Developing a Guided Web App for Postpartum Depression Symptoms: User-Centered Design Approach.

BACKGROUND: Psychological internet-based interventions have shown promise in preventing and treating perinatal depression, but their effectiveness can be hindered by low user engagement. This challenge often arises from a misalignment between technology attributes, user needs, and context. A user-centered, iterative approach involving all stakeholders is recommended. OBJECTIVE: In this paper, we aimed to develop a user-friendly psychological internet-based intervention aimed at addressing the symptoms of perinatal depression through an iterative, user-centered approach. METHODS: The development process followed the Center for eHealth Research and Disease Management Roadmap phases of contextual inquiry, value specification, and design. It involved a comprehensive literature review, 2 surveys, 10 focus groups, 5 usability interviews, and 1 technical pilot. RESULTS: The contextual inquiry revealed a demand for accessible interventions for perinatal mental health, with internet-based solutions seen as viable options. Insights from the literature influenced intervention content and features. Stakeholders' openness to the intervention became evident during this phase, along with the integration of the first set of values. Initially, we assessed the broader perinatal context to identify the optimal period for the intervention. On the basis of the findings and practical considerations, we decided to specifically target postpartum depression symptoms. The value specification phase further defined the central values and translated them into requirements. In the design phase, feedback was obtained on the user experience of an early digital prototype and on the prototype's final version. The resulting intervention, named Mamá, te entiendo ("Mom, I get you"), is a guided web app based on cognitive behavioral therapy principles, integrating elements from attachment and mentalization theories. It aims to reduce depressive symptoms in women during the first months postpartum and consists of 6 core sequential modules, along with 3 additional modules, including 5 case examples illustrating depressive symptoms and therapeutic techniques. The intervention provides homework exercises and offers users the opportunity to receive feedback from an e-coach through the web app. CONCLUSIONS: This study emphasizes the importance of a user-centered and iterative development process for psychological internet-based interventions. This process helps clarify user needs and provides valuable feedback on service design and quality, ultimately having the potential to enhance the utility and, presumably, the effectiveness of the intervention. The Discussion section shares valuable insights from the project, such as the value of the requirement sessions.

Prenatal diagnosis of critical congenital heart disease associated with lower postpartum depressive symptoms: a case-control study.

OBJECTIVE: When the expectant mother is faced with an unforeseen event during pregnancy, she may experience emotional fragility and depression. This study was carried out to test the association between the time of diagnosis of critical congenital heart disease (CCHD) and depressive symptoms in puerperal women. METHOD: A case-control study. All mothers answered a semi-structured questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). Pearson's correlation and multiple linear regression analysis were used to determine factors associated with depression. RESULTS: 50 puerperal women, 23 cases and 27 controls. The proportion of puerperal depressive symptoms was 26.1 % among mothers of infants prenatally diagnosed with CCHD and 77.8 % among mothers of infants postnatally diagnosed (p = 0.001 [OR] 9.917; 95 % CI 2.703-36.379). Multiple linear regression analysis showed that the use of psychotropic drugs and time of diagnosis were significantly associated with puerperal depressive symptoms. CONCLUSION: Prenatal diagnosis of CCHD was associated with significantly lower levels of depressive symptoms.

Mother-infant bonding: The role of postpartum depression, violence, and bonding established with one's own mother during childhood.

Mother-infant bonding is influenced by several risk and protective factors, and the literature has investigated the relationships between these factors independently. This study aimed to verify the interrelationships of some of these factors and how they influence mother-infant bonding in Brazil. In this study, 361 mothers participated, and the outcome variable of mother-infant bonding was assessed using the Postpartum Bonding Questionnaire (PBQ). Multivariate regression analysis was performed using a hierarchical model with three blocks structured according to the influence exerted on mother-infant bonding. The PBQ's factor scores were estimated and used in the subsequent analyses to decrease measurement error. The variable "violence experienced by mothers" was statistically significant for explaining the second block model but not significant for the third block. Network analysis was performed after multiple regression, showing that the violence experienced by mothers does not directly influence mother-infant bonding but rather is mediated by postpartum depression. This explains why violence is not significant in the hierarchical multiple regression when maternal depression is added to the model. This study's strengths lie in its utilization of PBQ factor scores and network analysis, enabling the estimation of conditional relationships among variables. This approach provides deeper insights into factors affecting mother-infant bonding.

Varios factores de riesgo y de protección ejercen influencia sobre la unión afectiva madre­infante; la literatura disponible ha investigado las relaciones entre estos factores de una manera independiente. Este estudio se propuso verificar las interrelaciones de algunos de estos factores y cómo ellos influyen en la unión afectiva madre­infante. Se consultó un total de 361 madres y el variable resultado de afectividad madre­infante se evaluó por medio del Cuestionario de Afectividad de Postparto (PBQ). Se llevaron a cabo análisis de regresión multivariados usando un modelo jerárquico con tres estructuras de bloques de acuerdo con la influencia ejercida sobre la unión afectiva madre­infante. Se estimaron y usaron los puntajes de factores del PBQ en los análisis subsecuentes para disminuir el error en la medida. La variable "violencia experimentada por las madres" fue estadísticamente significativa para explicar el segundo modelo de bloque, pero no significativa para el tercer bloque. Se llevó a cabo un análisis de interrelaciones después de la regresión múltiple, demostrando que la violencia experimentada por las madres no influye directamente la afectividad madre­infante, sino que la misma es mediada por la depresión posterior al parto. Esto explica por qué la violencia no es significativa en la jerárquica regresión múltiple cuando la depresión materna se le agrega al modelo. Entre los puntos fuertes de este estudio se incluye el uso de los puntajes de factores del PBQ y el análisis de interrelaciones, lo cual permitió que se estimaran las relaciones condicionales existente dentro del grupo de variables, aportando una mayor comprensión de algunos factores que interfieren en la unión afectiva madre­infante.

Depresión puerperal: impacto en la madre gestante y en el desarrollo físico, emocional y cognitivo posnatal de sus hijas/os. Una mirada ecológica / Postpartum depression: Impact on pregnant women and the postnatal physical, emotional, and cognitive development of their children. An ecological perspective

Los problemas de salud mental materna durante el embarazo, parto y puerperio son un desafío para la salud pública. Su falta de reconocimiento atenta contra el diagnóstico y tratamientos oportunos, e impacta en la madre y el establecimiento del vínculo fundamental del binomio. Debemos reconocer los factores de riesgo (edad, situación socioeconómica, antecedentes psicopatológicos, disfunción familiar, entorno desfavorable), las manifestaciones clínicas y las herramientas de detección. Existen evidencias de que el efecto del estrés, la ansiedad y la depresión durante el embarazo afectan negativamente el neurodesarrollo fetal y condicionan los resultados del desarrollo infantil. Describimos el impacto negativo de la depresión puerperal durante los primeros meses de vida, que afecta el vínculo madre-hija/o, el desarrollo posnatal (emocional, conductual, cognitivo, lenguaje) y el mantenimiento de la lactancia materna. También reconocemos factores protectores que atemperan sus efectos. Es fundamental establecer estrategias preventivas y abordajes diagnósticos y terapéuticos interdisciplinarios para minimizar los riesgos sobre la madre y sus hijas/os.

Maternal mental health problems during pregnancy, childbirth, and the postpartum period are a challenge for public health. Not recognizing them hinders a timely diagnosis and treatment and has an impact on the mother and the establishment of the fundamental bond of the mother-child dyad. We must recognize the risk factors (age, socioeconomic status, mental health history, family dysfunction, unfavorable environment), clinical manifestations, and screening tools. There is evidence that the effect of stress, anxiety, and depression during pregnancy negatively affect fetal neurodevelopment and condition child developmental outcomes. Here we describe the negative impact of postpartum depression during the first months of life, which affects mother-child bonding, postnatal development (emotional, behavioral, cognitive, language), and the maintenance of breastfeeding. We also recognize protective factors that mitigate its effects. It is essential to establish preventive strategies and interdisciplinary diagnostic and therapeutic approaches to minimize the risks to the mother and her children.

The interplay between emotional and breastfeeding difficulties in first-time mothers.

AIM/BACKGROUND: Both mental maternal health and breastfeeding difficulties impact maternal and infant health. The present study analyses the association between psychosocial and breastfeeding variables and maternal mental health. DESIGN/METHODS: The participants were 107 first-time mothers from Chile. Sociodemographic variables and breastfeeding difficulties were assessed at 6 weeks postpartum. Depression and anxiety symptoms, parental self-efficacy, and perceived social support were measured using validated, self-report questionnaires at 6 weeks and 5 months postpartum. This study is a secondary analysis of an intervention trial. RESULTS: 76% of the women reported having experienced some breastfeeding difficulty in the first postpartum weeks. The number of breastfeeding difficulties was associated with maternal mental health symptoms at 6 weeks postpartum and parental self-efficacy at both assessment times. Women who did not experience breastfeeding difficulties presented significantly fewer depressive (t(102) = 2.5, p = .015) and anxiety symptoms (t(50) = 2.3, p = .028) at 6 weeks postpartum than those who did. Mothers who exclusively breastfed at 5 months postpartum presented significantly higher parental self-efficacy (t(94) = 2.4, p = .044). A higher number of breastfeeding difficulties and low perceived social support contributed to higher depressive symptoms (R2 = .30; F(3,103) = 14.6, p < .001), anxiety symptoms (R2 = .32, F(3.103) = 17.27, p < .001) and lower parental self-efficacy at 6 weeks postpartum (R2 = .39; F(2,103) = 9.4, p < .001). CONCLUSION: Breastfeeding difficulties and social support are associated with fewer mental health symptoms and higher parental self-efficacy during early postpartum in first-time mothers.

Prevalence of postpartum depression symptoms in high-income, and low- and middle-income countries in the Covid-19 pandemic: a systematic review with meta-analysis.

OBJECTIVE: To perform a meta-analysis and comparison between high-income, and low- and middle-income countries postpartum depression symptoms prevalences. METHODS: PubMed, Embase, Virtual Health Library, Scopus, Web of Science, PsycINFO and CINAHL databases were searched until October 2022 for studies that collected data from pandemic. The metaprop command was used in the Stata statistical software v.12.0 to run a random-effects meta-analysis. RESULTS: A total of 15 studies with 4,788 postpartum women were included. The overall prevalence of postpartum depression symptoms was 31% (95% CI: 21.85-40.99). The pooled prevalence of postpartum depression symptoms among women from high-income countries [30.5% (95% CI: 16.95-46.02)] did not differ significantly from that among women from low- and middle-income countries [31.5% (95% CI: 19.26-45.15)]. However, studies that analyzed women up to one month after childbirth had a lower prevalence of postpartum depression symptoms [17.5% (95% CI: 9.85-26.62)] compared to those that observed them up to one year after childbirth [38.3% (95% CI: 33.96-42.83)]. CONCLUSIONS: The prevalence of postpartum depression symptoms was high regardless of the country's human development index and it must be regularly tracked around the world to assess, discuss, and recommend more assertive steps that may be implemented based on the particular characteristics of each country.

Postpartum depression in adolescent mothers before and during COVID-19 and the role of self-esteem, maternal self-efficacy, and social support / Depresión posparto en madres adolescentes antes y durante la pandemia por COVID-19 el papel de la autoestima, la autoeficacia materna y el apoyo social

Abstract Introduction Although the COVID-19 pandemic negatively impacted the mental health of vulnerable populations, such as adolescent mothers, very few studies have documented the prevalence of postpartum depression (PPD) in this population. Objective a) Determine the frequency of PPD (Edinburgh Postnatal Depression Scale [EPDS] ≥ 9) in adolescent mothers before (AM-BP) and during (AM-DP) the pandemic, b) Examine psychosocial factors (self-esteem, maternal efficacy, social support, depression and anxiety in pregnancy, planned and wanted pregnancy) in AM-BP and AM-DP, and c) Determine whether being an AM-DP was a significant factor for experiencing PPD (EPDS ≥ 9). Method Cross sectional study. Subjects: Forty-one AM-BP recruited at Health Centers and interviewed face to face and forty-one AM-DP surveyed online. Results PPD (EPDS ≥ 9) was 42% (p = .001) more frequent in AM-DP. The groups differed significantly in all psychosocial factors, with AM-DP faring worse. Unadjusted regressions showed that being an AM-DP, having lower maternal efficacy and self-esteem, greater dissatisfaction with social support, and depression and/or anxiety in pregnancy increased PPD (EPDS ≥ 9). Adjusted multiple analysis indicated that lower self-esteem was the only factor to maintain its association with PPD (EPDS ≥ 9; p = .017). Discussion and conclusion The pandemic negatively affected PPD (EPDS ≥ 9) and psychosocial factors in AM-DP, as compared to AM-BP, with self-esteem being the main factor associated with PPD (EPDS ≥ 9). In situations of extreme stress as happened in the pandemic, the mental health of adolescent mothers should be prioritized to prevent negative effects such as PPD. PPD preventive and treatment interventions should consider strengthening self-esteem.

Resumen Introducción La pandemia por COVID-19 tuvo un impacto negativo en la salud mental de poblaciones vulnerables, como las madres adolescentes, no obstante, escasos estudios documentaron la prevalencia de depresión posparto (DPP) en esta población. Objetivo a) Conocer la frecuencia de DPP (Escala Edinburgh para la Depresión Postnatal [EPDS] ≥ 9) en madres adolescentes antes de la pandemia (MA-AP) y durante la pandemia (MA-DP), b) Examinar algunos factores psicosociales (autoestima, eficacia materna, apoyo social, depresión y ansiedad en el embarazo, embarazo planeado y deseado) en MA-AP y MA-DP, y, c) Analizar si ser MA-DP, fue un factor significativo para experimentar DPP (EPDS ≥ 9). Método Estudio transversal. Participantes: 41 MA-AP captadas en Centros de Salud y 41 MA-DP encuestadas en línea. Resultados La DPP (EPDS ≥ 9) fue 42% (p = .001) más frecuente en las MA-DP. Los grupos difirieron significativamente en todos los factores psicosociales, en detrimento de las MA-DP. Las regresiones no ajustadas mostraron que ser MA-DP, tener menor eficacia materna y autoestima, mayor insatisfacción con el apoyo social, y depresión y/o ansiedad en el embarazo incrementaron la DPP (EPDS ≥ 9). El análisis múltiple ajustado indicó que una menor autoestima fue el único factor que mantuvo su asociación con DPP (EPDS ≥ 9; p = .017). Discusión y conclusión La pandemia tuvo un efecto negativo en la DPP (EPDS ≥ 9) y en factores psicosociales en MA-DP; la autoestima fue el principal factor asociado a la misma. Ante situaciones de estrés extremo, la salud mental de madres adolescentes debería ser prioritaria para prevenir efectos negativos como la DPP. Intervenciones preventivas y de tratamiento de DPP deben fortalecer la autoestima.

Bibliometric analysis of peer-reviewed literature on perinatal depression in Mexico / Análisis bibliométrico de la literatura revisada por pares sobre depresión perinatal en México

Abstract Background Perinatal depression (PND) is a clinical disease developed in any stage during the pregnancy and postpartum period with serious health and economic implications. Objective The aim of this work was to analyze via bibliometrics indicators Mexico's production on PND to provide a view of the academic landscape and a comprehensive reference for subsequent research in the country. Method The Scopus and Web of Science (WoS) databases were used to perform a search for peer reviewed papers related to PND in México. The search was made following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The extracted data were processed with VOS Viewer to examine link strength and clusters associations of diverse bibliometrics variables. Results A total of 132 records were retrieved and we included 70 studies in the bibliometric analysis after application of the exclusion criteria. The authors with more papers were Navarrete L., and Asunción Lara M. The institutions with more papers were the National Institute of Perinatology, Ramón de la Fuente National Institute of Psychiatry, and National Institute of Public Health of Mexico. A diminution of the research considered in PND is observed in the last two years. Four keyword clusters were identified related to PND: symptoms, prevalence, pregnancy. Discussion and conclusion The scarce literature concerning PND in Mexico compared with other countries could be due the limited collaboration between the health institutes. An urgent need to increase research on PND in Mexico is evident to be applicable in the management of resources in the healthcare system.

Resumen Antecedentes La depresión perinatal (PND) es una enfermedad clínica que se desarrolla en cualquier etapa del embarazo y posparto con graves implicaciones sanitarias y económicas. Objetivo El objetivo de este trabajo fue analizar a través de indicadores bibliométricos la producción de México sobre PND, para brindar una visión del panorama académico y un referente integral para investigaciones posteriores en el país. Método Se utilizaron las bases de datos Scopus y Web of Science (WoS) para realizar una búsqueda de artículos revisados por pares relacionados con la PND en México. La búsqueda se realizó siguiendo los elementos de informes preferidos para revisiones sistemáticas y metaanálisis (PRISMA). Los datos extraídos se procesaron con VOS Viewer para examinar la fuerza de los enlaces y las asociaciones de grupos de diversas variables bibliométricas. Resultados Se recuperaron un total de 132 registros y se incluyeron 70 estudios en el análisis bibliométrico después de la aplicación de los criterios de exclusión. Los autores con más artículos fueron Navarrete L. y Asunción Lara M. Las instituciones con más artículos fueron el Instituto Nacional de Perinatología, el Instituto Nacional de Psiquiatría Ramón de la Fuente y el Instituto Nacional de Salud Pública de México. Se observa una disminución de las investigaciones consideradas en el PND en los últimos dos años. Se identificaron cuatro grupos de palabras clave relacionadas con la PND: síntomas, prevalencia y embarazo. Discusión y conclusión La escasa literatura sobre PND en México en comparación con otros países podría deberse a la limitada colaboración entre los institutos de salud. Se evidencia una necesidad urgente de realizar más investigaciones sobre PND en México que sean aplicables y útiles en la gestión de recursos en el sistema de salud.

O impacto da depressão pós-parto no desenvolvimento cognitivo infantil / The impact of postpartum depression on child cognitive development

Objetivo: avaliar as consequências da depressão pós-parto no desenvolvimento cognitivo infantil. Métodos: trata-se de uma revisão narrativa, com caráter analítico quantitativo, realizada por meio da busca de artigos científicos publicados, nas plataformas Google Acadêmico, Scielo e PubMed, sobre a relação entre depressão pós-parto e desenvolvimento infantil. Resultados: foi selecionado um total de 23 artigos entre os três bancos de dados. Os resultados apontam que filhos de mães deprimidas são mais propensos a ter alterações no desenvolvimento cognitivo, social e linguístico do que filhos de mães não deprimidas. Entretanto, deve-se lembrar que essa alteração não acontece exclusivamente pela depressão pós-parto, uma vez que ela pode estar associada a outros fatores de risco, como condições socioeconômicas e apoio marital. Conclusão: a depressão pós-parto como fator isolado afeta o bebê de maneira sutil, mas, diante de diversos fatores ambientais e conduta parental, o efeito nocivo pode ser intensificado, o que pode prejudicar os desempenhos nos testes cognitivos, de atenção e aprendizagem. Desse modo, compreende-se que é importante incentivar um acompanhamento pré-natal que valorize a saúde mental das gestantes, para que qualquer manifestação psicológica negativa seja prontamente identificada e receba o apoio necessário o mais rápido possível.

Objective: to evaluate the consequences of postpartum depression on child cognitive development. Methods: this is a narrative review, with a quantitative analytical character, carried out by searching for scientific articles published on the Google Scholar, Scielo and PubMed platforms on the relationship between postpartum depression and child development. Results: a total of 23 articles were selected from the three databases. The results indicate that children of depressed mothers are more likely to have changes in cognitive, social and linguistic development than children of non-depressed mothers. However, it should be remembered that this change does not occur exclusively due to postpartum depression, as it may be associated with other risk factors, such as socioeconomic conditions and marital support. Conclusion: postpartum depression as an isolated factor affects the baby in a subtle way, but, given several environmental factors and parental behavior, the harmful effect can be intensified, which can harm performance in cognitive, attention and learning tests. Therefore, it is understood that it is important to encourage prenatal care that values the mental health of pregnant women, so that any negative psychological manifestations are promptly identified and receive the necessary support as quickyl as possible.

Postpartum depression: Impact on pregnant women and the postnatal physical, emotional, and cognitive development of their children. An ecological perspective. / Depresión puerperal: impacto en la madre gestante y en el desarrollo físico, emocional y cognitivo posnatal de sus hijas/os. Una mirada ecológica.

Maternal mental health problems during pregnancy, childbirth, and the postpartum period are a challenge for public health. Not recognizing them hinders a timely diagnosis and treatment and has an impact on the mother and the establishment of the fundamental bond of the mother-child dyad. We must recognize the risk factors (age, socioeconomic status, mental health history, family dysfunction, unfavorable environment), clinical manifestations, and screening tools. There is evidence that the effect of stress, anxiety, and depression during pregnancy negatively affect fetal neurodevelopment and condition child developmental outcomes. Here we describe the negative impact of postpartum depression during the first months of life, which affects mother-child bonding, postnatal development (emotional, behavioral, cognitive, language), and the maintenance of breastfeeding. We also recognize protective factors that mitigate its effects. It is essential to establish preventive strategies and interdisciplinary diagnostic and therapeutic approaches to minimize the risks to the mother and her children.

Los problemas de salud mental materna durante el embarazo, parto y puerperio son un desafío para la salud pública. Su falta de reconocimiento atenta contra el diagnóstico y tratamientos oportunos, e impacta en la madre y el establecimiento del vínculo fundamental del binomio. Debemos reconocer los factores de riesgo (edad, situación socioeconómica, antecedentes psicopatológicos, disfunción familiar, entorno desfavorable), las manifestaciones clínicas y las herramientas de detección. Existen evidencias de que el efecto del estrés, la ansiedad y la depresión durante el embarazo afectan negativamente el neurodesarrollo fetal y condicionan los resultados del desarrollo infantil. Describimos el impacto negativo de la depresión puerperal durante los primeros meses de vida, que afecta el vínculo madre-hija/o, el desarrollo posnatal (emocional, conductual, cognitivo, lenguaje) y el mantenimiento de la lactancia materna. También reconocemos factores protectores que atemperan sus efectos. Es fundamental establecer estrategias preventivas y abordajes diagnósticos y terapéuticos interdisciplinarios para minimizar los riesgos sobre la madre y sus hijas/os.

The relationship between women's personality traits and fear of childbirth, birth satisfaction, and postpartum depression

SUMMARY OBJECTIVE: This study was conducted to determine the relationship between women's personality traits and their fear of childbirth, birth satisfaction, and postpartum depression. METHODS: This cross-sectional study was conducted between April and August 2022 among healthy third-trimester pregnant women aged 18-49 years who applied to the obstetrics and gynecology outpatient clinic of a state hospital. Data were collected by the researchers by face-to-face interview method in three stages. Participants were administered the Personal Information Form, the Five-Factor Personality Scale, and the Birth Anticipation/Experience Scale at the first interview; the Birth Satisfaction Scale on the 10th day after normal birth; and the Edinburg Postpartum Depression Scale 4 weeks after birth. RESULTS: There was a significant positive correlation between neurotic personality traits and fear of childbirth and postpartum depression, while there was a negative correlation with other personality traits (p<0.001). There was no significant relationship between birth satisfaction and personality traits (p>0.05). The effect of personality traits on fear of childbirth and postpartum depression was analyzed by multiple linear regression analysis. The regression model tested for the effect of personality traits on fear of childbirth and postpartum depression was found significant (p<0.001). According to the model, 26% of the variability in fear of childbirth and 9.1% of the variability in postpartum depression were explained by personality traits. CONCLUSION: This study showed that neuroticism, which is one of the personality traits of women, had a positive effect on fear of childbirth and postpartum depression. No significant relationship was found between birth satisfaction and personality traits.

Association between childhood trauma and postpartum depression among Brazilian puerperal women / Asociación entre traumas en la infancia y depresión posparto en puérperas brasileñas / Associação entre trauma na infância e depressão pós-parto em puérperas brasileiras

Objective: to evaluate the association between different forms of childhood trauma and postpartum depression in Brazilian puerperal women. Method: this cross-sectional survey included 253 puerperal women who were evaluated using the Edinburgh Postnatal Depression Scale and the Childhood Trauma Questionnaire. Multivariate logistic regression analyses were performed to verify the association of different types of trauma and the co-occurrence of forms of abuse and neglect with postpartum depression. Results: postpartum depression was identified in 93 women (36.8%; 95% Confidence Interval: 30.8-42.7). All forms of childhood trauma assessed (emotional abuse, emotional neglect, physical abuse, physical neglect and sexual abuse) were independently associated with postpartum depression after adjusting for confounding variables. Emotional abuse remained associated with postpartum depression when the co-occurrence of all forms of childhood trauma was analyzed. Conclusion: the results suggest an association between the different forms of childhood trauma and postpartum depression. In this sense, childhood trauma is an indicator for Nursing professionals to screen for risk factors of postpartum depression during obstetric_follow-up.

Objetivo: evaluar la asociación entre diferentes formas de traumas en la infancia y depresión posparto en puérperas brasileñas. Método: en este estudio transversal se incluyó a 253 puérperas que fueron evaluadas con la Edinburgh Postnatal Depression Scale y el Childhood Trauma Questionnaire . Se realizaron análisis de regresión logística multivariados para verificar la asociación de diferentes tipos de trauma y la coocurrencia de formas de abuso y negligencia con la depresión posparto. Resultados: se identificó depresión posparto en 93 mujeres (36,8%; intervalo de confianza del 95%: 30,8-42,7). Todas las formas de traumas en la infancia que se evaluaron (abuso emocional, negligencia emocional, abuso físico, negligencia física y abuso sexual) estuvieron asociadas de manera independiente con la depresión posparto después de ajustar por variables de confusión. El abuso emocional siguió estando asociado con la depresión posparto cuando se analizó la coocurrencia de todas las formas de traumas en la infancia. Conclusión: los resultados sugieren una asociación entre las diferentes formas de traumas en la infancia y la depresión posparto. En este sentido, los traumas en la infancia son un indicador para que los profesionales de Enfermería detecten factores de riesgo para la depresión posparto en los controles obstétricos.

Objetivo: avaliar a associação entre diferentes formas de trauma na infância e depressão pós-parto em puérperas brasileiras. Método: estudo transversal incluiu 253 puérperas que foram avaliadas pela Edinburgh Postnatal Depression Scale e pelo Childhood Trauma Questionnaire . Análises multivariadas de regressão logística foram realizadas para verificar a associação entre diferentes tipos de trauma e a coocorrência de formas de abuso e negligência com depressão pós-parto. Resultados: a depressão pós-parto foi identificada em 93 mulheres (36,8%; Intervalo de Confiança de 95%: 30,8-42,7). Todas as formas de trauma na infância avaliadas (abuso emocional, negligência emocional, abuso físico, negligência física e abuso sexual) foram independentemente associadas à depressão pós-parto após ajuste para variáveis de confusão. O abuso emocional permaneceu associado à depressão pós-parto quando foi analisada a coocorrência de todas as formas de trauma na infância. Conclusão: os resultados sugerem associação entre as diferentes formas de trauma na infância e depressão pós-parto. Nesse sentido, o trauma na infância é um indicador para os profissionais de Enfermagem rastrearem fatores de risco de depressão pós-parto durante o acompanhamento obstétrico.

A Critical Look at Omega-3 Supplementation: A Thematic Review.

Postpartum depression (PPD) affects 10-20% of women. Traditional treatments have raised concerns, but omega-3 fatty acids show potential as an alternative. This thematic review, sourced from databases like PubMed and Scopus between 1 February 2023 and 15 March 2023, seeks to delve into the various perspectives on omega-3 supplementation for PPD. The criteria included studies detailing depressive symptoms, social functioning, and neurobiological variables. The review includes research with women showing PPD symptoms, randomized clinical trials, and articles in Spanish, English, and French. Exclusions were studies lacking proper control comparisons and other interventions besides omega-3. Data extraction was performed independently. Two key studies provide contrasting findings on omega-3's impact on PPD symptoms. In the study comparing DHA supplementation to a placebo, significant differences were not found in the EPDS scale, but differences were observed in the BDI scale. In contrast, another study recorded a significant decrease in depression scores in all dose groups, with reductions of 51.5% in the EPDS scale and 48.8% in the HRSD scale. Other studies, encompassing both prenatal and postpartum periods, underscore the differentiation between prenatal depression and PPD. Despite shared diagnostic criteria, PPD presents unique symptoms like restlessness, emotional lability, and baby-related concerns. It is crucial to address biases and obtain specific results, recommending exclusive PPD-focused studies. This review emphasizes the need for continuous exploration of omega-3's relationship with PPD to enhance the life quality of pregnant women and their families.

Mecanismos neuroendocrinos a la base de la asociación entre salud mental materna y lactancia / Neuroendocrine mechanisms underlying the association between maternal mental health and breastfeeding

La lactancia materna es fundamental para la salud del infante y se ve influida por diversos factores, entre ellos la salud mental materna. En particular, las madres que tienen síntomas depresivos tienen mayor riesgo de presentar dificultades de lactancia y de interrumpir tempranamente la lactancia exclusiva y la lactancia en general. Por otra parte, la lactancia materna actúa como un factor protector de la salud mental materna en algunas circunstancias, en tanto las dificultades de lactancia tienen un impacto negativo en la salud mental de la mujer. La presente revisión describe algunos de los mecanismos fisiológicos que subyacen al establecimiento y la mantención de la lactancia, asociados a la prolactina, la oxitocina, la dopamina y la serotonina, así como a la experiencia de la lactancia y la presencia de dificultades en esta área, y como estas interactúan con las dificultades emocionales de la madre. Se ofrece un modelo integrativo que considera aspectos hormonales y fisiológicos para comprender la asociación compleja y bidireccional entre el establecimiento de una lactancia exitosa y la salud mental materna.

Breastfeeding is essential for infant health and development. It is influenced by multiple factors, including maternal mental health. In particular, mothers who present depressive symptoms are at greater risk of presenting breastfeeding difficulties and presenting shorter exclusive breastfeeding and breastfeeding in general. On the other hand, breastfeeding acts as a protective factor for maternal mental health in some circumstances. Also, breastfeeding difficulties have a negative impact on womens mental health. This review describes some of the physiological mechanisms underlying the establishment and maintenance of lactation, associated with prolactin, oxytocin, dopamine, and serotonin. As well as how the lactation experience and the presence of difficulties in this area interact with the mothers emotional functioning. An integrative model is proposed, which considers hormonal and physiological aspects involved in the complex and bidirectional association between breastfeeding successful establishment and maternal mental health.

Association between maternity leave policies and postpartum depression: a systematic review.

PURPOSE: Working mothers are at greater risk for postpartum depression. Maternity leave characteristics, including length, wage replacement and employment protection, could have relevant implications for mothers' mental health. We propose to explore whether there is an association between maternity leave characteristics and postpartum depression. METHODS: We conducted a systematic review searching for randomized controlled trials, quasi-experimental, cohort or cross-sectional studies on five databases using search terms including maternity and parental leave and depression, as well as references in relevant articles. We identified 500 articles and included 23 of those. We used the EPHPP Quality Assessment Tool for Quantitative Studies to assess the quality of the studies. RESULTS: Paid and longer maternity leaves tend to be associated with a reduction of postpartum depression symptoms in high-income countries. No studies explored the association between employment protection and postpartum depression. The quality of studies ranged from strong to weak, mostly influenced by study design. CONCLUSION: More restrictive maternity leave policies tend to be associated with higher rates of postpartum depression, although more research needs to be conducted in the Global South.

Breastfeeding Practices and Postpartum Depression in Mexican Women during the COVID-19 Pandemic: A Cross-Sectional Study.

Background: Breastfeeding is a characteristic process of mammals that ensures delivery of an adequate nutritional supply to infants. It is the gold standard food source during an infant's first months of life. Since the onset of the COVID-19 pandemic in 2020, people in quarantine have experienced a wide range of feelings, which may make isolation challenging in terms of maternal health. This study focused on the prevalence of breastfeeding practices and postpartum depression (PPD) among Mexican women during the COVID-19 pandemic. Materials and Methods: This cross-sectional study included 586 postpartum women who completed an online survey 4-8 weeks after delivery from April to December 2020 in Guadalajara, Mexico. The aim was to identify potentially depressed mothers according to the Edinburgh Postnatal Depression Scale (EPDS) and describe their breastfeeding practices. Results: The mean maternal age was 30.4 ± 4.6 years, the mean EPDS score was 9.6 ± 5.0, and the PPD prevalence according EPDS scores was 27.1%. Exclusive breastfeeding (EBF) was reported by 32.3% of mothers in the first 48 h and by 70.3% of mothers 48 h after delivery. EBF was associated with a lower prevalence of PPD during the first 48 h (p = 0.015) and after the first 48 h (p = 0.001) after delivery. Skin-to-skin contact (SSC) was reported by 385 (65.7%) mothers. PPD was less frequent in mothers practicing SSC (20.3%) than it was in those not practicing SSC (40.3%) (p = 0.001). A higher percentage of mothers practiced SSC breastfed (66.9%) and used EBF (150, 79.4%) (p = 0.012 and 0.001, respectively). Conclusions: Results suggest that the pandemic emergency and restrictions imposed on the population significantly affected the well-being of mothers after birth, and that these effects may have posed risks to the mental health and emotional stability of postpartum mothers. Therefore, encouraging BF or EBF and SSC may improve or limit depressive symptoms in postpartum mothers.

Factors associated with postpartum depression symptoms among postpartum women in five countries during the COVID-19 pandemic: an online cross-sectional study.

BACKGROUND: This study aimed to examine factors associated with postpartum depression (PPD) symptoms during the COVID-19 pandemic among postpartum women in five countries, a subject that has not been investigated thus far. METHODS: A multi-country, cross-sectional, online survey was conducted with a convenience sample of 3,523 postpartum women in Brazil, South Korea, Taiwan, Thailand, and the United Kingdom, from July to November 2021. Sociodemographic and obstetric data, food insecurity, COVID-19 positive status, COVID-19 vaccination, infant feeding, breastfeeding belief score, and social support were investigated. PPD and social support were measured using the Edinburgh Postnatal Depression Scale and Maternal Social Support Scale, respectively. Descriptive statistics, chi-squared tests, and t-tests were used to identify associations with PPD symptoms. A binary logistic regression model was used to identify explanatory factors associated with PPD and adjusted odds ratios (OR) and 95% confidence intervals (CIs) were calculated. RESULTS: Women in Taiwan (AOR = 0.5; 95%CI 0.34, 0.73) and Thailand (AOR = 0.68; 95%CI 0.46, 0.99) had a lower risk of PPD symptoms than those in Brazil. In addition, women with planned pregnancies had a lower risk of PPD (AOR = 0.74; 95%CI 0.60, 0.91). Younger women (AOR = 1.62; 95%CI 1.05, 2.51), health problems during pregnancy, delivery, or postpartum (AOR = 1.71; 95%CI 1.42, 2.06), and no change or worse food insecurity during COVID-19 (AOR = 1.66; 95%CI 1.21, 1.27 for no change and AOR = 1.68; 95%CI 1.27, 1.23, respectively) presented a higher likelihood of having PPD. Feeding babies with expressed human milk (AOR = 1.25; 95%CI 1.03, 1.50) and/or complementary food (AOR = 1.51; 95%CI 1.17, 1.94) were associated with PPD symptoms. Women who received low (AOR = 7.74; 95%CI 5.43, 11.03) or medium support (AOR = 3.25; 95%CI 2.71, 3.88) had higher likelihoods of PPD. CONCLUSION: PPD symptoms during the pandemic were high in young women, particularly Brazilian women, with health problems in the puerperal pregnancy cycle who fed their babies expressed breast milk and/or complementary food. Low social support also impacted PPD symptoms. This study highlights the need for the professional screening for PPD and provision of virtual or personal support.

Saúde mental de puérperas durante a pandemia de Covid-19 no Brasil / Postpartum women mental health during the Covid-19 pandemic in Brazil / Salud mental de mujeres posparto durante la pandemia de Covid-19 en Brasil

Estudos internacionais têm reportado níveis elevados de sintomas de depressão e ansiedade em mulheres no período perinatal em resultado da atual pandemia. O presente estudo avaliou a sintomatologia de depressão e ansiedade em puérperas durante a pandemia de COVID-19 no Brasil. Participaram 625 mulheres, com idades entre 18 e 44 anos (M = 31.6; DP = 5.3), que tinham um bebê até 6 meses de idade. Foram administrados o Questionário de Transtorno de Ansiedade Generalizada (GAD-7) e a Escala de Depressão Pós-Natal de Edimburgo (EPDS). Os resultados mostraram níveis clinicamente significativos de depressão (EPDS ≥13) em 47.4% das participantes, níveis clinicamente significativos de ansiedade generalizada (GAD-7 ≥10) em 41.8% dos casos, e sintomas comórbidos em 33.1% da amostra. Registrou-se uma correlação positiva significativa entre os sintomas de depressão e ansiedade. Além disso, mais dias de vida do bebê, idade mais jovem da mãe e menor nível de escolaridade estavam associados a níveis potencialmente clínicos de sintomas. Assim, é prioritária a definição de programas de prevenção e intervenção na saúde mental perinatal durante o atual período pandêmico, com continuidade para o futuro.

International studies have reported high levels of depression and anxiety symptoms in perinatal women due to the ongoing pandemic. The present study examined symptoms of depression and anxiety in postpartum women during the COVID-19 pandemic in Brazil. Participants were 625 women, aged between 18 and 44 years (M = 31.6; SD = 5.3), who had an infant up to 6 months of age. The Generalized Anxiety Disorder Questionnaire (GAD-7) and the Edinburgh Postnatal Depression Scale (EPDS) were administered. Results showed clinically significant levels of depression (EPDS ≥13) in 47.4% of the participants, clinically significant levels of generalized anxiety (GAD-7 ≥10) in 41.8% of the cases, and comorbid symptoms in 33.1% of the participants. There was a significant positive correlation between symptoms of depression and anxiety. Furthermore, infant's older age, mother's younger age, and lower educational level were associated with potentially clinical levels of symptoms. Thus, prevention and intervention programs targeting perinatal mental health during the ongoing pandemic and beyond should be developed and prioritized.

Estudios internacionales han reportado altos niveles de síntomas de depresión y de ansiedad en mujeres em el período perinatal como consecuencia de la actual pandemia. El presente estudio examinó los síntomas de depresión y ansiedad en mujeres posparto durante la pandemia de COVID-19 en Brasil. Las participantes fueron 625 mujeres, con edades entre 18 y 44 años (M = 31.6; SD = 5.3), que tenían un hijo de hasta 6 meses de edad. Se administró el Cuestionario de Trastorno de Ansiedad Generalizada (GAD-7) y la Escala de Depresión Postnatal de Edimburgo (EPDS). Los resultados mostraron niveles clínicamente significativos de depresión (EPDS ≥13) en el 47.4 % de las participantes, niveles clínicamente significativos de ansiedad generalizada (GAD-7 ≥10) en el 41.8 % de los casos y síntomas comórbidos en el 33.1 % de las participantes. Hubo una correlación positiva significativa entre los síntomas de depresión y ansiedad. Además, más días de vida del bebé, menor edad de la madre y menor nivel educativo se asociaron con niveles potencialmente clínicos de síntomas. Por lo tanto, se debe priorizar la definición de programas de prevención e intervención dirigidos a la salud mental perinatal durante la pandemia en curso, con continuidad para el futuro.

Examining the association between subjective childbirth experience and maternal mental health at six months postpartum.

PROBLEM: Childbirth experience can have long-lasting effects on maternal wellbeing. BACKGROUND: Positive childbirth experiences may strengthen maternal self-confidence, in contrast, negativeexperiences may promote a sense of failure or distrust. AIM: To examine the contribution of maternal hospital childbirth experience on mental health at 6 months postpartum in a community-based, Chilean sample. An additional aim is to examine which childbirth-related aspects contribute to the global birth experience. METHODS: One hundred and forty-eight women completed self-report measures of mental health during the third trimester of pregnancy and 3 and 6 months postpartum. At 3months after childbirth, subjective childbirth experience was assessed. Logistic regression analysis examined the contribution of childbirth experience to maternal mental health. FINDINGS: Negative subjective experience of childbirth contributes to maternal depression and anxiety up to 6 months after childbirth, controlling for mental health during pregnancy and at 3 months postpartum. Quality of care from health professionals made the largest, statistically significant contribution to the global perception of childbirth. DISCUSSION AND CONCLUSIONS: Subjective experience of childbirth is a modifiable risk factor for the development of postpartum maternal depression and anxiety. Health providers in direct contact with childbearing women may promote maternal emotional wellbeing through sensitive and respectful care.

Lactational exposure to venlafaxine provokes late repercussions on reproductive parameters in male rat offspring.

Exposure to selective serotonin reuptake inhibitors can affect hormone-dependent processes, such as the brain sexual differentiation. Because the use of these antidepressants cause concern during lactation, we evaluated the possible effects of venlafaxine on lactational exposure and its late repercussions on reproductive parameters in male rats. Lactating rats were exposed to venlafaxine (3.85, 7.7, or 15.4 mg/kg/body weight; gavage), from lactational day 1 to 20. Venlafaxine and O-desmethylvenlafaxine residues were found in all milk samples of dams treated, demonstrating the lactational transfer of this antidepressant to the offspring. Although the maternal behavior was normal, the dams presented an increase in urea and uric acid levels in the groups treated with 7.7 and 15.4, respectively, as well as a spleen weight increased in the 3.85 and 15.4 groups. The male offspring showed a decrease in play behavior parameters in the intermediate dose group. Sperm analysis indicated a reduction in sperm motility in all treated groups. The androgen receptor expression in the hypothalamus was decreased in the highest dose group, although the sexual behavior had not been affected. In conclusion, venlafaxine was transferred through breast milk and promoted changes in play behavior, sperm quality, and hypothalamic androgen receptor (AR) content, which may indicate an incomplete masculinization of the brain of male offspring.