Prevalence and risk factors of postpartum depression in a population-based sample of women in Tangxia Community, Guangzhou

Multidimensional influencing factors of postpartum depression based on the perspective of the entire reproductive cycle: evidence from western province of China

OBJECTIVE

China has a serious burden of Postpartum depression (PPD). In order to improve the current situation of high burden of PPD, this study explores the factors affecting PPD from the multidimensional perspectives with physiology, family support and social support covering the full-time chain of pre-pregnancy-pregnancy-postpartum.

METHODS

A follow-up survey was conducted in the Qujing First People's Hospital of Yunnan Province from 2020 to 2022, and a total of 4838 pregnant women who underwent antenatal checkups in the hospital were enrolled as study subjects. Mothers were assessed for PPD using the Edinburgh Postnatal Depression Scale (EPDS), and logistic regression was used to analyse the level of mothers' postnatal depression and identify vulnerability characteristics.

RESULTS

The prevalence of mothers' PPD was 46.05%, with a higher prevalence among those who had poor pre-pregnancy health, had sleep problems during pregnancy, and only had a single female fetus. In the family support dimension, only family care (OR = 0.52, 95% CI 0.42-0.64) and only other people care(OR = 0.78, 95% CI 0.64-0.96) were the protective factors of PPD. The experience risk of PPD was higher among mothers who did not work or use internet.

CONCLUSION

The PPD level in Yunnan Province was significantly higher than the global and Chinese average levels. Factors affecting mothers' PPD exist in all time stages throughout pregnancy, and the influence of family support and social support on PPD shouldn't be ignored. There is an urgent need to extend the time chain of PPD, move its prevention and treatment forward and broaden the dimensions of its intervention.

Exploring predictors and prevalence of postpartum depression among mothers: Multinational study

BACKGROUND

Postpartum depression (PPD) affects around 10% of women, or 1 in 7 women, after giving birth. Undiagnosed PPD was observed among 50% of mothers. PPD has an unfavorable relationship with women's functioning, marital and personal relationships, the quality of the mother-infant connection, and the social, behavioral, and cognitive development of children. We aim to determine the frequency of PPD and explore associated determinants or predictors (demographic, obstetric, infant-related, and psychosocial factors) and coping strategies from June to August 2023 in six countries.

METHODS

An analytical cross-sectional study included a total of 674 mothers who visited primary health care centers (PHCs) in Egypt, Yemen, Iraq, India, Ghana, and Syria. They were asked to complete self-administered assessments using the Edinburgh Postnatal Depression Scale (EPDS). The data underwent logistic regression analysis using SPSS-IBM 27 to list potential factors that could predict PPD.

RESULTS

The overall frequency of PPD in the total sample was 92(13.6%). It ranged from 2.3% in Syria to 26% in Ghana. Only 42 (6.2%) were diagnosed. Multiple logistic regression analysis revealed there were significant predictors of PPD. These factors included having unhealthy baby adjusted odds ratio (aOR) of 11.685, 95% CI: 1.405-97.139, p = 0.023), having a precious baby (aOR 7.717, 95% CI: 1.822-32.689, p = 0.006), who don't receive support (aOR 9.784, 95% CI: 5.373-17.816, p = 0.001), and those who are suffering from PPD. However, being married and comfortable discussing mental health with family relatives are significant protective factors (aOR = 0.141 (95% CI: 0.04-0.494; p = 0.002) and (aOR = 0.369, 95% CI: 0.146-0.933, p = 0.035), respectively.

CONCLUSION

The frequency of PPD among the mothers varied significantly across different countries. PPD has many protective and potential factors. We recommend further research and screenings of PPD for all mothers to promote the well-being of the mothers and create a favorable environment for the newborn and all family members.

Increased risk of postpartum depression in women with lactational mastitis: a cross-sectional study

Background

A high incidence of lactational mastitis mainly occurs during the first month of breastfeeding. It may cause severe pain, frustration, fatigue, stress, and breastfeeding concerns. However, few studies investigated the effects of lactational mastitis on postpartum depression. This study investigated the potential association between lactational mastitis and postpartum depression.

Methods

We examined the associations of lactational mastitis with postpartum depression in 1,551 Chinese women. Lactational mastitis was diagnosed by breast specialists. The presence of depression symptoms was evaluated by the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire 9 (PHQ9) at 6 weeks after delivery. Multiple linear regression analysis and multivariable log-binomial regression analysis were performed to estimate the association between lactational mastitis and postpartum depression.

Results

Among the 1,551 mothers, 147 (9.5%) experienced lactational mastitis diagnosed by breast specialists during the postpartum period. Compared with women without lactational mastitis, the proportion of women with depression symptoms was significantly higher (38.1% vs. 27.4%, p = 0.008), and the risk of postpartum depression increased by 68% (RR = 1.68, 95% CI, 1.18, 2.40) in women who had experienced lactational mastitis. In addition, the risk of self-harm or suicidal ideation increased by 89% (RR = 1.89, 95% CI, 1.08, 3.29) in women who experienced lactational mastitis. In stratified analysis, the associations of lactational mastitis with postpartum depression appeared stronger among women aged ≥35 years, with maternal comorbidities, and who delivered a female neonate.

Conclusion

The study results suggest that lactational mastitis is a risk factor for depression during the postpartum period. The impact of lactational mastitis on maternal mental health requires further attention.

Clinical trial registration

chictr.org.cn, ChiCTR2000041519.

Association of Social Support and Postpartum Depression According to the Time After Childbirth in South Korea

OBJECTIVE

This study examined the association between social support and postpartum depression (PPD) according to the time after childbirth within 12 months in South Korea.

METHODS

Data were collected from 1,481 women in Chungnam Province, South Korea from September 21 to 30, 2022. Multivariate logistic regression models were used to examine the association between social support and PPD. Subgroup analysis of the associations of support from family, friends, and significant others with PPD according to the time after childbirth was undertaken using crude and adjusted models.

RESULTS

Of the participants, 39.91% had PPD. The prevalence of PPD was 36.05% at <3 months, 37.50% at 3≤ to <6 months, and 44.41% at 6≤ to <12 months. A 1-point increase in the social support score was associated with an increase in the adjusted odds ratio of PPD of 0.91 (95% confidence interval=0.90-0.93). Social support from family was significantly associated with PPD regardless of the time after childbirth. Support from significant others was significantly associated with PPD after 6≤ to <12 months.

CONCLUSION

Family support should be provided consistently to women after birth; social connections with significant others can prevent PPD.

Investigating the association between maternal childbirth intention, labor epidural analgesia, and postpartum depression: A prospective cohort study

BACKGROUND

Postpartum depression (PPD) is a general depressive episode after childbirth. Studies have shown that unmatched analgesic intention increases the risk of PPD, but the use of labor epidural analgesia (LEA) during childbirth can reduce this risk. We aimed to investigate the association between maternal childbirth intention, LEA, and PPD and risk factors that may be related to PPD.

METHODS

A total of 590 mothers were included in this prospective cohort study. Demographic, prenatal, intrapartum and postpartum data were recorded. We investigated the association between childbirth intention, LEA and PPD and assessed the interactions between two factors. Logistic regression analysis was used to screen variables that might be associated with the occurrence of PPD.

RESULTS

Overall, 130 of 451 women completing the study at 3 months had PPD (28.8 %). We did not find an association between unmatched childbirth intention, use of LEA and PPD (adjustOR = 0.684 CI 0.335-1.396, p = 0.296; adjustOR = 0.892, CI 0.508-1.565, p = 0.690). Chronic pain affecting daily life, prenatal EPDS, SAS, SSRS score, family accompaniment during labor, and 1-day numerical rating scale (NRS) score were significantly associated with PPD (p < 0.05).

LIMITATIONS

In the 3-month follow-up, we only recorded the EPDS score, not the pain score, and did not evaluate the association between postpartum chronic pain and PPD.

CONCLUSIONS

The association between maternal childbirth intention, LEA and PPD was not significant. Chronic pain affecting daily life, prenatal EPDS, SAS, SSRS score, family accompaniment during labor, and 1-day NRS score were significantly related to the occurrence of PPD (p < 0.05).

Mediating role of perceived stress on the association between domestic violence and postpartum depression: cross-sectional study in Bangladesh

BACKGROUND

Postpartum depression (PPD) is a major depressive disorder developed after childbirth that negatively affects the well-being of both mother and infant. The relationship between domestic violence and the development of PPD symptoms is well documented. However, empirical evidence is lacking on how a person's perception of stress mediates this relationship.

AIMS

To estimate the degree to which perceived stress may explain the association between being the victim of domestic violence and developing PPD symptoms among Bangladeshi mothers.

METHOD

A cross-sectional survey design was employed from October to December 2019 to collect data from 497 postpartum mothers within the first 6 months of giving birth. The associations between domestic violence victimisation and developing PPD symptoms were assessed using multivariable logistic regressions. The Karlson-Holm-Breen method was used for mediation analysis.

RESULTS

One-third (34%) of the mothers in this sample reported experiencing PPD within 6 months. A one-item increase in the number of reported experiences ('items') of controlling behaviour, emotional domestic violence and physical domestic violence increased the odds of developing PPD symptoms by 27%, 40% and 31% respectively, after controlling for other variables and mediators. Furthermore, after adjusting for other variables, the mediating effect of perceived stress on the association of controlling behaviour, emotional domestic violence, physical domestic violence and any form of domestic violence with developing PPD symptoms was 45.1%, 43.0%, 31.2% and 37.5% respectively.

CONCLUSIONS

Findings suggest that perceived stress partially mediates the association between domestic violence victimisation and developing PPD symptoms. Understanding these complex relationships may help policymakers to formulate appropriate intervention strategies and support services.

Postpartum depression and health-related quality of life: a Saudi Arabian perspective

Background and Objectives

The mental and physical functioning of an individual is partly determined by their health-related quality of life (HRQOL), which is a multifaceted component. Women who have recently given birth must have a good quality of life to provide proper care and development for their infant. The purpose of this study was to assess the relationship between postpartum depression (PPD) and HRQOL in Saudi Arabian women and to identify potential risk factors that could influence them.

Methods

This study comprised 253 mothers aged 1-24 weeks postpartum from several health centers in Saudi Arabia, recruited by random purposive sampling. The study's questionnaire featured three sections: the first section had demographic information; the second and third sections contained the Edinburgh Postnatal Depression Scale (EPDS) scale and the HRQOL scale (SF-12), respectively. Data were analyzed using descriptive statistics, chi square analyses, independent samples t-tests and binary logistic regression analysis using IBM SPSS 25.

Results

Results of current study indicate that 59.68% of the patients exhibited probable post-partum depression symptoms. Participants who were depressed had significantly lower mental component (MCS) and physical component scores than participants who were in good health. When compared to non-smokers, smokers have a 21-fold higher risk of developing depression. Similar to this, mothers who worked had a 3.98 times higher risk of depression, and patients with a history of depression had a 3.6 times higher chance of getting PPD. The probability of developing PPD was also significantly higher in those who lived outside the Riyadh region, had given birth more than twice before this time, and had experienced undesired pregnancies.

Conclusion

Our study demonstrated an inverse correlation between postpartum depression and health-related quality of life scores. Treatment for depression, particularly among mothers, is crucial for improving their quality of life and, as a result, creating a favorable environment for the development of newborn babies.

Psychometric properties of the Postpartum Depression Literacy Scale (PoDLiS) among Chinese perinatal women: a cross-sectional study

Background

The aim of the present work was to cross-culturally adapt the Postpartum Depression Literacy Scale (PoDLiS) and use a descriptive cross-sectional design to evaluate its psychometric properties in Chinese perinatal women.

Methods

Brislin’s translation theory was applied to translate the PoDLiS, with subsequent cultural adaptation. The reliability and validity of the PoDLiS were determined using a questionnaire in 635 Chinese perinatal women.

Results

Good internal consistency was found (omega coefficient, 0.894) for the Chinese version of the Postpartum Depression Literacy Scale (PoDLiS-C), with omega coefficients of the six dimensions of 0.865, 0.870, 0.838, 0.777, 0.837 and 0.794, and a test–retest reliability coefficient of 0.874. The item-level content validity index (CVI) ranged from 0.8 to 1 while the scale-level CVI was 0.968. Moreover, confirmatory factor analysis (CFA) determined satisfactory construct validity of the PoDLiS-C, with the six-factor model explaining 60.76% of the total variance, demonstrating good model fit (likelihood ratio χ²/df, 1.003; goodness-of-fit index, 0.916; adjusted goodness-of-fit index, 0.901; comparative fit index, 0.999; incremental fit index, 0.999; root mean square error of approximation, 0.003; and standardized root mean square error of approximation, 0.0478).

Conclusions

The PoDLiS-C has adequate psychometric properties. This tool could be used to assess the postpartum depression literacy of perinatal women in Chinese-speaking populations.

Additional evidence on prevalence and predictors of postpartum depression in China: A study of 300,000 puerperal women covered by a community-based routine screening programme

BACKGROUND

Previous studies on the prevalence and predictors of postpartum depression (PPD) in China were mostly hospital-based with relatively small study samples. Basing on a routine screening programme, this study assessed the prevalence and factors associated with PPD at community level.

METHODS

A cross-sectional study was conducted with all the women who delivered in a hospital and were screened for depression during routine postpartum home visits in Shenzhen between 2015 August and 2017 April. The Edinburgh Postnatal Depression Scale was used as the screening tool with a cut-off score of 10. Predictors of PPD were determined by Chi-square test and stepwise logistic regression.

RESULTS

Approximately 300,000 puerperal women were included in the study with a PPD prevalence of 4.3%. Prenatal anxiety and depression were associated with 4.55 and 3.80 times of PPD risk, respectively. Stressful life events, family history of mental illness, poor economic status, low Apgar scores and birth defects of the infants, bottle and mixed feeding, as well as living with parents-in-low after childbirth were related to moderate risk. Higher gravidity and parity, larger gestation age, prenatal education, and living with the women's own parents were associated with lower risk.

LIMITATIONS

The large sample size might have suggested statistically significant differences which were not practical.

CONCLUSIONS

The prevalence of PPD at community level is significantly lower than the rates detected within hospitals. Prenatal anxiety and depression are the most important predictors of PPD. Integrating depression screening into routine postpartum home visits facilitates achievement of universal coverage.

Effects of family relationship and social support on the mental health of Chinese postpartum women

Background

Numerous studies suggest that interpersonal relationships and social support influence the development of postpartum depression and sleep quality for women. However, the effect of support from the husband or the mother-in-law has not been thoroughly validated. The current study examined the relative contribution of marital satisfaction, perceived caring of the mother-in-law, and social support on postpartum depression and sleep quality simultaneously in a path model.

Methods

A cross-sectional study was conducted from March to June 2017 in Hebei, China, using a self-report questionnaire. A total of 817 women participated at 6 weeks postpartum. Sociodemographics and information about marital satisfaction, perceived caring of the mother-in-law, social support, postpartum depression, and sleep were collected. Path analysis was used to analyze the cross-sectional data.

Results

The final model had a highly satisfactory fit. Marital satisfaction and perceived caring of mother-in-law had both direct and indirect effects on postpartum depression through social support, but these two variables had only an indirect effect on sleep quality through social support and postpartum depression. Sleep quality is a consequence of postpartum depression at 6 weeks after delivery. The prevalence of minor and major postpartum depressive symptoms at 6 weeks postpartum was 41.49 and 23.13%, respectively. A total of 371 (45.41%) women experienced sleep disturbance at 6 weeks postpartum.

Conclusions

These findings suggest that interpersonal relationships with family members play important roles in postpartum depression and sleep quality through social support in Chinese women. Improving the relationship between new mothers and their husbands or mothers-in-law and then enhancing social support might reduce postpartum depression and sleep disturbance.

Pathways Linking Intimate Partner Violence and Postpartum Depression Among Jewish and Arab Women in Israel

Intimate partner violence (IPV) is a major risk factor for postpartum depression (PPD), with 9% to 28% of PPD cases reporting IPV at some point in their lives. Yet little is known about how these phenomena are associated. We asked, "What direct and indirect pathways link IPV to PPD in women belonging to different ethnic-national groups in Israel?" We recruited a stratified sample of Jewish and Arab women, 18 to 48 years old and 6 months postpartum, during their visits to maternal and child health clinics. We computed path analyses to identify both direct and indirect predictors linking IPV frequency and PPD in a stratified sample of Jewish (n = 807) and Arab (n = 248) women. The overall rate of PPD was estimated at 10.3%, whereas the rate of IPV for the total sample was 36%. We identified a direct link between IPV and PPD. IPV also appeared to have an equivalent, indirect effect on PPD via greater chronic stress and reduced social support. IPV was greater and social support was lower for Arab women, who also reported higher PPD, independent of sociodemographic differences between ethnic groups (i.e., education, occupation). Of note, an unplanned pregnancy appeared to increase the risk of both IPV and PPD. Our findings suggest that complex pathways link IPV to PPD and that indirect effects of IPV are equivalent to its direct effects on postpartum women. These findings contribute to a growing international body of research showing the significant effects of IPV on health and well-being. The factors we identified as directly and indirectly associated with PPD might inform interventions to identify and treat PPD.

Assessment of difference in postpartum depression among caesarean and vaginally delivered women at 6-week follow-up in hospitals in Pune District, India: an observational cohort study

OBJECTIVES

To compare the proportion of postpartum depression at 6 weeks among women who had caesarean delivery and women who had vaginal delivery and to assess its association with some sociodemographic factors.

DESIGN

This is a descriptive comparative study with prospective enrolment. We followed the enrolled women and assessed them for postpartum depression 6 weeks after delivery.

SETTING

We conducted the study in Pune District, India from July 2017 to December 2018. The study sites were all non-teaching government hospitals performing five or more caesarean sections per month and two teaching hospitals: one government and one private.

PARTICIPANTS

We included in the study group women who have undergone caesarean section in the participating hospitals and were residents of Pune District. Women who delivered vaginally and matched in age and parity were included in the comparison group. We followed 1556 women in each group.

MAIN OUTCOME MEASURES

An Edinburgh Postnatal Depression Scale score of 10 or more for each woman was the primary outcome. χ2 test and multivariable binary logistic regression were performed to assess the effect of mode of delivery on postpartum depression.

RESULTS

The proportion of postpartum depression at 6 weeks was 3.79% among women who had caesarean delivery and 2.35% among those who had vaginal delivery (χ2=4.50, p=0.03). The adjusted OR was 1.86 (95% CI 1.14 to 3.03). Women of age less than 25 years had higher risk of postpartum depression. The adjusted OR was 2.10 (95% CI 1.21 to 3.65). The study did not observe any association between postpartum depression and income, education, occupation or sex of the newborn child.

CONCLUSIONS

We conclude that young women particularly those who had caesarean delivery should be screened 6 weeks after delivery.

Association between mode of delivery and postpartum depression: The Japan Environment and Children's Study (JECS): a prospective cohort study

BACKGROUND

Postpartum depression (PPD) has been associated with adverse health outcomes including maternal suicide. Mode of delivery has been suggested to be a risk factor for PPD, but no large cohort study has examined the association between mode of delivery and PPD. We aimed to examine the association between mode of delivery and risks of PPD at 1 and 6 months after childbirth.

METHODS

In a nationwide study of 89,954 mothers with a live singleton birth, we examined the association between mode of delivery and risks of PPD. PPD was measured by the Edinburgh Postnatal Depression Scale (≥13) at 1 and 6 months after childbirth. Odds ratios (ORs) with 95% confidence intervals (CIs) of PPD were calculated using multivariable logistic regression analyses after adjustment of antenatal physical, socioeconomic, and mental factors.

RESULTS

Among 89,954 women, 3.7% and 2.8% had PPD at 1 and 6 months after childbirth, respectively. Compared with unassisted vaginal delivery, cesarean section (CS) was marginally associated with PPD at 1 month, but not at 6 months; adjusted ORs were 1.10 (95% CI, 1.00-1.21) and 1.01 (95% CI, 0.90-1.13), respectively. The association with PPD at 1 month was evident in women with antenatal psychological distress: adjusted OR was 1.15 (95% CI, 1.03-1.28). The observed associations were attenuated after adjusting for infant feeding method.

CONCLUSIONS

Women who had antenatal psychological distress and underwent CS delivery may be regarded as a target for monitoring PPD.

Prevalence and incidence of postpartum depression and environmental factors: The IGEDEPP cohort

BACKGROUND

IGEDEPP (Interaction of Gene and Environment of Depression during PostPartum) is a prospective multicenter cohort study of 3310 Caucasian women who gave birth between 2011 and 2016, with follow-up until one year postpartum. The aim of the current study is to describe the cohort and estimate the prevalence and cumulative incidence of early and late-onset postpartum depression (PPD).

METHODS

Socio-demographic data, personal and family psychiatric history, as well as stressful life events during childhood and pregnancy were evaluated at baseline. Early and late-onset PPD were assessed at 8 weeks and 1 year postpartum respectively, using DSM-5 criteria.

RESULTS

The prevalence of early-onset PPD was 8.3% (95%CI 7.3-9.3), and late PPD 12.9% (95%CI 11.5-14.2), resulting in an 8-week cumulative incidence of 8.5% (95%CI 7.4-9.6) and a one-year cumulative incidence of PPD of 18.1% (95%CI: 17.1-19.2). Nearly half of the cohort (N = 1571, 47.5%) had a history of at least one psychiatric or addictive disorder, primarily depressive disorder (35%). Almost 300 women in the cohort (9.0%) reported childhood trauma. During pregnancy, 47.7% women experienced a stressful event, 30.2% in the first 8 weeks and 43.9% between 8 weeks and one year postpartum. Nearly one in five women reported at least one stressful postpartum event at 8 weeks.

CONCLUSION

Incident depressive episodes affected nearly one in five women during the first year postpartum. Most women had stressful perinatal events. Further IGEDEPP studies will aim to disentangle the impact of childhood and pregnancy-related stressful events on postpartum mental disorders.

Who is the main caregiver of the mother during the doing-the-month: is there an association with postpartum depression?

BACKGROUND

To examine the relationship between the main caregiver during the "doing-the-month" (a traditional Chinese practice which a mother is confined at home for 1 month after giving birth) and the risk of postpartum depression (PPD) in postnatal women.

METHODS

Participants were postnatal women stayed in hospital and women who attended the hospital for postpartum examination, at 14-60 days after delivery from November 1, 2013 to December 30, 2013. Postpartum depression status was assessed using the Edinburgh Postnatal Depression Scale. Univariate and multivariable logistic regressions were used to identify the associations between the main caregiver during "doing-the-month" and the risk of PPD in postnatal women.

RESULTS

One thousand three hundred twenty-five postnatal women with a mean (SD) age of 28 (4.58) years were included in the analyses. The median score (IQR) of PPD was 6.0 (2, 10) and the prevalence of PPD was 27%. Of these postnatal women, 44.5% were cared by their mother-in-law in the first month after delivery, 36.3% cared by own mother, 11.1% by "yuesao" or "maternity matron" and 8.1% by other relatives. No association was found between the main caregivers and the risk of PPD after multiple adjustments.

CONCLUSIONS

Although no association between the main caregivers and the risk of PPD during doing-the-month was identified, considering the increasing prevalence of PPD in Chinese women, and the contradictions between traditional culture and latest scientific evidence for some of the doing-the-month practices, public health interventions aim to increase the awareness of PPD among caregivers and family members are warranted.

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSION

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

Association of Childbirth Pain with Postnatal Depressive and Anxiety Disorders in Nulliparous Parturients: A Prospective Study

PURPOSE

There is limited knowledge on the relationship between postnatal depression and childbirth pain characteristics associated with childbirth. We investigated whether the characteristics of childbirth pain, as assessed by Short-form-McGill Pain Questionnaire-2 (SF-MPQ-2), were associated with postnatal anxiety and depressive disorders.

PATIENTS AND METHODS

Nulliparous parturients who received labor epidural analgesia (LEA) and delivered in our institution were invited to have a Mini-International Neuropsychiatric Interview (MINI) assessment following their 5-9 weeks post-delivery follow-up phone survey of a larger study. Parturients' demographics, pre-delivery questionnaires on pain and psychological vulnerabilities, LEA data, maternal and neonatal outcomes, postnatal follow-up survey on pain and psychological vulnerabilities, pain and breastfeeding were collected accordingly. The primary outcome was the binary variable (yes/no) of the presence of postnatal depression and/or anxiety disorders based on the post-delivery MINI assessment.

RESULTS

Among the 107 parturients who participated in the post-delivery MINI assessment, a total of 40 (42.5%) patients were found to have postnatal anxiety and depressive disorders. A greater pre-delivery SF-MPQ-2 neuropathic pain mean subscale score (adjusted odds ratio (OR) 1.32, 95% CI 1.00-1.73, p=0.0482) and greater post-delivery Edinburgh Postnatal Depression Scale (EPDS) at 5-9 weeks post-delivery (adjusted OR 1.30, 95% CI 1.13-1.50, p=0.0002) were independently associated with the presence of postnatal anxiety and/or depressive disorders (receiver operating characteristic (ROC) = 0.7489).

CONCLUSION

Patients with greater pre-delivery neuropathic pain and higher EPDS scores at 5-9 weeks post-delivery are more likely to have postnatal depression and/or anxiety disorders, suggesting possible associations between pain and psychological vulnerability in the development of postnatal mental disorders.

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

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

Parental Depression Symptoms at Neonatal Intensive Care Unit Discharge and Associated Risk Factors

OBJECTIVE

To investigate the prevalence and risk factors associated with parental depressive symptoms at neonatal intensive care unit (NICU) discharge and determine the relationships among depressive symptoms, stress, and social support.

STUDY DESIGN

Parents participating in the Giving Parents Support trial (n = 300) were surveyed before NICU discharge. Depressive symptoms, stress, and social support were assessed using the Center for Epidemiological Studies Depression Scale (CESD-10), Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU), Perceived Stress Scale (PSS-10), and Multidimensional Scale of Perceived Social Support (MSPSS). Regression analyses examined relationships among depressive symptoms, stress, social support, and parent/infant factors.

RESULTS

At NICU discharge, 45% of parents reported depressive symptoms and 43% reported elevated perceived stress. Increased odds of elevated depressive symptoms were associated with older gestational age (P = .02), female infant (P = .02), and longer length of stay (P = .045). Odds of depression were 7.87 (95% CI, 2.15-28.75) for parents of infants with gestational age ≥37 weeks compared with gestational age <28 weeks. Parental NICU stress was higher in younger parents (P < .01). Depressive symptoms were positively associated with parental stress. Each 1-point increase in PSS:NICU score was associated with a 2.1-point (95% CI, 1.6-2.9; P < .001) increase in CESD-10 score. Social support was inversely associated with depressive symptoms.

CONCLUSION

The prevalence of depressive symptoms in parents at NICU discharge was high, even among parents of term infants. Older gestational age, greater parental stress, and lower levels of social support were strong correlates of depressive symptoms. Strategies to support parents, including depression screening, stress reduction strategies, and mental health referrals, are needed.

Prevalence of perinatal depression and its determinants in Mainland China: A systematic review and meta-analysis

BACKGROUND

Perinatal depression is a maternal mental health condition that is associated with various adverse health outcomes both for the mothers and the babies. The study aim was to estimate the prevalence of perinatal depression and its risks and determinants in Mainland China.

METHODS

Systematic searches were conducted in 10 major databases and random effect meta-analysis was performed to achieve the pooled variance of perinatal depression. Subgroup analyses were conducted based on region, scale, methods of diagnosis and study design. Meta-regression was performed with the variables such as age, quality assessment score and gross domestic product (GDP) of the province.

RESULTS

Pooled prevalence of perinatal depression was 16.3% (CI=95%; 14.7% to 18.2%, P < 0.001), with antenatal depression 19.7% (CI=95%; 15.8% to 24.2%, P < 0.001) and postnatal depression 14.8% (CI=95%; 13.1% to 16.6%, P < 0.001). Significant publication bias was found and heterogeneity was I2= 98.13%. Lower socioeconomic status, poor physical health, anxiety about pregnancy and reduced social support were major risk factors while better living conditions and higher level of education were protective factors. The prevalence of perinatal depression showed a significant increasing trend in the last decade.

LIMITATIONS

The review does not include studies with small sample size (n <250). Moreover a narrative review of risk and protective factors was done, these were not included in meta-analysis.

CONCLUSION

The prevalence of perinatal depression in China is similar to low and middle-income countries. Urgent attention is needed to address this public health priority in China.

Prevalence and factors associated with postpartum depression during the COVID-19 pandemic among women in Guangzhou, China: a cross-sectional study

BACKGROUND

The 2019 coronavirus disease (COVID-19) is a public health emergency of international concern. To date, there are limited studies that have investigated the impact of COVID-19 pandemic on mental health among female population. Therefore, the study aims to investigate the prevalence of postpartum depression (PPD) and it's related factors among women in Guangzhou, China, during the COVID-19 pandemic.

METHODS

A cross-sectional study was performed from 30th March 2020 to 13th April 2020 using anonymous online questionnaire among 864 women at 6-12 weeks postpartum. The Chinese version of Edinburgh Postnatal Depression Scale and a questionnaire regarding associated factors were administered to all participants. Multivariate logistic regression was used to determine factors that were significantly associated with PPD.

RESULTS

The prevalence of PPD among women at 6-12 weeks postpartum was 30.0%. A multivariate logistic regression model identified significant factors as: immigrant women, persistent fever, poor social support, concerns about contracting COVID-19 and certain precautionary measures.

CONCLUSIONS

The findings suggest the need for policies and interventions to not only mitigate the psychological impacts but also target disadvantaged sub-groups of women following childbirth during the COVID-19 pandemic.

Prevalence of postpartum depression at the clinic for obstetrics and gynecology in Kosovo teaching hospital: Demographic, obstetric and psychosocial risk factors

INTRODUCTION

Postpartum depression affects 10 up to 15 % of women of childbearing age in industrialized countries and presents significant public health problem which leads to short and long-term consequences for mother, child and her family. However, social determinants, including poverty, gender stereotypes, domestic violence, gender discrimination and cultural differences make this medical issue more problematic in less developed countries. The aim of this study was to examine the prevalence and risk factors of postpartum depression at the Clinic for Obstetrics and Gynecology in Pristina, Kosovo (a tertiary referral center).

MATERIAL AND METHODS

A prospective observational cohort study was conducted from June 2019 to October 2019 at the Clinic for Obstetrics and Gynecology in Pristina, Kosovo. A total of 247 delivery women were screened for postpartum depression at 6 weeks following delivery using the Edinburg Postnatal Depression Scale (EPDS). Socio-demographic, obstetric and psychologic factors were tested as predictors of PPD using bivariate or multivariate logistic regression analysis (Logit model). Odds ratio (OR) with 95 % confidence intervals were calculated for each risk factor. The p values < 0.05 were considered statistically significant.

RESULTS

The prevalence of PPD at the Clinic for Obstetrics and Gynecology in Kosovo teaching hospital was 21 % at 6 weeks following childbirth. The bivariate and multivariate logistic regression analysis identified four predictor variables for postpartum depression: pregnancy complications (OR 1.057; 95 % CI; 1.002-1.114 and P = 0.040); fear of childbirth (OR 1.121; 95 % CI; 1.057-1.190 and P = 0.00016); prenatal depression or anxiety (OR 1.088; 95 % CI; 1.032-1.147 and P = 0.0018); poor marital relation (OR 1.085, 95 % CI; 1.002-1.174 and P = 0.044). No statistically significant association was found between the postpartum depression (PPD) and maternal age, education, employment, family type, smoking, previous abortion, parity, household income, social support, child gender, birthweight, and breast feeding.

CONCLUSIONS

The high prevalence of postpartum depression in our setting and its known adverse effects on woman, infant and her family implies an urgent need for evidence-based interventions. Such interventions are needed to promote knowledge of perinatal mental illness and improve maternal mental health in particular in less developed countries. Future efforts should address early identification of high-risk women, assessment of risk factor during the antenatal period, early postpartum depression screening and timely therapeutic approaches, to improve social and psychological functioning of the woman.

Prevalence and Associated Factors of Postpartum Anxiety and Depression Symptoms Among Women in Shanghai, China

BACKGROUND

Postpartum anxiety (PPA) and postpartum depression (PPD) are associated with immediate and long-term health risks for both mothers and babies. The purpose of this paper was to evaluate relationships between sociodemographic, perinatal variables, and PPA and PPD symptoms of parturients 6 weeks postpartum.

METHODS

A cross-sectional survey with 1204 women who had a healthy and term birth in a baby-friendly hospital, Shanghai, China. PPA and PPD symptoms were measured by using the Self-Rating Anxiety Scale (SAS) and the Edinburgh Postnatal Depression Scale (EPDS).

RESULTS

The mean score of SAS and EPDS was 40.79 ± 8.48 and 8.18 ± 5.80, respectively. The estimated prevalence of PPA and PPD symptoms was 15.2% and 23.2%, respectively. Multivariable logistic regression analysis showed that the presence of fatigue and PPD symptoms were risk factors for PPA symptoms, whereas having support from family and being satisfied with labor experience were protective factors. In terms of PPD symptoms, its risk factors included smoking before pregnancy, maternal separation from baby, fatigue, encountering difficulties in breastfeeding, and the presence of PPA symptoms. In contrast, the protective factors for PPD symptoms were having support from family and having support from colleagues or friends.

LIMITATIONS

Convenience sampling and voluntary participation may have led to a selection bias.

CONCLUSION

PPA and PPD symptoms occur commonly among parturients in Shanghai, China. The findings from this research provide a better understanding of factors associated with PPA and PPD symptoms and will help guide personalized approaches to the management of postpartum anxiety and depression.

Postnatal depression and its association with adverse infant health outcomes in low- and middle-income countries: a systematic review and meta-analysis

Background

Postnatal Depression (PND) is a mood disorder that steals motherhood and affects the health and development of a newborn. While the impact of PND on motherhood and newborn in developed countries are well described, its epidemiology and health consequences in infant is not well known in middle-and low-income countries. The objective of this review was to determine the burden and association of PND with adverse infant health outcomes in low-and middle- income countries.

Methods

We searched observational studies written in the English language and conducted in middle-and low-income countries between December 1st, 2007, and December 31st, 2017. The CINHAL, MEDLINE, Emcare, PubMed, Psych Info, and Scopus databases were searched for the following search terms: PND, acute respiratory infection, pneumonia, diarrhea, exclusive breastfeeding, common infant illnesses, and malnutrition. We excluded studies in which the primary outcomes were not measured following a standardized approach. We have meta-analyzed the estimates from primary studies by adjusting for possible publication bias and heterogeneity. The analysis was conducted in Stata 14. The study was registered in PROSPERO protocol number CRD42017082624.

Result

Fifty-eight studies on PND prevalence (among 63,293 women) and 17 studies (among 32,454 infants) on infant health outcomes were included. PND prevalence was higher in the low-income countries (Pooled prevalence (PP) = 25.8%; 95%CI: 17.9–33.8%) than in the middle-income countries (PP = 20.8%; 95%CI: 18.4–23.1%) and reached its peak in five to ten weeks after birth. Poor obstetric history and social support, low economic and educational status, and history of exposure to violence were associated with an increased risk of PND. The risk of having adverse infant health outcomes was 31% higher among depressed compared to non-depressed postnatal mothers (Pooled relative risk (PRR) = 1.31; 95%CI: 1.17–1.48). Malnutrition (1.39; 1.21–1.61), non-exclusive breastfeeding (1.55; 1.39–1.74), and common infant illnesses (2.55; 1.41–4.61) were the main adverse health outcomes identified.

Conclusions

One in four and one in five postnatal mothers were depressed in low and middle-income countries, respectively. Causes of depression could be explained by social, maternal, and psychological constructs. High risk of adverse infant health outcomes was associated with PND. Timely screening of PND and evidence-based interventions were a pressing need in low and middle-income countries.

My job, my child, my house: the predictive value of job- and housework-related factors on depressive symptoms during the postpartum period

BACKGROUND

Many mothers combine two sides of their life: They are both educated employees and family organizers. The aim of this study is to investigate risk and protective factors of depressive symptoms during the postpartum period (PPD symptoms) on both those sides of mothers' life, including education, job-, and housework-related factors.

METHODS

Data (n = 689) were drawn from the prospective-longitudinal cohort study "Dresden Study on Parenting, Work, and Mental Health" (DREAM). Education, job satisfaction, job burden, and the housework-related factor ministering to family needs (MTFN) were measured during pregnancy. Depressive symptoms were measured 8 weeks postpartum. Multiple linear regression analyses were conducted.

RESULTS

While education was not significantly associated with PPD symptoms, low job satisfaction, high job burden, and low MTFN levels were significant risk factors for PPD symptoms. When controlling for further potential confounders, job satisfaction and job burden remained significant predictors.

LIMITATIONS

Generalization of findings might be limited due to participation bias and some systematic dropout.

CONCLUSIONS

Job characteristics should be considered in future research on postpartum mental health. For the prevention of PPD symptoms, it seems important to ensure satisfying and less burdensome working conditions during pregnancy. Additionally, the results indicate that further research on the effects of housework-related factors on PPD symptoms is worthwhile.

Early detection of mental illness for women suffering high-risk pregnancies: an explorative study on self-perceived burden during pregnancy and early postpartum depressive symptoms among Chinese women hospitalized with threatened preterm labour

BACKGROUND

The mental health of pregnant women, particularly those with elevated risks, has been an issue of global concern. Thus far, few studies have addressed the mental health of pregnant women with threatened preterm labour (TPL). This study investigated the prevalence of self-perceived burden (SPB) among Chinese women hospitalized due to TPL during pregnancy and early postpartum depressive disorders, exploring the effect of SPB and other potential risk factors on the early signs of postpartum depressive disorders.

METHODS

A self-reported survey was conducted in the obstetrics department of Anhui Provincial Hospital, China. Women hospitalized with TPL were approached 1 week after delivery. One hundred fifty women were recruited from January 2017 to December 2017. The Self-Perceived Burden Scale (SPBS) and Edinburgh Postnatal Depression Scale (EPDS) were the main measures. Descriptive statistics, Spearman correlations, and a multiple logistic regression were employed for data analysis.

RESULTS

SPB and early postpartum depressive disorders were commonly experienced by Chinese women hospitalized with TPL, and SPB was positively and significantly correlated with depressive symptoms. A multiple logistic regression analysis revealed that for the women hospitalized with TPL during pregnancy, the emotional aspect of SPB (OR = 1.42, 95% CI = 1.11-1.83, p = 0.006), age (OR = 1.14, 95% CI = 1.02-1.27, p = 0.023), occupation (OR = 3.48, 95% CI = 1.18-10.20, p = 0.023), the history of scarred uterus (OR = 7.96, 95% CI = 1.49-42.48, p = 0.015), the delivery mode of the present birth (OR = 6.19, 95% CI = 1.72-22.30, p = 0.005), and family support during pregnancy (OR = 0.60, 95% CI = 0.45-0.82, p = 0.001) were significant factors predicting early postpartum depressive symptoms.

CONCLUSION

This study indicates that SPB and early postpartum depressive disorders are prevalent mental issues among Chinese women hospitalized with TPL, and that SPB, especially perceived emotional burden, is a strong predictor of early postpartum depressive disorders. Our study suggests the necessity of paying attention to mental health issues, e.g. SPB and postpartum depressive symptoms among hospitalized women with TPL, and providing appropriate interventions at the prenatal stage to prevent adverse consequences.

Prevalence and associated factors of postpartum depression among immigrant women in Guangzhou, China

Background

Although there has been mounting research on postpartum depression (PPD), the impact of immigration on PPD has remained quite unexplored. The purpose of this study is to investigate the prevalence and associated factors of PPD among immigrant women living in Guangzhou at 6 weeks postpartum.

Methods

A cross-sectional study was conducted involving 1230 immigrant women in a tertiary hospital of Guangzhou from December 2016 to December 2017 at 6 weeks postpartum. The Chinese version of Edinburgh Postnatal Depression Scale and a structured questionnaire regarding associated factors were administered to all participants. Multivariate logistic regression was used to determine factors that were significantly associated with PPD.

Results

The prevalence of PPD among immigrant women at 6 weeks postpartum was 34.0%. A multivariate logistic regression model identified significant obstetric and social factors as: living in Guangzhou for less than 2 years, insufficient family income, poor social support and marital relationship.

Conclusion

Prevalence of PPD among immigrant women from Guangzhou at 6 weeks postpartum is high. The development of PPD among immigrant women is associated with individual and social factors. There’s an urgent need for healthcare providers to take a more active role in engaging immigrant women in their psychological needs.

Incidence and risk factors associated with postpartum depression among women of advanced maternal age from Guangzhou, China

PURPOSE

To investigate whether advanced maternal age (AMA) increases the risk of postpartum depression (PPD) at 6 weeks after birth and to explore the risk factors.

DESIGN AND METHODS

A cross-sectional study was conducted at 6 weeks postpartum. The Edinburgh Postnatal Depression Scale and a self-designed questionnaire were administered to participants. Multivariate logistic regression was used to determine risk factors.

FINDINGS

The prevalence of PPD in women of AMA was 18.0%. Poor relationships with mothers-in-law, female fetus, inconsistency between expected sex and actual sex and primiparae were identified as risk factors.

PRACTICE IMPLICATIONS

Mothers of AMA require specialized care and support to alleviate their concerns.

Prevalence and predictors of postpartum depression in Riyadh, Saudi Arabia: A cross sectional study

OBJECTIVE

Postpartum depression (PPD) is inversely correlated with women's functioning, marital and personal relationships, mother-infant interaction quality, and children's social, behavioural, and cognitive development. The purpose of this study was to determine the prevalence of postpartum depression (PPD) in Riyadh and correlate them with possible predictors by a cross-sectional approach.

METHODS

In this study, 174 mothers receiving treatments in different hospitals of Riyadh completed self-administered measures of the Edinburgh Postnatal Depression Scale (EPDS) along with a list of probable predictors. The data was analyzed by logistic regression analysis using SPSS-IBM 25.

RESULTS

Of 174 participants of the study, 38.50% (n = 67) reported postpartum depression. Around (115) of the participants were in an age group of 25-45 years with most of them highly educated (101) but unemployed (136). Significant association was noted between occurrence of PPD with unsupportive spouse (P value = 0.023) and recent stressful life events (P value = 0.003). The significant predictors for PPD were unsupportive spouse (OR = 4.53, P = 0.049), recent stressful life events (OR = 2.677, P = 0.005), and Caesarean section as a mode of delivery (OR = 1.958, P = 0.049).

CONCLUSION

The prevalence of PPD among the study participants was high, especially those with recent stressful life event and unsupportive spouse. To promote health and wellbeing of mothers, it was recommended to screen all high-risk mothers for PPD, when they visit hospitals for postnatal follow ups. Prevention of PPD is not only essential for wellbeing of mothers but it is important to provide good conducive atmosphere for the new born.

Prevalence and factors associated with postpartum depression at a primary healthcare facility in Eswatini

Background

Routine mental health screening has not been integrated into maternal and child health (MCH) services in many developing countries, including in Eswatini (formerly Swaziland). As a result, the burden of postpartum depression (PPD) is not well understood and thus PPD remains untreated in such settings.

Aim

To describe the prevalence and factors associated with PPD among women seeking postnatal and child welfare services at a primary healthcare facility in Eswatini.

Setting

The study was conducted at the King Sobhuza II Public Health Unit in Manzini, Eswatini.

Methods

This was a cross-sectional study that used convenience sampling and the Edinburgh Postnatal Depression Scale (EPDS) to screen for depression among 114 mothers during the first 6 weeks of postpartum at the King Sobhuza II Public Health Unit, Manzini, Eswatini. Multiple logistic regression analysis was conducted to determine sociodemographic and clinical factors associated with PPD.

Results

A majority of the participants were older than 24 years (52.6%) and unemployed (64.9%), whereas 47.4% screened positive for PPD (≥ 13 score). Adjusting for other covariates, those who were unemployed (odds ratio [OR] = 3.20, 95% confidence interval [CI] 1.17–8.79) and with poor social support from their partners (OR = 9.41, 95% CI: 3.52–25.14) were more likely to be depressed, while those who attended antenatal classes fewer than four times were less likely to be depressed (OR = 0.32, 95% CI 0.11–0.92).

Conclusion

We found a high prevalence of PPD. There is a need to introduce routine maternal mental health screening during the postpartum period to ensure early detection and treatment of PPD.

Occupational Hazard Exposures and Depressive Symptoms of Pregnant Workers

OBJECTIVES

The aim of this study was to explore the prevalence of exposure to occupational hazards and depressive mood with associated underlying risk factors among pregnant workers.

METHODS

Women at 12 weeks of gestation (n = 172) were recruited during regular prenatal screening. Data were obtained via questionnaires that explored job details and Edinburgh Postnatal Depression Scale.

RESULTS

The most commonly encountered hazard was prolonged standing. The majority of women reported that the workplace provided no information on the safety or rights of pregnant women, but those exposed to at least four hazards had more access to such services (P < 0.05). Thirteen percent may have suffered from depressive symptomatology. Higher-level work-related burnout, lower job control, and reduced workplace support were significantly associated with possible antenatal depressive symptoms.

CONCLUSION

Pregnant workers are exposed to substantial levels of occupational hazards and may experience depressive symptoms; thus, their work conditions require monitoring and improvement.

Risk Factors for Postnatal Depression among Primipara Mothers

In recent years postnatal depression (PND) has become one of the most important public health issues because of its prevalence. Estimates for those affected by PND suggest a range of 10-15% of new mothers worldwide. In the context of Saudi society, attitudes toward this disorder are influenced by various beliefs, traditions, cultural factors, and values. These variables trigger considerable disparity in terms of frequency of symptoms. The symptoms of postnatal depression vary and can arise over a period of months, causing profound effects on mothers, also effecting mother-baby and broader familial relationships. The current study establishes the rate of occurrence and risk factors for PND in the western region of Saudi Arabia, to build on existing data. In total, 217 new Saudi mothers were recruited and data was collected using the Edinburgh Postnatal Scale (EPDS) in conjunction with a self-report questionnaire. Based on recommendations in previous studies, an EPND cut-off point of 13 ≥ was applied herein. Findings show the prevalence of PND, approximately 17.1% among the participants, and contributing factors included a previous history of depression, χ2 = 67.74, df = 1, p &lt; .05, problems with the child's health, χ2 = 31.42, df = 1, p &lt; .05, issues with home support, χ2 = 43.47, df = 1, p &lt; .05, and pregnancy complications, χ2 = 7.19, df = 1, p &lt; .05. Meanwhile, no correlation was found between PND and the baby's gender, delivery type, breastfeeding, mother's age, or mother's educational level. Additional studies are required to confirm these findings, and to identify other risk factors.

A study protocol of mobile phone app-based cognitive behaviour training for the prevention of postpartum depression among high-risk mothers

BACKGROUND

The changes in China's family planning policy in recent years have led to changes in the age structure of pregnant women, and the prevalence of postpartum depression (PPD) is also on the rise. Cognitive Behaviour Training (CBT) as an effective intervention is widely used for postpartum depression. However, the shortage and health disparities of mental health resources, the stigma of postpartum depression in postpartum women and the need for postpartum recovery and child care prevent postpartum women from seeking traditional face-to-face CBT. Therefore, the purpose of this proposed study is to examine the effect of mobile phone applications (App) based CBT on postpartum depression, anxiety, pressure and parenting sense of competence.

METHODS

A double blind, randomized controlled trial will be used in this study to examine the effectiveness of App-based CBT in reducing the prevalence of postpartum depression compared with usual postpartum care in China. A total of 120 participants will be recruited in this study. The intervention consists of a weekly theme module app for continuous six weeks, each module including learning content and assignments. The control group received usual postpartum care content through the App. Outcome measures include postpartum depression, anxiety, pressure and parenting sense of competence at 0-, 3- and 6-month after the intervention.

DISCUSSION

If our intervention is effective, it will provide a time-friendly and unrestricted intervention for the psychological care of perinatal women, which can effectively solve the shortage and unevenness of mental health resources.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1900020735 . Registered 15 January 2019.

"Doing the month" and postpartum depression among Chinese women: A Shanghai prospective cohort study

BACKGROUND

The Chinese postpartum custom of "doing the month" characterized by generous social support available through the traditional cultural practices was considered to protect women from postpartum depression in early puerperium.

METHODS

This study used data from the Shanghai Birth Cohort, a study of 2615 postpartum women from Shanghai, China, that was conducted between 2013 and 2016. Detailed information on the traditional "doing the month" practices and the on the Edinburgh Postnatal Depression Scale scores was collected from questionnaires administered on the 42nd day after childbirth. Logistic regression models were used to examine the association between the adopting traditional puerperium practices and postpartum depression.

RESULTS

The estimated prevalence of postpartum depression in women from the Shanghai area in China was 11.8% (n = 308) at six weeks postpartum. Women who went outside their homes during the first month postpartum showed higher risks of postpartum depression compared with those who never left the house (1-2 times: OR = 1.9, 95% CI = 1.4-2.4; 3-5 times: OR = 2.3, 95% CI = 1.5-3.5; ≥6 times: OR = 2.5, 95% CI = 1.2-5.1). Women with average sleep of 6 h or less per night were more likely to suffer from postpartum depression compared with those who slept 8 h (6 h: OR = 1.7, 95% CI = 1.2-2.4; less than 6 h : OR = 3.3, 95% CI = 2.2-5.0). Women who opened the house windows most of the time exhibited decreased risks of postpartum depression compared to those who never or rarely opened the windows (often: OR = 0.6, 95% CI = 0.4-0.9; always: OR = 0.4, 95% CI = 0.3-0.7).

CONCLUSIONS

Our results suggested that not all the activities of "doing the month" provided protection against developing PPD. This study emphasized the need for flexibility to fit and adjust the ritual into the modern life to enhance the positive effects of traditional practices on maternal health.

Postpartum Depression and Risk Factors among Vietnamese Women

Postpartum depression (PPD) places a burden on maternal health. PPD exerts a negative impact on mothers' health and children's life. The purpose of this research was to identify the prevalence of PPD and the risk factors contributing to PPD. Therefore, a cross-sectional quantitative study was conducted. 116 women were categorized into two groups. One category included new mothers who received scores of Edinburgh Postpartum Depression Scale (EPDS) 12 or more. The other category included mothers who received scores less than 12. Descriptive statistic and then binary logistic regression were also performed. For EPDS ≥ 12, the prevalence of PPD was 27.6% among new mothers during the first year after delivery. Level of education, diseases during pregnancy, being the first-time mothers, dissatisfaction about family, and limited communication and interaction with others were significant predictors of PPD.

Prevalence and Factors Associated with Postpartum Depression Among Mothers Attending Public Health Centers of Addis Ababa, Ethiopia, 2016

OBJECTIVES

Postpartum Depression (PPD) is a serious public health problem that leads to high maternal morbidity and mortality, enormously affecting the infant, family and society. Thus, the aim of this study was to assess the prevalence and factors associated with postpartum depression among postpartum mothers attending public health centers in Addis Ababa, Ethiopia, 2016.

METHODS

Facility-based cross-sectional study was conducted from March 2016-April 2016 among 633 postpartum women. Four sub cities were identified through simple random sampling technique among 10 sub cities in Addis Ababa, Ethiopia. Furthermore, the study participants were determined by systematic random sampling after 10 health centers were selected by lottery method and the number of participants in each health center was proportionally allocated. In order to determine postpartum depression, participants were rated using the Edinburgh Postnatal Depression Scale (EPDS) and the findings were analyzed using bivariate and multivariate logistic regression. P-value less than 0.05 with 95% confidence interval was used to state the association.

RESULTS

The study revealed prevalence of postpartum depression among mothers was 23.3%. Moreover, women who were unmarried, had unplanned pregnancy, delivered without presence of any relatives in health institutions, had previous history of child health, had history of substance use and had low income were found to more often display postpartum depression.

CONCLUSION

For optimal maternal health care provision in regards to postpartum depression, integration of mental health service in addition to inter sectoral collaboration of women's affair with health institutions is crucial.

Postpartum depressive symptoms in the context of high social adversity and reproductive health threats: a population-based study

Background

Postpartum depression is an important but neglected public health issue in low- and middle-income countries. The aim of this study was to assess postpartum depressive (PPD) symptoms and associated factors in a rural Ethiopian setting characterized by high social adversity and reproductive health threats. We hypothesized that infant gender preference would be associated with PPD symptoms.

Methods

A cross-sectional, population-based study was conducted in Sodo district, southern Ethiopia, between March and June 2014. A total of 3147 postpartum women (one to 12 months after delivery) were recruited and interviewed in their homes. The questionnaire included demographic, reproductive health and psychosocial factors in addition to a culturally validated measure of depressive symptoms, the Patient Health Questionnaire. Scores of 5 or more were indicative of high levels of PPD symptoms.

Results

The prevalence of high PPD symptoms was 12.2%, with 95% confidence interval (CI) between 11.1 and 13.4. Of these, 12.0% of the study participants had suicidal ideation. Preference of the husband for a boy baby was associated with PPD symptoms in univariate analysis (crude odds ratio 1.43: 95% CI 1.04, 1.91) but became non-significant after adjusting for confounders. In the final multivariable analysis, rural residence [adjusted odds ratio (aOR) 2.56: 95% CI 2.56, 4.19], grand multiparity (aOR 2.00: 1.22, 3.26), perinatal complications (aOR: 2.55: 1.89, 3.44), a past history of abortion (aOR 1.50: 1.07, 2.11), experiencing hunger in the preceding 1 month (aOR 2.38: 1.75, 3.23), lower perceived wealth (aOR 2.11: 1.19, 3.76), poor marital relationship (aOR 2.47: 1.79, 3.42), and one or more stressful events in the preceding 6 months (aOR 2.36: 1.82, 3.06) were associated significantly with high PPD symptoms.

Conclusion

PPD symptoms affected more than one in 10 women in this Ethiopian community setting. Social adversity and reproductive health threats were associated with poorer mental health. Interventions focusing on poor rural women with low access to care are necessary. This research can serve as an entry point for the adaptation of a psychosocial intervention.

Review of the prevalence of postnatal depression across cultures

The purpose of this review was to examine articles related to recent epidemiological evidence of the prevalence of maternal postnatal depression (PND) across different countries and cultures and to identify specific epidemiological studies that have been carried out exclusively in Malaysia on the prevalence of maternal PND. The review was undertaken in two stages, an initial review and an updated review. At both stages systematic literature searches of online databases were performed to identify articles on the prevalence of maternal PND. A total of 124 articles concerning research conducted in more than 50 countries were included in the final analysis. There were wide variations in the screening instruments and diagnostic tools used although the Edinburgh Postnatal Depression Scale (EPDS) was the most common instrument applied to identify PND. The prevalence of maternal PND ranged from 4.0% to 63.9%, with Japan and America recording the lowest and highest rates, respectively. Within continents, a wide variation in reported prevalence was also found. The reported rates of maternal PND in Malaysia were much higher than that previously documented with a range of 6.8–27.3%. This review indicated that the widely cited prevalence of maternal PND of 10–15% underestimates rates of PND worldwide. The reasons for this variability may not be fully explained by review methods. Future studies should evaluate the nature of women's PND experiences across cultures to explain these wide variations.

Domestic Violence as a Risk Factor for Postpartum Depression Among Ethiopian Women: Facility Based Study

BACKGROUND

Mental illness in women leads to an increased maternal morbidity and mortality. Postpartum depression accommodates various groups of depressive disorders and syndromes that occur within the first immediate year after delivery. Thus, this study aimed to assess the prevalence of postpartum depression symptoms and correlates among mothers attending public health centers of Addis Ababa, Ethiopia.

METHODS

Facility-based cross-sectional study was conducted on 618 women in their postpartum period. Simple random sampling technique was used to select three out of ten sub cities in Addis Ababa. Then, nine health centers were selected by lottery method from the three sub-cities. The number of women included from each health center was determined by proportional allocation. Study participants were enrolled by systematic random sampling. The Edinburgh Postnatal Depression Scale was used at a cutoff point >13 to detect depression. Descriptive statistics were done. The bivariate and multivariate analysis was also carried out to identify predictors of postpartum depression.

RESULTS

Significant proportion 144 (23.3%) of the women had the symptom of postpartum depression. Respondents who were the victims of domestic violence [AOR 3.1; 95% CI: 1.6-5.9], reported to have diagnosed with postpartum depression [AOR 4.41; 95% CI: 2.4-8.3], and dissatisfied with their marriage [AOR 2.9; 95% CI: 1.5-5.6] had higher odds of reporting postpartum depression symptoms.

CONCLUSION

Postpartum depression is a common mental health problem during the postnatal period. Domestic violence was positively and significantly associated with the symptom of postpartum depression. Maternity services shall consider a sector that provides health care for women who encounter violence and develop symptoms of postpartum depression.

Prevalence and factors associated with postpartum depression in women from single-child families

OBJECTIVE

To investigate the prevalence of postpartum depression (PPD) and its associated factors among women without siblings from south China.

METHODS

A cross-sectional study was conducted involving 468 mothers from single-child families who were assessed at 6 weeks after childbirth at a tertiary hospital in Guangzhou, China, from June 2015 to July 2016. The Chinese version of the Edinburgh Postnatal Depression Scale and a self-designed questionnaire regarding risk factors were administered to all participants.

RESULTS

The prevalence of PPD in women from single-child families was 56.2%. A multivariate logistic regression model identified the following pregnancy-related and psychological risk factors: unplanned pregnancy (odds ratio [OR] 2.35, 95% confidence interval [CI] 1.73-3.32), being a first-time mother (OR 3.00, 95% CI 1.73-4.93), poor mother-in-law relationship (OR 3.15, 95% CI 2.93-3.36), and poor family support (OR 2.13, 95% CI 1.84-2.45). Sociodemographic characteristics were not associated with the development of PPD.

CONCLUSION

The development of PPD in women from single-child families is an important public health concern. Health practitioners should offer psychoeducation and culturally sensitive counseling during the postpartum period, and the screening of mood disorders from the prenatal to the postpartum period should be covered by maternity insurance.

Association between secondhand smoke exposure and quality of life in pregnant women and postpartum women and the consequences on the newborns

PURPOSE

Secondhand smoke (SHS) exposure is prevalent and could damage the health of non-smokers, especially that of pregnant women (PW) and postpartum women (PPW). Nevertheless, there is no study on the impact of SHS during pregnancy on the quality of life (QOL) of PW and PPW. The study's purpose is to study the effects of exposure to SHS on the QOL of pregnant and postpartum women and health of the newborns.

METHODS

Self-reports and urine tests for cotinine were used to obtain data on SSH exposure in 296 women in the second trimester of pregnancy and 106 women in the postpartum period at the Obstetrics & Gynecology Clinic located in a university hospital. The WHOQOL-BREF-THAI and the Edinburgh Postnatal Depression Scale were used to assess QOL and postpartum depression, respectively.

RESULTS

Of the participants, 88.2% of PW and 62.3% of PPW reported exposure to SHS during pregnancy. Of the PPW, 5.7% had postpartum depression. PW with good QOL were less likely to have family member who smoked (p = 0.007) or to be exposed to SHS in public parks (p = 0.037) or in the household or workplace (p = 0.011). Likewise, PPW with good QOL in the psychological domain were less likely to be exposed to SHS during pregnancy, as shown in both verbal report (p = 0.010) and objective measure of urine cotinine test (p = 0.034). In addition, maternal exposure to SHS during pregnancy is associated with low birth weight and other health problems in the newborns (p < 0.05).

CONCLUSIONS

Exposure to SHS during pregnancy is associated with a lower QOL and a poorer health condition in the newborns.

Association between Duration of Folic Acid Supplementation during Pregnancy and Risk of Postpartum Depression

Postpartum depression (PPD), as a common complication of childbearing, could have adverse consequences on mothers, children, and families. This cohort study aimed to assess the association between duration of folic acid (FA) supplementation during pregnancy and the onset of PPD in Chinese women. A total of 1592 participants were recruited, and data collected between July 2015 and March 2017 in Tianjin, China. Participants’ baseline data were collected regarding socio-demographic and lifestyle characteristics, obstetric history, and FA supplementation during pregnancy. The Chinese version of the self-rating depression scale was used to assess depressive symptoms at 6–12 weeks postpartum, and the prevalence of PPD in participants was 29.4%. Pregnant women who took FA supplements for >6 months had a lower prevalence of PPD, compared to those who took FA for ≤6 months. After using the 1:1 ratio propensity score matching, 601 FA-users ≤ 6 months and 601 FA-users > 6 months were included in the further analyses; this also yielded similar results (P < 0.05). Logistic regression analysis showed that FA intake for >6 months was an independent determinant of PPD (odds ratio = 0.76; 95% confidence interval: 0.59–0.98; P < 0.05). Thus, prolonged FA supplementation during pregnancy was associated with a decreased risk of PPD in Chinese women.

Risk factors, cross-cultural stressors and postpartum depression among immigrant Chinese women in Japan

The purpose of this mixed-method design study was to examine factors contributing to depression among immigrant Chinese women (primipara and multipara) (n = 22) delivering a child for the first time in Japan. Data were obtained just after hospital discharge by using the Edinburgh Postnatal Depression Scale (EPDS), the Social Support Scale, a new scale to measure cross-cultural stressors in the postpartum setting and a visual analogue scale for stress and a demographic survey. The average EPDS score was 9.0 (SD ± 3.7) at 1-3 weeks postpartum; yet, more than half of the subjects (n = 12; 54.5%) were high risk for depression (EPDS ≥ 10). Low household income and primiparous status were associated with depression scores. New mothers with depression also reported more general stress and more cross-cultural stress in the postpartum setting, although social support appeared to mediate cross-cultural stressors. Semi-structured interviews were held with two immigrant women at high risk for depression; these new mothers described additional stress because they could not follow Zuoyuezi, an important postpartum Chinese tradition, in the Japanese hospital. These findings suggest that immigrant Chinese women are at higher risk for postpartum depression when they give birth for the first time in Japan.

Cesarean section and risk of postpartum depression: A meta-analysis

OBJECTIVE

The association of cesarean section (CS) with the risk of postpartum depression (PPD) remains controversial. Therefore, we conducted a meta-analysis to explore the association between CS and the risk of PPD.

METHODS

A systematic literature search was performed in PubMed, Web of Science and Embase databases for relevant articles up to November 2016. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with fixed-effects model or random-effects model.

RESULTS

A total of 28 studies from 27 articles involving 532,630 participants were included in this meta-analysis. The pooled OR of the association between CS and PPD risk was 1.26 (95% CI: 1.16-1.36). In subgroup analyses stratified by study design [cohort studies: (1.25, 95% CI: 1.10-1.41); case-control studies: (1.25, 95% CI: 1.00-1.56); cross-sectional studies: (1.44, 95% CI: 1.14-1.82)] and adjustment status of complications during pregnancy [adjusted for: (1.29, 95% CI: 1.12-1.48); not-adjusted for: (1.24, 95% CI: 1.13-1.36)], the above-mentioned associations remained consistent. The pooled ORs of PPD were 1.15 (95% CI: 0.92-1.43) for elective cesarean section (ElCS) and 1.47 (95% CI: 1.33-1.62) for emergency cesarean section (EmCS).

CONCLUSION

This meta-analysis suggests that CS and EmCS increase the risk of PPD. Further evidence is needed to explore the associations between the specific types of CS and the risk of PPD.

Influence of Val108/158Met COMT Gene Polymorphism on the Efficacy of Modified Electroconvulsive Therapy in Patients with Treatment Resistant Depression

Depression is a common emotional disorder associated with increased risk of suicide and rate of disability. In this double-blinded control study, we tested the efficacy of modified electroconvulsive therapy (MECT) in patients with treatment resistant depression (TRD) using the Hamilton Depression Rating Scale for Depression (HAMD). The total scores of HAMD were found to be significantly decreased after the treatment. The genotyping of catechol-O-methyltransferase (COMT) was carried out with polymerase chain reaction-based testing. Our results demonstrated that frequency of mutant COMT alleles in TRD patients was significantly higher than that of the controls indicating a correlation of the enzyme genotype to the occurrence of TRD. Moreover, the patients homozygous for wild-type COMT gene (G/G) were evidenced to be more sensitive to MECT treatment than those with an heterozygous mutant genotype (A/G).