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PubMedDate not supplied

Revision of the postpartum depression predictors inventory.

Postpartum depression has been described as a thief that steals motherhood. Early recognition is one of the major challenges with this devastating mood disorder. This article describes a revised version of the Postpartum Depression Predictors Inventory (PDPI) based on the results of an updated meta-analysis. This revised inventory consists of 13 risk factors related to postpartum depression. Guide questions for each of the 13 predictors that clinicians can use during an interview process also are included. Included among these 13 predictors in the PDPI-Revised are four new risk factors: self-esteem, marital status, socioeconomic status, and unplanned/unwanted pregnancy. Ideally, this checklist should be completed each trimester to update a pregnant woman's risk status. After a woman gives birth, the PDPI-Revised should be used to continue to monitor her risk status because she can develop postpartum depression at any time during the 1st year after childbirth.

Depression, Postpartum↗
PubMedDate not supplied

Risk factors for early postpartum depressive symptoms.

OBJECTIVE: Postpartum depressive disorders are common and symptoms may appear as early as the first 2 weeks postpartum. Data regarding hormone-related risk factors for depressive symptoms occurring in the very early postpartum period are scarce and may be of importance in identifying serious postpartum illness. We examined the association between the reported history of psychiatric symptoms of possible hormonal etiology and very early postpartum depressive symptoms. METHODS: All women (n= 1,800) in a general hospital maternity ward were assessed during the first 3 days after parturition for potential risk factors for postpartum depressive disorders by a self-reported questionnaire and for present mood symptoms (Edinburgh Postnatal Depression Scale, EPDS). The associations between potential risk factors and postpartum depressive symptoms were analysed. RESULTS: The incidence of women with an EPDS >or=10 was 6.8% (88/1,286). Significant risk factors for early postpartum depressive symptoms were a history of mental illness including past postpartum depression (PPD), premenstrual dysphoric disorder (PMDD), and mood symptoms during the third trimester. CONCLUSION: In accordance with other studies, a history of depression was found to be a risk factor for early postpartum mood symptoms. An association was also found between some risk factors of possible hormone-related etiology such as PMDD and third trimester mood symptoms and early postpartum mood symptoms. As such, early postpartum symptoms may indicate vulnerability to subsequent PPD; it may be of importance to assess these risk factors and mood immediately after parturition. A prospective study is needed to determine which of these risk factors is associated with progression to PPD and which resolves as the blues.

Adult↗
PubMed2001

Venlafaxine in the treatment of postpartum depression.

BACKGROUND: Although postpartum depression is a highly prevalent illness, antidepressant treatment studies of postpartum depression are sparse. Incomplete recognition and treatment of puerperal illness place women at risk for chronic depression and may have adverse effects on child development. METHOD: An 8-week, flexible-dose, open study of venlafaxine (immediate release; mean dose = 162.5 mg/day) was performed in a group of 15 women who met DSM-III-R criteria for major depressive disorder with onset within the first 3 months postpartum. Patients were assessed at baseline and every 2 weeks across the study. Measurements of outcome included the 17-item Hamilton Rating Scale for Depression (HAM-D), the Kellner Symptom Questionnaire, and the Clinical Global Impressions scale (CGI). RESULTS: Despite baseline scores of depression that were particularly high, response to treatment was robust. Twelve of 15 patients experienced remission of major depression (HAM-D score < or = 7 or CGI score < or = 2). Dramatic decrease in anxiety paralleled the decrease in depression across the sample. CONCLUSION: Venlafaxine is effective in the treatment of postpartum major depression. Early identification of women who suffer from postpartum mood disturbance is critical to minimize the morbidity associated with untreated mood disturbance and the effect of depression on children and families.

Adult↗
PubMed2001

Thyroid peroxidase antibodies during gestation are a marker for subsequent depression postpartum.

OBJECTIVE: Depression is not adequately diagnosed in many cases. Therefore, the question arises as to whether markers exist for depression. We investigated whether the presence of thyroperoxidase antibodies (TPOAbs) during pregnancy can be regarded as a marker for depression in the first year postpartum, particularly in relation to (overt or subclinical) thyroid dysfunction and other determinants of depression. DESIGN: This work was a prospective observational study. PATIENTS: A cohort of 310 unselected women (residing in the Kempen Region, southeastern Netherlands) were visited at 12 and 32 weeks gestation and at 4, 12, 20, 28 and 36 weeks postpartum. METHODS: At each visit, TSH, free thyroxine and TPOAb testing was performed, determinants associated with depression were asked for, and depression was assessed (according to the Research Diagnostic Criteria). Multiple logistic regression was performed to determine independent risk factors (odds ratios, ORs) for depression in gestation and/or postpartum depression. RESULTS: Data for 291 women were available for analysis; 41 women (14.1%) had TPOAbs at one or more time points, and 117 women (40.1%) had depression at one or more time points postpartum. The multiple logistic regression analysis showed that TPOAbs were independently associated with depression at 12 weeks gestation and at 4 and 12 weeks postpartum (OR, 95% confidence interval: 2.4 (1.1-6.0), 3.8 (1.3-7.3) and 3.6 (1.2-7.1) respectively). After the exclusion of women who were depressed at 12 weeks gestation (n=70), the presence of TPOAbs during early pregnancy was still found to be associated with the development of postpartum depression (OR, 95% confidence interval: 2.8 (1.7-4.5); after exclusion of women who had had depression in earlier life (n=51), TPOAb during early gestation was still associated with postpartum depression (OR, 95% confidence interval: 2.9 (1.8-4.3). CONCLUSIONS: The presence of TPOAbs during gestation is associated with the occurrence of subsequent depression during the postpartum period and as such can be regarded as a marker for depression.

Adult↗
PubMed2002

Etiology and treatment of postpartum depression.

This article reviews the risk factors, pathogenesis, treatment, and prevention of postpartum depression. Postpartum depression is common and occurs in up to 18% of newly delivered mothers. Though the hormonal changes occurring after childbirth are believed to play a role in postpartum depression, no hormonal etiology has been identified. Estrogen appears somewhat helpful for postpartum depression, but its use is limited by problematic medical sequelae. Several antidepressants are effective for postpartum depression and appear safe for use by breastfeeding women. Psychosocial interventions and cultural rituals, which may prevent or ameliorate postpartum depression, have also been employed.

Antidepressive Agents↗
PubMed1995

[Impact of placental hormone withdrawal on postpartum depression].

Prenatal and postpartum measurements of serum beta-hCG, estradiol (E2) and progesterone (P) concentration were done by radioimmunoassay in 20 cases of postpartum depression (PD) and 20 cases without postpartum depression (NPD). The results showed significantly higher serum levels of P and beta-hCG (at 36-37 gestational week) in PD, but no difference in the serum P and beta-hCG concentration between the PD and NPD after childbirth. The falling of the two hormones was faster in PD than in NPD. In neither prenatal nor postpartum test was any difference seen in serum E2 concentration between PD and NPD. These results suggest that supposely, the endogenous risk factor, the rapid withdrawal of the placental hormones (P and beta-hCG) after delivery, leads to PD.

Chorionic Gonadotropin↗
PubMed2005

Prevalence of pre- and postpartum depression in Jamaican women.

BACKGROUND: Maternal depression during pregnancy has been studied less than depression in postpartum period. The aims of this study were to find out the prevalence of prepartum and postpartum depression and the risk factors associated in a cohort of Afro-Jamaican pregnant women in Jamaica. METHODS: The Zung self-rating depression scale instrument was administered to 73 healthy pregnant women at 28 weeks gestation and at 6 weeks postpartum for quantitative measurement of depression. Blood samples were collected at 8, 28, 35 weeks gestation and at day 1 and 6 weeks postpartum to study the thyroid status. RESULTS: Study demonstrated depression prevalence rates of 56% and 34% during prepartum and postpartum period, respectively. 94% women suffering depression in both periods were single. There were significant variations in both FT3 and TT4 concentrations which increased from week 8 to week 28 prepartum (p < 0.05) and then declined at the 35th week (p < 0.05 compared with week 28) and 1 day post delivery study (p < 0.05 compared with week 35). The mean values for TSH increased significantly from week 8 through week 35. The mean values at 1 day postpartum and 6 week postpartum were not significantly different from the 35 week values. For FT3, TT4 and TSH there were no significant between group differences in concentrations. The major determinants of postpartum depression were moderate and severe prepartum depression and change in TT4 hormone concentrations. CONCLUSION: High prevalence of depression was found during pre- and postpartum periods. Single mothers, prepartum depression and changes in TT4 were factors found to be significantly associated with postpartum depression.

Journal Article↗
PubMed2002

Seafood consumption, the DHA content of mothers' milk and prevalence rates of postpartum depression: a cross-national, ecological analysis.

BACKGROUND: Mothers selectively transfer docosahexaenoic acid (DHA) to their fetuses to support optimal neurological development during pregnancy. Without sufficient dietary intake, mothers become depleted of DHA and may increase their risk of suffering major depressive symptoms in the postpartum period. We postulated that the DHA content of mothers' milk and seafood consumption would both predict prevalence rates of postpartum depression across countries. METHODS: Published prevalence data for postpartum depression were included that used the Edinburgh Postpartum Depression Scale (n=14532 subjects in 41 studies). These data were compared to the DHA, eicosapentaenoic acid (EPA) and arachidonic acid (AA) content in mothers' milk and to seafood consumption rates in published reports from 23 countries. RESULTS: Higher concentrations of DHA in mothers' milk (r=-0.84, p<0.0001, n=16 countries) and greater seafood consumption (r=-0.81, p<0.0001, n=22 countries) both predicted lower prevalence rates of postpartum depression in simple and logarithmic models, respectively. The AA and EPA content of mothers' milk were unrelated to postpartum depression prevalence. LIMITATIONS: These findings do not prove that higher omega-3 status cause lower prevalence rates of postpartum depression. Data on potentially confounding factors were not uniformly available for all countries. CONCLUSIONS: Both lower DHA content in mothers' milk and lower seafood consumption were associated with higher rates of postpartum depression. These results do not appear to be an artifact of cross-national differences in well-established risk factors for postpartum depression. Interventional studies are needed to determine if omega-3 fatty acids can reduce major postpartum depressive symptoms.

Arachidonic Acid↗
PubMed1994

[Postpartum depression].

Depression following childbirth (postpartum depression) is a common psychiatric illness of women, postpartum. We review Japanese and English literature on postpartum depression. Problems with definition, study design and validity of the diagnosis prevented comprehensive understanding whether postpartum depression is a distinct subtype of endogenous depression. In general, postpartum depression seems to be the same illness as depression at other times in life. The biological and psycho-social pathogenetic factors, unique to the puerperal period, are not yet known. Clinicians caring for women and infants should learn to screen their patients for this multifactorial (genetic, temperamental, and environmental) disorder, and try to integrate a multidisciplinary (pharmaco-, psycho-, socio-, familial) approach.

Depressive Disorder↗
PubMed2004

The pediatrician's role in recognizing and intervening in postpartum depression.

Increasing evidence of postpartum depression is encouraging pediatricians to include screening and intervention for postpartum depression in standard newborn and infant care. Pediatricians have the most frequent exposure to mothers and infants in the most high-risk time period and they have a vested interest in the well-being of the child and mother. Because the time required to achieve basic screening and referral services is minimal, there is enough evidence that postpartum screening and intervention are crucial components of comprehensive newborn and infant care. It is incumbent upon pediatricians to screen for and intervene in cases of postpartum depression to provide thorough care for infants and their families.

Child Development↗
PubMed2004

Psychosocial and psychological interventions for preventing postpartum depression.

BACKGROUND: The cause of postpartum depression remains unclear, with extensive research suggesting a multi-factorial aetiology. However, epidemiological studies and meta-analyses of predictive studies have consistently demonstrated the importance of psychosocial and psychological variables. While interventions based on these variables may be effective treatment strategies, theoretically they may also be used in pregnancy and the early postpartum period to prevent postpartum depression. OBJECTIVES: Primary: to assess the effect of diverse psychosocial and psychological interventions compared with usual antepartum, intrapartum, or postpartum care to reduce the risk of developing postpartum depression. Secondary: to examine (1) the effectiveness of specific types of psychosocial and psychological interventions, (2) the effectiveness of individual versus group-based interventions, (3) the effects of intervention onset and duration, and (4) whether interventions are more effective in women selected with specific risk factors. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (January 27 2004), the Cochrane Depression, Anxiety and Neurosis Group trials register (October 2003), the Cochrane Central Register of Controlled Trials (October 2003), MEDLINE (1966 to 2004), EMBASE (1980 to 2004) and CINAHL (1982 to 2004). We scanned secondary references and contacted experts in the field. SELECTION CRITERIA: All published and unpublished randomised controlled trials of acceptable quality comparing a psychosocial or psychological intervention with usual antenatal, intrapartum, or postpartum care. DATA COLLECTION AND ANALYSIS: Both reviewers participated in the evaluation of methodological quality and data extraction. Additional information was sought from several trial researchers. Results are presented using relative risk for categorical data and weighted mean difference for continuous data. MAIN RESULTS: Fifteen trials, involving over 7600 women, were included. Overall, women who received a psychosocial intervention were equally likely to develop postpartum depression as those receiving standard care (relative risk (RR) 0.81, 95% confidence interval (CI) 0.65 to 1.02). One promising intervention appears to be the provision of intensive postpartum support provided by public health nurses or midwives (RR 0.68, 95% CI 0.55 to 0.84). Identifying mothers 'at-risk' assisted the prevention of postpartum depression (RR 0.67, 95% CI 0.51 to 0.89). Interventions with only a postnatal component appeared to be more beneficial (RR 0.76, 95% CI 0.58 to 0.98) than interventions that also incorporated an antenatal component. While individually-based interventions may be more effective (RR 0.76, 95% CI 0.59 to 1.00) than those that are group-based, women who received multiple-contact intervention were just as likely to experience postpartum depression as those who received a single-contact intervention. REVIEWERS' CONCLUSIONS: Overall psychosocial interventions do not reduce the numbers of women who develop postpartum depression. However, a promising intervention is the provision of intensive, professionally-based postpartum support.

Depression, Postpartum↗
PubMedDate not supplied

A checklist to identify women at risk for developing postpartum depression.

This article describes the Postpartum Depression Predictors Inventory, a checklist to identify women at risk for developing this devastating illness. Postpartum depression wreaks havoc not only on mothers, but also on their entire families. Researchers have reported that postpartum depression has a moderate to large adverse effect on mother-infant interaction. Children older than 1 year whose mothers had postpartum depression have been reported to display more behavioral problems and cognitive deficits than children of mothers who were not depressed. It is crucial to identify and treat women with postpartum depression as early as possible. This problem often continues due to lack of identification. Identifying women at risk and providing early treatment interventions are the first steps in dealing with this problem.

Child↗
PubMed2005

Pharmacotherapy of postpartum depression: current practice and future directions.

Postpartum depression has well-documented consequences for the mother, child, family and society as a whole. Despite an increasing awareness of postpartum depression, it often remains unrecognised by clinicians and poorly understood by researchers. The current trend is undoubtedly a result of the complex nature of depressive disorders accentuated by difficulties with the current classification schemas. Systematic prospective data on the onset of depression during pregnancy and the postpartum period, as well as on the risk of relapse during these periods in women with previous histories of mood and anxiety disorders, are limited. This article reviews clinically relevant outcomes and current trends in the pharmacotherapy of postpartum depression from selected clinical trials. Critical issues of the neurobiology and phenomenology of postpartum depression are raised, and future directions of the pharmacological treatments of postpartum depression are examined.

Antidepressive Agents↗
PubMedDate not supplied

Fatigue as a predictor of postpartum depression.

BACKGROUND: The postpartum is a time when women commonly report increased fatigue that may contribute to depression. Studies have not examined fatigue alone as a predictor of postpartum depression. OBJECTIVE: To examine whether and when fatigue in the early postpartum is predictive of postpartum depression. DESIGN: Correlational, longitudinal study. SETTING: Two hospitals and participants' homes in central Pennsylvania. PARTICIPANTS: Convenience sample of 38 healthy women recruited from hospital maternity units within 24 hours after an uncomplicated birth. MAIN OUTCOME MEASURES: Fatigue was measured using the Modified Fatigue Symptom Checklist (MFSC) on Days 0, 7, 14, and 28 after childbirth. Depression was assessed using the Center for Epidemiological Studies-Depressive Symptomatology Scale (CES-D) on Day 28. RESULTS: After adjustments for multiple comparisons, a significant correlation was obtained between fatigue as measured by the MFSC and postpartum depression on Day 7 (r = .46; p < .05), Day 14 (r = .57), and Day 28 (r = .70). Fatigue on Day 0 was correlated with fatigue on Day 7 (r = .45), Day 14 (r= .58), and Day 28 (r = .34). CONCLUSIONS: Fatigue as early as 7 days postpartum is predictive of depression at Day 28 postpartum.

Adult↗
PubMed2004

Identifying women at-risk for postpartum depression in the immediate postpartum period.

OBJECTIVE: To develop a multifactorial predictive model of depressive symptomatology in the first week postpartum in order to assist in targeted screening procedures. METHOD: As part of a longitudinal study, a population-based sample of 594 mothers in a health region near Vancouver, British Columbia completed a mailed questionnaire at 1-week postpartum that included diverse risk factors from the following domains: sociodemographic, biological, pregnancy-related, life stressors, social support, obstetric and adjustment to motherhood. Following univariate analysis, sequential regression analysis was completed to develop a multifactorial predictive model. RESULTS: In the multivariate model, the factors predictive of depressive symptomatology at 1-week postpartum included immigration within the last 5 years, history of depression independent of childbirth, diagnosis of pregnancy-induced hypertension, vulnerable personality style, stressful life events, lack of perceived support, lack of readiness for hospital discharge and dissatisfaction with infant feeding method. CONCLUSION: The findings suggest that several risk factors for depressive symptomatology in the immediate postpartum period are consistent with previously identified factors but other factors such as recent immigrant status, feeling unready for hospital discharge, dissatisfaction with their infant feeding method, and pregnancy-induced hypertension should also be examined.

Adolescent↗
PubMed1997

Assessment of postpartum depression: a review of the research.

The postpartum period is a time when many women are vulnerable for the development of a variety of emotional syndromes. One of the problems with treating the emotional problems is the difficulty in differentiating them. For example, there are at least three distinct postpartum depression disorders: postpartum blues, postpartum psychosis, and postpartum depression. Each of these syndromes is discussed. A review of the instruments used to test for risk factors for the development of postpartum affective disorders indicates that conceptual muddiness still exists in differentiating the three disorders. The notion of whether postpartum depression is a reactive depression to stress or a syndrome is examined. A suggestion is made to more closely examine the role of culture in the development of affective disorders in the puerperium.

Journal Article↗
PubMed1998

Childhood abuse, parenting and postpartum depression.

OBJECTIVE: While the potential negative effects on children of maternal depression has been documented, the influence of a maternal history of childhood abuse on child development is unclear. This study, the first stage of a 3-year follow-up study, looks at childhood abuse in women with depression in the postpartum period. METHOD: Fifty-six women admitted with postpartum depressive disorders were assessed with respect to their wellbeing, relationships and infant interaction. Twenty-eight women had a history of sexual abuse before the age of 16, nine physical/emotional abuse and 19 had no history of abuse. RESULTS: The mother-infant relationship was seen to be impaired in the sexually abused group (p = 0.007). The significance increased when all abused women were compared to controls (p = 0.001). In addition, abuse was associated with more severe depression on the Beck Depression Inventory (p = 0.046), and a trend to higher anxiety and longer lengths of stay (p = 0.05 for physical abuse). Partners rated themselves as being more skilled and confident parents. CONCLUSIONS: The effect of childhood abuse was indistinguishable between emotional and physical abuse in postpartum depressed women. The most significant effect was a deleterious one on the mother-infant relationship in those women with a history of abuse.

Adolescent↗
PubMed2003

[Effects of intervening measures on postpartum depression].

OBJECTIVE: To study the related factors of postpartum depression (PPD) and the effects of intervening measures to PPD incidence. METHODS: 1 597 pregnant women selected from our antenatal care clinic were investigated by using the hospital anxiety and depression questionnaire (HAD) during pregnancy and the Edinburgh postpartum depression scale (EPDS) after childbirth. All the enrolled women were randomly divided into control group and intervening group by the proportion of 1 to 2. Six intervening measures were used in the latter group. RESULTS: (1) There were 49 women whose HAD >or= 11 score (anxiety-depression mood) with 28 cases (57.1%) had got postpartum depression in the control group. In the intervening group, however, there were 94 women whose HAD >or= 11 score with 24 cases (25.5%) had got postpartum depression. There is a significant difference between the two groups (P < 0.01). (2) There were 71 (13.0%) women whose EPDS >or= 13 score (postpartum depression) in the control group. In the intervening group, however, there were 63 (6.0%) women whose EPDS >or= 13 score. There had a significant difference between the two groups (P < 0.01). (3) PPD women had higher N and P scores than those of non-PPD women (P < 0.01). CONCLUSION: (1) Prenatal anxiety, depression, negative personality and postpartum psychological and physiological changes were high risk factors to PPD. (2) Psychological personality play an important role in PPD. (3) Incidence of PPD was significantly reduced by social support.

China↗