1
|
Clarke JR, Gibson M, Savaglio M, Navani R, Mousa M, Boyle JA. Digital screening for mental health in pregnancy and postpartum: A systematic review. Arch Womens Ment Health 2024:10.1007/s00737-024-01427-3. [PMID: 38557913 DOI: 10.1007/s00737-024-01427-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 01/19/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE This systematic review aimed to determine if digital screening for mental health in pregnancy and postpartum is acceptable, feasible and more effective than standard care (paper-and pen-based screening or no screening). The second aim was to identify barriers and enablers to implementing digital screening in pregnancy and postpartum. METHOD OVID MEDLINE, PsycINFO, SCOPUS, CINAHL, Embase, Web of Science, Joanna Briggs Database and All EMB reviews incorporating Cochrane Database of Systematic Reviews (OVID) were systematically searched for articles that evaluated digital screening for mental health in pregnancy and postpartum between 2000 and 2021. Qualitative articles were deductively mapped to the Theoretical Domains Framework (TDF). RESULTS A total of 34 articles were included in the analysis, including qualitative, quantitative and mixed-methods studies. Digital screening was deemed acceptable, feasible and effective. TDF domains for common barriers included environmental context and resources, skills, social/professional role and identity and beliefs about consequences. TDF domains for common enablers included knowledge, social influences, emotion and behavioural regulation. CONCLUSION When planning to implement digital screening, consideration should be made to have adequate training, education and manageable workload for healthcare professionals (HCP's). Organisational resources and support are important, as well as the choice of the appropriate digital screening assessment and application setting for women. Theory-informed recommendations are provided for both healthcare professionals and women to inform future clinical practice.
Collapse
Affiliation(s)
- Jocelyn R Clarke
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Melanie Gibson
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
- Te Tātai Hauora o Hine - National Centre for Women's Health Research Aotearoa, Wellington Faculty of Health,, Victoria University of Wellington,, Wellington, New Zealand
| | - Melissa Savaglio
- Health and Social Care Unit (HSCU), School of Public Health and Preventive Medicine (SPHPM), Monash University, Melbourne, Australia
| | | | - Mariam Mousa
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Jacqueline A Boyle
- Health Systems and Equity, Eastern Health Clinical School,, Monash University, Melbourne, Australia.
| |
Collapse
|
2
|
Ozer O, Keles E, Eker HH, Baydili KN, Osman MM. Postpartum depressive symptoms in women with female genital mutilation in Somalia. J Matern Fetal Neonatal Med 2023; 36:2256445. [PMID: 37748867 DOI: 10.1080/14767058.2023.2256445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/02/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES This study aimed to identify associated factors for postpartum depression (PPD) among women with female genital mutilation (FGM) in Somalia. METHODS This was a cross-sectional study conducted between February and May 2021 in Somalia Mogadishu-Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia. Mothers with any known chronic disease, or psychiatric disorders and who refused to participate were excluded from the study. The cutoff point for depression was defined as ≥13 points according to the Edinburgh Postnatal Depression Scale. RESULTS Out of 446 postpartum mothers, 267 (59.9%) had increased depressive symptoms in the early postpartum period. PPD scale scores of mothers who were very poor were significantly higher depression scores than their counterparts (p = .002). Education level, place of residence, occupational status, number of children, type of FGM, and the presence of perineal tear did not differ significantly between depressed and non-depressed groups. CONCLUSIONS Women with FGM had increased depressive symptoms in the early postpartum period in Somalia. In addition, women who had lower income had higher PPD scores than their counterparts. Further studies are needed to develop a deeper understanding of the relationships between FGM and PPD and its causes.
Collapse
Affiliation(s)
- Ozgur Ozer
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Mogadishu Somalia-Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Esra Keles
- Department of Gynecologic Oncology, Zeynep Kamil Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Hasan Huseyin Eker
- Department of Public Health, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Istanbul, Turkey
- Department of Public Health, University of Health Sciences Turkey, Mogadishu Somalia-Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Kurşad Nuri Baydili
- Department of Biostatistics, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Istanbul, Turkey
| | - Marian Muse Osman
- Department of Public Health, University of Health Sciences Turkey, Mogadishu Somalia-Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| |
Collapse
|
3
|
Hinds C, Lindow SW, Abdelrahman M, Hehir MP, O'Connell MP. Assessment of antenatal anxiety, depression and obsessive-compulsive disorder in pregnant women in the COVID-19 era. Ir J Psychol Med 2023; 40:547-553. [PMID: 34433505 DOI: 10.1017/ipm.2021.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the mental health of pregnant women, with reference to anxiety, depression and obsessive-compulsive (OC) symptoms, during the COVID-19 pandemic. METHODS A cross-sectional survey was conducted in Ireland during the third wave of the pandemic between February and March 2021. Psychiatric, social and obstetric information was collected from pregnant women in a Dublin maternity hospital, alongside self-reported measures of mental health status. RESULTS Of 392 women responding, 23.7% had anxiety, scoring >9 for GAD-7 (7-item generalised anxiety disorder), 20.4% had depression, scoring >9 for PHQ-9 (9-item depression screening tool: Patient health questionnaire) and 10.3% had obsessive-compulsive disorder (OCD), scoring >13 for Yale-Brown obsessive-compulsive scale symptom checklist (Y-BOCS). Amongst self-reported OCD symptoms, there was a preponderance for obsessions rather than compulsions. Of 392 women, 36.2% described their mental health as worse during the pandemic, most frequently describing symptoms of anxiety and sleep disturbance. When analysed against test scores, self-reported worsening of mental health was significantly associated with higher scores on the GAD-7, PHQ-9 and Y-BOCS scales. The three scores were positively interrelated. Poor mental health scores were associated with self-reported strain in relationship with the baby's father, and current or previous history of mental illness. CONCLUSION This study found high levels of depression, anxiety and OC symptoms amongst pregnant women during COVID-19. This highlights the vulnerability of this group to mental illness and the importance of enhanced screening and support during pandemics.
Collapse
Affiliation(s)
- Catherine Hinds
- Consultant Perinatal Psychiatrist, Coombe Women and Infants University Hospital, Cork Street, Dublin, Ireland
| | - Stephen W Lindow
- Director of Masters Projects, Coombe Women and Infants University Hospital, Cork Street, Dublin, Ireland
| | - Mona Abdelrahman
- Specialist Registrar in Obstetrics and Gynaecology, The Meath Foundation University, Tallaght, Dublin, Ireland
| | - Mark P Hehir
- Consultant Obstetrician and Gynaecologist, Coombe Women and Infants University Hospital, Cork Street, Dublin, Ireland
| | - Michael P O'Connell
- Master, Consultant Obstetrician and Gynaecologist, Coombe Women and Infants University Hospital, Cork Street, Dublin, Ireland
| |
Collapse
|
4
|
Li Y, Wu Y, Jiang T, Xing H, Xu J, Li C, Ni R, Zhang N, Xiang G, Li L, Li Z, Gan L, Liu Y. Opportunities and challenges of pharmacovigilance in special populations: a narrative review of the literature. Ther Adv Drug Saf 2023; 14:20420986231200746. [PMID: 37780667 PMCID: PMC10540608 DOI: 10.1177/20420986231200746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023] Open
Abstract
The relatively new discipline of pharmacovigilance (PV) aims to monitor the safety of drugs throughout their evolution and is essential to discovering new drug risks. Due to their specific and complex physiology, children, pregnant women, and elderly adults are more prone to adverse drug reactions (ADRs). Additionally, the lack of clinical trial data exacerbates the challenges faced with pharmacotherapy in these populations. Elderly patients tend to have multiple comorbidities often requiring more extensive medication, which adds additional challenges for healthcare professionals (HCPs) in delivering safe and effective pharmacotherapy. Clinical trials often have inherent limitations, including insufficient sample size and limited duration of research; as some ADRs are attributed to long-term use of a drug, these may go undetected during the course of the trial. Therefore, the implementation of PV is key to insuring the safe and effective use of drugs in special populations. We conducted a thorough review of the scientific literature on PV systems across the European Union, the United States, and China. Our review focused on basic physiological characteristics, drug use, and PV for specific populations (children, pregnant women, and the elderly). This article aims to provide a reference for the development of follow-up policies and improvement of existing policies as well as provide insight into drug safety with respect to patients of special populations.
Collapse
Affiliation(s)
- Yanping Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yuanlin Wu
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Tingting Jiang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Haiyan Xing
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Jing Xu
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Chen Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Rui Ni
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Ni Zhang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Guiyuan Xiang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Li Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Ziwei Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Lanlan Gan
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yao Liu
- Department of Pharmacy, Daping Hospital, Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing 400042, China
| |
Collapse
|
5
|
Fonseca A, Branquinho M, Monteiro F, Araújo-Pedrosa A, Bjørndal LD, Lupattelli A. Treatment options and their uptake among women with symptoms of perinatal depression: exploratory study in Norway and Portugal. BJPsych Open 2023; 9:e77. [PMID: 37139793 DOI: 10.1192/bjo.2023.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Perinatal depression is the most undertreated clinical condition during the perinatal period. Knowledge about women's decision-making in seeking and receiving treatment is scarce. AIMS To investigate and compare treatment option uptake in perinatal women with depressive symptoms in Portugal and Norway, and to identify sociodemographic and health-related factors associated with treatment uptake. METHOD Participants were women resident in Portugal or Norway (≥18 years) who were pregnant or had given birth in the past 12 months, who presented with active depressive symptoms (Edinburgh Postnatal Depression Scale score ≥10). In an electronic questionnaire, women reported treatment received and sociodemographic and health-related factors. RESULTS The sample included 416 women from Portugal and 169 from Norway, of which 79.8% and 53.9%, respectively, were not receiving any treatment. Most Portuguese women were receiving psychological treatment, either alone (45.2%) or combined with pharmacological treatment (21.4%). Most Norwegian participants were receiving only pharmacological (36.5%) or combined treatment (35.4%). Compared with the Portuguese sample, a higher proportion of Norwegian women started treatment before pregnancy (P < 0.001). In Portugal, lower depressive symptoms and self-reported psychopathology were significantly associated with higher likelihood of receiving treatment. CONCLUSIONS We found that, in both Norway and Portugal, a substantial number of perinatal women with depressive symptoms do not receive any treatment. Differences exist regarding the chosen treatment option and timing of treatment initiation in the two countries. Only mental health-related factors were associated with treatment uptake for perinatal depression in Portugal. Our results highlight the importance of implementing strategies aimed to improve help-seeking behaviours.
Collapse
Affiliation(s)
- Ana Fonseca
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - Mariana Branquinho
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Portugal
| | - Fabiana Monteiro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - Anabela Araújo-Pedrosa
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal; and Clinical Psychology Service, Department of Gynaecology, Obstetrics, Reproduction and Neonatology (Maternity Daniel de Matos), Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Ludvig D Bjørndal
- PROMENTA Research Center, Department of Psychology, University of Oslo, Norway
| | - Angela Lupattelli
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Norway
| |
Collapse
|
6
|
Abstract
Many (> 40%) women discontinue antidepressants during pregnancy because of concerns about effects on the foetus, based on information from inadequately-controlled studies. The sibling-control study design provides the best control for confounding factors, notably maternal depression. The purpose of this review was to investigate the evidence from sibling-control analyses for adverse outcomes in offspring associated with antidepressant exposure during pregnancy. Fourteen sibling-control studies were identified through searches of PubMed and Embase. Outcomes included preterm birth, small for gestational age, neonatal size, birth defects, autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), behavioural problems, neurodevelopmental deficits, and scholastic attainment. For the majority of these outcomes, no statistically significant associations were found when comparing exposed and unexposed siblings. Single studies reported associations with preterm birth, reduced gestational age, ADHD, anxiety at 36 months, and lower mathematics test scores, which persisted in the sibling-control analyses. However, differences were small and possibly not clinically significant. Moreover, effects of residual confounding could not be excluded. These findings provide evidence that many of the previously reported associations between prenatal antidepressant exposure and adverse outcomes in offspring are no longer statistically significant when exposed offspring are compared with unexposed siblings. The few statistically significant differences in sibling-control analyses were generally small with doubtful clinical significance. Decisions on antidepressant treatment during pregnancy should be made individually, based on evidence from properly controlled studies, not on misleading information based on studies that have not controlled adequately for confounding factors.
Collapse
|
7
|
Suenaga H. Comparison of response options and actual symptom frequency in the Japanese version of the Edinburgh Postnatal Depression Scale in women in early pregnancy and non-pregnant women. BMC Pregnancy Childbirth 2022; 22:937. [PMID: 36522699 PMCID: PMC9753857 DOI: 10.1186/s12884-022-05257-y] [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: 09/13/2022] [Accepted: 11/28/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The positive predictive rate of the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS) is lower than those of other versions. This study aimed to confirm whether the EPDS Japanese version reflects actual symptom frequency and to examine the possibility of improving the positive predictive rate. METHODS This is a methodological study aimed at improving the positive predictive value of EPDS. The participants were 63 non-pregnant and 382 pregnant women. They answered the 10 questions of the Japanese version of the EPDS and reported the specific number of days as the frequency. The EPDS score (EPDS-S) and the frequency score (FREQ-S) were calculated for three factors of emotion: anhedonia, anxiety, and depression. RESULTS The positive rates of the EPDS-S and FREQ-S in pregnant women were 6% and 8%, respectively, which were lower than those in non-pregnant women (17%). On comparing the EPDS-S with the FREQ-S, a significant underestimation of frequency was observed in approximately 3% of pregnant women. The FREQ-S showed better internal consistency than the EPDS-S. Among the factors of emotion, women tended to rate anhedonia lower in the EPDS-S than in the frequency scale. CONCLUSION Pregnant women tended to report a lower frequency on the Japanese version of the EPDS than their actual symptom frequency, which was especially true for those with a desire to self-harm. The combined use of the FREQ-S and EPDS-S can prevent underestimation and help improve the detection rate of depression.
Collapse
Affiliation(s)
- Hiromi Suenaga
- grid.268397.10000 0001 0660 7960Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
| |
Collapse
|
8
|
Treatment of Peripartum Depression with Antidepressants and Other Psychotropic Medications: A Synthesis of Clinical Practice Guidelines in Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041973. [PMID: 35206159 PMCID: PMC8872607 DOI: 10.3390/ijerph19041973] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/29/2022] [Accepted: 01/29/2022] [Indexed: 02/04/2023]
Abstract
This study examined (1) the availability and content of national CPGs for treatment of peripartum depression, including comorbid anxiety, with antidepressants and other psychotropics across Europe and (2) antidepressant and other psychotropic utilization data as an indicator of prescribers' compliance to the guidelines. We conducted a search using Medline and the Guidelines International Network database, combined with direct e-mail contact with national Riseup-PPD COST ACTION members and researchers within psychiatry. Of the 48 European countries examined, we screened 41 records and included 14 of them for full-text evaluation. After exclusion of ineligible and duplicate records, we included 12 CPGs. Multiple CPGs recommend antidepressant initiation or continuation based on maternal disease severity, non-response to first-line non-pharmacological interventions, and after risk-benefit assessment. Advice on treatment of comorbid anxiety is largely missing or unspecific. Antidepressant dispensing data suggest general prescribers' compliance with the preferred substances of the CPG, although country-specific differences were noted. To conclude, there is an urgent need for harmonized, up-to-date CPGs for pharmacological management of peripartum depression and comorbid anxiety in Europe. The recommendations need to be informed by the latest available evidence so that healthcare providers and women can make informed, evidence-based decisions about treatment choices.
Collapse
|
9
|
Li D, Cui Y, Liu Y, Zheng Y, Zeng Y, Cheng ASK. A Chain Mediation Model of Perceived Stress, Neuroticism, and Psychological Inflexibility on Depressive Symptoms of Chinese New Fathers. Am J Mens Health 2021; 15:15579883211054351. [PMID: 34719998 PMCID: PMC8559288 DOI: 10.1177/15579883211054351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
There is a growing concern about mental health issues in new fathers, such as postpartum depression (PPD). Factors associated with PPD in men include personality traits and perceived stress. This study examined a set of hypothesized paths using perceived stress, neuroticism, and psychological inflexibility to predict depressive symptoms. A total of 189 participants took part. The mean age of these first-time fathers was 36.12 years (SD = 2.39). Perceived stress, neuroticism, and psychological inflexibility positively predicted new fathers’ depressive symptoms (B = 0.13, 0.37, and 0.31, respectively). These predictors explained 48% (R2 = 0.48) of the variance in the measured outcome of depressive symptoms in these new Chinese fathers. The total standardized direct effects of the three variables on depressive symptoms were 0.47 (95% CI [0.38, 0.53]). In conclusion, this study provides novel information about the chain mediating role played by neuroticism and psychological inflexibility in the relationship between perceived stress and PPD. Perceived stress significantly predicted neuroticism and psychological inflexibility, which in turn significantly predicted depressive symptoms in new Chinese fathers. The relationship between perceived stress and depressive symptoms was also mediated by each of psychological inflexibility or neuroticism alone.
Collapse
Affiliation(s)
- Danian Li
- Department of Brain Diseases, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, P. R. China
| | - Ying Cui
- Department of Psychiatry, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, P. R. China
| | - Yujie Liu
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, P. R. China
| | - Yanting Zheng
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, P. R. China
| | - Yingchun Zeng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, P. R. China
| | - Andy S K Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, P. R. China
| |
Collapse
|
10
|
Škodová Z, Bánovčinová Ľ, Urbanová E, Grendár M, Bašková M. Factor Structure of the Edinburgh Postnatal Depression Scale in a Sample of Postpartum Slovak Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126298. [PMID: 34200855 PMCID: PMC8296120 DOI: 10.3390/ijerph18126298] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postpartum depression has a negative impact on quality of life. The aim of this study was to examine the factor structure and psychometric properties of the Slovak version of the Edinburgh Postnatal Depression Scale (EPDS). METHODS A paper and pencil version of the 10-item EPDS questionnaire was administered personally to 577 women at baseline during their stay in hospital on the second to fourth day postpartum (age, 30.6 ± 4.9 years; 73.5% vaginal births vs. 26.5% operative births; 59.4% primiparas). A total of 198 women participated in the online follow-up 6-8 weeks postpartum (questionnaire sent via e-mail). RESULTS The Slovak version of the EPDS had Cronbach's coefficients of 0.84 and 0.88 at baseline (T1) and follow-up, respectively. The three-dimensional model of the scale offered good fit for both the baseline (χ2(df = 28) = 1339.38, p < 0.001; CFI = 0.99, RMSEA = 0.02, and TLI = 0.99) and follow-up (χ2(df = 45) = 908.06, p < 0.001, CFI = 0.93, RMSEA = 0.09, and TL = 0.90). A risk of major depression (EPDS score ≥ 13) was identified in 6.1% in T1 and 11.6% in the follow-up. Elevated levels of depression symptoms (EPDS score ≥ 10) were identified in 16.7% and 22.7% of the respondents at baseline and follow-up, respectively. CONCLUSIONS The Slovak translation of the EPDS showed good consistency, convergent validity, and model characteristics. The routine use of EPDS can contribute to improving the quality of postnatal health care.
Collapse
Affiliation(s)
- Zuzana Škodová
- Department of Midwifery, Jessenius Faculty of Medicine, Comenius University, 03601 Martin, Slovakia; (Z.Š.); (Ľ.B.); (E.U.)
| | - Ľubica Bánovčinová
- Department of Midwifery, Jessenius Faculty of Medicine, Comenius University, 03601 Martin, Slovakia; (Z.Š.); (Ľ.B.); (E.U.)
| | - Eva Urbanová
- Department of Midwifery, Jessenius Faculty of Medicine, Comenius University, 03601 Martin, Slovakia; (Z.Š.); (Ľ.B.); (E.U.)
| | - Marián Grendár
- Bioinformatic Unit, Biomedical Center Martin, Jessenius Faculty of Medicine, Comenius University, 03601 Martin, Slovakia;
| | - Martina Bašková
- Department of Midwifery, Jessenius Faculty of Medicine, Comenius University, 03601 Martin, Slovakia; (Z.Š.); (Ľ.B.); (E.U.)
- Correspondence:
| |
Collapse
|
11
|
Endomba FT, Ndoadoumgue AL, Mbanga CM, Nkeck JR, Ayissi G, Danwang C, Bigna JJ. Perinatal depressive disorder prevalence in Africa: A systematic review and Bayesian analysis. Gen Hosp Psychiatry 2021; 69:55-60. [PMID: 33550036 DOI: 10.1016/j.genhosppsych.2021.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To curb the burden of perinatal depression (PND) in Africa, it is important to have an accurate estimate of its burden in the continent. Hence, we determined the prevalence of (major) depressive disorder in the perinatal period in Africa. METHODS We searched PubMed, EMBASE, Africa Index Medicus, and Africa Journal Online, to identify studies reporting the prevalence of (major) depressive disorder in the perinatal period in Africa, between January 1st 2000 and February 17th 2020. PND prevalence was estimated using Bayesian modelling. RESULTS We identified 154 studies (192 data points; 113,147 women). In pregnant women, the prevalence of depressive disorder was 22.8% (95%Credible interval [CrI]: 21.5-24.1) among women with no specific condition and 31.9% (95%CrI: 30.2-33.6) among those with HIV. In post-partum, the prevalence was 21.2% (95%CrI: 20.0-22.5), 30.0% (95%CrI: 28.2-31.8), and 44.6% (95%CrI: 35.9-53.8) among women with no specific condition, with HIV, and with poor pregnancy outcomes, respectively. CONCLUSIONS This study depicted a high prevalence of PND in Africa. This prevalence varied across pre-defined clinical profiles. HIV-infected women or those with poor pregnancy outcomes having a higher prevalence of depression. This highlights the need for more attention and preventive interventions geared towards these sub-groups.
Collapse
Affiliation(s)
- Francky Teddy Endomba
- Health Economics & Policy Research and Evaluation for Development Results Group, Yaoundé, Cameroon; Psychiatry Internship Program, University of Bourgogne, 21000 Dijon, France
| | | | - Clarence M Mbanga
- Health Economics & Policy Research and Evaluation for Development Results Group, Yaoundé, Cameroon; School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jan René Nkeck
- Health Economics & Policy Research and Evaluation for Development Results Group, Yaoundé, Cameroon; Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Gregory Ayissi
- Health Economics & Policy Research and Evaluation for Development Results Group, Yaoundé, Cameroon; Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Celestin Danwang
- Health Economics & Policy Research and Evaluation for Development Results Group, Yaoundé, Cameroon; Epidemiology and Biostatistics Unit, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon.
| |
Collapse
|
12
|
Ceulemans M, Foulon V, Ngo E, Panchaud A, Winterfeld U, Pomar L, Lambelet V, Cleary B, O'Shaughnessy F, Passier A, Richardson JL, Hompes T, Nordeng H. Mental health status of pregnant and breastfeeding women during the COVID-19 pandemic-A multinational cross-sectional study. Acta Obstet Gynecol Scand 2021; 100:1219-1229. [PMID: 33475148 PMCID: PMC8014496 DOI: 10.1111/aogs.14092] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 12/21/2022]
Abstract
Introduction Evidence on perinatal mental health during the coronavirus disease 2019 (COVID‐19) pandemic and its potential determinants is limited. Therefore, this multinational study aimed to assess the mental health status of pregnant and breastfeeding women during the pandemic, and to explore potential associations between depressive symptoms, anxiety, and stress and women's sociodemographic, health, and reproductive characteristics. Material and methods A cross‐sectional, web‐based study was performed in Ireland, Norway, Switzerland, the Netherlands, and the UK between 16 June and 14 July 2020. Pregnant and breastfeeding women up to 3 months postpartum who were older than 18 years of age were eligible. The online, anonymous survey was promoted through social media and hospital websites. The Edinburgh Depression Scale (EDS), the Generalized Anxiety Disorder seven‐item scale (GAD‐7), and the Perceived Stress Scale (PSS) were used to assess mental health status. Regression model analysis was used to identify factors associated with poor mental health status. Results In total, 9041 women participated (including 3907 pregnant and 5134 breastfeeding women). The prevalence of major depressive symptoms (EDS ≥ 13) was 15% in the pregnancy cohort and and 13% the breastfeeding cohort. Moderate to severe generalized anxiety symptoms (GAD ≥ 10) were found among 11% and 10% of the pregnant and breastfeeding women. The mean (±SD) PSS scores for pregnant and breastfeeding women were 14.1 ± 6.6 and 13.7 ± 6.6, respectively. Risk factors associated with poor mental health included having a chronic mental illness, a chronic somatic illness in the postpartum period, smoking, having an unplanned pregnancy, professional status, and living in the UK or Ireland. Conclusions This multinational study found high levels of depressive symptoms and generalized anxiety among pregnant and breastfeeding women during the COVID‐19 outbreak. The study findings underline the importance of monitoring perinatal mental health during pandemics and other societal crises to safeguard maternal and infant mental health.
Collapse
Affiliation(s)
- Michael Ceulemans
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Teratology Information Service, Pharmacovigilance center Lareb, 's-Hertogenbosch, the Netherlands
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Elin Ngo
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Alice Panchaud
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Ursula Winterfeld
- Swiss Teratogen Information Service, Service de Pharmacologie Clinique, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Léo Pomar
- Materno-Fetal and Obstetrics Research Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Valentine Lambelet
- Materno-Fetal and Obstetrics Research Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Brian Cleary
- Rotunda Hospital, Dublin, Ireland.,School of Pharmacy, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Fergal O'Shaughnessy
- Rotunda Hospital, Dublin, Ireland.,School of Pharmacy, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Anneke Passier
- Teratology Information Service, Pharmacovigilance center Lareb, 's-Hertogenbosch, the Netherlands
| | - Jonathan L Richardson
- UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust and Public Health England, Newcastle upon Tyne, UK
| | - Titia Hompes
- Department of Neurosciences, KU Leuven, Leuven, Belgium.,Adult Psychiatry, UPC KU Leuven, Leuven, Belgium
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
13
|
Association between Antidepressant Treatment during Pregnancy and Postpartum Self-Harm Ideation in Women with Psychiatric Disorders: A Cross-Sectional, Multinational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010046. [PMID: 33374665 PMCID: PMC7793536 DOI: 10.3390/ijerph18010046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 01/02/2023]
Abstract
This study sought to estimate whether there is a preventative association between antidepressants during pregnancy and postpartum self-harm ideation (SHI), as this knowledge is to date unknown. Using the Multinational Medication Use in Pregnancy Study, we included a sample of mothers who were in the five weeks to one year postpartum period at the time of questionnaire completion, and reported preexisting or new onset depression and/or anxiety during pregnancy (n = 187). Frequency of postpartum SHI ('often/sometimes' = frequent, 'hardly ever' = sporadic, 'never') was measured via the Edinburgh Postnatal Depression Scale (EPDS) item 10, which reads "The thought of harming myself has occurred to me". Mothers reported their antidepressant use in pregnancy retrospectively. Overall, 52.9% of women took an antidepressant during pregnancy. Frequent SHI postpartum was reported by 15.2% of non-medicated women and 22.0% of women on past antidepressant treatment in pregnancy; this proportion was higher following a single trimester treatment compared to three trimesters (36.3% versus 18.0%). There was no preventative association of antidepressant treatment in pregnancy on reporting frequent SHI postpartum (weighted RR: 1.90, 95% CI: 0.79, 4.56), relative to never/hardly ever SHI. In a population of women with antenatal depression/anxiety, there was no preventative association between past antidepressant treatment in pregnancy and reporting frequent SHI in the postpartum year. This analysis is only a first step in providing evidence to inform psychiatric disorder treatment decisions for pregnant women.
Collapse
|
14
|
Roldan Munoz S, Lupattelli A, de Vries ST, Mol PGM, Nordeng H. Differences in medication beliefs between pregnant women using medication, or not, for chronic diseases: a cross-sectional, multinational, web-based study. BMJ Open 2020; 10:e034529. [PMID: 32029496 PMCID: PMC7044950 DOI: 10.1136/bmjopen-2019-034529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To assess whether medication beliefs differ between women who use or not use medication for their somatic chronic diseases during pregnancy and whether this association varies across diseases. DESIGN Cross-sectional web-based survey. SETTING Multinational study in Europe. PARTICIPANTS Pregnant women or women with children less than 1 year old from European countries and with asthma, allergy, cardiovascular, rheumatic diseases, diabetes, epilepsy and/or inflammatory bowel diseases (IBD). PRIMARY AND SECONDARY OUTCOME MEASURE Differences in scores of the Beliefs about Medicines Questionnaire (BMQ). RESULTS In total, 1219 women were included (ranging from 736 for allergy to 49 for IBD). Women using medication for their chronic disease (n=770; 63%) had higher scores on the BMQ subscales necessity (16.6 vs 12.1, p<0.001) and benefits (16.2 vs 15.4, p<0.001), and lower values on the subscales overuse (12.5 vs 13.1; p=0.005) and harm (9.8 vs 10.7, p<0.001) than women not using medication. No significant differences were shown for the concerns subscale (12.5 vs 12.3, p=0.484). Beliefs varied somewhat across diseases but in general more positive beliefs among women using medication were shown. Epilepsy was the disease where less differences were observed between women using and not using medication. CONCLUSION Women's beliefs were associated with medication use during pregnancy with only small differences across the diseases. Knowing pregnant women's beliefs could help identify women who are reluctant to use medication and could guide counselling to support making well-informed treatment decisions.
Collapse
Affiliation(s)
- Sonia Roldan Munoz
- Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Angela Lupattelli
- Pharmaco Epidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Sieta T de Vries
- Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter G M Mol
- Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hedvig Nordeng
- Pharmaco Epidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
| |
Collapse
|
15
|
Impact of antidepressant use, discontinuation, and dosage modification on maternal depression during pregnancy. Eur Neuropsychopharmacol 2019; 29:803-812. [PMID: 31248651 DOI: 10.1016/j.euroneuro.2019.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/31/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
Women tend to discontinue their antidepressants during pregnancy. This study compared the risk of depressive symptoms in the second-half of pregnancy in women who discontinue or continue with or without dosage modification their antidepressant during gestation. Women were eligible if they called MothertoBaby during 2006-2010 and within 14 completed weeks of pregnancy. A total of 367 pregnant women were included. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depression during the first and second half of pregnancy. Presence of depressive symptoms was defined as EPDS ≥13. Among participants, 149 did not use antidepressants, 38 used antidepressants at the beginning of pregnancy but discontinued before the end of second-trimester, and 180 used antidepressants continuously throughout pregnancy. Among continued users, 46 modified antidepressant dosage before the end of the second trimester, and 134 did not modify dosage. The majority of antidepressant users (150/218, 68.8%) had mild to moderate depression. Thirteen percent (13%) of women who continued antidepressant use throughout pregnancy without dosage modification remained depressed. Adjusting for potential confounders including maternal depression/anxiety before pregnancy, and compared to non-users, discontinued users were 5.95 times (95%CI: 1.54-23.02), and continued users without dosage modification 4.59 times (95%CI: 1.44-14.64) more at risk of depression in the second-half of pregnancy. Those with dosage modifications were at a similar risk of depression during pregnancy than non-users (adjusted odds ratio 0.58, 95%CI: 0.06-5.52). In conclusion, in a cohort of mild to moderate depressive pregnant women, discontinuing or continuing antidepressant use without dosage modification during pregnancy were associated with an increased risk of depression during the remaining gestational period.
Collapse
|
16
|
Cauli G, Iapichino E, Rucci P, Quartieri Bollani M, Marconi AM, Bassi M, Gala C. Promoting the well-being of mothers with multidisciplinary psychosocial interventions in the perinatal period. J Affect Disord 2019; 246:148-156. [PMID: 30580200 DOI: 10.1016/j.jad.2018.12.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 11/05/2018] [Accepted: 12/16/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Antenatal depressive and anxiety symptoms are common and may persist over time after delivery, with negative consequences on the mothers and their children. Evidence on the efficacy of psychological and pharmacological interventions during pregnancy aimed at preventing post-partum depression is controversial. METHODS A consecutive sample of 318 women presenting for scheduled obstetric visits during pregnancy was screened for risk factors and anxiety or depressive symptoms. Based on the screening results, women were classified into three groups at increasing risk of post-partum depression (PPD) and were offered different interventions. RESULTS Depressive or anxiety symptoms were found in 91 (28.6%) women, 89 (28.0%) had low risk of PPD and 138 (43.4%) had no risk of PPD. The multidisciplinary psychosocial interventions offered to women with clinical symptoms were well accepted, with an uptake of 76/91 (83.5%). Thirty-three women who did not improve with psychotherapy were offered sertraline or paroxetine as a second-line treatment: 7 accepted and 26 (78.8%) refused. Eleven women already on medication at baseline continued their treatment along with the MPI. The MPI interventions had some positive effects in terms of post-partum recovery, symptom reduction, and in preventing a new onset of depression. Among the 227 non-symptomatic during pregnancy, only 5 (2.2%) developed symptoms in the post-partum period. At 12 months post-partum, 84.6% of women who were symptomatic at 2 months post-partum recovered. LIMITATIONS Our results should be interpreted in light of important limitations, including the lack of a control group that was not offered the MPI, the lack of information on the reasons for refusal and discontinuation and on the number of psychotherapy sessions attended. CONCLUSIONS Our findings underscore the potential usefulness of MPI in recognizing early signs or symptoms during pregnancy and the advantage of building specific interventions for preventing post-natal depression. The MPI has positive effects on women with depressive or anxiety symptoms during pregnancy, that however did not exceed significantly those observed in women who refused the intervention. Thus, in the absence of a control group, our results are preliminary and warrant confirmation and testing in future randomized clinical trials.
Collapse
Affiliation(s)
- G Cauli
- Division of Psychiatry, San Paolo Hospital, 51, ASST Santi Paolo e Carlo, Milan, Italy
| | - E Iapichino
- Division of Psychiatry, San Paolo Hospital, 51, ASST Santi Paolo e Carlo, Milan, Italy
| | - P Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy.
| | - M Quartieri Bollani
- Division of Psychiatry, San Paolo Hospital, 51, ASST Santi Paolo e Carlo, Milan, Italy
| | - A M Marconi
- Department of Obstetrics and Gynecology, San Paolo Hospital Medical School, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | - M Bassi
- Division of Psychiatry, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - C Gala
- Division of Psychiatry, San Paolo Hospital, 51, ASST Santi Paolo e Carlo, Milan, Italy
| |
Collapse
|
17
|
Arsova S, Hadzhihamza K, Bajraktarov S, Isjanovski V. Treatment of Depressive Conditions in Pregnancy. Open Access Maced J Med Sci 2018; 6:2079-2083. [PMID: 30559864 PMCID: PMC6290404 DOI: 10.3889/oamjms.2018.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/20/2018] [Accepted: 10/21/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mother's mental state during pregnancy is of substantial importance for the mother, but also for the infant and his/her future growth and development. Depressive maternal disorders during pregnancy have a significant influence on the development of the baby during pregnancy as well as on the future development and mother-baby relation, the breastfeeding process and care for the baby. AIM This study aimed to determine the influence of SSRI antidepressant therapy and psychosocial and therapeutic interventions on depression during pregnancy. It was also our aim to determine the relation between severity of depression and sociodemographic characteristics. METHODS The study included 40 women, with diagnosis F32 and F33 according to ICD 10, that is, with severe depressive disorder within depressive episodes or recurrent depressive disorder. Patients were evaluated at the beginning of the treatment and 3 months after antidepressant treatment. They were followed-up for two years. RESULTS The results obtained have shown that a larger number of mothers treated with antidepressant medications, had normal childbirth with the unremarkable condition of both, the mother and the newborn baby. CONCLUSION A well-combined treatment of maternal depression during pregnancy reduces the risk of postpartum depression, which is by itself a prerequisite for normal emotional and behavioural development of the child.
Collapse
Affiliation(s)
- Slavica Arsova
- University Clinic of Psychiatry, Skopje, Republic of Macedonia
| | | | | | | |
Collapse
|