Abstract
Depression is a serious disabling illness that affects approximately 10% of children and 16% of adults. This mental health disorder is strongly associated with short- and long-term morbidity and death. Depression is strongly correlated with dysfunctional capabilities in daily routines including school activities and work responsibilities. In the case of post partum depression, a woman’s mental disorder is directly associated with pregnancy. Unfortunately, women who present with symptoms of post partum depression are not even aware that they clinically are experiencing this mental disorder. To date, there are no specific predictive factors that may facilitate a clinician to determine whether the pharmacological treatment of a patient diagnosed with depression, even post partum depression, will be helpful or harmful.
Introduction
Problem statement
This research proposal aims to determine whether peer support may serve as treatment or complementary support for patients positively diagnosed with post partum depression.
Review of related research
Depression is a serious disabling illness that affects approximately 10% of children and 16% of adults. This mental health disorder is strongly associated with short- and long-term morbidity and death (Kessler et al., 2003). Depression is strongly correlated with dysfunctional capabilities in daily routines including school activities and work responsibilities (Myers, 2007). The symptoms of this depression are the same among affected children and adults, with the exception that pediatric patients do not present a despondent mood but instead show a significant frequency of irritability. Depression among individuals may be observed in individuals who show a sudden decrease in the quality of work productivity or an abrupt decrease in school grades. Patients also show some kind of modifications in terms of interrelationships with friends, by simply decreasing and at times, refusing to interact and spend time with his usual peers and relatives. Depression also involves significant changes in patterns of sleeping and eating, which can be observed at extremes of either not sleeping well or sleeping during most of the day that the individual does not get to finish what he is expected to do or complete for that day. Depressed individuals also chronically feel tired and carry a sense of worthlessness, hopelessness. In a considerable portion of depressed individuals, thoughts of committing suicide are also reported. Among depressed adolescents as well as adults, an increased activity of substance abuse is also detected.
Pharmacological treatment of depression involves the administration of anti-depressants, which are classified as either first-generation or second-generation anti-depressants. The first-generation antidepressants include tricyclic antidepressants and monoamine oxidase inhibitors, while second-generation anti-depressants include the serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Specific examples of SSRIs include fluoxetine, citalopram, escitalopram, paroxetine and sertraline, while SNRIs include mirtazapine, nefazodone and venlafaxine. The effectivity of these two generation types of anti-depressants has been reported to be the same (Song et al., 1993). Yet, it has also been observed that first-generation anti-depressants generally cause several side effects that provide discomfort and intolerability among patients that receive such specific treatment regimen (Anderson, 2001). In some cases, an overdose of first-generation anti-depressants is associated with a great risk for harming oneself. Such observations resulted in the created of second-generation anti-depressants. Patients diagnosed with depression generally recover from their mental illness after 1 to 2 years, with or without pharmacological treatment. However, approximately 40% to 70% of these individuals succumb to a second episode of depression.
To date, there are no specific predictive factors that may facilitate a clinician to determine whether the pharmacological treatment of a patient diagnosed with depression will be helpful or harmful. It is therefore imperative that the clinician be cautious regarding the presentation of any abrupt changes in the individual during his treatment. In post partum depression, it is relatively easy to diagnose a patient because the term of pregnancy is closely related to the onset of the depression. It is thus important that a good interaction between the clinician and the patient’s immediate family should be established so that any unexpected and untoward actions that the patient may attempt to do, such as suicide or pain instigation, may be avoided and prevented. In addition, the clinician should assess every patient with complete objectivity, in terms of whether the individual fits the criteria for the diagnosis of post partum depression. And once post partum depression is diagnosed, the patient and the members of his immediate family should be educated about the mental health disorder. The clinician should also discuss options that are available for the treatment of such disorder, as well as disclose the side-effects of each treatment. It is also important that the clinician determine whether the family of the patient shows any history of suicidal behavior, as well as any new ideas and thoughts even during the treatment period. Pharmacological treatment for depression generally starts at the low dose, and the dosage is increased at regular intervals until the maximum effective dose is achieved. It is also essential that weekly or biweekly monitoring of the clinician be performed in order to adjust the treatment dose of the patient.
Psychoanalytical treatment of patients involves a comprehensive understanding of both psychological concepts and specific cultural features of the client. The qualities of kindness, forgiveness and togetherness are among the several general features of individuals. These concepts are imperative to the success in the psychoanalysis of clients because these issues provide differential interpretation and consequently, and serve as a basis for the design of personalized treatment and therapy of category of clients. An individual cherishes the concept of family, with each member playing a specific role in the client’s maturation and psychological development. These types of clients strongly associate their past, present and future situations with their values, morals and priorities. This includes the importance of keeping one’s family intact, in terms of residence, career and reputation.
Peer support is considered as an effective form for of counseling, especially in cases when the patient has been determined to have special needs such as sharing her emotions with other individuals. Peer support incorporates personal interactions and encouragement that are custom-made to the patient’s healing rate and level of improvement. In addition, peer support allows a supporter or peer to determine whether the patient is able to grasp the subject through a feedback mechanism. Should there be a need to correct or encourage a patient, sufficient time is allowed because peer support is basically a personal method of counseling. Another feature that facilitates psychotherapy through peer support is that this method involves emotional involvement and it is easier for both peer supporter and the patient to determine whether the interaction is productive or not. Patients are also given the chance to proceed at their own paces and not feel any intimidation from other patients that may be present in group counseling.
Peer support is generally classified based on the age range of the peer supporter and the patient. Peer support thus pertains to the counseling of a patient who is at the same age range as that of the peer supporter. On the other hand, cross-age counseling pertains to the form of personal instruction that involves an older supporter and a younger patient (Schneider and Barone, 1997). Peer support has caught the interest of clinicians and psychoanalysts as well because its practice suggests that the age difference between peer supporter and patient is not the major criteria for an effective counseling. Interestingly, it has also been observed that younger supporters reap more positive results in counseling than older counselors (Luca and Clarkson, 2002). One plausible reason for such discrepancy is that young counselors or peer supporters can relate to the problems and difficulties that patients encounter during their illness and thus they can immediately provide aid and other helpful hints that would show the patient how to approach medical disorders and issues. In addition, the same age range of both counselor or supporter and patient lessens the intimidation of the patient and allows them to approach their counselor or supporter without the feeling of embarrassment.
Another interesting observation regarding peer support is that patients have a capacity to sense whether the patient or peer is experiencing difficulty with a certain issue related to post partum depression (Fuchs et al., 2002). Such sensitivity is detected by simple nonverbal actions and thus this capacity is far more beneficial in assisting patients in their healing process. Difficulties in coping with motherhood among patients with post partum depression are often neglected by older counselors and supporters and they have no other method to determine if a patient is struggling in her condition unless they see that their post partum depression has worsened after a couple of weeks or months. It has been observed that peer supporters who earlier struggled during and after their pregnancy are more patient with post partum depression patients because they could understand what the patient is personally and actually experiencing. On the other hand, cross-age counselors carry high expectations from their patients and this lack of empathy further cause issues in the patient’s healing process (Gaustad, 1992).
The employment of peer support and counseling has augmented the atmosphere in psychotherapy clinics because these personal forms of therapy have reduced the sense of competition and intimidation among patients in a clinic. In addition, the personal support that the patients receive during sessions and counseling decrease the chances that the patient with post partum depression will encounter disapproval and discouragement in the actual motherhood setting (Eggers, 1995).
It has been reported that peer support or counseling benefits both parties, wherein the patient not only receives some form of encouragement and guidance from the peer supporter or counselor, but that the peer supporter or counselor herself is honed into the subject and becomes more specialized and adept with the counseling process (Allen, 1976). As it has long been observed that practice enhances one’s capabilities and the same philosophy may be applied to peer support or counseling. A peer supporter or counselor also needs to prepare his resource materials before the actual psychotherapy session itself and this preparation enhances the peer supporter’s retention of the material that she is to share with the patient. In addition, the peer supporter is also provided with an opportunity to integrate personal, medical and psychological information that will help both the supporter himself and the post partum depression patient in addressing issues that are related to post partum depression, pregnancy and motherhood. The communication skills of a peer supporter are also improved when she is subjected to counseling a patient on post partum depression. Not only is her knowledge of the subject area used in counseling, but she is also placed in a situation where interaction is the key aspect of counseling.
A mutual relationship is involved in peer support and counseling, wherein the self-esteem of the peer supporter increases when her patient learns and improves her mental condition and copes with her new condition of motherhood. Such meaningful and worthwhile effect on the peer supporter is priceless and this feeling helps them to continue what they do for the next patients that come in. However, caution should also be exercised between a peer supporter and a patient because not all combinations result in positive counseling. Peer supporters who are knowledgeable of the subject of post partum depression yet are not trained for counseling may not be effective enough in helping a patient. In these cases, peer supporters are impatient with the slowness of the patient’s pace for improvement and this may be coupled with different forms of punishment and penalties. There are also instances when a peer supporter would not accept a patient who is of her age range, although she is capable of helping a patient of any other age. Such selection of patients may thus influence which patients will be able to receive personal counseling and thus peer supporters should be trained to counsel almost any age of a patient, as long as the patient is willing to be counseled and interact with the peer counselor or supporter.
Methods
This research study will be conducted with prior ethics approval for the corresponding review boards of the state. In addition, the subjects who will participate in the interviews will be guaranteed confidentiality and anonymity. The research will be conducted in a very cautious manner as not to insult or affect any aspect of the study population, wherein if an approval of the immediate family was needed to be procured, it will be availed.
Subjects
The inclusion criteria for the participants of the study will be classified in order to fit into the bases of the study. The participants will be at least 18 years old, all female and positively diagnosed with post partum depression by an attending physician. The recruitment will conducted through invitations published in newspapers that an educational program specific for post partum depression will be held at a specific time, date and venue. The research will also be sensitive enough to adapt the project to the language barriers of the participants, in which announcements will be sent out in both English as well as Spanish so that all women may receive the information and possibly attend the educational program. In addition, as an incentive, the women who attended the educational program will be given free items such as lunch and door prizes. The research will also employ an informed consent form for every participant that will be included in the study.
The planned study population will be composed of at least 50 women who have been positively diagnosed with post partum depression. All of the participants will be checked in terms of residence within the state. The research will follow a control group strategy that will involve setting up of two groups composed of the 25 women. The experimental group will be subjected to an educational program on post partum depression and its associated peer support group, while the control group will be subjected to an educational program on proper nutrition. The assignment of educational programs that each participant would attend will be based on a random picking of names. This part of the experimental setup is designed in order for a random method of selection to be performed on the subjects and the participants themselves will not feel that each will be separated intentionally based on their friendships. After the appropriate educational programs, the subjects will be given questionnaires that will ask their perceptions on post partum depression and the associated peer support groups.
Measurement and instruments
The research will be conducted using three questionnaires that were translated into the appropriate language of each participant in order to rule out any language barriers. One questionnaire will contain questions regarding the demographics of the participants and the questions will be constructed using sixth-grade degree of comprehension, to assure proper understanding by the participants. Another questionnaire will involve a test, which will ask about the participants’ knowledge of post partum depression. The questions in this tool will constructed with consistency so that the participants can easily comprehend what was necessary to be completed. Thus, if a high score from the test is attained for a participant, this high score meant that the participant understood the educational program that she attended. A third questionnaire will involve the theory of the Health Belief Model, wherein a participant may respond to questions that reflect their perceptions on post partum depression. In addition, the questionnaire will also include questions on the benefits of the peer support and counseling on post partum depression. A 5-point scoring system will be employed in rating the answers of the test. Most of the questions will involve responses on whether the participant agreed or disagreed with particular aspects of post partum depression and its associated peer counseling tools.
Data analysis plan
All the information gathered from the questionnaires will be analyzed using the SPSS mathematical analysis software. The t-test statistical analysis will be evaluated using the significance level of 0.05 in order to determine whether the educational program on post partum depression and its associated peer support influenced the way these women behaved.
Analysis of the information gathered from the 3 questionnaires that were given to the participants will show whether the women were more knowledgeable of the mental disorder after attending the educational program that was provided. At the same time, the participants who attended the educational program on nutrition will also determine whether the peer support counseling did indeed help in the understanding and healing of the women who have been positively diagnosed with post partum depression. Any particular participants who still carry their old beliefs and conditions with regards to post partum depression and will regarded as cases that did not benefit from peer support group. The research study will also determine the perception of patients with post partum depression, as well as show whether peer support groups are really helpful in counseling the patients to feel better and to facilitate in their coping strategies for their new lifestyles as mothers. It is thus encouraging to know whether proper education of individuals helps in the understanding of post partum depression and to explain to these participants that peer counseling is another method for psychotherapy that is available to any patient who requests for it.
References
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