Published online Aug 19, 2022. doi: 10.5498/wjp.v12.i8.1061
Peer-review started: October 4, 2021
First decision: December 12, 2021
Revised: January 8, 2022
Accepted: July 18, 2022
Article in press: July 18, 2022
Published online: August 19, 2022
Depression is a common public health problem. It is an important cause of morbidity for mothers in their peripartum period, with an estimated prevalence of 7%-58% or even higher in some countries. A common prevalence of antepartum or postpartum depression reported in different studies is approximately 13%. The suggested mechanism(s) of peripartum depression include(s) complex interplay between biological factors (fluctuation in reproductive, thyroid, and hypothalamic pituitary adrenal axis hormones), immune system activity, genetics, and psychosocial stressors. Therefore, World health Organization and United States Preventive Services Task Force recommend screening for women in peripartum period looking for manifestations of depression and determine their risks.
The research hotspots include determination of: (1) The prevalence of peripartum (antepartum and postpartum) depression. Because related studies are few for antepartum compared to postpartum depression; (2) The severities of depression in relation to different demographic, social, obstetric, hormonal, and psychological variables; and (3) The predictors which are independently associated with each of antepartum or postpartum depression.
This study systematically assessed women in their peripartum period to estimate the prevalence and predictors of peripartum depression.
The Edinburgh Postpartum Depression Scale screening questionnaire; designed unstructured clinical questionnaire to gather information about the women's reactions to recent life circumstances, events, and stress in relation to the recent pregnancy; Beck Depression Inventory II, the State-Trait Anxiety Inventory for Adults, and Parenting Stress Index-Short Form for severity categorization of depression, anxiety, and parenting stress respectively; psychiatric interviewing to confirm the diagnosis of major depressive disorder (according to the Diagnostic and Statistical Manual of Mental Disorders, version 5); and measurements of triiodothronine, thyroxine, and thyroid stimulating hormone levels in the antepartum and postpartum periods.
The prevalence of women with clinically significant symptoms of peripartum depression in our locality is 20.66%. Major depression was found in 7.44%. Symptoms of depression were less severe in postpartum period than antepartum. Antepartum anxiety was the only predictor for both antepartum and postpartum depression. Antepartum anxiety and depression and parenting stress were the predictors for postpartum depression.
Nearly one fifth of women developed clinically significant manifestations of depression in their peripartum period, mainly attributed to anxiety and parenting stress.
In our locality, the importance of antepartum depression as a risk for postpartum depression and subsequently parenting stress has been largely under-recognized. Health care providers and insurance policies need to focus attention to the magnitude of the problem of peripartum depression to encourage education for obstetricians, mothers, and families about its high prevalence and associated risks. A multidisciplinary team for screening and management of peripartum depression is required (e.g., prevention and expertise guidance related to the recommended treatment options, such as psychotherapy and/or pharmacotherapy).