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Segre G, Clavenna A, Cartabia M, Bonati M. Postpartum depression screening in mothers and fathers at well-child visits: a feasibility study within the NASCITA cohort. BMJ Open 2023; 13:e069797. [PMID: 37355274 PMCID: PMC10314581 DOI: 10.1136/bmjopen-2022-069797] [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: 11/03/2022] [Accepted: 05/23/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVE To assess the feasibility of the family paediatrician's (FP) role in identifying the signs of postpartum depression in parents in time to guarantee child well-being. DESIGN, SETTING AND PARTICIPANTS Data for this observational prospective study were collected within the NASCITA (NAscere e creSCere in ITAlia) cohort. During the first visit, paediatricians collected sociodemographic data regarding the parents and information about their health status, the pregnancy and the delivery. Whooley questions were administered during the first and second visits (scheduled 60-90 days after childbirth). Moreover, on the third visit (5-7 months after childbirth) the FP was asked to answer 'yes' or 'no' to a question on the parental postpartum depression, based on his knowledge and on the acquired information. RESULTS In 2203 couples who completed the assessment, 529 mothers (19.9%), 141 fathers (6.3%) and 110 (5%) couples reported any depressive symptomatology. Of these, 141 mothers (5.3% of the total sample) and 18 fathers (0.8% of the total sample) were classified as 'likely depressed'. An association was found between maternal postnatal depressive symptoms and having a diagnosed psychiatric disorder during pregnancy (OR 9.49, 95% CI: 3.20 to 28.17), not exclusively breastfeeding at hospital discharge (OR 1.76, 95% CI: 1.19 to 2.61) and the presence of child sleeping disorders at 3 (OR 2.46, 95% CI: 1.41 to 4.28) and 6 months (OR 2.18, 95% CI: 1.37 to 3.47). Another significant predictor of postpartum depression was being primiparous (OR 1.99, 95% CI: 1.31 to 3.02). Concerning the fathers, a significant association was reported only between likely depressed fathers and child sleeping disorders at 3 months (OR 7.64, 95% CI: 2.92 to 19.97). Moreover, having a likely depressed partner was strongly associated with depressive symptoms in fathers (OR 85.53, 95% CI 26.83 to 272.69). CONCLUSIONS The findings of this study support the feasibility of an active screening programme for parental postnatal depression during well-child visits as an integral part of postpartum care. TRIAL REGISTRATION NUMBER NCT03894566; Pre-results.
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Affiliation(s)
- Giulia Segre
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Antonio Clavenna
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Massimo Cartabia
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Maurizio Bonati
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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The impact of the 2015 ACOG screening guidelines on the diagnosis of postpartum depression among privately insured women. J Affect Disord 2023; 328:103-107. [PMID: 36764363 DOI: 10.1016/j.jad.2023.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 01/25/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Postpartum depression (PPD), is underdiagnosed and undertreated. In 2015, the American College of Obstetricians and Gynecologists (ACOG) recommended that women be screened for PPD at least once during the perinatal period. The effect of the recommendation on PPD diagnosis is unknown. METHODS Using the MerativeTM MarketScan® database, PPD prevalence was identified in privately insured women ages 13-45 with a live birth between 2013 and 2016. Postpartum depression was defined as an ICD diagnosis code for PPD or other depression, or a new pharmacy claim for an antidepressant medication during the first 12 months following delivery. Multivariable logistic regression was used to estimate the likelihood of PPD both before and after the ACOG PPD Committee Opinion. RESULTS The study included 244,624 women ages 13-45 who had a live birth in 2013 through 2016. PPD prevalence before and after the 2015 ACOG Committee Opinion was 15.1 % and 17.2 %, respectively. The likelihood of PPD was not statistically different following the 2015 Committee Opinion (adjusted OR, 1.00, 95 % CI, 0.97-1.03) when controlling for age, year, delivery complications, and geographic region. LIMITATIONS Sociodemographic variables are not included in the MarketScan database and therefore could not be analyzed as covariates. Re-defining a PPD diagnosis as above interfered with the ability to measure a prior history of mood disorders as a covariate. CONCLUSION Implementation of the ACOG recommendations was not associated with a significant increase in PPD diagnosis. This suggests that physician organization recommendations alone are not sufficient to increase detection of PPD.
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Brown HK, Chen S, Vigod SN, Guttmann A, Havercamp SM, Parish SL, Tarasoff LA, Lunsky Y. A population-based analysis of postpartum acute care use among women with disabilities. Am J Obstet Gynecol MFM 2022; 4:100607. [PMID: 35248782 PMCID: PMC9703340 DOI: 10.1016/j.ajogmf.2022.100607] [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: 02/10/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Disability is common in reproductive-aged women, and as many as 1 in 8 pregnancies occur in women with a disability. Women with disabilities experience significant social and health disparities, and are at greater risk than their nondisabled counterparts for perinatal complications. Yet, few studies have examined their postpartum acute care use. OBJECTIVE To examine risks of postpartum emergency department visits and hospital admissions among women with and without physical, sensory, and intellectual/developmental disabilities. STUDY DESIGN In this population-based study in Ontario, Canada, women with a singleton obstetrical delivery from 2003 to 2019 were classified into those with physical (n=155,500), sensory (n=49,338), intellectual/developmental (n=2650), and multiple disabilities (≥2 disabilities; n=9904), and women without disabilities (n=1,701,574). Primary outcomes were emergency department visits and hospital admissions 0 to 365 days after index delivery hospital discharge. Secondary outcomes were emergency department visits and hospital admissions by primary diagnosis (medical, psychiatric) and by timing (0-7, 8-42, 43-365 days postpartum). Adjusted relative risks comparing each disability group to those without disabilities were adjusted for age; parity; income quintile; rurality; immigrant/refugee status; prepregnancy chronic medical conditions, mental illness, and substance use disorders; and prenatal care provider type. RESULTS Any postpartum emergency department visit occurred in 23.5% of women without a disability, with risks elevated in women with physical (32.9%; adjusted relative risk, 1.27; 95% confidence interval, 1.26-1.28), sensory (30.0%; adjusted relative risk, 1.16; 95% confidence interval, 1.15-1.18), intellectual/developmental (48.8%; adjusted relative risk, 1.38; 95% confidence interval, 1.33-1.44), and multiple disabilities (42.0%; adjusted relative risk, 1.44; 95% confidence interval, 1.41-1.48) compared with women without disabilities. Similarly, any postpartum hospital admission occurred in 3.0% of women without a disability, with elevated risks in women with physical (4.8%; adjusted relative risk, 1.37; 95% confidence interval, 1.34-1.40), sensory (4.0%; adjusted relative risk, 1.19; 95% confidence interval, 1.14-1.24), intellectual/developmental (9.6%; adjusted relative risk, 1.96; 95% confidence interval, 1.73-2.21), and multiple disabilities (7.3%; adjusted relative risk, 1.77; 95% confidence interval, 1.64-1.90). Results were consistent by primary diagnosis and timing in the postpartum period. CONCLUSION Women with disabilities have elevated risk of emergency department visits and hospital admissions in the postpartum period, indicating greater postpartum morbidity, which requires attention through enhanced and extended follow-up across the postpartum period.
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Affiliation(s)
- Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada (Drs Brown and Tarasoff); Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (Drs Brown, Vigod, and Guttmann); Women's College Research Institute, Women's College Hospital, Toronto, Canada (Drs Brown and Vigod); Institute for Clinical Evaluative Sciences, Toronto, Canada (Drs Brown, Chen, Vigod, Guttmann, and Lunsky).
| | - Simon Chen
- Institute for Clinical Evaluative Sciences, Toronto, Canada (Drs Brown, Chen, Vigod, Guttmann, and Lunsky)
| | - Simone N Vigod
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (Drs Brown, Vigod, and Guttmann); Women's College Research Institute, Women's College Hospital, Toronto, Canada (Drs Brown and Vigod); Institute for Clinical Evaluative Sciences, Toronto, Canada (Drs Brown, Chen, Vigod, Guttmann, and Lunsky); Department of Psychiatry, University of Toronto, Toronto, Canada (Drs Vigod and Lunsky)
| | - Astrid Guttmann
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (Drs Brown, Vigod, and Guttmann); Institute for Clinical Evaluative Sciences, Toronto, Canada (Drs Brown, Chen, Vigod, Guttmann, and Lunsky); Hospital for Sick Children, Toronto, Canada (Dr Guttmann); Department of Pediatrics, University of Toronto, Toronto, Canada (Dr Guttmann)
| | - Susan M Havercamp
- Center for Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, OH (Dr Havercamp)
| | - Susan L Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, VA (Dr Parish)
| | - Lesley A Tarasoff
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada (Drs Brown and Tarasoff); Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Canada (Drs Tarasoff and Lunsky)
| | - Yona Lunsky
- Institute for Clinical Evaluative Sciences, Toronto, Canada (Drs Brown, Chen, Vigod, Guttmann, and Lunsky); Department of Psychiatry, University of Toronto, Toronto, Canada (Drs Vigod and Lunsky); Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Canada (Drs Tarasoff and Lunsky)
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Perinatal depression screening: a systematic review of recommendations from member countries of the Organisation for Economic Co-operation and Development (OECD). Arch Womens Ment Health 2022; 25:871-893. [PMID: 35849215 PMCID: PMC9492701 DOI: 10.1007/s00737-022-01249-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/21/2022] [Indexed: 11/02/2022]
Abstract
Perinatal depression (PND) screening recommendations are made by national, state-based and professional organisations; however, there is disagreement regarding screening timing, provider responsible, screening setting, screening tool as well as the follow-up and referral pathways required post-screening. This systematic review aimed to identify, describe and compare PND screening recommendations from member countries of the Organisation for Economic Co-operation and Development (OECD). Publications were identified through systematically searching PubMed, Google and the Guidelines International Network (GIN). Recommendations regarding PND screening endorsement, timing, frequency, responsible provider, tools/assessments and follow-up and referral were extracted. Twenty-one publications, including guidelines, from five countries were included. Most made recommendations in support of PND screening using the Edinburgh Postnatal Depression Scale. Details differed regarding terminology used, as well as frequency of screening, follow-up mechanisms and referral pathways. A broad range of health providers were considered to be responsible for screening. This is the first review to identify and compare PND screening recommendations from OECD member countries; however, only online publications published in English, from five countries were included. Heterogeneity of publication types and inconsistency in definitions rendered quality assessment inappropriate. While most publications generally endorsed PND screening, there are exceptions and the associated details pertaining to the actual conduct of screening vary between and within countries. Developing clear, standardised recommendations based on current evidence is necessary to ensure clarity amongst healthcare providers and a comprehensive approach for the early detection of PND.
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Byatt N, Masters GA, Bergman AL, Moore Simas TA. Screening for Mental Health and Substance Use Disorders in Obstetric Settings. Curr Psychiatry Rep 2020; 22:62. [PMID: 32936340 DOI: 10.1007/s11920-020-01182-z] [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] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW The objective of this review is to describe the extent to which (1) obstetric settings are currently screening for mental health and substance use disorders and social determinants of health (SDoH), and (2) screening is followed by systematic approaches for ensuring an adequate response to positive screens. Additionally, clinical and policy implications of current screening practices and recommendations are discussed. RECENT FINDINGS Screening for perinatal depression in obstetric settings has increased. Despite their prevalence and negative impact, screening for other mental health and substance use disorders and SDoH is much less common and professional society recommendations are either nonexistent, less consistent, or less prescriptive. To truly address maternal mental health, we need to move beyond focusing solely on depression and address other mental health and substance use disorders and the contextual social determinants in which they occur.
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Affiliation(s)
- Nancy Byatt
- University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - Grace A Masters
- University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Aaron L Bergman
- University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Tiffany A Moore Simas
- University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA
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McKean M, Caughey AB, Yuracko McKean MA, Cabana MD, Flaherman VJ. Postpartum Depression: When Should Health Care Providers Identify Those at Risk? Clin Pediatr (Phila) 2018; 57:689-693. [PMID: 28969467 DOI: 10.1177/0009922817733696] [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] [Indexed: 11/16/2022]
Abstract
Maternal postpartum depression (PPD) has an impact on mothers and infants. The American Academy of Pediatrics recommends screening for PPD at well-child visits during the first 6 months. We conducted a secondary data analysis of depression screening data collected each month during months 1 to 12 postpartum for 152 mothers with an infant participating in a randomized controlled trial. We used descriptive statistics to describe the incidence and the cumulative incidence of a positive PPD screen during months 1 to 12 postpartum. The results indicate that the initial positive screen for PPD can occur any time during the first 12 months postpartum and 15% had their first positive screen between months 6 and 12. Additionally, positive PPD screens are consistently high throughout the first year postpartum with the highest rate of positive screens at 12 months postpartum (23%). Our data suggest that PPD screening through 12 months may be most beneficial for families.
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Olin SCS, McCord M, Stein REK, Kerker BD, Weiss D, Hoagwood KE, Horwitz SM. Beyond Screening: A Stepped Care Pathway for Managing Postpartum Depression in Pediatric Settings. J Womens Health (Larchmt) 2017; 26:966-975. [PMID: 28409703 DOI: 10.1089/jwh.2016.6089] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The negative consequences of untreated postpartum depression (PD) for both the woman and her infant are well established. The impact of maternal depression has led to recommendations on systematic perinatal depression screening. Unfortunately, large-scale initiatives on PD screening have found no benefit unless systems are in place to facilitate appropriate interventions for women who screen positive. Pediatric primary care has been a focus of efforts to support screening and management of PD because pediatric providers, unlike adult healthcare providers, have the most frequent contact with postpartum women through well-child visits. Well-child visits thus present an unparalleled opportunity to detect and intervene with PD. Literature reviews suggest that specific strategies are feasible within pediatric settings and could benefit both the woman and her child. In this article, we present a stepped care approach for screening and managing PD, integrating common elements found in existing pediatric-based models. A stepped care approach is ideal because PD is a heterogeneous condition, with a range of presentations and hence responsiveness to various interventions. This care pathway begins with systematic screening for depression symptoms, followed by a systematic risk assessment for women who screen positive and care management based on risk profiles and responsiveness. This approach allows pediatric providers to be optimally flexible and responsive in addressing the majority of women with PD within the context of the family-centered medical home to improve child well-being. Challenges to managing PD within pediatrics are discussed, including strategies for addressing them. Implications for research, policy, and practice are discussed.
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Affiliation(s)
- Su-Chin Serene Olin
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Mary McCord
- 2 Department of Pediatrics, New York University School of Medicine , New York, New York.,3 Department of Pediatrics, Gouverneur Health Services , New York, New York
| | - Ruth E K Stein
- 4 Albert Einstein College of Medicine/Children's Hospital at Montefiore , New York, New York
| | - Bonnie D Kerker
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Dara Weiss
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Kimberly E Hoagwood
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Sarah M Horwitz
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
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Glasser S, Levinson D, Bina R, Munitz H, Horev Z, Kaplan G. Primary Care Physicians' Attitudes Toward Postpartum Depression: Is It Part of Their Job? J Prim Care Community Health 2016; 7:24-9. [PMID: 26574564 PMCID: PMC5932674 DOI: 10.1177/2150131915611827] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES This study surveyed Israeli primary care physicians' attitudes and practice regarding postpartum depression (PPD). METHODS Participants included 224 pediatricians and family practitioners responding to an online survey (65% response rate). RESULTS Almost all respondents (98.0%) considered it important that they be able to recognize the signs of PPD. Most (89.8%) noted that if they suspected PPD, they would become somewhat involved: clarifying, keeping attentive, consulting with colleagues, and/or referring the woman to another professional. Six respondents--only family practitioners--stated that they would treat the case themselves (P = .01). Family practitioners were significantly more willing to screen for PPD than were pediatricians (91.2% vs 64.6%; P < .0001). There were no differences between physicians by region or between males and females when comparing all respondents, as well as when comparing within medical specialty (P < .05). CONCLUSIONS There is a clear difference between considering the importance of recognizing signs of PPD and acting on it. Family practitioners had more favorable attitudes than did pediatricians, however screening in pediatric facilities is considered by many to be optimal. Hopefully future directions for medical education and health policy for family practitioners and pediatricians, as well as obstetrician/gynecologists, will meet the challenge of early identification and treatment of PPD for the benefit of women, infants and families.
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Affiliation(s)
- Saralee Glasser
- Gertner Institute for Epidemiology and Health Services Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Daphna Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - Rena Bina
- Bar Ilan University, Ramat Gan Israel
| | | | | | - Giora Kaplan
- Gertner Institute for Epidemiology and Health Services Research, Sheba Medical Center, Tel Hashomer, Israel
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Jain A, Tyagi P, Kaur P, Puliyel J, Sreenivas V. Association of birth of girls with postnatal depression and exclusive breastfeeding: an observational study. BMJ Open 2014; 4:e003545. [PMID: 24913326 PMCID: PMC4054658 DOI: 10.1136/bmjopen-2013-003545] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES AND HYPOTHESIS To examine the influence of gender of the baby on exclusive breastfeeding and incidence of postnatal depression (PND). We hypothesise that in a society with a male gender bias there may be more PND and less exclusive breastfeeding of the girl child. DESIGN Prospective study. SETTING The study was conducted in an urban, tertiary hospital in Delhi. PARTICIPANTS Mothers delivering normally with their babies roomed-in.1537 eligible women participated in the study. PRIMARY AND SECONDARY OUTCOME MEASURES Exclusive breastfeeding within the first 48 h of life and score on the Edinburgh Postnatal Depression Scale (EPDS) were recorded. RESULTS 3466 babies were born in the hospital. There were 792 girls for every 1000 boys. Among primiparous women, the sex ratio was 901 girls per 1000 boys. For second babies, the sex ratio was 737:1000. If the first child was a girl the birth ratio fell to 632. 1026 mothers were exclusively breastfeeding. Exclusive breastfeeding of boys was significantly higher (70.8% vs 61.5%, p<0.001). The EPDS score was significantly higher with the birth of girls (EPDS 6.0±3.39 vs 5.4±2.87, p<0.01). Women with an EPDS score >11 were less likely to exclusively breastfeed (p<0.01). CONCLUSIONS The results point to a pro-male gender bias evidenced by a low sex ratio at birth, higher EPDS score in mothers of girls and less breastfeeding of female children.
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Affiliation(s)
- Akanksha Jain
- Department of Pediatrics, St Stephen's Hospital, Tis Hazari, Delhi, India
| | - Prashant Tyagi
- Department of Pediatrics, St Stephen's Hospital, Tis Hazari, Delhi, India
| | - Prabhjeet Kaur
- Department of Pediatrics, St Stephen's Hospital, Tis Hazari, Delhi, India
| | - Jacob Puliyel
- Department of Pediatrics, St Stephen's Hospital, Tis Hazari, Delhi, India
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Agapidaki E, Souliotis K, Jackson SF, Benetou V, Christogiorgos S, Dimitrakaki C, Tountas Y. Pediatricians' and health visitors' views towards detection and management of maternal depression in the context of a weak primary health care system: a qualitative study. BMC Psychiatry 2014; 14:108. [PMID: 24725738 PMCID: PMC3984632 DOI: 10.1186/1471-244x-14-108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 04/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study's aim has been to investigate, identify and interpret the views of pediatric primary healthcare providers on the recognition and management of maternal depression in the context of a weak primary healthcare system. METHODS Twenty six pediatricians and health visitors were selected by using purposive sampling. Face to face in-depth interviews of approximately 45 minutes duration were conducted. The data were analyzed by using the framework analysis approach which includes five main steps: familiarization, identifying a thematic framework, indexing, charting, mapping and interpretation. RESULTS Fear of stigmatization came across as a key barrier for detection and management of maternal depression. Pediatric primary health care providers linked their hesitation to start a conversation about depression with stigma. They highlighted that mothers were not receptive to discussing depression and accepting a referral. It was also revealed that the fragmented primary health care system and the lack of collaboration between health and mental health services have resulted in an unfavorable situation towards maternal mental health. CONCLUSIONS Even though pediatricians and health visitors are aware about maternal depression and the importance of maternal mental health, however they fail to implement detection and management practices successfully. The inefficiently decentralized psychiatric services but also stigmatization and misconceptions about maternal depression have impeded the integration of maternal mental health into primary care and prevent pediatric primary health care providers from implementing detection and management practices.
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Affiliation(s)
- Eirini Agapidaki
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece
| | - Kyriakos Souliotis
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece
- Faculty of Social Sciences, University of Peloponnese, Korinth, Greece
| | - Suzanne F Jackson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Vassiliki Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Stylianos Christogiorgos
- Department of Child Psychiatry, University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Christina Dimitrakaki
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece
| | - Yannis Tountas
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece
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Abstract
BACKGROUND Early television (TV) viewing has been linked with maternal depression and has adverse health effects in children. However, it is not known how early TV viewing occurs. This study evaluated the prevalence at which parents report TV viewing for their children if asked in the first 2 years of life and whether TV viewing is associated with maternal depression symptoms. METHODS Using a cross-sectional design, TV viewing was evaluated in children 0 to 2 years of age in 4 pediatric clinics in Indianapolis, IN, between January 2011 and April 2012. Families were screened for any parental report of depression symptoms (0-15 months) and for parental report of TV viewing (before 2 years of age) using a computerized clinical decision support system linked to the patient's electronic health record. RESULTS There were 3254 children in the study. By parent report, 50% of children view TV by 2 months of age, 75% by 4 months of age, and 90% by 2 years of age. Complete data for both TV viewing and maternal depression symptoms were available for 2397 (74%) of children. In regression models, the odds of parental report of TV viewing increased by 27% for each additional month of child's age (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.25-1.30; p < .001). The odds of TV viewing increased by almost half with parental report of depression symptoms (OR, 1.47; CI, 1.07-2.00, p = .016). Publicly insured children had 3 times the odds of TV viewing compared to children with private insurance (OR, 3.00; CI, 1.60-5.63; p = .001). Black children had almost 4 times the odds (OR, 3.75; CI, 2.70-5.21; p < .001), and white children had one-and-a-half times the odds (OR, 1.55; CI, 1.04-2.30; p = .032) of TV viewing when compared to Latino children. CONCLUSIONS By parental report, TV viewing occurs at a very young age in infancy, usually between 0 and 3 months and varies by insurance and race/ethnicity. Children whose parents report depression symptoms are especially at risk for early TV viewing. Like maternal depression, TV viewing poses added risks for reduced interpersonal interactions to stimulate infant development. This work suggests the need to develop early targeted developmental interventions. Children as young as 0 to 3 months are viewing TV on most days. In the study sample of 0 to 2 year olds, the odds of TV viewing increased by more than a quarter for each additional month of child's age and by as much as half when the mother screened positive for depression symptoms.
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Affiliation(s)
- Vibha Anand
- Pediatric Institute, Cleveland Clinic, Cleveland, OH
| | - Stephen M Downs
- Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, IN
- The Regenstrief Institute for Health Care, Indianapolis, IN
| | - Nerissa S Bauer
- Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, IN
- The Regenstrief Institute for Health Care, Indianapolis, IN
| | - Aaron E. Carroll
- Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, IN
- The Regenstrief Institute for Health Care, Indianapolis, IN
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Agapidaki E, Souliotis K, Christogiorgos S, Zervas L, Leonardou A, Kolaitis G, Giannakopoulos G, Dimitrakaki C, Tountas Y. A theory-based educational intervention to pediatricians in order to improve identification and referral of maternal depression: a quasi-experimental study. Ann Gen Psychiatry 2013; 12:37. [PMID: 24266909 PMCID: PMC3874664 DOI: 10.1186/1744-859x-12-37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/01/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Maternal depression has a negative impact on both the mother and child's physical and mental health, as well as impairs parenting skills and pediatric health care utilization. The pediatricians' role in identification and management of maternal depression is well established. Although it can be successfully and easily treated, maternal depression remains under-recognized and under-treated. Despite the heightened emphasis, there is lack of interventions to pediatricians in order to improve detection and management of maternal depression. METHODS To address this gap, an educational intervention based on the 'Health Belief Model' was developed, implemented, and evaluated. The present quasi-experimental study, aimed to assess the pediatricians' knowledge, self-efficacy, beliefs, and attitudes toward maternal depression at baseline and post-intervention measurements. A total of 43 randomly selected primary care pediatricians residing in Athens completed a 59-item survey by mail in 2011. Pediatricians in the intervention group received a toolkit about the recognition and management of maternal depression, while pediatricians in the control group received a leaflet about mental health. Descriptive statistics, t test, chi-square, Fisher's exact test, and analysis of variance were used for the statistical analysis. RESULTS Post-intervention measurement revealed differences at a statistical significance level between the two groups, in the following variables: beliefs, attitudes, self- efficacy, perceived barriers, and management practices of maternal depression. Furthermore, at post-measurement, pediatricians in the intervention group demonstrated increased perceived responsibility and increased self-efficacy for detection and referral of maternal depression. CONCLUSIONS Educational interventions to pediatricians seem to be beneficial for the improvement of the pediatricians' knowledge, self-efficacy, and attitudes regarding maternal depression. Studies using large, representative population samples are needed to provide evidence if the training interventions to pediatricians for maternal depression are translated to changes in their clinical practice and improved the patients' health outcomes.
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Affiliation(s)
- Eirini Agapidaki
- Center for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Alexandroupoleos st, 25, Athens 115 27, Greece.
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Bunik M, Talmi A, Stafford B, Beaty B, Kempe A, Dhepyasuwan N, Serwint JR. Integrating mental health services in primary care continuity clinics: a national CORNET study. Acad Pediatr 2013; 13:551-7. [PMID: 24238682 DOI: 10.1016/j.acap.2013.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 07/01/2013] [Accepted: 07/08/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine whether pediatric continuity clinics integrate mental health (MH) services into care delivery; and to determine whether the level of MH integration is related to access to MH services, types of MH screening performed, self-efficacy, satisfaction with referral sites, and communication with the primary care provider. METHODS Pediatric Residency Integrated Survey of Mental Health in Primary Care (PRISM_PC) is a newly designed cross-sectional, Web-based survey of continuity clinic directors participating in a national network of pediatric continuity clinics (CORNET). Definitions of MH models included integrated or nonintegrated MH models or traditional care. The survey included questions regarding access, screening that was performed at sites, comfort with MH management as well as provider satisfaction and communication with referral sites. RESULTS Seventy-eight percent (57 of 73) of CORNET site directors responded, representing input from 30% of US pediatric residency continuity programs. Thirty-five percent (n = 20) reported an integrated MH model while 65% (n = 37) reported a nonintegrated MH model. Seventy-nine percent screened for attention-deficit/hyperactivity disorder, 44% for behavioral-emotional issues, and 19% for pediatric depression. No differences were found in terms of screening or tools used on the basis of the level of MH integration. Those with integrated programs were more likely to have access to an on-site psychologist (P = .001) or psychiatrist (P = .006). CONCLUSIONS Directors from one-third of training programs surveyed reported some level of MH integration in their primary care teaching clinics. Future studies are needed to compare patient and resident education outcomes between integrated and nonintegrated sites.
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Affiliation(s)
- Maya Bunik
- Department of Pediatrics, University of Colorado, Denver; Department of Children's Outcome Research, Children's Hospital Colorado, Denver.
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Radesky JS, Zuckerman B, Silverstein M, Rivara FP, Barr M, Taylor JA, Lengua LJ, Barr RG. Inconsolable infant crying and maternal postpartum depressive symptoms. Pediatrics 2013; 131:e1857-64. [PMID: 23650295 DOI: 10.1542/peds.2012-3316] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To quantify the extent to which maternal report of inconsolable infant crying, rather than colic (defined by Wessel's criteria of daily duration of fussing and crying >3 hours), is associated with maternal postpartum depressive symptoms. METHODS Participants were 587 mothers who were recruited shortly before or after delivery and followed longitudinally. At 5 to 6 weeks postpartum, mothers recorded the duration and mode (fussing, crying, or inconsolable crying) of their infant's distress by using the Baby's Day Diary. The Edinburgh Postnatal Depression Scale (EPDS) was administered at enrollment and at 8 weeks postpartum. Using regression models that included baseline EPDS scores and multiple confounders, we examined associations of colic and inconsolable crying with later maternal EPDS scores at 8 weeks postpartum. RESULTS Sixty mothers (10%) met the EPDS threshold for "possible depression" (score ≥9) at 8 weeks postpartum. For mothers reporting >20 minutes of inconsolable crying per day, the adjusted odds ratio for an EPDS score ≥9 was 4.0 (95% confidence interval: 2.0-8.1), whereas the adjusted odds ratio for possible depression in mothers whose infants had colic was 2.0 (95% confidence interval: 1.1-3.7). These associations persisted after adjusting for baseline depression symptoms. CONCLUSIONS Maternal report of inconsolable infant crying may have a stronger association with postpartum depressive symptoms than infant colic. Asking a mother about her ability to soothe her infant may be more relevant for potential intervention than questions about crying and fussing duration alone.
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Prenatal and postpartum maternal psychological distress and infant development: a systematic review. Child Psychiatry Hum Dev 2012; 43:683-714. [PMID: 22407278 DOI: 10.1007/s10578-012-0291-4] [Citation(s) in RCA: 429] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Infant development plays a foundational role in optimal child development and health. Some studies have demonstrated an association between maternal psychological distress and infant outcomes, although the main emphasis has been on postpartum depression and infant-maternal attachment. Prevention and early intervention strategies would benefit from an understanding of the influence of both prenatal and postpartum maternal distress on a broader spectrum of infant developmental outcomes. We conducted a systematic review of studies assessing the effect of prenatal and postpartum maternal psychological distress on five aspects of infant development: global; cognitive; behavioral; socio-emotional; and psychomotor. These findings suggest that prenatal distress can have an adverse effect on cognitive, behavioral, and psychomotor development, and that postpartum distress contributes to cognitive and socio-emotional development.
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Chaudron LH, Szilagyi PG, Tang W, Anson E, Talbot NL, Wadkins HIM, Tu X, Wisner KL. Accuracy of depression screening tools for identifying postpartum depression among urban mothers. Pediatrics 2010; 125:e609-17. [PMID: 20156899 PMCID: PMC3030186 DOI: 10.1542/peds.2008-3261] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The goal was to describe the accuracy of the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory II (BDI-II), and Postpartum Depression Screening Scale (PDSS) in identifying major depressive disorder (MDD) or minor depressive disorder (MnDD) among low-income, urban mothers attending well-child care (WCC) visits during the postpartum year. METHODS Mothers (N = 198) attending WCC visits with their infants 0 to 14 months of age completed a psychiatric diagnostic interview (standard method) and 3 screening tools. The sensitivities and specificities of each screening tool were calculated in comparison with diagnoses of MDD or MDD/MnDD. Receiver operating characteristic curves were calculated and the areas under the curves for each tool were compared to assess accuracy for the entire sample (representing the postpartum year) and subsamples (representing early, middle, and late postpartum time frames). Optimal cutoff scores were calculated. RESULTS At some point between 2 weeks and 14 months after delivery, 56% of mothers met criteria for either MDD (37%) or MnDD (19%). When used as continuous measures, all scales performed equally well (areas under the curves of > or =0.8). With traditional cutoff scores, the measures did not perform at the expected levels of sensitivity and specificity. Optimal cutoff scores for the BDI-II (> or =14 for MDD and > or =11 for MDD/MnDD) and EPDS (> or =9 for MDD and > or =7 for MDD/MnDD) were lower than currently recommended. For the PDSS, the optimal cutoff score was consistent with current guidelines for MDD (> or =80) but higher than recommended for MDD/MnDD (> or =77). CONCLUSIONS Large proportions of low-income, urban mothers attending WCC visits experience MDD or MnDD during the postpartum year. The EPDS, BDI-II, and PDSS have high accuracy in identifying depression, but cutoff scores may need to be altered to identify depression more accurately among urban, low-income mothers.
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Affiliation(s)
- Linda H Chaudron
- University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, USA.
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Groner JA, Skybo T, Murray-Johnson L, Schwirian P, Eneli I, Sternstein A, Klein E, French G. Anticipatory guidance for prevention of childhood obesity: design of the MOMS project. Clin Pediatr (Phila) 2009; 48:483-92. [PMID: 19246415 PMCID: PMC4492159 DOI: 10.1177/0009922809331799] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prevalence of childhood overweight and obesity in the United States has increased by more than 100% since 1971. Primary care clinicians have a unique opportunity to influence child health during the first year of life via anticipatory guidance (AG). However, little is known about whether AG regarding feeding and meal structure is effective in promoting optimal nutrition and eating behaviors. The purpose of this project, "Making our Mealtimes Special" (MOMS), was to assess 2 distinct methods of pediatric AG during infancy versus a "usual care" condition, with the ultimate goal of prevention of childhood overweight and obesity. The purpose of this article is to describe the ( a) study design and rationale, (b) implementation plan, (c ) assessment of outcomes, and (d) population enrolled. This project will generate important information on the usefulness of nutritional AG during the first year of life in promoting healthy eating behaviors during early childhood.
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Affiliation(s)
- Judith A. Groner
- Section of Ambulatory Pediatrics, Nationwide Children's Hospital
| | | | | | - Patricia Schwirian
- Department of Family Practice, Ohio State University College of Medicine
| | - Ihuoma Eneli
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital
| | - Amy Sternstein
- Center for Healthy Weight and Nutrition Nationwide Children's Hospital
| | - Elizabeth Klein
- Department of Health Promotion/ Health Behavior, Ohio State University College of Public Health Columbus, Ohio
| | - Gina French
- Kapiolani Children's Hospital, Honolulu, Hawaii
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Abstract
Postpartum depression is common in women with infants in the neonatal ICU. Maternal depression can affect infant health and development adversely. A screening program for depression in the neonatal ICU could identify women who have depressive symptoms and facilitate their referral for follow-up services.
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Affiliation(s)
- Kyle O Mounts
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road Milwaukee, WI 53226, USA.
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Beacham TD, May M, Williams PR, Schenk L, Askew R, Walker J, Norwood A. Assessing postpartum depression in women: the home health nurse perspective. HOME HEALTHCARE NURSE 2008; 26:552-562. [PMID: 18849723 DOI: 10.1097/01.nhh.0000338516.79485.de] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Tracilia Drew Beacham
- University of Mississippi Medical Center, School of Nursing, Jackson, MS 39216, USA.
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Kabir K, Sheeder J, Kelly LS. Identifying postpartum depression: are 3 questions as good as 10? Pediatrics 2008; 122:e696-702. [PMID: 18762505 DOI: 10.1542/peds.2007-1759] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Postpartum depression is the most common medical problem that new mothers face. Anxiety is a more prominent feature of postpartum depression than of depression that occurs at other times in life. Routine, universal screening significantly improves detection in primary health care settings. Thus, an ultrabrief scale that could be incorporated into a general health survey or interview would be useful. OBJECTIVE We tested the hypothesis that, during the first 6 postpartum months, the 3-item anxiety subscale of the Edinburgh Postpartum Depression Scale is a better ultrabrief depression screener than 2 Edinburgh Postpartum Depression Scale questions that are almost identical to the widely used Patient Health Questionnaire. METHODS A cohort of 199 14- to 26-year-old participants in an adolescent-oriented maternity program completed the Edinburgh Postpartum Depression Scale at well-child visits during the first 6 postpartum months. Three subscales of the Edinburgh Postpartum Depression Scale were examined as ultrabrief alternatives: the anxiety subscale (3 items; Edinburgh Postpartum Depression Scale-3), the depressive symptoms subscale (7 items; Edinburgh Postpartum Depression Scale-7), and 2 questions that resemble the Patient Health Questionnaire (Edinburgh Postpartum Depression Scale-2). The reliability, stability, and construct validity of the Edinburgh Postpartum Depression Scale and 3 subscales were compared. Criterion validity was assessed by comparison with a score of >/=10 on the full, 10-item Edinburgh Postpartum Depression Scale. RESULTS A total of 41 mothers (20.6%) met study criteria for referral for evaluation of depression (Edinburgh Postpartum Depression Scale-10 score >/= 10). The Edinburgh Postpartum Depression Scale-3 exhibited the best screening performance characteristics, with sensitivity at 95% and negative predictive value at 98%. It identified 16% more mothers as depressed than the Edinburgh Postpartum Depression Scale did. The performance of the Edinburgh Postpartum Depression Scale-2 was markedly inferior, with sensitivity at 48% to 80%. Moreover, the Edinburgh Postpartum Depression Scale-2 was unreliable for mothers who had not been depressed in the past. CONCLUSION The brevity, reliability, and operating characteristics of the Edinburgh Postpartum Depression Scale-3 make it an attractive postpartum depression screening tool for primary health care settings in which the goal is to detect depression, not to assess its severity. Validation by diagnostic psychiatric interview is needed.
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Affiliation(s)
- Karolyn Kabir
- University of Colorado and Health Sciences Center, Children's Hospital, Department of Pediatrics, 1056 E 19th St, Box B025, Denver, CO 80218, USA.
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Orhon FS, Soykan A, Ulukol B. Patient compliance to psychiatric interventions and course of postpartum mood disorders. Int J Psychiatry Med 2008; 37:445-57. [PMID: 18441631 DOI: 10.2190/pm.37.4.g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patient compliance to the psychiatric interventions may affect the outcomes of the mothers with postpartum mood disorders. The aim of this study was to assess the course of depressive symptoms of compliant and noncompliant mothers with postpartum mood disorders. METHOD One hundred-three mothers were followed with the Edinburgh Postnatal Depression Scale (EPDS) during 12-month follow-up period. Mothers with an EPDS score of 12 or higher were consulted with a psychiatrist. "Noncompliant patient" term was defined in this study for the patients who refused psychiatric consultation or treatment suggestions. Outcomes of the depressive symptoms were followed up according to the EPDS scores. Response rate based EPDS scoring was defined. RESULTS A total of 35 (34%) mothers received a higher EPDS score; 28 (27.2%), who accepted the consultation, were diagnosed with postpartum mood disorder. Twenty-three mothers (10 mothers with major depressive disorder and 13 mothers with adjustment disorder) complied with treatment suggestions, and all of them responded to the treatment. EPDS scores was more likely to decrease in these compliant mothers (p = 0.010). However, of the noncompliant mothers (n = 12), only 50% responded to treatment; moreover, the drop out rate was quite high (58.3%). CONCLUSIONS This study reveals that noncompliance to psychiatric interventions may lead to a much less favorable course in depressive symptoms, and to a tendency in drop-outs from visits. Health professionals can give advice to the mothers about postpartum mood disorders and could assist them in getting better outcome.
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Desired assistance versus care received for postpartum depression: access to care differences by race. Arch Womens Ment Health 2008; 11:81-92. [PMID: 18463943 PMCID: PMC2760316 DOI: 10.1007/s00737-008-0001-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Accepted: 01/28/2008] [Indexed: 10/22/2022]
Abstract
One in seven women who have a baby will experience postpartum depression. Although there are many treatments for postpartum depression, many women do not receive assistance. When left untreated, this condition can have a deleterious affect on the woman's health/mental health, the child's cognitive, psychological, emotional and social development, the marital relationship and ability to contribute to society. This study examined 45 women's self-reported desire for PPD care and ability to obtain to these services in Erie County, New York. Results showed differences in desired care by race, differences in access to care by race and revealed the lack of PPD care in general.
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Cutler CB, Legano LA, Dreyer BP, Fierman AH, Berkule SB, Lusskin SI, Tomopoulos S, Roth M, Mendelsohn AL. Screening for maternal depression in a low education population using a two item questionnaire. Arch Womens Ment Health 2008; 10:277-83. [PMID: 17710366 DOI: 10.1007/s00737-007-0202-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 07/29/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess a two-question screening tool, the Patient Health Questionnaire-2 (PHQ-2), for identifying depressive symptomatology in economically disadvantaged mothers of children in pediatric settings and to explore risk factors associated with a positive depression screen. METHODS A convenience sample of mothers was enrolled at an inner city well-child clinic with children age 3 days to 5 years. The PHQ-2 and Edinburgh Postnatal Depression Scale (EPDS) (as reference scale) were completed. RESULTS Ninety-four mothers participated. Agreement of the PHQ-2 and EPDS was moderate. The sensitivity of the PHQ-2 for identifying a positive screen on the EPDS was 43.5%; the specificity was 97.2%. The sensitivity of the PHQ-2 was higher for mothers with education beyond high school compared to those with less education. Perceived lack of support with child care and having two or more children were associated with a positive screen. The rate of positive screen was similar for mothers with infants and with older children. CONCLUSION Given the low sensitivity of the PHQ-2 in lower educated mothers, additional research in populations with varying sociodemographic characteristics is indicated. Similar rates of symptoms for mothers within and beyond the postpartum period and mothers previously screened support the need for periodic screening.
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Affiliation(s)
- C B Cutler
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY 10016, USA.
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Orhon FS, Ulukol B, Soykan A. Postpartum mood disorders and maternal perceptions of infant patterns in well-child follow-up visits. Acta Paediatr 2007; 96:1777-83. [PMID: 18001335 DOI: 10.1111/j.1651-2227.2007.00557.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS The aims of this study were to evaluate the associations between postpartum depressive symptoms and maternal perceptions of infant patterns with 1-year follow-up examinations, and to assess the impacts of treatment on these perceptions. METHODS One hundred three mother-infant pairs were evaluated. Data on maternal reports of infant feeding, sleeping and temperament patterns were collected at each well-child visit. The Edinburgh Postpartum Depression Scale was used to assess depressive symptoms. A psychiatrist interviewed the mothers with depressive symptoms, and psychiatric treatments were administered accordingly. The associations between depressive symptoms and maternal perceptions at each visit were analyzed by taking into account the entire follow-up period. RESULTS Thirty-five mothers (34%) scored within the clinical range of the EPDS during the follow-up period. Mothers with elevated depressive symptoms were more inclined to report infant cry-fuss, sleeping and temperamental problems through the follow-up. Such complains on infant cry-fuss and temperament problems and maternal sleeping problems improved after treatment in compliant mothers. The dropout rate was high (58.3%) in noncompliant mothers. CONCLUSION Postpartum depressive symptoms may lead to negative maternal perceptions of infant patterns. Earlier management of these disorders and maternal compliance to psychiatric suggestions may provide a better care for the mother-infant pairs.
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Affiliation(s)
- Filiz Simsek Orhon
- Department of Social Paediatrics, Ankara University, School of Medicine, Ankara, Turkey.
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Chaudron LH, Szilagyi PG, Campbell AT, Mounts KO, McInerny TK. Legal and ethical considerations: risks and benefits of postpartum depression screening at well-child visits. Pediatrics 2007; 119:123-8. [PMID: 17200279 DOI: 10.1542/peds.2006-2122] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatric professionals are being asked to provide an increasing array of services during well-child visits, including screening for psychosocial and family issues that may directly or indirectly affect their pediatric patients. One such service is routine screening for postpartum depression at pediatric visits. Postpartum depression is an example of a parental condition that can have serious negative effects for the child. Because it is a maternal condition, it raises a host of ethical and legal questions about the boundaries of pediatric care and the pediatric provider's responsibility and liability. In this article we discuss the ethical and legal considerations of, and outline the risks of screening or not screening for, postpartum depression at pediatric visits. We make recommendations for pediatric provider education and for the roles of national professional organizations in guiding the process of defining the boundaries of pediatric care.
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Affiliation(s)
- Linda H Chaudron
- Department of Psychiatry, University of Rochester School of Medicine, 300 Crittenden Blvd, Rochester, NY 14642, USA.
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Akman I, Kusçu K, Ozdemir N, Yurdakul Z, Solakoglu M, Orhan L, Karabekiroglu A, Ozek E. Mothers' postpartum psychological adjustment and infantile colic. Arch Dis Child 2006; 91:417-9. [PMID: 16452109 PMCID: PMC2082735 DOI: 10.1136/adc.2005.083790] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Infantile colic is a common problem of early infancy. There is limited data on the relation between postpartum maternal psychological problems and colic. AIM : To investigate whether infantile colic is associated with postpartum mood disorders or insecure adult attachment style of the mother. METHODS Seventy eight mothers and newborns were enrolled in this prospective, longitudinal study. Maternal depressive symptoms were screened with Edinburgh Postpartum Depression Score (EPDS) and maternal anxiety was assessed with State-Trait Anxiety Inventory (STAI). The Adult Attachment Scale was used to determine the attachment style of the mother. Infantile colic was defined according to Wessel criteria. RESULTS Infantile colic was present in 17 infants (21.7%); 12.9% of the mothers had an EPDS > or =13. The mean EPDS of the mothers whose infants had infantile colic (10.2+/-6.0) was significantly higher than that of the mothers of infants without colic (6.3+/-4.0). Among infants with infantile colic, 62.5% had mothers who had insecure attachment style, whereas only 31.1% of mothers had insecure attachment when the infant did not have infantile colic. CONCLUSION Postpartum maternal depressive symptoms and insecure attachment style are associated with infantile colic. Screening and early intervention of postpartum depression might promote the health of both the mother and infant.
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Affiliation(s)
- I Akman
- Marmara University Medical School, Department of Pediatrics, Division of Neonatology Istanbul, Turkey.
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Munoz C, Agruss J, Haeger A, Sivertsen L. Postpartum Depression: Detection and Treatment in the Primary Care Setting. J Nurse Pract 2006. [DOI: 10.1016/j.nurpra.2006.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Furman L, O'Riordan MA. How Do Mothers Feel About Their Very Low Birth Weight Infants? Development of a New Measure. Infant Ment Health J 2006. [DOI: 10.1002/imhj.20086] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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