A Middle Range Theory of
Analysis and Application
by Jennifer R. Marsh, RN BSN
Abstract: This paper examines Cheryl
Tatano Beck’s middle range theory of
postpartum depression: Teetering on the
Edge. Concepts and definitions of the
theory are outlined, as well as assumptions and propositions. The postpartum depression theory is further examined and
evaluated in its relation to the field of
nursing, its applicability to practice, and
author’s scope of practice.
Keywords: postpartum depression, Beck, pregnancy, Middle Range Theory
For over 20 years, Cheryl Tatano Beck has focused her
research on postpartum mood disorder and anxiety. In 1993,
Beck published her middle range theory on postpartum
depression, titled Teetering on the Edge. As Beck completed a literature review on postpartum depression (PPD), she came
to realize that there was limited qualitative research available. Beck’s primary goal was to produce a study/research in which humanity (through what one experienced) was
represented in its’ relation to PPD.
Components of the Theory
The use of Beck’s theory on PPD is a relevant tool for
any provider, whether midwife, childbirth educator, or nurse, to enhance the care provided to pregnant and postpartum
clientele. Providers that interact with this particular clientele for a limited time need to be diligent to recognize signs and symptoms of PPD. Not only do providers need to be able
to recognize PPD but also adequately educate our clientele
regarding PPD and the range of emotions that may be experienced along with methods of seeking help. One out of five women will experience postpartum depression (Albert, 2002). Beck explored the concept of PPD beyond the analysis of symptoms and definition of major
depressive mood disorders essentially because the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) does
not include PPD as a diagnosis (Beck & Driscoll, 2006). A
qualitative study was designed to investigate specific social psychological problems of PPD and the social psychological
process used to resolve PPD. With the help of 12 women
in a support group, which met for an 18 month period,
Beck interviewed these women and asked them to describe
continued on next page
Figure 1. Beck’s 4 Stage Process of Postpartum
Depression Encompassing Loss of Control
Theory is the foundation of nursing and is essential
to the profession. As a profession, nursing applies conceptual frameworks to guide practice through describing and predicting specific behavior. It is through the use of guided phenomena that one is able to expand concepts via research;
ultimately, advancing knowledge in regards to concept, experience, and application to practice.
50 | International Journal of Childbirth Education | Volume 28 Number 4 October 2013
A Middle Range Theory of Postpartum Depression
continued from previous page
their experiences. The main problem perceived was a loss of
control (Beck,1993). Women that experienced PPD felt as
though they could not control their emotions, thought processes, and at times even actions. Beck titled this particular loss of control as Teetering on the Edge. According to Beck this “refers to walking a fine line between sanity and insanity” (Beck, 1993, p. 44). The theoretical assumption amidst loss
of control encompasses four stages (see Figure 1); encountering terror, dying of self, struggling to survive, and regaining control (Beck, 1993).
Structure of Theory: Assumptions and
Encountering Terror may occur within a few weeks to six
months post-delivery. During this stage, women unexpectedly feel as though they are trapped with no means of escape. Horrifying anxiety attacks may occur that are described as
losing one’s mind, and at times feel worse than the actual depression. In conjunction with anxiety attacks, relentless
obsessive thinking often occurs. This form of thinking takes place...
References: Albert, C. (2002). The dark days of postpartum depression. Advance for NPs
& PAs, 10(6), 67
Beck, C. T. (1991). Early postpartum discharge: Literature review and critique. Women and Health, 17, 125-138.
Beck, C. T. (1992). The lived experinece of postpartum depression: A phenomenological study. Nursing Research, 41, 166-170.
Beck, C. T. (1993). Teetering on the edge: A substantive theory of postpartum depression. Nursing Research, 42(1), 42-48.
Beck, C. T. (1996). A meta-analysis of predictors of postpartum depression.
Beck, C. T. (1998). The effects of postpartum depression on child development: A meta-analysis. Archives of Psychiatric Nursing, 12(1), 12-20.
Beck, C. T. (2001). Predictors of postpartum depression: An update. Nursing
Research, 50, 275-285.
Beck, C. T. (2002). Postpartum depression a meta-synthesis. Quality Health
Research, 12, 453-472.
Beck, C. T. (2002). Revision of the Postpartum Depressin Predictors Inventory. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 31(4), 394-402.
Beck, C. T., & Driscoll, J. W. (2006). Postpartum mood and anxiety disorders:
A clinician’s guide
Beck, C. T., Gable, R. K., Sakala, C., & Declercq, E. R. (2011). Posttraumatic
stress disorder in new mothers: results from a two-stage U.S
Dennis, T. R., & Moloney, M. F. (2009). Surviving postpartum depression
and choosing to be a mother
Lasiuk, G. C., & Ferguson, L. M. (2005). From practice to midrange theory
and back again: Beck’s Theory of Postpartum Depression
Logsdon, M., Wisner, K., & Shanahan, B. (2007). Evidence on postpartum
depression: 10 publications to guide nursing practice
Morse, C., Durkin, S., Buist, A., & Milgram, J. (2004). Improving the postnatal outcomes of new mothers. Journal of Advanced Nursing, 45(5), 465-475.
Please join StudyMode to read the full document