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PubMed2006

Raising the awareness of primary care providers about postpartum depression.

About 13% of women experience depression in the first year after childbirth. Postpartum depression has deleterious effects on the woman's relationships, her functional status, and her ability to care for her infant. Primary care providers have the most contact with postpartum women, but may be unable or unwilling to screen, treat, and/or refer the women. Thus, many women with postpartum depression are not receiving mental health services. The purpose of this article is to describe methods to raise the awareness of primary care providers about postpartum depression, thereby eliminating a major barrier to mental health treatments of postpartum women.

Attitude of Health Personnel↗
PubMed2000

Postpartum depression: identification of women at risk.

OBJECTIVE: To identify and test the predictive power of demographic, obstetric, and psychosocial risk factors of postpartum depression. DESIGN: Community-based, prospective follow up study based on questionnaires on past history of psychiatric disease, psychological distress and social support during pregnancy and depression at four months after delivery. Obstetric files were collected at time of birth. SETTING: Antenatal care clinic and delivery ward, Aarhus University Hospital, Denmark. POPULATION: 6,790 women giving birth between 1 January 1994 and 31 December 1995, who attended the antenatal clinic during pregnancy; 5,252 (78%) completed all questionnaires. The validation population comprised 528 women enrolled immediately prior to and after the study period. MAIN OUTCOME MEASURE: Postpartum depression four months after giving birth assessed by the Edinburgh Postnatal Depression Scale. RESULTS: 5.5% of the women suffered from postpartum depression, corresponding to a score of 13 or higher on the Edinburgh Postnatal Depression Scale. Risk factors identified by multivariate logistic regression analysis included psychological distress in late pregnancy (OR 6.3 [95% CI 4.4-9.1]), perceived social isolation during pregnancy (OR 3.6 [95% CI 1.9-7.0]); high parity (OR 3.8 [95% CI 1.8-8.0]); and a positive history of prepregnant psychiatric disease (OR 2.1 [95% CI 1.4-3.2]). No association was found between pregnancy or delivery complications, and postpartum depression. The maximum predictive power of the identified risk factors was 0.3. According to these results, one out of three women who suffers from psychological distress in late pregnancy with perceived social isolation will develop postpartum depression. CONCLUSION: Antenatal focus on psychosocial wellbeing may help to identify women at risk of postpartum depression.

Adolescent↗
PubMedDate not supplied

Antenatal risk factors for postpartum depression: a synthesis of recent literature.

Postpartum nonpsychotic depression is the most common complication of childbearing, affecting approximately 10-15% of women and, as such, represents a considerable health problem affecting women and their families. This systematic review provides a synthesis of the recent literature pertaining to antenatal risk factors associated with developing this condition. Databases relating to the medical, psychological, and social science literature were searched using specific inclusion criteria and search terms, in order to identify studies examining antenatal risk factors for postpartum depression. Studies were identified and critically appraised in order to synthesize the current findings. The search resulted in the identification of two major meta-analyses conducted on over 14,000 subjects, as well as newer subsequent large-scale clinical studies. The results of these studies were then summarized in terms of effect sizes as defined by Cohen. The findings from the meta-analyses of over 14,000 subjects, and subsequent studies of nearly 10,000 additional subjects found that the following factors were the strongest predictors of postpartum depression: depression during pregnancy, anxiety during pregnancy, experiencing stressful life events during pregnancy or the early puerperium, low levels of social support, and a previous history of depression. Critical appraisal of the literature revealed a number of methodological and knowledge gaps that need to be addressed in future research. These include examining specific risk factors in women of lower socioeconomic status, risk factors pertaining to teenage mothers, and the use of appropriate instruments assessing postpartum depression for use within different cultural groups.

Adult↗
PubMedDate not supplied

Postpartum depression. The lived experiences of Middle Eastern migrant women in Australia.

The aim of this study was to explore the lived experiences of postpartum depression among the Middle Eastern women living in Sydney, Australia. A phenomenologic research design was used to conduct in-depth, unstructured interviews with a purposive sample of 45 mothers who had experienced postpartum depression. The interviews were conducted in the mothers' homes. Transcriptions of these interviews were analyzed using Colaizzi's (1978) phenomenologic method. Five themes emerged that illustrated the Middle Eastern woman's experiences of postpartum depression: 1) loneliness due to feelings of isolation and lack of social support, 2) helplessness due to inability to cope with the overwhelming task of fulfilling her traditional role as mother and wife, 3) fear of failure and being labeled a "bad mother" by in-laws, 4) insufficient knowledge about postpartum depression and available support services, and 5) coming to terms with postpartum depression by undertaking diversional activities and learning new skills. The exhaustive description of postpartum depression as experienced by the women that emerged from this phenomenologic study will help midwives and other health care professionals to be more sensitive to and understanding of women from different cultural backgrounds so that appropriate interventions can be designed that meet their specific needs and beliefs.

Adaptation, Psychological↗
PubMed2005

"Struggling with life": narratives from women with signs of postpartum depression.

AIM: The aim of this study was to explore and describe how Swedish women with signs of postpartum depression two months postpartum experience the first months with their child. METHOD: A grounded theory approach was chosen. Twenty-two women who showed signs of depression, i.e. scored 10 or more on the Edinburgh Postnatal Depression Scale (EPDS), were interviewed at an average of 80 days after the delivery. RESULTS: The new mothers were struggling with life related to the self, the child, and the partner. They expressed feelings of loss of who they are, felt overwhelmed by the responsibility for the child, and were struggling with feelings of abandonment, worries, and breastfeeding problems. They often felt like "bad mothers" but they never blamed the child. Most mothers were reluctant to speak about their feelings and they assigned their depressed mood to personal weakness rather than illness. In relationship to the partner the mothers were struggling to keep their equality in the new situation and to get him involved in childcare. CONCLUSIONS: The findings suggest that depressed feelings postpartum may be explained in terms of losses and changes. However, postpartum depressive symptoms remain hidden and it is important to understand the complexity of postpartum depressive mood, described here as struggling with life related to three different dimensions: the self, the child, and the partner.

Adaptation, Psychological↗
PubMedDate not supplied

A hospital survey of postpartum depression education at the time of delivery.

OBJECTIVE: To assess and characterize health education regarding postpartum depression (PPD) received by recently delivered women during their postpartum hospital stay. DESIGN: Mailed, self-administered survey. SETTING: All 121 hospitals in Ohio that provide obstetric and postpartum care. PARTICIPANTS: Nurse managers for obstetric services, 90 (74%) of whom returned surveys. MAIN OUTCOME MEASURES: Types of postpartum education provided, format of postpartum depression education delivery, attitudes regarding postpartum depression education. RESULTS: Most hospitals (89.7%) educate newly delivered women about PPD, most often by passive methods. Specific educational programs were offered by only 14% of hospitals. Most PPD education was provided during hospitalization after delivery; however, 50% of respondents felt that it should be provided at every possible opportunity. CONCLUSION: PPD education is one of several topics covered during hospitalization for newly delivered mothers. Health providers of all disciplines should be involved in educating a new mother about PPD.

Attitude of Health Personnel↗
PubMed2005

Impact of postpartum depression on the mother-infant couple.

BACKGROUND: Few studies have explored the influence of postpartum depression on later life among mothers in Taiwan. The present follow-up study aims to explore the effects of postpartum depression on the psychosocial health of mothers and on the overall development of their infants. METHODS: Follow-up evaluations were carried out on 29 postnatally depressed and 31 nondepressed mothers and their infants at 1 year after childbirth. Dependent variables were measured by means of five structured questionnaires. RESULTS: Postnatally depressed mothers reported significantly higher perceived stress, but lower social support and self-esteem than nondepressed mothers at 1 year after childbirth. The participants' postpartum depression had no significant effect on their infants' eight developmental areas, nor did depression influence their plans about the number of children to have in the future. CONCLUSIONS: Postpartum depression may have a negative influence on the psychosocial health of women, but it does not appear to influence the overall development of their infants and their family planning.

Adult↗
PubMed2006

Risk of postpartum depression in relation to dietary fish and fat intake in Japan: the Osaka Maternal and Child Health Study.

BACKGROUND: An ecological analysis found that the docosahexaenoic acid content in mother's milk and seafood intake were inversely correlated with postpartum depression. This prospective study investigated the relationship of consumption of selected high-fat foods and specific types of fatty acids with the risk of postpartum depression. METHOD: The subjects were 865 Japanese women. Dietary data were obtained from a self-administered diet history questionnaire during pregnancy. The Edinburgh Postnatal Depression Scale (EPDS) was used for the evaluation of postpartum depression. Adjustment was made for age, gestation, parity, cigarette smoking, family structure, family income, education, changes in diet in the previous month, season when data at baseline were collected, body mass index, time of delivery before the second survey, medical problems in pregnancy, baby's sex and baby's birthweight. RESULTS: The percentage of women with high depression scores was 14.0%. No evident dose-response associations were observed between intake of fish, meat, eggs, dairy products, total fat, saturated fatty acids, monounsaturated fatty acids, n-3 polyunsaturated fatty acids, n-6 polyunsaturated fatty acids, linoleic acid, alpha-linolenic acid, arachidonic acid, eicosapentaenoic acid or docosahexaenoic acid and the ratio of n-3 to n-6 polyunsaturated fatty acids and the risk of postpartum depression. However, there was an inverted J-shaped relationship between intake of n-3 polyunsaturated fatty acids and docosahexaenoic acid and the risk of postpartum depression. CONCLUSIONS: This study failed to substantiate a clear inverse relationship between fish and n-3 polyunsaturated fatty acid intake and postpartum depression. Further investigations are needed to determine whether fish and n-3 polyunsaturated fatty acid consumption is preventive against postpartum depression.

Animals↗
PubMed1998

The effects of postpartum depression on child development: a meta-analysis.

The adverse, short-term effects of postpartum depression on maternal-infant interaction have been repeatedly documented. Are there long-term sequelae for children whose mothers had experienced postpartum depression? The purpose of this meta-analysis was to determine the magnitude of the effect of postpartum depression on the cognitive and emotional development of children older than the age of 1 year. Nine studies which met the sample criteria were included in this meta-analysis. Results indicated that postpartum depression had a small but significant effect on children's cognitive and emotional development. The r indicator for effect size ranged from .18 to .22 whereas the d indicator ranged from .36 to .45. Implications for future research are addressed.

Adaptation, Psychological↗
PubMed2005

[Postpartum depression: we know the risks, can it be prevented?].

In the past 20 years, there has been increasing recognition that for some women, pregnancy may be burdened with mood problems, in particular depression, that may impact both mother and child. With identification of risk factors for postpartum depression and a growing knowledge about a biologic vulnerability for mood change following delivery, research has accumulated on attempts to prevent postpartum depression using various psychosocial, psychopharmacologic, and hormonal strategies. The majority of psychosocial and hormonal strategies have shown little effect on postpartum depression. Notwithstanding, results from preliminary trials of interpersonal therapy, cognitive-behavioural therapy, and antidepressants indicate that these strategies may be of benefit. Information on prevention of postpartum depression using dietary supplements is sparse and the available evidence is inconclusive. Although a few studies show promising results, more rigorous trials are required. The abounding negative evidence in the literature indicates that postpartum depression cannot be easily prevented, yet.

Antidepressive Agents↗
PubMed2002

Diagnosing postpartum depression: can we do better?

OBJECTIVE: The purpose of this study was to evaluate the efficacy of the Edinburgh Postnatal Depression Scale versus routine clinical evaluation to detect postpartum depression among a low-income inner-city population and to evaluate risk factors associated with a positive score on the Edinburgh Postnatal Depression Scale. STUDY DESIGN: On the basis of the day of the month, all English-speaking patients who were seen for their postpartum visit were assigned either to routine clinical evaluation for postpartum depression or routine clinical evaluation plus the use of the 10-question Edinburgh Postnatal Depression Scale. RESULTS: During the 7-week study period, 72 women participated in the study: 35 women in the routine evaluation group and 37 women in the Edinburgh Postnatal Depression Scale group. Women who completed the Edinburgh Postnatal Depression Scale were significantly more likely than those in the routine evaluation group to be identified as being at risk for depression: 11 of 37 women (30%) versus 0 of 35 women (P <.001). A failed attempt at breast-feeding was associated with an increased risk of a score of > or =10 on the Edinburgh Postnatal Depression Scale (relative risk, 3.78; 95% CI, 1.03-13.89). CONCLUSION: The Edinburgh Postnatal Depression Scale appears to be a valuable and efficient tool for the identification of patients who are at risk for postpartum depression.

Adult↗
PubMedDate not supplied

The early detection of postpartum depression: midwives and nurses trial a checklist.

OBJECTIVE: To evaluate the use of a standard pen-and-paper test versus the use of a checklist for the early identification of women at risk of postpartum depression and to investigate the experiences of nurses in using the checklist. DESIGN: A prospective cohort design using repeated measures. SETTING: The booking-in prenatal clinic at a regional hospital in Victoria, Australia, and the community-based postpartum maternal and child health service. PARTICIPANTS: 107 pregnant women over 20 years of age. MAIN MEASURES: Postpartum Depression Prediction Inventory (PDPI), Postpartum Depression Screening Scale (PDSS), Edinburgh Postnatal Depression Scale (EPDS), demographic questionnaire, and data on the outcome from the midwives and nurses. RESULTS: The PDPI identified 45% of the women at risk of depression during pregnancy and 30% postpartum. The PDSS and EPDS both identified the same 8 women (10%), who scored highly for depression at the 8-week postpartum health visit. Nurses provided 80% of the women with anticipatory guidance on postpartum depression in the prenatal period and 46% of women at the 8-week postpartum health visit. Nurse counseling or anticipatory guidance was provided for 60% of the women in the prenatal period. CONCLUSION: The PDPI was found to be a valuable checklist by many nurses involved in this research, particularly as a way of initiating open discussion with women about postpartum depression. It correlated strongly with both the PDSS and the EPDS, suggesting that it is useful as an inventory to identify women at risk of postpartum depression.

Adult↗
PubMed2005

The onset of postpartum depression: Implications for clinical screening in obstetrical and primary care.

OBJECTIVE: Inconsistent diagnostic criteria fail to delineate guidelines for postpartum depression surveillance. This study evaluates the validity of commonly accepted postpartum onset criteria. STUDY DESIGN: Consecutive referrals to the Emory Women's Mental Health Program for evaluation of postpartum depression fulfilling criteria for major depression and taking no psychotropic medication were included. Diagnostic interview, demographics, depression scales, and the time of illness onset were obtained. Descriptive analysis was conducted for 3 participant groups: pregnancy onset, early postpartum onset within 6 weeks of delivery, and late postpartum onset. RESULTS: Among participants, 11.5% reported prenatal onset, 22.0% late postpartum onset, and 66.5% early postpartum symptom onset. Those reporting pregnancy onset were more likely to be unmarried, and those with a late postpartum onset were less likely to report a past history of postpartum depression. CONCLUSION: The perinatal vulnerability to depression begins before delivery and extends beyond 6 weeks postpartum. Depression surveillance is therefore warranted during prenatal visits, at the postnatal check up, and at pediatric visits during the initial 6 months of the first postnatal year.

Adult↗
PubMed1997

Postpartum depression: a review for perinatal social workers.

Postpartum depression is a common and treatable clinical syndrome which effects up to fifty percent of all women and which can best be considered as a triad of disorders. Postpartum blues, postpartum affective disorders or major depressions, and postpartum psychosis have distinct symptoms with corresponding implications for social work interventions and treatment strategies. The role of prevention can be pivotal in terms of reducing negative impacts of psychological problems after birth and minimizing adverse consequences for the new baby and all family members.

Adjustment Disorders↗
PubMed2004

Treatment of postpartum depression, part 1: a critical review of biological interventions.

BACKGROUND: While postpartum depression is a major health issue for many women from diverse cultures, this affective condition 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 biological perspective. METHOD: 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 in various combinations. Published peer-reviewed articles in English from 1990 to 2003 were chosen for review, although select earlier studies were also included based on good methodological quality and/or the absence of more recent work. 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: Nine studies that met study criteria were examined. The interventions studied included antidepressant medication, estrogen therapy, critically timed sleep deprivation, and bright light therapy. Although some of these interventions have been better studied for depression unrelated to childbirth, methodological limitations render their efficacy equivocal for postpartum depression with limited strong evidence available to guide practice or policy recommendations. CONCLUSIONS: Despite the recent upsurge of interest in this area, many questions remain unanswered, resulting in diverse research implications. In view of the lack of randomized controlled trials, psychiatrists who are experts in the treatment of postpartum mood disorders have developed consensus guidelines. These guidelines will require regular updating as better and stronger evidence emerges.

Antidepressive Agents↗
PubMedDate not supplied

Teetering on the edge: a substantive theory of postpartum depression.

Using the grounded theory method, a substantive theory of postpartum depression was developed. Data were obtained through participant observation in a postpartum depression support group over an 18-month period. In addition, 12 in-depth taped interviews were conducted with mothers who had attended the support group. Analysis of the data by the constant comparative method revealed loss of control as the basic social psychological problem. Women suffering from postpartum depression attempted to cope with the problem of loss of control through the four-stage process of teetering on the edge. The stages that emerged from the data included (a) encountering terror, (b) dying of self, (c) struggling to survive, and (d) regaining control.

Adaptation, Psychological↗
PubMed2004

Postpartum depression: identification, screening, and treatment.

Depression during the postpartum period is a significant public health concern, affecting 8%-15% of women and resulting in considerable morbidity for women, and their infants and families. Risk, prevalence, and distinguishing features of postpartum mood disorders are provided. Anxiety and depression frequently co-occur, suggesting symptoms of anxiety should also be attended to when screening for postpartum depression. Recommendations include the use of a brief, valid screening instrument as a routine clinical practice and the unique role of the obstetrician/gynecologist, pediatrician, and family practice physician in identification and referral. A summary of evidence-based treatment options for postpartum depression, along with current information about psychotropic medication, is provided to assist in risk-benefit analyses and decision making with patients.

Antidepressive Agents↗
PubMed2003

Parental acceptance, postpartum depression, and maternal sensitivity: mediating and moderating processes.

Mothers (n = 92), fathers (n = 84), and their infants (60% male) participated in a longitudinal study of postpartum depression and maternal sensitivity. Mothers completed questionnaire measures of remembered parental acceptance, depressive symptoms, and infant distress to novelty and limits. Mothers and partners reported on marital aggression and avoidance. Maternal sensitivity was observed in the laboratory at 6 months. Characteristics of mothers, partners, and infants combined to predict postpartum depression and maternal sensitivity. Remembered parental rejection predicted postpartum depressive symptoms with prenatal depression controlled; self-esteem mediated this effect. Paternal acceptance buffered against postpartum depression when infants were highly reactive and when partners were aggressive. Paternal acceptance reduced the impact of postpartum depression on maternal sensitivity; having an aggressive marital partner exacerbated the effect.

Adult↗