Prevalence and Risk Factors for Postpartum Depressive Symptoms Among Women Enrolled in WIC

The objectives of this study were to determine the prevalence and correlates of postpartum depressive symptoms (PDS) among women with a recent live birth and specifically among women participating in and eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Pregnancy Risk Assessment and Monitoring System data from 22 states in 2006–2008 (n = 75,234) were used to estimate the prevalence of PDS using a two-question screener. Associations between PDS and respondent demographics, risk factors and behaviors, and WIC program eligibility and participation were assessed using logistic regression. Overall prevalence of PDS was 13.8 %:19.8 % among WIC participants, 16.3 % among non-participants eligible for WIC, and 6.8 % of women not eligible for the program. PDS prevalence was higher among younger, less educated, and poorer women, as well as those engaging in risky behaviors during pregnancy (smoking and binge drinking), and those with an unintended pregnancy and who experienced intimate partner violence during pregnancy. Controlling for these factors, the odds of PDS were no different between WIC participants and women eligible but not participating in the program (aOR 1.08, 95 % CI 0.97–1.22), but WIC enrollees were significantly more likely than ineligible women to report PDS (aOR 1.65, 95 % CI 1.39–1.95). WIC serves more than 1 million pregnant women each year, one-fifth of whom may experience PDS. WIC has a unique opportunity to screen and provide referrals to new mothers receiving postpartum WIC benefits.     

Factors Associated with Risk of Perinatal Depressive Symptoms Among Puerto Rican Women with Hyperglycemia

Maternal and Child Health Journal - Rates of perinatal depression and pregnancy hyperglycemia are higher in Hispanic women as compared to non-Hispanic white women. In turn, depressive symptoms may...     

Depressive Symptoms and Neurocognitive Performance Among HIV-Infected Women

The aims of this article were to explore the relationship between depressive symptoms and neuropsychological performance in a sample of HIV-infected women, and to examine the contribution of demographic, HIV-related variables, and depressive symptoms to neurocognitive performance. In this cross-sectional study, a sample of 103 HIV-infected women, recruited from February to December 2010, were assessed for depressive symptoms (with the Beck Depression Inventory) and neurocognitive performance (with the HIV Dementia Scale). Severe depressive symptoms were reported by 31.1% of the women. Findings indicated that severe levels of depressive symptoms were significantly associated with reduced cognitive functioning in HIV-infected women, particularly in domains of attention, psychomotor speed, and construction. Older age and low education level were significantly associated with neurocognitive impairment in univariate analyses. In the multivariate model, only depressive symptoms were significantly related to neurocognitive impairment. Compared to participants with none/minimal depressive symptoms, those with moderate and severe depressive symptoms had odds ratios for neurocognitive impairment of 5.03 (95% CI, 1.33–18.99) and 3.22 (95% CI, 1.15–9.06), respectively. These findings support continued investigation of the presence of neurocognitive impairment, particularly among women, and may help mental health providers with early detection, planning, and implementation of more effective interventions.     

安徽留守儿童抑郁状况及其影响因素分析

目的了解安徽省留守儿童抑郁症状的性别差异及其与父母打工类型的关系,为改善儿童心理健康提供依据。方法采用无记名面对面的调查方式,以城乡留守儿童为目标人群,共在安徽省城乡调查941人,使用儿童抑郁量表(CDI)评定其抑郁症状,运用多因素Logistic回归分析探讨留守儿童抑郁症状的影响因素。结果留守儿童抑郁症状检出率(15.8%)高于非留守儿童(10.9%),男生抑郁症状检出率高于女生。多因素Logistic回归分析结果表明,父亲外出打工是女生抑郁症状发生的危险因素。结论留守儿童抑郁症状较为普遍,研究留守儿童心理卫生问题时应考虑到性别差异和父、母的角色。     

Mother-Infant Interaction, Life Events and Prenatal and Postpartum Depressive Symptoms Among Urban Minority Women in Primary Care

Objectives: Prenatal and postpartum depression are significant mental health problems that can have negative effects on mother-infant interactions. We examined the relationships among mother-infant interactions, depressive symptoms, life events, and breastfeeding of low-income urban African American and Hispanic women in primary care settings. Methods: Participants were 89 African American and Hispanic women who were part of a larger mental health intervention study conducted in community health centers. Questionnaire data on depression, as well as negative and positive life events, were collected during pregnancy and at three-months postpartum, while mother-infant interaction observations and breastfeeding practice were only collected at three-months postpartum. Results: The ratings of maternal behavior for ‘depressed’ mothers did not differ from ‘nondepressed’ mothers. Except for gaze aversion behavior, infants' behavior while interacting with their mothers did not differ by maternal depression level. Hierarchical regression analyses revealed that maternal positive life events positively predicted infant interactional summary ratings, while maternal negative life events were inversely associated with maternal interactional summary ratings. Conclusions: To improve services in primary care, perinatal screenings for depression can help identify those women most at risk. When follow-up use of structured diagnostic instruments is not possible or cost-effective, clinician assessment of severity of depression will determine women with clinical levels of depression. Reducing negative life events is beyond the control of women or clinicians but cognitive interventions to help women focus on positive life events can reduce the deleterious effects of depression on mothers and their infants.     

Differences in Sexual Risk Behavior and HIV/AIDS Risk Factors Among Foreign-Born and US-Born Hispanic Women

Hispanic women in the United States (US) are disproportionately affected by human immunodeficiency virus (HIV) infection. There are very limited data on the sexual risk differences among US-born Hispanic women (USBHW) and foreign-born Hispanic women (FBHW). Sexually active USBHW and FBHW were asked to complete a self-administered questionnaire. Demographics, sexual history, testing for HIV or sexually transmitted infection (STI), condom use, partner sexual risk and alcohol/substance use were compared between USBHW and FBHW. FBHW were 3.5 years older than USBHW at first sexual experience (95% CI: 2.8, 4.1; P < 0.001). This remained significant after controlling for age and education. There was no difference between groups in the proportion of women with >1 reported sexual partner in the last year. FBHW reported fewer risk behaviors and lower rates of STI and alcohol/drug abuse. However, FBHW were less likely to have been tested for HIV. HIV prevention strategies would better target Hispanic women in the US if differences in risk behavior between FBHW and USBHW were incorporated.     

Prevalence and Factors Associated with Depressive Symptoms in Malay Women

Background: Due to a dearth of research on depressive symptoms in Malaysia, particularly in Malay women, a community study was conducted to examine the prevalence and factors associated with current depressive symptoms in rural and urban Malay women with low socioeconomic status.

Method: Four hundred eighty-seven women (N rural = 242, N urban = 245) were interviewed. Information on socio-demographic variables, potential risk factors (family history of mental health problems, lifetime major depressive symptoms, and current life stressors), and current depressive symptoms (measured by the Centre for Epidemiologic Studies Depression Scale, CES-D) was collected.

Results: The prevalence of current depressive symptoms (CES-D scores ≥ 16) reported was 34.5%, while the prevalence of lifetime major depressive symptoms was 27.5%. A significantly higher rate of current depressive symptoms was observed in urban women compared to rural women, χ² (1, N = 487) = 3.99, p < .05. However, no significant difference was found in the two groups of women in the prevalence of lifetime major depressive symptoms. The results of the multiple hierarchical regression analysis indicated that three potential factors (family history of mental health problems, lifetime major depressive symptoms, and current life stressors) were positively associated with current depressive symptoms, accounting for 17.8% of the variance, over and above the socio-demographic variables.

Conclusion: The prevalence of depressive symptoms reported in the study was comparable to past studies. Among the factors associated with current depressive symptoms, the single most important was lifetime major depressive symptoms, followed by current life stressors, and family history of mental health problems. Among the socio-demographic variables used, perceived health status was the most important. The factors associated with depressive symptoms found in this study are consistent with past findings in the West, implying the universality of the phenomenon and common factors related to depressive symptoms in women.     

Factors Associated with Depressive Symptoms in the Early Postpartum Period Among Women with Recent Gestational Diabetes Mellitus

Women with gestational diabetes mellitus (GDM) have a substantial risk of subsequently developing type 2 diabetes. This risk may be mitigated by engaging in healthy eating, physical activity, and weight loss when indicated. Since postpartum depressive symptoms may impair a woman’s ability to engage in lifestyle changes, we sought to identify factors associated with depressive symptoms in the early postpartum period among women with recent GDM. The participants are part of the baseline cohort of the TEAM GDM (Taking Early Action for Mothers with Gestational Diabetes Mellitus) study, a one-year randomized trial of a lifestyle intervention program for women with a recent history of GDM, conducted in Boston, Massachusetts between June 2010 and September 2012. We administered the Edinburgh Postnatal Depression Scale (EPDS) at 4–15 weeks postpartum to women whose most recent pregnancy was complicated by GDM (confirmed by laboratory data or medical record review). An EPDS score ≥9 indicated depressive symptoms. We measured height and thyroid stimulating hormone, and administered a questionnaire to collect demographic data and information about breastfeeding and sleep. We calculated body mass index (BMI) using self-reported pre-pregnancy weight and measured height. We reviewed medical records to obtain data about medical history, including history of depression, mode of delivery, and insulin use during pregnancy. We conducted bivariable analyses to identify correlates of postpartum depressive symptoms, and then modeled the odds of postpartum depressive symptoms using multivariable logistic regression. Our study included 71 women (mean age 33 years ± 5; 59 % White, 28 % African-American, 13 % Asian, with 21 % identifying as Hispanic; mean pre-pregnancy BMI 30 kg/m² ± 6). Thirty-four percent of the women scored ≥9 on the EPDS at the postpartum visit. In the best fit model, factors associated with depressive symptoms at 6 weeks postpartum included cesarean delivery (aOR 4.32, 95 % CI 1.46, 13.99) and gestational weight gain (aOR 1.21 [1.02, 1.46], for each additional 5 lbs gained). Use of insulin during pregnancy, breastfeeding, personal history of depression, and lack of a partner were not retained in the model. Identifying factors associated with postpartum depression in women with GDM is important since depression may interfere with lifestyle change efforts in the postpartum period. In this study, cesarean delivery and greater gestational weight gain were correlated with postpartum depressive symptoms among women with recent GDM (Clinicaltrials.gov NCT01158131).     

Depressive Symptoms and Weight Status Among Women Recently Immigrating to the US

Objectives Depressive symptoms have been associated with obesity. Little is known about this relationship among immigrants. We examined relationships between depressive symptoms and weight status in immigrant women from three ethnic groups. Methods Participants were Brazilian, Haitian, and Latina women (n = 345) enrolled in Live Well, a community-based, randomized intervention designed to prevent weight gain in recent immigrants. Study data are from baseline when participants completed the Center for Epidemiological Studies Depression Scale (CES-D), Perceived Stress Scale, a physical activity questionnaire, and socio-demographic questions; BMI was calculated from measured height and weight. Results Forty-four percent of participants (36 % of Brazilians, 66 % of Haitians, 30 % of Latinas) had high depressive symptoms (CES-D ≥ 16), and 38 % (26 % of Brazilians, 49 % of Haitians, 42 % of Latinas) were obese (BMI ≥ 30.0). Those reporting more depressive symptoms were more likely to be obese (Wald Chi square = 4.82, p < .05). An interaction between depressive symptoms, ethnic group, and income was revealed (F(4,340) = 2.91, p < .05), such that higher depressive symptoms were associated with higher BMI among Brazilians earning ≥$30,000 per year and with lower BMI among Brazilians earning <$30,000. The relationship between depressive symptoms and obesity did not differ by income among Haitians or Latinas. Conclusions Depressive symptoms and obesity were highly prevalent among these recently-immigrated women. Positive relationships between these variables were consistent across ethnic and income groups, with the exception of lower-income Brazilians. While these findings suggest similar patterns and health needs across several groups of immigrants, cultural differences should be considered when addressing these health conditions.     

Prenatal Predictors of Maternal Attachment and Their Association with Postpartum Depressive Symptoms in Mexican Women at Risk of Depression

Objectives Although maternal attachment is an important predictor of infant developmental outcomes, little is known about its pre- and postnatal predictors. The purpose of this secondary data analysis is to assess several risk factors for maternal attachment at 6 months postpartum in a sample of Mexican women at risk of depression. The predictors included were prenatal depressive symptoms, pregnancy intendedness, partner relationship, social support, maternal history of childhood sexual abuse, and postpartum depressive symptoms. Methods A total of 156 pregnant women seeking antenatal care at three health centers were selected because they displayed depressive symptoms (CES-D?≥?16) or had previously suffered depression. Women were interviewed during pregnancy and at 6 months postpartum. A step-wise multivariate logistic regression was conducted to evaluate the pre- and postpartum risk factors for postpartum depression related to low maternal attachment. Results Pre- and postpartum depressive symptoms increased the risk of low maternal attachment by factors of 3.00 and 3.97, respectively, compared with women who did not present these symptoms; low level of adjustment with the partner increased the risk by a factor of 3.11, low social support by a factor of 2.90, and CSA by a factor of 2.77. Conclusions for practice Prevention programs during pregnancy to reduce depressive symptoms should strengthen strategies to promote maternal attachment by improving partner relations and increasing social support. However, evidence shows that such programs alone are insufficient, so direct interventions should also be implemented. Women with a history of childhood sexual abuse should be given additional attention during prenatal care.     

Factors Related to Depressive Symptoms Among Long-Term Survivors of Cervical Cancer

In this article we describe depressive symptoms among survivors of cervical cancer. Study participants were previously diagnosed and treated with cervical cancer 5 to 25 years prior to the completion of a telephone survey. Through a population-based survey of women identified via a state tumor registry in southern New England, the investigators learned that depressive symptoms are prevalent among a subgroup of long-term survivors long after diagnosis and treatment. The at-risk participants included those who were at a lower economic status and whose marital status and ability to work had changed, and who continued to experience pain and diarrhea caused by radiotherapy. Findings from this study warrant additional research with this potentially vulnerable group of women.     

Nutritional Factors Associated with Antenatal Depressive Symptoms in the Early Stage of Pregnancy Among Urban South Indian Women

Many women of reproductive age from developing countries have poor nutritional status, and the prevalence of depression during pregnancy is high. The objective of the present study was to assess the prevalence of antenatal depressive symptoms in early pregnancy, and to identify the demographic and nutritional factors associated with these symptoms in a sample of urban South Indian pregnant women. This cross-sectional study was the baseline assessment of a prospective randomized controlled trial of vitamin B₁₂ supplementation in urban pregnant south Indian women between the ages of 18 and 40 years (www.clinicaltrials.gov: NCT00641862). 365 women in their first trimester of pregnancy were screened for depressive symptoms at an urban clinic in Karnataka, South India, using the Kessler Psychological Distress Scale (K-10). Nutritional, clinical and biochemical factors were also assessed. Mean (SD) age of the cohort was 22.6 (3.7) years and mean (SD) BMI was 20.4 (3.3) kg/m². 121 (33 %) of the women in the 1st trimester had symptoms consistent with depression (K-10 score >6). In multivariate log binomial regression analysis, presence of antenatal depressive symptoms in the first trimester were positively associated with vomiting, prevalence ratio (PR) = 1.54 (95 % CI 1.10, 2.16) and negatively with anemia, PR = 0.67 (95 % CI 0.47, 0.96). Nutrient intakes, serum vitamin B₁₂, methylmalonic acid, homocysteine and red cell folate levels were not associated with measures of depression. Antenatal depressive symptoms in early pregnancy are highly prevalent in urban Indian women and are more common in women with vomiting and without anemia. In this cross-sectional data, blood concentrations of vitamin B₁₂ and folate were not associated with depressive symptoms. The relationship between nutritional status and depressive symptoms may require larger and longitudinal studies.     

Trajectories of Depressive Symptoms Over 2 Years Postpartum Among Overweight or Obese Women

BackgroundAlthough depressive symptoms are common postpartum, few studies have followed women beyond 12 months postpartum to investigate changes in the number and severity of these symptoms over time, especially in overweight and obese women. Using two complementary analytical methods, this study aims to identify trajectories of depressive symptoms over 2 years postpartum among overweight or obese mothers, and assess the demographic, socioeconomic, and health covariates for these trajectories.MethodsUsing longitudinal data from two behavioral intervention studies (Kids and Adults Now!-Defeat Obesity [KAN-DO] and Active Mothers Postpartum (AMP); n = 844), we used latent growth modeling to identify the overall trajectory of depressive symptoms and how it was related to key covariates. Next, we used latent class growth analysis to assess the heterogeneity in the depressive symptom trajectories over time, and thereby, identify subgroups of women with distinct trajectories.FindingsThe overall trajectory of depressive symptoms over 2 years postpartum was relatively stable in our sample. However, the presence of three distinct latent class trajectories (stable-low [82.5%], decreasing symptoms [7.3%], and increasing symptoms [10.2%]), identified based on trajectory shape and mean depressive symptom score, supported heterogeneity in depressive symptom trajectories over time. Lower maternal education was related to a higher symptom score, and poorer subjective health status at baseline predicted inclusion in the increasing symptoms trajectory.ConclusionsIn some overweight or obese mothers, postpartum depressive symptoms do not resolve quickly. Practitioners should be aware of this phenomenon and continue to screen for depression for longer periods of time postpartum.     

Associations of Drug Use,Violence, and Depressive Symptoms with Sexual Risk Behaviors Among Women with Alcohol Misuse

Background

Alcohol misuse is associated with increased human immunodeficiency virus sexual risk behaviors by women. Drug use, intimate partner violence (IPV), and depressive symptoms frequently co-occur, are well-recognized alcohol misuse comorbidities, and may interact to increase risk behaviors. Using a syndemic framework we examined associations between drug use, IPV, and depressive symptoms and sexual risk behaviors by 400 women with alcohol misuse attending an urban sexually transmitted infections clinic.

Gestational Weight Gain Among Hispanic Women

To describe gestational weight gain among Hispanic women and to examine psychological, social, and cultural contexts affecting weight gain. A total of 282 Hispanic women were surveyed post-partum before leaving the hospital. Women were queried about their prepregnancy weight and weight gained during pregnancy. Adequacy of gestational weight gain was based on guidelines set by the Institute of Medicine in 2009. Independent risk factors for excessive or insufficient weight gain were examined by logistic regression. Most women were unmarried (59 %), with a mean age of 28.4 ± 6.6 years and an average weight gain of 27.9 ± 13.3 lbs. Approximately 45 % of women had gained too much, 32 % too little, and only 24 % had an adequate amount of weight gain. The mean birth weight was 7.3, 7.9, and 6.8 lbs among the adequate, excessive, and insufficient weight gain groups. Among women who exercised before pregnancy, two-thirds continued to do so during pregnancy; the mean gestational weight gain of those who continued was lower than those who stopped (26.8 vs. 31.4 lbs, p = 0.04). Independent risk factors for excessive weight gain were being unmarried, U.S. born, higher prepregnancy body mass index, and having indifferent or negative views about weight gain. Independent risk factors for insufficient weight gain were low levels of support and late initiation of prenatal care. Depression, stress, and a woman’s or her partner’s happiness regarding pregnancy were unrelated to weight gain. The results of this study can be used by prenatal programs to identify Hispanic women at risk for excessive or insufficient gestational weight gain.     

Loneliness Mediates the Relationship Between Pain During Intercourse and Depressive Symptoms Among Young Women

Previous research suggests that women who experience pain during intercourse also experience higher rates of depressive symptoms. Loneliness might be one factor that contributes to this relationship. We hypothesized that women who experience more severe and interfering pain during intercourse would report higher rates of loneliness and higher rates of depressive symptoms. Further, we hypothesized that loneliness would mediate the relationship between pain during intercourse and depressive symptoms. A total of 104 female participants (85.6% white, 74.03% partnered, 20.9 [3.01] years old) completed an online survey including demographic information, PROMIS Vaginal Discomfort Measure, PROMIS Depression Measure, and Revised UCLA Loneliness Scale. Pearson correlations and bootstrapped mediation analysis examined the relationships among pain during intercourse, loneliness, and depressive symptoms. Pain during intercourse, loneliness, and depressive symptoms were all significantly correlated (p < .05). Results of the mediation analysis indicated that loneliness was a significant mediator of the relationship between pain during intercourse and depressive symptoms (indirect effect = 0.077; 95% CI 0.05–0.19). After accounting for loneliness, pain during intercourse was not significantly related to depressive symptoms, suggesting that loneliness fully mediated the relationship between pain during intercourse and depressive symptoms. These findings are consistent with previous studies highlighting that pain during intercourse is related to depressive symptoms. The current study adds to that literature and suggests that more frequent and severe pain during intercourse leads to more loneliness, which then leads to increased depressive symptoms. This line of work has important implications for treating women who experience depressive symptoms and pain during intercourse.     

Depressive Symptoms and Interpersonal Victimization Among African American Women Attending an Urban STD Clinic

OBJECTIVES: This study evaluated the association of depressive symptom levels and interpersonal victimization. The sample was comprised of 455 African American women attending an urban sexually transmitted disease clinic. Interpersonal victimization was defined as whether a woman was forced to have sexual intercourse and whether a woman was ever hit, slap or physically hurt by a boyfriend, girlfriend, or spouse in the past 12 months. METHODS: Using audio computer-assisted self-interviewing (ACASI), women responded to questions regarding interpersonal victimization and depressive symptom levels (e.g., depression, sadness, loneliness and crying in the past week). RESULTS: Results indicated that women with a history of interpersonal victimization were more likely to experience higher levels of depressive symptoms when compared with women who did not. Statistically significant differences were found for being forced to have sexual intercourse (all p's <0.0001) and ever being hit, slap or physically hurt by a boyfriend, girlfriend, or spouse in the past 12 months (p's range from 0.012 to 0.0003) with regard to each depressive symptom item. CONCLUSION: Behavioral women-focused interventions need to address mental health issues associated with risky sexual behaviors in order to be more efficacious.