Introduction

In the United States, maternal depression is a significant health concern where at least one child out of ten is associated with a depressed mother in every year (Hahn-Holbrook, Cornwell-Hinrichs & Anaya, 2018). It is crucial that healthcare providers and other specialists who interact with children and mothers learn about the severe health implications of maternal depression. In the US the issue is increasingly being recognized as a public health concern that also affects children under the care of these mothers. Many factors are contributing to the development of maternal depression which makes the problem very common and hence burdening the healthcare sector. Observable depression features have a substantial ability to impact the functionality of a mother in providing adequate care to her children. The development of major depression leads to increased comorbidity, severe functioning impairment, and other psychological disorder. Additionally, maternal stress is related to stressful life factors such as divorce, loss of a job or lack of social support.

Studies conducted to evaluate maternal depression identify that maternal functioning is significantly impaired. Mothers become less responsive to children; they cannot provide sufficient simulation and depict parenting difficulties (Taraban et al., 2017). Also, mothers under depression cannot seek appropriate medical care to their children and neither can they engage in preventive healthcare practices efficiently. Therefore, being under depression puts the health of the babies under enormous risk. Hence, there is an association between poor infancy outcome, childhood development, and adolescence with maternal depression. As such, it is observable that the effects of maternal stress have a lifelong impact on offspring. Therefore it is important to gather accurate information concerning maternal depression risk factors, the rate of occurrence, comorbidities and other negative factors associated with maternal stress. Collecting such information is essential for designing policies, designing the right healthcare intervention, promoting research and wellbeing for both mothers and children.

The PICOT Framework and Maternal Depression

Precise Question

In the endeavor to solve the problem of maternal depression, which maternal psychological health interventions are effective in preventing the challenges of development for the infants in the early stages?

Background Information

Analysis of postnatal mental health hitches between different countries shows that over the past four decades there has been clear evidence of predominant postpartum problems of mental health from high-income countries which ranges from 10 percent to 15 percent. On the contrary, there has been very little evidence of perinatal mental health problems from both low and middle-income countries. In the recent decade, however, there has been consistent evidence from a series of researches that the rate of postpartum problems of mental health among women in low and middle-income countries may be double those in high-income countries. These problems constitute severe burdens to women’s health. In addition to the women’s burdens, there is emerging evidence internationally about the effects of the mood disturbance on the health and development of the infants as well as young children of such women. The major contributing factors to maternal depression in low-income countries include high rates of diarrhea, the problems of infectious diseases, prolonged admission in hospitals, and failure to complete the recommended immunization schedules. Other factors that are linked to maternal depression include problems in the development of their children which can be physical, emotional, social, behavioral and cognitive. These factors may lead to minimal chances of child survival.

PICOT Analysis Based on the Maternal Depression

Population

The problem of maternal depression affects mothers and their infants notably in the low and middle-income countries. The causes of postnatal depression mostly involve the developmental health problems of their babies. Both the mother and the infant feel the effects of postnatal depression. For instance, a mother has mental illness and then becomes less responsive to the infant’s needs.

Intervention

            Various health interventions have been put forward to mitigate the problem of maternal depression with the aim of providing psychological and social support to mothers after delivery. Some of the support initiatives include visiting them at their homes, giving psychological education to prepare them for postnatal experiences, providing knowledge to them about the practice of child-rearing as well as providing training programs for both parents.

Comparison

            The interventions have been proposed in comparison with another option which is the usual treatment given to given to mothers after delivery with no intervention.

Outcome

            The outcomes of maternal depression would affect the growth and development of a victimized child. It would also affect the interaction between the infant and its mother. Besides, it would affect the moods and mental health of the mother.

Time

            The timeframe for maternal depression mainly covers the period from pregnancy to the period of child rearing. Nevertheless, depression is commonly noted during the postnatal period when the infant is still in the early stages of growth.

Discussion of Literature

First Article

The first analyzed article is a peer-reviewed article about new mothers and postpartum depression (Leger & Letourneau, 2014). The authors of the paper conducted a systematic search and identified six peer-reviewed journal papers that discussed postpartum depression (PPD). A review of the six studies is presented in a narrative format. The article recognizes that PPD causes significant effects to both the mother and the child; therefore it is an issue that needs to be addressed. As such the article focuses on presenting the findings of studies that evaluate the outcomes of PPD interventions. The search for articles was done through ancestry and systematic search of databases. The article employed four databases, the Cochrane library, CINAHL, psychoInfo, and Medline. Use of keywords such as PPD, maternal depression, stress, and others.

Recruitment of new mothers participants in all the study papers was done through various methods.one of them was screening clinics for immunization. Another recruitment method is the use of phone calls done by a public healthcare nurse after giving postpartum care. Some studies recruited new mothers at antenatal clinics while others were recruited within two weeks after delivery. The recruitment criteria identified by the studies included age, location, and language. Potential participants who met the stipulated criteria by the studies were recruited. Since the studies were also concerned with peer support, they also recruited voluntary participants to participate in providing support to the new mothers. Recruitment of participants entailed advertisements, flyers, community centers, and press. In this manner, the researchers managed to attract a considerable number of participants. The criterion for volunteer selection by all studies but one included a history and recovery from maternal depression, living in the same location as the new mother to be assisted, and the desire to help the new mothers.

The mode of intervention applied by the reviewed studies varied from one paper to the other. It depended on the level of support, the frequency, and the style of delivery. Some of the research papers utilized phone-based support. Another study provided both one on one and telephone-based support. While another study provided one on one home support, volunteers providing this type of help must have recovered entirely from PPD in the past, and they were to contact new mother in less than three days and maintain contact after the first support was delivered. The minimum number of connections that volunteers made was four, and they were expected to adequately and efficiently associate with all the new mothers that they have made contact. The interaction activities were recorded by the volunteers where they filled in an activity log which explains the interactions between them and the new mothers. The recording of such information was crucial in all studies at it provided primary data about mothers at risk of developing maternal depression.

In five of the reviewed studies, results regarding the depressive symptomology of new mothers receiving peer support are presented in the papers. One of the research papers focused on assessing the difficulties of healthcare professionals that work as peer support providers to people with PPD. One of the other five studies provides a report for comparing the outcomes of three group of women participating in the study: a group of case-matched controls, some mothers receiving supports and women that were not receiving support but were being offered. The paper reports that depressive symptomology did not differ as there were no significant differences among the three groups.

In evaluating both major and minor depression significant findings identified is that later occurrence of depression is likely to happen when depression is noticed at two months, another significant result is that if a mother receives increased social support, then her possibility of developing maternal depression is significantly diminished. Likewise, the evaluation of depressive symptoms found that having high depression symptoms at twelve months was related to being more stressed at two months, as such, the prediction of symptom development is more accurate when the woman had depression at two months. One the same note, offering strong social support to the mother at two months significantly reduces the possibility of major or minor depression occurring 12 months later.

One of the studies also endeavored to compare the outcome between the control and intervention group. Receiving peer support is identified to provide statistically significant consequences on depressive symptoms within four to eight weeks after beginning the peer support intervention. Women under the control group produced contradictory results that do not support the use of peer groups as an intervention strategy in assisting new mothers. Also, some researchers claim that women in the control group had a double chance of having maternal depression similar to those in the intervention group. The results provided by the studies significantly inform about how vital peer support is and how much it contributes to reducing the rate of maternal depression occurrence. As such, it should be adopted as an intervention strategy to assist new mothers

The overall satisfaction by all participating mothers exceeded 80% indicating a positive response to the applied intervention. Many women responded appropriately in sharing information with their supporters and appreciated their services. Key areas that were connected to satisfaction was listening. Women identified that their peer supporter listened to them and this allowed them to open up since there is someone to talk to. Satisfaction with the intervention was also based on the fact that the support helped them with household chores and childcare. Overall the women in the study identified that they received an appraisal, emotional support, and felt understood. Additionally, the consideration that the peer volunteer is trustworthy caused the intervention to have a positive impact.

Second Article

The second article describes maternal depression anxiety disorders and child development. It examines the association between the three factors for a Manitoba population. The study was a retrospective cohort design that collected data from a repository containing healthcare data about Manitoba population. The population used for the research was children at the age of five that were born in 2000 (Comaskey et al., 2017). The selected children were then linked with their birth mothers. To be eligible for participation, the mother and child pair must have insurance coverage for the whole period of the study. The health insurance should cover the period one year before birth to the first school year. From the database, the number of mother-child pair identified was 23,236, and this included mothers with multiple children.

For the six years of the research, mothers who remained in contact with healthcare facilities for maternal depression and anxiety disorders (MDAD) were tracked and their healthcare data collected. So, for the period one year before the birth of the child to six months before the child joined kindergarten maternal depression and physicians evaluated anxiety disorder. From the study, three aspects of MDAD were assessed. The first one was the assessment of the timing of child exposure to maternal depression and anxiety disorder and early development instrument (EDI) outcomes. The recurrence of MDAD is also assessed by the study where the number of times a mother has taken prescriptions or visited the physician due to MDAD. When the MDAD happens more than once, it shows that the condition is recurrent. The severity of MDAD was measured based on the number of physician contact during the study period. Greater MDAD severity was negatively correlated with EDI outcomes. Therefore the study established that maternal stress is associated with prolonged adverse outcomes in children.

Conclusion

The research papers looked at maternal depression and made substantial discoveries about the impact of maternal stress on both the mother and the child. The effect is identified to be, and therefore there is a need to evaluate risk factors and enact preventive measures continuously. Maternal depression causes healthcare problems as the mother cannot seek proper medical care for the child and themselves, also, it leads to the mother being unable to meet effective parenting. Additionally, the analyzed studies identify that the occurrence of maternal stress in the first two months often leads to recurrence of the condition in one year. Furthermore, the frequent occurrence of maternal depression and anxiety correlated with poor early development outcomes. Thus maternal depression requires prevention since its effects are extensive and can affect the child to adulthood.

References

Comaskey, B., Roos, N., Brownell, M., Enns, M., Chateau, D., Ruth, C., & Ekuma, O. (2017). Maternal depression and anxiety disorders (MDAD) and child development: A Manitoba population-based study. PLOS ONE, 12(5), e0177065. doi: 10.1371/journal.pone.0177065

Hahn-Holbrook, J., Cornwell-Hinrichs, T., & Anaya, I. (2018). Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries. Frontiers In Psychiatry, 8(248). doi: 10.3389/fpsyt.2017.00248

Leach, P., 2017. B: Perinatal risk factors with demonstrable long-term Ill-effects. In Transforming Infant Wellbeing (pp. 89-138). Routledge.

Leger, J., & Letourneau, N. (2014). New mothers and postpartum depression: a narrative review of peer support intervention studies. Health & Social Care In The Community, 23(4), 337-348. doi: 10.1111/hsc.12125

Taraban, L., Shaw, D., Leve, L., Wilson, M., Dishion, T., & Natsuaki, M. et al. (2017). Maternal depression and parenting in early childhood: Contextual influence of marital quality and social support in two samples. Developmental Psychology, 53(3), 436-449. doi: 10.1037/dev0000261