The four-stage process to regain control of Postpartum Depression

Postpartum depression (PPD) is characterized by a major depressive episode that begins within four to six weeks following delivery, as per international diagnostic criteria. Recurrence rates for PPD are high, with 40% of affected women experiencing depression again in their lifetime and nearly 50% facing another episode in subsequent pregnancies. Symptoms of PPD encompass fatigue, irritability, anxiety, lack of pleasure, feelings of helplessness, sleep and appetite disturbances, indifference towards life events, low self-esteem, and feelings of incompetence as a parent, among others. PPD is considered a multifactorial condition influenced by both environmental and genetic risk factors for depression.

Risk factors for PPD  include:

• Previous depression.
• Adverse life events.
• Lack of social support.
• Socioeconomic position.
• Personal and family psychiatry history.
• Stressful experiences (such as trauma).
• Specific pregnancy-related factors.
• Intimate partner violence (IPV) occurring close to or during pregnancy also elevates the risk of postpartum depression.

The impacts of PPD are significant and extend beyond the affected individual. They include poor attachment between the mother and newborn, potential stunted growth and low weight in the child, disrupted breastfeeding, and adverse effects on the infant’s cognitive, emotional, and social development. There is also an increased risk for psychiatric disorders in the child during infancy, childhood, adolescence, and adulthood. Women of color and those with lower incomes are more likely to suffer from postpartum depression and may face barriers to accessing treatment (Gopalan et al., 202).

The four-stage process to regain control of Postpartum Depression

Women experiencing PPD often undergo a four-stage process in an attempt to regain control:

1. In the initial stage, mothers grapple with intense worries, persistent obsessive thoughts, and difficulties focusing.
2. In the second stage, women feel a sense of loss of their “regular selves,” describing a robotic feeling while caring for their infants. Withdrawal may occur, and thoughts of self-harm or suicide may surface.
3. The third stage involves women planning strategies to overcome PPD, such as seeking help from healthcare providers, engaging in prayer, or finding comfort in support groups.
4. In the final stage, women regain control of their thoughts and feelings as despair lifts.
   Four Major Diseases linked to smoking

   According to the Centers for Disease Control and Prevention (2021), Cigarette smoking damages almost every organ in the body, leading to numerous diseases and overall health decline. In the United States, smoking is responsible for over 480,000 deaths each year, nearly one in five deaths. For women, smoking can make it more difficult to conceive and can adversely affect a baby’s health before and after birth. In men, smoking can reduce sperm quality, decreasing fertility and increasing the risk of congenital disabilities and miscarriage. Smoking also harms oral health, potentially leading to tooth loss. Moreover, it increases the risk of cataracts, which cloud the eye’s lens and impair vision. It can cause age-related macular degeneration (AMD), damaging a small spot near the retina’s center needed for central vision. Additionally, smoking is a risk factor for type 2 diabetes mellitus and can complicate its management, with active smokers having a 30-40% higher risk of developing diabetes compared to nonsmokers.

   The four major diseases linked to smoking are

   • Cardiovascular Diseases
     • Increased mortality rates due to smoking.
     • Elevated risk of ischemic heart diseases.
   • Respiratory Conditions
     • Smoking is a primary cause of chronic respiratory deaths.
     • Increased risk of respiratory diseases and tuberculosis.
   • Stroke
     • A Study reports a Positive correlation between smoking prevalence and stroke-related deaths.
   • Lung Cancer
     • Study reports there is a higher likelihood of lung cancer with increased daily cigarette consumption.

   Unlocking the Benefits of Consistent Physical Activity

   Inadequate exercise or physical activity can contribute to the prevalence of non-communicable diseases. Given that non-communicable diseases account for over 80% of deaths in some nations, they are regarded as “the number one killer” globally. Physical exercise is any movement that requires energy, like housework, manual labor, walking, or manual labor. Exercise, on the other hand, is a regimen of physical activity that is organized and planned to enhance physical fitness.

   Evidenced-based benefits.

   1. Physical Health: Research reported that 150 min of moderate-intensity or 75 min of vigorous-intensity physical activity led to a 14% risk reduction in all-cause mortality in patients with cardiovascular disease. In healthy adults, the risk decreased by 7%. Regular exercise has been shown in numerous studies to be beneficial in lowering the risk of cardiovascular disease as well as improving the health of patients with a variety of other conditions, such as certain cancers. stroke, type 2 diabetes, age-related sarcopenia, obesity, and multiple sclerosis.
   2. Mental Health: Research findings indicate that youth with mild to moderate mental health issues can benefit from organized sports and exercise programs. In one study, participants highlighted the significance of intensity choice for their enjoyment and commitment to the program, and it was shown that a self-selected intensity sport and exercise intervention was beneficial for depression. Research findings indicate that youth with mild to moderate mental health issues can benefit from organized sports and exercise programs. In one study, participants highlighted the significance of intensity choice for their enjoyment and commitment to the program, and it was shown that a self-selected intensity sport and exercise intervention was beneficial for depression. Also, engaging in physical exercise for 14 weeks can considerably improve mental symptoms, reduce anxiety and somatization, lessen obsessive-compulsive symptoms, and lift depressed moods.
   3. Quality Sleep: Study indicated that quality of sleep was positively impacted by exercise. Additionally, insomnia was somewhat alleviated following the exercise intervention. For instance, studies reveal that first-year students who exercise more get better sleep than those who exercise less during the night.

   Evidenced-based research recommended the following:

   1. Adults should aim for more than 300 minutes of moderate-intensity aerobic physical activity, 150 minutes of vigorous-intensity aerobic physical activity spread out over the week, or an equivalent mix of moderate-intensity and vigorous-intensity aerobic physical activity.
   2. Engage in moderate-to-intense muscle-strengthening activities that target all major muscle groups two or more days a week.
   3. Adults 65 and older engage in multicomponent physical activity that involves functional balance and strength training at a moderate or higher intensity for at least three days a week in addition to aerobic exercises.

   Contributing factors to the High Obesity Rates Among African American Women

   Research reports that American women are disproportionately affected, with the highest obesity rates among all groups in the U.S. About 80% are classified as overweight or obese.

   Disparities in weight loss

   Research indicates that African American (AA) women tend to lose less weight compared to their Caucasian counterparts.

   Contributing Factors

   The contributing factors to the disparities are;

   • Limited access to nutritious food
   • Inadequate health insurance
   • Lack of safe spaces for physical activity

   Barriers to Weight Management

   Challenges that hinder weight management efforts include:

   • Personal beliefs
   • Limited time
   • Family dynamics
   • Lack of motivation
   • Financial constraints

   Cultural Influence on Body Image

   Cultural norms within the AA community, which often embrace larger body sizes and promote a positive body image, can also influence health behaviors. While fostering a positive body image has psychological benefits, it may reduce motivation to maintain a healthy weight. In Black culture, obesity and being overweight are often considered acceptable and carry little to no stigma. Cultural perspective may partially explain why general health promotion efforts are less effective in this community. The study reports that many Black female students aim to embody the culturally valued “thick and curvy” figure, consuming specific foods to shape their bodies while avoiding activities that might result in weight loss.

   Why it may be difficult to seek care

   A deep-rooted distrust of the healthcare system makes it difficult for many AA women to seek medical advice or treatment.

   Physical inactivity as a health risk factor

   Underestimating body weight can reduce engagement in healthy behaviors, such as regular physical activity. Physical inactivity is a major contributor to non-communicable diseases and mortality, emphasizing the need to address these issues within the AA community.

   Risk Factors for Uterine Fibroids Among Black Women

   Uterine fibroids (UFs) represent the most prevalent non-cancerous tumors among women of reproductive age. Symptomatic fibroids can lead to significant health issues and are the primary reason for hysterectomies in the United States and globally, contributing to substantial socioeconomic impacts and affecting over 70% of women of reproductive age (Langton et al., 2024). African American women tend to develop fibroids approximately 10 years earlier than White women in the US and bear a disproportionate health burden from these tumors

   Black women experience UFs at higher rates, with an earlier onset, more severe symptoms, and faster disease progression compared to other groups.

   According to Sithembinkosi Ndebele (2024), 85% of participants were non-Hispanic Blacks. Black participants had a higher likelihood of a UF diagnosis, and the following risk factors were reported contributing to the high prevalence of UFs in Black individuals:

   1. Socioeconomic Status: Lower socioeconomic status is reported to increase the rates of UFs.
   2. Adverse Environmental Exposures: Increased exposure to environmental pollutants is associated with a higher prevalence of UFs.
   3. Chronic Stress: Experiences that increase chronic stress are significant contributors.

   Lifestyle and socioeconomic factors, closely tied to neighborhood characteristics, further influence UF prevalence. These factors include:

   1. Body Mass Index (BMI): A higher BMI correlates with a higher risk of UFs.
   2. Alcohol Use: Regular alcohol consumption is positively correlated with UF diagnosis.
   3. Income and Occupation: These factors influence access to healthy food and healthcare.

   Coronary Heart Disease Risk Factors: Measures for Reduction

   Coronary Heart Disease (CHD) is a chronic and intricate ailment associated with substantial morbidity and mortality, primarily attributed to atherosclerotic lesions in coronary vessels, ultimately leading to myocardial infarction (MI) and stroke. Unhealthy eating habits, often influenced by chronic inflammation, are closely linked to CHD. Various health conditions, lifestyle choices, as well as your age and family history, can elevate the risk of developing heart disease; approximately 47% of Americans have at least one of the three primary risk factors for heart disease: high blood pressure, elevated cholesterol levels, and smoking. Certain risk factors for heart disease, such as age or family history, are beyond your control. However, you can proactively reduce your risk by changing the factors you can control.

   Behaviors that heighten the risk for heart disease are

   • Smoking: The Food & Drug Administration (FDA) estimates that cardiovascular disease causes 800,000 deaths and 400,000 premature deaths per year. About one-fifth and one-third of these result from smoking, respectively. Additionally, research reported that smoking resulted in a 51% increased risk of coronary heart disease in patients with diabetes. Cigarette smoking has the potential to harm the heart and blood vessels, amplifying the risk for heart conditions like atherosclerosis and heart attacks. Even nonsmokers face an increased risk of heart disease when exposed to secondhand smoke.
   • Excessive alcohol consumption can elevate blood pressure and elevate the risk of heart disease. It also leads to increased triglyceride levels, a fatty substance in the blood associated with an elevated risk of heart disease.
   • Sedentary lifestyle: Insufficient physical activity is a precursor to heart disease and can strengthen the likelihood of other medical conditions that serve as risk factors, including obesity, high blood pressure, high cholesterol, and diabetes. Engaging in regular physical activity can effectively decrease the risk of heart disease.
   • Unhealthy Eating Habits: A diet rich in saturated fats, trans fats, and cholesterol has been associated with heart disease and related conditions like atherosclerosis. Recent research has provided more explicit evidence that trans-fat significantly raises the risk of cardiovascular disease by adversely affecting lipids, endothelial function, insulin resistance, and inflammation. For each 2% increase in calories consumed from trans-fat, there is a 23% higher risk of coronary artery disease. Recent studies and systematic reviews have focused on red and processed meat consumption. The research consistently demonstrates an increased risk of coronary heart disease and cardiovascular events. The risk ranges from 15% to 29% higher with red meat consumption and 23% to 42% higher with processed meat consumption

   Measures for Reducing the Risk of Coronary Heart Disease

   •  Educating children and adolescents about the dangers of smoking to deter the initiation of tobacco use. The Food & Drug Administration (FDA) reported that the risk of coronary artery disease decreases to the level of lifetime nonsmokers within four years of quitting and within ten years. 
   • The DASH, Mediterranean, and vegetarian diets have the most evidence for cardiovascular disease prevention. The DASH diet has been shown to lower systolic blood pressure by up to 11.5 mmHg in adults with hypertension. Additionally, reported findings indicate a 21% reduction in coronary artery disease risk with adopting the DASH diet.
   •  The American Heart Association suggests substituting saturated fat with polyunsaturated and monounsaturated fats. A 5% shift from saturated fat to polyunsaturated fat consumption is linked to a 10% lower risk of coronary artery disease.
   • Engaging in about 150 minutes per week of moderate-intensity aerobic activity significantly lowers the risk of cardiovascular disease. Moderate-intensity aerobic exercise is characterized by activity that maintains a heart rate between 50 to 70 percent of the individual’s maximum heart rate, calculated as 220 beats per minute minus the person’s age.

   The Struggle to Survive: Living Through the Rising Cost

   The rising cost of living has become a significant public health concern, particularly for low-income individuals who are struggling daily to survive. Addressing the social determinants of health among this population remains an urgent issue, as many face ongoing challenges accessing essential needs such as food, housing, transportation, and healthcare. During my assessment of some of the low-income individuals, I found that several individuals eat only once a day to save money for rent. Many reported choosing to go hungry rather than risk homelessness. Some have been living in their cars for nearly a year, while others rely on the homes of friends to shower and change clothes. It is heartbreaking to witness the difficult situations people endure every day to stay alive.

   The rising cost of living has multiple impacts on health and well-being. According to Grewal et al. (2024), increasing housing costs—one of the key components of living expenses—can have both direct and indirect health consequences. Their study indicates that:

   • Financial strain from high housing and living expenses contributes to increased stress, anxiety, and depression, particularly among renters and low-income individuals.
   • Food insecurity often results when households must prioritize rent or transportation over nutrition, leading to poor dietary intake and higher risks of chronic diseases.
   • Limited access to healthcare arises when individuals cannot afford medical visits, medications, or preventive care due to competing financial demands.
   • Housing instability or homelessness can expose individuals to unsafe environments, lack of sanitation, and interrupted social support networks, which worsen both physical and mental health outcomes.

   Overall, Grewal et al. (2024) emphasize that the effects of rising housing and living costs are unequally distributed, disproportionately affecting low-income individuals who already face multiple barriers to health. This highlights the need for comprehensive policy approaches that integrate housing affordability, income support, and healthcare access as essential strategies to promote health equity.

   Source: https://doi.org/10.1186/s12889-024-18360-w

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