Identification of depression and anxiety during pregnancy: A systematic review and meta-analysis of test accuracy.

INTRODUCTION: Depression and anxiety are significant contributors to maternal perinatal morbidity and a range of negative child outcomes. This systematic review and meta-analysis aimed to review and assess the diagnostic test accuracy of selected screening tools (Edinburgh Postnatal Depression Scale [EPDS], EPDS-3A, Patient Health Questionnaire [PHQ-9]-, PHQ-2, Matthey Generic Mood Question [MGMQ], Generalized Anxiety Disorder scale [GAD-7], GAD-2, and the Whooley questions) used to identify women with antenatal depression or anxiety in Western countries. MATERIAL AND METHODS: On January 16, 2023, we searched 10 databases (CINAHL, Cochrane Library, CRD Database, Embase, Epistemonikos, International HTA Database, KSR Evidence, Ovid MEDLINE, PROSPERO and PsycINFO); the references of included studies were also screened. We included studies of any design that compared case-identification with a relevant screening tool to the outcome of a diagnostic interview based on the Diagnostic and Statistical Manual of Mental Disorders, fourth or fifth edition (DSM-IV or DSM-5), or the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). Diagnoses of interest were major depressive disorder and anxiety disorders. Two authors independently screened abstracts and full-texts for relevance and evaluated the risk of bias using QUADAS-2. Data extraction was performed by one person and checked by another team member for accuracy. For synthesis, a bivariate model was used. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). REGISTRATION: PROSPERO CRD42021236333. RESULTS: We screened 8276 records for eligibility and included 16 original articles reporting on diagnostic test accuracy: 12 for the EPDS, one article each for the GAD-2, MGMQ, PHQ-9, PHQ-2, and Whooley questions, and no articles for the EPDS-3A or GAD-7. Most of the studies had moderate to high risk of bias. Ten of the EPDS articles provided data for synthesis at cutoffs ≥10 to ≥14 for diagnosing major depressive disorder. Cutoff ≥10 gave the optimal combined sensitivity (0.84, 95% confidence interval [CI]: 0.75-0.90) and specificity (0.87, 95% CI: 0.79-0.92). CONCLUSIONS: Findings from the meta-analysis suggest that the EPDS alone is not perfectly suitable for detection of major depressive disorder during pregnancy. Few studies have evaluated the other instruments, therefore, their usefulness for identification of women with depression and anxiety during pregnancy remains very uncertain. At present, case-identification with any tool may best serve as a complement to a broader dialogue between healthcare professionals and their patients.

Listening Visits for maternal depression: a meta-analysis.

Listening Visits are a non-directive counseling intervention delivered by nurses to depressed postpartum women. In 2007, Listening Visits were listed as a recommended treatment in British national guidelines. They were removed from the guideline update, due to the small effect size drawn from a meta-analysis of five clinical trials with depressed and non-depressed postpartum women. The purpose of this meta-analysis is to provide an estimate of the true population effect of Listening Visits as a treatment for maternal depression compared to control conditions. A meta-analytic review was conducted of studies published before October 2020. Inclusion criteria required that the study was a pragmatic or randomized trial of Listening Visits delivered by non-mental health specialists to mothers with elevated symptoms of maternal depression. Post-treatment depression rates for the treatment and control groups were extracted from eligible studies. Six studies met eligibility criteria which included 703 participants. Analyses of observed effect sizes corrected for study artifacts revealed an estimate of 0.66 (95% CI: 0.32, 0.99) with high heterogeneity (Q = 17.95, p = 0.003, I2 = 72.14). After removing outliers and addressing heterogeneity across observed effect sizes, the meta-analytic estimate across four methodologically similar studies and 651 participants was 0.43 (95% CI: 0.24, 0.62). The moderate effect size for Listening Visits, considered together with the advantages afforded by how, where, and who provides this treatment, supports Listening Visits as a first-line intervention in a stepped care approach for mothers with mild to moderately severe depression symptoms.

Fathers' depressive symptoms in the postnatal period: Prevalence and correlates in a population-based Swedish study.

AIMS: The aim of this study was to investigate the prevalence and correlates of depression in new fathers. METHODS: A population-based sample of 885 Swedish fathers and their partners completed a questionnaire, including the Edinburgh Postnatal Depression Scale at three months postpartum. Correlates of depressive symptoms were analysed with univariate and multiple variable regression models. RESULTS: Symptoms of depression were found in 6.3% of the fathers and 12.0% of the mothers, and the point prevalence of major depression in fathers was 1.3%. The strongest correlates of depressive symptoms in fathers were problems in the partner relationship, a low educational level, previous depression, stressful life events and low partner support. The cross-sectional design could affect the magnitude of the results, and causal inferences cannot be made. CONCLUSIONS: Although the rate of depressive symptoms is lower in fathers than in mothers at three months postpartum, the associated factors are similar to those found in studies of mothers. The first visits at the child health centre could include a discussion with both parents about normal transition problems; balancing work, personal and family needs; and distress. When signs of distress or partner relationship difficulties are picked up, this should be followed up and support interventions offered.

Fathers' involvement in Swedish child health care - the role of nurses' practices and attitudes.

AIM: To investigate how nurses in Swedish child health care perceived working with fathers, and to what extent they offered support to, and included fathers in clinical encounters. METHODS: A random sample of all nurses in Swedish child health care, 499 nurses, were asked to complete a postal questionnaire. The response rate was 70%. Data were analysed with content analysis, the chi-square test and logistic regression models. RESULTS: Almost all of the nurses found working with fathers positive. Fathers' participation in child health care was much lower than that of mothers'. Almost 90% of the nurses estimated that it rarely came to their attention that a father was distressed, and less than one of five nurses had offered supportive counselling to any distressed father in the previous year. Nurses with regular supervision on mental health issues and nurses with a paediatric specialization were more likely to offer supportive counselling to fathers. Approximately 50% of the nurses had an ambivalent attitude towards fathers' caring capacity when compared to that of mothers. CONCLUSIONS: Fathers received less support from child health nurses, and many nurses were ambivalent about fathers' caring abilities. Methods need to be developed to involve both parents in child health care.

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

Sweden has a unique opportunity to identify and follow up women presenting with, or at risk for, perinatal mental health problems and disorders because universal screening programmes are provided by its primary healthcare system. Although they are implemented across almost the entire population, screening programmes are not necessarily leading to effective interventions because the multidisciplinary perinatal mental healthcare teams that provide for the assessment and treatment of moderate to severe disorders are very few in number and must be increased. In particular, efforts to reach immigrant parents must be intensified to achieve equal quality of care for all.

Care-seeking behavior and disclosure on self-reported mental health among young women in urban Shanghai, China.

Mental health is a major public health concern in China. Help-seeking behavior typically does not involve professionals. Aim of the study was to assess Shanghai women's care-seeking behavior for common mental health disorders. Using an online survey, fielding questions regarding perinatal mental health status and help-seeking behavior. A total of 487 women participated. One fifth of participants reporting badwell-being did not seek help for mental distress. A total of 82.2 percent seek online support. A majority entrusted in family and avoided professional contact. Mother-in-laws were the least trusted source of support. Shanghai women avoid seeking professional help for mental health issues. Friends, spouses, and online resources are preferred venues.

Perinatal mental health in China: views of health system professionals in Shanghai / 《全球健康杂志（英文）》

Background:Mental health has recently been receiving a growing amount of attention in mainland China,with mental disorders increasingly being recognized as a major public health concern.However,the treatment gap for mental health care is markedly high in China.Previous research and clinical practice have focused on high-risk physical disorders but overlooked psychosocial factors,especially during the perinatal period.Aims:To explore Chinese professionals' perception and attributions of perinatal mental health in China.Method:The study was conducted in Shanghai,China,in 2018,drawing on interviews with 15 key informants including health professionals,government officials,and policymakers recruited through snowball sampling.Content analysis of the semi-structured interviews was performed.Results:The study yielded insights into the perceptions of perinatal mental health among health professionals in Shanghai.Three themes emerged from the informants' reports:(1) mental health influenced by tradition— describing traditions affecting the perception of mental health at both the societal and individual level;(2) societal changed contributing perinatal mental health problems—referring to a rapidly changing cultural and economic backdrop as a source of stress leading to mental health problems;and (3) existing and required resources— demonstrating a lack of professional training,staff shortages,and inadequacy of resources to provide the required mental health care.Conclusion:Our results provide new insights into key health professionals' perceptions of mental health problems in Shanghai.Hesitation to seek care owing to a lack of knowledge,and resource shortages in health care systems are obstacles to improve mental health among women in urban China.

How well does the Edinburgh Postnatal Depression Scale identify depression and anxiety in fathers? A validation study in a population based Swedish sample.

BACKGROUND: Fathers are increasingly involved in infant care, and depression in postnatal fathers as well as mothers may have negative effects on child development and behaviour. The EPDS has been validated to identify depression in new mothers, but few validation studies have involved fathers and there is doubt as to whether the EPDS measures the same constructs in men as in women. SUBJECTS AND METHODS: A population-based sample of 1014 couples were sent the EPDS and the HAD-A subscale 3 months postnatally. All high-scoring fathers and a random sample of fathers scoring low were invited for a diagnostic interview to assess the presence of any depression or anxiety disorder. A factor analysis of the EPDS data was conducted for mothers and fathers. FINDINGS: A factor analysis of the EPDS data revealed a different factor structure for fathers, implying that the scale picks up more worry, anxiety and unhappiness than depression. The EPDS yields high sensitivity and specificity, but low positive predictive value when screening for probable major depression at the optimal cut-off score of 12 or more. The accuracy of the EPDS, however, is modest for minor depression, and low for anxiety disorders. Neither the EPDS-3A score nor the HAD-A subscale reached acceptable validity in this study. CONCLUSIONS: The EPDS seems to pick up more distress than pure depression in new fathers. It is a valid instrument for screening for probable major depression, but it is questionable if it should be used to screen for minor depression. Neither the EPDS nor the HAD-A subscale can be recommended for screening for anxiety in postnatal fathers. LIMITATIONS: Confidence intervals around the estimates are wide and the interviewed fathers were selected preferentially.

Screening for postnatal depression in Swedish child health care.

AIM: To investigate how postnatal depressive mood was identified by child health nurses and which factors were associated with the implementation of screening for postnatal depression and with offering supportive listening visits. METHODS: A random sample of all 2580 nurses in child health services in Sweden, 499 nurses, were asked to complete a postal questionnaire. A response rate of 70% was achieved. RESULTS: Half of the nurses in the study used the Edinburgh Postnatal Depression Scale (EPDS) and at least another 7% were going to begin. Having the appropriate training, access to regular supervision and pathways to care were essential, and increased the likelihood of using the EPDS. The odds of using the EPDS were six times greater for nurses with access to supervision as compared with nurses without supervision. Most of the nurses who used the EPDS included a follow-up interview on the same occasion as the mother completed the scale, and four out of five nurses allowed extra time for the EPDS. More than half of these allowed half an hour or more. The significance of factors associated with the implementation of routine screening is discussed. CONCLUSION: Training, supervision and pathways to care were essential for the implementation of routine screening with the EPDS.