Postpartum Depression is one of the most prevalent postnatal mood disorder experiences women encounter. Researchers have searched for root patterns or indicators which may add knowledge to the causes and effective treatment of the disorder. Women experience many emotional and psychological changes after pregnancy. The failure to bond, which frequently results from postpartum depression causes social and psychological problems in the child’s development (Raynor, Sullivan, & Oates, 2003). In severe cases, the mother harms the baby. A large percentage of women are unaware that they suffer from and thus, do not receive any type of treatment. This research paper is intended to gain insights into various aspects of postpartum depression to enhance the understanding of the pathophysiology of the disease and various treatment strategies.
Table of Contents
Abstract……………………………………………………………………………………………1
Chapter 1 Introduction 3
1.1 Overview 3
1.2 Understanding Postnatal Depression 4
Chapter 2 Effects of Postnatal Depression on Children 10
Chapter 3 Literature Review 12
Chapter 4 Research Process 15
4.1 Clinical Trials 18
Chapter 5Critique of Material 21
5.1 Awareness 22
5.2Influence of Postpartum Depression on Society 23
Chapter 1 Introduction
By way of Mother Nature, expectancy brings about anticipatory changes. The female body experiences many physiological and psychological changes from conception to a substantial period after childbirth. Immediately, the body begins to cater to the fetus, which constantly demands extra nutrients, sleep, and stamina. Psychologically, the mother succumbs daily, to an impending chapter of life to be defined by emotions, physical exertion, family, and finances. Expectation progresses to become dual: what the mother may expect on delivery day, and what delivery day will expect of the mother.
For most women, the miraculous presence of a new life overrides the physical and emotional toll of the pregnancy. However, for some, the experience is overwhelming and reactions to motherhood are less glorious. When a woman is pregnant, she gains weight, loses sleep, worries about the health of the child and battles with constant hunger and fatigue. Heredity, the stresses of life, fatigue, and negative self-perception constantly impact the health of the average female. Every day, someone’s mother, someone’s sister or someone’s daughter is coping with some type of health issue. Weight and pregnancy issues top the charts in women’s health journals. Women, particularly, are greatly impacted by health issues because they bear children. One of the most prevalent pregnancy issues women face is postpartum depression.Eventually studies began to include research of men as possible victims of PND.
According to researchers and medical journals, both women and men are susceptible to postpartum depression. The demands of new parenthood become more equal after the baby arrives because the responsibility can be shared. In some cases, the mother has a strong support group from her spouse, family, friends, and medical staff. In other cases the mother has no one. In either scenario, the mother can struggle from PND.
Parenthood is a different experience for mothers than for fathers. Because most of the strain is on the mother, she is much more likely to suffer from a mood disorder than the father. This paper will examine current research of the Postpartum Depression mood disorder to obtain a theoretical perspective of its causes and diagnosis, treatment and management strategies for women who suffer from it.
- Overview
The study of depression is wide in scope.Post-partum depression (PND) is defined as ‘a mood disorder: any serious form of depression experienced within the first year after the birth of a baby’ (Davey, 2006). Thus, any depression a woman experiences for up to a year after a pregnancy can be considered some form of post-partum depression.
Post-partum blues is a milder form of PND, which is less intense and shorter in duration. According to a study by Michael O’Hara, the causes of PND are as ambiguous as other types of depression: “In regards to the medical aspects and causes, PND is very similar to other types of depression. Extreme variations of depression which can prevent the mother from function normally from day to day occurs approximately once in every 1000 births. Intensive inpatient treatment is required. (O’Hara, 1987). However, researchers agree that a likely cause is a variation of hormone levels that occurs during and after pregnancy. Despite clinical research of the disorder, the specific causes of the disorder are unknown.
PND is a popular topic in psychological and gynecological research because of the complexity of the pathogenesis of the disease, and also in the treatment of it.The causes and treatment of PND have become a focus of psychological research. The need to understand the disorder spans well past the parents, as it affects everyone associated with the child. Severe cases that go undiagnosed or receiveadequate treatment increases the percentages of suicide and child neglect.
1.2 Understanding Post-Partum Depression.
Many women are unaware that they are experiencing postpartum depression and cope with the symptoms without medical intervention. According to a discussion by Rd. Peter Schmidt and Kathleen O’Leary: “Postpartum depression is one of the most under-recognized and under-treated disorders. The disorder challenges the lives of hundreds of thousands of new mothers” (Schmidt & O’Leary, 2010). Prior research has focused on a high risk group of comprised of women who have experienced depression outside of pregnancy as well as women with bipolar disorders. It is difficult to attribute feelings of depression specifically with one thing. Post-partum may be confirmed as a factor, but not necessarily a cause; especially in women who have experienced depression at other times.
Postpartum depression is defined three ways: postnatal blues, postnatal depression and postnatal psychosis (Diane 2006).Several theories of the causes of PND suggest different biological reasons from the collection of blood in the breast to past occurrences of some type of depression in the mother’s family or the mother herself. These theories were accepted in the past as sound psychiatric medical doctrine until a renewed interest surged in the nineteenth century where different thoughts emerged attempting to explain a mother’s behaviour after child birth.
Diagnosis of postpartum depression is generally based upon the same strategies for diagnosis of other types of depression. Prior to establishing a diagnosis, other disorders with similar symptoms must be ruled out. Medical conditions such as Alzheimer’s disease, Hyperthyroidism, Chronic Fatigue Syndrome, and Encephalitis have similar symptoms to depression. Common symptoms of Postnatal Depression include fatigue, alcohol and drug abuse, stress, and insomnia (see Table x-1).Fatigue is a normal reaction for most people who experience emotional and physical strain, overwork, or have several people they are responsible for, all of which women experience during and after a pregnancy. However, people react differently to such pressures; particularly men and women. Childbirth is hard work, especially births of more than one baby, prolonged births that extend past the due date, and births that become complicated and require specialized attention such as cesarean sections. During labor, a woman’s body energy is spent, her pores are open, and in cases where the pregnancy had issues the combination of pressures is sometimes overwhelming. The scars from a caesarean section alone can be tremendously depressing to any woman. Some may even blame the infant for the transfigurations of their .
According to Farlex, when fatigue has not been addressed, like any undiagnosed disorder, oncoming disease or severe emotional stress usually follow (Farlex2, 2013). Physical and emotional stress and fatigue are heightened at the end of the pregnancy and the first weeks of post-delivery. Stress is defined in medical terminology as the sum of biological reactions to an adverse stimulus that disturbs the balance (Farlex, 2013).According to Farlex, when these reactions occur inappropriately, they too can lead to mental and physical disease.
Table 1Triggers of Postpartum Depression
| Under age 20 |
| Abuse of alcohol, illegal substances, or smoke |
| Unplanned pregnancy |
| Previous struggles with depression, bipolar disorder or an anxiety disorder |
| Stressful event during pregnancy or delivery: personal illness, death or illness of a loved one, a difficult or emergency delivery, premature delivery, or illness or birth defect in the baby |
| Depression or anxiety in family members |
| Poor relationship with baby’s father |
| Money or housing problems |
| Little support from family, friends, spouse or partner |
| Changes in your body from pregnancy and delivery
|
| Changes in work and social relationships |
| Having less time and freedom |
| Lack of sleep
|
| Worries about being a good mother
|
Source: (Zieve& Merrill, 2012)
Postnatal psychosis is a case of extreme postpartum depression, which is incapacitating, and fortunately less common disorder that many women face. Severe cases of PND develop near the time of birth, characterized by psychotic reactions such as delusions or hallucinating. Many times the symptoms of PND are not so obvious. Some women smile and interact with others on a superficial basis until they are alone. They may treat their children differently around other people. For this reason, studies where the patient is aware of being observed are only valid to a certain degree. The same applies to surveys when the participant does not wish to disclose her personal emotions she may check the boxes that seem appropriate to society.
Women who fight depression often endure long periods of sadness, low self-esteem, withdrawal, a lack of interest in hobbies and irritability for no apparent reason. Difficult and unexpected pregnancies commonly bring negative reactions such as resentment, victimization, or entrapment by the mother or by both parents (Beck 2001).Chronic Fatigue Syndrome, which is also prevalent in women, produces many of the same symptoms and its cause is unknown.
Studies have shown that men seem to develop symptoms of PND much later than the mothers after the child is born (Edhborg 2004). It has also been observed that fathers often develop depressive symptoms as a result of being around a depressed mother, from the baby may be born with a defect or grossly premature, or not having a job to help support the baby. In these settings, depression has been misdiagnosed as Post Traumatic Stress Disorder. Post-Traumatic Stress may be present for reasons which have nothing to do with pregnancy and childbirth. The deterioration of intimacy due to lack of communication and the stresses of a new baby is said to cause postpartum depression in fathers, and about 25 percent of all couples divorce within five years of having a child (Parks 2005). Men experience the same symptoms as women with PND including excessive weight gain or loss, insomnia, sadness, or despair, and a loss of interest in normal activities or hobbies, and difficulty making decisions, due to the shift to parenthood (Smyth 2003).
Treatment of PPD is individualized, based on the medical profile of the patient. Of equal challenge is the management of the disorder.The timescale for PPD is much longer than for general depression, which lasts for up to 6 weeks. However, studies show that the mother’s increased vulnerability to depression may last indefinitely depending upon the basis for the depression. It is likely that the condition has many causes and thus, each case must be evaluated individually.
Also up for debate is whether mothers should be given prescription medicine to treat PND. Alternatives to prescription drugs, such as mindfulness meditation techniques, have been trialled in place of medicine.Support of the use of medication to treat PND is that it affects everyone involved with the patient, including the infant, the spouse, and other members of the family. However, medication for depression typically carries side effects that can compound the problems associated with the disorder. Those who do not desire to take prescription medicine to treat the disorder seek solutions outside of medication and therapy sessions. Many have turned to meditation to cope. The meditation technique of mindfulness based intervention is said to help relieve patients from discomforts associated with medical disorders. The basis of the technique is that it promotes awareness (Farlex, 2013). Reduction of stress has been obtained to be one essential factor in the successful treatment of depression patients. In theory, the need to reduce stress and depression may arise because of other issues that promote depression.
A strong association exists between the emotional stress of the affected individual and the stress that follows. The symptoms of stress and fatigue tend to deteriorate during the process of treatment of the patient affected (Glare and Christakis, 2008). It has been obtained that interventions that can reduce stress within such patients are also capable of reducing the fatigue in the body also (Kearney and Richardson, 2006).
Amidst a raging sea of prescription drugs, therapies, and clinical trials, most mothers who suffer from postpartum depression are tired and overwhelmed. Some studies claim that children with depressed mothers may exhibit long-term deficits that affect the child beyond infancy to school age, such as inhibited speech development and a weak mother-child relationship (Puckering 2005; Toneguzzi 2004; Meltz 2003).Improved lifestyle factors like moderate physical activity, elimination of smoking and alcohol habits, or reducing them to moderation are considered positive factors that may decrease the severity of the disorder.
Chapter 2 Effects of Post-partum Depression in Children
Most studies on PND agree that depressed and stressed mothers will display long-term shortages that affect the child to school age, such as speech delay and insufficient mother-child relationships, because the mother finds it difficult to love. The disorder occurs during the early stages of the child’s development, which is the most critical time for children to develop psychological and social stability. For this reason, cases of PND require intervention at the onset for the sake of the mother’s health and also the normal development of the child.
Children with parents who suffer from PND exhibit similar symptoms in their everyday lives. The behaviours children of PND parents include frequency of emotional disturbance, behavioural, and developmental problems, learning disabilities including poor cognitive ability, and lower standardized intellectual achievement test scores. Children of depressed mothers will exhibit poorer mental and motor development (Hall 2006). The scars of depression have lifelong effects on the mother and the child. Murray (2003) suggests that infants of mothers with PND were more likely to have insecure attachment and perform worse on cognitive skill tests.
The children of PND mothers have been found to exhibit irritability by excessive crying and seemingly continual unhappiness. Many times the child is perceived as a burden by the mother and little effort is made to make the child smile. Edhborg et al (2000) suggests infant of depressed mothers tend to be insatiable, less interactive and withdrawn, and quiet. In a study reviewed by Walling (2006), the child’s development by two years of age reported results of behavioural and emotional problems, and hyperactivity. Information about behaviour of the children was drawn from a large population of children using EPDS to pinpoint symptoms of depression. The study produced a high correlation between PND in mothers and adverse emotional and behavioural activity.
Chapter 3 Case Studies on Depression
The studies that show mothers experience negative emotions in an environment that is supposed to bring joy is a puzzling phenomenon. Both medical practitioners and psychologists have shown continual interest in the Post-partum Depression mood disorder. Consequently, several studies have been conducted to find causes as well as treatments. The research results selected for this study were typically for patients examined for 1 to 24 months after childbirth. It should be noted that a large percentage of the studies were conducted by women, which can be considered a form of bias. Interpretations of the results by women who are mothers and have experienced a type of depression have limited validity. An objective study would be performed by a combination of men and women who have not experienced or been treated for depression.
Prevention of PND starts with discovery of risks associated with mood disorders. A 2001 study by Yonkers, Ramin, Rush, Navarette, Carmody, and March (2001)compared risk factors for PND in minority women. The method including a screening of women attending their first doctor’s visits after childbirth. The study used the Edinburgh Postnatal Depression Scale. A significant finding was that African American and Latino women seemed to acquire PND before the pregnancy rather than after, in higher rates than the Caucasian women. This could suggest the birth of the baby dispelled some of the fears or anxiety which may have been from worries other than those listed in the study.
In 2005 Stephanie Brown and Judith Lumley published Physical Health Problems after Childbirth and Maternal Depression at Six to Seven Months Postpartum, an important resource for mental health professionals. The publication contained the results of a statewide survey using EPDS. The objective of the research was to compare relationships between physical, mental, and emotional health for up to a year postpartum (Brown & Lumley, 2005). The significance of the book is the duration of time expounded on the surveys. The research period was long enough to cover all of the presently known stages of postnatal depression, postpartum blues, and other predefined periods. Conducted for mothers in Victoria, Australia, 1993, the study supported previous research that the relationships existed.
Much of the recent studies of postnatal depression have begun to focus on the safety of the infant. This is due to increasing development problems in children and criminal cases where the mother harms the child or all of her children. A pediatric study by Horowitz (2001) focused on the negative impact of PND on the infant. The case study was comprised of home visits with the mothers to obverse coached interactions with the children. The Horowitz et al. (2001) study revealed that mothers are often involuntarily neglectful and communicate less, and are more passive, perceiving themselves to be not good enough. The purpose of the study was to mend the mothers’ ability to respond to the needs of the newborns. PND poses significant risk to the mother and child relationship as well as to children emotional and physical health. Researchers mentioned by Horowitz et al. (2001) have established relationships between PND and deficits in affectionate, withdrawal, hostile maternal behaviours, and subsequently negative infant behaviours.Sociology supports the concept that fathers can also experience PND. Kleiman (2006) published a study of effects of childbirth on men where over half of fathers experienced PND early following the birth. Because the causes of PND are not completely understood, distinguishing between the research of PND in both women and men is limited and often biased. Traditional medical circles of thought still consider postnatal depression as a ‘female problem’ and see no need to explore instances of the disorder in men. Many men from traditional social circles believe postnatal depression is a female problem and would not consider being evaluated.
The results for the mothers varied where less than half of the participants had scores above the cut-off point. The results indicated that after childbirth, PND is experienced by both parents, which is the likely situation, even if the father only experiences PND for a brief period. The only situation where the father is unaffected by the pregnancy and birth is if he is not there. To validate the impact of childbirth on men in regard to post natal depression, population samples should be drawn and compared from fathers who live in the home and fathers who are not directly present during the pregnancy and delivery, and at the home with the newborn.
Chapter 4 Influence on Health Care to Benefit Patients
Comparisons were made of several variations of PND research study results including, Brown and Lumley (2000), Horowitz (2001), and Kleiman (2006).The outcomes of interest for this study are both pragmatic and explanatory. The research is based on secondary studies involving qualitative research methods. A qualitative research method involves a natural approach to the topic for results derived from facts and figures. This approach makes use of case studies, individual experiences, and any related processes that would provide insight into mental health.
Qualitative data consists of current medical conditions rather than for previous struggles with depression. According to a University of Wisconsin study: “Qualitative data collection methods play an important role in impact evaluation by providing information useful to understand the processes behind observed results and assess changes in people’s perceptions of well-being” (EAU Claire, 2013). It should be noted that as the infant grows, sleeps more regularly, and becomes more independent, the basis for post partum depression changes and the research data must be classified according to dates and times.
Since focus of the study is based upon secondary sources, there exists only so much information available that is reliable and useful. Measurement of the credibility and authenticity of the data is limited. The validity of previous studies is systematically lower as it is affected by the lack of technology and bias of the samples. Some of the previous studies should be re-conducted with the technology we have now, which allows for greater capacities of research by population size and demographics. Moreover secondary sources reflect the studies and information that have already been in existence for a while. The study uses current theories and results to form an intelligent conclusion about the subject. Yet still, new research study results are less abundant, and hence there is a greater dependency on previous research.
4.1 Clinical Trials
Clinical research studies have been conducted to gain insight into the causes of mood disorders and ways to treat the patient, which are based upon different theories of what causes postpartum depression based upon the stage in the pregnancy, birth, or postpartum. To date, the specific causes of Post-Partum Depression are still unknown. The cause of the disorder is likely a combination of factors which deviate as time passes.
In the United Kingdom (UK),a study with a sample of 9028 experienced and first time mothers, at an EPDS cut off at 13, revealed rates above 9% from 8 weeks and 8 months. The low PND rates could be the result of a sample of mothers whose scores were higher than the responders’.
Studies by Hipwell et al. (2000) confirm that depressive disorders directly affect a mother’s ability to maintain a healthy relationship with her children. Mothers who suffer from PPD often are oblivious to the infants crying and sleep patterns, communicate less, and spend little or no time in positive interaction. Depressed mothers demonstrate reduced affection, reduced rapport, increase withdrawal and hostility toward the child and engage in less positive interaction with their children.
In a study highlighted by Dennis & Ross (2006), PPD resulted in the mother ‘feeling like a robot’ or automated when caring for the child, desiring purposeful distance between them and their children.
A smaller sample of 143 first time mothers was researched by Morse et al. (2004) and revealed a prevalence rate of 11% at 6 weeks and of 10.6% at 3 months which was a decrease for the period Evans et al. (2001). The difference in prevalence rates may be attributed to variations of sampling methodologies and rate scales, which were identified with first time mothers. Also using a sample of first time mothers in Sydney, but no longer period of study, Matteyet al. (2000) reported an even lower rate of 6.4% at 4 months postpartum, with a cut off of 13 on the EPDS.
After 15 months, the result showed that 17.6% of PND mothers were less affectionate and more anxious compare to 2.9% of non PND mothers. The postnatal depressed mothers demonstrated less verbal and playing interaction. Infants of PND mothers performed less on object concept tasks, and were more often insecurely attached to their mothers.
For women suffering from PND, living a functional life includes getting along with others, keeping a job, and caring for the children. In cases were the depression is severe, none of these may be possible. It is here that a psychiatric problem is concerned a mental disability by most government agencies. The patient receives subsidy to live because self-sufficiency is not possible. Rather than a cure for PND, treatments help the patient to cope with the many symptoms and to live functional lives despite the disorder.
Most mental health studies for new mothers find that the impact of PND extends far beyond when the mother’s depression ends. Althoughfathers who experience symptoms of PND usually recover in a short period of time, after a period of adjustment to being a new father, the mother may experience PND for the entire adolescent life of the child. Depression can hinder living functionally and can cause other health problems.
Chapter 5 Critique of
A strength of this study is that it includes results from studies conducted from large population samples from different areas and social divisions. The more people who participate in the studies, the more represented the results will be. Another strength of the study are indicators that by the large sample of eligible couples involved, generalisation can be achieved by testing men and women from different social backgrounds. Limitations of the study include the bias of female researchers who were mothers and that non-probability sampling was used. Non-probability sampling is based on the assumption that the researcher had knowledge about the population and the result could be biased. Also, little is mentioned about the baby at birth. The complications of the pregnancy and the health of the baby are important factors that seem to be underrepresented in the studies.
An additional limitation of the studies was that some researchers were unable touse a diagnostic assessment of paternal depression, although the instrument used EPDS which possesses good sensitivity and specificity for a diagnosis of depression. While the good things that come with fatherhood are being recognised, the negative aspects have not been discussed with the same intensity as the discussions regarding the mother. An explanation for the lack focus could be that only recently were men even considered as potential sufferers of PND. When both genders became the focus of the studies, there was no sample population for the men.
Although research yielded much information on Post Natal Depression, less information was available about the fathers, siblings and other important people connected to the family. Most family members were not unaware of PND as a mood disorder and perhaps accepted the mother’s issues as a personality dysfunction. Studies of postpartum depression in men reflect a delay in symptoms compared to the women. This may be attributed to the fact that the mother has experienced more stress throughout the pregnancy. The father may only become distressed at the point of birth and subsequently from a crying newborn at home. Studies have shown that PND frequently occurs 4 to 6 weeks after the birth in the fathers.
5.1 Awareness
One of the greatest challenges to combating mental health issues is the level of awareness a of the disorder in both society and the medical community. Because psychiatric medical problems do not exhibit physical symptoms, they can be more difficult to diagnose, treat, and to inform others about. Advances in technology have escalated research capabilities and thus, new information is generated about PND and other disorders that were medical speculations in the past. As new breakthroughs of information come through for postpartum depression, the medical staff must be retrained through continuing education programs to be updated. The government health agencies must provide literature that is easy to read and comprehend about PND, and make them available at the medical facilities and throughout the community.
Community services for women must be created to raise awareness of the issues surrounding a transition to motherhood; that it can be an emotionally damaging experience to new moms. This will enable them to make choices to minimize the impact of new motherhood and decrease their chances of becoming depressed. Educating couples and the community about the symptoms of PND enables educators to increase the likelihood that the parents will seek out proper screening, diagnosis, and thus, treatment.
Government agencies pass legislation and create programs to help society and promote the best interests of the community. Strategies that acknowledge ethics and social responsibility produce long-term progress. “Making ethical decisions consistently is a key to long-term success, although legislators may end of with less short term results’ (Ingram, 2012). The National Health Service (NHS) has enhanced its strategies to improve the level and availability of health care in the United Kingdom. Many have complained about the lack of availability of resources for people of limited income and resources. Complaints have also been made of the availability of treatment after diagnosis of the disorder and a prescription is assigned. The NHS has since provided more funding to support needed programs and increase availability of treatment.
Legislation and medical research must focus more on advocacy, anti-discrimination and empowerment. Intervention has had a profound effect on PND cases to date; however, Postnatal Depression is much more prevalent than the statistics suggest. Unreported cases increase the number and represent the population that needs help the most.
Awareness that PND is an illness that can occur in typical situations involving an environment of stress will give new mothers to get help without feeling stigmatized. This knowledge will empower new mothers courage to seek support through community resources that will help them (Zauderer 2009).
5.2 Influence of Postpartum Depression on Society
Mothers should have access to intervention programs available from the beginning of the pregnancy through birth through postnatal. Not addressing the problem thoroughly at the onset can mean a continuation of suffering for years after the trade-off.Awareness through education should be the goal because describing PND and how it affects people empowers everyone involved to make good choices and to get help when the mood disorder first develops.
Legislation plays an important role in several ways. For one, postpartum depression is often used as an insanity defense in some criminal cases in which mothers harm or kill their children. In some instances, the spouse harms the wife or husband. When these cases were first scrutinized, forms of depression were not viewed as an illness. Also, if a person suffered from depression, traditional fatality cases were of suicide not murder. Extreme cases of depression were classified as psychosis or extreme mental insanity not depression. Even mental illness cases are heavily scrutinized as to whether the defendant is responsible and using a disorder as a means of less punishment.In these cases where the defendant was found guilty, the sentence for mental illness claims may be incarceration in a mental facility rather than general population at a prison facility. The chances of being released back into society are greater in this setting than in general population or death row.
The implementation of PND research and legislation has come together forcefully through an increase in criminal cases where the defendant uses depression as a defence. Juries struggle to consider whether depression can cause a woman to murder her own children. Because the causes of depression are only speculator, the jurors do not have much medical information to form such an opinion.
Mental health issues in criminal cases have remained rigid in accepting mood or mental disorders as an alibi. Society is not ready for multiple murders due to depression because traditionally, in such cases suicide is what makes sense. Most would argue that the desire to harm someone else must stem from more than just low self-worth or a lack of personal motivation.
Helping patients who suffer from depression has been limited to a lack of knowledge about the mood disorder by the medical researchers and the patients themselves. Government and private health agencies have limited funding to focus on several topics in mental health care. Many other mood disorders are still being researched for causes and effective prevention and treatment methods.
To raise the standards for diagnosis and treatment, methods for identifying and treating those who suffer from depression must be developed. Today, many medical circles have become aware of the severity of the disorder and pooled together to find out more about it. Different types of medicine have been developed to help treat PND that seem to minimize its effect.
People need help. Depression, along with many other disorders is wreaking havoc in the personal lives of people to whom the conditions are very real. Suicide and murder rates reflect a deficiency in mental health awareness and treatment. Because psychiatric disorders carry a negative connotation and people do not want to be labeled as ‘crazy’, they keep the issues hidden. An effective strategy is needed which capitalizes on intelligent interpretations of mental health and mood disorder issues, particularly depression patients, to define where to go to help depression patients and a map of how to get there. Society and its norms are part of the cause for depressive disorders.
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While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.
Engineering
Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.
Nursing
In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.
Sociology
Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.
Business
We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!
Statistics
We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.
Law
Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.
What discipline/subjects do you deal in?
We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.
Are your writers competent enough to handle my paper?
Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.
What if I don’t like the paper?
There is a very low likelihood that you won’t like the paper.
Reasons being:
- When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
- We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.
In the event that you don’t like your paper:
- The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
- We will have a different writer write the paper from scratch.
- Last resort, if the above does not work, we will refund your money.
Will the professor find out I didn’t write the paper myself?
Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.
What if the paper is plagiarized?
We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.
When will I get my paper?
You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.
Will anyone find out that I used your services?
We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.
How our Assignment Help Service Works
1. Place an order
You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.
2. Pay for the order
Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.
3. Track the progress
You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.
4. Download the paper
The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.
PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY AND GET A PERFECT SCORE!!!
