Comparing the factor structures and reliabilities of the EPDS and the PHQ-9 for screening antepartum and postpartum depression: a multigroup confirmatory factor analysis.

To evaluate and compare the factor structure and reliability of EPDS and PHQ in antepartum and postpartum samples. Parallel analysis and exploratory factor analysis were conducted to determine the structure of both scales in the entire sample as well as in the antepartum and postpartum groups. McDonald's omega statistics examined the utility of treating items as a single scale versus multiple factors. Multigroup confirmatory factor analysis (MCFA) was utilized to test the measurement invariance between the antepartum and postpartum groups. Two-factor models fit best for the EPDS in both the antepartum and postpartum groups; however, the most reliable score variance was attributable to a general factor for each scale. MCFA provided evidence of weak invariance across groups regarding factor loadings and partial invariance regarding item thresholds. PHQ-9 showed a two-factor model in the antepartum group; however, the same model did not fit well in the postpartum group. EPDS should be preferred to PHQ-9 for measuring depressive symptoms in peripartum populations. Both scales should be used as a single-factor scale. Caution is required when comparing the antepartum and postpartum scores.

Forensic mental health in Europe: some key figures.

PURPOSE: While the number of forensic beds and the duration of psychiatric forensic psychiatric treatment have increased in several European Union (EU) states, this is not observed in others. Patient demographics, average lengths of stay and legal frameworks also differ substantially. The lack of basic epidemiological information on forensic patients and of shared indicators on forensic care within Europe is an obstacle to comparative research. The reasons for such variation are not well understood. METHODS: Experts from seventeen EU states submitted data on forensic bed prevalence rates, gender distributions and average length of stay in forensic in-patient facilities. Average length of stay and bed prevalence rates were examined for associations with country-level variables including Gross Domestic Product (GDP), expenditure on healthcare, prison population, general psychiatric bed prevalence rates and democracy index scores. RESULTS: The data demonstrated substantial differences between states. Average length of stay was approximately ten times greater in the Netherlands than Slovenia. In England and Wales, 18% of patients were female compared to 5% in Slovenia. There was a 17-fold difference in forensic bed rates per 100,000 between the Netherlands and Spain. Exploratory analyses suggested average length of stay was associated with GDP, expenditure on healthcare and democracy index scores. CONCLUSION: The data presented in this study represent the most recent overview of key epidemiological data in forensic services across seventeen EU states. However, systematically collected epidemiological data of good quality remain elusive in forensic psychiatry. States need to develop common definitions and recording practices and contribute to a publicly available database of such epidemiological indicators.

Human biomonitoring to evaluate exposure to toxic and essential trace elements during pregnancy. Part B: Predictors of exposure.

Maternal exposure to toxic and essential trace elements represents a surrogate of exposure to the unborn child. Variables of exposure as sociodemographic, lifestyles and diet may contribute to different exposure of pregnant women to specific trace elements. Blood, urine and cord blood samples of 53 pregnant women of the HEALS-EXHES cohort, recruited in Reus (Catalonia, Spain) between 2016 and 2017, were analysed for the concentrations of As, Cd, Co, Cr, Cu, Hg, Mn, Ni, Pb, Se and Zn. Univariate and multivariate models were built in order to assess associations between element concentrations in each matrix, and variables obtained by questionnaires on mothers' characteristics and dietary habits. Results showed several significant associations between various variables and essential trace and toxic elements. Age was associated with higher levels of Cd and Pb in cord blood samples. Multiparous women showed lower levels of Cd in maternal blood and Pb in both maternal and cord blood than nulliparous women. Hispanic mothers presented higher levels of blood As and lower levels of blood Se compared to mothers of different ethnicity. Higher education level was associated with higher As and Hg concentrations in both maternal and cord blood samples. Higher annual income diminished the level of Pb in maternal blood. Smoking in pregnancy incremented the levels of Cd in mothers' blood. Alcohol consumption may affect the absorption of Cu, Mn and Zn. Supplementations with multivitamins, folic acid and iron showed effects on elements as Cr, Mn, Se and Zn. Regarding food group intake, bluefish incremented Pb levels, while canned fish and seafood affected levels of some elements as As, Hg, Cu and Se. Other elements such as Mn and Pb were influenced by the intake of different kinds of foods. The present results showed that some modifiable lifestyles and food intakes could be the target of interventions to help pregnant women to maintain suitable concentrations of essential elements and lower levels of toxic ones, and to improve consequently neonatal health outcomes.

Pregnancy exposome and child psychomotor development in three European birth cohorts.

Characterization of the exposome, the totality of all environmental factors that one is exposed to from conception onwards, has been recommended to better evaluate the role of environmental influences on developmental programming and life-course vulnerability to major chronic diseases. In the framework of the Health and Environment-wide Associations based on Large population Surveys (HEALS) project we considered the pregnancy exposome exploiting two databases (PHIME and REPRO_PL) that include birth cohorts from three EU countries (Croatia, Slovenia and Poland). The databases contained information on several chemical exposures, socio-demographic, lifestyle and health related factors from conception to child birth, and neuropsychological scores assessed by the Bayley Scales of Infant and Toddler Development in the first two years of life. Our main goal was to assess consistency of environmental influences on neurodevelopment, if any, across European countries differing for geographical, socio-demographic characteristics and levels of chemical exposures to metals such as lead (Pb), mercury (Hg), cadmium (Cd) and trace elements, including micronutrients such as zinc (Zn) and selenium (Se). To this aim, we first selected variables common to the different databases, then applied univariate and multivariate regression analyses to identify factors linked to neurodevelopment, and finally performed meta-analysis to detect potential heterogeneity among cohorts and pooled estimates. Significant differences in exposure levels among the three sub-cohorts were observed as for Hg and Se; exposure levels under study were relatively low and within the range described in existing EU biomonitoring studies. The univariate analyses did not show any common pattern of association as only in the Polish cohort chemical exposure had an impact on neuropsychological outcome. In the meta-analysis, some consistent trends were evident, relative to the adverse influence of Pb on children's language and cognition and the positive influence of Se on language abilities. The effects of the neurotoxic metal Hg positively influenced the motor scores in the Polish cohorts, while it decreased the motor scores in the Slovenia and Croatian sub-cohorts. The only socio-demographic factor consistently associated to the outcome among cohorts was child's sex, with females performing better than males on cognitive and language scores. These findings point to the need of harmonizing existing cohorts or creating prospective study designs that facilitate comparisons in the exposome over time, places and kind of environmental exposures.

A screening and treatment programme to deal with perinatal anxiety and depression during the COVID-19 pandemic.

During a pandemic, pregnancy and the postnatal period are complicated by multiple factors. On the one hand, worries about one's own health and the health of loved ones, in particular of the newborn child, can increase the risk of some mental disorders, such as depression and anxiety in the pregnant woman. On the other hand, as happened for the COVID-19 epidemic in Italy, given the need for physical distancing, the maintenance of the social and family network, so important for new parents in the perinatal period, is lacking. In addition, health services are forced to reorganize their offerings to ensure maximum safety for their operators and patients. This work proposes a model of screening and treatment aimed at identifying women at risk and providing them with effective and safe treatment.

Prenatal and early postnatal phthalate exposure and child neurodevelopment at age of 7 years - Polish Mother and Child Cohort.

Phthalates are among the most frequently investigated environmental chemicals influencing children's health and particularly their neuropsychological development. However, the reported effects of these compounds on child behavior, cognitive and psychomotor outcomes are not fully consistent. The aim of this study is to evaluate the associations between prenatal and early postnatal phthalate exposures and child neurodevelopment at age of 7 years. A total of 134 mother-child pairs from Polish Mother and Child Cohort (REPRO_PL) constitute the basis for current analysis. Eleven phthalate metabolites were measured in urine samples collected from mothers in the 3rd trimester of pregnancy and from children at the age of 2 years. Child neuropsychological development at early school age (7 years) was assessed by both the Strengths and Difficulties Questionnaire (SDQ) filled by mothers and the Polish adaptation of the Intelligence and Development Scales (IDS) performed by psychologists. Mono-ethyl phthalate (MEP) concentration during pregnancy was significantly associated with increased risk of peer relationship problems in SDQ (OR = 2.7, p = 0.03). The results of the IDS analyses focused on child's cognitive and psychomotor development are not fully conclusive. Negative associations were evident between some phthalates in early childhood period and fluid intelligence and cognition (MEP: ß = -5.2; p = 0.006; ß = -4.2; p = 0.006; mono-n-butyl phthalate (MnBP): ß = -4.9; p = 0.03; ß = -4.0; p = 0.03; respectively), while positive associations have been found in the prenatal period (mono-2-ethyl-5-oxo-hexyl phthalate (oxo-MEHP): ß = 3.6; p = 0.03 for fluid intelligence; ß = 2.9; p = 0.03 for cognition). Further studies are required in order to elucidate which are the most critical periods of phthalate exposure on children's neurodevelopmental outcomes.

Cross-cultural adaptation and validation of the Italian version of the Hip disability and Osteoarthritis Outcome Score (HOOS).

OBJECTIVE: To create a translated version of the HOOS to fit the Italian population and to test its psychometric properties and validity in hip osteoarthritis (OA) patients undergoing total hip arthroplasty (THA). DESIGN: The HOOS Italian version was developed according to published international guidelines that include preparation, forward translation and reconciliation, backward translation, review and harmonization, and proof reading. The Italian HOOS was administered to 145 patients (mean age 65.7 ± 11.6 years, 34-89, 58.6% women) undergoing THA. The following psychometric properties were evaluated: internal consistency (Cronbach's alpha); test-retest reliability (Pearson's r and intra-class correlation coefficient, ICC); convergent validity (Spearman's rho between HOOS and SF-36); responsiveness (comparison of pre/post-THA scores, Wilcoxon signed rank test). Interpretability (floor and ceiling effects, skewness and kurtosis indexes) and acceptability (time to compiling, missing answers, and autonomy in compilation) were also evaluated. RESULTS: Translation and transcultural adaptation were conducted in accordance with the international recommendation. The translation was deemed understandable and appropriate as to the transcultural adaptation. None of the patients reported to have met any difficulties in reading and understanding the HOOS items. Internal consistency and test-retest reliability were good for each HOOS subscale (Cronbach's alpha ≥0.7, Pearson's r and ICC > 0.80). Convergent validity showed the highest correlations (Spearman's rho > 0.5) between HOOS and SF-36 subscales relating to similar dimensions. As to responsiveness, all HOOS subscales scores improved significantly after THA (p < 0.01). Interpretability was acceptable despite ceiling effect in post-THA assessment. Acceptability was good: HOOS resulted easy and quick to fill out (12 min on average). CONCLUSIONS: The HOOS was successfully cross-culturally adapted into Italian. The Italian HOOS showed good psychometric properties therefore it can be useful to assess outcomes in OA patients after THA. This study provided a basis for its use within the Italian Arthroplasty Registry and for future clinical trials.

Micronutrients during pregnancy and child psychomotor development: Opposite effects of Zinc and Selenium.

Studies on the impact of micronutrient levels during different pregnancy periods on child psychomotor functions are limited. The aim of this study was to evaluate the association between maternal plasma concentrations of selected micronutrients, such as: copper (Cu), zinc (Zn), selenium (Se), and child neuropsychological development. The study population consisted of 539 mother-child pairs from Polish Mother and Child Cohort (REPRO_PL). The micronutrient levels were measured in each trimester of pregnancy, at delivery and in the cord blood. Psychomotor development was assessed in children at the age of 1 and 2 years using the Bayley Scales of Infant and Toddler Development. The mean plasma Zn, Cu and Se concentrations in the 1st trimester of pregnancy were 0.91±0.27mg/l, 1.98±0.57mg/l and 48.35±10.54µg/l, respectively. There were no statistically significant associations between Cu levels and any of the analyzed domains of child development. A positive association was observed between Se level in the 1st trimester of pregnancy and child language and motor skills (ß=0.18, p=0.03 and ß=0.25, p=0.005, respectively) at one year of age. Motor score among one-year-old children decreased along with increasing Zn levels in the 1st trimester of pregnancy and in the cord blood (ß=-12.07, p=0.003 and ß=-6.51, p=0.03, respectively). A similar pattern was observed for the association between Zn level in the 1st trimester of pregnancy and language abilities at one year of age (ß=-7.37, p=0.05). Prenatal Zn and Se status was associated with lower and higher child psychomotor abilities, respectively, within the first year of life. Further epidemiological and preclinical studies are necessary to confirm the associations between micronutrient levels and child development as well as to elucidate the underlying mechanisms of their effects.

Is long-term cancer survivors' quality of life comparable to that of the general population? An italian study.

PURPOSE: Since long-term survivorship is now a reality for an increasingly number of people with a history of cancer, understanding their quality of life (QoL) can inform health care policy as well as help supporting individual patients. This study was aimed to quantify QoL of this specific population in comparison with data provided for both the general population and cancer patients and to assess QoL association with several sociodemographic, clinical, and psychological variables. METHODS: Three hundred fourteen Italian long-term cancer survivors (people who have been free from cancer and cancer treatments for at least 5 years) completed a battery of questionnaires including the SF12 for QoL assessment. RESULTS: Both physical and mental functioning were higher than those among Italian cancer patients but lower than those of the Italian general population (p < .001). Poorer QoL (physical and mental functioning) was associated more often with psychological conditions (as anxiety and depression) than with sociodemographic and cancer-related variables. CONCLUSIONS: These data support an ongoing specific interest in the QoL of long-term cancer survivors and suggest the need for further study of multidimensional functioning in this population.

Screening for antenatal maternal depression: comparative performance of the Edinburgh Postnatal Depression Scale and Patient Health Questionnaire-9.

BACKGROUND: Maternal antenatal depression affects 21-28% of expectants globally and negatively impacts both maternal and child health in the short and long term. OBJECTIVE: To compare the psychometric properties and clinical utility of the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) in pregnant individuals. METHODS: In this cross-sectional study, 953 third-trimester pregnant Italian individuals completed both the EPDS and the PHQ-9. RESULTS: Both scales demonstrated good internal consistency (EPDS ω=0.83, PHQ-9 ω=0.80) and a moderate correlation between their scores (r=0.59). Concordance at recommended cut-off points (≥14 for both) was moderate (k=0.55). Factor analyses indicated a bifactor solution for the EPDS (dimensions: "depression" and "anxiety") and for the PHQ-9 (dimensions: "depression", "pregnancy symptoms", "somatic"). Benchmarks for clinical change were also established. CONCLUSIONS: The EPDS and PHQ-9 capture distinct aspects of perinatal depressive symptomatology. Clinically, these findings recommend using both scales in obstetric and gynaecologic settings to minimize false positives and negatives.

Patients With First-Episode Psychosis are Not a Homogeneous Population: Implications for Treatment.

OBJECTIVE: This study aimed at defining the characteristics of a population of patients diagnosed with first-episode psychosis (FEP), and accessing for the first time a center for early intervention in psychosis in the health district of Milan and its surroundings. METHODS: Patients were included in the study from January 2007 to December 2008; criteria: first contact with any public mental health service of the catchment area for a first episode of schizophrenia or related syndromes according to the ICD-10 criteria. Cluster analysis was used to divide patients into groups based on the main socio-demographic and clinical characteristics at presentation. RESULTS: Overall, 91 FEP patients were enrolled in the study. Two clusters were identified, which differed principally by symptom profile. Patients in cluster 1 (n=36) had severe agitation, and a history of alcohol and/or substance abuse at presentation more often than those in cluster 2 (n=55), who were more likely to suffer at presentation from severe depression or apathy, anxiety, poor self-care, functional or work impairment and severe social withdrawal. After six months of treatment patients improved on almost all symptomatic dimensions on the Health of the Nation Outcome Scale and the Brief Psychiatric Rating Scale, with greater improvement in cluster 1 than in cluster 2. CONCLUSIONS: The findings of this study need replication in larger samples and on a wider severity scale. Nevertheless, the heterogeneity of patients with FEP might impact on treatment. Policymakers should recognize the importance of the diagnostic and outcome assessment in the treatment of severe mental disorders.

Epidemiology of perinatal depression in Italy: systematic review and meta-analysis.

INTRODUCTION: This review aims to synthesise the studies that have estimated the prevalence of perinatal depression in Italy, summarising the results of the existing literature based on their quality. MATERIALS AND METHODS: Systematic searches were conducted in four major databases, and a random effect meta-analysis was performed to achieve the pooled variance of perinatal depression. RESULTS: The pooled prepartum risk of depression prevalence was 20.2% (CI 95% 15.3-24.5) while the postpartum risk of depression prevalence was 27.5% (CI 95% 17.8-37.3) for an Edinburgh Postnatal Depression Scale (EPDS) cut-off score ≥9 and 11.1% (CI 95% 6.0-16.2) for an EPDS cut-off score ≥12. Significant publication bias was found and was determined by the presence of a small study with a low prevalence and a large study with a high prevalence. CONCLUSION: The prevalence of perinatal risk of depression is similar to that reported in other countries. The high prevalence of prepartum risk suggests the need to activate specific prevention actions during this period.

Prevalence of anxiety and depression risk during the prepartum period in the different groups of women and responses from the Italian National Health Service.

BACKGROUND: Specific screening for anxiety and depression in pregnant women is important to identify those at risk and to provide timely intervention. The aims of the study were: 1) to compare the risk of anxiety and depression in four groups of pregnant women belonging to four types of healthcare centers distinguished by the level of risk: at low-risk; at high-risk for an obstetric reason; at high-risk for fetal anomalies; at high-risk for psychiatric conditions and 2) to identify the response that the National Health Service offers to women positively screened for anxiety and depression. METHODS: A cross-sectional study was conducted on 2801 pregnant women, cared for by National Health Service, divided into four groups: 1) low-risk pregnancy (N.=1970); 2) high-risk pregnancy for an obstetric reason (N.=218); 3) high-risk for fetal anomalies (N.=505); and 4) high-risk for psychiatric conditions (N.=108). Participants were screened using the Edinburgh Postnatal Depression Scale, the General Anxiety Disorder, and sociodemographic, anamnestic, and clinic questionnaires. RESULTS: 28.9% of participants obtained an EPDS Score ≥9 and 17.1% a GAD-7 Score ≥8. The group at high-risk for fetal anomalies presented the highest prevalence of anxiety (29.3%) and depression (49.1%) while the group at low risk presented the lowest prevalence of anxiety (13%) and depression (24.6%). The groups at risk for obstetric reasons presented an intermediate prevalence. Psychiatric conditions constituted a higher risk for anxiety than depression. Counselling is recommended for about 70% of women at risk for anxiety and depression. Moreover, about 15% of women positive for screening were initiated into psychotherapy and about 1.5% into pharmacotherapy. 15% of women positive for screening were referred to other specialists. CONCLUSIONS: This study underlined the relevance of a prompt response by the National Health Service to mental health needs, especially in the risk conditions related to obstetric and/or fetal anomalies and psychopathology.

A Brief Depression Screening Tool for Perinatal Clinical Practice: The Performance of the PHQ-2 Compared with the PHQ-9.

INTRODUCTION: There is ongoing interest in using brief screening instruments to identify perinatal depression in clinical practice. One ultra-brief screening instrument for depression is the Patient Health Questionnaire-2 (PHQ-2), but thus far its accuracy in perinatal clinical practice has been barely researched. In the present study, we aimed to assess the screening accuracy of the PHQ-2 against the Patient Health Questionnaire-9 (PHQ-9) in a large sample of perinatal women. METHODS: A total of 1155 consecutive women attending 11 health care centers throughout Italy completed the PHQ-9 (which includes the PHQ-2) during pregnancy (27-40 weeks) or postpartum (1-13 weeks). Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio positive, likelihood ratio negative, and overall accuracy were calculated using cut points 3 or greater and 2 or greater. RESULTS: During pregnancy, PHQ-2 greater than or equal to 3 revealed low sensitivity (38.4%-44.7%) but high specificity (97.8%-99.3%). In postpartum, it revealed moderate sensitivity (56.9%-70.6%), high specificity (95.8%-99.8%), and fair overall accuracy in pregnancy (70%). The alternative threshold greater than or equal to 2 revealed very high sensitivity (pregnancy: 92.1%-95.2%; postpartum: 87.1%-95.2%), moderate specificity (pregnancy: 78.1%-83.2%; postpartum: 68.8%-81.1%) and good overall accuracy, both during pregnancy (87%) and postpartum (84%). DISCUSSION: The PHQ-2 provided acceptable accuracy for screening for depression compared with the PHQ-9. In perinatal screening practice, a threshold of 2 or greater should be preferred as this ensures high sensitivity, missing only approximately 6% to 8% of cases, and a false-positive rate (percentage of women classified as affected with depressive symptoms when they are not) of 19% to 25%.

The Impact of the COVID-19 Pandemic on Women's Perinatal Mental Health: Preliminary Data on the Risk of Perinatal Depression/Anxiety from a National Survey in Italy.

Increasing evidence suggests that during the COVID-19 pandemic, anxiety and depression during the perinatal period increased. The aim of the study is to estimate the prevalence of risk for both maternal depression and anxiety among women attending 18 healthcare centres in Italy during the SARS-COV-2 pandemic and to investigate the psychosocial risks and protective factors associated. It was divided into a retrospective phase (2019, 2020, and the first nine months of 2021) and a prospective phase (which began in November 2021 and it is still ongoing), which screened 12,479 and 2349 women, respectively, for a total of 14,828 women in the perinatal period. To evaluate the risk of anxiety and depression, the General Anxiety Disorder-7 (GAD-7), the Edinburgh Postnatal Depression Scale (EPDS), and an ad hoc form were used to collect sociodemographic variables. In the prospective study, the average age of the women is 31 (range 18-52) years. Results showed that the percentage of women who had EPDS score ≥9 increased from 11.6% in 2019 to 25.5% in the period ranging from November 2021 to April 2022. In logistic regression models, the variables associated with the risk of depression at a level ≤0.01 include having economic problems (OR 2.16) and not being able to rely on support from relatives or friends (OR 2.36). Having the professional status of the housewife is a lower risk (OR 0.52). Those associated with the risk of anxiety include being Italian (OR 2.97), having an education below secondary school level (OR 0.47), having some or many economic problems (OR 2.87), being unable to rely on support from relatives or friends (OR 2.48), and not having attended an antenatal course (OR 1.41). The data from this survey could be useful to determine the impact of the SARS-COV-2 pandemic on women and to establish a screening program with common and uniformly applied criteria which are consistent with national and international women's mental health programs.

[Effectiveness of a manualized cognitive-behavioural intervention for postnatal depression]. / Efficacia di un intervento cognitivo-comportamentale manualizzato nella depressione post-partum.

AIM: Important guidelines recommend cognitive-behavioural interventions for postnatal depression but in the clinical practice they are not really diffused. This study describes the results and effectiveness of a structured cognitive-behavioural intervention implemented in a public mental health department. METHODS: The study involved 54 depressed women drawn from a community screening programme for postnatal depression in Bergamo province. Intervention was conducted on group and individual basis following a cognitive-behavioural programme of 10-15 weeks duration, including at least one partner session and adhered to a structured manual. Baseline and post intervention measures of depression and health were collected through validated rating scales. RESULTS: Following treatment, a significant improvement was demostrated on Edinburgh Post Natal Depression Scale, Beck Depression Inventory, Patient Health Questionnaire-9, Short Form-12. The improvements were manteined after a 12 mounths follow up. CONCLUSIONS: These results are encouraging and suggest that brief and structured cognitive behavioral interventions can be effective as a treatment for depression in postnatal period and routinely implemented in the clinical practice.

Prevalence of Maternal Postnatal Anxiety and Its Association With Demographic and Socioeconomic Factors: A Multicentre Study in Italy.

Anxiety is a common perinatal disorder that can cause severe adverse consequences. This study (a) assesses the prevalence of maternal postnatal anxious symptomatology, and (b) analyses its association with demographic and socioeconomic variables as well as obstetric and other psychosocial variables. The assessment included 307 mothers aged ≥18 years with a biological baby aged ≤ 52 weeks and from seven Italian healthcare centres, evaluated using a Psychosocial and Clinical Assessment Form (also covering demographic and socioeconomic factors), and the state scale of the State-Trait Anxiety Inventory. We found an overall prevalence of self-reported postnatal anxious symptoms of 34.2%. More specifically, the prevalence was 34.5% at 1-24 weeks postpartum, and 30.8% at >24 weeks postpartum. No associations between postnatal anxious symptoms and demographic or socioeconomic variables were observed. As regards the other variables, the findings indicated antenatal depression or anxiety, parity, and current psychological support from the partner as having the strongest relationships.

The limited screening accuracy of the Patient Health Questionnaire-2 in detecting depression among perinatal women in Italy.

BACKGROUND: The PHQ-2 was recently recommended by the International Consortium for Health Outcomes Measurement as a form of initial perinatal screening, followed by the EPDS only for women with positive PHQ-2 score. However, the accuracy of the PHQ-2 in perinatal clinical practice has been barely researched, to date. In the present study, we aim to assess the accuracy of the PHQ-2 against the EPDS in a large sample of perinatal women. METHODS: A total of 1155 consecutive women attending eleven primary or secondary health care centres throughout Italy completed the EPDS and the PHQ-2 during pregnancy (27-40-weeks) or postpartum (1-13-weeks). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio, negative likelihood ratio, post-test probabilities and area under the curve (AUC) of the PHQ-2, using a cut-off of ≥ 3, were calculated. MAIN FINDINGS: During pregnancy, PHQ-2 revealed low sensitivity (39.5%) and PPV (39.4%) but high specificity and NPV (97.5%). In postpartum, it revealed very low sensitivity (32.7%) and moderately high NPV (80.9%), but high specificity (99.3%) and PPV (94.4%). Given the low sensitivity despite the high specificity, the PHQ-2 demonstrated poor accuracy (AUC from 0.66 to 0.68). CONCLUSION: Initial screening by means of PHQ-2 failed to identify an acceptable number of perinatal women at-risk of depression in Italian clinical practice. The PHQ-2 performance suggested that it has insufficient sensitivity and discriminatory power, and may be inadequate as a screening tool for maternal depression.

Prevalence of comorbid anxiety and depressive symptomatology in the third trimester of pregnancy: Analysing its association with sociodemographic, obstetric, and mental health features.

BACKGROUND: Little is known about the prevalence of comorbid anxiety and depression (CAD) during pregnancy and its risk factors. The aims of this study are to determine the prevalence of CAD in the third trimester of pregnancy and analyse its association with socio-demographic, obstetric, and mental health features. METHODS: In a sample of 934 Italian pregnant women, CAD was defined as having (1) a score of ≥ 10 on the EPDS - depression subscale and/or on the PHQ-9, and (2) a score of ≥ 40 on the State-Trait Anxiety Inventory State and/or a score of ≥ 6 on the EPDS - anxiety subscale. Logistic regression analyses were used to identify socio-demographic, obstetrics, and mental health risk factors of CAD. RESULTS: The prevalence of CAD was 6.8%. Age between 30 and 35 years (OR=3.01, 95% CI: 1.22-7.45) compared to younger age, current sleep disorders (OR=7.88, 95% CI: 3.83-16.23), and preconception mood disorders (OR=2.76, 95% CI: 1.31-5.84) were associated with higher odds of CAD. Conversely, the presence of no or few economic problems (OR=0.21, 95% CI: 0.07-0.65; OR=0.26, 95% CI: 0.09-0.77) and the perception of enough or more than enough practical support from friends or relatives (OR=0.32, 95% CI: 0.13-0.80; OR=0.22, 95% CI: 0.09-0.53) were associated with lower odds of developing CAD. LIMITATIONS: The cross-sectional design; the use of self-report questionnaires. CONCLUSION: CAD is relatively common among third-trimester antepartum women. The provision of economic/practical support may reduce CAD prevalence and its direct and indirect costs.

Prevalence of maternal antenatal and postnatal depression and their association with sociodemographic and socioeconomic factors: A multicentre study in Italy.

BACKGROUND: Perinatal depression is a widespread and burdensome mental disorder. The objectives of this study were to assess the prevalence of both antenatal and postnatal depression in a large sample of women in Italy and to analyse their association with sociodemographic and socioeconomic factors. METHODS: Cross-sectional data from eleven healthcare centres located throughout Italy (2017-2018) were analysed (n = 1471). Depressive disorder was assessed with the Edinburgh Postnatal Depression Scale (EPDS), and sociodemographic and socioeconomic factors were also measured. Prevalences by perinatal period and by sociodemographic and socioeconomic factors were estimated, and their associations were evaluated using logistic regression models. All analyses were stratified by perinatal period: antenatal (i.e., from conception to delivery) vs. postnatal (i.e., the nine months after delivery). RESULTS: With a cut-off score set at 12 points, the prevalence of perinatal depression was 6.4% during pregnancy and 19.9% in the postnatal period, and the odds ratio for postpartum vs. antepartum depression was 3.65 (2.56-5.39). High economic status was associated with an approximate fivefold reduction in odds of depression in the antenatal period (ORa: 0.23, 95%CI: 0.10-0.54) and about a sixfold reduction in the postnatal period (ORa: 0.15, 95%CI: 0.05-0.45). LIMITATIONS: The data were cross-sectional. The EPDS has a sensitivity of 55.6%. CONCLUSION: The prevalence of perinatal depression in Italy is strongly associated with socioeconomic disadvantages. Early procedures to evaluate socioeconomic status and the provision of economical support for mothers might reduce the prevalence of perinatal depression and its direct and indirect costs.