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PubMed2000

The North Staffordshire Maternity Hospital prospective study of pregnancy-associated depression.

The objective of the study was to establish the frequency of depression during pregnancy and the puerperium, and its relationship to marital disharmony and sociodemographic variables. A prospective longitudinal study was carried out in a district general hospital in the West Midlands, UK. The cohort consisted of 417 women booked for confinement at the hospital. Depression was measured as a proportion of high scores (> 14) on the Edinburgh Postnatal Depression Scale (EPDS) and marital disharmony was determined by the Spanier Dyadic Adjustment Scale. Using recommended cut-offs, 41/417 (9.8%) of the women were depressed during pregnancy and 31/417 (7.4%) were depressed at 3 months postpartum. There was a significant association between antenatal and postnatal depression, seven of the 31 women who were depressed postpartum had also been depressed in the antenatal period. Only five of the 41 women with antenatal depression and eight of the 31 women with postnatal depression were identified by their general practitioners as depressed. Marital disharmony was sequentially associated with depression before and after delivery. We conclude that antenatal depression is more common than generally thought, and that both antenatal and postnatal depression are frequently missed during routine consultation. Pregnancy-associated depression is more common where marital disharmony exists. More widespread use of the EPDS during pregnancy may help to highlight these often unidentified mental health problems.

Adolescent↗
PubMed1998

Prospective study of postpartum depression in an Israeli cohort: prevalence, incidence and demographic risk factors.

This study aimed to assess the prevalence and incidence of postpartum depression (PPD) and to identify risk factors in a community cohort of Israeli-born, as well as new and veteran immigrant women. A random sample of 288 registrants at a community clinic was assessed for depressive symptoms at 26 weeks' pregnancy using the Beck Depression Inventory (BDI) and at 6 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Information regarding risk factors was gathered through interviews and medical record abstracting. The prevalence of PPD was 22.6%. Two-thirds of the women had scored 'depressed' during pregnancy, and one-third (6.9%) were new incident cases. Immigrant status was the only significant demographic predictor of PPD identified by either univariate or multivariate analysis, with Russian new immigrants having over twice the risk for PPD as Israeli-born subjects. The rate of PPD in this Israeli cohort was comparable to that found in other countries. The finding that immigrant status was the most potent demographic predictor may support the role of stressful life events in the etiology of PPD. The use of the EPDS for PPD screening was found acceptable and feasible in the primary health setting.

Analysis of Variance↗
PubMed2004

[The effects of the systemic follow up health care program on the health promotion and the risk reduction in premature infants and their mothers].

PURPOSE: This research was conducted to evaluate the effects of a systemic follow-up care program on health promotion and risk reduction in 64 high-risk infants (HRI) including premature infants and their mothers. METHOD: The intervention consisted of systemic NICU education, tele-counseling and 3 home visits in 6 months. The subjects were divided into either the intervention group or the control group receiving the conventional education without the tele-counseling and home visiting. Infant health promotion was measured using physical assessment, types of health problems, reflexes, OPD visiting history, DDST, immunization, feeding assessment, Infant death rate, etc. Maternal self-esteem, postpartum depression and family function were measured using the maternal self-report inventory (MRI), EPDS, and family apgar score (Fapgar), retrospectively. RESULT: All premature infants in the intervention group were in the normal range of growth and development, and the regular vaccination schedule. The health problems in the intervention group were addressed early so not to develop into adverse effects. The follow-up program for 6 months showed beneficial effects on MRI, EPDS, and Fapgar. CONCLUSION: A systemic follow-up health care program is beneficial on health promotion and risk reduction in 64 HRI including premature infants and their mothers.

Adult↗
PubMed1992

Increased risk of postnatal depression after emergency caesarean section.

OBJECTIVE: To examine whether women having an emergency caesarean section are at increased risk of developing postnatal depression at one, three and six months postpartum. DESIGN: Participants were part of a larger study examining the relationship between personality dysfunction and postnatal depression. All women were recruited at an antenatal clinic in the first trimester of their pregnancy. These women were followed up at one, three and six months postpartum to identify cases of postnatal depression, defined by the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Data were collected from 188 women, who were divided into three groups by method of delivery: 21 women had an emergency caesarean section, 49 had a forceps delivery and 118 had a spontaneous vaginal delivery. Comparison of the groups indicated a significant difference at three months postpartum only. Women having an emergency caesarean section had significantly higher EPDS scores than women who had forceps or spontaneous vaginal delivery (9.15 +/- 6.18 v. 5.05 +/- 3.81 v. 5.79 +/- 4.47; F(2,143) = 4.2, P less than 0.02). Analysis of postnatal depression at three months indicated that women in the emergency caesarean section group had a relative risk of 6.82 (95% confidence interval, 2.85-16.15) compared with women in the other groups. CONCLUSIONS: When compared with women having spontaneous vaginal or forceps deliveries, women having an emergency caesarean section had more than six times the risk of developing postnatal depression three months postpartum. Special attention to this group appears warranted.

Cesarean Section↗
PubMed2000

Early discharge and postnatal depression: a prospective cohort study.

OBJECTIVES: To determine whether women discharged from hospital < or = 72 hours after childbirth (early discharge) were at greater risk of developing symptoms of postnatal depression during the following six months than those discharged later (late discharge), their reasons for early discharge and their level of postnatal support. DESIGN AND SETTING: Population-based, prospective cohort study with questionnaires at Day 4, and at 8, 16 and 24 weeks postpartum, conducted at all birth sites in the Australian Capital Territory (ACT). PARTICIPANTS: Women resident in the ACT giving birth to a live baby from March to October 1997. MAIN OUTCOME MEASURE: A score > 12 on the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: 1295 (70%) women consented to participate; 1193 (92%) were retained in the study to 24 weeks and, of these, 1182 returned all four questionnaires. Of the 1266 women for whom length-of-stay data were available, 467 (37%) were discharged early and 799 (63%) were discharged late. There were no significant differences between the proportion of women discharged early who ever scored > 12 on the EPDS during the six postpartum months and those discharged late (17% v. 20%), even after controlling for other risk factors (adjusted OR, 0.67; 95% CI, 0.44-1.01). Of women discharged early, 93% had at least one postnatal visit at home from a midwife and 81% were "very satisfied" with the care provided. Most women (96%) reported they had someone to help in practical ways. CONCLUSIONS: Women discharged early after childbirth do not have an increased risk of developing symptoms of postnatal depression during the following six months.

Adult↗
PubMed2002

To screen or not to screen--that is the question in perinatal depression.

Significant perinatal distress and depression affects 14% of women, producing short and long term consequences for the family. This suggests that measures for early detection are important, and non-identification of these women may exacerbate difficulties. Screening provides an opportunity to access large numbers of women and facilitate pathways to best-practice care. A valid, reliable, economical screening tool (the Edinburgh Postnatal Depression Scale, EPDS) is available. Arguments against screening pertain largely to lack of evidence about the acceptability of routine use of the EPDS during pregnancy and the postnatal period, and inadequate evidence regarding outcomes and cost-effectiveness. To address these concerns, the National Postnatal Depression Prevention and Early Intervention Program will evaluate outcomes of screening in terms of acceptability, cost-effectiveness, access and satisfaction with management in up to 100 000 women.

Australia↗
PubMed1999

[Postpartum depression in the health area of Toledo].

OBJECTIVES: To find how common post-natal depression is in our area and its relationship with social and demographic variables, vital events and morbidity. DESIGN: Descriptive crossover study based on initial interview face-to-face, and follow-up telephone interview. SETTING: Community framework; our area's health districts. PARTICIPANTS: 190 women who attended our reference hospital to give birth between February and April 1998. MEASUREMENT AND RESULTS: Through face-to-face interview at the hospital, social and demographic variables, morbidity, intercurrent vital events and family support were collected for 190 women. Six to eight weeks after the birth, these women were phoned and the Edinburgh Depression Scale (EPDS) was conducted. According to the EPDS, the frequency of depression was 13.16% (95% CI, 8.86-19). Characteristics of the sample were: mean age 30.13 (SD 4.63), rural setting. 56% had basic schooling. 32% had psychiatric history, and 44% had family history of depression. 80% thought they were going to be supported after the birth: after seven weeks this figure was 75%. In comparison between women with and without post-natal depression, we found statistically significant differences on relating it to psychiatric history of the woman (p < 0.05) and of the women's family (p < 0.01). For mother's educational level, we found a nearly significant association (p < 0.1). No significant differences were found with the other variables studied. CONCLUSIONS: The frequency of post-natal depression found was similar to in the literature. Our profile of women with post-natal depression was: medium-low educational level, personal and family history of depression. Unlike other studies, we found no relationship between post-natal depression and family support during the puerperium.

Adult↗
PubMed2000

Cultural elements of postpartum depression. A study of 327 Jewish Jerusalem women.

OBJECTIVE: To examine the social, cultural and religious factors underlying postpartum depression within a cultural cross-section of Jewish Jerusalem women. STUDY DESIGN: A prospective, repeated-measures study of 327 women. The Edinburgh Postpartum Depression Scale (EPDS) was administered immediately postpartum and 6-10 weeks later. Detailed sociodemographic information included perceptions of the pregnancy, community supports and religious affiliation. Odds ratios, 95% confidence interval and P values were calculated for all covariates. Multiple logistic regression was performed to estimate the degree of independent association between religiosity and postpartum depression. RESULTS: Postpartum depressive symptoms significantly associated with secular affiliation (odds ratio [OR] 2.9 [1.3-6.3] and tended toward an inverse association with orthodox affiliation (OR 0.6 [0.3-1.3]). Across secular, traditional, religious and orthodox groups, there was a decreasing trend in EPDS mean scores. Other predictors of depressive symptoms were psychiatric history, immigrant status and poor support with newborn care. CONCLUSION: Our study sample was particularly suitable for the assessment of cultural and religious elements of postpartum depression. We found religiosity, with its associated social and community structuring and well-defined social roles, to be significantly associated with self-reported postpartum depressive symptoms. These findings suggest that cultural factors, including role definitions, community support and rituals, may explain discrepancies found in the incidence of postpartum depression.

Adult↗
PubMed2000

Costs and benefits of community postnatal support workers: a randomised controlled trial.

OBJECTIVES: This study aimed to measure the effect and the total cost per woman of providing postnatal support at home, based on a Dutch model. The research hypothesis was furnished by some existing evidence that postnatal support could reduce the risk of postnatal depression and encourage breastfeeding. DESIGN: The randomised controlled trial aimed to measure differences in health status in a group of women who were offered postnatal support from a community midwifery support worker (SW) compared with a control group of women who were not offered this support. Women were followed-up by postal questionnaire at 6 weeks and 6 months postnatally. SETTING AND SUBJECTS: All women who delivered a baby at the recruiting hospital were eligible to take part in the trial if they lived within the study area, were aged 17 years or over, and could understand English. INTERVENTION: The intervention consisted of the SW offering practical and emotional support and to help women rest and recover after childbirth. The SW offered ten visits in the first 28 days postnatally, for up to 3 hours per day. The SW's activities included housework, talking with the mother, and care for the baby or other siblings. The service was provided in addition to routine visits by the community midwife. MAIN OUTCOME MEASURES: The primary outcome was the general health perception domain of the Short Form-36 at 6 weeks. Secondary outcomes were mean Edinburgh Postnatal Depression Scale (EPDS), Duke Functional Social Support (DUFSS) scores and breastfeeding rates. RESULTS: The 623 randomised women were well-matched by group with a good response to follow-up. At 6 weeks there was no evidence of a significant difference between the two groups for the primary outcome. There was a non-significant trend for the control group to have better mean DUFSS and EPDS scores at 6 weeks. Breastfeeding rates were not significantly different at follow-up. At 6 months, both groups had similar health status. Satisfaction with the service was higher than for all other services received. The incremental cost of introducing the service comprised setting up and running the service. There were no differences between the groups in other resource use (general practitioner contacts, hospital services, prescriptions or medicines bought for mothers and babies) to 6-month follow-up. The total mean NHS cost to 6-month follow-up for the intervention group was pound180 per woman greater than for the control group (confidence interval, pound79.60, pound272.40). CONCLUSIONS: Although women valued the service, there was no evidence of any health benefit at the 6-week or 6-month follow-up, no difference in use of NHS services, and the additional cost of the service provision would be around pound 180 per woman.

Adolescent↗
PubMed1999

[Depression scale for research in and identification of postpartum depression].

Postpartum depression (PPD) is a relatively frequent and serious condition, with negative consequences for the mother, her infant, and the family. From research and clinical experience in many countries, it has been found that PPD can be identified early, and women at risk for developing PPD can be identified before delivery in the framework of primary health care service. The Edinburgh Postnatal Depression Scale (EPDS) has been found valid for this purpose, both in the original English version, and in translation to numerous languages. The Hebrew translation of the EPDS is presented, and it is recommended that Israeli researchers use the same translation to facilitate accumulation of knowledge regarding the epidemiology of PPD and intervention strategies in various Israeli population groups, and for comparison with data from other countries.

Depression, Postpartum↗
PubMed1999

[Study for the factors related to postpartum depression].

OBJECTIVE: To study the prevalence rate of postpartum depression(PD) and related factors. METHODS: 1,052 pregnant women were selected in random from our antenatal clinic from January to November, 1997 for mood study by hospital anxiety and depression (HAD), and 866 cases were further follow-up till 7 days after childbirth with Edinburgh postpartum depression scale (EPDS). RESULTS: The prevalence rate of PD was 15.01% by EPDS. Using single factor and mutifactorial stepwise regression analyses for the affected factors of PD, 7 factors were most strongly related to the onset of PD: they were women's health condition; the relationship between husband and wife; the medical workers' attitude during labor; husband's desire for boy child; the number of antenatal educational classes received; anxiety and depression mood during pregnancy. The number of educational classes received was negatively correlated with PD, while the other 6 factors were all positively correlated. CONCLUSION: The main factors related to PD are the mood of anxiety and depression during pregnancy.

Adult↗
PubMed2003

Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression. I. Impact on maternal mood.

BACKGROUND: Psychological interventions for postnatal depression can be beneficial in the short term but their longer-term impact is unknown. AIMS: To evaluate the long-term effect on maternal mood of three psychological treatments in relation to routine primary care. METHOD: Women with post-partum depression (n=193) were assigned randomly to one of four conditions: routine primary care, non-directive counselling, cognitive-behavioural therapy or psychodynamic therapy. They were assessed immediately after the treatment phase (at 4.5 months) and at 9, 18 and 60 months post-partum. RESULTS: Compared with the control, all three treatments had a significant impact at 4.5 months on maternal mood (Edinburgh Postnatal Depression Scale, EPDS). Only psychodynamic therapy produced a rate of reduction in depression (Structured Clinical Interview for DSM-III - R) significantly superior to that of the control. The benefit of treatment was no longer apparent by 9 months post-partum. Treatment did not reduce subsequent episodes of post-partum depression. CONCLUSIONS: Psychological intervention for post-partum depression improves maternal mood (EPDS) in the short term. However, this benefit is not superior to spontaneous remission in the long term.

Adolescent↗
PubMedDate not supplied

[Working memory in children with phonological deviation].

BACKGROUND: working memory. AIM: to verify the performance of children with normal speech development (NSD) and with evolutional phonological deviation (EPD), in tasks which demand the use of working memory. METHOD: as a research instrument, subtest 5 of the Illinois Test of Psycholinguistics Abilities (ITPA) was used, as well as the meaningless word repetition test. The answers were analyzed based on the results of the digit repetition test and the meaningless word repetition test, comparing the performance of both groups. RESULTS: when comparing the groups, it was verified that the performance of children with EPD is lower than children with NSD in both of the analyzed tests. CONCLUSION: the obtainded results confirm that the working memory is fundamental for the development of speech and for the phoneme choice when producing words.

Articulation Disorders↗
PubMed1992

Effects of a thromboxane synthetase inhibitor (OKY-046) on vascular reactivity to angiotensin II after stricture of the abdominal aorta in pregnant rabbits.

The abdominal aorta of 20 pregnant rabbits was surgically constricted below the renal arteries on the 21st day of pregnancy, producing a stricture that decreased the blood flow by 60%. Four pregnant rabbits underwent sham operation and served as control. The pressor response to angiotensin II (A-II) was assessed by measuring the systolic blood pressure in the ear of rabbits. We intravenously administered 20 mg/kg of OKY-046, a thromboxane A2 (TXA2) synthetase inhibitor (OKY group: n = 13) or saline (n = 7) daily from the 23rd day of pregnancy until the day of delivery. After stricture of the abdominal aorta, the "effective pressor dose" (EPD:nanograms of A-II/kg/min necessary to cause a 20 mmHg rise in systolic pressure) was significantly lower in the saline group than in the control group. On the 27th and 29th day of pregnancy, the EPD in the OKY group was significantly higher than that in the control group. The plasma thromboxane B2 (TXB2) level in the OKY group was significantly lower than that in the saline group on the 27th day. The fetal birth weight in the saline group was significantly lower than that in the control group. These finding suggest that OKY-046 restores the vascular refractoriness induced by A II and suppresses TXA2 synthesis in pregnant rabbits with aortic constriction.

Angiotensin II↗
PubMed1990

Study of neu-protein expression in mammary Paget's disease with and without underlying breast carcinoma and in extramammary Paget's disease.

Correlation between neu/c-erbB-2/Her-2 gene amplification and overexpression of the neu gene product has been reported in tumors of glandular origin, especially ductal breast carcinomas. Formalin-fixed and dewaxed sections from 23 cases of mammary (MPD) and 9 cases of extramammary (EPD) Paget's disease were immunohistochemically stained by means of the monoclonal antibody 3B5 directed against an intracellular domain of the neu gene protein. All MPDs exhibited a distinct membrane staining of tumor cells independent of the presence of ductal breast carcinomas found in 18 cases. All these breast carcinomas also were positive for neu staining. In contrast to MPD, all EPDs were negative. Normal epidermis was always negative. Northern blot analysis sustained the immunohistologic findings in that the presence of neu mRNA could be demonstrated in two of three cases with MPD. Negativity in one case was due to dilution effects by nontumor cells. Our results suggest that Paget cells of mammary and extramammary localization, although very similar phenotypically, derive from different genetic accidents. Furthermore neu positivity in all MPDs and all underlying ductal carcinomas suggests common genetic alterations for both tumors. However the finding of five neu protein-positive MPDs without associated ductal breast carcinomas may suggest a somewhat different transformation process.

Breast Neoplasms↗
PubMed1994

Antepartum and postpartum depression and infant feeding pattern: a prospective study.

Mother's depression during pregnancy and postpartum is a risk factor that can adversely affect mother's relationship with her infant. As breast feeding is an important situation for early mother-child interaction the effect of mother's depression on her breast feeding attitude and practice was decided to be studied prospectively. In this study, 158 primigravidae attending antenatal clinics in two MCH centres were interviewed at third trimester. The interview data covered social background, attitudes to breast feeding as well as self rating of depression using the Edinburgh Postnatal Depression Scale (EPDS). At postnatal interview 72 mother-infant pairs could be reached between 6-16 weeks after birth. They were subjected again to EPDS along with inquiry about type of infant feeding and breast feeding practices. Findings revealed that the prevalence of antepartum depression was 25.32%. Antepartum depression was significantly linked to postpartum depression and negative attitudes to breast feeding. Persistent maternal depression (ante- and postpartum) was a risk factor for early resorting to mixed infant feeding, retarded infant growth as well as some adverse maternal and infant health outcomes. Logistic analysis indicated that negative mothers' attitudes to breast feeding and postpartum depressive scores taken together predicted mixed infant feeding. Hence, preventive programs should be directed specifically towards modifying the mother's psychological status and her attitude on behalf of her infant.

Adolescent↗
PubMed1985

Vulvar sweat gland carcinomas.

Sweat gland carcinomas constitute less than 10% of all malignant tumors of the vulva, including those associated with extramammary Paget's disease (EPD). The histopathologic diagnosis of vulvar sweat gland carcinomas is difficult because of their rarity; their resemblance to metastatic carcinomas of the internal female genitalia, kidneys, and other sites; and their diversity of microscopic appearances. We report five examples of vulvar sweat gland carcinomas, two of which were associated with EPD. The other tumors included one example each of ductal eccrine adenocarcinoma, eccrine porocarcinoma, and clear cell hidradenocarcinoma. The clinical behavior of these neoplasms is correlated with their histologic types; we also discuss differential diagnosis and treatment recommendations.

Adenoma, Sweat Gland↗