Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms

What does Chilean research tell us about postpartum depression (PPD)?

BACKGROUND

In Chile, a country with a so called emerging market-economy, where rapid social and life style changes are taking place, women and the more socially disadvantaged are more at risk of becoming depressed.

METHODS

Results of several studies are summarized in the context of a review of the literature.

RESULTS

A third of Chilean women have depressive and/or anxiety symptoms during midpregnancy, while prevalence figures both in the early and the late postpartum period increase up to 50% in most studies. If strict operational criteria describing well defined depressive disorders are used postnatally, differences in prevalence and incidence figures arise depending on socioeconomic status. Whereas incidence rates for postpartum depression (around 9%) are very similar to those found in the northern hemisphere and do not appear to vary across different socioeconomic levels, higher prevalence rates are found among women from lower socioeconomic status.

LIMITATIONS

The studies focused on current diagnostic entities and did not consider different clusters or dimensions.

CONCLUSION

A shared biological etiology may be triggered by the physiology of childbirth and account for similarities in incidence across different socioeconomic levels. In turn, we hypothesize that the higher prevalence of postpartum depression (PPD) in Chilean women from lower socioeconomic status is the result of pre-existing depression and is not caused by more new cases of the illness.

Comparing postpartum depression and major depressive disorder: issues in assessment

Postpartum Depression (PPD) is an important social and health problem for women and their families with an incidence of at least 13%. In comparing the diagnosis, timing, and symptom patterns of PPD and Major Depressive Disorder (MDD), there are distinct differences that may partially explain why PPD is under-diagnosed and under-treated. The purpose of this manuscript is to compare and critique the most common instruments used to assess PPD. The Postpartum Depression Screening Scale developed by C.T. Beck and Gable is recommended for use by mental health providers.

Maternal depression and infant growth: a review of recent evidence

Depressive disorder occurring during pregnancy and the post-natal period (maternal depression) is common in both developed and developing countries. It can cause functional impairment at a time when the mother is performing tasks vital to her infant's growth and development. This article reviews recent research investigating whether there is an association between maternal depression and infant growth impairment. A search was made using Medline for articles published in the last 10 years, and the results were scrutinized for relevance and quality. Eight studies from developing countries, and three from the UK, are described. Cohort studies from both India and Pakistan provide evidence that maternal depression is an independent risk factor for poor infant growth. However, studies from other developing countries are limited and conflicting in their findings. The UK-based research suggests that such an association occurs in mothers/infants living in conditions of socio-economic deprivation. This review discusses the potential mechanisms by which the relationship between maternal depression and infant growth outcomes may be explained: the effect of infant growth 'failure' upon maternal mood; the impact of maternal depression upon health-seeking behaviours, breastfeeding and mother-child interaction; the relationship between antenatal depression and low infant birthweight; and economic, socio-cultural and confounding factors that may explain the variation between results from different settings.

The Edinburgh Postnatal Depression Scale (EPDS): translation and validation study of the Iranian version

BACKGROUND

The Edinburgh Postnatal Depression Scale (EPDS) is a widely used instrument to measure postnatal depression. This study aimed to translate and to test the reliability and validity of the EPDS in Iran.

METHODS

The English language version of the EPDS was translated into Persian (Iranian language) and was used in this study. The questionnaire was administered to a consecutive sample of 100 women with normal (n = 50) and caesarean section (n = 50) deliveries at two points in time: 6 to 8 weeks and 12 to 14 weeks after delivery. Statistical analysis was performed to test the reliability and validity of the EPDS.

RESULTS

Overall 22% of women at time 1 and 18% at time 2 reported experiencing postpartum depression. In general, the Iranian version of the EPDS was found to be acceptable to almost all women. Cronbach's alpha coefficient (to test reliability) was found to be 0.77 at time 1 and 0.86 at time 2. In addition, test-rest reliability was performed and the intraclass correlation coefficient was found to be 0.80. Validity as performed using known groups comparison showed satisfactory results. The questionnaire discriminated well between sub-groups of women differing in mode of delivery in the expected direction. The factor analysis indicated a three-factor structure that jointly accounted for 58% of the variance.

CONCLUSION

This preliminary validation study of the Iranian version of the EPDS proved that it is an acceptable, reliable and valid measure of postnatal depression. It seems that the EPDS not only measures postpartum depression but also may be measuring something more.

Use of contemporary antidepressants during breastfeeding: a proposal for a specific safety index

Despite the well known severe repercussions of maternal depression on infants' well being, women are often reluctant to seek pharmacological treatment for postnatal depression. The fear of adverse events for the suckling infant plays an important role in such maternal considerations. However, the pharmacological approach to mood disorders at postpartum onset often represents one of the most realistic options in a number of clinical conditions. Therefore, the necessity exists to establish the safety of antidepressant treatment in the breastfed infant. For this reason, the aim of this article is to propose a specific safety index that assesses the frequency and degree of severity of adverse events in infants associated with maternal treatment with second-generation antidepressants during puerperium. The index is derived from a simple formula that uses the number of reports of adverse events in infants exposed to antidepressants as the numerator and the combined total of reports of healthy outcomes and reports of adverse events as the denominator. The sum is then multiplied by 100. A value of < or =2 indicates that the drug should be relatively safe for use during breastfeeding, a value of 2.1-10 indicates that the drug should be used with great caution and a value >10 indicates that the drug should be contraindicated in breastfeeding mothers. In addition to the figure created by this calculation, each drug will also be assigned a letter or the combination of a letter and a subscripted number to symbolise, respectively, the type and clinical management of the most serious recorded event. At this early developmental stage of the index, a complete classification of contemporary antidepressants regarding their safety in infants nursed to the breast is unfeasible. Indeed, because of the lack of suitable published data, so far the index has been limited to the evaluation of four antidepressants. In accordance with the index classification for these four antidepressants, sertraline and paroxetine should be considered as first-line medications in women who need to start antidepressant treatment during the postpartum period and wish to continue breastfeeding. The utilisation of fluoxetine and citalopram seems conversely to be associated with a relatively higher risk of adverse events (with a low degree of severity, however). For the other newer antidepressant drugs, the index is still of no assistance to the patient or physician in deciding on the safety of their use in lactation.