Intervention
Effectiveness of a discharge education program in reducing the severity of postpartum depression: A randomized controlled evaluation study

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Abstract

Objective

The effectiveness of a hospital discharge education program including information on postnatal depression was evaluated to reduce psychological morbidity after childbirth.

Methods

A randomized controlled trial (RCT) was conducted in a regional hospital in Taipei. Two hundred first-time mothers agreed to take part and were randomly allocated to an intervention group (n = 100) or control group (n = 100). The intervention group received discharge education on postnatal depression provided by postpartum ward nurses. The control group received general postpartum education. The main outcome measure was the Edinburgh Postnatal Depression Scale (EPDS) administered by postal questionnaire at six weeks and three months after delivery.

Results

Women who received discharge education intervention on postnatal depression were less likely to have high depression scores when compared to the control group at three months postpartum.

Conclusion

A discharge educational intervention including postnatal depression information given to women during the postpartum stay benefits psychological well-being.

Practice implications

A postpartum discharge education program including information on postnatal depression should be integrated into postpartum discharge care in general practice.

Introduction

Postpartum depression (PPD) or postnatal depression is a mental and behavioral disorder associated with the puerperium, typically commencing within six weeks of delivery. Women with PPD often experience episodes of irritability, guilt, exhaustion, anxiety, sleep disorders and somatic symptoms which have a disabling effect on mothers, children and families of sufferers [1], [2]. Estimates of the incidence of PPD vary widely, depending on the measuring instruments used, the criteria for diagnosis employed, the time of assessment and the characteristics of the women studied. O’Hara and Swain used a meta-analysis of 59 studies to identify a 13% prevalence of PPD [3]. While the cause of PPD is multi-factorial psychosocial elements also play an important role. Thirteen significant predictors were revealed: prenatal depression, self-esteem, childcare stress, prenatal anxiety, life stress, social support, marital relationship, history of previous depression, infant temperament, maternity blues, marital status, socioeconomic status, and unplanned pregnancy [4].

Few studies have investigated the effect of support on women's psychological health during the postpartum period. Elliott et al. found that a prenatal psychosocial intervention was successful in reducing the postnatal depression for a vulnerable parents group, especially for the first-time mothers [5]. Zlotnick et al. provided the evidence that standard antenatal care plus interpersonal psychotherapy was effective in reducing the occurrence of major depressive disorder among financially disadvantaged women during three months postpartum [6]. Heh and Fu found that women who received information about PPD six weeks after childbirth experienced lower Edinburgh Postnatal Depression Scale (EPDS) scores at three months postpartum [7], whereas Webster et al. found the educational interventions in the prenatal period unsuccessful [8]. In two studies by Hayes, prenatal education intervention for primiparous women did not reduce postnatal depression. These results challenge the tenets that health education in childbearing women can reduce depression and that antenatal education intervention can endure into the postnatal period [9], [10]. No consistent findings have been reported regarding intervention studies on PPD.

Nearly half of PPD affected women are not diagnosed [11]. Symptoms of PPD are often difficult to recognize and may mimic the physiological changes that happen during and after delivery. Many new mothers are uncomfortable discussing depressive symptoms because of shame or stigma [12]. Health professionals need to be concerned about postpartum women's health, especially in view of the fact that 42.6% of Taiwanese postpartum women were reported to be suffering from postnatal depression by using the cut-off scores of EPD ≧12 [13]. Effective interventions for postnatal depression need to be initiated as early as possible and to match the individual mother's needs [14]. Although postpartum hospitalization is short, education given to women about self and newborn care is still very important before discharge. In Taiwan, most of the discharge plans include physical care for postpartum women and newborn babies. Mentioning potential postnatal depression and offering women the chance to discuss their psychological well-being with a primary care nurse is rare. The purpose of this study was to investigate an education discharge plan that included information about postnatal depression to reduce the severity of depression after childbirth.

The experimental group that received discharge education about postnatal depression provided by postpartum ward nurses during hospitalization after delivery would experience less depression at six weeks and three months postpartum respectively than the control group who received the usual education program.

Section snippets

Intervention

The educational intervention was developed from an extensive review of the research literature and adapted to the needs of the postpartum women. The education program included a printed three-page booklet containing the incidence, symptoms, causes, and management information about the PPD developed by Heh and Fu [7]. Women in the experimental group received PPD informational booklet plus discussed it with primary care nurses on the second day after delivery.

Recruitment and data collection

The criteria for recruitment of

Results

The two groups of women were similar on the demographic variables. No significant differences were found in age (29.2 ± 3.4 vs. 29.4 ± 3.2), education, family income, working status during their pregnancy, the plan of the pregnancy, newborn's gender, type of feeding, and the first month of the postnatal experience (p > 0.05). The response rate was high, ranging from 83% of the control group responded while 92% of the intervention group responded six weeks postpartum. Nineteen out of 92 (21%) in the

Discussion

Women who received discharge education program including content about depression after childbirth experience fewer depressive symptoms. It is appropriate to give information about postnatal depression to women during hospitalization after delivery. Women are more receptive to this information at that time than before childbirth [19]. These results also support the statement that information about depression provided after delivery, is an effective in reducing this disorder [7]. Providing

Acknowledgement

The research project was support by a grant from Fu-Jen Catholic University, Taiwan.

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