Epidemiological investigation of perinatal depression among pregnant and postpartum women: findings from a cross-sectional survey in the Philippines.

The current COVID-19 pandemic is a unique stressor with potentially negative consequences for pregnant and postpartum women. We investigated the impact of the COVID-19 pandemic on perinatal depression and anxiety in Spain. This cross-sectional study was conducted from June to December 2020. A total of 3,356 adult pregnant and postpartum women (with infants up to 6 months of age) from all Spanish regions were surveyed. The assessment included measures of Coronavirus Perinatal Experiences (COPE-IS questionnaire) and Generalized Anxiety Disorder Screener (GAD-7=10) and Edinburgh Postnatal Depression Scale (EPDS=10). The prevalence of perinatal anxiety and depression (above established cut-offs) was 33.3% and 47.2%, respectively; 29.2% of women screened positive for both conditions. Higher rates of perinatal depression and anxiety were associated with increased concern about threats of COVID-19, especially employment and the financial impact, along with increased overall levels of distress. Exposure to COVID-19 and its symptoms did not appear to be a relevant risk factor. More COVID-19-related predictors and a higher rate of depression were found in postpartum women. The current study highlights the substantial increase in symptoms of perinatal depression and anxiety, especially in postpartum women. Interventions for perinatal mental health should be a priority.

Perinatal depression occurs in 12% to 18% of childbearing women. Telehealth is a promising platform for delivering perinatal mental health care, particularly during a pandemic when in-person services have been significantly curtailed. However, there is little research to document the feasibility of telehealth to address perinatal depression. This pilot study evaluated the feasibility and preliminary results of an 8-week facilitated group videoconference intervention. The study enrolled pregnant and postpartum women into an 8-week group mindfulness-based cognitive behavioral intervention, delivered via videoconference platform. Women receiving care at outpatient clinics who either screened positive for perinatal depression symptoms or had risk factors predictive of perinatal depression were invited to participate. Women attended weekly one-hour group sessions using their own electronic device and completed the Edinburgh Postnatal Depression Scale (EPDS) at several time points. Session attendance and survey completion rates were evaluated. A total of 47 women enrolled (8 postpartum; 39 prenatal) into groups of 4 to 6. Twenty-four (51.1%) women were currently experiencing mild to moderate perinatal depression symptoms (EPDS score of 10-20), whereas 23 (48.9%) women had EPDS scores less than 10 but were at high risk for developing perinatal depression due to health history and significant life events. Seventy percent of women attended at least 5 of the 8 sessions. Trajectories of EPDS measures were promising (ie, downward among those with current perinatal depression symptoms and stable among those at high risk for developing perinatal depression). These observational results are promising, suggesting further study of effectiveness for women with symptoms of perinatal depression, as well as for women at high risk for developing perinatal depression. Randomized trials could evaluate the effectiveness of the intervention, compared with standard of care approaches. Telehealth interventions can be tailored to meet the needs of different communities, and increase access to care, regardless of where women live or inability to receive in-person services.

Conception by means of in vitro fertilization is not associated with maternal depressive symptoms during pregnancy or postpartum

This study assessed prevalence of perinatal depression symptoms (PNDS) during the COVID-19 pandemic among Arab and Jewish women in Israel and identified COVID-19-related risk factors for PNDS, while comparing Arab and Jewish women. Sample included 730 perinatal women (604 Jewish and 126 Arab) aged 19–45 years, who filled out an online self-report questionnaire. The questionnaire assessed several areas: perinatal experiences and exposure to COVID-19, social support, and financial and emotional impact. PNDS was measured by the Edinburgh Postnatal Depression Scale (EPDS). Prevalence of PNDS (EPDS ≥ 10) in the entire study population was 40.0%. Prevalence among Arab women was significantly higher compared to Jewish women (58% vs. 36%, PV < 0.001). Higher PNDS were significantly associated with anxiety symptoms (GAD ≥ 10) (PV < 0.001), stress related to COVID-19 (PV < 0.001), adverse change in delivery of healthcare services (PV = 0.025), and unemployment (PV = 0.002). PNDS has elevated more than twofold during COVID-19 in Israel. Such high rates of PNDS may potentially negatively impact women, and fetal and child health development. This situation requires special attention from public health services and policy makers to provide support and mitigation strategies for pregnant and postpartum women in times of health crises.

BackgroundThe COVID-19 pandemic was a significant threat to perinatal mental health. This study examined differences in clinically significant depression, anxiety, and co-morbid symptoms among pregnant and postpartum women across several countries and compared prevalence of perinatal depression and anxiety before and during the pandemic in each participating country. MethodsParticipants were 3326 pregnant and 3939 postpartum women (up to six months postpartum) living in Brazil, Chile, Cyprus, Greece, Israel, Portugal, Spain, Turkey, and the United Kingdom. An online survey was completed between June 7th and October 31st 2020, and included the Edinburgh Postnatal Depression Scale (EPDS) and the Generalized Anxiety Disorder Screener (GAD-7). The pre-pandemic studies were identified through literature review. ResultsPrevalence of clinically significant depression (EPDS≥13), anxiety (GAD-7 ≥ 10), and co-morbid (EPDS≥13 and GAD-7 ≥ 10) symptoms was 26.7 %, 20 % and 15.2 %, in pregnant women, and 32.7 %, 26.6 % and 20.3 %, in postpartum women, respectively. Significant between-country differences were found in all mental health indicators in both perinatal periods. Higher levels of symptoms were observed during (versus before) the pandemic, especially among postpartum women. LimitationsParticipants were mostly highly educated and cohabiting with a partner. The online nature of the survey may have limited the participation of women from vulnerable socio-economically backgrounds. ConclusionsOur findings expand previous literature on the negative impact of the COVID-19 pandemic on perinatal mental health, by highlighting that this may be influenced by country of residence. Mental health care policies and interventions should consider the unique needs of perinatal women in different parts of the world.

BackgroundDepression and anxiety impact up to 1 in 5 pregnant and postpartum women worldwide. Yet, as few as 20% of these women are treated with frontline interventions such as evidence-based psychological treatments. Major barriers to uptake are the limited number of specialized mental health treatment providers in most settings, and problems with accessing in-person care, such as childcare or transportation. Task sharing of treatment to non-specialist providers with delivery on telemedicine platforms could address such barriers. However, the equivalence of these strategies to specialist and in-person models remains unproven.MethodsThis study protocol outlines the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) randomized trial. SUMMIT is a pragmatic, non-inferiority test of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a brief, behavioral activation (BA) treatment for perinatal depressive and anxiety symptoms. Specialists (psychologists, psychiatrists, and social workers with ≥ 5 years of therapy experience) and non-specialists (nurses and midwives with no formal training in mental health care) were trained in the BA protocol, with the latter supervised by a BA expert during treatment delivery. Consenting pregnant and postpartum women with Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 10 (N = 1368) will be randomized to one of four arms (telemedicine specialist, telemedicine non-specialist, in-person specialist, in-person non-specialist), stratified by pregnancy status (antenatal/postnatal) and study site. The primary outcome is participant-reported depressive symptoms (EPDS) at 3 months post-randomization. Secondary outcomes are maternal symptoms of anxiety and trauma symptoms, perceived social support, activation levels and quality of life at 3-, 6-, and 12-month post-randomization, and depressive symptoms at 6- and 12-month post-randomization. Primary analyses are per-protocol and intent-to-treat. The study has successfully continued despite the COVID-19 pandemic, with needed adaptations, including temporary suspension of the in-person arms and ongoing randomization to telemedicine arms.DiscussionThe SUMMIT trial is expected to generate evidence on the non-inferiority of BA delivered by a non-specialist provider compared to specialist and telemedicine compared to in-person. If confirmed, results could pave the way to a dramatic increase in access to treatment for perinatal depression and anxiety.Trial registrationClinicalTrials.gov NCT 04153864. Registered on November 6, 2019.

Leveraging Telehealth in the United States to Increase Access to Opioid Use Disorder Treatment in Pregnancy and Postpartum During the COVID-19 Pandemic.

BackgroundYazidi survivors of a 2014 genocidal attack by the self-proclaimed Islamic State of Iraq and Syria (ISIS) have complex medical and mental health needs in the perinatal and postpartum period. Few studies have assessed perinatal mental health needs for this population of women who are living in camps for Internally Displaced Persons (IDP) in the Kurdistan Region of Iraq (KRI).MethodsThe specific aim of this formative cross-sectional study was to assess the prevalence of perinatal depressive symptoms, specifically the risk of perinatal depression symptoms, among a purposive sample of Yazidi women living in camps for internally displaced persons in the Kurdistan region of Iraq. One hundred twenty-two pregnant and recently postpartum (<1 year) Yazidi women completed a Kurdish-language version of the Edinburgh Postnatal Depression Scale (EPDS) questionnaire. Pregnant and postpartum participants’ responses were analyzed together, in order to assess an overall combined risk of perinatal mental health issues for the study population. Logistic regression analyses were used to measure the association of participant characteristics with an elevated risk of perinatal depressive symptoms.ResultsParticipants were 17-45 years of age (mean 32 years, SD 7.63) Among the 122 women, 67.2% (n=82) were pregnant and 32.8% (n=40) were <1 year postpartum. Overall, 78% (n=95) of participants were at an elevated risk of depression (EPDS >10), and 53% (n=65) of all participants were at risk of moderate to severe depression (EPDS >12). Thoughts of self-harm (EPDS item 10) were reported among 97% (n=118) of participants. Logistic regression analysis indicated that increased risk of perinatal depressive symptoms was significantly associated with reports of health problems during pregnancy (OR=3.22, 95% [CI]:1.08-9.61) and marital status (OR=16.00; 95% [CI]: 0.42-0.50). Age (OR= 0.84; 95% [CI]: 0.75–0.94) and level of education (OR=0.15; 95% [CI]: 0.42-0.50) had protective effects.ConclusionsRates of perinatal depressive symptoms risk among internally displaced Yazid pregnant and postpartum women are higher than the general Kurdish-speaking population in Iraq (28.4%). Culturally responsive trauma informed perinatal and postpartum care services, which include both community-based and clinical strategies for perinatal depressive symptoms and suicide prevention for this population, are critically needed.

Special Report: Women’s Reproductive Mental Health—A Clinical Framework

Purpose/AimTo evaluate the outcomes of a program designed to standardize mental health screenings and facilitate entry to mental health care for low‐income inner‐city pregnant and postpartum women.Research Questions1) Identify the most common stressors affecting pregnant and postpartum women 2) Determine the percentage of women who engage in mental health care and whether adherence with mental health care varies by setting or pregnancy status; and 3) Describe the changes in depressive symptoms from early pregnancy to 6 weeks postpartum.Significance/BackgroundUndetected and untreated depression is associated with poorer maternal and neonatal outcomes. Unfortunately, mental health resources are limited, particularly for vulnerable women living in impoverished communities. Our program was designed to maximize mental health resources. Key elements include: 1) provider training, 2) co‐located mental health services, and 3) inclusion of a mental health “meet‐and‐greet” visit into the primary care visit for women in crisis.MethodsData on depressive symptoms, reasons for referral to mental health services, and adherence to care were abstracted from the medical records of pregnant and postpartum women receiving care from January 1, 2010 to June 30, 2012.FindingsOur protocol resulted in high rates of screening for and adherence to mental health care; 95.0% of pregnant women (n = 425) and 90.0% of postpartum women (n = 269) were screened for depressive symptoms. Higher rates of depressive symptoms, as measured by a positive Patient Health Questionnaire‐2 (PHQ‐2) score, were seen prenatally (43%) than in early postpartum (7%), although clinical depression was more common postpartum than during pregnancy. For women who continued care and were rescreened postpartum (n = 118), 48% had depressive symptoms neither in pregnancy nor postpartum, 41% experienced depressive symptoms only in pregnancy, 6% reported symptoms after birth not in pregnancy, and 5% were symptomatic in both time periods. Fifty percent of referrals were prompted by significant psychosocial factors such as personal or family stress, need for concrete services, and prior history of depression, anxiety, or trauma. Compliance with recommended care was significantly higher for care offered on‐site (P &lt; .01). Of the pregnant (n = 110) and postpartum (n = 22) women referred for mental health services, 57.8% of pregnant women and 84.2% of postpartum women were known to have kept their appointments in‐house compared to only 11.1% of pregnant and 33.3% of postpartum women who were referred to another facility.DiscussionOur results highlight differences in the prevalence of depressive symptoms and clinical depression in pregnant and postpartum women. In‐house mental health services were associated with significantly higher attendance rates for mental health care. Implementing a standardized screening and referral system, with the majority of services provided on‐site, resulted in high screening rates and compliance with mental health care.

Physical activity (PA) may help reduce severity of depressive symptoms in women with perinatal depression (depression during pregnancy or postpartum). However, less than one third of pregnant and postpartum women meet national PA recommendations, and PA is likely even lower in women with perinatal depression. Barriers and motivators for PA among women with perinatal depression are not well understood. PURPOSE: The aim of this study was to identify barriers and motivators for PA among women with perinatal depression. METHODS: Pregnant and postpartum women with perinatal depression were identified using Kaiser Permanente Northern California’s universal perinatal depression screening program. We conducted 8 focus groups totaling 35 women with prenatal (n=15) and postpartum depression (n=20). Focus groups were analyzed using an inductive approach. RESULTS: Pregnant women were, on average, 27 weeks gestation (range: 11-37) with mild to moderately severe depressive symptoms (Patient Health Questionnaire (PHQ)-8 mean: 10; range: 4-19). Postpartum women were, on average, 12.5 months postpartum (range: 8.5-16.5) with no to moderately severe depressive symptoms (PHQ-8 mean: 7; range: 0-16). Perceived barriers to PA identified by pregnant and postpartum women included low energy and mood, limited time due to other priorities, feeling discouraged when comparing to pre-pregnancy self, and limited geographic accessibility and high cost of group exercise classes. Unique barriers identified by pregnant women were physical discomfort and fear of judgement from others. Postpartum women identified lack of childcare as an additional barrier. Motivators for PA identified by pregnant and postpartum women included self-care (“me time”), improved mood after PA, making progress toward goals, being strong and fit to keep up with their children, and having a social support system. CONCLUSIONS: Interventions to increase PA in pregnant and postpartum women with perinatal depression should include components addressing motivation, time, geographic accessibility, and cost barriers. Interventions can also increase PA by promoting potential mood benefits, fostering a sense of accomplishment, and leveraging social support as motivators in pregnant and postpartum women with perinatal depression.

BackgroundPerinatal depression is broadly defined as depressive symptoms during pregnancy or within the 12 months following delivery, affecting approximately 20–25% of pregnant and postpartum women in low- and middle-income countries. The wide accessibility of mobile phones allows mobile health (mHealth) interventions to be considered a solution to identify perinatal depression and provide appropriate referrals for treatment. This study, nested in a larger SMS communication project, examined the prevalence and correlates of perinatal depression, determined the association between antenatal depression and infant morbidity and mortality, and compared SMS communication patterns between women with and without perinatal depression.MethodsThis was a prospective longitudinal cohort study of pregnant women seeking antenatal services at two public sector health clinics in Kenya. SMS messages were sent to participants with educational content related to their pregnancy and infant health and two-way SMS communication occurred with a nurse. Sociodemographic and obstetric characteristics, SMS messaging behaviors, infant health status, and depressive symptoms were assessed by a standardized questionnaire administered at enrollment (30–36 weeks gestation) and follow-up (14 weeks postpartum). Generalized estimating equation (GEE) with Poisson link was used to evaluate correlates of perinatal depressive symptoms, infant outcomes, and frequency of SMS messaging.ResultsOf the 572 women with complete follow-up information, 188 (32.9%) screened positive for elevated depressive symptoms (≥10 by EPDS scale) at some time point during pregnancy or postpartum. The strongest predictors of any depressive symptoms included interpersonal abuse during pregnancy, fewer years of schooling, and maternal unemployment. Antenatal depressive symptoms were associated with an increased risk of infant illness or hospitalization (RR = 1.12, 95% CI: 1.11, 1.13). Women with antenatal or persistent perinatal depressive symptoms sent fewer SMS messages during the study period than their counterparts without depression.ConclusionsPrevalence of elevated perinatal depressive symptoms was high in this cohort of Kenyan women. Our findings highlight the importance of screening perinatal women for experiences of symptoms of depression as well as abuse. Differences in messaging frequency between women with vs. without depressive symptoms presents an opportunity to provide more tailored support for those perinatal depression.

Unmet needs in perinatal mental healthcare are an important public health issue particularly in the context of a stressful life event such as the COVID-19 pandemic but data on the extent of this problem are needed. The aim of this study is to determine the (1) proportion of women with clinically significant symptoms of perinatal depression, anxiety or comorbid symptoms of depression and anxiety, receiving mental healthcare overall and by country and (2) factors associated with receiving mental healthcare. Women in the perinatal period (pregnancy or up to 6 months postpartum) participating in the Riseup-PPD-COVID-19 cross-sectional study, reported on sociodemographic, social support health-related factors, and COVID-19 related factors, and on symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (Generalised Anxiety Disorder [GAD-7]) using self-report questionnaires. Clinically significant symptoms were defined as EPDS ≥ 13 for depression and GAD-7 ≥ 10 for anxiety. Mental healthcare was defined as self-reported current mental health treatment. Of the 11 809 participants from 12 countries included in the analysis, 4 379 (37.1%) reported clinically significant symptoms of depression (n = 1 228; 10.4%; EPDS ≥ 13 and GAD-7 ⟨ 10), anxiety (n = 848; 7.2%; GAD-7 ≥ 10 and EPDS ⟨ 13) or comorbid symptoms of depression and anxiety (n = 2 303; 19.5%; EPDS ≥ 13 and GAD-7 ≥ 10). Most women with clinically significant symptoms of depression, anxiety, or comorbid symptoms of depression and anxiety were not receiving mental healthcare (89.0%). Variation in the proportion of women with clinically significant symptoms of depression and/or anxiety reporting mental healthcare was high (4.7% in Turkey to 21.6% in Brazil). Women in the postpartum (vs. pregnancy) were less likely (OR 0.72; 95% CI 0.59-0.88), whereas women with previous mental health problems (vs. no previous mental health problems) (OR 5.56; 95% CI 4.41-7.01), were more likely to receive mental healthcare. There are high unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety across countries during the COVID-19 pandemic. Studies beyond the COVID-19 pandemic and covering the whole range of mental health problems in the perinatal period are warranted to understand the gaps in perinatal mental healthcare.

Background: Annually, more than a million low birthweight (LBW) is born in India, often afflicting disadvantaged families. Several studies have undertaken the association of poverty, nutritional status, and obstetric factors with LBW. Through our study, we aimed to examine the possibility of any relation between the Edinburgh Postnatal Depression Scale (EPDS) score measured during pregnancy with the incidence of babies born Small for Gestational Age (SGA). Methods: Pregnant women attending the antenatal clinic at a public hospital between 14 to 32 weeks were recruited from April 2016 to Oct 2017. The EPDS was administered to assess depression through face-to-face interviews. Newborn anthropometry was performed post-delivery. For analysis, birth weight <10 percentile was classified as SGA. Results: Prevalence of depressive symptoms (EPDS score >11) was 16.5% (n=108/654) in antenatal mothers. These women delivered a higher proportion of SGA babies (21.3 v/s 15.8) compared to women with no symptoms. The odds of women giving birth to a child with SGA were twice as high for women with EPDS scores >11 (adjusted OR = 2.03; 95% CI = 1.12 - 3.70) compared to the women with EPDS scores of ≤11, The EPDS 12 (Adjusted OR = 1.96; 95% CI = 1.04 - 3.69) and EPDS 13 (Adjusted OR = 2.42; 95% CI = 1.24 - 4.70) cut-off categories also proved to be a risk factor for SGA with significant p-value (0.0006 and 0.0003) and the individuals with more than 13 EPDS score is found to have the highest odds of SGA. Conclusions: We found a strong association of antenatal depressive symptoms during pregnancy with SGA measured by EPDS. Thus, we recommend the implementation of timely and effective screening, diagnostic services, and evidence-based antenatal mental health services to combat SGA and further associated-metabolic syndromes.

Perinatal depression affects 10-20% of women and is associated with poor outcomes for mother and child. Inflammation is associated with depression in non-pregnant adults. Perinatal depression and inflammation in pregnancy are independently associated with morbidities including obesity, gestational diabetes, preeclampsia, and preterm birth. The role of inflammation in perinatal depression has received little attention. We hypothesized an association between self-reported perinatal depressive symptoms and serum inflammatory biomarkers TNF-α, IL-6, IL-1β, and CRP. 110 healthy gravidas were recruited in third trimester from an academic medical center, with a baseline study visit at a mean of 32.5 (SD ± 1.8) weeks gestational age. Sixty-three participants completed the Edinburgh Postnatal Depression Scale (EPDS) and provided demographic information and serum samples upon enrollment and at 3 and 6months postpartum. Serum inflammatory markers were quantified by multiplex array. Multiple linear mixed effects models were used to evaluate trends of biomarkers with the EPDS score in the third trimester of pregnancy and the postpartum period. Elevated serum TNF-α was associated with lower EPDS total score (β= - 0.90, p = 0.046) after adjusting for demographics and medication use. In contrast, IL-6, CRP, and IL-1β did not demonstrate statistically significant associations with depressive symptoms by the EPDS in either crude or adjusted models. Study findings showed no association or an inverse (TNF-α) association between inflammatory markers and perinatal depressive symptoms. Relevant literature evaluating a role for inflammation in depression in the unique context of pregnancy is both limited and inconsistent, and further exploration is merited.