Systematic Review and Meta-Analysis of the Prevalence of the Maternity Blues in the Postpartum Period

ObjectiveTo determine the prevalence of maternity blues among women in the postpartum period.Data SourcesWe conducted our systematic review and meta-analysis by searching the literature for relevant articles published in three international databases, PubMed, Web of Science, and Scopus, from date of inception through December 11, 2019, using the keywords prevalence, incidence, maternity blues, and baby blues.Study SelectionFrom 336 articles initially screened, we included 26 articles in the systematic review and meta-analysis.Data ExtractionTwo independent reviewers used a standardized form to extract data from eligible articles. We evaluated the quality of individual studies and the overall evidence according to Hoy et al.’s risk of bias tool.Data SynthesisThe prevalence of maternity blues in the 26 included studies was 13.7% to 76.0%. Based on the results of the random effects model, the prevalence of maternity blues in 5,667 women was 39.0% (95% confidence interval [32.3, 45.6]; I² = 96.6%). The prevalence of maternity blues among women in Africa was greatest at 49.6%.ConclusionConsidering the great prevalence of maternity blues in women after childbirth, paying attention to the key symptoms of maternity blues and implementing educational programs for health care providers and mothers after childbirth are essential.     

产母抑郁对母乳喂养的影响

目的探讨产母抑郁对母乳喂养的影响.方法对206例初产妇采用自评抑郁量表评分,分成产母抑郁组和对照组,研究泌乳指标、泌乳素水平、新生儿生理性体重下降和产后4个月纯母乳喂养率的差异.结果产母抑郁组泌乳始动时间迟,产后24h泌乳率仅为10.71%;泌乳量少,产后72h泌乳量多者仅9例;产后第三天泌乳素水平低,为198.54士21.32μg/L,新生儿生理性体重下降持续时间长,达76.82士4.73h,幅度大,为138.12士21.35g,1周体重回复率低,仅48.81%;产后4个月纯母乳喂养率低,仅16.67%.经统计学处理,两组比较有显著性差异(P＜0.01).结论产母抑郁对母乳喂养有不利影响,应引起重视,应加强对产妇进行心理健康指导.     

产后抑郁症

产后抑郁症发病率国外报道为3.5%～33%,国内报道为3.8%～16.7%.临床表现涉及情绪、认识、行为、生活等几个方面,特点为产后2周发病,4～6周症状明显.主要特征是以婴儿、丈夫相关事为主,一般认为病因是多因素的.但是,产妇分娩前后体内的内分泌变化及产妇的个性心理特点,是产后抑郁症发生的重要先决条件,一些应激性生活事件和产前产时的并发症又是产后抑郁症的主要促发因素.目前,诊断尚缺乏客观指标,多依据各种症状自评量表,由产妇自填后以相应的评分结果判定.主要是心理治疗,约1/3的患者需药物治疗.     

Postpartum Home Visits by Maternity Nursing Students

A program in which third-year nursing students in a baccalaureate program make postpartum home visits is described. Parents were assisted in adjusting to the postpartum experience by a student nurse who had cared for them during pregnancy or labor and delivery. The program was found to be beneficial by both families and nursing students.     

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.     

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.     

Culturally Induced Postpartum Depression

A three-factor theory, hasrd on an independently conducted survey of 49 primigravidas, is postulated to explain the potential that exists for cultural attitudes toward pregnancy to become precipitating agents in the postpartum depression syndrome. Changes in body proportions, public attitudes, and the social lives of expectant woman are viewed primarily as negative experiences which result in a loss of self-esteem. A means of reducing cognitive dissonance by increasing interaction with those also pregnant is proposed.     

Screening Methods for Postpartum Depression

Nine to fifteen percent of women who have recently given birth experience postpartum depression; however, only a small portion of these women are identified as depressed by health professionals. To improve this poor detection rate, a new screening tool, the Postpartum Depression Checklist (PDC), was constructed, based on the findings of two qualitative studies. The PDC is a simple, practical device for use by health professionals that provides an opportunity to engage a woman actively in a dialogue about her experiences with the 11 symptoms included on the checklist. Its use by health professionals during the 1st year postpartum may help to ensure that mothers who experience postpartum depression receive treatment.     

Postpartum Depression: A Review

ABSTRACT: Some studies link postpartum depression with the 4-day “blues,” and with severe postpartum mental illness, while other studies show differences between these or define each distinctly. Research on possible contributors to postpartum depression has moved from psychoanalytic and hormonal theories to factors in the pregnancy, birth, and postpartum periods. Interpersonal and adaptational models are presented in detail.     

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.     

Postpartum Depression Identification of High-risk Mothers

Various types of puerperal depressions, symptoms exhibited, and factors that predispose women to develop postpartum depression are reviewed. A case example of a woman who experienced a postpartum depression is discussed. A prenatal checklist is presented to assist clinicians working in obstetrics in evaluating the risk of postpartum depression in their various clients.     

A Systematic Review of the Relationship Between Postpartum Sleep Disturbance and Postpartum Depression

ObjectiveTo examine the relationship between postpartum sleep disturbance and postpartum depression and describe the characteristics and demographics of the samples.Data SourcesElectronic databases Medline, PubMed, Cochrane, EPOC, CINAHL, ProQuest, and Psych INFO. In addition, hand searches of bibliographies supplemented the electronic search.Study SelectionEnglish language primary studies on the relationship between postpartum sleep disturbance and postpartum depression were included. Thirteen observational studies met the inclusion criteria.Data ExtractionData that specified the relationship between sleep disturbance and postpartum depression were extracted from the studies. The data were organized per author, year, participants, setting, country, demographics, design, sample size, outcomes, evidence, and effect size.Data SynthesisThe effect size indicating the relationship between sleep disturbance and postpartum depression across the studies ranged between 0.4 and 1.7. There was evidence of a strong relationship between sleep disturbance and postpartum depression; however, the participants in the 13 studies were predominantly educated, middle class, older than age 30 years, and White. Likewise, the definition and measurement of postpartum sleep varied across the studies, which increased the possibility of bias.ConclusionsFurther research within the postpartum period involving underserved, younger women and samples with more diversity in race and ethnicity are needed.     

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.