Linguistic features of postpartum depression using Linguistic Inquiry and Word Count text analysis

ObjectiveThis qualitative study examines the linguistic features associated with postpartum depression.MethodsIn this longitudinal online study, 53 mothers completed self-report questionnaires assessing symptoms of postpartum depression and an expressive writing exercise about their pregnancy and birth. Mothers were randomly divided into two groups (intervention and control groups). Linguistic Inquiry and Word Count [LIWC] was used to examine the written data for depression and no depression groups.ResultsThe overall use of words varied depending on the severity of depressive symptoms. Negative emotions and introspective terms were associated with depression and lower use of first-person plural pronouns but not singular pronouns. Additionally, the groups of individuals with depression showed a positive correlation between depressive symptoms and words referring to friends, leisure activities, the body, breastfeeding, exercise, and eating attitudes.ConclusionIn addition to self-disclosure, word analysis and appropriate categorization could be useful for perinatal symptomatology in pregnant women, and interestingly also a meaningful tool that can be taught and used as a preventive care measure among pregnant and postpartum women.     

Adherence to "Doing-the-month" practices is associated with fewer physical and depressive symptoms among postpartum women in Taiwan

According to traditional Chinese custom, women should be confined to home and assisted with tasks for 1 month after giving birth to a child. This restrictive regimen is referred to as doing-the-month. The objectives of this study were to describe adherence to doing-the-month practices and to explore the association between adherence to doing-the-month practices and physical symptoms and depression among postpartum women in Taiwan. Participants were 202 women at 4-6 weeks after delivery. Adherence to doing-the-month practices was associated with lower severity of physical symptoms and lower odds of postnatal depression, after adjustment for potential confounders. Adherence to doing-the-month practices was associated with better health status among postpartum women in Taiwan.     

The association between depressive symptoms and social support in Taiwanese women during the month

The purpose of the study was to explore the association between depressive symptoms and social support in Taiwanese women doing the month. A correlational survey design using the Postpartum Social Support Questionnaire (PSSQ) and the Edinburgh Postnatal Depression Scale (EPDS) to measure social support and postnatal depressive symptomatology was employed. Two hundred and forty postpartum women receiving care in two teaching hospitals in Taipei, Taiwan, aged between 20 and 35, with no peri-natal complications or previous psychiatric history, experiencing a normal spontaneous delivery of one full term healthy baby, were selected. Each was mailed the PSSQ and the EPDS as well as a short, semi-structured self-report questionnaire requesting demographic details and subjective data relating to the experience of doing the month and depressive symptoms during the fourth week following birth. One hundred and eighty six women (78%) returned questionnaires. Taiwanese postpartum women were less depressed when they stayed in their parents' home and had their own mothers take care of them. It was found that the greater the level of postpartum social support received by the women doing the month, the lower the risk of postnatal depressive symptoms experienced. Almost a quarter (24%) of the variance of the symptoms was attributed to dissatisfaction with parents' instrumental support and unwanted emotional support from parents-in-law. It is concluded that the ritual of doing the month provides valuable social support and may help to prevent postnatal depression in Taiwanese women.     

Relationships between perineal pain and postpartum depressive symptoms: A prospective cohort study

BackgroundThe relationship between concurrent or previous postnatal pain and depressive symptoms remains controversial. To the best of our knowledge, no previous study has used validated measures and multiple scales to evaluate perineal pain, or examined its relationship with depressive symptoms during the postpartum period.ObjectivesWe investigated the association between pain and previous postnatal pain with depression during the 6-month postpartum period, and the influence of previous postnatal depressive symptoms.DesignA prospective cohort study design was used.SettingMaternity unit of a medical center.ParticipantsThis study included 432 participants; data regarding demographic characteristics, perineal pain, and any pain and depression during the 6-month postpartum period were collected.MethodsPain and depressive symptoms were measured using the Short Form-McGill Pain Questionnaire and Center for Epidemiologic Studies Depression Scale, respectively. A generalized estimating equation was used to examine factors associated with postpartum depression.ResultsAfter adjusting for covariates, women who had perineal pain at 4–6 weeks postpartum showed an increased risk for depression at 4–6 weeks (risk ratio [RR]: 1.9, 95% confidence limits [CL]: 1.2, 3.2) and 6 months (RR: 1.9, 95% CL: 1.1, 3.3) compared to those with no perineal pain. Perineal pain severity, 4–6 weeks postpartum, also predicted depressive symptoms at 6 months postpartum (β = 0.63, p = 0.02). Any pain intensity score at 3–5 days postpartum predicted depression at 3 months (β = 0.01, p = 0.04). Women with high depression scores at 3–5 days had a two- or three-fold higher risk for depression at 4–6 weeks and 3 and 6 months, respectively, compared to those with low depression scores (RR: 3.5, 95% CL: 2.2, 5.4; RR: 2.2, 95% CL: 1.3, 3.4; and RR: 2.8, 95% CL: 1.7, 4.8, respectively).ConclusionsOur study provides robust evidence that perineal pain 4–6 weeks postpartum is associated with depressive symptoms 4–6 weeks and 6 months postpartum; pain at 3–5 days postpartum predicts depressive symptoms at 3 months postpartum; and previous postnatal depressive symptoms, particularly depressive symptoms 3–5 days postpartum, predict depressive symptoms during the 6-month postpartum period.     

Depressive mood in women at childbirth predicts their mood and relationship with infant and partner during the first year postpartum

Scand J Caring Sci; 2012; 26; 245–253 Depressive mood in women at childbirth predicts their mood and relationship with infant and partner during the first year postpartum Background: Although many studies have reported negative impact of maternal depressive symptoms on family relations, few studies have explored whether or not early depressive symptoms influence interfamily relationships. The aim was to describe first‐time mothers’ feelings for their infant and partner during the first postpartum year in relation to maternal depressive symptoms. Research questions were addressed about: What is the prevalence of maternal depressive symptoms 10 days postpartum? How does maternal depressive symptoms on day 10 relate to her mood and feelings for the infant and partner at days 3 and 10, and at 6 and 12 months postpartum? Methods: A longitudinal study with first‐time mothers, normal pregnancies, giving birth to healthy babies participated in the study; altogether, n = 419. Depressive symptoms were measured by Edinburgh Postnatal Depression Scale (EPDS) at 3 and 10 days. Additional questionnaires assessing the woman’s mood and relationship with her infant and partner were filled out at days 3 and 10, and at 6 and 12 months postpartum. Results: Twenty‐two per cent of the women scored high on EPDS on day 10 postpartum. In addition, low mood seemed to remain prevalent over the baby’s first year, as confirmed by the mood scale at 6 and 12 months postpartum. Women with depressive symptoms showed less closeness, warmth and confidence as measured by the infant and partner relationship scales over the first year. Mothers with a high EPDS score on day 3 scored less optimal on the relationship scale to the infant at days 3 and 10, but not 6 or 12 months postpartum. Conclusions: To screen women for depressive symptoms, 10 days postpartum seems to be predictive of maternal assessment of maternal–infant relationship throughout the first year and enables early intervention.     

Prevalence and Predictors of Depressive Symptoms in Pregnant African American Women

African American women may be especially vulnerable to antepartum depression, a major health concern during pregnancy. This study investigated the prevalence and predictors of depressive symptoms in a sample of African American women who were between 14–17 weeks pregnant, a timeframe that is typically thought to be a time of general well-being. Two-thirds reported a CES-D score ≥ 16 indicative of depressive symptomatology. Age, perceived stress (as measured by the Perceived Stress Scale [PSS]), and anxiety (as measured by the State Trait Anxiety Inventory [STAI]) predicted depressive symptoms; the interaction between PSS and STAI scores was also a significant predictor. Our study findings suggest that early identification of stress and anxiety, in addition to depressive symptoms, is vital for intervention with this group.     

Prevalence,Severity, and Correlates of Sleep-Wake Disturbances in Long-Term Breast Cancer Survivors

ContextCurrent evidence shows that sleep-wake disturbances are a persistent problem linked to poor quality of life in women surviving breast cancer. Information regarding correlates of sleep-wake disturbances in long-term survivors is sparse.ObjectivesThe objective of this study was to refine knowledge regarding prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors (BCS) compared with age-matched women without breast cancer (WWC).MethodsThe cross-sectional convenience sample included 246 BCS and 246 WWC who completed a quality-of-life study and were matched within ±5 years of age.ResultsBCS were a mean of 5.6 years beyond completion of cancer treatment (range = 5.6–10.0 years). Based on Pittsburgh Sleep Quality Index (PSQI) scores, BCS had significantly more prevalent sleep-wake disturbances (65%) compared with WWC (55%) (P < 0.05). BCS also had significantly higher PSQI global scores indicating poorer sleep quality compared with WWC (P < 0.05). Significant correlates of prevalence of poor sleep for BCS included hot flashes, poor physical functioning, depressive symptoms, and distress, and for WWC, these included hot flashes, poor physical functioning, and depressive symptoms. Significant correlates (P < 0.05) of severity of poor sleep for BCS included presence of noncancer comorbidities, hot flashes, depressive symptoms, and residual effects of cancer treatment. For WWC, these included hot flashes, poor physical functioning, depressive symptoms, and impact of a life event.ConclusionKnowledge of prevalence, severity, and correlates of sleep-wake disturbances provides useful information to health care providers during clinical evaluations for treatment of sleep-wake disturbances in BCS.     

Different profiles of mental and physical health and stress hormone response in women victims of intimate partner violence

ObjectivesTo analyse the individual differences in the impact that intimate male partner violence (IPV) has on a woman's depressive and posttraumatic stress disorder (PTSD) symptomatology, and to determine the association of the different profiles of mental dysfunction with cortisol and dehydroepiandrosterone (DHEA) basal saliva levels as well as physical health symptoms.MethodsA cross-sectional study was carried out in which IPV victims (n=73) and control non-abused (n=31) women participated. Information was obtained through structured interviews and saliva samples were collected for hormonal assays under baseline conditions.ResultsThere were three profiles of mental symptoms in IPV subjects: no symptoms (n=19); with depressive symptoms (n=36), and depressive/PTSD symptom (n=18). None of the non-abused women had depressive or PTSD symptoms. The stress hormone response differed between groups. Only the IPV-depressive group had higher evening cortisol, and both morning and evening DHEA, but lower morning cortisol/DHEA ratio than non-abused women. Furthermore, there were differences between the IPV groups. The IPV-depressive group had lower morning cortisol and morning cortisol/DHEA ratio than the IPV-no symptoms and lower morning cortisol/DHEA ratio than the IPV-depressive/PTSD group. With respect to the physical symptoms there was an association between the mean of symptoms and the profile of mental health, the incidence being higher in the depressive/PTSD group than in the other groups.ConclusionsThis study demonstrates that there are individual differences in the impact that IPV has on the stress response and health status in women victims.     

Depressive symptoms in mothers of infants identified as genetically at risk for type 1 diabetes

OBJECTIVE: This study describes maternal depression associated with newborn genetic screening for type 1 diabetes after risk notification. RESEARCH DESIGN AND METHODS: Mothers of at-risk infants (n = 192), identified through newborn genetic screening as part of the Prospective Assessment of Newborns for Diabetes Autoimmunity study, were administered a structured telephone interview assessing maternal depressive symptoms 1 and 3.5 months after risk notification. Statistical analyses were conducted to examine predictors and correlates of maternal depressive symptoms. RESULTS: For the total sample, maternal depressive symptoms in response to infant risk status were not elevated at 1 and 3.5 months after risk notification. However, at the first interview, mothers from ethnic minority backgrounds (P < 0.002), with limited education (P < 0.001), and with postpartum depression symptomatology (P < 0.001) reported significantly more depressive symptoms in response to risk notification (r2 = 0.354). At the second interview, postpartum depression symptomatology remained a powerful predictor of depressive symptoms in response to risk notification (P < 0.001). In addition, certain coping styles (wishful thinking, self-blame, and seeking social support) were associated with increased depressive symptoms. A history of major depression was a correlate of both postpartum depressive symptomatology (r = 0.26) and maternal depressive response to risk notification (r = 0.21). CONCLUSIONS: For the most part, mothers of infants genetically at risk for type 1 diabetes do not appear to evidence elevated depressive symptoms. This suggests that most mothers are resilient when notified of infant risk. However, certain maternal characteristics such as ethnic minority status, less than a high school education, postpartum depression symptomatology, a history of major depression, and certain coping strategies (wishful thinking, self-blame, and seeking social support) appear to be associated with a more difficult maternal response to the news of an infant's increased genetic risk for type 1 diabetes.     

Hospital Delirium and Psychological Distress at 1 Year and Health-Related Quality of Life After Moderate-to-Severe Traumatic Injury Without Intracranial Hemorrhage

ObjectivesTo determine whether delirium during the hospital stay predicted health-related quality of life (HRQOL) at 1 year after injury in trauma intensive care unit (ICU) survivors without intracranial hemorrhage, and to examine the association between depressive and posttraumatic stress disorder (PTSD) symptoms and each of the HRQOL domains at 1-year follow-up.DesignPrognostic cohort with a 1-year follow-up.SettingLevel 1 trauma ICU.ParticipantsAdult patients without intracranial hemorrhage (N=173) admitted to a level 1 trauma ICU.InterventionsNot applicable.Main Outcome MeasuresHRQOL was measured with the Medical Outcomes Study 36-Item Short-Form Health Survey at 1 year after traumatic injury.ResultsAverage delirium duration ± SD was .51±1.1 days. Hierarchical multivariable linear regression analyses did not find a statistical relationship between delirium and HRQOL at 1-year follow-up. However, increased levels of depressive symptoms at 1 year were statistically associated with poorer functioning in all physical and mental health HRQOL domains, whereas PTSD at 1 year was statistically associated with all HRQOL domains except role-physical (P<.05).ConclusionsThere was no statistical association between delirium during the hospital stay and HRQOL at 1 year, which may be due to the short time spent in delirium by our study population. Depressive symptoms demonstrated a stronger relationship with mental and physical HRQOL domains at 1 year than PTSD, indicating their own unique pathway after trauma. Findings lend support for the separate assessment and management of depression and PTSD. Additional research on the duration and subtypes of delirium is needed within the trauma ICU population, as the effects are not widely known.     

Paternal depressive symptoms during the early postpartum period and the associated factors following the implementation of the two-child policy in China

AimTo evaluate the prevalence of paternal depressive symptoms during the first three days of childbirth, as well as the associated factors, following the implementation of the two-child policy in China in 2015, which allows couples to have two children in the Chinese mainland.MethodsA cross-sectional study was conducted among 318 fathers. Paternal depressive symptoms and self-efficacy of fathers were screened using the Edinburgh Postnatal Depression Scale and the General Self-Efficacy Scale, respectively. In addition, basic information of all parents and neonates was collected. Univariate analysis, binary logistic regression analysis, and principal component analysis (PCA) were used to identify the relationship between paternal depressive symptoms and its associated factors.ResultsTwenty-two percentage of fathers had depressive symptoms during the first three days of childbirth. Binary logistic regression analysis revealed that older fathers, those who slept for more than 8 h per night, or were dissatisfied with their living conditions were more susceptible to developing the symptoms. On the contrary, protective factors such as the educational level of fathers, planned pregnancy, prenatal guidance, having the second-born child, and higher self-efficacy were found to reduce the development of paternal depressive symptoms. PCA showed that the main components that influenced the paternal depressive symptoms were parental age and parity.ConclusionsThe prevalence of paternal depressive symptoms during the postpartum period did not increase significantly after the implementation of the two-child policy in China. However, focusing on the associated factors is necessary in order to manage postpartum depression during the early postpartum period.     

Perinatal depressive symptoms among Thai women: A hospital‐based longitudinal study

The authors of this longitudinal study investigated risk factors for postpartum depressive symptoms and differences in depressive symptoms at late pregnancy and at 1 and 3 months postpartum. In Sakhonnakhon Province, in northeastern Thailand, 449 women were recruited during late pregnancy and followed at 1 and 3 months postpartum with the use of psychosocial factors. Depressive symptom scores were measured using the Edinburgh Postnatal Depression Scale (EPDS). The scores were compared using dependent‐samples t‐tests, and multiple linear regression analyses were used to identify risk factors for depressive symptoms at 1 and 3 months postpartum. EPDS scores decreased from late pregnancy to 1 month postpartum and remained on the same level until 3 months postpartum. Low psychological well‐being scores and low personal monthly income were risk factors for increased EPDS scores at 1 and 3 months postpartum. Pregnant women in Thailand who have a low income, have limited social support, and report low psychological well‐being are at increased risk for postpartum depression. Results of this study suggest they should be screened for depressive symptoms during pregnancy, referred for diagnosis, and provided treatment to reduce the risk of ongoing depressive symptoms during the postpartum period.     

Depressive symptoms among HIV-positive postpartum women in Thailand

Depressive symptoms have been linked to faster progression to AIDS in HIV-positive individuals. The purpose of this correlational, cross-sectional study was to examine the prevalence and predictors of depressive symptoms among postpartum women in Thailand who are HIV-positive. Data were collected at postpartum outpatient units in four hospitals in Thailand from June 2005 to December 2007. Eighty-five HIV-positive postpartum women completed questionnaires on depressive symptoms, self-esteem, emotional support, physical symptoms, infant health status, and demographics. Results showed that 74.1% of the participants reported depressive symptoms. Self-esteem, infant health status, and education were negatively associated with depressive symptoms. Because of the high rates of depression in our study, all HIV-positive postpartum women in Thailand should be screened for depressive symptoms.     

Altered Perceptions of Personal Control About Retained Weight and Depressive Symptoms in Low-Income Postpartum Women

Postpartum weight retention and depressive symptoms have a high prevalence among low income women. This qualitative study describes low-income women's experiences of weight changes and depressive symptoms during the late postpartum period. Women (n = 25) who were either overweight or had depressive symptoms, or both, at 12 months postpartum participated in an ethnically-congruent focus group. Women's experiences indicated altered personal control related to retained postpartum weight and depressive feelings. Retained weight negatively affected self-esteem and family functioning. Depression left women feeling isolated yet reluctant to seek help. These findings could provide the basis for health promotion interventions relevant to this population.     

Predicting Changes in Depressive Symptoms from Pregnancy to Postpartum: The Role of Brooding Rumination and Negative Inferential Styles

The current study examined the role of cognitive factors in the development and maintenance of depressive symptoms from pregnancy into the postpartum period. One hundred and one women were assessed for levels of rumination (brooding and reflection), negative inferential styles, and depressive symptoms in their third trimester of pregnancy and depressive symptom levels again at 4 and 8 weeks postpartum. We found that, although none of the three cognitive variables predicted women’s initial depressive reactions following childbirth (from pregnancy to 1 month postpartum), brooding rumination and negative inferential styles predicted longer-term depressive symptom changes (from pregnancy to 2 months postpartum). However, the predictive validity of women’s negative inferential styles was limited to women already exhibiting relatively high depressive symptom levels during pregnancy, suggesting that it was more strongly related to the maintenance of depressive symptoms into the postpartum period rather than increases in depressive symptoms following childbirth. Modifying cognitive risk factors, therefore, may be an important focus of intervention for depression during pregnancy.     

Do secondary conditions explain the relationship between depression and health care cost in women with physical disabilities?

Morgan RO, Byrne MM, Hughes RB, Petersen NJ, Taylor HB, Robinson-Whelen S, Hasche JC, Nosek MA. Do secondary conditions explain the relationship between depression and health care cost in women with physical disabilities?

Objective

To examine the influence of depression on health care utilization and costs among women with disabilities and to determine whether the severity of other secondary health conditions affects this association.

Design

A time series of 7 interviews over a 1-year period.

Setting

Large, southern metropolitan area.

Participants

Community-dwelling women (N=349) with a self-identified diagnosis of a physical disability.

Interventions

Not applicable.

Main Outcome Measures

Primary disability, secondary health conditions (Health Conditions Checklist), depressive symptoms (Beck Depression Inventory-Second Edition), and health care utilization (based on the Health and Social Service Utilization Questionnaire and the Stanford Health Assessment Questionnaire). We estimated health care costs using standardized criteria and published average costs.

Results

Outpatient and emergency department health care utilization and overall costs were higher in women with depressive symptoms and increased with the frequency and severity of the symptoms. Depressive symptoms were highly correlated with the severity of secondary health conditions. Adjusting for demographics and primary disability, both the presence and severity of depressive symptoms were associated with significantly higher health care costs. However, secondary health condition severity explained the association between depressive symptoms and cost; it also substantially increased the variance in cost that was explained by the multivariate models.

Conclusions

Secondary health conditions are significantly associated with depressive symptoms and higher health care costs, with secondary health conditions accounting for the association between depressive symptoms and costs. This association suggests that effective management of secondary health conditions may help reduce both depressive symptomatology and health care costs.     

Predictors of psychological distress in low‐income mothers over the first postpartum year

Up to 25% of postpartum women experience psychological distress including stress, depressive, or anxiety symptoms during the postpartum period. The purpose of this study was to explore the extent to which social determinants of health and allostatic load score, a 10‐item index of biologic measures of chronic stress, predict psychological distress in low‐income pregnant women over the first postpartum year. We conducted a secondary data analysis of the Child Community Health Research Network data set. The psychological distress outcome variables were perceived stress (n = 842), depression ( n = 845), and anxiety ( n = 846) symptoms, all measured categorically over the first year postpartum (T1:1 month, T2: 24–29 weeks, and T3: 50–65 weeks). Our predictors were social determinants of health (e.g., demographics, maternal hardship, percent poverty level, interpersonal violence, and food security) and allostatic load score. Generalized linear mixed models were used to determine which predictors were significantly associated with psychological distress symptoms across the first postpartum year. Interpersonal violence was a statistically significant risk factor for stress, depression, and anxiety symptoms over the first year postpartum. Other significant risk factors included low‐income level, nativity, and perceived food security. Receiving food stamps was a significant protective factor for stress symptoms. The significance of risk factors for psychological distress, both modifiable and nonmodifiable, can be used as potential targets for further research, screening, and intervention. Future work should explore why and in what conditions these risk factors vary over time.     

Acculturation level and postpartum depression in Hispanic mothers

PURPOSE: Perinatal health outcomes for Hispanic women are associated with acculturation. The purpose of this study was to explore the relationship between acculturation levels and postpartum depressive symptomatology and diagnosed postpartum depression among Hispanic subgroups. STUDY DESIGN AND METHODS: The Postpartum Depression Screening Scale and the Short Acculturation Scale were used in the two phases of data collection. Phase 1 and 2 samples consisted of 377 and 150 Hispanic mothers, respectively. Puerto Rican mothers showed higher levels of acculturation than Mexican and other Hispanic women. A DSM-IV diagnostic interview (SCID) was used to establish a diagnosis of depression. Hierarchical regression analyses were used to study the unique relationships between ethnicity, depressive symptomatology, diagnosed depression, and acculturation. RESULTS: There was no consistent relationship between acculturation and postpartum depression. Significant predictors of elevated postpartum depressive symptoms in Hispanic mothers were Puerto Rican ethnicity and cesarean delivery. Single marital status was a significant risk factor for postpartum depression. A limitation of the study was use of language as the sole criterion measure for acculturation. Acculturation is a complex construct with problematic measurement that needs greater refinement to facilitate research in which it is used as a variable. CLINICAL IMPLICATIONS: Hispanic mothers are a heterogeneous group and should not be treated as a homogeneous group. Subgroups of Hispanic mothers may not have the same level of acculturation or the same level of postpartum depressive symptomatology.