Postpartum depression (PPD) is linked to diminished maternal, pediatric, and family health outcomes and is designated as the most common childbirth complication. PPD is an international public health concern and found in most populations. Studies suggest that American Indian/Alaska Native (AI/AN) women suffer higher PPD prevalence (14% to 29%) than other United States' women, revealing a racial/ethnic disparity. Health disparities research is a national public health priority and substantiates the need to explore PPD in AI/AN women. Clinicians define PPD as an episode of major depressive disorder with a "peripartum onset" specifier that occurs within the first year after delivery.
This dissertation work explored and synthesized PPD research about AI/AN women, where there remains considerable mystery surrounding the causes and consequences of PPD. Even with federal regulations in place requiring the inclusion of minorities and women and other underrepresented groups in research, AI/AN women have been mostly excluded, as evidenced by few studies and small sample compositions that include AI/AN women in PPD research.
Using a comparative analysis approach, validation studies of the EPDS and the PHQ-9 were examined. While possessing excellent concurrent validity, the low predictive accuracy of both tools in non-Western samples suggests cultural bias. No PPD screening instrument has been validated in samples of AI/AN women. Cross-cultural adaptation advances the science of comparative effectiveness research, and is therefore a logical next step. Using a phenomenological methodology with a community-based participatory approach, AI/AN women's "lived" PPD experiences were described. AI/AN women who experienced PPD now or in the past were interviewed using a semi-structured interview guide. De-identified demographic data were collected. Thematic analysis guided by Moustakas' (1994) procedure followed and seven major themes emerged.
This dissertation has advanced nursing science by providing an understanding of PPD in AI/AN women. Future research for AI/AN women with PPD should focus on: 1) their access to and use of PPD services; 2) the cross-cultural adaptation for PPD screening; 3) the possible relationship between PPD and intimate partner violence; 4) their preferences for PPD treatment; and 5) the possible relationship between PPD and acculturation.
|Advisor:||Wilson, Janet S.|
|Commitee:||Eschiti, Valerie, Holtzclaw, Barbara J., Marfurt, Stephanie, Parker, Judy G.|
|School:||The University of Oklahoma Health Sciences Center|
|School Location:||United States -- Oklahoma|
|Source:||DAI-B 80/06(E), Dissertation Abstracts International|
|Subjects:||Mental health, Womens studies, Nursing, Clinical psychology, Native American studies|
|Keywords:||Mental illness, Native american, Postpartum depression, Postpartum depressive symptoms|
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