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Ogbo FA, Eastwood J, Hendry A, Jalaludin B, Agho KE, Barnett B, Page A. Determinants of antenatal depression and postnatal depression in Australia. BMC Psychiatry 2018; 18:49. [PMID: 29463221 PMCID: PMC5819705 DOI: 10.1186/s12888-018-1598-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/08/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Depression is a leading source of morbidity and health loss in Australian women. This study investigates the determinants of antenatal depressive symptoms and postnatal depressive symptoms in an Australian population, including people from culturally and linguistically diverse (CALD) backgrounds. METHOD The study used a retrospective cohort of mothers of all live births in public health facilities in 2014 (N = 17,564) within South Western Sydney Local Health District and Sydney Local Health District in New South Wales, Australia. Prevalence of antenatal and postnatal depressive symptoms were estimated for the cohort. Multivariate logistic regression models were conducted to investigate the sociodemographic, psychological and health service determinants of antenatal and postnatal depressive symptoms, measured using the Edinburgh Postnatal Depression Scale (EPDS). RESULTS The prevalence of antenatal and postnatal depressive symptoms was 6.2% and 3.3% of the cohort, respectively. Significant risk factors for maternal depressive symptoms during pregnancy were, a lack of partner support, history of intimate partner violence, being from the CALD population and low socioeconomic status. Self-reported antenatal depressive symptoms were strongly associated with postnatal depressive symptoms. Risk factors for postnatal depressive symptoms were similar to those for antenatal depressive symptoms, as well as assisted delivery. CONCLUSION Factors relating to demographic and psychosocial disadvantage were associated with subsequent antenatal and postnatal depressive symptoms in New South Wales, Australia. Our study suggests that screening for probable depression and timely referral for expert assessment of at-risk mothers may be an effective strategy to improve maternal mental health outcomes.
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Affiliation(s)
- Felix Akpojene Ogbo
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
- Ingham Institute for Applied Medical Research, University of New South Wales, 1 Campbell Street, Liverpool, NSW 2170 Australia
| | - John Eastwood
- Ingham Institute for Applied Medical Research, University of New South Wales, 1 Campbell Street, Liverpool, NSW 2170 Australia
- School of Women’s and Children’s Health, University of New South Wales, Kensington, Sydney, NSW 2052 Australia
- Menzies Centre for Health Policy, Charles Perkins Centre, School of Public Health, Sydney University, Sydney, NSW 2006 Australia
- School of Public Health, Griffith University, Gold Coast, QLD 4222 Australia
- Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Rd, Croydon, NSW 2132 Australia
| | - Alexandra Hendry
- Ingham Institute for Applied Medical Research, University of New South Wales, 1 Campbell Street, Liverpool, NSW 2170 Australia
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, University of New South Wales, 1 Campbell Street, Liverpool, NSW 2170 Australia
- Healthy People and Places Unit, South Western Sydney Local Health District, Liverpool, NSW Australia
| | - Kingsley E. Agho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | | | - Andrew Page
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
- Ingham Institute for Applied Medical Research, University of New South Wales, 1 Campbell Street, Liverpool, NSW 2170 Australia
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Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I. Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries. Front Psychiatry 2018; 8:248. [PMID: 29449816 PMCID: PMC5799244 DOI: 10.3389/fpsyt.2017.00248] [Citation(s) in RCA: 300] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/07/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) poses a major global public health challenge. PPD is the most common complication associated with childbirth and exerts harmful effects on children. Although hundreds of PPD studies have been published, we lack accurate global or national PPD prevalence estimates and have no clear account of why PPD appears to vary so dramatically between nations. Accordingly, we conducted a meta-analysis to estimate the global and national prevalence of PPD and a meta-regression to identify economic, health, social, or policy factors associated with national PPD prevalence. METHODS We conducted a systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To test for country level predictors, we drew on data from UNICEF, WHO, and the World Bank. Random effects meta-regression was used to test national predictors of PPD prevalence. FINDINGS 291 studies of 296284 women from 56 countries were identified. The global pooled prevalence of PPD was 17.7% (95% confidence interval: 16.6-18.8%), with significant heterogeneity across nations (Q = 16,823, p = 0.000, I2 = 98%), ranging from 3% (2-5%) in Singapore to 38% (35-41%) in Chile. Nations with significantly higher rates of income inequality (R2 = 41%), maternal mortality (R2 = 19%), infant mortality (R2 = 16%), or women of childbearing age working ≥40 h a week (R2 = 31%) have higher rates of PPD. Together, these factors explain 73% of the national variation in PPD prevalence. INTERPRETATION The global prevalence of PPD is greater than previously thought and varies dramatically by nation. Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.
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Affiliation(s)
- Jennifer Hahn-Holbrook
- Department of Psychology, University of California, Merced, Merced, CA, United States
- Center for Excellence in Biopsychosocial Approaches to Health, Chapman University, Orange, CA, United States
| | | | - Itzel Anaya
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
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Vivekanandarajah S, Wen LM, Baur L. Demographic Predictors of Family Functioning and Its Change Over the First 5 Years Postpartum: Findings From the Healthy Beginnings Trial. FAMILY & COMMUNITY HEALTH 2018; 41:2-9. [PMID: 29135789 DOI: 10.1097/fch.0000000000000175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There are very few longitudinal studies examining family functioning in early childhood. This was a prospective cohort study to identify maternal sociodemographic factors associated with family functioning over the first 5 years postpartum, using data from the Healthy Beginnings Trial. Family functioning was measured using the General Functioning Subscale of the McMaster Family Assessment Device. A total of 667 first-time mothers participated, of which 369 remained at 5 years. Family functioning did not change significantly over the 5 years. Mothers being Australian born, being employed, and having a partner were predictors for healthy family functioning. Targeting support for immigrants, low-income and single-mother families may therefore improve family functioning.
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Affiliation(s)
- Sinthu Vivekanandarajah
- The Children's Hospital at Westmead, Sydney, Australia (Dr Vivekanandarajah and Dr Baur); Health Promotion Service, Sydney Local Health District, Camperdown, Australia (Dr Wen); School of Public Health (Drs Wen and Baur) and Discipline of Paediatrics and Child Health (Dr Baur), Health Promotion Unit, Sydney Local Health District; Sydney Medical School, University of Sydney, Australia; and School of Public Health, Fudan University, and Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China (Dr Wen)
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Petri E, Palagini L, Bacci O, Borri C, Teristi V, Corezzi C, Faraoni S, Antonelli P, Cargioli C, Banti S, Perugi G, Mauri M. Maternal–foetal attachment independently predicts the quality of maternal–infant bonding and post-partum psychopathology. J Matern Fetal Neonatal Med 2017; 31:3153-3159. [DOI: 10.1080/14767058.2017.1365130] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Eleonora Petri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Laura Palagini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Olivia Bacci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Borri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valentina Teristi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Camilla Corezzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Faraoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudio Cargioli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Susanna Banti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mauro Mauri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Özcan NK, Boyacıoğlu NE, Dinç H. Postpartum Depression Prevalence and Risk Factors in Turkey: A Systematic Review and Meta-Analysis. Arch Psychiatr Nurs 2017; 31:420-428. [PMID: 28693880 DOI: 10.1016/j.apnu.2017.04.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 04/09/2017] [Indexed: 11/15/2022]
Abstract
Postpartum depression (PPD) is a common problem with adverse consequences for the mother and the infant. This study was performed to determine the prevalence of and risk factors for PPD in Turkey. In this study, 52 primary studies that were published between January 1999 and January 2015 were examined. The prevalence of PPD was determined through a meta-analysis, and the risk factors were determined through a systematic review. The prevalence of PPD in Turkey was found to be 23.8%. Developed cities had a prevalence of 21.2%, and developing cities had a prevalence of 25%. Just as throughout the world, PPD is a common problem in Turkey. It is more prevalent in developing cities. The following factors were the strongest predictors of postpartum depression: economic status and the employment status of the spouse, planned pregnancy and having a stressor/illness during pregnancy, health problems in the newborn, previous psychiatric illness, problems with family and spouse, reduced social support, and a history of psychiatric illness in the family.
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Affiliation(s)
- Neslihan Keser Özcan
- Istanbul University, Faculty of Health Sciences, Department of Midwifery, Turkey.
| | - Nur Elçin Boyacıoğlu
- Istanbul University, Faculty of Health Sciences, Department of Midwifery, Turkey.
| | - Hüsniye Dinç
- Istanbul University, Faculty of Health Sciences, Department of Midwifery, Turkey.
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Letourneau NL, Kozyrskyj AL, Cosic N, Ntanda HN, Anis L, Hart MJ, Campbell TS, Giesbrecht GF. Maternal sensitivity and social support protect against childhood atopic dermatitis. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2017; 13:26. [PMID: 28559916 PMCID: PMC5446757 DOI: 10.1186/s13223-017-0199-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/17/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Many studies have identified associations between qualities of maternal-child relationships and childhood asthma, but few have examined associations with childhood atopic dermatitis (AD), a common precursor to asthma. Moreover, maternal psychological distress, including prenatal and postnatal depression, anxiety and stress, may increase risk, while social support from partners may reduce risk for childhood AD. We sought to uncover the association between maternal-infant relationship qualities (maternal sensitivity towards infant behavioral signals, controlling behavior, and unresponsiveness) and child AD after accounting for risk (i.e., prenatal and postnatal maternal depression, anxiety and stress) and protective (i.e., social support) factors. METHODS We conducted a secondary analysis of data collected on a subsample of 242 women and their infants enrolled during pregnancy in the ongoing Alberta Pregnancy Outcomes and Nutrition cohort study. Inclusion criteria required mothers to be >16 years of age, English speaking and <22 weeks gestational age at enrollment. Data on depression, anxiety and stress in the prenatal and postnatal periods and physician diagnosis of childhood AD at 18 months were gathered via maternal report. Maternal sensitivity, unresponsiveness and controlling behaviours were assessed via videotaped observations using the Child-Adult Relationship Experimental (CARE)-Index at 6 months of infant age. RESULTS Higher maternal sensitivity, or the inability of the mother to appropriately understand and respond to infant needs based on behavioral signals, predicted reduced odds of AD independent of and in combination with low prenatal and postnatal anxiety and high paternal support. After adjustment, higher maternal controlling behaviours and unresponsiveness also predicted greater odds of AD. CONCLUSIONS Low maternal sensitivity is a risk factor for childhood AD, independently and in combination with perinatal anxiety and low social support. Thus, interventions that improve maternal-infant relationship quality, especially sensitivity, reduce anxiety and improve social support from partners could reduce odds of childhood AD.
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Affiliation(s)
- Nicole L. Letourneau
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - Anita L. Kozyrskyj
- Departments of Pediatrics, Obstetrics & Gynecology, Faculty of Medicine and Dentistry, and School of Public Health, University of Alberta, Edmonton, AB T6G 2R3 Canada
| | - Nela Cosic
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - Henry N. Ntanda
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - Lubna Anis
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - Martha J. Hart
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - Tavis S. Campbell
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4 Canada
| | - Gerald F. Giesbrecht
- Cumming School of Medicine, Department of Pediatrics & Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - The APrON Team
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Departments of Pediatrics, Obstetrics & Gynecology, Faculty of Medicine and Dentistry, and School of Public Health, University of Alberta, Edmonton, AB T6G 2R3 Canada
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Department of Pediatrics & Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
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Sidor A, Fischer C, Cierpka M. The link between infant regulatory problems, temperament traits, maternal depressive symptoms and children's psychopathological symptoms at age three: a longitudinal study in a German at-risk sample. Child Adolesc Psychiatry Ment Health 2017; 11:10. [PMID: 28286548 PMCID: PMC5340036 DOI: 10.1186/s13034-017-0148-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 02/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Difficult conditions during childhood can limit an individual's development in many ways. Factors such as being raised in an at-risk family, child temperamental traits or maternal traits can potentially influence a child's later behaviour. The present study investigated the extent of regulatory problems in 6-month-old infants and their link to temperamental traits and impact on externalizing and internalizing problems at 36 months. Moderating effects of maternal distress and maternal depressive symptoms were tested as well. METHODS In a quasi-experimental, longitudinal study, a sample of 185 mother-infant dyads at psychosocial risk was investigated at 6 months with SFS (infants' regulatory problems) and at 3 years with CBCL (children's behavioural problems), EAS (children's temperament), ADS (maternal depressive symptoms) and PSI-SF (maternal stress). RESULTS A hierarchical regression analysis yielded a significant association between infants' regulatory problems and both externalizing and internalizing behaviour problems at age 3 (accounting for 16% and 14% variance), with both externalizing and internalizing problems being linked to current maternal depressive symptoms (12 and 9% of the variance). Externalizing and internalizing problems were found to be related also to children's temperamental difficulty (18 and 13% of variance) and their negative emotionality. With temperamental traits having been taken into account, only feeding problems at 6 months contributed near-significant to internalizing problems at 3 years. CONCLUSIONS Our results underscore the crucial role of temperament in the path between early regulatory problems and subsequent behavioural difficulties. Children's unfavourable temperamental predispositions such as negative emotionality and generally "difficult temperament" contributed substantially to both externalizing and internalizing behavioural problems in the high-risk sample. The decreased predictive power of regulatory problems following the inclusion of temperamental variables indicates a mediation effect of temperamental traits in the path between early regulatory problems and subsequent behavioural problems. Our results support the main effects of a child's temperament, and to some degree maternal depressive symptoms, rather than the diathesis stress model of interaction between risky environment and temperamental traits. Trial registration D10025651 (NZFH).
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Affiliation(s)
- Anna Sidor
- Institute for Psychosocial Prevention, University Clinic Heidelberg, Bergheimerstr. 54, 69115 Heidelberg, Germany
| | - Cristina Fischer
- Institute for Psychosocial Prevention, University Clinic Heidelberg, Bergheimerstr. 54, 69115 Heidelberg, Germany
| | - Manfred Cierpka
- Institute for Psychosocial Prevention, University Clinic Heidelberg, Bergheimerstr. 54, 69115 Heidelberg, Germany
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Sylvén S, Thomopoulos T, Kollia N, Jonsson M, Skalkidou A. Correlates of Postpartum Depression in First Time Mothers Without Previous Psychiatric Contact. Eur Psychiatry 2016; 40:4-12. [DOI: 10.1016/j.eurpsy.2016.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/08/2016] [Accepted: 07/10/2016] [Indexed: 10/20/2022] Open
Abstract
AbstractBackgroundPostpartum depression (PPD) is a common disorder after childbirth. The strongest known predictors are a history of depression and/or a history of PPD. However, for a significant proportion of women, PPD constitutes their first depressive episode. This study aimed to gain further insight into the risk factors for PPD in first time mothers without previous psychiatric contact.MethodsWomen delivering in Uppsala University Hospital, Sweden, from May 2006 to June 2007, were asked to participate and filled out questionnaires five days and six weeks postpartum, containing inter alia the Edinburgh Postnatal Depression Scale (EPDS). Univariate logistic regression models, as well as a path analysis, were performed to unveil the complex interplay between the study variables.ResultsOf the 653 participating primiparas, 10.3% and 6.4% reported depressive symptoms (EPDS ≥ 12 points) five days and six weeks postpartum, respectively. In the path analysis, a positive association between anxiety proneness and depressive symptoms at five days and six weeks postpartum was identified. For depressive symptoms six weeks after delivery, additional risk factors were detected, namely depressive symptoms five days postpartum and subjective experience of problems with the baby. Caesarean section and assisted vaginal delivery were associated with fewer depressive symptoms at 6 six weeks postpartum.ConclusionsIdentification of anxiety proneness, delivery mode and problems with the baby as risk factors for self-reported depressive symptoms postpartum in this group of primiparas can be important in helping health care professionals identify women at increased risk of affective disorders in the perinatal period, and provide a base for early intervention.
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Schmied V, Langdon R, Matthey S, Kemp L, Austin MP, Johnson M. Antenatal psychosocial risk status and Australian women's use of primary care and specialist mental health services in the year after birth: a prospective study. BMC Womens Health 2016; 16:69. [PMID: 27782825 PMCID: PMC5078921 DOI: 10.1186/s12905-016-0344-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 09/16/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Poor mental health in the perinatal period can impact negatively on women, their infants and families. Australian State and Territory governments are investing in routine psychosocial assessment and depression screening with referral to services and support, however, little is known about how well these services are used. The aim of this paper is to report on the health services used by women for their physical and mental health needs from pregnancy to 12 months after birth and to compare service use for women who have been identified in pregnancy as having moderate-high psychosocial risk with those with low psychosocial risk. METHODS One hundred and six women were recruited to a prospective longitudinal study with five points of data collection (2-4 weeks after prenatal booking, 36 weeks gestation, 6 weeks postpartum, 6 months postpartum and 12 months postpartum) was undertaken. Data were collected via face-to-face and telephone interviews, relating to psychosocial risk factors, mental health and service use. The prenatal psychosocial risk status of women (data available for 83 of 106 women) was determined using the Antenatal Risk Questionnaire (ANRQ) and was used to compare socio-demographic characteristics and service use of women with 'low' and 'moderate to high' risk of perinatal mental health problems. RESULTS The findings indicate high use of postnatal universal health services (child and family health nurses, general practitioners) by both groups of women, with limited use of specialist mental health services by women identified with moderate to high risk of mental health problems. While almost all respondents indicated that they would seek help for mental health concerns most had a preference to seek help from partners and family before accessing health professionals. CONCLUSION These preliminary data support local and international studies that highlight the poor uptake of specialist services for mental health problems in postnatal women, where this may be required. Further research comparing larger samples of women (with low and psychosocial high risk) are needed to explore the extent of any differences and the reasons why women do not access these specialist services.
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Affiliation(s)
- Virginia Schmied
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, 2751, NSW, Australia.
| | - Rachel Langdon
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, 2751, NSW, Australia
- Centre for Applied Nursing Research (a joint facility of the South Western Sydney Local Health District and Western Sydney University, Liverpool, Australia
- The Ingham Institute for Applied Medical Research, Liverpool, Sydney, NSW, Australia
| | - Stephen Matthey
- School of Psychology, University of Sydney and Research Director, Infant, Child & Adolescent Mental Health Service, South West Sydney Local Health District, Sydney, Australia
| | - Lynn Kemp
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, 2751, NSW, Australia
| | - Marie-Paule Austin
- Chair, Perinatal Mental Health Unit University of New South Wales & St John of God Health Care, Burwood , Sydney, Australia
- The Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia
- The Ingham Institute for Applied Medical Research, Liverpool, Sydney, NSW, Australia
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Eastwood JG, Kemp LA, Jalaludin BB. Realist theory construction for a mixed method multilevel study of neighbourhood context and postnatal depression. SPRINGERPLUS 2016; 5:1081. [PMID: 27468381 PMCID: PMC4945545 DOI: 10.1186/s40064-016-2729-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 06/30/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND We have recently described a protocol for a study that aims to build a theory of neighbourhood context and postnatal depression. That protocol proposed a critical realist Explanatory Theory Building Method comprising of an: (1) emergent phase, (2) construction phase, and (3) confirmatory phase. A concurrent triangulated mixed method multilevel cross-sectional study design was described. The protocol also described in detail the Theory Construction Phase which will be presented here. METHODS The Theory Construction Phase will include: (1) defining stratified levels; (2) analytic resolution; (3) abductive reasoning; (4) comparative analysis (triangulation); (5) retroduction; (6) postulate and proposition development; (7) comparison and assessment of theories; and (8) conceptual frameworks and model development. THEORY CONSTRUCTION The stratified levels of analysis in this study were predominantly social and psychological. The abductive analysis used the theoretical frames of: Stress Process; Social Isolation; Social Exclusion; Social Services; Social Capital, Acculturation Theory and Global-economic level mechanisms. Realist propositions are presented for each analysis of triangulated data. Inference to best explanation is used to assess and compare theories. A conceptual framework of maternal depression, stress and context is presented that includes examples of mechanisms at psychological, social, cultural and global-economic levels. Stress was identified as a necessary mechanism that has the tendency to cause several outcomes including depression, anxiety, and health harming behaviours. The conceptual framework subsequently included conditional mechanisms identified through the retroduction including the stressors of isolation and expectations and buffers of social support and trust. CONCLUSION The meta-theory of critical realism is used here to generate and construct social epidemiological theory using stratified ontology and both abductive and retroductive analysis. The findings will be applied to the development of a middle range theory and subsequent programme theory for local perinatal child and family interventions.
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Affiliation(s)
- John G. Eastwood
- />Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Road, Croydon, NSW 2132 Australia
- />School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
- />School of Women’s and Children’s Health, The University of New South Wales, Sydney, NSW 2052 Australia
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
- />School of Public Health, The University of Sydney, Sydney, NSW 2006 Australia
- />School of Medicine, Griffith University, Gold Coast, QLD 4222 Australia
| | - Lynn A. Kemp
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
- />School of Nursing and Midwifery, Western Sydney University, Campbelltown, NSW 2560 Australia
| | - Bin B. Jalaludin
- />School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
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Norhayati MN, Nik Hazlina NH, Aniza AA, Asrenee AR. Severe Maternal Morbidity and Postpartum Depressive Symptomatology: A Prospective Double Cohort Comparison Study. Res Nurs Health 2016; 39:415-425. [DOI: 10.1002/nur.21741] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Mohd Noor Norhayati
- Associate Professor; Department of Family Medicine; School of Medical Sciences; Universiti Sains Malaysia; 16150 Kota Bharu Kelantan Malaysia
| | - Nik Hussain Nik Hazlina
- Women's Health Development Unit; School of Medical Sciences; Universiti Sains Malaysia; Kota Bharu Kelantan Malaysia
| | - Abd Aziz Aniza
- Faculty of Medicine; Universiti Sultan Zainal Abidin; Kuala Terengganu Terengganu Malaysia
| | - Ab Razak Asrenee
- Department of Psychiatry; School of Medical Sciences; Universiti Sains Malaysia; Kota Bharu Kelantan Malaysia
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Eastwood JG, Kemp LA, Jalaludin BB. Being alone and expectations lost: a critical realist study of maternal depression in South Western Sydney. SPRINGERPLUS 2015; 4:700. [PMID: 26609502 PMCID: PMC4646882 DOI: 10.1186/s40064-015-1492-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 10/30/2015] [Indexed: 11/29/2022]
Abstract
The study reported here is part of a critical realist multilevel study. It seeks to identify and explain complex perinatal contextual social and psychosocial mechanisms that may influence the developmental origins of health and disease, with a focus on the role of postnatal depression. The aims of the greater study are to: (1) describe the phenomenon of postnatal depression in South Western Sydney; and (2) identify mechanisms that would add to our understanding of the psycho-social causes of maternal depression. This paper will move beyond our previous quantitative descriptions of individual-level predictors of depressive symptoms by seeking the views of local mothers and practitioners, to explain the mechanisms that might be involved. The study was set in South Western Sydney, New South Wales, Australia. An Explanatory Theory Building Method was used. The previously reported quantitative study was a non-linear principal component analysis and logistic regression study of 15,389 months delivering in 2002 and 2003. This intensive qualitative study used open coding of interviews, of seven practitioners and three naturally occurring mothers groups, to enable maximum emergence. The theoretical concepts identified were: attachment and nurturing, infant temperament, unplanned pregnancy and sole parenthood, support for mothers, access to services, stress, financial hardship, isolation and marginalisation, mothers' "loss of control" and "power", and expectations and dreams. Being alone and expectations lost emerged as possible triggers of stress and depression for mothers. These findings might also apply to others who have their dreams shattered during life's transitions. In these situations social and cultural context can either nurture and support or marginalise and isolate. The challenge for policy and practice is to support mothers and their partners during the transition to parenthood within a challenging social and material context.
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Affiliation(s)
- John G. Eastwood
- />Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Road, Croydon, NSW 2132 Australia
- />School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
- />School of Women’s and Children’s Health, The University of New South Wales, Sydney, NSW 2052 Australia
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
- />School of Public Health, The University of Sydney, Sydney, NSW 2006 Australia
- />School of Medicine, Griffith University, Gold Coast, QLD 4222 Australia
| | - Lynn A. Kemp
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
- />School of Nursing and Midwifery, Western Sydney University, Campbelltown, NSW 2560 Australia
| | - Bin B. Jalaludin
- />School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
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63
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Falah-Hassani K, Shiri R, Vigod S, Dennis CL. Prevalence of postpartum depression among immigrant women: A systematic review and meta-analysis. J Psychiatr Res 2015; 70:67-82. [PMID: 26424425 DOI: 10.1016/j.jpsychires.2015.08.010] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/03/2015] [Accepted: 08/07/2015] [Indexed: 12/20/2022]
Abstract
The aims of this systematic review and meta-analysis were threefold: to estimate the prevalence of postpartum depressive symptoms in immigrant women, compare this prevalence to non-immigrant women, and determine risk factors for postpartum depressive symptoms in immigrant women. Literature searches were conducted in PubMed, Embase, PsycINFO, Web of Science, Scopus, ResearchGate and Google Scholar databases from 1950 until October 2014. Twenty-four studies met the inclusion criteria of which 22 (12 cross-sectional and 10 prospective cohort) contributed data for meta-analyses. Heterogeneity and publication bias were assessed. The prevalence of postpartum depressive symptoms in immigrant women was 20% (95% confidence interval [CI] 17-23%, 18 studies, N = 13,749 women). Immigrant women were twice more likely to experience depressive symptoms in the postpartum period than non-immigrant women (pooled unadjusted odds ratio [OR] = 2.10 [95% CI 1.62-2.73, 15 studies, N = 50,519 women] and adjusted OR = 2.18 [95% CI 1.60-2.96, 7 studies, N = 35,557 women]). There was, however, evidence of publication bias with the pooled adjusted OR reduced to 1.63 (95% CI 1.22-2.17) after adjustment for bias. Risk factors associated with postpartum depressive symptoms among immigrant women included shorter length of residence in the destination country, lower levels of social support, poorer marital adjustment, and perceived insufficient household income. This study suggests that postpartum depression is a common condition among immigrant women. Moreover, immigrant women are at higher risk of postpartum depression than non-immigrant women. Further prospective studies on the risk factors of postpartum depression among immigrant women verified by a clinical diagnosis are needed.
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Affiliation(s)
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Simone Vigod
- Women's College Hospital and Research Institute, Toronto, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada
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64
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Lee LC, Hung CH. Predictors of post-partum stress in Vietnamese immigrant women in Taiwan. Jpn J Nurs Sci 2015; 13:38-45. [DOI: 10.1111/jjns.12084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 03/31/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Li-Chun Lee
- School of Nursing; Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Nursing; I-Shou University; Kaohsiung Taiwan
| | - Chich-Hsiu Hung
- School of Nursing; Kaohsiung Medical University; Kaohsiung Taiwan
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65
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Norhayati MN, Hazlina NHN, Asrenee AR, Emilin WMAW. Magnitude and risk factors for postpartum symptoms: a literature review. J Affect Disord 2015; 175:34-52. [PMID: 25590764 DOI: 10.1016/j.jad.2014.12.041] [Citation(s) in RCA: 457] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- M N Norhayati
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia.
| | - N H Nik Hazlina
- Women Health Development Unit, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - A R Asrenee
- Department of Psychiatry, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - W M A Wan Emilin
- Perpustakaan Hamdan Tahir, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
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66
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Letourneau N, Secco L, Colpitts J, Aldous S, Stewart M, Dennis CL. Quasi-experimental evaluation of a telephone-based peer support intervention for maternal depression. J Adv Nurs 2015; 71:1587-99. [PMID: 25705786 DOI: 10.1111/jan.12622] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2014] [Indexed: 12/16/2022]
Abstract
AIMS To evaluate the effect of telephone-based peer support on maternal depression and social support BACKGROUND Postpartum depression is a global health concern and lack of treatment options mean many mothers are depressed beyond the first year after birth. Strong evidence has shown telephone-based peer support, provided by a mother recovered from depression, effectively improves depression outcomes. This model has not been tested with mothers with depression any time up to two years postpartum. DESIGN Quasi-experimental, one group pre-test, posttest. METHOD The study population was mothers in New Brunswick, Canada with depression up to 24 months after delivery. The sample (N = 64) was recruited between May 2011-October 2013. Peer volunteers recovered from postpartum depression were trained and delivered an average of 8·84 (Range 1-13) support telephone calls. Depression and social support outcomes were assessed at intervention mid-point (average 7·43 weeks, n = 37) and end (average 13·9 weeks, n = 34). RESULTS Mean depression significantly declined from baseline, 15·4 (N = 49), to mid-point, 8·30 and end of the study, 6·26. At mid-point 8·1% (n = 3/37) of mothers were depressed and at endpoint 11·8% (4/34) were depressed suggesting some relapse. Perceptions of social support significantly improved and higher support was significantly related with lower depression symptoms. CONCLUSION Findings offer promise that telephone-based peer support is effective for both early postpartum depression and maternal depression up to two years after delivery.
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Affiliation(s)
- Nicole Letourneau
- Faculties of Nursing & Medicine, University of Calgary, Alberta, Canada
| | - Loretta Secco
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Jennifer Colpitts
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Sarah Aldous
- Public Health Practice and Population Health, New Brunswick Department of Health, New Brunswick, Canada
| | - Miriam Stewart
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
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Eastwood JG, Jalaludin BB, Kemp LA, Phung HN. Realist identification of group-level latent variables for perinatal social epidemiology theory building. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2015; 44:407-33. [PMID: 25618983 DOI: 10.2190/hs.44.3.a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We have previously reported in this journal on an ecological study of perinatal depressive symptoms in South Western Sydney. In that article, we briefly reported on a factor analysis that was utilized to identify empirical indicators for analysis. In this article, we report on the mixed method approach that was used to identify those latent variables. Social epidemiology has been slow to embrace a latent variable approach to the study of social, political, economic, and cultural structures and mechanisms, partly for philosophical reasons. Critical realist ontology and epistemology have been advocated as an appropriate methodological approach to both theory building and theory testing in the health sciences. We describe here an emergent mixed method approach that uses qualitative methods to identify latent constructs followed by factor analysis using empirical indicators chosen to measure identified qualitative codes. Comparative analysis of the findings is reported together with a limited description of realist approaches to abstract reasoning.
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68
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Luoma I, Korhonen M, Salmelin RK, Helminen M, Tamminen T. Long-term trajectories of maternal depressive symptoms and their antenatal predictors. J Affect Disord 2015; 170:30-8. [PMID: 25218734 DOI: 10.1016/j.jad.2014.08.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 08/04/2014] [Accepted: 08/11/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Depressive symptoms, often long-term or recurrent, are common among mothers of young children and a well-known risk for child well-being. We aimed to explore the antecedents of the long-term trajectories of maternal depressive symptoms and to define the antenatal factors predicting the high-symptom trajectories. METHODS The sample comprised 329 mothers from maternity centers. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) antenatally and at two months, six months, 4-5 years, 8-9 years and 16-17 years after delivery. Maternal expectations concerning the baby were assessed with the Neonatal Perception Inventory (NPI). Background information was gathered with questionnaires. RESULTS A model including four symptom trajectories (very low, low-stable, high-stable and intermittent) was selected to describe the symptom patterns over time. The high-stable and the intermittent trajectory were both predicted pairwise by a high antenatal EPDS sum score as well as high EPDS anxiety and depression subscores but the other predictors were specific for each trajectory. In multivariate analyses, the high-stable trajectory was predicted by a high antenatal EPDS sum score, a high EPDS anxiety subscore, diminished life satisfaction, loneliness and more negative expectations of babies on average. The intermittent trajectory was predicted by a high antenatal EPDS sum score, a poor relationship with own mother and urgent desire to conceive. LIMITATIONS Only self-report questionnaires were used. The sample size was rather small. CONCLUSIONS The results suggest a heterogeneous course and background of maternal depressive symptoms. This should be considered in intervention planning.
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Affiliation(s)
- Ilona Luoma
- University of Tampere, School of Medicine, University of Tampere, FI-33014, Finland; Tampere University Hospital, Department of Child Psychiatry, PO Box 2000, FI-33521 Tampere, Finland.
| | - Marie Korhonen
- University of Tampere, School of Medicine, University of Tampere, FI-33014, Finland
| | - Raili K Salmelin
- Tampere University Hospital, Department of Child Psychiatry, PO Box 2000, FI-33521 Tampere, Finland; University of Tampere, School of Health Sciences, University of Tampere, FI-33014, Finland
| | - Mika Helminen
- University of Tampere, School of Health Sciences, University of Tampere, FI-33014, Finland; Pirkanmaa Hospital District, Science Center, PO Box 2000, FI-33521 Tampere, Finland
| | - Tuula Tamminen
- University of Tampere, School of Medicine, University of Tampere, FI-33014, Finland; Tampere University Hospital, Department of Child Psychiatry, PO Box 2000, FI-33521 Tampere, Finland
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69
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Heller HM, van Straten A, de Groot CJM, Honig A. The (cost) effectiveness of an online intervention for pregnant women with affective symptoms: protocol of a randomised controlled trial. BMC Pregnancy Childbirth 2014; 14:273. [PMID: 25123230 PMCID: PMC4141113 DOI: 10.1186/1471-2393-14-273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 08/07/2014] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Women in pregnancy and postpartum have an increased vulnerability to develop an affective disorder. Affective disorders in pregnancy are associated with an increased risk of prematurity, dysmaturity (foetal weight below the 10th percentile as determined by ultrasound) and the development of postpartum depressive disorder. Untreated affective disorders and their complications may also result in considerable costs. Recent meta-analyses showed that interventions during pregnancy are less effective than postpartum interventions probably because of high attrition due to the barriers pregnant women experience with attending sessions outside their homes. An internet-based self-help intervention may overcome these barriers as it can be followed at home, and also in one's own time. Such internet interventions showed to be effective for decreasing affective symptoms in general.This randomised clinical trial examines whether an internet-based self-help intervention is effective in the reduction of affective symptoms in pregnancy and postpartum and results in an improvement of the perinatal outcome. We will also determine the cost-effectiveness of the intervention. METHODS/DESIGN We will investigate the effectiveness of a 6 week internet-based self-help problem solving treatment (PST) for affective symptoms in pregnancy. We aim to include 286 women with mild to severe affective symptoms who will be randomly assigned to the internet-based intervention or a waiting list control group. Primary outcome measures are affective symptoms and the perinatal outcome. Secondary outcome measures are quality of life, and economic costs. All assessments are based on self-report and will take place at baseline (T0), 10 weeks later (after completion of the intervention (T1), 4 weeks before the expected day of birth (T2), and 6 weeks after delivery (T3). The control group will be measured at the same moments in time. Analysis will be based on the intention-to-treat principle. DISCUSSION If shown (cost) effective, internet-based PST will offer new possibilities to treat pregnant women for affective symptoms, to improve their perinatal outcome and to prevent the development of postpartum depressive disorders. TRIAL REGISTRATION Nederlands Trial Register: NTR4321.
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Affiliation(s)
- Hanna M Heller
- Department of Psychiatry, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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70
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Shrestha S, Adachi K, Petrini MA, Shrestha S. Factors associated with post-natal anxiety among primiparous mothers in Nepal. Int Nurs Rev 2014; 61:427-34. [PMID: 25039801 DOI: 10.1111/inr.12118] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Nepal, new mothers are fatigued by childcare responsibilities because of lack of knowledge and preparation for their new role. Knowledge deficit and adherence to traditional health practices place infants at risk. Some cultural practices for the care of newborns may cause tetanus, hypothermia or other life-threatening illnesses. Maternal education, previous experience of newborn care, economic status, relationship problems with husband or mothers-in-law and dissatisfaction with social relations are the variables of interest for this study. AIMS To examine the association between socio-demographic variables and post-natal anxiety among primiparous mothers in Nepal. DESIGN The study was designed as a correlational study. SETTING A major maternity hospital in Kathmandu, Nepal. PARTICIPANTS The sample were 216 primiparous mothers who were followed at 5-6 weeks after delivery. METHODS Three instruments were used for data collection: a demographics questionnaire, the Newborn Care Knowledge Questionnaire and the State-Trait Anxiety Inventory for Adults. RESULTS The mothers' knowledge of newborn care, general educational level and income were inversely related to maternal anxiety, that is, mothers with a lower educational level and socio-economic status demonstrated a higher level of post-natal anxiety. Poor relationships with husbands or mothers-in-law and low social support presented potential for the development of anxiety and depression during post-partum period. CONCLUSION Maternal education, socio-economic status and knowledge of newborn care were major factors of post-natal anxiety. On the other hand, women with low income and education, poor relationships with their husbands or mothers-in-law, and insufficient social support are vulnerable to the development of moderate to severe anxiety. HEALTH POLICY Policy implications from these results indicate the need for support and funding from the Ministry of Health for education for women at hospitals, which must work together to offer newborn care education during the ante-natal and post-natal periods.
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Affiliation(s)
- S Shrestha
- Division of Nursing Sciences, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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Gaillard A, Le Strat Y, Mandelbrot L, Keïta H, Dubertret C. Predictors of postpartum depression: prospective study of 264 women followed during pregnancy and postpartum. Psychiatry Res 2014; 215:341-6. [PMID: 24370337 DOI: 10.1016/j.psychres.2013.10.003] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 09/24/2013] [Accepted: 10/11/2013] [Indexed: 10/26/2022]
Abstract
The prevalence of postpartum depression is approximately 13%. Postpartum depression is associated with a higher maternal morbidity and mortality, and also with pervasive effects on the emotional, cognitive and behavioral development of the child. The aim of our study was to identify socio-demographic, psychosocial and obstetrical risk factors of postpartum depression in a middle class community sample, using a prospective design. We enrolled consecutively 312 pregnant outpatients in a single maternity unit. The first assessment was conducted between 32 and 41 weeks gestation, and a second time between 6 and 8 weeks after delivery. Depressive symptoms were measured using the French version of the Edinburgh Postnatal Depression Scale (EPDS). A cut-off score of 12/30 or above was considered as indicative of Major Depression. Of the initial sample of 312 women, 264 (84.6%) were followed-up between 6 and 8 weeks after delivery and considered for analysis. Depression during pregnancy, migrant status, and physical abuse by the partner were independently associated with postpartum depression when considered together, whereas physical complications were significantly associated with postpartum depression only when adjusting for antenatal depression. Depression during pregnancy, history of physical abuse, migrant status and postpartum physical complications are four major risk factors for postpartum depression.
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Affiliation(s)
- Adeline Gaillard
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Psychiatry Department, Colombes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France; Service Hospitalo-Universitaire, Centre Hospitalier Sainte Anne, Paris, France
| | - Yann Le Strat
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Psychiatry Department, Colombes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, Paris, France; INSERM U894, Centre Psychiatrie et Neurosciences, Paris, France
| | - Laurent Mandelbrot
- Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Gynecology and Obstetrics Departments, Colombes, France
| | - Hawa Keïta
- Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Anesthesiology Department, Colombes, France
| | - Caroline Dubertret
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Psychiatry Department, Colombes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, Paris, France; INSERM U894, Centre Psychiatrie et Neurosciences, Paris, France.
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72
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Eastwood JG, Jalaludin BB, Kemp LA, Phung HN. Bayesian hierarchical spatial regression of maternal depressive symptoms in South Western Sydney, Australia. SPRINGERPLUS 2014; 3:55. [PMID: 24555171 PMCID: PMC3921342 DOI: 10.1186/2193-1801-3-55] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 01/20/2014] [Indexed: 11/26/2022]
Abstract
Background There is increasing interest in the role played by maternal depression in mediating the effects of adversity during pregnancy and poor infant outcomes. There is also increasing evidence from multilevel regression studies for an association of area-level economic deprivation and poor individual mental health. The purpose of the study reported here is to explore the spatial distribution of postnatal depressive symptoms in South Western Sydney, Australia, and to identify covariate associations that could inform subsequent multilevel studies. Methods Mothers (n = 15,389) delivering in 2002 and 2003 were assessed at 2–3 weeks after delivery for risk factors for depressive symptoms. The individual-level binary outcome variables were Edinburgh Depression Scale (EDS) >9 and >12. The association between social, demographic and ecological factors and aggregated outcome variables were investigated using exploratory factor analysis and multivariate hierarchical Bayesian spatial regression. Relative risks from the final EDS >12 regression model were mapped to visualise the contribution from explanatory covariates and residual components. Results The exploratory factor analysis identified six factors: neighbourhood adversity, social cohesion, health behaviours, housing quality, social services, and support networks. Variables associated with neighbourhood adversity, social cohesion, social networks, and ethnic diversity were consistently associated with aggregated depressive symptoms. Measures of social disadvantage, lack of social cohesion and lack of social capital were associated with increased depressive symptoms. The association with social disadvantage was not significant when controlling for ethnic diversity and social capital. Conclusions The findings support the theoretical proposition that neighbourhood adversity causes maternal psychological distress and depression within the context of social buffers including social networks, social cohesion, and social services. The finding have implications for the distribution of health services including early nurse home visiting which has recently been confirmed to be effective in preventing postnatal depression. Electronic supplementary material The online version of this article (doi:10.1186/2193-1801-3-55) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John G Eastwood
- Community Paediatrics, South Western Sydney Local Health District, Locked Mail Bag 7008, Liverpool, BC 1871 New South Wales Australia ; School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia ; School of Women's and Children's Health, The University of New South Wales, Sydney, NSW 2052 Australia ; School of Public Health, University of Sydney, Sydney, NSW 2006 Australia ; School of Public Health, Griffith University, Gold Coast, Queensland, 4222 Australia
| | - Bin B Jalaludin
- Community Paediatrics, South Western Sydney Local Health District, Locked Mail Bag 7008, Liverpool, BC 1871 New South Wales Australia ; School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
| | - Lynn A Kemp
- Community Paediatrics, South Western Sydney Local Health District, Locked Mail Bag 7008, Liverpool, BC 1871 New South Wales Australia ; School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
| | - Hai N Phung
- Community Paediatrics, South Western Sydney Local Health District, Locked Mail Bag 7008, Liverpool, BC 1871 New South Wales Australia ; School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia ; School of Public Health, Griffith University, Gold Coast, Queensland, 4222 Australia
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Eastwood J, Kemp L, Jalaludin B. Explaining ecological clusters of maternal depression in South Western Sydney. BMC Pregnancy Childbirth 2014; 14:47. [PMID: 24460690 PMCID: PMC3909479 DOI: 10.1186/1471-2393-14-47] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/08/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The aim of the qualitative study reported here was to: 1) explain the observed clustering of postnatal depressive symptoms in South Western Sydney; and 2) identify group-level mechanisms that would add to our understanding of the social determinants of maternal depression. METHODS Critical realism provided the methodological underpinning for the study. The setting was four local government areas in South Western Sydney, Australia. Child and Family practitioners and mothers in naturally occurring mothers groups were interviewed. RESULTS Using an open coding approach to maximise emergence of patterns and relationships we have identified seven theoretical concepts that might explain the observed spatial clustering of maternal depression. The theoretical concepts identified were: Community-level social networks; Social Capital and Social Cohesion; "Depressed community"; Access to services at the group level; Ethnic segregation and diversity; Supportive social policy; and Big business. CONCLUSIONS We postulate that these regional structural, economic, social and cultural mechanisms partially explain the pattern of maternal depression observed in families and communities within South Western Sydney. We further observe that powerful global economic and political forces are having an impact on the local situation. The challenge for policy and practice is to support mothers and their families within this adverse regional and global-economic context.
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Affiliation(s)
- John Eastwood
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Department of Community Paediatrics, South Western Sydney Local Health District, Locked Bag 7279, Liverpool BC, NSW 1871, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
- School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Lynn Kemp
- Centre for Health Equity Training Research and Evaluation, University of New South Wales, Sydney, NSW 2052, Australia
| | - Bin Jalaludin
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
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Morgan KJ, Eastwood JG. Social determinants of maternal self-rated health in South Western Sydney, Australia. BMC Res Notes 2014; 7:51. [PMID: 24447371 PMCID: PMC3899616 DOI: 10.1186/1756-0500-7-51] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 01/16/2014] [Indexed: 11/18/2022] Open
Abstract
Background From 2000 a routine survey of mothers with newborn infants was commenced in South Western Sydney. The aim of this study is to examine the relationship of maternal self-rated health, as a measure of well-being, to various socio-demographic factors including measures of social capital, country of birth, financial status and employment. Results The sample consisted of 23,534 mothers who delivered in South Western Sydney between 2004 and 2006. The data were collected as part of a routine post-partum assessment at 2–4 weeks postpartum. We examined the relationship of self-rated health with socio-demographic variables using binary logistic regression. Worse self-rated health was reported in 4% of women. Variables which were found to be significantly associated with worse self-rated health were: poor financial situation, public housing accommodation, fathers employment, no car access, unplanned pregnancy, maternal smoking, poor emotional and social support, and motherhood being more difficult than expected. Conclusion We confirmed the importance of social disadvantage and social isolation as independent risk factors for poor self-reported health. The findings reported here provide further justification for public health interventions which increase support for socially excluded mothers and strengthen their connection to their community.
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Affiliation(s)
| | - John G Eastwood
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia.
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Eastwood JG, Jalaludin BB, Kemp LA, Phung HN, Barnett BEW. Immigrant maternal depression and social networks. A multilevel Bayesian spatial logistic regression in South Western Sydney, Australia. Spat Spatiotemporal Epidemiol 2013; 6:49-58. [PMID: 23973180 DOI: 10.1016/j.sste.2013.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 03/11/2013] [Accepted: 04/17/2013] [Indexed: 11/17/2022]
Abstract
The purpose is to explore the multilevel spatial distribution of depressive symptoms among migrant mothers in South Western Sydney and to identify any group level associations that could inform subsequent theory building and local public health interventions. Migrant mothers (n=7256) delivering in 2002 and 2003 were assessed at 2-3 weeks after delivery for risk factors for depressive symptoms. The binary outcome variables were Edinburgh Postnatal Depression Scale scores (EPDS) of >9 and >12. Individual level variables included were: financial income, self-reported maternal health, social support network, emotional support, practical support, baby trouble sleeping, baby demanding and baby not content. The group level variable reported here is aggregated social support networks. We used Bayesian hierarchical multilevel spatial modelling with conditional autoregression. Migrant mothers were at higher risk of having depressive symptoms if they lived in a community with predominantly Australian-born mothers and strong social capital as measured by aggregated social networks. These findings suggest that migrant mothers are socially isolated and current home visiting services should be strengthened for migrant mothers living in communities where they may have poor social networks.
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Affiliation(s)
- John G Eastwood
- South Western Sydney Local Health District, Locked Mail Bag 7008, Liverpool BC, NSW 1871, Australia.
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