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PubMedDate not supplied

The relationship between previous elective abortions and postpartum depressive reactions.

To test the hypothesis that primiparas who have had a previous elective abortion will have a higher incidence of depressive reactions postpartum than will primiparas who have not, 48 women pregnant for the first time and 25 who had had one abortion were interviewed six to eight weeks postpartum. No significant difference in the incidence of depression between the two groups could be found. In addition, when associations between their mean depression scores and other variables such as planned pregnancy, preferred infant sex, identified obstetrical problems, help at home, experiencing the baby blues, and an identified recent sad life event were calculated, no significant differences were noted. Spontaneous comments from the previously aborted women suggested that anxiety during pregnancy concerning the infant's health was a greater source of discomfort than was postpartum depression.

Abortion, Legal↗

PubMedDate not supplied

Further development of the Postpartum Depression Predictors Inventory-Revised.

OBJECTIVES: To describe the newly developed item coding and computation of the total score for the Postpartum Depression Predictors Inventory-Revised along with recommended cutoff points. DESIGN: Methodologic research. SETTING: Obstetrician and gynecologist offices in the Pacific Northwest. PARTICIPANTS: This longitudinal study included 139 women; the study began in the participant's third trimester of pregnancy and ended at 8 months after childbirth. METHODS: The participants completed the Postpartum Depression Predictors Inventory-Revised in their third trimester of pregnancy and again at 2 and 6 months after childbirth. Postpartum depression symptoms were measured by the Edinburgh Postnatal Depression Scale and psychiatric nurse practitioner interview at 2 and 6 months after childbirth. MAIN OUTCOME MEASURES: Sensitivity and specificity of the Postpartum Depression Predictors Inventory-Revised at three points: prenatal and 2 and 6 months after childbirth. RESULTS: The receiver operating characteristic curve analysis indicated that the Prenatal Postpartum Depression Predictors Inventory-Revised performed well and explained 67% of the variance of postpartum depressive symptomatology as measured by Edinburgh Postnatal Depression Scale scores. The Prenatal Postpartum Depression Predictors Inventory-Revised yielded a sensitivity of .76 and a specificity of .54 at a cutoff score of 10.5. CONCLUSIONS: A cutoff score of 10.5 is recommended when using the Postpartum Depression Predictors Inventory-Revised during pregnancy. Further research needs to be conducted on recommended cutoff scores for use of the Postpartum Depression Predictors Inventory-Revised during the postpartum period.

Analysis of Variance↗

PubMedDate not supplied

Postpartum depression screening scale: Spanish version.

BACKGROUND: Postpartum depression is a global phenomenon. OBJECTIVE: The purpose of this study was to develop and psychometrically evaluate the Spanish version of the Postpartum Depression Screening Scale (PDSS). METHODS: Eight translators representing the predominant Hispanic groups in the United States translated the PDSS into a Spanish version. A total of 377 Hispanic mothers completed the PDSS-Spanish Version within 12 weeks postpartum at two sites: Connecticut and Texas. Confirmatory factor analysis and item response theory analysis were conducted to assess construct validity. RESULTS: For the total sample of 377 Hispanic women, the alpha reliability for the total PDSS was.95; dimension-level alphas ranged from.76 to.90. The total PDSS alphas by group were as follows: .94 (Mexican), .96 (Puerto Rican), and .93 (Other). Confirmatory factor analysis provided empirical support for the existence of the hypothesized constructs assessed by the PDSS. Item response theory analysis supported the adequacy of the construct definitions and confirmed that the response options for the Likert categories were an "ordered" attitude continuum in which higher responses corresponded to higher levels of "agreement" with the depressive symptomatology items. CONCLUSIONS: When compared to the original English PDSS, the reliability and validity psychometrics for the Spanish version were slightly lower, but still within the acceptable range.

Adult↗

PubMed2006

Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice.

OBJECTIVE: Data are scarce regarding the sociodemographic predictors of antenatal and postpartum depression. This study investigated whether race/ethnicity, age, finances, and partnership status were associated with antenatal and postpartum depressive symptoms. SETTING: 1662 participants in Project Viva, a US cohort study. DESIGN: Mothers indicated mid-pregnancy and six month postpartum depressive symptoms on the Edinburgh postpartum depression scale (EPDS). Associations of sociodemographic factors with odds of scoring >12 on the EPDS were estimated. MAIN RESULTS: The prevalence of depressive symptoms was 9% at mid-pregnancy and 8% postpartum. Black and Hispanic mothers had a higher prevalence of depressive symptoms compared with non-Hispanic white mothers. These associations were explained by lower income, financial hardship, and higher incidence of poor pregnancy outcome among minority women. Young maternal age was associated with greater risk of antenatal and postpartum depressive symptoms, largely attributable to the prevalence of financial hardship, unwanted pregnancy, and lack of a partner. The strongest risk factor for antenatal depressive symptoms was a history of depression (OR = 4.07; 95% CI 3.76, 4.40), and the strongest risk for postpartum depressive symptoms was depressive symptoms during pregnancy (6.78; 4.07, 11.31) or a history of depression before pregnancy (3.82; 2.31, 6.31). CONCLUSIONS: Financial hardship and unwanted pregnancy are associated with antenatal and postpartum depressive symptoms. Women with a history of depression and those with poor pregnancy outcomes are especially vulnerable to depressive symptoms during the childbearing year. Once these factors are taken in account, minority mothers have the same risk of antenatal and postpartum depressive symptoms as white mothers.

Adult↗

PubMed2004

[The predictors of postpartum depression].

PURPOSE: This study was designed to determine the predictors of postpartum depression. METHOD: One hundred- sixty one women within one year after delivery from one public health center located in the northern area of Seoul were used in this study. The instruments were a survey of general characteristics, the Edinburgh Postnatal Depression Scale, recent life events index, perceived social support from family, Quality of marriage index, parenting stress index, and Rosenberg's self-esteem inventory. Data was analysed using descriptive statistics, Pearson correlation coefficients, and logistic regression. RESULT: The average item score of the EPDS was 6.67. 12.4% of respondents, who scored above a threshold 12, were likely to be suffering from a depression of varying severity. The fitness of the model for explaining postpartum depression from six variables, plan for pregnancy, family support, quality of marital relation, perceived social support, life events, childcare stress, and self-esteem, was statistically significant and the predictive power of these variables was 90.9%. The significant predictors of postpartum depression were family support and child care stress. CONCLUSION: Further research is needed to identify the prevalence rate of postpartum depression using more reliable sampling methods from a large general population. Nursing interventions need to be developed for promoting family support and reducing childcare stress.

Adult↗

PubMed1991

Prospective study of postpartum depression: 4 1/2-year follow-up of women and children.

The consequences of maternal postpartum depression for mothers and children were investigated in a 4 1/2-year follow-up study, which included 70 of 99 women who had participated in an earlier study of postpartum depression. Information about maternal adjustment and depression during the follow-up period and child adjustment at age 4 1/2 years was obtained. Women who had experienced a postpartum depression were predicted to be at increased risk for subsequent depression and poor adjustment of their child. Postpartum depression was directly related to subsequent depression but not child problems. Later depression was related to child problems at 4 1/2 years. We concluded that postpartum depression may increase risk for later maternal depression and in turn increases risk for child behavior problems. Intervening with women who have experienced a postpartum depression may reduce likelihood of future depressions and child behavior problems.

Adaptation, Psychological↗

PubMed2000

The role of cognitive vulnerability and stress in the prediction of postpartum depressive symptomatology.

OBJECTIVES: The present study was designed to test the diathesis-stress components of Beck's cognitive theory of depression and the reformulated learned helplessness model of depression in the prediction of postpartum depressive symptomatology. DESIGN AND METHODS: The research used a two-wave longitudinal design--data were collected from 65 primiparous women during their third trimester of pregnancy and then 6 weeks after the birth. Cognitive vulnerability and initial depressive symptomatology were assessed at Time 1, whereas stress and postpartum depressive symptomatology were assessed at Time 2. RESULTS: There was some support for the diathesis-stress component of Beck's cognitive theory, to the extent that the negative relationship between both general and maternal-specific dysfunctional attitudes associated with performance evaluation and Time 2 depressive symptomatology was strongest for women who reported high levels of parental stress. In a similar vein, the effects of dysfunctional attitudes (general and maternal-specific) associated with performance evaluation and need for approval (general measure only) on partner ratings of emotional distress were evident only among those women whose infants were rated as being temperamentally difficult. CONCLUSION: There was no support for the diathesis-stress component of the reformulated learned helplessness model of depression; however, there was some support for the diathesis-stress component of Beck's cognitive theory.

Adult↗

PubMed1991

The comparison of postpartum with non-postpartum depression: a rose by any other name.

A strong tradition exists in the psychiatric literature to consider postpartum depression a distinct diagnosis. However, the empirical evidence indicates that, in terms of etiology and relapse rates, postpartum depression is indistinguishable from non-postpartum depression. Symptomatically, postpartum depression seems to involve a milder disturbance, suggesting that it is best seen as an adjustment disorder. This paper summarizes the empirical evidence relevant to the distinct diagnosis question, and considers the benefits to be derived from challenging the traditional view of postpartum depression.

Adjustment Disorders↗

PubMedDate not supplied

Web sites for postpartum depression: convenient, frustrating, incomplete, and misleading.

PURPOSE: To evaluate the content and the technology of Web sites providing information on postpartum depression. STUDY DESIGN AND METHODS: Eleven search engines were queried using the words "Postpartum Depression." The top 10 sites in each search engine were evaluated for correct content and technology using the Web Depression Tool, based on the Technology Assessment Model. RESULTS: Of the 36 unique Web sites located, 34 were available to review. Only five Web sites provided >75% correct responses to questions that summarized the current state of the science for postpartum depression. Eleven of the Web sites contained little or no useful information about postpartum depression, despite being among the first 10 Web sites listed by the search engine. Some Web sites contained possibly harmful suggestions for treatment of postpartum depression. In addition, there are many problems with the technology of Web sites providing information on postpartum depression. CLINICAL IMPLICATIONS: A better Web site for postpartum depression is necessary if we are to meet the needs of consumers for accurate and current information using technology that enhances learning. Since patient education is a core competency for nurses, it is essential that nurses understand how their patients are using the World Wide Web for learning and how we can assist our patients to find appropriate sites containing correct information.

Databases, Bibliographic↗

PubMed2003

The prevention and psychotherapeutic treatment of postpartum depression.

The efficacy of psychotherapeutic interventions for the acute treatment of postpartum depression is strongly supported by empirical data, which suggest that counseling is of benefit as a stand-alone treatment for postpartum depression. Given the paucity of treatment trials using medication for postpartum depression, and the fact that psychotherapeutic interventions do not confer any "exposure" risks to breastfeeding infants, the data also suggest that psychotherapy should be considered a first-line treatment, rather than as an adjunct to medication treatment. There is also some data supporting the use of psychotherapy as a means of preventing postpartum depression, though research is still needed regarding the type of interventions to be used and the types of patients towards whom the interventions should be directed.

Adult↗

PubMedDate not supplied

The lived experience of postpartum depression in a psychiatric population.

PROBLEM: Studies have examined the quantitative causal factors of postpartum depression. However, the lived experience of postpartum depression has not been investigated. METHOD: Using a psychophenomenological design, the investigators examined reports from seven clients with a psychiatric diagnosis of postpartum depression and the role life experiences played in their labor, delivery, and postpartum periods. FINDINGS: Phenomenological analysis indicated that the psychological and physiological effects of abuse interact to create a cognitive frame of reference similar to the experience of abuse. CONCLUSION: The normal developmental event of childbearing contributes to the recall of abuse and sets the stage for postpartum depression.

Adaptation, Psychological↗

PubMed2000

An international study exploring levels of postpartum depressive symptomatology.

OBJECTIVE: Differences in postpartum depressive symptomatology (PPDS) among an international sample of 892 women from nine countries representing five continents were explored. METHOD: Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory (BDI) were used to assess PPDS among a convenience sample that completed the two questionnaires twice, yielding a total of four sets of scores per subject. Women sampled were primiparae with no obstetrical complications, and had a healthy baby. Depression history and therapy were ruled out as exclusion criteria. RESULTS: Mean scores for EPDS and BDI varied across sites at both time points (P value<.001). European and Australian women had the lowest levels of PPDS, USA women fell at the midpoint, and women from Asia and South America had the highest depressive symptom scores. The moderate concordance between the EPDS and BDI suggested that the measures have complementary uses for screening and assessment. CONCLUSION: Utility of EPDS and BDI for yielding profiles of postpartum women's depressive symptomatology was demonstrated. Further research to validate depressive symptom measures with diverse international populations is indicated.

Adult↗

PubMed2002

The treatment of postpartum depression: minimizing infant exposures.

The first 3 postpartum months represent a high-risk period for psychiatric illnesses. This article reviews the prevalence and diagnostic criteria for postpartum illnesses, including the "maternal blues," postpartum depression, and postpartum psychosis. Pharmacologic treatment of these disorders is often complicated by a patient's desire to breast-feed, yet there are no controlled trials of antidepressant treatment during lactation. Infant exposure and limitations to monitoring infant sera are reviewed. Lastly, a model and guide for reducing fetal and infant exposures is presented.

Adult↗

PubMed2002

Obstetric, somatic, and demographic risk factors for postpartum depressive symptoms.

OBJECTIVE: To identify and test the predictive power of potential independent risk factors of postpartum depressive symptoms during pregnancy and the perinatal period. METHODS: We conducted a case-control study where 132 women with postpartum depressive symptoms were selected as an index group and 264 women without depressive symptoms as a control group. Data related to sociodemographic status, medical, gynecologic, and obstetric history, pregnancy, and perinatal events were collected from standardized medical records. RESULTS: The strongest risk factors for postpartum depressive symptoms were sick leave during pregnancy and a high number of visits to the antenatal care clinic. Complications during pregnancy, such as hyperemesis, premature contractions, and psychiatric disorder were more common in the postpartum depressed group of women. No association was found between parity, sociodemographic data, or mode of delivery and postpartum depressive symptoms. CONCLUSION: Women at risk for postpartum depression can be identified during pregnancy. The strongest risk factors, sick leave during pregnancy and many visits to the antenatal care clinic, are not etiologic and might be of either behavioral or biologic origin. The possibilities of genetic vulnerability and hormonal changes warrant further investigation to reach a more thorough understanding.

Adolescent↗

PubMedDate not supplied

The lived experience of postpartum depression: a phenomenological study.

The purpose of this phenomenological study was to describe the essential structure of the lived experience of postpartum depression. Seven mothers who had suffered from postpartum depression were interviewed regarding their subjective experiences. Data were analyzed using Colaizzi's (1978) method of phenomenology. Forty-five significant statements were extracted and clustered into 11 themes. These results were integrated into the essential structure of postpartum depression. Postpartum depression was a living nightmare filled with uncontrollable anxiety attacks, consuming guilt, and obsessive thinking. Mothers contemplated not only harming themselves but also their infants. The mothers were enveloped in loneliness and the quality of their lives was further compromised by a lack of emotions and all previous interests. Fear that their lives would never return to normal was all-encompassing.

Adult↗

PubMed2004

Treatment of postpartum depression, part 2: a critical review of nonbiological interventions.

BACKGROUND: While postpartum depression is a common mental condition with significant burden, it often remains undiagnosed and untreated. The objective of this article is to critically review the literature to determine the current state of scientific knowledge related to the treatment of postpartum depression from a nonbiological perspective. DATA SOURCES: Databases searched for this review included MEDLINE, PubMed, CINAHL, PsycINFO, EMBASE, ProQuest, the Cochrane Library, and the WHO Reproductive Health Library from 1966 to 2003. The search terms used were postpartum/postnatal depression and randomized controlled/clinical trials. Published peer-reviewed articles in English from 1990 to 2003 were included in the review, although select earlier studies were also included based on good methodological quality and/or the absence of more recent work. METHOD: The criteria used to evaluate the interventions were based on the standardized methodology developed by the U.S. Preventive Services Task Force and the Canadian Task Force on Preventive Health Care. RESULTS: Twenty-one studies that met inclusion criteria were examined. These studies included interpersonal psychotherapy, cognitive-behavioral therapy, peer and partner support, nondirective counseling, relaxation/massage therapy, infant sleep interventions, infant-mother relationship therapy, and maternal exercise. Although some of these interventions have been better studied for depression unrelated to childbirth, methodological limitations render their efficacy equivocal for postpartum depression. CONCLUSIONS: Definite conclusions cannot be reached about the relative effectiveness of most of the nonbiological treatment approaches due to the lack of well-designed investigations. Randomized controlled trials are needed to compare different treatment modalities, examine the effectiveness of individual treatment components, and determine which treatments are most useful for women with different risk factors or clinical presentations of postpartum depression.

Cognitive Behavioral Therapy↗

PubMed2006

Postpartum depression, delayed maternal adaptation, and mechanical infant caring: a phenomenological hermeneutic study.

BACKGROUND: With 10-15 percent of mothers experiencing postpartum depression this mental health problem is a significant public health issue. One concern is that normal infant development is at risk. Understanding how Postpartum depression impacts on mothering is important knowledge in managing this health problem. OBJECTIVES: To: Explore what is it like to become a mother, and examine how postpartum depression impacts on maternal adaptation. DESIGN: A hermeneutic approach was used guided by the philosophical works of Heidegger and Gadamer SETTING: A relatively affluent metropolitan area, including surrounding rural areas within Australia. PARTICIPANTS: Via purposeful, maximum variation sampling, eleven women who had been medically diagnosed with postpartum depression following childbirth but who were not experiencing psychosis participated in the study. METHODS: In-depth interviews and reflective journaling. RESULTS: Mothers with postpartum depression become "stuck" in a liminal state, an incomplete process of the rite of passage. Therefore, adaptation to the social role of a mother was found to be delayed. Additionally, a delay in becoming competent in parenting skills was evident. A lack of maternal-infant attachment was noted, however, mothers continued to care for their infants but in an unthinking manner that was labelled "mechanical infant caring". CONCLUSIONS: The distress caused by the delay in adapting to being a mother could be addressed by providing a mentor to at-risk women. The mentor should be a mother who has previously recovered from postpartum depression and would act as a symbol of hope. Additionally, on-going education and the insight that occurs during the liminal phase can facilitate mothers with postpartum depression to adapt appropriately.

Adaptation, Psychological↗

PubMedDate not supplied

Further validation of the Postpartum Depression Screening Scale.

BACKGROUND: Up to 50% of all cases of postpartum depression go undetected. The Edinburgh Postnatal Depression Scale (EPDS) has been the only instrument available that was specifically designed to screen for this mood disorder. None of the items on the EPDS, however, are written in the context of new motherhood. OBJECTIVE: The purpose of this study was to further assess the construct validity of the newly designed Postpartum Depression Screening Scale (PDSS) along with its sensitivity, specificity, and predictive values. METHOD: A total sample of 150 mothers within 12 weeks postpartum participated in the study. Each mother completed in random order three questionnaires: The PDSS, EPDS, and The Beck Depression Inventory-II (BDI-II). Immediately after completing these three questionnaires, each woman was interviewed by a nurse psychotherapist using the Structural Clinical Interview for DSM-IV Axis 1 Disorders. RESULTS: Twelve percent (n = 18) of the mothers were diagnosed with major postpartum depression, 19% (n = 28) with minor postpartum depression, and 69% (n = 104) with no depression. The PDSS was strongly correlated with both the BDI-II (r = 0.81) and the EPDS (r = 0.79). The ability of the PDSS to explain variance in diagnostic classification of postpartum depression above that explained by the BDI-II and EPDS (i.e., incremental validity) was assessed using hierarchical regression. After explaining variance in group classification by the other two depression instruments, the PDSS explained an additional 9% of the variance in depression diagnosis. Using receiver operating characteristic (ROC) curves, a PDSS cut-off score of 80 (sensitivity 94% and specificity 98%) is recommended for major postpartum depression and a cut-off score of 60 (sensitivity 91% and specificity 72%) for major or minor depression. CONCLUSION: Based on the results of this psychometric testing, the PDSS is considered ready for use in routine screening of mothers.

Adult↗