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Poporodna depresija v veliki meri zaznamuje materinstvo, odraža pa se tudi v intimnih partnerskih odnosih, kar mnoge pare privede tudi do iskanja pomoči zakonskega in družinskega terapevta. V doktorski disertaciji smo želeli raziskati intimne partnerske odnose in funkcioniranje v izvirni družini v povezavi s poporodno depresivno simptomatiko pri partnerki. V raziskavo smo vključili tudi proces relacijske družinske terapije pri parih, kjer partnerka izraža simptome poporodne depresije. Poporodna depresija in relacijska družinska terapija, kot je pričujoča doktorska disertacija tudi naslovljena, se v osnovi členi na na dva dela: teoretični in empirični del. V teoretičnem delu smo najprej izpostavili problematiko duševnih motenj in dosedanjih spoznanj o depresiji. Sledila je predstavitev poporodnih duševnih motenj s poudarkom na poporodni depresiji. Slednjo smo razčlenili tako z vidika preventive in kurative, kot tudi z vidika materinstva in razvoja otroka. Dotaknili smo se tudi poporodne depresije pri očetih in njenega vpliva na očetovsko vlogo. V nadaljevanju smo se posvetili intimnim partnerskim odnosom in odkrivali, kako intenzivno lahko vplivajo na razvoj poporodne depresije, ki smo jo razdelali tudi z vidika starševske vloge in razvoja otroka v najzgodnejšem obdobju. Zadnji poglavji v teoretičnem delu smo posvetili predstavitvi relacijske družinske terapije v povezavi s poporodno depresijo, in sicer ob spremljavi duhovnosti oz. v kontekstu biblično-teološkega vidika. Tudi empirični del smo razdelili na dva dela: na kvantitativni in kvalitativni del. V kvantitativnem delu so nas zanimale razlike v zadovoljstvu znotraj partnerskega odnosa in funkcioniranju v izvirni družini pri partnerkah, ki izražajo simptome poporodne depresije, in tistimi, ki jih ne izražajo. V raziskavo je bilo vključenih 245 prostovoljnih udeleženk, od katerih je polovica izražala simptome poporodne depresije. Na podlagi rezultatov analize smo ugotovili, da med ženskami s poporodno depresivno simptomatiko obstaja statistično pomembna razlika v zadovoljstvu s partnerskim odnosom, prav tako obstaja statistično pomembna razlika v avtonomiji in intimnosti v izvirni družini. V pretežno kvalitativnem delu smo želeli raziskati, ali z relacijsko družinsko terapijo lahko odpravimo simptome poporodne depresije. V raziskavo smo vključili pet parov (10 udeležencev), pri katerih partnerka na podlagi vprašalnika EPDS izraža simptome poporodne depresije. Podatke smo zbirali skozi vseh 12 srečanj, ki obsegajo en terapevtski cikel. Zanimalo nas je, kako bodo pari po terapevtskem procesu doživljali spremembe na intrapsihičnem, interpersonalnem in sistemskem nivoju, ter, ali se bodo zmanjšali oz. odpravili tudi simptomi poporodne depresije.Ugotovili smo, da so vse udeleženke identificirale vsaj en ključni trenutek spremembe, do katerega je prišlo zunaj ali znotraj terapevtskega procesa. Pri udeleženkah je prišlo do pomembnih sprememb na različnih področjih življenja, poleg tega se je pri nekaterih parih zvišalo zadovoljstvo v odnosu. Simptomi poporodne depresije so se pri vseh udeleženkah zmanjšali oz. odpravili. Izsledke celotne raziskave je potrebno razumeti z upoštevanjem nekaterih omejitev. Te se kažejo kot nereprezentativen vzorec in odsotnost kontrolne skupine. Prav tako je potrebno upoštevati pogosto izostajanje partnerjev, kar je vplivalo na potek terapije in končne rezultate zadovoljstva v odnosu. Omeniti je potrebno tudi alternativne metode pomoči v obliki podpornih skupin za mame po porodu, na podlagi katerih lahko sklepamo, da so zelo verjetno pripomogle k boljšemu počutju in zmanjšanju oz. odpravi depresivnih simptomov. Upoštevati pa bi bilo vredno tudi druge dejavnike, ki se lahko izkažejo kot pomemben faktor pri pojavu depresivnih simptomov (npr. genetske in hormonalne). Smiselno bi bilo izvesti še en ciklus terapij, tokrat v polni prisotnosti obeh partnerjev ter ponoviti meritve. Izsledki naše raziskave se ujemajo z ugotovitvami predhodnih raziskav, obenem pa prinašajo pomemben prispevek k razumevanju poporodne depresije v povezavi z intimnim partnerskim odnosom in izvirno družino, ter odstirajo nova spoznanja o značilnostih terapevtskega procesa in partnerskega odnosa, kjer je prisotna poporodna depresija. Raziskava izpostavlja tudi spoznanja o ključnih trenutkih terapevtske spremembe ter z njimi povezanih pozitivnih spremembah na številnih področjih življenja udeleženk. Vse to pa omogoča bolj celovito razumevanje obravnave parov v procesu relacijske družinske terapije pri predelavi simptomov poporodne depresije. Postnatal depression significantly influences motherhood, yet it simultaneously affects the intimate relationship between two partners, which can result in many couples seeking help of a marriage and family therapist. This doctoral dissertation endeavoured to study intimate relationships and the functioning in a family of origin in relation to the symptoms of postnatal depression present with a female partner. The study also encompassed the process of relational family therapy with the couples in which a female partner exhibits symptoms of postnatal depression. The doctoral dissertation called Postnatal Depression and the Process of Relational Family Therapy is divided into two parts: the theoretical and the empirical one. The theoretical part first emphasised the problem of mental disorders and the findings about the postnatal depression presented so far. Afterwards followed the presentation of postnatal mental disorders with the focus on postnatal depression, which is further elaborated on from the point of view of prevention and curative, as well as from the point of view of motherhood and child development. What is more, postnatal depression with fathers and its effect on the role of a father is also touched upon. In the following chapters, the attention was drawn to intimate relationships and their impact on the development of postnatal depression, which is studied with respect to the role of a parent and from a point of view of child development in the earliest period. The last two chapters of the theoretical part presented a process of relational family therapy with reference to postnatal depression, which is discussed from a spiritual perspective or biblically theological perspective. The empirical part is subdivided into a quantitative and a qualitative part. The emphasis of the quantitative part was on differences in satisfaction within a relationship and its functioning in a family of origin with female partners who suffer from symptoms of postnatal depression and those who do not. Two hundred and forty-five female volunteers were included in the research and a half of them experienced symptoms of postnatal depression. On the basis of the analysis’ results, it was ascertained that there is a statistically significant difference in satisfaction with a relationship amongst females displaying symptoms of postnatal depression and that there is also a statistically significant difference in autonomy and intimacy in a family of origin. The predominantly qualitative part tended to examine whether symptoms of postnatal depression can be suppressed through relational family therapy. Five couples (ten participants), in which a female partner exhibited symptoms of postnatal depression based on the EPDS (Edinburgh postnatal depression scale) questionnaire, were included in the study the data was obtained during twelve sessions, which represent one therapeutic cycle. The primary interest in this part of the study was whether the female participants can identify the key moments of therapeutic change, how they experience changes on an intrapsychic, interpersonal and system level and whether the symptoms of postnatal depression will be reduced or suppressed. It was discovered that all female participants identified at least one key moment of therapeutic change which occurred inside or outside of the therapy process. The female participants experienced salient changes in various domains of their life, what is more, some couples observed an increase in satisfaction in their relationship. All the female participants were subjected to the reduction or suppression of the symptoms of postnatal depression. To correctly understand the results of the entire study, some restrictions need to be taken into account, such as an unrepresentative sample and the absence of a control group. Moreover, the fact that male partners were often not present needs to be considered as well since this affected the course of the therapy and the final results concerning satisfaction in a relationship. In addition, alternative methods of help, such as birth mother support groups, need a special mention since they are liable to have ameliorated the well-being of a mother and reduced or suppressed the symptoms of depression. Other factors that are of great significance for the emergence of the symptoms of postnatal depression would also be worth considering (for instance: genetic and hormonal symptoms). It would be thus reasonable to undergo an additional therapy cycle, this time with both partners present all the time in order to reobtain the measurements. The research’s results, proved to match the findings of previous studies in this domain, significantly contribute to the understanding of postnatal depression with regard to an intimate relationship and a family of origin, and they simultaneously reveal new discoveries concerning the characteristics of a therapeutic process and an intimate relationship where postnatal depression is present. The research also emphasises the findings concerning key moments of therapeutic change and the correlated positive changes observed in various spheres of the female participants’ lives. The study, therefore, allows a more wholesome understanding of couples’ treatment in the process of relational family therapy aimed at relieving the symptoms of postnatal depression.

Zaradi pomanjkanja tovrstnih raziskav in literature na slovenskem območju smo si z našo raziskavo zadali nalogo preučiti poporodno posttravmatsko stresno motnjo (PP-PTSM), njeno prevalenco v slovenski populaciji in komorbidnost s poporodno depresijo (PPD). Zanimal nas je tudi vpliv travme iz otroštva tako na razvoj PP-PTSM kot tudi na PPD. Vprašalnik je v celoti izpolnilo 361 žensk, ki so rodile v zadnjih 12 mesecih, delno pa 434 žensk, a smo jih zaradi izpolnitve vsaj dveh vprašalnikov vseeno vključili v raziskavo. Večina (72,1 %) udeleženk je bilo starih od 25 do 35 let. Za merjenje poporodnega depresivnega razpoloženja smo uporabili Edinburško lestvico poporodne depresije – EPDS, z Lestvico porodne travme – CityBiTS smo merili poporodno PTSM, izkušnje travme v otroštvu in mladostništvu pa smo ocenjevali z retrospektivnim merskim instrumentom CTQ. Pri 116 udeleženkah je bila izmerjena visoka verjetnost depresije. 10 udeleženk je izpolnjevalo vse kriterije za PP-PTSM. Največ udeleženk (17,3 %) je v otroštvu doživelo emocionalno zanemarjanje, temu sledijo emocionalna zloraba (10,9 %), fizično zanemarjanje (10,6 %), spolna zloraba (9,7 %) in fizična zloraba (5,8 %). Zaznali smo razlike v izraženosti depresivnega razpoloženja in simptomov PTSM med skupinama žensk, ki so porodile zdravega otroka, in tistimi, ki so izgubile otroka med nosečnostjo, po porodu ali s prisotnimi zdravstvenimi zapleti pri novorojencu. Skupini, razdeljeni glede na izkušnjo poroda, se razlikujeta v izraženosti depresivnega razpoloženja. Rezultati raziskave so pokazali povezavo med travmo iz otroštva in pojavnostjo simptomov PPD in PP-PTSM. Na našem vzorcu sta s PP-PTSM najizraziteje povezana emocionalna zloraba in fizično zanemarjanje, s PPD pa emocionalna zloraba. Analiza je pokazala tudi visoko, statistično pomembno korelacijo med simptomi PPD in PP-PTSM. Due to the lack of such research and literature in Slovenian language, our study aimed to investigate postpartum post-traumatic stress disorder (PP-PTSD), its prevalence in the Slovenian population and comorbidity with postpartum depression (PPD). We were also interested in the impact of childhood trauma on the development of both PP-PTSD and PPD. The questionnaire was fully completed by 361 women who gave birth in the past 12 months. 434 completed the survey only partially, but were still included because they completed at least two of the questionnaires. Majority (72.1 %) participants were between 25 and 35 years old. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure postnatal depressed mood, the Childbirth Trauma Scale (CityBiTS) was used to measure postnatal PTSD, and childhood and adolescent trauma experiences were assessed with the CTQ retrospective instrument. 116 participants were measured as having a high probability of depression and 10 participants met full criteria for PP-PTSM. Most female participants (17.3 %) experienced emotional neglect in childhood, followed by emotional abuse (10.9 %), physical neglect (10.6 %), sexual abuse (9.7 %) and physical abuse (5.8 %). We found differences in the expression of depressed mood and symptoms of PTSD between the groups of women who gave birth to a healthy baby and those who lost a baby during pregnancy, after delivery or with medical complications for the newborn. The two groups divided according to the experience of childbirth differ in the expression of depressed mood. The results of the study showed an association between childhood trauma and the incidence of PPD and PP-PTSD symptoms. In our sample, emotional abuse and physical neglect are most strongly associated with PP-PTSD, while emotional abuse is most strongly associated with PPD. The analysis also showed a high statistically significant correlation between PPD symptoms and PP-PTSD.

Poporodna depresija je resna duševna bolezen, ki prizadene veliko populacijo žensk. Namen zaključnega dela je raziskati obravnavo poporodne depresije na primarnem nivoju zdravstvenega varstva pri nas in v tujini. V zaključnem delu smo uporabili sistematičen pregled strokovne in znanstvene literature ter kvantitativno metodologijo raziskovanja. Literaturo smo pridobili iz slovenskih in tujih iskalnih baz podatkov (PubMed, ScienceDirect, SAGE Journas, COBISS). Pri tem smo si pomagali z vključitvenimi in izključitvenimi kriteriji. Vključili smo angleške in slovenske članke, ki so bili objavljeni od leta 2005 naprej ter polno dostopne članke. V podrobno analizo smo vključili 9 člankov. Ugotovili smo, da je v Sloveniji dobro poskrbljeno za obravnavo žensk na primarnem nivoju zdravstvenega varstva, saj so vse ženske vključene v preventivne programe, ki se izvajajo. To se razlikuje v drugih državah, kjer za ženske ni tako dobro poskrbljeno. Pregled literature je pokazal, da se obravnava žensk in poporodne depresije na primarnem nivoju zelo razlikuje. Za preprečevanje poporodne depresije je zelo pomembno zgodnje odkrivanje – izvajanje preventivnih programov. Potrebno bo nameniti več pozornosti pri obravnavi poporodne depresije, predvsem v smislu preprečevanja, tako pri nas kot tudi v tujini. Postpartum depression is a dangerous mental disorder and a lot of women are mentally handicapped by it. The aim of my thesis is to realize how postpartum depression is treated at the primary health care level in our country and in some foreign countries too. The systematic overview of nonfiction and scientific literature, and the quantitative method of the research were both used in conclusion of my thesis. We got the literature from the Slovenian and foreign databases (PubMed, ScienceDirect, SAGE Journas, COBISS). We used the commonly known inclusion and exclusion criteria for the systematic literature overview. We analysed English and Slovene articles that have been published since 2005, and some other fully accessible articles. Nine articles were retrieved for more detailed analysis. We reached the conclusion that in Slovenia all those women at the primary health care level are already included in some preventive programmes and are treated very well by them. But in some other foreign countries the situation hasn’t been improved yet. The systematic literature overview showed that treatment of those women differs from postpartum depression. In order to prevent this disorder, we are obligated to take some preventive measures, like including all those women into the preventive programmes in order to prevent, not to cure. This applies for Slovenia and foreign countries too.

Izhodišča. Po porodu so značilna obdobja naglega spreminjanja razpoloženja, ki jih povzročajo hormonska nihanja. Izmenjavanje potrtosti in vznesenosti običajno ne traja dlje kot teden dni, kadar pa simptomi ne izginejo in se začnejo poglabljati, takrat lahko govorimo o poporodni depresiji. Ta se lahko pojavi kadarkoli v prvem letu po porodu. V diplomskem delu smo predstavili vzroke, znake in klasifikacijo poporodne depresije ter predstavili vlogo oklice. Namen raziskave je ugotoviti seznanjenost nosečnic o poporodni depresiji. Raziskovalna metodologija. Za raziskavo je bila uporabljena deskriptivna metoda dela. Kot raziskovalni instrument smo uporabili delno strukturiran anketni vprašalnik. Kvantitativne podatke smo statistično obdelali in prikazali s frekvenčno distribucijo v grafih. Raziskava je bila opravljena v enem izmed zdravstvenih domov Slovenije, v njej pa je sodelovalo 35 nosečnic. Rezultati. Raziskava je pokazala, da so nosečnice solidno seznanjene s problemom poporodne depresije. Z znaki, s katerimi se kaže poporodna depresija, so nosečnice sicer seznanjene, vendar bi jih veliko lahko spregledalo začetne opozorilne znake, kar je bistveno. Podatki so pokazali, da si večina nosečnic želi izvedeti več o poporodni depresiji, da bi v primeru začetnega obolenja lahko pravočasno ukrepale. Diskusija in zaključek. Nosečnice potrebujejo več znanja o znakih in problemu poporodne depresije, da bi znale ukrepati v primeru, da zbolijo za le-to. Primerno znanje potrebujejo tudi partner in ožji svojci, da bi opazili spremembe pri otročnici in tako lahko pravočasno poiskali strokovno pomoč. Introduction. Immediately after childbirth the bodies of new mothers are exposed to great hormon oscillations which cause the periods of rapid mood changes. However, these periods of euphoria and melancholy should not last for more than a week. When these symptoms of mood changes do not disappear but tend to intensify, we speak about the postnatal depression. It can occur at any time in the first year after childbirth. In this diploma work there have been presented the symptoms, causes and classsifications of postnatal depression as well as the importance and influence of its background. The main aim of this diploma work was to find out how far pregnant women have been acknowledged with the postnatal depression. Research methodology. The research has been done by the descriptive work method. As a research instrument we used a structured survey.The quantitative data was statistically processed and presented by a frequency distribution in graphs. The research was performed in one medical centre in Slovenia with 35 pregnant women involved. Results. The research has shown that pregnant women are well informed about the postnatal depression problems. Despite the satisfactory knowledge level of the postnatal depression symptoms, women could still quite easily underestimate the first warning signs which are essential for a successful treatment. The research has also shown that women wish to be more educated about this problem in order to take some measures of precaution if necessary. Conclusion. Pregnant women need more education about the signs and problems of the natal depression to prevent further health problems. The knowledge of the natal depression should be passed also on their partners and family members to get immediate professional help when needed.