Predictors of postpartum depression: Prospective study of 264 women followed during pregnancy and postpartum

The prevalence of postpartum depression is approximately 13%. Postpartum depression is associated with a higher maternal morbidity and mortality, and also with pervasive effects on the emotional, cognitive and behavioral development of the child. The aim of our study was to identify socio-demographic, psychosocial and obstetrical risk factors of postpartum depression in a middle class community sample, using a prospective design. We enrolled consecutively 312 pregnant outpatients in a single maternity unit. The first assessment was conducted between 32 and 41 weeks gestation, and a second time between 6 and 8 weeks after delivery. Depressive symptoms were measured using the French version of the Edinburgh Postnatal Depression Scale (EPDS). A cut-off score of 12/30 or above was considered as indicative of Major Depression. Of the initial sample of 312 women, 264 (84.6%) were followed-up between 6 and 8 weeks after delivery and considered for analysis. Depression during pregnancy, migrant status, and physical abuse by the partner were independently associated with postpartum depression when considered together, whereas physical complications were significantly associated with postpartum depression only when adjusting for antenatal depression. Depression during pregnancy, history of physical abuse, migrant status and postpartum physical complications are four major risk factors for postpartum depression.     

母亲产后抑郁对喂养方式及子代体重增加量影响的队列研究

目的比较产后抑郁母亲与正常对照组对子代喂养方式的差异,明确产后抑郁是否对子代的体重增加有所影响。方法分别在西南医科大学附属医院、泸州市中医院、泸州市江阳区妇幼保健院和泸州市妇女儿童医院对住院待产的产妇进行筛查,对符合入组标准的48例产妇在产后第4、8、12周,使用爱丁堡产后抑郁量表(EPDS)和婴幼儿喂养方式及体重增加量调查表进行评定,将在首次评定时EPDS评分≥13分的被试归入产后抑郁组(n=14),将EPDS评分13分者归入对照组(n=34),比较两组人口学资料、EPDS评分、喂养方式及其婴儿体重增加量等方面的差异。结果产后第12周,产后抑郁组婴儿体重增加量高于对照组(Z=-2.612,P=0.009)。各随访时间点,产后抑郁组平均每日非母乳喂养的比例均高于对照组(Z_(4周)=-2.652,Z_(8周)=-3.591,Z_(12周)=-2.822,P均0.05)。产后抑郁组平均每日非母乳喂养的次数(Z_(4周)=-2.403,Z_(8周)=-3.666,Z_(12周)=-2.834,P均0.05)和非母乳喂养量(Z_(4周)=-2.289,Z_(8周)=-3.347,Z_(12周)=-2.609)均高于对照组。产后抑郁组当月用于婴儿食品等消耗品的支出均高于对照组(Z_(4周)=-3.404,Z_(8周)=-4.130,Z_(12周)=-3.859,P均0.05)。结论截止产后第12周,产后抑郁母亲的子代较少接受母乳喂养,但喂养方式的差异并未影响子代体重的增加。     

孕期家庭亲密度适应性对产妇产后抑郁的影响

目的分析孕期家庭亲密度适应性对产妇产后抑郁的影响。方法选取2013-03-2014-03我院收治的晚期妊娠孕妇160例为研究对象,分别于产前和产后6周采用爱丁堡产后抑郁量表和家庭亲密度适应性量表对其进行调查。结果观察组和对照组实际适应性和适应性不满意程度评分相比,差异具有统计学意义(t=-3.509,2.657;P均0.05)。观察组和对照组实际亲密度和亲密度不满意程度评分相比,差异具有统计学意义(t=-2.472,3.005;均P0.05)。实际适应性、适应性不满意程度、实际亲密度和亲密度不满意程度是产后抑郁的影响因素。结果孕期家庭亲密度适应性差会导致产妇产后抑郁,护理人员要重视对家庭亲密度重要性的宣传,降低产妇产后抑郁发生率。     

Validity of depression rating scales during pregnancy and the postpartum period: Impact of trimester and parity

The objective of the current study was to delineate the optimal cutpoints for depression rating scales during pregnancy and the postpartum period and to assess the perinatal factors influencing these scores. Women participating in prospective investigations of maternal mental illness were enrolled prior to 28 weeks gestation and followed through 6 months postpartum. At each visit, subjects completed self-rated depression scales - Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory (BDI) and clinician-rated scales - Hamilton Rating Scale for Depression (HRSD₁₇ and HRSD₂₁). These scores were compared to the SCID Mood Module for the presence of fulfilling diagnostic criteria for a major depressive episode (MDE) during 6 perinatal windows: preconception; first trimester; 2nd trimester; 3rd trimester; early postpartum; and later postpartum. Optimal cutpoints were determined by maximizing the sum of each scale’s sensitivity and specificity. Stratified ROC analyses determined the impact of previous pregnancy and comparison of initial to follow-up visits. A total of 534 women encompassing 640 pregnancies and 4025 follow-up visits were included. ROC analysis demonstrated that all 4 scales were highly predictive of MDE. The AUCs ranged from 0.857 to 0.971 and were all highly significant (p < .0001). Optimal cutpoints were higher at initial visits and for multigravidas and demonstrated more variability for the self-rated scales. These data indicate that both clinician-rated and self-rated scales can be effective tools in identifying perinatal episodes of major depression. However, the results also suggest that prior childbirth experiences and the use of scales longitudinally across the perinatal period influence optimal cutpoints.     

Prevalence of postpartum depression among immigrant women: A systematic review and meta-analysis

The aims of this systematic review and meta-analysis were threefold: to estimate the prevalence of postpartum depressive symptoms in immigrant women, compare this prevalence to non-immigrant women, and determine risk factors for postpartum depressive symptoms in immigrant women. Literature searches were conducted in PubMed, Embase, PsycINFO, Web of Science, Scopus, ResearchGate and Google Scholar databases from 1950 until October 2014. Twenty-four studies met the inclusion criteria of which 22 (12 cross-sectional and 10 prospective cohort) contributed data for meta-analyses. Heterogeneity and publication bias were assessed. The prevalence of postpartum depressive symptoms in immigrant women was 20% (95% confidence interval [CI] 17–23%, 18 studies, N = 13,749 women). Immigrant women were twice more likely to experience depressive symptoms in the postpartum period than non-immigrant women (pooled unadjusted odds ratio [OR] = 2.10 [95% CI 1.62–2.73, 15 studies, N = 50,519 women] and adjusted OR = 2.18 [95% CI 1.60–2.96, 7 studies, N = 35,557 women]). There was, however, evidence of publication bias with the pooled adjusted OR reduced to 1.63 (95% CI 1.22–2.17) after adjustment for bias. Risk factors associated with postpartum depressive symptoms among immigrant women included shorter length of residence in the destination country, lower levels of social support, poorer marital adjustment, and perceived insufficient household income. This study suggests that postpartum depression is a common condition among immigrant women. Moreover, immigrant women are at higher risk of postpartum depression than non-immigrant women. Further prospective studies on the risk factors of postpartum depression among immigrant women verified by a clinical diagnosis are needed.     

Alterations in platelet serotonin transporter binding in women with postpartum onset major depression

There is considerable debate as to whether postpartum depression (PPD) is biologically distinct from other depressive syndromes. Although abnormalities in serotonergic neural systems have repeatedly been reported in depression, few such studies have been conducted in PPD. In the present study, platelet serotonin transporter (SERT) binding was assessed using [(3)H]paroxetine in 14 depressed pregnant women, 31 normal healthy pregnant women, 39 depressed postpartum women, and 27 normal healthy postpartum women; all of the subjects were drug-free. Significant differences were detected among the 4 groups with respect to the dissociation constant (Kd) of platelet binding sites for [(3)H]paroxetine with the highest Kd values among those with PPD. The density (Bmax) of platelet binding sites for [(3)H]paroxetine did not differ between the study groups. These data suggest that PPD may be associated with unique alterations in serotonergic function that are specific to the puerperium.     

Epilepsy and postpartum depression

Purpose:   Postpartum depression occurs in 10–20% of women who have recently given birth, but less than half of cases are recognized. The purpose of this study was to examine whether there was a difference in the rate of postpartum depression between patients with epilepsy and healthy controls, and to determine the relationship between epilepsy and postpartum depression.
Methods:   The sample consisted of 55 patients with epilepsy and 55 patients without epilepsy. All patients were recruited at the Regional Epilepsy Center and at the Department of Obstetrics and Gynecology, University of Milan, St. Paolo Hospital (Italy). Every woman was assessed with the Edinburgh Postnatal Depression Scale and a clinical interview to screen for postpartum depression.
Results:   We found a statistically significant higher rate of postpartum depression in patients with epilepsy compared with controls (p < 0.05).
Discussion:   These findings highlight the importance of screening for postpartum depression; it can improve the recognition of the disorder and can provide adequate treatment and follow-up.     

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.     

不安全依恋、述情障碍对产后抑郁的影响研究

目的探讨分娩前后述情障碍、不安全依恋和抑郁变化以及三者之间的关系。方法选取安阳市人民医院就诊的孕期≥28周的525名孕妇为研究对象,采用爱丁堡产后抑郁量表(EPDS)、依恋方式问卷[ASQ,包括安全型依恋(Attachment-secure)、焦虑/矛盾型依恋(Insecure-ambivalent)、回避型依恋(Insecure-avoidant)3个分量表]、多伦多述情障碍量表(TAS-20)进行测评。结果分娩后产妇焦虑/矛盾型依恋因子得分低于产前[(47.78±9.61)vs.(46.03±8.48)],差异有统计学意义(P0.05)。产妇EPDS得分与回避型依恋因子得分、焦虑/矛盾型依恋因子得分、TAS-20得分呈正相关(r=0.31~0.39,P均0.01)。逐步多元线性回归分析显示,产后EPDS得分与TAS-20得分、焦虑/矛盾型依恋得分呈正相关(β=0.24~0.28),焦虑型依恋得分×TAS-20得分、回避型依恋×TAS-20得分与EPDS得分回归关系成立(β=0.15~0.32,P均0.05)。结论产妇焦虑型依恋分娩后降低,产后不安全依恋直接或间接与述情障碍相互作用于抑郁情绪。     

述情障碍在领悟社会支持与产后抑郁间的中介效应

目的探讨分娩前、后产妇述情障碍、领悟社会支持、抑郁变化及三者之间的关系。方法选取安阳市人民医院就诊的孕期≥28周的525名孕妇为研究对象,追踪调查至分娩后一周,采用爱丁堡产后抑郁量表(EPDS)、孕产妇社会支持量表(MSSS)、多伦多述情障碍量表[TAS-20,包括情感识别障碍(DIF)、情感描述障碍(DDF)、外向性思维(EOT)3个分量表]进行测评。结果产妇DIF得分低于分娩前[(19.11±4.67)vs.(18.14±4.46),P0.05]。产后EPDS得分与MSSS得分呈负相关(r=-0.39)、与TAS-20各因子得分呈正相关(r=0.16~0.37,P均0.05)。逐步回归分析显示,EPDS得分与MSSS得分呈负相关(β=-0.42)、与DIF得分呈正相关(β=0.26,P均0.05)。MSSS在TAS-20对EPDS影响中不完全中介效应成立(β=-0.33),χ2/df=0.909、P=0.436、RMSEA=0.009、NFI=0.995、RFI=0.983、IFI=0.991、TLI=0.971、CFI=0.989。结论产妇述情障碍直接或间接通过降低产妇对社会支持的领悟能力而影响产后抑郁。     

Insomnia treatment in the third trimester of pregnancy reduces postpartum depression symptoms: A randomized clinical trial

Mental health is an important medical issue in perinatal care, and there is increasing evidence that insomnia during pregnancy is associated with postpartum depression (PPD). Therefore, the present study evaluated the effect of insomnia treatment during the third trimester of pregnancy on PPD symptoms. Fifty-four pregnant women with insomnia were randomly assigned to trazodone, diphenhydramine, or placebo treatment. Sleep quality was measured by actigraphy at baseline, and after 2 and 6 weeks of treatment. In addition, depression was assessed 2 and 6 weeks after delivery. Trazodone and diphenhydramine improved sleep profile compared to placebo after 6 weeks of treatment. Further, depressive symptoms were reduced 2 and 6 weeks after delivery in trazodone and diphenhydramine groups compared to placebo. No differences in depressive symptoms were observed between the trazodone and diphenhydramine groups. These findings indicate that insomnia treatment with trazodone or diphenhydramine during the third trimester of pregnancy may prevent PPD.     

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...     

Depression screening and patient outcomes in pregnancy or postpartum: A systematic review

Objective

Clinical practice guidelines disagree on whether health care professionals should screen women for depression during pregnancy or postpartum. The objective of this systematic review was to determine whether depression screening improves depression outcomes among women during pregnancy or the postpartum period.

Methods

Searches included the CINAHL, EMBASE, ISI, MEDLINE, and PsycINFO databases through April 1, 2013; manual journal searches; reference list reviews; citation tracking of included articles; and trial registry reviews. RCTs in any language that compared depression outcomes between women during pregnancy or postpartum randomized to undergo depression screening versus women not screened were eligible.

Results

There were 9,242 unique titles/abstracts and 15 full-text articles reviewed. Only 1 RCT of screening postpartum was included, but none during pregnancy. The eligible postpartum study evaluated screening in mothers in Hong Kong with 2-month-old babies (N = 462) and reported a standardized mean difference for symptoms of depression at 6 months postpartum of 0.34 (95% confidence interval = 0.15 to 0.52, P < 0.001). Standardized mean difference per 44 additional women treated in the intervention trial arm compared to the non-screening arm was approximately 1.8. Risk of bias was high, however, because the status of outcome measures was changed post-hoc and because the reported effect size per woman treated was 6–7 times the effect sizes reported in comparable depression care interventions.

Conclusion

There is currently no evidence from any well-designed and conducted RCT that screening for depression would benefit women in pregnancy or postpartum. Existing guidelines that recommend depression screening during pregnancy or postpartum should be re-considered.     

Lower levels of prepulse inhibition of startle response in pregnant women compared to postpartum women

OBJECTIVE: During the postpartum period, estradiol and progesterone levels decline from very high levels during late pregnancy to low levels within 48h of parturition. This period is associated with dysphoric states such as the postpartum blues. Animal studies have suggested an enhanced acoustic startle response and deficient prepulse inhibition (PPI) of startle response following progesterone withdrawal and during the postpartum period. The aim of the current study was to compare acoustic startle response and PPI in healthy third trimester pregnant women and healthy postpartum women. METHODS: Twenty-eight healthy pregnant and 21 healthy postpartum women (examined between 48h and 1 week after delivery) were recruited for the study. In addition, to evaluate the time-course of postpartum changes 11 early postpartum women (examined within 48h following delivery) were included in the study. The eyeblink component of the acoustic startle reflex was assessed using electromyographic measurements of m. Orbicularis Oculi. Twenty pulse-alone trials (115dB 40ms broad-band white noise) and 40 prepulse-pulse trials were presented. The prepulse stimuli consisted of a 115dB 40ms noise burst preceded at a 100ms interval by 20ms prepulses that were 72, 74, 78 or 86dB. RESULTS: Pregnant women exhibited lower levels of PPI compared to late postpartum women, p<0.05. There was no difference between pregnant women and postpartum women examined within 48h of delivery. There was no difference in startle response or habituation to startle response between pregnant women and either of the two groups of postpartum women. CONCLUSION: Healthy women display lower levels of PPI during late pregnancy when estradiol and progesterone levels are high compared to the late postpartum period when ovarian steroid levels have declined.     

产后抑郁的有关心理、社会和生物学因素研究

目的调查产后抑郁的发生率以及相关的生物、心理、社会因素。方法对299名产妇在产后第3天用Edinburgh产后抑郁量表(EPDS)进行评定,并收集有关的心理社会因素以及产科因素。其中的117名完成产后第42天的EPDS评定。结果产后抑郁的发生率为23.08%,家庭支持等心理社会因素和产后抑郁密切相关。结论产后抑郁的发生具有一定的社会和心理因素。     

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.     

Decision making for depression treatment during pregnancy and the postpartum period

Background: To explore women's perspectives about the treatment decision‐making process for depression during pregnancy and after birth. Method: One hundred pregnant and postpartum women completed an anonymous web‐based surveys regarding treatment decision making for depression. Results: Survey data reveal that most women in this sample prefer an active collaborative role in treatment decision making for depression. Sixty‐five percent of the sample made a decision for treatment of their major depressive disorder, including a decision for no treatment, and 34% reported not having made a decision or feeling unsure about their decision. More than half of the sample preferred combination treatment with medications and counseling (55%) followed by counseling (22%), no treatment (8%), and medications (8%). Overall, respondents in this sample had low levels of decisional conflict (uncertainty) with younger women in the sample reporting higher levels of decisional conflict. Conclusions: Treatment decision making for depression during the perinatal period is complex. Asking women about their preferences for participation in decision making, their treatment preferences and their decision making needs during the clinical encounter may lead to improved communication, decision making and quality of care. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.