Postnatal Depressive Symptomatology Research Articles

Socioeconomic resources moderate the relationship between maternal prenatal obsessive-compulsive symptoms and infant negative affectivity

Perinatal maternal depression, anxiety, and stress are associated with poor infant outcomes. However, no known study has investigated the effects of perinatal maternal obsessive-compulsive symptomatology on infant outcomes while considering important situational factors such as socioeconomic resources. Therefore, we investigated the effects of prenatal and postnatal obsessive-compulsive symptomatology on infant behavioral reactivity, beyond the effects of postnatal depressive symptomatology, at 6 months of age. It was expected that socioeconomic resources would moderate this relationship. We recruited 125 pregnant women from a Health Professional Shortage Area for mental health and primary care in the Midwest United States and interviewed them at approximately 34 weeks gestation and again at 6 months postnatally. They were administered questionnaires at both time points measuring obsessive-compulsive and depressive symptoms. Infant behavioral reactivity was gathered during 6-month follow-up through behavioral observation coding and maternal-report modalities. Maternal-reported infant negative affectivity at 6 months was related to greater severity of maternal postnatal depressive symptomatology, and socioeconomic resources moderated the relationship between maternal prenatal obsessive-compulsive symptoms and maternal-reported infant negative affectivity. However, neither of these relations was statistically significant when infant reactivity was quantified using behavioral observations.

Examining the relationship between maternal childhood abuse history and mother-infant bonding: The mediating roles of postpartum depression and maternal self-efficacy

BackgroundThe detrimental effects of childhood abuse on long-term outcomes are well-known, however few studies have examined these effects in the context of postpartum psychopathology, maternal self-efficacy, and mother-infant bonding quality. ObjectiveThis study aimed to examine the relationship between a maternal childhood abuse experience (i.e., physical, psychological, and sexual) and mother-infant bonding disturbances, and whether this relationship was mediated by postnatal depression symptomatology and maternal self-efficacy. MethodA sample of 191 postpartum women (Mage = 32.88, SD = 4.20) recruited online from the general population completed self-report measures of the constructs of interest. ResultsPostnatal depression symptomatology and maternal self-efficacy were found to fully mediate the relationship between psychological child abuse experience and mother-infant bonding disturbances (β = 0.06, SE = 0.03, 95% CI: 0.01, 0.12). Postnatal depression symptomatology (but not maternal self-efficacy) was an independent mediator between psychological child abuse experience and mother-infant bonding (β = 0.07, SE = 0.03, 95 % CI: 0.01, 0.13). After inclusion of other abuse types as covariates in the analyses, the findings for maternal child physical abuse attenuated to non-significance. Child sexual abuse was not associated with the mediating or outcome variables, highlighting the issue of disclosure despite the anonymous online environment. ConclusionThis study highlights the negative impact of psychological childhood abuse experience on the quality of the mother-infant bond during the postpartum period and potential pathways that underlie this relationship. This study also draws attention to the need to recognize comorbidity of abuse types in research.

Higher Levels of Postnatal Depressive Symptomatology, Post-Traumatic Growth, and Life Satisfaction among Gay Fathers through Surrogacy in Comparison to Heterosexual Fathers: A Study in Israel in Times of COVID-19

This study aimed to explore the psychological welfare, as indicated by postnatal depressive symptomatology, life satisfaction, and posttraumatic growth (growth after contending with stressful birth events), of Israeli gay fathers through surrogacy in comparison to heterosexual fathers. For that purpose, a sample of 167 Israeli fathers (M = 35.6, SD = 4.4) was recruited (68 identified as gay fathers through surrogacy and 99 as heterosexual fathers). Participants completed questionnaires assessing their postnatal depressive symptomatology, life satisfaction, and sense of posttraumatic growth after becoming fathers. Results indicated that gay fathers through surrogacy reported higher levels of life satisfaction and posttraumatic growth than heterosexual fathers. Yet, gay fathers also reported higher levels of postnatal depressive symptomatology than heterosexual fathers when life satisfaction or posttraumatic growth values were low or medium. The findings were interpreted in light of the hardships associated with cross-border surrogacy and the psychological outcomes associated with succeeding to become fathers after contending with them. The study contributes to the limited literature on postnatal depressive symptomatology and posttraumatic growth among gay fathers through surrogacy and provides clinicians and policymakers with relevant information on the psychological strengths and potential difficulties associated with cross-border surrogacy among gay fathers.

Maternal antenatal anxiety and electrophysiological functioning amongst a sub-set of preschoolers participating in the GUSTO cohort

BackgroundAntenatal maternal anxiety is a risk for offspring psychological and cognitive difficulties. The preschool years represent an important time for brain development, and so may be a window for intervention. However, electrophysiological investigations of maternal anxiety and preschoolers’ brain functioning are lacking. We ask whether anxiety symptoms predict neurophysiology, and consider timing specificity (26-weeks antenatal or 24-months postnatal), form of insult (anxiety symptoms, per se, or also depression symptoms), and offspring gender.MethodsThe sample consisted of a subset of 71 mothers and their 3 year old children taking part in the prospective birth cohort, GUSTO. Mothers provided antenatal (26 weeks) and postnatal (2 years) anxiety and depressive symptomatology data, respectively via the “State Trait Anxiety Questionnaire” and the “Edinburgh Postpartum Depression Scale.” Offspring provided electrophysiological data, obtained while they indicated the emotional expression of actors whose facial expressions remained consistent throughout a pre-switch block, but were reversed at “post-switch.”ResultsThree electrophysiological components linked to different information processing stages were identified. The two earliest occurring components (i.e., the N1 and P2) differed across blocks. During post-switch, both were significantly predicted by maternal anxiety, after controlling for pre-switch neurophysiology. Similar results were observed with depression. Antenatal mental health remained a significant predictor after controlling for postnatal mental health.ConclusionIn combination with past work, these findings suggest the importance of reducing symptoms in women prior to and during pregnancy, and offering support to offspring early in development.

A Comprehensive Analysis of Post-partum Depression Risk Factors: The Role of Socio-Demographic, Individual, Relational, and Delivery Characteristics.

Postpartum depression is a common and complex phenomenon that can cause relevant negative outcomes for children, women and families. Existing literature highlights a wide range of risk factors. The main focus of this paper is to jointly investigate different types of risk factors (socio-demographic, psychopathological, relational, and related to labor and birth experience) in post-partum depression onset in women during first-child pregnancy, identifying which of these are the most important predictors. A cohort longitudinal study was conducted on 161 Italian nulliparous low-risk women (Mage = 31.63; SD = 4.88) without elective cesarean. Data was collected at three different times: Socio-demographic, prenatal anxiety and depression, and quality of close relationship network (with mother, father and partner, and the prenatal attachment to child) were assessed at T1 (week 31–32 of gestation); clinical data on labor and childbirth (mode and typology of delivery, duration of labor, duration of eventual administration of epidural analgesia, and child's APGAR index at birth) were registered at T2 (the day of childbirth); and the degree of post-natal depression symptomatology was measured at T3 (1 month after birth). Postpartum depression is associated with several risk factors (woman's age, woman's prenatal psychopathological characteristics, the level of prenatal attachment to child, the quality of romantic relationship, and some clinical delivery difficulties). Overall, the level of prenatal attachment to child was the most important predictor of post-partum depression. These findings emphasize the very important role of prenatal attachment for the onset of postpartum depression and the need to promote adequate and targeted prevention interventions. Limitations, strengths, and theoretical and clinical implications are discussed.

The burden and risk factors for postnatal depression and depressive symptomatology among women in Kampala.

Major depressive disorder (MDD) is a major global health challenge and postnatal women may be at an increased risk for this disorder. Very few studies have tested this hypothesis in sub-Saharan Africa (SSA), so it is uncertain whether risk factors implicated elsewhere in the world are relevant in SSA. We explored prevalence and risk factors for MDD and depressive symptomatology among postnatal mothers in Kampala. Three hundred postnatal mothers at Nsambya Hospital were assessed for MDD using the DSM IV-based MINI; prevalence and risk factors were determined using frequencies and regressions, respectively. Four women (1.33%) had MDD; however, 94 (31%) had 'sub-threshold' or depressive symptomatology, with which partner violence is particularly associated. MDD is rare among postnatal women in a paying hospital in Kampala; however, the high prevalence of depressive symptomatology suggests susceptibility to MDD. Longitudinal studies should investigate this hypothesis and the susceptibility due to partner violence should guide appropriate interventions.

Associations of childhood maltreatment with pre-pregnancy obesity and maternal postpartum mental health: a cross-sectional study

Pre-pregnancy obesity and postpartum mental disorders are prevalent health risks to both the mother and the offspring. The objective of our study was to examine whether a history of childhood maltreatment is associated with pre-pregnancy obesity and postpartum mental health and whether childhood maltreatment and pre-pregnancy BMI independently predict postpartum mental health. We obtained self-reported data from 741 postpartum women before 16 weeks after delivery (M = 8.1 weeks, SD = 3.2). Childhood sexual, physical, and emotional abuse and physical and emotional neglect were assessed with the Childhood Trauma Questionnaire. Depression and anxiety were assessed using the BDI and SCL-90-R. We conducted logistic regression models adjusted for demographic covariates and co-occurrence of different types of maltreatment. 7.6% of the included women entered pregnancy with obesity. Forty-six percent reported any type of childhood maltreatment. 6.4% displayed at least moderate postnatal depressive symptomatology and 20.5% scored above the 75th percentile for postpartum anxiety. Severe physical abuse, moderate emotional abuse and severe physical and emotional neglect were associated with pre-pregnancy obesity. After controlling for the presence of all other types of childhood maltreatment, only severe physical abuse was still predictive for pre-pregnancy obesity (adj.OR = 5.24, 95% CI = 1.15-23.75). Pre-pregnancy obesity was associated with an increased risk of postpartum depression (adj.OR = 2.55, 95% CI = 1.08-6.00) but not with elevated anxiety. Pre-pregnancy obesity and severe childhood sexual abuse independently predicted postpartum depression. After controlling for histories of different types of childhood maltreatment, the association between pre-pregnancy obesity and postpartum depression attenuated to non-significance. To our knowledge, this is the first study examining empirical relations between childhood maltreatment, pre-pregnancy BMI and postpartum mental health controlling for the co-occurrence of other maltreatment types. Childhood maltreatment has been found being associated with both pre-pregnancy obesity and impaired postpartum mental health and may at least partly account for the association between pre-pregnancy obesity and postpartum depression. Therefore childhood maltreatment is related to two common risk conditions during pregnancy and postpartum which bear several health risks for the mother and the child, and routine screening for histories of childhood maltreatment among pregnant women is warranted.

Developmental care, neonatal behavior and postnatal maternal depressive symptomatology predict internalizing problems at 18 months for very preterm children.

To provide a prospective developmental model for behavioral outcomes in preterm infants in relation to developmental care (DC) practices and postnatal maternal depression. A longitudinal, multicenter, follow-up study conducted in 25 Italian tertiary neonatal intensive care units (NICUs). Participants were 162 healthy very preterm infants and their mothers. The level of quality of DC was assessed for each hospital. Infant's neurobehavioral profile was evaluated twice: at discharge (T1) and at 18 months for behavioral problems (T3). Maternal depressive symptomatology was measured at T1 and at 6 months (T2). Low-quality DC in NICUs was associated with lower levels of infant neurobehavioral adaptability and higher levels of maternal depressive symptoms. Maternal depressive symptomatology in conjunction with higher infant dysregulation predicted more internalizing problems at 18 months of age. DC interventions and postnatal maternal depression, as well as infant behavior have an impact on short- and long-term infant outcomes.

Maternal Childhood Sexual Trauma and Early Parenting: Prenatal and Postnatal Associations.

Existing research suggests that approximately 19% of females experience childhood sexual trauma (CST). Little is known, however, about the parenting behaviour of mothers who have experienced CST. Using propensity-matched controls, the present study examines prenatal psychosocial distress, postnatal depressive symptomatology, and caregiving behaviours of women reporting CST at or before the age of 14. Data for these analyses were obtained from mother reports and from observational protocols from a longitudinal study of low-income, rural families. Propensity score methodology was used to create a contrast group matched on family of origin variables in an effort to isolate and examine the long-term associations of CST beyond the effects of other childhood adversities such as poverty. Study findings provide evidence that women with CST histories report greater prenatal psychosocial distress compared to women without trauma histories. Findings further provide evidence for a spillover process from prenatal distress to the broader caregiving system including less sensitive parenting through postnatal depressive symptoms for women with CST histories. These results highlight the importance of screening for CST and psychosocial distress and depression prenatally. Interventions for women with CST histories and directions for future study are proposed.

Exposure to active and passive smoking among Greek pregnant women.

BackgroundActive smoking and exposure to passive smoke are responsible for numerous adverse pregnancy outcomes for women and their infants. The aim of this study was to explore the perceptions, attitudes, patterns of personal tobacco use and exposure to environmental smoke among a sample of pregnant women in Greece.MethodA cross sectional survey was undertaken of 300 women identified from the perinatal care records of the Maternity Departments of two hospitals in Athens between February 2013 and May 2013. Data on active and passive maternal smoking status in the first, second, and third trimesters of pregnancy, fetal and neonatal tobacco related complications, exposure to environmental tobacco smoke during pregnancy, quit attempts, behaviors towards avoiding passive smoking and beliefs towards smoking cessation during pregnancy were collected using self-administered questionnaires on the 3rd postnatal day. Women also completed the Edinburgh Postnatal Depression Scale (EPDS).ResultsOf 300 women recruited to the study 48 % reported tobacco use during the first trimester of pregnancy. Amongst participants who were tobacco users, 83.3 % reported making an attempt to quit but less than half (45.1 %) were successful. Among women who continued to smoke during pregnancy the majority (55.8 %) reported that they felt unable to quit, and 9.3 % reported that they considered smoking cessation was not an important health issue for them. Participants who continued to smoke during pregnancy were more likely to report fetal (χ2 = 11.41; df = 5; p < 0.05) and newborn complications (χ2 = 6.41; df = 2; p < 0.05), including preterm birth and low birth weight. Participants who reported that their partners were smokers were more likely to smoke throughout their pregnancy (χ2 = 14.62; df = 1; p < 0.001). High rates of second-hand smoke exposure were reported among both smoking and non-smoking women. Pregnant smokers had significantly higher levels of postnatal depressive and anxiety symptomatology, as measured using the EPDS, than non-smokers.ConclusionOur data supports the importance of ensuring that pregnant women, their partners and close relatives are educated on the health risks of active and passive smoking and how these could have an adverse effect to their fetus and infants, as well as the pregnant women themselves.

High-frequency intimate partner violence during pregnancy, postnatal depression and suicidal tendencies in Harare, Zimbabwe

Intimate partner violence (IPV) is a common form of violence experienced by pregnant women and is believed to have adverse mental health effects postnatally. This study investigated the association of postnatal depression (PND) and suicidal ideation with emotional, physical and sexual IPV experienced by women during pregnancy. Data were collected from 842 women interviewed postnatally in six postnatal clinics in Harare, Zimbabwe. We used the World Health Organization versions of IPV and Centre for Epidemiological Studies - Depression Scale measures to assess IPV and PND respectively. We derived a violence severity variable and combined forms of IPV variables from IPV questions. Logistic regression was used to analyse data whilst controlling for past mental health and IPV experiences. One in five women [21.4% (95% CI 18.6-24.2)] met the diagnostic criteria for PND symptomatology whilst 21.6% (95% CI 18.8-24.4) reported postpartum suicide thoughts and 4% (95% CI 2.7-5.4) reported suicide attempts. Two thirds (65.4%) reported any form of IPV. Although individual forms of severe IPV were associated with PND, stronger associations were found between PND and severe emotional IPV or severe combined forms of IPV. Suicidal ideation was associated with emotional IPV. Other forms of IPV, except when combined with emotional IPV, were not individually associated with suicidal ideation. Emotional IPV during pregnancy negatively affects women's mental health in the postnatal period. Clinicians and researchers should include it in their conceptualisation of violence and health. Further research must look at possible indirect relationships between sexual and physical IPV on mental health.

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

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

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.

Risk profiles associated with postnatal depressive symptoms among women in a public sector hospital in Mexico: the role of sociodemographic and psychosocial factors.

This study examined the association between postnatal depressive symptoms and a set of demographic and psychosocial factors among 604 women attending a public hospital for postnatal care in Mexico City. Specific profiles of women that would indicate an increased probability for developing postnatal depression (PND) based on discrete combinations of risk and protective factors were generated. In a logistic model, followed by the estimation of predicted probabilities, we examined the association between depressive symptomatology and psychosocial factors: low social support, unplanned pregnancies, history of depression, and exposure to moderate or severe intimate partner violence (IPV) during pregnancy. Postnatal depressive symptomatology was reported by 10.6% of the women, as measured by scores at 12 or above on the Edinburgh Postnatal Depression Scale. The cumulative probability of presenting PND in the simultaneous presence of the psychosocial factors was 67.0%; however, this could be reduced to 5.5% through preventive measures that work to eliminate low social support, unplanned pregnancy, and exposure to severe IPV during pregnancy. Early identification of psychosocial risk factors, specifically low social support, unplanned pregnancies, history of depression, and exposure to violence during pregnancy, is recommended.

Physiological regulation in cigarette exposed infants: An examination of potential moderators

The primary purpose of this study was to examine pathways from prenatal cigarette exposure to physiological regulation at 2 months of age. Specifically, we explored the possibility that any association between prenatal cigarette exposure and infant physiological regulation was moderated by fetal growth, prenatal or postnatal environmental tobacco smoke (ETS) exposure or maternal depressive symptomatology during pregnancy. We evaluated whether exposed infants who were also exposed to ETS after birth, were small for gestational age (SGA) or had mothers with higher depressive symptoms during pregnancy had the highest levels of physiological dysregulation. Respiratory sinus arrhythmia (RSA) was obtained from 234 (166 exposed and 68 nonexposed) infants during sleep. As expected, cigarette-exposed infants had significantly lower RSA than nonexposed infants. This association was not moderated by prenatal or postnatal ETS exposure, or maternal depressive symptomatology during pregnancy. However, small for gestational age status did moderate this association such that nonexposed infants who were not small for gestational age had a significantly higher RSA than nonexposed small for gestational age infants and exposed infants. These findings provide additional evidence that prenatal cigarette exposure is directly associated with dysregulation during infancy.

First‐time mothers: social support, maternal parental self‐efficacy and postnatal depression

To examine the relationships between social support, maternal parental self-efficacy and postnatal depression in first-time mothers at 6 weeks post delivery. Social support conceptualised and measured in different ways has been found to positively influence the mothering experience as has maternal parental self-efficacy. No research exists which has measured the relationships between social support, underpinned by social exchange theory and maternal parental self-efficacy using a domain-specific instrument, underpinned by self-efficacy theory and postnatal depression, with first-time mothers at 6 weeks post delivery. A quantitative correlational descriptive design was used. Data were collected using a five-part questionnaire package containing a researcher developed social support questionnaire, the Perceived Maternal Parental Self-Efficacy Scale and the Edinburgh Postnatal Depression Scale. Four hundred and ten mothers completed questionnaires at 6 weeks post delivery. Significant relationships were found between functional social support and postnatal depression; informal social support and postnatal depression; maternal parental self-efficacy and postnatal depression and informal social support and maternal parental self-efficacy at 6 weeks post delivery. Nurses and midwives need to be aware of and acknowledge the significant contribution of social support, particularly from family and friends in positively influencing first-time mothers' mental health and well-being in the postpartum period. The development of health care policy and clinical guidelines needs to define and operationalise social support to enhance maternal parental self-efficacy. These findings suggest that nurses and midwives need to be cognisant of the importance of social support for first-time mothers in both enhancing maternal parental self-efficacy and reducing postnatal depressive symptomatology in the early postpartum period.

The relation of positive emotions to post partum depression

Positive emotions have been implicated in the development of coping resources and resilience for psychological health across various significant life events. Childbirth is often an event that incites positive emotions in a woman, and it may be that such emotions have an immobilizing effect on the onset of post natal depressive symptoms. In efforts to examine the influence of positive emotions on women during their transition into motherhood, the present study assessed 195 women across two stages: before and after childbirth. The aim of the study was to examine the variety of positive emotions that arise from childbirth, the relationship of positive emotions that arise from childbirth to maternity and other demographic variables and the relation between positive emotions that arise from childbirth and depressive post natal symptoms. Results revealed a significant manifestation of specific positive emotions such as joyfulness, pride, and interest after childbirth. Participants between the ages of 30 and 34 experienced a greater variety and intensity of positive emotions before and after. In turn, a negative relationship was found between the experience of positive emotion intensity and post natal depressive symptomatology. Factors such as education level, whether the birth was planned or not, and environmental and partner support were found to relate significantly to the manifestation of positive emotions.

Prevalence and risk factors for a high level of postnatal depression symptomatology in Italian women: A sample drawn from ante-natal classes

Background Depression after childbirth is a major problem affecting 10–22% of all mothers. In Italy, postnatal depression has not yet been systematically studied. Methods In this retrospective study we have sought to identify risk factors, assessed during pregnancy, and their importance for postnatal depression symptoms in a sample of 297 Italian women attending ante-natal classes organised by the local Consultorio Familiare Unit of the National Health Service, Italy. The Postpartum Depression Predictors Inventory – revised form (PDPI-Revised), was used to identify risk factors, 8–9 month of pregnancy. A double-test strategy using the Edinburgh Postnatal Depression Scale (EPDS) and 12-item General Health Questionnaire (GHQ12), was administered to screen women with a higher occurrence of symptoms of postnatal depression six–eight weeks after delivery. Women with high EPDS (<8) and high GHQ12 (<3) scores were compared with those who had scored below the EPDS and/or GHQ12 threshold scores. Results We found that 13% of the women studied showed high postnatal depressive symptomatology, which is very similar to rates of prevalence of postnatal depression in the first year after the birth of the child reported in other Western World studies. Feeling anxious during pregnancy is a strong predictor of high symptoms of depression at 6–8 weeks after delivery. However, University education and friends' support appear to be important protective factors. Conclusion These findings could be useful both for Italian health professionals and for researchers interested in the transcultural aspects of postnatal depression.

The course of maternal depressive symptomatology during the first 18 months postpartum in an Italian sample

Postnatal depression (PND) affects about 10-15% of women and can last more than a year in chronic cases. The Edinburgh Postnatal Depression Scale (EPDS) is a well-known questionnaire for screening PND symptomatology during the first weeks after birth, but its use in later periods is rare, reflecting a tendency to pay more attention to the onset of PND instead of its course. The study aimed to explore stability of PND symptomatology at 3, 9 and 18 months after birth, using the EPDS. Depression rate decreased from 3 to 18 months postpartum. Onset of symptoms was mainly within the first 3 months; 23.4% of 167 women showed an EPDS score > or =13 on at least one of the assessments, and 7.2% of women did so on at least two assessments. Over the 18-month period, the number of women who had recovered in the period from one assessment to the following was not significantly different from the number of women becoming depressed. Our findings underline the need to consider the existence of different courses of depressive symptomatology in research and clinical practice; women with persistent or recurrent depressive symptoms need forms of preventive intervention that cover at least the first postpartum year.

Predictors of postnatal depression: using an antenatal needs assessment discussion tool

Depression affects 13% of postnatal women and the long‐term repercussions affect women, children and families. Health visitors are being urged to increase antenatal support, including preparation for the impact of becoming a parent, and identification of vulnerable families. An antenatal tool incorporating validated measures was developed to facilitate discussion on childhood experiences, perceived physical and emotional social support and to screen for depression (using EPDS). Postnatal information was also collected. Health visitors in Bristol PCT used the tool when visiting primiparous women antenatally at home over two years. Twenty health visitors covering seven GP practices in South Bristol completed 187 antenatal and 142 postnatal records. There was a significant correlation between the 118 antenatal and postnatal EPDS scores recorded. An antenatal 13+ EPDS cut‐off gave a positive predictive value (PPV) of 35% for a high postnatal EPDS score and the 15+ cut off gave a PPV of 67%; women with high antenatal EPDS scores were significantly more likely to have postnatal depression symptomatology. Computed ‘At risk’ scores, combining high antenatal EPDS, poor antenatal emotional support and a high proportion of negative childhood adjectives were compared with postnatal EPDS scores. This score had a PPV of 86% using the antenatal EPDS 15+ score and a very high odds ratio for the likelihood of screening high postnatally. The high predictive value of the ‘at risk’ tool in identifying primiparous women who are likely to develop postnatal depression indicates that it is important to start these discussions in the antenatal period.