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Ning J, Deng J, Li S, Lu C, Zeng P. Meta-analysis of association between caesarean section and postpartum depression risk. Front Psychiatry 2024; 15:1361604. [PMID: 38606408 PMCID: PMC11006970 DOI: 10.3389/fpsyt.2024.1361604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
Background The association of caesarean section (CS) for postpartum depression (PPD) remains controversial. This study aims to explore the relationship between CS and the risk of PPD, in order to provide a basis for preventing PPD. Material and methods We searched PubMed, Web of Science, Cochrane Library, and EMBASE databases for literature about the correlation between CS and PPD published as of February 2024. The combined odds ratios (ORs) and 95% confidence intervals (Cls) were obtained by flexible use of fixed-effects models or random-effects models. Results A total of 18 publications were ultimately included in the analysis. Among these, 14 were cohort studies and 4 were case-control reports, encompassing 844,328 total cases. All of the included studies were deemed to be of moderate or higher quality. The meta-analysis indicated that the prevalence of PPD among parturients undergoing CS was 13.4% (95% CI: 6.5%-25.5%).The adjusted odds ratio (OR) for the association between CS and PPD was 1.12 (95% CI: 1.04-1.20) compared to the natural vaginal delivery (NVD) group. Specifically, the adjusted OR for the association between CS and PPD was 1.29 (95% CI: 1.18-1.40) during the first 1-6 months postpartum, and 1.23 (95% CI: 1.14-1.33) after 6 months postpartum. Furthermore, in comparison to the NVD group, the adjusted OR for elective caesarean section (ELCS) and emergency caesarean section (EMCS) were 0.96 (0.83, 1.10) and 1.20 (1.08, 1.34), respectively. Conclusion Our findings suggest that PPD risk may rise in the presence of CS. In particular, the risk was increased by 20% in the EMCS group, and the risk of PPD within one to six months postpartum after CS increases by 6% compared to that at six months postpartum. In the future, more rational designs and in-depth studies are needed to obtain more accurate information. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42023389265.
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Affiliation(s)
- Jiajie Ning
- Nursing College, Guangxi Medical University, Nanning, China
| | - Jing Deng
- Nursing College, Guangxi Medical University, Nanning, China
| | - Shanshan Li
- Nursing College, Guangxi Medical University, Nanning, China
| | - Caina Lu
- Department of Neonatology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Pingping Zeng
- Nursing College, Guangxi Medical University, Nanning, China
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Boisvert C, Talarico R, Gandhi J, Kaluzienski M, Dingwall-Harvey AL, White RR, Sampsel K, Wen SW, Walker M, Muldoon KA, El-Chaâr D. Screening for postpartum depression and risk of suicidality with obstetrical patients: a cross-sectional survey. BMC Pregnancy Childbirth 2023; 23:635. [PMID: 37667173 PMCID: PMC10478309 DOI: 10.1186/s12884-023-05903-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/07/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Pregnancy is a vulnerable time where the physical and social stress of the COVID-19 pandemic affects psychological health, including postpartum depression (PPD). This study is designed to estimate the prevalence and correlates of PPD and risk of suicidality among individuals who gave birth during the COVID-19 pandemic. METHODS We surveyed individuals who gave birth at The Ottawa Hospital and were ≥ 20 days postpartum, between March 17 and June 16, 2020. A PPD screen consisted of a score ≥ 13 using the Edinburgh Postnatal Depression Scale. A score of 1, 2, or 3 on item 10 ("The thought of harming myself has occurred to me") indicates risk of suicidality. If a participant scores greater than ≥ 13 or ≥ 1 on item 10 they were flagged for PPD, the Principal Investigator (DEC) was notified within 24 h of survey completion for a chart review and to assure follow-up. Modified Poisson multivariable regression models were used to identify factors associated with PPD and risk of suicidality using adjusted risk ratios (aRR) and 95% confidence intervals (CI). RESULTS Of the 216 respondents, 64 (30%) screened positive for PPD and 17 (8%) screened positive for risk of suicidality. The maternal median age of the total sample was 33 years (IQR: 30-36) and the infant median age at the time of the survey was 76 days (IQR: 66-90). Most participants reported some form of positive coping strategies during the pandemic (97%) (e.g. connecting with friends and family, exercising, getting professional help) and 139 (64%) reported negative coping patterns (e.g. over/under eating, sleep problems). In total, 47 (22%) had pre-pregnancy anxiety and/or depression. Negative coping (aRR:2.90, 95% CI: 1.56-5.37) and pre-existing anxiety/depression (aRR:2.03, 95% CI:1.32-3.11) were associated with PPD. Pre-existing anxiety/depression (aRR:3.16, 95% CI:1.28-7.81) was associated with risk of suicidality. CONCLUSIONS Almost a third of participants in this study screened positive for PPD and 8% for risk of suicidality. Mental health screening and techniques to foster positive coping skills/strategies are important areas to optimize postpartum mental health.
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Affiliation(s)
- Carlie Boisvert
- Faculty of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jasmine Gandhi
- Faculty of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Mark Kaluzienski
- Faculty of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | | | - Ruth Rennicks White
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
| | - Kari Sampsel
- Faculty of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Shi Wu Wen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Mark Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- International and Global Health Office, University of Ottawa, Ottawa, Canada
- Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, Ottawa, Canada
| | - Katherine A Muldoon
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
| | - Darine El-Chaâr
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
- Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, Ottawa, Canada.
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Ayre K, Liu X, Howard LM, Dutta R, Munk-Olsen T. Self-harm in pregnancy and the postnatal year: prevalence and risk factors. Psychol Med 2023; 53:2895-2903. [PMID: 37449482 PMCID: PMC10235666 DOI: 10.1017/s0033291721004876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Self-harm in pregnancy or the year after birth ('perinatal self-harm') is clinically important, yet prevalence rates, temporal trends and risk factors are unclear. METHODS A cohort study of 679 881 mothers (1 172 191 pregnancies) was conducted using Danish population register data-linkage. Hospital treatment for self-harm during pregnancy and the postnatal period (12 months after live delivery) were primary outcomes. Prevalence rates 1997-2015, in women with and without psychiatric history, were calculated. Cox regression was used to identify risk factors. RESULTS Prevalence rates of self-harm were, in pregnancy, 32.2 (95% CI 28.9-35.4)/100 000 deliveries and, postnatally, 63.3 (95% CI 58.8-67.9)/100 000 deliveries. Prevalence rates of perinatal self-harm in women without a psychiatric history remained stable but declined among women with a psychiatric history. Risk factors for perinatal self-harm: younger age, non-Danish birth, prior self-harm, psychiatric history and parental psychiatric history. Additional risk factors for postnatal self-harm: multiparity and preterm birth. Of psychiatric conditions, personality disorder was most strongly associated with pregnancy self-harm (aHR 3.15, 95% CI 1.68-5.89); psychosis was most strongly associated with postnatal self-harm (aHR 6.36, 95% CI 4.30-9.41). For psychiatric disorders, aHRs were higher postnatally, particularly for psychotic and mood disorders. CONCLUSIONS Perinatal self-harm is more common in women with pre-existing psychiatric history and declined between 1997 and 2015, although not among women without pre-existing history. Our results suggest it may be a consequence of adversity and psychopathology, so preventative intervention research should consider both social and psychological determinants among women with and without psychiatric history.
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Affiliation(s)
- Karyn Ayre
- Section of Women's Mental Health, Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, London, UK
| | - Xiaoqin Liu
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Louise M. Howard
- Section of Women's Mental Health, Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, London, UK
| | - Rina Dutta
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, London, UK
- Academic Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Trine Munk-Olsen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Postpartum Help-Seeking: The Role of Stigma and Mental Health Literacy. Matern Child Health J 2022; 26:1030-1037. [PMID: 35258854 DOI: 10.1007/s10995-022-03399-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Postpartum depression is the most common complication associated with child-bearing. The current study investigated attitudes toward professional psychological help-seeking and the effects of stigma and mental health literacy on postpartum women recruited from social media (N = 326). METHOD Hierarchical linear regression was used to analyze the data and the interaction effect of stigma and mental health literacy. RESULTS Stigma was negatively associated with attitudes toward professional psychological help-seeking, while mental health literacy was positively associated with attitudes toward professional psychological help-seeking. The interaction effect was not statistically significant. The results yield implications for screening practices and reducing stigma for mental health care in the postpartum period.
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Abstract
PURPOSE OF REVIEW Suicide is a leading cause of death in the perinatal period (pregnancy and 1 year postpartum). We review recent findings on prevalence, risk factors, outcomes, and prevention and intervention for suicide during pregnancy and the first year postpartum. RECENT FINDINGS Standardization of definitions and ascertainment of maternal deaths have improved identification of perinatal deaths by suicide and risk factors for perinatal suicide. Reports of a protective effect of pregnancy and postpartum on suicide risk may be inflated. Clinicians must be vigilant for risk of suicide among their perinatal patients, especially those with mental health diagnoses or prior suicide attempts. Pregnancy and the year postpartum are a time of increased access to healthcare for many, offering many opportunities to identify and intervene for suicide risk. Universal screening for suicide as part of assessment of depression and anxiety along with improved access to mental health treatments can reduce risk of perinatal suicide.
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Affiliation(s)
- Kathleen Chin
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959, NE Pacific Street, Box 356560, Seattle, WA 98195 USA
| | - Amelia Wendt
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959, NE Pacific Street, Box 356560, Seattle, WA 98195 USA
| | - Ian M. Bennett
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959, NE Pacific Street, Box 356560, Seattle, WA 98195 USA ,Department of Family Medicine, University of Washington, Seattle, WA USA ,Department of Global Health, University of Washington, Seattle, WA USA
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959, NE Pacific Street, Box 356560, Seattle, WA, 98195, USA.
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Chen YY, Canetto SS, Chien-Chang Wu K, Chen YL. Women's Suicide in the First-Year Postpartum: A Population-based Study. Soc Sci Med 2021; 292:114594. [PMID: 34844078 DOI: 10.1016/j.socscimed.2021.114594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/30/2021] [Accepted: 11/20/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND In dominant suicidology there is a long traditionof theorizing that women are protected from suicide, particularly when mothers and during the postpartum. Studies have mostly confirmed the postpartum suicide-protection theory, with low suicide mortality generally observed among postpartum women. A limitation of these studies is that most were conducted in majority European-descent-population countries. A challenge to the more general maternal suicide-protection theory is that in East-Asia women of childbearing age exhibit substantial suicidality, nonfatal and fatal. This study evaluated whether suicide is less likely in first-year postpartum women as compared to women past the first-year postpartum. METHODS This population-based, nested case-control study focused on women whose live birth was between 2001 and 2016 in East-Asian Taiwan. To ascertain suicide outcomes, the women were followed until 2017. For each suicide case, four control cases were randomly selected from the Birth Certificate Application dataset, with a 1:4 matching ratio based on age of last live-delivery and parity (one delivery record vs. two or more records) (cases N = 1571; controls N = 6284). Conditional logistic regression analyses were conducted to assess whether suicide was less likely in women in the first-year postpartum relative to women past the first-year postpartum. RESULTS The odds ratios of suicide were elevated at 42 days postpartum [Odds Ratio (OR) = 2.06; 95% Confidence Interval (CI) = (1.04, 4.16)], six-months postpartum [OR = 2.28; 95% CI = (1.60, 3.29)] and one-year postpartum [OR = 2.26; 95% CI = (1.76, 2.96)], when controlling for sociodemographic and mental-disorder variables. Suicide was more likely in women who were single at index birth, had lower socioeconomic status, or had a mental disorder history. CONCLUSION Our findings suggest that the postpartum stage is not suicide-protective per se. Whether the postpartum stage is associated with suicide protection or suiciderisk appears to depend on context and culture.
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Affiliation(s)
- Ying-Yeh Chen
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei City, Taiwan; Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei City, Taiwan
| | | | - Kevin Chien-Chang Wu
- Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei City, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Yi-Lung Chen
- Department of Healthcare Administration, Asia University, Taichung, Taiwan; Department of Psychology, Asia University, Taichung, Taiwan.
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7
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Suicidal behaviours in the peripartum period: a systematic scoping review of data linkage studies. Arch Womens Ment Health 2021; 24:579-593. [PMID: 33742281 DOI: 10.1007/s00737-021-01102-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/11/2021] [Indexed: 10/21/2022]
Abstract
The purpose of this scoping review was to summarize research that uses linked data to examine peripartum suicidal behaviours and critically appraise studies to identify evidence gaps and future research priorities. A systematic search of PubMed, Scopus, and grey literature was undertaken to identify data linkage studies that examined suicidal behaviours among women in the peripartum period. All articles available through PubMed and Scopus up until the search date of 26 September 2019 were deemed eligible for inclusion. A grey literature search was also undertaken, through the Google search engine, on 11 November 2019. Studies were analysed descriptively and synthesized qualitatively. Eighteen studies were identified that met inclusion criteria. All studies examined the incidence of suicidal behaviours. Twelve studies examined sociodemographic correlates, associations, or risk factors, and nine studies examined mental health. There was a high degree of variability regarding how both peripartum status and suicidal behaviours were defined. Few studies used data linkage to examine suicidal behaviours from a health services or social services perspective. The evidence base could benefit from conceptual clarity and standardization of constructs regarding suicidal behaviours in the peripartum period, to enable meaningful synthesis of results across studies. Data linkage can be used to improve understandings of risk factors and pathways. It can also be harnessed to examine both health and social services utilization, to inform coordinated multi-sectoral interventions and care pathways for women and their children.
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Wang Y, Li H, Peng W, Chen Y, Qiu M, Wang J, Hao Q, Tu Y, Liu Y, Zhu T. Non-pharmacological interventions for postpartum depression: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2020; 99:e21496. [PMID: 32756183 PMCID: PMC7402874 DOI: 10.1097/md.0000000000021496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) is one of the most common mental disorders in women following childbirth with heightened prevalence across the globe. Both pharmacotherapy and non-pharmacological interventions are effective for PPD. However, due to the concerns about the side effect on the mother and child of pharmacological treatments, most of women with PPD choose non-pharmacological therapies as their first line option. Prescription of these non-drug approaches should be guided by high quality evidence. Therefore, this network meta-analysis aims to compare, rank and interpret existed non-pharmacological evidence for the effective treatment of women with PPD. METHODS Electronic bibliographic databases including EMBASE, PubMed, Scopus, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI),VIP Database, Wanfang Database and Chinese Biomedical Literature Database will be searched for relevant randomized controlled trials (RCTs) of non-pharmacological interventions for PPD. Heterogeneity and inconsistencies will be analyzed by I statistic and Z test, respectively. We will assess the quality of evidence by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and evaluate the risk of bias according to Cochrane risk of bias tool. R software 3.6.1 (R Foundation for Statistical Computing, Vienna, Austria) will be used to conduct a network meta-analysis. RESULTS Formal ethical approval is not required, because the present study is a meta-analysis based on existed studies. The findings of this research will be reported in a recognized journal. CONCLUSION The review results will ascertain the hierarchy of effectiveness of different non-pharmacological approaches for PPD, and systematically provide suggests for physicians and patients. TRIAL REGISTRATION NUMBER PROSPERO CRD42020166801.
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Affiliation(s)
- Yang Wang
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine
- Department of Rehabilitation, Shuangliu Maternal and Child Health Care Hospital
| | - Hui Li
- School of Medicine, Chengdu University
| | - Wei Peng
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Yalin Chen
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine
| | - Mimi Qiu
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine
| | - Jun Wang
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine
| | - Qinghong Hao
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine
| | - Yang Tu
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine
| | - Yunlu Liu
- Institute of Laboratory Animal Sciences, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Tianmin Zhu
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine
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Ni Q, Cheng G, Chen A, Heinonen S. Early detection of mental illness for women suffering high-risk pregnancies: an explorative study on self-perceived burden during pregnancy and early postpartum depressive symptoms among Chinese women hospitalized with threatened preterm labour. BMC Psychiatry 2020; 20:250. [PMID: 32434583 PMCID: PMC7240988 DOI: 10.1186/s12888-020-02667-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/13/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The mental health of pregnant women, particularly those with elevated risks, has been an issue of global concern. Thus far, few studies have addressed the mental health of pregnant women with threatened preterm labour (TPL). This study investigated the prevalence of self-perceived burden (SPB) among Chinese women hospitalized due to TPL during pregnancy and early postpartum depressive disorders, exploring the effect of SPB and other potential risk factors on the early signs of postpartum depressive disorders. METHODS A self-reported survey was conducted in the obstetrics department of Anhui Provincial Hospital, China. Women hospitalized with TPL were approached 1 week after delivery. One hundred fifty women were recruited from January 2017 to December 2017. The Self-Perceived Burden Scale (SPBS) and Edinburgh Postnatal Depression Scale (EPDS) were the main measures. Descriptive statistics, Spearman correlations, and a multiple logistic regression were employed for data analysis. RESULTS SPB and early postpartum depressive disorders were commonly experienced by Chinese women hospitalized with TPL, and SPB was positively and significantly correlated with depressive symptoms. A multiple logistic regression analysis revealed that for the women hospitalized with TPL during pregnancy, the emotional aspect of SPB (OR = 1.42, 95% CI = 1.11-1.83, p = 0.006), age (OR = 1.14, 95% CI = 1.02-1.27, p = 0.023), occupation (OR = 3.48, 95% CI = 1.18-10.20, p = 0.023), the history of scarred uterus (OR = 7.96, 95% CI = 1.49-42.48, p = 0.015), the delivery mode of the present birth (OR = 6.19, 95% CI = 1.72-22.30, p = 0.005), and family support during pregnancy (OR = 0.60, 95% CI = 0.45-0.82, p = 0.001) were significant factors predicting early postpartum depressive symptoms. CONCLUSION This study indicates that SPB and early postpartum depressive disorders are prevalent mental issues among Chinese women hospitalized with TPL, and that SPB, especially perceived emotional burden, is a strong predictor of early postpartum depressive disorders. Our study suggests the necessity of paying attention to mental health issues, e.g. SPB and postpartum depressive symptoms among hospitalized women with TPL, and providing appropriate interventions at the prenatal stage to prevent adverse consequences.
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Affiliation(s)
- Qianqian Ni
- grid.59053.3a0000000121679639The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001 Anhui China
| | - Guizhi Cheng
- grid.59053.3a0000000121679639The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001 Anhui China
| | - An Chen
- Institute of Healthcare Engineering, Management and Architecture (HEMA), Department of Industrial Engineering and Management, Aalto University, Maarintie 8, 02150, Espoo, Finland.
| | - Seppo Heinonen
- grid.15485.3d0000 0000 9950 5666Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, 00290 Helsinki, Finland
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Klomek AB. Prevention of postpartum suicidality in Israel. Isr J Health Policy Res 2019; 8:77. [PMID: 31661032 PMCID: PMC6819442 DOI: 10.1186/s13584-019-0347-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022] Open
Abstract
Postpartum suicidality in Israel had not been systematically studied until the recent important investigation by Glasser and colleagues. The authors review rates, trends, and characteristics of postpartum women who considered, attempted, or completed suicide in Israel. This commentary argues that, although postpartum suicidality is relatively rare, it is extremely tragic-not just for the women, but for the entire family and community. The main aim of this commentary is to emphasize that preventive efforts should continue and expand, especially among at-risk groups. At-risk groups include the youngest age group, postpartum Arab women, and postpartum former Soviet Union immigrants. Identification of women at risk or suffering from postpartum depression (PPD) is mandated in Israel. Efforts should include broader screening for various types of suicide ideation and behavior. Assessments should specifically include passive suicide ideation, active suicide ideation with method, intent, and plan, as well as various types of suicide attempts and preparatory behaviors. In addition, specific interventions formulated on evidence-based psychotherapies should be provided in family practice, obstetric, and pediatric settings. These settings are less stigmatized in comparison to mental health settings. Potential therapies can be (among others) Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT), which are effective in preventing perinatal depression.
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Affiliation(s)
- Anat Brunstein Klomek
- Baruch Ivcher School of Psychology, Interdiciplinary Center (IDC), PO BOX 167, 8 Ha university Street, 46101, Herzliya, Israel.
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11
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Martini J, Bauer M, Lewitzka U, Voss C, Pfennig A, Ritter D, Wittchen HU. Predictors and outcomes of suicidal ideation during peripartum period. J Affect Disord 2019; 257:518-526. [PMID: 31323593 DOI: 10.1016/j.jad.2019.07.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/27/2019] [Accepted: 07/04/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Suicide belongs to the leading causes of maternal perinatal mortality and suicidal ideation is one of the strongest predictors for suicide attempt and completion and thus represents an opportunity for early intervention prior to self and infant harm. This post-hoc analysis aims to investigate predictors of peripartum suicidality (PS) and potential maternal and infant outcomes of PS. METHODS In the prospective-longitudinal Maternal Anxiety in Relation to Infant Development (MARI) study, n = 306 women were repeatedly examined from early pregnancy until 16 months postpartum using interviews (Composite International Diagnostic Interview for Women) and questionnaires (Edinburgh Postnatal Depression Scale, Brief Symptom Inventory) to obtain sociodemographic, gynecological and offspring characteristics as well as information about PS (thoughts of death/self-harm, suicide plans, suicide attempt). RESULTS PS was indicated by n = 15 women. A stepwise multivariate logistic regression revealed a history of suicide attempt (OR = 17.84, 95%CI: 4.61-69.05), living together with the partner (OR = 0.14, 95%CI: 0.03-0.63), and social support (OR = 0.35, 95%CI: 0.13-0.91) as significant predictors for PS (model fit: AUC = 0.7926). As compared to women with no PS, infants of women with PS presented lower scores in neuropsychological development (p = 0.020). LIMITATIONS This post-hoc analysis was conducted with the aim of generating hypotheses for future research. The small number of women who indicated PS limits the statistical power. CONCLUSION PS is an important perinatal complication that requires clinical attention. Larger prospective studies are warranted to verify the findings. This will lead to improved preventive and therapeutic approaches and a better understanding of the motives behind maternal suicide and infanticide.
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Affiliation(s)
- Julia Martini
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.
| | - Michael Bauer
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Ute Lewitzka
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Catharina Voss
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany.
| | - Andrea Pfennig
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Dirk Ritter
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Hans-Ulrich Wittchen
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany; Department of Psychiatry & Psychotherapy, Ludwig Maximilans Universitaet Munich, Germany.
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