1
|
Klein S, Błażek M, Świetlik D. Risk and protective factors for postpartum depression among Polish women - a prospective study. J Psychosom Obstet Gynaecol 2024; 45:2291634. [PMID: 38064700 DOI: 10.1080/0167482x.2023.2291634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
This prospective study conducted at a single center in 2022 aims to identify risk and protective factors for postpartum depression (PPD) in Polish women and to assess the impact of pregnancy, delivery, the postpartum period, and psychosocial factors on PPD. After delivery and 4 weeks later, 311 women filled out two questionnaires of our design related to risk factors for PPD. Immune Power Personality Questionnaire, Walsh Family Resilience Questionnaire, and Edinburg Postnatal Depression Scale were also applied. The predictors of PPD identified at two time points included: use of antidepressants, previous depressive episodes, family history of depression, risk of preterm delivery, anxiety about child's health, and breastfeeding and sleep problems. Risk factors for PPD found only after delivery were: suicidal ideation before pregnancy, stressful life events, premature rupture of the membranes, and cesarean section. Inhalation analgesia during labor reduced the PPD frequency. At 4 weeks' postpartum, regular physical activity was also predictive of PPD, while breastfeeding, financial satisfaction, and sufficient sleep duration were protective factors. PPD after delivery was negatively correlated with capacity to confide, hardiness, assertiveness, self-complexity, and communication. PPD at 4 weeks postpartum decreased belief systems, organization patterns, and communication. Two proposed self-designed questionnaires can be useful for effectively screening PPD in the Polish population.
Collapse
Affiliation(s)
- Sebastian Klein
- Department of Obstetrics and Gynecology, Pomeranian Hospitals, Wejherowo, Poland
| | - Magdalena Błażek
- Department of Quality of Life Research, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Świetlik
- Division of Biostatistics and Neural Networks, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
2
|
Luoma I, Korhonen M, Salmelin RK, Siirtola A, Mäntymaa M, Valkonen-Korhonen M, Puura K. Mothers' and their children's emotional and behavioral symptom trajectories and subsequent maternal adjustment: Twenty-seven years of motherhood. J Affect Disord 2024; 361:299-309. [PMID: 38876318 DOI: 10.1016/j.jad.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/30/2024] [Accepted: 06/11/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND This study aims to describe maternal depressive symptoms (MDS) trajectories in a longitudinal study extending from pregnancy to 27 years after the birth of the firstborn child. We also explored the associations of both MDS trajectories and child internalizing and externalizing problem trajectories with maternal adjustment (adaptive functioning, emotional and behavioral problems). METHODS The population-based study was conducted in Tampere, Finland, and the sample comprised 356 first-time mothers. MDS were screened with the Edinburgh Postnatal Depression Scale during pregnancy, first week after delivery, 2 and 6 months postnatally, and when the child was 4-5, 8-9, 16-17, and 26-27 years of age. The internalizing and externalizing problems of the children were assessed with the Child Behavior Checklist when the child was 4-5, 8-9, and 16-17 years of age. Maternal adaptive functioning and internalizing and externalizing problems were assessed with the Adult Self Report at 26-27 years after the birth of the first child. Complete follow-up data were available for 168 mothers. RESULTS We describe a three-group trajectory model of MDS (High Stable, Low Stable, Very Low). Elevated depressive symptom patterns were associated with less optimal maternal outcomes regarding both adaptive and problem dimensions. The child's internalizing and externalizing problem trajectories were associated with maternal internalizing and externalizing problems but not with maternal adaptive functioning. LIMITATIONS Maternal and child measures were based on maternal reports only. CONCLUSIONS The interconnectedness of the well-being of the mother and child should be noted in health and mental health services for adults and children.
Collapse
Affiliation(s)
- Ilona Luoma
- University of Eastern Finland, Faculty of Health Sciences, Kuopio, Finland; Kuopio University Hospital, Department of Child Psychiatry, Kuopio, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Marie Korhonen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Helsinki University Hospital, Department of Child Psychiatry, Helsinki, Finland
| | - Raili K Salmelin
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Tampere University Hospital, Department of Child Psychiatry, Tampere, Finland
| | - Arja Siirtola
- Tampere University Hospital, Department of Child Psychiatry, Tampere, Finland
| | - Mirjami Mäntymaa
- University of Oulu, Faculty of Medicine, Oulu, Finland; Oulu University Hospital, Department of Child Psychiatry, Oulu, Finland
| | - Minna Valkonen-Korhonen
- University of Eastern Finland, Faculty of Health Sciences, Kuopio, Finland; Kuopio University Hospital, Department of Psychiatry, Kuopio, Finland
| | - Kaija Puura
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Tampere University Hospital, Department of Child Psychiatry, Tampere, Finland
| |
Collapse
|
3
|
Singh AK, Palepu S, Saharia GK, Patra S, Singh S, Taywade M, Bhatia V. Association between Gestational Diabetes Mellitus and Postpartum Depression among Women in Eastern India: A Cohort Study. Indian J Community Med 2023; 48:351-356. [PMID: 37323735 PMCID: PMC10263052 DOI: 10.4103/ijcm.ijcm_759_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/17/2022] [Indexed: 06/17/2023] Open
Abstract
Background The study was planned to evaluate the association between Gestational Diabetes Mellitus (GDM) and Postpartum Depression (PPD) in a rural population of Odisha, Eastern India. Material and Methods Pregnant women in the first trimester were recruited and followed up till six weeks of postpartum. Gestational Diabetes Mellitus was assessed with 75 grams glucose challenge test and PPD was assessed at six weeks after delivery with Edinburgh Postnatal Depression Scale. Statistical difference between variables was assessed using Chi-square test, Fischer's exact test, and unpaired T-test. Covariates were adjusted using bivariate and multivariate logistic regression to estimate the association between GDM and PPD. Results Out of 436 pregnant women recruited, 347 (89.6%) remained in the study. Prevalence of GDM was 13.9% (95% CI: 10.7-17.3) and PPD was 9.8% (95% CI: 6.6-12.9). Incidence of PPD in the GDM group was 14.58% (95% CI: 4.2-24.9) and in women without GDM was 9.06% (95% CI: 5.76-12.3). However, the association was not significant on multivariate logistic regression (Risk Ratio (RR) = 1.56, 95% C.I: 0.61-6.16; P-value = 0.35). Conclusion This study demonstrated that women with GDM were at higher risk of developing PPD suggesting that an "at risk" approach should be implemented for screening.
Collapse
Affiliation(s)
- Arvind Kumar Singh
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sarika Palepu
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Gautom Kumar Saharia
- Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Suravi Patra
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sweta Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Manish Taywade
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Vikas Bhatia
- Executive Director and CEO, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| |
Collapse
|
4
|
Sun J, Xiao Y, Zou L, Liu D, Huang T, Zheng Z, Yan X, Yuan A, Li Y, Huang X. Epidural Labor Analgesia Is Associated with a Decreased Risk of the Edinburgh Postnatal Depression Scale in Trial of Labor after Cesarean: A Multicenter, Prospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2408063. [PMID: 32025517 PMCID: PMC6991168 DOI: 10.1155/2020/2408063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/13/2019] [Indexed: 02/02/2023]
Abstract
Postpartum depression is a disabling mental disorder commonly seen in parturients under trial of labor after cesarean, which causes serious harm to the parturients. The etiology is unclear. We hypothesized that epidural labor analgesia can reduce the incidence rate of postpartum depression. Enrolled multiparas were divided into the epidural labor analgesia group (n = 263) or nonanalgesia group (n = 160) according to their own request. Edinburgh Postnatal Depression Scale was used to assess their mental status at 48 hours and 42 days after delivery. Relative perinatal variables were collected and further analyzed using univariate analysis and multivariate logistic regression analysis to assess the relation of epidural analgesia with the occurrence of postpartum depression under trial of labor after cesarean. The Edinburgh Postnatal Depression Scale score 48 hours ≥ 10 in the no epidural analgesia group was 26.42% while the epidural analgesia group was 8.49% (OR, 0.209; 95% CI, 0.096-0.429; P < 0.001). The Edinburgh Postnatal Depression Scale score 42 day ≥ 10 in the no epidural analgesia group was 25.16% while the epidural analgesia group was 6.59% (OR, 0.235; 95% CI, 0.113-0.469; P < 0.001). The incidence of postpartum depression was significantly lower in the epidural labor analgesia group at 48 hours and 42 days. There was also a significant relation between the Edinburgh Postnatal Depression Scale scores at 48 hours and 42 days after delivery. Epidural analgesia, discomfort within 42 days, and self-rating anxiety scale are independent predictors of postpartum depression for trial of labor after cesarean in 42 days. Epidural labor analgesia is associated with a decreased risk of postpartum depression. Further study with a large sample size and more centers is needed to evaluate the impact of epidural analgesia on the occurrence of postpartum depression. Chinese Clinical Trial Register, ChiCTR-ONC-17010654.
Collapse
Affiliation(s)
- Jing Sun
- Department of Anesthesiology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China
| | - Yuci Xiao
- Department of Anesthesiology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China
| | - Liwei Zou
- Department of Anesthesiology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China
| | - Danyong Liu
- Department of Anesthesiology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China
| | - Ting Huang
- Department of Obstetrics, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China
| | - Zhao Zheng
- Department of Anesthesiology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China
| | - Xuetao Yan
- Department of Anesthesiology, Bao'an Maternal and Child Health Hospital, Jinan University, Shenzhen 518106, China
| | - Aiwu Yuan
- Department of Anesthesiology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Shenzhen 518172, China
| | - Yuantao Li
- Department of Anesthesiology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China
| | - Xiaolei Huang
- Department of Anesthesiology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China
| |
Collapse
|
5
|
Azami M, Badfar G, Soleymani A, Rahmati S. The association between gestational diabetes and postpartum depression: A systematic review and meta-analysis. Diabetes Res Clin Pract 2019; 149:147-155. [PMID: 30735772 DOI: 10.1016/j.diabres.2019.01.034] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/30/2018] [Accepted: 01/30/2019] [Indexed: 01/18/2023]
Abstract
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.
Collapse
Affiliation(s)
- Milad Azami
- School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Gholamreza Badfar
- Department of Pediatrics, Behbahan Faculty of Medical Sciences, Behbahan, Iran
| | | | - Shoboo Rahmati
- School of Public Health, Ilam University of Medical Sciences, Ilam, Iran.
| |
Collapse
|
6
|
Usuda K, Nishi D, Okazaki E, Makino M, Sano Y. Optimal cut-off score of the Edinburgh Postnatal Depression Scale for major depressive episode during pregnancy in Japan. Psychiatry Clin Neurosci 2017; 71:836-842. [PMID: 28767198 DOI: 10.1111/pcn.12562] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/04/2017] [Accepted: 07/28/2017] [Indexed: 11/30/2022]
Abstract
AIM Depression during pregnancy adversely affects both mother and child. As antenatal depression is a predictor of postnatal depression, early detection might prevent postnatal depression. The Edinburgh Postnatal Depression Scale (EPDS) is frequently used during the perinatal period, but the cut-off score during pregnancy has not been verified for the Japanese population. We aimed to clarify the optimal EPDS cut-off score in mid-pregnancy in Japan. METHODS We recruited pregnant women aged 20 years or older at 12-24 gestational weeks and those who scored ≥9 on the EPDS were invited to participate in this study. In parallel with the EPDS, the Japanese version of the Mini-International Neuropsychiatric Interview was administered to determine diagnosis of major depressive episode. We then calculated the receiver-operator curve, sensitivity and specificity, and positive and negative predictive values for the EPDS. RESULTS All 210 participants were in the second trimester except for one (12 gestational weeks). Twenty participants were diagnosed with major depressive episode. With a cut-off score set at 13 points, the area under the curve was 0.956; sensitivity and specificity were 90.0% and 92.1% [Correction added on 10 November 2017, after first online publication: The percentage for specificity has been corrected from 79.0% to 92.1%.], respectively; and positive and negative predictive values were 54.5% and 98.9%, respectively. CONCLUSION To our knowledge, this is the first study to clarify the optimal EPDS cut-off score in the second trimester for Japan. This finding will be helpful for appropriate screening for antenatal depression in Japan.
Collapse
Affiliation(s)
- Kentaro Usuda
- Toda Chuo Women's Hospital, Saitama, Japan.,Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry,, Tokyo, Japan
| | - Daisuke Nishi
- Toda Chuo Women's Hospital, Saitama, Japan.,Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry,, Tokyo, Japan
| | - Emi Okazaki
- Toda Chuo Women's Hospital, Saitama, Japan.,Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry,, Tokyo, Japan
| | - Miyuki Makino
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo,, Japan
| | - Yo Sano
- Toda Chuo Women's Hospital, Saitama, Japan
| |
Collapse
|
7
|
Upadhyay RP, Chowdhury R, Aslyeh Salehi, Sarkar K, Singh SK, Sinha B, Pawar A, Rajalakshmi AK, Kumar A. Postpartum depression in India: a systematic review and meta-analysis. Bull World Health Organ 2017; 95:706-717C. [PMID: 29147043 PMCID: PMC5689195 DOI: 10.2471/blt.17.192237] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To provide an estimate of the burden of postpartum depression in Indian mothers and investigate some risk factors for the condition. METHODS We searched PubMed®, Google Scholar and Embase® databases for articles published from year 2000 up to 31 March 2016 on the prevalence of postpartum depression in Indian mothers. The search used subject headings and keywords with no language restrictions. Quality was assessed via the Newcastle-Ottawa quality assessment scale. We performed the meta-analysis using a random effects model. Subgroup analysis and meta-regression was done for heterogeneity and the Egger test was used to assess publication bias. FINDINGS Thirty-eight studies involving 20 043 women were analysed. Studies had a high degree of heterogeneity (I2 = 96.8%) and there was evidence of publication bias (Egger bias = 2.58; 95% confidence interval, CI: 0.83-4.33). The overall pooled estimate of the prevalence of postpartum depression was 22% (95% CI: 19-25). The pooled prevalence was 19% (95% CI: 17-22) when excluding 8 studies reporting postpartum depression within 2 weeks of delivery. Small, but non-significant differences in pooled prevalence were found by mother's age, geographical location and study setting. Reported risk factors for postpartum depression included financial difficulties, presence of domestic violence, past history of psychiatric illness in mother, marital conflict, lack of support from husband and birth of a female baby. CONCLUSION The review shows a high prevalence of postpartum depression in Indian mothers. More resources need to be allocated for capacity-building in maternal mental health care in India.
Collapse
Affiliation(s)
- Ravi Prakash Upadhyay
- Department of Community Medicine, Room 517, 5th floor, College Building, Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
| | | | - Aslyeh Salehi
- School of Health and Human Sciences, Southern Cross University, Queensland, Australia
| | - Kaushik Sarkar
- Directorate of National Vector Borne Disease Control Programme, New Delhi, India
| | - Sunil Kumar Singh
- Department of Community Medicine, Room 517, 5th floor, College Building, Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
| | - Bireshwar Sinha
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Aditya Pawar
- Department of Psychiatry, Drexel University College of Medicine, Philadelphia, United States of America
| | | | - Amardeep Kumar
- Department of Psychiatry, Patna Medical College, Patna, Bihar, India
| |
Collapse
|
8
|
Differentiating between Transient and Enduring distress on the Edinburgh Depression Scale within screening contexts. J Affect Disord 2016; 196:252-8. [PMID: 26943942 DOI: 10.1016/j.jad.2016.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 12/24/2015] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Research has shown that women screened as being 'possibly depressed' on the Edinburgh Depression Scale consist of two distinct duration types: those with Transient distress, and those with Enduring distress. This paper reports on the exploration of antenatal data to ascertain if information from the initial EDS screening can help determine which women may have Transient, and which Enduring, distress after just a few weeks. METHODS Data from three antenatal studies were explored, where the EDS had been given twice within a psychosocial screening setting. Repeat testing of the EDS, together with a diagnostic interview, was conducted 2-5 weeks later. RESULTS Women with Enduring distress (those scoring high on both occasions) were significantly more likely to meet criteria for a depressive disorder than those with Transient distress. They also scored significantly and clinically meaningfully higher on their initial EDS, though no cut-off score was optimal in discriminating between the two duration categories. Differentiation could also not be made from the endorsement of the self-harm question, but was best when women were asked to predict how they would be feeling, and why. LIMITATIONS The data come from three studies just with English-speaking women with slightly different methodologies, producing information on a fairly small number of women with Transient (n=12-29) and Enduring (n=14-25) distress. In addition the EDS re-test interval of between 2 and 5 weeks was quite wide. CONCLUSIONS Clinical implications are that women who score high initially on the EDS are most likely to continue to score high (have Enduring distress) if they themselves think this will be the case, or if they only give wishful thinking as the reason as to why they think they will feel better. Research studies should also therefore analyse their data taking into account this duration category.
Collapse
|
9
|
Matthey S, Souter K, Mortimer K, Stephens C, Sheridan-Magro A. Routine antenatal maternal screening for current mental health: evaluation of a change in the use of the Edinburgh Depression Scale in clinical practice. Arch Womens Ment Health 2016; 19:367-72. [PMID: 26349571 DOI: 10.1007/s00737-015-0570-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 08/26/2015] [Indexed: 11/25/2022]
Abstract
A hospital antenatal clinic conducting routine psychosocial screening changed the Edinburgh Depression Scale (EDS) referral criterion for determining which women needed to be referred to a multidisciplinary meeting health professional ("Safe Start meeting"). The criterion was changed from a score of 10 or more to 13 or more, when no other psychosocial risks were present. Women scoring 10-12 on the EDS, with no other psychosocial risks, were now informed they should contact the Social Work Department if they had issues they wanted to discuss with a health professional. The study evaluated the impact of this change in EDS clinical practice. Records were audited over a 20-month period. In addition, 20 women scoring in this EDS marginal range (10-12), with no other psychosocial risks, participated in a telephone interview to ascertain if they should have been referred to the Safe Start meeting. Of 174 eligible women who scored in the marginal EDS range, none had contacted the Social Work Department. In addition, none of the 20 women interviewed indicated that they would have wanted to talk further with a health professional. This change in clinical practice reduced monthly referrals to the Safe Start meeting by about 20%. There was a linear relationship between the increasing EDS category scores and the likelihood of psychosocial risks being endorsed. Increasing the automatic referral EDS cutoff score from 10 or more to 13 or more does not appear to result in women "in need" being missed. The reduction in referrals allowed more time in the Safe Start meeting to be devoted to women with greater needs.
Collapse
Affiliation(s)
- Stephen Matthey
- South Western Sydney Local Health District, Sydney, Australia.
- School of Psychology, University of Sydney, Sydney, Australia.
- School of Psychiatry, University of New South Wales, Sydney, Australia.
| | - Kay Souter
- South Western Sydney Local Health District, Sydney, Australia
| | - Kylie Mortimer
- South Western Sydney Local Health District, Sydney, Australia
| | | | | |
Collapse
|
10
|
Hall E, Steiner M. Psychiatric symptoms and disorders associated with reproductive cyclicity in women: advances in screening tools. ACTA ACUST UNITED AC 2015; 11:397-415. [PMID: 26102476 DOI: 10.2217/whe.15.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Female-specific psychiatric illness including premenstrual dysphoria, perinatal depression, and psychopathology related to the perimenopausal period are often underdiagnosed and treated. These conditions can negatively affect the quality of life for women and their families. The development of screening tools has helped guide our understanding of these conditions. There is a wide disparity in the methods, definitions, and tools used in studies relevant to female-specific psychiatric illness. As a result, there is no consensus on one tool that is most appropriate for use in a research or clinical setting. In reviewing this topic, we hope to highlight the evolution of various tools as they have built on preexisting instruments and to identify the psychometric properties and clinical applicability of available tools. It would be valuable for researchers to reach a consensus on a core set of screening instruments specific to female psychopathology to gain consistency within and between clinical settings.
Collapse
Affiliation(s)
- Elise Hall
- Women's Health Concerns Clinic, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Meir Steiner
- Women's Health Concerns Clinic, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.,Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
11
|
Nakić Radoš S, Herman R, Tadinac M. Is the Predictability of New-Onset Postpartum Depression Better During Pregnancy or in the Early Postpartum Period? A Prospective Study in Croatian Women. Health Care Women Int 2015; 37:23-44. [DOI: 10.1080/07399332.2014.992522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
12
|
Luoma I, Korhonen M, Salmelin RK, Helminen M, Tamminen T. Long-term trajectories of maternal depressive symptoms and their antenatal predictors. J Affect Disord 2015; 170:30-8. [PMID: 25218734 DOI: 10.1016/j.jad.2014.08.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 08/04/2014] [Accepted: 08/11/2014] [Indexed: 11/17/2022]
Abstract
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.
Collapse
Affiliation(s)
- Ilona Luoma
- University of Tampere, School of Medicine, University of Tampere, FI-33014, Finland; Tampere University Hospital, Department of Child Psychiatry, PO Box 2000, FI-33521 Tampere, Finland.
| | - Marie Korhonen
- University of Tampere, School of Medicine, University of Tampere, FI-33014, Finland
| | - Raili K Salmelin
- Tampere University Hospital, Department of Child Psychiatry, PO Box 2000, FI-33521 Tampere, Finland; University of Tampere, School of Health Sciences, University of Tampere, FI-33014, Finland
| | - Mika Helminen
- University of Tampere, School of Health Sciences, University of Tampere, FI-33014, Finland; Pirkanmaa Hospital District, Science Center, PO Box 2000, FI-33521 Tampere, Finland
| | - Tuula Tamminen
- University of Tampere, School of Medicine, University of Tampere, FI-33014, Finland; Tampere University Hospital, Department of Child Psychiatry, PO Box 2000, FI-33521 Tampere, Finland
| |
Collapse
|
13
|
Pereda Ríos A, Navarro González M, Viñuela Benéitez M, Aguarón de la Cruz A, Ortiz Quintana L. Desórdenes psiquiátricos en el puerperio: nuestro papel como obstetras. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2014. [DOI: 10.1016/j.gine.2013.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Ding T, Wang DX, Qu Y, Chen Q, Zhu SN. Epidural Labor Analgesia Is Associated with a Decreased Risk of Postpartum Depression. Anesth Analg 2014; 119:383-392. [DOI: 10.1213/ane.0000000000000107] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
15
|
Jones BA, Griffiths KM, Christensen H, Ellwood D, Bennett K, Bennett A. Online cognitive behaviour training for the prevention of postnatal depression in at-risk mothers: a randomised controlled trial protocol. BMC Psychiatry 2013; 13:265. [PMID: 24131528 PMCID: PMC3853016 DOI: 10.1186/1471-244x-13-265] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 09/30/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Postnatal depression (PND) is the most common disorder of the puerperium with serious consequences for both mother and child if left untreated. While there are effective treatments, there are many barriers for new mothers needing to access them. Prevention strategies may offer a more acceptable means of addressing the problem. Internet interventions can help overcome some barriers to reducing the impact of PND. However, to date there are no published studies that investigate the efficacy of internet interventions for the prevention of PND. METHODS/DESIGN The proposed study is a two-arm double blind randomised controlled trial. 175 participants will be recruited in the immediate postnatal period at an Australian community hospital. Women who meet inclusion criteria (internet access, email address, telephone number, over 18, live birth, fluent English) will complete the Edinburgh Postnatal Depression Scale (EPDS). Those with a score above 9 will undertake the Structured Clinical Interview for DSM Disorders (SCID). Those with a clinical diagnosis of depression, or a lifetime diagnosis of bipolar disorder or psychosis on the SCID will be excluded. Following completion of the baseline battery women will be randomised using a computer-generated algorithm to either the intervention or control condition. The intervention will consist of 5 modules of automated, interactive cognitive behaviour training (CB training), completed weekly with email reminders. The control will replicate the level of contact participants experience with the intervention, but the content will be of a general health nature. Participants will complete questionnaires immediately post-intervention (6 weeks) and 3-, 6- and 12 months follow-up. There will also be a second SCID delivered via telephone at 6 months. We hypothesise that relative to the control group, the intervention group will show a greater reduction in postnatal distress on the EPDS (primary outcome measure). We also hypothesise that the intervention group will demonstrate lower levels of anxiety and stress and higher levels of parenting confidence than the control group following intervention and/or follow-up. DISCUSSION The proposed study addresses a number of limitations of earlier trials. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registers, ACTRN12609001032246.
Collapse
Affiliation(s)
- Bethany A Jones
- Centre for Mental Health Research, The Australian National University, Building 63 Eggleston Road, Acton ACT 0200, Australia.
| | - Kathleen M Griffiths
- Centre for Mental Health Research, The Australian National University, Building 63 Eggleston Road, Acton ACT 0200, Australia
| | - Helen Christensen
- The Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, NSW 2031, Australia
| | - David Ellwood
- School of Medicine, Gold Coast campus, Griffith University, QLD 4222, Australia
| | - Kylie Bennett
- Centre for Mental Health Research, The Australian National University, Building 63 Eggleston Road, Acton ACT 0200, Australia
| | - Anthony Bennett
- Centre for Mental Health Research, The Australian National University, Building 63 Eggleston Road, Acton ACT 0200, Australia
| |
Collapse
|
16
|
Mortazavi F, Chaman R, Mousavi SA, Khosravi A, Ajami ME. Maternal psychological state during the transition to motherhood: a longitudinal study. Asia Pac Psychiatry 2013; 5:E49-57. [PMID: 23857812 DOI: 10.1111/appy.12075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 02/26/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the psychological state of women and its associated factors in the third trimester of pregnancy and at 8 weeks postpartum and to explore the changes in psychological state between these two time points. METHODS This survey study was carried out on 358 pregnant women visiting urban health centers in Shahroud, northeast Iran, in 2011. The women were followed at 8 weeks postpartum. In the third trimester of pregnancy, the participants completed the 28-item General Health Questionnaire (GHQ-28) and two other questionnaires on sociodemographic characteristics and frequent psychosocial stressors. They also completed the GHQ-28 and an obstetric information form at 8 weeks postpartum. The cutoff score for GHQ-28 in Iran has been calculated as 24, which denotes probable psychological health problems. RESULTS The mean total GHQ score decreased from 23.7 in the third trimester of pregnancy to 18.8 postpartum (P < 0.001). The proportion of women with a GHQ-28 score of 24 or higher in the third trimester of pregnancy and postpartum were 42% and 26%, respectively. Multiparity, caring for other family members, financial problems, and anxiety about personal and fetal health were the predictors of psychological health problems in the third trimester of pregnancy. The two predictors for postpartum psychological health problems were psychological health problems in the third trimester of pregnancy and the method of infant feeding at 8 weeks postpartum. DISCUSSION The prevalence of psychological symptoms was high among women in the third trimester of pregnancy. Psychological state of women improved after childbirth.
Collapse
Affiliation(s)
- Forough Mortazavi
- Student Research Committee, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | | | | | | |
Collapse
|
17
|
Conradt E, Manian N, Bornstein MH. Screening for Depression in the Postpartum using the Beck Depression Inventory-II: What Logistic Regression Reveals. J Reprod Infant Psychol 2012; 30:427-435. [PMID: 23569330 PMCID: PMC3618416 DOI: 10.1080/02646838.2012.743001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To identify items on the BDI-II that best discriminate between clinically depressed and nondepressed postpartum women. BACKGROUND Postpartum depression is a serious and widespread health burden, and the Beck Depression Inventory (BDI-II) is commonly used to detect depression in the postpartum. Yet certain depressive symptoms are "normative" sequelae of childbirth, calling into question the discriminative utility of the BDI-II. METHODS We examined the prospective contribution of BDI-II items to identify items that have the strongest relation with clinical postpartum depression. Women with BDI-II scores >12 were invited to participate in a structured clinical interview. A logistic regression was conducted to determine which BDI-II items discriminated between women who were later diagnosed as Depressed (n = 75) and Nondepressed (n = 78). RESULTS Of the 11 BDI-II items that differed between the two groups, eight represented cognitive/affective symptoms. Results from the logistic regression indicated that four BDI-II symptoms were significant predictors of Depression status: sadness, pessimism, loss of interest, and changes in appetite. CONCLUSION The BDI-II should be used in the postpartum with caution. Professionals who screen for postpartum depression should pay particular attention to cognitive/affective symptoms, as they appear more robust to normative physical and emotional changes that occur in the postpartum.
Collapse
|
18
|
Screening for postpartum depression using Kurdish version of Edinburgh postnatal depression scale. Arch Gynecol Obstet 2011; 285:1249-55. [PMID: 22159747 DOI: 10.1007/s00404-011-2165-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 11/23/2011] [Indexed: 12/27/2022]
Abstract
BACKGROUND One of the important public health problems affecting maternal and child health is postpartum depression (PPD). It generally occurs within 6-8 weeks after childbirth. OBJECTIVES To determine the prevalence of postpartum depression (PPD) using a Kurdish version of Edinburgh postpartum depression scale (EPDS) and to analyze the risk factors for postpartum depression in a population of puerperal Kurdish women in Erbil city. PATIENTS AND METHODS A cross-sectional study was conducted between 20th of June and 30th of November 2010, in 14 antenatal care units of primary health centers, in Erbil city, Kurdistan region, Iraq. The sample of the study included 1,000 puerperal women (6-8 weeks postpartum), ranging in age from 14 to 48 years. Data were collected after interviewing the women using a questionnaire designed by the researchers, and the Kurdish version of the EPDS. Chi square test of association and the logistic regression tests were used in the analysis. RESULTS The prevalence of postpartum depression was 28.4%. Logistic regression analysis showed that the factors found to be associated with PPD were: physical or sexual abuse, delivery by cesarean section, history of past psychiatric illness, and family history of past psychiatric illness; while marriage with no previous agreement, and high socio-economic level were associated with lower levels of PPD. CONCLUSION The Kurdish version of the EPDS can be successfully used to screen depression in a Kurdish population of puerperal women.
Collapse
|
19
|
|
20
|
Sylvén SM, Papadopoulos FC, Olovsson M, Ekselius L, Poromaa IS, Skalkidou A. Seasonality patterns in postpartum depression. Am J Obstet Gynecol 2011; 204:413.e1-6. [PMID: 21439544 DOI: 10.1016/j.ajog.2011.01.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 01/14/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the possible association between postpartum depressive symptoms and season of delivery. STUDY DESIGN During 1 year, delivering women in the Uppsala University Hospital were asked to participate in the study by filling out 3 postpartum questionnaires containing the Edinburgh Postnatal Depression scale and questions assessing life style, medical history, breastfeeding, and social support. RESULTS Two thousand three hundred eighteen women participated. Women delivering in the last 3 months of the year had a significantly higher risk of self-reported depressive symptomatology both at 6 weeks (odds ratio, 2.02, 95% confidence interval, 1.32-3.10) and at 6 months after delivery (odds ratio, 1.82, 95% confidence interval, 1.15-2.88), in comparison to those delivering April-June, both before and after adjustment for possible confounders. CONCLUSION Women delivering during the last quartile of the year had a significantly higher risk for depressive symptoms 6 weeks and 6 months postpartum and would thus benefit from a closer support and follow-up after delivery.
Collapse
Affiliation(s)
- Sara M Sylvén
- Department of Women's and Children's Health, Uppsala University, Sweden
| | | | | | | | | | | |
Collapse
|
21
|
Abstract
BACKGROUND Diagnostic and Statistical Manual (DSM) IV-based depression interviews, valued for their diagnostic accuracy, are often considered to be essential for depression treatment trials. However, this requirement can be problematic because of participant burden. The purpose of this article is to describe our experience with the depression component of the Structured Clinical Interview for DSM Disorders (SCID) in a postpartum depression treatment trial. METHODS In this prospective cohort study of 506 mothers of infants from 7 primary care clinics, participants were asked to complete the depression module of the SCID interview soon after enrollment. They were asked to complete the 9-item Patient Health Questionnaire (PHQ-9) depression survey at 0 to 1, 2, 4, 6, and 9 months postpartum. RESULTS Forty-five women (8.9%) had a positive SCID interview and 112 (22.1%) had a positive PHQ-9 during 0 to 9 months postpartum. Problems encountered when using the SCID depression interview included (1) lower than expected SCID-based rates of depression diagnosis (8.9%); (2) SCID noncompletion by 75 women (14.8%); SCID noncompleters (vs completers) were younger, poorer, less educated, and more likely to be single and black (vs white); and (3) inconsistent SCID/PHQ-9 results. Nineteen women with moderately severe to severe PHQ-9 score elevations (≥15) had negative SCID scores; all of these women were functionally impaired. More than 90% of women with positive PHQ-9 scores reported some degree of impairment because of their depressive symptoms. CONCLUSIONS The requirement of a diagnostic depression interview resulted in selection bias and missed opportunities for depression diagnosis; these are problems that detract from the interview's key strength-its diagnostic accuracy. These problems should be considered when electing to use a DSM-IV-based depression interview in research.
Collapse
|
22
|
Choi EY, Lee EH, Choi JS, Choi SH. A Comparative Study on the Postpartum Depression of Vietnamese Marriage Immigrant Women and Korean Women. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2011; 17:39-51. [PMID: 37697573 DOI: 10.4069/kjwhn.2011.17.1.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
PURPOSE This study aimed to examine postpartum depression of Vietnamese married immigrant women and Korean women, and to identify factors that affect postpartum depression. METHODS Subjects of one hundred and thirty-five women who had delivered a baby within 3 years were part of the study. Of these women, sixty were Vietnamese married immigrant women and sixty -seven were Korean women living in Gangwon Province. Kim's (2005) Korean version of Cox's (1987) EPDS (Edinburgh Postnatal Depression Scale) was used to evaluate postpartum depression. The reliability of the entire subjects was Cronbach's alpha=.677, Vietnamese women .743, and Korean women .654. RESULTS There were significant differences between the two groups in demographic data and obstetric history. There were significant differences in EPDS (t=-0.236, p=.814) of the type of household between the two groups. Korean women experienced more depression in the items of EPDS 1,2,5, and Vietnamese women experienced more depression in the items of EPDS 7, 8, and 10 when comparing item by item. The influencing factors of EPDS in entire subjects were marriage type, satisfaction of relationship with the husband and other household extended family members, and emotional experience during pregnancy. CONCLUSION Postpartum depression has occurred regardless of ethnicity, therefore prevention programs targeted at depression, and family support programs should be developed for all childbearing women.
Collapse
Affiliation(s)
- Eun Young Choi
- Department of Nursing, Gangneung-Wonju National University, Korea
| | - Eun Hee Lee
- Department of Nursing, Gangneung-Wonju National University, Korea
| | - Jung Sook Choi
- Department of Nursing, Gangneung-Wonju National University, Korea
| | - Sun Ha Choi
- Department of Nursing, Gangneung-Wonju National University, Korea
| |
Collapse
|
23
|
Lee SO, Yeo JH, Ahn SH, Lee HS, Yang HJ, Han MJ. Postpartum Depressive Score and Related Factors Pre- and Post-delivery. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2010; 16:29-36. [PMID: 37697614 DOI: 10.4069/kjwhn.2010.16.1.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
PURPOSE This study aimed to identify the scores of postpartum depression(PPD) on the first day, 1st week, and 6th week after the delivery and to explore their related factors before and after delivery in postpartum women. METHODS With a survey design, 293 postpartum women were recruited from a postpartum unit, Ilsin Christian hospital in Pusan via convenience sampling and were followed at 1st week and 6th week in the outpatient clinic. RESULTS Results showed that the scores of PPD(EPDS score) were low at postpartum 1st day, 1st week and 6th week but prevalence of PPD(EPDS > or =13) was 3.1% at 1st day, 8.2% at 1st week and 7.5% at 6th week, respectively. The pre-delivery factors were experience of depression, and the post-delivery factors were baby's sex(1st day), no caregiver for baby(1st week), and no help and concern for taking care of baby from husband and family(1st day and 6th week). The greater satisfaction with becoming a mother and her life, and greater maternal attachment were related to lower level of PPD at the three time points. CONCLUSION Regular screening for postpartum depression and supportive and informative education is needed for postpartum women visiting the outpatient clinic for follow-up.
Collapse
Affiliation(s)
- Sun Ok Lee
- Department of Nursing, Silla University, Korea
| | | | - Suk Hee Ahn
- Department of Nursing, Silla University, Korea
| | | | | | - Mi Jung Han
- Department of Nursing, Silla University, Korea
| |
Collapse
|
24
|
Law LW, Pang MW, Chung TKH, Lao TTH, Lee DTS, Leung TY, Sahota DS, Lau TK. Randomised trial of assigned mode of delivery after a previous cesarean section – Impact on maternal psychological dynamics. J Matern Fetal Neonatal Med 2010; 23:1106-13. [DOI: 10.3109/14767050903551434] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
25
|
Skalkidou A, Sylvén SM, Papadopoulos FC, Olovsson M, Larsson A, Sundström-Poromaa I. Risk of postpartum depression in association with serum leptin and interleukin-6 levels at delivery: a nested case-control study within the UPPSAT cohort. Psychoneuroendocrinology 2009; 34:1329-37. [PMID: 19427131 DOI: 10.1016/j.psyneuen.2009.04.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 02/12/2009] [Accepted: 04/04/2009] [Indexed: 11/19/2022]
Abstract
Although postpartum depression (PPD) is a common condition, it often goes undiagnosed and untreated, with devastating consequences for the woman's ability to perform daily activities, to bond with her infant and to relate to the infant's father. Leptin, a protein synthesised in the adipose tissue and involved in regulation of food intake and energy expenditure has been related to depressive disorders, but studies report conflicting results. The aim of this study was to evaluate the association between serum leptin levels at the time of delivery and the subsequent development of postpartum depression in women, using data from a population-based cohort of delivering women in Uppsala, Sweden. Three hundred and forty seven women from which serum was obtained at the time of delivery filled out at least one of three structured questionnaires containing the Edinburgh Scale for Postnatal Depression (EPDS) at five days, six weeks and six months after delivery. Mean leptin levels at delivery did not significantly differ between the 67 cases of PPD and the 280 controls. Using linear regression analysis and adjusting for maternal age, body-mass index, smoking, interleukin-6 levels, duration of gestation and gender of the newborn, the EPDS scores at six weeks and six months after delivery were found to be negatively associated with leptin levels at delivery (p<0.05). Serum leptin levels at delivery were found to be negatively associated with self-reported depression during the first six months after delivery. No such association was found concerning serum IL-6 levels at delivery. If these finding are replicated by other studies, leptin levels at delivery could eventually serve as a biological marker for the prediction of postpartum depression.
Collapse
Affiliation(s)
- Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden.
| | | | | | | | | | | |
Collapse
|
26
|
Ip WY, Tang CSK, Goggins WB. An educational intervention to improve women’s ability to cope with childbirth. J Clin Nurs 2009; 18:2125-35. [DOI: 10.1111/j.1365-2702.2008.02720.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
27
|
Park ER, Chang Y, Quinn V, Regan S, Cohen L, Viguera A, Psaros C, Ross K, Rigotti N. The association of depressive, anxiety, and stress symptoms and postpartum relapse to smoking: a longitudinal study. Nicotine Tob Res 2009; 11:707-14. [PMID: 19436040 DOI: 10.1093/ntr/ntp053] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The aim of this prospective repeated measures, mixed-methods observational study was to assess whether depressive, anxiety, and stress symptoms are associated with postpartum relapse to smoking. METHODS A total of 65 women who smoked prior to pregnancy and had not smoked during the last month of pregnancy were recruited at delivery and followed for 24 weeks. Surveys administered at baseline and at 2, 6, 12, and 24 weeks postpartum assessed smoking status and symptoms of depression (Beck Depression Inventory [BDI]), anxiety (Beck Anxiety Inventory [BAI]), and stress (Perceived Stress Scale [PSS]). In-depth interviews were conducted with women who reported smoking. RESULTS Although 92% of the participants reported a strong desire to stay quit, 47% resumed smoking by 24 weeks postpartum. Baseline factors associated with smoking at 24 weeks were having had a prior delivery, not being happy about the pregnancy, undergoing counseling for depression or anxiety during pregnancy, and ever having struggled with depression (p < .05). In a repeated measures regression model, the slope of BDI scores from baseline to the 12-week follow-up differed between nonsmokers and smokers (-0.12 vs. +0.11 units/week, p = .03). The slope of PSS scores also differed between nonsmokers and smokers (-0.05 vs. +0.08 units/week, p = .04). In qualitative interviews, most women who relapsed attributed their relapse and continued smoking to negative emotions. DISCUSSION Among women who quit smoking during pregnancy, a worsening of depressive and stress symptoms over 12 weeks postpartum was associated with an increased risk of smoking by 24 weeks.
Collapse
Affiliation(s)
- Elyse R Park
- Tobacco Research and Treatment Center, Institute for Health Policy, and Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, MA 02114, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Mann R, Hewitt CE, Gilbody SM. Assessing the quality of diagnostic studies using psychometric instruments: applying QUADAS. Soc Psychiatry Psychiatr Epidemiol 2009; 44:300-7. [PMID: 18836883 DOI: 10.1007/s00127-008-0440-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 09/15/2008] [Indexed: 01/25/2023]
Abstract
BACKGROUND There has been an increase in the number of systematic reviews of diagnostic tests, which has resulted in the introduction of two checklists: statement for reporting of diagnostic accuracy (STARD) and quality assessment of diagnostic accuracy studies (QUADAS). OBJECTIVE To examine the validity and usefulness of QUADAS when applied to diagnostic accuracy studies using psychometric instruments and to examine the quality in reporting of these studies during practical application of the checklist. METHOD Two reviewers independently rated the quality of 54 studies using QUADAS. The proportion of agreement was used to assess overall agreement and individual agreement of QUADAS items between reviewers. RESULTS The overall agreement between the two reviewers for all QUADAS items combined was 85.7%. The proportion of agreement between reviewers for each item ranged from just over 57-100% and was over 80% for 8 of the items. The poorest agreement was associated with the items for selection criteria, indeterminate results and withdrawals. None of the studies adequately reported all relevant information to enable all QUADAS item to be scored as 'yes'. CONCLUSION Overall QUADAS was relatively easy to use and appears to be an acceptable tool for appraising the quality of diagnostic accuracy studies using psychometric instruments. The application of QUADAS was hampered by the poor quality of reporting encountered.
Collapse
Affiliation(s)
- Rachel Mann
- Dept. of Health Sciences, University of York, York YO10 5DD, UK
| | | | | |
Collapse
|
29
|
Posmontier B. Functional status outcomes in mothers with and without postpartum depression. J Midwifery Womens Health 2008; 53:310-8. [PMID: 18586183 DOI: 10.1016/j.jmwh.2008.02.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 01/29/2008] [Accepted: 02/11/2008] [Indexed: 12/17/2022]
Abstract
Our objective was to compare functional status between women with and without postpartum depression (PPD). A two-group cross-sectional design compared functional status between 23 women with and 23 women without PPD. Participants were 6 to 26 weeks postpartum and from obstetric practices in the northeastern United States. Structured clinical interviews were used to establish diagnoses of PPD. Participants were matched on type of delivery, weeks postpartum, and parity. Participants compared current functioning to prepregnancy functioning using the Inventory of Functional Status After Childbirth. The Postpartum Depression Screening Scale was used to measure PPD severity. Hierarchical multiple and logistic regression models were used to analyze data. We found that after controlling for infant gender, number of nighttime infant awakenings, and income, PPD predicted lower personal (P < .001), household (P < .05), and social functioning (P < .001), but no difference in infant care. Women with PPD were 12 times less likely to achieve prepregnancy functional levels. We conclude that interventions are needed to address household, social, and personal functioning in women with PPD. Clinicians may find functional assessment is a useful adjunct and a less threatening way to screen and monitor treatment for PPD.
Collapse
|
30
|
Abstract
OBJECTIVE To compare and measure the effects of sleep quality in women with and without postpartum depression. DESIGN A case-control repeated measures matched pairs design. SETTING Home and obstetric office. PARTICIPANTS Forty-six women who were 6 to 26 weeks postpartum. Two participants were dropped from the final analysis because they were outliers. METHODS Participants underwent wrist actigraphy at home for 7 consecutive days to measure sleep quality. The Postpartum Depression Screening Scale measured depression severity. Psychosocial variables were collected during a screening interview. A structured clinical interview was used to diagnose postpartum depression. Correlations, t tests, and hierarchical multiple regressions were run to analyze data. RESULTS With the exception of wake episodes, sleep latency (B=1.80, SE=0.73, p<.05), wake after sleep onset (B=6.85, SE=2.85, p<.05), and thus sleep efficiency (B=-6.31, SE=3.13, p<.05) predicted postpartum depression symptom severity. CONCLUSIONS Women with postpartum depression experienced poorer sleep quality than women without postpartum depression, and sleep quality worsened with increasing postpartum depression symptom severity. Clinicians need to address measures to improve sleep quality in depressed mothers to decrease symptom severity, and researchers need to develop interventions to facilitate better sleep quality in women with postpartum depression.
Collapse
Affiliation(s)
- Bobbie Posmontier
- Drexel University, College of Nursing and Health Professions, Newtown, PA 18940, USA.
| |
Collapse
|
31
|
|
32
|
Santos IS, Matijasevich A, Tavares BF, da Cruz Lima AC, Riegel RE, Lopes BC. Comparing validity of Edinburgh scale and SRQ20 in screening for post-partum depression. Clin Pract Epidemiol Ment Health 2007; 3:18. [PMID: 17903254 PMCID: PMC2233608 DOI: 10.1186/1745-0179-3-18] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 09/28/2007] [Indexed: 11/27/2022]
Abstract
The Edinburgh Postnatal Depression Scale (EPDS) is the instrument most used worldwide for screening of Post-Partum Depression (PPD). The SRQ20 questionnaire has been largely used for screening of minor psychiatric disorders. This study aimed to compare the accuracy of the two instruments in screening for PPD. At the third-month follow-up home visit to infants of the 2004 Pelotas Birth Cohort, Southern Brazil, a sub-sample of 378 mothers was selected. Among other questions, EPDS and SRQ20 were applied by trained fieldworkers. Up to 15 days later, a mental health professional re-interviewed the mother (the gold standard interview). Sensitivity and specificity of each cutoff point were calculated for EPDS and SRQ20 and the results were plotted at a ROC curve. The areas under both curves were compared. Highest sensitivity and specificity cutoff were observed for EPDS ≥ 10 (sensitivity 82.7%, 95%CI 74.0 – 89.4; specificity 65.3%, 95%CI 59.4 – 71.0) and for SRQ20 ≥ 6 (sensitivity 70.5%, 95%CI 60.8 – 79.0%; specificity 75.5%, 95%CI 70.0 – 80.5%). Shape of ROC curves and areas under both curves were virtually identical (respectively, 0.8401 ± 0.02 for EPDS and 0.8402 ± 0.02 for SRQ20; p = 0.9). In conclusion SRQ20 showed to be as valid as EPDS as a screening tool for PPD at third month after delivery.
Collapse
Affiliation(s)
- Iná S Santos
- Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Alicia Matijasevich
- Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Beatriz F Tavares
- Department of Mental Health, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Andrey C da Cruz Lima
- Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Rafael E Riegel
- Department of Mental Health, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Bruna C Lopes
- Department of Mental Health, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil
| |
Collapse
|
33
|
Abstract
PURPOSE OF REVIEW Common and important psychosomatic disorders in pregnancy reviewed here include perinatal depression, posttraumatic stress disorders, anxiety disorders, eating disorders, and postpartum psychosis. RECENT FINDINGS Research has focused on antenatal depression as postpartum depression often has onset prior to delivery. Certain psychosocial and psychological interventions can effectively prevent postnatal depression. Although the use of selective serotonin reuptake inhibitors was associated with miscarriage, preterm delivery, and fetal death, discontinuation of antidepressants also increased the relapse rate during pregnancy. Studies also show that about 8% of mothers had eating problems during their pregnancy, which increased to 19% in the postpartum period. Postpartum psychosis is an important diagnosis related to maternal death from suicide. Personal and family history of bipolar disorders are important risk factors. SUMMARY Recent findings highlight the importance of correct diagnosis and awareness of serious mental illness. In view of the higher rate of relapse, women should be counselled carefully regarding discontinuation of antidepressants during pregnancy. Differentiation of posttraumatic stress disorders with comorbid anxiety and depression, awareness of risk factors, and clinical features of psychosis are important in the management of psychosomatic disorders in pregnancy.
Collapse
Affiliation(s)
- Wing Hung Tam
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong.
| | | |
Collapse
|
34
|
Pitanupong J, Liabsuetrakul T, Vittayanont A. Validation of the Thai Edinburgh Postnatal Depression Scale for screening postpartum depression. Psychiatry Res 2007; 149:253-9. [PMID: 17084907 DOI: 10.1016/j.psychres.2005.12.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2005] [Revised: 11/15/2005] [Accepted: 12/28/2005] [Indexed: 12/14/2022]
Abstract
This study aimed to validate and determine an appropriate cut-off score on the Thai Edinburgh Postnatal Depression Scale (EPDS) as a screen for postpartum depression. A prospective cohort of postpartum women at 6-8 weeks were tested using the EPDS and clinically interviewed by psychiatrists to establish a DSM-IV diagnosis of major or minor depressions in a university hospital in Southern Thailand. Of 351 postpartum women interviewed, 38 postpartum women met the criteria for depressive disorders, major depression in four women (1%) and minor depressive disorder in 34 women (10%). The area under the curve was 0.84 (95% confidence interval 0.76-0.91). Using an EPDS cut-off sum score of 6/7, major and/or minor depression was detected with a sensitivity of 74%, specificity of 74%, positive predictive value of 26% and negative predictive value of 95%. When the cut-off score was higher, the sensitivity was lower but the specificity was higher. The Thai version of the EPDS is a valid self-report instrument and is useful in Thailand where no other screening instrument for postpartum depression is available.
Collapse
Affiliation(s)
- Jarurin Pitanupong
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | | | | |
Collapse
|
35
|
Dennis CL, Ross LE. Depressive symptomatology in the immediate postnatal period: identifying maternal characteristics related to true- and false-positive screening scores. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2006; 51:265-73. [PMID: 16986815 DOI: 10.1177/070674370605100501] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine whether true- and false-positive postnatal depression screening scores can be distinguished during the early postpartum period by examining characteristic differences between 2 groups: 1) women with depressive symptomatology at 1 week postpartum who continue to exhibit symptoms at 8 weeks postpartum, compared with those who do not; and 2) women with depressive symptomatology at 8 weeks postpartum who previously exhibited symptoms at 1 week postpartum, compared with those who did not. METHOD As part of a longitudinal postpartum depression study, a population-based sample of 594 women completed mailed questionnaires at 1, 4, and 8 weeks postpartum. RESULTS Among women with depressive symptomatology at 1 week postpartum, diverse variables distinguished between those whose symptoms persisted or remitted at 8 weeks. These variables included recent immigrant status, psychiatric history, premenstrual symptoms, vulnerable personality, low self-esteem, child abuse history, and insufficient support. Variables that distinguished between women with depressive symptomatology at 8 weeks postpartum who previously exhibited symptoms at 1 week postpartum and those who did not included vulnerable personality, life stressors, perceived stress, insufficient support, and partner conflict. CONCLUSIONS To address both the benefits and potential harms of early screening, positive screening scores on the Edinburgh Postnatal Depression Scale should also include an assessment of each individual woman's risk for postpartum depression and (or) chronic major depression.
Collapse
|
36
|
Boyd RC, Le HN, Somberg R. Review of screening instruments for postpartum depression. Arch Womens Ment Health 2005; 8:141-53. [PMID: 16133785 DOI: 10.1007/s00737-005-0096-6] [Citation(s) in RCA: 247] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 07/16/2005] [Indexed: 01/03/2023]
Abstract
This paper presents a review and discussion of eight self-report measures used to assess for depressive symptoms in the postpartum period. Because postpartum depression is a significant mental health problem, there is a need for reliable and valid screening instruments. Published psychometric data (e.g., reliability, sensitivity, specificity, positive predictive value, concurrent validity) of each self-report instrument are presented and critiqued. Results suggest that the Edinburgh Postnatal Depression Scale is the most extensively studied measure with postpartum women with moderate psychometric soundness. This review illustrates the need for more research in this area. Issues involved in the selection of measures are considered. Implications for clinical practice, research, culture and language are discussed.
Collapse
Affiliation(s)
- R C Boyd
- University of Pennsylvania School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | | | | |
Collapse
|