Postpartum Depressive Symptomatology Research Articles

Attachment ratings in couples as predictors of depressive symptomatology postpartum

Objective: To determine how far self and mutual attachment ratings within couples predict postpartum depressive symptomatology. Method: At 20 weeks prepartum (T1) 163 women completed depression, attachment and dyadic adjustment measures. At T1 partners completed the same attachment measure (the Relationship Questionnaire, RQ), completed by women and partners as self-ratings, and also as each believed the other would complete it. At 3 months postpartum (T2) the women again completed the depression measure. Results: Including only those women for whom there were data at T1 and T2, and from the partner at T1, as bivariate correlations women’s depression at T2 was predicted by higher T1 depression, lower dyadic adjustment, lower self-rated RQ-derived ‘model of self’ (MOS) and ‘model of other’ (MOO), and the woman believing that her partner would rate his MOS lower. How the partner rated his own attachment models did not predict the woman’s T2 depression. In a hierarchical regression, T2 depression was predicted by higher T1 depression, the woman’s lower self-rated MOS, and the absolute discrepancy in ratings of her MOS. Conclusions: Both a woman’s self-rated MOS, and discrepancies with how her partner believes she would rate her MOS, uniquely improved the prediction of postpartum depression. The findings suggest that an aspect of partner understanding may contribute to a woman’s adjustment postpartum.

Seeking Help for Postpartum Depression in the Israeli Jewish Orthodox Community: Factors Associated with Use of Professional and Informal Help

Postpartum depression (PPD) has potentially devastating personal and familial consequences. However, very few women receive treatment, either professional or informal. Use patterns and factors associated with both professional and informal help for PPD have not yet been investigated. This study examined factors associated with use of professional and informal help for PPD in an Israeli sample that included women from secular, traditional, orthodox, and ultra-orthodox Jewish religious groups. One to two days postpartum, 1,059 women were recruited from a large hospital in Jerusalem, Israel, and completed an initial survey; 805 women (76%) participated at the 6-week follow-up; 94 women (12%) screened positive for PPD symptoms at the 6-week follow-up and were referred for help; and 88 women completed the 6-month postpartum follow-up interview. Of the women referred for help, 69% used some sort of help, with 24% using professional help and 45% using informal help. Confidence in mental health professionals and higher levels of PPD symptomatology were associated with use of professional help. Recognition of personal need for professional psychological help was negatively associated with use of informal help. Findings from this study highlight the importance of routine screening for PPD and culturally sensitive referrals using informal sources of help.

L’accouchement prématuré : une naissance traumatique ? Symptômes de stress posttraumatique et variables associées

ObjectivesWhile researches focusing on posttraumatic stress disorder (PTSD) symptoms following childbirth tend to develop, few studies have been conducted on French samples. The aim of the current study was to explore the prevalence rate of women developing postpartum PTSD following preterm birth and highlighting associated features. Patients and methodIn the 4weeks following the preterm infant's hospital discharge, a sample of 110 French women (mean age [SD]=29.5 [4.3]years) who delivered prematurely completed questionnaires assessing PTSD symptoms (Impact of Event Scale-Revised) postpartum depressive symptomatology (Edinburgh Postnatal Depression Scale), quality of marital relationship (Dyadic Adjustment Scale) and partner support (Multidimensional Scale of Perceived Social Support). Sociodemographic and gynecologic data were also gathered. ResultsThirty percent of our sample reported a score on the IES-R highlighting a probable posttraumatic stress disorder. Increased postpartum depressive symptoms (β=0.47, P<0.05), having undergone a caesarian section (β=0.24, P<0.05), and prior traumatic event (β=0.20, P<0.05), were independently associated with the intensity of PTSD symptoms. Discussion and conclusionGiven the traumatic impact of preterm birth on mothers, further studies focusing on the trauma of premature delivery are warranted.

Examining Relationships Between Body Dissatisfaction, Maladaptive Perfectionism, and Postpartum Depression Symptoms

To explore body dissatisfaction and maladaptive perfectionism as risk factors for postpartum depression symptomatology. Prospective, cohort design. Urban and suburban hospital-based obstetrician and midwifery offices. Forty-six (46) adult ethnically diverse pregnant women with gestational age greater than or equal to 28weeks. Body dissatisfaction and maladaptive perfectionism were assessed in the offices of health care providers during the third trimester of pregnancy. Postpartum depression symptomatology was assessed at least 2months postpartum using the Edinburgh Postnatal Depression Scale (EPDS) via postal mail or e-mail. Body dissatisfaction predicted postpartum depression symptoms, even after controlling for previously established risk factors. No main effect emerged between maladaptive perfectionism and postpartum depression symptoms. Body dissatisfaction in the third trimester of pregnancy serves as a risk factor for postpartum depression. Therefore, assessment of body image during the third trimester of pregnancy may help health care providers identify women at risk of postpartum depression. Body dissatisfaction also may be an important target for postpartum depression prevention and treatment programs.

Immigrant women’s experiences of postpartum depression in Canada: a protocol for systematic review using a narrative synthesis

BackgroundLiterature documents that immigrant women in Canada have a higher prevalence of postpartum depression symptomatology than Canadian-born women. There exists a need to synthesize information on the contextual factors and social determinants of health that influence immigrant women’s reception of and behavior in accessing existing mental health services. Our research question is: what are the ethnoculturally defined patterns of help-seeking behaviors and decision-making and other predictive factors for therapeutic mental health care access and outcomes with respect to postpartum depression for immigrant women in Canada?Methods/designOur synthesis incorporates a systematic review using narrative synthesis of reports (peer- and non-peer reviewed) of empirical research and aims to provide stakeholders with perspectives on postpartum mental health care services as experienced by immigrant women. To reach this goal we are using integrated knowledge translation, thus partnering with key stakeholders throughout the planning, implementation and dissemination stages to ensure topic relevancy and impact on future practice and policy. The search and selection strategies draw upon established systematic review methodologies as outlined by the Centre for Reviews and Dissemination and also incorporate guidelines for selection and appraisal of gray literature. Two search phases (a database and a gray literature phase) will identify literature for screening and final selection based on an inclusion/exclusion checklist. Quality appraisal will be performed using the tools produced by the Centre for Evidence Based Management. The narrative synthesis will be informed by Popay et al. (2006) framework using identified tools for each of its four elements. The integrated knowledge translation plan will ensure key messages are delivered in an audience-specific manner to optimize their impact on policy and practice change throughout health service, public health, immigration and community sectors.DiscussionThe narrative synthesis methodology will facilitate understandings and acknowledgement of the broader influences of theoretical and contextual variables, such as race, gender, socio-economic status, pre-migration history and geographical location. Our review aims to have a substantive and sustainable impact on health outcomes, practice, programs and/or policy in the context of postpartum mental health of immigrant women. PROSPERO registration number CRD42012003020.

A longitudinal study of maternal attachment and infant developmental outcomes

Extant research has demonstrated that compared to adults with insecure attachment styles, more securely attached parents tend to be more responsive, sensitive, and involved parents, resulting in improved outcomes for their children. Less studied is the influence of a mother's attachment style on her attachment to her unborn child during pregnancy and the consequent developmental outcomes of the child during early childhood. Thus, the aim of this prospective longitudinal study was to examine the relationship between maternal-fetal attachment (MFA) during pregnancy and infant and toddler outcomes and the role of mothers' attachment style on early childhood developmental outcomes in an economically disadvantaged sample of women and their children. Gamma regression modeling demonstrated that an avoidant maternal attachment style (b = .98, 95% CI [.97, .98], p < 0.001) and post-partum depressive symptomatology (b = .97, 95% CI [.96-.99], p = 0.03) were significant predictors of early childhood development. Women demonstrating higher avoidant attachment styles and greater depressive symptomatology were more likely to have children demonstrating early childhood developmental delays than those women with less avoidant attachment styles and less depressive symptomatology. Furthermore, women reporting higher MFA during pregnancy had more secure attachment styles, and their children had more optimal early childhood development than those women reporting lower MFA and less secure attachment styles. Findings have implications for enhancing early intervention programs aimed at improving maternal and childhood outcomes. An earlier identification of disruptions in attachment may be beneficial in tailoring interventions focused on the mother-child dyad.

Efecto del contacto piel con piel sobre la presencia de síntomas depresivos post parto en mujeres de bajo riesgo obstétrico

Background: Postpartum depression can interfere with bonding between the mother and the child. The skin-to-skin contact is defined as the contact of the newborn, dry and naked, prone on the mother's bare chest and with a warm blanket placed across the infant's back; this contact takes place immediately after delivery, for at least an hour. Objective: To examine the relationship between skin-to-skin contact and the incidence of depressive symptoms in women with low risk pregnancies. Patients and Method: A prospective analytical study was performed in 393 postpartum women with low obstetric risk in order to evaluate the postpartum depressive symptomatology and its association with biodemographic and skin-to-skin contact variables. Data were collected through a questionnaire at 24 to 48 hours postpartum and through telephone follow-up, at 8 weeks postpartum, in order to screen depressive symptoms using the Edinburgh Depression Scale. Results: 29% of women reported depressive symptoms. The analysis showed that skin-to-skin contact and early initiation of breastfeeding are significantly associated with the absence of postpartum depressive symptomatology. Conclusion: Skin-to-skin contact was the only variable in this study that can explain the absence of depressive symptoms in women with low risk pregnancies. Skin-to-skin contact implementation is suggested as a preventive strategy.

The Relationship Between Postpartum Depression, Domestic Violence, Childhood Violence, and Substance Use

The objective of this study was to determine the contribution of interpersonal violence and substance use to the prediction of postpartum depressive symptomatology. A community-based sample of 634 women in British Columbia, Canada was screened for interpersonal violence and substance use using the Antenatal Psychosocial Health Assessment (ALPHA) form. Of these women, 497 (78%) subsequently completed questionnaires at 8 weeks postpartum to assess for depressive symptomatology using the Edinburgh Postnatal Depression Scale (EPDS). A predictive model for postpartum depressive symptomatology (EPDS > 9) was developed using regression analysis. Findings suggest that women who experience past or current interpersonal violence or personal or partner substance use problems should be considered for targeted screening for postpartum depression (PPD).

A Resilience Perspective of Postpartum Depressive Symptomatology in Military Wives

To estimate the prevalence of postpartum depressive symptoms in a sample of military wives, and to provide a comparative descriptive analysis of demographic, risk and protective factors. A comparative descriptive design. A large military base in southeastern United States. Military wives (N=71) who had given birth within the preceding 3 months. Participants were recruited from a military immunization clinic during the infant's 8-week health maintenance visit. Assessments were conducted to screen mothers for symptoms of postpartum depression (PPD) and to measure risk and protective factors of PPD. More than one half of the participants (50.7%, n=36) scored above the cutoff point for elevated depressive symptoms suggestive of PPD. Examination of the risk and protective factors showed that military wives with depressive symptoms had greater family changes and strains, lower self-reliance, and lower social support than those without depressive symptoms. Examining postpartum depressive symptoms in military wives from a resilience perspective offers unique insights into risk and protective factors that may influence this population. Through better understanding, nurses can identify those most at risk for PPD and focus interventions on risk reduction while capitalizing on the new mothers' strengths and resources.

1049 – Correlates of postpartum depressive symptomatology

Introduction Postpartum depressive symptomatology is highly prevalent and has negative impact in the entire family. Objective To identify correlates of postpartum depressive symptomatology. Methods 201 3-months postpartum women completed the Portuguese versions of Postpartum Depression Screening Scale/PDSS, Profile of Mood States, Difficult Infant Temperament Questionnaire/DITQ, Multidimensional Perfectionism Scale and questions on sociodemographic variables (marital status, work status, educational level, parity), Lifetime history of insomnia/LTHD, Lifetime history of depressive symptomatology /LTHDS, Current insomnia, Sleep needs, Health perception/HP, Stress perception/SP, Perceived social support/PSS, Quality of life/QOL, Health problem/complication postpartum, Sensibility to hormonal fluctuations, Type of delivery and Type of feeding. Results Total PDSS significantly correlated with LTHDS (rs=.35), LHI (rs=.22), Current insomnia (rs=.37), SP (rs=39), PSS (rs=.25), Perceived QOL (rs=.31), Health perception (rs=.28), Health problem or complication in the postpartum (rs=.16), Negative Affect/NA (r=.59), Positive Affect/PA (r=-.67), Conditional Acceptance/CA(r=.29) and DIT (r=.40) (all p M-1DP) DIT, CA, NA and low vs. high PA had significantly higher mean scores in AI (all p Conclusion These results are in line with previous findings and contribute to the progress on this topic.

Is Maternal Depressive Symptomatology Effective on Success of Exclusive Breastfeeding During Postpartum 6 Weeks?

The aim of this prospective study was to examine the relationship between success of exclusive breastfeeding and postpartum depressive symptomatology. Our hypothesis was that mothers with depressive symptoms initially fail exclusive breastfeeding. One hundred ninety-seven mothers were enrolled in the study. The participants were interviewed twice. The first visit was within the first 48 hours after birth. The Edinburgh Postnatal Depression Scale (EPDS) was completed by the participants. The second interview was performed at 6 weeks. Participants answered questions regarding methods of breastfeeding for 6 weeks, any methodological problems, and nipple pain. The EPDS was again completed by the participants at 6 weeks. All newborns were term infants. All the participants were divided into two groups: exclusive breastfeeding and mixed-feeding (partial breastfeeding and/or bottle feeding). Both groups were compared in terms of features, such as mode of delivery, parity, prevalence of depressive symptomatology (at 48 hours and 6 weeks), and delayed onset of lactation within the first 48 hours. Statistical significance was found for only three variables: delayed onset of lactation within the first 48 hours, gestational age, and the problems related to breastfeeding methods. Clinicians should pay special attention to any lactation difficulty during the first week postpartum. Early lactation difficulties are associated with greater risk of early termination of breastfeeding and lower breastfeeding success.

1294 Is Maternal Depressive Symptomatology Effective on Exclusive Breastfeeding During Postpartum 6 Weeks?

AimThe aim of this prospective study was to examine the relationship between exclusive breastfeeding and postpartum depressive symptomatology. Our hypothesis was that mothers with depressive symptoms initially, fail exclusive breastfeeding.MethodsOne...

Can a Brief Antepartum Preventive Group Intervention Help Reduce Postpartum Depressive Symptomatology?

Background: Psychosocial and psychological interventions are generally effective in reducing depressive symptomatology in the postpartum period. Our aim was to evaluate the effectiveness of a brief preventive group intervention for postpartum depression (PPD) in a naturalistic setting, and study the effect of this on social and psychological risk factors. Methods: We conducted a randomized controlled trial (n = 1,719) in south-eastern Hungary in 62 antepartum centers. Pregnant women (n = 710) underwent a 4-session preventive group intervention whereas a control group (n = 1,009) attended 4 sessions providing the same information given in usual care. Results: Our intervention appeared to significantly reduce the risk of PPD, as defined by Leverton Questionnaire total scores (OR = 0.69). It resulted in an absolute risk reduction of about 18% in those with antepartum depression and 0.5% in those with no depression at recruitment. A multiple logistic regression analysis revealed a much reduced risk in those with a perceived lack of partner support (OR = 0.4) in the treatment group. Unplanned pregnancy, an irreversible risk factor affecting every fifth woman, also seemed to have a reduced effect on PPD after our group intervention (OR = 0.81). Conclusions: A brief preventive antepartum group intervention focusing on psychoeducation, stress management, improving coping mechanisms, and the development of social support can be effective in reducing postpartum depressive symptomatology.

Prevalence and characteristics of Postpartum Depression symptomatology among Canadian women: a cross-sectional study

BackgroundThis study aims to look at the prevalence and characteristics of postpartum depression symptomatology (PPDS) among Canadian women. Studies have found that in developed countries, 10-15% of new mothers were affected by major postpartum depression. Mothers who suffer from postpartum depression may endure difficulties regarding their ability to cope with life events, as well as negative clinical implications for maternal-infant attachment.MethodsAn analysis based on 6,421 Canadian women, who had a live birth between 2005 and 2006 and were part of the Maternity Experience Survey (MES), was performed. PPDS was measured based on the Edinburgh Postnatal Depression Scale. Various factors that assessed socio-economic status, demographic factors, and maternal characteristics were considered for the multinomial regression model.ResultsThe national prevalence of minor/major and major PPDS was found to be 8.46% and 8.69% respectively. A mother's stress level during pregnancy, the availability of support after pregnancy, and a prior diagnosis of depression were the characteristics that had the strongest significant association with the development of PPDS.ConclusionsA significant number of Canadian women experience symptoms of postpartum depression. Findings from this study may be useful to increase both the attainment of treatment and the rate at which it can be obtained among new mothers. Interventions should target those with the greatest risk of experiencing PPDS, specifically immigrant and adolescent mothers.

Intergenerational transmission of postpartum depression

Objective: This study aimed to explore the hypothesis of an intergenerational transmission of postpartum depression. Mother’s postpartum depressive symptomatology was linked to former depression, postpartum depression of her mother as well as the quality of the mother–daughter relationship. Method: A sample of 65 women and their mothers completed questionnaires one month after delivery: the Edinburgh Postnatal Depression Scale (EPDS), dimension A of the International Mini Neuropsychiatric Interview (MINI) assessing a former depressive episode, the Mother and Adult Daughter Questionnaire (MAD) as well as the Inventory of Peer and Relative Attachment (IPPA). Their mothers completed the Bromley Postnatal Depression Scale (BPDS) in order to retrospectively diagnose a postpartum depression. Results: Women whose mother had suffered from a postnatal depression had significantly higher scores on the EPDS. Former depression symptoms and grandmother’s former postnatal depression were significant predictors of postpartum depression symptoms intensity. Conclusion: this study confirms the hypothesis of an intergenerational transmission of postpartum depression and highlights the need to provide an in‐depth examination of these issues.

P03-509 - The role of perfectionism in perinatal depression (ICD-10, DSM-IV and BDI-II, PDSS)

AimsThe role of perfectionism as a correlate of perinatal depressive symptomatology, and as a predictor of postpartum depressive disorder was examined.Methods386 women in their third trimester of pregnancy (mean age = 30.08 years; SD = 4.205; range = 19–44) completed the Portuguese versions of Multidimensional Perfectionism Scale, Beck Depression Inventory-II/BDI-II, Postpartum Depression Screening Scale/PDSS and three additional questions evaluating anxiety trait, life stress perception and social support. Diagnoses of depression (ICD-10/DSM-IV) were obtained using the Portuguese version of the Diagnostic Interview for Genetic Studies/OPCRIT system. Women who were clinically depressed in pregnancy (ICD-10/DSM-IV) were excluded from the analysis.ResultsSelf-Oriented Perfectionism/SOP and Socially Prescribed Perfectionism/SPP subcomponents were significant correlates of depressive symptomatology (BDI-II/PDSS) in pregnancy. SPP-Others High Standards/OHS was a significant predictor of postpartum depressive symptomatology (BDI-II/PDSS), and SPP-Conditional Acceptance/CA was a predictor of postpartum depressive symptomatology (PDSS). None of the perfectionism subscales predicted postpartum depressive disorder (ICD-10/DSM-IV).ConclusionsSOP and SPP have shown to be relevant correlates of depressive symptomatology in pregnancy. In the present study, SPP-OHS and SPP-CA were also significant correlates of perinatal depressive symptomatology, as well as important risk factors for depressive symptomatology in postpartum. Perfectionism subscales were not significant predictors of postpartum depressive disorder (ICD-10/DSM-IV). While SPP maladaptive influence was supported, SOP was shown to be more heterogeneous in its consequences. These findings may have important implications both for clinical practice and for research.

Is insomnia in late pregnancy a risk factor for postpartum depression/depressive symptomatology?

The aim of the present work was to investigate if insomnia in late pregnancy is a risk factor for postpartum depressive symptomatology/postpartum depression (PPD). 581 women in their last trimester of pregnancy answered questions/questionnaires about lifetime history of insomnia, current sleep perception, current mood and depressive symptomatology. They were interviewed with the Portuguese version of the Diagnostic Interview for Genetic Studies. After delivery 382 (65.7%) mothers participated again in the study. Insomnia in pregnancy was not a risk factor for PPD (DSM-IV or ICD-10) but was a significant predictor of postpartum depressive symptomatology. Negative Affect (NA) was a significant predictor of postpartum depressive symptomatology. Women with higher NA were 4.6 (CI95%=1.69–12.74) and 5.3 times (CI95%=2.26–12.58) more likely of experiencing PPD (DSM-IV/ICD-10, respectively) than women with lower NA. Lifetime Depression was a significant predictor of postpartum depressive symptomatology and ICD-10/PPD (OR=2.6; CI95%=1.16–4.38). Positive Affect (PA) showed to be a protective factor for postpartum depressive symptomatology and DSM-IV/PPD (OR=1.5; CI95%=1.20–2.33). Controlling NA, PA and Lifetime Depression, insomnia lost its predictive role, suggesting these variables might work as mediators. Associations between insomnia, NA, PA and Lifetime Depression should be assessed in pregnancy. This might help to preventively target NA, enhance PA and reduce the likelihood of experiencing postpartum depressive symptomatology.

Role of pelvic sensory signalling during delivery in postpartum mental health

Background: Animal research demonstrates that pelvic sensory signalling at parturition initiates behavioural and emotional changes that are protective for mother and offspring. In contrast, research with humans has found no effect of caesarean delivery (i.e. procedure that blocks pelvic signalling) on mother's mental health. The lack of effect may reflect little consideration for the use of epidurals, another intervention that blocks pelvic signalling. The following study examines whether blocking pelvic signalling during delivery predicts postpartum depression symptomatology. Method: Longitudinal mental health data were collected prospectively from 142 primiparous women who had a caesarean delivery and/or received epidural anaesthesia (Intervention) or delivered vaginally without anaesthesia (No‐Intervention). Measurements began in late pregnancy and continued through the first postpartum year. Results: Intervention mothers reported more depressive symptoms at the end of the first postpartum year compared to those in the No‐Intervention group. This effect was independent of socio‐cultural factors known to predict levels of depressive symptoms. Conclusion: These results suggest that pelvic sensory signalling may help to prepare women for the postpartum period. Considering there are many factors influencing the mental health of mothers, the present finding suggest that populations vulnerable to postpartum depression should consider a delivery without intervention, when medically permissible.

Antenatal reports of pre-pregnancy abuse is associated with symptoms of depression in the postpartum period

The purpose of this study is to estimate characteristics predictive of postpartum mood change symptoms among urban women. Women receiving prenatal care at The Mount Sinai Hospital OB/GYN Diagnostic and Treatment Center and who delivered over one calendar year (2007; n = 884) were evaluated for psychosocial risk factors at their first prenatal visit and then subsequently for postpartum mood symptomatology (n = 510) at 6 weeks postpartum. Symptoms associated with postpartum depression (PPD) were best predicted by a pre-pregnancy history of physical or sexual abuse, a history of psychiatric problems, or psychiatric diagnosis at the time of first prenatal visit. This study provides the first large sample evidence that PPD is associated with the report of sexual or physical abuse. Screening for a history of abuse, a history of psychiatric problems, or having a psychiatric illness at the time of the first prenatal visit may be an efficient means to identify women at risk for developing PPD. Early identification of women at risk would provide an opportunity to provide a selective prevention intervention to reduce the likelihood of PPD symptomatology.

Prevalence and risk factors concerning postpartum depression among women within early postnatal periods in Turkey

Postpartum depression (PPD) stands out as an important health issue that affects not only the mother but her partner and the entire family. A few studies from Turkey have found the high prevalence for PPD. In the current study we aimed: (1) to report the prevalence of postpartum depression among Turkish women in Manisa province; (2) description of the association of PPD with risk factors. To achieve the goals of the current study, we employed the Edinburgh Postpartum Depression Scale (EPDS). The perceived social support (PSS) scale was used to assess social support in the postnatal period. Socio-demographic and obstetric variables were collected through a socio-demographic and obstetric questionnaire. The mean EPDS scores of the study participants were 8.53 ± 4.93. The EPDS-based prevalence of PPD (a score of ≥13) was 28.3%. We found a significant negative correlation between EPDS scores and perceived social support from the family (PSS-Fa) and from friends (PSS-Fr) scores. The present study also revealed a significant association between postpartum depressive symptomatology and unintended pregnancy, insufficient social support, and previous history of depression. The findings of the current study revealed high EPDS-based PPD prevalence in a sample of Turkish women and described a number of risk factors associated with PPD. The high prevalence found in this study indicated a need for developing new interventions for early detection and treatment of PPD. A significant number of Turkish immigrants live in western countries. We believe the findings of the current study may be helpful for physicians in locations where a large number of Turkish immigrants live.