Postpartum Depression Screening Research Articles

Racial And Ethnic Inequities In Postpartum Depressive Symptoms, Diagnosis, And Care In 7 US Jurisdictions.

Understanding whether racial and ethnic inequities exist along the postpartum mental health care continuum is vital because inequitable identification of depression can lead to inequitable referral to and receipt of care. We aimed to expand on existing cross-sectional and single-state data documenting potential racial and ethnic disparities in postpartum depression care. Using early (from two to six months) and late (from twelve to fourteen months) postpartum survey data from seven US jurisdictions, we documented patterns of early postpartum depressive symptoms, perinatal mood and anxiety disorder (PMAD) diagnosis, and receipt of postpartum mental health care overall and by racial and ethnic identity. Of 4,542 people who delivered live births in 2020, 11.8percent reported early postpartum depressive symptoms. Among the sample with these symptoms, only 25.4percent reported receiving a PMAD diagnosis, and 52.8percent reported receiving some form of postpartum mental health care. There were no significant differences in diagnosis by race and ethnicity. Respondents identifying as Asian; Native Hawaiian or Pacific Islander; Southwest Asian, Middle Eastern, or North African; Hispanic; and non-Hispanic Black were significantly less likely than non-Hispanic White respondents to receive mental health care, demonstrating stark inequities in the management of postpartum depressive symptoms. Policies mandating and reimbursing universal postpartum depression screening, facilitating connection to care, reducing insurance coverage gaps, and enhancing clinician training in culturally responsive care may promote equitable postpartum mental health care.

Postpartum depression among women with under 1-year-old babies in Ngo Quyen district, Hai Phong city in 2023

Objectives: Describe the current status of postpartum depression through screening according to the EPDS in women with under 1-year-old babies in 2 wards, Ngo Quyen district, Hai Phong in 2023. Methods: Cross-sectional descriptive study was conducted among 206 mothers with under 1 year old children from October 2022 to July 2023 in Dong Khe and Dang Giang wards, Ngo Quyen district, Hai Phong. The study utilized the Edinburgh Postnatal Depression Scale to screen for postpartum depression. Results: The mean score of postpartum depression screening according to the EPDS among mothers was 4.32 ± 0.32; The proportion of mothers with postpartum depression (EPDS score ≥10) was 20.4%. Conclusion: Postpartum depression in women with under 1-year- old babies in Hai Phong city was still high, these mothers need advising and intervening promptly.

Exploring postpartum depression in the Vietnamese moms scenario: Risk factors under a culture perspective

The diagnosis and screening of postpartum depression (PPD) are increasingly crucial for promoting the mental well-being of perinatal women. Postpartum depression (PPD) can have a detrimental impact on mothers’ mental well-being and can also affect the mental health of individuals in their immediate circle. Additionally, PPD can hinder the development of the crucial bond between mother and infant during the early years of a baby's life. There is insufficient literature on cultural risk factors for postpartum depression in Vietnamese mothers. A search was conducted for papers published from 2010 to 2023. The examined articles revealed some important risk factors under cultural perspectives related to postpartum depression in Vietnamese mothers.

Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery

Postpartum depression (PPD) is one of the most common mental health conditions during the perinatal and postpartum periods, which can have adverse effects on both mother and infant. To investigate the efficacy of perioperative adjunctive esketamine administration after cesarean deliveries in the prevention of PPD. A single-center, double-blind, placebo-controlled, randomized clinical trial was conducted from January 1, 2022, to January 1, 2023, at Fujian Provincial Hospital among 298 women aged 18 to 40 years, with an American Society of Anesthesiologists grade I to III classification and singleton full-term pregnancies who were scheduled for elective cesarean deliveries. Primary analyses were performed on a modified intention-to-treat basis. Patients were randomly assigned to the esketamine (n = 148) and control (n = 150) groups. Those in the esketamine group received a single intravenous injection of 0.25 mg/kg of esketamine immediately after fetal delivery, followed by 50 mg of esketamine as an adjuvant in patient-controlled intravenous analgesia for 48 hours after surgery. Saline was given to the control group of patients. The primary outcome was assessments of PPD symptoms by using the Edinburgh Postnatal Depression Scale (EPDS) at postpartum day 7. Positive screening for PPD was defined as a score of 10 or more points on the EPDS. In addition, the EPDS was analyzed as a continuous variable to evaluate depressive symptoms. Secondary outcomes included the Numeric Rating Scale (NRS) of postoperative pain, along with safety evaluations including adverse events and clinical assessments at postpartum days 14, 28, and 42. A total of 298 pregnant women were included, with 150 in the control group (median age, 31.0 years [IQR, 29.0-34.0 years]) and 148 in the esketamine group (median age, 31.0 years [IQR, 28.0-34.0 years]). The prevalence of depression symptoms was significantly lower among patients given esketamine compared with controls (23.0% [34 of 148] vs 35.3% [53 of 150]; odds ratio, 0.55; 95% CI, 0.33-0.91; P = .02) on postpartum day 7. In addition, the esketamine group also showed a significantly lower change in EPDS scores (difference of least-squares means [SE], -1.17 [0.44]; 95% CI, -2.04 to -0.31; effect size, 0.74; P = .008). However, there were no differences between the groups in the incidence of positive screening results for PPD or in changes from the baseline EPDS scores at postpartum days 14, 28, and 42. There were no differences in NRS scores at rest and on movement except on movement at 72 hours postoperatively, when scores were significantly lower in the esketamine group (median, 3.0 [IQR, 2.0-3.0] vs 3.0 [IQR, 3.0-3.5]; median difference, 0 [95% CI, 0-0]; P = .03). These results suggest that intravenous administration of esketamine during the perioperative period of elective cesarean delivery can improve depression symptoms during the early postpartum period. However, this antidepression effect may not be universally applicable to patients with low EPDS scores. Chinese Clinical Trial Registry Identifier: ChiCTR2100054199.

Association of Postpartum Depression with Maternal Serum Magnesium Levels, Infant Growth, and Neurodevelopmental Indices.

Postpartum depression (PPD) can exert both short-term and long-term effects on a child's health. Offspring born to mothers who suffer from PPD face an elevated susceptibility to encountering psychological disturbances and developmental delays. Moreover, there has been conjecture surrounding a plausible connection between maternal magnesium (Mg) levels and psychiatric manifestations. This study aims to investigate the relationship between maternal Mg levels and PPD and the correlation between PPD and an infant's growth and neurodevelopment at 6 and 12 months. This longitudinal study is a sub-study derived from the "PERSIAN Birth Cohort Study," encompassing 224 mother-infant pairs randomly enlisted during 2019-2020 in Isfahan. Maternal serum magnesium (Mg) levels were measured at 38 weeks of gestation. PPD was evaluated employing the Edinburgh Postpartum Depression Scale (EPDS) four weeks postpartum. Measurements of birth size were undertaken, adhering to standardized protocols at birth, 6 months, and 12 months. Anthropometric parameters and the Persian version of the validated Ages and Stages Questionnaires (ASQ) were employed to assess infant neurodevelopmental status at 6 and 12 months. Overall, 22.3% of mothers grappled with PPD. The mean (standard deviation) maternal magnesium levels (Mg) were 1.95 ± 0.23 mg/dL. No statistically significant association was detected between maternal serum magnesium (Mg) levels and the incidence of PPD. Correspondingly, no significant association emerged between PPD and indices of growth. However, a noteworthy distinction materialized in the communication scores of offspring born to depressed and non-depressed mothers following adjustments for confounding variables at 12 months (β = 1.81; 95% confidence interval: 0.32-3.30). Furthermore, a substantial regression in communication skills became apparent between 6 and 12 months. This study failed to establish a significant association between maternal serum magnesium (Mg) levels and PPD. Nevertheless, research lends credence to an inverse correlation between maternal depression and subsequent behavioral difficulties in offspring, such as communication skills. Thus, the imperative nature of screening for PPD should be underscored to facilitate its early detection and intervention, thereby enhancing infant well-being.

Heart Rate Variability Measurement Can Be a Point-of-Care Sensing Tool for Screening Postpartum Depression: Differentiation from Adjustment Disorder.

Postpartum depression (PPD) is a serious mental health issue among women after childbirth, and screening systems that incorporate questionnaires have been utilized to screen for PPD. These questionnaires are sensitive but less specific, and the additional use of objective measures could be helpful. The present study aimed to verify the usefulness of a measure of autonomic function, heart rate variability (HRV), which has been reported to be dysregulated in people with depression. Among 935 women who had experienced childbirth and completed the Edinburgh Postnatal Depression Scale (EPDS), HRV was measured in EPDS-positive women (n = 45) 1 to 4 weeks after childbirth using a wearable device. The measurement was based on a three-behavioral-state paradigm with a 5 min duration, consisting of rest (Rest), task load (Task), and rest-after-task (After) states, and the low-frequency power (LF), the high-frequency power (HF), and their ratio (LF/HF) were calculated. Among the women included in this study, 12 were diagnosed with PPD and 33 were diagnosed with adjustment disorder (AJD). Women with PPD showed a lack of adequate HRV regulation in response to the task load, accompanying a high LF/HF score in the Rest state. On the other hand, women with AJD exhibited high HF and reduced LF/HF during the After state. A linear discriminant analysis using HRV indices and heart rate (HR) revealed that both the differentiation of PPD and AJD patients from the controls and that of PPD patients from AJD patients were possible. The sensitivity and specificity for PPD vs. AJD were 75.0% and 90.9%, respectively. Using this paradigm, an HRV measurement revealed the characteristic autonomic profiles of PPD and AJD, suggesting that it may serve as a point-of-care sensing tool in PPD screening systems.

In the Shadows of Motherhood: A Comprehensive Review of Postpartum Depression Screening and Intervention Practices.

This comprehensive review delves into the multifaceted landscape of postpartum depression (PPD), exploring its prevalence, impact on maternal and infant well-being, and the efficacy of existing screening and intervention practices. PPD emerges as a critical concern, with implications extending beyond individual mental health to encompass the dynamics of mother-infant relationships and societal well-being. The analysis underscores the complexity of addressing PPD, emphasizing the challenges associated with screening tools and the importance of evidence-based interventions. A call to action resonates throughout, urging healthcare providers, policymakers, and stakeholders to prioritize mental health support for new mothers through enhanced screening protocols and improved accessibility to interventions. Furthermore, the review highlights the need for destigmatization and awareness campaigns to foster a supportive environment. Future research directions are outlined, emphasizing the refinement of screening tools, developing innovative interventions, and exploring cultural and socioeconomic influences on PPD outcomes. The review envisions a collaborative effort to dispel the shadows of PPD, striving for a future where mothers receive comprehensive support, ensuring optimal mental health and overall well-being.

Prevalence, characteristics, and associated determinants of postpartum depression among adolescent mothers in Kenyatta National Hospital and Pumwani Maternity Hospital from March to July 2023: A prospective, cross-sectional study

Background: Postpartum depression (PPD) is a depressive episode that occurs in women within 6 weeks of parturition. It has a global prevalence of 13-19%. Long-term consequences include a high likelihood of experiencing depression in mothers, suicide, and infanticide. There is currently no routine screening for postpartum depression at the postnatal clinic. Objectives: To determine the prevalence of postpartum depression among adolescent mothers, characteristics, and associated determinants in Kenyatta National Hospital (KNH) and Pumwani Maternity Hospital (PMH). Methods: This was a cross-sectional study, involving 162 consenting postnatal adolescent mothers (14-19 years) at Kenyatta National and Pumwani Maternity hospitals. Consecutive sampling was employed. Data were collected using a structured sociodemographic questionnaire and the Edinburg Postpartum Depression Scale (EPDS). Data were analyzed using SPSS version 25.  Results: Of all participants, 77.2% were from PMH and 22.8% were from KNH. Most participants were 18–19 years old, had primary education as the highest entry level, were single, depended on their parents for financial support, and were Christians. For obstetric characteristics, the majority had no history of miscarriage, were primipara, had unintended pregnancy, had amenorrhea as the first symptom, had an initial antenatal clinic (ANC) visit during the first trimester, had at least four ANC visits, and delivered via spontaneous vaginal birth. The prevalence of postpartum depression was 22.2%. The most prominent characteristics of PPD were feeling overwhelmed, sadness, anxiety, and crying episodes. Associated determinants of PPD in adolescent mothers were age <18 years, starting ANC visits after the second trimester, less than four ANC visits, being HIV-positive, unsupportive partner, and having a post-delivery illness for the mother. Conclusion: This study established that approximately one in four adolescent mothers are likely to suffer from postpartum depression.  

Is there a correlation between prepartum anaemia and an increased likelihood of developing postpartum depression? A prospective observational study.

Postpartum depression (PPD) represents a significant challenge to maternal and child health. Early screening for PPD is essential to ensure appropriate treatment and support. The present study aimed to assess whether maternal prepartum anaemia influences the likelihood of developing PPD within 3days after delivery. In collaboration with the Department of Psychiatry, a prospective observational study was carried out at the Gynaecology and Obstetrics Department of the University of Campania "Luigi Vanvitelli" in Naples. A total of 211 full-term pregnant women were enrolled, and their predelivery haemoglobin value was recorded. Women with gestational diabetes, hypertension, pre-eclampsia, intrauterine growth restriction, intellectual disability, or pre-existing diagnosis of psychotic spectrum disorder were excluded. Participants provided written informed consent to fill out the Edinburgh Postnatal Depression Scale (EPDS) 3days after delivery. EPDS cut-off score of ≥ 10 was used to identify women at risk of developing PPD. Statistical analysis was performed using Student's t test, the Wilcoxon Rank Sum test, and linear regression. The participants were categorized into 2 groups based on EPDS scores: EPDS < 10 (176 patients) or EPDS ≥ 10 (35 patients). The two groups showed homogeneity in terms of socio-demographic and clinical characteristics. The mean haemoglobin values of anaemic pregnant women in the EPDS ≤ 10 group (11.78 ± 1.39g/dl) and the EPDS > 10 group (11.62 ± 1.27g/dl) were not significantly different (p = 0.52). There was no significant correlation between the predelivery haemoglobin value and the EPDS postpartum score of < 10 or ≥ 10. The Wilcoxon Rank Sum test and the estimated coefficients of the linear regression model did not show any statistical relationship between continuous and binary haemoglobin values. Our study found that maternal prepartum anaemia did not negatively impact the likelihood of developing postpartum depressive symptoms, in the first 3days after delivery.

Self-harm thoughts among postpartum women - associated factors

ABSTRACT Background Even though in many countries suicide is the leading cause of maternal deaths during the postpartum period, the prevalence of thoughts of self-harm (SHTs), an important risk factor for suicide attempts, is still not well documented. Aim We aimed to investigate the prevalence of SHTs in a Polish cohort of postpartum women and identify socio-demographic and maternal mental health factors associated with experiencing SHTs. Method 1545 women took part in a midwife-led postpartum depression (PPD) screening. 337 of them reported SHTs. The Edinburgh Postpartum Depression Scale (EPDS) was administered. Specifically, we used an abbreviated 5-item version to assess depression symptoms, item 10 to assess SHTs, a composite score of items 1 and 2 - anhedonia, and a composite score of items 3, 4, and 5 - anxiety. Logistic regression analyses were performed to examine associations between variables. Results Approximately 2% (n = 337) of women self-reported experiencingSHTs. Within the group of postpartum mothers who self-reported SHTs, 65.60% (n = 221) manifested the symptoms of PPD, and 56.40% (n = 190) - of anxiety. The symptoms of PPD, a mood disorder diagnosed in the past, and younger age were predictors of SHTs. Conclusion The results of this study can contribute to the development of prevention strategies: analysing separately items from PPD screening questionnaires focusing on SHTs can be an important part of prevention. The lack of the symptoms of PPD and anxiety risk does notexclude experiencing SHTs.

Effect of Dexmedetomidine on Postpartum Depression in Women With Prenatal Depression

Postpartum depression (PPD) is emerging as a major public health problem worldwide. Although the particular period and context in which PPD occurs provides an opportunity for preventive interventions, there is still a lack of pharmacologic prevention strategies for PPD. To assess the efficacy and safety of dexmedetomidine for prevention of PPD among women with prenatal depression undergoing cesarean delivery. This randomized clinical trial enrolled 338 women who screened positive for prenatal depression at 2 hospitals in Hunan, China from March 28, 2022, to April 16, 2023. Women with an Edinburgh Postnatal Depression Scale score of more than 9 who were 18 years of age or older and were scheduled for elective cesarean delivery were eligible. Eligible participants were randomly assigned in a 1:1 ratio to either the dexmedetomidine group or the control group via centrally computer-generated group randomization. Dexmedetomidine, 0.5 μg/kg and 0.9% saline were intravenously infused for 10 minutes after delivery in the dexmedetomidine and control groups, respectively. After infusion, sufentanil or dexmedetomidine plus sufentanil was administered via patient-controlled intravenous analgesia for 48 hours in the control group and dexmedetomidine group, respectively. The primary outcome was positive PPD screening results at 7 and 42 days post partum, defined as a postpartum Edinburgh Postnatal Depression Scale score of more than 9. Analysis was on an intention-to-treat basis. All 338 participants were female, with a mean (SD) age of 31.5 (4.1) years. Positive PPD screening incidence at 7 and 42 days post partum in the dexmedetomidine group vs the control group was significantly decreased (day 7, 21 of 167 [12.6%] vs 53 of 165 [32.1%]; risk ratio, 0.39 [95% CI, 0.25-0.62]; P < .001; day 42, 19 of 167 [11.4%] vs 50 of 165 [30.3%]; risk ratio, 0.38 [95% CI, 0.23-0.61]; P < .001). The dexmedetomidine group showed no significant difference in adverse events vs the control group (46 of 169 [27.2%] vs 33 of 169 [19.5%]; P = .10), but the incidence of hypotension increased (31 of 169 [18.3%] vs 16 of 169 [9.5%]; risk ratio, 2.15 [95% CI, 1.13-4.10]; P = .02). Dexmedetomidine administration in the early postpartum period significantly reduced the incidence of a positive PPD screening and maintained a favorable safety profile. Chinese Clinical Trial Registry Identifier: ChiCTR2200057213.

Postpartum Depression Screening Scale: Its Availability for Use.

A silent health crisis in the United States is the underdiagnosed and undertreated mental health of women related to childbirth. This discussion paper describes the Postpartum Depression Screening Scale (PDSS) with its scoring and interpretation along with its psychometric testing and translations. In addition to the studies conducted by the instrument developers, databases were searched for studies where other researchers used the PDSS to assess postpartum depressive symptoms. Studies were included that measured the psychometrics of the scale and studies that reported the translation of the PDSS into other languages. Evidence is presented that the PDSS is a reliable and valid screening scale for use by psychiatric mental health nurses and other health care providers. The scale also has been translated into 14 languages, so it is available to screen non-English speaking mothers. Childbirth is one of the most powerful triggers of psychiatric illness in a woman's life. Postpartum depression is a treatable mental health condition, but first, women need to be screened so they can be identified and referrals made. Screening for this devastating mood disorder in new mothers is an essential role of psychiatric mental health nurses and other clinicians so that treatment can be started as early as possible to avoid harmful consequences.

Prevalence and associated risk factors of postpartum depression in India: A comprehensive review.

Postpartum depression (PPD) is a psychological illness that affects women following delivery. According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), PPD is a serious form of depression that begins four weeks following birth and continues for one year. Pregnancy and the period after delivery can be hazardous for women. Mothers undergo significant biological, emotional, financial, and societal changes during this time. Some women are predisposed to mental health disorders such as melancholy and worry. Many postpartum women do not acknowledge the seriousness of their condition, and many depressed mothers go untreated. Untreated PPD is harmful to both the mother and the newborn. The exact cause of PPD is unclear; however, hormonal fluctuations during pregnancy and childbirth, genetic susceptibility, birth trauma as well as psychosocial and demographic factors may serve as potential risk factors. The objective of this study is to determine the prevalence and risk factors of PPD in India. The review evaluates English language literature on PPD using Scopus, PubMed, and Google Scholar databases searched electronically between 2000 and 2022. The keywords "postpartum depression," or "postnatal depression," and "prevalence," and "causes," and "risk factors," or "predisposing factors," or "predictive factors" were used to search the database. The prevalence of PPD varies in different geographical regions and study settings. In India, the overall prevalence of PPD is 22%. However, the greatest prevalence was in the southern regions (26%; 95% confidence interval [CI]: 19-32) and the lowest in the northern regions (15%; 95% CI: 10-21). This study outlines the burden of PPD in India. Comprehensive intervention programs should be implemented to address the disease at a national level. The national authorities should incorporate PPD screening in the National Mental Health Program and emphasize health promotion activities.

Risk Factors of Postpartum Depression Among Korean Women: An Analysis Based on the Korean Pregnancy Outcome Study (KPOS).

Postpartum depression (PPD) can negatively affect infant well-being and child development. Although the frequency and risk factors of PPD symptoms might vary depending on the country and culture, there is limited research on these risk factors among Korean women. This study aimed to elucidate the potential risk factors of PPD throughout pregnancy to help improve PPD screening and prevention in Korean women. The pregnant women at 12 gestational weeks (GW) were enrolled from two obstetric specialized hospitals from March 2013 to November 2017. A questionnaire survey was administered at 12 GW, 24 GW, 36 GW, and 4 weeks postpartum. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale, and PPD was defined as a score of ≥ 10. PPD was prevalent in 16.3% (410/2,512) of the participants. Depressive feeling at 12 GW and postpartum factors of stress, relationship with children, depressive feeling, fear, sadness, and neonatal intensive care unit admission of baby were significantly associated with a higher risk of PPD. Meanwhile, high postpartum quality of life and marital satisfaction at postpartum period were significantly associated with a lower risk of PPD. We developed a model for predicting PPD using factors as mentioned above and it had an area under the curve of 0.871. Depressive feeling at 12 GW and postpartum stress, fear, sadness, relationship with children, low quality of life, and low marital satisfaction increased the risk of PPD. A risk model that comprises significant factors can effectively predict PPD and can be helpful for its prevention and appropriate treatment.

Trends in Risk Factors for Peripartum Depression in Socio-economically Disadvantaged Childbearing Community

Introduction: Perinatal depression is defined as a depressive episode(s) during the pregnancy and/or postpartum period up to one year. Studies have shown that childbearing people in urban settings experience a higher burden of social factors, such as low socioeconomic status, which may influence the likelihood of developing perinatal depression. Of note, episodes of perinatal depression have been shown to negatively impact child development. Our study has identified population trends in Center for Epidemiological Studies Depression Scale (CES-D) scores &gt;10 during perinatal periods alongside significant social risk factors for people served by LSA Family Health Service providing skilled home-based nursing visits to reduce adverse outcomes. Methods: A retrospective chart review of nursing notes from 2009-2017 was conducted for this cross-sectional study. Outcome measures included antepartum (AP) and postpartum (PP) Center for Epidemiological Studies Depression Scale (CES-D) scores, with a score of &gt; 10, suggesting a positive risk for developing depression. Data were grouped and analyzed using Microsoft Excel and SPSS software (SPSS version 23). Data have been presented as yearly population percentages scoring &gt;10 on their CES-D screen. Results: The maternal outreach program (MOP) enrolled 1,183 birthing individuals from 2009-2017. The mean parental age was 27 years. 70% were Latinx (n=829) and 20.88% (n=247) were Black. Spanish was the primary language for 43.62% (n=516) of participants. Among CES-D screens completed in the antepartum period, 4.5% to 24.6% of the population met criteria over the 9-year study period for risk of developing depression. Positive CES-D screens completed postpartum ranging from 11.9% to 27.2% during the study period. Significant risk factors for positive postpartum CES-D screens were postpartum risk assessment score (p=0.03), increased gestational age (p=0.05), low income (p=0.03), teen/inexperienced parents (p=0.003), and low education levels (p=0.04). Conclusion: Trends of positive antepartum and postpartum depression screens in this population have fluctuated over the study period; however, we have identified significant risk factors for positive postpartum screens. Screening for postpartum depression risk factors is important to identify birthing parents who may most benefit from mental health interventions.

Increasing postpartum depression screening and resources in pediatric primary care: A quality improvement project to enhance provider confidence

BackgroundUnidentified and untreated postpartum depression (PPD) can have a negative impact on children. This Quality Improvement (QI) project aimed to increase PPD screening through provider education and enhancing pediatric primary care provider (PCP) confidence in using the Edinburg Postnatal Depression Screening (EPDS) tool, discussing PPD with mothers, and providing resources. Design and methodsPCPs and staff were educated on the project. Providers were surveyed prior to and after implementation to assess confidence with screening for and addressing PPD. Mothers of infants 0–6 months were screened using the EPDS at well-care visits. Discussion of PPD and resource support was provided if needed. ResultsA total of 273 mothers met criteria for screening, and of those 65% (n = 178) had a documented score. 12.4% of mothers had a score of 10 or greater, indicating high risk for PPD. Results from PCPs were compared both pre- and post-project. Screening for PPD increased from 3 to 4.5, using the EPDS tool from 2.25 to 4.75, discussing PPD with mothers from 2.75 to 4.25, and providing resources from 2.25 to 4.25. ConclusionsPPD screening increased, and provider confidence with using the EPDS, discussing PPD with mothers, and providing resources in pediatric primary care increased.Practice Implications: Educating PCPs on the importance of PPD screening and providing resources for at-risk mothers can increase identification of PPD in the primary care setting. Enhancing the confidence of providers to discuss PPD with mothers and offer resources to those in need can lead to better outcomes for pediatric patients and their families.

Examining the Relationship Between Screening for Postpartum Depression and Associated Child Health Service Utilization and Costs: A Study Using the All Our Families Cohort and Administrative Data

IntroductionDespite a recognized association between maternal postpartum depression (PPD) and adverse child health outcomes, evidence examining the relationship between PPD symptoms and associated child health service utilization and costs remains unclear. In addition, there is a paucity of evidence describing the relationship between early identification of maternal PPD and associated health service utilization and costs for children. This study aims to address this gap by describing the secondary associations of screening for maternal PPD and annual health service utilization and costs for children over their first five years of life.MethodsMothers and children enrolled in the prospective All Our Families cohort were linked to provincial administrative data in Alberta, Canada. Multivariable generalized linear models were used to estimate the average annual inpatient, outpatient, physician, and total health service utilization and costs from a public health system perspective for children of mothers screened high risk for PPD, low/moderate risk for PPD, or unscreened.ResultsTotal mean costs were greatest for children during their first year of life than other years. Those whose mothers were not screened had significantly lower costs compared to those whose mothers were screened low/moderate risk, despite equivalent health service utilization.DiscussionFindings from this study describe the secondary associations of screening for maternal PPD using a public health system perspective. More research is required to fully understand variations in health costs for children across maternal PPD screening categories.

Validating the Edinburgh Postnatal Depression Scale Against the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition for Use in Uganda.

The Edinburgh Postnatal Depression Scale (EPDS) is a widely acknowledged screening tool for postpartum depression (PPD) globally, but its validation in Uganda has been lacking. This study aimed to assess the EPDS's accuracy as a PPD screening tool in Uganda compared to the Mini-International Neuropsychiatric Interview (MINI 7.0.2) based on the DSM-5. This was a descriptive cross-sectional study conducted at a referral hospital and two peri-urban primary care postpartum clinics in rural southwestern Uganda. We enrolled 287 mothers aged 18 to 49 at their six-week postpartum visit. The EPDS was used for initial screening, and the MINI 7.0.2 was employed for clinical diagnosis. The study used the Runyankore-Rukiga language version of the EPDS and collected data from November 11, 2019, to June 10, 2020, with the MINI 7.0.2 as the reference standard. The overall PPD prevalence was 29.5%, as opposed to 26.5% with EPDS and MINI 7.0.2 DSM-5 criteria (p = 0.239). The EPDS demonstrated a sensitivity of 86.8%, specificity of 92.1%, positive predictive value of 80.5%, and negative predictive value of 94.9%. A cutoff score of ≥10 was found to be the most effective acceptable point after drawing the AUC of ROC and determining the most appropriate point using Youden's index. The area under the ROC curve, indicating the scale's overall performance against MINI 7.0.2, was 0.89 for Bwizibwera HCIV, 0.97 for Kinoni HCIV, and 0.84 for MRRH. In conclusion, the EPDS can effectively screen for postpartum depression in southwestern Uganda using a cutoff score of ≥10. It exhibits strong diagnostic performance in correctly identifying PPD in postpartum mothers.

Feasibility and Utility of Posttraumatic Stress Disorder Screening Among Postpartum Patients at an Urban Safety-Net Institution.

Posttraumatic stress disorder (PTSD) is underdiagnosed peripartum. We administered a primary care screening tool and a pregnancy-related PTSD screening tool to postpartum patients presenting to our urban safety-net institution within 6 months of delivery, between August 2021 and February 2022. Our primary outcome was prevalence of positive PTSD screening results. Most patients (364/376, 96.8%) completed screening. Thirty (8.4%) had a positive score on at least one instrument, and seven of these 30 (23.3%) did not have a positive postpartum depression screening result. Among patients with a positive score, the majority (66.7%) obtained behavioral health follow-up. We found that routine PTSD screening for postpartum patients is feasible and identified patients at risk for PTSD. Obstetric practitioners should consider integrating PTSD screening into routine care.

Risk Factors Associated With Maternity Blues and Postpartum Depression in Ecuadorian Women Going Through Their Immediate Puerperium During 2021: A Cross-sectional Study

IntroductionPerinatal factors such as lack of breastfeeding, complications during pregnancy or childbirth, and psychosocial factors such as maternal psychiatric history or socioeconomic status have been associated with the development of postpartum mood disorders. The combination of these factors during the peripartum can predict the development of maternity blues (MB) and postpartum depression (PD). ObjectiveTo characterize risk factors associated with MB and PD in Ecuadorian women going through their immediate puerperium in the gynecology and obstetrics service of “Hospital General San Francisco” in Quito-Ecuador. MethodA cross-sectional study was conducted, with a sample of 250 women attending their immediate puerperium. Data was collected using a self-applied questionnaire during the first 24 postpartum hours. Stein blues scale (SBS) was applied for MB screening and the Edinburgh Postpartum Depression Scale (EPDS) for PD screening. Informed consent and data confidentiality were explained to all participants. ResultsUsing the SBS, a probability of MB of 32.4% (n=81) was observed, while applying the EPDS, a PD probability of 17.6% (n=44) was established. MB and PD protective factors were rooming-in (OR .21, p<.001) (OR .21, p<.001), pregnancy planning (OR .13, p<.001) (OR .25, p<.001) and breastfeeding (OR .20, <.001) (OR .23, p<.001). Meanwhile MB and PD risk factors found were: breastfeeding difficulties (OR 5.88, p<.001) (OR 5.14, p<.001), complications during pregnancy (OR 8.39, p<.001) (OR 7.02, p<.001), complications during delivery (OR 5.29, p<.001) (OR 5.58, p<.001) and economic instability (OR 2.10, p .023) (OR 2.61, p .009). Discussion and conclusionThe risk and protective factors associated with MB and PD in the Ecuadorian population are similar to those described internationally. The recognition of risk factors by health personnel can improve early identification and timely management of puerperal mood disorders.