Conceptualizations of Postpartum Depression by Public-Sector Health Care Providers in Mexico

Abstract

In this article we describe the knowledge frameworks that 61 physicians, nurses, social workers, and psychologists from five public-sector health care facilities in Mexico used to conceptualize postpartum depression. We also demonstrate how providers applied social and behavioral antecedents in their conceptualizations of postpartum depression. Using grounded theory, we identify two frameworks that providers used to conceptualize postpartum depression: biochemical and adjustment. We highlight an emerging model of the function of social and behavioral antecedents within the frameworks, as well as the representation of postpartum depression by symptoms of distress and the perception among providers that these symptoms affected responsibilities associated with motherhood. The results provide a foundation for future study of how providers' conceptualizations of postpartum depression might affect detection and treatment practices and might be useful in the development of training materials to enhance the quality of care for women who experience any form of distress in the postpartum period.

Healthcare Practitioners’ Views of Postnatal Depression: A Qualitative Synthesis

“…Most commonly, PND were discussed based on the signs and symptoms by the HCPs. These HCPs mainly detected PND from the observational or empirical signs, such as withdrawal, sadness, lack of interest in the infant and weight loss (Heneghan et al 2007;Mivsek et al 2008;Junior et al 2013;Agapidaki et al 2014;Place et al 2015). On the other hand, some HCPs conceptualized PND based on the impacts it could have on the functioning and well-being of the women, the childand the family (Lloyd & Hawe 2003).…”

“…On the other hand, some HCPs conceptualized PND based on the impacts it could have on the functioning and well-being of the women, the childand the family (Lloyd & Hawe 2003). These impacts included inability of the women to fulfil maternal duties, self-harm or harm of others, child abuse and developmental problems for the child (Lloyd & Hawe 2003;Agapidaki et al 2014;Place et al 2015). In addition, there were HCPs who did not conceptualize all distress as PND.…”

“…In addition, there were HCPs who did not conceptualize all distress as PND. Instead, these HCPs viewed PND as 'a worry about their condition and their situation at home', 'emotional turmoil rather than depression' or described the distress as 'pathologized' or exaggerated by the women (Lloyd & Hawe 2003;Chew-Graham et al 2008;Place et al 2015).…”

“…In explaining the causes of PND, the HCPs primarily described psychosocial factors as the origins of the disorder with only a minority of them perceiving biological factors as the important causes (Junior et al 2013;Place et al 2015). In this review, psychosocial factors refer to the women's psychological aspects and their interactions with the social network.…”

Detection and care practices for postpartum depressive symptoms in public‐sector obstetric units in Mexico: Qualitative results from a resource‐constrained setting

“…The lack of policies and protocols on detection and care of PPD in Mexico contributes to a health care context whereby providers are not universally instructed in how to address the disorder . Health care providers largely understand the biological and psychosocial nature of PPD and the symptoms of distress associated with it . What remains unclear is how providers currently address PPD as they interact with women in the postpartum period.…”