STAFF PERCEPTIONS OF THE RISK FACTORS ASSOCIATED WITH PARENTAL DEPRESSION

STAFF PERCEPTIONS OF THE RISK FACTORS ASSOCIATED WITH PARENTAL DEPRESSION

ABSTRACT

Recent medical studies show that the cases of prenatal depression are becoming widespread and prevalent not only in developed countries like America but also in developing nations of Africa and Asia. In the United States, sixteen per cent of the expectant women experience prenatal depression. Most women relate with postpartum depression which affects women after childbirth and regards it as a regular experience. However, perinatal women are not aware of prenatal depression as they confuse it with mood swings which are natural during pregnancy. Certain risk factors predispose pregnant women to antenatal depression such as economic stress, intimate partner violence, previous history of depression and unplanned pregnancies. This study will, therefore, help establish and understand other risk factors and causes of prenatal depression.

Medical practitioners and perinatal women perceive prenatal depression differently, and this study will explore the various measures the pharmaceutical sector in conjunction with the government are taking to promote fetal depression awareness. Moreover, the study will examine the available policies put in place to enhance the support system of perinatal women with depression. Support from the medical staff is essential as it motivate the pregnant women to seek medical assistance. The study will adopt a qualitative research methodology in data collection and analysis.

KEYWORDS: Prenatal Depression, Risk Factors, Perinatal Women.

CHAPTER ONE

INTRODUCTION

• Background Information

Statistics show that prenatal depression affects one in every ten women globally. Although prenatal/antenatal depression is a common phenomenon, it exposes pregnant women to further mental problems such as postpartum depression, miscarriages and in worst cases death (Venkatesh & Kaimal 2016, pg. 928). It is rather challenging to identify prenatal depression since some women find mood swings and emotional imbalances as regular occurrences during pregnancy. However, some women fail to understand that depression is a severe psychological disorder that requires medical attention. Furthermore, various risk factors contribute to prenatal depression, such as the previous history of depression, economic challenges, unexpected pregnancy and exposure to domestic violence during pregnancy (Bowen & Muhajarine 2016, pg.102).

The study will, therefore, help in the identification of more risk factors that increase the likelihood of prenatal depression to improve the health of the mother and child. Some of the variables/determinants of antenatal depression include physiological risks factors, behavioural risk factors and demographics (Grote & Katon 2010, pg.1020). Medical professionals, especially those in maternal and pediatric health, ought to collaborate with psychiatrists to help expectant mothers identify the indicators of prenatal depression. In addition to identifying the risk factors, the study will address the practice and policy gaps that challenge the treatment of antenatal depression (Alder & Bitzer 2011, pg, 1404). Statistically, a significant number of expectant women and medical physicians possess little knowledge of prenatal depression, and the study will seek to provide accurate information to reduce the adverse outcomes of depression.

Information barriers concerning prenatal depression affect the delivery of efficient medical services. The policymakers, therefore, propose antenatal depression literacy programs in hospitals to educate pregnant women, medical personnel and midwives (Jomeen &Davies 2009, pg.300). Moreover, access to effective prenatal mental care remains a challenge, especially in developing nations like India and Africa (Gentile 2017, pg. 154). The present study, therefore, attempts to expound and evaluate existing policies in addressing the gaps in prenatal depression.

• Problem Statement

Prenatal depression remains a significant hindrance to the health of the mother and child. The concept is slowly becoming prevalent, especially in the 21^st century. The lack of awareness in information regarding perinatal depression is much affecting the delivery of mental care to perinatal women (Hayes & Carlson 2013, pg. 150). Owing to recent studies on the effects of prenatal depression, a lot of women do not relate to depression during pregnancy since they are more familiar with postpartum depression. The study will, therefore, deconstruct prenatal depression and present the various risks factors increase the predisposition of perinatal women to depression (Field 2011, pg. 13). Depression tops the list of the major psychological disorders with anxiety disorders following closely. Prenatal depression, therefore, requires more medical attention because it may result in health complications during and after birth.

1.3 Objectives of the study

The objectives of the survey will be;

1. To identify and understand the various risk factors and causes of prenatal depression.
2. To explore the policies and efforts put in place to improve the support system of women dealing with prenatal depression.

• To assess the provision of prenatal depression education in hospitals and non-health facilities.
  • Research Questions

The study aims to answer the following questions:

1. What are the underlying risk factors and causes of perinatal depression?
2. Are there existing policies put in place to improve the support system of prenatal women?
3. How does education help alleviate the misconceptions of prenatal depression among pregnant women, nurses and doctors?

CHAPTER TWO

LITERATURE REVIEW

2.1 Risk Factors

Prenatal depression, in most cases, is a result of an integration of various risk factors which directly or indirectly affect the expectant women. The common risk factors perceived by most medical staff include; perinatal woman’s history of abuse, unplanned pregnancies, lack of a support system, drug and substance abuse, biological factor (genetics), intimate partner violence, economic pressures and illiteracy (Manikkam & Burns 2012, pg. 941).

2.1.1 History of Depression

According to Heron and Glover (2004), postpartum depression correlates with the onset of perinatal depression. Depression can be recurrent, especially in women who develop postpartum depression after giving birth. Postnatal depression can revive prenatal depression, especially when the expectant mother lacks the necessary support system (Coelho & Cooper 2011, pg. 363). Furthermore, mothers who fail to address postpartum depression are more likely to have depressive episodes during their current pregnancy. In addition to postpartum depression, previous exposure to other mental conditions such as post-traumatic stress disorder and dependent personality disorder can result in antenatal depression. Untreated childhood trauma and mental problems can spark the onset of perinatal mental problems (Olivier & Poromaa 2015, pg. 260).

2.1.2 Economic Pressures

The socio-economic status of the expectant woman impacts their psychological state. Perinatal women earning low-income from their daily jobs are more likely to suffer from depression compared to stable women. Access to basic needs such as food, shelter and clothing can be a challenge to unemployed parents. With the possibility of an additional member(s), the expectant mother can develop anxiety and personal stress (Eastwood & Page 2017. pg. 213). Children come with responsibilities and providing the necessary infant care is vital and demanding. In the absence of the crucial financial support or a stable income accessing the proper antenatal mental care can prove difficult. The medical staff perceive economic stress as the primary contributor to perinatal depression (Saeed & Humayum 2015, pg. 64).

2.1.3 Unplanned Pregnancy

Pregnancy is a major source of joy to most women, but to some, it is a precursor of depression and difficult moments (Siddlebottom & Kim 2012, pg. 370). Unexpected pregnancies make the women feel anxious and hence exposing them to depression as they are not able to comprehend what to do next. For teenage girls, pregnancy can present both mental and health problems, especially anxiety, which can hurt the baby. Social support is critical, especially in assisting new women in adapting and undertaking motherhood responsibilities (Pajulo & Piha, 2001, pg. 15). With the right support system, perinatal mothers can accept the reality of the situation and carry the pregnancy to full term.

2.1.4 Intimate Domestic Violence

Women who undergo domestic abuse during pregnancy are more susceptible to prenatal depression. The emotional abuse from the significant spouse affects their mental state since they lack a companion and emotional support to deal with the violence and pregnancy. In cases of physical abuse, the expectant women get overly fearful and anxious, putting the baby’s health at risk. Domestic abuse is a major risk factor of prenatal depression, especially in aggressive households (Reid & Cheshire 2009, pg. 505). Some primitive cultures in Africa support physical abuse claiming that it is a form of discipline.

2.1.5 Lack of a Strong Social Support System

Pawbly and Pariante (2011) agree that social support is among the top risk factors of antenatal depression. The presence or absence of any form of social support determines the mental state of perinatal women. First-time expectant women are mostly imparted by social support from close relatives and friends and those who lack it struggle more and experience negative emotions and individual stress hence exposing them to perinatal depression. Social support can include; material/financial support, emotional support and information studies. Recent studies show that poor social networks during pregnancy increase the chances of developing emotional stress not only with the pregnant mother but also on the paternal father (Redshaw & Henderson 2013, pg. 520).

2.1.6 Drug and Substance Abuse

A significant number of medical personnel perceive drug and alcohol abuse as a risk factor of perinatal depression. Pregnant women receive medical advice against the use of certain types of drugs, especially tobacco, marijuana and alcohol (Yedid Sion & Sheiner 2016, pg. 867). These drugs pose great harm to the unborn child and women with a history of drug and alcohol addiction are more likely to feel anxious during pregnancy, especially during the mood swings. They may opt to take the drugs to reduce the depressive emotions, which further predisposes them to perinatal depression. Medical prescriptions such as cortisol, dopamine present negative association with perinatal depression (Osborne & Pariante 2018, pg 220).

2.1.7 Level of Education

In recent studies, the literacy level of a perinatal woman plays a significant is determining antenatal depression. School drop-outs teenagers and women are more likely to misconceive information about perinatal depression. Moreover, a significant number of women are unfamiliar with antenatal depression, unlike postpartum depression. Lack of awareness of the important risk factors of prenatal depression presents negative effects during pregnancy. When expectant women fail to self-report experiencing depressive symptoms, they are prone to developing high-risk pregnancy (Orr & Reiter 2007, pg. 540).

2.1.8 Genetics of Health Complications

Pregnant women with a history of birth complications or high-risk complications are at a high risk of getting depressed. Statistics show that women who carry high-risk pregnancies are more likely to suffer emotional turmoil as they are anxious as to whether they will carry the baby to full term. Moreover, expectant women with a history of miscarriages are also at risk of developing depression during the pregnancy (Koutra & Kogevinas 2014, pg.714). However, the limitation of the literature review is that it fails to account for women who successfully carry their pregnancies to term even with health complications

2.2 Social Support Measures

Perinatal women require adequate social support since they undergo both physical and emotional changes. With the right social support, expectant women can control their emotions since they feel important and well-taken care of not just materially but also socially. Absence of social support during pregnancy predisposes the women to depression which is among the major risk factors of antenatal depression. Perinatal women perceive social support as an essential need as it makes them feel less vulnerable and cared for by their families. The lack of a strong social support system exposes pregnant women to feelings of anxiety, nervousness and personal stress (Lefkovics & Rigo 2014, pg. 355).

In most cultures and nations, perinatal women receive much appraisal and recognition by society since the family lineage continues. As a result, women receive adequate social support during pregnancy and after delivery. In the traditional cultures of Africa and Asia, pregnant women are taken care of by not only the close family but the whole community (Lee & Chung 2004, pg. 95). However, with modernization and rural-urban migration, the social support system is slowly diminishing as people settle in different regions. As a risk factor of prenatal depression, a robust support system can help identify a depressed perinatal woman/mother. Social support can be either emotional or practical. Psychological support may include encouraging pregnant women when faced with mood swings and understanding them. Practical help, on the other hand, comprises monetary aid, information and service assistance during the pregnancy (Misri & Grunau 2010, pg. 225).

In response to the prevalence of prenatal depression, screening perinatal women for depression has been successful through social support. Recent studies show that social support screening by nurses and medical experts assist them in treating prenatal depression (Coll & Stein 2017, pg. 145). The government has collaborated with the health facilities to improve the support systems, especially to young and poor pregnant women by providing the necessary support depending on the underlying risk factor. Information support, such as creating awareness about antenatal depression, has also been productive. The antenatal clinics are educating first-time and experience perinatal women on the signs and symptoms of prenatal depression and the treatment options for the same.

CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Epistemology

The social and interpersonal theory provides an in-depth insight into the demographic and personal risk factors of prenatal depression (Biaggi & Pariante 2016, pg.65). Individuals who struggle with attachment are more likely to developmental problems. Failure to receive the necessary social support from the right people also exposes perinatal women to depression. The attachment theory proposes that personality struggles that people go through increases their chances of developing depressive emotions and feelings. Perinatal women, therefore, expect precise treatment and support from their partners during the pregnancy, failure to which they will experience disappointments and later depression. Personally, the attachment theory supports the research question on the impact of social support in addressing prenatal depression hence reliable for the study.

3.2 Research Methodology

This study will utilize qualitative methods of data collection such as scholarly articles, face to face interview, open=ended questionnaire and content analysis. Qualitative data collections such as face to face interview allow researchers to interact one on one with the respondents. Qualitative research methods are advantageous as they provide detailed and subjective data from the respondents. Qualitative methods such as direct observation allow researchers to participate in the research study alongside the participants.. In addition to individual data, qualitative methodology such as open-ended questions during interviews allow respondents to provide more detailed information relevant for the study as they do not limit the data.

Qualitative methods also possess a high response rate since they are more inclusive. Qualitative methodology such as interviews researchers record the process; hence the information remains retrievable during analysis and further research. Qualitative methods also allow follow-ups during and after the research process. Unanswered queries can require fllow-ups up since some of the respondents leave their contact information. Additionally, qualitative data from existing online and print sources enable researchers analyze the data more speculatively without feeling the limitations as are present in quantitative research. Most qualitative methods of data collection are flexible, allowing researchers to include or remove a particular variable hence enabling respondents to adapt to the necessary changes smoothly.

The disadvantages of incorporating qualitative methods in data collection and analysis are that the research process can be time-consuming and expensive. For researchers to gather and collect reliable information from respondents, the researcher will have to spend long hours with the participants, which can be overwhelming. Another disadvantage of qualitative data collection methods is that researchers rely a great deal on the information collected from the respondents, and it will, therefore, be challenging to ascertain the validity and accuracy of the information. Moreover, there is a high likelihood that researchers will understand and analyze the information differently in the case of face to face interviews. It will be difficult for the researchers to come into a consensus once the interviewing process ends.

The cost of funding qualitative research is high in comparison to quantitative analysis. Holding face to face interviews or direct observation can be expensive since the meeting and observer has to pay accommodation, transport and maintenance costs. Qualitative sampling techniques can be rather challenging and may not necessarily provide the true nature of the research problem in question. Still, in this focus, sampling participants may prove prejudicial, especially when researchers expect a specific outcome from the study. Lastly, it is difficult to ascertain whether the respondents are understanding the questions or offering the right answers, and it is therefore essential for researchers to frame the open-ended questions correctly.

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