Identification and Classification of Postpartum Psychiatric Disorders

The effect of acupuncture on condition being studied emotional disorders in patients with postpartum: A protocol for systematic review and meta-analysis

BACKGROUND

As one of the common postpartum diseases, postpartum emotional disorders (PEDs) mainly include postpartum depression, postpartum anxiety, posttraumatic stress disorder, and obsessive-compulsive disorder, which significantly affect the patient's quality of life. Acupuncture has been widely used as a popular alternative complementary therapy for the treatment of PEDs. Nevertheless, its effectiveness and safety remain uncertain. Hence, the first systematic review and meta-analysis will be urgently executed to explore the effectiveness and safety of acupuncture in the treatment of PEDs.

METHODS

Eight databases will be searched, including the PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang Database, and Technology Periodical Database. Only randomized controlled trials of acupuncture for PEDs will be considered. The languages are limited to English and Chinese. All publications were retrieved by 2 researchers independently. Assessment of the Edinburgh Postpartum Depression Scale will be dedicated as a primary outcome, and secondary outcomes include the Hamilton Anxiety Inventory, the Hamilton Depression Inventory, the Orientation to Life Questionnaire (sense of coherence 29-item scale), and adverse effects of acupuncture. The Cochrane Risk of Bias tool will be used to assess the quality of the eligible publications. Additionally, the level of evidence for results will be evaluated by using the Grades of Recommendation, Assessment, Development, and Evaluation method. All data will be analyzed statistically by using RevMan V.5.3 software.

RESULTS

This study will provide a high level of the evidence-based basis for the effectiveness and safety of acupuncture in the treatment of PEDs.

CONCLUSION

The findings of this study will assess the safety, efficacy, and adverse effects of acupuncture in the treatment of PEDs.

ETHICS AND DISSEMINATION

No ethical approval is required as patient data will not be collected. In addition, the results of this meta-analysis will be disseminated through publication in peer-reviewed scholarly journals or relevant academic conferences.

REGISTRATION NUMBER

INPLASY 2021120091.

Influence of parental competence on postpartum depression mediated via negative thoughts: moderating role of type of delivery

The present study intended to explore and compare the mediating role of negative thoughts between the sense of parental competence and postpartum depression in postpartum mothers who gave birth to their baby either through vaginal or cesarean delivery. A purposive sample of 170 women suffering from postpartum depression was recruited from different hospitals in Gujrat, Pakistan. Urdu versions of the Parenting Sense of Competency Scale, Automatic Thoughts Questionnaire, and Edinburgh Postnatal Depression Scale were used to measure the focal constructs of the study. Data were collected from May 2018 to October 2018. Path analysis revealed that parental competence had negative direct effects on postpartum depression (β = -.17, p < .05) and negative thoughts (β = -.27, p < .05) and both of these effects were stronger for women with cesarean delivery (Δβ = .04, p < .001; Δβ = .36, p < .001, respectively). Negative thoughts had a positive direct effect on postpartum depression (β = .43, p < .05) and this direct effect was also stronger among women with cesarean delivery (Δβ = -.12, p < .001). Furthermore, parental competence reduced the negative thoughts, which in turn, lowered the postpartum depression (β = -.12, p < .05), however, this indirect effect was true only for the group of women with cesarean delivery (Δβ = .20, p < .05). Our findings indicate the powerful role of parental competence in reducing the likelihood of postpartum depression through the regulation of negative thoughts and highlight that cesarean delivery may increase mothers' vulnerability to negative thoughts and postpartum depression.

Postpartum Practices and Depression Prevalences: Technocentric and Ethnokinship Cultural Perspectives

Reports of non-Western prevalence of postpartum depression (PPD) are highly variable. This variation may indicate that the label of PPD may be unacceptable in some groups or not used, that manifestations may vary by culture, or that cross-cultural diagnostic standards do not match Western clinical criteria. These factors complicate efforts to explore the relationship of postpartum traditional practices to PPD between Western and non-Western cultures. Although Stern and Kruckman viewed PPD as a culture-bound phenomenon of Western culture, an expanding international literature has demonstrated that PPD occurs in a variety of countries. To address these issues, the authors examined the literature to describe cultural postpartum traditions, to explore possible relationships among practices and PPD prevalence, to critique the culture-bound theory, and to discuss clinical practice implications.

The Effect of Social Support and Acculturation on Postpartum Depression in Mexican American Women

Postpartum depression was studied in 66 multiparous Mexican American women using a prospective longitudinal design. Interviews were conducted at 34 to 36 weeks prenatally and 4 to 6 weeks postpartum. Women expressing prenatal depression were more likely to continue to experience depression postpartum. Other predictors included a high need for postpartum support, specific support network characteristics, acculturation, and poor quality relationships within the family. It is important for the health care provider to assess the presence of depressive symptoms and available social support during the prenatal period and work with Mexican American mothers to increase support and secure help in dealing with daily life stressors.

Predictors of postpartum depression among rural women in Minia, Egypt: an epidemiological study

OBJECTIVES

To study the prevalence of postpartum depression (PPD) in a certain rural area in Upper Egypt, identifying the factors that might be involved in its genesis.

STUDY DESIGN

The current study is a cross-sectional community-based study.

METHODS

The study was conducted in El-Burgaia village, 5 km north to El-Minia city over a period of three months. Systematic random sampling was used to interview 200 female subjects, who gave birth within the last 14 months preceding interview. The Edinburgh Postnatal Depression Scale (EPDS) was applied to these females to identify the presence of PPD.

RESULTS

The sample size analysed was 200 females, 99 (49.5%) of them had PPD (29.5% had minor PPD and 20% had major PPD). The age of the study subjects ranged between 19 and 45 years old (mean age 29 ± 5.2 years). PPD occurred more significantly among wives of less educated husbands (P = 0.03). PPD was more common among those previously diagnosed of having depression or prescribed antidepressants (P = 0.02), in addition to those females experiencing financial problems after delivery (P = 0.0001). PPD was even more common among females having complications after delivery (P = 0.01). Using logistic regression analysis, total household income, child sleeping hours, complications after delivery and support of husband after delivery were found to be statistically associated with PPD.

CONCLUSIONS

PPD is relatively common among rural females of El-Minia Governorate. Certain factors in these females, in the mere gestation and delivery after which they become depressed, and in the environment in which they live in, may all come to play a part in the emergence of their psychiatric illness.

Women's experience of postpartum psychotic episodes--analyses of narratives from the internet

The aim of this study was to gain an insight into women's experiences of postpartum psychosis (PPP). Ten narratives taken from the Internet, which met the definition of PPP, were analyzed using cross-case and content analyses. The results revealed women's experience of having unfulfilled dreams, being enveloped by darkness, having disabling symptoms, and being abandoned. The women's experiences point to the importance of further education of nurses and doctors concerning PPP. It is vital not only for those working in psychiatric health care but also midwives and nurses who are working in maternity wards and child welfare centers. This would facilitate early recognition of signs and symptoms of the disorder, which, in turn, would make early treatment possible, thus supporting recovery. Furthermore, greater knowledge could contribute to providing more effective and compassionate care for these women.

Prevalence and characteristics of postpartum depression symptomatology among Canadian women: a cross-sectional study

Background

This study aims to look at the prevalence and characteristics of postpartum depression symptomatology (PPDS) among Canadian women. Studies have found that in developed countries, 10-15% of new mothers were affected by major postpartum depression. Mothers who suffer from postpartum depression may endure difficulties regarding their ability to cope with life events, as well as negative clinical implications for maternal-infant attachment.

Methods

An analysis based on 6,421 Canadian women, who had a live birth between 2005 and 2006 and were part of the Maternity Experience Survey (MES), was performed. PPDS was measured based on the Edinburgh Postnatal Depression Scale. Various factors that assessed socio-economic status, demographic factors, and maternal characteristics were considered for the multinomial regression model.

Results

The national prevalence of minor/major and major PPDS was found to be 8.46% and 8.69% respectively. A mother's stress level during pregnancy, the availability of support after pregnancy, and a prior diagnosis of depression were the characteristics that had the strongest significant association with the development of PPDS.

Conclusions

A significant number of Canadian women experience symptoms of postpartum depression. Findings from this study may be useful to increase both the attainment of treatment and the rate at which it can be obtained among new mothers. Interventions should target those with the greatest risk of experiencing PPDS, specifically immigrant and adolescent mothers.

The Edinburgh Postnatal Depression Scale detects but does not distinguish anxiety disorders from depression in mothers of infants

Specific screening tests to detect postpartum anxiety are as yet unavailable. The aim of this study was to test the ability of the Edinburgh Postnatal Depression Scale (EPDS) to detect anxiety disorders in women admitted to residential early parenting centres. Consecutive cohorts of English speaking women admitted with their infants to two centres in Melbourne, Australia completed the Composite International Diagnostic Interview and the Edinburgh Postnatal Depression Scale (EPDS). Anxiety and depression diagnoses were compared with EPDS scores. Of the 145 women (78% recruitment rate), 138 (95%) provided complete data of whom 35 (25%) had at least one anxiety disorder. EPDS scores over 12 correctly identified 28 women (44%) as having major depression, either alone or co-morbid with an anxiety disorder but 10 (16%) had only an anxiety disorder and were not depressed. All of the 26 (41%) women with EPDS scores over 12 with neither diagnosis met diagnostic criteria for minor depression or an adjustment disorder. EPDS scores were unable to distinguish between these diagnostic groups. The presumption that EPDS scores over 12 indicate only probable depression is an oversimplification. Current national initiatives recommend that EPDS scores over 12 warrant treatment for depression, which may lead to inappropriate labeling and therapy.

Risk for postpartum depression, breastfeeding practices, and mammary gland permeability

In a cross-sectional study, 163 breastfeeding women completed the Edinburgh Postnatal Depression Scale (EPDS), a questionnaire on demographics and infant feeding and hand-expressed breast milk for Na and K quantification, between 2 and 12 weeks postpartum. Forty women (24.5%) had an EPDS score compatible with the risk of a depressive episode, and 63 (41%) did not feel confident about breastfeeding. These 2 variables were significantly correlated to each other and individually correlated to breastfeeding exclusiveness. Weeks postpartum was correlated to breastfeeding exclusiveness and Na:K in milk (all P < .001). A logistic regression model showed that supplementation increased the risk of high Na:K in milk by 209%, whereas a longer time postpartum lowered the risk for mammary gland permeability. This study suggests that postpartum depression and low breastfeeding confidence, which may be present concomitantly, are associated with increased mammary gland permeability, only to the extent in which depression dissuades the mother from exclusive breastfeeding.

Anxiety, obsessions and morbid preoccupations in pregnancy and the puerperium

129 mothers referred to specialist psychiatric services in Birmingham and Christchurch were interviewed with the Birmingham Interview. Anxiety disorders were more frequent than depression during pregnancy, and equally frequent after delivery. The focus of pre- and post-partum anxiety may be important for psychological treatment. At a severe level, the most common prepartum theme was fear of foetal death; this was associated with a history of reproductive losses or infertility. After delivery the commonest themes were the pathological fear of cot death and fear of the criticism of mothering skills (which was a clue to a disordered mother-infant relationship). Clinicians should be vigilant for obsessional disorders, querulant (complaining) disorders, post-traumatic stress disorder, conjugal jealousy and dysmorphophobic states, which are all quite common. Patients with "postpartum depression" usually had at least one other (co-morbid) disorder, and 27% had two or more. These findings emphasize the diversity of postpartum psychiatric illness.

Postpartum psychiatric disorders

This review summarises the psychiatry of the puerperium, in the light of publications during the past 5 years. A wide variety of disorders are seen. Recognition of disorders of the mother-infant relationship is important, because these have pernicious long-term effects but generally respond to treatment. Psychoses complicate about one in 1000 deliveries. The most common is related to manic depression, in which neuroleptic drugs should be used with caution. Post-traumatic stress disorder, obsessions of child harm, and a range of anxiety disorders all require specific psychological treatments. Postpartum depression necessitates thorough exploration. Cessation of breastfeeding is not necessary, because most antidepressant drugs seem not to affect the infant. Controlled trials have shown the benefit of involving the child's father in therapy and of interventions promoting interaction between mother and infant. Owing to its complexity, multidisciplinary specialist teams have an important place in postpartum psychiatry.