Management Of Postpartum Depression Research Articles

Stratifying Risk for Postpartum Depression at Time of Hospital Discharge.

Postpartum depression (PPD) represents a major contributor to postpartum morbidity and mortality. Beyond efforts at routine screening, risk stratification models could enable more targeted interventions in settings with limited resources. Thus, we aimed to develop and estimate the performance of a generalizable risk stratification model for PPD in patients without a history of depression using information collected as part of routine clinical care. We performed a retrospective cohort study of all individuals who delivered between 2017 and 2022 in one of two large academic medical centers and six community hospitals. An elastic net model was constructed and externally validated to predict PPD using sociodemographic factors, medical history, and prenatal depression screening information, all of which was known before discharge from the delivery hospitalization. The cohort included 29,168 individuals; 2,703 (9.3%) met at least one criterion for postpartum depression in the 6 months following delivery. In the external validation data, the model had good discrimination and remained well-calibrated: area under the receiver operating characteristic curve 0.721 (95% CI: 0.707-0.734), Brier calibration score 0.088 (95% CI: 0.084 - 0.092). At a specificity of 90%, the positive predictive value was 28.0% (95% CI: 26.0-30.1%), and the negative predictive value was 92.2% (95% CI: 91.8-92.7%). These findings demonstrate that a simple machine-learning model can be used to stratify the risk for PPD before delivery hospitalization discharge. This tool could help identify patients within a practice at the highest risk and facilitate individualized postpartum care planning regarding the prevention of, screening for, and management of PPD at the start of the postpartum period and potentially the onset of symptoms.

Commentary] Postpartum Depression: An Invisible Distress in the United Kingdom

This opinion piece explores the complexities of Postpartum Depression (PPD), its impact on the mother and child’s mental health, and the societal challenges it presents. PPD extends beyond the commonly experienced “baby blues” and can significantly impact a mother’s functionality due to its potential to evolve into a long-term depressive disorder if not properly addressed. The piece highlights the inadequacy of current maternal mental health support structures within the National Health Service (NHS), pointing out the lack of specialised treatment options tailored to new mothers' unique needs. It discusses the compound effects of social stigma and cultural barriers that limit access to necessary support, underscoring the urgent need for enhanced support systems and policy reforms. The piece highlights the serious long-term effects of PPD on children, such as developmental delays and emotional and behavioural challenges, advocating for early intervention and comprehensive support systems that address the needs of both mothers and their families. It calls for the adoption of thorough PPD management strategies, including the use of effective screening tools such as the Edinburgh Postnatal Depression Scale, and extensive educational campaigns to identify early PPD symptoms. The piece further urges for policy changes to provide new mothers with tailored resources and support, promoting a more inclusive and supportive healthcare environment for affected families.

Biopsychosocial Predictors of Postpartum Depression: Protocol for Systematic Review and Meta-Analysis.

During the postpartum period, psychological disorders may emerge. Aims and objectives: With the current study, we aim to explore the biological determinants that act on women during labor and incur the risk for postpartum depression (PPD). To reach the aim, we will perform the following tasks: (i) identify biological peripartum risk factors and calculate pooled prevalence of PPD for each of them; (ii) explore the strength of the relationship between peripartum risk factors and PPD; (iii) rank the predictors by their prevalence and magnitude of association with PPD. The knowledge obtained will support the development and implementation of early diagnostic and preventive strategies. Methods and analysis: We will systematically go through peer-reviewed publications available in the PubMed search engine and online databases: Scopus, Web of Science, EMBASE. The scope of the review will include articles published any time in English, Arabic, or Polish. We will deduplicate literature sources with the Covidence software, evaluate heterogeneity between the study results, and critically assess credibility of selected articles with the Joanna Briggs Institute's bias evaluation tool. The information to extract is the incidence rate, prevalence, and odds ratio between each risk factor and PPD. A comprehensive analysis of the extracted data will allow us to achieve the objectives. The study findings will contribute to risk stratification and more effective management of PPD in women.

Efficacy and safety of electroacupuncture in patients with postpartum depression: a meta-analysis.

This study aimed to assess the clinical effectiveness and safety of electroacupuncture (EA) for the treatment of postpartum depression (PPD). We systematically retrieved relevant randomized controlled trials (RCTs) from electronic databases, including PubMed, Cochrane Library, China National Knowledge Infrastructure, EMBASE, China Science and Technology Journal Database, Chinese Biological Medical Database, and the Wanfang database from their inception to November 2023. The outcomes measured were the Hamilton Depression Rating Scale (HAMD) scores, Edinburgh Postnatal Depression Scale (EPDS) scores, adverse events (AEs), and the total response rate. The study aimed to estimate heterogeneity, publication bias, mean difference (MD), and risk ratios (RR) with 95% confidence intervals (CIs). This study included 12 RCTs with a total of 1364 participants (571 in the treatment group and 793 in the control group) for analysis. The results of the meta-analysis indicated that EA did not significantly reduce HAMD (MD = 1.49, 95% CI = [-0.30, 3.27], P = 0.1, I2 = 0%) and EPDS (MD = 1.12, 95% CI = [-1.62, 3.85], P = 0.42, I2 = 32%) scores compared to sham EA among patients with PPD, resulting in low heterogeneity. In terms of the total response rate, the EA group exhibited superior results compared to the placebo group (RR = 1.77, 95% CI = [1.15, 2.74], P = 0.01, I2 = 0%) and the sham EA group (RR = 1.2, 95% CI = [1.02, 4.4], P = 0.02, I2 = 0%), with statistical significance and low heterogeneity. The incidence of AEs was lower, also with low heterogeneity (RR = 0.9, 95% CI = [0.57, 1.43], P = 0.66, I2 = 12%). The current evidence indicates that the effectiveness and safety of EA in the treatment of PPD warrant affirmation. However, EA does not demonstrate superiority over sham EA in reducing HAMD and EPDS scores in patients with PPD. Due to the limited quantity and quality of curent research, the above conclusion should be further validated through high-quality studies to confirm the efectiveness of EA in PPD management. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=318917, identifier CRD42023318917.

Zuranolone: The First FDA-Approved Oral Treatment Option for Postpartum Depression.

The objective of this study was to review the characteristics, efficacy, and safety of zuranolone in the management of postpartum depression (PPD). Literature was identified using PubMed (1966-August 2023) and EMBASE (1973-August 2023) and clinicaltrials.gov. Search terms included zuranolone, SAGE-217, and PPD with further limitation of those published in English. Articles selected for inclusion included trials evaluating zuranolone for the treatment of PPD. Zuranolone was evaluated for the treatment of moderate to severe PPD in 2 phase III trials. Both studies resulted in statistically significant improvement in depressive symptoms at day 15 (P = 0.003 and P < 0.001). Sustained differences in remission rates favoring zuranolone were found in both studies at day 45 compared with placebo (P = 0.01 and P < 0.05). Zuranolone was well tolerated, with somnolence, dizziness, headache, and sedation reported as the most common side effects. Zuranolone is only the second medication approved by the Food and Drug Administration (FDA) for PPD and offers an advantage over brexanolone in that it can administered orally in the outpatient setting. The rapid onset of effect of zuranolone is advantageous to traditional antidepressant therapy which can be weeks to months; however, limited information is available on safety during lactation. The recent FDA approval of oral zuranolone for PPD offers a second rapid-acting treatment for PPD, extending the opportunity for treatment to patients in the outpatient setting.

Exploring the Relationship Between Circadian Rhythm Shifts and Postpartum Depression

This review paper explores the relationship between circadian rhythm and postpartum depression (PPD). Postpartum depression is a prevalent and debilitating mood disorder that affects a significant number of women after childbirth. Emerging evidence suggests that disruptions in circadian rhythm may contribute to the development of PPD. This paper provides an overview of the current understanding of circadian rhythm disturbances in the postpartum period, their potential impact on PPD, and the underlying mechanisms involved. Additionally, therapeutic approaches targeting circadian disruptions in the prevention and treatment of PPD are discussed. Further research in this field has the potential to provide novel insights and interventions for the management of PPD.

Wellbeing Forecasting in Postpartum Anemia Patients.

Postpartum anemia is a very common maternal health problem and remains a persistent public health issue globally. It negatively affects maternal mood and could lead to depression, increased fatigue, and decreased cognitive abilities. It can and should be treated by restoring iron stores. However, in most health systems, there is typically a six-week gap between birth and the follow-up postpartum visit. Risks of postpartum maternal complications are usually assessed shortly after birth by clinicians intuitively, taking into account psychosocial and physical factors, such as the presence of anemia and the type of iron supplementation. In this paper, we investigate the possibility of using machine-learning algorithms to more reliably forecast three parameters related to patient wellbeing, namely depression (measured by Edinburgh Postnatal Depression Scale-EPDS), overall tiredness, and physical tiredness (both measured by Multidimensional Fatigue Inventory-MFI). Data from 261 patients were used to train the forecasting models for each of the three parameters, and they outperformed the baseline models that always predicted the mean values of the training data. The mean average error of the elastic net regression model for predicting the EPDS score (with values ranging from 0 to 19) was 2.3 and outperformed the baseline, which already hints at the clinical usefulness of using such a model. We further investigated what features are the most important for this prediction, where the EDPS score and both tiredness indexes at birth turned out to be by far the most prominent prediction features. Our study indicates that the machine-learning model approach has the potential for use in clinical practice to predict the onset of depression and severe fatigue in anemic patients postpartum and potentially improve the detection and management of postpartum depression and fatigue.

EDUKASI MANAJEMEN KOPING PENCEGAHAN DAN TATALAKSANA DEPRESI POST PARTUM

Postpartum depression is a serious condition, especially for mothers who are giving birth for the first time or mothers with sibling conditions who have not been prepared. The impact that occurs on the mother and baby should be prevented with good management. The purpose of this community service is to provide education on coping management about the prevention and management of postpartum depression, for postpartum mothers in collaboration with the Punggul-Mojokerto Village Polindes Midwife. Implementation of activities in January 2023, starting from the preparation stage to the evaluation stage. The output of the activity is an increase in the understanding of postpartum mothers, the readiness of mothers to undergo childbirth, and new roles. In efforts to improve maternal and child health, modules and booklets are available related to postpartum and newborn care, with the hope that reproductive mothers will increase their knowledge about maternal issues

Aromatherapy for Postpartum Depression: A Systematic Review and Meta-Analysis.

The incidence and prevalence of postpartum depression is increasing due to multiple factors. Aromatherapy is a widely used complementary and alternative (CAM) therapy in the management of depression. This systematic review and meta-analysis was done to find the effect of aromatherapy on postpartum depression. Electronic databases like PubMed, Scopus, Cochrane Library and Science Direct since inception till February 2021 were searched using related keywords to obtain eligible studies. Randomised controlled trial studies (RCTs) reporting the effects of aromatherapy therapy in women with postpartum depression were included. Aromatherapy studies conducted on population other than postpartum women were excluded. The primary outcome was depression scores obtained by using valid depression scales. Meta-analysis was performed using the random-effects model of Der Simonian and Laird to produce summary treatment effects in terms of Hedges' g effect sizes with 95% confidence interval (CI). A total of 4 RCTs (n=303) were included. The results indicate that aromatherapy (Hedges' g =-0.94, 95 CI= -2.55, 0.61, I2=88%, p<0.01) reduces depression levels among postpartum women without statistical significance. The available evidences suggest aromatherapy may be effective in reducing post-partum depression. The number of scientific evidences currently available are very limited and more studies with robust study designs are required to strongly recommend aromatherapy in the management of post-partum depressions. However, being a safer intervention with no adverse effects being reported in previous studies, aromatherapy could definitely be added as an effective complementary therapy in the management of post-partum depression along with conventional medicine.

Risk factors and management of postpartum depression

ABSTRACT Background: After giving birth, some women experience the common and complex mood disorder known as postpartum depression (PPD). PPD has multiple etiological factors, including hormonal fluctuations, genetic susceptibility, and psychosocial stressors. Objective: Detailed overview of PPD standard of care effectiveness in management with pharmacological interventions. Method: To gather pertinent publications about the most recent advancements in management, a Pubmed search for PPD articles was conducted. Result: PPD is characterized by a variety of emotional and psychological symptoms, such as irritability, persistent sadness, anxiety, and hopelessness. These symptoms can have a serious negative effect on a new mother’s quality of life and capacity to care for her child. Conclusion: Effective management and the avoidance of long-term detrimental effects for the mother and her child depend on early detection and intervention.

Diagnosis and Management of Postpartum Depression

Postpartum Depression (PPD) is a severe mental health problem that affects up to 15% of mothers. It is highly prevalent, and its drawbacks are not limited to the affected mothers. It also extends to their offspring, causing disturbances in their development. Recent research has identified several psychosocial and biological risk factors for PPD, including past depression, stressful life events, poor marital relationships, and social support. The obstetrician, pediatrician and primary health care physicians have a crucial role in screening for and treating PPD. This review aims to provide a holistic approach for PPD diagnosis and management.

A Review on Risk Factors of Postpartum Depression in India and Its Management.

Postpartum depression is the term used for depression that predominates in the postpartum period, which is increasingly seen in research and clinical practice up to 1 year after delivery. Other symptoms commonly seen in women with postpartum depression include mood swings or lability and excessive worry about the baby. In addition, postpartum depression is often associated with anxiety disorders or significant anxiety symptoms. Women with a history of psychiatric illness are prone to postpartum depression. Postpartum depression is a crucial psychological health ailment that confers a vast degree of disability in females and is often associated with significant emotional, behavioral, and cognitive dangers in children. It is a disorder that is often unrecognized and undertreated. Postpartum depression is a critical issue to be addressed because it interferes with a woman’s self-care and parenting. It also affects a child’s mental growth and development. For these reasons, evaluation of risk factors is required to consider every facet of postpartum depression in women. This article reviews the associated risk factors and management of postpartum depression in India. Traditional studies for risk factors in postpartum depression have typically categorized women according to a particular stage of pregnancy that follows them into postpartum depression. Pregnancy-associated risk factors are estimated during pregnancy and are looked up for their predictive association with postpartum depression defined by clinical diagnostic methods or self-report assessment. Treatment options include psychotherapy and antidepressant medication. The risk of postpartum depression in fathers also follows maternal postpartum depression. Paternal depressive disorder is associated with adverse effects on child development. Early intervention for postpartum depression and anxiety may decrease the severity and recurrence of symptoms as well as the negative effects on the baby's health and development.

The role of the practice nurse in the management of Postpartum depression

IntroductionNurses specializing in maternal and child health are poised to play a pivotal role in the early identification and prompt treatment of perinatal depression. Postpartum period it is well-known for presenting high-risk for the appearance of a mental illness.ObjectivesThis study has been carried out with the aim of investigating the level of knowledge of the nurses and their role in the management of post-partum depression.Methods73 participants (n=73) were selected which are professional nurses. The data were collected through a questionnaire formed out of 16 questions. The questionnaire is structured on three parts: general information about the participants, the nurse’s knowledge about the postpartum depression, and the identification and the management of the patient’s cases.Results73 of the nurses questioned, consider that they were not properly prepared for this role and they were not able to identify and manage the patients with post-partum depression. They also consider that the ideal training should contain more theoretical information. Amongst these (32, 87%) do not know the symptomatology, and 38, 35% are not aware of the risk factors of post-partum depression.ConclusionsPostpartum depression is seen in approximately 10% of women who have recently given birth, but also in 3, 3% of men. Despite of this numbers, the Romanian medical staff is not yet well prepared in facing this affection.DisclosureNo significant relationships.

Allopregnanolone in Postpartum Depression

Postpartum depression (PPD) is a debilitating psychiatric disorder characterized by a high worldwide prevalence and serious long-term negative outcomes for both mothers and children. The lack of a specific treatment and overreliance on pharmacotherapy with limited efficacy and delayed treatment response has constituted a complication in the management of PPD. Recently, the Food and Drug Administration (FDA) in the USA approved a synthetic formulation of the GABAergic neurosteroid allopregnanolone, administered intravenously (brexanolone) for the rapid, long-lasting and effective treatment of PPD. Hereinafter, we review findings on allopregnanolone biosynthesis and GABAA receptor plasticity in the pathophysiology of PPD. We also discuss evidence supporting the efficacy of brexanolone for the treatment of PPD, which opens a promising new horizon for neurosteroid-based therapeutics for mood disorders.

Discharge instructions given to women following delivery by cesarean section in Sub-Saharan Africa: A scoping review.

A scoping review of discharge instructions for women undergoing cesarean section (c-section) in sub-Saharan Africa (SSA). Studies were identified from PubMed, Globus Index Medicus, NiPAD, EMBASE, and EBSCO databases. Eligible papers included research based in a SSA country, published in English or French, and containing information on discharge instructions addressing general postnatal care, wound care, planning of future births, or postpartum depression targeted for women delivering by c-section. For analysis, we used the PRISMA guidelines for scoping reviews followed by a narrative synthesis. We assessed quality of evidence using the GRADE system. We identified 78 eligible studies; 5 papers directly studied discharge protocols and 73 included information on discharge instructions in the context of a different study objective. 37 studies addressed wound care, with recommendations to return to a health facility for dressing changes and wound checks between 3 days to 6 weeks. 16 studies recommended antibiotic use at discharge, with 5 specifying a particular antibiotic. 19 studies provided recommendations around contraception and family planning, with 6 highlighting intrauterine device placement immediately after birth or 6-weeks postpartum and 6 studies discussing the importance of counselling services. Only 5 studies provided recommendations for the evaluation and management of postpartum depression in c-section patients; these studies screened for depression at 4-8 weeks postpartum and highlighted connections between c-section delivery and the loss of self-esteem as well as connections between emergency c-section delivery and psychiatric morbidity. Few studies in SSA directly examine discharge protocols and instructions for women following c-section. Those available demonstrate wide variation in recommendations. Research is needed to develop structured evidence-based instructions with clear timelines for women. These instructions should account for financial burden, access to resources, and education of patients and communities.

Dietary Factors in the Prevention and Management of Postpartum Depression: A Literature Review

Background: The prevalence of postpartum depression (PPD) in women has become a major global mental health concern, thus how to conduct effective and safe intervention based on the pathogenesis of PPD has become an important research topic. Discussion: In this literature review, the aim was to identify the role of prenatal and postpartum healthy dietary factors in the management of PPD. Several dietary patterns, food groups, and nutrients (from food sources or supplements) that can be beneficial for PPD (or depression) were all discussed. Besides, dietary recommendations that may be effective in reducing the incidence of PPD were further summarized based on a review of the relevant literature (from the conclusion, the level of evidence of study design, the sample size, and the risk of bias) and dietary guidelines. Conclusion: Several existing healthy eating patterns (including some specific foods) and nutrient supplements for pregnant women and postpartum mothers are potentially effective means of managing the occurrence and symptoms of PPD through their nutritional contents (i.e., the possible mechanisms of those nutrients, such as anti-inflammatory action). Although some of the studies reviewed in this paper have had inconsistent results regarding the effects of certain nutrients and foods on PPD, considering that diet management of PPD is a more acceptable and feasible intervention for women during pregnancy and postpartum, more longitudinal studies are needed to further demonstrate the effectiveness of these diet-based interventions and to develop optimal dietary content-matching strategies for preventing and relieving PPD.

Postpartum depression and the scarcity of generalizable evidence: A mini-review of existing literature and the way forward

The first known reference to Postpartum Depression (PPD), was Hippocrates’ 4th century hypothesis that drainage of lochia, if suppressed, could flow to the brain resulting in agitation, delirium, and episodes of mania. This hypothesis became dogma and lasted over a millennium. Over the years, knowledge of PPD has evolved but researchers still struggle to establish it as a distinct disease entity. It was initially recognized as Major Depressive Disorder (MDD) with postpartum onset in the 1994 revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the “bible” of diagnostic criteria for mental health professionals and researchers. It is currently recognized as MDD with peripartum onset (DSM-V) and researchers have admitted that persuasive evidence to indicate that postpartum depression is distinct from other existing depressive disorders, has not been found. Several diagnostic tools such as the Edinburg Postpartum Depression Scale (EDPS), the Beck Depression Inventory (BDI-II), Patient Health Questionnaire (PHQ-9), and the Postpartum Depression Screening Scale (PDSS) are available for use but none of these is universally accepted. With much of the published literature plagued with bias and structural inconsistencies, the credibility of the evidence has been greatly diminished. The difficulty with disease designation, the absence of a universally accepted tool for diagnosis and the scarcity of generalizable evidence on the subject has impaired the early recognition and effective management of PPD. It is therefore expedient, to critically appraise some of the available literature and proffer solutions to navigating this conundrum.

Management of Postpartum Depression in the Covid Pandemic

One of the most common complications after childbirth is postpartum depression. The COVID pandemic caused an increase in the incidence of this pathology both by direct damage to the central nervous system by the SARS-COV2 virus, but also indirectly by maintaining social distance, lack of effective doctor-patient communication.

Effects of Yoga in Pregnancy on Postpartum Depression: A Systematic Review

Background: Postpartum depression is a common condition, which is managed by antidepressants. Antidepressants are generally considered to be safe during breastfeeding, and the probability of exposure to antidepressants through breast milk is low to very low. Due to the beliefs of breastfeeding women that antidepressants may have side effects on infants, complementary and alternative medicine (CAM) is being investigated to play a role in the management of postpartum depression. Yoga is among the complementary therapies that showed preventive effects against depression in some age and disease groups. Objectives: The aim of this systematic review was to assess the effects of Yoga intervention on healthy pregnant women and its preventive effects on postpartum depression. Methods: Clinical databases, including Scopus, PubMed, Medlib, Web of Science, Psych Info, and Cochrane Library, as well as Google Scholar, were searched using search keywords, including pregnant women, women, maternal period, yoga, mindfulness, postpartum depression, and depression. Clinical trial, case-control, and cohort articles in English language that assessed the effects of Yoga on postpartum depression in healthy women were reviewed. Among the initial 982 identified studies, five studies (271 subjects) were eligible for the review. Due to the high heterogeneity in the studies, meta-analysis was not performed. Results: One study had medium quality, one study had good quality, and three studies had high quality. Yoga intervention included physical and mindfulness exercises and assessed mood and behavior during pregnancy. The intervention duration ranged between 6 and 24 weeks during pregnancy. In the majority of studies, Yoga intervention reduced postpartum depression and other mental disorders. Conclusions: Yoga may be a beneficial and safe choice in the management of postpartum depression in healthy pregnant women.

Digital Health Needs of Women With Postpartum Depression: Focus Group Study.

BackgroundAlthough approximately 10% of new mothers in Canada develop postpartum depression (PPD), they face many barriers when accessing care. eHealth offers a unique opportunity to provide psychosocial skills and support to new mothers; however, patient populations are not consistently engaged in eHealth development processes. Thus, the diversity of women’s backgrounds and needs are often not reflected in existing tools.ObjectiveThis study aims to engage women from a variety of backgrounds and locations around British Columbia (BC) who have previously experienced PPD to determine the unmet psychoeducational needs of women with PPD and how a web-enabled platform used to deliver psychosocial skills and education to assist in the management of PPD could fulfill those needs.MethodsFocus groups were conducted in 7 cities across BC with a total of 31 women (mean age 34.5 years, SD 4.9), with each group ranging from 2-7 participants. Focus groups were cofacilitated by the study coordinator and a local service provider in each community using a semistructured guide to discuss participants’ needs, ideas, and opinions as they relate to the use of technology in PPD management. Transcripts were approached inductively using thematic analysis to identify themes and qualitative description to frame what was observed in the data.ResultsA total of 5 themes were identified: bridging gaps to meet needs; providing validation to combat stigma; nurturing capacity to cope, manage, and/or reach wellness; empowering people to take ownership over their mental health; and offering customization to ensure relevance. Each theme identified a need (eg, combatting stigma) and a way to address that need using a web-enabled intervention (eg, providing validation). At the intersection of these themes was the overarching value of promoting agency for women experiencing PPD.ConclusionsUltimately, new mothers require accessible mental health care that promotes their agency in mental health care decision making. Our participants believed that a web-enabled intervention could help meet this need. These data will be used to guide the design of such an intervention, with the eventual implementation of this resource as a first-line management option for PPD.