Medical and psychosocial determinants of risk of postpartum depression: a cross-sectional study

Predictive Validity of Screening Tools and Role of Self-Esteem and Coping in Postpartum Depression Risk

Background/Objectives: Postpartum depression (PPD) is a prevalent mental health disorder affecting women after childbirth, with significant adverse effects on both maternal and infant outcomes. Early detection and intervention are critical to improving health trajectories. Material and Methods: This narrative review compares the predictive validity of commonly used screening instruments for PPD, including the Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9), and brief tools like PHQ-2 and PHQ-4. It also examines the role of self-esteem, assessed using the Rosenberg Self-Esteem Scale (RSES), and coping mechanisms, evaluated through the COPE Inventory, in moderating PPD risk. Results: Validation studies reveal variability in the performance of screening tools across different populations, emphasizing the need for contextual calibration. Low self-esteem and maladaptive coping strategies are consistently associated with higher PPD risk, with socioeconomic status (SES) further influencing these relationships. Interventions focusing on enhancing self-esteem and promoting adaptive coping, such as cognitive-behavioral therapy and psychoeducation, show promise in reducing PPD incidence. Conclusions: This review highlights gaps in existing research, particularly regarding screening during pregnancy, and calls for integrated predictive models incorporating psychosocial variables. Early, context-sensitive screening approaches are essential for effective PPD prevention and management.

Associations of Education Attainment With Postpartum Depression and the Mediating Exploration: A Mendelian Randomization Study

Background: Many studies have explored the relationship between education and postpartum depression (PPD), with inconsistent results. Our study is to identify which education-related factors (education attainment, qualifications, cognitive performance) played the predominant role in PPD using Mendelian randomization (MR) analysis. Then, we explored the factors that may mediate the effect of education on PPD. Method: We performed two-sample multivariable Mendelian randomization (MVMR) to assess the independent impact of education-related factors on PPD. Based on the literature review, three mediating factors that may play a role in the path of education attainment and PPD were involved in mediation analysis, including childbearing age, neuroticism score, and average total household income before tax. Then, we used two-step MR and MVMR to estimate the indirect effect of these mediators. Results: We identified genetically predicted 1-SD (3.71 years) higher education attainment (OR: 0.632; [95% confidential interval (CI): 0.464-0.860]); qualifications (OR: 0.418; [95% CI: 0.245-0.714]); or cognitive performance (OR: 0.770; [95% CI: 0.652-0.909]) was associated with lower risk of PPD, and the causal effects of education attainment (OR: 0.407; [95% CI: 0.214-0.773]) on PPD were independent of qualifications and cognition. Childbearing age (β: -0.497; [95% CI: -0.788-0.238]; p  < 0.001) and neuroticism score (β: -0.07; [95% CI: -0.120-0.030]; p  < 0.001) were identified as mediators of the association between education attainment and PPD. Conclusions: These results suggested the predominant impact of education attainment on PPD independent of qualifications and cognition. Education level mainly affects PPD by changing the childbearing age. Trial Registration: Chinese Clinical Trial Registry identifier: ChiCTR2000033433.

The Influence of Personality Traits on Postpartum Depression: A Systematic Review Based on the NEO-FFI Scale

Postpartum depression (PPD) is a significant global health concern with profound implications for mothers, families, and societies. This systematic review aims to synthesize current research findings to understand better how personality traits, as assessed by the NEO Five-Factor Inventory (NEO-FFI), contribute to the development and progression of PPD. Conducted in January 2024, this review searched major databases like PubMed, PsycINFO, and Scopus up to December 2023, focusing on the NEO-FFI's role in evaluating PPD. Following PRISMA guidelines, studies were selected based on strict criteria, including the exclusive use of NEO-FFI for personality assessment and a focus on postpartum women. A total of seven studies were included after a rigorous two-step screening process, and their data were qualitatively synthesized. The review covered a total of 4172 participants, with a prevalence of clinically significant postpartum depression symptoms ranging from 10.6% to 51.7%. Notably, Neuroticism emerged as a significant predictor of PPD, with odds ratios ranging from 1.07 (95% CI: 0.96-1.20) in some studies to as high as 1.87 (95% CI: 1.53-2.27) in others. In contrast, traits like Extraversion and Conscientiousness generally showed protective effects, with lower scores associated with reduced PPD risk. For instance, Extraversion scores correlated negatively with PPD risk (Beta = -0.171) in one study. However, the impact of other traits such as Openness and Agreeableness on PPD risk was less clear, with some studies indicating negligible effects. The review highlights Neuroticism as a consistent and significant predictor of PPD risk, with varying impacts from other personality traits. The findings suggest potential pathways for targeted interventions in maternal mental health care, emphasizing the need for comprehensive personality evaluations in prenatal and postnatal settings.

Prevalence of postpartum major depression and depressive symptoms in Spanish women: A longitudinal study up to 1 year postpartum

OBJECTIVE

Depression is a prevalent mental disorder in the postpartum period, with consequences for both the mother and her offspring. However, longitudinal studies determining the moments of greatest vulnerability and severity of depression during the postpartum period are scarce. The aims of this research were to determine the prevalence and trajectories of probable depression and major depression during the first year postpartum.

DESIGN

Longitudinal study.

SETTING

Interviews were conducted personally at three times: 2 months, 6 months and 1 year postpartum.

PARTICIPANTS

561 postpartum women.

MEASUREMENTS AND FINDINGS

Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders (DSM). Descriptive and comparative analyses have been carried out. The prevalence of probable depression at 2 months, 6 months and 1 year postpartum, using a cut-off point ≥ 10, was 30.3%, 26.0% and 25.3%, respectively; and that of major depression using SCID was 10.3%, 10.9% and 14.8, respectively. The prevalence of probable depression was highest at 2 months postpartum and that of major depression at 1 year postpartum. Probable depression followed a downward trajectory and major depression followed an upward trajectory.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The clinical relevance of this research is that it has made it possible to demonstrate that depression is very prevalent in the first year postpartum and that, far from subsiding, the prevalence remains very high even at 1 year postpartum. Our findings highlight the importance of taking mental health care into account throughout at least the first year postpartum.

The effects of family function, relationship satisfaction, and dyadic adjustment on postpartum depression

PURPOSE

To determine the effect of family function, relationship satisfaction, and dyadic adjustment on postpartum depression DESIGN AND METHODS: This descriptive, cross-sectional study was conducted in 337 postpartum mothers.

FINDINGS

Fifty-five mothers scored above the depression scale cutoff point (>13). Emotional violence from husband, poor problem solving and communication, low relationship satisfaction, dyadic adjustment, and consensus were important risk factors for postpartum depression (p < .0.05).

PRACTICE IMPLICATIONS

Family function and partner relationships should be a key focus for midwives and nurses in the postpartum period. Providing psychological interventions aimed at improving relationship functioning can help protect mothers against postpartum depression.

Relationship of premenstrual syndrome with postpartum depression and mother-infant bonding

PURPOSE

This study was conducted to investigate the relationship between pre-pregnancy premenstrual syndrome (PMS) history with postpartum depression and mother-infant bonding.

DESIGN AND METHODS

The sample of this descriptive and cross-sectional study included 322 mothers. Data were collected using the Premenstrual Syndrome Scale (PMSS), Edinburgh Postnatal Depression Scale (EPDS), and Brockington Postpartum Bonding Questionnaire (BPBQ).

FINDINGS

There were positive statistically significant correlations between PMSS total and subscale scores and EPDS scores and BPBQ. In addition, there were statistically significant positive correlations between EPDS score scores and BPBQ.

IMPLICATIONS FOR NURSING PRACTICE

Especially by achieving success in PMS management in the pre-pregnancy period, the risk of postpartum depression development can be prevented, and healthy development of mother-infant bonding can be achieved.

Additional evidence on prevalence and predictors of postpartum depression in China: A study of 300,000 puerperal women covered by a community-based routine screening programme

BACKGROUND

Previous studies on the prevalence and predictors of postpartum depression (PPD) in China were mostly hospital-based with relatively small study samples. Basing on a routine screening programme, this study assessed the prevalence and factors associated with PPD at community level.

METHODS

A cross-sectional study was conducted with all the women who delivered in a hospital and were screened for depression during routine postpartum home visits in Shenzhen between 2015 August and 2017 April. The Edinburgh Postnatal Depression Scale was used as the screening tool with a cut-off score of 10. Predictors of PPD were determined by Chi-square test and stepwise logistic regression.

RESULTS

Approximately 300,000 puerperal women were included in the study with a PPD prevalence of 4.3%. Prenatal anxiety and depression were associated with 4.55 and 3.80 times of PPD risk, respectively. Stressful life events, family history of mental illness, poor economic status, low Apgar scores and birth defects of the infants, bottle and mixed feeding, as well as living with parents-in-low after childbirth were related to moderate risk. Higher gravidity and parity, larger gestation age, prenatal education, and living with the women's own parents were associated with lower risk.

LIMITATIONS

The large sample size might have suggested statistically significant differences which were not practical.

CONCLUSIONS

The prevalence of PPD at community level is significantly lower than the rates detected within hospitals. Prenatal anxiety and depression are the most important predictors of PPD. Integrating depression screening into routine postpartum home visits facilitates achievement of universal coverage.

Personality traits as a risk factor for postpartum depression: A systematic review and meta-analysis

BACKGROUND

Certain personality traits increase vulnerability to depression, but the evidence linking personality and postpartum depression (PPD) is less robust. This systematic review aimed to identify personality traits that increase the risk of PPD.

METHODS

We systematically reviewed studies retrieved from PubMed/Medline, PsycINFO, Scopus, CINAHL, and Cochrane, following the PRISMA guidelines for reporting. We carried out a meta-analysis on the association between neuroticism and PPD.

RESULTS

A total of 34 studies were analyzed. Of these, 31 considered at least one trait associated with PPD; 10 studies considered at least one trait not associated with PPD. The meta-analysis included 13 studies, concluding that neuroticism was associated with PPD (OR: 1.37; 95%CI: 1.22-1.53; p<0.001).

LIMITATIONS

Study design and approach to personality assessment influence results. Prospective longitudinal studies of persons with no prior history of mood disorder would provide stronger evidence about whether particular personality traits predict PPD. Most studies reviewed used self-report measures to assess personality. Study design and approach to personality assessment influence results, and indications of publication bias were found.

CONCLUSIONS

Neuroticism is the personality trait most widely studied in relation to PPD. Our meta-analysis found this trait is strongly related with PPD. Moreover, vulnerable personality style and trait anxiety are also associated with PPD. Screening for these traits might help identify women at risk, improving prevention, early detection, and possibly treatment.

Fear of Coronavirus, Stress and Fear of Childbirth in Polish Pregnant Women during the COVID-19 Pandemic

The COVID-19 pandemic is the largest pandemic of an aggressive coronavirus in the human population in the 21st century. The pandemic may have a negative emotional impact on pregnant women, causing fear and stress. Negative feelings during pregnancy later affect fear of childbirth. Our study aimed to determine the relationship between fear of COVID-19, stress and fear of childbirth. We assume that fear of COVID-19 will be a mediator of the relationship between perceived stress and fear of childbirth. A total of 262 Polish pregnant women participated in this study. Perceived Stress Scale (PSS-10), Fear of COVID-19 Scale (FOC-6) and Labour Anxiety Questionnaire (KLP II) were used in the study. There was a statistically significant, moderate, and positive relationship between perceived stress, fear of COVID-19, and fear of childbirth. Fear of COVID-19 was a statistically significant mediator in the relationship between perceived stress and fear of childbirth. The COVID-19 epidemic may have a negative emotional impact on pregnant women, causing fear, stress and increased fear of childbirth. Childbirth during the COVID-19 pandemic is perceived by women as a threat to their well-being and health. Therefore, it is especially important to support a woman in the perinatal period and to enable her to give birth to a child.

Prevalence and risk factors of postpartum depression in China: A hospital-based cross-sectional study

BACKGROUND

Postpartum depression (PPD) is a major public health problem worldwide, which adversely affects maternal and infant health. The purpose of this study was to determine the prevalence and related factors of postpartum depression in Chinese puerperium women.

METHODS

A cross-sectional study was conducted in Baoan Maternal and Child Health Hospital located in the west of Shenzhen, China. The Chinese version of the Edinburgh Postpartum Depression Scale (EPDS) was used to screen PPD. A score of ≥10 was used as the threshold of postpartum depression.

RESULTS

A total of 4813 puerperal women were included in this study, 11.5% of whom were considered to have PPD. Multivariate logistic regression analysis found that family history of mental illness (OR = 1.94; 95% CI, 1.05-3.57; P = 0.033), living with parents-in-law (OR = 1.41; 95% CI, 1.16-1.72; P < 0.001), anxiety during pregnancy (OR = 3.66; 95% CI, 2.97-4. 52; P < 0.001), depression during pregnancy (OR = 4.25; 95% CI, 3.28-5.50; P < 0.001), and stressful life events (OR = 1.50; 95% CI, 1.03-2.20; P = 0.036) were associated with the high prevalence of PPD.

LIMITATIONS

The cross-sectional survey cannot assess direct causality. EPDS is just a screening tool and not a diagnostic one.

CONCLUSION

Postpartum depression is a common disease in Chinese puerperal population. High-risk pregnant women with postpartum depression need routine screening and targeted intervention for PPD.

History of premenstrual syndrome and development of postpartum depression: A systematic review and meta-analysis

BACKGROUND

Premenstrual syndrome (PMS) is thought to be a risk factor for postpartum depression (PPD), but results from studies examining the association have been mixed.

OBJECTIVES

To estimate the association between pre-pregnancy history of PMS and development of PPD and evaluate the risk of bias of included evidence.

SEARCH STRATEGY

PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Library, CNKI, Wanfang Data, and reference lists of relevant papers were searched.

SELECTION CRITERIA

Observational studies that collected pre-pregnancy history of PMS and measured PPD status between one week and one year after delivery were included.

DATA COLLECTION AND ANALYSIS

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effect models were used to calculate pooled odds ratios (ORs) with 95% confidence interval (CI). Small study effect was analysed by funnel plot. Risk of bias was assessed using the Risk of Bias Instrument for Non-Randomized Studies of Exposures (ROBINS-E).

MAIN RESULTS

Our meta-analysis included 19 studies. Overall, women with a pre-pregnancy history of PMS had more than double the odds of PPD compared to those without PMS (OR: 2.20, 95% CI: 1.81-2.68). However, the quality of evidence was low: five studies had moderate risk, eleven studies had serious risk, and three studies had critical risk of bias.

CONCLUSIONS

Current evidence supports a significant association between history of PMS and development of PPD. Well-designed prospective studies are needed to further investigate this relationship.