Stress in women with postpartum depression

The objective of conducting a critique to a research article is to verify that the conclusions reached are valid and that any claimed empirical evidence has been identified as a result of applying the conventions and procedures of empirical research that lead to such evidences. This, of course, requires evaluating the article from a number of angles, e. g. design, methodology, the selection of participants and the ethical issues related, interpreting data empirically and reaching the valid evidences.

Therefore, in order to criticize objectively this research paper, I am going to review the report and write a summary of the research report. Then I am going to look at the research report critically in order to identify strengths and weaknesses of the report. While this requires reading extensively in the literature, it would not be appropriate to cite all the readings in this critique. However, all literature referred to thoroughly or skimmed through will be included in the bibliography.

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Review (Summary of the Article) Introduction Postpartum depression, a worldwide problem, is thought t be caused by stress experienced after childbirth in adjusting and adapting psychologically, socially and culturally. Higher levels of depressive symptoms are reported for women exposed to stress events during pregnancy and early puerperium. In the literature it is reported that cultural customs and rituals combined with the roles of family members can reduce postpartum stress.

Literature review indicates that postnatal stress up to date have deployed quantitative approaches in collecting data for research. Postpartum stress in relation to postpartum depression is cited as an important issue in literature, however; the detailed description of stress experienced by women with postnatal depression leaves room for further research. Therefore, the paper is designed to report an in-depth investigation of this problem. Background A number of stress factors were reported in literature as evidentially associated with postpartum depression.

In addition to the list of stress factors, another list stressful events both antenatal and postnatal have been cited in literature. As a result of previous studies five most stressful events of the postpartum period were identified: having a sick baby, an unhappy experience of delivery, caesarean section delivery, concern about body shape and baby’s welfare. Stress itself was also categorized into four types: role, tasks, relationship and resources. However, all earlier studies were limited to quantitative data analysis.

Therefore, the present study of in-depth investigation of stresses using a qualitative approach is justified. The Study The aim is stated as the description of lived experience of postpartum stress among depressed Chinese mothers in Hong Kong. The design is too briefly described to adopt a phenomenological approach. Participants A purposive sample of 11 recruited from a larger group of a larger study. Screening for postpartum depression at the sixth postpartum week was done using the Edinburgh Postnatal Depression Scale. (EPDS). Data Collection

Data was collected by in-depth interview conducted using open-ended questions supported by prompts. During the lengthy interviews of 45 – 60 minutes privacy was respected by giving participants the option of selecting a part of the house where they feel comfortable and a convenient time. To ensure reliability of data collected the first author, who was in touch with the subjects during pregnancy, conducted all the interviews. These were also followed by debriefing sessions and some remedial actions were taken when necessary.

Certain measures were enforced to ensure the validity of data, though the measures applied are not supported by any evidence from literature. Ethical consideration This was well approached by seeking approval from university and hospitals as well as obtaining written consents from the participants. Data Analysis Recorded tapes of interviews were transcribed into verbatim reports avoiding paraphrasing. Consistency was ensured by regular meeting of the three researchers.

Then the data was further analyzed using Colaizzi’s method. Findings Under this heading a detailed description of participants was given though this belongs to the section by the heading title Participants. As a result of data analysis five themes were identified: parenting competence, the expectation-experience gap, baby-minder arrangements, childcare demands, and conflict with culture and tradition. A detailed description of the experiences of participants in each theme is given. Discussion

The discussion covers the five themes in contrast with the same themes or others covered in previous studies. It also covered the experience of participants in coping with the difficulties of these themes. The problems of participants within these themes that become stressful events were identified and discussed in relation to the findings of previous researches. Conclusions In Hong Kong where ‘East meets West’ the different living styles related to different cultures create stressful and conflicting situations.

“The overwhelming and conflicting advice between the Chinese tradition and the modern style of childcare were found to be the major source of stress for many participants” The authors recommend encouraging health care staff and new mothers to have a flexible view of child care considering the traditional ritual, thinking, customs and the modern child care traditions. Conclusions also suggest the application of their findings for migrant groups in other countries. Further research on postpartum stress and depression is recommended. Critiques Phenomenological Approach

The article is described as a phenomenological study and therefore phenomenological methodology in research should be clearly defined and described. Some of the definitions offered are too broad that they only relate phenomenological study to observation. For example, according to Aiken, L. (1994) it is defined as “study of objects and events as they appear to the experiencing observer. ” However, it is not so simple that the appearance of the subject as it is experienced by the observer should be the basis for data analysis and inference.

While the growing interest in phenomenological study has been due to the “richness of individual experience”, this method of study is challenging because of the complexity of ideas that are inherent in this type of research. Indeed, “Confusions abound as to what phenomenology means, let alone how to apply it as a research method,” (Finlay, 1999) The following quote further illustrates this point: “Phenomenology began as a movement in philosophy that deals with the essences of objects, or phenomena as they present themselves in human consciousness.

The founding father of phenomenology, Husserl, believed that through rigorous examination of objects, as they are presented in one’s consciousness, a person could come to intuitively know the essence of those objectivities, or realities. He proposed that other disciplines might benefit from phenomenology as a way of identifying the main objectivities with which the discipline deals, before undertaking other inquiry. The phenomenological method outlines the steps of such an investigation. ” (Gray, 1997)

Within such understanding of the phenomenological methodology one would argue this research method can suit certain types of research where observation is the main tool of collecting data. For example, Bates et al (1993) used this method of research for their study of disabled adult’s adaptation to wheelchair use. Here where the subject is only one disabled adult, the adaptation of the disabled adult can be observed easily and notes on challenges and progress can also be recorded easily.

In the case of the article in hand it is not very clear how the research method can be used when the manifestations of the depressions are not observed but rather described by the subjects during interviews. It is valid to ask here how the researcher would record his results when the subject is asked if he was depressed at the time of the interview and he says no while the observation of the researcher was that he was in fact depressed.

It is definite that the observation of a subject adapting to use a piece of equipment is less complicated and easy to record and measure while observing the depressed subject is not equally easy and is of course complicated because the indications of depression are very often emotional signs that one cannot definitely evaluate and record. Yet in the literature there is evidence that in-depth investigation of the problem through interviews, for example can reveal valid data for phenomenological study.

It is stated that phenomenological approach is used for the purpose of illuminating “the specific to identify phenomena through how they are perceived by the actors in a situation In the human sphere this normally translates into gathering ‘deep’ information and perceptions through inductive, qualitative methods such as interviews, discussions and participant observation, and representing it from the perspective of the research participant(s).

Phenomenology is concerned with the study of experience from the perspective of the individual, ‘bracketing’ taken-for-granted assumptions and usual ways of perceiving. Epistemologically, phenomenological approaches are based in a paradigm of personal knowledge and subjectivity, and emphasise the importance of personal perspective and interpretation.

As such they are powerful for understanding subjective experience, gaining insights into people’s motivations and actions, and cutting through the clutter of taken-for-granted assumptions and conventional wisdom. ” (Lester, 1999). Therefore, it can be concluded that the author f the article rightly used the phenomenological approach in his research and his decision to adopt the phenomenological approach should positively serve the purposes of his paper.

Ethical Aspects Since the ‘purposive sample of 11’ was recruited according to a selection criteria that included: the participants being Hong Kong Chinese residents, had been staying in Hong Kong for postnatal care after delivery, lived with the baby and baby’s father after delivery, and classified as depressed according to the EPDS, it is clear that the participants were not subjected to any harm whatsoever.

The benefits of the research may not be directly received by the participants, but the general benefits of the study will affect the category (patients suffering postpartum depression) directly or indirectly. It is also clear that no type of coercion or unacceptable influence was used to recruit the members of the sample. Furthermore, ethical approval was obtained from the university and five hospitals that accommodate the participants. , as well as writte consents from the participants.

Therefore, it can be concluded that ethical aspects were considered adequately to the standards of empirical research. Literature Review It seems that the author thought of literature review as peripheral to empirical research. This is apparent in the article where there is no reference to ‘literature review’ but instead the review is discussed under the heading: ‘Background’. In a research paper dealing with stress and postpartum depression only four references are sited.

It is clearly apparent that literature review was not thoroughly covered. Consequently no balanced review of points of view supporting the topic of the paper or those contradicting it are pointed out. The importance of literature reviews lies in its purposes in a research paper. It is meant to bring to the attention of the reader what has already be done on the topic you are researching now. Based on this the researcher can introduce his topic as an original topic that has not been studied before.

The literature review can also illustrate how your research can fill a gap in the field your topic belongs to. It is not, as it is sometimes mistaken, an annotated bibliography. Neither is it a disjointed paragraphs summarizing a number of research papers related to the topic. Despite the fact that the literature review in this article was covered in more than one place, i. e. under background, discussion and findings, literature review in this article leaves much to be desired.

Hypotheses Instead of stating a hypotheses the researchers only state the aim of the research paper. There are some research types including qualitative and descriptive ones that do not have a hypothesis to validate; instead at the end of the research such papers state a hypotheses as a result of the research and recommend it for further research. Design It is clear from the format of the paper that an appropriate design was not selected and used.

Despite the approach suggested being qualitative empirical research type, the authors did not introduce a specific design for the paper. The classical subheadings are missing, i. e. abstract, introduction, hypotheses, literature review, method, results, discussions and analysis, findings etc. While the paper is an empirical research one, the format of design used make it look like a literature review research. Method This is the approach to gathering data and analyzing it in order to confirm evidences or rule them out.

In this paper this is discussed under data analysis. The way data is going to be gathered and how the participants are going to be recruited is the main purpose here. In phenomenological approaches the experiments subjects can be a small group or an individual case. The way gathering data is conducted differs from a single subject to a purposive group. The methodology here is to use “interviews, conversations, participant observation, action research, focus meetings and analysis of personal texts.

” The methodology of phenomenological approach mainly depends on the sample used: “While single-case studies are able to identify issues which illustrate discrepancies and system failures – and to illuminate or draw attention to ‘different’ situations – positive inferences are less easy to make without a small sample of participants. In multiple-participant research, the strength of inference which can be made increases rapidly once factors start to recur with more than one participant.

In this respect it is important to distinguish between statistical and qualitative validity: phenomenological research can be robust in indicating the presence of factors and their effects in individual cases, but must be tentative in suggesting their extent in relation to the population from which the participants or cases were drawn. ” (Lester, 1999) Although the paper describes the purposive group and how they were recruited, the way data was collected and analyzed was limited to interviews recorded and transcribed.

The interviews which were identified as in-depth ones were only described rather than giving samples of questions. However, this point that may complete the research report should not affect the results of the research. The analysis of data in phenomenological and associated approaches is rather difficult because of the type of data collected, i. e. interviews recordings. The paper does not mention any difficulties encountered or expected in this area but simply describe the resulting themes.

“One ‘problem’ of phenomenological research is that it generates a large quantity of interview notes, tape recordings, jottings or other records all of which have to be analysed. Analysis is also necessarily messy, as data doesn’t tend to fall into neat categories and there can be many ways of linking between different parts of discussions or observations. Two methods I use are described below. ” (Lester, 1999) Findings Findings were appropriately identified by analyzing data and the use of EPDS scores for the sixth postpartum week and month.

As a result five major themes were identified. On the assumption that the research was appropriately designed and the phenomenological approach was accurately applied, the paper has successfully identified the themes of stress related to postpartum depression among the sample studied. In conclusion I would say that the research paper was generally successful despite the limitations identified in the area of literature review and the design of the report format. References

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Holism in occupational therapy: elusive fiction and ambivalent struggle. The American Journal of Occupational Therapy, 55, 268-276. 5. Lister, R. (1999). Loss of ability to drive following a stroke: The early experiences of three elderly people on discharge from hospital. The British Journal of Occupational Therapy, 62, 514-520 6. Gray, J. M. (1997). Application of the phenomenological method to the concept of occupation. Journal of Occupational Science: Australia, 4, 5-17 7. Lester, San (1999) An introduction to phenomenological research – downloaded on 25 October 2006 from:

http://www. devmts. demon. co. uk/resmethy. htm 8. Anonymous – A guide for critique of research articles – downloaded on 25 October 2006 from: http://www. csulb. edu/~arezaei/ETEC551/critique-guide. htm 9. Anonymous – Guidelines for Critiquing Research Articles – downloaded on 25 October 2006 from: www. sonoma. edu/users/n/nolann400/critique. html 10. Rodgers, Beth L. (1997) – Critique: balanced, including strengths and weaknesses, and constructive, providing suggestions for how the study might be improved – downloaded on 25 October 2006 from: http://www. webct.

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