Butts and Rich (201 7 ) define a conceptual framework as a "set of relatively abstract and general concepts that address the phenomena of a central interest to a discipline , the propositions that broadly describe these concepts, and the state relatively abstract and general relations between two or more concepts." According to Butts and Rich (201 7 ), conceptual frameworks are the foundations of nursing as a discipline, and they have a practical value as they provide guidelines for research and practice. Conceptual frameworks are founded on the identification of the primary concepts as well as the relationships among the concepts. The interaction between an individual and the environment constantly changes over time. Nursing can be described as a resource in the environment that is an enabler to the health of an individual through the process of inquiry, practice, and care.
Depression is a well-established mental health condition that affects millions of people worldwide. Psychological stress plays a vital role in depression, and this leads to negative health outcomes in the individual. Postpartum depression (PPD) is the leading cause of disability in women that occurs within the first four weeks after delivery or following the delivery of the newborn baby (Lindsay, Greaney, Wallington, Wright & Hunt, 2017). In the United States, Latinas are the fasted growing minority groups, and in 2015, immigrant Latinas accounted for almost 56 percent of births in the United States. According to the American Psychiatric Association, PPD is the leading medical condition that among new mothers and an estimated 20 percent of new mothers are affected from the general population (Lindsay, Greaney, Wallington, Wright & Hunt, 2017). In 2016, the Latina population stands 58 million which can be attributed to the changes in education and immigration thus accounting for almost half of the national population growth since the year 2000. According to research, psychological stressors have been identified as important risk factors in the prevalence of PPD ((Hayden, Connelly, Baker-Ericzen, Hazen & McCue Horwitz, 2013). The biological mechanisms that are associated with psychosocial stressors thus leading to the increased risks of PPD are not well understood.
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The evidence available in literature suggests that the prolonged exposure to stress that is mainly associated with the hyperactivity of stress systems becomes dysregulated over time thus making it impossible for an individual to adapt to later stressors in life (Hayden, Connelly, Baker-Ericzen, Hazen & McCue Horwitz, 2013). The hypothalamic-adrenal-pituitary (HPA) axis which is the central stress response system in the human body is the affected by the psychosocial stressors in Latinas. To help address the gap in research , a conceptual framework in both psychological and psychosocial risk factors that are associated with PPD in U.S-born and immigrant Latinas was developed towards the achievement of an integrated model of PPD and stress. Latinas are a heterogeneous group in the United States, and they are more than likely to experience specific stressors that are associated with their migration (Hayden, Connelly, Baker-Ericzen, Hazen & McCue Horwitz, 2013). On the other hand, Latinas born in the united states as children of immigrants are likely to experience and be exposed to contextual and cultural stressors (Sampson, Torres, Duron & Davidson, 2017). The biological and contextual factors that are associated with PPD include:
Contextual stress such as lifetime trauma and poverty
Cultural stress such as discrimination, border-crossing trauma, acculturative stress and the generation and status of the immigrant (Sampson, Torres, Duron & Davidson, 2017).
Poverty is an important culturally- and contextually relevant factor that poses a risk during the perinatal period (Sampson, Torres, Duron & Davidson, 2017). High levels of poverty are experienced in the Latina population, and one in four Latina women lives in abject poverty in the United States. The high demands that are associated with pregnancy and taking care of an infant in addition to the day to day stress of being poor make Latinas vulnerable to PPD as this population is inclined to limited access to health care and at times they also experience food scarcity (Lara-Cinisomo et al., 2018). Traumatic events in both childhood and adulthood relevant to adulthood include physical and sexual violence, childhood sexual and physical violence, particularly during the pregnancy period (Lara-Cinisomo et al., 2018). The conceptual model captures the timing and history of trauma and its proximity to the postpartum period and its relation to PPD.
During the perinatal period, women are vulnerable to depressions because of the psychological and physiological stress that is associated with motherhood and pregnancy (Lara-Cinisomo et al., 2018). Latinas experience a high number of stressors during their lifetime, and it's vital to understand the effects of stress as well as the interventions that may contribute to the population adapting to the psychological and physiological stress of motherhood. Inadequate caregiving practices such as breastfeeding and safety practices such as punishment and the thoughts of harming infants are the effects of PPD on women. PPD in the Latina population presents high-risk factors to both the mother and the child, and in the most extreme cases, some women experience suicidal thoughts (Lara-Cinisomo et al., 2018). It is therefore important for healthcare institutions to provide screening for paternal and maternal depression during the postpartum period. Early interventions of PPD include yoga, psychotherapy and interaction coaching for the mother and infant massaging for the infants. High social support systems have been found for the Latina population during the perinatal period.
Latinas experience contextual and cultural contributors for PPD (Sampson, Torres, Duron & Davidson, 2017). Health care providers are obligated to routinely asses the presence and the degree of the contributing factors to PPD when evaluating both U.S-born and immigrant Latinas for postpartum stress disorders. Health care practitioners should also consider the adverse effects of dysregulated HPA stress responses and their effects on women. It is there critical for providers to take into consideration the biological, contextual and cultural contributors to PPD during the early stages of perinatal care.
References
Butts, J., & Rich, K. (2017). Philosophies and Theories for Advanced Nursing Practice . Massachusetts: Jones & Bartlett Learning.
Lara-Cinisomo, S., Zhu, K., Fei, K., Bu, Y., Weston, A., & Ravat, U. (2018). Traumatic events: exploring associations with maternal depression, infant bonding, and oxytocin in Latina mothers. BMC Women's Health , 18 (1). doi: 10.1186/s12905-018-0520-5 .
Lindsay, A., Greaney, M., Wallington, S., Wright, J., & Hunt, A. (2017). Depressive Symptoms and Length of U.S. Residency Are Associated with Obesity among Low-Income Latina Mothers: A Cross-Sectional Analysis. International Journal Of Environmental Research And Public Health , 14 (8), 869. doi: 10.3390/ijerph14080869
Hayden, M., Connelly, C., Baker-Ericzen, M., Hazen, A., & McCue Horwitz, S. (2013). Exploring Perceptions and Experiences of Maternal Depression in Latinas: A Qualitative Study. Issues In Mental Health Nursing , 34 (3), 180-184. doi: 10.3109/01612840.2012.701708 .
Sampson, M., Torres, M., Duron, J., & Davidson, M. (2017). Latina Immigrants’ Cultural Beliefs About Postpartum Depression. Affilia , 33 (2), 208-220. doi: 10.1177/0886109917738745 .
