Prediction of postpartum depression by sociodemographic, obstetric and psychological factors: a prospective study

Aim:  Many studies have documented serious effects of postpartum depression. This prospective study sought to determine predictive factors for postpartum depression.
Methods:  Pregnant women ( n  = 239) were enrolled before 24 weeks in their pregnancy. At 6 weeks postpartum, 30 women who had postpartum depression and 30 non-depressed mothers were selected. The Edinburgh Postnatal Depression Scale (EPDS), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Rosenberg Self-Esteem Scale (RSES) Marital Satisfaction Scale (MSS), and the Childcare Stress Inventory (CSI) were administered to all 60 mothers at 24 weeks pregnancy, 1 week postpartum, and 6 weeks postpartum.
Results:  The differences in most of the diverse sociodemographic and obstetric factors assessed were not statistically significant. There were significant differences in MSS scores at 24 weeks pregnancy ( P  = 0.003), and EPDS ( P  < 0.001; P  = 0.002), BDI ( P  = 0.001; P  = 0.031), and BAI ( P  < 0.001; P  < 0.001) at both 24 weeks pregnant and 1 week postpartum, while there was no significant difference in the RSES scores at 24 weeks pregnant ( P  = 0.065). A logistic regression analysis was performed on the following factors: 'depressive symptoms immediately after delivery' (EPDS and BDI at 1 week postpartum), 'anxiety' (BAI prepartum), 'stress factors from relationships' (MSS prepartum and CSI at 1 week postpartum) or 'self-esteem' (RSES prepartum). When these four factors were added individually to a model of the prepartum depressive symptoms (EPDS and BDI prepartum), no additional effect was found.
Conclusions:  The optimum psychological predictor is prepartum depression, and other psychological measures appear to bring no significant additional predictive power.     

Global and relationship-specific perceptions of support and the development of postpartum depressive symptomatology

Background A lack of social support has consistently been demonstrated to be an important modifiable risk factor for postpartum depression. As such, a greater understanding of specific support variables may assist health professionals in the development of effective preventive interventions. The purpose of this paper was two-fold: (1) to determine if women discriminated between global and relationship-specific perceptions of support, and (2) to examine the influence of global and relationship-specific perceptions of support in the immediate postpartum period on the development of depressive symptomatology at 8 weeks postpartum. Methods As part of a longitudinal study, a diverse sample of 594 mothers completed questionnaires that included the Edinburgh Postnatal Depression Scale (EPDS) and global and relationship-specific (e.g., partner, mother, and other women with children) measures of support. Results Mothers clearly discriminated between global and relationship-specific perceptions of support and those with depressive symptomatology at 8 weeks had significantly lower perceptions of both global and relationship-specific support at 1-week postpartum. Using discriminant function analysis, four variables, reliable reliance from partner, nurturance from partner, attachment to other women with children, and EPDS score at 1-week postpartum, differentiated between mothers who experienced depressive symptomatology at 8 weeks and those who did not. Conclusion Relationship-specific interventions may be beneficial if they include strategies that target a positive partner relationship through preceptions of reliable alliance and feeling needed and provide opportunites for interaction with other mothers. Maternal mood at 1 week postpartum was the largest predictor of depressive symptomatology at 8 weeks.     

A study of the Edinburgh Postnatal Depression Scale (EPDS) on 859 mothers: detection of mothers at risk for postpartum depression

The postpartum is a high-risk period for the occurrence of anxious and depressive episodes. Indeed, during the first few days after delivery, mothers can present postpartum blues symptomatology: fatigue, anxiety, disordered sleeping and a changing mood. Postpartum depression is characterised by a changing mood, anxiety, irritability, depression, panic and obsessional phenomena. It occurs in approximately 10 to 20% mothers. The exact prevalence depending on the criteria used for detection. The first symptoms usually appear between the fourth and sixth week postpartum. However, postpartum depression can start from the moment of birth, or may result from depression evolving continuously since pregnancy. We can add that the intensity of postpartum blues is a risk factor that can perturb maternal development. So it is important for health professionals to dispose of predictive tools. This study is a validation of the French version of the EPDS. The aims of the study were to evaluate the postpartum depression predictive value at 3 days postpartum and to determine a cut-off score for major depression. Subjects participating in this study were met in 3 obstetrical clinics in, or in the vicinity of, Toulouse. Mothers with psychological problems, under treatment for psychological problems or mothers whose babies present serious health problems were excluded from the study. The EPDS was presented to 859 mothers (mean age=30.3; SD=4.5) met at one of the clinics at 3 days postpartum (period 1). They had an EPDS mean score of 6.4 (SD=4.6); 258 (30%) mothers had an EPDS score 9. 82.6% of these mothers experienced a natural childbirth and 17.3% a caesarean section; 51.5% gave birth to their first child, 36.2% to their second child and 12.3% to their third or more. All subjects were given a second EPDS with written instructions to complete the scale during the period 4 to 6 weeks postpartum and return it for analysis (period 2). Between the 4 to 6 weeks postpartum period, 722 mothers replied again to the EPDS. 131 mothers had an EPDS score 11 (mean age=30.3; SD=4.8). They had an EPDS mean score of 13.6 (SD=3.3). Mothers with probable depression were interviewed and assessed, using the Mini (Mini Neuropsychiatric Interview, Lecrubier et al. 1997), the SIGH-D (Structured Interview Guide for the Hamilton Depression Scale) and the BDI (Beck Depression Inventory) in order to diagnose a major depressive episode. They had a HDRS mean score of 13.7 (SD=5.1) and a BDI mean score of 13.6 (SD=5). At 3 days postpartum, we observed that 258 mothers (30%) had an EPDS scores 9 and 164 mothers (19%) had an EPDS scores 11. Between 4 and 6 weeks postpartum, we observed 18.1% of postpartum depression (EPDS 11) and 16.8% (EPDS 12) of major postpartum depression. The analysis of the sensitivity and the specificity at 3 days postpartum provides a cut-off score of 9 (Sensibility: 0.88) (Specificity: 0.50) as predictive of postpartum depression, for this cut-off score, the type I error is low (5.8%) but the type II error is more higher (18.9%). The analysis of the sensitivity and the specificity between 4 and 6 weeks postpartum provides a cut-off score of 12 (Sensibility: 0.91) (Sensibility: 0.74) for the detection of major postpartum depression. Factor analysis shows at 3 days postpartum that the internal structure of the scale is composed of two subscales. The first factor F1 "anxiety" accounts 28% of the variance and the second factor F2 "depression" accounts 20% of the variance. Between 4 and 6 weeks postpartum, factor analysis suggests an unidimensional model in the evaluation of postpartum depression which is better than a two factor model. This factor accounts 40% of the variance. The scale has a good predictive value, and we can observe a significant correlation with the EPDS periods 1 and 2 (r=0.56; p<0.05). This result shows that the depressive mothers mood intensity predicts a future depressive risk. Furthermore, correlations between EPDS and BDI (r=0.68; p<0.05) and EPDS and HDRS (r=0.67; p<0.05) show a good convergent validity. The reliability study confirms the good internal consistency of the EPDS, at 3 days postpartum and in the postpartum depression -symptomatology evaluation (Cronbach's Alpha>0.80). In conclusion, this scale demonstrates good validity and is fast and easy use in obstetrical services, allowing early detection of women who risk to develop postpartum depression and, in the first week of postpartum, of mothers who suffer from a major postpartum depression. The use of the EPDS for an early screening of the risk of postnatal depression which is essential considering the consequences that postnatal depression can have on the development of the infant, on the quality of the relationship within the couple and on other social relationships. Mothers at risk for postnatal depression should be controlled and surveyed by the health professionals in obstetrical clinics.     

流产后抑郁障碍调查

目的：主要调查香港地区中国妇女流产后精神疾病的患病率。方法：对282名妇女在流产后6周用30项一般健康问卷（GHQ）、Edinburgh产后抑郁量表（EPDS）和Beck抑郁量表（BDI）进行评定,以DSM－Ⅲ-R定式检查（SCID）建立诊断,检验GHQ、EPDS与DSM－Ⅲ-R诊断间效标效度,以及和BDI间的平行效度。结果：29名妇女（10．3％）符合DSM-Ⅳ-R重症抑郁诊断,GHQ、EPDS具有良好的效标效度和平行效度。结论：中国香港妇女流产后精神障碍患病率降低,EPDS、GHQ适合用于综合性医院中流产后抑郁障碍的筛查。     

Expression of depressive symptoms in a nonclinical Brazilian adolescent sample.

OBJECTIVE: This study aimed to detect the prevalence of depressive symptomatology and its expression in a nonclinical Brazilian adolescent student sample. METHOD: A sample of students from private and public schools (n = 1555, aged 13 to 17 years) answered the Beck Depression Inventory (BDI). We performed factor analysis of the BDI as an indicator of the expression of depressive symptomatology. The following cut-off scores defined nonclinical subgroups: "nondepressed," BDI < 15; "dysphoria," BDI 16 to 20; and "depressed," BDI > 20. We used discriminant analysis to test whether these subgroups could be separated by the depression-specific and nonspecific items. RESULTS: The point prevalence of depression was 7.6%, according to the BDI cut-off of 20. Girls had higher scores than boys in several items. Scores increased with age. Students from public schools had higher scores than did private school students. Factor analysis showed 2 common factors for the total sample and for each sex: the cognitive affective dimension and the somatic nonspecific dimension. In the adolescents showing clinical depression, items related to self-depreciation, sense of failure, guilty feelings, self-dislike, suicidal wishes, and distortion of body image were common components of BDI factors. Discriminant analysis showed that the BDI highly discriminates depressive symptomatology in adolescent students and also measures specific aspects of depression. CONCLUSIONS: The BDI is useful as a measure of specific aspects of depression in nonclinical adolescent samples; it was able to detect depression in approximately 7% of the surveyed population. The expression of depressive symptoms in a Brazilian adolescent population is compatible with international studies in this age group. Detecting depressive symptoms in a school population is a critical preventive strategy; to avoid damage to the learning process, it should be followed with further referral to treatment when needed.     

共情能力与产后抑郁症状的相关性研究

目的:探讨共情能力与产后抑郁症状的相关性.方法:对1366例符合入组标准的产后42 d回院进行产后保健的产妇,按照自愿原则进行一般人口学资料的收集,并进行爱丁堡产后抑郁量表(EPDS)、人际反应指针问卷(IRI-C)自评;以EPDS≥9分为划界值将入组者分组及组间比较;分析EPDS评分与IRI-C评分间的关系.结果:共...     

Prevalence of postnatal depression in Western Nigerian women: a controlled study

Objective The objective of this study is to compare the prevalence of depression in postpartum women and that of non-postpartum women. Method A total of 876 women recruited at 6 weeks postpartum and 900 matched non-postpartum women were administered the Beck's Depressive Inventory (BDI) and translated local version of the EPDS. Psychiatric diagnosis was made using the using the modified non-patient version of Structured Clinical Interview for DSM-III-R (SCID-NP). Results Depressive disorder was diagnosed in 128 (14.6%) of the postpartum women and in 55 (6.3%) of the non-postpartum women, and the difference was found to be significant (t=8.919, df=875, P<0.001). The postpartum women had higher EPDS and BDI scores than the non-postpartum women. The EPDS correlated well with the SCID-NP diagnosis with a Spearman's correlation of 0.600 (P<0.001) and with the BDI score with a Spearman's correlation of 0.461 (P<0.001). The sensitivity of the EPDS at cut-off score of 8/9 was 94% and specificity was 97%. Conclusion The prevalence of postnatal depression in Nigeria is comparable to that of the western world and the Yoruba version of EPDS is a valid instrument for screening postnatal women for depressive disorders in a Nigerian community.     

The relationship between alexithymia and perinatal depressive symptomatology

OBJECTIVE: The purpose of this study was to examine the relationship between alexithymia and perinatal depressive symptoms and the stability of the alexithymia construct in a sample of low-income, predominantly Latina women during pregnancy and the early postpartum period. METHODS: Seventy-seven pregnant women completed self-report questionnaires and were classified as "high risk" or "low risk" for developing a major depressive episode based on a history of depression and/or current high depressive symptom scores. Measures included the Toronto Alexithymia Scale, the Center for Epidemiological Studies Depression Scale, and the Maternal Mood Screener, and were completed during pregnancy and at postpartum month 2. RESULTS: Alexithymia was positively associated with depressive symptoms during pregnancy and early postpartum. Women at high risk for depression had significantly higher alexithymia levels than low-risk women during pregnancy but not during postpartum. Alexithymia and depressive symptoms were independently and strongly correlated across the ante- and postpartum periods. Hierarchical regression analyses indicate that alexithymia scores at postpartum were predicted by alexithymia scores during pregnancy, above and beyond the variance explained by the depressive symptom scores during pregnancy and postpartum. CONCLUSION: Alexithymia is positively correlated with depressive symptoms during the perinatal period and is a stable phenomenon.     

Depressive symptomatology in the immediate postnatal period: identifying maternal characteristics related to true- and false-positive screening scores.

OBJECTIVE: To determine whether true- and false-positive postnatal depression screening scores can be distinguished during the early postpartum period by examining characteristic differences between 2 groups: 1) women with depressive symptomatology at 1 week postpartum who continue to exhibit symptoms at 8 weeks postpartum, compared with those who do not; and 2) women with depressive symptomatology at 8 weeks postpartum who previously exhibited symptoms at 1 week postpartum, compared with those who did not. METHOD: As part of a longitudinal postpartum depression study, a population-based sample of 594 women completed mailed questionnaires at 1, 4, and 8 weeks postpartum. RESULTS: Among women with depressive symptomatology at 1 week postpartum, diverse variables distinguished between those whose symptoms persisted or remitted at 8 weeks. These variables included recent immigrant status, psychiatric history, premenstrual symptoms, vulnerable personality, low self-esteem, child abuse history, and insufficient support. Variables that distinguished between women with depressive symptomatology at 8 weeks postpartum who previously exhibited symptoms at 1 week postpartum and those who did not included vulnerable personality, life stressors, perceived stress, insufficient support, and partner conflict. CONCLUSIONS: To address both the benefits and potential harms of early screening, positive screening scores on the Edinburgh Postnatal Depression Scale should also include an assessment of each individual woman's risk for postpartum depression and (or) chronic major depression.     

Detection, prevention and treatment of postpartum depression: a controlled study of 859 patients

This study evaluated the clinical effectiveness of a programme aimed at detecting, preventing and treating postpartum depression. The French version of the EPDS was used to measure the intensity of postpartum blues on a sample of 859 women, during their stay at the obstetrical clinic. Subjects under treatment for psychological problems were excluded from the study. Mothers scoring 9 or above on the EPDS, which is predictive of pospartum depression, were randomly assigned to a prevention and a control group. Written informed consent was obtained from the subjects after the study procedure had been explained. The prevention group received a counselling session integrating supportive, educational and cognitive-behavioral components. Therapists included five female Master's Degree level students in psychology. All therapists participated in didactic and clinical training as wells as weekly supervision from the first author. All subjects were given a second EPDS with written instructions to complete the questionnaire during the period 4 to 6 weeks postpartum and return it for analysis. At four to 6 weeks, women in the prevention group had significant reductions in the frequency of probable depression, as defined by a score of 11 or above on the EPDS (30.2% vs 48.2%, chi 2 = 7.36, dl = 1, p = 0.0067) and in the intensity of depressive symptoms measured by the mean score on the EPDS (8.5, SD = 4 vs 10.3, SD = 4.4, t = 3.06, dl = 209, p = 0.0024). Mothers with a probable depression were interviewed at home and assessed using the MINI (Mini Neuropsychiatric Interview, Lecrubier et al., 1997) to diagnose major depressive episode, the SIGH-D (Structured Interview Guide for the Hamilton Depression Rating Scale, Williams, 1988) and the BDI (Beck Depression Inventory, Beck et al., 1988). The baseline depression rating scores, EPDS (mean = 13.6, SD = 4), BDI (mean = 15.7, SD = 5.9), HDRS (mean = 14.8, SD = 6), were consistent with moderate depression. No significant differences in baseline scores were observed between the two groups on all the rating scales (p < 0.001). Mothers with probable depression in the prevention group were offered a program of 5 to 8 home visits. Most of the mothers in the prevention group (72%) agreed to participate in the program. On the contrary, most of the mothers (83.3%) who scored below 9 on the first EPDS and 11 or above on the second, who so did not received the preventive counselling session, declined to participate. This suggests the importance of the preventive session in establishing therapeutic alliance. The home visits program integrated four components, supportive, educational, cognitive-behavioral and psychodynamic centred on the mother-infant relationship in terms of the mother's personal history. Therapist participated in clinical training and weekly supervision. Fifteen women (71.4%) in the study group demonstrated complete symptom remission, as defined by HDRS score below 7 after the intervention, compared with 4 women (10.5%) in the control group (chi 2 = 23, p < 0.0001). A clearly therapeutic response to treatment was observed in the treated group with a mean reduction in HDRS score of 9.5 (DS = 6.7) from baseline. The improvement in the women in the treated group, as measured by the mean HDRS scores was statistically greater than that in the control group (m = 5.35, SD = 3.5 vs m = 15.8, SD = 4.6, t = 8.24, dl = 52, p < 0.0001). Our results indicate that a program based on an intervention at obstetrical clinics and on home visits is efficacious and well accepted for prevention, detection and treatment of postpartum depression.     

Detecting women at risk for postnatal depression using the Edinburgh Postnatal Depression Scale at 2 to 3 days postpartum.

OBJECTIVE: This study evaluates the capacity of the Edinburgh Postnatal Depression Scale (EPDS) implemented in the first days postpartum to detect women who will suffer from postnatal depression. METHOD: A sample of 1154 women completed the EPDS at 2 to 3 days postpartum and again at 4 to 6 weeks postpartum. RESULTS: There was a highly significant positive correlation between EPDS scores on both occasions (Spearman rank correlation: r = 0.59, P < 0.0001). The cut-off scores of 10 and 11 for EPDS administered at 2 to 3 days obtained good specificity, sensitivity, and positive predictive values for the cut off scores proposed for the diagnosis of postnatal depression at 4 to 6 weeks postpartum. CONCLUSION: The EPDS completed at 2 to 3 days postpartum is a useful means of detecting women at risk of postnatal depression.     

性激素、催乳素与产后抑郁的相关研究

目的：本研究主要探讨产后雌二醇（Ｅ２）、催乳素（ＰＲＬ）变化和产后抑郁症状间的关系。方法：对３８名产妇在产程开始前和产后第７２小时分别抽取血标本,使用放射免疫法检测产后Ｅ２、Ｐ和ＰＲＬ的数量变化,同时用Ｅｄｉｎｇｂｕｒｇｈ产后抑郁量表（ＥＰＤＳ）、Ｂｅｓｋ抑郁量表（ＢＤＩ）、一般健康问卷（ＧＨＱ）对产妇在产后第３天和产后第４２天进行评定。结果：产后第３天ＥＰＤＳ和ＢＤＩ量表分值显著高于产后第４２天,产后Ｅ２变化与ＥＰＤＳ、ＢＤＩ量表分呈显著负相关,产后Ｐ变化和产后第４２天ＧＨＱ量表分呈显著正相关,ＰＲＬ变化和产后情绪状况无明显关系。结论：产后内分泌激素变化可能是产后抑郁的病因之一。     

Symptomatic expression of depression among Jewish adolescents: effects of gender and age

BACKGROUND: Depression symptomatology was assessed with the Beck Depression Inventory (BDI) in a sample of Jewish adolescents, in order to compare the frequency and severity of depression with non-Jewish adolescents as well as examine gender difference of the expression of depressive symptomatology. METHOD: Subjects comprised 475 students from Jewish private schools, aged 13-17 years, who were compared with an age-matched non-Jewish sample (n=899). Kendall's definition was adopted to classify these adolescents according to level of depressive symptoms. The frequency of depression was calculated for ethnicity, gender and age strata. Discriminant analysis and principal component analysis were performed to assess the importance of depression-specific and non-specific items, along with the factor structure of the BDI, respectively. RESULTS: The overall mean score on the BDI in the Jewish and the non-Jewish sample was 9.0 (SD=6.4) and 8.6 (SD=7.2), respectively. Jewish girls and boys had comparable mean BDI scores, contrasting with non-Jewish sample, where girls complained more of depressive symptoms than boys (p<0.001). The frequency of depression, adopting a BDI cutoff of 20, was 5.1% for the Jewish sample and 6.3% for the non-Jewish sample. The frequency of depression for Jewish girls and boys was 5.5% (SE=1.4) and 4.6% (SE=1.5), respectively. On the other hand, the frequency of depression for non-Jewish girls and boys was 8.4% (SE=1.2) and 4.0% (SE=1.0), respectively. The female/male ratio of frequency of BDI-depression was 1.2 in the Jewish sample, but non-Jewish girls were twice (2.1) as likely to report depression as boys. Discriminant analysis showed that the BDI highly discriminates depressive symptomatology among Jewish adolescents, and measured specific aspects of depression. Factor analysis revealed two meaningful factors for the total sample and each gender (cognitive-affective dimension and somatic dimension), evidencing a difference between Jewish boys and Jewish girls in the symptomatic expression of depression akin to non-Jewish counterparts. CONCLUSIONS: Ethnic-cultural factor might play a role in the frequency, severity and symptomatic expression of depressive symptoms in Jewish adolescents. The lack of gender effect on depression, which might persist from adolescence to adulthood among Jewish people, should be investigated in prospective studies.     

The effect of peer support on postpartum depression: a pilot randomized controlled trial.

OBJECTIVE: To evaluate the effect of peer support (mother-to-mother) on depressive symptomatology among mothers identified as high-risk for postpartum depression (PPD). METHOD: Forty-two mothers in British Columbia were identified as high-risk for PPD according to the Edinburgh Postnatal Depression Scale (EPDS) and randomly assigned to either a control group (that is, to standard community postpartum care) or an experimental group. The experimental group received standard care plus telephone-based peer support, initiated within 48 to 72 hours of randomization, from a mother who previously experienced PPD and attended a 4-hour training session. Research assistants blind to group allocation conducted follow-up assessments on diverse outcomes, including depressive symptomatology, at 4 and 8 weeks postrandomization. RESULTS: Significant group differences were found in probable major depressive symptomatology (EPDS > 12) at the 4-week (chi 2 = 5.18, df = 1; P = 0.02) and 8-week (chi 2 = 6.37, df = 1; P = 0.01) assessments. Specifically, at the 4-week assessment 40.9% (n = 9) of mothers in the control group scored > 12 on the EPDS, compared with only 10% (n = 2) in the experimental group. Similar findings were found at the 8-week assessment, when 52.4% (n = 11) of mothers in the control group scored > 12 on the EPDS, compared with 15% (n = 3) of mothers in the experimental group. Of the 16 mothers in the experimental group who evaluated the intervention, 87.5% were satisfied with their peer-support experience. CONCLUSIONS: Telephone-based peer support may effectively decrease depressive symptomatology among new mothers. The high maternal satisfaction with, and acceptance of, the intervention suggests that a larger trial is feasible.     

Efficacy of interpersonal psychotherapy for postpartum depression

BACKGROUND: Postpartum depression causes women great suffering and has negative consequences for their social relationships and for the development of their infants. Research is needed to evaluate the efficacy of psychotherapy for postpartum depression. METHODS: A total of 120 postpartum women meeting DSM-IV criteria for major depression were recruited from the community and randomly assigned to 12 weeks of interpersonal psychotherapy (IPT) or to a waiting list condition (WLC) control group. Subjects completed interview and self-report assessments of depressive symptoms and social adjustment every 4 weeks. RESULTS: Ninety-nine of the 120 patients completed the protocol. Hamilton Rating Scale for Depression (HRSD) scores of women receiving IPT declined from 19.4 to 8.3, a significantly greater decrease than occurred in the WLC group (19.8 to 16.8). The Beck Depression Inventory (BDI) scores of women who received IPT declined from 23.6 to 10.6 over 12 weeks, a significantly greater decrease than occurred in the WLC group (23.0 to 19.2). A significantly greater proportion of women who received IPT recovered from their depressive episode based on HRSD scores of 6 or lower (37. 5%) and BDI scores of 9 or lower (43.8%) compared with women in the WLC group (13.7% and 13.7%, respectively). Women receiving IPT also had significant improvement on the Postpartum Adjustment Questionnaire and the Social Adjustment Scale-Self-Report relative to women in the WLC group. CONCLUSIONS: These findings suggest that IPT is an efficacious treatment for postpartum depression. Interpersonal psychotherapy reduced depressive symptoms and improved social adjustment, and represents an alternative to pharmacotherapy, particularly for women who are breastfeeding.     

Two studies on suicidality in the postpartum

Objective: Research in the prevalence of and risk factors for suicidality in the postpartum is extremely limited. We present here data on the prevalence of and factors associated with suicidality from two postpartum samples. Method: The first sample (SC) comprised 317 women consecutively screened for a trial of psychotherapy for postpartum depression. The second sample was a population‐based (PB) sample of 386 women. We used the Mini‐International Neuropsychiatric Interview (MINI) to assess suicidality in the SC sample and the self‐harm question of the Beck Depression Inventory (BDI9) in the PB sample. Results: According to the MINI and the BDI9, prevalence of high suicide risk was 5.7% and 11.1%, respectively, in the SC sample. Previous suicide attempts and a positive BDI were retained as predictors of suicidality. The BDI9 indicated suicidality in 8.3% of the 386 women in the PB sample; a positive BDI was retained in the multivariate analysis as a risk of suicidality. Conclusion: Clinicians should enquire vigorously about suicidality in women presenting with depressive symptoms or previous suicide attempts in the postpartum.     

Comparative performance of the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-9 in pregnant and postpartum women seeking psychiatric services

Adoption of a standard depression measures across clinics and populations is advantageous for continuity of care and facilitation of research. This study provides information on the comparative utility of a commonly used perinatal-specific depression instrument (the Edinburgh Postnatal Depression Scale-EPDS) with a general depression screener (Patient Health Questionnaire-9-PHQ-9) in a sample of perinatal women seeking psychiatry services within a large health care system. Electronic medical records (which included PHQ-9 and EDPS) were abstracted for a final sample of 81 pregnant and 104 postpartum patients (n=185). Psychometric properties were examined among women who met the criteria for Major Depressive Disorder (MDD) based on clinician diagnoses, as compared to women without any mood disorder diagnosis. Using commonly recommended cut-off scores, both measures had comparable sensitivity, specificity, PPV and NPV for both pregnant and postpartum women. Comparative AUC for ROC contrasts were not significantly different between the two measures. Thus, this study found few significant differences in the performance of the PHQ-9 and EPDS in detecting clinician-diagnosed MDD in a psychiatry outpatient sample of pregnant and postpartum women.     

Postnatal depressive symptoms go largely untreated

Background Prior studies providing estimates of the prevalence of postnatal depressive symptoms (PNDS) in New Zealand have been hampered by methodological shortcomings. Aims of this study were to derive an accurate estimate of PNDS prevalence and treatment frequency in an urban population of a major city in New Zealand. Method This was a one-wave postal survey of a probability, community sample of all women in Auckland who were 4 months postpartum. PNDS was assessed with the Edinburgh Postnatal Depression Scale (EPDS). Results There were 225 usable responses (78% response-rate): 36 women (16.0%) scored above the threshold for depressive symptomatology, and nine of them were in treatment. A further 31 women (13.8%) scored just below the threshold region for depressive symptomatology, and none were in treatment. Conclusion The prevalence rate of PNDS in urban New Zealand is slightly higher than the world-wide average, and goes largely untreated in the community. Health care providers should remain vigilant to the finding that almost one in three mothers with infants is suffering with symptoms of depression and may need strong encouragement to admit they need help.     

Seasonal effects on depression risk and suicidal symptoms in postpartum women

Background: Postpartum depression (PPD) is the most common complication of childbirth. Suicide is a leading cause of maternal death in the first postpartum year. Depressed mothers often have suicidal ideation (SI). Depression and suicidality may vary across the seasons. Previous studies of seasonality and PPD were relatively small or encumbered by study design constraints. We examined the possible relationship between seasonality, depression, and SI in 9,339 new mothers. Methods: From 2006 to 2010, the investigators screened women within 4–6 weeks postpartum with the Edinburgh Postnatal Depression Scale (EPDS). We used spectral analysis to explore seasonal variation in risk for depression and suicidality. Results: The study team screened 9,339 new mothers, of whom 1,316 (14%) women had positive depression scores (EPDS≥10) which suggest PPD risk; 294 (3%) women had SI (item 10≥1). A positive EPDS was associated significantly with SI. PPD risk varied significantly across 12‐months—risk was highest in December. We detected no seasonal variation in SI. Conclusions: Effects of seasonal light variation may contribute to increased risk for depressive symptoms. Suicidality could be related to maternal depression but not seasonal variation. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Blood manganese levels during pregnancy and postpartum depression: A cohort study among women in Mexico

BackgroundOccupational studies have shown an association between elevated Mn exposure and depressive symptoms. Blood Mn (BMn) naturally rises during pregnancy due to mobilization from tissues, suggesting it could contribute to pregnancy and postpartum depressive symptoms.ObjectivesTo assess the association between BMn levels during pregnancy and postpartum depression (PPD), creating opportunities for possible future interventions.MethodsWe studied 561 women from the reproductive longitudinal Programming Research in Obesity, Growth, Environment, and Social Stressors (PROGRESS) cohort in Mexico City. BMn was measured at the 2^nd and 3^rd trimesters, as well as delivery. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PPD symptoms at 12-months postpartum. We used a generalized linear model assuming a Poisson distribution to assess the association between BMn levels and PPD, with adjustments for age, stress and depressive symptoms during pregnancy, education, socioeconomic status, and contemporaneous blood lead levels.ResultsThe mean ± standard deviation (SD) EPDS score at 12-months postpartum was 6.51 ± 5.65, and 17.11% of women met the criteria for possible PPD (score ≥ 13). In adjusted models, BMn during the 3^rd trimester (β: 0.13, 95% CI: 0.04-0.21) and BMn levels averaged at the 2^nd and 3rd trimester (β: 0.14, 95% CI: 0.02-0.26) had a positive association with EPDS scores at 12 months postpartum. BMn at the 2^nd trimester (β: 0.07, 95% CI: -0.09-0.22) and delivery (β: 0.03, 95% CI: -0.04-0.10) had a non-significant positive association with EPDS scores at 12-months postpartum. Stress and depressive symptoms during pregnancy was associated with higher EPDS scores at 12-months postpartum in all of the adjusted models but were only significant when either BMn during 3^rd trimester or BMn averaged across 2^nd and 3^rd trimester was assessed as the exposure.DiscussionOur results demonstrate that elevated BMn levels during pregnancy predict PPD symptoms and could be a potential pathway for intervention and prevention of PPD.