Higher Edinburgh Postnatal Depression Scale Research Articles

Prevalence and associated risk factors of postpartum depression: a cross sectional study

Background Postpartum mood disturbance affects up to 85% of women, with most symptoms of this disturbance being temporary and mild. However up to one in seven women experience a persistent type of depression which is associated with major maternal and neonatal morbidity if it is not managed. Objective To estimate the prevalence of postpartum depression and to identify the associated risk factors. Methods A cross sectional study was conducted in randomly selected 3 primary health care centers affiliated to Suez governorate, Egypt. An interviewed questionnaire was used containing potential risk factors for postpartum depression. An Arabic version of the Edinburgh postnatal depression scale (EPDS) was used to screen for postpartum depression symptoms. Results A total of 237 postpartum mothers were included in the study. 139 (58.6%) of the mothers completed secondary level of education, 195 (82.3%) of them were housewives and 181 (76.4%) had cesarean section. The estimated postpartum depression prevalence was 26.6% and suicidal ideation accounted for 4.6%. Factors significantly associated with high EPDS scores were bad relationship with the husband, having >2 children, an unplanned pregnancy and unhealthy newborn; with P-values of 0.000, 0.004, 0.000, and 0.018, respectively. Discussion the prevalence of postpartum depression among Egyptian women is considered slightly high with its negative and long term consequences on the mothers and their children, accordingly screening, proper management & referral to specialist care is highly recommended.

Risk for Depressive Symptoms among Hospitalized Women in High-Risk Pregnancy Units during the COVID-19 Pandemic.

Objective: Higher rates of mental disorders, specifically depression, were found among affected people in previous epidemiological studies taken after disasters. The aim of the current study was to assess risk for depression among pregnant women hospitalized during the “coronavirus disease 2019” (COVID-19) pandemic, as compared to women hospitalized before the COVID-19 pandemic. Study design: A cross-sectional study was performed among women hospitalized in the high-risk pregnancy units of the Soroka University Medical Center (SUMC). All participating women completed the Edinburgh Postnatal Depression Scale (EPDS), and the results were compared between women hospitalized during the COVID-19 strict isolation period (19 March 2020 and 26 May 2020) and women hospitalized before the COVID-19 pandemic. Multivariable logistic regression models were constructed to control for potential confounders. Results: Women hospitalized during the COVID-19 strict isolation period (n = 84) had a comparable risk of having a high (>10) EPDS score as compared to women hospitalized before the COVID-19 pandemic (n = 279; 25.0% vs. 29.0%, p = 0.498). These results remained similar in the multivariable logistic regression model, while controlling for maternal age, ethnicity and known mood disorder (adjusted odds ratio (OR) 1.0, 95% CI 0.52–1.93, p = 0.985). Conclusion: Women hospitalized at the high-risk pregnancy unit during the COVID-19 strict isolation period were not at increased risk for depression, as compared to women hospitalized before the COVID-19 pandemic.

The Effects of Antepartum Depressive Symptoms on Postcesarean Opioid Consumption.

The study aimed to test the hypothesis that higher Edinburgh Postnatal Depression Scale (EPDS) scores are associated with increased pain scores and opioid use during postpartum hospitalization following cesarean section. We conducted a retrospective cohort of English or Spanish-speaking women ≥18 years who had prenatal care for a singleton gestation and delivered by cesarean at ≥36 weeks within a tertiary center during 2017. Exclusions included women with fetal anomalies, intrauterine fetal demise, sickle cell disease, previously diagnosed pain disorders (e.g., chronic pain or fibromyalgia), substance use disorder (based on documented prescription or use of methadone or buprenorphine), or reoperation during hospital stay. Women without an EPDS recorded antenatally were also excluded. Major depressive symptoms (MDS) were defined as a documented antenatal EPDS ≥12. Women with and without MDS were compared, and multivariable linear regression models were generated to evaluate associations between MDS status and both pain scores and opioid use. Of the 891 women meeting other inclusion criteria, 676 (76%) had documented antenatal EPDS scores, and 104 (15.4%) of those had MDS. Women with MDS were more likely to be use tobacco and have general anesthesia for cesarean delivery, but groups were otherwise similar. Women with MDS reported higher daily and average pain scores postpartum (2.4 vs. 1.7 average; p < 0.001). Women with MDS used more morphine milligram equivalents (MME) each day during their postpartum hospitalization, leading to a higher total MME use (121 mg [60.5-214.5] vs. 75 mg [28.5-133.5], p < 0.001). We found an association between antepartum depressive symptoms and acute pain after cesarean delivery leading to increased opioid use. Given the current focus on opioid stewardship, further research into this association, exploration of tailored pain control, and determining whether treatment of antepartum MDS reduces postpartum pain, and therefore opioid use, will be of the utmost priority. · Women with MDS report higher pain scores postcesarean.. · Women with MDS use more opioids postcesarean.. · Future studies are needed for the treatment of MDS..

Relationship between a high Edinburgh Postnatal Depression Scale score and premenstrual syndrome: A prospective, observational study

ObjectiveThis study aimed to evaluate whether the Edinburgh Postnatal Depression Scale (EPDS) score predicts the occurrence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) after delivery. Materials and methodsThe women in this study were registered at 35–36 weeks of pregnancy at Mie University Hospital from 2013 to 2015. We prospectively divided the puerperants into those with an EPDS score ≥9 (the high-EPDS group) and those with an EPDS score <9 (the low-EPDS group) at 1 month postpartum. We compared the incidence rate of severe PMS and PMDD between both groups at 1 year after delivery. ResultsOf 200 registered cases, 178 (89.0%) did not experience severe PMS or PMDD before pregnancy. Among them, 21 were in the high-EPDS group, and 89 in the low-EPDS group. Four of the 21 women (19.0%) in the high-EPDS group and five of the 89 (5.6%) in the low-EPDS group had severe PMS or PMDD at 1 year after delivery. The incidence rate of severe PMS or PMDD in the high-EPDS group was higher than that in the low-EPDS group (p = 0.07). ConclusionsThe novel finding of this study is that the EPDS may predict the occurrence of severe PMS/PMDD after delivery. The EPDS will contribute to the early detection of these diseases and to improving the quality of life of the patients by allowing treatment initiation at an early stage.

Perinatal risk assessment of women for psychological problems

Perinatal risk assessment of women for psychological problems - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/j.ijogr.2019.071, Indian Journal of Obstetrics and Gynecology Research-Indian J Obstet Gynecol Res

311: Objectively-measured sleep parameters and antepartum depressive symptoms

To determine if objectively-measured sleep disturbances in the second trimester are associated with high depression scores later in pregnancy In a large prospective cohort study of nullipara, participants completed the Edinburgh Postnatal Depression Scale (EPDS) during the first trimester and again at the third study visit (between 22 and 29 6/7 weeks). In the midtrimester, between these depression assessments, a subgroup underwent actigraphy and completed a sleep diary for 7 days. A high EPDS score was defined as an EPDS score > 10 or any thoughts of self harm. Sleep disturbances were defined as follows: short sleep duration < 7 hours, high fragmentation index >75%ile, high wake after sleep onset (WASO) >75%ile, elevated sleep onset latency >30 minutes, low time above light threshold 1000 lux (TALT) <25%ile, low sleep efficiency <80%. Univariable analyses were performed to investigate the association between maternal baseline characteristics, sleep disturbances and high depression scores later in pregnancy. All significant (P<0.05) covariates in univariable analysis were included in multivariable analysis. The study population for this analysis includes 778 women who had visit 3 EPDS scores and who underwent actigraphy assessment. This cohort represented a racially and ethnically diverse group of women with an average age of 27 years (Table). At visit 3, 108 (13.9%) women had high EPDS scores. Univariable analyses demonstrated that these women were significantly more likely to be younger, single, publicly insured, smokers, diagnosed with a mental health condition prior to pregnancy, and to have high EPDS scores at the first study visit as compared to women with low scores at visit 3. Women with elevated sleep onset latency and low-sleep efficiency were significantly more likely to have high EPDS scores at visit 3 (Table). However, in multivariable logistic regression, only preexisting mental health conditions (OR 3.7, confidence interval 2.2-12.0) and high EPDS scores at the first visit (OR 7.7, confidence interval 3.4-17.5) remained associated with high EPDS scores at visit 3. Objectively-measured sleep disturbances in the middle of pregnancy were not independently associated with high depression scores later in pregnancy.

870: Posts to an anonymous digital health platform may help assess depression risk among pregnant women

The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used tool for depression screening among perinatal women. Recent literature leveraging machine learning and natural language processing has found associations between the content and structure of social media posts and the likelihood of screening positive for depression. The objective of this study was to determine which one- and two-word combinations used in the Community feature of Ovia Pregnancy — a platform where users can post and respond to questions anonymously — are associated with a score of “probable depression” (13+) on the EPDS. A retrospective observational study was performed based on data from 148,347 Ovia Pregnancy app users who completed the EPDS between May 2017 and April 2018. A statistical modeling software used regression methodologies to assess the association between posts in Ovia Pregnancy’s Community and EPDS scores. Women who scored either ≤7 (n=86,235) or 13+ (n=62,112) on the EPDS were included (n=148,347). Questions (608,330) and comments (4,520,889) from Ovia’s Community were analyzed. The words ‘depression’, ‘depressed’, ‘anxiety’, and ‘boyfriend’ were most strongly associated with high EPDS scores, while ‘nursing’, ‘read’, ‘husband’, and ‘hubby’ were the four words most strongly associated with low EPDS scores. Women who scored 13+ on the EPDS were more likely to post words related to mental health conditions. Additionally, there seems to be an association between the type of committed relationship a woman is in during her pregnancy and her EPDS score. The way app users present themselves and their thoughts in an anonymous digital platform may help assess risk of depression.

Vitamin D and depressive symptoms during pregnancy

Postpartum depression (PPD) is a common disorder that affects 10–15% of postpartum women, and it can have negative effects on both the mother and newborn. Recent studies have suggested that low levels of vitamin D are associated with poor mood and depression. The aim of this prospective study was to evaluate a possible association between PPD and serum levels of 25-hydroxy vitamin D3 (25(OH)D3), a reliable measurement of vitamin D, during mid-pregnancy.The source population consisted of all pregnant women between 24 and 28 gestational weeks from June 2012 to October 2012 at Bornova Health Research and Application Hospital, Sifa University. In order to better evaluate a possible effect between vitamin D levels and PPD, individuals with characteristics that put them at risk for developing PPD were excluded from the study. Serum 25(OH)D3 levels were evaluated mid-pregnancy in the study group. Serum 25(OH)D3 concentrations ≤20 ng/mL (50 nmol/L) were classified as a mild deficiency and those ≤10 ng/mL (25 nmol/L) were classified as a severe deficiency. Pregnant subjects having complications during birth or with the newborn after delivery were excluded from the study. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess maternal PPD 1 week, 6 weeks, and 6 months after delivery. A Pearson correlation was used to measure the strength of the associations between the EPDS scores and vitamin D levels analyzed during the three time periods. A logistic regression analysis was used to determine the independent effects of vitamin D on PPD.Six hundred and eighty-seven pregnant women were included in this study. After excluding women due to PPD risk factors (in two stages), 179 pregnant women were screened for vitamin D levels during mid-pregnancy and in the 6th month postpartum. Eleven percent of our study group had severe vitamin D deficiency and 40.3% had mild vitamin D deficiency. The frequency of PPD was 21.6% at the 1st week, 23.2% at 6th week, and 23.7% at the 6th month. There was a significant relationship between low 25(OH)D3 levels in mid-pregnancy and high EPDS scores, which is indicative of PPD for all three follow-up periods (p = 0.003, p = 0.004 and p < 0.001, respectively). In addition, there was a significant negative correlation between vitamin D levels and EDPS at all three time points (r = −0.2, −0.2, −0.3, respectively).Vitamin D deficiency in mid-pregnancy may be a factor affecting the development of PPD. More extensive studies are required to be carried out on this subject.

Correlation of Infant Gender with Postpartum Maternal and Paternal Depression and Exclusive Breastfeeding Rates.

Male bias in India has resulted in an altered sex ratio. It also results in maternal postpartum depression (PPD) and lower breastfeeding rates. We studied depression among fathers in this context. Edinburgh postnatal depression scale (EPDS) questionnaire was administered to 479 parents separately. Breastfeeding on day 7 was determined. Depression was significantly higher in fathers of girls. Mean EPDS score was 5.86 ± 4.98 versus 2.5 ± 2.64 (p < 0.001). Concordance between parents was significant (r = 0.95, p < 0.001). Boys were more likely to be exclusively breastfed (64.46% versus 35.54%, p < 0.001). In second-order births, if the first born was a girl and second baby was again a girl, 23% were exclusively breastfed compared with 86% if it was boy after a girl (p < 0.001). Among parents who had EPDS scores ≥11, no babies were exclusively breastfed. Among the 25 babies who received no breast milk, 21 were girls and 4 were boys (p < 0.042). The multiple logistic regression analysis indicated that birth of girls (OR 0.269, 95% CI 0.076-0.953), high EPDS score in mothers (OR = 0.080, 95% CI 0.026-0.249), and high EPDS score in fathers (OR = 0.096, 95% CI 0.031-0.299) were associated with lower breastfeeding rates. Paternal depression correlates closely with maternal PPD and low exclusive breastfeeding of girls. Breastfeeding has implications for survival of girls. Efforts are needed to support the parents of girl children with PPD and such support must extend to fathers to improve survival.

Cohort study of the depression, anxiety, and anhedonia components of the Edinburgh Postnatal Depression Scale after delivery.

To investigate the applicability of the Edinburgh Postnatal Depression Scale (EPDS) for identifying depressive symptoms following vaginal or cesarean delivery. The present observational study included consecutive Italian-speaking women who underwent vaginal or cesarean deliveries of uncomplicated singleton pregnancies at term at Policlinico Abano Terme, Abano Terme, Italy, between February 1, 2014, and May 31, 2015, who completed the EPDS 2days after delivery. EPDS scores and the depression, anxiety, and anhedonia subscale items were compared between delivery methods to identify factors predictive of high EPDS scores. There were 950 patients included in the analysis; 694 (73.1%) and 256 (26.9%) patients underwent vaginal and cesarean deliveries, respectively. Total EPDS scores were higher among patients who had cesarean deliveries compared with vaginal deliveries (6.95±4.80 vs 6.05±4.20; P=0.007); the depression (0.53±0.72 vs 0.37±0.65; P=0.007), anxiety (1.07±0.88 vs 1.16±0.93; P=0.021), and anhedonia (0.32±0.59 vs 0.19±0.48; P=0.009) subscale scores were all higher among patients who underwent cesarean deliveries. Women who underwent cesarean deliveries demonstrated higher EPDS scores and could be at increased risk of developing early postpartum depressive symptomatology, particularly anhedonia, anxiety, and depression.

Correlates of Postpartum Maternal Functioning in a Low-Income Obstetric Population.

Perinatal mental health has been characterized primarily via depression evaluation. However, there may be advantages to complementary assessment of postpartum functional status. The purpose of this study was to examine sociodemographic and clinical factors associated with maternal functioning in low-income obstetrics patients. One hundred and twenty-eight women receiving postpartum obstetrical care at a large medical center in medically underserved, Middle Georgia were screened for depressive symptoms with the Edinburgh Postnatal Depression Scale. The women also completed the Barkin Index of Maternal Functioning and a sociodemographic survey. Multivariate analysis was performed to elucidate factors independently associated with maternal functioning. Higher Edinburgh Postnatal Depression Scale scores ( p < .0001) and being married ( p = .043) were associated with decreased maternal functioning. Health care providers should be cognizant of the relationship between postnatal depression and maternal functioning and its potential implications for family health.

Impact of a high Edinburgh Postnatal Depression Scale score on obstetric and perinatal outcomes

The aim of this retrospective study was to characterise intrapartum and neonatal outcomes in women with an antenatally recorded Edinburgh Postnatal Depression Score (EPDS) ≤ 9 compared with women with a score of ≥12 at a major Australian tertiary maternity hospital. Women with scores ≥12 are at particularly high risk of major depressive symptomatology. There were 20512 (78.6%) women with a score ≤ 9 and 2708 (10.4%) had a score ≥ 12. Category 1 caesarean sections where there was immediate threat to life (maternal or fetal) were more common in women with EPDS scores ≥12 (5.2% vs. 4.3%, OR 1.24 95% CI 1.03–1.49, p = 0.024). Pre-term birth (<37 weeks) was also more common (11.7% vs. 8.6%, OR 1.38 95% CI 1.21–1.57, p < 0.001). Women with high scores had higher rates of babies with birth weights <5th centile (6.2% vs. 4.4%, p < 0.001). Apgar score < 7 at 5 minutes were more frequent in the high EPDS group (3.1% vs. 2%, OR 1.52 95% CI 1.18–1.93, p < 0.001). Resuscitation at birth (34.4% vs. 30.6%, p < 0.001) and neonatal death (0.48% vs. 0.13%, OR 2.52 95% CI 1.2–5.0, p < 0.001) were higher in babies of these women. These results suggest poorer intrapartum and neonatal outcomes for women with high EPDS scores.

The behavior over time of postnatal depression symptomatology and its early detection via the Edinburgh Postnatal Depression Scale: An Italian longitudinal study

Background: Becoming a mother for the first time is a significant developmental transition and postpartum mood disorders represents the most frequent form of maternal morbidity following delivery.Objective: To investigate the ability of Edinburgh Postnatal Depression Scale (EPDS) to detect, in the first days postpartum, mothers at risk of developing depressive symptomatology over time.Results: The percentage of mothers with an EPDS score ≥10 decreases over time: 23.77% at 2/5 days postpartum, 15.57% at 2 months and 9.02% at 6 months after delivery. Among mothers with a depressive symptomatology after 2/5 days postpartum, 41.38% maintained an EPDS score ≥10 at 2 months too, while 20.69% of them manifested depressive symptoms at 6 months as well. Both correlation and linear regression showed a significant association between EPDS scores in all three administrations of the study but EPDS score at 2/5 days postpartum is more associated and predictive to maternal mood at two months than at six months postpartum.Method: A longitudinal study was conducting on 122 primiparous mothers who filled out EPDS and a General Information Questionnaire at 2/5 days postpartum, at 2/3 and 6/7 months after delivery. Women with high EPDS scores (≥10) were compared to those who had scored &lt;10 in all the three steps and longitudinal analysis were conducted.Conclusion: Implementing EPDS in the first week postpartum allows identifying women at high risk to maintain depressive symptoms over time. These findings could be useful for health care interventions after delivery and for researchers involved in the study of transcultural aspects of postnatal depression.

Stability of depressive symptoms over 3 months post-partum.

Prolonged depression during the post-partum period is associated with maternal and infant mortality and morbidity. Less attention has been given to factors that predict the persistence of depression beyond the first 3 months post-partum. From a longitudinal cohort of 2279 women who attended Mazandaran's primary health centres in 2009, 478 women with an Edinburgh Postnatal Depression Scale (EPDS) score of 12 or greater in the third trimester of pregnancy were recruited. Persistently depressed women (depressed at all three occasions: during pregnancy, and at 2 and 12 weeks post-partum) were compared with those without depression to determine demographic, cultural, obstetric and biopsychosocial predictors for persistence of depression. Data were analysed using chi-square test, t-test and logistic regression models. The stability of depression was found in 193 (46.2 %) of 418 depressed cases who were followed up over the study period. Of those mothers who scored more than the threshold of 12 during the third trimester of pregnancy, 277 (66.3%) and 221 (52.9%) had high EPDS at 2 and 12 weeks post-partum. Psychological distress (based upon the General Health Questionnaire), low maternal parental self-efficacy (based upon the Parental Expectation Survey) and perceived social isolation (based upon the Network Orientation Scale) were independent predictors of persistent depression. Fewer depressed mothers in this study were found to recover during the first 3 months after giving birth. Psychosocial factors predicted sustained depression from pregnancy to 3 months post-partum. The findings highlight the significance of support in enhancing maternal mental health.

Links Among High EPDS Scores, State of Mind Regarding Attachment, and Symptoms of Personality Disorder.

Underlying persistent psychological difficulties have been found to moderate potential adverse effects of maternal postpartum depression (PPD) on parenting and infant development. The authors examined whether mothers presenting postpartum depressive symptoms showed higher levels of personality pathology and more insecure state of mind regarding attachment compared to nondepressed mothers. Participants (N = 85) were assessed with the Edinburgh Postnatal Depression Scale (EPDS), the Present State Examination, the Adult Attachment Interview, and the Structured Clinical Interview for DSM-IV Axis II. Mothers with high EPDS scores were more likely to have a preoccupied insecure state of mind and to have personality disorder compared with mothers scoring below clinical cutoff. Furthermore, multiple regression analysis showed that personality disorder and AAI classification were independently related to EPDS score, and that these two factors together accounted for 48% of the variance in EPDS score. Findings are discussed in terms of heterogeneity in PPD populations and underline the importance of examining potential coexisting psychological difficulties when studying PPD.

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Objectives The prevalence of perinatal depression is unknown in hypertensive disorders of pregnancy. Our aim was to determine the occurrence of depression and anxiety in the early postpartum period in women with different forms of hypertensive diseases during pregnancy compared to normotensive, healthy pregnant women. Methods 41 women with gestational hypertension, 41 with chronic hypertension, 65 with preeclampsia, 38 with superimposed preeclampsia and 157 normotensive, healthy pregnant women were enrolled in our study. The level of depression and anxiety was examined by self-rating scales on days 2–3 after delivery. The depression was detected with the Edinburgh Postnatal Depression Scale (EPDS), while the anxiety was assessed with the State-Trait Anxiety Inventory (STAI). Results In the early postpartum period, preeclamptic patients had significantly higher EPDS and STAI scores than healthy pregnant women. In addition, the number of cases requiring psychiatric intervention was also significantly higher in the preeclamptic group than in the control group. Conclusions The occurrence of postpartum depression and anxiety is higher in preeclamptic women. Therefore, they require special psychiatric attention after delivery. Disclosures J. Rigo: None. A. Kecskemeti: None. A. Molvarec: None. E. Lefkovics: None. B. Szita: None. I. Baji: None.

Long-term trajectories of maternal depressive symptoms and their antenatal predictors

BackgroundDepressive symptoms, often long-term or recurrent, are common among mothers of young children and a well-known risk for child well-being. We aimed to explore the antecedents of the long-term trajectories of maternal depressive symptoms and to define the antenatal factors predicting the high-symptom trajectories. MethodsThe sample comprised 329 mothers from maternity centers. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) antenatally and at two months, six months, 4–5 years, 8–9 years and 16–17 years after delivery. Maternal expectations concerning the baby were assessed with the Neonatal Perception Inventory (NPI). Background information was gathered with questionnaires. ResultsA model including four symptom trajectories (very low, low-stable, high-stable and intermittent) was selected to describe the symptom patterns over time. The high-stable and the intermittent trajectory were both predicted pairwise by a high antenatal EPDS sum score as well as high EPDS anxiety and depression subscores but the other predictors were specific for each trajectory. In multivariate analyses, the high-stable trajectory was predicted by a high antenatal EPDS sum score, a high EPDS anxiety subscore, diminished life satisfaction, loneliness and more negative expectations of babies on average. The intermittent trajectory was predicted by a high antenatal EPDS sum score, a poor relationship with own mother and urgent desire to conceive. LimitationsOnly self-report questionnaires were used. The sample size was rather small. ConclusionsThe results suggest a heterogeneous course and background of maternal depressive symptoms. This should be considered in intervention planning.

Mid-pregnancy vitamin D levels and postpartum depression

ObjectivesPostpartum depression (PPD) is a common disorder that affects 10–15% of postpartum women, and it can have negative effects on both the mother and newborn. Recent studies have suggested that low levels of vitamin D are associated with poor mood and depression. The aim of this prospective study was to evaluate a possible association between PPD and serum levels of 25-hydroxy vitamin D3 (25(OH)D3), a reliable measurement of vitamin D, during mid-pregnancy. Study designThe source population consisted of all pregnant women between 24 and 28 gestational weeks from June 2012 to October 2012 at Bornova Health Research and Application Hospital, Sifa University. In order to better evaluate a possible effect between vitamin D levels and PPD, individuals with characteristics that put them at risk for developing PPD were excluded from the study. Serum 25(OH)D3 levels were evaluated mid-pregnancy in the study group. Serum 25(OH)D3 concentrations ≤20ng/mL (50nmol/L) were classified as a mild deficiency and those ≤10ng/mL (25nmol/L) were classified as a severe deficiency. Pregnant subjects having complications during birth or with the newborn after delivery were excluded from the study. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess maternal PPD 1 week, 6 weeks, and 6 months after delivery. A Pearson correlation was used to measure the strength of the associations between the EPDS scores and vitamin D levels analyzed during the three time periods. A logistic regression analysis was used to determine the independent effects of vitamin D on PPD. ResultsSix hundred and eighty-seven pregnant women were included in this study. After excluding women due to PPD risk factors (in two stages), 179 pregnant women were screened for vitamin D levels during mid-pregnancy and in the 6th month postpartum. Eleven percent of our study group had severe vitamin D deficiency and 40.3% had mild vitamin D deficiency. The frequency of PPD was 21.6% at the 1st week, 23.2% at 6th week, and 23.7% at the 6th month. There was a significant relationship between low 25(OH)D3 levels in mid-pregnancy and high EPDS scores, which is indicative of PPD for all three follow-up periods (p=0.003, p=0.004 and p<0.001, respectively). In addition, there was a significant negative correlation between vitamin D levels and EDPS at all three time points (r=−0.2, −0.2, −0.3, respectively). ConclusionsVitamin D deficiency in mid-pregnancy may be a factor affecting the development of PPD. More extensive studies are required to be carried out on this subject.

Prospective study on prevalence and risk factors of postpartum depression in Al-dakhliya governorate in oman.

Postnatal Depression (PND) is a major health problem. It has a serious impact on the mother, her child and family. Studies have shown wide diversity of its prevalence across different cultures. Its epidemiology and its associated risk factors in Oman remain unknown. The objectives of this study were to estimate the prevalence of PND in the Al-Dakhliya governorate and to identify the risk factors contributing to the development of PND. A total of 282 Omani women who gave birth in September 2010 were part of a prospective study conducted in Al-Dakhliya governorate. An Arabic version of the Edinburgh Postnatal Depression Scale (EPDS) was used to assess the PND symptoms. Negative binomial regression model was used to identify the independent predictors of outcome (EPDS scores at two and eight weeks post-delivery) due to the non-normal distribution of the EPDS scores. The study results showed that at two weeks, 13.5% of mothers and 10.6% at eight weeks had EPDS scores of 13. Bahla district was found to have the highest number of depression scores among the other six districts in the governorate. It was found that mothers less than 25 years of age were more likely to report high EPDS scores. The independent predictor was work difficulties both at two and eight weeks postpartum (p=0.001 and p=0.019, respectively). At two weeks postpartum, significant association was also found between depression scores and conflict with a family member (p=0.017), and sickness of a family member (p=0.010). There was no significant association between EPDS scores and socio-demographic, obstetric or other clinical factors. This study is among the few studies looking at PND in the Middle East and shows on average 12% of Omani women are at a high risk of developing PND (EPDS scores of ≥13). Although the study findings were based on an unvalidated version of EPDS for Omani women, they can be used as a basis for further research.

Can insomnia in pregnancy predict postpartum depression? A longitudinal, population-based study.

BackgroundInsomnia and depression are strongly interrelated. This study aimed to describe changes in sleep across childbirth, and to evaluate whether insomnia in pregnancy is a predictor of postpartum depression.MethodsA longitudinal, population-based study was conducted among perinatal women giving birth at Akershus University Hospital, Norway. Women received questionnaires in weeks 17 and 32 of pregnancy and eight weeks postpartum. This paper presents data from 2,088 of 4,662 women with complete data for insomnia and depression in week 32 of pregnancy and eight weeks postpartum. Sleep times, wake-up times and average sleep durations were self-reported. The Bergen Insomnia Scale (BIS) was used to measure insomnia. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms.ResultsAfter delivery, sleep duration was reduced by 49 minutes (to 6.5 hours), and mean sleep efficiency was reduced from 84% to 75%. However, self-reported insomnia scores (BIS) improved from 17.2 to 15.4, and the reported prevalence of insomnia decreased from 61.6% to 53.8%. High EPDS scores and anxiety in pregnancy, fear of delivery, previous depression, primiparity, and higher educational level were risk factors for both postpartum insomnia and depression. Insomnia did not predict postpartum depression in women with no prior history of depression, whereas women who recovered from depression had residual insomnia.LimitationsDepression and insomnia were not verified by clinical interviews. Women with depressive symptoms were less likely to remain in the study.ConclusionsAlthough women slept fewer hours at night after delivery compared to during late pregnancy, and reported more nights with nighttime awakenings, their self-reported insomnia scores improved, and the prevalence of insomnia according to the DSM-IV criteria decreased. Insomnia in pregnancy may be a marker for postpartum recurrence of depression among women with previous depression.