Chinese Women's Acceptance and Uptake of Referral after Screening for Perinatal Depression

Status and Perceived Barriers of Psychological Help-Seeking Behaviors for Perinatal Depressive Symptoms Among Chinese Women: A Cross-Sectional Study

PURPOSE

To investigate attitudes, intentions, and behaviors toward seeking professional psychological help among Chinese perinatal women with depressive symptoms, and further identify influencing factors and perceived barriers to such help-seeking.

METHOD

Individuals who were pregnant or within 42 days postpartum were recruited from two tertiary hospitals in Hunan Province, China. A comprehensive questionnaire and list of possible perceived barriers to seeking psychological help were collected from participants.

RESULTS

The prevalence of perinatal depressive symptoms was 28%, with only 11.3% of participants having sought psychological help. The most frequent perceived barriers to seeking psychological help were lack of knowledge of perinatal depressive symptoms and negative attitudes about perinatal depressive symptoms and psychological help-seeking.

CONCLUSION

Participants had low levels of professional psychological help-seeking behaviors. Further studies should explore this mechanism and develop interventions targeting perceived barriers. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Factors influencing the intention of women with perinatal depression and their spouses to seek professional psychological help: a cross-sectional latent profile analysis

Background

Seeking professional psychological help can improve outcomes for women with perinatal depression (PND). However, the use of professional psychological help-seeking behaviors for women with PND is not promising. Spouses are important sources of support and play a decision-making role in the process of seeking professional psychological help for women with PND. Exploring the factors that influence couples' intention to seek professional psychological help is important for developing effective interventions. This study aims to investigate the level and latent profiles of intention to seek professional psychological help in women with PND and their spouses, and identify influencing factors associated with different profiles.

Methods

A cross-sectional study involving 267 women with PND and 267 spouses was conducted. The General Help-Seeking Questionnaire-the Intention to Seek Professional Psychological Help (GHSQ-ISPH), the Questionnaire of Stigma for Seeking Professional Psychological Help Questionnaire, the Attitude Toward Seeking Professional Psychological Help Scale, the Self-Efficacy for Seeking Mental Health Care Help Scale and the Edinburgh Postnatal Depression Scale were used. Latent profile analysis was used to identify groups with similar levels of GHSQ-ISPH. Multiple logistic regression was used to explore influencing factors associated with the intention to seek professional psychological help.

Results

The mean GHSQ-ISPH scores of women with PND and their spouses were 12.17 ± 4.06 and 12.61 ± 3.88, respectively. LPA yielded three profiles. The profiles were named based on the GHSQ-ISPH score to reflect the level to which women with PND and their spouses intend to seek professional psychological help: "Women low-Spouses high intention for help" (Profile 1), "Women high-Spouses low intention for help" (Profile 2) and "Couple high intention for help" (Profile 3). Multiple logistic regression showed that spouses with a monthly income (858-1285/USD), with lower openness to seeking treatment for emotional problems, lower knowledge competence beliefs, and negative attitudes toward seeking professional psychological help were significantly associated with Profile 2 than with Profile 3 (P < 0.05 or P < 0.001). PND women who received a university or college and with lower public stigma were more significantly related to Profile 1 than Profile 3 (P < 0.05).

Conclusion

The findings of this study indicate a moderate level of intention to seek professional psychological help among women experiencing PND and their partners. These results offer valuable insights for perinatal nurses, suggesting the necessity for the development of targeted interventions aimed at enhancing couples' intentions to pursue professional psychological support. Identifying the factors associated with each profile outlined in this research offers the opportunity for more personalized and effective interventions. Tailored approaches like these could substantially enhance engagement with mental health resources, leading to improved outcomes for couples affected during the perinatal period.

Effect of the thinking healthy programme-based internet intervention model for maternal perinatal depression: A pilot study

BACKGROUND

Thinking Healthy Programme (THP) is an evidence-based psychosocial intervention that can be delivered by non-psychologists and does not require the implementer to have a mental health background or field experience. The THP has been tested in maternal health in many countries. However, the application of the THP model in Chinese maternal and child health has not been reported.

OBJECTIVE

This study aimed to explore the feasibility of the Thinking Healthy Programme (THP) model for improving perinatal depressive symptoms and infant growth when implemented by non-psychologists (e.g., nurses) for Chinese pregnant women.

METHODS

122 pregnant women with Edinburgh Postnatal Depression Scale (EPDS) ≥ 10 were selected from a tertiary hospital in Fujian Province between January 2022 to May 2022. Participants were randomly assigned to the intervention group (n = 61) and the control group (n = 61). The intervention group received the THP-based online delivery intervention and enhanced usual care (EUC), while the control group only received EUC. The outcomes were maternal depressive symptoms, infant growth, and other maternal and infant outcomes. Outcomes were assessed at baseline (during pregnancy), 3 months postpartum, and 6 months postpartum.

RESULTS

The Generalized Linear Mixed Model (GLMM) showed that there were significant time effects for EPDS scores and PHQ-9 scores between the two groups over time (p < 0.001, p = 0.040). The depression subscale of EPDS and PHQ-9 scores decreased significantly only within the intervention group between 6 months postpartum and baseline (p = 0.003, p = 0.023), the comparison group did not. Compared with the control group, the intervention group had a statistically significantly longer breastfeeding time (5.52 ± 1.25 vs. 4.50 ± 1.69, p = 0.012) at 6 months postpartum, and a lower absolute value of BMI-for-age z-score at post intervention and follow up post intervention (3 and 6 months post-delivery) (-0.87 ± 1.41 vs. -1.41 ± 2.53, p = 0.229; -0.14 ± 1.19 vs. -0.29 ± 1.11, p = 0.539) although no statistically significant difference.

LIMITATIONS

This study had several limitations. First, it was a single-center study and the sample size was small, which may limit the results. This finding needs to be confirmed by further large multicenter studies. Second, the outcomes were based on maternal self-report alone, which was subjected to social desirability and recall bias. Third, the study only monitored the effects up to the 6-month endpoint. Future studies should incorporate a longer-term evaluation of its effects on infant behavioral and temperament outcomes.

CONCLUSION

The THP-based online delivery intervention model helped to improve maternal perinatal depressive symptoms, with important benefits for improving maternal and infant health. This suggested the feasibility for non-psychologists to implement the THP model.

Uptake rate of interventions among women who screened positive for perinatal depression: A systematic review and meta-analysis

BACKGROUND

Perinatal depression is a global public health problem that seriously affects the health of perinatal women. This study evaluated the pooled uptake rate of interventions among women who screened positive for perinatal depression to provide a basis for clinical intervention.

METHODS

We systematically searched four databases (PubMed, Embase, Cochrane Library and Web of Science) from the establishment of the database to May 1, 2023. All included studies were used to derive the pooled uptake rate. We also performed meta-regression and subgroup analysis to explore the potential sources of heterogeneity using STATA 17.0.

RESULTS

Of 15024 retrieved articles, only 41 met the inclusion criteria. The overall uptake rate was 55 % (95 % CI 43-67 %). Meta-regression and subgroup analyses both showed that the uptake rate in high-income countries 57 % (95 % CI 50-65 %) was higher than that in low and middle-income countries 37 % (95 % CI 18-56 %).

LIMITATIONS

First, only English publications were included. Therefore, articles in other languages were likely missed. Second, of the 41 studies included, there were only six randomized controlled trials, with limited quality of evidence. Third, we could not adequately explain the source of heterogeneity because there were too many mediating variables, although further subgroup and sensitivity analysis were performed.

CONCLUSIONS

About a half of women did not receive interventions after screening positive, and the uptake rate of interventions in high-income countries was higher than that in low and middle-income countries.

The big heroine genre: motherhood and the maternal body in postsocialist Chinese television

This article explores the feminist social critique in the 'big heroine' drama, a newly emerged genre of television that focuses on empowering yet dramatic stories of urban women in contemporary China. The article theorises the genre as a site of ongoing contestations to inform and critique women's maternal reality in neoliberal, pronatalist China. The big heroine genre is situated in the postsocialist structure of feeling defined by alienation and precarity, responding to China's need to stabilise the emerging population crisis and labour shortage. Using a popular instance within the genre, Left Right (2022), as a case study, the article argues that the show validates the legitimacy of women's anxieties and challenges in maternity and then invites viewers to engage in a multifaceted analysis of the intricate web of structural injustices women experience in pregnancy, childbirth, the postpartum and having a second child. By doing so, it not only resonates with viewers' yearning for recognition and empathy but also stimulates a broader discourse on new and persisting maternal challenges in pronatalist China. I conclude that the genre's contradictory and contingent nature mirrors the complexities of the Chinese party-state's attempt to navigate the ideological instability surrounding maternity and motherhood. The genre is progressive in its alternative imagination of kinship and care networks for women navigating the moral, medical, and cultural dilemmas of the maternal body and motherhood in the moment of the state's transitioning into a more aggressive form of pronatalism.

An Evaluation of the Health Economics of Postnatal Depression Prevention and Treatment Strategies in China: A Cost-Effectiveness Analysis

OBJECTIVE

The primary objectives of this study are to assess the cost-effectiveness of early postnatal screening and prenatal psychological interventions for the prevention and treatment of postpartum depression (PPD) among Chinese pregnant women. Additionally, we aim to explore the most cost-effective prevention and treatment strategies for PPD in China.

METHODS

We used TreeAge 2019 to construct a decision tree model, with the model assuming a simulated queue size of 10,000 people. The model employed Monte Carlo simulation to assess the cost-effectiveness of PPD prevention and treatment strategies. Transfer probabilities were derived from published studies and meta-analyses. Cost and effectiveness data were obtained from published sources and relevant studies. Incremental cost-effectiveness ratios (ICERs) were used to describe the results, with willingness-to-pay (WTP) thresholds set at China's gross domestic product (GDP) per capita.

RESULTS

Compared to the usual care group, the cost per additional quality-adjusted life year (QALY) for the early postnatal screening group and the prenatal psychological interventions is USD 6840.28 and USD 3720.74, respectively. The cure rate of mixed treatments for PPD has the greatest impact on the model, while patient participation in treatment has a minor impact on the cost-effectiveness of prevention and treatment strategies.

CONCLUSION

Both early postnatal screening and prenatal psychological interventions are found to be highly cost-effective strategies for preventing and treating PPD in China. Prenatal psychological interventions for pregnant women are the most cost-effective prevention and treatment strategy. As such, from the perspective of national payers, we recommend that maternal screening for PPD be implemented in China to identify high-risk groups early on and to facilitate effective intervention.

Stigma and its influencing factors for seeking professional psychological help among pregnant women: A cross-sectional study

BACKGROUND

Although the stigma associated with seeking professional psychological help has received significant attention, few studies have focused on the status and factors influencing this stigma among pregnant women, especially those with a Chinese cultural background. This study aimed to assess the status of stigma associated with seeking professional psychological help and its influencing factors.

METHODS

A total of 1325 pregnant women were recruited from Hunan Province, China. The Stigma for Seeking Professional Psychological Help questionnaire, Patient Health Questionnaire-9, Perceived Social Support Scale, Simplified Coping Style Questionnaire, and questionnaires on sociodemographic characteristics and pregnancy-related information were used. Descriptive, univariate, correlation, and multivariate linear regression analyses were used to investigate the status of stigma and identify its influencing factors.

FINDINGS

Pregnant Chinese women experienced a mild to moderate level of stigma associated with seeking professional psychological help, and self-stigma was more common than social stigma associated with seeking psychological help. The results of the multivariate analysis suggested that perceived social support, positive coping styles, negative coping styles, and depressive symptoms were the factors influencing self-stigma and social stigma associated with seeking professional psychological help. Advanced age and a low educational level were the only predictors associated with self-stigma, while a history of multiple pregnancies had an effect only on social stigma associated with seeking professional psychological help.

CONCLUSION

Chinese pregnant women experienced a mild to moderate level of stigma associated with seeking professional psychological help. Destigmatizing interventions focusing on self-stigma and social stigma should be designed according to maternal characteristics, social support, coping style, and depressive symptoms.

Postpartum quality of life and mental health in women with heart disease: Integrated clinical communication and treatment

BACKGROUND

Postpartum quality of life (QoL) in women with heart disease has been neglected.

AIM

To improve clinical communication and treatment, we integrated medical data and subjective characteristics to study postpartum QoL concerns.

METHODS

The study assessed QoL 6 wk after birth using the 12-Item Short-Form Health Survey. The Edinburgh Postnatal Depression Scale, Cardiac Anxiety Questionnaire, European Heart Failure Self-Care Behavior Scale, and a self-designed questionnaire based on earlier research were also used to assess patient characteristics. Patient data were collected. Prediction models were created using multiple linear regression.

RESULTS

This retrospective study examined postpartum QoL in 105 cardiac patients. Postpartum QoL scores were lower (90.69 ± 13.82) than those of women without heart disease, with physical component scores (41.09 ± 9.91) lower than mental component scores (49.60 ± 14.87). Postpartum depression (33.3%), moderate anxiety (37.14%), pregnancy concerns (57.14%), offspring heart problems (57.14%), and life expectancy worries (48.6%) were all prevalent. No previous cardiac surgery, multiparity, higher sadness and cardiac anxiety, and fear of unfavorable pregnancy outcomes were strongly related to lower QoL (R2 = 0.525).

CONCLUSION

Postpartum QoL is linked to physical and mental health in women with heart disease. Our study emphasizes the need for healthcare workers to recognize the unique characteristics of these women while developing and implementing comprehensive management approaches during their maternity care.

Developing and evaluating an interprofessional shared decision-making care model for patients with perinatal depression in maternal care in urban China: a study protocol

BACKGROUND

The majority of patients with perinatal depression (PND) in China do not receive adequate treatment. As forming a therapeutic alliance with patients is crucial for depression treatment, shared decision-making (SDM) shows promise in promoting patients' uptake of evidence-based mental health services, but its impact on patient outcomes and implementation in real-world maternal care remain uncertain. Therefore, this study aims to develop and evaluate an interprofessional shared decision-making (IP-SDM) model for PND to enhance maternal mental health services.

METHODS

This study contains four research phases: feasibility testing (Phase 1), toolkit development (Phase 2), usability evaluation (Phase 3), and effectiveness evaluation (Phase 4). During the development stage, focus group interviews will be conducted with expectant and new mothers, as well as maternal care providers for feasibility testing. A toolkit, including a patient decision aid along with its user guide and training materials, will be developed based on the findings of Phase 1 and syntheses of up-to-date evidence and appraised by the Delphi method. Additionally, a cognitive task analysis will be used for assessing the usability of the toolkit. During the evaluation stage, a prospective randomized controlled trial embedded in a mixed methods design will be used to evaluate the effectiveness and cost-effectiveness of the IP-SDM care model. The study targets to recruit 410 expectant and new mothers who screen positive for depression. They will be randomly assigned to either an intervention group or a control group in a 1:1 ratio. Participants in the intervention group will receive decision aid, decision coaching, and clinical consultation, in addition to usual services, while the control group will receive usual services. The primary outcome is the quality of decision-making process, and the secondary outcomes include SDM, mental health service utilization and costs, depressive symptoms, and health-related quality of life. In-depth interviews will be used to explore the facilitating and hindering factors of SDM.

DISCUSSION

This study will develop an IP-SDM care model for PND that can be implemented in maternal care settings in China. This study will contribute to the understanding of how SDM impacts mental health outcomes and facilitate the integration of mental health services into maternal care.

TRIAL REGISTRATION

ChiCTR2300072559. Registered on 16 June 2023.

Identifying the common elements of psychological and psychosocial interventions for preventing postpartum depression: Application of the distillation and matching model to 37 winning protocols from 36 intervention studies

AIM

Postpartum depression is prevalent worldwide and seriously endangers maternal and child health. Previous studies have demonstrated the effectiveness of psychological and psychosocial intervention programmes in preventing postpartum depression. However, the literature offers limited practice guidance. Therefore, this study aimed to deeply analyse prior findings to gather rich evidence-based information on this topic.

METHODS

Using the distillation and matching model, we conducted a systematic review of psychological and psychosocial interventions used to effectively prevent postpartum depression. Four researchers trained in coding system independently read eligible studies and identified reliable (Cohen's kappa >0.40) and frequently occurring (frequency ≥3 winning study groups) practice elements.

RESULTS

Our review included 36 studies containing 37 winning study groups. Fourteen practice elements were identified and subsequently divided into six categories: postpartum practical problems-related, social support-related, interpersonal psychotherapy-related, cognitive behavioural therapy-related, labour trauma-related and non-specific techniques. The most common practice elements were baby care skills and mother-infant bonding/interaction enhancement. Inter-rater reliability averaged 0.86, ranging from 0.48 to 1.

CONCLUSION

The practice elements identified in this study provide rich evidence-based information that can guide clinical practitioners in selecting or developing effective, realistically available intervention programmes.

Attitudes and intentions toward seeking professional psychological help among Chinese healthcare workers during the COVID-19 pandemic

Background

It has been suggested that healthcare workers (HCWs) are experiencing massive stressors that threaten their mental health during the COVID-19 pandemic, but little is known about their attitudes and intentions toward seeking professional psychological help. This study aimed to investigate the attitudes and intentions of Chinese HCWs toward seeking professional psychological help during the COVID-19 pandemic and the associated factors.

Methods

A total of 1,224 Chinese HCWs working in hospitals were recruited online from 12 hospitals in Hunan province in China for a survey conducted in November 2022. The Chinese version of the attitudes toward seeking professional psychological help scale-short form (ATSPPH-SF) and the general help-seeking questionnaire (GHSQ) were separately used to assess the attitudes and intentions of the respondents toward seeking professional psychological help. Demographic and socio-psychological data were collected using a self-developed questionnaire, the perceived social support scale, the self-stigma of seeking help scale, and the patient health questionnaire-9 scale.

Results

The 1,208 HCWs in the final analysis showed relatively negative attitudes and low intentions toward seeking professional psychological help during the COVID-19 pandemic. Results of the multiple linear regression analysis showed that female sex (p = 0.031), experience of psychological learning (p < 0.001), and social support (p < 0.001) had a positive predictive effect on the attitudes of these HCWs toward seeking professional psychological help, whereas self-stigma of seeking help (p < 0.001) and depressive symptoms (p < 0.001) exerted negative effects. Moreover, experience of psychological learning (p = 0.004) and social support (p < 0.001) had a positive predictive effect on the intentions of these HCWs toward seeking professional psychological help, whereas divorced marital status (p = 0.011) and self-stigma of seeking help (p < 0.001) exerted negative effects.

Conclusion

The overall attitudes and intentions of HCWs toward seeking professional psychological help were not optimistic. Effective interventions targeted at influencing factors should be formulated to promote the professional psychological help-seeking attitudes and intentions of HCWs who are at risk of developing mental health problems.

Interventions to increase help-seeking for mental health care in low- and middle-income countries: A systematic review

Mental health problems are a significant and growing cause of morbidity worldwide. Despite the availability of evidence-based interventions, most people experiencing mental health problems remain untreated. This treatment gap is particularly large in low- and middle-income countries (LMIC) and is due to both supply-side and demand-side barriers. The aim of this systematic review is to identify and synthesise the evidence on interventions to improve help-seeking for mental health problems in LMICs. The protocol was registered a priori (Registration number: CRD42021255635). We searched eight databases using terms based on three concepts: 'mental health/illness' AND 'help-seeking' AND 'LMICs'; and included all age groups and mental health problems. Forty-two papers were eligible and included in this review. Intervention components were grouped into three categories following the steps in the help-seeking process: (1) raising mental health awareness among the general population (e.g., distribution of printed or audio-visual materials), (2) identification of individuals experiencing mental health problems (e.g., community-level screening or detection), and (3) promoting help-seeking among people in need of mental health care (e.g., sending reminders). The majority of interventions (80%) included components in a combination of the aforementioned categories. Most studies report positive outcomes, yet results on the effectiveness is mixed, with a clear trend in favour of interventions with components from more than one category. Ten out of 42 studies (24%) yielded a statistically significant effect of the intervention on help-seeking; and all targeted a combination of the aforementioned categories (i.e., raising awareness, identification and help-seeking promotion). Only six studies (14%) focused on children and adolescents. Due to the limited number of robust studies done in LMICs and the heterogeneity of study designs, outcomes and components used, no definite conclusions can be drawn with regards to the effects of individual strategies or content of the interventions.

Postpartum depression literacy in Chinese perinatal women: a cross-sectional study

Background

Postpartum depression literacy is a specific mental health literacy that can help perinatal women identify, manage, and prevent postpartum depression. However, the current status and associated factors of postpartum depression literacy among Chinese perinatal women are still unclear. This study investigated postpartum depression literacy and its associated factors among this group.

Methods

A cross-sectional survey was conducted involving 386 cases of perinatal women using the convenience sampling method. Participants completed four questionnaires to evaluate their general characteristics, postpartum depression literacy, perceived social support, and general self-efficacy. The SPSS 24.0 software was used for descriptive statistical analysis, univariate analysis, and multivariate analysis.

Results

The total PoDLiS score was (3.56 ± 0.32). The factors that composed the final multiple regression equation included planned pregnancy condition (β = -0.137, p = 0.003), education (β = 0.127, p < 0.001), history of depression (β = -0.271, p < 0.001), social support (β = 0.0012, p < 0.001), self-efficacy (β = 0.030, p < 0.001), and complications (β = -0.0191, p = 0.0019). They accounted for 32.8% of the total postpartum depression literacy variation (R² = 0.328, F = 24.518, p < 0.001).

Conclusion

The findings of this study improved our understanding of perinatal women's postpartum depression literacy and its associated factors. Women with low postpartum depression literacy urgently need to be identified. Comprehensive nursing intervention measures should be taken from six dimensions of mental health literacy, social support, and self-efficacy to improve the postpartum depression literacy of perinatal women.

Barriers and facilitators for referring women with positive perinatal depression screening results in China: a qualitative study

BACKGROUND

Timely screening and referral can improve the outcomes of perinatal depression (PND). However, uptake rates of referral after PND screening are low in China and the reasons are unclear. The aim of this article is to explore the barriers and facilitators for referring women with positive results of PND screening in the Chinese primary maternal health care system.

METHODS

Qualitative data were collected from four primary health centers located in four different provinces of China. Each of the four investigators conducted 30 days of participant observations in the primary health centers from May to August 2020. Data were collected via participant observations and semi-structured in-depth interviews with new mothers who had positive results of PND screening, their family members, and primary health providers. Two investigators analyzed qualitative data independently. A thematic analysis was conducted, and data were framed using the social ecological model.

RESULTS

A total of 870 hours of observation and 46 interviews were carried out. Five themes were identified: individual (new mothers' knowledge of PND, perceived need to seek help), interpersonal (new mothers' attitudes towards providers, family support), institutional (providers' perception of PND, lack of training, time constraints), community (accessibility to mental health services, practical factors), and public policy (policy requirements, stigma).

CONCLUSIONS

The likelihood of new mothers accepting PND referral is related to factors in five areas. Intervention strategies can be developed around these themes and may include educating new mothers and their families about PND, training primary health providers to improve their awareness of condition and indication for referral, building mental health support in routine postpartum home visits, and providing support through mobile technology.

Attitudes toward seeking professional psychological help among Chinese pregnant women: A cross-sectional study

BACKGROUND

There exists a gap between the high prevalence of mental health problems and negative attitudes toward seeking professional psychological help among Chinese pregnant women. This study aimed to investigate the attitudes and factors toward seeking professional psychological help among Chinese pregnant women to provide some suggestions for improving pregnant women's psychological help-seeking behaviors.

METHODS

A total of 1024 pregnant women were recruited. The Chinese version of the Attitude Toward Seeking Professional Psychological Help Scale (ATSPPH) was used to assess the attitudes toward professional psychological help-seeking. Demographic and socio-psychological factors were collected by self-developed questionnaire, Perceived Social Support Scale, Simplified Coping Style Questionnaire, and Patient Health Questionnaire-9 Scale.

RESULTS

1006 pregnant women were included in the final analysis. Only 3.7 % of participants chose professionals as their first choice for psychological help-seeking. The attitudes toward seeking professional psychological help were relatively positive, with the highest score of stigma tolerance among four subscales in ATSPPH. Education level, perceived social support, and positive coping style had a positive predictive effect on the four subscales of ATSPPH. Women with prenatal depressive symptoms had a lower score in the subscales of recognition of need for psychotherapeutic help and confidence in mental health practitioner; women with higher scores of negative coping style had a lower score in the subscales of stigma tolerance and interpersonal openness. History of professional psychological help-seeking behaviors was only associated with the subscale of recognition of need for psychotherapeutic help; Maternal age was only associated with the subscale of interpersonal openness.

CONCLUSION

The attitudes toward seeking professional psychological help were relatively positive among Chinese pregnant women, and stigma tolerance was the significant barrier to professional psychological help-seeking. More attention should be paid to those women with older age, negative coping style, and women with prenatal depressive symptoms.

Group-Based Trajectory Analysis for Postpartum Depression Symptoms among Chinese Primiparous Women

Background: Subgroups of individuals sharing similar patterns of postpartum depression (PPD) among Chinese women are unknown thus far. Using a group-based trajectory model, this study aimed to explore the subgroups of Chinese primiparous women that share similar patterns of PPD and to explore the predictors of PPD trajectory membership over the course of the first six months postpartum. Methods: In total, 674 first-time Chinese mothers were recruited, and their depression status was assessed using the Edinburgh Postnatal Depression Scale (EPDS) at four time points. Findings: Around 18.0% of participants belonging to Group 1 labeled as “few or no symptoms” remained stable, with an EPDS score of less than 5 during a six-month postpartum period. Almost one-third of subjects fell within the second trajectory, labeled “subclinical but present symptoms”, and peaked into the range of mild PPD but mostly stayed in the minimal range and had few or no PPD symptoms. Group 3 included 31.2% of women labeled “minor PPD status”, and their mean EPDS scores increased to a peak of 14.66 at six weeks postpartum. Group 4, with “major PPD status”, comprised 19.2% of the population, and the mean EPDS scores dramatically increased, reaching a peak of 19.59 at 12 weeks postpartum. Fewer types of support and not attending parenting training were associated with membership in the minor and major PPD status trajectories. Conclusions: Almost half of the Chinese new mothers in the study were found to fall into the two groups with minor or major PPD status trajectories, who should be given more attention and awareness from health professionals and researchers. Understanding predictors of group membership could help health providers to identify folks to prioritize getting connected to care as well as forming targeted interventions. Less degree of received support and not attending parenting training were identified to predict PPD trajectory membership. The regular, routine screening of PPD should be conducted at least 12 weeks postpartum, especially for new mothers in the major PPD status trajectory.

Towards Universal Screening for Postpartum Depression in China: Lessons Learned from a Comprehensive Prevention Programme in Shenzhen

PURPOSE

This study was conducted to assess the real-world efficacy of a universal programme for the prevention of postpartum depression (PPD) in Shenzhen. Given the lack of evidence on routine PPD screening and intervention in China, it sought to provide insights for programme planning and implementation, particularly in relation to achievement of the targets set by the first national guidelines for PPD prevention and treatment.

METHODS

Using routine health information system data, the PPD screening, referral and intervention rates for 2015-2019 were calculated and compared to the programmes targets. Trends of variables were tested by using trend χ².

RESULTS

The programme screened 137,761 to 178,857 women for PPD every year with the coverage among all postpartum women increased steadily from 71.1% to 82. 5% (χ² = 10145.251, p < 0.001). The PPD-positive rate maintained between 4.06% and 4.89%. However, although referral messages were given to an increased percentage of PPD-positive women (χ² = 1090.908, p < 0.001), the intervention rate (i.e., referral uptake) were far lower than the programme target of 80%.

CONCLUSIONS

This study demonstrated high efficacy of Shenzhen's comprehensive PPD prevention programme initiated in 2013. The resultant rise in the screening rate among all postpartum women, together with a high referral rate of those screened positive, have contributed to the city's relatively low PPD prevalence. PPD screening and intervention should be included as part of basic public health services to ensure universal coverage and specific strategies should be adopted to ensure referral uptake.

Online and Offline Intervention for the Prevention of Postpartum Depression among Rural-to-Urban Floating Women: Study Protocol for a Randomized Control Trial

Background: As a higher-risk group of postpartum depression (PPD), rural to urban floating women urgently require effective and accessible mental health care after childbirth to prevent PPD. Even though there were various interventions, only a small number of women have sought professional help to reduce their depressive symptoms after childbirth, suggesting the need for an innovative intervention delivery to overcome women’s help-seeking barriers. Online and offline (OTO) interventions, which combine face-to-face and internet-based interventions, provide apparent benefits. As a result, the protocol for a randomized controlled study (RCT) was designed to examine the effectiveness and acceptability of OTO intervention on psychosocial outcomes for Chinese rural-to-urban floating women including the reduction of PPD symptoms and PPD stigma, and the improvement of social support and quality of life. Methods: A double blind, multicenter, RCT will be used and a total of 226 participants will be recruited. The OTO intervention called the “Hi, Mom” program will integrate two face-to-face consulting sessions with online sessions comprising an information module, a communication module, an ask-the-expert module, and a peer story module over a period of three months. The control group will receive routine postpartum care. Outcome measures including PPD symptoms, PPD stigma, social support, quality of life, mother–child bonding, and satisfaction with health care received will be conducted at baseline, postintervention, and three-month follow-up. Results and Discussion: If the intervention is effective, it will provide a convenient and effective intervention program on postpartum mental well-being for rural-to-urban floating women. As the first study to test the effects of an OTO intervention for the prevention of PPD in China, the outcomes gained from this study will provide evidence-based knowledge for clinical practice on PPD prevention based on online and offline health technologies. Moreover, it could be used to plan a culturally appropriate OTO intervention for migrant mothers from different countries.

Pregnancy-Related Stress Among Pregnant Women Receiving Tocolytic and Non-Tocolytic Treatments Where Both Used Complementary Medicine

Objective: This study aimed to compare the pregnancy stress among pregnant women in receiving tocolytic and non-tocolytic treatments where both used complementary medicine.

Methods: A cross-sectional survey was conducted among 35 pregnant women receiving tocolytic treatment and 35 receiving non-tocolytic treatment, where both used complementary medicine in a medical center in central Taiwan. A basic information questionnaire that contained demographic variables and types of complementary medicine used and the Pregnancy Stress Rating Scale were used for the analysis.

Results: The types of complementary medicines were surveyed using the multiple-choice questionnaire. Natural products (77.5%) were most commonly used by pregnant women receiving tocolytic treatment, followed by alternative medicine (13.75%), manipulative and body-based practices (5%), and mind and body medicine (3.75%). In pregnant women who were receiving non-tocolytic treatment, natural products (59.1%) were most commonly used, followed by manipulative and body-based practices (16.4%), alternative medicine (15.4%), mind and body medicine (7.3%), and energy therapy (1.8%). According to the analysis of covariance test results, while both used complementary medicine in groups, pregnant women receiving tocolytic treatment were less stressed than those who were receiving non-tocolytic treatment (Pregnancy Stress Rating Scale score, p = 0.038), especially in dimension 2 (stress caused by infant care and changes in family relationships) (p = 0.015) and dimension 5 (stress caused by changes in physical appearance and function) (p = 0.008), which showed statistically significant differences (p < 0.05). Linear regression analysis results showed that the gestational age significantly associated with pregnancy stress (Pregnancy Stress Rating Scale score, p = 0.029; dimension 2, p = 0.016; and dimension 5, p = 0.001).

Conclusion: Among both who used complementary medicine, pregnancy stress was significantly lower in pregnant women who were receiving tocolytic treatment than in those who were receiving non-tocolytic treatment. This finding can be used as a reference for future pregnant women’s health studies.

Surveillance of Parenting Outcomes, Mental Health and Social Support for Primiparous Women among the Rural-to-Urban Floating Population

China has the largest population of floating rural-to-urban women worldwide, most of whom are of childbearing age. However, few studies have been conducted to monitor the changing trends in parenting outcomes, mental health and social support for these women in the early postpartum period. In this quantitative longitudinal study, 680 primiparous women among the floating population were recruited in Shenzhen, China. Face-to-face collection of socio-demographic questionnaires was completed by researchers in maternity wards on the third postnatal day. Follow-up electronic questionnaires were dispatched to women via email or WeChat at 6 weeks and 12 weeks following childbirth, including the Self-efficacy in Infant Care Scale (SICS), Edinburgh Postnatal Depression Scale (EPDS) and Postnatal Social Support Scale (PSSS), to measure maternal self-efficacy (MSE), postpartum depression (PPD) and social support, respectively. The mean scores of MSE for these floating women were 67.16 (14.35) at 6 weeks postpartum and slightly increased to 68.71 (15.00) at 12 weeks postpartum. The mean scores of EPDS remained almost stable, from 11.19 (4.89) to 11.18 (5.34) at the two time points. The prevalence of mild and severe PPD among floating women at 6 and 12 weeks after childbirth decreased from 54.4% to 40.1% and from 50.6% to 35.4%, respectively. The mean score of social support was 37.04 (10.15) at 6 weeks postpartum and slightly improved to 38.68 (10.46) at 12 weeks postpartum. Primiparous women among the rural-to-urban migrant population had an obviously negative status of parenting outcomes and mental health; and there was a lack of social support after childbirth. In future, tailored evidence-based interventions are highly needed to promote floating women’s parenting outcomes, mental wellbeing and social support in the early stages of motherhood. As a higher-risk group of PPD, primiparous women among the floating population require effective and accessible mental health care after childbirth, such as early PPD screening and timely therapeutic methods.

Association Between Dietary Quality and Postpartum Depression in Lactating Women: A Cross-Sectional Survey in Urban China

Background: Evidence on the effects of dietary quality on the risk of postpartum depression in the Chinese population is limited. This study aimed to examine the association between dietary quality and postpartum depression in Chinses lactating women. Methods: A total of 939 participants from 10 cities were included in this analysis. A one-time 24-h dietary recall was used to obtain the data on food consumption and dietary quality was assessed based on Diet Balance Index. The Edinburgh postnatal depression scale was considered at a cutoff point of 10 to detect postpartum depression. Poisson regression models were used to explore the association of dietary quality with postpartum depression. Results: Depressed women tended to have a more inadequate intake of vegetables and have more insufficient food variety. The median (25th, 75th) of the overall high bound score (HBS), low bound score (LBS), and diet quality distance (DQD) was 9 (5, 14), 30 (25, 37), and 40 (34, 47), respectively. Compared with subjects with the lowest quartile of LBS, those with the highest quartile of LBS had a higher risk of postpartum depression [adjusted prevalence ratio (aPR), 1.08; 95% confidence interval (95% CI), 1.01, 1.15; P for trend, 0.043]. We also observed a significant association between DQD and postpartum depression (Q4 vs. Q1: aPR, 1.07; 95% CI: 1.00, 1.14; P for trend, 0.036). Conclusion: Poor dietary quality was associated with postpartum depression in Chinese lactating women.

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.

States Transitions Inference of Postpartum Depression Based on Multi-State Markov Model

Background: Postpartum depression (PPD) has been recognized as a severe public health problem worldwide due to its high incidence and the detrimental consequences not only for the mother but for the infant and the family. However, the pattern of natural transition trajectories of PPD has rarely been explored. Methods: In this research, a quantitative longitudinal study was conducted to explore the PPD progression process, providing information on the transition probability, hazard ratio, and the mean sojourn time in the three postnatal mental states, namely normal state, mild PPD, and severe PPD. The multi-state Markov model was built based on 912 depression status assessments in 304 Chinese primiparous women over multiple time points of six weeks postpartum, three months postpartum, and six months postpartum. Results: Among the 608 PPD status transitions from one visit to the next visit, 6.2% (38/608) showed deterioration of mental status from the level at the previous visit; while 40.0% (243/608) showed improvement at the next visit. A subject in normal state who does transition then has a probability of 49.8% of worsening to mild PPD, and 50.2% to severe PPD. A subject with mild PPD who does transition has a 20.0% chance of worsening to severe PPD. A subject with severe PPD is more likely to improve to mild PPD than developing to the normal state. On average, the sojourn time in the normal state, mild PPD, and severe PPD was 64.12, 6.29, and 9.37 weeks, respectively. Women in normal state had 6.0%, 8.5%, 8.7%, and 8.8% chances of progress to severe PPD within three months, nine months, one year, and three years, respectively. Increased all kinds of supports were associated with decreased risk of deterioration from normal state to severe PPD (hazard ratio, HR: 0.42-0.65); and increased informational supports, evaluation of support, and maternal age were associated with alleviation from severe PPD to normal state (HR: 1.46-2.27). Conclusions: The PPD state transition probabilities caused more attention and awareness about the regular PPD screening for postnatal women and the timely intervention for women with mild or severe PPD. The preventive actions on PPD should be conducted at the early stages, and three yearly; at least one yearly screening is strongly recommended. Emotional support, material support, informational support, and evaluation of support had significant positive associations with the prevention of PPD progression transitions. The derived transition probabilities and sojourn time can serve as an importance reference for health professionals to make proactive plans and target interventions for PPD.