Untreated depression in the first trimester of pregnancy leads to postpartum depression: high rates from a natural follow-up study

The effect of cortisol in early pregnancy on postpartum depressive symptoms

The first months after childbirth are a tremendous challenge for women and, consequently, a time when women's mental health problems often arise. Knowledge of the prenatal predictors of these problems is of fundamental importance in preventing them. This study aimed to test whether first trimester hair cortisol influenced maternal postpartum depressive symptoms. The women (N = 75) were tested twice: in the first trimester of pregnancy and within three months after giving birth. In the first trimester, they had hair samples taken and were examined using a sociodemographic survey and questionnaires: the Edinburgh Postnatal Depression Scale (EPDS), the Perceived Stress Scale (PSS-10), and the Zimbardo Time Perspective Inventory. After delivery, women completed a survey about the course of delivery and their child's health, EPDS, and PSS-10. Low hair cortisol concentration in the first trimester was a predictor of a high level of postpartum depressive symptoms. This relationship was mediated by fatalistic time perspective. The results suggest that low hair cortisol concentration in the first trimester of pregnancy indicates a high probability of postpartum depression, and that low levels of cortisol may be associated with passivity, a sense of lack of control, and helplessness.

Association of Pregnant Women's Perinatal Depression with Sociodemographic, Anthropometric and Lifestyle Factors and Perinatal and Postnatal Outcomes: A Cross-Sectional Study

Background: In recent decades, the incidence of depression has gradually increased in the general population globally. Depression is also common during gestation and could result in detrimental gestational complications for both the mother and the fetus. The survey presented aimed to evaluate whether pregnant women's perinatal depression could be associated with socio-demographic, anthropometry and lifestyle factors, and perinatal and postnatal outcomes. Methods: This is a cross-sectional survey conducted on 5314 pregnant women. Socio-demographic and lifestyle factors were recorded by relevant questionnaires via face-to-face interviews. Anthropometric parameters were measured by qualified personnel. Perinatal depressive symptomatology status was evaluated by Beck's Depression Inventory (BDI-II) questionnaire. Results: Depressive symptoms throughout gestation were found in 35.1% of the enrolled women. Perinatal depression was significantly associated with lower educational and economic level, pre-pregnancy regular smoking and reduced levels of Mediterranean diet adherence levels, a higher prevalence of gestational diabetes and preterm birth, as well as a higher incidence of delivering by caesarean section and abnormal childbirth weight. Perinatal depression was also significantly associated with a higher prevalence of maternal postpartum depression and lower prevalence of exclusive breastfeeding practices, as well as with a higher incidence of childhood asthma. Conclusions: Pregnant women's perinatal depression appears to be associated with various socio-demographic, anthropometry, and lifestyle characteristics and with a higher frequency of several adverse pregnancy complications. The present findings emphasize the importance of pregnant women's perinatal mental health, highlighting the need to develop and apply public strategies and policies for psychological counseling and support of future mothers to minimize probable risk factors that may trigger perinatal depression. Novel well-organized, follow-up surveys of enhanced validity are highly recommended to establish more definitive conclusions.

Implication of red meat consumption habits in serum uric acid levels and mood disorders among first-trimester pregnant women

BACKGROUND

Dietary pattern involving meat consumption has an association with serum uric acid level which subsequently has an impact on moods. However, this relationship is not clearly established in pregnant women, particularly those who are accustomed to daily meat consumption.

OBJECTIVE

This study investigated the relationship between red meat consumption and uric acid level and the subsequent impact on mood disorders in 1st trimester pregnant women.

METHODOLOGY

A total of 92 pregnant women in their first trimester (8-12 weeks), were selected for this study. Socio-demographic characteristics including age, body mass index (BMI), educational qualification, sleep hours, blood pressure and exercise status were recorded. To assess meat consumption, classification based on the recruited population consumption was divided into low and high meat consumption groups. Serum uric acid level was estimated in plasma. Mood disorder, namely, depression and anxiety were assessed using a self-reported Hospital Anxiety and Depression Scale (HADS) questionnaire. Collected data was analysed using different statistical tools.

RESULTS

Logistic regression analysis showed higher odds of depression (OR = 0.059, 95% CI 0.02-0.172, p < 0.001) and anxiety (OR = 0.144, 95% CI 0.055-0.375, p < 0.001) in the high meat consumption group. Further, the potential confounders, high BMI and less exercise increased the odds of depression and anxiety in high meat consumption groups. Linear regression analysis revealed a significant influence of meat consumption on uric acid level (F (1, 90) = 305.385, p < 0.01).

CONCLUSIONS

The study recommends regular clinical screening of mood disorders, and recommends reasonable consumption of lean meat and/or replacing some portions with fish, as well as, a commitment to eating a healthy, balanced diet. It also suggests extensive studies because it could be linked to postpartum mood disorders among those who consume red meat every day.

Oxytocin system polymorphisms rs237887 and rs2740210 variants increase the risk of depression in pregnant women with early abuse

Prepartum depression is associated with early adversity, pregnancy complications, preterm delivery, postpartum depression, and long-term effects on child neurodevelopment. The oxytocin (OXT) system is affected by early adverse experiences and has been associated with depression. In the current study, we investigated risk factors for prenatal depressive symptoms, mainly the effects of early childhood and adolescence trauma, in combination with the presence of certain variants of polymorphisms of OXT and OXT receptor (OXTR) genes. We hypothesized that early childhood and adolescence trauma has higher negative effects in carriers of genetic variants of the OXT/OXTR system, increasing their risk for depression. Early in pregnancy (8-14 weeks), 141 pregnant women from a Uruguayan population were asked to provide DNA samples and complete questionnaires that assessed their experience of child abuse, depression symptoms, and other variables that included demographic information. Our results showed that 23.5% of pregnant women had depressive symptoms. Several OXT and OXTR genetic variants were associated with higher risk of prepartum depression only in those pregnant women who suffered emotional abuse during infancy or adolescence. Logistic regression (Nagelkerke's R2  = .33) revealed that women who suffered early abuse and were carriers of the variants CC of rs2740210 (OXT) or AA of rs237887 (OXTR) had significantly higher risk of experiencing depressive symptoms. Antecedents of psychiatric disorders also contributed to the risk of depression. We conclude that emotional abuse contributes to the risk of depression in different ways in women carrying different OXT and OXTR genetic variants. Early detection and closer follow-up of women with child abuse and certain OXT genetic variants, among other risk factors, could reduce the long-term impact of prepartum depression.

Predictors of spontaneous remission and recovery among women with untreated perinatal depression in India and Pakistan

Background

Mothers with perinatal depression can show different symptom trajectories and may spontaneously remit from depression, however, the latter is poorly understood. This is the first study which sought to investigate predictors of spontaneous remission and longer-term recovery among untreated women with perinatal depression.

Methods

We analysed data from two randomised controlled trials in women with perinatal depression in India and Pakistan. Analyses were restricted to women in the control groups who did not receive active treatment. Generalised estimating equations and logistic regressions were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for within-person correlation.

Results

In multivariable analyses, remission was associated with a husband who is not working (adjusted OR, aOR = 2.04, 95% CI 1.02-4.11), lower Patient Health Questionnaire-9 score at baseline (aOR = 0.43, 95% CI 0.20-0.90 for score of ≥20 vs. 10-14) and better social support at baseline (aOR = 2.37, 95% CI 1.32-4.27 for high vs. low social support).

Conclusions

Women with low baseline severity may remit from perinatal depression with adequate social support from family and friends. These factors are important contributors to the management of perinatal depression and the prevention of clinical worsening, and should be considered when designing low-threshold psychological interventions.

Substance use and mental health in pregnant women during the COVID-19 pandemic

OBJECTIVES

We examined the prevalence of substance use as a coping mechanism and identified relationships between maternal mental health over time and use of substances to cope during the Coronavirus Disease 2019 (COVID-19) pandemic among pregnant women in the U.S.A.

METHODS

Self-reported repeated measures from 83 pregnant women were collected online in April 2020 and May 2020. Women retrospectively reported their mental/emotional health before the pandemic, as well as depression, stress, and substance use as a result of the pandemic at both time points. Linear regression measured cross-sectional and longitudinal associations between mental health and substance use.

RESULTS

Pre-COVID-19 reports of poorer mental/emotional health (b = 0.46) were significantly (p < .05) associated with number of substances used to cope with the pandemic. Elevated stress (b = 0.35) and depressive symptoms (b = 0.27) and poorer mental/emotional health (b = 0.14) in April were also significantly related to higher numbers of substances used in May (p < .05).

CONCLUSION

Pregnant women's psychological well-being may be a readily measured indicator substance use risk during crises such as the COVID-19 pandemic. Interventions addressing increased stress and depression may also mitigate the emergence of greater substance use among pregnant women.

Effects of bright light therapy for depression during pregnancy: a randomised, double-blind controlled trial

OBJECTIVES

Approximately 11%-13% of pregnant women suffer from depression. Bright light therapy (BLT) is a promising treatment, combining direct availability, sufficient efficacy, low costs and high safety for both mother and child. Here, we examined the effects of BLT on depression during pregnancy.

DESIGN

Randomised, double-blind controlled trial.

SETTING

Primary and secondary care in The Netherlands, from November 2016 to March 2019.

PARTICIPANTS

67 pregnant women (12-32 weeks gestational age) with a DSM-5 diagnosis of depressive disorder (Diagnostic and Statistical Manual of Mental Disorders).

INTERVENTIONS

Participants were randomly allocated to treatment with either BLT (9000 lux, 5000 K) or dim red light therapy (DRLT, 100 lux, 2700 K), which is considered placebo. For 6 weeks, both groups were treated daily at home for 30 min on awakening. Follow-up took place weekly during the intervention, after 6 weeks of therapy, 3 and 10 weeks after treatment and 2 months postpartum.

PRIMARY AND SECONDARY OUTCOME MEASURES

Depressive symptoms were measured primarily with the Structured Interview Guide for the Hamilton Depression Scale-Seasonal Affective Disorder. Secondary measures were the Hamilton Rating Scale for Depression and the Edinburgh Postnatal Depression Scale. Changes in rating scale scores of these questionnaires over time were analysed using generalised linear mixed models.

RESULTS

Median depression scores decreased by 40.6%-53.1% in the BLT group and by 50.9%-66.7% in the DRLT group. We found no statistically significant difference in symptom change scores between BLT and DRLT. Sensitivity and post-hoc analyses did not change our findings.

CONCLUSIONS

Depressive symptoms of pregnant women with depression improved in both treatment arms. More research is necessary to determine whether these responses represent true treatment effects, non-specific treatment responses, placebo effects or a combination hereof.

TRIAL REGISTRATION NUMBER

NTR5476.

Trajectories of antidepressant drugs during pregnancy: A cohort study from a community-based sample

AIMS

The aim of this study was to monitor the trajectories of antidepressant use during pregnancy and the postpartum period among women chronically treated with antidepressants before their pregnancy, and to assess characteristics associated with each trajectory.

METHODS

This cohort study included all pregnant women whose data were included in the General Sample of Beneficiaries (EGB) database affiliated with the French Health Insurance System, from 2009 to 2014. Women were followed up until 6 months after childbirth. Chronic treatment was defined as exposure over the 6-month period preceding pregnancy. A group-based trajectory model (GBMT) was estimated to identify distinctive longitudinal profiles of antidepressant use.

RESULTS

Among 760 women chronically treated with antidepressants before their pregnancy, 55.8% stopped their treatment permanently in the first trimester, 20.4% discontinued it for a minimum of 3 months and resumed it postpartum, and 23.8% maintained it throughout pregnancy and postpartum. No sociodemographic or medical characteristics were associated with any trajectory group. Women who maintained treatment presented more frequent obstetric complications and postpartum psychiatric disorders. Among women who interrupted treatment, prescription of benzodiazepines and anxiolytics decreased initially but rose postpartum to a higher level than before pregnancy.

CONCLUSIONS

Pregnant women treated with antidepressant require a re-evaluation of psychiatric treatment. It is necessary to pay attention to obstetric complications for severely depressed women. Additionally, as relapse was associated with increased benzodiazepine use, it is important to carefully monitor all women who stop antidepressant treatment during pregnancy.

Dutch trends in the use of potentially harmful medication during pregnancy

Aims

Recent population‐based data on drug utilization around pregnancy are lacking. This study aims to examine the prevalence of drug exposure in the Netherlands during the preconception, pregnancy and postpartum periods, with special emphasis on trends of potentially harmful medication over the years.

Methods

A population‐based study was conducted using records from the PHARMO Perinatal Research Network. From 1999 to 2017, the proportion of pregnancies during which women used any medication or potentially harmful medication was assessed, overall and stratified by timing of exposure relative to pregnancy and by the year of delivery.

Results

Overall, 357 226 (73%) and 166 484 (34%) of 487 122 selected pregnancies were exposed to any and potentially harmful medication, respectively. Among these 487 122 pregnancies, preconception prevalence for use of potentially harmful medication was 43%, 24% during the first trimester, 19% during the second, 16% during the third, and 45% postpartum. A declining trend was observed for exposure to any medication, from 84% in 1999 to 68% in 2017. No clear changes were observed over time for the proportion of pregnancies exposed to potentially harmful medication.

Conclusions

Our study shows that the use of potentially harmful medication was high over the last two decades. Although there was a declining trend over the years in overall medication use, during a steady one‐third of pregnancies, women used potentially harmful medication. Our findings highlight the need for an increased sense of urgency among both healthcare providers and women of reproductive age regarding potential risks associated with pharmacological treatment during pregnancy.

How often do women use non-drug treatment methods for psyschiatric symptoms during pregnancy and postpartum periods?

The aim of this study was to determine the prevalence of complementary and alternative medical applications (CAM) and non-drug treatments of women during their pregnancies, postpartum periods and the changes between these periods. The Screening Form for Non-pharmacologic Methods Used during Pregnancy and Postpartum period was administered to the participants. Passiflora (Incarnata), Hypericum perforatum (St. John's Wort), omega 3 supplements, bright light treatment, transmagnetic stimulation, S-adenosyl- methionine, herbal teas, biofeedback/neurofeedback, amulets, exercise, acupuncture and psychotherapy were investigated. The ratio of the use of one of the CAM methods for psychiatric complaints during people's lifetime was found to be 33.3% (n=162). Herbal teas were the main practice used during pregnancy (58.8%) and the postpartum. The use of CAM according to the utilization periods of the participants statistically significantly decreased in those who were currently pregnant (Cochran's Q=298.007; P<0.05). The use of participants' non-drug treatments in the periodical follow-up decreased in those who are currently pregnant and increased during the postpartum period.

Threatened miscarriage and depressive and anxiety symptoms among women and partners in early pregnancy

BACKGROUND

Antenatal depression has been associated with poor maternal and fetal outcomes, and threatened miscarriage is often seen clinically to impact adversely on maternal wellbeing, notwithstanding the limited research evidence. Our study aims to examine the link between threatened miscarriage and antenatal depression and anxiety in an Asian obstetric population.

METHODS

We recruited 121 women and 68 partners facing threatened miscarriage, and 241 women and 180 partners experiencing uncomplicated pregnancies from a tertiary maternity hospital in Singapore. All participants completed a Patient Information Questionnaire and the Edinburgh Postnatal Depression Scale (EPDS).

RESULTS

The proportion of women with major depressive and anxiety symptomatology was significantly higher among women facing threatened miscarriage compared to those with stable pregnancies (depressive: 33.1% vs. 17.0%, p = 0.008; anxiety: 48.8% vs. 23.7%, p < 0.0001). Amongst their partners, there was a non-significant trend towards a similar finding (depressive: 10.3% vs. 7.2%, p = 0.439; anxiety: 23.5% vs. 18.9%, p = 0.478). Threatened miscarriage remained significantly associated with major depressive symptomatology after adjusting for potential confounders among women (OR 2.70; 95% CI 1.55, 4.71; p < 0.0001) but not among their partners (OR 1.47; 95% CI 0.56, 3.87; p = 0.430).

LIMITATIONS

This study is limited by its cross-sectional design and relatively small sample size for male partners.

CONCLUSION

Antenatal depressive and anxiety symptomatology affects one in four women in their first trimester, with even higher prevalence among women facing threatened miscarriage. Targeted depression and anxiety screening that includes women facing threatened miscarriages may facilitate early and efficient detection and management of mental health problems among pregnant women.

Women With Mental Illness Seeking Assisted Reproduction Considerations in Ethical Candidate Selection

PURPOSE OF REVIEW

This review aims to provide guidance to clinicians facing requests for assisted reproduction from women with mental illness.

RECENT FINDINGS

The paper explores the clinical and safety aspects of initiating fertility treatment in this context, including the use of psychotropic medication and the risk of untreated psychiatric mood or psychotic disorders. It also presents the ethical considerations involved in candidate selection, including treating similar cases equitably to avoid biased decisions based solely on "gut-feelings," respect for women's reproductive autonomy, and an effort to protect patients and prospective fetuses/children from harm by employing optimal strategies regarding medication and psychosocial support. Clinicians ought to be informed regarding recent evidence related to the safety and efficacy of psychopharmacologic treatment of women during pregnancy and the post-partum. They should also carry out a thoughtful ethical analysis to ensure minimal violation of women's reproductive autonomy.

The tip of the iceberg: postpartum suicidality in Israel

Background

Postpartum suicidality, a result of extreme distress or depression, is a tragedy for the woman, infant, and family. Screening for postpartum depression (PPD) is mandatory in Israel, including a question on suicidal ideation. This study presents and analyzes data regarding rates, trends and characteristics of postpartum women who considered, attempted, or completed suicide, to help direct services aimed at preventing these occurrences.

Methods

Suicidal ideation data based on PPD screening was drawn from various publications and databases. Suicide attempt data was obtained from the Emergency Department database for 2006–2015 and matched with the National Birth Registry. Cause of death from the national database for those years were similarly linked to births to identify postpartum suicides and deaths. Postpartum and non-postpartum suicide attempt rates were computed by year, and by age and ethnic/immigrant group. A multivariate logistic model was used to estimate relative risk for postpartum attempts, controlling for age and ethnic group.

Results

Suicidal ideation in recent years has been reported as 1% or less, with higher rates found in studies of Arab women. Suicide attempt rates for non-postpartum women were 3–5 times that of postpartum women, rising over the years, while remaining relatively stable for postpartum women. Adjusted risk of suicide attempt for non-postpartum women was significantly higher; adjusted odds ratio was 4.08 (95% CI 3.75–4.44). It was also significantly higher for Arabs and immigrants from the Former Soviet Union, compared to Israeli-born Jews/veteran immigrants, and for younger women compared to those aged 35–44. Seven postpartum suicides were recorded during 2006–2015, a rate of 0.43 per 100,000 births.

Conclusion

Postpartum suicidality in Israel is low relative to other countries. Although relatively rare and lower than among non-postpartum women, health professionals should be attentive to risk factors, such as past psychiatric disorders, suicide attempts and current emotional distress, particularly among higher-risk populations. The universal screening program for PPD is a valuable opportunity for this, but increased resources should be allotted to implement and utilize it optimally. Prenatal screening should be added as an Israeli Quality Indicator, and postpartum completed suicides should be thoroughly investigated to guide prevention efforts.

Prevalence and Risk Factors for Antenatal Depression in Ethiopia: Systematic Review

INTRODUCTION

Antenatal depression is a syndrome, in which women experience depressed mood, excessive anxiety, insomnia, and change in weight during the period of pregnancy. Maternal depression negatively influences child outcomes and maternal health. Antenatal depression was measured by different rating scales, namely, BDI, EPDS, and PHQ. The objective of this systematic review was to synthesize logical evidence about the prevalence and potential risk factors of antenatal depression in Ethiopia.

METHODS

Our team explored multiple databases including PSYCHINFO, MEDLINE, Embase, Google Scholar, and Google Search to detect studies published with data on the prevalence of antenatal depression. We found 246 research papers on antenatal depression, of which 210 did not correspond to the title and 27 were duplicates. Subsequently, nine articles were used for synthesis prevalence, of which four studies were selected in the analysis of the effect of unplanned pregnancy on antenatal depression. Figures were extracted from published reports and grey literature, and any lost information was requested from investigators. Estimates were pooled using random-effects meta-analyses.

RESULTS

The pooled prevalence of antenatal depression for five studies selected, which had used BDI, was 25.33 (20.74, 29.92). The other four studies that had included other screening tools (3 EPDS and 1 PHQ) had the prevalence decreased to 23.56 (19.04, 28.07), and the pooled effect of unplanned pregnancy on antenatal depression was 1.93 (1.81, 2.06). Factors such as age, marital status, income, occupation, history of the previous mental disorder, antenatal follow-up, unplanned pregnancy, complication during to pregnancy, age of mother during pregnancy, conflict, and social support were associated with antenatal depression.

CONCLUSIONS

Antenatal depression is a common maternal problem; further attention should be given to the effect of unplanned pregnancy, social support, pregnancy-related complications, family conflicts, and violence on pregnant women. All these are possible risk factors for antenatal depression.

Pacifiers and Exclusive Breastfeeding: Does Risk for Postpartum Depression Modify the Association?

BACKGROUND

Postpartum depression is associated with lower rates of breastfeeding. Evidence describing the effect of pacifiers on breastfeeding is inconsistent, and previous research suggests that pacifiers may help vulnerable mothers breastfeed. Research aim: This study aimed to determine (a) how receiving a pacifier in the hospital affects exclusive breastfeeding (EBF) at 1 week and 3 months postpartum and (b) whether this association is modified by risk for postpartum depression (PPD).

METHODS

Data were derived from Listening to Mothers III. We included participants ( n = 1,349) who intended to breastfeed and delivered at term. Mothers were considered at high risk for PPD if they reported feeling the need to receive treatment for depression during pregnancy. We used weighted multivariable logistic regression models to adjust for covariates.

RESULTS

Receiving a pacifier in the hospital was not significantly associated with EBF at 1 week (odds ratio [ OR] = 0.84, 95% confidence interval [CI] [0.62, 1.12]) but was significantly associated with lower odds of EBF at 3 months postpartum ( OR = 0.72, 95% CI [0.54, 0.95]). Risk for PPD modified this association. Among mothers at high risk for PPD, receiving a pacifier was significantly associated with increased odds of EBF ( OR = 3.31, 95% CI [1.23, 8.97] at 1 week and OR = 5.27, 95% CI [1.97, 14.12] at 3 months); however, among mothers who were at lower risk for PPD, receiving a pacifier was associated with decreased odds of EBF ( OR = 0.75, 95% CI [0.56, 1.02] at 1 week and OR = 0.62, 95% CI [0.46, 0.82] at 3 months).

CONCLUSION

Pacifiers may help protect against early cessation of EBF among mothers at high risk for depression. Additional research is needed to better understand this association.

Obstetric risk factors for depression during the postpartum period in South Korea: a nationwide study

OBJECTIVE

Postpartum depression is related to many adverse effects in both mothers and their children; therefore, proper screening and early interventions are needed. This study aims to identify the risk factors of postpartum depression. Our primary focus is on obstetric risk factors.

METHODS

This study is a cross-sectional study which we extracted the data of women who gave birth between January 1st, 2010 and December 31st, 2012 from the Health Insurance Review and Assessment service (HIRA) database. We analyzed the data using multivariable logistic regression models.

RESULTS

A total of 17,483 (1.4%) women suffered from depression during the postpartum period. Younger (<20years) and advanced maternal age (≥35years), primiparity, previous depression, peripartum hysterectomy, uterine artery embolization, preterm delivery, placental abruption, cesarean delivery, induced labor, and preeclampsia were found to increase the likelihood of having depression after delivery.

CONCLUSIONS

Our findings suggest that there are several risk factors that lead women to postpartum depression. Therefore, early detection and well-management of the symptoms and risk factors for postpartum depression along with social support can help both physical and psychological conditions of women after childbirth.

The association between food insecurity and depressive symptoms severity among pregnant women differs by social support category: a cross-sectional study

Common mental disorders, such as depression and anxiety, affect approximately 16% of pregnant women in low- and middle-income countries. Food insecurity (FI) has been shown to be associated with depressive symptoms. It has also been suggested that the association between FI and depressive symptoms is moderated by social support (SS); however, there is limited evidence of these associations among pregnant women living in low-income and middle-income countries. We studied the association between FI and depressive symptoms severity and assessed whether such an association varied among Ugandan pregnant women with low vs. high SS. Cross-sectional data were collected among 403 pregnant women in northern Uganda. SS was assessed using an eight-item version of the Duke-UNC functional SS scale. FI and depressive symptoms were assessed by, respectively, the individually focused FI scale and the Center for Epidemiologic Studies-Depression scale. Women were categorized into two SS groups, based on scoring < or ≥ to the median SS value. Multivariate linear regression models indicated an independent association between FI and depressive symptoms severity. The association between FI and depressive symptoms severity was moderated by SS i.e. was stronger among women in the low SS category (adjusted beta (95%CI): 0.91 (0.55; 1.27)) than for women belonging to the high SS group (0.53 (0.28; 0.78)) (adjusted p value for interaction = 0.026). There is need for longitudinal or interventional studies among pregnant women living in northern Uganda or similar contexts to examine the temporal sequence of the associations among food insecurity, depressive symptoms severity and social support. © 2016 John Wiley & Sons Ltd.

Social support and depression across the perinatal period: A longitudinal study

AIMS AND OBJECTIVES

To report changes in the prevalence of depression and the level of social support at three different time points in the perinatal period (late pregnancy, 1 week postpartum and 4 weeks postpartum) and to examine the relationship between depression and social support at these points in time.

BACKGROUND

Social support is a modifiable factor for depression. Existing research is limited to examining social support at a single time point in relation to antepartum or postpartum depression.

DESIGN

A longitudinal study.

METHODS

In total, 240 pregnant women were recruited from the prenatal clinic at a general hospital in China between June-September 2013. The Edinburgh Postnatal Depression Scale and Perceived Social Support Scale were used to measure the risk of depression and perceived social support at late pregnancy, within the first week postpartum, and at 4 weeks postpartum.

RESULTS

The Perceived Social Support Scale scores within the first week after birth were higher than scores at the late pregnancy and postpartum week 4, while the Edinburgh Postnatal Depression Scale scores at late pregnancy were higher than scores at the two postpartum times. Women who had higher Perceived Social Support Scale scores at late pregnancy had less likelihood of developing antepartum depression, and women with higher Perceived Social Support Scale scores at postpartum week 4 were less likely to have postpartum depression. However, the Perceived Social Support Scale scores at late pregnancy did not predict the risk of postpartum depression.

CONCLUSION

The study revealed that social support perceived by women changed over the perinatal period. Social support at each stage of the perinatal period was an important buffer against depression at this stage.

RELEVANCE TO CLINICAL PRACTICE

An increased focus on the relationship between social support and depression at each stage of the perinatal period is necessary for future research and practice.

Intimate Partner Violence during Pregnancy and Postpartum Depression in Japan: A Cross-sectional Study

Background

The impact of intimate partner violence (IPV) on postpartum depression (PPD) has been reported in various countries by many studies. However, the association between IPV and PPD in Japan has been scarce. In addition to the limited number of research on the relationship between IPV and PPD, the number of women seeking help from IPV support centers has been steadily increasing in Japan. Hence, it is of interest to explore the relationship between IPV during pregnancy and PPD in Japan.

Methods

Four-page questionnaires assessing sociodemographic characteristics, women’s personal situation during pregnancy, and PPD were mailed to participants prior to the checkup and collected at the checkup sites or mailed back to the health center. Of 9,707 eligible mothers, 6,590 responded to a questionnaire at a 3- or 4-month infant health checkup (response rate: 68%). Verbal and physical IPV from partners was assessed with two questions in the questionnaire. Logistic regression analysis was conducted. PPD was evaluated using the Edinburgh Postnatal Depression Scale (EPDS) with a cutoff score of 8/9.

Results

Partners’ verbal and physical abuse during pregnancy was significantly associated with PPD after adjusting for possible confounders. Specifically, odds ratios (ORs) of PPD for women who had been verbally abused by their partners during pregnancy at a frequency of “often” were 4.85 (95% CI, 2.23–10.55). ORs of PPD among women who had been physically abused by their partners during pregnancy at a frequency of “sometimes or often” were 7.05 (95% CI, 2.76–17.98). A positive dose-response relationship between both types of IPV and PPD was statistically significant (both p < 0.001). In addition, about 80% of physically abused women reported being verbally abused as well, indicating that these forms of IPV were highly comorbid.

Conclusion

Both verbal and physical IPV during pregnancy is associated with PPD in Japan. This is the first study investigating the impact of IPV on PPD using a large number of subjects in the country. Further study using the same participants of the current study would allow us to explore the causality between IPV during pregnancy and PPD.

Prevalence of Antenatal Depressive Symptoms and Associated Factors among Pregnant Women in Maichew, North Ethiopia: An Institution Based Study

BACKGROUND

Antenatal depression is one of the common problems during pregnancy with a magnitude of 20% to 30% globally. It can negatively endanger women's and off springs lives. As there are scarce reports on this area in Northern Ethiopia, it is important to carry out different studies that explore the magnitude of the problem and related factors in rural areas. The aim of this study is thus to assess the magnitude of antenatal depressive symptoms and associated factors among women at Maichew Town, North Ethiopia.

METHODS

A facility based cross sectional study was conducted among 196 pregnant women from April to June 2015. Pregnant women who had antenatal care follow-ups at the public health facilities were included in the study. Through proportional allocation to each facility, systematic random sampling technique was used to select the study participants. We used the local language version of Beck Depression Inventory to assess depressive symptoms with a cutoff point of 14 or more. Data was collected by trained Psychiatric Nurses; data entry and analysis were processed by SPSS window 20. The level of significance was determined using odds ratio and 95% confidence interval.

RESULTS

About 16.3% of the participants had never given birth before, and 46.4% and 42.3% were in the third and second trimesters of pregnancy respectively. Unwanted pregnancy was reported by 25.5% of the participants. Among those with previous pregnancy, 7.1% had previous obstetric complication. The magnitude of depression was 31.1%. Pregnant women with low level of income (AOR=3.66 (95%CI; 1.12, 11.96)), unmarried (AOR=4.07 (95% CI; 1.18, 14.04)) and house wives (AOR= 4.24 (1.38, 13.03)) were risk groups for depression.

CONCLUSION

Antenatal depression is a common problem; thus screening activities of depression in antenatal care services should be emphasized with more concern to unmarried women, those with low level of income and house wives.

Mental disorders in pregnancy and 5-8 years after delivery

BACKGROUND

Even though mental disorders represent a major public health problem for women and respective children, there remains a lack of epidemiological longitudinal studies to assess the psychological status of women throughout pregnancy and later in life. This epidemiological cohort study assessed the relationship between mental disorders of 409 Brazilian women in pregnancy and 5-8 years after delivery.

METHODS

The women were followed from 1997 to 2000 at 17 health services, and subsequently from 2004 to 2006 at their homes. Mental disorders were investigated by the Perceived Stress Scale-PSS, General Health Questionnaire-GHQ and State-Trait Anxiety Inventories-STAI. The relationship between scores of the PSS, GHQ and STAI 5-8 years after delivery and in pregnancy was assessed by multivariate linear regression analysis, controlling for the following confounders: maternal age, education, per capita income, family size, work, marital status and body mass index.

RESULTS

Scores of the PSS, GHQ and STAI 5-8 years after delivery were positively associated with scores of the PSS, GHQ and STAI in the three trimesters of pregnancy, and inversely associated with maternal age and per capita income (adj. R2 varied from 0.15 to 0.37). PSS, GHQ and STAI scores in the 3rd trimester of pregnancy were positively associated with scores of the PSS, GHQ and STAI in the 1st and 2nd trimesters of pregnancy (adj. R2 varied from 0.31 to 0.65).

CONCLUSIONS

The results of this study reinforce the urgency to integrate mental health screening into routine primary care for pregnant and postpartum women.

The Effect of Mindfulness-integrated Cognitive Behavior Therapy on Depression and Anxiety among Pregnant Women: a Randomized Clinical Trial

Introduction: Pregnancy can be associated with different psychological problems such as depression and anxiety. These problems are often neglected and left untreated. This study aimed to examine the effect of mindfulness-integrated cognitive behavior therapy on depression and anxiety among pregnant women. Methods: A convenient sample of 80 pregnant women were selected. Participants were randomly allocated to either the experimental or the control groups. Participants in the experimental group received mindfulness-integrated cognitive behavior therapy while women in the control group only received routine prenatal care services. A demographic questionnaire, the Edinburgh Postnatal Depression Scale, and the Beck Anxiety Inventory were used for data collection. Descriptive statistics measures such as frequency, mean, and standard deviation as well as the repeated-measures analysis of variance test were used for data analysis. Results: After the study intervention, the mean scores of anxiety and depression in the experimental group were significantly lower than the control group. Conclusion: Mindfulness-integrated cognitive behavior therapy can significantly alleviate pregnant women's depression and anxiety. So implementation of this method alongside with other prenatal care services is recommended.

Tablet computers for implementing NICE antenatal mental health guidelines: protocol of a feasibility study

INTRODUCTION

Depression is one of the most common mental health disorders that may affect women during pregnancy. The prompt identification of this disorder, and the provision of treatment, may help to reduce the likelihood of post-partum depression, prevent severe forms of the disease, and reduce its intergenerational impact. Despite women's repeated encounters with health services throughout their antenatal care, depression often goes undiagnosed. This is one area where mobile health could prove useful. We will assess the feasibility of using tablets to incorporate depression screening into antenatal pathways. We will also assess if survey layout could affect the quality of the data collected through these devices.

METHODS AND ANALYSIS

We will test the feasibility of using iPad Airs for the administration of the Whooley questions and the Edinburgh Postnatal Depression Scale (EPDS) to pregnant women attending antenatal clinics in England. We will assess the impact of survey layout on the quality of the responses given to these screening scales using a parallel, randomised controlled study design. We will calculate the positive predictive value, the negative predictive value and the false omission rate of the Whooley questions in comparison with the EPDS. We will calculate differences in data equivalence, time needed to complete the surveys, break-off rates, data completeness and requests for help between the 2 experimental groups: using all questions in one screen and navigation by vertical scrolling, or a single question per screen and navigation by multiple pages.

ETHICS AND DISSEMINATION

This study has been approved by the National Research Ethics Service Committee South East Coast--Surrey. Our findings will be disseminated through academic peer-reviewed publications, conferences and discussion with peers.