Identification of perceptions and support needs for women with postnatal depression
Postnatal depression, more commonly known as postpartum depression, is defined as a mental health condition that takes place after childbirth (Swami et al., 2020). It is a common condition and is known to affect 1 in 10 women who give birth (Stanescu et al., 2018). The common symptoms of the condition include anxiety, fearfulness, stress, and feelings of hopelessness and despair. However, there is also a persistent stigma around postnatal depression that impacts help-seeking in the individuals (Alexandrou et al., 2020). The diagnosis is done through the DSM-5 checklist and is associated with similar methods for diagnosis, such as the major depressive episode in the individuals (Rizzo et al., 2022). Maternal postpartum depression can be fatal and have a major impact on the health and wellbeing of the mother as well as that of the child. These include disturbances in the cognitive, social, and behavioral development of the child. The stigma around the condition impacts the perception of an individual to seek help (Jidong et al., 2021). This is also associated with limited knowledge and understanding of the care needs of the affected individuals (Swami et al., 2020). This document will propose research with an evidence-based approach aimed at identifying the perceptions and support needs of women with postnatal depression Identification of perceptions and support needs for women with postnatal depression
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Searching for quality evidence is one of the primary needs to complete the research process (Portney, 2020). To complete this research, the evidence to develop a background and foundation of the research is needed.
The approach towards the evidence search for keywords and databases was used for primary research. The specific keywords were used for the development of the primary research, and search stings were developed using Boolean operators: And, Or, and Not. The databases that were used for conducting the research included: PubMed, SCOPUS, Science Direct, Elsevier, Google Scholar, and Pubmed central.
The search strings that were developed included: ” Postnatal depression AND stigma,” “Postnatal depression AND help,” “postpartum depression AND women”, “Postpartum depression OR PPD and stigma”, and “postpartum depression NOT major depressive disorder AND care needs”.
The PRISMA (Preferred Reporting of Items for Systematic reviews and Meta-analysis) framework was used for conducting a focused search strategy. This method is beneficial as it helps in the classification of literature and allows assessment of its quality based on the inclusion and exclusion criteria (Portney, 2020)Identification of perceptions and support needs for women with postnatal depression.
Figure 1: PRISMA flowchart for selection of research articles
The selected articles were then evaluated for their quality and evidence. The following findings were obtained:
| S.no. | Authors of the research | Title of the research | Key findings and significance of the paper | Hierarchy of the evidence |
| 1 | Rubyal and Siegel (2019) | “Attribution theory and reducing stigma toward women with postpartum depression: Examining the role of perceptions of stability.” | The paper highlighted that women who suffer from postpartum depression have to also deal with stigma in society. Social support and closeness with relationships were associated with the stability and management of postpartum depression in women. | Level II |
| 2 | Sakina et al. (2021) | “Stigma of postpartum depression: The role of lady health workers in health care—A qualitative study.” | Stigma about postpartum depression is associated with a lack of awareness among the women. The paper asserted that the knowledge and support of healthcare workers could help in the identification of support needs and promoting wellness in the communities. | Level II |
| 3 | Johnson et al. (2020) | “The lived experience of postpartum depression: A review of the literature.” | The incidence of postpartum depression impacts the well-being of women and that of children to a major extent. The review suggests that a massive gap exists between the understandings of postpartum depression in the society where the incidence of the condition is not related to mental illness. This impacts the understanding of the needs of the population and also the care needs of the affected individuals. | Level I |
| 4 | Zhou et al. (2022). | “The effectiveness of mHealth interventions on postpartum depression: a systematic review and meta-analysis.” | The study focuses on assessing the effectiveness of mobile health interventions to support the needs of women with postpartum depression. The findings indicate that mobile health interventions can be seen as an effective means for the management of postpartum depression in women. | Level I |
| 5 | Ukatu & Brulja (2018) | “Postpartum depression screening tools: a review.” | Different types of screening tools exist for the identification and diagnosis of postpartum depression. However, these tools fail to acknowledge the individual needs of women with the condition and hence, these tools need to be developed in a more comprehensive and systematic manner. | Level V |
| 6 | Jannati et al. (2020) | “Effectiveness of an app-based cognitive behavioral therapy program for postpartum depression in primary care: A randomized controlled trial.” | The study focussed on the identification of the effectiveness of cognitive behavioral therapy for the management of postpartum depression. The study helped in confirming that cognitive behavioral therapy can help the management of individuals with postpartum depression. |
The classification of papers in the hierarchy of evidence has been developed as per the chart developed by John Hopkins University.
Figure 2: Hierarchy of evidence (Dearholt & Dang, 2017)
The purpose of the research pilot design is to focus on developing a systematic plan for research with an evidence-based and timely approach.
Research question
What are the perceptions and support needs for women with postnatal depression?
Research design
Based on the nature of the methodology to be undertaken for the completion of research, research is classified into quantitative and qualitative study types (Rinjit, 2020). Quantitative research is design based on a collection of numerical data and performs analysis to achieve an inference through mathematical calculation (LoBiondo-Wood & Haber, 2021). This study will follow a primary quantitative research design. One of the primary benefits of using quantitative methods of research is that it helps in focused analysis and objective research. Further, the use of quantitative data helps in enhancing the objective approach to the data and eliminates subjectivity. Further, through quantitative research design, data from a large sample size can be collected and analyzed in less time (Grove & Gray, 2018)Identification of perceptions and support needs for women with postnatal depression.
Systematic Search Strategy
Hence, this approach of research is suitable with a concrete and robust sample size along with the derivation of statistical relationships in the study. Since the data in a quantitative research design is based on a larger population, it can be used for the generalizability of the findings to a greater section of the population (Chinn et al., 2021). Quantitative research is beneficial as it can help in the generation of numerical data that can help in understanding the cause and effect relationships. It can also help in understanding the correlational factors that are associated with the primary question of research to develop an inferential understanding. Since the data will be based on objective information collected in the research, there will also be a minimized risk of bias and improved objectivity in the research outcomes (LoBiondo-Wood & Haber, 2021).
Research setting
This research will be conducted through online means and will be focused on maternity care hospitals.
Sampling method
The sampling method for this research will be based on purposive sampling. Purposive sampling is a non-probabilistic method of sampling that can help in the identification of a suitable population for the research. Since this research is based only on the individuals who have faced postpartum depression, this method of sampling will help in focusing of the research on the identified population. In the purposive sampling method, the individual characteristics of the population are defined and are included by the researchers. (Peate, 2019) Hence, a set of inclusion and exclusion criteria is developed for the identified population.
The purposive sampling is beneficial as it helps in the extraction of maximum data out of the target population and thus can help retrieve the suitable research outcomes. Since the proposed study is only focussed on a specific section of the population, and hence the same is applicable in the case of purposive sampling (Shrama, 2018). Purposive sampling is also beneficial for the identification and selection of information rich cases. It is a cost effective method and allows for screening through only the relevant data. Hence, this method will allow the collection of systematic data and assessment based on a certain population, and the same can be applied in the case of a specific population size (LoBiondo-Wood & Haber, 2021)Identification of perceptions and support needs for women with postnatal depression.
Inclusion and exclusion criteria
The specific inclusion and exclusion criteria will be used for the selection of participants in the research. The inclusion criteria of this research will be based on the selection of women who have given birth in the last 9-10 months and have been facing or have faced symptoms associated with postpartum depression. Women belonging to all cultural, social, and economic backgrounds will be included in the study. It will also be essential that participants of the research report their past medical history in context with mental illnesses for participation in this research. Hence, the following inclusion criteria will be used for the selection of the participants:
- Individuals who have experienced the signs and symptoms of postnatal depression will be included in the study.
- Individuals who self-diagnosed incidence of any form of mental distress and depression like symptoms after the birth of their child will be included in the study.
- It is essential that all the participants of the study have given birth in the last 9-10 months for inclusion in the study.
- Individuals from different social, cultural, economic, and ethnic backgrounds will be included in the study.
- Mothers between the age of 21-40 years will be included in the study.
The following exclusion criteria will be used to eliminate individuals from participation in the research:
- Individuals who will have a complex history of mental health disorders will not be included in the study.
- Individuals who will have the genetics of postnatal depression or any other form of mental health disorders will not be included in the study.
- Individuals who do not understand English as a means of written communication will not be included in the study.
Relevant Literature And Its Evaluation
Recruitment
The recruitment of participants will be done through an online survey and by the collection of data from the nursing homes. The participants will be screened based on the liability criteria for inclusion in the research and will then be approached for participation with the effective filling of a valid consent form for participation in the research. It is ideal that a large sample size is recruited for the collection of data. However, a time frame of three months will be used for the collection of data, and as many as responses that can be collected will be included for the research.
Ethics
Ethics in a research are foundational and are important as they help in asserting that no harm was implicated in the completion of the research and the research is being completed with the intention of welfare (LoBiondo-Wood & Haber, 2021). The four primary principles that direct the process of ethics in the research include the principles of justice, autonomy, beneficence, and non-maleficence. In this research, the primary principles of autonomy and beneficence are of key importance. The participation in the research will be voluntary and will be based on the effective collection and submission of the consent form by the participants. The collection of a valid consent is essential in the process of research (Sharma, 2018)Identification of perceptions and support needs for women with postnatal depression. The collection of an informed consent is associated with the ensuring that the participants of the research are well-informed about the research processes and are aware of the risks and benefits of participation in the research. It is important that the focus is laid on the consideration that women that participate in this study are informed about this research so that they can decide if they wish to participate in the study. To ensure this, all the participants of the research will be given a disclaimer that will explain the nature of the study and the meaning of survey completion. Further, the participants will have the freedom to abort from the process when they feel like it and if they do not wish to provide the answer to any of the questions in the research. The participants will be given a trigger warning before the research questions are asked along with the consent form, and if for any particular question a participant feels that they do not wish to answer, they will have the option to skip the survey. However, only completed survey forms will be included in the final analysis of the research.
No personal information will be collected from the participants that can be used as an identifier. Hence, anonymity will be maintained in the completion of the research. The data collected through this research will be available for access to only the researchers and will be stored in a protected form digitally to ensure that no data breach is possible, and the information provided is safe and secured (Tappen, 2022).
It will be ensured that the study proposal is approved by the Ethics Committee of the university so that the research can be processed in the direction of the same.
Part II: Research Pilot Design
Collection of data
The collection of data will be done through surveys. Surveys based on questionnaires are one of the efficient data collection tools for quantitative research. As a tool for data collection, they are cost-effective, flexible and easy to distribute (Chinn et al., 2021). Hence, they are also able to gather responses from a wide range of populations and ensure a greater sample size for research (LoBiondo-Wood & Haber, 2021). To conduct a survey for the collection of quantitative data, questionnaires are often used. This helps in the collection of a wide range of information from a large range of respondents. The questions in a quantitative survey are designed as objective questions are close ended. This can help in the collection of large amounts of data with a simple response and can also allow for easy translation of the survey data into a numeric form for further analysis (Grove & Gray, 2018). Close ended questions are defined as questions where the respondent has to answer is either yes or no. These questions are easy to understand and the respondents can answer quickly and more instantly. It also helps in getting data that is measurable and is associated with an improved response rate. Further, it helps in the collection of highly objective data and eliminates the unnecessary information (Chinn et al., 2021).
Hence, for the collection of data, a questionnaire will be developed with close-ended questions. The survey will be assessed and analyzed using a systematic approach for its reliability and validity before distribution to the larger population for data collection and analysis (LoBiondo-Wood & Haber, 2021)Identification of perceptions and support needs for women with postnatal depression. The distribution of the survey will be done digitally and the responses will also be collected through digital means. Once the responses are collected, they will be assessed and analyzed to reach the suitable inference.
Analysis of data
Analysis of data is one of the primary components associated with systematic research and its findings. The survey responses collected from the data collection procedure will be assessed using statistical methods. Inferential statistical methods will be used for this process (Grove & Cipher, 2019). Inferential statistics method is used when a deduction is to be made from a small representative population about a bigger population. The statistical analysis tools such as one sample hypothesis test, confidence interval, and regression analysis will be taken into consideration (Grove & Cipher, 2019).
Dissemination plan
The findings of this research will be important as it will help in understanding the role and prevalence of stigma regarding postnatal depression in women and its impact on the individuals (Wrighting et al., 2021). Further, this research will also be helpful in understanding the needs of individuals who suffer from postnatal depression. The dissemination of the findings will be done in alignment with the science communication policies and guidelines of the university. Further, the findings will also be communicated to the nursing homes and the primary stakeholders, such as expecting mothers, nurses, midwives and the carers. This shall be done by the development of science outreach programs and policies and focussed discussions with the professionals (Leon & Bourk, 2018).
The dissemination plan should be developed in the consideration with the use of simple language and in a manner to de-stigmatize the mental health of the mothers suffering from postnatal depression. Individual as well as community based strategies such as focussed discussion plans, seminars, and workshops need to be undertaken to ensure the same (Fontaine et al., 2019).
Implementation of changes
The implementation of changes that will be needed to ensure improved care for the individuals based on the needs of the mothers with postnatal depression will require policy development and action. In addition, education of the care service providers, affected individuals and the families will also be essential. (Galatzan & Carrington, 2018) Identification of perceptions and support needs for women with postnatal depression
The implementation of change can be done through systematic development of the PDSA (Plan, Do, See, Act) cycles (Fontaine et al., 2019). This will help in the development of a continuous development program for the implementation of changes and also help them track effectively by making improvements through systematic interventions where needed. In conjunction, a feedback strategy should be applied through the designing of an evaluation program that can be used for the assessment of the implemented program (Portney, 2020).
Factors that will facilitate and hinder the dissemination and implementation
The primary factor that will facilitate the completion of this research and its findings will include the need of understanding of stigma and needs of mothers with postnatal depression and a common interest among the individuals and professionals to ensure the wellbeing of mothers and the children (Jidong et al., 2021).
However, certain limitations also need to be taken into consideration. The primary limitation that can hinder the completion of this research is the poor participation of individuals. One of the essential needs to ensure the success of this research is significant participation of the individuals (Rinjit, 2020). Hence, it is needed that the individuals participate in this research. Postnatal depression is a sensitive topic and it can be difficult to engage more participants in the process of research (Leon & Bourk, 2018). To ensure active participation, it is needed that the benefits of this research are communicated to participants effectively. Further security and safety of the data also need to be ensured to convince the participation of individuals.
For the dissemination of the research, one of the limitations that can impact the research is that prevalent stigma with mental health can be associated with limited interest and engagement of individuals in the research and in its findings (Wrighting et al., 2021). The use of complicated or jargon-based language can also impact the dissemination of the participants. The engagement of individuals can be enhanced by helping the communities and stakeholders understand the massive need for improved needs and care for postnatal depression and management of individuals with depression in the young mothers. The use of simplified language will also be beneficial in ensuring improved dissemination of the findings of the research (Leon & Bourk, 2018)Identification of perceptions and support needs for women with postnatal depression.
Conclusion
Postnatal depression is one of the common conditions that affect one in ten women. The condition is associated with signs of hopelessness, withdrawal and sadness in women after the delivery of the child. However, with the prevalent stigma against mental health disorders and limited knowledge and understanding of mental health needs, postnatal depression is often ignored. This document provides a guided proposal for the analysis of the perceptions and stigma surrounding the postnatal needs of the individuals that can impact the mothers. This document summarises a brief background of the research and by identification of the relevant evidence through an evidence search. This paper also summarises the research pilot designs and outlines the primary quantitative research based on a collection of surveys for the collection of data and its systematic analysis. A purposive sampling method has been suggested for completion of this research along with a defined inclusion and exclusion criteria. Ensuring the use of proper ethical procedures and guidelines has been indicated, along with inferential statistics for data analysis. This paper concludes that it is important to focus on the needs of women with postnatal depression and de-stigmatize the conversations around the same. The communication and dissemination of the research findings and facilitators and barriers in the same have been identified in this research for a holistic analysis.
References
Alexandrou, F., Sakellari, E., Kourakos, M., & Sapountzi?Krepia, D. (2018). Health visitors’ perceptions on their role to assess and manage postpartum depression cases in the community. Health & Social Care in the Community, 26(6), 995-1000. https://onlinelibrary.wiley.com/doi/abs/10.1111/hsc.12638
Chinn, P. L., Kramer, M. K., & Sitzman, K. (2021). Knowledge development in nursing e-book: theory and process. Elsevier Health Sciences. https://books.google.com/books?hl=en&lr=&id=cSBCEAAAQBAJ&oi=fnd&pg=PP1&dq=Research+methods+in+nursing+book&ots=BWPFtj1pDo&sig=s96-LEYij-ZMD6OwO8HXjHZo5os
Dearholt, S.L. & Dang, D. (2017). Johns Hopkins nursing evidence-based practice model and guidelines. Indianapolis, IN: Sigma Theta Tau International Honor Society of Nursing. https://www.google.com/url?sa=t&rct=j&q=&edata-src=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwinr-GK2LP3AhWp7HMBHRS2BD8QFnoECAMQAQ&url=https%3A%2F%2Fiau-neyshabur.ac.ir%2FDorsapax%2Fuserfiles%2Ffile%2FAmozesh%2FEDO%2FAmozesh%2F977_Johns_Hopkins_Nursing_Evidence.pdf&usg=AOvVaw3o5jorcvzc2kdjhCQHiR2S
Fontaine, G., Maheu-Cadotte, M. A., Lavallée, A., Mailhot, T., Rouleau, G., Bouix-Picasso, J., & Bourbonnais, A. (2019). Communicating science in the digital and social media ecosystem: scoping review and typology of strategies used by health scientists. JMIR public health and surveillance, 5(3), 14447. https://publichealth.jmir.org/2019/3/e14447/ Identification of perceptions and support needs for women with postnatal depression