Maternal depression trajectories and child BMI in a multi-ethnic sample: a latent growth modeling analysis.

BACKGROUND: Perinatal (antenatal and postpartum) depression impacts approximately 12% of mothers. Perinatal depression can impact everyday functioning for mothers, and the relationship with, and development of, their children. The purpose of this study was to investigate depression trajectories from the antenatal period through 54-months postpartum and associations with child body mass index at 54-months postpartum. METHODS: This study applied latent growth modeling to the Growing Up in New Zealand study, which is a longitudinal pregnancy cohort study that provides nationally representative-level data, to investigate associations between depression at three time points (antenatal, 9-months postpartum, 54-months postpartum) and child body mass index at 54-months (n=4897). RESULTS: The average slope of depression for this sample is low and decreases over time. When child BMI was added to the model as an outcome variable, both antenatal depression (B=.25, p<.01), and the rate of change of depression across the perinatal and postpartum periods (B=.09, p<.01) were associated with child BMI at 54-months postpartum. After controlling for sociodemographic characteristics, antenatal depression, but not the slope of depression, remained significantly associated with child BMI (B=.05, p<.05). When controlling for maternal pre-pregnancy BMI the effect of antenatal depression on child BMI at 54-months was entirely attenuated (χ2 (9) = 39.60, p < .05, SRMR = 0.01, CFI = .99, RMSEA = 0.03, BIC=53213). CONCLUSIONS: Our findings align with the Developmental Origins of Health and Disease theory and imply that both the physical and mental health of mothers during pregnancy may be important indicators of child growth and development outcomes. Early intervention directed towards women who have even mild depression scores during pregnancy may promote healthy child development outcomes. Additionally, given the heterogeneity of depressive symptoms over time seen in this study, multiple assessment periods across the postpartum period may be valuable to adequately address and support maternal mental health.

The international postpartum depression: action towards causes and treatment (PACT) consortium.

The International Postpartum depression: Action towards Causes and Treatment (PACT) Consortium was founded with the overarching goal of creating an international perinatal psychiatry consortium to conduct novel investigations with large sample sizes to understand the genetic signature of perinatal mood disorders. PACT uses a collaborative and team science approach that includes investigators across 19 institutions and seven continents. The large sample sizes allow for statistically rigorous analyses to investigate perinatal psychiatric disorders, with an initial focus on postpartum depression (PPD). Our current aims are to identify clinical sub-types of PPD that contribute diagnostic heterogeneity, and to elucidate the genetic basis of PPD by conducting the first large genome-wide association study of PPD. To accomplish the latter aim, we are partnering with the Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium. To date, our consortium members have recruited 17,912 participants and 11,344 participants have been identified using the PPD ACT mobile app, of which 8,432 are PPD cases. Ultimately, we hope this approach will improve detection, diagnosis, and treatment of women who suffer from perinatal psychiatric disorders.

Validation of three mental health scales among pregnant women in Qatar.

OBJECTIVES: The objective of this study is to validate three mental health scales in a targeted sample of pregnant Arab women living in Qatar: the Kuwait University Anxiety Scale, the Perceived Stress Scale, and the Edinburgh Postnatal Depression Scale. METHODS: Random split-half exploratory factor analysis and confirmatory factor analyses (n = 336; n = 331), conducted separately, were used to evaluate scale dimensionality, factor loadings, and factor structure of the KUAS, the PSS, and the EPDS. RESULTS: Fit statistics for the three scales suggested adequate fit to the data and estimated factor loadings were positive, similar in magnitude, and were significant. The final CFA model for the KUAS supported a 19-item, two factor structure. CFA models also confirmed 8- and 10-item, single-factor structures for the PSS and EPDS, respectively. CONCLUSIONS: The validation of scales for these aspects of mental health in Arab pregnant women is critical to ensure appropriate screening, identification, and treatment to reduce the risk of sequelae in women and their children. Findings offer a useful comparison to mental-health scale validations in other Arab contexts.

Profiles and characteristics of clinical subtypes of perinatal depressive symptoms: A latent class analysis.

AIMS: To investigate clinically relevant subtypes of perinatal depressive symptoms. DESIGN: Cross-sectional study. METHODS: A sample of 2,783 women at different prenatal and postnatal periods was recruited between August 2015 - August 2017. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms. Data analyses consisted of latent class analysis (LCA), analysis of variance and multinomial logistic regression. RESULTS: (a) Five latent subtypes (Classes 5/4/3/1/2) were identified: 'no symptoms', 'mild physio-somatic symptoms', 'severe physio-somatic symptoms and moderate anhedonia', 'moderate-to-severe symptoms' and 'severe symptoms'; (b) Postpartum women were more likely to belong to the severe depressive symptoms group, whereas pregnant women were likely to report severe physio-somatic symptoms; and (c) History of abortion and perinatal complications increased the likelihood of belonging to all moderate-to-severe classes. Lower levels of education increased the probability of belonging to Class 2. Younger women were more likely to be categorized into Classes 1 and 2. CONCLUSIONS: This is the first study to examine heterogeneity of perinatal depressive symptoms and delineate the characteristics of subtypes at different prenatal and postnatal periods via the PHQ-9, using LCA in a Chinese general population. IMPACT: This research details the heterogeneity of perinatal depressive symptoms and delineates the characteristics of subtypes at different prenatal and postnatal periods in a Chinese general population.

A longitudinal study of women's depression symptom profiles during and after the postpartum phase.

BACKGROUND: An issue of critical importance for psychiatry and women's health is whether postpartum depression (PPD) represents a unique condition. The Diagnostic and Statistical Manual of Mental Disorders asserts that major depressive disorder (MDD) may present with peripartum onset, without suggesting any other differences between MDD and PPD. The absence of any distinct features calls into question the nosologic validity of PPD as a diagnostic category. The present study investigates whether symptom profiles differ between PPD and depression occurring outside the postpartum phase. METHODS: In a prospective, longitudinal study of parturient women (N = 239), we examine the manifestation of depression symptoms. We assess factor structure of symptom profiles, and whether factors are differentially pronounced during and after the postpartum period. RESULTS: Factors were revealed representing: Worry, Emotional/Circadian/Energetic Dysregulation, Somatic/Cognitive, Appetite, Distress Display, and Anger symptoms. The factor structure was validated at postpartum and after-postpartum timepoints. Interestingly, the Worry factor, comprising anxiety and guilt, was significantly more pronounced during the postpartum timepoint, and the Emotional/Circadian/Energetic Dysregulation factor, which contained sadness and anhedonia, was significantly less pronounced during the postpartum period. CONCLUSIONS: These results suggest that PPD may be a unique syndrome, necessitating research, diagnosis, and treatment strategies distinct from those for MDD. Results indicate the possibility that Worry is an enhanced feature of PPD compared to depression outside the postpartum period, and the crucial role of sadness/anhedonia in MDD diagnosis may be less applicable to PPD diagnosis.

A tricky object to classify: evidence, postpartum depression and the DSM-IV.

The concept of evidence has become central in Western healthcare systems; however, few investigations have studied how the shift toward specific definitions of evidence actually occurred in practice. This paper examines a historical case in psychiatry where the debate about how to define evidence was of central importance to nosological decision making. During the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders a controversial decision was made to exclude postpartum depression (PPD) as a distinct disorder from the manual. On the basis of archival and interview data, I argue that the fundamental issues driving this decision were related to questions about what constituted suitable hierarchies of evidence and appropriate definitions of evidence. Further, although potentially buttressed by the evidence-based medicine movement, this shift toward a reliance on particular kinds of empirical evidence occurred when the dominant paradigm in American psychiatry changed from a psychodynamic approach to a research-based medical model.

Revisiting the dimensional structure of the Edinburgh Postnatal Depression Scale (EPDS): empirical evidence for a general factor.

BACKGROUND: The Edinburgh Postnatal Depression Scale (EPDS) has been proposed as a one-dimensional instrument and used as a single 10-item scale. This might be considered questionable since repeated psychometric studies have shown multi-dimensionality, which would entail using separate component subscales. This study reappraised the dimensional structure of the EPDS, with a focus on the extent of factor correlations and related factor-based discriminant validity as a foundation for deciding how to effectively scale the component items. METHODS: The sample comprised 811 randomly selected mothers of children up to 5 months attending primary health services of Rio de Janeiro, Brazil. Strict Confirmatory Factor Analysis (CFA) and Exploratory Factor Analysis modeled within a CFA framework (E/CFA) were sequentially used to identify best fitting and parsimonious model(s), including a bifactor analysis to evaluate the existence of a general factor. Properties concerning the related 10-item raw-score scale were also investigated using non-parametric items response theory methods (scalability and monotonicity). RESULTS: An initial CFA rejected the one-dimensional structure, while an E/CFA subscribed a three-dimensional solution. Yet, factors were highly correlated (0.66, 0.75 and 0.82). The ensuing CFA showed poor discriminant validity (some square-roots of average variance extracted below the factor correlations). A general bifactor CFA was then fit. Results suggested that, although still weakly encompassing three specific factors, the EPDS might be better described by a model encompassing a general factor (loadings ranging from 0.51 to 0.81). The related 10-item raw score showed adequate scalability (Loevinger's H coefficient = 0.4208), monotonicity e partial double monotonicity (nonintersections of Item Step Response Functions). CONCLUSION: Although the EPDS indicated the presence of specific factors, they do not qualify as independent dimensions if used separately and should therefore not be used empirically as sub-scales (raw scores). An all-encompassing scale seems better suited and continuing its use in clinical practice and applied research should be encouraged.

The neural processing of negative emotion postpartum: a preliminary study of amygdala function in postpartum depression.

While contemporary diagnostic nosology characterizes postpartum depression (PPD) as a specifier of a major depressive disorder (MDD), this classification continues to be questioned. Functional magnetic resonance imaging (fMRI) holds the promise of helping to characterize the neuroanatomical dysfunction associated with dysregulated emotion after childbirth. Twenty postpartum women underwent fMRI in the presence of emotionally valenced stimuli. The observation of relative amygdala non-responsivity in subjects demonstrating greater depression symptomotology stands in contrast to imaging studies of MDD and provides insight into possible phenotypic differences of PPD.

Iterative generation of diagnostic categories through production and practice: the case of postpartum depression.

Examining the process undertaken to name and codify psychiatric illnesses provides important insights into how everyday healthcare practices are shaped by knowledge production processes. However, studies of illness classification often rely on an overly simplified distinction between the production of diagnostic categories and the application of those categories in practice. Drawing insight from science and technology studies, I argue that psychiatric diagnostic categories are iteratively generated through production and practice, even during the development of those categories. Through a discursive analysis of interviews, archival documents, and psychiatric literature, I identify the practical politics that enabled the creation of the postpartum depression (PPD) modifier in the Diagnostic and Statistical Manual of Mental Disorders, version four (DSM-IV). In addition, I demonstrate how the overarching discourses of evidence-based decision-making and biomedicine shaped the development of the postpartum modifier, and draw together comments made by interview participants regarding the administrative value of a PPD-related category in the DSM. These remarks suggest that, in their practice, researchers and clinicians also take into consideration their own knowledge about DSM production processes, providing further support for the argument that diagnostic categories are iteratively generated.

Effect of Fathers' Presence and Involvement in Newborn Care in the NICU on Mothers' Symptoms of Postpartum Depression.

OBJECTIVE: To determine the prevalence of symptoms of postpartum depression (PPD) and examine how fathers' presence and involvement in the care of their newborns affect symptoms of PPD within the first 2 weeks after birth among mothers with newborns in the NICU. DESIGN: Observational cohort study. SETTING: Open-bay, 40-bed, tertiary level NICU in Eastern Canada. PARTICIPANTS: Mothers (N = 105) of newborns who were anticipated to survive and required more than 5 days of hospitalization in the NICU. METHODS: Participants completed the Postpartum Depression Screening Scale (PDSS) 14 days after they gave birth. They kept daily diaries to record the amount of time that fathers spent by the newborns' bedsides (i.e., presence) and actively caring for their newborns (i.e., involvement such as skin to skin). Participants completed daily diaries from the time of enrollment in the study until their newborns were discharged home. We analyzed the data using linear regression; score on the PDSS was the dependent variable, and fathers' presence and involvement were the independent variables. We adjusted for covariates. RESULTS: The prevalence of positive screening for symptoms of major PPD was 24.1% (n = 20), and the prevalence of significant symptoms of PPD was 27.7% (n = 23). Participants reported that fathers were present in the NICU an average of 3.8 hours per day and were actively involved with their newborns 53% of the time. Fathers' involvement was significantly associated with lower scores on the PDSS (adjusted ß = -3.85; 95% confidence interval [CI] [-6.10, -1.60]). A history of anxiety was significantly associated with greater scores on the PDSS (adjusted ß = 12.06, 95% CI [2.07, 22.05]). Maternal age and income less than $50,000 CAD were marginally associated with greater scores on the PDSS (adjusted ß = -0.86, 95% CI [-1.77, 0.05] and adjusted ß = 10.69, 95% CI [-0.73, 22.11], respectively). The overall explained variance in the PDSS scores with the independent variables was R2 = 0.35. CONCLUSION: Fathers' involvement in the care of their newborns in the NICU was significantly associated with fewer symptoms of PPD among mothers. We recommend research with targeted interventions to promote fathers' involvement in the NICU to potentially mitigate the symptoms of PPD among mothers of newborns in the NICU.

[Events of life and links with severe depression at different ages]. / Evénements de vie et sévérité de la dépression aux différents âges de la vie.

Major depression is a common, severe, chronic, and often life-threatening illness. There is a growing body of evidence that, far from being a disease with purely psychological manifestations, major depression is a systemic disease with deleterious effects on multiple organ systems. Stressful life events have a substantial causal association with depression, and there is now compelling evidence that even early life stress constitutes a major risk factor for the subsequent development of depression. This review will focus on the association between severity of depression and diachronic vulnerability across the life-span, in terms of events of life, stress, and hormonal modulation, with a special focus on depression in young adults, women during postpartum and in depression in ederly people. Given the high prevalence of depressive disorders, the significant burden and the severity of disease in adolescents and young adults experiencing their first episode, they represent a group at high risk of relapse, recurrence, comorbidity and suicide to whom early intervention and prevention efforts should be targeted. Females exhibit different stress sensitivities than males which might contribute to their increased vulnerability for depression and the disease exhibit a prevalence among women which is 2-3x higher than in men. The postpartum period is considered the time of greatest risk for women to develop major depression and postpartum depression affects approximately 15% of women. In old age, depression mainly affects those with chronic medical illness, severe disability or mental decline. Depression in elderly worsens the outcomes of many medical illness and increases mortality. Environmental factors, such as isolation, caregiving and bereavement, contribute to further increase susceptibility to depression or triggering depression in already vulnerable elderly people. Suitable treatment of depression in elderly reduces the symptoms, prevents suicidal ideation, improves cognitive and functional status in order to improve the recovery of a good quality of life, as well as the mortality risk.

[Bipolar disorder, pregnancy and the postpartum--risks and possibilities of pharmacotherapy]. / Psychopharmaka in Schwangerschaft und Stillzeit--Risiken und Möglichkeiten bei Frauen mit einer bipolaren affektiven Störung.

Pregnancy and the postpartum are times of increased risk for women with bipolar disorder to develop mood episodes, especially depressions that may require pharmacotherapy. If mood stabilizing agents are discontinued prior or due to pregnancy, the risk for relapse increases dramatically. On the other hand, there is no psychotropic drug that is completely risk-free for the unborn. Some mood stabilizing medications are teratogenic, others can cause severe perinatal complications. Thus, the decision whether to treat the pregnant women with psychotropic drugs is difficult to make. In this paper, the reproductive risks of mood stabilizing agents, antidepressants, neuroleptics and benzodiazepines for the fetus are reviewed. During the postpartum period severe mood disorders can occur. The signs and symptoms of these disorders are reviewed and therapeutic strategies are discussed.

Treatment of postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile: a randomised controlled trial.

BACKGROUND: The optimum way to improve the recognition and treatment of postnatal depression in developing countries is uncertain. We compared the effectiveness of a multicomponent intervention with usual care to treat postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile. METHODS: 230 mothers with major depression attending postnatal clinics were randomly allocated to either a multicomponent intervention (n=114) or usual care (n=116). The multicomponent intervention involved a psychoeducational group, treatment adherence support, and pharmacotherapy if needed. Usual care included all services normally available in the clinics, including antidepressant drugs, brief psychotherapeutic interventions, medical consultations, or external referral for specialty treatment. The primary outcome measure was the Edinburgh postnatal depression scale (EPDS) score at 3 and 6 months after randomisation. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00518830. FINDINGS: 208 (90%) of women randomly assigned to treatment groups completed assessments. The crude mean EPDS score was lower for the multicomponent intervention group than for the usual care group at 3 months (8.5 [95% CI 7.2-9.7] vs 12.8 [11.3-14.1]). Although these differences between groups decreased by 6 months, EPDS score remained better in multicomponent intervention group than in usual care group (10.9 [9.6-12.2] vs 12.5 [11.1-13.8]). The adjusted difference in mean EPDS between the two groups at 3 months was -4.5 (95% CI -6.3 to -2.7; p<0.0001). The decrease in the number of women taking antidepressants after 3 months was greater in the intervention group than in the usual care group (multicomponent intervention from 60/101 [59%; 95% CI 49-69%] to 38/106 [36%; 27-46%]; usual care from 18/108 [17%; 10-25%] to 11/102 [11%; 6-19%]). INTERPRETATION: Our findings suggest that low-income mothers with depression and who have newly born children could be effectively helped, even in low-income settings, through multicomponent interventions. Further refinements to this intervention are needed to ensure treatment compliance after the acute phase.

Screening for depression in the postpartum period: a comparison of three instruments.

OBJECTIVES: Postpartum depression, the most prevalent complication of childbirth, is often unrecognized. Our objective was to compare the effectiveness of three screening instruments--Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire (PHQ-9), and the 7-item screen of the Postpartum Depression Screening Scale (PDSS)--for identifying women with postpartum depression in the first 6 months after delivery. METHODS: We administered the three instruments via telephone to women who were > or =18 years and had delivered infants 6-8 weeks earlier. We arranged home interviews to confirm DSM-IV criteria current major depressive disorder (MDD) in women who had an above-threshold score on any of the instruments. For women who screened negative on the 6-8 week call, we repeated the screening at 3 months and 6 months to identify emergent symptoms. The primary outcome measures were the screening scores and DSM-IV diagnoses. RESULTS: Of 135 women reached, 123 (91%) were screened, 29 (24%) had home visits, and 13 (11%) had an MDD within 6 months of delivery. Analyses of the scores at 6-8 weeks postpartum and the DSM-IV diagnoses indicated the EPDS at a cutoff point of > or =10 identified 8 (62%) of cases, the PHQ-9 at a cutoff point of > or =10 identified 4 (31%), and the PDSS 7-item Short Form (PDSS_SF) at a cutoff point of > or =14 identified 12 (92%). However, 15 of 16 (94%) women without current MDD screened positive on the PDSS_SF. The EPDS was significantly more accurate (p = 0.01) than the PDSS_SF and PHQ-9 with the cutoff points used. After correcting for verification bias, we found the EPDS and the PDSS_SF were significantly more accurate than the PHQ-9 (p < 0.03). CONCLUSIONS: Administering the EPDS by phone at 6-8 weeks postpartum is an efficient and accurate way to identify women at high risk for postpartum depression within the first 6 months after delivery.

[Study of the prevalence of postpartum depression among 213 Tunisian parturients]. / Etude de la prévalence de la dépression du post-partum auprès de 213 parturientes tunisiennes.

OBJECTIVE: The objective of our study was to estimate the prevalence of the depression in postpartum in a population of Tunisian parturients. PATIENTS AND METHODS: Prospective study, in two stages: first week then between sixth and tenth week of the postpartum. The study was done at CHU Hédi Chaker in Sfax, Tunisia. For tracking postpartum depression, we used the Arab version of Edinburgh Postnatal Scale Depression (EPDS). An epidemiologic questionnaire was used to collect the sociodemographic and clinical data. RESULTS: In T(1), 213 women were examined. In T(2), 136 were reexamined (63, 8% of the initial population). In the first stage, the prevalence of the intense postpartum blues, according to EPDS, was 19,2%. In the second stage, the prevalence of the postpartum depression was 13, 2%. DISCUSSION AND CONCLUSION: The postpartum depressions are frequent among Tunisian parturients. The difference in the rates of prevalence between the two stages of evaluation was noted in other studies. This leads us to think that the relatively high rate in the first stage would be contaminated by an intense postpartum blues. However, a high rate persists at the sixth to tenth week, indicating the importance of tracking postpartum depression. This became possible by using EPDS, available in an Arab version and which should be generalized for the new mothers. This detection should be done early in postpartum or else in the later postnatal consultations. This allows an adequate treatment for the mothers, for the mother-newborn relationship and, later, for the psychological equilibrium of the child.

[Mental disorders during pregnancy and postpartum period--epidemiology, etiology, classification and treatment]. / Zaburzenia psychiczne okoloporodowe--epidemiologia, etiologia, klasyfikacja, leczenie.

The paper presents current knowledge about the prevalence of mental disorders during pregnancy and postpartum period and its' classification. Possible pathomechanisms of its incidence, risk factors and therapeutic possibilities based on the newest research were described.

An epidemiological and clinical investigation of postpartum psychiatric illness in Japanese mothers.

A case note study of postpartum psychiatric illness as defined by Research Diagnostic Criteria (RDC) was conducted in an epidemiologically defined large area of Japan. The admission rate was 0.34/1000 live births. The most frequent diagnostic category was affective disorder (53%). "Atypical" symptoms were observed in 31% of all cases and were more frequent (67%) in patients with schizoaffective disorder. Fifty six percent of mothers developed a psychiatric illness within two weeks of delivery. The patients with "atypical" symptoms were admitted much more quickly and their length of stay in hospital was shorter.

Postpartum depressive disorders.

Despite the high prevalence of postpartum depressive disorders, many signs and symptoms of this illness are dismissed as normal physiologic changes associated with childbirth. Prompt recognition and treatment are imperative in order to limit the negative impact on both the mother and infant. Mood disturbances may have a minor functional impact that respond well to social support (eg. postpartum blues) or cause significant functional compromise requiring more aggressive therapy (eg. postpartum depression). The most extreme case of postpartum depressive disorder, postpartum psychosis, occurs when patients develop psychosis, mania, or thoughts of infanticide. Depression during pregnancy or the presence of risk factors suggests the need for careful follow-up. If postpartum depression develops, psychotherapy is the first-line treatment. Antidepressant treatment may be warranted for some patients, and the risks and benefits to both the mother and infant should be considered in the decision to institute pharmacotherapy.

Routine screening for postpartum depression.

BACKGROUND: Postpartum depression (PPD) is a common and often overlooked condition. Validated screening tools for PPD exist but are not commonly used. We present the 1-year outcome of a project to implement universal PPD screening at the 6-week postpartum visit. METHODS: Universal screening with the Edinburgh Postnatal Depression Scale (EPDS) was implemented in all community postnatal care sites. One-year outcome assessments (diagnosis and treatment of PPD) were completed for a sample of the women screened using medical record review of all care they received during the first year postpartum. RESULTS: Sixty-eight (20%) of the 342 women whose medical records were reviewed had been given a documented diagnosis of postpartum depression, resulting in an estimated population rate of 10.7%. Depression was diagnosed in 35% of the women with elevated EPDS scores (> or =10) compared with 5% of the women with low EPDS scores (<10) in the first year postpartum. Treatment was provided for all women diagnosed with depression, including drug therapy for 49% and counseling for 78%. Four women were hospitalized for depression. Some degree of suicidal ideation was noted on the EPDS by 48 women but acknowledged in the chart of only 10 women, including 1 with an immediate hospitalization. The rate of diagnosis of postpartum depression in this community increased from 3.7% before the routine use of EPDS screening to 10.7% following screening. CONCLUSIONS: A high EPDS score was predictive of a diagnosis of postpartum depression, and the implementation of routine EPDS screening at 6 weeks postpartum was associated with an increase in the rate of diagnosed postpartum depression in this community.