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Yaqoob H, Ju XD, Bibi M, Anwar S, Naz S. "A systematic review of risk factors of postpartum depression. Evidence from Asian culture ". Acta Psychol (Amst) 2024; 249:104436. [PMID: 39142256 DOI: 10.1016/j.actpsy.2024.104436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 07/08/2024] [Accepted: 07/25/2024] [Indexed: 08/16/2024] Open
Abstract
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.
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Affiliation(s)
- Hina Yaqoob
- School of Psychology, Northeast Normal University, Changchun, Jilin, China.
| | - Xing-Da Ju
- School of Psychology, Northeast Normal University, Changchun, Jilin, China; Jilin Provincial Key Laboratory of Cognitive Neuroscience and Brain Development, China.
| | - Maryum Bibi
- School of Psychology, Northeast Normal University, Changchun, Jilin, China.
| | - Saeed Anwar
- School of Psychology, Northeast Normal University, Changchun, Jilin, China.
| | - Sumaira Naz
- School of Psychology, Northeast Normal University, Changchun, Jilin, China.
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Lee J, Kim SG, Lee SI, Youn H. Psychosocial Factors Associated With Thoughts Regarding Life-Sustaining Treatment for Oneself and Family Members. Psychiatry Investig 2024; 21:646-654. [PMID: 38960442 PMCID: PMC11222083 DOI: 10.30773/pi.2024.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/12/2024] [Accepted: 04/10/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE This study aims to investigate the thoughts of the general population regarding life-sustaining treatment for both oneself and family members and to assess the factors associated with those thoughts. METHODS A total of 1,500 individuals participated in this study by completing a questionnaire consisting of self-reporting items with some instructions, basic demographic information, thoughts on life-sustaining treatment, and psychosocial scales. The disease status was calculated using the Charlson Comorbidity Index. The psychosocial scales included the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index, and Multidimensional Scale of Perceived Social Support. RESULTS The majority of participants did not want to receive life-sustaining treatment for both themselves and their families. However, more people wanted life-sustaining treatment for their family members (35.9%) than for themselves (21.6%). Among the basic demographic characteristics, there were significant differences in age, sex, marital status, living arrangements, occupational status, religion, and disease status. Regarding the psychosocial scales, there were significant differences in the PHQ-9 and GAD-7 scores between the group that preferred life-sustaining treatment for family members and the group that did not. CONCLUSION The findings suggest that life-sustaining treatment decisions for oneself and for one's family members can be different. We recommend a more clear expression of one's preferences regarding the last moments of one's life, including advance directives.
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Affiliation(s)
- Jeewon Lee
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Shin-Gyeom Kim
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Soyoung Irene Lee
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - HyunChul Youn
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
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Nie X, Xu Z, Ren H. Analysis of risk factors of preeclampsia in pregnant women with chronic hypertension and its impact on pregnancy outcomes. BMC Pregnancy Childbirth 2024; 24:307. [PMID: 38658851 PMCID: PMC11040943 DOI: 10.1186/s12884-024-06476-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE To investigate the risk factors and maternal and fetal outcomes of preeclampsia after pregnancy in patients with primary chronic hypertension. METHODS A total of 500 singleton pregnant women with a history of hypertension who were admitted for delivery at our Hospital from March 2015 to May 2022 were retrospectively collected by random sampling and divided into the non-occurrence group (n = 200) and the occurrence group (n = 300) according to whether they were complicated by preeclampsia. Afterward, the general data and the pregnancy-related data of patients were collected for comparison. RESULTS The univariate analysis showed significant differences between the non-occurrence group and the occurrence group in terms of the proportion of preeclampsia history (4.00% VS 24.67%, χ2 = 37.383, P < 0.001), duration of hypertension > 3 years (18.00% VS 31.67%, χ2 = 11.592, P < 0.001), systemic therapy (20.50% VS 10.00%, χ2 = 10.859, P < 0.001), gestational age at admission [37.72 (34.10, 38.71) VS 35.01 (31.91, 37.42) weeks, Z = -9.825, P < 0.001]. Meanwhile, the multivariate analysis showed that a history of preeclampsia (OR = 6.796, 95% CI: 3.575 ∼ 10.134, χ2 = 8.234, P < 0.001), duration of hypertension > 3 years (OR = 3.456, 95% CI: 2.157 ∼ 5.161, χ2 = 9.348, P < 0.001), and a lack of systemic antihypertensive treatment (OR = 8.983, 95% CI: 7.735 ∼ 9.933, χ2 = 9.123, P < 0.001) were risk factors for chronic hypertension complicated by preeclampsia during pregnancy. CONCLUSION A history of preeclampsia, a longer duration of hypertension, and a lack of systematic antihypertensive treatment are risk factors for chronic hypertension complicated by preeclampsia during pregnancy. The occurrence of preeclampsia in pregnant women with chronic hypertension increases the incidence of maternal HELLP syndrome and fetal distress.
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Affiliation(s)
- Xiaorui Nie
- Department of obstetrics and gynecology Beijing Chaoyang District Maternal and Child Health Care Family Planning Service Center (Beijing Chaoyang District Maternal and Child Health Care Hospital), No. 25 Huaweili, Panjiayuan Street, Chaoyang District, Beijing, 100021, China
| | - Zijie Xu
- Department of obstetrics and gynecology Beijing Chaoyang District Maternal and Child Health Care Family Planning Service Center (Beijing Chaoyang District Maternal and Child Health Care Hospital), No. 25 Huaweili, Panjiayuan Street, Chaoyang District, Beijing, 100021, China
| | - Hong Ren
- Department of obstetrics and gynecology Beijing Chaoyang District Maternal and Child Health Care Family Planning Service Center (Beijing Chaoyang District Maternal and Child Health Care Hospital), No. 25 Huaweili, Panjiayuan Street, Chaoyang District, Beijing, 100021, China.
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Froeliger A, Deneux-Tharaux C, Loussert L, Bouchghoul H, Madar H, Sentilhes L. Prevalence and risk factors for postpartum depression 2 months after a vaginal delivery: a prospective multicenter study. Am J Obstet Gynecol 2024; 230:S1128-S1137.e6. [PMID: 38193879 DOI: 10.1016/j.ajog.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Very little is known about the prevalence and risk factors of postpartum depression among women with vaginal births without major pregnancy complications. OBJECTIVE This study aimed to assess the prevalence of postpartum depression and identify its characteristics 2 months after singleton vaginal delivery at or near term. STUDY DESIGN This was an ancillary cohort study of the TRanexamic Acid for Preventing Postpartum Hemorrhage After Vaginal Delivery randomized controlled trial, which was conducted in 15 French hospitals in 2015-2016 and enrolled women with singleton vaginal deliveries after 35 weeks of gestation. After randomization, the characteristics of labor, delivery, and the immediate postpartum experience, including the experience of childbirth, were prospectively collected. Medical records provided women's other characteristics, particularly any psychiatric history. Of note, 2 months after childbirth, provisional postpartum depression diagnosis was defined as a score of ≥13 on the Edinburgh Postnatal Depression Scale, a validated self-administered questionnaire. The corrected prevalence of postpartum depression was calculated with the inverse probability weighting method to take nonrespondents into account. Associations between potential risk factors and postpartum depression were analyzed by multivariate logistic regression. Moreover, an Edinburgh Postnatal Depression Scale cutoff value of ≥11 was selected to perform a sensitivity analysis. RESULTS The questionnaire was returned by 2811 of 3891 women (72.2% response rate). The prevalence rates of the provisional diagnosis were 9.9% (95% confidence interval, 8.6%-11.3%) defined by an Edinburgh Postnatal Depression Scale score of ≥13 and 15.5% (95% confidence interval, 14.0%-17.1%) with a cutoff value of ≥11. The characteristics associated with higher risks of postpartum depression in multivariate analysis were mostly related to prepregnancy characteristics, specifically age of <25 years (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-2.9) and advanced age (adjusted odds ratio, 1.8; 95% confidence interval, 1.2-2.6), migration from North Africa (adjusted odds ratio, 2.9; 95% confidence interval, 1.9-4.4), previous abortion (adjusted odds ratio, 1.4; 95% confidence interval, 1.0-2.0), and psychiatric history (adjusted odds ratio, 2.9; 95% confidence interval, 1.8-4.8). Some characteristics of labor and delivery, such as induced labor (adjusted odds ratio, 1.5; 95% confidence interval, 1.1-2.0) and operative vaginal delivery (adjusted odds ratio, 1.4; 95% confidence interval, 1.0-2.0), seemed to be associated with postpartum depression. In addition, bad memories of childbirth in the immediate postpartum were strongly associated with postpartum depression symptoms at 2 months after giving birth (adjusted odds ratio, 2.4; 95% confidence interval, 1.3-4.2). CONCLUSION Approximately 10% of women with vaginal deliveries have postpartum depression symptoms, assessed by a score of ≥13 on the depression scale that was used at 2 months. Prepregnancy vulnerability factors; obstetrical characteristics, such as induced labor and operative vaginal delivery; and bad memories of childbirth 2 days after delivery were the main factors associated with this provisional diagnosis. A screening approach that targets risk factors may help to identify women at risk of postpartum depression who could benefit from early intervention.
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Affiliation(s)
- Alizée Froeliger
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France; Perinatal Obstetrical and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics, National Institute of Health and Medical Research, Université Paris Cité, Paris, France
| | - Catherine Deneux-Tharaux
- Perinatal Obstetrical and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics, National Institute of Health and Medical Research, Université Paris Cité, Paris, France
| | - Lola Loussert
- Perinatal Obstetrical and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics, National Institute of Health and Medical Research, Université Paris Cité, Paris, France; Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse, France
| | - Hanane Bouchghoul
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Hugo Madar
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
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Shang J, Hackett ML, Harris K, Woodward M, Roberts LM, Zhang P, Henry A. Mental health in the two years following hypertensive and normotensive pregnancy: The Postpartum, Physiology, Psychology and Paediatric follow-up (P4) cohort study. Pregnancy Hypertens 2024; 35:43-50. [PMID: 38171140 DOI: 10.1016/j.preghy.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/18/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Postpartum mental illnesses and hypertensive disorders of pregnancy (HDP) are both common, and both associated with adverse maternal and child health outcomes. However, the relationship between them is unclear. This study aimed to investigate prevalence and symptom severity of depression, anxiety, and post-traumatic stress disorder (PTSD) 2-years postpartum in women with normal blood pressure (NBP) during pregnancy versus preeclampsia or gestational hypertension (GH). METHODS Two-years follow-up of the prospective Postpartum, Physiology, Psychology and Paediatric (P4) Cohort Study was conducted in metropolitan Australia. Prevalence and symptom severity of depression (Edinburgh Postnatal Depression Scale, EPDS > 12), anxiety (7-item Generalized Anxiety Disorder scale, GAD-7 ≥ 10) and PTSD (Posttraumatic stress Diagnostic Scale, PDS/PDS-5) were measured and calculated for women with NBP, preeclampsia and GH. RESULTS Among 365 participants (NBP: n = 271, preeclampsia: n = 75, GH: n = 19), 2-years postpartum depression prevalence was 3.9% (95% CI 2.3-6.4%): 4.4% after NBP, and 2.7% after preeclampsia (p = 0.53). Anxiety prevalence was higher after GH than NBP (15.8% versus 3.3%, p = 0.02). Prevalence of any mental illness (depression/anxiety/PTSD) was 5.9% (95% CI 3.8-8.8%); 5.6% after NBP, 4.1% after PE, and 15.8% after GH (p = 0.15). Although PTSD prevalence was low (1.4%), and similar between groups (p = 0.97), around 3 times more women after PE (8.1%), compared to NBP (2.5%), recalled childbirth as traumatic (p = 0.003). CONCLUSIONS Preeclampsia, although associated with persistent perceptions of traumatic childbirth, did not alter the risk of mental illnesses at 2-years postpartum. GH (albeit in a small subgroup) was associated with increased anxiety scores. Larger, multicentre studies are required to clarify relationships between HDP and postpartum mental illness. TRIAL REGISTRATION Retrospectively registered on 18/11/2013 with the Australian and New Zealand Clinical Trials Registry. REGISTRATION NUMBER ACTRN 12613 00,126 0718.
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Affiliation(s)
- Jie Shang
- Discipline of Women's Health, School of Clinical Medicine, Faculty of Medicine, and Health, University of New South Wales, Sydney, Australia; The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
| | - Maree L Hackett
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Katie Harris
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Mark Woodward
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; The George Institute for Global Health, School of Public Health, Imperial College London, UK
| | - Lynne M Roberts
- Department of Women's and Children's Health, St George Hospital, Kogarah, NSW, Australia; St George and Sutherland Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | | | - Amanda Henry
- Discipline of Women's Health, School of Clinical Medicine, Faculty of Medicine, and Health, University of New South Wales, Sydney, Australia; The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Department of Women's and Children's Health, St George Hospital, Kogarah, NSW, Australia.
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Shim SH, Lee SY, Jung I, Heo SJ, Han YJ, Kwak DW, Kim MH, Park HJ, Chung JH, Lim JH, Kim MY, Cha DH, Shim SS, Cho HY, Ryu HM. Risk Factors of Postpartum Depression Among Korean Women: An Analysis Based on the Korean Pregnancy Outcome Study (KPOS). J Korean Med Sci 2024; 39:e31. [PMID: 38258363 PMCID: PMC10803203 DOI: 10.3346/jkms.2024.39.e31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/09/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Postpartum depression (PPD) can negatively affect infant well-being and child development. Although the frequency and risk factors of PPD symptoms might vary depending on the country and culture, there is limited research on these risk factors among Korean women. This study aimed to elucidate the potential risk factors of PPD throughout pregnancy to help improve PPD screening and prevention in Korean women. METHODS The pregnant women at 12 gestational weeks (GW) were enrolled from two obstetric specialized hospitals from March 2013 to November 2017. A questionnaire survey was administered at 12 GW, 24 GW, 36 GW, and 4 weeks postpartum. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale, and PPD was defined as a score of ≥ 10. RESULTS PPD was prevalent in 16.3% (410/2,512) of the participants. Depressive feeling at 12 GW and postpartum factors of stress, relationship with children, depressive feeling, fear, sadness, and neonatal intensive care unit admission of baby were significantly associated with a higher risk of PPD. Meanwhile, high postpartum quality of life and marital satisfaction at postpartum period were significantly associated with a lower risk of PPD. We developed a model for predicting PPD using factors as mentioned above and it had an area under the curve of 0.871. CONCLUSION Depressive feeling at 12 GW and postpartum stress, fear, sadness, relationship with children, low quality of life, and low marital satisfaction increased the risk of PPD. A risk model that comprises significant factors can effectively predict PPD and can be helpful for its prevention and appropriate treatment.
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Affiliation(s)
- So Hyun Shim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Su Young Lee
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Inkyung Jung
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - You Jung Han
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Dong Wook Kwak
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Min Hyoung Kim
- Department of Obstetrics and Gynecology, Gangseo MizMedi Hospital, Seoul, Korea
| | - Hee Jin Park
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Jin Hoon Chung
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hyae Lim
- Smart MEC Healthcare R&D Center, CHA Future Medicine Research Institute, CHA Bundang Medical Center, Seongnam, Korea
| | - Moon Young Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Dong Hyun Cha
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Sung Shin Shim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Hee Young Cho
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
| | - Hyun Mee Ryu
- Smart MEC Healthcare R&D Center, CHA Future Medicine Research Institute, CHA Bundang Medical Center, Seongnam, Korea
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
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Grisbrook MA, Dewey D, Cuthbert C, McDonald S, Ntanda H, Letourneau N. The Association between Cesarean Section Delivery and Child Behavior: Is It Mediated by Maternal Post-Traumatic Stress Disorder and Maternal Postpartum Depression? Behav Sci (Basel) 2024; 14:61. [PMID: 38247713 PMCID: PMC10813011 DOI: 10.3390/bs14010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/28/2023] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
Cesarean sections (C-sections) account for up to 21% of births worldwide. Studies have linked delivery via C-section with an increased risk of child behavior problems, such as internalizing and externalizing behaviors. Maternal postpartum depression (PPD) is also linked to child behavioral problems and may play a mediating role in the association between the mode of delivery and child behavior. Mixed findings between mode of delivery and PPD may be due to a failure to distinguish between C-section types, as unplanned/emergency C-sections are linked to post-traumatic stress disorder (PTSD), which has been linked to PPD. The objectives of this study were to determine whether, (1) compared with spontaneous vaginal delivery (SVD) and planned C-section, unplanned/emergency C-sections are associated with increased child behavior problems at two to three years of age and (2) maternal PTSD and PPD mediate the association between delivery type and child behavior problems. A secondary data analysis was conducted on 938 mother-child dyads enrolled in the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Conditional process modeling was employed. Child behavior was assessed using the Child Behavior Checklist (CBCL) 1.5-5 years, and maternal PPD and PTSD were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Psychiatric Diagnostic Screening Questionnaire (PDSQ), respectively. No associations were found between delivery type and child behaviors; however, the indirect effect of emergency C-section on child behaviors was significant via the mediating pathway of maternal PTSD on PPD symptoms.
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Affiliation(s)
- Marie-Andrée Grisbrook
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 4N1, Canada; (M.-A.G.); (C.C.)
| | - Deborah Dewey
- Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada; (D.D.); (H.N.)
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Colleen Cuthbert
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 4N1, Canada; (M.-A.G.); (C.C.)
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Sheila McDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Henry Ntanda
- Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada; (D.D.); (H.N.)
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Nicole Letourneau
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 4N1, Canada; (M.-A.G.); (C.C.)
- Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada; (D.D.); (H.N.)
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
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8
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Dutsch-Wicherek MM, Bączkowska M, Knafel A, Sadowski P, Gałązka K, Lew-Starowicz M. An analysis of placental chorionic villous and decidual basalis tissue immunoreactivity in patients after cesarean section due to a placenta accreta spectrum disorder and elective cesarean section followed by the depressed mood. J Obstet Gynaecol Res 2024; 50:55-64. [PMID: 37909688 DOI: 10.1111/jog.15821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 10/07/2023] [Indexed: 11/03/2023]
Abstract
An analysis of placental chorionic villous and decidual basalis tissue immunoreactivity in patients after cesarean section due to a placenta accreta spectrum disorder and elective cesarean section followed by a depressed mood. RESEARCH BACKGROUND Over the past few years, interest in investigating immune dysfunction in patients with psychiatric disorders has increased. B7-H4 is a molecule with immunosuppressive properties that seems to play a key role in establishing maternal tolerance against fetal antigens. The aim of this study was to compare the B7-H4 immunoreactivity levels in patients after cesarean section. METHODS Placental and decidual tissue samples were obtained from 49 women who delivered at Bielański Hospital in Warsaw between 2009 and 2015. Fifteen of the patients developed postpartum depression and 14 had a diagnosis of placenta accreta spectrum. The control group consisted of 20 healthy patients on whom cesarean section was performed due to breech presentation at term. RESULTS The highest levels of B7-H4 immunoreactivity were found in the placental chorionic villous and decidual basalis tissue samples of the patients who later developed postpartum depression, while the lowest levels were found in the samples of those patients with a placenta accreta spectrum disorder. The difference between the B7-H4 immunoreactivity levels of these two groups was statistically significant. The B7-H4 expression levels were statistically significantly higher in the women in the postpartum depression group than in the control group. CONCLUSION Postpartum depression follows a disturbance of the suppressive milieu responsible for rebalancing the maternal immune system after the initial cytotoxic activation during labor.
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Affiliation(s)
| | - Monika Bączkowska
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Anna Knafel
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Piotr Sadowski
- Department of Pathomorphology, Jagiellonian University Medical College, Krakow, Poland
| | - Krystyna Gałązka
- Department of Pathomorphology, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Lew-Starowicz
- Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw, Poland
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9
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Orovou E, Eskitzis P, Mrvoljak-Theodoropoulou I, Tzitiridou-Hatzopoulou M, Dagla M, Arampatzi C, Iliadou M, Antoniou E. The Relation between Neonatal Intensive Care Units and Postpartum Post-Traumatic Stress Disorder after Cesarean Section. Healthcare (Basel) 2023; 11:1877. [PMID: 37444711 DOI: 10.3390/healthcare11131877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The experience of a neonate hospitalized in the NICU is an understandably traumatic experience for parents, especially for the mothers of neonates. This mental distress resulting from preterm birth and/or NICU hospitalization can be understood as post-traumatic symptomatology, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 version). The aim of this study is to investigate the impact of the admission of a neonate to the NICU (forany reason) on the development of postpartum PTSD in a sample of women after cesarean section. METHODS A total of 469 women who gave birth with cesarean section from July 2019 to June 2020 participated in this study out of the original sample of 490 women who consented to participate. Data were obtained from the researcher's socio-demographic questionnaire and the post-traumatic stress checklist (PCL-5) from the Diagnostic and Statistical Manual of Mental Disorders DCM-5 version. RESULTS In total,11.7% of the sample experienced postpartum PTSD. There is a strong relationship between the inclusion of a neonate to the NICU due to perinatal stress, breathing difficulties, infections, and IUGR with postpartum PTSD (37.7%) in relation to the perinatal stress Criterion A (fear for the life of the neonate), the first criterion of postpartum PTSD. CONCLUSIONS Additional measures must be taken for mothers of children who have been admitted to the neonatal intensive care unit with psychological support interventions and a reassessment of their mental state.
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Affiliation(s)
- Eirini Orovou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | | | | | - Maria Dagla
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Christiana Arampatzi
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Evangelia Antoniou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
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10
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Orovou E, Eskitzis P, Mrvoljak-Theodoropoulou I, Tzitiridou-Chatzopoulou M, Arampatzi C, Rigas N, Palaska E, Dagla M, Iliadou M, Antoniou E. The Involvement of Neonatal Intensive Care Unit and Other Perinatal Factors in Postpartum PTSD After Cesarean Section. JOURNAL OF MOTHER AND CHILD 2023; 27:158-167. [PMID: 37920113 PMCID: PMC10623112 DOI: 10.34763/jmotherandchild.20232701.d-23-00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The experience of a neonate hospitalised in the Neonatal Intensive Care Unit (NICU) is an understandably traumatic experience for the parents, especially, for the mothers of neonates. This mental distress resulting from preterm birth and/or NICU hospitalisation can be understood as post-traumatic symptomatology, according to the Diagnostic and Statistical Manual-5 version. The aim of this study is to investigate the impact of the admission of a neonate to the NICU (from any reason) on the development of postpartum post-traumatic stress disorder (PTSD) in a sample of women after cesarean sections. MATERIAL AND METHODS A total of 469 women who gave birth with cesarean section from July 2019 to June 2020 participated in this study, from the original sample of 490 women who consented to participate. Data were obtained from the researcher's socio-demographic questionnaire, the past traumatic Life Events Checklist, the perinatal stressor Criterion A, and the Post-Traumatic Stress Checklist from the Diagnostic and Statistical Manual-5 version. RESULTS A percentage of 46.64% of sample experienced postpartum PTSD. Factors associated with PTSD were placenta previa type4, abruption, bleeding (β = .07, p = .049), premature contractions (β = .08, p = .039), heavy medical history or previous gynecological history and preeclampsia (β = .08, p = .034), abnormal heart rate, premature rupture of membrane, premature contractions, infections (β = .14, p = .004), life of child in danger (β = .12, p = .025), complications involving child (β = .15, p = .002), complications involving both (child and mother) (β = .12, p = .011), traumatic cesarean section (β = .041, p < .001) and prematurity (β = .12, p = .022). CONCLUSIONS Additional measures must be taken for mothers of children who have been admitted to the NICU with psychological support interventions and reassessment of their mental state.
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Affiliation(s)
- Eirini Orovou
- Department of Midwifery, University of West Attica, Egaleo, Greece
- Department of Midwifery, University of Western Macedonia, Keptse, Ptolemaida, Greece
| | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, Keptse, Ptolemaida, Greece
| | | | | | - Christiana Arampatzi
- Department of Midwifery, University of Western Macedonia, Keptse, Ptolemaida, Greece
| | - Nikolaos Rigas
- Department of Midwifery, University of West Attica, Egaleo, Greece
| | - Ermioni Palaska
- Department of Midwifery, University of West Attica, Egaleo, Greece
| | - Maria Dagla
- Department of Midwifery, University of West Attica, Egaleo, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Egaleo, Greece
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11
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Tsai JM, Tsai LY, Tsay SL, Chen YH. The prevalence and risk factors of postpartum depression among women during the early postpartum period: a retrospective secondary data analysis. Taiwan J Obstet Gynecol 2023; 62:406-411. [PMID: 37188444 DOI: 10.1016/j.tjog.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE Postpartum depression (PPD) is common and detrimental affecting both maternal health and child development. The purpose of this study was to determine the prevalence and factors of PPD screened immediately after delivery. MATERIALS AND METHODS A retrospective study design using secondary data analysis is applied. Four years of data, containing linkable maternal, neonate and PPD screen records between 2014 and 2018, was retrieved and combined from the electronic medical systems of MacKay Memorial Hospital in Taiwan. For each woman, the PPD screen record contained self-reported depressive symptoms assessed by the Edinburgh Postnatal Depression Scale (EPDS) within 48-72 h after delivery. A set of factors pertaining to maternal, pregnancy and obstetric, neonatal and breastfeeding were selected from the combined data set. RESULTS In total, 10.2% (1244 of 12,198) of women reported with the symptoms of PPD (EPDS ≥10). Through logistic regression analysis, eight predictors of PPD were identified. Specifically, PPD was shown to be associated with educational level of high school or lower (odds ratio (OR) = 1.57, 95% confidence interval (CI) 1.27-1.93), marital status of unmarried (OR = 1.52, 95% CI 1.18-1.99), unemployed (OR = 1.26, 95% CI 1.11-1.42), Cesarean section (OR = 1.7, 95% CI 1.5-1.93), unplanned pregnancy (OR = 1.38, 95% CI = 1.22-1.57), gestational age at 24-36 weeks (OR = 1.3, 95% CI 1.08-1.56), non-intention of breastfeeding (OR = 1.7, 95% CI 1.18-2.45) and Apgar at 5 min < 7 (OR = 2.18, 95% CI 1.11-4.29). CONCLUSION Low educational level, unmarried, unemployed, Caesarean section, unplanned pregnancy, preterm delivery, not breastfeeding and low Apgar at 5 min are predictors for postpartum women to develop PPD. These predictors are easily recognized in the clinical environment for patient guidance, support and referral as early as possible to ensure the health and well-being of the mothers and the neonates.
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Affiliation(s)
- Jung-Mei Tsai
- College of Nursing and Health Sciences, Dayeh University, No. 168, University Rd., Dacun, Changhua, 515006, Taiwan; Mackay Memorial Hospital, Taipei City, Taiwan; Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Li-Yun Tsai
- College of Nursing, Central Taiwan University of Science and Technology, No. 666, Buzih Rd., Beitun Dist., Taichung, 406053, Taiwan.
| | - Shiow-Luan Tsay
- College of Nursing and Health Sciences, Dayeh University, No. 168, University Rd., Dacun, Changhua, 515006, Taiwan.
| | - Yi-Heng Chen
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
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12
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Moya E, Mzembe G, Mwambinga M, Truwah Z, Harding R, Ataide R, Larson LM, Fisher J, Braat S, Pasricha SR, Mwangi MN, Phiri KS. Prevalence of early postpartum depression and associated risk factors among selected women in southern Malawi: a nested observational study. BMC Pregnancy Childbirth 2023; 23:229. [PMID: 37020182 PMCID: PMC10074867 DOI: 10.1186/s12884-023-05501-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND The birth of a child should be a time of celebration. However, for many women, childbirth represents a time of great vulnerability to becoming mentally unwell, a neglected maternal morbidity. This study aimed to determine the prevalence of early postpartum depression (PPD) and its associated risk factors among women giving birth at health facilities in southern Malawi. Identifying women vulnerable to PPD will help clinicians provide appropriately targeted interventions before discharge from the maternity ward. METHOD We conducted a nested cross-sectional study. Women were screened for early PPD using a locally validated Edinburgh Postpartum Depression Scale (EPDS) as they were discharged from the maternity ward. The prevalence of moderate or severe (EPDS ≥ 6) and severe (EPDS ≥ 9) PPD was determined, including 95% confidence intervals (CI). Data on maternal age, education and marital status, income source, religion, gravidity, and HIV status, among others, were collected during the second trimester of pregnancy, and obstetric and infant characteristics during childbirth were examined as potential risk factors for early PPD using univariable and multivariable logistic regression analyses. RESULTS Data contributed by 636 women were analysed. Of these women, 9.6% (95% CI; 7.4-12.1%) had moderate to severe early PPD using an EPDS cut-off of ≥ 6, and 3.3% (95% CI; 2.1-5.0%) had severe early PPD using an EPDS cut-off of ≥ 9. Multivariable analyses indicated that maternal anaemia at birth (aOR; 2.65, CI; 1.49-4.71, p-value; 0.001) was associated with increased risk for moderate and/or severe early PPD, while live birth outcome (aOR; 0.15, 95% CI; 0.04-0.54, p-value; 0.004), being single compared to divorced/widowed (aOR; 0.09, 95% CI; 0.02-0.55, p-value; 0.009), and lower education level (aOR; 0.36, 95% CI; 0.20-0.65, p-value; 0.001) were associated with decreased risk. Being HIV positive (aOR; 2.88, 95% CI; 1.08-7.67, p-value; 0.035) was associated with severe PPD only. CONCLUSION The prevalence of early PPD was slightly lower in our selected sample compared to previous reports in Malawi and was associated with maternal anaemia at birth, non-live birth, being divorced/widowed and HIV-positive status. Therefore, health workers should screen for depressive symptoms in women who are at increased risk as they are discharged from the maternity ward for early identification and treatment.
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Affiliation(s)
- E Moya
- Department of Public Health, School of Global and Public Health, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, BT3, Blantyre, Malawi.
- Training and Research Unit of Excellence (TRUE), 1 Kufa Road, PO Box 30538, Chichiri, Blantyre, BT3, Malawi.
| | - G Mzembe
- Department of Public Health, School of Global and Public Health, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, BT3, Blantyre, Malawi
- Training and Research Unit of Excellence (TRUE), 1 Kufa Road, PO Box 30538, Chichiri, Blantyre, BT3, Malawi
| | - M Mwambinga
- Training and Research Unit of Excellence (TRUE), 1 Kufa Road, PO Box 30538, Chichiri, Blantyre, BT3, Malawi
| | - Z Truwah
- Training and Research Unit of Excellence (TRUE), 1 Kufa Road, PO Box 30538, Chichiri, Blantyre, BT3, Malawi
| | - R Harding
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, Melbourne, VIC, 3052, Australia
| | - R Ataide
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, Melbourne, VIC, 3052, Australia
- The Peter Doherty Institute for Immunity and Infection, Dept of Infectious Diseases, The University of Melbourne, Melbourne, VIC, Australia
| | - Leila M Larson
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - J Fisher
- Global and Women's Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - S Braat
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, Melbourne, VIC, 3052, Australia
| | - S R Pasricha
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, Melbourne, VIC, 3052, Australia
| | - M N Mwangi
- Training and Research Unit of Excellence (TRUE), 1 Kufa Road, PO Box 30538, Chichiri, Blantyre, BT3, Malawi
- The Health Mothers Healthy Babies Consortium, Micronutrient Forum, 1201 Eye St, NW, 20005-3915, Washington, DC, USA
| | - K S Phiri
- Department of Public Health, School of Global and Public Health, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, BT3, Blantyre, Malawi
- Training and Research Unit of Excellence (TRUE), 1 Kufa Road, PO Box 30538, Chichiri, Blantyre, BT3, Malawi
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13
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Kim O, Kim B, Kim SY, Cho E, Lee HY, Cha C, Bae N, Kim M, Lee DH, Chavarro JE, Park HY, Kim S. Comparison of factors associated with postpartum depression from two cohorts of nurses: the Korea Nurses' Health Study and the Nurses' Health Study 3. Occup Environ Med 2023; 80:209-217. [PMID: 36823104 DOI: 10.1136/oemed-2022-108609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES This study aimed to identify whether differences exist in postpartum depression (PPD) in US and Korean nurses and its related factors. Identifying occupational and personal factors that underlie potential differences will be helpful for women's occupational health. METHODS Baseline and postpartum survey data from employed nurses in the Korea Nurses' Health Study and Nurses' Health Study 3 (1244 Korean; 2742 US nurses) were analysed. Postpartum data collection was done via online survey. PPD was analysed based on cultural validation from prior studies using the Edinburgh Postnatal Depression Scale (cut-off of 10 for Korea and 13 for USA); depressive symptoms prior to pregnancy and childbirth, general characteristics and sleep satisfaction were also measured. Descriptive statistics, χ2 tests and t-tests and multivariate ordinal logistic regression analysis were performed. RESULTS 45.9% of Korean participants had clinical symptoms of PPD (≥10), whereas US participants presented with 3.4% (≥13). Prior depressive symptoms were also higher in Korean participants (22.5%) compared with their US counterparts (4.5%). Prior depressive symptoms and poor sleep satisfaction were significant risk factors of PPD in both cohort groups, and vaginal birth was an additional influencing factor in Korean participants. CONCLUSIONS Differences in PPD rates and related factors suggest the role of stress, cultural variation and differing work systems. Nurses and other women shift-workers noted to have depressive symptoms before and during pregnancy and exhibit PPD symptoms should especially be followed closely and offered supportive mental health services that include greater flexibility in returning to work.
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Affiliation(s)
- Oksoo Kim
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | - Bohye Kim
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | - Su-Young Kim
- Department of Psychology, Ewha Womans University, Seoul, South Korea
| | - Eunyoung Cho
- Department of Dermatology and Epidemiology, Brown University, Providence, Rhode Island, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Hea Young Lee
- Department of Nursing, Doowon Technical University, Anseong, South Korea
| | - Chiyoung Cha
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | - Nohyun Bae
- Department of Nursing Science, Seojeong University, Yangju, South Korea
| | - Minjoo Kim
- Department of Psychology, Ewha Womans University, Seoul, South Korea
| | - Dong Hoon Lee
- Department of Sports Industry Studies, Yonsei University, Seoul, South Korea
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jorge E Chavarro
- Department of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Hyun-Young Park
- Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, South Korea
| | - Sue Kim
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
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14
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Buckley S, Uvnäs-Moberg K, Pajalic Z, Luegmair K, Ekström-Bergström A, Dencker A, Massarotti C, Kotlowska A, Callaway L, Morano S, Olza I, Magistretti CM. Maternal and newborn plasma oxytocin levels in response to maternal synthetic oxytocin administration during labour, birth and postpartum - a systematic review with implications for the function of the oxytocinergic system. BMC Pregnancy Childbirth 2023; 23:137. [PMID: 36864410 PMCID: PMC9979579 DOI: 10.1186/s12884-022-05221-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/15/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND The reproductive hormone oxytocin facilitates labour, birth and postpartum adaptations for women and newborns. Synthetic oxytocin is commonly given to induce or augment labour and to decrease postpartum bleeding. AIM To systematically review studies measuring plasma oxytocin levels in women and newborns following maternal administration of synthetic oxytocin during labour, birth and/or postpartum and to consider possible impacts on endogenous oxytocin and related systems. METHODS Systematic searches of PubMed, CINAHL, PsycInfo and Scopus databases followed PRISMA guidelines, including all peer-reviewed studies in languages understood by the authors. Thirty-five publications met inclusion criteria, including 1373 women and 148 newborns. Studies varied substantially in design and methodology, so classical meta-analysis was not possible. Therefore, results were categorized, analysed and summarised in text and tables. RESULTS Infusions of synthetic oxytocin increased maternal plasma oxytocin levels dose-dependently; doubling the infusion rate approximately doubled oxytocin levels. Infusions below 10 milliunits per minute (mU/min) did not raise maternal oxytocin above the range observed in physiological labour. At high intrapartum infusion rates (up to 32 mU/min) maternal plasma oxytocin reached 2-3 times physiological levels. Postpartum synthetic oxytocin regimens used comparatively higher doses with shorter duration compared to labour, giving greater but transient maternal oxytocin elevations. Total postpartum dose was comparable to total intrapartum dose following vaginal birth, but post-caesarean dosages were higher. Newborn oxytocin levels were higher in the umbilical artery vs. umbilical vein, and both were higher than maternal plasma levels, implying substantial fetal oxytocin production in labour. Newborn oxytocin levels were not further elevated following maternal intrapartum synthetic oxytocin, suggesting that synthetic oxytocin at clinical doses does not cross from mother to fetus. CONCLUSIONS Synthetic oxytocin infusion during labour increased maternal plasma oxytocin levels 2-3-fold at the highest doses and was not associated with neonatal plasma oxytocin elevations. Therefore, direct effects from synthetic oxytocin transfer to maternal brain or fetus are unlikely. However, infusions of synthetic oxytocin in labour change uterine contraction patterns. This may influence uterine blood flow and maternal autonomic nervous system activity, potentially harming the fetus and increasing maternal pain and stress.
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Affiliation(s)
- Sarah Buckley
- grid.1003.20000 0000 9320 7537Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Zada Pajalic
- grid.463529.f0000 0004 0610 6148Faculty for Health Sciences, VID Specialized University, Oslo, Norway
| | - Karolina Luegmair
- grid.9018.00000 0001 0679 2801Institute for Health Care and Nursing Studies, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Anette Ekström-Bergström
- grid.412716.70000 0000 8970 3706Department of Health Sciences, University West, Trollhättan, Sweden
| | - Anna Dencker
- grid.8761.80000 0000 9919 9582Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Claudia Massarotti
- grid.5606.50000 0001 2151 3065Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Alicja Kotlowska
- grid.11451.300000 0001 0531 3426Department of Clinical and Experimental Endocrinology, Faculty of Health Sciences, Medical University of Gdańsk, Gdańsk, Poland
| | - Leonie Callaway
- grid.1003.20000 0000 9320 7537Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sandra Morano
- grid.5606.50000 0001 2151 3065Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Ibone Olza
- European Institute of Perinatal Mental Health, Madrid, Spain
| | - Claudia Meier Magistretti
- grid.425064.10000 0001 2191 8943Institute for Health Policies, Prevention and Health Promotion, Lucerne University of Applied Sciences and Arts, Luzern, Switzerland
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15
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Orsolini L, Pompili S, Mauro A, Volpe U. Foreign Nationality, Family Psychiatry History and Pregestational Neoplastic Disease as Predictors of Perinatal Depression in a Cohort of Healthy Pregnant and Puerperal Women during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:428. [PMID: 36767003 PMCID: PMC9914901 DOI: 10.3390/healthcare11030428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Background: Perinatal depression (PND) represents one of the most common mental disorders in the pregnancy and/or postpartum period, with a 5-25% prevalence rate. Our aim was to investigate predictors associated with PND in a cohort of pregnant and puerperal women based in an Italian setting during the COVID-19 pandemic. Methods: We retrospectively recruited 199 (55 pregnant and 144 puerperal) women, afferent to our Perinatal Mental Outpatient Service of Ancona (Italy). Participants were administered an ad hoc case-report form, Whooley Questions (WQ), the General Health Questionnaire-12 (GHQ-12), the Stress Holmes-Rahe scale (HR) and the Edinburgh Postnatal Depression Scale (EPDS). Results: Around 10% of the sample had a confirmed PND. Being a foreigner woman (RR = 3.8), having a positive psychiatric family history (RR = 5.3), a pre-pregnancy medical comorbidity (RR = 1.85) and a comorbid medical illness occurring during the pregnancy (RR = 2) were much likely associated with PND. Multiple linear regression analysis demonstrated that GHQ, medium- and high-risk at the HR, foreign nationality, positive family psychiatric history, and neoplastic disease before conception significantly predicted EPDS [F(1, 197) = 10.086, R2 = 0.324, p < 0.001]. Limitations: The sample size, poor heterogeneity in terms of socio-demographic, clinical and gynecological-obstetric characteristics, the cross-sectional design of the study. Conclusions: Our study showed a set of predictors associated with a higher risk for the PND onset, including gestational and pregestational medical disease. Our findings outline the need to screen all fertile women, particularly in gynecological and medical settings, in order to identify at-risk women for PND and promptly suggest a psychiatric consultation.
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Affiliation(s)
| | | | | | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, 60126 Ancona, Italy
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16
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Prevalence of and factors associated with postnatal depression and anxiety among parents of preterm infants: A systematic review and meta-analysis. J Affect Disord 2023; 322:235-248. [PMID: 36400151 DOI: 10.1016/j.jad.2022.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 09/24/2022] [Accepted: 11/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study aimed to determine the prevalence of and factors associated with postpartum depression and anxiety among mothers and fathers of preterm infants and to examine the relationships between maternal and paternal symptoms. METHODS Six electronic databases were searched to identify eligible studies reporting parental depression and anxiety within 1 year postpartum. Data were extracted for a random-effects meta-analysis to estimate the prevalence with 95 % confidence intervals (CIs). Subgroup and meta-regression analyses were conducted to analyze associations between study characteristics and prevalence estimates. RESULTS In total, 79 studies were included. The meta-analysis of studies on mothers generated estimates of prevalence for depression (29.2 %, 95 % CI, 21.8 %-37.9 %) and anxiety (37.7 %, 95 % CI, 24.1 %-53.6 %). The meta-analysis of fathers indicated a pooled depression prevalence of 17.4 % (95 % CI, 12.5 %-23.8 %) and an anxiety estimate of 18.3 % (95 % CI, 8.1 %-36.3 %). Assessment time points and methods as well as the geographic continent in which the study was conducted were significant moderators of depression and anxiety. Significant inter-correlations were found between mothers' and fathers' depression and anxiety symptoms (p < 0.05). LIMITATIONS Limited data from specific geographic continents, including Africa and Asia. CONCLUSIONS Prevalence of depression and anxiety among preterm infants' parents was high, highlighting the need for early psychological screening and assessment. Further research is required to improve services that focus on parents' postpartum psychological needs in the family context.
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17
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Accortt E, Mirocha J, Zhang D, Kilpatrick SJ, Libermann T, Karumanchi SA. Perinatal mood and anxiety disorders: biomarker discovery using plasma proteomics. Am J Obstet Gynecol 2023:S0002-9378(23)00016-9. [PMID: 36649818 DOI: 10.1016/j.ajog.2023.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Perinatal mood and anxiety disorders encompass a range of mental health disorders that occur during pregnancy and up to 1 year postpartum, affecting approximately 20% of women. Traditional risk factors, such as a history of depression and pregnancy complications including preeclampsia, are known. Their predictive utility, however, is not specific or sensitive enough to inform clinical decision-making or prevention strategies for perinatal mood and anxiety disorders. Better diagnostic and prognostic models are needed for early identification and referral to treatment. OBJECTIVE This study aimed to determine if a panel of novel third-trimester plasma protein biomarkers in pregnant women can be used to identify those who have a high predisposed risk for perinatal mood and anxiety disorders within 3 months postpartum. STUDY DESIGN We studied 52 women (n=34 with a risk for perinatal mood and anxiety disorders and n=18 controls) among whom mental health screening was conducted at 2 time points, namely in the third trimester and again at 3 months postdelivery. An elevated perinatal mood and anxiety disorder risk was identified by screening individuals with above-validated cutoffs for depression (Edinburgh Postnatal Depression Scale ≥12), anxiety (Overall Anxiety Severity and Impairment Scale ≥7), and/or posttraumatic stress disorder (Impact of Events Scale >26) at both time points. Plasma samples collected in the third trimester were screened using the aptamer-based SomaLogic SomaScan proteomic assay technology to evaluate perinatal mood and anxiety disorder-associated changes in the expression of 1305 protein analytes. Ingenuity Pathway Analysis was conducted to highlight pathophysiological relationships between perinatal mood and anxiety disorder-specific proteins found to be significantly up- or down-regulated in all subjects with perinatal mood and anxiety disorder and in those with perinatal mood and anxiety disorders and no preeclampsia. RESULTS From a panel of 53 significant perinatal mood and anxiety disorder-associated proteins, a unique 20-protein signature differentiated perinatal mood and anxiety disorder cases from controls in a principal component analysis (P<.05). This protein signature included NCAM1, NRCAM, and NTRK3 that converge around neuronal signaling pathways regulating axonal guidance, astrocyte differentiation, and maintenance of GABAergic neurons. Interestingly, when we restricted the analysis to subjects without preeclampsia, a 30-protein signature differentiated perinatal mood and anxiety disorder cases from all controls without overlap on the principal component analysis (P<.001). In the nonpreeclamptic perinatal mood and anxiety disorder group, we observed increased expression of proteins, such as CXCL11, CXCL6, MIC-B, and B2MG, which regulate leucocyte migration, inflammation, and immune function. CONCLUSION Participants with perinatal mood and anxiety disorders had a unique and distinct plasma protein signature that regulated a variety of neuronal signaling and proinflammatory pathways. Additional validation studies with larger sample sizes are needed to determine whether some of these molecules can be used in conjunction with traditional risk factors for the early detection of perinatal mood and anxiety disorders.
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Affiliation(s)
- Eynav Accortt
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - James Mirocha
- Cedars-Sinai Biostatistics Core and Clinical & Translational Research Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Dongsheng Zhang
- Department of Medicine, Division of Nephrology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sarah J Kilpatrick
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Towia Libermann
- Department of Medicine and Genomics, Proteomics, Bioinformatics and Systems Biology Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - S Ananth Karumanchi
- Department of Medicine, Division of Nephrology, Cedars-Sinai Medical Center, Los Angeles, CA
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Hanach N, Radwan H, Fakhry R, Dennis CL, issa WB, Faris ME, Obaid RS, Al Marzooqi S, Tabet C, De Vries N. Prevalence and risk factors of postpartum depression among women living in the United Arab Emirates. Soc Psychiatry Psychiatr Epidemiol 2023; 58:395-407. [PMID: 36239744 PMCID: PMC9971080 DOI: 10.1007/s00127-022-02372-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 10/02/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Postpartum depression received almost no attention in the United Arab Emirates (UAE). The aim was to examine the prevalence of depressive symptomatology and the associated risk factors among women in the UAE. METHODS A prospective cohort study recruited women from postpartum wards in hospitals across four emirates in the UAE. Women completed questionnaires immediately after childbirth and at 3 and 6 months postpartum. Depressive symptomatology was measured using the Edinburgh Postnatal Depression Scale (EPDS > 12). Risk factors were identified using the generalized estimating equation. A stratified analysis of the postpartum period was performed. RESULTS Among the 457 women recruited, 35% exhibited depressive symptomatology within the first 6 months postpartum. Younger women (< 25 years), part-time employment, the receipt of financial support from the family, and difficulty in managing monthly income were associated with a higher risk of postpartum depression. Husband's employment, husband's support, and living in own house were associated with a lower risk of postpartum depression. Maternity leave of more than 3 months increased the risk of depression during the first 3 months postpartum. From 3 to 6 months postpartum, Muslim women had a higher risk of depression whereas women who breastfed other children and in the past 7 days, and perceived their infant as healthy had a lower risk of depression. CONCLUSIONS The prevalence of maternal depressive symptomatology is considerable in the UAE. Risk factors change over the 6-month postpartum period suggesting the need for an innovative multidisciplinary approach to the management of postpartum depression, including follow-up screening.
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Affiliation(s)
- Nivine Hanach
- Faculty of Health, Medicine, and Life Sciences, CAPHRI, Maastricht University, P.O. Box 616, Maastricht, Netherlands.
| | - Hadia Radwan
- grid.412789.10000 0004 4686 5317Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Randa Fakhry
- grid.412789.10000 0004 4686 5317Department of Nursing, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Cindy-Lee Dennis
- grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Wegdan Bani issa
- grid.412789.10000 0004 4686 5317Department of Nursing, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - MoezAlIslam E. Faris
- grid.412789.10000 0004 4686 5317Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Reyad Shaker Obaid
- grid.412789.10000 0004 4686 5317Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Suad Al Marzooqi
- grid.43519.3a0000 0001 2193 6666Department of Psychology, Al Ain, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Charbel Tabet
- grid.450307.50000 0001 0944 2786CREG, Grenoble Alpes University, Paris, France
| | - Nanne De Vries
- grid.5012.60000 0001 0481 6099Faculty of Health, Medicine, and Life Sciences, CAPHRI, Maastricht University, P.O. Box 616, Maastricht, Netherlands
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Louis D, Akil H, Bolton JM, Bacchini F, Netzel K, Oberoi S, Pylypjuk C, Flaten L, Cheung K, Lix LM, Ruth C, Garland A. Mental Disorders Among Mothers of Children Born Preterm: A Population-Based Cohort Study in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 68:338-346. [PMID: 36412096 DOI: 10.1177/07067437221138237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Our aim was to examine the association between preterm delivery and incident maternal mental disorders using a population-based cohort of mothers in Canada. METHODS Retrospective matched cohort study using Manitoba Centre for Health Policy (MCHP) administrative data in Manitoba. Mothers who delivered preterm babies (<37 weeks gestational age) between 1998 and 2013 were matched 1:5 to mothers of term babies using socio-demographic variables. Primary outcome was any incident mental disorder within 5 years of delivery defined as any of (a) mood and anxiety disorders, (b) psychotic disorders, (c) substance use disorders, and (d) suicide or suicide attempts. Multivariable Poisson regression model was used to estimate the 5-year adjusted incidence rate ratios (IRRs). RESULTS Mothers of preterm children (N = 5,361) had similar incidence rates of any mental disorder (17.4% vs. 16.6%, IRR = 0.99, 95% CI, 0.91 to 1.07) compared to mothers of term children (N = 24,932). Mothers of term children had a higher rate of any mental disorder in the first year while mothers of preterm children had higher rates from 2 to 5 years. Being the mother of a child born <28 week (IRR = 1.5, 95% CI, 1.14 to 2.04), but not 28-33 weeks (IRR = 1.03, 95% CI, 0.86 to 1.19) or 34-36 weeks (IRR = 0.96, 95% CI, 0.88 to 1.05), was associated with any mental disorder. INTERPRETATION Mothers of preterm and term children had similar rates of incident mental disorders within 5-years post-delivery. Extreme prematurity was a risk factor for any mental disorder. Targeted screening and support of this latter group may be beneficial.
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Affiliation(s)
- Deepak Louis
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - Hammam Akil
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - James M Bolton
- Department of Psychiatry, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada.,Manitoba Centre for Health Policy, 8664University of Manitoba, Winnipeg, Canada
| | | | - Karen Netzel
- Neonatal Intensive Care Unit, Women's Hospital, Winnipeg, Canada
| | - Sapna Oberoi
- Department of Pediatric Hematology Oncology, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - Christy Pylypjuk
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - Lisa Flaten
- Manitoba Centre for Health Policy, 8664University of Manitoba, Winnipeg, Canada
| | - Kristene Cheung
- Department of Clinical Health Psychology, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - Lisa M Lix
- Manitoba Centre for Health Policy, 8664University of Manitoba, Winnipeg, Canada.,Department of Community Health Sciences, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - Chelsea Ruth
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada.,Manitoba Centre for Health Policy, 8664University of Manitoba, Winnipeg, Canada
| | - Allan Garland
- Manitoba Centre for Health Policy, 8664University of Manitoba, Winnipeg, Canada.,Department of Medicine, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
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Risk and protective factors related to immediate postpartum depression in a baby-friendly hospital of Taiwan. Taiwan J Obstet Gynecol 2022; 61:977-983. [DOI: 10.1016/j.tjog.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
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21
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de Paula Eduardo JAF, Figueiredo FP, de Rezende MG, da Roza DL, de Freitas SF, Batista RFL, da Silva AAM, Barbieri MA, Carvalho Cavalli R, Bettiol H, Ferraro AA, Del-Ben CM. Preterm birth and postpartum depression within 6 months after childbirth in a Brazilian cohort. Arch Womens Ment Health 2022; 25:929-941. [PMID: 35849216 DOI: 10.1007/s00737-022-01248-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 06/15/2022] [Indexed: 11/26/2022]
Abstract
Preterm birth (PTB) and postpartum depression (PPD) are important public health issues, and although literature mainly supports the association between them, some reviews have highlighted methodological limitations in the studies in this field, restricting the interpretation of such finding. This study aimed at assessing the association between PTB and PPD, by comparing groups of preterm and full-term mothers in two Brazilian cities with contrasting sociodemographic indicators. This prospective convenience cohort study assessed 1421 women during pregnancy, at childbirth, and in the postpartum period. The Edinburgh Postnatal Depression Scale (EPDS) was administrated to assess PPD within 6 months after delivery and women were considered probably depressed if scores were EDPS ≥ 12. PTB was defined as the delivery before 37 completed weeks of pregnancy. A multivariate Poisson regression was used to estimate relative risk for PPD in mothers of preterm infants, and the final analysis models were adjusted for psychosocial variables, selected according to the directed acyclic graph (DAG) approach. Frequencies of PPD were not significantly different in mothers of preterm and full-term infants, in neither city. In the final adjusted model, PTB was not associated with PPD. The association between PTB and PPD was not confirmed in two large samples from two Brazilian cities with contrasting socioeconomic profile. However, maternal health during pregnancy plays an important role in predicting PPD. Prenatal care should promote maternal mental health as an effort towards decreasing unfavored outcomes for mothers, infants, and families.
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Affiliation(s)
| | - Felipe Pinheiro Figueiredo
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcos Gonçalves de Rezende
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Daiane Leite da Roza
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Stella Felippe de Freitas
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | - Marco Antônio Barbieri
- Department of Puericulture and Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ricardo Carvalho Cavalli
- Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Heloisa Bettiol
- Department of Puericulture and Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Cristina Marta Del-Ben
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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22
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Lin R, Lu Y, Luo W, Zhang B, Liu Z, Xu Z. Risk factors for postpartum depression in women undergoing elective cesarean section: A prospective cohort study. Front Med (Lausanne) 2022; 9:1001855. [PMID: 36250100 PMCID: PMC9553994 DOI: 10.3389/fmed.2022.1001855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPostpartum depression (PPD) has adverse effects on maternal and child health. Cesarean section (CS) is suggested to be associated with PPD, but no study has examined the risk factors for PPD in women who underwent CS. Therefore, this study aimed to investigate this association.MethodsA prospective observational study was conducted between December 2020 and September 2021. In total, 590 women who underwent elective CS participated in this study. Data were collected using a questionnaire through a face-to-face interview at three time points: 32nd week of gestation, 2 days postpartum, and 6 weeks postpartum. PPD was defined by an Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 11 at 6 weeks postpartum. Multivariate logistic regression analysis was performed to identify the risk factors for PPD.ResultsAmong the 590 women, 25.4% had PPD (142/590). After adjustment for the confounding factors, high antenatal self-rating anxiety scale score (OR = 1.10, 95% CI = 1.04–1.16), PPD symptoms (EPDS ≥ 11) at 2 days postpartum (OR = 6.17, 95% CI = 1.35–28.31), and pain at 6 weeks postpartum (OR = 2.14, 95% CI = 1.24–3.69) were independently associated with PPD.ConclusionPrenatal anxiety, PPD symptoms occurring at an early postoperative stage, and pain at 6 weeks postpartum may be associated with an increased risk of PPD among women who undergo CS.
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Affiliation(s)
- Rong Lin
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan Lu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Luo
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bing Zhang
- Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhiqiang Liu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Zhiqiang Liu,
| | - Zhendong Xu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- Zhendong Xu,
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23
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Kang SY, Khang YH, June KJ, Cho SH, Lee JY, Kim YM, Cho HJ. Prevalence and risk factors of maternal depression among women who participated in a home visitation program in South Korea. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1167-1178. [PMID: 35044478 DOI: 10.1007/s00127-022-02226-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/06/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE The psychosocial health of mother is crucial for healthy prenatal period and early childhood. We investigated the prevalence and risk factors of maternal depression during pregnancy and postpartum among women who participated in a home visitation program in Seoul, South Korea (Seoul Healthy First Step Project, SHFSP). METHODS We analyzed 80,116 women who participated in the SHFSP, which was launched by Seoul metropolitan government in 2013, and defined peripartum depression as a score ≥ 10 on the Korean version of the Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic factors and psychosocial health status were evaluated through a standardized questionnaire completed by participants upon program registration. We calculated the prevalence of women at risk for peripartum depression and evaluated associated factors by multivariable logistic regression analysis. RESULTS Prevalence of women at risk for peripartum depression was 17.7% (prepartum depression: 14.2%, postpartum depression: 24.3%). Younger maternal age, low income (OR 2.40, 95% CI 2.03-2.84), disability (2.61, 1.96-3.47), single parenthood (3.27, 2.69-3.99), and smoking (2.02, 1.44-2.83) increased the peripartum depression risk. Furthermore, experience of stress, change, or loss over the past 12 months (3.36, 3.22-3.50), history of treatment for emotional issues (2.47, 2.27-2.70), experience of child abuse (1.91, 1.74-2.11), and domestic violence (2.25, 1.81-2.80) increased the risk for peripartum depression, whereas having helpers for the baby (0.62, 0.58-0.67), having someone to talk with (0.31, 0.27-0.35), and considering oneself confident (0.30, 0.29-0.31) decreased the risk. CONCLUSIONS Policies to reduce and manage peripartum depression should be strengthened, with a focus on high-risk pregnant and puerperal women.
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Affiliation(s)
- Seo Young Kang
- International Healthcare Center, Asan Medical Center, Seoul, South Korea
| | - Young-Ho Khang
- The Support Team for the Seoul Healthy First Step Project, Seoul, South Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
- Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung Ja June
- The Support Team for the Seoul Healthy First Step Project, Seoul, South Korea
- Department of Nursing, Soonchunhyang University, Cheonan, South Korea
| | - Sung-Hyun Cho
- The Support Team for the Seoul Healthy First Step Project, Seoul, South Korea
- College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
| | - Ji Yun Lee
- The Support Team for the Seoul Healthy First Step Project, Seoul, South Korea
- College of Nursing, Kangwon National University, Chuncheon, South Korea
| | - Yu-Mi Kim
- The Support Team for the Seoul Healthy First Step Project, Seoul, South Korea
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, South Korea
- School of Public Health, Hanyang University College of Medicine, Seoul, South Korea
| | - Hong-Jun Cho
- The Support Team for the Seoul Healthy First Step Project, Seoul, South Korea.
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 05505, South Korea.
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Mothers at risk of postpartum depression in Sri Lanka: A population-based study using a validated screening tool. PLoS One 2022; 17:e0268748. [PMID: 35613119 PMCID: PMC9132337 DOI: 10.1371/journal.pone.0268748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 05/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background Postpartum depression is an important public health concern. The prevalence of postpartum depression is estimated to be 18% worldwide. The purpose of this study was to estimate the prevalence of mothers at risk of postpartum depression in Sri Lanka and to investigate its associated risk factors. Methods This was a cross-sectional study conducted among 975 mothers in Galle district, Sri Lanka. The prevalence of mothers at risk of postpartum depression was assessed using the Edinburgh Postpartum Depression scale (EPDS) which has been validated for screening for mothers at risk of postpartum depression in Sri Lanka with a cut-off score 9 or more. Prevalence was estimated using a cut-off 9 or more, 10 or more, 11 or more and 12 or more to assess the difference in prevalence using unvalidated cut-offs for screening. Data from routine records on pregnancy, delivery and postnatal care was collected to investigate possible predictors of EPDS score 9 or more (risk of postpartum depression). Univariate and multivariable logistic regressions were performed to identify risk factors for EPDS score 9 or more (risk of postpartum depression). Results The prevalence of mothers with EPDS score 9 or more was found to be 9.4% (95%CI: 7.8–11.4); EPDS score 10 or more was 5.6% (95%CI: 4.4–7.3). EPDS score 9 or more (risk of postpartum depression) was associated with the following risk factors: Former history of mental illness (aOR 32.9, 95%CI: 7.9–136.2), high maternal age 30–39 (aOR 2.2, 95%CI: 1.3–3.8), BMI 25.0–29.9 (aOR 2.6, 95%CI: 1.5–4.5), hypertension (aOR 3.6, 95%CI: 1.2–10.9) and newborn death (aOR 28.9, 95%CI: 4.5–185.1). One in five women reported thoughts of self-harm. Conclusion Around one in ten mothers in Sri Lanka experience symptoms of postpartum depression, highest risk among mothers who reported former history of mental illness and newborn death. The prevalence estimates were lower with a higher cut-off for screening and this highlights the importance of using the validated cut-off for screening in future studies on postpartum depression in Sri Lanka. Mothers at increased risk should be identified in antenatal care and are important targets of referral.
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Associations among Caesarean Section Birth, Post-Traumatic Stress, and Postpartum Depression Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084900. [PMID: 35457767 PMCID: PMC9025262 DOI: 10.3390/ijerph19084900] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 02/04/2023]
Abstract
Caesarean section (C-section) deliveries account for nearly 30% of births annually with emergency C-sections accounting for 7-9% of all births. Studies have linked C-sections to postpartum depression (PPD). PPD is linked to reduced quality of parent-child interaction, and adverse effects on maternal and child health. New mothers' perceptions of more negative childbirth experiences, such as unplanned/emergency C-sections, are linked to post-traumatic stress disorder (PTSD), which in turn is related to PPD. Our objectives were to determine: (1) the association between C-section type (unplanned/emergency vs. planned) and PPD symptoms, and (2) if postnatal PTSD symptoms mediate this association. Employing secondary analysis of prospectively collected data from 354 mother-child dyads between 2009 and 2013 from the Alberta Pregnancy Outcomes and Nutrition (APrON) study, conditional process modeling was employed. The Edinburgh Postnatal Depression Scale (EPDS) and the Psychiatric Diagnostic Screening Questionnaire (PDSQ) were administered at three months postpartum, to assess for postpartum depressive and post-traumatic stress symptoms. The direct effect of emergency C-section on PPD symptoms was non-significant in adjusted and non-adjusted models; however, the indirect effect of emergency C-section on PPD symptoms with PTSD symptoms as a mediator was significant after controlling for prenatal depression symptoms, social support, and SES (β = 0.17 (SE = 0.11), 95% CI [0.03, 0.42]). This suggests that mothers who experienced an emergency or unplanned C-section had increased PTSD scores of nearly half a point (0.47) compared to mothers who underwent a planned C-section, even after adjustment. Overall, emergency C-section was indirectly associated with PPD symptoms, through PTSD symptoms. Findings suggest that PTSD symptoms may be a mechanism through which emergency C-sections are associated with the development of PPD symptoms.
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Girchenko P, Robinson R, Rantalainen VJ, Lahti-Pulkkinen M, Heinonen-Tuomaala K, Lemola S, Wolke D, Schnitzlein D, Hämäläinen E, Laivuori H, Villa PM, Kajantie E, Räikkönen K. Maternal postpartum depressive symptoms partially mediate the association between preterm birth and mental and behavioral disorders in children. Sci Rep 2022; 12:947. [PMID: 35042942 PMCID: PMC8766431 DOI: 10.1038/s41598-022-04990-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/03/2022] [Indexed: 01/10/2023] Open
Abstract
Preterm birth has been linked with postpartum depressive (PPD) disorders and high symptom levels, but evidence remains conflicting and limited in quality. It remains unclear whether PPD symptoms of mothers with preterm babies were already elevated before childbirth, and whether PPD symptoms mediate/aggravate the effect of preterm birth on child mental disorders. We examined whether preterm birth associated with maternal PPD symptoms, depressive symptoms trajectories from antenatal to postpartum stage, and whether PPD symptoms mediated/aggravated associations between preterm birth and child mental disorders. Mothers of preterm (n = 125) and term-born (n = 3033) children of the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction study reported depressive symptoms four times within 8 weeks before and twice within 12 months after childbirth. Child mental and behavioral disorder diagnoses until age 8.4-12.8 years came from medical register. Preterm birth associated with higher PPD symptoms (mean difference = 0.19 SD, 95% CI 0.01, 0.37, p = 0.04), and higher odds (odds ratio = 2.23, 95% CI 1.22, 4.09, p = 0.009) of the mother to belong to a group that had consistently high depressive symptoms levels trajectory from antenatal to postpartum stage. PPD symptoms partially mediated and aggravated the association between preterm birth and child mental disorders. Preterm birth, maternal PPD symptoms and child mental disorders are associated, calling for timely prevention interventions.
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Affiliation(s)
- Polina Girchenko
- Institute of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, (Haartmaninkatu 3), P.O BOX 21, 00014, Helsinki, Finland.
| | - Rachel Robinson
- Institute of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, (Haartmaninkatu 3), P.O BOX 21, 00014, Helsinki, Finland
| | - Ville Juhani Rantalainen
- Institute of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, (Haartmaninkatu 3), P.O BOX 21, 00014, Helsinki, Finland
| | - Marius Lahti-Pulkkinen
- Institute of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, (Haartmaninkatu 3), P.O BOX 21, 00014, Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland.,Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Kati Heinonen-Tuomaala
- Institute of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, (Haartmaninkatu 3), P.O BOX 21, 00014, Helsinki, Finland.,Psychology/Welfare Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sakari Lemola
- Department of Psychology, University of Warwick, Coventry, UK.,Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK
| | - Daniel Schnitzlein
- Leibniz University of Hannover, Hannover, Germany.,IZA Bonn, Bonn, Germany
| | - Esa Hämäläinen
- Department of Clinical Chemistry, University of Eastern Finland, Kuopio, Finland
| | - Hannele Laivuori
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Pia M Villa
- Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eero Kajantie
- National Institute for Health and Welfare, Public Health Promotion Unit, Helsinki, Finland.,University of Oulu, Oulu, Finland
| | - Katri Räikkönen
- Institute of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, (Haartmaninkatu 3), P.O BOX 21, 00014, Helsinki, Finland
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Yuan M, Bedell S, de Vrijer B, Eastabrook G, Frisbee JC, Frisbee SJ. Highlighting the Mechanistic Relationship Between Perinatal Depression and Preeclampsia: A Scoping Review. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:850-866. [PMID: 36340477 PMCID: PMC9629976 DOI: 10.1089/whr.2022.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although there is scientific literature supporting an association between depression and preeclampsia (PE), little is known about the underlying mechanistic pathways that may explain these observed associations. Thus, this study aimed to outline the relationship between depression and PE, and to highlight the underlying cardiovascular and metabolic risk factors that are common to both. METHODS A scoping review of the literature was conducted in Medline, Scopus, and Web of Science. RESULTS From 706 articles initially identified, 23 articles met the inclusion criteria and were included in this review. Although some studies reported a positive association between PE and postpartum depressive symptoms, challenges comparing different methodologies, measurement instruments and when measurements were administered, and patient populations do not permit a decisive conclusion. In addition, very few studies addressed potential underlying mechanisms that may be contributing to observed associations; thus, a secondary search was conducted to identify cardiovascular and metabolic risk factors that are common to both depression and PE. CONCLUSION The cardiovascular and metabolic risk factors (i.e., increased inflammation and oxidative stress and decreased vascular and endothelial function) common to both depression and PE suggest that these factors may contribute as underlying mechanisms in both conditions. These similarities underscore the importance to better understand these mechanisms so preventative and therapeutic strategies could be developed to improve maternal health.
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Affiliation(s)
- Mei Yuan
- Department of Pathology and Laboratory Medicine, Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Samantha Bedell
- Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Barbra de Vrijer
- Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
- Lawson Health Research Institute, London, Canada
| | - Genevieve Eastabrook
- Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
- Lawson Health Research Institute, London, Canada
| | - Jefferson C. Frisbee
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Stephanie J. Frisbee
- Department of Pathology and Laboratory Medicine, Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
- Lawson Health Research Institute, London, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
- Address correspondence to: Stephanie J. Frisbee, PhD, MSc, Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond Street, Dental Sciences Building, Room 4041, London N6A 5C1, Canada,
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Effects of Cognitive Nursing Combined with Continuous Nursing on Postpartum Mental State and Rehabilitation. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4131917. [PMID: 34901271 PMCID: PMC8660180 DOI: 10.1155/2021/4131917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
Purpose This study is aimed at exploring the effects of cognitive nursing combined with continuous nursing on postpartum mental state and rehabilitation. Methods Totally, 124 puerperas admitted to our hospital from January 2019 to January 2020 were selected and divided into a research group and a control group according to different nursing methods, with 62 cases in each group. The control group received routine care, while the research group received cognitive nursing combined with continuous nursing on this basis. The mental state, rehabilitation indicators, quality of life, incidence of complications, and nursing satisfaction were compared between the two groups after intervention. Results Before nursing, there was no statistically significant difference in the SAS and SDS scores between the two groups (P > 0.05); after intervention, the SAS and SDS scores of the two groups were significantly reduced, and those of the research group were lower than those of the control group (P < 0.05). After intervention, the time of the first breastfeeding, duration of lochia rubra, length of hospital stay, and score of uterine contraction pain of the research group were lower than those of the control group (P < 0.05); the psychological function, physical function, material life, and social function scores of the research group were higher than those of the control group (P < 0.05); the incidence of complications in the research group was 4.84%, lower than 20.97% in the control group (P < 0.05); the nursing satisfaction of the research group was 96.77%, which was significantly higher than 83.87% in the control group (P < 0.05). Conclusions Cognitive nursing combined with continuous nursing can effectively improve the mental state, shorten the length of hospital stay, increase the perceived well-being, and promote the physical rehabilitation in puerperas, which is worth promoting in clinical practice.
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Ponti L, Ghinassi S, Tani F. Spontaneous and induced labor: association with maternal well-being three months after childbirth. PSYCHOL HEALTH MED 2021; 27:896-901. [PMID: 34296958 DOI: 10.1080/13548506.2021.1956554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A woman's first childbirth represents a moment of elevated maternal emotional vulnerability. Indeed, there is a prevalence of anxiety and depression symptomatology in primiparas during the postpartum period that negatively influences the well-being of the woman, of her newborn, and of the quality of their attachment bond. Much attention has been paid to the possible risk factors involved in the onset of mood disturbance in the postpartum. However, knowledge is still limited regarding the role played by the specific clinical aspects linked to labor. Therefore, the aim of the present study was to explore whether spontaneous or elective induction labor is linked to the level of postnatal depression and anxiety three months after birth. One hundred and sixty-one women (Mage = 31.63; SD = 4.88) were recruited, using the following inclusion criteria: native Italian women; age > 18 years; physically and psychologically healthy nulliparous with singleton no-risk pregnancy; no previous abortion or interruption of pregnancy; no previous psychopathological diagnoses. Exclusion criteria: twin pregnancy, fetal pathologies, and planned elective cesarean. Data was collected at two different times: T1 (day of childbirth) clinical data of labor (spontaneous or induced) from hospital records; T2 (three months after birth) level of mother's depression and anxiety. In order to explore if the level of depression and anxiety three months after childbirth differ in women according to the type of labor, spontaneous or induced, two univariate analyses of variance (ANOVA) were conducted. Results showed that women who had a spontaneous labor reported lower levels of anxiety and depression than women who had an induced labor. Our results highlight the significant implications that the mode of labor has on the emotional well-being of mothers, underlining the need to support women throughout all their transition to motherhood, including the childbirth experience.
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Affiliation(s)
- Lucia Ponti
- Department of Education, Languages, Intercultures, Literatures and Psychology, University of Florence, Florence, Italy
| | - Simon Ghinassi
- Department of Education, Languages, Intercultures, Literatures and Psychology, University of Florence, Florence, Italy
| | - Franca Tani
- Department of Health Sciences, University of Florence, Florence, Italy
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30
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Guvenc G, Yesilcinar İ, Ozkececi F, Öksüz E, Ozkececi CF, Konukbay D, Kok G, Karasahin KE. Anxiety, depression, and knowledge level in postpartum women during the COVID-19 pandemic. Perspect Psychiatr Care 2021; 57:1449-1458. [PMID: 33336416 DOI: 10.1111/ppc.12711] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/22/2020] [Accepted: 11/30/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE This study aimed to assess anxiety, depression, and knowledge level in postpartum women during the COVID-19 pandemic. DESIGN AND METHODS This cross-sectional study was conducted on 212 postpartum women using a web-based online survey in Ankara, Turkey. FINDINGS The prevalence of depression was 34.0%. The mean anxiety and COVID-19 knowledge scores were 42.69 ± 9.93 and 9.69 ± 1.94, respectively. There was a statistically significant difference between the anxiety scores and depression status (p < 0.001) of women. There were statistically significant differences between fear about being infected with COVID-19 for themselves (p = 0.01) and for babies (p = 0.01) and the postpartum depression (PPD). PRACTICE IMPLICATIONS During the COVID-19 pandemic, early detection and appropriate and timely intervention to prevent and detect anxiety and PPD are crucial to the well-being of a woman.
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Affiliation(s)
- Gulten Guvenc
- Department of Obstetrics and Gynecology Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey
| | - İlknur Yesilcinar
- Department of Nursing, Faculty of Health Sciences, Izmir Katip Celebi University, İzmir, Turkey
| | - Fulden Ozkececi
- Department of Nursing, Faculty of Health Sciences, Yuksek Ihtisas University, Ankara, Turkey
| | - Emine Öksüz
- Department of Psychiatric and Mental Health Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey
| | - Coşkun F Ozkececi
- Department of Pediatrics, Gulhane Education and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Dilek Konukbay
- Department of Pediatric Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey
| | - Gulsah Kok
- Department of Obstetrics and Gynecology Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey
| | - Kazım E Karasahin
- Department of Obstetrics and Gynecology, Gulhane Education and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
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31
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Sun L, Wang S, Li XQ. Association between mode of delivery and postpartum depression: A systematic review and network meta-analysis. Aust N Z J Psychiatry 2021; 55:588-601. [PMID: 32929976 DOI: 10.1177/0004867420954284] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Postpartum depression is one of the most common postpartum diseases, which has an important impact on the interaction between mother, infant, partner and family, as well as the long-term emotional and cognitive development of infants. However, there are still great disagreements on whether the delivery mode will affect the risk of postpartum depression. The purpose of this study is to explore whether the mode of delivery will affect the risk of postpartum depression through the comprehensive network meta-analysis of elective cesarean section, emergency cesarean section, instrumental vaginal delivery and spontaneous vaginal delivery. METHODS We searched in three electronic databases: PubMed, EMBASE and Cochrane Library. RESULTS This paper included 43 studies with a total sample size of 1,827,456 participants. Direct meta-analysis showed that the odds ratio of postpartum depression risk was 1.33 (95% confidence interval = [1.21, 1.46]) between cesarean section and vaginal delivery. The odds ratios of high Edinburgh Postpartum Depression Scale score between cesarean section and vaginal delivery in the three postpartum periods (within 2 weeks, within half a year and over half a year) were basically the same. There was no difference between cesarean section and vaginal delivery in the risk of severe postpartum depression at the Edinburgh Postpartum Depression Scale cut-off point ⩾13 (odds ratio = 1.07; 95% confidence interval = [0.99, 1.16]). Network meta-analysis showed that the risk of postpartum depression in the pairwise comparisons emergency cesarean section vs spontaneous vaginal delivery and elective cesarean section vs spontaneous vaginal delivery was odds ratio = 1.53 (95% confidence interval = [1.22, 1.91]) and 1.47 (95% confidence interval = [1.16, 1.86]). CONCLUSION The mode of delivery has a significant effect on the occurrence of mild postpartum depression. Women who give birth by cesarean section, especially who give birth by emergency cesarean section, are at a higher risk of mild postpartum depression. We should carefully monitor the progress of postpartum mental disorders in women who delivered by cesarean section and make it possible for women to have a quick access to mental healthcare.
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Affiliation(s)
- Lei Sun
- Department of Psychology, School of Philosophy and Sociology, Jilin University, Jilin, China
| | - Su Wang
- School of Psychology, Northeast Normal University, Jilin, China
| | - Xi-Qian Li
- Department of Obstetrics and Gynecology, China-Japan Union Hospital of Jilin University, Jilin, China
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32
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Kim H, Kim Y, Fava M, Mischoulon D, Shin MH, Lee DY, Jeon HJ. Increased risk of depression before and after unilateral or bilateral oophorectomy: A self-controlled case series study using a nationwide cohort in South Korea. J Affect Disord 2021; 285:47-54. [PMID: 33631480 DOI: 10.1016/j.jad.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is insufficient evidence of the association between oophorectomy and depression. METHODS A nationwide medical records database of South Korea was used to investigate incidence rate ratios (IRRs) of major depressive disorder before and after oophorectomy (n = 36,284) using a self-controlled case series design. Outcomes before and after hysterectomy (n = 25,415) were identified to compare with those around oophorectomy. RESULTS In all oophorectomy and hysterectomy groups, the risk of depression was increased before and after surgery, peaking immediately before or after the operation, with no significant difference in the pattern of the results according to type of surgery. In the bilateral oophorectomy group, the IRR was increased between 2-3 months before the surgery, peaking immediately before surgery at 1.39 (95% CI: 1.30-1.49, p < .0001), and remained heightened for one-year postexposure. Subgroup analyses performed according to ovarian cancer, age group, and hormone replacement therapy produced results similar to those of the main outcome. LIMITATIONS Because we used claims data, the detailed clinical information related to oophorectomy is lacking. There is possibility that time-varying confounder besides age and season might have affected the results CONCLUSIONS: The risk of depression increased before and after oophorectomy. The increase in risk of depression started before oophorectomy and peaked immediately before or after the operation, but no significant differences between unilateral and bilateral surgery and cancer and noncancer or among age groups were noted.
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Affiliation(s)
- Hyewon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yuwon Kim
- Department of Data Science, Evidnet, Seongnam, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Myung-Hee Shin
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, South Korea.
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
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33
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Kim H, Kim Y, Myung W, Fava M, Mischoulon D, Lee U, Lee H, Na EJ, Choi KW, Shin MH, Jeon HJ. Risks of suicide attempts after prescription of zolpidem in people with depression: a nationwide population study in South Korea. Sleep 2021; 43:5581583. [PMID: 31586200 DOI: 10.1093/sleep/zsz235] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 08/04/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To investigate the association between zolpidem prescription and suicide attempts in people with depression. METHODS A nationwide, population-based electronic medical records database from the Health Insurance Review & Assessment Service of South was used to investigate the incidence rate ratios (IRRs) of suicide attempts and probable suicide attempts in people with depression before and after zolpidem prescription using self-controlled case series design. RESULTS In a total of 445 people who attempted suicide and 23 141 people who attempted probable suicide attempt, the IRRs of suicidal behavior during the risk periods before and after zolpidem prescription increased compared with those at the baseline. The IRRs gradually increased and peaked immediately before the prescription of zolpidem. The IRR was 70.06 (95% CI: 25.58-191.90) on day 2 before zolpidem prescription and 63.35 (95% CI: 22.99-174.59) on day 1 after zolpidem prescription in the suicide attempt group. The IRR was 24.07 (95% CI: 20.50-28.26) on the day before zolpidem prescription and 14.96 (95% CI: 12.21-18.34) on the day after zolpidem prescription in the probable suicide attempt group. The ratios declined eventually after zolpidem was prescribed. CONCLUSIONS Although zolpidem prescription was associated with an increased risk of suicide attempts in people with depression, the risk increased and peaked immediately before zolpidem prescription. The risk declined gradually thereafter. This result indicates that the risk of suicide attempts increases at the time of zolpidem prescription. However, zolpidem prescription does not contribute to additional increase in the risk of suicide attempts.
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Affiliation(s)
- Hyewon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yuwon Kim
- Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Woojae Myung
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Unjoo Lee
- Department of Electronic Engineering, Hallym University, Kangwon, South Korea
| | - Hyosang Lee
- Department of Brain and Cognitive Sciences, DGIST, Daegu, South Korea
| | - Eun Jin Na
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Korean Psychological Autopsy Center (KPAC), Seoul, South Korea
| | - Kwan Woo Choi
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Psychiatry, Anam Hospital, Korea University College of Medicine and School of Medicine, Seoul, South Korea
| | - Myung-Hee Shin
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Korean Psychological Autopsy Center (KPAC), Seoul, South Korea.,Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
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An R, Chen X, Wu Y, Liu J, Deng C, Liu Y, Guo H. A survey of postpartum depression and health care needs among Chinese postpartum women during the pandemic of COVID-19. Arch Psychiatr Nurs 2021; 35:172-177. [PMID: 33781396 PMCID: PMC7886635 DOI: 10.1016/j.apnu.2021.02.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The COVID-19 pandemic seriously endangers the public's mental health, especially to pregnant and postpartum women. But little is known about postpartum depression and health care needs among Chinese postpartum women. AIM To investigate the status and risk factors of postpartum depression and health care needs among Chinese postpartum women during the COVID-19 pandemic. METHODS In this cross-sectional study, 209 Chinese postpartum women were recruited from May to July 2020 by convenience sampling and assessed online with self-designed Maternal General Information Questionnaire, Edinburgh Postpartum Depression Scale (EPDS) and Chinese Version of the Perceived Stress Scale (CPSS). Descriptive statistics, chi-square test, independent samples t-test, one-way ANOVA, Pearson correlation and multiple linear regression were used for data analysis. RESULTS With the EPDS cut-off value of 10, the incidence of postpartum depressive symptoms was 56.9%. Age, history of abortion and perceived stress were the influencing factors of postpartum depression (adjusted R2 = 0.432, F = 23.611, p < .001). The top three health care needs were infant rearing guidance (78.0%), maternal and infant protection guidance (60.3%) and dietary guidance (45.0%). The proportion of psychological rehabilitation guidance needs in the depressed group was significantly higher than that in the non-depressed group (34.5% vs. 20.0%, p < .05). CONCLUSIONS Maternal postpartum depression in China was at a high level during the COVID-19 pandemic. Women aged 25-34, with a history of abortion and high stress levels were at higher risk for postpartum depression. Timely psychological counselling, intervention and COVID-19-related health education are in great need for postpartum women.
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Affiliation(s)
- Ran An
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Xiaoli Chen
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Yuanyuan Wu
- Department of Nursing, Suizhou Hospital , Hubei University of Medicine, Suizhou, Hubei, China
| | - Juan Liu
- Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Che Deng
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Yanqun Liu
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China.
| | - Hongxia Guo
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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35
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Youn H, Lee KJ, Kim SG, Cho SJ, Kim WJ, Lee WJ, Hwang JY, Han C, Shin C, Jung HY. The Behavioral Effects of Combination Therapy of Memantine and Acetylcholinesterase Inhibitors Compared with Acetylcholinesterase Inhibitors Alone in Patients with Moderate Alzheimer's Dementia: A Double-Blind Randomized Placebo-Controlled Trial. Psychiatry Investig 2021; 18:233-240. [PMID: 33685036 PMCID: PMC8016683 DOI: 10.30773/pi.2020.0329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/13/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This study aimed to investigate treatment effects of combination therapy of memantine and acetylcholinesterase inhibitors (AchEIs) compared with AchEIs alone on behavioral and psychological symptoms of dementia (BPSD) in patients with moderate Alzheimer's dementia (AD). METHODS This was a 12-week, double-blind, randomized, placebo-controlled trial. A total of 148 patients with moderate AD participated in this study. Mini-Mental State Examination, Neuropsychiatric Inventory (NPI), Clinician's Interview-Based Impression of Change plus caregiver input, Gottfries-Bråne-Steen Scale, and Zarit Burden Interview were used as assessment scales. RESULTS There were no significant differences in age, sex, or education between AChEIs alone and combination groups. The combination group showed significantly more improvement of NPI-disinhibition score (0.76±2.15) than the AChEIs alone group (-0.14±1.71) after 12 weeks. CONCLUSION Our findings suggest that the combination therapy of memantine and AchEIs might be a beneficial option for reducing disinhibition symptoms of patients with moderate AD compared with AchEIs alone. We believe that clinicians need to consider additional memantine treatment when patients with moderate AD complain disinhibition symptom. A larger clinical trial is needed to further determine the efficacy and advantages of such combination therapy of memantine and AchEIs for treating BPSD of patients with moderate AD.
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Affiliation(s)
- HyunChul Youn
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Kang Joon Lee
- Department of Psychiatry, Ilsanpaik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Shin-Gyeom Kim
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Woo Jung Kim
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Won Joon Lee
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jae Yeon Hwang
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cheolmin Shin
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Han-Yong Jung
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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36
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Desta M, Memiah P, Kassie B, Ketema DB, Amha H, Getaneh T, Sintayehu M. Postpartum depression and its association with intimate partner violence and inadequate social support in Ethiopia: a systematic review and meta-analysis. J Affect Disord 2021; 279:737-748. [PMID: 33234282 DOI: 10.1016/j.jad.2020.11.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/16/2020] [Accepted: 11/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS Despite remarkable progress in the reduction of maternal mortality, postpartum depression remains a major public health problem among vulnerable populations. In Ethiopia, study findings regarding postpartum depression and its association with intimate partner violence and social support have been inconsistent. Therefore, this systematic review and meta-analysis estimate the pooled prevalence of postpartum depression and its association with intimate partner violence and inadequate social support in Ethiopia. METHODS We systematically searched international databases like PubMed, Web of Science, SCOPUS, CINAHL, PsycINFO, Google Scholar, Science Direct, and the Cochrane Library. All identified observational studies reporting the postpartum depression and or its predictors in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. The I2 statistics were used to assess the heterogeneity of the studies. A random-effects model was computed to estimate the pooled prevalence of postpartum depression and its associations with the selected predictors. RESULTS The random effect meta-analysis of thirteen studies showed a pooled prevalence of postpartum depression was 21.55% (95% CI: 17.89, 25.94). The highest prevalence of postpartum depression occurred in Addis Ababa, 23.3% and the lowest was in Harar, 13.11%. Our meta-analysis indicated a 5.46 folds increased risk of postpartum depression among women exposed to intimate partner violence (POR = 5.46 (95%CI: 3.94, 7.56, I2=38.8%) and 6.27 folds increased risk postpartum depression among women who had inadequate social support (POR = 6.27 (95%CI: 4.83, 8.13, I2=0) relative to those who had adequate social support. The meta-analysis further revealed that marital dissatisfaction (POR = 2.6%; 95%CI: 1.48-4.65), previous postpartum depression (POR = 2.03%; 95%CI: 1.72-2.4), and substance abuse (POR = 2.03%; 95%CI: 1.72-2.4) were associated with postpartum depression. CONCLUSIONS Our study indicates that two in every ten postpartum women in Ethiopia are suffering from postpartum depression. Intimate partner violence and social support should be a major focus to improve women's mental health during postpartum period with the reduction of substance abuse. There is an urgent need for concerted efforts in the reduction of postpartum depression through prevention efforts of intimate partner violence and substance abuse.
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Affiliation(s)
- Melaku Desta
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
| | - Peter Memiah
- Division of Epidemiology and Prevention: Institute of Human Virology, University of Maryland, School of Medicine, Baltimore, Maryland
| | - Bekalu Kassie
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Daniel Bekele Ketema
- Department of Public health, College of Health Sciences, Debre Markos University, Ethiopia
| | - Haile Amha
- Department of Psychiatry, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Temesgen Getaneh
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mezinew Sintayehu
- Department of Psychiatry, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Does Urinary Incontinence and Mode of Delivery Affect Postpartum Depression? A Nationwide Population-Based Cohort Study in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020437. [PMID: 33429855 PMCID: PMC7827536 DOI: 10.3390/ijerph18020437] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/18/2020] [Accepted: 01/06/2021] [Indexed: 11/16/2022]
Abstract
We investigated the association between urinary incontinence and postpartum depression. Data were extracted from the Korean National Health Insurance Service-National Sample Cohort and included women who delivered between 2004 and 2013. Postpartum depression was determined using diagnostic codes during the six-month postpartum period. Urinary incontinence was identified as having a prescription of incontinence drugs or a diagnosis. Cox proportional hazard models were used to calculate adjusted hazard ratios. Of the 83,066 women, 5393 (6.49%) had urinary incontinence and 691 (0.83%) had postpartum depression. Postpartum depression was higher among women with urinary incontinence, aged 15–19 years, ≥40 years old, the lowest income level, and who underwent cesarean section delivery. In the combined analysis, women with urinary incontinence and cesarean section had an approximately three times higher risk of postpartum depression compared with those without urinary incontinence and with spontaneous delivery. Women without urinary incontinence and cesarean section, and those with urinary incontinence and spontaneous delivery were at higher risk of postpartum depression compared with the reference group. Urinary incontinence and cesarean section delivery were significantly associated with postpartum depression during the first six months after childbirth. Therefore, further research should be conducted to evaluate whether urinary incontinence contributes to postpartum depression.
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Yokoyama M, Tanaka K, Sugiyama T, Arakawa M, Miyake Y. Cesarean section is associated with increased risk of postpartum depressive symptoms in Japan: the Kyushu Okinawa Maternal and Child Health Study. J Affect Disord 2021; 278:497-501. [PMID: 33017676 DOI: 10.1016/j.jad.2020.09.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/27/2020] [Accepted: 09/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The association between cesarean section and the risk of postpartum depressive symptoms remains controversial. The present prebirth cohort study examined this issue in Japan. METHODS Study subjects were 1310 women. Information under study was obtained using a self-administered questionnaire. Postpartum depressive symptoms were defined as a total Edinburgh Postnatal Depression Scale score of nine or higher between three and four months postpartum. Multivariate logistic regression analysis was used to adjust for age, body mass index, gestational weeks at baseline, gestational weeks at delivery, number of children at baseline, previous miscarriage or stillbirth, previous abortion, history of depression, family history of depression, region of residence, employment status, educational level, household income, family structure, breastfeeding status, smoking during pregnancy, infant's birthweight, and infant's sex. RESULTS Postpartum depressive symptoms were identified in 8.2%. After adjustment for the confounding factors, compared with vaginal delivery, cesarean section was independently associated with an increased risk of postpartum depressive symptoms: the adjusted odds ratio (OR) was 1.95 (95% confidence interval [CI]: 1.16-3.23). This positive association was more apparent among those who had no other children at baseline than among those who already had one or more children: the adjusted ORs were 2.94 (95% CI: 1.35-6.26) and 1.45 (95% CI: 0.68-2.92), respectively; however, this interaction was not significant. LIMITATIONS Information on whether each cesarean section was emergency or elective and other obstetric complications was not available. CONCLUSIONS Cesarean section may be associated with an increased risk of postpartum depressive symptoms, especially among women without children at baseline.
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Affiliation(s)
- Maki Yokoyama
- Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Ehime, Japan.
| | - Keiko Tanaka
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Takashi Sugiyama
- Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Masashi Arakawa
- Health Tourism Research Fields, Graduate School of Tourism Sciences, University of the Ryukyus, Okinawa, Japan
| | - Yoshihiro Miyake
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
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Brown LA, Menendez-Bobseine M. Placenta Accreta Spectrum. J Midwifery Womens Health 2020; 66:265-269. [PMID: 33338302 DOI: 10.1111/jmwh.13182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/24/2020] [Accepted: 09/15/2020] [Indexed: 11/29/2022]
Abstract
Placenta accreta spectrum is a term used to describe abnormal adherence and abnormal invasion of the placenta into the uterine wall during pregnancy. The incidence of placenta accreta spectrum has steadily increased over the last 40 years and is most notably linked to rising cesarean birth rates. This condition is associated with increased maternal morbidity and mortality because of the high risk of severe hemorrhage and likely need for hysterectomy at the time of birth. Early diagnosis of abnormal placentation is preferable in order to coordinate birth planning with a interprofessional collaborative team within a high-level perinatal care center. This article describes the case of a woman diagnosed with placenta accreta spectrum and the clinical course of her pregnancy and birth.
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Smithson S, Mirocha J, Horgan R, Graebe R, Massaro R, Accortt E. Unplanned Cesarean delivery is associated with risk for postpartum depressive symptoms in the immediate postpartum period. J Matern Fetal Neonatal Med 2020; 35:3860-3866. [PMID: 33108930 DOI: 10.1080/14767058.2020.1841163] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Postpartum depression (PPD) is a common pregnancy complication. The association between cesarean delivery (CD) and PPD has shown conflicting results in prior studies, although emergent CD appears to be a clear risk factor. Establishing PPD risk is critical and may, however, be related to the unplanned nature of the CD, rather than the surgery itself. Our objective was to determine whether women who underwent unplanned CD were more likely than those with vaginal delivery to have higher depressive symptoms and thus screen positive for PPD risk in the immediate postpartum period. MATERIALS AND METHODS This cohort study was conducted at a community medical center using data for deliveries between 8/2015-1/2016. Women were screened in the hospital for depressive symptoms (PPD risk) using the Edinburgh Postnatal Depression Scale (EPDS) within 4 days post-delivery. Logistic regression, adjusting for maternal race/ethnicity and parity, was performed to evaluate the association between delivery route (vaginal vs planned vs unplanned CD) and PPD risk (EPDS ≥ 10). RESULTS A total of 2094 women had complete data for analysis. Overall, 44 women (2.1%) screened positive for PPD risk. Logistic regression results showed that unplanned CD was significantly associated with PPD risk (OR = 2.28, 95% CI 1.13-4.57, p = .022), after adjusting for parity and race/ethnicity. Planned CD was not associated with PPD risk. CONCLUSION Unplanned CD may be an independent risk factor for PPD risk in the immediate postpartum period. This finding might explain why some previous studies have demonstrated different results with regards to risk of CD where the unplanned nature of the delivery was not accounted for.
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Affiliation(s)
- S Smithson
- Department of Obstetrics and Gynecology, Monmouth Medical Center, Long Branch, NJ, USA.,Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - J Mirocha
- Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - R Horgan
- Department of Obstetrics and Gynecology, Monmouth Medical Center, Long Branch, NJ, USA
| | - R Graebe
- Department of Obstetrics and Gynecology, Monmouth Medical Center, Long Branch, NJ, USA
| | - R Massaro
- Department of Obstetrics and Gynecology, Monmouth Medical Center, Long Branch, NJ, USA
| | - E Accortt
- Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
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Preeclampsia as a risk factor for postpartum depression and psychosis: a systematic review and meta-analysis. Arch Womens Ment Health 2020; 23:493-505. [PMID: 31802249 DOI: 10.1007/s00737-019-01010-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/07/2019] [Indexed: 12/12/2022]
Abstract
Postpartum depression (PPD) and postpartum psychosis (PPP) are serious mental conditions that are usually not diagnosed early enough, leading to delayed treatment. Several studies confirmed an association between preeclampsia (PE) and psychiatric disorders during pregnancy. We conducted a systematic review of the literature aiming to investigate whether women with a history of PE are more likely to develop PPD or PPP, and whether PE is a risk factor for depression outside the perinatal period (PROSPERO protocol number CRD42018114188). We also conducted a meta-analysis to quantitatively assess the severity of depressive symptoms between women with and without a history of PE. A literature search with no year and no language restriction was conducted. The search yielded 950 articles, with 698 remaining after duplicate removal, and 13 being suitable for the systematic review. Eight of the 13 studies found an association between preeclampsia and depression. All studies assessed the impact of PE on depression, and only two studies assessed the impact of PE on PPP. Eight of the studies were included in the meta-analysis, which yielded a higher severity of depressive symptoms postpartum in women with PE. However, these results must be interpreted with caution considering the high heterogeneity of the included studies. Our meta-analysis also showed that women with a history of PE showed higher severity of depressive symptoms outside of the puerperal period. In conclusion, this systematic review and meta-analysis suggest that that PE is not only a risk factor for development of depression, but it is also associated with higher severity of depressive symptoms.
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Abstract
BACKGROUND Postpartum depression (PPD) affects one in seven women in the United States. Korean Americans are one of the six largest Asian American (AA) subgroups, representing 9% of the AA population in the United States. Women of Asian descent have not always been represented in studies of PPD. PURPOSE The purpose of this study was to understand postpartum experiences, perceptions of PPD, and mental health help-seeking among Korean women living in the United States. METHODS Individual, face-to-face, semistructured interviews of Korean immigrant women, over age 18, who were able to read, write, and speak English or Korean, and who had given birth to a live infant within the past 12 months, were conducted using a qualitative exploratory design. Thematic analysis approach was used to analyze qualitative data The Edinburgh Postnatal Depression Screening Scale (EPDS) was used to assess frequency of depressive symptoms over the past week. RESULTS Eleven women participated. Total EPDS scores ranged from 2 to 17 (mean 6.5, SD = 3.2); three women had scores indicating a high risk for developing PPD. Two overall themes, postpartum experiences and perceptions of PPD and professional help-seeking, along with several subthemes were identified. They included postpartum challenges, importance of keeping Korean postpartum traditions, desire for professional Korean postpartum care, "Sanhoo-Joeri" postpartum support and social networking, normalization of PPD symptoms, family first for health seeking attitude and behavior, and stigma attached to mental health care. CLINICAL IMPLICATIONS Nurses working with Korean women during postpartum can provide culturally competent care by assessing postpartum care needs, respecting cultural practices, and providing resources such as Korean postpartum care centers Sanhoo-Joeriwon, which can be found in major U.S. cities with large Korean communities (e.g., Los Angeles), and in-home postpartum care providers, Sanhoo-Joerisa. Nurses should be comfortable educating women about normal signs and symptoms of PPD and those requiring immediate medical follow-up.
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Labrague LJ, McEnroe-Petitte D, Tsaras K, Yboa BC, Rosales RA, Tizon MM, D'souza MS. Predictors of postpartum depression and the utilization of postpartum depression services in rural areas in the Philippines. Perspect Psychiatr Care 2020; 56:308-315. [PMID: 31355473 DOI: 10.1111/ppc.12428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 06/07/2019] [Accepted: 07/14/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study explored the prevalence and predictors of postpartum depression (PPD) as well as the utilization and evaluation of PPD services among postpartum women in rural areas of the Philippines. DESIGN AND METHODS A cross-sectional study was conducted. One hundred sixty-five women who visited maternal facilities in the rural areas of the Central Philippines completed the Edinburgh Postnatal Depression Scale (EPDS). FINDINGS The prevalence of PPD was 16.4% at the sixth postpartum week. Occupation and marital status had significant direct influences on PPD. PPD services were not routinely provided by doctors and nurses. PRACTICE IMPLICATIONS Our results highlight a greater need to intensify government programs relative to PPD services, specifically related to the early detection and screening of PPD among high-risk pregnancies.
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Affiliation(s)
- Leodoro J Labrague
- Department of Fundamentals and Administration, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | | | - Konstantinos Tsaras
- Department of Nursing, Technological Educational Institute of Thessaly, Larissa, Greece
| | - Begonia C Yboa
- College of Nursing and Health Sciences, Catbalogan, Philippines
| | | | - Maricel M Tizon
- College of Nursing and Health Sciences, Catbalogan, Philippines
| | - Melba S D'souza
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
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Kim H, Kim Y, Baek JH, Fava M, Mischoulon D, Nierenberg AA, Choi KW, Na EJ, Shin MH, Jeon HJ. Predictive factors of diagnostic conversion from major depressive disorder to bipolar disorder in young adults ages 19-34: A nationwide population study in South Korea. J Affect Disord 2020; 265:52-58. [PMID: 31957692 DOI: 10.1016/j.jad.2020.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/19/2019] [Accepted: 01/03/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Predicting patients who convert to bipolar disorder is important for deciding appropriate treatment for young adults with major depressive disorder (MDD). We focused on the predictive factors of bipolar conversion in a large population of young adults. METHODS A nationwide, population-based electronic medical records database from the Health Insurance Review & Assessment service of South was used to investigate adjusted hazard ratio (HR) of each potential predictor of the bipolar converter group compared to the non-converter group using Cox regression analysis including age of onset, medication use, clinical features, comorbid disorders, admission, self-harm, and negative life events in childhood. RESULTS Among 291,721 subjects who were initially diagnosed with MDD in young adults, 12,376 subjects experienced diagnostic conversion to bipolar disorder. The cumulative incidence was 6.46% during the average 3.26 years of follow-up. Among the predictive factors during diagnosis of MDD, antipsychotic use (HR 3.12, 95%CI, 2.99-3.26, p < 0.0001) and mood stabilizers (HR 2.45, 95%CI, 2.35-2.55, p < 0.0001) showed the strongest association with diagnostic conversion to bipolar disorder. In addition, female sex, younger age of onset, mood stabilizer use, recurrent depression, psychotic symptoms, and admission to a psychiatric ward during diagnosis of MDD were also associated with diagnostic conversion to bipolar disorder. CONCLUSION In young adults with MDD, antipsychotic and mood stabilizer use during diagnosis of MDD were the strongest predictive factors with diagnostic conversion to bipolar disorder during follow-up. If young adults with MDD need antipsychotics or mood stabilizer, patients should be carefully evaluated for possibility of bipolar disorder.
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Affiliation(s)
- Hyewon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135770, South Korea
| | - Yuwon Kim
- Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Ji Hyun Baek
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135770, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Andrew A Nierenberg
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States; Bipolar Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kwan Woo Choi
- Department of Psychiatry, Anam Hospital, Korea University College of Medicine and School of Medicine, Seoul, South Korea
| | - Eun Jin Na
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135770, South Korea
| | - Myung-Hee Shin
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135770, South Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
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de Paula Eduardo JAF, de Rezende MG, Menezes PR, Del-Ben CM. Preterm birth as a risk factor for postpartum depression: A systematic review and meta-analysis. J Affect Disord 2019; 259:392-403. [PMID: 31470184 DOI: 10.1016/j.jad.2019.08.069] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND This systematic review aimed to critically analyze the studies that explored preterm birth as risk factor for postpartum depression in the last 10 years. METHODS Two independent researchers performed a systematic review of indexed studies in PubMed/Medline, Web of Science and PsycInfo database. The PRISMA for reporting systematic review model was used to conduct data extraction. A meta-analysis was performed including a sub-group of studies. RESULTS The final sample consisted of 26 studies and 12 were included in the meta-analysis. Most of the studies supported the association between preterm birth (PTB) and postpartum depression (PPD). However, 8 studies did not find such association and, even among studies with positive findings, results were heterogeneous, given the methodological discrepancies among the studies. The meta-analysis provided evidence of higher risk for PPD among mothers of preterm infants in assessments performed up to 24 weeks after childbirth. LIMITATIONS Most of the studies did not consider the role of important confounding variables, such as previous history of depression. Heterogeneity of assessment tools and cut-off scores were also considered a limitation. CONCLUSIONS Further prospective population-based studies with an integrative approach of PPD are needed to provide consistent evidence of such association. Important confounding variables and biological measures implicated in PPD should be considered. Our findings highlight the importance of maternal mental health care in this target population, as preterm birth experience seem to affect both babies and mothers. We encourage PPD assessment for mothers of preterm infants, especially in the early postpartum period.
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Affiliation(s)
| | | | - Paulo Rossi Menezes
- Department of Preventive Medicine, Faculdade de Medicina, University of São Paulo, Brazil
| | - Cristina Marta Del-Ben
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Brazil
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Sahin E, Seven M. Depressive symptoms during pregnancy and postpartum: a prospective cohort study. Perspect Psychiatr Care 2019; 55:430-437. [PMID: 30430584 DOI: 10.1111/ppc.12334] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/07/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim was to determine the prevalence and risk factors of postpartum depression, and changes over time from pregnancy to postpartum period. DESIGN AND METHODS A prospective cohort study was conducted in 23 cities in Turkey, with 497 pregnant women. FINDINGS Of women, 13.5% had a high level of depressive symptoms during pregnancy and 4.8% during the postpartum period. Significant relationships emerged between total Edinburgh Postnatal Depression Scale score and mean age of participants and their husbands, duration of marriage, parity, and history of receiving professional psychological support. PRACTICE IMPLICATIONS Family planning education could be an important intervention to prevent depression in young couples.
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Affiliation(s)
- Eda Sahin
- Health Science Faculty, Giresun University, Giresun, Turkey
| | - Memnun Seven
- School of Nursing, Koç University, İstanbul, Turkey
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Development of Postpartum Depression in Pregnant Women with Preeclampsia: A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9601476. [PMID: 30937313 PMCID: PMC6415313 DOI: 10.1155/2019/9601476] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/11/2019] [Accepted: 02/05/2019] [Indexed: 12/17/2022]
Abstract
Background Postpartum depression (PPD) and preeclampsia (PE) are both common diseases in obstetrics that affect maternal health and infant development. However, the relationship between the two diseases still requires clarification. Objective The purpose of this study was to (1) determine the incidence rate of PPD in patients with PE and (2) identify the association between the prevalence of PPD and the severity of PE. Methods We conducted a retrospective analysis of women with and without PE who delivered between January 1, 2017, and August 30, 2018, in the First Affiliated Hospital of Chongqing Medical University. We used a questionnaire survey methodology that included the Edinburgh Postnatal Depression Scale (EPDS) to test the influence of PE on the development of new-onset PPD in the 6 weeks after delivery. We determined PPD based on a score ≥10 on the EPDS. Bivariate analysis was used to compare data between the two groups. Results A total of 180 women participated in this study. Thirty-five people screened positive for PPD, while the remaining 145 screened negative. The prevalence of PPD was 26.67% (24/90) in patients with PE, which was two times the prevalence in normal women (12.22%). Multiple logistic regression showed that women who had PE had nearly 3-fold increased odds of PPD compared to normal women and the risk of PPD increased with the aggravation of PE. Patients with severe PE had a more than 4-fold increased risk of screening positive for PPD. Conclusion PE was independently associated with PPD. Furthermore, the risk of PPD seemed to increase with the aggravation of PE. Thus, additional prevention efforts and support methods should be provided for women with PE to reduce the incidence of PPD.
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