Postpartum depression, delayed maternal adaptation, and mechanical infant caring: a phenomenological hermeneutic study

BACKGROUND: With 10-15 percent of mothers experiencing postpartum depression this mental health problem is a significant public health issue. One concern is that normal infant development is at risk. Understanding how Postpartum depression impacts on mothering is important knowledge in managing this health problem. OBJECTIVES: To: Explore what is it like to become a mother, and examine how postpartum depression impacts on maternal adaptation. DESIGN: A hermeneutic approach was used guided by the philosophical works of Heidegger and Gadamer SETTING: A relatively affluent metropolitan area, including surrounding rural areas within Australia. PARTICIPANTS: Via purposeful, maximum variation sampling, eleven women who had been medically diagnosed with postpartum depression following childbirth but who were not experiencing psychosis participated in the study. METHODS: In-depth interviews and reflective journaling. RESULTS: Mothers with postpartum depression become "stuck" in a liminal state, an incomplete process of the rite of passage. Therefore, adaptation to the social role of a mother was found to be delayed. Additionally, a delay in becoming competent in parenting skills was evident. A lack of maternal-infant attachment was noted, however, mothers continued to care for their infants but in an unthinking manner that was labelled "mechanical infant caring". CONCLUSIONS: The distress caused by the delay in adapting to being a mother could be addressed by providing a mentor to at-risk women. The mentor should be a mother who has previously recovered from postpartum depression and would act as a symbol of hope. Additionally, on-going education and the insight that occurs during the liminal phase can facilitate mothers with postpartum depression to adapt appropriately.     

Adolescents coping with mood disorder: a grounded theory study

A grounded theory methodology was used to explore the phenomenon of coping as experienced by adolescents with a mood disorder. Mood disorders among children and adolescents are more persistent than previously thought and have numerous negative associated features, including further episodes of depression, impaired social, academic and vocational relationships, use of alcohol and other drugs, and an increased risk of suicide. Current literature offered little awareness of how adolescents cope with a mood disorder, as well as their perspective of how such an illness impacts their lives. A substantive theory regarding the process of coping for adolescents with a mood disorder was generated from the data collected from one male and eight female adolescents. Using grounded theory coding procedures, a four-phase coping theory identified by the categories feeling different, cutting off connections, facing the challenge/reconnecting, and learning from the experience was developed. The core category identified in this research was An Unplanned Journey: Coping Through Connections. Implications identified for nursing practice, research and education included greater attention on the prevention of adolescent mood disorder, and the education of adolescents about the development and enhancement of healthy coping skills.     

The problem drinker's lived experience of suffering: an exploration using hermeneutic phenomenology

Research in the area of problem drinking has traditionally relied on quantitative methodologies which view the problem from the researcher's perspective. The purpose of this hermeneutic-phenomenological study was to describe and understand the problem drinker's lived experience of suffering using a philosophy and research approach which preserves the uniqueness of the experience from the sufferer's point of view. The method involved conducting in-depth interviews with a sample of six problem drinkers. Interviews were analysed using an interpretive process, which aimed at generating a deeper understanding of the topic by facilitating a fusion of the world views of both participant and researcher. A reflexive journal recorded the involvement of the self of the researcher throughout the research process. Suffering was viewed as a spiralling vicious circle of physical, psychological, social and spiritual distress. Symptoms of physical dependence, shame and guilt emerged strongly as being both sequelae of heavy drinking and cues to further drinking bouts. Evoking memories of previous suffering through telling one's story was found to be an empowering and motivating force. The results have relevance to specialist and generic workers, who are urged to pay greater attention to the social, psychological and spiritual care of problem drinkers.     

Graphical exploration of dimensions of preterm infant growth in weight in association with biological, nutritional, and energy expenditure conditions

The small sample sizes of studies involving preterm infants limit the use of statistics for examination of multivariate conditions contributing to clinically important growth dimensions of weight: rate of weight gain, body composition (fat-free and fat mass), and weight relative to reference infants (z score). The authors used graphical analyses, including multivariate proportional matrix, parallel coordinates, and bivariate plots with regression lines and splines, to explore specific variables derived from a theoretical model of biological, nutritional intake, and energy expenditure conditions influencing growth dimensions. The sample included 28 infants in 4 birth-weight categories: extremely low (<1,000 g), very low/smaller (1,000-1,249 g), very low/larger (1,250-1,499 g), and low (1,500-1,750 g). The authors examined the rate of weight gain before and after nipple feeding initiation. Fat-free mass was estimated with total body water and fetal reference data, and fat mass with skinfold thicknesses. Despite infants achieving the expected rate of weight gain for a fetus of the same postconceptional age, by hospital discharge 13 infants showed growth restriction with weight <10th centile. Infants with respiratory distress syndrome history were highest in negative z-score change from regain of birth weight to discharge, despite higher ordering on protein intake and fat-free mass. Graphical analyses provided visual patterns of distributions and orderings of measures of multiple variables that, taken together, identified potential influencing conditions and raised questions for further study. Other variables, including feeding protocols and practices, infant feeding competence, and health status, may contribute to variability in weight growth dimensions and influence relationships with biologic, nutritional, and energy expenditure conditions.     

Mothers'' working models of infant feeding: description and influencing factors

This study examined four aspects of mothers' working models of infant feeding: (1) infant behaviour that cues feeding decisions; (2) infant self-regulative behaviour; (3) importance of infant self-regulative behaviour and maternal effort directed to it; and (4) maternal effort and value given to task-oriented and efficient feeding. The relation of these aspects to maternal experience, age, formal education, family income, and feeding method was also explored. Subjects were 122 mothers of healthy, term infants between 14 and 60 days old. A telephone interview obtained demographic and attribute data and assessed the four aspects with 30 scaled items. Crying before and sleepiness during feeding were relatively compelling cues for maternal action. Most mothers gave only moderate ratings to the importance of infant self-regulative behaviour and to task-oriented and efficient feeding. Parity and feeding method affected response to specific items, with primiparae more concerned about length and regularity of feedings. Mothers who bottle-fed their infants were more concerned about maintaining a feeding once initiated than mothers who breast-fed their infants. Four-factor analysis yielded two item clusters with good internal consistency: Cluster a. Maternal Effort to Accomplish Feeding Goals; and Cluster b. Importance of Infant Self-Regulative Behaviour. Cluster a. and b. were strongly correlated. Feeding method influenced both clusters, and the interaction of parity and feeding method had an effect on Cluster a. Mothers with lower family income had higher scores on Cluster b; multiparae with lower family income on Cluster a. How and when infant self-regulation develops as a goal is a question in need of study.     

Drowsiness and poor feeding in a breast-fed infant: association with nefazodone and its metabolites

OBJECTIVE: To investigate whether adverse effects in a premature neonate could be attributed to nefazodone exposure via breast milk. CASE SUMMARY: The breast-fed white infant (female, 2.1 kg, 36 weeks corrected gestational age) of a 35-year-old woman (60 kg) taking nefazodone 300 mg/d was admitted to the hospital because she was drowsy, lethargic, unable to maintain normal body temperature, and was feeding poorly. A diagnosis of exposure to nefazodone via breast milk was considered only after other more likely diagnoses had been excluded. After breast feeding was discontinued, the infant's symptoms resolved slowly over a period of 72 hours. The maternal plasma and milk concentration-time profiles for nefazodone and its metabolites, triazoledione, HO-nefazodone, and m-chlorphenylpiperazine, were quantified by HPLC. The calculated infant dose for nefazodone and its active metabolites (as nefazodone equivalents) via the milk was only 0.45% of the weight-adjusted maternal nefazodone daily dose. DISCUSSION: Our data suggest a putative association between maternal nefazodone ingestion and adverse effects in a premature breast-fed neonate. The measured amount of drug exposure would normally be considered safe in a full-term infant. However, there was a temporal relationship between resolution of adverse effects in the infant and cessation of breastfeeding. CONCLUSIONS: This case highlights the importance of individualizing the risk-benefit analysis for exposure to antidepressants in breast milk, especially when dealing with premature neonates.     

Ultrasonography in the jaundiced infant: a new approach

Diagnostic ultrasonography plays a major role in the evaluation of jaundiced infants. Seventeen such infants were studied in both fasting and post-prandial states. The gallbladder and biliary tract were evaluated to define features most useful in distinguishing children with biliary atresia from those with other causes of jaundice. Demonstration of a decrease in gallbladder size following feeding virtually eliminates the diagnosis of biliary atresia, even in children with abnormal HIDA scans.     

Metabolic syndrome and childhood trauma: Also comorbidity and complication in mood disorder

Studies for prevalence and causal relationship established that addressing comorbidities of mental illnesses with medical disease will be another revolution in psychiatry. Increasing number of evidence shows that there is a bidirectional connection between mood disorders and some medical diseases. Glucocorticoid/insulin signal mechanisms and immunoenflammatory effector systems are junction points that show pathophysiology between bipolar disorder and general medical situations susceptible to stress. A subgroup of mood disorder patients are under risk of developing obesity and diabetes. Their habits and life styles, genetic predisposition and treatment options are parameters that define this subgroup. Medical disease in adults had a significant relationship to adverse life experiences in childhood. This illustrates that adverse experiences in childhood are related to adult disease by two basic etiologic mechanisms: (1) conventional risk factors that actually are compensatory behaviors, attempts at self-help through the use of agents and foods; and (2) the effects of chronic stress.     

Mothers' mood and perceptions regarding their preterm infants' behavioral state following a feeding intervention

A 2 × 3 repeated measures design was used with 22 mother–infant dyads to examine infants' state behavior, mothers' mood and perceptions immediately following and 1 week after a 7-day developmental intervention.During feeding infants who received a 1-week intervention showed less variability in their state behavior at 1-week post intervention (F = 11.61, df = 1, p = .003) and across time (F = 7.401, df = 2, p = .002) than control infants.The intervention and control groups' scores on the Positive PANAS and the intervention groups' scores on the Negative PANAS were related to infant state behavior at Time 2. Infant state behavior for the intervention group was related to mothers' perceptions at T₂.After feeding, infants' state behavior was related to mothers' perception at T₂ and scores on the negative PANAS at Time 3. Mothers' mood and perception were related at T₂ for the intervention group.