Postpartum Depression Predictors Research Articles

Psychometric testing and the predictive validity of the Postpartum Depression Predictors Inventory-Revised (PDPI-R): A longitudinal study with Turkish women

ObjectiveThe aim of this study was to investigate the validity and reliability of the prenatal and postnatal versions of the Postpartum Depression Predictors Inventory-Revised (PDPI-R) and to examine the predictive validity of PDPI-R in Turkish women, considering two gold standards to determine postpartum depression (PPD). MethodsThis prospective longitudinal study was conducted between August 2021 and September 2023. A total of 301 pregnant women participated in the study. Participants completed the PDPI-R during the third trimester of pregnancy (T1) and at 4 weeks postpartum (T2). At T2, participants also completed the Edinburgh Postnatal Depression Scale (EPDS), and women were interviewed using the Structured Clinical Interview for DSM-IV Disorders. ResultsThe prenatal version of the PDPI-R predicted PPD with 64% (R:0.64) accuracy on the basis of the EPDS and 78% accuracy (R:0.78) according to DSM IV criteria. The postnatal version of the PDPI-R predicted PPD with 71% (R:0.71) accuracy on the basis of the EPDS and 81% accuracy (R:0.781) based on DSM IV criteria. The cut-off points exhibited the highest sensitivity and specificity values at 8.5 for the prenatal version and 10.5 for the postnatal version. ConclusionsThe PDPI-R is a valid and reliable screening tool for identifying Turkish women at high risk of developing PPD and for estimating the psychosocial risk associated with PPD.

For Whom and for How Long Does the “Be a Mom” Intervention Work? A Secondary Analysis of Data From a Randomized Controlled Trial Exploring the Mid-Term Efficacy and Moderators of Treatment Response

This study explored clinical and sociodemographic moderators of treatment response to “Be a Mom”, an internet-based cognitive behavioral therapy (iCBT) intervention, from baseline to postintervention, in women at high risk for postpartum depression (PPD). The study also assessed the stability of women’s treatment gains from baseline to 4-months postintervention (follow-up). This open-label randomized controlled trial (RCT) involved a sample of 1,053 postpartum Portuguese women identified as being at high risk for PPD (i.e., having a score of 5.5 or higher on the Postpartum Depression Predictors Inventory-Revised); participants were allocated to “Be a Mom” intervention group or a waiting-list control group, and completed self-report measures at baseline, postintervention, and a 4-month follow-up (554 women completed follow-up assessments). Depressive and anxiety symptoms were measured using the Edinburgh Postnatal Depression Scale and the anxiety subscale of the Hospital Anxiety and Depression Scale, and flourishing/positive mental health was assessed with the Mental Health Continuum. Regression models and linear mixed models were used to examine moderators of treatment and the mid-term efficacy of the “Be a Mom” intervention, respectively. The results revealed that treatment completion, higher depression scores at baseline, and higher income levels were linked to greater symptom reduction and positive mental health enhancement. Moreover, the efficacy of the “Be a Mom” intervention was supported at the 4-month follow-up. The “Be a Mom” intervention appears to be an effective iCBT tool for reducing psychological distress and enhancing positive mental health in women at risk for PPD, with therapeutic improvements maintained over a 4-month period.

Validity of the Maternal Antenatal Attachment Scale-Spanish Version for Mexican Pregnant Women

During pregnancy, parents experiment emotions, thoughts, and behaviors related to their unborn child as precursors of attachment in the caretaker-infant dyad. The Maternal Antenatal Attachment Scale (MAAS) is an instrument that has shown adequate psychometric properties to evaluate this construct in developed countries. The aim of this study was to assess the reliability and concurrent validity of the Maternal Antenatal Attachment Scale-Spanish version for Mexican women (MAAS-Spanish version). A sample of 142 women in their third trimester of pregnancy who received care in a tertiary hospital was selected. The full scale of the MAAS-Spanish version obtained a Cronbach alpha of .79. A significant negative correlation was found between the global MAAS-Spanish version score (r = -.23, p ≤ .01) and the Postpartum Depression Predictors Inventory-Revised and depressive symptoms (r = -.36 , p ≤ .01). The translated and adapted scale has adequate internal consistency and concurrent validity to measure this construct in this population.

Psychological, Psychosocial and Obstetric Differences between Spanish and Immigrant Mothers: Retrospective Observational Study.

This study analyzed the influence of psychological and psychosocial factors of pregnant women at an obstetric level. The possible differences between Spaniards and immigrants were studied. This was a retrospective observational study. The sample has been divided into two study cohorts, one consisting of Spanish pregnant women and one consisting of foreign pregnant women. Both completed the Revised Postpartum Depression Predictors Inventory and the Patient Health Questionnaire-9. A total of 15.9% of Spanish women and 23.2% of immigrants had depressive symptoms. Immigrants claim to have less support at the partner, family, and friendship levels than Spaniards. Moreover, 16.4% of Spaniards vs. 8.1% of immigrants had pregnancy complications; Cesarean section was performed in 16.2% of Spaniards vs. 7.9% of immigrants. A greater number of premature births were detected in immigrants than in Spaniards. Access to universal healthcare is a protective factor against socioeconomic and cultural conditions affecting the mental and obstetrical health of immigrants.

Hubungan Dukungan Sosial dengan Kejadian Postpartum Blues pada Ibu Nifas di Wilayah Kerja Puskesmas Pomalaa

Postpartum blues is a natural response to drastic hormonal changes after giving birth that affect the physical and emotional state of postpartum mothers. These drastic hormonal changes are not the main factor in the occurrence of postpartum blues, but the impact on the mother's psychological life, such as the lack of support from her husband, family, or community, postpartum fatigue, worries about economic conditions, and other social problems. This study aimed to determine the relationship between social support and the incidence of postpartum blues in postpartum mothers in the working area of the Pomalaa Health Center. This type of research is a correlation analytic with a cross-sectional design with a population of 50 postpartum mothers. Data was collected using the Postpartum Depression Predictors Inventory (PDPI) and the Edinburgh Postnatal Depression Scale (EPDS) questionnaire. 12 postpartum mothers experienced postpartum blues (24%). Four received less social support, and 8 people received good social support. There is a relationship between social support and postpartum blues in postpartum mothers in the Pomalaa Health Center working area with a p-value of 0.002. Husbands and families, as the closest people, are expected to be able to provide social support to postpartum mothers so that mothers avoid postpartum blues.

Be a Mom: Patterns of Program Usage and Acceptability Among Women With Low-Risk and High-Risk for Postpartum Depression

BackgroundBe a Mom is a self-guided web-based intervention developed to prevent postpartum depression (PPD) symptoms and to promote maternal wellbeing, respectively among high and low-risk new mothers. This study aims to examine and compare (1) Be a Mom's patterns of usage and (2) Be a Mom's acceptability among women presenting high and low risk for PPD.MethodsThe sample was composed by 800 women who were randomized to Be a Mom [542 presenting high-risk (Postpartum Depression Predictors Inventory-Revised ≥ 5.5) and 258 presenting low-risk for PPD]. Data regarding patterns of usage were collected through the Be a Mom website. Acceptability data were collected through a brief questionnaire.Results27.9% of high-risk and 36.3% of low-risk women completed the program. A higher proportion of participants in the low-risk group completed Be a Mom [ = 5.29, p = 0.021] and completed more modules [t(723) = −3.01, p = 0.003]. No significant differences were found between the groups in number of logins, minutes spent on the program, exercises completed and number of times audios were played. a higher proportion of women in the high-risk group considered that participating in Be a Mom was too demanding [ = 8.21, p = 0.004].ConclusionsDespite the low rates of completion, Be a Mom appears to be an acceptable option for both women with high-risk and low-risk for PPD. Lack of time seems to be the main reason for non-completion, so it is important to develop briefer versions of the program and introduce engagement strategies that may increase completion rate.

Self-compassion and complete perinatal mental health in women at high risk for postpartum depression: The mediating role of emotion regulation difficulties.

There is evidence suggesting that self-compassion is linked to key mechanisms in emotion regulation models of depression and anxiety. However, the majority of prior research has targeted community samples and overlooked the analysis of such mechanisms in relation to positive mental health. This study sought to examine the direct and indirect effects, via emotion regulation difficulties, of self-compassion on the complete mental health outcomes of women at high risk for postpartum depression (PPD). Cross-sectional, correlational study. The sample for this study comprised 1053 postpartum women presenting high risk for PPD, as determined by the clinical cut-off score obtained through the Postpartum Depression Predictors Inventory-Revised. The assessment protocol further included self-report measures of self-compassion, depression and anxiety symptoms, flourishing and emotion regulation difficulties. Correlation analyses were conducted to ascertain associations between variables, and path analysis was performed to examine direct and indirect effects. Difficulties in emotion regulation mediated the links between self-compassion and negative (distress) and positive (flourishing) mental health outcomes. The overall mediation model explained 48% and 39% of variance for psychological distress and flourishing/positive mental health respectively. These findings support the applicability of an emotion regulation model of self-compassion to women identified as being at high risk of developing PPD. Self-compassion interventions directed at these women are likely to decrease their levels of emotion dysregulation and to improve their complete mental health outcomes.

Suicidal ideation: Prevalence and risk factors during pregnancy

Introduction: Although suicide is the main cause of maternal death during pregnancy in industrialized countries, there are few research regarding the prevalence and risk factors of suicidal ideation during pregnancy, especially in Spain. Method: In a multicenter study, the sample included 1,524 pregnant women recruited from an obstetrics setting from two Spanish tertiary-care public hospitals. The prevalence of prenatal suicidal ideation was estimated by analyzing their responses to item 9 on the Patient Health Questionnaire (PHQ-9). The risk factors (which increases the probability of having suicidal ideation) included sociodemographic and biomedical variables, and the stress subscale from the revised prenatal version of the Postpartum Depression Predictors Inventory (PDPI-R). Results: A total of 2.6% of pregnant women reported suicidal ideation. Risk factors of suicidal ideation during pregnancy include sociodemographic, such as prior history of depression (β = 0.120, p < .05), unemployment (β = 0.149, p < .05), and being an immigrant (β = 0.140, p < .01), and biomedical variables, such as previous abortion (β =0.169, p < .01) and assisted reproduction (β = -0.100, p < .05). Discussion: Given that the prevalence of suicidal ideation is higher than expected, the results of the study suggest the critical need for screening and designing preventive interventions adapted to pregnant women to decrease risk of associated suicidal behavior. In protocols carried out by midwives, specific risk factors should be included in health screenings during pregnancy.

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

This cross-sectional study aimed to evaluate the prevalence of postpartum depression and the associated risk factors in a sample of Italian women at three months after delivery. Eighty women were screened by completing the Edinburgh Postnatal Depression Scale (EPDS). Women with a score ≥10 were evaluated as positive and other variables were detected through the administration of the Postpartum Depression Predictors Inventory. The prevalence of postpartum depression in the sample was 11.25% (EPDS score >10). A statistically significant relationship was found between the predisposition to postnatal depression and various risk factors such as prenatal depression, stressful life experiences marital problems. Furthermore, strong emotional and instrumental support from the partner and a good economic status can represent protective factors. It is essential to promote an integrated approach to postpartum affective disorders in which psychosocial risk factors are taken into account, and adequate screening programs are implemented. Impact Statement What is already known on this subject? Pregnancy can cause emotional stress for women with consequent development, in some cases, of mood disorders such as postpartum depression. What do the results of this study add? According to this study, women suffering from postpartum depression showed a significant tendency to anxiety and depression, low perceived support from the partner, and low socio-economic status. What are the implications of these findings for clinical practice and/or further research? It would be desirable to promote an integrated approach to postpartum affective disorders in which psychosocial risk factors are taken into account and adequate screening programs are implemented.

Factors influencing prenatal and postpartum depression in Korea: a prospective cohort study.

PurposeThis study explored the prevalence of prenatal and postpartum depression in Korea and its influencing factors from 20 weeks of pregnancy to 12 weeks postpartum.MethodsUsing a prospective cohort study design, data on women’s depression and its influencing factors were collected at 20, 28, and 36 weeks of pregnancy and at 2, 6, and 12 weeks postpartum. The participants were 219 women and 181 spouses during pregnancy; and 183 mothers and 130 spouses after childbirth. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale and influencing factors were measured by the Postpartum Depression Predictors Inventory-Revised, parity, and spousal depression.ResultsThe prevalence of maternal depression was 10.5% to 21.5% before birth, and it was 22.4% to 32.8% postpartum. The prevalence slightly decreased during the prenatal period but peaked at 2 weeks postpartum. Antenatal depression was influenced by low socioeconomic status, lower self-esteem, having experienced prenatal depression, having experienced prenatal anxiety, a previous history of depression, lower social support, lower marital satisfaction, and higher life stress. The factors influencing postpartum depression were lower self-esteem, having experienced prenatal depression, having experienced prenatal anxiety, lower social support, lower marital satisfaction, and higher life stress, as well as infant temperament and maternal blues. Parity and spousal depression had no impacts.ConclusionThe prevalence and influencing factors of maternal depression changed over time. Nurses need to screen women accordingly during the perinatal period and should provide education or counseling to prevent depression and promote adjustment to parenthood.

Early Association Factors for Depression Symptoms in Pregnancy: A Comparison between Spanish Women Spontaneously Gestation and with Assisted Reproduction Techniques.

Women with assisted reproduction techniques (ART) have a different psychological profile than women with a spontaneous pregnancy. These differences may put the former group at higher risk for depressive symptomatology. Our aim was to determine what sociodemographic factors and psychological variables interact with early depressive symptoms in pregnant women with ART. This is a cross-sectional, non-interventional, and observational study where a total of 324 women were analyzed in the first trimester of pregnancy at the Hospital Universitario Central de Asturias (Spain). Women completed a sociodemographic questionnaire, the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder 7-item Scale, the Resilience inventory, the General concerns (ad hoc scale), the Stressful life events, and the prenatal version of Postpartum Depression Predictors Inventory-Revised (PDPI-R), including socioeconomic status, pregnancy intendedness, self-esteem, partner support, family support, friends support, marital satisfaction, and life stress. According to our models, women undergoing ART had significantly increased the PHQ-9 scores (β = 6.75 ± 0.74; p-value < 0.001). Being single also increased the PHQ-9 score. Related to the psychological variables, anxiety (β = 0.43 ± 0.06; p-value < 0.001) and stressful life events (β = 0.17 ± 0.06; p-value = 0.003) increased PHQ-9 scores. In contrast, resilience (β = −0.05 ± 0.02; p-value = 0.004), self-esteem (β = −1.21 ± 0.61; p-value = 0.048), and partner support (β = −1.50 ± 0.60; p-value = 0.013) decreased PHQ-9 scores. We concluded that women undergoing ART need interventions to reduce anxiety and stressful life events, and to improve resilience, self-esteem, and emotional partner support to prevent depressive symptomatology during this important phase in their lives.

Predicting postpartum depression by evaluating temperament during pregnancy

Aim: The purpose of this study was to investigate premorbid temperaments to predict postpartum depression in pregnant women with no previous psychiatric history and to clarify the correlation between postpartum depression and the factors included in the Postpartum Depression Predictors Inventory-Revised (PDPI-R) and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Auto questionnaire (TEMPS-A)/Munich Personality Test (MPT). Methods: A total of 170 eligible pregnant women filled out both questionnaires, the first between the 8th and 23rd week of gestation, and the latter between the 34th and 38th week of gestation. Participants filled out The Edinburgh Postnatal Depression Scale (EPDS) one month postpartum to measure for postpartum depression symptoms. All participants delivered full-term healthy babies. Results: Seventeen (10%) women met the criteria for postpartum depression with a score of 9 or higher on the EDPS. The factors significantly related to developing postpartum depression were schizoid and melancholic temperament on the TEMPS-A/MPT and marital dissatisfaction on the PDPI-R. The total score on the PDPI-R was significantly correlated with depressive, cyclothymic, irritable, and anxious temperaments on the TEMPS-A/MPT. A lack of social support on the PDPI-R was significantly correlated with depressive, irritable, and anxious temperaments on the TEMPS-A/MPT. Conclusion: The findings suggest that postpartum depression may be related to schizoid and melancholic temperaments and marital dissatisfaction. The hyperthymic temperament was identified as a significant predictor in preventing PPD. Careful observation during puerperium is recommended if a pregnant woman is likely to have these temperaments or psychological conditions. Temperament evaluation should be done during pregnancy as a form of postpartum depression screening.

Evaluation of the clinical application of the Postpartum Depression Predictors Inventory-Revised for postpartum women in China.

This study was designed to assess the clinical applicability of the Postpartum Depression Predictors Inventory-Revised (PDPI-R) during the 1st month following delivery among women in China and to survey the prevalence of postpartum depression (PPD)-related risk factors included in the PDPI-R in this population. This was a cross-sectional study which recruited 447 women from the People's Liberation Army Hospital in Hefei of Anhui province. All participants completed the Chinese version of the PDPI-R (PDPI-R-C) and the Chinese version of the Edinburgh Postnatal Depression Scale (C-EPDS) within 1 month of delivery. The predictive ability of the PDPI-R was then evaluated through receiver operating characteristic (ROC) curve analyses. The PDPI-R-C was able to accurately predict 73.2% of PPD cases (area under the ROC curve=0.732; 95% CI 0.69-0.78) using a cut-off score of 5.5, as defined by a C-EPDS score of ≥10 (sensitivity=62.8%; specificity=73.5%; positive predictive value=74.5%; negative predictive value=61.5%). All 13 risk factors in the PDPI-R-C other than socioeconomic status and marital status were associated with the risk of PPD. The PDPI-R-C was found to be an effective and easy-to-implement tool that has promise as a means of screening for PPD in Chinese populations.

Development and validation of a machine learning-based postpartum depression prediction model: A nationwide cohort study.

Currently, postpartum depression (PPD) screening is mainly based on self-report symptom-based assessment, with lack of an objective, integrative tool which identifies women at increased risk, before the emergent of PPD. We developed and validated a machine learning-based PPD prediction model utilizing electronic health record (EHR) data, and identified novel PPD predictors. A nationwide longitudinal cohort that included 214,359 births between January 2008 and December 2015, divided into model training and validation sets, was constructed utilizing Israel largest health maintenance organization's EHR-database. PPD was defined as new diagnosis of a depressive episode or antidepressant prescription within the first year postpartum. A gradient-boosted decision tree algorithm was applied to EHR-derived sociodemographic, clinical, and obstetric features. Among the birth cohort, 1.9% (n = 4104) met the case definition of new-onset PPD. In the validation set, the prediction model achieved an area under the curve (AUC) of 0.712 (95% confidence interval, 0.690-0.733), with a sensitivity of 0.349 and a specificity of 0.905 at the 90th percentile risk threshold, identifying PPDs at a rate more than three times higher than the overall set (positive and negative predictive values were 0.074 and 0.985, respectively). The model's strongest predictors included both well-recognized (e.g., past depression) and less-recognized (differing patterns of blood tests) PPD risk factors. Machine learning-based models incorporating EHR-derived predictors, could augment symptom-based screening practice by identifying the high-risk population at greatest need for preventive intervention, before development of PPD.

Intimate partner violence and perinatal depression and anxiety: Social support as moderator among Mexican women

AimsTo assess the frequency of perinatal Intimate Partner Violence (IPV), the association between IPV and depressive and anxiety symptoms, and the role of social support (SS) in the relation between IPV and depressive and anxiety symptoms, controlling for sociodemographic factors. MethodWomen were assessed during pregnancy and at six months postpartum (n = 210). The instruments used were: Stressful Life Events Scale; the Patient Health Questionnaire-9; the Anxiety Subscale of the Symptom Checklist-90 and the Social Support Subscale of the Postpartum Depression Predictors Inventory-Revised. ResultsThe prevalence of IPV was 10.7% in pregnancy and 11% during postpartum. IPV increases the risk of suffering depression in pregnancy (OR = 3.5) and at six months postpartum (OR = 18.3), as well as anxiety (OR = 5.9 and OR = 6.2, respectively). Women with lower educational attainment (OR = 3.8) and income (OR = 3.0) had a higher risk of being victims of IPV during pregnancy. Likewise, lack of SS has a great impact on IPV both during pregnancy (OR = 14.12) and the postpartum period (OR = 5.49). This association decreases the impact and significance of the relationship between perinatal depression and anxiety and IPV. ConclusionsHigh levels of SS may partially offset the effect of IPV on postpartum depressive s and perinatal anxiety symptoms. it is necessary for IPV victims to have multiple protective factors. Lack of access to education, poverty and women’s submissive role in relation to men lead to greater vulnerability, constituting a distinct social disadvantage for women.

Faktor Prediktor Terjadinya Depresi Postpartum di Rumah Sakit Panti Rapih Yogyakarta

Background: The postpartum period was a physical and psychological adaptation process. Psychological disturbances could present in form of postpartum blues, postpartum depression, and postpartum psychosis.&#x0D; Objective: The objective of this research was to determine the incidence of postpartum depression, identify predictors of postpartum depression and identify the dominant predictors of postpartum depression.&#x0D; Methods: this research used a cross sectional design. Sample were pregnant women which were chosen by random sampling technique. Data was collected with questionnaire to measure the predictors of postpartum depression was carried out with the Revision Postpartum Depression Predictors Inventory (PDPI) questionnaire and to measure depression scores used with the Edinburgh Postnatal Depression Scale (EPDS). Data analysis was done by univariate and bivariate analysis with with chi-square statistical tests and multivariate with logistic regression tests.&#x0D; Results: The results showed that the significant predictors were economic status, self-esteem, marital satisfaction, postpartum blues, and prenatal depression. The dominant predictor factor is satisfaction in marriage with a t value of 2.778 times.&#x0D; Conclusion: The results of the study show that marital satisfaction is a dominant predictor of postpartum depression, indicating that marital satisfaction or relationship quality is one of the important support systems because of the need for partner involvement in care actions during the pregnancy period until with the puerperium as efforts to prevent postpartum depression.&#x0D; &#x0D; &#x0D; Keywords: postpartum depression, postpartum period, postpartum bues

The Prevalence and Risk Factors for Antenatal Depression Among Pregnant Immigrant and Native Women in Spain.

Introduction: The aim was to examine the risk factors of anternatal depression among immigrant and native pregnant women in Spain. Method: A total of 1,524 pregnant women completed the Patient Health Questionnaire and the Postpartum Depression Predictors Inventory-Revised form. Results: The native group reported a lower prevalence (15.2%) compared with immigrant group (25.8%). For immigrants, primiparity, moving, and perceived lack instrumental support from friends or emotional support from partners and family members were significant risk factors. Discussion: The study identified risk factors that can be used for preventive interventions during pregnancy. Significance: Screening and interventions for depression during pregnancy should take migration status into account to maximize effective health care. Also, health providers should consider how migration status can result in different risk factors that affect depression during pregnancy.

Relationships of Perfectionism Dimensions with Postpartum Depression

Purpose: The aim of this study was to explore the relationship between perfectionism dimensions and postpartum depression among parturient women between 2 weeks to 12 months, using the Frost Multidimensional Perfectionism Scale (FMPS). Methods: Participants were 150 women who had their infants examined for health in two public health centers in a city. The participants completed a self-administered questionnaire, which included the FMPS, Postpartum Depression Predictors Inventory-Revised and the Korean version of the Edinburgh Postpartum Depression Scale (K-EPDS). The data were analyzed using independent t-tests and a multiple linear regression. Results: The prevalence of postpartum depression was 43.3% (K-EPDS≥9.5). Multiple regression analysis showed that postpartum depression was significantly associated with parental criticism (β=.21), concern over mistakes (β=.19), postnatal maternal blues (β=.22), history of depression (β=.20), social support (β=.13), marital relationship/satisfaction (β=.14), prenatal anxiety (β=.17), and self-esteem (β=.15, all p values < .05). These variables explained 57.2% of the variance in postpartum depression. Conclusion: Parental criticism and concern over mistakes are personality dimensions that can be exhibited by participants and are therefore associated with the development of postpartum depression in parents of infants. The perfectionism assessment is needed to detect postpartum depression and develop strategies to provide effective and preventive interventions.

What protects at-risk postpartum women from developing depressive and anxiety symptoms? The role of acceptance-focused processes and self-compassion.

Not all women presenting risk factors for postpartum depression (PPD) develop depressive symptoms. Research has shown that acceptance-focused processes (nonjudgmental appraisal of thought content, psychological flexibility) and self-compassion play an important protective role in the development of psychological symptoms. However, considering the perinatal period, little is known about what variables can modify the negative impact of risk. The sample consisted of 185 postpartum women at risk of developing PPD (Postpartum Depression Predictors Inventory-Revised > 5.5). Data were collected regarding depressive (Edinburgh Postnatal Depression Scale) and anxiety symptoms (Hospital Anxiety and Depression Scale), psychological flexibility (Acceptance and Action Questionnaire-II), nonjudgmental appraisal of thought content (Postnatal Negative Thoughts Questionnaire) and self-compassion (Self-Compassion Scale-Short Form). Women not presenting depressive and anxiety symptoms reported significantly higher levels of psychological flexibility, nonjudgmental appraisal of thought content and self-compassion than women presenting depressive and anxiety symptoms. Hierarchical logistic regression showed that women with higher levels of psychological flexibility (OR = 1.06, CI: 1.01-1.12) and nonjudgmental appraisal of thought content (OR = 1.33, CI: 1.15-1.53) had a significantly higher likelihood of not presenting depressive and anxiety symptoms. The limitations of this study were the cross-sectional design, the use of self-report questionnaires and the self-selected bias in recruitment. This study emphasizes the important role of acceptance-based processes, suggesting that at-risk women who are more accepting of their private events may be more protected from developing psychological symptoms. Preventive interventions should consider the promotion of these processes to improve women's adjustment to this period.

Predictive validity of the Postpartum Depression Predictors Inventory-Revised (PDPI-R): A longitudinal study with Portuguese women

ObjectiveThis study examined the predictive validity of the prenatal and postnatal versions of the Postpartum Depression Predictors Inventory-Revised (PDPI-R) in European Portuguese women, considering two gold standards to determine postpartum depression (PPD). DesignProspective longitudinal study conducted between November 2015 and September 2017. SettingOne public referral maternity hospital in the central region of Portugal. ParticipantsA total of 140 Portuguese women participated in the study. MeasurementsParticipants completed the PDPI-R during the second trimester of pregnancy (T1) and at 6 weeks postpartum (T2). At T2, participants also answered the Edinburgh Postnatal Depression Scale (EPDS). During the fourth month postpartum (T3), women were interviewed with the Structured Clinical Interview for DSM-IV Disorders, and between 6 and 9 months postpartum (T4), they completed the EPDS. FindingsRates of clinically significant depressive symptoms (EPDS ≥ 10) were 16.4% (23/140) at T2 and 23.2% (23/99) at T4. Six (4.3%) women met the criteria for a clinical diagnosis of PPD (major depressive episode) at T3. Overall, the postnatal version of the PDPI-R performed better than did the prenatal version (average area under the curve = 82% vs. 71%), but both versions accurately predicted women who developed a clinical diagnosis of PPD, at a cut-off score of 4.5 for the prenatal version (sensitivity = 83.3%; specificity = 85.8%) and 9.5 for the postnatal version (sensitivity = 83.3%; specificity = 94.8%). Key conclusions and implications for practiceDespite the low prevalence of PPD (albeit consistent with prior estimates of major depression at three months postpartum), this clinical condition has very serious consequences for the mother, the baby and the whole family when present. The PDPI-R is a valid screening tool to estimate the psychosocial risk for developing PPD among Portuguese women and can be used in research (e.g., for cross-cultural comparisons) and clinical practice. The recommended cut-off scores could assist health professionals (namely, midwives) in identifying the women who would benefit from appropriate referrals and/or closer monitoring to prevent them from developing PPD.