Beck’s Postpartum Depression Theory is a unique tool for working with postpartum women. Remarkably, 9% to 15% of women experience symptoms of postpartum depression, but only a minority of women get a diagnosis (McEwen & Wills, 2019). The use of theory helps achieve comfort, health, and well-being for many women and contributes to nursing education and scientific discourse. A detailed study of the underlying principles, structure, and concept of the theory will allow for a better understanding of its application in nursing practice. This paper aims to describe, analyze and evaluate Beck’s Postpartum Depression Theory.
Beck’s Postpartum Depression Theory was based on research on postpartum depression and was applied to help nurses professionally help women get through this challenging life span. Scientists defined postpartum depression as a process of balancing on the brink of the postpartum period, which consists of four stages. The goal of the theory was to change the perception of postpartum depression and to improve patient care. Since the model views postpartum depression as a biological problem, it suggests specific nursing interventions. An essential aspect of the theory is informing nurses about the consequences of the postpartum period. As a result, mothers who suffer from the postpartum period receive the support they need through various interventions, including support groups.
Concepts, Definitions, and Relationships
The four stages of postpartum depression, according to the theory, include encountering terror, dying of self, struggling to survive, and regaining control. Experiencing terror can be expressed in “horrifying anxiety attacks, obsessive thinking, and enveloping fogginess,” and dying of self can feel like “alarming unrealness, isolation of self, and contemplation of self-destruction” (McEwen & Wills, 2019, p. 238). At the same time, struggling to survive can be expressed in “battling the system, praying for relief, and seeking solace,” while regaining control includes “making transitions, mounting lost time, and attaining a guarded recovery” (McEwen & Wills, 2019, p. 238).
Beck also developed the list of predictors of postpartum depression, including prenatal depression, prenatal anxiety, life stress, marital satisfaction, social support, parenting stress, child temperament, self-esteem, economic status, and whether the pregnancy was planned (McEwen & Wills, 2019). Other symptoms are sleep and eating disorders, emotional lability, anxiety, insecurity, confusion, guilt and shame, loss of self, and suicidal thoughts.
Therefore, the basic concepts on which the theory is based include four stages of balancing on the brink. These concepts are defined through the symptoms characteristic of each stage. At the same time, predictors or risk factors, together, increase the likelihood of symptoms and the development of disease states. Understanding the structure of the phenomenon of postpartum depression is the most important component and goal of the theory, as it allows you to change the attitude towards bad mood and well-being after childbirth, which millions of women face.
The structure of the phenomenon is based on Beck’s concept of postpartum depression as a condition caused by biological factors. This approach allows a change in attitudes towards symptoms, and women can more easily interact with symptoms while receiving treatment. The essence of the phenomenon is that after childbirth, women may experience various negative mental states or emotions, representing the phenomenon of postpartum depression. It is a biological phenomenon; however, it can be exacerbated by multiple socioeconomic and emotional factors.
Abdollahi et al. (2016) note that Beck took the medical model as a basis for the theory, which considers the phenomenon of postpartum depression as a disease or medical condition. According to the theory, health workers should perceive the phenomenon as a pathological mood disorder caused by biological processes and not by social or external conditions. Beck also determined that postpartum depression occurs in 9-15% of women, but only a tiny proportion of this group receive a corresponding diagnosis (Beck, 1995). She has developed a new screening tool to improve detection rates for postpartum depression. This tool, called the Postpartum Depression Checklist (PDC), helps create a dialogue about women’s experiences with 11 of the checklist symptoms.
Subsequently, the theory began to be widely used in research and medical practice. Beck and Gable developed a Screening Scale (PDSS) that was revised in 2002 and 2006 and then validated (McEwen & Wills, 2019). In particular, scientists used PDSS to conduct online screening, which was confirmed to be a viable tool. The researchers also investigated the use of PDSS in hospitals to study parental stress and depressive symptoms. The scale has also been used to measure postpartum depression in selected groups, such as Hispanic expatriates.
Beck developed the Postpartum Depression Theory in 1993, using a grounded theory approach for formulation (McEwen & Wills, 2019). In 1995 and 1998, Beck first tested the theory through meta-analysis to document its effects. Based on the analysis, Beck and Gable created the Postpartum Depression Screening Scale in 2000, revised it in 2002, translated it into Spanish in 2003, and revised it again in 2006. In 2002 Beck developed the meta-synthesis of the theory with the list of predictors. After 2006, the theory and the Postpartum Depression Screening Scale were widely used in research in many languages.
Scientists today widely apply the theory for a variety of purposes. Kizenga (2020) applies attribution theory to study the critical risk factor – the presence or absence of social support for women and its effect on the severity of symptoms. Scholar believes that the perception of postpartum depression as a temporary phenomenon increases the desire for social support, which demonstrates the benefits of understanding the theory for women due to the change in the activity of postpartum depression. Beck (2020) continues to refine the theory and focuses on the importance of integrating metaphors into the medical vocabulary when working with mothers. It is necessary because mothers are better able to express their connection with babies through metaphors.
Interestingly, the study results by Yu et al. (2021) disprove the suggestion that social support influences postpartum depression. Curiously, for a woman in depression, support is no less important than the willingness to receive it or the expectation of support, as formulated by Kizenga (2020). Hammond et al. (2021) studied the impact of negative breastfeeding experiences and identified them as an additional predictor or aggravating factor for postpartum depression. These experiences compromise the sense of authenticity in parenting; at the same time, authenticity mitigates negative results.
In Postpartum Depression Theory, there are particular concepts of person, environment, health, and nursing. A person is a woman who has gone through childbirth and is in a difficult transition period. It is influenced by many social, economic, emotional, and biological factors. The child’s personality is not considered in theory directly, but only indirectly, as another factor influencing the state of a woman, including the child’s character and the mother’s attachment to him. The nurse’s personality is being looked at more closely, with many scientists focusing on how nurses should understand and apply theory in practice, providing additional guidance and theoretical justification.
The environment is viewed as a hospital and home environment in physical, emotional, economic, and social contexts. Health is the dominant theory, given that Beck explains postpartum depression as a purely biological condition. Therefore, nursing focuses on identifying symptoms and treating a condition that is considered a disease.
Significance and Comprehensiveness
The theory is instrumental because of its social and cultural significance. The main benefit of the theory is that women can change attitudes towards their condition and get rid of feelings of guilt for it. At the same time, thanks to nurses’ understanding of this condition, women can receive adequate assistance. Understanding the biological causes of postpartum depression can also improve the social relationships of a woman and her environment by raising her expectations for social support. The cultural significance is attributed to an increased culture of interaction between nurses and patients and a decrease in secondary irritation.
The theory is comprehensive and holistic, providing a clear framework for understanding the situation and providing a toolkit for working with the theory through assessing symptoms. Considering that the theory has been revised and supplemented many times, its content is self-explanatory and thorough. The universality of the theory is expressed in the fact that it applies to women of any socioeconomic status and age.
Logical Congruence and Credibility
The theory is consistent and clear; various researchers and Beck use the concepts consistently throughout the literature. The most important concept is “postpartum depression”; this concept is synonymous with theory and was formulated by Beck, after which it became widespread and became a household name. The concepts of predictors and risk factors are also often used without further explanation, implying an exhaustive list of factors presented by Beck. Postpartum Depression Theory is widely recognized by scholars around the world and has been translated into many languages. Beck’s ideas continue to receive development and additions from scientists who consider previously unexplored aspects of the theory or test for the authenticity of some of the assumptions associated with it.
Contribution to Nursing
The theory is of unique importance for nursing practice, education, and research as it allows patients to change their attitudes towards symptoms associated with postpartum depression. Moreover, the nurse’s awareness of the existence of the disease of postpartum depression allows for timely treatment and interventions. The development of the theory within the scientific discourse allows continuing to contribute to nursing education as the theory is considered for application in target groups. Many of its aspects, such as symptoms and predictors, are refuted or scientifically validated.
Thus, Beck’s Postpartum Depression Theory was described, analyzed, and evaluated. The purpose, concepts, and structure of the theory and the related assumptions were discussed. Analysis featured the theory’s origin, focus, and content, and evaluation considered significance, comprehensiveness, logical unity, credibility, and contribution to nursing. Beck’s Postpartum Depression Theory can be confidently used as a basis for nursing practice when working with women in the postpartum period.
Abdollahi, F., Lye, M. S., & Zarghami, M. (2016). Perspective of postpartum depression theories: A narrative literature review. North American Journal of Medical Sciences, 8(6), 232. Web.
Beck, C. T. (1995). Screening methods for postpartum depression. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 24(4), 308-313. Web.
Beck, C. T. (2020). Mother–infant interaction during postpartum depression: A metaphor analysis. Canadian Journal of Nursing Research, 52(2), 108-116. Web.
Hammond, M., Brooker, R. J., Mistry-Patel, S., Schlegel, R. J., Vess, M., Wines, M., & Havens, J. (2021). Feelings of parental authenticity moderate concurrent links between breastfeeding experience and symptoms of postpartum depression. Frontiers in Global Women’s Health, 2, 25. Web.
Kizenga, C. (2020). Increasing social support for women with postpartum depression using the attribution theory (Doctoral dissertation, Dublin, National College of Ireland). 1-22. Web.
McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing. Lippincott Williams & Wilkins.
Yu, M., Sampson, M., Liu, Y., & Rubin, A. (2021). A longitudinal study of the stress-buffering effect of social support on postpartum depression: a structural equation modeling approach. Anxiety, Stress, & Coping, 1-15. Web.