Introduction and Bio-psycho Social Model of Postnatal Depression

Effect of Postnatal Depression 

Postnatal depression (PND) has a profound effect on maternal mental and physical wellbeing. Postnatal Depression refers to a kind of depression that parents specifically mothers experience after giving birth. The issue of PND is globally widespread; according to the Science Direct report, the 121 million mothers are affected world widely after giving birth.

The WHO reported (2018) that around 13% of women experience postnatal depression after childbirth. The ratio of PND has been reported even higher in developing countries, i.e., 19.8%.

The CDC reports (2017) suggested that in the United States about 11-20% of mothers experience the postnatal depression symptoms after childbearing (World Health Organization, 2018).
In short, 4 million live the childbirths occur each year, and around 600,000 of mothers encounter postpartum depression. 

 In the past decades the postnatal depression (PND) has been associated mostly with mothers, but the recent studies indicated the PND also exists in men. Some studies proposed that 4 to 25 percent of fathers suffer from PND immediate after childbirth (Wittchen, Becker, Lieb, &  Krause, 2002). The ratio of Postpartum depression is significantly higher among mothers. Therefore, the current project aims to highlight the etiology, diagnosis, prognosis and management plan to overcome the current alarming situation. 

How to Diagnose the Postnatal Depression?

The woman who suffers from postnatal depression finds difficulty in assessing the symptoms of the PND. They suffer from lack locus of control as they are in denial of what they are going through they may lack insight and knowledge of how out of control their depression has gotten (Thompson, & Fox, 2010). Postnatal depression (PPD) is a state in the psychiatric catalog refers to a significant depressive episode start within the first four weeks of childbearing. The current study aims to provide a clear conceptual framework about the signs, symptoms, risk factor and intervention of PND (Guille et al., 2013). 

Although there is plenty of broacher and booklet are available for the awareness of Postnatal depression, but the current product defines the risk factor regarding Bio-psycho and social model with the critical statistic and management plan (Wittchen, Becker, Lieb, &  Krause, 2002).
The product will make the women able to identify their abnormal mental and physical states and suggest a collaborative work of postnatal women and psychiatrist or psychologist to overcome the problem. 

Symptoms of Postnatal Depression

Childbirth is a significant life event, and women experience the full range of emotions during and after childbearing. The intense reactions and emotions might cause mental health problems such as anxiety and depression. Women express numerous symptoms after childbirth, which are quite overwhelming d interrupt the child health care process (Thompson, & Fox, 2010). 

The postpartum depression symptoms may define emotional, physical, cognitive and behavioral categories. The emotional symptoms comprised of feeling sad, despairing, cry a lot or inability to cry, mood swings, feeling ups and down, loss of interest/pleasure, and enjoyment, and careless attitude towards the baby (Guille et al., 2013). The physical signs indicate lack of energy, sleep disturbance, agitated, irritability, eating much or less and loss of interest in sex.

The cognitive symptoms refer the distort thought patterns such as criticizing self (I am not a good mother), jumping to conclusion (I am responsible for this mess), thought about other and the world (nobody cares for me or loves me). The distort thinking also causes poor concentration, inability to make the decision and cluttered thoughts (Wittchen, Becker, Lieb, &  Krause, 2002). The behavioral symptoms signify the putting off making the decision, shouting, more argumentative, avoiding an everyday task, and people. 

What is Bio-psycho Social Model of Mental Health or Postnatal Depression

The etiology of postnatal depression is inconsistent and ambiguous. A substantial body of researches proposed diverse etiological models. However, no single theory can clarify this phenomenon. The boi-psycho social model of health better explains the risk factors for postnatal depression. The bio-psycho social model in counselling for depressed patients has significant importance in literature. The bio-psycho social approach in psychology categorized the etiological factors in biological, social and psychological segments. The biological approaches stressed that the medical model of PND is an imperative theoretical model, which evaluate illness results from biological imbalance.

Biological Model

According to biological model parents, specifically, mothers are passive individuals towards biological factors and suffer more from depressive episodes in critical periods during their lifespan. The biological model put forward different theories regarding pathophysiological hormonal effects after child birth (Abiodun, 2016).  These theories comprised of the withdrawal theory, interaction among HAP system (hypothalamic pituitary adrenal) and the hypothalamic pituitary gonadal system and alteration in the level of gonadal hormones (Vigod, Villegas, Dennis, & Ross, 2010).

During the initial stage of pregnancy, the interaction between the women reproductive system and hypothalamic pituitary adrenal axis alters. According to some studies, those mothers who suppress the corticotrophin-releasing hormone (CRH) during a postnatal depression, their HPA axis found functions differently that leads to affective disorder. In contrast, other studies reject the hypothesis that corticotropin-releasing hormone suppression correlates with affect/mood fluctuation. Due to the contradiction in literature, the hypothalamic pituitary adrenal axis in the physiology of PND is possibly not authentic (Wittchen, Becker, Lieb, &  Krause, 2002).

The sudden and rapid high or low alteration in hormones such as progesterone, human chorionic gonadotrophin, beta-endorphin, cortisol increase, and estrogen during pregnancy leads to PND (Guille et al., 2013). Moreover, the main cause of PND considered being a rapid decline in reproductive hormone levels after childbirth. According to the experimental study, the depressed group reported the reduced estradiol plasma levels as compared to the control group.
The neurotransmitters are interlinked with hormones such as Estrogen and progesterone that effects the emotional and cognitive processes. The estrogen controls the serotonin level that effects the mood and stress before during and after pregnancy. The level of estrogen varies before menstruation, during menopause, and after delivery (Guille et al., 2013). This variation of estrogen effect the serotonin functioning as well, as a result, the individual suffers from depression and mood disorder.  Similarly, the gonadal hormone also plays a significant role in developing or decreasing the symptoms of depression during pregnancy.

The decreased amount of gonadal hormones have been found to be associated with nonpsychotic and psychotic mental illness. However, the other contradictory research findings have not found any relationship between hypogonadal levels of progesterone or estrogen and the risk factor for PND
(Abiodun,  2016).

The postnatal depression is also associated with serotonin (5HT) system as depressed mothers reported wellness after taking to serotonergic antidepressants. According to the experimental study, 5HT1A serotonin receptor binding reduced around 28% in the experimental group than the control group (Vigod, Villegas, Dennis, & Ross, 2010).

Although, numerous studies and scholars have recommended physiological causes the PND, the genetic basis of gonadal steroids leftovers uncertain. The genetic polymorphisms control reproductive hormones may prepare several women vulnerable to mood disorders. In short, a unified conclusion has not been acquired due to negation in findings. It comes into view that the hormonal alteration causes the abnormal internal reaction that further leads to PND.

The Psycho-social Factors

The psycho-social factors indicate the risk factor that the self-structured. The social factors lead to psychological problems and are interrelated at high scale. The women age at the time of childbirth has been a topic of discussion by the researchers for an extended period to investigate the risk factors of PND. The result of studies varies as a few studies support the hypotheses that the younger mother suffers PND more than she suffers older age women.While the other studies indicate that older age, women experience more depressive symptoms after childbirth compared to the younger one. Some literature suggests that no relationship exist between maternal age and risk for PND (Thompson, & Fox, 2010).   

Some other social factor such as literacy rate, low socioeconomic status, substance/alcohol and drug abuse, lack of partner interest and support, stressful life event, death in family, single parenting, sexual abuse, violence, loneliness, and unemployment, have been studied and the outcomes projected the healthy relationship with PND (Guille et al., 2013).
Obesity is also an essential factor frequently associated with anxiety and depression disorders. The insufficient amount of evidence does not support the hypothesis that obesity enhances the risk for depressive disorders (Abiodun,  2016). However, the recent studies suggest that strong association exist between obesity and PND.

 Another central and controversial issue for newly delivered mothers PND interlinked with the gender of the neonate. The Literature is grounded with the studies that proposed mixed results. In the eastern countries if a woman gives birth to a girl, indicate more vulnerability to PND. On the other hand, in the culture of French, the finding put forward the fact that mothers giving birth to boys are more prone to develop PPD.  

The western societies have mixed gender preferences, such as Sweden is a country support the gender equality. As a result, mother found to be least influenced by the possible advantages or disadvantage of having a female offspring (Young, Midgley, Carlson, & Brown, 2000).
Multiple factors may cause PND is the Obstetric and gynecological aspect of pregnancy. The experience of unplanned pregnancy, cesarean section delivery, nausea and other complication during pregnancy have been debated as impending risk factors for PND (Wittchen, Becker, Lieb, &  Krause, 2002). 

Breastfeeding has also been a subject of interest that revolves around the bonding between mother and infant. Some studies point to the inverse correlation between decreased breastfeeding and enlarged risk for PND. The researchers believed that breastfeeding difficulties among mothers heighten the risk for PND. Sleep disturbance has also found to be a risk factor of PND as according to a study that insufficient amount of sleep during the first month of postpartum is probably linked with a privileged risk for PND (Young, Midgley, Carlson, & Brown, 2000). 

It is admitted fact that of sleep quality assessment is complicated in the postpartum period; due to the mismatch between mother-infant sleep cycle differences. Also, the sleeping patterns are too hard to interpret in patients, as depression is equally associated with both hypersomnia and insomnia. The substantial study indicates that sleep disturbance leads to depressive symptom and mood disorder after childbearing.

The premenstrual symptoms have been investigated about PND. Premenstrual signs are widespread among 80% fertile of women, and some women experience premenstrual disorders that are divided into two categories, PMS (premenstrual syndrome) and PMDD (premenstrual dysphoric disorder.
The diagnosis of the premenstrual disorders requires at least five physical or mood oriented symptoms that deteriorate the woman’s functioning at work or home. 

Premenstrual disorders increased the risk for mental, psychological, psychiatric illness. Literature is enriched with the facts that premenstrual symptoms increased the likeliness to PND. The prevalence rate of PND has been reported 30-75% in women diagnosed with PMDD in the past.
Although the bio-psycho-social model of postnatal depression better explains the risk factor/etiological framework of post-partum depression, still literature is full of gaps in providing an authentic scientific conceptual framework (Abiodun,  2016).

The above bio-psycho social model example helps in designing the management plan such as the ABC model of behavior, thought the record, problem-solving techniques, and balancing might be helpful in the modification of illogical or irritated thoughts. Literature recommended that the comparison between the bio-psycho social model of health advantage and disadvantage provides a clear picture regarding its implication and significance in clinical as well as research field. According to Cognitive Behavior Therapy, the dysfunctional or automatic thoughts leads to the disorganized feeling that further leads to unpleasant actions (Vigod, Villegas, Dennis, & Ross, 2010). 

For example, if a mother has automatic negative thoughts that she is not the useful mother, this thought may lead to negative feeling such as the feeling of low self-esteem, or worthless, and irritable mood that further affect the behavior of the mother. She starts paying no attention to her kids. As a result, the child may suffer from lack of attention and child neglection (Abdollahi et al., 2011). The proper guidance help to control the undesired situation and CBT proposed numerous techniques such as ABC model of behavior, thought the record, problem-solving techniques, and balancing.