Sociodemographic factors of families related to postnatal depressive symptoms of mothers

The association between the number of pregnancies and depressive symptoms: A population-based study

BACKGROUND

Depression is a psychosomatic disorder that affects reproductive health. The number of pregnancies is an important indicator of reproductive health. Multiple pregnancies and births may aggravate the risk of depression in females. However, the evidence of the connection between the number of pregnancies and depression is unclear. We aimed to investigate the relationship between the number of pregnancies and depressive symptoms.

METHODS

We used the National Health and Nutrition Examination Survey (NHANES) data with a total of 17,216 women from 2005 to 2020. The number of pregnancies obtained from the self-report questionnaire. Depressive symptoms were measured by the nine-item patient health questionnaire (PHQ-9). Multivariate logistic regression models were used to examine the risk factors of depression. The restricted cubic spline (RCS) was applied to explore the nonlinear relationship. In addition, subgroup analysis was used to support the accuracy of our findings.

RESULTS

We found that the number of pregnancies is positively associated with the prevalence of depression. According to the multivariable logistic regression analysis, pregnant women was 1.52-fold higher than the normal group to experience depression in the fully-adjusted model. No interaction between number of pregnancies and covariates in subgroups.

LIMITATIONS

This study was cross-sectional, which limits its ability to draw conclusions about the causal relationship between the number of pregnancies and depression.

CONCLUSION

In the United States, the number of pregnancies was positively associated with the prevalence of depression. It is critical to register the number of pregnancies for monitoring depressive symptoms.

Does interactive ultrasound intervention relieve minor depressive symptoms and increase maternal attachment in pregnancy? A protocol for a randomized controlled trial

Background

Perinatal depression, especially minor depression, is common during pregnancy and is likely to continue into the postpartum period. It may impair the mother’s health, the infant’s neurodevelopment, and the mother-infant relationship. Screening for perinatal depression is recommended; however, there is no consensus on how to treat depressive symptoms while simultaneously supporting the mother-infant relationship. Ultrasound examination has been shown to improve maternal-fetal attachment among pregnant women. Our aim is to develop a four-dimensional (4D) based interactive ultrasound intervention and test whether it relieves minor depressive symptoms and improves maternal-fetal attachment. Previous studies show that supporting the mother-infant relationship aids in relieving maternal depression. Until now, few studies have combined pregnancy ultrasound and psychological support.

Methods

A controlled randomized setting was designed to assess whether interactive 4D-ultrasound intervention would decrease maternal depressive symptoms, strengthen maternal-fetal attachment, and mother-infant relationship. An obstetrician and a psychologist specialized in infant mental health conduct the interventions. The focus is to jointly observe the behavior of the fetus according to the mothers’ wishes. Altogether, 100 women scoring 10–15 on Edinburgh Pre-/Postnatal Depression Scale (EPDS) and with singleton pregnancy are recruited using a web-based questionnaire. Half of the participants will be randomized to the intervention group and will undergo three interactive ultrasound examinations. The primary outcomes are a decrease in perinatal depressive symptoms assessed with EPDS and an increase in maternal attachment. The maternal attachment was assessed using the Working Model of the Child Interview (WMCI), the Maternal Antenatal Attachment Scale (MAAS), and the Maternal Postnatal Attachment Scale (MPAS). Secondly, we hypothesize that if the intervention decreases prenatal depressive symptoms and improves prenatal attachment, the decrease in depressive symptoms and improvement in mother-infant relationship is seen postnatally.

Discussion

Ultrasound is widely used during pregnancy. The interactive approach is unique and may be feasible as part of routine screenings and maternity clinic visits. Intervention that decreases depression and simultaneously supports maternal-fetal attachment would be a valuable addition to the treatment of minor depression among pregnant women.

Trial registration

ClinicalTrials.gov NCT03424642. Registered on January 5 2018.

Effectiveness of a brief psychoeducational intervention on postnatal depression in the slums, Nairobi: a longitudinal study

Research has shown that postnatal depression (PND) is higher in low- and middle-income countries as compared to higher-income countries. Despite this, little is known about practical interventions in these poorly resourced countries. This research investigated the effectiveness of a brief, prophylactic and therapeutic psychoeducational intervention in a low-resourced community in Nairobi. Two closely similar Maternal and Child Health (MCH) clinics in urban slums in Nairobi were identified and randomly selected. A total of 567 mothers formed the study population. The experimental group (284) mothers received the intervention, which included psychoeducation on PND, coping skills, healthy way of mother/child interaction and infant stimulation in addition to routine treatment, while the control group (283) mothers received treatment as usual. Data was collected using a social-demographic questionnaire and the English version of Becks Depression Inventory (BDI) at baseline. At 6 months, we reassessed both groups using BDI only. Within group comparison, the percentage reduction of depression was 35.6% among the experimental as compared to 2.3% in the control group. Between group comparison, the mean BDI depression score was significantly low in the experimental arm compared to the control arm at endline (p = 0.025). When all variables were adjusted, using a generalized linear model, BDI depression score reduction among the participants was significantly associated with the intervention (p = 0.040). A brief, psychoeducational intervention that targets the mother and her infant may reduce PND even in poorly resourced environments. Therefore, it can be integrated into existing MCH services.

Sadness along with happiness: depression and satisfaction with life among postpartum women in Faisalabad

The purpose of this study is to examine the relationship between demographic variables, Postpartum Depression (PPD) and Satisfaction With Life (SWL) in postpartum women of Faisalabad district. This is the first time that a study on postpartum women has been conducted in Faisalabad. In this cross-sectional study sample of 120 postpartum women (age range 20-40) has been collected from Saint Raphael Hospital Faisalabad by using convenience sample technique. Edinburgh Postnatal Depression Scale and Satisfaction with life Scale were used to measure PPD and SWL among postpartum women. A demographic form used to obtain demographic characteristics of the sample. Results show significant negative relationship between PPD and SWL among postpartum women of Faisalabad at r=0.659 and 0.868, respectively. Results also show significant positive relationship of age and language with postpartum depression at r=0.236 and 0.316, respectively, and significant negative relationship of economic status, residence, hospital, and checkup pattern with postpartum depression with r= -0.365, -0.284, -0.192, & -0.206. Moreover, there is a non-significant relationship between SWL and any demographic variable. Results indicated that PPD and SWL are inversely linked in postpartum women at Faisalabad. And demographic variables are also linked with postpartum depression. Implications are also discussed in the conclusions.

The dynamic course of peripartum depression across pregnancy and childbirth

OBJECTIVE

Peripartum depression (PPD) pertaining to depression in pregnancy and postpartum is one of the most common complications around childbirth with enduring adverse effects on mother and child health. Although psychiatric symptoms may improve or worsen over time, relatively little is known about the course of PPD symptoms and possible fluctuations.

METHODS

We applied a person-centered approach to examine PPD symptom patterns across pregnancy and childbirth. 824 women were assessed at three time points: first trimester (T1), third trimester (T2), and again at eight weeks (T3) postpartum. We assessed PPD symptoms, maternal mental health history, and childbirth variables.

RESULTS

Growth mixture modeling (GMM) analysis revealed four discrete PPD symptom trajectory classes including chronic PPD (1.1%), delayed (10.2%), recovered (7.2%), and resilient (81.5%). Delivery complications were associated with chronic PPD but also with the recovered PPD trajectory class. History of mental health disorders was associated with chronic PPD and the delayed PPD class.

CONCLUSION

The findings underscore that significant changes in a woman's depression level can occur across pregnancy and childbirth. While a minority of women experience chronic PDD, for others depression symptoms appear to significantly alleviate over time, suggesting a form of recovery. Our findings support a personalized medicine approach based on the woman's symptom trajectory. Future research is warranted to identify the mechanisms underlying modifications in PPD symptoms severity and those implicated in recovery.

Major depressive episodes during pregnancy and after childbirth: A prospective longitudinal study in Taiwan

BACKGROUND

Major depressive episodes (MDEs) are common during pregnancy and postpartum periods, and the consequences can be severe to mother and offspring. Few studies have investigated the clinical factors associated with the onset and remission of perinatal depression in different time points.

METHODS

A cohort of 234 pregnant women was recruited and assessed with structured Mini-International Neuropsychiatric Interview (MINI) for diagnoses of MDEs. The severity of mood status was measured with Taiwanese version of the Edinburgh Postnatal Depression Scale (EPDS-T) and the second edition of Beck Depression Inventory (BDI-II) at 16 weeks' gestation, 28 weeks' gestation and 4 weeks postpartum. Statistical analysis was conducted by independent t-tests, chi-squared, and Fisher's exact tests.

RESULTS

Thirty-one pregnant women (13.2%) developed MDEs; 11 (4.7%) at the 16th week, 8 (3.4%) at the 28th week of gestation, and 12 (5.1%) at the 4th week of postpartum. Among the 19 women with prenatal MDEs, 9 (47%) experienced remission by the end of pregnancy, and 10 sustained, resulting in the cumulative prevalence of 9.4% (22 out of 234) for postpartum MDEs. Women with lower levels of education, family history of psychiatric disorders, lack of postpartum recuperation, and family-bond stress were more likely to experience MDEs. More preterm birth and lower birth weights were reported in postpartum-onset than pregnancy-onset MDEs. Psychiatric interventions were associated with a higher percentage of remission of MDE during the perinatal period.

CONCLUSION

The findings of this study provide clinical implications for early detection and intervention of MDEs throughout the pregnancy.

Initiation and exclusivity of breastfeeding: association with mothers' and fathers' prenatal and postnatal depression and marital distress

INTRODUCTION

This study explored the effects of mothers' and fathers' prenatal and postnatal depressive symptoms and marital distress on breastfeeding initiation and exclusive breastfeeding (EBF) duration.

MATERIAL AND METHODS

This was a prospective follow-up of a cohort sample of 873 families participating to an intensive follow-up cohort of longitudinal Steps to the Healthy Development and Well-being of Children study (The STEPS study) in Southwestern Finland. The depressive symptoms were evaluated by The Edinburgh Postpartum Depression Scale and marital distress by the Revised Dyadic Adjustment Scale at 20th gestational week and at 4 months postpartum. EBF was self-reported real-time and defined as an infant receiving no food or drink other than mother's breast milk since birth, except occasionally water.

RESULTS

Neither parents' prenatal depressive symptoms predicted breastfeeding initiation or EBF duration. The mothers' prenatal depressive symptoms, in turn, predicted their postnatal depressive symptoms, which were associated with shorter duration of EBF. The EBF duration was shortest amongst the mothers who had depressive symptoms both pre- and postnatally compared to mothers who had depressive symptoms only in either time point alone (M = 1.54, 2.06 and 2.04 months, respectively). Higher prenatal maternal marital distress was associated with longer EBF duration.

CONCLUSIONS

The findings suggest that the continuity of maternal depressive symptoms throughout the perinatal period has adverse effect on EBF duration. Identification and treatment of mothers' depressive symptoms already during the prenatal period may improve breastfeeding practices. The finding of mothers' marital distress having positive impact on breastfeeding practices requires further investigation.

Breastfeeding and Postpartum Depression: An Overview and Methodological Recommendations for Future Research

Emerging research suggests that a relationship exists between breastfeeding and postpartum depression; however, the direction and precise nature of this relationship are not yet clear. The purpose of this paper is to provide an overview of the relationship between breastfeeding and postpartum depression as it has been examined in the empirical literature. Also, the potential mechanisms of action that have been implicated in this relationship are also explored. PubMed and PsycINFO were searched using the keywords: breastfeeding with postpartum depression, perinatal depression, postnatal depression. Results of this search showed that researchers have examined this relationship in diverse ways using diverse methodology. In particular, researchers have examined the relationships between postpartum depression and breastfeeding intention, initiation, duration, and dose. Due to a number of methodological differences among past studies we make some recommendations for future research that will better facilitate an integration of findings. Future research should (1) use standardized assessment protocols; (2) confirm diagnosis through established clinical interview when possible; (3) provide a clear operationalized definition for breastfeeding variables; (4) clearly define the postpartum period interval assessed and time frame for onset of symptoms; (5) be prospective or longitudinal in nature; and (6) take into consideration other potential risk factors identified in the empirical literature.

Prevalence of and factors influencing postnatal depression in a rural community in South Africa

Background

Knowledge about postnatal depression (PND) and associated risk factors which influence the development of PND is vital for early detection, intervention and prevention.

Setting

The study was conducted in primary health care clinics (PHC) in the Witzenberg subdistrict, a rural community in South Africa.

Objectives

Objectives of this study were to determine the prevalence of PND and to identify the contributing risk factors associated with PND.

Methods

A descriptive cross sectional research design with a quantitative approach was applied. The target population was mothers, 18 years and older. A convenience sampling method was used to select a sample of 159 (10%) from a population of 1605 live births. The Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory (BDI), two validated self-rating questionnaires, including a questionnaire based on demographical, psychosocial and obstetrical data, were applied. The data was analysed using various statistical tests to determine statistical associations between variables using a 95% confidence interval.

Results

PND was a serious health problem with 50.3% of the mothers who suffered from PND. A BDI analysis showed that of the participants who had PND, 28.8% was severe, 48.8% moderate and 22.5% mild. Factors influencing the development of PND included most participants (63.5%) were unmarried, 61.3% were unemployed and the majority (53.8%) had a history of a psychiatric illness. Significant associations between PND and unplanned and unwelcome babies (p < 0.01); partner relationship (p < 0.01); were identified.

Conclusion

Prevention, early detection, appropriate referral and treatment of PND are critical in managing maternal, child and family well-being.

Postpartum depression: A systematic review of the genetics involved

Postpartum depression is one of the most prevalent psychopathologies. Its prevalence is estimated to be between 10% and 15%. Despite its multifactorial etiology, it is known that genetics play an important role in the genesis of this disorder. This paper reviews epidemiological evidence supporting the role of genetics in postpartum depression (PPD). The main objectives of this review are to determine which genes and polymorphisms are associated with PPD and discuss how this association may occur. In addition, this paper explores whether these genes are somehow related to or even the same as those linked to Major Depression (MD). To identify gaps in the current knowledge that require investigation, a systematic review was conducted in the electronic databases PubMed, LILACS and SciELO using the index terms “postpartum depression” and “genetics”. Literature searches for articles in peer-reviewed journals were made until April 2014. PPD was indexed 56 times with genetics. The inclusion criteria were articles in Portuguese, Spanish or English that were available by institutional means or sent by authors upon request; this search resulted in 20 papers. Genes and polymorphisms traditionally related to MD, which are those involved in the serotonin, catecholamine, brain-derived neurotrophic factor and tryptophan metabolism, have been the most studied, and some have been related to PPD. The results are conflicting and some depend on epigenetics, which makes the data incipient. Further studies are required to determine the genes that are involved in PPD and establish the nature of the relationship between these genes and PPD.

Long-term trajectories of maternal depressive symptoms and their antenatal predictors

BACKGROUND

Depressive symptoms, often long-term or recurrent, are common among mothers of young children and a well-known risk for child well-being. We aimed to explore the antecedents of the long-term trajectories of maternal depressive symptoms and to define the antenatal factors predicting the high-symptom trajectories.

METHODS

The sample comprised 329 mothers from maternity centers. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) antenatally and at two months, six months, 4-5 years, 8-9 years and 16-17 years after delivery. Maternal expectations concerning the baby were assessed with the Neonatal Perception Inventory (NPI). Background information was gathered with questionnaires.

RESULTS

A model including four symptom trajectories (very low, low-stable, high-stable and intermittent) was selected to describe the symptom patterns over time. The high-stable and the intermittent trajectory were both predicted pairwise by a high antenatal EPDS sum score as well as high EPDS anxiety and depression subscores but the other predictors were specific for each trajectory. In multivariate analyses, the high-stable trajectory was predicted by a high antenatal EPDS sum score, a high EPDS anxiety subscore, diminished life satisfaction, loneliness and more negative expectations of babies on average. The intermittent trajectory was predicted by a high antenatal EPDS sum score, a poor relationship with own mother and urgent desire to conceive.

LIMITATIONS

Only self-report questionnaires were used. The sample size was rather small.

CONCLUSIONS

The results suggest a heterogeneous course and background of maternal depressive symptoms. This should be considered in intervention planning.

Mental health problems and influencing factors in Japanese women 4 months after delivery

BACKGROUND

Postpartum mental health problems are a major public health issue; however, studies on the mental health status of mothers and its influencing factors between 8 weeks and 1 year postpartum are scarce. Furthermore, it would be necessary to examine the factors influencing mothers' mental health in order to evaluate their physiological adaptations to the nursing environment.

METHODS

We examined the mental health status of postpartum women and the factors influencing poor mental health at 4 months after delivery. A cross-sectional study of 584 postpartum women was conducted. Information on mental health status, delivery, and other factors was collected using a self-administered questionnaire. Women were asked about their age, height, weight, gestational or marital status, whether they were eating regular meals, appetite, frequency of going out, financial difficulty, stressful life events, and history of depression. The Japanese version of the 12-item General Health Questionnaire (GHQ-12) was used to identify potential poor mental health status. Participants with GHQ-12 scores of ≥4 were classified as the high GHQ-12 score group (poor mental health status) and participants with GHQ-12 scores of ≤3 were classified as the low GHQ-12 score group (good mental health status).

RESULTS

Forty-five women (7.7%) were classified as having high GHQ-12 scores. Multiple logistic regression analysis revealed that older age, not eating meals regularly, and history of depression were significantly associated with poor mental health. Financial difficulty had a borderline association with poor mental health in this model.

CONCLUSIONS

These risk factors might help practitioners identify women at high risk of poor mental health after delivery.

The EPDS-Lifetime: assessment of lifetime prevalence and risk factors for perinatal depression in a large cohort of depressed women

Perinatal depression (PND) is a common complication of pregnancy and postpartum associated with significant morbidity. We had three goals: (1) to explore the performance of a new lifetime version of the Edinburgh Postnatal Depression Scale (EPDS-Lifetime) to assess lifetime prevalence of PND; (2) to assess prevalence of lifetime PND in women with prior histories of major depressive episode (MDE); and (3) to evaluate risk factors for PND. Subjects were from the Netherlands Study of Depression and Anxiety (NESDA). The EPDS was modified by adding lifetime PND screening questions, assessing worst episode, and symptom timing of onset. Of 682 women with lifetime MDD and a live birth, 276 (40.4 %) had a positive EPDS score of ≥12 consistent with PND. Women with PND more often sought professional help (p < 0.001) and received treatment (p = 0.001). Independent risk indicators for PND included younger age, higher education, high neuroticism, childhood trauma, and sexual abuse. We found that two in five parous women with a history of MDD had lifetime PND and that the PND episodes were more severe than MDD occurring outside of the perinatal period. The EPDS-Lifetime shows promise as a tool for assessing lifetime histories of PND in clinical and research settings.

Fear of childbirth predicts postpartum depression: a population-based analysis of 511 422 singleton births in Finland

OBJECTIVES

To study how reproductive risks and perinatal outcomes are associated with postpartum depression treated in specialised healthcare defined according to the International Classification of Diseases (ICD)-10 codes, separately among women with and without a history of depression.

DESIGN

A retrospective population-based case-control study.

SETTING

Data gathered from three national health registers for the years 2002-2010.

PARTICIPANTS

All singleton births (n=511 422) in Finland.

PRIMARY OUTCOME MEASURES

Prevalence of postpartum depression and the risk factors associated with it.

RESULTS

In total, 0.3% (1438 of 511 422) of women experienced postpartum depression, the prevalence being 0.1% (431 of 511 422) in women without and 5.3% (1007 of 18 888) in women with a history of depression. After adjustment for possible covariates, a history of depression was found to be the strongest risk factor for postpartum depression. Other strong predisposing factors for postpartum depression were fear of childbirth, caesarean birth, nulliparity and major congenital anomaly. Specifically, among the 30% of women with postpartum depression but without a history of depression, postpartum depression was shown to be associated with fear of childbirth (adjusted OR (aOR 2.71, 95% CI 1.98 to 3.71), caesarean birth (aOR 1.38, 95% CI 1.08 to 1.77), preterm birth (aOR 1.65, 95% CI 1.08 to 2.56) and major congenital anomaly (aOR 1.67, 95% CI 1.15 to 2.42), compared with women with no postpartum depression and no history of depression.

CONCLUSIONS

A history of depression was found to be the most important predisposing factor of postpartum depression. Women without previous episodes of depression were at an increased risk of postpartum depression if adverse events occurred during the course of pregnancy, especially if they showed physician-diagnosed fear of childbirth.

Obstetric and psychosocial risk factors for depressive symptoms during pregnancy

We aimed to determine the psychosocial and obstetric correlates of depressive symptomatology during pregnancy in South-Eastern Hungary. A total of 1719 women were screened for depression in four counties in 2006 and 2007, based on a Leverton Questionnaire (LQ) score of ≥12 at 14-24 weeks of gestation. The LQ scores indicated a probable depressive illness (PDI) in 17.2% of the study group. The best predictors in a multiple regression analysis were history of major depression (adjusted odds ratio [AOR]=3.23), and major life events (AOR=2.43). A perceived lack of social support from partner (AOR=1.79) and lack of support by family (AOR=1.23) were also significant determinants. Lack of planning of pregnancy (AOR=1.12) and a history of unfavourable obstetric outcome (AOR=1.42) also seem to predispose to PDI. Overall, psychosocial factors appeared important in the prediction of PDI, whereas economic features did not.

Can a brief antepartum preventive group intervention help reduce postpartum depressive symptomatology?

BACKGROUND

Psychosocial and psychological interventions are generally effective in reducing depressive symptomatology in the postpartum period. Our aim was to evaluate the effectiveness of a brief preventive group intervention for postpartum depression (PPD) in a naturalistic setting, and study the effect of this on social and psychological risk factors.

METHODS

We conducted a randomized controlled trial (n = 1,719) in south-eastern Hungary in 62 antepartum centers. Pregnant women (n = 710) underwent a 4-session preventive group intervention whereas a control group (n = 1,009) attended 4 sessions providing the same information given in usual care.

RESULTS

Our intervention appeared to significantly reduce the risk of PPD, as defined by Leverton Questionnaire total scores (OR = 0.69). It resulted in an absolute risk reduction of about 18% in those with antepartum depression and 0.5% in those with no depression at recruitment. A multiple logistic regression analysis revealed a much reduced risk in those with a perceived lack of partner support (OR = 0.4) in the treatment group. Unplanned pregnancy, an irreversible risk factor affecting every fifth woman, also seemed to have a reduced effect on PPD after our group intervention (OR = 0.81).

CONCLUSIONS

A brief preventive antepartum group intervention focusing on psychoeducation, stress management, improving coping mechanisms, and the development of social support can be effective in reducing postpartum depressive symptomatology.

Social dynamics of postpartum depression: a population-based screening in South-Eastern Hungary

PURPOSE

To determine contributing psychosocial factors to postnatal depression (PND) in Hungary in 1996 and in 2006.

METHODS

In 1996 and 2006, a total of 2,333 and 1,619 women, respectively, were screened for PND in South-Eastern Hungary, based on a Leverton questionnaire (LQ) score of ≥ 12 at 6-10 weeks after delivery.

RESULTS

The LQ scores indicated an increase in PND from 15.0% in 1996 to 17.4% in 2006. The best predictors for PND in a multiple regression analysis were living in an urban environment [adjusted odds ratio (AOR) = 11.26], unstable relationship (AOR = 3.1) and a perceived lack of social support from partner (AOR = 3.65) in 1996, and recent major life events (AOR = 3.38), unstable relationship (AOR = 3.84), self-reported low income (AOR = 1.82), and intention to return to work soon after delivery (AOR = 0.47) in 2006.

CONCLUSIONS

A self-defined low socioeconomic status and an intention to return to work have become significant factors in the development of PND. Besides the family factors recognized as salient variables in 1996, economic features came into prominence as newly identified main predictive factors for PND in 2006.

Gender differences in postpartum depression: a longitudinal cohort study

BACKGROUND

The course of depression from pregnancy to 1 year post partum and risk factors among mothers and fathers are not known.

AIMS

(1) To report the longitudinal patterns of depression from the third trimester of pregnancy to 1 year after childbirth; (2) to determine the gender differences between women and their partners in the effect of psychosocial and personal factors on postpartum depression.

METHODS

A longitudinal cohort study was carried out over a consecutive sample of 769 women in their third trimester of pregnancy and their partners attending the prenatal programme in the Valencian Community (Spain) and follow-up at 3 and 12 months post partum. The outcome variable was the presence of depression at 3 or 12 months post partum measured by the Edinburgh Postnatal Depression Scale. Predictor variables were: psychosocial (marital dissatisfaction, confidant and affective social support) and personal (history of depression, partner's depression and negative life events, depression during the third trimester of pregnancy) variables. Logistic regression models were fitted via generalised estimating equations.

RESULTS

At 3 and 12 months post partum, 9.3% and 4.4% of mothers and 3.4% and 4.0% of fathers, respectively, were newly diagnosed as having depression. Low marital satisfaction, partner's depression and depression during pregnancy increased the probability of depression during the first 12 months after birth in mothers and fathers. Negative life events increased the risk of depression only among mothers.

CONCLUSIONS

Psychosocial and personal factors were strong predictors of depression during the first 12 months post partum for both mothers and fathers.

Families' experiences of interaction with the public health nurse at the child health clinic in connection with mother's post-natal depression

The birth of a new family member causes many changes in the way a family functions. Annually some 10% of mothers giving birth suffer from post-natal depression. This depression affects the mother herself, the baby and the functioning of the entire family. The healthcare personnel are faced with an important task in supporting the family in the course of changes occasioned by the birth of a baby. According to earlier studies, families with small children are fairly satisfied with the service provided by the child health clinics. The purpose of the present study was to form a theory of interaction with the public health nurse in the child health clinic when the mother is suffering from post-natal depression from the viewpoint of family. The data for the study were gathered by interviewing nine families (nine mothers and five fathers) where the mother had displayed symptoms of post-natal depression. The data were analysed using continuous comparative analysis of grounded theory. The concepts of the theory emerged as a lack of continuing relationship, a need to be equal partners, a lack of individuality and a lack of family care. The relationships between categories were lack of discussing, lack of being confidential and lack of getting help enough. The core category emerging was lack of holistic cooperation with unique family. In spite of the emphasis placed on family centeredness in the operating principles of the work in child health clinics, its implementation in practical work cannot be taken for granted. Because of the limited resources available to the clinics, it is the experience of depressed mother in particular that they are not treated sufficiently as individuals and that they are subjected to adjudication in the clinics. The parents felt that the personality of the public health nurse was crucial to how they felt about the service they obtained from the clinic.

The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review

CONTEXT

The negative health consequences of postpartum depression are well documented, as are the benefits of breastfeeding. Despite the detailed research related to these maternal and infant health outcomes, the relationship between maternal mood and breastfeeding remains equivocal.

OBJECTIVE

A qualitative systematic review was conducted to examine the relationship between postpartum depressive symptomatology and infant-feeding outcomes.

METHODS

We performed electronic searchers in Medline (1966-2007), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982-2007), and Embase (1980-2007) by using specific key words. A hand search of selected specialist journals and reference lists of articles obtained was then conducted. Seventy-five articles were reviewed, of which 49 specifically provided data to be extracted related to postpartum depressive symptomatology and infant-feeding outcomes. Both authors independently extracted data including study design, participants (number and characteristics), and results.

RESULTS

The results from this review suggest that women with depressive symptomatology in the early postpartum period may be at increased risk for negative infant-feeding outcomes including decreased breastfeeding duration, increased breastfeeding difficulties, and decreased levels of breastfeeding self-efficacy. There is also beginning evidence to suggest that depressed women may be less likely to initiate breastfeeding and do so exclusively.

CONCLUSIONS

Depressive symptomatology in the postpartum period negatively influences infant-feeding outcomes. These findings have important clinical implications and support the need for early identification and treatment of women with depressive symptomatology. However, strategies to address help-seeking barriers are needed if women are to receive appropriate and timely treatment. Research to determine effective interventions to support depressed breastfeeding women is warranted.

Prevalence and risk factors for a high level of postnatal depression symptomatology in Italian women: a sample drawn from ante-natal classes

BACKGROUND

Depression after childbirth is a major problem affecting 10-22% of all mothers. In Italy, postnatal depression has not yet been systematically studied.

METHODS

In this retrospective study we have sought to identify risk factors, assessed during pregnancy, and their importance for postnatal depression symptoms in a sample of 297 Italian women attending ante-natal classes organised by the local Consultorio Familiare Unit of the National Health Service, Italy. The Postpartum Depression Predictors Inventory - revised form (PDPI-Revised), was used to identify risk factors, 8-9 month of pregnancy. A double-test strategy using the Edinburgh Postnatal Depression Scale (EPDS) and 12-item General Health Questionnaire (GHQ12), was administered to screen women with a higher occurrence of symptoms of postnatal depression six-eight weeks after delivery. Women with high EPDS (<8) and high GHQ12 (<3) scores were compared with those who had scored below the EPDS and/or GHQ12 threshold scores.

RESULTS

We found that 13% of the women studied showed high postnatal depressive symptomatology, which is very similar to rates of prevalence of postnatal depression in the first year after the birth of the child reported in other Western World studies. Feeling anxious during pregnancy is a strong predictor of high symptoms of depression at 6-8 weeks after delivery. However, University education and friends' support appear to be important protective factors.

CONCLUSION

These findings could be useful both for Italian health professionals and for researchers interested in the transcultural aspects of postnatal depression.

Consumers' views on the use of diagnostic labels to describe psychological distress in the postpartum: implications for health care

Postpartum psychological distress is common and its detection is important in primary health care. Australia’s residential early parenting centres admit mothers with their infants and treat both infant sleep and settling and maternal mental health. Many women have health problems but low uptake of professional assistance after discharge. Psychological distress may be conceptualised as either individual psychopathology or a normal reaction to caring for an unsettled infant, loss of identity and status, and limited emotional and practical assistance, but the potential benefits or harms of psychiatric labelling are uncertain. We examined the opinions of consumers of a residential early parenting centre. The method used was that, 12 months after discharge, a self-report survey was mailed. Results showed 50/94 (54%) women returned completed surveys. Participants identified perceived causes of postpartum psychological distress as: difficult infant temperament and behaviour (57%); fatigue (53%); and insufficient support (47%). Sixty-one per cent thought that diagnostic labels could improve access to health care, but 58% believed that it might cause others to question a woman’s mothering ability or limit access to employment (83%). Psychiatric labels may improve access to health care in the postpartum, but effective treatments will address causes of distress as understood by women.

Validation of the Leverton Questionnaire as a screening tool for postnatal depression in Hungary

OBJECTIVE

To assess the validity of the 24-item Leverton Questionnaire (LQ) in screening for postnatal depression (PND).

METHOD

A two-phase, cross-sectional study was designed. Between January and October 2006, a sample of 1552 women attending a routine postnatal check-up at 6 weeks postpartum completed the LQ in southeast Hungary. On the basis of the LQ total score, the participants were stratified and randomly selected within each stratum for clinical evaluation (Structured Clinical Interview for DSM-IV). Receiver operating characteristic (ROC) analyses were used to examine the sensitivity and specificity of the LQ to detect PND.

RESULTS

The best cut-off on the Hungarian version of the LQ for PND was 11/12, with a sensitivity of 88.0%, and a specificity of 94.4%, and a positive predictive value of 53.1%. Internal consistency was satisfactory (Cronbach alpha coefficients > or = 0.753). The sensitivity of the modified Beck Depression Inventory (BDI) in detecting PND was 86.2% and the specificity 90.4%. Although the BDI performed slightly better than the LQ in distinguishing between minor and major depression, both psychometric scales showed satisfactory screening performance.

CONCLUSIONS

Our data confirm the validity of the Hungarian version of the LQ reliably to identify PND. We propose a cut-off of 11/12 for screening purposes for PND, the range of 11-14 for detecting minor depression and regarding a total score of 15 points or above as indicative of major depression.

Maternal depression is associated with mother-infant interaction in preterm infants

AIM

The purpose of this study was to assess the prevalence and the background factors of maternal depressive symptoms and their relation to the quality of mother-infant interaction in a group of preterm infants and their mothers.

METHODS

The signs of maternal depression were evaluated in 125 mothers of very preterm infants (birth weight < or = 1500 g or < 32 gestational weeks) at 6 months of infant's corrected age using Edinburgh Postnatal Depression Scale (EPDS). The association between maternal depressive symptoms and the quality of mother-infant interaction as assessed by the parent child early relational assessment method (PCERA) method was studied at 6 and 12 months of corrected age in 32 preterm infants who were their mothers' firstborn infants and singletons.

RESULTS

The prevalence of depression assessed by EPDS in mothers of very preterm infants was 12.6%. Most interestingly, the number of postnatal signs of depression associated negatively with the quality of the maternal interaction behaviour with their preterm infants.

CONCLUSIONS

This study suggests that maternal depression may be a risk factor in the development of the mother-infant relationship between preterm infants and their mothers. Therefore, it would be important to identify signs of depression in mothers of preterm infants to offer early support.

Parity mediates the association between infant feeding method and maternal depressive symptoms in the postpartum

Maternal depression is the most common complication of the postpartum, having devastating and long lasting effects on mother and infant. Lactation is associated with attenuated stress responses, especially that of cortisol, and the lactogenic hormones, oxytocin and prolactin, are associated with anti-depressant and anxiolytic effects. These associations suggest that breast-feeding may decrease maternal depressive symptoms, yet empirical results have been conflicting. Recent findings have indicated that parity may mediate the association between breast-feeding and stress response. Because a decreased stress response is associated with a decreased risk for depression, parity may also mediate the association between infant feeding method and depressive symptoms. Specifically, the benefits of breast-feeding may appear in multiparous but not primiparous mothers. In the present study, data drawn from a national sample of primiparous and multiparous mothers were examined for possible associations between infant feeding method and depressive symptoms, as assessed by the Center for Epidemiological Survey-Depression scale (CES-D). After controlling for several possible confounding variables, breast-feeding by multiparas was associated with significantly decreased odds of having depression compared with bottle-feeders (OR = 0.41, CI 0.19-0.87, p = 0.02); however, no risk reduction from breast-feeding was evident among primiparas. The results support a parity-mediated association between lactation and maternal depressive symptoms. The results provide a reason for earlier conflicting findings, present new research avenues, and suggest possible clinical approaches.

Case study revisiting the association between breastfeeding and postpartum depression

Recent studies have focused on the impact of postpartum depression on breastfeeding; however, the role of breastfeeding and weaning in the onset of postpartum depression has not been adequately studied. This article describes the case of a woman who had 3 episodes of major depression, each following closely the cessation of breastfeeding. The clinical and research implications of the association between weaning and the onset of postnatal depression are discussed.

Comparison of effects of nursing care to problem solving training on levels of depressive symptoms in post partum women

OBJECTIVE

The aim of this study was to compare the effect of nursing intervention to the effect of problem solving training on the level of postpartum depressive symptom.

METHODS

We utilized a pretest-posttest mutual controlled semi experimental model for this study. The study consisted of 62 women (30 in care group and 32 in training group), all of who were at risk for postpartum depression, but without major depressive symptoms. These women were not undergoing pharmacologic or psychotherapeutic treatment, were all literate and consented to join the study in Erzurum, Turkey. Participants (N=62), recruited over a 9 month, were randomly assigned to one of two groups. Women in care group (average age=21, 33.3% primaparus) were given nursing care for her depressive symptoms. Women in training group (average age=25, 33.9% primaparus) were taught problem solving skills.

RESULTS

Depressive symptoms were assessed before and after nursing interventions. We found that nursing care was effective women for with depressive symptoms (McNemar test, p<0.001), and problem-solving training was also effective (McNemar test, p<0.05). When the effectiveness of nursing care and the problem solving education was compared utilizing the BDI, it was found out that the nursing care was more effective than education alone (t=4.529, p<0.05).

CONCLUSION

Results from this study suggest that nursing care and problem solving training may be use confidently in the primary care setting by nurses for women with postpartum depressive symptoms.

PRACTICE IMPLICATION

Nurses play on important role in its detection and can reduce depressive symptoms. Public health nurses are equipped with care paths addressing specific health needs of depressed women in the primary care setting. Our finding indicate that these two programs of study can converge with meaningful results, and perhaps future research could address these points in a theoretical framework.

Risk factors for depression in the first postnatal year: a Turkish study

BACKGROUND

The aim of the study was to identify risk factors for depression and to estimate its prevalence in postnatal mothers.

METHODS

This cross-sectional and multi-centre study was carried out on 1,350 Turkish women in their first postnatal year. Measures included a structured questionnaire and the Turkish version of the Edinburgh Postnatal Depression Scale (EPDS).

RESULTS

Of the women, 31.1% had a score of 13 or higher on the EPDS. The mean score and standard deviation was 9.8+/-5.7. In the multivariate analysis, EPDS scores were significantly associated with economic status, access to support from family members and close friends, emotional distress at the pregnancy, whether the pregnancy was planned, health problems during pregnancy, the perceived standard of baby care after delivery, and mental disorder before and during pregnancy.

CONCLUSION

The prevalence of EPDS-based depression among Turkish women in postnatal the period was high, and was associated with several social, economic and demographical factors.

A population-based study of exclusive breastfeeding in Icelandic women: is there a relationship with depressive symptoms and parenting stress?

This study investigated whether postpartum depressive symptoms and parenting stress are related to exclusive breastfeeding in mothers at 2-3 months postpartum. Data were collected from 734 Icelandic mothers postpartum. Parenting stress, depressive symptoms, feeding methods and demographical data were assessed by self-administered questionnaires. A high level of maternal education increased the likelihood of exclusive breastfeeding whereas lower maternal education, high levels of depressive symptoms, twins and single motherhood reduced the likelihood of exclusive breastfeeding. It is concluded that depressive symptoms are related to lower levels of exclusive breastfeeding and that exclusive breastfeeding becomes more likely with higher level of maternal education.

Family dynamics of postnatally depressed mothers - discrepancy between expectations and reality

BACKGROUND

The birth of a new family member always brings changes to family dynamics. The family has to adjust to a new situation and, although the time after childbirth is happy for most families, postnatal depression affects 10-15% of mothers annually.

AIMS AND OBJECTIVES

The purpose of this study was to ascertain families' experiences of family dynamics when the mother suffers from postnatal depression.

DESIGN

Nine families (nine mothers, five fathers) where the mother had displayed symptoms of postnatal depression took part for the study.

METHODS

Data were collected through interviews with nine families where the mother had scored 13 or more on the Edinburgh Postnatal Depression Scale, completed 6-8 weeks after childbirth. Families were offered the opportunity to volunteer for the interview while taking part in a follow-up study of postnatal depression in Finland. Interviews were analysed using the principles of grounded theory.

RESULTS

The findings showed that there was great discrepancy between expectations and reality in the depressed mothers' families. Parents, especially mothers, strove for perfection, perceived the infant to tie them down and had high expectations of family life.

CONCLUSIONS

Everyday family life and human relationships change, the depression and the parents' attitudes towards the infant manifest themselves in different ways, and support is of great importance.

RELEVANCE TO CLINICAL PRACTICE

Women, especially those expecting their first child need a great deal of information about mood changes after childbirth and the opportunity to discuss the changes brought about by the birth of a child.

Using the Edinburgh Postnatal Depression Scale to achieve best practice standards

The present paper reports the findings of a quantitative descriptive study that evaluated the use of the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool in the child health context. Two hundred and sixty-one women who attended child health clinics in one metropolitan health region of Western Australia over a designated 4-week period for a 6-8 week or 7-9 month health scheduled infant screening assessment agreed to participate. The study aimed to (i) identify the proportion of women in the study who scored 13 or greater on the EPDS; (ii) evaluate current practice outcomes from the use of the EPDS by child health nurses and; (iii) report demographic variables associated with scores obtained from participants. Findings showed that the EPDS is a useful screening tool to identify women who may be at risk of developing depression during the postpartum period. However, the study also identified a weakness in clinical practice protocols, with some child health nurses not referring women who reported symptoms of depression on the self-report scale. Therefore, to ensure best practice standards more education regarding clinical practice protocols needs to be implemented with child health nurses in order to facilitate optimal outcomes for women using the self-report scale.