Proposal on

Postpartum Depression
[Name of the writer]
[Name of the Institution]

Postpartum Depression 2
CHAPTER 1: INTRODUCTION

Outline of the Study

This study will be based on the topic Postpartum Depression. The first chapter will
provide an introduction to the topic including the purpose and significance of the study. The
second chapter will present a review of relevant literature, highlighting the previous research
carried out in this field. The third chapter will cover the methodology for this study. The analysis
of findings and discussion will be presented in the fourth chapter. The fifth chapter will conclude
the study, providing implications and useful recommendations for further research.

Background of the research

Depression, as a mental health disorder, is defined as persistent feelings of sadness that
interfere with daily functioning. Depression is a continuum of mood disorders that include major
depressive disorder, dysthymic disorder, psychotic depression, postpartum depression, and
seasonal affective disorder. A related disorder, biopolar disorder, includes extreme mood swings
that cycle from depressive to maniac states. Females outnumber males in major depressive
disorders at a ratio of 2:1 during a woman's childbearing years. However, both prior to puberty
and after menopause, rates of depressive disorders between males and females are similar. (Stern,
1995)
At least 13 percent of new mothers suffer from postpartum depression, with higher rates
occurring among women of color, single mothers, adolescent mothers, and low-income mothers.
Some degree of stress due to the adjustment to motherhood is normal, with baby blues
estimated to occur in 5080 percent of women during the first two weeks of motherhood.

Postpartum Depression 3
However, postpartum depression occurs when feelings of sadness, irritability, fatigue, and
worthlessness overwhelm new mothers. Post-partum depression is more severe and longer
lasting than the baby blues. It typically begins about one month postpartum and can last up to a
year. Postpartum depression is often undiagnosed and untreated, even though effective treatment
is available. (Compas, 1998)

Problem Statement
Increase in rates in depression is found, however, during the postpartum period. However,
hormonal changes alone are unlikely to cause postpartum depression, since rates within this
population are consistently higher among women with a personal and/or family history of
depressive episodes. There is no single cause for depression, and risk factors can include genetics
specifically having a first-degree relative with depression; sex hormones; and life stress and
trauma, such as sexual abuse, assault, domestic violence, and physical illness. Infertility,
miscarriage, and stillbirth are also associated with depression for women as traumatic and
uncontrollable life events, as well as through the increased stress of medical intervention
especially in the case of infertility.

Aims and Objectives

The main aims and objectives of this study will be:
-

To explore the concept of Postpartum Depression

To analyze different causes of Postpartum Depression
To find out the relationship between the postpartum depression, domestic violence and

sexual abuse, and

To figure out the cognitive behavioral therapy of women in the postpartum period.

Postpartum Depression 4
Research Question
1. What is the relationship between postpartum depression, domestic violence and sexual
abuse?
2. How cognitive behavioral therapy can help women in the postpartum period?
Ethical Concern
One profound moral issue that action researchers, like other scientists, cannot evade is the
use they make of knowledge that has been generated during inquiry. For this fundamental ethical
reason, the premises of any studybut particularly those of action researchmust be
transparent. Moreover, they must attend to a wider range of questions regarding intent and
purpose than simply those of validity and reliability. These questions might include
considerations such as the following:

Why was this topic chosen?

How and by whom was the research funded?

To what extent does the topic dictate or align with methodology?

Are issues of access and ethics clear?

From what foundations are the definitions of science and truth derived?

How are issues of representation, validity, bias, and reliability discussed?

What is the role of the research? In what ways does this align with the purpose of the

study?

In what ways will this study contribute to knowledge and understanding?

A defensible understanding of what constitutes knowledge and of the accuracy with

which it is portrayed must be able to withstand reasonable scrutiny from different perspectives.

Postpartum Depression 5
Time Scale
Time is an important factor when considering project work. One needs time to allow
adequate problem diagnosis before decisions are made about appropriate strategies and means of
implementation, however, this must remain flexible to allow for unforeseen factors.

Timescales have to be appropriate, realistic and achievable. According to researchers, a general

guide for any extended project or research is to plan to use only 75% of the supposed time
available, which should be tentatively allocated as follows: -

Introduction

5%

Literature review

35%

Research methods

10%

Data collection

20%

Analysis

15%

Conclusions and recommendations

10%

Bibliography and appendices

5%

Postpartum Depression 6
Gantt chart

TASKS
Construct research proposal
Draw up questionnaires
Submit proposal
Timetable interviews
Begin interviews, observations,
focus groups and hand out
questionnaires
Analysis and redefine problem(s)
Implement findings
Prepare draft report
Begin full data analysis
Write 8,000 word dissertation

WEEKS
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31

Postpartum Depression 7
CHAPTER 2: LITERATURE REVIEW

Postpartum Depression
Childbirth is one of the most profound biological and social transformations in women's
lives. For most mothers, joy and excitement accompany the arrival of their baby. Of course, the
physical and emotional demands of first-time and repeat motherhood are often intense and
unrelenting, and as mothers adjust to living with and caring for a newborn, mild to moderate
negative emotions are typically normal, expected, and short lived.
For a percentage of new mothers, however, intense negative emotions persisting beyond
the newborn phase may be indicative of a psychiatric disorder commonly referred to as
postpartum depression (PPD). In screening studies designed to identify women who would likely
be assigned a psychiatric diagnosis upon further evaluation by a trained professional, 1015
percent of North American women report symptoms of PPD. Prevalence estimates worldwide
range from less than 1 percent to over 50 percent. Postpartum psychosis, a more severe
postpartum mood disturbance, is estimated to occur in fewer than one in 1,000 women.
Depressive symptoms affect approximately 15 percent of mothers after childbirth, and
can persist for up to two years after delivery; the risk is higher among women with a history of
depression prior to pregnancy. Mothers suffering from depression may be at an increased risk to
negative health consequences for themselves and their infants/children. Further, other health
damaging behaviors, such as smoking, alcohol use, unmanaged stress, and poor eating habits,
contribute to depressive symptoms and complicate health outcomes. Pediatricians may have a
vital role to play in recognizing, accepting, and expecting postpartum depression, and

Postpartum Depression 8
constructing creative options for assessing new mothers during well-child appointments. During
the first year, there are several points in which pediatricians can recognize depressive symptoms
that can affect maternal health, and a mother's ability to adequately and appropriately care for her
infant. Women suffering from depressive symptoms may also wean their breastfeeding infants
prematurely. This is problematic, as breastfeeding has been associated with a myriad of positive
health benefits for infants.

Diagnosis of PPD
Though the term postpartum depression is widely used by professionals and the public
alike, no such diagnosis exists per se in major medical diagnostic systems. In the major medical
diagnostic systems used worldwide, the Diagnostic and Statistical Manual of Mental Disorders,
4th Edition and the International Classification of Diseases 10th Edition, women may be
assigned one of several depressive disorder diagnoses and given the qualifier of postpartum
onset. Both diagnostic systems have been criticized for use with postpartum women on the
grounds that too many of the symptoms are physically based and cannot be separated from the
physical effects of childbirth and newborn care. Also, distinct subgroups of women with PPD
symptoms appear to existanxious/depressive symptoms related to the psychological stress of
infant care, trauma from labor and delivery experiences, problems relating to the newborn, and
depression with psychotic features.
In the United States, women with a history of psychiatric diagnosis are greatest risk for
PPD. Up to one-third of women with high-risk pregnancy (a label that is somewhat arbitrary)

Postpartum Depression 9
may experience severe PPD. Other risk factors include poverty, living in a densely populated
urban area, exposure to violence, African or Mexican American ethnicity, and lone-parent status.
Many PPD experts view PPD as being based in the dramatic declines in female hormones
occurring in the early postpartum period. Evidence for this perspective is mixed, though
emerging data show that estrogen administration may have some preventive benefit. A
physiological basis for postpartum psychosis seems more plausible given the relative rarity and
unusual nature of associated symptoms.

Sociocultural Perspectives of PPD

From a sociocultural perspective, PPD comes about not from hormonal processes, but
from powerful cultural forces that have defined and restricted women's social role to that of
caregiver subordinate to male power. In cultures with so-called flexible gender roles, emphasis
on the nuclear family and self-reliance leaves many new mothers isolated and with inadequate
outside support for their around-the-clock care-giving responsibility. In this view, along with
women's culturally imposed subordinate position in relationship to men, the very concept of
psychiatric disorder is biased, in that male functioning is held as the standard to which women
must be compared.
Cross-cultural studies indicate widely varying prevalence rates of PPD symptoms
worldwide; it is virtually nonexistent in some nations (Singapore, 0.5 percent), low in others
(Sweden, 7 percent), and rampant in others (Guyana, 57 percent). In cultures with traditions of
extended family support, PPD symptoms tend to be lower. Cultural factors impacting varying

Postpartum Depression 10
estimates include whether a culture defines women's postpartum symptoms as pathological or as
normal effects of childbearing, the ways in which questions are asked, and a culture's disposition
toward revealing private emotions to others. Because childbirth is a major hormonal and social
transition invariant of culture, both physiological and cultural factors likely play a role.
PPD Treatments and Prevention
Available PPD treatments tend to focus on reducing symptoms. In recent years,
antidepressant medications have become more widely prescribed. Concerns over transmission of
medication to breastfeeding babies have been addressed, with a few studies showing no ill
effects. Important to consider are warnings required by the U.S. Food and Drug Administration
(FDA) of increased suicidal and/or homicidal behavior attached to several commonly prescribed
antidepressants, particularly in light of unknown medication interactions with postpartum
hormonal shifts. Medications used to treat psychosis have been found to have adverse effects on
infants neurological functioning. Because untreated postpartum psychosis poses real dangers to
mothers and their newborns, these women typically continue taking medication and bottle-feed
their infants.
Nonmedical treatments for PPD include primarily psychosocial and supportive
interventions designed to help mothers mobilize their support systems and alleviate depressive
symptoms. Interpersonal therapy (IPT) involves helping a mother strengthen relationships among
her supporters (usually the spouse or partner) as she adapts to life with a new baby. Cognitive
behavioral treatments involve helping mothers alter the thinking patterns that are causing them
distress. Problem-solving therapies involve helping mothers solve practical problems, such as
enlisting family and friends in assistance and emotional support. Postpartum home visits

Postpartum Depression 11
conducted by trained practitioners have been shown to reduce depressive symptoms in
vulnerable groups. Non-medical treatments have been found to be effective for some but not all
mothers. Affordability, availability, accessibility, and acceptability to mothers are important
considerations.
The American Academy of Pediatrics and American College of Obstetricians Guidelines
for Perinatal Care recommend that medical providers screen all prenatal care patients for PPD
risk, educate them during pregnancy, and conduct follow-up screening several times postpartum.
It remains to be established whether this process reduces PPD symptoms. Ethical concerns
surrounding large-scale screening efforts include arousing potentially unnecessary anxiety and
perpetuating the notion that postpartum mood shifts are pathological. Any screening programs
should occur in the context of appropriate follow-up resources.

Cognitive-Behavioral Therapy
Recent effectiveness research studies on the use of cognitive-behavioral therapy for
depression (Miranda & Munoz, 1994; Wells, 1997) have begun to include Spanish-speaking
Latinos. However, these studies must be viewed as the first step of a larger program of bringing
the benefits of clinical developments in effectiveness studies to all groups in society. Increased
research efforts, with sufficient sample sizes, are needed to explore the appropriateness of
cognitive-behavioral interventions for diverse racial/ethnic minority populations.
For example, interpersonal therapy for depression enhances recovery from postpartum
depression (O'Hara, Stuart, Goman, & Wenzel, 2000), a finding that is particularly important

Postpartum Depression 12
given that postpartum depression causes great individual and family suffering and impairs infant
development but often is not treated pharmacologically if women are breast-feeding.

Postpartum Depression 13
CHAPTER 3: METHODOLOGY

Research Method
The study would be following the mixed methodology. That is, both the qualitative and
the quantitative methods will be used in this study. The primary research will involve the data
collected through survey and the secondary data will also be used for the analysis of the study.

Mixed Method Research

This research approaches the gathering of the data using the multi-method strategy, or the
combination of quantitative and qualitative methods. Basically, the quantitative approach pursues
facts and is employed when researchers desire to acquire statistical truth.

Data Collection Method

Data will be collected through the questionnaires and also the secondary sources would
be considered to analyze the data and discussions.

Sampling Method
Random sampling would be used in this study. Most social science, business, and
agricultural surveys rely on random sampling techniques for the selection of survey participants
or sample units, where the sample units may be persons, establishments, land points, or other
units for analysis. Random sampling is a critical element to the overall survey research design.

Study Variable

Postpartum Depression 14
The variables selected for this study are:

postpartum depression;
postpartum depression can be diagnosed if a woman experiences anxiety or panic attacks,
unstable emotions, weight loss or gain, insomnia or hypersomnia, fatigue or loss of
energy, feelings of worthlessness or inappropriate guilt, difficulty concentrating, or
recurrent thoughts of death with or without plans for suicide up to one year postpartum
(number and duration of symptoms remains unclear).
The Edinburgh Postpartum Depression Scale (EPDS) will be used. It is a self report scale
designed to measure depressive symptoms amongst women after giving child birth (Cox,

et al, 1987).
Domestic Violence;
Domestic violence is defined narrowly as physical violence perpetrated by husbands
against their wives. The Composite Abuse Scale (CAS) is a widely used self report of

behaviors that women describe as abusive by their partners.

Sexual Abuse
Sexual abuse occurs when a sexual act, including the alteration of one's genital anatomy,
is imposed upon a non-consenting or underage person. The Composite Abuse Scale
(CAS) is a widely used self report of behaviors that women describe as abusive.

Literature Search
The relevance of the research topic and the publication year has been the criteria for the
selection of appropriate literature. The usage of public, private and the online libraries has been
made for the collection of the most valid available information. A few online databases for the
gathering of data accessed are: Questia, Proquest, Pheonix, Ebsco and so on.

Reliability and Validity

Postpartum Depression 15
The term bias is a historically unfriendly pejorative frequently directed at action research.
As much as possible, the absence of bias constitutes conditions in which reliability and validity
can increase. Most vulnerable to charges of bias are action research inquiries with a low
saturation point (i.e., a small N), limited interrater reliability, and unclear data triangulation.
Positivist studies make attempts to control external variables that may bias data; interpretivist
studies contend that it is erroneous to assume that it is possible to do any researchparticularly
human science research that is uncontaminated by personal and political sympathies and that
bias can occur in the laboratory as well as in the classroom. While value-free inquiry may not
exist in any research, the critical issue may not be one of credibility but, rather, one of
recognizing divergent ways of answering questions associated with purpose and intent. Action
research can meet determinants of reliability and validity if primary contextual variables remain
consistent and if researchers are as disciplined as possible in gathering, analyzing, and
interpreting the evidence of their study; in using triangulation strategies; and in the purposeful
use of participation validation. Ultimately, action researchers must reflect rigorously and
consistently on the places and ways that values insert themselves into studies and on how
researcher tensions and contradictions can be consistently and systematically examined.
The Composite Abuse Scale has the ability to classify women according to type and
severity of abuse, a common criticism of the current measures of abuse. The Composite Abuse
Scale has demonstrated face, content, criterion, and construct validity.

Postpartum Depression 16
REFERENCES
American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.
Guidelines for Perinatal Care, 5th edition. Washington, DC: American Academy of
Pediatrics/American College of Obstetricians and Gynecologists, 2002.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.
Arlington, VA: American Psychiatric Association, 1994.
Anderson, B. J. , Ho, J. , Brackett, J. , and Laffel, L. M. An office-based intervention to maintain
parent-adolescent teamwork in diabetes management: Impact on parent involvement,
family conflict, and glycemic control. Diabetes Care vol. 22 (1999). p. 713721
Avis, Nancy E. Depression During the Menopausal Transition. Psychology of Women
Quarterly v.27 (2003)
Belle, Deborah and Joanne Doucet Poverty, Inequality and Discrimination as Sources of
Depression Among U. S. Women. Psychology of Women Quarterly v.27 (2003)
Brockington, Ian Diagnosis and Management of Post-partum Disorders: A Review. World
Psychiatry, v.3/2 (2004).
Cohen, Lee S. , ed. and Ruta Nonacs eds. Mood and Anxiety Disorders During Pregnancy and
Postpartum. Arlington, VA: American Psychiatric Association, 2005.
Compas, B. E. , Haaga, D. A. , Keefe, F. J. , Leitenberg, H. , and Williams, D. A. Sampling of
empirically supported psychological treatments from health psychology: Smoking,
chronic pain, cancer, and bulimia nervosa. Journal of Consulting and Clinical Psychology
vol. 66 (1998). p. 89112.
Cox, J.L., Holden, J.M., & Sagovsky, R. (1987). Detection of postnatal depression of the 10-item
Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786

Postpartum Depression 17
Dennerstein, L. , E. Dudley , and J. Gutherie Empty Nest or Revoving Door? A Prospective
Study of Women's Quality of Life in Midlife During the Phase of Children Leaving and
Re-Entering the Home. Psychological Medicine v.32 (2002)
Dennis, C. L. , L. E. Ross , and S. Grigoriadis PsychoSocial and Psychological Interventions for
Treating Antenatal Depression. The Cochrane Library, v.4 (2008).
Dennis, C. L. and K. Allen Interventions (Other Than Pharmacological, Psychosocial or
Psychological) for Treating Antenatal Depression. The Cochrane Library, v.4 (2008).
Goodman, Sherryl H. Depression in Mothers. Annual Review of Clinical Psychology v.33/107
(2007)
Halbreich, Uriel and Sandhya Karkun Cross-Cultural and Social Diversity of Prevalence of
Postpartum Depression and Depressive Symptoms. Journal of Affective Disorders, v.91
(2006).
Holroyd, K. A. Assessment and psychological management of recurrent headache disorders.
Journal of Consulting and Clinical Psychology vol. 70 (2002). p. 656677
Keefe, F. J. , Caldwell, D. S. , Baucom, D. , Salley, A. , Robinson, E. , Timmons, K. , Beaupre, P.
, Weisberg, J. , and Helms, M. Spouse-assisted coping training in the management of
osteoarthritic knee pain. Arthritis Care and Research vol. 9 (1996). p. 279291
Keefe, F. J. , Smith, S. J. , Buffington, A. L. H. , Gibson, J. , Studts, J. L. , and Caldwell, D. S.
Recent advances and future directions in the biopsychosocial assessment and treatment of
arthritis. Journal of Consulting and Clinical Psychology vol. 70 (2002). p. 640655
Kendall-Tackett, Kathleen A. Depression in New Mothers: Causes, Consequences, and
Treatment Alternatives. New York: Routledge, 2005.

Postpartum Depression 18
Kessler, Ronald C. Epidemiology of Women and Depression. Journal of Affective Disorders
v.74 (2003)
O'Hara, M. W. , Stuart, S. , Gorman, L. L. , and Wenzel, A. Efficacy of interpersonal
psychotherapy for postpartum depression. Archives of General Psychiatry vol. 57 (2000).
p. 10391045
Olds, D. L., et al. Long Term Effects of Home Visitation on Maternal Life Course and Child
Abuse and Neglect: 15Year Follow Up of a Randomized Trial. Journal of the American
Medical Association, v.280 (1997).
Stern, Daniel . The Motherhood Constellation. New York: Basic Books, 1995.
United States Congress House Committee on Energy and Commerce. Melanie Blocker-Stokes
Postpartum Depression Research and Care Act: Report (to accompany H. R. 20)
(Including Cost Estimate of the Congressional Budget Office). Washington, DC: United
States Government Printing Office, 2007.

Postpartum Depression 19
APPENDIX
Brief Description of proposal topic and research questions/hypotheses:
Relationship Between Postpartum Depression, Domestic Violence And Sexual Abuse
Research Question
1. What is the relationship between postpartum depression, domestic violence and sexual abuse?
2. How cognitive behavioral therapy can help women in the postpartum period?
Independent Variable
Type of Variable
Name of Variable and Values
Nominal/Conceptual Definition

Independent Variable
Postpartum Depression
postpartum depression can be diagnosed if a woman e
panic attacks, unstable emotions, weight loss or gain,

hypersomnia, fatigue or loss of energy, feelings of wo

inappropriate guilt, difficulty concentrating, or recurre

with or without plans for suicide up to one year postp

duration of symptoms remains unclear).
Operational Definition/Measurement

The Edinburgh Postpartum Depression Scale (EPDS) will be

report scale designed to measure depressive symptoms amon

giving child birth (Cox, et al, 1987).
Dependent Variable 1
Type of Variable

Dependent Variable

Name of Variable and Values

Nominal/Conceptual Definition

Domestic Violence
Domestic violence is defined narrowly as physical vio
husbands against their wives.

Operational Definition/Measurement
Data Collection Technique
Feasibility
Norms
Reliability

The Composite Abuse Scale (CAS) is a widely used self repo

women describe as abusive by their partners.

CAS questionnaire will be distributed for the collection of da

The Composite Abuse Scale has the ability to classify women

Postpartum Depression 20

Validity

and severity of abuse, a common criticism of the current mea

The Composite Abuse Scale has demonstrated face, content,
construct validity.

Source
Dependent Variable 2
Type of Variable

Dependent Variable

Name of Variable and Values

Nominal/Conceptual Definition

Sexual Abuse
Sexual abuse occurs when a sexual act,
including the alteration of one's genital
anatomy, is imposed upon a nonconsenting

Operational Definition/Measurement

or underage person.
The Composite Abuse Scale (CAS) is a
widely used self report of behaviors that

Data Collection Technique

women describe as abusive.

CAS questionnaire will be distributed for the
collection of data.

Feasibility
Norms
Reliability

The Composite Abuse Scale has the ability

to classify women according to type and
severity of abuse, a common criticism of the

Validity

current measures of abuse.

The Composite Abuse Scale has
demonstrated face, content, criterion, and
construct validity.

Source
Dependent Variable 3
Type of Variable
Name of Variable and Values
Nominal/Conceptual Definition
Operational Definition/Measurement
Data Collection Technique and Desciption
Feasibility
Norms

Dependent Variable

Postpartum Depression 21
Reliability
Validity
Source
Control Variables
Type of Variable
Name of Variable and Values
Nominal/Conceptual Definition
Operational Definition/Measurement
Data Collection Technique
Feasibility
Norms
Reliability
Validity
Source
Demographic Variables

Control Variable
Gender
Gender is referred to feminine and
masculine forms
Women (Adult females) would be included

Type of Variable
Name of Variable and Values
Nominal/Conceptual Definition

Demographic Variable
AGE
The length of time that one has existed;

Operational Definition/Measurement

duration of life
Females above 20 years of age would be

included
Data Collection Technique
Feasibility
Norms
Reliability
Validity
Source
Other Variables can be additional DVs, Demographic Variables or Control Variables (please include a rational f
Type of Variable
Name of Variable and Values
Nominal/Conceptual Definition
Operational Definition/Measurement
Data Collection Technique
Feasibility
Norms
Reliability
Validity
Source

Postpartum Depression 22