping skills, low mood, inability to participate in baby care, suicidal thought, guilt, phantom crying, ambivalence on child (Collingwood, 2016) which suggests that their first goal is met. They have investigated the factors causing PND in mother’s view as uncaring partners, strict in-laws, feelings of trapping into situation with suicidal, infanticide and homicidal thoughts and met their second goal. But they could have studied other related factors as transition to new parenthood, societal stressors and expectations by involving their partner and family (Habel, 2015). Their third objective of identifying the help-seeking behavior of postnatal women was met by identifying that most of the Chinese mothers are not expressing their experience of PND. They have also identified that they are not seeking help from medical personnel’s till their possibility of PND was assessed in screening tool. They got help from psychiatric physicians, nurses and family only after diagnosis.

Basically a research methodology should be a systematic approach to solve the problems (Polit, 2016). The qualitative design used in the study involves linear progression of steps and has focused particularly on PND mothers. They have conducted the study based on the steps of phenomenological method. This study has used descriptive method which is indented to evaluate and describe PND that helps to accurately portray the characteristics of postnatal mothers with PND (Polit, 2016). They have selected only one PND clinic to avoid bias. They have selected appropriate samples of Hong Kong- Chinese postnatal mothers with PND by purposive sampling method to prevent probability in sampling. The sample size is inadequate. They have selected PND women with score more than 10 by using Edinburgh PND scale. They conducted interview with open-ended questions which helps to report directly by mothers. The data was collected by a single qualified nurse to maintain uniformity. The data analysis was performed by two persons which to avoid errors. Norhayati (2015) states that the use of structured questionnaire with interview gives best findings. It is evident from the study that the research design, approach, setting, population, sampling method, data analysis used are appropriate. Yet number of samples and data collection instruments could be better.

The findings suggest the sense of the research. They found that PND mothers will feel helpless, hopeless, guilty, ambivalence with phantom crying (APA, 2013). The study stated that the main factor that influenced PND is unsupportive partners and strict in-laws which have no clear evidence. It has studied about low economic status, educational and occupational factors. Yet, PND is caused by other factors as genetic inheritance, previous depressive disorders, unbearable stressors, stressful married life, drug, medicine or alcohol use, unwanted pregnancy, illegal child, support system and multiple births (Mazaheri, 2014, Walker, 2016). This study has not generalized the results as it doesn’t involve other factors. Moreover it views only mother’s aspect but not on partner’s/ family’s aspect. A depressive person will often express that they are ill-treated by others and wanted to kill themselves, child or family. Though this finding may help them to identify the presence of depression and motivate them for help-seeking behavior, it doesn’t give appropriate result. The study states that the Chinese mothers don’t seek help from others due to the stigma which is common in Singapore (Mama, 2015). The findings help to create awareness about PND in mothers and promote help-seeking behavior. The researchers suggest that antenatal as well as postnatal visit is very important to diagnose PND that helps early treatment. They stated that psychotherapy as family therapy and individual and family counseling should be given to the mothers. It is evident that outreach and home based care should be given for unwilling mothers. Even tele-support, supportive groups and primary level education should be given at home environment.

This research is the base for future research. Nearly 50% of PND begins in antenatal period (O’Hara, 2013) and so studies should be conducted during antenatal period. Future studies are needed to generalize the result with larger population. Singapore resides people of various cultures which necessitates individual studies for those people. According to SAMH (2016), 10-20% of women & 5-10% of men experience PND which necessities research in these aspects. There are only limited studies in Singapore and hence more studies are needed. The biological, socio-economical and environmental factors should be studied (Norhayati, 2015). The qualitative study based on partner’s and family’s view should be conducted. Quantitative researches should be proposed by using psychotherapies for PND. Further study should be based on stages of depression with questionnaire and other depression measuring scales. Correlation studies should be carried out in all the settings and between immigrants and emigrants.  

Basically, a study should follow all the ethical principles. This study has met the principle of beneficence as it helps the undiagnosed postnatal mothers with PND to be diagnosed and help them to seek help from professionals, friends, brothers and sisters. According to the principle of nonmaleficence, the study should not give any harm (physical, emotional, social and financial harm) to the participant. This study may cause emotional harm with stress, anxiety and fear to the mothers (Polit, 2016). They must be handled with sensitivity as qualitative studies involve in-depth assessing of the personal aspects. In this study, mothers were protected from physical harm but not from emotional harm. To avoid this, the researcher should frame questions based on the individual psychological differences. But the questions framed in this study might endorse fear about their depression and harm the mother. It met principle of full disclosure by explaining the purposes of study and interviews and got consent and also met principle of justice by assessing the mothers with common interview questions (Polit, 2016). They have maintained confidentiality and allowed the mothers to discontinue at any time (independence).

This research study gives an appropriate idea about the experiences of postnatal Chinese mothers on PND. It motivates to conduct further research in this aspect in Singapore and other countries. This research is well conducted, clearly stated and organized other than the drawbacks. They have followed all the ethical principles except few issues.

Collingwood, J. (2016). Risk Factors for Postpartum Depression: Psych Central. Retrieved from https://psychcentral.com/lib/risk-factors-for-postpartum-depression/

DSM- V. (2013). Diagnostic Criteria for Major Depressive Disorder and Depressive Episodes. Retrieved from American Psychiatry Association

Habel, C. (2015). Causes of women’s postpartum depression symptoms: Men’s and women’s perceptions: Midwifery Journal. 31 (7). doi: https://dx.doi.org/10.1016/j.midw.2015.03.007

Mama. (2015). More than baby blues: Postpartum Depression in Singapore. Retrieved form https://www.sassymamasg.com/postpartum-depression-in-singapore-resources/

Mazaheri, M.A. (2014). Understanding the factors affecting the postpartum depression in the mothers of Isfahan city: J Educ Health Promot. 3: 65. doi:  10.4103/2277-9531.134784

Norhayati. (2015). Magnitude and risk factors for postpartum symptoms: A literature review. Journal of Affective Disorders. Vol. 175. doi:https://dx.doi.org/10.1016/j.jad.2014.12.041. 34–52

O’Hara, M.W. (2013). Postpartum depression: Current status and future directions. The Annual Review of Clinical Psychology. vol. 9. 379-407. 

Polit, D.F & Beck, C.T. (2016). Nursing Research: Generating and assessing evidence for nursing practice. Lippincott Williams & Wilkins: New Delhi.

SAMH. (2016). Post natal depression: Singapore Association of Mental Health. Retrieved from https://sg.theasianparent.com/postnatal_depression_in_singapore/

Singhealth. (2014). Postnatal Depression. Retrieved from https://www.singhealth.com.sg/PatientCare/ConditionsAndTreatments/Pages/Postnatal-Depression.aspx

Walker, M. (2016). New Baby Blues or Postpartum Depression?. Psych Central. Retrieved from https://psychcentral.com/lib/new-baby-blues-or-postpartum-depression/