Screening of postpartum depression among new mothers in Istanbul: a psychometric evaluation of the Turkish Edinburgh Postnatal Depression Scale

The relationship between maternal-infant bonding and postpartum depression/anxiety: moderating effect of childhood psychological abuse and validation of the Mother-to-Infant Bonding scale (MIBS-8) in Arabic

BACKGROUND

The emotional bond that a mother senses to her infant is essential to their social, emotional, and cognitive development. Understanding the level of mother-infant bonding plays an imperative role in the excellence of care. However, in Lebanon, there is a paucity of information about mother-infant bonding in the postpartum period. Given that Lebanese pregnant women constitute an important part of the population to look at, the objectives of the study were to (1) validate the Arabic version of the mother-infant bonding scale and (2) the relation between mother-infant bond and postpartum depression/anxiety; (3) the moderating effect of child abuse in the association between mother-infant bond and postpartum depression/anxiety.

METHODS

This cross-sectional study was conducted from September 2022 until June 2023, enrolling 438 women 4-6 weeks after delivery (mean age: 31.23 ± 5.24 years). To examine the factor structure of the mother-infant bond scale, we used an Exploratory-Confirmatory (EFA-CFA) strategy. To check if the model was adequate, several fit indices were calculated: the normed model chi-square (χ2/df), the Steiger-Lind root mean square error of approximation (RMSEA), the Tucker-Lewis Index (TLI) and the comparative fit index (CFI).

RESULTS

EFA was conducted on the first subsample. Three items were removed. The five items remaining loaded on one factor, which explained 73.03% of the common variance (ω = .91 / α = .90). After adding a correlation between residuals for items 2-7 and 5-8, fit indices of the CFA results were acceptable: χ2/df = 6.97/3 = 2.32, RMSEA = .068 (90% CI .001, .135), SRMR = .017, CFI = .996, TLI = .988. The interaction maternal-infant bonding by child psychological abuse was significantly associated with depression and anxiety respectively. At low, moderate and high levels of child psychological abuse, higher maternal-infant bonding scores (greater difficulty in bonding) were significantly associated with higher depression and higher anxiety respectively.

CONCLUSION

This study provides, for the first time, a specific Arabic scale to assess mother-infant bonding reliably and validly. Furthermore, our study has suggested the existence of factors that have additive effects in potentiating the risk for depression and anxiety among Lebanese postpartum women, namely a history of psychological child abuse. Therefore, laborious awareness programs and healthcare services need to be implemented in order to prevent maternal mental health disorders from being unrecognized and left untreated.

Adaptation and integration of the thinking healthy programme into pregnancy schools in Istanbul, Turkey

BACKGROUND

Perinatal mental health is a major public health concern. In Turkey, public hospitals operate pregnancy schools which provides an opportunity to integrate an evidence-based Thinking Healthy Programme (THP) for perinatal depression. The aim of this study is to adapt the THP for universal use in the group setting and to understand its acceptability and feasibility for integration into the existing antenatal care programme for both face-to-face and online delivery.

METHODS

Following an expert-led adaptation process using the Bernal Framework, field testing was conducted on a group of women and facilitators followed by in-depth interviews (n:8) and group discussions (n = 13). Data were analysed using Thematic Framework Analysis.

RESULTS

Minor but significant adaptations were made to the individually delivered THP for use in the universal group pregnancy schools. Initial findings indicate that the THP-group version was acceptable to its target population and could be integrated into the antenatal care plan for delivery during face-to-face and online group classes.

CONCLUSION

THP is transferable to the Turkish cultural and healthcare context. The THP-group version has the potential to add value to Turkey's existing perinatal healthcare programme.

The effects of dyadic coping strategies and dyadic conflict resolution styles on postpartum depression of mothers in heterosexual marriages in Turkey

The authors of this study aimed to determine the effects of coping strategies and conflict resolution styles on postpartum depression in heterosexual mothers in the postpartum period in Turkey. A descriptive, cross-sectional study was conducted with 369 mothers with babies aged 1-12 months. The study was carried out between October 1, 2021, and December 1, 2021, in the pediatric outpatient clinic of the Medical Faculty Hospital of a province in the Central Anatolian Region of Turkey. Seventy-four (20.1%) mothers had scores above the depression scale cu-off point (>13). Having problems in marriage, getting a low score on the spouse's self-perception scale of dyadic coping with stress, and having negative, nonsubmissive, and retreating conflict resolution styles were found to be important factors associated with postpartum depression (p < .05). The incidence of postpartum depression was found to be associated with having problems in the marriage, not having good dyadic coping strategies, and having negative conflict resolution styles.

Postpartum Depression and Anxiety among Lebanese Women: Correlates and Scales Psychometric Properties

Background: We found that it was important to fill a gap in the literature and check the psychometric properties of the Edinburgh Postnatal Depression Scale (EPDS) and Perinatal Anxiety Screening Scale (PASS) in the Arabic language and delineate factors associated with postnatal depression (PPD) and anxiety (PPA) among Lebanese women 4−6 weeks after delivery. Methods: This cross-sectional study carried out between July 2018 and March 2019 enrolled 295 participants who came for a postnatal checkup at four clinics. Results: The EPDS and PASS scales’ items converged over two- and four-factor solutions, explaining 62.51% and 53.33% of the variance, respectively (KMO EPDS = 0.816, αCronbach EPDS = 0.826; KMO PASS = 0.878, αCronbach PASS = 0.920; Bartlett’s test of sphericity p < 0.001). Higher postpartum anxiety (Beta = 0.256), higher postpartum insomnia (Beta = 0.079), having hypotension during pregnancy (Beta = 2.760), and having a second (Beta = 1.663) or a third baby or more (Beta = 2.470) compared with the first one were significantly associated with higher postpartum depression. Higher postpartum depression (Beta = 1.33) was significantly associated with higher postpartum anxiety, whereas having a baby through a planned pregnancy (Beta = −4.365) and having a baby who ate regularly (Beta = −3.639) were significantly associated with lower postpartum anxiety. Conclusion: Depression and anxiety prevalence rates in the Lebanese population were higher compared with other countries, which may be due in part to the differences in regional, social and environmental culture.

Delivering the Thinking Healthy Programme as a universal group intervention integrated into routine antenatal care: a randomized-controlled pilot study

BACKGROUND

Women with perinatal depression and their children are at increased risk of poor health outcomes. There is a need to implement non-stigmatizing interventions into existing health systems which reduce psychosocial distress during pregnancy and prevent perinatal depression. We adapted the WHO-endorsed Thinking Healthy Programme (THP) to be delivered universally to all women attending routine online pregnancy schools in Istanbul, Turkey. This study aimed to evaluate the feasibility and acceptability of this intervention.

METHODS

This mixed-methods study incorporated a two-arm pilot randomized controlled trial and qualitative evaluation of the feasibility and acceptability of the adapted THP - Brief Group version (THP-BGV) to a range of stakeholders. We recruited pregnant women at 12-30 weeks' gestation through pregnancy schools within the University Hospital's catchment area. Women in the intervention arm received five online sessions of the THP-BGV delivered by antenatal nurses. The intervention employed principles of cognitive behaviour therapy to provide psychoeducation, behaviour activation, problem-solving strategies and group support to participants. In the control arm, women received usual care consisting of routine online educational pregnancy classes aided by the antenatal nurses. The women were assessed for depressive symptoms with the Edinburgh Postnatal Depression Scale at baseline and 4-6 weeks post-intervention and also evaluated for anxiety, perceived social support, partner relationship, level of disability and sleep quality. In-depth interviews were conducted with women and other key stakeholders.

RESULTS

Of the 99 consecutive women referred to the pregnancy schools, 91 (91.9%) were eligible and 88 (88.8%) consented to participate in the study and were randomized. Eighty-two (83%) completed the final assessments. Our main findings were that this preventive group intervention was feasible to be integrated into routine antenatal educational classes and it was valued by the women and delivery-agents. While the study was not powered to detect differences between intervention and control conditions, we found small trends towards reduction in anxiety and depressive symptoms favoring the intervention arm. No serious adverse events were reported.

CONCLUSIONS

Given the paucity of preventive interventions for perinatal depression in low and middle-income countries, a fully powered definitive randomized controlled trial of this feasible and acceptable intervention should be conducted.

TRIAL REGISTRATION

The study was registered at Clinical Trails.gov ( NCT04819711 ) (Registration Date: 29/03/2021).

Young children's sleep patterns and problems in paediatric primary healthcare settings: a multicentre cross-sectional study from a nationally representative sample

Studies describing paediatric sleep patterns are needed by taking culture into consideration. The aim of this study was to identify parent-reported sleep-wake patterns in young children and explore possible factors influencing sleep problems. The mothers of 2,434 young children enrolled from well-child outpatient clinics in Turkey completed an online survey including sociodemographic variables, Brief Infant Sleep Questionnaire, Edinburgh Postnatal Depression Scale and Generalised Anxiety Disorder scales. Overall, young children in Turkey go to bed late (10:00 p.m.), awaken twice per night for 30 min, and obtain 11.5 h of total sleep, showing no sex-specific differences. Distinct night-time sleep patterns emerged after 18 months of age. Importantly, although currently breastfed healthy children were 3.8-times less likely to sleep through the night, total sleep duration and exclusive breastfeeding duration were higher in children who were not sleeping through the night. Overall, bedsharing was identified in 11.5%, and only room sharing was reported in 52.9%. Parental perception of a child's sleep as problematic was 35.8%. Mothers with higher educational attainment were more likely to perceive their children's sleep as a problem. Maternal depressive and anxious symptoms and a history of excessive infant crying were the determinants predicting the likelihood of both parent-perceived sleep problems and poor sleepers. The present analysis of sleep structure in infancy and toddlerhood provides reference data for well-child visits. These findings highlight the importance of considering maternal anxiety, depression and behaviour management techniques to cope with fussy infants in addressing childhood behavioural sleep problems.

Efficacy of bright light therapy in perinatal depression: A randomized, double-blind, placebo-controlled study

BACKGROUND

Uncertainties and difficulties associated with the current treatment modalities for perinatal depression (PND) may cause some mothers to avoid treatment. Raising awareness about the effectiveness and safety of bright light therapy (BLT) may help to alleviate the challenges of PND. The main goal of this study was to evaluate the efficacy and safety of BLT versus placebo in PND.

METHOD

A total of 30 women who were either pregnant or in first year postpartum and diagnosed with major depressive disorder were enrolled; 23 completed the study. Patients were randomly assigned to either the BLT (10,000 lux) or placebo (<500 lux) group. BLT and placebo light were applied for 45 min in the morning every day for a 3-week period. The Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Depression Rating Scale (HAM-D), and Edinburgh Postnatal Depression Scale (EPDS) were administered weekly to evaluate response and remission rates and depression scores.

RESULTS

There was no significant difference between the two groups in terms of baseline depression scores. At the end of the study, the response rates assessed according to MADRS were 75% for BLT and 18.2% for placebo (p = .006), and remission rates were 41.7% vs. 0% (p = .016), respectively. There was no significant difference between the groups (p > .05) in terms of treatment-related side effects. The main limitation of this study is its small sample size, which limits the generalizability of the study's findings.

CONCLUSION

The results indicate that BLT is more effective than placebo and is reliable in terms of side effects in PND patients. In order to expand the use of BLT in PND, new studies with larger sample sizes are needed.

Communication Across Maternal Social Networks During England's First National Lockdown and Its Association With Postnatal Depressive Symptoms

Postnatal/postpartum depression (PND/PPD) had a pre-COVID-19 estimated prevalence ranging up to 23% in Europe, 33% in Australia, and 64% in America, and is detrimental to both mothers and their infants. Low social support is a key risk factor for developing PND. From an evolutionary perspective this is perhaps unsurprising, as humans evolved as cooperative childrearers, inherently reliant on social support to raise children. The coronavirus pandemic has created a situation in which support from social networks beyond the nuclear family is likely to be even more important to new mothers, as it poses risks and stresses for mothers to contend with; whilst at the same time, social distancing measures designed to limit transmission create unprecedented alterations to their access to such support. Using data from 162 mothers living in London with infants aged ≤6 months, we explore how communication with members of a mother's social network related to her experience of postnatal depressive symptoms during the first "lockdown" in England. Levels of depressive symptoms, as assessed via the Edinburgh Postnatal Depression Scale, were high, with 47.5% of the participants meeting a ≥11 cut-off for PND. Quasi-Poisson regression modelling found that the number of network members seen in-person, and remote communication with a higher proportion of those not seen, was negatively associated with depressive symptoms; however, contact with a higher proportion of relatives was positively associated with symptoms, suggesting kin risked seeing mothers in need. Thematic qualitative analysis of open text responses found that mothers experienced a burden of constant mothering, inadequacy of virtual contact, and sadness and worries about lost social opportunities, while support from partners facilitated family bonding. While Western childrearing norms focus on intensive parenting, and fathers are key caregivers, our results highlight that it still "takes a village" to raise children in high-income populations and mothers are struggling in its absence.

Green Purchase Behavior of University Students in Hungary: An Empirical Study

In this modern age of digitalization, consumers have access to an ample amount of information regarding a product’s quality and benefits, which makes consumers more conscious of their consumption patterns and their impact on social and environmental development. Likewise, marketing strategies have also taken a dramatic leap forward and started focusing on social responsibility, ethics, and environmental protection. The notion of environmental sustainability has created a market niche over several decades and has captured the market of pro-environmental consumers. However, there are still many latent factors that are obstacles to shifting the behavior of consumers towards buying green products. The present study was conducted to recognize factors that affect the consumers’ behavior when purchasing eco-friendly products. They were collected from 1185 university students in Hungary. To analyze the data, multiple regression and exploratory factor analysis (EFA) were used. The results showed that willingness to pay (WTP) and green purchase intention (GPI) are the chief factors that affect the green purchase behavior (GPB) of these students. Environmental knowledge (EK) also has an important and positive impact on the green purchase behavior (GPB) of consumers, although regarding demographic variables, no such influence was noted. To conclude, the study showed that there was no bias in terms of age, gender, or qualification in the behavior of young students, as they have sufficient knowledge of environmental problems and are very willing to pay for environmentally friendly products. This study will create self-awareness among young consumers about their environmentally friendly purchasing behavior. This research will further benefit policymakers and marketers of the EU and Hungary to enhance their marketing strategies to promote their green products and their benefits. Future research can be developed on this theoretical framework and will help academicians to further reduce the research gap by using different constructs and methodologies.