Factors affecting postpartum depressive symptoms of adolescent mothers

OBJECTIVE: To assess the extent that anticipated maternal emotions in response to infant care (infant care emotionality or frustration and dissatisfaction with infant crying or fussing, or both), several forms of social support, and socioeconomic status explain fourth-week postpartum depressive symptoms of adolescent mothers. DESIGN: Secondary multiple regression analysis of a subset of variables from a larger longitudinal study that examined adolescent mothers and infants. SETTING: Two university teaching hospitals in Western Canada. PARTICIPANTS: Convenience sample of 78 healthy adolescent mothers. MAIN OUTCOME MEASURES: Prenatal anticipated infant care emotionality, perceived family and friend social support, socioeconomic status, enacted social support, and postpartum depressive symptoms. RESULTS: Anticipated infant care emotionality (R2=.19) and socioeconomic status (R2=.07) significantly predicted postpartum depressive symptoms. Family support, friend support, and enacted social support were not significant predictors of postpartum depressive symptoms. CONCLUSION: Nurses in various settings can assess the pregnant adolescent's anticipated infant care emotionality and socioeconomic status to determine their potential risk or vulnerability to postpartum depressive symptoms. More negative prenatal infant care emotionality was the strongest predictor of postpartum depressive symptoms. Validation of study findings with a larger, more representative sample is recommended.     

Events after Stillbirth in Relation to Maternal Depressive Symptoms: A Brief Report

ABSTRACT: Background: Actions taken after a stillbirth can affect long‐term psychological morbidity. Our objective was to study how infant bonding and maternal actions after stillbirth are associated with ensuing depressive symptoms. Methods: Using the population‐based Swedish Medical Birth Register, we identified all 380 Swedish‐speaking women who gave birth to singleton stillborn infants in Sweden in 1991. Of these, 314 (83%) completed a postal questionnaire 3 years after the stillbirth. Items included actions taken to bond with the baby and demographics. The association between care‐related factors and later maternal depressive symptoms was quantified using relative risks estimated using multivariable regression. Results: We observed an almost sevenfold increased risk of depressive symptoms for mothers who reported not being with their babies as long as they wished (adjusted risk ratio [RR] 6.9, 95% CI 2.4–19.8). Compared with women who became pregnant again within 6 months, those with no later pregnancy were at higher risk of depressive symptoms (adjusted RR 2.8, 95% CI 0.9–8.4). In addition, compared with women who experienced a stillbirth in their first pregnancy, stillbirth occurring with an infant who was third in the birth order was related to a twofold risk of elevated depressive symptoms (adjusted RR 2.2, 95% CI 0.8–6.4). Furthermore, stillbirth occurring in a fourth or later pregnancy was associated with an almost sevenfold risk of depressive symptomatology (adjusted RR 6.7, 95% CI 2.2–20.5). No evidence of an association was found between other care‐related actions and subsequent maternal depressive symptoms. Conclusions: Our results suggest that a mother being with the stillborn baby for as long as desired and the birth order of the stillbirth may influence her later depressive symptomatology. Compared with mothers who became pregnant again within 6 months, those who did not have a subsequent pregnancy were at higher risk of depressive symptoms at 3 years’ follow‐up. (BIRTH 35:2 June 2008)     

帕罗西汀联合心理治疗对产后抑郁的疗效分析

目的:观察帕罗西汀加心理治疗治疗产后抑郁的效果。方法:采用Zung-抑郁自评量表(SDS)、Zung-焦虑自评量表(SAS),症状自评量表(SCL-90)、自尊量表(SEI)、特质应对量表(TCSQ)调查62例产后抑郁患者治疗前后的心理状态。实验组患者服用帕罗西汀加40分钟的心理治疗;对照组只予以帕罗西汀,为期8周。结果:两组患者的焦虑、抑郁、消极应对水平减少,自尊、积极应对水平提高,实验组与对照组差异有统计学意义(P<0.01)。结论:帕罗西汀加心理治疗治疗产后抑郁的效果显著。     

A conceptual model of psychological predictors of postpartum weight retention

Obesity and being overweight affect almost half of all women of childbearing age, with postpartum weight retention (PWR) being a key contributing factor. Retention of postpartum weight has a number of negative health implications for mothers and offspring, including longer-term higher body mass index (BMI). There is increasing evidence that psychological factors are associated with PWR, including depressive symptoms, anxiety, stress, and body dissatisfaction. However, what is less known is how these psychological factors might interact with maternal physiological and physical weight factors, sociocontextual influences, pregnancy-related medical factors, and maternal behaviours to lead to PWR. We have incorporated identified psychological influences within an empirically supported, multifactorial, conceptual model of hypothesised predictors of PWR, and argue that a systematic and rigorous evaluation of this conceptual model will inform the development of appropriate prevention strategies.     

Complementary therapies as adjuncts in the treatment of postpartum depression

Postpartum depression affects an estimated 13% of women who have recently given birth. This article discusses several alternative or complementary therapies that may serve as adjuncts in the treatment of postpartum depression. The intent is to help practitioners better understand the treatments that are available that their clients may be using. Complementary modalities discussed include herbal medicine, dietary supplements, massage, aromatherapy, and acupuncture. Evidence supporting the use of these modalities is reviewed where available, and a list of resources is given in the appendix.     

The experience of postnatal depression in South Asian mothers living in Great Britain: a qualitative study

Background: As the experience of what is termed as ‘postnatal depression’ (PND) in South Asian mothers living in Great Britain has received comparatively little attention, this study used a grounded theory approach to examine their understanding of PND. Methods: Ten South Asian mothers were interviewed from within the Greater Manchester area in England. They scored above 12 on the Edinburgh Postnatal Depression Scale and were interviewed 8–12 weeks after giving birth. Data were analysed using techniques associated with constant comparison and a grounded theory approach. Results and findings: The analyses showed that their experiences of PND were extremely dynamic and complex. Three core categories were identified and termed “internalising misery”, “Others will judge me and I feel on my own” and “I talk to my health professional and they don’t understand”. Conclusions: Potential links between these categories were considered and a tentative model for PND in South Asian mothers has been proposed. Some issues were specific to the experience of PND, but this sample also experienced “cultural clashes”, somatisation, isolation, poor input from services and barriers to and from services. The methodological limitations, clinical implications and areas for further research are considered.     

The experience of postnatal depression in West African mothers living in the United Kingdom: A qualitative study

Objective

to explore the lived experience of postnatal depression (PND) in West African mothers living in the United Kingdom (UK).

Design

using a qualitative design, semi-structured interviews were undertaken. Interpretative Phenomenological Analysis (IPA) was used to explore and analyse the data.

Setting

community health services within inner-city suburbs in Manchester, England.

Participants

six West African mothers (Nigeria=3; Ghana=3), who were experiencing low mood in the postnatal period.

Findings

five overarching themes emerged: (1) conceptualising PND, (2) isolation, (3) loss of identity, (4) issues of trust and (5) relationships as a protective factor. Women exhibited symptoms of PND but did not regard it as an illness. In their view, postnatal depression and distress resulted from social stress. Participants stated that their cultural background made it difficult to disclose feelings of depression thus adversely influencing their help-seeking behaviour.

Key conclusions

this is the first study to investigate the experiences of West African mothers with PND who live in the UK, and how they perceive and make sense of their experiences. The themes generated add to the body of existing research on PND in Black and ethnic minority populations and offer insight into the lived experience of West African women residing in England. Such insights are vital in order to deliver effective, culturally sensitive care.

Implications for practice

these findings have implications on how services should be designed to increase their accessibility to African women, by using a community psychology approach alongside systemic and group interventions. Challenges to help seeking and language used to describe experiences are considered.     

心理护理对产后抑郁的影响

目的：观察心理护理对初产妇产后抑郁的影响。方法：将138例初产妇随机分为观察组和对照组各69例。对照组给予常规护理,观察组在对照组护理基础上给予心理护理。采用爱丁堡产后抑郁量表（EPDS）和焦虑自评量表（SAS）对患者进行心理评估,并比较2组产后抑郁的发生情况。结果：2组护理后EPDS和SAS评分均低于护理前,且观察组低于对照组,差异有统计学意义（P〈0．05）。观察组护理后28、42d抑郁症发生率低于对照组,差异有统计学意义（P〈0．05）。结论：心理护理可显著减少初产妇产后抑郁的发生。     

Validation of the Edinburgh Postnatal Depression Scale and prevalence of postnatal depression at two months postpartum in a sample of Greek mothers

The EPDS has been validated as a screening instrument for postnatal depression in numerous communities over the last 20 years. Absence of a validation study for the Greek population has limited significantly its use in Greece. A community sample of 109 women was recruited on the second day postpartum in the two largest maternity hospitals in Athens. Ninety‐five women consented to participate and to complete the EPDS, the Beck Depression Inventory (BDI), the 28‐item General Health Questionnaire (GHQ), and the 26‐item WHO‐Quality of Life (WHO‐QOL). Of them, 81 consented to be reassessed 2 months later. At that time, in addition to the baseline questionnaires, the Structured Clinical Interview for DSM‐III‐R (SCID), non‐patient version, was conducted in order to establish psychiatric diagnosis of major and minor depression. The clinical diagnosis was used to test the criterion validity of the EPDS, and the GHQ, BDI and WHO‐QOL scores were used to assess the concurrent validity of the EPDS. Cronbach's alpha coefficient was used to measure the internal consistency of the scales. A cut‐off point of 11/12 on the EPDS showed optimum Receiver Operating Characteristics. The SCID showed that 12.4% of the subjects met criteria for depression at two months postpartum.     

Expanded Care for Women and Families after Preterm Birth

Prematurity is a complication of pregnancy for 1 in 8 families in the United States. The focus of care after preterm birth shifts to the fragile newborn, while the needs of the woman and her family may be overlooked. There are many challenges for parents, including impaired parent‐newborn attachment, difficulties with breastfeeding, postpartum mental health, and family disruption. Premature birth may even risk the developing relationship between parents and their child. Comprehensive care is recommended for parents who have experienced a preterm birth, including support of effective lactation, promotion of skin‐to‐skin care, reflection on the birth experience, support and evaluation of postpartum mental health, and provision of family‐centered care. Preconception care after preterm birth needs to include guidance about the recurrence risk for preterm birth as well as recommendations for risk reduction.     

Pharmacological prophylaxis of postpartum exacerbation in depressive and anxiety symptoms: a retrospective study

The aim of this study was to investigate the efficacy of prophylactic treatment with antidepressants for the prevention of postpartum exacerbation in depressive or anxiety symptoms. The study included data on 33 patients who were followed from pregnancy to the postpartum period at the Department of Psychiatry of a university Hospital. Psychiatric diagnoses were determined by means of a structured clinical interview. The severity of depressive and anxiety symptoms were assessed by means of Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A), respectively. Prophylactic treatment was initiated within the first 3 days after the delivery. The patients were assessed again with HAM-D and HAM-A at 4-week postpartum. Postpartum prophylaxis was carried out with administration of sertraline at 50?mg/day (n?=?7, 21.2%), paroxetine at 20?mg/day (n?=?24, 72.7%), and escitalopram at 10?mg/day (n?=?2, 6.1%). Statistical analyses indicated that the mean HAM-D and HAM-A scores before (9.45?±?7.01 and 10.09?±?6.42, respectively) and after (9.09?±?6.65 and 9.54?±?5.97, respectively) the delivery were not significant. Results of the present study suggest that prophylactic use of antidepressants following parturition may be useful in the prevention of postpartum exacerbation of symptoms in women with depression or anxiety disorders.     

Prenatal and perinatal influences on long-term psychomotor development in offspring of diabetic mothers

OBJECTIVE: Our purpose was to assess to what extent disturbances in antepartum maternal metabolism and perinatal complications and morbidities contribute to poorer psychomotor development in offspring of diabetic mothers.STUDY DESIGN: One hundred ninety-six pregnant women and their singleton offspring participated in this prospective cohort-analytic study. Ninety-five women had pregestational diabetes mellitus, and 101 women had gestational diabetes mellitus. Serial estimates of circulating maternal fuels were obtained throughout each index pregnancy along with detailed records of the perinatal course and outcome. Offspring were administered the psychomotor development index of the Bayley Scales of Infant Development at age 2 years and the Bruininks-Oseretsky Test of Motor Proficiency at ages 6, 8, and 9 years. Tests were performed blinded to the mother's antepartum metabolic status, and perinatal history, and the child's previous test scores. Partial correlations and analyses of covariance were used to control for other influences and confounds, such as family socioeconomic status, racial or ethnic origin, patient group (i.e., pregestational or gestational diabetes mellitus), and sex of child.RESULTS: Children's average score on the Bruininks-Oseretsky test at ages 6 to 9 years correlated significantly with maternal second (p < 0.02) and third trimester (p < 0.001) β-hydroxybutyrate. There was also a borderline association between the children's scores on the psychomotor development index at age 2 years and maternal third-trimester β-hydroxybutyrate levels (p = 0.06). No other correlations approached significance.CONCLUSIONS: Intrauterine metabolic experiences continue to influence the neurodevelopmental course in offspring of diabetic mothers. Prevailing practices in diabetes management and obstetric and neonatal care appear to effectively mitigate the potential long-term effects of most perinatal complications and morbidities.     

The effect of educational program on stress,anxiety and depression of the mothers of neonates having colostomy

Objective: One of the problems that mothers of neonates having colostomy face is their disability in caring colostomy at home. This article is going to demonstrate the impact of educational program for these mothers on their sense of empowerment in caring their neonates.

Methods: This clinical trial was performed in the Neonatal Intensive Care Units (NICUs) to evaluate the level of stress, anxiety and depression of mothers of neonates having colostomy before and after the educational program. In this program, 42 mothers were divided into two groups: experimental group (21 mothers who went under educational plan) and control group (21 mothers who only received the routine care). The levels of stress, anxiety and depression in all mothers were evaluated before and after the educational program with DASS 21 questionnaire.

Results: The results showed that educational program in the NICU for experimental groups made them independent and also empowered to care better for their babies. In addition, their depression, anxiety and stress levels were decreased.

Conclusion: Since the educational program led to a decrease in the levels of stress, anxiety and depression in mothers, this program is recommended to mothers of neonates having colostomy.     

The effects of lactation on bone mineral content in healthy postpartum women

Bone mineral contents were estimated by dual photon absorptiometry of the lumbar spine (L2-L4) and single photon absorptiometry of the mid- and distal radius in 19 healthy women on their second postpartum day and at 6 months postpartum. All bone mineral measurements were performed by one technician, and the single and dual photon absorptiometry results were read by one observer. Daily oral calcium intakes were estimated from dietary histories obtained by a dietitian. Twelve women who breast-fed exclusively throughout the first 6 months postpartum were compared with seven formula-feeding women who did not breast-feed or who breast-fed for less than 3 months postpartum. No differences were found in age, parity, height, weight, or daily calcium intake between the breast- and formula-feeding women. Breast-feeding women had a significant decrease (averaging 6.5%) in bone mineral of the lumbar spine at 6 months postpartum as compared with 2 days postpartum (1.14 +/- 0.03 versus 1.22 +/- 0.03 g/cm2, mean +/- SEM; P less than .001), whereas no significant change occurred in the formula-feeding women at 6 months (1.24 +/- 0.03 versus 1.26 +/- 0.04 g/cm2). At 6 months postpartum, the breast-feeding women had a significantly lower mean bone mineral content of the lumbar spine than did formula-feeding women (P less than .05). No significant changes were noted in bone mineral content of the mid- or distal radius in either group of women during the period of evaluation. We conclude that during the first 6 months postpartum, breast-feeding is associated with bone mineral loss from the lumbar spine, but not from the mid- or distal radius.     

Evaluation of the CORE-10 to assess psychological distress in pregnancy

ABSTRACT

Background

Women experience diverse symptoms of mental ill-health in pregnancy, yet measures usually only assess depression or anxiety. Measures may, therefore, miss out on identifying women experiencing distress.     

Anxiety Screening During Assessment of Emotional Distress in Mothers of Hospitalized Newborns

Objectives

To examine the incremental identification of emotional distress in mothers of hospitalized newborns by screening for anxiety in addition to depression and to provide practical information about anxiety screening scales to facilitate instrument selection and screening implementation by nurses in the NICU.

Maternal expectations and postpartum emotional adjustment in first-time mothers: results of a questionnaire survey

Abstract

Objective: Several predictors of postpartum mood have been identified in the literature, but the role of maternal expectations in postpartum mental health remains unclear. The aim of this study was to identify whether maternal expectations during the postpartum hospital stay predict adjustment and depressive symptoms at 6 weeks postpartum.

Methods: The sample included 233 first-time mothers recruited from the postpartum unit of a Midwestern hospital. Participants completed measures of maternal expectations and depressive symptoms (EPDS) at Time 1 (2?d postpartum) and completed EPDS and an Emotional Adjustment Scale (BaM-13) at Time 2 (6 weeks postpartum).

Results: A conditional relationship between the expectation that an infant’s behavior will reflect maternal skill and Time 2 outcomes (BaM-13 and EPDS) was found, such that endorsing this belief predicted increased depression and poorer adjustment in those with higher (but not lower) Time 1 EPDS scores. Time 2 BaM-13 scores were also negatively predicted by expectations of self-sacrifice and positively predicted by expectations that parenthood would be naturally fulfilling.

Conclusions: The expectations that new mothers hold about parenting soon after delivery are predictive of emotional adjustment in the early postpartum period, suggesting a role for discussion of expectations in future preventive strategies.     

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.