The impact of education, country, race and ethnicity on the self-report of postpartum depression using the Edinburgh Postnatal Depression Scale.

BACKGROUND: Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset. METHOD: Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA. RESULTS: Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) 0.01), but not between European countries (∆*CFI < 0.01). CONCLUSIONS: Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.

Is the perimenopause a time of increased risk of recurrence in women with a history of bipolar affective postpartum psychosis? A case series.

There is increasing awareness of the influence of female reproductive life events on the course of bipolar disorder. Here, we describe the case histories of 5 women diagnosed with postpartum psychosis who subsequently experienced major mood disorders in relation to the perimenopause. This case series suggests that (a) the perimenopause may be a time of increased risk for women who experienced postpartum bipolar episodes and (b) periods of hormonal change represent a major trigger for bipolar episodes in some women.

Healthcare worker's perceptions of barriers to care by immigrant women with postpartum depression: an exploratory qualitative study.

OBJECTIVE: We interviewed healthcare workers working in Toronto, Canada, regarding their experience of providing care to recent immigrant women suffering from postpartum depression. The objective was two-fold: 1) to identify potential barriers to care that recent immigrant women may encounter as perceived by healthcare workers; and 2) to identify challenges healthcare workers felt that they faced as providers of care to this population. METHODS: Qualitative semi-structured interviews were conducted with 16 key informants from various disciplines employed by healthcare agencies providing care to postpartum immigrant women in Toronto. Constant comparative analysis was used to analyze the data. RESULTS: Two main categories of barriers to care for recent immigrant women were identified: 'practical barriers' and 'culturally determined barriers'. Practical barriers included knowing where and how to access services, and language difficulties. Cultural barriers included fear of stigma and lack of validation of depressive symptoms by family and society. The challenges experienced by healthcare providers working with this population were organized into two other categories: 'professional limitations', and 'social/cultural barriers'. 'Professional limitations' included fear of incompetence, language barriers, and inadequate assessment tools. 'Social/cultural barriers' included the experience of cultural uncertainty. CONCLUSIONS: The results suggest that not only are there important barriers to accessing postpartum care for recent immigrant women, but it can also be challenging for healthcare workers to deliver such needed care. Understanding some of these barriers and challenges from the perspective of healthcare providers is an important step to remedying gaps and obstacles in the service system.

No 'latent period' in the onset of bipolar affective puerperal psychosis.

The weeks following childbirth are a period of high risk in bipolar women with manic or mixed affective episodes following 20-30% of deliveries. Although the vast majority of episodes have their onset within 2 weeks of delivery it is commonly believed that there is a "latent" or symptom-free period in the first few days after delivery. We examine the day of onset of clinically significant symptoms in 101 bipolar women who have experienced an episode of puerperal (postpartum) psychosis. We find no evidence of a latent period. Over 50% of symptom onsets occur on days 1-3, with over 22% occurring on the first postpartum day.