Postpartum Depresyonun Önlenmesinde Psikososyal ve Psikoeğitsel Müdahaleler İle Ebelik Bakımının Önemi

Yıl 2022, Cilt: 3 Sayı: 3, 44 - 56, 29.12.2022

Nilüfer Topkara , Nebahat Özerdoğan

Öz

Amaç: Bu derleme; postpartum depresyonun önlenmesine yönelik psikososyal ve psikoeğitsel müdahalelerin incelenmesi, postpartum depresyonun önlenmesinde ebelik bakımının öneminin vurgulanması, sağlık profesyonellerinin bu konudaki farkındalıklarının arttırılması amacıyla hazırlanmıştır.
Gereç-Yöntem: Araştırma Cochrane Library, Google Scholar, Medline/PubMed gibi arama motorlarında güncel literatür taraması yapılarak hazırlanmıştır.
Bulgular: Postpartum depresyon her yıl kadınların yaklaşık %10-15’ini etkileyen ciddi bir zihinsel sağlık sorunudur. Kadın yaşamına olumsuz etkileri, çocuğun gelişimsel sürecine ve geleceğine verdiği zararlar ile ailesel ve toplumsal sorunlara yol açması göz önünde bulundurulduğunda, postpartum depresyonun önlenmesi gereklidir. Bu kapsamda etkili ve erişilebilir önleyici müdahalelerin geliştirilmesi ve uygulanması büyük önem taşır. Bilişsel davranışçı terapi, ev ziyareti programları, farkındalık müdahaleleri, kişilerarası psikoterapi ve akran desteği postpartum depresyonun önlenmesinde kullanılabilen ve etkinliği kanıtlanmış olan psikososyal ve psikoeğitsel müdahale yöntemleridir.
Sonuç: Gebelik ve emzirme döneminde kadınların farmakolojik müdahalelerden kaçınmaları nedeniyle psikososyal ve psikoeğitsel müdahaleler postpartum depresyonun önlenmesinde tercih edilebilir ve etkili birer seçenek olabilir. Gebelikte ve postpartum dönemde kadınlarla yakın temas halinde olan ebelerin postpartum depresyon ve önleyici müdahaleler konusunda bilgi sahibi olması, bu bilgiyi antenatal ve postpartum dönemdeki takiplerinde kullanabilmesi önemli sorumluluklarındadır. Özellikle yüksek postpartum depresyonu riskine sahip olan bölgelerde sağlık profesyonellerinin hastalığın risk faktörleri ve belirtileri konusunda duyarlı olması, farkındalıklarının arttırılması önemlidir.

Anahtar Kelimeler

Postpartum depresyon, önleme, ebelik bakımı, psikososyal, psikoeğitim.

The Importance of Psychosocial and Psychoeducational Interventions and Midwifery Care in the Prevention of Postpartum Depression

Öz

Objective: This review; It has been prepared to examine psychosocial and psychoeducational interventions for the prevention of postpartum depression, to emphasize the importance of midwifery care in the prevention of postpartum depression, and to increase the awareness of health professionals on this issue.
Methods: The research was prepared by searching the current literature in search engines such as Cochrane Library, Google Scholar, Medline/PubMed.
Results: Postpartum depression is a serious mental health problem that affects approximately 10-15% of women each year. Considering the negative effects on women's life, the damages it causes to the developmental process and future of the child, and the fact that it causes familial and social problems, it is necessary to prevent postpartum depression. In this context, the development and implementation of effective and accessible preventive interventions is of great importance. Cognitive behavioral therapy, home visit programs, mindfulness interventions, interpersonal psychotherapy and peer support are psychosocial and psychoeducational intervention methods that can be used in the prevention of postpartum depression and whose effectiveness has been proven.
Conclusion: Because women avoid pharmacological interventions during pregnancy and lactation, psychosocial and psychoeducational interventions may be preferable and effective options in the prevention of postpartum depression. It is important for midwives, who are in close contact with women during pregnancy and postpartum period, to have knowledge about postpartum depression and preventive interventions, and to use this information in their antenatal and postpartum follow-ups. It is important for health professionals to be sensitive about the risk factors and symptoms of the disease and to increase their awareness, especially in regions with a high risk of postpartum depression.

Anahtar Kelimeler

Postpartum depression, prevention, midwifery care, psychosocial intervention, psychoeducation.

Kaynakça

• Adirim, T., & Supplee, L. (2013). Overview of the federal home visiting program. Pediatrics, 132(Supplement_2), S59-S64.
• Aktaş, M. C., Şimşek, Ç., & Aktaş, S. (2017). Etiology of postpartum depression: culture effect.
• Alpay, Ü., Aydoğdu, B. E., & Yorulmaz, O. (2018). Madde kullanımı olan yetişkinlerde farkındalık temelli müdahalelerin etkililiği: sistematik bir gözden geçirme. Addicta: The Turkish Journal on Addictions, 5(4), 721-746.
• Altin, G. E. (2012). Perinatal depresyon tedavisinde kişilerarası psikoterapi. Psikiyatride Güncel Yaklaşımlar, 4(2), 188-203.
• Balkaya, N. A. (2002). Postpartum dönemde annelerin bakim gereksinimleri ve ebe-hemşirenin rolü. Cumhuriyet Üniversitesi Hemşirelik Yüksekokulu Dergisi, 6(2), 42-9.
• Beck, A. T., & Haigh, E. A. (2014). Advances in cognitive theory and therapy: The generic cognitive model. Annual review of clinical psychology, 10(1), 1-24.
• Bilgiç, D., Dağlar, G., Özkan, S. A., & Kadıoğlu, M. (2015). Postpartum Depresyonda Tamamlayıcı ve Alternatif Tedaviler. Kadın Sağlığı Hemşireliği Dergisi, 2(2), 13-35.
• Brummelte, S., & Galea, L. A. (2016). Postpartum depression: Etiology, treatment and consequences for maternal care. Hormones and behavior, 77, 153-166.
• Carter, W., Grigoriadis, S., Ravitz, P., & Ross, L. E. (2010). Conjoint IPT for postpartum depression: literature review and overview of a treatment manual. American journal of psychotherapy, 64(4), 373-392.
• Cho HJ, Kwon JH, Lee JJ. Antenatal cognitive-behavioral therapy for prevention of postpartum depression: a pilot study. Yonsei medical journal. 2008; 49(4): 553-562. Christensen, H., & Marck, D. (2017). The efficacy of mindfulness based stress reduction (MBSR) for decreasing anxiety and depression among breast cancer survivors. Sch Physician Assist Stud, 16, 613.
• Cohen, J. S. (2010). Mindfulness and self-compassion in the transition to motherhood: a prospective study of postnatal mood and attachment. Columbia University.
• Cuijpers P, Brännmark JG, vanStraten, A. Psychological treatment of postpartum depression: a meta‐analysis. Journal of clinical psychology. 2008; 64(1): 103-118.
• Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. The Canadian Journal of Psychiatry, 58(7), 376-385.
• Dagli, E., Kul Uctu, A., & Özerdoğan, N. (2020). Sexual dysfunction in the postpartum period: Its relationship with postpartum depression and certain other factors. Perspectives in Psychiatric Care.
• Dennis, C. L. (2003). Peer support within a health care context: a concept analysis. International journal of nursing studies, 40(3), 321-332.
• Dennis, C. L., Hodnett, E., Kenton, L., Weston, J., Zupancic, J., Stewart, D. E., & Kiss, A. (2009). Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial. Bmj, 338.
• Dhillon, A., Sparkes, E., & Duarte, R. V. (2017). Mindfulness-based interventions during pregnancy: A systematic review and meta-analysis. Mindfulness, 8(6), 1421-1437.
• Duncan, L. G., Cohn, M. A., Chao, M. T., Cook, J. G., Riccobono, J., & Bardacke, N. (2017). Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison. BMC pregnancy and childbirth, 17(1), 1-11.
• Durmazoğlu, G., Oktay, A. K., Toksoy, S., Serttaş, M., Göçmen, F., Bezirgan, S., & Tatarlar, A. (2016). Postpartum Depresyonun Hemşire ve Ebeler Tarafından Öngörülebilmesi. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi, 19.
• Erdem, Ö., & Bucaktepe, P. G. E. (2012). Postpartum depresyon görülme sıklığı ve tarama yöntemleri. Dicle Tıp Dergisi, 39(3), 458-461.
• Fisher, C., Hauck, Y., Bayes, S., & Byrne, J. (2012). Participant experiences of mindfulness-based childbirth education: a qualitative study. BMC Pregnancy and Childbirth, 12(1), 1-10.
• Gao, L. L., Chan, S. W. C., & Sun, K. (2012). Effects of an interpersonal-psychotherapy-oriented childbirth education programme for Chinese first-time childbearing women at 3-month follow up: randomised controlled trial. International journal of nursing studies, 49(3), 274-281.
• Gillis, B. D., Holley, S. L., & Parish, A. L. (2019). Implementation of a perinatal depression care bundle in a nurse-managed midwifery practice. Nursing for Women's Health, 23(4), 288-298.
• Hall, H., Beattie, J., Lau, R., East, C., & Biro, M. A. (2015). The effectiveness of mindfulness training on perinatal mental health; a systematic review. Integrative Medicine Research, 4(1), 125.
• Hirst, K. P., & Moutier, C. Y. (2010). Postpartum major depression. American family physician, 82(8), 926-933.
• Koçak, D. Y, Büyükkayacı, D.N. (2016). Postpartum depresyon ve hemşirelik yaklaşımı. Psikiyatri/Nöroloji/Davranış Bilimleri Dergisi Sempozyum, 9: 21-6.
• Lakey, B., & Cohen, S. (2000). Social support theory and measurement.
• Lever Taylor, B., Cavanagh, K., & Strauss, C. (2016). The effectiveness of mindfulness-based interventions in the perinatal period: a systematic review and meta-analysis. PloS one, 11(5), e0155720. Lindahl, V., Pearson, J. L., & Colpe, L. (2005). Prevalence of suicidality during pregnancy and the postpartum. Archives of Women’s Mental Health, 8(2), 77-87.
• Mufson, L. H., Dorta, K. P., Olfson, M., Weissman, M. M., & Hoagwood, K. (2004). Effectiveness research: Transporting interpersonal psychotherapy for depressed adolescents (IPT-A) from the lab to school-based health clinics. Clinical Child and Family Psychology Review, 7(4), 251-261.
• Norhayati, M. N., Hazlina, N. N., Asrenee, A. R., & Emilin, W. W. (2015). Magnitude and risk factors for postpartum symptoms: a literature review. Journal of affective Disorders, 175, 34-52.
• O'Hara, M. W. (2009). Postpartum depression: what we know. Journal of clinical psychology, 65(12), 1258-1269.
• Özcan, Ö., & Çelik, G. G. (2017). Bilişsel davranışçı terapi. Türkiye Klinikleri, 3(2), 115-120.
• Patel, M., Bailey, R. K., Jabeen, S., Ali, S., Barker, N. C., & Osiezagha, K. (2012). Postpartum depression: a review. Journal of health care for the poor and underserved, 23(2), 534-542.
• Perinatal Services BC, 2011 perinatal services bcobstetrics guideline 20 postpartum nursing care pathway march 2011. http://www.perinatalservicesbc.ca/Documents/Guidelines.Standards/Maternal/PostpartumNursingCare-Pathway.pdf. Erişim: 19.11.2021).
• Sadat, Z., Abedzadeh-Kalahroudi, M., Atrian, M. K., Karimian, Z., & Sooki, Z. (2014). The impact of postpartum depression on quality of life in women after child's birth. Iranian Red Crescent Medical Journal, 16(2).
• Shields, N., Reid, M., Cheyne, H., Holmes, A., McGinley, M., Turnbull, D., & Smith, L. N. (1997). Impact of midwife-managed care in the postnatal period: an exploration of psychosocial outcomes. Journal of Reproductive and Infant Psychology, 15(2), 91-108. Slomian, J., Honvo, G., Emonts, P., Reginster, J. Y., & Bruyère, O. (2019). Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. Women's Health, 15, 1745506519844044.
• Sockol, L. E. (2015). A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression. Journal of Affective Disorders, 177, 7-21.
• Sockol, L. E. (2018). A systematic review and meta-analysis of interpersonal psychotherapy for perinatal women. Journal of affective disorders, 232, 316-328.
• Sockol, L. E., Epperson, C. N., & Barber, J. P. (2011). A meta-analysis of treatments for perinatal depression. Clinical psychology review, 31(5), 839-849.
• Sockol, L. E., Epperson, C. N., & Barber, J. P. (2014). The relationship between maternal attitudes and symptoms of depression and anxiety among pregnant and postpartum first-time mothers. Archives of women's mental health, 17(3), 199-212.
• Tel, H. (2018). Effects of home visits and planned education on mothers’ postpartum depression and quality of life. Journal of Clinical and Experimental Investigations, 9(3), 119-125.
• van Zoonen, K., Buntrock, C., Ebert, D. D., Smit, F., Reynolds III, C. F., Beekman, A. T., & Cuijpers, P. (2014). Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions. International journal of epidemiology, 43(2), 318-329.
• Werner, E. A., Gustafsson, H. C., Lee, S., Feng, T., Jiang, N., Desai, P., & Monk, C. (2016). PREPP: postpartum depression prevention through the mother–infant dyad. Archives of women's mental health, 19(2), 229-242.
• WHO (2007) WHO Reproductive Health Library; Geneva: World Health Organization (http://apps.who.int/rhl/pregnancy_childbirth/care_after_childbirth/mgcguide/en/ Erişim: 17.09.2021). Wisner, K. L., Sit, D. K., McShea, M. C., Rizzo, D. M., Zoretich, R. A., Hughes, C. L., ... & Hanusa, B. H. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA psychiatry, 70(5), 490-498.
• World Health Organization. (2009). Women and health: today's evidence tomorrow's agenda. World Health Organization.
• Yim, I. S., Tanner Stapleton, L. R., Guardino, C. M., Hahn-Holbrook, J., & Dunkel Schetter, C. (2015). Biological and psychosocial predictors of postpartum depression: systematic review and call for integration. Annual review of clinical psychology, 11, 99-137.