Prevalence and risk factors of postpartum depression in China: A hospital-based cross-sectional study

Trajectory on postpartum depression of Chinese women and the risk prediction models: A machine-learning based three-wave follow-up research

BACKGROUND

Our study delves into postpartum depression (PPD) extending observation up to six months postpartum, addressing the gap in long-term follow-ups and uncover critical intervention points.

METHOD

Through a continuous three-wave cohort study involving 3174 of 10,730 invited postpartum women, we utilized machine learning to predict PPD risk, incorporating self-reported surveys and health records from October 2021 to Jan 2023.

RESULTS

PPD prevalence slightly decreased from 30.9 % to 29.1 % over six months. The Random Forest model emerged as the most effective, identifying key predictors of PPD at different stages. The top three factors at first month were newborn's birth weight, maternal weight before delivery and before pregnancy. The EPDS scores of last time, newborn's birth weight and maternal weight before pregnancy and before delivery were main predictors for EPDS scores at third and sixth months postpartum.

LIMITATION

The study faces limitations such as potential selection bias due to the convenience sampling method and the reliance on self-reported measures, which may introduce reporting bias. Furthermore, the high attrition rate could affect the representativeness of the sample and the generalizability of the findings.

CONCLUSION

There is a slight decrease in PPD rates over six months, yet the prevalence remains high. This underscores the need for early and ongoing mental health support for new mothers. Our study highlights the efficacy of machine learning in enhancing PPD risk assessment and tailoring intervention strategies, paving the way for more personalized healthcare approaches in postpartum care.

Barriers and facilitators of screening postpartum depression by primary maternal health workers: A mixed methods study based on the normalization process theory

BACKGROUND

Postpartum depression (PPD) significantly impacts mothers and children's health. China aims to incorporate PPD screening in postpartum home visits, but research on implementation barriers and facilitators is scarce. We designed and implemented a new PPD screening program in Changsha, China, requiring maternal health workers to integrate PPD screening into their postpartum home visits.

AIMS

To identify real-world barriers and facilitators associated with integrating PPD screening into routine home visits from the perspective of maternal health workers.

METHODS

We employed a mixed-methods approach. Maternal health workers involved in the newly introduced PPD screening program were included. Guided by Normalization Process Theory (NPT), quantitative data were collected using the NoMAD instrument, and qualitative data were obtained through semi-structured interviews. Data were analyzed using descriptive statistics for the survey and thematic analysis for the interviews.

RESULTS

All 42 maternal health workers involved in the new PPD program completed the quantitative survey, and nine participated in qualitative interviews. The NoMAD survey revealed high scores for Coherence and Cognitive Participation, but lower scores for Collective Action, particularly regarding insufficient skills and resource adequacy. Thematic analysis identified several barriers, including workload concerns, the need for enhanced psychological healthcare capacity, and lack of economic incentives. Facilitators included the integration of structured feedback and clear referral pathways.

CONCLUSION

Addressing identified barriers through targeted skill training, well-defined referral pathways, and formal recognition of the screening program in performance evaluations could help achieve successful normalization.

The Relationship Between Adverse Childhood Experiences and Postpartum Depression: A Systematic Review and Meta-Analysis

Although numerous factors have been found to influence postpartum depression (PPD), no previous meta-analysis have systematically explored whether it is affected by adverse childhood experiences (ACEs). This study aimed to explore the influence of ACEs and their subtypes on PPD. A systematic literature search was conducted using Web of Science, PubMed, Embase, Wan Fang, China Science and Technology Journal Database, Chinese Biomedical Database, and China National Knowledge Infrastructure, and literature was screened according to inclusion and exclusion criteria. Methodological quality assessment and data extraction were performed on the included studies. A random-effects model was used to pool the effects. In total, 24 studies were included, and 73 independent effects were extracted from them. The meta-analysis revealed that ACE was a risk factor for PPD (odds ratio [OR] = 2.31, 95% confidence interval [CI] [2.04, 2.63]). The subgroup analysis results showed that emotional abuse was the ACE subtype most strongly related to the occurrence of PPD (OR = 2.95, 95% CI [2.08, 4.20]), followed by emotional neglect (OR = 2.87, 95% CI [1.89, 4.36]) and sexual abuse (OR = 2.81, 95% CI [1.93, 4.09]). In addition, family member incarceration (OR = 2.62, 95% CI [1.51, 4.54]), physical abuse (OR = 2.31, 95% CI [1.67, 3.19]), and physical neglect (OR = 2.15, 95% CI [1.36, 3.39]) also have strong effects on PPD. ACE is a risk factor for PPD. Early screening of ACE plays an important role in the prevention and intervention of PPD.

Non-biological factors associated with postpartum depression among women in Shenzhen: a case-control study

Background

Postpartum depression (PPD) presents a significant public health challenge. While PPD's impact extends from maternal health to child development, cultural stigma and a lack of public awareness, particularly in developing countries, contribute to its underestimation and under diagnosed. This study investigated the non-biological associated factors for PPD in Shenzhen city due to its unique socioeconomic landscape, where rapid urbanization and migrant influx could uniquely impact maternal mental health. By identifying local PPD determinants, the research aimed to contribute to targeted mental health interventions in the region.

Method

Data were collected from May to December 2019 at the Luohu Maternal and Child Health Medical Center, Shenzhen. Inclusion criteria were postpartum women without psychiatric histories who live within the locality. The Chinese Edinburgh Postnatal Depression Scale was utilized to confirm PPD diagnosis. Participant information including demographics, economic status and postnatal factors were collected via structured questionnaires. Statistical analyses of t-tests, Wilcoxon rank-sum tests, chi-square tests, and logistic regression, were performed using SPSS 20.0, with significance set at p ≤ 0.05.

Results

The study included 430 healthy mothers and 73 PPD mothers. Several factors were found to significantly influence the onset of PPD (p < 0.05): age (OR = 0.921, 95% CI: 0.864-0.981); living with in-laws (OR = 2.133, 95% CI: 1.108-4.106); bottle feeding (OR = 3.757, 95% CI: 1.567-9.006); prenatal depression (OR = 3.515, 95% CI: 1.61-7.675); prenatal anxiety (OR = 6.072, 95% CI: 3.209-11.49); and adverse life events during pregnancy (OR = 3.287, 95% CI: 1.165-9.269). Other factors were not found to have a significant effect.

Conclusion

Our study found that in the developed city of Shenzhen in Southern China, living with in-laws, exclusive bottle feeding, prenatal anxiety, depression, and adverse life events are non-biological associated factors for postpartum depression. The findings emphasize the importance of considering a range of factors when addressing maternal mental health within a specific local regions. It calls for targeted interventions or prevention program that take into considering the specific cultural, social, and individual factors.

Effects of postpartum fatigue, parenting stress, and family support on postpartum depression in Chinese first-time mothers: a cross-sectional study

PURPOSE

This study aimed to explore the levels of postpartum fatigue, parenting stress, family support, and postpartum depression (PPD) experienced by first-time Chinese mothers and to investigate their impact on PPD.

METHODS

This cross-sectional survey involved 150 primigravida women attending postnatal checkups in Hebi City, Henan Province, China. Demographic data and information on environmental variables (living conditions, family relationships), postpartum fatigue, parenting stress, family support (expected vs. actual level), and PPD were collected.

RESULTS

The average age of the women was 26.25 years (SD, ±3.90), with 78.7% at risk for PPD (score ≥10). Significant correlations were found between PPD and postpartum fatigue (r=.63, p<.001), parenting stress (r=.59, p<.001), and family support (r=.40, p<.001). In model 1, which examined the influence of women's demographic variables on PPD, significant factors included a poor relationship with parents (β=.24, p=.001), a poor relationship with parents-in-law (β=.18, p=.029), and a poor relationship with the husband (β=.20, p=.013). When the three research variables were incorporated into model 2, the factors contributing to a higher level of PPD included a poor relationship with parents-in-law (β=.14, p=.033), increased postpartum fatigue (β=.37, p<.001), increased parenting stress (β=.33, p<.001), and less family support than expected (β=.12, p=.048).

CONCLUSION

The most critical factors influencing PPD include postpartum fatigue, parenting stress, poor relationships with parents-in-law, and low family support among Chinese primiparas. To mitigate PPD levels, healthcare professionals should screen mothers for depression in outpatient clinics and offer education and counseling to both mothers and their families or companions regarding PPD.

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.

Prevalence and risk factors of postpartum depressive symptoms at 42 days among 2462 women in China

BACKGROUND

Postpartum depression is a common and serious mental health problem that is affecting an increasing percentage of the world's population. We aimed to evaluate the prevalence of postpartum depressive symptoms in Beijing, China, during the COVID-19 pandemic and identify several potential risk factors.

METHODS

This was a cross-sectional observational study conducted at Peking University First Hospital from 2020 to 2021. Women who delivered and had postpartum reviews at 42 days after delivery were invited to complete the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS) under the guidance of trained nurses. A score of ≥10 was used as the threshold of postpartum depression. t-tests, chi-square tests or Mann-Whitney U tests were applied. A multivariate logistic regression analysis was conducted to assess the risk factors for postpartum depressive symptoms.

RESULTS

A total of 2462 mothers were included in this study, 20.2 % of whom were considered to have postpartum depressive symptoms. Multivariate logistic regression analysis showed that formula feeding (OR = 2.219, 95 % CI: 1.300-3.786, P = 0.013), preterm birth (OR = 1.619, 95 % CI: 1.108-2.367, P = 0.013), cervical insufficiency (OR 3.022, 95 % CI: 1.200-7.615, P = 0.019) and history of depression (OR = 6.519, 95 % CI: 1.537-27.659, P = 0.011) were associated with a high prevalence of postpartum depressive symptoms.

CONCLUSION

There is a high prevalence of postpartum depressive symptoms in developed regions of China during the COVID-19 pandemic. More attention should be given to mothers with risk factors for PPD, and follow-up care is needed.

Support-Seeking Strategies, Family Communication Patterns, and Received Support Among Chinese Women with Postpartum Depression: A Content Analysis of Zhihu Posts

The incidence of postpartum depression (PPD) among Chinese women surpasses the global average, and this disparity is closely associated with the level of social support they receive. Using Sensitive Interaction Systems Theory and Family Communication Patterns Theory as guiding frameworks, we conducted a content analysis of 705 posts gathered from the hashtag #PPD (chanhou yiyu) on Zhihu, a popular Chinese social media platform. Our findings reveal that postpartum women primarily seek social support from their husbands and mothers-in-law through indirect nonverbal and direct verbal communication strategies. They tend to receive more problem-focused support than emotion-focused solace. Moreover, the use of direct verbal communication strategies promotes potential support providers' problem-solving behaviors, while the use of indirect nonverbal strategies elicits their avoidance behaviors. In addition, the conversation-oriented family communication pattern strengthens the positive association between direct verbal communication and support-providing behaviors, whereas the conformity-oriented family communication pattern weakens this relationship. This study contributes to the applicability of the abovementioned theories in the Chinese context and provides insights for future interventions aimed at addressing PPD among women.

Predictive factors of perinatal depression among women with gestational diabetes mellitus in the UAE: a cross-sectional clinical study

BACKGROUND

Gestational Diabetes Mellitus (GDM) is responsible for the development of 30-50% of type 2 diabetes mellitus that predisposes later to adverse consequences among affected mothers and their offspring. Several studies have suggested that GDM increases the risk of developing perinatal depression (PND); however, factors that are involved in this association are yet to be determined. This study aims to identify factors that interrelate GDM and PND among pregnant and postnatal women in the United Arab Emirates (UAE).

METHODS

A total of 186 women between 18 and 45 years old attending the obstetrics clinic during their 3rd trimester or up to 6 months postnatal were recruited between October 2021 and April 2022. Women who were known to have pre-existing diabetes mellitus (type 1 or type 2), kidney disease, liver disease, and those receiving hormonal therapy were excluded. Participants completed a structured questionnaire including sociodemographic data and the Edinburgh Postnatal Depression Scale (EPDS). Based on their EPDS scores, study participants were categorized into three groups: no depression (> 9), possible depression (9-11), and high possibility/strong positive depression (≥ 12). SPSS 26 was used for data analysis.

RESULTS

Among the 186 participants, 81% (n = 151) were Emirati, 41% (n = 76) had no GDM, and 58% (n = 110) had GDM. Of the study participants, 34.4% had a high possibility of strong positive depression, 40.9% had possible depression, and only 6.5% had no depression. The association between GDM and PND was clinically and statistically insignificant, with a calculated odds ratio (OR) of 1.574 (p value = 0.204) and a 95% confidence interval (0.781-3.172). However, age, personal history of depression, and BMI were found to be strong predictors of depression among pregnant/postpartum women in the UAE.

CONCLUSIONS

The study findings propose that age, personal history of depression, and obesity are strong predictors of depression during pregnancy. The strong correlation between obesity (which is a known strong predictor of GDM) and PND suggests that further studies with longitudinal designs and longer observational periods might better reveal the relationship between GDM and PND.

TRIAL REGISTRATION

Retrospectively registered study by Research Ethics Committees of the University Hospital Sharjah and the University of Sharjah (Ref. No.: UHS-HERC- 025-17122019) December 17, 2019.

Gestational diabetes and risk of perinatal depression in low- and middle-income countries: a meta-analysis

Background

The relationship between gestational diabetes (GDM) and the risk of depression has been thoroughly investigated in high-income countries on their financial basis, while it is largely unexplored in low- and middle- income countries. This meta-analysis aims to assess how GDM influences the risk of perinatal depression by searching multiple electronic databases for studies measuring the odds ratios between them in low- and middle-income countries.

Methods

Two independent reviewers searched multiple electronic databases for studies that investigated GDM and perinatal mental disorders on August 31, 2023. Pooled odds ratios (ORs) and confidence intervals (CIs) were calculated using the random effect model. Subgroup analyses were further conducted based on the type of study design and country income level.

Results

In total, 16 observational studies met the inclusion criteria. Only the number of studies on depression (n=10) satisfied the conditions to conduct a meta-analysis, showing the relationship between mental illness and GDM has been overlooked in low- and middle-income countries. Evidence shows an elevated risk of perinatal depression in women with GDM (pooled OR 1.92; 95% CI 1.24, 2.97; 10 studies). The increased risk of perinatal depression in patients with GDM was not significantly different between cross-sectional and prospective design. Country income level is a significant factor that adversely influences the risk of perinatal depression in GDM patients.

Conclusion

Our findings suggested that women with GDM are vulnerable to perinatal depressive symptoms, and a deeper understanding of potential risk factors and mechanisms may help inform strategies aimed at prevention of exposure to these complications during pregnancy.

The Effect of the Number of Breastfeeding Sessions per Day in the Early Postpartum Period on Postpartum Depression Scores Among Pregnant Women Without Risk Factors for Depression: A Retrospective Cohort Study

Background: The objective of this study was to investigate the relationship between the Edinburgh Postpartum Depression Scale (EPDS) score on the 10th day postpartum and the number of breastfeeding sessions per day among puerperal women (with no known depression risk factors and a low [<10] EPDS score after delivery). Materials and Methods: A total of 1,451 nulliparous, 37- to 41-week pregnant women who gave birth between August 2020 and August 2022 and who underwent routine postpartum checkups on the 10th day after delivery were included in this study. Pregnant women with risk factors for depression before pregnancy, during pregnancy, and after delivery were not included. Patients with an EPDS score of ≥10 after delivery were excluded from the study. On the 10th day after birth, the mean number of breastfeeding sessions per day of the population in the study was determined. Patients with a number of breastfeeding sessions per day above the mean value were classified as Group A (n = 45), and those with values below the mean were classified as Group B (n = 67). Results: The mean number of breastfeeding sessions per day was 10.15. The EPDS scores of Group A (6 [0-19]) were significantly lower than those of Group B (8 [0-20]) (p < 0.05). A negative linear relationship was found between the number of breastfeeding sessions per day and the EPDS scores on the 10th day postpartum (p < 0.05). No statistically significant difference was found between the EPDS scores and the education status, age, or gestational week of the patients (p > 0.05). There was no statistically significant difference between the number of breastfeeding sessions per day and the education status or age of the patients (p > 0.05). Conclusions: Higher number of breastfeeding sessions per day is associated with less risk of maternal postpartum depression. There is a need for new studies on the consequences of the number and quality of breastfeeding sessions.

The Impact of Physical Activity on the Development of Postpartum Depression

Although the benefits of physical activity (PA) on mental well‐being are well established, the vulnerability of women during pregnancy and the postpartum period poses challenges in studying the effects of PA on postpartum depression (PPD). This study investigated the association between total and domain‐specific PA levels during pregnancy and postpartum depressive symptoms. The study included 105 healthy pregnant women whose PA status was evaluated by the Serbian version of the Physical Activity Questionnaire during Pregnancy (PPAQ‐SRB) and their postpartum mental health by the Edinburgh Postnatal Depression Scale. Multivariable logistic regression was used to explore the independent relationship between PPAQ‐SRB scores and the prediction of the PPD symptom occurrence. Our analysis revealed that the development of PPD symptomatology was associated with a lower “Total PPAQ‐SRB score” (odds ratio (OR) 0.81; 95% confidence interval (CI) [0.70–0.93]; p = 0.03) and “Total Activity score” (OR 0.82; 95% CI [0.71–0.93]; p = 0.03) as well as lower scores of light‐intensity PA (OR 0.81; 95% CI [0.69–0.96]; p = 0.013), moderate‐intensity PA (OR 0.82; 95% CI [0.71–0.94]; p = 0.005), “Household/care” (OR 0.85; 95% CI [0.73–0.98]; p = 0.028), and “Occupational” activities (OR 0.80; 95% CI [0.78–0.95]; p = 0.012). Lower levels of light‐to‐moderate‐intensity household and occupational activities appeared to increase the risk of PPD, indicating the importance of circumstances under which PA is performed. Hence, our findings indicate that PA during pregnancy can mitigate mood disorders in postpartum mothers. Moreover, reduced participation in light‐to‐moderate‐intensity household and occupational activities seemed to increase the risk of PPD.

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.

Correlation of lifestyle behaviors during pregnancy with postpartum depression status of puerpera in the rural areas of South China

Background

Postpartum depression (PPD) is among the most common postpartum complications. Its prevalence is associated with strong regional variability. Women in rural areas of China have a high risk of PPD. The aim of this study was to investigate the PPD status of women in rural South China and explore the effects of modifiable lifestyle behaviors during pregnancy on their PPD status, thereby providing a scientific basis for the prevention and intervention of PPD in rural China.

Methods

A cohort study was conducted on 261 women from four maternal health institutions situated in rural areas of Guangdong Province and the Guangxi Zhuang Autonomous Region from October 2021 to December 2022. The questionnaires were administered to these women to obtain data about sociodemographic characteristics, health literacy, physical activity during pregnancy, and sleep and dietary status during pregnancy, as well as depression status on the 42nd day after delivery. The lifestyle behaviors during pregnancy and the PPD status of the study population were analyzed. Multiple linear regression models were used to determine the correlation between lifestyle behaviors and PPD status. Path analysis was performed to explore the interaction between various lifestyle behaviors.

Results

A total of 14.6% of women had a PPD status. Women who continued to work during pregnancy had an Edinburgh Postpartum Depression Scale (EPDS) score of 1.386 points higher than that of women who did not (В = 1.386, β = 0.141, p = 0.029). For every 1-point increase in the infant feeding-related knowledge score and pregnancy diet diversity score, the EPDS score decreased by 0.188 and 0.484 points, respectively, and for every 1-point increase in the Pittsburgh sleep quality index score, the EPDS score increased by 0.288 points. Age was related to infant feeding-related knowledge (indirect path coefficient = 0.023). During pregnancy, sedentary time was correlated with sleep quality (indirect path coefficient = 0.031) and employment status (indirect path coefficient = 0.043).

Conclusion

Employment status, infant feeding-related knowledge, sleep quality, and diet diversity during pregnancy directly influenced the PPD status, while age and sedentary time during pregnancy indirectly influenced the PPD status. Promoting healthy lifestyle behaviors, including reducing sedentary time, improving sleep quality, and increasing dietary diversity, may be effective in reducing PPD occurrence.

Investigating the relationship between hepatitis B virus infection and postpartum depression in Chinese women: a retrospective cohort study

Background

Postpartum depression (PPD) is associated with several psychological and obstetric factors. Hepatitis B virus (HBV) infection has been linked with a high risk of depression, but little is known about the relationship between maternal HBV infection and PPD. We aimed to investigate the association between HBV infection and PPD.

Methods

This retrospective cohort study included 3,808 mothers who gave birth in a hospital in southern China. Self-reported Edinburgh Postnatal Depression Scale (EPDS) was used to assess PPD. Multivariate logistic regression was used to determine whether maternal HBV infection was associated with PPD risk.

Results

Of the 3,808 participants, 11.9% of mothers had PPD at 6 weeks postpartum. Two hundred and seventy-eight (7.3%) and 3,530 (92.7%) were in the HBV and control groups, respectively. Women with HBV infection were more likely to test positive for PPD (14.7 vs.11.7%). The multivariate logistic regression analysis showed that HBV-infected women did not have a significantly higher incidence of PPD (OR = 1.23; 95% CI, 0.82-1.84) than those without HBV infection in the study cohort. Parity and postpartum hemorrhage were found to be associated with PPD. In addition, our study showed that e antigen positivity was not associated with PPD risk (OR = 0.56, 95% CI 0.19-1.63).

Conclusions

To our knowledge, this is the first investigation of the relationship between maternal HBV infection and PPD. In a cohort of women without prior history or family history of mental illness, having HBV infection was not significantly associated with self-reporting of PPD compared to not having HBV infection.

"It Slowly Drained the Life Out of Me, Leaving Me Dead Inside": Coping and Response Patterns Among Chinese Women Experiencing Postpartum Depression

The prevalence of postpartum depression (PPD) exceeds 20% in China. In this article, we unpack the coping strategies and involuntary responses to PPD among Chinese women and how such patterns are shaped by family communication dynamics and reflect distinct social, structural, and cultural contexts. Drawing upon the communication accommodation theory and the generic stress and coping model, we analyzed 661 posts collected under the hashtag #PPD (chanhou yiyuzheng) on Zhihu using the phronetic iterative approach. The analysis reveals that women self-identifying as having PPD often find themselves situated within a family environment marked by non-adaptive communication, culminating in insufficient support from their social circles. Furthermore, a significant number of these women lack effective coping mechanisms to manage PPD. Instead, they tend to stifle their expressions and needs through automatic responses, dedicating themselves to constant self-monitoring without practicing self-care. Our findings contribute to informed policymaking for postpartum support, addressing nuanced challenges encountered by new mothers in China.

Postpartum depression: The prevalence and associated factors among women attending postnatal clinics in the Bawku municipality, Upper East Region of Ghana

Introduction

This study examined postpartum depression (PPD) among mothers in the Bawku municipality of Ghana, aiming to assess its prevalence and associated risk factors.

Methods

A total of 242 women, 2-12 weeks postpartum, were randomly recruited for this cross-sectional analytical study. The Edinburgh Postnatal Depression Scale was used for depression screening, and multivariate logistic regression analysis was employed to assess the factors associated with PPD.

Results

The study showed that 34.7% of the postpartum mothers were within the age range of 25-29, with a mean age of 27.9 (standard deviation [SD] ± 6.33). The prevalence of PPD was 50.4% (95% confidence interval [CI] 43.9-56.9). Several significant risk factors were identified, including inadequate prenatal visits (adjusted odds ratio [aOR] = 13.44, 95% CI 3.66-49.37, P < 0.001), obstetric complications (aOR = 3.39, 95% CI 1.23-11.19, P = 0.019), less than 3 weeks postpartum (aOR = 8.14, 95% CI 1.95, 33.94, P = 0.004), 6-8 weeks postpartum (aOR = 7.72, 95% CI 1.71-34.80, P = 0.008), and stressful life events (aOR = 3.30, 95% CI 1.23-8.89, P = 0.018).

Conclusion

The study concluded that the prevalence of PPD in the Bawku municipality is higher than previously reported in Ghana, emphasizing the need for early identification of pregnant women at risk for PPD.

Nutritional factors and cross-national postpartum depression prevalence: an updated meta-analysis and meta-regression of 412 studies from 46 countries

Background

Postpartum depression (PPD) is the most common complication associated with childbirth and can lead to adverse outcomes for both mothers and their children. A previous meta-analysis found that PPD prevalence varies widely across countries. One potential underexplored contributor to this cross-national variation in PPD is diet, which contributes to mental health and varies significantly around the world. Here, we sought to update the global and national estimates of PPD prevalence using systematic review and meta-analysis. Further, we examined whether cross-national variation in PPD prevalence is associated with cross-national variation in diet using meta-regression.

Methods

To estimate national rates of PPD prevalence, we conducted an updated systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale between 2016-2021 and combined our findings with a previous meta-analysis of articles published between 1985-2015. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To examine dietary predictors, we extracted data on sugar-sweetened beverage, fruit, vegetable, total fiber, yogurt, and seafood consumption from the Global Dietary Database. Random effects meta-regression was used to test whether between-country and within-country variation in dietary factors predicted variation in PPD prevalence, controlling for economic and methodological variables.

Results

412 studies of 792,055 women from 46 countries were identified. The global pooled prevalence of PPD was 19.18% (95% confidence interval: 18.02 to 20.34%), ranging from 3% in Singapore to 44% in South Africa. Countries that consumed more sugar-sweetened beverages (SSBs) had higher rates of PPD (Coef. = 0.325, p = 0.044, CI:0.010-0.680); Moreover, in years when higher rates of sugar-sweetened beverages were consumed in a country, there were correspondingly higher rates of PPD in that country (Coef. = 0.129, p = 0.026, CI: 0.016-0.242).

Conclusion

The global prevalence of PPD is greater than previous calculations, and drastically varies by country. Sugar-sweetened beverage consumption explained some of the national variation in PPD prevalence.

Postpartum depression literacy in Chinese perinatal women: a cross-sectional study

Background

Postpartum depression literacy is a specific mental health literacy that can help perinatal women identify, manage, and prevent postpartum depression. However, the current status and associated factors of postpartum depression literacy among Chinese perinatal women are still unclear. This study investigated postpartum depression literacy and its associated factors among this group.

Methods

A cross-sectional survey was conducted involving 386 cases of perinatal women using the convenience sampling method. Participants completed four questionnaires to evaluate their general characteristics, postpartum depression literacy, perceived social support, and general self-efficacy. The SPSS 24.0 software was used for descriptive statistical analysis, univariate analysis, and multivariate analysis.

Results

The total PoDLiS score was (3.56 ± 0.32). The factors that composed the final multiple regression equation included planned pregnancy condition (β = -0.137, p = 0.003), education (β = 0.127, p < 0.001), history of depression (β = -0.271, p < 0.001), social support (β = 0.0012, p < 0.001), self-efficacy (β = 0.030, p < 0.001), and complications (β = -0.0191, p = 0.0019). They accounted for 32.8% of the total postpartum depression literacy variation (R² = 0.328, F = 24.518, p < 0.001).

Conclusion

The findings of this study improved our understanding of perinatal women's postpartum depression literacy and its associated factors. Women with low postpartum depression literacy urgently need to be identified. Comprehensive nursing intervention measures should be taken from six dimensions of mental health literacy, social support, and self-efficacy to improve the postpartum depression literacy of perinatal women.

A Psychometric Study of the Perinatal Assessment of Maternal Affectivity (PAMA) for the Screening of Perinatal Affective Disorders in Mothers

Recently, empirical evidence from perinatal studies has led researchers to pay more attention to fathers. The need to evaluate male suffering led at first to using the same screening tools developed for mothers. However, these instruments present validity concerns with fathers, and today the need to assume a gender-based perspective is clear. The Perinatal Assessment of Paternal Affectivity (PAPA) is a self-reported questionnaire for the screening of a variety of psychological and behavioral dimensions related to affectivity as experienced by fathers during the perinatal period. In the present study, the psychometric properties of the maternal version of the scale (Perinatal Assessment of Maternal Affectivity; PAMA) were examined. The study, based on 225 mothers and their partners (n = 215), used a cross-sectional design with a single assessment at the third trimester of pregnancy. Results indicated a one-factor structure for a seven-item version of the PAMA, which showed adequate internal consistency reliability and was associated in the expected direction with other clinically relevant variables (depression, psychological distress, perceived stress and dyadic adjustment). The findings suggest the usefulness of developing gender sensitive screening tools for the detection of perinatal affective disorders.

Hot spots and frontiers of postpartum depression research in the past 5 years: A bibliometric analysis

Objective

This study applied the bibliometric method to analyze the hotspots and frontiers in the field of postpartum depression research from 2017 to 2021.

Methods

A computer-based search for studies related to postpartum depression (PPD) was conducted in the Web of Science Core Collection from 2017 to 2021. Using CiteSpace 5.8. R3 visualization software, this paper analyzed the hot spots and frontiers of postpartum depression research from countries, institutions, authors, cited references and keywords, and drew corresponding knowledge maps.

Results

A total of 3,789 articles were retrieved, and the annual publication volume showed a steady increase. The countries and institutions with the most publications were the United States and the University of Toronto, respectively. Cindylee Dennis was the most productive author. The most frequently cited and centrally cited articles were meta-analyses on risk factors associated with antenatal depression or anxiety and meta-analyses on the prevalence of antenatal or postnatal anxiety, respectively. The research hotspots in the field of postpartum depression in the past 5 years mainly focused on the risk factors for PPD, and the impact of the COVID-19 epidemic on PPD. Providing various aspects of social and family support to women with PPD may be a research trend in this field.

Conclusion

This study provides a trend and frontier in the field of postpartum depression, and valuable information for researchers to find potential partners and partner countries, and a reference for future research topics and development directions.

Postpartum depression and its correlates: a cross-sectional study in southeast Iran

Background

Postpartum depression has a negative impact on both infants and women. This study aimed to determine the correlates of postpartum depression in women in southern Iran.

Methods

This cross-sectional study was performed on 186 mothers who had recently given birth to a baby. Data were collected using the demographic form, Quality of Prenatal Care Questionnaire, Edinburgh Postnatal Depression Scale (EPDS), Depression, Anxiety and Stress Scale—21 items (DASS-21) 3 days after delivery and EPDS and DASS-21 6 months after childbirth.

Results

Postpartum depression (PPD) was 24.2% and 3.2% 3 days and 6 months after delivery, respectively. Anxiety, Prenatal Care Quality and educational level predicted 34.0% of the variance of PPD 3 days after delivery (R² = 34.0%). Anxiety, type of delivery, and stress predicted 24% of the variance of PPD 6 months after delivery (R² = 24.0%).

Conclusions

With an increase in stress and anxiety and a reduction in the quality of prenatal care, the risk of postpartum depression increases. Therefore, attention to the quality of prenatal care and postpartum stress and anxiety should be carefully evaluated to prevent PPD. Psychological support and interventions are recommended to promote the mental health of women before and after childbirth.

Towards Universal Screening for Postpartum Depression in China: Lessons Learned from a Comprehensive Prevention Programme in Shenzhen

PURPOSE

This study was conducted to assess the real-world efficacy of a universal programme for the prevention of postpartum depression (PPD) in Shenzhen. Given the lack of evidence on routine PPD screening and intervention in China, it sought to provide insights for programme planning and implementation, particularly in relation to achievement of the targets set by the first national guidelines for PPD prevention and treatment.

METHODS

Using routine health information system data, the PPD screening, referral and intervention rates for 2015-2019 were calculated and compared to the programmes targets. Trends of variables were tested by using trend χ².

RESULTS

The programme screened 137,761 to 178,857 women for PPD every year with the coverage among all postpartum women increased steadily from 71.1% to 82. 5% (χ² = 10145.251, p < 0.001). The PPD-positive rate maintained between 4.06% and 4.89%. However, although referral messages were given to an increased percentage of PPD-positive women (χ² = 1090.908, p < 0.001), the intervention rate (i.e., referral uptake) were far lower than the programme target of 80%.

CONCLUSIONS

This study demonstrated high efficacy of Shenzhen's comprehensive PPD prevention programme initiated in 2013. The resultant rise in the screening rate among all postpartum women, together with a high referral rate of those screened positive, have contributed to the city's relatively low PPD prevalence. PPD screening and intervention should be included as part of basic public health services to ensure universal coverage and specific strategies should be adopted to ensure referral uptake.

Additional evidence on prevalence and predictors of postpartum depression in China: A study of 300,000 puerperal women covered by a community-based routine screening programme

BACKGROUND

Previous studies on the prevalence and predictors of postpartum depression (PPD) in China were mostly hospital-based with relatively small study samples. Basing on a routine screening programme, this study assessed the prevalence and factors associated with PPD at community level.

METHODS

A cross-sectional study was conducted with all the women who delivered in a hospital and were screened for depression during routine postpartum home visits in Shenzhen between 2015 August and 2017 April. The Edinburgh Postnatal Depression Scale was used as the screening tool with a cut-off score of 10. Predictors of PPD were determined by Chi-square test and stepwise logistic regression.

RESULTS

Approximately 300,000 puerperal women were included in the study with a PPD prevalence of 4.3%. Prenatal anxiety and depression were associated with 4.55 and 3.80 times of PPD risk, respectively. Stressful life events, family history of mental illness, poor economic status, low Apgar scores and birth defects of the infants, bottle and mixed feeding, as well as living with parents-in-low after childbirth were related to moderate risk. Higher gravidity and parity, larger gestation age, prenatal education, and living with the women's own parents were associated with lower risk.

LIMITATIONS

The large sample size might have suggested statistically significant differences which were not practical.

CONCLUSIONS

The prevalence of PPD at community level is significantly lower than the rates detected within hospitals. Prenatal anxiety and depression are the most important predictors of PPD. Integrating depression screening into routine postpartum home visits facilitates achievement of universal coverage.

Postpartum hemorrhage and postpartum depressive symptoms: A retrospective cohort study

BACKGROUND

Many psychological and obstetrical factors contribute to the development of postpartum depression. However, little is known about how postpartum hemorrhage (PPH) influences postpartum depressive symptoms. This study explored the relationship between PPH and postpartum depressive symptoms in the Chinese population.

METHODS

A retrospective cohort study was conducted at the Baoan Maternal and Child Health Hospital in Shenzhen, China, from January 2016 to June 2020. The Edinburgh Postnatal Depression Scale was used to assess postpartum depressive symptoms. A multivariate logistic regression model was used to estimate the odds ratios (ORs) with 95% confidence intervals (95% CIs) between PPH and risk of postpartum depressive symptoms.

RESULTS

Of the 7734 respondents, 293 (3.8%) and 7441 were in the PPH and control groups, respectively. Puerperal women with PPH were more likely to screen positive for postpartum depressive symptoms than those without PPH (16.4% vs. 11.7%, p = .016). Adjusting for other covariates, women with PPH still had higher risk of postpartum depressive symptoms (OR = 1.68, 95% CI: 1.16-2.42). Stratification analyses revealed no interaction between PPH and maternal age, prepregnancy body mass index, mode of delivery, and fetal sex in developing depressive symptoms (p for interaction > .05).

CONCLUSIONS

PPH may increase the risk of postpartum depressive symptoms. Therefore, women with PPH should be actively screened for depressive symptoms in the immediate postpartum period.

Predictors of Postpartum Depression among Italian Women: A Longitudinal Study

INTRODUCTION

Postpartum depression is commonly experienced by mothers worldwide and is associated with anxiety disorders, parenting stress, and other forms of distress, which may lead to a complex illness condition. Several studies have investigated the risk factors for this disorder, including biological and socio-demographic variables, medical and obstetric factors, and psychological and relational dimensions. The present study aimed to describe the psychological status of mothers up to 12 months postpartum, and to investigate the predictors of depressive symptoms at 12 months postpartum, considering obstetric factors along with psychological and relational variables.

METHODS

A sample of 137 women completed a questionnaire composed of a sheet on anamnestic and obstetric information and the following scales: Wijma Delivery Experience Questionnaire; State-Trait Anxiety Inventory; Edinburgh Postnatal Depression Scale; Parenting Stress Index (Short Form); Dyadic Adjustment Scale; and Multidimensional Scale of Perceived Social Support. Data were collected at four assessment times: 2-3 days, 3 months, 6 months, and 12 months postpartum.

RESULTS

Findings showed that the highest percentage of women with clinically significant symptoms of anxiety (state and trait) and depression was found at 12 months postpartum, which indicated that this was the most critical time. The quality of childbirth experience and trait anxiety at three months postpartum emerged as significant predictors of postpartum depression at 12 months.

CONCLUSION

Our findings highlight the importance of providing stable programs (such as educational programs) to mothers in the first year postpartum. Furthermore, because the quality of the childbirth experience is one of the most important predictors of PPD at 12 months postpartum, effort should be made by healthcare professionals to guarantee a positive experience to all women to reduce possible negative long-term consequences of this experience.