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Journal of Affective Disorders Jan 2017Previous reviews have provided preliminary insights into risk factors and possible prevalence of Post-traumatic Stress Disorder (PTSD) postpartum with no attempt to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Previous reviews have provided preliminary insights into risk factors and possible prevalence of Post-traumatic Stress Disorder (PTSD) postpartum with no attempt to examine prenatal PTSD. This study aimed to assess the prevalence of PTSD during pregnancy and after birth, and the course of PTSD over this time.
METHODS
PsychINFO, PubMed, Scopus and Web of Science were searched using PTSD terms crossed with perinatal terms. Studies were included if they reported the prevalence of PTSD during pregnancy or after birth using a diagnostic measure.
RESULTS
59 studies (N =24267) met inclusion criteria: 35 studies of prenatal PTSD and 28 studies of postpartum PTSD (where 4 studies provided prevalence of PTSD in pregnancy and postpartum). In community samples the mean prevalence of prenatal PTSD was 3.3% (95%, CI 2.44-4.54). The majority of postpartum studies measured PTSD in relation to childbirth with a mean prevalence of 4.0% (95%, CI 2.77-5.71) in community samples. Women in high-risk groups were at more risk of PTSD with a mean prevalence of 18.95% (95%, CI 10.62-31.43) in pregnancy and 18.5% (95%, CI 10.6-30.38) after birth. Using clinical interviews was associated with lower prevalence rates in pregnancy and higher prevalence rates postpartum.
LIMITATIONS
Limitations include use of stringent diagnostic criteria, wide variability of PTSD rates, and inadequacy of studies on prenatal PTSD measured in three trimesters.
CONCLUSIONS
PTSD is prevalent during pregnancy and after birth and may increase postpartum if not identified and treated. Assessment and treatment in maternity services is recommended.
Topics: Adaptation, Psychological; Delivery, Obstetric; Depression, Postpartum; Female; Humans; Parturition; Postpartum Period; Pregnancy; Prevalence; Risk Factors; Stress Disorders, Post-Traumatic
PubMed: 27865585
DOI: 10.1016/j.jad.2016.10.009 -
Critical Reviews in Food Science and... 2019Postpartum depression (PPD) is a prevalent mood disorder estimated to affect 20%-40% of women worldwide after childbirth. In recent studies, the effect of vitamin D on...
Postpartum depression (PPD) is a prevalent mood disorder estimated to affect 20%-40% of women worldwide after childbirth. In recent studies, the effect of vitamin D on prevention of mood disorders and depression has been investigated, but it is still unclear how vitamin D may affect PPD. The evidence on the relevance between vitamin D deficiency and PPD is inconsistent, and assessment of the recent literature has not previously been carried out. Moreover, there are few clinical studies on PPD and vitamin D supplementation. Five studies have so far assessed the relationship between the levels of vitamin D and PPD. Findings from cohort studies suggest that vitamin-D deficiency is related to the incidence of PPD and vitamin D may play a significant role in the recovery of women with PPD, but it is uncertain whether these actions are the effect of vitamin D on the function of hypothalamic-pituitary-adrenal (HPA) axis, the levels of estradiol, serotonin, pro-inflammatory cytokines, and/or of other mechanisms involved in PPD.
Topics: Depression, Postpartum; Dietary Supplements; Female; Humans; Vitamin D; Vitamin D Deficiency
PubMed: 29393662
DOI: 10.1080/10408398.2017.1423276 -
Annual Review of Clinical Psychology 2015Postpartum depression (PPD) adversely affects the health and well being of many new mothers, their infants, and their families. A comprehensive understanding of... (Review)
Review
Postpartum depression (PPD) adversely affects the health and well being of many new mothers, their infants, and their families. A comprehensive understanding of biopsychosocial precursors to PPD is needed to solidify the current evidence base for best practices in translation. We conducted a systematic review of research published from 2000 through 2013 on biological and psychosocial factors associated with PPD and postpartum depressive symptoms. Two hundred fourteen publications based on 199 investigations of 151,651 women in the first postpartum year met inclusion criteria. The biological and psychosocial literatures are largely distinct, and few studies provide integrative analyses. The strongest PPD risk predictors among biological processes are hypothalamic-pituitary-adrenal dysregulation, inflammatory processes, and genetic vulnerabilities. Among psychosocial factors, the strongest predictors are severe life events, some forms of chronic strain, relationship quality, and support from partner and mother. Fully integrated biopsychosocial investigations with large samples are needed to advance our knowledge of PPD etiology.
Topics: Depression, Postpartum; Endocrine System Diseases; Female; Humans; Pregnancy; Psychology; Risk Factors
PubMed: 25822344
DOI: 10.1146/annurev-clinpsy-101414-020426 -
Translational Psychiatry Oct 2021Postpartum depression (PPD) is the most common psychological condition following childbirth, and may have a detrimental effect on the social and cognitive health of...
Postpartum depression (PPD) is the most common psychological condition following childbirth, and may have a detrimental effect on the social and cognitive health of spouses, infants, and children. The aim of this study was to complete a comprehensive overview of the current literature on the global epidemiology of PPD. A total of 565 studies from 80 different countries or regions were included in the final analysis. Postpartum depression was found in 17.22% (95% CI 16.00-18.51) of the world's population. Meta-regression analysis showed that study size, country or region development, and country or region income were the causes of heterogeneity. Multivariable meta-regression analysis found that study size and country or area development were the most important predictors. Varied prevalence rates were noted in geographic regions with the highest rate found in Southern Africa (39.96%). Of interested was a significantly lower rate of PPD in developed countries or high-income countries or areas. Furthermore, the findings showed that there was a substantial difference in rates of PPD when marital status, educational level, social support, spouse care, violence, gestational age, breast feeding, child mortality, pregnancy plan, financial difficulties, partnership, life stress, smoking, alcohol intake, and living conditions were considered in the pooled estimates. Our results indicated that one out of every five women experiences PPD which is linked to income and geographic development. It is triggered by a variety of causes that necessitate the attention and committed intervention of primary care providers, clinicians, health authorities, and the general population.
Topics: Child; Depression; Depression, Postpartum; Female; Humans; Infant; Postpartum Period; Pregnancy; Prevalence; Social Support
PubMed: 34671011
DOI: 10.1038/s41398-021-01663-6 -
JAMA Network Open Jun 2022New and expectant parents experience perinatal mood disorders, with consequences to parenting ability, bonding with the neonate, interpersonal relationships, and health... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
New and expectant parents experience perinatal mood disorders, with consequences to parenting ability, bonding with the neonate, interpersonal relationships, and health and well-being of parents. Research shows that maternal and paternal perinatal mood disorders are associated, but no recent systematic review has addressed the prevalence of perinatal mood disorders in both mothers and fathers (parental dyad).
OBJECTIVE
To examine the prevalence of perinatal mood disorders in parental dyads and identify factors associated with perinatal mood disorders in parental dyads.
DATA SOURCES
Ovid (MEDLINE, Embase, and PsycINFO) and Web of Science were searched from January 1, 1990, to June 8, 2021, for observational studies reporting on the prevalence of perinatal depression or anxiety in a parental dyad.
STUDY SELECTION
Studies reporting the prevalence of anxiety or depression in both members of a parental dyad were included, with diagnosis according to established criteria (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition], International Classification of Diseases, 11th Revision) or use of validated screening tools.
DATA EXTRACTION AND SYNTHESIS
Prevalence data were extracted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were analyzed in subgroups: antenatal depression, early postnatal depression (0-12 weeks), late postnatal depression (3-12 months), and perinatal anxiety. Pooled prevalence was calculated using a random-effects meta-analysis model. Quality assessment was performed using Joanna Briggs Institute Appraisal Checklist for Studies Reporting Prevalence Data. Data were analyzed in June 2021.
MAIN OUTCOMES AND MEASURES
Prevalence of perinatal anxiety and perinatal depression in parental dyads.
RESULTS
Twenty-three studies were included, with data from 29 286 couples. The pooled prevalence of antenatal depression in both parents was 1.72% (95% CI, 0.96%-2.48%; P < .001). The prevalence of early postnatal depression (up to 12 weeks post partum) was 2.37% (95% CI, 1.66%-3.08%; P < .001) and the prevalence of late postnatal depression (3-12 months post partum) was 3.18% (95% CI, 2.3-4.05; P < .001). Only 3 studies reported on perinatal anxiety in both parents, precluding a quantitative analysis.
CONCLUSIONS AND RELEVANCE
In up to 3.18% of couples, both parents may concurrently experience perinatal depression. Perinatal health care must consider the mental health needs of parents, both as individuals and as a parental dyad. Further research is needed to examine outcomes in families where both parents experience perinatal mood disorders.
Topics: Anxiety; Depression; Depression, Postpartum; Female; Humans; Infant, Newborn; Parents; Pregnancy; Prevalence
PubMed: 35749112
DOI: 10.1001/jamanetworkopen.2022.18969 -
JMIR MHealth and UHealth Oct 2021Postpartum depression (PPD) is a prevalent mental health problem with serious adverse consequences for affected women and their infants. Clinical trials have found that... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Postpartum depression (PPD) is a prevalent mental health problem with serious adverse consequences for affected women and their infants. Clinical trials have found that telehealth interventions for women with PPD result in increased accessibility and improved treatment effectiveness. However, no comprehensive synthesis of evidence from clinical trials by systematic review has been conducted.
OBJECTIVE
The aim of this study is to evaluate the effectiveness of telehealth interventions in reducing depressive symptoms and anxiety in women with PPD. To enhance the homogeneity and interpretability of the findings, this systematic review focuses on PPD measured by the Edinburgh Postnatal Depression Scale (EPDS).
METHODS
PubMed, The Cochrane Library, CINAHL, PsycINFO, CNKI, and Wanfang were electronically searched to identify randomized controlled trials (RCTs) on the effectiveness of telehealth interventions for women with PPD from inception to February 28, 2021. Data extraction and quality assessment were performed independently by two researchers. The quality of included studies was assessed using the Cochrane risk-of-bias tool, and meta-analysis was performed using RevMan 5.4 software.
RESULTS
Following the search, 9 RCTs with a total of 1958 women with PPD were included. The EPDS (mean difference=-2.99, 95% CI -4.52 to -1.46; P<.001) and anxiety (standardized mean difference=-0.39, 95% CI -0.67 to -0.12; P=.005) scores were significantly lower in the telehealth group compared with the control group. Significant subgroup differences were found in depressive symptoms according to the severity of PPD, telehealth technology, specific therapy, and follow-up time (P<.001).
CONCLUSIONS
Telehealth interventions could effectively reduce the symptoms of depression and anxiety in women with PPD. However, better designed and more rigorous large-scale RCTs targeting specific therapies are needed to further explore the potential of telehealth interventions for PPD.
TRIAL REGISTRATION
PROSPERO CRD42021258541; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258541.
Topics: Anxiety; Depression, Postpartum; Female; Humans; Infant; Telemedicine; Treatment Outcome
PubMed: 34617909
DOI: 10.2196/32544 -
Journal of Affective Disorders Mar 2019It is still largely unknown whether physical activity (PA) during pregnancy may be useful to avert subsequent postpartum depression (PPD). We conducted a systematic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
It is still largely unknown whether physical activity (PA) during pregnancy may be useful to avert subsequent postpartum depression (PPD). We conducted a systematic review and meta-analysis to determine the preventive effects of PA during pregnancy on PPD.
METHODS
A systematic review of English and non-English articles was conducted using CINAHL, Cochrane Controlled Trials Register, PsycINFO, MEDLINE, SportDiscuss and Web of Science databases. Studies which tested the effect of any type of PA measured during pregnancy on depression or depressive symptoms in the first year postpartum were included. Relevant articles were extracted independently by 2 authors using predefined data fields, including study quality indicators. The protocol was registered on PROSPERO (CRD42018087086).
RESULTS
Twenty one studies, fit our selection criteria. Among them, seventeen studies were included in the meta-analysis, representing 93 676 women. Robust Variance Estimation random-effects meta-analysis indicated a significant reduction in postpartum depression scores (Overall SMD = -0.22 [95% CI -0.42 to -0.01], p = 0.04; I = 86.4%) for women physically active during pregnancy relative to those who were not active. This association was reinforced in intervention studies (SMD = -0.58 [9% CI -1.09 to -0.08]).
LIMITATIONS
Overall meta-analysis showed important heterogeneity in PA assessment, suggesting the existence of potential moderators such as intensity, frequency, trimester of pregnancy or type of physical activity practiced.
CONCLUSIONS
PA during pregnancy appears to reduce the risk of PPD symptoms. High quality studies addressing the role of PA in the perinatal period and its impact on new mother's mental health remain necessary.
Topics: Adult; Depression, Postpartum; Exercise; Female; Humans; Pregnancy; Risk Factors
PubMed: 30576955
DOI: 10.1016/j.jad.2018.12.009 -
BMJ (Clinical Research Ed.) Nov 2020To evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression in pregnant and postpartum women. (Meta-Analysis)
Meta-Analysis
Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data.
OBJECTIVE
To evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression in pregnant and postpartum women.
DESIGN
Individual participant data meta-analysis.
DATA SOURCES
Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (from inception to 3 October 2018).
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Eligible datasets included EPDS scores and major depression classification based on validated diagnostic interviews. Bivariate random effects meta-analysis was used to estimate EPDS sensitivity and specificity compared with semi-structured, fully structured (Mini International Neuropsychiatric Interview (MINI) excluded), and MINI diagnostic interviews separately using individual participant data. One stage meta-regression was used to examine accuracy by reference standard categories and participant characteristics.
RESULTS
Individual participant data were obtained from 58 of 83 eligible studies (70%; 15 557 of 22 788 eligible participants (68%), 2069 with major depression). Combined sensitivity and specificity was maximised at a cut-off value of 11 or higher across reference standards. Among studies with a semi-structured interview (36 studies, 9066 participants, 1330 with major depression), sensitivity and specificity were 0.85 (95% confidence interval 0.79 to 0.90) and 0.84 (0.79 to 0.88) for a cut-off value of 10 or higher, 0.81 (0.75 to 0.87) and 0.88 (0.85 to 0.91) for a cut-off value of 11 or higher, and 0.66 (0.58 to 0.74) and 0.95 (0.92 to 0.96) for a cut-off value of 13 or higher, respectively. Accuracy was similar across reference standards and subgroups, including for pregnant and postpartum women.
CONCLUSIONS
An EPDS cut-off value of 11 or higher maximised combined sensitivity and specificity; a cut-off value of 13 or higher was less sensitive but more specific. To identify pregnant and postpartum women with higher symptom levels, a cut-off of 13 or higher could be used. Lower cut-off values could be used if the intention is to avoid false negatives and identify most patients who meet diagnostic criteria.
REGISTRATION
PROSPERO (CRD42015024785).
Topics: Depression, Postpartum; Depressive Disorder, Major; Female; Humans; Pregnancy; Pregnancy Complications; Prenatal Care; Psychometrics; Sensitivity and Specificity
PubMed: 33177069
DOI: 10.1136/bmj.m4022 -
International Journal of Environmental... Apr 2020Pregnancy is a period of complex bio-psychological changes, during which the development of an attachment bond to the fetus takes on a central role. Depressive symptoms... (Meta-Analysis)
Meta-Analysis
Pregnancy is a period of complex bio-psychological changes, during which the development of an attachment bond to the fetus takes on a central role. Depressive symptoms are common during this period. Both symptoms of depression and low levels of prenatal attachment are related to negative outcomes in caregivers and infants. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement, this systematic review analyzes and systematizes 41 studies concerning the association between prenatal attachment and perinatal depression. The majority of the studies reported a significant association between the two. Specifically, prenatal depressive symptoms were found to be negatively associated with prenatal attachment. Furthermore, lower levels of prenatal attachment were related to higher postnatal depressive symptoms, although fewer studies assessed this association. While these results were found across different populations, conflicting findings emerged, suggesting they should be interpreted with caution, particularly in male samples and in non-normative pregnancies (e.g., high-risk pregnancies, medically assisted pregnancies, and pregnancies with previous perinatal losses). These results are clinically important for the perinatal screening process and for implementing preventive and treatment programs. However, future studies are needed to further confirm and generalize these results.
Topics: Depression; Depression, Postpartum; Depressive Disorder; Female; Fetus; Humans; Infant; Male; Mother-Child Relations; Mothers; Pregnancy
PubMed: 32290590
DOI: 10.3390/ijerph17082644 -
Journal of Affective Disorders Dec 2020Perinatal depression is a maternal mental health condition that is associated with various adverse health outcomes both for the mothers and the babies. The study aim was... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Perinatal depression is a maternal mental health condition that is associated with various adverse health outcomes both for the mothers and the babies. The study aim was to estimate the prevalence of perinatal depression and its risks and determinants in Mainland China.
METHODS
Systematic searches were conducted in 10 major databases and random effect meta-analysis was performed to achieve the pooled variance of perinatal depression. Subgroup analyses were conducted based on region, scale, methods of diagnosis and study design. Meta-regression was performed with the variables such as age, quality assessment score and gross domestic product (GDP) of the province.
RESULTS
Pooled prevalence of perinatal depression was 16.3% (CI=95%; 14.7% to 18.2%, P < 0.001), with antenatal depression 19.7% (CI=95%; 15.8% to 24.2%, P < 0.001) and postnatal depression 14.8% (CI=95%; 13.1% to 16.6%, P < 0.001). Significant publication bias was found and heterogeneity was I= 98.13%. Lower socioeconomic status, poor physical health, anxiety about pregnancy and reduced social support were major risk factors while better living conditions and higher level of education were protective factors. The prevalence of perinatal depression showed a significant increasing trend in the last decade.
LIMITATIONS
The review does not include studies with small sample size (n <250). Moreover a narrative review of risk and protective factors was done, these were not included in meta-analysis.
CONCLUSION
The prevalence of perinatal depression in China is similar to low and middle-income countries. Urgent attention is needed to address this public health priority in China.
Topics: China; Depression; Depression, Postpartum; Depressive Disorder; Female; Humans; Pregnancy; Prevalence
PubMed: 33065811
DOI: 10.1016/j.jad.2020.07.046