ETD Collection

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    Factors associated with postnatal depression at Levai Mbatha Community Healthcare Centre Evaton, Sedibeng District
    (2019) Phukuta, Nyundu
    Introduction Depression is a significant cause of disability globally, and approximately one in five women will experience an episode of depression during pregnancy and/or the postnatal period. Despite it being a common postnatal psychiatric condition with an important impact on not only the mother and child but also the family, postnatal depression (PND) has received only little attention in developing countries. This study aimed to determine the point prevalence and factors associated with PND among postnatal mothers attending Levai Mbatha clinic, in Gauteng South Africa. Method This cross-sectional study was conducted among 227 consecutively recruited mothers who attended the postnatal clinic. A researcher-administrated Edinburg Postnatal Depression Scale (EPDS) questionnaire was used to collect information on mothers’ mental state. In addition, socio-demographic and clinical information was also obtained. Analysis was done using descriptive statistics, chi square test and logistic regression. A score of more than 13 on the EPDS was considered positive for PND. Results Participants’ mean age was 27 years. More than half (52.4%) did not complete secondary school education, were single (55.5%), and employed or had an employed partner (60%). Using the EPDS, the point prevalence of PND was 38.8%. Most participants had no medical illness (67%) or previous PND (97%), were breastfeeding (88%), and had an unplanned pregnancy (58%). More than a third had a negative view of pregnancy or the sex of the child (37% and 34%, respectively). Most participants reported having had a favorable delivery (93%), were in a monogamous relationship (85%), and were financially supported by their partner or family (85%). Mothers who only completed primary school were significantly more likely to have PND (OR: 9.11; 95% CI: 1.03-80.22) than others. Mothers who used contraceptive methods prior falling pregnant were twice more likely to have PND compared to those who did not (OR: 2.05; 95% CI 1.12-3.72; p= 0.019). The likelihood of having PND was significantly lower for the mothers who iv had a relationship with the father of the index child compared to mothers who did not have relationship with the father of the index child (OR: 0.42; 95% CI 0.18-0.94; p= 0.037). Mothers who had ever thought of harming themselves or the baby were 22 times more likely to have PND. Conclusion This study found that PND is highly prevalent in the study setting. While this underscores the need for routine screening for PND in the parturient in the postpartum period, interventions aimed at addressing PND need to be cognizant of the influence of unstable relationship between the mother and the father, low level of education, contraception failure and thoughts of self-harm on the development, assessment and management of PND.
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    The effects of including nurse-led cognitive behavioural therapy groups compared to a standard nursing programme for inpatients with mood disorders
    (2017) Visagie, Hester Maria Petronella
    Background: The delivery of cost effective quality mental health care services pose a significant challenge in the South African public sector due to limited resources and unequal access to specialised mental health care services. Professional mental health care nurses are well placed to provide psycho-social interventions, seeing that they play a vital role in the nursing care processes and as part of the multi-disciplinary inpatient treatment team. Cognitive behavioural therapy is described as the psychological therapy with the most solid evidence base pertaining to efficacy and effectiveness when treating mood disorders, specifically depressive disorders (Westbrook, Kennerley and Kirk, 2011:18). Anecdotal reports from patients and nursing personnel highlighted limited therapeutic interventions. Despite available evidence, cognitive behavioural group therapy does not form part of standard nursing care programmes in inpatient units for patients with mood disorders and depressive disorders. Aim and objectives: The purpose of the study was to examine whether nurse-led cognitive behavioural therapy groups in the standard nursing care programme would promote change in the core beliefs, coping behaviour and depressive symptoms of patients admitted to an inpatient unit for mood disorders and depressive disorders. The objectives were to: To obtain base-line data of the patient outcomes before and after the standard nursing programme; to compile appropriate measurable evidence based intervention for patients with mood disorders and depressive symptoms (Nurse-led Cognitive Behavioural Therapy Manual); examine whether statistically significant differences exist between the standard nursing programme and the nurse-led CBT nursing programme; assess the effectiveness of the nurse-led CBT group intervention programme and to discuss the field notes and supporting observations made during the intervention programme and recommendations for psychiatric nursing practice in the unit and future research. Method: A quantitative, quasi-experimental design was utilised (pre-test / post-test with a control group and experimental group). A non-probability convenient sampling method was used to select patients who were admitted with mood disorders and depressive symptoms from April 2015 to November 2015 (n=35) to participate in the study. One group (Control group, A) received the standard nursing programme and treatment as usual. Group (B) received the nurse-led cognitive behavioural group therapy sessions (experimental group). The validated and tested Beck Depression Inventory Scale - BDI was applied to assess and measure the existence and severity of depressive symptoms. The BDI scale consists of 21 iv questions and measured symptoms of depression according to categories relating to cognitive, affective, somatic and behavioural domains. Results: Although the statistically significant differences between groups were small and therefore could not be generalised to a larger population, the results were important for clinical practice. According to the findings of this study, there is a higher prevalence of mood disorders and depressive disorders amongst single, older and white Afrikaans-speaking females, which are not only important for practice but also for future planning and research. Relevance of the study: The results of this study showed that nurse-led cognitive behavioural (CBT) group sessions had positive effects on the patient‟s well-being by relieving the symptoms of depression and to provide the opportunity to develop life skills. Participation and facilitation of the nurse-led CBT groups‟ added value to professional mental health care nursing practice and the therapeutic milieu.