Unemployment and psychological distress one year after childbirth in France

Prevalence and factors associated with postpartum depression at a primary healthcare facility in Eswatini

Background

Routine mental health screening has not been integrated into maternal and child health (MCH) services in many developing countries, including in Eswatini (formerly Swaziland). As a result, the burden of postpartum depression (PPD) is not well understood and thus PPD remains untreated in such settings.

Aim

To describe the prevalence and factors associated with PPD among women seeking postnatal and child welfare services at a primary healthcare facility in Eswatini.

Setting

The study was conducted at the King Sobhuza II Public Health Unit in Manzini, Eswatini.

Methods

This was a cross-sectional study that used convenience sampling and the Edinburgh Postnatal Depression Scale (EPDS) to screen for depression among 114 mothers during the first 6 weeks of postpartum at the King Sobhuza II Public Health Unit, Manzini, Eswatini. Multiple logistic regression analysis was conducted to determine sociodemographic and clinical factors associated with PPD.

Results

A majority of the participants were older than 24 years (52.6%) and unemployed (64.9%), whereas 47.4% screened positive for PPD (≥ 13 score). Adjusting for other covariates, those who were unemployed (odds ratio [OR] = 3.20, 95% confidence interval [CI] 1.17–8.79) and with poor social support from their partners (OR = 9.41, 95% CI: 3.52–25.14) were more likely to be depressed, while those who attended antenatal classes fewer than four times were less likely to be depressed (OR = 0.32, 95% CI 0.11–0.92).

Conclusion

We found a high prevalence of PPD. There is a need to introduce routine maternal mental health screening during the postpartum period to ensure early detection and treatment of PPD.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Association of returning to work with better health in working-aged adults: a systematic review

OBJECTIVES

We systematically reviewed the literature on the impact of returning to work on health among working-aged adults.

METHODS

We searched 6 electronic databases in 2005. We selected longitudinal studies that documented a transition from unemployment to employment and included a comparison group. Two reviewers independently appraised the retrieved literature for potential relevance and methodological quality.

RESULTS

Eighteen studies met our inclusion criteria, including 1 randomized controlled trial. Fifteen studies revealed a beneficial effect of returning to work on health, either demonstrating a significant improvement in health after reemployment or a significant decline in health attributed to continued unemployment. We also found evidence for health selection, suggesting that poor health interferes with people's ability to go back to work. Some evidence suggested that earlier reemployment may be associated with better health.

CONCLUSIONS

Beneficial health effects of returning to work have been documented in a variety of populations, times, and settings. Return-to-work programs may improve not only financial situations but also health.

Differences in preferences for obstetric care between nulliparae and their partners in the Netherlands: a discrete-choice experiment

BACKGROUND

In the Netherlands, in low-risk pregnancies, the views of pregnant women and their partners on characteristics of obstetric care services are leading for the selection of place of birth. The aim of this study was to investigate whether there are differences between the decision-making process of pregnant women and their partners with regard to these attributes of obstetric care.

METHODS

This study was a prospective cohort study with low-risk nulliparae and their partners. A questionnaire, based on the method of discrete-choice experiment, was used to gather the data.

RESULTS

Possibility of influencing decision-making was, both for pregnant women (n = 321) and their partners (n = 212), the most important characteristic of the obstetric care. For women, a home-like birth setting was an important characteristic, while the partners found the possibility on pain-relief treatment during birth important.

CONCLUSIONS

The results of this study suggest that women and their partners have clearly defined preferences for obstetric care. There are also some essential differences between the preferences of these two groups. The findings are important where policy issues related to aspects of maternity care service delivery are being considered.

Health education needs of family caregivers supporting an adolescent relative with schizophrenia or a mood disorder in taiwan

This study, which is part of a larger research program, examined the health education needs of family caregivers providing care and support for an adolescent relative with schizophrenia or mood disorder in Taiwan. Family caregivers reported significant unmet information needs, and those with higher incomes or educational levels were more likely to report unmet educational needs. Caregivers using information resources consistently had high unmet educational needs. Results revealed the importance of assessing specific educational needs of families, as educational needs of caregivers differed according to diagnostic group, especially with regard to etiology, symptoms, and coping strategies.

Violence and women's psychological distress after birth: an exploratory study in Italy

Our aim in conducting this study was to analyze the relationships between violence and maternal psychological distress 8 months after a birth, taking into account other important psychosocial factors, known to be associated both with violence and with new mothers' mental health. A total of 352 women responded to a questionnaire after the birth at a maternity hospital in northern Italy, and 292 also participated in a telephone interview 8 months later. We evaluated psychological distress with the General Health Questionnaire (GHQ), and partner and family violence with a 28-item scale. Eight months postpartum, 5% of women showed high psychological distress; 10% were currently experiencing violence from the partner or another family member. After adjustment for covariates, the odds ratio for depressive symptoms was 13.74 for women experiencing violence. We believe that these results provide support for the important role of violence in postpartum maternal psychological distress.

Women's psychological health according to their maternal status: a study in France

This study explored the extent to which the psychological distress of women is related to their motherhood status. A representative sample of 6970 women, aged 20-59, living in France, was interviewed. This analysis was restricted to the 2799 women aged between 25 and 39, 307 of whom had had a baby in the last year. Several indicators of psychological distress were used, including the 12-item General Health Questionnaire, psychotropic drug use and suicide attempts. Women with babies under the age of 12 months presented no more psychological problems than the other women. The proportion of respondents with scores above 5 for the GHQ was 8.7% for mothers with young babies, 11.4% for mothers of an older child and 12.0% for childless women. Adjusting for age, education, employment and couple status, no differences were observed between the three groups of women, except for a lower level of psychotropic drug use among the mothers of young babies. Overall, regardless of maternal status, a high proportion of women showed symptoms of anxiety and depression. Thus, research and clinical efforts should focus on risk factors for psychological distress in women and on preventive measures beyond the post-partum period.

The impact of current and past interpersonal violence on women's mental health

Violence against women, and more particularly male partner violence, is frequent. Although there are many studies on the consequences of violence on women's mental health, a number of aspects are still unclear. The impact of violence is seldom studied in the context of other risk factors of mental distress, psychological abuse is rarely considered, and older women are generally excluded from the sample. This study aims to analyze the relationships between current and past violence and three indicators of current women's health--psychological distress, the use of psychoactive drugs and a subjective evaluation of health--controlling for demographic and social characteristics. We conducted a cross-sectional survey among patients of family practices in an Italian town and 444 women responded to a self-administrated questionnaire: 20% of them had experienced some kind of abuse in the last 12 months and 5.2% reported physical or sexual aggression, mostly (4%) inflicted by a partner or ex-partner. Current violence was strongly associated with psychological distress, the use of psychoactive drugs and a negative evaluation of health. Experiencing solely psychological abuse with no sexual or physical violence was also associated with impaired health. The relationship between current violence and health was independent of age. After controlling for age, education, children, marital and employment status, women victims of partner violence were around 6 times more likely to be depressed and to feel in bad health, and 4 times more likely to use psychoactive pills than other women. Moreover, there was a strong association between past and current violence. Compared to women who reported no violence, women who reported both types were 5.95 times, women who reported only current but no past violence were 4.81 times, and women who reported only past but no current violence were 3.01 times more likely to report psychological distress.

Employment transitions and mental health: an analysis from the British household panel survey

STUDY OBJECTIVE

To describe the impact of changes between employment and various forms of non-employment, and vice versa, on the psychological wellbeing of men and of women.

DESIGN

Separate multivariate models for men and for women were constructed to study the association between employment transitions and episodes of psychological distress (general health questionnaire).

PARTICIPANTS

13,359 employment transitions from 5092 people aged 16-74 years in the British household panel survey from 1991 to 1998.

MAIN RESULTS

Transitions from paid employment to either unemployment or long term sick leave were associated with increased psychological distress for both men and women. Starting maternity leave or staying home to look after the family were also associated with psychological distress for women. Transitions from these roles to formal employment resulted in an improvement in mental health. There was some evidence that the effects were felt most strongly within six months of the transition.

CONCLUSIONS

This paper provides further evidence that movements between paid employment and various forms of non-employment, in addition to unemployment, have an impact on mental health. The emphasis on transitions between a full range of employment states for both men and women from a large population based longitudinal study and a comparison of the relative magnitude of effects are unique features of this analysis. Interventions are suggested to minimise the psychological distress associated with transitions.

Long-term sick leave and its risk factors during pregnancy among Danish hospital employees

AIM

The authors sought to describe risk indicators of long-term sick leave during pregnancy among hospital employees.

METHODS

A register-based study was undertaken of 4,852 female hospital employees aged 20-45 years from the second largest hospital in Denmark during 1995-99 based on job titles, working time, sick leave, and births combined with a survey among a total of 773 women who had been pregnant during their employment (response rate 85%).

RESULTS

Altogether 236 (31%) were on sick leave for at least 10% of their scheduled work time during their latest pregnancy and 169 (22%) had been absent at least 20% of the time. The pregnant women had an average sickness absence of 6.1 days per month, non-pregnant women 0.95 days per month. Sick leave was more frequent in late than in early gestation. Women employed as nursing aides or hospital orderlies, launderers, and nurses had more sick leave days than other hospital employees. Part-time work, previous sickness absence not related to pregnancy, and previous chronic back pain were risk factors for long-term sick leave as were much walking or standing, long working days, high work level, little practical support from supervisors and colleagues, low job control, much lifting and night or shift work. Sick leave was unrelated to family size, support from the family and number of working years.

CONCLUSION

Long-term sick leave during pregnancy was frequent and to some extent predictable. Efforts should be made to organize work for pregnant women in a manner that optimizes their health and well-being.

Considering a simple strategy for detection of women at risk of psychological distress after childbirth

BACKGROUND

Postpartum depression is a common, severe, yet often undetected condition. Between 10 and 15 percent of new mothers suffer from depressive disorders in the first year after childbirth. The objective of this study was to investigate whether asking women questions about their daily life constituted a useful strategy to detect women at risk of developing psychological distress after childbirth.

METHODS

A prospective study of 330 first- and second-time mothers was conducted. Structured interviews with women were performed at the maternity unit 1 to 2 days after childbirth, and postal questionnaires were sent to participants 5 months later. An interviewer wrote down her perception of the mood of participants, in the form of three short statements, immediately after the interview. This perception was compared with the score of the woman on the General Health Questionnaire scale, which was included in the 5 months' questionnaire.

RESULTS

The interviewer's perception of women's mood was significantly associated with the score on the General Health Questionnaire scale 5 months later. Multivariate analysis showed that the interviewer's perception of anxiety was a better predictor of postpartum psychological distress at 5 months than women's answers to questions about their mood before pregnancy and 1 to 2 days after delivery.

CONCLUSIONS

Asking the new mother questions about her private and occupational life can be considered as one of many possible ways to improve the identification of women at risk of developing postpartum depression.

Sem medo do desemprego: o caso do movimento dos trabalhadores desempregados

Este artigo é uma síntese da pesquisa realizada junto ao Movimento dos Trabalhadores Desempregados - MTD, durante um curso de mestrado no Programa de Pós-graduação em da PUCRS. A investigação objetivou conhecer as articulações psicossociais entre o engajamento no movimento social e a possibilidade de superar o desemprego, a partir de entrevistas semi-estruturadas e observações participante de reuniões gerais dos acampados. O estudo revelou que o engajamento na proposta coletiva está vinculado a um projeto de reforma urbana, que viabilize moradia e trabalho para comunidades de desempregados. Esta pesquisa aponta alterações em níveis micro e macrossociais, advindas de resultados concretos, como a posse de quatrocentos hectares de terra cedidos pelo governo estadual e a proliferação de outras ações coletivas com características semelhantes.

Debt, social disadvantage and maternal depression

Depression is common among women with young children, and is strongly associated with financial adversity. Debt is a common feature of such adversity, yet its relationship with depression has not been examined before. We have used longitudinal data, collected over six months, on 271 families with young children, to examine this relationship. Multiple regression was used to identify independent predictors of the total Edinburgh Post-natal Depression Scale score from a range of socioeconomic, demographic, social support and child health related variables. Worry about debt was the strongest independent socioeconomic predictor of the depression score at both initial and follow-up occasions. To account for the possibility of reverse causation, i.e. depression causing worry about debt, alternative regression models are reported which show that owing money by itself predicts depression and earlier debt worries predicts depression six months later. We were unable to show that earlier debt worries independently predicted subsequent depression scores after the initial depression score had been taken into account in the analysis. Although debt has not been shown to be an independent prospective predictor of depression, our results suggest it has a central place in the association between socioeconomic hardship and maternal depression. Evidence from qualitative studies on poverty and from studies on the causes of depression support this hypothesis. The implications for policy are that strategies to enable families to control debt should be an explicit part of wider antipoverty measures which are designed to reduce depression and psychological distress among mothers of young children.

Women's health after childbirth: a longitudinal study in France and Italy

OBJECTIVE

To describe the prevalence of various symptoms five months and twelve months after childbirth in two European countries, according to employment, financial difficulties and relationship with partner.

DESIGN

Longitudinal multicentre survey with a similar design in France and Italy. Women were interviewed three times: at birth and twice after childbirth. At 12 months after childbirth, the survey was postal in both countries.

POPULATION

Women who had been delivered of their first or second baby in three maternity units in France and five units in Italy. Women who had multiple pregnancies, a stillbirth or known neonatal death were excluded.

RESULTS

The response rates were 83% in France and 88% in Italy. Fifteen symptoms were considered. The results were similar in the two countries and showed that the prevalence of most symptoms was higher at 12 months than at five months after childbirth. When their baby was one year old, more than half of the women reported backache, anxiety and extreme tiredness. Around one-third of women reported headache, lack of sexual desire, sleep disorders and depression. Piles, constipation and painful intercourse were also common. One year postpartum women with financial problems or a difficult relationship reported poor psychological health more frequently.

CONCLUSION

Physical and emotional problems are common after birth, and they tend to increase over time. Backache, headache and piles can seriously interfere with day-to-day life. Sexual problems also may be a source of unhappiness for the woman and her partner. Extreme tiredness, anxiety and depression may make a woman feel guilty for not corresponding to the image of a healthy, happy and well-coping mother. There is a link between financial problems or a difficult relationship with her partner and her own wellbeing. Health professionals should be aware of the high prevalence of health problems among new mothers, and of the social context of women who are more likely to suffer from them. They should counsel the women in their care, in order to help them to find the best solution, be it medical or social in nature.