Unintended pregnancy and postpartum depression among first-time mothers

Sociodemographic and clinical features of postpartum depression among Turkish women: a prospective study

BACKGROUND

Postpartum depression (PPD) is moderate to severe depression in a woman after she has given birth. Findings from several well-designed studies reflect great variability in rates, from 10 to 22%, and also in risk factors for PPD. This variability may reflect geographical location. The incidence and risk factors for PPD among Turkish women are not well documented. It is, however, important to understand the risk factors to develop preventive intervention strategies. This study aims to examine the prevalence of PPD and associated risk factors among a sample of women receiving services at a tertiary obstetrics hospital in Ankara, Turkey.

METHODS

A sample of 671 women, between 36 and 40 gestational weeks, were enrolled and screened for depressive symptomatology using the Hospital Depression Inventory. Sociodemographic and clinical data were also collected. At a subsequent postpartum evaluation, 6-8 weeks post-delivery, 540 of the 671 were screened using the Edinburgh Postnatal Depression Scale (EPDS) for PPD.

RESULTS

Eighty-three (15.4%) of the 540 women had scores above the cutoff point (>13) on the EPDS. Statistically significant correlations were found between antenatal, prenatal and postpartum depression scores (r = 0.24). Women reporting suicidal thoughts during pregnancy (OR: 6.99), history of past PPD (OR: 6.64), physical violence during pregnancy (OR: 6.20) or during the postpartum period (OR: 5.87), previous psychiatric history (OR: 4.16), depressive symptoms during pregnancy (OR: 1.70), subjectively lower level of satisfaction with the pregnancy (OR:0. 69), a history of premenstrual syndrome (PMS) (OR: 2.05), and unplanned pregnancy (OR: 1.69) had higher odds for developing PPD.

CONCLUSION

One in six mothers screened as positive for PPD. Women who had previously been diagnosed with PPD, reported suicidal thoughts during pregnancy, or had been exposed to physical violence were at especially high risk for postpartum depression. To prevent and treat postpartum depression, special attention should be paid to women reporting these characteristics.

Magnitude and risk factors for postpartum symptoms: a literature review

BACKGROUND

The prevalence of postpartum depression worldwide varies from 0.5% to 60.8% in the first 12 months postpartum using self-reported questionnaire. This review aims to update the current magnitude of postpartum depression based on self-reported questionnaire and clinical interview and explore its associated factors in developed and developing countries.

METHODS

A literature search conducted between 2005 and 2014 identified 203 studies, of which 191 used self-reported questionnaire in 42 countries and 21 used structured clinical interview in 15 countries. Nine studies used a combination of self-reported questionnaire and clinical interview.

RESULT

The prevalence of postpartum depression varies from 1.9% to 82.1% in developing countries and from 5.2% to 74.0% in developed countries using self-reported questionnaire. Structured clinical interview shows a much lower prevalence range from 0.1% in Finland to 26.3% in India. Antenatal depression and anxiety, previous psychiatric illness, poor marital relationship, stressful life events, negative attitude towards pregnancy, and lack of social support are significant contributors to postpartum depression.

LIMITATION

All studies are included irrespective of the methodological quality, such as small sample size and their inclusion could affect the generalizability of the results.

CONCLUSION

The current prevalence of postpartum depression is much higher than that previously reported, and similar risk factors are documented. A culturally sensitive cut-off score with adequate psychometric properties of the screening instruments should be available. In future studies, examining the physical, biological, and cultural factors in qualitative studies and in those with adequate methodological qualities is recommended.

Psychological Aspects of Contraception, Unintended Pregnancy, and Abortion

The knowledge of important biopsychosocial factors linking women's reproductive health and mental health is increasing. This review focuses on psychological aspects of contraception, unintended pregnancy, and abortion because these are common reproductive health experiences in U.S. women's lives. This review addresses the mental-health antecedents and consequences of these experiences, mostly focusing on depression and depressive symptoms before and after unintended pregnancy and contraception. As mental-health antecedents, depressive symptoms predict contraceptive behaviors that lead to unintended pregnancy, and mental-health disorders have been associated with having subsequent abortions. In examining the mental-health consequences, most sound research does not find abortion or contraceptive use to cause mental-health problems. Consequently, evidence does not support policies based on the notion that abortion harms women's mental health. Nevertheless, the abortion-care setting may be a place to integrate mental-health services. In contrast, women who have births resulting from unintended pregnancies may be at higher risk of postpartum depression. Social policies (e.g., paid maternity leave, subsidized child care) may protect women from mental-health problems and stress of unplanned children interrupting employment, education, and pre-existing family care responsibilities.