Stress Reduction Techniques Healthcare Professionals
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This document contains slides from a presentation on stress reduction. It discusses how stress affects healthcare professionals and patients. It defines stress and identifies its causes such as overwork, role ambiguity, and understaffing. Long-term stress can increase risks of health issues like heart disease, diabetes and mental health problems. The presentation recommends organizational changes, stress management training, and coping strategies like mindfulness, social support and seeking help to reduce workplace stress.
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Stress Reduction Techniques Healthcare Professionals
- 1. Slide 1 Stress Reduction Theresa Byrd RN BSN Clinical Coordinator Norton Women’s Heart and Vascular Center ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 2 Objectives • Review data regarding stress in the workplace and its effect on the healthcare professional and patient. • Define stress, causes, and symptoms of stress. • Recognize stress reduction techniques and coping skills. • Identify resources for stress available in the community. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 3 Stress in the Workplace OSHA declares stress a hazard of the workplace. Costs American industry over $300 billion annually. 43% of all adults suffer adverse health effects of stress. 75-90% of all doctor visits are for stress-related ailments and complaints. www.webmd.com/mental-health/effects-of-stress-on-your-body ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 2. Slide 4 Surveys on Stress in Workplace 40% of workers report their job is “very or extremely stressful.” Northwestern National Life 29% of workers report they feel “quite a bit or extremely stressed at work.” Yale University 26% of workers report they are “often or very often burned out or stressed by their work.” Families and Work Institute ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 5 Women’s Health Study – Harvard Research Involved over 17,000 female health professionals. Women whose work is highly stressful are: 70% more likely to have a heart attack. Have a 40% increased risk of heart disease (heart attacks and need for coronary artery surgery). Women who worry about losing their jobs are more likely to have high blood pressure, unhealthy cholesterol levels, and to be obese. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 6 Work Stress Has been shown to result in: • Job dissatisfaction • Burnout (physical, emotional, and mental exhaustion) • Staff turnover • Occupational illness and injuries • Reduced mental health • Depression • Suicide Lundstrom et al, Am J Infect Control 2002;30:93-106 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 3. Slide 7 Studies on Job Stress • Found that medical residents feeling overwhelmed correlated with the reported number of minor medical mistakes. • Found a strong relationship between degree of stress (on a stress continuum scale) and the occurrence of patient incidents. • Found availability of technology was significantly associated with lower risk-adjusted mortality. Lundstrom et al, Am J Infect Control 2002;30:93-106 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 8 Studies on Staffing Ratios Understaffing resulted in: • decreased compliance with hand washing • increased rates of blood and body fluid exposure in nurses • increased rates of pneumonia and urinary tract infections Lundstrom et al, Am J Infect Control 2002;30:93-106 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 9 Studies on Staffing Ratios Found higher rates of infection with MRSA correlated with nurse overtime and the use of temporary staffing. Found rates of S aureus infection in neonatal ICU was 16 times higher after period of understaffing. Lundstrom et al, Am J Infect Control 2002;30:93-106 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 4. Slide 10 Studies on Job Stress and Burnout • Found that reduced length of stay, lower nurse turnover, and higher evaluations of quality of care significantly associated with: • Caregiver interactions • Unit culture • Leadership • Coordination • Communication • Conflict management Lundstrom et al, Am J Infect Control 2002;30:93-106 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 11 What is Stress? ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 12 What is Stress? The body’s physical and emotional reaction to change. Very individual. Everyone perceives and reacts to stress differently. Positive stress - normal, beneficial to help us keep alert, accomplish tasks, or prevent injury. Negative stress- harmful if ongoing, chronic, and not dealt with in a healthy manner. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 5. Slide 13 Stress ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 14 Fight or Flight Response Body reacts to life threatening events. Elevates levels of stress hormones, adrenaline and cortisol. Heart rate increases, Breathe faster. Blood pressure increases –damages artery linings. Blood sugar increases – may lead to diabetes. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 15 Stress Father of Stress - research 1930’s ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 6. Slide 16 Stressors Illness – personal, family member, or friend Becoming a caretaker Death of a friend or loved one Problems in relationships with family or friends Marital conflicts, separation, and/or divorce Family time management Childrearing Financial concerns Legal problems ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 17 Stressors Planning a wedding Pregnancy Retirement Perfectionism Crowds, traffic Unemployment Relocation Starting a new job, job promotion Work overload, deadlines ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 18 Occupational Stress • The National Institute for Occupational Safety and Health (NIOSH) defines Occupational Stress as: “the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker.” (NIOSH) ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 7. Slide 19 Causes of Occupational Stress • Work overload- infrequent rest breaks, long work hours, and shift work • Lack of task control - hectic and routine tasks that have little inherent meaning, do not utilize workers' skills, and provide little sense of control • Role ambiguity - Conflicting or uncertain job expectations, too much responsibility, too many "hats to wear” (NIOSH) ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 20 Causes Occupational Stress Organizational factors: • Poor interpersonal relations • Lack of support or help from coworkers and supervisors • Lack of management commitment to core values • Poor or lack of communication • Lack of participation by workers in decision making • Lack of family-friendly policies (NIOSH) ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 21 Causes Occupational Stress Training and career development issues: • lack of opportunity for growth, advancement, or promotion • job insecurity • rapid changes for which workers are unprepared Conflict between work and family roles and responsibilities Financial and economic factors (NIOSH) ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 8. Slide 22 Causes of Stress in Nurses • Work overload, understaffing, time pressure • Lack of social support at work • Exposure to infectious diseases • Needle stick injuries • Exposure to work-related violence or threats • Sleep deprivation • Role ambiguity • Career development issues • Dealing with difficult or seriously ill patients (NIOSH) ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 23 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 24 Causes of Stress in Physicians • Long hours • Excessive workload • Dealing with death and dying • Interpersonal conflicts with other staff • Patient expectations • Threat of malpractice litigation (NIOSH) ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 9. Slide 25 Emotional Symptoms • Job dissatisfaction • Anxiety • Easily agitated, frustrated, moody • Irritability or anger • Feeling overwhelmed • Difficulty relaxing and quieting your mind • Feeling worthless, powerless, negative thinking • Feeling lonely, sadness, and depressed ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 26 Physical Symptoms Low energy, tired, exhaustion, fatigue Headaches Upset stomach, nausea, diarrhea, constipation Aches, pains, and tense muscles (back pain, stiff neck) Chest pain and rapid heartbeat Insomnia Frequent colds and infections Loss of sexual desire and/or ability Nervousness and shaking Cold or sweaty hands and feet Dry mouth and difficulty swallowing Clenched jaw and grinding teeth ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 27 Cognitive Symptoms Constant worrying Racing thoughts Forgetfulness, poor memory, and disorganization Lack of motivation or inability to focus Poor judgment Difficulty making decisions Inability to concentrate Being pessimistic or seeing only the negative side Lack of creativity Loss of sense of humor ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 10. Slide 28 Behavioral Symptoms Absenteeism Sleep disturbances Changes in appetite – either not eating or eating too much Procrastinating and avoiding responsibilities Increased use of alcohol, drugs, or cigarettes Exhibiting more nervous behaviors, such as nail biting, fidgeting, and pacing Angry outbursts Social withdrawal Exercise less ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 29 Consequences of Long Term Stress Stress is “Dis…ease” ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 30 Consequences of Long Term Stress Cardiovascular disease- heart disease, high blood pressure, abnormal heart rhythm, blood clots, heart attack, heart failure, and stroke Diabetes Obesity and other eating disorders Mental health problems- depression, anxiety, and personality disorders Gastrointestinal (stomach) Disorders – GERD, gastritis, ulcerative colitis, irritable colon ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 11. Slide 31 Consequences of Long Term Stress Immune – sick more often, harder to fight off disease Asthma and other Respiratory Conditions Skin and hair problems – acne, psoriasis, eczema, hair loss Menstrual problems – painful menstruation, low fertility Sexual dysfunction – impotence, loss of desire ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 32 Reducing Stress in Workplace Organizational Change: • Ensure workload is in line with workers’ capabilities and resources • Provide adequate staffing and reasonable shift schedules • Clearly define workers’ roles and responsibilities • Provide organized, efficient, safe work environment and safe equipment (NIOSH) ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 33 Reducing Stress in Workplace • Give workers opportunity to participate in decisions and actions affecting their jobs • Improve communication – regular staff meetings • Reduce uncertainty about career development and future employment prospects • Provide opportunity for social interaction among workers (NIOSH) ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 12. Slide 34 Reducing Stress in Workplace Stress Management Intervention • Training in coping strategies • Progressive relaxation • Biofeedback • Cognitive-behavioral techniques • Time management • Interpersonal skills • Provide counseling and/or group therapy with mental health provider, Employee Assistance Programs (NIOSH) ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 35 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 36 Okinawans • Highest concentration of people 100 years or older • Okinawa - 34 centenarians/100,000 • United States – 10 centenarians/100,000 • Heart disease, stroke, cancer, obesity, and dementia rates are low. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 13. Slide 37 •Purposeful lives – give clear roles and feelings of being needed well into their 100s. •Secure social networks - family, friends, neighbors help each other and give financial and emotional support. • Strong spiritual commitment and a positive outlook on life. Okinawans ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 38 Okinawan Secret of Longevity • Low calorie, plant based diet - 7 servings fruits and vegetables/day, 7 servings of grain/day, fish several times per week, and 2 servings of soy/day. • Minimal dairy products and meat. • Regular exercise that connect the mind and body. • Gardening, walking, dancing, karate. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 39 Coping with Stress Identify your stress triggers. Keep a diary and record situations, events, and people who cause you to have a negative physical, mental, or emotional response. Describe: Where were you? Who was involved? What was your reaction? How did you feel? Tackle your stress triggers. Find a way to change the circumstances causing it. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 14. Slide 40 Coping with Stress • Set realistic goals – Review goals on regular basis and adjust as needed • Sharpen time management skills. • Make a priority list – do most important things first. • Protect your time – block out time on your calendar to work on an important project. • Delegate Tasks! ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 41 Coping with Stress • Get other points of view and suggestions. Talking can simply relieve stress. • Be with friends and family – have a cup of tea with during break with friend at work. • Phone call with sister. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 42 Coping with Stress S.T.O.P. - Live mindfully and consciously. • S – Stop what you are doing. • T – take a few deep breaths. • O – Observe your body and smile. • P - Proceed with kindness and compassion. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 15. Slide 43 The Dalai Lama suggests: Spend energy focusing on the solution rather than worrying about the problem. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 44 Coping with Stress Seek professional help. • Talk to your physician, • Mental health provider (Psychologist, psychiatrist). • Employee assistance program. • Take a stress management class (colleges, mental health providers, employer wellness programs). ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 45 Coping with Stress • Think positive – Optimism may affect your quality of life and enable you to cope better. • Focus on one thing at a time – Our conscious cannot multitask. • Take 20 minutes for yourself • Stretch or walk • Sit quietly without an agenda • Explore your spirituality. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 16. Slide 46 Coping with Stress • Make time for activities you enjoy: • Reading , Movie • Socializing • Volunteer • Concert • Art exhibit • Comedy show • Sporting event • Hobby - musical instrument, sewing, gardening, painting, singing, drawing ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 47 Coping with Stress Treat yourself with love as much as you love others. Get a massage or try self massage. Eat healthy – fresh fruits and vegetables, lean protein, whole grains. Limit alcohol and caffeine. Coffee raises stress hormone- switch to green tea or chamomile tea Take a vacation or long weekend when you can. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 48 Coping with Stress Deep breathing. Meditation, qigong. Imagery - Go to your “Happy Place”. Progressive muscle relaxation. Listen to music. • Journaling – let your thoughts flow. • Keep a “Gratitude Journal”. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 17. Slide 49 Tai Chi Improves stress management. Reduces anxiety and depression. Lowers blood pressure. Improves balance, flexibility, and muscle strength. Increase mental focus and concentration. YMCA, churches. Norton Health and Wellness Center – September, 2014 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 50 Yoga Improves strength, balance, flexibility and coordination. Reduces stress and anxiety. Helps blood pressure. Improves muscle mass and bone density. Increases mental focus and concentration. Helps relieve asthma symptoms. Reduces arthritis pain. Yoga Nidra Classes - Marshall Women’s Health and Education Center – July 2014 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 51 Coping with Stress Unplug yourself from the Office! Each night, block 30 minutes for email. Turn It Off ! Put Out of Sight! Don’t play catch up before bedtime – hard from brain to relax and sleep if in work mode. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 18. Slide 52 Coping with Stress Take it Outside – Be with Mother Nature. Natural light increases levels of mood lifting chemical serotonin. Notice the colors, the smells, fresh air. Feel breeze on your face. Notice shapes in clouds. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 53 Exercise •Boosts serotonin and immune system. •150 minutes of moderate physical activity per week or 75 minutes of vigorous activity per week. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 54 Stress Balls ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 19. Slide 55 Don’t Smoke, Avoid Secondhand Smoke Nicotine is a stimulant! Smoking Cessation Classes: Cooper-Clayton method, behavioral modification program involving nicotine replacement and nicotine reduction therapy, as well as group support. All classes meet once a week for 13 weeks. Norton Healthcare - 629-1234. Louisville Metro Public Health and Wellness - 574-STOP (7867). ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 56 Get Your Beauty Sleep! • Women with poor sleep had higher levels of psychological distress, and greater feelings of hostility, depression, and anger. • Women also had higher levels of C-reactive protein and interleukin-6 inflammation biomarkers. Duke University Study: March 2008 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 57 Fatty Fishes • Salmon, sardines, or tuna fish. • High in Omega 3 fatty acids and Vitamin B12. • Helps protect heart. • Help prevents surges in stress hormones. • Helps with mood disorders, depression and PMS. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 20. Slide 58 Warm Cup of Oatmeal or Green Tea • Oatmeal • Increases serotonin. • High in Vitamin B and Magnesium. • Green Tea • High in antioxidants, flavanoids and catechins that have a calming effect. • Helps you recover from stressful events more quickly. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 59 Fruits and Veggies Oranges • High in Vitamin C to help boost immune system. • Lowers levels of stress hormone – cortisol. Spinach • High in Magnesium. • Helps with fatigue and headaches. • Relaxes muscles and calms. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 60 Coping with Stress Show some love. Cuddle your pet. Give an unexpected hug. Snuggle with your spouse. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 21. Slide 61 Petting your Dog Body releases feel good hormone – serotonin, prolactin, and oxytocin. Decrease stress hormone, cortisol. Decrease blood pressure. Decreases anxiety. Boosts immunity. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 62 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 63 Laughter is the best medicine Increases oxygen and blood flow. Relieves tension. Releases good feeling hormones, serotonin. Reduces cortisol and epinephrine levels. Belly laugh is good workout for abdominal muscles, diaphragm, shoulders, and heart. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 22. Slide 64 Resources The Center for Women and Families 24 hour Crisis Line – 877-803-7577 Seven Counties Emergency & Crisis Numbers 24/7 • 502-589-4313 or 1-800-221-0446 For an appointment – 502-589-1100; 1-800-264-8799. National Suicide Prevention Lifeline 1-800-273-TALK (8255) www.suicidepreventionlifeline.org Kentucky Suicide Prevention Group (502) 931-3999 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 65 Resources Location of a Psychologist in Your area – American Psychologist Association – 1-800-964-2000 or www.apahelpcenter.org/ Hosparus/Hospice and Palliative Care – 456-5451 Postpartum Support International Postpartum Support Kentuckiana: 502-541-1818 Postpartum Depression Support Group Norton Suburban: 899-6220 Norton Women’s Counseling Services – Sheila Ward, APRN – 899-6220 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 66 Resources WomenHeart Support Network Coordinators Bev Hurt – 419-0583, Vanessa Rogers – 644-2288, WH-Louisville@womenheart.org ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 23. Slide 67 Resources Norton Stroke Support Group – 636-7349 Norton Wellness for Life Series – 629-1234 Norton Healthcare Grief Care – 629-5926 Norton Consoling Parents and Consoling Grandparents – 629-2103 Norton Healthcare Church and Health Ministries - 629-2700 Tai Chi or Yoga classes – 629-1234 Norton Music Therapy – 636-7054 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 68 Resources National Institute for Occupational Safety and Health (NIOSH) NIOSH Job Stress www.cdc.gov/niosh/topics/stress Your Portable Guide to Stress Relief www.health.harvard.edu/topic/stress National Institute of Mental Health “Fact Sheet on Stress” ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 69 Resources www.nlm.nih.gov/medlineplus/stress.html www.webmd.com/balance/stress- management/default.htm www.mayoclinic.com/health/depression/DS00175 www.mayoclinic.com/health/postpartum- depression/DS00546 www.webmd.com/depression/postpartum- depression/postpartum-depression-topic-overview ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 24. Slide 70 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 71 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________