Postpartum depression during the COVID-19 pandemic: an umbrella review and meta-analyses

Improving inpatient postpartum depression screening: results from a quality improvement initiative

PURPOSE

Screening is necessary to identify patients with postpartum depression or anxiety and facilitate access to mental healthcare. This study evaluated a quality improvement initiative for inpatient postpartum depression screening, which was implemented to better identify patients in need of mental healthcare. This initiative replaced the Patient Health Questionnaire (PHQ-9) administered verbally by nurses with the Edinburgh Postnatal Depression Scale (EPDS-10) self-administered by patients via iPads.

METHODS

Electronic medical records for patients who delivered June 2020-October 2023 at Cedars-Sinai were analyzed (N = 17,403). Differences in completed screenings, positive depression screenings, suicidal ideation, and social work referrals before and after the initiative were examined with chi-square tests and multiple logistic regression models. Factors associated with positive anxiety screenings on the EPDS-10 were also identified.

RESULTS

Overall, 98.6% of patients completed depression screenings. Among those who completed screenings, positive depression screenings increased from 4.0 to 11.4%, identified suicidal ideation increased from 0.2 to 1.1%, and social work referrals increased from 64.1 to 84.0%, before and after the initiative. Post-initiative, patients had higher odds of positive depression screenings, indicating suicidal ideation, and receiving social work referrals compared to pre-initiative. Among those who completed EPDS-10 screenings, 31% were positive for anxiety.

CONCLUSIONS

Compared to the PHQ-9 administered verbally by nurses, the EPDS-10 self-administered by patients via iPads resulted in higher rates of positive depression screenings, identified suicidal ideation, and social work referrals. It is imperative to accurately screen patients for postpartum depression and anxiety to facilitate access to mental healthcare and address morbidity and mortality.

CLINICAL TRIAL NUMBER

Not applicable.

Predictors of Postpartum Depression in Korean Women: A National Cross-Sectional Study During the COVID-19 Pandemic

BACKGROUND/OBJECTIVES

Postpartum depression (PPD) affects maternal well-being and infant development, with the COVID-19 pandemic exacerbating mental health challenges for new mothers. This study examined the prevalence and predictors of PPD among Korean mothers in the early postpartum period.

METHODS

A nationwide cross-sectional study was conducted in South Korea from 10 September 2021. A two-stage stratified cluster sampling method recruited 3127 mothers who gave birth between January and December 2020. Data collection included the Edinburgh Postnatal Depression Scale (EPDS) and assessments of sociodemographic, pregnancy-related, infant health, and paternal involvement factors.

RESULTS

The prevalence of PPD (EPDS score ≥ 13) was 26.5%. Risk factors included a history of depression during pregnancy (OR = 8.65, p < 0.001), multiparity (OR = 1.03, p = 0.012), and frequent infant medical treatments (OR = 1.04, p < 0.001). Protective factors included better maternal health (OR = 0.36, p < 0.001), longer postpartum care (OR = 0.99, p < 0.001), enhanced postpartum education (OR = 0.97, p < 0.001), positive infant health perception (OR = 0.44, p < 0.001), and greater paternal involvement (OR = 0.97, p < 0.001).

CONCLUSIONS

PPD is influenced by multiple factors, including maternal health, infant well-being, and paternal support. Routine screening and tailored interventions are essential to improve maternal mental health. Policies promoting holistic postpartum care and paternal involvement should be prioritized, especially during global crises like COVID-19.

"VID-KIDS" Video-Feedback Interaction Guidance for Depressed Mothers and Their Infants: Results of a Randomized Controlled Trial

VID-KIDS (Video-Feedback Interaction Guidance for Depressed Mothers and their Infants) is a positive parenting programme comprising three brief nurse-guided video-feedback sessions (offered in-person or virtually via Zoom) that promote "serve and return" interactions by helping depressed mothers to be more sensitive and responsive to infant cues. We examined whether mothers who received the VID-KIDS programme demonstrated improved maternal-infant interaction quality. The secondary hypotheses examined VID-KIDS' effects on maternal depression, anxiety, perceived parenting stress, infant developmental outcomes, and infant cortisol patterns. A parallel group randomized controlled trial (n = 140) compared the VID-KIDS programme to standard care controls (e.g., a resource and referral programme). The trial was registered in the US Clinical Trials Registry (number NCT03052374). Outcomes were assessed at baseline, nine weeks post-randomization (immediate post-test), and two months post-intervention. Maternal-infant interaction quality significantly improved for the intervention group with moderate to large effects. These improvements persisted during the post-test two months after the final video-feedback session. No significant group differences were detected for secondary outcomes. This study demonstrated that nurse-guided video-feedback can improve maternal-infant interaction in the context of PPD. These findings are promising, as sensitive and responsive parenting is crucial for promoting children's healthy development.