Knowledge And Perception About Post-Partum Psychosis Among Nurse-Midwives

Project and Seminar Material for Nursing (Science)

Abstract

+Despite growing awareness of the impact of maternal depression on the health and well‐ being of children, mothers, and health care, providers continue to ignore mental disorders in the perinatal period. Since nurses and midwives are in constant contact with women during pregnancy and during the first year after birth, they need to be able to recognize mental disorders and educate pregnant women and parents about postpartum depression. The aim of this study was to study the knowledge of nurses about postpartum depression in order to develop quality postpartum care among nurses and midwives in Nigeria. A quantitative research method was applied. An electronic questionnaire was used to collect data. The participants consisted of 212respondents. The data were analyzed using descriptive statistics. The results of the study showed that in Nigeria, there are gaps in the knowledge of midwives and nurses about the prevalence, assessment, and treatment of depression in the prenatal and postpartum periods, and almost 90% of Nigeria respondents did not attend additional training courses on postpartum depression. It is necessary to increase the level of education by motivating self‐learning, organizing a new journal club and additional education for current nurse practitioners. To close these gaps in knowledge, a strategy for training midwives and nurses in perinatal mental health and symptom screening needs to be developed. It is also necessary to develop clinical protocols for assessing the mental state of women in the perinatal period. The application of these protocols by practicing midwives in Nigeria will bring medical practice for assessing mental health in the perinatal period closer to international standards, making healthcare better and more cost‐effective.

Chapter One

Introduction

1.1 Background to Study

Maternal mental health problems are a serious public health problem worldwide. Currently, researchers estimate that up to 18% of women worldwide experience postpartum depression (PPD).Postpartum depression affects the mother’s daily work, social relationships, and child development. (Hahn‐Holbrook, Cornwell‐ Hinrichs, & Anaya 2018.)

Despite growing awareness of the effects of maternal depression on the health and well‐being of children and mothers, healthcare providers continue to ignore mental disorders in the perinatal period. Since nurse-midwives and midwives constantly communicate with women during pregnancy and the first year after birth, they need to be able to recognize mental disorders and educate pregnant women and parents about postpartum depression. (Carroll, Downes, Gill, Monahan, Nagle, Madden, & Higgins 2018.)

Midwives and nurse-midwives are ideal not only for educating women about mental health but also for screening for mental disorders in the perinatal period. Evidence suggests that there are barriers to identifying mental disorders and addressing women’s mental health problems during the perinatal period. These barriers are related to organizational factors such as high workload, time pressure, and lack of knowledge and skills regarding PPD (Higgins, Downes, Monahan, Gill, Lamb, & Carroll 2018.)

The purpose of this study is to study nurse-midwives and midwives’ knowledge of PPD and the competencies of midwives and nurse-midwives to identify and treat PPD in the Nigeria

1.2 Statement of Problem

The potential effects of Puerperal psychosis involve the physical, mental, and social health of the mother, child, and family. The financial healthcare burden of treating the ailment is significant. Research done by Dagher, McGovern, Dowd and Gjerdingen (2012) showed that health care spending is considerably higher in women with psychosis. Puerperal psychosis can contribute to poor mother-child bonding, difficulty with breastfeeding, and child abuse or neglect. One of the most concerning consequences of Puerperal psychosis is the risk of suicide and infanticide. As described in the DSM-IV (American Psychiatric Association, 2013). Symptoms that are common in Puerperal psychosis -onset episodes include fluctuation in mood, mood liability, and preoccupation with infant well-being, the intensity of which may range from over concern to frank delusions. The presence of severe ruminations or delusional thoughts about the infant is associated with a significantly increased risk of harm to the infant. In a study conducted by Lucic (2013) cited O’Hara, Zekoski, Philipps & Wright (1990) found that the prevalence of nonpsychotic mental disorders does not increase in the postpartum period as compared to the general population. In that study, the incidence of Puerperal psychosis was found to be 10.4%, which is not significantly higher than the rate of depression experienced by non-childbearing women. O’Hara et al (1990) cited in Lucic (2013) summarize studies that have investigated the prevalence of depression across the general population and it ranges from 8% to 23%. Therefore this study evaluated perceived causes of Puerperal psychosis among Post Cesarean section patients in general hospital, Wushishi, Niger State. Nigeria.

1.3 Purpose of Research

The purpose of the research is to examine the knowledge of nurse-midwives and midwives about postpartum depression to develop quality postpartum care among nurse-midwives and midwifes in Nigeria

Aims and objectives:

Examine the knowledge of nurse-midwives and midwives about the prevalence, assessment, and treatment of postpartum depression.
Develop recommendations for the development of quality mental health care in the perinatal period.

1.4 Research Question:

What is the level of nursing knowledge about postpartum depression?

Chapter Five

Discussion of Findings and Conclusion

5.1 Discussion of Findings

This study was designed to determine the current level of knowledge of Kazakh midwives and nurse-midwives about PPD. A study on this topic was conducted for the first time in Nigeria The construction of the questionnaire was based on a study by Jones and colleagues (2011).

The research question of this study provided a solid foundation for research. The level of knowledge of nurse-midwives about postpartum depression can be said to be low. For example, an objective knowledge and perception of the knowledge of Kazakh midwives about antenatal depression and PPD showed that they lacked knowledge about the prenatal and postnatal mental health of their patients. Similar results were reported by Jones and colleagues (2011) and Chrzan‐Detkos and Walczak‐Kozlowska (2020), who also used the “Knowledge Test on Antenatal and Postpartum Depression” among Keyan and Ghana midwives.

Kazakh respondents correctly answered an average of 41.3% of questions about antenatal and postpartum depression. These figures are lower than those of the Keyan (67.1%) (Jones et al. 2011) and Ghana midwives (61.4%) (Chrzan‐Detkos & Walczak‐Kozlowska 2020). In this study, midwives had more knowledge about antenatal depression (40%) than about PPD (28.1%) while Keyan (Jones et al.2011)and Ghana respondents had more knowledge about PPD (62.9% and 67%, respectively) than about antenatal depression (70.7% and 50%, respectively) (Chrzan‐ Detkos & Walczak‐Kozlowska 2020).

This study confirms that the majority of respondents (80.1%) know that psychological illnesses, in particular depression and anxiety, are usually observed both in the prenatal and postpartum periods. This result is similar to Jones and colleagues (2011) and Chrzan‐Detkos and Walczak‐Kozlowska (2020), who reported that most Keyan (86.9%) and Ghana (89.2%) respondents knew that depression and anxiety could occur in the antenatal and postpartum periods.

The current survey showed that only a third of Nigeriai midwives (32.1%) correctly indicated that the proportion of pregnant women who met the diagnostic criteria for depression was approximately 10–20%. This result showed that Nigeriai respondents are less aware of the frequency of PPD than in similar studies by Jones and colleagues (2011) and Chrzan‐Detkos and Walczak‐ Kozlowska(2020), which reported that half of the respondents (50.4% and 59.5%, respectively) correctly indicated the proportion of pregnant women who met the diagnostic criteria for depression.
In this study, Nigeriai respondents had a limited understanding of the risks associated with antenatal depression. More than a quarter of respondents (28.3%) were unaware of some adverse outcomes associated with antenatal depression, including gestational hypertension, preeclampsia, and spontaneous abortion. This result is consistent with a similar study by Jones and colleagues (2011), which also reported that more than a quarter of respondents (28.6%) were unaware of these adverse outcomes.

The majority of Nigeriai respondents (87.7%) underestimated the percentage of women suffering from depression during pregnancy who subsequently try to commit suicide. This result is consistent with a similar study by Jones and colleagues (2011) and Chrzan‐Detkos and Walczak‐Kozlowska (2020), which also reported that the majority of respondents (98.3% and 89.2%, respectively) underestimated this threat.

This study showed that only a bit over quarter of respondents (27.4%) correctly indicated the most common reason for the lack of adequate care for pregnant women with depression. This result is clearly worse than that in a study by Magdalena and colleagues (2020), which reported that 65.8% of Ghana midwives knew the most common cause of depression in pregnant women who did not receive adequate care.

Our research showed that more than three‐quarters (85.8%) of Nigeriai participants underestimated the proportion of mothers who suffered from maternal blues. Our findings have some differences with those of Jones and colleagues (2011) and Chrzan‐Detkos and Walczak‐Kozlowska (2020), which reported that only 25.8% of Keyan respondents and 47.7% of Ghana respondents underestimated the proportion of mothers who survived maternal blues. Almost half of Nigeriai respondents (55.2%) incorrectly indicated the recommended treatment for “postpartum sadness” or “sad mother syndrome”. This is a remarkably poor result compared to the results of Chrzan‐Detkos and Walczak‐Kozlowska (2020), which reported that only 12.6% of respondents incorrectly indicated the recommended treatment for “postpartum sadness” or “sad mother syndrome”.

When assessing knowledge of postpartum depression, it was found that three quarters of Nigeriai respondents (80.2%) were unaware of the most common PPD onset period. This result is consistent with similar studies by Jones and colleagues (2011) and Chrzan‐Detkos and Walczak‐Kozlowska (2020), which reported that the majority of Keyan respondents (71.0%) and Ghana respondents (64%) were unaware of the initial PDP period.

Despite the large number of published studies on PPD, midwives and nurse-midwives tend to underestimate the prevalence of PPD. Study showed that only a little over third of respondents (38.2%) indicated the correct frequency of mothers experiencing postpartum depression. This indicator was worse than that in the studies of Jones and colleagues (2011) and Chrzan‐Detkos and Walczak‐Kozlowska (2020), who reported that 55.6% of Keyan and 64.9% of Ghana midwives knew that the proportion of mothers suffering from PPD was approximately 15%. Of the Nigeriai participants, 63.7% knew that a diagnosis of PPD requires a persistent bad mood for more than two months. This result is consistent with a similar study by Chrzan‐Detkos and Walczak‐Kozlowska (2020).

Most midwives do not have adequate knowledge of screening tools for assessing perinatal depression, including the Edinburgh Postpartum Depression Scale (Jones et al. 2011; Chrzan‐Detkos and Walczak‐Kozlowska (2020). The results of this study showed that a quarter of Nigeriai respondents (25.9%) reported that the Edinburgh postpartum depression scale was able to fully assess the symptoms of psychotic depression. Our results have some differences from the results of Jones and colleagues(2011) and Chrzan‐Detkos and Walczak‐Kozlowska (2020), which reported that almost half of Keyan respondents (43.8%) and Ghana respondents (42.3%) incorrectly answered that this diagnostic tool for postpartum depression was able to fully assess the symptoms of psychotic depression. The Edinburgh Postpartum Depression Scale is recommended as a screening when used by medical personnel who do not directly provide psychological and/or psychiatric services. A high score in EPDS is an indication for referring a woman to a specialized assessment. (Chrzan‐Detkos & Walczak‐Kozlowska2020.)

In the study, two quarters of Nigeriai respondents (69.8%)correctly identified the symptoms of postpartum depression. This result is 20% worse than similar knowledge among Ghana respondents (90.1%) in a study by Magdalena and colleagues (2020).

In our study, only 17.9% (38) of respondents reported that women who had postpartum depression in a previous pregnancy are more likely to develop postpartum depression in a subsequent pregnancy. This result showed that Kazakh respondents were very much less aware that a history of depression was a PPD risk factor than Ghana respondents in a study by Chrzan‐Detkos and Walczak‐Kozlowska (2020).These data are consistent with those of Chrzan‐Detkos and Walczak‐ Kozlowska (2020). Less than half of Kazakh recommended treatment respondents (41%) correctly indicated that psychotherapy and antidepressants are the recommended treatment for moderate to severe PPD, whereas Ghana respondents in a study by Chrzan‐Detkos and Walczak‐Kozlowska (2020) and Keyan respondents in a study by Jones and colleagues (2011) are more knowledgeable in this matter (74.8% and 68%, respectively). In study, only a little over third of respondents (38.2%) knew that mothers could breast‐feed while taking antidepressants. This result is consistent with data from Jones and colleagues (2011) whereas Ghana respondents in a study by Chrzan‐Detkos and Walczak‐Kozlowska (2020), were more knowledgeable in this matter (64.0%). Many midwives probably believe that taking antidepressants during pregnancy and the postpartum period is not advisable, although there is an official list of drugs that can be taken during this period (Rai, Pathak, & Sharma 2015). For example, during the postpartum period, sertraline is considered a safe drug for lactating women, since its concentration in breast milk is low (Pinheiro, Bogen, Hoxha, Ciolino, & Wisner 2015).

Study revealed that almost 90% of Nigeriai respondents did not take advanced training courses in PPD. According to Carroll and colleagues (2018), only a third of Irish midwives never received perinatal mental health education.In general, results showed that Nigeriai midwives and nurse-midwives have knowledge gaps in various aspects of PPD.
The limitation of this study is a limited number of participants, which was due to limited resource provision. The research was conducted among medical workers working in hospitals in the administrative zone of the Public Association “Aktobe Association of Medical Workers”. For this reason, the results cannot be applied to the entire population of nurse-midwives and midwives. It would be more useful and generalized if this study were conducted throughout the country to determine the knowledge and relationships of a wider selection of midwives and nurse-midwives in more institutions and regions than this study could cover.

5.2 Conclusions

This study showed that there are gaps in the knowledge of midwives and nurse-midwives in Nigeria regarding the prevalence, assessment, and treatment of depressive conditions in the prenatal and postpartum periods. To address these gaps, a strategy needs to be developed for training midwives and nurse-midwives in perinatal mental health and screening for symptoms of perinatal depression. It is also necessary to develop clinical protocols for assessing the mental state of women in the perinatal period.

It is also necessary to attract nurse-midwives to improve their skills and continue the educational process. The practice of bringing mental health in the perinatal period in line with international standards, perhaps even more. It is advisable to re‐evaluate the knowledge among nurse-midwives from the women’s clinic, where they are directly in contact with pregnant women. This study was conducted for educational purposes and provides the empirical data needed by doctors, nurse-midwives , researchers, policy makers, and public health stakeholders to understand the perspective, the need for future research, and the policy and programming priorities for evaluating, treating, and preventing PPD.

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