Re-examination of perinatal mental health policy frameworks for women signalling distress on the Edinburgh Postnatal Depression Scale (EPDS) completed during their antenatal booking-in consultation: a call for population health intervention

Effectiveness of the mom supports mom peer support intervention in treating antenatal mental health difficulties in women

PROBLEM

Up to 75 % of at-risk perinatal women do not receive treatment in Czechia.

BACKGROUND

Pregnant women with mental health difficulties are more likely to undergo less controversial nonpharmaceutical treatment during pregnancy, but structural and psychological barriers interfere with their capacity to seek professional help.

AIM

We tested the effectiveness of the telephone-based peer support intervention Mom Supports Mom (MSM) in Czech pregnant women at risk of mental disorder.

METHODS

The Edinburgh Postnatal Depression Scale (EPDS) was used to assess risk in women (EPDS ≥ 10). Women at risk were randomized into two groups; the intervention group received the MSM, while the control group received the care as usual, which did not contain any psychological support intervention. One month after completing the EPDS, the women's mental statuses were again measured and compared, this time with data before and after the intervention, using the Perinatal Anxiety Screening Scale (PASS) to measure anxiety, the EPDS to measure depression, the Prenatal Psychosocial Profile (PPP) to measure stress, and the Prenatal Attachment Inventory - Revised (PAI-R) to measure attachment. The trial was registered under the name Pregnancy without psychosocial stress (ClinicalTrials.gov ID NCT04853693).

FINDINGS

A total of 167 women were included in the study and randomized into two groups. Depressive symptoms did not decrease (Cohen´s d; 95 % CI = 0.48; 0.17-0.79; p = .002), but levels of anxiety (Cohen´s d; 95 % CI = 0.44; 0.13-0.75; p = .005) and psychosocial stress (Cohen´s d; 95 % CI = 0.55; 0.20-0.82; p = .002) were reduced in women in the intervention group compared with women in the control. In addition, prenatal attachment increased among intervened women (Cohen´s d; 95 % CI = 0.48; 0.17-0.79; p = .002).

DISCUSSION

The telephone-based peer support intervention MSM is effective in reducing stress and anxiety and increasing prenatal attachment but does not reduce depression among high-risk women.

Social Support and Spousal Relationship Quality Improves Responsiveness among Anxious Mothers

Maternal responsiveness, a mother's ability to consistently identify infant cues and then act on them, is critical for healthy child development. A woman's social support and spousal relationship may affect responsiveness to an infant, especially among mothers with anxiety. We assessed how social support and spousal relationship quality is associated with responsiveness among anxious mothers, and if postpartum depression (PPD) moderated these associations. Cross-sectional data were collected from 2019 to 2022 in a public hospital in Pakistan from 701 women at six-weeks postpartum. Eligible women had at least mild anxiety in early- to mid- pregnancy. Linear regression analyses assessed if spousal relationship quality and social support from family and friends were associated with maternal responsiveness, measured using the Maternal Infant Responsiveness Instrument. Interaction terms were used to examine if PPD moderated these associations. Spousal relationship quality (B = 2.49, 95% CI: 1.48, 3.50) and social support (B = 1.07, 95% CI: 0.31, 1.83) were positively related to maternal responsiveness to the infant. Emotional support from a spouse was positively associated with responsiveness (B = 1.08, 95% CI: 0.12, 2.03 depressed; B = 2.96, 95% CI: 1.34, 4.58 non-depressed), and conflict with the spouse was negatively associated with responsiveness (B=-1.02, 95% CI: -1.94, -0.09 depressed; B=-2.87, 95% CI: -4.36, -1.37 non-depressed). However, social support was related to responsiveness only in non-depressed women (B = 2.61, 95% CI: 1.14, 4.07). While spousal relationships and social support enhance maternal responsiveness, for depressed women, spousal relationships were particularly critical. In considering maternal-infant interventions to improve child development outcomes, our study indicates the importance of supportive relationships that foster effective responsiveness.

Mental health and mental health help-seeking behaviors among first-generation voluntary African migrants: A systematic review

PURPOSE

Mental health challenges are highly prevalent in African migrants. However, understanding of mental health outcomes in first-generation voluntary African migrants is limited, despite the unique challenges faced by this migrant subgroup. This review aimed to synthesize the literature to understand the mental health challenges, help-seeking behavior, and the relationship between mental health and mental health help-seeking behavior in first-generation voluntary African migrants living outside Africa.

METHODS

Medline Complete, EMBASE, CINAHL Complete, and APA PsychINFO were searched for studies published between January 2012 to December 2023. Retrieved articles were processed, data from selected articles were extracted and synthesized to address the study aims, and included studies were evaluated for risk of bias.

RESULTS

Eight studies were included, including four quantitative and four qualitative studies, which focused on women with postnatal depression. Mental health challenges reported in the quantitative studies were depression, interpersonal disorders, and work-related stress. Risk (e.g., neglect from health professionals and lack of social/spousal support) and protective (e.g., sensitivity of community services and faith) factors associated with mental health were identified. Barriers (e.g., cultural beliefs about mental health and racial discrimination) and facilitators (sensitizing African women about mental health) of mental health help-seeking behavior were also identified. No significant relationship was reported between mental health and mental health help-seeking behavior, and the risk of bias results indicated some methodological flaws in the studies.

CONCLUSION

This review shows the dearth of research focusing on mental health and help-seeking behavior in this subgroup of African migrants. The findings highlight the importance of African migrants, especially mothers with newborns, examining cultural beliefs that may impact their mental health and willingness to seek help. Receiving countries should also strive to understand the needs of first-generation voluntary African migrants living abroad and offer mental health support that is patient-centered and culturally sensitive.

Anxiety-focused cognitive behavioral therapy delivered by non-specialists to prevent postnatal depression: a randomized, phase 3 trial

Anxiety experienced by women during pregnancy is highly prevalent, especially in resource-poor settings and strongly predicts postnatal common mental disorders (CMDs), anxiety and depression. We evaluated the effectiveness of an anxiety-focused early prenatal intervention on preventing postnatal CMDs. This study was a phase 3, two-arm, single-blind, randomized controlled trial conducted in Pakistan with women who were ≤22 weeks pregnant and had at least mild anxiety without clinical depression. Participants were randomized to the Happy Mother-Healthy Baby program, based on cognitive behavioral therapy, consisting of six one-on-one intervention sessions in pregnancy delivered by non-specialist providers, or to enhanced care alone. The primary outcome was major depression, generalized anxiety disorder or both at 6 weeks after delivery. Overall, 755 women completed postnatal assessments (380 (50.3%), intervention arm; 375 (49.7%) enhanced-care arm). The primary outcomes were met. Examined jointly, we found 81% reduced odds of having either a major depressive episode (MDE) or moderate-to-severe anxiety for women randomized to the intervention (adjusted odds ratio (aOR) = 0.19, 95% CI 0.14-0.28). Overall, 12% of women in the intervention group developed MDE at 6 weeks postpartum, versus 41% in the control group. We found reductions of 81% and 74% in the odds of postnatal MDE (aOR = 0.19, 95% CI 0.13-0.28) and of moderate-to-severe anxiety (aOR = 0.26, 95% CI 0.17-0.40), respectively. The Happy Mother-Healthy Baby program early prenatal intervention focusing on anxiety symptoms reduced postpartum CMDs. ClinicalTrials.gov identifier NCT03880032 .

Barriers and enablers to exclusive breastfeeding by mothers in Polokwane, South Africa

Background

Exclusive breastfeeding (EBF) for six months, with the introduction of appropriate complementary feeding thereafter, and breastfeeding continuing for up to 2 years and beyond, is highly recommended. This could save the lives of up to 1.4 million children each year worldwide. Despite this, breastfeeding rates in South Africa remain sub-optimal, with the recommended target of 50% by the World Health Assembly (WHA) not being achieved. The study aimed to investigate the reasons influencing mothers' practice of exclusive breastfeeding in the Polokwane municipality of Limpopo province in South Africa.

Methodology

A cross-sectional health facility-based quantitative and descriptive survey was conducted using a validated-structured questionnaire administered to 146 mothers. The data was analyzed using STATA. Chi-square tests were used to determine the relationship between selected demographic variables and their reasons not to breastfeed exclusively.

Results

Although 94% of the mothers had initiated breastfeeding, at the time of data collection 8% had stopped. Of those who had stopped breastfeeding, 5% did so within one month of starting. Thirty- nine percent of mothers' breastfed exclusively, while 61% practiced mixed feeding. A positive association between exclusive breastfeeding practices and the age of the mother were observed, with older mothers more likely to breastfeed. The reasons mothers stopped breastfeeding were: the mother was ill (45%) or they returned to school or work (27%). Reasons for not breastfeeding were cited as: medical conditions, not enough milk, and infant refusal to breastfeed (33%). Mothers believe that HIV-positive women should breastfeed their infants (57%), and health workers were found to be the main source of HIV information to mothers (77%).

Discussion

Exclusive breastfeeding during the first six months was less practiced. Infant formula and solid foods were introduced at an early age, usually within the first month of breastfeeding. This study sheds light on factors influencing the early initiation of breastfeeding and the practice of EBF as practiced in Polokwane.

Association Between Physical Activity During Pregnancy and Perinatal Depressive Symptoms in Pregnant Individuals With Overweight and Obesity

INTRODUCTION

Current research on the association between physical activity and perinatal depression is inconclusive. This study examined the association between objectively measured physical activity during pregnancy and perinatal depressive symptoms among individuals with overweight and obesity.

METHODS

Data came from the Health in Pregnancy and Postpartum study (N = 205). Physical activity was measured using the SenseWear Armband at 16 weeks' or fewer and 32 weeks' gestation and categorized into 1) never meeting 2018 physical activity guidelines, 2) meeting the guidelines at one time point, or 3) meeting the guidelines at both time points. Antenatal depressive symptoms were assessed at 32 weeks' gestation, and postpartum depressive symptoms were assessed at 6 and 12 months postpartum using the Edinburgh Postnatal Depression Scale. A score of 10 or higher was defined as probable at least minor depression (hereafter, probable depression).

RESULTS

Nearly one-half of the participants (45.4%) met physical activity guidelines both in early and late pregnancy. Pregnant individuals who met physical activity guidelines at one (adjusted odds ratio, 0.07; 95% confidence interval, 0.01-0.76) or both time points (adjusted odds ratio, 0.08; 95% confidence interval, 0.01-0.69) during pregnancy had lower odds of probable depression at 6 months postpartum than individuals who never met physical activity guidelines during pregnancy. No significant associations were found between prenatal physical activity and probable antenatal or postpartum depression at 12 months.

CONCLUSIONS

Antenatal physical activity was associated with lower odds of probable depression at 6 months after childbirth. Physicians should use evidence-based strategies to encourage pregnant people, especially those who are at risk for postpartum depression, to meet physical activity guidelines.

"They should ask about our feelings": Mongolian women's experiences of postpartum depression

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.

Association of maternal psychosocial stress with newborn body composition in the Healthy Start study

Maternal psychosocial stress is associated with delivery of both small- and large-for-gestational-age newborns. Prior studies have relied on methods that do not capture fat mass (FM) vs. fat-free mass (FFM). We aimed to assess the relationship of maternal psychosocial stress, using the Edinburgh Postnatal Depression Scale (EPDS) and Cohen's Perceived Stress Scale (PSS), with newborn body composition. The sample included 604 mother/newborn pairs in the Healthy Start study. We used linear regression to examine associations of EPDS (>6.5 vs. ≤6.5) and PSS (>21 vs. ≤21) with newborn adiposity (FM and %FM measured by air displacement plethysmography [ADP], BMI-for-age, weight-for-length, and weight-for-age z-scores) and lean mass (FFM and length-for-age z-score). Average age of the women was 29.2 ± 6 y. Fifty-five percent of the women were white, 26.2% Hispanic, and 12.1% Black. Twenty-four percent of women had EPDS >6.5 and 18.1% had PSS >21. Mean ± SD birthweight was 3136 ± 437 g. After adjustment for confounders, EPDS >6.5 vs. ≤6.5 corresponded with 35.3 (95% CI: 6.6, 64.0) g lower offspring FM and 0.18 (-0.03, 0.39) units shorter length z-score. PSS was not associated with any neonatal outcomes. Maternal psychosocial stress is associated with delivery of shorter newborns with less FM.

Antenatal depression risk under the NSW SAFE START Strategic Policy: Who is missing out on universal screening?

AIM

To examine antenatal depression risk screening coverage under the NSW SAFE START Strategic Policy and to explore maternal and sociodemographic factors associated with under-screening.

METHODS

Completion rates for the Edinburgh Depression Scale (EDS) were examined in a retrospective dataset of routinely collected antenatal care data including all women who birthed at public health facilities in Sydney Local Health District from 1 October 2019 to 6 August 2020. Potential sociodemographic/clinical factors associated with under-screening were identified using univariate and multivariate logistic regression. Free-text responses regarding reasons for EDS non-completion were examined using qualitative thematic analysis techniques.

RESULTS

A total of 4810 women (96.6%) in our sample (N = 4980) completed antenatal EDS screening; only 170 (3.4%) were not screened or lacked data to indicate that screening had occurred. Multivariate logistic regression analyses showed that women under certain models of antenatal care (public hospital care, private midwife/obstetrician or no formal care), non-English speaking women who required an interpreter, and women whose smoking status during pregnancy was unknown had a higher odds of missing screening. The reasons for EDS non-completion indicated in the electronic medical record revealed language and time/practical constraints to be the most commonly-reported barriers.

CONCLUSIONS

Antenatal EDS screening coverage was high in this sample. Refresher training for staff involved can emphasise the need to ensure appropriate screening for women who access shared care in external services (particularly private obstetric care). Additionally, at the service level, improved access to interpreter services and foreign language resources may help minimise EDS under-screening for culturally and linguistically diverse families.

Screening for Partner Postpartum Depression: A Systematic Review

BACKGROUND

Postpartum depression is a significant mental health condition affecting an estimated 7% to 20% of women, with higher rates among individuals with increased risk factors. Most research on postpartum depression has focused on mothers, with less recognition of the mental health changes experienced by their partners. Research suggests almost 20% of partners may experience postpartum depression, yet our understanding is limited. An enhanced understanding of postpartum depression in a birthing person's partner is critical, given the mental and physical health sequelae associated with depression.

PURPOSE

The purpose of this review was to systematically examine the current tools available to assess partner postpartum depression.

METHODS

We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were identified using selected key terms in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Ovid MEDLINE. Studies were included if they assessed partner depressive symptoms and identified the specified use of a tool or screening measure.

RESULTS

Seventeen studies met inclusion criteria. Seven different measures were used to assess postpartum depression. The Edinburgh Postnatal Depression Scale (EPDS) was used in 16 out of the 17 studies for depression assessment.

CLINICAL IMPLICATIONS

Routine screening of partners for postpartum depression should be recommended as part of standard care. Nurses are critical liaisons for assessing risk and connecting relevant and timely resources to birthing people and their partners. Identifying the available screening tools may help to avoid adverse clinical outcomes associated with increased symptom severity and burden.

Gestational hemodilution as a putative risk factor for postpartum depression: A large-scale nationwide longitudinal cohort study

BACKGROUND

While anemia during pregnancy has been linked to increased postpartum depression (PPD) risk, longitudinal studies on the association between gestational hemodilution, represented by decreased hematocrit (Hct) during the transition from the 1st to 2nd trimester, and PPD risk, are scarce. The current study aimed to investigate this association in a nationwide cohort over the perinatal period.

METHODS

This retrospective cohort study included 104,715 women who gave birth between January 2008 and December 2015. The cohort was followed up for new-onset PPD during the year post birth and gestational hemodilution was assessed by the change in Hct levels (Δ: 2nd-1st trimester). The cohort was divided into three hemodilution groupings: maximal and minimal 10 % of mothers and intermediate 80 %. Multivariable regression analyses were performed to estimate the association between gestational hemodilution and PPD, adjusting for confounders.

RESULTS

Among the full cohort, 2.2 % (n = 2263) met the definition of new-onset PPD. Mothers with greater hemodilution had higher rates of PPD: 2.7 % (n = 269) in the maximal hemodilution group, 2.1 % (n = 1783) in the intermediate and 1.9 % (n = 211) in the minimal hemodilution group (p < 0.001). The maximal hemodilution group had higher rates of pre-gestational psychiatric disorders (p < 0.001) and higher adjusted risk for PPD [OR = 1.18, 95 % CI (1.04, 1.35)].

LIMITATIONS

Data on iron levels and supplementation were unavailable, thus it could not be adjusted for in the analysis.

CONCLUSIONS

Women in the top 10th percentile of gestational hemodilution may be at risk for PPD, justifying monitoring of gestational Hct as a biomarker for PPD.

The Impact of COVID-19 Related Distress on Antenatal Depression in Australia

Globally, the impact of COVID-19 on mental health has been significant. Pregnant women are known to be a vulnerable population in relation to mental health. In Australia, there was an unprecedented demand during the pandemic for mental health services, including services for pregnant women. Maternal mental health has unique and enduring features that can significantly shape a child's overall development and poor maternal mental health can have considerable social and economic costs. This cross-sectional study evaluated symptoms of antenatal depression and COVID-19-related distress in a sample of two hundred and sixty-nine pregnant women residing in Australia aged between 20 and 43 (M = 31.79, SD = 4.58), as part of a larger study. Social media advertising was used to recruit participants between September 2020 and November 2021. Prevalence rates for antenatal depression were found to be higher in this study (16.4%) compared with previous Australian prevalence rates (7%). COVID-19 distress in relation to having a baby during a COVID-19 outbreak significantly predicted symptoms of antenatal depression, B = 1.46, p < 0.001. Results from this study suggest that mothers and families may have increased mental health vulnerabilities as a consequence of the pandemic for some time yet.

The Mother-Baby Bond: Role of Past and Current Relationships

During the perinatal period, up to 25% of women experience difficulties in relating to their child. The mother-child bond promotes the transition to motherhood, protects the woman from depression, and protects the child from the intergenerational transmission of the disease. This study prospectively investigated if the relationship with the co-parent, the attachment style, and the bond that women had with their parents influenced the mother-fetus and then mother-child bond. We also explored the role of depression and anxiety. One hundred nineteen pregnant women were enrolled. We administered clinical interviews and psychometric tools. A telephone interview was conducted at 1, 3, and 6 months of follow-up. Maternal insecure attachment style (r = −0.253, p = 0.006) and women’s dyadic adjustment in the couple’s relationships (r = 0.182, p = 0.049) were correlated with lower maternal–fetal attachment. Insecure attachment styles and depression correlate with bottle-feeding rather than breastfeeding. The bond women had with their mothers, not their fathers, was associated with breastfeeding. Depression (OR = 0.243, p = 0.008) and anxiety (OR = 0.185, p = 0.004; OR = 0.304, p < 0.0001) were related to mother-infant bonding. Close relationships, past and present, affect the bond with the fetus and the child differently. Psychotherapy can provide reassuring and restorative intersubjective experiences.

Psychosocial interprofessional perinatal education: Design and evaluation of an interprofessional learning experience to improve students' collaboration skills in perinatal mental health

BACKGROUND

Perinatal mental health disorders are one of the leading causes of maternal illness and suffering and care and services need to be well coordinated by an interprofessional team who are skilled in working collaboratively.

AIM

The aim of this paper is to describe the design and evaluation of an innovative interprofessional education initiative to increase midwives and other health professional students' knowledge and skills in caring collaboratively for women with psychosocial issues in the perinatal period, including women experiencing domestic and family violence.

METHODS

The Psychosocial Interprofessional Perinatal Education workshop was designed for midwifery, psychology, social work and medical students. It provided a simulated learning experience with case studies based on real life situations. Students undertook pre and post surveys to measure changes in students' perceptions of interprofessional collaboration and their experiences of participating in the interprofessional simulation-based learning activity. Quantitative survey data were analysed using paired t-tests and a qualitative content analysis was undertaken on the open-ended questions in the survey.

FINDINGS

Comparison of pre and post surveys found students from all disciplines reported feeling more confident working interprofessionally following the workshop. The following categories were generated from analysis of the open ended survey data: Greater understanding of each others' roles; Recognising benefits of interprofessional collaboration; Building on sense of professional identity; Respecting each other and creating a level playing field; and Filling a pedagogical gap.

CONCLUSION

Through this innovative, simulated interprofessional education workshop students developed skills essential for future collaborative practice to support women and families experiencing psychosocial distress.

Meta-analysis of diagnostic properties of the Whooley questions to identify depression in perinatal women

BACKGROUND

This study's objective was to assess the diagnostic properties of the Whooley questions in identifying depression among perinatal women according to previously published studies. We conducted a systematic review and meta-analysis of studies investigating the diagnostic accuracy of the Whooley questions in perinatal women.

METHODS

Nine databases were searched in October 2021. All primary studies evaluated the diagnostic properties of the Whooley questions compared with a diagnostic gold standard in women during the perinatal period or, if not identified as being in the perinatal stage within the study, women between 20 weeks' gestation to 4 weeks post-delivery. A bivariate mixed-effects meta-analysis was performed to estimate pooled diagnostic properties and measure heterogeneity. Meta-regression was conducted to evaluate factors contributing to heterogeneity.

RESULTS

Six studies were included in the review; five were used in the meta-analysis. The pooled sensitivity (95 % confidence interval) was 0.95 (0.81-0.99), pooled specificity was 0.60 (0.44-0.74), pooled positive likelihood ratio was 2.4 (1.6-3.4), pooled negative likelihood ratio was 0.09 (0.02-0.32), and pooled diagnostic odds ratio was 27 (7-106); heterogeneity was substantial (I² = 0.90, 0.81-1.00). Participant age and setting (community vs. hospital) significantly contributed to heterogeneity.

CONCLUSIONS

The Whooley questions have high sensitivity but moderate specificity for perinatal women. The Whooley questions are a short and acceptable tool for identifying depression in perinatal women. However, a potential risk exists of incorrectly identifying a high proportion of women as positive. Using the Whooley questions followed by a secondary case-finding tool could reduce the misdiagnosis risk.

Implementing a Perinatal Depression Screening in Clinical Routine: Exploring the Patient's Perspective

Introduction Perinatal depression (PND) is a frequently observed mental disorder, showing a prevalence of up to 20% and resulting in unfavorable maternal and neonatal outcomes. Targeted screening for PND offers the potential to identify and treat undiagnosed cases and help prevent its deleterious consequences. The aim of the present study was to evaluate participants' personal attitudes and acceptance of a routine screening program for PND in pregnancy care, identify any potential underlying factors, and appraise the general perspective on perinatal mental health problems. Methods In total, 732 women in their second trimester of pregnancy took part in a PND screening program that was incorporated in routine prenatal care using the Edinburgh Postnatal Depression Scale (EPDS) and completed a web-based survey on screening acceptance. Results Participants viewed PND screening as useful (78.7%, n = 555/705), especially in terms of devoting attention to perinatal mental health problems (90.1%, n = 630/699), easy to complete (85.4%, n = 606/710), and without feelings of discomfort (88.3%, n = 628/711). Furthermore, women with previous or current mental health issues rated the usefulness of screening significantly higher, as did women with obstetric risks (p < 0.01 - p = 0.04). The final regression model explained 48.4% of the variance for screening acceptance. Conclusion Patient acceptance for PND screening was high in our study cohort, supporting the implementation of screening programs in routine pregnancy care with the potential to identify, sensitize, and treat undiagnosed patients to reduce stigmatization and offer access to tailored dedicated PND care programs.

Characterization of Maternal Psychosocial Stress During Pregnancy: The Healthy Start Study

Objective

To capture multidimensional maternal psychosocial stress using responses from the Edinburgh Postnatal Depression Scale (EPDS) and Cohen's Perceived Stress Scale (PSS) administered during pregnancy, and to identify sociodemographic, biological, and health behavioral correlates of the stress domains.

Methods

Using data from 1,079 pregnant women, we implemented principal component analysis on EPDS and PSS responses and retained factors based on the Scree plot and Eigenvalues >1. We then used linear regression to identify perinatal correlates of each domain.

Results

We identified three stress domains: "Feeling Overwhelmed," "Anhedonia," and "Lack of Control," which accounted for 10.6% of variance in questionnaire responses. In multivariable analyses, household income ≤$70,000 (β = 0.21 confidence interval [95% CI: 0.05-0.39]), primiparity (0.36 [0.02-0.71]), inadequate (0.21 [0.04-0.39]) or excessive gestational weight gain (0.27 [0.11-0.42]), and Healthy Eating Index (HEI) score ≤57 (0.14 [0.00-0.28]) were associated with Feeling Overwhelmed. Older age (0.02 [0.00-0.03] per 1-year), Hispanic ethnicity (0.19 [0.00-0.38]), and HEI score ≤57 (0.15 [0.02-0.28]) were associated with Anhedonia. Non-Hispanic Black race/ethnicity (0.37 [0.10-0.63]), not having graduated from college (0.16 [-0.02 to 0.35]), having a partner born outside the United States (0.17 [-0.02 to 0.37]), household size of ≥5 persons (0.21 [-0.02 to 0.37]), receiving public assistance (0.18 [-0.02 to 0.37]), and prenatal smoking (0.32 [0.05-0.59]) were associated with Lack of Control.

Conclusions

Three domains of maternal psychosocial stress during pregnancy (Feeling Overwhelmed, Anhedonia, and Lack of Control) were differentially related to sociodemographic, biological, and health behavioral characteristics that may be targets for interventions to ameliorate stress in pregnant women.

Clinical Trial Registry

: The Healthy Start study is registered as an observational study at clinicaltrials.gov (NCT #002273297).

Does interactive ultrasound intervention relieve minor depressive symptoms and increase maternal attachment in pregnancy? A protocol for a randomized controlled trial

Background

Perinatal depression, especially minor depression, is common during pregnancy and is likely to continue into the postpartum period. It may impair the mother’s health, the infant’s neurodevelopment, and the mother-infant relationship. Screening for perinatal depression is recommended; however, there is no consensus on how to treat depressive symptoms while simultaneously supporting the mother-infant relationship. Ultrasound examination has been shown to improve maternal-fetal attachment among pregnant women. Our aim is to develop a four-dimensional (4D) based interactive ultrasound intervention and test whether it relieves minor depressive symptoms and improves maternal-fetal attachment. Previous studies show that supporting the mother-infant relationship aids in relieving maternal depression. Until now, few studies have combined pregnancy ultrasound and psychological support.

Methods

A controlled randomized setting was designed to assess whether interactive 4D-ultrasound intervention would decrease maternal depressive symptoms, strengthen maternal-fetal attachment, and mother-infant relationship. An obstetrician and a psychologist specialized in infant mental health conduct the interventions. The focus is to jointly observe the behavior of the fetus according to the mothers’ wishes. Altogether, 100 women scoring 10–15 on Edinburgh Pre-/Postnatal Depression Scale (EPDS) and with singleton pregnancy are recruited using a web-based questionnaire. Half of the participants will be randomized to the intervention group and will undergo three interactive ultrasound examinations. The primary outcomes are a decrease in perinatal depressive symptoms assessed with EPDS and an increase in maternal attachment. The maternal attachment was assessed using the Working Model of the Child Interview (WMCI), the Maternal Antenatal Attachment Scale (MAAS), and the Maternal Postnatal Attachment Scale (MPAS). Secondly, we hypothesize that if the intervention decreases prenatal depressive symptoms and improves prenatal attachment, the decrease in depressive symptoms and improvement in mother-infant relationship is seen postnatally.

Discussion

Ultrasound is widely used during pregnancy. The interactive approach is unique and may be feasible as part of routine screenings and maternity clinic visits. Intervention that decreases depression and simultaneously supports maternal-fetal attachment would be a valuable addition to the treatment of minor depression among pregnant women.

Trial registration

ClinicalTrials.gov NCT03424642. Registered on January 5 2018.

Disparities in postpartum depression screening participation between immigrant and Danish-born women

BACKGROUND

Qualitative studies suggest that immigrant women experience barriers for postpartum depression (PPD) screening. This study examines the prevalence of participation in PPD screening in the universal home-visiting programme in Denmark, in relation to migrant status and its association with acculturation factors, such as length of residence and age at migration.

METHODS

The sample consists of 77 694 births from 72 292 mothers (2015-18) that participated in the programme and were registered in the National Child Health Database. Lack of PPD screening using the Edinburgh Postpartum Depression Scale (EPDS) was examined in relation to migrant group and acculturation factors. We used Poisson regression with cluster robust standard errors to estimate crude and adjusted relative risk.

RESULTS

In total, 27.8% of Danish-born women and 54.7% of immigrant women lacked screening. Compared with Danish-born women, immigrant women in all groups were more likely to lack PPD screening (aRR ranging from 1.81 to 1.90). Women with low acculturation were more likely to lack screening. Women who migrated as adults [aRR = 1.27 (95% CI 1.16, 1.38)] and women who had resided in Demark for <5 years [aRR = 1.37 (95% CI 1.28, 1.46)] were more likely to lack screening.

CONCLUSIONS

Immigrant women in Denmark, particularly recent immigrants, are at increased risk of not being screened for PPD using the EPDS. This can lead to under-recognition of PPD among immigrant women. More work is needed to understand how health visitors recognize the mental health needs of immigrant women who are not screened, and whether this gap results in reduced use of mental health services.

Association between maternal depression during pregnancy and newborn DNA methylation

Around 15-65% of women globally experience depression during pregnancy, prevalence being particularly high in low- and middle-income countries. Prenatal depression has been associated with adverse birth and child development outcomes. DNA methylation (DNAm) may aid in understanding this association. In this project, we analyzed associations between prenatal depression and DNAm from cord blood from participants of the South African Drakenstein Child Health Study. We examined DNAm in an epigenome-wide association study (EWAS) of 248 mother-child pairs. DNAm was measured using the Infinium MethylationEPIC (N = 145) and the Infinium HumanMethylation450 (N = 103) arrays. Prenatal depression scores, obtained with the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Depression Inventory-II (BDI-II), were analyzed as continuous and dichotomized variables. We used linear robust models to estimate associations between depression and newborn DNAm, adjusted for measured (smoking status, household income, sex, preterm birth, cell type proportions, and genetic principal components) and unmeasured confounding using Cate and Bacon algorithms. Bonferroni correction was used to adjust for multiple testing. DMRcate and dmrff were used to test for differentially methylated regions (DMRs). Differential DNAm was significantly associated with BDI-II variables, in cg16473797 (Δ beta = -1.10E-02, p = 6.87E-08), cg23262030 (Δ beta per BDI-II total IQR = 1.47E-03, p = 1.18E-07), and cg04859497 (Δ beta = -6.42E-02, p = 1.06E-09). Five DMRs were associated with at least two depression variables. Further studies are needed to replicate these findings and investigate their biological impact.

Do depressive symptoms among pregnant women assisted in Primary Health Care services increase the risk of prematurity and low birth weight?

Objective:

to investigate associations between depressive symptoms during pregnancy, low birth weight, and prematurity among women with low-risk pregnancies assisted in public Primary Health Care services.

Method:

prospective cohort with 193 pregnant women, using the Edinburgh Postnatal Depression Scale, telephone interviews, and medical records available in the health services. Associations of interest were obtained using the Cox regression model.

Results:

the participants were aged 24.9 years old (median) and had 11 years of schooling (median); 82.4% lived with their partners, and gestational age at the birth was 39 weeks (median). Twenty-five percent of the participants scored ≥13 on the Edinburgh scale. Depressive symptoms did not appear associated with low birth weight (RR=2.06; CI95%=0.56-7.61) or prematurity (RR=0.86; CI95%=0.24-3.09) in the adjusted analysis. However, premature labor increased the risk of low birth weight (RR=4.81; CI95%=1.01-23.0) and prematurity (RR=7.70; CI95%=2.50-23.7). Additionally, each week added to gestational age decreased the risk of low birth weight (RR=0.76; CI95%=0.61-0.95).

Conclusion:

the presence of depressive symptoms among women with low-risk pregnancies was not associated with low birth weight or prematurity.

Increased sugar-sweetened beverage use tendency in pregnancy positively associates with peripartum Edinburgh postpartum depression scores

The association among sugar sweetened beverages (SSB) consumption, addiction and depression in adults, children and adolescents is widely reported. Dieting patterns during pregnancy is complicated by maternal fetal concerns. Specifically, restrained use of SSB might be potentially a source of perinatal distress. The current study modified diagnostic criteria for Substance Use Disorder (SUD) in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), into SSB-specific questions to assess SSB use tendency. Edinburgh Postpartum Depression Scores (EPDS) is used to assess maternal distress during pregnancy. One hundred and ninety-six consecutive pregnant women receiving antenatal care at Kaohsiung Medical University Hospital were invited to participate in this study. In the first trimester, 46.6% of women had none or 1 DSM-5 symptom, 27.0% had 2–3 symptoms, while 26.4% had ≥ 4 symptoms. The mean numbers of DSM-5 symptoms in each trimester were found to be 2.5 ± 2.25, 2.6 ± 2.45, 2.4 ± 2.43 for the first, second and third trimester, respectively, p = 0.750. While EPDS score showed no difference among DSM-5 symptoms 0–1, 2–3 and ≥ 4 groups in the first trimester (8.1 ± 4.59, 8.4 ± 5.00, 8.8 ± 4.82, p = 0.343), women with ≥ 4 DSM-symptoms was found significantly higher EPDS scores than those with < 4 DSM-symptoms in the second (7.2 ± 4.81, 7.7 ± 4.98, 8.8 ± 4.33, p = 0.030) and third trimester (6.8 ± 5.00, 7.2 ± 4.63, 8.7 ± 5.24, p = 0.019). The relationship remained significant after adjusting for covariates including actual SSB amount consumed (adjusted β = 0.25 with 95% confident interval (CI) 0.04–0.45 and 0.21 with 95% CI 0.04–0.38 for the second and third trimesters, respectively). Overall, the study is the first to characterize the positive relationship between SSB use tendency and antenatal distress in pregnancy, independent of actual SSB amount consumed. The observational nature of the study design precludes inferences of its underlying socio-psychomotor mechanisms, although restrained SSB use in pregnancy is suspected to contribute. The novel employment of modified SSB-specific DSM-5 scores and EPDS in this setting is feasible and further validation is promising. With better understanding and awareness, pregnant women with increased SSB use tendency should be properly counseled with special attention to their mental state.

The risk for nonpsychotic postpartum mood and anxiety disorders during the COVID-19 pandemic

OBJECTIVE

The coronavirus disease 2019 (COVID-19) appears to be the largest pandemic of our times. The aim was to recognize the risk factors for nonpsychotic postpartum mood and anxiety disorders (NPMADs) in women during the pandemic and state of emergency police lockdown in Serbia.

METHODS

We assessed 108 postpartum women who completed the Edinburgh Postnatal Depression Scale (EPDS) and an additional survey constructed for this study. We also used the additional, previously mentioned survey, in 67 healthy age-matched women with children who were ≥2 years of age. The additional survey allowed us to gain insight into the impact of the pandemic as well as postpartum period on the risk of NPMADs.

RESULTS

In 16 (14.8%) subjects we found a score ≥10 on EPDS. Higher rates on the EPDS were noticed in elderly, single, and unemployed, women who lost their jobs due to the pandemic, or women who were dissatisfied with their household income (p < 0.05). The risk of NPMADs was linked significantly to quarantine, and social isolation, the absence of social support, as well as having emotional problems. Postpartum women, compared to non-postpartum women, were more anxious and had feelings of helplessness during social isolation.

CONCLUSION

Understanding the factors that increase the risk of NPMADs during the pandemic could help prevent mental disorders during a possible future pandemic.

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

INTRODUCTION

Poor sleep and depressive symptoms are common throughout the perinatal period, but little is known about the extended time course of depression and the sleep dimensions associated with these trajectories.

OBJECTIVE

This study investigated different depression trajectories in New Zealand Māori and non-Māori women from late pregnancy to 3 years postnatal. Relationships between multiple dimensions of sleep and these depression trajectories were also investigated.

METHODS

Data from 856 women (30.6% Māori and 69.4% non-Māori) from the longitudinal Moe Kura cohort study were used. Depressive symptoms and multiple dimensions of sleep (quality, duration, latency, continuity and daytime sleepiness) were collected at 36 weeks' gestation, 12 weeks postnatal and 3 years postnatal. Trajectory analysis was completed using latent class analysis.

RESULTS

Latent class analysis revealed two distinct groups of depressive symptom trajectories: 'chronic high' and 'stable mild' for both Māori and non-Māori women. Māori women in both trajectories were more likely than non-Māori women to have clinically significant depressive symptoms at every time point. Poorer sleep quality, latency, continuity and greater daytime sleepiness were consistently associated with the chronic high depressive symptom trajectory at all three time points, after controlling for sociodemographic factors.

CONCLUSION

A significant proportion of Māori and non-Māori women experience chronically high depressive symptoms during the perinatal period and the following years. Across this extended time frame, Māori women have a higher probability of experiencing clinically significant depressive symptoms compared to non-Māori women. These persistent patterns of depressive symptoms occur concurrently with multiple dimensions of poor sleep. Given the well-described impact of maternal depression on the mother, child, family and community, this highlights the importance of healthcare professionals asking about mothers' sleep quality, continuity, latency and daytime sleepiness as potential indicators of long-term mood outcomes.

Postnatal depression and anxiety screening and management by maternal and child health nurses in community settings: A scoping review

OBJECTIVE

To examine the range and nature of primary research evidence on postnatal depression and anxiety screening and management by maternal and child health nurses within community settings.

BACKGROUND

Maternal and child health nurses are well-placed to identify and support women at risk of, or experiencing, postnatal depression and anxiety- a prevalent public health issue which remains largely undetected.

METHODS

Scoping methodology, guided by the Arksey and O'Malley (2005) framework, was used. The following electronic databases were searched in June 2019 and again in July 2020: Cumulative Index of Nursing and Allied Health Literature, MEDLINE, PsycINFO, and COCHRANE Library. Primary studies that were published in English, between 2008 and 2020, were included. PRISMA checklist and PRISMA flow diagram were used to adhere to best practice guidelines.

RESULTS

Twenty-three articles, relating to 22 studies, met the inclusion criteria. Two principal themes were identified: 'screening for postnatal depression and anxiety' and 'factors that influence postnatal depression and anxiety management'. Subthemes in the former related to attitudes toward screening, routine screening practice, screening efficacy, and attitudes toward the Edinburgh Postnatal Depression Scale. Subthemes in the latter included availability of formal care pathways, referral options, knowledge and confidence, and multiagency collaboration.

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

While maternal and child health nurses value their role in identifying and supporting mothers at risk of postnatal depression and anxiety, certain individual and organisational factors contribute to a gap between best practice and clinical practice. Narrowing the gap between evidence and practice is unlikely without directly addressing these barriers. Gaps in maternal and child health nurses' knowledge, skills and confidence regarding effective screening and management of mothers experiencing, or at risk of, postnatal depression and anxiety, impacts the quality of care provided. Ongoing training and professional development which adequately addresses these gaps is required.

Psychosocial stratification of antenatal indicators to guide population-based programs in perinatal depression

BACKGROUND

There is increasing awareness that perinatal psychosocial adversity experienced by mothers, children, and their families, may influence health and well-being across the life course. To maximise the impact of population-based interventions for optimising perinatal wellbeing, health services can utilise empirical methods to identify subgroups at highest risk of poor outcomes relative to the overall population.

METHODS

This study sought to identify sub-groups using latent class analysis within a population of mothers in Sydney, Australia, based on their differing experience of self-reported indicators of psychosocial adversity. This study sought to identify sub-groups using latent class analysis within a population of mothers in Sydney, Australia, based on their differing experience of self-reported indicators of psychosocial adversity. Subgroup differences in antenatal and postnatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale.

RESULTS

Latent class analysis identified four distinct subgroups within the cohort, who were distinguished empirically on the basis of their native language, current smoking status, previous involvement with Family-and-Community Services (FaCS), history of child abuse, presence of a supportive partner, and a history of intimate partner psychological violence. One group consisted of socially supported 'local' women who speak English as their primary language (Group L), another of socially supported 'migrant' women who speak a language other than English as their primary language (Group M), another of socially stressed 'local' women who speak English as their primary language (Group Ls), and socially stressed 'migrant' women who speak a language other than English as their primary language (Group Ms.). Compared to local and not socially stressed residents (L group), the odds of antenatal depression were nearly three times higher for the socially stressed groups (Ls OR: 2.87 95%CI 2.10-3.94) and nearly nine times more in the Ms. group (Ms OR: 8.78, 95%CI 5.13-15.03). Antenatal symptoms of depression were also higher in the not socially stressed migrant group (M OR: 1.70 95%CI 1.47-1.97) compared to non-migrants. In the postnatal period, Group M was 1.5 times more likely, while the Ms. group was over five times more likely to experience suboptimal mental health compared to Group L (OR 1.50, 95%CI 1.22-1.84; and OR 5.28, 95%CI 2.63-10.63, for M and Ms. respectively).

CONCLUSIONS

The application of empirical subgrouping analysis permits an informed approach to targeted interventions and resource allocation for optimising perinatal maternal wellbeing.

Development and validation of a machine learning-based postpartum depression prediction model: A nationwide cohort study

BACKGROUND

Currently, postpartum depression (PPD) screening is mainly based on self-report symptom-based assessment, with lack of an objective, integrative tool which identifies women at increased risk, before the emergent of PPD. We developed and validated a machine learning-based PPD prediction model utilizing electronic health record (EHR) data, and identified novel PPD predictors.

METHODS

A nationwide longitudinal cohort that included 214,359 births between January 2008 and December 2015, divided into model training and validation sets, was constructed utilizing Israel largest health maintenance organization's EHR-database. PPD was defined as new diagnosis of a depressive episode or antidepressant prescription within the first year postpartum. A gradient-boosted decision tree algorithm was applied to EHR-derived sociodemographic, clinical, and obstetric features.

RESULTS

Among the birth cohort, 1.9% (n = 4104) met the case definition of new-onset PPD. In the validation set, the prediction model achieved an area under the curve (AUC) of 0.712 (95% confidence interval, 0.690-0.733), with a sensitivity of 0.349 and a specificity of 0.905 at the 90th percentile risk threshold, identifying PPDs at a rate more than three times higher than the overall set (positive and negative predictive values were 0.074 and 0.985, respectively). The model's strongest predictors included both well-recognized (e.g., past depression) and less-recognized (differing patterns of blood tests) PPD risk factors.

CONCLUSIONS

Machine learning-based models incorporating EHR-derived predictors, could augment symptom-based screening practice by identifying the high-risk population at greatest need for preventive intervention, before development of PPD.

Tackling inequality in maternal health: Beyond the postpartum

Healthcare systems prioritise antenatal and intrapartum care over the postpartum period. This is reflected in clinical resource allocation and in research agendas. But from metabolic disease to mental health, many pregnancy-associated conditions significantly affect patients' lifelong health. Women from black and ethnic minority backgrounds and lower socioeconomic groups are at greater risk of physical and psychiatric complications of pregnancy compared to white British women. Without sufficiently tailored and accessible education about risk factors, and robust mechanisms for follow-up beyond the traditional 6-week postpartum period, these inequalities are further entrenched. Identifying approaches to address the needs of these patient populations is not only the responsibility of obstetricians and midwives; improvement requires cooperation from healthcare professionals from a wide range of specialties. Healthcare systems must encourage data collection on the long-term effects of metabolic and psychiatric conditions after the postpartum, and s support research that results in evidence-based care for the neglected field of women's postpartum health.

Income disparity in school readiness and the mediating role of perinatal maternal mental health: a longitudinal birth cohort study

AIMS

There is compelling evidence for gradient effects of household income on school readiness. Potential mechanisms are described, yet the growth curve trajectory of maternal mental health in a child's early life has not been thoroughly investigated. We aimed to examine the relationships between household incomes, maternal mental health trajectories from antenatal to the postnatal period, and school readiness.

METHODS

Prospective data from 505 mother-child dyads in a birth cohort in Singapore were used, including household income, repeated measures of maternal mental health from pregnancy to 2-years postpartum, and a range of child behavioural, socio-emotional and cognitive outcomes from 2 to 6 years of age. Antenatal mental health and its trajectory were tested as mediators in the latent growth curve models.

RESULTS

Household income was a robust predictor of antenatal maternal mental health and all child outcomes. Between children from the bottom and top household income quartiles, four dimensions of school readiness skills differed by a range of 0.52 (95% Cl: 0.23, 0.67) to 1.21 s.d. (95% CI: 1.02, 1.40). Thirty-eight percent of pregnant mothers in this cohort were found to have perinatal depressive and anxiety symptoms in the subclinical and clinical ranges. Poorer school readiness skills were found in children of these mothers when compared to those of mothers with little or no symptoms. After adjustment of unmeasured confounding on the indirect effect, antenatal maternal mental health provided a robust mediating path between household income and multiple school readiness outcomes (χ2 126.05, df 63, p < 0.001; RMSEA = 0.031, CFI = 0.980, SRMR = 0.034).

CONCLUSIONS

Pregnant mothers with mental health symptoms, particularly those from economically-challenged households, are potential targets for intervention to level the playing field of their children.

Factors Associated with Nonadherence to Inhaled Corticosteroids for Asthma During Pregnancy

BACKGROUND

Nonadherence is common among pregnant women prescribed inhaled corticosteroids (ICS) for asthma and may have serious consequences for mother and baby. Factors associated with ICS nonadherence have not been determined in this population.

OBJECTIVES

To determine factors associated with {1} nonadherence to ICS in early-mid pregnancy (cross-sectional) and {2} persistent nonadherence to ICS during pregnancy (longitudinal).

METHODS

Data used come from 3 prospective studies (2004-2019) involving women with asthma recruited by 23 weeks' gestation (N = 1614). Demographics, asthma history, and current symptoms were assessed, and spirometry was performed at baseline and throughout pregnancy. Women self-reported current medication use and number of ICS doses missed in the past week. Nonadherence was defined as ≥20% of prescribed dosages missed in the past week (baseline) and on at least 2 occasions during follow-up (persistent). Factors associated with ICS nonadherence were examined using backward stepwise logistic regression.

RESULTS

Of 610 (38%) women prescribed ICS at baseline, 236 (39%) were classified as nonadherent. Of 612 (38%) women prescribed ICS during at least 2 follow-up visits, 149 (24%) were classified as persistent nonadherent. Factors associated with nonadherence at baseline were current or ex-smoking, non-Caucasian/non-Indigenous ethnicity, adult diagnosis of asthma, and lower lung function. Factors associated with persistent nonadherence to ICS were lower maternal age, higher parity, and no prescribed ICS at baseline.

CONCLUSION

Young multiparous non-Caucasian/non-Indigenous mothers are at increased risk of being nonadherent to ICS during pregnancy. Strategies to improve ICS nonadherence should address maternal smoking and target women who (re-)initiate ICS use in pregnancy.

A pilot longitudinal sleep education intervention from early pregnancy and its effect on optimizing sleep and minimizing depressive symptoms

OBJECTIVES

Investigate the efficacy of a pilot longitudinal sleep education program for optimizing sleep and minimizing depressive symptoms in nulliparous pregnant women.

DESIGN

Early and longitudinal sleep education intervention pilot study.

SETTING

Community-based convenience sample of New Zealand women.

PARTICIPANTS

15 nulliparous women who were involved in a pilot of a longitudinal sleep education intervention during pregnancy (N = 15) were compared to a comparison group (n = 76) from another observational study with the same time points. Groups were matched on depression history and parity.

INTERVENTION

A longitudinal sleep education program was developed. Women in the intervention group participated in three individualized and trimester specific education sessions designed to increase sleep knowledge and improve sleep practices. The comparison group received no sleep education.

MEASUREMENTS

Self-reports of depressive symptoms and five dimensions of sleep (duration, quality, continuity, latency, daytime sleepiness) were compared between groups using linear mixed model analysis of variance.

RESULTS

At the conclusion of the intervention, the intervention group had fewer depressive symptoms with none experiencing clinically significant depressive symptoms, while 21% of the comparison group were considered to have clinically significant depressive symptoms. The intervention group also had better sleep quality, sleep initiation and sleep continuity than the comparison group at late pregnancy.

CONCLUSIONS

Findings suggest that a longitudinal sleep education intervention commencing early in pregnancy may be effective in optimizing sleep and minimizing depressive symptoms for nulliparous women with a history of depression. Further investigation of sleep education interventions to improve maternal mental health in pregnancy and postnatally is warranted.

How rates of perinatal mental health screening in Australia have changed over time and which women are missing out

OBJECTIVES

To report rates of perinatal mental health screening from 2000 to 2017 and investigate factors associated with not being screened both antenatally and postnatally more recently (2013-2017).

METHODS

A longitudinal community-based study of self-reported perinatal mental health screening with a national sample of 7,566 mothers from the Australian Longitudinal Study on Women's Health reporting on 9,384 children. The main outcome measure was whether mothers were asked about their emotional wellbeing by a health professional, including completing a questionnaire.

RESULTS

From 2000 to 2017, the percentage of women not screened decreased from 40.6% to 1.7%. The percentage of women screened both antenatally and postnatally increased from 21.3% to 79.3%. From 2013 to 2017, women who were older (aOR, 0.65; 95%CI, 0.52-0.81) or had reported emotional distress (aOR, 0.77; 95%CI, 0.60-0.99) were less likely to have been screened both antenatally and postnatally.

CONCLUSIONS

Despite improvements, perinatal mental health screening is not yet universal. One-in-five women are not screened both antenatally and postnatally, including women in high-risk populations such as those who have reported emotional distress. Implications for public health: Women are in regular contact with health professionals in the perinatal period. This opportunity to detect women at risk of perinatal mental health issues is too important to be missed.

Psychosocial and obstetric determinants of women signalling distress during Edinburgh Postnatal Depression Scale (EPDS) screening in Sydney, Australia

BACKGROUND AND OBJECTIVES

The perinatal period presents a high-risk time for development of mood disorders. Australia-wide universal perinatal care, including depression screening, make this stage amenable to population-level preventative approaches. In a large cohort of women receiving public perinatal care in Sydney, Australia, we examined: (1) the psychosocial and obstetric determinants of women who signal distress on EPDS screening (scoring 10-12) compared with women with probable depression (scoring 13 or more on EPDS screening); and (2) the predictive ability of identifying women experiencing distress during pregnancy in classifying women at higher risk of probable postnatal depression.

METHODS

We analysed routinely collected perinatal data from all live-births within public health facilities from two health districts in Sydney, Australia (N = 53,032). Perinatal distress was measured using the EPDS (scores of 10-12) and probable perinatal depression was measured using the EPDS (scores of 13 or more). Logistic regression models that adjusted for confounding variables were used to investigate a range of psychosocial and obstetric determinants and perinatal distress and depression.

RESULTS

Eight percent of this cohort experienced antenatal distress and about 5 % experienced postnatal distress. Approximately 6 % experienced probable antenatal depression and 3 % experienced probable postnatal depression. Being from a culturally and linguistically diverse background (AOR = 2.0, 95% CI 1.8-2.3, P < 0.001), a lack of partner support (AOR = 2.9, 95% CI 2.3-3.7) and a maternal history of childhood abuse (AOR = 1.9, 95% CI 1.6-2.3) were associated with antenatal distress. These associations were similar in women with probable antenatal depression. Women who scored 10 to12 on antenatal EPDS assessment had a 4.5 times higher odds (95% CI 3.4-5.9, P < 0.001) of experiencing probable postnatal depression compared with women scoring 9 or less.

CONCLUSION

Antenatal distress is more common than antenatal depressive symptoms and postnatal distress or depression. Antenatal maternal distress was associated with probable postnatal depression. Scale properties of the EPDS allows risk-stratification of women in the antenatal period, and earlier intervention with preventively focused programs. Prevention of postnatal depression could address a growing burden of illness and long-term complications for mothers and their infants.

Perinatal Distress and Depression in Culturally and Linguistically Diverse (CALD) Australian Women: The Role of Psychosocial and Obstetric Factors

Perinatal distress and depression can have significant impacts on both the mother and baby. The present study investigated psychosocial and obstetric factors associated with perinatal distress and depressive symptoms among culturally and linguistically diverse (CALD) Australian women in Sydney, New South Wales. The study used retrospectively linked maternal and child health data from two Local Health Districts in Australia (N = 25,407). Perinatal distress was measured using the Edinburgh Postnatal Depression Scale (EPDS, scores of 10-12) and depressive symptoms, with EPDS scores of 13 or more. Multivariate multinomial logistic regression models were used to investigate the association between psychosocial and obstetric factors with perinatal distress and depressive symptoms. The prevalence of perinatal distress and depressive symptoms among CALD Australian women was 10.1% for antenatal distress; 7.3% for antenatal depressive symptoms; 6.2% for postnatal distress and 3.7% for postnatal depressive symptoms. Antenatal distress and depressive symptoms were associated with a lack of partner support, intimate partner violence, maternal history of childhood abuse and being known to child protection services. Antenatal distress and depressive symptoms were strongly associated with postnatal distress and depressive symptoms. Higher socioeconomic status had a protective effect on antenatal and postnatal depressive symptoms. Our study suggests that current perinatal mental health screening and referral for clinical assessment is essential, and also supports a re-examination of perinatal mental health policy to ensure access to culturally responsive mental health care that meets patients' needs.