Development Of Postnatal Depression Research Articles

Investigating Factors Associated with the Development of Postnatal Depression After Cesarean Delivery: A Validation Cohort Study.

This study aimed to validate a proposed association model previously published to determine the clinical relevance of pre-operative determinants in the development of PND after Cesarean delivery (CD). Parturients undergoing elective CD under neuraxial anesthesia were recruited for a prospective cohort study between Oct 2021 and Oct 2022 at KK Women's and Children's Hospital, Singapore. Predelivery pain, psychological and mechanical temporal summation, and demographic data were recorded. A follow-up survey was conducted at 6 to 10 weeks after CD. The primary outcome was the incidence of PND, defined as an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10. A total of 180 patients were recruited for validation. PND 6 to 10 weeks post-delivery occurred in 18.9% of recruited parturients. Multivariate regression analyses showed that higher pre-operative CSI scores (p=0.0156), higher anxiety levels about upcoming surgery (p=0.0429), increased pre-operative pain scores on movement (p=0.0110), and higher pre-operative HADS subscale scores on anxiety (p=0.0041) were independently associated with the development of PND weeks post-CD. Lower anticipation of pain medication needs (p=0.0038) was independently associated with the development of PND post-CD. The area under curve (AUC) of this multivariable model (training cohort), internal cross validation (training cohort) and external cross validation (validation cohort) were 0.818 (95% CI, 0.746 to 0.889), 0.785 (95% CI, 0.707 to 0.864) and 0.604 (95% CI, 0.497 to 0.710) respectively. The proposed model performed well in a local population. Further refinement is necessary to test the proposed model in populations with social and cultural differences.

The prevalence of postnatal depression and associated factors among clinic attendees in Maseru, Lesotho

The purpose of the study was to screen for postnatal depression (PND) symptoms among women attending primary health care (PHC) facilities within Maseru City Council in Lesotho. The Edinburg Postnatal Depression Scale (EPNDS) was used to screen for PND symptoms in a sample of 393 postnatal mothers, and a quantitative questionnaire was used to collect socio-demographic data. The Pearson chi-test of association was used to explore associations between socio-demographic variables and EPND scores (p<0.05). The ages of the participants ranged from 17 to 40, with a mean of 27 years. Most were married (n = 310, 78.88%) and unemployed (n = 254, 64.63%), with high school as their highest level of education (n = 272, 69.21%). The majority (n = 312, 79.6%) had between 1 and 2 children. A third of the sample were HIV positive (n = 117, 29.77%). The prevalence of PND symptoms was 43%. Social support, financial support from the partner, relationships with the partner, knowledge of HIV status, and having experienced a severe financial crisis were significantly associated with PND symptoms. On multivariate logistic regression, only financial support from a partner and having experienced a severe financial crisis remained significantly associated with the development of PND (p = 0.05). Risk factors for PND are mostly socio-economic. The high prevalence of PND highlighted the need to integrate routine screening of mothers for PND, which will enable early diagnosis and treatment and thus contribute to the improvement of maternal and child well-being in the country.

Caesarean Delivery and Postnatal Depression in a Tertiary Hospital in Southern Nigeria

Background: Postnatal depression is one of the most devastating of the mental disorders affecting women six weeks postpartum, accounting for more than 20% of maternal deaths after childbirth. It is said that young children of mothers with postnatal depression have greater behavioural problems than those of non- depressed mothers. Mode of delivery with other risk factors has been implicated as a predictive factor and caesarean section in any form is said to be most implicated. This study intends to contribute to the raging arguments on the relationship between caesarean section and postnatal depression.
 Objective: To examine the relationship between caesarean sections and postnatal depression.
 Methods: Women visiting the postnatal clinic six weeks postpartum who consented to the study, where interviewed and screened for depression using the study designed questionnaire and the Edinburg postnatal depressive scale (EPDS). Data obtained were analysed using the statistical package for social sciences (SPSS) version 23.0, p values <0.05 were statistically significant.
 Results: Out of 405 women who participated in the study, 135 (33.3%) had an EPDS score of > 12 points. Among the risk factors isolated which included co-habiting, death of children, children challenges and partner violence, caesarean section showed a very strong association p=0.001, OR 1.68, 95% cl=1.10-2.58. Emergency caesarean section showed a stronger association p=0.001, OR 3.6, 95%cl=2.35-5.69.
 Conclusion: Emergency caesarean section has a strong significant impact on the development of postnatal depression.

Association between Physical Activity and Postnatal Depression

Many changes could occur in a woman’s body, both mental and physical, during pregnancy and the postnatal period. The process of childbirth and a changing role as a new mom can be associated with many disturbances of emotions. Besides that, the development of baby blues or postpartum depression may occur in the puerperium period. Depression in post partum occurs in one month after childbirth and may be prolonged to one year. Depressive disorders in a young mother affect the mother and the newborn’s health status. That is why it is crucial to identify for factors that could significantly reduce the likelihood of developing depression in this period. The literature review was aimed at describing the relationship of physical activity during pregnancy and postpartum and the development of postnatal depression. It was shown that physical activity during pregnancy and puerperium, or in the postnatal period itself reduces the risk of developing depression in pregnancy and after delivery. Physical activity can be an essential factor in preventing depressive disorders in women in the postnatal period.

The Effect of Antepartum Depression on the Outcomes of Pregnancy and Development of Postpartum Depression: A prospective cohort study of Omani women.

ObjectivesThis study aimed to identify the relationship between antenatal depression and pregnancy outcomes, including the risk of developing postpartum depression in Oman.MethodsThis follow-up prospective longitudinal cohort study included pregnant women attending primary healthcare institutions in Muscat, Oman from January to November 2014. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for antenatal and postnatal depression. Pregnant Omani women with a gestational age ≥32 weeks attending 12 local health centres for antenatal care in Muscat were invited to participate. Recruited women were followed-up at 6–8 weeks after delivery. The following pregnancy outcomes were assessed: mode of delivery (normal or Caesarean section [CS]), gestational age at delivery (preterm or full-term), baby’s birth weight and development of postnatal depression.ResultsA total of 959 women participated in this study (response rate: 97.3%). In total, 233 women (24.4%) had antenatal depression with a score of ≥13 on the EPDS. Of the 592 participants (61.7%) who attended postnatal clinics at 6–8 weeks post-delivery, 126 (21.3%) were positive for postnatal depression. Logistic multivariate regression analysis showed that antenatal depression was associated with increased risk of CS (odds ratio [OR] = 1.79; 95% confidence interval [CI]: 1.20–2.66) and postnatal depression (OR = 8.63; 95% CI: 5.56–13.39).ConclusionScreening women for antenatal depression and providing appropriate management may reduce adverse pregnancy outcomes and the risk of developing postnatal depression.

Postnatal depressive features in mothers of neonates admitted to a neonatal unit at Steve Biko Academic Hospital: The role of sociodemographic and psychosocial factors

Background . Postnatal depression (PND) is one of the most common complications following delivery. The development of PND is closely linked with biological, psychological, socioeconomic and cultural factors. Objectives. To determine the prevalence and identify risk factors for PND in mothers delivering at Steve Biko Academic Hospital (SBAH) whose babies were admitted to the neonatal unit. Methods. We conducted a prospective observational study at SBAH, Pretoria, South Africa (SA). Women who delivered between 26 and 42 weeks' gestation at SBAH and whose babies were admitted to the neonatal unit were recruited at delivery. Interview screening using the Edinburgh Postnatal Depression Scale (EPDS) was conducted regarding the mother’s experience of her pregnancy and delivery. Sociodemographic and psychosocial data from the mothers were included in a multiple logistic regression model to estimate association with PND symptoms. Results. Between 11 March and 30 December 2017, 2 671 mothers delivered at SBAH. Of these, 196 (7.3%) babies were admitted to the neonatal intensive care unit (NICU) and 10 (0.3%) were admitted to the neonatal high care unit (NHC). Mothers’ accommodation during their babies’ admission to the neonatal unit ( p =0.002), having poor interpersonal relationships ( p <0.0001), and intimate partner violence (IPV) ( p =0.004) were significantly associated with screening positive for PND. Conclusion. Accommodation during neonatal care, availability of counselling, inclusion of the partner in postnatal care and IPV are significant factors in the depressive symptoms experienced by mothers postpartum in this setting

Factors Associated with the Development of Postnatal Depression After Cesarean Delivery: A Prospective Study.

PurposePre-operative association factors (pain and psychological vulnerability) could significantly contribute to post-Cesarean pain; however, limited information is available on the development of postnatal depression (PND). We aimed to investigate the development of PND and its association with pain vulnerability and psychological vulnerability factors.Patients and MethodsWomen undergoing Cesarean delivery under spinal anesthesia were given pre-operative questionnaires, psychological and pain assessments including pain on local anesthetic injection during spinal anesthesia and mechanical temporal summation. Post-operative assessments were administered at 6 to 10 weeks post-Cesarean delivery via follow-up survey to assess post-Cesarean psychological and pain outcomes.ResultsPND occurred in 21.1% (43 of 205) of patients who underwent elective Cesarean delivery. An increased pre-operative pain score with movement (Odds ratio (OR) 1.65, 95% CI 1.12–2.44, p = 0.0110), anxiety about upcoming surgery (OR 1.02, 95% CI 1.00–1.04, p = 0.0429), higher pre-operative Hospital Anxiety and Depression Scale (HADS) subscale on anxiety (OR 1.25, 95% CI 1.07–1.45, p = 0.0041) and higher pre-operative central sensitization inventory (CSI) scores (OR 1.05, 95% CI 1.01–1.09, p = 0.0156) were independently associated with an increased risk of PND. Anticipated pain medication needs were associated with reduced risk of PND (OR 0.48, 95% CI 0.29–0.79, p = 0.0038) (Receiver operating characteristic (ROC) = 0.8177).ConclusionHigher pre-operative anxiety, pain score, central sensitization and lower anticipated pain medication needs were associated with increased risks of PND. Further work using larger sample size will be needed to validate the model in predicting PND development after Cesarean delivery.

Physical Activity and the Occurrence of Postnatal Depression-A Systematic Review.

Background and Objectives: During pregnancy and the postnatal period many changes occur in a woman’s body, both in mental and physical spheres. The birth of a child and a new role—of a mother—can sometimes be associated with numerous negative emotions, uncertainty, fear, anxiety, disgust, depression, or sadness. In the puerperium period, the development of baby blues or postpartum depression may occur. Postpartum depression develops within one month of childbirth and may last up to one year. Depressive disorders that may develop in a young mother affect both her and the newborn’s health. That is why it is so important to try to search for factors that could significantly reduce the likelihood of developing depression in this period. The study aims at assessing the relationship between physical activity during pregnancy and puerperium or in the postpartum and the development of postnatal depression. Materials and Methods: A review of the literature was carried out in the Medline-PubMed database. The search terms were “pregnancy” AND “physical activity AND postpartum depression”. The study included only English-language publications published in the period 2000–2018. Results: A total of 216 references were found. After establishing the inclusion and exclusion criteria based on the analysis of titles and abstracts, 173 articles were excluded from the review. A total of 43 publications were read in full. Finally, 16 articles were included in the review. It was shown that regular physical activity during pregnancy, pregnancy, and puerperium, or in the postnatal period itself as compared to inactivity, reduces the risk of developing depression in pregnant women and after the birth of a child. Conclusions: Physical activity can be an essential factor in the prevention of depressive disorders of women in the postnatal period.

Effect of fetal microchimeric cells on the development of postnatal depression

Effect of fetal microchimeric cells on the development of postnatal depression

Chronic Stress protection for postnatal dEpREssioN prEvention (SERENE): a protocol for an exploratory study

IntroductionThe prevalence of postnatal depression (PND) is significant: reaching up to 20% in the general population. In mechanistic terms, the risk of PND lies in an interaction between a maternal...

Postnatal depression, maternal–infant bonding and social support: a cross-cultural comparison of Nigerian and British mothers

Objectives: The high prevalence of Post-Natal Depression (PND) in low and lower-middle income countries of Africa raises questions about the functionality of the abundant informal support accessed in the enmeshed family structure. This study examined the interaction between social support, parity and culture in the development of PND and maternal–infant bonding (MIB) among Nigerian, British and Nigerian Immigrant mothers in the UK.Methods: Participants (N = 124) were recruited from the UK and Nigeria via local support groups for mothers, websites offering motherhood-related content and social media. Questionnaires including the Edinburgh Postnatal Depression Scale (EPDS), Postpartum Bonding Questionnaire and Norbeck's Social Support Questionnaire were uploaded onto SurveyMonkey®.Results: Findings revealed significant cultural differences in PND and social support. Multiple regression analyses revealed that PND, social support and culture could predict MIB, with PND being the only significant independent predictor.Conclusions: Our findings highlight the importance that cultural factors play in the development of PND and the establishment of MIB in the context of culturally attuned healthcare services.

Postnatal depression and its associated factors among Northeastern Nigerian women

Background: Postnatal depression is a serious psychiatric condition that occurs in puerperium. It is associated with increased morbidity and can overwhelm new mothers and interfere with the care of their babies. This study aimed to determine the prevalence rate of postnatal depression and assess factors that are associated with its development among northeastern Nigerian women. Materials and Methods: Edinburgh Postnatal Depression Scale (EPDS) questionnaire was administered to four hundred and eighty-three women who delivered at the maternity unit of a tertiary health institution in northeastern Nigeria. Their sociodemographic and clinical variables were also obtained using pro forma questionnaire designed by the researchers. Results: One hundred and eight respondents scored 13 or more points on EPNDS, making the prevalence rate of postnatal depression 22.4%. Factors that are associated with the development of postnatal depression are unemployment [odds ratio (OR) = 0.49, 95% (CI) = 0.27-0.86, P value = 0.018), lack of support from the husband (OR = 0.34, 95% CI = 0.19-0.60, P value = 0.000), and primiparity (OR = 0.56, 95% CI = 0.35-0.88, P value = 0.013); others are unplanned pregnancy (OR = 0.56, 95% CI = 0.35-0.88, P value = 0.013) and physical illness in the mother (OR = 1.81, 95% CI = 1.77-2.79, P value = 0.007). Conclusion: The study showed that a significant proportion of new mothers have postnatal depression. This may negatively affect their parenting skills and may have adverse effects on them and their children. Early detection and effective management, together with an efficient collaboration among psychiatrists, obstetricians, and other health workers who are involved in the care of new mothers, will go a long way in reducing the negative consequences that may result from this condition.

The role of self-esteem instability in the development of postnatal depression: A prospective study testing a diathesis-stress account

Background and objectivesUnderstanding vulnerability factors involved in the development of postnatal depression has important implications for theory and practice. In this prospective study, we investigated whether self-esteem instability during pregnancy would better predict postnatal depressive symptomatology than level of self-esteem. In addition, going beyond former studies, we tested the possible origin of this instability, examining whether day-to-day fluctuations in self-esteem could be explained by fluctuations in mood state, and whether this day-to-day self-esteem reactivity would predict postnatal depressive symptoms. Methods114 healthy never-depressed women were tested during the late second or third trimester of their gestation (Time 1) and at 12 weeks after delivery (Time 2). Day-to-day levels of self-esteem and depressed mood state were assessed at Time 1. At Time 2, postnatal depressive symptoms were assessed. ResultsThe results show that, after controlling for initial depressive symptomatology, age and socio-economic status, postnatal depressive symptomatology at 12 weeks after childbirth could be predicted by self-esteem instability and not level of self-esteem. In addition, multi-level analyses demonstrated that these changes in day-to-day levels of self-esteem are associated with changes in day-to-day levels of depressed mood state and that those subjects with greater prenatal self-esteem reactivity upon depressed mood report higher levels of depressive symptoms post-partum. LimitationsWe used paper and pencil day-to-day measures of state self-esteem, which can be subject to bias. ConclusionThese results provide evidence for a diathesis-stress account of postnatal depression, highlighting the importance of a multi-dimensional view of self-esteem and the predictive role of self-esteem instability.

2705 – Cultural issues in the prevention and treatment of perinatal disorders

The birth of a child is a crucial event in the woman life, generally is a moment of joy and fulfillment, but instead often experienced by new mother with concern, fear and anxiety. The psychological vulnerability of women during the postnatal period is commonly referred to a “postpartum depression”, a term that is actually referred to a cluster of symptoms with a very different clinical level, severity and duration. If a network of family and social support, which is active in caring for new mothers and newborns, is usual for the European women, for the migrant woman in most cases this support is totally lacking. The absence of a social support, with economic and housing precariousness, frequently brings foreign women into a particular vulnerability situation, with an increased risk for the development of postnatal depression. Many studies clearly show an increased postpartum depression risk for migrant women than for women living in their country of origin.

Social dynamics of postpartum depression: a population-based screening in South-Eastern Hungary

To determine contributing psychosocial factors to postnatal depression (PND) in Hungary in 1996 and in 2006. In 1996 and 2006, a total of 2,333 and 1,619 women, respectively, were screened for PND in South-Eastern Hungary, based on a Leverton questionnaire (LQ) score of ≥ 12 at 6-10 weeks after delivery. The LQ scores indicated an increase in PND from 15.0% in 1996 to 17.4% in 2006. The best predictors for PND in a multiple regression analysis were living in an urban environment [adjusted odds ratio (AOR) = 11.26], unstable relationship (AOR = 3.1) and a perceived lack of social support from partner (AOR = 3.65) in 1996, and recent major life events (AOR = 3.38), unstable relationship (AOR = 3.84), self-reported low income (AOR = 1.82), and intention to return to work soon after delivery (AOR = 0.47) in 2006. A self-defined low socioeconomic status and an intention to return to work have become significant factors in the development of PND. Besides the family factors recognized as salient variables in 1996, economic features came into prominence as newly identified main predictive factors for PND in 2006.

Does traumatic birth increase the risk of postnatal depression?

The aim of the study was to review if experiencing a traumatic birth, in the form of caesarean section or assisted vaginal births, increases the risk of developing postnatal depression. This issue is significant to health professionals when planning postnatal care. A focused search of databases containing medical and psychiatric research relevant to this question was performed and the selected papers critically appraised and reviewed. The numbers of mothers recording depressive symptoms for each birth method were measured using a validated outcome tool for postnatal depression. Two research papers met the inclusion criteria and were reviewed using a checklist for critically appraising cohort studies. Although the papers met many of the quality markers, both reported limited data relating to obstetric factors in the development of postnatal depression and both sets of published results were incomplete. More studies may be found by searching psychological and psychiatric medicine-oriented databases as just one was included in this evaluation. The conclusion of this review is that there is no evidence on which to base a reappraisal of current clinical practice.

Predicting postnatal depression

Background: The contribution that recently identified risk factors for Postnatal Depression (PND) made to an existing prenatal screening tool (‘Predictive Index’ of PND; Cooper et al., 1996) was assessed in an attempt to improve the performance of this measure. Method: The Predictive Index and measures of appraisal and coping were administered during the final trimester of pregnancy ( n=306). The Edinburgh Postnatal Depression Scale (EPDS) and Childcare Stress Inventory were completed at 6-weeks postpartum ( n=223). Results: The predictive index identified 23% of PND cases. The addition of specific appraisal and coping factors increased predictive performance by 26%. Inclusion of maternal reports of childcare stress in the early postpartum period resulted in a further 15% of PND cases being identified. Limitations: Diagnostic criteria were not used to assess the incidence of PND; instead PND case status was assessed using an established cut-off criterion on the EPDS. In addition, the contribution that women’s prenatal appraisal and coping processes made to improving the predictive index was not assessed on a second independent sample. Conclusions: The inclusion of prenatal appraisal, coping and maternal reports of childcare stress in a screening tool for PND substantially increased predictive performance, resulting in 64% of PND cases being identified. These findings highlight the importance of negative prenatal appraisal and coping processes in the development of PND and have important implications for the prevention and treatment of this disorder.

Relationship between premenstrual syndrome and postnatal depression: An exploratory study

The present study examined the relationship between postnatal depression (PND) and premenstrual syndrome, using the Menstrual Distress Questionnaire (MDQ) and the Edinburgh Postnatal Depression Scale (EPDS). Fifty-one mothers participated in the study. A nondepressed group consisted of 25 mothers with no reported PND symptoms, while a depressed group comprised 26 mothers with clearly diagnosed PND symptomatology. The present findings provide further evidence of an association between premenstrual syndrome and the later development of postnatal depression, raising the possibility of predicting subsequent PND from pre-existing premenstrual syndrome (PMS).

Postpartum blues: a clinical syndrome and predictor of postnatal depression?

Although the obstetricians have been aware of puerperal psychiatric events, atypical postnatal depression was only identified during the 1960s. Early screening is therefore required to enable preventive measures to be taken. Our prospective study was intended to uncover early signs of, or a predisposition towards, postnatal depression before postpartum discharge from the hospital. Studying a population of 186 women who had just given birth and using two tools, the self-administered questionnaires designed by Pitt and by Cox, we found a relationship between postpartum blues, evaluated with Pitt's tool on the 3rd day after delivery, and postnatal depression, evaluated 8 months later. We thus show that the postpartum blues, evaluated with Pitt's tool, especially when severe, is predictive of the subsequent development of postnatal depression.

Preventing post-natal depression

The plethora of anxieties and discomforts which can accompany women throughout pregnancy, childbirth and the early stages of motherhood may not be sufficiently addressed in 'traditional' parent-craft teaching. Debbie Okpala describes the small study she organised which aimed first to identify and then ameliorate the problems which, if left unattended, can predispose to the development of post-natal depression. While wider conclusions cannot be drawn from her work, the success she achieved with this particular group of women stands as testimony to her perception and commitment.