Prospective study of postpartum depression in an Israeli cohort: prevalence, incidence and demographic risk factors

Peripartum dissociation, sense of control, postpartum posttraumatic stress disorder and emotional adjustment to motherhood in adult survivors of childhood maltreatment

Survivors of childhood maltreatment (CM) may experience difficulties in the peripartum period and in adjustment to motherhood. In this study we examined a model wherein CM is associated with maternal self-efficacy and maternal bonding three months postpartum, through mediation of peripartum dissociation and reduced sense of control during childbirth and postpartum-posttraumatic-stress disorder (P-PTSD). Women were recruited in a maternity ward within 48 h of childbirth (T1, N = 440), and contacted three-months postpartum (T2, N = 295). Participants completed self-report questionnaires: peripartum dissociation, sense of control (T1), and CM, P-PTSD, postpartum-depression, maternal self-efficacy and bonding (T2). Obstetrical data were collected from medical files. Structural equation modeling was conducted to test the hypothesized model, controlling for mode of delivery and postpartum-depression. Reported CM included child emotional neglect (CEN; 23.5%), child emotional abuse (CEA; 16.3%), child sexual abuse (CSA; 12.9%) and child physical abuse (CPA; 7.1%). CM was positively associated with peripartum dissociation and P-PTSD (p < .001). Peripartum dissociation was positively associated with P-PTSD (p < .001). P-PTSD was negatively associated with maternal self-efficacy (p < .001) and maternal bonding (p < .001). Association between CM and maternal self-efficacy and bonding was serially mediated by peripartum dissociation and P-PTSD, but not by sense of control. Findings remained significant after controlling for mode of delivery and postpartum-depression. CM is a risk factor for adjustment to motherhood, owing to its effects on peripartum dissociation and P-PTSD. Implementation of a trauma-informed approach in obstetric care and recognition of peripartum dissociative reactions are warranted.

Maternal Postpartum Emotional Distress and Preterm Social Withdrawal in the Bedouin Culture

This study aimed to test a serial mediation model proposing that prematurity would be related to changes in maternal emotional distress, which in turn would be related to the mother-child (M-C) interaction, which would ultimately be related to infant social withdrawal. Bedouin mothers and their preterm (n = 48) and full-term (n = 57) infants participated in this study. Mothers' mean age was 27.67 years. In addition, 39.4% of the mothers were primiparas and 60.6% were multiparas. Infants and their mothers were recruited shortly after birth (T1) in the maternity ward or Neonatal Intensive Care Unit (NICU) at Soroka Medical Center and were followed up at ages 6 months (T2) and 12 months (T3). Findings indicated that HIGHER levels of maternal emotional distress during the second half of the first year postpartum and LOWER levels of mother-child interaction, were associated with HIGHER levels of infant social withdrawal at T3. Furthermore, the overall indirect effect suggested that HIGHER levels of maternal nonhostility was a main variable mediating the link between prematurity and LOW levels of infant social withdrawal. Our findings provide evidence that changes in maternal emotional distress during the first year are related to lower infant social withdrawal. Moreover, mothers of premature infants showed higher levels of nonhostility when interacting with their premature infants. These findings highlight the importance of gaining a better understanding of maternal behaviors. Specifically, our study provides important information for researchers and clinicians on a possible mechanism leading to early socioemotional difficulties of premature infants.

Pathways Linking Intimate Partner Violence and Postpartum Depression Among Jewish and Arab Women in Israel

Intimate partner violence (IPV) is a major risk factor for postpartum depression (PPD), with 9% to 28% of PPD cases reporting IPV at some point in their lives. Yet little is known about how these phenomena are associated. We asked, "What direct and indirect pathways link IPV to PPD in women belonging to different ethnic-national groups in Israel?" We recruited a stratified sample of Jewish and Arab women, 18 to 48 years old and 6 months postpartum, during their visits to maternal and child health clinics. We computed path analyses to identify both direct and indirect predictors linking IPV frequency and PPD in a stratified sample of Jewish (n = 807) and Arab (n = 248) women. The overall rate of PPD was estimated at 10.3%, whereas the rate of IPV for the total sample was 36%. We identified a direct link between IPV and PPD. IPV also appeared to have an equivalent, indirect effect on PPD via greater chronic stress and reduced social support. IPV was greater and social support was lower for Arab women, who also reported higher PPD, independent of sociodemographic differences between ethnic groups (i.e., education, occupation). Of note, an unplanned pregnancy appeared to increase the risk of both IPV and PPD. Our findings suggest that complex pathways link IPV to PPD and that indirect effects of IPV are equivalent to its direct effects on postpartum women. These findings contribute to a growing international body of research showing the significant effects of IPV on health and well-being. The factors we identified as directly and indirectly associated with PPD might inform interventions to identify and treat PPD.

Prematurity, maternal emotional distress, and infant social responsiveness among Arab-Bedouin families: The role of social support as a resilience factor

This study investigated predictors of early infant social development and the role of social support as a resilience factor among Arab-Bedouin families. We propose a mediation model in which social support will be related to maternal postpartum emotional distress (PPED), which in turn will be related to infant social responsiveness. One hundred five Arab-Bedouin mothers (age range = 17-44 years) and their preterm (n = 48) and full-term (n = 57) infants were recruited shortly after birth and were followed up at age 12 months. Findings demonstrate that, among the preterm group, higher levels of social support predicted lower levels of maternal PPED, and this, in turn, predicted higher levels of infant social responsiveness.

Maternal Emotional Distress Following the Birth of a Preterm Baby: The Case of Bedouin Mothers Living in Southern Israel

Mothers of preterm infants are at higher risk for postpartum emotional distress (PPED). In this study, we investigated PPED among Bedouin mothers, an ethnic minority group living in Israel. Our aim was to understand how maternal acculturation style and birth order were related to mothers’ PPED following a premature birth. Three hundred twenty-one Bedouin mothers and their babies (preterm: n = 66; full-term: n = 255) participated in the study. Data were collected in the maternity ward and the NICU (Neonatal Intensive Care Unit) of a large general hospital in Southern Israel providing medical care to all populations in the southern region. Mothers completed questionnaires on maternal postpartum depression and anxiety. Additionally, maternal acculturation style was assessed using the acculturation questionnaire and information on child birth order. Mothers of preterm infants indicated having more symptoms of PPED than mothers of full-term infants. Additionally, both maternal acculturation style as well as birth order (i.e., whether the preterm was first- or later-born) were found to act as moderators in the link between prematurity and PPED. Specifically, we found that among the preterm group, low levels of Westernized acculturation style and the birth of a preterm infant who was later-born predicted higher levels of PPED. Our findings indicate that ethnicity, acculturation, and birth order are important variables that need to be considered when studying PPED and premature birth. Results highlight the fact that mothers from an ethnic minority group who have had a premature birth are at higher risk for experiencing PPED. However, individual differences emerged when examining maternal acculturation style and birth order. Culturally—informed clinical implications are proposed.

Postpartum depression and infant development up to 24 months: A nationwide population-based study

AIMS

Postpartum depression (PPD) is the most common complication women experience after delivery. We aimed to examine the association of maternal PPD with delays in child development, in a population-based study, in the first two years of life.

METHODS

A nation-wide population-based historical cohort study in the setting of the Mother and Child Health Clinics in Israel, where infants are routinely evaluated for growth and development. Data were retrieved on 96,623 infants born in 2014-2015 whose mothers had PPD screening. Logistic regressions were used to estimate the associations of PPD with the achievements of developmental milestones, controlling for potential confounders.

RESULTS

PPD was identified in 4,268 mothers (4.7%). PPD was associated with delays in language skills, including the production of voices in dialogue (OR=1.88, 95% CI: 1.41-2.52) and speaking 2-3 words (OR=1.24, 95% CI: 1.13-1.37). PPD was associated with about 1.5 times increased odds of delays in personal-social skills, including reacting to voices (OR=1.43, 95% CI: 1.22-1.67) and pointing to selected objects (OR=1.47 95% CI: 1.10-1.97). Associations were also seen with delays in fine motor and adaptive skills, such as pinching (OR=1.50, 95% CI: 1.20-1.86), and gross motor skills, such as ground crawling (OR=1.36, 95% CI: 1.15-1.60).

CONCLUSIONS

In this population-based large cohort study, PPD as estimated in a national screening program, was associated with delays in early child development, which were shown in all assessed domains. Future studies should confirm our results and intervention programs should be developed to effectively minimize these gaps.

Long-term psychological and physical outcomes of women after postdural puncture headache: A retrospective, cohort study

BACKGROUND

Postdural puncture headache after accidental dural puncture during labour may lead to chronic sequalae.

OBJECTIVES

We aimed to measure the incidence of postpartum depression, posttraumatic stress disorder, chronic headache, backache and breastfeeding rates after a postdural puncture headache.

DESIGN

A retrospective, case-matched cohort study.

SETTING

A review of documented cases of dural puncture and matched case controls occurring at Rabin Medical Center and Shamir Medical Center from 01 January 2012 to 30 September 2018.

PATIENTS

The study cohort consisted of women with a documented postdural puncture headache and the controls were women with uneventful labour epidurals in the same 24-h period. Women were interviewed by telephone.

PRIMARY OUTCOMES MEASURE

The primary outcome measure was the incidence of postpartum depression after a postdural puncture headache.

RESULTS

Women with postdural puncture headache (n = 132) and controls (n = 276) had similar demographic data. The incidence of postpartum depression was 67/128 (52.3%) versus 31/276 (11.2%) for controls, P < 0.0001, 95% confidence intervals of the difference 31.5 to 50.2. Posttraumatic stress disorder was more frequent among women with postdural puncture headache, 17/132 (12.8%) versus controls 1/276 (0.4%), P < 0.0001, 95% confidence intervals of the difference 7.6 to 19.5. Women with postdural puncture headache breastfed less, 74/126 (54.5%) versus controls 212/276 (76.8%), P < 0.0001, 95% confidence intervals of the difference 33.1 to 55.2. Current headache and backache were significantly more frequent among women with postdural puncture headache [current headache 42/129 (32.6%) versus controls 42/276 (15.2%) P < 0.00001, 95% confidence intervals 0.085 to 0.266; current backache 58/129 (43.9%) versus controls 58/275 (21%) P < 0.0001, 95% confidence intervals 14.1 to 33.5].

CONCLUSION

We report an increased incidence of postpartum depression, posttraumatic stress disorder, chronic headache and backache and decreased breastfeeding following a postdural puncture headache. Our findings emphasise the need for postpartum follow-up for women with postdural puncture headache.

TRIAL REGISTRY NUMBER

Clinical trial registry number: NCT03550586.

Ethnic disparities in receiving benefits for disability following postpartum mental illness during first two years after delivery: an Israeli nationwide study

BACKGROUND

Despite relatively high rates of Postpartum Depression (PPD), little is known about the granting of social security benefits to women who are disabled as a result of PPD or of other postpartum mood and anxiety disorders (PMAD). This study aims to identify populations at risk for underutilization of social security benefits due to PMAD among Israeli women, with a focus on ethnic minorities.

METHODS

This retrospective cohort study is based on the National Insurance Institute (NII) database. The study population included a simple 10% random sample of 79,391 female Israeli citizens who gave birth during 2008-2016 (these women delivered a total of 143,871 infants during the study period), and who had not been eligible for NII mental health disability benefits before 2008. The dependent variable was receipt of Benefit Entitlement (BE) due to mental illness within 2 years following childbirth. Maternal age at delivery, population group, Socio-Economic Status (SES), family status, employment status of the mother and her spouse, and infant mortality were the independent variables. Left truncation COX proportional hazard model with time-dependent variables was used, and birth number served as a time discrete variable.

RESULTS

Bedouin and Arab women had significantly lower likelihood of BE (2.6 times lower and twice lower) compared with other ethnic groups (HR = 0.38; 95% CI: 0.26-0.56; HR = 0.47; 95% CI: 0.37-0.60 respectively). The probability of divorced or widowed women for BE was significantly higher compared to those living with a spouse (HR = 3.64; 95% CI: 2.49-5.33). Lack of employment was associated with higher likelihood of BE (HR = 1.54; 95% CI: 1.30-1.82). Income had a dose-response relationship with BE in multivariable analysis: lower income was associated with the nearly four-fold greater probability compared to the highest income quartile (HR = 3.83; 95% CI: 2.89-5.07).

CONCLUSIONS

Despite the exceptionally high prevalence of PMAD among ethnic minorities, Bedouins and Arabs had lowest likelihood of Benefit Entitlement. In addition to developing programs for early identification of postpartum emotional disorders among unprivileged ethnic groups, awareness regarding entitlement to a mental health disability allowance among ethnic minorities should be improved.

Prevalence and associated factors of postpartum depression among immigrant women in Guangzhou, China

Background

Although there has been mounting research on postpartum depression (PPD), the impact of immigration on PPD has remained quite unexplored. The purpose of this study is to investigate the prevalence and associated factors of PPD among immigrant women living in Guangzhou at 6 weeks postpartum.

Methods

A cross-sectional study was conducted involving 1230 immigrant women in a tertiary hospital of Guangzhou from December 2016 to December 2017 at 6 weeks postpartum. The Chinese version of Edinburgh Postnatal Depression Scale and a structured questionnaire regarding associated factors were administered to all participants. Multivariate logistic regression was used to determine factors that were significantly associated with PPD.

Results

The prevalence of PPD among immigrant women at 6 weeks postpartum was 34.0%. A multivariate logistic regression model identified significant obstetric and social factors as: living in Guangzhou for less than 2 years, insufficient family income, poor social support and marital relationship.

Conclusion

Prevalence of PPD among immigrant women from Guangzhou at 6 weeks postpartum is high. The development of PPD among immigrant women is associated with individual and social factors. There’s an urgent need for healthcare providers to take a more active role in engaging immigrant women in their psychological needs.

Associations of sociodemographic and clinical factors with perinatal depression among Israeli women: a cross-sectional study

BACKGROUND

Perinatal depression is a common problem that affects about 18% of women worldwide, though the heterogeneity between countries is great. The aims of this study were to assess the prevalence of perinatal depressive symptoms in a national sample of women in Israel, and to investigate associations of these symptoms with demographic, medical and lifestyle factors.

METHODS

The study included all members of Maccabi Health Services, the second largest health maintenance organization in Israel, who filled the Edinburgh Postnatal Depression Scale (EPDS) during 2015-2016. Crude odds ratios (ORs) and adjusted ORs (aORs) are presented for associations of sociodemographic, medical and lifestyle factors with perinatal depressive symptoms, according to a score ≥ 10 on the EPDS.

RESULTS

Of 27,520 women who filled the EPDS, 1346 (4.9%) met the criteria for perinatal depression. In a logistic regression analysis we found the following factors associated with perinatal depression: the use of antidepressant medications (aOR = 2.34, 95% CI 1.94-2.82, P < 0.001 and aOR = 3.44; 95% CI 2.99-3.97, P < 0.001 for ≤3 months and > 3 months respectively), a diagnosis of chronic diabetes mellitus (aOR = 2.04; 95% CI 1.22-3.43, P = 0.007), Arab background (aOR = 2.28; 95% CI 1.82-2.86, P < 0.001), current and past smoking (aOR = 1.62; 95% CI 1.35-1.94, P < 0.001 and aOR = 1.36; 95% CI 1.05-1.76, P = 0.021, respectively), and anaemia (aOR = 1.17; 95% CI 1.04-1.32, P = 0.011). Orthodox Jewish affiliation and residence in the periphery of the country were associated with lower perinatal depression (aOR = 0.48; 95% CI 0.36-0.63, P < 0.001 and aOR = 0.72; 95% CI 0.57-0.92, P = 0.007, respectively).

CONCLUSIONS

The prevalence of perinatal depression in this study was 4.9%. Perinatal depression was associated with a number of demographic, medical and lifestyle factors, including the use of antidepressant medication, chronic diabetes mellitus, Arab background, current or past smoking, and anaemia. These risk factors may help identify women at risk of perinatal depression.

The tip of the iceberg: postpartum suicidality in Israel

Background

Postpartum suicidality, a result of extreme distress or depression, is a tragedy for the woman, infant, and family. Screening for postpartum depression (PPD) is mandatory in Israel, including a question on suicidal ideation. This study presents and analyzes data regarding rates, trends and characteristics of postpartum women who considered, attempted, or completed suicide, to help direct services aimed at preventing these occurrences.

Methods

Suicidal ideation data based on PPD screening was drawn from various publications and databases. Suicide attempt data was obtained from the Emergency Department database for 2006–2015 and matched with the National Birth Registry. Cause of death from the national database for those years were similarly linked to births to identify postpartum suicides and deaths. Postpartum and non-postpartum suicide attempt rates were computed by year, and by age and ethnic/immigrant group. A multivariate logistic model was used to estimate relative risk for postpartum attempts, controlling for age and ethnic group.

Results

Suicidal ideation in recent years has been reported as 1% or less, with higher rates found in studies of Arab women. Suicide attempt rates for non-postpartum women were 3–5 times that of postpartum women, rising over the years, while remaining relatively stable for postpartum women. Adjusted risk of suicide attempt for non-postpartum women was significantly higher; adjusted odds ratio was 4.08 (95% CI 3.75–4.44). It was also significantly higher for Arabs and immigrants from the Former Soviet Union, compared to Israeli-born Jews/veteran immigrants, and for younger women compared to those aged 35–44. Seven postpartum suicides were recorded during 2006–2015, a rate of 0.43 per 100,000 births.

Conclusion

Postpartum suicidality in Israel is low relative to other countries. Although relatively rare and lower than among non-postpartum women, health professionals should be attentive to risk factors, such as past psychiatric disorders, suicide attempts and current emotional distress, particularly among higher-risk populations. The universal screening program for PPD is a valuable opportunity for this, but increased resources should be allotted to implement and utilize it optimally. Prenatal screening should be added as an Israeli Quality Indicator, and postpartum completed suicides should be thoroughly investigated to guide prevention efforts.

Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries

BACKGROUND

Postpartum depression (PPD) poses a major global public health challenge. PPD is the most common complication associated with childbirth and exerts harmful effects on children. Although hundreds of PPD studies have been published, we lack accurate global or national PPD prevalence estimates and have no clear account of why PPD appears to vary so dramatically between nations. Accordingly, we conducted a meta-analysis to estimate the global and national prevalence of PPD and a meta-regression to identify economic, health, social, or policy factors associated with national PPD prevalence.

METHODS

We conducted a systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To test for country level predictors, we drew on data from UNICEF, WHO, and the World Bank. Random effects meta-regression was used to test national predictors of PPD prevalence.

FINDINGS

291 studies of 296284 women from 56 countries were identified. The global pooled prevalence of PPD was 17.7% (95% confidence interval: 16.6-18.8%), with significant heterogeneity across nations (Q = 16,823, p = 0.000, I2 = 98%), ranging from 3% (2-5%) in Singapore to 38% (35-41%) in Chile. Nations with significantly higher rates of income inequality (R2 = 41%), maternal mortality (R2 = 19%), infant mortality (R2 = 16%), or women of childbearing age working ≥40 h a week (R2 = 31%) have higher rates of PPD. Together, these factors explain 73% of the national variation in PPD prevalence.

INTERPRETATION

The global prevalence of PPD is greater than previously thought and varies dramatically by nation. Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.

Association between secondhand smoke exposure and quality of life in pregnant women and postpartum women and the consequences on the newborns

PURPOSE

Secondhand smoke (SHS) exposure is prevalent and could damage the health of non-smokers, especially that of pregnant women (PW) and postpartum women (PPW). Nevertheless, there is no study on the impact of SHS during pregnancy on the quality of life (QOL) of PW and PPW. The study's purpose is to study the effects of exposure to SHS on the QOL of pregnant and postpartum women and health of the newborns.

METHODS

Self-reports and urine tests for cotinine were used to obtain data on SSH exposure in 296 women in the second trimester of pregnancy and 106 women in the postpartum period at the Obstetrics & Gynecology Clinic located in a university hospital. The WHOQOL-BREF-THAI and the Edinburgh Postnatal Depression Scale were used to assess QOL and postpartum depression, respectively.

RESULTS

Of the participants, 88.2% of PW and 62.3% of PPW reported exposure to SHS during pregnancy. Of the PPW, 5.7% had postpartum depression. PW with good QOL were less likely to have family member who smoked (p = 0.007) or to be exposed to SHS in public parks (p = 0.037) or in the household or workplace (p = 0.011). Likewise, PPW with good QOL in the psychological domain were less likely to be exposed to SHS during pregnancy, as shown in both verbal report (p = 0.010) and objective measure of urine cotinine test (p = 0.034). In addition, maternal exposure to SHS during pregnancy is associated with low birth weight and other health problems in the newborns (p < 0.05).

CONCLUSIONS

Exposure to SHS during pregnancy is associated with a lower QOL and a poorer health condition in the newborns.

Addressing the needs of new mothers in a multi-cultural setting: an evaluation of home visiting support for new mothers - Mom to Mom (Negev)

This study evaluated the Mom to Mom (M2M) program operating in the Negev region of Israel, an area with a high proportion of immigrants. M2M helps women cope with the first year of parenting through home visits of volunteer mothers. Specific objectives were to evaluate (1) Participants' motivations for joining M2M; (2) Gains from participation; and (3) The effect of participation on post-partum depression (PPD). Three stages included (1) Analysis of demographics of all 440 mothers in M2M; (2) A telephone survey of 51 mothers to assess gains from participation; and (3) 137 mothers filled out the Edinburgh Post-Natal Depression Scale (EPDS) and were followed for one year. Most mothers in M2M were first time mothers, with a high rate of perinatal complications (54.4%) and positive EPDS scores (38.7%). Two major reasons for participation were being an immigrant and having low income. The greatest gains from home visits were increased self-confidence, improved parenting skills and communication with the partner. Seventy-nine percent of mothers with PPD symptoms were functioning at work and at home after a year from joining the program. Our findings suggest that M2M has the capacity to address challenges in the post-natal period among women from diverse cultures.

Prevalence, continuation, and identification of postpartum depressive symptomatology among refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women: results from a prospective cohort study

This study assessed the prevalence, continuation, and identification of maternal depressive symptomatology over the first 16 weeks postpartum among refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women. A sample of 1125 women (143 refugees, 369 asylum-seekers, 303 non-refugee immigrant, and 310 Canadian-born) completed the Edinburgh Postnatal Depression Scale (EPDS) at 1 and 16 weeks postpartum. The sensitivity, specificity, and predictive power of the 1-week EPDS to identify women with elevated EPDS scores at 16 weeks were determined. The total number of women with EPDS scores >9 for each group at 1 and 16 weeks, respectively, was 26.6 and 18.2 % for refugees; 25.2 and 24.1 % for asylum-seekers; 22.4 and 14.2 % for non-refugee immigrants, and 14.8 and 7.4 % for Canadian-born. Using the cut-off score of 9/10, the 1-week EPDS accurately classified 77.6 % refugee, 73.4 % asylum-seeking, 76.6 % non-refugee immigrant, and 85.5 % Canadian-born women at 16 weeks with or without postpartum depressive symptomatology. The 1-week EPDS was significantly correlated to the 16-week EPDS (r = 0.46, p < 0.01). All groups were significantly more likely to exhibit depressive symptomatology at 16 weeks if they had EPDS scores >9 at 1 week postpartum: refugees (OR = 6.9, 95 % CI = 2.8-17.3), asylum-seekers (OR = 4.0, 95 % CI = 2.4-6.7), non-refugee immigrants (OR = 3.8, 95 % CI = 2.0-7.6), and Canadian-born women (OR = 8.0, 95 % CI = 3.3-19.8). Our findings suggest that refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women at risk of postpartum depression may be identified early in the postpartum period such that secondary preventive interventions may be implemented.

Screening mixed depression and bipolarity in the postpartum period at a primary health care center

INTRODUCTION

Mixed depression is a clinical condition accompanied by the symptoms of (hypo)mania and is considered to be a predictor for bipolar disorder. Compared to pure major depression, mixed depression is worse in progress. There are limited data on the prevalence of mixed depression since it is a relatively new entity. Therefore, the present study aimed to investigate the prevalence of mixed depression during the postpartum period which is risky for mood disorders.

METHODS

The study included 63 postpartum women. The participants were administered Beck Depression Scale, Edinburgh Postnatal Depression Scale (EPDS), Mood Disorders Questionnaire (MDQ), and Modified Hypomania Symptom Checklist-32 (mHCL-32).

RESULTS

The MDQ scores of the women with expected depression according to the EPDS cut-off scores, were significantly higher than the women with lower EPDS scores (t=-4.968; p<0.001). The modified hypomania scores were significantly higher in the women with higher depression scores compared to the women under EPDS cut-off scores (t=-4.713; p<0.001). According to the EPDS and BDS results, 27 (42.9%) and 14 (22.2%) women needed additional clinical examination for depression, respectively. In addition, 3 (4.8%) women require additional clinical examination for bipolar disorder. The scores for the first item of MDQ were above the cut-off value in 11 (17.5%) women. According to the mHCL-32 results, 50 (79.4%) women had at least 1 symptom, 45 (71.4%) women had at least 3 symptoms, and 43 (68.3%) women had at least 5 symptoms of mixed depression.

CONCLUSION

Postpartum mixed depression should be promptly diagnosed by using appropriate diagnostic tools, particularly by primary health care physicians. Patients with mixed depression should be closely monitored to avoid manic switch.

Prevalence of postpartum depression among immigrant women: A systematic review and meta-analysis

The aims of this systematic review and meta-analysis were threefold: to estimate the prevalence of postpartum depressive symptoms in immigrant women, compare this prevalence to non-immigrant women, and determine risk factors for postpartum depressive symptoms in immigrant women. Literature searches were conducted in PubMed, Embase, PsycINFO, Web of Science, Scopus, ResearchGate and Google Scholar databases from 1950 until October 2014. Twenty-four studies met the inclusion criteria of which 22 (12 cross-sectional and 10 prospective cohort) contributed data for meta-analyses. Heterogeneity and publication bias were assessed. The prevalence of postpartum depressive symptoms in immigrant women was 20% (95% confidence interval [CI] 17-23%, 18 studies, N = 13,749 women). Immigrant women were twice more likely to experience depressive symptoms in the postpartum period than non-immigrant women (pooled unadjusted odds ratio [OR] = 2.10 [95% CI 1.62-2.73, 15 studies, N = 50,519 women] and adjusted OR = 2.18 [95% CI 1.60-2.96, 7 studies, N = 35,557 women]). There was, however, evidence of publication bias with the pooled adjusted OR reduced to 1.63 (95% CI 1.22-2.17) after adjustment for bias. Risk factors associated with postpartum depressive symptoms among immigrant women included shorter length of residence in the destination country, lower levels of social support, poorer marital adjustment, and perceived insufficient household income. This study suggests that postpartum depression is a common condition among immigrant women. Moreover, immigrant women are at higher risk of postpartum depression than non-immigrant women. Further prospective studies on the risk factors of postpartum depression among immigrant women verified by a clinical diagnosis are needed.

Relationship between body mass index and women’s body image, self-esteem and eating behaviours in pregnancy: A cross-cultural study

This study examined the relationship between self-esteem, restrained eating, body image and body mass index during pregnancy. A total of 110 pregnant Israeli and UK women completed the Rosenberg Self-Esteem Questionnaire, the Dutch Eating Behaviour Questionnaire, scales to assess body image and demographics. Body mass index was calculated from antenatal records. Regression modelling determined the relationship between variables, countries and body mass index categories. High correlations were found between body image and body mass index with significantly higher body dissatisfaction for Israeli women. Self-esteem scores for pregnant women were similar to those reported for non-pregnant women. Poorer body image and higher prevalence of restrained eating were found in healthy weight Israeli women.

Sociodemographic risk factors of perinatal depression: a cohort study in the public health care system

OBJECTIVE

To assess the sociodemographic risk factors for the prevalence and incidence of relevant postpartum depressive symptoms.

METHOD

We studied a cohort of women in their perinatal period with the assistance of the public health system in the city of Pelotas-RS, Brazil. We assessed depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS) in the prenatal and postnatal periods. RESULTS We interviewed 1,109 women. The prevalence of meaningful depressive symptoms during pregnancy was 20.5% and postpartum was 16.5%. Women with prenatal depression were at higher risk for postpartum depression.

CONCLUSION

The mother's poverty level, psychiatric history, partner absence and stressful life events should be considered important risk factors for relevant postpartum depressive symptoms.

Evolution of perinatal depressive symptoms from pregnancy to two years postpartum in a low-risk sample: the MATQUID cohort

BACKGROUND

Few studies have explored the evolution of perinatal depressive symptoms (PNDS) throughout the perinatal period.

AIMS

To evaluate in a low-risk sample, whether different evolutive profiles of PNDS exist from pregnancy to 2-years postpartum, and whether the subgroups differ regarding psychopathological and demographic characteristics.

METHODS

In a prospective, longitudinal study from 8 months pregnancy to 2 years postpartum, repeated measures of PNDS using the CES-D were performed on a sample of 579 women at low-risk for PNDS. First, semiparametric mixture models were used to identify groups of women with distinct trajectories of PNDS. Second, multinomial logistic regressions were used to identify risk factors for each group.

RESULTS

Four distinct trajectories of PNDS evolution were found: (i) 72% of the women never presented with clinically significant depressive symptoms; (ii) 4% presented with depressive symptoms only during the postnatal period; (iii) 21% presented with depressive symptoms throughout the follow-up period, with a higher intensity during pregnancy; (iv) 3% presented with stable highly intense symptoms throughout the follow-up period. Psychosocial risk factors for PNDS were mainly identified in the patients of the third group, with an influence of socio-economical variables and anxiety traits.

LIMITATIONS

The main limitations of the present study are the small size of the sample and the low level of risk for PNDS, so the results cannot be extrapolated to all types of populations.

CONCLUSION

Different subtypes of evolutionary profiles of PNDS are found in a low-risk sample, and are associated with different profiles of risk factors.

Postnatal depression and its effects on child development: a review of evidence from low- and middle-income countries

INTRODUCTION OR BACKGROUND

It is well established that postnatal depression (PND) is prevalent in high-income countries and is associated with negative personal, family and child developmental outcomes.

SOURCES OF DATA

Here, studies on the prevalence of maternal PND in low- and middle-income countries are reviewed and a geographical prevalence map is presented. The impact of PND upon child outcomes is also reviewed.

AREAS OF AGREEMENT

The available evidence suggests that rates of PND are substantial, and in many regions, are higher than those reported for high-income countries. An association between PND and adverse child developmental outcomes was identified in many of the countries examined.

AREAS OF CONTROVERSY

Significant heterogeneity in prevalence rates and impact on child outcomes across studies means that the true extent of the disease burden is still unclear.

AREAS TIMELY FOR DEVELOPING RESEARCH

Nonetheless, there is a compelling case for the implementation of interventions to reduce the impact of PND on the quality of the mother-infant relationship and improve child outcomes.

Postpartum depression among Israeli Bedouin women

Postpartum depression (PPD) is a common complication of childbirth with prevalence estimated at 10-20% reported in many countries, including Israel. However, no data has been reported for Israeli Bedouin women, whose lifestyle is significantly different from that of the general population. This study aimed to determine the prevalence of PPD among Bedouin women in the southern Negev. The study included 104 women attending public health clinics for pregnancy and postpartum care. PPD symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). The rate of PPD symptoms was 43% at the EPDS cut-off score of 10, and 26% at the more stringent cut-off score of 13. This rate is considerably higher than reported rates among Israeli Jewish women. No significant difference was found between a score of ≥10 and maternal age, number of children, or level of education; however, at the EPDS score of ≥13, there was an inverse relationship between educational level and PPD symptoms. Lower rates were found among women whose pregnancies were planned and those who worked out of the home. The high rate of PPD among these Israeli Bedouin women challenges health authorities to find ways minimize the negative consequences for themselves, their children, and families.

The incidence of mental illness in early motherhood in a population-based survey

The present study examined the risk of mental disorders within the first 3 postpartum years in a nationally representative sample and the sociodemographic risk factors for mental illness in early motherhood. Women aged 18 to 55 years were asked, "Are you pregnant at this time?" at baseline. A total of 13,839 women answered, with 365 of these women reporting pregnancy. Mental disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV version. After adjusting for sociodemographics, postpartum women were found to be at lower risk than non-postpartum women for having several first onset mental disorders (adjusted odds ratio range: 0.49-0.58). Postpartum women with a history of mental illness were at lower risk for the onset of any mental disorder (adjusted odds ratio: 0.60, 95% confidence interval: 0.39-0.91). No sociodemographic correlates of mental disorders were identified. Clinicians should be aware of these findings when counseling women about mental disorder risk postbirth.

Postpartum depression among immigrant women

PURPOSE OF REVIEW

Although there has been an increase in research on postpartum depression (PPD), an inadequate focus has been placed on immigrant women. This is a significant limitation given the rapidly changing demographics in North America.

RECENT FINDINGS

Immigrants face unique and multiple layers of challenges that may compromise their mental health and prevent them from receiving adequate and equitable care. For immigrant women, many of these stressors are especially compounded in the vulnerable postpartum period, resulting in PPD. Cultural values and practices may be protective in some instances, whereas in other instances they exacerbate PPD. There is a significant gap in existing literature regarding the complex psychosocial, cultural, and spiritual factors that may moderate the effects of the depression. Furthermore, the measurement of PPD is hampered by cross-cultural methodological challenges.

SUMMARY

Given the complexity of the psychosocial issues facing immigrant women, there is a need to develop a comprehensive response toward addressing the multifaceted challenges, ensuring equitable immigration and related policies; adequate community resources and social services to address social determinants of health; inclusiveness in public health and prevention strategies; equitable access to a culturally competent healthcare system; capacity building of marginalized communities; and culturally competent interventions at the individual level. Additional research using the bidimensional model of acculturation is needed.

The relationships between physical violence, verbal abuse and women's psychological distress during the postpartum period

OBJECTIVE

To analyse the relationship between violence in the post-partum period and mothers' psychological distress.

METHOD

Three hundred and fifty two women responded to a questionnaire after the birth, at the Trieste Hospital (Italy), and 292 of them responded to a telephone interview 8 months later. Psychological distress was evaluated with the General Health Questionnaire (GHQ); partner and family violence were evaluated with a 28-item scale.

RESULTS

Eight months post-partum, 10% of women were experiencing violence either from the partner or from another family member; 5% showed high psychological distress. Multivariate analyses show that, after adjustment for covariates, the OR for depressive symptoms was 19.17 for women experiencing partner or family violence. Being dissatisfied with their working situation, hospitalisation of the baby and pre-pregnancy mental health were also significantly associated with high GHQ scores.

CONCLUSION

These results stress the relationship between violence in post-partum and maternal psychological distress. Measures aimed to identify and end violence against women around pregnancy could contribute to the improvement of women's mental health post-partum.

Post-adoption depression among adoptive mothers

OBJECTIVE

To evaluate the rate of depressive symptomatology and possible underlying factors in adoptive mothers during the transition to motherhood.

DESIGN

Cohort survey.

SETTING

General Community.

PARTICIPANTS

Thirty-nine adoptive mothers of reproductive age registered with international adoption agencies.

INTERVENTIONS

All women completed the Edinburgh Postnatal Depression Scale (EPDS), the Beck Depression Inventory (BDI), and the Brief Symptom Inventory (BSI) before and 6 weeks after the adoption.

MAIN OUTCOME MEASURES

Responses were compared between the study group and published findings for biological mothers in the general population, and within the study group, before and after adoption.

RESULTS

Symptoms of depression were found in 15.4% of the study group. This rate was similar to that for postpartum depression in the general population, and lower than the rate recorded in the study group before adoption (25.6%). All women with symptoms of depression after the adoption had also shown evidence of depressive features before the adoption. Similar findings were noted for other psychopathologies as well.

CONCLUSION

Adopting a child does not cause new-onset, reactive depression among adoptive mothers. It may even lead to a decrease in depressive features, perhaps in response to relief from other adjustment difficulties.

Violence and women's psychological distress after birth: an exploratory study in Italy

Our aim in conducting this study was to analyze the relationships between violence and maternal psychological distress 8 months after a birth, taking into account other important psychosocial factors, known to be associated both with violence and with new mothers' mental health. A total of 352 women responded to a questionnaire after the birth at a maternity hospital in northern Italy, and 292 also participated in a telephone interview 8 months later. We evaluated psychological distress with the General Health Questionnaire (GHQ), and partner and family violence with a 28-item scale. Eight months postpartum, 5% of women showed high psychological distress; 10% were currently experiencing violence from the partner or another family member. After adjustment for covariates, the odds ratio for depressive symptoms was 13.74 for women experiencing violence. We believe that these results provide support for the important role of violence in postpartum maternal psychological distress.

Antenatal psychosocial assessment for reducing perinatal mental health morbidity

BACKGROUND

Mental health conditions arising in the perinatal period, including depression, have the potential to impact negatively on not only the woman but also her partner, infant, and family. The capacity for routine, universal antenatal psychosocial assessment, and thus the potential for reduction of morbidity, is very significant.

OBJECTIVES

To evaluate the impact of antenatal psychosocial assessment on perinatal mental health morbidity.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, the Cochrane Depression, Anxiety and Neurosis Group's Trials Register (CCDAN TR-Studies), HSRProj in the National Library of Medicine (USA), and the Current Controlled Trials website: http://www.controlled trials.com/ and the UK National Research Register (last searched March 2008).

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials.

DATA COLLECTION AND ANALYSIS

At least two review authors independently assessed trials for eligibility; they also extracted data from included trials and assessed the trials for potential bias.

MAIN RESULTS

Two trials met criteria for an RCT of antenatal psychosocial assessment. One trial examined the impact of an antenatal tool (ALPHA) on clinician awareness of psychosocial risk, and the capacity of the antenatal ALPHA to predict women with elevated postnatal Edinburgh Depression Scale (EDS) scores, finding a trend towards increased clinician awareness of 'high level' psychosocial risk where the ALPHA intervention had been used (relative risk (RR) 4.61 95% confidence interval (CI) 0.99 to 21.39). No differences between groups were seen for numbers of women with antenatal EDS scores, a score of greater than 9 being identified by ALPHA as of concern for depression (RR 0.69 95% CI 0.35 to 1.38); 139 providers. The other trial reported no differences in EPS scores greater than 12 at 16 weeks postpartum between the intervention (communication about the EDS scores with the woman and her healthcare providers plus a patient information booklet) and the standard care groups (RR 0.86 95% CI 0.61 to 1.21; 371 women).

AUTHORS' CONCLUSIONS

While the use of an antenatal psychosocial assessment may increase the clinician's awareness of psychosocial risk, neither of these small studies provides sufficient evidence that routine antenatal psychosocial assessment by itself leads to improved perinatal mental health outcomes. Further studies with better sample size and statistical power are required to further explore this important public health issue. It will also be important to examine outcomes up to one year postpartum not only for mother, but also infant and family.

Stability and change in depressive symptoms from pregnancy to two months postpartum in childbearing immigrant women

The present study explored changes in mental health and functional status from pregnancy to 2 months postpartum in a sample of 106 childbearing immigrant women. Three sets of variables were examined in relation to postpartum depressive symptomatology: (1) prenatal depression, worries, and somatic symptoms; (2) social relationships (marital quality and social support), and (3) factors related to migration (premigration stress and length of stay in the host country). We found that 37.7% of the women in this community sample scored above the cutpoint of 12 on the Edinburgh Postnatal Depression Scale; prenatal depressive and somatic symptoms, as well as marital quality, were the best predictors of postpartum depressive symptomatology. An examination of differing trajectories from pregnancy to the postpartum period suggests that women with relatively few somatic complaints, low levels of perinatal stress, and satisfactory marital relations were less likely to exhibit mental health problems during pregnancy and postpartum. Women who were not depressed prenatally but reported postpartum depressive symptomatology exhibited several predisposing risk factors during pregnancy: many somatic complaints, high perinatal anxiety, and premigration stress. Women who were depressed during pregnancy but not postpartum reported improved physical function after childbirth. The implications of these findings for screening childbearing immigrant women are discussed.

[Diagnosis of depression in Sub-Saharan immigrants]

OBJECTIVE

The migratory process, its social-demographic characteristics, and the lack of integration into the social and health networks of Sub-Saharan immigrants could favour an increase in mental health-related pathology. The objective is to find the prevalence of depression among this population and its risk factors.

DESIGN

Cross-sectional, descriptive survey.

SETTING

Community of Madrid, Spain.

PARTICIPANTS

Sub-Saharan immigrants over 18 years old who attended 2 "Health Care Programmes for immigrants in the Community of Madrid" between August 2003 and February 2004.

MEASUREMENTS

Semi-structured interviews (DSM-IV criteria) conducted by trained staff and the Beck Depression Inventory were used to diagnose depression.

RESULTS

Of 606 Sub-Saharan immigrants, 55.45% were men. Average age was 27 +/- 6.61. Depression diagnosis was 5.4% (95% CI, 3.78-7.56). There was greater risk of depression among those immigrants who had lived in Spain for over 2 years (13.1%), among those who had children (10.7%), and among those with certain health problems, such as muscle and skeletal trouble (18.9%), gastro-intestinal problems (18.8%), neurology problems (17.4%), dermatology problems (20.5%) and fatigue (70.6%). Six percent of immigrants with depression took pharmacological treatment.

CONCLUSIONS

The prevalence of depression among Sub-Saharan immigrants is similar to that of the native population. There is an increase as they stay longer in our country, probably due to their social and economic situation, which over time can act as a chronic stress factor. The other main fact is the lack of treatment of immigrants diagnosed with depression.

Healthcare worker's perceptions of barriers to care by immigrant women with postpartum depression: an exploratory qualitative study

OBJECTIVE

We interviewed healthcare workers working in Toronto, Canada, regarding their experience of providing care to recent immigrant women suffering from postpartum depression. The objective was two-fold: 1) to identify potential barriers to care that recent immigrant women may encounter as perceived by healthcare workers; and 2) to identify challenges healthcare workers felt that they faced as providers of care to this population.

METHODS

Qualitative semi-structured interviews were conducted with 16 key informants from various disciplines employed by healthcare agencies providing care to postpartum immigrant women in Toronto. Constant comparative analysis was used to analyze the data.

RESULTS

Two main categories of barriers to care for recent immigrant women were identified: 'practical barriers' and 'culturally determined barriers'. Practical barriers included knowing where and how to access services, and language difficulties. Cultural barriers included fear of stigma and lack of validation of depressive symptoms by family and society. The challenges experienced by healthcare providers working with this population were organized into two other categories: 'professional limitations', and 'social/cultural barriers'. 'Professional limitations' included fear of incompetence, language barriers, and inadequate assessment tools. 'Social/cultural barriers' included the experience of cultural uncertainty.

CONCLUSIONS

The results suggest that not only are there important barriers to accessing postpartum care for recent immigrant women, but it can also be challenging for healthcare workers to deliver such needed care. Understanding some of these barriers and challenges from the perspective of healthcare providers is an important step to remedying gaps and obstacles in the service system.

Perinatal depression: hiding in plain sight

OBJECTIVE

To promote prompt identification and treatment ofperinatal depression and enhance preventive care for women at risk.

METHODS

Using MEDLINE and PubMed searches, we reviewed the recent research on the origins, course, and consequences of pregnancy-related depression.

RESULTS

Depressive disorders are more common in pregnancy and postpartum than widely assumed, and there is no predictable protective effect of pregnancy. Relapse rates are high, and the postpartum period represents a time of increased vulnerability to depression.

CONCLUSION

Early identification and treatment ofperinatal depression will minimize morbidity and mortality for the woman, the child, and the family.

Demographic characteristics of participants in studies of risk factors, prevention, and treatment of postpartum depression

OBJECTIVES

Metaanalyses have found that sociodemographic variables are not strong predictors of postpartum depression. However, no studies have systematically examined the extent to which the samples used in published research on postpartum depression have included sufficiently diverse samples of women to merit this conclusion. The objectives o this study were to examine the demographic characteristics of participants in previously published studies and to document existing gaps in the current literature.

METHOD

We extracted age, ethnicity, relationship status, and socioeconomic status of 51 453 participants from 143 studies previously selected for systematic literature reviews.

RESULTS

Few studies reported complete demographic data; however, existing data indicate that participants were predominantly aged 25 to 35 years, white, partnered, and of mid- or high-socioeconomic status.

CONCLUSIONS

To assess the external validity of the findings, improved reporting of demographic characteristics is required in publications related to postpartum depression. Additional research is needed to understand postpartum depression among understudied populations.

Depressive symptomatology in the immediate postnatal period: identifying maternal characteristics related to true- and false-positive screening scores

OBJECTIVE

To determine whether true- and false-positive postnatal depression screening scores can be distinguished during the early postpartum period by examining characteristic differences between 2 groups: 1) women with depressive symptomatology at 1 week postpartum who continue to exhibit symptoms at 8 weeks postpartum, compared with those who do not; and 2) women with depressive symptomatology at 8 weeks postpartum who previously exhibited symptoms at 1 week postpartum, compared with those who did not.

METHOD

As part of a longitudinal postpartum depression study, a population-based sample of 594 women completed mailed questionnaires at 1, 4, and 8 weeks postpartum.

RESULTS

Among women with depressive symptomatology at 1 week postpartum, diverse variables distinguished between those whose symptoms persisted or remitted at 8 weeks. These variables included recent immigrant status, psychiatric history, premenstrual symptoms, vulnerable personality, low self-esteem, child abuse history, and insufficient support. Variables that distinguished between women with depressive symptomatology at 8 weeks postpartum who previously exhibited symptoms at 1 week postpartum and those who did not included vulnerable personality, life stressors, perceived stress, insufficient support, and partner conflict.

CONCLUSIONS

To address both the benefits and potential harms of early screening, positive screening scores on the Edinburgh Postnatal Depression Scale should also include an assessment of each individual woman's risk for postpartum depression and (or) chronic major depression.

Risk factors associated with the development of postpartum mood disorders

BACKGROUND

Various factors have been reported to be associated with the development of postpartum mood disorders. The relationship between postpartum mood disorders and putatively hormone-related phenomena such as premenstrual dysphoric disorder (PMDD) is unclear. This study attempts to determine whether such mood phenomena are risk factors for postpartum mood disorders.

METHODS

Postpartum women (n=1800) were assessed for risk factors for postpartum mood disorders during the first 2-4 days after parturition. Of these, 133 were defined as "high risk" and 109 as "low risk" according to fixed criteria. A structured phone diagnostic interview was performed at 6-8 weeks postpartum to assess for the presence of postpartum depression or the blues.

RESULTS

Premenstrual dysphoric disorder (PMDD), mood symptoms during the first 2-4 days postpartum, a past history of depression and mood symptoms during past oral contraceptive use, were found to be significant risk factors for postpartum mood disorders. Women at high risk for postpartum mood disorders had a 9.3-, 1.5-, 1.6- and 2.6-fold increase in risk for major depression, minor depression, the blues and adjustment disorder respectively compared to women at low risk.

LIMITATIONS

While the study design is prospective, it is limited by the retrospective assessment of risk factors.

CONCLUSIONS

This study provides preliminary evidence that putatively hormone-related phenomena such as PMDD are related to the occurrence of postpartum mood disorders. The results go some way to support the hypothesis that the etiology for postpartum mood disorders may be related to differential hormonal sensitivity. Such risk factors should be included in any assessment of the risk for these disorders.

Implications of Ethnic Group Origin for Israeli Women’s Mental Health

Israel is an immigrant society comprised of diverse ethnic groups differentiated by variables such as emigration history, health status, educational level, and economic status. The major question addressed in this study is whether differences in women's mental health status are related to ethnic group origin, per se, or rather can be explained by the associated social-demographic strata. The impact of ethnic group origin, social support, health status, education, and economic difficulties was assessed on a set of mental health outcomes. The analysis was carried out in a random sample of 522 women residing in the Negev region of Israel-a culturally diverse area. The findings indicate that social support, economic status, health status, and ethnic group origin all contribute to shaping women's mental health status.

Factors associated with depression in pregnant immigrant women

This study examined psychosocial risk factors for depressive symptomatology in a community sample of pregnant immigrant women in Montreal, Canada. One hundred and nineteen participants were recruited through hospitals and responded to questionnaires assessing depression, somatic symptoms, functional status, social support, stressful life events and marital adjustment. Forty-two percent of participants scored above the cut-off for depression. Depressive symptoms were associated with poorer functional status and more somatic symptoms. Depressed women reported a lack of social support, more stressful life events and poorer marital adjustment. Transitions associated with migration may place pregnant immigrant women at high risk for depression.

Identifying women at-risk for postpartum depression in the immediate postpartum period

OBJECTIVE

To develop a multifactorial predictive model of depressive symptomatology in the first week postpartum in order to assist in targeted screening procedures.

METHOD

As part of a longitudinal study, a population-based sample of 594 mothers in a health region near Vancouver, British Columbia completed a mailed questionnaire at 1-week postpartum that included diverse risk factors from the following domains: sociodemographic, biological, pregnancy-related, life stressors, social support, obstetric and adjustment to motherhood. Following univariate analysis, sequential regression analysis was completed to develop a multifactorial predictive model.

RESULTS

In the multivariate model, the factors predictive of depressive symptomatology at 1-week postpartum included immigration within the last 5 years, history of depression independent of childbirth, diagnosis of pregnancy-induced hypertension, vulnerable personality style, stressful life events, lack of perceived support, lack of readiness for hospital discharge and dissatisfaction with infant feeding method.

CONCLUSION

The findings suggest that several risk factors for depressive symptomatology in the immediate postpartum period are consistent with previously identified factors but other factors such as recent immigrant status, feeling unready for hospital discharge, dissatisfaction with their infant feeding method, and pregnancy-induced hypertension should also be examined.

A Cross-Sectional Prevalence Study of Depression at Various Times after Delivery in Mersin Province in Turkey

BACKGROUND

Postpartum depression (PPD) is defined as a major depression occurring after delivery. Depression in mothers postpartum may affect the development of the infant and life quality of the mother negatively. In this study, PPD prevalence in the first 2 months after delivery was compared with the prevalence in later periods.

METHODS

This study was conducted in 2001 in the province of Mersin in Turkey. In-home questionnaires were given to nonpregnant married women age 15-44 years from primary healthcare centers identified through a multistage, stratified sampling method. Depression was defined as a score of 13 or higher on the Edinburgh Postpartum Depression Scale (EPDS).

RESULTS

Data were available on 1447 women. PPD prevalence was 29.0% at 0-2 months, 36.6% at 3-6 months, 36.0% at 7-12 months, and 42.7% >or= 13 months postpartum. PPD prevalence in the 0-2-month postpartum period was lower than in the other groups (F = 4.6, p < 0.01). The prevalence increased with the time since delivery. When compared with the prevalence in months 0-2, PPD risk was 1.41 times greater in months 3-6, 1.37 times greater in months 7-12, and 1.82 times greater in months >or=13 (chi-square for trend test = 11.7, p < 0.001).

CONCLUSIONS

In this Turkish population, PPD prevalence was substantial at all time points. The prevalence was at its lowest level before the second postpartum month and increased with time. The decrease in the intensive social and physical support given to the mother immediately after delivery may explain this trend.

Postpartum depression and related psychosocial variables in Hong Kong Chinese women: Findings from a prospective study

Research on predictors of postpartum depression (PPD) in Hong Kong (HK) Chinese women is scant. A prospective study with 385 HK Chinese postpartum women was conducted to identify correlations between PPD and demographic variables, and antenatal depression and psychosocial variables, and to determine which of these variables were predictors of PPD. Using the Edinburgh Postnatal Depression Scale (EPDS), we classified 19.8% of participants as postnatally depressed. Fifty-six percent of the variance in PPD was explained by social support and stress factors. However, social support factors accounted for only a small percentage of that variance. The major predictors were antenatal depression, postnatal perceived stress, and childcare stress. HK women may benefit from a culturally appropriate intervention focused on reducing stress in the postpartum period.

Antenatal screening for postnatal depression: a systematic review

OBJECTIVE

To describe the screening properties of the antenatal tools which have been developed to predict depression after birth and to summarize the implications of the findings for antenatal screening.

METHOD

Systematic review and secondary analysis of published papers.

RESULTS

Sixteen studies including sufficient data for the calculation of screening properties were identified. The majority developed a study-specific screening instrument. Outcome assessments used the Edinburgh Postnatal Depression Scale or standardized diagnostic psychiatric interviews, or both. In the two largest population-based studies, the proportion of women screening as positive ('at risk' of postnatal depression) was 16 and 52%, respectively, and of these only 35 and 8% actually developed depression after birth.

CONCLUSION

No screening instrument(s) met the criteria for routine application in the antenatal period. Factors that may have affected poor sensitivity and positive predictive values include the exclusion of key domains in predicting risk, particularly personality, a past history of abuse and postnatal events, the contribution of which may be being under-estimated in studies evaluating antenatal risk prediction tools.