The association between prepregnancy obesity and screening positive for postpartum depression.

OBJECTIVE: To describe the association between reported prepregnancy body mass index (BMI) and screening positive for depression. DESIGN: Cohort study. SETTING: Four urban hospitals in Utah, USA. POPULATION: Women delivering a term, singleton, live-born infant at one of four urban hospitals in Utah in the period 2005-2007. METHODS: Women were enrolled immediately postpartum. Demographic, anthropometric, stressors, psychiatric, and medical/obstetric and family-history data were obtained. Prepregnancy height, weight, and pregnancy weight gain were self-reported. The primary exposure variable, prepregnancy BMI, was calculated. Women were stratified into the six World Health Organization BMI categories (underweight, normal weight, pre-obese, or obese class 1-3). MAIN OUTCOME MEASURE: At 6-8 weeks postpartum, women were screened for depression using the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome measure was a prespecified EPDS score of > or =12. RESULTS: Among the 1053 women studied, 14.4% of normal weight women screened positive for postpartum depression. This proportion was greater in women classed as underweight (18.0%, n = 11), pre-obese (18.5%, n = 38), obese class 1 (18.8%, n = 16), obese class 2 (32.4%, n = 11), and obese class 3 (40.0%, n = 8) (P < 0.01). Controlling for demographic, psychological, and medical/obstetric factors, prepregnancy class-2 (aOR 2.87, 95% CI 1.21-6.81) and class-3 (aOR 3.94, 95% CI 1.38-11.23) obesity remained strongly associated with screening positive for postpartum depression, compared with women of normal weight. CONCLUSIONS: Self-reported prepregnancy obesity may be associated with screening positive for depression when measured postpartum.

Social support, life events, and depression during pregnancy and the puerperium.

A sample of 99 women was studied prospectively from the second trimester of pregnancy until nine weeks post partum. Depressed and nondepressed women identified at the second-trimester assessment and the postpartum assessment were compared on measures of stressful life events and social support provided by their spouses and close confidants. Nine percent of women during pregnancy and 12% of women after delivery were depressed. Women experiencing postpartum depression reported more stressful life events and less support from their spouses after delivery than the women not experiencing postpartum depression. Women experiencing depression during pregnancy reported somewhat less support from their spouses and more support from their confidants than nondepressed women. The results of the study suggest that different causes may be responsible for prepartum and postpartum depression.

Efficacy of interpersonal psychotherapy for postpartum depression.

BACKGROUND: Postpartum depression causes women great suffering and has negative consequences for their social relationships and for the development of their infants. Research is needed to evaluate the efficacy of psychotherapy for postpartum depression. METHODS: A total of 120 postpartum women meeting DSM-IV criteria for major depression were recruited from the community and randomly assigned to 12 weeks of interpersonal psychotherapy (IPT) or to a waiting list condition (WLC) control group. Subjects completed interview and self-report assessments of depressive symptoms and social adjustment every 4 weeks. RESULTS: Ninety-nine of the 120 patients completed the protocol. Hamilton Rating Scale for Depression (HRSD) scores of women receiving IPT declined from 19.4 to 8.3, a significantly greater decrease than occurred in the WLC group (19.8 to 16.8). The Beck Depression Inventory (BDI) scores of women who received IPT declined from 23.6 to 10.6 over 12 weeks, a significantly greater decrease than occurred in the WLC group (23.0 to 19.2). A significantly greater proportion of women who received IPT recovered from their depressive episode based on HRSD scores of 6 or lower (37. 5%) and BDI scores of 9 or lower (43.8%) compared with women in the WLC group (13.7% and 13.7%, respectively). Women receiving IPT also had significant improvement on the Postpartum Adjustment Questionnaire and the Social Adjustment Scale-Self-Report relative to women in the WLC group. CONCLUSIONS: These findings suggest that IPT is an efficacious treatment for postpartum depression. Interpersonal psychotherapy reduced depressive symptoms and improved social adjustment, and represents an alternative to pharmacotherapy, particularly for women who are breastfeeding.

Prospective study of postpartum blues. Biologic and psychosocial factors.

Potential biologic and psychosocial causative factors for the postpartum blues were tested in a prospective study of 182 women followed up from the second trimester of pregnancy until postpartum week 9. Personal and family history of depression, depressive symptoms, stressful life events, and social adjustment were all assessed during the second trimester. Levels of progesterone, prolactin, estradiol, free and total estriol, and free and total cortisol were measured on several occasions during late pregnancy and early puerperium. Obstetric and child-care stressors and the postpartum blues were assessed after delivery. Predictors of the postpartum blues were personal and family history of depression, social adjustment, stressful life events, and levels of free and total estriol. Our results support the hypothesis that the postpartum blues is within the spectrum of affective disorders.

Description and evaluation of the Iowa Depression Awareness, Recognition, and Treatment Program.

OBJECTIVE: The National Institute of Mental Health developed the Depression Awareness, Recognition, and Treatment Program to provide up-to-date information and training to health, mental health, and social service professionals regarding the identification and treatment of depression. This study was undertaken to evaluate a series of these programs for professionals who provide services to rural residents in the Midwest. METHOD: The 18 2-day training programs were attended by a total of 1,221 participants, physicians, psychologists, social workers, and nurses. Participants' knowledge regarding depression was assessed both before and after each program. Practice characteristics and perceived ability to assess and treat depression were assessed. Finally, 6-month follow-up evaluations of the usefulness of the training to the participants were undertaken. RESULTS: Following the programs, participants evidenced significant increases in levels of knowledge of depression and a high degree of satisfaction with most elements of the program. Six-month follow-up evaluations indicated a continued positive evaluation of the program. CONCLUSIONS: These outcomes suggest that the goals of the Depression Awareness, Recognition, and Treatment Program were met and provide support for the wider dissemination of these training programs.

Measurement of depression in clinical trials: an overview.

The purpose of this article is to provide an overview of the commonly used measures of depression in order to help clinicians better interpret the results of clinical studies of depression. In the first section comprehensive and specific depression measures are contrasted. In the second section five classes of depression measures are defined: self-report, self-monitoring, ratings of significant others, clinical ratings, and ward observations. Several methodological issues are illustrated in discussing the liabilities, assets, and possible misuses of each class. Recommendations for accurate interpretation of depression measures are listed in the conclusion.

A prospective study of sleep, mood, and cognitive function in postpartum and nonpostpartum women.

OBJECTIVE: To compare the sleep patterns, mood states, and cognitive functioning of primiparous mothers during the first 3 weeks postpartum with those of a control group of nonpostpartum women and to assess the relationships among these variables. METHODS: For the first 3 weeks postpartum, 30 primiparous women and 28 nonpostpartum mothers completed daily assessments of mood and recorded multiple aspects of sleep including time of retiring, occurrence and duration of sleep interruption, time of awakening, and morning alertness. Objective measures of memory, attention/concentration, and psychomotor performance were obtained on three occasions. RESULTS: Postpartum women reported more evening awakenings, more time awake after retiring, and more naps than controls, but overall sleep time was similar. New mothers experienced a higher level of dysphoric mood during the first week than nonpostpartum controls; however, controlling for the effect for "time awake" at night eliminated the significant effect for dysphoric mood. Few differences were observed on the multiple assessments of cognitive function; however, performances of new mothers on memory and psychomotor tasks were likely to be influenced by sleep loss. CONCLUSION: Women must make important adjustments in their sleep patterns during the postpartum period. In the study group, these adjustments were largely successful, particularly after the first week postpartum, in avoiding the negative consequences of sleep disturbances such as dysphoric mood and impaired cognitive function. Nevertheless, the significant associations between sleep indices and mood and objective measures of cognitive function point to the importance of encouraging appropriate amounts of sleep for recently delivered women.

Abuse history and chronic pain in women: I. Prevalences of sexual abuse and physical abuse.

OBJECTIVE: To compare the prevalences of childhood and adult physical and sexual abuse in women with chronic pelvic pain to those in women with chronic nonpelvic pain (headache) and pain-free women. METHODS: Using a structured interview, we assessed the prevalence rates of both sexual abuse and physical abuse in 64 women with chronic pelvic pain, 42 women with chronic headache, and 46 pain-free women. Abuse histories were stratified by age at occurrence and severity. Demographic characteristics of the three groups were also assessed. RESULTS: Women with chronic pelvic pain were found to have a higher lifetime prevalence of sexual abuse, involving penetration or other contact with the unclothed genitals or anus (ie, major sexual abuse), than either comparison group. Further, more women in the chronic pelvic pain group had experienced major sexual abuse in both childhood and adulthood than women in the headache group, but there was no difference with the pain-free group. With respect to physical abuse, women in the chronic pelvic pain group had a higher lifetime prevalence than pain-free women, but not compared to those with chronic headache. In addition, more women with chronic pelvic pain reported physical abuse in both childhood and adulthood and both major sexual abuse and physical abuse at some time in their lives than did either comparison group. CONCLUSIONS: These results support a specific association between major sexual abuse and chronic pelvic pain and a more general association between physical abuse and chronic pain. Moreover, the global nature of the abuse histories of the women in the chronic pelvic pain group suggests that more rigorous studies of the relation between abuse history and chronic pelvic pain are needed.

Abuse history and chronic pain in women: II. A multivariate analysis of abuse and psychological morbidity.

OBJECTIVE: To assess the potential role of childhood and adulthood physical and sexual abuse and complaints of chronic pain in accounting for psychiatric symptomatology in adult women. METHODS: We assessed sexual abuse, physical abuse, depression, anxiety, and somatization in 64 women with chronic pelvic pain, 42 women with chronic headache, and 46 women without chronic pain complaints. Using multiple regression analyses, we tested a model comprising sociodemographic, chronic pain, childhood sexual abuse and physical abuse, and adulthood sexual abuse and physical abuse variables in the prediction of depression, anxiety and somatization. RESULTS: This model significantly predicted all three outcomes. However, childhood sexual abuse was not significant in the prediction of any of the outcome variables, whereas childhood physical abuse was significant in the prediction of all three. Further, the adulthood abuse variable set contributed significantly to the prediction of somatization, and the individual variable of adulthood sexual abuse was predictive of anxiety. CONCLUSIONS: The relation observed between childhood sexual abuse and the outcomes of depression, anxiety, and somatization in women may be a function of its association with other forms of abuse, particularly childhood physical abuse. Further investigation is clearly needed of the nature of the relations between the various categories of abuse and psychological morbidity.

Item characteristics of the Hamilton Rating Scale for Depression.

The Hamilton Rating Scale for Depression has become a popular instrument for quantifying clinical assessments of the severity of depression in psychiatric research, and data on its psychometric properties continue to accumulate. Data are presented on item interrater reliability, internal consistency, concurrent validity, and ability to differentiate depressed from non-depressed groups. Recommendation for a reduced scale and for anchoring point guidelines are made.

Symptom contamination of life event scales.

One hundred and seventy postpartum women completed the Social Readjustment Rating Scale (SRRS) and the Beck Depression Inventory (BDI). The point-biserial correlation between each item on the SRRS and the BDI was calculated. The four items identified by Lehman (1978) as being symptoms rather than life events per se were more highly correlated with the BDI than the remaining items. However, the correlation between the life event scale and the BDI was not significantly lowered after these items were removed. It is concluded that while life event scales should not include such symptom-like items, the contention made by some critics of the life event literature that all research using the Holmes and Rahe instrument is undermined soley because of the inclusion of these items, may be inappropriate.

Increases in depressive symptomatology in the rural elderly: results from a cross-sectional and longitudinal study.

Depressive symptomatology was examined in a large sample of noninstitutionalized older adults using the Center for Epidemiological Studies-Depression scale (CES-D). Both cross-sectional and longitudinal data showed age-related increases in mean CES-D scores and increases in the percentage of respondents scoring at or above the cutoff score of 16. Variables collected at baseline in the longitudinal study from 2,032 participants 65 years of age and older were significant predictors of depressive symptomatology 3 and 6 years later. Baseline CES-D scores accounted for the largest proportion of the variance.

Self-discrepancies in clinically anxious and depressed university students.

Self-discrepancy theory proposes that anxiety and depression are the result of different types of conflicting self-beliefs. This study examined self-discrepancies in four groups of university students who completed a questionnaire assessing levels of self-discrepancy and were characterized by the following disorders: (a) depression, (b) anxiety, (c) both anxiety and depression, or (d) no psychiatric disorder. As predicted, subjects with anxiety or depressive disorders had higher levels of self-discrepancy than normal subjects. Depressive subjects had higher levels of actual:ideal discrepancies than nondepressive subjects. Anxious subjects (with or without depressive disorders) had higher levels of actual:ought discrepancies than nonanxious subjects (normals and depressed-only subjects). Results provided general support for self-discrepancy theory in accounting for depressive and anxiety disorders.

Prospective study of postpartum depression: 4 1/2-year follow-up of women and children.

The consequences of maternal postpartum depression for mothers and children were investigated in a 4 1/2-year follow-up study, which included 70 of 99 women who had participated in an earlier study of postpartum depression. Information about maternal adjustment and depression during the follow-up period and child adjustment at age 4 1/2 years was obtained. Women who had experienced a postpartum depression were predicted to be at increased risk for subsequent depression and poor adjustment of their child. Postpartum depression was directly related to subsequent depression but not child problems. Later depression was related to child problems at 4 1/2 years. We concluded that postpartum depression may increase risk for later maternal depression and in turn increases risk for child behavior problems. Intervening with women who have experienced a postpartum depression may reduce likelihood of future depressions and child behavior problems.

Controlled prospective study of postpartum mood disorders: comparison of childbearing and nonchildbearing women.

A controlled prospective study was undertaken to determine the extent to which pregnancy and the puerperium are associated with increased risk for minor and major depression, depressive symptom-atology, and poor social adjustment. A large sample of childbearing (CB) women were recruited during the second trimester of pregnancy along with an equal sized, matched sample of nonchild-bearing (NCB) women. Ss were assessed multiple times during pregnancy and after delivery by questionnaire and through personal interview on measures of depression and other mood states and marital and social adjustment. There were no differences between CB and NCB Ss with respect to rates of minor and major depression during pregnancy or after delivery. However, CB women experienced significantly higher levels of depressive symptomatology and poor social adjustment than NCB women during late pregnancy and the early puerperium.

Controlled prospective study of postpartum mood disorders: psychological, environmental, and hormonal variables.

Demographic, psychiatric, social, cognitive, and life stress variables were used to determine the etiology of depression in childbearing (CB; n = 182) and nonchildbearing (NCB; n = 179) women. Hormonal variables in postpartum depression were also evaluated. In the CB group predictors of depression diagnosis were previous depression, depression during pregnancy, and a Vulnerability (V) x Life Stress (LS) interaction; predictors of depressive symptomatology were previous depression, depressive symptoms during pregnancy, life events, and V x LS. Only estradiol was associated with postpartum depression diagnosis. In the NCB group V X LS was the only predictor of depression diagnosis; depressive symptoms during pregnancy and life events were predictors of depressive symptomatology. Previous findings about depression vulnerability were replicated. The significant V x LS interactions support the vulnerability-stress model of postpartum depression.

Memory complaint and memory performance in the depressed elderly.

Depressed and nondepressed elderly subjects recruited in the context of a large epidemiological study of health were compared on measures of self-reported memory disturbance and an objective index of memory performance (free recall). Three groups were studied including (a) subjects meeting Research Diagnostic Criteria (RDC) for major depression, (b) subjects with high levels of self-reported depressive symptoms who did not meet RDC for major depression, and (c) subjects with low levels of self-reported depressive symptoms. Subjects with high depression symptom levels reported significantly higher levels of memory complaint than did subjects with low symptom levels. However, there were no differences in self-reported memory disturbance as a function of depression diagnosis. Further, there were no significant differences between groups on the free-recall measure, either as a function of symptom level or diagnosis. It is argued that symptom severity rather than diagnosis of depression is important in determining impairment in depressed elderly people.

The effects of maternal mood on mother-infant interaction.

The effects of depressed mood on mother-infant interaction were studied in 30 mother-infant dyads using the Velten mood induction procedure. It was predicted that maternal depressed mood would induce dysphoria in the infants, disrupt the infants' natural responsiveness to their mothers, and interfere with the mothers' ability to manage the interaction. In addition, it was predicted that such deficits would be the result of depressed maternal mood and not simply due to any change in maternal mood. The results indicated that the infants were sensitive to depressed mood and were less contingently responsive to their mothers than were controls. Also, mothers in the depression induction condition were less successful in eliciting positive responses from their infants than were controls. These results have implications for the development of a helplessness vulnerability in infants and for the two-way direction of effect present in depressed mother-infant dyads.

Treatment-resistant pain and distress during pediatric burn-dressing changes.

Recent research has suggested some efficacy for the use of hypnosis in the control of pain and distress in a pediatric population undergoing painful medical procedures. Here, we study a sample (N=23) of pediatric subjects undergoing burn-dressing changes and receiving either an imagery-based or control (social-support) treatment. Subjects' levels of distress were assessed with the Observational Scale of Behavioral Distress. Results indicated that distress behaviors in this population can be measured reliably using this scale. However, no support was found for the main hypothesis that imagery treatment would be superior to control treatment in the alleviation of distress, nor were these treatments effective in comparison to baseline conditions. We discuss the formidable problem that burn and dressing-change pain presents, as well as the reasons why this treatment attempt might have failed to have the predicted effects. We also discuss important developmental considerations regarding the adequate assessment of pain and distress.

Parent participation during burn debridement in relation to behavioral distress.

The data on the benefits of parent participation during pediatric medical procedures are mixed. Although a wealth of clinical experience and survey data strongly recommend parent participation in a child's medical care, the mere presence of a parent, particularly during medical procedures, may be insufficient to decrease behavioral distress. This study examined a sample of children aged 3 through 12 undergoing three successive burn dressing changes. For some sessions, parents were present, and for others, they were not. A valid and reliable measure of behavioral distress was taken, as was an informal measure of the level of parent participation. Results indicated no differences between mothers and fathers in the level or the nature of participation, little change in the level of participation across time, and higher levels of physical comforting than verbal comforting. Results also indicated higher levels of behavioral distress in subjects when parents were present versus when absent, which extends previous findings. Results are discussed in terms of the literature on parent and child preferences for parent involvement and parent coaching programs.