Peripartum changes in social support among women with and without anxiety and depressive disorders prior to pregnancy: a prospective-longitudinal study

The Day-in-the-Life method for assessing infant caregiving in rural Pakistan

Objective

This manuscript describes the Day-in-the-Life (DIL) method for assessing child caregiving activities, its implementation, and findings regarding family members' roles and associations with maternal depression symptoms.

Background

Infant caregiving activities are most commonly performed by the mother, although there is increasing acknowledgement of others' contribution. Few methods exist to measure the diverse caregiving activities that mothers and others perform.

Method

Method development occurred within the Bachpan Cohort Study in rural Pakistan (N = 1,154 maternal-child dyads) when the child was 3 months old. The DIL was designed as a semi-structured interview in which the mother describes her child's day from their perspective. Regression analyses were then used to explore the correlation between the DIL and depression symptoms, using the Patient Health Questionnaire-9 (PHQ-9) measure.

Results

The DIL method was easy to administer and displayed excellent interrater agreement. The findings indicated that instrumental caregiving was mostly provided by the mother alone, others in the household tended to contribute more to infant social interactions, and there was more support from others when the mother was less able to provide care (e.g., when ill). Depression symptoms were higher among women who experienced less contribution from family members when the mother was less able to provide care.

Conclusions

The DIL can be deployed to measure infant caregiving activities and associations with maternal mental health.

Implications

This method is promising for researchers interested in disentangling the contribution of multiple family members toward child caregiving and its impacts on maternal and child health.

Contributors to COVID-19-Related Childbirth Anxiety among Pregnant Women in Two Pandemic Waves

COVID-19 has impacted all levels of daily life for people everywhere, with particularly serious implications for pregnant women. This paper examines the COVID-19-related childbirth anxiety (CCA) of Israeli women in the first two waves of the pandemic. We first present two psychotherapeutic case studies with pregnant women in the two waves. This is followed by an empirical study that compared the contribution of background variables, psychological distress, economic concerns, and personal resources to CCA in two samples, Wave 1, March-April 2020 (n = 403) and Wave 2, September-October 2020 (n = 1401), and two subpopulations, Jewish and Arab women. Findings reveal that CCA was significantly lower in Wave 2 than in Wave 1. Furthermore, poorer health, higher education, being an Arab, later gestational week, at-risk pregnancy, wave, higher psychological distress, greater economic concerns, and lower self-compassion contributed to higher childbirth anxiety. Wave moderated the association between optimism and anxiety. The findings of the empirical study, together with insights from the case studies, provide evidence of a decrease in CCA later in the crisis, and indicate the significance of resources for coping with the psychological implications of the pandemic. Moreover, they suggest the importance of empowering self-reliance techniques, such as self-compassion, which was significantly associated with lower anxiety, above and beyond the background and psychological variables. Clinical Impact Statement: Using both psychotherapeutic cases and empirical findings, this study points to the risk and resilience factors that contributed to pregnant women's COVID-19-related childbirth anxiety (CCA) in the first two waves of the pandemic. The study suggests that CCA was higher in the first wave, as well as among women from a minority group. At the same time, the research shows that resilience resources of optimism and self-compassion contributed to the reduction of anxiety. These findings may guide interventions for the vulnerable group of pregnant women in times of crisis.

Sources of social support for postpartum women with a history of childhood maltreatment: Consequences for perceived stress and general mental health in the first year after birth

BACKGROUND

Women with a history of childhood maltreatment (CM) experience the postpartum period as particularly stressful and may benefit less from social support, implicating a higher risk for mental health problems and higher stress levels in mothers with CM.

OBJECTIVE

Thus, we investigated the complex relationship of CM and social support provided by different sources (intimate partner, parents, parents-in-law, friends) in predicting stress perception and mental health over the course of the first year postpartum.

PARTICIPANTS

In N = 295 postpartum women we assessed CM experiences, stress perception, perceived social support and general mental health 3 and 12 months postpartum.

METHOD

Linear mixed effect models were used to examine the course of social support over the first year postpartum and path analyses were used to investigate mediation and moderation effects.

RESULTS

We found that CM was linked to lower levels of perceived social support, accounted for more mental health problems, and amplified the negative association between perceived stress and maternal mental health. Most importantly, we showed that only partner support was beneficial for maternal mental health, and this association was mediated by reductions in perceived stress.

CONCLUSION

CM as a major risk factor for mental health impairs the stress resilience of affected postpartum women. Extending previous research, our results reveal that the source of postpartum social support determines its benefits for maternal health. Our findings emphasize the need of at-risk mothers to be provided with additional sources of support to cope with daily practical, organizational and emotional challenges.

Social connectedness as a determinant of mental health: A scoping review

Public health and epidemiologic research have established that social connectedness promotes overall health. Yet there have been no recent reviews of findings from research examining social connectedness as a determinant of mental health. The goal of this review was to evaluate recent longitudinal research probing the effects of social connectedness on depression and anxiety symptoms and diagnoses in the general population. A scoping review was performed of PubMed and PsychInfo databases from January 2015 to December 2021 following PRISMA-ScR guidelines using a defined search strategy. The search yielded 66 unique studies. In research with other than pregnant women, 83% (19 of 23) studies reported that social support benefited symptoms of depression with the remaining 17% (5 of 23) reporting minimal or no evidence that lower levels of social support predict depression at follow-up. In research with pregnant women, 83% (24 of 29 studies) found that low social support increased postpartum depressive symptoms. Among 8 of 9 studies that focused on loneliness, feeling lonely at baseline was related to adverse outcomes at follow-up including higher risks of major depressive disorder, depressive symptom severity, generalized anxiety disorder, and lower levels of physical activity. In 5 of 8 reports, smaller social network size predicted depressive symptoms or disorder at follow-up. In summary, most recent relevant longitudinal studies have demonstrated that social connectedness protects adults in the general population from depressive symptoms and disorders. The results, which were largely consistent across settings, exposure measures, and populations, support efforts to improve clinical detection of high-risk patients, including adults with low social support and elevated loneliness.

Women's Social Well-Being During Pregnancy: Adverse Childhood Experiences and Recent Life Events

BACKGROUND

Adverse experiences during childhood and recent stressful life events are each associated with women's reduced well-being and poorer health during pregnancy. Few studies, however, have focused upon pregnant women's social well-being, and inclusion of both independent variables in the same analysis is rare. This study focuses upon adverse experiences during childhood as well as recent life events in relationship to four aspects of social well-being: social support, couple aggression for partnered women, neighborhood safety, and food insecurity.

MATERIALS AND METHODS

A diverse community sample of 176 pregnant women completed questionnaires during their third trimester. A cross-sectional design was used that included retrospective reports of childhood experiences, as well as reports of recent life events and current well-being.

RESULTS

Adverse experiences during childhood were uniquely associated with couple aggression (β = 0.206, p = 0.026) and lower neighborhood safety (β = -0.185, p = 0.021). Recent stressful life events were uniquely associated with lower social support (β = -0.247, p = 0.001) and greater food insecurity (β = 0.494, p = 0.000). For social support and food insecurity, there was a significant indirect pathway from adverse childhood experiences through recent stressful life events. Adverse child experiences and recent stressful life events did not interact.

CONCLUSIONS

A life-course perspective that considers women's experiences across their life span is critical for use by both researchers and health practitioners. Adverse childhood experiences and recent stressful life events are important for understanding social features of pregnant women's daily lives.

Physical and mental health changes in the five years before and five years after childbirth: A population-based panel study in first-time mothers and fathers from Germany

BACKGROUND

The transition to parenthood is characterized by far-reaching changes in life. However, little prospective-longitudinal evidence from general population samples exists on changes of general physical and mental health in the years around the birth of a child among mothers and fathers.

METHODS

Using data from the German Socio-Economic Panel Study (SOEP), this study examined continuous and discontinuous short- and long-term changes of general physical and mental health from five years before until five years after the birth of the first child in women (N = 1,912) and men (N = 1,742). Whether a child was born was assessed annually throughout the study. Physical and mental health was assessed biannually from 2002 to 2018 with the SF-12v2.

RESULTS

Multilevel analyses revealed that women experienced a considerable decrease of physical health during pregnancy, which remitted after delivery. On average, women's mental health increased in the last year before and first year after delivery. These mental health improvements were stronger in older vs. younger mothers and remained largely stable in the years after childbirth. In contrast, little evidence for changes of general physical or mental health in (expectant) fathers was found.

LIMITATIONS

Physical and mental health was assessed with a short questionnaire only (SF-12v2).

CONCLUSIONS

On average, women's mental health tends to improve before and after the birth of the first child. Men seem to be much less affected by the birth of a child than many previous studies suggest.

Paternal prevalence and risk factors for comorbid depression and anxiety across the first 2 years postpartum: A nationwide Canadian cohort study

OBJECTIVE

To determine the prevalence of comorbid depression and anxiety symptoms in fathers and investigate the predictors for comorbidity during the first- and second-year following birth.

METHODS

In a longitudinal Canadian study, couples were recruited within 3 weeks of childbirth. Fathers completed a survey after the birth of their child followed by questionnaires at 3, 6, 9, 12, 18, and 24 months postpartum on paternal depression and anxiety symptoms and potential risk factors. Sequential logistic regression was used for analysis.

RESULTS

Of the 3217 enrolled fathers, 2544 (79.08%) provided data for at least one time point during the first year postpartum and 2442 (75.29%) in the second year. Overall, 569 fathers (22.4%) had comorbid depression and anxiety symptoms at some point during the first year postpartum (2.2% at baseline to 8.9% at 6 months), and 323 fathers (13.2%) had comorbidity at some point during their second year postpartum (8.1% at 18 months and 8.6% at 24 months). Strongest risk factors associated with paternal comorbidity were poor or fair perceived health at 4 weeks postpartum, depression before pregnancy, anxiety in the current pregnancy, significant adverse childhood experiences, positive ADHD screen, and victim of intimate partner violence.

CONCLUSION

High rates of comorbidity among fathers in the first 2 years postpartum demonstrate the importance of perinatal mental health management at a family level. The identification of important modifiable comorbidity risk factors highlights areas for further research and the development of interventions to support paternal mental health to optimize child and family outcomes.

Childbirth anxieties in the shadow of COVID-19: Self-compassion and social support among Jewish and Arab pregnant women in Israel

The study examined two angles of childbirth anxieties of Jewish and Arab pregnant women in Israel during the COVID-19 pandemic (March-April, 2020). Specifically, we examined the contribution of personal resources: self-compassion and perceived social support, as well as a couple of COVID-19-related fears of being infected and concern for the foetus, to both the woman's global fear of childbirth (FOC) and her COVID-19-related childbirth anxiety. Participants were Jewish and Arab pregnant women (n = 403) aged 20-47, who completed a set of structured self-report questionnaires from 18 March to 9 April 2020. Findings indicated that Arab women reported higher level of COVID-19-related childbirth anxiety and COVID-19-related fears of being infected and concern for the foetus. In addition, poorer health, being an Arab woman, being in the third trimester, lower self-compassion, and higher COVID-19-related fears contributed significantly to greater COVID-19-related childbirth anxiety. Furthermore, poorer health, being primiparous, at-risk pregnancy, lower self-compassion and higher fear of being infected contributed significantly to greater FOC. Importantly, social support was found to moderate the association between self-compassion and FOC. The results highlight the need to be attentive to pregnant women in times of crisis, and in particular to especially vulnerable subgroups, such as cultural minorities. They also highlight the importance of personal resources that may be applied in targeted interventions to reduce distress in vulnerable populations.

Preventing postnatal depression: a causal mediation analysis of a 20-year preconception cohort

Postnatal depression (PND) is common and predicts a range of adverse maternal and offspring outcomes. PND rates are highest among women with persistent mental health problems before pregnancy, and antenatal healthcare provides ideal opportunity to intervene. We examined antenatal perceived social support as a potential intervention target in preventing PND symptoms among women with prior mental health problems. A total of 398 Australian women (600 pregnancies) were assessed repeatedly for mental health problems before pregnancy (ages 14-29 years, 1992-2006), and again during pregnancy, two months postpartum and one year postpartum (2006-2014). Causal mediation analysis found that intervention on perceived antenatal social support has the potential to reduce rates of PND symptoms by up to 3% (from 15 to 12%) in women with persistent preconception symptoms. Supplementary analyses found that the role of low antenatal social support was independent of concurrent antenatal depressive symptoms. Combined, these two factors mediated up to more than half of the association between preconception mental health problems and PND symptoms. Trialling dual interventions on antenatal depressive symptoms and perceived social support represents one promising strategy to prevent PND in women with persistent preconception symptoms. Interventions promoting mental health before pregnancy may yield an even greater reduction in PND symptoms by disrupting a developmental cascade of risks via these and other pathways. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

The pregnancy-related anxiety characteristics in women with gestational diabetes mellitus: why should we care?

Background

Gestational diabetes mellitus (GDM) is very commonly-seen in clinical settings, and GDM patients may have higher levels of anxiety. It’s necessary to evaluate the anxiety level and potentially influencing factors in patients with GDM, to provide insights for the management of anxiety of GDM patients.

Methods

Patients with GDM treated in our hospital from May, 2018 to May, 2020 were included. We evaluated the characteristics of patients and the scores of pregnancy-related anxiety scale for anxiety level, vulnerable personality style questionnaire (VPSQ) for personality, general self-efficacy scale (GSES) for self-efficacy, social support rating scale (SSRS) for social support level. Logistic regression analyses were conducted to identify the potential influencing factors of anxiety in GDM patients.

Results

A total of 386 GDM patients were included, the incidence of anxiety in patients with GDM was 59.07%. Anxiety was positively correlated with the susceptible personality (r = 0.604, p = 0.023), and it was negatively correlated with self-efficacy and social support (r = -0.586 and -0.598 respectively, all p < 0.05). The education level, monthly income, abnormal pregnancy (miscarriage, premature rupture of membranes) and cesarean section history and first pregnancy were the independent influencing factors for the anxiety in the patients with GDM (all p < 0.05).

Conclusions

The anxiety of GDM patients is very common, early care and interventions are warranted for those patients with abnormal pregnancy and cesarean section history, first pregnancy, lower education level, and less monthly income.

Jewish and Arab pregnant women's psychological distress during the COVID-19 pandemic: the contribution of personal resources

OBJECTIVE

The study sought to examine the psychological distress of Israeli pregnant women during the worldwide spread of COVID-19. As Israel has a diverse cultural-religious population, the sample included both Jewish and Arab women, allowing us to explore the differences between them. Furthermore, we examined the contribution of personal resources, both internal (self-mastery and resilience) and external (perceived social support), as well as the level of infection-related anxiety to the women's psychological distress.

METHOD

A convenience sample of 403 Israeli women (233 Jewish and 170 Arab) was recruited through social media.

RESULTS

Arab women reported significantly higher infection-related anxiety and psychological distress than Jewish women. In addition, Jewish women reported significantly higher self-mastery than Arab pregnant women. Finally, poorer health, being an Arab woman, and lower levels of self-mastery, resilience, and perceived social support, as well as a higher level of infection-related anxiety, contributed significantly to greater psychological distress.

CONCLUSIONS

The findings show that pregnant women in general may be at risk of psychological distress in times of crisis, and that minority populations in particular may be at greater risk than others. Moreover, the results highlight the contribution of women's personal and environmental resources in the face of crisis, an understanding that may be used in targeted interventions to reduce distress in vulnerable populations.

Personality and Peripartum Changes in Perceived Social Support: Findings From Two Prospective-Longitudinal Studies in (Expectant) Mothers and Fathers

OBJECTIVE

The aim of this study was to examine changes in perceived social support from early pregnancy to 2 years postpartum and to test whether these changes (a) differ between mothers and fathers or (b) vary as a function of the Big Five personality traits.

BACKGROUND

Higher peripartum social support in (expectant) mothers and fathers has been associated with fewer complications during pregnancy and delivery as well as better parental and offspring health.

METHODS

Prospective-longitudinal data from two regional-epidemiological samples from Germany were used: MARI (N = 396, including n = 293 mothers and n = 103 fathers) and DREAM (N = 2,819, including n = 1,689 mothers and n = 1,130 fathers). The Big Five personality traits were assessed during pregnancy in MARI as well as 8 weeks after the anticipated birth date in DREAM with short forms of the Big Five Inventory. Perceived social support was assessed during pregnancy, 4 months postpartum, and 16 months postpartum in MARI as well as during pregnancy, 14 months postpartum, and 2 years postpartum in DREAM using the short version of the Social Support Questionnaire.

RESULTS

Multilevel analyses revealed that perceived social support decreased across the peripartum period, and this decrease did not differ between mothers and fathers. More extraverted, emotionally stable, agreeable, conscientious, and open parents perceived higher levels of social support across the peripartum period. The peripartum decrease of perceived social support was smaller in parents who were more extraverted.

CONCLUSION

Our findings suggest that especially extraversion plays an important role for high and stable levels of perceived social support across the peripartum period.

IMPLICATIONS

Particularly highly introverted parents might profit from targeted social support interventions.

The course of panic disorder during the peripartum period and the risk for adverse child development: A prospective-longitudinal study

BACKGROUND

Panic disorders during pregnancy and after delivery may have detrimental effects for mother and child, but no firm conclusions regarding the course and outcomes of peripartum panic disorders can be drawn from previous studies.

METHODS

N = 306 women were repeatedly interviewed with the Composite International Diagnostic Interview for Women. Social support and partnership quality, gestational outcomes, duration of breastfeeding, regulatory disorders, maternal bonding and parenting style were assessed via medical and maternal reports. Standardized observations of neuropsychological development, infant temperament and attachment were conducted 4 and 16 months after delivery.

RESULTS

Women reported heterogenous courses of panic disorders, and panic disorders/panic attacks were commonly observed during the early stages of pregnancy. Women with peripartum panic disorders presented with a worse psychosocial situation (e.g., lower social support). Clear behavioral differences (temperament, attachment) in infants of women with panic disorders as compared to women with no anxiety and depressive disorder could not be detected in this study, but differences concerning gestational outcomes, duration of breastfeeding, maternal parenting, and bonding as well as regulatory problems in infants were identified.

LIMITATIONS

This prospective-longitudinal multi-wave study is restricted by the relative small sizes of the particular groups that limit the power to detect group differences.

CONCLUSIONS

Heterogenous courses and outcomes of perinatal panic disorders require intensive monitoring of affected mother-infant-dyads who may benefit from early targeted interventions to prevent an escalation of dyadic problems.

The effect of counseling with a skills training approach on maternal functioning: a randomized controlled clinical trial

Background

The role of the mother can be deeply satisfying, but it is associated with many challenges including challenges during the postpartum period that may impede the optimal development of the infant. Therefore, the aim of the present study was to investigate the effects of counseling using the Skills Training Approach (STA) on postpartum maternal functioning.

Methods

This randomized controlled trial was performed on 68 postpartum women who referred to health centers of Tabriz-Iran in 2019. Participants were assigned to one of two groups - either counseling or control through the block randomization method. The intervention group received four counseling sessions using the Skills Training Approach (STA). Before and two weeks after the completion of the intervention, the Barkin Index of Maternal Functionning (BIMF) was completed by the participants. The independent t-test and ANCOVA (Analysis of Covariance) was used to analyze the data.

Results

There was no statistically significant difference between the two groups in terms of sociodemographic characteristics and the baseline scores of the BIMF and its domains (p > 0.05). Before the intervention, the mean (SD) total score of the BIMF in the intervention group was 73.1 (8.5) and in the control group, it was 71.6 (4.8). Post-intervention, the mean (SD) of the total score of the BIMF in the intervention group was 95.8 (11.8) and in the control group, it was 70.3 (4.5). Based on the ANCOVA test and after adjusting the baseline score, the mean total score of the BIMF was significantly higher in the intervention group than in the control group (Mean Difference (MD): 22.9; 95% CI: 18.2 to 27.6; p < 0.001). The post-intervention scores of all domains of the BIMF including self-care (MD: 3.8), infant care (MD: 2.0), mother-child interaction (MD: 4.8), psychological wellbeing (MD: 8.4), social support (MD: 4.0), management (MD: 6.8), and adjustment to new motherhood (MD: 3.2) were significantly higher in the intervention group compared to the control group (P < 0.001).

Conclusion

In this study, counseling, using STA, was effective in improving maternal functioning in all of the domains. This intervention, aimed at skill-building, should be strongly considered where improved postpartum functioning is the goal.

Trial registration

IRCT20120718010324N49. Registered 18 January 2019.

Changes in psychopathological symptoms during pregnancy and after delivery: A prospective-longitudinal study in women with and without anxiety and depressive disorders prior to pregnancy

BACKGROUND

The role of anxiety and depressive disorders prior to pregnancy for changes in peripartum psychopathological symptoms has not been resolved yet.

METHODS

A regional-epidemiological sample of 306 women was prospectively followed in seven waves from early pregnancy until 16 months postpartum. Lifetime DSM-IV anxiety and depressive disorders were assessed at baseline with the CIDI-V. Psychopathological symptoms (somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism) were measured with the BSI three times during pregnancy and three times after delivery.

RESULTS

Multilevel analyses revealed that women with versus without lifetime anxiety (β=0.22 to β=0.32) and depressive (β=0.24 to β=0.34) disorders prior to pregnancy experienced higher peripartum psychopathological symptoms. All symptoms linearly decreased during pregnancy (β=-0.02 to β=-0.07 per month). Somatization (β=-0.46) was lower, whereas paranoid ideation (β=0.26) and obsession-compulsion (β=0.21) were higher after delivery than during pregnancy. Though, obsession-compulsion linearly decreased after delivery (β=-0.02). Lifetime anxiety disorders prior to pregnancy interacted with linear changes in anxiety (β=-0.04) and phobic anxiety (β=-0.05) during pregnancy. That is, only women with, but not without anxiety disorders prior to pregnancy experienced a linear decline in anxiety and phobic anxiety during pregnancy.

LIMITATIONS

Lifetime anxiety and depressive disorders were assessed in early pregnancy and might be biased.

CONCLUSIONS

Peripartum psychopathological symptoms are higher in women with versus without lifetime anxiety and depressive disorders prior to pregnancy, but symptom changes only slightly vary by lifetime diagnostic status.

Associations between social support, mental wellbeing, self-efficacy and technology use in first-time antenatal women: data from the BaBBLeS cohort study

Background

Information and communication technologies are used increasingly to facilitate social networks and support women during the perinatal period. This paper presents data on how technology use affects the association between women’s social support and, (i) mental wellbeing and, (ii) self-efficacy in the antenatal period.

Methods

Data were collected as part of an ongoing study - the BaBBLeS study - exploring the effect of a pregnancy and maternity software application (app) on maternal wellbeing and self-efficacy. Between September 2016 and February 2017, we aimed to recruit first-time pregnant women at 12–16 gestation weeks in five maternity sites across England and asked them to complete questionnaires. Outcomes included maternal mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale), and antenatal self-efficacy (antenatal version of the Tool to Measure Parenting Self-Efficacy). Other variables assessed were perceived social support (Multidimensional Scale of Perceived Social Support), general technology use (adapted from Media and Technology Usage and Attitudes Scale). Potential confounders were age, ethnicity, education, socioeconomic deprivation, employment, relationship status and recruitment site. Linear regression models were developed to analyse the relationship between social support and the outcomes.

Results

Participants (n = 492, median age = 28 years) were predominantly white British (64.6%). Half of them had a degree or higher degree (49.3%), most were married/living with a partner (83.6%) and employed (86.2%). Median (LQ-UQ) overall scores were 81.0 (74.0–84.0) for social support (range 12–84), 5.1 (4.7–5.4) for technology use (range 1–6), 54.0 (48.0–60.0) for mental well-being (range 14–70), and 319.0 (295.5–340) for self-efficacy (range 0–360). Social support was significantly associated with antenatal mental well-being adjusting for confounders [adj R² = 0.13, p < .001]. The addition of technology use did not alter this model [adj R² = 0.13, p < .001]. Social support was also significantly associated with self-efficacy after adjustment [adj R² = 0.14, p < .001]; technology had limited impact on this association [adj R² = 0.13, p < .001].

Conclusions

Social support is associated with mental well-being and self-efficacy in antenatal first-time mothers. This association was not significantly affected by general technology use as measured in our survey. Future work should investigate whether pregnancy-specific technologies yield greater potential to enhance the perceived social support, wellbeing and self-efficacy of antenatal women.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-2049-x) contains supplementary material, which is available to authorized users.

Determinants of comorbid depression and anxiety postnatally: A longitudinal cohort study of Chinese-Canadian women

BACKGROUND

Women with comorbid depression and anxiety in the postpartum period experience more complex and severe symptoms than women with depression or anxiety alone; however, little is known about what influences these symptoms, especially among women from specific ethnic backgrounds. The objective of this study was to identify determinants of comorbid depression and anxiety symptomatology by 24 weeks postpartum in a cohort of Chinese-Canadian women.

METHODS

A longitudinal cohort study was completed where 549 Chinese immigrant and Canadian-born women in Toronto were followed to 24 weeks postpartum. Questionnaires included risk factors measured at 4 weeks. Logistic regression was used to develop a model of comorbidity (Edinburgh Postnatal Depression Scale score > 9; State-Trait Anxiety Inventory score > 40) up to and including 24 weeks.

RESULTS

Previous history of postpartum (AOR 2.42, 95% CI 1.42-4.14) and non-postpartum (AOR 4.20, 95% CI 2.21-7.98) depression, maternal age < 26 years (AOR 1.83, 95% CI 1.04-3.22), perception of support (AOR 0.97, 95% CI 0.94-1.00), acculturative stress (AOR 1.03, 95% CI 1.01-1.04), maternal fatigue (AOR 1.12, 95% CI 1.07-1.17), and perceived infant sleep problems (AOR 2.06, 95% CI 1.27-3.43) were significantly associated with comorbid depression and anxiety in the first 24 weeks postpartum.

LIMITATIONS

Our sample consisted of Chinese-Canadian women; this study should be replicated in other ethnic groups to see if and how risk factors of postpartum comorbidity differ.

CONCLUSION

The factors identified herein offer insight into groups of Chinese-Canadian women who might benefit most from early identification and treatment and suggest targets for prevention.

Therapist-Supported Internet-Based Cognitive Behavior Therapy for Stress, Anxiety, and Depressive Symptoms Among Postpartum Women: A Systematic Review and Meta-Analysis

Background

A growing number of meta-analyses have supported the application of therapist-supported Internet-based cognitive behavior therapy (iCBT) for psychological disorders across different populations, but relatively few meta-analyses have concentrated on postpartum women.

Objective

This meta-analysis evaluated the efficacy of therapist-supported iCBT in improving stress, anxiety, and depressive symptoms among postpartum women.

Methods

A total of 10 electronic databases were used to search for published and unpublished trials. Cochrane Collaboration tool for assessing risk of bias was utilized to measure methodological quality. Meta-analysis was performed using the RevMan software (Review Manager version 5.3 for Windows from the Nordic Cochrane Centre, the Cochrane Collaboration, 2014). Among the 789 studies identified, 8 randomized controlled trials were selected, involving 1523 participants across 6 countries.

Results

More than half (65%) of the eligible studies had a low risk of bias with no heterogeneity. Results revealed that therapist-supported iCBT significantly improved stress (d=0.84, n=5), anxiety (d=0.36, n=6), and depressive symptoms (d=0.63, n=8) of the intervention group compared with those of the control group at post-intervention.

Conclusions

This review revealed that therapist-supported iCBT significantly improves stress, anxiety, and depressive symptoms among postpartum women with small to large effects. Future effectiveness studies should establish the essential components, format, and approach of iCBT with optimal levels of human support to maximize a long-term effect.

Associations of social support and stress with postpartum maternal mental health symptoms: Main effects, moderation, and mediation

Poor maternal mental health during the postpartum period can have significant effects on the health of mothers, infants, and families. The findings from cross-sectional studies suggest that stress and social support are related to maternal mental health. This study contributes to the literature through the use of longitudinal data, and examines moderation and mediation among these factors. In 2012-2013, mothers completed surveys assessing stress, social support, and depressive and anxiety symptoms following birth (n = 125), and 3 months (n = 110) and 6 months (n = 99) after birth. The authors examined temporal associations, moderation, and mediation of social support on the relationship between stress and postpartum depressive and anxiety symptoms using modified Poisson regression models and the counterfactual approach to mediation. Current levels of stress and social support were associated with depressive and anxiety symptoms, both independently and when considered together at multiple time points. Social support did not strongly moderate or mediate the relationships between stress and maternal mental health. Interventions to reduce current perceptions of stress and increase social support for mothers during the postpartum period may help improve maternal mental health symptoms. Efforts are needed to assess the current needs of mothers continuously.