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See attached. You may or may not use the old one. Only if you want to. Plagiarism free work, please.

The Assignment. Cover all areas of the questions.

Select one of the articles from the Learning Resources to evaluate for this Assignment.

In a 6- to 10-slide PowerPoint presentation, address the following:
· Provide an overview of the article you selected, including answers to the following questions:
· What type of group was discussed?
· Who were the participants in the group? Why were they selected?
· What was the setting of the group?
· How often did the group meet?
· What was the duration of the group therapy?
· What curative factors might be important for this group and why?
· What “exclusion criteria” did the authors mention?
· Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your own client groups. If so, how? If not, why?
· Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article.

*My selected article*

Using Short-Term Group Psychotherapy as an Evidence-Based Intervention for First-Time Mothers at Risk for Postpartum Depression

Images

    

Authors:

Pessagno, Richard A.
Hunker, Diane

Source:

PERSPECTIVES IN PSYCHIATRIC CARE
; JUL 2013, 49 3, p202-p209, 8p.

Publisher Copyright:

WILEY-BLACKWELL

ISSN:

00315990

DOI:

10.1111/j.1744-6163.2012.00350.x

Journal SEE ARTICLE BELOW

Author Keywords:

First-time mothers
group psychotherapy
postpartum depression
psychiatric nursing THE ARTICLE

Using Short-Term Group Psychotherapy as an Evidence-Based Intervention for First-Time Mothers at Risk for Postpartum Depressionppc_350 202..209 Richard A. Pessagno, DNP, RN, APN-C, CGP, and Diane Hunker, PhD, MBA, RN Richard A. Pessagno, DNP, RN, APN-C, CGP, is Clinical Assistant Professor, Rutgers, The State University of New Jersey, College of Nursing, Newark, New Jersey, USA; and Diane Hunker, PhD, MBA, RN, is Assistant Professor, Chatham University, Pittsburgh, Pennsylvania, USA. Search terms: First-time mothers, group psychotherapy, postpartum depression, psychiatric nursing Author contact: [email protected], with a copy to the Editor: [email protected]c.edu Conflict of Interest Statement There are no financial disclosures to make relative to this manuscript. First Received March 12, 2012; Final Revision received June 25, 2012; Accepted for publication June 27, 2012. doi: 10.1111/j.1744-6163.2012.00350.x PURPOSE: The purposes were to (a) provide an 8-week, short-term, psychotherapy group as a nonpharmacologic, evidence-based intervention for first-time mothers at risk for postpartum depression (PPD) and (b) determine if women’s scores in the Edinburgh Postnatal Depression Scale changed after participation in the intervention. CONCLUSION: The women who participated in the short-term group psychotherapy intervention experienced a decrease in their Edinburgh Postnatal Depression Scale scores, reducing their risk for PPD. PRACTICE IMPLICATIONS: Group psychotherapy is an effective, evidence-based intervention to reduce the risk for PPD and should remain a current competency of psychiatric advanced practice nurses. Postpartum depression (PPD) is a serious medical condition that dates back to 400 B.C. (Tovino, 2009). Although it has been noted that nearly 85% of women experience some type of mood change after giving birth (Horowitz & Goodman, 2005), the actual prevalence of PPD is between 10% and 20% (Gjerdingen & Yawn, 2007). While in-hospital postpartum screening has helped to increase the recognition of those at risk for developing PPD (Perfetti, Clark, & Fillmore, 2004), fewer than half of those women who are screened and who develop PPD will actually be identified and treated (Gjerdingen & Yawn, 2007; Logsdon, Wisner, & Pinto-Foltz, 2006). As women are discharged from acute care hospitals quickly after giving birth, inpatients often lack readily available access to interventions, even for women identified at risk for PPD. Pharmacological interventions are a common treatment option for PPD, but many women leave the acute setting, opting not to take medication and having limited resources to access mental health services. Taking medication, specifically psychotropic medication, can raise concerns for many women, especially for first-time mothers (Gjerdingen, 2003). Often, concerns are raised about the use of medications, especially among those breast-feeding mothers, relative to the potential risk to their infants. Identifying and accessing timely nonpharmacological treatment can be difficult for women who are at risk for PPD or who have PPD. This article describes an evidence-based practice intervention that used short-term group psychotherapy as a nonpharmacologcial intervention with first-time mothers who were identified as being at risk for PPD. Background While various factors have been examined in relation to the etiology of PPD, such as hormonal and metabolic changes, lifestyle adjustments, obstetric factors, and changing new roles (Flores & Hendrick, 2002), epidemiological studies have fairly consistently demonstrated that the etiology of PPD is most closely linked to psychosocial factors (Beck, 1996a). PPD has often been associated with women who are from lower socioeconomic backgrounds, who are less educated, and who lack occupational prestige (Séguin, Potvin, St-Denis, & Loiselle, 2001). Yet Anderson (2009) found that PPD is also found in significant numbers among women who are well educated, middle class, and in stable relationships. These findings support the need to adequately screen and provide Perspectives in Psychiatric Care ISSN 0031-5990 202 Perspectives in Psychiatric Care 49 (2013) 202–209 © 2012 Wiley Periodicals, Inc. early intervention to all women who give birth, and not only profiled women from disadvantaged backgrounds. The risk for PPD may be greatest for first-time mothers who hold high expectations regarding childbearing but no personal experience with which to compare their experiences (Epperson, 1999). Because new mothers may not be aware that they are experiencing PPD, they may normalize their feelings. New mothers may fear that others judge their feelings as an inappropriate maternal response (Logsdon, Foltz, Scheetz, & Myers, 2010). First-time mothers are less apt to express the need for help during the postpartum period because of the perceived stigma of being depressed, as well as the hesitancy to report depressive symptoms (Thurgood, Avery, & Williamson, 2009). The results can leave first-time mothers feeling even more isolated and unprepared to cope with multiple changes that can negatively impact their health status and parenting effectiveness (Reich, Silbert-Mazzarella, Spence, & Siegel, 2005). Impact of PPD The detrimental effects of PPD have gained increasing public awareness, with some extreme cases of PPD in which mothers have harmed their children (Logsdon, Wisner, & Shanahan, 2007). Untreated PPD in first-time mothers, coupled with a lack of maternal experience and fear, can lead to a host of maladaptions for both the mother and her baby. These maladaptions can include issues such as severe social isolation, decreased mother–child bonding, decreased maternal ability to care for the infant, increased incidence of developmental delay in infants, and a reduced rate of identifying infant cues (Reich et al., 2005). Although women who have given birth more than once have also been shown to be at risk for PPD, women with more than one child tend to seek intervention at a higher rate than first-time mothers (Rich-Edwards et al., 2006). The occurrence of PPD has been linked to a host of negative outcomes. Beck (1998) noted that women with PPD can negatively impact infant behaviors and influence childhood development through the age of 14. A review of eight phenomenological studies on women with PPD suggested that mothers with PPD were often filled with guilt, had feelings of loss, and engaged in irrational thinking. These themes were linked to mothers experiencing a sense of detachment from their infants, as well as failure to respond to clues from her children (Beck, 1996b). Current research suggests that there is a negative relationship between the presence of PPD and infant development (Beck, Records, & Rice, 2006). Treatment of PPD Treatments for depression and PPD are varied and include psychotherapy, psychoeducation, and support groups, as well as pharmacotherapy. Treatment choices for patients depend on multiple factors, including availability, cost, convenience, the influence of family and friends, and patient preference (Burlingame, Fuhriman, & Mosier, 2003). The costeffectiveness of group psychotherapy draws many patients to this treatment option (Burlingame et al., 2003; McRoberts, Burlingame, & Hoag, 1998). Group psychotherapy has been supported in the literature as being an efficient, cost-effective, nonpharmacologic, evidence-based intervention that can be used for patients exhibiting depressive symptoms. A meta-analysis of 48 research studies examining the effect of group psychotherapy on depression revealed that group psychotherapy was effective in reducing depressive symptoms, further noting that 43 of the studies evidenced that group psychotherapy provided a statistically significant decrease in depressive symptoms for group participants (McDermut, Miller, & Brown, 2001). Several studies have reported that mothers with PPD responded well to group psychotherapy treatment. Klier, Muzik, Rosenblum, and Lenz (2001) noted in their study (n = 17) that group psychotherapy was an effective intervention that decreased depressive symptoms,with a continued diminishment of PPD symptoms 6 months after treatment. Honey, Bennett, and Morgan (2002), in a study of 45 women scoring 12 or higher on the Edinburgh Postnatal Depression Scale (EPDS), identified that brief group experience reduced depressive symptoms, as evidenced by lower EPDS scores. Other studies on group psychotherapy as a treatment for PPD have reported similar trends (Gruen, 1993; Kurzweil, 2008; Meager & Milgrom, 1996; Ugarriza, 2004). The benefits of group psychotherapy have been linked to more rapid remission of symptoms, cost-effectiveness, and improved social support. The literature has also demonstrated that group psychotherapy can be an efficacious treatment for patients at risk for PPD. Some evidence supports the idea that group psychotherapy may provide longevity of symptom relief for some patients up to 6 months posttreatment. The literature cites the importance of screening and early identification of the risk for PPD in first-time mothers and the effectiveness of group psychotherapy as an evidencebased intervention. Interpersonal psychotherapy (IPT) is an effective, timelimited treatment, which has been shown to be highly effective for depression (Markowitz & Weissman, 2004). Depression is identified as a medical illness that connects an individual’s life events to the individual’s depression (Markowitz & Weissman, 2004). Therapy focuses on helping individuals to create or enhance one’s social relationships while addressing issues such as conflicts and role change. Within the context of a group environment, IPT can provide a setting where individuals with a similar diagnosis can meet to address relationship issues and explore how these issues may be leading to depressive symptoms or other struggles within various relationships. Using Short-Term Group Psychotherapy as an Evidence-Based Intervention for First-Time Mothers at Risk for Postpartum Depression Perspectives in Psychiatric Care 49 (2013) 202–209 203 © 2012 Wiley Periodicals, Inc. For the purposes of this project, IPT was organized by using an unstructured format for group sessions. Group participants were asked to recognize and notice their affect response, cognitions, and reactions during sessions, and then use those recognitions as a means of relating to others in the groups. Participants were able to use group interactions to address their relationship issues and their role changes. The group was used to help participants improve interpersonal relationships, enhance their ability to empathize, and learn new skills. Intervention The purposes of this project were to (a) provide a nonpharmacologic, evidence-based intervention for first-time mothers at risk for PPD and to (b) determine if women’s scores in the EPDS change after participation in the intervention. The intervention was an 8-week, short-term psychotherapy group offered by an advanced practice psychiatric nurse to first-time mothers. The project was approved by the Institutional Review Board for protection of all participants. Sample. A total of 202 women gave birth on the postpartum unit during the 3-week recruitment period for this project.All 202 women completed the EPDS, and 24 women were then recruited for participation in the project. All 24 women completed EPDS within 3 days after having given birth to their first child and had a score of 11 or higher on the EPDS.A score of 11 or higher triggered a psychiatric evaluation, which was established by hospital policy to determine fitness for discharge from the postpartum unit. After completing a psychiatric screening, eligible women were approached by a postpartum nurse to determine if they were interested in participating in the group psychotherapy intervention. These eligible women then discussed their interest with the advanced practice psychiatric nurse who would be leading the intervention groups, and the women were given details about the groups. Sixteen (Table 1) of the 24 women chose to participate in one of two short-term psychotherapy intervention groups. The age range of participants was between 20 and 38,with a mean age of 28.5 years. More than 68% of the women were between 26 and 30 years old. Thirteen, or 81.25%, of the women were married; two women had a significant other; and one woman was single. The majority of the women were Catholic (62.5%), and all 16 women were Caucasian. More than 92% had at least a high school education,with more than 86% having completed a 4-year college degree. Ten (62%) of the women worked outside their homes in a variety of professional, technical, and service industry roles. With regard to previous mental health treatment, six participants (37.5%) had some experience with previous mental health treatment. Four women had participated in counseling or psychotherapy, and two women had used psychotropic medications previously. None of the participants had previously been hospitalized for psychiatric treatment. None of the women were taking psychotropic medication during the intervention. Six of the participants had been previously diagnosed with depression.All 16 women had given birth within 1 month before the start of the group intervention, with 5 women giving birth to male children and 11 giving birth to female children. Women who did not participate decided against participation because of childcare issues, concerns about length of the commitment to the group, and/or lack of interest in participating in a group-related activity. Each participant was randomly assigned to one of the two short-term group psychotherapy intervention groups. The remaining women who did not meet the criteria for participation or who decided not to participate in the intervention were referred to other mental health services within the community. Screening for the project took place in May 2010. Procedure. The short-term group psychotherapy intervention was provided to two groups with eight women each for a period of 8 weeks. Each of the 8-week sessions lasted 90 min and started within 1 month of discharge from the hospital. Table 1. Demographics of Groups Variables Intervention Group 1 (n = 8) Intervention Group 2 (n = 8) Ages 20–25 1 2 26–30 6 4 31–35 1 1 36–38 0 1 Education 11. The EPDS is easily administered and scored,making it an efficacious tool for utilization in a variety of postpartum healthcare settings. The EPDS has been utilized in more than 20 countries and is noted to have a significant level of sensitivity (86%), as well as specificity (78%), in identifying and indicating symptoms of PPD (Harvey & Pun, 2007). Results The mean preintervention score on the EPDS for group 1 (3 days postpartum) was 16.13 (SD = 2.78) and for group 2 was 15.5 (SD = 1.19) (Table 2). These scores reflect the risk for Table 2. Pre- and Postintervention EPDS Scores Groups Preintervention Postintervention M (SD) Range M (SD) Range t (df) p 1 16.12 (2.74) 11–18 6.38 (1.50) 4–9 21.51 (7) .001 2 15.50 (1.19) 13–17 6.63 (1.99) 6–10 18.50 (7) .001 Note: 8 women/group. EPDS, Edinburgh Postnatal Depression Scale. Using Short-Term Group Psychotherapy as an Evidence-Based Intervention for First-Time Mothers at Risk for Postpartum Depression Perspectives in Psychiatric Care 49 (2013) 202–209 205 © 2012 Wiley Periodicals, Inc. depressive symptoms, in which a maximum potential score of 30 would indicate severe depression and 0 noting no depressive symptomology. Scores of 10 or greater are indicative of symptoms presentation, which should warrant further evaluation. Following the intervention, the scores decreased significantly. The mean postintervention score for group 1 was 6.38 (SD = 1.50) and for group 2 was 6.63 (SD = 1.99). These data represent the combined scores of all group members with and without a history of depression. There was a significant decrease in EPDS scores from preintervention to postintervention for both groups 1 and 2 (Table 2), as well as for women with previous depression and women with no previous depression (Table 3), all indicating fewer self-reported symptoms that put women at risk for PPD. The long-term effects of the group intervention were evaluated at 6 months postintervention for participants from group 1 and group 2 (Table 4), and for women with each group based on previous history of depression and no previous history of depression (Table 5). Both groups demonstrated a significant decrease in scores on the EPDS. These data demonstrate a continued effect of the group intervention for participants 6 months beyond the intervention. This is suggestive that group psychotherapy can have long-term effects to reduce risk for PPD for first-time mothers. During the initial group sessions, the women bonded quickly and developed a strong alliance with one another. Many of the women stated that they really enjoyed talking with other women who were struggling with similar issues and who were also first-time mothers. Several women stated they felt “safer” talking with other first-time mothers because they did not feel judged. Many of the women stated that they worried about being judged by others when they shared their worries or concerns about being new mothers. The homogeneity of the group also seemed to be a factor that added to the success of the group. A common theme noted among the women in both groups was that the women looked forward to attending groups because the group offered a place where the women could be authentic, as well as a place to share “real feelings.” The theme of looking forward to the group could have been one factor that led to all the members attending all the group sessions. None of the women missed any of the sessions, which added to group cohesion, group process, and group stability. These factors could have also added to the effectiveness of the group. Table 3. EPDS Scores With Prior Depression and Without Prior Depression Groups Preintervention Postintervention M (SD) Range M (SD) Range t (df) p With previous depression 1a (n = 4) 16.23 (1.50) 15–18 7.00 (2.16) 4–9 14.70 (3) .001 2a (n = 2) 16.00 (1.41) 15–17 6.50 (2.12) 5–8 5.26 (2) .001 No prior depression 1b (n = 4) 16.00 (3.36) 11–18 6.38 (1.50) 4–9 5.43 (6) .001 2b (n = 6) 15.50 (1.36) 13–17 6.67 (1.96) 4–9 8.86 (10) .001 EPDS, Edinburgh Postnatal Depression Scale. Table 4. All Participants’ EPDS Scores at 8 Weeks and 6 Months Postintervention Groups Postintervention 8 weeks Postintervention 6 Months M (SD) Range M (SD) Range 1 6.38 (1.50) 4–9 6 (1.69) 3–8 2 6.63 (1.99) 6–10 6.12 (1.45) 4–8 Note: 8 women/group. EPDS, Edinburgh Postnatal Depression Scale. Table 5. EPDS Scores of Participants With Prior Depression and Without Prior Depression at 8 Groups Weeks and 6 Months Postintervention Postintervention 8 weeks Postintervention 6 Months M (SD) Range M (SD) Range With previous depression 1 (n = 4) 7.50 (1.00) 4–9 6.25 (1.70) 4–8 2 (n = 2) 6.50 (2.12) 5–8 5.50 (2.12) 4–7 No previous depression 1 (n = 4) 6.38 (1.50) 4–9 5.75 (1.89) 3–7 2 (n = 6) 6.67 (1.96) 4–9 6.16 (1.32) 4–8 EPDS, Edinburgh Postnatal Depression Scale. Using Short-Term Group Psychotherapy as an Evidence-Based Intervention for First-Time Mothers at Risk for Postpartum Depression 206 Perspectives in Psychiatric Care 49 (2013) 202–209 © 2012 Wiley Periodicals, Inc. It was also noted that some of the women were referred for additional treatment after the intervention concluded. While all of the women showed a decreased risk for PPD postintervention, two of the women who had a previous history of depression requested additional psychotherapy support. Both women noted that the group had raised their awareness of the importance of remaining healthy and keeping their depression in remission. Both women believed that participating in additional individual therapy would help them continue to learn healthy ways of coping and adapting to their new roles. Effectiveness of Intervention The findings that participants in the group psychotherapy intervention experienced a decrease in their EPDS scores are congruent with the literature noting that participation in group psychotherapy is an effective means of reducing symptoms associated with depression (Gruen, 1993; Klier et al., 2001; Kurzweil, 2008; Meager & Milgrom, 1996; Ugarriza, 2004). The results demonstrate a gap in clinical services for first-time mothers at risk for PPD and subsequently support an evidence-based, psychiatric nursing intervention to bridge that gap. Providing a group psychotherapy intervention that was connected to an acute care hospital allowed for a more rapid and seamless referral process for women who were identified as being at risk for PPD. Barriers to treatment for women at risk for PPD vary and can include limited numbers of mental health providers skilled in treating PPD issues and long wait times to access treatment. Typically, hospital referrals for community-based mental health services for women at risk for PPD have led to long wait times to be seen for treatment. There is a lack of qualified mental health professionals who have knowledge and interest in working with the population. Identifying short-term group therapy as an intervention that could be provided by the psychiatric advanced practice nurse (APN) can bridge a potential gap in clinical services for first-time mothers at risk for PPD, who may otherwise have no other mental health services. Short-term group psychotherapy can also provide an effective and cost-effective expansion of services for women who could potentially develop PPD. The utilization of short-term group psychotherapy has wide application across the healthcare system, as well as to various psychiatric disorders beyond PPD. Limitations The main limitation was the use of a nondirective group process style for this intervention. Nondirected group process lends itself to providing members the ability to focus more on relationships and developing empathy. The dynamics with a nondirective psychotherapy group may vary from group to group. This may provide some account for the differences appreciated in postintervention scores. Additionally, group EPDS scores versus individual EPDS scores were compared for preintervention and postintervention,which could also be noted as a limitation of the project. For the purposes of this project, all scores were aggregated together and compared as a cohort group. Another limitation of the project was that the group psychotherapy intervention was provided at no cost to participants. Additionally, childcare was available to the women as well. It is realized that providing no-cost psychotherapy is not the norm in most cases, and childcare is not always available. Both of these issues may have also influenced the results of the project. Another limitation to take into account is the interpretation of group scores. While this was an evidence-based practice project that applied current research findings to address a clinical problem and not an original research project, it should be mentioned that change in EPDS scores have both a ceiling and a basement effect, and those members scoring on the higher end of the EPDS can change more dramatically than those members scoring on the lower end of the EPDS. It should be noted that members in group 2 who scored in the bottom range of the EPDS did not change significantly. The scope of the project was limited to implementing an evidence-based intervention based on already produced research evidence, so advanced interpretation of the changing score postintervention results was beyond the scope of this project. Still, a cautionary note must be mentioned relative to the interpretation of postintervention group scores. Implications for Nursing Practice For states that mandate screening for PPD, implementing nonpharmacologic interventions such as short-term group psychotherapy across settings is a logical progression of expansion of services for women at risk for PPD. Barriers to treatment for women at risk for PPD vary and can include limited numbers of mental health providers skilled in treating PPD issue and long wait times to access treatment. Developing programs that include such interventions within healthcare agencies where pregnant or postpartum mothers seek healthcare services could improve access to mental health care for these women and have a positive impact on both the physical and mental health of mothers and their infants. Nonpharmacologic interventions, such as short-term group psychotherapy, meet the needs of women who decide against the use of medication.Mental health providers should be exploring alternative interventions that augment choice for patients relative to pharmacologic and nonpharmacologic interventions. The efficacy of group psychotherapy in reducing risk for the development of depressive symptoms may reduce or eliminate the need for subsequent medication use, Using Short-Term Group Psychotherapy as an Evidence-Based Intervention for First-Time Mothers at Risk for Postpartum Depression Perspectives in Psychiatric Care 49 (2013) 202–209 207 © 2012 Wiley Periodicals, Inc. which has significant implications for healthcare spending for both the system as a whole and for individual consumers. Group psychotherapy has also been shown to be cost-effective when compared with the costs of individual psychotherapy (McCrone et al., 2005). While the cost of this intervention group was free of charge, the cost of group psychotherapy has historically been more cost-effective for consumers when compared with the cost for individual psychotherapy. Group psychotherapy also allows mental health providers the ability to treat several patients at the same time, which can allow the provider to see larger numbers of patients. Many healthcare insurance plans do provide coverage for group psychotherapy, and the short nature of this group psychotherapy intervention provides a discreet number of sessions over a discreet time frame, which might also be an incentive for insurance companies to encourage members to participate. With this type of timelimited intervention, insurance providers would know up front that their insured members would be in treatment for 8 weeks. This type of intervention could be seen as a costeffective service that provides evidence-based outcomes for this specific patient population, namely women at risk for PDD, which could potentially reduce the need for other mental health services. It is suggested that having a part-time psychiatric advanced practice position as a member of the women’s health service line could also prove to be cost-effective, as the services provided by the psychiatric APN are potentially reimbursable. Additionally, having a psychiatric APN within a women’s health service line would provide access for patients and allow other healthcare providers, including nurses, easier access to a psychiatric practitioner for consultations. Within this project, the psychiatric APN’s salary came out of the psychiatric services cost center. The cost to the institution offering the two groups for this project was incorporated into the costs of the psychiatric APN salary. Group psychotherapy services offered for this project were a new service not previously provided by the psychiatric APN. This project articulated a potentially new revenue source as well. The outcomes of the intervention also articulated the need for psychiatric APNs to utilize the full spectrum of their education and clinical training to meet the needs of women at risk for PPD. Psychiatric APNs are uniquely trained to identify and treat both those at risk for PPD and those who may have PPD. Psychiatric APNs can utilize both nonpharmacologic interventions, such as short-term group psychotherapy, and pharmacologic interventions management services to treat patients. In today’s mental health services market, significant focus is paid on the importance of medication management skills of the psychiatric APN, yet the intervention in this project supports the need for continued education and training of advanced practice psychiatric nursing as psychotherapists with group psychotherapy skills. It is vital that advanced practice psychiatric nurses be able to provide a wide variety of interventions, including psychopharmacologic and nonpharmacological therapies and group psychotherapy. When advanced practice psychiatric nurses are able to provide both pharmacological and nonpharmacological interventions, there is a potential expansion of psychiatric services, which could improve both the utilization and the access to mental health services by consumers.This expansion also creates potentially greater choice among the types of psychiatric services from which consumers can select. Advanced practice psychiatric nurses with training and skill in both pharmacologic and nonpharmacologic psychiatric interventions also become uniquely positioned within the mental health system as providers who offer a wide variety of services. Conclusion Short-term group psychotherapy as a nonpharmacological psychiatric nursing intervention for first-time mothers who were identified as being at risk for PPD is effective to reduce symptoms associated with depression. Identifying women at risk for developing PPD shortly before discharge from the hospital provided a means for engaging those women who might benefit from a short-term group psychotherapy intervention. Implementing short-term psychotherapy group interventions to two groups of eight first-time mothers demonstrated lower scores on the EPDS, reflecting a decrease in symptoms presentation and risk for PPD. Lowering the risk for PPD has been associated with a wide variety of improved healthcare outcomes for both new mothers and for their infants. Group psychotherapy should be taught to advance practice psychiatric nursing students and practiced by advance practice psychiatric nurses, in order to improve access to mental health services, improve outcomes, and to potentially impact healthcare spending. Acknowledgment The first author was a participant in the 2012 NLN Scholarly Writing Retreat sponsored by the NLN Foundation for Nursing Education. References Anderson, P. (2009). Postpartum depression, anxiety, may affect infant development. Medscape Nurses. October 10, 2009. Retrieved from http://www.medscape.com/viewarticle/707719 Beck, C. (1996a). A meta-analysis of predictors of postpartum depression. Nursing Research, 45(5), 297–303. Beck, C. (1996b). Postpartum depressed mothers’ experiences interacting with their children. Nursing Research, 45(2), 98–104. 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Journal of Obstetric, Gynecologic, & Neonatal Nursing, 35(11), 652–658. Logsdon, M., Wisner, K., & Shanahan, B. (2007). Evidence of postpartum depression: 10 publications to guide nursing practice.Issues in Mental Health Nursing, 28(5), 445–451. Markowitz, J., & Weissman, M. (2004). Interpersonal psychotherapy: Principles and applications. World Psychiatry, 3(3), 136–139. McCrone, P., Weeramanthri, T., Knapp, M., Rushton, A., Trowell, J., Miles, G., & Kolvin, I. (2005). Cost-effectiveness of individual versus group psychotherapy for sexually abused girls. Child and Adolescent Mental Health, 10(1), 26–31. McDermut, W., Miller, I., & Brown, R. (2001). The efficacy of group psychotherapy for depression: A meta-analysis and review of the empirical research. Clinical Psychology: Science and Practice, 8(1), 98–116. McRoberts, C., Burlingame, G., & Hoag, M. (1998). Comparative efficacy of individual and group psychotherapy: A meta-analysis.Group Dynamics: Theory, Research, and Practice, 2(2), 101–107. Meager, I., & Milgrom, J. (1996). Group treatment for postpartum depression: A pilot study. Australian and New Zealand Journal of Psychiatry, 30(6), 852–860. Perfetti, J., Clark, R., & Fillmore, C. (2004). Postpartum depression identification, screening, and treatment. Wisconsin Medical Journal, 103(6), 56–63. Reich, W., Silbert-Mazzarella, B., Spence, J., & Siegel, H. (2005). Self-structure and postpartum dejection in first-time mothers. Journal of Psychology, 9, 250–250. Rich-Edwards, J., Kleinman, K., Abrams, A., Harlow, B., McLaughlin, T., Joffe, H., & Gill, M. (2006). Sociodemographic predictors of antennal and postpartum depressive symptoms among women in a medical group. Journal of Epidemiologic Community Health, 60(3), 221–227. Séguin, L., Potvin, L., St-Denis, M., & Loiselle, J. (2001). Depressive symptoms in the late postpartum depression among low socioeconomic status women. Birth, 26(3), 157–163. Tovino, S. (2009). Scientific understanding of postpartum illness: Improving health law and policy. Harvard Journal of Law and Gender, 33, 99–173. Thurgood, S., Avery, D., & Williamson, L. (2009). Postpartum depression. American Journal of Clinical Medicine, 6(2), 17–22. Ugarriza, D. (2004). Group therapy and its barriers for women suffering from postpartum depression. Archives of Psychiatric Nursing, 18(2), 39–48. Using Short-Term Group Psychotherapy as an Evidence-Based Intervention for First-Time Mothers at Risk for Postpartum Depression Perspectives in Psychiatric Care 49 (2013) 202–209 209 © 2012 Wiley Periodicals, Inc. Copyright of Perspectives in Psychiatric Care is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use.

RESOURSES

Required Readings

Leszcz, M., & Kobos, J. C. (2008). Evidence-based group psychotherapy: Using AGPA’s practice guidelines to enhance clinical effectiveness. Journal of Clinical Psychology, 64(11), 1238-1260. doi:10.1002/jclp.20531

Marmarosh, C. L. (2014). Empirical research on attachment in group psychotherapy: Moving the field forward. Psychotherapy, 51(1), 88-92. doi:10.1037/a0032523

Microsoft. (2017). Basic tasks for creating a PowerPoint presentation. Retrieved from https://support.office.com/en-us/article/Basic-tasks-for-creating-a-PowerPoint-2013-presentation-efbbc1cd-c5f1-4264-b48e-c8a7b0334e36

Tasca, G. A. (2014). Attachment and group psychotherapy: Introduction to a special section. Psychotherapy, 51(1), 53-56. doi:10.1037/a0033015 

Tasca, G. A., Francis, K., & Balfour, L. (2014). Group psychotherapy levels of interventions: A clinical process commentary. Psychotherapy, 51(1), 25-29. doi:10.1037/a0032520 

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.
· Chapter 11, “Group Therapy” (Review pp. 407–428.)

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.
· Chapter 1, “The Therapeutic Factors” (pp. 1–18)

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.
· Chapter 2, “Interpersonal Learning” (pp. 19–52)

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.
· Chapter 3, “Group Cohesiveness” (pp. 53–76)

You will select one of the following articles on group therapy to evaluate for this week’s Assignment.

Bélanger, C., Laporte, L., Sabourin, S., & Wright, J. (2015). The effect of cognitive-behavioral group marital therapy on marital happiness and problem solving self-appraisal. American Journal of Family Therapy, 43(2), 103-118. doi:10.1080/01926187.2014.956614

Himelhoch, S., Medoff, D., & Oyeniyi, G. (2007). Efficacy of group psychotherapy to reduce depressive symptoms among HIV-infected individuals: A systematic review and meta-analysis. AIDS Patient Care & Stds, 21(10), 732-739. doi:10.1089/apc.2007.0012
Efficacy of group psychotherapy to reduce depressive symptoms among HIV-infected individuals: A systematic review and meta-analysis by Himelhoch, Medoff, & Oyeniyi, in AIDS Patient Care and STDs, Vol. 21/ Issue 10. Copyright 2007 by Mary Ann/Liebert, Inc. Publishers. Reprinted by permission of Mary Ann/Liebert, Inc. Publishers via the Copyright Clearance Center. 

Pessagno, R. A., & Hunker, D. (2013). Using short-term group psychotherapy as an evidence-based intervention for first-time mothers at risk for postpartum depression. Perspectives in Psychiatric Care, 49(3), 202-209. doi:10.1111/j.1744-6163.2012.00350.x

Sayın, A., Candansayar, S., & Welkin, L. (2013). Group psychotherapy in women with a history of sexual abuse: What did they find helpful? Journal of Clinical Nursing, 22(23/24), 3249-3258. doi:10.1111/jocn.12168 

Yildiran, H., & Holt, R. R. (2015). Thematic analysis of the effectiveness of an inpatient mindfulness group for adults with intellectual disabilities. British Journal of Learning Disabilities, 43(1), 49-54. doi:10.1111/bld.12085

GROUP PSYCHOTHERAPY FOR FIRST‐TIME MOTHERS AT RISK FOR POSTPARTUM DEPRESSION
H
UNIVERSITY
INSTRUCTOR:
NRNP-6650
, 2021

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Overview of the article
The article’s objective was to implement 8-week short-term group psychotherapy as a nonpharmacological evidence-based intervention for first-time mothers who have high chances of developing postpartum depression (PPD). It will determine if these first moms partake in the group therapy; their Edinburgh Postnatal Depression Scale (EPDS) score will change.
Postpartum depression (PPD) is an emotional and mental disorder newly delivered mothers go through after having babies. The disorder requires immediate recognition to initiate appropriate medical and pharmacological interventions to prevent further complications.

Postpartum depression (PPD) is a common complication of childbearing associated with a mood disorder that develops within a couple of weeks of delivery. Symptoms include tiredness, lack of energy, inability to eat adequately, lack of interest in caring for self, the baby, and other activities. Further signs include losing or gaining weight, unable to sleep properly or adequately, and suicidal ideations or tendencies (Dlamini, Mahanya, Dlamini & Shongwe, 2019). PPD has a significant adverse effect on the mother to interact appropriately with her child resulting in an inability to care for herself and the baby. To prevent PPD, It is of great importance to scrutinize newly delivered moms early immediately following delivery to identify women with predisposing factors that can lead to PPD and initiate prompt and efficient treatment. Encouraging women to participate in group psychotherapy will serve as a nonpharmacological intervention that is effective and evidenced-based in decreasing the chances of developing postpartum depression (Pessagno & Hunker, 2013).
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Group Discussed/Participants/Reasons for selection
Affected group are Women within age group of 20 and 38 and fist-time moms.
The participants were 24 women
All 24 women completed the Edinburgh Postnatal Depression Scale within three days of childbearing with a score of 11 or higher on the EPDS, which necessitate the need for psychiatric evaluation.
All are first-time mom and are at risk of experiencing PPD

The group that qualifies to participate in the psychotherapy is first-time new moms who just delivered new babies and 24 in number. The psychotherapy will last for eight weeks and will serve as a platform for moms with high chances of developing PPD to socialize among themselves.

The postpartum period starts immediately following childbirth to the first six weeks after delivery, including significant hormonal changes (Sharma & Sherkhane, 2018). These 24 newly delivered first-time moms completed the Edinburgh Postnatal Depression Scale (EPDS) within three days after giving birth.

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Setting of the Group, Frequency and Duration of the therapy
The setting was a community hospital in New Jersey. The hospital maintains the policy of screening all postpartum moms for PPD within 72 hours post delivery.
The group comprises of eight women that meets every week for eight weeks.
The therapy session commences from one month of discharge from the hospital with a duration of 90 minutes per therapy session.

These 24 newly delivered first-time moms have a minimum score of 11 on the EPDS. According to the hospital policy, a mom with an 11 or higher score in EPDS will need psychiatric evaluation for the hospital to determine that mom is fit for discharge from postpartum unit.
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Curative Factors/Exclusion Criteria
The Curative factors to this group include to provide adequate support and instill hope and knowledge about postpartum depression in new mothers.
Ensure stable and steady financial security
Ensure there is an absence of underlining mental health problems and complications of childbirth.
Exclusion criteria include women with childcare issues, women that are worried about the length of commitment to the therapy and women with no interest in group related activities.

Women with careers that ensure a stable and steady income source can afford to provide care and other financial expenses, thereby ensuring a typical postpartum experience with a decreased risk of PPD. While consequences of inadequate income sources, lack of a job, financial constraint, and poverty can lead to mental ill-health (Dlamini, Mahanya, Dlamini & Shongwe, 2019). Women who have their babies naturally with no complications and have no predisposing factors to emotional or mental instability are more satisfied and contented with lower chances of developing PPD (Ezzeddin, Jahanihashemi, Zavoshy & Noroozi, 2018).
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Outcomes of Study and Translation into Practice
The outcome indicates a significant decrease in the EPDS score (less than 11).
Women with low EPDS score most likely, may not develop postpartum depression.
Other literature written by other researchers supports the findings of this study as an evidence-based practice.
The outcome of this study can be implemented/utilized clinically in my client group.

At the end of the study, the result shows that lower numbers on the EPDS scores (less than 11); the implication is that moms with lower numbers on their EPDS scores may not develop PPD. The outcome of this study supports the use of group therapy as an approach or intervention to provide nonpharmacological intervention to first-time moms that may likely develop PPD to eliminate stigma. The outcome of this study also supports the use of group psychotherapy as a tool to scrutinize newly delivered moms immediately following delivery to identify on-time women with predisposing factors that can lead to PPD and initiate prompt and efficient treatment (Pessagno & Hunker, 2013).
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Limitations of the Study
The use of nondirective group process style that allows members of the group to focus more on relationship
Though the study has some limitations; it will not impact the ability to utilize the findings of the study
The benefits outweigh the shortcomings because one of the outcomes is developing a psychotherapy group that is evidence-based in lowering chances of PPD in first time moms that are just delivered.

The shortcomings of this study will not limit implementing positive outcomes in a clinical setting. Studies from other researchers support the findings’ results based on the available evidence (Pessagno & Hunker, 2013).
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References
Dlamini, L. P., Mahanya, S., Dlamini, S. D., & Shongwe, M. C. (2019). Prevalence and factors associated with postpartum depression at a primary healthcare facility in Eswatini. South African Journal of Psychiatry, 25(1), 1-7.
Ezzeddin, N., Jahanihashemi, H., Zavoshy, R., & Noroozi, M. (2018). The Prevalence of Postpartum Depression and Its Association with Food Insecurity among Mothers Referring to Community Health Centers. Iranian journal of psychiatry, 13(4), 280.
Pessagno, R. A., & Hunker, D. (2013). Using Short‐Term Group Psychotherapy as an Evidence‐Based Intervention for First‐Time Mothers at Risk for Postpartum Depression. Perspectives in psychiatric care, 49(3), 202-209.
Sharma, P., & Sherkhane, M. S. (2018). Prevalence and risk factors of postpartum depression in women–a cross-sectional study.

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Postpartum depression (PPD) is a common complication of childbearing associated with a mood disorder that develops within a couple of weeks of delivery. Symptoms include tiredness, lack of energy, inability to eat adequately, lack of interest in caring for self, the baby, and other activities. Further signs include losing or gaining weight, unable to sleep properly or adequately, and suicidal ideations or tendencies (Dlamini, Mahanya, Dlamini & Shongwe, 2019). PPD has a significant adverse effect on the mother to interact appropriately with her child resulting in an inability to care for herself and the baby. To prevent PPD, It is of great importance to scrutinize newly delivered moms early immediately following delivery to identify women with predisposing factors that can lead to PPD and initiate prompt and efficient treatment. Encouraging women to participate in group psychotherapy will serve as a nonpharmacological intervention that is effective and evidenced-based in decreasing the chances of developing postpartum depression (Pessagno & Hunker, 2013).
*
The group that qualifies to participate in the psychotherapy is first-time new moms who just delivered new babies and 24 in number. The psychotherapy will last for eight weeks and will serve as a platform for moms with high chances of developing PPD to socialize among themselves.

The postpartum period starts immediately following childbirth to the first six weeks after delivery, including significant hormonal changes (Sharma & Sherkhane, 2018). These 24 newly delivered first-time moms completed the Edinburgh Postnatal Depression Scale (EPDS) within three days after giving birth.

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These 24 newly delivered first-time moms have a minimum score of 11 on the EPDS. According to the hospital policy, a mom with an 11 or higher score in EPDS will need psychiatric evaluation for the hospital to determine that mom is fit for discharge from postpartum unit.
*
Women with careers that ensure a stable and steady income source can afford to provide care and other financial expenses, thereby ensuring a typical postpartum experience with a decreased risk of PPD. While consequences of inadequate income sources, lack of a job, financial constraint, and poverty can lead to mental ill-health (Dlamini, Mahanya, Dlamini & Shongwe, 2019). Women who have their babies naturally with no complications and have no predisposing factors to emotional or mental instability are more satisfied and contented with lower chances of developing PPD (Ezzeddin, Jahanihashemi, Zavoshy & Noroozi, 2018).
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At the end of the study, the result shows that lower numbers on the EPDS scores (less than 11); the implication is that moms with lower numbers on their EPDS scores may not develop PPD. The outcome of this study supports the use of group therapy as an approach or intervention to provide nonpharmacological intervention to first-time moms that may likely develop PPD to eliminate stigma. The outcome of this study also supports the use of group psychotherapy as a tool to scrutinize newly delivered moms immediately following delivery to identify on-time women with predisposing factors that can lead to PPD and initiate prompt and efficient treatment (Pessagno & Hunker, 2013).
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The shortcomings of this study will not limit implementing positive outcomes in a clinical setting. Studies from other researchers support the findings’ results based on the available evidence (Pessagno & Hunker, 2013).
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