Repeated Depression Screening During the First Postpartum Year

PURPOSE

Postpartum depression (PPD) screening at 4 to 12 weeks’ postpartum can improve outcomes for women when linked to in-practice management programs. The benefit of repeated PPD screening during the first year postpartum remains unclear.

METHODS

We report a substudy of a large pragmatic trial of early PPD screening and practice management, the Translating Research into Practice for Postpartum Depression (TRIPPD) study. Outcome analyses were based on demographic information and Patient Health Questionnaire (PHQ-9) screening scores from questionnaires mailed to all enrolled women at baseline (4 to 12 weeks’ postpartum) and again at 6 and at 12 months’ postpartum. The main outcomes of this substudy were the 6- and 12-month rates of PHQ-9 scores that were 10 or greater for women whose baseline PHQ-9 scores were less than 10. Women whose scores were 10 or greater would be considered at high risk of PPD and appropriate for further evaluation.

RESULTS

At 6 months, 134 (10.9%) of the 1,235 women who did not have PHQ-9 scores greater than 10 at baseline had elevated scores appropriate for further evaluation. At 12 months, 59 (6.1%) of the 969 women who did not have PHQ-9 scores greater than 10 at baseline or at 6 months had elevated scores. Together the 6- and 12-month repeated screenings identified 193 women at high risk of depression. This finding represents 13.5% of the 1,432 women whose screening results were negative for PPD at baseline.

CONCLUSIONS

Repeated PPD screening at 6 and 12 months’ postpartum increases the percentage of women identified as being at high risk of PPD. Further work will be required to understand the impact of this repeated screening on patient outcomes.     

318例产妇产褥期抑郁症患病率相关因素及防治策略探讨

目的了解产妇产褥期抑郁症的患病率,探讨相关因素及防治策略,以降低产妇产褥期抑郁症的发病率和危害性。方法采用爱丁堡产后抑郁量表(EPDS)和自拟的一般资料调查表对318例产妇进行调查。结果对318例产妇的有效资料进行分析,其中产褥期情绪不良患病率为21.38%,产褥期抑郁症患病率为11.95%。青春期、高龄初产妇、婚姻满意度差、孕期情绪不稳定、不良妊娠分娩史、对新生儿性别期望高、社会支持低、认为养孩子是负担、对抚养孩子缺乏信心、曾有过产褥期抑郁症或抑郁症病史等是产褥期抑郁症的主要影响因素。结论产褥期抑郁症的患病率较高,是多种因素综合作用的结果。针对病因进行预防及采取相应的对策,可减少产后抑郁症的发生,提高妇女生活质质。     

产后抑郁发生情况及影响因素调查

了解上海市徐汇区6家社区产妇产后抑郁的发生情况,并分析产后抑郁情绪的相关影响因素,为采取相应干预措施提供依据。

选取徐汇区6家社区2021年8月1日—2022年2月28日分娩的476例产妇为调查对象,填写一般情况及相关影响因素调查表、爱丁堡产后抑郁量表（EPDS）,对产后抑郁的相关影响因素进行单因素和多因素非条件logistic回归分析。

根据EPDS评分,徐汇区476例产妇中72例发生产后抑郁,产后抑郁的发生率为15.13%。多因素非条件logistic回归分析结果显示,产妇性格内向（OR=2.845,95%CI：1.033~7.842）、新生儿人工喂养（OR=11.448,95%CI：2.438~53.767）、产后失眠（OR=2.559,95%CI：1.244~5.262）、产后缺乏育儿经验（OR=2.324,95%CI：1.121~4.820）、家人在意孩子性别（OR=4.415,95%CI：1.500~12.994）是产后抑郁的独立危险因素,配偶为独生子女（OR=0.434,95%CI：0.224~0.840）是产后抑郁的保护因素。

徐汇区产妇产后抑郁受多方面因素影响,应加强对高危人群的筛查和干预,降低产后抑郁的发生。

     

Socio-Economic Determinants and Self-Reported Depressive Symptoms During Postpartum Period

The researchers' aims were to estimate the prevalence of postpartum depressive symptoms in Italy. Cross-sectional data from the survey, “Health and use of health care in Italy” were analyzed. The authors focused on 5,812 women, pregnant some time during five years before the survey. Multiple logistic regression was used to evaluate risk factors independently associated with postpartum depressive symptoms. Evaluation of seasonal trends was also performed.In the total sample, 23.5% (n = 1,365) reported having suffered postpartum depressive symptoms: 20.7% experienced baby blues, and 2.8% postpartum depression. Factors significantly associated with baby blues were, among others, living in northern or central areas (adjusted odds ratio [aOR] 1.88; 95%CI 1.57–2.15 and 1.40; 95%CI 1.20–1.63, respectively), history of depression (aOR 1.34; 95%CI 1.15–1.56), and attendance at antenatal classes (aOR 1.13; 95%CI 1.04–1.22). Factors significantly associated with postpartum depression were: anamnesis of depression (aOR 3.32; 95%CI 2.69–4.09), gaining more than 16 kg of weight during pregnancy (aOR 1.48; 95%CI 1.03–2.12), and undergoing a cesarean section (planned: aOR 1.56; 95%CI 1.05–2.29; unplanned: aOR 1.78; 95%CI 1.16–2.73). Multiparity was a protective factor both for baby blues (aOR 0.80; 95%CI 0.70–0.91), and postpartum depression (aOR 0.71; 95%CI 0.51–0.98). No clear seasonality was observed for postpartum depression, while for baby blues a certain aggregation of events was registered during the central months of the year. The authors' study highlighted variables associated with baby blues and postpartum depression to target screening for women for postpartum depressive symptoms.     

产后抑郁症干预措施的探讨及有效性的评估

目的探讨针对孕产妇保护性和危险性因素制定的综合干预措施的有效性。方法选取产后42d复查的800位产妇进行问卷调查,通过分析找出与产后抑郁症有关的保护性和危险性因素,针对这些影响因素对300位孕妇进行孕期、产时、产后干预,产后42d进行调查,对两组的调查结果进行评估。结果孕期保健、分娩的准备、家人帮助等9项相关因素对产后抑郁症的发生有统计学意义。观察组中产后抑郁症的发生率为18．13％,对照组产后抑郁症的发生率比观察组下降了4．72％,但无统计学意义。结论产后抑郁症的发生原因是多因素的,针对其影响因素进行预防性干预,可以降低产后抑郁症发生。     

产后抑郁症的发生率及其心理社会因素研究

目的 :调查产后抑郁症的发生率以及相关的心理社会因素。方法 :采用爱丁堡产后抑郁量表 ( Edinburgh PostnatalDepression Scale,EPDS)对 4 2 7例产后 4～ 6周妇女的抑郁状态进行调查 ,相关的心理社会因素用 logistic回归模型分析。结果 :产后抑郁症的发生率为 7.3% ( 31/ 4 2 7) ;产后缺乏社会支持、孕期抑郁情绪、过低或过高的家庭收入与产后抑郁症密切相关。结论 :心理社会因素对产后抑郁症发生的影响不容忽视     

Violence Against Women and Postpartum Depression: The Experience of Chilean Women

This article is based on the findings from a cross-sectional study of women (N = 163) who were at least two weeks postpartum and attending primary care clinics in Arica, Chile. The researcher in this study examined the prevalence of history of violence and its association with postpartum depression. The Women Abuse Screen and the Postpartum Depression Screening Scale–Spanish version were used to assess interpersonal violence and postpartum depression. A history of violence was reported by 64% of the women. Of those who experienced abuse, 44% reported ongoing abuse during their pregnancy. Women who experienced violence screened positive for elevated symptoms categories of postpartum depression such as anxiety/insecurity, emotional lability, and mental confusion compared to women who had not experienced violence. Postpartum depression symptom reporting decreased with increasing number of pregnancies (OR = 0.70, 95% CI 0.54–0.97) and greater social support (OR = 0.64, 95% CI 0.46–0.88). Postpartum depression symptom reporting increased with smoking (OR = 1.71, 95% CI 1.00–2.86), and with reporting history of violence (OR = 1.79, 95% CI 1.24–2.34). Acknowledgment of the strong association between domestic violence and postpartum depression should lead to routine screening during prenatal and postpartum periods as a way to isolate risk for postpartum depression.     

Prevalence of Postpartum Depression in a Native American Population

Objectives: Data were collected on postpartum depression from 151 women, ages 16–40 years who received postpartum health services from a rural obstetrical clinic in North Carolina between September 2002 and May 2003. Reflective of the racial and socio-economic make-up of the county, 60.9% of the sample were American Indian (Lumbee tribe) 25.8% were African American and 13.3% were Caucasian or other. Methods: The Postpartum Depression Screening Scale (PDSS) was utilized to explore the prevalence of postpartum depression requiring clinical intervention in a largely unexplored population, minority women. Results: The incidence of postpartum depression symptoms was over 23%, which is significantly higher than even the most liberal estimates in other populations. As with previous literature on risk factors, the sample demonstrates a strong association between symptoms of depression, history of depression and receiving treatment for depression. Conclusions: The PDSS proved to be a clinically useful tool in this setting. Findings support the importance of implementing routine screening protocols to guide practice and implement support services.     

TRIPPD: a practice-based network effectiveness study of postpartum depression screening and management

PURPOSE

Postpartum depression is common but inadequately recognized and undertreated. Continuing depressive symptoms are associated with adverse outcomes for the woman, her infant, and family. We wanted to determine the effect of a practice-based training program for screening, diagnosis, and management of depression in postpartum mothers.

METHODS

In this practice-based effectiveness study, 28 practices were randomized to usual care (n = 14) or intervention (n = 14), and 2,343 women were enrolled between 5 and 12 weeks’ postpartum. The intervention sites received education and tools for postpartum depression screening, diagnosis, initiation of therapy, and follow-up within their practices. Usual-care practices received a 30-minute presentation about postpartum depression. Screening information for the usual care was obtained from baseline surveys sent directly to the central site but was not available for patient care. Outcomes were based on patient-reported outcomes (level of depressive symptoms) from surveys at 6 and 12 months, plus medical record review (diagnosis and therapy initiation).

RESULTS

Among the 2,343 women enrolled, 1,897 (80.1%) provided outcome information, and were included in the analysis. Overall, 654 (34.5% of 1,897) women had elevated screening scores indicative of depression, with comparable rates in the intervention and usual-care groups. Among the 654 women with elevated postpartum depression screening scores, those in the intervention practices were more likely to receive a diagnosis (P = .0006) and therapy for postpartum depression (P = .002). They also had lower depressive symptom levels at 6 (P = .07) and 12 months’ (P=.001) postpartum.

CONCLUSIONS

Primary care–based screening, diagnosis, and management improved mother’s depression outcomes at 12 months. This practical approach could be implemented widely with modest resources.     

产后抑郁症及其严重程度对母乳喂养的影响

目的研究产后抑郁症及其严重程度对母乳喂养的影响。方法采用产后抑郁筛查量表（PDSS）对205名初产妇进行问卷式调查．根据PDSS诊断标准以总分≥60分作为筛查产后抑郁产妇的临界值,总分≥80分作为筛查严重产后抑郁产妇的临界值．按得分情况分为3组研究泌乳指标。结果产妇泌乳始动时间延迟随产后抑郁程度递增,而泌乳量则递减;无抑郁组、轻度组、重度组产后1天泌乳率分别为59.3％、11．76％和0,产后3天泌乳量分别为83．51％、41．18％和0,三者比较有显著性差异（P〈0．05）。结论产后抑郁症可影响母乳喂养,且其严重程度与母乳喂养成负相关,应该积极预防及早期对症治疗。     

What is worse for your sex life: Starving,being depressed,or a new baby?

OBJECTIVE: To compare the current sexual functioning of women in an intimate relationship with anorexia nervosa, with major depression, and in the postpartum period. METHOD: Complete data were available for 76 women who reported being in an intimate relationship (anorexia = 10; depression = 24; postpartum = 42). Sexual functioning was assessed using the Social Adjustment Scale (Weissman and Bothwell, Arch Gen Psychiatry, 33, 1111-1115, 1976). RESULTS: Significant differences were found among groups for the frequency of sex (p =.03) and problems with sex (p < .001), but not for enjoyment of sex (p = .55). In the previous 2 weeks, women with anorexia nervosa or major depression were more likely to have had sex than postpartum women, but were also more likely to have had sexual problems than postpartum women. Most women with anorexia nervosa, women with major depression, and postpartum women reported enjoying sex. CONCLUSION: Women with anorexia nervosa and women with major depression who are in an intimate relationship report a similar profile of current sexual functioning that is different from postpartum women both in the frequency of sexual encounters and in reported problems with sex.     

年龄与发育进程问卷中国常模及心理测量学特性研究

  目的  探讨产后抑郁与婴儿发育的关系。  方法  于2015年1月 — 2016年12月采用方便抽样法在湖南省怀化市鹤城区妇幼保健中心招募产后42 d初次建卡的母婴队列1 251对,产后42 d及产后6个月采用爱丁堡产后抑郁量表（EPDS）评定母亲抑郁症状,婴儿6个月采用年龄与发育进程问卷中文版（ASQ-C）评定婴儿发育情况,并测定体格发育指标。  结果  母亲产后42 d抑郁检出率为17.03 %,产后6月抑郁检出率为4.32 %;母亲产后42 d抑郁组的婴儿ASQ-C总分及沟通、解决问题、个人–社会3个能区得分低于非抑郁组,差异有统计学意义（P < 0.01）,母亲当前抑郁组的婴儿粗大运动能区得分低于非抑郁组,差异有统计学意义（P < 0.05）,母亲产后42 d及当前抑郁的2组婴儿体格发育差异均无统计学意义（P > 0.05）,logistic回归分析显示,产后42 d母亲抑郁是6个月婴儿发育迟缓的危险因素（OR = 2.655,95 % CI = 1.843～3.825） ,母亲当前抑郁症状与婴儿发育迟缓的关联无统计学意义（OR = 1.776,95 % CI = 0.859～3.671）。  结论  母亲产后抑郁症状对婴儿发育有负面影响,应在孕期及产后积极开展健康指导,降低母亲抑郁症状发生。     

产后抑郁症的妇科护理分析

目的 探讨产后抑郁症妇科护理的对策及效果.方法 选取2011年2月-2013年2月我院收治的48例产后抑郁症患者,分析其产后抑郁症的相关因素,并实施针对性护理干预.采用汉密尔顿抑郁量表（HAMD）评价护理效果.结果 48例患者均在3-5d内走出心理阴影区,7-1 0d融入母亲角色,20d内均痊愈出院.出院后随访1-3个月,无1例发生自杀行为.结论 分析产妇产后抑郁的原因,采取针对性护理对策,能明显改善产后抑郁症的症状,帮助产妇度过这段特殊的生理阶段.     

孕期叶酸摄入与MTHFR基因多态性对产后抑郁的影响

目的 探讨叶酸摄入量与亚甲基四氢叶酸还原酶(MTHFR)基因多态性与产后抑郁的关系.方法 将2014年1月至2016年6月之间来延安大学附属医院产科进行产检的800例孕妇纳入本项研究,采用开放式问卷调查的方式收集妊娠12周和28周妇女服用叶酸的信息,通过PCR-RFLP检测MTHFR基因C677T和A1298C多态性.于产后8周通过爱丁堡产后抑郁量表(EPDS)进行产后抑郁诊断.统计分析叶酸摄入与MTHFR C677T和A1298C基因多态性与产后抑郁的关系.结果 800例受试者中产后抑郁症患者218例,正常582例.产后抑郁妇女与正常妇女妊娠期间每天的叶酸摄入量和不同时间补充叶酸无明显差异,但是产后抑郁妇女血清叶酸水平显著低于正常妊娠妇女(x2=15.76,P＜0.001).两组受试者MTHFR C677T和A1298C多态性位点的基因型频率间差异存在统计学意义,其中杂合子CT(x2=13.67,P＜0.01)、AC(x2=3.39,P=0.02)和纯合子Tr(x2=8.65,P＜0.01)、CC(x2=15.18,P＜0.01)是产后抑郁发生的高风险因子.此外,不同MTHFR C677T和A1298C基因型(CC、CT、rr和AA、AC、CC)产后抑郁的妇女在孕期摄入的叶酸量、不同时间补充叶酸和血清叶酸水平无明显差异(x2值为0.07 ～ 2.79,均P ＞0.05).结论 低叶酸摄入量和不同时间补充叶酸不是产后抑郁发病的风险因素,但叶酸水平与MTHFR C677T和A1298C基因型是产后抑郁发病的独立风险因素.     

Correlates of Early Postpartum Depressive Symptoms

Background: Postpartum depressive symptoms negatively affect the quality of life and daily functioning of mothers and infants. Little research has examined the impact of situational factors such as physical symptom burden and function on early postpartum depressive symptoms. Objectives: To explore the association between situational factors and early postpartum depressive symptoms. To predict correlates of early postpartum depressive symptoms. Methods: Cross sectional telephone survey of 720 mothers between 2 and 6 weeks postpartum. Mothers reported on demographic factors, physical and psychological symptoms, daily function, infant behaviors, social support, and skills in managing infant and household. The association between these factors and postpartum depressive symptoms were investigated with bivariate and multivariable analyses. Results: Nearly, 39% of patients screened positive for depressive symptoms. Bivariate analyses showed symptomatic patients were more likely to be nonwhite, have lower incomes, less education, a past history of depression, have higher physical symptom burdens, more physical functional limitations, more infant colic, receive less social support, and have lower-self-efficacy scores as compared with patients without symptoms of depression. In a multivariable model predicting depressive symptoms, nonwhite race (odds ratio (OR) of 1.96, 95% confidence interval (CI) of 1.38, 2.78), more physical symptoms (OR 1.16, 95% CI 1.01, 1.32), infant colic (OR 1.79, 95% CI 1.29, 2.50) lack of social support (OR 0.90, 95% CI 0.86, 0.95), and lower self-efficacy scores (OR 0.90, 95% CI 0.86, 0.94) were associated with depressive symptoms. Conclusions: Nonwhite race, physical symptom burden, infant colic, lack of social support, and lower self-efficacy scores are associated with early postpartum depressive symptoms. Further research is needed to investigate whether providing social support and teaching skills to enhance self-efficacy will reduce the incidence of early postpartum symptoms of depression.The opinions, view, and conclusions expressed in this article are those of the authors and not necessarily those of the Robert Wood Johnson Foundation or Agency for Healthcare Research and Quality.     

The Association between Postpartum Practice and Chinese Postpartum Depression: Identification of a Postpartum Depression-Related Dietary Pattern

Conflicting results of Chinese traditional postpartum practices have aroused concerns over their health effects. The role of postpartum practices in postpartum depression (PPD) is still a matter of discussion, especially from a dietary practice point of view. The current study was designed to (1) explore the association between postpartum practices and PPD, (2) to identify the dietary pattern related to PPD, and (3) to identify the possible pathways among postpartum practices and PPD. This study is part of the YI Study, which was a cross-sectional study conducted in 10 cities in China. Data for 955 postpartum women were used in the current analysis. The Edinburgh Postnatal Depression Scale (EPDS-10) was used to evaluate PPD with a cutoff value of 9. Postpartum practice was based on the participants’ self-reported practices. Individual practices were recorded and categorized as dietary and non-dietary practices. The dietary pattern was identified based on the food intake frequencies of 25 food groups using the method of reduced rank regression. Structural equation modeling was used to explore the potential pathways between postpartum practices and PPD. The current study observed significant associations between postpartum practices and PPD (Adjusted OR = 1.41, 95% CI: 1.04–1.90). A similar trend was also found between dietary postpartum practices and PPD (Adjusted OR = 1.39, 95%CI: 1.03–1.88) but not for non-dietary practices and PPD (Adjusted OR = 1.26, 95%CI: 0.92–1.75). A PPD-related dietary pattern was identified with the characteristics of a high intake of meat and eggs and a lower intake of vegetables, mushrooms, and nuts. This dietary pattern was significantly associated with a higher chance of adhering to postpartum practice (Adjusted OR = 1.26, 95% CI: 1.10–1.44). Based on the pathway analysis, this study also observed the association between postpartum practices and PPD, and the association between dietary practices and PPD were both mediated by sleep quality. In conclusion, this study demonstrated that a substantial proportion of women in modern China experience traditional postpartum Chinese practices and that either overall or dietary-related postpartum practices are associated with a higher risk of PPD. The current dietary practices in postpartum rituals may play an important role in developing PPD. A culturally embedded, science-based dietary guideline is required to help women to achieve both physical and psychological health in the postpartum period.     

Temperament,Post-Partum Depression,Hopelessness, and Suicide Risk Among Women Soon After Delivering

The aim of the authors in this study was to assess the prevalence of postpartum depression and evaluate the association of affective temperaments with emotional disorders in a sample of 92 pregnant women consecutively admitted for delivery between March and December 2009. In the first few days postpartum, women completed the Suicidal History Self-rating Screening Scale, the Beck Hopelessness Scale, the Edinburgh Postnatal Depression Scale, the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Autoquestionnaire, and the Gotland Male Depression Scale. Fifty percent of the women reported an Edinburgh Postnatal Depression Scale score of 9 or higher, and 23% a score of 13 or higher. Women with a dysphoric-dysregulated temperament had higher mean scores on the Beck Hopelessness Scale (p < 0.05), the Gotland Male Depression Scale (p < 0.001), the Edinburgh Postnatal Depression Scale (p < 0.001), and the Suicidal History Self-Rating Screening Scale (p < 0.01) than other women after adjusting for covariates. Multiple logistic regression analysis with the temperament groups as the dependent variable indicated that only the Gotland Male Depression Scale was significantly associated with temperament when controlling for the presence of other variables. Women with a dysphoric-dysregulated temperament were 1.23 times as likely to have higher depressive symptom scores. Future studies should evaluate the effectiveness of psychiatric screening programs in the postpartum period as well as factors associated with depression and suicidality during the same period.     

Associations among postpartum depression, eating disorders, and perfectionism in a population-based sample of adult women

OBJECTIVE: The current study investigated associations among eating disorders, depressive symptoms during pregnancy and postpartum, and perfectionism in a population-based sample of women. METHOD: Females who reported > or = 1 pregnancy (N = 1,119) completed questionnaires assessing perfectionism, eating disorder symptomatology, and depression during pregnancy and postpartum. Information regarding participants' history of major depressive disorder (MDD) was also available from structured psychiatric interviews completed during a previous wave of data collection. RESULTS: Depressive symptoms during pregnancy and postpartum were high among women with a history of eating disorders. Both binge eating disorder (BED) and bulimia nervosa (BN) were positively associated with symptoms of postpartum depression (PPD), even when lifetime MDD was controlled. However, logistic regression indicated that women with a history of BN and BED are at particular risk of developing PPD symptomatology. Linear regression analyses conducted with the subset of the sample who endorsed a PPD screening item suggested that the severity of PPD symptomatology may be attributable to Concern Over Mistakes, a specific aspect of perfectionism. CONCLUSION: These results highlight the importance of assessing specific features of perfectionism. In addition, they suggest that women with BN, BED, or high Concern over Mistakes may be at particular risk of developing PPD symptoms, and could benefit from prenatal screening.     

西安某医院1994名产妇产后抑郁发生的相关因素分析

目的 探讨西安高新医院产妇产后抑郁发生率及相关因素.方法 通过随机抽样法对西安市高新医院分娩的1994名产妇进行问卷调查以了解其产后出现抑郁的情况及影响因素分析.结果 产妇产后有593例出现抑郁,其发生率为33.71%(593/1759);单因素分析结果显示产妇在婴儿性别、新生儿性别接受度、产次、喂养方式、夫妇关系、家庭支持、月子主要照护者及母亲角色适应对比均存在明显差异(χ2值分别为32.86、39.86、4.53、28.87、7.98、43.87、37.96、4.14、3.97,均P<0.05);多因素Logistic回归分析结果显示:产次(OR=0.32,95% CI:0.01~0.96)、夫妇关系(OR=7.46,95% CI:3.76~14.82)、家庭支持(OR=5.21,95% CI:2.29~11.86)及母亲角色适应(OR=4.90,95%CI:1.74~13.86)均是其产后出现抑郁的影响因素.结论 产妇产后出现抑郁的发生率较高,产次是其重要影响因素,对初产妇者进行孕产相关知识教育,院内尽可能提供舒适的疗养环境,可以降低其产后出现抑郁的发生率.     

Health visitors' perceptions on their role to assess and manage postpartum depression cases in the community

The present study gives an insight into the health visitors' perceptions on their role in assessing, managing, and supporting mothers with postpartum depression (PPD). The study took place in Cyprus among health visitors of a community Maternity and Child Welfare Clinic using qualitative approach. Data were collected through individual semistructured interviews. The findings showed that although health visitors are able to identify PPD cases, they stress the importance of protocols and evidence‐based care as well as preventive interventions, and they also point out the importance of home visits. Finally, they support the need for education. It is concluded that health visitors can play an important role in women's health and their intervention on the prevention of PPD in the community especially through home visits is very important.