Early Detection of Postpartum Depressive Symptoms in Mothers and Fathers and Its Relation to Midwives' Evaluation and Service Provision: A Community-Based Study.

Jana Anding,Melita Grieshop,Bernd Röhrle,Hanna Christiansen,Beate Schücking

doi:10.3389/fped.2015.00062

Abstract

Postpartum parental mental health problems pose a serious risk for child development and often remain undetected in postpartum primary care. Within the framework of the German Midwifes Prevention Study, the aim of this study was to investigate the presence of postpartum emotional distress in mothers and fathers, and the detection of distressed parents by midwives in a primary care setting. We also examined whether a temporal extension of the postpartum midwife care period is associated with greater use of midwife contacts and higher rates of referral to further professional support if needed. Mothers, fathers, and midwives filled out questionnaires at 2 weeks (t 1) and 6 months (t 2) postpartum. Compared to standard care in the control group (CG), midwives in an intervention group (IG) offered extended postpartum care of 6 months postpartum. Parental psychological distress was assessed using the Edinburgh postnatal depression scale (EPDS). Midwives reported on parental psychological distress as well as the number of postpartum contacts and referrals to additional social- and health-care providers. Based on their ratings, midwives identified half of mothers and around one-quarter of fathers with elevated depressive symptoms according to the EPDS at t 1 and t 2. IG mothers used significantly more midwife contacts than CG mothers. IG mothers with high-postnatal psychological distress at t 2 used significantly more contacts than mothers with lower levels of distress. IG mothers with high-psychological distress at t 2 were referred to additional support services more often than mothers with lower levels of distress.

Highlights

The birth of a child is a joyful event and a gain in resources for most families [1,2,3], but the transition to parenthood requires major adaptations and involves a set of challenges and demands that can result in parental emotional distress
The results of this study show that irrespective of referrals arranged by midwives, 53% of highly distressed mothers were using additional support at 6 months postpartum
A significant number of newborn children are confronted with psychologically distressed parents, which is a major risk factor for child development [21,22,23]

Summary

Introduction

The birth of a child is a joyful event and a gain in resources for most families [1,2,3], but the transition to parenthood requires major adaptations and involves a set of challenges and demands that can result in parental emotional distress. In a German community sample, Reck et al [8] reported a somewhat lower prevalence rate of 8.7% for elevated depressive symptoms measured with the EPDS within the first 3 months postpartum. Research has strongly focused on postnatal mental health in mothers, the postpartum period is challenging for fathers [9]. Gawlik et al [16] recently reported a prevalence of 7.8% for elevated depressive symptoms measured with the EPDS in fathers 4–6 weeks postpartum in a German community sample. Within the framework of the German Midwifes Prevention Study, the aim of this study was to investigate the presence of postpartum emotional distress in mothers and fathers, and the detection of distressed parents by midwives in a primary care setting. We examined whether a temporal extension of the postpartum midwife care period is associated with greater use of midwife contacts and higher rates of referral to further professional support if needed

Objectives

Methods

Results

Discussion

Conclusion