[Risk factors for post partum depression]

Postpartum Depression in Fathers: A Systematic Review

Background/Objectives: Postpartum depression is usually defined as a major depressive episode that occurs shortly after childbirth. This condition is most commonly found in females; however, paternal postpartum depression has begun to attract more research attention. This study aims to identify different instruments for measuring this mental health problem and to detect risk factors as well as the main sources of resilience in paternal postpartum depression. Methods: A literature review was conducted following the PRISMA method. Results: After analyzing 10 articles, it was determined that the Edinburgh Postpartum Depression Scale is the most widely used instrument for the diagnosis of postpartum depression in the female population, and after several studies, it has already been validated for the male sex. After several studies were analyzed to highlight the main risk factors for paternal postpartum depression, it was established that the most influential factor is male gender role stress. These findings highlight the traditional role of fathers today. Most health professionals see the mother as the priority. Conclusions: Paternal depression is a major problem for mothers and fathers today, as well as for the newborn. As time goes on, there is a growing need to incorporate fathers into current and future mental health programs to be able to provide the necessary support.

Risk factors associated with postpartum depression in a high-risk maternity clinic: a cross-sectional study

BACKGROUND

The aim of this study was to evaluate obstetric, epidemiological and social factors related to postpartum depression (PPD) and investigate possible risk factors related to this disorder, in puerperal women who had their childbirth and were referred to the High-Risk Outpatient Clinic.

METHODS

A cross-sectional study from August-December/2019 was carried out. One hundred seventy-one puerperal women were analyzed by filling out an epidemiological questionnaire and the Edinburgh Postpartum Depression Scale (EPDS) Form. Scores ≥10 were considered positive. Research on risk factors for postpartum depression was carried out.

RESULTS

29.8% of mothers had a score related with PPD. Breastfeeding without complication is protective against PPD (P=0.002 and χ²=12.533). In contrast, not having a planned pregnancy (P=0.0175, χ²=5.717), having depression at any stage of life (P=0.013, χ²=6.237), depression during pregnancy (P≤0.0001, χ²=46.201) or having a family history of depression (P=0.001, χ²=10.527), are factors associated with the development of PPD. Moreover, just having depression during pregnancy was found to be a significant risk factor for the occurrence of PPD, increasing the risk of developing this pathology by 12 times (OR=12.891).

CONCLUSIONS

Depression during pregnancy is an important risk factor for the development of PPD. This can easily be detected using the Edinburgh Postpartum Depression Scale and treated in a timely manner.

Relationship between perceived obstetric violence and the risk of postpartum depression: An observational study

OBJECTIVE

To determine the relationship between perceived obstetric violence and the risk of postpartum depression (PPD).

DESIGN

A cross-sectional observational study SETTING: During 2019 in Spain PARTICIPANTS: 782 women who had given birth in the preceding 12 months in Spain.

MEASUREMENTS

Online questionnaires were distributed to the women via their midwives and women's associations. The questionnaire included sociodemographic and clinical variables, and questions regarding the mothers' perception of obstetric violence globally and in its different forms: verbal, physical and psycho-affective. The response rate was 93.65%. Crude and adjusted odds ratios (OR and aOR, respectively) were estimated using binary logistic regression. Risk of PPD was estimated by the Edinburgh Postnatal Depression Scale (EPDS).

FINDINGS

The mean EPDS score was 8.34 points (standard deviation: 3.80), with 25.4% (199) at risk of PPD (≥ 10 points). Risk factors for PPD included, multiparity (aOR: 1.62, 95% CI:1.10-2.39), newborn NICU admission (aOR: 1.93, 95% CI: 1.06-3.51), experiencing verbal obstetric violence (aOR: 2.02, 95% CI: 1.35-3.02), and psycho-affective obstetric violence (aOR: 2.65, 95% CI: 1.79-3.93). The perception of support during pregnancy, birth, and the puerperium was found to be a protective factor: aOR 0.15 (95% CI: 0.04-0.54) for women who perceived enough support and aOR 0.13 (95% CI: 0.0-0.45) for women who received much support KEY CONCLUSIONS: One in four women are at risk of PPD. Multiparous women, those whose newborn required NICU admission, those who lacked partner support, and those who experienced verbal or psycho-affective obstetric violence had a higher prevalence of PPD risk.

FUNDING

The authors declare that this study was conducted without funding.

Cultural adaptation of an intervention to prevent postnatal depression and anxiety in Chilean new mothers

Objective: The aim of this study was to culturally adapt What Were We Thinking (WWWT), an Australian psychoeducational intervention to prevent symptoms of depression and anxiety among first-time mothers, to be used in the Chilean primary health system.Background: Mental health symptoms are common in first-time mothers. Despite the availability of effective screening and referral in the Chilean primary health system, very few women access treatment due to diverse barriers. This highlights the importance of using a preventive approach. The evidence that culturally-adapted, evidence-based preventive programmes can reduce maternal mental health problems supports the development of this study.Methods: WWWT materials were translated into Spanish. Cultural Adaptation and field testing were conducted following the Cultural Adaptation Model.Results: Modifications to the intervention included adding an explicit infant mental health approach, a simplification of written information, and changes in the number and duration of the sessions. The adapted version of WWWT was considered understandable and relevant for local perinatal mental health specialists, new mothers and their partners.Conclusion: The Spanish version of WWWTis a culturally sensitive intervention, its potential for effective use in the Chilean context warrants further investigation. Limitations and implications for future studies are discussed.

BDI in the Assessment of Depression in Different Medical Conditions

As a common disorder, depression must be diagnosed not only in psychiatric but also in different medical settings, especially in patients with chronic diseases. Beck Depression Inventory is valuable and sensitive self-report inventory used worldwide for assessment depressive symptoms. In this research we present obtained scores of BDI in different group of disorders and we showed that BDI scores are related to the clinical condition, as well as with the age.

Factors associated to depressive symptoms in mothers with children hospitalized in pediatric and neonatology units of Peru: a case-control study

Introduction

Postpartum depression has increased significantly worldwide, but in the central Peruvian mountain, there are no studies that address this problem.

Objectives

To identify and to establish risk factors for postpartum depression in mothers whose children are hospitalized in pediatrics/neonatology units in Huancayo.

Methods

This is a case-control study. Medical records of mothers whose children were hospitalized in pediatrics/neonatology units during 2017 were included. The cases were defined as patients who “had symptoms of postpartum depression." This variable was crossed with other variables using logistical regression, odds ratio were obtained, their confidence intervals were set to 95%, and the p values were calculated.

Results

Sixty-one medical records of mothers with postpartum depression (cases) and 61 medical records of mothers without postpartum depression (control) were evaluated. In the multivariate analysis, the unemployed mothers had a bigger chance of postpartum depression (p < 0.001), as well as single mothers (p < 0.001), and those with an unplanned pregnancy (p = 0.003). Conversely, mothers who reported having serious problems with their partner had a smaller chance of postpartum depression (p = 0.003).

Conclusions

Different factors were found to be related to postpartum depression: marital situation, relationship with their partners, work conditions, and having an unplanned pregnancy.

Fatores de Risco e Proteção Associados à Depressão Pós-Parto no Pré-Natal Psicológico

Resumo: Esta investigação teve por objetivos gerais: a) identificar fatores de risco e de proteção associados à Depressão Pós-Parto (DPP); e b) avaliar a contribuição do Pré-Natal Psicológico (PNP) como programa de prevenção em Saúde da Mulher. Para tanto, empreendeu-se uma pesquisa-ação organizada em três fases, reunindo um total de 198 gestantes. Na última fase, as participantes foram distribuídas em Grupo Intervenção – GI (n = 47) e Grupo Controle – GC (n = 29). Para coleta de dados, utilizaram-se: Questionário Gestacional, BAI, BDI-II e EPDS. Os dados foram submetidos a análises estatísticas descritivas e comparativas. Não foi possível relacionar variáveis socioeconômicas, participação no PNP e desejo de gravidez com maior risco de DPP. Em contrapartida, verificou-se tal associação quanto a gravidez não planejada e a falta de apoio do pai do bebê. Contrariamente ao GC, não se constatou associação entre ansiedade e depressão gestacionais com a DPP no GI. Nesse grupo, 10,64% das puérperas revelaram tendência para DPP, ao passo que, em GC, 44,83% mostraram tal propensão. Em suma, considera-se que o PNP, somado a fatores de proteção, constitui ação preventiva a ser desenvolvida pelo profissional de Psicologia no contexto do acompanhamento pré e pós-natal.

[Postpartum depression: prevalence and associated factors]

The aim was to identify the prevalence of postpartum depression and associated factors in women in a medium-sized city in Southern Brazil during 2013. Trained female interviewers applied a standardized questionnaire to all participants in the city's two maternity hospitals. The study analyzed demographic, socioeconomic, behavioral, social support, and disease characteristics. Screening for depression was done within the first 48 hours postpartum, using the Edinburgh Scale with a cutoff of ≥ 10. Multivariate analysis used Poisson regression with robust variance. Of the 2,687 women interviewed, 14% (95%CI: 12.9-15.6) were identified with depression. Factors such as previous depression, third-trimester sadness, and family history of depression were associated with increased risk of postpartum depression, as were younger maternal age and multiparity. Social support from the health team for the pregnant woman was an important protective factor, reducing the prevalence of postpartum depression by 23%. The results suggest the need for actions by health services for pregnant women in order to provide enhanced care during this delicate phase.

Factors associated with postpartum depressive symptomatology in Brazil: The Birth in Brazil National Research Study, 2011/2012

BACKGROUND

Depression is one of the most common postpartum mental disorders. Many sociodemographic and individuals risk factors are associated with maternal depression but the impact of high levels of birth intervention is unclear. The Brazilian context is characterized by excessive intervention and frequent non-compliance with recommended obstetric protocols. This study therefore examined the impact of sociodemographic, individual, and obstetric risk factors in postpartum depression.

METHODS

The Birth in Brazil research study is a national study of 23,894 postpartum women. Information about depression was obtained by telephone interview at 6-18 months after birth and was measured using the Edinburgh Postnatal Depression Scale.

RESULTS

The prevalence of probable cases of depression was 26.3%. A multiple logistic regression model identified significant sociodemographic and individual risk factors as: brown skin color (OR=1.15 CI 1.01-1.31), lower economic class (OR=1.70 CI 1.41-2.06), alcohol use (OR=1.41 CI 1.09-1.84) and a history of mental disorders (OR=3.13 CI 1.80-5.44). Significant obstetric factors were unplanned pregnancy (OR=1.22 CI 1.05-1.43 for wanted later and OR=1.38 CI 1.20-1.60 for never wanted), multiparity (OR=1.97 CI 1.58-2.47 for 3 or more children), and poor care during birth (OR=2.02 CI 1.28-3.20) or of the newborn (OR=2.16 CI 1.51-3.10). Obstetric interventions and complications were not associated with maternal depression.

LIMITATIONS

Depression was measured only once so we are not able to examine the course over time. The associational and reverse causality cannot be ruled out for some variables.

CONCLUSIONS

The prevalence of postpartum depression is high in Brazilian women six months after birth. Poor care of women and babies during birth is more important in postpartum depression than physical obstetric or neonatal intervention and complications.