Effectiveness of peer support intervention Program (PIP) for postnatal depression (PND) in community care setting

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Catherine McAuleySchool of Nursing and MidwiferyBrookfield Health Sciences Complex√University College CorkModule Code and Title: NU5058, Health Promotion Module.Title of Course: HDip Midwifery Title of Project/Essay: Effectiveness of peer support intervention Program (PIP) for postnatal depression (PND) in community care setting. Student name Student Number: RAMACHANDRAN RAJENDIRAN ,119108048.Word Count: 1561 Date: 18th October 2019I have read the School’s Policy on Plagiarism, and I declare that the content of this assignment is all my own work. Where the work of others has been used to augment my assignment, it has been referenced in accordance with academic convention. 45720056832500This essay complies with School of Nursing and Midwifery requirements and guidelines on plagiarism: YES4572004000500NO(Please tick one box.)Signed: RAMACHANDRAN RAJENDIRANI attest that I have not submitted this material in whole or in part for the assessment of another programme or award in this School or university or any other higher education institution.45720015811500YES45720018732500NO(Please tick one box.)Signed RAMACHANDRAN RAJENDIRANTABLE OF CONTENTSTITLE PAGE NO1.Introduction 3 1.1. National and International policies on maternal mental health 32.Discussion 5 2.1Health promotion model 63.Conclusion 7Introduction:Pregnancy brings a lot of happiness to a mother and her family, but not every woman enjoys it. In the journey of pregnancy, women experience physical, physiological and psychological changes in their body. Although the changes are inevitable, in some women it results in mental health illness that affects their wellbeing. The World Health organization (WHO,2019) estimates that globally 10% of pregnant women and 13% of delivered mothers are affected by pregnancy related mental health problems. Whereas, in developing countries it further increased to15.6% and 19.8 % respectively. Poor maternal mental health leads to a range of illnesses such as depression, psychosis and even suicidal tendency, (WHO, 2019). Wellbeing of mental health is determined by social, economic and physical conditions of an individual. The more inequalities prevail, there is a greater chance of developing mental health illnesses, (WHO, 2014). Considering the mental health of Irish citizens, Ireland has allocated 84million euro in the Slaintecare health budget 2019 to improve the accessibility of General Practitioner (GP) care by families and elderly people, (Mental Health Ireland, 2019).National and International policies on maternal mental health:In terms of maternal health and wellbeing, it is important to diagnose maternal mental health problems in the early stage of pregnancy. All international and national policies emphasize the reorganization of mental health illnesses in the community setting. One of the main objectives of the WHO’s mental health action plan 2013-2020 is that extensive care has to be provided against mental health illness at a community-based level, (WHO, 2013 p21). National Institute for Health and Care Excellence (NICE) guidelines on antenatal and postnatal mental health recommend that the health practitioners should ask Postnatal depression (PND) identifying questions to the mother on her first pregnancy booking visit, (NICE, 2018 p1.5.4). The National Maternity Strategy 2016-2026 also instructs all Public Health Nurses (PHN) to deliver better care to mothers and babies by screening PND risk mothers within 72 hours of discharge from hospital, (Department of Health Ireland, 2016, p16). Ireland’s vision for change -mental health policy also recommended that, experienced nurse and psychiatrist have to be recruited nationally to treat pregnancy related mental health issues, (HSE-vision for change, R15.5.4 p157)In the context of maternal mental health in Ireland, it is an aim of Health Care Professionals (HCP) such as the GP, Public Health Nurse (PHN) and Midwives to prevent the most common mental illnesses which affect mother in pregnancy. Among maternal mental health issues, depression is highly common (WHO, 2019) and it may strike at any point of time during pregnancy. Postpartum Support International (PSI,2019) states that occurrence of PND is 5% higher than the Antenatal Depression (AND) In Ireland, on average15% of first-time mothers encounter PND in their birth experience, (HSE, 2019). In a study by Glavin and Leahy-Warren, 2013 PND is identified as a public health issue in Ireland and Norway needs to addressed effectively by involving PHN’s. By considering the importance of PHN and HCP to combat PND in community care level, a search was made to find out the possible intervention to prevent PND from the available literature evidences. It is strongly suggested that, Peer-support Intervention Program (PIP) could be an effective intervention to curtail PND at a community base level. This essay will carefully examine the evidence about potency of PIP and how it can be implemented among suffering mothers using health promotion model. Search tools such as PubMed and Cinahl were used to find out the literature article using key words as follows “postnatal depression”,” postpartum depression” and “peer support”. Discussion:PND is a type of depression which usually occurs in the first year after child birth, (HSE, 2019). According to WHO’s ten Essential Public Health Operation (EPHO) points, overall health of population can be improved by primary prevention and early detection of illness, (WHO-05EPHO,2019). HCP play a pivotal role in screening of PND in the community settings as a part of health promotion and primary prevention, (HSE, 2019). PIP may be considered as one of a number of interventions to prevent PND in a community care setting by HCP. A piece of advice, psychological support or motivation received from a person who has experienced the same kind of problem is called peer support, (American Mental wellness, 2019). Having been guided and educated by HCP, anyone can provide peer support including mothers or volunteers who have previously suffered from PND. In order to comprehend the effectiveness and future improvement of PIP in preventing PND, Leger et al, (2015) analyzed a few systematic and narrative reviews published between 2000 to 2010 and suggested that PIP can be effective when appropriate training provided to volunteers related to the mother’s needs. Another study done by Prevatt et al, (2018) to identify the effectiveness of PIP in preventing PND concludes that PIP provides improvement in mental health and a better plan of care to support new mothers about their changes in life after birth. However, there was no certainty about the improvement in women’s mental health, so a need for further research is suggested to justify the PIP effectiveness. A study of O’Neill et al, (2019) recorded noticeable reduction in PND after implementing PIP by three types of social groups (significant others, family and friends) to the postnatal mothers. Yet, it is advised to approach the findings with caution due to small size sample of the study. A randomized study outcome of Letourneau et al, (2015) provides that Telephone Based Peer Support (TBPS) can also be an effective intervention for PND until 24 months of postpartum period. Letourneau et al (2015) also added that, nurses have important role in assessment of maternal depression, mental wellbeing and social support. Further researches done by Shorey et al (2019) added the evidences of reduction in PND by technology -based peer support intervention, but a need to carry out more researches before implementing in community case setting. Despite there were some limitations in results, Studies done by all authors highlight that PIP can be one of the best options to prevent and reduce the occurrence of PND. Health promotion model:In terms of preventing PND, a holistic approach to implement PIP in community setting is required. There are several models and theories available for implementation of this intervention. The most common method is health promotion model. Behavior changes of an individual can be predicted by health promotion model, (Rural health information hub, 2005). Fahey et al (2013) highlighted some important points in perinatal maternal health promotion model. First of all, women are highly prone for imbalance in her health after the delivery due to physical and psychological changes that is not only related to giving birth but also due to lack of self-efficacy to the requirement of new motherhood. Following that, early detection and treatment based on health promotion model concentrating on four main life skills to achieve health and wellbeing of mother. The skills are mobilization of social skills, positive coping, self-efficacy and realistic expectation. These life skills are directly related to enhancement of mothers’ health. Another important point in health promotion model is that women can be supported during pregnancy by encouraging these life skills through educational awareness and activities. It is also suggested by Fahey et al (2013) that precise and timely awareness to women by HCP is valuable resource to utilize their health promotion skills in postpartum period, it is duty of HCP including midwife to teach the mothers about their health needs and building life skills. Atkins R. (2010) assessed single mothers about their self-efficacy using Pender’s health promotion model, having answered to the health promotion model questioners, it is said to be easy to identify depression prone mothers and prevent depression. Thus, it can be considered from the study that health promotion model could be a better model to implement PIP in community care system for the health promotion of mothers and children. Conclusion:To conclude, maternal mental health is an important zone to be monitored diligently by a country for its development towards health. Among the maternal mental health problems such as depression, psychosis and suicidal tendency, depression is highly common in pregnancy. As stated by WHO, PND is one of the most common illnesses affects women in major. Undetected and untreated PND can lead to a severe mental health illness called psychosis, (WHO,2019). In particular, depression affects postnatal mothers in a higher incidence than antenatal mother, (PSI,2019). Since PND is a public health issue (Glavin and Leahy-Warren, 2013), HCP in community-based setting has big role to play. It is understood from the available literature shreds of evidence that PIP may be an effective way to prevent PND in community bases setting despite the fact that it was not proved with complete certainty. A few studies have shown some evidences of preventing PND by technology-based PIP. Technology based PIP could be used in community-based setting where accessibility of PND prone mothers is limited. The Perinatal health promotion model cited by Fahey et al (2013) may be the best way to approach the implementation of PIP in the prevention of PND, because it concentrates on four important life skills attributing towards health of mother such as mobilization of social skills, positive coping, self-efficacy and realistic expectation. Hence, it is a cardinal duty of HCP including midwives to help mothers to understand their health needs and developing life skills as said by Fahey et al ,2013. References:Atkins R. (2010) Self-efficacy and the promotion of health for depressed single mothers. Mental health in family medicine, 7(3), 155–168.Americanmentalwellness.org. (2019). The American Mental Wellness Association » Peer Support. [online] Available at: https://www.americanmentalwellness.org/intervention/peer-support/.Euro.who.int. (2019). EPHO5: Disease prevention, including early detection of illness. [online] Available at: http://www.euro.who.int/en/health-topics/Health-systems/public-health-services/policy/the-10-essential-public-health-operations/epho5-disease-prevention,-including-early-detection-of-illness2.Fahey, J. and Shenassa, E. (2013) Understanding and Meeting the Needs of Women in the Postpartum Period: The Perinatal Maternal Health Promotion Model. Journal of Midwifery & Women’s Health, 58(6), 613-621.Glavin, K. and Leahy-Warren, P. (2013) Postnatal Depression Is a Public Health Nursing Issue: Perspectives from Norway and Ireland. Nursing Research and Practice, 2013, p.1-7.https://www.hse.ie/eng/services/publications/children/postnatal-depression-a-guide-for-mothers,-family-and-friends.pdf .Health.gov.ie. (2016). Gov.ie – National Maternity Strategy – Creating a Better Future Together 2016-2026. [online] Available at: https://health.gov.ie/blog/publications/national-maternity-strategy-creating-a-better-future-together-2016-2026/.Leger, J. and Letourneau, N. (2015) New mothers and postpartum depression: a narrative review of peer support intervention studies. Health & Social Care in the Community, 23(4), 337–348. doi: 10.1111/hsc.12125.Letourneau, N. et al. (2015) Quasi-experimental evaluation of a telephone-based peer support intervention for maternal depression. Journal of Advanced Nursing, 71(7), pp. 1587–1599. doi: 10.1111/jan.12622.Mental Health Ireland. (2019). [online] Available at: https://www.mentalhealthireland.ie/news-events/budget-2019-e84m-mental-health-allocation/ .Nice.org.uk. (2019). 1 Recommendations | Antenatal and postnatal mental health: clinical management and service guidance | Guidance | NICE. [online] Available at: https://www.nice.org.uk/guidance/cg192/chapter/1-recommendations.O’Neill P., Cycon A. and Friedman L. (2019) Seeking social support and postpartum depression: A pilot retrospective study of perceived changes. Midwifery, 71, 56–62. doi: 10.1016/j.midw.2019.01.003.Postpartum Support International – PSI. (2019) Depression During Pregnancy & Postpartum | Postpartum Support International (PSI). [online] Available at: https://www.postpartum.net/learn-more/depression-during-pregnancy-postpartum/ [Accessed 6 Oct. 2019].Prevatt, B.-S., Lowder, E. M. and Desmarais, S. L. (2018) Peer-support intervention for postpartum depression: Participant satisfaction and program effectiveness. Midwifery, 64, 38–47. doi: 10.1016/j.midw.2018.05.009.Ruralhealthinfo.org. (2005). The Health Belief Model – Rural Health Promotion and Disease Prevention Toolkit. [online] Available at: https://www.ruralhealthinfo.org/toolkits/health-promotion/2/theories-and-models/health-belief.Shorey, S. et al. (2019) Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 1): Randomized Controlled Trial’, Journal of Medical Internet Research, 21(8), p.N.PAG. doi: 10.2196/12410Shorey, S. and Ng, E. D. (2019) Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 2): Qualitative Study’, Journal of Medical Internet Research, 21(8), p. N.PAG. doi: 10.2196/12915.Who.int. (2019). WHO | Maternal mental health. [online] Available at: https://www.who.int/mental_health/maternal-child/maternal_mental_health/en/ [Accessed 6 Oct. 2019].World Health Organization. (2013). Mental health action plan 2013 – 2020. [online] Available at: https://www.who.int/mental_health/publications/action_plan/en/ World Health Organization. (2014). Social determinants of mental health. [online] Available at: https://www.who.int/mental_health/publications/gulbenkian_paper_social_determinants_of_mental_health/en/