NURS FPX 6026 Assessment 1 Analysis of Position Papers for Vulnerable Populations EZ

NURS FPX 6026 Assessment 1 Analysis of Position Papers for Vulnerable Populations EZ

Analysis of Position Papers for Vulnerable Populations

Postpartum Depression in Latina Women

NURS FPX 6026 Assessment 1 Analysis of Position Papers for Vulnerable Populations EZ

As a society, the importance of maternal mental health is often overlooked. Perinatal mood disorder, most referred to as postpartum depression (PPD), occurs during and after pregnancy for many women. Women can experience difficulty bonding with their newborns because of PPD which can lead to sleep disturbances, poor feeding, or cognitive defects for the infant. Unfortunately, some groups of women are at higher risk for PPD than others. Women of color experience worse maternal and child health outcomes compared to White women (Sampson et al., 2021). Latinas are affected by postpartum depression two to three times higher than the general population (Ponting et al., 2020). Postpartum in Latinas is a significant issue because Latinos make up approximately 17% of the total U.S. population and the number is expected to more than double in the next 40 years (Sampson et al., 2018).

In obstetrics, depression and anxiety symptoms are assessed using the Edinburgh Postnatal Depression Scale (EPDS). Physicians use the EPDS because it takes less than five minutes to complete and is quite easy to administer. EPDS is a list of questions consisting of ten self-reported questions based on the expectant mother’s level of health literacy (Lyubenova et al., 2021). EPDS is the most used depression screening tool for women in pregnancy or postpartum. The EPDS can be found in many languages. If the questionnaire totals to a score of ten or higher it is indicative of depression. The expectant mothers should complete the EPDS before and after they give birth, ideally during all prenatal and postpartum appointments.

Barriers to Care

Expectant mothers younger than 24 years of age, Medicaid insured, or do not speak English are less likely to receive adequate screenings (Ponting et al., 2020). Language barriers and miscommunication are some of the hurdles Latina women face during their obstetric appointments. Latina women have not been the subject of many studies regarding PPD until recent years (Khanlari et al., 2019). Historically, clinicians who work with the Latina population are unaware of the cultural constraints, struggles or stigmas they experience. Different cultures may present or verbalize their symptoms in different ways (Sampson et al., 2021). Involving an interprofessional team that is culturally diverse and knowledgeable of the different signs of PPD in diverse populations is imperative. 

NURS FPX 6026 Assessment 1 Analysis of Position Papers for Vulnerable Populations EZ

Research in Latina PPD is relatively new; studies published suggest Latinas do not have a higher rate of prevalence of PPD yet a higher rate of nontreatment (Mukherjee et al., 2018). These studies used assessments based on common symptoms presented in White married women that have never experienced any of the stressors specific to women of color. Understanding the struggles of minority women in the United States and awareness that their symptoms will not always correlate with those of White women is key in proper diagnosis which can lead to accurate prevalence numbers (Ponting et al., 2020).

There has been an increase in research on PPD among Latinas in the United States the past twenty years (Zayas and Sampson, 2014). Low self-esteem, stressful life events, limited prenatal care, lack of social support, low income and reduced partner support are known risk factors for PPD. Latinas in the United States often experience many of the common risk factors yet are less likely to seek mental health treatment when they experience symptoms. Their higher rates of PPD and low levels of treatment are due to a variety of factors, including being both socially and emotionally disadvantaged as well as cultural beliefs on mental health issues. 

Mental Health and Latino Culture

Beliefs regarding mental illness and seeking behavioral health services differ based on culture. Being subordinate to others, maintaining harmony with partners by remaining silent, and not sharing what happens in the home with those outside of the home are behaviors associated with increased risk of depression (Lara-Cinisomo et al., 2018). Stigma, lack of recognition of symptoms or misconceptions about PPD among Latinas and their physicians can complicate early detection of symptoms (Sampson et al., 2021). Most Latin American countries, believe that family problems should not be shared with those outside of the home. This leads to expectant mothers feeling alone or hopeless with their conditions. Educating the expectant mother and their support system on the possible effects of PPD on a newborn can emphasize the importance of early detection of PPD. Identifying concerns early on will allow time for the mother to get connected to a social worker or community resources prior to giving birth. Including any family members, partners, or caregivers in PPD education is also key to have a source of monitoring at home. The consequences of not receiving adequate treatment for PPD can be devastating for women, early detection is crucial for those at risk.

Edinburgh Postnatal Depression Scale

NURS FPX 6026 Assessment 1 Analysis of Position Papers for Vulnerable Populations EZ

Healthcare workers are vital in assessing, identifying, and supporting expectant mothers at risk for PPD. An integral part of the interprofessional team role is to help expectant mothers and their families maintain optimal health of themselves and their unborn child. An interprofessional team, to provide adequate care to Latina expectant mothers, ideally include a physician or nurse practitioner, lactation consultant, social worker, a primary nurse and a community health worker (CHW).

CHWs build individual and community relationships by increasing health knowledge through outreach, community education, informal counseling, social support, and advocacy for a specific community (Early et al., 2016). Adding a CHW to the interprofessional team is beneficial because they can serve as trainers for the clinical staff on how to screen for symptoms specific to the Latina women in order to detect and treat PPD early. CHW can also assist the social workers with finding culturally appropriate resources for the specific Latino culture in the community. 

Obstetric and gynecological providers are often utilized as the primary source of healthcare for women since they are regularly engaged throughout prenatal visits, delivery, and postpartum care. Referrals to a social worker and CHW should be arranged at the initial visit by the physician this allows time to establish rapport with the expectant mothers. Building rapport is crucial to be able to assess any differences in affect or demeanor since physicians are not always allotted the time necessary to establish those relationships. The CHW can be a supportive person for Latina expectant mothers as well as a trusted partner for providing adequate care to this population.

Conclusion

Latina women are more likely to suffer PPD during pregnancy and after childbirth. Latinas have cultural beliefs contradicting PPD and seeking mental health treatment. Providing adequate education on the possible effects PPD can have on their babies will challenge the stigmas they have grown to believe. Utilizing CHWs with first-hand knowledge of the Latino culture can be a support to the mothers and a collaborative partner for clinicians. While Latina PPD studies are relatively new, the population continues to grow and experience PPD leading to many babies at risk for developmental issues. Latinas need encouragement to seek mental health services and support to meet their mental health needs. 

References

Early, J., Burke-Winkelmann, S., & Joshi, A. (2016). On the front lines of prevention: Promotores de salud and their role in improving primary care for latina women, families, and communities. Global Journal of Health Education and Promotion, 17(2), 58. https://doi.org/10.18666/GJHEP-2016-V17-I2-7130

Khanlari, S., Barnett Am, B., Ogbo, F. A., & Eastwood, J. (2019). Re-examination of perinatal mental health policy frameworks for women signaling distress on the Edinburgh Postnatal Depression Scale (EPDS) completed during their antenatal booking-in consultation: A call for population health intervention. BMC Pregnancy and Childbirth, 19(1), 221-221. https://doi.org/10.1186/s12884-019-2378-4

Lara-Cinisomo, S., Wood, J., & Fujimoto, E. M. (2019). A systematic review of cultural orientation and perinatal depression in latina women: Are acculturation, marianismo, and religiosity risks or protective factors? Archives of Women’s Mental Health, 22(5), 557-567. https://doi.org/10.1007/s00737-018-0920-4

Lyubenova, A., Neupane, D., Levis, B., Wu, Y., Sun, Y., He, C., Krishnan, A., Bhandari, P. M., Negeri, Z., Imran, M., Rice, D. B., Azar, M., Chiovitti, M. J., Saadat, N., Riehm, K. E., Boruff, J. T., Ioannidis, J. P. A., Cuijpers, P., Gilbody, S., Thombs, B. D. (2021). Depression prevalence based on the edinburgh postnatal depression scale compared to structured clinical interview for DSM Disorders classification: Systematic review and individual participant data meta-analysis. International Journal of Methods in Psychiatric Research, 30(1), 1-13. https://doi.org/10.1002/mpr.1860

Mukherjee, S., Fennie, K., Coxe, S., Madhivanan, P., & Trepka, M. J. (2018). Racial and ethnic differences in the relationship between antenatal stressful life events and postpartum depression among women in the united states: Does provider communication on perinatal depression minimize the risk? Ethnicity & Health, 23(5), 542-565. https://doi.org/10.1080/13557858.2017.1280137

NURS FPX 6026 Assessment 1 Analysis of Position Papers for Vulnerable Populations EZ

Ponting, C., Chavira, D. A., Ramos, I., Christensen, W., Guardino, C., & Dunkel Schetter, C. (2020). Postpartum depressive symptoms in low-income latinas: Cultural and contextual contributors. Cultural Diversity & Ethnic Minority Psychology, 26(4), 544-556. https://doi.org/10.1037/cdp0000325

Sampson, M., Torres, M. I. M., Duron, J., & Davidson, M. (2018). Latina immigrants’ cultural beliefs about postpartum depression. Affilia, 33(2), 208-220. https://doi.org/10.1177/0886109917738745

Sampson, M., Yu, M., Mauldin, R., Mayorga, A., & Gonzalez, L. G. (2021). ‘You withhold what you are feeling so you can have a family’: Latinas’ perceptions on community values and postpartum depression. Family Medicine and Community Health, 9(3), e000504. https://doi.org/10.1136/fmch-2020-000504

Zayas, L. H., & Sampson, M. (2014). Perinatal depression treatments for US Latinas: A review of research findings. In S. Lara-Cinisomo & K. L. Wisner (Eds.), Perinatal depression among Spanish-speaking and Latin American women: A global perspective on detection and treatment (pp. 65–82). New York: Springer. 

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