"Social support and stressful life events: risk factors for antenatal depression in nulliparous and multiparous women".

Nulliparous (pregnant women who are giving birth for the first time) and multiparous (women who have multiple children) may have different concerns, which may be associated with risk of antenatal depression. This study aims to examine the role of social support and stressful life events as risk factors for antenatal depression in nulliparous and multiparous women. The sample included 1,524 pregnant women recruited from an obstetrics setting at the end of the first trimester of pregnancy from two Spanish tertiary-care public hospitals. The sample completed the Patient Health Questionnaire (PHQ-9), and the "social support" and "stressful life events" subscales of the Postpartum Depression Predictor Inventory-Revised (PDPI-R). Nulliparous women reported a lower prevalence of depressive symptoms (15.6 percent) compared to multiparous mothers (20.1 percent). In both groups, marriage/partner problems (NP: ß = 0.178, p < .01 vs MP: ß = 0.164, p < .01) and a perceived lack of instrumental support from friends (NP: ß = -0.154, p < .01 vs MP: ß = -0.154, p < .01) were significant risk factors for antenatal depression. However, nulliparous women have more risk factors such as unemployment (ß = 0.096, p < .05), job change (ß = 0.127, p < .01), financial problems (ß = 0.145, p < .01) and lack of instrumental support from partner (ß = -0187, p < .01). For multiparous women, moving (ß = 0.080, p < .05) and lack of instrumental support from family (ß = -0.151, p < .01) were risk factors. These results suggest the critical need for screening and designing preventive interventions adapted and taking into consideration parity to provide more effective health care during pregnancy.

A Cross-Cultural Analysis of the Prevalence and Risk Factors for Prenatal Depression in Spain and Mexico.

The prevalence and risk factors associated with prenatal depression among Spanish-speaking women in Spain and Mexico are examined and compared through a cross-cultural study. The study utilizes secondary data from 563 participants who received prenatal care in Madrid (N = 283) and in Mexico City (N = 280), assessed with the PHQ-9 and the PDPI-R. Spanish women reported a lower prevalence of depressive symptoms (10.0%) than Mexican women (20.3%). Regression analyses showed that previous prenatal anxiety and lack of family emotional support were common risk factors to the two countries. Within each country, significant risk factors included: (a) previous depression history (ß = 0.224; p < 0.001) in Spain; and (b) unplanned pregnancy (ß = - 0.116; p < 0.027), lack of emotional support from others (ß = 0.129; p < 0.032), marital dissatisfaction (ß = 0.186; p < 0.009), and life stress due to financial problems (ß = 0.117; p < 0.026), and life stress due to marital problems (ß = 0.114; p < 0.040) in Mexico. Health professionals can tailor interventions to their particular risk factors to reduce the adverse effects on mothers and infants.

Preventing perinatal depression in Spain: a pilot evaluation of Mamás y Bebés.

Objective: This pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of a cognitive-behavioural intervention to prevent perinatal depressive symptoms in pregnant women at high risk for perinatal depression in Spain. Background: Perinatal depression (PD) can negatively affect maternal and infant outcomes. Mamás y Bebés/The Mothers and Babies Course (MBC) is an evidence-based CBT intervention aimed at teaching women at high risk for depression mood regulation skills to prevent depression in the United States, including Spanish-speaking perinatal women in the United States. However, there is limited research on preventive interventions for PD in Spain. Method: Pregnant women screened for high risk for PD were recruited in their first trimester in an obstetrics clinic at two urban hospitals in Spain. In a non-experimental design, 30 women completed eight weekly group sessions of the MBC. The Patient Health Questionnaire was the main depression outcome at four time points: pre-intervention, post-intervention, and at 3 months and 6 months postpartum. Participants completed an evaluation questionnaire at the end of each session to assess the acceptability of the intervention. Results: The MBC was effective in reducing depressive symptoms from baseline to all three time points: post-intervention, 3 and 6 months postpartum. Attendance was high (76.7% attended all eight sessions). Mothers reported positive feedback from the participating in the MBC. Conclusion: This pilot study suggests that the intervention is feasible, acceptable, and provides promising evidence for reducing depressive symptoms in urban Spanish perinatal women. Larger and rigorous randomised trials are needed to confirm these findings.

The Prevalence and Risk Factors for Antenatal Depression Among Pregnant Immigrant and Native Women in Spain.

Introduction: The aim was to examine the risk factors of anternatal depression among immigrant and native pregnant women in Spain. Method: A total of 1,524 pregnant women completed the Patient Health Questionnaire and the Postpartum Depression Predictors Inventory-Revised form. Results: The native group reported a lower prevalence (15.2%) compared with immigrant group (25.8%). For immigrants, primiparity, moving, and perceived lack instrumental support from friends or emotional support from partners and family members were significant risk factors. Discussion: The study identified risk factors that can be used for preventive interventions during pregnancy. Significance: Screening and interventions for depression during pregnancy should take migration status into account to maximize effective health care. Also, health providers should consider how migration status can result in different risk factors that affect depression during pregnancy.

The structure of the Patient Health Questionnaire-9 in pregnant women in Spain.

OBJECTIVE: To evaluate psychometric properties and the factor structure of the Spanish version of the Patient Health Questionnaire (PHQ-9) in pregnant women received care in an urban public hospital in Spain. RESEARCH DESIGN/SETTING: In a cross-sectional study, the reliability and factor structure were examined. Exploratory and confirmatory factor analyses were conducted to examine the latent structure of the PHQ-9 with a pregnant Spanish-speaking sample (n = 445) recruited during the first trimester in an obstetrics clinic in Madrid. MEASUREMENTS AND FINDINGS: The Spanish version of PHQ-9 had moderate internal consistency (α = 0.81). Exploratory factor analysis revealed a two-factor (cognitive-affective, somatic) and three-factor (cognitive-affective, somatic, pregnancy-related) structure of the PHQ-9, whereas confirmatory factor analyses support a three-factor model (cognitive-affective, somatic, pregnancy-related) as the best fit to the data. KEY CONCLUSIONS: The Spanish version of PHQ-9 is reliable and can be used to screen for depression during pregnancy. A three-factor model structure is adequate to evaluate the components and symptoms of depression for Spanish pregnant women. IMPLICATION FOR PRACTICE: Midwives can screen for depression during the PHQ-9 and can tailor interventions to minimize the adverse effects on mothers and infants, before and after birth.