Postnatal Depression in Surabaya,Indonesia

Postnatal depression or postpartum depression is a major psychiatric illness affecting many women with uncertainty remaining over causative factors or etiology [1]. The Edinburgh Postnatal Depression Scale, used for the first time in Indonesia, evaluated demographic data and risk factors to determine any correlation of women with and without postpartum depression. Some 434 women attending antenatal care were included in the study beginning the third term of pregnancy and concluded four to six weeks postpartum. Finding of 22.35 percent of postnatal mothers reporting postpartum depression in our study is similar to other studies. No significant differences were found between women with and without postpartum depression when evaluating demographic variables. Significant differences between the two groups were found when comparing risk factors. Also, women who had more risk factors had postpartum depression. The need for educational programs to create awareness and assist in identifying the condition early is important. Finally, ongoing support of mothers during the postpartum period is necessary in preventing postpartum depression.     

Treating depressive symptoms in schoolchildren

Abstract. Although studies on sub-threshold depression in childhood and adolescence havedemonstrated an at risk profile that merits further attention, only few investigators examined the impact of therapy with these children. In this study, twenty elementary schoolchildren (aged 10–12) with moderate depressive symptoms were randomly assigned to an eighteen-session cognitive-behavioural treatment programme or to a waiting list (WL) control group (= Study 1). The key components of the programme Taking Action used in the study were: affective education, problem-solving, cognitive restructuring and engaging in enjoyable activities. Child self-reports and parent reports were used to evaluate the outcome. Paired ttests comparing the 4-months follow-up results with baseline measurements, revealed a significant improvement on the Children Depression Inventory and on the Self-Perception Profile for Children, but only in the treatment group. Afterwards, the WL control group was treated as well. All children were followed in a long-term follow-up study (= Study 2). Analyses at the 12 month stage of the follow-up study showed a further improvement of the scores on the Self-Perception Profile. Moreover, a significant decrease was found on the Children Depression Inventory, the State-Trait Anxiety Inventory and the Child Behaviour Checklist parent measure. It was concluded that the protocol is suitable for European children. The most remarkable findings in this pilot study are discussed.     

Alexithymia in Parkinson's disease is related to severity of depressive symptoms

The authors investigated the possible relationship between depression and alexithymia in a population of hospitalized patients suffering from Parkinson's disease (PD). Fifty-eight PD patients without dementia participated in the study. Alexithymia was screened using the 20 item version of the Toronto Alexithymia Scale (TAS 20). Depression was diagnosed using a Structured Clinical Interview (SCID I) for DSM-IV. Severity of depression was evaluated with the Beck Depression Inventory (BDI). The prevalence of Alexithymia was about 21%. PD patients with major depression were significantly more alexithymic (TAS 20 average score = 61.4) than PD patients without depression (TAS 20 average score = 47.4) and, also, tended to be more alexithymic than PD patients with minor depression (MiD; TAS 20 average score =50.6), whereas no difference was found between PD patients with MiD and PD patients without depression. Moreover, high scores obtained on the BDI were found to strongly predict high level of alexithymia in these patients. These results extend to a cohort of PD patients previous data from the literature evidencing a strong association between alexithymia and severity of depressive symptoms.     

The Edinburgh Postnatal Depression Scale: validation on a Swedish community sample

The Edinburgh Postnatal Depression Scale (EPDS) was designed to be used by community health workers to screen for postnatal depression. We report data from a population-based sample of 1655 women who completed the EPDS at 2 months and 3 months postpartum. A total of 128 women were interviewed with the Montgomery Asberg Depression Rating Scale (MADRS) and assessed according to DSM-III-R criteria for major depression. A cut-off score of 11.5 on the EPDS identified all but two women with major depression, giving it a sensitivity of 96%, a specificity of 49% and a positive predictive value of 59%. This study supports the validity of the EPDS shown in earlier studies, and indicates that the scale is a useful screening instrument for identifying postnatal depression in primary health care in Sweden.     

Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders

Screening for postnatal mood disorders in English-speaking women often uses the validated cut-off score of 13 or more on the Edinburgh Postnatal Depression Scale (EPDS) to detect probable major depression. Increasingly there is evidence that for many women, and men, anxiety disorders can occur postnatally in the absence of depression. This study therefore examined data on the three EPDS items frequently found to cluster together on an anxiety factor for women (items 3, 4, and 5: EPDS-3A), to determine the optimum cut-off score to screen for specified anxiety disorders. A sample of 238 women and 218 men were administered a diagnostic interview for anxiety and depressive disorders, and completed the EPDS, at 6 weeks postpartum. The receiver operating characteristics show that the optimum cut-off score on the EPDS-3A for women is 6 or more (possible range: 0-9), and for men it is 4 or more, though it appears that the factor structure for men is different than for women. The conclusion is that the EPDS can be used to screen for probable depression in women (using the validated total cut-off score of 13 or more) and also probable anxiety (using the EPDS-3A cut-off score of 6 or more). For men there is already a validated total cut-off score for both depression and anxiety (6 or more)--however, if services are not using this, they can use the EPDS-3A score of 4 or more to screen for probable anxiety disorders in fathers, though further work needs to be undertaken to clarify whether the anxiety factor structure for men is different to that found for women.     

Screening for postnatal depression in a population-based Swedish sample

This study surveyed the prevalence of postnatal depression and demographic factors associated with it in a Swedish population. A community sample of 1584 women was screened at 8 and 12 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). The point prevalence of depression, using a threshold of 11/12 on the EPDS, was 12.5% at 8 weeks and 8.3% at 12 weeks postpartum. The period prevalence for 8 to 12 weeks postpartum was 4.5%. A significantly increased risk of postnatal depression was found for single women. Parity, maternal age and occupational status were not found to be related to postnatal depression. The findings suggest that screening for postnatal depression is feasible at the time of postnatal checks on the baby, and that it can aid in the identification of women at risk for depression. A two-stage screening procedure will identify women at risk for more persistent postnatal depression.     

Atypical depressive symptoms and clusters in unipolar and bipolar depression

In order to examine differences in the atypical symptoms of depression between unipolar and bipolar patients, we studied 109 depressed patients (79 unipolar and 30 bipolar subjects) diagnosed with DSM-IV criteria. Patients were assessed using the Atypical Depression Diagnostic Scale (ADDS), a semi-structured interview that rates mood reactivity and other atypical depressive symptoms. Although atypical depression was common in this sample (28% of cases with definite atypical depression), no differences were found between the unipolar and bipolar patients in either the atypical symptom profile or the prevalence of an atypical depression diagnosis. The interrelationships between the atypical symptoms were also examined using a hierarchical cluster analysis. A five-cluster solution maximized differences between groups, with results suggesting that atypical depression may be a heterogeneous diagnosis.     

Association between depressive symptoms and age,sex, loneliness and treatment among older people in Sweden

Objectives: The objective of this study was to examine the prevalence of and the association between depressive symptoms and loneliness in relation to age and sex among older people (65–80 years) and to investigate to what extent those who report depressive symptoms had visited a health care professional and/or used antidepressant medication.

Method: A cross-sectional study was conducted in a Swedish sample randomized from the total population in the age group 65–80 years (n = 6659). Chi square tests and logistic regression analyses were conducted.

Results: The data showed that 9.8% (n = 653) reported depressive symptoms and 27.5% reported feelings of loneliness. More men than women reported depressive symptoms, and the largest proportion was found among men in the age group 75–80 years. An association between the odds to have a depressive disorder and loneliness was found which, however, decreased with increasing age. Of those with depressive symptoms a low proportion had visited a psychologist (2.9%) or a welfare officer (4.2%), and one in four reported that they use antidepressant medication. Of those who reported depressive symptoms, 29% considered that they had needed medical care during the last three months but had refrained from seeking, and the most common reason for that was negative experience from previous visits.

Conclusion: Contrary to findings in most of the studies, depressive symptoms were not more prevalent among women. The result highlights the importance of detecting depressive symptoms and loneliness in older people and to offer adequate treatment in order to increase their well-being.     

Parsing the clinical phenotype of depression: the need to integrate brief depressive episodes

OBJECTIVE: To expand the concept of recurrent brief depression (RBD) to brief depression (BD) and to test its clinical relevance. METHOD: Subjects (N = 591) were studied prospectively six times from ages 20/21 to 40/41 years. RBD was defined according to DSM-IV as episodes under 2 weeks with about monthly recurrence and work impairment. BD embraces RBD and brief depressive episodes with a frequency of 1-11 per year. RESULTS: Pure BD and pure major depressive episodes (MDE) did not differ in treatment rates, family history of mood and anxiety disorders or comorbidity with bipolar spectrum and anxiety disorders but they differed in work impairment, suicide attempt rates and distress self-ratings. The combination of BD + MDE identified a very severe group of MDE, comparable with combined depression (MDE + RBD) and double depression (MDE + dysthymia). CONCLUSION: Our data argue for the use of BD as a diagnostic specifier for severe MDE. RBD remains an important independent subgroup.     

Dehydroepiandrosterone for depressive symptoms: A systematic review and meta-analysis of randomized controlled trials

Depression is a mental disorder that affects millions of people around the world. However, depressive symptoms can be seen in other psychiatric and medical conditions. Here, we investigate the effect of DHEA treatment on depressive symptoms in individuals with depression and/or other clinical conditions in which depressive symptoms are present. An electronic search was performed until October 2019, with no restrictions on language or year of publication in the following databases: Medline, EMBASE, LILACS, and Cochrane Library. Randomized controlled trials comparing DHEA versus placebo were included if the depressive symptoms were assessed. Fifteen studies with 853 female and male individuals were included in this review. To conduct the meta-analysis, data were extracted from 14 studies. In comparison with placebo, DHEA improved depressive symptoms (standardized mean difference [SMD] −0.28, 95% (CI) −0.45 to −0.11, p =.001, 12 studies, 742 individuals (375 in the experimental group and 367 in the placebo group), I² = 24%), very low quality of evidence, 2 of 14 studies reporting this outcome were removed in a sensitivity analysis as they were strongly influencing heterogeneity between studies. No hormonal changes that indicated any risk to the participants' health were seen. Side effects observed were uncommon, mild, and transient, but commonly related to androgyny. In conclusion, DHEA was associated with a beneficial effect on depressive symptoms compared to placebo. However, these results should be viewed with caution, since the quality of evidence for this outcome was considered very low according to the GRADE criteria.     

抑郁症患者的躯体症状

目的:了解抑郁症患者的躯体症状特征。方法:采用自制调查表对符合中国精神障碍分类与诊断标准第3版抑郁发作的119例门诊及住院患者进行调查。根据汉密尔顿抑郁量表(HAMD)评分,将119例患者分为轻度、重度抑郁症两组,比较两组的一般资料及躯体症状。结果:两组的一般资料差异无显著性,而重度抑郁组躯体症状与轻度抑郁组差异显著。结论:抑郁症的躯体症状非常突出,应引起足够重视。     

Effectiveness of Antenatal Emotional Self‐Management Training Program in Prevention of Postnatal Depression in Chinese Women

PURPOSE: This study aimed to study the effectiveness of an emotional self‐management training program to antenatal women in the prevention of postnatal depression. DESIGN AND METHODS: The sample comprised 240 women who were at 32 weeks antenatal. They were randomly assigned into the intervention group and the control group. FINDINGS: On completion of the program, the intervention group reported significantly lower mean Patient Health Questionnaire‐9 and Edinburgh Postnatal Depression Scale scores than the control group. Fewer participants from the intervention group were diagnosed as having postnatal depression using the Structured Clinical Interview for DSM‐IV. PRACTICE IMPLICATIONS: An antenatal emotional self‐management training that may lower the risk of developing postnatal depression among Chinese women is recommended.     

A Comparative Study of the Experiences of a Group of Hong Kong Chinese and Australian Women Diagnosed With Postnatal Depression

PURPOSE.  This study examined the experiences of postnatal depression between a group of Chinese and Caucasian women.
DESIGN AND METHODS.  This was a secondary analysis of two phenomenological studies. Thirty-five Chinese women and 12 Australian women were interviewed.
FINDINGS.  Women felt being trapped in the depression. The Hong Kong women attributed their depression to their mothers-in-law and husbands, and expressed much anger. The Australian women attributed their depression to not being able to live up to the ideal mother image, and felt guilty.
PRACTICE IMPLICATIONS.  Interventions were recommended with consideration for the cultural values that influenced women's experiences of postnatal depression.     

Predictors of depressive symptoms at hospital discharge in patients with major depressive disorder

Abstract

Objective. Often patients with major depressive disorder (MDD) leave the hospital with continued significant symptomatology. This study sought to evaluate demographic, clinical, and psychosocial predictors of the presence of clinically significant depressive symptoms, defined as a Modified Hamilton Rating Scale for Depression score of ≥ 14, immediately following hospitalization for MDD. Methods. The study enrolled 135 patients with MDD as part of a larger clinical trial investigating the efficacy of post-hospitalization pharmacologic and psychosocial treatments for depressed inpatients. Structured clinical interview and self-report data were available from 126 patients at hospital admission and discharge. Results. Despite the significant decreases in depressive symptoms over the course of hospitalization, 91 (72%) displayed clinically significant depressive symptoms at discharge. Multivariate logistic regression analysis revealed that female sex, earlier age of onset, and poorer social adjustment were unique predictors of symptom outcome. Conclusions. Results suggest that a large proportion of patients leave the hospital with continued significant symptomatology, and the presence of such symptoms following hospitalization for MDD is likely to be explained by a combination of factors.     

Physical discomfort in early pregnancy and postpartum depressive symptoms

Purpose: Pregnancy examinations conducted in general practice focus mainly on identifying high-risk pregnancies and pregnancy complications. The pregnancy health record has a biomedical focus, and consequently the woman’s mental well-being may receive less attention. The aim of this study was to evaluate the extent to which early pregnancy-related symptoms should be considered as indicators of an increased risk of postpartum depression.

Materials and methods: For a prospective cohort of 1508 pregnant women, the presence of 11 pregnancy-related symptoms was recorded at the first prenatal care consultation together with background information about socio-demography and health. Depression was assessed 8 weeks postpartum with the major depression inventory (MDI) and depression was considered present if MDI > 20. Multivariable logistic regression was used to assess the association between pregnancy-related symptoms and postpartum depressive symptoms, and to adjust for potential confounders.

Results: A high depression score (MDI score >20) 8 weeks postpartum was found among 6.6% of the women and showed apparent associations with physical discomfort in early pregnancy, such as back pain and pelvic cavity pain. Analysis of confounding revealed, however, that signs of vulnerable mental health, present in early pregnancy, explained most of these associations.

Conclusions: Indicators of an increased risk of postpartum depressive symptoms may be found in early pregnancy. Pregnancy-related pain in the first trimester may be a sign of psychological vulnerability or an aspect of an existing depressive state that calls for attention.