Psychoprophylaxis of postpartum depression.
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Depression↗
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Are family physicians appropriately screening for postpartum depression?
PURPOSE: Despite the availability of screening tools for postpartum depression (PPD), there is a general consensus that the condition is underdiagnosed. This study was conducted to determine how frequently family physicians screen for PPD, what methods they use to screen, and what influences their screening frequency. METHODS: A survey of members of the Washington Academy of Family Physicians was conducted. Three hundred sixty-two (60.9%) mailed surveys were returned. The 298 physicians who saw postpartum women and children younger than 1 year of age were included in the study. RESULTS: Of the study population, 70.2% always or often screened for PPD at postpartum gynecologic examinations, and 46% always or often screened mothers at well-child visits. Of those who screened, 30.6% reported using a validated screening tool. Of those, only 18% used a tool specifically designed to screen for PPD. Logistic regression modeling showed that female sex [odds ratio (OR) = 2.2], training in PPD during residency (OR = 8.1), training in PPD through medical literature (OR = 2.1), and agreement that postpartum depression is common enough to warrant screening (OR = 1.9) were all significantly associated with more frequent screening at postpartum gynecologic visits. Agreement that screening takes too much effort was associated with less frequent screening (OR = 0.8). CONCLUSIONS: Although family physicians believe that PPD is serious, identifiable, and treatable; screening is not universal and use of screening tools designed for PPD is uncommon. Training in postpartum depression and female sex are the variables most strongly associated with frequent screening.
Adult↗
Postpartum depression: do we still need this diagnostic term?
OBJECTIVE: The diagnostic term 'postpartum depression' is still widely used. This paper attempts to discuss if this is still justified in the light of recent research. METHOD: Comprehensive review of literature. RESULTS: Postpartum depression is not a specific entity in terms of having a specific aetiology. Rather, giving birth to a child with all its biological and psychosocial consequences seems to act as a major stressor, which - within a general vulnerability-stress model - can trigger the outbreak of the disease in predisposed women. Nevertheless, it might still be justified to continue the use of this diagnostic term, as depression in early motherhood confronts us with specific needs. Thus, help-seeking is often delayed due to shame and stigma, and diagnosis is often missed due to misinterpretation of symptoms. Services often do not meet these women's needs adequately, as they do not take into account their specific situation, problems and fears. Untreated, postpartum depression can have especially severe long-term consequences, not only for the mother but also for the child and the whole family. Therefore, special attention and special treatment is necessary. This necessitates modifications of our pharmacological, non-pharmacological and psychotherapeutic treatment and also provision of new low-threshold mother-infant services. CONCLUSION: Although postpartum depression is not a specific entity from an aetiological point of view, the diagnostic term [as 'specifier', as in the Diagnostic and Statistical Manual (DSM)-IV)] should not be abandoned, as depression in the postpartum period confronts us with specific needs for care.
Adult↗
Effects of pregnancy and delivery on serum prolyl endopeptidase (PEP) activity: alterations in serum PEP are related to increased anxiety in the early puerperium and to postpartum depression.
BACKGROUND: There is now some evidence that anxiety or anxiety disorders are related to increased activity of serum prolyl endopeptidase (PEP) and that major depression is related to lower serum PEP. The aims of the present study were to examine (i) the effects of pregnancy and delivery on serum PEP and (ii) the relationships between serum PEP and postpartum depression, anxiety in the early puerperium and a past history of depression. METHODS: Serum PEP activity was measured in 11 healthy nonpregnant and in 98 pregnant women 3 days before delivery and 1 and 3 days after delivery. On the same occasions, pregnant females completed the Spielberger State Anxiety Inventory (STAI) and were divided into high and low anxiety responders, as defined by changes in the STAI. The presence of a previous depression and postpartum depression within 3 months of delivery was assessed by means of DSM-IV criteria. RESULTS: Serum PEP activity was significantly higher 1 and 3 days after delivery than before. Women with a past history of depression as well as anxiety responders had significantly increased serum PEP activity over nonpregnant women and puerperae with a negative history and anxiety nonresponders, respectively. Parturients who developed a postpartum major, but not minor, depression had significantly lower serum PEP than parturients without postpartum depression. The results were controlled for maternal and labor variables, such as type of analgesia and delivery, induction of labor, breast feeding, parity, and duration of pregnancy and labor. CONCLUSIONS: Our results show that, in puerperae, increased serum PEP is related to increased state anxiety in the early puerperium and that lowered serum PEP is related to a subsequent postpartum major depression. INTERPRETATION: The results suggest that increased serum PEP may be related to postpartum anxious blues and that lowered serum PEP may predispose toward postpartum major depression.
Adult↗
Screening for postpartum depression in an inner-city population.
OBJECTIVE: This study was undertaken to determine the prevalence of positive screens for postpartum depression by using the Edinburgh Postnatal Depression Scale (EPDS) in an inner-city population. STUDY DESIGN: At their postpartum visits, women who were seen in two inner-city practices between February 20 and April 30, 2002, self-administered the EPDS. A threshold of 10 or more points was selected as a positive screen for postpartum depression. If the patient responded that she had thoughts of harming herself or others, she was referred immediately for social work or psychiatric evaluation. Otherwise, providers were blinded to the results of the screen. RESULTS: Of the 443 patients who were scheduled for postpartum visits during this time period, 285 (64%) patients presented for their postpartum visit. One hundred twenty-one (42%) of these patients participated in the study and 1 patient did not complete the questionnaire. Twenty-seven (22%) of the 121 patients had a positive screen for postpartum depression. Eight patients (6.6%) reported experiencing suicidal ideation within the previous week. Without use of the screening tool, providers identified 16 (13%) patients who they thought were at risk for postpartum depression. Of those 16 patients, 14 had positive screens on the EPDS. Eight patients eventually had clinical depression diagnosed. There was a significant relationship between women with elevated scores on the EPDS and a personal history of depression (P <.0006), history of prior treatment for depression (P <.0001), and feeling depressed during the pregnancy (P <.0001). Providers failed to comment on the patient's mood in 34 (28%) of the 121 patients. CONCLUSION: A larger than expected number of women had a positive screen for postpartum depression in our population. This unexpected finding suggests the need for more resources to be directed toward the research, identification, and treatment of postpartum depression in inner-city populations.
Adolescent↗
[The epidemiology and pathogenesis of postpartum depression].
Mood disorders--maternity blues, depression and bipolar disorders with psychotic features--are common and increased in rate during the postpartum period as compared to the non-postpartum period. Several authors showed a frequent recurrence of postpartum depression in women with a history of postpartum depression. Bloch, et al: (2000) showed that 5 of 8 women(62.5%) with a history of postpartum depression and none of the 8 control women developed significant mood symptoms during the withdrawal from high serum levels of progesterone and estradiol. These findings indicate that a history of postpartum depression produces hypersensitivity or reverse tolerance to subsequent exposure to an acute decrease of gonadal steroids at least for a subgroup of women with a past postpartum depression.
Adult↗
Demographic characteristics of participants in studies of risk factors, prevention, and treatment of postpartum depression.
OBJECTIVES: Metaanalyses have found that sociodemographic variables are not strong predictors of postpartum depression. However, no studies have systematically examined the extent to which the samples used in published research on postpartum depression have included sufficiently diverse samples of women to merit this conclusion. The objectives o this study were to examine the demographic characteristics of participants in previously published studies and to document existing gaps in the current literature. METHOD: We extracted age, ethnicity, relationship status, and socioeconomic status of 51 453 participants from 143 studies previously selected for systematic literature reviews. RESULTS: Few studies reported complete demographic data; however, existing data indicate that participants were predominantly aged 25 to 35 years, white, partnered, and of mid- or high-socioeconomic status. CONCLUSIONS: To assess the external validity of the findings, improved reporting of demographic characteristics is required in publications related to postpartum depression. Additional research is needed to understand postpartum depression among understudied populations.
Adult↗
Detection of postpartum depressive symptoms by screening at well-child visits.
OBJECTIVE: To assess 1) the feasibility of universal postpartum depression screening during well-child visits in the first year of life, 2) the prevalence of postpartum depressive symptoms among mothers who attend first-year well-child visits, 3) detection of postpartum depressive symptoms in a pediatric clinic before and after universal screening at each first-year well-child visit, and 4) social work referrals before and after universal screening. METHODS: The practice instituted universal screening for postpartum depressive symptoms during first-year well-child visits using the Edinburgh Postnatal Depression Scale (EPDS). We randomly selected 110 infant medical records before (cohort 1) and 110 after (cohort 2) screening was initiated. Measures included demographics, notation of depression or depressive symptoms in the well-child visit note, and referral for depression. EPDS scores were collected for cohort 2 only. Before-after comparisons were made for detection of depression or depressive symptoms and mental health referrals. RESULTS: The EPDS was included in the medical record in 46% of well-child visits. Eighty-eight percent of these forms were completed. Twenty-one percent of completed EPDS forms had scores > or =10, and 27% of women who completed the EPDS had scores > or =10 sometime during the postpartum year. There was a significant increase in documentation of depressive symptoms with the EPDS after initiation of universal screening (1.6% of visits [cohort 1] vs 8.5% [cohort 2]). Social work referrals for mental health reasons increased significantly (0.2% of visits [cohort 1] to 3.6% [cohort 2]). CONCLUSIONS: Women with high levels of postpartum depressive symptoms are common in an urban population and can be detected at well-child visits throughout the first postpartum year by pediatricians using a standardized screening tool. Because screening for depression during well-child visits is feasible using a standardized screening instrument, pediatricians can play an active role in early detection and referral for postpartum depression.
Adult↗
Interpersonal psychotherapy adapted for the group setting in the treatment of postpartum depression.
Interpersonal psychotherapy (IPT) has demonstrated efficacy in the individual treatment of antepartum and postpartum depression. The current investigation extends prior work by examining the efficacy of a group IPT approach for the treatment of postpartum depression. Depression scores of 17 women diagnosed with postpartum depressive disorder (DSM-IV criteria) decreased significantly from pre- to post-treatment. Follow-up assessments at 6 months revealed continuation of the treatment effect. Results indicate that IPT adapted for a group model has positive implications for the treatment of postpartum depression, demonstrating both short-term and longer-term effects in the reduction of depressive symptomatology. Study limitations include the small sample size, absence of control group, possible bias in therapist's assessments, and lack of monitoring adherence, which may have jeopardized the accuracy of the results.
Adult↗
The relationship between maternal role attainment and postpartum depression.
The purpose of this study is to examine the relationship between postpartum depressive symptoms and maternal role attainment. This study was part of a larger project using a nonrandomized, longitudinal, descriptive design. A convenience sample of 168 primiparous women in their last trimester of an uncomplicated pregnancy were recruited from community hospital-sponsored prenatal classes in central Illinois, and 136 women completed questionnaires 9-14 weeks after delivery. Postpartum depression was measured with the Edinburgh Postnatal Depression Scale. Three measures of maternal role attainment were the Myself as Mother Scale, My Baby Scale, and Perceived Competence Scale. Postpartum depression demonstrated a significant, negative relationship to all measures of maternal role attainment (r = -.20 to -.35, p < .01). The occurrence of postpartum depression and its negative influence on maternal role attainment emphasize the need to assess all new mothers for depression 2-3 months after delivery.
Adolescent↗
Human skin microbiota and postpartum depression: A bidirectional Mendelian randomization study.
Postpartum depression (PPD) is a common mental health disorder after childbirth. Although microbiome research in PPD has mainly focused on the gut, the role of skin microbiota remains unclear. We used Mendelian randomization (MR) to assess potential causal associations between skin microbiota and PPD. A bidirectional 2-sample MR analysis used genome-wide association study (GWAS) summary statistics. Genetic instruments for skin microbial features were obtained from a published skin microbiota GWAS, and PPD data were derived from 67,205 mothers (7604 cases, 59,601 controls). Instruments were selected at P <1 × 10-5, linkage disequilibrium-clumped, harmonized, and filtered for weak instruments (F statistic <10). Because this microbiome threshold is exploratory, Benjamini-Hochberg false discovery rate correction was applied within taxonomic levels. The inverse-variance weighted method was primary, complemented by weighted median and mode-based methods. Heterogeneity, pleiotropy, and outliers were assessed using Cochran Q, MR-Egger intercept, and MR-PRESSO. Three skin microbial taxa showed nominal associations with PPD. Higher genetically predicted Acinetobacter on the dorsal forearm (dry skin; 9 single nucleotide polymorphisms [SNPs]; mean F = 22.12) and Proteobacteria in the antecubital fossa (moist skin; 6 SNPs; mean F = 23.44) were associated with increased PPD risk, whereas Betaproteobacteria in the antecubital fossa (11 SNPs; mean F = 21.54) was associated with decreased risk. Associations were directionally consistent, with no substantial heterogeneity or horizontal pleiotropy. After multiple-testing assessment, the findings were exploratory rather than definitive. Reverse MR did not support an effect of PPD on the identified skin microbiota. This MR study provides exploratory genetic evidence linking specific skin microbial features to PPD risk. The findings extend microbiota-related hypotheses beyond the gut microbiome but require validation in larger microbiome GWAS datasets, longitudinal cohorts, and mechanistic studies before clinical or causal conclusions are drawn.
Humans↗
Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review.
BACKGROUND: Despite the well-documented risk factors and health consequences of postpartum depression, it often remains undetected and untreated. No study has comprehensively examined postpartum depression help-seeking barriers, and very few studies have specifically examined the acceptability of postpartum depression treatment approaches. The objective of this study was to examine systematically the literature to identify postpartum depression help-seeking barriers and maternal treatment preferences. METHODS: Medline, CINAHL, and EMBASE databases were searched using specific key words, and published peer-reviewed articles from 1966 to 2005 were scanned for inclusion criteria. RESULTS: Of the 40 articles included in this qualitative systematic review, most studies focused on women's experiences of postpartum depression where help seeking emerged as a theme. A common help-seeking barrier was women's inability to disclose their feelings, which was often reinforced by family members and health professionals' reluctance to respond to the mothers' emotional and practical needs. The lack of knowledge about postpartum depression or the acceptance of myths was a significant help-seeking barrier and rendered mothers unable to recognize the symptoms of depression. Significant health service barriers were identified. Women preferred to have "talking therapies" with someone who was nonjudgmental rather than receive pharmacological interventions. CONCLUSIONS: These results suggest that women did not proactively seek help, and the barriers involved both maternal and health professional factors. Common themes related to specific treatment preferences emerged from women of diverse cultural backgrounds. The clinical implications outlined in this review will assist health professionals in addressing these barriers and in developing preventive and treatment interventions that are in accord with maternal preferences.
Adult↗
[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↗
The clinical utility of maternal self-reported personal and familial psychiatric history in identifying women at risk for postpartum depression.
BACKGROUND: To determine whether maternal self-reported data on personal and family psychiatric history would significantly predict postpartum depressive symptomatology at 8 weeks postpartum and to examine which of these variables were the most predictive for inclusion in an obstetrical clinical assessment aimed at early identification of postpartum depression. METHODS: As part of a longitudinal study, a population-based sample of 622 women completed mailed questionnaires at 1 and 8 weeks postpartum. RESULTS: At 8 weeks postpartum, mothers who indicated that they had any personal psychiatric history were almost four times more likely to exhibit depressive symptomatology (Edinburgh Postnatal Depression Scale score > 9) than those with no previous mental health difficulties (odds ratio [OR] 3.65, 95% CI 2.30-5.82). Any family psychiatric history was not a significant risk factor. Variables most predictive of depressive symptomatology at 8 weeks, explaining 42% of the variance, included: maternal antenatal depression (OR 3.77, p=0.03), maternal history of postpartum depression (OR 2.21, p=0.02), and Edinburgh Postnatal Depression Scale score >9 at 1 week postpartum (OR 18.23, p<0.001). CONCLUSIONS: The results suggest that maternal variables, particularly those related to the index and past pregnancies, not family psychiatric history, are the best predictors of postpartum depressive symptoms. These findings highlight the importance of assessing symptoms of depression and anxiety during pregnancy and the early postpartum period, in order to facilitate timely identification of women at risk for developing postpartum depression.
Adult↗
Prediction of postpartum depression.
This article briefly reviews definitions, etiology, and cultural aspects of postpartum depression. Studies attempting to predict postpartum depression are examined, and a summary of risk factors is given. The importance of educating all pregnant women about postpartum depression is stressed, and sample patient education information is presented.
Cultural Characteristics↗
Bupropion SR for the treatment of postpartum depression: a pilot study.
Despite the prevalence of postpartum depression, few studies have assessed the efficacy of antidepressants for the treatment of this disorder. Failure to treat postpartum depression (PPD) places the woman at risk for chronic depression and may have adverse effects on child wellbeing and development. Eight female outpatients aged 18-45 yr were enrolled in an 8-wk open-label trial of bupropion SR for PPD. All patients met DSM-IV criteria for major depression with onset within 3 months of delivery and scored 17 or greater on the Hamilton Depression Rating Scale (HAMD) at baseline. Those with onset of depressive symptoms during pregnancy, psychotic symptoms, or significant medical illness were excluded. Median scores on the HAMD declined from 20.5 (range 15-38) at baseline to 10.0 (range 1-20) at end-point (p<0.05, Wilcoxon signed-ranks test; LOCF). Six out of the eight subjects demonstrated a > or =50% decrease in HAMD scores from baseline; three subjects achieved remission (HAMD score of < or =7) at week 8. Median final dosage of bupropion SR was 262.5 (range 37.5-300). Bupropion SR was well tolerated, and no subjects discontinued treatment as a result of medication side-effects. Bupropion SR represents an effective and well-tolerated antidepressant for the treatment of PPD.
Adolescent↗
Postpartum depression following normal vaginal delivery among Nigerian women.
The study investigated postpartum depression among Nigerian women by comparing 83 mothers who had normal vaginal deliveries with 83 matched controls. Analysis of scores on the Zung Self-rating Depression Scale indicated that the mothers and the controls were not significantly different on depression during the immediate postpartum period. There were significant relationships between postpartum depression and education after birth, not having male children at after 6 wk., primiparity after birth, and puerperal complications.
Adult↗
Postpartum depression: a clinical view.
Recent studies identify a much higher incidence of postpartum depression than had previously been acknowledged and show that a mother's depression may have a highly deleterious effect on the early development of her infant. Although a variety of theories exist concerning the etiology of postpartum depression, many writers now accept a transactional model of causality. This article suggests that for many women early depriving or abusive experiences are necessary but not sufficient conditions to explain the development of severe postpartum depression. Four different types of postpartum depression are presented with widely differing prognoses and needs for treatment. It is suggested that a wide range of treatment modalities may be needed with the more serious depressions and that such services are lacking in most communities.
Depressive Disorder↗