A video-based intervention to overcome pregnancy smoking stigma among healthcare students: a randomised controlled trial.

OBJECTIVES: This study tests a video intervention to reduce pregnancy smoking stigma among French healthcare students. DESIGN: The participants were randomly selected to watch online either an experimental video (presenting educational content regarding stigma and contact with pregnant smokers) or a control video (presenting standard educational content about the risks of smoking). The students completed scales assessing stigma, intention to address smoking cessation and self-efficacy to do so, before the intervention (T0, n = 252), one week after the intervention (T1, n = 187), and one month after the intervention (T2, n = 131). RESULTS: Compared to the medical students, especially men, the midwifery students reported lower derogative cognitions (η2p = .18), negative behaviours (η2p = .07) and personal distress (η2p = .06). However, the midwifery students also reported lower levels of intention to address smoking (η2p = .02) than the medical students. The experimental video decreased derogative cognitions to a greater extent than the control video (η2p = .23) in both the short and medium term. This study is the first intervention designed to reduce the stigmatisation of pregnant smokers by healthcare students. We recommend that the issue of stigma should receive more attention in the medical curriculum.

Women's quality of life and mental health in the first year after birth: Associated factors and effects of antenatal preventive measures among mothers in the ELFE cohort.

BACKGROUND: During the perinatal period, women's perceived quality of life (QOL) may be altered due to physiological, psychological, and bodily changes, as well as changes in family functioning. OBJECTIVES: to explore in a sample of women from the general population, the associations between physical and mental QOL at 1 year post-partum and i) pregnancy social support, demographic, socioeconomic, medical and child health-related factors, paternal and maternal psychological characteristics at 2 months and 1 year post-partum, ii) antenatal preventive measures (early prenatal interview/antenatal classes). METHODS: We used data from the "French Longitudinal Study since Childhood" (ELFE), a representative cohort of children and their parents followed from birth to adulthood. Data were collected from mothers in the maternity ward, at 2 months and 1-year post-partum. QOL was assessed using the SF12 physical (PCS-12) and mental (MCS-12) subscales. RESULTS: Women with both low PCS-12 and MCS-12 scores were more likely to have high maternal age and to experience psychological difficulties during pregnancy. They also had more frequent PNDS, quarrels with insults within the couple, low sleep time at 2 months postpartum, and more frequently received psychological, social and child caregiver support, and were more often housewives or students at 1-year post-partum. Others factors are specific for low PCS-12 or MCS-12. There was no association with antenatal preventive measure and QOL at 1-year post-partum. CONCLUSION: Factors influencing maternal QOL are multiple and multidimensional and can mostly be identified during the ante or early postnatal period. A graduated and coordinated preventive and curative pathway would improve women's health. An ecosystemic approach to pregnancy and the perinatal period could help preventing the negative effects of environment on mothers and thus infants during the "1000-day period".

[Advance directives in perinatal psychiatry: A parenting aid for women with bipolar disorder?] / Directives anticipées en psychiatrie périnatale : une aide à la parentalité pour les femmes ayant un trouble bipolaire ?

Advance directives in psychiatry (ADP) allow patients to anticipate their requests for care. Their purpose is to promote the acceptation of care, prevent relapses and maintain the autonomy of people with severe and persistent disorders such as bipolar disorder (BD). The risk of relapse is particularly high during the perinatal period. ADPs could be a tool to facilitate care pathway and so maintain mood stability for women with BD during the perinatal period and provide good conditions for child development.

Pregnancy denial: a complex symptom with life context as a trigger? A prospective case-control study.

OBJECTIVE: To identify risk factors for a woman to experience pregnancy denial. DESIGN, SETTING AND POPULATION: A French multicentric prospective case-control study with 71 mother-infant dyads having experienced a pregnancy denial versus a control group of 71 dyads. METHODS: Data were collected in the week after delivery using an observational leaflet and two psychiatric scales (MINI and QSSP). MAIN OUTCOME MEASURES: Statistically significant differences between the two groups regarding social, demographic, medical and psychiatric data. RESULTS: Not being in a stable relationship (odds ratio [OR] 17.18, 95% CI 3.37-87.60]; P < 0.0001), not having a high school diploma (OR 1.11, 95% CI 1.04-1.38]; P < 0.0001) and having a psychiatric history (OR 6.33, 95% CI 1.62-24.76; P = 0.0002) were risk factors to experience pregnancy denial, whereas being older was a protective factor (OR 0.86, 95% CI 0.79-0.93; P = 0.0054) (logistic regression, Wald 95% CI). Other risk factors included late declarations of pregnancy history and past pregnancy denials (case n = 7, 9.7% versus 0% in controls; P = 0.01), past pregnancy denials in the family (case n = 13, 18% versus control n = 4, 5.6%; P = 0.03), and use of a contraceptive method (75% for cases versus 7% in control; P < 0.0001), primarily an oral contraceptive (75%). CONCLUSION: Family or personal history of pregnancy denial should be part of the systematic anamnesis during the first visit of a patient of child-bearing age. Further, our study points out that life context (young age, single status, socio-economic precarity, pill-based contraception) could be a trigger for pregnancy denial in certain women. TWEETABLE ABSTRACT: Life context can be a trigger for pregnancy denial.

Maternal post-natal depressive symptoms at 2 months: Effects of French antenatal preventive measures in the E.L.F.E. cohort.

BACKGROUND: Given the high incidence of perinatal maternal depression, implementation of preventive actions is crucial. In France, two prenatal preventive measures are available to the general population: early prenatal interview (EPI) and antenatal classes (ANC). OBJECTIVE: To explore the independent associations between EPI and / or ANC and maternal depressive symptoms at 2 months postpartum. METHOD: We used data from the Etude Longitudinale Française depuis l'Enfance (ELFE), a French national representative cohort of children and their parents, followed-up from birth to early adulthood. Data concerning characteristics were collected from the mothers during the maternity stay and between 6/8 weeks' post-partum. The level of depressive symptoms was scored by the French version of the Edinburgh Postnatal Depression Scale (EPDS) between 6/8 weeks' post-partum. We considered EPDS score ≥10 indicative of postnatal psychological distress (PPD) and EPDS ≥12 for postnatal depressive symptoms (PNDS). After data imputation, multivariate logistic regression analysis was performed. RESULTS: Among the 16,411 mothers included in our sample, 26% benefited both from EPI and ANC, 31.1 % of ANC, 7.7% of an EPI and 35% of neither; 20,1% presented PPD and 12,1% PNDS. The likelihood of presenting PPD was significantly higher in mothers who had neither had EPI nor ANC (OR = 1.15 (95% CI : 1.01-1.30). There was no association between receiving or not an EPI and/or ANC and presenting PNDS. CONCLUSIONS: Antenatal preventive measures may be helpful to prevent PPD at 2 months' post- partum, while PNDS do not seem to be influenced by these actions.

[Early mother-infant care, definition and effectiveness: A review of the literature]. / Soins précoces mère-enfant, définition et efficacité : revue de la littérature.

OBJECTIVE: Professionals agree on the need for early joint mother-baby care, but its effectiveness remains poorly studied. The aim of our work is to propose a review of the literature on this subject. METHODS: We included randomized or non-randomized controlled clinical trials of interventions targeting the mother-baby dyad which can begin during pregnancy or during the first three years of life. RESULTS: Forty-one studies met the inclusion criteria and focused on mother-baby psychotherapy, educational or guidance programs, care for premature infants, infant massage, and home visits. The results show an improvement of the quality of the interactions whatever the type of approach, but according to different indications or modalities. The heterogeneity of intervention methods and indications make the comparison of results almost impossible. CONCLUSION: This work highlights the lack of consensus on mother-child care methods, both for their indications and their effectiveness. The isolated evaluation of interactions is an insufficient criterion for judging the effectiveness of care. Finally, whatever the theoretical models, the interventions must take into account the environment of the child.

Validity of the Measure of Intensive Mothering Ideology (MIMI).

OBJECTIVE: The aim of this study was to test the validity of the Measure of Intensive Mothering Ideology (MIMI), a French scale assessing beliefs about mothering and childcare. METHOD: The MIMI was submitted online to Mothers/mothers-to-be (n=249) and Childless women (n=231). To test structural validity, confirmatory factor analyses were conducted in both groups. Then, to test known-groups validity, means comparisons were conducted according to parity (mothers/mothers-to-be and childless women) and employment status (full-time, part-time and housewives). It was also hypothesized that MIMI scores would be negatively correlated with education. RESULTS: Model fit was satisfactory for Mothers/mothers-to-be (X2/df=2.52, AGFI=.957, NFI=.937 RMR=.087) and, to a lesser extent, for Childless women (X2/df=3.31, AGFI=.948, NFI=.907, RMR=.104). In both groups, most dimensions were moderately correlated (.22-.70). As hypothesized, Mothers/mothers-to-be and Housewives had higher score than Childless women and Employed women. MIMI scores were also negatively and moderately correlated with education. CONCLUSION: The MIMI shows good structural validity and known-groups validity. This scale offers interesting research avenues notably regarding perinatal parental adaptation.

[Mental health of children in foster care, a literature review]. / La santé mentale des enfants placés. Une revue de la littérature.

In France more than 140 000 children live in foster homes under the responsibility of the French Child Protection Agency. These children have lived in environments that cannot be good for their development and have been separated from their families which have to have consequences on their mental development. A literature review in France and abroad was made to identify the profiles of these children, their risk factors, and the mental disorders they can present. French child protection is handled by smaller territories, called Départements of which there are more than 90 and count around 1 000 000 people each. The number of foster children differ byDépartement, as do the placement types and meaning of the placement. More than half of these children have suffered maltreatment prior to placement. Comparing them to children of the same age, they present more internalizing and externalizing disorders, more addiction problems and suicidal behaviors. Protection factors have nonetheless been identified, such as early age of placement and placement stability. The main inhibitors of good health care are the absence of a common regulatory framework, source of organization difficulties, and the lack of collaboration between health and social services. French cohort studies using validated tools are necessary to precise and confirm these results. They could then lead to national recommendations for mental health screening and care organization, as well as validation of protocols for specific therapies for foster children.

Intensive mothering ideology in France: A pilot study.

OBJECTIVE: The aim of this pilot study was to adapt the intensive mothering ideology concept in a French sample and to get an assessment tool. METHOD: First, the Intensive Parenting Attitudes Questionnaire (IPAQ), a U.S. scale comprising 25 items, was translated and submitted online to French mothers and mothers-to-be (n=250). Structural validity was tested through confirmatory factor analysis with poor results. Secondly, to increase the cultural validity of a new tool, new items were derived from French women speech. French mothers and mothers-to-be (n=22) were asked about their views regarding motherhood and childcare (semi-structured interviews). A thematic content analysis was performed with good inter-judge agreement (0.53-0.86) and 27 items were created. Finally, the total set of 52 items was submitted online to French mothers and mothers-to-be (n=474). The structure was tested through exploratory factor analysis. RESULTS: A new tool called the Measure of Intensive Mothering Ideology (MIMI) was obtained. This 21 items scale with 6 dimensions (Essentialism, Consuming Fulfillment, Child-centrism, Challenge, Sacrifice and Stimulation) explains 59.75% of variance. Internal consistencies were satisfactory (0.61-0.83) and most dimensions were positively and moderately correlated (0.17-0.38). CONCLUSION: The MIMI is the first French-language scale assessing IMI and offers interesting research avenues notably regarding perinatal parental adaptation.

Maternal depressive symptoms and early childhood cognitive development: a meta-analysis.

BACKGROUND: Previous findings have been mixed regarding the relationship between maternal depressive symptoms and child cognitive development. The objective of this study was to systematically review relevant literature and to perform a meta-analysis. METHOD: Three electronic databases (PubMed, EMBASE, PsycINFO) were searched. Initial screening was conducted independently by two reviewers. Studies selected for detailed review were read in full and included based on a set of criteria. Data from selected studies were abstracted onto a standardized form. Meta-analysis using the inverse variance approach and random-effects models was conducted. RESULTS: The univariate analysis of 14 studies revealed that maternal depressive symptoms are related to lower cognitive scores among children aged ⩽56 months (Cohen's d = -0.25, 95% CI -0.39 to -0.12). The synthesis of studies controlling for confounding variables showed that the mean cognitive score for children 6-8 weeks post-partum whose mothers had high depressive symptoms during the first few weeks postpartum was approximately 4.2 units lower on the Mental Developmental Index (MDI) of the Bayley Scales of Infant and Toddler Development (BSID) compared with children with non-symptomatic mothers (B̂ = -4.17, 95% CI -8.01 to -0.32). CONCLUSIONS: The results indicated that maternal depressive symptoms are related to lower cognitive scores in early infancy, after adjusting for confounding factors. An integrated approach for supporting child cognitive development may include program efforts that promote maternal mental health in addition to family economic wellbeing, responsive caregiving, and child nutrition.

[Early prenatal interview and antenatal education for childbirth and parenthood: Associated psychosocial and obstetric characteristics in women of the ELFE cohort]. / Entretien prénatal précoce et séances de préparation à la naissance et à la parentalité : caractéristiques psychosociales et obstétricales associées chez les femmes de la cohorte ELFE.

OBJECTIVES: Early prenatal interview (Entretien prénatal précoce [EPP]) is aimed at defining with couples their physical, psychological and social needs during perinatal period. Antenatal education for childbirth and parenthood (Préparation à la naissance et à la parentalité [PNP]) is aimed at promoting global perinatal health. The objective was to identify the psychological, demographic and obstetrical characteristics independently associated with participation in: (i) an EPP; (ii) a PNP. MATERIALS AND METHODS: Multivariate analyses were applied to data collected during the maternity stay of mothers whose children were included in the French cohort French Longitudinal Study since the Childhood (ELFE), a nationally representative cohort of children followed-up from birth to adulthood. RESULTS: Among the 14,595 mothers of the sample, 33% had an EPP and 52% a PNP. Primiparous mothers, born in France, with high educational level, employed or unemployed, with psychological difficulties more often benefit from EPP and/or PNP. Women who were young, benefiting from free health insurance (Couverture Maladie Universelle [CMU]), with unplanned pregnancy, with less antenatal care and obstetrical complications less often benefit from PNP. CONCLUSION: The EPP and the PNP reach high sociodemographic level populations. They should be integrated into a wider system of prevention and care, in order to reach the most vulnerable populations and to contribute to the improvement of the psychological and social environment of all the women during the perinatal period.

Post-partum depressive symptoms and medically assisted conception: a systematic review and meta-analysis.

STUDY QUESTION: Does medically assisted conception increase the risk of post-partum depressive symptoms? SUMMARY ANSWER: Our literature review and meta-analysis showed no increased risk of post-partum depressive symptoms in women after medically assisted conception. WHAT IS KNOWN ALREADY: Women who conceive with medically assisted conception, which can be considered as a stressful life event, could face an increased risk of depressive symptoms. However, no previous meta-analysis has been performed on the association between medically assisted conception and post-partum depressive symptoms. STUDY DESIGN, SIZE, DURATION: A systematic review with electronic searches of PubMed, ISI Web of Knowledge and PsycINFO databases up to December 2014 was conducted to identify articles evaluating post-partum depressive symptoms in women who had benefited from medically assisted conception compared with those with a spontaneous pregnancy. Meta-analyses were also performed on clinically significant post-partum depressive symptoms according to PRISMA guidelines. PARTICIPANTS/MATERIALS, SETTING, METHODS: From 569 references, 492 were excluded on title, 42 on abstract and 17 others on full-text. Therefore, 18 studies were included in the review and 8 in the meta-analysis (2451 women) on clinically significant post-partum depressive symptoms after medically assisted conception compared with a spontaneous pregnancy. A sensitivity meta-analysis on assisted reproductive technologies and spontaneous pregnancy (6 studies, 1773 women) was also performed. The quality of the studies included in the meta-analyses was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology Statement for observational research. The data were pooled using RevMan software by the Cochrane Collaboration. Heterogeneity between studies was assessed from the results of the χ(2) and I(2) statistics. Biases were assessed with funnel plots and Egger's test. A fixed effects model was used for the meta-analyses because of the low level of heterogeneity between the studies. MAIN RESULTS AND THE ROLE OF CHANCE: The systematic review of studies examining post-partum depressive symptoms after medically assisted conception compared with spontaneous pregnancy is not in favor of an association. Our meta-analysis on clinically significant post-partum depressive symptoms showed no significant difference between women who used medically assisted conception and those with spontaneous pregnancy: odds ratio (OR) = 0.93 (0.67-1.31), Z = 0.40, P = 0.69. The sensitivity meta-analysis reported no significant difference either: OR = 1.04 (0.71-1.52), Z = 0.18, P = 0.86. LIMITATIONS, REASONS FOR CAUTION: The literature on post-partum depressive symptoms and medically assisted conception is sparse. Only eight studies were available for our meta-analysis taking into account the rates of clinically significant post-partum depressive symptoms after medically assisted conception. However, the quality of the studies was high and the heterogeneity between trials was not significant. Whilst post-partum anxiety is more prevalent than depressive states and they can co-occur, it was not considered in these review and meta-analyses. In addition, other risk factors, such as maternal age, socio-demographic data or obstetric factors, are important for the assessment of post-partum depressive symptoms. Our review reported that several of these confounding risk factors were, however, analyzed and controlled for in the studies. WIDER IMPLICATIONS OF THE FINDINGS: Our literature review and meta-analyses showed no increased risk of post-partum depressive symptoms in women after medically assisted conception. Even if the rates of depressive symptoms are the same in the medically assisted conception population as among controls, the risk factors could be different. Though medically assisted conception can be considered as a stressful life event, these women have also lower prevalence of the usual risks. Professionals should also be careful to screen for prenatal and post-partum depressive symptoms, as with all pregnant women. Further studies are needed to clarify the specific features of post-partum depressive symptoms in this population.

Predictors of persistent maternal depression trajectories in early childhood: results from the EDEN mother-child cohort study in France.

BACKGROUND: Maternal depression in the pre- and postpartum period may set women on a course of chronic depressive symptoms. Little is known about predictors of persistently elevated depressive symptoms in mothers from pregnancy onwards. The aims of this study are to determine maternal depression trajectories from pregnancy to the child's fifth birthday and identify associated risk factors. METHOD: Mothers (N = 1807) from the EDEN mother-child birth cohort study based in France (2003-2011) were followed from 24-28 weeks of pregnancy to their child's fifth birthday. Maternal depression trajectories were determined with a semi-parametric group-based modelling strategy. Sociodemographic, psychosocial and psychiatric predictors were explored for their association with trajectory class membership. RESULTS: Five trajectories of maternal symptoms of depression from pregnancy onwards were identified: no symptoms (60.2%); persistent intermediate-level depressive symptoms (25.2%); persistent high depressive symptoms (5.0%); high symptoms in pregnancy only (4.7%); high symptoms in the child's preschool period only (4.9%). Socio-demographic predictors associated with persistent depression were non-French origin; psychosocial predictors were childhood adversities, life events during pregnancy and work overinvestment; psychiatric predictors were previous mental health problems, psychological help, and high anxiety during pregnancy. CONCLUSIONS: Persistent depression in mothers of young children is associated to several risk factors present prior to or during pregnancy, notably anxiety. These characteristics precede depression trajectories and offer a possible entry point to enhance mother's mental health and reduce its burden on children.

Prenatal psychological distress and access to mental health care in the ELFE cohort.

BACKGROUND: Pregnant women are vulnerable to the deleterious impact of environmental stressors. The aims were to identify the environmental and pregnancy characteristics independently associated with prenatal psychological distress and access to mental health care. METHODS: We used data from the French cohort Étude Longitudinale Française depuis l'Enfance (ELFE), a nationally representative cohort of children followed-up from birth to adulthood. Information about prenatal psychological status and access to mental health care was collected during the maternity stay. Maternal/pregnancy characteristics independently associated with psychological distress and access to mental health care were explored using multivariate analyses. RESULTS: Of the 15,143 mothers included, 12.6% reported prenatal psychological distress. Prenatal distress was more frequent in women with very low economical status, alcohol/tobacco use, unplanned/unwanted pregnancy, late pregnancy declaration, multiparity and complicated pregnancy (high number of prenatal visits, prenatal diagnosis examination, obstetrical complications). Of the women reporting prenatal distress, 25% had a prenatal consultation with a mental health specialist and 11% used psychotropic drugs during pregnancy. Decreased likelihood to consult a mental health specialist was found in young women, with intermediate educational level and born abroad. LIMITATIONS: Causal inferences should be made cautiously as the questionnaire did not collect information on the temporal sequence between psychological distress and associated characteristics. CONCLUSIONS: Women with social and obstetrical vulnerabilities are at increased risk of poor mental health during pregnancy. Improving mental health care access during pregnancy is a public health priority.

Evolution of perinatal depressive symptoms from pregnancy to two years postpartum in a low-risk sample: the MATQUID cohort.

BACKGROUND: Few studies have explored the evolution of perinatal depressive symptoms (PNDS) throughout the perinatal period. AIMS: To evaluate in a low-risk sample, whether different evolutive profiles of PNDS exist from pregnancy to 2-years postpartum, and whether the subgroups differ regarding psychopathological and demographic characteristics. METHODS: In a prospective, longitudinal study from 8 months pregnancy to 2 years postpartum, repeated measures of PNDS using the CES-D were performed on a sample of 579 women at low-risk for PNDS. First, semiparametric mixture models were used to identify groups of women with distinct trajectories of PNDS. Second, multinomial logistic regressions were used to identify risk factors for each group. RESULTS: Four distinct trajectories of PNDS evolution were found: (i) 72% of the women never presented with clinically significant depressive symptoms; (ii) 4% presented with depressive symptoms only during the postnatal period; (iii) 21% presented with depressive symptoms throughout the follow-up period, with a higher intensity during pregnancy; (iv) 3% presented with stable highly intense symptoms throughout the follow-up period. Psychosocial risk factors for PNDS were mainly identified in the patients of the third group, with an influence of socio-economical variables and anxiety traits. LIMITATIONS: The main limitations of the present study are the small size of the sample and the low level of risk for PNDS, so the results cannot be extrapolated to all types of populations. CONCLUSION: Different subtypes of evolutionary profiles of PNDS are found in a low-risk sample, and are associated with different profiles of risk factors.

A prospective longitudinal study of the impact of early postnatal vs. chronic maternal depressive symptoms on child development.

BACKGROUND: Few studies of the effects of postnatal depression on child development have considered the chronicity of depressive symptoms. We investigated whether early postnatal depressive symptoms (PNDS) predicted child developmental outcome independently of later maternal depressive symptoms. METHODS: In a prospective, longitudinal study, mothers and children were followed-up from birth to 2 years; repeated measures of PNDS were made using the Edinburgh Postnatal Depression Scale (EPDS); child development was assessed using the Bayley Scales II. Multilevel modelling techniques were used to examine the association between 6 week PNDS, and child development, taking subsequent depressive symptoms into account. RESULTS: Children of mothers with 6 week PNDS were significantly more likely than children of non-symptomatic mothers to have poor cognitive outcome; however, this association was reduced to trend level when adjusted for later maternal depressive symptoms. CONCLUSION: Effects of early PNDS on infant development may be partly explained by subsequent depressive symptoms.

Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: a prospective survey of the MATQUID cohort.

OBJECTIVE: Studies have suggested that women with pregnancy anxiety may be at greater risk of postnatal depression (PND). However, due to the high comorbidity between anxiety and depressive disorders, this finding may be confounded by the association between prenatal depression and postnatal depression. The aim of the present prospective study was to assess whether anxiety disorder (AD) during pregnancy is an independent predictor of intensity of postnatal depressive symptoms. METHOD: The MATQUID cohort survey was conducted on pregnant women (n = 497) attending a state maternity hospital. Psychiatric status during pregnancy was assessed during the third trimester using a structured diagnostic interview. Intense postnatal depressive symptoms at 6 weeks post-partum were defined by a score >12 on the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Nearly one out of four women (24.1%) presented with at least one pregnancy AD, and 29 (5.8%) presented with a score >12 on the EPDS. After adjustment for presence of major depression during pregnancy and other confounding factors, women with pregnancy AD were nearly three times more likely to present with intense postnatal depressive symptoms (OR = 2.7, 95%CI 1.1-6.3, P = 0.03). CONCLUSION: Promoting the recognition and management of AD in pregnant women may be of interest for the prevention of postnatal depression.

Postnatal depression across countries and cultures: a qualitative study.

BACKGROUND: Postnatal depression seems to be a universal condition with similar rates in different countries. However, anthropologists question the cross-cultural equivalence of depression, particularly at a life stage so influenced by cultural factors. AIMS: To develop a qualitative method to explore whether postnatal depression is universally recognised, attributed and described and to enquire into people's perceptions of remedies and services for morbid states of unhappiness within the context of local services. METHOD: The study took place in 15 centres in 11 countries and drew on three groups of informants: focus groups with new mothers, interviews with fathers and grandmothers, and interviews with health professionals. Textual analysis of these three groups was conducted separately in each centre and emergent themes compared across centres. RESULTS: All centres described morbid unhappiness after childbirth comparable to postnatal depression but not all saw this as an illness remediable by health interventions. CONCLUSIONS: Although the findings of this study support the universality of a morbid state of unhappiness following childbirth, they also support concerns about the cross-cultural equivalence of postnatal depression as an illness requiring the intervention of health professionals; this has implications for future research.

Adaptation of the structured clinical interview for DSM-IV disorders for assessing depression in women during pregnancy and post-partum across countries and cultures.

BACKGROUND: To date, no study has used standardised diagnostic assessment procedures to determine whether rates of perinatal depression vary across cultures. AIMS: To adapt the Structured Clinical Interview for DSM-IV Disorders (SCID) for assessing depression and other non-psychotic psychiatric illness perinatally and to pilot the instrument in different centres and cultures. METHOD: Assessments using the adapted SCID and the Edinburgh Postnatal Depression Scale were conducted during the third trimester of pregnancy and at 6 months postpartum with 296 women from ten sites in eight countries. Point prevalence rates during pregnancy and the postnatal period and adjusted 6-month period prevalence rates were computed for caseness, depression and major depression. RESULTS: The third trimester and 6-month point prevalence rates for perinatal depression were 6.9% and 8.0%, respectively. Postnatal 6-month period prevalence rates for perinatal depression ranged from 2.1% to 31.6% across centres and there were significant differences in these rates between centres. CONCLUSIONS: Study findings suggest that the SCID was successfully adapted for this context. Further research on determinants of differences in prevalence of depression across cultures is needed.