1
|
Norazman CW, Lee LK. The influence of social support in the prevention and treatment of postpartum depression: An intervention-based narrative review. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241275587. [PMID: 39238240 PMCID: PMC11378223 DOI: 10.1177/17455057241275587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
Postpartum depression (PPD) is a mental health disorder that affects 10%-15% women globally. Longitudinal and meta-analyses have consistently demonstrated the negative impacts of PPD on both the affected mothers and subsequent infant development. Given the consideration that antidepressant side effects in breastfeeding infants and the cost-effectiveness considerations of psychotherapies, attention has been paid towards the promising role of social support interventions in order to prevent and reduce the PPD symptoms. Confirming the assertion, this narrative review examines the potential of five social support interventions to ameliorate PPD-related maternal and infant outcomes. The wide implications of psychoeducational strategy, nurses' supportive and non-directive counselling and home-visiting approach are outlined. Furthermore, the evidence underlying the role of peer support, culturally tailored intervention and community-based participatory approach in PPD is elucidated. In clinical practice, this review reinforce the roles of discharge educational intervention led by the experienced nurse during the postpartum stay, in order to maintain psychological mental health among the postpartum mothers. More importantly, the skilled and competence public health nurses act as valuable assets in treating PPD, and this effective treatment alternative should be considered by healthcare planners. In future, major investigations will be strategized to discover the synergistic effects of combined social support approaches to yield a better outcome in the prevention and treatment of PPD.
Collapse
Affiliation(s)
- Camilla Wahida Norazman
- Food Technology Program, School of Industrial Technology, Universiti Sains Malaysia, Gelugor, Pulau Pinang, Malaysia
| | - Lai Kuan Lee
- Food Technology Program, School of Industrial Technology, Universiti Sains Malaysia, Gelugor, Pulau Pinang, Malaysia
| |
Collapse
|
2
|
Withers M, Trop J, Bayalag M, Schriger SH, Ganbold S, Doripurev D, Davaasambuu E, Bat-Erdene U, Gendenjamts B. "They should ask about our feelings": Mongolian women's experiences of postpartum depression. Transcult Psychiatry 2023; 60:1005-1016. [PMID: 37731351 DOI: 10.1177/13634615231187256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Between 16 and 20% of perinatal women in low- and middle-income countries experience depression. Addressing postpartum depression (PPD) requires an appreciation of how it manifests and is understood in different cultural settings. This study explores postpartum Mongolian women's perceptions and experiences of PPD. We conducted interviews with 35 postpartum women who screened positive for possible depression to examine: (1) personal experiences of pregnancy/childbirth; (2) perceived causes and symptoms of PPD; and (3) strategies for help/support for women experiencing PPD. Unless extreme, depression was not viewed as a disease but rather as a natural condition following childbirth. Differences between a biomedical model of PPD and local idioms of distress could explain why awareness about PPD was low. The most reported PPD symptom was emotional volatility expressed as anger and endorsement of fear- or anxiety-related screening questions, suggesting that these might be especially relevant in the Mongolian context. Psychosocial factors, as opposed to biological, were common perceived causes of PPD, especially interpersonal relationship problems, financial strain, and social isolation. Possible barriers to PPD recognition/treatment included lack of awareness about the range of symptoms, reluctance to initiate discussions with providers about mental health, and lack of PPD screening practices by healthcare providers. We conclude that educational campaigns should be implemented in prenatal/postnatal clinics and pediatric settings to help women and families identify PPD symptoms, and possibly destigmatize PPD. Healthcare providers can also help to identify women with PPD through communication with women and families.
Collapse
Affiliation(s)
- Mellissa Withers
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Justin Trop
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Munkhuu Bayalag
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Solongo Ganbold
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | | | | | - Undral Bat-Erdene
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | | |
Collapse
|
3
|
Øygarden AMU, Berg RC, Abudayya A, Glavin K, Strøm BS. Measurement instruments for parental stress in the postpartum period: A scoping review. PLoS One 2022; 17:e0265616. [PMID: 35303028 PMCID: PMC8932572 DOI: 10.1371/journal.pone.0265616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Parenting stress is a particular type of stress that is conceptualized as a negative psychological response to the numerous obligations associated with raising children. Despite a considerable increase in research on parenting stress, little attention has been given to the ways parenting stress are measured. OBJECTIVES This scoping review aimed to provide an overview of available instruments measuring parental stress and to describe their psychometric properties. METHODS We conducted a scoping review in accordance with international guidelines for scoping reviews. The main search strategy was searches in seven electronic databases. Pairs of reviewers selected relevant studies based on predetermined inclusion and exclusion criteria. Studies had to report one or more psychometric properties of an instrument measuring stress in parents with children 0-12 months. For each included study, we collected information relevant to the review question, guided by the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN). Finally, we collated, summarized, and reported the findings descriptively. RESULTS From 2164 unique record, 64 studies from 24 countries were included. They described 15 instruments, of which four were generic and eleven parental-specific self-administered instruments. Only two studies examined parental stress among fathers. Eleven of the studies were validation studies, but they only described seven of the 15 instruments. Internal consistency was the only information provided by 73.4% of the included studies. None of the instruments had information on all measurement properties as per the COSMIN criteria, and there was no information about measurement error, responsiveness, or interpretability for any of the 15 instruments. DISCUSSION There are presently 15 instruments with some associated psychometric information being used to measure parental stress among parents with young children, but the amount of information on the instruments' psychometric properties is slight. There is a need for further research.
Collapse
Affiliation(s)
- Anne-Martha Utne Øygarden
- Centre of Diakonia and Professional Practice, VID Specialized University, Oslo, Norway
- Faculty of Health, VID Specialized University, Oslo, Norway
| | - Rigmor C. Berg
- Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
- University of Tromsø The Arctic University of Norway, Tromsø og Finnmark, Norway
| | | | - Kari Glavin
- Faculty of Health, VID Specialized University, Oslo, Norway
| | | |
Collapse
|
4
|
Bhat A, Nanda A, Murphy L, Ball AL, Fortney J, Katon J. A systematic review of screening for perinatal depression and anxiety in community-based settings. Arch Womens Ment Health 2022; 25:33-49. [PMID: 34247269 DOI: 10.1007/s00737-021-01151-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/24/2021] [Indexed: 02/02/2023]
Abstract
Screening for perinatal depression and anxiety in community-based maternal and child health settings may help close the detection and treatment gap among women at higher risk for these conditions. We aim to review perinatal depression and anxiety screening tools, timing, and follow-up processes for positive screens in community-based settings. We conducted a systematic review of the literature to identify papers describing screening and interventions for perinatal depression and anxiety in community-based settings. We identified 49 papers describing 47 studies of perinatal depression or anxiety screening in community-based settings. The Edinburgh Postnatal Depression Scale (EPDS) was the most frequently used screening tool. Referral and referral tracking for those who screened positive for symptoms were inadequately described. Types of training and technical assistance provided for screening varied widely. It is feasible and acceptable to screen for perinatal depression in community settings, but there is a need for systematic research examining which screening tools to use, the ideal frequency of screening, and referral completion rates. There is a lack of information regarding perinatal anxiety screening and a lack of uniformity in training regarding screening in community-based settings. Future studies should compare the efficacy of screening in community-based settings to screening in healthcare settings.
Collapse
Affiliation(s)
- Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Arjun Nanda
- Department of Child and Adolescent Psychiatry, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | - Lauren Murphy
- College of Medicine - Tucson, The University of Arizona, Tucson, AZ, USA
| | - Andrea L Ball
- MultiCare Institute for Research and Innovation, Tacoma, WA, USA
| | - John Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Jodie Katon
- VA Puget Sound Health Care System, WA, Seattle, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| |
Collapse
|
5
|
Waqas A, Koukab A, Meraj H, Dua T, Chowdhary N, Fatima B, Rahman A. Screening programs for common maternal mental health disorders among perinatal women: report of the systematic review of evidence. BMC Psychiatry 2022; 22:54. [PMID: 35073867 PMCID: PMC8787899 DOI: 10.1186/s12888-022-03694-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/05/2022] [Indexed: 11/17/2022] Open
Abstract
Postpartum depression and anxiety are highly prevalent worldwide. Fisher et al., estimated the prevalence of depression and anxiety at 15.6% during the antenatal and 19.8% during the postpartum period. Their impact on maternal and child health is well-recognized among the public health community, accounting for high societal costs. The public health impact of these conditions has highlighted the need to focus on the development and provision of effective prevention and treatment strategies.In recent decades, some advances have been made in the development of effective universal and targeted screening programmes for perinatal depression and anxiety disorders. Recent research has shown potential benefits of universal and targeted screening for perinatal depression, to identify and treat undiagnosed cases, and help thwart its deleterious consequences. Ethical implications, however, for these screening programmes, without the provision of treatment have often been emphasized.The present mixed-methods systematic review and meta-analysis was conducted to collate evidence for screening programmes for perinatal depression and anxiety. It aims to answer the following questions, in a global context: For women in the perinatal period, do screening programmes for perinatal depression and anxiety compared with no screening improve maternal mental health and infant outcomes?A series of meta-analyses reveal a reduction in perinatal depression and anxiety among perinatal women undergoing screening programmes. For the outcome of depressive disorder, meta-analysis indicates a positive impact in favour of the intervention group (OR = 0.55, 95% CI: 0.45 to 0.66, n = 9009), with moderate quality of evidence. A significant improvement (high quality) was also observed in symptoms of anxiety among perinatal women (SMD = - 0.18, 95% CI: - 0.25 to - 0.12, n = 3654).
Collapse
Affiliation(s)
- Ahmed Waqas
- Institute of Population Health, University of Liverpool, Liverpool, L69 3GF, UK.
| | - Ahmreen Koukab
- Human Development Research Foundation, Islamabad, Pakistan
| | - Hafsa Meraj
- Human Development Research Foundation, Islamabad, Pakistan
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Neerja Chowdhary
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Batool Fatima
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, L69 3GF, UK
| |
Collapse
|
6
|
Newham JJ, McLean K, Ginja S, Hurt L, Molloy C, Lingam R, Goldfeld S. Brief evidence-based interventions for universal child health services: a restricted evidence assessment of the literature. BMC Public Health 2020; 20:993. [PMID: 32580720 PMCID: PMC7315474 DOI: 10.1186/s12889-020-09104-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background Universal child health services (UCHS) provide an important pragmatic platform for the delivery of universal and targeted interventions to support families and optimize child health outcomes. We aimed to identify brief, evidence-based interventions for common health and developmental problems that could be potentially implemented in UCHS. Methods A restricted evidence assessment (REA) of electronic databases and grey literature was undertaken covering January 2006 to August 2019. Studies were eligible if (i) outcomes related to one or more of four areas: child social and emotional wellbeing (SEWB), infant sleep, home learning environment or parent mental health, (ii) a comparison group was used, (iii) universal or targeted intervention were delivered in non-tertiary settings, (iv) interventions did not last more than 4 sessions, and (v) children were aged between 2 weeks postpartum and 5 years at baseline. Results Seventeen studies met the eligibility criteria. Of these, three interventions could possibly be implemented at scale within UCHS platforms: (1) a universal child behavioural intervention which did not affect its primary outcome of infant sleep but improved parental mental health, (2) a universal screening programme which improved maternal mental health, and (3) a targeted child behavioural intervention which improved parent-reported infant sleep problems and parental mental health. Key lessons learnt include: (1) Interventions should impart the maximal amount of information within an initial session with future sessions reinforcing key messages, (2) Interventions should see the family as a holistic unit by considering the needs of parents with an emphasis on identification, triage and referral, and (3) Brief interventions may be more acceptable for stigmatized topics, but still entail considerable barriers that deter the most vulnerable. Conclusions Delivery and evaluation of brief evidence-based interventions from a UCHS could lead to improved maternal and child health outcomes through a more responsive and equitable service. We recommend three interventions that meet our criteria of “best bet” interventions.
Collapse
Affiliation(s)
- James J Newham
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Karen McLean
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Samuel Ginja
- School of Psychology, Ulster University, Coleraine, UK
| | - Lisa Hurt
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Carly Molloy
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Raghu Lingam
- School of Women's & Children's Health, University of New South Wales, Randwick, Australia.
| | - Sharon Goldfeld
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| |
Collapse
|
7
|
Reilly N, Kingston D, Loxton D, Talcevska K, Austin MP. A narrative review of studies addressing the clinical effectiveness of perinatal depression screening programs. Women Birth 2020; 33:51-59. [DOI: 10.1016/j.wombi.2019.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 12/27/2018] [Accepted: 03/06/2019] [Indexed: 12/17/2022]
|
8
|
Baratieri T, Natal S. Ações do programa de puerpério na atenção primária: uma revisão integrativa. CIENCIA & SAUDE COLETIVA 2019; 24:4227-4238. [DOI: 10.1590/1413-812320182411.28112017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 04/11/2018] [Indexed: 11/22/2022] Open
Abstract
Resumo O puerpério trata-se de um período de significativa morbimortalidade para as mulheres, e a Atenção Primária à saúde (APS) é importante no desenvolvimento de ações para atender as necessidades de saúde das mulheres. Objetivou-se sistematizar o conhecimento produzido sobre as ações de programas de atenção pós-parto no âmbito da APS, tanto em nível nacional, como internacional. Utilizou-se revisão integrativa de literatura de artigos junto às bases Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde), BDENF (Base de dados em Enfermagem), SciELO (Scientific Electronic Library Online) e PubMed (Biblioteca Nacional de Medicina dos Estados Unidos). A busca ocorreu de abril a maio de 2017. Atenderam aos critérios de seleção 43 artigos. Os resultados apontam que: a APS possui estrutura física para atenção à puérpera, porém com déficit em recursos humanos e materiais; há baixa cobertura de consulta pós-parto e visita domiciliar; boa avaliação do incentivo ao aleitamento materno, porém com foco na criança; rastreamento da Depressão Pós-Parto internacionalmente por meio da “Edimburgh Post-Natal Depression Scale”, e déficit na atenção a esse agravo no Brasil. A atenção pós-parto ainda tem como foco o cuidado ao recém-nascido e são restritos, em sua maioria, ao puerpério imediato e tardio.
Collapse
Affiliation(s)
| | - Sonia Natal
- Universidade Federal de Santa Catarina, Brazil
| |
Collapse
|
9
|
Topatan S, Demirci N. Frequency of Depression and Risk Factors among Adolescent Mothers in Turkey within the First Year of the Postnatal Period. J Pediatr Adolesc Gynecol 2019; 32:514-519. [PMID: 31026502 DOI: 10.1016/j.jpag.2019.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/05/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE Postpartum depression (PPD) emerges within the first 4 weeks of the postnatal period and might continue for as long as 1 year. The aims of this prospective study were to examine the prevalence, severity, and risk factors for PPD among adolescent mothers in Turkey. DESIGN, SETTING, AND PARTICIPANTS The study consisted of 84 adolescent mothers between the ages of 15 and 19 years. INTERVENTIONS AND MAIN OUTCOME MEASURES The participants were questioned about PPD at 3 postnatal periods: 4 weeks, 6 months, and 1 year. A 23-item question form, prepared to evaluate the risk of PPD, and the Edinburgh Postnatal Depression Scale were used. RESULTS The risk of adolescent PPD was 19 (22.6%). There was a statistically significant association between the risk of PPD and various factors, such as age, educational background, trouble with partner and family, problems with sexual intercourse in the postnatal term, and assertiveness in making decisions about children (P < .05). At the 6-month follow-up, the scores of the Edinburgh Postnatal Depression Scale risk group remained the same, but they were lower at the 1-year follow-up. CONCLUSION The results revealed that adolescent mothers need the assistance of partners, families, midwives/nurses, and other support systems, especially during the first postnatal year, to reduce the prevalence of adolescent PPD.
Collapse
Affiliation(s)
- Serap Topatan
- Department of Mıdwıfery, Ondokuz Mayıs Unıversıty, Faculty of Health Scıences, Samsun, Turkey.
| | - Nurdan Demirci
- Department of Nursıng, Marmara Unıversıty, Faculty of Health Scıences, Istanbul, Turkey
| |
Collapse
|
10
|
Glavin K, Schaffer MA, Kvarme LG. The Public Health Intervention Wheel in Norway. Public Health Nurs 2019; 36:819-828. [DOI: 10.1111/phn.12657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/30/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022]
|
11
|
Haga SM, Drozd F, Lisøy C, Wentzel-Larsen T, Slinning K. Mamma Mia - A randomized controlled trial of an internet-based intervention for perinatal depression. Psychol Med 2019; 49:1850-1858. [PMID: 30191779 PMCID: PMC6650775 DOI: 10.1017/s0033291718002544] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/09/2018] [Accepted: 08/16/2018] [Indexed: 11/02/2022]
Abstract
BACKGROUND Studies suggest that 10-15% of perinatal women experience depressive symptoms. Due to the risks, problems with detection, and barriers to treatment, effective universal preventive interventions are needed. The aim of this study was to assess the effectiveness of an automated internet intervention ('Mamma Mia') on perinatal depressive symptoms. Mamma Mia is tailored specifically to the perinatal phase and targets risk and protective factors for perinatal depressive symptoms. METHODS A total of 1342 pregnant women were randomized to an intervention ('Mamma Mia') and control group. Data were collected at gestational week (gw) 21-25, gw37, 6 weeks after birth, and 3 and 6 months after birth. We investigated whether (1) the intervention group displayed lower levels of depressive symptoms compared with the control group, (2) the effect of Mamma Mia changed over time, (3) the effect on depressive symptoms was moderated by baseline depressive symptoms, previous depression, and parity, and (4) this moderation changed by time. Finally, we examined if the prevalence of mothers with possible depression [i.e. Edinburgh Postnatal Depression Scale (EPDS)-score ⩾10] differed between the intervention and control group. RESULTS Participants in the Mamma Mia group displayed less depressive symptoms than participants in the control group during follow-up [F(1) = 7.03, p = 0.008]. There were indications that the effect of Mamma Mia was moderated by EPDS score at baseline. The prevalence of women with EPDS-score ⩾10 was lower in the Mamma Mia group at all follow-up measurements. CONCLUSIONS The study demonstrated the effects of the automated web-based universal intervention Mamma Mia on perinatal depressive symptoms.
Collapse
Affiliation(s)
- Silje Marie Haga
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo,Norway
| | - Filip Drozd
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo,Norway
| | - Carina Lisøy
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo,Norway
| | - Tore Wentzel-Larsen
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo,Norway
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo,Norway
| | - Kari Slinning
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo,Norway
- Department of Psychology, University of Oslo, Oslo,Norway
| |
Collapse
|
12
|
Torres A, Gelabert E, Roca A, Navarro P, Plaza A, Subirà S, Martin-Santos R, Ascaso C, Garcia-Esteve L. Course of a major postpartum depressive episode: A prospective 2 years naturalistic follow-up study. J Affect Disord 2019; 245:965-970. [PMID: 30699882 DOI: 10.1016/j.jad.2018.11.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 09/30/2018] [Accepted: 11/03/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Survival methodology has not already been used in studies about postpartum depression (PPD) course. The aims of the present study were to estimate the duration of a Major Postpartum Depressive Episode (MPDE) during 2 years, as well as to explore factors associated with the course. METHOD This was a prospective, naturalistic, longitudinal study with a cohort of 165 women with a MPDE (DSM-IV criteria). Potential predictors of prognosis were recorded at baseline. Follow-up was conducted using the Longitudinal Interval Follow-up Evaluation (LIFE). RESULTS Of the total sample, 110 (66.7%) completed the 2 years follow-up. The mean time to full remission was 49.4 weeks (95% CI: 44.0-59.8). The probability of recovering was 30.2% (95% CI: 22.1%-37.4%) at 6 months of follow-up, 66.3% (95% CI: 57.4%-73.4%) at 12 months of follow-up, and 90.3% (95% CI: 79.8%-95.4%) at 24 months of follow-up. Mothers with financial difficulties, onset of depressive episode previous to birth, and those with prior treated depressive episodes took longer in achieving full remission. LIMITATIONS Results are only generalizable to mothers with PPD treated in a psychiatric outpatient setting. Psychopharmacological treatment was uncontrolled and personality was not assessed. CONCLUSIONS Our findings suggest that PPD could become a chronic disorder, particularly in mothers with an onset of the episode previous to birth, with a history of depression or with financial problems. Knowledge of these factors may help to improve the guidelines of depression management and treatment during the perinatal period.
Collapse
Affiliation(s)
- Anna Torres
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain; Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Psychiatry and Clinical Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Estel Gelabert
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Alba Roca
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain
| | - Purificación Navarro
- Servei de Psicologia, Regidoria de Polítiques de Gènere Ajuntament de Terrassa, Terrassa, Spain
| | - Anna Plaza
- Unitat de Crisi i Prevenció del Suicidi, CPB-Dreta Eixample, Barcelona, Spain
| | - Susana Subirà
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Rocío Martin-Santos
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Psychiatry and Clinical Psychology, Hospital Clinic, Barcelona, Spain; Department of Medicine, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), Spain
| | - Carlos Ascaso
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biostatistics Unit, Public Health Department, Universitat de Barcelona, Barcelona, Spain
| | - Lluïsa Garcia-Esteve
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain; Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| |
Collapse
|
13
|
Alexandrou F, Sakellari E, Kourakos M, Sapountzi-Krepia D. Health visitors' perceptions on their role to assess and manage postpartum depression cases in the community. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:995-1000. [PMID: 30152070 DOI: 10.1111/hsc.12638] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 07/10/2018] [Accepted: 07/16/2018] [Indexed: 06/08/2023]
Abstract
The present study gives an insight into the health visitors' perceptions on their role in assessing, managing, and supporting mothers with postpartum depression (PPD). The study took place in Cyprus among health visitors of a community Maternity and Child Welfare Clinic using qualitative approach. Data were collected through individual semistructured interviews. The findings showed that although health visitors are able to identify PPD cases, they stress the importance of protocols and evidence-based care as well as preventive interventions, and they also point out the importance of home visits. Finally, they support the need for education. It is concluded that health visitors can play an important role in women's health and their intervention on the prevention of PPD in the community especially through home visits is very important.
Collapse
Affiliation(s)
| | - Evanthia Sakellari
- Department of Public and Community Health, University of West Attica, Athens, Greece
- Department of Nursing Science, University of Turku, Finland
| | | | | |
Collapse
|
14
|
The Associations of Weight Status and Body Attitudes with Depressive and Anxiety Symptoms Across the First Year Postpartum. Womens Health Issues 2018; 28:530-538. [DOI: 10.1016/j.whi.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/29/2018] [Accepted: 07/11/2018] [Indexed: 11/18/2022]
|
15
|
Byatt N, Cox L, Moore Simas TA, Kini N, Biebel K, Sankaran P, Swartz HA, Weinreb L. How obstetric settings can help address gaps in psychiatric care for pregnant and postpartum women with bipolar disorder. Arch Womens Ment Health 2018; 21:543-551. [PMID: 29536256 PMCID: PMC6126942 DOI: 10.1007/s00737-018-0825-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/28/2018] [Indexed: 10/17/2022]
Abstract
To elucidate (1) the challenges associated with under-recognition of bipolar disorder in obstetric settings, (2) barriers pregnant and postpartum women with bipolar disorder face when trying to access psychiatric care, and (3) how obstetric settings can identify such women and connect them with mental health services. Structured, in-depth interviews were conducted with 25 pregnant and postpartum women recruited from obstetric practices who scored ≥ 10 on the Edinburgh Postnatal Depression Scale and met DSM-IV criteria for bipolar disorder I, II, or not otherwise specified using the Mini International Neuropsychiatric Interview. Quantitative analyses included descriptive statistics. Interviews were transcribed, and resulting data were analyzed using a grounded theory approach. Most participants (n = 19, 79.17%) did not have a clinical diagnosis of bipolar disorder documented in their medical records nor had received referral for treatment during pregnancy (n = 15, 60%). Of participants receiving pharmacotherapy (n = 14, 58.33%), most were treated with an antidepressant alone (n = 10, 71.42%). Most medication was prescribed by an obstetric (n = 4, 28.57%) or primary care provider (n = 7, 50%). Qualitative interviews indicated that participants want their obstetric practices to proactively screen for, discuss and help them obtain mental health treatment. Women face challenges in securing mental health treatment appropriate to their bipolar illness. Obstetric providers provide the bulk of medical care for these women and need supports in place to (1) better recognize bipolar disorder, (2) avoid inappropriate prescribing practices for women with undiagnosed bipolar disorder, and (3) ensure women are referred to specialized treatment when needed.
Collapse
Affiliation(s)
- Nancy Byatt
- University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - Lucille Cox
- University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Tiffany A Moore Simas
- University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Nisha Kini
- European Medical and Clinical Division, Terumo Europe N.V., Researchpark Hassrode 1520, Interleuvenlaan 40, 3001, Leuven, Belgium
| | - Kathleen Biebel
- University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Padma Sankaran
- University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Holly A Swartz
- University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Linda Weinreb
- University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA
| |
Collapse
|
16
|
Glasser S, Levinson D, Gordon ES, Braun T, Haklai Z, Goldberger N. The tip of the iceberg: postpartum suicidality in Israel. Isr J Health Policy Res 2018; 7:34. [PMID: 29936911 PMCID: PMC6016135 DOI: 10.1186/s13584-018-0228-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 06/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background Postpartum suicidality, a result of extreme distress or depression, is a tragedy for the woman, infant, and family. Screening for postpartum depression (PPD) is mandatory in Israel, including a question on suicidal ideation. This study presents and analyzes data regarding rates, trends and characteristics of postpartum women who considered, attempted, or completed suicide, to help direct services aimed at preventing these occurrences. Methods Suicidal ideation data based on PPD screening was drawn from various publications and databases. Suicide attempt data was obtained from the Emergency Department database for 2006–2015 and matched with the National Birth Registry. Cause of death from the national database for those years were similarly linked to births to identify postpartum suicides and deaths. Postpartum and non-postpartum suicide attempt rates were computed by year, and by age and ethnic/immigrant group. A multivariate logistic model was used to estimate relative risk for postpartum attempts, controlling for age and ethnic group. Results Suicidal ideation in recent years has been reported as 1% or less, with higher rates found in studies of Arab women. Suicide attempt rates for non-postpartum women were 3–5 times that of postpartum women, rising over the years, while remaining relatively stable for postpartum women. Adjusted risk of suicide attempt for non-postpartum women was significantly higher; adjusted odds ratio was 4.08 (95% CI 3.75–4.44). It was also significantly higher for Arabs and immigrants from the Former Soviet Union, compared to Israeli-born Jews/veteran immigrants, and for younger women compared to those aged 35–44. Seven postpartum suicides were recorded during 2006–2015, a rate of 0.43 per 100,000 births. Conclusion Postpartum suicidality in Israel is low relative to other countries. Although relatively rare and lower than among non-postpartum women, health professionals should be attentive to risk factors, such as past psychiatric disorders, suicide attempts and current emotional distress, particularly among higher-risk populations. The universal screening program for PPD is a valuable opportunity for this, but increased resources should be allotted to implement and utilize it optimally. Prenatal screening should be added as an Israeli Quality Indicator, and postpartum completed suicides should be thoroughly investigated to guide prevention efforts.
Collapse
Affiliation(s)
- Saralee Glasser
- Women & Children's Health Research Unit, Gertner Institute for Epidemiology & Health Policy Research, Ltd. Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.
| | - Daphna Levinson
- Mental Health Division, Ministry of Health, Jerusalem, Israel
| | | | - Tali Braun
- Israel Center for Disease Control, Ramat Gan, Israel
| | - Ziona Haklai
- Health Information Division, Ministry of Health, Jerusalem, Israel
| | | |
Collapse
|
17
|
van der Zee-van den Berg AI, Boere-Boonekamp MM, IJzerman MJ, Haasnoot-Smallegange RME, Reijneveld SA. Screening for Postpartum Depression in Well-Baby Care Settings: A Systematic Review. Matern Child Health J 2018; 21:9-20. [PMID: 27520555 PMCID: PMC5226980 DOI: 10.1007/s10995-016-2088-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction Postpartum depression (PPD) is a mental health problem frequently experienced by mothers in the first year postpartum. Early detection and treatment can help to reduce its negative effect on the development of the newborn child. Well-baby care (WBC) is a promising screening setting for early detection of PPD. This systematic review investigates the evidence of the effectiveness of screening for PPD in WBC settings regarding mother and child outcomes. Methods Three electronic databases were searched: SCOPUS, PsychINFO and CINAHL. Two reviewers independently performed the study selection. Data extraction was based on a predefined data extraction form. Results Six studies were included; a quality assessment rated two studies as strong and four as weak. Four studies measuring outcomes at process level showed improvement in detection, referral and/or treatment rates. Four studies, including the two strong ones, where screening and enhanced care were combined, showed improvements in the Edinburgh Postnatal Depression Scale scores of the mothers in the intervention groups. No improvements were reported on other outcomes at parent level or at child level. At child level, weight was the only outcome that was measured. Discussion This review provides limited yet positive evidence for the value of screening for PPD in a WBC setting. The outcomes are comparable with studies on screening for PPD in general. The evidence that we found is very promising but the small number of available studies shows a need for additional high-quality studies, to strengthen the evidence regarding the potential benefits of screening in a WBC setting.
Collapse
Affiliation(s)
- Angarath I van der Zee-van den Berg
- Department Health Technology and Services Research, Institute of Innovation and Governance Studies, University of Twente, Ravelijn Building Room RA 5260, PO Box 217, 7500 AE, Enschede, The Netherlands.
| | - Magda M Boere-Boonekamp
- Department Health Technology and Services Research, Institute of Innovation and Governance Studies, University of Twente, Ravelijn Building Room RA 5260, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Maarten J IJzerman
- Department Health Technology and Services Research, Institute of Innovation and Governance Studies, University of Twente, Ravelijn Building Room RA 5260, PO Box 217, 7500 AE, Enschede, The Netherlands
| | | | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
18
|
Morrell CJ, Sutcliffe P, Booth A, Stevens J, Scope A, Stevenson M, Harvey R, Bessey A, Cantrell A, Dennis CL, Ren S, Ragonesi M, Barkham M, Churchill D, Henshaw C, Newstead J, Slade P, Spiby H, Stewart-Brown S. A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression. Health Technol Assess 2018; 20:1-414. [PMID: 27184772 DOI: 10.3310/hta20370] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Postnatal depression (PND) is a major depressive disorder in the year following childbirth, which impacts on women, their infants and their families. A range of interventions has been developed to prevent PND. OBJECTIVES To (1) evaluate the clinical effectiveness, cost-effectiveness, acceptability and safety of antenatal and postnatal interventions for pregnant and postnatal women to prevent PND; (2) apply rigorous methods of systematic reviewing of quantitative and qualitative studies, evidence synthesis and decision-analytic modelling to evaluate the preventive impact on women, their infants and their families; and (3) estimate cost-effectiveness. DATA SOURCES We searched MEDLINE, EMBASE, Science Citation Index and other databases (from inception to July 2013) in December 2012, and we were updated by electronic alerts until July 2013. REVIEW METHODS Two reviewers independently screened titles and abstracts with consensus agreement. We undertook quality assessment. All universal, selective and indicated preventive interventions for pregnant women and women in the first 6 postnatal weeks were included. All outcomes were included, focusing on the Edinburgh Postnatal Depression Scale (EPDS), diagnostic instruments and infant outcomes. The quantitative evidence was synthesised using network meta-analyses (NMAs). A mathematical model was constructed to explore the cost-effectiveness of interventions contained within the NMA for EPDS values. RESULTS From 3072 records identified, 122 papers (86 trials) were included in the quantitative review. From 2152 records, 56 papers (44 studies) were included in the qualitative review. The results were inconclusive. The most beneficial interventions appeared to be midwifery redesigned postnatal care [as shown by the mean 12-month EPDS score difference of -1.43 (95% credible interval -4.00 to 1.36)], person-centred approach (PCA)-based and cognitive-behavioural therapy (CBT)-based intervention (universal), interpersonal psychotherapy (IPT)-based intervention and education on preparing for parenting (selective), promoting parent-infant interaction, peer support, IPT-based intervention and PCA-based and CBT-based intervention (indicated). Women valued seeing the same health worker, the involvement of partners and access to several visits from a midwife or health visitor trained in person-centred or cognitive-behavioural approaches. The most cost-effective interventions were estimated to be midwifery redesigned postnatal care (universal), PCA-based intervention (indicated) and IPT-based intervention in the sensitivity analysis (indicated), although there was considerable uncertainty. Expected value of partial perfect information (EVPPI) for efficacy data was in excess of £150M for each population. Given the EVPPI values, future trials assessing the relative efficacies of promising interventions appears to represent value for money. LIMITATIONS In the NMAs, some trials were omitted because they could not be connected to the main network of evidence or did not provide EPDS scores. This may have introduced reporting or selection bias. No adjustment was made for the lack of quality of some trials. Although we appraised a very large number of studies, much of the evidence was inconclusive. CONCLUSIONS Interventions warrant replication within randomised controlled trials (RCTs). Several interventions appear to be cost-effective relative to usual care, but this is subject to considerable uncertainty. FUTURE WORK RECOMMENDATIONS Several interventions appear to be cost-effective relative to usual care, but this is subject to considerable uncertainty. Future research conducting RCTs to establish which interventions are most clinically effective and cost-effective should be considered. STUDY REGISTRATION This study is registered as PROSPERO CRD42012003273. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- C Jane Morrell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Sutcliffe
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Stevens
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alison Scope
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rebecca Harvey
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alice Bessey
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy-Lee Dennis
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Shijie Ren
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Margherita Ragonesi
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Michael Barkham
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Dick Churchill
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Carol Henshaw
- Division of Psychiatry, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Jo Newstead
- Nottingham Experts Patients Group, Clinical Reference Group for Perinatal Mental Health, Nottingham, UK
| | - Pauline Slade
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Stewart-Brown
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
19
|
Ben-David V, Jonson-Reid M, Tompkins R. Addressing the Missing Part of Evidence-based Practice: The Importance of Respecting Clinical Judgment in the Process of Adopting a New Screening Tool for Postpartum Depression. Issues Ment Health Nurs 2017; 38:989-995. [PMID: 28771385 PMCID: PMC7017911 DOI: 10.1080/01612840.2017.1347221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of the present study was to examine the role of nurse's clinical judgment in the uptake of an evidence-based tool assessing postpartum depression, the Edinburgh Postpartum Depression Scale. Nurses in a home visitation program were being asked to regularly screen for postpartum depression. The screener was introduced as a new standard of practice for nurses. A qualitative investigation of the nurses' reactions in addition to an evidence-based screener was conducted. Prior to and during the implementation, several meetings were held with the nurses and the research team to discuss the nurses' experience with the tool. Nurses participated in semi-structured interviews and notes were reviewed to identify themes that may be useful in further understanding evidence-based practice in nurses' home visitation. It was found that the process of uptake included three phases: dissatisfaction with the utility of the tool; problem solving and integration of clinical judgment into a complementary instrument, and eventual reliance on the standardized tool. Respecting the nurses' field experience and clinical judgment was the key to the process of adoption of an evidence-based tool. The process uncovered here requires a larger scale study to see if this can be used across various settings and with differing screening mechanisms to increase comfort with the use of recommended non-health screening tools.
Collapse
Affiliation(s)
- Vered Ben-David
- a Brown School of Social Work , Washington University in St. Louis , St. Louis , Missouri , USA
| | - Melissa Jonson-Reid
- a Brown School of Social Work , Washington University in St. Louis , St. Louis , Missouri , USA
| | - Ron Tompkins
- b Nurses for Newborns , St. Louis , Missouri , USA
| |
Collapse
|
20
|
Lin WC, Chang SY, Chen YT, Lee HC, Chen YH. Postnatal paternal involvement and maternal emotional disturbances: The effect of maternal employment status. J Affect Disord 2017; 219:9-16. [PMID: 28501681 DOI: 10.1016/j.jad.2017.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/04/2017] [Accepted: 05/06/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND Recently, studies have begun emphasizing paternal involvement during the perinatal period and its impact on maternal health. However, most studies have assessed maternal perception and focused on adolescents or minority groups in Western countries. Therefore, the current study investigated the association between paternal involvement and maternal postnatal depression and anxiety, along with the effects of maternal job status in the Asian society of Taiwan. METHODS This study recruited pregnant women in the first trimester of pregnancy as well as their partners on prenatal visits from July 2011 to September 2013 at four selected hospitals in metropolitan areas of Taipei, Taiwan. In total, 593 parental pairs completed the first interview and responded to the follow-up questionnaires until 6 months postpartum. Self-reported data were collected, and multiple logistic regression models were used for analyses. RESULTS Lower paternal childcare and nursing frequency was independently associated with an increased risk of maternal postpartum depression (adjusted odds ratio (OR) =4.33, 95% confidence interval (CI)=1.34-13.98), particularly among unemployed mothers. Furthermore, among unemployed mothers, the risk of postnatal anxiety was 3.14 times higher in couples with fathers spending less time with the child, compared with couples with fathers spending more time (95% CI=1.10-8.98). However, no significant findings were obtained for employed mothers. CONCLUSIONS The high prevalence of maternal postnatal emotional disturbances warrants continual consideration. Higher paternal involvement in childcare arrangements should be emphasized to aid in ameliorating these maternal emotional disturbances, particularly among unemployed mothers.
Collapse
Affiliation(s)
- Wan-Chien Lin
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Shin-Yow Chang
- Department of Living Science, National Open University, Taipei, Taiwan
| | - Yi-Ting Chen
- Department of Educational Psychology and Counseling, National Taiwan Normal University (Doctoral Student), Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
21
|
Matthey S, Agostini F. Using the Edinburgh Postnatal Depression Scale for women and men-some cautionary thoughts. Arch Womens Ment Health 2017; 20:345-354. [PMID: 28078472 DOI: 10.1007/s00737-016-0710-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/22/2016] [Indexed: 12/16/2022]
Abstract
The objective of the study was to critically consider some of the possible limitations in the Edinburgh Depression Scale (EDS), given that great emphasis is put on the results of this measure within both clinical and research fields. Using findings and discussion points from other studies, as well as from a critical analysis of issues by the authors based upon their clinical and research experience, possible limitations with the scale in nine areas are discussed. Possible limitations include the following: (1) ambiguous items, (2) exclusion of certain types of distress, (3) scoring difficulties, (4) low positive predictive value, (5) frequent use of incorrect cut-off scores, (6) a vast array of validated cut-off scores, (7) validation against a questionable gold-standard, (8) limited anxiety detection and of depressive symptoms in men, and (9) many screen positive women only have transient distress. While the EDS has unquestionably been an extremely valuable instrument in aiding in the recognition of the importance of perinatal mental health, users of the scale should be aware that it, like other measures, has limitations. We discuss possible strategies to overcome these limitations and describe a recent scale that has been developed to surmount these shortcomings more effectively.
Collapse
Affiliation(s)
- Stephen Matthey
- South Western Sydney Local Health District, University of Sydney and UNSW, Sydney, Australia.
| | | |
Collapse
|
22
|
Sanner N, Smith L, Wentzel-Larsen T, Moe V. Early identification of social-emotional problems: Applicability of the Infant-Toddler Social Emotional Assessment (ITSEA) at its lower age limit. Infant Behav Dev 2015; 42:69-85. [PMID: 26708234 DOI: 10.1016/j.infbeh.2015.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/21/2015] [Accepted: 11/05/2015] [Indexed: 11/26/2022]
Abstract
ITSEA is an often recommended tool for assessment of social-emotional problems and competence delays in children aged 12-36 months, but concerns have been raised about low variability and age-inappropriate questions for children as young as 12 months. This study explored ITSEA's (1) psychometric properties, (2) properties concerning the detection of clinically significant problems and competence delays and (3) discriminant validity at 12 months. A total of 102 children with high versus low risk scores on marker measures of developmental status and parenting stress obtained at 6 months, were selected from a longitudinal population-based study to participate in the present study. Risk status was operationalized as Bayley III Screening Test (Bayley, 2005a. Bayley scales of infant and toddler development: Screening test manual (3rd ed.). San Antonio, TX: Pearson) Composite Subscale scores and Parenting Stress Index total score (PSI, 3rd edition, Abidin, 1995. Parenting Stress Index. Professional manual. (3rd ed.). Odessa, FL: Psychological Assessment Resources). At 12 months, ITSEA was administered to parents as a structured interview to identify guidance needs and to collect qualitative information about the items, and the assessment of developmental level and parenting stress was repeated. All ITSEA domains and subscales were found to be relevant. However, nearly all respondents needed guidance. Moreover, there were substantial floor/ceiling effects on subscale level and one item had to be discarded. ITSEA was used in combination with the Bayley-III Screener and PSI to detect cases with clinically significant scores, with ITSEA making a unique contribution to case detection. Dysregulation problems were the most frequently detected, and the differences between high-risk and low-risk group children and gender differences indicated adequate discriminant validity. The results suggest that ITSEA may be meaningfully applied even among children as young as 12 months.
Collapse
Affiliation(s)
- Nina Sanner
- National Network for Infant Mental Health, The Center for Child and Adolescent Mental Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway.
| | - Lars Smith
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Tore Wentzel-Larsen
- National Network for Infant Mental Health, The Center for Child and Adolescent Mental Health, Oslo, Norway; Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Vibeke Moe
- National Network for Infant Mental Health, The Center for Child and Adolescent Mental Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| |
Collapse
|
23
|
Norhayati MN, Hazlina NHN, Asrenee AR, Emilin WMAW. Magnitude and risk factors for postpartum symptoms: a literature review. J Affect Disord 2015; 175:34-52. [PMID: 25590764 DOI: 10.1016/j.jad.2014.12.041] [Citation(s) in RCA: 457] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND The prevalence of postpartum depression worldwide varies from 0.5% to 60.8% in the first 12 months postpartum using self-reported questionnaire. This review aims to update the current magnitude of postpartum depression based on self-reported questionnaire and clinical interview and explore its associated factors in developed and developing countries. METHODS A literature search conducted between 2005 and 2014 identified 203 studies, of which 191 used self-reported questionnaire in 42 countries and 21 used structured clinical interview in 15 countries. Nine studies used a combination of self-reported questionnaire and clinical interview. RESULT The prevalence of postpartum depression varies from 1.9% to 82.1% in developing countries and from 5.2% to 74.0% in developed countries using self-reported questionnaire. Structured clinical interview shows a much lower prevalence range from 0.1% in Finland to 26.3% in India. Antenatal depression and anxiety, previous psychiatric illness, poor marital relationship, stressful life events, negative attitude towards pregnancy, and lack of social support are significant contributors to postpartum depression. LIMITATION All studies are included irrespective of the methodological quality, such as small sample size and their inclusion could affect the generalizability of the results. CONCLUSION The current prevalence of postpartum depression is much higher than that previously reported, and similar risk factors are documented. A culturally sensitive cut-off score with adequate psychometric properties of the screening instruments should be available. In future studies, examining the physical, biological, and cultural factors in qualitative studies and in those with adequate methodological qualities is recommended.
Collapse
Affiliation(s)
- M N Norhayati
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia.
| | - N H Nik Hazlina
- Women Health Development Unit, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - A R Asrenee
- Department of Psychiatry, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - W M A Wan Emilin
- Perpustakaan Hamdan Tahir, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| |
Collapse
|
24
|
Depression screening and patient outcomes in pregnancy or postpartum: a systematic review. J Psychosom Res 2014; 76:433-46. [PMID: 24840137 DOI: 10.1016/j.jpsychores.2014.01.006] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/17/2014] [Accepted: 01/18/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Clinical practice guidelines disagree on whether health care professionals should screen women for depression during pregnancy or postpartum. The objective of this systematic review was to determine whether depression screening improves depression outcomes among women during pregnancy or the postpartum period. METHODS Searches included the CINAHL, EMBASE, ISI, MEDLINE, and PsycINFO databases through April 1, 2013; manual journal searches; reference list reviews; citation tracking of included articles; and trial registry reviews. RCTs in any language that compared depression outcomes between women during pregnancy or postpartum randomized to undergo depression screening versus women not screened were eligible. RESULTS There were 9,242 unique titles/abstracts and 15 full-text articles reviewed. Only 1 RCT of screening postpartum was included, but none during pregnancy. The eligible postpartum study evaluated screening in mothers in Hong Kong with 2-month-old babies (N=462) and reported a standardized mean difference for symptoms of depression at 6 months postpartum of 0.34 (95% confidence interval=0.15 to 0.52, P<0.001). Standardized mean difference per 44 additional women treated in the intervention trial arm compared to the non-screening arm was approximately 1.8. Risk of bias was high, however, because the status of outcome measures was changed post-hoc and because the reported effect size per woman treated was 6-7 times the effect sizes reported in comparable depression care interventions. CONCLUSION There is currently no evidence from any well-designed and conducted RCT that screening for depression would benefit women in pregnancy or postpartum. Existing guidelines that recommend depression screening during pregnancy or postpartum should be re-considered.
Collapse
|
25
|
Horowitz JA, Murphy CA, Gregory K, Wojcik J, Pulcini J, Solon L. Nurse home visits improve maternal/infant interaction and decrease severity of postpartum depression. J Obstet Gynecol Neonatal Nurs 2014; 42:287-300. [PMID: 23682696 DOI: 10.1111/1552-6909.12038] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To test the efficacy of the relationship-focused behavioral coaching intervention Communicating and Relating Effectively (CARE) in increasing maternal/infant relational effectiveness between depressed mothers and their infants during the first 9 months postpartum. DESIGN Randomized clinical trial (RCT) with three phases. METHODS In this three-phase study, women were screened for postpartum depression (PPD) in Phase I at 6 weeks postpartum. In Phase II, women were randomly assigned to treatment or control conditions and maternal/infant interaction was video recorded at four intervals postpartum: 6 weeks, 3 months, 6 months, and 9 months. Phase III involved focus group and individual interviews with study participants. SETTING Phase I mothers were recruited from obstetric units of two major medical centers. Phase II involved the RCT, a series of nurse-led home visits beginning at 6 weeks and ending at 9 months postpartum. Phase III focus groups were conducted at the university and personal interviews were conducted by telephone or in participants' homes. PARTICIPANTS Postpartum mother/infant dyads (134) representative of southeastern New England, United States participated in the RCT. One hundred and twenty-five mother/infant dyads were fully retained in the 9-month protocol. RESULTS Treatment and control groups had significant increases in quality of mother/infant interaction and decreases in depression severity. Qualitative findings indicated presence of the nurse, empathic listening, focused attention and self-reflection during data collection, directions for video-recorded interaction, and assistance with referrals likely contributed to improvements for both groups. CONCLUSIONS Efficacy of the CARE intervention was only partially supported. Nurse attention given to the control group and the data collection process likely confounded results and constituted an unintentional treatment. Results suggest that nurse-led home visits had a positive effect on outcomes for all participants.
Collapse
Affiliation(s)
- June Andrews Horowitz
- Boston College, W. F. Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
| | | | | | | | | | | |
Collapse
|
26
|
Eberhard-Gran M, Slinning K, Rognerud M. Screening for barseldepresjon – en kunnskapsoppsummering. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:297-301. [DOI: 10.4045/tidsskr.13.0068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
27
|
Abstract
After participating in this educational activity, the physician should be better able to 1. Identify the risk factors associated with persistence of postpartum depression. 2. Evaluate the limitations of the literature. 3. Determine the implications of the findings on women with postpartum depression and their children.This article aims to critically review studies published between 1985 and 2012 concerning the course of postpartum depression (PPD), as well as factors implicated in PPD with a chronic course. We provide a systematic, qualitative review of studies on the course of PPD, following PRISMA guidelines. The results show that although the majority of women recover from PPD, it becomes chronic in a relatively large subgroup of women. Several studies have identified risk factors predicting a chronic course of PPD. This review also emphasizes and discusses important conceptual and methodological limitations in existing research, which preclude drawing strong conclusions. Finally, the implications of these findings and suggestions for future research and clinical intervention are outlined.
Collapse
|
28
|
Byatt N, Hicks-Courant K, Davidson A, Levesque R, Mick E, Allison J, Moore Simas TA. Depression and anxiety among high-risk obstetric inpatients. Gen Hosp Psychiatry 2014; 36:644-9. [PMID: 25149040 PMCID: PMC4399814 DOI: 10.1016/j.genhosppsych.2014.07.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/16/2014] [Accepted: 07/21/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the following among women hospitalized antenatally due to high-risk pregnancies: (1) rates of depression symptoms and anxiety symptoms, (2) changes in depression symptoms and anxiety symptoms and, (3) rates of mental health treatment. METHODS Sixty-two participants hospitalized for high-risk obstetrical complications completed the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder 7-item scale (GAD-7) and Short-Form 12 weekly until delivery or discharge, and once postpartum. RESULTS Average length of total hospital stay was 8.3 ± 7.6 days for women who completed an initial admission survey (n = 62) and 16.3 ± 8.9 (n = 34), 25.4 ± 10.2 (n = 17) and 35 ± 10.9 days (n = 9) for those who completed 2, 3 and 4 surveys, respectively. EPDS was ≥ 10 in 27% (n=17) and GAD-7 was ≥ 10 in 13% (n = 8) of participants at initial survey. Mean anxiety (4.2 ± 6.5 vs. 5.2 ± 5.1, p = .011) and depression (4.4 ± 5.6 vs. 6.9 ± 4.8, p = .011) scores were lower postpartum compared to initial survey. Past mental health diagnosis predicted depression symptoms [odds ratio (OR) = 4.54; 95% confidence interval (CI) 1.91-7.17] and anxiety symptoms (OR = 5.95; 95% CI 3.04-8.86) at initial survey; however, 21% (n = 10) with no diagnostic history had EPDS ≥ 10. Five percent (n = 3) received mental health treatment during pregnancy. CONCLUSION Hospitalized high-risk obstetrical patients may commonly experience depression symptoms and/or anxiety symptoms and not receive treatment. A history of mental health treatment or diagnosis was associated with depression symptoms or anxiety symptoms in pregnancy. Of women with an EPDS ≥ 10, > 50% did not report a past mental health diagnosis.
Collapse
Affiliation(s)
- Nancy Byatt
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA; Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Katherine Hicks-Courant
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA,Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Ruth Levesque
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Eric Mick
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jeroan Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Tiffany A. Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
29
|
Glavin K, Schaffer MA. A comparison of the Well Child Clinic services in Norway and the Nurse Family Partnership programme in the United States. J Clin Nurs 2013; 23:492-503. [DOI: 10.1111/jocn.12206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Kari Glavin
- Department of Nursing; Diakonova University College; Oslo Norway USA
| | | |
Collapse
|
30
|
Glavin K, Leahy-Warren P. Postnatal depression is a public health nursing issue: perspectives from norway and ireland. Nurs Res Pract 2013; 2013:813409. [PMID: 24089636 PMCID: PMC3780656 DOI: 10.1155/2013/813409] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 07/16/2013] [Accepted: 08/01/2013] [Indexed: 11/17/2022] Open
Abstract
The framework provided by the Millennium Development Goals includes maternal health as an area of priority. Postnatal depression (PND) is a serious public health issue because it occurs at a crucial time in a mothers' life, can persist for long periods, and can have adverse effects on partners and the emotional, behavioural, and cognitive development of infants and children. Internationally, public health nurses (PHNs) are key professionals in the delivery of health care to mothers in the postpartum period, and international research collaborations are encouraged. Two researchers from the European Academy of Nursing Science (EANS) identified a need to collaborate and strengthen research capacity and discussion on postnatal depression, a public health nursing issue in both countries. Within the context of public health and public health nursing in Ireland and Norway, the aim of this paper is to present a discussion on the concept of PND, prevalence, and outcomes; screening issues for PHNs; and the research evidence of the benefits of social support in facilitating recovery for new mothers.
Collapse
Affiliation(s)
- Kari Glavin
- Department of Nursing, Diakonova University College, Fredensborgveien 24 Q, 0177 Oslo, Norway
| | - Patricia Leahy-Warren
- School of Nursing & Midwifery, Brookfield Health Sciences Complex, University College Cork, Ireland
| |
Collapse
|
31
|
Motzfeldt I, Andreasen S, Pedersen AL, Pedersen ML. Prevalence of postpartum depression in Nuuk, Greenland--a cross-sectional study using Edinburgh Postnatal Depression Scale. Int J Circumpolar Health 2013; 72:21114. [PMID: 23984294 PMCID: PMC3753142 DOI: 10.3402/ijch.v72i0.21114] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this study is to estimate the prevalence of postnatal depression in Nuuk, Greenland. STUDY DESIGN Cross-sectional study. METHODS The primary health care system in Nuuk initiated a project aiming to screen new mothers for depression using the Edinburgh Postnatal Depression Scale (EPDS). EPDS has a range on a scale from 0 to 30. All mothers residing in Nuuk who had given birth in 2011 were included in the study group. The screening was performed by health care visitors approximately 3 months following birth. Mothers who scored 13 points or above were defined as having possible postpartum depression (PPD). These mothers were then referred to a physician. A score at or less than 8 was defined as normal, whereas an intermediate score from 9 to 12 indicated a need for an extra visit. RESULTS During 2011, a total of 217 mothers gave birth in Nuuk. Of them, 80.2% (174) were screened for PPD using EPDS. Fifteen mothers scored 13 points or above corresponding to a prevalence of possible PPD at 8.6% (15/174). Seventy-nine percentage scored less than 9 points (137/174), whereas 15% (22/174) scored from 9 to 12 points. CONCLUSION PPD seems to be a common problem in Nuuk, Greenland. EPDS seems to be a valuable tool in identifying women with PPD and vulnerable mothers with extra needs for support in a Greenlandic context. Continual routine screening is recommended.
Collapse
Affiliation(s)
- Iben Motzfeldt
- Queen Ingrid Centre for Primary Health Care, Nuuk, Greenland
| | | | | | | |
Collapse
|
32
|
Matthey S, Lee C, Črnčec R, Trapolini T. Errors in scoring the Edinburgh Postnatal Depression scale. Arch Womens Ment Health 2013; 16:117-22. [PMID: 23248004 DOI: 10.1007/s00737-012-0324-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 12/02/2012] [Indexed: 11/28/2022]
Abstract
This study examined the errors made by clinicians when scoring the Edinburgh Postnatal Depression Scale (EPDS). This measure has items with reverse scoring that may increase the likelihood of errors being made. Four hundred ninety-six EPDS forms from client files in four clinical services were examined for item scoring errors and addition errors. Clinicians (N = 22) from the four services were also surveyed as to what rate of errors they expected the study would find and what rate would be unacceptable. Errors of either type were present in between 13.4 and 28.9% of forms across the four sites. These error rates were greater than most of the surveyed clinicians expected and were at a level that was considered by most to be problematic. However, the error rates did not have a meaningful impact on the rates of women scoring above various cutoff scores often used with the EPDS. The EPDS is often incorrectly scored by practitioners at a level that is of concern to clinicians of these services. Clinical teams should adopt the use of scoring templates and a double adding-up procedure when using measures such as the EPDS as a way that may reduce such scoring errors.
Collapse
Affiliation(s)
- Stephen Matthey
- South Western Sydney Local Health District, Sydney, Australia.
| | | | | | | |
Collapse
|
33
|
Thiagayson P, Krishnaswamy G, Lim ML, Sung SC, Haley CL, Fung DSS, Allen JC, Chen H. Depression and anxiety in Singaporean high-risk pregnancies - prevalence and screening. Gen Hosp Psychiatry 2013; 35:112-6. [PMID: 23265951 DOI: 10.1016/j.genhosppsych.2012.11.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 11/13/2012] [Accepted: 11/14/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Data on psychiatric morbidity in high-risk pregnant Singaporean women are limited. This study aimed to establish the prevalence of antenatal depression and anxiety in high-risk pregnancies, compare the prevalence of antenatal depression in high-risk pregnancies vs. pregnancies of unspecified obstetric risk and examine the Edinburgh Postnatal Depression Scale (EPDS) and State Trait Anxiety Inventory (STAI) as screening tools for these disorders. METHOD Two hundred high-risk pregnant inpatients at a national public maternity hospital were included. Three psychometric assessment tools were used to evaluate all participants: the diagnostic Mini International Neuropsychiatric Interview and the screening EPDS and STAI. RESULTS Rates of major depression, minor depression, anxiety disorder (agoraphobia, generalized anxiety disorder, panic disorder), and comorbid depression and anxiety were 11%, 7%, 12.5% and 5%, respectively. Major depression was more prevalent in high-risk pregnancies than in the historical cohort of unspecified obstetric risk (11% versus 4.3%). EPDS (cutoff 8/9) screens well for depression and anxiety in high-risk pregnancies (area under the receiver operating characteristic curve=0.82-0.87). CONCLUSION Antenatal depression and anxiety are highly prevalent in a sample of high-risk pregnant Singaporean women. EPDS performs well in screening for depression and anxiety in high-risk pregnant women, with further psychiatric assessment recommended for women with score ≥ 9.
Collapse
Affiliation(s)
- Pavaani Thiagayson
- Duke-NUS Graduate Medical School, Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857, Singapore.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Byatt N, Simas TAM, Lundquist RS, Johnson JV, Ziedonis DM. Strategies for improving perinatal depression treatment in North American outpatient obstetric settings. J Psychosom Obstet Gynaecol 2012. [PMID: 23194018 DOI: 10.3109/0167482x.2012.728649] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To identify core barriers and facilitators to addressing perinatal depression and review clinical, programmatic, and system level interventions that may optimize perinatal depression treatment. METHOD Eighty-four MEDLINE/PubMed searches were conducted using the terms perinatal depression, postpartum depression, antenatal depression, and prenatal depression in association with 21 other terms. Of 7768 papers yielded in the search, we identified 49 papers on barriers and facilitators, and 17 papers on interventions in obstetric settings aimed to engage women and/or providers in treatment. RESULTS Barriers include stigma, lack of obstetric provider training, lack of resources and limited access to mental health treatment. Facilitators include validating and empowering women during interactions with health care providers, obstetric provider and staff training, standardized screening and referral processes, and improved mental health resources. CONCLUSION Specific clinical, program, and system level changes are recommended to help change the culture of obstetric care settings to optimize depression treatment.
Collapse
Affiliation(s)
- Nancy Byatt
- Department of Psychiatry and Ob/Gyn, UMass Medical School, Worcester, MA 01655, USA.
| | | | | | | | | |
Collapse
|
35
|
Byatt N, Biebel K, Lundquist RS, Moore Simas TA, Debordes-Jackson G, Allison J, Ziedonis D. Patient, provider, and system-level barriers and facilitators to addressing perinatal depression. J Reprod Infant Psychol 2012. [DOI: 10.1080/02646838.2012.743000] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Nancy Byatt
- a University of Massachusetts Medical School , Worcester , Massachusetts , USA
| | - Kathleen Biebel
- a University of Massachusetts Medical School , Worcester , Massachusetts , USA
| | | | | | | | - Jeroan Allison
- a University of Massachusetts Medical School , Worcester , Massachusetts , USA
| | - Douglas Ziedonis
- a University of Massachusetts Medical School , Worcester , Massachusetts , USA
| |
Collapse
|
36
|
Skreden M, Skari H, Malt UF, Pripp AH, Björk MD, Faugli A, Emblem R. Parenting stress and emotional wellbeing in mothers and fathers of preschool children. Scand J Public Health 2012; 40:596-604. [PMID: 23042456 DOI: 10.1177/1403494812460347] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The aims of the study were to compare parenting stress and emotional wellbeing in mothers and fathers of preschool children, to look for predictors of different aspects of parenting stress in mothers and fathers, and to discriminate parenting stress from psychological distress and anxiety. METHODS We studied 256 mothers and 204 fathers of children aged 1-7 years. The Swedish Parenthood Stress Questionnaire (SPSQ) assesses stress related to parenting. Emotional wellbeing was defined by the General Health Questionnaire-28 (GHQ-28) and the State Anxiety Inventory (STAI-X1) that measures psychological distress and anxiety, respectively. RESULTS Fathers reported significantly more social isolation than mothers (P < 0.001). On all other parameters mothers, had higher scores, representing more stress and less wellbeing than fathers. Anxiety and psychological stress were strong predictors of parental stress in both mothers and fathers. Furthermore, maternal parental stress was predicted by birth of subsequent children and younger child age. Higher educational attainment predicted increased role restriction in fathers and more health problems in mothers. A principal component analysis (PCA) of the SPSQ, GHQ-28, and STAI-X1 showed that all endpoints of the analysis are positively correlated. CONCLUSIONS Fathers reported significantly more social isolation, but less role restriction, incompetence and state anxiety than mothers. The SPSQ together with GHQ-28 and STAI-X1 allow a targeted screening aimed at contrasting parents who experience reduced emotional wellbeing with those who struggle with stress directly related to their parenting role.
Collapse
|
37
|
Santos Junior HPO, Rosa Gualda DM, de Fátima Araújo Silveira M, Hall WA. Postpartum depression: the (in) experience of Brazilian primary healthcare professionals. J Adv Nurs 2012; 69:1248-58. [DOI: 10.1111/j.1365-2648.2012.06112.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2012] [Indexed: 11/26/2022]
|
38
|
Abstract
Objective: The objective of this paper is to describe and discuss a municipal model for prevention, identification and treatment of postpartum depression (PPD). Major findings: The changed care in the municipality was associated with a significant difference in Edinburgh Postnatal Depression Scale scores between the intervention municipality and the usual care municipality at 6 weeks, 3, 6 and 12 months postpartum. The women who had been depressed at least once during the first postpartum year reported significantly higher levels of parenting stress at 12 months. The public health nurses found the scale easy to score and easy for the mothers to complete, and they were confident that they identified PPD more frequently than before. Conclusion: The results of the present study suggest a basis for a municipality model that gives the primary health care system better possibilities to help women with mental health problems in the postpartum period. The changed care consisted of several elements considered important for the result of this study. The results can be incorporated in a descriptive model for prevention, identification and treatment in municipalities. The components are (1) preconditions in the municipality, (2) initiatives to prevent PPD, (3) identification of women with PPD, (4) treatment of PPD and (5) follow-up.
Collapse
Affiliation(s)
- Kari Glavin
- Associate Professor, Department of Nursing, Diakonova University College, Norway
| |
Collapse
|