PURPOSE: The purpose of this literature review is to identify risk factors for postpartum depression (PPD) in order to initiate evidence-based research into the nurse’s role in preventing undiagnosed or late diagnosed mothers with PPD.
BACKGROUND: It is estimated that 10-15% of new mothers will develop PPD, but there is evidence that postpartum depression is largely underdiagnosed and undertreated. The Edinburgh Postpartum Depression Scale (EPDS) has been demonstrated to be an effective screening tool for PPD, although current American College of Obstetricians and Gynecologists (ACOG) recommendations include screening a minimum of one time through the perinatal period. This poses the risk for too few women to get diagnosed with, and therefore treated for, PPD.
METHODS: In this review, we identified a variety of psychosocial and biological factors that impact the risk of new mothers developing PPD. The search strategy included articles found in PubMed database that screened with the EPDS between 2013-2018 in English using the search terms of “predictors”, “risks”, “postpartum depression”, and “depression in new mothers.”
RESULTS: Using secondary analysis of literature, risk factors found include low BMI, history of depression, age greater than 35 years old, age younger than 24 years old, baby born at gestational age less than 32 weeks, instrument assisted birth, cesarean section birth, physical disability of mother, history of partner violence, postpartum complications, and an unwanted or unplanned pregnancy, all which are suggested to increase a mother’s risk of developing PPD. Using the relative risk associated with each of these risk factors, a framework for risk factors was produced with the hope of spurring further research into the creation of a screening tool for nurses in order to have an active role in the prevention and treatment of PPD.
RECOMMENDATIONS: Next steps include the further development of the evidence-based screening tool, which can then be assessed for validity and reliability and piloted by postpartum nurses in order to identify mothers at higher risk of developing PPD. The tool would apply statistical principles to categorize a woman as low risk, moderate risk, or high risk to ensure that further screening intervals and implementation of protective factors would be utilized.
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