Perinatal depression is associated with a higher polygenic risk for major depressive disorder than non-perinatal depression.

BACKGROUND: Distinctions between major depressive disorder (MDD) and perinatal depression (PND) reflect varying views of PND, from a unique etiological subtype of MDD to an MDD episode that happens to coincide with childbirth. This case-control study investigated genetic differences between PND and MDD outside the perinatal period (non-perinatal depression or NPD). METHODS: We conducted a genome-wide association study using PND cases (Edinburgh Postnatal Depression Scale score ≥ 13) from the Australian Genetics of Depression Study 2018 data (n = 3804) and screened controls (n = 6134). Results of gene-set enrichment analysis were compared with those of women with non-PND. For six psychiatric disorders/traits, genetic correlations with PND were evaluated, and logistic regression analysis reported polygenic score (PGS) association with both PND and NPD. RESULTS: Genes differentially expressed in ovarian tissue were significantly enriched (stdBeta = 0.07, p = 3.3e-04), but were not found to be associated with NPD. The genetic correlation between PND and MDD was 0.93 (SE = 0.07; p = 3.5e-38). Compared with controls, PGS for MDD are higher for PND cases (odds ratio [OR] = 1.8, confidence interval [CI] = [1.7-1.8], p = 9.5e-140) than for NPD cases (OR = 1.6, CI = [1.5-1.7], p = 1.2e-49). Highest risk is for those reporting both antenatal and postnatal depression, irrespective of prior MDD history. CONCLUSIONS: PND has a high genetic overlap with MDD, but points of distinction focus on differential expression in ovarian tissue and higher MDD PGS, particularly for women experiencing both antenatal and postpartum PND.

A qualitative study of women's views on the acceptability of being asked about mental health problems at antenatal booking appointments.

OBJECTIVE: To explore women's views on the acceptability of being asked about mental health problems at antenatal booking. DESIGN: Qualitative study. SETTING: Brief semi-structured qualitative interviews were conducted with women in a private setting at a hospital, or at women's homes. Interview discussions centered around three key questions: "What was it like for you answering the questions about your mood?", "Were there any questions you found upsetting, distressing or confronting?" and "Did the midwife give you some feedback about your answers?" MEASUREMENTS: Interviews were audio-recorded, transcribed verbatim, and analysed using thematic and framework approaches. PARTICIPANTS: An ethnically diverse sample [32% white British/Irish, 68% non-white, non-British] of 52 women living in the study area. FINDINGS: Most women found mental health enquiry acceptable. A smaller proportion reported difficulties and many of these women had a past or current mental health problem and/or a history of abuse. These women reported difficulty due to the emotional responses triggered by the questions and the way disclosures were handled. In general, women wanted to be asked clear questions about mental health problems, to have sufficient time to discuss issues, and to receive responses from midwives which were normalising and well-informed about mental health. CONCLUSIONS: This study highlights that women want midwives to ask clearly-framed questions about mental health problems [addressing past and current mental health concerns], and value responses from midwives that are normalising, well-informed and allow for discussion. IMPLICATIONS FOR PRACTICE: Training should be provided to midwives on how to appropriately respond to women's distress during mental health enquiry, and on referral to support services.

Improving the postnatal outcomes of new mothers.

BACKGROUND: Postnatal depression persists worldwide as a troubling issue for many new mothers and their families. The practice of early discharge within 72 hours after birth from maternity hospitals in Australia requires community-based care of new mothers, typically provided by community midwives initially, and then by maternal and child health nurses (MCHN). This latter workforce encounters the onset of distress/depression in vulnerable women and is expected to manage their care, but their training does not equip sufficiently them to do this. AIMS: The aim of the study was to evaluate the effectiveness of brief training for MCHN in early detection and effective management of mildly distressed new mothers. METHODS: A controlled comparative longitudinal study was carried out with a group of first-time mothers recruited through antenatal clinics at four major hospitals in a large Australian city. Forty MCHN were allocated to the intervention group. Those in the intervention group received training in the identification and management of distressed mothers. Intervention group nurses also had access to a liaison psychiatric network for consultation and referrals. Other nurses were allocated to the control group, which provided standard management services to new mothers in their catchment areas. Mothers' outcomes in psychological and psychosocial functioning were assessed; comparing those cared for by the nurses who had received the intervention with those cared for by standard practices. Mothers' satisfaction with the maternal and child health nurse services was also assessed. RESULTS: Levels of distress peaked in early pregnancy in both groups and reduced over the study period. Rates and group levels of psychological distress and psychosocial functioning did not differ over time between mothers receiving care from the enhanced trained nurses and those receiving standard care. Differential group findings were apparent in attrition, with the more distressed mothers withdrawing from the control group and the less distressed withdrawing from the intervention group. Satisfaction with maternal and child health nurse services was high in both groups. Limitations of the study included events occurring while the study was in progress, such as staffing upheaval and unrest following the introduction of compulsory competitive tendering requirements, heavy workloads and the concurrent introduction of computerized case records that required the rapid familiarization with computer usage. CONCLUSIONS: Findings indicate that the extra training of MCHN did not substantially assist in the detection and management of postnatal distress in these new mothers. Unexpected ecological conditions of workforce disruption and extra workloads may have mitigated against the success of the programme. Limitations of the study are examined and the implications for future research are discussed.