Use of video feedback intervention in an inpatient perinatal psychiatric setting to improve maternal parenting.

This study utilizes video feedback to improve maternal parenting behavior in clinically depressed mothers admitted to a perinatal inpatient psychiatric unit. Depressed mothers (n = 74) were randomized to "video" (n = 25), "verbal" (n = 26), or "standard care" (n = 23). "Video" mothers were taped playing with their infant; interaction was reviewed with a mental health specialist. "Verbal" mothers only discussed interaction with their infant. "Standard care" mothers received only routine inpatient care. Mothers were assessed for mental health status, perceptions of baby behavior, and parenting competence. There was significant improvement in mental health status of all participants, regardless of intervention. Neither intervention had an advantage, compared to standard care, in improving parenting confidence or perceptions of infant behavior. Video mothers were more likely to report no change in their parenting confidence the more feedback sessions completed. The number of intervention sessions for each participant was limited by the duration of their inpatient admission. Most participants were on simultaneous pharmacotherapy and psychotherapy, as well as receiving intensive mothercraft assistance; this may have influenced intervention effectiveness. Results suggest that this type of intervention may be beneficial, but in the current format does not add sufficiently to standard care to be detected by the measures used.

Primary care physician's attitudes and practices regarding antidepressant use during pregnancy: a survey of two countries.

Little is known about the practices of primary care physicians regarding the prescribing of antidepressants during pregnancy. An anonymous survey was administered to a group of nonrandomly selected Australian general practitioners (n = 61 out of 77) and randomly selected Canadian family physicians (n = 35 out of 111). Responses to a hypothetical scenario and questions regarding beliefs about the use of antidepressant medication during pregnancy were collected. Physicians from both countries feel strongly that antidepressant use during pregnancy is a decision complicated by conflicting reports of safety and risk.

Bipolar affective disorder in the postnatal period: investigating the role of sleep.

OBJECTIVES: Psychotic disorders have a high rate of relapse in the postpartum period for reasons that are unclear, but may be related to changes in sleep patterns that occur during pregnancy and after birth. Understanding of the influence of sleep on postpartum psychosis presentation is limited. The aim of the current study was to investigate changes in sleep/wake activity during pregnancy and the postpartum period in women with a history of psychosis. METHODS: Women with a history of bipolar disorder and/or postpartum psychosis (HxW) were recruited (n = 23) together with a control population (CtW) (n = 15). Data on demographic and psychosocial factors, mental health status, and sleep/wake activity were collected at seven timepoints-the last week of each trimester of pregnancy and four times during the postpartum (weeks 1, 4, and 8, and at month 6). Longitudinal data were analysed using an HLM version 6 repeated-measures multilevel model. RESULTS: No significant differences were noted in sleep/wake activity between HxW and CtW. None of the HxW who were taking a mood stabilizer during their pregnancy, including at delivery, relapsed during the study. Of those taking an antidepressant or antipsychotic, or no medication, 3 relapsed within the first six months and 2 within the first two months. HxW were more likely to report a poor partner relationship than CtW. CONCLUSION: Results suggest that during the perinatal period, there is no difference in sleep/wake activity in women with a history of a psychotic disorder. Use of mood stabilizer during pregnancy and at delivery appears important in preventing psychotic relapse in the postpartum.

A geographic comparison of the prevalence and risk factors for postnatal depression in an Australian population.

OBJECTIVE: This study sought to compare the contribution of demographic and psychosocial variables on the prevalence of, and risk for, PND in urban and rural women. METHODS: Demographic, psychosocial risk factor and mental health data was collected from urban (n=908) and rural (n=1,058) women attending perinatal health services in Victoria, Australia. Initial analyses determined similarities and significant differences between demographic and psychosocial variables. The association between these variables and PND case/non-case was evaluated using logistic regression analysis. RESULTS: There were a number of significant differences between the two cohorts in terms of socio-economic status (SES), age, marital status and past history of psychopathology Antenatal depression was more common in the urban group compared to the rural group (8.5% vs 3.4%, p=0.006); there was no significant difference in the prevalence of PND (6.6% vs 8.5%, p=0.165). For urban mothers, antenatal EPDS score was the best predictor of PND. For rural mothers antenatal EPDS score, SES and psychiatric history had a significant influence on postnatal mood. CONCLUSIONS: Findings confirm the contribution of established risk factors such as past psychopathology, antenatal EPDS score and SES on the development of PND and reiterate the need for procedures to identify and assess psychosocial risk factors for depression in the perinatal period. Other predictors such as efficacy of social support and perceived financial burden may strengthen statistical models used to predict PND for women living in a rural setting.

Single motherhood versus poor partner relationship: outcomes for antenatal mental health.

OBJECTIVE: In the transition to parenthood, lack of social support significantly impacts on maternal mood. This paper compares the influence of single-mother status and level of partner support in a partnered relationship, on antenatal emotional health. METHODS: Antenatal demographic, psychosocial and mental health data, as determined by Edinburgh Postnatal Depression Scale (EPDS) score, were collected from 1578 women. The association between these variables, and marital status, was investigated using logistic regression. RESULTS: Sixty-two women (3.9%) were identified as single/unpartnered. Elevated EPDS scores (>12) were found in 15.2% (240/1578) of the total cohort and 25.8% (16/62) of the single/unpartnered women. EPDS scores were significantly lower for single/unpartnered women than for women with unsupportive partners (8.9+/-5.3 vs 11.9+/-6.5, p<0.001). Compared to the partnered cohort, single/unpartnered women were more likely to have experienced >or=2 weeks of depression before the current pregnancy (p<0.05), a previous psychopathology (p<0.001), emotional problems during the current pregnancy (p<0.01) and major life events in the last year (p<0.01). Binary logistic regression modelling to predict antenatal EPDS scores suggests that this is mediated by previous psychiatric history (p<0.001) and emotional problems during pregnancy (p=0.02). CONCLUSION: Women in a partnered-relationship with poor partner-derived support were at an increased risk of elevated antenatal EPDS scores compared to single/unpartnered women. A previous history of depression and current emotional problems, rather than single mother status, were significant risk factors for elevated EPDS scores. The present study reiterates the contribution of psychosocial risk factors as important mediators of antenatal emotional health.

Postnatal mental health of women giving birth in Australia 2002-2004: findings from the beyondblue National Postnatal Depression Program.

OBJECTIVES: To describe the postnatal mental health status of women giving birth in Australia 2002-2004 at 6-8 weeks postpartum. METHOD: Women were recruited from 43 health services across Australia. Women completed a demographic questionnaire and an Edinburgh Postnatal Depression Scale (EPDS) in pregnancy; the latter was repeated at 6-8 weeks following childbirth. RESULTS: A total of 12 361 postnatal women (53.8% of all postnatal women surveyed) completed questionnaires as part of a depression screening programme; 15.5% of women screened had a postnatal EPDS>9 and 7.5% of women had an EPDS>12 at 6-8 weeks following childbirth. There was significant variation between States in the percentage of women scoring as being potentially depressed. The highest percentage of women scoring EPDS>12 were in Queensland and South Australia (both 10.2%) while Western Australia had the lowest point prevalence (5.6%). Women recruited from private health services in Western Australia had a significantly lower prevalence of elevated EPDS scores than those women recruited from the public health service (EPDS >12: 3.6% vs 6.4%, p=0.026); differences in the prevalence of elevated EPDS scores were not significant between public and private in Australian Capital Territory (EPDS>12: 7.6% vs 5.8%, p=0.48), where income and education was significantly higher than other States for both groups. CONCLUSIONS: Postnatal depressive symptoms affect a significant number of women giving birth in Australia, and the point prevalence on the EPDS may be higher for women in the public sector, associated with lower incomes and educational levels. Maternity services--particularly those serving women with these risk factors--need to consider how they identify and manage the emotional health needs of women in their care. Specific State-related issues, such as availability of specialist perinatal mental health services and liaison between treating health professionals, also need to be considered.

To screen or not to screen--that is the question in perinatal depression.

Significant perinatal distress and depression affects 14% of women, producing short and long term consequences for the family. This suggests that measures for early detection are important, and non-identification of these women may exacerbate difficulties. Screening provides an opportunity to access large numbers of women and facilitate pathways to best-practice care. A valid, reliable, economical screening tool (the Edinburgh Postnatal Depression Scale, EPDS) is available. Arguments against screening pertain largely to lack of evidence about the acceptability of routine use of the EPDS during pregnancy and the postnatal period, and inadequate evidence regarding outcomes and cost-effectiveness. To address these concerns, the National Postnatal Depression Prevention and Early Intervention Program will evaluate outcomes of screening in terms of acceptability, cost-effectiveness, access and satisfaction with management in up to 100 000 women.