Postpartum Depression and Anxiety Disorders in Women

Pregnancy is a process of bringing a new life into the world. In most situations it is perceived as a joyous time filled with happiness, excitement, and anticipation. The focus is on this tiny human being grown in the womb and who will soon fill lives with love, joy, and happiness. Unfortunately, though, there are also moments pregnancy can bring about anxiety and depression. Instead of moments of excitement and joy, there are moments filled with worry, panic, and sadness. When someone suffers from depression and/or anxiety there is the possibility of those symptoms increasing during a pregnancy or all of the sudden becoming prevalent during a pregnancy. “Mood and Anxiety Disorders in Pregnant and Postpartum Women” is a reality needing attention in the medical field. It is important for medical personnel to be able to identify and treat women who may be at risk for anxiety and depression while pregnant or post-partum.

Typically, women seek medical treatment when they become pregnant and that medical treatment lasts through the pregnancy and, typically at times beyond the pregnancy. Being a nurse in the medical field working with women who are pregnant are in a wonderful position to assist in meeting not only the medical needs, but the emotional needs of their patients. As stated in the AWONN position statement, “All pregnant and post-partum women should be screened for mood and anxiety disorders”. The article states there are approximately ten to twenty percent of women who experience some type of mood disorder during their pregnancy and/or post-partum period. “As a result, these conditions are the most common complication of childbirth”. There are physical and emotional symptoms women who are suffering from anxiety and depression deal with, which could cause long term effects on themselves, and also their unborn child. Research is an ever-evolving science and there have been studies regarding depression in pregnant and post-partum women. It is very important for nurses to be aware of the signs and symptoms of anxiety and depression and are able to identify signs and offer education, support, and options for an expecting or new mother. Research is important throughout the process of treating anxiety and depression. Unfortunately, “Research is limited regarding treatment for perinatal mood disorders other than depression” and research “…regarding treatment of perinatal anxiety disorders is in its beginning stages”.

“AWONN supports the implementation of legislation, polices and public health initiatives that help raise awareness, remove stigma, reduce barriers to treatment, and expand research related to perinatal mood and anxiety disorders”. This is important as the emotional and mental well-being of patients impacts not only the patients we treat as expecting mothers but also the unborn child and other family members as well. Anxiety and depression are still relatively new topics that patients are becoming comfortable talking about and acknowledging as a part of their lives. Not only does depression and anxiety affect the patient, it can have medical and emotional effects on the fetus and even the family members can also suffer effects. As a nurse, being able to implement a screening and understanding possible concerns regarding anxiety and depression in the patient will be able to make the nurses job more effective. The nurse is typically the person who will spend the most time with the patient and who the patient will learn to trust and become very comfortable with. Being able to assess possible depression and anxiety can give the opportunity to provide education, options, and information for other medical staff. Implementations of risk factor screenings are important for the entire childbearing families, for their health and safety.

Postpartum depression can affect any and all of the mother who are carried a child. Postpartum depression can be more common if the mother has any prior anxiety, but that does not necessarily mean anything. Any woman, any race, and social class can and may be affected by postpartum depression. Many studies have been conducted regarding the impact of post-partum depression (PPD) and depression and the roles they play on a patient, the unborn child and other family members. When depression is a concern, there is a large continuum of symptoms needing to be assessed. From withdrawal and lack of contact with the baby to suicidal or homicidal thoughts and everywhere in between. The Epinburgh Postnatal Depression Scale (EPDS) is a screening tool often used to assess those depressive symptoms. Although this scale is a good assessment for depression, “there are questions whether a total score or a subscale score of the EPDS is most accurate in detecting anxiety”. In many situations of utilizing the EPDS for screening, anxiety is not indicated. There has been recommendations of using the GAD-7 as a separate screening but “there is no one standard recommendation or screening tool”.

It is obvious there are limited tools to screen for depression and especially for anxiety in pregnant and post-partum women. This is an issue as studies have shown there are detrimental risk factors for babies whose mother suffers from depression and/or anxiety. “A recent report from the Centers for Disease Control and Prevention (CDC) estimates that 1 in 9 women experience symptoms of postpartum depression. The prevalence of anxiety disorders during pregnancy and the early postpartum period is not well-known, but studies suggest that perinatal anxiety is much more prevalent than depression”. There are many risk factors associated with untreated depression and anxiety. “Various studies indicate that women who experiences clinically significant anxiety symptoms during pregnancy are more likely to have preterm labor and low birth weight infants, as well as other complications, including pre-eclampsia”. There are concerns with post-partum anxiety and the mother’s ability or desire to want to bond with her child which can also cause long term effects. “A recent narrative review describes numerous studies that illustrate that negative effects of postpartum anxiety on bonding, breastfeeding, infant temperament, early childhood development, and conduct disorders”. As a nurse who spends the majority of time with a mother to be, it is vitally important to be able to appropriately assess, monitor and support her during her pregnancy and after to effectively help her through any depression or anxiety she might be having. Nursing practices could be improved with the development of better screenings to assess depression and anxiety and be able to possibly prevent long term issues for the mother and the baby. “Maternal depression is a serious mental illness that not only concerns the affected mother, but also impacts the fetus and child”.

Many studies have been conducted regarding the impact of postpartum depression (PPD), depression and the role they play on the patient, the unborn child and other family members. When depression is a concern, there is a large continuum of symptoms needing to be assessed. From withdrawal and lack of contact with the baby to suicidal or homicidal thoughts, and everywhere in between. The Epinburgh Postnatal Depression Scale (EPDS) is a screening tool often used to assess those depressive symptoms. Although this scale is a good assessment for depression, “there are questions whether a total score or a subscale score of the EPDS is most accurate in detecting anxiety”. In many situations of utilizing the EPDS for screening, anxiety is not indicated. There had been recommendations of using the GAD-7 as a separate screening but “there is no one standard recommendation or screening tool”. However, it has not been determined whether or not the GAD-7 is the best indication for anxiety needing to be treated in pregnancy and post-partum women. “GAD specific studies in the perinatal population remain sparse; however, several studies have addressed the impact of anxiety symptoms not diagnosed as GAD”. It is vital to be able to assess and treat anxiety as much as depression as there have been studies conducted making a correlation of effects on the baby due to the anxiety level of the mother. According to the Journal of Women’s Health, studies were conducted on pregnant women who suffered from anxiety. They found that a post-natal mother who suffered from anxiety would be withdrawn from their infant and have less interaction. Infants also displayed effect from their mother as they would also be more withdrawn. The article found, a “statistically signification association between maternal anxiety during pregnancy and an increased risk of preterm birth and low birth weight”. The article further states that extensive studies indicate a mother to be who deal with anxiety carries a risk for their baby to have difficulties with milestones in growth and development. “Consequences include: negative infant behavior reactivity at 4 months, difficult infant temperament at 4/6 months, lower mental development at age 2 years, negative affectively at 2 years, lower inhibitory controls in girls, and lower visuospatial working memory in boys and girls aged 6-9 years”. To conclude, not only would being able to better assess and treat anxiety and depression help, the mother, it would also help in decreasing possible long-term effects on the newborn.

The Joint Commission safety goal that correlates with Mood and Anxiety disorders in Pregnant and Postpartum Women, would be the safety goal of “Improve the effectiveness of communication among caregivers”. This safety goal relates to my topic on postpartum and depression because in order for the women who are suffering from depression and anxiety to be open and honest with the caregivers, especially us nurse, we need to improve how we communicate with our patients. As stated, before in this paper, the way healthcare professionals can effectively treat depression and anxiety in pregnant and postpartum, professionals first need to be able to effectively communicate and build an open and trusting relationship with the patients. This allows the patient to have faith and trust, as the caregiver, and will be more willing to open up and discuss the things that are truly bothering them, such as depression and anxiety.

Being able to effectively assess and treat depression and anxiety in pregnant and postpartum women would greatly benefit the women, as well as, the infant. Undetected depression and anxiety effects both mother and baby in negative ways. What should be thought of as a joyous time, when a baby is born, is filled with sadness and worry. As a medical provider, it is important to have tools available to help in assessing anxiety and depression. A nurse spends a great amount of time with their patients and being able to have better assessment tools and the proper education and knowledge to assess “Mood and Anxiety disorders in Pregnant and Postpartum Women” would be extremely beneficial. As a nurse, one would be able to do a more thorough job and the likelihood of treatment would increase and better results of less unnecessary outcomes of postpartum depression would affect our patients.