Cases Of Postpartum Depression Research Articles

Substance Use Disorder as a Risk Factor for Postpartum Depression: A Retrospective Chart Review in a Community Hospital.

This retrospective study examines the relationship between postpartum depression (PPD) and substance use disorder (SUD) in a community hospital setting. This retrospective chart review explored the association between SUD and PPD in a community hospital. Data from January 2016 to December 2018 were extracted from electronic medical records (EPIC EMR (Epic Systems Corporation, Verona, WI)), identifying mothers with PPD (n = 99) using billing code F53.0. Substance use disorder was assessed using diagnostic codes F10-F19. Odds ratios (OR), relative risk (RR), and chi-square tests were calculated to quantify and assess the significance of the association between SUD and PPD. Ethical approval was obtained from the Institutional Review Board (IRB). Among 2,517 deliveries during the study period, 51 cases of PPD co-occurred with SUD. Mothers with SUD had a 4.3 times higher risk of PPD compared to those without SUD (OR = 4.8), highlighting a significant association. These findings emphasize the importance of screening for PPD and SUD in pregnant and postpartum women, especially in community healthcare settings where routine screening may be limited. Targeted interventions can mitigate adverse effects on maternal and infant well-being.

Patterns of disease-modifying therapy utilization before, during, and after pregnancy and postpartum relapses in women with multiple sclerosis

BackgroundPregnancy is a common consideration for people with multiple sclerosis (pwMS); MS onset is typically between 20 and 45 years of age, during potential child-bearing years. Pregnancy and postpartum care are a significant factor influencing disease-modifying therapy (DMT) selection for many pwMS. To date, few DMTs are considered safe to continue during pregnancy and real-world treatment patterns before, during, and after pregnancy remain uncharacterized. Evolving guidance is needed regarding how to optimize management of the pregnancy and postpartum periods considering the changing DMT landscape. This analysis in two large claims databases describes DMT utilization for the treatment of MS before, during, and after pregnancy and relapse patterns during pregnancy and postpartum. MethodsIn this retrospective, observational study, the US MarketScan Commercial and Medicaid claims database was assessed for female patients aged 18–55 years with ≥1 insurance claim submitted under the diagnosis code of MS from 01 January 2016–30 April 2021 and continuous enrollment eligibility from ≥6 months prior to pregnancy date (preconception) through 6 months of follow-up following delivery (postpartum period). Comorbid conditions were examined preconception and postpartum, including anxiety and depression. Moderate/severe relapse was defined as MS-related hospitalization, or an outpatient visit and one claim within 7 days of the visit with steroids or total plasma exchange. ResultsA total of 944 patients (mean [standard deviation] age, 32.4 [5.0] years) were eligible; 688 (73%) were commercially insured and 256 (27%) received Medicaid. Compared with commercially-insured patients, use of DMTs was lower among Medicaid patients at 6 months preconception (25.4% vs 40.4%; p < 0.001), with similar patterns observed both during pregnancy and postpartum. Overall, prevalence of DMT use declined sharply during pregnancy, from 36.3% of patients in the 6 months preconception to 17.9%, 5.3%, and 5.8% in trimesters 1, 2 and 3, respectively. Postpartum DMT utilization increased to 20.9% at 0–3 months and 24.4% at 4–6 months. Of all patients in the preconception period, the most frequently used DMTs were glatiramer acetate (14.3%), dimethyl fumarate (6.0%), interferon (5.2%), and natalizumab (4.9%). Due to small sample size, information was limited for anti-CD20s and alemtuzumab. The proportion of patients with any moderate/severe relapse declined over pregnancy (preconception, n = 82 [8.7%]; pregnancy, n = 25 [2.6%]), but increased postpartum (n = 94 [10.0%]). Of the 889 patients who stopped DMT during pregnancy, the risk of postpartum relapses was lower in the patients who resumed DMT postpartum (10/192) than in patients who did not (76/697) (5.2% vs 10.9%; odds ratio, 0.455 [95% confidence interval 0.216–0.860], p = 0.018). Cases of postpartum depression and anxiety were significantly lower in commercially-insured patients vs Medicaid patients (postpartum depression, 13.7% vs 27.0%, p < 0.01; postpartum anxiety, 16.3% vs 30.5%, p < 0.01). ConclusionDMT utilization declined sharply during pregnancy; it gradually increased postpartum but remained below pre-pregnancy use. The proportion of pwMS experiencing a moderate/severe relapse and number of relapses declined over pregnancy but increased postpartum. Reinitiation of DMT during the postpartum period was associated with lower risk of relapses, supporting a role for early reinitiation of DMT postpartum. Study supported byBiogen

Prolonged HPA axis dysregulation in postpartum depression associated with adverse early life experiences: A cross-species translational study.

Childhood and adolescent stress increase the risk of postpartum depression (PPD), often providing an increased probability of treatment refractoriness. Nevertheless, the mechanisms linking childhood/adolescent stress to PPD remain unclear. Our study investigated the longitudinal effects of adolescent stress on the hypothalamic-pituitary-adrenal (HPA) axis and postpartum behaviors in mice and humans. Adolescent social isolation prolonged glucocorticoid elevation, leading to long-lasting postpartum behavioral changes in female mice. These changes were unresponsive to current PPD treatments but improved with post-delivery glucocorticoid receptor antagonist treatment. Childhood/adolescent stress significantly impacted HPA axis dysregulation and PPD in human females. Repurposing glucocorticoid receptor antagonists for some cases of treatment-resistant PPD may be considered.

Postpartum and non-postpartum depression: a population-based matched case-control study comparing polygenic risk scores for severe mental disorders

It remains inconclusive whether postpartum depression (PPD) and depression with onset outside the postpartum period (MDD) are genetically distinct disorders. We aimed to investigate whether polygenic risk scores (PGSs) for major mental disorders differ between PPD cases and MDD cases in a nested case-control study of 50,057 women born from 1981 to 1997 in the iPSYCH2015 sample in Demark. We identified 333 women with first-onset postpartum depression (PPD group), who were matched with 993 women with first-onset depression diagnosed outside of postpartum (MDD group), and 999 female population controls. Data on genetics and depressive disorders were retrieved from neonatal biobanks and the Psychiatric Central Research Register. PGSs were calculated from both individual-level genetic data and meta-analysis summary statistics from the Psychiatric Genomics Consortium. Conditional logistic regression was used to calculate the odds ratio (OR), accounting for the selection-related reproductive behavior. After adjustment for covariates, higher PGSs for severe mental disorders were associated with increased ORs of both PPD and MDD. Compared with MDD cases, MDD PGS and attention-deficit/hyperactivity disorder PGS were marginally but not statistically higher for PPD cases, with the OR of PPD versus MDD being 1.12 (95% CI: 0 .97–1.29) and 1.11 (0.97–1.27) per-standard deviation increase, respectively. The ORs of PPD versus MDD did not statistically differ by PGSs of bipolar disorder, schizophrenia, or autism spectrum disorder. Our findings suggest that relying on PGS data, there was no clear evidence of distinct genetic make-up of women with depression occurring during or outside postpartum, after taking the selection-related reproductive behavior into account.

Meta-Analyses of Genome-Wide Association Studies for Postpartum Depression.

Postpartum depression (PPD) is a common subtype of major depressive disorder (MDD) that is more heritable, yet is understudied in psychiatric genetics. The authors conducted meta-analyses of genome-wide association studies (GWASs) to investigate the genetic architecture of PPD. Meta-analyses were conducted on 18 cohorts of European ancestry (17,339 PPD cases and 53,426 controls), one cohort of East Asian ancestry (975 cases and 3,780 controls), and one cohort of African ancestry (456 cases and 1,255 controls), totaling 18,770 PPD cases and 58,461 controls. Post-GWAS analyses included 1) single-nucleotide polymorphism (SNP)-based heritability ([Formula: see text]), 2) genetic correlations between PPD and other phenotypes, and 3) enrichment of the PPD GWAS findings in 27 human tissues and 265 cell types from the mouse central and peripheral nervous system. No SNP achieved genome-wide significance in the European or the trans-ancestry meta-analyses. The [Formula: see text] of PPD was 0.14 (SE=0.02). Significant genetic correlations were estimated for PPD with MDD, bipolar disorder, anxiety disorders, posttraumatic stress disorder, insomnia, age at menarche, and polycystic ovary syndrome. Cell-type enrichment analyses implicate inhibitory neurons in the thalamus and cholinergic neurons within septal nuclei of the hypothalamus, a pattern that differs from MDD. While more samples are needed to reach genome-wide levels of significance, the results presented confirm PPD as a polygenic and heritable phenotype. There is also evidence that despite a high correlation with MDD, PPD may have unique genetic components. Cell enrichment results suggest GABAergic neurons, which converge on a common mechanism with the only medication approved by the U.S. Food and Drug Administration for PPD (brexanolone).

Pursuit of Euthymia in Postpartum Depression Through Homoeopathy

This review study contributes to shedding light on homoeopathy’s importance in treating postpartum depression. Both the mother and the child suffer long-term effects from postpartum depression. In this essay, an intuition on assessment of this problem and its homoeopathic therapy are offered because the majority of postpartum depression cases go undetected and untreated. Homoeopathy has a lot of potential for treating depression and promotes mother and child health. Keywords: Postpartum Depression, Mother, Child, Homeopathy.

Mental health issues during pregnancy - overview of the current knowledge

Depressive disorders of antenatal and postnatal period are diagnostic challenge, as well as increasingly frequent social problem. Incidence of antenatal depression varies from 10% to 16%. Around one third of all postpartum depression cases has its beginning during the antenatal period. From the beginning of 2019, Ministry of Health’s regulations specified for the first time the recommendation to perform screening of depressive symptoms - twice during the pregnancy and once during the perinatal period, defined as the first six weeks after the delivery. Therefore the review of current studies in the subject of mental health issues during pregnancy was conducted in order to establish possible risk factors.

Maternal and Neonatal Outcomes in Pregnant Women With COVID-19 Admitted to Imam Khomeini Hospital of Sari, Iran, 2019 - 2020

Background: The COVID-19 infection may adversely affect both the mother and baby. Evaluation and identification of aggravating factors can help prevent adverse outcomes. Objectives: The present study aimed to examine pregnant women with COVID-19 infection and evaluate the disease outcomes in Sari, Iran. Methods: The present case series study was performed on 17 pregnant women hospitalized for COVID-19 in Sari. A convenience sampling method was used. First, the researcher took the demographic information and medical history and obtained informed consent from all participants. Then, the selected subjects were examined for inclusion and exclusion criteria, and a throat swab sample was taken from eligible ones for PCR. The PCR was performed for amniotic fluid and neonatal throat samples at pregnancy termination. Six weeks after delivery, the status of rehospitalization of the baby, breastfeeding status, rehospitalization of the mother due to COVID-19, and the state of depression of the mother were evaluated by a 21-item questionnaire over the phone. The collected data were analyzed in SPSS version 23 using the chi-square test. Results: Out of 19 participants, 17 (68%) had positive results for COVID-19 laboratory tests. The prevalence of preterm labor, admission to the neonatal intensive care unit, and vertical transmission were significantly high in pregnant women with COVID-19 and positive PCR results for amniotic fluid (P &lt; 0.050). The frequency of admission to the ICU was significantly higher in pregnant women with diabetes infected with COVID-19 (P = 0.025). There was no rehospitalization of the mother and newborn due to COVID-19, but one case of postpartum depression (9.5%) and two cases of formula feeding (11.8%) were reported. Conclusions: Due to the high risk of maternal and neonatal outcomes of COVID-19 during pregnancy and the high probability of vertical transmission, it is recommended to take special precautions to prevent the disease during this period.

Association between urban green space and postpartum depression, and the role of physical activity: a retrospective cohort study in Southern California

Little research exists regarding the relationships between green space and postpartum depression (PPD). We aimed to investigate the relationships between PPD and green space exposure, and the mediating role of physical activity (PA). Clinical data were obtained from Kaiser Permanente Southern California electronic health records in 2008-2018. PPD ascertainment was based on both diagnostic codes and prescription medications. Maternal residential green space exposures were assessed using street view-based measures and vegetation types (i.e., street tree, low-lying vegetation, and grass), satellite-based measures [i.e., Normalized Difference Vegetation Index (NDVI), land-cover green space, and tree canopy cover], and proximity to the nearest park. Multilevel logistic regression was applied to estimate the association between green space and PPD. A causal mediation analysis was performed to estimate the proportion mediated by PA during pregnancy in the total effects of green space on PPD. In total, we included 415,020 participants (30.2±5.8 years) with 43,399 (10.5%) PPD cases. Hispanic mothers accounted for about half of the total population. A reduced risk for PPD was associated with total green space exposure based on street-view measure [500 m buffer, adjusted odds ratio (OR) per interquartile range: 0.98, 95% CI: 0.97-0.99], but not NDVI, land-cover greenness, or proximity to a park. Compared to other types of green space, tree coverage showed stronger protective effects (500 m buffer, OR=0.98, 95% CI: 0.97-0.99). The proportions of mediation effects attributable to PA during pregnancy ranged from 2.7% to 7.2% across green space indicators. Street view-based green space and tree coverage were associated with a decreased risk of PPD. The observed association was primarily due to increased tree coverage, rather than low-lying vegetation or grass. Increased PA was a plausible pathway linking green space to lower risk for PPD. National Institute of Environmental Health Sciences (NIEHS; R01ES030353).

PREVALENCE AND SOCIODEMOGRAPHIC FACTORS ASSOCIATED WITH PERIPARTUM DEPRESSION IN INDONESIA: NATIONAL BASIC HEALTH RESEARCH DATA 2018

Abstract&#x0D; &#x0D; Background: peripartum depression is common and causes maternal and infant morbidity if left untreated. This illness has several severity levels and onset stages that could emerge as prenatal depression, ‘baby blues’ syndrome or postpartum depression. &#x0D; Objective: This analysis aimed to investigate the national prevalence of depression among women in peripartum periods and its association with sociodemographic risk factors in Indonesia. &#x0D; Method: Data from the 2018 Ministry of Health’s cross-sectional survey that employed a multistage sampling (the 2018 Basic Health Research [Riskesdas]) were examined. Out of 8889 married or ever married women aged 15-49 years old who were pregnant and giving birth between January 1, 2017 and December 31, 2018, a total of 268 mothers was the total sample of respondents. They gave consent to respond to the modified Indonesia version of the Mini International Neuropsychiatric Interview (MINI) questionnaires for assessing the prevalence of peripartum depression. Chi-square tests and multivariate logistic regression analysis were used to determine the association between prenatal depression and participants’ characteristics. &#x0D; Result: Findings showed that peripartum depression included 7.9% of cases of prenatal depression and 16.4% of cases of postpartum depression. The estimated prevalence of prenatal depression was 10.2%, 7.7%, and 6.7% consecutively by the first, second and third trimesters. A statistically significant relationship was found between prenatal depression, each trimester of pregnancy and women’s educational level. Postpartum depression rates varied slightly between 15.9% (less than 2 weeks postpartum), 17.9% (2 to 4 weeks) and 16.9% (more than 4 weeks). Trimester of pregnancy, none/unfinished primary school, and not working were significantly associated with prenatal depression. Regrettably, the total of postpartum women was inadequate for multivariable analysis. Conclusion: Screening of depressive peripartum symptoms for early detection and prevention needs to be integrated into routine prenatal and postpartum care.&#x0D; Keywords: Peripartum Depression, Prevalence, Prenatal Depression, Postpartum Depression

Integrating Mental Health Screening into Antenatal Care

Pregnancy demands comprehensive care, focusing on mental well-being and physical health. Depression and anxiety are prevalent during pregnancy, potentially impacting the mother and foetus. Early intervention is crucial, as severe prenatal depression can adversely affect foetal neurocognitive development. Additionally, a significant proportion of postpartum depression cases originate in the antenatal period, with stressors intensifying throughout pregnancy. Routine screening offers a sophisticated safety net for both mother and foetus. However, effective implementation requires collaborative efforts among healthcare stakeholders. The Obstetrics and Gynaecological Distress Measurement Scale (OGDMS) is a promising tool for comprehensive early screening for the Indian population. It evaluates distress across psychological, physiological, and environmental domains. The OGDMS facilitates dialogue between practitioners and patients, driving modifications in treatment protocols. Involving attending doctors and caregivers fosters a more engaged and effective therapeutic journey. While promising, further studies are essential to solidify the OGDMS’s impact. Future advancements in screening methods promise even more targeted and timely results, ensuring optimal care for expectant mothers.

Postpartum depression: a developed and validated model predicting individual risk in new mothers

Postpartum depression (PPD) is a serious condition associated with potentially tragic outcomes, and in an ideal world PPDs should be prevented. Risk prediction models have been developed in psychiatry estimating an individual’s probability of developing a specific condition, and recently a few models have also emerged within the field of PPD research, although none are implemented in clinical care. For the present study we aimed to develop and validate a prediction model to assess individualized risk of PPD and provide a tentative template for individualized risk calculation offering opportunities for additional external validation of this tool. Danish population registers served as our data sources and PPD was defined as recorded contact to a psychiatric treatment facility (ICD-10 code DF32-33) or redeemed antidepressant prescriptions (ATC code N06A), resulting in a sample of 6,402 PPD cases (development sample) and 2,379 (validation sample). Candidate predictors covered background information including cohabitating status, age, education, and previous psychiatric episodes in index mother (Core model), additional variables related to pregnancy and childbirth (Extended model), and further health information about the mother and her family (Extended+ model). Results indicated our recalibrated Extended model with 14 variables achieved highest performance with satisfying calibration and discrimination. Previous psychiatric history, maternal age, low education, and hyperemesis gravidarum were the most important predictors. Moving forward, external validation of the model represents the next step, while considering who will benefit from preventive PPD interventions, as well as considering potential consequences from false positive and negative test results, defined through different threshold values.

Altered extracellular mRNA communication in postpartum depression is associated with decreased autophagy.

We investigated whether extracellular RNA communication, which is a recently discovered mode of intercellular communication that is involved in a variety of important biological processes including pregnancy, is associated with postpartum depression (PPD). Extracellular RNA communication is increased during pregnancy and is involved in embryo implantation, uterine spiral artery remodeling, parturition, preterm birth, immunity, and the inflammatory response. Since immune anomalies are associated with PPD, we characterized the mRNA content of extracellular vesicles (EV) in a cohort of prospectively collected blood plasma samples at six time-points throughout pregnancy and the postpartum (2nd trimester, 3rd trimester, 2 weeks postpartum, 6 weeks postpartum, 3 months postpartum, and 6 months postpartum) in an academic medical setting from women who went on to develop PPD (N = 7, defined as euthymic in pregnancy with postpartum-onset depressive symptoms assessed by Edinburgh Postnatal Depression Scale ≥13 at any postpartum time point) and matched unaffected controls (N = 7, defined as euthymic throughout pregnancy and postpartum). Blood samples were available for all participants at the T2 and W6 timepoints, with fewer samples available at other time points. This analysis revealed that EV mRNA levels during pregnancy and the postpartum period were extensively altered in women who went on to develop PPD. Gene set enrichment analysis revealed that mRNAs associated with autophagy were decreased in PPD cases. In contrast, EV mRNAs from ribosomes and mitochondria, two organelles that are selectively targeted by autophagy, were elevated in PPD cases. Cellular deconvolution analysis discovered that EV mRNAs associated with PPD originated from monocytes and macrophages. Quantitative PCR analysis for four relevant genes in another cohort replicated these findings and confirmed that extracellular RNA levels are altered in PPD. We demonstrate that EV mRNA communication is robustly altered during pregnancy and the postpartum period in women who go on to develop PPD. Our work also establishes a direct link between reduced autophagy and PPD in patient samples. These data warrant investigating the feasibility of developing EV mRNA based biomarkers and therapeutic agents for PPD.

Edinburgh Post-natal Depression Scale (EPDS): Deteksi Dini dan Skrining Depresi Post-partum

The Edinburgh post-natal depression scale (EPDS) is an instrument that can be used worldwide for screening for symptoms of post-partum depression (PPD). PPD is a mood disorder/mood swings that occur after delivery which usually occurs within 4 weeks after delivery. In Indonesia, the number of cases of PPD is often undetected because it is considered a common symptom in newborns. This EPDS instrument is in the form of a questionnaire with 10 easy-to-use questions to assess the heart/mood that one has been feeling for the past week with not too long processing time. Each has a score scale of 0-3 with a maximum of 30 points. The EPDS has a sensitivity of 96% and a specificity of 82% with a cut-off value of 10. With the high sensitivity and specificity of the EPDS instrument and its ease of use, the EPDS can be used as a tool for comprehensive screening before making the diagnosis of PPD without specifying the cause of depression. It is hoped that this paper, can add references to the use of EPDS in Indonesia and its benefits so that it can detect early and screen the incidence of PPD in Indonesia so that it can be handled from the start without any impact on mothers and children as a result of PPD experienced.

Genetic liability to posttraumatic stress disorder and its association with postpartum depression.

Childbirth may be a traumatic experience and vulnerability to posttraumatic stress disorder (PTSD) may increase the risk of postpartum depression (PPD). We investigated whether genetic vulnerability to PTSD as measured by polygenic score (PGS) increases the risk of PPD and whether a predisposition to PTSD in PPD cases exceeds that of major depressive disorder (MDD) outside the postpartum period. This case-control study included participants from the iPSYCH2015, a case-cohort of all singletons born in Denmark between 1981 and 2008. Restricting to women born between 1981 and 1997 and excluding women with a first diagnosis other than depression (N = 22 613), 333 were identified with PPD. For each PPD case, 999 representing the background population and 993 with MDD outside the postpartum were matched by calendar year at birth, cohort selection, and age. PTSD PGS was calculated from summary statistics from the Psychiatric Genomics Consortium with LDpred2-auto. Odds ratios (ORs) were estimated using conditional logistic regression adjusted for parental psychiatric history and country of origin, PGS for MDD and age at first birth, and the first 10 principal components. The PTSD PGS was significantly associated with PPD (OR 1.42, 95% CI 1.20-1.68 per standard deviation increase in PTSD PGS) compared to healthy female controls. Genetic PTSD vulnerability in PPD cases did not exceed that of matched female depression cases outside the postpartum period (OR 1.10, 95% CI 0.94-1.30 per standard deviation increase). Genetic vulnerability to PTSD increased the risk of PPD but did not differ between PPD cases and women with depression at other times.

Blood T-helper 17 cells and interleukin-17A correlate with the elevated risk of postpartum depression and anxiety.

BackgroundT‐helper (Th) cells regulate inflammation and immunity, which is implicated in psychological disorders. The current study aimed to explore the clinical role of blood Th1, Th2, and Th17 cells and their main secreted cytokines in postpartum depression (PPD) and postpartum anxiety (PPA).MethodsA total of 226 postpartum women were included. At 6 weeks postpartum, Edinburgh Postnatal Depression Scale (EPDS) and State Trait Anxiety Inventory 6 item version (STAI6) scores were assessed; meanwhile, blood Th1, Th2, and Th17 cells were detected by flow cytometry, serum interferon‐gamma (IFN‐γ), interleukin‐4 (IL‐4), and IL‐17A were detected by enzyme‐linked immunosorbent assay.ResultsThe incidence of PPD and PPA were 24.3% and 27.9%, respectively. Th17 cells and IL‐17A were positively correlated with EPDS score and STAI6 score (all p < 0.001). Besides, Th17 cells (p < 0.001) and IL‐17A (p = 0.002) were increased in PPD cases vs. non‐PPD cases, and they were also elevated in PPA cases vs. non‐PPA cases (both p < 0.05). However, Th1 cells, Th2 cells, IFN‐γ, and IL‐4 were not linked with EPDS score or STAI6 score (all p > 0.05); besides, they did not vary in PPD cases vs. non‐PPD cases or in PPA cases vs. non‐PPA cases (all p > 0.05). Multivariate logistic regression model analysis showed that Th17 cells were independently associated with an elevated risk of PPD (odds ratio [OR] = 1.600, p = 0.001) and PPA (OR = 1.371, p = 0.022).ConclusionBlood Th17 cells and IL‐17A are positively linked with the risk of PPD and PPA, indicating which may be involved in the development of PPD and PPA.

A quantitative comparison of two measures of postpartum depression

BackgroundStudies investigating the prevalence and risk factors for postpartum depression (PPD) have used different definitions. Some studies have used a high score on the Edinburgh Postnatal Depression Scale (EPDS) to define PPD, whereas others have used information on antidepressant medication use and/or diagnostic information on treatment for depression at a psychiatric hospital. We wanted to compare results using these two approaches to evaluate to what degree results can be compared. Moreover we wanted to evaluate, whether use of EPDS or PPAT (defined below) leads to identification of different risk factor profiles.MethodsWe identified women who delivered a child between 1 January 2014 and 31 December 2016 in Copenhagen or in one of the municipalities that were part of the Danish Health Visitors’ Child Health Database. The potential risk factors were demographic factors and pregnancy- and obstetrical events. Outcomes of interest were an EPDS score ≥ 13, use of antidepressants (ATC: N06A) and/or a diagnosis of depression (F32) within six months after birth. Use of antidepressants and/or diagnosis of depression will be referred to as postpartum antidepressant treatment (PPAT). Agreement between EPDS ≥ 13 and PPAT was evaluated by the kappa coefficient. Associations between risk factors and the two outcomes (EPDS ≥ 13 and PPAT) were estimated by risk ratios (RR) using log-linear binomial regression. Presence of a systematic difference between RRs based on EPDS ≥ 13 (RREPDS≥13) and PPAT (RRPPAT) was evaluated in a meta-regression approach weighted by inverse-variance and with logarithm of the RRs as outcome.ResultsThe estimated PPD prevalence using EPDS ≥ 13 was 3.2% and of PPAT 0.4%. The agreement between the two measures was small (Kappa = 0.08), but their risk factor profile was very similar with no systematic difference between them.ConclusionsUsing the two different methods of case identification produced different prevalence estimates, but a similar risk factor profile. The differences in estimated prevalence and low agreement suggest that the two measures identify different potential PPD cases and using only one of the methods in defining PPD would underestimate PPD prevalence. The similar risk factor profile suggests that the considered risk factors are involved in the general development of PPD.

Design and Evaluation of a Postpartum Depression Ontology.

Postpartum depression (PPD) remains an understudied research area despite its high prevalence. The goal of this study is to develop an ontology to aid in the identification of patients with PPD and to enable future analyses with electronic health record (EHR) data. We used Protégé-OWL to construct a postpartum depression ontology (PDO) of relevant comorbidities, symptoms, treatments, and other items pertinent to the study and treatment of PPD. The PDO identifies and visualizes the risk factor status of variables for PPD, including comorbidities, confounders, symptoms, and treatments. The PDO includes 734 classes, 13 object properties, and 4,844 individuals. We also linked known and potential risk factors to their respective codes in the International Classification of Diseases versions 9 and 10 that would be useful in structured EHR data analyses. The representation and usefulness of the PDO was assessed using a task-based patient case study approach, involving 10 PPD case studies. Final evaluation of the ontology yielded 86.4% coverage of PPD symptoms, treatments, and risk factors. This demonstrates strong coverage of the PDO for the PPD domain. The PDO will enable future researchers to study PPD using EHR data as it contains important information with regard to structured (e.g., billing codes) and unstructured data (e.g., synonyms of symptoms not coded in EHRs). The PDO is publicly available through the National Center for Biomedical Ontology (NCBO) BioPortal ( https://bioportal.bioontology.org/ontologies/PARTUMDO ) which will enable other informaticists to utilize the PDO to study PPD in other populations.

728Comparative performance of WHO-5, PHQ-9 and PSS Scale for screening antenatal depression and suicide risk

Abstract Background This study evaluated the psychometric properties of three self-reported scales including WHO Well-Being Index (WHO-5), Patient Health Questionnaire-9 items (PHQ-9), and Perceived Stress Scale (PSS) for determining the severity of antenatal depression and suicide risk. Methods Extracted from a multi-site birth cohort study in eight countries, we test the reliability and validity of tri-scales among 148 women in the third trimester and 3-months after childbirth in Vietnam. Results Reliability testing achieved good internal consistency for the set of scales (Alpha = 0.75–0.81). The multitrait-multimethods matrix and SEM model indicated a good fit [Chi-square (230) = 337.5, p &amp;lt; 0.001; Root Mean Square Error of approximation= 0.56, Comparative Fit Index= 0.91] and good discriminant validity of WHO-5 lower discriminant validity of PSS and PHQ-9. The proportion of correctly classified cases and optimum balanced indicators of sensitivity and specificity suggested the cut-off scores of ≥ 6 for PHQ-9 and ≥ 25 for PSS for suicide risk screening. Regarding to predictive validity for postpartum depression of PHQ-9, we found that the cut-off scores of ≥ 6 for prenatal PHQ-9 screening can predict approx.70% of mild postpartum depression cases after 3-month childbirth. Conclusions This present study suggested adequate validity and reliability of the WHO-5, PHQ9 and PSS to measure antenatal depression and suicide risk in Vietnam. Key messages Further studies might consider to use one or a set of scales to understand multiple domains of mental disorder as it is simple to administer and acceptable duration for completion in the community.

UTILITY OF HOMOEOPATHY IN POST PARTUM DEPRESSION- A CASE REPORT

Postpartum depression is commonly experienced by women, which postpartum can be very distressing for the mother and interfere with normal maternal-infant bonding and adversely affect child development. Recent reports show that most affected pregnant women are hesitant about taking antidepressant drugs, with a high percentage discontinuing their use, specically due to stigma as well as lack of awareness about this condition. In this article, a case of postpartum depression, treated successfully with homeopathy, is presented, wherein the patient got better not just in symptoms, but improved in quality of life, withing a short span of 3-4weeks without any use of antidepressants or structured psychotherapy.