Seasonal variation in postnatal depression

Maternal childbirth experience and time of delivery: a retrospective 7-year cohort study of 105 847 parturients in Finland

OBJECTIVES

To explore how the time of delivery influences childbirth experience.

DESIGN

A retrospective cohort study.

SETTING

Childbirth in the four Helsinki and Uusimaa Hospital District hospitals, Finland, from 2012 to 2018.

PARTICIPANTS

105 847 childbirths with a singleton live fetus.

MAIN OUTCOME MEASURES

Childbirth experience measured by Visual Analogue Scale (VAS).

RESULTS

The major difference in average childbirth experience measured by VAS was between primiparas (8.03; 95% CI 8.01 to 8.04) and multiparas (8.47; 95% CI 8.45 to 8.48). Risk ratio (RR) of the low VAS (≤5) was 2.3 when primiparas were compared with multiparas. Differences in VAS between distinct periods were found in two stages: annual and time of day. The decrease in VAS from 2012-2016 to 2017-2018 in primiparas was from 7.97 (95% CI 7.95 to 7.99) to 7.80 (95% CI 7.77 to 7.83) and from 2014-2016 to 2017-2018 in multiparas from 8.60 (95% CI 8.58 to 8.61) to 8.49 (95% CI 8.47 to 8.52). Corresponding RRs of low VAS were 1.3 for primiparas and 1.2 for multiparas. Hourly differences in VAS were detected in primiparas between office hours 08:00-15:59 (7.97; 95% CI 7.94 to 7.99) and other times (night 00:00-07:59; 7.91; 95% CI 7.88 to 7.94; and evening 16:00-23:59; 7.90; 95% CI 7.87 to 7.92). In multiparas differences in VAS were detected between evening (8.52; 95% CI 8.50 to 8.54) and other periods (night; 8.56; 95% CI 8.54 to 9.58; and office hours; 8.57; 95% CI 8.55 to 8.59).

CONCLUSION

The maternal childbirth experience depended on the time of delivery. Giving birth during the evening led to impaired childbirth experience in both primiparas and multiparas, compared with delivery at other times. The impact of labour induction on childbirth experience should be further examined. The reorganisation of delivery services and the reduction of birth preparations might affect annual VAS. VAS is a simple method of measuring the complex entity of childbirth experience, and our results indicate its ability to capture temporal variation.

The effects of viewing a winter forest landscape with the ground and trees covered in snow on the psychological relaxation of young Finnish adults: A pilot study

Forest bathing is an outdoor activity, and it might be a promising preventive treatment for social problems involving stress. A vast number of studies confirm the positive effects of this activity on people's health. Nevertheless, little is known about the influence of winter forest bathing when conducted in an environment with snow cover on the ground and trees. Thus, a crossover experiment was designed in this study, with the participation of twenty-two healthy university students from Finland. During the experiment, a short exposition by a forest environment or landscape with buildings (as a control) was applied. Participants self-reported their psychological relaxation before and after the exposition, and the results were analyzed and compared. The mood, emotions, restorativeness, and subjective vitality were recorded as indices reflecting the psychological relaxation effect. The negative mood indices decreased significantly after exposition by the snow-covered environment, but the positive 'vigor' indices did not increase or decrease significantly. The level of negative emotions increased after the exposition with the control environment. Likewise, positive emotions decreased after the interaction with the control. Restorativeness was significantly increased after the exposition by the experimental forest but decreased after the viewing of the control buildings. The size of the effect in terms of restorativeness was the highest in this experiment. The subjective vitality was lowered as affected by the control, but it did not increase or decrease after the exposition with the experimental forest. There is probably an effect from the slight interruption in the process from the influence of the forest greens on participants because their vigor and vitality did not increase after the exposition with this environment in the study. However, snow might influence the participants as a calming and emotion-lowering component of the environment, but this idea needs to be further explored with the involvement of participants from other countries who would be viewing forest environments with snow cover and whose psychological relaxation could be measured.

Use of Traditional Chinese Medicine for Patients Diagnosed with Postpartum Depression: A Nationwide Population-Based Study

Postpartum depression (PPD) is one of most common postnatal complications, affecting approximately 10%-15% of women after childbirth annually. Traditional Chinese medicine (TCM) has been gaining popularity as the choice of treatment for PPD in Taiwan. Hence, our aim was to analyze the utilization of TCM among PPD patients in Taiwan. A cross-sectional study was conducted using a random sample of one million beneficiaries selected from the Taiwanese National Health Insurance Research Database. We identified patients with PPD who had received either TCM treatment or non-TCM treatment from the database during 2000-2012. Multivariate logistic regression analysis was used to identify the factors associated with the use of TCM. A total of 653 patients with PPD were enrolled. The majority of patients with PPD were 26-30 years old, lived in a highly urbanized area of Taipei, had a monthly income <20,000 NT$, and were private enterprise employees. Around 52.7% of PPD patients had the motivation to seek TCM services. Younger women, who resided in central and southern Taiwan and who had used TCM one year before PPD diagnosis, were more likely to use TCM services. PPD patients who underwent TCM treatment had a lower overall medical expenditure than non-TCM users. Most TCM users chose simple Chinese herbal medicine. The coexisting factors that made PPD patients to seek TCM services were respiratory or oral infections. We demonstrated the characteristics of those that seek TCM for PPD, which may provide useful insights to health care providers towards resource allocation.

An integrated community mental healthcare program to reduce suicidal ideation and improve maternal mental health during the postnatal period: the findings from the Nagano trial

BACKGROUND

During the perinatal period, suicides are more likely to occur in those with depression and who are not receiving active treatment at the time of death. Suicide is a common outcome in people with suicide ideation. We developed an intervention program taking care of comprehensive perinatal maternal mental healthcare to prevent suicide ideation. We hypothesized that our intervention program could reduce postnatal suicide ideation and improve maternal mental health.

METHODS

We performed a controlled trial to examine the usual postnatal care plus a maternal suicide prevention program (the intervention group) compared with usual postnatal care alone, which comprised home visits by public health nurses without mental health screening (the control group) in Nagano city, Japan. In total, 464 women were included; 230 were allocated to the control group and 234 to the intervention group. The intervention had three components: 1) all the women received postnatal mental health screening by public health nurses who completed home visits during the neonatal period, 2) the intervention was administered by a multidisciplinary clinical network, and 3) systematic follow-up sheets were used to better understand bio-psycho-social characteristics of both the mothers and their infants and develop responsive care plans. We measured the participants' mental health at 3-4 months postpartum (T1) and 7-8 months postpartum (T2) using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS).

RESULTS

Suicidal ideation was significantly lower in the intervention group compared with the control group at T1 (p = 0.014); however, this significant between-group difference did not continue to T2 (p = 0.111). We measured the intervention effects on maternal mental health using the total score of the EPDS, which was significantly improved in the intervention group compared with the control group at T1. Here, the significant difference continued to T2 (p = 0.049).

CONCLUSIONS

Our results indicate that our program may reduce maternal suicidal ideation at 3-4 months postnatally and improve women's mental health during the postnatal periods of 3-4 to 7-8 months. Postnatal maternal mental healthcare, including services to reduce suicide ideation, should be included as an important component of general postnatal care.

TRIAL REGISTRATION

Name of registry: A multidisciplinary intervention program for maternal mental health in perinatal periods. UMIN Clinical Trials Registry number: UMIN000033396 . Registration URL: https://upload.umin.ac.jp/cgibin/ctr/ctr_view_reg.cgi?recptno=R000038076 Registration date: July 15, 2018. Registration timing: retrospective.

Seasonal and gestational variation in perinatal depression in a prospective cohort in New Zealand

BACKGROUND

Perinatal depression has wide-ranging impacts on the health of mothers, babies and their families. Previously published data suggest seasonal variation in the prevalence of perinatal depression, as well as possible variation with gestation.

AIMS

To describe the prevalence of perinatal depression in a New Zealand population; to describe the trend in depression over gestational age; and to assess the influence of season on perinatal depression.

MATERIALS AND METHODS

We performed a secondary analysis of data from a prospective cohort of 260 women in Dunedin, New Zealand. Edinburgh Depression Scores were collected at four antenatal time points and at six months postpartum.

RESULTS

Prevalence of depression decreased from 8.1% to 4.6% antenatally, and to 6.6% postnatally, but the variation was non-significant. Prevalence was significantly higher in winter and spring antenatally (odds ratio (OR) 3.15, 95% CI 1.01-9.82 and OR 3.16, CI 1.05-9.55), and in spring postnatally (OR 8.40, 95% CI 1.01-69.52) compared to autumn. Antenatal depression was associated with poor sleep quality (OR 4.27, 95% CI 1.22-14.93), while postnatal depression was associated with caesarean delivery (OR 5.03, 95% CI 1.29-19.64).

CONCLUSIONS

This is the first NZ cohort to assess depression over multiple antenatal and postnatal time points. A significantly higher rate of depression was identified in winter and spring antenatally and in spring postnatally, corresponding to a higher risk of postnatal depression with autumn deliveries. These findings should prompt greater awareness at these higher risk time periods.

Seasonality of depressive symptoms during pregnancy

Various risk factors have been identified for antepartum depression. This study evaluated seasonal influences on antepartum depressive symptoms. Data of 2,438 pregnant women on current depressive symptoms was obtained from a large-scale cross-sectional study in The Netherlands. Most women were screened during the first trimester. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and dichotomized using ≥ 9 as cut-off score. The seasonal relationship between antepartum depressive symptoms and the month of assessment was estimated by fitting a sinusoidal curve to the data. A total of 323 women (13.2%) scored above cut-off. In the full sample, we found no significant evidence for seasonal influences on depressive symptoms after adjusting for confounders. Additionally, we found that the seasonal influence was obscured by the modification of the effect by current treatment status. In women untreated for psychiatric complaints, we found a minimum of depressive symptomatology in September and a maximum in March. In women treated for psychiatric complaints we found a minimum of depressive symptomatology in December and a maximum in June. Thus, the effects of seasonality are apparent, but opposite in treated and untreated women. However, health professionals should be aware of depressive symptoms the whole year through.

Meteorological parameters and air pollen count in association with self-reported peripartum depressive symptoms

BACKGROUND

Meteorological parameters and air pollen count have been associated with affective disorders and suicide. Regarding peripartum depression, the literature is restricted and inconclusive.

METHODS

This cross-sectional study included women (pregnant, n = 3843; postpartum, n = 3757) who participated in the BASIC (Biology, Affect, Stress, Imaging, and Cognition) study 2010-2015 and the UPPSAT (Uppsala-Athens) study (postpartum, n = 1565) in 2006-2007. Cases were defined according to presence of depressive symptoms during pregnancy (gestational week 32) and 6 weeks postpartum, using the Edinburgh Postnatal Depression Scale (EPDS). Exposure of sunshine, temperature, precipitation, snow coverage, and air pollen counts of durations of 1, 7, and 42 days prior to the outcome were studied for associations with depressive symptoms, using negative binomial regression.

RESULTS

Prior to Bonferroni correction, the concentration of mugwort pollen, both one week and six weeks before the EPDS assessment at gestational week 32, was inversely associated with depressive symptoms in pregnancy, both before and after adjustment for season. No associations were found between the exposure to meteorological parameters and pollen and depressive symptoms, at the same day of depressive symptoms' assessment, the previous week, or the six weeks prior to assessment, either during pregnancy or postpartum after Bonferroni correction.

CONCLUSIONS

There was no evidence that neither short-term nor long-term exposure to meteorological parameters or air pollen counts were associated with self-reported peripartum depressive symptoms in Uppsala, Sweden.

Seasonal patterns in self-reported peripartum depressive symptoms

BACKGROUND

In the peripartum period, the literature on seasonality in depression is still scarce and studies present varying findings. The aims of this study were to investigate whether seasonal patterns in postpartum depressive symptoms previously identified in a Swedish study could be replicated in a larger study, as well as to assess seasonal patterns in depressive symptoms during pregnancy.

METHODS

This was a nested case-control study comprised of 4129 women who participated in the BASIC project and gave birth at Uppsala University Hospital, Uppsala, Sweden, between February 2010 and December 2015.

RESULTS

Women who gave birth in October-December 2011 had an increased odds of depressive symptoms at 6 weeks postpartum, when compared with women giving birth in April-June 2011 (aOR=2.42; 95% CI: 1.12-5.26). The same pattern was found among women with a history of depression. No other seasonal patterns for depressive symptoms during pregnancy or at 6 weeks postpartum were identified.

CONCLUSIONS

In general, no consistent seasonal patterns were found in peripartum depressive symptoms. Whether the seasonal patterns found in some studies during certain years may be due to other factors relating to specific years and seasons, such as extreme climatic conditions or other particular events, warrants further investigation.

Geographical and climatic factors and depression risk in the SUN project

BACKGROUND

Depression incidence has been related with seasonal periodicity and climate. The aim of the study was to estimate the possible association between depression and specific meteorological factors, namely temperature, light and rain.

METHODS

In total, 13,938 participants from the SUN (Seguimiento Universidad de Navarra) cohort study were included in the analysis. Subjects were classified according to daily mean temperature, number of daylight hours and amount of rain, by year, at their geographical area of residence, data supplied by the Spanish Agency of Meteorology. Participants were considered as incident cases of depression whenever they reported a physician diagnosis of depression or the use of antidepressant medication in any of the follow-up questionnaires. Cox regression models were fit to assess the relationship between climatic and geographical factors and the incidence of depression.

RESULTS

Male subjects living in the south and centre areas of Spain showed a higher risk to develop depression compared with those living in the north area (hazard ratio = 1.6, 95% CI = 1.16-2.23 and hazard ratio = 1.41, 95% CI = 1.06-1.87, respectively). Moreover, among males, a direct association between the number of daily light hours and mean temperature and the risk of depression was also found. For men, living in rainy areas was associated with a lower risk of developing depression.

CONCLUSION

Our results suggest that climate-depression relationship is more complex than previously thought, and strongly different between men and women.

Antepartum depression severity is increased during seasonally longer nights: relationship to melatonin and cortisol timing and quantity

Current research suggests that mood varies from season to season in some individuals, in conjunction with light-modulated alterations in chronobiologic indices such as melatonin and cortisol. The primary aim of this study was to evaluate the effects of seasonal variations in darkness on mood in depressed antepartum women, and to determine the relationship of seasonal mood variations to contemporaneous blood melatonin and cortisol measures; a secondary aim was to evaluate the influence of seasonal factors on measures of melancholic versus atypical depressive symptoms. We obtained measures of mood and overnight concentrations of plasma melatonin and serum cortisol in 19 depressed patients (DP) and 12 healthy control (HC) antepartum women, during on-going seasonal variations in daylight/darkness, in a cross-sectional design. Analyses of variance showed that in DP, but not HC, Hamilton Depression Rating Scale (HRSD) scores were significantly higher in women tested during seasonally longer versus shorter nights. This exacerbation of depressive symptoms occurred when the dim light melatonin onset, the melatonin synthesis offset, and the time of maximum cortisol secretion (acrophase) were phase-advanced (temporally shifted earlier), and melatonin quantity was reduced, in DP but not HC. Serum cortisol increased across gestational weeks in both the HC and DP groups, which did not differ significantly in cortisol concentration. Nevertheless, serum cortisol concentration correlated positively with HRSD score in DP but not HC; notably, HC showed neither significant mood changes nor altered melatonin and cortisol timing or quantity in association with seasonal variations. These findings suggest that depression severity during pregnancy may become elevated in association with seasonally related phase advances in melatonin and cortisol timing and reduced melatonin quantity that occur in DP, but not HC. Thus, women who experience antepartum depression may be more susceptible than their nondepressed counterparts to phase alterations in melatonin and cortisol timing during seasonally longer nights. Interventions that phase delay melatonin and/or cortisol timing-for example, increased exposure to bright evening light-might serve as an effective intervention for antepartum depressions whose severity is increased during seasonally longer nights.

Biological aspects of postpartum depression

In comparison with the vast epidemiological literature on postpartum depression (PPD), relatively few studies have examined the biological aspects of the disorder. However, research into the biological mechanisms of PPD is a challenging task, as normal pregnancy and the postpartum period cause adaptive endocrine changes, which would otherwise be considered pathological in nonpregnant women. This review focuses on the adaptive changes of childbearing and nursing, which ultimately may put women at increased risk of PPD. In light of the normal physiology, the authors also attempt to describe the current evidence of the biological changes associated with the development of depression in the postpartum period, including ovarian steroids, the hypothalamic-pituitary-adrenal axis, the serotonergic neurotransmitter system, the thyroid system and inflammatory markers. In addition, current knowledge on candidate genes associated with PPD is reviewed.

Postpartum depressive symptoms and the BDNF Val66Met functional polymorphism: effect of season of delivery

Postpartum depression (PPD) is an often underdiagnosed and undertreated mood disorder, with negative impact on the mother's and infant's health. Seasonal variation has been discussed as a risk factor for PPD. Candidate genes, such as those encoding for the brain-derived neurotrophic factor (BDNF), serotonin transporter (5-HTT), and Period2 (PER2), have been associated with depression and seasonal disorders. The present study is aimed to examine whether functional polymorphic variants, BDNF Val66Met, 5-HTTLPR, or PER2 SNP 10870, are associated with PPD symptoms and whether these genetic polymorphisms interact with season in predicting PPD symptoms. This case-control study comprised of 275 women from a population-based cohort of delivering women in Sweden, who completed a questionnaire containing the Edinburgh postnatal depression scale (EPDS) at 6 weeks and 6 months postpartum. Stressful life events (SLEs) and maternity stressors were also assessed. The results did not reveal any statistically significant overall association between the studied genetic polymorphisms and PPD symptoms. However, a significant association between BDNF Met66 carrier status and development of PPD symptoms at 6 weeks postpartum, even when controlling for prepartum and postpartum environmental risk factors, was evident among mothers delivering during autumn/winter. No gene-gene interactions were found but a cumulative effect was detected with carriers of a greater number of 5-HTTLPR S and BDNFVal66Met Met alleles reporting higher EPDS scores, if delivered during autumn/winter. Our findings propose a role of the BDNF gene in the development of PPD symptoms, potentially mediated by season of delivery.

The delivery mode and seasonal variation are associated with the development of postpartum depression

INTRODUCTION

Previous studies have indicated that mode of delivery and/or season of delivery might be risk factors for postpartum depression (PD). However, only a few studies have provided support for this supposition. This study aim was to confirm the association between mode of delivery and/or season of delivery and PD.

METHODS

We analyzed 2003-2006 Taiwan National Health Insurance Research Database (NHIRD). A group of 2107 mothers who were diagnosed with PD within 6months of delivery in 2005 were selected as the case group and another 8428 mothers without PD during the same timeframe were selected as the control group. Logistic regression was performed after controlling for age, antepartum comorbidities and postpartum complications to confirm the degree of association with the risk of PD.

RESULTS

The results of the logistic regression analysis showed that the risk of acquiring PD was lower in mothers with a normal vaginal delivery or an instrumental vaginal delivery compared to mothers with an emergency caesarean section (odds ratio [OR]=0.67, p<0.0001; OR=0.56, p<0.0001). But the women who elected to have a caesarean section was higher risk than an emergency caesarean section (OR=1.48, p=0.0168). In addition, the risk of PD for winter deliveries was higher compared to other seasons.

CONCLUSIONS

This study provides a reference for gynecologists, obstetricians and health providers that should help with the prevention of PD among pregnant women and mothers.

Prevalence and characteristics of postpartum depression symptomatology among Canadian women: a cross-sectional study

Background

This study aims to look at the prevalence and characteristics of postpartum depression symptomatology (PPDS) among Canadian women. Studies have found that in developed countries, 10-15% of new mothers were affected by major postpartum depression. Mothers who suffer from postpartum depression may endure difficulties regarding their ability to cope with life events, as well as negative clinical implications for maternal-infant attachment.

Methods

An analysis based on 6,421 Canadian women, who had a live birth between 2005 and 2006 and were part of the Maternity Experience Survey (MES), was performed. PPDS was measured based on the Edinburgh Postnatal Depression Scale. Various factors that assessed socio-economic status, demographic factors, and maternal characteristics were considered for the multinomial regression model.

Results

The national prevalence of minor/major and major PPDS was found to be 8.46% and 8.69% respectively. A mother's stress level during pregnancy, the availability of support after pregnancy, and a prior diagnosis of depression were the characteristics that had the strongest significant association with the development of PPDS.

Conclusions

A significant number of Canadian women experience symptoms of postpartum depression. Findings from this study may be useful to increase both the attainment of treatment and the rate at which it can be obtained among new mothers. Interventions should target those with the greatest risk of experiencing PPDS, specifically immigrant and adolescent mothers.

Seasonality patterns in postpartum depression

OBJECTIVE

To investigate the possible association between postpartum depressive symptoms and season of delivery.

STUDY DESIGN

During 1 year, delivering women in the Uppsala University Hospital were asked to participate in the study by filling out 3 postpartum questionnaires containing the Edinburgh Postnatal Depression scale and questions assessing life style, medical history, breastfeeding, and social support.

RESULTS

Two thousand three hundred eighteen women participated. Women delivering in the last 3 months of the year had a significantly higher risk of self-reported depressive symptomatology both at 6 weeks (odds ratio, 2.02, 95% confidence interval, 1.32-3.10) and at 6 months after delivery (odds ratio, 1.82, 95% confidence interval, 1.15-2.88), in comparison to those delivering April-June, both before and after adjustment for possible confounders.

CONCLUSION

Women delivering during the last quartile of the year had a significantly higher risk for depressive symptoms 6 weeks and 6 months postpartum and would thus benefit from a closer support and follow-up after delivery.

Seasonal effects on depression risk and suicidal symptoms in postpartum women

BACKGROUND

Postpartum depression (PPD) is the most common complication of childbirth. Suicide is a leading cause of maternal death in the first postpartum year. Depressed mothers often have suicidal ideation (SI). Depression and suicidality may vary across the seasons. Previous studies of seasonality and PPD were relatively small or encumbered by study design constraints. We examined the possible relationship between seasonality, depression, and SI in 9,339 new mothers.

METHODS

From 2006 to 2010, the investigators screened women within 4-6 weeks postpartum with the Edinburgh Postnatal Depression Scale (EPDS). We used spectral analysis to explore seasonal variation in risk for depression and suicidality.

RESULTS

The study team screened 9,339 new mothers, of whom 1,316 (14%) women had positive depression scores (EPDS≥10) which suggest PPD risk; 294 (3%) women had SI (item 10≥1). A positive EPDS was associated significantly with SI. PPD risk varied significantly across 12-months-risk was highest in December. We detected no seasonal variation in SI.

CONCLUSIONS

Effects of seasonal light variation may contribute to increased risk for depressive symptoms. Suicidality could be related to maternal depression but not seasonal variation.

The use of Edinburgh Postnatal Depression Scale to identify postnatal depression symptoms at well child visit

OBJECTIVES

1) to evaluate the role of the pediatrician in detecting postnatal depression (PD) symptoms by the Edinburgh Postnatal Depression Scale (EPDS); 2) to detect factors increasing the risk of PD and, 3) to assess the importance of scores gained from fathers' questionnaire.

METHODS

we surveyed 1122 mothers and 499 fathers who were assessed using the EPDS during the first well-child visit. After 5 weeks, high scoring parents, completed a second EPDS. High scoring parents were examined by a psychiatrist who had to confirm the PD diagnosis.

RESULTS

26.6% of mothers and 12.6% of fathers at the first visit, 19.0% of mothers and 9.1% of fathers at the second visit, gained scores signaling the risk of PD. Four mothers and two fathers had confirmed PD diagnosis. Younger maternal age, non-Italian nationality and low socio-economic condition were related to higher EPDS scores.

CONCLUSION

PD is common in the average population. Using a simple and standardized instrument, pediatricians are able to detect parents with higher risk of suffering from PD.

Maternal depression is associated with mother-infant interaction in preterm infants

AIM

The purpose of this study was to assess the prevalence and the background factors of maternal depressive symptoms and their relation to the quality of mother-infant interaction in a group of preterm infants and their mothers.

METHODS

The signs of maternal depression were evaluated in 125 mothers of very preterm infants (birth weight < or = 1500 g or < 32 gestational weeks) at 6 months of infant's corrected age using Edinburgh Postnatal Depression Scale (EPDS). The association between maternal depressive symptoms and the quality of mother-infant interaction as assessed by the parent child early relational assessment method (PCERA) method was studied at 6 and 12 months of corrected age in 32 preterm infants who were their mothers' firstborn infants and singletons.

RESULTS

The prevalence of depression assessed by EPDS in mothers of very preterm infants was 12.6%. Most interestingly, the number of postnatal signs of depression associated negatively with the quality of the maternal interaction behaviour with their preterm infants.

CONCLUSIONS

This study suggests that maternal depression may be a risk factor in the development of the mother-infant relationship between preterm infants and their mothers. Therefore, it would be important to identify signs of depression in mothers of preterm infants to offer early support.

Seasonality of symptoms in women with postpartum depression

It is important to consider the potential contribution of seasonality to postpartum depression (PPD; Hiltunen et al, 2004). A possible link between seasonality and PPD may have implications for not only choice of treatment, but also in considering pregnancy planning. The objectives of this pilot study were to examine whether women with seasonal mood changes demonstrated greater incidence of PPD, and to determine if seasonality scores were predictive of PPD. The Seasonal Pattern Assessment Questionnaire (SPAQ; Rosenthal et al, 1987) was used to assess seasonality of mood. A logistic regression analysis was conducted to determine the association between clinical factors, SAD diagnosis, SPAQ global seasonality score (GSS) and season of SPAQ administration and PPD. In our sample, twice as many women in the PPD group were found to have SAD compared to the control group. The PPD group also had a higher group GSS mean (10.44) than did the control group (8.84). However, logistic regression analysis showed that higher seasonality scores in women with PPD were not necessarily predictive of PPD. While more women in the PPD group reported increased seasonal weight fluctuation and less sleep in the spring and summer, these items alone did not predict depression after childbirth.

Predictive validation study of the Edinburgh Postnatal Depression Scale in the first week after delivery and risk analysis for postnatal depression

BACKGROUND

Postnatal depression is a major public health problem. The aim of this study is to validate the use of the Edinburgh Postnatal Depression Scale (EPDS) in the early postpartum, and to identify the markers for risk of postnatal depression.

METHODS

815 women filled out an EPDS and general information questionnaire between the third and the fifth day postpartum. The women with an EPDS score of >8 and a randomized control group from those with scores of <8 were contacted 8 weeks postpartum. 363 women therefore had a structured diagnostic interview by telephone at 8 weeks postpartum (MINI-DSM-IV), without knowledge of their EPDS scores, to screen for a major or minor depressive episode.

RESULTS

The sensitivity of EPDS was measured as 0.82 [0.78-0.86], with a positivity threshold of 9.5/30. For an estimated prevalence for all depressive episodes of 16.1%, the positive predictive value of EPDS was measured as 42.8% [39.1-46.5%]. Multivariate risk analysis using logistical regression identified the following as risk markers for postnatal depression: previous history of depression (postnatal or other), unemployment, premature delivery or stopping breast-feeding in the first month for non-medical reasons.

CONCLUSION

The use of EPDS between the third and fifth day postpartum is valid. An EPDS score of >10 should be completed by a clinical assessment and suitable management. The risk markers identified here are clinical indices that can be used for first-line early screening by non-psychiatric health workers.

Postpartum depression assessments at well-baby visits: screening feasibility, prevalence, and risk factors

BACKGROUND

Postpartum depression (PPD) is a disorder with broad public health implications and consequences that impact almost every aspect of child development.

METHODS

In this pilot study, study participants were 96 women who brought their babies to the University of Arizona Pediatrics Clinic for their 8-week well-baby visit. Participants completed a packet that consisted of questions about demographics, potential correlates of PPD, and the Edinburgh Postpartum Depression Scale (EPDS). English and Spanish versions were available.

RESULTS

Of a total of 172 women who brought their babies in for their 8-week well-baby visit, 96 women completed the packets, for an overall response rate of 56.9%. Observed EPDS scores ranged from 0 to 18, with a mean of 5.44 and a standard deviation (SD) of 4.83. Using the cutoff of EPDS > or = 12, 14.6% of participants were likely suffering from clinically significant depression. Higher EPDS scores and also categorical depression classification were statistically associated with reported smoking and a family history of mental health problems.

CONCLUSIONS

We conclude that screening for mothers at well-baby visits is feasible and that the data collected are of sufficient quality to identify reliable predictors even with small sample sizes.

Seasonality and seasonal affective disorder (SAD): an evolutionary viewpoint tied to energy conservation and reproductive cycles

The characteristic symptoms of SAD, including hypersomnia and weight gain, might reflect a genetically programmed attempt to conserve energy during historically predictable periods of dwindling food supply. While this basic hypothesis has obvious conceptual appeal, few authors have considered the specific positive selection pressures that might have contributed to such a process. The goal of the current paper is to further develop an evolutionary model of SAD with a focus on energy conservation in the context of seasonal reproductive cycles. To accomplish this, seasonal data on birth rates are considered from an evolutionary viewpoint. There is considerable indirect evidence that in temperate climates, the symptoms of SAD reflect a predisposition for conception to occur in late spring/early summer to ensure a peak of births in the late winter/early spring. The adaptive value of such a pattern, and its putative role in natural selection in humans, is also discussed.