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The birth of a baby is good news to family members because they get to meet their bundle of joy. However, this joy may be interrupted by feelings of dejection in the new mother, which may progress to a severe, longstanding form of depression, otherwise known as postpartum depression (PPD). Symptoms of PPD include feelings of guilt, irritability, sadness, anxiety, hopelessness, loss of appetite, insomnia, and loss of focus among others. It is necessary to address this condition to prevent adverse outcomes such as the development of suicidal tendencies or acute depressive symptoms in the future. The nursing practice strives to ensure the physical, emotional, and spiritual wellbeing of patients. Therefore, when caring for postpartum women, anticipating the symptoms of PPD is beneficial in helping the nurse practitioner to provide proper care. This research article looks at various physiological, psychological, and environmental factors that influence the occurrence of PPD (Katon, Russo, & Gavin, 2014). The purpose of this paper is to critique the research article to identify its strengths and weaknesses as well as its implications for evidence-based nursing practice.
The goal of the study was to look into various socio-demographic influences, health risk conduct, medical disorders associated with pregnancy, and birth sequels as risk factors for PPD. Though it is not stated explicitly, the research question is “What are the predictors of PPD?” From my observation, all instances of depression are linked to the ongoings in the life of an individual. For example, constant physical disturbances may cause stress to an individual thus affecting their inner peace. Research also shows that depression is a consequence of modifications in brain chemistry, which may arise from fluctuations in hormone levels, grief, difficult living conditions, genetics, and some medical disorders (Lopresti, Hood, & Drummond, 2013). Additionally, the occurrence of one episode of depression sets the stage for a future incidence of the same condition. It is for this reason that a large number of depression incidents occur among people with a prior history of depression. Going by these observations, it is necessary to ascertain whether or not these factors can foretell the occurrence of PPD.
This study uses a prospective cohort approach to screen the subjects and examine the described risk factors of PPD. In a prospective cohort study, the researcher identifies study participants and observes them over a specified duration, which in most cases is several years. The researcher observes the subjects to decide if they contract a condition and when the condition manifests. At the time of recruitment into the study, the participants are free of the condition under investigation. One benefit of a prospective cohort study is that it is possible to identify disease risk factors in the study population accurately. Consequently, evidence obtained from such studies is ranked higher in the hierarchy of evidence than evidence gathered from retrospective cohort studies. It is hypothesized that the authors of the study wished to establish, with certainty, the effect of the proposed predictors for the development of PPD. Additionally, there are low chances of recall errors because disease incidence data are collected at regular intervals. However, the main disadvantage of this approach is the lengthy period required to follow up subjects, which results in high research costs.
Katon et al. (2014) recruited 1,423 pregnant women into the study between January 2004 and June 2011. Women with intellectual and language inability as well as those who were younger than 15 years at the time of delivery were excluded from the study. The sample size was adequate for the study because it is representative of the entire population. The goal of the study was to investigate the impact of six factors on the development of PPD. I think that this sample size was adequate for the study variables. There were no gaps regarding the sample size because the authors indicate the inclusion and exclusion criteria used in the enrollment of participants.
Data Collection Methods
The researchers administered the Patient Health Questionnaire-9 (PHQ-9) to the subjects during the second and third trimesters as well as postpartum. The questionnaires assessed mood and other important socio-demographic, clinical, and interactive information. Scores approaching 10 were indicators of clinically significant depressive symptoms. Means of (PHQ-9) scores were used in the final analysis. Fischer exact tests, t-tests, and hierarchical logistic regression were used to determine the forecasters of PPD. The authors do not indicate any ethical considerations that were taken in the course of the study. For example, they do not explain whether the subjects were informed about the purpose of the study before receiving questionnaires. A notable gap in the data collection method is the mean age of the participants. The authors indicate that subjects younger than 15 years were excluded from the study. However, they do not report the average age of the other participants whose data were used to compile the findings of the investigation.
Limitations of the Study
Researchers need to report study limitations to avoid misconstructions of the inadequacies by reviewers and readers. Also, the discussion of limitations influences future research agendas. The main limitation of this study is that the authors chose the subjects from a university clinic located in one geographical area of the United States. Therefore, there was a lack of diversity in patient characteristics. Future studies could overcome this restriction by recruiting participants from different areas of the country. The authors also admitted that they did not use organized psychiatric interviews to diagnose depression or its history before the incidence of depressive spells. Another inadequacy was failing to measure body mass index (BMI) of the subjects’ social support, which are known to influence depression levels. These limitations could be overcome in future studies by using established psychiatric measures to gauge depression levels at the baseline of the study and considering extraneous influences such as BMI and social support among the risk factors of depression.
Findings of the Study
It was reported that the incidence of significant PPD symptoms was high in young women, those without jobs, women with pregnancy-related
depressive signs, psychosocial stress, a medication history of antidepressants during pregnancy, and smokers. The incidence of pre-pregnancy medical ailments such as diabetes and neurologic complaints was also linked to a high incidence of PPD. These findings answered the research question indicated at the beginning of the study. The results described in this study are credible because they are backed by statistical evidence. Also, the large sample size increases the applicability of the findings to the population.
A critical review of the paper indicates that the researchers conducted their investigation satisfactorily. Even though a few gaps were identified, they did not compromise the integrity of the outcomes. The authors of the paper sought to identify the risk factors of PPD. It was noted that useful predictors of PPD included young age, joblessness, prenatal depressive signs, taking antidepressants, longstanding physical ailments before pregnancy, smoking, and psychosocial stressors. These findings are statistically significant thus showing their validity in the prediction of depression and their suitability to warrant a change in practice. The evidence-based nursing practice involves the incorporation of strong evidence into nursing processes to improve nursing practice. Overall, it was concluded that socio-demographic influences, health risk mannerisms, and medical problems associated with pregnancy are useful predictors of PPD. Therefore, nurse practitioners need to pay attention to these risk factors to promote the timely diagnosis of PPD.
Katon, W., Russo, J., & Gavin, A. (2014). Predictors of postpartum depression. Journal of Women’s Health, 23(9), 753-759.
Lopresti, A. L., Hood, S. D., & Drummond, P. D. (2013). A review of lifestyle factors that contribute to important pathways associated with major depression: Diet, sleep and exercise. Journal of Affective Disorders, 148(1), 12-27.