Early Postpartum Depressive Symptoms Research Articles

Racial And Ethnic Inequities In Postpartum Depressive Symptoms, Diagnosis, And Care In 7 US Jurisdictions.

Understanding whether racial and ethnic inequities exist along the postpartum mental health care continuum is vital because inequitable identification of depression can lead to inequitable referral to and receipt of care. We aimed to expand on existing cross-sectional and single-state data documenting potential racial and ethnic disparities in postpartum depression care. Using early (from two to six months) and late (from twelve to fourteen months) postpartum survey data from seven US jurisdictions, we documented patterns of early postpartum depressive symptoms, perinatal mood and anxiety disorder (PMAD) diagnosis, and receipt of postpartum mental health care overall and by racial and ethnic identity. Of 4,542 people who delivered live births in 2020, 11.8percent reported early postpartum depressive symptoms. Among the sample with these symptoms, only 25.4percent reported receiving a PMAD diagnosis, and 52.8percent reported receiving some form of postpartum mental health care. There were no significant differences in diagnosis by race and ethnicity. Respondents identifying as Asian; Native Hawaiian or Pacific Islander; Southwest Asian, Middle Eastern, or North African; Hispanic; and non-Hispanic Black were significantly less likely than non-Hispanic White respondents to receive mental health care, demonstrating stark inequities in the management of postpartum depressive symptoms. Policies mandating and reimbursing universal postpartum depression screening, facilitating connection to care, reducing insurance coverage gaps, and enhancing clinician training in culturally responsive care may promote equitable postpartum mental health care.

Feeling better? - Identification, interventions, and remission among women with early postpartum depressive symptoms in Sweden: a nested cohort study.

Postpartum depression affects around 12% of mothers in developed countries, with consequences for the whole family. Many women with depressive symptoms remain undetected and untreated. The aim of this study was to investigate to what extent women with depressive symptoms at 6weeks postpartum are identified by the healthcare system, the interventions they received, and remission rates at 6months postpartum. Postpartum women scoring 12-30 on the Edinburgh Postnatal Depression Scale (EPDS) at 6weeks after delivery (n=697) were identified from the longitudinal cohort study "Biology, Affect, Stress, Imaging and Cognition" (BASIC) in Uppsala, Sweden. A total of 593 women were included. Background and remission information at 6months was collected from the BASIC dataset. Medical records were examined to identify interventions received. Most women (n=349, 58.7%) were not identified by the healthcare system as having depressive symptoms and 89% lacked any record of interventions. Remission rates at 6months postpartum were 69% in this group. Among women identified by the healthcare system, 90% received interventions and about 50% were in remission at 6months postpartum. The EPDS reduction during the study period was largest in the group identified by the child health services (CHS, -5.15) compared to the non-identified (-4.24, p<0.001). Despite screening guidelines, many women with depressive symptoms had no documentation of screening or interventions by the healthcare system. Furthermore, a significant proportion did not achieve remission despite interventions. Being identified by CHS was associated with the largest reduction of symptoms. Research is needed to understand gaps in the healthcare processes, to better identify peripartum depression.

The first three years: The association of early postpartum depressive symptoms with infant and toddler development.

The influence of postpartum depression (PPD) on child development has been a source of professional interest and practical relevance. This study investigated the association of early PPD symptoms with developmental domains. This historical cohort study included 574,282 children attending Mother Child Healthcare Centers in Israel from January 1, 2014 to July 31, 2020, who underwent at least one developmental screening examination by public health nurses up to age 36 months, and whose mothers completed the Edinburgh Postnatal Depression Scale (EPDS) postnatally. Developmental milestone tasks included four domains: fine and gross motor, language/communication, and social/behavioral. The rate of failure to complete age-appropriate tasks was higher among children whose mothers had scored≥10 on the EPDS on the majority of tasks in every domain. This large population-based study has demonstrated the association between early maternal postnatal depressive symptoms and failure to meet developmental milestones across domains, until three years. Recommendations for practice focus on the mother, the child, and health policy.

Resilience resources, life stressors, and postpartum depressive symptoms in a community sample of low and middle-income Black, Latina, and White mothers.

Resilience resources refer to factors that protect against the physical and mental health effects of stress exposure. This study used a cross-sectional design to test whether three individual-level resilience resources-mastery, self-esteem, and perceived social support-moderated associations between prenatal major life stressors and postpartum depressive symptoms at approximately 8weeks postpartum. Participants were 2510 low- and middle-income women enrolled after the birth of a baby in a multi-site study of five communities in the United States. At approximately 8weeks postpartum, participants were interviewed in their homes to assess the three resilience resources, symptoms of depression, and major life stressors that had occurred during the pregnancy. The results of path analyses revealed that mastery and self-esteem moderated the positive association between prenatal life stressors and postpartum depressive symptoms adjusting for race/ethnicity, partner status, years of education, and household income. Perceived social support was associated with fewer postpartum depressive symptoms but did not moderate the association between life stressors and depressive symptoms. Higher levels of two personal resilience resources, mastery and self-esteem, attenuated the association between prenatal life stressors and early postpartum depressive symptoms in a large, predominantly low-income multi-site community sample. These findings highlight the protective nature of individual-level resilience resources in the early postpartum period when maternal adjustment shapes parent and child health outcomes.

Psychosocial predictors of early postpartum depressive and anxious symptoms in primiparous women and their partners

BackgroundWhile the majority of research on postpartum depressive and anxious symptoms has focused on mothers, a growing body of research suggests a need to understand the role of the partner’s health and relationship quality as predictors of postpartum maternal depression, while also better understanding correlates of partner or paternal depression in the postpartum period. The purpose of the current study is to evaluate mother and partner stress, anxiety, mood, infant care support, and relationship quality as predictors of perinatal depressive and anxious symptoms in first time mothers and partners during the postpartum hospital stay.MethodsFirst time parent couples (n = 116) completed a survey during the two-day postpartum stay in a Midwest hospital. Depressive (EPDS) and anxiety symptoms (DASS-21-Anxiety) were assessed in both mothers and partners. Hierarchical linear regression was used to evaluate relationship satisfaction, partner infant care support, stress, and co-parent mood as predictors of mood in mothers and partners separately.ResultsStress was a predictor of anxiety and depression symptoms in both mothers and partners. Additionally, co-parent anxiety significantly predicted anxiety in both mothers and partners. Maternal relationship satisfaction was a predictor of the partner’s depressive symptoms, and maternal perceptions of partner infant support predicted maternal depressive symptoms.ConclusionsTogether, these results suggest that stress, relationship satisfaction, and co-parent mood are related to depressive and anxious symptoms in mothers and partner, underscoring the need to continue exploring mother and partner mental health in a dyadic framework.

839 The association between early breastfeeding cessation and postpartum depressive symptoms among women intending to breastfeed

An association between sustained breastfeeding and a decrease in postpartum depression has been identified. However, over half of US women cease breastfeeding earlier than desired. Our objective was to evaluate whether early cessation of breastfeeding is associated with postpartum depressive symptoms in women with identified mental health conditions. This retrospective cohort study included women enrolled in an outpatient collaborative care perinatal mental health program (COMPASS) during pregnancy and reported an intent to breastfeed at delivery between 02/2017-02/2020. Women were referred to COMPASS either due to a history of mental health conditions or due to incident mental health concerns. Women completed validated depression screens [Patient Health Questionnaire-9 (PHQ-9)] during pregnancy and at the postpartum visit. Scores were compared between women who intended to breastfeed but were exclusively formula feeding at the postpartum visit and women who reported continued breastfeeding. Worsening depression was defined as an increase of one standard deviation (i.e. 5 or more) on the PHQ-9 between the 2nd or 3rd trimester screen and the postpartum screen, an increase in antidepressant medication requirement, or subjective report of worsening of mood symptoms in the absence of a formalized screen. Bivariable and multivariable analyses were performed. Of the 377 women who met inclusion criteria, 314 (83%) reported continued breastfeeding at the postpartum visit. Women who intended but were not breastfeeding at the postpartum visit were more likely to experience a worsening of postpartum depressive symptoms (19.0% vs 9.2%, p=.02). After controlling for potential confounders, women who ceased breastfeeding by the postpartum visit had a greater odds of worsening depressive symptoms (aOR 2.58, 95% CI 1.15-5.78). Women with known mental health conditions or at risk for perinatal mental health conditions who desire to breastfeed but are unable to continue past the immediate postpartum period are at an increased risk of worsening mood symptoms.

Postpartum depressive symptoms in low-income Latinas: Cultural and contextual contributors.

Using a conceptual model of postpartum depression risk in Latinas including both contextual and cultural stressors, we tested contributions to depressive symptom levels and trajectories over the course of 1 year following birth in a community sample of Latinas. A multisite sample of low-income U.S.-born and foreign-born Latinas (n = 537; M age = 25.70) was interviewed on many topics including measures of stress and maternal health at 1, 6, and 12 months postpartum. Nested multilevel growth curve models were implemented to test associations of contextual stressors (poverty, domestic violence) with trajectories of depressive symptoms, adjusting for confounds. This model was compared to 1 that added cultural stress variables (everyday discrimination, foreign-born status, language preference, age at immigration) measured 1-month postpartum. The best fitting model provided evidence for the independent effects of cultural and contextual stressors. Discrimination (β = .13 SE = .02, p = < .001) and domestic violence (β = .39 SE = .09, p = < .001) predicted trajectories with higher levels of depressive symptoms 1 month postpartum, but not linear change in symptoms over the year. The present study provides evidence that discrimination, a cultural factor, and domestic violence, a contextual factor, each predict higher levels of early postpartum depressive symptoms. Interventions addressing discrimination and maternal safety are recommended. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Early detection of mental illness for women suffering high-risk pregnancies: an explorative study on self-perceived burden during pregnancy and early postpartum depressive symptoms among Chinese women hospitalized with threatened preterm labour

BackgroundThe mental health of pregnant women, particularly those with elevated risks, has been an issue of global concern. Thus far, few studies have addressed the mental health of pregnant women with threatened preterm labour (TPL). This study investigated the prevalence of self-perceived burden (SPB) among Chinese women hospitalized due to TPL during pregnancy and early postpartum depressive disorders, exploring the effect of SPB and other potential risk factors on the early signs of postpartum depressive disorders.MethodsA self-reported survey was conducted in the obstetrics department of Anhui Provincial Hospital, China. Women hospitalized with TPL were approached 1 week after delivery. One hundred fifty women were recruited from January 2017 to December 2017. The Self-Perceived Burden Scale (SPBS) and Edinburgh Postnatal Depression Scale (EPDS) were the main measures. Descriptive statistics, Spearman correlations, and a multiple logistic regression were employed for data analysis.ResultsSPB and early postpartum depressive disorders were commonly experienced by Chinese women hospitalized with TPL, and SPB was positively and significantly correlated with depressive symptoms. A multiple logistic regression analysis revealed that for the women hospitalized with TPL during pregnancy, the emotional aspect of SPB (OR = 1.42, 95% CI = 1.11–1.83, p = 0.006), age (OR = 1.14, 95% CI = 1.02–1.27, p = 0.023), occupation (OR = 3.48, 95% CI = 1.18–10.20, p = 0.023), the history of scarred uterus (OR = 7.96, 95% CI = 1.49–42.48, p = 0.015), the delivery mode of the present birth (OR = 6.19, 95% CI = 1.72–22.30, p = 0.005), and family support during pregnancy (OR = 0.60, 95% CI = 0.45–0.82, p = 0.001) were significant factors predicting early postpartum depressive symptoms.ConclusionThis study indicates that SPB and early postpartum depressive disorders are prevalent mental issues among Chinese women hospitalized with TPL, and that SPB, especially perceived emotional burden, is a strong predictor of early postpartum depressive disorders. Our study suggests the necessity of paying attention to mental health issues, e.g. SPB and postpartum depressive symptoms among hospitalized women with TPL, and providing appropriate interventions at the prenatal stage to prevent adverse consequences.

The role of personality dimensions, depressive symptoms and other psychosocial variables in predicting postpartum suicidal ideation: a cohort study.

Suicidability has been associated with neuroticism and psychoticism, but its role during perinatal period has not been analyzed. We explore the association between personality dimensions, depressive symptoms, and other psychosocial variables in postpartum suicidal ideation. A cohort of 1795 healthy Spanish women from the general population was assessed for suicidal ideation (EPDS-Item10) in early postpartum, 8 and 32 weeks postpartum. Sociodemographic, obstetric, and reproductive variables, psychiatric history, social support, stressful life-events during pregnancy, depressive symptoms (EPDS), and the Eysenck's personality dimensions (EPQ-RS) were also assessed at baseline. A major depressive episode (DSM-IV) was confirmed in women with EPDS>10 at follow-up assessments. Descriptive, bivariate, and multivariate analyses were conducted. Adjusted logistic regression analysis was reported as odds ratio (ORs) with 95% confidence intervals (CIs). Seven percent of mothers reported suicidal ideation during the first 8 months postpartum. Sixty-two percent of women with suicidal ideation had a major depressive episode at 8 weeks, and 70% at 32 weeks postpartum. Neuroticism and psychoticism predicted suicidal ideation throughout the first 2 weeks after delivery (OR, 1.03; 95%CI 1.01-1.06; and OR, 1.03; 95%CI 1.01-1.05 respectively). Early postpartum depressive symptoms (OR 1.2; 95%CI 1.11-1.26), personal psychiatric history (OR 2.1; 95%CI 1.33-3.27), and stressful life events during pregnancy (OR 1.88; 95%CI 1.12-3.16) also emerged as predictors of postpartum suicidal ideation. Analysis of women for postpartum suicidal ideation should include not only psychiatric symptoms but also psychosocial assessment (i.e., covering psychiatric history, stressful events, or long-standing personality vulnerabilities) in order to identify those in need of early psychosocial or psychiatric care.

The healthy migrant effect and predictors of perinatal depression

ProblemAlthough prenatal depression is a risk factor for postpartum depression, current screening tools for prenatal depression fail to predict postpartum depression in some marginalized populations. BackgroundThe assessment of other risk factors along with prenatal depression may be needed to improve prediction of postpartum depression and these risk factors may be specific to immigrants. AimsWe investigated the predictive utility of several measures in relation to postpartum depressive symptoms in: recent immigrants, less recent immigrants and Canadian-born women. MethodsMeasures pertaining to psychosocial risk factors, generalized anxiety, perinatal somatic and depressive symptoms were administered. Data were collected at 4 time-points: 12–14 weeks and 24–28 weeks gestation as well as 1-week and 8-weeks postpartum. Perinatal factors were entered into 3 different regression models to predict postpartum depressive symptoms at the last time-point. FindingsCanadian-born women reported significantly more psychosocial risk factors compared to immigrant women. The best predictors of postpartum depressive symptoms at 8-weeks among Canadian-born women included psychosocial risk, prenatal anxiety and depressive symptoms as well as early postpartum depressive symptoms. Prenatal somatic symptoms predicted postpartum depressive symptoms among recent immigrants. Depressive symptoms at 1-week postpartum and the lack of an emotionally supportive partner were significant predictors of postpartum depressive symptoms for both Canadian-born and immigrant women. DiscussionThere appears to be both overlapping and distinct predictors of postpartum depressive symptoms for immigrant and Canadian-born women. ConclusionThe findings from this research will help guide routine screening options and patient-centered approaches to management of perinatal depression for diverse populations.

Predicting early post-partum depressive symptoms among older primiparous Japanese mothers.

The number of older primiparas is increasing in Japan. These women have been shown to be more vulnerable to post-partum depression. This study aimed to identify factors for predicting post-partum depressive symptoms during hospitalization after childbirth in Japanese primiparas aged 35 years and over. The present authors used the data of 479 primiparas aged 35 years and over from a prospective cohort study. Data were collected using self-report questionnaires on the day before hospital discharge. The questionnaire consisted of: demographics and background information; depressive symptoms; fatigue; maternal confidence and maternal satisfaction; child-care values; physical symptoms; perceptions of daily life during hospitalization; concerns about child care and daily life; and infant feeding. Additionally, vital records data were obtained from the hospitals. A stepwise logistic regression analysis was performed on the binary outcome variable of depressive symptoms, measured by the Japanese version of the Edinburgh Postnatal Depression Scale. Women who scored 9 or more were considered to be at high risk for post-partum depression. The authors obtained informed consent from all participants and institutional ethics approvals before initiating the study. The following six variables reliably predicted the risk of post-partum depression: emergency cesarean section, lower satisfaction with birth experience, higher physical burden in daily life, long-term complications with the newborn, more concerns about newborn caretaking after discharge, and more concerns about one's own life after discharge. Recognition of women with these factors will help nurses to identify those at risk for developing post-partum depression and to provide appropriate care during hospitalization after childbirth.

초기산욕기 산모의 사상체질에 따른 우울과 피로수준의 변화

Objectives: The purpose of this study was to identify the tendency toward depression and fatigue in early postpartum women and to determine the relationship between the symptoms of these conditions, according to the women's Sasang constitutions. Methods: In this study, 73 healthy postpartum women were analyzed according to Sasang constitution: 33 Taeeumin, 22 Soyangin, and 18 Soeumin. Symptoms of depression and fatigue were assessed using the Edinburgh Postnatal Depression Scale-K(EPDS-K) and the Fatigue Continuum Form(FCF), respectively, on the fourth(time 1), seventh(time 2), and fifteenth(time 3) days postpartum. Sasang constitutional types were determined by a medical specialist, using results from the Two Step Questionnaire for Sasang Constitution Diagnosis(TS-QSCD). Results: 1. The overall depressive symptoms and fatigue scores decreased significantly over time in early postpartum women. 2. The mean scores for the EPDS and FCF were higher in the Soeumin group than in other groups. The scores for EPDS and FCF dropped sharply in comparison to a former level in the Soyangin group. And the mean EPDS score was lower in the Soyangin group than in other groups. The EPDS and FCF scores in the Taeeumin group changed slightly over time. However, these results were not statistically significant according to Sasang constitution. 3. The relationship between postpartum depression and fatigue showed a significant positive correlation. Conclusions: These results suggest that, in early postpartum women, depressive symptoms and fatigue differ according to Sasang constitution.

Lack of Preparation, Physical Health After Childbirth, and Early Postpartum Depressive Symptoms

Prior research has not examined the association of patient expectations or preparation by providers for the postpartum experience with depressive symptoms. We investigated whether lack of preparation for the postpartum experience and physical health after uncomplicated childbirth were associated with early postpartum depressive symptoms. We conducted a telephone survey of 720 early postpartum mothers in New York City. Mothers reported on depressive symptoms, physical symptoms, provider preparation for the postpartum experience, and other factors. Nearly 39% of patients reported depressive symptoms; 24% did not feel adequately prepared by their provider for the postpartum experience. Mothers reported a range of physical symptoms: 98% reported daily vaginal bleeding, 79% reported cesarean section or episiotomy site pain, 82% reported breast pain, and 32% reported urinary incontinence. Patients who reported inadequate preparation by their provider were more likely to report depressive symptoms compared with patients who reported adequate preparation (53% vs. 35%, p < 0.001). In a multivariable model predicting postpartum depressive symptoms, adjusted odds ratios (ORs) remained elevated for perceived lack of preparation for the postpartum experience, more physical symptoms, and more physical functional limitations. Further research is needed to investigate whether preparing patients for expected health consequences after pregnancy may reduce the incidence of early postpartum depressive symptoms.

Influence of Intimate Partner Violence During Pregnancy and Early Postpartum Depressive Symptoms on Breastfeeding Among Chinese Women in Hong Kong

Numerous studies show that breastfeeding is beneficial to both mothers and babies. This study explores two understudied correlates that may influence breastfeeding initiation: intimate partner violence during pregnancy and early postnatal depressive symptoms. A cross-sectional comparative study design investigated the correlates of feeding modes of 1200 Chinese mother and infant pairs in a university-affiliated regional hospital in Hong Kong. The prevalence rates of breastfeeding and mixed feeding were 42.25% and 26.25%, respectively. Women who had no experience of intimate partner violence during pregnancy were significantly more likely to initiate breastfeeding (adjusted odds ratio = 1.84; 95% confidence interval, 1.16-2.91) after adjustment for demographic, socioeconomic, and obstetric variables. Early postnatal depressive symptoms were not significantly associated with feeding modes in a multinomial logistic regression model. Midwives are in a key position to identify and intervene to encourage more successful breastfeeding practice.

Risk factors for early postpartum depressive symptoms

Objective Postpartum depressive disorders are common and symptoms may appear as early as the first 2 weeks postpartum. Data regarding hormone-related risk factors for depressive symptoms occurring in the very early postpartum period are scarce and may be of importance in identifying serious postpartum illness. We examined the association between the reported history of psychiatric symptoms of possible hormonal etiology and very early postpartum depressive symptoms. Methods All women ( n=1800) in a general hospital maternity ward were assessed during the first 3 days after parturition for potential risk factors for postpartum depressive disorders by a self-reported questionnaire and for present mood symptoms (Edinburgh Postnatal Depression Scale, EPDS). The associations between potential risk factors and postpartum depressive symptoms were analysed. Results The incidence of women with an EPDS ≥10 was 6.8% (88/1286). Significant risk factors for early postpartum depressive symptoms were a history of mental illness including past postpartum depression (PPD), premenstrual dysphoric disorder (PMDD), and mood symptoms during the third trimester. Conclusion In accordance with other studies, a history of depression was found to be a risk factor for early postpartum mood symptoms. An association was also found between some risk factors of possible hormone-related etiology such as PMDD and third trimester mood symptoms and early postpartum mood symptoms. As such, early postpartum symptoms may indicate vulnerability to subsequent PPD; it may be of importance to assess these risk factors and mood immediately after parturition. A prospective study is needed to determine which of these risk factors is associated with progression to PPD and which resolves as the blues.

Correlates of Early Postpartum Depressive Symptoms

Postpartum depressive symptoms negatively affect the quality of life and daily functioning of mothers and infants. Little research has examined the impact of situational factors such as physical symptom burden and function on early postpartum depressive symptoms. To explore the association between situational factors and early postpartum depressive symptoms. To predict correlates of early postpartum depressive symptoms. Cross sectional telephone survey of 720 mothers between 2 and 6 weeks postpartum. Mothers reported on demographic factors, physical and psychological symptoms, daily function, infant behaviors, social support, and skills in managing infant and household. The association between these factors and postpartum depressive symptoms were investigated with bivariate and multivariable analyses. Nearly, 39% of patients screened positive for depressive symptoms. Bivariate analyses showed symptomatic patients were more likely to be nonwhite, have lower incomes, less education, a past history of depression, have higher physical symptom burdens, more physical functional limitations, more infant colic, receive less social support, and have lower-self-efficacy scores as compared with patients without symptoms of depression. In a multivariable model predicting depressive symptoms, nonwhite race (odds ratio (OR) of 1.96, 95% confidence interval (CI) of 1.38, 2.78), more physical symptoms (OR 1.16, 95% CI 1.01, 1.32), infant colic (OR 1.79, 95% CI 1.29, 2.50) lack of social support (OR 0.90, 95% CI 0.86, 0.95), and lower self-efficacy scores (OR 0.90, 95% CI 0.86, 0.94) were associated with depressive symptoms. Nonwhite race, physical symptom burden, infant colic, lack of social support, and lower self-efficacy scores are associated with early postpartum depressive symptoms. Further research is needed to investigate whether providing social support and teaching skills to enhance self-efficacy will reduce the incidence of early postpartum symptoms of depression.

Racial and Ethnic Differences in Factors Associated With Early Postpartum Depressive Symptoms

To explore racial differences in reporting of early postpartum depressive symptoms. To explore whether racial differences in early postpartum experience (such as mother's health status and social context) might account for racial differences in reported postpartum depressive symptoms. This was a telephone survey of 655 white, African-American, and Hispanic mothers between 2 and 6 weeks postpartum. Mothers reported on demographic factors, physical symptoms, daily function, infant behaviors, social support, skills in managing infant and household, access, and trust in the medical system. We explored racial differences in report of early postpartum depressive symptoms using bivariate and multivariate statistics. African-American and Hispanic women more commonly reported postpartum depressive symptoms (43.9% and 46.8%, respectively) than white women (31.3%, P < .001). Similar factors (physical symptom burden, lack of social support, and lack of self-efficacy) were associated with early postpartum depressive symptoms in white, African-American, and Hispanic mothers. In a comprehensive model including other demographic factors, history of depression, physical symptoms, daily function, infant behavior, social support, skills in managing infant and household, access, and trust, the adjusted odds ratio for reported postpartum depressive symptoms remained elevated for African-American women at 2.16 (95% confidence interval 1.26-3.70) and Hispanic women at 1.89 (95% confidence interval 1.19-3.01) as compared with white women. African-American and Hispanic mothers are at higher risk for reporting early postpartum depressive symptoms as compared with white mothers. Factors associated with these symptoms are similar among African-American, Hispanic, and white mothers.