Transcript Lunch and Learn Powerpoint - AASWG Southern California

Lunch and Learn Series
Research on Postpartum Support
Groups: Women Report the Benefits
and Barriers
KAMRIN YELLEY, MSW
WEST CHESTER UNIVERSITY
Objectives
Attendees will better understand the importance of
support groups for women with postpartum
depression.
2. Attendees will be able to describe strategies for
facilitating effective support groups for women
with postpartum depression.
3. Attendees will be better informed about relevant
postpartum depression literature.
4. Areas of need for postpartum depression support
groups will be discussed.
1.
Background: What is Postpartum Depression?
 My interest in the topic: internship at Phoenixville
Hospital (Phoenixville, PA) working with new
mothers directly after birth, and providing education
on PPD.
 Postpartum depression is “moderate to severe
depression” that a woman may experience after
giving birth. It typically occurs within three months
of delivery, but can occur up to one year after the
birth of the baby. Postpartum depression can affect
any woman, regardless of race, age or economic
background.
Depression and Bipolar Support Alliance, 2010
Background: What is Postpartum Depression?
 Up to 85% of women experience some mild mood
disturbance after birth.
 10-15% of women experience a more disabling and
persistent form of depression called postpartum
depression, and another, 0.1-0.2% of women
experience postpartum psychosis. Postpartum
psychosis is very rare, but very serious. The symptoms
include hallucinations, rapid mood swings, and
attempts to hurt oneself or the baby.
 Post Partum Depression Educational Video -New
Jersey

http://youtu.be/yH3WMQO-ooU
O’Hara, Neunaber & Zekoski, 1984; Women’s Health, 2009; Insel, 2010; Cox, 2010.
Background: What is Postpartum Depression?
 In the United States in 2011, 4 million births occurred.
According to the above prevalence rates, at least 400,000
women experienced PPD last year and approximately
4,000 experienced postpartum psychosis.
 2010 California Birth rate was 510,000 births. In
California, conservatively 51,000 women experienced PPD
that year.
 After Melanie Blocker-Stokes committed suicide in 2001
while suffering from postpartum psychosis, the Melanie
Blocker-Stokes Mothers Act passed in 2009. This act
provides support for research into the causes, diagnoses,
and treatment of postpartum depression and psychosis.
O’Hara, Neunaber & Zekoski, 1984; Women’s Health, 2009; Insel, 2010; Cox, 2010; CA Dept of Public Health.
Background: Literature Review
 Little research is currently available on the effectiveness
of support groups when working with women with PPD.
Of the seventy five articles I reviewed on PPD, only five
studied postpartum support groups, and the results of
the studies varied from finding the support groups
effective to believing them to be harmful to participants’
self-esteem.
DiMascio et al, 2008
Literature Review: Article One
 In DiMascio et al's article “Recovery
from postnatal depression: A
consumer's perspective” written in
2008, the researchers had women
identify what they found to be effective
in recovering from postpartum
depression
 95.6% of the women surveyed ranked
support groups as “very important” for
their recovery
DiMascio et al, 2008
Literature Review: Article Two
 Lane et al., 2010 was POSITIVE
 “It's just different in the country: postnatal
depression and group therapy in a rural
setting”
 This article showed that all participants
achieved a lower Edinburgh Postnatal
Depression Scale (EPDS) score by the end of
the group.
DiMascio et al, 2008
Literature Review: Article Three
 Armstrong and Edwards, 2003 was
AMBIVALENT
 “The effects of exercise and social
support on mothers reporting
depressive symptoms: A pilot
randomized controlled trial”
 This article researched the effectiveness
of exercise and social support groups
on reducing PPD symptoms. The
exercise group reduced depressive
DiMascio et al, 2008
Literature Review: Article Four
 Fleming et al., 1992 was NEGATIVE
 “The effects of social support groups on depression,
maternal attitudes, and behavior in new mothers”
 The researcher found that regardless of the intervention,
mothers moods improved over time. And they found that
social support groups possibly had a negative effect on
the self-confidence of women who were depressed. They
believe this could be due to a “comparison effect”, or a
mother's perception that she was worse than the rest of
the group participants.
DiMascio et al, 2008
Literature Review: Article Five
 Webster et al., 2001 was POSSIBLY NEGATIVE
 “Postnatal depression: Use of health services and
satisfaction with health care providers”
 In this study, 30% of the women with PPD who attended
support groups found them to not be helpful.
DiMascio et al, 2008
Problem
 The findings of the literature review reflect
that more specific research is needed in the
area of support groups.
 The purpose of my research was to evaluate
participant's perceptions of the effectiveness
of postpartum depression support groups.
Research Design
 Non-experimental, exploratory study of perceptions
on the effectiveness of support groups.
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No control group was used.
Mixed-design study, with open-ended questions that were
evaluated for themes/trends related to perceptions of the
effectiveness of the group.
I attended the support group, and the group facilitator
collected data in my absence. Subjects received and completed
their questionnaires at the end of the support group.
Data Collection
 Subjects completed the Edinburgh Postnatal
Depression Scale, which determines depression. A
score of ten was used to screen for PPD.

EPDS has been used in multiple studies to determine PPD.
 A questionnaire had already been developed by the
hospital to evaluate the effectiveness of the support
group. I used the same survey instrument and added
more questions that were relevant to my research.
 Informed consent was obtained before conducting
research.
Data Collection
 Convenience sample:
 The support group is advertised on the hospital website, and
through community education programs. Subjects are typically
referred to the support group by professionals and through a
postpartum stress center, and referrals come from other
hospitals or through other members of the community.
 The data collected during observation of the support
group and from the questionnaires was analyzed for
themes about the effectiveness of the support group.
Direct quotes are identified that support these
themes.
The Support Group
 I was able to participate as a guest of the support
group, which has been running for approximately
five years now. It is co-facilitated by a postpartum
center nurse and a hospital social worker.
Membership typically includes a small core-group of
5 members who attended for 1-2 years and are slowly
replaced by a new core-group, and then several
others who attend a few meetings while in crisis. The
group meets once per month for two hours from
6:30-8:30pm and childcare is provided by hospital
volunteers. The meeting begins with introductions
and welcome, and then moves quickly into
discussion of participant concerns about PPD.
The Support Group
 The meeting is ended with a quick summary, since it
typically runs over time. Also, some months a guest
speaker is invited to provide information the
participants have requested. All participants are new
mothers, and have experienced or are experiencing
PPD or other stressors. I also want to mention that
members are active in leadership roles, recruitment
of new participants, and advocating for themselves in
the political arena.
Results: Demographics
 19 of the 20 participants in the support group are White.
1 participant is Hispanic. Ages ranged from 27 to 40, with
three participants choosing to not answer this question.
The mode age is 39 years.
 10 percent of participants have 3 children, 20 percent
have 2, and 70 percent have 1.
 Most of the participants had been referred by a
professional to the group. The remainder were referred
by friends, and one was referred by another group. This
allows us to understand who is referring, and where we
should focus efforts on education about the support
group if we want to increase attendance.
Results
 The support group is perceived as effective by
participants. I came to this conclusion because:

All 20 participants found the group to be “Very Helpful” or
“Extremely Helpful”. The median and mode score for the eight
questions referring to satisfaction with the group is 5, with 5
being the highest score possible. The mean scores for each
question are 4.75 and higher.
Results: Themes
 From the open-ended questions and observation of the
group, four themes were identified regarding the
effectiveness of the support group.
 Normalizing

“It was helpful to hear from other women and know that my
thoughts and what I was going through was okay and could be
conquered. That PPD is not scary, wrong, or something I did to
myself or did wrong. That PPD is something that can be overcome,
and that there is a powerful caring community of women”.
 Supportive Structure

One participant said it was helpful to know that “We are there for
each other to support each other through this challenging time”.
Another participant explained that “other people mean well, but they
really just don't understand it. I don't think they mean to be
insensitive but they have no idea. Until you go through [postpartum
depression] you can't know what it is”.
Results: Themes
 Increased Confidence

“I realized 'It's all on you. You don't need [person's name] anymore.
You can handle this now.' Things are getting better and I can do this
now”. During the time in which they have participated in the group,
members have come to believe that they can manage and understand
their postpartum depression.
 Decreased self-blame

“we don't have to feel guilty about having negative feelings. You can
be grateful to be a mom, but still get upset”.
 Areas of need

The areas of need include: more structure, guest speakers who can
provide educational information, assigned themes for meetings, and
more outreach efforts to support women who are not attending the
support group.
Discussion
 Findings

Participants were very satisfied with the
support group, in managing symptoms and
positively changing behaviors to cope with
their negative symptoms. Most of the
participants felt no change was needed to
make the support group more effective.
Those who advocated for change asked for
simple structural changes, such as starting
and ending meetings on time. Almost all
participants did ask that the group meet
Discussion
 Challenges and Limitations
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This is a relatively small sample size (20) so the study can’t be
generalized to larger populations.
The facilitator and I were only able to collect data from three
sessions, which does not reflect enough time to do a quasiexperimental design and assess the effectiveness of the group in
lowering subjects' scores on the EPDS, which would be more ideal in
providing evidence-based findings. Instead, I relied on subjects'
perceptions of the effectiveness of the group.
The sample used is a convenience sample, which will not generalize
to larger populations like a random sample would. No control group
was created, due to time limitations and for ethical reasons of not
denying treatment to women who wished to be participants in the
support group
Implications for Social Work Practice
 Those working with new mothers, including perinatal social
workers, should be able to educate patients about what postpartum
is. Evidence-based treatment and support services should be
provided, that are culturally and linguistically appropriate.

If research is not available, social workers should conduct the research
themselves. We should be able to provide information about available support
groups addressing postpartum issues, and also support and educate the
interdisciplinary team.
 Social workers have the responsibility of helping mothers with PPD
and their children and to make them aware of the best treatment
options available for PPD.
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If a mother doesn’t receive treatment for postpartum depression, the symptoms
can continue for months and years. This impacts mother-infant interaction and
stresses the family system. The baby can develop an adjustment disorder, and
have a hard time forming healthy social relationships later in life.
Babies of moms with postpartum depression have also been found to have
“delays in language development, problems bonding, behavior problems, and
increased crying”.
NAPSW, 2009; Office on Women’s Health, 2009; Peindl, Wisner & Hanusa, 2004
Implications for Future Research
 More research should be conducted to determine why results about the
effectiveness of PPD support groups conflict between studies.
 The majority of those attending the hospital's support group for
Postpartum depression are white and over 30. However, the literature
review shows that 18-24 year-old women are the most likely to be
depressed, and no research shows white women to be more likely to
develop PPD. From this information we can infer that the majority of
women suffering from PPD near this hospital are not receiving treatment
from a support group for their depression.
 Research should be conducted to determine what strategies the majority of
women with PPD, especially minorities, use to treat their depression.
Furthermore, research and community planning should concentrate on
discovering what strategies can be used to promote attendance to PPD
support groups by young mothers and minorities.
 An experimental, longitudinal design is needed to determine the true
effects of postpartum support groups, and to create an evidence-based
practice for social workers working with women with PPD.
References
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Cox, S. (2010) Melanie’s battle: The hidden plague of postpartum psychosis and depression.
NAPSW Forum, 30(3), 13-14.
Depression and Bipolar Support Alliance. (2006, revised 2010). Postpartum Depression.
Retrieved from
http://www.dbsalliance.org/site/PageServer?pagename=about_depression_postpartum
Di Mascio, V., Kent, A., Fiander, M. & Lawrence, J. (2008). Recovery from postnatal
depression: A consumer's perspective. Archives of Women's Mental Health, 11, 253257.
Insel, T. (2010, October 28). Spotlight on postpartum depression [National Institute of
Mental Health Director's Blog]. Retrieved from http://www.nimh.nih.gov
National Association of Perinatal Social Workers. (2009). Standards for Perinatal Social
Workers Working with Patients Experiencing Post Partum Depression.
Washington, DC: Author.
O'Hara M., Neunaber D. & Zekoski E. (1984). Prospective study of postpartum depression:
prevalence, course, and predictive factors. Journal of Abnormal Psychology, 93(2):15871.
Peindl K., Wisner K. & Hanusa B. (2004). Identifying depression in the first postpartum
year: guidelines for office-based screening and referral. Journal of Affect Disorders,
80(1): 37-44.
US Department of Health and Human Services Office on Women’s Health. (2009, March
6). Depression during and after pregnancy fact sheet [Data file]. Retrieved from
http://www.womenshealth.gov/publications/our-publications/fact-sheet/depressionpregnancy.cfm