Temporal Stability of Responses to the Edinburgh Postpartum Depression Scale by Bedouin Mothers in Southern Israel

The detection and treatment of mental illness during pregnancy and postpartum are essential for the well-being of both mother and child. For this study, we set out to estimate the prevalence of perinatal depression among Bedouin mothers in southern Israel and determine if the latent structure of responses to the Edinburgh Postpartum Depression Scale (EPDS)-including depression, anxiety, and anhedonia-previously reported also applies to this population. A total of 332 women completed the EPDS during pregnancy (26-38 weeks) and again 2-4 months postpartum. Confirmatory factor analyses were performed to determine if first-order factors were correlated, or instead measure a second- or higher-order latent construct. We next performed temporal invariance analyses to compare the latent structure of EPDS responses over time. When pregnant, 35% of women provided EPDS responses suggestive of elevated depressive symptomology; this decreased to 23% postpartum. At both points, each EPDS factor significantly measures a higher-order, latent construct. The EPDS appears to measure three factors, labeled sadness, anxiety, and anhedonia. This latent structure appears stable (i.e., during pregnancy and postpartum). Further research is needed to validate EPDS responses versus structured clinical interviews. The construct validity of EPDS factors should be examined across other at-risk groups and over time.

A Study on Postpartum Depression and its Association with Infant Feeding Practices and Infant Nutritional Status among Mothers Attending the Anganwadi Centers of Valsad District, Gujarat, India

Background:

Systematic reviews on postpartum depression (PPD) suggest that PPD mothers are more likely to interrupt exclusive breastfeeding with inappropriate feeding practices resulting malnutrition in child. A community-based study was planned with the objective to find the risk factors associated with PPD and its possible association on infant feeding practices and infant nutritional status.

Materials and Methods:

This was a cross-sectional study conducted among 116 postpartum mothers attending Anganwadi centers under the Urban Health Training Centre and Rural Health Training Centre of Medical College. A purposive sampling technique was applied. Informed and written consent in local language was taken. Data were collected in predesigned, pretested, and semi-structured pro forma. The mothers were screened for possible PPD using the 10-item well-validated Edinburgh PPD Scale in Gujarati language. The cutoff point is score more than 10.5 based on previous studies. Infant's nutritional status and breastfeeding practices were assessed according to the WHO Growth Chart and Infant and Young Child Feeding guidelines.

Results:

(1) 6.8% of the prevalence of PPD was reported in the study; (2) sociodemographic factors such as relationship of mothers with in-laws/husbands, help at home in childcare, literacy status, age at marriage and first child, and own desired/in-laws of sex of child are found to be significantly associated with PPD. (3) The Association of PPD and poor nutritional status of child was statistically significant.

Conclusions:

The study highlights the need of screening for PPD in the community. The potential risk factors for PPD can be taken into consideration during routine antenatal/postnatal care and for planning of preventive strategies.

Factors associated with postpartum depression in women from low socioeconomic level in Argentina: A hierarchical model approach

PURPOSE

to estimate the prevalence of depression at 4-week postpartum using the Edinburgh postpartum Depression Scale (EPDS) in women who delivered in a public maternity hospital in Argentina.

METHODS

This prospective cohort study was carried out from March to August 2016 in northwest Argentina. Eligibility included delivering a singleton live birth 28 weeks of gestational age or over, 18 years or older and resided within 1h from the maternity hospital. Women were excluded if they or their newborn were in the intensive care unit. We defined a positive screening as an EPDS score of 10 or higher or a positive response to item 10, which indicates thoughts of self-harm.

RESULTS

A total of 587 women were enrolled and 539 women completed the home visit interview and the EPDS. A total of 167 (31.0%, 95% CI 27.1-35.1) mothers screened positive in the EPDS using a score ≥ 10 and 99 (18.4%, 95% CI 15.1-21.6%) using a score ≥ 13, which indicate increased severity of depressive symptoms. In both cases, the 23 (4.3%) women that responded as having thoughts of self-harm were included.

CONCLUSION

Nearly a third of women who participated had depressive symptoms at four weeks postpartum in a public hospital in Tucumán, Argentina. Socio-demographic, particularly personal psychiatric history, factors and social and cultural influences can impact results. Our results highlight the need for improved screening and better diagnostic tool for women with postpartum depression in Argentina and to investigate the impact of postpartum depressive symptoms on women's health and their families.

Postpartum Depressive Symptoms and Associated Factors in Married Women: A Cross-sectional Study in Danang City, Vietnam

Introduction

Postpartum depression (PPD) among women is a common mental health concern. It occurs at a time of major life change, coupled with the increased responsibilities associated with the care of a newborn infant. In Vietnam, the prevalence of depressive symptoms after giving birth has not been fully investigated. Research in the Northern provinces, in Ho Chi Minh City, and in Hue suggests postnatal depressive symptoms among women are common. This research aims to (1) estimate the prevalence of PPD symptoms among married women in one Vietnam city (Danang) and (2) identify the social and personal factors associated with postpartum depressive symptoms.

Methods

This cross-sectional study was conducted from July 2013 to August 2014 in 10 wards of Hai Chau District, Danang. A total of 600 mothers who gave birth 4 weeks to 6 months prior to being interviewed were recruited. Interviews were conducted using structured questionnaires, which included several dimensions: demographics, family living arrangements, expectations of pregnancy, expectations of infant gender, the woman’s relationship with her husband, exercise after birth, infant health, and anxiety about matters other than the birth. The Edinburgh Postpartum Depression Scale (EPDS) was used to examine PPD symptoms, with a cutoff point of 12/13.

Results

EPDS scores indicated the prevalence of PPD symptoms was 19.3% (95% CI: 16.16–22.50). Among women with PPD symptoms, 37.9% had suicidal thoughts in the previous seven days. Multivariate logistic regression indicated that the following key factors were significantly associated with PPD symptoms: Not being able to rely on their husband for help, having a husband who does not spend time to discuss problems, having anxiety about matters other than the birth, not exercising after giving birth, and having an ill baby.

Conclusion

These findings should be interpreted in relation to other recent research in Vietnam. A consistent pattern of prevalence estimates and associated social factors is emerging that has implications for the postpartum care of mothers.

Universal versus risk factor-targeted early inpatient postpartum depression screening

OBJECTIVE

To assess differences in two different approaches to early inpatient Edinburgh Postnatal Depression Scale (EPDS) screening (targeted risk factor screening versus universal screening).

METHODS

Retrospective study of two cohorts delivering from January 2010 to June 2010. Cohort 1 included 5-weeks of consecutive deliveries. Risk factors for a positive EPDS screen were determined by multivariable logistic regression. Cohort 2 included all delivering women in the subsequent 5 months who had the most common risk factor (history of mental illness) for postpartum depression identified from Cohort 1.

RESULTS

For Cohort 1 of universal screening (N = 322), 11 (3.4%) had positive screens with seven (63.6%) having a history of any mental illness yielding the number needed to screen to identify one EPDS positive mother of 29. For Cohort 2 (N = 215), there were 33 (15.3%) positive screens and the number needed to have a positive screen was 6. Without a history of mental illness, predictive models for a positive screen were poor with the number needed to screen of 80.

CONCLUSIONS

Early EPDS screening targeted for those with a history of mental illness is an efficient way to identify postpartum women with active mental health problems, but may miss up to 36.4% of potential screen positive women.