Psychology

Introduction
Depression is a very common mental disease nowadays in which person feels sad, hopeless worthless and is unable to come out of these feelings. Depression has many types and phases. Sometimes a person becomes depressed due to some circumstantial changes in his life and at other times the whole life of the patient is spent under the spell of depression.

Developmental Perspective
Case facts
Here we are presented with the case of a 32 year old woman Chantel of Guyanian descent who has gone through a delivery of a stillborn child. Her husband has a low income job which is being neglected now because of her recent illness. Also her husband goes for training in the army camps which does not make her happy. She herself is an assistant at the local university hospital but she feels unsupported and uncomfortable in her job and thinks of not joining back. This would further detoriate her financial condition.

Taking a look at her background we find that her mother died in her infancy and she was raised by a loving grandmother who died a few years back. She does not have a very positive relationship with her father. Before she married Jack, she had married a man whom she divorced and she has a 12 year old daughter from that marriage who visits her occasionally. She has a number of cousins and aunts in the extended family circle but she is not close to them.

Case assessment
The case of Chantel is very obviously a case of post partum depression and after affects of the shock of losing a child. When a woman becomes pregnant and goes through the pregnancy years an expectation of motherhood and an anticipation of holding the child, loving and caring for her find its place in her heart. Giving birth to a still born child has snatched away all these feelings from Chantel leaving her feeling empty and depressed. Chantel has plunged into the deep sea of post partum depression due to loss of her child.

Taking a look at the other problems in her life we find that she has had a past relationship failure and her 12 year old daughter visits her occasionally. This may also be a drawback as already having a child away from her and then letting go of another child can add to the distress. Also the similarities between her own childhood life living with grandmother and visiting father and her daughter living with her father and visiting her may also lead to troublesome memories from the past.

Interaction with husband and home
It is clear that Chantel is facing financial problems with her husband and is openly critical of his career failures. She is also stressed by his training ventures. In these conditions her job is also necessary to support them financially this puts her under stress to work at a place where she does not feel comfort and understanding. Facing daily work problems or working under stressful conditions can also be a source of depression.

Interaction with neighbors, family and friends
Her interaction with neighbors, family and friend are not very cordial. She does not have much connection with her extended family and her father is also critical on her and also away in Guyana. This shows she is not close with him. Her bonding with her friends is also weak and at this time of her need she is not supported by them.

Interaction with organizations and social system
The place where she works is another of her problem are she is not happy with her job relations as well and says she does not find sympathy and understanding there. The social system of Chantel is very weak and she does not have any family or friend condoling her at this time of need. Her maternal grandmother that raised her also died a few years back.

Effect of ethnicity, class and gender
Social class is a way of ascribing status, prestige and power. It is based on education, income and occupation (Hutchison, 2007). Chantels class identity may also play a role in the weak support system that she has. Being a Guyanian she may not be able to form attachments and friendships as people like to socialize within their own ethnic and class groups shutting out the outsiders who then look beyond these people for friendships and social attachments. But class differences do exist, and they document another form of cultural inequality, as well as imperfections in our capitalist economic system (Hutchison, 2007). The social systems and cultural differences play a great role in bringing the people closer together on in this case setting them apart. Racism has become a fundamental principle of social organization even though it has no validity as a biological category (Hutchison, 2007). This situation also weakens the optimistic level of a person and slowly and unnoticeably the person may sink into depression due to this second class treatment that they have to face on a daily basis. Similarly gender is also important in this regard. Men are more emotionally stable and can bear stress more effectively then women.

Identify the presenting case
The present case of Chantel after review seems to be a severe case of post partum depression, which she is suffering due to the death of her infant girl. This is the blow that has shaken her and sunk her into depression. But another kind of depression namely adjustment disorder depression which is due to some major changes in life. Even before the death of her child she has a number of husband and work related problems and pressures of the social system with no outlet to her stress which is suppressing her spirits for a period of time. These problems have compounded by the death of her child and now she seems unable to help herself out of the situation. She is being bore down by all these pressing issues on her life. One more aspect is her past that is her previous marriage and childhood. There also she has a number of sour experiences and no content is derived from looking back into her past. Another source of contentment is usually obtained from religious source but as Chantel herself describes she is not that religious so she does not even find solace at the door of religion.

Literature review
Post partum depression
 Post partum or post natal depression is common among mothers after they give birth. Upto 80 percent of new mothers experience post partum depression after giving birth.  Women are more likely to experience psychiatric illness after childbirth than at any other time in their life (Kendell et al, 1987). This depression is heightened for mothers who loose their child during delivery. If depression prevails presence of other forms of clinical depression may be examined. Lack of social support can be a major factor that may cause postpartum depression (OHara 1985, Gotlib et al. 1991). Segre et al., also found a correlation between a mothers social class and PPD. Not surprisingly, women with fewer resources indicate a higher level of postpartum depression and stress than those with more financial resources. Numerous studies support the correlation between postpartum depression and lack of social support (Beck 2001 Hagen 1999). In 2009, researchers reported that the levels of placental corticotropin-releasing hormone (CRH) during the 25th week of pregnancy may help predict a womans chances of developing postpartum depression.

Adjustment depression and Anxiety
Adjustment depression is related to some specific situations in life like job or home conditions that become a definite stressor for the person. The diagnosis of an adjustment disorder implies that specific psychological symptoms have developed in response to a specific and identifiable psychosocial stressor. But if a person experiences a trauma, and develops the symptoms of a major depression, then the diagnosis of adjustment disorder is not used, even though the depression developed in response to a psychosocial stressor. Therefore, adjustment disorder with depression is used to categorize mild to moderate depression, following a stressful event.Significant impairment is observed in occupational or social functioning. Women have been shown to be more vulnerable to stressors across all ages and types of stressors (Turner et al., 1995). Asnis et al. (1993) found that AD patients report persistent ideation or suicide attempts less frequently than those diagnosed with major depression.

Theory of family life cycle
Researchers have distributed the human life into a number of stages with each stage contributing to the emotional maturity and understanding in human being. As the human crosses each stage in their life they become more mature and learn a new set of rules for application to the next level. As each level is progressed smoothly the character of the person becomes strong and mature and helps him face the challenges of the next level. But this is not the case for all people, sometimes a person may not be able to cross the stages with ease and confidence because the challenges they face is unable to bear and may put them back in the race of live. In these cases they cannot stop the next stage from arriving but they become weak and unsure of their ability to cope with the next level challenges. This way they feel the stress of passing life weighing upon their shoulder and holding them back from gaining trust and confidence required to live a smooth and happy life. The life seems to them a burden to behold and each passing level increases to their burden until they find themselves sinking into depression with no desire to go on.

The family life cycle is a transition from one role to another that a person has to take during the course of his life. Following are the key stages in the family life cycle

Independence This is the phase from childhood to independent state where a person gathers most of his maturing skills on which the rest of his life cycle is based.

Coupling or marriage In this level the person finds a mate gives up his independent life and settles for a family life.

Having babies, children through adolescent This phase is concerned more with bearing children and concerning oneself with the well being of children. Both parent focus now shifts to the children.
Launching adult children This phase is called leaving the nest phase where your children are ready to test their feathers and fly for themselves.

Retirement or senior years This is the declining phase for the parent when he feels the affects of aging and derives pleasure from reliving past memories.

Case in the light of this theory
As it is very obvious by evaluating the family life cycle in detail that Chantel has been among the unlucky persons who got off from the wrong since the start of her family cycle. If we study her life events we shall find in infancy she lost her mother and was separated from her father. She was raised by maternal grandmother who was a positive influence and gave her a positive influence in life. As she grew in her teens she moved to a place where she faced racial and ethnic problems. In the next stage of her life, when she marries she meets with failure in her marriage and divorces her husband leaving a girl in his care. Separation from husband and child leaves negative impact on her emotional and maturity levels. Now again that she is married and has a prospect of a child she is again ditched by luck and the child is snatcher from her by death at the time of delivery. These events one after another are leaving their marks on her and her stress level is rising to the point that she feels like a failure. Having to give up one child and losing another send her into depression and she is not able to adjust to the fact. Moreover she has problems at work and with her husbands financial crisis she is forced to work in an environment where she is not comfortable. Her friend network is weak and she has practically no one to confide her feelings and create an outlet of her negative emotions. These problems are weighing down on Chantel making it impossible to adjust to these changes in her life and sending her into depression where she finds no motivation to face the challenges of life and move forward.

Annotated Bibliography
Beck, C.T. (2001) Predictors of Postnatal Depression An Update. Nursing Research, 50, 275285.  Comment this article reviews ways to discover signs in women during pregnancy that may suggest them later suffering of postpartum depression. This way they can be helped earlier with the depression issue.

Bronish, T.,  Hecht, H. (1989). Validity of adjustment disorder, comparison with major depression. Journal of Affective Disorders, 17, 229236. Comment This article briefly discusses adjustment depression and then tries to link it with depression of the worst kind that is major depression.
Hagen, E., and Barrett, H. C. (2007). Perinatal sadness among Shuar women Support for an evolutionary theory of psychic pain. Medical Anthropology Quarterly, 21, 2240. Comment This article is not directly linked with case study but it is useful as it tries to analyze the cause for postpartum depression in mothers.

Heene, E., Buysse A., Oost P.V, (2007) An Interpersonal Perspective on Depression the Role of Marital Adjustment, Conflict Communication, Attributions, and Attachment within a Clinical Sample, Journal article Family Process, Vol. 46 Comment This book covers important domains of depression in the context of marital adjustment and indirect ways are explored in which depression and marital adjustment are associated.

Landry-Meyer, L.,  Newman, B. (2004). An exploration of the grandparent caregiver role. Journal of Family Issues, 25(8), 1005-1025. Comment This journal has been included due to the role of grandparent in the case study. The effect on children raised by grandparents in the absence of parents are explored here.

OHara, M.W. Depression and marital adjustment during pregnancy and after delivery. American Journal of Family Therapy 134955, 1985. Comment This journal gives lots of genuine information regarding depression and also suggests ways to cope with it.

Robertson, E., Celasun, N., and Stewart, D.E. (2003). Risk factors for postpartum
depression. In Stewart, D.E., Robertson, E., Dennis, C.-L., Grace, S.L.,  Wallington, T. (2003). Postpartum depression Literature review of risk factors and interventions. Comment This book has a range of information on Postpartum Period  Increased Risk of Severe Psychiatric Illness. This provides insight on how Mothers are affected during postpartum period.

Segre, Lisa S, Mary E. Losch, Michael W. OHara. RaceEthnicity and Perinatal Depressed Mood. Journal of Reproductive and Infant Psychology. Vol 24 No 2 99106 Comment This article relates the raceethnicity factor to Perinatal depression and the role of this factor in postpartum phase.
Vandervalk, I., Spruijt, E., De Goede, M., Meeus, W.,  Maas, C. (2004). Marital status, marital process, and parental resources in predicting adolescents emotional adjustment. Journal of Family Issues, 25(3), 291- 317. Comment This article is a very useful guide to evaluating adjustment problems in married life and factors leading to adjustment issues.

Vandsburger, E.,  Biggerstaff, M.A., (2004). Evaluation of the stress adjustment and adaptation model among families reporting economic pressure. Journal of Family Social Work, 8(2), 65-84. Comment This is also a great article and helps analyze the economic factors that result in adjustment disorders. We have a very clear study report here which helps families to adjust and adapt during economic pressure.