Postpartum Depression: A Social Work Case Study and Treatment Plan

Case Background

Sheila is a 34-year-old married mother of three. Her youngest child is 6 months old, her middle child is 2 years old, and her oldest is 4 years old. She is a university graduate who worked at a bank for six years before resigning to care for her children at home. Sheila is married to Steve, a 36-year-old lawyer. The couple lives in a well-off gated community.

Sheila was an only child raised by a stay-at-home mother, whom she credits as having contributed immensely to the person she became. It is largely for this reason that she resigned from her job a few months after the birth of her third child — she wanted to give her children the happiness and privilege of having a stay-at-home parent. Steve was also an only child, but was raised by a single mother who worked three jobs to provide for him. He learned independence early and frequently helped care for his exhausted mother. Steve was supportive of Sheila's decision to resign and took on the role of sole financial provider for the family.

All was well in this family until, shortly after Sheila gave birth to her third child, she was diagnosed with postpartum depression.

Problem

Perinatal depression (PND) is defined as a major depressive condition that occurs during pregnancy or after the adoption or birth of a baby (Reproductive Mental Health Program, 2014). Postpartum depression is a non-psychotic mental condition and a common complication that affects 10 to 15% of women after giving birth. The effects of postpartum depression (PPD) are well documented: for a mother, the condition can lead to recurrent depressive episodes for up to five years after birth. Because of the nature of PPD symptoms, mothers who have recently given birth may risk harming their children through delusions, command hallucinations, practical incompetence, or neglect. This may cause developmental delays or difficulties in social interaction as the child grows (Vigod, Villegas, Dennis, & Ross, 2010).

Diagnosis

The symptoms and signs of postpartum depression are often similar to those associated with major depression, including low morale, anhedonia, and depressed mood. Some individuals diagnosed with the condition have also been reported to have suicidal tendencies. Somatic symptoms linked to postpartum depression include lack of appetite, insomnia, low energy, and reduced libido (Vigod et al., 2010).

Theoretical Orientation: Defining Perinatal Depression

Under the American Psychiatric Association's classification of psychological conditions, perinatal depression is a sub-category of major depressive disorder. The DSM-V criteria for a major depressive disorder include:

I. Either anhedonia or a depressed mood must be present within a 14-day period.

II. One or more of the following must also be expressed over the same 14-day period:

• Difficulty making decisions or staying focused
• Feelings of low self-worth
• Insomnia
• Decreased pleasure or interest in most activities
• Lack of energy or enthusiasm on an almost daily basis
• Suicidal thoughts or plans

III. The signs and symptoms must manifest in a way that disrupts normal activities or daily routines. Moreover, symptoms may be expressed at any point during pregnancy or within one year following birth (Reproductive Mental Health Program, 2014).

Intervention

Treatment is typically recommended based on individual factors such as:

1. The woman's desires, available resources, and support network
2. The patient's previous response to treatment
3. The severity of the symptoms
4. The nature of the depressive disorder (Reproductive Mental Health Program, 2014)

Psychological and psychosocial interventions are frequently used to treat postpartum depression. These interventions can help reduce depressive symptoms by offering information about the benefits of positive behavior on overall well-being, developing positive psychological states, encouraging individual motivation, preventing maladaptive responses and behaviors, and decreasing feelings of loneliness and depression (Dennis & Dowswell, 2013).

Goals of the Intervention

Over the next three months, the objectives are:

• To identify negative behavior patterns and their causes and effects
• To determine how to eliminate such behavior patterns
• To identify preferred, healthier behavior patterns
• To develop better and more positive behavior patterns
• To help the client join a relevant support group within the first half of the full duration of the therapy

Problem Definition and Focus of Treatment

Direction of the Intervention

Reducing and eliminating negative behavior: This will be achieved by evaluating the processes through which the patient engages in these behaviors and then working to reduce the likelihood of such behaviors recurring.

Developing positive behavior patterns: This will be achieved by first defining what positive behavior means for the client, then working to incorporate such behavior into her daily life.

Integrating the patient into a support system: This will enable her to regain balance and adopt a healthier lifestyle.

Evaluation and Management of the Intervention

The client was initially assessed using the Edinburgh Postnatal Depression Scale (EPDS) to identify her depression level, which was found to be 24. According to the EPDS, a score of 10 or above indicates depression (Edinburgh Postnatal Depression Scale, n.d.).

Measure of Success

The EPDS will be used over the next three months to evaluate the client's progress. The objective is to reduce her score to below 10.

Duration of the Intervention

The intervention will be divided into two equal phases. The initial 8 weeks will focus on integrating a support system into the patient's life to provide a foundation for change. The subsequent 8 weeks will focus on gradually withdrawing that support and assessing the patient's ability to function independently while maintaining positive behavioral patterns.

Using the EPDS as an evaluation tool, the client should progress over the three-month period from one extreme — characterized by uncontrollable, unhealthy perceptions — to another, characterized by good health, positive perceptions, and constructive conduct. Sheila should also become able to independently identify and eliminate the triggers of her unhealthy behavior. She should then be able to develop positive health behaviors and thought processes.

Conclusion

Vigod, S. N., Villegas, L., Dennis, C. L., & Ross, L. E. (2010). Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: A systematic review. BJOG: An International Journal of Obstetrics & Gynaecology, 117, 540–550.