Serum oxytocin and corticotropin-releasing hormone levels in the third trimester of pregnancy for predicting postpartum depression in Thai women

"A systematic review of risk factors of postpartum depression. Evidence from Asian culture "

OBJECTIVES

One of the largest health concerns, postpartum depression (PPD), has detrimental effects on new mothers, their child, and their family. Investigating under-researched risk factors for postpartum depression in Asian women is the goal of this review of the literature.

METHODS

The literature was searched using a number of electronic research databases. This review included studies that meet the following requirements: (a) they evaluated risk variables; (b) they were conducted in Asian countries using quantitative or qualitative methods; and (c) they were published in English in peer-reviewed journals between 2007 and 2023. A total of 90 studies from 14 different countries were reviewed, compiled, and synthesized.

RESULTS

In Asian countries, where rates ranged from 0.82 % to 93 %, South Korea and Japan had the lowest and highest rates of postpartum depression, respectively. The risk factors for postpartum depression were divided into five main categories: biological/physical (e.g., ABO blood group, oxytocin level), psychological (e.g., antenatal depression, body dissatisfaction, child care stress), obstetric/pediatric (e.g., loss of baby, abortions, pain), socio-demographic (e.g., low social support, poverty, loss of autonomy), and cultural (e.g., gender preference).

CONCLUSION

This phenomenon is prevalent in Asian cultures as it is in European Countries. The repercussions of untreated postpartum depression can lead to long-term psychological and developmental issues in children and strain the familial bonds essential for a nurturing environment. Moreover, understanding the specific risk factors faced by Asian women can pave the way for culturally sensitive interventions and support systems designed to address and mitigate these challenges effectively.

Heart Rate Variability Measurement Can Be a Point-of-Care Sensing Tool for Screening Postpartum Depression: Differentiation from Adjustment Disorder

Postpartum depression (PPD) is a serious mental health issue among women after childbirth, and screening systems that incorporate questionnaires have been utilized to screen for PPD. These questionnaires are sensitive but less specific, and the additional use of objective measures could be helpful. The present study aimed to verify the usefulness of a measure of autonomic function, heart rate variability (HRV), which has been reported to be dysregulated in people with depression. Among 935 women who had experienced childbirth and completed the Edinburgh Postnatal Depression Scale (EPDS), HRV was measured in EPDS-positive women (n = 45) 1 to 4 weeks after childbirth using a wearable device. The measurement was based on a three-behavioral-state paradigm with a 5 min duration, consisting of rest (Rest), task load (Task), and rest-after-task (After) states, and the low-frequency power (LF), the high-frequency power (HF), and their ratio (LF/HF) were calculated. Among the women included in this study, 12 were diagnosed with PPD and 33 were diagnosed with adjustment disorder (AJD). Women with PPD showed a lack of adequate HRV regulation in response to the task load, accompanying a high LF/HF score in the Rest state. On the other hand, women with AJD exhibited high HF and reduced LF/HF during the After state. A linear discriminant analysis using HRV indices and heart rate (HR) revealed that both the differentiation of PPD and AJD patients from the controls and that of PPD patients from AJD patients were possible. The sensitivity and specificity for PPD vs. AJD were 75.0% and 90.9%, respectively. Using this paradigm, an HRV measurement revealed the characteristic autonomic profiles of PPD and AJD, suggesting that it may serve as a point-of-care sensing tool in PPD screening systems.

Convergent Validity of the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire (PHQ-9) in Pregnant and Postpartum Women: Their Construct Correlations with Functional Disability

This study aimed to evaluate the convergent validity of the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) in Thai pregnant and postpartum women, using the 12-item WHO Disability Assessment Schedule (WHODAS) as the reference standard. Participants completed the EPDS, PHQ-9, and WHODAS during the third trimester of pregnancy (over 28 weeks in gestational age) and six weeks postpartum. The sample included 186 and 136 participants for the antenatal and postpartum data analyses, respectively. The antenatal and postpartum data showed moderate correlations between both the EPDS and the PHQ-9 scores and the WHODAS scores (Spearman's correlation coefficients = 0.53-0.66, p < 0.001). The EPDS and PHQ-9 were moderately accurate in distinguishing disability (WHODAS score ≥ 10) from non-disability (WHODAS score < 10) in pregnant and postpartum participants, but the area under the curve of the PHQ-9 receiver operating characteristic curves in postpartum participants was significantly larger than that of the EPDS, with a difference (95% CI; p-value) of 0.08 (0.16, 0.01; p = 0.044). In conclusion, the EPDS and PHQ-9 are valid for assessing PND-related disability in pregnant and postpartum women. The PHQ-9 may perform better than the EPDS in distinguishing disability from non-disability in postpartum women.