Routine E-Screening for Perinatal Mental Health During the COVID-19 Emergency: Beyond the Instrument Cut-Off Points.

The COVID-19 pandemic represents a significant risk factor for mental distress in perinatal women. Assessment for mental health issues should therefore be an integral part of safeguarding health at every stage of pregnancy and postpartum. Considering the impact of the COVID-19 pandemic on the planning of healthcare services locally, it is important to employ information-gathering techniques such as seeking feedback from both patients and staff. E-screening conforms to stay-at-home COVID restrictions and can improve the efficiency of mental healthcare. The symptomatologic levels indicated by the cut-off points, as well as the real time concerns expressed by perinatal women through open questions, are valuable on many levels. Future studies are needed not only on the sensitivity of the e-screening routines in the context of daily clinical practice, but also on the deeper meaning of the personal concerns reported in e-screening open questions in both positive and negative screening environments.

Perinatal psychological well-being in women with zero postnatal anxiety-depressive symptoms scores: a retrospective descriptive study.

Background: A total absence of psychological symptoms during pregnancy or postpartum period is not common. Although there are some considerations on zero scores detected by EPDS, no thorough analysis is currently present in the literature of the eventuality and meaning of a total absence of postpartum symptoms following the compilation of two or more self-report symptom questionnaires.Methods: In a sample of 960 Italian women, three groups of 31 subjects are defined retrospectively by scores on the EPDS-GHQ12: women with 'zero', 'lower', and 'higher' postnatal symptomatology. The psychological well-being of these groups was compared as detected in pregnancy and after childbirth by PWB questionnaire.Results: Higher and excessive scores in Environmental mastery dimension connote the profile of women with a total absence of postpartum anxiety-depression symptoms. Positive relations with other dimension were less characterising, but it should be noted as a distinctive trait in the 'zero' symptoms postnatal symptomatology group. In the same 'zero' group, the scores of the six PWB questionnaire dimensions - except Personal growth - are all higher than the scores obtained by women in the general population.Conclusion: The atypical self-reported perinatal mood condition present in the 'zero' symptoms group have currently unknown clinical significance.

Routine screening for postnatal depression in a public health family service unit: a retrospective study of self-excluding women.

At this time, there is limited scientific knowledge about women who exclude themselves from screening programs for postnatal depression. In this retrospective descriptive study, we have sought to investigate the socio-demographic and psycho-social factors of women who withdraw from PND screening of their own accord. Study participants were 525 women attending antenatal classes who later took part in institutional routine screening for PND at the Consultorio Familiare Service of the National Health Service, Italy. The PND screening program consisted of the completion of the postpartum depression predictors inventory-revised and psychological well-being (PWB) questionnaires within eight to nine months of pregnancy, and Edinburgh Postnatal Depression Scale, GHQ-12 and PWB within six to eight weeks after childbirth. The Responders group was made up of 346 subjects - 65.9% of the total sample - who completed the entire program of screening for PND. The Non-Responders group, on the other hand, consisted of 179 subjects - 34.1% of the total sample - who, after childbirth, withdrew from the screening program. Compared to the Responders group, the Non-Responders group showed a greater number of subjects with marital dissatisfaction, and with unemployment as a stressful event. Health professionals who detect marital dissatisfaction and/or unemployment as a stressful event in pregnant women should bear in mind that these individuals, besides being at high risk for depression after delivery, will also tend to exclude themselves from screening for PND.

Maternity blues in Italian primipara women: symptoms and mood states in the first fifteen days after childbirth.

The maternity blues is the most commonly observed puerperal mood disturbance. In Italy, the mother's daily affective experience after childbirth has not yet been published. During each of the first 15 days after the birth of the child, 36 primipara women completed the Kellner Symptoms Questionnaire (SQ) and the Profile of Mood States (POMS). We found that the mothers studied showed both psychological symptoms and mood disturbances of slight entity. Conversely, somatic symptoms were particularly acute in the first few days after childbirth. In this same period, slight anxiety symptoms, confusion, and bewilderment may develop.

Preventing, Mitigating, and Treating Women's Perinatal Mental Health Problems during the COVID-19 Pandemic: A Scoping Review of Reviews with a Qualitative Narrative Synthesis.

Meeting the mental health needs of perinatal women during the COVID-19 pandemic is a serious concern. This scoping review looks at how to prevent, mitigate or treat the mental health problems faced by women during a pandemic, and lays out suggestions for further research. Interventions for women with pre-existing mental health problems or health problems that develop during the perinatal period are included. The literature in English published in 2020-2021 is explored. Hand searches were conducted in PubMed and PsychINFO using the terms COVID-19, perinatal mental health and review. A total of 13 systematic and scoping reviews and meta-analyses were included. This scoping review shows that every woman should be assessed for mental health issues at every stage of her pregnancy and postpartum, with particular attention to women with a history of mental health problems. In the COVID-19 era, efforts should be focused on reducing the magnitude of stress and a perceived sense of lack of control experienced by perinatal women. Helpful instructions for women with perinatal mental health problems include mindfulness, distress tolerance skills, relaxation exercises, and interpersonal relationship building skills. Further longitudinal multicenter cohort studies could help improve the current knowledge. Promoting perinatal resilience and fostering positive coping skills, mitigating perinatal mental health problems, screening all prenatal and postpartum women for affective disorders, and using telehealth services appear to be indispensable resources. In future, governments and research agencies will need to pay greater attention to the trade-offs of reducing the spread of the virus through lockdowns, physical distancing, and quarantine measures and developing policies to mitigate the mental health impact on perinatal women.

Erratum: Perinatal mental health around the world: priorities for research and service development in Italy - CORRIGENDUM.

[This corrects the article DOI: 10.1192/bji.2019.31.].

Sexuality in the perinatal period: A systematic review of reviews and recommendations for practice.

In the time of transition to parenthood, many physical, psychological and social changes may affect the multidimensional theme of sexuality. This area plays a significant role in the overall well-being of the individual, the couple and the family. The aim of this systematic review is to consider current and emerging trends in the study of sexual function during pregnancy and after childbirth, evaluating the available evidence in the literature reported in specific reviews, and pulling together the suggestions that various authors have brought forward as being useful for daily clinical practice. A total of 4 databases were searched on EBSCOhost: MEDLINE, Cochrane reviews, CINAHAL, and PsychInfo. A systematic search strategy was formulated using the key terms Sexuality, Sexual, Pregnancy, Postpartum, Puerperium, Perinatal, and Review. Eleven articles were included. The results revealed a gradual decline in the frequency of sexual behaviour throughout pregnancy, sharper in the third trimester. Sexual activity started to be resumed around 6-8 weeks after childbirth, to fully recover only after 6 months. A simultaneous change in sexual function was also found, such as less orgasm, sexual desire and satisfaction, more dyspareunia. Many aspects are related to these changes: physical, psychological and social factors, fears about negative consequences of sexual intercourse, inadequate or absent professional counselling about sexuality, method of delivery and breastfeeding. Healthcare professionals need to adequately inform couples about the common fluctuations in sexual activity, interest, desire, and responsiveness over the course of the pregnancy and following childbirth. Joint counselling, if possible, is preferred.

Perinatal mental health around the world: priorities for research and service development in Italy.

In Italy, most studies on perinatal mental health and initiatives aimed at improving the early detection and management of perinatal mental disorders have been carried out at the local level. National population-based studies are lacking. A study of pregnant women, recruited and diagnosed by a university hospital, found a 12.4% prevalence of minor and major depression during pregnancy, and a prevalence of 9.6% in the postpartum period. In a population-based surveillance system, covering 77% of national births, suicide was identified to be one of the main causes of maternal death within the first year after birth, yet half of those who were known to have a high suicide risk during the postpartum period had not been referred to a mental health service. The value of recognising depressive or anxiety symptoms early, during pregnancy, has been emphasised by recent research and should be linked to multi-professional psychosocial interventions. Since 2017, the Italian public primary care services that are dedicated to pregnancy assistance (Family Care Centres) have been tasked to provide free psychological assessment to pregnant and postpartum women. Action is now needed in order to improve access to Italian Family Care Centres for pregnant women and to develop an integrated care model involving obstetric and mental health services.

Prevalence and risk factors for a high level of postnatal depression symptomatology in Italian women: a sample drawn from ante-natal classes.

BACKGROUND: Depression after childbirth is a major problem affecting 10-22% of all mothers. In Italy, postnatal depression has not yet been systematically studied. METHODS: In this retrospective study we have sought to identify risk factors, assessed during pregnancy, and their importance for postnatal depression symptoms in a sample of 297 Italian women attending ante-natal classes organised by the local Consultorio Familiare Unit of the National Health Service, Italy. The Postpartum Depression Predictors Inventory - revised form (PDPI-Revised), was used to identify risk factors, 8-9 month of pregnancy. A double-test strategy using the Edinburgh Postnatal Depression Scale (EPDS) and 12-item General Health Questionnaire (GHQ12), was administered to screen women with a higher occurrence of symptoms of postnatal depression six-eight weeks after delivery. Women with high EPDS (<8) and high GHQ12 (<3) scores were compared with those who had scored below the EPDS and/or GHQ12 threshold scores. RESULTS: We found that 13% of the women studied showed high postnatal depressive symptomatology, which is very similar to rates of prevalence of postnatal depression in the first year after the birth of the child reported in other Western World studies. Feeling anxious during pregnancy is a strong predictor of high symptoms of depression at 6-8 weeks after delivery. However, University education and friends' support appear to be important protective factors. CONCLUSION: These findings could be useful both for Italian health professionals and for researchers interested in the transcultural aspects of postnatal depression.