Postpartum Mood Disorders Research Articles

Investigating perspectives on e-health interventions to enhance maternal mental well-being: Results of a stakeholder interview.

Peripartum mental disorders are highly prevalent conditions and associated with adverse outcomes for the mother, the infant and the whole family. Despite the high burden, help-seeking is low. E-mental health interventions could overcome help-seeking barriers and thus improve perinatal mental health. However, usage and adherence are rather low. This study aims to assess attitudes and needs of different stakeholder groups and to identify relevant topics to develop an intervention meeting the needs of pregnant and postpartum women and thus, increasing utilization and adherence. Therefore, semi-structured interviews and focus groups with pregnant women (n = 3), mothers (n = 4), women who have suffered from a postpartum mood disorder in the past (n = 5), gynaecologists (n = 5), and midwives (n = 5) were conducted. All interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. Almost half of the stakeholders reported previous experiences with e-mental health services. Anonymity, flexibility, promoting help-seeking, or bridging waiting-time for treatment as usual were regarded as the main benefits. Concerns regarding the usefulness of e-mental health interventions, absence of face-to-face contact or lack of integration into routine care were considered as barriers. With regard to the desired program content, six main topics were identified: pregnancy and puerperium, peripartum mood swings and disorders, support options, self-care, partnership, and fatherhood. Regarding preferred characteristics of e-mental health programs, stakeholders mentioned customizability, individual guidance, evaluation of user-feedback and continuous adoption, as well as a responsive and user-friendly design. Overall, online interventions for perinatal mental health were mainly considered as beneficial. Stakeholders underlined the high need for education regarding the use and effectiveness of e-mental health, to overcome concerns and obstacles and improve acceptability. Furthermore, developing customizable and individually-guided interventions were considered as promising to increase utilization of and adherence to e-mental health interventions.

Implementation research priorities for addressing the maternal health crisis in the USA: results from a modified Delphi study among researchers

BackgroundMaternal health outcomes in the USA are far worse than in peer nations. Increasing implementation research in maternity care is critical to addressing quality gaps and unwarranted variations in care. Implementation research priorities have not yet been defined or well represented in the plans for maternal health research investments in the USA.MethodsThis descriptive study used a modified Delphi method to solicit and rank research priorities at the intersection of implementation science and maternal health through two sequential web-based surveys. A purposeful, yet broad sample of researchers with relevant subject matter knowledge was identified through searches of published articles and grant databases. The surveys addressed five implementation research areas in maternal health: (1) practices to prioritize for broader implementation, (2) practices to prioritize for de-implementation, (3) research questions about implementation determinants, (4) research questions about implementation strategies, and (5) research questions about methods/measures.ResultsOf 160 eligible researchers, 82 (51.2%) agreed to participate. Participants were predominantly female (90%) and White (75%). Sixty completed at least one of two surveys. The practices that participants prioritized for broader implementation were improved postpartum care, perinatal and postpartum mood disorder screening and management, and standardized management of hypertensive disorders of pregnancy. For de-implementation, practices believed to be most impactful if removed from or reduced in maternity care were cesarean delivery for low-risk patients and routine discontinuation of all psychiatric medications during pregnancy. The top methodological priorities of participants were improving the extent to which implementation science frameworks and measures address equity and developing approaches for involving patients in implementation research.ConclusionsThrough a web-based Delphi exercise, we identified implementation research priorities that researchers consider to have the greatest potential to improve the quality of maternity care in the USA. This study also demonstrates the feasibility of using modified Delphi approaches to engage researchers in setting implementation research priorities within a clinical area.

Postpartum Mood Disorders: Insights into Diagnosis, Prevention, and Treatment.

Postpartum mood disorders pose significant challenges to women's mental health and well-being during the postpartum period. This review article provides insights into these disorders' diagnosis, prevention, and treatment. The article begins by discussing the background information on postpartum mood disorders, their significance, and the purpose of understanding them. It then delves into the classification and types of postpartum mood disorders, emphasizing the need for accurate diagnosis and differentiation. Prevalence and incidence rates are explored to highlight the scope and impact of these disorders. The review examines various risk factors associated with postpartum mood disorders, including biological, psychological, and socioeconomic factors. Understanding these risk factors helps identify high-risk populations and guide targeted interventions. Screening and diagnosis of postpartum mood disorders are crucial for early detection and intervention. The article provides an overview of screening tools, highlights the challenges in diagnosis, and emphasizes the importance of early identification for better outcomes. Prevention strategies are explored, including antenatal education, psychosocial support programs, and the role of healthcare professionals in promoting preventive measures. Effective prevention interventions and their outcomes are discussed to guide healthcare providers and policymakers in implementing evidence-based strategies. Treatment approaches for postpartum mood disorders include pharmacological interventions, psychotherapy options, alternative and complementary therapies, and multidisciplinary approaches. The article discusses the effectiveness and considerations of each approach, highlighting the importance of individualized care. Challenges and barriers in diagnosing, preventing, and treating postpartum mood disorders are addressed, including stigma, limited access to healthcare services, and gaps in healthcare provider knowledge and training. Recommendations are provided for healthcare professionals and policymakers to overcome these challenges and improve outcomes. The review concludes by highlighting the need for future research, innovations in prevention and treatment approaches, and collaborative efforts in the field of postpartum mood disorders. Promising areas for research are identified, including long-term outcomes, understanding risk factors, and cultural considerations. The article emphasizes the importance of interdisciplinary collaboration and stakeholder engagement in advancing the field.

Postpartum Insomnia and Poor Sleep Quality Are Longitudinally Predictive of Postpartum Mood Symptoms.

Insomnia and poor sleep quality are frequently reported by perinatal women. Both are noted to increase the risk of postpartum depression, with less known about their association with postpartum anxiety. This study sought to assess whether perinatal sleep disturbances predicted depression and anxiety symptoms across each month of the first 6 months postpartum in women with a history of depression. Pregnant women without active depression at enrollment ( N = 159), 18 to 45 years of age, were recruited. In late pregnancy and for up to 6 months postpartum, women completed monthly online questionnaires including the Insomnia Symptom Questionnaire, Pittsburgh Sleep Quality Index, Edinburgh Postnatal Depression Scale, and Generalized Anxiety Disorder-7. Repeated-measures multilevel models were used to predict depression and anxiety across the postpartum. The prevalence of insomnia was 20.4%, and the prevalence of poor sleep quality was 67.8% across the first 6 months postpartum. Postpartum insomnia and poor sleep quality at the between-subject and within-subject levels tended to uniquely predict greater depressive and anxiety symptoms, even after controlling for demographic characteristics, prenatal insomnia, and prenatal poor sleep quality. Most of the women in our sample had sleep disturbances across the perinatal period. Consistent with the extant literature, postpartum insomnia and poor sleep quality, but not prenatal measures of sleep, longitudinally predicted greater postpartum depression and anxiety symptoms. The chronic sleep deprivation of insomnia and the subjective experience of poor sleep quality are uniquely relevant risks of postpartum mood disorders. Evaluation and mitigation of perinatal sleep disturbance are ideal opportunities to reduce postpartum mood disorders and subsequent health outcomes.

Effects of Drospirenone only pill contraception on postpartum mood disorders: A prospective, comparative pilot study

ObjectiveThe aim of this non-randomized control study was to assess the effect of Drospirenone (DRSP) only pill (DOP) 4 mg, in a 24 active/4 placebo regimen, on the mood of postpartum women who wanted to use a hormonal contraceptive. Study designSeventy-one women in the study group, and 78 in the control group, were included in intention-to-treat analyses. The depression score was assessed using the self-administrated Edinburgh Postnatal Depression Scale (EPDS) at the childbirth preparation course (T0), and at 2 (T1), 12 (T2), and 24 (T3) weeks postpartum follow-ups. ResultsFrom T0 to T1 an increase in the scores was observed in both groups: in the study group from 9.2 ± 2.5 to 10.1 ± 2.4 (p = 0.02), and in the control group from 8.7 ± 2.7 to 10.3 ± 2.2 (p < 0.001). At the T2 follow-up, the EPDS score reduction was statistically significant in the study group (p < 0.001) but not in the control group (p = 0.16). Similarly, at the T3 follow-up, the score was statistically reduced in the study (p < 0.01), but not in the control group (p = 0.35). The intergroup statistical analysis showed no differences between groups at T0 (p = 0.19) and at T1 (p = 0.55). Instead, they were statistically significant at T2 and T3 (p < 0.001). EPDS scores had no significant correlation with the mode of delivery (r = 0.2; p > 0.05) and with the mode of breastfeeding (r = 0.3; p > 0.05). On the other hand, EPDS scores demonstrated a positive correlation with the social status of single (r = 0.99; p < 0.002) and low education level (r = 0.82; p < 0.004). ConclusionPostpartum mood disorders may have persistent effects that compromise the mother's health and newborn development. DRSP, used as DOP, could modulate mood disorders of the postpartum period in women with individual sensitivity to steroid levels.

Incidence and risk factors for postpartum mood and anxiety disorders among women veterans

BackgroundOur aim was to determine rates of postpartum mood and anxiety disorders (PMADs) among U.S. women Veterans and the overlap among PMADs. We further sought to identify PMAD risk factors, including those unique to military service. MethodsA national sample of women Veterans completed a computer-assisted telephone interview (N = 1414). Eligible participants were aged 20–45 and had separated from service within the last 10 years. Self-report measures included demographics, general health, reproductive health, military exposures, sexual assault, childhood trauma, and posttraumatic stress disorder (PTSD). The PMADs of interest were postpartum depression (PPD), postpartum anxiety (PPA) and postpartum PTSD (PPPTSD). This analysis included 1039 women Veterans who had ever been pregnant and who answered questions about PPMDs related to their most recent pregnancy. ResultsA third (340/1039, 32.7%) of participants were diagnosed with at least one PMAD and one-fifth (215/1039, 20.7%) with two or more. Risk factors common for developing a PMAD included: a mental health diagnosis prior to pregnancy, a self-report of ever having had a traumatic birth experience, and most recent pregnancy occurring during military service. Additional risk factors were found for PPD and PPPTSD. ConclusionWomen Veterans may be at an increased risk for developing PMADs due to high rates of lifetime sexual assault, mental health disorders, and military-specific factors including giving birth during military service and military combat deployment exposures.

0627 Postpartum Insomnia and Poor Sleep Quality are Uniquely Predictive of Postpartum Mood Disorders

Abstract Introduction Many postpartum women experience symptoms of depression (PPD) and anxiety (PPA). Insomnia and poor sleep quality are frequently reported by postpartum women and are risk factors for postpartum mood disorders. This longitudinal study sought to assess whether perinatal insomnia or sleep quality predicted depression and anxiety across each month of the first 6 months postpartum in women with a history of depression. Methods Pregnant women (N = 178) aged 18-45 years with a self-reported prior history of depression were recruited from social media in late pregnancy. None of the women were depressed at enrollment. In late pregnancy and for up to six months postpartum, women completed monthly online questionnaires including the ISQ, PSQI, EPDS, and GAD-7. Repeated-measures multilevel models were performed using the generalized linear mixed model command in the software IBM SPSS 28 to determine predictive associations across the postpartum. Demographics (age, education, race, and sex of baby) were statistically controlled for in these models. Results The rate of depression averaged (15.7%) and anxiety averaged (17.0%) across the postpartum. The prevalence of insomnia was 20.4%, and the prevalence of poor sleep quality was 67.8% across the first 6 months postpartum. Insomnia in the postpartum predicted greater depressive and anxiety symptoms, even after controlling for prenatal insomnia. Likewise, poor sleep quality in the postpartum predicted greater depressive and anxiety symptoms after controlling for prenatal poor sleep quality scores. When considering clinical cutoffs of the EPDS ≥ 12 and GAD ≥ 10, postpartum insomnia and sleep quality uniquely predicted postpartum depression (OR = 5.69, 95% CI 3.33-9.74 and OR = 3.13, 95% CI 1.70 -5.77). Insomnia predicted postpartum anxiety (OR = 11.15, 95% CI 5.99-20.78), with sleep quality trending (OR = 1.76, 95% CI 0.99 -3.12). None of the demographic variables significantly contributed (P’s &amp;gt; 05). Conclusion Both postpartum insomnia and poor sleep quality contributed to clinical postpartum mood. The chronic sleep deprivation of insomnia and the subjective experience of poor sleep quality are uniquely relevant to risk for postpartum mood. The consideration and treatment of both is important as they are uniquely associated with adverse outcomes for mother and child. Support (if any) Happiest Baby, Inc

Should Severe Preeclampsia Be Considered a Risk Factor for Postpartum Depression and Anxiety? [ID: 1376999

INTRODUCTION: Postpartum mood disorders are common and seen in approximately 20% of women. It is important to understand risk factors associated with this diagnosis so that earlier interventions can be initiated. To date, the effect of preeclampsia on postpartum mood disorders has not been thoroughly investigated. The purpose of this study was to investigate whether severe preeclampsia (SPE) acts as a risk factor for postpartum depression (PPD) or postpartum anxiety (PPA). METHODS: A retrospective chart review of participants who delivered between January 1, 2015, and April 1, 2022, was conducted after IRB approval. Inclusion criteria required: 1) at least one prenatal visit, 2) a postpartum visit, 3) an Edinburgh Postnatal Depression Scale (EPDS) score, 4) a SPE diagnosis, and 5) no other significant perinatal complications. Control records met #1–3 and #5 criteria. Data analysis was conducted using an independent-samples t test. RESULTS: Of 216 SPE participants and 253 control participants queried, 150 and 200 participants respectively met inclusion criteria. An independent-samples t test comparing EPDS scores of SPE and control participants found no significant difference, t(299)=0.40, P=.693. Comparing EPDS anxiety scores (EPDS-3A) likewise found no significant difference between the two groups, t(240)=.85, P=.397. CONCLUSION: Results indicate that SPE is not a risk factor for PPD or PPA diagnosis. Despite null findings, those with and without preeclampsia must be screened for PPD because of its prevalence and detrimental effect if left untreated. Future studies should examine PPD and PPA diagnoses within 12 months postpartum instead of the immediate postpartum period.

Real-Time Assessment of Symptoms for Postpartum Care via a Smartphone Application: Pilot Evaluation [ID: 1376090

INTRODUCTION: Leading causes of morbidity and mortality in women occur in the postpartum period and include postpartum mood disorders, substance use disorders, hypertensive disorders, and infection. This study pilots Gator MOMitor, a smartphone application utilizing ecological momentary assessment (EMA) technology, which allows clinicians to monitor symptoms in at-risk postpartum women in real time. METHODS: Gator MOMitor used a HIPAA-compliant EMA platform to send tailored assessments through the app to postpartum women with health risks in the initial 6 weeks postpartum, including mood disorder (n=401), cesarean infections (n=162), preeclampsia (n=154), and diabetes (n=9). Nonresponsiveness or critical responses submitted by patients in the app generated a trigger based on assessment algorithms, prompting a call from a nurse for follow-up and/or referral. RESULTS: A total of 401 participants were enrolled. 60% identified as White race, 22% Black race, and 14% identified as Hispanic ethnicity. Half (52%) were enrolled in Medicaid, and most (84%) had a term delivery. A total of 3,778 assessments were completed in the app: 1,599 for postpartum mood, 620 for cesarean incision, 1,536 for hypertension, and 24 for diabetes. There were 52, 103, and 39 positive screenings, respectively, in mood assessments (≥12 on the Edinburgh Postnatal Depression Scale), hypertension (BP≥140/90), and cesarean incision concerns, and zero positive screens in the diabetes group. The assessment-based triggers from positive screens resulted in 209 nurse follow-ups, 35 face-to-face visits, and 8 hospital admissions. CONCLUSION: GatorMOMitor may be an effective tool for extended assessment and monitoring of postpartum women that could reduce maternal mortality and morbidity.

Perceived social support, newborn temperament and socioeconomic status in postpartum depression: report from southwest Serbia

Aim of the studyThe aim of this study is to asses the relationship between postpartum depression and perceived social support, newborn temperament, and selected sociodemographic variables.Subject or material and methodsThe sample consisted of 145 mothers, with an average age of 27, mostly married. The following instruments were used in the research: Questionnaire on sociodemographic characteristics, Neonatal temperament scale, Edinburgh scale of postpartum depression - EPDS and Scale of perceived social support.ResultsThe results showed that reduced social support from partners, friends, and family, difficult newborn temperament, and low socioeconomic status correlated with postpartum depression.DiscussionThe practical implications of the research are reflected in the understanding of social support as a significant predictor of depression in the postpartum period and the implementation of the social component in the system of support and assistance to pregnant women and mothers.ConclusionsRecognizing the factors that cause mood disorders after childbirth is an important part of the diagnosis and prevention of postpartum depression. Postpartum depression is a non-psychotic postpartum mood disorder that can last up to 12 months postpartum. The etiological disorder is still not differentiated because it is differentiated through a bio-psycho-social basis.

Relationship between postpartum depression and plasma vasopressin level at 6–8 weeks postpartum: a cross-sectional study

Postpartum depression (PPD) is the most important postpartum mood disorder due to its significant effect on both the infant and family health. Arginine vasopressin (AVP) has been suggested as a hormonal agent involved in the development of depression. The purpose of this study was to investigate the relationship between the plasma concentrations of AVP and the score of Edinburgh Postnatal Depression Scale (EPDS). This cross-sectional study was conducted in 2016–2017 in Darehshahr Township, Ilam Province, Iran. In the first phase, 303 pregnant women, who were at 38 weeks, met the inclusion criteria, and were not depressed (according to their EPDS scores) were included in the study. In the 6–8 week postpartum follow-up, using the EPDS, 31 depressed individuals were diagnosed and referred to a psychiatrist for confirmation. The maternal venous blood samples of 24 depressed individuals still meeting the inclusion criteria and 66 randomly selected non-depressed subjects were obtained to measure their AVP plasma concentrations with ELISA assay. There was a significant positive relationship between plasma AVP levels and the EPDS score (P = 0.000, r = 0.658). Also the mean plasma concentration of AVP was significantly higher in the depressed group (41.35 ± 13.75 ng/ml) than in the non-depressed group (26.01 ± 7.83 ng/ml) (P < 0.001). In a multiple logistic regression model for various parameters, increased vasopressin levels were associated with increased odds of PPD (OR = 1.15, 95% CI = 1.07–1.24, P = 0.000). Furthermore, multiparity (OR = 5.45, 95% CI = 1.21–24.43, P = 0.027) and non-exclusive breastfeeding (OR = 13.06, 95% CI = 1.36–125, P = 0.026) were associated with increased odds of PPD. Maternal gender preference (having a baby of desired and desired sex) decreased the odds of PPD (OR = 0.13, 95% CI = 0.02–0.79, P = 0.027 and OR = 0.08, 95% CI = 0.01–0.5, P = 0.007). AVP seems to be a contributor to clinical PPD by affecting the hypothalamic–pituitary–adrenal (HPA) axis activity. Furthermore, primiparous women had significantly lower EPDS scores.

The impact of nonpsychotic postpartum psychiatric disorders (NPPDs) on offspring

IntroductionNon-psychotic postpartum psychiatric disorders (NPPDs) are among the most common underdiagnosed mental disorders with a preserved reality test after delivery.ObjectivesNPPDs have been shown to have an association with infant growth, attachment, sleep, temperament and ultimately offspring’s emotional, behavioural, cognitive and social development.MethodsMost prevalent NPPDs are postpartum mood and anxiety disorders, as well as obsessive–compulsive disorder, post-traumatic stress disorder and eating disorders.ResultsThe high methodological quality of the reviewed studies strengths the association between NPPDs and different disorders in the neurodevelopmental period with a negligible impact on mental status in adolescence and adulthood. NPPDs showed an effect on offspring’s emotional, behavioural, cognitive and social development, due to common developmental mechanisms.ConclusionsTimely accurate identifying and treating NPPDs, by using NPPDs symptoms screening tools could reduce the incidence of mental disorders in offspring. Although neurodevelopmental disorders and mental disorders related to pregnancy as separate diagnostic categories have been insufficiently researched, the potential impact of postpartum mental disorders on children’s development is an extremely unexplored field that should be focused on in further scientific research.Disclosure of InterestNone Declared

Maternity Blues: A Narrative Review.

Puerperium is a period of great vulnerability for the woman, associated with intense physical and emotional changes. Maternity blues (MB), also known as baby blues, postnatal blues, or post-partum blues, include low mood and mild, transient, self-limited depressive symptoms, which can be developed in the first days after delivery. However, the correct identification of this condition is difficult because a shared definition and well-established diagnostic tools are not still available. A great heterogenicity has been reported worldwide regarding MB prevalence. Studies described an overall prevalence of 39%, ranging from 13.7% to 76%, according to the cultural and geographical contexts. MB is a well-established risk factor for shifting to more severe post-partum mood disorders, such as post-partum depression and postpartum psychosis. Several risk factors and pathophysiological mechanisms which could provide the foundation of MB have been the object of investigations, but only poor evidence and speculations are available until now. Taking into account its non-negligible prevalence after childbirth, making an early diagnosis of MB is important to provide adequate and prompt support to the mother, which may contribute to avoiding evolutions toward more serious post-partum disorders. In this paper, we aimed to offer an overview of the knowledge available of MB in terms of definitions, diagnosis tools, pathophysiological mechanisms, and all major clinical aspects. Clinicians should know MB and be aware of its potential evolutions in order to offer the most timely and effective evidence-based care.

Utilizing Sleep Education to Reduce Postpartum Mood Disorder in New Mothers

Background: Infant sleep biology and maternal intuition challenge the idea of behavioral sleep training being authoritative knowledge in Western society. Behavioral sleep training may increase stress levels in postpartum mothers who feel conflicted and wish to use alternative methods. The aim of this study was to determine whether having access to infant sleep education improves maternal mental health. Subjects and Method: A quasi-experimental pretest-posttest design using web-based surveys was used to assess the impact of a three-week virtual infant sleep education program on the dependent variables of depression outcomes and consolidated infant sleep. The target population were postpartum women between the age of 18 and 50. Sample size was 18 subjects were recruited through convenience and criterion sampling. Pre-tests and post-tests included nominal questions, Likert scale items, and the Edinburg Postnatal Depression Scale (EPDS). Analysis included difference analyses, Shaprio-Wilk normality checks, Spearman’s rho and Bayes factor bounds. Results: The average improvement on the EPDS was a decrease of 1.89 points, 95% CI= -∞ to 0.11; p= 0.116), VS-MPR = 1.47, with the highest magnitude of improvements in domains regarding feelings of failure if their baby does not sleep through the night (r= 0.78; 95% CI= 0.40 to ∞; p= 0.012, desire to sleep train (r= 0.50; 95% CI = -0.10 to ∞; p= 0.091) and decreased feelings of self-blame (r= 0.34; 95% CI= -0.13 to ∞; p = 0.080). Conclusion: Sleep education can be beneficial in reducing stress related to infant sleep and feelings of failure as a parent in postpartum women. Keywords: behavioral training, maternal mental health, sleep education, postpartum depression.

Disparities in Emergency Department Utilization Among Women with Postpartum Mood Disorders (2006-2016).

Postpartum mood disorders are associated with adverse outcomes for newborns and mothers and may require urgent evaluation. The emergency department is often a healthcare entry point, but factors associated with these emergency department visits are unknown. A longitudinal retrospective analysis using the Nationwide Emergency Department Sample to assess national estimates of emergency department visits by women ages 15-49 with primary diagnosis of a postpartum mood disorder between 2006 and 2016. Emergency department visit rates for postpartum mood disorders per 100,000 live births were calculated. Emergency department visits related to postpartum mood disorders remained stable from 2006 to 2016 (5153 to 5390 respectively). Two-thirds of visits were by patients younger than 30. Approximately half of visits for postpartum mood disorders were funded by Medicaid (42.4-56.7%) compared to 27.4-41.2% funded by Medicaid for all other age-matched women. Of postpartum mood disorder visits 30.3% were by women from the lowest income quartile. The highest rate of emergency department visits occurred in the youngest patients (ages 15-19: 231 visits versus ages 35-49: 105 visits). Postpartum mood disorder admissions were higher than those for age-matched women with all other diagnoses (19.8% vs. 6.5%). The high rate of women that are young and with public insurance visiting the emergency department for postpartum mood disorders demonstrates an increased risk for these disorders in these populations and an opportunity for targeted intervention by policymakers and providers. Higher admission rates for postpartum mood disorders compared to all other diagnoses reveals a chance to optimize outpatient screening and treatment.

The association between tryptophan levels and postpartum mood disorders: a systematic review and meta-analysis

Over 50% of women experience mood disturbance in the postpartum period, with significant implications for maternal and infant health but identifying those at risk is not easily possible. The essential amino acid, tryptophan (TRP) through its neuroactive metabolites, has been implicated in the pathology of mood disorders. Thus, TRP levels tested in the peripartum period have been proposed as a potential biomarker for subsequent development of postpartum mood disturbances, in particular postpartum depression (PPD). A systematic review and meta-analysis following PROSPERO guidelines [CRD42021252462] was conducted on peer-reviewed, English language studies that measured blood levels of TRP during the postpartum period in women who were also evaluated for postpartum “blues” or PPD. Thirteen studies met the inclusion criteria, of which five studies contained sufficient data to conduct a meta-analysis. Low total TRP levels in postpartum days 1 to 5 were significantly associated with PPD (SMD: -5.39, 95%CI [-7.72, -3.05]). No significant association was found between free TRP levels in the postpartum period and PPD (SMD: -3.43, 95%CI [-7.76, 0.89]). Our findings confirm the necessity for more replicable designed studies regarding TRP and its relationship to postpartum depression. If there were greater clarity regarding TRP metabolism during pregnancy, then the next step would be to consider measuring total plasma TRP levels on postpartum days 1 to 5 to identify women at greater risk of developing PPD.

National Cross-Sectional Study of Mental Health Screening Practices for Primary Caregivers of NICU Infants.

Universal screening for postpartum mood and anxiety disorders (PMADs) has been recommended for all new parents at outpatient postpartum and well-child visits. However, parents of newborns admitted to the NICU are rarely able to access these services during their infant’s prolonged hospitalization. The objective of this study was to determine the prevalence of mental health screening and treatment programs for parents or other primary caregivers in NICUs across the country. In this cross-sectional study, US NICU medical directors were invited to complete an online survey about current practices in mental health education, screening, and treatment for primary caregivers of preterm and ill infants in the NICU. Comparative analyses using Fisher’s exact test were performed to evaluate differences in practices among various NICU practice settings. Survey responses were obtained from 75 out of 700 potential sites (10.7%). Of participating NICUs, less than half routinely provided caregivers with psychoeducation about mental health self-care (n = 35, 47%) or routinely screened caregivers for PPD or other mental health disorders (n = 33, 44%). Nearly one-quarter of the NICUs did not provide any PMAD screening (n = 17, 23%). Despite consensus that postpartum psychosocial care is essential, routine mental health care of primary caregivers in the NICU remains inadequate.

Postpartum Mood and Anxiety Disorders: A Lexicon of Metaphors.

Undiagnosed and untreated postpartum mental health disorders represent a silent health crisis. The aim of this paper was to develop a lexicon of metaphors women use to describe their postpartum mood and anxiety disorders to assist holistic nurses in recognizing as early as possible these struggling mothers. Mothers may not know the medical terminology to articulate their mental health problems and may turn to using metaphors. The metaphors included in this lexicon were obtained from the author's earlier qualitative studies of metaphors women used to describe their experiences of postpartum depression, postpartum panic disorder, and posttraumatic stress disorder due to traumatic childbirth. In this lexicon these metaphors are organized by these three mental health disorders and includes a table of definitions of each metaphor along with examples of the context of the metaphors represented by quotes from the mothers. Metaphors can be keys that open and unlock doors that stand between holistic nurses and their patients. Being attentive to metaphorical language women use to describe how they are feeling after giving birth can be an innovative approach holistic nurses can use to identify these vulnerable women and provide an opportunity to nurture and empower new mothers.

Motherhood and Me (Mom-Me): The Development of an Acceptance-Based Group for Women with Postpartum Mood and Anxiety Symptoms.

Untreated postpartum mood and anxiety disorders (PMADs) place women and their families at risk for negative biopsychosocial sequelae. Innovative and tailored treatments are needed to address potential disruptions in maternal functioning. Third-wave cognitive–behavioral approaches, including acceptance and commitment therapy (ACT) and dialectical behavioral therapy (DBT), hold promise for optimizing functioning given the focus on values-based living, rather than symptom reduction. Purpose: The purpose of this paper is to describe the development of an innovative psychotherapy group for women with symptoms of PMADs. Methods: This seven-session group, Motherhood and Me (Mom-Me), includes selected skills training from ACT, DBT, and Emotion-Centered Problem-Solving Therapy. Results: Mom-Me group sessions are described, and an outline of key information (session goals, content, and homework assignments) is provided to facilitate practical implementation. Conclusion: In line with third-wave approaches, this group was developed to enhance maternal functioning, which, in turn, may help women cope with psychological distress during the transition to motherhood.

Relationship between social support and post-discharge mental health symptoms in mothers of preterm infants

ABSTRACT Background Social support is associated with decreased symptoms of postpartum mood and anxiety disorders (PMAD) in mothers of healthy infants, but less is known about social support and PMADs in mothers with preterm infants. The purpose of this study was to examine the relationship between social support and symptoms of PMADs reported by mothers in the months following hospital discharge of their preterm infant. Methods Mothers of infants less than 33 weeks gestational age were enrolled from neonatal intensive care units (NICU) at 6 sites. Mothers completed PMAD measures of depression, anxiety and post-traumatic stress approximately 3 months following their infant’s discharge. Multivariable regression was used to evaluate relationships between social support and PMAD measures. Results Of 129 mothers, 1 in 5 reported clinically significant PMAD symptoms of: depression (24%), anxiety (19%), and post-traumatic stress (20%). Social support was strongly inversely associated with all 3 PMADs. Social support explained between 21% and 26% of the variance in depression, anxiety and post-traumatic stress symptoms. Conclusion Increased social support may buffer PMAD symptoms in mothers of preterm infants after discharge. Research is needed to determine effective screening and interventions aimed at promoting social support for all parents during and following their infant’s hospitalisation.