Postpartum Depression-Identifying Risk and Access to Intervention

Peripartum Depression: What's New?

PURPOSE OF THE REVIEW

Peripartum depression (PPD), including both depression during pregnancy and postpartum, is the most frequent health disorder during the perinatal period. It is a significant public health issue in many countries due to its prevalence and its impact on women, as well as on their partners and offspring. Here, we will attempt to untangle the most recent studies and publications, considering what it is essential to know in 2024 about PPD as a specific perinatal issue.

RECENT FINDINGS

PPD appears to be a very heterogeneous disorder in which a complex interplay between different factors contributes to its pathophysiology. Thus, the need to enhance diagnosis and referral through a better understanding of its severity and co-morbidities has emerged as a major public health issue. Indeed, research has consistently shown that PPD negatively impacts parent-infant interactions and infants' cognitive, social, and emotional development. Evidence underlining its global risk has accumulated over the past three decades, but many questions remain, including how these vulnerable offspring developmental trajectories unfold.

The Effect of Health Education Based on the PRECEDE-PROCEED Model on the Psychological State of the Spouses of Primiparous Women During the Puerperium and on Maternal Breastfeeding

Background

Based on the PRECEDE-PROCEED (Predisposing, Reinforcing, and Enabling Causes in Educational Diagnosis and Evaluation-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development) model (PPM), we investigated the psychological status of the spouses of primiparous women to implement a health education program.

Methods

The study retrospectively analyzed 310 spouses of primigravid women who gave birth from March 2022 to March 2024. 154 spouses received regular education, and 156 spouses aslo received health education of PPM. Binary logistic regression analysis was performed to analyze the independent risk factors for negative emotions of the spouses of primigravid women during puerperium. Analysis of variance was performed to determine the differences in the effect of maternal breastfeeding on the growth and development of infants between the two models of health education.

Results

The health education group based on the PPM was defined as Group A, while the regular health education group was defined as Group B. The SAS (Anxiety self-assessment scale) and SDS (Depression self-assessment scale) of the spouses in Group A were significantly lower than those of the spouses in Group B three days postpartum. Health education intervention (OR = 0.239, P = 0.001), maternal psychological state (OR = 0.458, P = 0.004), and the education level of the spouses (OR = 0.480, P = 0.006) independently influenced the emergence of negative emotions in spouses. The SCL-90 (symptom checklist 90) scores of Group A were significantly lower than those of Group B but significantly higher than the national norm (P < 0.05).

Conclusion

The content of the program not only helps increase the adaptability and participation of the spouses in their role as fathers but also helps increase the effect of maternal breastfeeding on the growth and development of infants.

Creative art therapy for postpartum depression： A systematic review and meta-analysis

OBJECTIVE

This study aims to ascertain the effectiveness of creative art therapy (CAT) in alleviating symptoms of postpartum depression (PPD).

METHODS

A systematic review of all randomized controlled trials of CAT for PPD was conducted. Eight bibliographic databases, namely, PubMed, The Cochrane Library, Embase, Web of Science, CNKI, Wanfang Database, VIP Database, and China Biomedical Literature Database were searched digitally, while Google Scholar database was searched manually for a comprehensive literature search. The search period is from the establishment of the database to May 2024. Literature screening and data extraction were conducted independently by two researchers, and the risk of bias in the included studies was evaluated. Finally, RevMan5.3 software and STATA 15.1 software were used for meta-analysis.

RESULTS

Twelve studies, including 1633 patients, were included in this review. The results of our meta-analysis revealed that the intervention group was significantly better than the control group in depression [SMD = -0.882, 95 % CI: -1.256 to -0.508, P ＜ 0.001][WMD = 0.680, 95 % CI: 0.407-0.953, P ＜ 0.001], anxiety [SMD = -0.712, 95 % CI: -1.405 to -0.019, P = 0.044], and personal state [WMD = -5.180, 95 % CI: -5.869 to -4.491, P ＜ 0.001][SMD = 0.388, 95 % CI: 0.132-0.643, P = 0.003], and the difference was statistically significant. Sensitivity analysis revealed that the above results were stable.

CONCLUSION

CAT (music and creative games) was found to be effective in relieving depression, anxiety, and personal state in patients with PPD. Though CAT appears to be worthy of clinical application, more high-quality and large-sample studies are required to explore various aspects in the current context.

Potential association between mobile phone usage duration and postpartum depression risk: Evidence from a Mendelian randomization study

The widespread adoption of mobile phones in daily life has raised concerns regarding their impact on mental health, including among postpartum women. Considering the rising prevalence of postpartum depression (PPD) and the pervasive use of mobile phones in modern society, this study aimed to rigorously investigate the causal relationship between mobile phone use duration and the risk of developing PPD. Data were collected through an online survey assessing mobile phone usage and mental health among postpartum women. The survey's reliability and validity were evaluated using Statistical Package for the Social Sciences software. In total, 2015 participants completed the survey. To explore causal relationships, genetic data were sourced from open-access databases, and two-sample Mendelian randomization (MR) techniques were employed. Statistical analysis, including chi-square tests, revealed a significant association between higher mobile phone use and lower incidence of PPD. MR analysis supported these findings, indicating a protective effect of mobile phone use against PPD (P < .05 based on inverse variance weighting and the weighted median method). This MR-based study provides evidence that increased mobile phone use is associated with a decreased risk of PPD, suggesting that mobile phones could serve as an effective tool for PPD prevention. These findings highlight the importance of evidence-based evaluations of lifestyle factors in mental health research.

The Impact of Mental Health on Patient Outcomes in Peripheral Arterial Disease and Critical Limb Threatening Ischemia and Potential Avenues to Treatment

The physical consequences of peripheral artery disease (PAD) are well established; however, the impact of comorbid mental health disorders such as depression and anxiety are not well understood. The impact of psychological stress is not only associated with worse perioperative morbidity and mortality but also with a physiologic cascade that accelerates plaque formation. Increasing screening to identify and subsequently treat comorbid mental health disorders is an integral next step in improving outcomes in PAD management. Failure to adequately address social and psychological impact on PAD patients will further widen the gap in disparities faced by high-risk and disenfranchised populations. Integration of mental health professionals, addiction specialists, and community navigators into multidisciplinary care teams can bolster support for PAD patients and improve outcomes.

Call For Action: The Obstetrician's Role In Peripartum Mental Health

Peripartum mental health is an underdiagnosed and undertreated entity; obstetricians are in a dilemma when patients present with signs of any mental disturbance. The peripartum period is fraught with triggers that can cause, or exacerbate, mental illness, and obstetricians need to be aware of diagnoses and treatment of blues, depression, psychosis and other problems. Key strategies that can be adopted are discussed in this review, along with the scenario in India.

Prenatal depression outcomes in the next generation: A critical review of recent DOHaD studies and recommendations for future research

Prenatal depression, a common pregnancy-related risk with a prevalence of 10-20 %, may affect in utero development and socioemotional and neurodevelopmental outcomes in the next generation. Although there is a growing body of work that suggests prenatal depression has an independent and long-lasting effect on offspring outcomes, important questions remain, and findings often do not converge. The present review examines work carried out in the last decade, with an emphasis on studies focusing on mechanisms and leveraging innovative technologies and study designs to fill in gaps in research. Overall, the past decade of research continues to suggest that prenatal depression increases risk for offspring socioemotional problems and may alter early brain development by affecting maternal-fetal physiology during pregnancy. However, important limitations remain; lack of diversity in study samples, inconsistent consideration of potential confounders (e.g., genetics, postnatal depression, parenting), and restriction of examination to narrow time windows and single exposures. On the other hand, exciting work has begun uncovering potential mechanisms underlying transmission, including alterations in mitochondria functioning, epigenetics, and the prenatal microbiome. We review the evidence to date, identify limitations, and suggest strategies for the next decade of research to detect mechanisms as well as sources of plasticity and resilience to ensure this work translates into meaningful, actionable science that improves the lives of families.

Addressing the challenges of integrating care for perinatal depression in primary care in Nigeria

PURPOSE

This report provides the results of a task-shared approach for integrating care for perinatal depression (PND) within primary maternal and child healthcare (PMCH), including the factors that may facilitate or impede the process.

METHODS

This hybrid implementation-effectiveness study guided by the Replicating Effective Programmes framework was conducted in 27 PMCH clinics in Ibadan, Nigeria. The primary implementation outcome was change in the identification rates of PND by primary health care workers (PHCW) while the primary effectiveness outcome was the difference in symptom remission (EPDS score ≤ 5) 6 months postpartum. Outcome measures were compared between two cohorts of pregnant women, one recruited before and the other after training PHCW to identify and treat PND. Barriers and facilitators were explored in qualitative interviews.

RESULTS

Identification of PND improved from 1.4% before to 17.4% after training; post-training rate was significantly higher in clinics where PHCW routinely screened using the 2-item patient health questionnaire (24.8%) compared to non-screening clinics (5.6%). At 6-months postpartum, 60% of cohort one experienced remission from depression, compared to 56.5% cohort two [OR-0.9 (95%CI-0.6, 1.3) p = 0.58]. Identified facilitators for successful integration included existence of policy specifying mental health as a component of PHC, use of screening to aid identification and supportive supervision, while barriers included language and cultural attitudes towards mental health and human resource constraints. PHCW were able to make adaptations to address these barriers.

CONCLUSIONS

Successful implementation of task-shared care for perinatal depression requires addressing staff shortages and adopting strategies that can improve identification by non-specialist providers.

TRIAL REGISTRATION

This study was retrospectively registered 03 Dec 2019. https://doi.org/10.1186/ISRCTN94230307 .

Health Equity and Perinatal Mental Health

PURPOSE OF REVIEW

Pregnancy and the postpartum period are vulnerable times to experience psychiatric symptoms. Our goal was to describe existing inequities in perinatal mental health, especially across populations, geography, and in the role of childbirth.

RECENT FINDINGS

People of color are at an increased risk for perinatal mental health difficulties and more likely to experience neglect, poor communication, and racial discrimination. LGBTQ + individuals encounter unique challenges, implicating the role of heteronormativity, cisnormativity, and gender dysphoria through pregnancy-related processes. Rural-dwelling women are significantly less likely to seek care, be screened for, or receive treatment for perinatal mental health conditions. Trauma-informed, comprehensive mental health support must be provided to all patients during pregnancy, childbirth, and the postpartum period, especially for racially and ethnically minoritized individuals that have often been omitted from care. Future research needs to prioritize inclusion of perinatal populations not well represented in the literature, including rural-dwelling individuals.

Characterizing the utilization of doula support services among birthing people of color in the United States: a scoping review

BACKGROUND

Birthing people of color experience disproportionately higher rates of infant and maternal mortality during pregnancy and birth compared to their white counterparts. The utilization of doula support services may lead to improvements in the birthing experiences of birthing people of color. Yet, the research in this area is sparse. Thus, the purpose of this review is to characterize the research on doula utilization among birthing people of color, identify gaps in the field, and provide recommendations for future research.

METHODS

Utilizing PRISMA guidelines, we conducted a scoping review, searching PubMed, PsycINFO, CINAHL, and Google Scholar for peer-reviewed articles published between January 1, 2016, to July 3, 2022.

RESULTS

Twenty-five articles met inclusion criteria. We identified the three themes characterizing included studies: (1) how doulas support (HDS) their clients, (2) doula support outcomes (DSO), and (3) considerations for implementing doula support services (CIDS). Despite doulas being described as agents of empowerment, and providing social support, education, and advocacy, birthing people of color reported low utilization of doula support services and findings regarding their effectiveness in improving birthing outcomes were mixed.

CONCLUSIONS

While some studies suggest that doulas may offer important services to birthing people of color, doulas are largely under-utilized, with many birthing people reporting low knowledge of their potential roles during the pre- and post-partum periods. Moreover, few studies were designed to assess intervention effects, limiting our ability to draw firm conclusions. Birthing people of color are at elevated risk for maternal mortality. As such, interventions are needed to support this population and improve outcomes. Our review suggests that, while doulas have the potential to make important contributions to the birthing support team, they are underutilized, and intervention studies are needed to enable estimates of their true effectiveness.

Project ECHO in Psychiatric Workforce Development: the Example of a Perinatal Mental Health ECHO

OBJECTIVE

Perinatal mental health and substance use disorders (PMHSUD) often go unrecognized and untreated. This study examined the use of the Project ECHO model to teach obstetric, primary care, and mental health clinicians about screening, diagnosis, and treatment of PMHSUD.

METHODS

Participants in 3 years of the University of Washington's Moms' Access Project (MAP) ECHO program (2019-2022) completed pre- and post-program surveys. Nine participants in year 1 completed qualitative interviews. Dedoose was used for qualitative analysis of interviews.

RESULTS

Of 136 participants, 62.5% (15/24) completed both pre- and post-surveys in year 1, 56% (28/50) in year 2, and 32.2% (20/62) in year 3. Most respondents agreed or strongly agreed that they were glad to have participated (96.8%; 60/62) and that they had used information learned in the program in treating a patient (95.1%; 58/61). In all years, respondents endorsed increased confidence regarding learning objectives of the program. Qualitative interviews following year 1 yielded themes of hierarchy of competence, motivation versus results of participation, connection, and politics of change: position and practice type.

CONCLUSIONS

Findings supported the feasibility, acceptability, and self-reported effectiveness of the ECHO model for workforce development in PMHSUD.

An Evaluation of the Health Economics of Postnatal Depression Prevention and Treatment Strategies in China: A Cost-Effectiveness Analysis

OBJECTIVE

The primary objectives of this study are to assess the cost-effectiveness of early postnatal screening and prenatal psychological interventions for the prevention and treatment of postpartum depression (PPD) among Chinese pregnant women. Additionally, we aim to explore the most cost-effective prevention and treatment strategies for PPD in China.

METHODS

We used TreeAge 2019 to construct a decision tree model, with the model assuming a simulated queue size of 10,000 people. The model employed Monte Carlo simulation to assess the cost-effectiveness of PPD prevention and treatment strategies. Transfer probabilities were derived from published studies and meta-analyses. Cost and effectiveness data were obtained from published sources and relevant studies. Incremental cost-effectiveness ratios (ICERs) were used to describe the results, with willingness-to-pay (WTP) thresholds set at China's gross domestic product (GDP) per capita.

RESULTS

Compared to the usual care group, the cost per additional quality-adjusted life year (QALY) for the early postnatal screening group and the prenatal psychological interventions is USD 6840.28 and USD 3720.74, respectively. The cure rate of mixed treatments for PPD has the greatest impact on the model, while patient participation in treatment has a minor impact on the cost-effectiveness of prevention and treatment strategies.

CONCLUSION

Both early postnatal screening and prenatal psychological interventions are found to be highly cost-effective strategies for preventing and treating PPD in China. Prenatal psychological interventions for pregnant women are the most cost-effective prevention and treatment strategy. As such, from the perspective of national payers, we recommend that maternal screening for PPD be implemented in China to identify high-risk groups early on and to facilitate effective intervention.

Therapeutic effect of manual massage on early postpartum rectus abdominis separation and postpartum depression

BACKGROUND

Rectus abdominis separation (DRA) affects pelvic stability and body image. No studies have explored the effects of manual massage on early postpartum DRA and postpartum depression.

AIM

To analyze the curative effect of massage on early postpartum DRA and its impact on postpartum depression and thus its ability promote the overall psychosomatic rehabilitation of postpartum women.

METHODS

Data were retrospectively collected on 70 primiparous women with postpartum DRA who underwent rehabilitation at the Postpartum Rehabilitation Center of Huzhou Maternal and Child Health Hospital from October 2022 to September 2023. The patients were divided into the Group S (35 cases, biomimetic electrical stimulation treatment) and Group L (35 cases, biomimetic electrical stimulation combined with manual massage treatment). Baseline data, the edinburgh postpartum depression scale (EPDS) score, and the visual analog scale (VAS) scores for rectus abdominis distance, waist circumference, and lower back pain before and after treatment were compared.

RESULTS

No significant differences were found in the baseline data, rectus abdominis distance, waist circumference, and VAS and EPDS scores between the two groups before treatment (P > 0.05). After treatment, the distance between rectus abdominis and waist circumference in Group L were significantly smaller than those in Group S (P < 0.05). Furthermore, lower back pain (VAS score) and the EPDS score in Group L were significantly lower than those in Group S (P < 0.05).

CONCLUSION

Manual massage can significantly reduce early postpartum DRA, waist circumference, and back pain and improve the patient’s mental state and postpartum depression.

Postpartum depression and partner support during the period of lactation: Correlation research and its influencing factors

BACKGROUND

Postpartum depression (PPD) not only affects the psychological and physiological aspects of maternal health but can also affect neonatal growth and development. Partners who are in close contact with parturient women play a key role in communication and emotional support. This study explores the PPD support relationship with partners and its influencing factors, which is believed to establish psychological well-being and improve maternal partner support.

AIM

To explore the correlation between PPD and partner support during breastfeeding and its influencing factors.

METHODS

Convenience sampling was used to select lactating women (200 women) who underwent postpartum examinations at the Huzhou Maternity and Child Health Care Hospital from July 2022 to December 2022. A cross-sectional survey was conducted on the basic information (general information questionnaire), depression level [edinburgh postnatal depression scale (EPDS)], and partner support score [dyadic coping inventory (DCI)] of the selected subjects. Pearson's correlation analysis was used to analyze the correlation between PPD and DCI in lactating women. Factors affecting PPD levels during lactation were analyzed using multiple linear regression.

RESULTS

The total average score of EPDS in 200 lactating women was (9.52 ± 1.53), and the total average score of DCI was (115.78 ± 14.90). Dividing the EPDS, the dimension scores were: emotional loss (1.91 ± 0.52), anxiety (3.84 ± 1.05), and depression (3.76 ± 0.96). Each dimension of the DCI was subdivided into: Pressure communication (26.79±6.71), mutual support (39.76 ± 9.63), negative support (24.97 ± 6.68), agent support (6.87 ± 1.92), and joint support (17.39 ± 4.19). Pearson's correlation analysis demonstrated that the total mean score and individual dimension scores of EPDS during breastfeeding were inversely correlated with the total score of partner support, stress communication, mutual support, and co-support (P < 0.05). The total mean score of the EPDS and its dimensions were positively correlated with negative support (P < 0.05). Multiple linear regression analysis showed that the main factors affecting PPD during breastfeeding were marital harmony, newborn health, stress communication, mutual support, negative support, co-support, and the total score of partner support (P < 0.05).

CONCLUSION

PPD during breastfeeding was associated with marital harmony, newborn health, stress communication, mutual support, negative support, joint support, and the total DCI score.

An Overview for the General Psychiatrist Evaluating Patients With Obstetric and Neonatal Complications and Perinatal Loss

When neonatal and obstetrical complications occur, the identification and management of mood and anxiety disorders become complex with an ever-expanding array of psychiatric needs that include the management of grief- and trauma-related disorders. With high rates of maternal morbidity and mortality in the United States and laws in many states restricting reproductive health access, psychiatrists must be proficient in managing psychiatric sequelae in this context. High-risk groups for peripartum mood and anxiety disorders, posttraumatic stress disorder, and complicated grief include those with neonatal intensive care unit (NICU) stays and those who have experienced infertility and recurrent pregnancy loss. Groups who have been historically marginalized by the medical system (e.g., Black, Indigenous, people of color) and those from LGBTQ+ communities are at similarly high risk, and more interventions are needed to support these groups. Strategies emphasizing trauma-informed care, psychotherapeutic approaches, and using patient-centered language are recommended.

Analysis of influencing factors and the construction of predictive models for postpartum depression in older pregnant women

BACKGROUND

Changes in China's fertility policy have led to a significant increase in older pregnant women. At present, there is a lack of analysis of influencing factors and research on predictive models for postpartum depression (PPD) in older pregnant women.

AIM

To analysis the influencing factors and the construction of predictive models for PPD in older pregnant women.

METHODS

By adopting a cross-sectional survey research design, 239 older pregnant women (≥ 35 years old) who underwent obstetric examinations and gave birth at Suzhou Ninth People's Hospital from February 2022 to July 2023 were selected as the research subjects. When postpartum women of advanced maternal age came to the hospital for follow-up 42 d after birth, the Edinburgh PPD Scale (EPDS) was used to assess the presence of PPD symptoms. The women were divided into a PPD group and a no-PPD group. Two sets of data were collected for analysis, and a prediction model was constructed. The performance of the predictive model was evaluated using receiver operating characteristic (ROC) analysis and the Hosmer-Lemeshow goodness-of-fit test.

RESULTS

On the 42nd day after delivery, 51 of 239 older pregnant women were evaluated with the EPDS scale and found to have depressive symptoms. The incidence rate was 21.34% (51/239). There were statistically significant differences between the PPD group and the no-PPD group in terms of education level (P = 0.004), family relationships (P = 0.001), pregnancy complications (P = 0.019), and mother-infant separation after birth (P = 0.002). Multivariate logistic regression analysis showed that a high school education and below, poor family relationships, pregnancy complications, and the separation of the mother and baby after birth were influencing factors for PPD in older pregnant women (P < 0.05). Based on the influencing factors, the following model equation was developed: Logit (P) = 0.729 × education level + 0.942 × family relationship + 1.137 × pregnancy complications + 1.285 × separation of the mother and infant after birth -6.671. The area under the ROC curve of this prediction model was 0.873 (95%CI: 0.821-0.924), the sensitivity was 0.871, and the specificity was 0.815. The deviation between the value predicted by the model and the actual value through the Hosmer-Lemeshow goodness-of-fit test was not statistically significant (χ2 = 2.749, P = 0.638), indicating that the model did not show an overfitting phenomenon.

CONCLUSION

The risk of PPD among older pregnant women is influenced by educational level, family relationships, pregnancy complications, and the separation of the mother and baby after birth. A prediction model based on these factors can effectively predict the risk of PPD in older pregnant women.

Symptoms of Depression in the Postpartum Period: Targeting Maternal Mental Health in the Perinatal Period

This cross-sectional study aimed to examine the relationship between postpartum depression symptoms, anxiety, and stress during the postpartum period. A total of 101 women were assessed using the Depression, Anxiety and Stress Scale (DASS-21) and the Edinburgh Postnatal Depression Scale (EPDS) within 14 days after delivery. Multivariate regression analysis revealed that paid work, tobacco use, and stress symptoms were significantly associated with a higher incidence of postpartum depression symptoms. These results underscore the importance of comprehensive prenatal care and effective postpartum follow-up to address maternal mental health and prevent adverse outcomes for both mothers and children.