Does antenatal screening for psychosocial risk factors predict postnatal depression? A follow-up study of 154 women in Adelaide, South Australia

OBJECTIVE: This study investigated the effectiveness of antenatal screening for psychosocial risk factors in predicting postnatal depression, in women living in a socioeconomically deprived area. METHOD: 154 women completed the Antenatal Psychosocial Questionnaire (APQ) and the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression analysis was used to identify antenatal psychosocial risk factors predictive of EPDS caseness, with an EPDS score of 10 or more being taken to indicate depression. RESULTS: Antenatal depression was more common than postnatal depression. 44 women (30%) met criteria for antenatal depression and 33 women (22.6%) met criteria for postnatal depression. 21 women (14.4%) were depressed both before and after delivery of their baby, and women who had antenatal depression were significantly more likely to be depressed postnatally. Whilst there were high rates of endorsement of antenatal psychosocial risk factors, the only item from the APQ that predicted postnatal depression was emotional abuse as a child. CONCLUSION: Antenatal screening for psychosocial risk factors was useful in identifying problems during the antenatal period, but was not useful as a predictor of postnatal depression.     

Religiosity, spirituality, and depressive symptoms in pregnant women

OBJECTIVE: Depression during pregnancy has potential repercussions for both women and infants. Religious and spiritual characteristics may be associated with fewer depressive symptoms. This study examines the association between religiosity/spirituality and depressive symptoms in pregnant women. METHOD: Pregnant women in three southern obstetrics practices were included in a cross sectional study evaluating religiosity, spirituality, and depressive symptoms. Symptoms of depression were measured using the Edinburgh Postnatal Depression Scale (EPDS). The depression outcome was measured in two ways: the EPDS score as a continuous outcome, and a score at or above the recommended EPDS cutoff (> 14). A wide array of potential confounders was addressed. Special attention was given to the interplay between religiosity/spirituality, social support, and depressive symptoms. RESULTS: The mean EPDS score was 9.8 out of a maximum possible score of 30. Twenty-eight women (8.1%) scored above the recommended EPDS cutoff score. Overall religiosity/spirituality was significantly associated with fewer depressive symptoms when controlling for significant covariates, but there was a significant interaction such that the association became weaker as social support increased. Social support did not appear to be an important mediator (intermediate step) in the pathway between religiosity/spirituality and depressive symptoms. CONCLUSIONS: Religiosity and spirituality may help protect from depressive symptoms when social support is lacking. Longitudinal research is needed to assess the directionality of the observed relationships.     

Antenatal psychosocial risk factors and depression among women living in socioeconomically disadvantaged suburbs in Adelaide, South Australia

OBJECTIVE: This study reports the prevalence of psychosocial risk factors and the incidence of depression in women presenting for their first antenatal visit at a general hospital in a socioeconomically deprived area. We also investigated the association between specific psychosocial risk factors and antenatal depression. METHOD: Four hundred and twenty one women completed the Antenatal Psychosocial Questionnaire (APQ) and the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression analysis was used to identify psychosocial risk factors predictive of EPDS caseness. RESULTS: 88% of women endorsed at least one psychosocial risk factor. 35.6% had been abused as children, 34.9% had suffered recent major life stresses, 24.5% had thoughts of self harm, 8% admitted to recently hitting or hurting someone in anger and 5.6% had been victims of violence since becoming pregnant. The incidence of depression, measured using an EPDS cut-off score of 10 or more, was 29.7%. The questionnaires were generally acceptable, apart from questions about drug and alcohol abuse which were not completed by one in five subjects. Factors associated with an increased risk of antenatal depression were being hit by someone since becoming pregnant, having recently hit someone else in anger, obsessional traits, previous feelings of depression and anxiety, and requiring both past and current treatment for emotional problems. Protective factors were having someone to talk to and feeling confident. CONCLUSION: Our findings suggest that women birthing at the LMHS are a very vulnerable group. Violence (either by or towards the pregnant women) was the strongest predictor of antenatal depression and may be under recognized. Antenatal screening for psychosocial risk factors and depression was useful and was well accepted by the women and the clinic staff. It is important that appropriate services are available once women at risk are identified.     

Sociodemographic risk factors of perinatal depression: a cohort study in the public health care system

ObjectiveTo assess the sociodemographic risk factors for the prevalence and incidence of relevant postpartum depressive symptoms.MethodWe studied a cohort of women in their perinatal period with the assistance of the public health system in the city of Pelotas-RS, Brazil. We assessed depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS) in the prenatal and postnatal periods.ResultsWe interviewed 1,109 women. The prevalence of meaningful depressive symptoms during pregnancy was 20.5% and postpartum was 16.5%. Women with prenatal depression were at higher risk for postpartum depression.ConclusionThe mother's poverty level, psychiatric history, partner absence and stressful life events should be considered important risk factors for relevant postpartum depressive symptoms.     

Recurrence of depression during pregnancy: psychosocial and personal functioning correlates

Background: This study examined psychosocial and personal functioning during pregnancy in women at risk for depression recurrence based on having had at least one major depressive episode (MDE) preceding the pregnancy. Methods: Three groups of women, who differed in recurrence of depression during pregnancy, were compared: (1) women who had at least one recurrent episode meeting diagnostic criteria for a MDE (n=23), (2) women who had a recurrence of clinically significant levels of depressive symptoms but did not meet criteria for a MDE (n=18), and (3) women who had no recurrence of depression (n=38) during pregnancy. Results: Results indicated that recurrences of depression during pregnancy are associated with a range of psychosocial and personal functioning correlates. Furthermore, the correlates of depression during pregnancy were the same for women who met diagnostic criteria for MDE and women who had subthreshold levels of depression. Conclusions: The findings support extending psychosocial models of depression to depression recurrence during pregnancy with an emphasis on the broader context within which depression occurs. The findings also have implications for understanding subclinical depression during pregnancy as being associated with problems in functioning equal in severity and breadth to episodes of major depression. Depression and Anxiety, 2009. Published 2008 Wiley‐Liss, Inc.     

Postnatal mental health of women giving birth in Australia 2002-2004: findings from the beyondblue National Postnatal Depression Program

OBJECTIVES: To describe the postnatal mental health status of women giving birth in Australia 2002-2004 at 6-8 weeks postpartum. METHOD: Women were recruited from 43 health services across Australia. Women completed a demographic questionnaire and an Edinburgh Postnatal Depression Scale (EPDS) in pregnancy; the latter was repeated at 6-8 weeks following childbirth. RESULTS: A total of 12 361 postnatal women (53.8% of all postnatal women surveyed) completed questionnaires as part of a depression screening programme; 15.5% of women screened had a postnatal EPDS>9 and 7.5% of women had an EPDS>12 at 6-8 weeks following childbirth. There was significant variation between States in the percentage of women scoring as being potentially depressed. The highest percentage of women scoring EPDS>12 were in Queensland and South Australia (both 10.2%) while Western Australia had the lowest point prevalence (5.6%). Women recruited from private health services in Western Australia had a significantly lower prevalence of elevated EPDS scores than those women recruited from the public health service (EPDS >12: 3.6% vs 6.4%, p=0.026); differences in the prevalence of elevated EPDS scores were not significant between public and private in Australian Capital Territory (EPDS>12: 7.6% vs 5.8%, p=0.48), where income and education was significantly higher than other States for both groups. CONCLUSIONS: Postnatal depressive symptoms affect a significant number of women giving birth in Australia, and the point prevalence on the EPDS may be higher for women in the public sector, associated with lower incomes and educational levels. Maternity services--particularly those serving women with these risk factors--need to consider how they identify and manage the emotional health needs of women in their care. Specific State-related issues, such as availability of specialist perinatal mental health services and liaison between treating health professionals, also need to be considered.     

Single motherhood versus poor partner relationship: outcomes for antenatal mental health

OBJECTIVE: In the transition to parenthood, lack of social support significantly impacts on maternal mood. This paper compares the influence of single-mother status and level of partner support in a partnered relationship, on antenatal emotional health. METHODS: Antenatal demographic, psychosocial and mental health data, as determined by Edinburgh Postnatal Depression Scale (EPDS) score, were collected from 1578 women. The association between these variables, and marital status, was investigated using logistic regression. RESULTS: Sixty-two women (3.9%) were identified as single/unpartnered. Elevated EPDS scores (>12) were found in 15.2% (240/1578) of the total cohort and 25.8% (16/62) of the single/unpartnered women. EPDS scores were significantly lower for single/unpartnered women than for women with unsupportive partners (8.9+/-5.3 vs 11.9+/-6.5, p<0.001). Compared to the partnered cohort, single/unpartnered women were more likely to have experienced >or=2 weeks of depression before the current pregnancy (p<0.05), a previous psychopathology (p<0.001), emotional problems during the current pregnancy (p<0.01) and major life events in the last year (p<0.01). Binary logistic regression modelling to predict antenatal EPDS scores suggests that this is mediated by previous psychiatric history (p<0.001) and emotional problems during pregnancy (p=0.02). CONCLUSION: Women in a partnered-relationship with poor partner-derived support were at an increased risk of elevated antenatal EPDS scores compared to single/unpartnered women. A previous history of depression and current emotional problems, rather than single mother status, were significant risk factors for elevated EPDS scores. The present study reiterates the contribution of psychosocial risk factors as important mediators of antenatal emotional health.     

The role of estrogen and progesterone in depression after birth

Previous reports suggest that massive hormonal changes that accompany the peripartum period may trigger perinatal depression. We investigated the relationship between magnitude of change and total level of estrogen and progesterone and grade of peripartal depression and depressive symptoms. One hundred and ninety two women were assessed in the 38th week of pregnancy (SDS scores), peripartum period (DSM-III-R diagnosis (n=105); SDS scores) and 6 months postpartum (EPDS; n=89) regarding diagnosis of depression, self-ratings of depressive symptoms and levels of estrogen and progesterone. The comparison of three diagnostic groups (lifetime major depressive disorder MDD (N=7), MDD at birth (N=12), healthy controls (N=70) showed that there were no differences in the magnitude of decline of estrogen and progesterone from day 1 to day 3 after birth . With respect to total levels of estrogen and progesterone, estrogen on day 3 was significantly higher [F(2,92)=6.6, p<0.05] in women with current MDD than in those with lifetime MDD or normal controls. Depression scores were significantly higher at the end of pregnancy (12.6% self-identified as depressed) than in postpartum period (5.8% day 3 p<.0004; 9.2% day 5 p<.008), whereas 13.3% of women received a DSM-III -R diagnosis for MDD 5 days postpartum. The results were in contrast to the current hypotheses of estrogen withdrawal or hypogonadal levels as an etiological factor for peripartum depression. But a limitation of the actual study is the low number of subjects with depression; therefore the current non-significant findings should be interpreted with great caution.     

Prenatal IL-6 levels and activation of the tryptophan to kynurenine pathway are associated with depressive but not anxiety symptoms across the perinatal and the post-partum period in a low-risk sample

Depression and anxiety symptoms are highly prevalent among women during pregnancy and post-partum. Previous studies suggest that one of the pathophysiological underpinnings could be an enhanced metabolism of tryptophan (Trp) into kynurenine (Kyn) due to increased inflammation. However, the longitudinal changes in the Kyn pathway and the complex interplay with inflammation and stress in women with perinatal depressive or anxiety symptoms are incompletely understood. We examined a cohort of healthy women at 34–36 gestational weeks. One hundred and ten women were assessed for salivary cortisol and 97 participants were also assessed for serum levels of Trp, Kyn and Interleukin 6 (IL-6). Women filled in two screening questionnaires for depressive (Edinburgh Postnatal Depression Scale (EPDS)) and anxiety (State Trait Anxiety Inventory subscale (STAI-S)) symptoms at 34–36 gestational weeks, delivery, 3 and 12 months postpartum. Unexpectedly, lower prenatal Kyn levels were associated with higher depressive symptoms in late pregnancy. Furthermore, prenatal Trp levels and the Kyn/Trp ratio moderate the association between IL-6 levels and depressive symptoms during the perinatal and the post-partum period. We found no interactions between Trp and Kyn biomarkers and cortisol on depressive symptoms. The observed associations were more robustly found for depressive symptoms, whereas weak and non-significant effects were found for the trajectory of anxiety symptoms. Overall, our data support the involvement of the Trp to Kyn pathway and inflammation in the course of depressive but not anxiety symptoms in women from late pregnancy until one-year post-partum, providing new evidence on the mechanisms regulating emotions during pregnancy and after delivery in a low-risk sample.     

Ethnicity,social disadvantage and psychotic‐like experiences in a healthy population based sample

Objective:  We sought to investigate the prevalence and social correlates of psychotic‐like experiences in a general population sample of Black and White British subjects. Method:  Data were collected from randomly selected community control subjects, recruited as part of the ÆSOP study, a three‐centre population based study of first‐episode psychosis. Results:  The proportion of subjects reporting one or more psychotic‐like experience was 19% (n = 72/372). These were more common in Black Caribbean (OR 2.08) and Black African subjects (OR 4.59), compared with White British. In addition, a number of indicators of childhood and adult disadvantage were associated with psychotic‐like experiences. When these variables were simultaneously entered into a regression model, Black African ethnicity, concentrated adult disadvantage, and separation from parents retained a significant effect. Conclusion:  The higher prevalence of psychotic‐like experiences in the Black Caribbean, but not Black African, group was explained by high levels of social disadvantage over the life course.     

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.     

Psychoses, ethnicity and socio-economic status

BACKGROUND: Consistent observation of raised rates of psychoses among Black and minority ethnic (BME) groups may possibly be explained by their lower socio-economic status. AIMS: To test whether risk for psychoses remained elevated in BME populations compared with the White British, after adjustment for age, gender and current socio-economic status. METHOD: Population-based study of first-episode DSM-IV psychotic disorders, in individuals aged 18-64 years, in East London over 2 years. RESULTS: All BME groups had elevated rates of a psychotic disorder after adjustment for age, gender and socio-economic status. For schizophrenia, risk was elevated for people of Black Caribbean (incidence rate ratios (IRR)=3.1, 95% CI 2.1-4.5) and Black African (IRR=2.6, 95% CI 1.8-3.8) origin, and for Pakistani (IRR=3.1, 95% CI 1.2-8.1) and Bangladeshi (IRR=2.3, 95% CI 1.1-4.7) women. Mixed White and Black Caribbean (IRR=7.7, 95% CI 3.2-18.8) and White Other (IRR=2.1, 95% CI 1.2-3.8) groups had elevated rates of affective psychoses (and other non-affective psychoses). CONCLUSIONS: Elevated rates of psychoses in BME groups could not be explained by socio-economic status, even though current socio-economic status may have overestimated the effect of this confounder given potential misclassification as a result of downward social drift in the prodromal phase of psychosis. Our findings extended to all BME groups and psychotic disorders, though heterogeneity remains.     

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.     

Optimal cut‐off score of the Edinburgh Postnatal Depression Scale for major depressive episode during pregnancy in Japan

Aim

Depression during pregnancy adversely affects both mother and child. As antenatal depression is a predictor of postnatal depression, early detection might prevent postnatal depression. The Edinburgh Postnatal Depression Scale (EPDS) is frequently used during the perinatal period, but the cut‐off score during pregnancy has not been verified for the Japanese population. We aimed to clarify the optimal EPDS cut‐off score in mid‐pregnancy in Japan.

Methods

We recruited pregnant women aged 20 years or older at 12–24 gestational weeks and those who scored ≥9 on the EPDS were invited to participate in this study. In parallel with the EPDS, the Japanese version of the Mini‐International Neuropsychiatric Interview was administered to determine diagnosis of major depressive episode. We then calculated the receiver–operator curve, sensitivity and specificity, and positive and negative predictive values for the EPDS.

Results

All 210 participants were in the second trimester except for one (12 gestational weeks). Twenty participants were diagnosed with major depressive episode. With a cut‐off score set at 13 points, the area under the curve was 0.956; sensitivity and specificity were 90.0% and 92.1% [Correction added on 10 November 2017, after first online publication: The percentage for specificity has been corrected from 79.0% to 92.1%.], respectively; and positive and negative predictive values were 54.5% and 98.9%, respectively.

Conclusion

To our knowledge, this is the first study to clarify the optimal EPDS cut‐off score in the second trimester for Japan. This finding will be helpful for appropriate screening for antenatal depression in Japan.

     

Obstetrical complications and the development of postpartum depressive symptoms: a prospective survey of the MATQUID cohort

Verdoux H, Sutter AL, Glatigny‐Dallay E, Minisini A. Obstetrical complications and the development of postpartum depressive symptoms: a prospective survey of the MATQUID cohort. Acta Psychiatr Scand 2002: 106: 212–219. © Blackwell Munksgaard 2002. Objective: To prospectively investigate in a cohort of pregnant women the association between obstetrical complications (OCs) and depressive symptomatology in the early postpartum period. Method: A total of 441 pregnant women attending the State Maternity Hospital in Bordeaux were interviewed during the third trimester of pregnancy, then at 3 days and 6 weeks after birth. Maternal depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Data on a large range of pregnancy, delivery and neonatal somatic adverse events were collected by interviewing the mothers. Data on OCs were rated using the McNeil–Sjöström scale for OCs. A dimensional definition of postnatal depression (EPDS summary score 6 weeks after delivery) was used to explore the relationships between OCs and early postnatal depressive symptoms. Results: Exposure to severe OCs during pregnancy was associated with more intense depressive symptoms in the early postnatal period, independently from demographic characteristics, marital adjustment, parity, and a history of depressive or anxiety disorder during pregnancy (adjusted B=0.16, 95% CI 0.007, 0.30, P=0.04). No association was found between the severity of postnatal depressive symptoms and labour/delivery or neonatal complications. Conclusion: Severe pregnancy complications may increase the severity of postnatal depressive symptoms by acting as acute or chronic stressors during pregnancy. The links between OCs, maternal psychopathology, and child development, need to be explored further.     

Anxiety in a socially high-risk sample of pregnant women in Canada

OBJECTIVE: To determine if an anxiety dimension in the Edinburgh Postnatal Depression Scale (EPDS) could be identified in a sample of pregnant women with high social risk factors. METHOD: Four hundred women attending prenatal outreach programs, most of whom were single, low-income, and Aboriginal, participated in a study of feelings in pregnancy. The primary outcome measure was the EPDS. Data were also collected on sociodemographic, obstetrical-biological, psychological, and behavioural variables. RESULTS: Factor analysis of the EPDS revealed 3 factors: anxiety, depression, and self-harm. The anxiety factor accounted for the greatest variance in the overall EPDS score. Comparisons of different groups of women revealed significantly more anxiety in the women aged under 19 years, compared with those over 25 years (P < 0.01). Linear regression analysis showed anxiety was associated with age, stressors (that is, pregnancy, health of the baby, birth of the baby, money, and other), history of depression, and fluctuating moods. CONCLUSIONS: Anxiety symptoms were predominant in the emotional distress identified by the EPDS in this sample of socially high-risk pregnant women. Younger women appear to experience the highest levels of anxiety. Anxiety in pregnancy in socially high-risk women should not be normalized.     

Is peripartum anhedonia a missing target?

The perinatal period is an extremely delicate phase that can involve a high risk for onset of depressive disorders. The Edinburgh Postnatal Depression Scale (EPDS) is a widely validated instrument for assessing perinatal depressive symptoms, including the dimension of anhedonia. There are studies suggesting that the neural mechanism underlying the occurrence of anhedonia in patients with major depressive disorder (MDD) and bipolar depression (BD) might be distinct. Anhedonia seems to represent a more stable and frequent symptom in women with postpartum bipolar relative to unipolar depressive disorder and is associated with significantly higher depressive symptom severity. Perinatal medicine is an important component of women's health. Treatment of anhedonia can be challenging, and the most effective treatment can be a combination of psychotherapy and medication, but the screening of anhedonia in peripartum women can prevent the development of other psychiatric disorders and maladaptive behaviors.     

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.     

Cardiovascular reactivity to mental arithmetic and cold pressor in African Americans,Caribbean Americans,and White Americans

Background: Caribbean Americans and African Americans, two of the largest Black ethnic groups in the United States, differ in cardiovascular-disease-related mortality rates.Purpose: Cardiovascular reactivity to psychological stress may be an important marker or mediator of risk for cardiovascular disease development in Blacks in the United States, yet little attention has been paid to ethnicity among Blacks in reactivity research. This study examined cardiovascular reactivity to psychological stress in African American, Caribbean American, and White American participants.Methods: Forty-five women and 43 men performed mental arithmetic and hand cold pressor (CP) tasks.Results: Caribbean Americans displayed larger decreases in heart period variability during mental arithmetic than White Americans (p = .02). White Americans exhibited a pre-ejection period decrease, whereas African Americans and Caribbean Americans displayed pre-ejection period increases during CP (p = .023). African Americans exhibited greater decreases in interbeat interval during CP than White Americans (p = .013). Caribbean Americans displayed greater decreases in cardiac output than White Americans during CP (p = .009). White Americans exhibited significantly greater increases in systolic blood pressure than Caribbean Americans during CP (p = .014).Conclusions: These findings suggest that differences in reactivity to psychological stress exist among Black ethnic groups in the United States and underscore the need to consider ethnicity as a factor in reactivity research with Black Americans. This study was supported by the National Institute of Mental Health Grant 1 F31 MH12330-01A1 to Carlotta M. Arthur. We thank Stefan Wiens and William Guethlein for programming assistance. We also thank Robert M. Kelsey, Ronald Friend, K. Daniel O’Leary, Richard P. Sloan, Laura D. Kubzansky, Ichiro Kawachi, and Norman B. Anderson for their valuable comments.     

Mood changes during pregnancy and the postpartum period: development of a biopsychosocial model

OBJECTIVE: Women are vulnerable to mood changes during pregnancy and the postpartum period. We set out to empirically test the hypothesis that biological and psychosocial variables interact to result in this vulnerability. METHOD: Using structural equation modeling techniques, we developed an integrative model of perinatal mood changes from clinical, psychosocial, hormone and mood data collected from 150 women in late pregnancy and at 6-weeks postpartum. RESULTS: In the prenatal model, biological variables had no direct effect on depressive symptoms. However, they did act indirectly through their significant effects on psychosocial stressors and symptoms of anxiety. The same model did not fit the postpartum data, suggesting that different causal variables may be implicated in postpartum mood. CONCLUSION: This model demonstrates the importance of considering both biological and psychosocial variables in complex health conditions such as perinatal mood disorders.