Multiple dimensions of sleep are consistently associated with chronically elevated depressive symptoms from late pregnancy to 3 years postnatal in Indigenous and non-Indigenous New Zealand women

Mental health and well-being of women (menarche, perinatal, and menopause)

Mental well-being is now an increasingly researched and discussed topic that primarily involves taking care of mental health in a preventive manner and is more of a subjective concept. Mental well-being ensures mental health and measures taken toward it can protect the person's overall health. Discussing and researching this concept is of paramount importance as this will not just safeguard an individual life but the society at large. The lifetime of a woman is multidimensionally unique with a complex interplay of biological, sociocultural, and environmental aspects. This demands a diverse variety of factors required to ensure mental well-being in a woman. In addition to this, these determinants vary on the life stage the woman is in. Factors that influence this well-being are also specific when it comes to an Indian context. This chapter considers and discusses in detail the various aspects of the mental health and well-being of women in the pubertal, perinatal, and menopausal age groups. Determinants are unique to particular age groups of women, and measures to focus on and ensure it will be elaborated on. Finally, recommendations towards policy making are also suggested.

Identification of postpartum symptom subgroups and associated long-term maternal depressive symptoms and well-being

Many postpartum women experience postpartum symptoms which often occur in clusters (i.e., three or more co-occurring symptoms that are related to each other). To date, research has focused on individual symptoms, which limits our understanding of how postpartum symptom clusters manifest and influence health. This secondary analysis used the Community and Child Health Network study data (N = 1784). No patient or public directly participated or contributed to the current analysis. Guided by the Symptom Management Theory, latent class analysis was performed to identify subgroups of postpartum women with different symptom experiences using observed variables at 6 months postpartum: anxiety (MINI-anxiety), general stress (PSS-10), posttraumatic stress (PCL-C), postpartum depression (EPDS), sleep disturbance (PSQI-sleep disturbance), and sleep duration (PSQI-sleep duration). Bivariate and multiple regression analyses were conducted to examine the association between subgroups and (a) individual characteristics and (b) long-term depressive symptoms (CES-D-9) and well-being at 18 and/or 24 months postpartum. Five subgroups were selected that had better-fit indices, entropy, and interpretability. Subgroups were labeled as (1) Minimum overall, (2) Mild-moderate overall, (3) Moderate-high sleep symptoms, (4) High psychological symptoms, and (5) High overall. After adjusting for covariates, postpartum women in Subgroups 4 and 5 had higher CES-D-9 scores at 18 and 24 months and lower well-being scores at 24 months. More postpartum women in Subgroups 4 and 5 experienced a history of depression or unemployment. Clinicians should provide targeted interventions for postpartum women in high-symptom subgroups.

Exploring Heterogeneity in perinatal depression: a comprehensive review

Perinatal depression (PND) is a significant contributor to maternal morbidity globally. Recognized as a major cause of poor infant development, epidemiological and interventional research on it has increased over the last decade. Recently, studies have pointed out that PND is a heterogeneous condition, with variability in its phenotypes, rather than a homogenous latent entity and a concrete diagnosis, as previously conceptualized in psychometric literature and diagnostic systems. Therefore, it is pertinent that researchers recognize this to progress in elucidating its aetiology and developing efficacious interventions.This systematic review is conducted in accordance with the Meta-analysis of observational studies in epidemiology (MOOSE). It aims to provide an updated and comprehensive account of research on heterogeneity in phenotypes of PND and its implications in research, public health, and clinical practice. It provides a synthesis and quality assessment of studies reporting heterogeneity in PND using cutting-edge statistical techniques and machine learning algorithms. After reporting the phenotypes of PND, based on heterogeneous trajectories and symptom profiles, it also elucidates the risk factors associated with severe forms of PND, followed by robust evidence for adverse child outcomes. Furthermore, recommendations are made to improve public health and clinical practice in screening, diagnosis, and treatment of PND.

A scoping review of non-pharmacological perinatal interventions impacting maternal sleep and maternal mental health

Background

A woman’s vulnerability to sleep disruption and mood disturbance is heightened during the perinatal period and there is a strong bidirectional relationship between them. Both sleep disruption and mood disturbance can result in significant adverse outcomes for women and their infant. Thus, supporting and improving sleep in the perinatal period is not only an important outcome in and of itself, but also a pathway through which future mental health outcomes may be altered.

Methods

Using scoping review methodology, we investigated the nature, extent and characteristics of intervention studies conducted during the perinatal period (pregnancy to one-year post-birth) that reported on both maternal sleep and maternal mental health. Numerical and descriptive results are presented on the types of studies, settings, sample characteristics, intervention design (including timeframes, facilitation and delivery), sleep and mood measures and findings.

Results

Thirty-seven perinatal interventions were identified and further described according to their primary focus (psychological (n = 9), educational (n = 15), lifestyle (n = 10), chronotherapeutic (n = 3)). Most studies were conducted in developed Western countries and published in the last 9 years. The majority of study samples were women with existing sleep or mental health problems, and participants were predominantly well-educated, not socio-economically disadvantaged, in stable relationships, primiparous and of White race/ethnicity. Interventions were generally delivered across a relatively short period of time, in either the second trimester of pregnancy or the early postnatal period and used the Pittsburgh Sleep Quality Index (PSQI) to measure sleep and the Edinburgh Postnatal Depression Scale (EPDS) to measure mood. Retention rates were high (mean 89%) and where reported, interventions were well accepted by women. Cognitive Behavioural Therapies (CBT) and educational interventions were largely delivered by trained personnel in person, whereas other interventions were often self-delivered after initial explanation.

Conclusions

Future perinatal interventions should consider spanning the perinatal period and using a stepped-care model. Women may be better supported by providing access to a range of information, services and treatment specific to their needs and maternal stage. The development of these interventions must involve and consider the needs of women experiencing disadvantage who are predominantly affected by poor sleep health and poor mental health.

Trajectories and Predictors of Symptoms of Depression in Chinese Women From Early Pregnancy to the Early Postpartum Period

OBJECTIVE

To explore the trajectories and predictors of symptoms of depression in Chinese women from early pregnancy to 3 months after birth.

DESIGN

Prospective cohort study.

SETTING

Several maternal and child health care institutions and obstetric departments of general hospitals in Beijing, Jiangsu, Hunan, Sichuan, Shandong, Guangdong, and Shanxi provinces in China.

PARTICIPANTS

Chinese women (N = 667) during pregnancy and the postpartum period.

METHODS

From August 2019 to June 2020, participants from several tertiary hospitals in China who completed at least three measurements during early pregnancy to 3 months after birth (from time point 1 to time point 5) were included for data analysis. We used the self-administered basic information questionnaire and the Edinburgh Postnatal Depression Scale for follow-up. We used Mplus version 8.3 to construct the growth mixture modeling and SPSS version 25.0 to carry out logistic regression analysis.

RESULTS

We found three potential trajectories of symptoms of depression during pregnancy and the postpartum period: the down-then-up healthy group (Class 1, 68.5%), steady-growth moderate-risk group (Class 2, 27.5%), and up-then-down high-risk group (Class 3, 4.0%). Multinomial logistic regression analysis showed that being pregnant for the first time, being a company employee, being less satisfied with the living environment, and the occurrence of negative life events were significant predictors of the Class 2 trajectory, whereas younger age, being less satisfied with food, and the occurrence of negative life events were predictors of the Class 3 trajectory.

CONCLUSION

The trajectories of symptoms of depression during pregnancy and the postpartum period among Chinese women showed significant group heterogeneity. The trajectory categories were influenced not only by demographics and pregnancy-related factors but also by maternal subjective feelings.