The Postnatal Depression Intervention Program "PNDIP": A 10-year review.

The Postnatal Depression Intervention Program is a screening program looking at postnatal depression in newly delivered mothers at KK Hospital in Singapore. The primary objective of the paper is to evaluate the outcomes based on changes in scores from baseline to end of intervention with reference to depressive symptoms, using the Edinburgh Postnatal Depression Scale and overall functioning based on the Global Assessment of Functioning. These changes were found to be statistically significant. We also described the demographics of the 10-year cohort with majority being married, Chinese, aged between 25 and 34 years old and received at least tertiary education.

Primary health level screening for postpartum depression during well-child visits: Prevalence, associated risk factors, and breastfeeding.

Postpartum depression (PPD) is a public health problem that is associated with detrimental effects on the wellbeing of the mother, child and family. Early detection for PPD at the primary health level provides an opportunity for intervention. We aim to examine: (1) the prevalence rate of PPD in the primary care population, (2) acceptance and attendance rates of intervention for women who screened positive for PPD, (3) sociodemographic and maternal risk factors of PPD, and (4) the impact of PPD on breastfeeding. We implemented a mother-child dyadic screening program using the modified Patient Health Questionnaire-2 during routine well-child visits at 2 or 3 months postpartum between July 2019 and December 2021. We performed multivariable logistic regression to identify independent risk factors for PPD and described using adjusted odds ratio (OR) with corresponding 95 % confidence intervals. Among 5561 mothers, the prevalence rate of probable PPD was 2.4 %. About half (54.4 %) of mothers who screened positive accepted intervention and of these, about two-thirds accepted onward referrals to tertiary care and community mental health service, with higher attendance at the latter. In the final adjusted model, mothers who had probable PPD were more likely to be older than age 35 years (OR 1.88, 95 % CI 1.05-3.45; p < 0.05) and not breastfeeding (OR 1.9, 95 % CI 1.06-3.38; p < 0.05). Overall, our findings highlight the importance of early PPD screening and management in primary care. These findings can help inform maternal mental health service development and utilization, thereby optimizing maternal and infant outcomes.

A cross-sectional survey of what patients find most therapeutic in perinatal mental healthcare in Singapore.

Supportive counselling is an important part of the treatment process for perinatal mood disorders in KK Women's and Children's Hospital (KKH). This study aims to investigate the extent to which patients deem each component of supportive counselling important to their treatment and recovery process. Sixty-six patients seen during their pregnancy or postnatal period for anxiety or depressive disorders were surveyed at the point of their discharge. Patients were asked to rate on a four-point scale the importance they attributed to each of thirteen components of supportive counselling practised by the perinatal mental health team at KKH. Patients were also asked to identify the three most important components in their treatment experience. The final two survey questions assessed the effects of the treatment process on patients' perceived partner support and patients' optimism towards motherhood. Results corroborate the importance of building a trusting relationship between treatment providers and patients, providing empathic support while patients learn to accept the changes in their lives and engaging patients' partners in the treatment process. It is recommended that perinatal mental healthcare providers continue to build on the therapeutic effects of empathic understanding and engaging patients' partners in the treatment process.

Patterns and predictors of treatment outcome for antenatal major depression.

INTRODUCTION: Antenatal major depression is a relatively common and potentially debilitating illness, but knowledge of its treatment outcomes and strategies is still lacking. This study aimed to explore the clinical profiles and treatment outcomes of patients with antenatal major depression, to look for patterns and associations that could guide subsequent research and clinical applications. METHODS: From May 2006 to November 2010, 118 consecutive patients with antenatal major depression were naturalistically assessed over eight months of individualised therapy, and their characteristics were assessed as potential predictors of treatment outcome. RESULTS: All participants accepted supportive counselling and case management, although only 51 (43.2%) participants accepted low-dose antidepressant therapy. Overall, 95 (80.5%) of them were successfully discharged, while 12 (10.2%) required extended treatment into the postnatal period. An equation for prognosticating the need for extended treatment was obtained using multiple logistic regression analysis, which incorporated three predictors: previous depression (odds ratio [OR] 12.4, 95% confidence interval [CI] 1.40-110; p = 0.024); maternal age < 26 years or > 35 years (OR 6.88, 95% CI 1.67-28.4; p = 0.008); and no use of antidepressant (OR 6.94, 95% CI 0.79-60.9; p = 0.080). Among participants with previous depression and at either extreme of maternal age, the number needed to treat with antidepressants to avert extended treatment was three. CONCLUSION: The majority of women with antenatal major depression recovered after receiving short-term treatment. Those with previous depression and who were of relative extreme maternal age were most likely to benefit from antidepressant treatment to expedite recovery.

Association of premenstrual/menstrual symptoms with perinatal depression and a polymorphic repeat in the polyglutamine tract of the retinoic acid induced 1 gene.

BACKGROUND: Depression during pregnancy or after childbirth is the most frequent perinatal illness affecting women. We investigated the length distribution of a trinucleotide repeat in RAI1, which has not been studied in perinatal depression or in the Chinese population. METHODS: Cases (n=139) with confirmed diagnosis of clinical (major) depression related to pregnancy/postpartum were recruited from the outpatient clinic. Controls were patients who came to the obstetrics clinics and scored <7 on the Edinburgh Postnatal Depression Scale (EPDS) (n=540). Saliva samples for DNA analysis, demographic information and self-reported frequency of occurrence of various premenstrual/menstrual symptoms were collected from all participants. Genomic DNA was extracted from saliva and relevant region sequenced to determine the number of CAG/CAA repeats that encodes the polyglutamine tract in the N terminal of the protein. Difference between groups was assessed by chi-square analysis for categorical variables and analysis of variance for quantitative scores. RESULTS: Compared to control subjects, patients with perinatal depression reported more frequent mood changes, cramps, nausea, vomiting, diarrhoea, and headache during premenstrual/menstrual periods (p=0.000). For the RAI1 gene CAG/CAA repeat, there was a statistically significant difference in the genotypic distribution between cases and controls (p=0.031). There was also a statistically significant association between the 14-repeat allele and perinatal depression (p=0.016). LIMITATIONS: Family history, previous mental illness, and physical and psychological symptoms during the premenstrual/menstrual periods were self-reported. EPDS screening was done only once for controls. CONCLUSIONS: The RAI1 gene polyglutamine repeat has a different distribution in our population. The 14-repeat allele is associated with perinatal depression and more frequent experience of physical and psychological symptoms during menstrual period.

Screening for postnatal depression in Chinese-speaking women using the Hong Kong translated version of the Edinburgh Postnatal Depression Scale.

INTRODUCTION: The Edinburgh Postnatal Depression Scale (EPDS) may not be a uniformly valid postnatal depression (PND) screen across populations. We evaluated the performance of a Chinese translation of 10-item (HK-EPDS) and six-item (HK-EPDS-6) versions in post-partum women in Singapore. METHODS: Chinese-speaking post-partum obstetric clinic patients were recruited for this study. They completed the HK-EPDS, from which we derived the six-item HK-EPDS-6. All women were clinically assessed for PND based on Diagnostic and Statistical Manual, Fourth Edition-Text Revision criteria. Receiver-operator curve (ROC) analyses and likelihood ratio computations informed scale cutoff choices. Clinical fitness was judged by thresholds for internal consistency [α ≥ 0.70] and for diagnostic performance by true-positive rate (>85%), false-positive rate (≤10%), positive likelihood ratio (>1), negative likelihood ratio (<0.2), area under the ROC curve (AUC, ≥90%) and effect size (≥0.80). RESULTS: Based on clinical interview, prevalence of PND was 6.2% in 487 post-partum women. HK-EPDS internal consistency was 0.84. At 13 or more cutoff, the true-positive rate was 86.7%, false-positive rate 3.3%, positive likelihood ratio 26.4, negative likelihood ratio 0.14, AUC 94.4% and effect size 0.81. For the HK-EPDS-6, internal consistency was 0.76. At 8 or more cutoff, we found a true-positive rate of 86.7%, false-positive rate 6.6%, positive likelihood ratio 13.2, negative likelihood ration 0.14, AUC 92.9% and effect size 0.98. DISCUSSION: The HK-EPDS (cutoff ≥13) and HK-EPDS6 (cutoff ≥8) are fit for PND screening for general population post-partum women. The brief six-item version appears to be clinically suitable for quick screening in Chinese speaking women.

Identifying mothers with postpartum depression early: integrating perinatal mental health care into the obstetric setting.

With prevalence rates of postnatal depression (PND) as high as at least 7%, there was a need for early detection and intervention of postpartum mental illness amongst Singaporean mothers. This is a report on the first year results of our country's first PND Intervention Programme. The programme consists of two phases: (1) postpartum women were screened with the Edinburgh Postnatal Depression Scale and provided appropriate care plans; (2) individualized clinical intervention using a case management multidisciplinary team model. Screening for PND was generally acceptable, as 64% eligible women participated voluntarily. Nine percent (126) were identified as probable cases from 1369 women. Forty-one women accepted intervention and achieved 78% reduction in the EPDS symptom scores to below the cutoff of 13, 76% had improvement in GAF functioning scores, and 68% had improved health quality scores. Preliminary results are promising, and this intervention model can be replicated.