Infant massage improves mother-infant interaction for mothers with postnatal depression

BACKGROUND: Postnatal depression can have long term adverse consequences for the mother-infant relationship and the infant's development. Improving a mother's depression per se has been found to have little impact on mother-infant interaction. The aims of this study were to determine whether attending regular massage classes could reduce maternal depression and also improve the quality of mother-infant interaction. METHOD: Thirty-four primiparous depressed mothers, median 9 weeks postpartum, identified as being depressed following completion of the Edinburgh Postnatal Depression Scale (EPDS) at 4 weeks postpartum, were randomly allocated either to an infant massage class and a support group (massage group) or to a support group (control group). Each group attended for five weekly sessions. Changes in maternal depression and mother-infant interaction were assessed at the beginning and the end of the study by comparing EPDS scores and ratings of videotaped mother-infant interaction. RESULTS: The EPDS scores fell in both groups. Significant improvement of mother-infant interaction was seen only in the massage group. LIMITATION: The sample size was small and had relatively high dropout. It was not possible to distinguish which aspects of the infant massage class contributed to the benefit. CONCLUSION: This study suggests that learning the practice of infant massage by mothers is an effective treatment for facilitating mother-infant interaction in mothers with postnatal depression.     

Maternal touch and maternal child-directed speech: effects of depressed mood in the postnatal period

BACKGROUND: Postnatal depression affects the emotional state of mothers and the quality of mother-infant interaction. METHOD: Touch behaviour and content of child-directed speech were analysed for 72 mothers and their infants during pleasurable play. Infants (18) of mothers with depressed mood and 18 controls were seen when they were 6 months old; and 18 infants of mothers with depressed mood and 18 controls were seen when they were 10 months old. RESULTS: Depressed mothers in comparison with non-depressed mothers lifted their infants more, restraining their behaviours. Infants of depressed mothers in contrast to infants of non-depressed mothers spent greater periods of time in touching self rather than mother or toy, compensating for the lack of positive touch from their mothers. Mothers with depressed mood of 6-month-old infants included fewer affective and informative features in their speech than their controls. Non-depressed mothers of younger babies showed a higher use of affective features when compared with non-depressed mothers of older infants. In contrast, depressed mothers of 6- and 10-month-old babies showed similar frequencies of affect-salient speech during interactions in spite of their infants' changing developmental demands. LIMITATIONS: Mothers in this study were only mildly depressed, as assessed by the Edinburgh Postnatal Depression Scale (EPDS). Nevertheless, the findings indicate that mothers with depressive symptoms differ from non-depressed mothers in relation to touch and content of speech when interacting with their infants. CONCLUSIONS: These results suggest that postnatal depression may influence touch behaviour as well as the affective and informative content of maternal speech. The effect is that mothers with depressed mood in comparison with non-depressed mothers touch their infants more negatively and their speech is less well adjusted concerning the amount of emotional vs. information-related content thereby preventing depressed mothers from responding effectively to their infants' developmental needs.     

The Edinburgh Postnatal Depression Scale detects but does not distinguish anxiety disorders from depression in mothers of infants

Specific screening tests to detect postpartum anxiety are as yet unavailable. The aim of this study was to test the ability of the Edinburgh Postnatal Depression Scale (EPDS) to detect anxiety disorders in women admitted to residential early parenting centres. Consecutive cohorts of English speaking women admitted with their infants to two centres in Melbourne, Australia completed the Composite International Diagnostic Interview and the Edinburgh Postnatal Depression Scale (EPDS). Anxiety and depression diagnoses were compared with EPDS scores. Of the 145 women (78% recruitment rate), 138 (95%) provided complete data of whom 35 (25%) had at least one anxiety disorder. EPDS scores over 12 correctly identified 28 women (44%) as having major depression, either alone or co-morbid with an anxiety disorder but 10 (16%) had only an anxiety disorder and were not depressed. All of the 26 (41%) women with EPDS scores over 12 with neither diagnosis met diagnostic criteria for minor depression or an adjustment disorder. EPDS scores were unable to distinguish between these diagnostic groups. The presumption that EPDS scores over 12 indicate only probable depression is an oversimplification. Current national initiatives recommend that EPDS scores over 12 warrant treatment for depression, which may lead to inappropriate labeling and therapy.     

Postpartum depression and mother-infant relationship at 3 months old

Background: This paper is part of a prospective, epidemiologic study concerning postpartum depression (PPD). The women were first examined during pregnancy; after delivery they were seen with their infants at 3 and 18 months. The present study focuses on the 3-months-postpartum results. Methods: A sample of 570 women and their infants were examined 3 months after delivery. Using the EPDS (Edinburgh Postnatal Depression Scale; Cox et al., 1987. Br. J. Psychiatry 150:782–786), 10.2% of these new mothers presented PPD. The focus of the study concerned the effects of this neurotic disorder on the mother, the infant and on the mother–infant relationship. Results: The deleterious effects concerning the infant were functional disorders such as eating or sleeping difficulties. The ‘depressed’ dyads presented less vocal and visual communications, less corporal interactions and less smiling. Conditions surrounding delivery and tiredness at 3 months are linked to difficulties in mother–infant relationship for the non-depressed mothers. Logistic models showed that primiparous PPD mothers have difficulties bathing their infants, whereas multiparous PPD mothers are more tired. Limitation: This study did not take into account either protective factors or the effects of the infant himself. Clinical relevance: Knowledge of the mothers’ and infants’ difficulties may help caregivers to detect these at-risk dyads and initiate therapeutic measures.     

Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners

BACKGROUND: The Edinburgh Postnatal Depression Scale (EPDS) has been validated and used extensively in screening for depression in new mothers, both in English speaking and non-English speaking communities. While some studies have reported the use of the EPDS with fathers, none have validated it for this group, and thus the appropriate cut-off score for screening for depression or anxiety caseness for this population is not known. METHODS: Couples were recruited antenatally and interviewed at six weeks postpartum. EPDS scores and distress caseness (depression or anxiety disorders) for 208 fathers and 230 mothers were determined using the Diagnostic Interview Schedule. RESULTS: Analyses of the EPDS for fathers using distress caseness (depression or anxiety disorders) as the criterion shows that a cut-off of 5/6 has optimum receiver operating characteristics. Furthermore acceptable reliability (split-half and internal consistency) and validity (concurrent) coefficients were obtained. For mothers the optimum cut-off screening value to detect distress caseness was 7/8. Item analysis revealed that fathers endorsed seven of the ten items at lower rates to mothers, with the most significant being that referring to crying. CONCLUSIONS: The EPDS is a reliable and valid measure of mood in fathers. Screening for depression or anxiety disorders in fathers requires a two point lower cut-off than screening for depression or anxiety in mothers, and we recommend this cut-off to be 5/6.     

Interventions with depressed mothers and their infants: modifying interactive behaviours

BACKGROUND: Postpartum depression (PPD) has a prevalence ranging from 3% to 30% and is associated with serious infant growth and developmental problems. Interventions directed at improving maternal mood have been unsuccessful in producing changes in observed face-to-face interactions between mother and infant. The Keys to Caregiving (KTC) is an intervention program that helps parents to understand and respond to infant behaviours, with a goal of increasing positive affective expressions in infants. In this pilot study, KTC was used with mothers suffering from mild to moderate PPD and their infants. METHODS: PPD was confirmed by scores on the Edinburgh Postnatal Depression Scale and the Beck Depression Inventory. Eleven dyads completed the study. KTC was carried out in 5 weekly group sessions, beginning at infant age of 3 months. Dyads were videotaped prior to and after KTC, using the Face-to-Face Still-Face paradigm, which assesses infants' responses during normal play and the effects of the Still-Face perturbation. The tapes were scored for infant facial emotion expressions. RESULTS: After intervention, infants displayed a marked increase in Interest and Joy when interacting face-to-face with their mothers, even though mothers' depression ratings did not change. LIMITATIONS: This pilot study is limited by lack of control dyads, however, it provides the foundation necessary for a full trial. CONCLUSIONS: This study suggests that intervention that focuses on what mothers do with their infants instead of how they feel can be effective in increasing infants' positive responsiveness and improving infant outcomes. Such interventions can be an essential component of treatment when mothers present with postpartum depression.     

Mother-child bonding at 1 year; associations with symptoms of postnatal depression and bonding in the first few weeks

Some mothers experience neutral or negative feelings toward their new infant. This study examined the association between symptoms of postnatal depression and mother–infant bonding and the persistence of these feelings over the first year. Bonding was assessed using the Mother–Infant Bonding Scale (MIBQ), at four times postnatal, “early weeks” (1–4 weeks), 9 weeks, 16 weeks and 1 year, in 50 depressed, Edinburgh Postnatal Depression scale (EPDS) ≥13 at 4 weeks post natal, and 29 non-depressed mothers. A significant association between the EPDS score at 4 weeks and bonding score at 1–4 weeks, 9 weeks, and at 1 year postnatal, χ ²(1)?=?9.85, p?<?0.01, 5.44, p?<?0.05 and 5.21, p?<?0.05, respectively, was found, with a trend at 16 weeks. There was a strong association between bonding in the early weeks and all later time points χ ²(1)?=?17.26, p?<?0.001, 7.89, p?<?0.01 and 13.69, p?<?0.001, respectively. Regression showed early bonding rather than early depression was the major predictor of bonding at 1 year. Women who are depressed postnatally can fail to bond well with their baby and this can persist for a year. Early identification and intervention for poor bonding is indicated.     

Postpartum Maternal Sleep,Maternal Depressive Symptoms and Self-Perceived Mother–Infant Emotional Relationship

This study examined the links between maternal sleep, maternal depressive symptoms, and mothers’ perceptions of their emotional relationship with their infant in a self-recruited sample of mothers. Eighty mothers of infants 3–18 months old completed sleep diaries for 5 consecutive nights, and questionnaires assessing sleep (Insomnia Severity Index [ISI]), depressive symptom severity (Edinburgh Postnatal Depression Scale [EPDS]), and perceived mother–infant relationship (Postpartum Bonding Questionnaire [PBQ] and Maternal Postnatal Attachment Questionnaire [MPAQ]). Significant correlations, controlling for depression severity, were found between more disturbed maternal sleep and more negative maternal perceptions of the mother-infant relationship. Regression analyses revealed that EPDS showed the strongest association with PBQ, whereas ISI demonstrated the strongest association with MPAQ. The present study highlights the importance of deepening and expanding our understanding of the negative implications of maternal sleep problems.     

Identifying depression in the first postpartum year: guidelines for office-based screening and referral

BACKGROUND: Some 10-15% of women experience postpartum-onset major depression (PPMD). The objective of this study was to determine if the Edinburgh Postnatal Depression Scale (EPDS) is an effective screen for major depression (MD) prospectively. The outcome of the study was identification of a recurrence of major depression in the first year postpartum by a clinical interview and the EPDS. We had the unique opportunity to examine the relationship between EPDS scores and PPMD. METHODS: Participants were pregnant women who had experienced an episode of previous PPMD but were well during their index pregnancy. This study was part of a double-blind, randomized clinical trial in which new mothers received nortriptyline or placebo within 24 h following delivery for prevention of PPMD. Recurrence of depression was established according to Research Diagnostic Criteria. Participants completed the EPDS weekly through 20 weeks postpartum and into a 1-year follow-up phase. RESULTS: Out of 50 women, 13 experienced recurrence of MD in the first 20 weeks postpartum with a total of 20 out of 50 recurring in the first year. The EPDS score of >9 at week 4 postpartum identified 60% of women who nurtured in the first 20 weeks and 80% who recurred in the first postpartum year. Limitations: The study population included only women who had a previous episode of postpartum depression. The generalizability to all women is limited. CONCLUSIONS: The EPDS is an effective depression screen for women who had a previous episode of PPMD. Clinical guidelines are provided for use of the EPDS to identify MD in the first postpartum year in primary care settings.     

Association between parental depressive symptoms and impaired bonding with the infant

Impaired bonding with the infant is associated with maternal postpartum depression but has not been investigated extensively in fathers. The primary study aim was to evaluate associations between maternal and paternal depressive symptoms and impaired bonding with their infant. A secondary aim was to determine the associations between parents’ marital problems and impaired bonding with the infant. The study is part of a population-based cohort project (UPPSAT) in Uppsala, Sweden. The Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks and 6 months postpartum and the Postpartum Bonding Questionnaire at 6 months postpartum were completed by 727 couples. The prevalence of impaired bonding was highest among couples in which both spouses had depressive symptoms. Impaired bonding was associated with higher EPDS scores in both mothers and fathers, as well as with experiencing a deteriorated marital relationship. The association between maternal and paternal impaired bonding and the mothers’ and fathers’ EPDS scores remained significant even after adjustment for relevant confounding factors. Depressive symptoms at 6 weeks postpartum are associated with impaired bonding with the infant at 6 months postpartum for both mothers and fathers. It is critical to screen for and prevent depressive symptoms in both parents during early parenthood.     

Antenatal risk factors for postnatal depression: a large prospective study

BACKGROUND: This study measured antenatal risk factors for postnatal depression in the Australian population, both singly and in combination. Risk factor data were gathered antenatally and depressive symptoms measured via the beyondblue National Postnatal Depression Program, a large prospective cohort study into perinatal mental health, conducted in all six states of Australia, and in the Australian Capital Territory, between 2002 and 2005. METHODS: Pregnant women were screened for symptoms of postnatal depression at antenatal clinics in maternity services around Australia using the Edinburgh Postnatal Depression Scale (EPDS) and a psychosocial risk factor questionnaire that covered key demographic and psychosocial information. RESULTS: From a total of 40,333 participants, we collected antenatal EPDS data from 35,374 women and 3144 of these had a score >12 (8.9%). Subsequently, efforts were made to follow-up 22,968 women with a postnatal EPDS. Of 12,361 women who completed postnatal EPDS forms, 925 (7.5%) had an EPDS score >12. Antenatal depression together with a prior history of depression and a low level of partner support were the strongest independent antenatal predictors of a postnatal EPDS score >12. LIMITATIONS: The two main limitations of the study were the use of the EPDS (a self-report screening tool) as the measure of depressive symptoms rather than a clinical diagnosis, and the rate of attrition between antenatal screening and the collection of postnatal follow-up data. CONCLUSIONS: Antenatal depressive symptoms appear to be as common as postnatal depressive symptoms. Previous depression, current depression/anxiety, and low partner support are found to be key antenatal risk factors for postnatal depression in this large prospective cohort, consistent with existing meta-analytic surveys. Current depression/anxiety (and to some extent social support) may be amenable to change and can therefore be targeted for intervention.     

Can we identify mothers at risk for postpartum depression in the immediate postpartum period using the Edinburgh Postnatal Depression Scale?

BACKGROUND: Postpartum depression is a major health issue for many women around the world with well-documented negative health consequences for the mother, child and family. While research has demonstrated the amenability of postpartum depression to treatment, there is preliminary evidence suggesting maternal mood in the immediate postpartum period may be predictive of postpartum depression such that secondary preventive interventions may be implemented. METHODS: A population-based sample of 594 mothers completed the Edinburgh Postnatal Depression Scale (EPDS) at 1, 4 and 8 weeks postpartum. The sensitivity, specificity and predictive power of the 1-week EPDS in relation to identifying mothers with elevated EPDS scores at 4 and 8 weeks was determined. The predictive power of the 1-week EPDS was further assessed using odds ratios and receiver operator characteristic (ROC) curves. RESULTS: At 1 week postpartum, 29.5% of mothers scored >9 on the EPDS, decreasing to 23% at 4 weeks and 20.5% at 8 weeks. Using the cut-off score of 9/10, the 1-week EPDS accurately classified 85.4% mothers at 4 weeks and 82.5% mothers at 8 weeks with or without postpartum depression symptomatology. The 1-week EPDS was significantly correlated to the 4-week (r=0.72, P<0.001) and 8-week (r=0.65, P<0.001) EPDS. Mothers with a 1-week EPDS score >9 were 30.3 times more likely at 4 weeks (95% CI=17.5-42.3) and 19.1 times more likely at 8 weeks (95% CI=11.0-32.9) to exhibit postpartum depression symptomatology. LIMITATIONS: Psychiatric interviews were not completed in collaboration with the EPDS. CONCLUSION: The EPDS administered in the 1st week postpartum was predictive of maternal mood at 4 and 8 weeks postpartum. To identify mothers at high risk for postpartum depression, health care professionals could consider screening all new mothers in the immediate postpartum period such that secondary preventive interventions may be implemented.     

Patterns of brain electrical activity in infants of depressed mothers who breastfeed and bottle feed: the mediating role of infant temperament

Successful breastfeeding involves a dyadic interaction between a mother and her infant. The present study was designed to examine the association between breastfeeding and temperament in infants of depressed mothers. Seventy-eight mothers, 31 who were depressed, and their infants participated. Depressed mothers who had stable breastfeeding patterns were less likely to have infants with highly reactive temperaments. Multivariate analyses of variances (MANOVAs) showed that infants of depressed mothers who breastfed did not show the frontal asymmetry patterns, i.e., left frontal hypoactivity, previously reported. Moreover, breastfeeding stability, even in depressed mothers, was related to more positive dyadic interactions. Finally, a model was supported, in which the effects of maternal depression on infant feeding are mediated by infant frontal EEG asymmetry and infant temperament. These findings could provide a foundation for developing intervention techniques, employing breastfeeding promotion and support, directed toward attenuating the affective and physiological dysregulation already noted in infants of depressed mothers.     

Mood and anxiety disorders in a sample of Canadian perinatal women referred for psychiatric care

Perinatal depression currently receives considerable attention, but not all perinatal women presenting for psychiatric care are depressed. The Edinburgh Postnatal Depression Scale (EPDS) is now routinely administered, but high scores are interpreted as evidence for depressive illness only. This study examined psychiatric diagnoses and mean EPDS scores among perinatal women at a tertiary center. Women accessing care between March 2006 and June 2008 completed a clinical diagnostic interview and the EPDS. Mean EPDS scores were calculated for each psychiatric diagnosis; sensitivity and specificity were calculated for major depressive episode (MDE) and generalized anxiety disorder (GAD). The majority of the sample (N?=?91), 49.5%, had GAD comorbid with MDE or another anxiety disorder, followed by MDE (38.5%) comorbid with an anxiety disorder. One third (29.7%) met criteria for MDE and GAD. Only 3.3% had MDE alone and 5.5% had GAD alone. Half the sample (50.5%) had more than one psychiatric disorder. Mean EPDS scores exceeded 11 for the majority of diagnostic groups. Sensitivity of the EPDS for MDE was 0.78 and 0.70 for GAD. Most women had an anxiety disorder and met criteria for more than one psychiatric disorder. Mean EPDS scores were consistently high. Sensitivity of the EPDS for MDE and GAD was comparable.     

Attachment quality is related to the synchrony of mother and infant monitoring patterns

We investigated whether attachment quality is related to infant–mother dyadic patterns in monitoring animated social situations. Sixty 12-month-old infants and their mothers participated in an eye-tracking study in which they watched abstractly depicted distress interactions involving the separation of a “baby” and a “parent” character followed by reunion or further separation of the two characters. We measured infants’ and their mothers’ relative fixation duration to the two characters in the animations. We found that infant attachment disorganization moderated the correspondence between the monitoring patterns of infant–mother dyads during the final part of the animations resulting in reunion or separation. Organized infants and their mothers showed complementary monitoring patterns: the more the mothers focused their attention on the “baby” character, the more the infants focused their attention on the “parent” character, and vice versa. Disorganized infant–mother dyads showed the opposite pattern although the correlation was nonsignificant: mothers and their infants focused on the same character. The attachment-related differences in the nature of the synchrony in the attentional processes of infants and their mothers suggest that by 12 months the dyads’ representations of social situations reflect their shared social–emotional experiences.     

Maternal depression and infant daytime cortisol

The effect of maternal depressive disorder on infant daytime cortisol production was studied in three groups of infants; one group with mothers with comorbid depression and anxiety (n = 19), a second group with mothers with depression only (n = 7), and a third group with non‐depressed mothers (n = 24). The infants' cortisol production pattern was measured when they were 6, 12, and 18 months old in combination with repeated measures of parenting stress and depression symptoms. Multilevel modeling analyses showed that infants of mothers with comorbid depression and anxiety had relatively higher cortisol production from morning to bedtime and higher bedtime values as compared to infants of non‐depressed mothers and infants of depressed only mothers when they were 6 and 12 months old, but not when 18 months old. The results were interpreted in light of possible changes in the infants' stress regulatory capacities or changes in maternal coping strategies at infant age 18 months. © 2012 Wiley Periodicals, Inc. Dev Psychobiol 55: 334–351, 2013     

Psychological outcomes of a support intervention in mothers of children with ongoing health conditions: The parent-to-parent network

We compared depression, anxiety, anger, cognitive disturbance, and total scores on the Psychiatric Symptom Index (Ilfeld, 1976) for 365 mothers of 5-to-8 year-olds with diverse health conditions who were randomized either to an experimental (EG) or control (CG) group. EG mothers were offered a 12-month community-based support intervention; CG mothers received standard care. Posttest scores of EG and CG mothers did not differ significantly. Although intervention effects were not related to participation level or illness-related and sociodemographic factors, a significant interaction with stressful life events (SLE) was found. Among mothers reporting more than five SLE in the past year, posttest anxiety was lower in the EG than in the CG, but no difference was found between EG and CG mothers having less than five SLE. The intervention also acted as a moderator variable, with correlations of SLE and posttest depression, anxiety, and total symptoms significantly lower in the EG than CG. Possible explanations for these findings are discussed. © 1997 John Wiley & Sons, Inc.     

Screening women for postpartum depression at well baby visits: resistance encountered and recommendations

Summary Objective: Postpartum major depression afflicts 10–15% of childbearing women and can have serious consequences. Unrecognized and therefore untreated episodes of postpartum major depression can predispose women to future depressive episodes, especially those related to other reproductive events. In the United States, women typically have one visit at six weeks postpartum with their obstetrican which is focused on physical recovery from delivery. Pediatricians typically see new mothers 4–6 times per year at well baby visits. Therefore, our objective is to test the utility of screening women for postpartum depression at each well baby visit over the course of the first postpartum year as compared with controls derived from clinical practice and chart review. Method: Subjects for this prospective study were recruited at their first well baby visit at the UCSD Primary Care Pediatric Clinic and interviewed by telephone. Subjects then were asked to complete the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Depression Inventory (BDI) at intervals consistent with the timing of well baby visits. If scores on the EPDS or the BDI exceeded the thresholds (EPDS ≥ 12 and BDI ≥ 10) then subjects were assessed further with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (SCID-DSM IV). If diagnosed with postpartum major depression, subjects were referred for appropriate treatment. Results: Out of 160 study packets distributed, only 7 women volunteered for the study, despite endorsement and presentation of the study by their pediatricians. Of those participants, five scored above threshold values at some point in the interval studied. Discussion: The difficulty in recruitment in this study highlights some of the problems encountered in clinical practice in terms of identifying and referring women with postpartum mental illnesses. We recommend further study be focused on how to attract potentially affected women while simultaneously addressing their fears of stigma. Since resistance also was encountered in other physicians, we recommend that educational efforts be aimed at increasing knowledge and awareness of postpartum mental illnesses in both the lay and professional spheres. Accepted July 26, 2002; Published online October 7, 2002 Acknowledgement This project was supported by a grant for the Eli Lilly Center for Women's Health. Correspondence: Leslie Westlund Tam, M.D., 591 Camino de la Reina, #821, San Diego, CA 92116, U.S.A. e-mail: ltam@ucsd.edu     

Contribution to the epidemiology of postnatal depression in Germany – implications for the utilization of treatment

Summary Using a longitudinal screening model, 772 mothers were screened for postnatal depression after delivery in Stuttgart (Germany). This model contained the Edinburgh Postnatal Depression Scale (EPDS) and the Hamilton Depression Scale (HAMD). The first screening was 6–8 weeks after delivery with the EPDS. Mothers with high scores in the first screening had a second screening 9–12 weeks after delivery with the EPDS at least three weeks after the first. Mothers with high scores in both screenings were investigated with the Hamilton Depression Scale (HAMD).Classification was performed with the DSM-IV. After observation until the third month after delivery, 3.6% (N = 28) of the 772 mothers were diagnosed with postnatal depression. Various methods of therapy were offered to those mothers. 18% (N = 5) accepted one or more of these methods of treatment. The rest of the mothers with postnatal depression refused – mostly for attitudinal or practical reasons. 13.4% of the mothers showed high scores in the first screening but not in the second. For those mothers a longitudinal observation is currently being performed to distinguish between a depressive episode and a depression with oscillating symptoms.     

Postnatal depression in Japanese women. Detecting the early onset of postnatal depression by closely monitoring the postpartum mood

OBJECTIVES: The terminology and definition of mood disturbance during the early postpartum period has yet to be clearly elucidated among clinical practitioners. Criteria for maternity blues have not been well established, and it may overlap with the beginning of a postnatal depression. The aims of the present study, are firstly to survey the symptomatic features of mood disturbance in the very early postpartum period and secondary, to develop a guideline for detecting and predicting postnatal depression during the same period using a simple screening technique. SUBJECTS AND METHODS: Eighty-eight mothers recruited from a maternity ward for the prospective study completed the whole protocol. Two methods were used to survey the symptomatic features of mood disturbance; (1) interview and (2) self-report questionnaires. The interviews were carried out twice. At three weeks postpartum, the Schedule for Affective Disorder and Schizophrenia (SADS)/Research Diagnostic Criteria was administered, together with an interview of the symptoms of "maternity blues". The SADS interview was re-administered at three months postnatally. Two self-report questionnaires addressing mood disturbance were administered: (1) Maternity Blues Scale; (Stein, 1980). (2) Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987). The Maternity Blues Scale was administered on the first five consecutive postnatal days. The EPDS was administered on the fifth day, one month and three months postnatally. In addition, the Life Event Scale (Burgha et al., 1985) was also administered at one month postnatally. Obstetric notes were also examined. RESULTS: At the first interview, 12 mothers were diagnosed with postnatal depression and 10 of these had their onset within one week. At the second interview three additional mothers were newly diagnosed with depression. In all mothers, depression was detected at one month using the EPDS, with a cut-off of 8/9. The EPDS scores on the fifth postnatal day were also higher in the depressed mothers and could detect early onset of postnatal depression. CONCLUSION: The use of the EPDS during the early postnatal days, can be a simple and useful screening instrument for the onset of early postnatal depression.