Postpartum Depression and Help‐Seeking Behavior

The objective of this analysis was to investigate the demographic differences between women who report postpartum depression symptoms (PPDS) and seek help versus those who report symptoms but who do not seek help, using data from the Utah Pregnancy Risk Assessment Monitoring System (PRAMS) 2004 dataset. Overall, 14.7% of Utah women reported experiencing PPDS in 2004. Sixty percent of the women who reported having PPDS did not seek help Seeking help for depression during pregnancy was associated with help‐seeking behavior postpartum (adjusted odds ratio [aOR] = 0.1; 95% confidence interval [CI], 0.04–0.2). Other factors associated with seeking help included having an infant admitted to the intensive care unit (aOR = 0.4; 95% CI, 0.2–0.9) and rural residency (aOR = 0.3; 95% CI, 0.2–0.7). Nonwhite women were 12.1 times (95% CI, 3.0–48.5) more likely to not seek help for depression compared to white women. Further, Hispanic women (aOR = 3.2; 95% CI, 1.3–8.1) and women who experienced emotional abuse had increased odds of not seeking help (aOR = 2.9; 95% CI, 1.3–6.2). Nearly 15% of Utah women in this study reported PPDS, yet fewer than half sought help. Target populations, such as nonwhite, Hispanic, emotionally abused, and urban women, have been identified for public health interventions.     

Postpartum Depression Help‐Seeking Barriers and Maternal Treatment Preferences: A Qualitative Systematic Review

ABSTRACT: Background: Despite the well‐documented risk factors and health consequences of postpartum depression, it often remains undetected and untreated. No study has comprehensively examined postpartum depression help‐seeking barriers, and very few studies have specifically examined the acceptability of postpartum depression treatment approaches. The objective of this study was to examine systematically the literature to identify postpartum depression help‐seeking barriers and maternal treatment preferences. Methods: Medline, CINAHL, and EMBASE databases were searched using specific key words, and published peer‐reviewed articles from 1966 to 2005 were scanned for inclusion criteria. Results: Of the 40 articles included in this qualitative systematic review, most studies focused on women’s experiences of postpartum depression where help seeking emerged as a theme. A common help‐seeking barrier was women’s inability to disclose their feelings, which was often reinforced by family members and health professionals’ reluctance to respond to the mothers’ emotional and practical needs. The lack of knowledge about postpartum depression or the acceptance of myths was a significant help‐seeking barrier and rendered mothers unable to recognize the symptoms of depression. Significant health service barriers were identified. Women preferred to have “talking therapies” with someone who was nonjudgmental rather than receive pharmacological interventions. Conclusions: These results suggest that women did not proactively seek help, and the barriers involved both maternal and health professional factors. Common themes related to specific treatment preferences emerged from women of diverse cultural backgrounds. The clinical implications outlined in this review will assist health professionals in addressing these barriers and in developing preventive and treatment interventions that are in accord with maternal preferences. (BIRTH 33:4 December 2006)     

Establishment of a Community Advisory Board to Address Postpartum Depression Among Indigenous Women

In this article, we describe the process of establishing an academically and tribally supported community advisory board (CAB) to guide and inform community-engaged research about postpartum depression (PPD) among Indigenous women. Using a community-based participatory research framework, we created a CAB with stakeholders from the Chickasaw Nation because they are well situated to inform a research agenda about PPD in Indigenous women. We developed CAB roles, goals, and responsibilities; established processes for compensation and recognition; identified and recruited potential members; and conducted meetings to build rapport, brainstorm, receive feedback, and invite discussion of topics related to PPD that have been deemed important by the tribe (October 2021 through June 2022). The CAB defined specific roles, goals, and responsibilities for the academic–community partnership, including assumptions, expectations, and confidentiality. We used a standing agenda item to recognize member achievements. Members of the CAB represented many tribal departments and professional disciplines. We use a CAB framework to evaluate our process and to provide recommendations for future research and policymaking.     

Differentiation and Clinical Implications of Postpartum Depression and Postpartum Psychosis

Postpartum depression and postpartum psychosis are serious mood disorders encountered by nurses working in a variety of settings. Postpartum depression refers to a nonpsychotic depressive episode, while postpartum psychosis refers to a manic or affective psychotic episode linked temporally with childbirth. The nursing profession plays a crucial role in the early identification and treatment of these postpartum mood disorders. This article explains the classification, clinical presentation, epidemiology, management, and long-term outcomes of postpartum depression and postpartum psychosis.     

Smoking Status and Symptoms of Depression During and After Pregnancy Among Low-Income Women

ObjectiveTo describe the point prevalence rates, relapse rates, smoking status, and symptoms of depression and to examine the relationship between smoking status and symptoms of depression from early pregnancy to 12 months after childbirth among low-income women.DesignSecondary data analysis.SettingData from the national Nurse-Family Partnership program.ParticipantsWomen who were enrolled in the national Nurse-Family Partnership program between 2011 and 2016 with histories of smoking 3 months before pregnancy (N = 1,554).MethodsWe used smoking status and Edinburgh Postnatal Depression Scale scores in early pregnancy, late pregnancy, and 12 months after childbirth to identify point prevalence rates, relapse rates, smoking status, and symptoms of depression. We used chi-square and additional analyses to examine the relationship between smoking status and symptoms of depression.ResultsThe prevalence of smoking was 30.12% (n = 468) in early pregnancy, 24.39% (n = 379) in late pregnancy, and 50.58% (n = 786) 12 months after childbirth. Prevalence rates of a positive depression screening result were 30.31% (n = 471), 20.46% (n = 318), and 18.08% (n = 281), respectively. Smoking relapse rates were 2.45% (n = 38) during the third trimester and 27.86% (n = 433) at 12 months after childbirth. Eight distinct patterns of smoking and depression were identified. Women who smoked were significantly more likely to also have positive depression screening results during the third trimester and at 12 months after childbirth compared with nonsmoking women (OR = 1.37, 95% confidence interval [1.04, 1.81] and OR = 1.93, 95% confidence interval [1.47, 2.51], respectively).ConclusionPrevalence rates of smoking, relapse, and positive depression screening results were great in this sample of low-income women during and after pregnancy. Pivotal time points exist where the trajectory of smoking and depression screening patterns may change. It is important for smoking cessation interventions to incorporate mental health assessment and treatment.     

Community Awareness of Postpartum Depression

Objective: To explore awareness of postpartum depression and its symptoms and available community resources for women with postpartum depression.
Design: Cross-sectional surveillance research, using population-based data.
Setting: Eight communities in southern and eastern Ontario, Canada.
Participants: A random selection of adults 18 years of age and older with telephones.
Method: Logistic regression and chi-square test were used to analyze awareness of postpartum depression and its symptoms, the baby blues, and sources of assistance for women with postpartum depression.
Results: The vast majority of respondents were aware of postpartum depression (90.1%± 0.6% confidence interval) ( n= 8,750) as compared with the baby blues (62.5%± 1.1%). Awareness of postpartum depression, its symptoms, the baby blues, and sources of assistance varied according to the demographic profiles of the respondents (family structure, education, and language spoken at home).
Conclusion: Awareness of the term postpartum depression does not necessarily imply awareness of its symptoms or sources of assistance. Public education is needed to address this fact in order to provide social support and encourage treatment for symptomatic women and their families. Education should target individuals with lower levels of education and non-English–speaking groups.     

Management of Postpartum Depression

The mainstays of treatment for peripartum depression are psychotherapy and antidepressant medications. More research is needed to understand which treatments are safe, preferable, and effective. Postpartum depression, now termed peripartum depression by the DSM‐V, is one of the most common complications in the postpartum period and has potentially significant negative consequences for mothers and their families. This article highlights common clinical challenges in the treatment of peripartum depression and reviews the evidence for currently available treatment options. Psychotherapy is the first‐line treatment option for women with mild to moderate peripartum depression. Antidepressant medication in combination with therapy is recommended for women with moderate to severe depression. Although pooled case reports and small controlled studies have demonstrated undetectable infant serum levels and no short‐term adverse events in infants of mothers breastfeeding while taking sertraline (Zoloft) and paroxetine (Paxil), further research is needed including larger samples and long‐term follow‐up of infants exposed to antidepressants via breastfeeding controlling for maternal depression. Pharmacologic treatment recommendations for women who are lactating must include discussion with the patient regarding the benefits of breastfeeding, risks of antidepressant use during lactation, and risks of untreated illness. There is a growing evidence base for nonpharmacologic interventions including repetitive transcranial magnetic stimulation, which may offer an attractive option for women who wish to continue to breastfeed and are concerned about their infants being exposed to medication. Among severe cases of peripartum depression with psychosis, referral to a psychiatrist or psychiatric advanced practice registered nurse is warranted. Suicidal or homicidal ideation with a desire, intent, or plan to harm oneself or anyone else, including the infant, is a psychiatric emergency, and an evaluation by a mental health professional should be conducted immediately. Peripartum depression treatment research is limited by small sample sizes and few controlled studies. Much work is still needed to better understand which treatments women prefer and are the most effective in ameliorating the symptoms and disease burden associated with peripartum depression.     

A Multiple‐Baseline Study of the Effects Associated With Metacognitive Therapy in Postpartum Depression

Introduction: Postpartum depression is a disabling psychological disorder that, if left untreated, may have negative consequences for the mother, her partner, and the child. Although women with postpartum depression often experience symptoms of anxiety as well as depression, this has been underresearched. As metacognitive therapy assumes that the underlying mechanisms for both anxiety and depression are the same, it is a potentially useful psychological treatment for postpartum depression. Methods: A pilot study was carried out using a multiple‐baseline single case series to examine the effects associated with metacognitive therapy in the treatment of depression. Six women with postpartum depression were assigned to no‐treatment baselines of 3 to 6 weeks, followed by 8 to 12 sessions of metacognitive therapy. Follow‐up with participants took place at 3 and 6 months posttreatment. Results: All participants experienced clinically significant reductions in symptoms of depression and anxiety, with corresponding reductions in metacognitive beliefs consistent with the idea that this may be the mechanism by which change occurred. Furthermore, all scores fell within the normal range posttreatment, and effect sizes were large. Treatment gains were maintained at 3 and 6 months posttreatment by all participants. Discussion: This pilot study suggests that metacognitive therapy may be an effective psychological treatment for postpartum depression.     

Mediating Role of Labor on the Relationship Between Prenatal Psychopathologic Symptoms and Symptoms of Postpartum Depression in Women Who Give Birth Vaginally

ObjectiveTo investigate how prenatal symptoms of anxiety and depression and clinical aspects of labor (duration of labor, administration of oxytocin and epidural analgesia) interact with each other to contribute to symptoms of postpartum depression in women who give birth vaginally.DesignA longitudinal design with measurement at three different time points: Time 1, 31 to 32 weeks gestation; Time 2, the day of labor and birth; and Time 3, 1 month after birth.SettingMaternity ward of the Misericordia e Dolce Hospital in Prato, Italy.ParticipantsA total of 186 women at 31 to 32 weeks gestation were recruited during childbirth preparation courses at the maternity ward.MethodsAt Time 1, women completed the Beck Depression Inventory and the State portion of the State–Trait Anxiety Inventory. At Time 2, midwives recorded clinical data related to labor, including duration of labor and administration of oxytocin and epidural analgesia. At Time 3, the women completed the Edinburgh Postnatal Depression Scale. Structural equation modeling was performed.ResultsSymptoms of depression (β = 0.36; p < .001; 95% confidence interval [CI] [0.17, 0.49]) and state anxiety (β = 0.25; p < .001; 95% CI = [0.04, 0.27]) during pregnancy positively affected symptoms of depression after birth. Greater levels of these prenatal symptoms predicted a more complicated labor (depression: β = 0.29; p < .01; 95% CI [0.00, 0.19]; anxiety: β = 0.30; p < .01; 95% CI [0.01, 0.14]), which, in turn, positively predicted greater levels of symptoms of depression at 1 month after birth (β = 0.34; p < .001; 95% CI [0.38, 1.51]). Moreover, results highlighted indirect effects that high levels of anxiety symptoms during pregnancy have on postpartum symptoms of depression through the clinical aspects of labor (β = 0.10; p < .01; 95% CI [0.00, 0.13]). These indirect effects were not significant for antenatal symptoms of depression (β = 0.10; p < .05; 95% CI [–0.02, 0.20]).ConclusionOur findings confirm that symptoms of anxiety and depression during pregnancy represent significant risk factors for the clinical aspects of labor and for the development of symptoms of postpartum depression in the first month after childbirth.     

Research Recommendations on the Effects of Postpartum Depression and Pain on Infant Care and Development

Postpartum depression is one of the most common complications of childbirth, and another is pain. A growing body of research shows that the severity and duration of postpartum pain can increase a woman’s risk for postpartum depression. Postpartum depression and pain negatively affect maternal well-being, and postpartum depression has been associated with adverse outcomes in children. However, there is a dearth of information about the effects of postpartum depression and pain on infant care and development. The objectives of this commentary were to highlight the need to address this gap in the literature, offer a preliminary conceptual model to advance the field, and ignite new lines of inquiry to inform infant care and development.     

The Association between Immediate Postpartum Etonogestrel Implants and Positive Postpartum Depression Screens in Adolescents and Young Adults

ObjectiveWe aimed to compare rates of positive postpartum depression screens at 6 weeks postpartum among adolescents and young adults (AYA) initiating immediate postpartum contraceptive implants and those initiating other methods.DesignThrough a retrospective observational design, we collected data on demographics, reproductive history, prenatal and postnatal depression, and postpartum contraception.SettingPatients participating in an AYA prenatal-postnatal program were eligible for inclusion.ParticipantsA total of 497 patients were enrolled between January 2013 and December 2016. The median age was 19 years (range 13-22 years); 86% were primiparous, 50% were Latina, 24% were black, and 16% were white; 34% initiated immediate postpartum implants (n = 169).InterventionThose initiating a contraceptive implant within the first 14 days postpartum were included in the intervention group.Main Outcome MeasureWe compared rates of positive Edinburgh Postpartum Depression Scales (EDPS) (scores ≥10) in AYA initiating immediate postpartum implants and those initiating other contraceptive methods.ResultsThe AYA initiating immediate postpartum implants were similar to the rest of the cohort in baseline characteristics, aside from an increased rate of preterm births among the intervention group (19.4% vs 12.1%; P = .03). Prenatally, 14% had an elevated Center for Epidemiologic Studies Depression Scale (CES-D) scores (11.5% immediate postpartum implants vs 15.4% comparison, P = .25). At 6 weeks postpartum, 7.6% had a positive postpartum depression screen; this rate was significantly lower for those initiating immediate postpartum implants compared to those choosing other methods (4.1% vs 9.5%, P = .04).ConclusionsProviders should continue to encourage AYA to choose whichever highly effective contraceptive method they prefer for postpartum use.     

Use of the Postpartum Depression Screening Scale in a collaborative obstetric practice

Postpartum depression is a clinical depressive episode that occurs in 13% to 20% of women after birth or miscarriage. This illness has potentially devastating consequences for both mother and infant, and is thought to be highly underreported and under-diagnosed. Our study examined the use of the Postpartum Depression Screening Scale (PDSS) in a high-volume collaborative obstetric and midwifery practice. The prevalence of women with a positive screen for major postpartum depression in our study was 16%, which is consistent with other studies. An additional 20% of the participants had symptoms that indicated a potential postpartum depression. Obstetric clinicians were willing to use the PDSS, and 15 of 20 clinicians actively participated in the study. Women who had a positive screen at 6 weeks after birth were more likely to have not completed a high school education, be unpartnered, be exclusively bottle feeding, and have a history of depression. Two variables were statistically significant predictors of screening positively with the PDSS following logistic regression: history of depression (risk ratio, 4.8; 95% confidence interval, 4.4-5.2) and exclusive bottle feeding (risk ratio, 2.0; 95% confidence interval, 1.6-2.4).