The prevalence of postpartum depression

Background Little is known about the prevalence of clinically significant postpartum depression in women of varying social status. The purpose of the present study was to examine the prevalence of postpartum depression as a function of three indices of social status: income, education and occupational prestige. Method A sample of 4,332 postpartum women completed a demographic interview and the Inventory to Diagnose Depression, a self-report scale developed to identify a major depressive episode in accordance with DSM diagnostic criteria. Logistic regression was used to assess the relative significance of the three social status variables as risk factors for postpartum depression controlling for the effects of correlated demographic variables. Results In the logistic regression, income, occupational prestige, marital status, and number of children were significant predictors of postpartum depression controlling for the effects of other related demographic characteristics. The Wald Chi Square value for each of these significant predictors indicates that income was the strongest predictor. Conclusions The prevalence of postpartum depression was significantly higher in financially poor relative to financially affluent women. Maternal depression screening programs targeting women who are financially poor are well placed. Future research is needed to replicate the present findings in a more ethnically diverse sample that includes the full age range of teenage mothers.     

Identifying women at-risk for postpartum depression in the immediate postpartum period

OBJECTIVE: To develop a multifactorial predictive model of depressive symptomatology in the first week postpartum in order to assist in targeted screening procedures. METHOD: As part of a longitudinal study, a population-based sample of 594 mothers in a health region near Vancouver, British Columbia completed a mailed questionnaire at 1-week postpartum that included diverse risk factors from the following domains: sociodemographic, biological, pregnancy-related, life stressors, social support, obstetric and adjustment to motherhood. Following univariate analysis, sequential regression analysis was completed to develop a multifactorial predictive model. RESULTS: In the multivariate model, the factors predictive of depressive symptomatology at 1-week postpartum included immigration within the last 5 years, history of depression independent of childbirth, diagnosis of pregnancy-induced hypertension, vulnerable personality style, stressful life events, lack of perceived support, lack of readiness for hospital discharge and dissatisfaction with infant feeding method. CONCLUSION: The findings suggest that several risk factors for depressive symptomatology in the immediate postpartum period are consistent with previously identified factors but other factors such as recent immigrant status, feeling unready for hospital discharge, dissatisfaction with their infant feeding method, and pregnancy-induced hypertension should also be examined.     

Missed bipolarity and psychiatric comorbidity in women with postpartum depression

Objective:  To investigate the diagnostic profile of women referred for postpartum depression.
Methods:  Fifty-six women seen consecutively with the referral diagnosis of postpartum depression were administered structured instruments to gather information about their DSM-IV Axis I diagnoses.
Results:  In terms of frequency of occurrence, the primary diagnoses in this sample were: major depressive disorder (46%), bipolar disorder not otherwise specified (29%), bipolar II disorder (23%), and bipolar I disorder (2%). A current comorbid disorder, with no lifetime comorbidity, occurred among 32% of the sample; by contrast, lifetime comorbidity alone (i.e., with no currently comorbid disorder) was found among 27%. Both a lifetime and a current comorbidity were found among 18% of the women, and 23% had no comorbid disorder. The most frequently occurring current comorbid disorder was an anxiety disorder (46%), with obsessive-compulsive disorder (62%) being the most common type of anxiety disorder. For lifetime comorbidity, substance use (20%) and anxiety disorders (12%) were the two most common. Over 80% of patients who scored positive on either the Highs Scale or the Mood Disorder Questionnaire met the diagnostic criteria for a bipolar disorder.
Conclusion:  The results suggest that postpartum depression is a heterogeneous entity and that misdiagnosis of bipolar disorder in the postpartum period may be quite common. The findings have important clinical implications, which include the need for early detection of bipolarity through the use of reliable and valid assessment instruments, and implementation of appropriate prevention and treatment strategies.     

Supportive counseling for postpartum depression in Asian mothers

Introduction: The aim of the present study was to describe the role of supportive counseling for postpartum depression (PPD) in an Asian population and explore the treatment outcomes of supportive counseling with and without antidepressants. Oral antidepressants remain the mainstay treatment in depression. However in postpartum depression, mothers are often concerned about breastfeeding and the effects of medication on the developing child. For mothers willing to take antidepressants, the class of antidepressant more efficacious for postpartum depression still remains unclear. Non‐pharmacological treatments appear to have an important role in recent studies. Methods: In this naturalistic prospective cohort study, patients were identified from a postpartum depression screening program in a maternity hospital. Patients diagnosed with PPD were treated with antidepressant and counseling, or counseling alone. Outcomes were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and Global Assessment of Functioning Scale (GAF). Statistical Package for the Social Sciences (SPSS) was used for statistical analyses (SPSS Inc., Chicago, IL, USA). Results: Between April 2008 and December 2009, 87 patients were recruited in this study. Sixty‐nine percent of all patients achieved remission at 6 months. Combining antidepressants and counseling did not appear to significantly improve outcome compared to counseling alone. Discussion: The majority of all depressed mothers with supportive counseling had remission of symptoms by 6 months. The benefit of combining antidepressants and counseling needs to be further studied.     

The prevalence of early postpartum psychiatric morbidity in Dubai: a transcultural perspective

There have been numerous studies of the prevalence of postpartum psychiatric illness and its putative risk factors in Western Europe and North America, but very few studies have been undertaken in developing countries, including the Arab world. A total of 95 women admitted to the New Dubai Hospital in Dubai, United Arab Emirates, for childbirth were studied. All subjects were assessed in the postpartum period using clinical and socio-cultural instruments, namely the Self-Reporting Questionnaire (SRQ) on day 2 and the Edinburgh Postnatal Depression Scale (EPDS) on day 7 after delivery. The prevalence of psychiatric morbidity was 24% according to the SRQ and 18% according to the EPDS. A number of psychosocial factors emerged as putative risk factors for postpartum psychiatric disturbance, including depressive illness. It is concluded that the prevalence of postpartum psychiatric morbidity and its risk factors in this Arab culture are similar to the results obtained in numerous previous studies conducted in industrialized countries. These findings have implications for the early detection and care of women at risk for postpartum psychiatric illness.     

Perceptual defense and vulnerability to postpartum depression

The objective was to assess the relationship between vulnerability to postpartum depression and perceptual defense evoked by tachistoscopic stimuli alluding to perinatal themes in pregnant women. Tachistoscopic stimuli have been shown to produce different thresholds of conscious identification according to their emotional content: a phenomenon termed perceptual defense. A total of 412 women in their 3rd of 4th month of pregnancy were asked to identify 14 pictures and 18 verbal stimuli shown for initially very brief but increasing durations. Presentation times required for a correct identification were measured. Depression was assessed, at 2 and 6 months postdelivery, by the Hamilton Depression Rating Scale: 53 women were defined as depressed by a score ≥ 15. Discriminant analysis showed that the women who would become depressed 7 to 11 months later were slower than the nondepressed to identify 5 stimuli alluding to pregnancy, sexuality or a father image. Particular attitudes towards the themes of being pregnant, of sexuality and of the father could be components of a psychological predisposition to the development of depressed mood in the postpartum.     

度洛西汀单用与合并认知行为治疗对产后抑郁症患者疗效的对照研究

目的：探讨度洛西汀合并认知行为治疗（ CBT）对产后抑郁症的疗效。方法：将66例产后抑郁症患者分为研究组和对照组各33例,两组均给予度洛西汀治疗,研究组在此基础上合并CBT,每周1次,疗程8周。于治疗前后进行功能失调性状况评定量表（ DAS）评定,比较两组疗效及认知改善程度。结果：治疗前两组DAS评分差异无统计学意义;治疗8周,研究组DAS总分（ t=4.435）、脆弱性（ t=4.303）、完美化（t=4.206）、依赖性（t=4.753）及自主性态度（t=3.304）评分较治疗前明显下降（P均<0.01）;对照组DAS各项评分与治疗前比较差异无统计学意义（ P>0.05）。两组间比较,治疗后研究组DAS总分（t=2.759）、脆弱性（t =3.325）、完美化（t=4.105）、依赖性（t=4.743）、自主性态度（t=2.021）因子分较对照组显著降低（P<0.05或P<0.01）。结论：度洛西汀单用或合并CBT对产后抑郁症均有明显疗效;但CBT能明显改善患者功能失调性认知损害。     

A multirisk approach to predicting chronicity of postpartum depression symptoms

Background: Persistence of postpartum depression (PPD) carries potential adverse implications for the emerging mother–child relationship and for child development. Methods: This study was designed to investigate factors related to the onset and persistence of PPD; in particular, we examined the cumulative effect of a range of psychosocial risk factors in predicting chronic PPD symptoms. One hundred and five women were interviewed at three assessment periods: within the first days after childbirth, at 6 months, and at 18 months postpartum. Results: Depressive symptoms at 6 months predicted 18 months depressive symptoms, even when controlling for the contribution of maternal depression at birth. Psychosocial risk had a moderating influence on the stability of depressive symptomatology. Women with two or more risk factors at birth were more likely to have stable depressive symptomatology across the infants' first 18 months of life. Conclusion: To prevent a chronic course of PPD it may be necessary to identify both depressive symptoms and relevant psychosocial risk factors. Depression and Anxiety 25:718–724, 2008. © 2008 Wiley‐Liss, Inc.     

Altered functional connectivity density and couplings in postpartum depression with and without anxiety

Postpartum depression (PPD) is the most common psychological health issue among women, which often comorbids with anxiety (PPD-A). PPD and PPD-A showed highly overlapping clinical symptoms. Identifying disorder-specific neurophysiological markers of PDD and PPD-A is important for better clinical diagnosis and treatments. Here, we performed functional connectivity density (FCD) and resting-state functional connectivity (rsFC) analyses in 138 participants (45 unmedicated patients with first-episode PPD, 31 PDD-A patients and 62 healthy postnatal women, respectively). FCD mapping revealed specifically weaker long-range FCD in right lingual gyrus (LG.R) for PPD patients and significantly stronger long-range FCD in left ventral striatum (VS.L) for PPD-A patients. The follow-up rsFC analyses further revealed reduced functional connectivity between dorsomedial prefrontal cortex (dmPFC) and VS.L in both PPD and PPD-A. PPD showed specific changes of rsFC between LG.R and dmPFC, right angular gyrus and left precentral gyrus, while PPD-A represented specifically abnormal rsFC between VS.L and left ventrolateral prefrontal cortex. Moreover, the altered FCD and rsFC were closely associated with depression and anxiety symptoms load. Taken together, our study is the first to identify common and disorder-specific neural circuit disruptions in PPD and PPD-A, which may facilitate more effective diagnosis and treatments.     

共情能力与产后抑郁症状的相关性研究

目的:探讨共情能力与产后抑郁症状的相关性.方法:对1366例符合入组标准的产后42 d回院进行产后保健的产妇,按照自愿原则进行一般人口学资料的收集,并进行爱丁堡产后抑郁量表(EPDS)、人际反应指针问卷(IRI-C)自评;以EPDS≥9分为划界值将入组者分组及组间比较;分析EPDS评分与IRI-C评分间的关系.结果:共...     

Seasonal effects on depression risk and suicidal symptoms in postpartum women

Background: Postpartum depression (PPD) is the most common complication of childbirth. Suicide is a leading cause of maternal death in the first postpartum year. Depressed mothers often have suicidal ideation (SI). Depression and suicidality may vary across the seasons. Previous studies of seasonality and PPD were relatively small or encumbered by study design constraints. We examined the possible relationship between seasonality, depression, and SI in 9,339 new mothers. Methods: From 2006 to 2010, the investigators screened women within 4–6 weeks postpartum with the Edinburgh Postnatal Depression Scale (EPDS). We used spectral analysis to explore seasonal variation in risk for depression and suicidality. Results: The study team screened 9,339 new mothers, of whom 1,316 (14%) women had positive depression scores (EPDS≥10) which suggest PPD risk; 294 (3%) women had SI (item 10≥1). A positive EPDS was associated significantly with SI. PPD risk varied significantly across 12‐months—risk was highest in December. We detected no seasonal variation in SI. Conclusions: Effects of seasonal light variation may contribute to increased risk for depressive symptoms. Suicidality could be related to maternal depression but not seasonal variation. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

A longitudinal study of hypomania and depression symptoms in pregnancy and the postpartum period

Objectives:  Childbirth is a potent precipitant of severe episodes of bipolar disorder. We investigate mood longitudinally through pregnancy and the postpartum period, using the Highs Scale and the Edinburgh Postnatal Depression Scale (EPDS), to examine if the postpartum period is a time of increased risk for hypomanic symptoms in the general population.
Methods:  A total of 446 women were recruited at 12 weeks of pregnancy from the Birmingham Women's Hospital and four midwife-led community clinics. Women completed the Highs Scale and the Edinburgh Postnatal Depression Scale at 12 weeks of pregnancy, one week postpartum, and eight weeks postpartum.
Results:  Cases of probable depression, as defined by an EPDS score of 13 or greater, did not significantly increase from pregnancy to the postpartum period. The prevalence of 'the highs' was eightfold higher in the postpartum week than during pregnancy.
Conclusions:  Consistent with the increased rates of severe manic illness following childbirth, we find that more minor hypomanic states are also increased. We consider the clinical relevance of postpartum hypomanic symptoms and the implications of these findings for research into postpartum-onset mood symptoms.     

A cautionary note on the use of antidepressants in postpartum depression

OBJECTIVES: This paper discusses the effect of antidepressant use on the illness course in three women who were treated for first-onset postpartum depression (PPD) following childbirth. METHODS: A report of three cases of early-onset PPD in which bipolarity manifested following antidepressant treatment. RESULTS: There was no past history of psychiatric disturbance but in each case there was a family history of bipolar (BP) disorder. Treatment with antidepressants resulted in a highly unstable illness course characterized by a mixed episode, cycle acceleration, and a postpartum psychosis. However, discontinuation of antidepressants and institution of treatment with mood stabilizers and atypical neuroleptics resulted in sustained improvement and symptom remission. CONCLUSIONS: Caution is urged in the use of antidepressants to treat early-onset PPD in women at risk for developing BP disorder due to a family history of bipolar illness.     

Individual coping style and psychological attitudes during pregnancy predict depression levels during pregnancy and during postpartum

Fifty primigravidae were investigated from 30 weeks of gestation until 6 months after delivery to assess the predictive value of individual coping style, conception time and specific psychological changes during pregnancy for the depression levels assessed during the third trimester of pregnancy and 5 days, 6 weeks and 6 months after delivery. The individual coping style is an effective predictor of depression levels during the third trimester of pregnancy and 6 months after delivery, but not for the depression levels 5 days and 6 weeks after delivery. A path analysis revealed that high depressive coping and low social support-seeking predict a longer conception time, which all predict a more important lack of spousal support during pregnancy. Higher depressive coping, a longer conception time and a more important lack of spousal support during pregnancy all predict high depression levels 6 months after delivery. The present findings thus suggest helpful predictors for the psychological adaptation during the transition to parenthood.