Postnatal depression is a significant health problem. Up to 15% of women after child delivery is suffering from this depression. To ameliorate its negative effects, nurses’ interventions in the process of mother-infant interaction might be helpful. The purpose of this investigation was to evaluate the effect of nurses’ interventions on the level of women’s postnatal depression and their emotional state. Mixed (quantitative and qualitative) methods were used in the investigation. For the depression evaluation, the Edinburg Postnatal Depression Scale was applied. The personal questionnaire was developed to estimate women’s emotional state and their reaction to the nurses’ interventions. No significant difference in the level of depression between a test and control group was detected. The positive effect of nurses’ interventions on women’s emotional states was observed. The results of the study might be useful for the nurses’ practice.
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The American Journal of Nursing Research (AJNR) was chosen for publication. This journal is peer-reviewed, open access, and indexed by major databases, which is important for sharing the research results among specialists in the field. The AJNR publishes reviews and research articles in a wide range of nursing research major fields, including child nursing and mental health. To be submitted, the research project must be 5 to 25 pages, including abstract, title, authors’ information, introduction, materials and methods, results, discussion, conclusion, and references.
Adverse effect of postnatal depression on the mental health of women after a child delivering and the mother-infant interaction.
Postnatal depression (PPD) is a widespread health problem that affects up to 15% of women after childbearing (Zlotnick, Tzilos, Miller, Seifer, & Stout, 2016). The PPD generally affects women during the first year after childbirth. Women with depression are suffering from emotional disorders and dysphoria, insomnia, and suicidal ideation. In rare cases, the PPD could lead to child harming and suicide (Dennis & Dowswell, 2013). Thus, it is highly important to develop effective measures to preventing and treatment of postnatal depression.
It was shown by Dennis and Dowswell (2013) that nurses’ interventions are an effective measure to mitigate the adverse effect of the PPD on mothers after childbirth. However, the number of researches, dedicated to effective intervention approaches development and analysis, is limited (Horowitz et al., 2013). Therefore, the current research aimed to evaluate the effect of nurses’ interventions on the level of women’s postnatal depression and their emotional state.
Research hypotheses and questions
The following hypotheses were tested:
- After nurses’ interventions providing, a tested group will have a significantly lower level of PPD, comparing with a control group.
- Nurses’ interventions will have a positive effect on mothers’ emotional states.
Based on the hypotheses, the following research question was formulated: what types of nurses’ interventions will be the most efficient for the mothers’ emotional state improvement?
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Significance of the research
The current study provided novel data according to the importance of nurses’ interventions for women with PPD. The research might be used by nurses with the purpose to improve the effectiveness of care.
Materials and Methods
The research was provided in a local clinic and at participants’ homes from January to April 2017. The study was a repeated measure randomized clinical trial. Participants were divided randomly into two (control and test) groups. Generally, 78 women with symptoms of the PPD were included in the investigation: 38 in a control group and 40 in a test group. Women from the test group were provided with nurse’ interventions, while women from the control group received standard nurses’ care.
Nurses’ interventions design
As an intervention, the nurse’s participation in the mother-infant interaction was applied. A nurse taught a mother how to care for a baby: provided recommendations according to the breast or formula feeding, bathing, playing with an infant, and rocking.
Mixed methods (quantitative and qualitative) were used. To identify the PPD, the Edinburg Postnatal Depression Scale (EPDS) was used (Cox, Holden, & Sagovsky, 1987). The EPDS is considered to be a standard approach for depression identification and evaluation (Horowitz et al., 2013). Participants were screened twice: at the beginning of the investigation and the final point after two months of the interaction with nurses. To estimate the mothers’ emotional state and the positive/negative/neutral effect of nurses’ interventions, a personal questionnaire was developed. For statistical analysis of the data, the Student’s t-test with independent samples was used.
The study consisted of two stages: the in-clinic (I) stage and the at-home (II) stage. At the beginning of the investigation, women were screened with the EPDS. During the first stage (average, one-week duration), a nurse daily visited a woman, provided standard care procedures (for the control group) or care + interventions (for the test group). During the second stage (two months), a nurse visited a woman at home twice a week. For the control group, a nurse provided the standard medical examination of a mother and a child. For the test group, a nurse provided medical examination and interventions. After the investigation, women were screened with the EPDS and were asked to fill in the personal questionnaire. The questionnaire included questions according to women’s personal feelings about nurse’s care and interventions and the effect of these interventions on their emotional state and the interaction with a baby.
Results and Discussion
Results of the hypothesis 1 testing
The EPDS allows determining the level of the PPD. It provides a score from 0 to 30 points. If a woman gets a score higher than 13, it could be claimed that she is suffering from depression (Cox, Holden, & Sagovsky, 1987). The difference between EPDS scores among the control and the test group and between the beginning and the end of the investigation was analyzed (Table 1).
Table 1. Results of the EPDS screening.
|Group||Average EPDS Score|
Although the average EPDS score at the end of the test was lower in the test group, comparing with the control group, the results were not statistically significant. Thus, the first hypothesis was considered to be false. The negative results could be explained by the small sample and the short duration of the experiment.
Results of the hypothesis 2 testing
According to the results of the questionnaire, almost all the participants (95%) noted the positive effect of the nurses’ interventions on their emotional state. They mentioned that communication with a nurse helped them to overcome negative thoughts and feelings and to improve the interaction with an infant. This is a positive result of this investigation. Thus, hypothesis 2 could be claimed to be true.
The data from the questionnaire was considered for answering the research question. According to it, nurses’ participation in child bathing was found especially significant by mothers due to their lack of experience and fear to perform this procedure alone. Nurse’ recommendations and participation in the procedure made women feel more confident. Besides, cooperative plays with a baby had a positive impact on the mothers’ emotional state.
The positive effect of nurses’ interventions in the process of child care and mother-infant interaction on women’s emotional state was determined in the investigation. Among other, cooperative plays and bathing were important for women’s emotional state improvement and self-confidence increase. Nurses could develop their inventions approach, based on the results of this study, with the purpose to increase the quality of care. However, no significant difference between average EPDS scores of the control and test group was shown. This negative result underlined the need for further investigations.
The investigation was funded by NAME OF UNIVERSITY
Statement of Competing Interests
The author has no competing interests.
List of Abbreviations
PPD – postnatal depression
EPDS – Edinburg postnatal depression scale.
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This project is important for nursing research and career. It provided the data which might be helpful for the quality of nurse care improvement. It was postulated that psychological intervention and nurse-patient communication are useful for care providing. For patients with depression, personal communication is especially important. In some cases, it might be even more efficient than medical treatment (Horowitz et al., 2013). Thus, the development of intervention approaches of nurses’ care for women with postnatal depression might increase the quality of the healthcare provider’s service. Developed approaches might be used in everyday nurses’ practice.
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150(6), 782-786.
Dennis, C. L., & Dowswell, T. (2013). Psychosocial and psychological interventions for preventing postnatal depression (Review). Cochrane Database of Systematic Reviews. 2, 1–206. Web.
Horowitz, J. A., Murphy, C. A., Gregory, K., Wojcik, J., Pulcini, J., & Solon, L. (2013). Nurse home visits improve maternal/infant interaction and decrease severity of postnatal depression. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 42(3), 287-300. Web.
Zlotnick, C., Tzilos, G., Miller, I., Seifer, R., & Stout, R. (2016). Randomized controlled trial to prevent postnatal depression in mothers on public assistance. Journal of Affective Disorders, 189, 263-268. Web.