CHAPTER-1 INTRODUCTION

INTRODUCTION
1

The postnatal period is well established as an increased time of risk for the development of serious mood disorders. There are three common forms of postpartum affective illness: the blues (baby blues, maternity blues), postpartum (or postnatal) depression and puerperal (postpartum or postnatal) psychosis each of which differs in its prevalence, clinical presentation, and management.1 Maternity Blues The maternity ,baby or third day blues occur in the first two to three weeks after delivery. The depression often follows a latent period of three or four day ,is usually mild and transitory but can be more intense .Ma!imum tearfulness and depression occur on fifth postpartum day. This condition is often aggravated by a sore perineum ,breast, fatigue from broken nights and endless visitor. " woman#s sense of success or failure about her labour, delivery and baby, as well as thoughts comments from staff can be triggering factors too. The mother#s response to her baby may not have been what she had e!pected perhaps the automatic surge of love did not materli$e, the fact that friends, relations and hospital staff seem more interested in the baby than in her life. "ny or all of these can play a part in the blues, which are e!perienced by as many as %&'of newly delivered mother. (esearch suggests that about )*'of mother e!periencing severe postnatal blues will go on to develop post natal depression2. The postpartum blues, maternity blues, or baby blues is a transient condition with a comple! mi!ture of physical, emotional, and behavioral changes that mothers could e!perience shortly after childbirth with a wide variety of symptoms which generally involve mood liability, tearfulness, and some mild an!iety and depressive symptoms. Baby blues is not postpartum depression, unless it is abnormally severe.1

+ostpartum blues is the most common observed puerperal mood disturbance, with estimates of prevalence ranging from ,& -*' 3.The symptoms begin within a few days of delivery, usually on day , or ., and persist for hours up to several days. The symptoms include mood labiality, irritability, tearfulness, generali$ed an!iety, and sleep and appetite disturbance. +ostnatal blues are by definition time limited and mild and do not re/uire treatment other than reassurance, the symptoms remit within days 4.The propensity to develop blues is unrelated to psychiatric history, environmental stressors, cultural conte!t, breastfeeding, or parity, however, those factors may influence whether the blues lead to ma0or depression . 1p to )&' of women with blues will go on to develop ma0or depression in the first year postpartum.3 " wide variety of complementary therapies claim to improve health by producing rela!ation. 2ome use the rela!ed state as a means of promoting psychological change. 3thers incorporate movement, stretches, and breathing e!ercises. (ela!ation and 4stress management5 are found to a certain e!tent within conventional medicine. 5 3ne well known e!ample of a rela!ation techni/ue is known variously as progressive muscle rela!ation, systematic muscle rela!ation, and 6acobson rela!ation and Mitchell#s rela!ation. The patient sits comfortably in a /uiet room. 7e or she then tenses a group of muscles, such as those in the right arm, holds the contraction for 8* seconds, then releases it while breathing out. "fter a short rest, this se/uence is repeated with another set of muscles. 9n a systematic fashion, ma0or muscle groups are contracted, then allowed to rela!. :radually, different sets of muscle are combined. +atients are encouraged to notice the differences between tension and rela!ation. ;hile postpartum depression is a ma0or health issue for many women from diverse cultures, this condition often remains
3

undiagnosed. "lthough several measures have been created to detect depressive symptomatology in women who have recently given birth, the development of a postpartum depression screening program re/uires careful consideration.1 (ela!ation can help to relieve the symptoms of stress. "lthough the cause of the an!iety will not disappear, you will probably feel more able to deal with it once you have released the tension in your body and cleared your thoughts. 6acobson#s progressive rela!ation techni/ue involves contracting and rela!ing the muscles to make you feel calmer. <on=t worry if you find it difficult to rela! at first. 9t is a skill that needs to be learned and it will come with practice. 3nce you have mastered it you will be able to use it throughout your life, for e!ample when driving a car, sitting in your office or standing in a supermarket /ueue.6

+rogressive rela!ation techni/ue is a systematic techni/ue for achieving a deep state of rela!ation. 9t was developed by <r. >dmund 6acobson more than fifty years ago. <r. 6acobson discovered that a muscle could be rela!ed by first tensing it for a few seconds and then releasing it. Tensing and releasing various muscle groups throughout the body produces a deep state of rela!ation, which <r. 6acobson found capable of relieving a variety of conditions like maternity blues. The work of >dmund 6acobson and involves alternately contracting and rela!ing muscle groups progressively round the body to develop recognition of the difference between tension and rela!ation.6 +rogressive rela!ation techni/ue muscle originated from the theory that a psychobiological state called neuromuscular hypertension is the basis for a variety of negative emotional states and psychosomatic diseases. 7e asserted that
4

rela!ation of muscles would lead to rela!ation of the mind, ??because an emotional state fails to e!ist in the presence of complete rela!ation of the peripheral parts involved#7. 9n other words, rela!ation inhibits the generation of thoughts and emotions, and undoes the effects of neuromuscular hypertension on the body. Briefly, in +M( clients sit in a comfortable chair and the therapist instructs them in contracting and releasing different muscle groups. "n individual ??learns to recogni$e contraction in the various parts in a certain order. The large muscle groups are attended to first, because the sensation from them is most conspicuous. ;hen an individual rela! a given part, they simultaneously rela! all parts that have previously received practice5. "fter they master rela!ation while lying down, they are taught how to rela! muscles in real life situations, which re/uires ??differential rela!ation,## minimi$ing tension in the muscles needed for some activity while completely rela!ing muscles not being used. @lassical +M( was time consuming. 9nitially suggested ,& to A& min treatments several times a week for up to more than a year.8 +rogressive muscle rela!ation is especially helpful for people whose an!iety is strongly associated with muscle tension. 3ther symptoms that respond well to progressive muscle rela!ation include tension headaches, backaches, tightness in the 0aw, tightness around the eyes, muscle spasms, high blood pressure, and insomnia. 2ystematically rela!ing your muscles tends to help slow down your mind. The immediate effects of progressive muscle rela!ation include all the benefits of the rela!ation response described above. Bong term effects of regular practice of progressive muscle rela!ation include:8 " decrease in depression. " decrease in anticipatory an!iety related to phobias.
5

 (eduction in the fre/uency and duration of panic attacks. 9mproved ability to face phobic situations through graded e!posure. 9mproved concentration. "n increased sense of control over moods. 9ncreased self esteem. 9ncreased spontaneity and creativity. Mitchell#s rela!ation techni/ue is a method physiological rela!ation. 9t is the name given to a techni/ue of rela!ing the whole, or part, of your body, thus relieving the muscle tendons produced by stress. 9t can be applied rapidly, either as full rela!ation of your whole body or rela!ation of selected parts of body not in use at any given moment. 9n this way rest can be obtained in one part of body, while activity may be going on in another.2

This method utili$es knowledge of the typical stressCtension posture and reciprocal rela!ation of muscle whereby one muscle group rela!es as opposing group contract. 2tress induced tension in the muscle that work to create the typical posture may be released by voluntary contraction of the opposing muscle groups. +ropioreceptive receptor in 0oints and muscle tendons record the resulting position of ease and this is relayed to and registered in the cerebrum.2 Mitchell#s method involves adopting body positions that are opposite to those associated with an!iety (fingers spread rather than hands clenched, for e!ample). 9n autogenic training, patients concentrate on e!periencing

physical sensations, such as warmth and heaviness, in different parts of their bodies in a learned se/uence.9

CHAPTER-2 NEED OF STUDY

NEED OF STUDY
7

"ccording to ;73,,)' of women are affected from maternity blues or post partum depression.1 "mong the various techni/ues used for achieving rela!ation, no study till date has compared between 6acobson#s and Mitchell#s rela!ation techni/ues .The comparison of two intervention will help the therapist to decide which rela!ation techni/ue is effective in management of Maternity Blues.

CHAPTER-3 OBJECTIVES

OBJECTIVES

 To study the effects of Mitchell#s rela!ation techni/ue in maternity blues. To study the effects of progressive rela!ation techni/ue in maternity blues. To compare the effects of +rogressive rela!ation techni/ue and Mitchell rela!ation techni/ue on maternity blues.

10

CHAPTER-4 HYPOTHESIS

HYPOTHESIS
A!"#$%&"'(# )*+,")#-'-: The progressive rela!ation techni/ue would be more effective than Mitchell#s rela!ation techni/ue in the management of maternity
11

blue.

N.!! )*+,")#-'- The progressive rela!ation techni/ue would not be more effective than Mitchell#s rela!ation techni/ue in the management of maternity blue.

12

CHAPTER-5 OPERATIONA/ DEFINITIONS

OPERATIONA/ DEFINITIONS:
M"T>(D9TE BB1> Maternity blues, or baby blues is a transient condition with a comple! mi!ture of physical, emotional, and behavioral changes that mothers could
13

e!perience shortly after childbirth with a wide variety of symptoms which generally involve mood liability, tearfulness, and some mild an!iety and depressive symptoms. Baby blues is not postpartum depression, unless it is abnormally severe 2 .The maternity, baby or third day blues occur in the first two to three weeks after delivery. The depression often follows a latent period of three or four day. +(3:(>229F> (>B"G"T93D T>@7D9H1> +rogressive muscle rela!ation was described by <r.>dmund 6acobson .9t is a systematic techni/ue for achieving a deep state of rela!ation. Tensing and releasing various muscle groups throughout the body.6 M9T@7>BB (>B"G"T93D T>@7D9H1>
Mitchell#s rela!ation techni/ue is a method physiological rela!ation. 9t is the name given to a techni/ue of rela!ing the whole, or part, of your body, thus relieving the muscle tendons produced by stress. 9t can be applied rapidly, either as full rela!ation of your whole body or rela!ation of selected parts of body.I)J

><9DB1(:7 +32TD"T"B <>+(>2293D 2@"B> ><+2 scale was used for measure the +ostpartum depression .

14

CHAPTER-6 REVIE0 OF /ITERATURE

REVIE0 OF /ITERATURE
1#%2&!! #" &!:The maternity ,baby or third day blues occur in the first two to three weeks after delivery. The depression often follows a latent period of three or four day ,is usually mild and transitory but can be more intense .Ma!imum tearfulness and depression occur on fifth postpartum day. This condition is often aggravated by a sore perineum, breast, fatigue from
15

broken nights and endless visitor ." women#s sense of success or failure about her labour, delivery and baby, as well as thoughts comments from staff can be triggering factors too.2

O H&$& #" &! : +ostpartum blues is the most common observed puerperal mood disturbance, with estimates of prevalence ranging from ,& -*' 3.The symptoms begin within a few days of delivery, usually on day , or ., and persist for hours up to several days. The symptoms include mood lability irritability, tearfulness, generali$ed an!iety, and sleep and appetite disturbance. +ostnatal blues are be definition time limited and mild and do not re/uire treatment other than reassurance, the symptoms remit within days.4 The propensity to develop blues is unrelated to psychiatric history, environmental stressors, cultural conte!t, breastfeeding, or parity (7apgood et al.,8K%%) ,,8, however, those factors may influence whether the blues lead to ma0or depression (Miller, )&&)). 1p to )&' of women with blues will go on to develop ma0or depression in the first year postpartum.331 S"#'% 419856 :Lound that postnatal blues peaked on days . *. <ay to day mood in the first three weeks after childbirth were e!amined by Mendall et al (8K%.). 9n %8 unselected women, there was a sharp peak in ratings of changes depression, tears and labiality on day * postpartum, and thereafter the ratings declined steadily 15. Bevy (8K%-) used the 2tein (8K%&) blues rating /uestionnaire to compare postpartum women with women undergoing ma0or or minor surgery. The number of postpartum women e!periencing symptoms peaked on days ,to ., and declined on days * and A. The numbers in the surgical groups 8,K of ,K,.15

H&!,%#% &%2 P&--7&% :reported on a study of prenatal preparation in which they assigned .% pregnant women, who had received labor specific rela!ation training, to one of four groups: (8) additional rela!ation training, ()) e!tended rela!ation training that emphasi$ed possible postpartum
16

stressors, (,) discussion of postpartum stressors, and (.) a control discussion about their awareness of postpartum stress. They found that the groups receiving rela!ation training were significantly less distressed than the non rela!ation training groups during the first K weeks postpartum. They also found that the groups that discussed possible postpartum stressors were less elated after delivery than the groups not e!posed. The authors recommended the use of e!tended, nonspecific rela!ation training both before and after delivery as a way of reducing postpartum emotional distress.24

8'9)&#! 0.O H&$& 2tudies of the prevalence of the blues have reported a wide range ()A' to %*'). 2tudies reporting relatively high prevalence rates have used criteria such as the presence of crying at some time during the first week after delivery. Bower prevalence rates have been obtained in studies using more stringent criteria for the blues, such as high scores on standard depression or mood scales.11 E27.%2 J&9,:-,% trained his patients to voluntarily rela! the muscles in their body whenever they are not being used to perform a particular task. 7e found that the rela!ation procedure is effective against a number of ailments including ulcers, insomnia, and hypertension.6 P$,;$#--'(# $#!&<&"',% 9s a techni/ue for learning to control the state of tension in ones muscles. 9t was developed by "merican physician >dmund 6acobson in the early 8K)&s.12 6acobson did not ever fully understand how by shutting down ones responses to e!ternal and internal stimulants one could not only reduce an!iety, but actually reduce such problems as skin allergies and rashes. 9t is not at all clear how shutting down our physical responses can be so effective in curing various disorders.12 OH&$& = S>&'% 41996): 9n a meta analysis of *K studies from Dorth "merica, >urope, "ustralasia and 6apan (nN8),%8& sub0ects), found an overall prevalence rate of postpartum depression of 8,'. This was based on studies that assessed symptoms after at least two weeks postpartum. (to avoid confounding of postpartum blues) and used a validated or standardi$ed measure to assess depression.1
17

B.""%#$ 883 O?H&$& 803 0&"-,% D. 2512 The structure of women=s mood in the early postpartum. 2tates that Opostpartum bluesO is a mild, predictable mood disturbance occurring within the first several days following childbirth. +revious analyses of the ObluesO symptom structure yielded inconclusive findings, making reliable assessment a significant methodological limitation. The current study aimed to e!plicate the symptom structure of women=s mood following childbirth, and to e!amine psychometric properties of the <aily >!periences Huestionnaire (<>H), an adapted version of the Mennerly Blues Huestionnaire that included additional items from the +ositive and Degative "ffect 2chedule. Mothers who recently delivered (D N )8A) were recruited from a university hospital and asked to complete mood ratings on si! consecutive days using the <>H. >!ploratory factor analysis yielded an interpretable two factor solution identified as Degative "ffect and +ositive "ffect. 2cale reliability indices were e!cellent, with a high level of agreement in factor structure over time. This two factor model provides reliable assessment of women=s mood in the early postpartum, informing the study of reproductive related mood disorders.13

N&$&-'7)&'&) @ 8&%A.%&")3 @'$'*&++& V#%B&"#-)3 R&A&%%& 2511 : +ostpartum blue is common in socially and economically insecure mothers , "mong the 8,& women screened, 8), mothers fulfilled the inclusion criteria and were recruited in this study. 3f the 8), women screened, -) were diagnosed to have ++B, accounting for *%.*' prevalence rate. Most of the mothers were literate (K8') and housewives (--'). "bout K' of the mothers had previous history of miscarriage and %' had a history of psychiatric illness. Two mothers had marked suicidal tendency (by >+<2).14 F&'-&!-C.$* A3 8#%#C#- PR3 T#2#-9, JJ3 1&)&!!# S3 D.;&': 8. 2558 Maternity ObluesO: prevalence and risk factors. >stimated the prevalence and track the risk factors associated with, Maternity blues (MB). " transversal study was performed with 88, women, on the tenth day of puerperium. +itt 2cale (8KA%), 2tein (8K%&), and a /uestionnaire with socio demographic and obstetric data were used for assessment. (esults of study showed the prevalence of Maternity Blue was ,).-' according to the 2tein scale 22315. 9n the univariated analysis, civil status and tobacco use were associated with MB. Begally married women and nonsmokers showed a risk appro!imately . times lower of e!periencing the problem.15
18

P#"$,CC' A3 @&;!'&$2' /.2513 "n!ious and depressive components of >dinburgh +ostnatal <epression 2cale in maternal postpartum psychological problems statedthat >dinburgh +ostnatal <epression 2cale (>+<2) is a widely used instrument for screening for postpartum depression, but it might also detect an!iety symptoms. This study suggests that >+<2 subscales immediately after delivery help to understand the spectrum of maternal postpartum psychological problems. "n!ious symptoms immediately after delivery are fre/uent but transient, linked probably to maternity blues or atypical depression.16

J&!#%E.#- I3 /#;$&%2 @. 2559 +ost partum blues and depression states that +ost partum time is an eventful period with modifications of somatic but also biological and psychological status of women, leading to increased risk of an!ious and depressive disorders. <iagnosis of post partum blues (++B) or post partum depression (++<) is sometimes difficult. ++B is usually benignP thus a punctual help is usually sufficient. " severe or long duration ++B is associated with an increased risk of ++< which has to be taken into account. ++< can be difficult to diagnose because of multiple clinical forms and specially variations in intensity. " treatment of ++< is essential because it has an important impact on mother and child=s health.17 7ypnosis and rela!ation

A%2$#> V'9B#$- C&")#$'%# D,!!7&% 1999 therapies states that a

wide variety of the complementary therapies claim to improve health by producing rela!ation. 2ome use the rela!ed state to promote psychological change. 3thers incorporate movement, stretches, and breathing e!ercises. (ela!ation and 4stress management5 are found to a certain e!tent within standard medical practice.5 J&7'# A!&% B#!! 3J,-#""# B#""&%* S&!"'B,( 2555 Mitchell=2 (ela!ation Techni/ue: 9s 9t >ffectiveQ 2howed effectiveness of Mitchell=s rela!ation techni/ues including diaphragmatic breathing, compared with diaphragmatic breathing alone and supine lying. Lorty five normal male sub0ects were randomly assigned to three groups: (8) Mitchell with diaphragmatic breathingP ()) diaphragmatic breathing aloneP (,) the control condition of supine lying. >ach sub0ect underwent one 8% minute treatment session.
19

7eart rate was measured using a pulse o!imeter , at baseline, and before and after intervention .The supine position showed reduction in heart rate significantly in all groups. <iaphragmatic breathing with and without Mitchell=s rela!ation techni/ue significantly reduced heart rate.18 C,%$&2 A3 R,") 0T 2557: Muscle rela!ation therapy for an!iety disorders: it works but howQ 2tates that Muscle rela!ation therapy (M(T) has continued to play an important role in the modern treatment of an!iety disorders. The original progressive M(T protocol I6acobson, >. (8K,%). +rogressive rela!ation ()nd edition). @hicago: 1niversity of @hicago +ressJ have been found to be effective in panic disorder (+<) and generali$ed an!iety disorder (:"<). This review describes the most common M(T techni/ues, summari$es recent evidence of their effectiveness in treating an!iety, and e!plains their rationale and physiological basis. +atients reported less an!ious. Better designed studies will be re/uired to identify the mechanisms of M(T and to advance clinical practice.19

@,!,7:#B U. 2551 I+rogressive muscle $#!&<&"',% (+M() according to

J&9,:-,% in a department of psychiatry and psychotherapy empirical resultsJ. 2tates that )A- patients admitted to a psychiatric hospital, who were taking part in +M( treatment from 8&CK% to KC&&, were /uestioned about their e!periences. "nalysis of the data reveals a division into three group:8 st patients with positive effects AK ', ) nd patients with negative effects showing a deterioration of symptoms 8* ', ,(rd) patients with nonspecific reactions 8A '. Marked difficulties are found in patients with ma0or depressive disorder, especially those with a distinctive feeling of emptiness and disturbance of body sense. <ifficulties are also found in patients with personality disorders, who respond with depersonali$ation andCor dissociative phenomena. "lternative therapeutic methods (body movement ")#$&+*, self awareness training) or +M( in a modified way (single setting) should be employed for those patients.7

J,$7 AF3 8,$;&% AJ3 H#"$'9B SE. 2558 (ela!ation for <epression determines whether rela!ation techni/ues reduce depressive symptoms and improve responseCremission. 9t concludes (ela!ation techni/ues were more effective at reducing self rated depressive symptoms than no or minimal treatment. 7owever, they were not as effective as psychological treatment. <ata on clinician rated depressive symptoms were less conclusive. Lurther research is re/uired to investigate the possibility of rela!ation being used as
20

a first line treatment in a stepped care approach to managing depression, especially in younger populations and populations with sub threshold or first episodes of depression.25

V'9",$'& / S&!"3 1&")!##% 8 1#$$ 1997 : Mitchell=s 2imple +hysiological (ela!ation and 6acobson=s +rogressive (ela!ation Techni/ues: " comparison. This study was aimed to compare the short term physiological effects of Mitchell=s simple physiological rela!ation and 6acobson=s progressive rela!ation. Twenty four nor motensive sub0ects, 8. men and ten women, participated in the si! week study. 2ystolic blood pressure (2B+) and diastolic blood pressure (<B+), respiratory rate ((() and heart rate (7() were monitored by conventional methods.21

P'"" <iagnosed women as having the blues if they 4felt tearful and depressed in the puerperium5 (defined as within the first week to 8& days after delivery).22 2tein reported that a score of % on his blues /uestionnaire (range, & to )A) usually indicated that a mood swing has occurred (on that day)23.3=7ara and associates,building on the work of 7andley and colleagues specified seven blues symptoms: dysphonic mood, mood labiality, crying, an!iety, insomnia, loss of appetite, and irritability. "t least four of the seven symptoms had to be present and definitely noticeable to the patient or others (assessed in the conte!t of a diagnostic interview) for a diagnosis of the blues to be made.13322323325

1#%%#$!*= @&")1989F P'""3 19736. Mennerly and :ath (8K%K) interviewed 8&& newly delivered women once in the ten days following the birth. ;omen described in their own words the feelings they were e!periencing, and whether these e!periences differed from their normal feelings. Lrom this, .K items or mood ad0ectives were described. These were incorporated into a draft /uestionnaire and tested on a further 8&& women. 4, Lollowing revision, )% items remained on the /uestionnaire and these were given to a further *& recently delivered women. @luster analysis identified - symptoms associated with ?primary blues#, namelyP tearfulness, fatigue, an!iety, feeling over emotional,change ability in mood. Bow spiritedness ,
21

forgetfulness Cmuddled thinking. +rimary blues emerged as a separate cluster from depression and was more fre/uent (,A' versus 8A', respectively). The final /uestionnaire was validated on a further sample of %- newly delivered women, comparing prenatal scores to the mean of scores obtained on days 8to 8& postpartum. The scores for the primary blues cluster significantly increased postpartum, while scores for depression did not change. These findings may indicate that changes in depression are not characteristic in the early puerperium. " second study by Mennerly and :ath (Mennerly 8K%K) on88) women compared maternal blue /uestionnaire scores with the women# s social environment and personality type (>ysenck +ersonality 9nventory).+ostnatal blues was significantly associated with neuroticism, poor social ad0ustment with the role as a house worker, and a poor relationship in either the family unit, e!tended family or marriage.431331 H&+;,,2 #" &!.31988 The propensity to develop blues is unrelated to psychiatric history, environmental stressors, cultural conte!t, breastfeeding, or parity . 7owever, those factors may influence whether the blues lead to ma0or depression (Miller, )&&)). 1p to )&' of women with blues will go on to develop ma0or depression in the first year postpartum (@ampbell et al., 8KK)P 3=7ara et al., 8KK8b).331 "mong the 8,& women screened, 8), mothers fulfilled the inclusion criteria and were recruited in this study. 3f the 8), women screened, -) were diagnosed to have ++B, accounting for *%.*' prevalence rate. Two mothers had marked with suicidal tendency (by >+<2)..

22

CHAPTER-7 8ATERIA/S AND 8ETHOD

8ETHODS
NU8BER OF SUBJECTS A& 21B6>@T2 SOURCE OF SUBJECTS
23

8. <ept.of obstetrics and gaynaecology in career institution of medical sciences,Bhopal . ). +arulkar nursing home, Bhopal. ,. (oshan child care and Maternity care ,Bhopal . .. 2ultania 6annana 7ospital,Bhopal. SE/ECTION CRITERIA: I%9!.-',% 9$'"#$'& 8. Between the age of 8% ,Kyears. ). Lemales without clinical and systemic complication. ,. Lemales ;ithout current or past history of depression or psychiatric treatment. .. Lemales whose new born were not congenitally disfigured and had "+:"( score higher than - in the * min. of life. E<9!.-',% 9$'"#$'& 8. Lemales who had secondary complications of pregnancy. ). Lemales whose pregnancy were classified as high risk pregnancy. ,. Lemales with known psychiatric disorder. .. Lemales whose newborn were congenitally disfigured . *. Lemales whose newborn were born with congenital disorder DURATION OF STUDY A weeks

24

SA8P/IN@
SA8P/E SIDE The sample si$e consists of A& sub0ects in maternity blues. SA8P/E CRITERIA: 2ystematic random sampling method is used to divide the patient in to two groups. :roup " M9T@7>BB#2 (>B"G"T93D T>@7D9H1>
25

(nN,&)

:roup B

6"@3B23D#2 (>B"G"T93D T>@7D9H1>

(nN,&)

VARIAB/E OF THE STUDY I%2#+#%2#%" (&$'&:!#+rogressive rela!ation techni/ue Mitchell#s rela!ation techni/ue

D#+#%2#%" (&$'&:!#<epression scores on >dinburgh +ostnatal 2cale (><+2)

8ATERIA/ Lirm mattress or bed +illows @omfortable chair with arm rest.

PROCEDURE
DESI@N OF STUDY " comparative clinical study

26

 +rospective pre test and post test of group " and group B. There were two groups each group having ,& sub0ects. :roup " Mitchell#s rela!ation techni/ue and :roup B 6acobson#s rela!ation techni/ue.

8ETHODO/O@YA& sub0ects of the age group between 8% ,Kyears were taken for the study. The sub0ect who met the inclusion criteria were included in the study. +ermission for the study was taken from the above hospitals and ethical committee of career institute of medical sciences . "n informed and written consent form was also taken from the females, where the patient agreed to participate in the study and the data was collected from females by using evaluation tools. The participant were divided into two groups .:roup " (,&) and :roup B(,&) using the systematic random sampling method after taking the informed consent from them. Huestionnaire were used in this study. 2ub0ects were encouraged to complete the /uestionnaire on their own with minimum assistance to avoid bias. The >dinburgh +ostnatal <epression 2cale (>+<2), used to diagnose the ++B. The >+<2 included 8& /uestions and each one is valued on a four point scale with ma!imum possible score of ,&. 28329. The sub0ects who scored more than 8& were considered to be suffering from Obaby blues.

@ROUP A-8ITCHE//S RE/AGATION TECHNIHUE 4%I356

27

<o each e!ercise twice very slowly, counting for four seconds as tension is e!erted in the muscles. @an be done, sitting in a chair, standing, or lying in bed. (fig no.8,)) 8. +ull your shoulders down towards your feet. 7old tension for four seconds and then release. ). Move your elbows away from your side, let them fall and rela!. ,. 2tretch your fingers wide apart. .. Tighten buttock muscles so that the knees go outwards. *. >nsure the legs are not straight. 3pen (A& degree) angle behind knee A. +oint the toes, then release. ;iggle toes to and fro to ensure no cramping occurs. -. +ush yourself into the support. (elease. %. +ush your head into the head rest (or cupped hands). K. Breath using the diaphragm. +ush tummy out as you breathe in. Lour seconds in and hold for four seconds then breathe out for four seconds. <o four times.(fig no.8) 8&.<rag the 0aw downwardsP silent scream. 88.+ress the tongue down in the mouth, or poke out and silent scream. 8).@lose the eyes lightly and look through the eye lids at the redC black colour and count to four slowly. (epeat. 8,.Meep eyes closed. (un fingers hard over scalp from front to back. ;ith this sensation, imagine a smoothing waves going from front to back of the head.
28

8..;ith eyes still closed imagine a calm place and put yourself in a deck chair in the scene. Meditate on that scene. (emember that you should never drive away in a car after work without doing this sort of e!ercise first to ensure that neckC0aw tension is not creating tunnel vision for you. @ROUP B-PRO@RESSIVE RE/AGATION TECHNIHUE 4%I356 The system comprises8* )& basic e!ercises, which have been found to be effective, if practiced regularly.8 There are no contraindications for progressive muscle rela!ation unless the muscle groups to be tensed and rela!ed have been in0ured. 9f you take tran/uili$ers, you may find that regular practice of progressive muscle rela!ation will enable you to lower your dosage. @.'2#!'%#- J,$ P$&9"'9'%; P$,;$#--'(# 8.-9!# R#!&<&"',% 4,$ A%* F,$7 ,J D##+ R#!&<&"',%6 The following guidelines will help you make the most use of progressive muscle rela!ation. They are also applicable to any form of deep rela!ation you undertake to practice regularly, including self hypnosis, guided visuali$ation, and meditation.8 8. +ractice at least )& minutes per day. Two )& minute periods are preferable. 3nce day is mandatory for obtaining generali$ation effects. ). Lind a /uiet location to practice where you won=t be distracted. <on=t permit the phone to ring while you=re practicing. ,. +ractice at regular times. 3n awakening, before retiring, or before meals are :enerally the best times. " consistent daily rela!ation routine will increase the Bikely hood of generali$ation effects. .. +ractice on an empty stomach. Lood digestion after meals will tend to disrupt deep rela!ation. *. "ssume a comfortable position. Eour entire body, including your head, should be supported. Bying down on a sofa or bed or sitting in a reclining chair are two
29

ways of supporting your body most completely. (;hen lying down, you may want to place a pillow beneath your knees for further support.) 2itting up is preferable to lying down if you are feeling tired and sleepy. 9t=s advantageous to e!perience the full depth of the rela!ation response consciously without going to sleep. A. Boosen any tight clothing and take off shoes, watch, glasses, contact lenses, 0ewelry, and so on. -. Make a decision not to worry about anything. :ive yourself permission to put a side the concerns of the day. "llow taking care of yourself and having peace of mind to take precedence over any of your worries. %. "ssume a passive, detached attitude. This is probably the most important element. Eou want to adopt a Olet it happenO attitude and be free of any worry about how well you are performing the techni/ue. <o not try to rela!. <o not try to control your body. <o not 0udge your performance. . P$,;$#--'(# 8.-9!# R#!&<&"',% T#9)%'E.# The idea is to tense each muscle group hard (not so hard that you strain, however) for about 8& seconds, and then to let go of it suddenly .Eou then give yourself 8* )& seconds to rela!, noticing how the muscle group feels when rela!ed in contrast to how it felt when tensed, before going on to the ne!t group of muscles. Eou might also say to yourself O9 am rela!ing,O OBetting go,O OBet the tension flow away,O or any other rela!ing phrase during each rela!ation period between successive muscle groups. Throughout the e!ercise, maintain your focus on your muscles. ;hen your attention wanders, bring it back to the particular muscle group you=re working on: The guidelines below describe progressive muscle rela!ation in detail: ;hen you release the muscles, do so abruptly, and then rela!, en0oying the sudden feeling of limpness. "llow the rela!ation to develop for at least 8* )& seconds before going on to the ne!t group of muscles. 3nce you are comfortably supported in a /uiet place, follow the detailed instructions below: The actual techni/ue 8. To begin, take three deep abdominal breaths, e!haling slowly each time. "s you e!hale, imagine that tension throughout your body begins to flow away.
30

). @lench your fists. 7old for - 8& seconds and then release for 8* )& seconds. 1se these same time intervals for all other muscle groups .(fig no.,) ,. Tighten your biceps by drawing your forearms up toward your shoulders and Omaking a muscleO with both arms. 7old... and then rela!. .. Tighten your triceps the muscles on the undersides of your upper arms by e!tending your arms out straight and locking your elbows. 7old ... and then rela!. *. Tense the muscles in your forehead by raising your eyebrows as far as you can. 7old ... and then rela!. 9magine your forehead muscles becoming smooth and limp as they rela!. A. Tense the muscles around your eyes by clenching your eyelids tightly shut. 7old... and then rela!. 9magine sensations of deep rela!ation spreading all around them. -. Tighten your 0aws by opening your mouth so widely that you stretch the muscles around the hinges of your 0aw. 7old ... and then rela!. Bet your lips part and allow your 0aw to hang loose. %. Tighten the muscles in the back of your neck by pulling your head way back, as if you were going to touch your head to your back (be gentle with this muscle group to avoid in0ury). Locus only on tensing the muscles in your neck. 7old ... and then rela!. 2ince this area is often especially tight, it=s good to do the tense rela! cycle twice. K. Take a few deep breaths and tune in to the weight of your head sinking into whatever surface it is resting on. 8&. Tighten your shoulders by raising them up as if you were going to touch your ears. 7old ... and then rela!. 88. Tighten the muscles around your shoulder blades by pushing your shoulder blades back as if you were going to touch them together. 7old the tension in your shoulder blades ... and then rela!. 2ince this area is often especially tense, you might repeat the tense rela! se/uence twice. 8). Tighten the muscles of your chest by taking in a deep breath. 7old for up to 8&
31

seconds ... and then release slowly. 9magine any e!cess tension in your chest flowing away with the e!halation. 8,. Tighten your stomach muscles by sucking your stomach in. 7old ... and then release. 9magine a wave of rela!ation spreading through your abdomen.

8.. Tighten your lower back by arching it up. (Eou should omit this e!ercise if you have lower back pain.) 7old ... and then rela!. 8*. Tighten your buttocks by pulling them together. 7old ... and then rela!. 9magine the muscles in your hips going loose and limp. 8A. 2/uee$e the muscles in your thighs all the way down to your knees. Eou will probably have to tighten your hips along with your thighs, since the thigh muscles attach at the pelvis. 7old ... and then rela!. Leel your thigh muscles smoothing out and rela!ing completely. 8-. Tighten your calf muscles by pulling your toes toward you (fle! carefully to avoid cramps). 7old ... and then rela!. (fig no..) 8%. Tighten your feet by curling your toes downward. 7old ... and then rela!. 8K. Mentally scan your body for any residual tension. 9f a particular area remains tense, repeat one or two tense rela! cycles for that group of muscles. )&. Dow imagine a wave of rela!ation slowly spreading throughout your body, starting at your head and gradually penetrating every muscle group all the way down to your toes. E%2 ,J $#!&<&"',% -#--',% :radually allow your awareness to e!pand to become aware of your breathing and of the contact between your body and the floor, bed or chair. ;hen you feel ready, open your eyes, and have a gentle stretch. A--#--7#%" - A& sub0ects divided into two groups :roup " receives , weeks of Mitchell#s rela!ation treatment and group B will receive ,weeks of 6acobson#s rela!ation techni/ue .The sub0ect were assessed on
32

first day of the commencement of the treatment. Then they were given respective treatment as decided per group. The sub0ects were reassessed on the last day of the treatment.

Lig no 8 M9T@7>BB#s (>B"G"T93D T>@7D9H1> 9D 21+9D> BE9D:

33

Lig no ) M9T@7>BB#s (>B"G"T93D T>@7D9H1> 9D 29<> BE9D:

34

Lig. no , 6"@3B23D#2 (>B"G"T93D T>@7D9H1>35

"sk the patient to clenched your fist and hold for- 8& seconds than rela!.

Lig no .. 6"@3B23D#2 (>B"G"T93D T>@7D9H1>

36

"sk the patient . Tighten your calf muscles by pulling your toes toward you (fle! carefully to avoid cramps). 7old ... and then rela!.

O."9,7# 7#&-.$#8EASURE8ENT OF DEPRESSION

37

The depression score was assessed by using an ><+2(>dinburgh postnatal depression scale). +ostpartum depression is the most common complication of childbearing. ) The 8& /uestion >dinburgh +ostnatal <epression 2cale (>+<2) is a valuable and efficient way of identifying patients at risk for 4peri natal5 depression. The >+<2 is easy to administer and has proven to be an effective screening tool. Mothers who score above 8, are likely to be suffering from a depressive illness of varying severity. The >+<2 score should not over ride clinical 0udgment. " careful clinical assessment should be carried out to confirm the diagnosis. The scale indicates how the mother has felt during the previous week. The scale will not detect mothers with an!iety neuroses, phobias or personality disorders.28329 2@3(9D: Huestions 8, ), R . (without an S) "re scored &, 8, ) or , with top bo! scored as & and the bottom bo! scored as ,. Huestions ,, *8& (marked with an S) "re reverse scored, with the top bo! scored as a , and the bottom bo! scored as &. Ma!imum score: ,& +ossible <epression: 8& or greater "lways look at item 8& (suicidal thoughts)

38

CHAPTER-8 DATA ANA/YSIS

STASTICA/ ANA/YSIS

39

I%"$& ;$,.+ 9,7+&$'-,% 8RT-+$# " "#-" ,J @ROUP A "ssessment 2chedule ><+2 of assessment M(T +re test +ost test Dumber of sub0ects ,& ,& Mean 8*.,, %.)& 2tandard deviation ,.,)* ).)%& t value 8*.8)p value &.&&&

JRT-+$#-+,-" "-"#-" ,J @ROUP B "ssessment 2chedule ><+2 of assessment 6(T +re test +ost test Dumber of Mean sub0ects ,& ,& 8*.AA -.8&& 2tandard deviation ,.*-* ).&-, t value 8,..%& p value .&&&&

40

I%"#$ ;$,.+ 9,7+&$'-,% :* EDPS A--#--7#%" S9)#2.!# N.7:#$ 8#&% S"&%2&$2 ",J ,J 2#('&"',% (&!.# &--#--7#%" -.:A#9"8RT JRT P,-" "#-" 9,7+&$'-,% 8RT JRT 35 35 35 35 15.33 15.66 8.25 7.15 3.325 3.575 2.28 2.573 1.95 5.555 5.374 +(&!.# 5.715

P$# T#-" 9,7+&$'-,%

41

CHAPTER-9 RESU/T

RESU/T
This chapter deals with the most important and crucial aspect of investigating the data to answer the research /uestion through suitable statistical treatment.

42

" sample of A& patients were selected and allotted randomly into two groups of e/ual si$e of ,& sub0ects using systematic random sampling method .:roup " received Mitchell#s rela!ation techni/ue and :roup B received 6acobson rela!ation techni/ue. The assessment was done by >dinburgh postnatal depression scale. The collected data was statistically analy$ed. The score were following: 8.M(T 2cores::roup " +re test mean 8*.,, and standard deviation ,.,)* +ost test mean %.)& and standard deviation ).)%& ).6(T 2cores::roup B +re test mean 8*.AA and standard deviation was ,.*-* +ost test mean -.8&& and standard deviation was ).&-, .@omparison within the groups before and after treatment : BE ><+2 a) M(T : pre Fs post t and p value tN 8*.8)-, p N.&&&

b) 6(T : pre Fs post t and p value t N 8,..%& , p N.&&&

,) @omparison between Mitchell#s rela!ation and 6acobson#s rela!ation techni/ue on ><+2 using independent t test: +re test comparison: tN&.,-.P pN &.-8&
43

 +ost test comparison: tN 8.K*P pN&.&**

44

@RAPH

INTER @ROUP CO8PARISON BET0EEN @ROUP A AND @ROUP-B BY EDINBUR@H POSTNATA/ DEPRESSION SCA/E

45

CHAPTER -15 DISCUSSION

DISCUSSION

46

9n this study the effectiveness of progressive rela!ation techni/ue Fs Mitchell rela!ation techni/ue on maternity blues was assessed. A& sub0ects of the age group between 8% ,Kyears were taken for the study .The sub0ect who met the inclusion criteria were included in the study .+ermission for the study was taken from the above hospitals and ethical committee of career institute of medical sciences . "n informed and written consent form was also taken from the females , where the patient agreed to participate in the study and the data was collected from females by using evaluation tools. The participant were divided into two groups. :roup " (,&) and :roup B (,&) using the systematic random sampling. <uring A week of study, sub0ect were evaluated to check the progress. The first evaluation was done before the commencement of the treatment. "fter, this assessment was carried out at the end of the last day of the therapy.

" /uestionnaire >dinburgh +ostnatal <epression 2cale (>+<2) was used in this study28329. 2ub0ects were encouraged to complete the /uestionnaire on their own with minimum assistance to avoid bias. >dinburgh +ostnatal <epression 2cale (>+<2) was used to assess as the outcome measure. 9n this study the pre treatment values of ><+2 have shown that there was no significant difference between both the groups. <ue to the homogenous nature of the basal values, the post treatment score were comparable. 9ntra group evaluation was also done to check the efficacy of the treatment regimes. " gradual improvement was seen throughout the session. The pre and
47

post treatment score of >dinburgh +ostnatal <epression 2cale (>+<2) showed significant improvement observed in the both groups but more improvement was observed in progressive rela!ation techni/ue.(pN&.&**) V'9",$'& / S&!"3 1&")!##% 8 1#$$ 1997 : Mitchell=s 2imple +hysiological (ela!ation and 6acobson=s +rogressive (ela!ation Techni/ues: " comparison. This study was aimed to compare the short term physiological effects of Mitchell=s simple physiological rela!ation and 6acobson=s progressive rela!ation. Twenty four nor motensive sub0ects, 8. men and ten women, participated in the si! week study. 2ystolic blood pressure (2B+) and diastolic blood pressure (<B+), respiratory rate ((() and heart rate (7() were monitored by conventional methods.21

P#"$,CC' A3 @&;!'&$2' /.2513 "n!ious and depressive components of >dinburgh +ostnatal <epression 2cale in maternal postpartum psychological problems stated that >dinburgh +ostnatal <epression 2cale (>+<2) is a widely used instrument for screening for postpartum depression, but it might also detect an!iety symptoms. This study suggests that >+<2 subscales immediately after delivery help to understand the spectrum of maternal postpartum psychological problems. "n!ious symptoms immediately after delivery are fre/uent but transient, linked probably to maternity blues or atypical depression.16

@,!,7:#B U.2551 I+rogressive muscle $#!&<&"',% (+M() according to

J&9,:-,% in a department of psychiatry and psychotherapy empirical resultsJ. 2tates that )A- patients admitted to a psychiatric hospital, who

48

were taking part in +M( treatment from 8&CK% to KC&&, were /uestioned about their e!periences.7

J&7'# A!&% B#!! 3J,-#""#B#""&%* S&!"'B,( 2555 Mitchell=2 (ela!ation Techni/ue: 9s 9t >ffectiveQ 2howed effectiveness of Mitchell=s rela!ation techni/ues including diaphragmatic breathing, compared with diaphragmatic breathing alone and supine lying.1.

"s maternity blues is postpartum depressive condition. Maternal blues is a common condition in most of the +ostpartum women and left untreated.27. "mong the rela!ation techni/ues, we emphasi$e that of +rogressive Muscle (ela!ation, which is used in this study. 9t is mainly based on the premise that an!iety and rela!ation are e!cluding situations. The procedures used are simple: the individual retracts a specific set of muscles as much as possible and e!periences as tension sensation. The muscles are then rela!ed as much as possible and the individual focuses on the rela!ation sensations. 9t is, therefore, a participant e!ercise in which the individual herself seeks a state of rela!ation and physical well being.;hen +rogressive Muscle (ela!ation is practiced and incorporated to the mother#s life style, it can help to neutrali$e some of the effects of stress reaction.24 The distinction in the current study is that both techni/ues either 6acobson progressive rela!ation techni/ue or Mitchell#s rela!ation techni/ue were used to produce rela!ation in maternal blues rather than physiological effects on cardiac components. "lthough the current study does not provide information about the
49

mechanism of action or change, however it suggests that both methods were found effective significantly.

50

CHAPTER-11 CONC/USION

51

CONC/USION

9n this study we found that both the techni/ue Mitchell#s rela!ation and 6acobson#s rela!ation techni/ue are effective in the management of maternity blues but 6acobson#s rela!ation was found to be more effective than Mitchell#s rela!ation techni/ue. (esult of this study suggest that a gradual improvement was seen throughout the session. The pre and post treatment score of >dinburgh +ostnatal <epression 2cale (>+<2) showed significant improvement observed in the both groups but more improvement was observed in progressive relation techni/ue(pN&.&**). The present study re0ects the null hypothesis and accept the alternative hypothesis i.e the progressive rela!ation techni/ue would be more effective than Mitchell#s rela!ation techni/ue in the management of maternity blue.

52

CHAPTER-12 /I8ITATIONS

/I8ITATIONS
53

 This study was conducted on a small sample si$e of A& patients. +opulation of the both groups was smallP only ,& patients in each group might not represent the ma0ority of the maternal blues population. The study was not consent and concluded with appropriate interval follow ups. 2ome follow ups should be conducted to strengthen the conclusion. 3nly one scale was used to assess the maternal blues. The ><+2 Huestionnaire was designed to measure postpartum depression and maternal blues might give useful information about individual feedbackP but it seems not to provide ample information about the patients. 2ome other /uestionnaire along with ><+2 /uestionnaire should be used in forthcoming study. 9n addition, since the assessment of the pretest and post test was conducted by the author herself, it is unavoidable that in this study, certain degree of sub0ectivity can be found. 9n fact, it would have been sort of ob0ective if it had been decided by two or three e!aminers.

54

CHAPTER -13 BIB/IO@RAPHY

55

BIB/IO@RAPHY
1. (obertson, >., @elasun, D., and 2tewart, <.>. ()&&,). (isk factors for postpartumdepression. 9n 2tewart, <.>., (obertson, >., <ennis, @. B., :race, 2.B., R ;allington, T.()&&,). +ostpartum depression: Biterature review of risk factors and interventions by ;73. 2. Margaret +olden and 6ill Mantle physiotherapy in obstetric and gaynaecology. 3. . 3=7ara M;, 2chlechte 6", Bewis <", ;right >6: +rospective study of postpartum blues: Biologic and psychosocial factors. "rch :en +sychiatry .%: %&8, 8KK8 . 4. Mennerly 7, :ath <: Maternity Blues: 8. <etection and measurement by /uestionnaire. Br 6 +sychiatry 8**: ,*A, 8K%K. 5."ndrew Fickers and @atherine Tollman I7ypnosis and rela!ation therapiesJ BM6. 8KKK Dovember )&P ,8K(-))8): 8,.AU8,.K. +M@9<: +M@888-&%,. 6. 6acobson, >. (8K,%). +rogressive rela!ation. @hicago: 1niversity of @hicago +ress@raske R Barlow ()&&A), ;orry, 3!ford 1niversity +ress, 9nc., p. *,. 7.:olombek 1. I+rogressive muscle rela!ation (+M() according to 6acobson in a department of psychiatry and psychotherapy empirical resultsJ. +sychiatric +ra!. )&&8 DovP)%(%):.&) .. :erman +ub Med +M9<: 88-)8))%. 8. >!pert physio 6acobson#s rela!ation Techni/ue :"n attempt towards deep rela!ation. 9. McMenna 6M. The Mitchell method of physiological rela!ation. +hysiotherapy. 15 .2tein :: The maternity blues. 9n Brockington 9L, Mumar ( (edps): Motherhood and Mental 9llness, pp 88KU8*.. Dew Eork, :rune R 2tratton, 8K%). 11. Michaeal w.o hara.vol.A ch %. postpartum mental disorder. 12. +revention of postnatal depression. +rogressive muscle rela!ation Lrom ;ikipedia, the free encyclopedia Mallikar0un +M, 3yebode L.
56

13. +ost partum depression literature review of risk factor and interventions :Buttner MM, 3=7ara M;, ;atson <. The structure of women=s mood in the early postpartum. "ssessment. )&8) 6unP8K()):).- *A. doi:8&.88--C8&-,8K8888.)K,%%.>pub )&88 <ec A. +ubMed +M9<: ))8*A-8K. 14. Man0unath D:, Fenkatesh :, (. +ostpartum blue is common in socially and economically insecure mothers. 9ndian 6 @ommunity Med Iserial onlineJ )&88 Icited )&8, 6un )8JP,A:),8 ,. "vailable from: http:CCwww.i0cm.org.inCte!t.aspQ )&88C,AC,C),8C%A*)-. 15. Laisal @ury ", Mene$es +(, Tedesco 66, Mahalle 2, Tugaib M. Maternity ObluesO:prevalence and risk factors. 2pan 6 +sychol. )&&% novP88()):*K, K. +ubMed +M9<: 8%K%%.... 16. +etro$$i ", :agliardi B. "n!ious and depressive components of >dinburgh+ostnatal <epression 2cale in maternal postpartum psychological problems.6+erinat Med. )&8, Leb )8:8 A.doi: 8&.8*8*C0pm )&8) &)*%. I>pub ahead of printJ+ubMed +M9<: ),.)A%A). 17. 6alen/ues 9, Begrand :. I+ost partum blues and depressionJ. (ev +rat. )&&K "pr)&P*K(.):.KK *&A. Lrench. +ubMed +M9<:8K.A )%-&. 18. 6amie "lan Bell, 6osette Bettany 2altikov IMitchell=2 (ela!ation Techni/ue: 9s 9t >ffectiveQJ http:CCd!.doi.orgC8&.8&8AC2&&,8 K.&A(&*)A&%&K -. 19. @onrad ", (oth ;T. Muscle rela!ation therapy for an!iety disorders: it worksbut howQ 6 "n!iety <isord. )&&-P)8(,):)., A.. > pub )&&A 2ep 8. (eview. +ubMed+M9<: 8AK.K).%. 25. 6orm "L, Morgan "6, 7etrick 2> .2ource <epartment of +sychiatry, 3rygen Eouth 7ealth (esearch @entre, 1niversity of Melbourne , Bocked Bag 8&, ,* +oplar (oad, +arkville, Melbourne, F9@, "ustralia, ,&*). R#!&<&"',% for depression.

57

21.Fictoria B 2alt, Mathleen M Merr Mitchell=s 2imple +hysiological (ela!ation and 6acobson=s +rogressive (ela!ation Techni/ues: " comparison +hysiotherapy Folume %,, 9ssue ., "pril 8KK-, +ages )&&U)&-http:CCd!.doi.orgC8&.8&8AC2&&,8 K.&A(&*)AA&%8 A. 22. +itt B: 4Maternity blues.5 Br 6 +sychiatry 8)): .,8, 8K-,. 23. 2tein :: The pattern of mental change and body weight change in the first post partum week. 6 +sychosom (es ).: 8A*, 8K%& 8,. 7andley 2B, <unn TB, ;aldron : et al: Tryptophan, cortisol and puerperal mood. Br 6 +sychiatry 8,A: .K%, 8K%& . 24. The use of the 4+rogressive muscle rela!ation5 techni/ue for pain relief in gaynaecology and obstetrics . "driana "parecida <elloiagono de +aula8 >milia @ampos de @arvalho)@laudiaBenedita dos 2antos,+aula ""<, @arvalho >@, 2antos @B. The use of the 4progressive muscle rela!ation5 techni/ue for pain relief in gynecology and obstetrics. (ev Batino am >nfermagem )&&) setembro outubroP 8&(*):A*. K. 25. B(9@> +9TTV @onsultant +sychiatrist, <epartment of +sychiatry, The Bondon 7ospital, ;hite chapel, Bondon, >.8 26. 2tefanie Taers8, Melanie ;aschke8 and 1lrike >hlert8 8 1niversity of TWrich, 2wit$erland X @orrespondence: 1lrike >hlert, <epartment of @linical +sychology and +sychotherapy, 9nstitute of +sychology, 1niversity of TWrich, Bin$muhlestr. 8., @7 %&*&, TWrich, 2wit$erland u.ehlertYpsychologie.uni$h.ch (ead More: http:CCinformahealthcare.comCdoiCabsC8&.8&%&C&8A-.%)&-&8%&.,). )-.2tewart, <.>., (obertson, >., <ennis, @ B., :race, 2.B., R ;allington, T. ()&&,). +ostpartum depression: Biterature review of risk factors and interventions of risk factors and interventions. 28. 2ource: @o!, 6.B., 7olden, 6.M., and 2agovsky, (. 8K%-. <etection of postnatal depression: <evelopment of the 8& item. >dinburgh +ostnatal <epression 2cale. British 6ournal of +sychiatry 8*&:-%) -%A . 35. 2ource: M. B. ;isner, B. B. +arry, @. M. +iontek, +ostpartum <epression D >ngl 6 Med vol. ,.-, Do ,, 6uly 8%, )&&),8K. 8KK.
58

CHAPTER-14 ANNEGURE

59

ANNEGURE- I INFOR8ED CONSENT FOR8

T'"!# ,J ")# -".2* 4The effect of progressive rela!ation techni/ue Fs Mitchell#s rela!ation techni/ue on maternity blues5 I%(#-"';&",$ "nkita :upta 9, ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ, freely and voluntarily agree to participate in her research pro0ect. P.$+,-# ,J -".2* 9 have been informed that this study is going to help me in maternity blues . (ela!ation techni/ue is an acceptable management to treat maternity blues and will help the healthcare professionals to predict better treatment in future. P$,9#2.$# 9 understand that i will be treated with either 6acobson rela!ation techni/ue or Mitchell#s rela!ation techni/ue. 9 also understand that this would be done under the physiotherapist#s supervision. 9 am aware that 9 will have to follow therapist#s instructions. B#%#J'"This treatment will help to improve /uality of life, and will reduce depression. 9t would also help in detecting better choice of treatment for maternity blues.

60

C,%J'2#%"'&!* 9 understand that the medical information produced by this study will be confidential. 9f the data are used for publication in the medical literature or teaching purpose, no names will be used and other literature such as photographs or audio or visual tapes will be used only with permission. R#E.#-" J,$ 7,$# '%J,$7&"',% 9 understand that 9 am free to ask /uestions about the study at any time. The therapist will be available to answer my /uestion. @opy of this consent form will be given to me to keep for my careful reading. R#J.-&! ,$ >'")2$&>&! ,J +&$"'9'+&"',% 9 understand that my participation is voluntary and 9 may refuse to withdraw consent and discontinue participation at any time. 9 also understand that she may terminate my participation in the study at any time after she has e!plained the reason to doing so.

2ign of 9nvestigator

2ign. 3f +articipant

61

ANNEGURE- II CASE PRO-FOR8A=ASSESS8ENT CHART

T'"!# 4The effect of progressive rela!ation techni/ue Fs Mitchell#s rela!ation techni/ue on maternity blues5 N&7# ,J ")# -9),!&$ : "nkita :upta @.'2# : <r. 2wapnil (amteke(+T)

P&$"'9.!&$- ,J +&"'#%" Dame "ge "ddress and +hone Do: Marital status: MarriedC1nmarried >ducation: 1>C+(C2C:C+: 3ccupation 3ffice staffC2tudentC3thersC Don working C)'#J 9,7+!&'%"- >'") 2.$&"',% 2erial Do 3+.Do <omicile: 1rban C(ural

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@#%#$&! #<&7'%&"',% +ulse: (espiratory rate: ;eight: +resentC"bsent Blood pressure: 7eart rate: Built: Temperature: 7eight: +allor:

63

S*-"#7'9 #<&7'%&"',% 8 @ardio vascular system: ). (espiratory system: ,. :enito 1rinary system: .. :astro 9ntestinal system: *. @entral Dervous system: E2'%:.$;) +,-"%&"&! 2#+$#--',% -9&!#Before Treatment "fter Treatment 8st Lollowup )nd follow up

+atient 2ignature

+hysiotherapist

64

ANNEGURE- III H'%2' "$&%-!&"#2 E2'%:.$;) P,-"%&"&! D#+$#--',% S9&!# 4EPDS)

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 5. ? * , 6. * , , 7. ? * , 8. ? * , 9. ? * ,
66

 10. ? * ,
SCORING QUESTIONS 1, 2, & 4 (without an *) are scored 0, 1, 2 or 3 with top box scored as 0 and the bottom box scored as 3. QUESTIONS 3, 5-1 (!a"#$% with an *) a re reverse scored, with the top box scored as a 3 and the bottom box scored as 0. Maximum score: 30 Possible Depression: 10 or greater lwa!s loo" at item 10 #suicidal thoughts$

ANNEGURE-IV FEEDBAC1 FOR8

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Sl.no

Students Name

Class

Contact No

Feedback & Remark

Signature

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CHAPTER-15 8ASTER CHART

8ASTER CHART
Sl. No GROUP-A 69 GROUP-B

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Total Mea S!

MRT-PRE TREATMENT 15 14 16 12 15 18 16 12 11 19 13 17 16 15 21 11 20 17 15 23 18 13 15 15 22 14 13 12 11 11 15.33 3.325

MRT-POST TREATMENT 9 11 12 6 10 7 9 6 7 11 10 8 7 9 9 6 10 6 7 15 8 9 7 6 10 8 6 7 5 5 8.20 2.280

JRT-PRE TREATMENT 11 20 15 21 16 17 20 12 15 10 12 20 12 15 17 12 17 16 10 20 13 15 15 12 14 13 20 23 19 18 15.66 3.575

JRT-POST TREATMENT 9 5 6 7 8 5 4 5 10 4 6 12 5 6 10 5 6 7 5 8 7 8 9 5 9 9 7 10 7 9 7.100 2.073

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