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Motofelea N, Motofelea AC, Tamasan IF, Hoinoiu T, Ioana JTM, Vilibić M, Cringu AI, Bernad BC, Trinc S, Navolan DB. Predictive Validity of Screening Tools and Role of Self-Esteem and Coping in Postpartum Depression Risk. Diagnostics (Basel) 2025; 15:1152. [PMID: 40361970 PMCID: PMC12071209 DOI: 10.3390/diagnostics15091152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2025] [Revised: 04/27/2025] [Accepted: 04/29/2025] [Indexed: 05/15/2025] Open
Abstract
Background/Objectives: Postpartum depression (PPD) is a prevalent mental health disorder affecting women after childbirth, with significant adverse effects on both maternal and infant outcomes. Early detection and intervention are critical to improving health trajectories. Material and Methods: This narrative review compares the predictive validity of commonly used screening instruments for PPD, including the Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9), and brief tools like PHQ-2 and PHQ-4. It also examines the role of self-esteem, assessed using the Rosenberg Self-Esteem Scale (RSES), and coping mechanisms, evaluated through the COPE Inventory, in moderating PPD risk. Results: Validation studies reveal variability in the performance of screening tools across different populations, emphasizing the need for contextual calibration. Low self-esteem and maladaptive coping strategies are consistently associated with higher PPD risk, with socioeconomic status (SES) further influencing these relationships. Interventions focusing on enhancing self-esteem and promoting adaptive coping, such as cognitive-behavioral therapy and psychoeducation, show promise in reducing PPD incidence. Conclusions: This review highlights gaps in existing research, particularly regarding screening during pregnancy, and calls for integrated predictive models incorporating psychosocial variables. Early, context-sensitive screening approaches are essential for effective PPD prevention and management.
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Affiliation(s)
- Nadica Motofelea
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (N.M.); (J.T.M.I.); (B.C.B.)
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania;
- Department of Clinical Practical Skills, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Alexandru Catalin Motofelea
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (N.M.); (J.T.M.I.); (B.C.B.)
- Center of Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Ionela Florica Tamasan
- Department XI: Pediatrics, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Teodora Hoinoiu
- Department of Clinical Practical Skills, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Jabri Tabrizi Madalina Ioana
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (N.M.); (J.T.M.I.); (B.C.B.)
- Department of Clinical Practical Skills, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Maja Vilibić
- Department of Psychiatry, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia;
- School of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
| | - Antoniu Ionescu Cringu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Saint Pantelimon Clinical Emergency Hospital, 020021 Bucharest, Romania
| | - Brenda Cristiana Bernad
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (N.M.); (J.T.M.I.); (B.C.B.)
- Center for Neuropsychology and Behavioral Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Sorin Trinc
- Department of Microscopic Morphology, Genetics Discipline, Center of Genomic Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Dan-Bogdan Navolan
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania;
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Nikpour F, Ansari S, Abedi P, Jahanfar S, Sharifat N, Hooshmand G, Maraghi E. The effect of curcumax on postpartum women's depression: a randomized controlled trial. Front Psychiatry 2024; 15:1302174. [PMID: 39319351 PMCID: PMC11420044 DOI: 10.3389/fpsyt.2024.1302174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 07/31/2024] [Indexed: 09/26/2024] Open
Abstract
Background Postpartum depression is a major psychiatric disorder that affects the mother-baby attachment and may impair cognitive development of the child. Objective This study aimed to evaluate the effect of curcumax (including ginger, turmeric, and black pepper) on postpartum depression in reproductive-aged women. Material and methods This was a randomized controlled trial in which 124 women were recruited and randomly assigned into two groups of curcumax (n=62) and placebo (n=62) who consumed curcumax or placebo for 8 weeks (one capsule each day). Postpartum depression was measured using Edinburgh Depression Scale. Data were analyzed using Chi-square, independent t-test, and GEE. Results The mean (SD) score of depression score was 15.83 (2.77) and 15.45 (2.97) before intervention, which reduced to 3.48 (4.29) and 7.22 (3.98) in the intervention and control groups, respectively after 4 weeks (p<0.0001). After eight weeks of intervention, these scores reduced to 1.72 (3.30) and 5.85 (3.67) in the intervention and control groups, respectively (p<0.0001). Conclusion The results of this study showed that curcumax significantly reduced the mean score of postpartum depression among reproductive-aged women. Because it is the first time this herb was used as an anti-depressant, its effective dose was not available. Therefore, further studies with higher doses of this herb are recommended. Clinical Trial Registration https://irct.behdasht.gov.ir/search/result?query=IRCT20210822052254N1, identifier IRCT20210822052254N1.
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Affiliation(s)
- Fatemeh Nikpour
- Midwifery Department, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Somayeh Ansari
- Midwifery Department, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parvin Abedi
- Midwifery Department, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shayesteh Jahanfar
- Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA, United States
| | - Naeim Sharifat
- Psychiatry and Behavioral Center, Addiction Institute, Department of Pharmacology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Gholamreza Hooshmand
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Department of Pharmacology Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Elham Maraghi
- Biostatistics Department, Public Health School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Felten CL, Smith KS, Aylesworth MB. An Integrated Approach to Address Perinatal Mental Health Within an Obstetrics Practice. J Midwifery Womens Health 2024; 69:778-783. [PMID: 38923106 DOI: 10.1111/jmwh.13658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/10/2024] [Indexed: 06/28/2024]
Abstract
Outpatient perinatal care providers (one certified nurse-midwife, one nurse practitioner, and one physician assistant) at a high-volume, suburban health system in southeastern Pennsylvania developed and implemented a care model to identify and care for patients at risk for perinatal and postpartum mental health conditions. The program, Women Adjusting to Various Emotional States (WAVES), was created to bring the most up-to-date, evidence-based treatment recommendations to patients while addressing the increased demand placed on the health care system by pregnant and postpartum patients in need of psychiatric services. WAVES is a specialized program offered for anyone who is pregnant or up to one year postpartum who is struggling with mental health symptoms or concerns. Perinatal mood and anxiety disorders have become one of the most prevalent pregnancy ailments, yet mental health is not always addressed during routine prenatal care visits. Common obstacles to patients obtaining mental health care during pregnancy include lack of access, clinician gaps in knowledge, and stigma surrounding diagnoses. WAVES offers a method to empower perinatal providers with the education and tools to address this need. The model outlines how to appropriately assess, diagnose, manage, or refer patients for mental health services. Patient feedback has been overwhelmingly positive, and this novel care model shows great promise for the future of perinatal care. The development of integrated programs like WAVES may be a valuable resource to help combat the perinatal mental health epidemic.
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Affiliation(s)
- Christina L Felten
- Lehigh Valley Health Network, Allentown, Pennsylvania
- Obstetrics and Gynecology, Lehigh Valley Physician Group, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Kayla S Smith
- Lehigh Valley Health Network, Allentown, Pennsylvania
- Obstetrics and Gynecology, Lehigh Valley Physician Group, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Melissa B Aylesworth
- Lehigh Valley Health Network, Allentown, Pennsylvania
- Obstetrics and Gynecology, Lehigh Valley Physician Group, Lehigh Valley Health Network, Allentown, Pennsylvania
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Orkaby N, Kalfon-Hakhmigari M, Levy S, Krissi H, Peled Y, Handelzalts JE. COVID-19-Related worries mediate the association between attachment orientation and elevated depression levels at 21-month postpartum. J Reprod Infant Psychol 2024; 42:550-562. [PMID: 36210511 DOI: 10.1080/02646838.2022.2132382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The study's aims were to examine whether the COVID-19 pandemic was associated with increases in depression levels of 21 months postpartum women who were initially sampled before the pandemic and whether COVID-19-related worries mediated the association between women's attachment orientations and this hypothesized increase. METHODS Participants comprised 185 postpartum women sampled in the maternity ward of a tertiary healthcare center in Israel followed from childbirth to 21 months postpartum in four-time points. . We analyzed demographic and obstetric information and the Experiences in Close Relationships (ECR) scale at T1; changes in the Edinburgh Postnatal Depression Scale (EPDS) levels at all timepoints (T1-4); and COVID-19-related worries at T4. RESULTS Results showed a significant increase in depression levels at T4 compared to T2 and T3, and an increase in the prevalence of women at the lower clinical EPDS threshold. COVID-19-related worries mediated the association between anxious attachment and depression (indirect effect: B = .21, p < .05, 95% CI = (.015, .47), R2=0.12). DISCUSSION The evident effect of COVID-19 on postpartum depression is associated with variability between people. Thus, early assessment of women's attachment orientations might provide a strategy for identifying and treating women at risk.
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Affiliation(s)
- Naomi Orkaby
- School of Behavioral Sciences, Academic College of Tel-Aviv-Yafo, Tel-Aviv, Israel
| | | | - Sigal Levy
- School of Behavioral Sciences, Academic College of Tel-Aviv-Yafo, Tel-Aviv, Israel
| | - Haim Krissi
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoav Peled
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jonathan E Handelzalts
- School of Behavioral Sciences, Academic College of Tel-Aviv-Yafo, Tel-Aviv, Israel
- Department of Psychiatry, University of Michigan, Ann Arbor, Michiga, USA
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Wei X, Wang W, Law YW, Zhang H. The Impacts of Intimate Partner Violence on Postpartum Depression: An Updated Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:1531-1550. [PMID: 37480328 DOI: 10.1177/15248380231188068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
The associations between intimate partner violence (IPV) and postpartum depression (PPD) have been well established in previous reviews. However, none has explored potential differences between IPV subtypes or exposure times, which could help healthcare providers recognize the adverse impacts of various IPV subtypes and conduct comprehensive IPV screening. This study aimed to estimate the impacts of overall IPV and its subtypes (physical, psychological, and sexual) on PPD using an updated meta-analysis and to examine the potential role of IPV exposure time and regional income levels. Four English databases (Medline, PsycINFO, PubMed, and Web of Science) and two Chinese databases (China National Knowledge Infrastructure [CNKI] and Wanfang Database) were systematically searched. We included 76 studies with 388,966 samples. Random-effects models were used to pool the odds ratios (ORs) across studies. Overall, IPV and its subtypes had statistically significant impacts on PPD (overall: OR = 2.50, physical: OR = 2.31, psychological: OR = 2.22, sexual: OR = 1.75). A higher impact of IPV on PPD was observed in middle- and low-income regions (OR = 3.01) than in high-income regions (OR = 1.92). IPV during pregnancy (OR = 2.73) had a greater impact on PPD than lifetime IPV (OR = 2.24). This study provides updated evidence for the significant impact of IPV and its subtypes and exposure time on PPD. Women at risk of exposure to physical IPV, especially during pregnancy, are in urgent need of support to reduce the risk of PPD.
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Affiliation(s)
- Xinyi Wei
- The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Yik Wa Law
- The University of Hong Kong, Pokfulam, Hong Kong
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Cardenas A, Esser K, Wright E, Netten K, Edwards A, Rose J, Vigod S, Cohen E, Orkin J. Caring for the Caregiver (C4C): An Integrated Stepped Care Model for Caregivers of Children With Medical Complexity. Acad Pediatr 2023; 23:236-243. [PMID: 35680082 DOI: 10.1016/j.acap.2022.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
Children with medical complexity (CMC) are a medically fragile subset of children who rely on parental caregivers for substantial care needs. Caregivers of CMC often experience adverse health outcomes such as depression and anxiety, sleep deprivation, financial hardships, and social isolation. Caregivers of CMC are at risk of premature mortality, which is thought to be mediated by chronic and elevated stress, as well as psychiatric morbidity risk. Access to mental health care, where the needs of both the caregiver and child are considered, can enable caregivers to meet high caregiving demands and improve both child and caregiver outcomes. We describe the Caring for the Caregiver (C4C) model, a novel integrated stepped care model consisting of collaboration between a psychiatrist and a pediatric complex care program. This model provides support in 3 steps: 1) early identification of distress, 2) social work assessment, intervention and psychotherapy, and 3) psychiatric care, including diagnosis or medication initiation, for caregivers of CMC. This innovative model will be the first to embed support for the mental health needs of caregivers of CMC within a pediatric team, facilitating access to psychiatric care and serving as a foundation for future integrated stepped care models.
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Affiliation(s)
- Analyssa Cardenas
- Child Health Evaluative Sciences (A Cardenas, K Esser, E Cohen, and J Orkin), The Hospital for Sick Children, Toronto, ON, Canada
| | - Kayla Esser
- Child Health Evaluative Sciences (A Cardenas, K Esser, E Cohen, and J Orkin), The Hospital for Sick Children, Toronto, ON, Canada
| | - Elisabeth Wright
- Department of Psychiatry (E Wright, S Vigod), Women's College Hospital, Toronto, ON, Canada; Department of Psychiatry (E Wright, S Vigod), University of Toronto, Toronto, ON, Canada
| | - Kathy Netten
- Division of Pediatric Medicine (K Netten, A Edwards, E Cohen, and J Orkin), The Hospital for Sick Children, , Toronto, ON, Canada
| | - Ashley Edwards
- Division of Pediatric Medicine (K Netten, A Edwards, E Cohen, and J Orkin), The Hospital for Sick Children, , Toronto, ON, Canada
| | - Julie Rose
- SickKids Family Advisory Network (J Rose), The Hospital for Sick Children, Toronto, ON, Canada
| | - Simone Vigod
- Department of Psychiatry (E Wright, S Vigod), Women's College Hospital, Toronto, ON, Canada; Department of Psychiatry (E Wright, S Vigod), University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Child Health Evaluative Sciences (A Cardenas, K Esser, E Cohen, and J Orkin), The Hospital for Sick Children, Toronto, ON, Canada; Division of Pediatric Medicine (K Netten, A Edwards, E Cohen, and J Orkin), The Hospital for Sick Children, , Toronto, ON, Canada; Department of Pediatrics (E Cohen, J Orkin), University of Toronto, Toronto, ON, Canada; Edwin S.H. Leong Centre for Healthy Children (E Cohen), University of Toronto, Toronto, ON, Canada
| | - Julia Orkin
- Child Health Evaluative Sciences (A Cardenas, K Esser, E Cohen, and J Orkin), The Hospital for Sick Children, Toronto, ON, Canada; Division of Pediatric Medicine (K Netten, A Edwards, E Cohen, and J Orkin), The Hospital for Sick Children, , Toronto, ON, Canada; Department of Pediatrics (E Cohen, J Orkin), University of Toronto, Toronto, ON, Canada.
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Diagnosis and Management of Perinatal Depression. Nurs Womens Health 2022; 26:318-330. [PMID: 35714763 DOI: 10.1016/j.nwh.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 04/27/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022]
Abstract
Perinatal depression is a mood disorder that may occur during pregnancy or within a year after childbirth. It can be disabling for the birthing parent and cause attachment and developmental problems for the infant. A host of risk factors, including genetics, reproductive history, and life experiences, are associated with perinatal depression. With validated screening tools, health care providers can assess individuals, initiate treatment, and/or refer as appropriate. Successful treatment, which may include modalities such as cognitive behavioral therapy and/or pharmacologic therapies, helps individuals maintain a sense of control, develop self-confidence, take control of their thinking, and learn coping skills. Integrative therapies and lifestyle changes have some success but may not be adequate for many individuals. Patients may benefit from providers learning and initiating cognitive behavioral therapy techniques while awaiting therapy.
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Sultan P, Ando K, Elkhateb R, George RB, Lim G, Carvalho B, Chitneni A, Kawai R, Tulipan T, Blake L, Coker J, O’Carroll J. Assessment of Patient-Reported Outcome Measures for Maternal Postpartum Depression Using the Consensus-Based Standards for the Selection of Health Measurement Instruments Guideline: A Systematic Review. JAMA Netw Open 2022; 5:e2214885. [PMID: 35749118 PMCID: PMC9233232 DOI: 10.1001/jamanetworkopen.2022.14885] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Maternal depression is frequently reported in the postpartum period, with an estimated prevalence of approximately 15% during the first postpartum year. Despite the high prevalence of postpartum depression, there is no consensus regarding which patient-reported outcome measure (PROM) should be used to screen for this complex, multidimensional construct. OBJECTIVE To evaluate psychometric measurement properties of existing PROMs of maternal postpartum depression using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline and identify the best available patient-reported screening measure. EVIDENCE REVIEW This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. PubMed, CINAHL, Embase, and Web of Science were searched on July 1, 2019, for validated PROMs of postpartum depression, and an additional search including a hand search of references from eligible studies was conducted in June 2021. Included studies evaluated 1 or more psychometric measurement properties of the identified PROMs. A risk-of-bias assessment was performed to evaluate methods of each included study. Psychometric measurement properties of each PROM were rated according to COSMIN criteria. A modified Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the level of evidence supporting each rating, and a recommendation class (A, recommended for use; B, further research required; or C, not recommended) was given based on the overall quality of each included PROM. FINDINGS Among 10 264 postpartum recovery studies, 27 PROMs were identified. Ten PROMs (37.0%) met the inclusion criteria and were used in 43 studies (0.4%) involving 22 095 postpartum women. At least 1 psychometric measurement property was assessed for each of the 10 validated PROMs identified. Content validity was sufficient in all PROMs. The Edinburgh Postnatal Depression Scale (EPDS) demonstrated adequate content validity and a moderate level of evidence for sufficient internal consistency (with sufficient structural validity), resulting in a recommendation of class A. The other 9 PROMs evaluated received a recommendation of class B. CONCLUSIONS AND RELEVANCE The findings of this systematic review suggest that the EPDS is the best available patient-reported screening measure of maternal postpartum depression. Future studies should focus on evaluating the cross-cultural validity, reliability, and measurement error of the EPDS to improve understanding of its psychometric properties and utility.
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Affiliation(s)
- Pervez Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Kazuo Ando
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Rania Elkhateb
- Library, University of Arkansas for Medical Sciences, Little Rock
| | - Ronald B. George
- Department of Anesthesiology, University of California, San Francisco
| | - Grace Lim
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ahish Chitneni
- Physical Medicine and Rehabilitation, NewYork–Presbyterian–Columbia and Cornell, New York, New York
| | | | - Tanya Tulipan
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lindsay Blake
- Library, University of Arkansas for Medical Sciences, Little Rock
| | - Jessica Coker
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock
| | - James O’Carroll
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Taylor BL, Nath S, Sokolova AY, Lewis G, Howard LM, Johnson S, Sweeney A. The relationship between social support in pregnancy and postnatal depression. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1435-1444. [PMID: 35451605 PMCID: PMC9246777 DOI: 10.1007/s00127-022-02269-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 03/08/2022] [Indexed: 10/25/2022]
Abstract
PURPOSE Lack of social support is considered a potential risk factor for postnatal depression but limited longitudinal evidence is available. Pregnancy, when women have increased contact with healthcare services, may be an opportune time to intervene and help strengthen women's social networks to prevent feelings of depression postnatally, particularly for those at greatest risk. Our study examined the longitudinal relationship between social support in pregnancy and postnatal depression, and whether this is moderated by age or relationship status. METHODS We analysed data collected from 525 women from a diverse inner-city maternity population in England who were interviewed in pregnancy and again three months postnatally. Women provided sociodemographic information and completed self-report measures of depression (Edinburgh Postnatal Depression Scale) and social support (Social Provisions Scale). RESULTS Less social support in pregnancy was associated with postnatal depression, after adjusting for sociodemographic confounders and antenatal depression (Coef. = - 0.05; 95% CI - 0.10 to - 0.01; p = 0.02). There was weak evidence of a moderating effect of relationship status. Subgroup analysis showed a stronger relationship between social support in pregnancy and postnatal depression for women who were not living with a partner (Coef. = - 0.11; 95% CI - 0.21 to - 0.01; p = 0.03) than for those who were (Coef. = - 0.03; 95% CI - 0.09 to 0.02; p = 0.28). Sensitivity analysis using multiple imputations to account for missing data confirmed the main results. CONCLUSIONS Interventions that target social support in pregnancy have the potential to reduce depression postnatally. Future research should explore in greater detail which women would benefit most from which type of social support.
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Affiliation(s)
- Billie Lever Taylor
- Division of Psychiatry, Faculty of Brain Sciences, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Selina Nath
- grid.83440.3b0000000121901201Present Address: Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK ,grid.13097.3c0000 0001 2322 6764Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF UK
| | - Antoaneta Y. Sokolova
- grid.83440.3b0000000121901201Lived Experience Advisory Group, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Gemma Lewis
- grid.83440.3b0000000121901201Division of Psychiatry, Faculty of Brain Sciences, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Louise M. Howard
- grid.13097.3c0000 0001 2322 6764Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF UK
| | - Sonia Johnson
- grid.83440.3b0000000121901201Division of Psychiatry, Faculty of Brain Sciences, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Angela Sweeney
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK.
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Schouten BC, Westerneng M, Smit AM. Midwives' perceived barriers in communicating about depression with ethnic minority clients. PATIENT EDUCATION AND COUNSELING 2021; 104:2393-2399. [PMID: 34340845 DOI: 10.1016/j.pec.2021.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/13/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to assess the most influential barriers midwives perceive in communicating about depression-related symptoms with ethnic minority clients. METHODS In-depth interviews were held with midwives (N = 8) and Moroccan-Dutch women (N = 6) suffering from perinatal depression to identify the most salient communication barriers. Subsequently, an online survey among midwives (N = 60) assessing their perceived barriers and the occurrence of these barriers in practice was administered. Composite scores using the QUOTE methodology were calculated to determine influential barriers. RESULTS Three types of barriers emerged from the interviews. Educational-related barriers, client-related barriers and midwife-related barriers. Results of the survey showed that the most influential barriers were educational-related barriers (e.g. lack of culturally sensitive depression screening instruments) and client-related barriers (e.g. cultural taboo about talking about depression). CONCLUSION Culturally sensitive screening instruments for depression and patient education materials should be developed to mitigate the educational-related barriers to communicating about depression. Patient education materials should also target the clients' social environment (e.g. husbands) to help break the cultural taboo about depression. PRACTICE IMPLICATIONS Based on this study's results, communication strategies to empower both midwives and ethnic minority clients with depression can be developed in a collaborative approach.
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Affiliation(s)
- Barbara C Schouten
- Amsterdam School of Communication Research/ASCoR, Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands.
| | - Myrte Westerneng
- Amsterdam UMC, Free University Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, the Netherlands.
| | - Anne-Marike Smit
- Amsterdam UMC, Free University Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
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11
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Socioeconomic and racial/ethnic disparities in postpartum consultation for mental health concerns among US mothers. Arch Womens Ment Health 2021; 24:781-791. [PMID: 33855652 DOI: 10.1007/s00737-021-01132-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 04/07/2021] [Indexed: 11/27/2022]
Abstract
Limited research has examined factors that impact access to postpartum mental healthcare. We investigated the predisposing, enabling, and need factors associated with postpartum consultation for mental health concerns in US mothers with or without depressive symptoms and examined potential disparities in access. We utilized cross-sectional data from the Listening to Mothers II Survey, the second national US survey of women's childbearing experiences. The survey recruited 1573 women, aged 18-45 years, who spoke English and had given birth. Depressive symptoms were measured with the Postpartum Depression Screening Scale (PDSS-SF). The dependent variable was postpartum consultation for mental health concerns. Logistic regression analyses showed that mothers with scores of 14-21 and 22-35 on the PDSS-SF had higher odds of consulting a provider for mental health concerns (OR 3.97; OR 12.91). Latinas had lower odds of seeking mental health consultations than Whites (OR 0.39). Mothers who were employed prenatally full-time or part-time had lower odds of seeking consultations than non-employed mothers (OR 0.62; OR 0.52). Mothers with household incomes of $50,000-$74,999 had higher odds of seeking consultations than those with incomes less than $25,000 (OR 2.20). When regression analyses were restricted to mothers with PDSS-SF scores ≥ 14, findings were similar by race/ethnicity and prenatal employment. Significant depressive symptoms are common in women after giving birth and few sought any form of mental health consultation. Latinas and low-income women are less likely to seek postpartum mental health consultations. Mental health care interventions could be geared towards targeting these at-risk groups.
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12
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Wang L, Kroenke K, Stump TE, Monahan PO. Screening for perinatal depression with the Patient Health Questionnaire depression scale (PHQ-9): A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 68:74-82. [PMID: 33360526 PMCID: PMC9112666 DOI: 10.1016/j.genhosppsych.2020.12.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/13/2020] [Accepted: 12/13/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Perinatal depression (PND) is a prevalent and disabling problem both during pregnancy and the postpartum period. The legacy screening measure has been the Edinburgh Postnatal Depression Scale (EPDS). This systematic review examines the validity of the PHQ-9 as a screener for PND. METHODS The following databases were searched from January 2001 (when the PHQ-9 was first published) through June 2020: MEDLINE, Embase, and PsychInfo. Studies that compared the PHQ-9 to a criterion standard psychiatric interview were used to determine the operating characteristics of sensitivity, specificity and area under the curve (AUC). Studies comparing the PHQ-9 to the EPDS and other depression scales evaluated convergent validity. RESULTS A total of 35 articles were eligible for criterion (n = 10) or convergent (n = 25) validity. Meta-analysis of the 7 criterion validity studies using the standard PHQ-9 cut point ≥10 showed a pooled sensitivity, specificity and AUC of 0.84, 0.81 and 0.89, respectively. Operating characteristics of the PHQ-9 and EPDS were nearly identical in head-to-head comparison studies. The median correlation between the PHQ-9 and EPDS was 0.59, and categorical agreement was moderate. CONCLUSIONS The PHQ-9 appears to be a viable option for perinatal depression screening with operating characteristics similar to the legacy EPDS.
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Affiliation(s)
- Larry Wang
- Indiana University, School of Medicine, Indianapolis, IN, United States.
| | - Kurt Kroenke
- Indiana University, School of Medicine, Indianapolis, IN, United States; Regenstrief Institute Inc, Indianapolis, IN, United States.
| | - Timothy E Stump
- Department of Biostatistics, Indiana University, Fairbanks School of Public Health and School of Medicine, Indianapolis, IN, USA
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University, Fairbanks School of Public Health and School of Medicine, Indianapolis, IN, USA
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13
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Melnyk BM, Gennaro S, Szalacha LA, Hoying J, O'Connor C, Cooper A, Gibeau A. Randomized controlled trial of the COPE-P intervention to improve mental health, healthy lifestyle behaviors, birth and post-natal outcomes of minority pregnant women: Study protocol with implications. Contemp Clin Trials 2020; 98:106090. [PMID: 32745703 PMCID: PMC7686149 DOI: 10.1016/j.cct.2020.106090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emotionally distressed pregnant minority women experience multiple adverse outcomes, including pre-eclampsia, preterm birth, operative deliveries and low birth weight. Although the United States Preventive Services Task Force recommends screening in pregnant women, many practices do not screen because efficacious interventions and systems are not in place to treat them. AIM Purpose of this randomized controlled trial (RCT) is to test a group delivered manualized cognitive-behavioral skills building intervention entitled COPE-P versus an attention control program on the mental health, birth and postpartum outcomes of minority pregnant women experiencing depressive, anxiety and stress symptoms. METHODS Design is a longitudinal randomized block RCT with repeated measures (beginning with screening prior to 18 weeks, group prenatal care in both groups from 16 + 1 to 31 + 1 weeks and ending at 6 months postpartum) at two study sites (New York city and Columbus, Ohio). Race/ethnicity is being blocked to ensure equal numbers of Hispanic and Black women. 384 women are being recruited from antenatal clinics if they are: between 18 and 40 years; in an uncomplicated singleton pregnancy <18 weeks; and self-identify as Black or Hispanic. Valid and reliable measures are being used to assess healthy lifestyle behaviors and mental health outcomes immediately following the interventions, six - eight weeks postpartum and at the children's six-month well baby visit. Birth and delivery outcomes also are being assessed. CONCLUSION If found to be efficacious, the COPE-P intervention could be a key solution to managing those with emotional distress and improving their outcomes.
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Affiliation(s)
- Bernadette Mazurek Melnyk
- Health Promotion and Wellness, The Ohio State University, the Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, College of Nursing, Pediatrics & Psychiatry, College of Medicine, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210, United States of America.
| | - Susan Gennaro
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, United States of America
| | - Laura A Szalacha
- Research Methodology and Biostatistics Core, USF Health Morsani College of Medicine, College of Nursing, University of South Florida, United States of America
| | - Jacqueline Hoying
- Consumer Core, the Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, The Ohio State University College of Nursing, Columbus, OH, United States of America
| | - Caitlin O'Connor
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, United States of America
| | - Andrea Cooper
- The Ohio State University College of Nursing, Columbus, OH, United States of America
| | - Anne Gibeau
- Midwifery, Jacobi Medical Center, Bronx, NY, United States of America
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14
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Scorza P, Monk C, Lee S, Feng T, Berry OO, Werner E. Preventing maternal mental health disorders in the context of poverty: pilot efficacy of a dyadic intervention. Am J Obstet Gynecol MFM 2020; 2:100230. [PMID: 33345933 PMCID: PMC7893538 DOI: 10.1016/j.ajogmf.2020.100230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/27/2020] [Accepted: 09/16/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The United States Preventive Services Task Force recommends that clinicians provide or refer pregnant and postpartum women who are at an increased risk of perinatal depression to counseling interventions. However, this prevention goal requires effective interventions that reach women at risk of, but before, the development of a depressive disorder. OBJECTIVE We describe a pilot efficacy trial of a novel dyadic intervention to prevent common maternal mental health disorders, that is, Practical Resources for Effective Postpartum Parenting, in a sample of women at risk of maternal mental health disorders based on poverty status. We hypothesized that Practical Resources for Effective Postpartum Parenting compared with enhanced treatment as usual would reduce symptoms of maternal mental health disorders after birth. STUDY DESIGN A total of 60 pregnant women who were recruited from obstetrical practices at Columbia University Irving Medical Center were randomized to the Practical Resources for Effective Postpartum Parenting (n=30) or enhanced treatment as usual (n=30) intervention. The Edinburgh Postnatal Depression Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Patient Health Questionnaire were used to compare maternal mood at 6 weeks, 10 weeks, and 16 weeks after delivery. RESULTS At 6 weeks after delivery, women randomized to Practical Resources for Effective Postpartum Parenting had lower mean Edinburgh Postnatal Depression scores (P=.018), lower mean Hamilton Depression scores (P<.001), and lower mean Hamilton Anxiety scores (P=.041); however, the incidence of postpartum mental disorders did not differ by treatment group. CONCLUSION The Practical Resources for Effective Postpartum Parenting, which is an intervention integrated within obstetrical care, improves subclinical symptomology for at-risk dyads at a crucial time in the early postpartum period; however, our study did not detect reductions in the incidence of postpartum mental disorders.
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Affiliation(s)
- Pamela Scorza
- Departments of Obstetrics and Gynecology, Columbia University, New York, NY.
| | - Catherine Monk
- Departments of Obstetrics and Gynecology, Columbia University, New York, NY; Psychiatry, Columbia University, New York, NY; New York State Psychiatric Institute, New York, NY
| | - Seonjoo Lee
- New York State Psychiatric Institute, New York, NY
| | - Tianshu Feng
- New York State Psychiatric Institute, New York, NY
| | | | - Elizabeth Werner
- Departments of Obstetrics and Gynecology, Columbia University, New York, NY; Psychiatry, Columbia University, New York, NY
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15
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Smithson S, Mirocha J, Horgan R, Graebe R, Massaro R, Accortt E. Unplanned Cesarean delivery is associated with risk for postpartum depressive symptoms in the immediate postpartum period. J Matern Fetal Neonatal Med 2020; 35:3860-3866. [PMID: 33108930 DOI: 10.1080/14767058.2020.1841163] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Postpartum depression (PPD) is a common pregnancy complication. The association between cesarean delivery (CD) and PPD has shown conflicting results in prior studies, although emergent CD appears to be a clear risk factor. Establishing PPD risk is critical and may, however, be related to the unplanned nature of the CD, rather than the surgery itself. Our objective was to determine whether women who underwent unplanned CD were more likely than those with vaginal delivery to have higher depressive symptoms and thus screen positive for PPD risk in the immediate postpartum period. MATERIALS AND METHODS This cohort study was conducted at a community medical center using data for deliveries between 8/2015-1/2016. Women were screened in the hospital for depressive symptoms (PPD risk) using the Edinburgh Postnatal Depression Scale (EPDS) within 4 days post-delivery. Logistic regression, adjusting for maternal race/ethnicity and parity, was performed to evaluate the association between delivery route (vaginal vs planned vs unplanned CD) and PPD risk (EPDS ≥ 10). RESULTS A total of 2094 women had complete data for analysis. Overall, 44 women (2.1%) screened positive for PPD risk. Logistic regression results showed that unplanned CD was significantly associated with PPD risk (OR = 2.28, 95% CI 1.13-4.57, p = .022), after adjusting for parity and race/ethnicity. Planned CD was not associated with PPD risk. CONCLUSION Unplanned CD may be an independent risk factor for PPD risk in the immediate postpartum period. This finding might explain why some previous studies have demonstrated different results with regards to risk of CD where the unplanned nature of the delivery was not accounted for.
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Affiliation(s)
- S Smithson
- Department of Obstetrics and Gynecology, Monmouth Medical Center, Long Branch, NJ, USA.,Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - J Mirocha
- Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - R Horgan
- Department of Obstetrics and Gynecology, Monmouth Medical Center, Long Branch, NJ, USA
| | - R Graebe
- Department of Obstetrics and Gynecology, Monmouth Medical Center, Long Branch, NJ, USA
| | - R Massaro
- Department of Obstetrics and Gynecology, Monmouth Medical Center, Long Branch, NJ, USA
| | - E Accortt
- Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
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16
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The association between prenatal maternal anxiety disorders and postpartum perceived and observed mother-infant relationship quality. J Anxiety Disord 2019; 68:102148. [PMID: 31604204 DOI: 10.1016/j.janxdis.2019.102148] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/29/2019] [Accepted: 09/18/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Prenatal maternal anxiety disorders have been associated with adverse outcomes in offspring including emotional, behavioral and cognitive problems. There is limited understanding of the mechanisms underpinning these associations, although one possible candidate is an impaired mother-infant relationship. The authors investigated whether prenatal anxiety disorders were associated with poorer postpartum mother-infant relationship quality, measured by maternal self-reported bonding and observed mother-infant interactions. METHODS A cohort of 454 pregnant women recruited from an inner-city maternity service in London (UK) were assessed for mental disorders using the Structured Clinical Interview for DSM-IV and followed up at mid-pregnancy and 3-months postpartum. Depressive symptoms were assessed at baseline and mid-pregnancy (using the Edinburgh Postnatal Depression Scale). At three months postpartum, women were assessed for self-reported bonding difficulties (using the Postpartum Bonding Questionnaire) and a subsample (n = 204) participated in video-recorded mother-infant interaction, coded using the Child-Adult Relationship Experimental Index by an independent rater. RESULTS Prenatal anxiety disorders were associated with higher perceived bonding impairment, but not associated with observed poor mother-infant interaction quality. Higher levels of depressive symptoms were associated with lower maternal sensitivity. CONCLUSIONS Interventions for anxiety disorders in the perinatal period could be tailored to address anxieties about mother-infant relationship and co-morbid depressive symptoms.
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17
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McCarter DE, Demidenko E, Sisco TS, Hegel MT. Technology-assisted nursing for postpartum support: A randomized controlled trial. J Adv Nurs 2019; 75:2223-2235. [PMID: 31222789 PMCID: PMC6746586 DOI: 10.1111/jan.14114] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/25/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
Abstract
AIM To determine if an electronic nursing intervention during the first 6 months postpartum was effective in improving mood and decreasing stress. BACKGROUND Unmet needs postpartum can have a negative impact on mood and parenting stress. Technology-assisted nursing care may provide needed support and reduce risk. DESIGN Randomized controlled trial (RCT) with three conditions. METHODS Enrollment began on 11 May 2017. Participants were randomized into one of three groups after completion of the baseline survey. Intervention I participants received standardized electronic messages four times/week for 6 months postpartum. Intervention II participants additionally received the option for nurse contact. Depression and parenting stress as measured using the Edinburgh Postnatal Depression Scale (EPDS) and Parenting Stress Index-Short form (PSI-SF) was obtained at 3 weeks, 3 months and 6 months postpartum and results compared with a usual care group. Patient satisfaction and nursing factors were measured. RESULTS Significantly higher satisfaction scores were found in both intervention groups as compared with control, but there were no significant changes in EPDS or PSI-SF. CONCLUSION The interventions were perceived as helpful and not burdensome. Better nurse-sensitive outcome measures are needed to adequately assess effectiveness. IMPACT Postpartum women report unmet needs for support and education. The interventions were perceived as being helpful but did not significantly reduce depressive symptoms or parenting stress. Nurses can use this research to inform development of innovative approaches to support postpartum women. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02843022.
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Affiliation(s)
- DE McCarter
- Saint Anselm College, Manchester, New Hampshire
- Catholic Medical Center, Manchester, New Hampshire
| | - E Demidenko
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - TS Sisco
- Department of Sociology and Social Work, Saint Anselm College, Manchester, New Hampshire
| | - MT Hegel
- Emeritus-Active in Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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18
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Lawson A, Dalfen A, Murphy KE, Milligan N, Lancee W. Use of Text Messaging for Postpartum Depression Screening and Information Provision. Psychiatr Serv 2019; 70:389-395. [PMID: 30717643 DOI: 10.1176/appi.ps.201800269] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the feasibility of using text messages to enhance mental health screening and education of women in the immediate postpartum period. METHODS A total of 937 postpartum women were recruited from an obstetrics and gynecology clinic of a large urban hospital. Participants received a text message containing a two-question screen for postpartum depression every two weeks and three text messages per week about postpartum mental health for the first 12 weeks postpartum. Those who screened positive were administered the Edinburgh Postnatal Depression Scale. They were matched with a subset of women who were also assessed with the Edinburgh Postnatal Depression Scale after screening negative for depression with the text messaging screen. At 12 to 13 weeks postpartum, all participants received an online survey assessing satisfaction with the text messages. RESULTS Of 937 participants, 126 (13%) screened positive. Agreement between the texted screen and the Edinburgh Postnatal Depression Scale was moderate (κ=0.45), with good sensitivity (0.90, 95% confidence interval [95% CI]=0.81-0.96) and specificity (0.82, 95% CI=0.79-0.85). Nine hundred thirty (99%) participants responded to at least one of the six texted screens, whereas 632 (67%) responded to all six. Of the 589 (63%) who responded to the satisfaction survey, 459 (78%) recommended that all women be screened for postpartum depression via text messaging and that all women in the postpartum period be sent information texts about postpartum depression (N=504, 91%). CONCLUSIONS Using text messaging technology to screen women for postpartum depression and provide information on postpartum mental health appears to be sensitive, feasible, and well accepted.
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Affiliation(s)
- Andrea Lawson
- Department of Psychiatry (Lawson, Dalfen) and Department of Obstetrics and Gynaecology (Murphy, Milligan), Mount Sinai Hospital, Toronto; Department of Psychiatry (Lawson, Dalfen, Lancee) and Department of Obstetrics and Gynaecology (Murphy, Milligan), University of Toronto, Toronto
| | - Ariel Dalfen
- Department of Psychiatry (Lawson, Dalfen) and Department of Obstetrics and Gynaecology (Murphy, Milligan), Mount Sinai Hospital, Toronto; Department of Psychiatry (Lawson, Dalfen, Lancee) and Department of Obstetrics and Gynaecology (Murphy, Milligan), University of Toronto, Toronto
| | - Kellie E Murphy
- Department of Psychiatry (Lawson, Dalfen) and Department of Obstetrics and Gynaecology (Murphy, Milligan), Mount Sinai Hospital, Toronto; Department of Psychiatry (Lawson, Dalfen, Lancee) and Department of Obstetrics and Gynaecology (Murphy, Milligan), University of Toronto, Toronto
| | - Natasha Milligan
- Department of Psychiatry (Lawson, Dalfen) and Department of Obstetrics and Gynaecology (Murphy, Milligan), Mount Sinai Hospital, Toronto; Department of Psychiatry (Lawson, Dalfen, Lancee) and Department of Obstetrics and Gynaecology (Murphy, Milligan), University of Toronto, Toronto
| | - William Lancee
- Department of Psychiatry (Lawson, Dalfen) and Department of Obstetrics and Gynaecology (Murphy, Milligan), Mount Sinai Hospital, Toronto; Department of Psychiatry (Lawson, Dalfen, Lancee) and Department of Obstetrics and Gynaecology (Murphy, Milligan), University of Toronto, Toronto
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19
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Frieder A, Fersh M, Hainline R, Deligiannidis KM. Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development. CNS Drugs 2019; 33:265-282. [PMID: 30790145 PMCID: PMC6424603 DOI: 10.1007/s40263-019-00605-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Postpartum depression is one of the most common complications of childbirth. Untreated postpartum depression can have substantial adverse effects on the well-being of the mother and child, negatively impacting child cognitive, behavioral, and emotional development with lasting consequences. There are a number of therapeutic interventions for postpartum depression including pharmacotherapy, psychotherapy, neuromodulation, and hormonal therapy among others, most of which have been adapted from the treatment of major depressive disorder outside of the peripartum period. Current evidence of antidepressant treatment for postpartum depression is limited by the small number of randomized clinical trials, underpowered samples, and the lack of long-term follow-up. The peripartum period is characterized by rapid and significant physiological change in plasma levels of endocrine hormones, peptides, and neuroactive steroids. Evidence supporting the role of neuroactive steroids and γ-aminobutyric acid (GABA) in the pathophysiology of postpartum depression led to the investigation of synthetic neuroactive steroids and their analogs as potential treatment for postpartum depression. Brexanolone, a soluble proprietary intravenous preparation of synthetic allopregnanolone, has been developed. A recent series of open-label and placebo-controlled randomized clinical trials of brexanolone in postpartum depression demonstrated a rapid reduction in depressive symptoms, and has led to the submission for regulatory approval to the US Food and Drug Administration (decision due in March 2019). SAGE-217, an allopregnanolone analog, with oral bioavailability, was recently tested in a randomized, double-blind, placebo-controlled phase III study in severe postpartum depression, with reportedly positive results. Finally, a 3β-methylated synthetic analog of allopregnanolone, ganaxolone, is being tested in both intravenous and oral forms, in randomized, double-blind, placebo-controlled phase II studies in severe postpartum depression.
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Affiliation(s)
- Ariela Frieder
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA
| | - Madeleine Fersh
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA
| | - Rachel Hainline
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Kristina M Deligiannidis
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA.
- Departments of Psychiatry and Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Feinstein Institute for Medical Research, Manhasset, NY, USA.
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20
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Ma J, Huang Z, Wang S, Zheng S, Duan K. [Postpartum depression: association with genetic polymorphisms of noradrenaline metabolic enzymes and the risk factors]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:57-62. [PMID: 30692067 DOI: 10.12122/j.issn.1673-4254.2019.01.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate the association of genetic polymorphisms of norepinephrine metabolizing enzymes with postpartum depression and analyze the risk factors for postpartum depression in women following cesarean section. METHODS A total of 591 Chinese woman of Han Nationality undergoing caesarean section were enrolled in this study. The diagnosis of postpartum depression was established for an Edinburgh Postnatal Depression Scale (EPDS) score ≥9. For all the women without antepartum depression, the genotypes of catechol-O-methyltransferase (COMT; at 5 sites including rs2020917 and rs737865) and monoamine oxidase A (rs6323) were determined using Sequenom? Mass Array single nucleotide polymorphism (SNP) analysis. We analyzed the contribution of the genetic factors (SNPs, linkage disequilibrium and haplotype) to postpartum depression and performed logistic regression analysis to identify all the potential risk factors for postpartum depression and define the interactions between the genetic and environmental factors. RESULTS The incidence of postpartum depression was 18.1% in this cohort. Univariate analysis suggested that COMT polymorphism at rs2020917 (TT genotype) and rs737865 (GG genotype) were significantly correlated with the occurrence of postpartum depression (P < 0.05). Logistic regression analysis showed that COMT polymorphism at rs2020917 (TT genotype) and rs737865 (GG genotype), severe stress during pregnancy, and domestic violence were the risk factors for postpartum depression (P < 0.05); no obvious interaction was found between the genetic polymorphisms and the environmental factors in the occurrence of postpartum depression. CONCLUSIONS The rs2020917TT and rs737865GG genotypes of COMT, stress in pregnancy, and domestic violence are the risk factors for postpartum depression.
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Affiliation(s)
- Jiahui Ma
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Zhengdong Huang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Saiying Wang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Shanshan Zheng
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Kaiming Duan
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, China
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Abstract
BACKGROUND: Perinatal depression (PD) screening has been defined for decades, but treatment remains ill-defined, with few mental health (MH) providers helping depressed women during this delicate time. The nurse practitioner (NP) is in a position to help women through PD with the use of a collaborative treatment model. AIMS: This DNP (doctor of nursing practice) inquiry investigated a stepped collaborative care model (CCM) to see whether the PD model improved time from referral to evaluation and decreased depression scores over a 6-month treatment period for women who came to an NP MH practice. METHOD: After obtaining approval from the institutional review board and the clients, the Edinburgh Postnatal Depression Scale was administered to 37 women at psychiatric evaluation and subsequent MH visits over a 6-month period. Time from referral to evaluation and depression scores were analyzed. RESULTS: The CCM met the goal of 30 days from referral to evaluation. Prenatal clients had a statistically significant decrease in depression scores, and postpartum client scores were clinically significant. CONCLUSION: A CCM among care providers facilitates prompt intake to treatment time within 1 month of identification of depression, and a decrease in depression scores in women measured by sequential depression screen scores. The study may provide ideas for evidence-based NP practice by use of the model to treat depression in this group of women.
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Affiliation(s)
- Mary M Rock
- 1 Mary M. Rock, DNP, CRNP-BC, FNP-C, CNS-PMH-BC, Geisinger Holy Spirit, Camp Hill, PA, USA
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22
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Vogeli JM, Hooker SA, Everhart KD, Kaplan PS. Psychometric properties of the postpartum depression screening scale beyond the postpartum period. Res Nurs Health 2018; 41:185-194. [PMID: 29603768 DOI: 10.1002/nur.21861] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/26/2017] [Indexed: 11/08/2022]
Abstract
Accurate postpartum depression screening measures are needed to identify mothers with depressive symptoms both in the postpartum period and beyond. Because it had not been tested beyond the immediate postpartum period, the reliability and validity of the Postpartum Depression Screening Scale (PDSS) and its sensitivity, specificity, and predictive value for diagnoses of major depressive disorder (MDD) were assessed in a diverse community sample of 238 mothers of 4- to 15-month-old infants. Mothers (N = 238; M age = 30.2, SD = 5.3) attended a lab session and completed the PDSS, the Beck Depression Inventory-II (BDI-II), and a structured clinical interview (SCID) to diagnose MDD. The reliability, validity, specificity, sensitivity, and predictive value of the PDSS to identify maternal depression were assessed. Confirmatory factor analysis supported the construct validity of five but not seven content subscales. The PDSS total and subscale scores demonstrated acceptable to high reliability (α = 0.68-0.95). Discriminant function analysis showed the scale correctly provided diagnostic classification at a rate higher than chance alone. Sensitivity and specificity for major depressive disorder (MDD) diagnosis were good and comparable to those of the BDI-II. Even in mothers who were somewhat more diverse and had older infants than those in the original normative study, the PDSS appears to be a psychometrically sound screener for identifying depressed mothers in the 15 months after childbirth.
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Affiliation(s)
- Jo M Vogeli
- Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Stephanie A Hooker
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Kevin D Everhart
- Department of Psychology, University of Colorado Denver, Denver, Colorado
| | - Peter S Kaplan
- Department of Psychology, University of Colorado Denver, Denver, Colorado
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Psychological Problems and Socioemotional Wellbeing among Children of Mothers with Depression and Their Association with Sociodemographic Factors in a Sri Lankan Setting. PSYCHIATRY JOURNAL 2018; 2018:3809384. [PMID: 29850470 PMCID: PMC5926479 DOI: 10.1155/2018/3809384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/25/2018] [Accepted: 03/12/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Maternal depression is known to be associated with anxiety, depression, oppositional and conduct disorders, neurocognitive deficits, ADHD, substance abuse, and personality disorder in the offspring. We aimed to describe the proportion of psychological problems among children of mothers with depression in Sri Lanka and to describe the associated sociodemographic factors. METHODS A cross-sectional descriptive study was conducted on 100 children and adolescents between 4 and 16 years, whose mothers have a diagnosis of depression and are currently in remission. Specifically designed instruments were used to extract sociodemographic details and data on mother's illness. Strengths and Difficulties Questionnaire (SDQ) was used to detect psychological problems in children. RESULTS 14% of the children scored abnormally high in hyperactivity, 13% in conduct problems, 12% in emotional problems, 9% in peer problems, and 10% in total difficulties. Children (4-12 years) scored significantly higher than the adolescents in hyperactivity and externalizing problems (p < 0.05). Significant differences were also found in peer problems (p < 0.05), internalizing problems (p < 0.05), and total difficulties (p < 0.05) in relation to the age of the mother. CONCLUSION Screening the children of mothers with depression for psychological problems and developing a holistic management plan, which includes measures to ensure their wellbeing, is important.
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McCarter DE, Demidenko E, Hegel MT. Measuring outcomes of digital technology-assisted nursing postpartum: A randomized controlled trial. J Adv Nurs 2018; 74:10.1111/jan.13716. [PMID: 29772609 PMCID: PMC6240405 DOI: 10.1111/jan.13716] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/09/2018] [Accepted: 03/15/2018] [Indexed: 11/30/2022]
Abstract
AIM To determine if delivering electronic messages from nurses during the first 6 months postpartum is feasible, acceptable and effective in improving mood and decreasing parenting stress. BACKGROUND Competing demands during the postpartum hospitalization make focused time for nurses to provide education and support difficult. Unmet needs following discharge may increase the incidence of postpartum depression. Untreated depression negatively affects families, especially for vulnerable women with limited access to health care. DESIGN This is a longitudinal cohort study in three phases. Feasibility and acceptability were assessed during Phases 1 & 2. Phase 3 is a randomized controlled trial (RCT) with three conditions. METHODS This protocol was approved by the Institutional Review Board of the maternity hospital on 12 May 2015 and reviewed annually. Women are enrolled during the maternity hospitalization, after which randomization occurs. The control group receives usual care. Intervention I participants receive a standardized electronic message four times/week for 6 months postpartum. Intervention II participants receive the messages and the option to request a call from a nurse. Electronic surveys at 3 weeks, 3 months and 6 months postpartum measure depressive symptoms using the Edinburgh Postnatal Depression Scale and parenting stress using the Parenting Stress Index-Short form. Patient satisfaction, nursing time and expertise required are also measured. DISCUSSION Phase 1 and 2 have demonstrated the intervention is feasible and acceptable to women. Phase 3 enrolment is completed, and the last follow-up surveys were emailed to participants in February 2018. Results will help inform efforts to continue nursing care after hospital discharge.
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Affiliation(s)
- Deborah E McCarter
- Professor of Nursing, Saint Anselm College, Manchester, New Hampshire
- Staff Nurse, Catholic Medical Center, Manchester, New Hampshire
| | - Eugene Demidenko
- Professor of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Mark T Hegel
- Professor in Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Jones DE, Tang M, Folger A, Ammerman RT, Hossain MM, Short J, Van Ginkel JB. Neighborhood Effects on PND Symptom Severity for Women Enrolled in a Home Visiting Program. Community Ment Health J 2018; 54:420-428. [PMID: 29063413 DOI: 10.1007/s10597-017-0175-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 10/05/2017] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate the association between postnatal depression (PND) symptoms severity and structural neighborhood characteristics among women enrolled in a home visiting program. The sample included 295 mothers who were at risk for developing PND, observed as 3-month Edinburgh Postnatal Depression Scale (EPDS) scores ≥ 10. Two neighborhood predictor components (residential stability and social disadvantage) were analyzed as predictors of PND symptom severity using a generalized estimating equation. Residential stability was negatively associated with PND symptom severity. Social disadvantage was not found to be statistically significantly. The findings suggest that residential stability is associated with a reduction in PND symptom severity for women enrolled in home visiting program.
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Affiliation(s)
- David E Jones
- Counseling Program, School of Psychology and Counseling, Regent University , Virginia Beach, VA, USA.
| | - Mei Tang
- Counseling Program, School of Human Services, College of Education, Criminal Justice, and Human Services, Cincinnati, OH, USA
| | - Alonzo Folger
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert T Ammerman
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Md Monir Hossain
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jodie Short
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Judith B Van Ginkel
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Stigma and Postpartum Depression Treatment Acceptability Among Black and White Women in the First Six-Months Postpartum. Matern Child Health J 2018; 21:1457-1468. [PMID: 28102504 DOI: 10.1007/s10995-017-2263-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective To measure stigma associated with four types of postpartum depression therapies and to estimate the association between stigma and the acceptance of these therapies for black and white postpartum mothers. Methods Using data from two postpartum depression randomized trials, this study included 481 black and white women who gave birth in a large urban hospital and answered a series of questions at 6-months postpartum. Survey items included socio demographic and clinical factors, attitudes about postpartum depression therapies and stigma. The associations between race, stigma, and treatment acceptability were examined using bivariate and multivariate analyses. Results Black postpartum mothers were less likely than whites to accept prescription medication (64 vs. 81%, p = 0.0001) and mental health counseling (87 vs. 93%, p = 0.001) and more likely to accept spiritual counseling (70 vs. 52%, p = 0.0002). Women who endorsed stigma about receipt of postpartum depression therapies versus those who did not were less likely to accept prescription medication, mental health and spiritual counseling for postpartum depression. Overall black mothers were less likely to report stigma associated with postpartum depression therapies. In adjusted models, black women versus white women remained less likely to accept prescription medication for postpartum depression (OR = 0.42, 95% CI 0.24-0.72) and stigma did not explain this difference. Conclusions Although treatment stigma is associated with lower postpartum depression treatment acceptance, stigma does not explain the lower levels of postpartum depression treatment acceptance among black women. More research is needed to understand treatment barriers for postpartum depression, especially among black women.
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Medical and psychosocial determinants of risk of postpartum depression: a cross-sectional study. Acta Neuropsychiatr 2017; 29:347-355. [PMID: 28560935 DOI: 10.1017/neu.2017.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the degree of risk of maternal postpartum depression during the second month of puerperium. METHOD In total, 387 postnatal women filled out a questionnaire concerning their health and social status, as well as the following tests: the Edinburgh Postnatal Depression Scale (EPDS), the Patient Health Questionnaire-9 (PHQ-9), the Neo Five-Factor Inventory (NEO-FFI) Personality Inventory and the Berlin Social Support Scales. After 4-8 weeks, patients responded to another questionnaire with the EPDS and the PHQ-9. RESULTS In total, 48 patients (12.40%) were found to be at risk of postpartum depression between the fourth and eighth weeks after delivery. Premenstrual syndrome [adjusted odds ratio (ORa)=2.93, confidence interval (CI) 1.30-6.63] and EPDS>12 points during the first week after the delivery (ORa=3.74, CI 1.59-9.04) increased the risk of postnatal depression. A similar role is played by a high result in neuroticism scale of the NEO-FFI (ORa=1.50, CI 1.17-1.92) and a positive family history of any psychiatric disorder (ORa=1.03, CI 1.01-1.06). CONCLUSION A history of premenstrual syndrome and a higher risk of affective disorder soon after a childbirth are associated with greater chances of depressive symptoms in the second month postpartum. This is also the case if a patient is neurotic and has a relative with a history of any psychiatric disorder. Such women should have their mental status carefully evaluated.
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Potter MT. Nurse-Led Initiatives to Implement Universal Screening for Perinatal Emotional Complications. Nurs Womens Health 2017; 21:452-461. [PMID: 29223209 DOI: 10.1016/j.nwh.2017.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/13/2017] [Indexed: 06/07/2023]
Abstract
Perinatal emotional complications are the most common pregnancy complications in the United States. This article reviews three recent studies that illustrate the prevalence of and risk factors for perinatal emotional complications and sheds light on the inconsistency of screening by health care providers in acute care and outpatient settings. Also presented is an example of nurse-led quality improvement initiatives aimed at implementing universal screening in a rural New England county, which resulted in 100% screening with the Edinburgh Postnatal Depression Scale across health care facilities within the community, as well as a system-wide change in the approach to identifying and treating perinatal emotional complications.
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Sleep in the Postpartum: Characteristics of First-Time, Healthy Mothers. SLEEP DISORDERS 2017; 2017:8520358. [PMID: 29181201 PMCID: PMC5664311 DOI: 10.1155/2017/8520358] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/05/2017] [Accepted: 07/25/2017] [Indexed: 12/22/2022]
Abstract
Goals for the present study were to (a) describe the sleep of healthy new mothers over a 6-month postpartum period, (b) examine how sleep quality relates to daytime levels of fatigue and sleepiness, and (c) evaluate the relationship between mothers' and infants' sleep parameters. The sample consisted of 37 healthy, partnered, first-time mothers who had experienced full-term vaginal birth and had a healthy infant. We investigated infants' sleep parameters and mothers' sleep, mood, and daytime functioning 2 and 6 months postpartum. We found that at 2 months postpartum, mothers reported sleeping 6 hours at night and just under one hour during the day. Despite relatively frequent nocturnal awakenings, mothers experienced minimal insomnia, nonrefreshing sleep, anxiety, depression, daytime sleepiness, or fatigue at either 2 or 6 months. The most robust relationship between mothers' and infants' sleep was in the number of nocturnal sleep-wake episodes. Of note is that none of the infant sleep parameters was related to mothers' anxiety, depression, fatigue, sleepiness, or nonrefreshing sleep at either time period. Our results indicate that (1) selected low risk new mothers are resilient in terms of sleep quality, daytime functioning, and mood and (2) these are independent of their infants' sleep parameters.
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Feeley N, Hayton B, Gold I, Zelkowitz P. A comparative prospective cohort study of women following childbirth: Mothers of low birthweight infants at risk for elevated PTSD symptoms. J Psychosom Res 2017; 101:24-30. [PMID: 28867420 DOI: 10.1016/j.jpsychores.2017.07.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Nancy Feeley
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada; Centre for Nursing Research, Jewish General Hospital, Montreal, Quebec, Canada; Lady Davis Institute, Jewish General Hospital, Montreal, Canada.
| | - Barbara Hayton
- Department of Psychiatry, Jewish General Hospital, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Ian Gold
- Department of Psychiatry, McGill University, Montreal, Canada; Department of Philosophy, McGill University, Montreal, Quebec, Canada
| | - Phyllis Zelkowitz
- Lady Davis Institute, Jewish General Hospital, Montreal, Canada; Department of Psychiatry, Jewish General Hospital, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
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Abstract
Perinatal mental health has important implications for maternal and child outcomes. Most women with psychiatric disorders during pregnancy go undiagnosed and untreated, despite widespread initiatives for early identification. Universal screening for psychiatric disorders, particularly depression and anxiety, has been implemented in obstetric and primary care settings. However, there is little evidence regarding the effectiveness on psychiatric symptom reduction or prevention of adverse outcomes in children. Recently, comprehensive screening and follow-up programs integrated within obstetric or primary care settings have shown promising results in improving maternal mental health outcomes. Further work is needed to determine best clinical and most cost-effective practices.
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Affiliation(s)
- Shannon N Lenze
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8504, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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Abstract
This article focuses on six basic components of more effective depression care, emphasizing systems of team-based and collaborative care for diagnosis, monitoring, and follow-up. It also emphasizes the principles of stepped care and proactive and timely intensification of treatment, and discusses various augmentation strategies that all primary care providers could more readily employ.
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Affiliation(s)
- Elizabeth W Cozine
- Department of Family Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - John M Wilkinson
- Department of Family Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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Pierson ME, Prenoveau JM, Craske MG, Netsi E, Stein A. Psychometric properties of the Generalized Anxiety Disorder Questionnaire - IV (GAD-Q-IV) in postpartum mothers. Psychol Assess 2017; 29:1391-1399. [PMID: 28221055 PMCID: PMC5695386 DOI: 10.1037/pas0000443] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Generalized anxiety disorder (GAD) is a mental disorder of which the main feature is persistent and impairing worry. GAD symptoms are common for women during the postpartum period and GAD prevalence rates have been reported as higher in postpartum mothers than in the general population. Currently, little psychometric evidence exists for a screening measure to detect the possible presence of diagnosable GAD for postpartum women. The purpose of this investigation was to gather psychometric information for the Generalized Anxiety Disorder Questionnaire–IV (GAD-Q-IV; Newman et al., 2002) with a sample of postpartum mothers. Factor analyses were conducted to determine the factor structure of the GAD-Q-IV in postpartum women. Receiver-operating characteristic (ROC) analysis was used to determine a range of potential GAD-Q-IV cut-off scores for detecting the likely presence of GAD in postpartum women. Results from this study provided evidence to justify a 1-factor structure for the GAD-Q-IV responses from postpartum women, which demonstrated structural, metric, and scalar invariance over time. Findings from these analyses provided evidence of incremental validity, as there was a significant increase in predicting GAD diagnoses when GAD-Q-IV responses were used compared with another measure of postpartum depression. Last, using ROC analysis, a range of GAD-Q-IV cut-off scores was determined, which can be applied to screening for the likely presence or absence of GAD in postpartum women. The evidence presented in this study suggests that the GAD-Q-IV could be a viable screening measure used to identify the likely presence of GAD in postpartum women so that further evaluations and treatments can be recommended. The present investigation suggests that postpartum women experience higher levels of anxiety than the general population, which has a negative impact on their lives as well as their newborn children. We have provided evidence that physicians can use a measure of generalized anxiety disorder (GAD) to detect the likely presence of the disorder in postpartum women so that treatments can be recommended.
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Affiliation(s)
- Mark E Pierson
- Center for Social Organization of Schools, School of Education, Johns Hopkins University
| | | | - Michelle G Craske
- Anxiety Disorders Research Center of UCLA, University of California, Los Angeles
| | - Elena Netsi
- Department of Psychiatry, University of Oxford
| | - Alan Stein
- Department of Psychiatry, University of Oxford
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Gultekin L, Brush BL. In Their Own Words: Exploring Family Pathways to Housing Instability. JOURNAL OF FAMILY NURSING 2017; 23:90-115. [PMID: 27881686 PMCID: PMC11664298 DOI: 10.1177/1074840716678046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Housing instability threatens the health and well-being of millions of families across the United States, yet little is known about the characteristics or housing trajectories of at-risk families. To address this gap in our understanding of family risk for housing instability and homelessness, we undertook a qualitative descriptive study utilizing a convenience sample of 16 mothers recruited from a housing service agency living in Detroit and receiving emergency services to avoid homelessness. Participants completed the Brief Patient Health Questionnaire (PHQ), then narrated their life events and reasons for housing instability and disclosed desired interventions for homelessness prevention. Data analysis reveals that women experienced high rates of previously undisclosed trauma, broken family relationships, early parenting responsibilities, social isolation, and system failures that contributed to recurrent episodes of housing instability. We argue that housing instability is a symptom of multiple chronic underlying issues that need more than a temporary financial patch.
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Trost MJ, Molas-Torreblanca K, Man C, Casillas E, Sapir H, Schrager SM. Screening for maternal postpartum depression during infant hospitalizations. J Hosp Med 2016; 11:840-846. [PMID: 27527537 DOI: 10.1002/jhm.2646] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/17/2016] [Accepted: 06/23/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Postpartum depression is common and adversely affects children of afflicted mothers; postpartum depression recognition and treatment may improve outcomes. Hospitalization represents a potential health encounter for expanding screening and intervention. OBJECTIVE We aimed to assess for postpartum depression at infant hospitalization and examine postpartum depression risk factors in this population. DESIGN, SETTING, AND PARTICIPANTS We conducted a prospective observational study of 310 English- or Spanish-speaking women with an infant aged 2 weeks to 1 year admitted to a pediatric hospitalist service at a large urban freestanding children's hospital. MEASUREMENTS Mothers completed demographic questionnaires, a maternal-infant bonding scale, and the Edinburgh Postpartum Depression Scale (EPDS). Mothers with an EPDS score of 10 or higher (positive screen) received counseling and mental health referrals. Postenrollment calls followed trends in EPDS score and resource utilization. Multivariate logistic regression assessed relationships among risk factors and positive screens. RESULTS Eighty-seven mothers (28%) were EPDS+. Only 14.6% reported appropriate prior depression screening. Maternal factors associated with EPDS+ were poor social support (4.40, interquartile range [IQR] = 2.27-8.53) and history of psychiatric diagnoses (5.02, IQR = 2.49-10.15). Having an infant with neurodevelopmental comorbidities was associated with EPDS+ screens (2.78, IQR = 1.03-7.52). Of 21 initially EPDS+ mothers reached by phone, 8 (38%) utilized their doctor or referral resource, resulting in lower EPDS scores (F(1,19) = 5.743, P < 0.05) compared to those not seeking help. CONCLUSION Postpartum depression screening during infant hospitalizations captures women previously unscreened. Low social support, past psychiatric diagnoses, or having infants with neurodevelopmental problems may increase postpartum depression risk. Journal of Hospital Medicine 2015;11:840-846. © 2015 Society of Hospital Medicine.
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Affiliation(s)
- Margaret J Trost
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Kira Molas-Torreblanca
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Carol Man
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Ernesto Casillas
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Hoda Sapir
- Division of Social Work, Children's Hospital Los Angeles, Los Angeles, California
| | - Sheree M Schrager
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
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Owora AH, Carabin H, Reese J, Garwe T. Summary diagnostic validity of commonly used maternal major depression disorder case finding instruments in the United States: A meta-analysis. J Affect Disord 2016; 205:335-343. [PMID: 27566453 PMCID: PMC5568628 DOI: 10.1016/j.jad.2016.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/05/2016] [Accepted: 08/14/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Major Depression Disorder (MDD) is common among mothers of young children. However, its detection remains low in primary-care and community-based settings in part due to the uncertainty regarding the validity of existing case-finding instruments. We conducted meta-analyses to estimate the diagnostic validity of commonly used maternal MDD case finding instruments in the United States. METHODS We systematically searched three electronic bibliographic databases PubMed, PsycINFO, and EMBASE from 1994 to 2015 to identify relevant published literature. Study eligibility and quality were evaluated using the Standards for the Reporting of Diagnostic Accuracy studies and Quality Assessment of Diagnostic Accuracy Studies guidelines, respectively. Pooled sensitivity and specificity of case-finding instruments were generated using Bayesian hierarchical summary receiver operating models. RESULTS Overall, 1130 articles were retrieved and 74 articles were selected for full-text review. Twelve articles examining six maternal MDD case-finding instruments met the eligibility criteria and were included in our meta-analyses. Pooled sensitivity and specificity estimates were highest for the BDI-II (91%; 95% Bayesian Credible Interval (BCI): 68%; 99% and 89%; 95% BCI: 62%; 98% respectively) and EPDS10 (74%; 95% BCI: 46%; 91% and 97%; 95% BCI: 84%; 99% respectively) during the antepartum and postpartum periods respectively. LIMITATION No meta-regression was conducted to examine the impact of study-level characteristics on the results. DISCUSSION Diagnostic performance varied among instruments and between peripartum periods. These findings suggest the need for a judicious selection of maternal MDD case-finding instruments depending on the study population and target periods of assessment.
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Affiliation(s)
- Arthur H. Owora
- Correspondence to: 745 Martina Lane, Edmond, OK 73034, United Sates
| | - Hélène Carabin
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
| | - Jessica Reese
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
| | - Tabitha Garwe
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
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Mestad R, Lane SD, Hall M, Smith CJ, Carter DB, Rubinstein RA, Keefe RH, Jones-Moore C. Prenatal Depression: Screening and Referral for Women Who Are Low Income during Antenatal Care. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:557-564. [PMID: 27286463 DOI: 10.1080/19371918.2016.1160344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study uses prenatal clinical chart reviews of 245 women who were screened for depression while receiving antenatal care services at an urban hospital-based clinic in Syracuse, New York. The results indicate that more than one half of the mothers who screened positive are not being adequately referred and followed-up on to ensure they are receiving proper treatment. Among the mothers who are not being successfully referred are women who are non-English speaking, facing multiple life stressors, and inadequately insured. Recommendations for colocating services that may ease the ongoing burdens of new motherhood are addressed.
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Affiliation(s)
- Renee Mestad
- a Division Chief of Obstetrics and Gynecology , SUNY Upstate Medical University , Syracuse , New York , USA
| | - Sandra D Lane
- b Department of Public Health and Anthropology , Syracuse University , Syracuse , New York , USA
- c Department of Obstetrics and Gynecology , SUNY Upstate Medical University , Syracuse , New York , USA
| | - Meghan Hall
- d Department of Child & Family Studies , Syracuse University , Syracuse , New York , USA
| | - Carrie J Smith
- e School of Social Work, Syracuse University , Syracuse , New York , USA
| | - D Bruce Carter
- d Department of Child & Family Studies , Syracuse University , Syracuse , New York , USA
| | - Robert A Rubinstein
- f Department of Anthropology & International Relations , Maxwell School of Citizenship and Public Affairs, Syracuse University , Syracuse , New York , USA
| | - Robert H Keefe
- g School of Social Work, University at Buffalo, State University of New York , Buffalo , New York , USA
| | - Chevelle Jones-Moore
- h Upstate Cancer Center, SUNY Upstate Medical University , Syracuse , New York , USA
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Diagnostic performance of major depression disorder case-finding instruments used among mothers of young children in the United States: A systematic review. J Affect Disord 2016; 201:185-93. [PMID: 27240311 PMCID: PMC5578461 DOI: 10.1016/j.jad.2016.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/11/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Growing recognition of the interrelated negative outcomes associated with major depression disorder (MDD) among mothers and their children has led to renewed public health interest in the early identification and treatment of maternal MDD. Healthcare providers, however, remain unsure of the validity of existing case-finding instruments. We conducted a systematic review to identify the most valid maternal MDD case-finding instrument used in the United States. METHODS We identified articles reporting the sensitivity and specificity of MDD case-finding instruments based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) by systematically searching through three electronic bibliographic databases, PubMed, PsycINFO, and EMBASE, from 1994 to 2014. Study eligibility and quality were evaluated using the Standards for the Reporting of Diagnostic Accuracy studies and Quality Assessment of Diagnostic Accuracy Studies guidelines respectively. RESULTS Overall, we retrieved 996 unduplicated articles and selected 74 for full-text review. Of these, 14 articles examining 21 different instruments were included in the systematic review. The 10 item Edinburgh Postnatal Depression Scale and Postpartum Depression Screening Scale had the most stable (lowest variation) and highest diagnostic performance during the antepartum and postpartum periods (sensitivity range: 0.63-0.94 and 0.67-0.95; specificity range: 0.83-0.98 and 0.68-0.97 respectively). Greater variation in diagnostic performance was observed among studies with higher MDD prevalence. LIMITATION Factors that explain greater variation in instrument diagnostic performance in study populations with higher MDD prevalence were not examined. DISCUSSION Findings suggest that the diagnostic performance of maternal MDD case-finding instruments is peripartum period-specific.
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Kothari C, Wiley J, Moe A, Liepman M, Tareen R, Curtis A. Maternal depression is not just a problem early on. Public Health 2016; 137:154-61. [DOI: 10.1016/j.puhe.2016.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/09/2015] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
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Falah-Hassani K, Shiri R, Dennis CL. Prevalence and risk factors for comorbid postpartum depressive symptomatology and anxiety. J Affect Disord 2016; 198:142-7. [PMID: 27016657 DOI: 10.1016/j.jad.2016.03.010] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 02/19/2016] [Accepted: 03/07/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND To date, little is known about the prevalence and risk factors for comorbid postpartum depression and anxiety. The aims of this study were to estimate the prevalence of comorbid depressive symptomatology and anxiety during the first 8 weeks postpartum and to identify risk factors. METHODS As part of a longitudinal study conducted in a health region near Vancouver, British Columbia, a sample of 522 women completed mailed questionnaires at 1, 4, and 8 weeks postpartum. The presence of comorbid postpartum depressive symptomatology and anxiety was defined as having an Edinburgh Postnatal Depression Scale (EPDS) score of ≥10 and a State Trait Anxiety Inventory (STAI)-state anxiety score of ≥40 at the same time point. Risk factors associated with comorbidity were examined using generalized estimating equations (GEE). RESULTS The prevalence of comorbid depressive symptomatology and anxiety was 13.1% during the first 8 weeks postpartum. In multivariable analysis, immigration within past 5 years (adjusted odds ratio (AOR)=8.03, 95% CI 3.43-18.77), maternal vulnerable personality (AOR=1.42, 95% CI 1.02-1.97 for 1 SD increase), child care stress (AOR=1.66, 95% CI 1.18-2.35 for 1 SD increase) and perceived stress (AOR=3.00, 95% CI 2.01-4.47 for 1 SD increase) predicted a higher risk of comorbidity. Conversely, high breastfeeding self-efficacy (AOR=0.66, 95% CI 0.49-0.88 for 1 SD increase), maternal self-esteem (AOR=0.66, 95% CI 0.45-0.97 for 1 SD increase), and partner support (AOR=0.73, 95% CI 0.55-0.98 for 1 SD increase) were associated with a lower risk of developing comorbidity. LIMITATION In this study, women who were single or from non-Caucasian ethnic groups were underrepresented. CONCLUSIONS Comorbid postpartum depressive symptomatology and anxiety is a common condition with little known about risk factors. Additional research is warranted to develop strategies to reliably identify women with this comorbid condition and to determine effective treatment options.
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Affiliation(s)
- Kobra Falah-Hassani
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Bodnar-Deren S, Klipstein K, Fersh M, Shemesh E, Howell EA. Suicidal Ideation During the Postpartum Period. J Womens Health (Larchmt) 2016; 25:1219-1224. [PMID: 27227751 DOI: 10.1089/jwh.2015.5346] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the association between suicidal ideation (SI), 3 weeks, 3 months, and 6 months postpartum with demographic, psychosocial, clinical factors, and depressive/anxiety symptoms (measured 24-48 hours after delivery), among a cohort of postpartum women. METHODS This study included 1,073 mothers who gave birth in a large tertiary New York City hospital (2009-2010). Later, self-report SI was assessed using the suicide measure from the Edinburgh Postnatal Depression Scale and from the Patient Health Questionnaire. RESULTS Two percent of participants presented with SI during the first 6 months postpartum. In bivariate analyses, race/ethnicity, nativity, insurance, and language were significantly correlated with SI 3 weeks, 3 months, and 6 months postpartum. Screening positive for depression (p = 0.0245) and anxiety (0.0454), assessed 1-2 days postpartum, was significantly correlated with later SI in bivariate analyses, as were antepartum complications (p = 0.001), depressive history (0.001), and self-efficacy (0.045). In adjusted models, antepartum complications (OR = 4.681, 95% CI = 1.99-10.99) and depressive history (OR-3.780, 95% CI = 1.514-9.441) were significantly associated with later postpartum SI. Heightened self-efficacy reduced the odds of later SI (p = 0.050). CONCLUSION Findings suggest that SI among a relatively healthy group of new mothers occurs with some frequency. Mothers with a history of depression and antepartum complications may be at increased risk.
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Affiliation(s)
- Susan Bodnar-Deren
- 1 Department of Sociology and Institute of Women's Health, Virginia Commonwealth University , Richmond, Virginia
| | - Kimberly Klipstein
- 2 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Madeleine Fersh
- 2 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York.,3 Department of Psychiatry, North Shore LIJ, Zucker Hillside Hospital , Glen Oaks, New York
| | - Eyal Shemesh
- 2 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York.,4 Department of Pediatrics, Icahn School of Medicine at Mount Sinai , New York, New York.,5 Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Elizabeth A Howell
- 2 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York.,5 Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai , New York, New York.,6 Population Health Science and Policy, Icahn School of Medicine at Mount Sinai , New York, New York
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Venkatesh KK, Riley L, Castro VM, Perlis RH, Kaimal AJ. Association of Antenatal Depression Symptoms and Antidepressant Treatment With Preterm Birth. Obstet Gynecol 2016; 127:926-933. [PMID: 27054941 PMCID: PMC10034858 DOI: 10.1097/aog.0000000000001397] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the association of antenatal depression symptoms with preterm birth and small for gestational age (SGA). METHODS This was an observational cohort study conducted among women who completed Edinburgh Postnatal Depression Scale screening and delivered at 20 weeks of gestation or greater. The primary outcomes were preterm birth and an SGA neonate at birth (less than 10th percentile for gestational age); the primary predictor was an Edinburgh Postnatal Depression Scale antepartum score of 10 or greater, indicating symptoms of depression. Logistic regression models were used with and without consideration of antidepressant exposure during pregnancy. RESULTS Among 7,267 women, 831 (11%) screened positive for depression. In multivariable analyses adjusting for maternal age, race, income, body mass index, tobacco use, lifetime diagnosis of major depression and anxiety, diabetes, hypertension, and preeclampsia, women who screened positive for depression experienced an increased risk of preterm birth (less than 37 weeks of gestation) (adjusted odds ratio [OR] 1.27, 95% confidence interval [CI] 1.04-1.55) and very preterm birth (less than 32 weeks of gestation) (adjusted OR 1.82, 95% CI 1.09-3.02) as well as of having an SGA neonate (adjusted OR 1.28, 95% CI 1.04-1.58). In secondary analyses, among women who were treated with an antidepressant during pregnancy (19% of those who screened positive and 5% of those who screened negative), depressive symptoms were not associated with a significantly increased risk of preterm and very preterm birth or an SGA neonate. CONCLUSIONS In a large cohort of women screened for depression antepartum, those with depressive symptoms had an increased likelihood of preterm and very preterm delivery as well having an SGA neonate. Such risk was not apparent among women who were treated with an antidepressant medication.
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Affiliation(s)
- Kartik K Venkatesh
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Brigham and Women's Hospital, the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, and the Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, and the Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Evaluate the rationale for screening women for postpartum depression• Assess tools for screening for postpartum depression OBJECTIVE To perform a qualitative literature review on screening for postpartum depression (PPD), as applicable to the general psychiatrist. Results are classified by instrument, timing, and clinical setting of the screen. DATA SOURCES A literature search was conducted using the PubMed database for English-language articles published since January 1987. Of the 2406 citations initially identified, 61 articles remained after application of inclusion and exclusion criteria. RESULTS Among numerous screening tools for PPD, the Edinburgh Postnatal Depression Scale is the most widely used. Data suggest that screening for PPD should commence soon after delivery, with subsequent screens at multiple time-points in the postpartum period. Primary care, pediatric, and obstetric settings are all viable locations for screening, but are ineffective without follow-up mental health evaluations. Less data are available to define optimal patterns either for screening in psychiatric settings or for the psychiatrist's role in managing perinatal depression. CONCLUSIONS The American Congress of Obstetricians and Gynecologists, American Academy of Pediatrics, and most authors firmly recommend screening for PPD. The Edinburgh Postnatal Depression Scale can be administered in various clinical settings. Screening should occur at multiple time-points throughout the first postpartum year. The psychiatrist's role in early detection and prevention of PPD requires further exploration.
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Abstract
Using data from two postpartum depression randomized trials, we examined the association between postpartum depressive symptoms and parenting practices among a diverse group of mothers. We examined the association between safety practices (back sleep position, car seat use, smoke alarm), feeding practices (breastfeeding, infant intake of cereal, juice, water), and health care practices (routine well child and Emergency Room (ER) visits) with 3-month postpartum depressive symptoms assessed using the Edinburgh Depression Scale (EPDS ≥10). Fifty-one percent of mothers were black or Latina, 33 % had Medicaid, and 30 % were foreign born. Depressed mothers were less likely to have their infant use back sleep position (60 vs. 79 %, p < .001), always use a car seat (67 vs. 84 %, p < .001), more likely to feed their infants water, juice, or cereal (36 vs. 25 %, p = .04 respectively), and to bring their babies for ER visits (26 vs. 16 %, p = .03) as compared with non-depressed mothers. In multivariable model, depressed mothers remained less likely to have their infant use the back sleep position, to use a car seat, and to have a working smoke alarm in the home. Findings suggest the need to intervene early among mothers with depressive symptoms and reinforce positive parenting practices.
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BenDavid DN, Hunker DF, Spadaro KC. Uncovering the Golden Veil: Applying the Evidence for Telephone Screening to Detect Early Postpartum Depression. J Perinat Educ 2016; 25:37-45. [PMID: 26848249 DOI: 10.1891/1058-1243.25.1.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Postpartum depression (PPD) is often detected later than symptom onset, or even undetected, because of lack of prompt or adequate screening. An evidence-based PPD screening protocol using a telephone-based format within a primary care practice was developed to identify symptoms and initiate treatment between 2 and 3 weeks postpartum. The Edinburgh Postnatal Depression Scale was used, with positive screens referred for provider and support services, and then tracked for follow-through. Fifty-two percent of women screened positive. Sixty-four percent accepted both provider and support referrals, with 89% follow-through with provider referrals and 78% follow-through with support referrals. Outcomes support early screening for PPD using a telephone-based format to effectively identify symptoms and acceptance of referrals by participants.
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Patel HL, Ganjiwale JD, Nimbalkar AS, Vani SN, Vasa R, Nimbalkar SM. Characteristics of Postpartum Depression in Anand District, Gujarat, India. J Trop Pediatr 2015; 61:364-369. [PMID: 26179494 DOI: 10.1093/tropej/fmv046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Characteristics of postpartum depression (PPD) in Anand District, Gujarat, India. PPD affects 1 in 10 women in the developed world. It has been implicated as an independent factor with adverse effect on child health, and health care-seeking behavior of mothers. We sought to find the prevalence of PPD in our hospital by including mothers who registered and delivered live babies at our hospital. Basic demographic information related to pregnancy was acquired from mothers and Edinburgh Postnatal Depression Scale (EPDS), pre-translated and validated in Gujarati language, was administered. Current study observed prevalence of PPD as 48.5% using cutoff score of 10.5 for classifying depression in Gujarati women. Factors associated with depression after multivariable logistic regression were: age of mother, modified Kuppuswami category (MKC) score, family type, violence from husband, gravida, para and sex of infant. PPD has higher prevalence in our study vis-a-vis Western countries. This may be because of early administration of EPDS.
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Affiliation(s)
- Himadri L Patel
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat 388325, India
| | - Jaishree D Ganjiwale
- Central Research Services, Charutar Arogya Mandal, Karamsad, Gujarat 388325, India
| | - Archana S Nimbalkar
- Department of Physiology, Pramukhswami Medical College, Karamsad, Gujarat 388325, India
| | - Shashi N Vani
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat 388325, India
| | - Rohitkumar Vasa
- University of Chicago, Department of Pediatrics, 5841 South Maryland Avenue, Chicago, Illinois, 60637 USA
| | - Somashekhar M Nimbalkar
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat 388325, India Central Research Services, Charutar Arogya Mandal, Karamsad, Gujarat 388325, India
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Walker LO, Gao J, Xie B. Postpartum Psychosocial and Behavioral Health: A Systematic Review of Self-Administered Scales Validated for Postpartum Women in the United States. Womens Health Issues 2015; 25:586-600. [DOI: 10.1016/j.whi.2015.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 05/09/2015] [Accepted: 05/12/2015] [Indexed: 11/11/2022]
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