Qualitative Exploration of Postpartum Depression Among Mothers Attending St. Joseph Hospital, Koforidua
CHAPTER ONE
Purpose of the Study
The purpose of the study is to explore postpartum depression among mothers at St. Joseph Hospital, Koforidua.
Specific Objectives
The specific objectives are to;
- describe what mothers at St. Joseph Hospital, Koforidua consider to be PPD
- explore the perceived causes of PPD among mothers at St. Joseph Hospital, Koforidua
- explore the perceived effects of PPD on postpartum mothers at St. Joseph Hospital, Koforidua
CHAPTER TWO
LITERATURE REVIEW
This chapter provides a review of related literature on postpartum depression which has been thoroughly selected from various search engines like Science Direct, PUBMED, Sage, Google Scholar and Elsevier. “Effects of postpartum depression”, knowledge/understanding on postpartum depression”, causes of postpartum depression” were the search phrases and words used in the various search engines to collect the literatures.
Effects of PPD
Depressive disorder in the postpartum period in the mother appears to have a deleterious impact on young mothers, their babies, and their relationships with family members (Slomian et al., 2019). Depressed mothers disclose greater levels of negative emotions (which include sorrow, worry, anxiousness, and aggressive behaviour), have more challenging relationships with close relatives, which involves their siblings and parents (Smorti et al., 2019), as well as a greater degree of sexual frustration. They communicate with their infants less verbally, demonstrate less pleasant emotions in their faces and verbal expressions, and express fewer gestures of affection (Smorti et al., 2019). Mothers who are postpartum depressed abandon their children, practice bad parenting practices, and have poor relationships with their babies (Baumgartner et al., 2014; O’Mahony et al., 2012).
Using a systematic study, (Slomian et al., 2019) assessed both the new-born and maternal outcomes of undiagnosed maternal postpartum depression. The findings were organised into three categories: (a) the maternal repercussions of postpartum depression, which included mental and physical wellness, connections, and hazardous conduct; (b) the baby’s implications of postpartum depression, which included anthropometry, physical health, sleep, and motor, cognitive, language, social, psychological, and personality development; and (c) mother-child interactions, which included bonding, breastfeeding, and the maternal experience. (Slomian et al., 2019) concluded that postpartum depression produces an atmosphere that is not favourable to mothers’ personal growth or a child’s development to its fullest.
Postpartum depression (PPD), as described by (Atuhaire et al., 2021), is a prominent cause of maternal health problems particularly has serious effects on the well-being of mothers, new-borns, loved ones, and societies. PPD affects the mother’s ability to respond to the demands of her child. In life-threatening situations, mothers suffering from PPD are more likely to experience psychosis following childbirth, commit suicide, and, on rare occasions, commit infanticide (Atuhaire et al., 2021). For decades, the effects of maternal depression on babies have been recognised (Badr et al., 2018). Independently and synergistically, maternal postpartum depression and existing mental health difficulties raise children’s mental health concerns (Closa-Monasterolo et al., 2017). Depressed mothers struggle to acclimatize to parenthood and are less attentive to their infant cues, leading to a lack of optimum attachment to their new-borns. Even minor depression symptoms in the postpartum period can have an impact on mother-infant bonding, child growth and development, and quality of childcare (Badr et al., 2018). A detrimental mother-infant interaction in the child’s first few years of life causes long-term emotional, social, and intellectual consequences (Badr et al., 2018). According to (Mirhosseini et al., 2015), this disease has a major impact on children’s later development as well as growth.
Furthermore, childhood trauma caused by postpartum depression is linked to poor physical and mental health outcomes for people throughout their lives; it also has an unfavourable effect on succeeding generations, culminating to a perpetuation of deprivation (Choi et al., 2017). These findings suggest that maternal depression can have an immediate, concomitant influence on a baby’s intellectual growth as early as four months of age after birth (Closa-Monasterolo et al., 2017; Smith-Nielsen et al., 2016). On the other hand, (Aoyagi & Tsuchiya, 2019) argue that, while several studies have been conducted in order to examine the established consequences of maternal PPD on children’s physical and neurological development, there is insufficient proof that has revealed an association between maternal PPD and all the four categories of child development – physical, neuromotor, language acquisition and general intellectual capacity.
PPD, while restricted to the initial year after childbirth, may result in long-term consequences for mothers and those closest to them (Habel et al., 2015). Women who suffer from PPD are more likely to experience future depressive episodes (Habel et al., 2015). PPD may result in a negative impact on the relationship between a mother and her child and is linked to an increased likelihood of mental development delays, a lack of attachment, and lower social participation in children of PPD victims (Habel et al., 2015). Women’s partners are also affected by PPD (Habel et al., 2015). Given worry and perceived failure to aid their partner, partners encounter a variety of unpleasant emotions such as doubt in themselves, feeling powerless, rage, and fear. Spouses of women suffering from PPD are more likely to experience psychological disorders (Habel et al., 2015). According to a recent meta-analysis, approximately 10% of fathers experience depression symptoms, which are moderately and positively linked with mother-depressed symptoms (Habel et al., 2015). Notwithstanding the effectiveness of modern PPD treatments, multiple studies show that women with depressive symptoms are hesitant to seek help and deny receiving recommendations for mental health services (Habel et al., 2015). A major explanation for low healthcare utilization is a misalignment between women’s understanding of their needs and the services available (Habel et al., 2015). The way women and their partners comprehend their symptoms may influence their help-seeking behavior and care decisions. This insight could be a critical step in the establishment of greater acceptance of PPD services and intervention initiatives for women and their spouses (Habel et al., 2015).
Mothers suffering from postpartum depression have trouble getting along with their children which may damage them (Desy Meldawati, 2021). Postpartum depression can be triggered by several circumstances, one of which is pregnancy difficulties. A literature review was used in this investigation. Google Scholar, Biomed Central, and Pubmed were used to find the papers. According to the previous studies, pregnancy difficulties are the root cause of depression following delivery. Maternal anemia, which can arise during the pregnancy process till the birth process happens, is a common complication endured by pregnant women even following their delivery (Desy Meldawati, 2021). In addition, gestational diabetes constitutes a few of the pregnancy issues that affect pregnant women. Pregnant women have higher levels of hormones such as progesterone, human placental lactogen estrogen, and cortisol. Finally, if a pregnant woman had a history of depression prior to pregnancy, she is more likely to experience postpartum depression (Desy Meldawati, 2021).
(Çapik & Durmaz, 2018) used a cross-sectional research approach to investigate the effect of birthing anxiety, postpartum depression, and specific birth-related characteristics on postpartum Depression. The study’s sample consisted of 301 pregnant women who matched the study’s inclusion requirements. Fear of labor, contentment with medical personnel attitudes throughout childbirth, interpreting the childbirth experience, and the mother’s likelihood of having postpartum issues were found to be important predictors of PPD (Çapik & Durmaz, 2018).
Causes of PPD
The cause of maternal postpartum depression (PPD) is yet unknown (Aoyagi & Tsuchiya, 2019; Stewart & Vigod, 2019). However, numerous risk factors have been linked to the prevalence of post-partum depression. A family that supports an unanticipated birth is thought to be among the top contributors to the risk for postpartum depression (PPD) (Abdelmola et al., 2023).
Psychological: Postpartum depression is exacerbated by a history of sadness and anxiety, premenstrual syndrome (PMS), an unfavourable mind-set toward the infant, aversion to the baby’s gender, and a history of sexual assault (Stewart & Vigod, 2019)
Obstetric risk factors: PPD is connected with high-risk pregnancy including emergency caesarean section and hospitalization during pregnancy, meconium passage, umbilical cord prolapse, preterm or low birth child, and low haemoglobin associated with PPD (Stewart & Vigod, 2019)
Social factors: Postpartum depression can be caused by a lack of social support. Domestic violence, such as spousal sexual and physical abuse, as well as physical and verbal assault, can also play a role in the progression of the illness. Smoking while expecting a baby increases the likelihood of having PPD (Stewart & Vigod, 2019).
Lifestyle: Eating habits, sleep patterns, physical activity, and exercise may all have an impact on postpartum depression. Vitamin B6 has been linked to postpartum depression through its transformation to tryptophan and, later, serotonin, which impacts mood (Stewart & Vigod, 2019). The process of sleeping is one of the elements that influence depression risk. Sleep deprivation is well-linked to postpartum depression (Stewart & Vigod, 2019). Depression-related symptoms are reduced by regular physical activity and exercise. Exercise improves depression-related low self-esteem (Stewart & Vigod, 2019). Exercise boosts endogenous endorphins and opioids, which improves mental wellness.
CHAPTER THREE
METHODOLOGY
The methods used to conduct this research are described in this chapter. It includes; the research design, research setting, target population, sample size/ sampling technique, inclusion criteria, exclusion criteria, tool for data collection, data collection procedure, data analysis, rigour and ethical considerations.
Study Design
Akhtar (2016) describes the research design as “the conceptual blueprint within which research is conducted”. An exploratory qualitative methodology was used in this study. Busetto et al., (2020) defines Qualitative research as “the study of the nature of phenomena”, including “their quality, different manifestations, the context in which they appear or the perspectives from which they can be perceived”, but excluding “their range, frequency and place in an objectively determined chain of cause and effect” and It produces data that is not numerical (Busetto et al., 2020). Because qualitative research concentrates on comprehending a research inquiry from an idealistic perspective, this methodology was chosen. Authors also chose the qualitative methods technique because it is used to comprehend people’s attitudes, interactions, behaviours, and beliefs (Busetto et al., 2020)
Study Setting
The research was carried out at the St. Joseph Hospital in the Eastern Region’s New Juaben North Municipal, Effiduase, Koforidua. The St. Joseph Hospital is a Catholic missionary hospital. The hospital is one of the key referral centers in the region, and it is well-known for its capacity to manage orthopaedic cases, with patients coming from all over the neighbouring towns and Ghana. The hospital contains a large number of units that treat both specialist and general ailments. The medical/Surgical unit, Paediatric unit, Obstetric/Gynaecological unit, Orthopaedics and Prosthetic unit, Physiotherapy unit, and outpatient department are among the units. The hospital has a bed capacity of two hundred and fourteen with average daily OPD attendance of 243.
CHAPTER FOUR
RESULTS AND DISCUSSION
Results
Findings from the study are presented thoroughly in this chapter. Taking the specific objectives of the study into consideration, three main themes were explored which were on participants’ understanding on postpartum depression, their perceived causes as well as participants’ perceived effects of postpartum depression. One more theme emerged from respondents’ experiences which was their recommendations on how to prevent postpartum depression. Four main themes collectively emerged from the study.
Demographic Characteristics of Participants
A total of eleven (11) mothers were involved in the study. The youngest participant was at age twenty-five (25) years while the eldest was aged forty-one (41) years. Five (5) mothers had acquired tertiary education while five (5) had senior high school education and one (1) also had Junior High School education. All participants (11) were Christians. Although eight (8) participants were married, three (3) were not and were either cohabiting (2) or single (1). There were six (6) traders, two (2) teachers, a banker (1), a seamstress (1) and a caterer (1) as participants’ occupations. Five participants (5) had one child (1) each whereas three (3) had two children each and three (3) had three children each. Table 1 provides brief description of participant’s demographic characteristics.
CHAPTER FIVE
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
This chapter provides the summary, implications of the findings, limitations, conclusion and recommendations.
Summary
This study explored the understanding, perceived causes and effects of postpartum depression among mothers at the St. Joseph Hospital, Koforidua. This was a qualitative study where data was collected using recorded tapes during an interview with an interview guide. This was after consent and all ethical clearance principles had been fulfilled by the hospital authorities as well as study participants. The interviews were audio taped and transcribed verbatim between May 2023 and June 2023. Thematic content analysis was used to analyze the data.
Mothers demonstrated gaps in knowledge with regards to definitions, onset, frequency, manifestations, danger indicators, screening techniques, and therapy and but rather based focused on signs and symptoms they have witnessed in the past.
Various perceived causes of postpartum depression mentioned by mothers’ poor family support, low educational level, poverty, genetic/family history, fetal demise, congenital abnormalities, divorce/marital problems, spiritual causes, unplanned pregnancies, labor complications, preexisting diseases or pregnancy induced conditions (like hypertension, diabetes), sudden demise of a loved one, delivering at home and not attending antenatal clinic.
Various effects of postpartum depression were mentioned by participants including effects on family, society as well as on parenting
Finally, their recommendations focused on mass education on postpartum depression especially among reproductive aged women at the antenatal clinics.
Conclusion
Findings from the study have revealed several gaps in knowledge among mothers who are potential victims of postpartum depression. The perceived causes of postpartum depression although still unclear, have a multifactorial cause that needs to be targeted with urgency to prevent its prevalence. The debilitating effects of postpartum depression is as well acknowledged and cited by participants which eventually parenting, families, societies and the country as a whole.
Recommendations
- We recommend that all antenatal clinics should add postpartum depression to their outmost routine educational topics ensuring all women are well educated intra-partum before delivery
- Hospitals should have routine protocols set in place to looks out for early signs and symptoms of postpartum depression to ensure early diagnosis and management to prevent further complications
- The government through the ministry of health should provide adequate professionals available at hospitals to provide specialised care and early treatments to mothers diagnosed of postpartum depression as well as provide free medical care to them to relieve cost of burden on victims and their families
REFERENCES
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