A longitudinal study of perinatal depression among Chinese high-risk pregnant women

Risk factors of the antenatal depression in a sample of Italian pregnant women: a preliminary study

BACKGROUND

Antenatal depression is characterized by low mood, insomnia, disorganised behaviour, irritability, and agitation during the pregnancy. If underestimated, antenatal depression is untreated during the pregnancy. It is associated to higher levels of suicide, higher risk of depression after childbirth, preeclampsia, preterm birth, low birth weight, poor interactions between child and mother and severe obstetric outcomes. New data underlined the importance to prevent the risk of depression during the pregnancy. This study examines the predictive validity of potential risk factors, such as socio-demographic and psychological factors, in developing the antenatal depression.

METHODS

The sample was composed by Italian pregnant women (N = 247, mean age of 33.77, SD = 4.78 years). This sample completed the Edinburg Postnatal Depression Scale (EPDS), the Teate Depression Inventory (TDI) and questionnaires about demographic variables. To study associations among variables examined bivariate correlations were computed. To analyse the role of socio-demographic factors and the psychological dimension to predict the severity of the antenatal depression a logistic regression was performed.

RESULTS

Results showed significantly positive correlations between the EPDS and the TDI, and no associations among the EPDS and all socio-demographic factors. Therefore, only the psychological factors were significant predictive risk factors of antenatal period. Finally, higher score of the depression measured via TDI predicted higher score of the EPDS.

CONCLUSIONS

Our results had implications in clinical field. Indeed, the early diagnosis of depression during the pregnancy can help operators in the gynaecological field to prevent the depression in the post-partum period.

Psychiatric Symptoms in Women with High-risk Pregnancy in the Postpartum Period: A Case-control Study

OBJECTIVE

 Psychiatric symptoms are common mental issues in pregnancy and the postpartum period. There is limited information regarding the psychiatric symptoms of women with high-risk pregnancy in the postpartum period. This study aimed to compare the severity of psychiatric symptoms and psychological distress in women with high-risk and low-risk pregnancies in the postpartum period.

METHODS

 This case-control study examined 250 women in the postpartum period in two groups with low-risk (n = 112) and high-risk (n = 138) pregnancies. Women completed the Brief Symptom Inventory-53 (BSI-53) and the Risk Postnatal Psychosocial Depression Risk Questionnaire (PPDRQ).

RESULTS

 The mean severity of psychiatric symptoms in women with high-risk pregnancies was significantly higher than that in women with low-risk pregnancies (39.34 ± 17.51 vs. 30.26 ± 17.08). Additionally, the frequency of psychological distress in women with high-risk pregnancies was approximately twice higher than that in women with low-risk pregnancies (30.3% vs. 15.2%). Furthermore, the risk factors for depression in women with high-risk pregnancies were almost 1.5 times (59.8% vs. 39.8%) higher than the factors in women with low-risk pregnancies. The results of the logistic analysis indicated that high-risk pregnancies could be twice the odds ratio of developing postpartum psychological distress (ß = 2.14, 95% CI 1.4-6.3, p= 0.036).

CONCLUSION

 Psychiatric symptoms and the psychological distress index are higher in postpartum women with high-risk pregnancies than in postpartum women with low-risk pregnancies. The study suggests that obstetricians and pregnant women's health care providers should strongly consider screening of psychiatric symptoms in women with high-risk pregnancies both during pregnancy and after delivery as the women's routine care priorities.

Prenatal stress self-help mindfulness intervention via social media: a randomized controlled trial

BACKGROUND

Prenatal stress is a pressing issue. However, there is a lack of robust evidence for psychosocial interventions to manage this problem.

AIMS

This study aimed to examine the effectiveness of a mindfulness-based intervention on reducing prenatal stress compared to participation in health education groups.

METHODS

A randomized controlled trial was conducted in a prenatal clinic of comprehensive tertiary care from April to October 2017. A total of 108 pregnant women were randomly assigned to an intervention or a control group. Participants completed self-report measures of depression, anxiety, perceived stress, fatigue, positive and negative affect, and mindfulness before, immediately after, and 15 weeks after the 4-week intervention period. Generalized estimating equations were used to analyze the intervention outcomes.

RESULTS

The results supported greater improvement in terms of perceived stress (Wald χ²=26.94, p<0.001), fatigue (Wald χ²=17.61, p<0.001), positive affect (Wald χ²=9.03, p = 0.011), negative affect (Wald χ²=11.37, p = 0.003), and mindfulness (Wald χ²=24.97, p<0.001) in the intervention group than in the control group.

CONCLUSIONS

The self-help mindfulness intervention decreased prenatal stress and negative affect and improved positive affect and mindfulness.

[Associations between Maternal Postpartum Depression and Psychosocial Factors Including Marital Relationship and Social Support]

OBJECTIVES

We aimed to investigate the psychosocial factors for postpartum depression as indicated by a high score of the Edinburgh Postnatal Depression Scale (EPDS), including marital relationship and social support. Relevant factors for antenatal depression were also analyzed.

METHODS

Thirty-five wife-and-husband pairs who visited University Hospital A for the wife's antenatal health check-up participated in a questionnaire survey using the Japanese version of the EPDS. Social support from the wife's husband, kins, and others including friends at the third trimester of pregnancy and 1 month after birth was assessed. The Marital Love Scale (MLS) was also used, and two marital relationship questions were asked regarding the husband's and wife's considerate actions toward each other during pregnancy. Binary logistic regression analysis was conducted to determine adjusted associations between higher EPDS scores (≥5 for postpartum depression and ≥7 for antenatal depression) and indicators for social support and marital relationships.

RESULTS

The most relevant factor for higher postpartum EPDS scores was a higher antenatal EPDS score, followed by the couple's poor communication skills (the wife did not feel any appreciation from her husband) during pregnancy and no support from the wife's husband during the postpartum period. The wife's poor marital communication skills and the husband's low MLS scores during pregnancy were associated (borderline significance) with the wife's higher antenatal EPDS scores.

CONCLUSIONS

A good marital relationship before birth and support by the husband after birth may be important for preventing postpartum depression.

The protective role of social support on prenatal depression among pregnant women of advanced maternal age: a Three-Trimester follow-up study in China

The aim of this study was to compare the depressive symptoms during pregnancy between pregnant women aged over 35 years and those aged less than 35 years and to evaluate the protective effect of social support in early pregnancy against prenatal depressive symptoms. One hundred and seventy one women aged over 35 years and 342 trimester-matched women aged less than 35 years were included from a level III hospital in Shenzhen, China. The self-report Edinburgh Postnatal Depression Scale (EPDS) and Social Support Rating Scale (SSRS) were used to evaluate prenatal depression and social support in early pregnancy. The proportions of women aged over 35 years who screened positive for prenatal depression were 22.8%, 23.4%, and 24.0% in the first, second and third trimesters, respectively. Advanced maternal age (≥35 years) was a positive predictor of prenatal depressive symptoms (β = 0.747, P = 0,008). Social support, especially objective support (β = -0.030, P = 0.002) and subjective support (β = -0.028, P = 0.006) in early pregnancy, had stronger protective effects against prenatal depressive symptoms for women aged over 35 years than younger women. Our findings support that older pregnant women experience more depressive symptoms than younger pregnant women, and social support could serve as a targeted intervention to decrease prenatal depressive symptoms.Impact statementWhat is already known on this subject? Depressive symptoms, which are strongly associated with adverse psychosocial and birth outcomes, appear to be prevalent and change in nature. Social support is an important protective factor against prenatal depression.What the results of this study add? Pregnant women of advanced maternal age experienced more depressive symptoms than younger women during the prenatal period. Social support, especially objective support and subjective support, had stronger protective effects against prenatal depression for women aged over 35 years than women aged less than 35 years.What the implications of these findings are for clinical practice? Screening of prenatal depression should be strengthened, especially for women aged over 35 years, and improving subjective support could improve their emotional experience.

Psychosocial risk factors for postpartum depression in Chinese women: a meta-analysis

Background

Postpartum depression (PPD) has been identified as a recognized public health problem that may adversely affect mothers, infants, and family units. Recent studies have identified risk factors for PPD in Westerners; however, societal and cultural differences between China and the West could, potentially, lead to differences in risk factors for PPD. No comprehensive study has been conducted to collect all the evidence to provide estimates of psychological and social risk factors in China. Therefore, this study aimed to quantitatively assess all studies meeting the review’s eligibility criteria and identify the psychological and social risk factors for PPD in Chinese women.

Methods

The following databases were used in the literature search from their inception until December 2020: PubMed, Embase, Foreign Medical Literature Retrieval Service (FMRS), China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI), and China Biology Medicine disc (CBM). The quality was assessed through Newcastle-Ottawa quality assessment scale. The I²statistic was used to quantify heterogeneity. We extracted data for meta-analysis and generated pooled-effect estimates from a fixed-effects model. Pooled estimates from a random-effects model were also generated if significant heterogeneity was present. Funnel plot asymmetry tests were used to check for publication bias. Statistical analysis was conducted using Review Manager version 5.3 software.

Results

From a total of 1175 identified studies, 51 were included in the analysis. Prenatal depression (OR 7.70; 95% CI 6.02–9.83) and prenatal anxiety (OR 7.07; 95% CI 4.12–12.13) were major risk factors for PPD. A poor economic foundation (OR 3.67; 95% CI 3.07–4.37) and a poor relationship between husband and wife (OR 3.56; 95% CI 2.95–4.28) were moderate risk factors. Minor risk factors included a poor relationship between mother-in-law and daughter-in-law (OR 2.89; 95% CI 2.12–3.95), a lack of social support (OR 2.57; 95% CI 2.32–2.85), unplanned pregnancy (OR 2.55; 95% CI 2.08–3.14), and poor living conditions (OR 2.44; 95% CI 1.92–3.10), mother-in-law as the caregiver (1.95; 95% CI 1.54–2.48) .

Conclusions

This study demonstrated a number of psychological and social risk factors for PPD in Chinese women. The major and moderate risk factors are prenatal depression, prenatal anxiety, a poor economic foundation, and a poor relationship between husband and wife. These findings have potential implications for informing preventive efforts and modifying screening to target at-risk populations.

Postpartum depression symptoms in survey-based research: a structural equation analysis

BACKGROUND

Since the last decade, postpartum depression (PPD) has been recognized as a significant public health problem, and several factors have been linked to PPD. Mothers at risk are rarely undetected and underdiagnosed. Our study aims to determine the factors leading to symptoms of depression using Structural Equation Modeling (SEM) analysis. In this research, we introduced a new framework for postpartum depression modeling for women.

METHODS

We structured the model of this research to take into consideration the Malaysian culture in particular. A total of 387 postpartum women have completed the questionnaire. The symptoms of postpartum depression were examined using the Edinburgh Postnatal Depression Scale (EPDS), and they act as a dependent variable in this research model.

RESULTS

Four hundred fifty mothers were invited to participate in this research. 86% of the total distributed questionnaire received feedback. The majority of 79.6% of respondents were having depression symptoms. The highest coefficients of factor loading analysis obtained in every latent variable indicator were income (β = 0.77), screen time (β = 0.83), chips (β = 0.85), and anxiety (β = 0.88). Lifestyle, unhealthy food, and BMI variables were directly affected by the dependent variable. Based on the output, respondents with a high level of depression symptoms tended to consume more unhealthy food and had a high level of body mass indexes (BMI). The highest significant impact on depression level among postpartum women was unhealthy food consumption. Based on our model, the findings indicated that 76% of the variances stemmed from a variety of factors: socio-demographics, lifestyle, healthy food, unhealthy food, and BMI. The strength of the exogenous and endogenous variables in this research framework is strong.

CONCLUSION

The prevalence of postpartum women with depression symptoms in this study is considerably high. It is, therefore, imperative that postpartum women seek medical help to prevent postpartum depressive symptoms from worsening.

Gender of infant and risk of postpartum depression: a meta-analysis based on cohort and case-control studies

BACKGROUND

It is inconclusive nowadays for the association between infant's gender and their mothers' risk of developing postpartum depression (PPD). In addition, a complete overview is missing. A meta-analysis of cohort and case-control studies was performed to address the question of whether women who gave birth to a female infant were at an increased risk of developing PPD, compared with those giving birth to a male infant.

METHODS

Unrestricted searches were conducted, with an end date parameter of 31 January 2018, of PubMed, Embase, Google Scholar, Cochrane Libraries, and Chinese databases, to identify studies that met pre-stated inclusion criteria. Reference lists of retrieved articles were also reviewed. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates.

RESULTS

Twenty-three studies involving 119,736 women were included for analysis. Overall, mothers who gave birth to a female infant experienced a significantly increased risk of developing PPD compared with the reference group (OR = 1.15, 95%CI: 1.01-1.31; p = .03). However, substantial heterogeneity (p < .00001; I² = 75%) was observed across studies. Relevant heterogeneity moderators have been identified by subgroup analysis. Sensitivity analysis yielded consistent results. No evidence of publication bias was observed.

CONCLUSIONS

Although the role of potential bias and evidence of heterogeneity should be carefully evaluated, the present study suggests women giving birth to a girl are associated with a higher risk of developing PPD when compared with those giving birth to a boy. Improving family and social communication and reducing gender preference should be important components of any such interventions.Statement of significanceProblem or issue Interestingly, the known risk factors leading to PPD are basically the same in different regions and cultures, but the gender of the infant seems to be an exception.What is already known Some studies conducted in traditional western countries indicated that there is a weak or null association between infant's gender and risk of PPD, while others suggested a positive association. In contrast, studies conducted in Nigeria, India, Turkey and China showed that mothers giving birth to a female infant were at a higher risk of developing PPD.What this paper adds Today, the association between infant's gender and risk of developing postpartum depression (PPD) is still uncertain; additionally, a complete overview is missing. Our study represents the first meta-analysis of risk of PPD associated with infant's gender.

Association between social and family support and antenatal depression: a hospital-based study in Chengdu, China

BACKGROUND

Antenatal depression (AD) is considered as one of the major health burdens and has adverse effects on the outcome of expectant mothers and newborns. The present study aims to investigate the prevalence of antenatal depression (AD), and to explore the potential risk factors of AD among pregnant women in Chengdu, including personal background, related social factors, family factors and cognitive factors.

METHODS

The prospective nested case-control study included pregnant women who were in their second pregnancy and attended prenatal care at three tertiary hospitals and one regional hospital in Chengdu, China, between March 2015 and May 2016. Self-designed questionnaires were given to participants in their second and third trimesters to collect information on clinical and demographic characteristics, and a modified edition of Edinburgh Postnatal Depression Scale (EPDS) were used to measure AD. The logistic regression was applicated in analyses.

RESULTS

A total of 996 pregnant women were included in analysis. Ninety-three women suffered from AD symptoms only in their second trimester, 96 only in their third trimester, and 107 displayed persistent depression in both trimesters. In the univariate analyses, age and marital relationships were linked with AD occurrence in both second and third trimester. In addition, increasing age, full-time job, higher education level, and no gender preference of spouse were associated with reduced persistent depression. Multivariate analysis showed that gender preference and marital relationship were the potential risk factors of persistent depression.

CONCLUSIONS

Age, marital relationship relationships, with parents-in-law, the negative recognition of this pregnancy and husband's gender preference were found as risk factors of AD occurrence in some specific trimester. Gender preference of husbands and marital relationships were independently associated with persistent depression. These findings suggest that stronger family support can help improve mental health of pregnant women.

Natural sunlight plus vitamin D supplementation ameliorate delayed early motor development in newborn infants from maternal perinatal depression

BACKGROUND

Increased cortisol has been shown to be negatively correlated with infant motor development. Sunlight help decrease the level of cortisol. Vitamin D is associated with infant motor development. The present study aimed to determine whether natural sunlight exposure plus vitamin D supplements could ameliorate delayed early motor development in little infants from maternal perinatal depression.

METHODS

The term pregnant women waiting for delivery from the department of gynecology and obstetrics were assessed depressive symptoms by Hamilton Rating Scale for Depression (HAMD). 120 normal and 229 depressed subjects were recruited. During 2 days postpartum, infant motor development were assessed by Neonatal Behavioral Assessment Scale (NBAS). Infants of 2-day-old in maternal depression group were divided into four groups: control group, conventional vitamin D supplements (400IU/d) group, high dose of vitamin D supplements group (1000IU/d), sunlight plus conventional vitamin D supplement group (400IU/d). Serum and hair cortisol (HairF) in mothers and infants were measured.

RESULTS

The infants of perinatal depressed mothers displayed early motor developmental delay accompanied by increased cortisol. Sunlight plus conventional vitamin D supplement (400IU/d) were better than exclusive vitamin D supplements for the amelioration delayed early motor development in infants (p < 0.05). The infants exposure to sunlight 7-14 h/week plus conventional vitamin D supplement reached the best scores of motor development and the lowest HairF (p < 0.05).

LIMITATIONS

We should have measured the serum 25OH-vitamin D concentrations.

CONCLUSIONS

Sunlight plus vitamin D supplements could ameliorate delayed early motor development in little infants by decreasing cortisol from perinatal depression.