Measurement invariance of maternal depressive symptoms across the first 2 years since birth and across racial group, education, income, primiparity, and age.

Up to 19% of postpartum mothers experience depressive symptoms, which are associated with infant development. Thus, research examining postpartum depression has implications for mothers' and infants' well-being. However, this research relies on the often-untested assumption of measurement invariance-that measures capture the same construct across time and sociodemographic characteristics. In the absence of invariance, measurement bias may confound differences across time and group, contributing to invalid inferences. In a sociodemographically diverse (40.7% African American, 58.9% White; 67.9% below two times the federal poverty line; 19.4% with less than high school education), rural, longitudinal sample (N = 1,275) of mothers, we used moderated nonlinear factor analysis (MNLFA) to examine measurement invariance of the Brief Symptom Inventory-18 (BSI-18) Depressive Symptoms subscale across time since birth, racial group, education, income, primiparity, and maternal age at childbirth. We identified evidence of differential item functioning (DIF; i.e., measurement noninvariance) as a function of racial group and education. Subsequent analyses indicated, however, that the DIF-induced bias had minimal impacts on substantive comparisons examining change over time since birth and group differences. Thus, the presence of measurement noninvariance does not appear to bias substantive comparisons using the BSI-18 Depressive Symptoms subscale across the first 2 years since birth in a sample comprising primarily African American and White mothers living in predominately rural, low-income communities. This study demonstrates the importance of assessing measurement invariance and highlights MNLFA for evaluating the impact of noninvariance as a preliminary step that increases confidence in the validity of substantive inferences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Role of Latina Peer Mentors in the Implementation of the Alma Program for Women With Perinatal Depression.

This study examines the role that compañeras (peer mentors) play in the implementation of a program, Alma, which was designed to support Latina mothers who are experiencing depression during pregnancy or early parenting and implemented in the rural mountain West of the United States. Drawing from the fields of dissemination and implementation and Latina mujerista (feminist) scholarship, this ethnographic analysis demonstrates how the Alma compañeras facilitate the delivery of Alma by creating and inhabiting intimate mujerista spaces with other mothers and create relationships of mutual and collective healing in the context of relationships de confianza (of trust and confidence). We argue that these Latina women, in their capacity as compañeras, draw upon their cultural funds of knowledge to bring Alma to life in ways that prioritizes flexibility and responsiveness to the community. Shedding light on contextualized processes by which Latina women facilitate the implementation of Alma illustrates how the task-sharing model is well suited to the delivery of mental health services for Latina immigrant mothers and how lay mental health providers can be agents of healing.

Evaluating Culturally Tailored Strategies for Implementing Cognitive Interviewing on Edinburgh Postnatal Depression Scale Among Chinese Immigrant Women.

INTRODUCTION: While the Edinburgh Postnatal Depression Scale (EPDS) is a standard clinical screening tool for postpartum depression, it is unclear whether it is culturally appropriate for Chinese immigrant women in the United States. Cognitive interviewing (CI) is a method for evaluating a scale's cultural appropriateness. However, CI procedures are problematic with Chinese population. This study assesses three culturally tailored strategies for implementing CI to evaluate the Chinese version of the EPDS (C-EPDS). METHODOLOGY: CI was conducted with 12 participants in the United States. Three culturally tailored strategies-a CI description, a vignette exercise, and debriefing were used. Directed content analysis was used for data analysis. RESULTS: The strategies increased participants' understanding and ability to perform CI procedures, enabling them to discuss postpartum depression. Participants had difficulty responding to several C-EPDS items. DISCUSSION: Findings highlight the importance of using culturally tailored strategies for implementing CI to assess cultural appropriateness of clinical screening tools.

Risk and Resilience Factors of Postpartum Depression in Arab Women Living in the Palestinian Occupied Territories.

The research focuses on postpartum depression (PPD) among modern Arab women living in traditional societies. The purpose of the project is to explore the potential impact of the hitherto unstudied factors of level of modernism/traditionalism and the quality of spousal relationship. This study included 1202 participants of different levels of modernism, who completed research questionnaires. The finding showed that 15.2% of the participants suffered from PPD. Modern women suffered from PPD more than their traditional peers. Problematic spousal relationship did not affect PPD among the modern women. About one-third of the respondents were not familiar with the concept of PPD. Depressed respondents refused to disclose their predicament because of the negative stigma attached to PPD and the fear that the husband would marry a second wife. Traditional orientation serves as a resilience factor, which decreases the risk for PPD. It is highly recommended to design and implement antenatal and postnatal education programs for all married women and raise their awareness of PPD and feasible solutions. It is highly important to promise and secure full confidentiality while providing professional treatment. It is also recommended to offer marital counseling for couples who experience problematic relationship communication.

Maternal post-traumatic stress and depression symptoms and outcomes after NICU discharge in a low-income sample: a cross-sectional study.

BACKGROUND: Having a preterm newborn and the experience of staying in the neonatal intensive care unit (NICU) has the potential to impact a mother's mental health and overall quality of life. However, currently there are few studies that have examined the association of acute post-traumatic stress (PTS) and depression symptoms and infant and maternal outcomes in low-income populations. DESIGN/ METHODS: In a cross-sectional study, we examined adjusted associations between positive screens for PTS and depression using the Perinatal Post-traumatic stress Questionnaire (PPQ) and the Patient Health-Questionnaire 2 (PHQ-2) with outcomes using unconditional logistic and linear regression models. RESULTS: One hundred sixty-nine parents answered the questionnaire with 150 complete responses. The majority of our sample was Hispanic (68%), non-English speaking (67%) and reported an annual income of <$20,000 (58%). 33% of the participants had a positive PPQ screen and 34% a positive PHQ-2 screen. After adjusting for confounders, we identified that a positive PHQ-2 depression score was associated with a negative unit (95% CI) change on the infant's Vineland Adaptive Behavior Scales, second edition of - 9.08 (- 15.6, - 2.6) (p < 0.01). There were no significant associations between maternal stress and depression scores and infant Bayley Scales of Infant Development III scores or re-hospitalizations or emergency room visits. However, positive PPQ and screening score were associated with a negative unit (95% CI) unit change on the maternal Multicultural Quality of Life Index score of - 8.1 (- 12, - 3.9)(p < 0.01) and - 7.7 (- 12, - 3) (p = 0.01) respectively. CONCLUSIONS: More than one-third of the mothers in this sample screened positively for PTS and depression symptoms. Screening scores positive for stress and depression symptoms were associated with a negative change in some infant development scores and maternal quality of life scores. Thoughtful screening programs for maternal stress and depression symptoms should be instituted.

The EPDS and Australian Indigenous women: A systematic review of the literature.

PROBLEM: The Edinburgh Postnatal Depression Scale (EPDS) is considered the gold standard in perinatal mental health screening and the Australian Clinical Practice Guidelines recommend universal use. However, screening rates are four times lower with Indigenous Australian women compared to non-Indigenous women. Difficulties have been reported using the EPDS in this context. BACKGROUND: Evidence demonstrates the link between perinatal mental health and maternal and child outcomes. Indigenous Australian maternal and child health and wellbeing outcomes remain unacceptably poor across all measured parameters and reported psychological distress and child removal rates are increasing. METHODS: A systematic literature review was conducted to assess the effectiveness, validity, reliability, and cultural safety of the EPDS in the Indigenous Australian context and identify the availability and suitability of any adaptations. FINDINGS: The EPDS has not been validated for use with Indigenous Australian women. DISCUSSION: The findings and limitations identified in this review are consistent with concerns in other countries about the cross-cultural use of the EPDS and its sensitivity in predicting risk for postnatal depression amongst Indigenous women. Where adaptations of the EPDS have been used there has been no psychometric and cultural validation beyond the remote communities in which they were developed. CONCLUSIONS: There is no evidence to demonstrate that the EPDS in its current form and application is suitable for screening with Indigenous Australian women. Urgent work is required to evaluate and/or develop culturally meaningful screening tools that are predictive of risk for social and emotional wellbeing and perinatal mental distress in this context.

Racial and Ethnic Disparities in Hospital-Based Care Associated with Postpartum Depression.

OBJECTIVE: To estimate racial and ethnic differences in rates of hospital-based care associated with postpartum depression. METHODS: This is a retrospective cohort study using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes within data from the Office of Statewide Planning and Development in California. We included primiparous women who underwent delivery hospitalization from 2008 to 2012. The primary outcome was the first postpartum hospital encounter with a ICD-9-CM code for depression over a 9-month period after delivery. We examined the cumulative incidence of hospital-based care for postpartum depression by race/ethnicity. Logistic regression was used to estimate relative risk. RESULTS: The study cohort consisted of 984,167 primiparous women: 314,037 (32%) were non-Hispanic White; 59,754 (6%) were non-Hispanic Black; 150,855 (15%) were non-Hispanic Asian; 448,770 (46%) were Hispanic; and 10,399 (1%) were other races. The cumulative incidence of hospital-based care for postpartum depression was highest for Black women (39; 95% CI = 34-44 per 10,000 deliveries) and lowest for Asian women (7; 95% CI = 5-8 per 10,000 deliveries). Compared with White women, hospital-based care for postpartum depression was more likely to be provided to Black women (OR = 2.3; 95% CI = 1.9-2.7), whereas care was less likely for Asians (OR = 0.4; 95% CI = 0.3-0.5) and Hispanics (OR = 0.8; 95% CI = 0.7-1.0). Similar findings were observed after excluding women with antepartum depression, adjusting for sociodemographic and clinical variables, and stratifying according to care settings. CONCLUSION: Compared with White women, hospital-based care for postpartum depression more frequently impacts Black women. Identifying and improving inequities in access to and utilization of mental health care for postpartum women should be a maternal health priority.

Ethnic disparities in receiving benefits for disability following postpartum mental illness during first two years after delivery: an Israeli nationwide study.

BACKGROUND: Despite relatively high rates of Postpartum Depression (PPD), little is known about the granting of social security benefits to women who are disabled as a result of PPD or of other postpartum mood and anxiety disorders (PMAD). This study aims to identify populations at risk for underutilization of social security benefits due to PMAD among Israeli women, with a focus on ethnic minorities. METHODS: This retrospective cohort study is based on the National Insurance Institute (NII) database. The study population included a simple 10% random sample of 79,391 female Israeli citizens who gave birth during 2008-2016 (these women delivered a total of 143,871 infants during the study period), and who had not been eligible for NII mental health disability benefits before 2008. The dependent variable was receipt of Benefit Entitlement (BE) due to mental illness within 2 years following childbirth. Maternal age at delivery, population group, Socio-Economic Status (SES), family status, employment status of the mother and her spouse, and infant mortality were the independent variables. Left truncation COX proportional hazard model with time-dependent variables was used, and birth number served as a time discrete variable. RESULTS: Bedouin and Arab women had significantly lower likelihood of BE (2.6 times lower and twice lower) compared with other ethnic groups (HR = 0.38; 95% CI: 0.26-0.56; HR = 0.47; 95% CI: 0.37-0.60 respectively). The probability of divorced or widowed women for BE was significantly higher compared to those living with a spouse (HR = 3.64; 95% CI: 2.49-5.33). Lack of employment was associated with higher likelihood of BE (HR = 1.54; 95% CI: 1.30-1.82). Income had a dose-response relationship with BE in multivariable analysis: lower income was associated with the nearly four-fold greater probability compared to the highest income quartile (HR = 3.83; 95% CI: 2.89-5.07). CONCLUSIONS: Despite the exceptionally high prevalence of PMAD among ethnic minorities, Bedouins and Arabs had lowest likelihood of Benefit Entitlement. In addition to developing programs for early identification of postpartum emotional disorders among unprivileged ethnic groups, awareness regarding entitlement to a mental health disability allowance among ethnic minorities should be improved.

Effects of maternal depressive symptoms on sensitivity to infant distress and non-distress: Role of SES and race.

The goals of the present study were to examine the extent to which (a) maternal depressive symptoms (prenatal vs. postnatal depressive symptoms) undermine maternal sensitivity toward both infant distress and non-distress; (b) such effects are stronger in the context of socioeconomic risk. SES risk and depressive symptoms interacted such that depressive symptoms, both pre and postnatal, only predicted lower sensitivity among mothers at heightened SES risk. The effects were comparable for sensitivity to distress and non-distress and did not vary by maternal race.

Canadian Refugee Women Are at Increased Risk of Postpartum Depression: How Can We Help?

Refugee women in Canada are at increased risk of postpartum depression (PPD) compared with Canadian-born women. Physicians specializing in women's health are in a unique position to intervene with refugee women experiencing PPD. Although there are common contributors to the development of PPD in both Canadian-born and refugee women, refugee women face a number of additional barriers to treatment. These can include factors unique to the refugee experience (e.g., family separation, uncertainty regarding legal status, social mores of the new country) as well as social determinants of health (e.g., poverty, language barriers, barriers to accessing health care). Some authors have argued that all recent immigrant women who are pregnant should be considered at risk for developing PPD and have stressed the importance of early intervention with this group. This commentary argues that effective strategies to address the needs of women refugees who are pregnant focus on the following areas: early identification of women at risk, advocacy efforts, and mitigation of broader relevant social factors (e.g., food insecurity, poverty, lack of social supports). In addition to these strategies, more research is needed to identify how factors interact to increase the risk of PDD in women refugees and to identify factors that protect against the development of PPD in this group.

Prenatal Depression and Risk of Short Interpregnancy Interval in a Predominantly Puerto Rican Population.

Background: Short interpregnancy interval (IPI) is associated with risk of adverse pregnancy outcomes; however, few studies have evaluated the role of depression as a risk factor for short IPI. Puerto Rican women in the United States experience disparities in adverse birth outcomes and have the highest birth rates. Methods: We analyzed the association between prenatal depressive symptoms and IPI in Proyecto Buena Salud, a prospective cohort of predominantly Puerto Rican women in Western Massachusetts (2006-2011). Depression was measured using the Edinburgh Postnatal Depression Scale (EPDS) in early, mid, and late pregnancy. We calculated follow-up time as the difference between the date of delivery of the index pregnancy and the last menstrual period of the subsequent pregnancy using medical records and billing data. We defined short IPI as ≤18 months. Results: Of 1262 eligible women, 35% (n = 440) had at least probable minor depression (EPDS scores ≥13) and 25% (n = 315) had probable major depression (EPDS scores ≥15). Participants were followed for a median of 3.7 years (interquartile range = 1.4-6.0 years) and 240 (20.6%) participants experienced a short IPI. After adjusting for risk factors, women with probable minor depression (adjusted odds ratio [aOR] = 1.39, 95% confidence interval [CI] = 1.02-1.88) and probable major depression (aOR = 1.42, 95% CI = 1.02-1.97) during pregnancy had increased odds of short IPI. Conclusions: Prenatal depressive symptoms were common in this Puerto Rican population and were associated with a modest increase in odds of short IPI. Further examination of the pathways through which mental health may affect IPI in vulnerable populations is warranted.

Early detection of mental illness for women suffering high-risk pregnancies: an explorative study on self-perceived burden during pregnancy and early postpartum depressive symptoms among Chinese women hospitalized with threatened preterm labour.

BACKGROUND: The mental health of pregnant women, particularly those with elevated risks, has been an issue of global concern. Thus far, few studies have addressed the mental health of pregnant women with threatened preterm labour (TPL). This study investigated the prevalence of self-perceived burden (SPB) among Chinese women hospitalized due to TPL during pregnancy and early postpartum depressive disorders, exploring the effect of SPB and other potential risk factors on the early signs of postpartum depressive disorders. METHODS: A self-reported survey was conducted in the obstetrics department of Anhui Provincial Hospital, China. Women hospitalized with TPL were approached 1 week after delivery. One hundred fifty women were recruited from January 2017 to December 2017. The Self-Perceived Burden Scale (SPBS) and Edinburgh Postnatal Depression Scale (EPDS) were the main measures. Descriptive statistics, Spearman correlations, and a multiple logistic regression were employed for data analysis. RESULTS: SPB and early postpartum depressive disorders were commonly experienced by Chinese women hospitalized with TPL, and SPB was positively and significantly correlated with depressive symptoms. A multiple logistic regression analysis revealed that for the women hospitalized with TPL during pregnancy, the emotional aspect of SPB (OR = 1.42, 95% CI = 1.11-1.83, p = 0.006), age (OR = 1.14, 95% CI = 1.02-1.27, p = 0.023), occupation (OR = 3.48, 95% CI = 1.18-10.20, p = 0.023), the history of scarred uterus (OR = 7.96, 95% CI = 1.49-42.48, p = 0.015), the delivery mode of the present birth (OR = 6.19, 95% CI = 1.72-22.30, p = 0.005), and family support during pregnancy (OR = 0.60, 95% CI = 0.45-0.82, p = 0.001) were significant factors predicting early postpartum depressive symptoms. CONCLUSION: This study indicates that SPB and early postpartum depressive disorders are prevalent mental issues among Chinese women hospitalized with TPL, and that SPB, especially perceived emotional burden, is a strong predictor of early postpartum depressive disorders. Our study suggests the necessity of paying attention to mental health issues, e.g. SPB and postpartum depressive symptoms among hospitalized women with TPL, and providing appropriate interventions at the prenatal stage to prevent adverse consequences.

Prevalence and associated factors of postpartum depression among immigrant women in Guangzhou, China.

BACKGROUND: Although there has been mounting research on postpartum depression (PPD), the impact of immigration on PPD has remained quite unexplored. The purpose of this study is to investigate the prevalence and associated factors of PPD among immigrant women living in Guangzhou at 6 weeks postpartum. METHODS: A cross-sectional study was conducted involving 1230 immigrant women in a tertiary hospital of Guangzhou from December 2016 to December 2017 at 6 weeks postpartum. The Chinese version of Edinburgh Postnatal Depression Scale and a structured questionnaire regarding associated factors were administered to all participants. Multivariate logistic regression was used to determine factors that were significantly associated with PPD. RESULTS: The prevalence of PPD among immigrant women at 6 weeks postpartum was 34.0%. A multivariate logistic regression model identified significant obstetric and social factors as: living in Guangzhou for less than 2 years, insufficient family income, poor social support and marital relationship. CONCLUSION: Prevalence of PPD among immigrant women from Guangzhou at 6 weeks postpartum is high. The development of PPD among immigrant women is associated with individual and social factors. There's an urgent need for healthcare providers to take a more active role in engaging immigrant women in their psychological needs.

Patterns of family negativity in the perinatal period: Implications for mental health among Mexican-origin women.

Negativity in the family environment during the perinatal period is likely to have detrimental effects on maternal well-being, especially among low-income ethnic minority mothers who are at increased risk for experiencing postpartum depressive symptoms. With a sample of 322 Mexican and Mexican American families, this study used latent class growth analysis to identify meaningful subgroups of women based on their perceived family negativity reported prenatally and at 6, 12, 18, and 24 weeks postpartum. A 4-trajectory model of family negativity fit the data well: low-stable (58%), moderate-increasing (26%), high-decreasing (8%), and high-increasing (8%). Higher prenatal depressive symptomatology predicted membership in the moderate-increasing, high-decreasing, and high-increasing trajectories, relative to the low-stable trajectory. Findings suggest substantial heterogeneity in family negativity, identifying three significant growth patterns during the perinatal period with differential implications for maternal depressive symptomatology at 24 weeks and 12 months after delivery. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Postnatal depressive symptoms display marked similarities across continents.

BACKGROUND: Postnatal depressive symptoms measured by the Edinburgh Postnatal Depression Scale (EPDS) are reported to display measurement variance regarding factor structure and the frequency of specific depressive symptoms. However, postnatal depressive symptoms measured by EPDS have not been compared between women representing three continents. METHODS: A cross-sectional study including birth cohort samples from Denmark, Vietnam and Tanzania. Women were included during pregnancy at routine care sites. Depressive symptoms were self-reported 40-90 days postpartum using the EPDS. Exploratory and confirmatory factor analyses and generalized additive regression models were performed. RESULTS: A total of N = 4,516 participated in the study (Denmark N = 2,069, Vietnam N = 1,278, Tanzania N = 1,169). Factor analyses identified three factors (anhedonia, anxiety and depression) that were almost identical in the three study populations. The only variation between countries was that the item 'self-harm' loaded differently. Women from Tanzania and Denmark were more likely to have an EPDS total score above cut-off 12 (12.6% and 6.4%), compared to women from Vietnam (1.9%) (p<0.001). A low level of education was associated with significantly more depressive symptoms after adjusting for country (p<0.001). LIMITATIONS: EPDS data was collected at a later time point in the Danish sample. CONCLUSIONS: Postnatal depressive symptoms constitute a three-factor model across cultures including the factors anhedonia, anxiety and depression. The frequency of postnatal depressive symptoms differs between high-, medium-, and low-income countries. However, clinicians should bear in mind that low-educated women worldwide are more likely to experience postnatal depressive symptoms.

Sociocultural stressors across the perinatal period and risk for postpartum depressive symptoms in women of Mexican descent.

OBJECTIVES: In the United States, women of Mexican descent are affected by postpartum depression at disproportionate rates, often two to three times higher than the general population. Sociocultural stressors may contribute to this disparity. Traditionally, these stressors are measured at a single time point, and it is unknown if sociocultural stressors change from pregnancy to the postnatal period and if they are related to postpartum depressive symptoms. METHOD: Pregnant women of Mexican descent (N = 159) were assessed for acculturation (Mexican and Anglo orientation), perceived discrimination, acculturative stress, perceived stress, and depressive symptoms during the first trimester and postpartum period. RESULTS: Women reported increases in Mexican orientation, t(126) = -3.503, p = .01, and decreases in acculturative stress, t(159) = -3.503, p < .001, and perceived stress, t(159) = 6.332, p < .001, from pregnancy to postpartum. Only increases in Mexican orientation were associated with less postpartum depressive symptoms (R² = 0.050, B = -2.210, SE = 0.996, t = -2.120, p = .028), even when controlling for covariates. In addition, postnatal measurements of elevated acculturative stress and less Mexican orientation (R² = 0.127, B = 0.133, SE = 0.036, t = 3.721, p < .001; B = -2.194, SE = 0.769, t = -2.853, p < .001, respectively) were associated with more postpartum depressive symptoms; however, only Mexican orientation remained significant after covariates. CONCLUSIONS: Sociocultural stressors change across the perinatal period and contribute to postpartum depressive symptoms. Findings implicate a need for consideration of sociocultural stressors in postpartum depression prevention. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The role of education in maternal depressive symptoms among different ethnic groups: A cross-sectional study in rural western China.

OBJECTIVE: To estimate the maternal depressive symptoms (MDS) rates in different ethnic groups, and to explore possible reasons especially the role of education for its ethnic differences. METHODS: A community-based cross-sectional survey was conducted in 20 rural counties of 8 provinces in western China. The possible influencing factors of MDS were collected. The Edinburgh Postpartum Depression Scale (EPDS) was used to assess MDS. Univariate and multivariate logistic regression models were used to analyze the risk factors of MDS. Two multivariate logistic regression models that separately containing and not containing the factor of educational level were used to explore the role of education in the ethnic differences of MDS. RESULTS: A total of 3,163 mothers were included in the analysis, and the MDS rate was 15.6%. In multivariate analysis, educational level of primary school and below (adjOR1: 1.47, 95%CI: 1.07-2.03), delivery at home (adjOR1: 1.66, 95%CI: 1.11-2.47) and diarrhea of youngest child in the past two weeks (adjOR1: 1.31, 95%CI: 1.03-1.67) remained as independent predictors of MDS after adjusting all the factors significant in univariate analysis. If educational level was not adjusted in above multivariate model, women from Yi ethnic group (adjOR2: 1.39, 95%CI: 1.03-1.89) would additionally become significant. LIMITATIONS: EPDS is a screening tool and some possible risk factors for MDS were not included. CONCLUSION: The ethnic differences in MDS were largely due to the ethnic differences in educational level. To reduce the high risk of MDS among Yi mothers, further popularizing nine-year compulsory education could be effective.

Multiple forms of discrimination and postpartum depression among indigenous Palestinian-Arab, Jewish immigrants and non-immigrant Jewish mothers.

BACKGROUND: While discrimination takes multiple forms, racial or ethnic discrimination is a root cause of this health-damaging social phenomenon. We drew on intersectionality theory, which offers an account of discrimination's multiple effects, to consider associations between women's experiences of discrimination and postpartum depression (PPD) using four measures: single forms of discrimination (SFD); multiple forms of discrimination (MFD); ethnic discrimination combined with MFD (E-MFD); and a composite MFD that interacted with women's identity (C-MFD). METHODS: We interviewed a stratified sample of 1128 mothers face to face in 2014-2015 during mothers' visits to maternal and child health clinics. The mothers belonged to three groups in Israel: Palestinian-Arab minority, Jewish immigrant, and non-immigrant Jewish. We conducted unadjusted and adjusted logistic regressions for PPD, measured on the Edinburgh Postnatal Depression Scale, in associations with SFD (experiencing discrimination based on any of the following: age, sex, class, ethno-national identity, religiosity level and skin color); MFD (experiencing 0,1, 2 or ≥ 3 of SFD); E-MFD (ethnic discrimination combined with other MFD); and finally, C-MFD (interaction between MFD and women's identity). RESULTS: Palestinian-Arab mothers had higher PPD and reported higher SFD (based on ethnicity, religiosity level, and socioeconomic status), as well as higher MFD and E-MFD. This was followed by Jewish immigrant mothers, and lastly by non-immigrant Jewish mothers. However, both MFD and E-MFD had a strong association with PPD among non-immigrant Jewish mothers reporting 2MFD and ≥ 3MFD, and Palestinian-Arab mothers reporting ≥3MFD, but no significant association among immigrant Jewish mothers. When we used C-MFD, we found a dose-response association in which Palestinian-Arab mothers experiencing more MFD (2MFD and ≥ 3MFD) were more likely to experience PPD. This was followed by immigrant Jewish mothers (reporting 2MFD and ≥ 3MFD), and lastly by non-immigrant Jewish mothers. CONCLUSIONS: MFD should be considered in relation to women's identity (being part of a minority, immigrant, or non-immigrant majority group) in maternal mental health research and practice. Otherwise, we risk underestimating the effects of MFD on PPD, especially in minority and immigrant mothers, who are more likely to face interlocking forms of discrimination.

DNA methylation associated with postpartum depressive symptoms overlaps findings from a genome-wide association meta-analysis of depression.

BACKGROUND: Perinatal depressive symptoms have been linked to adverse maternal and infant health outcomes. The etiology associated with perinatal depressive psychopathology is poorly understood, but accumulating evidence suggests that understanding inter-individual differences in DNA methylation (DNAm) patterning may provide insight regarding the genomic regions salient to the risk liability of perinatal depressive psychopathology. RESULTS: Genome-wide DNAm was measured in maternal peripheral blood using the Infinium MethylationEPIC microarray. Ninety-two participants (46% African-American) had DNAm samples that passed all quality control metrics, and all participants were within 7 months of delivery. Linear models were constructed to identify differentially methylated sites and regions, and permutation testing was utilized to assess significance. Differentially methylated regions (DMRs) were defined as genomic regions of consistent DNAm change with at least two probes within 1 kb of each other. Maternal age, current smoking status, estimated cell-type proportions, ancestry-relevant principal components, days since delivery, and chip position served as covariates to adjust for technical and biological factors. Current postpartum depressive symptoms were measured using the Edinburgh Postnatal Depression Scale. Ninety-eight DMRs were significant (false discovery rate < 5%) and overlapped 92 genes. Three of the regions overlap loci from the latest Psychiatric Genomics Consortium meta-analysis of depression. CONCLUSIONS: Many of the genes identified in this analysis corroborate previous allelic, transcriptomic, and DNAm association results related to depressive phenotypes. Future work should integrate data from multi-omic platforms to understand the functional relevance of these DMRs and refine DNAm association results by limiting phenotypic heterogeneity and clarifying if DNAm differences relate to the timing of onset, severity, duration of perinatal mental health outcomes of the current pregnancy or to previous history of depressive psychopathology.

Understanding the lived experiences of severe postnatal psychiatric illnesses in English speaking South Asian women, living in the UK: a qualitative study protocol.

INTRODUCTION: The South Asian population is the UK's largest and fastest growing minority ethnic group. There is evidence to suggest the lay understanding of postnatal psychiatric illnesses of this group may fall outside the purview of Western biomedical perspectives. Alternative explanations include psychosocial, cultural and spiritual factors. Approaching psychiatric illnesses through a social perspective includes gaining insight to the patient's subjective experiences and understandings via qualitative inquiry. The objectives of this qualitative study are to explore South Asian women's narrative of living with a severe postnatal psychiatric illness and experiences of Perinatal Mental Health Services, care and support. METHODS AND ANALYSIS: Data collection is ongoing and will continue until 31 December 2018. Participants will be identified and recruited from Perinatal Mental Health Services in Birmingham and London. Eligible participants will be English speaking South Asian females aged 18 years or above with the capacity to give written informed consent. Participants are clinically diagnosed with a severe postnatal psychiatric illness. This qualitative study uses individual in-depth face-to-face interviews that aim to last 1 hour. Interviews will be audio recorded with participants' permission. Interview audio recordings will be transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). The primary goal of IPA is for the researcher to closely study and interpret how individuals make sense of their life experiences in a particular context by drawing on the fundamental principles of phenomenology, hermeneutics and idiography. ETHICS AND DISSEMINATION: The University of Birmingham, the South Birmingham Research Ethics Committee and the Health Research Authority have approved this study (approvals date: 18-12-2017 ref: 17/WM/0350). Local capability and capacity have been confirmed from Trust Research and Development departments. The researchers plan to publish the results from this study in journals and present findings at academic conferences.