Sociodemographic and obstetric risk factors for postpartum depressive symptoms in Nigerian women

High psychological stress levels related to delivery can increase the occurrence of postpartum mental disorders

Objective

The study sought to explore the relationship between high psychological stress levels related to delivery and postpartum mental disorders.

Methods

A total of 284 parturients were included in the study from July 2021 to January 2022. The stress level at 1 month postpartum was assessed by the Impact of Event Scale-Revised (IES-R). Parturients with an IES-R score ≤ 9 were included in the low psychological stress level group, and those with an IES-R score > 9 were included in the high psychological stress level group. The Edinburgh Postnatal Depression Scale (EPDS), Union Physio-Psycho-Social Assessment Questionnaire (UPPSAQ-70), Symptom Checklist-90 (SCL-90) and Mini-International Neuropsychiatric Interview (M.I.N.I.) were conducted at 42 ± 7 days postpartum to assess the mental health of parturients.The parturients' mental health after birth was assessed by the EPDS, UPPSAQ-70, and SCL-90. Semi-structured diagnostic interviews were conducted at 42 ± 7 days postpartum by using the M.I.N.I.

Results

The incidence rate of postpartum mental disorders was 20.42% (58/284), the incidence rates of postpartum depression, anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder were 17.96% (51/284), 11.97% (34/284), 4.58% (13/284) and 1.41% (4/284), respectively, and the comorbidity rate was 58.62% (34/58). A history of mental disorders and pregnancy complications were risk factors for postpartum depression (p = 0.028, p = 0.040, respectively); a history of mental disorders, a lack of physical exercise, partner violence and pregnancy complications were risk factors for postpartum anxiety disorders (p = 0.003, p = 0.007, p = 0.031, p = 0.048, respectively); and the delivery of female infants was a risk factor for postpartum obsessive-compulsive disorder (p = 0.022).The risk of postpartum depression, anxiety disorders and obsessive-compulsive disorder was 9.125 times (95% CI = 3.900 ~ 21.349, p < 0.01), 7.310 times (95% CI = 2.588 ~ 20.649, p < 0.01) and 6.259 times (95% CI = 1.347 ~ 29.093, p < 0.01) higher in postpartum women with high psychological stress levels related to delivery than in those with low psychological stress levels, respectively.

Conclusion

The incidence of postpartum mental disorders is high and has a positive correlation with the level of psychological stress. This may lead to a new perspective of the effect of psychological stress on postpartum mental disorders and attract more attention to other mental disorders in addition to postpartum depression.

The experience of maternal mental distress in The Gambia: A qualitative study identifying idioms of distress, perceptions of contributing factors and the supporting role of existing cultural practices

Maternal mental health problems are experienced frequently in the perinatal period and can be up to twice as common in women from low- and middle-income countries. The terms used to describe mental illness symptoms and the factors that contribute to developing these symptoms are affected by culture and context. Based on 14 focus group discussions held with pregnant women, health professionals and cultural leaders, this qualitative study aimed to understand women's experiences of mental distress during the perinatal period in The Gambia. To do this it aimed to 1) identify the most commonly used idioms of distress, 2) identify the factors believed to affect women's perinatal mental health and 3) explore the role of existing cultural practices, including musical practices, that were identified as locally significant in supporting maternal and mental health. Sondomoo tenkung baliyaa (Mandinka) and xel bu dalut (Wolof) were identified as the most commonly used idioms of distress which roughly translate to lack of a steady mind/heart. Using thematic analysis, six themes (Poverty of the healthcare system, Shifting cultural context, Economic factors, Social factors, Spiritual factors, and Cultural practices involving music) were identified to describe the factors that shape women's experience of mental health during the perinatal period. Lack of economic resources, the prevailing poverty of the health system, an unsupportive husband and spiritual attack by evil spirits or witches were common reasons given for a woman experiencing maternal mental distress. Various existing cultural practices involving music, such as fertility societies, naming ceremonies and community music-making, were recognised as valuable for supporting women's mental health during the perinatal period. This work emphasises that initiatives to support perinatal mental health should be grounded in an understanding of local community cultural practices, knowledge, and experiences.

Mistreatment of women during childbirth and postpartum depression: secondary analysis of WHO community survey across four countries

BACKGROUND

Postpartum depression (PPD) is a leading cause of disability globally with estimated prevalence of approximately 20% in low-income and middle-income countries. This study aims to determine the prevalence and factors associated with PPD following mistreatment during facility-based childbirth.

METHOD

This secondary analysis used data from the community survey of postpartum women in Ghana, Guinea, Myanmar and Nigeria for the WHO study, 'How women are treated during facility-based childbirth'. PPD was defined using the Patient Health Questionnaire (PHQ-9) tool. Inferential analyses were done using the generalised ordered partial proportional odds model.

RESULTS

Of the 2672 women, 39.0% (n=1041) developed PPD. 42.2% and 5.2% of mistreated women developed minimal/mild PPD and moderate/severe PPD, respectively. 43.0% and 50.6% of women who experienced verbal abuse and stigma/discrimination, respectively developed minimal/mild PPD. 46.3% of women who experienced physical abuse developed minimal/mild PPD while 7.6% of women who experienced stigma/discrimination developed moderate/severe PPD. In the adjusted model, women who were physically abused, verbally abused and stigma/discrimination compared with those who were not were more likely to experience any form of PPD ((OR: 1.57 (95% CI 1.19 to 2.06)), (OR: 1.42 (95% CI 1.18 to 1.69)) and (OR: 1.69 (95% CI 1.03 to 2.78))), respectively. Being single and having higher education were associated with reduced odds of experiencing PPD.

CONCLUSION

PPD was significantly prevalent among women who experienced mistreatment during childbirth. Women who were single, and had higher education had lower odds of PPD. Countries should implement women-centred policies and programmes to reduce mistreatment of women and improve women's postnatal experiences.

Relationships Between Maternal Perinatal Mood, Sex of Infant, and Disappointment with Sex of Infant in a North American Sample

OBJECTIVES

Little is known about the relationships between sex of infant, disappointment with sex of infant, and risk for perinatal depression, particularly in societies where the nature of parental sex preference is thought to be "balanced" between male and female offspring. We sought to explore relationships between these variables in a North American population.

METHODS

In this exploratory study, we used data from a large Canadian prospective longitudinal study in which data were collected at up to four timepoints: during pregnancy, and at 1 week, 1 month and 3 months postpartum. Data about sex of infant, maternal preference for, and disappointment in sex of infant were recorded at the first possible timepoint; while at each postpartum timepoint infant fussiness and EPDS scores were recorded. We performed a mixed-effects linear regression to evaluate relationships between these variables.

RESULTS

In our sample of N = 207 women, EPDS scores were higher for mothers of male versus female infants, and independently associated with infant fussiness. There was no interaction between sex of infant and maternal disappointment, or between maternal disappointment and EPDS scores.

CONCLUSIONS

Mothers of male infants may have slightly more depressive symptoms than mothers of female infants regardless of maternal preference for, or disappointment in sex of infant; sex-specific biological risk factors for PPD should be explored.

Comparing the Different Manifestations of Postpartum Mental Disorders by Origin, among Immigrants and Native-Born in Israel According to Different Mental Scales

We conducted a prospective study, aimed to study whether the prevalence of mental disorders after birth differs by country of origin. Parturient mothers of Ethiopian origin, Former-USSR (FSU) origin, or nonimmigrant, native-Israeli origin (n = 974, all Jewish) were recruited in hospitals in Israel and were followed 6–8 weeks and one year after birth. General linear models were used to study the associations between origin and mental health, comparing Ethiopian and FSU origin with native-Israeli. Ethiopian and FSU mothers were more likely to report on somatic symptoms, compared with native-Israeli women. Ethiopian origin was negatively and significantly associated with anxiety in all three interviews (β = −1.281, β = −0.678 and β = −1.072, respectively; p < 0.05 in all). FSU origin was negatively associated with depression after birth (β = −0.709, p = 0.036), and negatively associated with anxiety after birth and one-year postpartum (β = −0.494, and β = −0.630, respectively). Stressful life events were significantly associated with all mental disorders in the three time points of interviews. Our findings suggest that immigrants tend to express higher mental distress with somatic symptoms. Additional tools are needed for mental distress screening among immigrants.

Mapping global prevalence of depression among postpartum women

Postpartum depression (PPD) is the most common psychological condition following childbirth, and may have a detrimental effect on the social and cognitive health of spouses, infants, and children. The aim of this study was to complete a comprehensive overview of the current literature on the global epidemiology of PPD. A total of 565 studies from 80 different countries or regions were included in the final analysis. Postpartum depression was found in 17.22% (95% CI 16.00-18.51) of the world's population. Meta-regression analysis showed that study size, country or region development, and country or region income were the causes of heterogeneity. Multivariable meta-regression analysis found that study size and country or area development were the most important predictors. Varied prevalence rates were noted in geographic regions with the highest rate found in Southern Africa (39.96%). Of interested was a significantly lower rate of PPD in developed countries or high-income countries or areas. Furthermore, the findings showed that there was a substantial difference in rates of PPD when marital status, educational level, social support, spouse care, violence, gestational age, breast feeding, child mortality, pregnancy plan, financial difficulties, partnership, life stress, smoking, alcohol intake, and living conditions were considered in the pooled estimates. Our results indicated that one out of every five women experiences PPD which is linked to income and geographic development. It is triggered by a variety of causes that necessitate the attention and committed intervention of primary care providers, clinicians, health authorities, and the general population.

Prevalence of postpartum depression and associated factors among women in Mbarara and Rwampara districts of south-western Uganda

BACKGROUND

Postpartum depression (PPD) is a significant cause of maternal morbidity and has severe consequences on the well-being of mothers, new-borns, families, and communities. PPD reduces the mother's response to the child's needs. In severe cases, mothers suffering from PPD are prone to postpartum psychosis, commit suicide and, in rare cases, infanticide. We aimed to determine the prevalence and understand the factors associated with PPD among mothers in southwestern Uganda.

METHODS

This was a cross-sectional study between November 2019 and June 2020 among 292 mothers, 6 to 8 weeks' postpartum. Mothers were selected from three health facilities in southwestern Uganda and enrolled using stratified consecutive sampling. Postpartum depression was clinically diagnosed using the Diagnostic and Statistical Manual of Mental Disorders V. The factors associated with PPD were assessed by using a structured interviewer administered questionnaire. The factors were analyzed using bivariate chi square analyses and multivariate logistic regression.

RESULTS

Overall prevalence of PPD was 27.1% (95% CI: 22.2-32.5). This did not vary by the number of previous births or mode of birth. Five factors associated with PPD were low perceived social support, HIV positive status, rural residence, obstetrical complications and the baby crying excessively.

CONCLUSION AND RECOMMENDATIONS

Prevalence of PPD in Mbarara and Rwampara districts is higher than what has previously been reported in Uganda indicating an urgent need to identify pregnant women who are at increased risk of PPD to mitigate their risk or implement therapies to manage the condition. Midwives who attend to these mothers need to be empowered with available methods of mitigating prevalence and consequences of PPD. Women who are HIV positive, residing in rural settings, whose babies cry excessively, having low social support systems and who have birth complications may be a particularly important focus for Ugandan intervention strategies to prevent and reduce the prevalence of PPD.

Preterm Labor Using Tocolysis as a Possible Risk Factor for Postpartum Depression: A 14-Year Population-Based Study in Taiwan

Postpartum depression (PPD) is associated with negative physical and mental health outcomes for the mother and infant. Women often experience elevated symptoms of PPD, and the incidence of PPD has increased in recent years. There were lack of studies to investigate the effects of medications during pregnancy. Herein, we focused on the most common obstetric medical therapies used in labor and determined whether the medical therapies cause mental stress in pregnant women. This 14-year retrospective population-based nationwide study was based on the National Health Insurance Research Database. Univariate and multivariate logistic regression analyses were used to evaluate unadjusted and adjusted odds ratios and 95% confidence intervals for each tocolytic and uterotonic treatments during pregnancy and common medical illnesses. In comparing the effects of tocolytic and uterotonic medications on maternal PPD, tocolysis with the injection form of ritodrine resulted in a significantly higher risk of PPD based on multivariate analysis. This study supports existing research demonstrating an association between tocolysis with ritodrine and PPD. Ritodrine treatment for preterm labor was a significant risk factor for PPD, especially the injection form. This information provides obstetricians and health policy providers to pay attention to maternal mental health outcomes among high-risk pregnant women.

Association between mode of delivery and postpartum depression: A systematic review and network meta-analysis

BACKGROUND

Postpartum depression is one of the most common postpartum diseases, which has an important impact on the interaction between mother, infant, partner and family, as well as the long-term emotional and cognitive development of infants. However, there are still great disagreements on whether the delivery mode will affect the risk of postpartum depression. The purpose of this study is to explore whether the mode of delivery will affect the risk of postpartum depression through the comprehensive network meta-analysis of elective cesarean section, emergency cesarean section, instrumental vaginal delivery and spontaneous vaginal delivery.

METHODS

We searched in three electronic databases: PubMed, EMBASE and Cochrane Library.

RESULTS

This paper included 43 studies with a total sample size of 1,827,456 participants. Direct meta-analysis showed that the odds ratio of postpartum depression risk was 1.33 (95% confidence interval = [1.21, 1.46]) between cesarean section and vaginal delivery. The odds ratios of high Edinburgh Postpartum Depression Scale score between cesarean section and vaginal delivery in the three postpartum periods (within 2 weeks, within half a year and over half a year) were basically the same. There was no difference between cesarean section and vaginal delivery in the risk of severe postpartum depression at the Edinburgh Postpartum Depression Scale cut-off point ⩾13 (odds ratio = 1.07; 95% confidence interval = [0.99, 1.16]). Network meta-analysis showed that the risk of postpartum depression in the pairwise comparisons emergency cesarean section vs spontaneous vaginal delivery and elective cesarean section vs spontaneous vaginal delivery was odds ratio = 1.53 (95% confidence interval = [1.22, 1.91]) and 1.47 (95% confidence interval = [1.16, 1.86]).

CONCLUSION

The mode of delivery has a significant effect on the occurrence of mild postpartum depression. Women who give birth by cesarean section, especially who give birth by emergency cesarean section, are at a higher risk of mild postpartum depression. We should carefully monitor the progress of postpartum mental disorders in women who delivered by cesarean section and make it possible for women to have a quick access to mental healthcare.

Maternal mental health and child well-being in Nigeria: A systematic review

Maternal mental health distress has a disease burden of severe adverse effects for both mother and child. This review identified maternal mental health concerns, their impact on child growth and the current practice of maternal healthcare for both mothers and their children in Nigeria. The Population, phenomenon of Interest and Context (PICo) model was adopted to formulate the review strategy, and five databases were searched for published articles between 1999 and 2019. Databases include Scopus, PubMed, ProQuest, Applied Social Science Index and Abstracts and Web of Science. Boolean operators (AND/OR/NOT) helped to ensure rigorous use of search terms which include 'maternal', 'pre/peri/postnatal', 'mental health', 'mental illness', 'disorders', 'intervention,' 'Nigeria', 'child', 'infant growth', and 'wellbeing'. Thirty-four studies met the inclusion criteria, and extracted data were qualitatively synthesised and analysed thematically. Five themes emerged. These include (i) marital difficulties, (ii) relationship status of the mother, (iii) child's gender, (iv) mode of child delivery and (v) child growth and development. The review showed a significant paucity of literature on the impact of specific maternal mental health problems on child physical growth and cognitive development. We concluded that culturally appropriate and evidence-based psychological interventions for maternal mental health problems would benefit Nigerian indigenous mothers. Therefore, the study recommends randomised controlled trials that are culturally appropriate and cost-effective for distressed mothers with children.

Mental health experiences of mothers in Jos, Nigeria: An interpretative phenomenological analysis

OBJECTIVES

There is an increasing mental health disease burden in mothers with infants and young children, especially in low- and middle-income countries such as Nigeria. Children of distressed mothers suffer early-life exposure from the effects of maternal distress which contributes to the risk of physical and mental health problems in their childhood and beyond. This study explored mental health lived experiences of mothers in Jos, Nigeria.

METHODS

Purposive and Snowball sampling techniques were adopted, and a total of 40 mothers participated with 8 to 11 participants in one of the four focus group discussions. Participants were between the ages of 18 and 43 years, self-identified as mothers with each having a child between the ages of 3 and 48 months. Each focus group lasted approximately 60 minutes and was audio-recorded. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis.

RESULTS

Three overarching themes emerged from the data set such as (1) experience of persisting psychological distress from the time of labour/birth; (2) cultural practices that influence feelings; and (3) anxiety due to limited knowledge about childcare, access to support and healthy food.

CONCLUSION

Maternal mental health in Nigeria is under-researched and distressed mothers have limited knowledge about evidence-based early child development. The study recommends developing and testing culturally appropriate parenting interventions in Jos, Nigeria. This is likely to be beneficial for the mother and may also improve child health outcomes.

Impact of village health volunteer support on postnatal depressive symptoms in the remote rural areas of Lao People's Democratic Republic: a cross-sectional study

BACKGROUND

Village health volunteers (VHVs) are responsible for providing primary care in the communities of Laos. Unlike other districts, in Xepon more than 90% of VHVs are male and therefore experience difficulties interacting with pregnant women. To improve outreach to pregnant women, especially among ethnic minorities, a new project was implemented by local municipalities in 2017: newly selected female VHVs were paired to work with existing male VHVs. The objective of this study was to compare the postnatal depressive symptoms of ethnic minority mothers supported by pair-VHVs and single-VHVs in remote rural areas of Lao People's Democratic Republic (PDR).

METHODS

A cross-sectional study was conducted in March 2019. Mothers who had delivered a baby within 1 year preceding the study were recruited from 36 villages. Of the 305 mothers, 227 responded. The questionnaires included (1) demographic characteristics such as age, economic status, and birth experience; (2) self-decision to go to a health center/hospital to receive antenatal care; (3) type of VHVs (pair or single), support, and information from VHVs during pregnancy, support from husband and relationship with husband; (4) the Edinburgh Postnatal Depression Scale (EPDS). A Mann-Whitney U test, chi-square test, and multiple linear regression analysis were performed. Ethical approval was obtained from the University of the Ryukyus and National Ethics Committee for Health Research of Lao PDR.

RESULTS

The average total EPDS score was 5.5 among mothers supported by pair-VHV and 7.0 among mothers supported by single-VHV. Results of the multiple linear regression analysis showed that the EPDS score was significantly lower among mothers supported by pair-VHV (β=-1.18, p <0.05) even after adjusting for economic and biological factors.

CONCLUSIONS

Mothers supported by pair-VHV had a significantly lower EPDS score than those supported by single-VHVs in this study area, suggesting that the support of male and female VHV pairs contributed to improving mental health status among ethnic minority mothers in remote rural areas of Lao PDR. Expanding the program to train female VHVs working with male VHVs is necessary for improving maternal and child health in a rural district of Lao PDR.

Fetal sex and maternal postpartum depressive symptoms: findings from two prospective pregnancy cohorts

BACKGROUND

Fetal sex is known to modify the course and complications of pregnancy, with recent evidence of sex-differential fetal influences on the maternal immune and endocrine systems. In turn, heightened inflammation and surges in reproductive hormone levels associated with pregnancy and parturition have been linked with the development of perinatal depression. Here, we examined whether there is an association between fetal sex and maternal depression assessed during the prenatal and postnatal periods.

METHODS

The study included two multi-ethnic, prospective pregnancy cohorts that enrolled women from prenatal clinics in the Northeastern United States between 2001 and 2018. Maternal depressive symptoms were measured during the prenatal and postnatal periods using the Edinburgh Postpartum Depression Scale (EPDS), and newborn sex was reported by the mother following delivery. We used logistic regression to examine associations between fetal sex and maternal depressive symptoms (EPDS > 10) during the prenatal period only, postnatal period only, or both periods versus no depressive symptoms during either period. We considered both unadjusted models and models adjusted for a core set of sociodemographic and lifestyle variables.

RESULTS

In adjusted models using PRISM data (N = 528), women pregnant with a male versus female fetus had significantly greater odds of depressive symptoms during the postnatal period compared to women without depressive symptoms during either period (odds ratio [OR] = 5.24, 95% confidence interval [CI] = 1.93, 14.21). The direction of results was consistent in the ACCESS cohort, although the findings did not reach statistical significance (OR = 2.05, 95% CI = 0.86, 4.93). Significant associations were not observed in either cohort among women with prenatal symptoms only or women with prenatal and postnatal symptoms.

CONCLUSIONS

Male fetal sex was associated with the onset of depressive symptoms during the postnatal period.

Perceptions of quality of care during birth at private Chiranjeevi facilities in Gujarat: lessons for Universal Health Coverage

The Indian national health policy encourages partnerships with private providers as a means to achieve universal health coverage. One of these was the Chiranjeevi Yojana (CY), a partnership since 2006 with private obstetricians to increase access to institutional births in the state of Gujarat. More than a million births have occurred under this programme. We studied women's perceptions of quality of care in the private CY facilities, conducting 30 narrative interviews between June 2012 and April 2013 with mothers who had birthed in 10 CY facilities within the last month. The commonly agreed upon characteristics of a "good (sari) delivery" were: giving birth vaginally, to a male child, with the shortest period of pain, and preferably free of charge. But all this mattered only after the primary outcome of being "saved" was satisfied. Women ensured this by choosing a competent provider, a "good doctor". They wanted a quick delivery by manipulating "heat" (intensifying contractions) through oxytocics. There were instances of inadequate clinical care for serious morbidities although the few women who experienced poor quality of care still expressed satisfaction with their overall care. Mothers' experiences during birth are more accurate indicators of the quality of care received by them, than the satisfaction they report at discharge. Improving health literacy of communities regarding the common causes of severe maternal morbidity and mortality must be addressed urgently. It is essential that cashless CY services be ensured to achieve the goal of 100% institutional births.

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.

Adversity, social capital, and mental distress among mothers of small children: A cross-sectional study in three low and middle-income countries

BACKGROUND

Maternal mental health is becoming recognized as a global health priority. Mental distress among mothers of young children may be exacerbated by exposure to adversity. Social capital may buffer the impact of adversity on mental distress during the postnatal period and beyond. This paper examines the relationship between adversity, cognitive social capital and mental distress among mothers of young children in three low and middle-income countries.

METHODS

This study uses data from the Young Lives study on 5,485 women from Ethiopia, India, and Vietnam. Logistic regression was used to examine the association between exposure to stressful life events (SLEs) and mental distress in women between 6 months and 1.5 years post-partum. Logistic and linear regression was used to examine the potential for effect modification by social capital.

RESULTS

The proportion of women with mental distress during the period between 6-18 months following the birth of a child in the sample was 32.6% in Ethiopia, 30.5% in India and 21.1% in Vietnam. For each additional SLE to which a woman was exposed, the odds of MMD increased by 1.28 (95% CI: 1.22, 1.36; p<0.001) in Ethiopia, 1.17 (1.11, 1.25; p<0.001) in India, and 1.98 (1.75, 2.25; p<0.001) in Vietnam. Exposure to family SLEs was significantly associated with MMD in all three countries with odds ratios of 1.76 (95% CI: 1.30, 2.38; p<0.001), 1.62 (95% CI: 1.12, 2.33; p<0.01 in India), 1.93 (95% CI: 1.27, 2.92; p<0.01), respectively. In Ethiopia and India, economic SLEs were also significantly associated with MMD after adjustment (Ethiopia OR: 1.68; 95% CI: 1.12, 2.52; p<0.01 and India OR: 1.44; 95% CI: 1.01, 2.05; p<0.05), while in India, crime SLEs (OR: 1.93; 95% CI: 1.27, 2.92; p<0.01) were associated with MMD. Cognitive social capital was found to modify the association between SLEs and symptomology of mental distress in Ethiopia, India and Vietnam.

CONCLUSIONS

This study suggests that adversity may increase the risk of maternal mental distress in three LMICs, while social capital may buffer its effect.

Postnatal depressive symptoms display marked similarities across continents

BACKGROUND

Postnatal depressive symptoms measured by the Edinburgh Postnatal Depression Scale (EPDS) are reported to display measurement variance regarding factor structure and the frequency of specific depressive symptoms. However, postnatal depressive symptoms measured by EPDS have not been compared between women representing three continents.

METHODS

A cross-sectional study including birth cohort samples from Denmark, Vietnam and Tanzania. Women were included during pregnancy at routine care sites. Depressive symptoms were self-reported 40-90 days postpartum using the EPDS. Exploratory and confirmatory factor analyses and generalized additive regression models were performed.

RESULTS

A total of N = 4,516 participated in the study (Denmark N = 2,069, Vietnam N = 1,278, Tanzania N = 1,169). Factor analyses identified three factors (anhedonia, anxiety and depression) that were almost identical in the three study populations. The only variation between countries was that the item 'self-harm' loaded differently. Women from Tanzania and Denmark were more likely to have an EPDS total score above cut-off 12 (12.6% and 6.4%), compared to women from Vietnam (1.9%) (p<0.001). A low level of education was associated with significantly more depressive symptoms after adjusting for country (p<0.001).

LIMITATIONS

EPDS data was collected at a later time point in the Danish sample.

CONCLUSIONS

Postnatal depressive symptoms constitute a three-factor model across cultures including the factors anhedonia, anxiety and depression. The frequency of postnatal depressive symptoms differs between high-, medium-, and low-income countries. However, clinicians should bear in mind that low-educated women worldwide are more likely to experience postnatal depressive symptoms.

The association of intimate partner violence with postpartum depression in women during their first month period of giving delivery in health centers at Dessie town, 2019

BACKGROUND

Postpartum depression is a common psychiatric complaint of women following delivery and a multitude of psychosocial, maternal, newborn and husband-related factors were contributing to it. This condition has a detrimental impact on the mother-infant caregiving relationship and hastens the infant's cognitive, emotional and social development. However, a shortage of empirical evidence existed especially in developing countries including Ethiopia. Therefore, we implemented this study to determine the magnitude of postpartum depression and its correlates.

METHODS

A cross-sectional survey was implemented on 378 postnatal women in the maternal and child health clinic of Dessie health centers within 4 weeks of their delivery. Postpartum depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Intimate partner violence was operationalized as a psychological, physical and sexual abusive action imposed on women by their associates. We estimated the crude and adjusted odds ratio with its 95% CI using binary logistic regression to know the association and statistical significance was declared using a p-value < 0.05.

RESULTS

More than one-fourth, 102 (27%) (95% CI 22.5, 31.5) of participants were obtained to have postpartum depression. Being single from socio-demographic variables (AOR = 4.9, 95% CI 1.27, 16.74), dissatisfaction with child gender (AOR = 3.1, 95% CI 1.62, 6.69), unplanned pregnancy (AOR = 2.5, 95% CI 1.76, 7.23) and depression during current pregnancy (AOR = 3.2, 95% CI 2.81, 8.91) from pregnancy and newborn-related variables, intimate partner violence; psychological (AOR = 6.5, 95% CI 1.98, 15.85), sexual and physical violence (AOR = 3.46, 95%CI 2.34, 18.55), current husbands alcoholism (AOR = 2.2, 95% CI 1.48, 5.34) from husband/partner-related variables and current substance use (AOR = 1.8, 95% CI 1.16, 3.75) were found to have a statistically significant association with postpartum depression.

CONCLUSION

More than one-fourth of the interviewed women (27%) were found to have postpartum depression. Being single from socio-demographic variables, dissatisfaction with child gender, unplanned pregnancy, and depression during current pregnancy from pregnancy and newborn-related variables, intimate partner violence, and current husband's alcoholism from husband/partner-related variables and current substance use were the related factors. This suggests the need for integrating postpartum depression services into the existing postnatal maternal and child health services and basing intervention geared primarily to the mentioned factors above.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Postpartum depression among women with pre-eclampsia and eclampsia in Tanzania; a call for integrative intervention

BACKGROUND

Postpartum depression (PPD) complicates maternal wellbeing, maternal-infant bonding, and cognitive function in children and woman's relationship with her partner. Clinical observations suggest a higher risk of postpartum depression among those women with pre-eclampsia and eclampsia compared to the general population. However, the evidence is inconsistent and not from settings similar to Tanzanian. This study aimed to determine the magnitude and risk factors for PPD among women diagnosed with pre-eclampsia or eclampsia at Muhimbili National Hospital (MNH), Tanzania.

METHODS

This cross-sectional study was conducted among 390 women who had pre-eclampsia or eclampsia during pregnancy attending postnatal care clinic at MNH. PPD was assessed using Edinburg postnatal depression scoring scale (EPDS). Face to face interviews was conducted and data was analysed using descriptive and logistic regression analysis to address the two respective objectives.

RESULTS

PPD was prevalent among 20.5% of women who had pre-eclampsia or eclampsia but varied with severity. Factors associated with PPD included young age (AOR = 10.13 95% CI 1.99-52.02), being a single mother (AOR = 3.18 95% CI 1.02-9.95), having a lower level of education (AOR = 3.83 95% CI 1.45-10.16), having a perinatal death (AOR = 5.14 95% CI 2.53-10.45), lack of family support (AOR = 7.06 95% CI 1.25-39.90), and experience of stressful event during pregnancy (AOR = 15.14 95% CI 2.38-96.19).

CONCLUSION

One in five women with pre-eclampsia or eclampsia had PPD and the magnitude increased with the severity of the disease condition. To address PPD, efforts should be done to screen and provide treatment to pregnant women presenting with pre-eclampsia or eclampsia, especially those with young age, low education level, single marital status, perinatal loss, lack of family support, and those reported to have a stressful event during pregnancy.

Prevalence and risk factors of postpartum depression within one year after birth in urban slums of Dhaka, Bangladesh

Postpartum depression (PPD) is a serious pubic health concern and known to have the adverse effects on mother’s perinatal wellbeing; and child’s physical and cognitive development. There were limited literatures on PPD in Bangladesh, especially in urban slum context. The aim of this study was to assess the burden and risk factors of PPD among the urban slum women. A cross-sectional study was conducted between November-December 2017 in three urban slums on 376 women within first 12 months of postpartum. A validated Bangla version of Edinburgh Postnatal Depression Scale was used to measure the depression status. Respondent’s socio-economic characteristics and other risk factors were collected with structured validated questionaire by trained interviewers. Unadjusted Prevalence Ratio (PR) and Adjusted Prevalence Ratio (APR) were estimated with Generalized Linear Model (GLM) and Generalized Estimating Equation (GEE) respectively to identify the risk factors of PPD. The prevalence of PPD was 39.4% within first 12 months following the child birth. Job involvement after child delivery (APR = 1.9, 95% CI = 1.1, 3.3), job loss due to pregnancy (APR = 1.5, 95% CI = 1.0, 2.1), history of miscarriage or still birth or child death (APR = 1.4, 95% CI = 1.0, 2.0), unintended pregnancy (APR = 1.8, 95% CI = 1.3, 2.5), management of delivery cost by borrowing, selling or mortgaging assets (APR = 1.3, 95% CI = 0.9, 1.9), depressive symptom during pregnancy (APR = 2.5, 95% CI = 1.7, 3.8) and intimate partner violence (APR = 2.0, 95% CI = 1.2, 3.3), were identified as risk factors. PPD was not associated with poverty, mother in law and any child related factors. The burden of postpartum depression was high in the urban slum of Bangladesh. Maternal mental health services should be integrated with existing maternal health services. Research is required for the innovation of effective, low cost and culturally appropriate PPD case management and preventive intervention in urban slum of Bangladesh.

Factors associated with paternal perinatal depression in fathers of newborns in Nigeria

INTRODUCTION

There is a lack of information on paternal postnatal depression in developing countries such as Nigeria.

METHODS

This study aims to assess the prevalence of depression in fathers at the birth of their infants and the incidence of paternal postnatal depression at 6 weeks postpartum. We also examined the correlation between paternal postpartum depression (PPD) at 6 weeks and maternal PPD as well as the sociodemographic and other correlates of paternal PPD at 6 weeks.

RESULTS

All the 331 fathers recruited at baseline completed the study. Prevalence of depression in fathers at birth of their babies was 10 (3%). After excluding the 3%, the incidence of PPD in fathers (N = 321) at 6 weeks was 19 (5.9%). In all, 29 (8.8%) fathers had PPD. The prevalence of depression in mothers at 6 weeks postpartum was 57 (17.8%). The prevalence of depression in mothers at 6 weeks was significantly higher than the incidence of depression in fathers at 6 weeks (X² = 26.2, p < .001). There was no significant correlation between maternal PPD and paternal PPD. At baseline, prevalence of PPD among the unemployed fathers was higher than in the employed, 3 (21.4%) versus 7 (2.2%), this was significant (FE p < .01). There was no significant correlate of paternal PPD at 6 weeks.

DISCUSSION

Postpartum mental health services should be extended to fathers of newborns especially those who are unemployed. Our findings have implications for family health.

The association between gestational diabetes and postpartum depression: A systematic review and meta-analysis

AIMS

Postpartum period is a critical period for mothers, which is often accompanied by increased risk of depression. Many studies have evaluated the relationship between gestational diabetes (GDM) and postpartum depression (PPD), but contradictory results have been reported. Therefore, the present study was conducted to investigate the relationship between GDM and PPD.

METHODS

This systematic review and meta-analysis was conducted based on PRISMA Guideline. We searched all the relevant epidemiological studies in international databases of Scopus, PubMed, Science Direct, Embase, Web of Science, CINAHL, Cochrane Library, EBSCO, and Google scholar search engine using the MeSH Keywords in English without time limit until 2018. The heterogeneity of the studies was calculated using the I² index and Cochran's Q test. Relative risk (RR) and 95% confidence interval (CI) were extracted from each study. The results of the study were analyzed using the random effects model and Comprehensive Meta-Analysis Software Version 2.

RESULTS

A total of 18 studies with a sample size of 2,370,958 were reviewed. Meta-analysis results showed that GDM significantly increased the risk of PPD, and RR was 1.59 (95% CI: 1.22-2.07, p = 0.001). The RR for 15 cohort studies, 2 cross-sectional studies and 1 case-control study was 1.67 (95% CI: 1.22-2.28), 1.37 (95% CI: 0.91-2.05), and 1.29 (95% CI: 0.98-1.68), respectively.

CONCLUSIONS

GDM can be a risk factor for PPD. Therefore, PPD examination in pregnant women with GDM seems to be necessary.

Postnatal depressive symptoms in women with and without antenatal depressive symptoms: results from a prospective cohort study

Evidence exists that the risk factors for depression in the antenatal and postnatal period may differ, but only a handful of studies looked at depression longitudinally. The aims of this study were (1) to estimate the prevalence of postnatal depressive symptoms in Kuwait where data about postnatal depression are scarce and identify its determinants and (2) to compare these risk factors between women who had experienced antenatal depressive symptoms and those that did not. Data collected in the TRansgenerational Assessment of Children's Environmental Risk (TRACER) Study in Kuwait were used in this analysis. The sample was restricted to the 1348 women who answered the Edinburgh Postnatal Depression Scale (EPDS) both antenatally and postnatally. The prevalence of postnatal depressive symptoms, defined by an EPDS score ≥ 10, was 11.7%. Overall, antenatal depressive symptoms were the strongest determinant of postnatal depressive symptoms. Multivariable logistic regression analysis showed that in women with depressive symptoms in pregnancy, having a lower household income was the most significant risk factor for postnatal depressive symptoms. Among women without antenatal depressive symptoms, those who had lower income, were Kuwaitis, experienced other problems in pregnancy such as perceived stress, PTSD symptoms and social isolation, and those who delivered a boy had higher odds of postnatal depressive symptoms. Antenatal depressive symptoms and other psychosocial characteristics can predict postnatal depressive symptoms. Therefore, maternal mental health issues should be detected during the antenatal period and support should be provided in order to lower the risk of postnatal depression and its sequelae.

Mental health problems of reproductive age group women in a rural community of south west Nigeria

Background: Mental health is a component of reproductive health which is generally not given priority in low and middle income countries. Efforts to improve women's health have focused majorly on issues associated with reproduction such as family planning and child-bearing while women's mental health has been relatively neglected.Aim: This study was conducted to determine prevalence and factors influencing mental health problems in non-pregnant reproductive age women in a rural community of south west Nigeria.Methods: A community-based cross-sectional survey was conducted using a cluster sampling technique to select the study population. Mental health was assessed based on respondents' experience of any symptoms of depression and anxiety. Data were analysed using descriptive statistics, Chi-square and multivariate logistic regression model at p < 0.05.Results: The mean age of the respondents was 25.6 ± 7.8 years. The prevalence of depression and anxiety was 28.9% each while 19.8% experienced both. Gynecological conditions were a predictor of anxiety (OR 2.7; 95% CI 1.3-5.6) while previous history of miscarriage was a predictor of depression (OR 10.5; 95% CI 1.0-108.8).Conclusions: Our study demonstrated that mental health problems were quite prevalent in women of reproductive age group. We recommend that mental health be integrated into reproductive health policies.

Eine meta-analytische Untersuchung des sozioökonomischen Status als Risikofaktor für postpartale Depression

Zusammenfassung. Theoretischer Hintergrund: 13 % aller Gebärenden leiden an postpartalen Depressionen (PPD), einer Krankheit mit bedeutsamen gesundheitlichen und sozialen Konsequenzen für die Betroffenen. Zurzeit werden PPD jedoch häufig spät erkannt und behandelt. Eine Früherkennung könnte durch die Identifikation spezifischer Vulnerabilitätsfaktoren erleichtert werden. Niedriger sozioökonomischen Status (SES) wurde als potenzieller Risikofaktor für Depressionen diskutiert ( Lorant et al., 2003 ). Fragestellung: Das Ziel der vorliegenden Meta-Analyse ist die systematische Untersuchung, ob niedriger SES mit einem erhöhten Risiko für die Entwicklung einer PPD einhergeht. Methode: Um die Vergleichbarkeit der eingeschlossenen Studien zu gewährleisten, werden die internationalen Empfehlungen zur Erfassung des SES von Jöckel et al. (1998) als Inklusionskriterium herangezogen. Die identifizierten Studien werden meta-analytisch zusammengefasst. Ergebnisse: Weder Bildung mit einem relativen Risiko (RR) = 1.14 (95 % KI = 0.95, 1.45) noch Einkommen mit RR = 1.32 (95 % KI = 0.99, 1.74) waren signifikant mit der Entwicklung einer PPD assoziiert. Schlussfolgerung: Es wurde kein Zusammenhang zwischen dem erhöhten Risiko eine PPD zu entwickeln und dem Bildungsniveau oder dem Einkommen gefunden. Die vorliegende Studie macht auf die gravierenden methodischen Mängel im Bereich der Forschung von PPD und dem SES aufmerksam.

Mother's level of confidence in caring for her late preterm infant: A mixed methods study

AIM AND OBJECTIVES

To examine what it means to be a mother of a late preterm infant including a mother's level of confidence in caring for her late preterm infant over time and the effect of maternal depression of this experience.

BACKGROUND

Little is known about mothers' experiences of caring for their late preterm infants in the community, including their level of confidence and parenting stress within the context of a supported care environment by public health nurses.

DESIGN

A mixed methods study, sequential explanatory quantitative and qualitative study.

METHODS

A convenience sample of mothers with LPIs (n = 71) completed questionnaires on maternal confidence (3-4 weeks and 6-8 weeks), parenting stress (6-8 weeks), social support (6-8 weeks) and postpartum depression (6-8 weeks). A purposive sample of mothers (n = 11) underwent in-depth, semi-structured interviews.

RESULTS

Maternal confidence decreased from 3-4 weeks-6-8 weeks after delivery, and similar results were found for mothers who reported depressive symptoms. Narratives of the mothers suggested the decrease in maternal confidence over time was influenced by the demanding characteristics of the late preterm infant, the prospect of their rehospitalisation and the mother's reported interactions with public health nurses. Depression had an effect on maternal confidence; that is, the depressed mothers demonstrated less confidence about their caretaking role than the nondepressed mothers at 6-8 weeks. Mothers did not discuss mental health issues, which may reflect the protective effects of social support on emotional instability or an inability to recognise postpartum depression.

CONCLUSION

The confidence of mothers with LPIs decreased over the first 2 months following delivery and being home with their infants. Assisting mothers to meet their personal needs and the needs of their infant should promote maternal skills, which will likely increase maternal confidence related to the care of their late preterm infant.

RELEVANCE FOR CLINICAL PRACTICE

Characteristics of LPIs contributed more to parenting stress score than parent characteristics; mothers however attempted to normalise the late preterm infant in order to minimise the parenting stress. Evidence-informed brief interventions tailored based on late preterm infant and parent characteristics may improve maternal confidence over time. Healthcare professional should provide education and anticipatory guidance prior to discharge, consistent care in hospital and postdischarge as this may impact maternal level of confidence. Future research needs to examine standards of care for discharge of LPIs and adherence to these standards.

Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries

BACKGROUND

Postpartum depression (PPD) poses a major global public health challenge. PPD is the most common complication associated with childbirth and exerts harmful effects on children. Although hundreds of PPD studies have been published, we lack accurate global or national PPD prevalence estimates and have no clear account of why PPD appears to vary so dramatically between nations. Accordingly, we conducted a meta-analysis to estimate the global and national prevalence of PPD and a meta-regression to identify economic, health, social, or policy factors associated with national PPD prevalence.

METHODS

We conducted a systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To test for country level predictors, we drew on data from UNICEF, WHO, and the World Bank. Random effects meta-regression was used to test national predictors of PPD prevalence.

FINDINGS

291 studies of 296284 women from 56 countries were identified. The global pooled prevalence of PPD was 17.7% (95% confidence interval: 16.6-18.8%), with significant heterogeneity across nations (Q = 16,823, p = 0.000, I2 = 98%), ranging from 3% (2-5%) in Singapore to 38% (35-41%) in Chile. Nations with significantly higher rates of income inequality (R2 = 41%), maternal mortality (R2 = 19%), infant mortality (R2 = 16%), or women of childbearing age working ≥40 h a week (R2 = 31%) have higher rates of PPD. Together, these factors explain 73% of the national variation in PPD prevalence.

INTERPRETATION

The global prevalence of PPD is greater than previously thought and varies dramatically by nation. Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.

Maternal supplementation with small-quantity lipid-based nutrient supplements during pregnancy and lactation does not reduce depressive symptoms at 6 months postpartum in Ghanaian women: a randomized controlled trial

We examined the impact on depression at 6 months postpartum of maternal supplementation with small-quantity lipid-based nutrient supplement (SQ-LNS) compared to supplementation with iron and folic acid (IFA) or multiple micronutrients (MMN). In this partially double-blinded randomized controlled trial, pregnant women ≤20 weeks gestation (n = 1320) were recruited from antenatal clinics and randomly assigned to receive either (1) SQ-LNS during pregnancy and for 6 months postpartum, or (2) IFA during pregnancy only, or (3) MMN during pregnancy and for 6 months postpartum. Maternal depressive symptoms were measured at 6 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Women who scored 12 or more on the EPDS were considered to show symptoms of depression. One thousand one hundred fifty-one women were included in this analysis (LNS = 382, IFA = 387 and MMN = 382). Characteristics of the three groups were similar at baseline, and there were no significant differences between women who were included in the analysis (n = 1151) and those who were not (n = 169). At 6 months postpartum, 13% of the women overall showed symptoms of depression, and this did not differ by group (LNS = 13.1%, IFA = 11.2% and MMN = 14.7%. P = 0.36). The median (25, 75 percentile) EPDS score did not differ by group (LNS 4.0 (1.0, 8.0), IFA 4.0 (1.0, 8.0), MMN 5.0 (2.0, 9.0), P _transformed = 0.13). Adjustment for covariates did not alter these findings. Maternal supplementation with SQ-LNS compared to MMN or IFA did not affect postnatal depressive symptoms in this sample of Ghanaian women.

Exploring factors behind pregnant women's quality of life in Iran: a qualitative study

BACKGROUND AND OBJECTIVE

Pregnancy-related physiologic and psychosocial alterations can impact on the body and cause symptoms which may affect quality of life. Since qualitative studies can provide more in-depth understanding of quality of life and its determining factors, this study was conducted with the aim of exploring factors affecting pregnant women's quality of life.

METHODS

A qualitative descriptive study with conventional content analysis approach was made using the conventional content analysis approach on a purposeful sample of sixteen pregnant Iranian women in Hamadan, Iran from May 2015 to December 2015. Sampling was continued until data saturation. Data were collected through in-depth semi-structured personal interviews, and were analyzed using the conventional content analysis approach.

RESULTS

Data analysis resulted in three main categories, namely, the effects of pregnancy on different aspects of health (including psychological disorders, impaired interactions, disturbances in doing daily activities, disturbed body image, alterations in sexual relationships, physical disorders, and alterations in dietary habits and treatment regimens), pregnancy-related concerns (regarding the gender of the fetus, financial problems, childbirth, health, and the future), and coping with pregnancy (through strategies such as spirituality, positive attitude toward pregnancy, distraction and imagination, and support).

CONCLUSIONS

This study showed that different factors can affect pregnant women's quality of life. Nonetheless, prenatal care services are mainly focused on pregnancy-related physical problems, and other aspects of care are usually taken for granted. Consequently, healthcare professionals need to pay greater attention to pregnant women's quality of life and its contributing factors.

Postpartum unconscious dynamics emerging from the Lüscher color test in Ethiopian women

The aim of this study was to explore the feasibility of the Lüscher color test (LCT), a psychological instrument based on theory that colors are selected in unconscious way and that the color sensory perception of color is objective and universal. The research has involved 24 Ethiopian women, which delivered at the Getche Health Center in Gurage. It seemed to be relevant for the majority of Ethiopian women identify the rejected color (58.66%), the gray, than the favorite color, the yellow 33.33%). The yellow color suggests that they better express their personality in a physical context, while the gray color indicates that they want to live this experience intensely. This exploratory work lays the foundations for further studies in disadvantaged women, both in developing low-income Countries as well as in industrialized Countries characterized by an high level of emigration, and for clinical applications by the complete LCT version.

Perinatal mental health care in a rural African district, Uganda: a qualitative study of barriers, facilitators and needs

BACKGROUND

Perinatal mental illness is a common and important public health problem, especially in low and middle-income countries (LMICs). This study aims to explore the barriers and facilitators, as well as perceptions about the feasibility and acceptability of plans to deliver perinatal mental health care in primary care settings in a low income, rural district in Uganda.

METHODS

Six focus group discussions comprising separate groups of pregnant and postpartum women and village health teams as well as eight key informant interviews were conducted in the local language using a topic guide. Transcribed data were translated into English, analyzed, and coded. Key themes were identified using a thematic analysis approach.

RESULTS

Participants perceived that there was an important unmet need for perinatal mental health care in the district. There was evidence of significant gaps in knowledge about mental health problems as well as negative attitudes amongst mothers and health care providers towards sufferers. Poverty and inability to afford transport to services, poor partner support and stigma were thought to add to the difficulties of perinatal women accessing care. There was an awareness of the need for interventions to respond to this neglected public health problem and a willingness of both community- and facility-based health care providers to provide care for mothers with mental health problems if equipped to do so by adequate training.

CONCLUSION

This study highlights the acceptability and relevance of perinatal mental health care in a rural, low-income country community. It also underscores some of the key barriers and potential facilitators to delivery of such care in primary care settings. The results of this study have implications for mental health service planning and development for perinatal populations in Uganda and will be useful in informing the development of integrated maternal mental health care in this rural district and in similar settings in other low and middle income countries.

Changes in the Relationship Between Socioeconomic Position and Maternal Depressive Symptoms: Results from the Panel Study on Korean Children (PSKC)

Maternal depression is a common health problem during the perinatal period. The purpose of this study was to examine changes in the relationship between socioeconomic position and maternal depressive symptoms from prenatal to 3 years postpartum in Korean women. Prospective cohort data were collected from the Panel Study on Korean Children between 2008 and 2011. Maternal depression was assessed using the Kessler 6-Item Psychological Distress Scale. Socioeconomic position indicators used were maternal education, paternal education, maternal occupation, paternal occupation, and household income. Repeated-measures analyses with a generalized estimating equation approach were used to investigate relationships between socioeconomic position and maternal depressive symptoms during the study period. Low socioeconomic position was associated with greater levels of maternal depressive symptoms between 4 months after childbirth and 3 years postpartum, but the association was not evident between 1 month before and after childbirth. The magnitude of the significant association between socioeconomic position and maternal depression was the greatest at 1 year postpartum but then became smaller. Among the five socioeconomic position indicators included, maternal education, paternal education, and household income showed graded inverse relationships with maternal depressive symptoms, while no significant relationship was found for paternal occupation over the study period. Socioeconomic inequalities in maternal depressive symptoms emerged in early childhood in a prospective study of Korean mothers. These emerging inequalities may contribute to socioeconomic inequalities in childhood health and development.

Cognitive Behavioral Development in Children Following Maternal Postpartum Depression: A Review Article

Mothers’ constitute is a very important part of infants’ social environment and mediate their experience with the surrounding world. Postpartum depression, which is considered one of the most common and important psychiatric disorders, affects 10–15% of mothers, its causes are different. By investigating various sources, some effects of this disorder have been observed on the cognitive development of children, particularly among boys, such as language, intelligence quotient (IQ), and behavioral problems. Thus, it is imperative to study the effects of postpartum depression on children’s growth and development and to identify methods of reducing these effects. This review indicates that postpartum depression in mothers reduces children’s cognitive performance. The adverse effects of postpartum depression on children’s development seem to be mediated by the mother’s interpersonal behavior and the infant gender. The review of previous studies shows that postpartum depression reduces children’s cognitive performance by impairing maternal mental and behavioral care.

Perinatal distress in women in low- and middle-income countries: allostatic load as a framework to examine the effect of perinatal distress on preterm birth and infant health

In low- and middle-income countries (LMIC), determinants of women’s and children’s health are complex and differential vulnerability may exist to risk factors of perinatal distress and preterm birth. We examined the contribution of maternal perinatal distress on preterm birth and infant health in terms of infant survival and mother–infant interaction. A critical narrative and interpretive literature review was conducted. Peer-reviewed electronic databases (MEDLINE, Embase, Global Health, CINHAL), grey literature, and reference lists were searched, followed by a consultation exercise. The literature was predominantly from high-income countries. We identify determinants of perinatal distress and explicate changes in the hypothalamic–pituitary–adrenal axis, sympathetic, immune and cardiovascular systems, and behavioral responses resulting in pathophysiological effects. We suggest cultural–neutral composite measures of allostatic mediators (i.e., several biomarkers) of maternal perinatal distress as objective indicators of dysregulation in body systems in pregnant women in LMIC. Understanding causal links of maternal perinatal distress to preterm birth in women in LMIC should be a priority. The roles of allostasis and allostatic load are considered within the context of the health of pregnant women and fetuses/newborns in LMIC with emphasis on identifying objective indicators of the level of perinatal distress and protective factors or processes contributing to resilience while facing toxic stress. We propose a prospective study design with multiple measures across pregnancy and postpartum requiring complex statistical modeling. Building research capacity through partnering researchers in high-income countries and LMIC and reflecting on unique ethical challenges will be important to generating new knowledge in LMIC.

Determinants of postnatal depression in rural ghana: findings from the don population based cohort study

BACKGROUND

Risk factors for postnatal depression (PND), one of the most pervasive complications of child bearing, are poorly understood in Africa. A recent systematic review of 31 studies found that the strongest predictors are social and economic disadvantage and gender-based factors; only six of these studies were community based, and almost all were in South Asia.

METHODS

Cohort study nested within 4 weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths in the Kintampo Health Research Centre study area of Ghana. Women were screened for depression during pregnancy and after birth using the Patient Health Questionnaire to ascertain DSM-IV major or minor depression. Information was collected on determinants relating to the mother, birth, and baby, which were examined using logistic regression; effect sizes reported as relative risks with 95% confidence intervals.

RESULTS

Thirteen thousand nine hundred and twenty nine women were screened both during pregnancy and after birth, of whom 13,360 (95.9%) had complete data on potential determinants. Two hundred and fifty five (3.8%, 95% CI: 3.5%, 4.1%) had PND. Antenatal depression (AND) was the strongest determinant accounting for 34.4% of PND cases. Other determinants were season of delivery, peripartum/postpartum complications, newborn ill health, still birth, or neonatal death. Common determinants were observed for onset and persistent depression.

CONCLUSIONS

Although most AND resolves in this setting, more than a third of women with PND also had AND. Adverse birth- and baby-related outcomes are the other main determinants. We recommend that programs detect and treat depression during pregnancy and provide support to women with adverse birth outcomes.

Relationship of monoamine oxidase-A distribution volume to postpartum depression and postpartum crying

Postpartum depression (PPD) has a prevalence rate of 13% and a similarly high proportion of women report a subclinical state of one or more major depressive episode symptoms. The aim was to investigate whether monoamine oxidase-A (MAO-A) VT, an index of MAO-A density, is increased in the prefrontal and anterior cingulate cortex (PFC and ACC), during PPD or when a PPD spectrum symptom, greater predisposition to crying, is present. MAO-A is an enzyme that increases in density after estrogen decline, and has several functions including creating oxidative stress, influencing apoptosis and monoamine metabolism. Fifty-seven women were recruited including 15 first-onset, antidepressant naive, PPD subjects, 12 postpartum healthy who cry due to sad mood, 15 asymptomatic postpartum healthy women, and 15 healthy women not recently pregnant. Each underwent [(11)C]-harmine positron emission tomography scanning to measure MAO-A VT. Both PPD and greater predisposition to crying were associated with greater MAO-A VT in the PFC and ACC (multivariate analysis of variance (MANOVA), group effect, F21,135=1.856; p=0.019; mean combined region elevation 21% and 14% in PPD and crying groups, respectively, relative to postpartum asymptomatic). Greater MAO-A VT in the PFC and ACC represents a new biomarker in PPD, and the PPD symptom of predisposition to crying. Novel strategies for preventing PPD (and some PPD symptoms) may be possible by avoiding environmental conditions that elevate MAO-A level and enhancing conditions that normalize MAO-A level. These findings also argue for clinical trials in PPD with the newer, well-tolerated MAO-A inhibitor antidepressants.

Association of birth of girls with postnatal depression and exclusive breastfeeding: an observational study

OBJECTIVES AND HYPOTHESIS

To examine the influence of gender of the baby on exclusive breastfeeding and incidence of postnatal depression (PND). We hypothesise that in a society with a male gender bias there may be more PND and less exclusive breastfeeding of the girl child.

DESIGN

Prospective study.

SETTING

The study was conducted in an urban, tertiary hospital in Delhi.

PARTICIPANTS

Mothers delivering normally with their babies roomed-in.1537 eligible women participated in the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Exclusive breastfeeding within the first 48 h of life and score on the Edinburgh Postnatal Depression Scale (EPDS) were recorded.

RESULTS

3466 babies were born in the hospital. There were 792 girls for every 1000 boys. Among primiparous women, the sex ratio was 901 girls per 1000 boys. For second babies, the sex ratio was 737:1000. If the first child was a girl the birth ratio fell to 632. 1026 mothers were exclusively breastfeeding. Exclusive breastfeeding of boys was significantly higher (70.8% vs 61.5%, p<0.001). The EPDS score was significantly higher with the birth of girls (EPDS 6.0±3.39 vs 5.4±2.87, p<0.01). Women with an EPDS score >11 were less likely to exclusively breastfeed (p<0.01).

CONCLUSIONS

The results point to a pro-male gender bias evidenced by a low sex ratio at birth, higher EPDS score in mothers of girls and less breastfeeding of female children.

The Impact of Postpartum Depression on Quality of Life in Women After Child's Birth

BACKGROUND

Postpartum depression (PPD) is a common problem after child's birth and may influence the quality of life (QOL). Investigation of postpartum QOL and depression can be useful for better care for mothers and improvement of their well-being.

OBJECTIVES

The objective of this study was to assess the life quality in mothers with and without PPD.

PATIENTS AND METHODS

In a prospective study, women who had experienced child's birth with and without PPD were recruited in Kashan-Iran. PPD was measured using the Edinburgh Postnatal Depression Scale (EPDS) and QOL was measured by SF-36 questionnaire. Data collection was conducted at two assessment points: second month (n = 321) and fourth month (n = 300) postpartum. Based on EPDS, a score of 13 or more was defined as PPD. Mean scores of SF-36 questionnaire were compared between women with and without PPD at two assessment points and within each group from the first to the second assessments. Moreover, correlation between scores of EPDS and scores of life quality dimensions were evaluated. Data were analyzed by using the Student's t-test, Mann-Whitney U-test, ANOVA, Kruskal-Wallis, Chi-square test, Pair t test, Wilcoxon, Pearson and Spearman Correlation Coefficient.

RESULTS

Differences in seven out of eight mean scores of QOL dimensions (except role-physical) between depressed and non-depressed women at the first and the second assessments were significant. Results of changes in mean scores of QOL dimensions from the first to the second assessments in each group showed that non-depressed women scored higher in all of eight dimensions with significant differences in two dimensions (bodily pain and role-emotional as well as mental health component). In depressed women, scores of life quality decreased in some of QOL dimensions but differences were not significant. There were significant negative correlations between EPDS scores and scores of seven out of eight SF-36 sub-scales (except role-physical) in addition to physical and mental health components at two assessments. The highest correlation was found between EPDS scores and emotional well-being and total scores of SF-36 dimension at the first and the second assessments (r = -o.489, r = -0.381), respectively.

CONCLUSIONS

The findings demonstrated that postpartum depression leads to a lower life quality at second and fourth months postpartum. Integration of PPD screening into routine postnatal care is recommended.

Introducing depression and developmental screenings into the national programme on immunization (NPI) in southeast Nigeria: an experimental cross-sectional assessment

OBJECTIVES

This study investigates the possibility of introducing depression and developmental screening tools into the National Programme on Immunization (NPI) in southeast Nigeria. The specific objectives were to determine the prevalence of postpartum depression (PPD) among mothers attending immunization clinics and to assess the association of maternal PPD and infant growth in relation to World Health Organization (WHO) recommendations.

METHODS

Four hundred and eight (408) mothers completed the sociodemographic questionnaire and the self-report Edinburgh Postnatal Depression Scale (EPDS). The weights, lengths and head circumferences of their infants were recorded, while the WHO recommended equivalents at 50th percentiles were also recorded for each child. The mothers were then interviewed with the major depressive episode module of Mini International Neuropsychiatric Interview (M.I.N.I.) to make diagnosis of depression.

RESULTS

About 24.8% and 15.2% of the mothers were found to be depressed using EPDS and major depressive episode module of M.I.N.I., respectively. It was found that maternal PPD is significantly associated with the growth parameters of weights and lengths of the infants studied but not their head circumference.

CONCLUSIONS

NPI may provide appropriate forum for early screening of mothers for PPD and interventions in Nigeria. The NPI would also serve a useful avenue of screening for developmental concerns in Nigerian children.

Effect of mode of delivery on postpartum depression in Iranian women

AIM

The aim of this study was to determine the relation between mode of delivery (cesarean section [CS] or unassisted vaginal delivery) and postpartum depression (PPD).

MATERIAL AND METHODS

In a prospective study, 300 women who had experienced vaginal delivery (VD) or CS were recruited in Kashan, Iran. PPD was measured using the Edinburgh Postnatal Depression Scale (EPDS). A score of 13 or more was defined as PPD. Data collection was conducted at two assessment points: 2 months and 4 months postpartum. Mean scores of EPDS and PPD were compared between the VD and CS groups.

RESULTS

Differences in mean scores of EPDS between CS (n = 150) and VD (n = 150) groups at the first and the second assessments were not significant. The depression mean scores differences from the first to the second assessment were compared between the two groups; VD group showed more decrease on EPDS score (P = 0.006). Comparing the two assessments, the VD group showed a more decreased EPDS from the first to the second one. PPD prevalence rates (score ≥ 13) among the VD and CS groups were 24% and 20.7% for the first and 14.7% and 16.7% for the second assessment, respectively, which were not significantly different. The logistic regression showed that an unwanted pregnancy and PPD 2 months after delivery were determinants for PPD 4 months after delivery.

CONCLUSION

There was no relation between delivery mode and PPD at 2 and 4 months after delivery; however, the VD group showed greater decrease in EPDS score from 2 to 4 months after delivery.

A study of postpartum depression and maternal risk factors in Qatar

OBJECTIVE

The objective of this study was to investigate the association between maternal complications and postpartum depression (PPD) among postpartum women in Qatar by using the Edinburgh Postnatal Depression Scale (EPDS) as well as a structured questionnaire.

METHODS

This is a cross-sectional study of PPD of 1379 postpartum women within 6 months of delivery attending the primary healthcare centers of the State of Qatar.

RESULTS

The prevalence of PPD was 17.6% in the studied mothers. The results of the logistic regression analysis showed that the risk factors for PPD included various socio-demographic risk factors such as education, occupation, consanguinity and access to transportation. Amongst the maternal factors studied, history of unplanned pregnancy and infertility and other medical complications such as gestational diabetes, heart disease, threatened abortion and cesarean section were found to be risk factors for PPD. Amongst the postpartum women with maternal complications, items related to feeling scared and panicky and feeling sad and miserable were the most frequently reported symptoms of depression. These women were also more likely to be experiencing sleep difficulty (p = 0.029) compared to women without maternal complications.

CONCLUSION

While socio-demographic risk factors are well studied in the PPD literature, there is much less information on the impact of maternal complications on the psychological status of postpartum women. Postpartum women, especially those with maternal complications, need close screening and have quick access to mental healthcare within integrated reproductive health services.

A review of postpartum depression, preterm birth, and culture

Postpartum depression (PPD) varies worldwide and is considered a serious issue because of its devastating effects on mothers, families, and infants or children. Preterm birth may be a risk factor for PPD. In 2005, the global incidence of preterm birth was estimated to be 9.6%, and of these births, 85% occurred in Africa and Asia. Among Asian countries, Pakistan has a preterm birth rate of 15.7% and the highest prevalence rate of PPD (63.3%). A literature review was therefore undertaken to better understand the potential contribution of preterm birth to PPD and to identify gaps in the scientific literature. Limited studies compare prevalence rates of PPD in mothers of full-term infants and mothers of preterm infants. Furthermore, meta-analyses examining predictors of PPD have not included preterm birth as a variable. The interrelationship between preterm birth and PPD may be explained by early parental stress and mother-infant interaction among mothers of preterm infants. Culture plays an important role in shaping communication between mothers and their infants and defines social support rituals that may or may not mediate PPD. More research is needed to provide evidence for practice.

Socioeconomic, psychiatric and materiality determinants and risk of postpartum depression in border city of ilam, Western iran

Background. Postpartum depression (PPD) is considered as one of the mood disturbances occurring during 2-3 months after delivery. The present study aimed to determine the prevalence of PPD and its associated risk factors in border city of Ilam, western Iran. Methods. Through a descriptive cross-sectional study in 2011, overall, 197 women who attended Obstetrics & Gynecology clinics postpartumly in the border city of Ilam, western Iran, were randomly recruited. A standard questionnaire that was completed by a trained midwife through face to face interviews was used for data gathering. Results. Mean age ± standard deviations was 27.9 ± 5.2 years. Prevalence of PPD was estimated to be 34.8% (95% CI: 27.7-41.7). A significant difference was observed among depression scores before and after delivery (P ≤ 0.001). Type of delivery (P = 0.044), low socioeconomic status (P = 0.011), and women having low educational level (P = 0.009) were the most important significant risk factors associated with PPD. The regression analysis showed that employed mothers compared to housekeepers were more at risk for PPD (adjusted OR = 2.01, 95% CI: 1.22-2.28, P = 0.003). Conclusions. Prevalence of PPD in western Iran was slightly higher than the corresponding rate from either national or international reports.