-
The Journal of Family Practice Nov 2022Certain risk factors and this screening tool can help you identify patients at risk. Cognitive behavioral therapy and SSRIs can provide relief.
Certain risk factors and this screening tool can help you identify patients at risk. Cognitive behavioral therapy and SSRIs can provide relief.
Topics: Female; Humans; Depression, Postpartum; Depression
PubMed: 36538771
DOI: 10.12788/jfp.0510 -
Journal of Affective Disorders Jul 2023Clinical prediction models have been widely used to screen and diagnose postpartum depression (PPD). This study systematically reviews and evaluates the risk of bias and... (Review)
Review
OBJECTIVES
Clinical prediction models have been widely used to screen and diagnose postpartum depression (PPD). This study systematically reviews and evaluates the risk of bias and the applicability of PPD prediction models.
METHODS
A systematic search was performed in eight databases from inception to June 1, 2022. The literature was independently screened, and data were extracted by two investigators using the checklist for critical appraisal and data extraction for systematic reviews of prediction modeling studies (CHARMS). The risk of bias and applicability was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST).
RESULTS
After the screening, 12 studies of PPD risk prediction models were included, with the area under the ROC curve of the models ranging from 0.611 to 0.937. The most-reported predictors of PPD included several aspects, including prenatal mood disorders, endocrine and hormonal influences, psychosocial aspects, the influence of family factors, and somatic illness factors. The applicability of all studies was good. However, there was some bias, mainly due to inadequate outcome events, missing data not appropriately handled, lack of model performance assessment, and overfitting of the models.
CONCLUSIONS
This systematic review and evaluation indicate that most present PPD prediction models have a high risk of bias during development and validation. Despite some models' predictive solid performance, the models' clinical practice rate is low. Therefore, future research should develop predictive models with excellent performance in all aspects and clinical applicability to better inform maternal medical decisions.
Topics: Female; Humans; Pregnancy; Depression, Postpartum; Forecasting; Prognosis; Risk Factors
PubMed: 37084958
DOI: 10.1016/j.jad.2023.04.026 -
BMC Pregnancy and Childbirth Oct 2023Postpartum depression (PPD) is considered an important public health problem, and early recognition of PPD in pregnant and lactating women is critical. This study...
BACKGROUND
Postpartum depression (PPD) is considered an important public health problem, and early recognition of PPD in pregnant and lactating women is critical. This study investigated the knowledge, attitude, and practice (KAP) toward PPD among pregnant and lying-in women.
METHODS
This cross-sectional study was conducted at Binzhou Medical University Hospital between September 2022 and November 2022 and included pregnant and lying-in women as study participants. A questionnaire was designed by the researchers that included demographic data and knowledge, attitude, and practice dimensions. Correlations between knowledge, attitude, and practice scores were evaluated by Pearson correlation analysis. Factors associated with practice scores were identified by multivariable logistic regression.
RESULTS
All participants scored 6.27 ± 2.45, 36.37 ± 4.16, and 38.54 ± 7.93 93 from three sub-dimensions of knowledge, attitudes, and practices regarding PPD, respectively, with statistical differences in the three scores by age, education, and job status (p < 0.05). There were no significant differences between maternal (6.24 ± 2.34, 36.67 ± 3.82 and 38.31 ± 7.27, respectively) and pregnant women (6.30 ± 2.49, 36.00 ± 4.53 and 38.83 ± 8.69, respectively) in the total scores of knowledge, attitude, and practice dimensions. According to the results of multivariate logistic regression, the knowledge (OR = 1.235[1.128-1.353], P < 0.001) and attitude (OR = 1.052[1.005-1.102], P = 0.030) dimension scores were factors influencing the practice dimension scores.
CONCLUSION
The KAP of pregnant and lying-in women toward PPD is low. This study suggests that maternal awareness of PPD should be increased through the knowledge and attitudinal dimensions. Preventing PPD in pregnant and lying-in women can be achieved by improving both dimensions, thus enhancing practice.
Topics: Pregnancy; Female; Humans; Depression, Postpartum; Health Knowledge, Attitudes, Practice; Cross-Sectional Studies; Lactation; Pregnant Women
PubMed: 37904090
DOI: 10.1186/s12884-023-06081-8 -
Journal of Affective Disorders Nov 2023There is a need for effective interventions to reduce symptomatology of postpartum depression. The objective of this study was to test whether providing an ergonomic... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
There is a need for effective interventions to reduce symptomatology of postpartum depression. The objective of this study was to test whether providing an ergonomic infant carrier would reduce postpartum depression symptomatology.
METHODS
A randomized two-arm, parallel-group trial with 100 participants was conducted between February 2018 and June 2019 in a low-income community. At 30-weeks' gestation, 50 participants were randomly assigned to receive an ergonomic infant carrier and instructions on proper use (intervention group), and 50 participants were assigned to a waitlist (control group). Participants tracked the extent of their infant carrier use and completed the Edinburgh Postpartum Depression Scale (EPDS) to assess postpartum depression symptomatology at 6-weeks postpartum.
RESULTS
Participants in the intervention group reported using an infant carrier significantly more often than the control group (β = 2.69, SE = 0.347, p < .001, 95 % CI = 2.08-3.41). The intervention group reported fewer depressive symptoms at 6-weeks postpartum than the control group (β = -0.541, p = .042).
LIMITATIONS
The sample size was relatively small and thus our results may not be generalizable to the general population.
CONCLUSION
Infant carrying may be a cost-effective intervention to reduce postpartum depression symptomatology. Large-scale studies are warranted to further examine the efficacy and cost-effectiveness of providing carriers as an intervention to reduce postpartum depression symptomatology.
CLINICAL TRIAL REGISTRATION
Clinicaltrials.gov id: NCT04376021. Data Sharing Statement: Deidentified individual participant data will not be made available because we did not obtain permission to share individual data.
CLINICAL TRIAL REGISTRATION NUMBER
NCT0437602; https://beta.
CLINICALTRIALS
gov/study/NCT04376021.
Topics: Female; Humans; Infant; Depression, Postpartum; Postpartum Period; Psychiatric Status Rating Scales
PubMed: 37586649
DOI: 10.1016/j.jad.2023.08.044 -
MCN. the American Journal of Maternal...To examine the experiences of postpartum depression among U.S.-born women of color via an integrative review. (Review)
Review
PURPOSE
To examine the experiences of postpartum depression among U.S.-born women of color via an integrative review.
STUDY DESIGN AND METHOD
Databases searched were PubMed, CINAHL, Scopus, and PsycInfo. Sample inclusion criteria included qualitative research published in English that explored U.S.-born women of color's experiences of postpartum depression. There was no time limitation on when studies were published. Krippendorff's thematic content analysis method was used.
RESULTS
In this integrative review, eight qualitative studies investigating Black and Hispanic women's postpartum depression experiences and eight blog postings were synthesized. Five themes were identified that described postpartum depression experiences of Black and Hispanic women: (1) Struggling with an Array of Distressing Symptoms , (2) Cultural Stigma as a Powerful Roadblock, (3) Complicating Barriers to Seeking Much-Needed Professional Help, (4) Support as a Lifeline or "Just Pulling Yourself up by Your Bootstraps," and (5) Preferences for Help with Postpartum Depression .
CLINICAL IMPLICATIONS
Cultural stigma of mental illness plus lack of knowledge of postpartum depression were strong barriers to women of color seeking timely professional mental health care. Nurses can share information about perinatal mental illness with women in cultural communities to help decrease stigma and increase mental health literacy. All health care providers and policy makers need to focus attention on the impact that women of color's economic and social stressors have on their postpartum depression.
Topics: Female; Humans; Pregnancy; Depression, Postpartum; Qualitative Research; Black or African American; Hispanic or Latino
PubMed: 36472495
DOI: 10.1097/NMC.0000000000000889 -
The Journal of Maternal-fetal &... Dec 2022Postpartum depression (PPD) is a major public health problem that affects approximately 12-18% of women and is associated adverse maternal and infant outcome. Given that...
Postpartum depression (PPD) is a major public health problem that affects approximately 12-18% of women and is associated adverse maternal and infant outcome. Given that untreated maternal depression has negative consequences for both the mother and her child, it is important to deploy effective measures to treat or prevent PPD. Antidepressant treatment after delivery has been proposed for prophylaxis, however, this is not firmly established. Since insomnia is an early sign and a common symptom of PPD in this contribution we argue that management of insomnia may play a key role in the treatment and prevention of PPD. To this aim we by discussed the current evidence about the potential prophylactic role of antidepressants compared to that of insomnia treatment in PPD. We concluded that insomnia symptoms may be a better therapeutic target to prevent or treat PPD which is heterogeneous entity and may be more responsive to interventions addressing a common and early symptom such as insomnia.
Topics: Female; Humans; Infant; Antidepressive Agents; Depression, Postpartum; Mothers; Postpartum Period; Sleep Initiation and Maintenance Disorders
PubMed: 34844495
DOI: 10.1080/14767058.2021.2005021 -
Drugs Jun 2024Depression during the first year postpartum (postpartum depression) impacts millions of women and their families worldwide. In this narrative review, we provide a... (Review)
Review
Depression during the first year postpartum (postpartum depression) impacts millions of women and their families worldwide. In this narrative review, we provide a summary of postpartum depression, examining the etiology and consequences, pharmacological and psychological treatments, and potential mechanisms of change and current barriers to care. Psychological treatments are effective and preferred by many perinatal patients over medications, but they often remain inaccessible. Key potential mechanisms underlying their effectiveness include treatment variables (e.g., dosage and therapeutic alliance) and patient behaviors (e.g., activation and avoidance and emotional regulation). Among pharmacological treatments, the selective serotonin reuptake inhibitor (SSRI) sertraline is generally the first-line antidepressant medication recommended to women in the postpartum period due to its minimal passage into breastmilk and the corresponding decades of safety data. Importantly, most antidepressant drugs are considered compatible with breastfeeding. Neurosteroids are emerging as an effective treatment for postpartum depression, although currently this treatment is not widely available. Barriers to widespread access to treatment include those that are systematic (e.g., lack of specialist providers), provider-driven (e.g., lack of flexibility in treatment delivery), and patient-driven (e.g., stigma and lack of time for treatment engagement). We propose virtual care, task-sharing to non-specialist treatment providers, and collaborative care models as potential solutions to enhance the reach and scalability of effective treatments to address the growing burden of postpartum depression worldwide and its negative impact on families and society.
Topics: Humans; Depression, Postpartum; Female; Antidepressive Agents; Selective Serotonin Reuptake Inhibitors; Sertraline; Psychotherapy; Pregnancy
PubMed: 38811474
DOI: 10.1007/s40265-024-02038-z -
American Journal of Obstetrics &... May 2022Perinatal mood and anxiety disorders are common and may interfere with pregnancy, delivery, and the postpartum period. Best practice includes symptom screening, patient...
BACKGROUND
Perinatal mood and anxiety disorders are common and may interfere with pregnancy, delivery, and the postpartum period. Best practice includes symptom screening, patient education, and appropriate referrals; however, many hospitals struggle to identify and support perinatal mood and anxiety disorders patients.
OBJECTIVE
Therefore, the Cedars-Sinai Postpartum Depression Screening, Education and Referral Program was initiated and evaluated.
STUDY DESIGN
Using the Standards for QUality Improvement Reporting Excellence 2.0 guidelines, we reported outcomes (N=19,564 deliveries) from 4 interventions: (1) nurse-champion training; (2) use of the 9-item Patient Health Questionnaire-9 in the postpartum unit; (3) a series of brief in-service trainings; and (4) a 10-minute video training. We collected data including nurse feedback, screening rates, screen-positive rates, and social work consultation rates.
RESULTS
The 4 interventions increased: (1) nurse-champion screening comfort and perinatal mood and anxiety disorder knowledge; (2) Patient Health Questionnaire-9 screening rates from 10% to 99% and screen-positive rates from 0.04% to 2.9%; and (3) rates of social work consultation from 1.7% to 8.4%.
CONCLUSION
Quality improvement results from the first 3 years of the program suggest that 4 interventions improved screening rates, screen-positive rates, and social work consultation rates. Future work will focus on method of screening, patients at highest risk of perinatal mood and anxiety disorders, and ongoing nurse training.
Topics: Anxiety Disorders; Depression, Postpartum; Female; Humans; Inpatients; Pregnancy; Quality Improvement; Referral and Consultation
PubMed: 35123115
DOI: 10.1016/j.ajogmf.2022.100581 -
Journal of Affective Disorders Mar 2021Postpartum depression (PPD) is a major public health problem worldwide, which adversely affects maternal and infant health. The purpose of this study was to determine...
BACKGROUND
Postpartum depression (PPD) is a major public health problem worldwide, which adversely affects maternal and infant health. The purpose of this study was to determine the prevalence and related factors of postpartum depression in Chinese puerperium women.
METHODS
A cross-sectional study was conducted in Baoan Maternal and Child Health Hospital located in the west of Shenzhen, China. The Chinese version of the Edinburgh Postpartum Depression Scale (EPDS) was used to screen PPD. A score of ≥10 was used as the threshold of postpartum depression.
RESULTS
A total of 4813 puerperal women were included in this study, 11.5% of whom were considered to have PPD. Multivariate logistic regression analysis found that family history of mental illness (OR = 1.94; 95% CI, 1.05-3.57; P = 0.033), living with parents-in-law (OR = 1.41; 95% CI, 1.16-1.72; P < 0.001), anxiety during pregnancy (OR = 3.66; 95% CI, 2.97-4. 52; P < 0.001), depression during pregnancy (OR = 4.25; 95% CI, 3.28-5.50; P < 0.001), and stressful life events (OR = 1.50; 95% CI, 1.03-2.20; P = 0.036) were associated with the high prevalence of PPD.
LIMITATIONS
The cross-sectional survey cannot assess direct causality. EPDS is just a screening tool and not a diagnostic one.
CONCLUSION
Postpartum depression is a common disease in Chinese puerperal population. High-risk pregnant women with postpartum depression need routine screening and targeted intervention for PPD.
Topics: Child; China; Cross-Sectional Studies; Depression, Postpartum; Female; Hospitals; Humans; Pregnancy; Prevalence; Risk Factors
PubMed: 33601683
DOI: 10.1016/j.jad.2021.01.012 -
Journal of Perinatal Medicine Jun 2022To examine the relationship between postpartum depression (PPD), mode of delivery (MOD), and indication for unscheduled cesarean delivery (uCD).
OBJECTIVES
To examine the relationship between postpartum depression (PPD), mode of delivery (MOD), and indication for unscheduled cesarean delivery (uCD).
METHODS
Patients with antenatal and postpartum Edinburgh Postnatal Depression Scale (EPDS) scores were compared by MOD and indication for uCD if applicable. Patients with an antenatal EPDS>12 were excluded to ascertain the incidence of new depression. The primary outcome was EPDS≥13 by MOD. The secondary outcome was EPDS≥13 by indication for uCD.
RESULTS
Seven hundred and thirty eight patients met inclusion criteria. There were statistically significant differences in MOD by age, race, BMI, and multi-gestation pregnancy. Patients delivered via uCD had a higher rate of peripartum complications and NICU admission. There were no differences in medical comorbidities or use of psychiatric medications by MOD. There was no difference in EPDS by MOD. The rate of PPD was higher in patients with uCD for non-reassuring fetal heart tones (NRFHT) compared to other indications for uCD (p=0.02).
CONCLUSIONS
While there was no difference in the incidence of PPD by MOD, the incidence of PPD was higher among patients delivered via uCD for NRFHT. These findings may have implications for patient counseling, post-operative mental health surveillance, and support of postpartum patients.
Topics: Cesarean Section; Depression, Postpartum; Female; Humans; Postpartum Period; Pregnancy; Psychiatric Status Rating Scales; Retrospective Studies
PubMed: 35166090
DOI: 10.1515/jpm-2021-0575