Predictors of depressive symptoms in older Japanese primiparas at 1 month post-partum: A risk-stratified analysis

The role of anesthesiologists in postpartum depression: current perspectives and future directions

Postpartum depression is a common complication of childbirth that can seriously affect women, infants, and families. In 2020, the National Health Commission of the People's Republic of China mandated depression and anxiety screenings during pregnancy and postpartum visits to ensure timely medical intervention and referrals to appropriate behavioral health resources. Anesthesiologists are indispensable members in obstetric practice. Optimal peripartum pain control can reduce stress response; promote breastfeeding; and lower maternal anxiety and depression. Recently, the discovery of the rapid and sustained antidepressant properties of ketamine and emerging evidence supporting the effectiveness of anesthetic drugs in the treatment of depressive disorders have positioned anesthesiologists on a new frontier for treating neuropsychiatric disorders. This review aimed to explore the impact of labor epidural analgesia, obstetric anesthesia, and anesthetic drugs on postpartum depression while discussing the emerging role of anesthesiologists in its prevention and treatment based on recent evidence.

The effects of social support on depression and anxiety in the perinatal period: A mixed-methods systematic review

BACKGROUND

The social support offered to women in the perinatal period can buffer against depression and anxiety. The sources and types of support that reduce maternal levels of depression and anxiety are not well understood.

AIMS

To investigate the effects of structural and functional support on depression and anxiety in women in the perinatal period, and to explore the experiences of women around support during the perinatal period.

METHOD

A comprehensive search of six electronic databases was undertaken. Relevant studies published from January 2010 to April 2020 were included (PROSPERO reference number: CRD42020194228). Quantitative and qualitative studies were eligible if they reported the effects of, or had themes related to receiving functional or structural support in the perinatal period on women's levels of depression or anxiety. Qualitative data was synthesised using a thematic synthesis method. Quantitative data could not be pooled due to the lack of comparable RCTs or cohort studies and was thus presented in a narrative form.

RESULTS

Fifty-one articles (41 quantitative and 10 qualitative studies) were included. Analysis of quantitative studies demonstrated that insufficient support from partner, friends and family was associated with greater risk of symptoms of depression and anxiety. Distance-delivered interventions (via internet or telephone) diminished levels of depression and anxiety. Qualitative data revealed three overarching themes: appreciating all forms of support in the perinatal period, recognising appropriate and inappropriate support from health professionals and services, and having barriers to mobilising functional and structural support.

LIMITATIONS

Grey literature was not explored and search strategies only included English, Spanish and Portuguese language articles. The reviewed studies were heterogeneous and for this reason, quantitative assessments were not feasible.

CONCLUSION

Support from specific sources such as family members, friends who are also mothers, health professionals, neighbours, supervisors, co-workers and online communities still need to be further investigated. Implications for health professionals involved in the care of women in the perinatal period are discussed.

Childbirth Pain, Labor Epidural Analgesia, and Postpartum Depression: Recent Evidence and Future Directions

Pregnancy and childbirth are major life events for women and their families, characterized by physical, psychological, and emotional changes that can trigger anxiety, depression, and mental disorders in susceptible individuals. Acute labor pain is an independent risk factor for persistent pain in the postpartum period and is associated with depressive disorders. Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in pain management during labor. Although the relationships between labor pain, labor epidural analgesia, and postpartum depression have been studied by many investigators, the results of these studies are conflicting. Some literature suggest that labor epidural analgesia is associated with a reduction in the incidence of postpartum depression; however, other studies have failed to demonstrate this association. Unmet analgesic needs expectations, unmet birth expectations, and/or the quality of social support during labor may contribute to postpartum depression. The limitations of the published studies included differential misclassification of study variables and residual confounding, variations in the diagnosis of depression, and incomplete history data. Thus, future studies should include information on sociodemographic and patient-level variables and assessments of pain during labor or in the postpartum period. Better management of labor pain should be provided to prevent long-term morbidity and improve maternal and neonatal outcomes. Anesthesiologists could collaboratively work with obstetricians and perinatal psychiatrists to ensure that hospitals prioritize screening and treatment for postpartum depression.

Early risk factors for postpartum depression: A longitudinal Japanese population-based study

BACKGROUND

Postpartum depression (PPD) negatively impacts maternal health, parenting and development of children. Most previous studies on PPD risk factors are based on Western populations. Additionally, little is known about the association between psychosocial factors during early pregnancy period and PPD. We aimed to identify early risk factors for PPD until three months after delivery using a longitudinal population-based sample from Japan.

METHODS

The data was collected from 1050 mothers at four time points: first trimester, after the birth, and one and three months post-delivery. Mothers who had a Japanese Edinburgh Postnatal Depression Scale (EPDS) cutoff score above 9 at one or 3 months after delivery were recognized as having PPD (n = 91/8.7%).

RESULTS

Negative feelings about pregnancy, combined breast and bottle feeding, first-time motherhood, motherhood 24 or less years old, perceived maternal mental illness before pregnancy, and lack of social support were all significantly associated with PPD at three months after delivery.

LIMITATIONS

The data was collected from one city in Japan, which limits the generalization of the findings. Additionally, PPD was assessed by an EPDS questionnaire, and not by a clinical interview.

CONCLUSIONS

Even after controlling for the perceived mental illness before pregnancy, several risk factors as early as in the first trimester were associated with PPD. These risk factors should be identified and the mothers should be offered a suitable intervention, in order to prevent the development of PPD.

Relationship between postpartum depression and lactation status at a Japanese perinatal center: A cross-sectional study

Background:  Some studies have demonstrated that breastfeeding can protect mothers from postpartum depression; therefore, we examined the association between postpartum depression and lactation status at one month after delivery at a Japanese perinatal center.

Methods: We reviewed the obstetric records of all (total 809) nulliparous healthy women with vaginal singleton delivery at 37-41 weeks’ gestation at our institute between July 2018 and June 2019. A face-to-face interview with the women was conducted on admission for delivery to ask whether or not they hoped to perform exclusive breastfeeding for their babies, and an additional interview was conducted one month after delivery to ask about their feeding methods currently. Maternal mental status was examined based on the scores using the Edinburgh Postnatal Depression Scale (EPDS), and women with EPDS scores of ≥9 points were regarded as ‘positive screening’.

Results: 592 women (73.1%) hoped to perform exclusive breastfeeding for their babies on admission. Of these, at one month, 442 (74.7%) performed exclusive breastfeeding, while 150 (25.3%) performed mixed or artificial feeding. The average EPDS scores and the incidence of EPDS scores ≥9 points in the women performing exclusive breastfeeding were 4.3 ± 3.6 and 14.3% (63/442), respectively. They did not differ from those in the women performing mixed or artificial breast feeding [4.2 ± 3.7, p = 0.60 and 13.3% (20/150), p = 0.78].

Conclusion: Development of postpartum depression does not seem to be associated with incomplete breastfeeding at our hospital, and therefore there are other risk factors indicated in the development of postpartum depression.

Course of maternal fatigue and its associated factors during the first 6 months postpartum: a prospective cohort study

Aims

To identify the course of maternal fatigue during the first 6 months postpartum and to determine factors associated with it.

Design

A prospective cohort study.

Methods

Women (N = 2,697) in 13 Japanese hospitals provided longitudinal data using self‐report questionnaires at five time points. Maternal fatigue was assessed using the Postnatal Accumulated Fatigue Scale. We focused on the effect of maternal age and parity on the course of maternal fatigue and used a mixed between/within‐subjects analysis of variance. Factors associated with maternal fatigue were analysed using stepwise multiple regression.

Results

In the 6‐month postpartum period, the level of fatigue was highest at 1 month and significantly decreased from 1–4 months postpartum. Primiparas showed a significantly higher level of fatigue than multiparas during hospital stay and their levels of fatigue more closely approximated the 1‐month peak. Multiparas showed significantly higher levels of fatigue than younger primiparas at 6‐month postpartum. Factors associated with maternal fatigue included satisfaction with sleep, concerns about child‐rearing, satisfaction with social support, financial burden and meal times per day.

Cross-National Differences in Psychosocial Factors of Perinatal Depression: A Systematic Review of India and Japan

Perinatal depression is prevalent worldwide. However, there are few available studies that discuss the different cultural factors affecting perinatal depression within Asian countries. This study aims to compare the literature regarding related factors relating to perinatal depression in India and Japan, and to synthesize the evidence common to both countries in addition to the country-specific evidence. We conducted a systematic review using several databases (CINAHL, MEDLINE, Pubmed, Ovid, SCOPUS, IndMED, and ICHUSI). Keywords were “antenatal depression” or “postpartum depression”, and “India” or “Japan”. Both Japanese and English language papers were reviewed. The identified evidence was compared between the two countries, as well as with non-Asian countries based on previous reports. In total, 15 articles on India and 35 on Japan were reviewed. Although several factors were shared between the two countries as well as with other non-Asian countries (vulnerable personality, being abused, age, marital conflict, and lower socio-demographic status), some differing factors were identified between India and Japan and non-Asian countries; India: poor socioeconomic status, living only with the husband, pregnancy not welcomed by the husband, a female baby, and poor relationship with in-laws; Japan: infertility treatment, conflict with work–life balance, poor relationships with biological mother or in-laws, and concerns about social relations with the other mother’s friends. To conclude, involving the family and community may be important for implementing both global standardized and culture-specific interventions. In India, treatment involving the in-laws may be effective because large family structure is a significant predictor of perinatal depression. In Japan, a family/community approach involving not only the mother’s family of origin but also the working environment is essential.