Identification of postpartum depression

Awareness of postpartum depression among midwives and pregnant women in Arkhangelsk, Arctic Russia

BACKGROUND

Postpartum depression (PPD) affects approximately 17% of the women worldwide with nearly half of all cases going undetected. More research on maternal mental health, particularly among healthcare professionals and pregnant mothers, could help identify PPD risks and reduce its prevalence.

OBJECTIVE

Given that awareness of PPD is a crucial preventive factor, we studied PPD awareness among midwives and pregnant women in Arkhangelsk, Arctic Russia.

METHODS

A qualitative study was conducted using in-depth semi-structured interviews. Midwives and pregnant women were recruited from the women's clinic of the Arkhangelsk municipal polyclinic. Seven midwives and 12 pregnant mothers were interviewed.

RESULTS

Midwives described limited time for psychological counselling of pregnant women; they reported that their primary focus was on the physiological well-being of women. Pregnant women have expressed a desire for their families to share responsibilities. The participants considered PPD as a mix of psychological and physiological symptoms, and they also highlighted a discrepancy between the expectations of pregnant women and the reality of motherhood. The present study underscored the limited understanding of PPD identification.

CONCLUSIONS

The findings suggest that there is a need for increased awareness among midwives and pregnant women regarding PPD. Prevention programs targeting PPD with a specific emphasis on enhancing maternal mental health knowledge are warranted.

Determinants of postpartum depression among women in Kampong Chhnang Province, Cambodia

OBJECTIVE

This study aimed to identify the prevalence of postpartum depression (PPD) and the factors associated with PPD in Kampong Chhnang Province, Cambodia.

STUDY DESIGN

A cross-sectional study.

PARTICIPANTS

This study included 440 Cambodian women at 6-8 weeks postpartum who visited health centers between July and September 2021.

MATERIALS AND METHODS

Data were collected through face-to-face interviews by midwives and nurses using a structured questionnaire. The Edinburgh Postnatal Depression Scale (EPDS) in the Khmer language was used to screen for PPD, and suspected PPD was defined as a total EPDS score ≥ 10. Logistic regression analyses were performed to identify the factors associated with suspected PPD.

FINDINGS

The average age of participants was 28.6 years old. The prevalence of suspected-PPD was 30.2 % (n = 133). Factors associated with suspected PPD were income dissatisfaction (adjusted odds ratio (AOR) = 2.66, 95 % confidence interval (CI) 1.27-5.56, P = 0.010), unintended pregnancy (AOR = 1.99, 95 % CI 1.10-3.61, P = 0.023), and a partner employed as a manual laborer (AOR = 3.85, 95 % CI 1.11-13.33, P = 0.034), farmer (AOR = 3.69, 95 % CI 1.11-12.31, P = 0.034), and factory worker (AOR = 5.43, 95 % CI 1.38-21.41, P = 0.016). In addition, poor relationship with partners (AOR = 2.14, 95 % CI 1.17-3.94, P = 0.014), poor relationship with mother-in-law (AOR = 3.51, 95 % CI 1.70-7.21, P < 0.001), and a history of depression before pregnancy (AOR = 6.34, 95 % CI 1.59-25.34, P = 0.009) were significantly associated with suspected-PPD.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

This study highlighted the need for mental health services in primary healthcare settings. Mental health training for healthcare workers, particularly primary-level nurses, should be prioritized and strengthened. Further clinical study on EPDS validation should be carried out to justify the appropriate cut-off EPDS score for Cambodian women. The EPDS should be integrated into routine PNC services to identify women with suspected-PPD. Education on PPD should be provided not only to the nurses and midwives, but also to the women and their families to support the mental health of pregnant and postpartum women.

Harnessing Consumer Wearable Digital Biomarkers for Individualized Recognition of Postpartum Depression Using the All of Us Research Program Data Set: Cross-Sectional Study

BACKGROUND

Postpartum depression (PPD) poses a significant maternal health challenge. The current approach to detecting PPD relies on in-person postpartum visits, which contributes to underdiagnosis. Furthermore, recognizing PPD symptoms can be challenging. Therefore, we explored the potential of using digital biomarkers from consumer wearables for PPD recognition.

OBJECTIVE

The main goal of this study was to showcase the viability of using machine learning (ML) and digital biomarkers related to heart rate, physical activity, and energy expenditure derived from consumer-grade wearables for the recognition of PPD.

METHODS

Using the All of Us Research Program Registered Tier v6 data set, we performed computational phenotyping of women with and without PPD following childbirth. Intraindividual ML models were developed using digital biomarkers from Fitbit to discern between prepregnancy, pregnancy, postpartum without depression, and postpartum with depression (ie, PPD diagnosis) periods. Models were built using generalized linear models, random forest, support vector machine, and k-nearest neighbor algorithms and evaluated using the κ statistic and multiclass area under the receiver operating characteristic curve (mAUC) to determine the algorithm with the best performance. The specificity of our individualized ML approach was confirmed in a cohort of women who gave birth and did not experience PPD. Moreover, we assessed the impact of a previous history of depression on model performance. We determined the variable importance for predicting the PPD period using Shapley additive explanations and confirmed the results using a permutation approach. Finally, we compared our individualized ML methodology against a traditional cohort-based ML model for PPD recognition and compared model performance using sensitivity, specificity, precision, recall, and F1-score.

RESULTS

Patient cohorts of women with valid Fitbit data who gave birth included <20 with PPD and 39 without PPD. Our results demonstrated that intraindividual models using digital biomarkers discerned among prepregnancy, pregnancy, postpartum without depression, and postpartum with depression (ie, PPD diagnosis) periods, with random forest (mAUC=0.85; κ=0.80) models outperforming generalized linear models (mAUC=0.82; κ=0.74), support vector machine (mAUC=0.75; κ=0.72), and k-nearest neighbor (mAUC=0.74; κ=0.62). Model performance decreased in women without PPD, illustrating the method's specificity. Previous depression history did not impact the efficacy of the model for PPD recognition. Moreover, we found that the most predictive biomarker of PPD was calories burned during the basal metabolic rate. Finally, individualized models surpassed the performance of a conventional cohort-based model for PPD detection.

CONCLUSIONS

This research establishes consumer wearables as a promising tool for PPD identification and highlights personalized ML approaches, which could transform early disease detection strategies.

Zuranolone, a neuroactive drug, used in the treatment of postpartum depression by modulation of GABAA receptors

BACKGROUND

Postpartum depression [PPD] is a prevalent and debilitating mood disorder that affects mothers in the weeks to months after childbirth. Zuranolone (Zurzuvae) is a novel pharmaceutical agent that was approved by the US FDA on 4 August 2023 for the management of PPD. This review article provides a comprehensive overview of zuranolone, focusing on its dosing, chemistry, mechanism of action, clinical trials, adverse drug reaction, and overall conclusion regarding its utility in the management of PPD. It also discusses the recommended dosing strategies to achieve optimal efficacy while minimizing adverse effects as the dosage regimen of zuranolone is critical for its therapeutic application. Moreover, it gives insights into neurobiological pathways involved in PPD.

METHODOLOGY

Data from randomized controlled trials and observational studies was collected to provide a comprehensive understanding of zuranolone in the management and treatment of PPD.

CONCLUSION

Zuranolone represents a promising therapeutic option for women suffering from postpartum depression. However, ongoing research and post-marketing surveillance are essential to further elucidate its long-term safety and efficacy. The integration of zuranolone into clinical practice may significantly improve the quality of life for mothers facing the challenges of postpartum depression.

Postpartum Depression: Etiology, Treatment, and Consequences for Maternal Care

Postpartum depression (PPD) is a disabling condition that has recently shown an increase in prevalence, becoming an essential public health problem. This study is a qualitative review summarizing the most frequent risk factors associated with PPD, evaluating molecular aspects of PPD and current approaches to detect and prevent PPD. The most prevalent risk factors were detected in the areas of economic and social factors, obstetrical history, lifestyle, and history of mental illness. Research on the genetic basis for PPD has taken place in recent years to identify the genes responsible for establishing targeted therapeutic methods and understanding its pathogenesis. The most frequently studied candidate gene was the serotonin transporter gene (SERT) associated with PPD. Among biological studies, antidepressants and psychological interventions provided the most evidence of successful intervention. The obstetrician can serve an essential role in screening for and treating PPD. Postpartum women with risk factors should be screened using the Edinburgh Postnatal Depression Scale (EPDS), but, at the moment, there are no prevention programs in Europe. In conclusion, data from this review increase concerns among this vulnerable population and can be used to design a screening tool for high-risk pregnant women and create a prevention program.

Urinary incontinence increases risk of postpartum depression: systematic review and meta-analysis

OBJECTIVE

Postpartum depression is one of the most common complications after childbearing. Urinary incontinence is a frequent symptom during pregnancy and the postnatal period, often being the first time that women experience it. This systematic review and meta-analysis aimed to synthesize the evidence on the association between urinary incontinence and postpartum depression and to assess whether this association becomes weaker at 6 months after childbirth.

DATA SOURCES

MEDLINE, Embase, Cochrane Library, Web of Science, and PsycINFO were searched from inception to December 26, 2023.

STUDY ELIGIBILITY CRITERIA

Cross-sectional and cohort studies addressing the association between urinary incontinence and postpartum depression were included.

METHODS

Pooled odds ratios and their 95% confidence intervals, and 95% prediction intervals were estimated using a DerSimonian and Laird random-effects model for the association between urinary incontinence and postpartum depression. Subgroup analyses were conducted on the basis of time after delivery (<6 or ≥6 months). The risk of bias was assessed with the National Institutes of Health Quality Assessment Tool for Observational Cohort Studies.

RESULTS

Eleven published studies were included in the systematic review and meta-analysis. Overall, the odds ratio for the association between urinary incontinence and postpartum depression was 1.45 (95% confidence interval, 1.11-1.79; 95% prediction interval, 0.49-2.40; I2=65.9%; P=.001). For the 7 cohort studies, the odds ratio was 1.63 (95% confidence interval, 1.35-1.91; 95% prediction interval, 1.14-2.13; I2=11.1%; P=.345). For the 4 cross-sectional studies, the odds ratio was 1.05 (95% confidence interval, 1.04-1.05; 95% prediction interval, 1.04-1.06; I2=0.0%; P=.413). According to the time after delivery, the odds ratio estimates for cohort studies with a postpartum period <6 months were 1.44 (95% confidence interval, 1.07-1.81; prediction interval, 0.63-2.25; I2=0.0%; P=.603) and 1.53 (95% confidence interval, 1.16-1.89; prediction interval, 0.41-2.65; I2=50.7%; P=.087) for those with a postpartum period ≥6 months.

CONCLUSION

This systematic review and meta-analysis suggests that urinary incontinence may be a potential predictor of postpartum depression. Thus, it is important that health care professionals offer support and treatment options to women who experience these conditions.

In the Shadows of Motherhood: A Comprehensive Review of Postpartum Depression Screening and Intervention Practices

This comprehensive review delves into the multifaceted landscape of postpartum depression (PPD), exploring its prevalence, impact on maternal and infant well-being, and the efficacy of existing screening and intervention practices. PPD emerges as a critical concern, with implications extending beyond individual mental health to encompass the dynamics of mother-infant relationships and societal well-being. The analysis underscores the complexity of addressing PPD, emphasizing the challenges associated with screening tools and the importance of evidence-based interventions. A call to action resonates throughout, urging healthcare providers, policymakers, and stakeholders to prioritize mental health support for new mothers through enhanced screening protocols and improved accessibility to interventions. Furthermore, the review highlights the need for destigmatization and awareness campaigns to foster a supportive environment. Future research directions are outlined, emphasizing the refinement of screening tools, developing innovative interventions, and exploring cultural and socioeconomic influences on PPD outcomes. The review envisions a collaborative effort to dispel the shadows of PPD, striving for a future where mothers receive comprehensive support, ensuring optimal mental health and overall well-being.

Harnessing consumer wearable digital biomarkers for individualized recognition of postpartum depression using the All of Us Research Program dataset

Postpartum depression (PPD), afflicting one in seven women, poses a major challenge in maternal health. Existing approaches to detect PPD heavily depend on in-person postpartum visits, leading to cases of the condition being overlooked and untreated. We explored the potential of consumer wearable-derived digital biomarkers for PPD recognition to address this gap. Our study demonstrated that intra-individual machine learning (ML) models developed using these digital biomarkers can discern between pre-pregnancy, pregnancy, postpartum without depression, and postpartum with depression time periods (i.e., PPD diagnosis). When evaluating variable importance, calories burned from the basal metabolic rate (calories BMR) emerged as the digital biomarker most predictive of PPD. To confirm the specificity of our method, we demonstrated that models developed in women without PPD could not accurately classify the PPD-equivalent phase. Prior depression history did not alter model efficacy for PPD recognition. Furthermore, the individualized models demonstrated superior performance compared to a conventional cohort-based model for the detection of PPD, underscoring the effectiveness of our individualized ML approach. This work establishes consumer wearables as a promising avenue for PPD identification. More importantly, it also emphasizes the utility of individualized ML model methodology, potentially transforming early disease detection strategies.

A Comprehensive Review of Motherhood and Mental Health: Postpartum Mood Disorders in Focus

The journey of motherhood encompasses a profound array of emotions, experiences, and challenges that extend beyond the surface of joy and elation. This review delves into the crucial yet often underexplored realm of postpartum mood disorders, aiming to illuminate their significance and foster understanding. Postpartum mood disorders, including postpartum depression, anxiety disorders, and psychosis, impact the mental well-being of mothers during a pivotal phase of their lives. Through a comprehensive exploration, this review elucidates the various dimensions of these disorders, from their definitions and classifications to their prevalence and impact on both mothers and families. Identifying and diagnosing postpartum mood disorders is discussed in detail, shedding light on the emotional, cognitive, and physical symptoms that warrant attention. Screening and assessment tools are highlighted as essential instruments for early detection, while challenges in diagnosis, including the overlap with typical postpartum experiences and the influence of stigma, are explored. The review further delves into treatment and intervention, underscoring the importance of psychotherapy, pharmacological interventions, and individualised treatment plans. The roles of healthcare providers and mental health professionals in offering support and guidance are emphasised, emphasising the significance of a collaborative approach. Cultural and societal influences are crucial in shaping perceptions of motherhood and mental health. The review explores how these influences can create barriers to seeking help and highlights the importance of destigmatising postpartum mood disorders. It underscores the urgency of raising awareness and fostering a supportive environment that empowers mothers to seek assistance without fear of judgment. Looking toward the future, the review points to potential research directions, such as advances in understanding hormonal influences and exploring the long-term effects on maternal mental health. The overarching call to action resonates - increased awareness, support, and dismantling stigma are imperative. A hopeful vision is presented: a future where all mothers receive appropriate mental health care, no mother stands alone in her motherhood journey, and societal understanding and compassion thrive.

Thyroid Predictors of Postpartum Mood Disorders

Postpartum mood disorders (PMD) are currently among the leading causes of maternal postpartum morbidity and mortality. PMD include the conditions of postpartum blues (PB), postpartum depression (PPD), and postpartum psychosis. The pathogenesis of PMDs are ambiguous, and there are no reliable prenatal predictive markers despite current research efforts. Even though reliable indicators have not been found, leading ideas suggest an etiology of hormonal fluctuations. Although thyroid markers have long been linked to psychiatric disorders such as major depressive disorder (MDD), how they correlate with PMDs is still unclear. This study aimed to evaluate the pathophysiological link between thyroid function, PMDs, and the usefulness of thyroid markers as indicators of their occurrence and severity. The methodology consisted of a narrative literature review. Several inclusion and exclusion criteria were used to filter the results of literature searches in PubMed. Studies were included if they discussed any marker related to thyroid endocrinology in relation to the incidence or pathophysiology of any PMD. Both primary and secondary analyses were included. The permissive inclusion criteria were used due to the relative scarcity of research on the topic and the ambiguous pathophysiology of PMD. The results demonstrated the potential utility of thyroid autoimmunity as a predictor of late-onset PPD. Hypothyroidism, low euthyroid hormone levels, and the presence of thyroid autoantibodies were correlated with increased incidence of PPD and late postpartum depressive symptoms, past the timeline of PB. Most notably a rapid postpartum drop in cortisol level may precipitate thyroid autoimmunity in anti-thyroid peroxidase (TPO) antibody positive women, which could eventually produce a hypothyroid phase associated with depressive symptoms. There was insufficient evidence to suggest a relationship with postpartum psychosis. In conclusion, the exact pathophysiological mechanisms of PMDs remain ambiguous, but TPO-antibodies in the third trimester may be a predictor of late PPD.

Feasibility and impact of a mental health chatbot on postpartum mental health: a randomized controlled trial

BACKGROUND

Perinatal mood disorders are common yet underdiagnosed and un- or undertreated. Barriers exist to accessing perinatal mental health services, including limited availability, time, and cost. Automated conversational agents (chatbots) can deliver evidence-based cognitive behavioral therapy content through text message-based conversations and reduce depression and anxiety symptoms in select populations. Such digital mental health technologies are poised to overcome barriers to mental health care access but need to be evaluated for efficacy, as well as for preliminary feasibility and acceptability among perinatal populations.

OBJECTIVE

To evaluate the acceptability and preliminary efficacy of a mental health chatbot for mood management in a general postpartum population.

STUDY DESIGN

An unblinded randomized controlled trial was conducted at a tertiary academic center. English-speaking postpartum women aged 18 years or above with a live birth and access to a smartphone were eligible for enrollment prior to discharge from delivery hospitalization. Baseline surveys were administered to all participants prior to randomization to a mental health chatbot intervention or to usual care only. The intervention group downloaded the mental health chatbot smartphone application with perinatal-specific content, in addition to continuing usual care. Usual care consisted of routine postpartum follow up and mental health care as dictated by the patient's obstetric provider. Surveys were administered during delivery hospitalization (baseline) and at 2-, 4-, and 6-weeks postpartum to assess depression and anxiety symptoms. The primary outcome was a change in depression symptoms at 6-weeks as measured using two depression screening tools: Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale. Secondary outcomes included anxiety symptoms measured using Generalized Anxiety Disorder-7, and satisfaction and acceptability using validated scales. Based on a prior study, we estimated a sample size of 130 would have sufficient (80%) power to detect a moderate effect size (d=.4) in between group difference on the Patient Health Questionnaire-9.

RESULTS

A total of 192 women were randomized equally 1:1 to the chatbot or usual care; of these, 152 women completed the 6-week survey (n=68 chatbot, n=84 usual care) and were included in the final analysis. Mean baseline mental health assessment scores were below positive screening thresholds. At 6-weeks, there was a greater decrease in Patient Health Questionnaire-9 scores among the chatbot group compared to the usual care group (mean decrease=1.32, standard deviation=3.4 vs mean decrease=0.13, standard deviation=3.01, respectively). 6-week mean Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder-7 scores did not differ between groups and were similar to baseline. 91% (n=62) of the chatbot users were satisfied or highly satisfied with the chatbot, and 74% (n=50) of the intervention group reported use of the chatbot at least once in 2 weeks prior to the 6-week survey. 80% of study participants reported being comfortable with the use of a mobile smartphone application for mood management.

CONCLUSION

Use of a chatbot was acceptable to women in the early postpartum period. The sample did not screen positive for depression at baseline and thus the potential of the chatbot to reduce depressive symptoms in this population was limited. This study was conducted in a general obstetric population. Future studies of longer duration in high-risk postpartum populations who screen positive for depression are needed to further understand the utility and efficacy of such digital therapeutics for that population.

Depression Level and Its Associated Factors among Postpartum Working Women in Kuching, Sarawak-A Cross-Sectional Study

Background

Postpartum depression (PD) among women, if left untreated, may result in long-term health and social consequences for them and their families. This cross-sectional study aimed to determine the factors contributing to PD among working mothers in Kuching, Sarawak, Malaysia.

Methods

Systematic sampling was used to recruit working mothers who attended Kuching's maternal and child health clinics. They were interviewed with a validated translated questionnaire to obtain data on sociodemographics, health profiles, and Edinburgh Postnatal Depression Scale (EPDS) and postpartum symptoms. Data were analysed using IBM SPSS version 21.0.

Results

Out of the total 281 respondents, 15.3% of respondents had depression symptoms. Fatigue (42.7%), back or neck pain (36.3%), breast discomfort (16.4%), dizziness (13.5%) and nipple irritation (11.0%) were the most common physical symptoms experienced by the mothers. Regression analysis showed that working mothers who exhibited higher scores of physical symptoms were 1.26 times more likely to develop PD (adjusted odd ratio 1.26, P < 0.01; 95% CI: 1.071, 1.487).

Conclusion

Physical symptoms were the predictors of PD among working mothers.

Postpartum depression in Vietnam: a scoping review of symptoms, consequences, and management

BACKGROUND

Postpartum depression (PPD) is a major health issue that can affect both mothers and their newborn children. In Vietnam, approximately 20% of mothers suffer from PPD. However, there is a lack of synthesized evidence regarding the case management of PPD in the Vietnamese context. A review of early symptoms, consequences, and management strategies of PPD will help to inform best practices to reduce complications and shorten the recovery time after parturition.

METHODS

This scoping review aims to analyze and synthesize the findings of studies on PPD examining the symptoms, consequences, and management strategies among Vietnamese women. MEDLINE, CINAHL, PubMed, ScienceDirect, EBSCOHost, Google Scholar, and a networked digital library of projects, theses, and dissertations published between 2010 and 2022 in Vietnam were accessed following search terms including "Vietnam", "depression", "postpartum", "symptom/experience", "consequence", and "management".

FINDINGS

The most-reported symptoms were sadness, tiredness, the feeling of being ignored, lack of interest in the baby, reduced appetite, and sleep disturbance. The recognized consequences were child stunting and slow growth, without mentioning its long-term effects on mothers. Our findings indicated that PPD in Vietnam has not been sufficiently managed; mothers tend to seek help from 'fortune-tellers' or 'word-of-mouth' practices rather than from evidence-based modern medicine.

CONCLUSION

This scoping review provides an initial stage of PPD symptoms, consequences, and management along with facilitating an interventional program to support this vulnerable group of women. A large survey of Vietnamese mothers' symptoms, effects, and management strategies is needed.

Postpartum Mood Disorders: Insights into Diagnosis, Prevention, and Treatment

Postpartum mood disorders pose significant challenges to women's mental health and well-being during the postpartum period. This review article provides insights into these disorders' diagnosis, prevention, and treatment. The article begins by discussing the background information on postpartum mood disorders, their significance, and the purpose of understanding them. It then delves into the classification and types of postpartum mood disorders, emphasizing the need for accurate diagnosis and differentiation. Prevalence and incidence rates are explored to highlight the scope and impact of these disorders. The review examines various risk factors associated with postpartum mood disorders, including biological, psychological, and socioeconomic factors. Understanding these risk factors helps identify high-risk populations and guide targeted interventions. Screening and diagnosis of postpartum mood disorders are crucial for early detection and intervention. The article provides an overview of screening tools, highlights the challenges in diagnosis, and emphasizes the importance of early identification for better outcomes. Prevention strategies are explored, including antenatal education, psychosocial support programs, and the role of healthcare professionals in promoting preventive measures. Effective prevention interventions and their outcomes are discussed to guide healthcare providers and policymakers in implementing evidence-based strategies. Treatment approaches for postpartum mood disorders include pharmacological interventions, psychotherapy options, alternative and complementary therapies, and multidisciplinary approaches. The article discusses the effectiveness and considerations of each approach, highlighting the importance of individualized care. Challenges and barriers in diagnosing, preventing, and treating postpartum mood disorders are addressed, including stigma, limited access to healthcare services, and gaps in healthcare provider knowledge and training. Recommendations are provided for healthcare professionals and policymakers to overcome these challenges and improve outcomes. The review concludes by highlighting the need for future research, innovations in prevention and treatment approaches, and collaborative efforts in the field of postpartum mood disorders. Promising areas for research are identified, including long-term outcomes, understanding risk factors, and cultural considerations. The article emphasizes the importance of interdisciplinary collaboration and stakeholder engagement in advancing the field.

Postpartum Depression and Maternal Care: Exploring the Complex Effects on Mothers and Infants

Postpartum depression (PPD) is a common and debilitating mental health condition affecting many mothers worldwide. This review article aims to explore the complex effects of PPD on mothers and infants, focusing on maternal care. The transition to motherhood is a critical period characterized by numerous physical, psychological, and social changes, making women vulnerable to the onset of PPD. Consequently, PPD can significantly impact a mother's ability to provide optimal care for her infant, leading to potential adverse consequences for both parties. The article synthesizes existing research literature on the topic, encompassing studies from various disciplines, including psychology, psychiatry, obstetrics, and pediatrics. It begins by providing an overview of the prevalence and risk factors associated with PPD, emphasizing the importance of early detection and intervention. The impact of PPD on maternal caregiving behaviors, such as bonding, sensitivity, and responsiveness, is then examined, highlighting the potential disruptions in the mother-infant relationship. Furthermore, the article delves into the potential consequences of impaired maternal care on infant development, including emotional, cognitive, and social domains. Several factors contributing to the complex interplay between PPD and maternal care are discussed, including hormonal changes, psychosocial stressors, and the influence of social support networks. The review also addresses the bidirectional nature of the mother-infant relationship, whereby infant characteristics and behaviors can exacerbate or mitigate the effects of PPD on maternal care. Moreover, the article explores the role of healthcare providers and the importance of implementing effective screening, assessment, and treatment strategies for PPD to promote optimal maternal-infant outcomes. By consolidating current knowledge on the topic, this review article provides valuable insights into the multifaceted effects of PPD on both mothers and infants. Recognizing the significance of maternal care and understanding the mechanisms through which PPD disrupts it can inform the development of targeted interventions to promote early detection, effective treatment, and supportive interventions for mothers experiencing PPD. Ultimately, improving maternal mental health and enhancing maternal-infant relationships can yield long-term positive effects on mothers' and infants' well-being and development.

Intimate partner violence victimization during pregnancy increases risk of postpartum depression among urban adolescent mothers in South Africa

BACKGROUND

It is estimated that 38.8% of mothers develop postpartum depression (PPD) in South Africa. While empirical evidence documents an association between intimate partner violence (IPV) victimization in pregnancy and PPD among adult women, the association has been underexamined among adolescent mothers (< 19 years). The study's purpose is to examine whether IPV victimization during pregnancy is associated with PPD among adolescent mothers.

METHODS

Adolescent mothers (14-19 years) were recruited at a regional hospital's maternity ward in KwaZulu Natal, South Africa between July 2017-April 2018. Participants completed behavioral assessments at two visits (n = 90): baseline (up to 4 weeks postpartum) and follow-up (6-9 weeks postpartum, when PPD is typically assessed). The WHO modified conflict tactics scale was used to create a binary measure of any physical and/or psychological IPV victimization that occurred during pregnancy. Participants with scores ≥ 13 on the Edinburgh Postpartum Depression Scale (EPDS) were classified as having symptoms of PPD. We used a modified Poisson regression with robust standard errors to assess PPD in association with IPV victimization during pregnancy, controlling for relevant covariates.

RESULTS

Nearly one-half (47%) of adolescent mothers reported symptoms of PPD by 6-9 weeks post-delivery. Further, IPV victimization during pregnancy was highly prevalent (40%). Adolescent mothers who reported IPV victimization during pregnancy had marginally higher risk of PPD at follow-up (RR: 1.50, 95 CI: 0.97-2.31; p = 0.07). The association was strengthened and significant in covariate-adjusted analysis (RR: 1.62, 95 CI: 1.06-2.49; p = 0.03).

CONCLUSIONS

Poor mental health was common among adolescent mothers, and IPV victimization during pregnancy was associated with PPD risk among adolescent mothers. Implementing IPV and PPD routine screenings during the perinatal period may aid in identifying adolescent mothers for IPV and PPD interventions and treatment. With the high prevalence of IPV and PPD in this vulnerable population and the potential negative impact on maternal and infant outcomes, interventions to reduce IPV and PPD are needed to improve adolescent mothers' well-being and their baby's health.

Routine Screening for Peripartum Depression in the Gynecologic and Pediatric Setting - Evaluation of an Adapted EPDS Version

PURPOSE

The aim of the study was to investigate the feasibility and acceptability of a routine screening for peripartum depression (PD) by gynecologists and pediatricians. In addition, it was investigated whether two separate Plus Questions (PQ) of the "EPDS-Plus" are valid for screening experiences of violence or a traumatic birth and whether they can be associated with symptoms of PD.

METHODS

Using the EPDS-Plus the prevalence of PD was investigated in 5235 women. The convergent validity of the PQ with the Childhood Trauma Questionnaire (CTQ) and Salmon's Item List (SIL) was assessed using correlation analysis. The association between the experience of violence and/or traumatic birth experience and PD was subjected to the chi-square test. Furthermore, a qualitative analysis for acceptance and satisfaction by the practitioners was performed.

RESULTS

The prevalence was 9.94%/10.18% for antepartum/postpartum depression. The convergent validity of the PQ showed strong correlation with CTQ (p<0.001) and SIL (p<0.001). For violence and PD, a significant association was found. There was no significant association for traumatic birth experience and PD. There was a high level of satisfaction and acceptance of the EPDS-Plus questionnaire.

CONCLUSION

Screening for peripartum depression is feasible in regular care and can help to identify depressed as well as potentially traumatized mothers, especially in preparing trauma-sensitive birth care and treatment. Therefore, specialized peripartum "psych" treatment for all affected mothers in all regions has to be implemented.

Exploring the influence of postnatal depression on neonatal care practices among mothers in Western Kenya: A qualitative study

BACKGROUND

Postnatal depression (PND) is associated with adverse infant neurodevelopmental outcomes. Evidence is limited on how PND influences neonatal (<28 days old) outcomes in low- and middle-income countries, such as Kenya, which bear the global burden of neonatal morbidity and mortality.

OBJECTIVES

To explore how PND influences neonatal feeding and care practices among women in the early postnatal period in rural Western Kenya.

DESIGN

A cross-sectional study.

METHODS

Semi-structured interviews were conducted at 2-weeks postpartum among mothers of newborn infants identified <72 h old from the postnatal wards and clinics across five health facilities in Kisumu County of Western Kenya. They were all screened for features suggestive of postnatal depression using the Edinburgh Postnatal Depression Scale.

RESULTS

Twenty-four mothers were interviewed, 13 of whom had features suggestive of PND. All mothers experienced health or socio-economic adversities in the perinatal period, including traumatic deliveries, financial constraints, and challenging relationships with partners/other family members. Feeding difficulties due to perceived insufficient breastmilk were a particular challenge for mothers with features of PND, who were more likely to introduce complementary feeds. Maternal health-seeking decisions were influenced by high financial cost, long waiting times and poor interactions with health care providers that induced stress and fear among mothers. Maternal caregiving capacity was influenced by her ability to juggle other household duties, which was difficult for mothers with features suggestive of PND. Support from friends and relatives positively impacted maternal mood and caregiving ability.

CONCLUSION

Mothers experienced many stress-inducing events in the perinatal period which potentially exacerbated features of PND in the immediate postnatal period. Women with features of PND were particularly vulnerable to these stressors that influenced infant caregiving practices. Addressing the socio-economic challenges and health system gaps that include scale up of compassionate and respectful care for women during pregnancy and childbirth, as well as early screening and intervention of PND, through enhanced referral pathways between health facilities and community support structures, could mitigate against the impact of PND on neonatal caregiving.

Longitudinal assessment of maternal depression and early childhood asthma and wheeze: Effect modification by child sex

BACKGROUND

Studies report associations between maternal mental health and adverse respiratory outcomes in children; however, the impact of timing and duration of maternal distress remains understudied. We sought to longitudinally examine associations between maternal depression and childhood asthma and wheeze, and explore sex differences.

METHODS

Maternal depression (n = 601) was assessed using the Edinburgh Depression Scale questionnaire, dichotomized at a clinically relevant cutoff (>12) (a) during pregnancy, (b) postpartum, and (c) postpartum and subsequent time points postnatally (recurrent depression). Report of wheeze in the past 12 months (current wheeze) and asthma were obtained using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire at 48 and 72 months. Associations were analyzed using a modified Poisson regression adjusted for covariates, and in interaction models.

RESULTS

Both postpartum and recurrent depression were associated with higher risk of current wheeze (relative risk [RR]: 1.87, 95% confidence interval [CI]: 1.21, 2.90; RR: 2.41, 95% CI: 1.53, 3.79) and asthma at 48 months (RR: 2.42, 95% CI: 1.01, 5.84; RR: 2.45, 95% CI: 1.02, 5.84). In interaction analyses, associations were stronger in females. Recurrent depression was associated with a higher risk of current wheeze at 48 months in females (RR: 4.34, 95% CI: 2.02, 9.32) when compared to males (RR: 1.89, 95% CI: 1.05, 3.39).

CONCLUSIONS

Postpartum and recurrent depression were associated with a higher risk of wheeze and asthma in children. Understanding the temporal- and sex-specific effects of maternal depression may better inform prevention strategies.

Optimization of the Mood Disorder Questionnaire in identification of perinatal bipolar disorder

BACKGROUND

The recognition of bipolar disorder during the perinatal period is often challenging because birthing people most commonly present in a depressive episode. The phenotypic expression of episodes of bipolar depression is difficult to differentiate from major depressive disorder and can lead to misdiagnosis and inappropriate treatment. The Mood Disorder Questionnaire is a readily available screening tool for bipolar disorder that has been validated in previous studies for use in the general and perinatal populations. However, the discriminatory capacity of the Mood Disorder Questionnaire for perinatal people who screen positive for depression in nonpsychiatric settings is still unclear.

OBJECTIVE

This study aimed to evaluate the discriminatory capacity of the Mood Disorder Questionnaire to identify bipolar disorder in perinatal people who screen positive for depression on the Patient Health Questionnaire-9.

STUDY DESIGN

This retrospective cohort study included individuals enrolled in the Collaborative Care Model for Perinatal Depression Support Services, a collaborative care program for perinatal mental health services implemented in a quaternary care setting, from January 2017 to April 2021. All individuals completed the Mood Disorder Questionnaire and psychiatric evaluation by a licensed clinical social worker. Clinical and sociodemographic characteristics were compared between those with and without a clinical diagnosis of bipolar disorder using bivariable analyses. The discriminatory capacity and test characteristics of the Mood Disorder Questionnaire were assessed at each score cutoff using the gold standard of a psychiatric clinical evaluation for comparison.

RESULTS

From January 2017 to April 2021, 1510 birthing people were enrolled in the Collaborative Care Model for Perinatal Depression Support Services and included in this study. Among this group, 62 (4.1%) were diagnosed with bipolar disorder by psychiatric clinical evaluation using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria. A score of ≥7 on question 1 is often used in the general population to identify bipolar disorder, which has a 60% sensitivity and 88% specificity in our perinatal sample with an area under the receiver operating characteristic curve of 0.74 (95% confidence interval, 0.72-0.76). Lowering the threshold to ≥4 improves sensitivity to 81% and the discriminatory capacity to an area under the receiver operating characteristic curve of 0.75 (95% confidence interval, 0.70-0.80), at the expense of a reduction in specificity to 69%.

CONCLUSION

The administration of the Mood Disorder Questionnaire in the perinatal period can help to identify which individuals who have screened positive for depression on the Patient Health Questionnaire-9 are at risk of a bipolar or unipolar disorder. In this context, lowering the Mood Disorder Questionnaire score threshold from that used in the nonperinatal population down to 4 improves test characteristics and reduces the risk of a missed diagnosis of bipolar disorder.

Pre-partum HRV as a predictor of postpartum depression: The potential use of a smartphone application for physiological recordings

BACKGROUND

This study aimed to investigate the role of a time-domain Heart Rate Variability index (the root mean square of successive difference between NN intervals, rMSSD) as a predictor of the onset of postpartum depression. HRV has been related to an increased risk of depression in the general population. However, its role in pregnant women is not clear, and the potential use of smartphone applications to evaluate HRV in this population has not been investigated.

METHODS

In study 1, simultaneous electrocardiogram and smartphone photoplethysmography were collected. The rMSSD was determined from each recording to evaluate the accuracy of a smartphone application in the measurement of HRV. In study 2, 135 pregnant women provided rMSSD values measured through a smartphone application in the prepartum (second or third trimester) and filled in the Edinburgh Postnatal Depression Scale in the postpartum (one month after the childbirth).

RESULTS

Study 1 showed the excellent accuracy of the smartphone application in the measurement of rMSSD. Study 2 indicated that lower prepartum rMSSD predicted higher depressive symptoms in the postpartum (β = -0.217, p = 0.010) after controlling for prepartum depressive symptoms and other potential covariates.

LIMITATIONS

Artefacts (e.g., hand movements) might have corrupted the physiological signal registered.

CONCLUSION

This study showed that a reduced vagal tone, indexed by lower rMSSD, during pregnancy was a predictor of depressive symptoms one month after childbirth. The prepartum period may offer an important timeframe to implement preventive intervention on vagal modulation in order to prevent depressive symptoms in the postpartum.

The Effect of Dairy Products and Nutrient Intake after Childbirth on the Risk of Postpartum Depression

Previous studies have shown an association between the intake of dairy products during pregnancy and reduced symptoms of postpartum depression (PPD). However, the effect of postpartum intake of dairy products on PPD is not fully understood. This study evaluates the effects of dairy products and nutrient intake after childbirth on the risk of PPD. A cross-sectional survey-based study was conducted asking participants to fill out a food frequency questionnaire (FFQ) to assess intake of dairy products and other nutrients. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for PPD symptoms. Out of 530 participants, almost three-quarters subjectively reported PPD (N = 395, 74.11%). The risk of PPD was relatively high for a Q1 level of consumption of all four dairy products and other nutrients, and from Q2 to Q4 there appeared to be an increase in the risk of PPD as consumption increased. However, after adjustment for confounding factors, there was no significant association between postpartum intake of dairy products and other nutrients and PPD. The results indicate that the potential of dairy products and nutrient intake to reduce PPD are minimal. Further longitudinal and intervention studies of dairy products and other (particularly anti-depressants) nutrients are required to draw firm conclusions about their associations with the risk of PPD.

Single low-dose ketamine infusion for women with prenatal depressive symptoms undergoing cesarean delivery: A pilot randomized trial

Background

Ketamine is approved for antidepressant therapy, but evidence regarding its use in women with perinatal depression is lacking. Herein, we investigated the effects of low-dose ketamine in women with prenatal depressive symptoms and tested the feasibility of a future large randomized trial.

Methods

This was a randomized, double-blind, placebo-controlled pilot trial. Sixty-six women with prenatal depressive symptoms who were scheduled for elective cesarean delivery were randomized to receive either low-dose ketamine (0.5 mg/kg) or placebo (normal saline). The study drugs were intravenously infused over a 40-minute period after clamping the umbilical cord. The primary outcome was depression score assessed with the Edinburgh Postnatal Depression Scale at 48 h postpartum. Among other and safety outcomes, occurrence of nausea or vomiting was observed, pain intensity was assessed with the numeric rating scale. The feasibility of implementing the protocol was also evaluated.

Results

A total of 64 parturients were included in the intention-to-treat analysis. The depression score at 48 h did not differ between groups: median 9 (interquartile range 6 to 13) with ketamine vs. 8 (6 to 10) with placebo; median difference 1, 95% CI -1 to 3; P = 0.608. The pain intensity at 4 h postpartum was less severe in the ketamine group (median difference -1, 95% CI -1 to 0, P = 0.002). Among safety outcomes, intraoperative nausea or vomiting was less common in patients given ketamine (0.0% [0/33] with ketamine vs. 21.2% [7/33] with placebo, P = 0.011). Recruitment was satisfactory and the protocol was acceptable to participants and clinicians.

Conclusions

A single low-dose ketamine infusion did not decrease the depression score at 2 days, but reduced intraoperative nausea and vomiting and lowered pain intensity at 4 h after cesarean delivery among women with prenatal depressive symptoms. The study protocol is feasible for a large randomized trial.

Clinical Trial Registration

The study was registered with ClinicalTrials.gov (identifier: NCT03336541; 08/11/2017).

Body image dissatisfaction and interoceptive sensibility significantly predict postpartum depressive symptoms

BACKGROUND

During pregnancy women experience rapid and unique changes in body weight, shape and size over a relatively short time period. While research focused on the role of external bodily modifications during pregnancy, research on internal bodily variations is missing.

METHODS

In a longitudinal study, we recruited healthy pregnant women and measured whether and how depressive symptoms, body image dissatisfaction and the subjective tendency to focus on one's own internal bodily sensations, i.e., interoceptive sensibility, changed during pregnancy and postpartum. Pregnant women filled online self-report questionnaires during pregnancy (i.e. second and third trimester) and after (i.e. six weeks) the delivery, including the Body Areas Satisfaction Scale, the Multidimensional Assessment of Interoceptive Awareness, and the Edinburgh Postnatal Depression Scale.

RESULTS

While depressive symptoms remained stable in the peripartum, body image dissatisfaction increased in the postpartum compared to the pregnancy period, and interoceptive sensibility increased over pregnancy. Findings showed that the increase of body dissatisfaction through the peripartum and the levels of interoceptive sensibility in the early phase of pregnancy predicted depressive symptoms in the postpartum.

LIMITATIONS

Interoception was evaluated as a subjective measure (i.e., interoceptive sensibility). Future studies may include objective measures of interoceptive accuracy and interoceptive awareness.

CONCLUSIONS

The current study supports the importance of body image dissatisfaction and interoceptive sensibility in the development of postpartum depressive symptoms. Future studies need to investigate if interventions aimed to increase interoceptive sensibility might be useful in preventing depressive symptoms and identify the mechanisms that can lead to these changes.

Diagnosis and Management of Perinatal Depression

Perinatal depression is a mood disorder that may occur during pregnancy or within a year after childbirth. It can be disabling for the birthing parent and cause attachment and developmental problems for the infant. A host of risk factors, including genetics, reproductive history, and life experiences, are associated with perinatal depression. With validated screening tools, health care providers can assess individuals, initiate treatment, and/or refer as appropriate. Successful treatment, which may include modalities such as cognitive behavioral therapy and/or pharmacologic therapies, helps individuals maintain a sense of control, develop self-confidence, take control of their thinking, and learn coping skills. Integrative therapies and lifestyle changes have some success but may not be adequate for many individuals. Patients may benefit from providers learning and initiating cognitive behavioral therapy techniques while awaiting therapy.

Intergenerational neuroimaging study: mother-infant functional connectivity similarity and the role of infant and maternal factors

Mother and infant neural and behavioral synchrony is important for infant development during the first years of life. Recent studies also suggest that neural risk markers associated with parental psychopathology may be transmitted across generations before symptoms emerge in offspring. There is limited understanding of how early similarity in brain functioning between 2 generations emerges. In the current study, using functional magnetic resonance imaging, we examined the functional connectivity (FC) similarity between mothers and newborns during the first 3 months after the infant's birth. We found that FC similarity between mothers and infants increased as infant age increased. Furthermore, we examined whether maternal factors such as maternal socioeconomic status and prenatal maternal depressive symptoms may influence individual differences in FC similarity. For the whole-brain level, lower maternal education levels were associated with greater FC similarity. In previous literature, lower maternal education levels were associated with suboptimal cognitive and socioemotional development. Greater FC similarity may reflect that the infants develop their FC similarity prematurely, which may suboptimally influence their developmental outcomes in later ages.

Elevated Parental Stress Is Associated With Lower Self-Efficacy in Provider Communication During a Pandemic

BACKGROUND

Effective communication between physician and parent promotes a successful alliance with families. The association of parental stress with self-efficacy when communicating during parent-physician interactions is unknown in the context of a pandemic.

OBJECTIVES

Objectives of this study include quantifying and comparing the stress experienced by parents of hospitalized children before and after onset of the COVID-19 pandemic and examining the relationship of stress with self-efficacy in parent-physician communication during interactions throughout hospitalization.

METHODS

We conducted in-person surveys of parents of children aged 3 months to 17 years hospitalized at a quaternary-level children's hospital, before and after onset of COVID-19. Parents completed 2 validated tools: Parenting Stress Index (PSI-SF) and the Perceived Efficacy in Parent-Physician Interactions (PEPPI), measuring self-efficacy in communicating with physicians. Socioeconomic data were collected. Fisher exact test and t test were used to compare score proportions and means; linear regression was used to evaluate association between PSI-SF and PEPPI with confounder adjustments.

RESULTS

Forty-nine parents were recruited; the majority identified as non-White and female. An inverse relationship was noted between the total stress score and parental self-efficacy, which only attained statistical significance in the post-COVID-19 cohort (P = .02, multivariate P = .044). A significant increase in the mean was observed for subscale scores of Difficult Child (P = .019) and Parent-Child Dysfunctional Interaction after COVID-19 (P = .016).

CONCLUSIONS

Elevated parental stress is associated with decreased self-efficacy during parent-physician interactions and it worsened during the pandemic. Future studies should examine the effect of different communication styles on parental stress and self-efficacy during hospitalization.

Genetic variants in the genes of the sex steroid hormone metabolism and depressive symptoms during and after pregnancy

PURPOSE

The aim of this study was to conduct an association analysis of depressive symptoms and polymorphisms in the ESR1, PGR, CYP19A1, and COMT genes in pregnant and postpartum women.

METHODS

The Franconian Maternal Health Evaluation Study (FRAMES) recruited healthy pregnant women prospectively for assessment of maternal and fetal health. The German version of the 10-item Edinburgh Postnatal Depression Scale (EPDS) was completed at three time points in this prospective cohort study. Visit 1 was at study entry in the third trimester of pregnancy, visit 2 was shortly after birth, and visit 3 was 6-8 months after birth. Germline DNA and depression measurements from 361 pregnant women were available for analysis. Six single nucleotide polymorphisms (SNPs) in the above-mentioned genes were genotyped. After reconstruction of haplotypes for PGR (rs1042838 and rs10895068) and CYP19A1 (rs10046 and rs4646), a multifactorial linear mixed model was applied to the data to describe the association between haplotypes and depression values. The single SNPs for ESR1 (rs488133) and COMT (rs4680) were analyzed separately using linear mixed models analogously.

RESULTS

The mean antepartum EPDS measurement was 5.1, the mean postpartal measurement after 48-72 h was 3.5, and the mean value 6-8 months postpartum was 4.2. The SNPs in PGR were reconstructed into three haplotypes. The most common haplotype was GG, with 63.43% of patients carrying two copies and 33.52% carrying one copy. For haplotype GA, the group of carriers of two copies (0.28%) was combined with the carriers of one copy (9.70%). Haplotype reconstruction using CYP19A1 SNPs resulted in three haplotypes. The most common haplotype was TC, with 25.48% of patients carrying two copies and 51.52% one copy. None of the haplotype blocks and neither of the two single SNPs showed any significant associations with EPDS values.

CONCLUSIONS

The candidate haplotypes analyzed in PGR and CYP19A1 and single SNPs in ESR1 and COMT did not show any association with depression scores as assessed by EPDS in this cohort of healthy unselected pregnant women.

[Postpartum depression-who cares? Approaches to care via midwifery, gynaecology, paediatrics and general practice]

BACKGROUND

Postpartum depression (PPD) is one of the most common mental illnesses in the postpartum period. If left untreated, it can have serious consequences for the mother-child relationship and the development of the child. In order to prevent possible negative effects, early diagnosis of affected mothers and professional care are essential.

AIM OF THE STUDY

This article explores the sense of responsibility of the four primary care providers in the postpartum period-midwives, gynaecologists, general practitioners and paediatricians-and examines how they deal with the disease as well as the barriers and possibilities for optimisation in care.

MATERIALS AND METHODS

The primary care providers of postpartum women in Germany were interviewed in four independent studies. Quantitative questionnaires were used to interview midwives, gynaecologists and general practitioners, and a qualitative telephone survey was conducted with representatives of the German Association of Paediatricians and Adolescents (BVKJ). A systematic comparative analysis was carried out.

RESULTS AND DISCUSSION

Midwives and gynaecologists showed a significantly higher sense of responsibility for the recognition and treatment of PPD than general practitioners and paediatricians. Closer interdisciplinary cooperation and thus a wider range of referral and therapy options were named by all four professional groups as a central prerequisite for improving the care situation in Germany. A uniform regulation of financial remuneration is also an important aspect for all providers.

Investigating the Efficacy of an 18-Week Postpartum Rehabilitation and Physical Development Intervention on Occupational Physical Performance and Musculoskeletal Health in UK Servicewomen: Protocol for an Independent Group Study Design

Background

Postpartum women are at an increased risk of pelvic floor dysfunction, musculoskeletal injury, and poor psychological health and have reduced physical fitness compared to before pregnancy. There is no formal, evidence-based rehabilitation and physical development program for returning UK servicewomen to work following childbirth.

Objective

This study aims to examine the efficacy of a rehabilitation and physical development intervention for returning postpartum UK servicewomen to occupational fitness.

Methods

Eligible servicewomen will be assigned to a training or control group in a nonrandomized controlled trial 6 weeks after childbirth. Group allocation will be based on the location of standard pregnancy and postpartum care. The control group will receive standard care, with no prescribed intervention. The training group will start an 18-week core and pelvic health rehabilitation program 6 weeks post partum and a 12-week resistance and high-intensity interval training program 12 weeks post partum. All participants will attend 4 testing sessions at 6, 12, 18, and 24 weeks post partum for the assessment of occupational physical performance, pelvic health, psychological well-being, quality of life, and musculoskeletal health outcomes. Occupational physical performance tests will include vertical jump, mid-thigh pull, seated medicine ball throw, and a timed 2-km run. Pelvic health tests will include the Pelvic Organ Prolapse Quantification system, the PERFECT (power, endurance, repetitions, fast, every contraction timed) scheme for pelvic floor strength, musculoskeletal physiotherapy assessment, the Pelvic Floor Distress Inventory–20 questionnaire, and the International Consultation on Incontinence Questionnaire–Vaginal Symptoms. Psychological well-being and quality of life tests will include the World Health Organization Quality of Life questionnaire and the Edinburgh Postnatal Depression Scale. Musculoskeletal health outcomes will include body composition; whole-body areal bone mineral density; tibial volumetric bone mineral density, geometry, and microarchitecture; patella tendon properties; muscle architecture; muscle protein and collagen turnover; and muscle mass and muscle breakdown. Data will be analyzed using linear mixed-effects models, with participants included as random effects, and group and time as fixed effects to assess within- and between-group differences over time.

Results

This study received ethical approval in April 2019 and recruitment started in July 2019. The study was paused in March 2020 owing to the COVID-19 pandemic. Recruitment restarted in May 2021. The results are expected in September 2022.

Conclusions

This study will inform the best practice for the safe and optimal return of postpartum servicewomen to physically and mentally demanding jobs.

Trial Registration

ClinicalTrials.gov NCT04332757; https://clinicaltrials.gov/ct2/show/NCT04332757

International Registered Report Identifier (IRRID)

DERR1-10.2196/32315

Capacities for meta-cognition, social cognition, and alexithymia in postpartum depression

Postpartum depression (PPD), a female-specific disorder, is the most common medical complication associated with childbirth (10-20%). The pathological relevance of emotion processing, meta-cognition, alexithymia, and social cognition to PPD is unclear. We tested 25 mothers with PPD (mean age: 30.72 ± 5.76 years) and 25 healthy mothers (mean age: 32.03 ± 3.54 years) for alexithymia (Toronto Alexithymia Scale) and evaluated cognitive empathy (Faux Pas Test), affective empathy (Interpersonal Reactivity Index), meta-cognition (Meta-Cognitions Questionnaire), sociodemographic and clinical-psychometric characteristics and personality dimensions. Mothers with PPD showed higher levels of neuroticism and more anxiety-depressive characteristics. Their metacognitive abilities were significantly altered and they more often had alexithymia. Significant correlations between alexithymia and meta-cognition, trait anxiety, and neuroticism were found. Alexithymia, neurotic personality traits, and dysfunctional meta-cognition appear more frequently in PPD women than healthy women. Social cognition abilities were not significantly altered. Alexithymia and metacognitive distortions play important roles in the pathogenesis of PPD. Dysfunctional meta-cognition, neuroticism, and alexithymia may be risk factors that should be detected early in expectant mothers to prevent the development of PPD.

Validated tools to identify common mental disorders in the perinatal period: A systematic review of systematic reviews

BACKGROUND

Uncertainty remains regarding the validity of screening tools to detect common mental disorders (CMDs) during perinatal periods. This umbrella review aims to provide an up-to-date summary of psychometric properties of tools for the identification of perinatal CMDs.

METHODS

Reviews were identified via Ovid MEDLINE, PsychINFO, EMBASE, Global Health and Cochrane Database of Systematic Reviews electronic databases with no date or language restriction. Pooled sensitivity and specificity estimates and ranges were extracted and summarised using forest plots. Quality assessment was conducted using Measurement Tool to Assess Systematic Reviews (AMSTAR-2).

RESULTS

Of 7,891 papers identified, 31 reviews met inclusion criteria. 76 screening tools were identified; most frequently validated were Edinburgh Postnatal Depression Scale (EPDS) (n = 28 reviews), Beck's Depression Inventory (BDI) (n = 13 reviews) and Patient Health Questionnaire (PHQ) (n = 12 reviews). Forest plots demonstrated a pattern of decreasing sensitivity and increasing specificity with increasing cut-off scores. Sub-group analysis of data extracted from low quality reviews demonstrated wider 95% CIs and overall lower specificity. Validity also varied according to ethnicity, socio-economic background and age.

LIMITATIONS

Despite a low Covered Corrected Area (CCA) score the primary studies included within reviews overlapped; therefore we were unable perform meta-analysis.

CONCLUSIONS

The evidence suggests that the EPDS, PHQ and BDI are useful across a range of diverse settings but the context of tool application is a key factor determining validity. This review highlights that utilizing screening tools in clinical practice is complex and requires careful consideration of the population, context, and health system it will be used in.

Directionality of the associations between bedsharing, maternal depressive symptoms, and infant sleep during the first 15 months of life

OBJECTIVES

To identify predictors of infant sleep arrangement and examine the directionality of the relationships between maternal depressive symptoms, infant sleep problems, and bedsharing.

DESIGN

Secondary analysis of longitudinal data from the Mothers and Others: Family-Based Obesity Prevention for Infants and Toddlers randomized trial.

SETTING

Central North Carolina, USA.

PARTICIPANTS

Four-hundred and twenty-eight predominantly low-income, non-Hispanic Black mother-infant pairs.

MEASUREMENTS

Data were collected at 28 weeks pregnancy and 1, 3, 6, 9, 12, and 15 months postpartum. Maternal depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale and infant sleep variables were measured using the Brief Infant Sleep Questionnaire.

RESULTS

The prevalence of reported bedsharing increased from 16.7% at 1 month to 35.6% at 15 months postpartum. Bedsharing was associated with shortened breastfeeding duration and maternal perception of an infant sleep problem. Concurrently, maternal perception of an infant sleep problem, but not presence of maternal depressive symptoms, was associated with an increased likelihood of bedsharing. Longitudinally, neither maternal perception of an infant sleep problem nor presence of maternal depressive symptoms predicted bedsharing. Bedsharing predicted an increased likelihood of maternal perception of an infant sleep problem and presence of maternal depressive symptoms.

CONCLUSION

Prevalence of bedsharing increased over time and was predictive of maternal depressive symptoms. Providers should discuss the conflicting infant sleep recommendations with their patients and provide safe-sleep guidelines for mothers who intend to bedshare.

Pre-pregnancy sleep duration and postpartum depression: a multicenter study in Japan

Postpartum depression (PPD) is as a major public health issue and clinical priority worldwide. This study aimed to investigate the association between pre-pregnancy sleep duration and PPD. A multicenter retrospective study was conducted using clinical data of women who delivered at term between 2014 and 2018 at 12 maternity care hospitals in Japan. A total of 15,314 women were stratified into five groups according to their pre-pregnancy sleep duration: < 6, 6-7, 7-8, 8-9, and ≥ 9 h. Univariate and multivariate regression analyses were conducted to determine whether pre-pregnancy sleep duration affects the Edinburgh Postnatal Depression Scale (EPDS) scores at 1 month postpartum. We also evaluated whether the risk for PPD differs between primipara and multipara women classified according to pre-pregnancy sleep duration. The adjusted odds ratio for high EPDS scores (≥ 9) among women who slept for < 6 h and 6-7 h was 2.08 (95% confidence interval [CI]: 1.60-2.70) and 1.41 (95% CI: 1.18-1.68), respectively, relative to that in women with 7-8 h of sleep as the reference group. A 1-h increase in sleep duration was associated with an approximately 14% reduction in the risk for high EPDS scores. The association between short sleep duration and high EPDS scores was more remarkable in multipara women than in primipara women. Short pre-pregnancy sleep duration is associated with high EPDS scores, and this association is more significant in multipara women than in primipara women. Our findings emphasize the importance of collecting information on pre-pregnancy sleep duration to identify women at a high risk for PPD.

The limited screening accuracy of the Patient Health Questionnaire-2 in detecting depression among perinatal women in Italy

BACKGROUND

The PHQ-2 was recently recommended by the International Consortium for Health Outcomes Measurement as a form of initial perinatal screening, followed by the EPDS only for women with positive PHQ-2 score. However, the accuracy of the PHQ-2 in perinatal clinical practice has been barely researched, to date. In the present study, we aim to assess the accuracy of the PHQ-2 against the EPDS in a large sample of perinatal women.

METHODS

A total of 1155 consecutive women attending eleven primary or secondary health care centres throughout Italy completed the EPDS and the PHQ-2 during pregnancy (27-40-weeks) or postpartum (1-13-weeks). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio, negative likelihood ratio, post-test probabilities and area under the curve (AUC) of the PHQ-2, using a cut-off of ≥ 3, were calculated.

MAIN FINDINGS

During pregnancy, PHQ-2 revealed low sensitivity (39.5%) and PPV (39.4%) but high specificity and NPV (97.5%). In postpartum, it revealed very low sensitivity (32.7%) and moderately high NPV (80.9%), but high specificity (99.3%) and PPV (94.4%). Given the low sensitivity despite the high specificity, the PHQ-2 demonstrated poor accuracy (AUC from 0.66 to 0.68).

CONCLUSION

Initial screening by means of PHQ-2 failed to identify an acceptable number of perinatal women at-risk of depression in Italian clinical practice. The PHQ-2 performance suggested that it has insufficient sensitivity and discriminatory power, and may be inadequate as a screening tool for maternal depression.

Money and my mind: Maternal cash transfers and mental health

This paper documents important mental health spillovers in the context of a program that offered pregnant women modest cash incentives to use pre- and perinatal health care services. Program participation was randomized and the payments were made after the birth of the child (and after the completion of an endline mental health assessment). I present causal evidence that the program led to improvements in mothers' mental health. The effect size ranges from a 1-3 percentage point reduction in postpartum depression measured using the Edinburgh Postnatal Depression Scale. I present suggestive evidence that these beneficial effects on mental health may be related to program-induced improvements in child health. These results provide novel evidence that programs designed to improve birth outcomes may generate unanticipated spillover effects on mental health.

Changes in Depressive Symptoms, Stress and Social Support in Mexican Women during the COVID-19 Pandemic

The aim of this study was to examine changes in depression, stress and social support levels before and during the COVID-19 pandemic in women living in Mexico City. We studied 466 women enrolled in the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) study who completed the Edinburgh Depression Scale (EDS) questionnaire prior (2018–2019) and during the lockdown period of the pandemic (May–November 2020). Psychosocial stress and social support for both time periods were ascertained using the Crisis in Family Systems (CRISYS) questionnaire and the Social Support Network (SSN) Scale, respectively. Associations between stress, social support and change in EDS score/depression were analyzed using generalized linear models adjusting for covariates. Higher stress (>median) during the pandemic was associated with an increase in EDS score (β: 2.13; 95% CI (1.06, 3.19), p < 0.001), and higher odds of depression (OR: 3.75; 95% CI (2.17, 6.50), p < 0.001), while social support was associated with lower odds of depression (OR: 0.56, 95% CI (0.32, 0.97), p = 0.037). Higher levels of stress during the pandemic were associated with depression. Social support may act as a buffer for the effects of psychosocial stress. Future studies should examine the long-term effects of stress associated with the pandemic on mental and overall health.

Bipolar disorder: Treatment strategies for women of childbearing age

PURPOSE

Bipolar disorder is associated with increased rates of morbidity and mortality, magnified in women of childbearing age. The purpose of this paper is to provide an overview of the differential diagnosis and management of bipolar disorder in women of childbearing age.

CONCLUSIONS

Differential diagnoses for bipolar disorder include depressive disorders, anxiety disorders, trauma-related disorders, attention-deficit/hyperactivity disorder, and personality disorders. Pharmacotherapeutic options for the treatment of bipolar disorder include lithium, anti-epileptic medications, and atypical antipsychotics. In regard to women of childbearing age, consideration of risks, benefits, and alternative therapies is needed before initiating therapy.

PRACTICE IMPLICATIONS

Caring for patients with bipolar disorder, particularly women of childbearing age, requires careful differentiation of bipolar disorder from other mental health problems, and prudent consideration of pharmacotherapeutic options.

Prenatal Exposure to Bisphenols and Phthalates and Postpartum Depression: The Role of Neurosteroid Hormone Disruption

CONTEXT

Postpartum depression (PPD) is a serious psychiatric disorder. While causes remain poorly understood, perinatal sex hormone fluctuations are an important factor, and allopregnanolone in particular has emerged as a key determinant. Although synthetic environmental chemicals such as bisphenols and phthalates are known to affect sex hormones, no studies have measured allopregnanolone and the consequences of these hormonal changes on PPD have not been interrogated.

OBJECTIVE

To investigate associations of repeated measures of urinary bisphenols and phthalates in early and midpregnancy with serum pregnenolone, progesterone, allopregnanolone, and pregnanolone concentrations in midpregnancy and PPD symptoms at 4 months postpartum.

METHODS

Prospective cohort study of 139 pregnant women recruited between 2016 and 2018. Bisphenols and phthalates were measured in early and midpregnancy urine samples. Serum sex steroid hormone concentrations were measured in midpregnancy. PPD was assessed at 4 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Multiple informant models were fit using generalized estimating equations. Serum levels of allopregnanolone, progesterone, pregnanolone, and pregnenolone were examined as log-transformed continuous variables. PPD symptoms were examined as continuous EPDS scores and dichotomously with scores ≥10 defined as PPD.

RESULTS

Di-n-octyl phthalate (DnOP) and diisononyl phthalate (DiNP) metabolites were associated with reduced progesterone concentrations. Log-unit increases in ∑DnOP and ∑DiNP predicted 8.1% (95% CI -15.2%, -0.4%) and 7.7% (95% CI -13.3%, -1.7%) lower progesterone, respectively. ∑DnOP was associated with increased odds of PPD (odds ratio 1.48; 95% CI 1.04, 2.11).

CONCLUSION

Endocrine disrupting chemicals may influence hormonal shifts during pregnancy as well as contribute to PPD.

Contemporary management of unipolar depression in the perinatal period

Introduction: There is increasing recognition that antenatal depression and postpartum depression are highly prevalent and have significant impact on maternal and child health.Areas Covered: In the initial part of the manuscript, the authors review the epidemiology of antenatal and postpartum depression and its impact on maternal and child health. The later part of the manuscript reviews the current status of the medical management and psychosocial interventions targeting perinatal depression.Expert Opinion: Perinatal depression is the focus of several studies with increasing interest in developing effective interventions. While several psychosocial interventions targeting maternal depressive symptoms during pregnancy and postpartum are available, more studies are needed to address the need for safe and efficacious strategies for the use of antidepressant medication during pregnancy and in the postpartum period.

Psychiatric Conditions During Pregnancy and Postpartum in a Universally Insured American Population

BACKGROUND

Mental health conditions are common and can have significant effects during the perinatal period. Our objective was to determine the incidences and predictors of psychiatric conditions during pregnancy and postpartum among universally insured American women.

MATERIAL AND METHODS

This was an Institutional Review Board (IRB)-approved protocol using a retrospective cohort of 104,866 deliveries covered by TRICARE from 2005 to 2014. We used TRICARE claims data to identify pregnant women without current psychiatric conditions who developed new psychiatric condition(s) during pregnancy or postpartum compared with those who did not, as identified by International Classification of Diseases (ICD)-9 CM codes. Predictors of psychiatric conditions during pregnancy or postpartum were determined using stepwise logistic regression models.

RESULTS

A total of 104,866 women met the inclusion criteria; of these, 35% (n = 36,192) were diagnosed with a new psychiatric condition during pregnancy or within 1 year of delivery, 15% (n = 15,636) with a psychiatric condition during pregnancy, and 20% (n = 20,556) with a psychiatric condition within 1 year of delivery. We demonstrated that the African-American race (odds ratio [OR] 1.16, 95% CI 1.10-1.22), active duty status (OR 1.20, 95% CI 1.14-1.25), and severe maternal morbidity during delivery (OR 1.18, 95% CI 1.02-1.35) were significantly associated with the occurrence of a psychiatric condition within 1 year of delivery. For Asian women, there was a 28% higher odds of developing a psychiatric disorder during pregnancy (adjusted OR 1.28, 95% CI 1.17-1.40) compared with White women. Active duty women were twice as likely to be diagnosed with post-traumatic stress disorder (adjusted OR 2.31, 95% CI 1.83-2.90).

CONCLUSION

In a universally insured population, the incidences of psychiatric conditions in pregnancy and within a year of delivery were similar to the American population. Additionally, the development of psychiatric conditions in pregnancy and within a year of delivery may be associated with race, active duty status, and complicated births.

Prevalence of Postpartum Depression and Associated Predictors Among Taiwanese Women in a Mother-Child Friendly Hospital

Postpartum depression (PPD) is a highly prevalent disorder characterized by increased vulnerability to morbidity and mortality. This study explores the predictors and prevalence of PPD among Taiwanese women. A total of 914 postpartum women was recruited from a mother-child-friendly hospital. These participants completed self-report questionnaires at 1 month postpartum, and their medical records were also examined for relevant information. Multivariate analyses were used to identify independent predictors of PPD. At 1 month postpartum, 18.8% had developed PPD. Multivariate analysis showed that the odds ratios for PPD were significantly lower among women who were breastfeeding, had more family support, and attended a postpartum care center, while those who were younger, primiparous, and who experienced gestational complications had a higher prevalence of PPD. Meanwhile, structural equation modeling showed that family support from partners, parents, and parents-in-law diminished depression scores through direct effects.

An Exploration of Illness Narratives of Mothers with Maternal Depression in Semi-Urban Areas

This study explores the pre-diagnosis perceptions and experiences of semi-urban women regarding maternal depression and the issues in the follow-up of its treatment. Using the patient's end of Kleinman's Explanatory Model of Illness, it documents the whole episode of maternal depression in women. The main focus group of this study includes the women diagnosed with maternal depression and registered in the health facilities of Rawalpindi. Research was conducted in one primary health facility i.e. rural health centre of Khayaban e Sir Syed and one secondary health facility i.e. the Tehsil Headquarter Hospital of Taxila that were subject to the Mother and Child Health Program under the Rural Health Sector Reform Project in Punjab. The data shows that the socio-cultural setting of the women affects their perspectives and beliefs regarding maternal depression as well as shapes their health-seeking behavior, as there seemed to be a preference of religious and cultural coping mechanisms resulting in poor compliance with medical services and hurdles in the follow-up of medical treatment. Through understanding the illness beliefs of these women, effective measures can be taken for the provision of better health facilities and ensuring their follow-up.

Links between perinatal risk factors and maternal psychological distress: A network analysis

INTRODUCTION

This paper explores a range of perinatal risk factors that may increase maternal vulnerability to postnatal psychological distress in a sample of 17 531 women participating in the Millennium Cohort Study, a diverse British, longitudinal birth cohort study.

MATERIAL AND METHODS

Using a graphical network modeling framework, this study models the links between postnatal psychological distress and perinatal risk factors, while controlling for sociodemographic factors and history of depression and anxiety. Postnatal psychological distress was assessed at 9 months postpartum using the Rutter Malaise Inventory.

RESULTS

Results of the graphical network models indicate that lower levels of happiness about the pregnancy (Edge weight [w] = 0.084, 95% CI = 0.069-0.100, b = 0.095), smoking during pregnancy (w = 0.026, 95% CI = -0.009-0.060, b = 0.029), infection during pregnancy (w = 0.071, 95% CI = 0.024-0.118, b = 0.090), hyperemesis gravidarum (w = 0.068, 95% CI = 0.013-0.123, b = 0.083), baby in special care (w = 0.048, 95% CI = -0.004-0.099, b = 0.062), not being white (w = 0.101, 95% CI = 0.062-0.140, b = 0.118), being from a more deprived area (w = -0.028, 95% CI = -0.051 to -0.005, b = -0.039), lower income (w = -0.025, 95% CI = -0.055-0.005, b = -0.036), and history of depression or anxiety (w = 0.574, 95% CI = 0.545-0.603, b = 0.764) were associated with increased psychological distress.

CONCLUSIONS

Some perinatal risk factors may be directly associated with postnatal psychological distress, but many risk factors appear to be primarily associated with demographic factors. This emphasizes the importance of taking a holistic approach when evaluating an individual's risk of developing postnatal psychological distress.

A Program Evaluation of Behavioral Health Integration in a Freestanding Birth Center

The objective of this evaluation was to evaluate the integration of behavioral health services at a freestanding birth center. Program evaluation included (1) retrospective health record reviews and (2) provider and client evaluation of satisfaction. In May 2017, an urban freestanding birth center initiated grant-funded integrated behavioral health services. Participants included women receiving perinatal care from May 2016 to April 2018 (n = 831). Clients (n = 414) and providers (n = 9) were surveyed through e-mail, with 166 (40%) and 7 (78%) responses, respectively. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale. Screening and treatment of depression were identified from health records. The on-site therapist saw 21% of women who birthed during the program's first year. Compared with the year before the program began, in the program's first year, more women were screened for depression at least once (401/415 (96.6%) vs 413/415 (99.5%), P = .002) and more women with an indication received treatment (62.5% [105/168] vs 34.5% [38/110], P < .001). Provider and client satisfaction was high. The on-site therapist provided services easily integrated into the freestanding birth center practice, resulting in increased depression screening and treatment, with overwhelming client and provider satisfaction.

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

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

The Price of Pre-adolescent Abuse: Effects of Sexual Abuse on Perinatal Depression and Anxiety

INTRODUCTION

Childhood abuse is a major public health concern and a risk factor for subsequent poor maternal mental health. This study of 176 racially diverse women explored the associations between the histories of childhood sexual abuse and depression and anxiety during pregnancy, at six weeks postpartum, and 12 weeks postpartum.

METHODS

Data on depressive and anxiety symptoms were gathered during pregnancy, at six weeks postpartum, and 12 weeks postpartum. Sociodemographic data were collected during pregnancy, while data on childhood sexual abuse were gathered during the 12-week postpartum period. Bivariate analyses and repeated mixed-effects linear regression with bootstrapping were used to assess the association between childhood sexual abuse and perinatal depressive and anxiety symptoms.

RESULTS

Childhood sexual abuse was significantly associated with depressive symptoms (β = 2.52, 95% CI 1.72, 3.32, p < .001) and anxiety symptoms (β = 4.44, 95% CI 3.70, 5.81, p < .001) over time, while controlling for demographic characteristics and lifetime major depression and anxiety. Depressive and anxiety symptoms decreased over the perinatal period and were highest during pregnancy. Black women were more likely to report higher depressive symptoms (β = 1.35, 95% CI 0.51, 2.19, p = .002) and anxiety symptoms (β = 3.29 95% CI 1.72, 4.87, p < .001) over time compared to White women.

DISCUSSION

The results highlight the importance of assessing the long-term effects of childhood sexual abuse on perinatal depressive and anxiety symptoms to help inform the development of interventions for women, particularly Black women.

Postpartum Depression Screening and Referral in a Pediatric Emergency Department

OBJECTIVES

The aim of this study was to determine the (1) proportion of screened postpartum depression (PPD)-positive mothers, (2) associated risk factors, and (3) impact of PPD screening in a pediatric emergency department (PED).

STUDY DESIGN

We performed a pilot cohort study using a convenience sample of mothers (n = 209, all ages) of infant patients 6 months or younger presenting to a PED. Mothers completed a computerized survey that included the Edinburgh Postnatal Depression Scale. We assessed frequency of positive screens and performed multivariable logistic regression to identify associated risk factors. We assessed maternal attitudes toward screening at enrollment and 1-month follow-up with positive-screen mothers. Differences in ED utilization were measured.

RESULTS

Fifty-seven of 209 mothers (27%; 95% confidence interval [CI], 21%-33%) screened positive for PPD, with 14 (7%) reporting suicidal thoughts. Forty-seven percent (97/209) had never previously been screened, including 58% (33/57) of PPD screen-positive mothers. Current unemployment status (adjusted odds ratio [aOR], 2.76; 95% CI, 1.25-6.13) and first-time motherhood (aOR, 3.92; 95% CI, 1.72-8.91) were associated with a positive screen. At 1-month follow-up, mothers (35/37) reported PED-based PPD screening was important. After adjustment for sociodemographic factors, PPD screen-positive mothers had increased PED utilization (aOR, 1.29; 95% CI, 1.03-1.61).

CONCLUSIONS

Approximately 1 in 4 mothers screened positive for PPD in a PED, with almost 1 in 10 reporting suicidal thoughts. The majority of PPD screen-positive mothers had not been screened previously. Our study helps to inform future efforts for interventions to support mothers of young infants who use the PED for care.

Associations between commonly used patient-reported outcome tools in postpartum depression clinical practice and the Hamilton Rating Scale for Depression

The objective of this study is to explore the associations between the patient-reported Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ)-9 and clinician-reported 17-item Hamilton Depression Rating Scale (HAMD-17) in order to facilitate clinical decision-making. An integrated efficacy dataset of three randomized placebo-controlled trials (NCT02614547, NCT02942004, and NCT02942017) evaluating brexanolone injection, a neuroactive steroid chemically identical to allopregnanolone, in women with postpartum depression was used for this post hoc analysis. Data were pooled across treatment arms. Associations were assessed at day 30 (end-of-trial follow-up). Pearson correlation assessed the relationship between EPDS and PHQ-9 item and total scores and HAMD-17 total score. Cohen's kappa assessed agreement of EPDS remission (score < 10) and PHQ-9 remission (score < 5) with HAMD-17 remission (score ≤ 7). Ordinary least squares (OLS) regression models were used to develop equations estimating HAMD-17 total scores from EPDS and PHQ-9 scores, respectively. The total scores showed large correlations (HAMD-17/EPDS: r = 0.71, p < 0.001; HAMD-17/PHQ-9: r = 0.75, p < 0.001). Individual EPDS and PHQ-9 items significantly correlated (r= 0.35 to 0.67, all p < 0.001) with HAMD-17 total score. EPDS had 79% sensitivity and 67% specificity to detect HAMD-17 remission; corresponding estimates for PHQ-9 were 76% and 78%. OLS models yielded the following equations: HAMD-17 total = 2.66 + (EPDS total × 0.87) and HAMD-17 total = 3.99 + (PHQ-9 total × 0.97). There were large and statistically significant associations between patient-reported outcomes (EPDS, PHQ-9) and clinician-reported outcomes (HAMD-17) as clinical improvements were associated with patient-reported symptom improvement. These results provide tools to help translate clinical trial data to clinical practice, thus aiding shared decision-making for this critical population.