From antenatal to postnatal depression: associated factors and mitigating influences

Does the Edinburgh Postnatal Depression Scale (EPDS) identify antenatal depression and antenatal anxiety disorders? A validation study in Singapore

OBJECTIVE

Research on the usage of the Edinburgh Postnatal Depression Scale (EPDS) to detect common antenatal mental disorders in pregnant women attending outpatient clinics in Singapore is limited. This study aimed to investigate the psychometric properties of the EPDS in screening for antenatal depression (AND) and anxiety disorders.

METHOD

250 pregnant women from two national public obstetric clinics were included. The EPDS and EPDS-3A were validated against the Mini International Neuropsychiatric Interview (MINI) by analyzing key parameters at different cutoffs and obtaining the receiver operating characteristic analysis. Multivariable analysis was used to identify possible risk factors of AND.

RESULTS

The prevalence of AND and anxiety disorders was 4.4 % and 3.3 %, respectively. The EPDS demonstrated strong psychometric performance in screening for both conditions, with an Area Under the Curve (AUC) of 0.927 for depression and 0.829 for anxiety. In contrast, the EPDS-3A was not recommended as a screening tool due to its relatively poor psychometric properties. For clinical applicability of AND screening using EPDS in a busy outpatient clinic, a cutoff >11 is recommended, followed by further assessment and tiered care based on needs. Being a member of minority ethnic group was the only risk factor identified for AND in our study population.

CONCLUSION

EPDS performs well in screening for antenatal depression and anxiety disorders; however, further assessment is important.

Nurturing networks: A prospective longitudinal study of factors influencing help-seeking behaviours among mothers from low socioeconomic status

AIM

To explore the factors influencing help-seeking behaviours amongst mothers with low socioeconomic status at pregnancy, 1 month postpartum and 3 months postpartum.

METHODS

A prospective cohort study was conducted from September 2022 to August 2023. A total of 209 mothers aged 21 years and above, with low socioeconomic status and irrespective of parity, were recruited from a local hospital using convenience sampling. Self-administered questionnaires were used to collect data at (1) third trimester of pregnancy, (2) 1 month postpartum and (3) 3 months postpartum. Multiple regression analysis was used to identify significant factors influencing help-seeking behaviour at 3 months postpartum. Sub-analyses were conducted between primiparous mothers and multiparous mothers. General linear model repeated measures were used to identify longitudinal trends in outcomes of help-seeking behaviour.

RESULTS

Help-seeking behaviour at pregnancy and 1 month postpartum, sources of social support at 3 months postpartum, birth order of the child, attendance of antenatal classes, paternal involvement in feeding and changing diapers and mode of delivery significantly predicted mothers' help-seeking behaviour at 3 months postpartum. Amongst primiparous mothers, help-seeking behaviour at pregnancy at 1 month, social support at 3 months postpartum, employment in part-time jobs and exclusively breastfeeding their infant were significant factors in influencing their help-seeking behaviours at 3 months postpartum. For multiparous mothers, help-seeking behaviour at pregnancy and 1 month postpartum, number of hours of antenatal class attended, Malay ethnicity, educational background, parental satisfaction at 3 months postpartum and infant bonding at both time points were significant factors influencing their help-seeking behaviours at 3 months postpartum.

CONCLUSION

Primiparous mothers with low socioeconomic status who underwent caesarean section exhibited less help-seeking behaviours. Attendance of antenatal classes and greater paternal involvement in infant care encouraged mothers with low socioeconomic status to help-seeking behaviours. A tailored approach is needed to support mothers with low socioeconomic status by providing additional support in improving the accessibility of antenatal classes and involving fathers in infant care.

IMPACT

What Problem Did the Study Address? Mothers with low socioeconomic status tend to exhibit lower help-seeking behaviours due to limited support and access to care services. What Were the Main Findings? First-time mothers who underwent caesarean section, did not attend antenatal classes, and had husbands uninvolved in feeding and diaper changing were significantly less likely to seek help in the third month postpartum. One and 3 months postpartum are crucial time points when mothers with low socioeconomic status could benefit from additional support. Hospitals should explore online informational resources, forums, teleconsultations and virtual antenatal classes as possible alternative options to improve accessibility for mothers with low socioeconomic status. Where and on Whom Will the Research Have an Impact? Mothers with low socioeconomic status and healthcare providers of mothers with low socioeconomic status will benefit from the findings of this research. This study was conducted within the Singapore context. Findings could be generalizable to other cultural contexts with similar multi-ethnic populations.

REPORTING METHOD

STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Influencing factors of depressive symptoms during pregnancy in Beijing, China

Objective

Prenatal depression is a prevalent mental health challenge encountered during pregnancy and is notably associated with adverse maternal and neonatal outcomes. This study aimed to elucidate the likelihood and determinants of depressive symptoms among pregnant individuals in Beijing, thereby laying a foundational framework for the theoretical underpinning of prenatal screening and preemptive interventions for mental disorders.

Methods

The study dataset was derived from 4,564 pregnant individuals in Beijing utilizing a cross-sectional survey methodology. Data collection focused primarily on the personal and obstetric information of the participants. The Edinburgh Postnatal Depression Scale (EPDS) was employed as the primary screening tool to identify depressive symptoms.

Results

The prevalence of depressive symptoms among the included pregnant individuals was 4.1%. The univariate analysis results revealed statistically significant differences in the incidence of depressive symptoms in women with different parities, numbers of births, medication use, numbers of abortions, prepregnancy weights, and body mass indices (BMIs) (the χ2 values were 61.130, 52.008, 23.291, 5.293, and 12.681, respectively; P<0.05). There were statistically significant differences in the incidence of depressive symptoms among women with different occupation types (χ2 = 30.263, P<0.01). The multivariate logistic regression analysis results revealed that a greater number of pregnancies, number of births, and BMI were risk factors for prenatal depression, whereas the commercial and service worker occupation types were protective factors against prenatal depression.

Conclusion

Future directives should emphasize the enhancement of screening for depressive symptoms among pregnant individuals with greater parity and BMIs, alongside encouraging continued employment and flexible job selection. It is imperative to implement suitable intervention strategies for pregnant individuals exhibiting depressive symptoms to mitigate the incidence of adverse maternal and neonatal outcomes.

A multi-level meta-analysis of the relationship between decision-making during birth and postpartum mental health

Introduction

There is accumulating evidence of ineffective decision-making between birthing individuals and healthcare providers during childbirth. While research syntheses have demonstrated that negative birth experiences are associated with postpartum mental health, primary quantitative studies linking specific decision-making measures and mental health outcomes have not been synthesised. The present study aims to fill this gap in order to provide hands-on evidence on how to further improve perinatal care.

Methods

A systematic literature search using Bolean logic was conducted. A final set of 34 publications from 14 different countries could be included in our meta-analysis. Measures of intrapartum decision-making were consolidated into four key domains: information, respect, control, and involvement. We conducted multi-level meta-analyses to assess the overall relationship of intra-partum decision-making and mental-health outcomes, as well as the specific correlations associated with each decision-making domain.

Results

Our analysisrevealed that less effective intrapartum decision-making is associated with more postpartum overall mental health problems (r = -.25), depression (r = -.19), and posttraumatic stress disorder (r = -.29). More precisely, while all domains of intrapartum decision-making (information: r = -.22, involvement: r = -.23, respect: r = -.28, control: r = -.25) were associated with postpartum overall psychopathology, only information (r = -.18), respect (r = -.25), and control (r = -.12) were associated with depression, and only involvement (r = -.31), respect (r = -.32), and control (r = -.25) were associated with posttraumatic stress disorder. A higher percentange of planned cesarean sections in a sample and longer time lags between birth and post-effect measurement were identified as moderating variables.

Conclusions

Ineffective decision-making is a significant contributing factor to the development of adverse postpartum mental health problems outcomes. Implications for practice concern establishing numerous antenatal care contacts as a standard to enhance birth preparedness for both birthing individuals and providers. Additionally, measuring the experience of intrapartum decision-making as an indicator of quality of care as a default to monitor, analyse, and improve decision-making and to facilitate accountability systems.

Self-Reported Causes of Psychological Distress Among Czech Perinatal Women

BACKGROUND

Various risk factors to perinatal mental health disorders have been described; however, there is a dearth of data on the perspectives of women themselves regarding what increases the risk of psychological distress. This qualitative study explores women's perceptions of factors that increase the risk of perinatal psychological distress.

AIM

The aim of this study was to elucidate women's perceptions of factors that increase the risk of perinatal psychological distress.

METHODS

A qualitative design with an exploratory and descriptive approach is used. Women (N = 188) aged 18 to 45 years who self-report experiencing perinatal psychological distress complete an online survey.

RESULTS

Perceived causes of perinatal psychological distress include: adverse experiences with childbirth and/or breastfeeding, negative attitudes of people close to the participant, financial and social challenges, health challenges, staff behavior in a maternity hospital, a challenging baby, family circumstances, and the new role as mother.

CONCLUSION

Women's perceived causes of perinatal psychological distress may allow for women-centered innovations in perinatal mental health care. The results highlight the need to train maternity staff regarding perinatal mental health and communication. These findings can serve as important guidelines on women-centered planning of innovations of perinatal mental health care. Interventions need to focus on the role of partners and others close to women so as to support the women during the perinatal period.

Effectiveness of Telephone-Based Interpersonal Psychotherapy on Antenatal Depressive Symptoms: A Prospective Randomized Controlled Trial in The Kingdom of Jordan

BACKGROUND

Jordanian pregnant women report high prevalence of antenatal depressive symptoms, compared to their counterparts internationally. One potential nonpharmacological intervention is Interpersonal Psychotherapy (IPT), accessed by telephone.

AIM

The aim of this study is to compare the depressive symptom level(s) among Jordanian pregnant women who received IPT treatment with those who received routine antenatal care.

METHODS

A prospective randomized controlled trial design was used. Following ethical approval, a sample of 100 pregnant women (50 in each group) at 24 to 37 weeks gestation, was drawn from one governmental public hospital. Seven sessions (each half an hour) of telephone-based IPT were offered twice weekly to those assigned to the intervention arm: one pretherapy orientation, five intermediates, and one closing session. The Edinburgh Postnatal Depression Scale was administered before and after the intervention. Analysis of covariance was used to detect the intervention effect. The two groups were matched based on demographic and health characteristics.

RESULTS

Compared to the control group, pregnant women who received the intervention reported fewer depressive symptoms.

CONCLUSIONS

Midwives and general nurses should screen all pregnant women for symptoms of depression. The effectiveness of IPT treatment in alleviating depressive symptoms indicates the importance of using such supportive interventions by midwives and general nurses, who are trained in psycho-educational counseling techniques. Moreover, data provided by this study may encourage policymakers to legislate policies that make psychotherapists available and accessible in antenatal care units and ensure that staff have adequate training via continuing education programs to screen for antenatal depressive symptoms.

Risk factors of positive depression screening during the third trimester of pregnancy in a Chinese tertiary hospital: a cross-sectional study

OBJECTIVE

Pregnant women experience enormous psychological pressure, particularly during the late trimester. Symptoms of depression in late pregnancy may persist postpartum, increasing the incidence of postpartum depression. This study is aimed to investigate the factors influencing depressive symptoms among pregnant women in their third trimester at a Chinese tertiary hospital and provide information for effective intervention.

METHODS

Pregnant women in their third trimester who visited the Ningbo Women and Children's Hospital between January 1, 2020 and June 30, 2022 participated in this study. A score of ≥ 13 on the Edinburgh Postnatal Depression Scale (EPDS) was considered as positive for depressive symptom. Potential influencing factors were examined by using an online questionnaire and analyzed using multivariate logistic regression.

RESULTS

A total of 1196 participants were recruited. The mean EPDS score was 7.12 ± 4.22. The positive screening rate for depressive symptom was 9.9%. Univariate analysis showed that living with partner, annual family income, planned pregnancy, sleep quality, and partner's drinking habits were related to positive screening for depression(P < 0.05). Furthermore, multivariate logistic regression analysis showed that living away from the partner (odds ratio [OR]: 2.054, 95% confidence interval [CI]: 1.094-3.696, P = 0.02), annual family income < 150,000 Chinese Yuan (CNY; OR: 1.762, 95% CI: 1.170-2.678, P = 0.007), poor sleep quality (OR: 4.123, 95% CI: 2.764-6.163, P < 0.001), and partner's frequent drinking habit (OR: 2.227, 95% CI: 1.129-4.323, P = 0.019) were independent influencing factors for positive depression screening (P < 0.05).

CONCLUSION

Family's economic condition, sleep quality, living with partner, and partner's drinking habits were related to positive depression screening in late pregnancy. Pregnant women with these risk factors should be given more attention and supported to avoid developing depression.

A feasibility study of Online Mellow Bumps: A Turkish pilot study of an online group-based antenatal parenting intervention

BACKGROUND

As a result of the COVID-19 pandemic, Mellow Parenting proposed online strategies for some of their interventions. One such intervention was Mellow Bumps - becoming Online Mellow Bumps. The objective of this study was to evaluate the implementation of antenatal parenting intervention Mellow Bumps in an online format and determine if this can be done safely and without detriment to pregnant women in Turkey.

METHOD

The study used an exploratory study design to investigate routine evaluation data collected pre- and post-intervention. Outcomes were online feasibility, mental health symptoms (depression, anxiety and stress), maternal subjective well-being, perceived quality of relationship with baby, maternal confidence and maternal social connectivity. 128 mums-to-be took part in the intervention between January 2021 and May 2021 from a total of 21 different provinces in Turkey.

RESULTS

57 pre- and post-intervention responses were eligible for analysis. This gives a response rate of 44.5% for evaluation, though the intervention completion rate was high at 89.5%, suggesting the intervention is engaging and accessible. Improvements were found for maternal stress levels, maternal subjective well-being and perceived relationship with baby. Improvements were also found for maternal confidence and maternal social connectivity.

CONCLUSIONS

This is the first study to evaluate the antenatal parenting intervention Mellow Bumps in an online format, namely Online Mellow Bumps. The online format makes the programme accessible for at-risk mothers and families, with the potential to continue reaching wider audiences beyond the pandemic who otherwise might struggle to access support. The findings show that the online group can be effective in improving mental health symptoms and mental well-being, supporting expectant mothers before the baby is born. Future research using a control group, a larger and more inclusive sample, and assessing the longer-term effects on parent and child would be beneficial.

Effects of Recreational Therapy and 3D Ultrasonography for High-Risk Pregnancies on Psychological Well-Being during Hospitalization and in the Puerperal Phase

Hospitalization during pregnancy often produces psychosocial distress for pregnant women. In this study, 3D ultrasound and recreational therapy were compared to the standard treatment for their influence on depressive symptoms and anxiety. In this prospective one-year intervention study, women who were admitted to the hospital for any pregnancy complication, other than psychiatric, were included. A control group, with standard clinical treatment, and two intervention groups, both additionally receiving either 3D ultrasound or recreational therapy, were established. Psychological well-being was assessed at defined times by the PHQ-health-questionnaire. A total of 169/211 women were included: control group n = 79, 3D ultrasound group n = 43, and crochet group n = 83. A higher than estimated underlying depression was seen for all women on admission. The intervention groups showed less depression (p = 0.02762). No difference was seen between the intervention groups (p = 0.23029). Anxiety decreased throughout intervention, but not significantly. On admission, all women showed similar results of underlying depression, indicating that hospitalization itself already causes mild psychological stress. Both interventions decreased depressive symptoms. Intervention with either recreational therapy or 3D ultrasound can prevent the development of mild and major depression and decrease anxiety disorders, and therefore has a positive effect on well-being during hospitalization. These results emphasize the need to implement forms of interventions to improve the well-being of women, as this might improve pregnancy and neonatal outcome.

Perinatal depression and implementation of the "Thinking Healthy program" support intervention in an impoverished setting of Lima, Peru: Assessment before and during the COVID-19 pandemic

Socios En Salud (SES) implemented the Thinking Healthy program (THP) to support women with perinatal depression before and during the COVID-19 pandemic in Lima Norte. We carried out an analysis of the in-person (5 modules) and remote (1 module) THP intervention. Depression was detected using PHQ-9, and THP sessions were delivered in women with a score (PHQ-9 ≥ 5). Depression was reassessed and pre- and post-scores were compared. In the pre-pandemic cohort, perinatal depression was 25.4% (47/185), 47 women received THP and 27 were reassessed (57.4%), and the PHQ-9 score median decreased from 8 to 2, p < 0.001. In the pandemic cohort, perinatal depression was 47.5% (117/247), 117 women received THP and 89 were reassessed (76.1%), and the PHQ-9 score median decreased from 7 to 2, p < 0.001. THP's modalities helped to reduce perinatal depression. Pregnant women who received a module remotely also reduced depression.

Risk factors for the development of postpartum depression in individuals who screened positive for antenatal depression

BACKGROUND

Women with antenatal depression often have a higher risk of developing postpartum depression (PPD) after delivery. A number of factors associated with the PDD in those previously reporting antenatal depression have been suggested, but further research is needed. This study aimed to investigate factors associated with developing subsequent postnatal depression in women who had screened positive for antenatal depression.

METHODS

This study was carried out in Hangzhou women's Hospital. 578 women who experienced antenatal depression from this cohort were enrolled in this study. The sociodemographic and clinical characteristics of the participants were collected and tabulated against the incidence of postnatal depression. Binary logistic regression was used to estimate the effects of the principal underlying variables. The Chinese-version Edinburgh Postnatal Depression Scale (EPDS) was used to screen for PPD. Antenatal screening for depression was conducted at 28-34 weeks during pregnancy and postpartum depressive symptoms were assessed at 6 weeks after childbirth in the women. Path Analysis of Structural Equation Model (SEM) was employed to explore the direct, indirect, and total effects of risk factors of PPD.

RESULTS

57.6% (n = 333) of the participants subsequently developed PPD in our study. The results of the logistic analysis indicated that ages ≤ 35 years old (OR = 1.852; 95%CI: 1.002-3.423), non-one-child families (OR = 1.518; 95%CI: 1.047-2.200), and rare care from partner during pregnancy (OR = 2.801; 95%CI: 1.038-7.562), the antenatal EPDS score (OR = 1.128; 95%CI: 1.052-1.209), pyrexia during pregnancy (OR = 2.43; 95%CI: 1.358-4.345), fairly good (OR = 1.836; 95%CI: 1.009-3.340), fairly bad (OR = 3.919; 95%CI:2.072-7.414) and very bad postpartum sleep quality (OR = 9.18; 95%CI: 2.335-36.241) were associated with increased risk of PPD (compared to very good postpartum sleep quality). In path analysis model, antenatal EPDS score (standardized total β = 0.173) and pyrexia during pregnancy (standardized total β = 0.132) had both direct and indirect effects (the impact on outcome variables needs to be determined through other variables) on PPD. Sleep quality after delivery (standardized β = 0.226) and one-child family (standardized β = 0.088) had direct effects only on PPD.

CONCLUSION

The results from our study indicated that more than 50% of the women who experienced antepartum depression would subsequently develop PPD. Depressive symptoms and pyrexia during pregnancy increase PPD scores, and these effects were in part mediated via poor sleep quality during the postpartum period.

The impact of the Covid-19 pandemic on postnatal depression: analysis of three population-based national maternity surveys in England (2014-2020)

Background

Few studies have evaluated postnatal depression before and during the Covid-19 pandemic using comparable data across time. We used data from three national maternity surveys in England to compare prevalence and risk factors for postnatal depression before and during the pandemic.

Methods

Analysis was conducted using population-based surveys carried out in 2014 (n = 4571), 2018 (n = 4509), and 2020 (n = 4611). Weighted prevalence estimates for postnatal depression (EPDS score ≥13) were compared across surveys. Modified Poisson regression was used to estimate adjusted risk ratios (aRR) for the association between sociodemographic, pregnancy- and birth-related, and biopsychosocial factors, and postnatal depression.

Findings

Prevalence of postnatal depression increased from 10.3% in 2014 to 16.0% in 2018 (difference = +5.7% (95% CI: 4.0-7.4); RR = 1.55 (95% CI: 1.36-1.77)) and to 23.9% in 2020 (difference = +7.9% (95% CI: 5.9-9.9); RR = 1.49 (95% CI: 1.34-1.66)). Having a long-term mental health problem (aRR range = 1.48-2.02), antenatal anxiety (aRR range = 1.73-2.12) and antenatal depression (aRR range = 1.44-2.24) were associated with increased risk of postnatal depression, whereas satisfaction with birth (aRR range = 0.89-0.92) and social support (aRR range = 0.73-0.78) were associated with decreased risk before and during the pandemic.

Interpretation

This analysis indicates that Covid-19 had an important negative impact on postnatal women's mental health and may have accelerated an existing trend of increasing prevalence of postnatal depression. Risk factors for postnatal depression were consistent before and during the pandemic. Timely identification, intervention and follow-up are key to supporting women at risk, and it is essential that mechanisms to support women are strengthened during times of heightened risk such as the pandemic.

Funding

NIHR Policy Research Programme.

Anxiety, stress, and depression in Australian pregnant women during the COVID-19 pandemic: A cross sectional study

BACKGROUND

The COVID-19 pandemic necessitated rapid responses by health services to suppress transmission of the virus.

AIM

This study aimed to investigate predictors of anxiety, stress and depression in Australian pregnant women during the COVID-19 pandemic including continuity of carer and the role of social support.

METHODS

Women aged 18 years and over in their third trimester of pregnancy were invited to complete an online survey between July 2020 and January 2021. The survey included validated tools for anxiety, stress, and depression. Regression modelling was used to identify associations between a range of factors including continuity of carer, and mental health measures.

FINDINGS

1668 women completed the survey. One quarter screened positive for depression, 19% for moderate or higher range anxiety, and 15.5% for stress. The most significant contribution to higher anxiety, stress, and depression scores was a pre-existing mental health condition, followed by financial strain and a current complex pregnancy. Protective factors included age, social support, and parity.

DISCUSSION

Maternity care strategies to reduce COVID-19 transmission restricted women's access to their customary pregnancy supports and increased their psychological morbidity.

CONCLUSION

Factors associated with anxiety, stress and depression scores during the COVID-19 pandemic were identified. Maternity care during the pandemic compromised pregnant women's support systems.

Associations of Unintended Pregnancy With Maternal and Infant Health Outcomes: A Systematic Review and Meta-analysis

Importance

Unintended pregnancy is common in the US and is associated with adverse maternal and infant health outcomes; however, estimates of these associations specific to current US populations are lacking.

Objective

To evaluate associations of unintended pregnancy with maternal and infant health outcomes during pregnancy and post partum with studies relevant to current clinical practice and public health in the US.

Data Sources

Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, PsycINFO, SocINDEX, and MEDLINE databases (January 1, 2000, to June 15, 2022) and manual review of reference lists.

Study Selection

Epidemiologic studies relevant to US populations that compared key maternal and infant health outcomes for unintended vs intended pregnancies and met prespecified eligibility criteria were included after investigators' independent dual review of abstracts and full-text articles.

Data Extraction and Synthesis

Investigators abstracted data from publications on study methods, participant characteristics, settings, pregnancy intention, comparators, confounders, and outcomes; data were validated by a second investigator. Risk of bias was independently dual rated by investigators using criteria developed by the US Preventive Services Task Force. Results of studies controlling for confounders were combined by using a profile likelihood random-effects model.

Main Outcomes and Measures

Prenatal depression, postpartum depression, maternal experience of interpersonal violence, preterm birth, and infant low birth weight.

Results

Thirty-six studies (N = 524 522 participants) were included (14 cohort studies rated good or fair quality; 22 cross-sectional studies); 12 studies used large population-based data sources. Compared with intended pregnancy, unintended pregnancy was significantly associated with higher odds of depression during pregnancy (23.3% vs 13.9%; adjusted odds ratio [aOR], 1.59 [95% CI, 1.35-1.92]; I2 = 85.0%; 15 studies [n = 41 054]) and post partum (15.7% vs 9.6%; aOR, 1.51 [95% CI, 1.40-1.70]; I2 = 7.1%; 10 studies [n = 82 673]), interpersonal violence (14.6% vs 5.5%; aOR, 2.22 [95% CI, 1.41-2.91]; I2 = 64.1%; 5 studies [n = 42 306]), preterm birth (9.4% vs 7.7%; aOR, 1.21 [95% CI, 1.12-1.31]; I2 = 1.7%; 10 studies [n = 94 351]), and infant low birth weight (7.3% vs 5.2%; aOR, 1.09 [95% CI, 1.02-1.21]; I2 = 0.0%; 8 studies [n = 87 547]). Results were similar in sensitivity analyses based on controlling for history of depression for prenatal and postpartum depression and on study design and definition of unintended pregnancy for relevant outcomes. Studies provided limited sociodemographic data and measurement of confounders and outcomes varied.

Conclusions and Relevance

In this systematic review and meta-analysis of epidemiologic observational studies relevant to US populations, unintended pregnancy, compared with intended pregnancy, was significantly associated with adverse maternal and infant outcomes.

Trial Registration

PROSPERO Identifier: CRD42020192981.

Prevalence and risk factors of prenatal depression among pregnant women attending antenatal clinic at Adventist Hospital, Bekwai Municipality, Ghana

ABSTRACT

Depression, arising in the perinatal period are a major health issue in low- and middle-income countries. However, little attention has been paid in the research of depression symptoms. This study aimed to estimate the prevalence and risk factors of depression during pregnancy.A cross-sectional study was conducted in pregnant women attending antenatal clinic at Adventist Hospital in the Bekwai Municipality, Ghana, between February and May 2020. Information on sociodemographic, medical, and obstetric factors were collected from the antenatal booklet and prenatal depression symptoms was defined as a patient health questionnaire scores ≥10. Descriptive statistics, Chi-Squared test, and Fisher exact test were used to analyze dichotomous variables. Multivariate logistic regression model was applied to estimate the adjusted odds ratios (AOR) and 95% confidence interval (95% confidence interval [CI]) for risk factors associated with prenatal depression. All statistical analyses were performed using SPSS version 20.0.The prevalence of prenatal depression in this study was 26.9% (95% CI; 24.6%-29.2%). Advance maternal age ≥35years (AOR = 1.49, 95% CI 1.05-2.11, P < .026) and low educational attainment (AOR 2.15, 95% CI 1.23-2.34, P < .007) were significantly higher among women with parental depression compared with maternal age <35years and higher educational attainment respectively. Similarly, nulliparous women (AOR = 4.93, 95% CI 1.60-15.16, P < .005), primiparous women (AOR = 5.42, 95% CI 1.76-16.71, P < .003) and multiparous women (AOR = 4.79, 95% CI 1.61-14.22, P < .005) were significantly higher among women with parental depression compared with grand multiparous woman (≥7 deliveries). Finally, prenatal depression was found to be significantly associated with hypertension in pregnancy (AOR = 1.71, 95% CI: 1.12-2.60, P < .013).Depression during pregnancy is high in the study area and is significantly associated with advance maternal age, low educational attainment, parity less than 7 deliveries, and hypertension during pregnancy.

Risk factors of perinatal depression in women: a systematic review and meta-analysis

BACKGROUND

Perinatal depression in women is associated with high morbidity and mortality, and has attracted increasing attention. The investigation of risk factors of perinatal depression in women may contribute to the early identification of depressed or depression-prone women in clinical practice.

MATERIAL AND METHODS

A computerized systematic literature search was made in Cochrane Library, PubMed, Web of Science, and EMBASE from January 2009 to October 2021. All included articles were published in English, which evaluated factors influencing perinatal depression in women. Based on the recommendations of the Cochrane Collaboration protocols, Review Manager 5.3 was used as a statistical platform.

RESULTS

Thirty-one studies with an overall sample size of 79,043 women were included in the review. Educational level (P = 0.0001, odds ratio [OR]: 1.40, 95% CI: [1.18,1.67]), economic status of families (P = 0.0001, OR: 1.69, 95%CI: [1.29,2.22]), history of mental illness (P < 0.00001, OR: 0.29, 95% CI: [0.18, 0.47]), domestic violence (P < 0.00001, OR: 0.24, 95% CI: [0.17,0.34]), perinatal smoking or drinking (P = 0.005, OR: 0.63; 95% CI [0.45, 0.87]; P = 0.008, OR: 0.43, 95% CI, [0.23 to 0.80]; respectively), and multiparity(P = 0.0003, OR: 0.74, 95% CI: [0.63, 0.87]) were correlated with perinatal depression in women. The stability of our pooled results was verified by sensitivity analysis and publication bias was not observed based on funnel plot results.

CONCLUSION

Lower educational level, poor economic status of families, history of mental illness, domestic violence, perinatal smoking or drinking, and multiparity serve as risk factors of perinatal depression in women.

Is collaborative care a key component for treating pregnant women with psychiatric symptoms (and additional psychosocial problems)? A systematic review

Mental disorders during pregnancy are common, with long-lasting negative effects on mother and child. Treatment of these women is challenging, because of the high incidence of additional psychosocial problems and barriers on population and healthcare level. Collaborative care, collaboration between mental health and obstetric care professionals, may help to overcome these problems. The aim of this review is to review antenatal mental health interventions and analyse the impact of collaborative care. Two independent reviewers searched for RCT's in PubMed, Embase and PsycINFO. Trials studying the effect of psychological or pharmacological interventions on the mental health of pregnant women with psychiatric symptoms (and psychosocial problems) were eligible for inclusion. Two reviewers independently abstracted data and assessed study quality and risk of bias. Each study was scored on collaborative care criteria: multi-professional approach to patient care, structured management plan, scheduled patient follow-ups and enhanced interprofessional communication. Thirty-five studies were included. Most trials studied the effect of cognitive behavioural therapy and interpersonal psychotherapy on antenatal depression. Almost all interventions met at least one collaborative care criteria. Interventions were mostly provided by multiple professionals, but interprofessional communication rarely took place. Interventions that met more criteria did not more often show a positive effect on maternal mental health. There is lack of research on antenatal psychiatric disorders other than depressive and on long-term treatment outcomes. Collaborative care is partly implemented in most current interventions, but more trials (including interprofessional communication) are needed to be conclusive whether collaborative care is a key component in antenatal mental healthcare.

Prevalence and Associated Factors of Common Mental Disorders Among Pregnant Mothers in Rural Eastern Ethiopia

BACKGROUND

Antenatal common mental disorder is a significant public health issue, especially in low- and middle-income countries with an extensive treatment gap. Common mental disorders have multifaceted implications on maternal and fetal health outcomes during pregnancy with long-running economic and social sequels. This study aimed to determine the prevalence of common mental disorder and associated factors among pregnant mothers in eastern Ethiopia, Kersa and Haramaya Health, and Demographic surveillance sites.

METHODS

A community-based cross-sectional study was conducted in Kersa and Haramaya health and demographic surveillance sites from January 30 to April 30, 2021. World Health Organization Self-Reporting Questionnaire (SRQ-20) was used to measure common mental disorder among 1,015 randomly selected pregnant women. Data were collected face-to-face using open data kit software. Logistic regression was fitted to identify factors associated with common mental disorders.

RESULTS

The overall prevalence of common mental disorders (SRQ > 6) among pregnant women was 37.5% (95% CI: 34.5, 40.5). Current substance use (AOR = 1.99, 95% CI 1.37, 2.88), intimate partner violence (AOR = 2.67, 95% CI 2.02, 3.53), null parity (AOR = 3.10, 95% CI 1.65, 5.84), gestational age [first trimester (AOR = 2.22, 95% CI 1.01, 4.93) and third trimester (AOR = 1.74, 95% CI 1.31, 2.31)], history of abortion (AOR = 2.03, 95% CI 1.27, 3.24), and absence of antenatal care follow-up (AOR = 1.43, 95% CI 1.08, 1.89) were significantly associated with common mental disorder during pregnancy.

CONCLUSION

Common mental disorders are prevalent among pregnant women in the study area with significant correlates. Administration of regular screening programs for maternal mental health conditions in rural, low-income communities, integrating into primary health care settings is imperative to reduce the risk.

Antenatal depressive symptoms in Kenyan women living with HIV: contributions of recent HIV diagnosis, stigma, and partner violence

Depression among pregnant women living with HIV (WLWH) in sub-Saharan Africa leads to poor pregnancy and HIV outcomes. This cross-sectional analysis utilized enrollment data from a randomized trial (Mobile WAChX, NCT02400671) in six Kenyan public maternal and child health clinics. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), stigma with the Stigma Scale for Chronic Illness, and intimate partner violence (IPV) with the Abuse Assessment Screen. Correlates of moderate-to-severe depressive symptoms ("depression", PHQ-9 score ≥10) were assessed using generalized estimating equation models clustered by facility. Among 824 pregnant WLWH, 9% had depression; these women had more recent HIV diagnosis than those without depression (median 0.4 vs. 2.0 years since diagnosis, p = .008). Depression was associated with HIV-related stigma (adjusted Prevalence Ratio [aPR]:2.36, p = .025), IPV (aPR:2.93, p = .002), and lower social support score (aPR:0.99, p = .023). Using population-attributable risk percent to estimate contributors to maternal depression, 81% were attributable to stigma (27%), recent diagnosis (24%), and IPV (20%). Integrating depression screening and treatment in prevention of mother-to-child HIV transmission programs may be beneficial, particularly in women recently diagnosed or reporting stigma and IPV.

Association between Second-Time Mother's Prenatal Depression and Firstborn's Behaviour Problems: The Mediation Role of Parenting Daily Hassles

Background: With the relaxation of birth control policy in China in recent years, second-time mothers’ mental health has raised concerns. However, the impact of firstborn children’s behaviour problems on second-time mothers’ prenatal depression in families transitioning to siblinghood has received little attention from family psychologists. Aims: This research aims to investigate whether firstborn children’s behaviour problems affect second-time mothers’ prenatal depression and the mediation role of daily parenting hassles, i.e., minor stressors associated with parenting, on this relationship. Methods: Data about second-time mothers’ prenatal depression, parenting daily hassles, and firstborn children’s behaviour problems were collected from 105 families transitioning to two children families using mother-reported questionnaires. Regressions were used to analyze the data. Results: About half of the mothers in the sample have depressive symptoms. Firstborns’ behaviour problems did not have a direct effect on the mother’s prenatal depression, but the problems did have an indirect effect via parenting daily hassles. The mothers’ age was significantly associated with prenatal depression. Conclusions: The mediation role of parenting daily hassles in the association with firstborn’s behaviour problems and mother’s prenatal depression suggests the need for support that reduce the levels of daily parenting hassles from firstborn children.

Anxiety and depressive symptoms of women in the perinatal period during the COVID-19 pandemic: A systematic review and meta-analysis

AIMS

The prevalence of perinatal anxiety and depressive symptoms have been speculated to increase during an infectious disease outbreak but remains unknown in the context of the COVID-19 situation. Therefore, this review aimed to examine the prevalence of antenatal and postnatal anxiety and depressive symptoms among pregnant women and postpartum mothers during the COVID-19 period.

METHODS

Six electronic databases were systematically searched for articles from November 2019 to December 2020. Twenty-six observational studies and brief reports were included in the meta-analysis.

RESULTS

Overall, the prevalence of anxiety was greater than depression in both antenatal and postnatal periods, and the prevalence of depression was higher in the antenatal period than the postnatal period. The pooled prevalence for antenatal anxiety symptoms, antenatal depressive symptoms and postnatal depressive symptoms were 40% (95% confidence intervals (CI): 0.27-0.52), 27% (95% CI: 0.20-0.33) and 17% (95% CI: 0.10-0.24), respectively. Europe (56%, 95% CI: 0.28-0.85) had significantly higher prevalence of antenatal anxiety than Asia (16%, 95% CI: 0.09-0.23).

CONCLUSIONS

The heightened prevalence of perinatal psychological disorders served as an impetus for healthcare professionals and policy makers to ramp up their support and mitigation strategies for pregnant women and mothers in times of health crisis.

An Online Educational Intervention to Influence Medical and Nurse Practitioner Students' Knowledge, Self-Efficacy, and Motivation for Antepartum Depression Screening and Education

OBJECTIVE

To evaluate nurse practitioner and medical students' knowledge, self-efficacy, and motivation for antepartum depression screening and education before and after an online educational intervention.

DESIGN

Quasi-experimental study design.

SETTING/LOCAL PROBLEM

The University of South Florida, College of Nursing and College of Medicine. Historically, nursing and medical school curricula have a focus on postpartum depression. Testing nurse practitioner and medical students regarding maternal depression throughout pregnancy may give insight into curriculum preparedness.

PARTICIPANTS

Medical and nurse practitioner students were recruited by convenience sampling. In total, 71 participants completed the study. There were 52 (73%) nurse practitioner students and 19 (27%) medical students.

INTERVENTION/MEASUREMENTS

Participants used a self-directed learning activity in the form of a slide presentation on the virtual platform REDCap. Knowledge was tested before and after the intervention using the "Speak Up When You're Down"-Postpartum Depression Awareness Campaign examination. Self-efficacy and motivation were measured before and after the intervention by using the Physician/Nurse Practitioner Student Teaching Self-Efficacy Questionnaire and the Physician/Nurse Practitioner Student Teaching Motivation Questionnaire.

RESULTS

Nurse practitioner and medical students exhibited a mean increase in scores for knowledge, self-efficacy, and motivation. Both groups performed similarly from before to after the intervention, and student profession did not moderate the increase from before to after the intervention.

CONCLUSION

An intervention to influence health care students' knowledge, self-efficacy, and motivation for antepartum depression screening can be included in medical and nursing curricula and can also be used with currently practicing health care providers. Doing so could possibly benefit pregnant women by enhancing the antepartum care that they receive.

Experiences of breastfeeding during COVID-19: Lessons for future practical and emotional support

The COVID-19 pandemic and subsequent lockdown and social distancing led to changes to breastfeeding support available to women in the United Kingdom. Face-to-face professional support was reduced, and face-to-face peer support was cancelled. Anecdotal media accounts highlighted practices separating some mothers and babies in hospitals, alongside inaccurate stories of the safety of breastfeeding circulating. Meanwhile, new families were confined to their homes, separated from families and support networks. Given that we know breastfeeding is best supported by practices that keep mother and baby together, high-quality professional and peer-to-peer support, and positive maternal well-being, it is important to understand the impact of the pandemic upon the ability to breastfeed. To explore this, we conducted an online survey with 1219 breastfeeding mothers in the United Kingdom with a baby 0-12 months old to understand the impact of the pandemic upon breastfeeding duration, experiences and support. The results highlighted two very different experiences: 41.8% of mothers felt that breastfeeding was protected due to lockdown, but 27.0% of mothers struggled to get support and had numerous barriers stemming from lockdown with some stopped breastfeeding before they were ready. Mothers with a lower education, with more challenging living circumstances and from Black and minority ethnic backgrounds were more likely to find the impact of lockdown challenging and stop breastfeeding. The findings are vital in understanding how we now support those women who may be grieving their loss of breastfeeding and are affected by their negative experiences and how we can learn from those with a positive experience to make sure all breastfeeding women are better supported if similar future events arise.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Body Acceptance by Pregnant Women and Their Attitudes toward Pregnancy and Maternity as Predictors of Prenatal Depression

Background: Depressive symptoms during pregnancy may cause unfavorable consequences for both the mother and the infant's physiological and psychological health. Recent evidence indicates that body image plays an important role in prenatal depression. The present study's main purpose was to investigate the level of acceptance of physical appearance in pregnant women, their attitudes toward pregnancy and maternity, and some obstetric characteristics as significant predictors in the development of depression. Methods: A sample of 150 Polish pregnant women completed a set of self-report questionnaires, including the Edinburgh Postnatal Depression Scale (EPDS), Attitudes toward Maternity and Pregnancy Questionnaire (PRE-MAMA), and the Body-Self Questionnaire (EA-BSQ). All participants also answered a brief sociodemographic and obstetric information questionnaire. Results: A hierarchical binary logistic regression was conducted to predict prenatal depression from selected obstetric variables (unplanned pregnancy, multiparity, and miscarriages) and psychological variables (appearance evaluation and positive or anxious attitudes toward pregnancy and maternity). It was found that higher levels of negative evaluation of appearance increased chances of depression in pregnant women by almost one-and-a-half. The analysis revealed that positive attitudes toward pregnancy and maternity were the most important protective factor for depression. Conclusions: The results confirmed the importance of dissatisfaction with body image during pregnancy as a predictor of the onset of prenatal depression. However, in clinical practice, this risk factor should be considered in combination with positive maternal attitudes, not separately. The implications for future studies and interventions in the field of prenatal depression are discussed in this work.

The Importance of Antepartum Maternal Depression Screening and Education: A Narrative Review of the Literature

The purpose of this literature review is to explain the current practice of antepartum maternal depression screening and education. The American College of Obstetricians and Gynecologists recommends that pregnant women be screened at least once during the antepartum phase of pregnancy by their health care provider. The fact that many women present with depression or anxiety at several time points during pregnancy suggests that only one screening during pregnancy is not enough. Antepartum and postpartum depression education is lacking within the prenatal period. This lack of education may decrease self-identification, leading to the decreased screening of pregnant women. Antepartum depression has a high probability of becoming postpartum depression, which might have significant implications for early discovery during pregnancy. These circumstances make antepartum depression one of the most under-recognized and under-treated conditions. [Journal of Psychosocial Nursing and Mental Health Services, 58(10), 19-23].

The association between social support through contacts with Accredited Social Health Activists (ASHAs) and antenatal anxiety among women in Mysore, India: a cross-sectional study

PURPOSE

In India, antenatal anxiety prevalence estimates range from 6 to 48%. Social support is strongly associated with mental wellbeing, yet most studies have examined the impact of support from partners and family members rather than peers, community members, or health care providers. This study explores the supportive role of Accredited Social Health Activists (ASHA) contacts for antenatal anxiety.

METHODS

Data were analyzed from the Saving Children, Improving Lives project, a quasi-experimental study conducted among rural, pregnant women in India. Regression models were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals for the relationship frequency of ASHA contacts and antenatal anxiety. Antenatal anxiety was measured using a subscale of the Edinburgh Postnatal Depression Scale.

RESULTS

The sample consisted of 480 pregnant women. Reported antenatal anxiety prevalence was 27% (95% CI 23%, 31%). Participants who were more frequently visited by ASHAs at home (aPR: 0.90; 95% CI 0.76, 0.98) and more frequently accompanied by ASHAs to their antenatal care visits (aPR: 0.86, 95% CI 0.78, 0.95) were less likely to report antenatal anxiety. ASHA home visits were protective for the most vulnerable women (primigravida and those experiencing domestic violence) and ASHA accompaniment to antenatal care visits was equally protective for all women.

CONCLUSIONS

ASHAs are valued for their contribution towards maternal health education and linking women of reproductive age to healthcare services. Our findings additionally suggest the important role ASHAs play in providing social support to pregnant women, particularly those who are most vulnerable to experiencing antenatal anxiety.

Psychosocial factors, mental health symptoms, and disordered eating during pregnancy

OBJECTIVE

The impact of disordered eating extends beyond women with a diagnosed eating disorder. Scarce research to date has investigated disordered eating in a general perinatal population, including the complex interplay between psychosocial factors, mental health symptoms, and disordered eating at numerous pregnancy periods. Specifically, maternal attitudes and relationship satisfaction are psychosocial factors that have been identified as a gap in the literature.

METHOD

Pregnant women completed an online questionnaire between 18 and 24 weeks gestation (T1, n = 258) and again between 30 and 32 weeks gestation (T2, n = 159). Structural equation modeling was used to test an interrelated model of psychosocial factors-attitudes to pregnancy, attitudes to motherhood, and relationship satisfaction-and disordered eating, mediated by either depressive or anxiety symptoms. Invariance testing examined whether model weights differed between primiparous and multiparous women at each time point.

RESULTS

While at T1 and T2, there were significant direct associations between psychosocial factors and disordered eating, only at T2 were the associations between psychosocial factors and disordered eating mediated by depressive and anxiety symptoms. Furthermore, at T2, multiparous women were at greater risk of an association between maladaptive attitudes to pregnancy and motherhood, depressive symptoms, and disordered eating.

DISCUSSION

The present study highlights the need to investigate the relationships between psychosocial factors and disordered eating, while accounting for the unique antenatal needs of women during different pregnancy periods and across differing parity. The mediating effect of depressive and anxiety symptoms have implications for future research and clinical care.

Prenatal Psychological Distress and Access to Mental Health Care in the ELFE Cohort

Background:

Pregnant women are vulnerable to the deleterious impact of environmental stressors. The aims were to identify the environmental and pregnancy characteristics independently associated with prenatal psychological distress and access to mental health care.

Methods:

We used data from the French cohort Étude Longitudinale Française depuis l’Enfance (ELFE), a nationally representative cohort of children followed-up from birth to adulthood. Information about prenatal psychological status and access to mental health care was collected during the maternity stay. Maternal/pregnancy characteristics independently associated with psychological distress and access to mental health care were explored using multivariate analyses.

Results:

Of the 15,143 mothers included, 12.6% reported prenatal psychological distress. Prenatal distress was more frequent in women with very low economical status, alcohol/tobacco use, unplanned/unwanted pregnancy, late pregnancy declaration, multiparity and complicated pregnancy (high number of prenatal visits, prenatal diagnosis examination, obstetrical complications). Of the women reporting prenatal distress, 25% had a prenatal consultation with a mental health specialist and 11% used psychotropic drugs during pregnancy. Decreased likelihood to consult a mental health specialist was found in young women, with intermediate educational level and born abroad.

Limitations:

Causal inferences should be made cautiously as the questionnaire did not collect information on the temporal sequence between psychological distress and associated characteristics.

Conclusions:

Women with social and obstetrical vulnerabilities are at increased risk of poor mental health during pregnancy. Improving mental health care access during pregnancy is a public health priority.

Implications of the clinical gestational diagnosis of ZIKV infection in the manifestation of symptoms of postpartum depression: a case-control study

BACKGROUND

Traumatic events can trigger postpartum depression. Pregnant women in Brazil today are facing an extremely stressful experience. Thus, the objective here was to analyze the prevalence of symptoms of depression in the immediate postpartum period (IPPD) and associate these symptoms with previous stressful, social, psychological, behavioral, obstetrical, clinical, violent and infectious events, particularly exposure to Zika virus (ZIKV) infection during pregnancy.

METHODS

This was a case-control study. The sample comprised 213 puerperal women treated in the maternity ward of a public reference hospital in the Araguaia River Valley of Mato Grosso and Goiás, Brazil. Severe IPPD symptoms were confirmed based on the Edinburgh Postnatal Depression Scale (EPDS). A descriptive statistical analysis was carried out using the Epi Info™ version 7.1.5 suite of software tools and the Statistical Package for Social Sciences (SPSS) version 21.0.

RESULTS

A bivariate analysis revealed a significant association between "severe symptoms of IPPD" and the following variables: "clinical diagnosis of ZIKV during pregnancy" (OR = 13.36; 95% CI = 5.34-33.39); "was separated or divorced in the last year" (OR = 3.58; 95% CI = 1.42-8.99); "suffered an accident in the last year" (OR = 3.32, 95% CI = 1.12-9.82); "suffered emotional violence during pregnancy" (OR = 3.80; 95% CI = 1.81-7.99); "suffered physical violence during pregnancy" (OR = 11.86; 95% CI = 2.07-67.82); "fear of her partner" (OR = 17.90; 95% CI = 3.44-92.99); "dengue fever during pregnancy" (OR = 7.85; 95% CI: 1.66-37.05), and "has a family member diagnosed with mental illness" (OR = 2.54; 95% CI = 1.09-5.93). The multivariate analysis confirmed the association of severe PPD symptoms only with the variables of "clinical diagnosis of ZIKV during pregnancy" (OR = 19.82; 95% CI: 5.35-73.39) and "was separated or divorced in the last year" (OR = 3.92; 95% IC = 1.12-13.63).

CONCLUSIONS

Clinically diagnosed ZIKV during pregnancy may be one of the main events associated with severe IPPD symptoms, showing an almost 20-fold higher chance of occurrence than other factors.

Maternal subjective well-being and preventive health care system in Japan and Finland

Background

Maternal well-being is an important issue not only for mothers but also for their offspring and whole families. This study aims to clarify differences in subjective well-being for mothers with infants and associated factors by comparing Japanese and Finnish mothers.

Methods

In Finland, 101 mothers with infants who received health check-ups at child's age 4 months participated in the study. In Japan, 505 mothers with infants who should receive health check-ups at child's age 4 months and, whose age, age of the infant and number of children matched with the Finnish mothers were selected. The factors associated with maternal subjective well-being were explored by the linear regression analysis. All Finnish mothers had individual infant health check-ups by nurses in Child Health Clinics nearly monthly. The same nurse was responsible for following up the family throughout the years. All Japanese participants received group health check-up once at child's age 3 to 4 months, and a nurse did not cover same child and their mother.

Results

Finnish mothers showed significantly better subjective well-being compared with Japanese mothers. Whereas 85% of Finnish mothers responded that they had obtained childcare information from public health nurses, significantly fewer Japanese mothers indicated the same response (8%). Linear regression analyses disclosed that mothers' subjective well-being was associated with country, mothers' stress and age.

Conclusion

Finnish mothers had better subjective well-being than Japanese mothers. Our results may indicate that the Finnish health care system supports mothers better than the Japanese health care system does.

A prospective study of postnatal depressive symptoms and associated risk factors in first-time fathers

BACKGROUND

Recent studies show that paternal depression negatively impacts children's behavioral and emotional development. This study determined the prevalence of depressed mood in first-time fathers at 2 and 6 months postpartum and identified associated risk factors.

METHODS

A prospective cohort study with 622 men who completed sociodemographic and psychosocial questionnaires during their partner's third trimester of pregnancy. Fathers completed measures again at 2 and 6 months postpartum and partners completed the depressed mood measure at all three timepoints. A cutoff of ≥10 for the Edinburgh Postnatal Depression Scale identified depressed mood status.

RESULTS

The prevalence of depressive symptoms in fathers was 13.76% at 2 months and 13.60% at 6 months postpartum. Men who were depressed during their partner's pregnancy were 7 times more likely to be depressed at 2 months postpartum. Depressed mood status at both the antenatal and 2 month postpartum assessment was associated with increased risk of depressed mood at 6 months postpartum. Older age, poor sleep quality at study entry, worse couple adjustment, having a partner experiencing antenatal depressive symptoms and elevated parental stress were associated with depressive symptoms at 2 months postpartum. Poor sleep quality, financial stress and a decline in couple adjustment were independently associated to depressive symptoms at 6 months postpartum.

LIMITATIONS

This sample was fairly well-educated and predominately middle-class. Depressive symptoms were assessed using a self-report questionnaire.

CONCLUSIONS

The psychosocial risk factors identified provide opportunities for early screening and targeted prevention strategies for fathers at risk for depression during the transition to parenthood.

Postnatal depressive symptoms in women with and without antenatal depressive symptoms: results from a prospective cohort study

Evidence exists that the risk factors for depression in the antenatal and postnatal period may differ, but only a handful of studies looked at depression longitudinally. The aims of this study were (1) to estimate the prevalence of postnatal depressive symptoms in Kuwait where data about postnatal depression are scarce and identify its determinants and (2) to compare these risk factors between women who had experienced antenatal depressive symptoms and those that did not. Data collected in the TRansgenerational Assessment of Children's Environmental Risk (TRACER) Study in Kuwait were used in this analysis. The sample was restricted to the 1348 women who answered the Edinburgh Postnatal Depression Scale (EPDS) both antenatally and postnatally. The prevalence of postnatal depressive symptoms, defined by an EPDS score ≥ 10, was 11.7%. Overall, antenatal depressive symptoms were the strongest determinant of postnatal depressive symptoms. Multivariable logistic regression analysis showed that in women with depressive symptoms in pregnancy, having a lower household income was the most significant risk factor for postnatal depressive symptoms. Among women without antenatal depressive symptoms, those who had lower income, were Kuwaitis, experienced other problems in pregnancy such as perceived stress, PTSD symptoms and social isolation, and those who delivered a boy had higher odds of postnatal depressive symptoms. Antenatal depressive symptoms and other psychosocial characteristics can predict postnatal depressive symptoms. Therefore, maternal mental health issues should be detected during the antenatal period and support should be provided in order to lower the risk of postnatal depression and its sequelae.

Mental health help-seeking patterns and perceived barriers for care among nulliparous pregnant women

This study examined the patterns of consultation with health providers for emotional symptoms and barriers preventing mental health help-seeking among pregnant women. A total of 652 nulliparous women in their third trimester completed an online questionnaire assessing depressed mood, adjustment in their couple relationship, demographics, help-seeking behaviors for emotional problems and barriers to help-seeking in the past year. The prevalence of having consulted with at least one health provider over the past year for emotional symptoms was 20.1% for the entire sample and 32.7% for the subgroup of women reporting elevated depressive symptoms in the third trimester. Women in the 30-39 age range were more likely to discuss their emotional symptoms with a health provider in the past year compared to younger women (OR = 1.6, CI = 1.0, 2.6, p = 0.041). Among women depressed in the third trimester, being White was independently associated with a greater likelihood of having consulted with a health provider about their emotional symptoms (OR = 2.9, CI = 1.4, 6.1, p = 0.005). Barriers to mental help-seeking included not having gotten around to it (46.1%), being too busy (26.1%), deciding not to seek care (24.3%), cost (22.6%) and not knowing where to go (19.1%). Women with more depressive symptoms in the third trimester endorsed more barriers to mental health service use (β = 0.25, 95% CI = 0.02, 0.12, p = 0.015). Innovative, evidence-based approaches are needed to more effectively promote mental health during the perinatal period and help women overcome the practical barriers identified to help-seeking.

Care associated with stillbirth for the most disadvantaged women: A multi-method study of care in England

BACKGROUND

Most research on women experiencing stillbirth relies on online user group surveys or qualitative interviews. The objective of this study was to investigate the experience of women who are at a higher risk of stillbirth, living in areas of greatest deprivation, and are commonly not well represented.

METHODS

This study used birth and death registrations in 2012-2013 to identify a sample of mothers whose babies had died as a result of stillbirth. These women were sent a survey 6-9 months after the stillbirth. We undertook descriptive analysis of quantitative data and used binary logistic regression with the Index of Multiple Deprivation as a measure of disadvantage. We used thematic analysis to describe free text responses.

RESULTS

The survey response rate was 30% (N = 473). Ethnic minority, younger age, and single parenthood were associated with disadvantage. Women residents in the most deprived areas perceived care more negatively: during labor they were significantly less likely to be spoken to by medical staff so they could understand (73% compared with 90%, adjusted odds ratio [aOR] 0.33 [95% confidence interval {CI} 0.18-0.65]), or treated with respect by midwives (79% compared with 90%, aOR 0.41 [95% CI 0.22-0.77]). The qualitative themes identified were: "Difficulty in accessing care," "More could have been done," "Ineffective communication," and "Cared for and not cared for" which support the quantitative findings.

CONCLUSION

Women living in the most deprived areas reported poorer experiences of care compared with more advantaged women. All women need compassionate and sensitive care around the time of a stillbirth.

The Contribution of Untreated and Treated Anxiety and Depression to Prenatal, Intrapartum, and Neonatal Outcomes

Objective  To determine independent perinatal associations of anxiety and depression in women who were and were not treated with psychotropic drugs in comparison to unaffected pregnancies. Study Design  From 2013 to 2014, 978 (6.3%) cases of anxiety/depression, of which 35% used psychotropic drugs, were compared with 14,514 (93.7%) unaffected pregnancies using logistic regression. Results  Subjects were more likely to be Non-Hispanic Whites, use tobacco and illegal substances, be unmarried, use public insurance, and have medical complications of pregnancy. For independent maternal outcomes, untreated anxiety/depression was associated with labor induction (adjusted odds ratio [aOR] = 2.02), cesarean deliveries (aOR = 1.69), longer length of stay (aOR = 1.96), readmission (aOR = 2.40), fever (aOR = 2.03), magnesium exposure (aOR = 1.82), and postpartum hemorrhage (aOR = 2.57), whereas treated cases were associated with increased blood transfusion (aOR = 4.81), severe perineal lacerations (aOR = 2.93), and postpartum hemorrhage (aOR = 3.85), but decreased risk of cesarean deliveries (aOR = 0.59). Independent neonatal outcomes included small for gestational age (aOR = 3.04), meconium-stained fluid (aOR = 1.85; 2.61), respiratory failure (aOR = 5.84), neonatal adaptation syndrome (aOR = 11; 10.2), and neonatal seizures (aOR = 12.3) in treated cases, whereas untreated cases were associated with hypoxia (aOR = 2.83), low Apgar score (aOR = 3.82), and encephalopathy (aOR = 18.3). Exposure to multiple psychotropic medications independently increased the risk of neonatal adaptation syndrome, neonatal length of stay, and hypoglycemia. Conclusion  Untreated cases were associated with increased maternal adverse outcomes, whereas treated cases were associated with more adverse neonatal outcomes when compared with unaffected pregnancies.

Adverse childhood experiences and depressive symptomatology among pregnant women

INTRODUCTION

Adverse childhood experiences (ACE) result in somatic and mental health disturbances. Their influence on antenatal depression is scarcely studied. This study examined the association between experience of ACE and antenatal depressive symptomatology.

MATERIAL AND METHODS

1257 women from 172 antenatal clinics in Sweden were surveyed during pregnancy and 1 year after delivery. Demographics, previous medical history and Edinburgh Postpartum Depression Scale (EPDS) were collected in pregnancy and postpartum and ACE 1 year postpartum. ACEs were partitioned into 10 categories. Statistical analyses used linear and logistic regression with EPDS score as main outcome measure.

RESULTS

736 (58.6%) women reported at least one ACE category and 88 women (7%) reported five or more ACE categories. An EPDS score of ≥13, which qualifies for a probable depression diagnosis, was reported by 277 (23%) women. In simple regression analyses the EPDS score was positively associated with the number of ACEs, cigarette smoking before pregnancy, body mass index and psychiatric disorders, whereas education level was inversely associated. In a multiple regression analysis, ACEs, education level and psychiatric disorder remained associated to the EPDS score. Among women with an ACE score ≥5, the odds ratio of having an EPDS score indicating probable depression was 4.2 (CI 2.5-7.0).

CONCLUSIONS

ACE was commonly reported. ACE and depressive symptomatology in late pregnancy were strongly associated in a dose-response manner. Women with several ACEs had high odds of depressive symptomatology in late pregnancy and were more likely to report depressive symptoms both in late pregnancy and postpartum.

Antenatal depressive symptoms in Jamaica associated with limited perceived partner and other social support: A cross-sectional study

Background

Antenatal depression is associated with adverse maternal and infant well-being. However, compared to postpartum depression, it has been less frequently explored globally or in Jamaica. This study aimed to determine the prevalence of, and factors associated with, antenatal depressive symptoms among Jamaican women in order to inform policy and build interventions that could improve their management and reduce their negative consequences.

Methods

This secondary analysis of data from the second Jamaican Birth Cohort Study (JA-Kids Birth Cohort) included 3,517 women enrolled during pregnancy. Information was extracted from interviewer-administered questionnaires which recorded social, demographic, medical and obstetric information during pregnancy. The Edinburgh Postnatal Depression scale (EPDS) was used to screen for depression, with scores ≥13 considered indicative of a high likelihood of depression. Bivariate analysis examined associations between depressive symptoms and: age, income, financial difficulties, perceived social support, perceived partner infidelity, previous child-bearing unions and children with the current partner. Obstetric factors were also explored and included gravidity, prior adverse pregnancy outcome and complications from previous pregnancies. Variables that predicted the likelihood of depression based on an EPDS cut score of 13 were evaluated using logistic regression.

Results

One in five participants (19.6%; 95% CI 18.3–20.9%) had a high likelihood of antenatal depression (EPDS ≥13). Significant predictors of high depressive symptom severity included four indicators of poor perceived social and partner support [ORs (95% CI) ranged from: 1.61 (1.07–2.43); p = 0.024 to 3.14(1.69–5.84); p< 0.001], perceived partner infidelity [1.86 (1.36, 2.54); p<0.001], exposure to violence [2.36 (1.66–3.38); p<0.001] and financial difficulties [1.39 (1.07, 1.80); p = 0.013].

Conclusions

Women’s perceived social and partner support were strongly associated with depressive symptom severity. Within the Jamaican cultural context of unstable reproductive unions, efforts are needed to involve fathers in the antenatal care process to strategically improve the psychological well-being of new mothers which may positively influence long term developmental outcomes for their babies.

Prevalence of Antenatal Depression and Associated Factors among Pregnant Women Attending Antenatal Care at Dubti Hospital: A Case of Pastoralist Region in Northeast Ethiopia

BACKGROUND

Globally, depression affects an estimated 10 % to 20% of women during pregnancy. There is limited evidence on antenatal depression in Northeast Ethiopia. This study aimed to assess prevalence of antenatal depression and associated factors among Dubti Hospital Antenatal care attendants.

METHODS

Institution based cross-sectional study was conducted among 363 Antenatal care attendants at Dubti Hospital from March 07 to May 07, 2016. Beck's Depression Inventory tool was used to collect data. Data were entered into Epi-Data 3.1 and analyzed using SPSS 20. Bivariable and multivariable logistic regression analyses were fitted. Variables having p value < 0.05 were considered as statistically significant.

RESULTS

A total of 357 pregnant women were interviewed. The prevalence of antenatal depression was 17.9% [95% CI (14.0, 22.0%). Pregnancy planning [AOR: 0.04; 95% CI (0.014, 0.114), social support [AOR: 0.21; 95% CI (0.07, 0.66), and marital conflict [AOR: 6.45; 95% CI (2.1, 17.9)] were significantly associated with antenatal depression.

CONCLUSIONS

Nearly one in five pregnant women had depression. Marital conflict, pregnancy planning, and social support were significant predictors of antenatal depression. Dubti Hospital should strengthen its effort on prevention of unplanned pregnancy. Healthcare workers in antenatal care unit have to deal with marital conflict and social support as part of their routine investigation to avoid complications through early detection of antenatal depression.

Racial Differences in the Association Between Maternal Antenatal Depression and Preterm Birth Risk: A Prospective Cohort Study

BACKGROUND

In the United States, racial/ethnic disparities in preterm birth (PTB) are well documented, but explanations for why the disparity persists remain to be fully explored. We examined racial/ethnic differences in the association of maternal antenatal depression with PTB (<37 completed weeks of gestation) risk.

METHODS

In a prospective cohort study, participants (n = 2073) included non-Hispanic (NH) black, NH white, Asian, and Hispanic women who received prenatal care at a university obstetric clinic January 2004-March 2010, and delivered at the university's hospital. We obtained data from self-reported questionnaires and electronic medical records. We assessed antenatal depression using the Patient Health Questionnaire-9 and self-reported antenatal antidepressant medication use. Poisson regression models were used to estimate the association between antenatal depression and PTB risk, within strata of race/ethnicity.

RESULTS

NH black (risk ratio [RR] = 1.89; 95% confidence interval [CI]: 0.94, 3.80), NH white (RR = 1.58, 95% CI: 1.04, 2.39), and Asian (RR = 2.06; 95% CI: 0.69, 6.13) women with antenatal depression were at increased risk for delivering preterm infants, compared with women without antenatal depression, although the associations were statistically significant only among NH white women. There was no evidence of an association between antenatal depression and risk of PTB among Hispanic women (RR = 0.96; 95% CI: 0.28, 3.25); p-value for interaction = 0.81.

CONCLUSION

Our findings suggest race-specific associations of antenatal depression with an increased risk of delivering a preterm infant, supporting the importance of considering race/ethnicity when examining risk factors for health outcomes.

Care and self-reported outcomes of care experienced by women with mental health problems in pregnancy: Findings from a national survey

BACKGROUND

mental health problems in pregnancy and the postnatal period are relatively common and, in pregnancy, are associated with an increase in adverse outcome. It is recommended that all women are asked about their emotional and mental health and offered treatment if appropriate.

OBJECTIVES

to describe the care received by women self-identifying with mental health problems in pregnancy, and to describe the effects of support, advice and treatment on outcomes in the postnatal period.

DESIGN

this study used cross-sectional survey data collected in 2014 which described women's experience of maternity care.

SETTING

England PARTICIPANTS: a random sample of women who had a live birth in January 2014.

MEASUREMENTS

the questionnaire asked about sociodemographic characteristics, whether women were asked about emotional and mental health in pregnancy, support and treatment offered, about postnatal wellbeing, and questions relating to attachment to their baby. Descriptive statistics and logistic regression were used to examine the associations between mental health and outcomes taking account of sociodemographic characteristics.

FINDINGS

the survey response rate was 47%. Women with antenatal mental health problems were significantly more worried at the prospect of labour and birth, had lower satisfaction with the experience of birth, worse postnatal mental health, and indications of poorer attachment to their baby. They received substantially more care than other women but they did not always view this positively. Support, advice and treatment for mental health problems had mixed effects.

CONCLUSIONS

this study describes the significant additional care provided to women self-identifying with mental health problems in pregnancy, the mixed effects of support, advice and treatment, and the poor perception of staff interaction among women with mental health problems.

IMPLICATIONS FOR PRACTICE

health care professionals may need additional training to effectively support women with mental health problems during the perinatal period.

Mothers' accounts of the impact on emotional wellbeing of organised peer support in pregnancy and early parenthood: a qualitative study

BACKGROUND

The transition to parenthood is a potentially vulnerable time for mothers' mental health and approximately 9-21% of women experience depression and/or anxiety at this time. Many more experience sub-clinical symptoms of depression and anxiety, as well as stress, low self-esteem and a loss of confidence. Women's emotional wellbeing is more at risk if they have little social support, a low income, are single parents or have a poor relationship with their partner. Peer support can comprise emotional, affirmational, informational and practical support; evidence of its impact on emotional wellbeing during pregnancy and afterwards is mixed.

METHODS

This was a descriptive qualitative study, informed by phenomenological social psychology, exploring women's experiences of the impact of organised peer support on their emotional wellbeing during pregnancy and in early parenthood. Semi-structured qualitative interviews were undertaken with women who had received peer support provided by ten projects in different parts of England, including both projects offering 'mental health' peer support and others offering more broadly-based peer support. The majority of participants were disadvantaged Black and ethnic minority women, including recent migrants. Interviews were audio-recorded and transcripts were analysed using inductive thematic analysis.

RESULTS

47 mothers were interviewed. Two key themes emerged: (1) 'mothers' self-identified emotional needs', containing the subthemes 'emotional distress', 'stressful circumstances', 'lack of social support', and 'unwilling to be open with professionals'; and (2) 'how peer support affects mothers', containing the subthemes 'social connection', 'being heard', 'building confidence', 'empowerment', 'feeling valued', 'reducing stress through practical support' and 'the significance of "mental health" peer experiences'. Women described how peer support contributed to reducing their low mood and anxiety by overcoming feelings of isolation, disempowerment and stress, and increasing feelings of self-esteem, self-efficacy and parenting competence.

CONCLUSION

One-to-one peer support during pregnancy and after birth can have a number of interrelated positive impacts on the emotional wellbeing of mothers. Peer support is a promising and valued intervention, and may have particular salience for ethnic minority women, those who are recent migrants and women experiencing multiple disadvantages.

Association between walking, dysphoric mood and anxiety in late pregnancy: A cross-sectional study

Relationship between physical activity and mental disorders in late pregnancy is unclear. In this work, we demonstrate that there is a significant association between the time spent on walking and symptoms of depression and anxiety in antenatal period. The cross-sectional study was done on a sample of 200 healthy women in 9th month of physiological pregnancy at Health center Kraljevo, Serbia during 2015. Each participant was given a questionnaire consisting of general questions regarding physical activity, pregnancy, and other parameters. Also, each participant completed a Beck depression inventory (BDI) and Zung anxiety scale (ZAS). There was a statistically significant negative correlation (p<0.05) between the BDI score and the daily time spent on walking. There was also a strong positive connection between the daily time spent on walking and level of anxiety (p<0.01). To our knowledge this is the first study to jointly test the relationship between scores of Beck depression inventory and Zung anxiety scale, and time spent on walking as physical activity in antenatal period. The results represent the basis for further research in the field of gynecological psychology, psychiatry and behavioral physiology.

Prevalence of antenatal depression and associated factors among pregnant women hospitalized in a high-risk pregnancy unit in Greece

PURPOSE

Women who face pregnancy complications may require hospitalization in a high-risk pregnancy unit (HRPU), and this may have a negative impact on the pregnant woman's mental health. The purpose of this study was to screen for depressive symptoms in pregnant women admitted in a high-risk pregnancy unit and also to investigate associated risk factors.

METHODS

This was a cross-sectional study that enrolled pregnant women admitted at ≥24 gestational weeks in a university hospital HRPU, between September 2014 and November 2015. The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms on admission. A cutoff score ≥13 was considered as indicative of depression. Test results were then correlated with the reasons that led to the women's admission as well as socio-demographic characteristics.

RESULTS

Overall, 157 of the women admitted in the HRPU during the study period were eligible for the study and agreed to complete the questionnaire. The mean age of the pregnant women was 30 ± 6 years, and the mean gestational week at admission was 32 ± 3 weeks. The prevalence of antenatal depression (score ≥13) was 28 % (44/157). In the multivariate analysis, antenatal depression was significantly correlated with smoking (OR = 2.681, 95 % CI 1.089-6.601) and the existence of thoughts for pregnancy termination (OR = 3.624, 95 % CI 1.149-11.427).

CONCLUSIONS

Approximately one quarter of pregnant women hospitalized in the HRPU may show signs of depression at the time of admission. Smoking and an unwanted pregnancy were found to be independently associated with antenatal depression, whereas no association was found with any obstetric parameters.

The birth experience and women's postnatal depression: A systematic review

BACKGROUND

maternal postnatal depression confers strong risk for impaired child development. Little is known about the association between women's postnatal birth experience and postnatal depression.

PURPOSE

to systematically identify and review studies examining the association between the birth experience and postnatal depression.

METHODS

a systematic search strategy was employed using the Matrix Method (Garrard, 2014) and guided by the PRISMA reporting process.Criteria included broad search terms, English language, and publication years 2000-2015. The search revealed 1536 abstracts narrowed to full-text review of 112 studies.

FINDINGS

eleven of the 15 studies meeting search criteria demonstrated a significant association between women's postnatal birth experience and postnatal depression. Results show heterogeneity in birth experience instruments. Strength of evidence and potential for bias are discussed.

KEY CONCLUSIONS

in spite of methodological limitations, the weight of evidence suggests that a negative birth experience may contribute to postnatal depression. Further research is warranted.

IMPLICATIONS FOR PRACTICE

to promote a positive birth experience healthcare providers should provide supportive, nurturing care that promotes women's confidence, trust, respect, privacy, shared decision making, and feeling of safety. Healthcare policy that promotes quality caregiving may reduce risk of postnatal depression.

Impact of Hypnosis Intervention in Alleviating Psychological and Physical Symptoms During Pregnancy

Physical symptoms (e.g., vomiting) and psychological symptoms (stress, anxiety, and depression) during pregnancy are common. Various strategies such as hypnosis are available to reduce these symptoms. The objective of the authors in this study is to investigate the impact of a hypnosis intervention in reducing physical and psychological symptoms during pregnancy. A pre-test/post-test quasi-experimental design was employed in this study. The hypnosis intervention was given to the experimental group participants at weeks 16 (baseline), 20 (time point 1), 28 (time point 2), and 36 (time point 3) of their pregnancy. Participants in the control group received only the traditional antenatal care. Participants from both groups completed the Depression Anxiety Stress Scale-21 (DASS-21) and a Pregnancy Symptoms Checklist at weeks 16, 20, 28 and 36 of pregnancy. Results indicated that stress and anxiety symptoms were significantly reduced for the experimental group, but not for the control group. Although mean differences for the depressive symptoms were not significant, the experimental group had lower symptoms at time point 3. The physical symptoms' results showed significant group differences at time point 3, indicating a reduction in the experience of physical symptoms for the experimental group participants. Our study showed that hypnosis intervention during pregnancy aided in reducing physical and psychological symptoms during pregnancy.

Identifying the women at risk of antenatal anxiety and depression: A systematic review

BACKGROUND

Pregnancy is a time of increased vulnerability for the development of anxiety and depression. This systematic review aims to identify the main risk factors involved in the onset of antenatal anxiety and depression.

METHODS

A systematic literature analysis was conducted, using PubMed, PsychINFO, and the Cochrane Library. Original papers were included if they were written in English and published between 1st January 2003 and 31st August 2015, while literature reviews and meta-analyses were consulted regardless of publication date. A final number of 97 papers were selected.

RESULTS

The most relevant factors associated with antenatal depression or anxiety were: lack of partner or of social support; history of abuse or of domestic violence; personal history of mental illness; unplanned or unwanted pregnancy; adverse events in life and high perceived stress; present/past pregnancy complications; and pregnancy loss.

LIMITATIONS

The review does not include a meta-analysis, which may have added additional information about the differential impact of each risk factor. Moreover, it does not specifically examine factors that may influence different types of anxiety disorders, or the recurrence or persistence of depression or anxiety from pregnancy to the postpartum period.

CONCLUSIONS

The results show the complex aetiology of antenatal depression and anxiety. The administration of a screening tool to identify women at risk of anxiety and depression during pregnancy should be universal practice in order to promote the long-term wellbeing of mothers and babies, and the knowledge of specific risk factors may help creating such screening tool targeting women at higher risk.

Antenatal and postnatal depression: A public health perspective

Depression is widely prevalent among women in the child-bearing age, especially during the antenatal and postnatal period. Globally, post-partum depression has been reported in almost 10% to 20% of mothers, and it can start from the moment of birth, or may result from depression evolving continuously since pregnancy. The presence of depression among women has gained a lot of attention not only because of the rising incidence or worldwide distribution, but also because of the serious negative impact on personal, family and child developmental outcomes. Realizing the importance of maternal depression on different aspects-personal, child, and familial life, there is a crucial need to design a comprehensive public health policy (including a mental health strategy), to ensure that universal psychosocial assessment in perinatal women is undertaken within the primary health care system. To conclude, depression during pregnancy and in the postnatal period is a serious public health issue, which essentially requires continuous health sector support to eventually benefit not only the woman, but also the family, the community, and health care professionals.

[Female sexuality and parenthood]

From the child conception to the early years of life, couples generally present less sexual activity. Parenthood constraints are a burden for the couple's relationships. Generally, persistent sexual difficulties six months after delivery, despite those generated by depression or altered health raise the question of an alteration in the quality of the couple's relationships and lack of satisfaction of the mother with her partner's involvement in family life. Numerous parameters can be implied, especially with persistent trouble of desire, such as fatigue, body image problems and libido lessening of the partner due to modifications of his status. Women who presented sexual difficulties before pregnancy remain the same. In all cases, appropriate information can avoid the intimacy's difficulties and contribute to maintain pleasure and intimacy even when vaginal penetration remains difficult.