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Postpartum Depression Screening Program Evaluation

Introduction

Recent researches have confirmed that postpartum depression is one of the most common psychological complications after birth. According to Yonkers (2009), about 15% of women undergo postpartum depression, and this not only affects them but also their children and their families. Several women always develop some form of depression after birth. This form of depression is common among adolescents and impoverished women. This is a clear indication that one of the main causes of postpartum depression is the thought of how the child would be taken care of now that it has arrived. For the impoverished women, they try to visualize the kind of stress she and her child would undergo to survive. For adolescents, there is always the fear of possible rejections from peers and family members (Rothman, 1997). They tend to develop a feeling that they are no longer accepted by society. In both cases, this depression is common during first births. Postpartum depression affects the relationship between the mother and the child, and with other members of society. This explains why some women consider dumping their children immediately after giving birth.

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In the United States, postpartum depression screening has not been considered as a way that could help eliminate postpartum depression among women. Most of the public hospitals within this country offer excellent medical services to these women during the delivery process and then discharge them when they are stable enough for discharge (Saltzberg, 2009). However, it has been confirmed that upon discharge, some of these women would develop serious postpartum depression that may even affect them mentally. To manage the depression of mothers who have just delivered, it is important to introduce a routine postpartum depression-screening program in all public hospitals and where necessary, facilitate referrals to mental health care. This is the focus of this program.

Problem Statement

Healthy People 2020 program aims at achieving universal health for all Americans irrespective of their age, race, gender, or any other demographical differences (Cohen & Nonacs, 2005). However, postpartum depression is clouding this vision as more women get affected after delivery. Researchers have confirmed that about 15% of women who deliver in this country suffer from postpartum depression. This not only affects them but also their children and people around them. This psychological trauma has been attributed to mental problems that some mothers do develop after delivery. If not taken care of in time, postpartum depression may make a woman neglect the child or even commit homicide. This means that postpartum depression should be considered as a serious health problem, which should be addressed.

Goals

It is clear from the above discussion that there exists a problem, which needs urgent address, especially in public hospitals. This program seeks to introduce a routine postpartum depression screening in all public hospitals in order to detect cases of depression among mothers who have just delivered. This will help address the issue as early as possible in order to eliminate its negative consequences. In cases where the level of depression is relatively low and manageable, the health practitioners who are responsible for the patient will offer counseling to help the patient fight depression. In cases where the trauma is serious or there is a possibility of it worsening with time, then a referral to mental health care will be recommended. This will help fight this depression and eliminate all the consequences it comes with.

This program arrived at the above stated goals based on needs assessment project. This program was guided by the glaring fact that postpartum depression has made American women suffer after their deliveries. When they are discharged from hospitals, they are left under care of their family members. However, most of these family members do not have the capacity to detect this depression, making them unable to understand the sudden change of the patient’s attitude towards various issues in life. This strains the relationship between the mother and her child, and other members of the family. These goals were based on these needs for a program that would help these women.

Objectives of the program

According to Rothschild (2009), setting objectives for a program is part of the planning process that should be done with a lot of care. This scholar says that that it is the objectives that would help in assessing success or failure of a program. The assessment will always be based on how well the program has achieved the intended objectives. This means that the objectives must be specific, measurable, attainable, realistic, and time-bound in order to help state what the firm seeks to achieve. The following are the specific objectives for this project.

  • This program seeks to introduce a routine postpartum depression screening on all mothers after delivery in all public health facilities in this country in the next twelve months.
  • It is in the spirit of this program that when this project is implemented successfully, then effects associated with postpartum depression will be minimized or be eliminated within the next one year.
  • This program will also help minimize pressure on healthcare facilities, which is always caused by late diagnosis of postpartum depression.

Rationale

It is important to state clearly, why it is worth conducting this research. A report by Rosenfield (2006) noted that one of the main reasons why women commit homicide soon after birth is because of postpartum depression. In the United States, the government has committed many resources to help improve quality of health care. However, it is illogical to give a women quality health care during delivery only for them to suffer postpartum depression that can push them to actions that are not only unethical but also unlawful. For this reason, it is worth spending resources on this project to ensure that any possible case of postpartum depression is arrested in time.

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The history of the program

It is important to come up with a detailed report upon completion of this program that would help in its implementation in the public hospitals in order to eliminate negative consequences of postpartum depression. To make this a reality, it is important to review PPD screening programs, which have been described in selected peer-reviewed journals, conducted from 2004 to 2013. These reports will be taken from Medline/PubMed, PsychINFO, and Cinahl databases from their abstracts. During this search, it is only those programs with intervention and possible outcomes, which will be selected. In order to authenticate the findings from peer-reviewed journals, the program will involve a practical session where participants will be selected to take part in the project. This will take place at South Miami Hospital’s Center for Women and Infants. This program is expected to run for six weeks, and a follow-up project to determine the outcome will be conducted after three. This period will be enough for the program to come up with concrete conclusion of the appropriateness of postpartum depression screening among all mothers delivering in public hospitals.

Description of the program’s population

The population in this program will include 100 patients who are under pre-natal care, but nearing their delivery, preferably having a week or less to deliver. The participants will help give a true picture of the impact of postpartum depression among delivering mothers. It will also help in explaining how screening can help mitigate these negative consequences. The program will also include nurses who will be offering postpartum depression screening immediately after birth. Sampling will be based on stratified sampling techniques on those willing to take part. Stratified sampling will help in obtaining the right proportion of participants in each category.

Resources available to help the program run

This program will depend on the facilities provided by South Miami Hospital’s Center for Women and Infants as the site for the project. This means that approval of the management of this hospital will be needed before the onset of the program. The staff who will take part in this project as part of the participants will also come from this hospitals. About ten nurses will be needed to make this project a reality. To determine anxiety or depressive disorders, the program will use PRIME-MD. These are the main resources that this program will need.

Activities considered and Outcomes

This program will involve a series of activities before a report can finally be written on the way forward. The first step will be to analyze peer-reviewed literatures to determine how similar programs were done and what the outcomes of such programs were. This will help give this program a base upon which to lay this new program. By analyzing and understanding such previous programs, this program will be able to identify and avoid mistakes done on previous programs. This will make this program successful (Stone & Menken, 2008). It will also help this program identify avenues, which can enhance quality of this program. The findings of these previous programs will also help in developing hypothesis of the possible outcome of this project. When this is completed, the next step will involve carrying out various activities of this particular project as identified in the table below. The desirable time that this program should take is three months.

The diagram below shows the procedural activities that will be undertaken in this project, from planning stage to implementation.

It is important to note that the planning activities will not form part of the six-week program. Planning of this program will be done prior to the onset of the six-week project and the participants will not be involved at this stage. Data collection from peer-reviewed journals will also not involve the participants. However, it will be part of the six-week project. The activities and the expected outcomes are given in the worksheet below.

Long-term outcomes of the program

The long-term outcomes of this program as identified in the worksheet below will be to evaluate postpartum depression screening among the participants in order to determine its efficacy in fighting stress and trauma among American women after delivery. Previous researches have specified that about 15% of American women suffer from postpartum depression due to lack of screening done on them after delivery (Henshaw, Cox & Barton, 2009). This research program is meant to respond to their concern. The long-term project will be based on two fronts. The first front will be the ability of the program to come out with convincing statistics that postpartum depression screening is the best way of ensuring that American women do not suffer any psychological problems upon delivery.

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Worksheet
Inputs Activities Outputs/ Outcomes
Initial Subsequent Short-term Mid-term Long-term
Peer-reviewed Journals,
participants (the patients, nurses)
A detailed analysis of peer-reviewed journals on postpartum depression screening and the benefits it offers mothers who have just delivered The next step will be a five-week program where the participants will be categorized into two groups. The first group of fifty delivering mothers will receive postpartum depression screening while the other group will not. These participants will be requested to behave normally. The nurses who are participating in this project will determine the short-term output for this program. The main point of focus will be to compare between the two groups and determine the group that has positive mindset of their newborns by the time of leaving the facility. The mid-tem outcome will be determined after one month from the time the mother left the hospital. Again, the focus will be to determine the group coping well with their new status as mothers. Finally, the long-term outcome will be determined on the third month after delivery. The participating nurses will make the last follow-up on the mothers to determine their mental state and any other effects related to postpartum depression. Comparison of the two groups will be done.

The second front, which is very important, will be its ability to convince the responsible stakeholders to implement the recommendations of the program. This is because this research is meant to have a positive impact on the lives of American women after their delivery. This can only be possible if the outcome of this project is applied to come up with programs that can be implemented in medical institutions. It is only when this is achieved that it will be justified to say this project has achieved the set long-term goals. It is also expected that the nurses who will participate in this program will enhance their knowledge on undertaking postpartum depression screening before these patients can be discharged. The program is expected to impart this knowledge on the participating nurses. This knowledge should be put into practice in their fields.

Conclusion

It is a fact that postpartum depression has serious negative impact on the mental health of women after giving birth. This depression is common among the impoverished women and the adolescents. This is because of the thought that they might not be able to provide for the child because of their lack of financial security. Others get depressed for fear of rejection, while others just feel that the child has come at the wrong time. This depression can lead to serious mental problem if care is not taken to address it with the urgency that is needed. This program seeks to convince relevant stakeholders to introduce routine postpartum depression screening in all public hospital to help address this issue.

References

Cohen, L. S., & Nonacs, R. (2005). Mood and anxiety disorders during pregnancy and postpartum. Washington: American Psychiatric Publishers.

Henshaw, C., Cox, J. L., & Barton, J. (2009). Modern management of perinatal psychiatric disorder. London: RCPsych Publications.

Rosenfield, A. I. (2006). New research on postpartum depression. Hauppauge: Nova Science Publishers.

Rothman, K. (1997). Rock-A-By Baby: Feminism, Self-Help, and Postpartum Depression. Gender and Society, 11(6), 824-825.

Rothschild, A. J. (2009). Clinical manual for diagnosis and treatment of psychotic depression. Washington: American Psychiatric Publishers.

Saltzberg, M. (2009). A Year’s Experiences with a Postpartum Depression Group. Group, 27(1), 21-29.

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Stone, S. D., & Menken, A. E. (2008). Perinatal and postpartum mood disorders: Perspectives and treatment guide for the health care practitioner. New York: Springer Publishers.

Yonkers, K. (2009). Depression Screening of Perinatal Women: An Evaluation of the Healthy Start Depression Initiative. Psychiatric Services, 60(3), 322–328.

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