School or Institution Name (University at Place or Town, State)
Literature Review
Introduction
The purpose of this Evidence-Based Practice (EBP) is to initiate a more structured system of treatment and educational program to these patient populations during their stay in the hospital involving other practitioners and healthcare personnel that is tailored to increase awareness to the nature of the illness. Offering both pharmacological and alternatives treatment will promote holistic care and satisfaction, promote adherence to a treatment plan, and encourage follow-ups after discharge as recommended by both psychiatry and obstetricians and family involvement. This program will also assist in making sure that everyone involved in patient care is on the same page to prevent potential health problems during hospital stay and to determining the best and safest treatment options that will reduce risk and promote good behavioral outcome during the pregnancy. Interventions for depression in the postpartum period can include pharmacological treatments, nonpharmacological treatments, and watchful waiting or no intervention. Pharmacological treatments approved by the U.S. Food and Drug Administration (FDA) for depression and bipolar disorder in the depressed or mixed phases are listed in Table 1. There are also a wide array of nonpharmacological interventions that can be used to treat depression in the postpartum period including various psychotherapies, nonpharmacological treatment, including but not limited to over-the-counter treatments, osteopathic or naturopathic treatments, herbal remedies and vitamins, all forms of psychotherapy, case management, electroconvulsive therapy, nonrepetitive and repetitive transcranial magnetic stimulation, vagal nerve stimulation, exercise, meditation, and touch therapies.
Search Strategies
In order to collect the relevant sources of information, different databases were chosen. In order to adhere to credibility and the direction provided the databases used for the collection of research articles are CINAHL, Psych INFO, PubMed, and Academic Search Premier. After accessing the search engines, some keywords were selected from the Picot questions and those keywords were used for the searching relevant information. The selected Keywords were “psychiatric treatment, pregnancy, mental health, education, and mental illness”.
Those articles were selected that have a large relevance of the required keywords, they were less than 5 years old and the articles that were having more than three authors. There were a lot of articles that were rejected because of the fewer number of the authors, a greater number of the years of publication or there was less information related to the topic. After using all these keywords in different combination all apparent relevant articles were selected. After the evaluation of all the databases, the total number of articles that were calculated was 35. Out of these 35 articles, only 10 articles were selected taking into account the criteria that was mentioned above. It is also highlighted that each of the articles was thoroughly seen so as to avoid any gap in the form of lack of publication, removed authors or without date of publications.
Literature Review Guidelines
There are some guidelines that will be used for the critical appraisal or evaluation of the literature. Firstly, all the data collected in the form of readings and different themes would be tracked by using an extraction table. After that the purpose of the conducting literature review would be determined that some objectives can be set, these objectives would be the central part so it would comprise a statement about the outcome or the population that would be focused by the review. The third step in the literature review would be the identification of the methods that would be used for identifying and checking the required information. Some of the chunks of information that are mandatory to include are the type of study, type of publication, date of the publication, location and then the language of the publication. According to Burns and Grove, modified by Gyatt, there are different levels of the literature review. Level I refers to the evidence from the systemic review and the Meta-analysis of all the relevant RCT, level II refers to the evidence that is obtained from the relevant RCT, Level III defined crisis of the well designed and controlled trials without any randomization. Level IV would have well designed short studies and case-control. While level V, compared evidence from descriptive and qualitative studies, Level VI is designated by evidence from some simple or qualitative studies and level VII refers to opinion form different authorities or the expert opinions.
Summaries of the studies
Article 1: Qualitative Research Appraisal
Elements of Research
This research is related to the impact of Antenatal care on women suffering from depression during pregnancy. This study was conducted by a team of researchers that include, Bitew T, Hanlon C, Kebede E, Medhin G, Fekadu A. All these participants are affiliated with the Nursing Department.
The study is about the impact of maternal depression and the occurrence of antenatal depression in women. The study aims at finding the impact of antennal care mixed with other pregnancy treatments that can help to treat maternal depression. Previous researches were about Antenatal care only, but this research amalgamated antenatal care with the threat of other pregnancy inspections. An important fact about the research is, this research is a primary approach to the symptoms of depression that are even visible in frequent checkups and visits to the physicians (Shea et al. 2019).
The study is quantitative and it is done by the cross-sectional survey of women who are in the third trimester of pregnancy and they live in Ethiopia. 1131 women were chosen and they were made to take part in the research. The social, perinatal and some demographic characteristics were analyzed by using statistical techniques.
The results indicated that about 29% of women were having depressive symptoms and many of the women ended their depressing in visiting to the doctors. An establishment of a system that can help for the referral and treatment of the antenatal depression can help to promote antenatal care that can promote the efficiency of the healthcare system.
Strengths and weaknesses
The data analysis method was effective enough to yield required and precise data. Statistical analysis revealed accurate figures that can be used to define the credibility of the research. Usage of Statistical Package for Social Sciences version 20 and the Stat version 13 was used for the analysis of the data that added to the precious and credibility of the research
There was an urgent sample that was taken for identification, however having a minor sample could have facilitated study. There were eight missing data such as PHQ, IPV and the accessibility to the healthcare facilities long with 1 missing LTE.
Credibility, Trustworthiness, and Meaning
The research is credible because of the diversity, mentioning of all the required information and the procedure analysis of the risk that were to be mentioned in the study. The research used accurate figures that ensured positive essence and authenticity. Confinement to the women of Ethiopia is a smart choice that added to the worthiness of the research. However, the Research tools were already used by different researchers.
Article 2: Systemic Review
Elements of the Research
The research was designed to do the systematic review of the prevalence of the depression during pregnancy in women and the more precise estimate was required to analyze the level of the burden of disease along with the strategies that are provided for the management of diabetes. The participants of the research study were Bennett, Heather A. B Pharm*; Einarson, Adrienne RN†; Taddio, Anna PhD‡; Koren, Gideon MD†§; Einarson, Thomas R. All the researchers all belonged to the Department of Obstetrics and gynecology in the United States.
The study was conducted to know about the correct ratio of the women who are suffering from depression in pregnancy and what are the depression treatments or educations that are given to the patients in the form of treatment adherence. Systematic review was used to identify and evaluate the ratio of women and the adherence to treatment, where Medline and CINAHL databases were used to get information about the women. After the collection of the data, section extraction was used to collect concerned information, Meta-analysis model was used for the integration and tabulation of the data so that data segregation can be made. Also, heterogeneity was examined with the X2 test. About 714 articles were identified and they were categorized on the basis of the trimester, age and the time of suffering from depression (Bennett et al. 2014).
From the research, it was concluded that there is a large ratio of depression patients in the women who are in their second and third trimesters of pregnancy. Moreover, different clinical and economic studies were also included to estimate fetal or mental consequences.
Strengths and Weaknesses
The article is credible and authentic resources are used. The topic was addressed and the rates and tests used for the evaluation of information were credible and they have already been used in the same type of study. The description in the form of percentiles and figures added to the clarity of the information. However, the information of the databases is missing along with the credibility of Funnel plus and Begg-Mazumdar.
Credibility, trustworthiness, and meaning
The instruments used in the study were credible in nature (with no systematic biases), and the other tools were authentic. The description of data in figures was effective. The influencing factors were all determined such as social and geographical factors.
Article 3: Systematic Review and Meta-Analysis
Research Elements
The research is related to the effect of prenatal and postnatal maternal depression. The research was conducted by HYPERLINK "https://www.sciencedirect.com/science/article/abs/pii/S0165032718308826" \l "!" Nadège Jacques Christian Loretde Molab Gary Joseph Marilia Arndt Mesenburg HYPERLINK "https://www.sciencedirect.com/science/article/abs/pii/S0165032718308826" \l "!" Mariangela Freitasda Silveiraa who belonged to different departments but gathered to do the research. The purpose of the research was to review the effect of maternal depression on the mortality of the child and the analysis of maternal depression.
Systematic review was performed by collecting data from different databases such as PubMed, and LILACS. A number of original studies were are also included in the research so that analysis can be made in a realistic manner. In this research, random-effects models were used to conduct the research which evaluated XIs in total.
From the results, it was highlighted that about 1.44 women were at the risk of getting depression because they have shown the symptoms, about 1.95% of the population of women already had depression and 1.02% was at the risk of developing depression in future (Jacques et al. 2019).
Strengths and Weaknesses
Credible databases were used for the analysis and the investigation of the studies. However, there was a small number of studies that was used, there was no authentication of the affected model and there is no solid figure that is given for the identified population and there is no particular geographic association of the participants
Credibility, trustworthiness, and meaning
The research is credible in its manner, but the overall ambiguity and anonymity are prominent that diminished the accuracy of the research. These are no sound justifications in terms of the meanings and the results because of the percentages that are found and they are fluctuating.
Article 4: Quantitative Study Critical Appraisal
Elements of Research
This research is related to the effect of medical adherence and social support system on the depressive disorder in pregnancy (Li, Goo, Jiang, Eldadah, & Zhuang, 2019). The study was conducted by a team of scientists that include Tengteng Li, Nafei Guo, Hui Jiang, Maher Eldadah, and Wei Zhuang. Among these persons, Eldadah is working at Kaweah Delta Hospital, in California. The other participants are affiliated with the Nursing Department of Shanghai First Maternity and Infant Hospital, Tongji, in Shanghai, China.
. The study aims at finding the impact of the social support system in the treatment of depressive disorders during pregnancy. The previous research says that it is not clear whether the social support system has a considerable effect on the observed Chinese women or not. The study evaluates the social supportive system (SSS) for expecting women in Shanghai and tries to identify any correlation between SSS and perinatal depression.
The study is quantitative, and it employs a self-supporting survey that is cross-sectional. To conduct the study, two thousand women in Shanghai were chosen during the second trimesters of their pregnancy. Their social, demographic, and perinatal characteristics were analyzed using descriptive statistics. Further, the level of social support provided for them as well as the degree of depression was measured using the same tools. The socio-economic groups, social support system, and perinatal factors were subjected to correlation analysis.
The results indicate that the most influential perinatal factor is 'social support by partner'. The subsequent factors with relatively less influence were 'living standards in the previous year', 'social support by the parents', 'taking part in group activities', and 'social support by friends'.
The researchers concluded that perinatal depression has a connection with the social support provided by family members and friends. It can prove to be a protective factor against depression during pregnancy. Further studies on the subject can help explore more ways to cure the illness efficiently by effectively using the social resources available in a particular case.
Strengths and Weaknesses
The items put into the scale were the perinatal factors, social support system, and depression suffered in the second trimester's pregnancy. These variables when tested against one another yielded possibly more precise results. Data analysis used descriptive statistics to provide the subsequent scores, which was further used in Pearson/Spearman correlation analysis. These procedures allowed more precision in research by providing internal consistency.
A few items were missed in the research to undergo data analysis, that is, sources from where the financial support was received, sources of technical help, sources of relief, etc. The state-of-the-art scales of measurements (such as the Edinburgh Postnatal Depression Scale) could not be used in the study.
Credibility, Trustworthiness, and Meaning
The study was conducted in a big maternity hospital in a large metropolitan city, Shanghai. The expectation of getting more varied cases on a subject is greater than the smaller cities of the country (Watson, 2015). The population selected for study was also huge, and it will probably enable the study to be more comprehensive and inclusive. It was ensured prior to the research began that patients or subjects would be able to receive instant medical aid in case of any depressive disorder risk is indicated. It was beneficial for the study to select the second trimester of pregnancy for trial. The selection limited to only Chinese ethnicity women was a smart decision to keep the study and results coherent and simple, as per the socio-cultural context. The rating scales (social support rating scale, Zung’s self-rating depression scale) used to measure the involved quantities were reliable as those scales have already been used and validated by previous researchers.
Article 5: Qualitative Study Critical Appraisal
Elements of Research
The research was designed to conduct a qualitative study of anxiety related to pregnancy in Tanzania (Rosario, et. al., 2017). The participants of research included Melanie King Rosario, Shahirose Sadrudin Premji, Elias Charles Nyanza, Shelley Raffin Bouchal, and David East. These scholars are affiliated sparsely with Faculty of Nursing at the University of Calgary, Canada; Community Health Sciences in the University of Calgary, Canada; School of Public Health in the Catholic University of Health and Allied Sciences, Tanzania; and Faculty of Social Work in University of Calgary, Canada.
The study was conducted to explore the clinical conditions, particularly medical adherence. Pregnancy-related anxiety involves worries and fears related to fetal or maternal health, the child-delivery process, and parenting the infant (Bayrampour et al., 2016). A descriptive phenomenological approach was used to design the study. Two clinics were engaged in studying the subjects in Mwanza, Tanzania. The study comprised interviews with ten women who were aged between 18 and 34 while three of them were HIV positive. These women had obtained high scores on a pregnancy-related scale during a larger quantitative study before.
The interviews given were semi-structured and contained instructions concerning the experiences and priorities of women during pregnancy. The Colaizzi method was employed using the transcripts, translated in patients’ native languages and later retranslated to English for the researchers’ purpose. The transcripts were later hand-coded by the interviewer and underwent independent review by other researchers. Themes prominent in women’s experiences during pregnancy periods were included in the pregnancy-related anxiety (PRA) scale for doing the necessary measurements.
The subjects revealed in their narratives that the PRA had many bad effects on the mother as well as the fetus. There is an always need of medical treatment in women who are pregnant because there are some autonomous feelings of anxiety, low blood sugar and depression are associated with women.
Strengths and Weaknesses
The local health professionals actively participated in the study and helped in the development of methodologies, processes, and procedures. The interviews were made easier and more comprehensive for the participating women so that they could express their feelings and experiences clearly. The research skills of the international scholars involved made it possible to develop certain instruments of study to assess information precisely. The researchers also included postpartum women along with pregnant women to conduct the study. Postpartum women can better express their PRA experiences and give more information.
While the factors considered in conducting the interviews with women derived useful information on the topic, some missing factors limited the scope of research and affected the comprehensiveness of study. People's lack of knowledge, relationship with a partner, consulting with physicians, spiritual factors, and fear of fatal diseases like HIV were not included in the measurement scales.
Credibility, Trustworthiness, and Meaning
The instruments used in the study were reliable, and the study provided some insight into the situations of women suffering from PRA during pregnancy in Mwanza, Tanzania. However, it is quite possible that much information necessary for getting full insight could not be derived. This is because of the situational and local factors involved. The women might have been reluctant to participate in the study due to their mental health condition, the involvement of the translator, etc.
Article 6: Systematic Review
Research Elements
The research is related to the identification of the prevalence and risk of the factors for the antenatal depression in Ethiopia. The research is conducted by Wondale Getinet, Tadele Amare, Berhanu Boru, Shegaye Shumet, Wubet Worku, and Telake Azale All the researchers belonged to the School of nursing and college of medicine in Ethiopia. The aims of the research is to identify the facts and figures that are associated with and related to the risks and the prevalence of the antenatal depression in Ethiopia. The systematic review was conducted by using different databases such as MEDLINE, PHQ, BDI, Google Scholar and the Embassy. 246 research paper were found and then they were analyzed out of which 210 were not relevant but only nine articles were relevant that were used for the investigation of the topic by random-effect meta-analysis. As a result of the pool, factors such as age, gender, and marital status were classified to identify the rise with antenatal depression (Getinet et al. 2018).
The study concluded that special attention should be given to the risk of depression in antenatal depression because there are several social dilemmas such as unplanned pregnancies, violence and plover are associated with the risk factors.
Strengths and Weakness
The research is a unique step but the analyzed literature was very few so there are very few factors that are covered. However, it was a new and critical insight into the factors of maternal depression.
Credibility, trustworthiness, and meaning
The research was completed in accordance with the set limits where a different database was used. Although the samples were less still, the research conveyed highly useful information.
Article 7: Randomized Control Trial
Research elements
The research includes the effect of medicines or medical adherence on maternal depression. The research was conducted by Authors Caroline A.Smith Zewdneh Shewamene Megan Galbally Virginia Schmied Hannah Dahlen. All the researchers belonged to the department of nursing. It is highlighted that depression and anxiety are very common in pregnancy but maternal depression is very serious. In order to define the adherence or the impact of a medical treatment randomized controlled study was conducted. This was conducted by using different databases such as Embase and CENTRAL. The research comprised of twenty randomized controlled trials that contained 1092 women. It was found that Acupuncture reduced depression in one trial. Massage reduced depression in one trail of 149 women and light therapy also effected few but there was no evidence of the reeducation of depression from other activities such as yoga and fish oils (Smith et al. 2019).
Strengths and weaknesses
The research study was a positive approach to the identification of the treatments that can reduce depression but there were very few high quality randomized controlled trials of complementary medicine.
Credibility, trustworthiness, and meaning
The research was credible but the addition of more trial and more data would have added to the meaning of the research.
Article 8: Quantitative research
Research Elements
This article refers to the identification of Adherence to the antihypertensive treatment for screening depression in maternal pregnancy. The reach was conducted by Authors such as HYPERLINK "https://www.sciencedirect.com/science/article/pii/S2210778919300273" \l "!" Louise M.Webstera Kate Reeda Jenny E.Myersbc CatherineNelson-Piercya Lucy C.Chappellad. All the researchers belonged to the school of nursing. The aim of the research was to undergo a quantitative study so as to analyze the use of antihypertensive medication for the screening and treatment of chronic hypertension during pregnancy. The research highlighted that adherence to the medication is one of the major barriers in the identification of the torment of the depression. The data from 74 women were taken and they were undergone chromatography time mass spectrometry instrumentation which highlights metabolite detection in 88% women (Webster et al. 2019).
The research concluded that medical treatments are required for the adequate treatment of depression during pregnancy as it is one of the major medical issues
Strengths and Weaknesses
The research uses instrumentations that were (null of biases) all the results are presented in precise and clear form although the same, is small and larger population can bring into insight some major section or variation in the population.
Credibility, truthfulness, and meaning
The research was done by using some credible resources that paved the way for the identification of correct facts and figures.
Article 9: Qualitative Research
Research Elements
The article refers to the effect of substance abuse and addiction on women in pregnancy, along with its stance. The reach was conducted by Joan Keegan DO, Mehdi Parva MD, Mark Finnegan MD, Andrew Gerson MD and Michael Belden MD, where all of the researchers belonged to the Pharmaceutical organizations. The search aimed at the abstinence from drugs in pregnancy and the impact that it can cast in the pregnant women. Qualitative research was used to analyze the impact of drugs on the addicted woman. About 15 literature were analyzed and it was concluded that there is an increased rate of the women who are an addict in the present, it is one of the reasons of depression and it can lead to the negative impact on both mother and the child. The research concluded in the negative impacts of different drugs on maternal women (Getinet et al. 2018)
Strength and weaknesses
The research was one of the positive and informative additions to the women health but it has no sequential facts and figures that can be localized in the literary addition so there is no analysis. However, analytical vision is necessary for the credibility of research
Credibility trustworthiness and meaning
The research lacks credibility because of the lack of accurate sources of information that can convey the desired results. However, few major points are deciphered.
Article 10: qualitative research
Research elements
The research is related to the impact of substance use on pregnancy. The research includes Maria A., Mascola, MD, and Ann E Bodrders. All that three researchers belonged to the Committee on Obstetrics Practice and the American Society of Addiction Medicine. The researchers' highlight that opioid and other substance use is gaining significance with the passage of time and it must be recovered. In order to provoke this, screening test of the individuals was reported that highlighted that women would take special care regarding drugs in pregnancy as it may cause serious life threats. As a result of the literature review that comprises 50 screening test, some major recommendation was made reading therapies that can abstain from drugs (Webster et al. 2019).
The research concluded in a thought full approach and series of recommendations that were meant for the women who are pregnant and they take drugs so that their children can be bro n heath and they can themselves live a healthy life.
Strengths and weaknesses
The research used screening test to evaluate practical results that may improve effective in the long run and it conveyed information regarding a large population of people. However, there is a lack of facts and figures that can embed some solid data.
Credibility, trustworthiness, and meaning
The research is credible because it is done through proper resources and it conveys a large proportion of significant information about the facts and figures that were associated with the consumption of drugs during pregnancy and how it should be mitigated.
Evaluation and Synthesis
Taking into account the information that is collected from different resources, it is highlighted that maternal depressing is one of the most significant heat issues and its roots can be localized in almost all the department of life, There are different features that are associated with maternal depression such as consumption of drugs, carelessness toward lifestyles and lack of adequate care. It is also highlighted that trimesters are its self a driver to depression so women should be taught to act in ways that can help them control depression and think in a positive way. According to one of the researchers, it is important to get screening regarding depression because it grows with the passage of time and can become life-threating ta one of the stages of life. In one of the researchers, the researchers calculated that there are different therapies that can help to rescue depression to some extent and it is one of the easiest ways to get rid of depression. According to another information source, it is highlighted the medical assistance is a necessity that is required to depression, else it can harm the life of the children. Antenatal care is also one of the basic requirements for controlling and overcoming depression because it is a plague that can affect anything in its way. Also, the people who are more towards drugs are increasing day by day especially women, so it is necessary to make efforts that can help women overcome drug usage and other substance abuse for a healthy life. In another research, it is highlighted that the screening of depression is more like a necessity because as soon as depression is screened, efforts from its treatments can be made and the life of women can be saved.
Recommendation
There are a lot of recommendations that can be brought into practice, in order to address the negative factors that are associated with drug use and then its impact on maternal depression. The only positive and workable recommendation is awareness and teaching. It is something that can not only help women become aware of their significance but it can help them develop awareness and knowledge about the significance of the life of their children which can ultimately help to overcome maternal depression.
References
Avalos, L. A., Flanagan, T., & Li, D. K. (2019). Preventing Perinatal Depression to Improve Maternal and Child Health—a Health Care Imperative. JAMA pediatrics, 173(4), 313-314.
Bayrampour, H., Ali, E., McNeil, D. A., Benzies, K., MacQueen, G., & Tough, S. (2016). Pregnancy-related anxiety: A concept analysis. International Journal of Nursing Studies, 55, 115–130.
Bennett, H., Einarson, A., Taddio, A., Koren, G., & Einarson, T. (2014). Prevalence of Depression During Pregnancy: Systematic Review. Obstetrics & Gynecology, 103(4), 698-709. doi:10.1097/01.aog.0000116689.75396.5f
Getinet, W., Amare, T., Boru, B., Shumet, S., Worku, W., & Azale, T. (2018). Prevalence and Risk Factors for Antenatal Depression in Ethiopia: Systematic Review. Depression Research And Treatment, 2018, 1-12. doi:10.1155/2018/3649269
Jacques, N., de Mola, C., Joseph, G., Mesenburg, M., & da Silveira, M. (2019). Prenatal and postnatal maternal depression and infant hospitalization and mortality in the first year of life: A systematic review and meta-analysis. Journal Of Affective Disorders, 243, 201-208. doi:10.1016/j.jad.2018.09.055
Li, T., Guo, N., Jiang, H., Eldadah, M., & Zhuang, W. (2019). Social support and second-trimester depression. Midwifery, 69, 158–162.
Robinson, R., Lahti-Pulkkinen, M., Heinonen, K., Reynolds, R. M., & Räikkönen, K. (2019). Fetal programming of neuropsychiatric disorders by maternal pregnancy depression: a systematic mini review. Pediatric research, 85(2), 134-145.
Shea, A., Murphy, K., Dalfen, A., Snelgrove, J., & Wang, D. (2019). PHARMACOGENETICS AND THE NEONATAL ABSTINENCE SYNDROME FOLLOWING MATERNAL ANTIDEPRESSANT USE IN PREGNANCY. Journal of Obstetrics and Gynaecology Canada, 41(5), 733.
Smith, C. A., Shewamene, Z., Galbally, M., Schmied, V., & Dahlen, H. (2019). The effect of complementary medicines and therapies on maternal anxiety and depression in pregnancy: A systematic review and meta-analysis. Journal of affective disorders, 245, 428-439.
Webster, L., Reed, K., Myers, J., Burns, A., Gupta, P., & Patel, P. et al. (2019). Quantifying adherence to antihypertensive medication for chronic hypertension during pregnancy. Pregnancy Hypertension, 17, 12-14. doi:10.1016/j.preghy.2019.05.004
