Study protocol on criterion validation of Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire (PHQ-9) and Centre for Epidemiological Studies-Depression (CES-D) screening tools among rural postnatal women; a cross-sectional study

Anxiety and depression among perinatal women during the long-term normal prevention of COVID-19 pandemic period in China: a cross-sectional study

BACKGROUND

COVID-19 has increased the probability of occurrence of maternal anxiety and depression in pregnant women. However, there is limited research on anxiety and depression among pregnant women during the long-term normal prevention of COVID-19 pandemic period. This study aimed to examine the anxiety and depression and influencing factors among perinatal women during the long-term normal prevention of COVID-19 pandemic period in China.

METHODS

A cross-sectional survey was designed. A total of 1338 pregnant women were studied. The prenatal anxiety and depression were assessed by the Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS), respectively. Postnatal depression was assessed by the Edinburgh Postpartum Depression Scale (EPDS) in 10-14 days after delivery. The data analysis was processed by SPSS9.0. Descriptive analysis was expressed by mean and standard deviation. The counting data were expressed by percentage, χ2 test, multiple linear regression and binary logistic regression.

RESULTS

The incidence of prenatal anxiety (SAS score ≥ 50) was 27.95% (374 cases), prenatal depression (SDS score ≥ 0.5) was 34.01% (455 cases), and postpartum depression (EPDS score ≥ 0.5) was 25.04% (335 cases). Both the prenatal SAS score (r = 0.635, P < 0.001) and prenatal SDS score (r = 0.738, P < 0.001) were related to postpartum depression. Pregnant women who were younger than 35 years, in middle household income, lower education level, underweight before pregnancy, primiparous, and fear of being infected were at increased risk for developing anxiety and depression during the long-term normal prevention of COVID-19 pandemic.

CONCLUSIONS

The incidences of postpartum depression among perinatal women during the long-term normal prevention of COVID-19 pandemic period were a little lower than those during the COVID-19 outbreak period, but still higher than those before the COVID-19.

Assessment of Perinatal Depression Risk among internally displaced Yazidi Women in Iraq: a descriptive cross-sectional study

Background

Yazidi survivors of a 2014 genocidal attack by the self-proclaimed Islamic State of Iraq and Syria (ISIS) have complex medical and mental health needs in the perinatal and postpartum period. Few studies have assessed perinatal mental health needs for this population of women who are living in camps for Internally Displaced Persons (IDP) in the Kurdistan Region of Iraq (KRI).

Methods

The specific aim of this formative cross-sectional study was to assess the prevalence of perinatal depressive symptoms, specifically the risk of perinatal depression symptoms, among a purposive sample of Yazidi women living in camps for internally displaced persons in the Kurdistan region of Iraq. One hundred twenty-two pregnant and recently postpartum (<1 year) Yazidi women completed a Kurdish-language version of the Edinburgh Postnatal Depression Scale (EPDS) questionnaire. Pregnant and postpartum participants’ responses were analyzed together, in order to assess an overall combined risk of perinatal mental health issues for the study population. Logistic regression analyses were used to measure the association of participant characteristics with an elevated risk of perinatal depressive symptoms.

Results

Participants were 17-45 years of age (mean 32 years, SD 7.63) Among the 122 women, 67.2% (n=82) were pregnant and 32.8% (n=40) were <1 year postpartum. Overall, 78% (n=95) of participants were at an elevated risk of depression (EPDS >10), and 53% (n=65) of all participants were at risk of moderate to severe depression (EPDS >12). Thoughts of self-harm (EPDS item 10) were reported among 97% (n=118) of participants. Logistic regression analysis indicated that increased risk of perinatal depressive symptoms was significantly associated with reports of health problems during pregnancy (OR=3.22, 95% [CI]:1.08-9.61) and marital status (OR=16.00; 95% [CI]: 0.42-0.50). Age (OR= 0.84; 95% [CI]: 0.75–0.94) and level of education (OR=0.15; 95% [CI]: 0.42-0.50) had protective effects.

Conclusions

Rates of perinatal depressive symptoms risk among internally displaced Yazid pregnant and postpartum women are higher than the general Kurdish-speaking population in Iraq (28.4%). Culturally responsive trauma informed perinatal and postpartum care services, which include both community-based and clinical strategies for perinatal depressive symptoms and suicide prevention for this population, are critically needed.

Effect of mode of administration on Edinburgh Postnatal Depression Scale in the South Indian population: A comparative study on self-administered and interviewer-administered scores

BACKGROUND

Edinburgh Postnatal Depression Scale (EPDS) is a validated screening tool widely used to assess perinatal depression (PND). However, due to stigma associated with PND, respondents could answer sensitive questions differently depending on the mode of administration, especially in culturally and linguistically diverse country like India. The present study explored longitudinal differences in EPDS scores between self-administered and interviewer-administered modes.

METHODS

177 women from rural South India were administered EPDS, self-administration followed by interviewer-administered for four visits, twice each during prenatal and postnatal visits. EPDS scores were compared between the two modes descriptively, graphically and by repeated mixed measure models. Classification of antenatal depression (AD), postnatal depression (PD) and PND based on the two modes were compared by McNemar Chi-square test. Clinical and psychosocial characteristics were examined to identify factors associated with differences in the scoring modes. Concordance rates and Goodman Kruskal's Gamma coefficients were measured for individual EPDS items.

RESULTS

Longitudinal EPDS scores and rates of AD, PD and PND were significantly higher in self-administered mode. Recent adverse life events were the only factor observed to be significantly associated with the differences between the two modes. Rank correlation and concordance rates suggested stronger association for EPDS items relating to anhedonia subscale and moderate/weaker association for EPDS items relating to anxiety/depression subscales.

CONCLUSION

Our study findings suggest that the effect of mode of administration should be taken into account while using PND screening tools such as EPDS, especially in countries such as India with higher levels of illiteracy.

Anterior cingulate gyrus acts as a moderator of the relationship between problematic mobile phone use and depressive symptoms in college students

This study aimed to investigate the brain grey matter volume (GMV) related to problematic mobile phone use (PMPU), and whether these regions of GMV play a potential moderating role in the relationship between PMPU and depressive symptoms. We recruited 266 students who underwent magnetic resonance imaging (MRI) scanning. PMPU and depressive symptoms were assessed by a self-rating questionnaire for adolescent PMPU and patient health questionnaire-9, respectively. A multiple regression model was performed to detect GMV and white matter (WM) integrity associated with PMPU by voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) methods, and the moderating analysis was conducted by PROCESS using SPSS software. VBM analysis found an inverse correlation between the GMV of the anterior cingulate gyrus (ACC) and right fusiform gyrus (FFG) with PMPU (P_FDR < 0.05), and TBSS analysis revealed that fractional anisotropy (FA) in the body of the corpus callosum was negatively correlated with PMPU. The correlation between PMPU and depressive symptoms was moderated by the GMV of the ACC. These results suggest that the GMV of the ACC and right FFG, as well as FA in the body of the corpus callosum, was related to PMPU, and we further found that increased GMV of the ACC could reduce the relationship between PMPU and depressive symptoms in college students.

Screening for perinatal depression with the Patient Health Questionnaire depression scale (PHQ-9): A systematic review and meta-analysis

OBJECTIVES

Perinatal depression (PND) is a prevalent and disabling problem both during pregnancy and the postpartum period. The legacy screening measure has been the Edinburgh Postnatal Depression Scale (EPDS). This systematic review examines the validity of the PHQ-9 as a screener for PND.

METHODS

The following databases were searched from January 2001 (when the PHQ-9 was first published) through June 2020: MEDLINE, Embase, and PsychInfo. Studies that compared the PHQ-9 to a criterion standard psychiatric interview were used to determine the operating characteristics of sensitivity, specificity and area under the curve (AUC). Studies comparing the PHQ-9 to the EPDS and other depression scales evaluated convergent validity.

RESULTS

A total of 35 articles were eligible for criterion (n = 10) or convergent (n = 25) validity. Meta-analysis of the 7 criterion validity studies using the standard PHQ-9 cut point ≥10 showed a pooled sensitivity, specificity and AUC of 0.84, 0.81 and 0.89, respectively. Operating characteristics of the PHQ-9 and EPDS were nearly identical in head-to-head comparison studies. The median correlation between the PHQ-9 and EPDS was 0.59, and categorical agreement was moderate.

CONCLUSIONS

The PHQ-9 appears to be a viable option for perinatal depression screening with operating characteristics similar to the legacy EPDS.

The moderating effect of physical activity in the relation between problematic mobile phone use and depression among university students

AIM

To examine the moderating effect of physical activity (PA) between problematic mobile phone use (PMPU) and depression in university students.

METHODS

The sample consisted of 4624 students (55.5% females and 44.5% males) aged 17-25 years old (M=19.91, SD=1.27). Patient Health Questionnaire (PHQ-9) and Center for Epidemiologic Studies Depression Scale (CES-D) were applied to evaluate the state of depression in all participants. The data of PMPU and PA were collected by standardized questionnaires named Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use (SQAPMPU) and International physical activity Questionnaire-Short Form (IPAQ-SF). Chi-square tests and multivariate logistic regressions were applied to examine the associations of PMPU and depression, as well as the moderating effects of PA.

RESULTS

The prevalence of PMPU and depression were 27.5%, 6.1% (PHQ-9 at clinical level) and 25.1% (CES-D≥20), respectively. The relationships between PMPU and depression have been shown in our study. The rates of depression were higher among students with PMPU or low PA. Hierarchical analysis indicated that moderate or high PA was related to a greater decrease in the risk of depression for students with PMPU.

CONCLUSIONS

The findings indicate that PA moderates the association between PMPU and depression. Future researches with longitudinal design are warranted. The intervention programs of depression should consider individuals' health behaviors.

Recommended psychological crisis intervention response to the 2019 novel coronavirus pneumonia outbreak in China: a model of West China Hospital

The novel coronavirus pneumonia (COVID-19) epidemic has brought serious social psychological impact to the Chinese people, especially those quarantined and thus with limited access to face-to-face communication and traditional social psychological interventions. To better deal with the urgent psychological problems of people involved in the COVID-19 epidemic, we developed a new psychological crisis intervention model by utilizing internet technology. This new model, one of West China Hospital, integrates physicians, psychiatrists, psychologists and social workers into Internet platforms to carry out psychological intervention to patients, their families and medical staff. We hope this model will make a sound basis for developing a more comprehensive psychological crisis intervention response system that is applicable for urgent social and psychological problems.

Mediating Effect of Sleep Quality on the Relationship Between Problematic Mobile Phone Use and Depressive Symptoms in College Students

Background and Aim: Problematic mobile phone use (PMPU) and depression are great public health concerns among adolescents. The aim of this study was to determine the association between PMPU and symptoms of depression, as well as the mediating role of sleep quality. Methods: A total of 4,624 college students participated in this study. The Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use (SQAPMPU), Pittsburgh Sleep Quality Index (PSQI), and Patient Health Questionnaire-9 (PHQ-9) were administered to assess PMPU, sleep quality, and symptoms of depression. Mediation analysis was conducted using PROCESS macro in the SPSS software. Results: Of the participants, 27.5% were classified as PMPU, 44.9% exhibited symptoms of depression, and 15.6% reported sleep problems. Compared with those without PMPU, those with PMPU exhibited higher rates of sleep problems and depressive symptoms. The mediation analysis further revealed partial mediation effects of sleep quality on the association between PMPU and depression. Conclusions: This study demonstrated that PMPU was associated with mental health in college students, and sleep quality played a mediating role in this relationship. Our findings highlight the critical role of early intervention for depression with a focus on those with PMPU and, more specifically, on those with sleep problems.

Prevalence and factors associated with postnatal depression among women in two rural districts of Manicaland, Zimbabwe

Background

Low- and middle-income countries are disproportionately affected by postnatal depression (PND). High prevalence of PND in urban Zimbabwe has been reported but the situation in rural settings is largely unknown and this is one of the first studies to report prevalence of PND in Chipinge and Mutasa districts.

Objectives

This study explored the prevalence and associated factors of PND among women attending postnatal care services in two rural districts of Chipinge and Mutasa, Manicaland, Zimbabwe between August and September 2017.

Methods

One hundred and ninety-two women were recruited consecutively as they attended postnatal services at 7 days and 42 days post-delivery. The Diagnostic and Statistical Manual for Mental Disorders, fifth edition criteria was used to classify depression among participants. Prevalence of PND and 95.0% confidence intervals (CIs) were estimated and associations with key socio-demographic and risk factors assessed.

Results

The mean age of participants was 23.7 years (standard deviation = 6.14). Pooled prevalence of PND across the two districts was 26.0% (95% CI: 19.04–31.74). There was a higher prevalence of PND in Mutasa (31.0%) as compared to Chipinge (21.48%) but this was not statistically significant (p = 0.142). Having insufficient food in the household, intimate partner violence and having a child with birthweight under 2500 g significantly increased the likelihood of PND twofold: adjusted odds ratio (aOR) = 2.8 (95% CI: 1.2–6.1), aOR = 2.5 (95% CI: 1.2–5.3) and aOR = 2.4 (95% CI: 1.1–5.6), respectively.

Conclusion

The high prevalence of PND and its associated risk factors indicates the need for routine screening and targeted interventions for PND in Zimbabwe, especially in rural areas.