Depressive symptoms in early pregnancy, two months and one year postpartum-prevalence and psychosocial risk factors in a national Swedish sample.

BACKGROUND: Depression and other psychiatric disorders during pregnancy and postpartum is an important health problem, especially if the symptoms are recurrent or sustained. METHODS: All Swedish speaking women attending their first antenatal care visit during three predestined weeks were invited to participate. Depressive symptoms were evaluated using the Edinburgh Postnatal Depression Scale (EPDS) in early pregnancy, two months and one year postpartum. RESULTS: In all, 2430 women completed three questionnaires. A dose-effect relation was found between the numbers of stressful life events experienced in the year prior to pregnancy and mean EPDS score in pregnancy. The prevalence of recurrent or sustained depressive symptoms (EPDS> or =12 on all three evaluations) was 3% (79/2430). Three factors were associated with depressive symptoms, two or more stressful life events in the year prior to pregnancy, native language other than Swedish and unemployment. CONCLUSIONS: Apart from questions about psychiatric history, a psychosocial history in early pregnancy including stressful life events, native language and employment status could help the health professionals to identify women at risk for recurrent or sustained depression during pregnancy and the year after giving birth.

Postnatal depression across countries and cultures: a qualitative study.

BACKGROUND: Postnatal depression seems to be a universal condition with similar rates in different countries. However, anthropologists question the cross-cultural equivalence of depression, particularly at a life stage so influenced by cultural factors. AIMS: To develop a qualitative method to explore whether postnatal depression is universally recognised, attributed and described and to enquire into people's perceptions of remedies and services for morbid states of unhappiness within the context of local services. METHOD: The study took place in 15 centres in 11 countries and drew on three groups of informants: focus groups with new mothers, interviews with fathers and grandmothers, and interviews with health professionals. Textual analysis of these three groups was conducted separately in each centre and emergent themes compared across centres. RESULTS: All centres described morbid unhappiness after childbirth comparable to postnatal depression but not all saw this as an illness remediable by health interventions. CONCLUSIONS: Although the findings of this study support the universality of a morbid state of unhappiness following childbirth, they also support concerns about the cross-cultural equivalence of postnatal depression as an illness requiring the intervention of health professionals; this has implications for future research.

[Do not minimize signs of postpartum depression! Early intervention essential to prevent negative consequences for the child]. / Bagatellisera inte nyblivna mammors depressionstecken! Tidigt stöd avgörande för att motverka negativa konsekvenser för barnet.

Recent clinical research reveals that postnatal depression is associated with disturbances in the mother-infant relationship. These disturbances have in turn an adverse impact on the child's cognitive and emotional development. Postnatal depression affects 8-15 percent of women in the first months after delivery. The use of the Edinburgh Postnatal Depression Scale (EPDS) has proven useful in Swedish child health care to help nurses identify mothers with symptoms of depression. Weekly counselling visits by trained nurses are effective as the first treatment of choice for most women with postnatal depression.

The role of the Child Health Services in promoting mental health: an introduction.

This paper gives an introduction to the psychosocial work in the Swedish Child Health Services (CHS). There are substantial problems in defining and evaluating the preventive mental health work of the CHS. The issues raised include: why early preventive intervention is important; the promotion of parental mental health as an aim of the CHS; how the CHS can increase parenting knowledge and skills; what evidence there is about intervention among target groups; and finally, how recent research knowledge can be applied in the CHS.

Screening for postnatal depression in a population-based Swedish sample.

This study surveyed the prevalence of postnatal depression and demographic factors associated with it in a Swedish population. A community sample of 1,584 women was screened at 8 and 12 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). The point prevalence of depression, using a threshold of 11/12 on the EPDS, was 12.5% at 8 weeks and 8.3% at 12 weeks postpartum. The period prevalence for 8 to 12 weeks postpartum was 4.5%. A significantly increased risk of postnatal depression was found for single women. Parity, maternal age and occupational status were not found to be related to postnatal depression. The findings suggest that screening for postnatal depression is feasible at the time of postnatal checks on the baby, and that it can aid in the identification of women at risk for depression. A two-stage screening procedure will identify women at risk for more persistent postnatal depression.

The Edinburgh Postnatal Depression Scale: validation on a Swedish community sample.

The Edinburgh Postnatal Depression Scale (EPDS) was designed to be used by community health workers to screen for postnatal depression. We report data from a population-based sample of 1655 women who completed the EPDS at 2 months and 3 months postpartum. A total of 128 women were interviewed with the Montgomery Asberg Depression Rating Scale (MADRS) and assessed according to DSM-III-R criteria for major depression. A cut-off score of 11.5 on the EPDS identified all but two women with major depression, giving it a sensitivity of 96%, a specificity of 49% and a positive predictive value of 59%. This study supports the validity of the EPDS shown in earlier studies, and indicates that the scale is a useful screening instrument for identifying postnatal depression in primary health care in Sweden.

Counselling of postnatal depression: a controlled study on a population based Swedish sample.

In a two-stage screening procedure using the Edinburgh Postnatal Depression Scale (EPDS) at 8 and 12 weeks postpartum and the Montgomery-Asberg Depression Rating Scale (MADRS) and DSM-III-R at about 13 weeks postpartum, 41 women identified as depressed were randomly allocated to a study and a control group. The women in the study group received 6 weekly, counselling visits by the Child Health Clinic nurse and the control group received routine primary care. Twelve (80%) of 15 women with major depression in the study group were fully recovered after the intervention compared to 4 (25%) of 16 in the control group. Counselling by health nurses is helpful in managing postnatal depression and seems to work well within the Swedish Primary Health Care system.

Chemical methods in ethnopharmacology.

The impact of improved spectroscopic techniques on structural elucidation is shown by examples from recent work on CNS active tiglianes from Pycnocoma cornuta Muell. The limited quantities of substance now needed for structural analysis can usually be obtained by routine high performance chromatography, but this methodology is less suited for large scale preparations. It may then be worthwhile also to consider earlier materials and methods. Particularly liquid-liquid partitioning in old or new versions (CCC) may have advantages with respect to selectivity and mildness. In special cases activated carbon adsorbents may offer the benefits of selectivity and tolerance to high sample loads.

Mutagens in larger fungi. I. Forty-eight species screened for mutagenic activity in the Salmonella/microsome assay.

Specimens of large fungi (mushrooms) were screened for mutagenic activity by the Salmonella/microsome assay, with strains TA98, TA2637 and TA100. Our of 48 species tested, 37 exhibited a significant but for the most part weak activity. The activity observed in the presence of S9 mix was typically between 0 and 50% of that without, and in no case was the activity increased in the presence of microsomal enzymes. Six metabolites reported to occur in some of the species included in this investigation were also tested. Significant mutagenic activity was found with isovelleral (5) from Lactarius sp., agaritine (3) from Agaricus bisporus and related sp. and beta-nitraminoalanine (7) from Agaricus silvaticus. Isovelleral may be a major mutagen in some of the sharp-tasting and mutagenic Russulaceae sp. A. bisporus (cultivated specimen) was weakly mutagenic toward all three strains of S. typhimurium, used, and agaritine was weakly active toward TA2637 alone. This implies that this fungus might contain other mutagenic material as well. beta-Nitraminoalanine was not found in the particular collection of A. silvaticus tested here. The mutagenicity observed for the fungus in this work may therefore be due to other metabolites. Even though many species found to be mutagenic are used as food, it seems premature to make specific recommendations about eventual health risks. Further information is needed about the chemistry and toxicology of the active compounds as well as about the effects of various methods used in preparing mushrooms for food.

On the disulfiram-like effect of coprine, the pharmacologically active principle of Coprinus atramentarius.

Coprine or disulfiram was given to rats in various doses at various time intervals before the administration of 2 g/kg ethanol. The ratio acetaldehyde/ethanol in the alveolar air was measured by gas chromatography and was taken as an index of the aldehyde dehydrogenase (ALDH) activity. The activity of dopamine beta-hydroxylase (DBH) was estimated in the same animals by measuring the amount of 14C-octopamine formed from 14C-tyramine in the heart. Coprine and disulfiram both caused an increase in the acetylaldehyde/ethanol ratio, coprine being more potent than disulfiram. Disulfiram, but not coprine, reduced the net yield of 14C-octopamine. In rats pretreated with either coprine or disulfiram, blood-pressure and heart-rate were recorded before and after intraperitoneal injections of 0.4 g/kg ethanol. In both cases ethanol caused a marked and rapid fall in blood-pressure. However, this effect was accompanied by tachycardia only in animals treated with coprine. It is concluded that coprine like disulfiram inhibits ALDH, but only disulfiram causes an additional inhibition of DBH. This difference may account for differences in the cardiovascular response to ethanol.