User:Wilsonk05/Postpartum depression

Paternal postpartum depression has not been studied as intently as its maternal counterpart. However, postpartum depression affects 8 to 10% of fathers. In men, postpartum depression is typically defined as "an episode of major depressive disorder (MDD) occurring soon after the birth of a child". The cause may be distinct in males. There are no set criteria for men suffering from postpartum depression. Symptoms of postpartum depression in men are extreme sadness, fatigue, anxiety, irritability, and suicidal thoughts. Postpartum depression in men is most likely to occur 3–6 months after delivery, and is correlated with maternal depression, meaning that if the mother is experiencing postpartum depression, then the father is at a higher risk of developing the illness as well. Causes of paternal postpartum depression include hormonal changes during during pregnancy, which can be indicative of father-child relationships. For instance, male depressive symptoms have been associated with low testosterone levels in men. Low prolactin, estrogen, and vasopressin levels have been associated with struggles with father-infant attachment, which can lead to depression in first-time fathers. Postpartum depression in men leads to an increase risk of suicide, while also limiting healthy infant-father attachment. Men who experience PPD can exhibit poor parenting behaviors, distress, and reduce infant interaction. Reduced paternal interaction can later lead to cognitive and behavioral problems in children. Children as young as 3.5 years old experience problems with internalizing and externalizing behaviors, indicating that paternal postpartum depression can have long-term consequences. Furthermore, if children as young as two are not frequently red to, this negative parent-child interaction can have a harmful impact on their expressive vocabulary. Screening for postpartum depression is critical as up to 50% of cases go undiagnosed in the US, emphasizing the significance of comprehensive screening measures. In the US, the American College of Obstetricians and Gynecologists suggests healthcare providers consider depression screening for perinatal women. Additionally, the American Academy of Pediatrics recommends pediatricians screen mothers for PPD at 1-month, 2-month and 4-month visits. However, many providers do not consistently provide screening and appropriate follow-up. For example, in Canada, Alberta is the only province with universal PPD screening. This screening is carried out by Public Health nurses with the baby's immunization schedule. In Sweden, Child Health Services offer a free program for new parents that includes screening mothers for PPD at 2 months postpartum. However, there are concerns about adherence to screening guidelines regarding maternal mental health. The Edinburgh Postnatal Depression Scale, is used within the first week of their newborn being admitted. If mothers receive a score less than 12 they are told to be reassessed because of the depression testing protocol. It is also advised that mother's in the NICU to get screened every four to six weeks as their infant remains in the neonatal intensive care unit. Mothers who score between twelve and nineteen on the EPDS are offered two types of support. The mothers are offered LV treatment provided by a nurse in the NICU and they can be referred to the mental health professional services. If a mother receives a three on item number ten of the EPDS they are immediately referred to the social work team as they may be suicidal.

It is critical to acknowledge the diversity of patient populations diagnosed with postpartum depression and how this may impact the reliability of the screening tools used. There are cultural differences in how patients express symptoms of postpartum depression; those in non-western countries exhibit more physical symptoms, whereas those in western countries have more feelings of sadness. Depending on one's cultural background, symptoms of postpartum depression may manifest differently, and non-Westerners being screened in Western countries may be misdiagnosed because their screening tools do not account for cultural diversity. Aside from culture, it is also important to consider one's social context, as women with low socioeconomic status may have additional stressors that affect their postpartum depression screening scores. Sexual orientation has also been studied as a risk factor for PPD. In a 2007 study conducted by Ross and colleagues, lesbian and bisexual mothers were tested for PPD and then compared with a heterosexual sample group. It was found that lesbian and bisexual biological mothers had significantly higher Edinburgh Postnatal Depression Scale scores than did the heterosexual women in the sample. Postpartum depression is more common among lesbian women than heterosexual women, which can be attributed to lesbian women's higher depression prevalence. Lesbian women have a higher risk of depression because they are more likely to have been treated for depression and to have attempted or contemplated suicide than heterosexual women. These higher rates of PPD in lesbian/bisexual mothers may reflect less social support, particularly from their families of origin and additional stress due to homophobic discrimination in society. Rates of PPD have been shown to decrease as income increases. Women with fewer resources may be more likely to have an unintended or unwanted pregnancy, increasing risk of PPD. Women with fewer resources may also include single mothers of low income. Single mothers of low income may have more limited access to resources while transitioning into motherhood. These women already have fewer spending options, and having a child may spread those options even further. Low-income women are frequently trapped in a cycle of poverty, unable to advance, affecting their ability to access and receive quality healthcare to diagnose and treat postpartum depression. Those with PPD come across many help-seeking barriers, including lack of knowledge, stigma about symptoms, as well as health service barriers. There are also attitudinal barriers to seeking treatment, including stigma. Interpersonal relationships with friends and family, as well as institutional and financial obstacles serve as help-seeking barriers. The history of mistrust within the United States healthcare system or negative health experiences can influence one's willingness and adherence to seek postpartum depression treatment. Cultural responses must be adequate in PPD healthcare and resources. Representation and cultural competency are crucial in equitable healthcare for PPD. Different ethic groups may believe that healthcare providers will not respect their cultural values or religious practices, which influences their willingness to use mental health services or be prescribed antidepressant medications. Additionally, resources for PPD are limited and often don’t incorporate what mothers would prefer. The use of technology can be a beneficial way to deliver mothers with resources because it is accessible and convenient.