The Impact of Postpartum Depression on Quality of Life in Women After Child's Birth

Awareness of postpartum depression among midwives and pregnant women in Arkhangelsk, Arctic Russia

BACKGROUND

Postpartum depression (PPD) affects approximately 17% of the women worldwide with nearly half of all cases going undetected. More research on maternal mental health, particularly among healthcare professionals and pregnant mothers, could help identify PPD risks and reduce its prevalence.

OBJECTIVE

Given that awareness of PPD is a crucial preventive factor, we studied PPD awareness among midwives and pregnant women in Arkhangelsk, Arctic Russia.

METHODS

A qualitative study was conducted using in-depth semi-structured interviews. Midwives and pregnant women were recruited from the women's clinic of the Arkhangelsk municipal polyclinic. Seven midwives and 12 pregnant mothers were interviewed.

RESULTS

Midwives described limited time for psychological counselling of pregnant women; they reported that their primary focus was on the physiological well-being of women. Pregnant women have expressed a desire for their families to share responsibilities. The participants considered PPD as a mix of psychological and physiological symptoms, and they also highlighted a discrepancy between the expectations of pregnant women and the reality of motherhood. The present study underscored the limited understanding of PPD identification.

CONCLUSIONS

The findings suggest that there is a need for increased awareness among midwives and pregnant women regarding PPD. Prevention programs targeting PPD with a specific emphasis on enhancing maternal mental health knowledge are warranted.

Suicide attempts in the absence of depression: Differences between broad cultural groups

Suicide is one of the leading causes of death worldwide (WHO, 2021). Depression is a common precursor to suicide and suicidality; however, individuals' experience of depression and the meaning of suicide differs depending on one's cultural background (Colucci, 2013; Goodmann et al., 2021; Kleinman, 2004). The current study explores the relationship between suicide and depression among six broad cultural groups in a large sample (N = 17,015) of adults representing six broad cultural groups (Latin America, South Asia, former Soviet Bloc, Western English-speakers, Chinese, and Arab World). Participants were recruited to a multilingual depression and suicide screening study via Google Ads (Leykin et al., 2012; Gross et al., 2014). As expected, the presence of depression was associated with suicide attempts. However, cultural group moderated this association, with Chinese participants being most likely to report suicide attempts while screening negative for depression. Although depression remains an important predictor of suicidality, it appears that certain cultural groups may be at higher risk even when depression is not present. Clinicians should consider using culturally adapted assessments for depression and suicidality.

Feasibility of a Supervised Postpartum Exercise Program and Effects on Maternal Health and Fitness Parameters-Pilot Study

The postpartum period is marked by profound changes in women at physical, psychological, and physiological levels. Many of these changes persist after four to six weeks postpartum, and most women do not resume their levels of physical activity, which increases the risk of remaining inactive for many years. It is crucial to implement effective programs that promote exercise during the postpartum period. The objective of this study was to test the feasibility and analyze the effects of a structured and supervised postpartum exercise program on maternal health and fitness parameters. To analyze the potential effects of the intervention, the level of physical activity, quality of life, pelvic girdle and low back pain, fatigue, depression, and the level of functional and physical fitness were assessed at baseline, after 8 weeks, and after 16 weeks of intervention. Feedback on the exercise program was collected after the final assessment. The results showed that a structured and supervised postpartum exercise program was feasible and safe and produced positive effects on selected maternal health and fitness parameters. These results will encourage a study protocol with a larger sample in order to prove its effectiveness, improve the guidelines for postpartum exercise, and incorporate this program into a routine healthcare setting.

Late postpartum depression and associated factors: community-based cross-sectional study

BACKGROUND

Late postpartum depression is the presence of depressive symptoms beyond the early postpartum period and is a significant mental health problem that has a devastating impact on mothers, infants, partners, family members, the healthcare system, and the world's economy. However, there is limited information regarding this problem in Ethiopia.

OBJECTIVE

To assess the prevalence of late postpartum depression and associated factors.

METHOD

the community-based cross-sectional study was employed among 479 postpartum mothers in Arba Minch town from May 21 to June 21, 2022. The pre-tested face-to-face interviewer administered a structured questionnaire used to collect the data. A bivariate and multivariable analysis was done using a binary logistic regression model to identify factors associated with late postpartum depression. Both crude and adjusted odds ratios with 95% CI were calculated, and a p-value of < 0.05 was used to declare statistically significant factors.

RESULT

The prevalence of late postpartum depression was 22.98% (95% CI: 19.16, 26.80). Husband Khat use (AOR = 2.64; 95% CI: 1.18, 5.91), partner dissatisfaction with the gender of the baby (AOR = 2.53; 95% CI: 1.22, 5.24), short inter-delivery interval (AOR = 6.80; 95% CI: 3.34, 13.84), difficulty to meet husband sexual need (AOR = 3.21; 95% CI: 1.62, 6.37), postpartum intimate partner violence (AOR = 4.08; 95% CI: 1.95, 8.54), and low social support (AOR = 2.50; 95% CI: 1.25, 4.50) were significantly associated factors at p-value < 0.05.

CONCLUSION

Overall, 22.98% of mothers suffered from late postpartum depression. Therefore, based on the identified factors, the Ministry of Health, Zonal Health Departments, and other responsible agencies should establish effective strategies to overcome this problem.

[Associations between Maternal Postpartum Depression and Psychosocial Factors Including Marital Relationship and Social Support]

OBJECTIVES

We aimed to investigate the psychosocial factors for postpartum depression as indicated by a high score of the Edinburgh Postnatal Depression Scale (EPDS), including marital relationship and social support. Relevant factors for antenatal depression were also analyzed.

METHODS

Thirty-five wife-and-husband pairs who visited University Hospital A for the wife's antenatal health check-up participated in a questionnaire survey using the Japanese version of the EPDS. Social support from the wife's husband, kins, and others including friends at the third trimester of pregnancy and 1 month after birth was assessed. The Marital Love Scale (MLS) was also used, and two marital relationship questions were asked regarding the husband's and wife's considerate actions toward each other during pregnancy. Binary logistic regression analysis was conducted to determine adjusted associations between higher EPDS scores (≥5 for postpartum depression and ≥7 for antenatal depression) and indicators for social support and marital relationships.

RESULTS

The most relevant factor for higher postpartum EPDS scores was a higher antenatal EPDS score, followed by the couple's poor communication skills (the wife did not feel any appreciation from her husband) during pregnancy and no support from the wife's husband during the postpartum period. The wife's poor marital communication skills and the husband's low MLS scores during pregnancy were associated (borderline significance) with the wife's higher antenatal EPDS scores.

CONCLUSIONS

A good marital relationship before birth and support by the husband after birth may be important for preventing postpartum depression.

Postpartum depression and its correlates: a cross-sectional study in southeast Iran

Background

Postpartum depression has a negative impact on both infants and women. This study aimed to determine the correlates of postpartum depression in women in southern Iran.

Methods

This cross-sectional study was performed on 186 mothers who had recently given birth to a baby. Data were collected using the demographic form, Quality of Prenatal Care Questionnaire, Edinburgh Postnatal Depression Scale (EPDS), Depression, Anxiety and Stress Scale—21 items (DASS-21) 3 days after delivery and EPDS and DASS-21 6 months after childbirth.

Results

Postpartum depression (PPD) was 24.2% and 3.2% 3 days and 6 months after delivery, respectively. Anxiety, Prenatal Care Quality and educational level predicted 34.0% of the variance of PPD 3 days after delivery (R² = 34.0%). Anxiety, type of delivery, and stress predicted 24% of the variance of PPD 6 months after delivery (R² = 24.0%).

Conclusions

With an increase in stress and anxiety and a reduction in the quality of prenatal care, the risk of postpartum depression increases. Therefore, attention to the quality of prenatal care and postpartum stress and anxiety should be carefully evaluated to prevent PPD. Psychological support and interventions are recommended to promote the mental health of women before and after childbirth.

The Maternal Postpartum Quality of Life Instrument (MPQOL-I): development and psychometric evaluation in an exploratory sequential mixed-method study

Background

“ Postpartum quality of life” refers to women’s satisfaction of their position in life, based on cultural status, expectations, values, attitudes, goals, and living standards. Hence the need to pay attention to more specific dimensions of quality of life in the postpartum period is being sensed. This study was conducted to develop the Maternal Postpartum Quality of Life Instrument (MPQOL-I) and assess its psychometric properties.

Methods

This methodological study was conducted in 2019–2020. This exploratory, sequential mixed-method study was conducted in two phases. The first phase is MPQOL-I development and the second phase is psychometric evaluation of the developed scale. In the quantitative (psychometric evaluation) phase, face, content, construct, convergent, and discriminant validity and reliability of the scale were tested.

Results

In this study, 5 factors were extracted from items through exploratory factor analysis: (1) received support, (2) sexual relations, (3) bonding with newborn, (4) breastfeeding and newborn care, and (5) the transition period. These factors accounted for 53.26% of the total variance. The results of the confirmatory factor analysis suggested the goodness-of-fit indices was acceptable. Furthermore, the internal consistency and composite reliability indices of factors were greater than 0.7.

Conclusion

The sixteen-item Persian language MPQOL-I is a valid and reliable instrument for postpartum quality of life assessment. It includes items from different aspects of postpartum quality of life and can be used for the early diagnosis of impaired postpartum quality of life. Further studies are needed to assess the psychometric properties of MPQOL-I in different cultures and communities.

Association between labor and delivery pain and postpartum pain with symptoms and clinical diagnosis of postpartum depression in patients with overweight and obesity

Purpose

Childbirth pain has been associated with the risk for postpartum depression. However, existing studies have been limited by the use of depression screening tools as outcomes, and none to date have used a structured clinical interview for DSM-V (SCID), which is considered the gold standard for psychiatric diagnoses. This study aimed to quantify the relationships between labor and postpartum pain and postpartum depression diagnosis detected by SCID, as well as depression symptoms detected by the Center for Epidemiological Studies Depression Scale (CESD) screening tool, among a high-risk cohort.

Methods

The study was a secondary analysis of a prospective observational study of a cohort of women enriched for high risk for depression, i.e., pregnant women originally enrolled in a prospective study investigating factors leading to excessive gestational weight gain. Subjects were assessed prospectively for depression using both SCID and CESD at the third trimester and at 6 months postpartum. Overweight and obesity were defined as pre-gravid body mass index (BMI) ≥ 25 kg/m2. Both vaginal and cesarean deliveries were included in the cohort. Pain scores (0–10 numeric rating scale) during childbirth and after delivery were correlated with CESD and SCID. Propensity score matching was performed with propensity groups defined as those with low–moderate postpartum pain and those with high postpartum pain. The relationships between pain measures and 6-month postpartum depression diagnosis by SCID, and between pain measures and 6-month postpartum depression symptoms by CESD, were assessed by unweighted logistic regression and by logistic regression weighted by propensity score derived by average treatment effect (ATE) adjusted for baseline covariates.

Results

There were 237 subjects in the cohort for analysis. Labor and postpartum pain were not associated with depression diagnosis by SCID at 6 months postpartum. However, postpartum pain, but not labor pain, was associated with depressive symptoms on the CESD at 6 months postpartum. Women with higher maximum postpartum pain scores had significantly higher odds of developing clinically significant postpartum depressive symptoms at 6 months, compared to those with lower pain scores in the unweighted model (OR: 1.3, 95% CI 1.0, 1.5; P = 0.005) and ATE-weighted models (OR: 1.2, 95% CI 1.0, 1.5; P = 0.03). Consistent with prior work, SCID and CESD were strongly associated, and 92.9% (13/14) of participants with postpartum depression diagnosis by 6-month SCID also showed high CESD symptomology, P < 0.0001).

Conclusions

Although labor and postpartum pain were not associated with clinical diagnosis of depression (SCID) at 6 months postpartum, postpartum pain was linked to 6-month postpartum depression symptoms. Depressive symptoms are more likely to be exhibited in women with higher postpartum pain, potentially reflecting poorer birth recovery. The contribution of postpartum pain and depressive symptoms to overall patterns of poor recovery after childbirth should be assessed further.

The effect of mode of delivery on health-related quality-of-life in mothers: a systematic review and meta-analysis

Background

Previous research is inconclusive on the effects of mode of delivery on maternal health-related quality-of-life (HRQoL). We conducted a systematic review and meta-analysis to assess the current evidence for associations between mode of delivery and postpartum health-related quality-of-life.

Methods

Electronic databases MEDLINE ALL (OVID), Web of Science, The Cochrane Library, CINAHL and EMBASE (OVID) were searched for English written articles investigating the relationship between mode of delivery and quality-of-life published form inception to 15th October 2020. Two reviewers independently screened titles and abstracts, assessed full texts, and extracted data. Meta-analysis was conducted where possible.

Results

Twenty-one studies, including 19,879 women, met the inclusion criteria. A meta-analysis of 18 studies found HRQoL scores were significantly higher for women after vaginal delivery in comparison to caesarean (emergency and elective combined) (Effect Size (ES) 0.17, 95% CI 0.01–0.25, n = 7665) with highest scores after assisted vaginal delivery (ES 0.21, 95% CI 0.13–0.30, n = 2547). Physical functioning (ES 11.18, 95% CI = 2.29–20.06, n = 1746), physical role (ES 13.10, 95% CI = 1.16–25.05, n = 1471), vitality (ES 6.31, 95% CI = 1.14–10.29, n = 1746) and social functioning (ES 5.69, 95% CI = 1.26–10.11, n = 1746) were significantly higher after vaginal delivery compared to caesarean.

Conclusions

Health-related quality-of-life scores were higher for women after vaginal delivery in comparison to caesarean section. Consequently, women should be encouraged to deliver vaginally where possible. The findings of this research should be available to the relevant population to help support informed choice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04473-w.

Prevalence and Risk Factors Associated with Postpartum Depression during the COVID-19 Pandemic: A Literature Review and Meta-Analysis

Background: Owing to the high prevalence and detrimental consequences, postpartum depression (PPD) has been identified as one of the severe global public health issues in the last decade. Prior research found that during disasters or events, the prevalence rates of mental disorders among postpartum women are significantly high. However, the effect of the coronavirus disease 2019 (COVID-19) pandemic on PPD and its risk factors remained unclear for postpartum women. Therefore, the present systematic review and meta-analysis aimed to estimate the influence of the COVID-19 pandemic on the prevalence of PPD and to summarize risk factors for PPD during the COVID-19 pandemic. Methods: Three electronic databases of MEDLINE, EMBASE, and Cochrane library databases were systematically searched for articles from their commencements until 1 November 2021. Quality assessment of included studies, random-effects meta-analysis, and sensitivity analysis were performed. Results: A total of eight studies with 6480 postpartum women during the COVID-19 pandemic were included, and most studies were conducted in developed countries. The pooled prevalence of PPD was 34% (95% CI: 21–46%) during the COVID-19 pandemic, much higher than the incident of previous research during the non-pandemic period. Risk factors for PPD during the COVID-19 pandemic were defined as socio-demographic and clinical characteristics, stress and anxiety, lack of various supports, and the COVID-19 related factors. Conclusion: The research findings indicated that the COVID-19 pandemic could make detrimental effects on maternal mental wellbeing among women after childbirth. Investigating the prevalence and risk factors of PPD among postpartum women could shed some light on their mental and emotional states; so that support measures and tailored interventions from health professionals and policymakers could be offered to improve the maternal and infant outcomes, especially during the COVID-19 pandemic. Much more research on maternal psychological wellbeing during the COVID-19 pandemic was strongly recommended to undertake in the middle and low-income countries.

Women's trajectories of postpartum depression and social support: A repeated-measures study with implications for evidence-based practice

BACKGROUND

Postpartum depression is one of the most common psychological disorders of women after childbirth. Despite the importance of social support as an influencing factor, there have been few studies on the trends and characteristics of social support as it relates to postpartum depression.

AIMS

To explore the trends in postpartum depression and social support, to cross-analyze the correlation between the postpartum depression trajectory and the social support trajectory, and to investigate predictors of changes in postpartum depression trajectories.

METHODS

A prospective repeated-measure study and convenience sampling were used to recruit 230 women at 1, 3, and 6 months after childbirth. Structured questionnaires were used for data collection. Trajectory analysis was used to explore the trajectories of postpartum depression and social support during the 6 months after childbirth, and polynomial logistic regression was used to explore predictors of the trajectory of postpartum depression.

RESULTS

Postpartum depression was at its most serious in the third month after childbirth, showing patterns of low-risk, moderate-risk, and high-risk trajectories. Social support also showed low, moderate, and high patterns, and the trajectory of postpartum depression was significantly related to the trajectory of social support. The predictors of moderate-risk and high-risk postpartum depression were also found in this study.

LINKING EVIDENCE TO ACTION

Postpartum mental health education and online learning systems should be used to increase social support for women after childbirth and reduce the incidence of postpartum depression.

Quality of Life in Mothers With Perinatal Depression: A Systematic Review and Meta-Analysis

BACKGROUND

The prevalence of perinatal depression is high and its adverse effects on mothers and infants are extensive. Several studies have explored the relationship between perinatal depression and health-related quality of life (HRQoL), but little is known about the nature and magnitude of this effect. The objectives of this study were to evaluate the HRQoL of mothers with perinatal depression and compare the HRQoL of depressed mothers with that of non-depressed mothers.

METHODS

A systematic review was performed according to the PRISMA guidelines. PubMed, EMBASE, Scopus, PsycINFO, Web of Science, Cochrane Central Register, the China National Knowledge Infrastructure, the VIP Database, and the Wan Fang Database were searched. The retrieval time was from the establishment of the database to July 2020. A series of meta-analyses were run for each outcome pertaining to HRQoL sub-measures. Subgroup analyses were conducted based on country income category and time period.

RESULTS

Of 7,945 studies identified, 12 articles were included in the meta-analysis, providing HRQoL data for 4,392 mothers. Compared with non-depressed mothers, mothers with perinatal depression reported significantly poor scores across all the quality-of-life domains. Mixed-effects analysis showed that there was no difference in the HRQoL scores of mothers with antepartum and postpartum depression. Mothers with perinatal depression in higher-income countries reported higher disability on role-physical (p = 0.02) and social functioning domains (p = 0.001) than those from lower-income countries.

LIMITATIONS

Due to insufficient data, no regression analysis was performed. The inability to accurately determine the difference in HRQoL between antepartum and postpartum depression was because of the restriction of the included studies. Moreover, most of the included studies were conducted in middle-income countries and may have an impact on the applicability of the results. Subgroup analyses are observational and not based on random comparisons. The results of subgroup analyses should be interpreted with caution.

CONCLUSION

HRQoL is compromised in mothers with perinatal depression. Continuous efforts are required to improve the HRQoL of perinatal depressed mothers.Systematic Review Registration: CRD42020199488.

Achieving clinical response in postpartum depression leads to improvement in health-related quality of life

OBJECTIVE

To evaluate the health-related quality of life (HRQoL) burden associated with postpartum depression (PPD), determine the extent to which clinical response impacts HRQoL, and estimate the impact of PPD and clinical response on healthcare resource utilization (HRU) and productivity.

METHODS

Patient data (n = 127) from two multicenter, randomized, double-blind, placebo-controlled phase 3 clinical trials evaluating the safety and efficacy of brexanolone injection in adults with PPD were employed for these posthoc analyses. HRQoL and health utility was assessed with the SF-36-v2 Health Survey (SF-36v2) acute version. The 17-item Hamilton Rating Scale for Depression (HAMD-17) total score was used to identify clinical response (≥50% reduction in HAMD-17 total score). Baseline HRQoL burden was assessed by comparison to age- and gender-adjusted population normative data from the 2009 QualityMetric PRO Norming study. The impact of clinical response was evaluated by comparing day 7 and day 30 SF-36v2 scores between clinical responders and non-responders. Interpretations of the meaningfulness of clinical response were indirectly estimated via 2017 National Health and Wellness Survey data linking SF-36v2 mental component summary (MCS) scores to (HRU) and productivity.

RESULTS

Baseline HRQoL of patients with PPD was significantly below normative values. Day 7 and day 30 clinical response were associated with large and statistically significant improvements in HRQoL, greater likelihood of meeting SF-36v2 responder definitions, and reduced impairment. MCS levels corresponding to those observed in clinical responders were linked to lower HRU and productivity loss relative to non-responders.

CONCLUSIONS

PPD places a substantial burden on HRQoL. Achievement of rapid clinical response (at day 7) and clinical response sustained several weeks following the end of treatment (day 30) led to significant improvement in HRQoL, suggesting the importance of identifying women with PPD and providing effective treatment options.

Use of Patient-Reported Outcome Measures to Assess Outpatient Postpartum Recovery: A Systematic Review

IMPORTANCE

Outpatient postpartum recovery is an underexplored area of obstetrics. There is currently no consensus regarding which patient-reported outcome measure (PROM) clinicians and researchers should use to evaluate postpartum recovery.

OBJECTIVE

To evaluate PROMs of outpatient postpartum recovery using Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines.

EVIDENCE REVIEW

An initial literature search performed in July 2019 identified postpartum recovery PROMs and validation studies. A secondary search in July 2020 identified additional validation studies. Both searches were performed using 4 databases (Web of Science, Embase, PubMed, and CINAHL), with no date limiters. Studies with PROMs evaluating more than 3 proposed outpatient postpartum recovery domains were considered. Studies were included if they assessed any psychometric measurement property of the included PROMs in the outpatient postpartum setting. The PROMs were assessed for the following 8 psychometric measurement properties, as defined by COSMIN: content validity, structural validity, internal consistency, cross-cultural validity and measurement invariance, reliability, measurement error, hypothesis testing, and responsiveness. Psychometric measurement properties were evaluated in each included study using the COSMIN criteria by assessing (1) the quality of the methods (very good, adequate, doubtful, inadequate, or not assessed); (2) overall rating of results (sufficient, insufficient, inconsistent, or indeterminate); (3) level of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations assessment tool; and (4) level of recommendation, which included class A (recommended for use; showed adequate content validity with at least low-quality evidence for sufficient internal consistency), class B (not class A or class C), or class C (not recommended).

FINDINGS

In total, 15 PROMs (7 obstetric specific and 8 non-obstetric specific) were identified, evaluating outpatient postpartum recovery in 46 studies involving 19 165 women. The majority of psychometric measurement properties of the included PROMs were graded as having very-low-level or low-level evidence. The best-performing PROMs that received class A recommendations were the Maternal Concerns Questionnaire, the Postpartum Quality of Life tool, and the World Health Organization Quality of Life-BREF. The remainder of the evaluated PROMs had insufficient evidence to make recommendations regarding their use (and received class B recommendations).

CONCLUSIONS AND RELEVANCE

This review found that the best-performing PROMs currently available to evaluate outpatient postpartum recovery were the Maternal Concerns Questionnaire, the Postpartum Quality of Life tool, and the World Health Organization Quality of Life-BREF; however, these tools all had significant limitations. This study highlights the need to focus future efforts on robustly developing and validating a new PROM that may comprehensively evaluate outpatient postpartum recovery.

Usual-Risk Pregnant Women's Health-Related Quality of Life through Pregnancy and Puerperium with Anthroposophical Prenatal Care: A Retrospective Study

INTRODUCTION

Pregnancy is a physiological event that can lead to a decrease in quality of life. Symptoms within this period lack riskless treatment options. However, the anthroposophical integrative view points out the stimulation of vital energy recuperation as a possible inducer of changes in health perception for pregnant women.

OBJECTIVE

The aim was to observe the health-related quality of life variation in women during pregnancy and puerperium. The evaluation was based on the Medical Outcomes Study 36-Item Short-Form (SF-36).

METHOD

This is a retrospective longitudinal study of SF-36 questionnaires administered at 3 different time points: at the first appointment, at an appointment between the 36th ± 1 week of pregnancy and at another appointment within the puerperium period.

RESULTS

Sixty-five patients completed the 3 questionnaires within the period of the study. The 8 domains of SF-36 and women's behaviors throughout the prenatal and puerperal care period were analyzed. Quality of life decreased by the third trimester, with recuperation in the puerperium. Physical components were reduced significantly, while emotional and social components did not change significantly. Scores in mental health and vitality, as well as general health status, were higher in puerperium.

CONCLUSION

Multiprofessional intervention broadened by the anthroposophical perspective fosters the health-related quality of life of women through gestation and puerperium.

Factors Influencing Quality of Life in Early Postpartum Women

Postpartum women experience various changes in their physical and psychological health and in their relationships with their spouse and newborn. This study aimed to identify and evaluate the factors that affect the quality of life (QoL) of women within six weeks after childbirth. A prospective, cross-sectional correlational study was used. A convenience sample of 179 postpartum women was recruited from four postpartum care centers in South Korea. Participants completed structured questionnaires on postpartum fatigue, postpartum depression, marital intimacy, breastfeeding adaptation, and quality of life. Marital intimacy (β = 0.466, p < 0.001) was the most influencing factor on the QoL of women during the postpartum period. In descending order, postpartum fatigue (β = -0.192, p = 0.001), postpartum depression (β = -0.190, p = 0.001), breastfeeding adaptation (β = 0.163, p = 0.002), and occupation (β = 0.163, p = 0.004) all had a significant influence on QoL (F = 32.09, p < 0.001), and the overall explanatory power was 63.6%. It is necessary to assess and consider the physical, psychological, relational, and demographic factors of women during the early postpartum period. Comprehensive interventions need to be developed to improve the QoL of women during the postpartum period.

Effects of Postpartum Fatigue and Depressive Cognitions on Life Satisfaction and Quality of Life in Arab Postpartum Women: The Intervening Role of Resourcefulness

The purpose of this study is to explore the relationships among postpartum fatigue (PPF), depressive cognitions, resourcefulness, quality of life, and life satisfaction in Arab postpartum mothers. A conceptual framework is used in this study based on the middle range theory of resourcefulness, which Zauszniewski developed in 2006. The study is a cross-sectional descriptive design with 123 postpartum women who had given birth within the past six months. used WhatsApp and Facebook for recruitment. developed the self-administered online survey in Qualtrics and collected data from 6 January 2017, to 6 February 2017. Correlation analysis is used to address the research aim and used the P value of 0.05 to determine the significance of the results. There were significant correlations among depressive cognitions and resourcefulness, life satisfaction, and quality of life; there were also significant correlations between PPF and life satisfaction, as well as among resourcefulness, quality of life, and life satisfaction. The results of this study emphasized the importance of assessing depressive symptoms and PPF in mothers early in the postpartum period. The results may contribute to designing future intervention studies aimed toward decreasing the risk of mothers with PPF developing more serious depressive symptoms.

Postpartum depressive symptoms following implementation of the 10 steps to successful breastfeeding program in Kinshasa, Democratic Republic of Congo: A cohort study

BACKGROUND

Social support and relevant skills training can reduce the risk of postpartum depression (PPD) by reducing the impact of stressors. The 10-step program to encourage exclusive breastfeeding that forms the basis of the Baby-Friendly Hospital Initiative (BFHI) provides both, suggesting it may lessen depressive symptoms directly or by reducing difficulties associated with infant feeding. Our objective was to quantify the association of implementing Steps 1-9 or Steps 1-10 on postpartum depressive symptoms and test whether this association was mediated by breastfeeding difficulties.

METHODS AND FINDINGS

We used data from a breastfeeding promotion trial of all women who gave birth to a healthy singleton between May 24 and August 25, 2012 in 1 of the 6 facilities comparing different BFHI implementations (Steps 1-9, Steps 1-10) to the standard of care (SOC) randomized by facility in Kinshasa, Democratic Republic of Congo. Depressive symptoms, a non-registered trial outcome, was assessed at 14 weeks via the Edinburgh Postnatal Depression Scale (EPDS). Inverse probability weighting (IPW) was used to estimate the association of BFHI implementations on depressive symptoms and the controlled direct association through breastfeeding difficulties at 10 weeks postpartum. A total of 903 mother-infant pairs were included in the analysis. Most women enrolled had previously given birth (76%) and exclusively breastfed at 10 weeks (55%). The median age was 27 (interquartile range (IQR): 23, 32 years). The proportion of women reporting breastfeeding difficulties at week 10 was higher in both Steps 1-9 (75%) and Steps 1-10 (91%) relative to the SOC (67%). However, the number of reported difficulties was similar between Steps 1-9 (median: 2; IQR: 0, 3) and SOC (2; IQR: 0, 3), with slightly more in Steps 1-10 (2; IQR: 1, 3). The prevalence of symptoms consistent with probable depression (EPDS score >13) was 18% for SOC, 11% for Steps 1-9 (prevalence difference [PD] = -0.08; 95% confidence interval (CI): -0.14 to -0.01, p = 0.019), and 8% for Steps 1-10 (PD = -0.11, -0.16 to -0.05; p < 0.001). We found mediation by breastfeeding difficulties. In the presence of any difficulties, the PD was reduced for both Steps 1-9 (-0.15; 95% confidence level (CL): -0.25, -0.06; p < 0.01) and Steps 1-10 (-0.16; 95% CL: -0.25, -0.06; p < 0.01). If no breastfeeding difficulties occurred in the population, there was no difference in the prevalence of probable depression for Steps 1-9 (0.21; 95% CL: -0.24, 0.66; p = 0.365) and Steps 1-10 (-0.03; 95% CL: -0.19, 0.13; p = 0.735). However, a limitation of the study is that the results are based on 2 hospitals randomized to each group.

CONCLUSIONS

In conclusion, in this cohort, the implementation of the BFHI steps was associated with a reduction in depressive symptoms in the groups implementing BFHI Steps 1-9 or 1-10 relative to the SOC, with the implementation of Steps 1-10 associated with the largest decrease. Specifically, the reduction in depressive symptoms was observed for women reporting breastfeeding difficulties. PPD has a negative impact on the mother, her partner, and the baby, with long-lasting consequences. This additional benefit of BFHI steps suggests that renewed effort to scale its implementation globally may be beneficial to mitigate the negative impacts of PPD on the mother, her partner, and the baby.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01428232.

Fertility Behavior and Depression Among Women: Evidence From China

Using data from the China Labor-Force Dynamic Survey, this study employed logistic regressions to investigate the association between fertility behavior and depression among Chinese women. The empirical results show that in China, women having children were significantly less likely to have depressive symptoms (OR = 0.651) compared to childless women. We also found a U-shaped relationship between fertility levels and depression in women. The results were robust to using the propensity score matching approach to address the sample selection problem. Further, our heterogeneity analysis demonstrated that the negative relationship between fertility level and depression was more significant among women who were in their 30s, lived in urban areas, and lived in high-income households. Compared to having male children (boys) (OR = 0.874), having female children (girls) (OR = 0.795) was more significantly associated with fewer depressive symptoms among women. In the meantime, we did not find a significant relationship between the childbearing period and depression. The paper discussed possible reasons for our findings and policy implications from the perspectives of the government, society, and family.

Perinatal death triples the prevalence of postpartum depression among women in Northern Uganda: A community-based cross-sectional study

INTRODUCTION

Deaths during the perinatal period remain a big challenge in Africa, with 38 deaths per 1000 pregnancies in Uganda. The consequences of these deaths can be detrimental to the women; some ending up with postpartum depression. We examined the association between perinatal death and postpartum depression among women in Lira district, Northern Uganda.

METHODS

We conducted a community-based cross-sectional study of 1,789 women. Trained research assistants screened women for postpartum depressive symptoms on day 50 postpartum using the Edinburgh postpartum depression scale (EPDS). Socio-demographic, economic, birth and survival status of the neonate were collected during pregnancy and within one week postpartum. We used generalized estimating equation for the Poisson family with a log link using Stata to estimate the prevalence ratio of the association between postpartum depressive symptoms (EPDS scores ≥14) and perinatal death. Mothers who lost their babies between 7-49 days postpartum were excluded.

RESULTS

Of the 1,789 participants symptomatically screened for postpartum depression, 377 (21.1%) [95% confidence interval (95%CI): 17.2%, 23.0%] had probable depressive symptoms. The prevalence of postpartum depressive symptoms among the 77 women who had experienced perinatal death (37 stillbirths and 40 early neonatal deaths (≤7 days of life)) was 62.3% [95% CI: 50.8%, 72.6%] compared to 19.2% [95% CI: 17.4%, 21.2%], among 1,712 with live infants at day 50 postpartum. Women who had experienced a perinatal death were three times as likely to have postpartum depressive symptoms as those who had a live birth [adjusted prevalence ratio 3.45 (95% CI: 2.67, 4.48)].

CONCLUSIONS

The prevalence of postpartum depressive symptoms, assessed by EPDS, was high among women who had had a perinatal death in Northern Uganda. Women experiencing a perinatal death need to be screened for postpartum depressive symptoms in order to intervene and reduce associated morbidity.

Risk factors for postpartum depression: An evidence-based systematic review of systematic reviews and meta-analyses

PURPOSE

Postpartum depression (PPD) is the most common psychiatric condition after childbirth which not only effects the mother's health, but also might have impact on child's development and parenting behaviors. Because the etiology of PPD has not been fully cleared, the efforts towards identification of risk factors are crucial for both the children and mother's health.

METHOD

PubMed, EMBASE and PsycINFO databases were searched since inception until July 2019 to collect data about the risk factors of PPD and only systematic review and meta-analysis can be included.

RESULT

To identify the real risk factors, protective factors and controversial factors, nineteen parts of the interpretation were adopted. The risk factors are mainly concentrated in the following aspects: violence and abuse, immigration status, gestational diabetes, cesarean section, depressive history, vitamin D deficiency, obese and overweight, postpartum sleep disruption and poor postpartum sleep, lack of social support, traditional dietary pattern (Japanese, Indian, United Kingdom, and Brazilian dietary pattern), multiple births, preterm and low-birth-weight infants, postpartum anemia, negative birth experience. The controversial factors are serum level of cortisol, thyroid peroxidase autoantibodies status, acculturation, traditional confinement practices. Skin-to-skin care, higher concentrations of DHA in mothers' milk, greater seafood consumption, healthy dietary patterns, multivitamin supplementation, fish and PUFA intake, calcium, Vitamin D, zinc and possibly selenium are protective factors.

CONCLUSION

Thirteen risk factors were identified, but five factors still controversial due to the insufficient of the evidence. What's more, skin-to-skin care and some nutrition related factors are protective factors against PPD.

Neuronal life or death linked to depression treatment: the interplay between drugs and their stress-related outcomes relate to single or combined drug therapies

Depression is a serious medical condition, typically treated by antidepressants. Conventional monotherapy can be effective only in 60–80% of patients, thus modern psychiatry deals with the challenge of new methods development. At the same moment, interactions between antidepressants and the occurrence of potential side effects raise serious concerns, which are even more exacerbated by the lack of relevant data on exact molecular mechanisms. Therefore, the aims of the study were to provide up-to-date information on the relative mechanisms of action of single antidepressants and their combinations. In this study, we evaluated the effect of single and combined antidepressants administration on mouse hippocampal neurons after 48 and 96 h in terms of cellular and biochemical features in vitro. We show for the first time that co-treatment with amitriptyline/imipramine + fluoxetine initiates in cells adaptation mechanisms which allow cells to adjust to stress and finally exerts less toxic events than in cells treated with single antidepressants. Antidepressants treatment induces in neuronal cells oxidative and nitrosative stress, which leads to micronuclei and double-strand DNA brakes formation. At this point, two different mechanistic events are initiated in cells treated with single and combined antidepressants. Single antidepressants (amitriptyline, imipramine or fluoxetine) activate cell cycle arrest resulting in proliferation inhibition. On the other hand, treatment with combined antidepressants (amitriptyline/imipramine + fluoxetine) initiates p16-dependent cell cycle arrest, overexpression of telomere maintenance proteins and finally restoration of proliferation. In conclusion, our findings may pave the way to better understanding of the stress-related effects on neurons associated with mono- and combined therapy with antidepressants.

Predictors of postpartum depression and the utilization of postpartum depression services in rural areas in the Philippines

PURPOSE

This study explored the prevalence and predictors of postpartum depression (PPD) as well as the utilization and evaluation of PPD services among postpartum women in rural areas of the Philippines.

DESIGN AND METHODS

A cross-sectional study was conducted. One hundred sixty-five women who visited maternal facilities in the rural areas of the Central Philippines completed the Edinburgh Postnatal Depression Scale (EPDS).

FINDINGS

The prevalence of PPD was 16.4% at the sixth postpartum week. Occupation and marital status had significant direct influences on PPD. PPD services were not routinely provided by doctors and nurses.

PRACTICE IMPLICATIONS

Our results highlight a greater need to intensify government programs relative to PPD services, specifically related to the early detection and screening of PPD among high-risk pregnancies.

Quality of life and the related factors in early postnatal women in Malawi

OBJECTIVE

To explore the quality of life (QOL) and related factors in early postnatal women.

DESIGN

A descriptive, cross-sectional study.

SETTING

Liwonde, Malawi.

PARTICIPANTS

Women who underwent a normal vaginal birth (N = 173) were included from August to September 2018.

MEASUREMENTS

The QOL of participants was assessed using a World Health Organization QOL instrument. Demographic, obstetric, and health variables were collected using a structured questionnaire. Childbirth fear and depression were respectively assessed using the Wijma Delivery Experience Questionnaire and the Edinburgh Postnatal Depression Scale. A multiple linear regression was used to examine factors associated with the QOL.

RESULTS

The mean age of participants was 29 (standard deviation 6.7) years. The overall QOL and health were satisfactory. The mean score of the QOL was highest in the psychological health and social relationships domains, followed by the environmental and physical health domains. A higher educational level was negatively related to the physical health of QOL (p ≤ 0.01), with physician care positively related (p = 0.01). The employment status was positively related to psychological health and the environmental QOL (p ≤ 0.01). Furthermore, a higher income, and physician care were positively related to the environmental QOL (p ≤ 0.05). High levels of childbirth fear and depressive symptoms were negatively related to all domains of the QOL (p ≤ 0.05), except for the social relationships domain.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

The physical health QOL was lower in postnatal mothers in Malawi. Measures to improve physical health aspects and address women's fears and depressive symptoms during postpartum care are warranted. The findings should alert the health providers of the importance of assessing and improving women's physical health and psychological well-being during postpartum care.

The risk factors of antenatal depression: A cross-sectional survey

AIMS AND OBJECTIVES

To investigate the prevalence of depression in the third trimester of pregnancy and identify the related demographic risk factors.

BACKGROUND

Antenatal depression as a disabling and treatable disease has a wide-ranging impact on perinatal women and has received extensive attention from researchers.

DESIGN

A cross-sectional survey was conducted at three public hospitals.

METHODS

Demographic questionnaire was developed from the literature review, and depression was assessed using the Edinburgh Postnatal Depression Scale. A binary logistic regression model was used to assess the association between depression and demographic predictors. STROBE checklist for cross-sectional studies was applied in this paper (see Appendix S1).

RESULT

A total of 773 pregnant women participated in the study. 29.6% of participants scored more than 9 points on Edinburgh Postnatal Depression Scale. In the final logistic model, living in rural area, marital satisfaction, assisted reproductive technology, lacking of prenatal health knowledge and life events were strongly significantly associated with antenatal depression. Moreover, living in an extended family, without Medicare insurance, unemployed, working as civil servants or healthcare workers, and lower household income also predicted antenatal depression. However, education level, smoking or drinking before pregnancy was found not to be associated with antenatal depression.

CONCLUSION

Our findings suggest that the prevalence of antenatal depression was high. Satisfied with the current marital status, pregnancy without assisted reproductive technology, knowledge of perinatal care and no life events recently were considered as the protective factors for antenatal depression.

RELEVANCE TO CLINICAL PRACTICE

Antenatal psychological interventions should focus on how to improve the marital satisfaction and the relationship with their family members. More attentions should be paid to the women who have had some life events recently or received assisted reproductive technology for pregnancy.

Association of self-reported physical fitness with pain during pregnancy: The GESTAFIT Project

AIMS

To explore the association of self-reported physical fitness with bodily, lumbar and sciatic pain, and pain disability during pregnancy.

METHODS

The present study sample comprised 159 pregnant women (32.9 ± 4.7 years old). Self-reported physical fitness was assessed with the International Fitness Scale (IFIS), where higher scores indicate greater physical fitness. Bodily pain was assessed with the 36-Item Short Form Health Survey (SF-36), where higher scores indicate lower pain. Lumbar and sciatic pain were measured with a visual analogue scale (VAS). The Oswestry Disability Index (ODI) questionnaire was employed to assess the disability resulting from pain. Measures were assessed at 16th and 34th gestational weeks (g. w.).

RESULTS

Pregnant women showed low-moderate pain during pregnancy course. Most of them showed medium self-reported overall physical fitness. At 16th g. w., greater self-reported overall physical fitness and cardiorespiratory fitness were associated with less bodily and lumbar pain, and pain disability (all, P < 0.05). Greater muscular strength was associated with less bodily pain and pain disability (both, P < 0.05). Greater speed-agility was associated with less bodily pain (P < 0.01) and less pain disability (P < 0.05). Self-reported flexibility was not associated with any outcome (P > 0.05). At 34th g. w., greater overall physical fitness and its components were associated with less bodily and sciatic pain (all, P < 0.05).

CONCLUSION

Greater self-reported overall physical fitness and its components are associated with less bodily, lumbar and sciatic pain, and reduced pain disability during pregnancy. Future studies are needed to explore whether increasing physical fitness before and during pregnancy could decrease pain in this relevant stage.

A systematic review of prevalence and risk factors of postpartum depression in Chinese immigrant women

BACKGROUND

As the number of immigrants grows, the health of Chinese immigrant women, especially their perinatal health, has gradually attracted public attention. Our review has two main purposes. First, estimate the prevalence of postpartum depressive symptoms in Chinese immigrant women, and then determine risk factors for postpartum depressive symptoms among these women.

METHODS

The following databases: MEDLINE, Embase, Scopus, Web of Science, PsycINFO and PubMed were used in literature search from their commencements until November 21st 2017. The Joanna Briggs Institute (JBI) Critical Appraisal instruments were used to evaluate the quality of the article. Four studies met the inclusion criteria, contributed to our review and meta-analysis.

RESULT

The prevalence of postpartum depression is high in Chinese immigrant women. Risk factors for postpartum depression in Chinese immigrant women were defined as lack of social support, unstable economic status, and acculturation.

CONCLUSION

There have been few studies on postpartum depression among Chinese immigrant women. Existing studies have shown a high prevalence of postpartum depression in Chinese immigrant women. Moreover, there is an urgent need for studies on postpartum depression among Chinese immigrant women informing better understanding, programs of care and improving the perinatal health status of Chinese immigrant women.

A randomized controlled trial on the effect of lifestyle education for Iranian women and their husbands on post-partum anxiety and depression

This randomized controlled trial was conducted on 189 pregnant women to determine the effect of lifestyle-based training for women and their husbands on post-partum anxiety (PPA) and depression (PPD). Follow-ups were continued up for 6 weeks after childbirth. Participants were allocated to three groups using block randomization. In the first intervention group, both the women and their husbands, and in the second intervention group only the women received the lifestyle-based education. In the control group, women received only routine care. Participants completed the Edinburgh Postnatal Depression Scale and Spielberger State-Trait Anxiety Inventory pre-intervention and 6 weeks after childbirth. When compared with the control group, significant reductions in PPD (adjusted difference: -5.5), state anxiety (-13.6) and trait anxiety (-12.6) scores were observed in the lifestyle education-dyad group, and also significant reductions in PPD (-3.2), state anxiety (-5.8) and trait anxiety (-4.9) scores were observed in the lifestyle education-women only group. Also, significant reductions were observed in PPD (-2.2), state anxiety (-7.8) and trait anxiety (-7.7) scores in the lifestyle education-dyad group compared with the lifestyle education-women only group. Results showed the positive effect of lifestyle training on PPD and PPA, especially if the training is given to the parental dyad.

Postpartum Depression and Risk Factors among Vietnamese Women

Postpartum depression (PPD) places a burden on maternal health. PPD exerts a negative impact on mothers' health and children's life. The purpose of this research was to identify the prevalence of PPD and the risk factors contributing to PPD. Therefore, a cross-sectional quantitative study was conducted. 116 women were categorized into two groups. One category included new mothers who received scores of Edinburgh Postpartum Depression Scale (EPDS) 12 or more. The other category included mothers who received scores less than 12. Descriptive statistic and then binary logistic regression were also performed. For EPDS ≥ 12, the prevalence of PPD was 27.6% among new mothers during the first year after delivery. Level of education, diseases during pregnancy, being the first-time mothers, dissatisfaction about family, and limited communication and interaction with others were significant predictors of PPD.

Designation and psychometric properties of the Short Form Postpartum Quality of Life Questionnaire (SF-PQOL): an application of multidimensional item response theory and genetic algorithm

Background: Utilizing multidimensional item response theory (MIRT) and genetic algorithm (GA) we aimed to design and test the psychometric properties of the short form Postpartum Quality of Life Questionnaire (PQOL). Methods: In this methodological study, 500 women aged 18 to 42 were enrolled through a multistage random sampling scheme in Tabriz, Iran. We used MIRT model and GA to identify a short form of the 40-item PQOL measure (SF-PQOL). Construct and criterion validity of the SF-PQOL was assessed by confirmatory factor analysis (CFA) and the correlation between SFPQOL scores with a 12-item short form of QOL (SF-12) and Edinburg Postnatal Depression Scale (EPDS) scores, respectively. The internal consistency, test-retest reliability and feasibility of the measure were evaluated. Results: sixteen- and 13-item SF-PQOL were identified based on MIRT and GA, respectively.The results indicate the better performance of the MIRT based 13-item SF-PQOL; Construct and criterion validity, the test-retest and internal consistency reliability, and the feasibility were confirmed in the MIRT based SF-PQOL, but not in the GA-based SF-PQOL. Conclusion: The MIRT suggests a 13-item SF-PQOL with adequate content which demonstrated satisfactory validity, reliability, and feasibility. SF-PQOL could be used across the population for both research and clinical objectives.

Antenatal depressive symptoms during late pregnancy among women in a north-eastern province of Thailand: Prevalence and associated factors

BACKGROUND

Globally, depression is prevalent during pregnancy and several factors have been associated with antenatal depressive symptoms (ADS). However, ADS have rarely been investigated in Thailand. This study aimed at exploring the prevalence of ADS and factors associated with these symptoms among Thai women in late pregnancy.

METHODS

A cross-sectional study including 449 women in late pregnancy was carried out. The Edinburgh Postnatal Depression Scale (EPDS) was used to detect depressive symptoms with a score of 10 points or higher. Socio-demographic characteristics and psychosocial risks were measured in association with ADS. Percentage and 95% confidence interval (CI) were used to assess the prevalence of ADS. Odds ratio (OR) and 95%CI were used to determine ADS-related risk factors among women.

RESULTS

The prevalence of ADS was 46.8% (95%CI 42.3-51.4). Pregnant women aged less than 20 years (OR 2.58, 95%CI 1.14-5.84) and those not having enough money (OR 2.71, 95%CI 1.22-6.05) had an increased risk of ADS. Psychosocial risks related to ADS for women were low psychological well-being (OR 3.12, 95%CI 1.75-5.58), low self-esteem (OR 2.08, 95%CI 1.24-3.49), and low sense of coherence (OR 1.82, 95%CI 1.12-2.95).

CONCLUSIONS

The prevalence of ADS among Thai women in their late pregnancy is high. Socio-demographic characteristics and psychosocial factors are independently associated with ADS. Healthcare providers in Thailand should consider EPDS as a standardised screening tool for ADS and use it at antenatal care clinics. Implementing programs focusing on both pregnant women and their family might increase the prevention of perinatal depression.

Postpartum psychiatric disorders

Pregnancy is a complex and vulnerable period that presents a number of challenges to women, including the development of postpartum psychiatric disorders (PPDs). These disorders can include postpartum depression and anxiety, which are relatively common, and the rare but more severe postpartum psychosis. In addition, other PPDs can include obsessive-compulsive disorder, post-traumatic stress disorder and eating disorders. The aetiology of PPDs is a complex interaction of psychological, social and biological factors, in addition to genetic and environmental factors. The goals of treating postpartum mental illness are reducing maternal symptoms and supporting maternal-child and family functioning. Women and their families should receive psychoeducation about the illness, including evidence-based discussions about the risks and benefits of each treatment option. Developing effective strategies in global settings that allow the delivery of targeted therapies to women with different clinical phenotypes and severities of PPDs is essential.

Maternal quality of life in routine labor epidural analgesia versus labor analgesia on request: results of a randomized trial

INTRODUCTION

The purpose of this study was to evaluate the changes in maternal quality of life (QOL) from pregnancy to 6 weeks after delivery between routine labor epidural analgesia (EA) and pain relief on maternal request only.

METHODS

\Women delivering of a singleton in cephalic presentation beyond 36 + 0 weeks' gestation were randomly allocated to EA as a routine during labor (routine EA group), or to any kind of analgesia on request only (control group). The Short Form health survey (SF-36) was used to assess women's QOL before randomization, and 6 weeks postpartum. Data were analyzed according to the intention to treat principle.

RESULTS

A total of 488 women were included, and antepartum as well as postpartum SF-36 questionnaires were filled in by 356 (73.0%) women, 176 (49.4%) in the routine EA group, and 180 (50.6%) in the control group. Changes from the QOL antepartum to the QOL 6 weeks postpartum were comparable between both groups, also in the subgroup of women in the control group who gave birth without any pain medication (n = 41, 22.8%). Maternal age and the incidence of adverse events related to EA, which were both higher in the routine EA group, had no influence on the changes in QOL. Differences in request for pain relief were comparable with other studies.

CONCLUSION

Routine administration of EA during labor and pain relief on maternal request only are associated with comparable changes of women's QOL antepartum to 6 weeks postpartum.

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.

Investigation of the association between quality of life and depressive symptoms during postpartum period: a correlational study

Background

The onset of a major depressive episode is experienced by a large number of women in the weeks or months following delivery. Postpartum depression may deem those women experiencing it incapable of taking care for themselves, their family and their infants, while at the same time it could negatively affect their quality of life. The present study assessed the quality of life of a sample of mothers in Greece, in order to investigate the association between postpartum depression and quality of life (QoL).

Methods

145 women in a Private-General Obstetrics and Pediatric Clinic in Greece completed the Edinburgh Postnatal Depression scale (EPDS) and SF-36 questionnaire on the third and fourth day after delivery (caesarean or normal childbirth). The data were analyzed using SPSS version 17.0. Linear and logistic regression analysis was performed in order to find the independent factors related to the quality of life and postpartum depression symptoms.

Results

9.9% of the participants experienced postpartum depression symptoms. Significant associations were found between the place of residence and symptoms of postpartum depression, and more specifically, women outside of Attica indicated higher levels of postpartum depression symptoms (p = 0.008) than women living in Attica. The level of education was also found to be significantly associated with postpartum depression symptoms, since women with Primary and Secondary education experienced higher levels of postpartum depression symptoms (p = 0.005) than those with a tertiary education. Concerning quality of life, women with postpartum depression symptoms scored 24.27 lower in «Role-Physical», 15.60 lower in «Bodily pain», 11.45 lower in «General Health», 14.18 lower in dimension of «Vitality», 38.25 lower in Role – Emotional and 16.82 lower in dimension of mental health, compared to those without depression symptoms.

Conclusion

Postpartum depression symptoms are associated with the quality of life of women after pregnancy, and therefore constitute a powerful predictor of the quality of life. Health care professionals should provide individualized care for the prevention and treatment of Postpartum Depression symptoms in order to help women improve their quality of life.

Independent socio-demographic and clinical correlates associated with the perception of quality of life of women with postpartum depressionin North-central, Nigeria

OBJECTIVE

Quality of life (QoL) is probably the most desired outcome of all health care policies and monitoring. This concept is seldom used on women in the postpartum, especially in the developing world.

AIM

This study aimed at determining the independent socio-clinical variables associated with the perception of QoL of women with postpartum depression.

METHODS

A two-stage cross-sectional procedure was used to recruit 550 participants, out of whom 531 participants completed the questionnaires with 116 participants found to have postpartum depression and were the studied population, in Nigeria. The Socio-demographic questionnaire, the Edinburgh Postnatal Depression Scale, the World Health Organization Quality of Life-Bref-26 and the Depression Module of the Structured Clinical Interview for DSM-IV axis I Diagnosis were used.

RESULTS

Participants with postpartum depression had significantly poor perception of QoL in all the four domains of the WHOQoL-BREF-26. The independent socio-demographic and clinical correlate associated with poor perception for both rating of QoL and satisfaction with health was education (β = 0.321, p < .001 and β = 0.0326, p = .002, respectively); for physical domain [(modes of delivery) (β = -0.28, p = .016)]; psychological domain [(age <35years) (β = 0.391, p = .010)] and for social relationships [(complications during delivery) (β = 0.257, p = .043)].

CONCLUSIONS

The determination of the predictors of QoL, which is an indicator of disease outcome will improve service delivery to women of childbearing age.

[Post-partum depressive symptoms: Prevalence, risk factors and relationship with quality of life]

OBJECTIVE

The objective of our study was to estimate the prevalence of the post-partum depressive symptomatology in a sample of Tunisian women, to study associated factors and to assess its relationship to quality of life.

PATIENTS AND METHODS

This is a prospective study carried out in two stages: during the first week (T1), then between sixth and eighth week post-partum (T2). Depressive symptomatology and quality of life were assessed respectively by the Edinburgh Postnatal Depression Scale and the World Health Organization Quality of Life scale.

RESULTS

In the first stage, the prevalence of depressive symptomatology in the total sample (150 women) was 14.7% and was related to age above 35 years, low school level, personal psychiatric history, multiparity, caesarean delivery or forceps in the previous pregnancy and unplanned pregnancy. This prevalence was 19.8% among the 126 women reviewed in T2 and was correlated with the exaggerated sympathetic signs during pregnancy, namely perversion of taste and fatigue. Quality of life was strongly correlated with depressive symptoms in T1 and T2.

CONCLUSION

Post-partum depressive symptoms were common in our sample and were correlated with quality of life. Therapeutic measures should be proposed for women with post-partum depressive symptoms and particularly with several risk factors in order to improve their quality of life.

The effect of a telephone-based cognitive behavioral therapy on quality of life: a randomized controlled trial

Health-related quality of life (HRQoL) has emerged as a major public health concern in perinatal care. The purpose of this study was to examine the effect of telephone-based cognitive behavioral therapy (T-CBT) on HRQoL among Chinese mothers at risk of postnatal depression at 6 weeks and 6 months postpartum. A multi-center randomized controlled trial was conducted at the postnatal units of three regional hospitals. Three hundred and ninety-seven women at risk of postnatal depression were recruited and were randomly assigned to the T-CBT (n = 197) or usual care (n = 200). Assessment was conducted at baseline, 6 weeks and 6 months postpartum for HRQoL. Women in the T-CBT experienced greater improvement in the physical component of HRQoL from baseline to 6 weeks and 6 months postpartum than the usual care group. At 6 months postpartum, the T-CBT group also experienced better HRQoL in the mental component of HRQoL than the usual care group. The T-CBT appears to be feasible and effective in improving HRQoL in women at risk of postnatal depression in the primary care practice.

The effect of a self-care program based on the teach back method on the postpartum quality of life

Background

The postpartum period is a critical stage of life with major changes in the quality of life. Therefore, special consideration is needed to this issue.

Objective

To determine the effect of a self-care program based on the Teach Back method on the postpartum quality of life.

Methods

This experimental study was conducted on eighty postpartum women who had given birth in health centers across Darreh Shahr County, Ilam Province, Iran in 2016. The control group received only routine postpartum care according to the national guidelines. The trial group received the routine care in addition to two sessions of physical and psychological postpartum self-care based on the Teach Back method. The two groups were assessed in terms of their quality of life before and after the intervention using the Postpartum Quality of Life Questionnaire. The data were analyzed using SPSS version 21. Descriptive statistic tests, Chi squared, independent-samples t-test, paired-samples t-test, Wilcoxon and Mann Whitney’s test was used.

Results

Before the intervention, the postpartum quality of life score was 106.23±11.866 in the trial group and 107.30±13.197 in the control group; after the intervention, the score was 124.73±10.706 and 115.03±12.687 in the two groups respectively, suggesting a significant inter-group difference after the intervention (p<0.001). Significant differences were also observed between the two groups in terms of the mother’s feelings toward herself, toward her child and toward her spouse and others, and physical health before and after the intervention (p<0.001).

Conclusions

Using the Teach Back model for a self-care program appears to dramatically improve the postpartum quality of life and is therefore recommended as a useful method for postpartum care.

Trial registration

The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015012820854N1.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Prevalence of and factors influencing postnatal depression in a rural community in South Africa

Background

Knowledge about postnatal depression (PND) and associated risk factors which influence the development of PND is vital for early detection, intervention and prevention.

Setting

The study was conducted in primary health care clinics (PHC) in the Witzenberg subdistrict, a rural community in South Africa.

Objectives

Objectives of this study were to determine the prevalence of PND and to identify the contributing risk factors associated with PND.

Methods

A descriptive cross sectional research design with a quantitative approach was applied. The target population was mothers, 18 years and older. A convenience sampling method was used to select a sample of 159 (10%) from a population of 1605 live births. The Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory (BDI), two validated self-rating questionnaires, including a questionnaire based on demographical, psychosocial and obstetrical data, were applied. The data was analysed using various statistical tests to determine statistical associations between variables using a 95% confidence interval.

Results

PND was a serious health problem with 50.3% of the mothers who suffered from PND. A BDI analysis showed that of the participants who had PND, 28.8% was severe, 48.8% moderate and 22.5% mild. Factors influencing the development of PND included most participants (63.5%) were unmarried, 61.3% were unemployed and the majority (53.8%) had a history of a psychiatric illness. Significant associations between PND and unplanned and unwelcome babies (p < 0.01); partner relationship (p < 0.01); were identified.

Conclusion

Prevention, early detection, appropriate referral and treatment of PND are critical in managing maternal, child and family well-being.

Randomized Trial of Psychological Interventions to Preventing Postpartum Depression among Iranian First-time Mothers

Background:

The current study was conducted to examine the effect of cognitive behavior therapy on the reduction postpartum mood disorder and increasing the self-esteem of at-risk Iranian mothers.

Methods:

In this quasi-experimental study, 135 at-risk mothers were selected from the population by means of cluster sampling and randomly assigned into one of two groups: Intervention (n = 64), or control (n = 71). The control group received usual medical care, and the intervention group received an eight sessions’ cognitive behavior program during pregnancy. Assessments were administered at two time points (pretest at the beginning of the third trimester and posttest at 2 weeks postpartum). Beck anxiety, beck depression, Edinburgh postpartum depression, (PPD) Coopersmith self-esteem, and religious attitude questionnaire were used to collect data.

Results:

The mean age of participants was 25.8 ± 3.7 years. One-third of them had either bachelor or higher degrees in education (33%). About two-third of participants were unemployment with similar distribution in both the groups (intervention = 80%, control = 83%). The majority (70%) of the participants had cesarean section deliveries. There were no statistically significant differences respects to sociodemographic characteristics between the control and intervention groups (P > 0.05). The multivariate analysis of covariance results showed that the average scores of PPD were reduced significantly in the intervention group (P < 0.001). Also while the mean score of anxiety in the intervention group decreased from 23.31 (standard error [SE] =12.11) to 16.64 (SE = 8.33) and self-esteem increased from 29.09 (SE = 3.51) to 31.81 (SE = 2.76), no change was statistically significant in comparison to the control group.

Conclusions:

According to the findings of the present study, cognitive behavior intervention is effective in reducing PPD in at-risk mothers.

Depression and Quality of Life in Patients With Type 2 Diabetes

Background:

Frequency of mood disorders in patients with chronic diseases, especially diabetes and its effects on life quality are dramatically increasing.

Objectives:

This study aimed to investigate the relation between depression and quality of life in patients with diabetes.

Patients and Methods:

This is a cross sectional survey. Subjects were selected from 330 eligible people referred to the only diabetes clinic in Gorgan City during 6 months, using systematic random sampling. Beak Depression questionnaire and the brief questioner with 26 questions recommended by the World Health Organization (WHOQOL-BREF) were used to measure depression and quality of life, respectively. Data were analyzed through descriptive methods, Chi-square, Independent t test and linear regression model using SPSS16; moreover, P value < 0.05 was considered as significant.

Results:

In total, 330 patients with diabetes (35.5 % male and 64.5% women) were studied. The mean and standard deviation of their age and years involved with diabetes were 50.6 ± 9.0 and 5.4 ± 4.5 years, respectively. Range of age was 25 - 75 years, as well. The prevalence of depression in all patients with diabetes was 58.2% (124 mild, 56 medium, and 12 with severe depression). Hypertension was 13.9% more in diabetic patients with depression (P value < 0.001) and physical activity in 24.7% of the cases was less with a meaningful difference (P value = 0.01). The mean and standard deviation of quality of life in diabetic patients with and without depression was 50.7 ± 14 and 60.5 ± 13.3, respectively that was significant in two groups (P < 0.0001).

Conclusions:

The prevalence of depression is high in patients with diabetes and has a considerable impact on the consequences of diabetes and quality of life too.

Health status and quality of life in postpartum women: a systematic review of associated factors

Since health care is becoming more and more patient centered, patient-reported outcomes such as quality of life (QOL) and health status (HS) are becoming increasingly important. The aim of this systematic review was to provide an overview of physical, psychological, and social domains of QOL and HS in postpartum women, and to assess which factors are associated with QOL and HS domains postpartum. A computerized literature search was performed using the PubMed, PsycINFO, and Cochrane databases. Studies were selected if the three domains of QOL or HS were measured in a (sub)group of postpartum women, by using validated standardized questionnaires. The methodological quality of the 66 included studies was examined by two independent reviewers. All three domains of QOL were impaired in postpartum women with urinary incontinence, with even worse QOL in women with mixed urinary incontinence. Mental QOL was impaired in women with urge urinary incontinence after cesarean section. Social QOL was decreased in HIV-positive women. HS was impaired in all three domains in postpartum depressed women. Physical HS was impaired after cesarean section for at least two months postpartum. Additional supportive interventions from health care social support were not associated with improved HS. Urinary incontinence and being HIV-positive seemed to be associated with impaired QOL. Postpartum depression and a cesarean section seemed to be associated with impaired HS. Prospective longitudinal research is needed in order to draw valid conclusions regarding postpartum HS and QOL, and the predictive value of the associated factors.

Translation and validation of the German version of the Mother-Generated Index and its application during the postnatal period

OBJECTIVE

the Mother-Generated Index (MGI) is a validated tool to assess postnatal quality of life. It is usually administered several weeks or months after birth and correlates with indices of post partum mood states and physical complaints. The instrument had not been translated into German before or validated for use among German-speaking women, nor have the results of the tool been assessed specifically for the administration directly after birth. This paper aims to describe the systematic translation process of the MGI into German and to assess the convergent validity of the German version of the instrument directly after birth and seven weeks post partum.

DESIGN

prospective two-stage survey.

SETTING

two rural hospitals in the south of Germany and in the north of Switzerland.

PARTICIPANTS

all women giving birth between 1st October and 15th December 2012 with sufficient knowledge of German and whose babies were not referred to a neonatal care unit; 226 women were eligible to participate.

MEASUREMENT INSTRUMENTS

two questionnaires including questions relating to socio-demographic factors and perinatal care, and incorporating the MGI, the Hospital Anxiety and Depression Scale (HADS) and the Postnatal Morbidity Index (PMI). All instruments were subjected to forward and back translation and pilot-tested; the first questionnaire was then administered in the first two days after birth and the second six weeks post partum. Parametric and non-parametric tests were computed using SPSS.

FINDINGS

129 surveys were returned an average of three days after birth and 83 after seven weeks. Higher postnatal quality of life showed a significant correlation with a lower anxiety and depression score (p<0.01), fewer maternal physical complaints (p<0.05) and more favourable baby adjective scores (p<0.05) after birth. Significant associations were found between MGI scores and sufficient help (p=0.03) as well as ability to cope at home (p<0.01). MGI scores three days and seven weeks after birth correlated highly significantly and positively (p<0.001).

KEY CONCLUSIONS

convergent validity of the MGI with the HADS and the PMI suggests that the German version of the MGI is a valid indicator of physical and emotional post partum well-being.

IMPLICATION FOR PRACTICE

the German version of the MGI can be used in the post partum period to identify women whose quality of life is impaired during the first days after birth, in order to initiate extended midwifery care and referral if necessary.