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PubMed2003

Impact of postpartum depressive symptoms on mother and her 18-month-old infant.

BACKGROUND: Postpartum depression (PPD) is known to have important negative effects on mother, infant and mother-child relationship. METHODS: We present a case-control study of 35 mothers and their 18-month-old infants. These mothers suffered from postpartum depressive symptoms (PDS) when the infants were three months old, as rated with the Edinburgh Postnatal Depression Scale (EPDS, Cox 1987). A control group of 35 mothers without postpartum depressive symptoms (NPDS) with their 18-month-old infants was also evaluated. The infants were assessed using the Infant Behavior Record of the Bayley Scales of Infant Development, the Strange Situation and an object concept task. RESULTS: 15 months later, the PDS mothers were less affectionate and more anxious than the NPDS mothers. The PDS dyads demonstrated less verbal interaction and less playing interaction. 18-month-old infants of PDS mothers performed less well on object concept tasks, and were more often insecurely attached to their mothers. Only some results were linked to the mothers' depressive state (D-mothers) diagnosed at 18 months (e. g. responsiveness to persons). CONCLUSIONS: The important negative effects observed at 18 months on mother and infant of maternal PDS at 3 months confirm the need for early identification and therapeutic or preventive interventions.

Adult↗
PubMed2008

Symptom features of postpartum depression: are they distinct?

The clinical features of postpartum depression and depression occurring outside of the postpartum period have rarely been compared. The 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR(16)) provides a means to assess core depressive symptoms. Item response theory and classical test theory analyses were conducted to examine differences between postpartum (n=95) and nonpostpartum (n=50) women using the QIDS-SR(16). The two groups of females were matched on the basis of age. All met DSM-IV criteria for nonpsychotic major depressive disorder. Low energy level and restlessness/agitation were major characteristics of depression in both groups. The nonpostpartum group reported more sad mood, more suicidal ideation, and more reduced interest. In contrast, for postpartum depression sad mood was less prominent, while psychomotor symptoms (restlessness/agitation) and impaired concentration/decision-making were most prominent. These symptomatic differences between postpartum and other depressives suggest the need to include agitation/restlessness and impaired concentration/decision-making among screening questions for postpartum depression.

Adult↗
PubMed2000

The timing of norplant insertion and postpartum depression in teenagers.

BACKGROUND: This study tested the hypothesis that teenagers who have Norplant inserted during the puerperium report more depressive symptoms during the first postpartum year than their peers who do not receive Norplant. METHODS: We studied the prevalence of depressive symptoms in a group of 212 mothers aged 19 years less, in relation to the timing of Norplant insertion. The participants were divided into 3 groups: 100 (47%) had Norplant inserted during the puerperium (early Norplant users); 72 (34%) had Norplant inserted during the next 10 months (late Norplant users); and 40 (19%) used other contraceptives (40% oral contraceptives; 17% condoms; 43% nothing). Depressive symptoms were measured with the Center for Epidemiologic Studies - Depression Scale. Postpartum depression was defined as a scale score >/=16, 6-12 months after Norplant insertion or delivery. Variables examined as potential confounders were identified a priori from a review of the literature and controlled for in analysis of variance. RESULTS: At delivery, members of the 3 contraceptive groups did not differ significantly with regard to age, race, parity, educational, marital, or socioeconomic status. Late Norplant users were, however, more apt to have new boyfriends (p =. 03), to rate the support they received from the baby's father as poor (p =.004), and experience depression prior to Norplant insertion (p =.02). Contrary to the study hypothesis, late rather than early Norplant insertion was associated with postpartum depression. Multivariate analyses identified 3 independent predictors of the severity of depressive symptoms at follow-up (depression prior to Norplant insertion, a new boyfriend at delivery, and late Norplant insertion); R(2) = 41.3%. CONCLUSIONS: Contrary to the study hypothesis, puerperal Norplant insertion did not exacerbate postpartum depression. Delaying Norplant insertion may increase the risk of depression during the first postpartum year, particularly in teenagers with other psychosocial risk factors.

Adolescent↗
PubMed2005

Review of screening instruments for postpartum depression.

This paper presents a review and discussion of eight self-report measures used to assess for depressive symptoms in the postpartum period. Because postpartum depression is a significant mental health problem, there is a need for reliable and valid screening instruments. Published psychometric data (e.g., reliability, sensitivity, specificity, positive predictive value, concurrent validity) of each self-report instrument are presented and critiqued. Results suggest that the Edinburgh Postnatal Depression Scale is the most extensively studied measure with postpartum women with moderate psychometric soundness. This review illustrates the need for more research in this area. Issues involved in the selection of measures are considered. Implications for clinical practice, research, culture and language are discussed.

Depression, Postpartum↗
PubMed2006

The use of the Antenatal Psychosocial Health Assessment (ALPHA) tool in the detection of psychosocial risk factors for postpartum depression: a randomized controlled trial.

OBJECTIVE: Eliciting known risk factors for postpartum depression (PPD) during pregnancy may enable primary health care providers to identify women at increased risk of becoming depressed. The purpose of this study was to examine how well the Antenatal Psychosocial Health Assessment (ALPHA) form identified antenatal risk factors for PPD, compared with routine care, in a sample of pregnant women. METHODS: A randomized controlled trial was conducted to assess the effectiveness of the ALPHA form in detecting antenatal risk factors associated with the adverse postpartum outcomes of postpartum depression, intimate partner violence, child abuse, and couple dysfunction. The participants were primary antenatal care providers--family physicians, obstetricians, and midwives--from four diverse communities in Ontario. These providers were matched and then randomly allocated into the intervention group, who used the ALPHA form, or into the control group, who administered usual care. In total, 227 pregnant women were recruited: 98 in the ALPHA group and 129 in the control group. The data presented in this paper are from a secondary analysis focusing on PPD as the outcome. RESULTS: Providers randomized to the ALPHA group identified a statistically significantly higher proportion of women with antenatal psychosocial risk factors for PPD (36% vs. 26%) and a significantly higher number of risk factors per woman compared with the control group (mean 2.1 vs.1.8) (z = -1.96, P = 0.05). Providers in the ALPHA group also identified significantly more women having a "previous history of depression" (16% vs. 6%) (chi2 = 5.243, df = 1, P = 0.03) and "[having] witnessed or experienced abuse as a child" (17% vs. 3%) (chi2 = 12.488, df = 1, P = 0.0005), which are both established risk factors for PPD. CONCLUSION: The ALPHA provides a systematic means of eliciting antenatal psychosocial risk factors for PPD for primary care providers, and it may be particularly useful for raising and discussing sensitive issues. The detection of depressive symptomatology during pregnancy remains problematic, however, and detection may be improved by administering a simple standardized measure of depressive symptomatology during routine antenatal care.

Adolescent↗
PubMedDate not supplied

Proactive nursing: the evolution of a task force to help women with postpartum depression.

In response to several women who presented with postpartum depression in 1 year, a group of nurses developed a task force made up of hospital nurses, obstetricians, psychiatrists, pediatricians, family practitioners, lactation specialists, home care nurses, and mental health counselors. The purposes of this task force were to educate health care professionals about postpartum depression, to help identify women who might be affected, and to develop interventions for adjusting to parenthood. This article details the evolution of that task force, and how it has assisted not only the women but also the health care providers involved.

Community Health Nursing↗
PubMed2002

Dementia presenting as postpartum depression.

BACKGROUND: Other conditions that can mimic postpartum depression are rare but must be considered. CASE: A 37-year-old woman developed mood symptoms as well as progressive hyperphagia, hypersexuality, disinhibition, and impairment of judgment after delivery of her third child. She was unresponsive to multiple treatments for depression and was evaluated for frontal lobe syndromes. CONCLUSION: Frontotemporal dementia, formerly known as Pick disease, is a primary degenerative dementia for which no cause is clearly established. Family history or genetic abnormalities are found in about 50% of cases. The diagnosis is frequently missed or delayed, as in this case, because it occurs in a younger age group, presents with unusual signs and symptoms, and is far less prevalent than Alzheimer disease.

Adult↗
PubMedDate not supplied

Maternity blues and postpartum depression.

OBJECTIVE: To investigate the relationship between maternity blues and postpartum depression in mothers discharged early from the hospital and those discharged after the customary length of hospital stay. DESIGN: A descriptive correlation design. SETTING: 550-bed community and teaching hospital in the midwestern United States. PARTICIPANTS: 49 privately paying, primiparous, American-born women, 18 years of age or older, with uncomplicated pregnancies and vaginal deliveries of healthy neonates weighing 2,600-4,000 g. MEASURES: Stein Maternity Blues Scale and Beck Depression Inventory were used to collect data. RESULTS: No significant differences found between the two groups of mothers; significant relationships found between maternity blues at 1 week after delivery and postpartum depression at 6 and 12 weeks after delivery. CONCLUSIONS: Early discharge appears to pose no threat to psychologic well-being. Primiparas experiencing more severe maternity blues are at increased risk for postpartum depression.

Adult↗
PubMed2001

Childhood sexual abuse, parenting and postpartum depression--a 3-year follow-up study.

OBJECTIVE: This study is the second and final phase of a 3-year follow-up study of women who had been admitted with a major depressive episode in the postpartum period, along with their children and partners where present. The effect of a maternal sexual abuse history on the women's well-being and child outcome compared to those women without such a history is highlighted. METHOD: Forty-five of an original cohort of 56 women were seen with their child where possible, when the child was an average of 36.8 months old. Twenty-two women had no history of sexual abuse, and 23 gave a history of childhood sexual abuse. Women were assessed with respect to well-being, relationships, parenting stress and psychiatric history since recruitment. The child's behavior and cognitive development was also assessed. RESULTS: Women with a history of sexual abuse rated higher depression and anxiety scores (p < .05), and had greater life stresses (p < .05). Their partners rated themselves as more comforting and their children as more disturbed (p < .05). Over time, this group had failed to improve as much as the nonabuse group on these measures. There was no difference in child cognitive scores between groups. CONCLUSIONS: A history of sexual abuse in women who become depressed postpartum may have long term implications for the woman's mental health, her relationship with her child, as well as the emotional development of her child. It is critical to offer women in this high-risk group supports in an attempt to minimize these difficulties and any long-term adverse effects.

Adult↗
PubMedDate not supplied

A light in the fog: caring for women with postpartum depression.

It is estimated that at least 1 in 10 women will experience postpartum depression, yet systematic screening for it in clinical practice is too often neglected. The foggy unreality of this affective disorder leads women to believe they are losing their minds, and their efforts to find help can be elusive. Women with postpartum depression who go undetected and untreated are at risk for immediate harm and potential lifelong sequelae for themselves and their families, and especially for their children. This article provides 1) an understanding of the woman's experience of postpartum depression, 2) a review of two instruments, developed through a focused program of research to screen for the disorder, 3) triage in clinical practice, and 4) an overview of the three dimensions of treatment: psychopharmacology, psychotherapy, and psychosocial care. Practical guidance and client information are provided to assist midwives and primary care providers to incorporate systematic screening into clinical practice, to identify effective interdisciplinary treatment teams, and to muster family and community resources to help with this commonly hidden childbearing crisis.

Child↗
PubMed1999

Culture care meanings and experiences of postpartum depression among Jordanian Australian women: a transcultural study.

This study discovers, describes, and explains the personal experiences, perceptions, and care meanings of Jordanian women who have suffered postpartum depression. Most postpartum cases often are misdiagnosed as exclusively psychological and untreated by health care professionals without consideration to the cultural meanings of this problem. Understanding the experiences of these women is important, as their expressions often are contextually and culturally influenced. Using Leininger's Theory of Culture Care Diversity and Universality, a purposive sample of 22 Jordanian women diagnosed with postpartum depression, living in Sydney, were interviewed. The ethnonursing research method and data analysis procedures were used. Results revealed that Jordanian mothers experienced severe loss of control over emotions of loneliness, hopelessness, and feelings of being a bad mother. Three major themes focusing on the care meanings and experiences of Jordanian women are discussed: (a) Care means strong family support and kinship during the postpartum period, (b) care is carrying out and fulfilling traditional gender roles as mother and wife, and (c) care is preservation of Jordanian childbearing customs as expressed in the celebration of the birth of the baby.

Adult↗
PubMed2006

Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior.

BACKGROUND: Pediatric anticipatory guidance has been associated with parenting behaviors that promote positive infant development. Maternal postpartum depression is known to negatively affect parenting and may prevent mothers from following anticipatory guidance. The effects of postpartum depression in fathers on parenting is understudied. OBJECTIVE: Our purpose with this work was to examine the effects of maternal and paternal depression on parenting behaviors consistent with anticipatory guidance recommendations. METHODS: The 9-month-old wave of data from a national study of children and their families, the Early Childhood Longitudinal Study, provided data on 5089 2-parent families. Depressive symptoms were measured with a short form of the Center for Epidemiologic Studies Depression Scale. Interviews with both parents provided data on parent health behaviors and parent-infant interactions. Logistic and linear regression models were used to estimate the association between depression in each parent and the parenting behaviors of interest. These models were adjusted for demographic and socioeconomic status indicators. RESULTS: In this national sample, 14% of mothers and 10% of fathers exhibited levels of depressive symptoms on the Center for Epidemiologic Studies Depression Scale that have been associated with clinical diagnoses, confirming other findings of a high prevalence of postpartum maternal depression but highlighting that postpartum depression is a significant issue for fathers as well. Mothers who were depressed were approximately 1.5 times more likely to engage in less healthy feeding and sleep practices with their infant. In both mothers and fathers, depressive symptoms were negatively associated with positive enrichment activity with the child (reading, singing songs, and telling stories). CONCLUSIONS: Postpartum depression is a significant problem in both mothers and fathers in the United States. It is associated with undesirable parent health behaviors and fewer positive parent-infant interactions.

Adult↗
PubMed2004

Omega-3 fatty acids for the prevention of postpartum depression: negative data from a preliminary, open-label pilot study.

Based on the putative relationship between depleted omega-3 fatty acids and postpartum depression, we initiated an open-label pilot study of omega-3 fatty acid supplementation with the aim of preventing postpartum depression. Euthymic pregnant females with a past history of depression in the postpartum period were started on 2960 mg of fish oil (1.4:1 eicosapentaenoic acid:docosahexaenoic acid) per day between the 34th to 36th week of pregnancy and assessed through 12 weeks postpartum. Four of seven participants had a depressive episode during the study period. No participants withdrew from the study due to adverse events. This preliminary, small, open-label pilot study failed to show promising results for the use of omega-3 fatty acid monotherapy beginning at 34 to 36 weeks gestation for the prevention of postpartum depression in patients with a prior postpartum depression history. Controlled studies are lacking.

Adult↗
PubMed2005

Postpartum depression without delivering a child?

OBJECTIVE: Depression in people related to delivering women is documented in their mates, but only anecdotal in other family members. We describe a case of depression in a woman who had previously experienced postpartum depression after the birth of her nephew. METHOD: A clinical description of the case. RESULTS: A 53-year-old woman, hysterectomized at age 47 years, was admitted for attempted suicide. She developed major depressive episode 1 month after her daughter had delivered a son. She had a past history of two postpartum depressive episodes clinically identical to the current episode. The episode resolved after 5 weeks. At 1-year follow-up, the patient is still asymptomatic. CONCLUSION: Psychological and cultural factors were at play in this case more than hormonal and biopsychosocial ones.

Alprazolam↗
PubMedDate not supplied

Cesarean section and postpartum depression: a review of the evidence examining the link.

OBJECTIVE: The objective of this study was to examine the evidence for an association between cesarean section and postpartum depression. METHODS: Medline and PsychInfo databases were searched. All studies on cesarean section that evaluated maternal mood between 10 days and 1 year after delivery were reviewed. Nine methodologically superior studies, including the only randomized, controlled trial (RCT), were analyzed separately. The nine studies that provided adequate summary statistics were combined in a meta-analysis. RESULTS: Of the 24 studies that have examined the association between cesarean section and postpartum depression, five found a significant adverse association, 15 found no significant association, and four found mixed results. With only one exception, methodologically superior studies found either no significant association or mixed evidence for an association between cesarean section and postpartum depression. Meta-analyses of suitable studies failed to find evidence for a significant association between cesarean section and postpartum depression. Possible reasons why different studies have obtained different results are critically evaluated. CONCLUSION: A link between cesarean section and postpartum depression has not been established.

Adult↗
PubMed2026

Exploring the dose-response relationship between prenatal exercise and postpartum depression: A systematic review and meta-analysis of randomized controlled trials.

IMPORTANCE: Postpartum depression (PPD) is a hidden and widespread global public health crisis affecting millions of mothers and infants annually. Prenatal exercise is a potentially accessible nonpharmacological strategy for PPD prevention, but its optimal dose remains uncertain. OBJECTIVE: To explore the dose-response relationship between prenatal exercise and the incidence of PPD through meta-analysis of randomized controlled trials (RCTs). DATA SOURCES: Systematic searches were conducted in PubMed, Embase, Web of Science, and Cochrane Library using MeSH terms and keywords related to "pregnant women," "prenatal exercise," and "postpartum depression," up to June 23, 2025. STUDY SELECTION: RCTs included examined prenatal exercise interventions in pregnant women without a history of depression, with PPD incidence reported using validated depression scales (such as EPDS, CES-D). Non-RCT studies, duplicate publications, and studies with insufficient data were excluded. DATA EXTRACTION AND SYNTHESIS: Two researchers independently extracted data according to the PRISMA guidelines. A random-effects model was used to pool odds ratios (OR) and their 95% confidence intervals (CI). Linear and nonlinear dose-response models were employed to analyze and evaluate the relationship between exercise dose (measured in METs-min/week) and the incidence of PPD. MAIN OUTCOME(S) AND MEASURE(S): The primary outcome is the incidence of PPD, analyzing its relationship with prenatal exercise dose. RESULTS: Eight RCTs involving 2231 pregnant women were included. The pooled analysis showed that prenatal exercise was associated with a potential reduction in PPD incidence, although the overall effect did not reach statistical significance (OR=0.58, 95% CI [0.33, 1.02]). In dose-stratified analysis, exercise doses &#x2265;500 METs-min/week were associated with significantly lower PPD incidence (OR=0.44, 95% CI [0.24, 0.78]). Subgroup analyses suggested trends toward greater benefits among women aged &#x2265;30 years and those initiating exercise between 14 and 28 weeks of gestation; however, subgroup differences did not reach statistical significance. The linear dose-response trend did not reach statistical significance (p = 0.0533), and neither the overall spline association (p = 0.1704) nor the test for nonlinearity (p = 0.6361) was statistically significant. CONCLUSIONS AND RELEVANCE: Prenatal exercise may be associated with a lower risk of PPD, but the overall pooled effect did not reach statistical significance. Findings concerning &#x2265;500 METs-min/week and the apparent flattening of the dose-response curve should be considered exploratory and require confirmation in larger trials.

Humans↗
PubMed1999

Characteristics and treatment of women with antenatal and postpartum depression.

OBJECTIVE: Investigations of the efficacy of treatment for non-psychotic pregnancy-related mood disorders are scarce. Thus, a prospective, longitudinal study of six months duration, involving ninety-six index cases and forty-five healthy women as a reference group, was implemented to determine the response of mood, parenting stress and dyadic adjustment to an eclectic management. METHOD: In this naturalistic study, the index cases were offered treatment consistent with their symptoms, context, and level of compliance. All women received individual psychotherapy combining strategies from Interpersonal and Cognitive Behavioral Psychotherapy and/or Marital Interventions and Pharmacology. Rating scales (Dyadic Adjustment Scale, Hamilton Rating Scale for Depression, Edinburgh Postnatal Depression Scale, Child Stress Inventory) scored monthly, were used to measure the response to treatment over time. RESULTS: Depressive symptoms are generally alleviated by the second to third month of treatment. Dyadic discord accentuated by traditional sex role expectations and child care stress exacerbated by low self-esteem persisted throughout the trial at levels significantly different from the untreated reference group. CONCLUSIONS: Short-term interventions are cost-effective for the relief of mood disorders. However, creative solutions, during an era of economic restraints, are required to extend treatment sufficiently to address couple conflicts and facilitate the transition to parenthood for index cases.

Adjustment Disorders↗