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Hou Y, Shang M, Yu X, Gu Y, Li H, Lu M, Jiang M, Zhen H, Zhu B, Tao F. Joint effects of recent stressful life events and adverse childhood experiences on perinatal comorbid anxiety and depression. BMC Pregnancy Childbirth 2023; 23:41. [PMID: 36653742 PMCID: PMC9847044 DOI: 10.1186/s12884-023-05375-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Stressful life events (SLEs) and adverse childhood experiences (ACEs) have been reported to be associated with perinatal depression (PND) or perinatal anxiety (PNA) alone; however, in most cases, majority of PND and PNA coexist and could lead to more serious health consequences. The independent effect of recent SLEs and their joint effects with ACEs on perinatal comorbid anxiety and depression (CAD) remain inadequately explored. METHODS Based on a longitudinal study, 1082 participants receiving prenatal care in Ma'anshan, China were included. Women were recruited in the first trimester (T1: ≤14+ 6 weeks) and followed up at 15 ~ 27 weeks (T2), 28 ~ 40 weeks (T3), and postpartum (T4). Depression and anxiety status were assessed at all time points, while recent SLEs and ACEs were measured at T1. Logistic regression was conducted to examine the associations of SLEs with the risks of CAD at different time points, as well as their joint effects with ACEs on CAD. RESULTS Approximately 38.5% of women experienced at least one SLE, which was significantly associated with higher risks of CAD at all time points (p < 0.05). As the number of SLEs increased, the risk of CAD increased (p for trend < 0.05). Specific types of SLEs were associated with CAD in different periods, while only interpersonal events were consistently associated with risks of CAD throughout the whole perinatal period. The joint effects of SLEs with ACEs on CAD were identified throughout the perinatal period, with the highest observed in the first trimester (aOR = 7.47, 95% CI: 3.73-14.95; p for trend < 0.001). CONCLUSION Our study demonstrated independent associations of recent SLEs and their joint effects with ACEs with risks of perinatal CAD. SLEs combined with ACEs should be recognized as a major risk factor for perinatal CAD and managed at the earliest time to prevent and control CAD.
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Affiliation(s)
- Yanyan Hou
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, 230032 Hefei, Anhui China
| | - Mengqing Shang
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, 230032 Hefei, Anhui China
| | - Xiayan Yu
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, 230032 Hefei, Anhui China
| | - Yue Gu
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, 230032 Hefei, Anhui China
| | - Haiyan Li
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, 230032 Hefei, Anhui China
| | - Mengjuan Lu
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, 230032 Hefei, Anhui China
| | - Minmin Jiang
- grid.419897.a0000 0004 0369 313XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.186775.a0000 0000 9490 772XDepartment of Occupational Health and Environmental Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China
| | - Hualong Zhen
- grid.419897.a0000 0004 0369 313XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.186775.a0000 0000 9490 772XDepartment of Occupational Health and Environmental Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China
| | - Beibei Zhu
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, 230032 Hefei, Anhui China
| | - Fangbiao Tao
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, No 81 Meishan Road, 230032 Hefei, Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, 230032 Hefei, Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, 230032 Hefei, Anhui China
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Hoirisch-Clapauch S. The Fibrinolytic System in Peripartum Depression. Semin Thromb Hemost 2022; 49:382-390. [PMID: 36113504 DOI: 10.1055/s-0042-1756194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AbstractThe relationship between depression and reduced fibrinolytic activity reflects the role of tissue plasminogen activator and plasmin in brain remodeling underlying resilience, depression remission, and reward processing, rather than the dissolution of fibrin clots. Individuals who experience depression demonstrate hippocampal and prefrontal cortex atrophy, as well as impaired neuronal connectivity. Brain-derived neurotrophic factor (BDNF), synthesized as a precursor that is activated through cleavage by tissue plasminogen activator and plasmin, influences adult neurogenesis and neuronal plasticity in the hippocampus and prefrontal cortex. Depression is associated with decreased brain levels of BDNF, due to reduced activity of tissue plasminogen activator and plasmin. Tissue plasminogen activator and plasmin also mediate the release of dopamine, a neurotransmitter implicated in motivation and reward. Peripartum depression defines a depressive episode that occurs during pregnancy or in the first month after delivery, reinforcing the concept that postpartum depression may be a continuum of antenatal depression. This article describes the fibrinolytic status in the healthy brain, in stress and depression, emphasizing the links between biological markers of depression and defective fibrinolysis. It also discusses the association between hypofibrinolysis and risk factors for perinatal depression, including polycystic ovary syndrome, early miscarriage, preeclampsia, stressful life events, sedentariness, eating habits, gestational and type 2 diabetes, and antithyroid peroxidase antibodies. In addition, it reviews the evidence that antidepressant medications and interventions as diverse as placebo, psychotherapy, massage, video game playing, regular exercise, dietary modifications, omega 3 fatty acid supplementation, neurohormones, and cigarette smoking may reduce depression by restoring the fibrinolytic activity. Last, it suggests new directions for research.
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Atuhaire C, Rukundo GZ, Brennaman L, Cumber SN, Nambozi G. Lived experiences of Ugandan women who had recovered from a clinical diagnosis of postpartum depression: a phenomenological study. BMC Pregnancy Childbirth 2021; 21:826. [PMID: 34903199 PMCID: PMC8666838 DOI: 10.1186/s12884-021-04287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postpartum depression affects a significant proportion of women of childbearing age. The birth of a newborn baby is normally considered a joyful event, inhibiting mothers from expressing their depressive feelings. If the condition is not well understood and managed, mothers with postpartum depression are likely to experience suicidal ideation or even commit suicide. This study explored lived experiences of women who had recovered from a clinical diagnosis of postpartum depression in southwestern Uganda. METHODS This phenomenological study adopted the explorative approach through in-depth interviews as guided by the biopsychosocial model of depression. It was conducted in Mbarara Regional Referral Hospital, Bwizibwera Health Centre IV and Kinoni Health Centre IV located in Mbarara and Rwampara districts, southwestern Uganda. Data were collected from 30 postpartum mothers who were purposively selected, between 9th December 2019 and 25th September 2020. We analyzed this work using thematic data analysis and this was steered by the Colaizzi's six-step phenomenological approach of inquiry. RESULTS The findings were summarized into five major themes: 1) somatic experiences including insomnia and headache, breast pain, poor breast milk production, weight loss and lack of energy; 2) difficulties in home and family life including overwhelming domestic chores, lack of social support from other family members, fighting at home and financial constraints due to COVID-19 pandemic; 3) negative emotions including anger, self-blame, despondency and feelings of loneliness and regrets of conceiving or marriage; 4) feelings of suicide, homicide and self-harm including suicidal ideation and attempt, homicidal ideations and attempt and feelings of self-harm and 5) coping with postpartum depression including spirituality, termination of or attempt to leave their marital relationships, acceptance, counselling and seeking medical treatment, perseverance. CONCLUSION AND RECOMMENDATIONS Suicidal and homicidal thoughts are important parts of the postpartum depression experience, and these may put the lives of the mothers, their spouses and their babies at a great risk. Poor relationship quality, intimate partner violence and lack of financial resources contribute significantly to the negative emotional experiences of mothers with PPD.
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Affiliation(s)
- Catherine Atuhaire
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda.
| | - Godfrey Zari Rukundo
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Laura Brennaman
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Samuel Nambile Cumber
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Grace Nambozi
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
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Abstract
ABSTRACT Despite extensive research, the etiology behind postpartum depression (PPD) remains a mystery. Experts have theorized about various potential risk factors, including hormonal fluctuations, genetics, prior history of depression, low socioeconomic status, adolescent pregnancy, and certain personality traits. This article provides foundational information about PPD, reviewing the risk factors for and the consequences of this mood disorder. Postpartum blues and postpartum psychosis are briefly discussed for context, although they differ from PPD. Screening and treatment options are explained, and nursing implications for practice are presented.
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Affiliation(s)
- Barbara Marie Alba
- Barbara Marie Alba is the director of nursing for maternal-child health services at New York-Presbyterian Hospital, New York City. Contact author: . The author and planners have disclosed no potential conflicts of interest, financial or otherwise. A podcast with the author is available at www.ajnonline.com
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Faisal-Cury A, Tabb K, Matijasevich A. Partner relationship quality predicts later postpartum depression independently of the chronicity of depressive symptoms. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2021; 43:12-21. [PMID: 32725101 PMCID: PMC7861178 DOI: 10.1590/1516-4446-2019-0764] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/19/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Given the lifelong implications of extended postpartum depression (PPD), research is needed to examine the social factors implicated in its development (such as relationship quality) and associated predictors. This study sought to examine the association of partner relationship quality (PRQ) and decline of sexual life (DSL) with maternal PPD at 12-15 months after childbirth. METHODS Prospective study of 294 low-income postpartum women. A structured questionnaire and the Patient Health Questionnaire-9 (PHQ-9) captured responses for the main outcome variable and covariates. RESULTS The prevalence of the main outcome (PPD at 12-15 months) was 19.1%. Using logistic regression models, low PRQ (risk ratio [RR] = 1.58, 95%CI 1.01-2.49) and DSL (RR = 1.97, 95%CI 1.23-3.15) were associated with PPD at 12-15 months even after controlling for perinatal depression. CONCLUSIONS Late PPD (12 to 15 months after giving birth) is very common among low-income women, and is independently associated with different aspects of the couple's relationship. Improving PRQ may prevent late PPD. Future investigations are warranted.
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Affiliation(s)
- Alexandre Faisal-Cury
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Karen Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Badiya PK, Siddabattuni S, Dey D, Javvaji SK, Nayak SP, Hiremath AC, Upadhyaya R, Madras L, Nalam RL, Prabhakar Y, Vaitheswaran S, Manjjuri AR, Jk KK, Subramaniyan M, Raghunatha Sarma R, Ramamurthy SS. Identification of clinical and psychosocial characteristics associated with perinatal depression in the south Indian population. Gen Hosp Psychiatry 2020; 66:161-170. [PMID: 32871347 DOI: 10.1016/j.genhosppsych.2020.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Longitudinal perinatal depression (PND) data is sparsely available in the Indian population. We have employed Edinburgh Postnatal Depression Scale (EPDS) to assess the prevalence and identify characteristics associated with PND in the south Indian population. PND was assessed longitudinally using EPDS scores with traditional cut-off approach as well as a novel method of latent class mixture modeling (LCMM). The LCMM method, to the best of our knowledge, has been used for the first time in the Indian population. METHODS Three hundred and forty seven women, predominantly from economically-weaker sections of rural and urban South India were longitudinally assessed for antenatal depression (AD) and postnatal depression (PD) using EPDS cutoff-scores ≥13 and ≥10, respectively. Uni/multivariable analyses were used to identify PND associated characteristics. LCMM was then implemented, followed by risk characteristics identification. RESULTS PND prevalence from traditional approach was 24.50 % (12.68 % AD; 18.16% PD). Characteristics associated with PND were urban-site and recent adverse life events. Irregular menstrual history and chronic health issues were associated with AD and PD, respectively. Three distinct PND trajectories were observed from LCMM-analysis: low-risk (76.08%), medium-risk (19.89%) and high-risk (4.04%). Urban-site, recent adverse life events, irregular menstrual history and pregnancy complications were associated with medium-risk/high-risk trajectories. LIMITATIONS EPDS is a screening tool and not a diagnostic tool for depression. Since the study population included women from economically-weaker sections, the results need verification in other socio-economic groups. CONCLUSIONS Both the traditional cut-off-based approach and LCMM provided very similar conclusions regarding the prevalence of PND and characteristics associated with it. Higher PND prevalence was observed in urban women compared to rural women. In low-income countries, identifying risk characteristics associated with PND is a critical component in designing prevention strategies for PND related conditions because of the limited access to mental health resources.
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Affiliation(s)
- Pradeep Kumar Badiya
- STAR Laboratory, Department of Chemistry, Sri Sathya Sai Institute of Higher Learning, Prasanthi Nilayam, 515134 Anantapur, Andhra Pradesh, India
| | - Sasidhar Siddabattuni
- STAR Laboratory, Department of Chemistry, Sri Sathya Sai Institute of Higher Learning, Prasanthi Nilayam, 515134 Anantapur, Andhra Pradesh, India
| | | | - Sai Kiran Javvaji
- Department of Laboratory Medicine & Cardiology, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore 560066, India
| | - Sai Prasad Nayak
- Department of Chemistry, Sri Sathya Sai Institute of Higher Learning, Brindavan Campus, Kadugodi, Bangalore 560067, Karnataka, India
| | - Akkamahadevi C Hiremath
- Department of Obstetrics and Gynecology, Sri Sathya Sai General Hospital, Whitefield, Bangalore 560066, India
| | - Rajani Upadhyaya
- Department of Obstetrics and Gynecology, Sri Sathya Sai General Hospital, Prasanthi Nilayam, 515134 Anantapur, Andhra Pradesh, India
| | - Loukya Madras
- Department of Obstetrics and Gynecology, Sri Sathya Sai General Hospital, Prasanthi Nilayam, 515134 Anantapur, Andhra Pradesh, India
| | - Raj Lakshmi Nalam
- Department of Obstetrics and Gynecology, Sri Sathya Sai General Hospital, Prasanthi Nilayam, 515134 Anantapur, Andhra Pradesh, India
| | - Yendluri Prabhakar
- Department of Psychiatry, Government medical college/Government general hospital, Anantapur 515001, Andhra Pradesh, India
| | - Sridhar Vaitheswaran
- Dementia Care, Schizophrenia Research Foundation, Chennai 600101, Tamil Nadu, India
| | - A R Manjjuri
- College of Nursing, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore 560066, India
| | - Kiran Kumar Jk
- Department of Chemistry, Sri Sathya Sai Institute of Higher Learning, Brindavan Campus, Kadugodi, Bangalore 560067, Karnataka, India
| | - M Subramaniyan
- Department of Telemedicine & Hospital Management Information Systems, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, 560066 Bangalore, India
| | - R Raghunatha Sarma
- Department of Mathematics and Computer Science, Sri Sathya Sai Institute of Higher Learning, Prasanthi Nilayam, 515134 Anantapur, Andhra Pradesh, India
| | - Sai Sathish Ramamurthy
- STAR Laboratory, Department of Chemistry, Sri Sathya Sai Institute of Higher Learning, Prasanthi Nilayam, 515134 Anantapur, Andhra Pradesh, India.
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Gausman J, Austin SB, Subramanian SV, Langer A. Adversity, social capital, and mental distress among mothers of small children: A cross-sectional study in three low and middle-income countries. PLoS One 2020; 15:e0228435. [PMID: 31999768 PMCID: PMC6992203 DOI: 10.1371/journal.pone.0228435] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 01/15/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Maternal mental health is becoming recognized as a global health priority. Mental distress among mothers of young children may be exacerbated by exposure to adversity. Social capital may buffer the impact of adversity on mental distress during the postnatal period and beyond. This paper examines the relationship between adversity, cognitive social capital and mental distress among mothers of young children in three low and middle-income countries. METHODS This study uses data from the Young Lives study on 5,485 women from Ethiopia, India, and Vietnam. Logistic regression was used to examine the association between exposure to stressful life events (SLEs) and mental distress in women between 6 months and 1.5 years post-partum. Logistic and linear regression was used to examine the potential for effect modification by social capital. RESULTS The proportion of women with mental distress during the period between 6-18 months following the birth of a child in the sample was 32.6% in Ethiopia, 30.5% in India and 21.1% in Vietnam. For each additional SLE to which a woman was exposed, the odds of MMD increased by 1.28 (95% CI: 1.22, 1.36; p<0.001) in Ethiopia, 1.17 (1.11, 1.25; p<0.001) in India, and 1.98 (1.75, 2.25; p<0.001) in Vietnam. Exposure to family SLEs was significantly associated with MMD in all three countries with odds ratios of 1.76 (95% CI: 1.30, 2.38; p<0.001), 1.62 (95% CI: 1.12, 2.33; p<0.01 in India), 1.93 (95% CI: 1.27, 2.92; p<0.01), respectively. In Ethiopia and India, economic SLEs were also significantly associated with MMD after adjustment (Ethiopia OR: 1.68; 95% CI: 1.12, 2.52; p<0.01 and India OR: 1.44; 95% CI: 1.01, 2.05; p<0.05), while in India, crime SLEs (OR: 1.93; 95% CI: 1.27, 2.92; p<0.01) were associated with MMD. Cognitive social capital was found to modify the association between SLEs and symptomology of mental distress in Ethiopia, India and Vietnam. CONCLUSIONS This study suggests that adversity may increase the risk of maternal mental distress in three LMICs, while social capital may buffer its effect.
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Affiliation(s)
- Jewel Gausman
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - S. Bryn Austin
- Division of Adolescent and Young Adult Medicine, Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston Children’s Hospital, Boston, MA, United States of America
| | - S. V. Subramanian
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, United States of America
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Necho M, Belete A, Zenebe Y. The association of intimate partner violence with postpartum depression in women during their first month period of giving delivery in health centers at Dessie town, 2019. Ann Gen Psychiatry 2020; 19:59. [PMID: 33042207 PMCID: PMC7539435 DOI: 10.1186/s12991-020-00310-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 09/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postpartum depression is a common psychiatric complaint of women following delivery and a multitude of psychosocial, maternal, newborn and husband-related factors were contributing to it. This condition has a detrimental impact on the mother-infant caregiving relationship and hastens the infant's cognitive, emotional and social development. However, a shortage of empirical evidence existed especially in developing countries including Ethiopia. Therefore, we implemented this study to determine the magnitude of postpartum depression and its correlates. METHODS A cross-sectional survey was implemented on 378 postnatal women in the maternal and child health clinic of Dessie health centers within 4 weeks of their delivery. Postpartum depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Intimate partner violence was operationalized as a psychological, physical and sexual abusive action imposed on women by their associates. We estimated the crude and adjusted odds ratio with its 95% CI using binary logistic regression to know the association and statistical significance was declared using a p-value < 0.05. RESULTS More than one-fourth, 102 (27%) (95% CI 22.5, 31.5) of participants were obtained to have postpartum depression. Being single from socio-demographic variables (AOR = 4.9, 95% CI 1.27, 16.74), dissatisfaction with child gender (AOR = 3.1, 95% CI 1.62, 6.69), unplanned pregnancy (AOR = 2.5, 95% CI 1.76, 7.23) and depression during current pregnancy (AOR = 3.2, 95% CI 2.81, 8.91) from pregnancy and newborn-related variables, intimate partner violence; psychological (AOR = 6.5, 95% CI 1.98, 15.85), sexual and physical violence (AOR = 3.46, 95%CI 2.34, 18.55), current husbands alcoholism (AOR = 2.2, 95% CI 1.48, 5.34) from husband/partner-related variables and current substance use (AOR = 1.8, 95% CI 1.16, 3.75) were found to have a statistically significant association with postpartum depression. CONCLUSION More than one-fourth of the interviewed women (27%) were found to have postpartum depression. Being single from socio-demographic variables, dissatisfaction with child gender, unplanned pregnancy, and depression during current pregnancy from pregnancy and newborn-related variables, intimate partner violence, and current husband's alcoholism from husband/partner-related variables and current substance use were the related factors. This suggests the need for integrating postpartum depression services into the existing postnatal maternal and child health services and basing intervention geared primarily to the mentioned factors above.
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Affiliation(s)
- Mogesie Necho
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Asmare Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yosef Zenebe
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Abebe A, Tesfaw G, Mulat H, Hibdye G, Yohannes K. Postpartum depression and associated factors among mothers in Bahir Dar Town, Northwest Ethiopia. Ann Gen Psychiatry 2019; 18:19. [PMID: 31523264 PMCID: PMC6734592 DOI: 10.1186/s12991-019-0244-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 08/29/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Postpartum depressive symptoms are the occurrence of major depressive episode within 4 weeks following delivery. Globally, 10%-20% of mothers suffer from depressive symptoms during their postpartum course. Therefore, assessing postpartum depressive symptoms has a pivotal role in ensuring that their mental health needs are met. METHODS An institution-based cross-sectional study was conducted including 511 mothers coming for postnatal care service in public health centers in Bahir Dar Town. Data were collected using a pre-tested, structured, and interviewer-administered questionnaire, while the Edinburgh Postnatal Depression Scale (EPDS) was used to assess individuals' depressive symptoms. The systematic random sampling technique was employed to recruit the study participants. Adjusted odds ratio with a 95% confidence interval (CI) was used to declare the statistical significance of the factors. RESULTS Postpartum depressive symptoms among mothers were found to be 22.1 (95%, CI 18.6%, 25.8%). In multivariate logistic regression, stressful life events (AOR = 4.46, 95% CI 2.64, 7.54), domestic decision making (AOR = 4.26, 95% CI 2.54, 7.14), unplanned pregnancy (AOR = 1.86, 95% CI 1.02, 3.41), partner violence (AOR = 3.16, 95% CI 1.76, 5.67), and hospitalization of their babies (AOR = 2.24, 95% CI 1.17, 4.310) were factors significantly associated with postpartum depressive symptoms. CONCLUSIONS Postpartum depressive symptoms among mothers were common in the study area. Stressful life events, lack of empowerment in domestic decision making, intimate partner violence, unplanned pregnancy, and hospitalization of their baby were factors significantly associated with postpartum depression. The Ministry of Health needs to give training on how to screen postpartum depressive symptoms among mothers, and interventions that would address the above factors would benefit in tackling further complications.
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Affiliation(s)
- Amsale Abebe
- 1Department of Psychiatry, Felege Hiwot Referral Hospital, Bahir Dar University, Bahar Dar, Ethiopia
| | - Getachew Tesfaw
- 2Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haregewoine Mulat
- 2Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getahun Hibdye
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Kalkidan Yohannes
- 4Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, 419, Dilla, Ethiopia
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Kishore MT, Satyanarayana V, Ananthanpillai ST, Desai G, Bhaskarapillai B, Thippeswamy H, Chandra PS. Life events and depressive symptoms among pregnant women in India: Moderating role of resilience and social support. Int J Soc Psychiatry 2018; 64:570-577. [PMID: 30024292 DOI: 10.1177/0020764018789193] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Recent life events may be significant risk factors for depression during pregnancy. However, its association with the individual's resilience and social support is not clear. AIMS To understand the association between life events and depression during pregnancy and whether the association is moderated by resilience and social support. METHODS This study is part of a prospective cohort study on perinatal mental health in an urban antenatal clinic, which included 589 women recruited in the first and early second trimester. Participants were administered the Life Events Checklist adapted from the Social Readjustment Rating Scale by the authors to assess life events; Edinburgh Postnatal Depression Scale (EPDS) and Connor-Davidson Resilience Scale-10 to assess depression and resilience, respectively. The relationship between life events (12 months prior to the time of assessment) and antenatal depression and the moderating role of resilience and social support was analysed. RESULTS Thirty-eight women (6.5%) who had depression (EPDS score ⩾ 11) had significantly higher number of life events (i.e. on average three; U = 3,826; p < .01), lower resilience scores ( U = 4,053; p < .01) and lower perceived social support ( U = 2,423; p < .01) as compared to those who were negative for depression on EPDS. Life events predicted depression during pregnancy; however, the relationship was moderated by social support but not by resilience. CONCLUSION The pregnant women who experienced life events may experience depression during the first trimester of pregnancy, but the effect could possibly be reduced by enhancing the social support.
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Affiliation(s)
- M Thomas Kishore
- 1 Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Veena Satyanarayana
- 1 Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | | | - Geetha Desai
- 3 Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Binukumar Bhaskarapillai
- 4 Department of Biostatistics, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Harish Thippeswamy
- 3 Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Prabha S Chandra
- 3 Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
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Denckla CA, Mancini AD, Consedine NS, Milanovic SM, Basu A, Seedat S, Spies G, Henderson DC, Bonanno GA, Koenen KC. Distinguishing postpartum and antepartum depressive trajectories in a large population-based cohort: the impact of exposure to adversity and offspring gender. Psychol Med 2018; 48:1139-1147. [PMID: 28889814 PMCID: PMC5845817 DOI: 10.1017/s0033291717002549] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Distinguishing temporal patterns of depressive symptoms during pregnancy and after childbirth has important clinical implications for diagnosis, treatment, and maternal and child outcomes. The primary aim of the present study was to distinguish patterns of chronically elevated levels of depressive symptoms v. trajectories that are either elevated during pregnancy but then remit after childbirth, v. patterns that increase after childbirth. METHODS The report uses latent growth mixture modeling in a large, population-based cohort (N = 12 121) to investigate temporal patterns of depressive symptoms. We examined theoretically relevant sociodemographic factors, exposure to adversity, and offspring gender as predictors. RESULTS Four distinct trajectories emerged, including resilient (74.3%), improving (9.2%), emergent (4.0%), and chronic (11.5%). Lower maternal and paternal education distinguished chronic from resilient depressive trajectories, whereas higher maternal and partner education, and female offspring gender, distinguished the emergent trajectory from the chronic trajectory. Younger maternal age distinguished the improving group from the resilient group. Exposure to medical, interpersonal, financial, and housing adversity predicted membership in the chronic, emergent, and improving trajectories compared with the resilient trajectory. Finally, exposure to medical, interpersonal, and financial adversity was associated with the chronic v. improving group, and inversely related to the emergent class relative to the improving group. CONCLUSIONS There are distinct temporal patterns of depressive symptoms during pregnancy, after childbirth, and beyond. Most women show stable low levels of depressive symptoms, while emergent and chronic depression patterns are separable with distinct correlates, most notably maternal age, education levels, adversity exposure, and child gender.
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Affiliation(s)
- C. A. Denckla
- Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
| | | | | | | | - A. Basu
- Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
| | - S. Seedat
- Stellenbosch University, Cape Town, South Africa
| | - G. Spies
- Stellenbosch University, Cape Town, South Africa
| | | | - G. A. Bonanno
- Teacher’s College, Columbia University, New York City, USA
| | - K. C. Koenen
- Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
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