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1.
BMJ ; 371: m4022, 2020 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-33177069

RESUMO

OBJECTIVE: To evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression in pregnant and postpartum women. DESIGN: Individual participant data meta-analysis. DATA SOURCES: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (from inception to 3 October 2018). ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Eligible datasets included EPDS scores and major depression classification based on validated diagnostic interviews. Bivariate random effects meta-analysis was used to estimate EPDS sensitivity and specificity compared with semi-structured, fully structured (Mini International Neuropsychiatric Interview (MINI) excluded), and MINI diagnostic interviews separately using individual participant data. One stage meta-regression was used to examine accuracy by reference standard categories and participant characteristics. RESULTS: Individual participant data were obtained from 58 of 83 eligible studies (70%; 15 557 of 22 788 eligible participants (68%), 2069 with major depression). Combined sensitivity and specificity was maximised at a cut-off value of 11 or higher across reference standards. Among studies with a semi-structured interview (36 studies, 9066 participants, 1330 with major depression), sensitivity and specificity were 0.85 (95% confidence interval 0.79 to 0.90) and 0.84 (0.79 to 0.88) for a cut-off value of 10 or higher, 0.81 (0.75 to 0.87) and 0.88 (0.85 to 0.91) for a cut-off value of 11 or higher, and 0.66 (0.58 to 0.74) and 0.95 (0.92 to 0.96) for a cut-off value of 13 or higher, respectively. Accuracy was similar across reference standards and subgroups, including for pregnant and postpartum women. CONCLUSIONS: An EPDS cut-off value of 11 or higher maximised combined sensitivity and specificity; a cut-off value of 13 or higher was less sensitive but more specific. To identify pregnant and postpartum women with higher symptom levels, a cut-off of 13 or higher could be used. Lower cut-off values could be used if the intention is to avoid false negatives and identify most patients who meet diagnostic criteria. REGISTRATION: PROSPERO (CRD42015024785).


Assuntos
Depressão Pós-Parto/psicologia , Transtorno Depressivo Maior/psicologia , Complicações na Gravidez/psicologia , Psicometria , Feminino , Humanos , Gravidez , Cuidado Pré-Natal , Sensibilidade e Especificidade
2.
Dev Neuropsychol ; 45(6): 380-395, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33081504

RESUMO

The objective was to investigate whether perinatal maternal anxiety and depressive symptoms predicted child attention and executive function (EF). Mothers (N = 614) reported pregnancy and three-months postnatal anxiety and depressive symptoms. Attention and EF were measured at two-years-of-age. Covariates were demographics, alcohol use, mood disorder history, and pregnancy factors. Higher prenatal anxiety, b(SE) =.020(.005), p<.001, and postnatal depressive symptoms, b(SE) =.009(.004), p=.04, predicted poorer child attention. A prenatal-by-postnatal depressive symptom interaction emerged, b(SE) = -.005(.003), p=.04: When pregnancy depressive symptoms were low, higher postnatal symptoms predicted poorer attention. No distress variables predicted EF, p's>.22. Perinatal distress timing, kind, and change were important for child attention.


Assuntos
Ansiedade/psicologia , Atenção/fisiologia , Depressão Pós-Parto/psicologia , Função Executiva/fisiologia , Assistência Perinatal/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Mães , Gravidez
3.
PLoS One ; 15(10): e0240409, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33048971

RESUMO

INTRODUCTION: Deaths during the perinatal period remain a big challenge in Africa, with 38 deaths per 1000 pregnancies in Uganda. The consequences of these deaths can be detrimental to the women; some ending up with postpartum depression. We examined the association between perinatal death and postpartum depression among women in Lira district, Northern Uganda. METHODS: We conducted a community-based cross-sectional study of 1,789 women. Trained research assistants screened women for postpartum depressive symptoms on day 50 postpartum using the Edinburgh postpartum depression scale (EPDS). Socio-demographic, economic, birth and survival status of the neonate were collected during pregnancy and within one week postpartum. We used generalized estimating equation for the Poisson family with a log link using Stata to estimate the prevalence ratio of the association between postpartum depressive symptoms (EPDS scores ≥14) and perinatal death. Mothers who lost their babies between 7-49 days postpartum were excluded. RESULTS: Of the 1,789 participants symptomatically screened for postpartum depression, 377 (21.1%) [95% confidence interval (95%CI): 17.2%, 23.0%] had probable depressive symptoms. The prevalence of postpartum depressive symptoms among the 77 women who had experienced perinatal death (37 stillbirths and 40 early neonatal deaths (≤7 days of life)) was 62.3% [95% CI: 50.8%, 72.6%] compared to 19.2% [95% CI: 17.4%, 21.2%], among 1,712 with live infants at day 50 postpartum. Women who had experienced a perinatal death were three times as likely to have postpartum depressive symptoms as those who had a live birth [adjusted prevalence ratio 3.45 (95% CI: 2.67, 4.48)]. CONCLUSIONS: The prevalence of postpartum depressive symptoms, assessed by EPDS, was high among women who had had a perinatal death in Northern Uganda. Women experiencing a perinatal death need to be screened for postpartum depressive symptoms in order to intervene and reduce associated morbidity.


Assuntos
Depressão Pós-Parto/epidemiologia , Morte Perinatal , Natimorto/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Pesquisa Participativa Baseada na Comunidade , Estudos Transversais , Depressão Pós-Parto/psicologia , Feminino , Humanos , Recém-Nascido , Idade Materna , Pessoa de Meia-Idade , Gravidez , Prevalência , Escalas de Graduação Psiquiátrica , Uganda/epidemiologia , Adulto Jovem
4.
PLoS One ; 15(9): e0238109, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32870929

RESUMO

BACKGROUND: The global refugee population has reached a staggering 25.9 million. Approximately 16% of global refugees resettle in high-income countries which are often culturally very different from their home countries. This can create cross-cultural challenges when accessing health services, leading to inappropriate assessments, diagnoses and treatments if cultural background is not factored in. The impact of culture on the conceptualization and experience of postpartum depression (PPD) amongst migrant women has received growing attention in recent years, however, a specific focus on refugee and asylum-seeking women is lacking. Given the unique mental health challenges refugee women face, it is hypothesized that the interplay between culture and postpartum depression amongst refugee women may differ from other migrant women. Therefore, a scoping review was conducted to characterize what is known about the impact of culture on the conceptualization and experience of PPD in refugee women resettled in high-income countries. METHODS AND FINDINGS: This study was conducted as a scoping review in accordance with the Joanna Briggs Institute's Methodology for Scoping Reviews. A systematic search of studies addressing the relationship between culture and postpartum depression amongst refugee women (including asylum-seeking women) resettled in high-income countries was conducted across 6 databases including MEDLINE, PsycINFO and SOCINDEX between June 2018 and August 2019. A total of 637 articles were found. Studies were eligible if they focused on refugee women who had a pregnancy during forced migration or upon resettlement in a high-income country and focused on the impact of culture on women's conceptualization and/or experience of PPD. Eight studies met inclusion criteria and were included in the final analysis, the majority of which were qualitatively driven. Four key themes emerged: 1) there are diverse conceptualizations and experiences of postpartum depression amongst refugee women; 2) mental health stigma has a significant impact on women's conceptualizations and experiences of postpartum depression and help-seeking behaviors; 3) cultural traditions and social support play protective roles in postpartum mental wellbeing; and, 4) host culture has a significant influence on the pregnancy and postpartum experience of refugee women. The overall themes align with those seen in the literature on migrant women in general, however significant research gaps remain. CONCLUSION: The studies identified through this scoping review provide a rich description of the significant impact culture has on the conceptualization and experience of postpartum depression among refugee women resettled in high-income countries. Though overall themes align with those seen in the literature on migrant women in general, further research is needed to better characterize how culture impacts refugee women's experiences of PPD as a distinct sub-group of migrant women.


Assuntos
Cultura , Depressão Pós-Parto/psicologia , Países Desenvolvidos , Refugiados/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Percepção
5.
J Affect Disord ; 277: 5-13, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-32777604

RESUMO

BACKGROUND: Anxiety and depression symptoms in pregnancy typically affect between 10 and 25% of pregnant individuals. Elevated symptoms of depression and anxiety are associated with increased risk of preterm birth, postpartum depression, and behavioural difficulties in children. The current COVID-19 pandemic is a unique stressor with potentially wide-ranging consequences for pregnancy and beyond. METHODS: We assessed symptoms of anxiety and depression among pregnant individuals during the current COVID-19 pandemic and determined factors that were associated with psychological distress. 1987 pregnant participants in Canada were surveyed in April 2020. The assessment included questions about COVID-19-related stress and standardized measures of depression, anxiety, pregnancy-related anxiety, and social support. RESULTS: We found substantially elevated anxiety and depression symptoms compared to similar pre-pandemic pregnancy cohorts, with 37% reporting clinically relevant symptoms of depression and 57% reporting clinically relevant symptoms of anxiety. Higher symptoms of depression and anxiety were associated with more concern about threats of COVID-19 to the life of the mother and baby, as well as concerns about not getting the necessary prenatal care, relationship strain, and social isolation due to the COVID-19 pandemic. Higher levels of perceived social support and support effectiveness, as well as more physical activity, were associated with lower psychological symptoms. CONCLUSION: This study shows concerningly elevated symptoms of anxiety and depression among pregnant individuals during the COVID-19 pandemic, that may have long-term impacts on their children. Potential protective factors include increased social support and exercise, as these were associated with lower symptoms and thus may help mitigate long-term negative outcomes.


Assuntos
Ansiedade/epidemiologia , Infecções por Coronavirus , Depressão/epidemiologia , Pandemias , Pneumonia Viral , Gestantes/psicologia , Estresse Psicológico/epidemiologia , Adolescente , Adulto , Ansiedade/psicologia , Betacoronavirus , Canadá/epidemiologia , Depressão/psicologia , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Feminino , Acesso aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Gravidez , Cuidado Pré-Natal , Fatores de Risco , Isolamento Social , Apoio Social , Estresse Psicológico/psicologia , Inquéritos e Questionários , Adulto Jovem
6.
Lancet Psychiatry ; 7(9): 775-787, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32828167

RESUMO

BACKGROUND: Maternal depression has a recurring course that can influence offspring outcomes. Evidence on how to treat maternal depression to improve longer-term maternal outcomes and reduce intergenerational transmission of psychopathology is scarce, particularly for task-shifted, low-intensity, and scalable psychosocial interventions. We evaluated the effects of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal. METHODS: 40 village clusters in Pakistan were randomly allocated using a computerised randomisation sequence to receive a group-based, psychosocial intervention and enhanced usual care for 36 months, or enhanced usual care alone. Pregnant women (≥18 years) were screened for moderate or severe symptoms of depression (patient health questionnaire-9 [PHQ-9] score ≥10) and were recruited into the trial (570 participants), and a cohort without depression (PHQ-9 score <10) was also enrolled (584 participants). Including the non-depressed dyads enabled us to determine how much of the excess risk due to maternal depression exposure the intervention could mitigate. Research teams responsible for identifying, obtaining consent, and recruiting trial participants were blind to the allocation status throughout the duration of the study, and principal investigators, site coordinators, statisticians, and members of the trial steering committee were also blinded to the allocation status until the analysis of 6-month data for the intervention. Primary outcomes were maternal depression symptoms and remission (PHQ-9 score <10) and child socioemotional skills (strengths and difficulties questionnaire [SDQ-TD]) at 36-months postnatal. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02658994. FINDINGS: From Oct 15, 2014 to Feb 25, 2016 46 village clusters were assessed for eligibility, of which 40 (including 1910 mothers were enrolled. After exclusions, 288 women were randomly assigned to the enhanced usual care group and 284 to the intervention group, and 1159 women were included in a group without prenatal depression. At 36-months postnatal, complete data were available from 889 mother-child dyads: 206 (72·5%) in the intervention group, 216 (75·3%) in the enhanced usual care group, and 467 (80·0%) women who did not have prenatal-depression. We did not observe significant outcome differences between the intervention group and the enhanced usual care group for the primary outcomes. The standardised mean difference of PHQ-9 total score was -0·13 (95% CI -0·33 to 0·07), relative risk of patient health questionnaire-9 remission was 1·00 (95% CI 0·88 to 1·14), and the SDQ-TD treatment estimate was -0·10 (95% CI -1·39 to 1·19). INTERPRETATION: Reduced symptom severity and high remission rates were seen across both the intervention and enhanced usual care groups, possibly masking any effects of the intervention. A multi-year, psychosocial intervention can be task-shifted via peers but might be susceptible to reductions in fidelity and dosage over time (which were not among the outcomes of this trial). Early intervention efforts might need to rely on multiple models (eg, collaborative care), be of greater intensity, and potentially targeted at mothers who are at high risk for depression to reduce the intergenerational transmission of psychopathology from mothers to children. FUNDING: National Institutes of Health.


Assuntos
Desenvolvimento Infantil , Depressão Pós-Parto/terapia , Relações Mãe-Filho , Mães/psicologia , Grupo Associado , Psicoterapia de Grupo/métodos , Adolescente , Adulto , Comportamento Infantil , Pré-Escolar , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/psicologia , Feminino , Humanos , Paquistão , Escalas de Graduação Psiquiátrica , Resultado do Tratamento , Adulto Jovem
7.
Matern Child Health J ; 24(10): 1267-1277, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32780269

RESUMO

OBJECTIVES: Children raised by depressed mothers perform lower on measures of cognitive, emotional, and behavioral skills, compared to children of non-depressed mothers. It is unclear how maternal depressive symptoms (MDS), which persist and accrue over time, impact child development. The purpose of this study was to determine whether cumulative MDS from pre-pregnancy to postpartum influences child development in children by age 2.5. METHODS: Using a longitudinal population-based study design, 2679 racially and ethnically diverse mothers completed the 2014 Los Angeles Mommy and Baby (LAMB) and 2016 Follow-Up surveys. A total MDS score was created based on responses to standardized questions, including the Patient Health Questionnaire-2 (PHQ-2). Data was collected for before pregnancy, during pregnancy, and 4 months postpartum in the 2014 survey, and at 2.5 years postpartum in the 2016 survey. Child development was measured using the CDC's Learn the Signs. Act Early Milestones Checklist. Bivariate and multivariate logistic regressions were conducted. RESULTS: The prevalence of any cumulative MDS was 45.2%. Language, cognitive/adaptive, motor, and social-emotional delays for surveyed toddlers were 7.7%, 4.0%, 1.2%, and 14.2%. After adjusting for covariates, mothers reporting depressive symptoms at all four time points were significantly more likely to report a social-emotional delay in their child (aOR = 4.39, 95% CI - 1.72 to 11.18). CONCLUSIONS FOR PRACTICE: Mothers with cumulative depressive symptoms are at-risk of reporting social-emotional delays by age 2.5. Understanding these effects may help direct resources to target interventions that support mothers with depressive symptoms early-on and promote positive developmental outcomes among their children.


Assuntos
Filho de Pais Incapacitados/psicologia , Depressão Pós-Parto/complicações , Depressão/diagnóstico , Depressão/psicologia , Deficiências do Desenvolvimento/etiologia , Mães/psicologia , Período Pós-Parto/psicologia , Complicações na Gravidez/psicologia , Adulto , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Depressão/epidemiologia , Depressão Pós-Parto/psicologia , Emoções , Feminino , Humanos , Lactente , Estudos Longitudinais , Los Angeles , Masculino , Vigilância da População , Gravidez , Inquéritos e Questionários
8.
Sci Rep ; 10(1): 13770, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32792607

RESUMO

Mental health assessments of both members of a couple are important when considering the child-rearing environment. The prevalence and factors associated with both parents' psychological distress have not been fully investigated. A nationally representative sample from the 2016 Comprehensive Survey of Living Conditions in Japan was used to examine the prevalence of moderate and severe psychological distress in parents in the first year after childbirth. In total, 3,514 two-parent households raising children under one year old met the study criteria. The Japanese version of Kessler 6 was used to assess moderate and severe psychological distress. The prevalence of either or both parents experiencing psychological distress in the first year after birth were 15.1% and 3.4%, respectively. A multivariate logistic regression analysis showed factors of fathers who worked ≥ 55 h a week, reduced duration of sleep in mothers, age in months of the youngest child, and high household expenditures were significantly associated with both parents simultaneously having moderate or severe psychological distress. This study implied the importance of prevention and early detection of parental psychological distress in both parents. Assessing parents' psychological distress and work-style reform in the childcare period is an urgent issue to improve their mental health conditions.


Assuntos
Depressão/epidemiologia , Pais/psicologia , Período Pós-Parto/psicologia , Angústia Psicológica , Estresse Psicológico/epidemiologia , Estresse Psicológico/prevenção & controle , Adulto , Estudos Transversais , Depressão/psicologia , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Pai/psicologia , Feminino , Humanos , Japão/epidemiologia , Masculino , Mães/psicologia , Fatores de Risco , Estresse Psicológico/psicologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-32858960

RESUMO

Postpartum depression (PPD) has detrimental effects on the health of the mother, child and family. Socio-demographic variables can influence PPD. Sense of coherence (SOC) is a personal resource that mitigates the experience of stressful events. We hypothesized that SOC would have a protective effect against PPD over time. The aim was to investigate the effects of socio-demographic factors and SOC on PPD at birth (T1) and nine months postpartum (T2). A longitudinal study of primiparous women (n = 114; age range 18-47 years) measured PPD, SOC and socio-demographics at T1 and T2. The majority were married, had no economic difficulties and were employed before birth. Results showed that PPD at T1 (15.8%) declined to 6.2% (T2). Job status was positively associated with SOC at T1. The structured equation model accounted for 27% of the variance in PPD (T2). In the first pathway, job status was linked to PPD (T2) via SOC at T1 and T2. In the second, SOC and PPD (T1) and SOC (T2) mediated the link between job status and PPD (T2). Results and clinical implications are discussed in the context of the theory of conservation of resources. An intervention for enhancing SOC is recommended for woman at risk of PPD.


Assuntos
Depressão Pós-Parto/psicologia , Emprego/psicologia , Parto/psicologia , Qualidade de Vida/psicologia , Senso de Coerência , Adolescente , Adulto , Criança , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/etiologia , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Gravidez , Fatores de Risco , Adulto Jovem
10.
Br J Clin Psychol ; 59(4): 480-502, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32808684

RESUMO

OBJECTIVES: To investigate whether levels of perfectionism, organization, and intolerance of uncertainty predispose women to more negative birth experiences and post-partum post-traumatic stress symptoms (PTSS). Birth experience was also examined as a potential moderator of the relationship between levels of the personality traits and post-natal PTSS. DESIGN: Prospective survey. METHOD: First-time expectant mothers (N = 10,000) were contacted via Emma's Diary during the perinatal period. At 32-42 weeks' gestation, participants completed measures examining the three personality traits and prenatal mood. At 6-12 weeks' post-partum, instruments assessing childbirth experience, birth trauma, PTSS, and post-natal mood were completed. Data from 418 women were analysed. RESULTS: Higher perfectionism and intolerance of uncertainty were associated with more negative birth appraisals and PTSS. Organization was unrelated to birth experience or PTSS. In a regression, higher intolerance of uncertainty and perfectionism statistically predicted more negative birth appraisals. Only perfectionism predicted PTSS. Birth experience did not moderate the relationship between perfectionism or intolerance of uncertainty and PTSS. CONCLUSIONS: Personality risk factors for negative birth experiences and post-natal PTSS are identifiable prenatally. Maternity care providers could educate women about the unique roles of high perfectionism and intolerance of uncertainty during antenatal birth preparation. PRACTITIONER POINTS: Women who expect themselves to be more perfect or who find it more difficult to cope with uncertainty had more negative experiences of childbirth. Women with higher levels of perfectionism were more likely to experience more symptoms of post-traumatic stress during the early post-natal period. Being more perfectionistic continued to have a more negative effect on women's well-being after birth, regardless of whether they had a positive or negative experience of birth. Integrating these findings into antenatal discussion around birth preferences would increase women's awareness of predisposing and obstetric risk factors that partially explain experiences of unsatisfactory births and post-partum post-traumatic stress.


Assuntos
Ansiedade/psicologia , Parto Obstétrico/psicologia , Serviços de Saúde Materna/organização & administração , Parto/psicologia , Personalidade , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Estresse Psicológico/complicações , Incerteza , Adulto , Parto Obstétrico/efeitos adversos , Parto Obstétrico/normas , Depressão/psicologia , Depressão Pós-Parto/psicologia , Feminino , Humanos , Gravidez , Estudos Prospectivos , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico/psicologia , Inquéritos e Questionários
11.
Health Psychol ; 39(9): 758-766, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32833477

RESUMO

OBJECTIVE: Preventive interventions for postpartum depression (PPD) are critical for women at elevated risk of PPD. Mindfulness based cognitive therapy - perinatal depression (MBCT-PD) is a preventive intervention that has been shown to reduce risk for PPD in women with a prior history of depression. The objective of this clinical trial is to examine two potential mechanisms of action of MBCT-PD, emotion regulation and cognitive control, using behavioral and neuroimaging methods. METHOD: This baseline protocol describes a randomized control trial (RCT) with two arms, MBCT-PD and treatment as usual (TAU). We plan on enrolling 74 females with a prior history of a major depressive episode, with 37 participants randomized to each arm. Participants in the MBCT-PD arm will receive MBCT-PD during pregnancy, and the TAU group will receive standard prenatal care. All participants will complete the Center for Epidemiological Studies Depression Scale - Revised (CESD-R), Emotion Regulation Questionnaire (ERQ), and classic Stroop task at multiple points from pregnancy through six months postpartum. Participants will also complete an fMRI scan at six weeks postpartum. RESULTS: All primary outcomes are collected at six weeks postpartum. Primary behavioral outcomes include: depressive symptoms on the CESD-R, cognitive reappraisal on the ERQ, and Stroop task performance. In parallel, the primary neurobiological outcomes include whole-brain activation during fMRI tasks when participants 1) regulate emotional responding and 2) engage cognitive control. CONCLUSIONS: This results of this innovative RCT will help identify potential behavioral and neurobiological mechanisms of action of preventive interventions for PPD for in-depth examination in larger scale RCTs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental/métodos , Depressão Pós-Parto/psicologia , Atenção Plena/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Cuidado Pré-Natal , Resultado do Tratamento , Adulto Jovem
12.
Sci Rep ; 10(1): 11647, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32669610

RESUMO

The Edinburgh Postnatal Depression Scale (EPDS) is frequently used to screen for postpartum depression. However, its factor structure exhibits noticeable inconsistencies between studies. We examined the EPDS at two postpartum time points using a large dataset from outside Western countries. Participants were 91,063 mothers in an ongoing birth cohort of the Japan Environment and Children's Study. One-, two-, and three-factor structures of the EPDS at 1- and 6-months postpartum were extracted using exploratory factor analysis (EFA) with oblique rotation. Goodness-of-fit indices of extracted factor structures were compared with prior ones by conducting a confirmatory factor analysis (CFA). CFA revealed that a three-factor model extracted from the current EFA-anxiety (items 3, 4, 5, and 6), depression (items 7, 9, and 10), and anhedonia (items 1 and 2)-showed acceptably high goodness-of-fit and invariability across time. These three factors explained about 65% of the total variance with good reliability (all Cronbach's αs ≥ 0.70). Most three-factor structures (vs. two-) showed higher goodness-of-fit indices. In conclusion, although we only examined the postpartum period, the EPDS likely comprises three dimensions: anxiety, depression, and anhedonia. Our findings raise questions about the one- or two-factor structure of the EPDS.Trial registration: UMIN000030786.


Assuntos
Anedonia , Ansiedade/diagnóstico , Depressão Pós-Parto/diagnóstico , Mães/psicologia , Período Pós-Parto/psicologia , Adulto , Ansiedade/fisiopatologia , Ansiedade/psicologia , Estudos de Coortes , Conjuntos de Dados como Assunto , Depressão Pós-Parto/fisiopatologia , Depressão Pós-Parto/psicologia , Análise Fatorial , Feminino , Humanos , Parto , Período Pós-Parto/fisiologia , Gravidez , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Inquéritos e Questionários
13.
Medicine (Baltimore) ; 99(27): e20947, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629701

RESUMO

BACKGROUND: Depression and anxiety are common psychological manifestations encountered during the antenatal stage of pregnancy. Treatments by pharmacological interventions have been reported to impart negative implications on maternal and fetal health outcomes. Therefore, the use of psychotherapeutic interventions to bypass these side-effects and manage depression, anxiety has received a lot of attention. A meta-statistical consensus regarding the intervention is available, but with several limitations. In this study, we attempt to address these limitations and provide the current state of evidence evaluating the influence of psychotherapy on antenatal depression, anxiety, and maternal quality of life. OBJECTIVE: To demonstrate the effects of psychotherapy on depression, anxiety, and maternal quality of life during the antenatal stage of pregnancy. METHODS: A systematic identification of literature was performed according to PRISMA guidelines on four academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL. A meta-analysis evaluated the influence of psychotherapy on depression, anxiety, and maternal quality of life as compared to conventional obstetric care. RESULTS: Out of 1146 records, 22 articles including 2146 pregnant women (mean age: 28.6 ±â€Š2.8 years) were included in this review. This systematic review presents a 1b level of evidence supporting the use of psychotherapy for reducing depression, anxiety and enhancing maternal quality of life. The meta-analysis reveals the beneficial effects of psychotherapy for reducing depression (Hedge g: -0.48), anxiety (-0.47) and enhancing maternal quality of life (0.19) as compared to conventional obstetric care. CONCLUSIONS: The current systematic review and meta-analysis recommend the use of psychotherapy as for reducing depression, anxiety and enhancing maternal quality of life during the antenatal stage of pregnancy.


Assuntos
Transtornos de Ansiedade/psicologia , Depressão Pós-Parto/psicologia , Mães/psicologia , Qualidade de Vida , Adulto , Feminino , Humanos , Gravidez , Cuidado Pré-Natal , Psicoterapia
14.
Artigo em Inglês | MEDLINE | ID: mdl-32698403

RESUMO

Introduction: This study investigated the relationship between personal and family resources (i.e., social support, family functioning, self-efficacy in care, sense of coherence and perceived burden of care) and depressive and anxiety symptoms in women during the puerperium, adjusting for stressors. Methods: This is a quantitative research design, carried out through a descriptive, cross-sectional correlation study. This study includes 212 women over the age of 19 who gave birth from March to September 2019 in Maternal and Child Hospital of Jaén (Spain). Women were selected during the immediate postpartum period. The variables analysed were postpartum depressive symptoms (Edinburgh scale), anxiety symptoms (STAI state anxiety questionnaire), perceived social support (Duke-UNC-11), family functioning (family APGAR), self-efficacy in care (Lawton), sense of coherence (SOC-13), perceived burden (Caregiver Strain Index) and stressful life events (Holmes and Rahe). The main analysis consisted of a multiple linear regression. Results: The regression model of depressive symptoms found a positive association with perceived burden (ß = 0.230, p = 0.015) and negative associations with self-efficacy in care (ß = -0.348, p < 0.001), social support (ß = -0.161, p < 0.001) and sense of coherence (ß = -0.081, p = 0.001). The regression model of anxiety symptoms obtained a positive association with perceived burden (ß = 1.052, p < 0.001) and negative associations with self-efficacy in care (ß = -0.329, p = 0.041), social support (ß = -0.234, p = 0.001) and sense of coherence (ß = -0.262, p < 0.001). Discussion: Firstly, depressive and anxiety symptoms in the puerperium period may be more prevalent than in other periods of a woman's life. Secondly, perceived social support, self-efficacy in caring for the newborn and sense of coherence may be protective factors for depressive and anxiety symptoms in the puerperium period. Finally, perceived burden in caring for the newborn may be a risk factor for these symptoms.


Assuntos
Ansiedade/diagnóstico , Ansiedade/psicologia , Depressão Pós-Parto/psicologia , Depressão/diagnóstico , Depressão/psicologia , Mães/psicologia , Período Pós-Parto/psicologia , Apoio Social , Ansiedade/epidemiologia , Criança , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , Poder Familiar/psicologia , Gravidez , Autoeficácia , Senso de Coerência , Espanha/epidemiologia , Estresse Psicológico/psicologia , Inquéritos e Questionários
15.
Artigo em Inglês | MEDLINE | ID: mdl-32486285

RESUMO

When untreated, postpartum depression (PPD) can severely, negatively affect maternal health, child development, and the wellbeing and functioning of the entire family. Yet, despite screening and treatment programs for PPD, many women who experience depression with onset in the postpartum year do not communicate their symptoms. Negative relational experiences early in life, such as not receiving sensitive help and support when needed, often result in so-called insecure attachment styles, and there is evidence that these may contribute to the development and maintenance of PPD. However, the role of insecure attachment styles in non-help-seeking is unknown for this group. Using mixed quantitative and qualitative methodology, we identified help-seeking barriers of women who experienced depression with onset in the postpartum year but who had not sought help for their depression (N = 37), and explored links to their attachment orientations as assessed through both self-reported attachment style and narrative based attachment script assessment. The sample was non-normative regarding attachment, with an over-representation of avoidant attachment styles. Help-seeking barriers varied systematically with the mother's adult attachment style. Specifically, convictions of a strong self and lack of trust in healthcare professionals constituted a common barrier among women with avoidant attachment styles, while unrealistic expectations about motherhood constituted a barrier for women with secure attachment styles. This new knowledge on how barriers to communicating symptoms and seeking help when suffering from PPD vary systematically with attachment orientation can help formulate individualized, and therefore more efficient, approaches to addressing non-help-seeking behavior in women who suffer in silence.


Assuntos
Depressão Pós-Parto/psicologia , Comportamento de Busca de Ajuda , Mães/psicologia , Apego ao Objeto , Adulto , Criança , Desenvolvimento Infantil , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Período Pós-Parto , Gravidez , Inquéritos e Questionários
16.
Rev Bras Epidemiol ; 23: e200048, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32491045

RESUMO

INTRODUCTION: No studies were found that evaluate the association between intimate partner violence (IPV) before childbirth and sexual issues in the postpartum period. METHOD: A cross-sectional study with 700 women who received prenatal care in a basic health unit in São Paulo, between 2006 and 2007. Sexual issues were assessed through a questionnaire created by the authors, and intimate partner violence was evaluated using a structured questionnaire developed by the WHO. Postpartum depression was evaluated using the SRQ-20 instrument, with a cut-off point of 7/8 considered to be the mediating variable. A path analysis was performed to determine the different pathways: the direct association between outcome and exposure, and the indirect pathways through the mediator. RESULTS: The prevalence of sexual issues, intimate partner violence and postpartum depression were 30; 42.8; 27.8%, respectively. Violence occurring exclusively before childbirth did not show a direct association (ED = 0.072 (-0.06 - 0.20, p = 0.060)) or indirect (EI: 0.045 (-0.06 - 0.20, p = 0.123)), with sexual issues. CONCLUSION: Longitudinal studies that include other mediators may provide a better understanding of the causal chain and elucidate variables that influence postpartum sexuality issues.


Assuntos
Depressão Pós-Parto/psicologia , Violência por Parceiro Íntimo/psicologia , Período Pós-Parto/psicologia , Comportamento Sexual/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Autorrelato , Disfunções Sexuais Psicogênicas , Fatores Socioeconômicos , Fatores de Tempo , Adulto Jovem
17.
Epidemiol Psychiatr Sci ; 29: e133, 2020 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-32482189

RESUMO

Abstract. AIMS: Intimate partner violence (IPV) is an important risk factor for perinatal depression (PND). But IPV's impact on the natural prognosis of PND symptoms is not well understood. We tested two hypotheses: (1) pregnant women with IPV experiences will exhibit more severe PND symptoms than women without IPV experience; (2) IPV experience will impede the recovery prognosis of PND. We also explored the contribution of IPV to PND comparing with other risk factors. METHOD: The sample is comprised of 813 pregnant women followed through perinatal period in Hunan, China. We assessed IPV experience using items from the Short Form of the Revised Conflict Tactics Scale (CTS2S), and PND symptoms via the Edinburgh Postnatal Depression Scale (EPSD). We conducted Linear Mixed-effects Model to compare the trajectories of PND symptoms between victims and non-victims and a multistage Generalised Estimating Equations Model to explore salient factors on the trajectory of PND symptoms. RESULTS: There were 90 participants (11.07%) who reported IPV experience in the past 12 months. With respect to physical, psychological and sexual violence, the prevalence was 4.55% (37/813), 9.23% (75/813) and 2.34% (19/813). Victims reported more severe PND symptoms (t = 5.30, p < 0.01) and slower decreasing slope of trajectories (t = 28.89, p < 0.01). The PND trajectory was associated with IPV experience (OR = 3.78; 95% CI 1.39-10.26), social support (OR = 0.93; 95% CI 0.88-0.97), positive coping strategies (OR = 0.85; 95% CI 0.80-0.91), negative coping strategies (OR = 1.25; 95% CI 1.14-1.37) and monthly income of $0.15-$298.36 (compared to no income, OR = 0.0075; 95% CI 0.00052-0.11). CONCLUSIONS: The findings suggest the reported prevalence of IPV is lower in Hunan than most of the previous studies during perinatal period in other provinces of China, and IPV victimisation is associated with increased severity and slowed prognosis of PND symptoms. Future studies that screen for victimisation and establish its explicit mechanism to the poorer prognosis of PND symptoms would benefit the prevention and treatment of PND.


Assuntos
Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Vítimas de Crime/psicologia , Depressão Pós-Parto/diagnóstico , Depressão/diagnóstico , Violência por Parceiro Íntimo/psicologia , Violência por Parceiro Íntimo/estatística & dados numéricos , Mães/psicologia , Delitos Sexuais/psicologia , Maus-Tratos Conjugais/psicologia , Adaptação Psicológica , Adulto , China/epidemiologia , Estudos de Coortes , Estudos Transversais , Depressão/epidemiologia , Depressão/psicologia , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Feminino , Humanos , Violência por Parceiro Íntimo/etnologia , Pessoa de Meia-Idade , Assistência Perinatal , Pobreza/psicologia , Gravidez , Prevalência , Escalas de Graduação Psiquiátrica , Fatores de Risco , Delitos Sexuais/etnologia , Apoio Social , Adulto Jovem
18.
Psychiatry Res ; 291: 113161, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32562932

RESUMO

The prevalence and negative effects of perinatal depression are well known. The Edinburgh Postnatal Depression Scale (EPDS) is a common screening tool for perinatal depression and it is recommended for use by several professional organizations. The current study tested competing EPDS factor structures and assessed EPDS change from intake to 6-week follow-up, and identified demographic correlates in an outpatient obstetric sample. Using a retrospective observational study design, medical records were coded for demographic, mental health, and EPDS patient data (n = 524). Confirmatory factor analysis, t-tests, and ANOVA were utilized. Findings included: (1) a 3-factor model (i.e. anxiety, depression, anhedonia) of the EPDS displayed the best fit to the current data; (2) small declines in all 3 subscales of the EPDS from intake to 6-week follow-up appointments and; (3) demographic correlates of EPDS subscales included history of depression, history of anxiety, race, and pregnancy status (i.e. first child or not). The 3-factor structure can be used in clinical practice to assess perinatal depression in a nuanced fashion. Given that history of depression and anxiety are risk factors for perinatal depression, a thorough assessment of these items in clinical practice is needed.


Assuntos
Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/psicologia , Vigilância da População , Escalas de Graduação Psiquiátrica/normas , Psicometria/normas , Adulto , Feminino , Seguimentos , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Gravidez , Psicometria/métodos , Estudos Retrospectivos , Fatores de Risco
19.
Psychiatry Res ; 291: 113224, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32562937

RESUMO

Epidemiological evidence on the role of socioeconomic status on postpartum depressive symptoms has been inconsistent. The present prospective study investigated the relationship between employment, job type, income, and education and postpartum depressive symptoms. Subjects were 1316 Japanese women. The subjects were asked to complete an Edinburgh Postnatal Depression Scale (EPDS) between three and four months postpartum. Postpartum depressive symptoms were defined as EPDS score ≥ 9. The prevalence of postpartum depressive symptoms was 8.2%. Compared with unemployment, holding a sales job was independently related to a reduced risk of postpartum depressive symptoms: the adjusted odds ratio (OR) was 0.13 (95% CI: 0.01-0.66). Compared with a household income under four million yen per year, a household income of six million yen or more per year was independently inversely associated with postpartum depressive symptoms: the adjusted OR was 0.33 (95% CI: 0.16-0.63). Compared with less than 13 years of education, both 13 or 14 years and 15 years or more were independently inversely related to postpartum depressive symptoms: the adjusted ORs were 0.40 (95% CI: 0.23-0.69) and 0.48 (95% CI: 0.28-0.82), respectively. Holding a sales job, higher household income and higher educational levels may be inversely associated with postpartum depressive symptoms.


Assuntos
Saúde da Criança/tendências , Depressão Pós-Parto/psicologia , Escolaridade , Emprego/tendências , Renda/tendências , Saúde Materna/tendências , Adulto , Criança , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/epidemiologia , Emprego/psicologia , Feminino , Humanos , Japão/epidemiologia , Gravidez , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Classe Social , Desemprego/psicologia
20.
Aust N Z J Public Health ; 44(4): 301-306, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32510784

RESUMO

OBJECTIVES: To report rates of perinatal mental health screening from 2000 to 2017 and investigate factors associated with not being screened both antenatally and postnatally more recently (2013-2017). METHODS: A longitudinal community-based study of self-reported perinatal mental health screening with a national sample of 7,566 mothers from the Australian Longitudinal Study on Women's Health reporting on 9,384 children. The main outcome measure was whether mothers were asked about their emotional wellbeing by a health professional, including completing a questionnaire. RESULTS: From 2000 to 2017, the percentage of women not screened decreased from 40.6% to 1.7%. The percentage of women screened both antenatally and postnatally increased from 21.3% to 79.3%. From 2013 to 2017, women who were older (aOR, 0.65; 95%CI, 0.52-0.81) or had reported emotional distress (aOR, 0.77; 95%CI, 0.60-0.99) were less likely to have been screened both antenatally and postnatally. CONCLUSIONS: Despite improvements, perinatal mental health screening is not yet universal. One-in-five women are not screened both antenatally and postnatally, including women in high-risk populations such as those who have reported emotional distress. Implications for public health: Women are in regular contact with health professionals in the perinatal period. This opportunity to detect women at risk of perinatal mental health issues is too important to be missed.


Assuntos
Depressão Pós-Parto/epidemiologia , Depressão/epidemiologia , Programas de Rastreamento/tendências , Transtornos Mentais/diagnóstico , Saúde Mental/estatística & dados numéricos , Mães/psicologia , Assistência Perinatal/métodos , Adulto , Austrália/epidemiologia , Depressão/diagnóstico , Depressão/psicologia , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/psicologia , Feminino , Humanos , Estudos Longitudinais , Programas de Rastreamento/estatística & dados numéricos , Serviços de Saúde Materna/tendências , Saúde Mental/tendências , Parto , Assistência Perinatal/estatística & dados numéricos , Gravidez , Complicações na Gravidez , Angústia Psicológica , Inquéritos e Questionários , Adulto Jovem
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