Deepika Goyal

How much does Low Socioeconomic Status Increase the Risk of Prenatal and Postpartum Depressive Symptoms in First Time Mothers

OBJECTIVE To examine socioeconomic status (SES) as a risk factor for depressive symptoms in late pregnancy and the early postpartum period. A secondary objective was to determine whether SES was a specific risk factor for elevated postpartum depressive symptoms beyond its contribution to prenatal depressive symptoms. DESIGN Quantitative, secondary analysis, repeated measures, descriptive design. SETTING Participants were recruited from paid childbirth classes serving upper middle class women and Medicaid-funded hospitals serving low-income clients in Northern California. PARTICIPANTS A sample of 198 first-time mothers was assessed for depressive symptoms in their third trimester of pregnancy and at 1, 2, and 3 months postpartum. MAIN OUTCOME MEASURE Depressive symptoms were measured with the Center for Epidemiological Studies-Depression (CES-D) Scale. RESULTS Low SES was associated with increased depressive symptoms in late pregnancy and at 2 and 3 months, but not at 1 month postpartum. Women with four SES risk factors (low monthly income, less than a college education, unmarried, unemployed) were 11 times more likely than women with no SES risk factors to have clinically elevated depression scores at 3 months postpartum, even after controlling for the level of prenatal depressive symptoms. CONCLUSION Although new mothers from all SES strata are at risk for postpartum depression, SES factors including low education, low income, being unmarried, and being unemployed increased the risk of developing postpartum depressive symptoms in this sample.

Patterns of Sleep Disruption and Depressive Symptoms in New Mothers

Objectives This study describes the patterns of sleep disturbance and depressive symptoms in a sample of childbearing women from the third trimester through the postpartum period. The relationship between sleep and depressive symptoms is also examined. A secondary aim of this study was to examine the relationship between self-report measures of sleep and depressive symptoms between women with depressive symptoms in comparison with women with minimal or no depressive symptoms in the third trimester and in the third month postpartum. Methods This longitudinal, descriptive study followed 124 primiparous women from their last month of pregnancy through 3 months postpartum. Questionnaires on sleep and depressive symptoms were completed during the third trimester (Time 1), 1 month postpartum (Time 2), 2 months postpartum (Time 3), and during the third month postpartum (Time 4). Sleep measures in a subset of women with depressive symptoms were compared with those of women with minimal or no symptoms at Time 1 and Time 4. Results and Conclusions Sleep disturbance and depressive symptoms were associated at Time 1 and Time 4. For new mothers, a complaint of trouble falling asleep (delayed sleep onset latency) may be the most relevant screening question in relation to their risk for postpartum depression.

Moral Distress in Emergency Nurses

INTRODUCTION For nurses, moral distress leads to burnout, attrition, compassion fatigue, and patient avoidance. METHODS Using a quantitative, cross-sectional, and descriptive design, we assessed the frequency, intensity, and type of moral distress in 51 emergency nurses in 1 community hospital using a 21-item, self-report, Likert-type questionnaire. RESULTS Results showed a total mean moral distress level of 3.18, indicative of overall low moral distress. DISCUSSION Situations with the highest levels of moral distress were related to the competency of health care providers and following family wishes to continue life support, also known as futile care. Moral distress was the reason given by 6.6% of registered nurses for leaving a previous position, 20% said that they had considered leaving a position but did not, and 13.3% stated that they are currently considering leaving their position because of moral distress.

Clinically Identified Postpartum Depression in Asian American Mothers

OBJECTIVE To identify the clinical diagnosis rate of postpartum depression (PPD) in Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) compared to non-Hispanic Whites. DESIGN Cross-sectional study using electronic health records (EHR). SETTING A large, outpatient, multiservice clinic in Northern California. PARTICIPANTS A diverse clinical population of non-Hispanic White (N = 4582), Asian Indian (N = 1264), Chinese (N = 1160), Filipino (N = 347), Japanese (N = 124), Korean (N = 183), and Vietnamese (N = 147) mothers. METHODS Cases of PPD were identified from EHRs using physician diagnosis codes, medication usage, and age standardized for comparison. The relationship between PPD and other demographic variables (race/ethnicity, maternal age, delivery type, marital status, and infant gender) were examined in a multivariate logistic regression model. RESULTS The PPD diagnosis rate for all Asian American mothers in aggregate was significantly lower than the diagnosis rate in non-Hispanic White mothers. Moreover, of the six Asian American subgroups, PPD diagnosis rates for Asian Indian, Chinese, and Filipino mothers were significantly lower than non-Hispanic White mothers. In multivariate analyses, race/ethnicity, age, and cesarean were significant predictors of PPD. CONCLUSION In this insured population, PPD diagnosis rates were lower among Asian Americans, with variability in rates across the individual Asian American subgroups. It is unclear whether these lower rates are due to underreporting, underdiagnosis, or underutilization of mental health care in this setting.

Identification of Postpartum Depression in an Online Community

OBJECTIVE To identify the rate of postpartum depression symptoms in an online community. A secondary purpose was to identify womens experiences when accessing health care services for postpartum depression (PPD). DESIGN A quantitative, cross-sectional, survey design. SETTING The setting consisted of nine birth clubs from one online community specifically targeted toward new mothers. PARTICIPANTS A convenience sample of 469 mostly married (n = 373), White (n = 401) mothers with a mean age of 29.3 (SD = 5.3) years took part in this study. The majority (n = 433) reported living in the United States with access to health insurance coverage. METHODS The Edinburgh Postnatal Depression Scale (EPDS) was used to assess depression symptoms. Mothers indicating a previous diagnosis of PPD also completed the Access to Postpartum Depression Care (APDC) questionnaire. RESULTS Total EPDS scores ranged from 0 to 27 with a median of 7.0. Sixteen percent of participants (n = 75) scored ≥ 13, indicating a high risk for developing PPD. Of these 75 mothers, 18 (24%) indicated having thoughts of harming themselves sometimes and five (7%) indicated having these thoughts quite often. Additionally, 76 mothers indicating a previous history of PPD also completed the APDC questionnaire. Findings suggested mothers often received care that did not meet their expectations. Barriers to PPD care included insurance limitations and insensitive comments from their health care providers. CONCLUSIONS The rate of depression symptoms noted in this Internet-based population is in agreement with published rates. Therefore, findings of this study support further exploration and evaluation of using online platforms for PPD screening.

Patterns of Symptoms of Perinatal Depression and Stress in Late Adolescent and Young Adult Mothers

Objective: To compare symptoms of depression, maternal adjustment, and perceived stress in late adolescent and young adult mothers and to examine the patterns of these symptoms during the first 3 months after birth. Design: Secondary analysis of existing longitudinal data. Setting: San Francisco Bay Area, with participants in their home environments. Participants: Ethnically diverse women expecting their first infants recruited during the third trimester from childbirth education classes and antenatal clinics. The final sample included 34 participants in the late adolescent group (18–20 years) and 48 participants in the young adult group (21–24 years). Methods: The Center for Epidemiologic Studies Depression Scale was used to assess depression symptoms, the Maternal Adjustment and Maternal Attitudes Scale was used to assess maternal adjustment, and the 10‐item Perceived Stress Scale was used to assess perceived stress. Repeated‐measures analyses of variance were used to examine changes over time in depression, maternal adjustment, and perceived stress scores. Results: Compared with young adult participants, late adolescent participants had greater mean depression scores (F(1, 61) = 8.02, p = .006) and perceived stress scores (F(1, 62) = 9.45, p = .003) at all time points. Scores for maternal adjustment could not be compared because of the low internal validity of the instrument. Conclusion: Our results indicated that late adolescent mothers may have more symptoms of depression and stress in late pregnancy and the early postpartum period than young adult mothers. Clinicians in maternity and pediatric settings should be vigilant in screening for depression and stress in this vulnerable population during their transitions to motherhood.

Methods of Evaluating an Accelerated Associate Degree Registered Nurse to Baccalaureate Degree Continuation Program

Program evaluation guides curricular decision making and change. This article describes a comprehensive program evaluation of an accelerated associate degree to baccalaureate continuation program and includes some findings and lessons learned. Educators need to be responsible and accountable for the curricular changes that they make and assure that rigor is maintained and essentials are met. The use of comprehensive program evaluation adds significant value and richness of data because use of multiple study methods leads to data from multiple vantage points. Although a comprehensive program evaluation can be time consuming, not all of the methods described in this article may be required. Using the matrix provided, the reader may choose to carry out 1 or 2 of the methods described here.

Postpartum Traditions, Mental Health, and Help-Seeking Considerations Among Vietnamese American Women: a Mixed-Methods Pilot Study

The purpose of this study was to explore Vietnamese American mothers’ perceptions and experiences with postpartum traditions, postpartum depression (PPD), and mental health help-seeking behavior. Participants were 15 Vietnamese mothers who had given birth to at least one live infant within the previous year. A screening tool revealed that a third of the mothers had probable PPD. More than half reported having recent/current postpartum “sadness” during the interviews. Postpartum traditions played important roles in their well-being and maintaining strong cultural values. However, some reported feelings of isolation and the desire to be able to carry out postpartum traditions more frequently. Many who had reported sadness said that they would not seek professional help; all had felt that their condition was not “severe” enough to warrant help-seeking. Future PPD interventions should consider the importance of postpartum cultural traditions and address help-seeking barriers as ways to prevent the adverse effects of untreated PPD.

Perinatal Practices & Traditions Among Asian Indian Women.

AbstractAs the population in the United States grows more diverse, nurses caring for childbearing women must be aware of the many cultural traditions and customs unique to their patients. This knowledge and insight supports women and their families with the appropriate care, information, and resources. A supportive relationship builds trust, offers guidance, and allows for the new family to integrate information from nurses and other healthcare providers with the practice of certain perinatal cultural traditions. The Asian Indian culture is rich in tradition, specifically during the perinatal period. To support the cultural beliefs and practices of Asian Indian women during this time, nurses need to be aware of and consider multiple factors. Many women are navigating the new role of motherhood while making sense of and incorporating important cultural rituals. The purpose of this article is to provide an overview of perinatal cultural practices and traditions specific to the Asian Indian culture that perinatal nurses may observe in the clinical setting. Cultural traditions and practices specific to the pregnancy and postpartum period are described together with symbolism and implications for nursing practice. It is important to note that information regarding perinatal customs is provided in an effort to promote culturally sensitive nursing care and may not pertain to all Asian Indian women living in the United States.

Sleep Quality and Quantity in Low-Income Postpartum Women

Purpose: To describe and explore patterns of postpartum sleep, fatigue, and depressive symptoms in low-income urban women. Study Design and Methods: In this descriptive, exploratory, nonexperimental study, participants were recruited from an inpatient postpartum unit. Subjective measures were completed by 132 participants across five time points. Objective sleep/wake patterns were measured by 72-hour wrist actigraphy at 4 and 8 weeks. Mean sample age was 25 years, high school educated with 3.1 children. Over half the sample reported an annual income less than 50% of the federal poverty level. Results: Objectively, total nighttime sleep was 5.5 hours (week 4) and 5.4 hours (week 8). Subjectively, 85% met criteria for “poor sleep quality” at week 4, and nearly half were persistently and severely fatigued through 8 weeks postpartum. Clinical Implications: The majority (65%) of women in this study met the definition of “short sleep duration,” defined as sleeping ⩽ 6 hours per night. Adverse effects of this short sleep on physical and mental health as well as safety and functioning, especially within the context of poverty, may be profound. There is an urgent need for further research on sleep in low-income underrepresented women to identify interventions that can improve sleep and fatigue as well as discern the implications of sleep deprivation on the safety and physical and mental health of this population.