Psychosocial correlates of prepartum and postpartum depressed mood

Coping as a Mediator between Attachment and Depressive Symptomatology Either in Pregnancy or in the Early Postpartum Period: A Structural Equation Modelling Approach

Peripartum depression (PPD) is a major complication of pregnancy, and numerous risk factors have been associated with its onset, including dysfunctional coping strategies and insecure attachment styles, both during pregnancy and postpartum. The aim of our study was to investigate the role of coping strategies in mediating the relationship between women's attachment style and depressive symptomatology in pregnancy and one week after giving birth in a large sample of women (N = 1664). Our hypothesis was that the relationship between anxious and avoidant attachment and depressive symptomatology would be mediated by use of maladaptive coping strategies. The assessment instruments were Edinburgh Postnatal Depression Scale (EPDS), Brief Coping Orientation for Problem Experiences (COPE), and Experiences in Close Relationship Scale (ECR). The results indicated that the effect of insecure attachment styles (anxious and avoidant attachment) on antepartum depressive symptomatology was partially mediated by dysfunctional coping styles. Anxious attachment also has an indirect significant effect on postpartum depressive symptomatology through emotional coping; however, avoidant attachment does not seem to be significantly related to postpartum depressive symptoms. Our findings revealed that not only is it important to consider attachment in understanding peripartum depressive symptomatology, but also that coping plays an important role in these relationships. These findings would help a preventive coping-based intervention strategy to enhance the capacity of women with insecure attachment styles to use more adaptive coping during and after pregnancy.

Psychosocial factors associated with health behaviors in pregnant women of advanced maternal age in Korea

Objectives

To determine the association between psychosocial factors and health-promoting and health-impairing behaviors in pregnant women of advanced maternal age (AMA) in Korea.

Design

A cross-sectional survey study.

Setting

Online survey.

Samples

A total of 217 pregnant women aged 35 and older agreed to participate in the study, with 207 participants completing the self-report questionnaires.

Methods

We collected self-reported data on demographic, obstetric, and psychosocial factors and prenatal health behaviors using standardized measures. We conducted a descriptive analysis of the collected data and a linear regression to identify significant associations with health-promoting and health-impairing behaviors.

Results

We found that maternal-fetal attachment (β = 0.43, p < 0.001) and "social atmosphere" of pregnancy stress (β = 0.13, p = 0.047) were positively associated with prenatal health-promoting behaviors. We found that artificial conception (β =-0.16, p = 0.011) was negatively associated with prenatal health-impairing behaviors and that multiparity (β = 0.23, p = 0.001) and "maternal role" of pregnancy stress (β = 0.27, p = 0.003) positively associated with prenatal health-impairing behaviors.

Conclusion

Health-impairing behaviors of pregnant AMA women need assessment and the importance of health-promoting behaviors for maternal and infant health need reinforcing. We recommend pregnancy stress assessments at prenatal checkups and stress relief interventions that consider cultural differences and contexts rather than standardized interventions.

Evaluation of Physical Activity Level and Related Factors in Pregnancy During the COVID-19 Period

Objectives: It was aimed to determine the level of physical activity and related factors in pregnant women. Methods: The study is a mixed methods study. The participants are women applied to the pregnancy outpatient clinic of a hospital. The level of physical activity was assessed with the Pregnancy Physical Activity Questionnaire. Sociodemographic questions and seven questions of the International Physical Activity Environment Module were asked. Besides, in-depth interviews were conducted with 14 women. Results: The study was conducted with 304 women. The median age was 29.0 (18.0-40.0) years. The mean total activity and sedentary activity scores were 195.8 ± 107.9 and 37.22 ± 31.08 MET-hours/week, respectively. Pregnant women were mostly involved in light-intensity and housework/caregiving activities. Most of the participants mentioned that they were less active than pre-pregnancy period. The most common reasons for being less active were weakness, fatigue, lack of time and complaints such as low back pain and nausea. Conclusion: More than half of the pregnant women mentioned that they were less active during pregnancy. Thus, interventions should be planned to increase physical activity level of pregnant women.

Health Behaviors and Behavior Change during Pregnancy: Theory-Based Investigation of Predictors and Interrelations

(1) Background: Preventing pregnancy complications and maternal deaths and helping women stay healthy before, during, and after pregnancy by means of sexual health and behavior is imperative. Previous research demonstrated that a lack of social support and perceived discrimination have adverse effects on pregnancy outcomes. These determinants may impact health behavior as an important mediator of pregnancy outcomes. To better understand this relation, the Compensatory Carry-Over Action Model (CCAM) was applied. The research question was: how do predictors of health behavior, specifically intention, planning, self-efficacy, social support, and discrimination, interrelate with different health behaviors during pregnancy? (2) Methods: By means of qualitative interviews with ten pregnant women (20–39 years, mean = 28.6) from different cultural backgrounds, the predictors of health behaviors and experiences with pregnancy, including racial discrimination, were investigated. (3) Results: Not all women changed their unhealthy behaviors even though their higher-level goal was to ensure their baby’s and their own health. This appeared partially due to lack of social support, racial discrimination, and unexpected pregnancy side effects. The women who previously performed health behaviors revealed a healthier pattern with maintaining or even expanding their health behaviors, while those performing no health behavior in the past reported more obstacles with a healthy lifestyle. (4) Conclusions: Pregnant women appear to be having difficulties translating good intentions into behavior. The reasons include lack of support, fear, and insecurity, which impact self-efficacy and planning. Improvements in health behaviors were facilitated by specific circumstances, such as working from home. Policy and practice should take these aspects into account and help mobilize support and overcome discrimination by means of more rights and support for pregnant women while also empowering the individuals.

The sustained adverse impact of COVID-19 pandemic on mental health among pregnant women in Sri Lanka: a reassessment during the second wave

Objective

To study the change in trend of antenatal mental health and associated factors among a cohort of pregnant women during the second wave of COVID-19 using Hospital Anxiety and Depression Scale (HADS). Previous study using the same scale, during the first wave reported a higher prevalence of anxiety and depression.

Results

A descriptive cross-sectional study was carried out at the two large maternity hospitals in Colombo, Sri Lanka: Castle Street Hospital for Women (CSHW) and De Soysa Hospital for Women (DSHW). Consecutively recruited 311 women were studied. Out of which, 272 (87.5%) were having uncomplicated pregnancies at the time of the survey and 106 (34.1%) were either anxious, depressed, or both. Prevalence of anxiety was 17.0% and depression 27.0%. Overall, continuing COVID-19 pandemic increased antenatal anxiety and depression. The trend was to aggravate depression more intensively compared to anxiety in this cohort of women studied. Special support is needed for pregnant mothers during infectious epidemics taking more attention to antenatal depression.

Associations Between Spousal Relationship, Husband Involvement, and Postpartum Depression Among Postpartum Mothers in West Java, Indonesia

INTRODUCTION

Indonesia is actively promoting husband involvement in maternal health care, since it has been claimed to impact the wellbeing of mothers. This study aims to investigate the extent to which spousal relationship, husband involvement, and maternal health behavior affect postpartum depression among Indonesian mothers.

METHOD

A survey was carried out among 336 postpartum mothers who received maternal care in 27 independent midwifery clinics in 7 regions of West Java Province, Indonesia. The measurement model of husband involvement comprising 4 dimensions, namely maternity care engagement, instrumental support, emotional support, and informational support were developed and validated using confirmatory factor analysis. The Quality of Marriage Index (QMI) and the Edinburgh Postnatal Depression Scale (EPDS) were also validated and used to measure spousal relationship and postpartum depressive symptoms. A structural equation model was specified to examine the association between spousal relationship, husband involvement, maternal healthy behavior, and postpartum depression.

RESULTS

The study confirms the assumption that the quality of the spousal relationship could determine husband's involvement during pregnancy, childbirth, and postpartum (γ = .60, P < .001), eventually leading to better maternal healthy behavior (γ = .015, P < .001) and a decrease in postpartum depressive symptoms among mothers (γ = -.21, P < .001).

CONCLUSIONS

The study results suggest the needs to promote comprehensive husband involvement to enhance the wellbeing of mothers. This can be achieved through couple interventions at the community level and the inclusion of a supportive role for husbands in the maternal and childcare guidebook offered during ANC visits.

Perinatal depression screening and prevention: Descriptive findings from a multicentric program in the South of Italy

INTRODUCTION

Perinatal depression (PD) is a cluster of clinical depressive symptoms occurring globally during pregnancy or after childbirth, with a prevalence of 11.9%. Risk factors for PD among pregnant women may include personality traits of neuroticism, low personal resilience, higher anxiety, avoidance in close relationships, as well as dysfunctional coping strategies.

METHODS

We report on descriptive findings of a screening/prevention program aimed to detect depressive symptoms and associated risk factors in a large sample of women (N = 1,664) accessing the gynecological departments of the Regione Puglia (South of Italy) from July to November 2020. Pregnant women were assessed in their third trimester of pregnancy (T0), after childbirth (T1), and those at risk for PD within 1 year from delivery (T2-T4); The Edinburgh Postnatal Depression Scale (EPDS) has been employed for the screening of PD over time as well as other standardized measures for neuroticism, resilience, coping strategies, and quality of life.

RESULTS

Of 1,664, n = 1,541 were tested at T1, and 131 scored ≥ 12 at EPDS (14.6 ± 2.95), showing a higher risk for PD. They were followed over time at 1, 6, and 12 months after childbirth (T2-T4), and 15 of them scored ≥ 12 (EPDS) at T4. Women with a higher risk of PD also reported higher levels of neuroticism, lower levels of personal resilience, more anxiety and avoidance in close relationships, higher employment of dysfunctional coping strategies (e.g., denial, self-blame, etc.), and lower quality of life (0.0008 < all p < 0.0001).

CONCLUSION

This study confirmed the benefit of screening programs for the early detection of PD among pregnant women. We may suggest a set of risk factors to be considered in the clinical assessment of PD risk as well as the promotion of similar programs to improve depressive outcomes and pathways to care for PD on the basis of a more accurate assessment and referral.

The association between social support and antenatal depressive and anxiety symptoms among Australian women

Background

Antenatal depression and antenatal anxiety adversely affect several obstetric and foetal outcomes, and increase the rate of postnatal mental illness. Thus, to tackle these challenges the need for social support during pregnancy is vital. However, an extensive literature search failed to show a published study on the relationship between domains of social support and antenatal depressive, as well as antenatal anxiety symptoms in Australia. This study examined the association between domains of social support and antenatal depressive and anxiety symptoms among Australian women.

Methods

The current study used data obtained from the 1973–78 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH), focusing upon women who reported being pregnant (n = 493). Depression and anxiety were assessed using the 10 item Center for Epidemiological Studies Depression (CES-D-10) scale, and the 9-item Goldberg Anxiety and Depression scale (GADS) respectively. The 19 item-Medical Outcomes Study Social Support index (MOSS) was used to assess social support. A logistic regression model was used to examine the associations between domains of social support and antenatal depressive and anxiety symptoms after adjusting for potential confounders.

Result

The current study found 24.7 and 20.9% of pregnant women screened positive for depressive and anxiety symptoms respectively. After adjusting for potential confounders, our study found that the odds of antenatal depressive symptoms was about four and threefold higher among pregnant women who reported low emotional/informational support (AOR = 4.75; 95% CI: 1.45, 15.66; p = 0.010) and low social support (overall support) (AOR = 3.26; 95%CI: 1.05, 10.10, p = 0.040) respectively compared with their counterpart. In addition, the odds of antenatal anxiety symptoms was seven times higher among pregnant women who reported low affectionate support/positive social interaction (AOR = 7.43; 95%CI: 1.75, 31.55; p = 0.006).

Conclusion

A considerable proportion of pregnant Australian women had depressive symptoms and/or anxiety symptoms, which poses serious health concerns. Low emotional/informational support and low affectionate support/positive social interaction have a significant association with antenatal depressive and anxiety symptoms respectively. As such, targeted screening of expectant women for social support is essential.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04188-4.

Coping with Stress in Complicated Pregnancy and Gestational Weight Gain

Maternal obesity is one of the leading health problems in the world. Excessive gestational weight gain (GWG) can lead to many complications during pregnancy, especially when it is accompanied by diabetes. Moreover, the risk of excessive GWG in pregnant women is significant, irrespective of prenatal counseling. Studies on this subject concerning coping with stress are lacking in the literature. The present work is aimed at evaluating the styles of coping with stress and their relation to GWG in pregnant women with gestational diabetes (GDM) for whom sudden adaptation to dietary management during this period can be challenging. It was indicated that women with GDM reported high stress related to potential maternal-fetal complications and worries about compliance with dietary management. The overall weight gain of participants in pregnancy was determined in connection to their prepregnancy body mass index (BMI) and classified based on the Institute of Medicine guidelines. A standardized psychological scale was used to assess coping styles. The results showed that almost half of the participants did not meet the Institute of Medicine recommendations for weight gain during pregnancy. There were significant correlations between the styles of coping with stress and the GWG. Additionally, low correlations were indicated between emotional, avoidant, task-oriented coping styles and the age of pregnant women with GDM. Regression analysis showed that the stress-coping style that focused on emotions was the most predictive of overall weight gain. There is a need for a better understanding of psychological barriers in achieving the recommended GWG and potential limitations in providers' interventions, particularly for GDM.

Prenatal predictors of postpartum depression trajectories from birth to 24 months amongst smoking women

AIMS AND OBJECTIVES

We aimed to identify postpartum depression (PPD) trajectories and examine relevant predictors amongst smoking women.

BACKGROUND

PPD can adversely affect families. Predictors of PPD trajectories amongst smoking women are understudied.

DESIGN

Longitudinal cohort study.

METHODS

A cohort of 49 U.S. women (current or ex-smoking) completed the Edinburgh Postnatal Depression Scale from birth to 24 months postpartum. Latent class growth modelling was used to identify PPD trajectories. Predictors of PPD trajectories were identified, adjusting for confounders. Effect modification by prenatal Patient Health Questionnaire (PHQ) depression score was also assessed. STROBE guidelines were followed in reporting results.

RESULTS

Three PPD trajectories were identified: non-PPD, transient PPD and chronic PPD. In multinomial logistic regression, social support was associated with lower odds of membership in the chronic PPD trajectory compared to non-PPD trajectory: being married or having a partner sharing resources (odds ratio OR = .14 [.02, .85], p-value = .03), greater partner support (OR = .87 [.77, .98], p-value = .02) and greater family/friends support (OR = .53 [.34, .82], p-value = .004). Transient PPD showed no differences with non-PPD on any predictors. In ordinal logistic regression models, social support was associated with lower odds of membership in a more severe PPD depression trajectory when prenatal PHQ depression score was in the low range (being married or having a partner sharing resources: p for effect modification = .06; partner support: p for effect modification = .05; and family/friends support: p for effect modification = .005).

RELEVANCE TO CLINICAL PRACTICE

Compared to the general population, chronic PPD trajectories were more common amongst smoking women. Social support was an important predictor of more severe PPD trajectories, especially when prenatal depression is low.

CONCLUSION

Our findings indicated that social support might decrease likelihood of severe PPD trajectories, especially when prenatal depression was low. Relevant predictors of transient PPD remained elusive.

The relationship of cumulative psychosocial adversity with antepartum depression and anxiety

BACKGROUND

Exposure to multiple psychosocial risk factors may increase vulnerability for mental health conditions during pregnancy. This analysis examined the relationship of a novel psychosocial adversity index with the co-occurrence and persistence of depression and anxiety throughout pregnancy.

METHODS

This cross-sectional analysis included 1797 pregnant women screened in the second/third trimesters for depression and anxiety symptoms and for eight contextual and individual psychosocial factors. The factors were summed to create a psychosocial adversity index; reporting four or more factors indicated high adversity. Elevated symptoms in both trimesters indicated persistent depression/anxiety and elevated symptoms at the same trimester indicated comorbid symptoms. The associations between the psychosocial adversity index and mental health were estimated.

RESULTS

Compared with a low psychosocial adversity index, women reporting a high level of psychosocial adversities had 2.06 (95% confidence interval [CI]: 1.51-2.82) times higher adjusted odds of only depressive or anxiety symptoms, and 5.57 (95% CI: 3.95-7.85) times higher adjusted odds of comorbid symptoms. The associations for persistent symptoms were of similar direction and magnitude.

CONCLUSION

High psychosocial adversity was associated with persistent and comorbid depressive symptoms and anxiety during pregnancy. Assessing psychosocial adversity can help identify women at increased risk who would benefit from tailored mental health interventions.

Prevalence and determinants of low social support during pregnancy among Australian women: a community-based cross-sectional study

Background

Pregnancy is a time for women in which the need for social support is crucial. Social support reduces stressors and improves the emotional and physical well-being of pregnant women. Women receiving low social support during pregnancy are at risk of substances use, developing mental illness, and adverse birth outcomes. The current study aims to determine the prevalence and determinants of low social support during pregnancy among Australian women.

Methods

Data were obtained from the 1973–1978 cohort of Australian Longitudinal Study on Women’s Health (ALSWH) and those who report being pregnant (n = 493) were included in the current analyses. Social support was assessed using Medical Outcomes Study Social Support index (MOSS). A logistic regression model was applied to identify determinants of low social support, separately for each MOSS domain.

Result

The study found that 7.1% (n = 35) of pregnant women reported low social support. Significant determinants of low emotional support were non-partnered (AOR = 4.4, 95% CI: 1.27, 14.99), difficulty managing on available income (AOR = 3.1, 95% CI: 1.18, 8.32), experiencing depressive symptoms (AOR = 8.5, 95% CI: 3.29, 22.27) and anxiety symptoms (AOR = 2.9, 95% CI: 1.26, 7.03). Significant determinants of low affectionate support were suffering from depressive symptoms (AOR = 5.3, 95% CI: 1.59, 17.99), having anxiety symptoms (AOR: 6.9, 95% CI: 2.21, 22.11) and being moderately/very stressed (AOR: 3, 95% CI: 1.17, 7.89). Significant determinants of low tangible support were difficulty managing available income (AOR = 3, 95% CI: 1.29, 6.95), and being depressed (AOR = 2.8, 95% CI: 1.48, 5.34).

Conclusion

The study revealed that 7.1% of pregnant women reported low social support. Having a mental health problems, being stressed, being from low socio-economic status and being non-partnered were significant determinants of low social support during pregnancy. Maternal health professionals and policymakers can use this information to screen pregnant women at risk of receiving low social support and improve the level of support being provided.

Providing strong social support improves emotional and physical well-being, strengthens social relationships, promotes health, and enhances the stress coping ability of pregnant women. However, pregnant women receiving low social support are at risk of substances use, developing mental illness, and adverse birth outcomes. The current study aims to determine the prevalence and determinants of low social support during pregnancy among Australian women. Data were obtained from Survey 6 of the 1973–1978 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH) (n = 493, pregnant women aged 34–39 years). This cohort is one of ALSWH ongoing community-based study focusing on the health of women in Australia. Social support provided for a pregnant woman was the outcome variable, assessed using the 19-item Medical Outcomes Study Social Support index (MOSS). The prevalence of low social support in each domain was calculated for each of the independent variables. A logistic regression model, using a backward stepwise elimination approach, was employed to identify determinants of low social support. In the final model, the strength of association measured by adjusted odds ratios (AOR) with 95% confidence intervals. The significance level was set at p < 0.05. From the total participant pregnant women, 7.1% of them reported low social support. Significant determinants of low social support among pregnant Australian women were, having a mental illness, being stressed and/or being from low socio-economic status and being non-partnered. Maternal health professionals can use this information to screen pregnant women at risk of receiving low social support as well as develop policy to help enhance the social support being given and the psychological wellbeing being of pregnant women.

Depression remains a neglected public health problem among pregnant women in Northwest Ethiopia

BACKGROUND

Antenatal depression is highly prevalent but a neglected public health problem in low income countries. It has serious effects on the general health of women, birth outcomes and child health. However, there has been limited substantial evidence on the prevalence and predictors of antenatal depression in Ethiopia. This lack of evidence potentiates the consequences of the problem and can limit the attention to intervention. Thus, this study aimed to assess the prevalence and potential predictors of antenatal depression at Debre Tabor and Woreta towns, Northeast Ethiopia.

METHODS

A community-based cross-sectional study was employed on 548 pregnant women recruited by a cluster sampling method. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). The List of Threatening Experiences Questionnaire (LTE-Q), the Oslo-3 Social Support Scale (OSSS-3), Intimate Partner Violence (IPV) Scale and Fast Alcohol Screening Test (FAST) were also used to measure stressful events, social support, intimate partner violence (IPV) and hazardous alcohol use respectively. Bivariable and multivariable logistic regression analyses were carried out to identify factors associated with antenatal depression.

RESULTS

The prevalence of antenatal depression was found to be 24.45% (95% CI: 21.20, 28.30%). Being single (AOR =3.32, 95% CI = 1.36, 8.09); fear of pregnancy complication (AOR = 3.84, 95% CI = 1.53,9.62); history of chronic illness (AOR = 8.14, 95% CI = 2.14, 30.91); unplanned pregnancy (AOR = 2.99, 95% CI = 1.36,6.55); history of stillbirth (AOR = 3.56, 95% CI = 1.23, 10.29),one or more negative life events (AOR = 4.06, 95% CI = 1.71, 9.66) and intimate partner violence (AOR = 3.91, 95% CI = 1.65, 9.26) were factors significantly associated with antenatal depression.

CONCLUSION

Nearly a quarter of pregnant women suffer from depressive symptoms during pregnancy. Being single; fear of pregnancy complication; history of chronic illness; unplanned pregnancy; history of stillbirth; one or more negative life events and intimate partner violence were important predictors of antenatal depression in this study. Health care workers should consider addressing these risk factors during a routine antenatal care. Also, integrating early screening, detection, and treatment of antenatal depression into routine antenatal care is warranted to improve the quality of life of pregnant women and pregnancy outcomes as well.

Genetic Polymorphism of rs13306146 Affects α2AAR Expression and Associated With Postpartum Depressive Symptoms in Chinese Women Who Received Cesarean Section

Postpartum depressive symptom (PDS) is a common psychological and mental disorder after giving birth. Our previous studies showing the application of dexmedetomidine, an α₂-AR agonist, can significantly improve maternal sleep, as well as relieve and reduce the incidence of PDS. This study investigated the association between α_{2 A} AR gene polymorphisms and PDS. A total of 568 cesarean section patients were enrolled; the incidence of PDS is 18.13% (103 with PDS, 465 with non-PDS). The Edinburgh Postpartum Depression Scale score ≥10 was used to diagnose PDS at 42 days after delivery. The single-nucleotide polymorphisms of α_2AR were sequenced by pyrosequencing. The effect of rs13306146 A > G polymorphism on α_2AR transcription and the regulation of miR-646 on α_2AR expression were assessed by dual luciferase reporter assays or gene transfection. Increased stress during pregnancy, poor relationship between mother-in-law and daughter-in-law, spousal relationship, domestic violence, antenatal depression, self-harm ideation, and stressful life events were all associated with increased PDS incidence (p < 0.05). The logistic regression analysis found that the α_2AAR rs13306146 polymorphism was associated with PDS after adjusting confounding variables. The transcriptional function of the α_2AAR rs13306146 A allele was decreased compared with the G allele, and the α_2AAR expression level was correspondingly decreased (p < 0.05), as the strongest binding ability of miR-646 to the α_2AAR rs13306146 AA genotype. The effect of α_2AAR rs13306146 A > G polymorphism may change the binding ability of miR-646 at the 3'UTR of the α_2AAR gene, affecting the expression of α_2AAR. This study supports the involvement of the norepinephrine system in the pathogenesis of PDS. Genotypes of α_2AAR may be novel and useful biomarkers for PDS.

Perinatal depression prevention through the mother-infant dyad: The role of maternal childhood maltreatment

BACKGROUND

Prevention studies for perinatal depression rarely focus on the mother-infant dyad or consider the impact of maternal childhood maltreatment (CM).

METHODS

A secondary analysis of two combined randomized controlled trials of Practical Resources for Effective Postpartum Parenting (PREPP) examined the moderating role of CM on the efficacy of preventing perinatal depression and effects on infant behavior at six weeks.

RESULTS

32% of 109 pregnant women endorsed CM (CM+). At six weeks postpartum, women who received PREPP compared to enhanced treatment as usual (ETAU) had significant reductions in depression and anxiety based on the observer-rated Hamilton Rating Scale for Depression (HRSD) and Hamilton Rating Scale for Anxiety (HRSA) (mean difference of M=-3.84 (SD= 0.14, p<0.01) and M=- 4.31 (SD= 0.32, p <0.001) respectively). When CM was added to the models, there no longer was a significant PREPP versus ETAU treatment effect on HRSD and HRSA outcomes in CM+ women though effects remained for CM- women. However, CM+ women who received PREPP vs ETAU reported a mean increase in infant daytime sleep of 189.8 min (SE= 50.48, p = 0.001).

LIMITATIONS

Self-report measures of infant behavior were used.

CONCLUSIONS

CM+ women versus CM- had limited response to an intervention to prevent perinatal depression yet still reported an increase in infant daytime sleep. This study adds to the growing literature that prevention studies may need to incorporate approaches tailored to fit women with childhood trauma histories while also considering infant functioning as both may be treatment targets relevant to maternal mood.

Prenatal Care Disruptions and Associations With Maternal Mental Health During the COVID-19 Pandemic

As the novel coronavirus (COVID-19) spread across Canada in March 2020, provinces imposed restrictions. These changes impacted how pregnant individuals received prenatal care and experienced childbirth. The stress caused by these changes may negatively affect the well-being of pregnant individuals with impacts on the developing child. This study investigated the impact of the pandemic on prenatal care and birth plans of pregnant individuals in Canada and potential associations with maternal mental health. Data from 4,604 participants was collected from English- and French-speaking Canadians between April 5 and June 1, 2020 as part of the Canada-wide Pregnancy During the COVID-19 Pandemic study. Symptoms of maternal depression, general anxiety, and pregnancy-related anxiety were assessed. Participants also answered questions about disruptions and changes to prenatal care and their birth plans due to the COVID-19 pandemic. Logistic regression was used to estimate associations between prenatal care disruptions and maternal mental health. Cancellation of prenatal appointments and birth plan changes (specifically changes to childcare during birth and change of support person attending the birth) were significantly associated with greater odds of experiencing clinically elevated depression, anxiety, and/or pregnancy-related anxiety symptoms. These results highlight the need for reliable and accessible prenatal care during the pandemic, such as the integration of mental health screenings and co-ordination of prenatal care providers.

Perceived stress linking psychosocial factors and depressive symptoms in low-income mothers

Background

Little is known about associations between perceived stress, psychosocial factors (social support, emotional coping, coping self-efficacy, and autonomous motivation), and depressive symptoms in low-income overweight or obese mothers of young children. Using baseline data of a lifestyle intervention study, this secondary analysis investigates whether perceived stress might mediate the associations between the psychosocial factors and depressive symptoms.

Methods

Convenience sampling was applied. Low-income overweight or obese mothers of young children were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in Michigan, US. Survey data were collected through phone interviews. Participants (N = 740) responded to valid surveys measuring perceived stress, social support, emotional coping, coping self-efficacy, autonomous motivation, and depressive symptoms. Composite indicator structural equation modeling was performed to test for potential mediation.

Results

When investigating the potential role of perceived stress as a mediator, the indirect effects of social support (b = − 2.10, p < 0.01), emotion coping (b = − 3.81, p < 0.05), and coping self-efficacy (b = − 7.53, p < 0.01) on depressive symptoms through perceived stress were significant, but the indirect effect of autonomous motivation was not.

Conclusion

Future intervention studies aiming to alleviate depressive symptoms in low-income overweight or obese mothers of young children might consider including practical strategies to promote social support, emotional coping, and coping self-efficacy to reduce perceived stress, which might potentially decrease depressive symptoms.

Trial registration

Clinical Trials NCT01839708; registered February 28, 2013.

Respiratory sinus arrhythmia as a dyadic protective factor in the transition to parenthood

Considerable heterogeneity has been observed in couples' adjustment to the transition to parenthood (TTP). One potential yet understudied predictor of emotional adjustment to the TTP is the new parents' capacity for regulation. A widely accepted biological marker of this capacity is respiratory sinus arrhythmia (RSA), which is closely tied to parasympathetic activation. In the present work, we sought to examine the role of tonic RSA and RSA reactivity as possible protective dyadic factors in the TTP. As part of a larger study, we recruited a sample (N = 100) of TTP couples. At 15 weeks postpartum, the couples took part in a lab session during which their RSA was assessed both at rest (tonic RSA) and during four affiliative dyadic interactions (RSA reactivity). Following this session, couples completed daily diaries over a period of 3 weeks, reporting their daily levels of negative affect and stress. A Multivariate Actor Partner Interdependence Model was used to examine the extent to which each partner's RSA predicted their own and their partner's negative affect (NA) level, as well as NA stress-reactivity (i.e., the strength of the within-person stress-affect association). New mothers' tonic RSA predicted their own lower NA level and NA stress-reactivity; both their tonic RSA and RSA reactivity predicted their (male) partners' lower NA level; and finally, new fathers' tonic RSA and RSA reactivity predicted their (female) partners' lower NA stress-reactivity. These results suggest that RSA may serve as a personal and dyadic protective factor.

Separation, self‐disclosure, and social evaluation anxiety as facets of trait social anxiety

In the current article, we propose an expansion of the trait anxiety concept to include interpersonal or social facets of trait anxiety involving separation from significant others and disclosing aspects of the self to others, as a supplement to the existing focus on social evaluation anxiety. Participants in three studies completed a modified version of the Endler Multidimensional Anxiety Scales that included a measure of trait social evaluation anxiety, as well as new measures of trait separation anxiety and trait self‐disclosure anxiety (i.e., three measures of trait social anxiety). Results showed that the social evaluation, separation, and self‐disclosure trait anxiety scales have strong psychometric properties and that they represent distinct but related components of trait anxiety. With respect to validity, the facets of trait social anxiety were predictive of related variables including self‐concealment, anxiety sensitivity, and trait worry. The theoretical and practical implications of a multifaceted approach to trait social anxiety are discussed in terms of an expanded multidimensional interaction model of anxiety. Copyright © 2002 John Wiley & Sons, Ltd.

Antenatal psychological intervention for universal prevention of antenatal and postnatal depression: A systematic review and meta-analysis

BACKGROUND

The high prevalence and severe consequences of antenatal and postnatal depression makes their prevention critical. Previous systematic reviews and meta-analysis have shown the effects of psychological interventions on perinatal depression in individuals at risk. However, none have focused explicitly on universal prevention in the antenatal period. The purpose of this study is to conduct a systematic review and meta-analysis to clarify the effects of antenatal psychological interventions on perinatal depression, specifically focusing on universal prevention.

METHODS

Four electronic databases, the Cochrane Controlled Register of Trials (CENTRAL), Embase, PubMed, and PsycINFO, were used to search for published randomized controlled trials from inception to January 28, 2019. Twelve investigators conducted the first screening from title and abstract, individually, and then NY and ZN performed full-text review one by one. For the meta-analysis, a random effect model was conducted by using Review Manager 5.3 for Windows. Subgroup analyses were also conducted for studies that employed a cognitive behavioral (CB) based approach.

RESULTS

A total of 13,026 studies were initially searched. After removing duplicates, 9,919 studies were screened, and finally 18 studies met the inclusion criteria. The meta-analysis showed a significant effect of antenatal psychological intervention on both antenatal and postnatal depression (SMD = 0.28, 95% CI = 0.11 to 0.44, SMD = 0.37, 95% CI = 0.08 to 0.66) with moderate to high level of heterogeneity (I² = 61%, p = 0.01; I² = 84%, p < 0.001). For subgroup analysis, a significant effect of a CB based approach on antenatal depression was found in an antenatal period (SMD = 0.53, 95% CI = 0.13 to 0.94) with high heterogeneity (I² = 85%, p = 0.001), while non-significant results were shown on postnatal depression (SMD = 0.45, 95% CI = -0.03 to 0.92).

LIMITATIONS

Limitations include a language bias, as we included only studies published in English, and that the assessment of antenatal and postnatal depression using different methods caused high heterogeneity across studies.

CONCLUSIONS

Psychological intervention in an antenatal period could be effective for universal prevention of both antenatal and postnatal depression. However, the results were still inconclusive due to relatively low methodological quality in the included studies. The evidence from more well-designed trials is needed in future studies.

Which role for trait-anxiety in paternal perinatal depression? Preliminary results on healthy subjects

OBJECTIVES

Paternal Perinatal Depression (PPND) is a clinical condition, referred to emergence of depressive mood, i.e. sadness, hopelessness, despair and melancholy, but also loss of interest, and impairment in concentration and work performance, in fathers during the pregnancy in first postpartum year. Recently, the overlap with anxiety disorders is frequently observed. The study was aimed at evaluating a relationship between trait-anxiety and symptoms of PPND, in order to highlight trait-anxiety in onset of depressive syndrome.

STUDY DESIGN

A total number 79 participants have been recruited by convenience sampling method. Partners of pregnant women at the second trimester of pregnancy (17 ÷ 21 weeks of gestation) were consecutively recruited. At baseline, in 2nd trimester of pregnancy, and at 2nd months after childbirth, the psychiatric interview and socio-demographic data collection, were carried out and all subjects completed a self-administered STAI questionnaire. In postpartum period, the subjects completed the screening for postpartum depressive symptoms with PDSS scale.

RESULTS

Severity of "Anxiety proneness," assessed by STAI-Y, was "moderate in total sample (mean 58.7 ± 4.2). All fathers reported scores in clinical range, with one subject (1.3%) described as "mild," 56 "moderate" (70.9%), and 22 "severe" (27.8%). For symptoms of PPND, considering total sample, severity of depressive symptoms, was at the upper normal limit (mean score ± S.D. = 59.2 ± 33.1) and according to cutoff, in 35 subjects "normal adjustment" (44.3%), "significant symptoms" (13.9%) and "positive" in 33 (41.8%). We find a positive correlation among total score of STAI-Y and PDSS subscales, in particular section of Anxiety/Insecurity (p = .011), Emotional Liability (p = .007), Cognitive Impairment (p = .023), and Loss of Self (p = .012).

CONCLUSIONS

Trait-anxiety, as a personality dimension, is included in neuroticism, that is one of the risk factors of the clinical condition of prenatal depression. In our study, we found a level of pathological trait anxiety, assessed in the post-partum phase. This confirms the stability of the trait anxiety construct, as a dimensional component of the personality and the findings, may be useful for promote early intervention programs for psychological support of parents, focused on individual differences in anxiety vulnerability.

Relationships between psychosocial stressors among pregnant women in San Francisco: A path analysis

Pregnant women who experience psychosocial stressors, such as stressful life events, poor neighborhood quality, and financial hardship, are at an increased risk for adverse pregnancy outcomes. Yet, few studies have examined associations between multiple stressors from different sources, which may be helpful to better inform causal pathways leading to adverse birth outcomes. Using path analysis, we examined associations between multiple self-reported stressor exposures during and before pregnancy in the Chemicals in Our Bodies-2 study (N = 510), a demographically diverse cohort of pregnant women in San Francisco. We examined associations between eight self-reported exposures to stressors and three responses to stress which were assessed via interview questionnaire at the 2^nd trimester. Stressors included: neighborhood quality, stressful life events, caregiving, discrimination, financial strain, job strain, food insecurity, and unplanned pregnancy. Perceived stress, depression, and perceived community status were included as indicators of self-reported stress response. Our model indicated that women who experienced discrimination and food insecurity had a 3.76 (95% confidence interval [CI] = 1.60, 5.85) and 2.67 (95% CI = 1.31, 4.04) increase in depression scale scores compared to women who did not experience discrimination and food insecurity, respectively. We additionally identified job strain and caregiving for an ill family member as strong predictors of increased depressive symptoms (β = 1.63, 95% CI = 0.29, 3.07; β = 1.48, 95% CI = 0.19, 2.70, respectively). Discrimination, food insecurity, and job strain also influenced depression indirectly through the mediating pathway of increasing perceived stress, although indirect effects were less precise. In our study population, women who experienced discrimination, food insecurity, job strain and caregiving for an ill family member had an increased number of depressive symptoms compared to women who did not experience these stressors. Results from our study highlight the complex relationships between stressors and stress responses and may help to identify possible mediating pathways leading to adverse pregnancy outcomes.

Correlations Between SIRT Genetic Polymorphisms and Postpartum Depressive Symptoms in Chinese Parturients Who Had Undergone Cesarean Section

OBJECTIVE

To investigate the association of genetic polymorphisms of SIRT with postpartum depressive symptoms and analyze the risk factors for postpartum depressive symptoms in women following cesarean section.

METHODS

A total of 368 Chinese woman undergoing cesarean section were enrolled in this study. A cutoff of ≥10 for the Edinburgh Postnatal Depression Scale identified postpartum depressive symptoms. Genotypes of SIRT1, SIRT 2, and SIRT 6 were determined using Sequenom MassArray single-nucleotide polymorphism (SNP) analysis. We analyzed the contribution of genetic factors (SNPs, linkage disequilibrium, and haplotype) to postpartum depressive symptoms and performed logistic regression analysis to identify all potential risk factors for postpartum depressive symptoms and define interactions between genetic and environmental factors.

RESULTS

The incidence of postpartum depressive symptoms was 18.7% in this cohort. Univariate analysis suggested that SIRT2 polymorphism at rs2873703 (TT genotype) and rs4801933 ((TT genotype) and SIRT6 polymorphism at rs350846 (CC genotype) and rs107251 (TT genotype) were significantly correlated with the occurrence of postpartum depressive symptoms (p<0.05). Linkage disequilibrium was identified between SIRT6 polymorphisms rs350846 and rs107251. Incidence of postpartum depressive symptoms in cesarean-section parturients with SIRT2 haplotype CCC was decreased (OR 0.407, 95% CI 0.191-0.867; p=0.016). SIRT2 polymorphisms rs2873703 and rs4801933 were multiply collinear. Logistic regression analysis showed that SIRT2 polymorphism at rs2873703 (TT genotype) and rs4801933 (TT genotype), domestic violence, stress during pregnancy, and depressive prenatal mood were risk factors for postpartum depressive symptoms (p<0.05).

CONCLUSION

Pregnant women with SIRT2 genotypes rs2873703 TT and rs4801933 TT and experiencing domestic violence, stress during pregnancy, and prenatal depression are more likely to suffer from postpartum depressive symptoms.

Psychological intervention for universal prevention of antenatal and postnatal depression among pregnant women: protocol for a systematic review and meta-analysis

BACKGROUND

Prevention of antenatal and postnatal depression is crucial, given its high prevalence and severe consequences. Although several systematic reviews and meta-analyses have examined the effects of psychological interventions on the population at risk for perinatal depression, few studies have focused on universal prevention and none have focused specifically on universal prevention in pregnancy. The aim of this study is to examine the effects of psychological interventions with a universal prevention focus on perinatal depression during pregnancy by performing a systematic review and meta-analysis based on both the latest articles and a broader literature search.

METHODS

The literature search will be conducted using the Cochrane Controlled Register of Trials (CENTRAL), Embase, PubMed and PsycINFO, from inception onwards. Randomized controlled trials that examined the association between psychological interventions and universal prevention of antenatal and postnatal depression among pregnant women will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted following a priori defined methods in the protocol.

DISCUSSION

The findings of this systematic review and meta-analysis will have both clinical and political importance in the context of perinatal mental health. In addition, this study will promote future studies and clarify the direction of research on universal prevention of perinatal depression.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019118041.

A structural equation modelling of the buffering effect of social support on the report of common mental disorders in Zimbabwean women in the postnatal period

Objective

Globally, 13–20% of women experience a common mental disorder (CMD) postnatally. Unfortunately, the burden of CMDs is disproportionally substantial in women from low-income countries. Nevertheless, there is a growing recognition of the buffering effect of social support (SS) on psychiatric morbidity and the need for mental well-being support services/interventions. This study evaluated the relationship between psychiatric morbidity and SS levels, and factors influencing the mental health functioning of Zimbabwean women postnatally. Data were collected from 340 mothers and were analysed through structural equation modelling.

Results

The mothers’ mean age was 26.6 (SD 5.6) years. The mean Multidimensional Scale of Perceived Social Support score was 42.7 (SD 10.8), denoting high levels of SS. Additionally, 29.1% of the population reported excessive psychiatric morbidity, the median Shona Symptoms Questionnaire score was 5 (IQR: 2–8). The structural equation model demonstrated the buffering effects of SS on psychiatric morbidity (r = − 0.585, p = 0.01), and accounted for 70% of the variance. Being unmarried, increased maternal age, lower educational and income levels were associated with poorer maternal mental health. There is a need for routine; surveillance and treatment of CMDs in women in the postnatal period, including integration of low-cost, evidenced-based and task-shifting SS interventions.

Electronic supplementary material

The online version of this article (10.1186/s13104-019-4151-1) contains supplementary material, which is available to authorized users.

Perinatal Depressive Symptoms: Prevalence and Associated Psychosocial Factors

Perinatal depression is a major depression episode that starts during pregnancy and the postpartum period; and is an important cause of health risks in women and infants. A cross-sectional observational study was conducted with information from the records of 112 pregnant women or in the immediate postpartum period who were surveyed to determine the possible association between perinatal depressive symptoms and psychosocial factors occurring in the last year. The prevalence of clinically significant perinatal depressive symptoms using the Edinburgh scale was of 22.36%. The logistic regression model found association between clinically significant perinatal depressive symptoms (score on the Edinburgh scale ≥ 12 and the following psychosocial factors: end of the couple's relationship (OR=6.26; 95% CI, 1.91-20.49), severe economic problems (OR=6.61; 95% CI, 1.86-23.45), and the death of a family member (OR=3.79; 95% CI, 1.12-12.74). In this study one in four women had broken up with their partner and had severe economic problems during pregnancy, also one of ten had suffered the death of a loved one in the past year. These psychosocial factors were strongly associated with the presence of depressive symptoms with clinical importance. These finding offer the opportunity to consider psychosocial factors as a source of maternal stress that could be easily identified in the prenatal controls that pregnant women receive to identify women at risk of experiencing depressive symptoms in the perinatal period, which will enable appropriate treatment to be given to those who need it.

The IDO genetic polymorphisms and postpartum depressive symptoms: an association study in Chinese parturients who underwent cesarean section

Postpartum depressive symptoms (PDS) are not an uncommon mood disorder in postpartum women. Our previous research indicated a role for increased tryptophan (TRP) metabolism along the kynurenine pathway (KP) in the pathogenesis of PDS. Accordingly, this study was going to investigate the association of indoleamine-2,3-dioxygenase (IDO, a key enzyme of KP) genetic polymorphisms with PDS. Seven hundred twenty-five women receiving cesarean section were enrolled in this study. PDS was determined by an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 13. Subsequently, 48 parturients with PDS and 48 parturients without PDS were selected for investigation of perinatal serum concentrations of TRP, kynurenine (KYN), and KYN/TRP ratio, the latter is the representative of IDO activity. In addition, seven single nucleotide polymorphisms of the IDO gene were examined. Following this genotyping, 50 parturients carrying the IDO rs10108662 AA genotype and 50 parturients carrying the IDO rs10108662 AC + CC genotype were selected for comparisons of TRP, KYN, and KYN/TRP ratio levels. This study showed the PDS incidence of 6.9% in the Chinese population, with PDS characterized by increased IDO activity (p < 0.05), versus women without PDS. We also found that the variations of IDO1 gene rs10108662 were significantly related to PDS incidence (p < 0.05). Furthermore, there was a significant difference in IDO activity between the IDO rs10108662 CA + AA, versus CC, genotypes. Our findings indicate a role of the kynurenine pathway in the development of PDS, rs10108662 genetic polymorphism resulting in changes of IDO activity might contribute to PDS pathogenesis.

Role of psychosocial risk factors in predicting maternal and paternal depressive symptomatology during pregnancy

The aim of the present study was to investigate the role of several psychosocial risk factors in predicting depressive symptomatology during pregnancy in mothers and fathers, respectively. A total of 146 primiparous mothers and 105 primiparous fathers reporting a psychosocial risk condition were recruited independently from maternity and child health services, during the second trimester of pregnancy. All parents were evaluated for depressive symptomatology, anxiety, and perceived social support. Two hierarchical multiple regression analyses were performed to determine the role of psychosocial factors in predicting depressive symptomatology during pregnancy, in mothers and fathers. Marital dissatisfaction, personal history of depression, and personal trait anxiety were identified as significant predictors of depressive symptomatology during pregnancy, both in mothers and in fathers. Family history of substance abuse, conflictual relationship with the parents in the past year, and bereavement in the past year were identified as significant factors contributing to elevated depressive symptoms during pregnancy in mothers, but not fathers. In this study, several psychosocial risk factors were consistently related to an increase in maternal and paternal depressive symptoms during pregnancy; some of these factors seem to be specifically related to maternal depressive mood.

Perceived Psychological Traumatic Childbirth in Iranian Mothers: Diagnostic Value of Coping Strategies

Objectives

The aim of this study was to investigate the diagnostic value of a stress coping scale for predicting perceived psychological traumatic childbirth in mothers.

Methods

This cross-sectional study was performed on 400 new mothers (within 48 hours of childbirth). Psychological traumatic childbirth was evaluated using the 4 diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders. Coping was measured using Moss and Billings' Stress Coping Strategies Scale.

Results

The overall mean score of stress coping was 29 ± 14.2. There were 193 (43.8%) mothers that had experienced a psychological traumatic childbirth. A stress coping score ≤ 30, with a sensitivity of 90.16 (95% CI = 85.1-94.0), and a specificity of 87.44 (95% CI = 82.1-91.6), was determined as a predictor of psychological traumatic childbirth. So that among mothers with stress coping scores ≤ 30, 87% had experienced a psychological traumatic childbirth.

Conclusion

Investigating the degree of coping with stress can be used as an accurate diagnostic tool for psychological traumatic childbirth. It is recommended that during pregnancy, problem-solving and stress management training programs be used as psychological interventions for mothers with low levels of stress control. This will ensure that they can better cope with traumatic childbirth and post-traumatic stress in the postpartum stage.

Interventions to Prevent Perinatal Depression: Evidence Report and Systematic Review for the US Preventive Services Task Force

IMPORTANCE

Depression during pregnancy and the postpartum period is relatively common and can have adverse effects on both mother and child.

OBJECTIVE

To systematically review benefits and harms of primary care-relevant interventions to prevent perinatal depression, a major or minor depressive episode during pregnancy or up to 1 year after childbirth, to inform the US Preventive Services Task Force.

DATA SOURCES

MEDLINE, PubMED (for publisher-supplied records only), PsycINFO, and the Cochrane Central Register of Controlled Trials; surveillance through December 5, 2018.

STUDY SELECTION

Randomized clinical trials (RCTs) and nonrandomized controlled intervention studies of interventions (eg, behavior-based, antidepressants, dietary supplements) to prevent perinatal depression in general populations of pregnant and postpartum individuals or in those at increased risk of perinatal depression. Large cohort studies were considered for harms of antidepressant use only.

DATA EXTRACTION AND SYNTHESIS

Two investigators independently reviewed abstracts and full-text articles and quality rated included studies. Random-effects meta-analysis was used to estimate the benefits of the interventions.

MAIN OUTCOMES AND MEASURES

Depression status; depression symptoms; maternal, infant, and child health outcomes.

RESULTS

Fifty studies (N = 22 385) that met inclusion criteria were identified. Counseling interventions were the most widely studied interventions. Compared with controls, counseling interventions were associated with a lower likelihood of onset of perinatal depression (pooled risk ratio [RR], 0.61 [95% CI, 0.47-0.78]; 17 RCTs [n = 3094]; I2 = 39.0%). The absolute difference in the risk of perinatal depression ranged from 1.3% greater reduction in the control group to 31.8% greater reduction in the intervention group. Health system interventions showed a benefit in 3 studies (n = 5321) and had a pooled effect size similar to that of the counseling interventions, but the pooled effect was not statistically significant using a method appropriate for pooling a small number of studies (restricted maximum likelihood RR, 0.58 [95% CI, 0.22-1.53]; n = 4738; I2 = 66.3%; absolute risk reduction range, -3.1% to -13.1%). None of the behavior-based interventions reported on harms directly. A smaller percentage of participants prescribed sertraline had a depression recurrence compared with those prescribed placebo (7% vs 50%, P = .04) at 20 weeks postpartum in 1 very small RCT (n = 22 analyzed) but with an increased risk of adverse effects to the mother.

CONCLUSIONS AND RELEVANCE

Counseling interventions can be effective in preventing perinatal depression, although most evidence was limited to women at increased risk for perinatal depression. A variety of other intervention approaches provided some evidence of effectiveness but lacked a robust evidence base and need further research.

Reducing the Risk of Postpartum Depression in a Low-Income Community Through a Community Health Worker Intervention

Objectives To clarify the effectiveness of perinatal social support interventions in reducing postpartum depression among minority, low-income women. Methods The Transdisciplinary Research Consortium for Gulf Resilience on Women's Health supported a community-based participatory research project to improve perinatal health among low-income, first-time pregnant women living in a vulnerable Gulf Coast region. Community health workers (CHWs) were partnered with recruited women, and used a mix of mobile technology and home visits to develop a supportive relationship during the perinatal period. Results Women enrolled in the CHW-led intervention had lower (F: 2.38, p = 0.04) average postpartum depression scores (EPDS) 6 months postpartum than a comparison population. The difference, however, was not seen among women in the intervention group who reported relatively poor relationships with their CHWs. Conclusions for Practice Results reinforce the evidence that perinatal social support can affect postpartum depression outcomes. CHWs are increasingly utilized by public programs to reach at-risk populations. We discuss the potential efficacy of CHW programs, but also, the need to pair outreach with effective monitoring and evaluation of the relationship development between CHW and clients.

Modelling of psychosocial and lifestyle predictors of peripartum depressive symptoms associated with distinct risk trajectories: a prospective cohort study

Perinatal depression involves interplay between individual chronic and acute disease burdens, biological and psychosocial environmental and behavioural factors. Here we explored the predictive potential of specific psycho-socio-demographic characteristics for antenatal and postpartum depression symptoms and contribution to severity scores on the Edinburgh Postnatal Depression Scale (EPDS) screening tool. We determined depression risk trajectories in 480 women that prospectively completed the EPDS during pregnancy (TP1) and postpartum (TP2). Multinomial logistic and penalised linear regression investigated covariates associated with increased antenatal and postpartum EPDS scores contributing to the average or the difference of paired scores across time points. History of anxiety was identified as the strongest contribution to antenatal EPDS scores followed by the social status, whereas a history of depression, postpartum depression (PPD) and family history of PPD exhibited the strongest association with postpartum EPDS. These covariates were the strongest differentiating factors that increased the spread between antenatal and postpartum EPDS scores. Available covariates appeared better suited to predict EPDS scores antenatally than postpartum. As women move from the antenatal to the postpartum period, socio-demographic and lifestyle risk factors appear to play a smaller role in risk, and a personal and family history of depression and PPD become increasingly important.

The relationship among preconception depression, anxiety, and social support of the reproductive-aged women in China

The reproductive-aged women have to face physiological and psychological challenges as long as they plan to conceive. However, most previous studies focused on depression and anxiety during pregnancy. This study aimed to investigate the association among preconception depression, anxiety, and social support of the Chinese reproductive-aged women. Nine-hundred five reproductive-aged women who planned to conceive for the first or second time in the next three months were recruited through the Maternity and Child Healthcare Hospital and Obstetrics and Gynecology Hospital from three provinces in China. Social Support Rating Scale, Self-Rating Depression Scale, and Self-Rating Anxiety Scale were used in this study. The hierarchical regression model was employed to examine the prediction effect of the three sub-dimensions of social support on preconception depression and anxiety. Of the reproductive-aged women, 25.86 and 13.04% had preconception depression and anxiety symptoms. Nearly all reproductive-aged women had moderate and high social support before pregnancy. The significant differences in depression and anxiety among different levels of occupation and monthly income were found. For depression and anxiety, objective support, support availability, and subjective support simultaneously entered into the model still could significantly explain 5.9 and 6.7% of variations after controlling for the demographic variables, respectively. According to this study, there were significant correlations among preconception depression, anxiety, and social support. And objective support, support availability, and subjective support could negatively predict preconception depression and anxiety. Attaching importance to the preconception mental health and social support can provide effective scientific support for helping women fully understand and effectively use the social resources, and scientifically prepare for pregnancy.

The psychometric properties of the Iranian version of revised prenatal coping inventory (Nu PCI) in healthy pregnant women: a confirmatory factor analysis

The Revised Prenatal Coping Inventory (Nu PCI) is a self-report instrument that focuses on the coping styles of pregnant women during the prenatal period. The present study aimed to translate the scale and evaluate the psychometric properties of the Iranian version of the Nu PCI in healthy pregnant women. Beaton's recommendations have been used for the translation and cultural adaptation of this scale. Reliability, content, and face validity were performed to assess the psychometric properties of the scale. The results indicated that the Nu PCI was successfully translated into the Persian language, with both the total scale and subscales exhibiting both content validity and internal consistency. Confirmatory factor analyses revealed that the conceptual three-factor structure of the measure had good fit indices. Reliability was evaluated using internal consistency. Cronbach Alpha coefficient was 0.92 and intra-class correlation coefficient (ICC) was 0.91. Therefore, the Nu PCI is a reliable instrument to measure prenatal coping patterns in primigravida healthy pregnant women.

Prenatal Life Events, Maternal Employment, and Postpartum Depression across a Diverse Population in New York City

This study examined racial/ethnic disparities in three core postpartum depression (PPD) symptoms, and identified specific predictors of PPD including sociodemographic variables, life stressors and maternal employment. White, African American, Hispanic, and Asian/Pacific Islander women from the New York City area (n = 3010) completed the 2009-2011 Pregnancy Risk Assessment Monitoring System. African American women were less likely to have PPD than White women. Maternal employment during the postpartum was associated with an increased likelihood of PPD for White women relative to women who were not employed. Life stressors and maternal employment should be considered as culturally contextualized factors related to postpartum depression.

Prevalence and Risk Factors for Antenatal Depression in Ethiopia: Systematic Review

INTRODUCTION

Antenatal depression is a syndrome, in which women experience depressed mood, excessive anxiety, insomnia, and change in weight during the period of pregnancy. Maternal depression negatively influences child outcomes and maternal health. Antenatal depression was measured by different rating scales, namely, BDI, EPDS, and PHQ. The objective of this systematic review was to synthesize logical evidence about the prevalence and potential risk factors of antenatal depression in Ethiopia.

METHODS

Our team explored multiple databases including PSYCHINFO, MEDLINE, Embase, Google Scholar, and Google Search to detect studies published with data on the prevalence of antenatal depression. We found 246 research papers on antenatal depression, of which 210 did not correspond to the title and 27 were duplicates. Subsequently, nine articles were used for synthesis prevalence, of which four studies were selected in the analysis of the effect of unplanned pregnancy on antenatal depression. Figures were extracted from published reports and grey literature, and any lost information was requested from investigators. Estimates were pooled using random-effects meta-analyses.

RESULTS

The pooled prevalence of antenatal depression for five studies selected, which had used BDI, was 25.33 (20.74, 29.92). The other four studies that had included other screening tools (3 EPDS and 1 PHQ) had the prevalence decreased to 23.56 (19.04, 28.07), and the pooled effect of unplanned pregnancy on antenatal depression was 1.93 (1.81, 2.06). Factors such as age, marital status, income, occupation, history of the previous mental disorder, antenatal follow-up, unplanned pregnancy, complication during to pregnancy, age of mother during pregnancy, conflict, and social support were associated with antenatal depression.

CONCLUSIONS

Antenatal depression is a common maternal problem; further attention should be given to the effect of unplanned pregnancy, social support, pregnancy-related complications, family conflicts, and violence on pregnant women. All these are possible risk factors for antenatal depression.

Poor social support as a risk factor for antenatal depressive symptoms among women attending public antennal clinics in Penang, Malaysia

Background

Depression, a type of mental disorder which is portrayed by marked alterations in mood, is associated with distress and/or impaired functioning. Poor social support is an important risk factor for depression in pregnancy. An extensive literature search failed to show any published study conducted in Malaysia on antenatal depressive symptoms and the risk of poor social support on it. The aim of the study was to determine the risk of antenatal depressive symptoms due to poor social support.

Methods

This cross sectional study was conducted among 3000 pregnant women attending antenatal clinics in Penang, Malaysia. Edinburgh Postnatal Depression Scale (EPDS) was used to screen for antenatal depressive symptoms and the Oslo-3 Social Support Scale (OSS-3) was used to measure social support. Odds ratio and adjusted odds ratio were used to quantify the risk of antenatal depressive symptoms due to poor social support.

Results

The prevalence of depressive symptoms was 20%. Using OSS-3 scale to gauge social support, most of the participants had moderate support (61.3%) followed by poor support (22%) and strong support (16.7%). Social support was found to be significantly associated with depressive symptoms in this study (OR 2.2, aOR 2.1, AR 45%).

Conclusions

Considering that an expecting mother’s psychological factors are important in the wellbeing of the mother and child, antenatal depression must be quickly identified. Screening pregnant women for social support can help identify women with higher risk of depression.

Electronic supplementary material

The online version of this article (10.1186/s12978-017-0404-4) contains supplementary material, which is available to authorized users.

The relation between social anxiety and biased interpretations in adolescents with mild intellectual disabilities

BACKGROUND

Cognitive theories of anxiety emphasize the importance of cognitive processes in the onset and maintenance of anxiety disorders. However, little is known about these processes in children and adolescents with Mild Intellectual Disabilities (MID).

AIMS

The aim of this study was to investigate interpretation bias and its content-specificity in adolescents with MID who varied in their levels of social anxiety.

METHOD AND PROCEDURES

In total, 631 adolescents from seven special secondary schools for MID filled in questionnaires to measure their levels of social anxiety. They also completed the Interpretation Recognition Task to measure how they interpret ambiguous situations.

OUTCOMES AND RESULTS

Adolescents with higher self-reported levels of social anxiety interpreted ambiguous scenarios as more negative than adolescents with lower self-reported social anxiety. Furthermore, this negative interpretation was specific for social situations; social anxiety was only associated with ambiguous social anxiety-related scenarios, but not with other anxiety-related scenarios.

CONCLUSIONS AND IMPLICATIONS

These findings support the hypothesis that socially anxious adolescents with MID display an interpretation bias that is specific for stimuli that are relevant for their own anxiety. This insight is useful for improving treatments for anxious adolescents with MID by targeting content-specific interpretation biases.

Women's Perspectives of Needs Surrounding Adverse Birth Outcomes: A Qualitative Assessment of the Neighborhood Impact of Adverse Birth Outcomes

Objectives African Americans are two times more likely to suffer adverse birth outcomes (i.e., low birth weight, preterm birth, and infant mortality) when compared to all other ethnic groups and this pattern is no different for Douglas County, Nebraska, where the majority of African Americans in Nebraska reside. Our goal was to identify factors, as described by local women, that contribute to adverse birth outcomes in the predominantly African American community of Northeast Douglas County in Omaha, NE, to ensure that these women's voices were included in the development of interventions to improve their neighborhood's birth outcomes. The paper describes the results of a qualitative needs assessment of these women which will aid in the design and implementation of neighborhood-based solutions. Methods We brought together a group of women with varying levels of birthing experience, time spent living in the neighborhood, and overall community involvement. Individual in-depth, in person, and telephone interviews were used to collect participants' perceptions of birth outcomes, neighborhood resources for pregnant women, and neighborhood strengths and weaknesses. Results The needs assessment identified that, although women in this neighborhood have experience with adverse birth outcomes, these experiences are not discussed resulting in a lack of awareness of the wide spread racial disparities in birth outcomes and the efforts and resources to address this public health problem. Conclusions for Practice This study reveals the power of direct conversations with women impacted by adverse birth outcomes, as they must be primary partners in any efforts to improve birth outcomes.

Frequency and predictors of anxiety and depression among pregnant women attending tertiary healthcare institutes of Quetta City, Pakistan

Background

Anxiety and depression (A&D) are commonly reported among pregnant women from all over the world; however, there is a paucity of workable data from the developing countries including Pakistan. The current study, therefore, aims to find out the frequency and predictors of A&D among pregnant women attending a tertiary healthcare institutes in the city of Quetta, in the Balochistan province, Pakistan.

Methods

A questionnaire based, cross-sectional survey was conducted. The pre-validated Hospital Anxiety and Depression Scale (HADS) were used to assess the frequency of A&D among study respondents. Anxiety and depression scores were calculated via standard scoring procedures while logistic regression was used to identify the predictors of A&D. SPSS v. 20 was used for data analysis and p < 0.05 was taken as significant.

Results

Seven hundred and fifty pregnant women responded to the survey. The majority of the respondents belonged to age group of 26–35 year (424, 56.4%) and had no formal education (283, 37.6%). Furthermore, 612 (81.4%) of the respondents were unemployed and had urban residencies (651, 86.6%). The mean anxiety score was 10.08 ± 2.52; the mean depression score was 9.51 ± 2.55 and the total HADS score was 19.23 ± 3.91 indicating moderate A&D among the current cohort. Logistic regression analysis reported significant goodness of fit (Chi square = 17.63, p = 0.030, DF = 3), indicating that the model was advisable. Among all variables, age had a significant association when compared with HADS scores [adjusted OR (odds ratios) = 1.23, 95% CI = 1.13–1.62, p < 0.001].

Conclusion

Moderate A&D was reported among the study respondents. Furthermore, age was highlighted as a predictor of A&D. The evidence from this study provides a motion of support programs for anxious and depressed pregnant women. The benefits of implementing good mental health in antenatal care have long-lasting benefits for both mother and infant. Therefore, there is a need to incorporate A&D screening in the existing antenatal programs.

Effect of supervised exercise in groups on psychological well-being among pregnant women at risk of depression (the EWE Study): study protocol for a randomized controlled trial

Background

Pregnant women with depression and/or anxiety prior to pregnancy are at higher risk of preterm birth, breastfeeding problems, postpartum depression, and disruption of the mother-infant attachment. It is well documented that exercise improves psychological well-being in nonpregnant subjects with symptoms of depression. However, in only a few small studies have researchers examined the effect of exercise on symptoms of depression among pregnant women. We hypothesize that physiotherapist-supervised group exercise for pregnant women at risk of antenatal depression increases their psychological well-being. This paper describes the study protocol of a randomized controlled trial (RCT) on a supervised group exercise intervention for pregnant women with a current or previous history of depression and/or anxiety.

Methods/design

The RCT is being carried out at the Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, in the period 2016–2019. The inclusion criteria are pregnant women ≥18 years of age with depression and/or anxiety requiring treatment by a psychiatrist or a psychologist within the last 10 years and/or intake of antidepressants in the 3 months prior to conception and/or during pregnancy. The women must have appropriate Danish language skills, be pregnant with a single fetus, give written informed consent, and be at 17–22 gestational weeks when the intervention begins. The primary outcome is psychological well-being (the five-item World Health Organization Well-being Index). Secondary outcomes are symptoms of depression (Edinburgh Postnatal Depression Scale), functional ability (General Health Questionnaire), clinical symptoms of anxiety (State-Trait Anxiety Inventory), sleep quality and sleep disturbances (Pittsburgh Sleep Quality Index), and pregnancy and delivery outcomes. The intervention is supervised group exercise twice weekly for 12 weeks. The control group will receive standard antenatal care. On the basis of sample size calculation, a total of 300 women will be randomly assigned to either the intervention or the control group in a ratio of 1:1.

Discussion

The trial is expected to contribute to the body of knowledge used in planning antenatal care for pregnant women at risk of depression.

Trial registration

ClinicalTrials.gov, NCT02833519. Registered on 19 May 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-1938-z) contains supplementary material, which is available to authorized users.

Prevalence of Antenatal Depressive Symptoms and Associated Factors among Pregnant Women in Maichew, North Ethiopia: An Institution Based Study

BACKGROUND

Antenatal depression is one of the common problems during pregnancy with a magnitude of 20% to 30% globally. It can negatively endanger women's and off springs lives. As there are scarce reports on this area in Northern Ethiopia, it is important to carry out different studies that explore the magnitude of the problem and related factors in rural areas. The aim of this study is thus to assess the magnitude of antenatal depressive symptoms and associated factors among women at Maichew Town, North Ethiopia.

METHODS

A facility based cross sectional study was conducted among 196 pregnant women from April to June 2015. Pregnant women who had antenatal care follow-ups at the public health facilities were included in the study. Through proportional allocation to each facility, systematic random sampling technique was used to select the study participants. We used the local language version of Beck Depression Inventory to assess depressive symptoms with a cutoff point of 14 or more. Data was collected by trained Psychiatric Nurses; data entry and analysis were processed by SPSS window 20. The level of significance was determined using odds ratio and 95% confidence interval.

RESULTS

About 16.3% of the participants had never given birth before, and 46.4% and 42.3% were in the third and second trimesters of pregnancy respectively. Unwanted pregnancy was reported by 25.5% of the participants. Among those with previous pregnancy, 7.1% had previous obstetric complication. The magnitude of depression was 31.1%. Pregnant women with low level of income (AOR=3.66 (95%CI; 1.12, 11.96)), unmarried (AOR=4.07 (95% CI; 1.18, 14.04)) and house wives (AOR= 4.24 (1.38, 13.03)) were risk groups for depression.

CONCLUSION

Antenatal depression is a common problem; thus screening activities of depression in antenatal care services should be emphasized with more concern to unmarried women, those with low level of income and house wives.

Factors associated with onset timing, symptoms, and severity of depression identified in the postpartum period

BACKGROUND

Unipolar and bipolar depression identified in the postpartum period have a heterogeneous etiology. The objectives of this study are to examine the risk factors that distinguish the timing of onset for unipolar and bipolar depression and the associations between depression onset by diagnosis, and general and atypical depressive symptoms.

METHODS

Symptoms of depression were assessed at 4- to 6-weeks postpartum by the Structured Interview Guide for the Hamilton Depression Rating Scale-Atypical Depression Symptoms in an obstetrical sample of 727 women. Data were analyzed using ANOVA, Chi-square, and linear regression.

RESULTS

Mothers with postpartum onset of depression were more likely to be older, Caucasian, educated, married/cohabitating, have one or no previous child, and have private insurance in contrast to mothers with pre-pregnancy and prenatal onset of depression. Mothers with bipolar depression were more likely to have a pre-pregnancy onset. Three general and two atypical depressive symptoms distinguished pre-pregnancy, during pregnancy, and postpartum depression onset, and the presence of agitation distinguished between unipolar and bipolar depression.

LIMITATIONS

The sample was urban, which may not be generalizable to other populations. The study was cross-sectional, which excludes potential late onset of depression (after 4-6 weeks) in the first postpartum year.

CONCLUSIONS

A collective set of factors predicted the onset of depression identified in the postpartum for mothers distinguished by episodes of unipolar versus bipolar depression, which can inform clinical interventions. Future research on the onset of major depressive episodes could inform prophylactic and early psychiatric interventions.