Association between family members and risk of postpartum depression in Japan: Does “who they live with” matter? -The Japan environment and Children's study

Inverse Association Between Mothers' Cognitive Social Capital During Pregnancy and Postpartum Depression: The Japan Environment and Children's Study

Purpose

Several studies have reported an apparent inverse association between cognitive social capital and depression in various groups, but insights into this association in perinatal mothers are fairly limited. Therefore, we explored the possible associations between expectant mothers' cognitive social capital (ie, neighborhood trust and reciprocity and generalized trust and reciprocity) and postpartum depression at 1 and 6 months after delivery.

Patients and Methods

As part of an ongoing cohort study, the Japan Environment and Children's Study, cognitive social capital was evaluated using a questionnaire survey during mid-late pregnancy and postpartum depression was assessed using the Japanese version of the Edinburgh Postnatal Depression Scale. This study analyzed data from 81,670 mothers. Logistic regression analysis was performed to calculate the odds ratios (ORs) for postpartum depression by the degree of neighborhood and generalized trust and reciprocity (high, relatively high, neutral, relatively low, and low) using the high category as a reference.

Results

Regardless of the measurement time point, prevalence gradually increased as the degree of neighborhood trust decreased (all p < 0.001), suggesting a higher likelihood of postpartum depression with less neighborhood trust. A comparable tendency was also observed for the other three variables of cognitive social capital (all p < 0.001). Moreover, the inverse association of postpartum depression with generalized trust and reciprocity was markedly stronger (ORs for low category ≥ 2.70) than that with neighborhood trust and reciprocity (ORs for low category ≤ 1.96).

Conclusion

Our findings highlight a statistically significant inverse association between cognitive social capital during pregnancy and postpartum depression at both time points.

Maternal mental health and economic autonomy in lowland rural Nepal: Do parents-in-law provide constraint or support?

Background and objectives

In patrilocal societies, married women typically co-reside with their parents-in-law, who may act in their son's reproductive interests. These relationships may shape maternal mental health and autonomy. Few studies have examined these dynamics from an evolutionary perspective. Theoretically, marital kin may increase their fitness by increasing maternal investment or by reducing paternity uncertainty. We explored how co-residence with parents-in-law and husband is associated with maternal outcomes to evaluate whether marital kin provide support or constraint.

Methodology

We analysed data from 444 households in rural lowland Nepal. Maternal mental health was assessed by General Health Questionnaire. Logistic regression models investigated whether, relative to mothers living with both husband and parents-in-law, those co-resident with other combinations of relatives had poorer mental health and lower household economic autonomy (decision-making, bargaining power), adjusting for socio-economic confounders.

Results

Co-residence with husband only, or neither husband nor parents-in-law, was associated with higher odds of mothers reporting feeling worthless and losing sleep but also earning income and making household expenditure decisions. Husband co-residence was associated with overall maternal distress but also with less unpaid care work and greater decision-making responsibility. There were no differences in maternal outcomes for mothers living with parents-in-law only, relative to those living with both husbands and parents-in-law.

Conclusions and implications

Co-residence of parents-in-law and husbands was associated with contrasting patterns of maternal mental health and economic autonomy. We suggest that different marital kin place different economic demands on mothers, while restricting their autonomy in different ways as forms of 'mate-guarding'.

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

Background

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

Methods

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

Results

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

Conclusion

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

Relationship between family cohesion/adaptability and postpartum depressive symptoms: A single-center retrospective study

BACKGROUND

Depression is the most common mental illness in postpartum mothers, and the etiology of postpartum depression remains poorly understood. Over the past several decades, studies have reported that postpartum depression is caused by multiple factors, such as genetic, psychological, pregnancy, and environmental factors, with the family environment being an important environmental factor. The theory of family cohesion and adaptability put forward by Olson is a classic model that describes the level of family function. However, to date, this model has not been examined regarding its applicability to patients with postpartum depression.

AIM

To investigate the relationship between family cohesion and adaptability and the risk of postpartum depressive symptoms.

METHODS

We retrospectively analyzed 1446 patients admitted to the postpartum healthcare clinic of the Affiliated Foshan Maternity and Child Healthcare Hospital from April 2021 to December 2021. Patients were grouped according to whether postpartum depression symptoms were reported (symptoms, n = 454; no symptoms, n = 992). All patients completed the Edinburgh Postpartum Depression Scale and the Chinese version of the Family Cohesion and Adapt-ability Assessment Scale II. Baseline and clinical data were compared between groups. Univariate regression analysis was used to investigate the association between different types of family cohesion and postpartum depressive symptoms and the association between different family adaptability types and postpartum depressive symptoms.

RESULTS

After adjusting for age, education, occupation, gravidity, parity, and mode of delivery, disengaged [adjusted odds ratio (AOR) = 3.36, 95%CI: 1.91–5.91], and separated (AOR = 1.97, 95%CI: 1.34–2.90) family cohesion types showed a higher risk of postpartum depression than the connection type, whereas the enmeshed type (AOR = 0.38, 95%CI: 0.28–0.51) protected against postpartum depressive symptoms. Rigid (AOR = 4.41, 95%CI: 3.02–6.43) and structured families (AOR = 1.88, 95%CI: 1.34–2.63) had a higher risk of postpartum depressive symptoms than flexible families, whereas chaotic families (AOR = 0.35, 95%CI: 0.24–0.51) protected against postpartum depressive symptoms.

CONCLUSION

Family cohesion and adaptability are influencing factors for postpartum depressive symptoms, with higher family cohesion and adaptability being associated with a lower risk of postpartum depressive symptoms.

Relationship between Edinburg Postnatal Depression Scale (EPDS) Scores in the Early Postpartum Period and Related Stress Coping Characteristics

Despite postpartum depression being a common mental health problem, there is no screening method for it. The only risk assessment used is the Edinburgh Postnatal Depression Scale (EPDS). We investigated the relationship between Brief Scale for Coping Profile (BSCP) subscales performed during pregnancy and EPDS scores. We recruited 353 women with normal pregnancies (160 primiparas, and 193 multiparas) and performed BSCP at 26 weeks of gestation. The EPDS was first performed within one week after delivery (T1), and then after one month (T2). Spearman’s correlation coefficients were calculated for the BSCP and EPDS for the whole and primi/multipara groups. Multiple regression analysis was performed with the EPDS T2 scores as the dependent variable. The EPDS scores were higher in the primipara group compared to the multipara (p < 0.001), and the EPDS T1 scores were higher than the overall T2 score (p < 0.001). In the multiple regression analysis, EPDS T1 and the “seeking help for solution” subscale were selected as significant explanatory variables when analyzed in the whole group; EPDS T1 and “active solution” for the primiparas; and EPDS T1, “changing mood”, and “seeking help for solution” for the multiparas. The BSCP can be used as a screening tool for postpartum depression during pregnancy.

Causal model of the association of social support during pregnancy with a perinatal and postpartum depressive state: A nationwide birth cohort - the Japan Environment and Children's Study

BACKGROUND

Despite many epidemiological studies on the relationship between social support during pregnancy and perinatal/postpartum depression, its impact remains unclear. Therefore, this study examined this association using a causal model of risk based on various levels of social support.

METHODS

Participants were 88,711 mothers in an ongoing nationwide birth cohort study in Japan. Social support during pregnancy was set at four treatment levels. Depressive state was identified twice, with the Kessler Psychological Distress Scale (K6; score ≥ 5) and the Edinburgh Postnatal Depression Scale (EPDS; score ≥ 9). With the highest level of social support set as reference, marginal structural models were fitted to derive counterfactual risk ratios (cRRs).

RESULTS

cRRs (95% CIs) for EPDS cases increased as the level of social support decreased, with values of 1.06 (0.99-1.13) for upper-middle, 1.30 (1.23-1.39) for lower-middle, and 1.61 (1.52-1.71) for low. Also, cRRs (95% CIs) at the second measurement (interaction) tended to increase as social support decreased, with values of 1.05 (0.97-1.13) for upper-middle, 1.05 (0.98-1.13) for lower-middle, and 1.10 (1.03-1.18) for low. The same tendency was observed in K6 cases.

LIMITATION

Depressive state was identified by self-administered questionnaire.

CONCLUSIONS

Lower social support during pregnancy is associated with increased counterfactual risk of perinatal/postpartum depressive state and worsened counterfactual spontaneous recovery over time. These findings highlight the importance of sufficient social support for preventing perinatal/postpartum depression and promoting recovery.

TRIAL REGISTRATION

UMIN000030786.

Mothers with depressed mood: help-seeking from husbands and child-rearing behaviors

BACKGROUND

Mothers with depressed mood tend not to seek help or support from others. Yet, there is no research providing a detailed examination of the processes that mothers with depressed mood undergo while seeking child-rearing support from their husbands. This study aimed to clarify the processes that mothers with depressed mood go through in seeking child-rearing support from their husbands and performing child-rearing duties.

METHODS

The participants were 10 mothers living in Japan who had given birth within the past three years and were suspected of having depression after screening using the Edinburgh Postnatal Depression Scale. Semi-structured interview data were analyzed based on the grounded theory.

RESULTS

The responses revealed that the mothers felt as though they had insufficient time for themselves, which impelled them to seek support from their husbands, consequently leading them to conclude either that child-rearing and housework are difficult or that child-rearing can be managed some way or another.

CONCLUSION

When the husbands fully cooperated in child-rearing or demonstrated their willingness to cooperate in child-rearing, despite difficulty, the wives accepted their child-rearing support. On the other hand, if the husbands did not recognize their wives' efforts, the wives did not accept their support, even if they had helped with child-rearing. In this way, the wives re-evaluated their relationship with the husbands based on their husbands' attitudes toward child-rearing.

Investigating the Relationship between Media Usage, Depression, and Quality of Life among Older Adults

BACKGROUND

The uses and gratifications theory suggests that various types of media can greatly affect people's lives. This is especially true among older adults who tend to use media for leisure. However, there is insufficient research regarding the relationship between media usage, depression, and quality of life among older adults.

PURPOSE

The purpose of this study was to explore the association between media usage (traditional and internet media), depression, and quality of life among older adults.

METHODS

Using a cross-sectional design, this study recruited individuals aged 65 years and older in central Taiwan and collected data via a structured questionnaire. Contents of the questionnaire included demographic details, a media usage behavior questionnaire, the Brief Symptoms Rating Scale (BSRS-5), and the Quality of Life Scale developed by the World Health Organization (WHOQOL-BREF). Subsequently, multiple regression analyses were conducted to investigate the association between media usage, depression, and quality of life of older adults.

RESULTS

The average age of the 252 participants (107 males) was 70.0 ± 5.4 years. Regression analysis revealed a significant, negative relationship between the number of hours spent watching television and the degree of depression. Additionally, the number of hours spent watching television was significantly negatively related to the quality of life in terms of both the psychological health and social relationships categories. In contrast, the number of hours spent reading newspapers and magazines was significantly positively related to quality of life in the categories of psychological health, social relationships, and environment. Finally, the number of hours spent browsing internet media was significantly positively related to the quality of life in the psychological health category.

CONCLUSION

Media usage may affect the degree of depression and quality of life of older adults depending on the type of media and amount of usage.

Trust and well-being of postpartum women during the COVID-19 crisis: Depression and fear of COVID-19

During crisis, trust has been found to have a buffering effect in the prevention of the deterioration of mental well-being, as trust is considered to reflect the individual's capability to gain social resources including both formal and informal support. Additionally, during the COVID-19 pandemic, political trust has been found to reduce anxiety. Taking these findings into account, this study explores the association of generalised and political trust with mental well-being on current postpartum women who were particularly at risk due to a decline in social support leaving them an increased burden of caring newborns during the pandemic. We conducted a crosssectional survey in October 2020 in Japan (n=558). Depressive symptoms (above the cutoff of the Edinburgh Postnatal Depression Scale (EPDS)) and Fear of Coronavirus-19 Scale (FCV-19S) scores were used as mental well-being indicators. Generalised and political trust were captured by binary variables. Results of regression analyses, in which covariates were fully adjusted, showed that higher generalised trust had a statistically significant association with lower possibility of depressive symptoms and a lower FCV-19S score, while political trust was not significantly associated with either indicator. For further understanding, we divided respondents into two groups; women living in cities where higher COVID-19 cases were reported and women living in areas with lower COVID-19 cases, to test whether the role of trust differs depending on the infection spread status. It was found that a higher generalised trust was significantly associated with a lower probability of having depressive symptoms in the areas with lower COVID-19 cases. However, statistical significance was not observed in the areas with high COVID-19 cases. This highlighted that even postpartum women who were normally capable of receiving formal and informal social support need to be taken care of in the current situation.

The prevalence and determinants of postpartum depression (PPD) symptomatology among facility delivered mothers of Dhaka city

BACKGROUND

Postpartum depression (PPD) is among the top mental health issues and affects children's health and cognitive development. This study aimed to identify the prevalence of PPD symptomatology and possible determinants among facility delivered mothers of Dhaka city.

METHOD

A cross-sectional study was conducted among 291 mothers within the 12 months of postpartum during January to May 2019.

RESULTS

The prevalence of PPD symptomatology was 29.9 % among postpartum mothers. Multiple adjusted odds ratios of stepwise logistic regression analyses revealed, mothers age more than 30 years (AOR = 2.56:95 %CI = 1.21-5.39), being a mother for the first time (AOR = 2.08:95 %CI = 1.09-3.96), lost job or couldn't able to do paid work due to pregnancy (AOR = 2.60:95 %CI = 1.25-5.43), hypertension history (AOR = 2.48:95 %CI = 1.20-5.10), neonatal complication (AOR = 2.04:95 %CI = 1.05-3.95), and rare or no support from husband (AOR = 4.12:95 %CI = 2.14-7.95) were identified as significant predictors of PPD. However, having a household income of more than 50,000 Bangladeshi Taka per month (AOR = 0.36:95 %CI = 0.17-0.76) and passing less sedentary hours (AOR = 0.41:95 % CI = 0.23-0.75) were protective factors for PPD.

CONCLUSION

Our study has revealed a relatively high prevalence of PPD symptomatology; therefore, mental health counseling and proper management of cases are essential for bettering mothers and the next generation.

Paternal childcare at 6 months and risk of maternal psychological distress at 1 year after delivery: The Japan Environment and Children's Study (JECS)

Background

Paternal childcare is reported to benefit maternal mental health, but specific childcare behaviors have not been comprehensively determined. This study sought to identify paternal childcare behaviors associated with maternal mental health by adjusting for other covariates associated with maternal mental health and examining childcare behaviors.

Methods

This study investigated whether seven types of paternal childcare behaviors at 6 months after delivery were associated with maternal psychological distress at 1 year after delivery, which was assessed using the Kessler Psychological Distress Scale (K6). After exclusions from a dataset of 103,062 pregnancies obtained in the Japan Environment and Children’s Study, we evaluated data from 75,607 mothers.

Results

More than 70% of fathers were always or sometimes involved in “playing at home,” “playing outdoors,” “changing diapers,” and “bathing,” 60%–70% in “helping with feeding” and “dressing,” and 45.9% in “putting the child to bed.” All paternal childcare behaviors showed some beneficial association with less maternal psychological distress, both moderate (K6 score 5–12) and severe (K6 score ≥ 13) distress. Playing at home was the most beneficial association identified (adjusted odds ratio [aOR] 0.66, 95% confidence interval [CI] 0.56–0.76 for moderate psychological distress; aOR 0.36, 95% CI 0.28–0.48 for severe psychological distress).

Conclusions

These seven types of paternal childcare behaviors may help lessen maternal psychological distress. Emphasis should be given to building education systems and working environments that promote paternal childcare.

In-Law Relationships in Evolutionary Perspective: The Good, the Bad, and the Ugly

In-laws (relatives by marriage) are true kin because the descendants that they have in common make them "vehicles" of one another's inclusive fitness. From this shared interest flows cooperation and mutual valuation: the good side of in-law relationships. But there is also a bad side. Recent theoretical models err when they equate the inclusive fitness value of corresponding pairs of genetic and affinal (marital) relatives-brother and brother-in-law, daughter and daughter-in-law-partly because a genetic relative's reproduction always replicates ego's genes whereas reproduction by an affine may not, and partly because of distinct avenues for nepotism. Close genetic relatives compete, often fiercely, over familial property, but the main issues in conflict among marital relatives are different and diverse: fidelity and paternity, divorce and autonomy, and inclinations to invest in distinct natal kindreds. These conflicts can get ugly, even lethal. We present the results of a pilot study conducted in Bangladesh which suggests that heightened mortality arising from mother-in-law/daughter-in-law conflict may be a two-way street, and we urge others to replicate and extend these analyses.

A survey of postpartum depression and health care needs among Chinese postpartum women during the pandemic of COVID-19

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.

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

BACKGROUND

Postpartum depression (PPD) is a major public health problem worldwide, which adversely affects maternal and infant health. The purpose of this study was to determine the prevalence and related factors of postpartum depression in Chinese puerperium women.

METHODS

A cross-sectional study was conducted in Baoan Maternal and Child Health Hospital located in the west of Shenzhen, China. The Chinese version of the Edinburgh Postpartum Depression Scale (EPDS) was used to screen PPD. A score of ≥10 was used as the threshold of postpartum depression.

RESULTS

A total of 4813 puerperal women were included in this study, 11.5% of whom were considered to have PPD. Multivariate logistic regression analysis found that family history of mental illness (OR = 1.94; 95% CI, 1.05-3.57; P = 0.033), living with parents-in-law (OR = 1.41; 95% CI, 1.16-1.72; P < 0.001), anxiety during pregnancy (OR = 3.66; 95% CI, 2.97-4. 52; P < 0.001), depression during pregnancy (OR = 4.25; 95% CI, 3.28-5.50; P < 0.001), and stressful life events (OR = 1.50; 95% CI, 1.03-2.20; P = 0.036) were associated with the high prevalence of PPD.

LIMITATIONS

The cross-sectional survey cannot assess direct causality. EPDS is just a screening tool and not a diagnostic one.

CONCLUSION

Postpartum depression is a common disease in Chinese puerperal population. High-risk pregnant women with postpartum depression need routine screening and targeted intervention for PPD.

Risk of postpartum depression and very early child mistreatment among mothers reporting higher autistic traits: Evidence from the Japan Environment and Children's Study

BACKGROUND

Little is known about how mothers who report higher autistic traits face new parenthood. This study examined the association between antenatal non-clinical autistic traits and the risks of both postpartum depression (PPD) and child mistreatment at one-month postpartum and if these associations were mediated by preexisting social support.

METHODS

Participants included 73,532 singleton mothers without histories of psychiatric conditions from the Japan Environment and Children's Study, a nationwide birth cohort. Autistic traits were measured during the second/third trimesters using the short-version of the Autism Quotient-Japanese version. Participants were classified into three groups (i.e., typical-range, moderate-range, and high-range). PPD was measured using the Japanese version of the Edinburgh Postnatal Depression Scale, while participants self-reported experiences of child mistreatment (i.e., hit or shake the child); both assessments were conducted at one-month postpartum. Individual social support was reported during pregnancy. Data analyses were conducted through Poisson regressions.

RESULTS

A total of 7,147 (9.7%) participants reported PPD, while 12,994 (17.7%) reported child mistreatment at one-month postpartum. Autistic traits were associated with increased PPD risk (adjusted-relative risk [aRR] =1.74, 95%CI=1.64-1.84 for moderate-range; aRR=2.33, 2.13-2.55 for high-range) and child mistreatment (aRR=1.19, 1.13-1.24 for moderate-range; aRR=1.39, 1.28-1.50 for high-range) independently of confounders. Social support mediated 26-31% of these associations for moderate/high-range groups (both risks).

LIMITATIONS

Self-reported measurements were used.

CONCLUSIONS

Mothers who reported moderate-to-high autistic traits in the general population were vulnerable to PPD and newborn mistreatment at one-month postpartum, which was partially explained by the lack of social support during pregnancy.

Living With Parents-In-Law Increased the Risk of Postpartum Depression in Chinese Women

Background: A variety of psychological and socioeconomic factors contribute to the development of postpartum depression (PPD). However, the relationship between maternal living arrangements and PPD is unclear. Objective: To assess the relationship between maternal living arrangements and PPD in Chinese population. Methods: A cross-sectional survey was conducted among puerperal women delivered in Baoan Maternal and Child Health Hospital in Shenzhen, China. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PPD. A score of ≥10 was used as the threshold for postpartum depression. Results: A total of 4,813 women were recruited, of whom 2,535 (52.7%) lived only with their husbands, 664 (13.8%) lived with their parents, and 1,614 (33.5%) lived with their parents-in-law. Compared with women who lived with husbands, puerperal women who lived with their parents-in-law were more likely to be positive for PPD screening (14.1 vs. 10.5%, P < 0.001). After adjusting for other influencing factors, living with parents-in-law was significantly associated with the risk of PPD (OR = 1.38, 95% CI, 1.12-1.70). Additionally, stratification analyses showed that the association between living with parents-in-law and the presence of PPD was more significant in women with anxiety during pregnancy (P for interaction <0.05). Conclusions and Relevance: Our data confirms that the maternal living arrangements affect the risk of PPD, especially among women with anxiety during pregnancy. Therefore, more targeted preventive measures should be taken for postpartum depression in women who live with their parents-in-law.

Socio-economic-demographic determinants of depression in Indonesia: A hospital-based study

The association of socio-economic-demographic (SED; e.g., income-related) factors with depression is widely confirmed in the literature. We conducted a hospital-based case–control study of 160 patients with psychiatrist-diagnosed clinical depression. The control group comprised 160 participants recruited from local communities. We used a questionnaire to collect SED data from all participants. We replaced missing values using multiple imputation analyses and further analyzed the pooled data of five imputations. We also recorded the results from the original analysis and each imputation. Univariate analyses showed income was associated with depression. Multiple logistic regression analyses revealed that, among all SED variables, high income (odds ratio = 2.088 [95% confidence interval = 1.178–3.700]; p = 0.012), middle-level (completed junior or senior high school) education (1.688 [1.042–2.734]; p = 0.033) and cohabitating with four or more family members (1.632 [1.025–2.597]; p = 0.039) were significant predictors for the case group. We conclude that cash income is a determinant of depression in hospital outpatients in Indonesia. This study suggests health policy implications toward better hospital access and service for people with depression in middle- or low-income households, and recommends considering high income as correlated with a high risk of depression, owing to socio-cultural changes.

Dysmenorrhea increased the risk of postpartum depression in Chinese Han parturients

Several studies have shown that dysmenorrhea increased the risk of depression. However, the association between dysmenorrhea and postpartum depression (PPD) is unclear. The purpose of this study is to evaluate the effects of dysmenorrhea on the development of PPD among Chinese women. A case-control study was performed on parturients who delivered from January 1, 2016, to December 31, 2016, at Bao an Maternal and Child Health Hospital in Shenzhen, China. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for maternal postpartum depression. Logistic regression models were used to examine the association between dysmenorrhea and the risk of PPD. A total of 360 women including 120 cases and 240 controls were enrolled. Our study showed that parturients with PPD had a higher percentage of dysmenorrhea than women without PPD (64.2% vs 47.9%, P = 0.004). In univariate analysis, we observed that dysmenorrhea increased the risk for PPD (OR = 1.95; 95% CI: 1.24-3.06; P = 0.004). In the fully adjusted model, dysmenorrhea was still significantly associated with an increased risk of PPD (OR = 2.45; 95% CI: 1.36-4.54; P = 0.003). Our data confirmed that dysmenorrhea may be a risk factor for PPD. Therefore, screening for postpartum depression should be considered in parturients with a history of dysmenorrhea.

Relationship between postpartum depression and lactation status at a Japanese perinatal center: A cross-sectional study

Background:  Some studies have demonstrated that breastfeeding can protect mothers from postpartum depression; therefore, we examined the association between postpartum depression and lactation status at one month after delivery at a Japanese perinatal center.

Methods: We reviewed the obstetric records of all (total 809) nulliparous healthy women with vaginal singleton delivery at 37-41 weeks’ gestation at our institute between July 2018 and June 2019. A face-to-face interview with the women was conducted on admission for delivery to ask whether or not they hoped to perform exclusive breastfeeding for their babies, and an additional interview was conducted one month after delivery to ask about their feeding methods currently. Maternal mental status was examined based on the scores using the Edinburgh Postnatal Depression Scale (EPDS), and women with EPDS scores of ≥9 points were regarded as ‘positive screening’.

Results: 592 women (73.1%) hoped to perform exclusive breastfeeding for their babies on admission. Of these, at one month, 442 (74.7%) performed exclusive breastfeeding, while 150 (25.3%) performed mixed or artificial feeding. The average EPDS scores and the incidence of EPDS scores ≥9 points in the women performing exclusive breastfeeding were 4.3 ± 3.6 and 14.3% (63/442), respectively. They did not differ from those in the women performing mixed or artificial breast feeding [4.2 ± 3.7, p = 0.60 and 13.3% (20/150), p = 0.78].

Conclusion: Development of postpartum depression does not seem to be associated with incomplete breastfeeding at our hospital, and therefore there are other risk factors indicated in the development of postpartum depression.