Violence and Other Stressful Life Events as Triggers of Depression and Anxiety: What Psychosocial Resources Protect African American Mothers?

Understanding the risk and protective factors related to maternal mental health problems is important for improving the well-being of mothers and children, particularly in African American populations which may be at greater risk for maternal depression and resulting child behavior problems. This study explored whether three psychosocial resources??emotional resilience, social support, and ethnic identity??serve as protective factors in the face of specific stressful events that may trigger African American mothers?? depression and anxiety symptoms. Standard self-report measures of depression, anxiety, negative life events, community violence, abuse, emotional resilience, social support, and ethnic identity were administered to African American mothers (N = 209) of 2?C18 month-old children. Linear regression models revealed main effects of negative life events and abuse on increased depression and anxiety symptoms, while emotional resilience and social support predicted decreased symptoms. There was also a significant interaction revealing a protective-reactive effect of ethnic identity on the associations of witnessed community violence with depression and anxiety symptoms. It is important for primary care providers to screen African American mothers for negative life events and abuse to identify those at increased risk for maternal depression and anxiety symptoms. Treatment programs should target emotional resilience, enhanced social support, and stronger ethnic group affiliation, which may be most effective at preventing mental health problems among mothers exposed to relative lower levels of community violence.     

Postpartum Depression: Racial Differences and Ethnic Disparities in a Tri-racial and Bi-ethnic Population

Objectives This research investigated the differences and disparities of postpartum depression in a sample of African American, Hispanic, Native American, and White women. Methods A sample of 586 women were administered the Beck-Gable PDSS at 6-weeks postpartum. Factor analysis was applied to analyze the similarities among African American, Hispanic, Native American, and White participants. Confidence intervals of the rates of depression by group were estimated, followed by statistical tests to determine the differences among these rates. Risk assessment was performed with factor analysis and correlation methods. Results Hispanic women had a remarkably lower depression rate (2.5%) than other groups (P-values < 0.05). Significant differences for major depression were not found among African American, Native American, and White women; but Whites had higher minor depression (P-values < 0.05). Native American women had the highest rate of major depression (18.7%) and an average minor depression (10.5%). Although Whites had the second highest major depression (17.6%) and the highest minor depression (19.6%), their average full score (76.1) was noticeably lower than that of Native Americans (82.9) and slightly lower than that of African Americans (78.9; major and minor depression rates: 14.8% and 9.9%). The sample also demonstrated strong associations of depression with depression history and breastfeeding. Conclusion Statistically, postpartum depression can be ranked from high to low as Native Americans, Whites, African Americans and Hispanics (Hispanics have remarkably lower depression rates). This information is critically important to clinicians, researchers, agency administrators and social workers who work with these populations.     

The Association of Maternal Mental Health with Prenatal Smoking Cessation and Postpartum Relapse in a Population-Based Sample

To examine the association between mental health factors with smoking cessation during pregnancy and postpartum relapse. We used data from 1,416 women who participated in the Minnesota Pregnancy Risk Assessment Monitoring System survey in 2004–2006 and reported smoking immediately prior to pregnancy. Maternal mood during pregnancy, stressful life events and postpartum depression were the mental health variables. We used multivariate logistic regression to examine the association between these variables and two outcomes, smoking cessation during pregnancy and postpartum relapse. Stressful life events was associated with smoking cessation in multivariate regression models, however maternal mood was not. Smoking cessation was also associated with pre-conception smoking intensity, maternal education, and income. Maternal mood, stressful life events and postpartum depression were not associated with relapse in multivariate regression models. Breastfeeding at the time of the survey was the strongest correlate of relapse, with women who breast fed 60% less likely to resume smoking during the postpartum. Post-hoc analysis suggests that mental health variables may interact with other mitigating factors to influence smoking behavior during pregnancy. Mental health variables may be important to successful prenatal smoking cessation. Further research with larger sample sizes is needed to explore the possibility of interactive relationships between mental health variables and other co-factors on prenatal smoking cessation and postpartum relapse.     

深圳地区产后抑郁现状及危险因素分析

目的 调查深圳市产后抑郁发病现状，分析产后抑郁发病相关影响因素，为预防产后抑郁的发生及早期筛查提供科学依据。方法 选取2019年5月—2019年12月在深圳市妇幼保健院及深圳市中医院进行产后健康检查产妇为研究对象，填写产后抑郁自拟量表，对产后抑郁相关影响因素进行单因素方差分析后，再采用多因素二元logistic回归分析探讨产后抑郁与各项影响因素之间的关系。结果 共4 431名产妇参加调查和评估，产后抑郁发生率为11.6%。将单因素分析后有统计学差异的15个因素纳入多因素二元logistic回归分析。最终结果提示初产妇、婆媳关系欠佳、夫妻关系欠佳、产妇性格内向、纯母乳喂养、孕期未接受宣教、孕期焦虑、孕期抑郁、孕产期不良生活事件发生9个因素对产后抑郁的发生有负面影响。结论 深圳市产后抑郁发生率在全国范围内较低，家庭成员应对产妇予以更多的关注，同时医院应当加强产前、产时和产后全程心理辅导，并积极进行早期筛查。     

Symptoms of postpartum depression and early interruption of exclusive breastfeeding in the first two months of life

This study evaluates the association between postpartum depression and interruption of exclusive breastfeeding in the first two months of life. Cohort study of 429 infants < or = 20 days of age to four primary health care units in Rio de Janeiro, Brazil. Interruption of exclusive breastfeeding (outcome) was defined as the introduction of water, other types of liquids, milk, or formulas or any food. Postpartum depression was assessed using the Edinburgh Post-Natal Depression Scale. Associations between variables were expressed as prevalence ratios (baseline) and risk ratios (follow-up), with their respective 95% confidence intervals, estimated by Poisson regression with robust variance. Children of mothers with postpartum depressive symptoms were at higher risk of early interruption of exclusive breastfeeding in the first and second months of follow-up (RR = 1.46; 95%CI: 0.98-2.17 and RR = 1.21; 95%CI: 1.02-1.45, respectively). Considering mothers that were exclusively breastfeeding at the first month, postpartum depression was not associated with interruption of exclusive breastfeeding in the second month (RR = 1.44; 95%CI: 0.68-3.06). The results indicate the importance of maternal mental health for the success of exclusive breastfeeding.     

Challenges Faced by New Mothers in the Early Postpartum Period: An Analysis of Comment Data from the 2000 Pregnancy Risk Assessment Monitoring System (PRAMS) Survey

Objective To identify challenges that women face 2–9 months postpartum using qualitative data gathered by the Pregnancy Risk Assessment Monitoring System (PRAMS). Methods PRAMS is an on-going population-based surveillance system that collects self-reported information on maternal behaviors and experiences before, during, and after the birth of a live infant. We analyzed free text comment data from women in 10 states who answered the PRAMS survey in 2000. Preliminary analysis included a review of the comment data to identify major themes and a demographic comparison of women who commented (n = 3,417) versus women who did not (n = 12,497). Subsequent analysis included systematic coding of the data from 324 women that commented about postpartum concerns and evaluation to ensure acceptable levels of reliability among coders. Results We identified the following major themes, listed in order of frequency: (1) need for social support, (2) breastfeeding issues, (3) lack of education about newborn care after discharge, (4) need for help with postpartum depression, (5) perceived need for extended postpartum hospital stay, and (6) need for maternal insurance coverage beyond delivery. Conclusion The themes identified indicate that new mothers want more social support and education and that some of their concerns relate to policies regarding breastfeeding and medical care. These results can be used to inform programs and policies designed to address education and continuity of postpartum care for new mothers.     

Postpartum Depression Prevalence and Impact on Infant Health,Weight, and Sleep in Low-Income and Ethnic Minority Women and Infants

This study aimed to investigate the prevalence of maternal depressive symptoms at 5 and 9 months postpartum in a low-income and predominantly Hispanic sample, and evaluate the impact on infant weight gain, physical health, and sleep at 9 months. Participants included 132 low-income mother-infant pairs who participated in a larger investigation on prenatal care utilization. Mothers were interviewed in person 24–48 h after birth and by phone at 5 and 9 months postpartum. Clinically significant levels of depressive symptoms were reported in 33% of the women at 5 months postpartum, and 38% at 9 months postpartum. Higher depressive symptoms at 5 months were associated with less infant weight gain from 5 to 9 months, p = .002, increased infant physical health concerns, p = .05, and increased infant nighttime awakenings at 9 months, p = .001. Results suggest a striking prevalence of clinically significant depressive symptoms through 9 months postpartum in this very low income, largely ethnic minority sample. Further, the effects of postpartum depression include significant ramifications for infant physical health.     

Enhancing Breastfeeding Through Healthcare Support: Results from a Focus Group Study of African American Mothers

Objectives To explore African American women’s breastfeeding thoughts, attitudes, and experiences with healthcare professionals and subsequent influences on their breastfeeding interest and behavior. Insight was also sought about the most effective practices to provide breastfeeding support to African American women. Methods Thirty-eight pregnant or lactating African American women and racially diverse health professionals were recruited and participated in one of six membership specific focus groups in the metro Detroit area. An experienced focus group facilitator who was African American woman served as the primary group facilitator, using a semi-structured guide to discussions. Focus groups explored perceptions of personal and professional roles and behaviors that support African American women’s breastfeeding behavior. Discussions were digitally recorded and audiotapes were transcribed. Thematic content analysis was conducted in combination with a review of field notes. Results Participants generally agreed that breastfeeding is the healthier feeding method but perceived that healthcare providers were not always fully supportive and sometimes discouraged breastfeeding. Non-breastfeeding mothers often expressed distrust of the information and recommendations given by healthcare providers and relied more on peers and relatives. Health professionals lacked information and skills to successfully engage African American women around breastfeeding. Conclusions for Practice Breastfeeding initiation and duration among African American mothers may increase when postpartum breastfeeding interventions address social and cultural challenges and when hospital breastfeeding support with the right professional lactation support, is void of unconscious bias and bridges hospital, community, peers, and family support. Professional lactation training for healthcare professionals who are in contact with expectant and new mothers and an increase in the number of IBCLC of color could help.     

Life with a new baby: How do immigrant and Australian‐born women's experiences compare?

Objective: Little is known about immigrant mothers’ experiences of life with a new baby, apart from studies on maternal depression. Our objective was to compare the post‐childbirth experiences of Australian‐born and immigrant mothers from non‐English speaking countries. Methods: A postal survey of recent mothers at six months postpartum in Victoria (August 2000 to February 2002), enabled comparison of experiences of life with a new baby for two groups of immigrant women: those born overseas in non‐English‐speaking countries who reported speaking English very well (n=460); and those born overseas in non‐English‐speaking countries who reported speaking English less than very well (n=184) and Australian‐born women (n=9,796). Results: Immigrant women were more likely than Australian‐born women to be breastfeeding at six months and were equally confident in caring for their baby and talking to health providers. No differences were found in anxiety or relationship problems with partners. However, compared with Australian‐born women, immigrant mothers less proficient in English did have a higher prevalence of depression (28.8% vs 15%) and were more likely to report wanting more practical (65.2% vs 55.4%) and emotional (65.2% vs 44.1%) support. They were more likely to have no ‘time out’ from baby care (47% vs 28%) and to report feeling lonely and isolated (39% vs 17%). Conclusion and implications: Immigrant mothers less proficient in English appear to face significant additional challenges post‐childbirth. Greater awareness of these challenges may help to improve the responsiveness of health and support services for women after birth.     

Improving maternal postpartum mental health screening guidelines requires assessment of post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) has a prevalence of 4–17% in the postpartum period and, like better known postpartum depression (PPD), is linked to reduced quality maternal-child interactions, decreased maternal sense of life satisfaction and functioning, and negative impacts on child development. Currently, provincial and public health organizations throughout Canada screen new mothers for PPD with the Edinburgh Postpartum Depression Scale, which while laudable does not capture PTSD. PTSD is highly associated with PPD, 65% of women with PTSD also present with PPD, presenting a significant gap in postpartum maternal mental health screening. Numerous self-report PTSD screening questionnaires are available that could be incorporated into routine maternal postpartum mental health care. Furthermore, across Canada, regional differences in availability of maternal mental health screening, services, and programs suggest a gap in one of the tenets of Canadian health care—lack of universality. Not only does Canada require national maternal mental health screening, service and program guidelines, but PTSD screening must be incorporated, in order to identify and treat new mothers experiencing mental health problems.