Cheryl Tatano Beck
Postpartum
Depression Theory
Bocol, Xyanne Alex Andrienne
Ferraris, Rhianna Wenzel
Mariano, Rexsie Mae
Seno, John Amadeo
Credentials and Background
Education:
1970
Bachelors of Science in Nursing from Western
Connecticut University
1972
Master’s Degree in Maternal-Newborn Nursing
from Yale University
Cheryl Tatano Beck
DNSc, CNM, FAAN
1972
Certified Nurse-Midwife from Yale U
University
1982
Doctor of Nursing Science from Yale U
University
Credentials and Background
Cheryl Tatano Beck
DNSc, CNM, FAAN
Professional:
● Professor at the University of Connecticut School of
Nursing
● Member of Board of Trustees of Depression After
Delivery-National
● Member of Executive Board of the Marce
International Society
● Member of President’s Advisory Council of
Postpartum Support International
● Developed the Postpartum Depression Screening
Scale (PDSS)
● Authored over 100 journal articles
● Extensive Research on Postpartum Mood and
Anxiety Disorders
Credentials and Background
Cheryl Tatano Beck
DNSc, CNM, FAAN
Awards:
● Fellow in the American Academy of
Nursing
● Eastern Nursing Research Society’s
Distinguished Research Award
● Distinguished Alumna Award from Yale
University
● Connecticut Nurses’ Associations
Diamond Jubilee Award
Theoretical and Philosophical Sources
1
Jean Watson’s Theory of Transpersonal Caring
●
●
2
endorses caring as central to
nursing.
acknowledges that quantitative
methodologies may not adequately
reflect the ideal of transpersonal
caring.
Phenomenology
●
Colaizzi (1978)
Grounded Theory
●
●
3
Glaser and Strauss (1967)
Hutchinson (1986)
Sichel and Driscoll (1999) - Earthquake Model
●
4
“...a woman’s genetic makeup,
hormonal and reproductive history,
and life experiences all combine to
predict her risk of an ‘earthquake’
which occurs when her brain
cannot stabilize and mood
problems erupt.”
Robert Gable
●
assisted Beck with theoretical
operational instruments that could
predict and screen for postpartum
depression.
Major Concepts and
Definitions
Concept 1
Postpartum Mood Disorders
Postpartum Depression
● nonpsychotic major depressive disorder, more
difficult to treat than simple depression
Maternity Blues
● relatively transient and self-limited period of
melancholy and mood swings
Postpartum Psychosis
● psychotic disorder characterized by hallucinations,
delusions, agitation, inability to sleep, and bizarre
and irrational behavior
Concept 1
Postpartum Mood Disorders
Postpartum Obsessive-Compulsive Disorder
● repetitive intrusive thoughts of harming
the baby, a fear of being left alone with
the infant, and hypervigilance in
protecting the infant
Postpartum-Onset Panic Disorder
● acute onset of anxiety, fear, rapid
breathing, heart palpitations, and a sense
of impending doom
Concept 2
Loss of Control
1. Encountering Terror
● Horrifying anxiety attacks
● Enveloping fogginess
● Relentless obsessive thinking
2. Dying of Self
● Alarming unrealness
● Contemplating and attempting selfdestruction
● Isolating oneself
A descriptive theory capturing the process
undergone by women who felt like they were
“teetering on the edge.”
Concept 2
Loss of Control
A descriptive theory capturing the process
undergone by women who felt like they were
“teetering on the edge.”
3. Struggling to Survive
● Battling the system
● Seeking solace and support
groups
● Praying for relief
4. Regaining Control
● Unpredictable transitioning
● Guarded recovery
● Mourning lost time
Ipaglaban ang Additional Points Part 1 of 3
1. a nonpsychotic major depressive disorder, more difficult to treat than simple depression
a. Loss of Control
c. Postpartum Psychosis
b. Postpartum Depression
d. Maternity Blues
2. repetitive intrusive thoughts of harming the baby, a fear of being left alone with the
infant, and hypervigilance in protecting the infant
a. Dying of Self
c. Postpartum Obsessive-Compulsive Disorder
b. Encountering Terror
d. Postpartum-Onset Panic Disorder
3. - 6. the four stages of “Loss of Control”
Concepts 3-12
Risk Factors, Effect Size: Medium
3. Prenatal Depression
● Depression during the
trimesters of pregnancy
4. Child Care Stress
● Infant health problems and
difficulty in infant care
pertaining to feeding and
sleeping
5.
Life Stress
● Index of stressful events
during pregnancy and
postpartum
6. Social Support
● Lack of social support means
that the woman feels that she is
not receiving enough
instrumental or emotional
support
7. Prenatal Anxiety
● Anxiety throughout the
pregnancy
8. Marital Satisfaction
● Satisfaction in aspects of
marriage
Concepts 3-12
Risk Factors, Effect Size: Medium
9. History of Depression
● Report of having had a bout
of depression prior to the
pregnancy
11. Maternity Blues
● Prolonged episodes may predict
postpartum depression
10. Infant Temperament
● Infant’s disposition and
personality could be fussy,
irritable, unpredictable, and
difficult to console
12. Self-Esteem
● Low self-esteem reflects a
negative evaluation and feelings
about one’s self-capabilities
Concepts 13-15
Risk Factors, Effect Size: Small
13. Socioeconomic
Status
● Includes social
and economic
factors such as
income,
education, and
occupation
14. Marital Status
15. Unplanned or Unwanted
● Whether a
Pregnancy
woman is single,
● Of particular note is
married or
the pregnancy that
cohabiting,
remains unwanted
divorced,
after initial
separated,
ambivalence
widowed, or
partnered
Concepts 16-22
Predictors for Symptoms of PPD
16. Sleeping and Eating Disturbances
18. Emotional Lability
● Inability and difficulty regarding
● Sense that emotions are unstable
sleep even when baby is asleep
and out of control
● Loss of appetite and inability to
● Crying for no reason, irritability,
eat
explosive anger
● Fear of never being happy again
17. Anxiety and Insecurity
● Overattention to minor issues
19. Mental Confusion
● Ever-present insecurity
● Marked inability to concentrate,
● Overwhelmed by the new role as
focus on a task, or make a decision
a mother
● Unable to regulate own thought
processes
Concepts 16-22
Predictors for Symptoms of PPD
21. Guilt and Shame
● Feels that she is a
22. Suicidal Thoughts
20. Loss of Self
bad mother, has
● Frequent thoughts
● Women can no
negative thoughts
of harming
longer identify
about the infant
themselves and
who they are
● Inability to be open
ending their lives
● Fear of never
with others
● To escape the
returning to their
● Can delay
living nightmare of
real selves again
diagnosis and
PPD
prevention
Ipaglaban ang Additional Points Part 2 of 3
7. Give one example of a Risk Factor with Small Effect Size.
8. It is a Predictor for Symptoms of PPD, characterized by emotions that are unstable and
out of control, crying for no reason, irritability, explosive anger, and a fear of never being
happy again.
9. It is a Predictor for Symptoms of PPD, characterized by frequent thoughts of mothers
harming themselves and ending their lives to escape the living nightmare of PPD.
Major Assumptions
N
u
r
s
i
n
g
...a caring profession with
caring obligations to
persons nurses care for, to
students, and to each other.
Interpersonal interactions
between the nurses and those for
whom they care are the primary
ways nursing accomplishes the goals
of health and wholeness.
Person
...described in terms of wholeness with
biological, sociological, and
psychological components.
Persons or personhood is
understood within the context
of the family and community.
Environment
...the outside environment
includes events, situations,
culture, physicality ecosystems,
and sociopolitical ecosystems.
...the consequence of
women’s responses to the
contexts of their lives and
their environments.
Beck does not define health explicitly.
However, her writings include traditional ideas
of physical and mental health.
Theoretical
Assertions
● The brain can biochemically accommodate various
stressors, whether related to internal biology or
external events.
● Stressful events (internal or external), particularly over
long periods, cause disruption of the biochemical
regulation in the brain.
● Women’s unique and normal brain and hormonal
chemistry result in vulnerability to mood disorders at
critical times in their lives, including after giving birth.
● Postpartum depression is caused by a
combination of biological, psychological,
social, relational, economic, and situational
life stressors.
● Postpartum depression is not a homogenous
disorder.
● Culturally, women are expected to feel happy,
look happy, act happy, understand how to be
a mother naturally, and experience
motherhood with a sense of fulfillment. These
expectations make it difficult for women to
express genuine feelings of distress.
● The stigma attached to mental illness
increases dramatically when a mental
illness is related to the birth of a child,
leading women to suffer in silence.
● Within a level of prevention framework,
postpartum depression can be prevented
through identification and mitigation of
risk factors during the prepartum period.
● A number of biological, sociological, and
psychological issues and challenges are
entirely normal in all pregnancies. These
may include fatigue, sleep alterations,
questioning one’s abilities, and the like.
Ipaglaban ang Additional Points Part 3 of 3
10. ______________ between the nurses and those for whom they care are the primary
ways nursing accomplishes the goals of health and wholeness.
11. True or False: Postpartum depression is a homogenous disorder.
12. Give the complete name of the theorist of the Postpartum Depression Theory.
Acceptance by the
Nursing Community
Practice
The Postpartum Depression Screening Scale (PDSS) has
been instrumental to nursing practice.
● Medical University of South Carolina Hospital
The PDSS is a vehicle for opening
discussions with women.
● Healthy Start CORPS: Inter-Conceptual Care Case
Management Project
All new clients (women 6 weeks postpartum)
are given the PDSS.
● Ruth Rhoden Craven Foundation for Postpartum
Depression Awareness
The PDSS has been instrumental in community
intervention and education projects.
Education
Beck’s work sets the standard for knowledge and understanding about postpartum
depression.
It has also been used to educate members of other disciplines, such as physicians,
mental health workers, public health professionals, social workers, and those who work in
social service agencies that provide protective care for women and children.
Research
The Postpartum Depression Theory is
a middle-range, practice-level theory.
The global literature gives evidence of
nurses using her research and research
instruments to better understand the
experience of pregnancy and to improve
the care for mothers.
Lavoie (2015) reported on a study about
caring for breastfeeding mothers with Five Es -encouragement, empathy, education, engagement,
and evaluation -- which had a positive effect on
PPD.
Postpartum Depression...
for Fathers
Focusing on Depression in Expectant and New Fathers (2010)
James F. Paulson, PhD
Fathers are subject to psychosocial stressors that
accompany new parenthood and, therefore, may experience
distress uniquely tied to their new role.
A number of recent studies have documented that
depression in new fathers is both prevalent (ie, the incidence
is higher than in the general adult male population) and
associated with negative outcomes for the offspring.
In the months following childbirth, the incidence of
significant depression among fathers has been estimated to be
between 1.2% and 25.5%.
There is still a lack the terminology
even to describe the phenomenon (eg,
male postpartum depression or early
fatherhood depression).
The wide variance in methods used
to study early fatherhood depression is a
probable cause of the variable
prevalence estimates that have been
reported by Goodman, Pinheiro,
Paulson, and others.
Despite these challenges,
however, it has become clear that
depression in expectant and new
fathers is more common than we once
believed.
Maternal depression and paternal depression
are consistently associated. Several studies have
found a slight to moderate correlation in
depressive symptom severity between mothers
and fathers. One study investigated the correlates
of paternal depression in the first postnatal year.
The father’s depressive symptom severity,
rather than being influenced predominantly by
other personality characteristics, was predicted
primarily by the mother’s neuroticism, depressive
symptoms, and the quality of the marital
relationship.
Summary
Dr. Cheryl Tatano Beck's Postpartum Depression Theory
demonstrates how nursing research provides evidence to understand
and care for women experiencing PPD.
Increasingly, nurses and the wider society are recognizing that
issues on PPD have not been adequately understood or
acknowledged.
A growing awareness within nursing, other health care
professionals, and the public will allow greater identification of PPD
in the many contexts within which people live their lives.
Cheryl Tatano Beck
Postpartum
Depression Theory
Bocol, Xyanne Alex Andrienne
Ferraris, Rhianna Wenzel
Mariano, Rexsie Mae
Seno, John Amadeo