Social stress and women's risk for recurrent depression

A Cross-Sectional Study Exploring Postpartum Depression at a Tertiary Care Center in Eastern Uttar Pradesh, India

Background Postpartum depression (PPD) is a significant public health concern globally characterized by a spectrum of mood disturbances ranging from mild mood swings to severe depressive episodes initiating within four weeks post childbirth and potentially persisting up to 12 months. Besides affecting the mother, it also affects the mental health and development of the babies born to affected mothers. Despite its considerable burden and potential adverse effects on both maternal and child well-being, PPD often goes undetected and untreated. Materials and methods A cross-sectional study was conducted from January 2024 to March 2024 at a tertiary care center in Gorakhpur to assess PPD in 280 postpartum women. The Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10 was used to confirm depression. Data collection involved a pretested, structured questionnaire. Data were analyzed using SPSS version 22 (IBM Corp., Armonk, NY). A p-value < 0.05 was considered statistically significant. Results The prevalence of PPD was 12.14%. Age and education were significant sociodemographic risk factors (p < 0.05). In psychosocial factors, adverse life events (p < 0.001), wishing for a male child but giving birth to a female (p = 0.01), domestic violence (p = 0.005), relationship issues, an alcoholic spouse (p = 0.01), and poor in-law relations (p < 0.001) were found to be linked to PPD. Obstetric factors such as complicated antenatal history, physical illness, cesarean section, complicated intranatal history, and postpartum complications were also found to be important factors. Conclusion PPD affects many women, emphasizing the need for effective measures. Initiatives like the appointment of healthcare counselors and PPD screening programs in healthcare settings are essential to detect and support affected mothers.

How does ReDO®-10 work? Understanding the mechanisms of action of an intervention focused on daily activities and health from the perspective of participants

Evaluation of a complex healthcare intervention should include careful exploration of the mechanisms through which it brings about change. This paper describes a qualitative evaluation of the Redesigning Daily Occupations (ReDO®-10) programme as it was implemented for the first time with women with stress-related issues in a primary care setting in Ireland. The ReDO®-10 is a 10-week group intervention designed to support participants make changes to their daily activity patterns to have a more satisfying and balanced daily life. Fourteen women were interviewed after completing the programme. The aim was to explore changes that participants perceived they experienced and to understand how the content of ReDO®-10 was thought to bring about this change (if it did). Directed content analysis was used to analyse the qualitative data using the Behaviour Change Wheel and Theoretical Domains Framework as a coding framework. Overall, four BCW functions of ReDO® -10 were identified: Education, Persuasion, Modelling and Enablement. Participants described improved belief in their own capabilities, knowledge and goals around life changes. Many behaviour changes were also described, particularly in relation to doing more restorative activities in daily life. Behaviour change techniques that were identified as important for change were practicing new, restorative occupations in group sessions and as homework and the use of self-analysis activities to understand the relationship between activities and health for these participants. Modelling, support and other effects of group dynamics were also vital in changes that occurred.

The Problem of Malnutrition Associated with Major Depressive Disorder from a Sex-Gender Perspective

Major depressive disorder (MDD) is an incapacitating condition characterized by loss of interest, anhedonia and low mood, which affects almost 4% of people worldwide. With rising prevalence, it is considered a public health issue that affects economic productivity and heavily increases health costs alone or as a comorbidity for other pandemic non-communicable diseases (such as obesity, cardiovascular disease, diabetes, inflammatory bowel diseases, etc.). What is even more noteworthy is the double number of women suffering from MDD compared to men. In fact, this sex-related ratio has been contemplated since men and women have different sexual hormone oscillations, where women meet significant changes depending on the age range and moment of life (menstruation, premenstruation, pregnancy, postpartum, menopause…), which seem to be associated with susceptibility to depressive symptoms. For instance, a decreased estrogen level promotes decreased activation of serotonin transporters. Nevertheless, sexual hormones are not the only triggers that alter neurotransmission of monoamines and other neuropeptides. Actually, different dietary habits and/or nutritional requirements for specific moments of life severely affect MDD pathophysiology in women. In this context, the present review aims to descriptively collect information regarding the role of malnutrition in MDD onset and course, focusing on female patient and especially macro- and micronutrient deficiencies (amino acids, ω3 polyunsaturated fatty acids (ω3 PUFAs), folate, vitamin B12, vitamin D, minerals…), besides providing evidence for future nutritional intervention programs with a sex-gender perspective that hopefully improves mental health and quality of life in women.

Stressful life events among incarcerated women and men: Association with depression, loneliness, hopelessness, and suicidality

BACKGROUND

Justice-involved populations report a higher than average number of pre-incarceration stressful life events. However, few studies have described stressful life events which occur during incarceration, explored gender differences in these events, or evaluated the effect of these events on well-being.

METHOD

This study draws from a sample of male and female adults incarcerated in 6 prison facilities across two states (n = 160) to identify the number and type of stressful life events they experienced during incarceration, gender differences in stressful events, and the relationship between stressful life events and markers of well-being (i.e., depression, hopelessness, loneliness, suicidality). We also examined whether perceived social support would buffer the relationship between stressful events and well-being outcomes.

RESULTS

Participants on average reported experiencing 4 stressful life events during their current incarceration, the most common being relocation to another cell and being made fun of/insulted by someone in the prison. There were few gender differences in types of events experienced. Regression analyses showed that stressful life events were associated with more loneliness, as well as suicidality, but only when participants had low perceived social support.

CONCLUSIONS

Stressful life events, and drawing on social support networks to cope with stress, should be addressed in the context of correctional treatments to reduce suicide risk during incarceration.

Magnitude and associated factors of postpartum depression among women in Nekemte town, East Wollega zone, west Ethiopia, 2019: A community-based study

Background

Postpartum depression is a non-psychotic disorder that happens during the first 1year after childbirth. It affects both the mother’s health and child’s development and is given significant public health concern in developed countries. However, in developing countries including Ethiopia, postnatal care is mainly concerned with obstetric problems and the baby’s health, while the psychological well-being of the mother is given little attention. Therefore, this study was aimed to assess the magnitude and associated factors of postpartum depression among women in Nekemte town, East Wollega zone, West Ethiopia, 2019.

Methods

Community-based cross-sectional study was conducted on 295 postnatal women, from May 15 to June 5, 2019, in Nekemte town. The study participants were selected by a simple random sampling method and interviewed using structured questionnaires. Multivariable logistic regression was used to find the independent variables which are associated with postnatal depression. All associations between dependent and independent variables and statistical significance were measured using odds ratio at 95% confidence interval and p-value less than 0.05.

Results

From the total of 295 women sampled, 287 were participated in the study. Out of these 287 women participated, 20.9% had developed postnatal depression. Unplanned pregnancy (AOR = 7.84, 95% CI: 3.19, 19.26), Being first time mother (AOR = 4.99, 95% CI: 1.54, 16.09), History of previous depression (AOR = 3.06, 95% CI: 1.06, 8.82), Domestic violence (AOR = 5.92, 95% CI: 2.44, 14.40), History of substance use (AOR = 3.95, 95% CI: 1.52, 10.30) and poor social support (AOR = 6.59, 95% CI: 2.25, 19.29) were significantly associated with postnatal depression.

Conclusion

In this study, the magnitude of postnatal depression was found moderate compared to other studies. Perinatal depression screening and intervention need to be integrated with maternal health care services, especially for mothers at risk of postnatal depression.

Prevalence and risk factors of postpartum depression within one year after birth in urban slums of Dhaka, Bangladesh

Postpartum depression (PPD) is a serious pubic health concern and known to have the adverse effects on mother’s perinatal wellbeing; and child’s physical and cognitive development. There were limited literatures on PPD in Bangladesh, especially in urban slum context. The aim of this study was to assess the burden and risk factors of PPD among the urban slum women. A cross-sectional study was conducted between November-December 2017 in three urban slums on 376 women within first 12 months of postpartum. A validated Bangla version of Edinburgh Postnatal Depression Scale was used to measure the depression status. Respondent’s socio-economic characteristics and other risk factors were collected with structured validated questionaire by trained interviewers. Unadjusted Prevalence Ratio (PR) and Adjusted Prevalence Ratio (APR) were estimated with Generalized Linear Model (GLM) and Generalized Estimating Equation (GEE) respectively to identify the risk factors of PPD. The prevalence of PPD was 39.4% within first 12 months following the child birth. Job involvement after child delivery (APR = 1.9, 95% CI = 1.1, 3.3), job loss due to pregnancy (APR = 1.5, 95% CI = 1.0, 2.1), history of miscarriage or still birth or child death (APR = 1.4, 95% CI = 1.0, 2.0), unintended pregnancy (APR = 1.8, 95% CI = 1.3, 2.5), management of delivery cost by borrowing, selling or mortgaging assets (APR = 1.3, 95% CI = 0.9, 1.9), depressive symptom during pregnancy (APR = 2.5, 95% CI = 1.7, 3.8) and intimate partner violence (APR = 2.0, 95% CI = 1.2, 3.3), were identified as risk factors. PPD was not associated with poverty, mother in law and any child related factors. The burden of postpartum depression was high in the urban slum of Bangladesh. Maternal mental health services should be integrated with existing maternal health services. Research is required for the innovation of effective, low cost and culturally appropriate PPD case management and preventive intervention in urban slum of Bangladesh.

Bidirectional Relationships Between Stress, Depressive Symptoms, and Cognitive Vulnerabilities in Adolescents

Introduction: Depression is a highly prevalent problem in adolescence, with great clinical and social relevance. Recent models of psychopathology in childhood and adolescence underscore that the relationships between stress, cognitive vulnerabilities, and depressive symptoms are bidirectional. In addition, according to cognitive therapy models, cognitive vulnerabilities are organized hierarchically, with deep schemas guiding more superficial cognitive processes such as rumination. The present study examines the longitudinal predictive relationships between two levels of cognitions (early maladaptive schemas and rumination), stressors, and depression.

Method: A sample of 584 Spanish adolescents (262 girls; mean age = 15.99, SD = 1.10) completed measures of depression, stressors, rumination, and three early maladaptive schema domains (disconnection and rejection, impaired autonomy and other-directedness) over 4 intervals of 4 months. Path analysis was used to test the hypotheses of the study.

Results: Disconnection and rejection domain systematically predicted an increase in depression, new stressors, and rumination over time. In addition, depressive symptoms predicted an increase of disconnection/rejection scores at all time points. Finally, from Time 2 on, stressors predicted an increase in all schema domains.

Discussion: The outcomes suggest the importance of the disconnection and rejection schema domain. These results are important to understand the mechanisms underlying stress and depression in adolescents.

The long-run effect of maternity leave benefits on mental health: evidence from European countries

This paper examines whether maternity leave policies have an effect on women's mental health in older age. We link data for women aged 50 years and above from countries in the Survey of Health, Ageing and Retirement in Europe (SHARE) to data on maternity leave legislation from 1960 onwards. We use a difference-in-differences approach that exploits changes over time within countries in the duration and compensation of maternity leave benefits, linked to the year women were giving birth to their first child at age 16 to 25. We compare late-life depressive symptom scores (measured with a 12-item version of the Euro-D scale) of mothers who were in employment in the period around the birth of their first child to depression scores of mothers who were not in employment in the period surrounding the birth of a first child, and therefore did not benefit directly from maternity leave benefits. Our findings suggest that a more generous maternity leave during the birth of a first child is associated with a reduced score of 0.38 points in the Euro-D depressive symptom scale in old age.

Influence of serotonin transporter promoter variation on the effects of separation from parent/partner on depression

BACKGROUND

Loss of parent during childhood or loss of partner has been associated with adulthood depression. The serotonin transporter polymorphism (5-HTTLPR) has been reported to moderate stress sensitivity reflected for example in the relationship between childhood maltreatment and depression. Therefore, the effect of 5-HTT promoter variation on the relationship between the loss of parent or partner and depression was examined.

METHOD

411 depressive cases and 1347 control subjects from a large well-characterized longitudinal population-based sample of adult Swedes with data on life history and life situation, including psychiatric diagnostic instruments, were studied. Their DNA was genotyped for the mini-haplotype 5-HTTLPR-rs25531.

RESULTS

Individuals with low 5-HTT activity variants had an increased risk of depression given loss of partner last year compared to those with high activity variants. Conversely, 5-HTT activity variation appeared not to strongly influence the risk of depression given loss of parent during childhood.

LIMITATION

Small sample size for those with losses of both parent and partner. Limited power to detect small interaction effects.

CONCLUSION

The increased risk of depression given last year loss of partner appeared to be influenced by genetic variation regulating 5-HTT activity. This adds to previous findings of 5-HTT x stressful life events interactions on depression and is in agreement with stronger GxE effects when using objective environmental measures.

Social networks and risk for depressive symptoms in a national sample of sexual minority youth

The aim of the study was to examine the social networks of sexual minority youths and to determine the associations between social networks and depressive symptoms. Data were obtained from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative cohort study of American adolescents (N = 14,212). Wave 1 (1994-1995) collected extensive information about the social networks of participants through peer nomination inventories, as well as measures of sexual minority status and depressive symptoms. Using social network data, we examined three characteristics of adolescents' social relationships: (1) social isolation; (2) degree of connectedness; and (3) social status. Sexual minority youths, particularly females, were more isolated, less connected, and had lower social status in peer networks than opposite-sex attracted youths. Among sexual minority male (but not female) youths, greater isolation as well as lower connectedness and status within a network were associated with greater depressive symptoms. Moreover, greater isolation in social networks partially explained the association between sexual minority status and depressive symptoms among males. Finally, a significant 3-way interaction indicated that the association between social isolation and depression was stronger for sexual minority male youths than non-minority youths and sexual minority females. These results suggest that the social networks in which sexual minority male youths are embedded may confer risk for depressive symptoms, underscoring the importance of considering peer networks in both research and interventions targeting sexual minority male adolescents.

Trajectories of long-term outcomes for postnatally depressed mothers treated with group interpersonal psychotherapy

There is evidence that psychological treatments for postnatal depression are effective in the short-term; however, whether the effects are enduring over time remains an important empirical question. The aim of this study was to investigate the depressive symptoms and interpersonal functioning of participants in a randomised controlled trial (RCT) of group interpersonal psychotherapy (IPT-G) at 2 years posttreatment. The study also examined long-term trajectories, such as whether participants maintained their recovery status, achieved later recovery, recurrence or persistent symptoms. Approximately 2 years posttreatment, all women in the original RCT (N = 50) were invited to participate in a mailed follow-up. A repeated measures analysis of variance assessed differences between the treatment and control conditions on depression and interpersonal scores across five measurement occasions: baseline, mid-treatment, end of treatment and 3-month and 2-year follow-up. Chi-square tests were used to analyse the percentage of participants in the four recovery categories. Mothers who received IPT-G improved more rapidly in the short-term and were less likely to develop persistent depressive symptoms in the long-term. Fifty seven percent of IPT-G mothers maintained their recovery over the follow-up period. Overall, IPT-G participants were significantly less likely to require follow-up treatment. Limitations include the use of self-report questionnaires to classify recovery. The positive finding that fewer women in the group condition experienced a persistent course of depression highlights its possible enduring effects after treatment discontinuation. Further research is needed to improve our long-term management of postnatal depression for individuals who are vulnerable to a recurrent or chronic trajectory.

Sensitivity to stress among the offspring of parents with bipolar disorder: a study of daytime cortisol levels

BACKGROUND

It is well known that the hypothalamic-pituitary-adrenal (HPA) axis is compromised in major depression and bipolar disorder. There is increasing evidence that subtle HPA abnormalities, such as elevated cortisol levels, precede the development of an affective disorder. Interpersonal stress is also associated with the development of affective disorders. The present study sought to determine whether interpersonal chronic and episodic stress moderated the relationship between cortisol levels in the natural environment and risk status, defined as having a parent with bipolar disorder.

METHOD

Sixty-two offspring of parents with bipolar disorder (OBD) and 60 offspring with no family history of affective disorders (OFH-), aged 19.48 years (s.d.=3.38, range 14-28), completed interviews assessing mental disorders and chronic and episodic stress, and provided saliva samples over 3 days.

RESULTS

Regression analyses revealed that the OBD who experienced high interpersonal chronic stress displayed a larger cortisol rise following awakening than the OBD reporting low interpersonal chronic stress. The same relationship was also found for levels of non-interpersonal chronic stress. The OBD who reported experiencing severe interpersonal episodic stress exhibited higher levels of daytime cortisol than the OBD reporting interpersonal episodic stress of mild severity. Importantly, none of the above relationships were detected in the OFH-. Each of the interactions between family history of affective disorders and stress remained after controlling for age, gender and offspring lifetime affective disorders and current non-affective disorders.

CONCLUSIONS

A biological sensitivity to stress may underlie the susceptibility to affective disorders among the OBD.

Understanding the social interaction difficulties of women with unipolar depression

Poor social functioning is a prevalent complaint of unipolar depression, but subjective experiences of social interactions have not been systematically studied. A limited number of qualitative researchers have specifically addressed the social difficulties in depression. We conducted in-depth semistructured interviews with 11 depressed women. Thematic analysis was used to analyze the transcripts. Five themes emerged. The first two, diminished desire to socially interact and fear of social interactions, encompass perceptions that have not been previously reported. The third theme, the pressure to adhere to social norms, provided support for previous findings. The final two themes, the perceptions of others and isolation, elaborated on existing knowledge. We found that difficulties with social engagements are much broader than previously reported, with a lack of interest in others, being too emotionally overloaded to interact, perceptions that other people will not understand how women with depression are feeling, and fears of being a burden all contributing to the difficulties experienced in depression.

Support and Undermining in Interpersonal Relationships are Associated with Symptom Improvement in a Trial of Antidepressant Medication

The purpose of this study was to investigate the relationships of chronic stress, social undermining, and social support with symptom reduction and remission in depressed patients treated with antidepressant medication (citalopram), and to determine whether these relationships were moderated by ethnicity. A sample of 301 treatment-seeking adult patients with non-psychotic depression, including 169 African American and 132 Caucasian men and women, were enrolled in an eight week, dose-escalation clinical trial. Intent-to-treat analyses indicated that, consistent with expectations, more baseline social support was associated with greater symptom reduction and higher likelihood of remission, especially at higher levels of social undermining. Additionally, increases in social support from baseline to last visit were associated with more symptom reduction and higher likelihood of remission. However, contrary to expectations, higher levels of baseline social undermining were associated with more symptom reduction in Caucasians, but not in African Americans. Results supported the treatment-enhancing effect of available social support at the beginning of treatment and over the course of treatment. Efforts to enhance social support for patients on antidepressants should be considered as part of comprehensive treatment.

Buffers of Racial Discrimination: Links with Depression among Rural African American Mothers

The current study examines racial discrimination as a predictor of depression in a sample of 414 rural, low-income African American mothers of young children. The potential moderating role of optimism and church-based social support was also examined. Mothers completed questionnaires when their child was 24-months-old. Hierarchical regression revealed that mothers' perception of racism was a significant predictor of depression even after controlling for a variety of distal demographic characteristics and environmental stressors. Significant interactions suggested the importance of psychological and social characteristics in understanding maternal depression. Specifically, high levels of optimism and church-based social support buffered mothers from increased depressive symptomology due to perceived racism.

Earlier stress exposure and subsequent major depression in aging women

OBJECTIVE

Despite evidence that stress exposure earlier in the life course may have long-term consequences for psychopathology, most models of vulnerability for late life depression are limited to current stressors or to retrospective reports of stress history. This study estimates the influences of earlier stressors assessed longitudinally on subsequent major depressive disorder (MDD) in women at average age 60 (range 50-75).

METHOD

MDD, negative life events (NLE), and marital stress were assessed multiple times in a community-based sample of 565 women followed for three decades. Adverse events experienced in childhood also were assessed prior to outcome.

RESULTS

Greater childhood adversity, earlier high levels of NLE and marital stress, and a more rapid increase in marital stress over time elevated the odds of MDD at average age 60 independent of all stressors and other salient risk factors. Childhood adversity was mediated in part by intervening risks. Prior depression, earlier poor health status, a more rapid deterioration in health with age, and current disability owing to physical problems also were related independently to later MDD.

CONCLUSIONS

These findings support the enduring effects of earlier stress burden on MDD in women into old age and, in light of the increasing proportion of older women in the population, have important clinical implications for identification and treatment of those at risk for depression. Findings also underscore the need to develop resources to counteract or buffer similar stress exposure in younger generations of women.

Tailoring screening protocols for perinatal depression: prevalence of high risk across obstetric services in Western Australia

Given what appears to be an ever-increasing list of concerning consequences of perinatal depression, longitudinal studies have much to offer when considering the timing and efficacy of prevention and intervention strategies. The course of depressive symptomatology across the perinatal period at four obstetric services was investigated utilising Western Australian data collected as part of the beyondblue National Postnatal Depression Program. Pregnant women completed one or two Edinburgh Postnatal Depression Scale (EPDS) assessments during pregnancy and a demographic and psychosocial risk factors questionnaire. One or two EPDS assessments were administered within 12 months postpartum. Prevalence of high risk scores across gestational ages ranged from 14% to 5% during pregnancy and 6% to 9% in the postnatal period. For women who were screened twice, the prevalence of high risk scores appeared earlier and decreased with advancing gestation (p = 0.026). The prevalence of postnatal high risk increased after 12 weeks postpartum (p = 0.029). Screening protocols for depressive symptomatology during pregnancy may need to be fine-tuned across individual hospitals, and take into account gestational ages, in order to be most effective. As depressive symptomatology persists postnatally, screening protocols may need to extend beyond 12 weeks postpartum.

Chronic stress and stressful life events in the offspring of parents with bipolar disorder

BACKGROUND

The stress generation theory suggests that depressed individuals and children of depressed mothers are prone to create stressors that are interpersonal and dependent on their own behaviour. Exposure to "self-generated" stress is believed to increase the risk for onset and recurrence of depression. Much less is known about stress in the offspring of parents with bipolar disorder (OBD).

METHODS

As part of a longitudinal study, 37 OBD and 33 offspring of parents with no affective disorder (13 to 26 years old) were interviewed using the UCLA Life Stress Interview, assessing their current life circumstances (chronic stress) and recent negative life events (episodic stress).

RESULTS

The OBD reported more difficulties in interpersonal and non-interpersonal domains of chronic stress than controls. The group differences remained significant after controlling for the presence of affective disorders, indicating that the effect of risk status on chronic stress is independent of the problems associated with having a disorder. With respect to episodic stress, the OBD were 3.9 times more likely to have experienced a moderate to severe interpersonal stressor compared to the control group. There was no group difference for dependent events, but the OBD experienced more severe independent events than controls.

LIMITATIONS

Methodological limitations include a small sample size, large age range, and the absence of parent-reported stress and symptomatology.

CONCLUSIONS

Although the findings do not support the stress generation theory, they suggest that elevated levels of episodic and chronic stress may be important markers of risk for affective disorders in high-risk participants.

Life events, anxious depression and personality: a prospective and genetic study

BACKGROUND

The association between life events and anxious depression might be due to causality or to gene-environment correlation. We examined unidirectional and reciprocal causality and a gene-environment correlation model, in which genes that influence the vulnerability for anxious depression also increase the risk of exposure to life events. The effect of genes that influence environmental exposure might be mediated through personality and we therefore also examined the association between life events and personality (neuroticism and extraversion).

METHOD

Information on life events, anxious depression, neuroticism and extraversion was collected in 5782 monozygotic (MZ) and dizygotic (DZ) twins who participated in a longitudinal survey study of the Netherlands Twin Register. To examine causality, data were analysed longitudinally. To examine gene-environment correlation, the co-twin control method was used.

RESULTS

Anxious depression and, to a lesser extent, neuroticism scores increased after exposure to life events. Anxious depression and neuroticism also predicted the experience of life events. Prospectively, extraversion was not associated with life events. Anxious depression, neuroticism and extraversion scores did not differ between the non-exposed subjects of MZ and DZ twin pairs and unrelated subjects discordant for life events.

CONCLUSIONS

Our findings suggest that reciprocal causation explains the relationship between life events and anxious depression and between life events and neuroticism. Extraversion is not related to life events. No evidence was found for gene-environment correlation, i.e. the genes that influence anxious depression, neuroticism or extraversion do not overlap with the genes that increase the risk of exposure to life events.

Anxiety in a socially high-risk sample of pregnant women in Canada

OBJECTIVE

To determine if an anxiety dimension in the Edinburgh Postnatal Depression Scale (EPDS) could be identified in a sample of pregnant women with high social risk factors.

METHOD

Four hundred women attending prenatal outreach programs, most of whom were single, low-income, and Aboriginal, participated in a study of feelings in pregnancy. The primary outcome measure was the EPDS. Data were also collected on sociodemographic, obstetrical-biological, psychological, and behavioural variables.

RESULTS

Factor analysis of the EPDS revealed 3 factors: anxiety, depression, and self-harm. The anxiety factor accounted for the greatest variance in the overall EPDS score. Comparisons of different groups of women revealed significantly more anxiety in the women aged under 19 years, compared with those over 25 years (P < 0.01). Linear regression analysis showed anxiety was associated with age, stressors (that is, pregnancy, health of the baby, birth of the baby, money, and other), history of depression, and fluctuating moods.

CONCLUSIONS

Anxiety symptoms were predominant in the emotional distress identified by the EPDS in this sample of socially high-risk pregnant women. Younger women appear to experience the highest levels of anxiety. Anxiety in pregnancy in socially high-risk women should not be normalized.

Risk for recurrence in depression

Depression is a highly recurrent disorder with significant personal and public health consequences. Prevention of recurrence would be extremely desirable, and thus researchers have begun to identify risk factors that are specific to recurrence, which may be different from risk factors for first onset of depression. Methodological issues in this area of research are briefly reviewed (e.g., the various definitions of "recurrence" and "depression"), followed by a review of studies on specific risk factors, including demographic variables (gender, socio-economic status, and marital status), clinical variables (age at first onset, number of prior episodes, severity of first/index episode, and comorbid psychopathology), family history of psychopathology, and psychosocial and psychological variables (level of psychosocial functioning, cognitions, personality, social support, and stressful life events). In addition, scar theories are evaluated for their potential to explain how these variables and recurrent depression are linked. Our review suggests that recurrent depression reflects an underlying vulnerability that is largely genetic in nature and that may predispose those high in the vulnerability not only to recurrent depressive episodes, but also to the significant psychosocial risk factors that often accompany recurrent depression.

Stationäre Mutter-Kind-Behandlungseinheiten in Deutschland

Due to the high incidence of postpartum mental illness [postpartum depression (PPD): 10-15%], joint mother-baby treatment is the state-of-the-art, especially in Anglo-Saxon countries. The joint treatment furthermore allows the unique possibility of primary prevention for the high risk group, the children of the postpartum affected mothers, to be used. Compared to other European countries the development of German mother-baby units (MBUs) is delayed due to the higher uncovered costs of treatment, which result from treatment of the mother-baby relationship and the instructions in baby care for the mother. The committee "Qualitätssicherung in der Mutter-Kind-Behandlung" of the German section of the international Marcé-Society contacted all 470 psychiatric institutions in Germany with the goal of achieving an overview concerning the MBUs. A total of 173 institutions answered of which 83 gave an affirmative answer as far as mother-child treatment is concerned. All in all 157 treatment possibilities (134 inpatient and 24 day clinic) were recorded. From the number of treatment possibilities in England and assuming that all MBUs in Germany were recorded, only 21% of the necessary mother-child therapy places are covered.

Impact of Life Events and Difficulties on the Mental Health of Chinese Immigrant Women

This study examined the life events and difficulties inherent to the immigration process and the sources of social support that influenced mental health. A six-month longitudinal study, utilizing a detailed semi-structured interview protocol and standardized questionnaires, was conducted with a group of Chinese women who had migrated to Canada with their spouses in the last decade. All of the women and all of their spouses experienced major downward mobility. Correspondingly, the most frequent negative life event was employment-related and the most frequent difficulty was the financial strain of living below the poverty line, factors which significantly predicted the women's mental health. Social support had neither a main effect on mental health nor a buffer effect on the relationship between life events and difficulties and mental health. Implications for immigration and settlement policy are discussed.

Adverse childhood experiences, stressful life events or demographic factors: which are important in women's depression? A 2-year follow-up population study

OBJECTIVE

The aim of this study was to simultaneously test adverse background factors, namely adverse childhood experiences (ACEs), stressful life events and prior depressive symptoms, for their ability to predict recovery and non-recovery from depression in women among the general population.

METHOD

A stratified random sample of women (n = 835) from the general population was collected at baseline in 1999. Depression (Beck Depression Inventory, BDI-21), ACEs and background factors were assessed by postal questionnaire at baseline. Two years later, stressful life events during the study phase, social support, use of health services and current depression (BDI > or = 13) were similarly assessed.

RESULTS

Adverse childhood experiences were common among depressed women and these past experiences together with the use of health services were associated with recovery from depression. Financial difficulties and a poor subjective health status associated with non-recovery and current stressful life events increased the likelihood of depression on follow-up. Furthermore, the important variables explaining depression on follow-up were the quality of social support and the existence of prior depressive symptoms at baseline.

CONCLUSIONS

Our results suggest that women's current depression especially associates with stressful life events, insufficient social support, poor subjective health and financial difficulties. It seems possible that past adverse experiences predispose women to depression, but current stressful events actualize these symptoms. In addition, use of health services are associated with recovery in women who had ACEs.

Dual work and family roles and depressive symptoms in two birth cohorts of women

BACKGROUND

Rising depression rates in more recent cohorts of women have been attributed in part to their increased participation in dual family and work roles.

METHOD

This study examined associations among depressive symptoms, age, and work and marital status in two cohorts of women, all mothers, born between 1931 and 1944 (preboomers) or between 1945 and 1958 (baby boomers), assessed at comparable ages.

RESULTS

Being married (vs. divorced) was related to less depression within and across cohorts, whereas working was related to more depression in preboomers only. Moreover, divorced working preboomers were significantly more depressed than women in most other role status groups within and across cohorts. Depression scores declined across age among working women in the combined cohorts; however, that association held only for baby boomers when cohorts were analyzed separately. Among divorced working women, that decline was significantly greater in baby boomers than preboomers.

CONCLUSIONS

These cohort differences support a call for new social policies that address the mental health needs of women and their children.