Clinically identified postpartum depression in Asian American mothers

Experiences and perceptions of perinatal depression among new immigrant Chinese parents: a qualitative study

BACKGROUND

Immigrant status, acculturation level, race and ethnicity have been found to contribute to the utilization of mental health services in the perinatal period. This study explored perinatal experiences and perceptions among Chinese immigrant mothers and their spouses, as well as the possible barriers and facilitators that affect their health care utilization.

METHODS

We recruited 13 women ages 18-35 years born in mainland China, living in Rochester, New York, and residing less than 5 years in the United States. Participants primary language was Mandarin Chinese and all had given birth to at least one live infant within the past 7 years. Participants' age was at least 18 years old at the time of delivery. Five spouses also participated. We divided women in two focus groups and held one focus group for men, with data collection including demographic questionnaires and semi-structured focus group questions conducted in December 2014. Data were analyzed following thematic analysis.

RESULTS

Four themes emerged: experiences of perinatal depression; perceptions of perinatal depression; general preventive and coping strategies; and attitudes toward the supportive use social media applications (apps) and text messaging during the perinatal period. Participants had limited knowledge of perinatal depression and had difficulty distinguishing between normal perinatal mood fluctuations and more severe symptoms of depression. They discussed immigrant-related stress, conflicts with parents/in-laws while "doing the month", the perceived gap between the ideal of "perfect moms" and reality, and challenges with parenting as the causes of perinatal depression. Women approved of screening for the condition but were conservative about follow-up interventions. As for the management of perinatal depression, participants preferred to deal with the problem within the family before seeking external help, due to potential stigma as well as Chinese traditional culture. They were receptive to obtaining pertinent health information from anonymous social media apps, preferring these to personal text messages.

CONCLUSION

The recent immigrant Chinese parents to the United States in the study had limited knowledge of perinatal depression and did not make full use of mental health services for support due to language and cultural barriers. Screening for perinatal depression is only the first step. Future research should explore what interventions may serve as an acceptable approach to overcoming these gaps.

Intentions to Seek Mental Health Services During the COVID-19 Pandemic Among Chinese Pregnant Women With Probable Depression or Anxiety: Cross-sectional, Web-Based Survey Study

BACKGROUND

Mental health problems are prevalent among pregnant women, and it is expected that their mental health will worsen during the COVID-19 pandemic. Furthermore, the underutilization of mental health services among pregnant women has been widely documented.

OBJECTIVE

We aimed to identify factors that are associated with pregnant women's intentions to seek mental health services. We specifically assessed pregnant women who were at risk of mental health problems in mainland China.

METHODS

A web-based survey was conducted from February to March, 2020 among 19,515 pregnant women who were recruited from maternal health care centers across various regions of China. A subsample of 6248 pregnant women with probable depression (ie, those with a score of ≥10 on the 9-item Patient Health Questionnaire) or anxiety (ie, those with a score of ≥5 on the 7-item General Anxiety Disorder Scale) was included in our analysis.

RESULTS

More than half (3292/6248, 52.7%) of the participants reported that they did not need mental health services. Furthermore, 28.3% (1770/6248) of participants felt that they needed mental health services, but had no intentions of seeking help, and only 19% (1186/6248) felt that they needed mental health services and had intentions of seek help. The results from our multivariate logistic regression analysis showed that age, education level, and gestational age were factors of not seeking help. However, COVID-19-related lockdowns in participants' cities of residence, social support during the COVID-19 pandemic, and trust in health care providers were protective factors of participants' intentions to seek help from mental health services.

CONCLUSIONS

Interventions that promote seeking help for mental health problems among pregnant women should also promote social support from health care providers and trust between pregnant women and their care providers.

Pregnancy-Related Weight and Postpartum Depressive Symptoms: Do the Relationships Differ by Race/Ethnicity?

Background: There are significant racial/ethnic disparities in the prevalence of postpartum depression. Prior research in the general population suggests that weight status is related to depression and that this relationship varies by race/ethnicity. However, few studies have investigated whether race/ethnicity moderates the relationship between pregnancy-related weight and postpartum depressive symptoms (PPDS). The objective of this study is to examine the relationship between pregnancy-related weight and maternal PPDS overall and by race/ethnicity. Materials and Methods: This study used data from the Early Childhood Longitudinal Study-Birth Cohort (n ≈ 6950). Ordinary least-squares and logistic regression was used to examine whether pregnancy-related weight, including preconception weight status and gestational weight gain (GWG), was associated with PPDS measured using the Center for Epidemiologic Studies-Depression Scale (CES-D). Stratified analyses were used to assess whether these relationships varied by race/ethnicity. Results: Preconception obesity (body mass index [BMI] ≥30 kg/m²) was associated with higher levels of PPDS (β = 0.601, 95% confidence interval [CI], 0.149-1.053). GWG adequacy was not associated with PPDS. Among non-Hispanic (NH) whites, preconception obesity was positively associated with PPDS (β = 1.016, 95% CI, 0.448-1.584). In contrast, among Hispanics, preconception overweight (25 kg/m² ≤ BMI <30 kg/m²) was associated with lower levels of PPDS (β = -0.887, 95% CI, -1.580 to -0.195). There were no statistically significant relationships between pregnancy-related weight and PPDS among NH black or Asian women, but both groups were significantly more likely than NH whites to report PPDS. Conclusion: Whether and how pregnancy-related weight is associated with PPDS varies by race/ethnicity. Addressing preconception weight could help reduce overall levels of PPDS among NH whites but would likely fail to mitigate racial/ethnic disparities in postpartum mental health.

Prevalence and Risk Factors for Self-Reported Postpartum Depression Symptoms (SRPDS) in Hawai'i, 2012-2015

Postpartum depression (PPD) affects an estimated 10% to 20% of women in the United States, but little is known about the risk factors for PPD in Hawai'i. This study sought to identify PPD risk factors and examine whether disparities exist in Hawai'i. Aggregated 2012-2015 Hawai'i Pregnancy Risk Assessment Monitoring System (PRAMS) data from 5572 women with a recent live birth were analyzed. Two questions on the PRAMS survey about mood and interest in activities were used to create a brief measure of Self-Reported Postpartum Depression Symptoms (SRPDS). Multivariate generalized logit analysis was conducted to identify risk factors associated with SRPDS or possible SRPDS, adjusting for maternal race and age, intimate partner violence (IPV), prenatal anxiety, prenatal depression, illicit drug use before pregnancy, and stressful life events (SLEs). About 10.0% of women surveyed had SRPDS and 27.7% had possible SRPDS. SRPDS was more common among Native Hawaiians (adjusted odds ratios=1.77; 95% confidence interval: 1.17-2.70), Filipinos (2.16; 1.33-3.50), Japanese (2.88; 1.67-4.98), and other Pacific Islanders (OPI; 3.22; 1.78-5.82), when compared to white. Women aged 20-29 years (0.39; 0.24-0.65) and 30-52 years (0.41; 0.24-0.69) were less likely to have SRPDS than those 19 years and younger. SRPDS was highest among women who experienced IPV (2.65; 1.37-5.13), prenatal anxiety (2.10; 1.28-3.42), prenatal depression (2.78; 1.47-5.25), or used illicit drugs before pregnancy (1.97; 1.21-3.20). There was an upward trend in SRPDS based on the number of SLEs. Possible SRPDS had similar but smaller effects, suggesting the importance of clinical screening and appropriate follow-up for these high-risk groups.

Association between unintended pregnancy and internalizing disorders among Latina and Asian American mothers

BACKGROUND

Pregnancy, whether intended or unintended, is associated with internalizing symptoms among women; for some, these symptoms cause impairment and develop into an internalizing disorder (ID). With the growing diversity of the US population, there is a need to understand how pregnancy relates to IDs among minorities. This study examines the association between unintended pregnancy and lifetime and 12-month history of IDs among Latina and Asian mothers.

METHODS

Data come from the National Latino and Asian American Study (NLAAS), a nationally representative sample of Latino and Asian adults. Pregnancy intention was self-reported. ID history was assessed with the CIDI (DSM-IV). Logistic regression was used to examine the association between pregnancy intention and likelihood of lifetime and 12-month IDs.

RESULTS

Among 1915 mothers, 24.1% and 14.7% met criteria for a lifetime and 12-month ID, respectively. Relative to those who only reported intended pregnancies, Asian mothers reporting an unintended pregnancy had the highest odds of lifetime (Odds ratio (OR): 2.51, 95% Confidence Interval (CI): 1.55-4.08) and 12-month IDs (OR: 5.73, 95% CI: 2.67-12.29). Latina mothers reporting unintended pregnancies also had higher odds of lifetime (OR: 1.96, 95% CI: 1.41-2.72) and 12-month IDs (OR: 1.70, 95% CI: 1.12-2.59). Socioeconomic status had no significant modifying effect.

LIMITATIONS

Cross-sectional data and retrospective recall and social desirability could misclassify pregnancy intention.

CONCLUSIONS

Unintended pregnancy is associated with higher odds of IDs among mothers. Findings underscore the complex relationship between unintended pregnancy and maternal mental health.

Chinese American Women's Experiences with Postpartum Depressive Symptoms and Mental Health Help-Seeking Behaviors

PURPOSE

The objective of this study was to explore the perspectives of postpartum depression (PPD) and mental health help-seeking behaviors among Chinese American women.

STUDY DESIGN AND METHODS

Using a qualitative design, Chinese American women, who had given birth in the past year, participated in a semistructured interview (English or Mandarin). Depressive symptoms and mental health services questionnaires were also conducted.

RESULTS

All 15 participants were married and between 29 and 39 years of age. Content analysis revealed two main themes including culture-specific postpartum traditions and mental health help-seeking. Nine reported sadness or PPD symptoms, including three who scored above the cutoff of the Edinburgh Postnatal Depression Scale (EPDS score ≥9) for risk of PPD and others who disclosed such information during the interview. Many women shared that they experienced postpartum depressive symptoms, but some did not believe depression was applicable to Chinese women.

CLINICAL IMPLICATIONS

Healthcare professionals working with Chinese American women must be aware of culture-specific childbearing traditions to promote maternal-infant well-being outcomes.

How Postpartum Women With Depressive Symptoms Manage Sleep Disruption and Fatigue

Postpartum sleep and fatigue have bidirectional relationships with depressive symptoms and challenge women's everyday functioning. The everyday process of managing postpartum sleep and fatigue in the context of depressive symptoms remains unexplored. We conducted a grounded theory study with a sample of 19 women who screened positive on the Postpartum Depression Screening Scale (PDSS™) Short Form at 3 weeks postpartum. Women completed semi-structured in-home interviews and the full PDSS and Modified Fatigue Symptoms Checklist at 1, 3, and 6 months postpartum. The sample was on average 27 years old, with 2.8 children, and 63% were African-American. They described a basic social process of Finding a Routine Together, during which women's experiences with their infants progressed from Retreating at month 1 toward Finding a New Normal at month 6. In their work to Find a Routine Together, mothers' patterns of change over time were continuous, gradual, or prolonged. Their progress was influenced by depressive symptoms, social support, work and daycare, stability in social circumstances, and underlying stressors. This study's findings suggest the need to allocate resources and tailor interventions to meet the needs of women who are most vulnerable to the health effects of ongoing persistent severe fatigue, disordered sleep, and sub-clinical and clinical levels of depressive symptoms. © 2017 Wiley Periodicals, Inc.

'Big data' in mental health research: current status and emerging possibilities

PURPOSE

'Big data' are accumulating in a multitude of domains and offer novel opportunities for research. The role of these resources in mental health investigations remains relatively unexplored, although a number of datasets are in use and supporting a range of projects. We sought to review big data resources and their use in mental health research to characterise applications to date and consider directions for innovation in future.

METHODS

A narrative review.

RESULTS

Clear disparities were evident in geographic regions covered and in the disorders and interventions receiving most attention.

DISCUSSION

We discuss the strengths and weaknesses of the use of different types of data and the challenges of big data in general. Current research output from big data is still predominantly determined by the information and resources available and there is a need to reverse the situation so that big data platforms are more driven by the needs of clinical services and service users.

Cross-Cultural Approach of Postpartum Depression: Manifestation, Practices Applied, Risk Factors and Therapeutic Interventions

It is a well known fact that postpartum depression (PPD) is a global phenomenon that women may experience, regardless of cultural identity and beliefs. This literature review presents the cultural beliefs and postnatal practices around the world, in each continent and people's origins, looking through the extent to which they contribute positively or negatively to the onset of the disease. 106 articles were used in this research, through a systematic electronic search of Pubmed (Medline) and Scopus. Comparison is also made between the prevalence, the risk factors and the different ways of appearance of the disease around the world and among immigrants. Finally, the initiatives and interventions made so far by the governments and institutions with a view to prevent and address this global problem are presented. The results showed (a) that different cultures share the same risk factors towards the disease (b) significant differences in the prevalence of the disease among both Western and non Western cultures and between the cultures themselves (c) more tendencies for somatization of depressive symptoms in non-Western cultures, (d) different postnatal practices between cultures, which are not always effective (e) the more non-West a culture is, the less interventions concern on mental health; the same phenomenon is observed on populations burdened by immigration. The beliefs held by culture should be taken seriously in detecting of PPD, as well as the assessment of the needs of women who have recently given birth.

Prevalence of postpartum depression among immigrant women: A systematic review and meta-analysis

The aims of this systematic review and meta-analysis were threefold: to estimate the prevalence of postpartum depressive symptoms in immigrant women, compare this prevalence to non-immigrant women, and determine risk factors for postpartum depressive symptoms in immigrant women. Literature searches were conducted in PubMed, Embase, PsycINFO, Web of Science, Scopus, ResearchGate and Google Scholar databases from 1950 until October 2014. Twenty-four studies met the inclusion criteria of which 22 (12 cross-sectional and 10 prospective cohort) contributed data for meta-analyses. Heterogeneity and publication bias were assessed. The prevalence of postpartum depressive symptoms in immigrant women was 20% (95% confidence interval [CI] 17-23%, 18 studies, N = 13,749 women). Immigrant women were twice more likely to experience depressive symptoms in the postpartum period than non-immigrant women (pooled unadjusted odds ratio [OR] = 2.10 [95% CI 1.62-2.73, 15 studies, N = 50,519 women] and adjusted OR = 2.18 [95% CI 1.60-2.96, 7 studies, N = 35,557 women]). There was, however, evidence of publication bias with the pooled adjusted OR reduced to 1.63 (95% CI 1.22-2.17) after adjustment for bias. Risk factors associated with postpartum depressive symptoms among immigrant women included shorter length of residence in the destination country, lower levels of social support, poorer marital adjustment, and perceived insufficient household income. This study suggests that postpartum depression is a common condition among immigrant women. Moreover, immigrant women are at higher risk of postpartum depression than non-immigrant women. Further prospective studies on the risk factors of postpartum depression among immigrant women verified by a clinical diagnosis are needed.

Depression, Anxiety, and Pharmacotherapy Around the Time of Pregnancy in Hawaii

BACKGROUND

Depression and anxiety are common conditions among pregnant and postpartum women, but population-based information is lacking on treatments and help-seeking behaviors.

PURPOSE

This study described the prevalence of depression, anxiety, pharmaceutical treatment, and help-seeking behaviors among a multiethnic population of women with recent live births in Hawaii.

METHOD

Hawaii Pregnancy Risk Assessment Monitoring System data from 4735 respondents were weighted to be representative of all pregnancies resulting in live births in Hawaii in 2009-2011 and were used to estimate the prevalence of several indicators related to anxiety and depression before, during, and after pregnancy among women with recent live births.

RESULTS

Of Hawaii women with live births in 2009-2011, 7.3 % reported visiting a healthcare worker to be checked or treated for depression or anxiety in the year before their most recent pregnancy, 4.9 % reported having depression in the 3 months before pregnancy, 5.9 % reported having anxiety in the same period, 9.1 % screened positive for postpartum depression, and 6.9 % reported asking a doctor, nurse, or other healthcare worker for help for anxiety postpartum. The prevalence of antianxiety and antidepressant prescription drug use was 2.3 % in the month before pregnancy and 1.4 % during pregnancy. Hawaii had lower prevalence of pre-pregnancy depression, anxiety, and depression/anxiety health visits than other US states. Pre-pregnancy depression and anxiety and postpartum anxiety help-seeking behaviors differed significantly by race/ethnicity.

CONCLUSION

Depression and anxiety are common among pregnant and postpartum women in Hawaii. More research could better inform heath care professionals and patients of the treatment options available and their potential risks and benefits.

Prevalence, nature and determinants of postpartum mental health problems among women who have migrated from South Asian to high-income countries: a systematic review of the evidence

BACKGROUND

Women of reproductive age constitute a significant proportion of immigrants from South Asia to high-income countries. Pregnancy, childbirth and the postpartum period place increased demands on women׳s psychological resources and relationships. The aim of this review was to evaluate the available evidence about the prevalence, nature and determinants of postpartum mental health problems among South Asian women who have migrated to high-income countries.

METHODS

Using a systematic strategy, CINAHL, Medline, PsychInfo and Web of Science databases were searched.

RESULTS

Fifteen studies conducted in different high-income countries met inclusion criteria. Prevalence estimates of clinically significant symptoms of postpartum depression (CSS-PPD) varied widely (1.9-52%): the most common estimates ranged from 5 to 20%. Five studies found approximately a two-fold increase in risk of CSS-PPD (Odds Ratios 1.8-2.5) among overseas born women with a South Asian subgroup. The most common determinants appeared to be social factors, including social isolation and quality of relationship with the partner. Barriers to accessing health care included lack of English language proficiency, unfamiliarity with local services and lack of attention to mental health and cultural factors by health care providers.

LIMITATIONS

The settings, recruitment strategies, inclusion and exclusion criteria, representative adequacy of the samples and assessment measures used in these studies varied widely. Many of these studies did not use formally validated tools or undertake specific subgroup analyses.

CONCLUSIONS

Reductions in postpartum depression could be achieved by increasing awareness of available services and ensuring health care professionals support the mental health of women from diverse cultural and linguistic backgrounds.