 |
|||||||
Marce Society International Conference |
|||||||
 |
 |
 |
 |
 |
|||
|
| Abstracts 41 - 48
ABSTRACT 41DOES EARLY DISCHARGE FROM HOSPITAL AFTER CHILDBIRTH INCREASE THE RISK OF POSTNATAL DEPRESSION?Thompson
JF*, Ellwood DA*, Roberts C** **Obstetrics & Gynaecology, University of Sydney, Sydney, NSW.
Introduction: A recent Australian cohort study demonstrated an increased risk of postnatal depression in mothers discharged early from hospital after childbirth1. This finding has not been replicated in other controlled studies. This study was designed to explore this issue. Methods: The design was a population based, prospective cohort study of ACT residents. Women completed questionnaires on Day 4, and 8, 16, and 24 weeks postpartum. Early discharge was defined as discharge within 72 hours. Postnatal depression symptoms were assessed using the 10-item Edinburgh Postnatal Depression Scale (EPDS). Results: 1295 women participated. 1254 (96.8%) completed the second, 1221 (94.3%) the third and 1193 (92.1%) the fourth questionnaire. Overall, 129 (10.3%) of the participants scored >12 on the EPDS at 8 weeks, 91 (7.5%) at 16 weeks and 90 (7.6%) at 24 weeks postpartum. Excluding women with missing data, 455 women (36.5%) were discharged early and 790 (63.5%) after 3 days. Women discharged early were not more likely to score >12 on the EPDS than women discharged later. This was true at either 8 weeks (9.7% versus 10.7%; OR=0.90, 95%CI 0.62-1.31), 16 weeks (6.9% versus 7.6%; OR=0.91, 95%CI 0.57-1.43), or 24 weeks postpartum (6.1% versus 8.4%; OR=0.71, 95%CI 0.44-1.10). After adjusting for potential confounding factors in a multivariable logistic regression model there was still no significant association between early discharge and postnatal depression. Conclusions: There is no evidence from this study that early discharge after childbirth increases the risk of postnatal depression.
1. Hickey AR, Boyce PM, Ellwood D, Morris-Yates AD. Early discharge and risk for postnatal depression. Medical Journal of Australia 1997;167.244-247.
ABSTRACT 42
PSYCHOTHERAPEUTIC SUPPORT GROUP FOR THE PARTNERS OF WOMEN WITH POST NATAL DEPRESSION
Webster,
E, Markou, P, Huxley, M Brisbane Centre for Post Natal Disorders, Belmont Private Hospital, 1220 Creek Rd., Carina QLD 4152
Clinical experience in a perinatal psychiatric disorders aroused concern that the needs of the male partner of the depressed woman were not adequately addressed and that failure to do so was potentially deleterious for the man, the parent-child relationship, the marital relationship and the woman's clinical course. A pilot study of a psychotherapeutic group for these men was undertaken in 1998.
Participants were recruited from a survey sent to all men, whose partners had accessed the Brisbane Centre for Postnatal Disorders, Belmont Private Hospital, Brisbane, in the previous twelve months. The six men recruited were married and each had one or two children, aged three months to five years. The group was a psychodynamically informed, psychotherapeutic group, held for one and a half hours, weekly, for six sessions, facilitated by two psychiatrists. An evaluative focus group was conducted by the third researcher two weeks after the conclusion of the therapeutic group. The study employed repeated measures and descriptive clinical data. The Beck Depression Inventory (BDI) (Beck et al 1961), General Health Questionnaire-30 (Goldberg and Williams 1988), Significant Others Scale (Power et al 1988), Parenting Stress Index (Abidin 1983), and Dyadic Adjustment Scale (Spanier 1976) were administered pre-intervention, immediately post-intervention, and three months post-intervention. The female partners were also asked to complete the BDI, SOS, and DAS at the same intervals.
Findings: Whilst no statistical conclusions could be drawn, the review of the measures administered indicated significant psychopathology in all domains assessed. The GHQ-C drew attention to the chronicity of this pathology. There was no significant change in these measures following the group intervention. This conflicted with the men's self-report at the focus group of significant benefit, but supports the researchers clinical view that six sessions were inadequate for a group of this nature. Themes which emerged in the sessions included the extent to which the men's lives were dominated and constricted by their spouse's depression, their sense of confusion and powerlessness, and their lack of and need for support for themselves.
Conclusion: The clinical concern that the needs of male partners of women with postnatal depression require specific attention was confirmed. A short-term psychotherapeutic group was of limited benefit.
Recommendations: More research is needed into the experience and needs of the male partners of women with postnatal depression. Evaluation of a longer-term psychotherapeutic group intervention is proposed. Alternative interventions, such as a cognitive-behavioural therapy group need consideration.
ABSTRACT 43
A QUILT CAN DO MORE THAN KEEP YOU WARM
Roslyn
West, RN, RM, CHN, B App Sc. (Nsg) Kathy
Bruton, RN, RMHN
Initially, making a quilt as part of a PND therapy group provided us with a transition activity - an activity that signals the end of the first part of the session and prepares for the second. We also hoped that it would encourage group cohesiveness. What was achieved was far beyond our expectations.
The PND group runs for two hours a week over eight weeks. Women attending suffer moderate to severe depression. The transition activity has ten to fifteen minutes allocated between the information session and a relaxation session.
The idea of creating a quilt is initially quite daunting to the women, many declaring that they can't sew or that they will never be able to make THAT! At the end of eight weeks not only do they have a quilt that is proudly displayed in the community house but they have gained skills that will help in their recovery process.
The quilts are very carefully chosen. Each quilt must be able to be finished in seven weeks. Each woman must be able to complete her patch. Varying levels of ability (and depression) must be taken into account and the end product must be something that the women will be proud of.
"Small successes accumulate and thereby contribute to the 'feel good factor' about ourselves. Internal transformations occur perhaps neurologically and chemically as well as psychologically. Just as we know that running and laughter create a sense of well-being, so does activity." (Cracknell 1995)
Reference Cracknell E. A small achievable task. British Journal of Occupational Therapy. August 1995, 58(8), p343-344.
ABSTRACT 44
PSYCHO-SOCIAL FUNCTIONING IN SURROGATES DURING PREGNANCY AND THE POST NATAL PERIOD
Olga
van den Akker PhD
Studies of the psychological characteristics of surrogate mothers have been emerging slowly over the last 5 years. However, no empirical studies of pregnant and post natal surrogates have been conducted to date.
The present study describes the results of a number of standardized questionnaires administered to surrogates during pregnancy and post delivery. Questionnaires used included, Social support, Marital harmony, Anxiety, Adjustment to pregnancy/fetus/baby. Adjustment to motherhood and PND.
So far, 26 surrogates have completed the questionnaires. Preliminary data suggest, no major impairment in psychological state have emerged, and social relationships remain relatively constant. The results of the functioning during the postnatal period will also be discussed. The findings will be interpreted within the current British legislative, media and sociocultural climate.
ABSTRACT 45
THE BENEVOLENT SOCIETY'S FAMILIES TOGETHER PROGRAM - A PROGRAM TO SUPPORT FAMILIES WITH YOUNG CHILDREN WHERE A PARENT HAS A MENTAL ILLNESS
Jane
West Judith
Edwards
Less than a generation ago many parents with mental illness would have been institutionalised and children from these families were often placed in long term care. In the context of changes which have lead to deinstitutionalisation and the current emphasis on keeping children in their families wherever possible, the Benevolent Society launched the 'Families Together' program in 1994 to lessen or prevent the negative effects of parents' mental illness on their infants' development.
Because early life experiences have been shown to have disproportionate importance in organising the mature brain, early intervention to prevent or ameliorate disturbances in the earliest nurturing experiences is of critical importance. This is particularly important to children in families where parental mental health issues may lead to disruptions in the parent child relationship.
This presentation will discuss how secure attachments contribute to the development of resilience and use case examples from work in the Benevolent Society's Families Together program to explore how attachment is facilitated in families where a parent has a mental illness
ABSTRACT 46POSTNATAL DEPRESSION IN THE AUSTRALIAN CAPITAL TERRITORY AT 8 WEEKS POSTPARTUM-INCIDENCE AND RISK FACTORS.
Marian
Currie*, Jane Thompson*, David Ellwood*, Christine Roberts** * The
Canberra Hospital, PO Box 11 2606 ACT
Background: Postnatal depression affects approximately 10% of women in the first postpartum year. This is the first study specifically designed to identify risk factors for postnatal depression in a population based sample of Australian women. ACT women were thought to be vulnerable to postnatal depression because of the social demographics of this population. Aims: The aims of this paper are to provide information about the incidence of, and risk factors for, postnatal depression in the first 2 postpartum months in the ACT. Methods: Data were collected in 1997 during a population based, prospective cohort study known as The ACT Experience : A Survey of Mothers. Women completed questionnaires on day 4 and at 8, 16 and 24 weeks postpartum. Data from the first 2 questionnaires will be considered in this paper. The primary outcome measure was the score on the Edinburgh Postnatal Depression Scale (EPDS). Women with scores > 12 were classified as cases. Results: 1295 women agreed to participate and of these 1254 (96.8%) completed the second questionnaire. The incidence of positive scores on the EPDS at 8 weeks was 129/1254 (10.4%). After adjusting for confounding factors in a multivariate logistic regression model, the following factors remained significantly associated with scores >12 on the EPDS: age >40; previous psychiatric history; vulnerable personality; maternity blues; low social support; dissatisfaction with partner; poor relationship with mother and formula feeding. Conclusions: The incidence of and risk factors for postnatal depression are consistent with overseas findings.
ABSTRACT 47
PERINATAL DYSPHORIA: TESTING AN ANTENATAL EDUCATIONAL INTERVENTION AT THREE SITES IN AUSTRALIANURSING SCIENCE, PSYCHOLOGY AND STATISTICS
Barbara
A Hayes, Benjamin S Bradley, Danny Coomans. School
of Nursing Sciences, James Cook University, Townsville 4811. Ph: 07-4781-5340; Fx: 07-4781-4026; Email: barbara.hayes@jcu.edu.au
INTRODUCTION: Antenatal education is an established public health strategy to influence higher levels of perinatal physiological well-being for childbearing women in many countries. The influence of antenatal education on higher levels of perinatal psychological well-being in childbearing women is not documented so well.
METHOD: Three hundred and eight primiparous women participated in a study to test the effect of an antenatal educational intervention at the Royal Women's Hospital, Melbourne, the Flinders Medical Centre, Adelaide and the Kirwan Women's Hospital, Townsville. A prospective, longitudinal, experimental matched-group design was employed with women divided into two groups (Group A and Group B) and their mood measured once antenatally and twice postnatally with the Scale for Affective Disorders and Schizophrenia (modified for childbearing women) (SADS-M) and the Profile of Mood States (POMS) . Research assistants administered the educational intervention of a purpose-designed booklet and an audiotape of one woman's experience of postnatal dysphoria and depression to women in Group A at the three sites antenatally with a standardised interview which was repeated postnatally. Group B received the standardised interview only and Group C, as the control group, were recruited antenatally but measured for mood only once postnatally.
RESULTS: No significant difference were found between Group A and Group B on the SADS-M but Group A was lower than Group C on the following items: Dysphoric Mood; Quality of Mood; Worrying; Self-Reproach; and Weight Gain. Group A was also lower than Group C on the following POMS subscales: Fatigue and Tension. Mean age of all groups was 26 years.
FINDINGS: Although no measurable effect of an educational intervention administered antenatally was found, the results demonstrate that young Australian primiparous women who receive a structured interview to measure mood plus an educational interview antenatally are lower on measures of dysphoric mood, quality of mood, worrying and self-reproach postnatally than those who do not receive such attention. They are also less tense and less fatigued.
ABSTRACT 48
PREPARTUM AND POSTPARTUM DEPRESSION AMONG CHINESE WOMEN: PREVALENCE AND RISK FACTORS
Hui-chen Ko, PH.D. (1); Tzung-lieh Yeh, MD (2); Ling-ru Lee, PH.D.; Chiung-hsin Chang, MD (3); Rong-chang Wu, MD (3); Fong-ming Chang, MD (1) Graduate
Institute of Behavior Medicine (2) Department
of Psychiatry (3) Department
of Obsterics and Gynecology Medical College, National Cheng Kung University
The study was undertaken to investigate the prevalence and risk factors for the prepartum and postpartum depression in a larger sample of 599 Chinese women followed up 36 week's gestation until 4 months postpartum. Subjects were recruited at a prenatal visit at 36 week's gestation. They were interviewed using SADS-L, SADS, Family History RDC and Life Events Schedule. They completed the self-report measures at home and returned it by mail before delivery. Blood were obtained for hormone assays at 36 week's gestation and on day 1 and 3 postpartum. At 10 days, 8 weeks, and 4 months postpartum, subjects participated in a followed-up diagnostic interview by telephone. A total of 52 women (8.7%; 52/599) experienced a major or minor depression during pregnancy, 107 women (19.1%; 107/599) experienced postpartum blue defined by Handley Criteria within 10 days after delivery, 77 women (14.5%; 77/599) experienced minor or major depression, 1 woman had a manic episode and 2 women had hypomanic episodes during 8 weeks postpartum. We compared prepartum depressed, postpartum depressed, and non-depressed women on risk factors associated with depression. With respect to demographic and clinical variables, there were no differences on age, education, parity, delivery method, gender of babies and unexpected gender of babies. However, either of the depressed groups had a greater likelihood of having family history of depression, and premenstrual depression. Regarding the estradiol levels at 36 weeks of gestation, there was a significant difference between postpartum depressed women and controls. As to psychological vulnerability, postpartum depressed women reported they were more behavior-inhibition during childhood and had stronger negative cognition and attitude. Considering environmental factors, postpartum depressed women perceived their parents less caring and more controlling compared to controls. The prepartum depressed women experienced more negative life events during pregnancy, but the postpartum depressed experienced more childcare-related stress during the postpartum periods relative to controls. There were no differences among three subject groups with respect to the numbers of prepartum events. Regarding social support index, the prepartum depressed received less support from friends, parents, parents-in-law and spouses. However, there were no differences on the practice of traditional culture ritual of "doing the month" among three groups. The findings from this study support that there is similar prevalence and risk factors for postpartum depression among Chinese women in Taiwan with those in western cultures.
|
||||||
| The Marcé Society - Australasian Branch Home - Upcoming Conferences - Conference Abstracts - Office Bearers - Secretariat Designed and built by Tempus4 Design  |
|||||||
 |
|
|
|
|
|
|
|
