Psychosocial risk factors to major depression after childbirth

Plasma and breast milk adipokines in women across the first year postpartum and their association with maternal depressive symptoms and infant neurodevelopment: Protocol for the APPLE prospective cohort study

INTRODUCTION

Adiponectin and leptin play important roles in the central nervous system. During the postpartum period, there is a need for a better understanding of the relationship between these cytokines and the neurological development of the infant, as well as their influence on preventing maternal depressive symptoms.

OBJECTIVES

To assess the correlation between adiponectin and leptin in maternal plasma and breast milk and their association with: infant neurodevelopment at 6 and 12 months of age; and maternal mental health over the first year postpartum.

METHODS

Prospective cohort study with four follow-up. Mothers and their newborns are recruited within the first 15 days postpartum (baseline). Follow-up visits occur at 2, 6, and 12 months postpartum. Visits include blood and breast milk collection, application of the Edinburgh Postnatal Depression Scale and Beck Depression Inventory to assess maternal mental health, application of the Bayley-III scale for infant developmental assessment, maternal and infant anthropometry and body composition, evaluation of reproductive history, mother-infant bonding, breastfeeding, consumption of ultra-processed foods, sleep quality, and socio-economic and demographic data.

RESULTS

The research received funds in August 2022, and participant recruitment began in September 2022. The sample size will consist of 95 mother-child pairs. As of September 2023, 68 participants have been recruited.

CONCLUSION

The project will provide insights into the association between adiponectin and leptin with postpartum depression and infant neurodevelopment, ultimately promoting improved care and quality of life for these groups. Additionally, it will provide data on the type of delivery, infant physical growth, maternal and infant body composition changes, sleep quality, consumption of ultra-processed foods, and maternal metabolic health, including vitamin D metabolites, oxidized polyunsaturated fatty acid metabolites, phospholipid species and triacylglycerols, which are of significant relevance to public health and, when interconnected, may yield important results and contribute to the existing literature.

TRIAL REGISTRATION

Name of the registry: Brazilian Clinical Trials Registry (ReBec). Registration number: RBR-9hcby8c.

Relationship between postpartum depression and plasma vasopressin level at 6-8 weeks postpartum: a cross-sectional study

Postpartum depression (PPD) is the most important postpartum mood disorder due to its significant effect on both the infant and family health. Arginine vasopressin (AVP) has been suggested as a hormonal agent involved in the development of depression. The purpose of this study was to investigate the relationship between the plasma concentrations of AVP and the score of Edinburgh Postnatal Depression Scale (EPDS). This cross-sectional study was conducted in 2016-2017 in Darehshahr Township, Ilam Province, Iran. In the first phase, 303 pregnant women, who were at 38 weeks, met the inclusion criteria, and were not depressed (according to their EPDS scores) were included in the study. In the 6-8 week postpartum follow-up, using the EPDS, 31 depressed individuals were diagnosed and referred to a psychiatrist for confirmation. The maternal venous blood samples of 24 depressed individuals still meeting the inclusion criteria and 66 randomly selected non-depressed subjects were obtained to measure their AVP plasma concentrations with ELISA assay. There was a significant positive relationship between plasma AVP levels and the EPDS score (P = 0.000, r = 0.658). Also the mean plasma concentration of AVP was significantly higher in the depressed group (41.35 ± 13.75 ng/ml) than in the non-depressed group (26.01 ± 7.83 ng/ml) (P < 0.001). In a multiple logistic regression model for various parameters, increased vasopressin levels were associated with increased odds of PPD (OR = 1.15, 95% CI = 1.07-1.24, P = 0.000). Furthermore, multiparity (OR = 5.45, 95% CI = 1.21-24.43, P = 0.027) and non-exclusive breastfeeding (OR = 13.06, 95% CI = 1.36-125, P = 0.026) were associated with increased odds of PPD. Maternal gender preference (having a baby of desired and desired sex) decreased the odds of PPD (OR = 0.13, 95% CI = 0.02-0.79, P = 0.027 and OR = 0.08, 95% CI = 0.01-0.5, P = 0.007). AVP seems to be a contributor to clinical PPD by affecting the hypothalamic-pituitary-adrenal (HPA) axis activity. Furthermore, primiparous women had significantly lower EPDS scores.

Female UK Army Service personnel are at greater risk of work-related morbidity on return to duty postpartum

INTRODUCTION

The 2016 Interim Report on the Health Risks to Women in Ground Close Combat Roles highlighted an increased risk of skeletal injury and significant physiological changes, including increased ligament laxity and decreased bone mineral content, during the postpartum period. The report called for further research and a re-evaluation of postpartum policy to optimise the return of female Service personnel to arduous employment. The purpose of this study was to determine whether returning to duty is at greater risk of injury and illness in the first year postpartum than they were prepregnancy.

METHODS

Fifty-five female UK Army Service personnel aged 18-41 years, who had given birth in the previous 4 years, completed a lifestyle questionnaire and gave written consent for a review of their medical records. The number of working days lost (WDL) due to illness, injury and combined illness and injury was obtained from medical records, for 1 year prepregnancy and 1 year postpartum. Female Service personnel returned to duty at different time-points postpartum, so data were expressed as WDL/week.

RESULTS

WDL/week due to illness and combined illness and injury were higher postpartum compared with prepregnancy (p<0.05). WDL/week due to combined illness and injury was significantly lower prepregnancy (p<0.05) and at 0-26 weeks postpartum (p<0.05), compared with 26-52 weeks postpartum.

CONCLUSIONS

Postpartum female UK Army Service personnel are at greater risk of illness and a combination of illness and injury in the year after giving birth, compared with prepregnancy. The study suggests female Service personnel are unprepared for the demands of full active duty in the first year postpartum.

Risk Factors of Postpartum Depression

Postpartum depression (PPD) is a widespread mental health problem and one of the prime causes of maternal suffering and ill health. On a global level, the prevalence of the disorder is about 10 to 15%. Symptoms generally appear within the first four to six weeks, which is the high-risk period. However, it may develop up to one year post-delivery. PPD presents with symptoms of classical depression, including mood fluctuations, bouts of crying, lack of interest in the child, and even thoughts of suicide. PPD not only has adverse effects on the mother's health but also hampers the growth and development of the child. It hampers the formation of a healthy mother-child bond, which in turn may impact feeding practices. The social environment of the infant during the first few months is primarily provided by the mother, and PPD may thus impact the child's development. It also increases the child's susceptibility to malnutrition. Research on postpartum depression has garnered momentum within the last few years. However, the masses are still largely unaware of the disorder and its implications. There is also an inadequacy of awareness of the risk factors of PPD. The cross-cultural differences in manifestations and appropriate preventive measures have not been extensively studied. Some risk factors for PPD are similar to those for classic depression; however, obstetrical and pediatric factors are also involved. This literature review aims to assess the currently known risk factors for PPD, their strength of association, and probable mechanisms to help identify the high-risk group and enable the implementation of preventive measures or facilitate early diagnosis. The factors identified spanned sociodemographic, biological, psychological, and obstetric domains. These included socioeconomic standing, marital relationship, history of psychiatric illness, social support, gestational diabetes, vitamin D deficiency, immigration status, delivery method, violence and abuse, birth experience, and biological and epigenetic markers. The risk factors for postpartum depression are numerous and may have strong to weak associations with the development of PPD. A previous history of depression or psychiatric illness, depressive symptoms during pregnancy, gestational diabetes, and a lack of spousal and social support were the most powerful risk factors. Other significant factors include complications during pregnancy, low socioeconomic status, and stressful life events. Studies on maternal age and chronic illness as risk factors were inconclusive. The roles of genetic and epigenetic markers, cultural factors, and vitamin D insufficiency require further investigation.

Family History of Psychiatric Disorders as a Risk Factor for Maternal Postpartum Depression: A Systematic Review and Meta-analysis

Importance

Current evidence on the association between family history of psychiatric disorders and postpartum depression is inconsistent; family studies have identified familial risk of postpartum depression, whereas systematic reviews and umbrella reviews, compiling all risk factors for postpartum depression, often have not.

Objective

To investigate the association between family history of psychiatric disorders and risk of developing postpartum depression within 12 months post partum.

Data Sources

Literature searches were conducted in PubMed, Embase, and PsycINFO in September 2021 and updated in March 2022, accompanied by citation and reference search.

Study Selection

Studies eligible for inclusion comprised peer-reviewed cohort and case-control studies reporting an odds ratio (OR) or sufficient data to calculate one for the association between family history of any psychiatric disorder and postpartum depression. Study selection was made by 2 independent reviewers: title and abstract screening followed by full-text screening.

Data Extraction and Synthesis

Reporting was performed using the MOOSE checklist. Two reviewers independently extracted predefined information and assessed included studies for risk of bias using the Newcastle-Ottawa Scale. Data were pooled in a meta-analysis using a random-effects model. Heterogeneity was investigated with meta-regression, subgroup, and sensitivity analyses. Publication bias was investigated using a funnel plot, and GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used to evaluate the overall certainty of the findings.

Main Outcomes and Measures

The primary outcome was the pooled association between family history of psychiatric disorders and postpartum depression.

Results

A total of 26 studies were included, containing information on 100 877 women. Meta-analysis showed an increased OR of developing postpartum depression when mothers had a family history of psychiatric disorders (OR, 2.08; 95% CI, 1.67-2.59; I2 = 57.14%) corresponding to a risk ratio of 1.79 (95% CI, 1.52-2.09), assuming a 15% postpartum depression prevalence in the general population. Subgroup, sensitivity, and meta-regression analyses were in line with the primary analysis. The overall certainty of evidence was deemed as moderate according to GRADE.

Conclusions and Relevance

In this study, there was moderate certainty of evidence for an almost 2-fold higher risk of developing postpartum depression among mothers who have a family history of any psychiatric disorder compared with mothers without.

Personality traits as a risk factor for postpartum depression: A systematic review and meta-analysis

BACKGROUND

Certain personality traits increase vulnerability to depression, but the evidence linking personality and postpartum depression (PPD) is less robust. This systematic review aimed to identify personality traits that increase the risk of PPD.

METHODS

We systematically reviewed studies retrieved from PubMed/Medline, PsycINFO, Scopus, CINAHL, and Cochrane, following the PRISMA guidelines for reporting. We carried out a meta-analysis on the association between neuroticism and PPD.

RESULTS

A total of 34 studies were analyzed. Of these, 31 considered at least one trait associated with PPD; 10 studies considered at least one trait not associated with PPD. The meta-analysis included 13 studies, concluding that neuroticism was associated with PPD (OR: 1.37; 95%CI: 1.22-1.53; p<0.001).

LIMITATIONS

Study design and approach to personality assessment influence results. Prospective longitudinal studies of persons with no prior history of mood disorder would provide stronger evidence about whether particular personality traits predict PPD. Most studies reviewed used self-report measures to assess personality. Study design and approach to personality assessment influence results, and indications of publication bias were found.

CONCLUSIONS

Neuroticism is the personality trait most widely studied in relation to PPD. Our meta-analysis found this trait is strongly related with PPD. Moreover, vulnerable personality style and trait anxiety are also associated with PPD. Screening for these traits might help identify women at risk, improving prevention, early detection, and possibly treatment.

Prevalence and risk factors associated with perinatal depression in sexual minority women

Perinatal depression is associated with wide-ranging negative outcomes for women and their families, though little research has examined perinatal depression in sexual minority women. We examined depression in sexual minority women in the perinatal period, and whether there were unique minority stress-related risk and protective factors that predicted perinatal depression. One hundred ninety-four perinatal sexual minority women aged 18 years and older were recruited from the US and Australia. Participants completed an online questionnaire incorporating the Edinburgh Postnatal Depression Scale (EPDS) and measures of minority stress and social support. Over one third (35.6%) of the sample scored in the clinical range on the EPDS. Experiences of discrimination were associated with greater depression symptoms via poor social support from family. Higher concealment motivation was associated with greater depression symptoms via poor family and partner support. There were no direct or indirect effects of internalized stigma on depression. Rates of clinically elevated perinatal depression symptoms among sexual minority women are high, extending previous research demonstrating mental health disparities between sexual minorities and their heterosexual counterparts to the perinatal period. The role of social support in mediating the relationships between minority stress and depression suggests that increasing partner and family support might be effective targets for therapeutic interventions during the perinatal period.

Prevalence and predictors of postpartum depression in Upper Egypt: A multicenter primary health care study

BACKGROUND

Postpartum depression (PPD) is highly prevalent with a major impact on the mother and child health. We aimed to determine the prevalence of PPD in primary health care centres which provide vaccinations services to infants in Assiut city and to evaluate the possible risk factors associated with PPD.

METHODS

In this multicentre study, 257 mothers attended three primary health care centres for immunization of their babies were recruited from January 2019 to January 2020. All participants were evaluated for socio-demographic features, Family affluence scale (FAS), Edinburgh Postnatal Depression Scale (EPDS) and associated risk factors.

RESULTS

The mean age of the participants was 27.98 ± 4.7. About half of the mothers and their husbands had low education level. Most of the families (89%) have low socioeconomic scale (SES). About (33.5%) women were found to have possible PPD. In the logistic regression analysis, SES, history of depression, history of PPD, history of stressful conditions, familial support, unwanted pregnancy, and male preference were significant statistical in PPD (p < 0.05).

LIMITATIONS

We did not investigate the medical and psychological problems during antenatal care. Also, we did not assess relation of the type of delivery and medical problems during delivery on the postnatal care.

CONCLUSIONS

PPD was prevalent in 33.5% The possible risk factors of PPD were low SES, history of depression, history of PPD, history of stressful conditions, familial support, unwanted pregnancy, and male preference.

Endocrine stress response in pregnancy and 12 weeks postpartum - Exploring risk factors for postpartum depression

Pregnancy and the postpartum period are characterized by physiological alterations in cortisol and cortisone levels. In the present study, we sought to explore the risk factors for postpartum depression (PPD) and self-remitting postpartum adjustment disorder (AD) and whether cortisol/cortisone metabolism might have any bearing on them. Hair samples from 196 participants (mean age = 31.44, SD = 4.71) were collected at two time points (1-6 days after childbirth and 12 weeks postpartum) to determine the cumulative hair cortisol (HCC) and hair cortisone (HCNC) exposure in the third trimester and during the 12 weeks postpartum. Compared to the non-depressed group (ND, n = 141), more women in the AD (n = 28) and PPD (n = 27) groups had a personal or family history of depression and more stressful life events. Compared to ND and PPD, more women in the AD group had birth-related complications with their children being more often transferred to a pediatric ward. The factors associated with PPD were found to include being unmarried and having a lower household income, less support at home, more subjectively perceived stress after childbirth and lower maternal sensitivity. The natural decrease in HCC concentration from the third trimester to 12 weeks postpartum was significant only in the ND and AD groups, but not in PPD. In summary, prolonged subjectively perceived postpartum stress associated with living situations may contribute to the development of PPD while birth- and child-related complications are likely to trigger brief episodes of AD. Only in ND and AD, the pregnancy-related physiological changes in glucocorticoid levels return to the pre-pregnancy baseline after 12 weeks. Our observations point to the difference between the ND and PPD groups in glucocorticoid metabolism-related postpartum adjustment, which may be a factor in the development of PPD.

Partner relationship quality predicts later postpartum depression independently of the chronicity of depressive symptoms

OBJECTIVE

Given the lifelong implications of extended postpartum depression (PPD), research is needed to examine the social factors implicated in its development (such as relationship quality) and associated predictors. This study sought to examine the association of partner relationship quality (PRQ) and decline of sexual life (DSL) with maternal PPD at 12-15 months after childbirth.

METHODS

Prospective study of 294 low-income postpartum women. A structured questionnaire and the Patient Health Questionnaire-9 (PHQ-9) captured responses for the main outcome variable and covariates.

RESULTS

The prevalence of the main outcome (PPD at 12-15 months) was 19.1%. Using logistic regression models, low PRQ (risk ratio [RR] = 1.58, 95%CI 1.01-2.49) and DSL (RR = 1.97, 95%CI 1.23-3.15) were associated with PPD at 12-15 months even after controlling for perinatal depression.

CONCLUSIONS

Late PPD (12 to 15 months after giving birth) is very common among low-income women, and is independently associated with different aspects of the couple's relationship. Improving PRQ may prevent late PPD. Future investigations are warranted.

Prevalence and predictors of postpartum depression among postnatal women in Lagos, Nigeria

Background

Globally, postpartum depression is one of the most common but often unrecognized complications of childbirth, yearly affecting about 10–15% of postnatal women. This study aimed to determine the prevalence of postpartum depression and its predictors among postnatal women in Lagos.

Methods

A descriptive cross-sectional study was conducted among 250 mothers in Eti-Osa Local Government Area of Lagos State, Nigeria, attending six Primary Health Care centers for infant immunization at six weeks post-delivery. Data was collected using a pretested semi-structured interviewer administered questionnaire which included the Edinburgh Postnatal Depression Scale. Analysis was carried out using SPSS version 23TM. Chi-square and logistic regression analyses were used to determine associations and predictive relationships between various factors and the presence of postpartum depression. The level of significance was set at <0.05.

Results

The prevalence of postpartum depression was 35.6%. Multiparity, delivery by cesarean section, mother being unwell after delivery, and not exclusively breastfeeding the baby were the factors linked with postpartum depression. Following multiple logistic regression, having postpartum blues (p=0.000; OR=32.77; 95%CI=7.23–148.58)., not getting help with caring for the baby (p=0.008; OR=2.64; 95%CI=1.29–5.42), experiencing intimate partner violence (p=0.000; OR=5.2; 95%CI=2.23–11.91) and having an unsupportive partner (p=0.018; OR=2.6; 95%CI=1.17–5.78) were identified as predictors of postpartum depression.

Conclusion

This study revealed a high prevalence of postpartum depression, identifying both the obstetric and psychosocial predictors. Social support for women both in the pre- and postnatal periods and routine screening of women for postpartum depression should be encouraged for early detection and immediate intervention.

My job, my child, my house: the predictive value of job- and housework-related factors on depressive symptoms during the postpartum period

BACKGROUND

Many mothers combine two sides of their life: They are both educated employees and family organizers. The aim of this study is to investigate risk and protective factors of depressive symptoms during the postpartum period (PPD symptoms) on both those sides of mothers' life, including education, job-, and housework-related factors.

METHODS

Data (n = 689) were drawn from the prospective-longitudinal cohort study "Dresden Study on Parenting, Work, and Mental Health" (DREAM). Education, job satisfaction, job burden, and the housework-related factor ministering to family needs (MTFN) were measured during pregnancy. Depressive symptoms were measured 8 weeks postpartum. Multiple linear regression analyses were conducted.

RESULTS

While education was not significantly associated with PPD symptoms, low job satisfaction, high job burden, and low MTFN levels were significant risk factors for PPD symptoms. When controlling for further potential confounders, job satisfaction and job burden remained significant predictors.

LIMITATIONS

Generalization of findings might be limited due to participation bias and some systematic dropout.

CONCLUSIONS

Job characteristics should be considered in future research on postpartum mental health. For the prevention of PPD symptoms, it seems important to ensure satisfying and less burdensome working conditions during pregnancy. Additionally, the results indicate that further research on the effects of housework-related factors on PPD symptoms is worthwhile.

A prospective longitudinal study of the impact of early postnatal vs. chronic maternal depressive symptoms on child development

Background

Few studies of the effects of postnatal depression on child development have considered the chronicity of depressive symptoms. We investigated whether early postnatal depressive symptoms (PNDS) predicted child developmental outcome independently of later maternal depressive symptoms.

Methods

In a prospective, longitudinal study, mothers and children were followed-up from birth to 2 years; repeated measures of PNDS were made using the Edinburgh Postnatal Depression Scale (EPDS); child development was assessed using the Bayley Scales II. Multilevel modelling techniques were used to examine the association between 6 week PNDS, and child development, taking subsequent depressive symptoms into account.

Results

Children of mothers with 6 week PNDS were significantly more likely than children of non-symptomatic mothers to have poor cognitive outcome; however, this association was reduced to trend level when adjusted for later maternal depressive symptoms.

Conclusion

Effects of early PNDS on infant development may be partly explained by subsequent depressive symptoms.

Sleep quality buffers the effects of negative social interactions on maternal mood in the 3-6 month postpartum period: a daily diary study

Sleep and social relationships are two key determinants of psychosocial health that undergo considerable change across the transition to motherhood. The current study investigated the bidirectional relationship between daytime Positive and Negative Social Interactions (PSIs & NSIs) and nighttime sleep quality on maternal mood across 1 week in the 3-6 month postpartum period. Sixty healthy, non-depressed first-time mothers completed 7-consecutive days of daily social interaction and sleep diaries. Results indicated that higher than average sleep quality buffered the effect of higher than average NSIs on maternal mood (i.e., buffered mood reactivity) and appeared to promote mood recovery following a particularly "bad day" (i.e., higher than average NSIs). In addition, although PSIs were more common than NSIs overall, the most frequent and positively rated PSIs were with baby as were the most frequent and negatively rated NSIs. To our knowledge, our results are the first to characterize the impact of PSIs on postpartum maternal mood, assess maternal-infant social interactions in daily diary study of postpartum social relationships, and demonstrate the role that maternal sleep quality plays in social discord-related mood reactivity and mood recovery processes in the 3-6 month postpartum period.

Prenatal Life Events, Maternal Employment, and Postpartum Depression across a Diverse Population in New York City

This study examined racial/ethnic disparities in three core postpartum depression (PPD) symptoms, and identified specific predictors of PPD including sociodemographic variables, life stressors and maternal employment. White, African American, Hispanic, and Asian/Pacific Islander women from the New York City area (n = 3010) completed the 2009-2011 Pregnancy Risk Assessment Monitoring System. African American women were less likely to have PPD than White women. Maternal employment during the postpartum was associated with an increased likelihood of PPD for White women relative to women who were not employed. Life stressors and maternal employment should be considered as culturally contextualized factors related to postpartum depression.

Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries

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.

The Effect of Stressful Life Events on Postpartum Depression: Findings from the 2009-2011 Mississippi Pregnancy Risk Assessment Monitoring System

Objectives To determine the prevalence of postpartum depression (PPD) among new mothers in Mississippi during 2009–2011 and evaluate the effects of different stressful life events in the year before delivery on the likelihood of PPD. Methods We used Mississippi Pregnancy Risk Assessment Monitoring System (PRAMS) 2009–2011 data (n = 3695) to evaluate the effects of different stressful life events on PPD. We categorized 13 stressors into 4 groups: financial, relational, trauma-related, and emotional. A composite score of the mothers’ responses (≥10) to the three items: “I felt down, depressed, or sad”, “I felt hopeless”, and “I felt slowed down” was used to measure PPD. The items were rated on a Likert scale from (1) never to 5 (always). Descriptive statistics, Chi square tests, t tests, and logistic regression analyses were conducted using SAS 9.3 Proc Survey procedure (SAS Institute, Cary, NC, USA). Results The overall prevalence of self-reported PPD was 14.8 %. Mothers who experienced high relational with low financial and high trauma related stresses had the highest likelihood of PPD diagnosis after adjusting for confounders (OR = 8.6; 95 % CI, 3.5–21.3), followed by those who reported high relational stress with low financial and low trauma stresses (OR = 5.9; 95 % CI, 3.5–10.2). Those with high financial, low relational, and low trauma had the least likelihood of PPD (OR = 2.2; 95 % CI, 1.6–3.0) compared to women with low stress in all three categories. Conclusion Our findings showed that the likelihood of PPD was higher among women who had high relational stress, indicating that efforts to effectively prevent PPD need to focus on healthy relationships between partners during pregnancy.

Trajectories of maternal depressive symptoms in the early childhood period and family-wide clustering of risk

BACKGROUND

Previous research on individual differences in the course of maternal depressive symptoms has yielded inconsistent findings, with significant variation in the number and pattern of trajectories identified. In addition, missing from the literature is a comprehensive examination of predictors and longitudinal consequences of particular depression trajectories.

METHOD

Participants in this study included a community cohort of 501 women assessed for depression using the Center for Epidemiologic Depression Scale at infant age 2, 18, 36, and 54 months. A multi-informant approach was used to examine predictors and outcomes of trajectory membership.

RESULTS

Using growth mixture modeling, three distinct trajectories emerged: 84% of the sample demonstrated low-stable levels of depressive symptoms, 9.5% had high-decreasing scores, and 6.5% had moderate-increasing scores. While socioeconomic status and marital conflict differentiated the low-stable group from the high-decreasing and moderate-increasing group, neighborhood collective efficacy differentiated the latter two groups. At 54 months, a clustering of family risks was prevalent for the moderate-increasing depression group, including higher marital conflict and household chaos, lower parental positivity, and heightened levels of child psychopathology.

LIMITATIONS

Limitations include reliance on self-reports to assess maternal depression and the relatively small sample size of certain trajectory classes.

CONCLUSIONS

The onset and course of maternal depression in the early childrearing period is heterogeneous, with distinct subgroups in the population. Comprehensive assessment of individual, family, and neighborhood stressors augments our understanding of the predictors and consequences of trajectory membership over this critical period of child and family adaptation.

Sociodemographic and delivery risk factors for developing postpartum depression in a sample of 3233 mothers from the Czech ELSPAC study

BACKGROUND

In the postpartum period, certain groups of women are at a higher risk for developing depressive episodes. Several studies have described risk factors for developing postpartum depression (PPD). However, these studies have used limited numbers of participants, and therefore the estimated prevalence of PPD varies greatly.

METHODS

The objective of this study is to identify the main risk factors for developing PPD by using data collected via the Czech version of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC). This database provides a representative sample (n = 7589) observed prospectively and a large amount of data on depressive symptoms and on biological, socioeconomic, and environmental factors. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for incidence of PPD. The affective pathology was examined at three time points: before delivery, 6 weeks after delivery, and 6 months after delivery.

RESULTS

The prevalence of depressive symptoms before delivery was 12.8%, 6 weeks after delivery 11.8%, and 6 months after delivery 10.1%. The prevalence rates are based on women who completed questionnaires at all three time-points (N = 3233). At all three time points, the main risk factors for developing PPD identified as significant by both univariate and multivariate analysis were personal history of depressive episodes and mothers experiencing psychosocial stressors. Other risk factors occurring in both types of analysis were: family history of depression from expectant mother's paternal side (prenatal), mothers living without partners (6 weeks postpartum) and feelings of unhappiness about being pregnant (6 months postpartum). Several protective factors were also observed: male child gender (prenatal), primiparous mothers (6 months postpartum), and secondary education (prenatal, only by multivariate analysis). Significant risk factors found solely by univariate analysis were family history of depression in both parents of the expectant mother (prenatal and 6 weeks postpartum), family history of depression from subject's maternal side (6 months postpartum), unintentional pregnancy (prenatal and 6 weeks postpartum), feelings of unhappiness about being pregnant (prenatal and 6 weeks postpartum), primary education (prenatal and 6 weeks postpartum), mothers who opted not to breastfeed (6 months postpartum) and mothers living without partners (prenatal and 6 months postpartum). Family savings were identified as protective factor (prenatal and 6 months postpartum).

CONCLUSIONS

We identified significant predictors of PPD. These predictors can be easily detected in clinical practice, and systematic screening can lead to identifying potentially at risk mothers. Since the risk is linked with experience of psychosocial stressors it seems that they might benefit from increased psychosocial support to prevent affective pathology.

Postpartum depression among women with unintended pregnancy

OBJECTIVE

To analyze the association between unintended pregnancy and postpartum depression.

METHODS

This is a prospective cohort study conducted with 1,121 pregnant aged 18 to 49 years, who attended the prenatal program devised by the Brazilian Family Health Strategy, Recife, PE, Northeastern Brazil, between July 2005 and December 2006. We interviewed 1,121 women during pregnancy and 1,057 after childbirth. Unintended pregnancy was evaluated during the first interview and postpartum depression symptoms were assessed using the Edinburgh Postnatal Depression Screening Scale. The crude and adjusted odds ratios for the studied association were estimated using logistic regression analysis.

RESULTS

The frequency for unintended pregnancy was 60.2%; 25.9% presented postpartum depression symptoms. Those who had unintended pregnancies had a higher likelihood of presenting this symptoms, even after adjusting for confounding variables (OR = 1.48; 95%CI 1.09;2.01). When the Self Reporting Questionnaire (SRQ-20) variable was included, the association decreased, however, remained statistically significant (OR = 1.42; 95%CI 1.03;1.97).

CONCLUSIONS

Unintended pregnancy showed association with subsequent postpartum depressive symptoms. This suggests that high values in Edinburgh Postnatal Depression Screening Scale may result from unintended pregnancy.

Postpartum depression and its psychosocial correlates: A longitudinal study among a group of women in Turkey

The postpartum period is a window of risk for psychological disturbances and particularly for depressive symptoms. This study explored the relationships between postpartum depression and prepartum depressive symptoms, marital adjustment, support from family, previous depressive symptomology, and pregnancy planning. A total of 128 women who were receiving prenatal care at a state hospital in Istanbul, Turkey, and who were in the last trimester of their pregnancy participated in the first phase of the study. Of these, eighty-seven women also participated in the second phase, during the 3-6 month postpartum period. The results indicated that depressed mood in the last trimester of pregnancy, family support, care and support from spouse, previous depression history, and unplanned pregnancy were significant risk factors for postpartum depressive symptoms; significant differences were found for study variables as a function of women's scores on the Edinburgh Postnatal Depression Scale in pregnancy and in the postpartum period. The recommendation is made to use screening tools, like the Edinburgh Postnatal Depression Scale, in the course of routine prenatal care, and to refer women with Edinburgh Postnatal Depression Scale scores above the cutoff score for further clinical examination.

Clinical features of and risk factors for major depression with history of postpartum episodes in Han Chinese women: A retrospective study

BACKGROUND

We sought to investigate the clinical features of and risk factors for recurrent major depression (MD) with history of postpartum episodes (PPD) in Han Chinese women and the differences between first-onset postpartum MD (MD that has its first lifetime depressive episode in the postpartum period) and first-onset non-postpartum MD (MD with history of PPD and has its first lifetime depressive episode in a period other than postpartum).

METHODS

Data were derived from the China, Oxford and Virginia Commonwealth University Experimental Research on Genetic Epidemiology (CONVERGE) study (N=6017 cases) and analyzed in two steps. We first examined the clinical features of and risk factors for MD patients with (N=981) or without (N=4410) a history of PPD. We then compared the differences between first-onset postpartum MD (N=583) and first-onset non-postpartum MD (N=398) in those with a history of PPD. Linear, logistic and multinomial logistic models were employed to measure the associations.

RESULTS

A history of PPD was associated with more guilt feelings, greater psychiatric comorbidity, higher neuroticism, earlier onset and more chronicity (OR 0.2-2.8). Severe premenstrual symptoms (PMS) and more childbirths increased the risk of PPD, as did a family history of MD, childhood sexual abuse, stressful life events and lack of social support (OR 1.1-1.3). In the MD with history of PPD subsample, first-onset postpartum MD was associated with fewer recurrent major depressive episodes, less psychiatric comorbidity, lower neuroticism, less severe PMS and fewer disagreements with their husbands (OR 0.5-0.8), but more childbirths (OR 1.2).

LIMITATIONS

Data were obtained retrospectively through interview and recall bias may have affected the results.

CONCLUSIONS

MD with history of PPD in Han Chinese women is typically chronic and severe, with particular risk factors including severe PMS and more childbirths. First-onset postpartum MD and first-onset non-postpartum MD can be partly differentiated by their clinical features and risk factors, but are not clearly distinctive.

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.

Mental health problems and influencing factors in Japanese women 4 months after delivery

BACKGROUND

Postpartum mental health problems are a major public health issue; however, studies on the mental health status of mothers and its influencing factors between 8 weeks and 1 year postpartum are scarce. Furthermore, it would be necessary to examine the factors influencing mothers' mental health in order to evaluate their physiological adaptations to the nursing environment.

METHODS

We examined the mental health status of postpartum women and the factors influencing poor mental health at 4 months after delivery. A cross-sectional study of 584 postpartum women was conducted. Information on mental health status, delivery, and other factors was collected using a self-administered questionnaire. Women were asked about their age, height, weight, gestational or marital status, whether they were eating regular meals, appetite, frequency of going out, financial difficulty, stressful life events, and history of depression. The Japanese version of the 12-item General Health Questionnaire (GHQ-12) was used to identify potential poor mental health status. Participants with GHQ-12 scores of ≥4 were classified as the high GHQ-12 score group (poor mental health status) and participants with GHQ-12 scores of ≤3 were classified as the low GHQ-12 score group (good mental health status).

RESULTS

Forty-five women (7.7%) were classified as having high GHQ-12 scores. Multiple logistic regression analysis revealed that older age, not eating meals regularly, and history of depression were significantly associated with poor mental health. Financial difficulty had a borderline association with poor mental health in this model.

CONCLUSIONS

These risk factors might help practitioners identify women at high risk of poor mental health after delivery.

Culturally determined risk factors for postnatal depression in Sub-Saharan Africa: a mixed method systematic review

BACKGROUND

Research suggests that African women experience postnatal depression (PND) at a similar rate to that reported in developed countries. If PND is to be better understood in African populations, its risk factors need to be reliably identified. Studies in the developing world have found that risk factors are often culturally determined. This review aimed at improving our understanding of the culturally determined risk factors of PND within Sub-Saharan Africa by integrating evidence from quantitative and qualitative studies.

METHODS

A mixed-method systematic review was employed. Nine quantitative and three qualitative studies were quality assessed, synthesised, and integrated.

RESULTS

Quantitative studies indicated that stressful life events, cultural values and the African extended family system have an influential role in women's experience of PND. Qualitative studies described the impact of negative cultural perceptions of others and adhering to cultural traditions and values as contributing to the development and maintenance of PND.

LIMITATIONS

The small number of studies is a limitation within the available body of research. Search strategies only included English language articles.

CONCLUSIONS

Although some risk factors for postnatal depression were similar to those identified in studies in developed countries, important differences exist; most notably the influence of traditional African value systems, customs and antenatal exposure to extreme societal stress. The findings of this review are especially important for the development of a predictive model for PND within Sub-Saharan Africa and when working with migrant Sub-Saharan African mothers.

Rates and predictors of postpartum depression by race and ethnicity: results from the 2004 to 2007 New York City PRAMS survey (Pregnancy Risk Assessment Monitoring System)

The objective of this study was to examine racial/ethnic disparities in the diagnosis of postpartum depression (PPD) by: (1) identifying predictors that account for prevalence rate differences across groups, and (2) comparing the strength of predictors across groups. 3,732 White, African American, Hispanic, and Asian/Pacific Islander women from the New York City area completed the Pregnancy Risk Assessment Monitoring System from 2004 to 2007, a population-based survey that assessed sociodemographic risk factors, maternal stressors, psycho-education provided regarding depression, and prenatal and postpartum depression diagnoses. Sociodemographic and maternal stressors accounted for increased rates in PPD among Blacks and Hispanics compared to Whites, whereas Asian/Pacific Islander women were still 3.2 times more likely to receive a diagnosis after controlling for these variables. Asian/Pacific Islanders were more likely to receive a diagnosis after their providers talked to them about depressed mood, but were less likely than other groups to have had this conversation. Prenatal depression diagnoses increased the likelihood for PPD diagnoses for women across groups. Gestational diabetes decreased the likelihood for a PPD diagnosis for African Americans; a trend was observed in the association between having given birth to a female infant and increased rates of PPD diagnosis for Asian/Pacific Islanders and Whites. The risk factors that account for prevalence rate differences in postpartum diagnoses depend on the race/ethnic groups being compared. Prenatal depression is confirmed to be a major predictor for postpartum depression diagnosis for all groups studied; however, the associations between other postpartum depression risk factors and diagnosis vary by race/ethnic group.

Perinatal psychiatric disorders: an overview

Perinatal mental illness has a significant implication on maternal health, birth outcomes, and the offspring's development. Prevalence estimates of perinatal psychiatric illnesses range widely, with substantial heterogeneity in different population studies, with a lower prevalence rate in high- rather than low- or middle-income countries. Because of the potential negative impact on maternal and child outcomes and the potential lability of these disorders, the perinatal period is a critical time to identify psychiatric illnesses. Thus, obstetricians and midwives play a crucial role in assessing women's mental health needs and to refer identified women promptly for multidisciplinary specialist assessment. However, there is still limited evidence on best practice assessment and management policies during pregnancy and postpartum. This review focuses on the prevalence of common perinatal mental disorders and antenatal screening policies to identify women at risk. The effect of these conditions and their management on pregnancy, fetal outcomes, and child development are discussed.

Re-conceptualising prenatal life stressors in predicting post-partum depression: cumulative-, specific-, and domain-specific approaches to calculating risk

BACKGROUND

Prenatal life stress predicts post-partum depression (PPD); however, studies generally examine individual stressors (a specific approach) or the summation of such exposure (a cumulative approach) and their associations with PPD. Such approaches may oversimplify prenatal life stress as a risk factor for PPD. We evaluated approaches in assessing prenatal life stress as a predictor of PPD diagnosis, including a domain-specific approach that captures cumulative life stress while accounting for stress across different life stress domains: financial, relational, and physical health.

METHODS

The Pregnancy Risk Assessment Monitoring System, a population-based survey, was used to analyse the association of prenatal life stressors with PPD diagnoses among 3566 New York City post-partum women.

RESULTS

Specific stressors were not associated with PPD diagnosis after controlling for sociodemographic variables. Exposure to a greater number of stressors was associated with PPD diagnosis, even after adjusting for both sociodemographic variables and specific stressors [odds ratio (OR) = 3.1, 95% confidence interval (CI) = 1.5, 6.7]. Individuals reporting a moderate-to-high number of financial problems along with a moderate-to-high number of physical problems were at greater odds of PPD (OR = 4.2, 95% CI = 1.2, 15.3); those with a moderate-to-high number of problems in all three domains were at over fivefold increased odds of PPD (OR = 5.5, CI = 1.1, 28.5).

CONCLUSIONS

In assessing prenatal stress, clinicians should consider the extent to which stressors occur across different life domains; this association appears stronger with PPD diagnosis than simple assessments of individual stressors, which typically overestimate risk or cumulative exposures.

Estradiol modulates anhedonia and behavioral despair in rats and negative affect in a subgroup of women at high risk for postpartum depression

In an effort to address inconsistencies in the literature, we tested a cross-species estrogen withdrawal model of postpartum depression (PPD) with a series of rodent experiments and a prospective, naturalistic human study. All rats were ovariectomized prior to experimentation. The first rat experiment examined the effects of low- and high-dose estradiol administration and withdrawal on lateral-hypothalamic self-stimulation, a behavioral index of anhedonia, in experimental (n=7) and vehicle-only control animals (n=7). The second rat experiment examined the effects of high-dose estradiol withdrawal on activity and immobility during the forced swim test, an index of behavioral despair, in a separate group of experimental (n=8) and vehicle-only control animals (n=8). In the human study, women with (n=8) and without (n=12) a history of PPD completed mood ratings and collected saliva samples (to assess estradiol levels) daily during the third trimester of pregnancy through 10 days postpartum. The presence of PPD was assessed at one month postpartum. In the animal studies, rats in the estradiol withdrawal group demonstrated significantly greater immobility and less swimming than controls. Estradiol withdrawal resulted in reduced responding for electrical stimulation (multiple intensities) relative to estradiol administration. In the human study, there was no significant association between estradiol and negative affect among women with or without a history of PPD. However, there was a correlation between daily estradiol levels and negative affect in the women with incident PPD at one month postpartum. Despite important cross-species differences, both the rat and human studies provided evidence of the effects of estradiol on perinatal depressive symptoms.

Longitudinal study of depression and health status in pregnant women: incidence, course and predictive factors

The aim of this study was to determine the effect of isolated psychological intimate partner violence and psychosocial factors (social support and alcohol or drug use by a partner/family member) on psychological well-being (depression or poor self-perceived health status) at 5 and 12 months post-partum. A longitudinal cohort study was carried out with a consecutive sample of 1,400 women in their first trimester of pregnancy, who attended the prenatal programme in the Valencia Region (Spain) in 2008 and were followed up at 5 months and 12 months post-partum. A logistic regression model was fitted using generalized estimating equations, to assess the effect of isolated psychological intimate partner violence, social support, alcohol consumption and illicit drug use problems by a partner or family member on subsequent psychological well-being at follow-up. We observed a decrease in the incidence of poorer psychological well-being (post-partum depression and poor self-perceived health status) at 12 months post-partum. The strongest predictor of poor psychological well-being was depression (AOR = 6.83, 95 % CI: 3.44-13.58) or poor self-perceived health status (AOR = 5.34, 95 % CI: 2.37-12.02) during pregnancy. Isolated psychological IPV increased the risk of a deterioration in psychological well-being. Having a tangible social network was also a predictor of both post-partum depression and poor self-perceived health status. The effect of functional social support varied according to the type of psychological well-being indicator being used. Problems of alcohol consumption or illicit drug use by a partner or family member were a predictor of post-partum depression only. Psychological well-being during the first year after birth is highly affected by isolated psychological IPV and psychosocial factors.

An exploration of illness beliefs in mothers with postnatal depression

OBJECTIVE

to explore illness beliefs in women with postnatal depression and suggest an appropriate health belief model. About 10% of recently delivered mothers suffer from depression. Postnatal depression may differ from depression occurring at other times in an individual's life not only symptomatically but also experiences, perceptions and beliefs about the illness differ because of the individual's specific role as a carer for a newborn baby. Whilst illness beliefs have been extensively examined using models from physical health, recent studies have pointed out that physical health models may not provide an appropriate framework to explore mental health difficulties and require adapting.

DESIGN

qualitative study using face-to-face interviews for data collection.

SETTING

Greater Manchester, England.

METHODS

as illness beliefs have not yet been formally assessed using established questionnaires, the present study employed qualitative methodology to explore illness beliefs in mothers with postnatal depression (PND). Semi-structured interviews were conducted with 11 participants who were depressed following the birth of their child. Interview transcripts were analysed using grounded theory methodology. The point of theoretical sufficiency was reached with this sample size.

FINDINGS

the rich data allowed for a theory of illness beliefs in PND to be developed encompassing six core categories: 'unmet expectations', 'identifying stressors in their life context', 'conflict over label', 'antidepressants: the lesser of two evils', 'loss of time' and 'uncertain futures.'

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

participants made multiple appraisals of their PND in light of their initial difficulties, their improvements and consequences, the future and subsequent service involvement. Participants' narratives were conflicting and uncertain with internal struggles evident as mothers were torn between their desire to be good mothers and their perceptions that PND meant that they were not good enough mothers. Thus, the themes identified in this study did not match onto the key dimensions postulated by Leventhal's self-regulation model of illness beliefs.

Recognizing and treating peripartum depression

BACKGROUND

In this article, we review current data on the prevalence of, risk factors for, and treatment of peripartum depression.

METHOD

Pertinent publications were retrieved by searches in Medline and the Cochrane Library using the key words "peri/pre/post", "partum/partal/natal", "maternal/motherhood/pregnancy", and "depression/affective disorder".

RESULTS

Depression is the most common peripartal disease: The prevalence of depressive disorders is 18.4% during pregnancy and 19.2% in the puerperium. Prepartum depression is associated with preterm birth, low birth weight, and an abnormal fetal heart rate. In the long run, children of depressed mothers have been found to have impaired cognitive and emotional abilities. Risk factors for peripartal depression include prior depression, poor social support, poor quality of intimate relationship, and negative live events. Peripartum depression can be treated effectively with psychotherapy or drug therapy. Current data support the use of antidepressants during pregnancy and breastfeeding. In many places, pregnancy counseling centers offer low-threshold psychosocial assistance. Nonetheless, no more than 20% of the affected women are identified, even though rapid screening would be possible with instruments such as the Edinburgh Postnatal Depression Scale (EPDS) and the two Whooley questions.

CONCLUSION

Peripartum depression is both common and treatable. Screening for depression should become a routine part of both prepartum care by gynecologists and postpartum care by midwives. This will only be possible, however, with expanded availability of ambulatory and inpatient psychotherapy and psychiatric care for the affected women and their children.

Infant gender and postpartum sadness in the light of region of birth and some other factors: a contribution to the knowledge of postpartum depression

The purpose of this paper is to analyse postpartum depressive symptoms as related to baby gender, maternal region of birth, stress, perception of child difficult temperament and some demographic factors. The setting was 36 Swedish child health centres. Mothers of 1,848 19-month-old children completed a questionnaire, including an item about recall of postpartum sadness. A subsample of 360 answered the Edinburgh Postnatal Depression Scale (EPDS). Overall, significantly more mothers of boys than of girls recalled postpartum sadness. The same was found in mothers born in Sweden and in other regions, except for the Middle East (no significant result). Among those born in Sweden and in other regions, more mothers of boys than of girls scored ≥12 on the EPDS, except for Middle East mothers with the opposite pattern (no significant finding). More mothers of "difficult" boys than of "difficult" girls recalled postpartum sadness. Our findings are tentative but may inspire future research. Immigrant mothers in Sweden seem rather like the majority population, possibly with the exception of Middle East mothers. The significance of parents' knowledge of their child's gender in advance is an important area for research. Future parents could benefit from discussing gender expectations with a nurse or other professional.

Antenatal risk factors for postnatal depression: a prospective study of Chinese women at maternal and child health centres

BACKGROUND

Risk factors for postnatal depression (PND) are under-explored in the Chinese populations. There is increasing recognition of the importance of identifying predictive factors during the antenatal period for PND. The present study aimed to identify the risk factors for postnatal depression in a community cohort of Chinese women with special focus on the antenatal risk factors.

METHODS

Eight hundred and five Chinese women were interviewed during their third trimester of pregnancy and at around 2 months postnatally. Putative risk factors for PND were collected and the diagnosis of PND was confirmed by the Structured Clinical Interview for DSM-IV Axis I Disorders. The 2-month postnatal depression status was used as the dependent variable for univariate and multivariate analyses against putative risk factors.

RESULTS

Marital dissatisfaction (Relative Risk = 8.27), dissatisfied relationship with mother-in-law (Relative Risk = 3.93), antenatal depressive symptomatology (Relative Risk = 3.90), and anxiety-prone personality (Relative Risk = 2.14) predicted PND in Chinese women independently.

CONCLUSIONS

Chinese women tend to keep their own feelings and emotions and it is important to monitor Chinese pregnant women with these predictive risk factors so that PND can be identified early.

Alcohol misuse among partners: a potential effect modifier in the relationship between physical intimate partner violence and postpartum depression

PURPOSE

This study evaluated if the probability of postpartum depression (PPD) increases with an upward gradient of physical intimate partner violence (IPV) during pregnancy and whether substance use by any member of the couple modifies this relationship.

METHODS

The sample comprised 811 randomly selected mothers of children under 5 months old attending primary health services of Rio de Janeiro, Brazil. The Revised Conflict Tactics Scale (CTS2) gauged physical IPV, and the Edinburgh Postnatal Depression Scale (EPDS) assessed PPD. A hierarchical logistic regression model was employed to deal with confounding. Specific interaction terms between physical IPV and alcohol misuse or use of illicit drugs were also tested.

RESULTS

Physical IPV during pregnancy was reported by 37.8% of respondents and 24.3% were presumably depressed (EPDS score ≥ 12). Interaction between physical IPV and partners' alcohol misuse was statistically significant (p = 0.026). Although there was a significant increase in PPD with just one act of physical IPV in the absence of a partners' alcohol misuse, mounting acts did not have any further influence. Conversely, when partners misused alcohol, the probability progressively and steeply increased from two acts onwards, reaching almost sevenfold by six cumulative physical IPV events as opposed to none.

CONCLUSIONS

The results reinforce the relevance of physical IPV as a risk factor to PPD. They also suggest that context matters, partners' alcohol misuse acting as an important effect modifier. These evidences justify tailored preventive, screening and intervention procedures for IPV and alcohol misuse during pregnancy and the postpartum period.

Can managed care networks improve perinatal mental healthcare for Black and minority ethnic (BME) women?

Purpose

Perinatal mental illness is an important public health issue. Conditions such as postnatal depression increase mothers' risk of suicide and can herald onset of recurrent and chronic mental health problems. Maternal mental illness can also adversely impact the cognitive, physical, and psychological health and development of children. In light of known psychosocial risks, there is concern that fewer than expected women from black and minority ethnic (BME) backgrounds access care and treatment. This paper aims to address this issue.

Design/methodology/approach

Responding to persistent reports of patchy service provision across the UK more generally and particular concerns about potentially unmet needs among BME women, mixed‐method research was undertaken between September 2009 and March 2010. Using survey questionnaires and telephone interviews, the study sought to explore professional stakeholders' perspectives on current perinatal mental health provision and the extent to which it meets the needs of BME women. Findings from the study were intended to inform policy and plans to improve provision by establishing managed care networks (MCNs) for perinatal mental healthcare.

Findings

In total, 45 questionnaires were returned from the national survey. One‐third of respondents (n=14) consented to follow‐up telephone interviews. There was evidence of multi‐agency working among the 27 professional groups which respondents reported as being directly involved in delivering perinatal mental healthcare across the country. However, there was also evidence of disjuncture and poor communication – particularly between statutory and voluntary sectors and NHS primary and secondary care. Some respondents had difficulty defining “BME” or identifying the women to whom the acronym might be applied. They also questioned the validity of providing “BME‐specific” services. Instead, they endorsed more ethnically “inclusive models” of provision and “signposting” women to appropriate “community” services.

Practical implications

Taken together, these findings suggests that whilst there might be a theoretical argument for perinatal mental health MCNs, considerable effort is required if policy‐makers' aspirations for more “joined‐up” services capable of meeting the needs of all women are to be fully realised. Furthermore, current proposals for public sector reform coupled with reduction in voluntary sector provision is likely to disproportionately affect women from BME and other marginalised communities as they provide significant amounts of “below the radar” care and support.

Originality/value

This paper is of particular relevance to policy makers and practitioners. Findings suggest that women from BME backgrounds might be particularly vulnerable to perinatal mental illness. Contraction of voluntary sector provision increases the likelihood that the needs of BME women will remain unmet with deleterious consequences for their health and wellbeing of their families. This has potentially serious public health implications. MCNs/clinical networks have the potential to reduce inequalities by providing more “joined up” care for all women. However, the evidence base for levels of need and appropriate service response to perinatal mental illness among BME women is weak. Further research is required to bridge the evidence gap and to evaluate the impact of health and social care reform on vulnerable groups.

Employment conditions and maternal postpartum mental health: results from the Longitudinal Study of Australian Children

Maternal postpartum mental health is influenced by a broad range of risk and protective factors including social circumstances. Forty percent of Australian women resume employment in the first year postpartum, yet poor quality employment (without security, control, flexibility or leave) has not been investigated as a potential social determinant of maternal psychological distress. This paper examines whether poor quality jobs are associated with an increased risk of maternal postpartum psychological distress. Data were collected from employed mothers of infants ≤12 months (n = 1,300) participating in the Longitudinal Study of Australian Children. Logistic regression analyses estimated the association between job quality and maternal psychological distress, adjusting for prior depression, social support, quality of partner relationship, adverse life events and sociodemographic characteristics. Only 21% of women reported access to all four optimal job conditions. After adjustment for known risk factors for poor maternal mood, mothers were significantly more likely to report psychological distress (adjusted OR = 1.39, 95% CI 1.09, 1.77) with each reduction in the number of optimal employment conditions. Interventions for maternal postpartum affective disorders are unlikely to be successful if major risk factors are not addressed. These results provide strong evidence that employment conditions are associated with maternal postpartum mood, and warrant consideration in psychosocial risk assessments and interventions.

Newborn gender as a predictor of postpartum mood disturbances in a sample of Swedish women

Postpartum depression (PPD) is a condition that affects about 10% of newly delivered women. The aim of this study was to examine the possible association between offspring gender and risk for development of PPD in Sweden. The study was undertaken as part of the UPPSAT project, a population-based longitudinal study in Uppsala, Sweden. From May 2006 to June 2007, women who gave birth at Uppsala University Hospital and fulfilled the inclusion criteria were asked to participate. The participating women filled out, at three points during the first 6 months after delivery, questionnaires containing the Edinburgh Postnatal Depression Scale as well as questions concerning various lifestyle factors, medical history, breast feeding habits, social support parameters, and diet factors. No significant difference in risk of PPD in relation to baby gender could be shown 6 weeks and 6 months after delivery. However, women who gave birth to a male offspring had a significantly higher risk of self-reported depressive symptomatology 5 days after delivery. The association remained statistically significant after adjustment for possible confounders in a logistic regression model. This longitudinal study demonstrates that, in Sweden, the gender of the offspring is not associated with a higher risk for self-reported postpartum depression in the mother 6 weeks or 6 months after delivery. The birth of a baby boy, however, gives the mother a higher risk of postpartum blues 5 days after delivery.

Social dynamics of postpartum depression: a population-based screening in South-Eastern Hungary

PURPOSE

To determine contributing psychosocial factors to postnatal depression (PND) in Hungary in 1996 and in 2006.

METHODS

In 1996 and 2006, a total of 2,333 and 1,619 women, respectively, were screened for PND in South-Eastern Hungary, based on a Leverton questionnaire (LQ) score of ≥ 12 at 6-10 weeks after delivery.

RESULTS

The LQ scores indicated an increase in PND from 15.0% in 1996 to 17.4% in 2006. The best predictors for PND in a multiple regression analysis were living in an urban environment [adjusted odds ratio (AOR) = 11.26], unstable relationship (AOR = 3.1) and a perceived lack of social support from partner (AOR = 3.65) in 1996, and recent major life events (AOR = 3.38), unstable relationship (AOR = 3.84), self-reported low income (AOR = 1.82), and intention to return to work soon after delivery (AOR = 0.47) in 2006.

CONCLUSIONS

A self-defined low socioeconomic status and an intention to return to work have become significant factors in the development of PND. Besides the family factors recognized as salient variables in 1996, economic features came into prominence as newly identified main predictive factors for PND in 2006.

The Vulnerable Personality Style Questionnaire: psychometric properties in Spanish postpartum women

The Vulnerable Personality Style Questionnaire (VPSQ) is a nine-item self-report scale developed to asses personality traits which increase the risk of postpartum depression. The aim of the present study was to examine the psychometric properties of the Spanish version of the VPSQ in a sample of postpartum women. A cohort of 309 postpartum women was followed up for 32 weeks after delivery. All women were assessed with the Spanish version of the VPSQ, the Eysenck Personality Questionnaire-R Short Scale, the Frost Multidimensional Perfectionism Scale and the harm avoidance dimension of the Temperament and Character Inventory at 2-3 days postpartum. Depressive symptoms were evaluated at 8 and 32 weeks after delivery by the Edinburgh Postnatal Depression Scale, and a diagnostic interview was used to confirm the presence of major depression disorder. Factor analysis results revealed the unidimensionality of the Spanish version of the VPSQ. Cronbach's alpha coefficient for the VPSQ total score was 0.63. The test-retest reliability indicated a good temporal stability (ICC = 0.88; 95% confidence interval (CI) = 0.82-0.91). A moderate association between the VPSQ and other personality measures provided evidence for its construct validity. Logistic regression analyses showed that women with higher scores on the VPSQ had a higher risk of developing depressive symptoms (OR = 1.20; 95% CI = 1.11-1.29) and major depression (OR = 1.16; 95% CI = 1.07-1.26) throughout the 32 weeks after delivery. Overall, our results suggest adequate psychometric properties of the Spanish version of the VPSQ and its usefulness in identifying women with a personality style that increases the risk of developing postpartum depression.

Gender differences in postpartum depression: a longitudinal cohort study

BACKGROUND

The course of depression from pregnancy to 1 year post partum and risk factors among mothers and fathers are not known.

AIMS

(1) To report the longitudinal patterns of depression from the third trimester of pregnancy to 1 year after childbirth; (2) to determine the gender differences between women and their partners in the effect of psychosocial and personal factors on postpartum depression.

METHODS

A longitudinal cohort study was carried out over a consecutive sample of 769 women in their third trimester of pregnancy and their partners attending the prenatal programme in the Valencian Community (Spain) and follow-up at 3 and 12 months post partum. The outcome variable was the presence of depression at 3 or 12 months post partum measured by the Edinburgh Postnatal Depression Scale. Predictor variables were: psychosocial (marital dissatisfaction, confidant and affective social support) and personal (history of depression, partner's depression and negative life events, depression during the third trimester of pregnancy) variables. Logistic regression models were fitted via generalised estimating equations.

RESULTS

At 3 and 12 months post partum, 9.3% and 4.4% of mothers and 3.4% and 4.0% of fathers, respectively, were newly diagnosed as having depression. Low marital satisfaction, partner's depression and depression during pregnancy increased the probability of depression during the first 12 months after birth in mothers and fathers. Negative life events increased the risk of depression only among mothers.

CONCLUSIONS

Psychosocial and personal factors were strong predictors of depression during the first 12 months post partum for both mothers and fathers.

Pain as a confounding factor in postnatal depression screening

BACKGROUND

Postnatal depression (PND) is one of the most serious complications following delivery in developed countries today. Thus, early screening strategies by first-line healthcare workers are of primary importance. Pain following childbirth has been proposed as a possible risk-marker for later depressive disorder. We tested this assumption and explored the possible link between pain and overestimation of PND risk in routine clinical screenings.

METHODS

We assessed 320 women between the third and fifth day after delivery as well as at 8 weeks post-partum (PP). Midwives were asked to evaluate the risk of later PND upon discharge from the maternity unit; additionally, pain measurements were obtained using the Visual Analogic Scale (VAS) over the same time period. A stepwise logistic regression analysis was performed to identify the risk markers linked to a positive depressive disorder diagnosis (according to the MINI-DSM-IV) at 8 weeks PP.

RESULTS AND DISCUSSION

Multivariate risk analysis showed no statistical link between physical pain shortly after childbirth and subsequent PND diagnosis at 8 weeks PP. However, VAS measurements for pain were significantly higher for women that the midwives estimated to be at risk for PND (|Z| = 2.78, p = 0.005), suggesting the routine clinical screening for PND is susceptible for false-positives. Psychiatrists should encourage midwives to have an empathetic approach, to increase the detection as well as treatment of mental and physical suffering in early postpartum. At the same time, adequate education programmes for early PND screening should be proposed to non-psychiatric staffs to demonstrate that women at risk of PND often show minimal physical symptoms.