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American Family Physician Apr 1999Postpartum major depression occurs in approximately one of 10 childbearing women and is considerably underdiagnosed. If left untreated, the disorder can have serious... (Review)
Review
Postpartum major depression occurs in approximately one of 10 childbearing women and is considerably underdiagnosed. If left untreated, the disorder can have serious adverse effects on the mother and her relationship with significant others, and on the child's emotional and psychologic development. A simple screening instrument can be used to increase the detection of postpartum major depression. Although few well-controlled studies have been done to support the use of any one modality, the mainstay of treatment has been antidepressant therapy, alone or in combination with psychotherapy. Plasma concentrations of antidepressant drugs are usually low in the breast-fed infant, and most studies demonstrate that certain antidepressants can be used during lactation without any important adverse effects on the infant.
Topics: Antidepressive Agents; Depression, Postpartum; Female; Humans; Patient Education as Topic; Psychotherapy; Risk Factors; Teaching Materials
PubMed: 10221309
DOI: No ID Found -
American Journal of Obstetrics &... Mar 2024This study aimed to compare the efficacy and safety of the use of esketamine to reduce the risk for postpartum depression and pain after cesarean delivery. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aimed to compare the efficacy and safety of the use of esketamine to reduce the risk for postpartum depression and pain after cesarean delivery.
DATA SOURCES
Literature searches were conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wan fang from inception to August 2023.
STUDY ELIGIBILITY CRITERIA
The eligibility criteria were all randomized controlled trials of people who underwent a cesarean delivery and who were randomized to receive esketamine interventions irrespective of age or ethnicity. The outcomes that were assessed included the incidence of postpartum depression and the Edinburgh Postnatal Depression Scale score within 7 days and at 28 to 42 days after delivery, the pain score (visual analog scale or numerical rating scale, 0-10), the consumption of opioids, and intraoperative and postoperative adverse events.
METHODS
The Cochrane collaboration's tool was used for quality appraisal of the included studies. Statistical analysis of the data was performed using Review Manager 5.3 software, and the results were expressed as mean differences with 95% confidence intervals. Assessments were pooled using a random-effects or fixed-effects model. Study heterogeneity was assessed using the standard I statistic.
RESULTS
Among the 11 included randomized controlled trials that used the Edinburgh Postnatal Depression Scale for postpartum depression assessment, patients in esketamine group had a lower risk for postpartum depression within a week of surgery (risk ratio, 0.45; 95% confidence interval, 0.33-0.62). Intraoperative use of esketamine maintained a lower Edinburgh Postnatal Depression Scale score after surgery (mean difference, -1.64; 95% confidence interval, -2.14 to -1.14). Esketamine was associated with a beneficial effect in terms of the other outcomes, including a significant decline in pain score within 48 hours (mean difference, -0.71; 95% confidence interval, -0.89 to 0.52). Esketamine increased the risk for adverse neurologic and mental events during surgery without harming health, and there was no significant difference after delivery when compared with the control group.
CONCLUSION
Esketamine may reduce the risk for postpartum depression among patients who are undergoing cesarean delivery in the short term. In addition, as an adjunct to reduce analgesia, esketamine also effectively assists in pain management. Because of the lack of more high-quality evidence, we need more compelling evidence to confirm the value of esketamine in improving postpartum recovery.
Topics: Pregnancy; Female; Humans; Pain Management; Depression, Postpartum; Analgesia; Pain; Randomized Controlled Trials as Topic; Ketamine
PubMed: 38262519
DOI: 10.1016/j.ajogmf.2023.101241 -
Przeglad Lekarski 2002This paper is a literature review of current knowledge about postpartum depression. It presents the course and clinical picture of this disorder with regard of possible... (Review)
Review
This paper is a literature review of current knowledge about postpartum depression. It presents the course and clinical picture of this disorder with regard of possible complications. The stress was laid on early and efficient diagnosis and differentiation. The general rules of prophylaxis and treatment were also described. The authors also presented new hypothesis concerning biological basis of postpartum depression. The article should be useful not only for psychiatrists, but also for physicians of other specializations with special regard of obstetricians, paediatrists and general practitioners.
Topics: Depression, Postpartum; Female; Humans; Pregnancy
PubMed: 12715723
DOI: No ID Found -
Archives of Women's Mental Health Aug 2022Postpartum depression (PPD) is common and disproportionately affects people of color. Experiences of emotional upset due to racism (EUR) may be an important predictor of...
Postpartum depression (PPD) is common and disproportionately affects people of color. Experiences of emotional upset due to racism (EUR) may be an important predictor of PPD outcomes. Therefore, we aimed to determine if EUR during the 12 months before delivery was associated with PPD symptomology, asking for help for depression, and depression diagnosis among postpartum people of color (PPOC). We conducted a cross-sectional secondary data analysis among PPOC from 11 states and New York City using PRAMS data, 1/1/2015-12/31/2017. We assessed symptomology using an unvalidated PHQ-2. Logistic regression was performed without and with stratification by ethnicity (non-Hispanic PPOC vs Hispanic PPOC) to estimate whether EUR during 12 months before delivery was associated with (1) PPD symptoms, (2) asking for help for depression, and (3) depression diagnosis. Models adjusted for age, educational attainment, timely prenatal care, payment method, stress during pregnancy, and pre-pregnancy depression. Seventy-four thousand nine hundred nine (11.8%) PPOC reported EUR in the 12 months before delivery. After adjustment, EUR was associated with a 10.3 percentage point (%pt; 95% CI: 6.8, 13.8), 13.6%pt (95% CI: 8.8, 18.5), and 4.1%pt (95% CI: 1.4, 8.0) higher probability of positive PPD screening among all PPOC, non-Hispanic PPOC, and Hispanic PPOC, respectively. EUR was not associated with asking for help for depression but was associated with a higher prevalence of depression diagnosis among all PPOC (4.6%pt; 95% CI: 1.0, 8.4) and non-Hispanic PPOC (6.0%pt; 95% CI: 0.8, 11.2).Experiences of EUR are associated with an increased prevalence of PPD symptoms. Additional prospective research spanning the pre-pregnancy through postpartum periods is needed to examine the dynamic relationship between racism, symptomology, help-seeking, and diagnosis of depression.
Topics: Cross-Sectional Studies; Depression, Postpartum; Female; Humans; Postpartum Period; Pregnancy; Prospective Studies; Racism; Risk Factors
PubMed: 35504987
DOI: 10.1007/s00737-022-01232-w -
Pediatrics in Review May 2003
Review
Topics: Antidepressive Agents; Depression, Postpartum; Female; Humans; Parent-Child Relations; Parenting; Pediatrics; Physician's Role; Prognosis
PubMed: 12728188
DOI: 10.1542/pir.24-5-154 -
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 -
Journal of Pediatric Health Care :... 2022This evidence-based practice project established postpartum depression (PPD) screening and followed maternal use of mental health services in a multilingual low...
INTRODUCTION
This evidence-based practice project established postpartum depression (PPD) screening and followed maternal use of mental health services in a multilingual low socioeconomic status urban population.
METHOD
The Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care was used to establish a screening protocol for mothers at their infants' well-child checks. For mothers with positive screens, providers referred them to mental health care and updated their child's electronic health record diagnosis to prompt reassessment for future visits.
RESULTS
Over 6 months, 273 mothers were screened at 523 eligible office visits (83.5% screening rate), 26 (9.5%) screened positive, 19 (73.1%) were referred to mental health services, and 12 (63.2%) attended the referral. Thirteen (50%) mothers with PPD had the appropriate electronic health record flag in their infant's record.
DISCUSSION
This project successfully implemented the American Academy of Pediatrics PPD screening guidelines and could be applicable to other pediatric outpatient settings.
Topics: Adult; Depression, Postpartum; Female; Humans; Language; Mass Screening; Mothers; Public Health
PubMed: 34215463
DOI: 10.1016/j.pedhc.2021.02.005 -
Journal of Pediatric and Adolescent... Jun 2010Postpartum depression (PPD) affects a significant proportion of adolescent mothers. Adolescence presents unique challenges that may make the young mother more vulnerable... (Review)
Review
Postpartum depression (PPD) affects a significant proportion of adolescent mothers. Adolescence presents unique challenges that may make the young mother more vulnerable than her adult counterparts to PPD. PPD impacts a mother's ability to care for her infant and has been associated with adverse effects on child development. A review of the literature on adolescent PPD was undertaken. The prevalence and the effects of PPD are reviewed, common screening instruments for PPD are compared, and the results of treatment outcome studies are highlighted. There is a need for randomized controlled studies of interventions for adolescents with PPD. Findings from treatment outcome studies with adults with PPD and pregnant adolescents who are depressed suggest that psychosocial interventions may also be effective for adolescents with PPD. Issues in assessment and treatment of PPD among adolescents are considered.
Topics: Adolescent; Age Factors; Brief Psychiatric Rating Scale; Depression, Postpartum; Female; Humans; Mother-Child Relations; Psychotherapy, Brief
PubMed: 20496498
DOI: 10.1016/j.jpag.2009.09.003 -
BMC Psychiatry Aug 2023Women with antenatal depression often have a higher risk of developing postpartum depression (PPD) after delivery. A number of factors associated with the PDD in those...
BACKGROUND
Women with antenatal depression often have a higher risk of developing postpartum depression (PPD) after delivery. A number of factors associated with the PDD in those previously reporting antenatal depression have been suggested, but further research is needed. This study aimed to investigate factors associated with developing subsequent postnatal depression in women who had screened positive for antenatal depression.
METHODS
This study was carried out in Hangzhou women's Hospital. 578 women who experienced antenatal depression from this cohort were enrolled in this study. The sociodemographic and clinical characteristics of the participants were collected and tabulated against the incidence of postnatal depression. Binary logistic regression was used to estimate the effects of the principal underlying variables. The Chinese-version Edinburgh Postnatal Depression Scale (EPDS) was used to screen for PPD. Antenatal screening for depression was conducted at 28-34 weeks during pregnancy and postpartum depressive symptoms were assessed at 6 weeks after childbirth in the women. Path Analysis of Structural Equation Model (SEM) was employed to explore the direct, indirect, and total effects of risk factors of PPD.
RESULTS
57.6% (n = 333) of the participants subsequently developed PPD in our study. The results of the logistic analysis indicated that ages ≤ 35 years old (OR = 1.852; 95%CI: 1.002-3.423), non-one-child families (OR = 1.518; 95%CI: 1.047-2.200), and rare care from partner during pregnancy (OR = 2.801; 95%CI: 1.038-7.562), the antenatal EPDS score (OR = 1.128; 95%CI: 1.052-1.209), pyrexia during pregnancy (OR = 2.43; 95%CI: 1.358-4.345), fairly good (OR = 1.836; 95%CI: 1.009-3.340), fairly bad (OR = 3.919; 95%CI:2.072-7.414) and very bad postpartum sleep quality (OR = 9.18; 95%CI: 2.335-36.241) were associated with increased risk of PPD (compared to very good postpartum sleep quality). In path analysis model, antenatal EPDS score (standardized total β = 0.173) and pyrexia during pregnancy (standardized total β = 0.132) had both direct and indirect effects (the impact on outcome variables needs to be determined through other variables) on PPD. Sleep quality after delivery (standardized β = 0.226) and one-child family (standardized β = 0.088) had direct effects only on PPD.
CONCLUSION
The results from our study indicated that more than 50% of the women who experienced antepartum depression would subsequently develop PPD. Depressive symptoms and pyrexia during pregnancy increase PPD scores, and these effects were in part mediated via poor sleep quality during the postpartum period.
Topics: Pregnancy; Female; Humans; Adult; Depression, Postpartum; Depression; Postpartum Period; Parturition; Risk Factors
PubMed: 37528383
DOI: 10.1186/s12888-023-05030-1 -
Archives of Women's Mental Health Oct 2018Previous studies have reported different effect sizes for self-help interventions designed to reduce postpartum depression symptoms; therefore, a comprehensive... (Meta-Analysis)
Meta-Analysis Review
Previous studies have reported different effect sizes for self-help interventions designed to reduce postpartum depression symptoms; therefore, a comprehensive quantitative review of the research was required. A meta-analysis was conducted to examine the effectiveness of self-help interventions designed to treat and prevent postpartum depression, and identified nine relevant randomized controlled trials. Differences in depressive symptoms between self-help interventions and control conditions, changes in depressive symptoms following self-help interventions, and differences in postintervention recovery and improvement rates between self-help interventions and control conditions were assessed in separate analyses. In treatment trials, depression scores continued to decrease from baseline to posttreatment and follow-up assessment in treatment subgroups. Changes in treatment subgroups' depression scores from baseline to postintervention assessment were greater relative to those observed in prevention subgroups. Self-help interventions produced larger overall effects on postpartum depression, relative to those observed in control conditions, in posttreatment (Hedges' g = 0.51) and follow-up (Hedges' g = 0.32) assessments; and self-help interventions were significantly more effective, relative to control conditions, in promoting recovery from postpartum depression. Effectiveness in preventing depression did not differ significantly between self-help interventions and control conditions.The findings suggested that self-help interventions designed to treat postpartum depression reduced levels of depressive symptoms effectively and decreased the risk of postpartum depression.
Topics: Adult; Depression; Depression, Postpartum; Female; Humans; Pregnancy; Psychotherapy; Randomized Controlled Trials as Topic; Self Care; Severity of Illness Index; Treatment Outcome
PubMed: 29616334
DOI: 10.1007/s00737-018-0835-0