The process of recovery in women who experienced psychosis following childbirth

BMC Psychiatry

Anja Wittkowski¹  Angelika Wieck¹  Sarah Peters²  Laura McGrath² 

[1] Manchester Mental Health and Social Care Trust, Wythenshawe Hospital, Manchester, UK;School of Psychological Sciences, the University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK

关键词: United Kingdom;    Qualitative;    Grounded theory;    Recovery;    Postnatal psychosis;    Postpartum psychosis;    Puerperal psychosis;   

Others  :  1123855
DOI  :  10.1186/1471-244X-13-341

 received in 2013-04-16, accepted in 2013-11-11,  发布年份 2013

【 摘 要 】

Background

Psychosis following childbirth affects 1–2 mothers per 1000 deliveries. Onset is rapid and functioning is severely affected. Although prognosis in terms of symptom remission is generally good, long-term disability can persist. The study’s aim was to develop a theoretical understanding of recovery from psychosis following childbirth.

Methods

Semi-structured interviews were conducted with 12 women with experience of psychosis following childbirth. Interview transcripts were analysed using grounded theory methodology.

Results

A theory of four superordinate themes was developed from the data, including: (i) the process of recovery; (ii) evolving an understanding; (iii) strategies for recovery; and (iv) sociocultural context. The process of recovery and women’s understanding of their experience were conceptualised as parallel processes, which informed one another. Women found that a diagnosis facilitated their use of particular strategies.

Conclusions

This study highlighted a complex and ongoing process of recovery from psychosis following childbirth. Sensitivity to a woman’s position in the process of recovery has the potential to facilitate professionals in assessing readiness for different interventions which will be likely to result in women feeling more understood, accepted and supported.

【 授权许可】

   
2013 McGrath et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Estroff S: Self, identity and subjective experiences of schizophrenia. Schizophr Bull 1989, 15:189-196.
• [2]Anthony W: Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Psychosoc Rehab J 1993, 16(4):11-23.
• [3]Department of Health UK: The Journey to Recovery. London, UK: HMSO; 2001.
• [4]Slade M, Hayward M: Recovery, psychosis and psychiatry: research is better than rhetoric. Acta Psychiatr Scand 2007, 116(2):81-83.
• [5]Pitt L, Kilbride M, Nothard S, Welford M, Morrison A: Researching recovery from psychosis: a user-led project. Psychiatr Bull 2007, 31:55-60.
• [6]Harlow BL, Vitonis AF, Sparen P, Cnattingus S, Joffe H, Hultman CM: Incidence of hospitalization for postpartum psychotic and bipolar episodes in women with and without prior prepregnancy or prenatal psychiatric hospitalizations. Arch Gen Psychiatry 2007, 64:42-48.
• [7]Sit D, Rothschild A, Wisner K: A review of postpartum psychosis. J Womens Health 2006, 15:352-368.
• [8]Jabs B, Pfuhlmann B, Bartsch A: Cycloid psychoses: From clinical concepts to biological foundations. J Neur Transm 2002, 109:907-919.
• [9]Brockington IF, Winokur G, Dean C: Puerperal Psychosis. In Motherhood and Mental Illness. Edited by Brockington IF, Kumar R. Academic Press: London; 1982:37-69.
• [10]American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington DC: American Psychiatric Association; 2000.
• [11]World Health Organisation: International Statistical Classification of Diseases and Related Health Problems, 10th Revision. Geneva: WHO; 1992.
• [12]Andresen R, Oades L, Caputi P: The experience of recovery from schizophrenia: towards an empirically validated stage model. Aust N Z J Psychiatry 2003, 37:586-594.
• [13]Charmaz K: Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. London: Sage; 2006.
• [14]Boyce P, Barriball E: Puerperal psychosis. Arch Womens Ment Health 2010, 13:45-47.
• [15]Dey I: Grounding Grounded Theory: Guidelines for Qualitative Enquiry. San Diego: Academic Press; 1999.
• [16]Salmon P, Hall GM: Patient empowerment and control: a psychological discourse in the service of medicine. Soc Sci Med 2003, 57:1969-1980.
• [17]Leventhal H, Nerenz DR, Steele DJ: Illness Representations and Coping with Health Threats. In Handbook of Psychology and Health, Volume IV: Social Psychological Aspects of Health. Edited by Baum A, Taylor SE, Singer JE. Hillsdale, NJ: Erlbaum; 1884:219-252.
• [18]Kinderman P, Setzu E, Lobban F, Salmon P: Illness beliefs in schizophrenia. Soc Sci Med 2006, 63:1900-1911.
• [19]Bondi L, Burman E: Women and mental health: a feminist review. Fem Rev 2001, 68:6-33.
• [20]Hayne Y: Experiencing psychiatric diagnosis: client perspectives on being named mentally ill. J Psychiatric Ment Health Nurs 2003, 10(6):722-729.
• [21]Mauthner N: "Feeling low and feeling really bad about feeling low:" Women's experiences of motherhood and postpartum depression. Can Psychol 1999, 40(2):143-161.
• [22]Pitt L, Kilbride M, Nothard S, Welford M, Morrison A: Impact of a diagnosis of psychosis: user-led qualitative study. Psychiatr Bull 2009, 33:419-423.
• [23]Di Mascio V, Kent A, Fiander M, Lawrence J: Recovery from postnatal depression: a consumer's perspective. Arch Womens Ment Health 2008, 11:253-257.
• [24]McCubbin M, Cohen D: Extremely unbalanced: Interest divergence and power disparities between clients and psychiatry. Int J Law Psychiatry 1996, 19(1):1-25.
• [25]Mauthner N: The Darkest Days of my Life: Stories of Postpartum Depression. Cambridge, MA: Harvard University Press; 2002.
• [26]Williams J, Scott S, Waterhouse S: Mental health services for ‘difficult’ women: Reflections on some recent developments. Fem Rev 2001, 68:89-104.
• [27]Robertson E, Lyons A: Living with puerperal psychosis: A qualitative analysis. Psychology and Psychotherapy. Theo Res Prac 2003, 76:411-431.
• [28]Hagen B, Nixon G: 2011. Spider in a jar: Women who have recovered from psychosis and their experience of the mental health care system. Ethical Human Psychol Psychiatry 2011, 13:47-63.
• [29]Zauderer C: Postpartum depression: How childbirth educators can help break the silence. J Perinatal Ed 2009, 18(2):23-31.
• [30]Laithwaite H, Gumley A: Sense of self, adaptation and recovery in patients with psychosis in a forensic NHS setting. Clin Psychol Psychother 2007, 14:302-316.
• [31]Edin K, Kefalas M: Promises I Can Keep: Why Poor Women Put Motherhood Before Marriage. Berkeley: University of California Press; 2005.
• [32]Lopez SR, Guarnaccia PJJ: Cultural psychopathology: Uncovering the social world of mental illness. An Rev Psychol 2000, 51:571-598.
• [33]Entwistle VA, Sheldon TA, Sowden A, Watt IS: Evidence-informed patient choice. Int J Tech Assess Health Care 1998, 14:212-225.
• [34]Deegan P: Recovery: The lived experience of rehabilitation. Psychosoc Reh J 1988, 11:11-19.
• [35]Leete E: How I, perceive and manage my illness. Schizophr Bull 1989, 15:197-200.
• [36]McGlashan TH, Wadeson HS, Carpenter WT, Levy ST: Art and recovery style from psychosis. J Nerv Mental Dis 1997, 164:182-190.
• [37]Nicolson P: Loss, happiness and postpartum depression: The ultimate paradox. Can Psychol 1999, 40:162-178.
• [38]Beck C: Postpartum depression: A metasynthesis. Qual Health Res 2002, 12:453-472.
• [39]Kumar R: Postnatal mental illness: a transcultural perspective. Soc Psychiatry Psychiatr Epidem 1994, 29:250-264.
• [40]Weber-Cannon L, Higginbotham E, Leung M: Race and class bias in qualitative research on women. Gend Soc 1988, 2:449-462.
• [41]Rahim F, Al-Sabiae A: Puperperal psychosis in a teaching hospital in Saudi Arabia: clinical profile and cross-cultural comparison. Acta Psychiatr Scand 1991, 84:508-511.
• [42]Cox J, Amakiro : A Ugandan puerperal psychosis? Soc Psychiatry 1979, 14:49-52.
• [43]Nakigudde J, Airaksinen E, Musisi S, Muhwezi W, Neema S, Mirembe F: Perceptions regarding postpartum psychotic illness in two districts in Central Uganda. World Cultural. World Cultural Psychiatry Res Rev 2010, 5(2):57-69.