Cross-National Differences in Psychosocial Factors of Perinatal Depression: A Systematic Review of India and Japan

Effects of Parental Predictors on Postpartum Depression

BACKGROUND

Postpartum depression (PPD) is highly prevalent and plagues a significant proportion of parents. Postpartum depression also exerts various negative consequences on infant development and parent-infant relationships. Social support is identified as an important factor influencing many parental predictors, and may affect the development of PPD.

OBJECTIVE

This study aimed to investigate how perceived social support can indirectly influence PPD symptoms in parents at 6 months postpartum by influencing postpartum anxiety, parental satisfaction, and parental self-efficacy (PSE).

METHODS

A secondary analysis of data from a randomized controlled trial was used with a cross-sectional exploratory design. A total of 400 Singaporean parents (200 couples) were included, and structural equation modeling was used to analyze the relationships between PPD and potential predictors.

RESULTS

Findings revealed a less adequate fit between the hypothesized model and the data collected. Social support was found to be a significant predictor of postpartum anxiety, PSE, and parental satisfaction. Postpartum anxiety was a significant predictor of PPD, but PSE and parental satisfaction were not.

CONCLUSION

This study provides an overview of how different parental predictors may be associated with PPD among Asian parents. Postpartum anxiety significantly predicted PPD, but social support had negative effects on postpartum anxiety, parenting satisfaction, and PSE. The findings provide further insight into how parents at risk of PPD can be identified and demonstrated how social support might negatively impact parental outcomes. More qualitative research with Asian parents is needed to further explain these findings and inform the development of future interventions.

A parent-rating scale of postpartum depression: Maternity-monitoring scale by parents (MMSP)

Postpartum depression (PPD) is an illness that is difficult for the affected women themselves to recognize. Moreover, many mothers believe that mothers should not complain about the mental difficulties of taking care of their children. Therefore, in addition to self-evaluation for PPD, evaluation from others is also necessary. We aimed to develop a novel measure to screen for PPD based on a parent-rating scale that is administered to the parents of postpartum mothers. The 15-item maternity-monitoring scale by parents (MMSP) was designed and applied to the feasibility cohort (n = 61) and the emergency cohort (n = 55). The Edinburgh Postnatal Depression Scale (EPDS) (threshold score of 8/9) was used to evaluate a high risk of PPD. An egogram-based index, the over-adaptation index for depression (OAID), was performed along with the EPDS and MMSP. In the feasibility cohort, MMSP was moderately correlated with EPDS. In the emergency cohort, under the circumstance of the state of emergency declaration over the coronavirus disease 2019 in Japan, application of the MMSP was delayed, resulting in the proportion of parents who overlooked PPD symptoms in their daughters increasing from 33 % to 50 %. Our findings suggest that a novel approach of parent-rated PDD screening of postpartum women is potentially possible, and the MMSP is a potential candidate for screening. Moreover, the OAID is also helpful in identifying women with hidden PPD, along with the EPDS. The performance of the MMSP should be confirmed in the parents of patients with PPD diagnosed by psychiatrists.

Development of a family-community interaction programme in the treatment of women with postpartum depression: protocol for a randomised controlled trial

INTRODUCTION

Postpartum depression has great harm and becomes a serious public health problem. Most women stay at home after childbirth, so the support from community and family is particularly important in the treatment of postpartum depression. The cooperation between family and community can effectively improve treatment effect of patients with postpartum depression. It is imperative to conduct a study on the collaboration and interaction among patients, family and community in the treatment of postpartum depression.

METHODS AND ANALYSIS

The aim of this study is to determine the experience and demands of patients with postpartum depression, family caregivers and community providers for the interaction, construct an interaction intervention programme bettween family and community and promote the rehabilitation of patients with postpartum depression. From September 2022 to October 2022, this study will select postpartum depression patient families from seven communities in Zhengzhou City, Henan Province in China. The researchers, after training, will conduct semi-structured interview to collect research data. According to the integration results of qualitative research and literature review, the interaction intervention programme will be constructed and revised using the Delphi expert consultation method. Then the participants will be selected to accept the intervention of the interaction programme and evaluated through questionnaires.

ETHICS AND DISSEMINATION

The study is approved by the Ethics Review Committee of Zhengzhou University (ZZUIRB2021-21). The results of this study will contribute to clarify the responsibilities of family subjects and community subjects in the treatment of postpartum depression, more effectively promote the rehabilitation of patients with postpartum depression and reduce the burden of family and society. Moreover, this research will be a profitable exploration at home and abroad. And the findings will be disseminated through conference presentations and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

ChiCTR2100045900.

Association of maternal psychological distress and the use of childcare facilities with children's behavioral problems: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

BACKGROUND

Childcare facilities are a factor that lowers the established association of mother's postnatal psychiatric symptoms with children's behavioral problems. However, no studies have considered the prenatal psychiatric symptoms yet. This study examined whether the use of childcare facilities moderates the association of maternal psychological distress in early pregnancy and at two years postpartum with behavioral problems in children aged four years.

METHODS

The present study was based on the data from 23,130 mother-child pairs participating in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. K6 was used to classify maternal psychological distress in early pregnancy and at two years postpartum into four categories: none in both prenatal and postnatal periods (none), only the prenatal period (prenatal only); only the postnatal period (postnatal only); both prenatal and postnatal periods (both). The children's behavioral problems were assessed using the Child Behavior Checklist for Ages 1½-5 (CBCL) aged four years. The clinical range of the externalizing, internalizing, and total problem scales of the CBCL was defined as having behavioral problems. To examine whether availing childcare facilities moderates the association between maternal psychological distress and children's behavioral problems, we conducted a stratified analysis based on the use of childcare facilities or not, at two years of age. The interaction term between maternal psychological distress and use of childcare facilities was included as a covariate in the multivariate logistic regression analysis to confirm the p-value for the interaction.

RESULTS

The prevalence of the clinical ranges of externalizing problems, internalizing problems, and clinical range of total problems were 13.7%, 15.4%, and 5.8%, respectively. The association of maternal psychological distress with a high risk of children's behavioral problems was significant; however, the association between prenatal only psychological distress and externalizing problems in the group that did not use childcare facilities was not significant. Interactions between the use of childcare facilities and maternal psychological distress on behavioral problems in children were not significant.

CONCLUSIONS

Use of childcare facilities did not moderate the association of maternal psychological distress in early pregnancy and at two years postpartum with behavioral problems in children aged four years.

Development of a scale for parent-to-baby emotions: Concepts, design, and factor structure

Aim

Although infant crying is a prerequisite for a baby's survival, it often leads to negative consequences for the caregivers. We hypothesized that this would be mediated by a primary emotion that we feel directly in response to an internal or external event. Hence, this study aimed to develop a new scale to measure basic and self-conscious emotions as primary emotions towards an infant's cry.

Methods

We conducted a cross-sectional web survey including the scale for parent-to-baby emotions (SPBE)-with 73 items elicited from a literature review-targeted at mothers at 1 month after childbirth (N = 879). A series of explanatory and confirmatory factor analyses were conducted using item parcels. Internal consistency of the scale was calculated by omega indices. We also examined measurement invariance of the scale.

Results

The theory-driven six basic emotions bifactor model (comparative fit index [CFI] = 0.968, root mean square of error approximation [RMSEA] = 0.070) and four self-conscious emotions factor model (CFI = 0.973, RMSEA = 0.079) were judged as the best models. They were stable in terms of configural, measurement, and structural invariances across parity.

Conclusion

The SPBE we created is a psychometrically robust measure to assess the primary emotions under the rubric of parent-to-baby emotions. It is a promising tool for measuring parent-to-baby emotions in clinical and research settings.

Perinatal maternal depressive symptoms and risk of behavioral problems at five years

BACKGROUND

Evidence on the association between perinatal maternal depression and children's behavioral development is limited. We investigated the association between maternal depressive symptoms during pregnancy and postpartum and the risk of childhood behavioral problems using data from a birth cohort study.

METHODS

Study subjects were 1199 mother-child pairs. Maternal depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale during pregnancy and the Edinburgh Postnatal Depression Scale at 4 months postpartum. Children's behavioral development at 5 years of age was assessed with the Strengths and Difficulties Questionnaire.

RESULTS

Compared with children whose mothers did not experience depressive symptoms during pregnancy, those whose mothers did experience depressive symptoms during pregnancy had increased risk of emotional symptoms, conduct problems, hyperactivity, peer problems, and low prosocial behavior. Maternal depressive symptoms at around 4 months postpartum were associated with increased risk of childhood emotional problems. Compared with children whose mothers did not experience depressive symptoms during the perinatal period, those whose mothers did experience depressive symptoms both during pregnancy and postpartum had a fivefold increased risk of childhood emotional symptoms and a threefold increased risk of peer problems.

CONCLUSIONS

Our findings suggest that perinatal maternal depression is associated with behavioral problems in children.

IMPACT

Several epidemiological studies in Western countries have examined the association between perinatal maternal depression and children's behavioral development, yet the results are conflicting and inconclusive. There is limited evidence on this topic in Asia. In our study using data from a prospective pregnancy birth cohort, maternal depressive symptoms around 4 months postpartum were associated with an increased risk of emotional symptoms in children aged 5 years. Children whose mothers had exhibited depressive symptoms both during pregnancy and postpartum had a fivefold increased risk of childhood emotional symptoms and a threefold increased risk of peer problems.

Social and obstetric risk factors of antenatal depression: A cross-sectional study from South-India

PURPOSE

Antenatal depression is as prevalent as postpartum depression and studies on it are very few. It has been relatively neglected leading to adverse effects on the growing child as well as the mother. Hence screening of depression in high risk individuals, planning and adopting important strategies for prevention needs to be undertaken. Our study aimed to assess the modifiable social and obstetric risk factors of antenatal depression.

METHODS

Third trimester pregnant women of 18-40 years attending obstetric out-patient department and admitted in tertiary hospitals who had no past psychiatric illness were screened using Edinburgh postnatal depression scale after obtaining written consent, socio-demographic and obstetric details. Statistical analysis was calculated using IBM version SPSS 23.

RESULTS

Among 222 women recruited, 25.6% had antenatal depression. Significant associations were found between lower level of education (p = 0.02,O.R=1.87), urban population (p = 0.04,O.R=5.139), intimate partner violence (p = 0.01,O.R=15.769), daily alcohol use by husband (p < 0.00,O.R=15.281), poor relationship with in-laws (p < 0.000,O.R=21.733) and parents (p < 0.000,O.R=15.281), number of previous pregnancies (p = 0.026,O.R=5.545), parity (p = 0.04,O.R=4.187), previous abortions (p = 0.007,O.R=2.834), fear of labour (p < 0.000,O.R=5.77) and complications during pregnancy (p < 0.000,O.R=3.017) with antenatal depression. Living in urban area (p = 0.023, A.O.R=3.132), fear of labour (p < 0.000, A.O.R=7.398), intimate partner violence (p = 0.026, A.O.R=36.655), poor relationship with in-laws (p = 0.001, A.O.R=36.855) and parents (p = 0.042, A.O.R=8.377) were found to be predictors of antenatal depression.

CONCLUSION

Antenatal depression is multifactorial in origin and requires a multifactorial approach in prevention and treatment. Routine antenatal screening for depression must be conducted with efforts to build strong family, peer and social support at community level.

Assessment of the Postpartum Emotional Wellbeing among Women Participating and Not Participating in Antenatal Classes

The perinatal period is associated with an increased risk of emotional disorders. Exposure to stress impacts the functioning of the maternal brain, also shaping the developmental processes of the child's brain. To assess the emotional wellbeing of women participating and not participating in antenatal classes. The study involved a group of 200 women divided into two groups: the study group, participants of the antenatal classes (N = 100), and the control group, not participating in the antenatal classes (N = 100). The Edinburgh Postnatal Depression Scale (EPDS) and Mini-COPE inventory were used. EPDS was administered at two time points: on the 2nd day of puerperium and 6 weeks after the delivery, while Mini-COPE inventory was applied once during pregnancy. Severe symptoms of depression on the 2nd day after childbirth concerned 16.0% of the women (N = 15) participating in the antenatal classes and 11.0% of the controls (N = 11). Intensification of depressive symptoms 6 weeks after the delivery occurred in 19.5% of the females attending antenatal classes (N = 17) and 18.8% of the controls (N = 18). Severe symptoms of depression 6 weeks after the delivery in the group of women participating in antenatal classes were significantly related to adopting helplessness to cope with stress and a sense of being accepted by the husband/partner, family, and society. In the case of women not participating in antenatal classes, the severity of symptoms of depression 6 weeks after the delivery was slightly related to the sense of acceptance by the husband/partner, family, and society. Apart from identifying risk factors for emotional disorders in pregnancy, it is worth taking into account whether a woman participated in antenatal classes when planning the care in the perinatal period. This factor can be a potential protective factor in preventing emotional problems after childbirth.

The Value of HPA Axis Hormones as Biomarkers for Screening and Early Diagnosis of Postpartum Depression: Updated Information About Methodology

Because of the high prevalence of postpartum depression (PPD) and the suffering involved, early diagnosis is urgent; however, current screening tools and diagnosis are inadequate. In addition to conventional methods such as the Edinburgh Postnatal Depression Scale and clinical interviews, several hormones in the hypothalamic-pituitary-adrenal (HPA) axis, such as corticotrophin-releasing hormone, adrenocorticotropic hormone, and cortisol, have been considered because of their critical roles in stress regulation in the mothers. The study designs are complicated, however, and so the effectiveness of these hormones as biomarkers for PPD is still controversial. Such inconsistency may have resulted from the variation in methodology between studies. The methodology problems in the investigation of PPD and HPA axis hormones have not been reported extensively. We therefore sought to summarize the methodological problems of studies published in the past decade, including the strengths and weaknesses of the examinations and the technological difficulties involved. Our findings suggest that (a) suitable samples and appropriate detection methods would reduce heterogeneity among trials; (b) the cutoff value of the scale test should be carefully selected for determining the performance of biomarker tests; (c) evaluation methods and criteria should be chosen with consideration of the tools feasible for use in local hospitals and population; and (d) the cost of diagnosis should be reduced. We hope that these findings provide insight for future investigations of HPA axis hormones as biomarkers for screening and early diagnosis of PPD.

Sense of Coherence, Social Support, Maternal-Fetal Attachment, and Antenatal Mental Health: A Survey of Expecting Mothers in Urban India

Introduction: Pregnancy is associated with psychological, physiological and social shifts, and can be a vulnerable time in a woman's life. Despite a growing understanding of the importance of antenatal mental health, there is a paucity of research on psychosocial factors relevant to this phase, especially in developing countries. The aim of the present study was to investigate the associations of expecting mothers' sense of coherence, perceived social support, and maternal-fetal attachment with mental health outcomes. Method: Participants (N = 122) were nulliparous expectant mothers residing in urban India. Cross-sectional data was collected using an online questionnaire. Results: Participant reports of perceived social support and sense of coherence were negatively correlated with symptoms of antenatal depression, while reports of maternal-fetal attachment, sense of coherence, and social support were positively associated with antenatal well-being. In a multilinear regression model, perceived social support and sense of coherence uniquely contributed to symptoms of antenatal depression, while maternal-fetal attachment and sense of coherence uniquely contributed to antenatal well-being. Discussion: The findings of this study highlight the role of perceived social support, sense of coherence and maternal-fetal attachment in contributing to expecting mothers' mental health and well-being in urban India. These findings have implications for clinical practice and research, intending to the subjective experiences of pregnant women to improve antenatal mental health. Future research investigating these psychosocial factors using longitudinal designs is warranted and would help clinicians and practitioners identify women at risk for perinatal mental health concerns.

Father-child bonding among Japanese fathers of infants: A municipal-based study at the time of the 4-month child health checkup

We aimed to clarify the factor structure of a bonding measure among Japanese fathers with infants and the factors associated with the subscales. Among fathers of children attending the 4-month health checkup, the Japanese version of the Mother-to-Infant Bonding Scale had a two-factor structure comprising "anger" and "lack of affection." Anger was associated with fathers' work demands and poor mental condition, and lack of affection with fathers' older age, poor mental condition, and interpersonal problems at home. Paternal parenting support needs to account for not only the fathers themselves, but also interpersonal communication at home and in the work environment.

Does the Mode of Conception Influence Early Postpartum Depression? A Prospective Comparative Study from South India

BACKGROUND

Besides infertility, the treatment associated with it is potentially related to psychological stress to mothers. This study was conducted to know whether the mode of conception has any association with early postpartum depression.

METHOD

A prospective cohort study was conducted on postnatal mothers at a tertiary care hospital from January to June 2019. The study participants were divided into two groups: postnatal mothers who delivered following spontaneous conception and assisted conception. Basic sociodemographic and obstetric details were collected. Postnatal depression assessment was done at the end of first and sixth week after delivery on all the mothers by using the Edinburgh Postnatal Depression Scale (EPDS).

RESULTS

In total, 110 subjects (55 in each group) were included in the study. The primary outcome measured was the presence of postpartum depression (EPDS score ≥10). The mean (±SD) age of the participants was 29 ± 6.4 years. The sociodemographic profiles of the two groups were comparable except for mean age, mode of delivery, socioeconomic status, prepregnancy body mass index -the group differences in these variables were statistically significant (P ≤ 0.05). There was no significant difference in the EPDS scores at one week or six weeks of postpartum among the two groups. Comparison of EPDS score among the two groups by Fisher's exact test showed that those mothers with a past history of depression were more likely to have postpartum depression immediately after delivery.

CONCLUSION

Mode of conception was not associated with an increase in postpartum depression among women who underwent infertility treatment.

An Illustration of Interpersonal Psychotherapy for Perinatal Depression

This is a case of a 38-year-old married woman presenting with major depressive disorder one month after the birth of her third child. The depressive episode began in the context of interpersonal difficulties with her husband. In addition, she was also battling an internal conflict of continuing to pursue her career dream as an obstetrician and fulfilling her responsibility as a wife and a mother. Interpersonal psychotherapy (IPT) was selected as the treatment choice as an evidence-based peripartum treatment that could specifically address the two presenting problem areas, i.e., marital interpersonal dispute and role transition. This paper provides an illustration of IPT sessions conducted with verbatim selections of the sessions.

Postnatal Depression Risk Factors: An Overview of Reviews to Inform COVID-19 Research, Clinical, and Policy Priorities

The disruption of normal life due to the COVID-19 pandemic is expected to exacerbate extant risk factors for mental health problems. This may be particularly true for women who give birth during the crisis, especially those at risk for postnatal depression. Maternal postnatal depression has been identified as a public health issue with profound impacts on maternal and child well-being. Evidence from previous crises (e.g., earthquakes, terrorist attacks) has shown that crises significantly impact maternal mental health and some perinatal health outcomes. The aims of this paper were therefore to conduct a review to identify the established risk factors for maternal postnatal depression, and generate evidence-based hypotheses about whether the COVID-19 crisis would likely increase or decrease postnatal depression rates based on the identified risk factors. Several databases were searched during May-June 2020 for review papers (i.e., systematic reviews, meta-analyses, qualitative syntheses) using the following keywords: Depression, perinatal, postnatal, postpartum, systematic, review, predictors. Risk factors were extracted in conjunction with indicators for their strength of evidence (i.e., effect sizes, qualitative coding). Risk factors were critically evaluated in relation to their susceptibility to the impacts of the COVID-19 crisis. It was hypothesized that several health policies that were necessary to reduce the spread of COVID-19 (e.g., required restrictions) may be simultaneously impacting a range of these known risk factors and placing a larger number of women at heightened risk for postnatal depression. For instance, factors at a strong risk of being exacerbated include: Perceived low social support; exposure to traumatic events during or prior to pregnancy; significant life events occurring during pregnancy; and high stress associated with care of children. Future research and policy implications are discussed, including how policy makers could attempt to ameliorate the identified risk factors for postnatal depression following the current COVID-19 pandemic.

The association between social support through contacts with Accredited Social Health Activists (ASHAs) and antenatal anxiety among women in Mysore, India: a cross-sectional study

PURPOSE

In India, antenatal anxiety prevalence estimates range from 6 to 48%. Social support is strongly associated with mental wellbeing, yet most studies have examined the impact of support from partners and family members rather than peers, community members, or health care providers. This study explores the supportive role of Accredited Social Health Activists (ASHA) contacts for antenatal anxiety.

METHODS

Data were analyzed from the Saving Children, Improving Lives project, a quasi-experimental study conducted among rural, pregnant women in India. Regression models were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals for the relationship frequency of ASHA contacts and antenatal anxiety. Antenatal anxiety was measured using a subscale of the Edinburgh Postnatal Depression Scale.

RESULTS

The sample consisted of 480 pregnant women. Reported antenatal anxiety prevalence was 27% (95% CI 23%, 31%). Participants who were more frequently visited by ASHAs at home (aPR: 0.90; 95% CI 0.76, 0.98) and more frequently accompanied by ASHAs to their antenatal care visits (aPR: 0.86, 95% CI 0.78, 0.95) were less likely to report antenatal anxiety. ASHA home visits were protective for the most vulnerable women (primigravida and those experiencing domestic violence) and ASHA accompaniment to antenatal care visits was equally protective for all women.

CONCLUSIONS

ASHAs are valued for their contribution towards maternal health education and linking women of reproductive age to healthcare services. Our findings additionally suggest the important role ASHAs play in providing social support to pregnant women, particularly those who are most vulnerable to experiencing antenatal anxiety.

Paternal Involvement and Adverse Birth Outcomes in South Gujarat, India

BACKGROUND AND OBJECTIVES

While the impact of maternal factors on birth outcomes are widely reported, the extent to which paternal involvement and varying cultural family dynamics influence birth outcomes particularly in an international context, remain understudied. The purpose of this study was to assess the relationship between paternal involvement and adverse birth outcomes in South Gujarat, India.

METHODS

An in-person questionnaire was administered to adult women at delivery or during the one-month postpartum visit at New Civil Hospital, in South Gujarat, India between May and June 2016 to assess level of paternal support and attendance at prenatal appointments and household structure. Pregnancy variables including birthweight and gestational age at delivery were collected from maternal and newborn record/chart review. Chi-square and t-test were used to assess demographics, as appropriate. Logistic regression was used to examine the association between paternal involvement and pregnancy birth outcomes.

RESULTS

Of the 404 infants born during the study period, 26.7% were premature (<37 weeks gestation) and 29% were of low birth weight (<2500g). More than 40% of the women surveyed reported their in-laws were the primary household decision-makers; however, those who reported high paternal attendance were less likely to report in-laws as the primary decision-maker (p=0.03). Adjusted logistic regression analysis indicated the odds of delivering a low birth weight infant were greater among mothers who reported low paternal support and low paternal attendance at prenatal visits (OR=2.99 (95% Confidence Interval (CI): 1.84-4.86) and OR=2.16 (95% CI: 1.35-3.47), respectively).

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

Low paternal support during pregnancy may be a missed opportunity to increase healthy practices during pregnancy as well as decrease the risks associated with limited social support during pregnancy. It is important to consider varying socio-cultural family dynamics in different populations and how they may influence paternal involvement during pregnancy.

Evaluation of Peripartum Depression in Females

Background

Depression is the most common mental health condition affecting perinatal women and mothers worldwide. Worldwide, about 10% of pregnant women and 13% of women who have given birth experience a mental disorder, primarily depression. In developing countries like India, this is even higher, i.e., 15.6% during pregnancy and 19.8% after childbirth. The present study was initiated with the objective of studying the prevalence of depression among women in the peripartum period and to find the association of peripartum depression and its risk factors.

Materials and Methods

This was a hospital-based cross-sectional study, including mothers in antenatal and postnatal period. A sample size of 200 was calculated using Daniels' formula. A questionnaire was administered by the investigator in vernacular language by an interview technique for assessing awareness and behavior of all participants. The Edinburgh Postnatal Depression Scale was used to identify the patients at the risk of depression. Written informed consent was taken from every participant.

Results

The prevalence of peripartum depression was 14%. Younger age group (not <18 years), working female, joint family, first pregnancy, social support from in-laws, and not having desire/pressure for a male child were found to be associated with a lower prevalence of peripartum depression. Other variables which were not significantly associated with peripartum depression were education of the participants and their husbands and urban/rural locality.

Conclusion

The prevalence of peripartum depression is quite high and is negatively associated with first pregnancy, joint family, and working status.