Evidence Based Practice: Critique of Nursing Literature

The location and critique of nursing literature is centric to evidence based practice. The purpose of this paper is to analyze, critique and summarize an article in furtherance of the understanding of evidence based practice as a nursing student. The article is by Katon, Russo & Gavin (2014) and focuses on the predictors of postpartum depression and particularly investigates socio-demographic factors, pregnancy associated stress and depression (psychosocial), birth outcomes, pregnancy-associated illnesses, medical and psychiatric illnesses prior to pregnancy and health risk behaviors as risk factors of post partum depression (PPD). The paper contributors to the growing literature on postpartum depression in maternal health and shall help physicians in understanding and preventing the health problem.

            The research question in the article generally relates to the predictors of post partum depression. There are several cited in literature and the author has grouped them under socio-demographic factors, pregnancy associated psychosocial stress and depression, birth outcomes, pregnancy-associated illnesses, medical and psychiatric illnesses prior to pregnancy and health risk behaviors for the purposes of the study. The research question is quite broad encompassing risk factors of PPD under six categories. The question was prompted by two factors. First, there is a dearth of literature on the risk factors of PPD according to several systematic reviews. Secondly, PPD is a serious health problem leading to future cases of depression in women and functional impairment. It was therefore a significant issue that prompted the designation of the research question.

            The research design used in the study was a prospective cohort study. In such a research design, information is collected from a group of people (cohort) using the same instruments and for the same parameters before exposure to a disease condition or any other outcome (Bookwal, Hussain & Bhandari, 2011). The distinguishing feature in this method is that information is collected prior to the development of any of the outcomes under investigation. Thereby, the pregnant women in the study by Katon, Russo & Gavin (2014) were enrolled for the study prior to developing PPD and information on the various risk factors recorded. The relationship between the risk factors and the development of PPD was determined through logistic regression analysis. This design is suitable for healthcare research as it can be used to study risk factors and their effects over time. However, it is time consuming and potentially costly. The authors resorted to it due to its ability to correlate risk factors and outcomes like PPD.

            The sample of the study consisted of 1,423 pregnant women. These were screened at 4 and 8 months of pregnancy at a high risk university obstetrics clinic. The sample size was reasonable given that the study was longitudinal and involved the collection of a large amount of data. It was also sufficient for drawing a relationship between the risk factors and PPD. Those women under the age of 15, with a language barrier or mental illness were excluded from the study meaning that the participants had the capacity to take part in the study. The only challenge was that the sample was quite large and thus the collection of detailed information from each participant would be difficult.

            The data collection method used entailed questionnaires that were distributed to the study population as part of a quality improvement initiative. The first questionnaire was issued at 4 months and another at 8 months in both cases recording information on the various risk factors forming the subject of the study. Clinical officers were responsible for facilitating the study participants in filling the questionnaires and obtaining written consent for participating in the research. The only gap in the study is that there was no approval sought from an ethics committee and the authors did not declare any conflicts of interest save for financial disclosure.

            The study has hardly any significant limitations. However, the use of a prospective cohort study comes with various challenges. For instance, some of the PPD outcomes reported may have been due to confounding factors rather than the risk factors under study due to the lengthy period in which the study is undertaken. The large sample used also makes it vulnerable to administrative and clerical errors (Bookwal, Hussain & Bhandari, 2011). These challenges are inherent of a longitudinal study and can only be overcome by exercise of abundance of caution in collecting and recording data. Such limitations are important to discuss in a study in order to understand the extent to which the findings can be generalized.

            The findings of the study were that younger age, pre-pregnancy chronic illnesses, unemployment, taking anti-depressants, smoking, antenatal depressive symptoms and psychosocial stressors were independent risk factors of PPD. These findings were credible in that they reiterated the conclusions of available evidence in a number of systematic reviews.

            In the end, it was evident from the research study that a number of risk factors were associated with the development of PPD. The study deployed a prospective cohort design with a large sample of over a thousand women screened between 4 and 8 months. The findings of the study are important for physicians and other health professionals in understanding the causes of depression during the post partum period. However, the results are in isolation not adequate to warrant a change in practice. Further studies are needed to investigate the risk factors further and buttress the conclusions of the present research.

References

Bookwala, A., Hussain, N., & Bhandari, M. (2011). The three-minute appraisal of a prospective cohort study. Indian journal of orthopaedics, 45(4), 291.

Katon, W., Russo, J., & Gavin, A. (2014). Predictors of postpartum depression. Journal of women’s health, 23(9), 753-759.