The association of prenatal attachment and perinatal factors with pre- and postpartum depression in first-time mothers

Maternal depressive symptomatology during pregnancy is a risk factor affecting newborn's health: a longitudinal study

Background: Depression symptomatology in pregnant women is a condition that represents an important risk factor for the health of both women and children. Objectives: The aim of this study was to investigate the influence of women's depression symptomatology on the clinical aspects of their delivery, both directly and indirectly, through mothers' prenatal attachment to their unborn children. Moreover, we analysed whether these aspects affect the well-being of the newborn, assessed through the Apgar score. Methods: A longitudinal design was carried out on a total of 203 pregnant women. At weeks 31-32 of gestation, women filled out the Beck Depression Inventory and the Prenatal Attachment Inventory. The day of childbirth, hospital healthcare staff registered the clinical data of childbirth. Results: A woman's depressive symptomatology negatively affects prenatal attachment to her unborn child and positively affects the clinical aspects of the delivery, both directly and mediated by the quality of prenatal attachment. Moreover, the Apgar score was negatively influenced by the clinical aspects of the delivery and, indirectly, by the depressive symptomatology. Conclusion: Depressive symptomatology during pregnancy has negative outcomes, affecting the delivery experience of women, the first emotional bond with the child, and the well-being of the newborn.

Risk factors for impaired maternal bonding when infants are 3 months old: a longitudinal population based study from Japan

BACKGROUND

Impaired maternal bonding has been associated with antenatal and postnatal factors, especially postpartum depression. Only a few population-based, longitudinal studies have examined the association between maternal depression and bonding in outside western countries. In addition, little is known about the association between psychosocial factors during pregnancy and impaired maternal bonding. The aim of this study was to investigate risk factors associated with impaired maternal bonding 3 months after delivery using Japanese population-based, longitudinal study from pregnancy period to 3 months after delivery.

METHODS

This study was performed at the public health care center in Hekinan city, Aichi prefecture, Japan. Mothers who participated the infant's health check-up 3 months after delivery from July 2013 to Jun 2015 completed the Postpartum Bonding Questionnaire (PBQ) and the Edinburgh Postnatal Depression Scale (EPDS) 1 month after delivery. Information was also provided from home visit at 1 month after delivery, birth registration form, and pregnancy notification form. The study included 1060 mothers with a mean age of 29.90 years, who had given birth at a mean of 38.95 weeks.

RESULTS

Bivariate and multivariate logistic regression analyses were conducted to identify the association between antenatal and postnatal factors and impaired maternal bonding. The main findings were that maternal negative feelings about pregnancy (OR = 2.16, 95% CI = 1.02-4.56) and postpartum depression at 1 month after delivery (OR = 7.85, 95% CI = 3.44-17.90) were associated with higher levels of impaired maternal bonding 1 months after delivery. Mothers who had delivered their first child had increased odds of a moderate level of impaired maternal bonding 3 months after delivery (OR = 1.85, 95% CI = 1.22-2.81).

CONCLUSIONS

The findings emphasize the importance of identifying mothers with depression and those with maternal negative feelings towards pregnancy to assess possible impaired maternal bonding.

Perinatal depression among a global sample of Spanish-speaking women: A sequential-process latent growth-curve analysis

BACKGROUND

Despite high rates of perinatal depression among women from diverse backgrounds, the understanding of the trajectory of depressive symptoms is limited. The aim of this study was to investigate the trajectories of depressive symptoms from pregnancy to postpartum among an international sample of pregnant women.

METHODS

Hispanic/Latina (79.2%), Spanish-speaking (81%) pregnant women (N = 1796; Mean age = 28.32, SD = 5.51) representing 78 unique countries/territories participated in this study. A sequential-process latent growth-curve model was estimated to examine general trajectories of depression as well as risk and protective factors that may impact depression levels throughout both the prenatal and postpartum periods.

RESULTS

Overall, depression levels decreased significantly across the entire perinatal period, but this decrease slowed over time within both the prenatal and postpartum periods. Spanish-speaking women, those who were partnered, and those with no history of depression reported lower levels of depression during early pregnancy, but this buffer effect reduced over time. Depression levels at delivery best predicted postpartum depression trajectories (i.e., women with higher levels of depression at delivery were at greater risk for depression postpartum).

LIMITATIONS

Given the emphasis on language and not country or culture of origin this study was limited in its ability to examine the impact of specific cultural norms and expectations on perinatal depression.

CONCLUSIONS

Given these findings, it is imperative that providers pay attention to, and assess for, depressive symptoms and identified buffers for depression, especially when working with women from diverse communities.

Prenatal and Postnatal Attachment Among Turkish Mothers Diagnosed with a Mental Health Disorder

The presence of a mental disorder in the mother is one of the key factors affecting attachment. The present study aimed to evaluate prenatal and postnatal attachment among mothers diagnosed with a mental health disorder by comparing them to a healthy group. The patient group included women who received follow-up care in a psychiatric clinic (74 pregnant and 75 postpartum), and the healthy group consisted of women who attended a follow-up polyclinic (118 pregnant and 82 postpartum). Data were collected using questionnaire forms, including the Prenatal Attachment Inventory and the Maternal Attachment Scale. Mothers diagnosed with a mental health disorder were determined to have lower attachment scores than the healthy group, both during the prenatal and postnatal periods. The literature suggests that mothers diagnosed with a mental health disorder showed low maternal attachment scores during pregnancy and/or the postnatal period. Psychiatric nurses should be involved in initiatives that may increase the prenatal and maternal attachment.

Parental perception of child vulnerability and parental competence: The role of postnatal depression and parental stress in fathers and mothers

Introduction

Parents' perception that their child may be vulnerable to serious life-threatening illnesses can have negative effects on how they exercise their parenting. No studies have yet been carried out on parent´s perception of their child’s vulnerability, when the child has not suffered a severe illness. This study tries to analyze the relationship between parent´s perception of their children´s vulnerability and parental competence, and analyzes the mediating role of postnatal depression and parental stress.

Method

The study was carried out on mothers and fathers of full-term infants who did not have any serious illnesses. A total of 965 people (385 fathers and 580 mothers) participated in the study.

Results

The results revealed an association between parental perception of their child’s vulnerability and parent’s perception of parental competence through depression and parental stress. However, this association was different for fathers and mothers.

Conclusion

The variable of perception of child’s vulnerability was a relevant factor to understand parental competence.

Review of the prevalence of postnatal depression across cultures

The purpose of this review was to examine articles related to recent epidemiological evidence of the prevalence of maternal postnatal depression (PND) across different countries and cultures and to identify specific epidemiological studies that have been carried out exclusively in Malaysia on the prevalence of maternal PND. The review was undertaken in two stages, an initial review and an updated review. At both stages systematic literature searches of online databases were performed to identify articles on the prevalence of maternal PND. A total of 124 articles concerning research conducted in more than 50 countries were included in the final analysis. There were wide variations in the screening instruments and diagnostic tools used although the Edinburgh Postnatal Depression Scale (EPDS) was the most common instrument applied to identify PND. The prevalence of maternal PND ranged from 4.0% to 63.9%, with Japan and America recording the lowest and highest rates, respectively. Within continents, a wide variation in reported prevalence was also found. The reported rates of maternal PND in Malaysia were much higher than that previously documented with a range of 6.8–27.3%. This review indicated that the widely cited prevalence of maternal PND of 10–15% underestimates rates of PND worldwide. The reasons for this variability may not be fully explained by review methods. Future studies should evaluate the nature of women's PND experiences across cultures to explain these wide variations.

First-time mothers' confidence mood and stress in the first months postpartum. A cohort study

OBJECTIVES

The aims were to describe first-time mothers' confidence, mood and stress 2 and 6 months postpartum and to investigate the extent to which the tools measuring maternal confidence and maternal mood used alone or together at 2 months postpartum predict first-time maternal confidence, mood and stress 6 months postpartum.

DESIGN

A cohort including 513 first-time mothers' self-reported questionnaires concerning three scales: The Karitane Parenting Confidence Scale (KPCS), the Edinburgh Postnatal Depression Scale (EPDS), and the Parental Stress Scale (PSS) collected 2 and 6 months postpartum. Descriptive statistic, simple and multiple linear regression analysis were used.

RESULTS

First-time mothers' with confidence scores below the clinical cut-off (KPCS <40) fell significantly from 25% to 14% (p < 0.001), symptoms of depression above the clinical cut-off (EPDS ≥ 8) fell significantly from 16% to 12% (p < 0.001), and parental stress as a mother fell significantly from a mean of 32.88 to 30.98 (p < 0.001). The KPCS assessed at 2 months postpartum was the strongest predictor for both maternal confidence (R² = 0.38) and parental stress (R² = 0.26) 6 months postpartum.

CONCLUSION

The results support the assumption that parenthood is a complicated period for first-time mothers characterised by low confidence, symptoms of depression and high stress which improve over time for the majority of mothers. The KPCS at 2 months postpartum was the strongest predictor of the measures used. Further research is needed to identify parents who are struggling, especially for health professionals' whose role is to support parents in their parenthood the first period after birth.

Development of the Korean Paternal-Fetal Attachment Scale (K-PAFAS)

PURPOSE

This study is a methodological study aimed to develop the Korean Paternal-Fetal Attachment Scale (K-PAFAS) to measure the level of attachment between the father and the expected baby, and to examine its validity and reliability.

METHODS

The K-PAFAS was developed in four steps. The first step involved derivation of the initial items through review of the literature and in-depth interviews with 10 expectant fathers. The second step was the process of expert panel review, examining content validity for the initial items. In the third step, items were examined for their usability through a preliminary survey with 30 expectant fathers. As the last step, the final K-PAFAS was applied to 200 participants and examined for its psychometric profile.

RESULTS

K-PAFAS consisted of 20 items, and used a 5-point Likert scale with the total score ranging from 20 points to 100 points. A higher score indicated a higher level of attachment between the father and his unborn child. The K-PAFAS was composed of four factors. The K-PAFAS demonstrated satisfactory criterion validity, which was supported by its significant correlations with the Paternal Antenatal Attachment Scale, the Korean Dyadic Adjustment Scale, and the Center for Epidemiological Studies-Depression Scale. The Cronbach α of the K-PAFAS was .89. In test-retest reliability, the K-PAFAS showed a correlation coefficient of .91.

CONCLUSION

The K-PAFAS demonstrated initial validity and reliability. It was short, and relatively easy for use in evaluating the degree of paternal-fetal attachment in the antenatal management stage.

Prenatal parenting

Parenting begins before birth. This includes prenatal maternal and paternal bonding with the baby, and biological effects on fetal development. Recent research has confirmed how prenatal maternal stress can alter the development of the fetus and the child, and that this can persist until early adulthood. Children are affected in different ways depending, in part, on their own genetic makeup. The fetus may also have a direct effect on prenatal maternal mood and later parenting behaviour via the placenta. The father is important prenatally too. An abusive partner can increase the mother's prenatal stress and alter fetal development, but he can also be an important source of emotional support. New research suggests the potential benefits of prenatal interventions, including viewing of prenatal scans and cognitive behavioural therapy.

Predictors of postnatal mother-infant bonding: the role of antenatal bonding, maternal substance use and mental health

The emotional bond that a mother feels towards her baby is critical to social, emotional and cognitive development. Maternal health and wellbeing through pregnancy and antenatal bonding also play a key role in determining bonding postnatally, but the extent to which these relationships may be disrupted by poor mental health or substance use is unclear. This study aimed to examine the extent to which mother-fetal bonding, substance use and mental health through pregnancy predicted postnatal mother-infant bonding at 8 weeks. Participants were 372 women recruited from three metropolitan hospitals in Australia. Data was collected during trimesters one, two and three of pregnancy and 8 weeks postnatal using the Maternal Antenatal Attachment Scale (MAAS), Maternal Postnatal Attachment Scale (MPAS), the Edinburgh Antenatal and Postnatal Depression Scale (EPDS), the Depression and Anxiety Scales (DASS-21), frequency and quantity of substance use (caffeine, alcohol and tobacco) as well as a range of demographic and postnatal information. Higher antenatal bonding predicted higher postnatal bonding at all pregnancy time-points in a fully adjusted regression model. Maternal depressive symptoms in trimesters two and three and stress in trimester two were inversely related to poorer mother-infant bonding 8 weeks postnatally. This study extends previous work on the mother's felt bond to her developing child by drawing on a large sample of women and documenting the pattern of this bond at three time points in pregnancy and at 8 weeks postnatally. Utilising multiple antenatal waves allowed precision in isolating the relationships in pregnancy and at key intervention points. Investigating methods to enhance bonding and intervene in pregnancy is needed. It is also important to assess maternal mental health through pregnancy.

Association between theta power in 6-month old infants at rest and maternal PTSD severity: A pilot study

Compared to infants born to mothers without PTSD, infants born to mothers with active PTSD develop poorer behavioral reactivity and emotional regulation. However, the association between perinatal maternal PTSD and infant neural activation remains largely unknown. This pilot study (N=14) examined the association between perinatal PTSD severity and infant frontal neural activity, as measured by MEG theta power during rest. Results indicated that resting left anterior temporal/frontal theta power was correlated with perinatal PTSD severity (p=0.004). These findings suggest delayed cortical maturation in infants whose mothers had higher perinatal PTSD severity and generate questions regarding perinatal PTSD severity and infant neurophysiological consequences.

Postpartum Maternal Sleep, Maternal Depressive Symptoms and Self-Perceived Mother-Infant Emotional Relationship

This study examined the links between maternal sleep, maternal depressive symptoms, and mothers' perceptions of their emotional relationship with their infant in a self-recruited sample of mothers. Eighty mothers of infants 3-18 months old completed sleep diaries for 5 consecutive nights, and questionnaires assessing sleep (Insomnia Severity Index [ISI]), depressive symptom severity (Edinburgh Postnatal Depression Scale [EPDS]), and perceived mother-infant relationship (Postpartum Bonding Questionnaire [PBQ] and Maternal Postnatal Attachment Questionnaire [MPAQ]). Significant correlations, controlling for depression severity, were found between more disturbed maternal sleep and more negative maternal perceptions of the mother-infant relationship. Regression analyses revealed that EPDS showed the strongest association with PBQ, whereas ISI demonstrated the strongest association with MPAQ. The present study highlights the importance of deepening and expanding our understanding of the negative implications of maternal sleep problems.

Prenatal screening for psychosocial risks in a high risk-population in Peru using the KINDEX interview

BACKGROUND

Prenatal stress and other prenatal risk factors (e.g. intimate partner violence) have a negative impact on mother's health, fetal development as well as enduring adverse effects on the neuro-cognitive, behavioral and physical health of the child. Mothers of low socio-economic status and especially those living in crime-ridden areas are even more exposed to a host of risk factors. Societies of extreme violence, poverty and inequalities, often present difficulties to provide adequate mental health care to the most needed populations. The KINDEX, a brief standardized instrument that assesses 11 different risk factors was used by midwives to identify pregnant women at-risk, in a suburban area with one of the highest levels of domestic violence in Lima. The instrument was designed to be used by medical staff to identify high-risk child-bearing women and, based on the results, to refer them to the adequate psychological or social support providers. The aim of this study is to assess the feasibility of psychosocial screening using the KINDEX in a Latin American Country for the first time, and to explore the relationship of the KINDEX with thee major risk areas, maternal psychopathology, perceived stress and traumatic experiences.

METHODS

The study was conducted in cooperation with the gynecological department of a general hospital in a suburban area of Lima. Nine midwives conducted interviews using the KINDEX of ninety-five pregnant women attending the gynecological unit of the hospital. From these, forty pregnant women were re-interviewed by a clinical psychologist using established instruments in order to assess the feasibility of the prenatal assessment in public health settings and the relationship of the KINDEX with maternal perceived stress, psychopathology symptoms and trauma load during pregnancy.

RESULTS

We found high rates of risk factors in the examined pregnant women comparable with those found in the general population. Significant correlations were found between the KINDEX sum score and the three risks areas, stress, psychopathology and trauma load as assessed in the Clinical Expert interviews. The different risks assessed by the KINDEX are related to higher levels of stress, psychopathology and trauma load, depending on the risk.

CONCLUSIONS

The relationship between past adverse experience and current stressors with perceived maternal stress, psychopathology symptoms and traumatic experiences confirm the importance of prenatal assessment for psychosocial risks. The use of KINDEX by midwives providing obstetrical care to pregnant women in urban Peru is feasible and can be used to identify high-risk women and refer them to the adequate mental health or social services for necessary attention and support. Early interventions are essential to mitigating the adverse effects of maternal stress, trauma and psychopathology on the fetus and child.

Impact of Monochorionicity and Twin to Twin Transfusion Syndrome on Prenatal Attachment, Post Traumatic Stress Disorder, Anxiety and Depressive Symptoms

Monochronioric (MC) twin pregnancies are considered as high-risk pregnancies with potential complications requiring in-utero interventions. We aimed to assess prenatal attachment, anxiety, post-traumatic stress disorder (PTSD) and depressive symptoms in MC pregnancies complicated with Twin-To-Twin-transfusion syndrome (TTTS) in comparison to uncomplicated monochorionic (UMC) and dichorionic pregnancies (DC). Auto-questionnaires were filled out at diagnosis of TTTS and at successive milestones. Prenatal attachment, PTSD, anxiety and perinatal depression were evaluated respectively by the Prenatal Attachment Inventory (PAI) completed for each twin, the Post-traumatic Checklist Scale (PCLS), the State-Trait Anxiety Inventory (STAI) and the Edinburgh Perinatal Depression Scale (EPDS). There was no significant difference in the PAI scores between the two twins. In the DC and UMC groups, PAI scores increased throughout pregnancy, whilst it didn't for TTTS group. TTTS and DC had a similar prenatal attachment while MC mothers expressed a significantly higher attachment to their fetuses and expressed it earlier. At the announcement of TTTS, 72% of the patients present a score over the threshold at the EPDS Scale, with a higher score for TTTS than for DC (p = 0.005), and UMC (p = 0.007) at the same GA. 30% of mothers in TTTS group have PTSD during pregnancy. 50% of TTTS- patients present an anxiety score over the threshold (STAI-Scale), with a score significantly higher in TTTS than in UMC (p<0.001) or DC (p<0.001). The proportion of subject with a STAI-State over the threshold is also significantly higher in TTTS than in DC at 20 GW (p = 0.01) and at 26 GW (p<0.05). The STAI-state scores in UMC and DC increase progressively during pregnancy while they decrease significantly in TTTS. TTTS announcement constitutes a traumatic event during a pregnancy with an important risk of PTSD, high level of anxiety and an alteration of the prenatal attachment. These results should guide the psychological support provided to these patients.

Postnatal Mother-to-Infant Attachment in Subclinically Depressed Mothers: Dyads at Risk?

BACKGROUND

Dyadic interactions between children and depressed mothers have been characterized as less synchronous and with lower maternal sensitivity, fostering an inharmonious, insecure attachment relationship between mother and child. Thus, these children may experience enhanced early life stress and are at higher risk of disturbed socioemotional development. Recently, this association has also been found in women with mild depressive symptoms. However, potential confounding effects of mother's history of own rearing experiences or infant temperament on the link between depressive symptoms and postnatal mother-to-infant attachment have not yet been investigated.

METHODS

Differences in mother-to-infant attachment (e.g. quality of attachment, absence of hostility, and pleasure in interaction) between mothers with and without symptoms of depression 6-8 months postpartum were analyzed in a low-risk community sample (n = 38, 19 per group). Depressive symptomatology was measured with the Beck Depression Inventory (BDI-II) and the Edinburgh Postnatal Depression Scale (EPDS). Depressed mothers indicated mild-to-moderate depressive symptomatology (mean BDI-II 11.26 ± 3.86) but did not fulfill criteria for a major depressive episode and, thus, were referred to as 'subclinically' depressed. Potential confounders, namely maternal history of own rearing experiences and infant temperament, were explored by multivariate AN(C)OVA.

RESULTS

Primiparous mothers with subclinical depression differed significantly from healthy control mothers, i.e. showed poorer mother-to-infant attachment and higher infant-related hostility 6-8 months postpartum. As expected, infant temperament and mother's history of own rearing experiences were both associated with mother-to-infant attachment but did not explain the negative effects of subclinical depression on the mother-infant relationship.

CONCLUSIONS

Given the high prevalence of maternal depression, the current findings give reason for increased concern for the developing mother-child relationship. Therefore, early interventions are needed that focus on the mother-child dyad and target not only clinically but also subclinically depressed mothers.

Psychiatric outcomes after childbirth: can posttraumatic growth protect me from disordered eating symptoms?

PURPOSE

While many studies on mood disorder and posttraumatic stress disorder (PTSD) following childbirth have been conducted, little is known regarding posttraumatic growth (PTG) and disordered eating in the postpartum period. This study aims to (a) identify the typology of women following childbirth based on anxiety, depressive, PTSD symptoms and level of PTG and (b) evaluate whether these profiles differ on disordered eating symptoms.

METHODS

Up to 2 years after childbirth, 306 French-speaking mothers [mean age (SD) = 29.4 (4.6) years] completed questionnaires assessing PTSD, depressive, anxiety and disordered-eating symptoms and level of posttraumatic growth.

RESULTS

Four profiles were highlighted: a first one labeled growing cluster (22.2 % of the sample, n = 68), a second one labeled low level of symptoms cluster (37.6 % of the sample, n = 115), a third one labeled vulnerable cluster (21.6 % of the sample, n = 66) and a last one labeled anxious-depressed-traumatized cluster (18.6 % of the sample, n = 57). Our findings also highlight an impact of these profiles on disordered eating symptoms, suggesting that disordered eating in postpartum would not be the result of pregnancy.

CONCLUSION

Consistent with our expectation, our findings suggest a potential protective role of posttraumatic growth on the development of disordered eating symptoms. Further researches focusing on traumatic experience, disordered eating and posttraumatic growth in postpartum are warranted.

Apego materno-fetal, ansiedade e depressão em gestantes com gravidez normal e de risco: estudo comparativo

Este estudo teve como objetivo verificar as possíveis diferenças nos comportamentos de apego materno-fetal, bem como nos níveis de ansiedade e depressão apresentados por gestantes com e sem risco na gravidez, durante o segundo trimestre gestacional. Participaram da pesquisa 25 mulheres com gravidez sem risco e 23 com gravidez de risco, sendo que quatro delas tiveram fetos malformados. A Escala de Apego Materno-fetal e os Inventários de Ansiedade e Depressão de Beck foram utilizados. Os resultados mostram que não há diferenças no nível de apego materno-fetal entre os dois grupos de gestantes, os quais apresentaram valores máximos. Os índices de ansiedade e depressão mostraram-se mais elevados, mas não estatisticamente significativos, entre as gestantes de risco, principalmente para aquelas que tinham suspeita de fetos malformados. Conclui-se que a gravidade da realidade vivida por essas mães implica em níveis mais elevados de ansiedade e depressão, porém, não impede a formação da relação de apego entre elas e seus filhos.

Personality, preterm labor contractions, and psychological consequences

PURPOSE

Research of psychological factors associated with imminent preterm labor (PTL) is sparse, compared with considerable research of preterm birth. We explored state and trait psychological variables associated with PTL, both pre- and postpartum.

METHODS

During 2012-2014, 56 women hospitalized due to PTL, and 33 pregnant women without PTL, responded during gestational week 20-33, to a demographic questionnaire, the Big-Five Inventory (BFI), the Brief Symptom Inventory (BSI), the Fear of Childbirth Questionnaire, and the Maternal-Fetal Attachment Inventory (MFAS). At 4-6 weeks postpartum, 35 and 23 of the women in the respective groups responded online to the Edinburgh Postnatal Depression Scale (EPDS) and the Mother to Infant Bonding Scale (MIBS).

RESULTS

Compared to women without PTL, women with PTL scored higher on neuroticism, openness to experience, and MFAS (p < 0.01 each), scored lower on consciousness and agreeableness (p < 0.01 each), and showed greater fear of childbirth (p < 0.05). Significant differences were not found in the postpartum variables of EPDS and MIBS. In the PTL group, MFAS (β = 0.36, p < 0.01), but not fear of childbirth (β = 0.08, p = NS), remained higher, after controlling for demographic variables and neuroticism.

CONCLUSIONS

PTL was associated with personality variables, but not with psychological consequences, other than elevated prepartum attachment to the fetus.

Psychiatric symptoms and disorders associated with reproductive cyclicity in women: advances in screening tools

Female-specific psychiatric illness including premenstrual dysphoria, perinatal depression, and psychopathology related to the perimenopausal period are often underdiagnosed and treated. These conditions can negatively affect the quality of life for women and their families. The development of screening tools has helped guide our understanding of these conditions. There is a wide disparity in the methods, definitions, and tools used in studies relevant to female-specific psychiatric illness. As a result, there is no consensus on one tool that is most appropriate for use in a research or clinical setting. In reviewing this topic, we hope to highlight the evolution of various tools as they have built on preexisting instruments and to identify the psychometric properties and clinical applicability of available tools. It would be valuable for researchers to reach a consensus on a core set of screening instruments specific to female psychopathology to gain consistency within and between clinical settings.

Magnitude and risk factors for postpartum symptoms: a literature review

BACKGROUND

The prevalence of postpartum depression worldwide varies from 0.5% to 60.8% in the first 12 months postpartum using self-reported questionnaire. This review aims to update the current magnitude of postpartum depression based on self-reported questionnaire and clinical interview and explore its associated factors in developed and developing countries.

METHODS

A literature search conducted between 2005 and 2014 identified 203 studies, of which 191 used self-reported questionnaire in 42 countries and 21 used structured clinical interview in 15 countries. Nine studies used a combination of self-reported questionnaire and clinical interview.

RESULT

The prevalence of postpartum depression varies from 1.9% to 82.1% in developing countries and from 5.2% to 74.0% in developed countries using self-reported questionnaire. Structured clinical interview shows a much lower prevalence range from 0.1% in Finland to 26.3% in India. Antenatal depression and anxiety, previous psychiatric illness, poor marital relationship, stressful life events, negative attitude towards pregnancy, and lack of social support are significant contributors to postpartum depression.

LIMITATION

All studies are included irrespective of the methodological quality, such as small sample size and their inclusion could affect the generalizability of the results.

CONCLUSION

The current prevalence of postpartum depression is much higher than that previously reported, and similar risk factors are documented. A culturally sensitive cut-off score with adequate psychometric properties of the screening instruments should be available. In future studies, examining the physical, biological, and cultural factors in qualitative studies and in those with adequate methodological qualities is recommended.

Postpartum depression and timing of spousal military deployment relative to pregnancy and delivery

OBJECTIVE

This study aimed to determine the relationship between spousal deployment and postpartum depression diagnosis among U.S. military wives, accounting for the timing of deployment with respect to pregnancy and delivery.

METHODS

A retrospective cohort study was conducted to evaluate the association between spousal deployment and postpartum depression among pregnant wives of active-duty service members. Electronic medical records for 161,454 births occurring between 2004 and 2009 were used to define postpartum depression. Three non-mutually exclusive exposure variables were created to categorize deployments as occurring before, during, or after the infant's delivery. A multivariable logistic regression model mutually adjusted for these exposure variables was fitted, producing an odds ratio for each of the three timing categories.

RESULTS

A modest significant association was detected only in those whose husbands deployed in pregnancy and returned after delivery (i.e., deployed during delivery) [odds ratio (OR) 1.10, 95 % confidence interval (CI) 1.04-1.15]. An interactive effect between preexisting depression or anxiety and deployment during delivery was also detected in the data (OR 1.13, 95 % CI 1.07-1.20 for those without a preexisting diagnosis; OR 0.87, 95 % CI 0.80-0.95 for those with a preexisting diagnosis).

CONCLUSION

Health care providers should continue to be aware of spousal deployment as a military-unique stressor in this population and rigorously screen for potential symptoms of postpartum depression, especially among those whose husbands are absent at delivery.

Obstetric care providers are able to assess psychosocial risks, identify and refer high-risk pregnant women: validation of a short assessment tool - the KINDEX Greek version

Background

Prenatal assessment for psychosocial risk factors and prevention and intervention is scarce and, in most cases, nonexistent in obstetrical care. In this study we aimed to evaluate if the KINDEX, a short instrument developed in Germany, is a useful tool in the hands of non-trained medical staff, in order to identify and refer women in psychosocial risk to the adequate mental health and social services. We also examined the criterion-related concurrent validity of the tool through a validation interview carried out by an expert clinical psychologist. Our final objective was to achieve the cultural adaptation of the KINDEX Greek Version and to offer a valid tool for the psychosocial risk assessment to the obstetric care providers.

Methods

Two obstetricians and five midwives carried out 93 KINDEX interviews (duration 20 minutes) with pregnant women to assess psychosocial risk factors present during pregnancy. Afterwards they referred women who they identified having two or more psychosocial risk factors to the mental health attention unit of the hospital. During the validation procedure an expert clinical psychologist carried out diagnostic interviews with a randomized subsample of 50 pregnant women based on established diagnostic instruments for stress and psychopathology, like the PSS-14, ESI, PDS, HSCL-25.

Results

Significant correlations between the results obtained through the assessment using the KINDEX and the risk areas of stress, psychopathology and trauma load assessed in the validation interview demonstrate the criterion-related concurrent validity of the KINDEX. The referral accuracy of the medical staff is confirmed through comparisons between pregnant women who have and have not been referred to the mental health attention unit.

Conclusions

Prenatal screenings for psychosocial risks like the KINDEX are feasible in public health settings in Greece. In addition, validity was confirmed in high correlations between the KINDEX results and the results of the validation interviews. The KINDEX Greek version can be considered a valid tool, which can be used by non-trained medical staff providing obstetrical care to identify high-risk women and refer them to adequate mental health and social services. These kind of assessments are indispensable for the promotion of a healthy family environment and child development.

The harm argument against surrogacy revisited: two versions not to forget

It has been a common claim that surrogacy is morally problematic since it involves harm to the child or the surrogate-the harm argument. Due to a growing body of empirical research, the harm argument has seen a decrease in popularity, as there seems to be little evidence of harmful consequences of surrogacy. In this article, two revised versions of the harm argument are developed. It is argued that the two suggested versions of the harm argument survive the current criticism against the standard harm argument. The first version argues that the child is harmed by being separated from the gestational mother. The second version directs attention to the fact that surrogacy involves great incentives to keep the gestational mother's level of maternal-fetal attachment low, which tend to increase the risk of harm to the child. While neither of the two arguments is conclusive regarding the moral status of surrogacy, both constitute important considerations that are often ignored.

Postpartum depression: is mode of delivery a risk factor?

There are various factors related to postpartum depression. In this study we have aimed to determine the effect of mode of delivery on the risk of postpartum depression. A total of 318 women who applied for delivery were included in the study. Previously diagnosed fetal anomalies, preterm deliveries, stillbirths, and patients with need of intensive care unit were excluded from the study. Data about the patients were obtained during hospital stay. During the postpartum sixth week visit Edinburgh postnatal depression scale (EPDS) was applied. There was no significant difference between EPDS scores when compared according to age, education, gravidity, wanting the pregnancy, fear about birth, gender, family type, and income level (P > 0.05). Those who had experienced emesis during their pregnancy, had a history of depression, and were housewives had significantly higher EPDS scores (P < 0.05). Delivering by spontaneous vaginal birth, elective Cesarean section, or emergency Cesarean section had no effect on EPDS scores. In conclusion healthcare providers should be aware of postpartum depression risk in nonworking women with a history of emesis and depression and apply the EPDS to them for early detection of postpartum depression.