Controlled prospective study of postpartum mood disorders: Comparison of childbearing and nonchildbearing women

Antenatal depression among pregnant mothers in Afghanistan: A cross-sectional study

BACKGROUND

Approximately one in five pregnant women experience antenatal depression globally. The purpose of the present study was to estimate the prevalence of antenatal depression and explore its relationship between various demographic variables, recent sexual engagement, and recent adverse life events among pregnant Afghan women.

METHODS

A cross-sectional survey study was carried out between January, 2023 and April 2023 among 460 women aged 15-45 years who were recruited using convenience sampling from Herat province (Afghanistan). Logistic regression models were utilized to explore the relationship between antenatal depression and socio-demographic characteristics among the participants.

RESULTS

The prevalence of antenatal depression symptoms was 78.5%. Multiple regression analysis indicated that antenatal depression was significantly associated with (i) being aged 30-45 years (AOR: 4.216, 95% CI: 1.868-9.515, p = .001), (ii) being of low economic status (AOR:2.102, 95% CI: 1.051-4.202, p = .036), (iii) not being employed (AOR: 2.445, 95% CI:1.189-5.025, p = .015), (iv) not having had sex during the past seven days (AOR: 2.335, 95% CI: 1.427-3.822, p = .001), and (v) not experiencing a traumatic event during the past month (AOR:0.263, 95% CI: 0.139-0.495, p < .001).

CONCLUSION

The present study provides insight into the factors associated with the high prevalence of antenatal depression among pregnant Afghan women (e.g., demographic variables, recent adverse life events, and recent sexual engagement). It highlights the urgency of addressing antenatal depression in Afghanistan and provides a foundation for future research and interventions aimed at improving the mental health and well-being of pregnant women in the Afghan context.

Role of estrogen in treatment of female depression

Depression is a neurological disorder that profoundly affects human physical and mental health, resulting in various changes in the central nervous system. Despite several prominent hypotheses, such as the monoaminergic theory, hypothalamic-pituitary-adrenal (HPA) axis theory, neuroinflammation, and neuroplasticity, the current understanding of depression's pathogenesis remains incomplete. Importantly, depression is a gender-dimorphic disorder, with women exhibiting higher incidence rates than men. Given estrogen's pivotal role in the menstrual cycle, it is reasonable to postulate that its fluctuating levels could contribute to the pathogenesis of depression. Estrogen acts by binding to a diversity of receptors, which are widely distributed in the central nervous system. An abundance of research has established that estrogen and its receptors play a crucial role in depression, spanning pathogenesis and treatment. In this comprehensive review, we provide an in-depth analysis of the fundamental role of estrogen and its receptors in depression, with a focus on neuroinflammation, neuroendocrinology, and neuroplasticity. Furthermore, we discuss potential mechanisms underlying the therapeutic effects of estrogen in the treatment of depression, which may pave the way for new antidepressant drug development and alternative treatment options.

The effectiveness of kangaroo mother care in lowering postpartum depression in mothers of preterm and low birth weight babies: a systematic review and meta-analysis

Background

Kangaroo mother care (KMC) intervention involves skin-to-skin contact between mother and infant. Some studies have shown a decrease in postpartum depression (PPD) in mothers of preterm and low birth weight (LBW) infants. However, the literature is scattered and of variable quality.

Aims

To conduct a systematic review of available literature and provide a comprehensive picture of the effect of KMC on PPD among mothers of preterm and LBW infants.

Methods

The study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines. After PROSPERO registration, a systematic search was conducted using PubMed, Cochrane Central Library, and Google Scholar from the inception of the databases till 14 June 2021. Of the 2944 studies assessed for titles and abstracts, nine studies with 2042 participants were included in the review. Included articles targeted mothers with LBW (<2500 g) or preterm infants (<37 weeks), used an authentic PPD tool, and had standard care or an incubator as the control group. Studies not published in English and in which mothers had a previous psychiatric illness were excluded. The risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized control trials and the Newcastle-Ottawa Scale for observational studies. All the results were converted to standard mean deviation and pooled together using a random-effects model with a 95% CI. A P-value of less than 0.05 is considered significant.

Results

KMC Intervention was significantly associated with a lower depression score than control groups. The reduction in depression in the intervention (KMC) group was moderate: SMD=-0.38 (-0.68 to -0.08; 95% CI; I 2=86%; P=0.013). No significant difference was found between the PPD scores of both groups using the Edinburgh Postpartum Depression Scale score.

Conclusions

The authors conclude that the negative effects of LBW and preterm birth experience on maternal mental health can be avoided to a moderate degree by KMC. Due to a lack of methodological uniformity, different scales for outcome measurement, and discrepancies in intervention features, significantly high heterogeneity was detected. The authors need further larger-scale studies with a uniform study design to better predict the efficacy of KMC better.

The relationship of childbirth experience with postpartum depression and anxiety: a cross-sectional study

BACKGROUND

The childbirth experience is a personal life event that is influenced by physiologic and mental-psychological processes. Due to the prevalence of psychiatric problems after childbirth, it is important to recognize the factors affecting women's emotional reactions. This study was conducted to define the relationship of childbirth experience with postpartum anxiety and depression.

METHODS

This cross-sectional study was conducted on 399 women from 1 to 4 months after their childbirth who were referred to health centers in Tabriz-Iran from January 2021 to September 2021. Socio-demographic and obstetric characteristics questionnaire, Childbirth Experience Questionnaire (CEQ 2.0), Edinburgh Postpartum Depression Scale (EPDS), and Postpartum Specific Anxiety Scale (PSAS) were used to collect the data. The general linear modeling was used along with adjustment of socio-demographic characteristics to determine the relationship between the childbirth experience with depression and anxiety.

RESULTS

The mean (SD) of the overall score for childbirth experience, anxiety, and depression were 2.9 (0.2) (score range: 1 to 4), 91.6 (4.8) (score range: 0 to153), and 9.4 (0.7) (score range: 0 to 30), respectively. There was a significant inverse correlation between the overall score of childbirth experiences, the depression score (r= -0.36, p < 0.001), and the anxiety score (r= -0.12, p = 0.028) based on the Pearson correlation test. According to the general linear modeling and with adjustment of socio-demographic characteristics, with the increasing score of the childbirth experience, the depression score decreased (B= -0.2; 95%CI: -0.3 to -0.1). Moreover, the variable of control during pregnancy was a predictor for postpartum depression and anxiety, so in women with the control during pregnancy, the mean score of postpartum depression (B= -1.8; CI 95%: -3.0 to -0.5; P = 0.004) and anxiety (B=-6.0; CI 95%: -10.1 to -1.6; P = 0.007) was less.

CONCLUSION

Based on the study results, postpartum depression and anxiety are related to childbirth experiences, therefore considering the effects of mothers' mental health on other aspects of a woman and her family's life, the core role of health care providers and policymakers in creating positive childbirth experiences is determined.

Maternity Blues: A Narrative Review

Puerperium is a period of great vulnerability for the woman, associated with intense physical and emotional changes. Maternity blues (MB), also known as baby blues, postnatal blues, or post-partum blues, include low mood and mild, transient, self-limited depressive symptoms, which can be developed in the first days after delivery. However, the correct identification of this condition is difficult because a shared definition and well-established diagnostic tools are not still available. A great heterogenicity has been reported worldwide regarding MB prevalence. Studies described an overall prevalence of 39%, ranging from 13.7% to 76%, according to the cultural and geographical contexts. MB is a well-established risk factor for shifting to more severe post-partum mood disorders, such as post-partum depression and postpartum psychosis. Several risk factors and pathophysiological mechanisms which could provide the foundation of MB have been the object of investigations, but only poor evidence and speculations are available until now. Taking into account its non-negligible prevalence after childbirth, making an early diagnosis of MB is important to provide adequate and prompt support to the mother, which may contribute to avoiding evolutions toward more serious post-partum disorders. In this paper, we aimed to offer an overview of the knowledge available of MB in terms of definitions, diagnosis tools, pathophysiological mechanisms, and all major clinical aspects. Clinicians should know MB and be aware of its potential evolutions in order to offer the most timely and effective evidence-based care.

The severity and role of somatic depressive symptoms in psychological networks in a longitudinal sample of peripartum women

The inclusion of somatic symptoms in assessing peripartum depression (PPD), which encompasses depression during pregnancy and the postpartum period, has remained controversial, as there is substantial overlap between somatic depression symptoms and normal features of pregnancy/postpartum. This study examined whether trajectories differed by PPD symptom subscale and whether PPD symptom networks changed as a function of the peripartum phase. 418 women with a history of neuropsychiatric illness participated in a longitudinal observational study, completing symptom questionnaires assessing affective, cognitive, and somatic symptoms throughout pregnancy and the first year postpartum. Assessments were grouped into five peripartum phases: three trimesters of pregnancy and early/late postpartum. Two analyses were performed. First, a series of multilevel spline regression models examined depression subscale trajectories over peripartum phase. Second, symptom networks and related metrics were estimated for each peripartum phase and compared. Somatic symptoms were most severe and had the most variable peripartum trajectory. The role of somatic symptoms within the networks also changed as a function of peripartum phase. Our results suggest that somatic symptoms can be severe and may play a crucial role in the maintenance of PPD. Thus, somatic symptoms should not be disregarded when assessing for PPD in obstetrical, psychiatric, and pediatric clinics, and clinical research.

Perinatal depression screening using smartphone technology: Exploring uptake, engagement and future directions for the MGH Perinatal Depression Scale (MGHPDS)

Women may experience new-onset or worsening depressive disorders during pregnancy and the postpartum. If untreated, there may be detrimental consequences to the health and wellbeing of the woman and to her baby. There is a need for improved tools and approaches that can be easily and broadly implemented to effectively detect depression during the perinatal period. Early identification of depression during pregnancy is an important first step towards connecting women to treatment and preventing continued depression into the postpartum or beyond. This report provides preliminary findings from a pilot study of a digital screening app for perinatal depression expiring potential for app reach, engagement, and user demographics and mental health symptoms. With mainly passive recruitment efforts, we collected cross-sectional mental health data on over 700 women during the perinatal period, including women across over 30 countries. We report on mean depression scores among women during pregnancy and the postpartum as well as on constructs that are commonly comorbid with depression, including anxiety, sleep dysregulation, and perceived stress. Over half of the women during pregnancy and over 70% of women in the postpartum had a depression score indicative of clinical depression. Future research directions for this work and potential for public health impact are discussed, including longitudinal data collection and analyses of symptomology over time and embedding evidence-based digital therapeutics into the app as a means to increase access to mental health services.

Mood during pregnancy: Trends, structure, and invariance by gestational day

Mood dynamics during pregnancy are important in understanding a critical period of human development, and also as a model for biopsychosocial stress processes. Here, in four large samples of smartphone app respondents (differentiated by time period and number of responses), we modeled mood for each gestational day during the pregnancy period. We aimed to delineate patterns of changes in mood across pregnancy, as well as potential changes in measurement properties across the period. Results indicated that three prominent mood factors - positivity, distress, and irritability - could account for responses in this period, and that changes in measurement properties of mood items across pregnancy were small in magnitude. Mean irritability increased, and positivity decreased, in the first trimester before reversing in direction; there was also some evidence for previously reported U-shaped trends in mood, where negative mood is greatest early in pregnancy, decreases, and then increases again. Results help characterize mood processes at a detailed level during a critical period, and point to directions for future research to explicate causes and effects of mood changes during this time.

Shortening the Edinburgh postnatal depression scale using optimal test assembly methods: Development of the EPDS-Dep-5

AIMS

This study used a large database to develop a reliable and valid shortened form of the Edinburgh Postnatal Depression Scale (EPDS), a self-report questionnaire used for depression screening in pregnancy and postpartum, based on objective criteria.

METHODS

Item responses from the 10-item EPDS were obtained from 5157 participants (765 major depression cases) from 22 primary screening accuracy studies that compared the EPDS to the Structured Clinical Interview for DSM (SCID). Unidimensionality of the EPDS latent construct was verified using confirmatory factor analysis, and an item response theory model was fit. Optimal test assembly (OTA) methods identified a maximally informative shortened form for each possible scale length between 1 and 9 items. The final shortened form was selected based on pre-specified validity and reliability criteria and non-inferiority of screening accuracy of the EPDS as compared to the SCID.

RESULTS

A 5-item short form of the EPDS (EPDS-Dep-5) was selected. The EPDS-Dep-5 had a Cronbach's alpha of 0.82. Sensitivity and specificity of the EPDS-Dep-5 for a cutoff of 4 or greater were 0.83 (95% CI, 0.73, 0.89) and 0.86 (95% CI, 0.80, 0.90) and were statistically non-inferior to the EPDS. The correlation of total scores with the full EPDS was high (r = 0.91).

CONCLUSION

The EPDS-Dep-5 is a valid short form with minimal loss of information when compared to the full-length EPDS. The EPDS-Dep-5 was developed with OTA methods using objective, pre-specified criteria, but the approach is data-driven and exploratory. Thus, there is a need to replicate results of this study in different populations.

Effect of Excessive Body Weight and Emotional Disorders on the Course of Pregnancy and Well-Being of a Newborn before and during COVID-19 Pandemic

This study aimed to evaluate whether excessive body weight and the COVID-19 pandemic affect depression, and subsequently whether depression, excessive body weight, and the COVID-19 pandemic affect the course of pregnancy, as well as the well-being of a newborn. The research material included data retrieved from the medical records of 280 pregnant women who were provided with care by medical facilities in Lublin (100 women with normal weight, 100 overweight women, 50 with Class I and 30 with Class II obesity). They completed a Beck depression inventory (BDI) in pregnancy twice, in order to assess the risk of occurrence of postpartum depression. Pre-pregnancy BMI positively correlated with the severity of depression, both at 10–13 weeks of pregnancy (p < 0.001), and at 32 weeks of pregnancy (p < 0.001). The higher the pre-pregnancy BMI, on average the higher the severity of depression. The severity of depression was significantly higher during the pandemic than before it in women with normal body weight before pregnancy (p < 0.001), as well as in those overweight (p < 0.001) and with Class II obesity (p = 0.015). Excessive body weight before pregnancy leads to depressive disorders during pregnancy, increases the risk of preterm delivery, and exerts a negative effect on the state of a newborn. Depressive symptoms among pregnant, overweight and obese women intensified during the COVID-19 pandemic.

Postpartum Depression: Identification and Treatment in the Clinic Setting

Perinatal care, including the management of mental health issues, often falls under the auspices of primary care providers. Postpartum depression (PPD) is a common problem that affects up to 15% of women. Most women at risk can be identified before delivery based on psychiatric history, symptoms during pregnancy, and recent psychosocial stressors. Fortunately, there have been a variety of treatment studies using antidepressants, nonpharmacologic interactions, and most recently, allopregnanolone (Brexanolone) infusion that have shown benefits. The most commonly used screening scale, Edinburgh Postnatal Depression Scale, a 10-item self-rated scale, has been translated into a variety of languages.

Brexanolone, a GABAA Modulator, in the Treatment of Postpartum Depression in Adults: A Comprehensive Review

Postpartum depression (PPD) is one of the three major categories on the spectrum of postpartum psychiatric syndromes. Postpartum psychiatric syndromes are classified as either postpartum blues, postpartum depression, or postpartum psychosis. Postpartum depression is important to recognize clinically because of the effect it can have on the mother-child bond. The neurosteroid allopregnanolone, a progesterone derivative, is important for its role in positively modulating GABA_A receptors. GABA-mediated signaling has been previously implicated in major depressive disorder. Allopregnanolone-mediated signaling has been identified as an important therapeutic target. Treatment with an allopregnanolone-analog, brexanolone, has been shown to improve depression scores in trials for the treatment of PPD. Brexanolone is a positive allosteric modulator of GABA_A and is the first drug approved by the FDA to treat postpartum depression. Brexanolone enhances the inhibitory effects of GABA_A, restores dysfunctional GABA_A transmembrane channels, and mimics a naturally produced progesterone metabolite that fluctuates during pregnancy and postpartum. One open-label study and two phase two studies have some significant reduction in HAM-D scores after treatment and that the effect was still there 30 days post-treatment. Per the data reported, intravenous infusion of brexanolone could be efficacious and safe for the treatment of women suffering from postpartum depression.

Effects of COVID-19 Epidemic Lockdown on Postpartum Depressive Symptoms in a Sample of Italian Mothers

The extraordinary health emergency of the COVID-19 pandemic represents a new challenge for mental health researchers and clinical practitioners. The related containment measures may be a risk factor for psychological distress and mood disorders, especially in at-risk populations. This study aims to explore the impact of COVID-19 on postpartum depressive symptoms in mothers with children below 1 year of age. An online questionnaire survey was therefore conducted in Italy between May and June 2020. The survey consisted of several self-administered questionnaires: besides some ad-hoc questionnaires, the Edinburgh Postnatal Depression Scale (EPDS), the Scale of Perceived Social Support (SPSS) and the Maternity Social Support Scale (MSSS) were used. Two hundred forty-three Italian women were included in the study. The prevalence of postpartum depression symptomatology among mothers was 44%, as measured through the EPDS (cut-off >12). Women who spent the isolation in northern Italy adopted maladaptive coping strategies significantly more than women living in areas at lower risk. The analysis highlighted a significant difference between the group that was not directly affected by the virus and women who have had a direct or indirect contact with it. Besides situational factors specific to the pandemic, the results show that there are some risk factors tied to the personal history of the mother (e.g., having had a previous abortion). These data should inform and enlighten future protocols of intervention.

The Relationship Between Paternal and Maternal Depression During the Perinatal Period: A Systematic Review and Meta-Analysis

Background: Meta-analyses suggest an increased prevalence of paternal depression during the perinatal period of around 10%. The relationship between paternal and maternal symptoms, however, has received little attention. Objective: To determine pooled estimates pertaining to the relationship between paternal and maternal depression during the perinatal period according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources: Studies reporting on the relationship between depression in fathers and mothers between the first trimester and the first year following childbirth were identified using PubMed, PsycINFO, and EMBASE for the period between November 2009 and February 2020. Study selection: A total of 28 primary, empirical studies published in English or German, reporting effect estimates for the relationship of depression in mother-father/partner dyads, involving 11,593 couples, were included. Ten studies included multiple assessments, resulting in 64 extracted effects. Analysis: Information on correlations and odds ratios were extracted. Four random-effects analyses were conducted for the pooled association between paternal and maternal depression: (a) during the prenatal and (b) during the postnatal period, as well as for the prospective relationships between (c) paternal depression and maternal depression at a later timepoint, and (d) vice versa. Models were specified as restricted maximum-likelihood estimation. Heterogeneity was assessed using H 2 and I 2. Funnel plots, the Egger method, and the trim-and-fill test were used to assess publication bias. Sensitivity analyses with and without studies for which we approximated r were conducted. Data synthesis: With substantial heterogeneity, positive associations were found between paternal and maternal depression (a) during pregnancy (r = 0.238), (b) in the postnatal period (r = 0.279), as well as for the prospective relationship between (c) paternal and later maternal depression (r = 0.192), and (d) maternal and later paternal depression (r = 0.208). Conclusion: Paternal depression showed positive correlations with maternal depression across the perinatal period. Given notable methodological and cultural heterogeneity and limitations of individual studies, it was not possible to further identify determining or moderating factors. Increasing evidence for implications of parental depression for child development warrants further scientific attention.

Panic disorder during pregnancy and postpartum period

Background

– Earlier studies on the influence of pregnancy and postpartum period on the course of panic disorder have been inconsistent. The present study aims to quantify panic manifestations in these periods in large sample of women.

Method

– Panic manifestations, including exacerbations and new manifestations of panic disorder, were assessed retrospectively in a sample of 128 women with panic disorder with or without agoraphobia, 93 of whom had had 195 pregnancies.

Results

– Panic manifestations were fewer during pregnancy and more frequent in the postpartum period when compared with the control period. Women who had never been pregnant had significantly more panic manifestations than women with prior pregnancies. Breastfeeding and miscarriages did not have a significant effect. Women with postpartum panic reported more psychosocial stress events during this period.

Conclusions

– Possible reasons for postpartum panic and the protective effects of pregnancy are discussed, including psychosocial or hormonal factors and other neurobiological changes. Postpartum panic coincides with a sudden drop of hormones after delivery.

Pregnancy, postpartum and parity: Resilience and vulnerability in brain health and disease

Risk and resilience in brain health and disease can be influenced by a variety of factors. While there is a growing appreciation to consider sex as one of these factors, far less attention has been paid to sex-specific variables that may differentially impact females such as pregnancy and reproductive history. In this review, we focus on nervous system disorders which show a female bias and for which there is data from basic research and clinical studies pointing to modification in disease risk and progression during pregnancy, postpartum and/or as a result of parity: multiple sclerosis (MS), depression, stroke, and Alzheimer's disease (AD). In doing so, we join others (Shors, 2016; Galea et al., 2018a) in aiming to illustrate the importance of looking beyond sex in neuroscience research.

Effect of Thyroxine Therapy on Depressive Symptoms Among Women With Subclinical Hypothyroidism

OBJECTIVE

To estimate the effect of antenatal treatment of subclinical hypothyroidism on maternal depressive symptoms.

METHODS

We conducted an ancillary study to a multicenter trial in women with singleton pregnancies diagnosed with subclinical hypothyroidism randomized to antenatal thyroxine therapy or placebo. Treatment was discontinued at the end of pregnancy. Women with overt thyroid disease, diabetes, autoimmune disease, and those diagnosed with depression were excluded. Participants were assessed for depressive symptoms using the Center for Epidemiological Studies-Depression scale (CES-D) before starting the study drug (between 11 and 20 weeks of gestation), between 32 and 38 weeks of gestation, and at 1 year postpartum. The primary outcome was maternal depressive symptoms score as assessed using the CES-D. Secondary outcome was the percentage of women who scored 16 or higher on the CES-D, as such a score is considered screen-positive for depression.

RESULTS

Two hundred forty-five (36.2% of parent trial) women with subclinical hypothyroidism were allocated to thyroxine (n=124) or placebo (n=121). Median CES-D scores and the proportion of participants with positive scores were similar at baseline between the two groups. Treatment with thyroxine was not associated with differences in CES-D scores (10 [5-15] vs 10 [5-17]; P=.46) or in odds of screening positive in the third trimester compared with placebo, even after adjusting for baseline scores (24.3% vs 30.1%, adjusted odds ratio 0.63, 95% CI 0.31-1.28, P=.20). At 1 year postpartum, CES-D scores were not different (6 [3-11] vs 6 [3-12]; P=.79), nor was the frequency of screen-positive CES-D scores in the treated compared with the placebo group (9.7% vs 15.8%; P=.19). Treatment with thyroxine during pregnancy was also not associated with differences in odds of screening positive at the postpartum visit compared with placebo even after adjusting for baseline scores. Sensitivity analysis including women who were diagnosed with depression by the postpartum visit did not change the results.

CONCLUSIONS

This study did not achieve its planned sample size, thus our conclusions may be limited, but in this cohort of pregnant women with subclinical hypothyroidism, antenatal thyroxine replacement did not improve maternal depressive symptoms.

Postpartum changes in affect-related behavior and VTA dopamine neuron activity in rats

The onset of motherhood is accompanied by alterations in emotional and affective behaviors. Many new mothers experience transient and mild depressive symptoms that typically resolve spontaneously (i.e. postpartum blues) but increase the risk for postpartum depression (PPD). There is little data regarding the neural adaptations occurring in response to parturition and shortly after birth that may be associated with these affective changes. Although the dopamine (DA) system is involved in affect, maternal motivation and PPD, little is known about postpartum DA function. We compared affective behavior in virgin and postpartum adult female rats at early and late time points. In vivo extracellular recordings of VTA DA neurons were performed to evaluate 3 parameters: number of active DA neurons (i.e. population activity), firing rate, and firing pattern. Compared with virgins, postpartum rats exhibited increased anxiety-like behavior in the elevated plus maze at 1-day postpartum; reduced social motivation at 1- and 3-days postpartum, reduced anxiety-like behavior in the novelty suppressed feeding test throughout the first week postpartum and increased forced swim test immobility at 1-day postpartum. 1- and 3-day postpartum females exhibited attenuated VTA population activity without changes in firing rate or pattern. None of these effects were observed in late postpartum females when compared with virgins. These data suggest that parturition induces time-dependent changes in a subset of affect-related behaviors and DA function during the postpartum period in rodents, with early postpartum females exhibiting depression-related phenotypes (i.e. low social motivation, higher immobility, blunted DA activity).

Delivery mode is associated with maternal mental health following childbirth

Childbirth is a life-transforming event often followed by a time of heightened psychological vulnerability in the mother. There is a growing recognition of the importance of obstetrics aspects in maternal well-being with the way of labor potentially influencing psychological adjustment following parturition or failure thereof. Empirical scrutiny on the association between mode of delivery and postpartum well-being remains limited. We studied 685 women who were on average 3 months following childbirth and collected information concerning mode of delivery and pre- and postpartum mental health. Analysis of variance revealed that women who had cesarean section or vaginal instrumental delivery had higher somatization, obsessive compulsive, depression, and anxiety symptom levels than those who had natural or vaginal delivery as well as overall general distress, controlling for premorbid mental health, maternal age, education, primiparity, and medical complication in newborn. Women who underwent unplanned cesarean also had higher levels of childbirth-related PTSD symptoms excluding those with vaginal instrumental. The risk for endorsing psychiatric symptoms reflecting clinically relevant cases increased by twofold following unplanned cesarean and was threefold for probable childbirth-related PTSD. Maternal well-being following childbirth is associated with the experienced mode of delivery. Increasing awareness in routine care of the implications of operative delivery and obstetric interventions in delivery on a woman's mental health is needed. Screening at-risk women could improve the quality of care and prevent enduring symptoms. Research is warranted on the psychological and biological factors implicated in the mode of delivery and their role in postpartum adjustment.

Gender disappointment in India: SEM modeling approach

Despite people emphasizing their luck of having healthy baby, many secretly mourn for not having a baby which they preferred leading to gender disappointment. Hence, it is critical to explore factors contributing to gender disappointment particularly girl child which is pervasive in Asian countries. The study analyzes the variation in gender disappointment among different genders and age groups using percentage analysis and also employs structural equation modeling (SEM) to determine the direct factors and moderators contributing to gender disappointment. The findings reveal that societal pressure, cultural factors, economic expectancy, and safety expectancy significantly explain the gender disappointment with girl child. Neuroticism, conscientiousness, extraversion, and intellect were found to be the most significant personality bias moderators. The findings of the study give an insight for the government in designing awareness programs and free counseling programs to persuade people with different personalities to suppress gender disappointment, thereby enhancing women's mental health. Focusing on exploring the factors causing gender disappointment with girl babies, the role of personality in explaining gender disappointment and variation in gender disappointment between different genders and age groups makes the study unique from other research contributions. It also gives an insight for the government to create awareness programs and free counseling programs among people to eradicate these issues for the well-being of the society.

Use of Prescribed Psychotropics during Pregnancy: A Systematic Review of Pregnancy, Neonatal, and Childhood Outcomes

This paper reviews the findings from preclinical animal and human clinical research investigating maternal/fetal, neonatal, and child neurodevelopmental outcomes following prenatal exposure to psychotropic drugs. Evidence for the risks associated with prenatal exposure was examined, including teratogenicity, neurodevelopmental effects, neonatal toxicity, and long-term neurobehavioral consequences (i.e., behavioral teratogenicity). We conducted a comprehensive review of the recent results and conclusions of original research and reviews, respectively, which have investigated the short- and long-term impact of drugs commonly prescribed to pregnant women for psychological disorders, including mood, anxiety, and sleep disorders. Because mental illness in the mother is not a benign event, and may itself pose significant risks to both mother and child, simply discontinuing or avoiding medication use during pregnancy may not be possible. Therefore, prenatal exposure to psychotropic drugs is a major public health concern. Decisions regarding drug choice, dose, and duration should be made carefully, by balancing severity, chronicity, and co-morbidity of the mental illness, disorder, or condition against the potential risk for adverse outcomes due to drug exposure. Globally, maternal mental health problems are considered as a major public health challenge, which requires a stronger focus on mental health services that will benefit both mother and child. More preclinical and clinical research is needed in order to make well-informed decisions, understanding the risks associated with the use of psychotropic medications during pregnancy.

Depression Following Major Life Transitions in Women: A Review and Theory

Depression can occur due to common major life transitions, such as giving birth, menopause, retirement, empty-nest transition, and midlife crisis. Although some of these transitions are perceived as positive (e.g., giving birth), they may still lead to depression. We conducted a systematic literature review of the factors underlying the occurrence of depression following major life transition in some individuals. This review shows that major common life transitions can cause depression if they are sudden, major, and lead to loss (or change) of life roles (e.g., no longer doing motherly or fatherly chores after children leave family home). Accordingly, we provide a theoretical framework that explains depression caused by transitions in women. One of the most potential therapeutic methods of ameliorating depression associated with life transitions is either helping individuals accept their new roles (e.g., accepting new role as a mother to ameliorate postpartum depression symptoms) or providing them with novel life roles (e.g., volunteering after retirement or children leave family home) may help them overcome their illness.

Frank Beach Award Winner - The future of mental health research: Examining the interactions of the immune, endocrine and nervous systems between mother and infant and how they affect mental health

Pregnancy and the postpartum period are periods of significant change in the immune and endocrine systems. This period of life is also associated with an increased risk of mental health disorders in the mother, and an increased risk of developmental and neuropsychiatric disorders in her infant. The collective data described here supports the idea that peripartum mood disorders in mother and developmental disorders in her infant likely reflects multiple pathogeneses, stemming from various interactions between the immune, endocrine and nervous systems, thereby resulting in various symptom constellations. In this case, testing the mechanisms underlying specific symptoms of these disorders (e.g. deficits in specific types of learning or anhedonia) may provide a better understanding of the various physiological interactions and multiple etiologies that most likely underlie the risk of mental health disorders during this unique time in life. The goal here is to summarize the current understanding of how immune and endocrine factors contribute to maternal mental health, while simultaneously understanding the impact these unique interactions have on the developing brain of her infant.

Is depression more likely following childbirth? A population-based study

Postpartum depression (PPD) is characterized as a depressive episode conditional on childbirth. We examined whether the risk of depression is higher following childbirth than that at a randomly generated time unrelated to childbirth. In a prospective cohort of all women with live singleton births in Sweden, 1997-2008, we first calculated the relative risk (RR) of PPD for mothers with a history of depression compared to mothers without such a history. Next, we repeated the calculations, but now for depression following a computer-generated arbitrary "phantom delivery" date, unrelated to the true date of delivery. For this phantom delivery date, we used the average expected date of delivery for all women of the same age. For the analyses of each group, women were followed for a full calendar year. We fitted Poisson regression and calculated RR and two-sided 95% confidence intervals (CI). Among a total of 707,701 deliveries, there were 4397 PPD cases and 4687 control depression cases. The RR of PPD was 21.0 (CI 19.7-22.4). The RR of depression in the control group was 26.2 (CI 24.7-27.9). We provide evidence that the risk for PPD is no greater following childbirth than following a random date unrelated to childbirth. This finding suggests that the postpartum period may not necessarily represent a time of heightened vulnerability for clinically significant depression and that the well-established observation of depression covarying with childbirth does not necessarily equate to causation, but rather may be a secondary effect of postpartum women representing a medically captured population.

The dynamic serotonin system of the maternal brain

Many pregnant and postpartum women worldwide suffer from high anxiety and/or depression, which can have detrimental effects on maternal and infant well-being. The first-line pharmacotherapies for prepartum and postpartum affective disorders continue to be the selective serotonin reuptake inhibitors (SSRIs), despite the lack of large well-controlled studies demonstrating their efficacy in reproducing women and the potential for fetal/neonatal exposure to the drugs. Prepartum or postpartum use of SSRIs or other drugs that modulate the brain's serotonin system is also troubling because very little is known about the typical, let alone the atypical, changes that occur in the female central serotonin system across reproduction. We do know from a handful of studies of women and female laboratory rodents that numerous aspects of the central serotonin system are naturally dynamic across reproduction and are also affected by pregnancy stress (a major predisposing factor for maternal psychopathology). Thus, it should not be assumed that the maternal central serotonin system being targeted by SSRIs is identical to non-parous females or males. More information about the normative and stress-derailed changes in the maternal central serotonin system is essential for understanding how serotonin is involved in the etiology of, and the best use of SSRIs for potentially treating, affective disorders in the pregnant and postpartum populations.

Pathophysiological mechanisms implicated in postpartum depression

This review aims to summarize the diverse proposed pathophysiological mechanisms contributing to postpartum depression, highlighting both clinical and basic science research findings. The risk factors for developing postpartum depression are discussed, which may provide insight into potential neurobiological underpinnings. The evidence supporting a role for neuroendocrine changes, neuroinflammation, neurotransmitter alterations, circuit dysfunction, and the involvement of genetics and epigenetics in the pathophysiology of postpartum depression are discussed. This review integrates clinical and preclinical findings and highlights the diversity in the patient population, in which numerous pathophysiological changes may contribute to this disorder. Finally, we attempt to integrate these findings to understand how diverse neurobiological changes may contribute to a common pathological phenotype. This review is meant to serve as a comprehensive resource reviewing the proposed pathophysiological mechanisms underlying postpartum depression.

Women's decision making about antidepressant use during pregnancy: A narrative review

BACKGROUND

Depression is common, particularly among women of childbearing age, and can have far-reaching negative consequences if untreated. Efficacious treatments are available, but little is known about how women make depression treatment decisions during pregnancy. The purpose of this narrative review is to interpretively synthesize literature on women's decision making (DM) regarding antidepressant use during pregnancy.

METHODS

The databases PubMed, CINAHL, and PsycINFO were searched between May 2015 and August 2017 for peer-reviewed, English-language papers using terms such as "depression," "pregnancy," and "DM." The literature matrix abstraction method was used to systematically abstract data from full articles that met criteria for inclusion.

RESULTS

Of the articles abstracted (N = 10), half did not cite a DM theory on which the work was based. Key aspects of DM for this population were need for information and decision support, desire for active participation in DM, reflection on beliefs and values, evaluation of treatment option sequelae, and societal expectations. Treatment DM for depression during pregnancy is particularly impacted by the stigma associated with depression and societal expectations of pregnant women related to medication use during pregnancy. These findings, however, were based on studies of predominantly Caucasian and well-educated women.

CONCLUSIONS

Women require a nonjudgmental environment, in which shared DM feels safe, to foster positive DM experiences and outcomes. Future research is needed to define how to best support women to make depression treatment decisions in pregnancy, with particular attention to DM in the second and third trimesters of pregnancy.

Maternity blues: risk factors in Greek population and validity of the Greek version of Kennerley and Gath's blues questionnaire

Aim: To validate the Greek version of Kennerley and Gath's Blues Questionnaire (BQ) and gather further knowledge on maternity blues (MB) associations with certain clinical and sociodemographic factors in Greek population.Material and methods: 116 postpartum women, who met the inclusion criteria, completed the Blues Questionnaire and the Edinburgh Postnatal Depression Scale on the third day after delivery. Sociodemographic and clinical data were also collected.Results: Fifty women (43.1%) experienced severe MB on the third day postpartum. Lower number of previous births, fewer years of marriage, and husband's occupation were found to be associated with MB occurrence. Of them, years of marriage (odds 0.21, p = .001) and husband's occupation in private sector (odds 1.21, p = .04) were independent predictors of MB in logistic regression analysis. Cronbach's α for the total 28-item Greek version of BQ was 0.85. Cluster analysis in our data showed that the optimal number of clusters of BQ items was 4; these four clusters of items presented similarities with the Bartholomew and Horowitz's four-category model of attachment styles (avoidant - dismissing, preoccupied, secure, avoidant - fearful).Conclusions: The Greek version of Blues Questionnaire is a reliable tool for the detection and measurement of MB. Fewer years of marriage and the economic insecurity seem to have strong impact on the occurrence of MB. Further investigation is needed to evaluate whether the phenomenon of MB is associated with parental or mother-to-infant bonding disorders.

The psychoneuroimmunology of pregnancy

Pregnancy is associated with a number of significant changes in maternal physiology. Perhaps one of the more notable changes is the significant alteration in immune function that occurs during pregnancy. This change in immune function is necessary to support a successful pregnancy, but also creates a unique period of life during which a female is susceptible to disease and, as we'll speculate here, may also contribute to mental health disorders associated with pregnancy and the postpartum period. Here, we review the known changes in peripheral immune function that occur during pregnancy and the postpartum period, while highlighting the impact of hormones during these times on immune function, brain or neural function, as well as behavior. We also discuss the known and possible impact of pregnancy-induced immune changes on neural function during this time and briefly discuss how these changes might be a risk factor for perinatal anxiety or mood disorders.

Maternal programming: Application of a developmental psychopathology perspective

The fetal phase of life has long been recognized as a sensitive period of development. Here we posit that pregnancy represents a simultaneous sensitive period for the adult female with broad and persisting consequences for her health and development, including risk for psychopathology. In this review, we examine the transition to motherhood through the lens of developmental psychopathology. Specifically, we summarize the typical and atypical changes in brain and behavior that characterize the perinatal period. We highlight how the exceptional neuroplasticity exhibited by women during this life phase may account for increased vulnerability for psychopathology. Further, we discuss several modes of signaling that are available to the fetus to affect maternal phenotypes (hormones, motor activity, and gene transfer) and also illustrate how evolutionary perspectives can help explain how and why fetal functions may contribute to maternal psychopathology. The developmental psychopathology perspective has spurred advances in understanding risk and resilience for mental health in many domains. As such, it is surprising that this major epoch in the female life span has yet to benefit fully from similar applications.

Screening for Mental Health Disorders among Pregnant Women Availing Antenatal Care at a Government Maternity Hospital in Bengaluru City

INTRODUCTION

Antepartum anxiety and depression are two of the most common risk factors for the development of postpartum depression. Women are at a higher risk of developing depression and suffering from mental disorders during pregnancy and the postnatal period. Psychopathological symptoms during pregnancy have physiological consequences for the fetus, such as impaired blood flow leading to low birth weight, as well as cognitive delay and behavioral problems.

OBJECTIVES

To screen antenatal women for common mental health disorders and to determine the factors associated with mental health disorders during pregnancy.

METHODS

A cross-sectional study among 208 pregnant mothers in the third trimester attending the antenatal clinic at a Government Maternity Home in a low-income urban area of Bengaluru was conducted using clinical interview schedule-revised (CIS-R) questionnaire as a screening tool for detecting the presence of mental morbidity. Data collected were analyzed using SPSS version 16.

RESULTS

In the study population, 12 (5.8%) screened positive for antepartum mental morbidities, of which depression was the most common. 3.8% of all women screened positive for depression, with 15.4% demonstrating depressive symptoms. Overall, 82 (39.4%) had the presence of one or more psychological symptoms, including fatigue, irritability, anxiety, and problems with sleep and concentration but scored less than the CIS-R cutoff score of 12. Factors associated with the presence of antepartum mental morbidities included poor relationships with their spouse, poor/satisfactory relationship with siblings or in-laws, as well as the desire to have a male child.

CONCLUSION

In the study population, 12 (5.8%) screened positive for antepartum mental morbidities. Considering the effects on quality of life for these women as well as poor fetal outcomes associated with maternal mental morbidity, it is important to include screening and treatment of mental morbidity as a part of routine antenatal care.

The impact of maternal anxiety disorder on mother-infant interaction in the postpartum period

Background

This study investigated whether postpartum anxiety disorder is associated to altered patterns of infant as well as maternal engagement in a Face-to-Face-Still-Face interaction (FFSF).

Sampling and methods

n = 39 women with postpartum DSM-IV anxiety disorder and n = 48 healthy mothers were videotaped during a FFSF with their infant (M = 4.1 months).

Results

Infants of the clinical group showed significantly less positive engagement during the play episode than infants of controls. This result depended on infant sex: male controls demonstrated more positive interaction than males of anxious mothers. There was no such effect for female infants who engaged significantly less positively during the play episode than males and did not change their positive engagement during the FFSF. These findings imply pronounced interactive positivity and early vulnerability to maternal anxiety symptoms in male infants. Only the infants of the controls showed the still-face effect. They also protested significantly more during the still-face, while the clinical infants’ protest increased significantly during the reunion. Women of both groups did not differ in their interaction. Maternal intrusiveness was associated to infant protest in the course of the FFSF.

Conclusions

Results suggest that mother-infant intervention should consider affect regulation and infant sex-specific characteristics in anxious mother-infant dyads.

Post-partum depression, anxiety and marital satisfaction: A perspective from Southeastern Nigeria

Background

Many studies have noted the high prevalence of post-partum depression (PPD) and anxiety associated with poor marital satisfaction, albeit amidst a dearth of literature on comorbid PPD and anxiety among women in Nigeria.

Objective

The study was aimed to assess the prevalence of PPD and anxiety, and to investigate their relationship with marital satisfaction in low-risk women in Enugu, Southeastern Nigeria.

Method

A cross-sectional study of 309 randomly selected nursing mothers at two tertiary health institutions. Socio-demographic Questionnaire, Hospital Anxiety and Depression Scale, and Index of Marital Satisfaction (IMS) were used to collect data on demography, anxiety and depression and marital relationship respectively. All statistical tests were performed at a significant level of 0.05.

Results

The age range of the respondents was 20–46 years; mean and s.d. was 29.65 and ± 4.87, respectively, and most of them were graduates of tertiary educational institutions (74.1%). The prevalence of post-partum anxiety was 31.1% and of PPD was 33.3%. Marital dissatisfaction was observed in 39.5% (122) of the respondents who were mothers. Those with co-morbid depression and anxiety (22.0%) had worse marital dissatisfaction. The strongest correlation with depression and anxiety was item 12 of IMS (‘feel that my partner doesn’t confide in me’).

Conclusion

There was a high prevalence of marital dissatisfaction, PPD and anxiety among nursing mothers in Enugu, but with low detection rate. The effects of PPD and anxiety on the mother, her marital relationship and her infant make them essential conditions for early diagnosis, prevention and treatments.

Adaptation of the Structured Clinical Interview for DSM-IV Disorders for assessing depression in women during pregnancy and post-partum across countries and cultures

Background

To date, no study has used standardised diagnostic assessment procedures to determine whether rates of perinatal depression vary across cultures.

Aims

To adapt the Structured Clinical Interview for DSM–IV Disorders (SCID) for assessing depression and other non-psychotic psychiatric illness perinatally and to pilot the instrument in different centres and cultures.

Method

Assessments using the adapted SCID and the Edinburgh Postnatal Depression Scale were conducted during the third trimester of pregnancy and at 6 months postpartum with 296 women from ten sites in eight countries. Point prevalence rates during pregnancy and the postnatal period and adjusted 6-month period prevalence rates were computed for caseness, depression and major depression.

Results

The third trimester and 6-month point prevalence rates for perinatal depression were 6.9% and 8.0%, respectively. Postnatal 6-month period prevalence rates for perinatal depression ranged from 2.1% to 31.6% across centres and there were significant differences in these rates between centres.

Conclusions

Study findings suggest that the SCID was successfully adapted for this context. Further research on determinants of differences inprevalence of depression across cultures isneeded.

Perinatal depression and psychosis: an update

About 85% of women experience some type of postpartum mood disturbance. Generally, the symptoms are mild and short-lived, but a minority of women develop depressive illness or sudden psychosis. About half of episodes of apparently postnatal depression start during pregnancy and some seemingly postpartum psychoses start before delivery. Untreated antenatal depression can lead to poor obstetric outcomes, subsequent depression in the mother, and developmental disadvantage and depression later in life in the offspring. In this article we discuss the aetiology of perinatal depression and consider recommended pharmaceutical and psychosocial management of postpartum blues, perinatal depression and postpartum psychosis.

Modeling trait depression amplifies the effect of childbearing on postpartum depression

BACKGROUND

The literature on the relative risk for depression in the postpartum period has largely focused on state (or episodic) depression, and has not addressed trait depression (a woman's general tendency to experience depressed mood). The present study evaluates the association between childbirth and depression in the postpartum period, taking into account the role of stable differences in women's vulnerability for depression across a 10-year span.

METHODS

Data from the National Longitudinal Survey of Youth 1997 Cohort (N = 4385) were used. The recency of childbirth was used as a predictor of state depression in two models: one that modeled stable depressive symptoms over time (a multi-state single-trait model; LST), and one that did not (an autoregressive cross-lagged model; ARM).

RESULTS

Modeling trait depression, in addition to state depression, improved model fit and had the effect of increasing the magnitude of the association between childbirth and state depression in the postpartum period.

LIMITATIONS

The secondary nature of the data limited the complexity of analyses (e.g., models with multivariate predictors were not possible), as the data were not collected with the present study in mind.

CONCLUSIONS

These findings may reflect the fact that some of the covariance between childbirth and episodic depression is obscured by the effect of trait depression, and it is not until trait depression is explicitly modeled that the magnitude of the relationship between childbirth and depression becomes clear.

Rating scale item assessment of self-harm in postpartum women: a cross-sectional analysis

We examined the utility of screening instruments to identify risk factors for suicidal ideation (SI) in a population of women with neuropsychiatric illnesses at high risk for postpartum depression. Pregnant women with neuropsychiatric illness enrolled prior to 20 weeks of gestation. Follow-up visits at 4-8-week intervals through 13 weeks postpartum included assessment of depressive symptoms with both clinician and self-rated scales. A total of 842 women were included in the study. Up to 22.3% of postpartum women admitted SI on rating scales, despite the majority (79%) receiving active pharmacological treatment for psychiatric illness. Postpartum women admitting self-harm/SI were more likely to meet criteria for current major depressive episode (MDE), less than college education, an unplanned pregnancy, a history of past suicide attempt, and a higher score on the Childhood Trauma Questionnaire. In women with a history of neuropsychiatric illness, over 20% admitted SI during the postpartum period despite ongoing psychiatric treatment. Patient-rated depression scales are more sensitive screening tools than a clinician-rated depression scale for +SI in the postpartum period.

Distress levels in pregnant and matched non-pregnant women

This study examined self-rated symptoms of distress (Depression Anxiety and Stress Scale-DASS-21 and Perceived Stress Scale-PSS-4) among 93 pregnant women and a comparison group of 93 non-pregnant women matched on age and educational attainment. There were no significant differences between the groups, either on mean levels of distress or on proportions above a clinical cut-off point. Overall, 22%, 31% and 16% of pregnant women reported experiencing at least moderate levels of depression, anxiety and stress, respectively. Implications for conceptualising distress in pregnancy and identifying and providing support for the substantial minority who are distressed are discussed.

Activation of Sigma-1 Receptor Alleviates Postpartum Estrogen Withdrawal-Induced "Depression" Through Restoring Hippocampal nNOS-NO-CREB Activities in Mice

Postpartum depression affects approximately 15 % of mothers; however, its pathological mechanisms still remain unclear. Ovariectomized adult mice received the administration of estrogen (E2) and progesterone with a subsequent alone E2, termed hormone-simulated pregnancy (HSP). Affective behaviors as assessed by forced swim and tail suspension tests, hippocampal neuronal nitric oxide synthase (nNOS), nitric oxide (NO), cyclic AMP (cAMP) response element binding protein (CREB) phosphorylation (phosphor-CREB), and neurosteroidogenesis were examined before E2 withdrawal (EW; HSP mice) and on days 2-4 (early-EW mice) and days 8-10 (late-EW mice) after EW. Depressive-like behaviors were observed in early-EW mice but not in late-EW mice. Levels of nNOS, NO, and phosphor-CREB were increased in HSP mice followed by a significant decline in early-EW mice with a subsequent restoration in late-EW mice. The treatment of early-EW mice with NO donor alleviated depressive-like behaviors and decline of phosphor-CREB. The nNOS inhibitor and NO scavenger caused depressive-like behaviors and reduced phosphor-CREB in HSP mice and late-EW mice. Notably, the levels of steroidogenic enzymes StAR and P450scc were elevated in late-EW mice. The sigma-1 receptor (σ1R) agonist could alleviate depressive-like behaviors and decline of nNOS-NO-CREB in early-EW mice. The pharmacological blockade or deficiency of σ1R in late-EW mice caused depressive-like behaviors with decline of nNOS-NO-CREB. The reduction of hippocampal brain-derived neurotrophic factor (BDNF) or N-methyl-D-aspartic acid (NMDA) receptor NR2B phosphorylation in early-EW mice could recover in late-EW mice, which was sensitive to the blockade of σ1R. The NMDA receptor agonist, but not TrkB receptor activator, could correct the decline of nNOS-NO-CREB in early-EW mice. The findings indicate that the activation of σ1R can alleviate postpartum "depression" through increasing nNOS-NO-CREB activities.

The Neurobiology of Postpartum Anxiety and Depression

Ten to twenty percent of postpartum women experience anxiety or depressive disorders, which can have detrimental effects on the mother, child, and family. Little is known about the neural correlates of these affective disorders when they occur in mothers, but they do have unique neural profiles during the postpartum period compared with when they occur at other times in a woman's life. Given that the neural systems affected by postpartum anxiety and depression overlap and interact with the systems involved in maternal caregiving behaviors, mother-infant interactions are highly susceptible to disruption. Thus, there is an intricate interplay among maternal mental health, the mother-infant relationship, and the neurobiological mechanisms mediating them that needs to be the focus of future study.

Homeopathic Treatment for Postpartum Depression: A Case Report

Postpartum psychosis has long-lasting consequences for mother and child. Beside depression, sleep and eating disturbances, exhaustion, social withdrawal, and anxiety, postpartum depression can also interfere with normal maternal-infant bonding and adversely affect child development. Recent reports show that most affected pregnant women are hesitant about taking antidepressant drugs, with a high percentage discontinuing their use. Some authors suggest that the reluctance of pregnant women to take antidepressant drugs should encourage clinicians to discuss with their patients the use of psychological interventions or alternative forms of treatment. In this article, a case of severe postpartum depression, treated successfully with homeopathic therapy, is presented. Considering the high noncompliance of women suffering from postpartum depression with conventional antidepressant medication, research in safe complementary medical methods is justified. One of these methods should be homeopathy.

Which DSM validated tools for diagnosing depression are usable in primary care research? A systematic literature review

INTRODUCTION

Depression occurs frequently in primary care. Its broad clinical variability makes it difficult to diagnose. This makes it essential that family practitioner (FP) researchers have validated tools to minimize bias in studies of everyday practice. Which tools validated against psychiatric examination, according to the major depression criteria of DSM-IV or 5, can be used for research purposes?

METHOD

An international FP team conducted a systematic review using the following databases: Pubmed, Cochrane and Embase, from 2000/01/01 to 2015/10/01.

RESULTS

The three databases search identified 770 abstracts: 546 abstracts were analyzed after duplicates had been removed (224 duplicates); 50 of the validity studies were eligible and 4 studies were included. In 4 studies, the following tools were found: GDS-5, GDS-15, GDS-30, CESD-R, HADS, PSC-51 and HSCL-25. Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value were collected. The Youden index was calculated.

DISCUSSION

Using efficiency data alone to compare these studies could be misleading. Additional reliability, reproducibility and ergonomic data will be essential for making comparisons.

CONCLUSION

This study selected seven tools, usable in primary care research, for the diagnosis of depression. In order to define the best tools in terms of efficiency, reproducibility, reliability and ergonomics for research in primary care, and for care itself, further research will be essential.

The Relationship Among Breastfeeding, Postpartum Depression, and Postpartum Weight in Mexican American Women

OBJECTIVE

To determine if symptoms of postpartum depression and postpartum weight varied according to the level of breastfeeding among women of Mexican origin at 1 month and 6 months postpartum.

DESIGN

Secondary quantitative analysis to study the differences in postpartum weight and depression among the mothers in the study who breastfed and those who did not.

SETTING

A heavily Hispanic community located in a major Southwestern U.S. city.

PARTICIPANTS

Women of Mexican origin (N = 150) who enrolled during their third trimesters in a local Special Supplemental Nutrition Program for Women, Infants, and Children clinic and were followed for 6 months.

METHODS

Weight was measured at 1 month and at 6 months postpartum at home visits with validated digital scales. Breastfeeding was measured according to World Health Organization criteria and recorded after monthly phone calls. Depression was measured at home visits at 1 month and 6 months with the Edinburgh Postnatal Depression Scale.

RESULTS

At 6 months postpartum, participants who did not breastfeed had the highest scores on the Edinburgh Postnatal Depression Scale; participants who breastfed nonexclusively had the lowest scores (p = .067). At both time points, there was a significant difference in weight (p = .017) between women who were doing any breastfeeding and women who were not breastfeeding.

CONCLUSION

Breastfeeding, even if not exclusive, contributed to lower depression scores and significantly lower postpartum weight among this sample of Mexican American women.

Alexithymia and postpartum anxiety and depression symptoms: a follow-up study in a pregnancy cohort

INTRODUCTION

There is a lack of longitudinal studies assessing the significance of alexithymia on the emergence of mental illnesses. We aimed to evaluate the potential effect of alexithymia on postpartum anxiety and depression symptoms in a sample of parents to be.

METHODS

In a pregnancy cohort, longitudinal data were available from three time points (gestational weeks 18-20, and 3 and 12 months postpartum) for 100 mothers and 65 fathers. The 20-item Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia, the State-Trait Anxiety Inventory (STAI) to evaluate anxiety symptoms and the Edinburgh Postnatal Depression Scale (EPDS) to assess depression. Linear regression analyses were used to estimate the effect of alexithymia on the symptom scale score changes from baseline.

RESULTS

Both in mothers and fathers, the TAS-20 total score was significantly correlated with the STAI and EPDS scores at several time-points, with a higher TAS-20 score indicating more symptoms. In the regression analyses, the association of alexithymia with later symptoms became non-significant in mothers. However, in fathers, the TAS-20 score had a statistically significant effect on the increase of the STAI score at 3 months postpartum (p = 0.006). For the separate TAS-20 subscales, difficulty identifying feelings had a significant effect on the increase of anxiety by 12 months postpartum (p = 0.023) and difficulty describing feelings on the increase by 3 months postpartum (p < 0.001).

DISCUSSION

Although the setting did not facilitate the assessment of actual diagnoses regarding the anxiety and depression symptoms, alexithymia appears to have a significant effect on the increase of postpartum anxiety symptoms in fathers-to-be.

The Effectiveness of Mindfulness-Based Interventions in the Perinatal Period: A Systematic Review and Meta-Analysis

Perinatal mental health difficulties are associated with adverse consequences for parents and infants. However, the potential risks associated with the use of psychotropic medication for pregnant and breastfeeding women and the preferences expressed by women for non-pharmacological interventions mean it is important to ensure that effective psychological interventions are available. It has been argued that mindfulness-based interventions may offer a novel approach to treating perinatal mental health difficulties, but relatively little is known about their effectiveness with perinatal populations. This paper therefore presents a systematic review and meta-analysis of the effectiveness of mindfulness-based interventions for reducing depression, anxiety and stress and improving mindfulness skills in the perinatal period. A systematic review identified seventeen studies of mindfulness-based interventions in the perinatal period, including both controlled trials (n = 9) and pre-post uncontrolled studies (n = 8). Eight of these studies also included qualitative data. Hedge's g was used to assess uncontrolled and controlled effect sizes in separate meta-analyses, and a narrative synthesis of qualitative data was produced. Pre- to post-analyses showed significant reductions in depression, anxiety and stress and significant increases in mindfulness skills post intervention, each with small to medium effect sizes. Completion of the mindfulness-based interventions was reasonable with around three quarters of participants meeting study-defined criteria for engagement or completion where this was recorded. Qualitative data suggested that participants viewed mindfulness interventions positively. However, between-group analyses failed to find any significant post-intervention benefits for depression, anxiety or stress of mindfulness-based interventions in comparison to control conditions: effect sizes were negligible and it was conspicuous that intervention group participants did not appear to improve significantly more than controls in their mindfulness skills. The interventions offered often deviated from traditional mindfulness-based cognitive therapy or mindfulness-based stress reduction programmes, and there was also a tendency for studies to focus on healthy rather than clinical populations, and on antenatal rather than postnatal populations. It is argued that these and other limitations with the included studies and their interventions may have been partly responsible for the lack of significant between-group effects. The implications of the findings and recommendations for future research are discussed.

Estimated prevalence of antenatal depression in the US population

The purpose of this study is to determine the prevalence of minor and major depression among pregnant women in the USA. Also, we compare prevalence of depression among pregnant and non-pregnant women while controlling for relevant covariates. A population-representative sample of pregnant women (n = 3010) surveyed for the 2006 Behavioral Risk Factor Surveillance System was compared to a sample of women who were not pregnant (n = 68,620). Binary logistic regression was used to determine prevalence ratios of depression for pregnant and non-pregnant women while controlling for the effects of age, race, annual income, employment status, educational level, marital status, general health, and availability of emotional support. Depression was measured by the Patient Health Questionnaire-8 (PHQ-8). The prevalence of major depression was no greater among pregnant women (6.1%) compared to non-pregnant women (7%; adjusted prevalence ratio (PR) = 1.1, 95% confidence interval (CI) .8 and 1.5). The prevalence of minor depression was greater among pregnant women (16.6%) compared to non-pregnant women (11.4%; adjusted PR = 1.5, 95% CI 1.2 and 1.9). Prevalence ratios are adjusted for the effects of covariates noted above. Prevalence of major depression is not associated with pregnancy, but minor depression is more likely among women who are pregnant.

Couple comorbidity and correlates of postnatal depressive symptoms in mothers and fathers in the first two weeks following delivery

BACKGROUND

Postnatal depression affects a significant number of parents; however, its co-occurrence in mothers and fathers has not been studied extensively. Identifying predictors and correlates of postnatal depressive symptoms can help develop effective interventions.

METHODS

Questionnaires on several socio-demographic and psychosocial factors were administered to 276 couples within two weeks after birth. Depressive symptoms in mothers and fathers were assessed using the Edinburgh Postnatal Depression Scale (EPDS). After calculating the correlation coefficient between mothers and fathers' EPDS scores, univariate and multivariate linear regression analyses were performed to identify significant correlates of postnatal depressive symptoms in mothers and fathers.

RESULTS

Prevalence of maternal and paternal postnatal depressive symptoms was 15.9% (EPDS>12) and 5.4% (EPDS>10), respectively. There was a moderate positive correlation between mothers and fathers' EPDS scores (r=.30, p<.001). Multivariate analyses indicated that parental stress was the strongest predictor for maternal and paternal postnatal depressive symptoms. Pregnancy- and birth-related distress and partners' EPDS scores were also associated with depressive symptoms in both parents. Relationship satisfaction was only inversely related with fathers' EPDS scores, while mothers' EPDS scores were additionally associated with critical life events, history of childhood violence, and birth-related physiological complaints.

LIMITATIONS

Since information about participation rates (those who declined) is unavailable, we cannot rule out sampling bias. Further, some psychosocial factors were assessed using single items.

CONCLUSION

Since co-occurrence of depressive symptoms in mothers and fathers is high, developing and evaluating postnatal depression interventions for couples may be beneficial. Interventions to reduce parenting stress may help prevent parental postnatal depression.

Diagnostic accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for detecting major depression in pregnant and postnatal women: protocol for a systematic review and individual patient data meta-analyses

INTRODUCTION

Studies of the diagnostic accuracy of depression screening tools often used data-driven methods to select optimal cut-offs. Typically, these studies report results from a small range of cut-off points around whatever cut-off score is identified as most accurate. When published data are combined in meta-analyses, estimates of accuracy for different cut-off points may be based on data from different studies, rather than data from all studies for each cut-off point. Thus, traditional meta-analyses may exaggerate accuracy estimates. Individual patient data (IPD) meta-analyses synthesise data from all studies for each cut-off score to obtain accuracy estimates. The 10-item Edinburgh Postnatal Depression Scale (EPDS) is commonly recommended for depression screening in the perinatal period. The primary objective of this IPD meta-analysis is to determine the diagnostic accuracy of the EPDS to detect major depression among women during pregnancy and in the postpartum period across all potentially relevant cut-off scores, accounting for patient factors that may influence accuracy (age, pregnancy vs postpartum).

METHODS AND ANALYSIS

Data sources will include Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science. Studies that include a diagnosis of major depression based on a validated structured or semistructured clinical interview administered within 2 weeks of (before or after) the administration of the EPDS will be included. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Bivariate random-effects meta-analysis will be conducted for the full range of plausible cut-off values. Analyses will evaluate data from pregnancy and the postpartum period separately, as well as combining data from all women in a single model.

ETHICS AND DISSEMINATION

This study does not require ethics approval. Dissemination will include journal articles and presentations to policymakers, healthcare providers and researchers.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2015:CRD42015024785.