Risk Factors For Postnatal Depression Research Articles

Multicentre prospective study of perinatal depression in Japan: incidence and correlates of antenatal and postnatal depression

A multicentre study on the epidemiology of perinatal depression was conducted among Japanese women expecting the first baby (N = 290). The incidence rate of the onset of the DSM-III-R Major Depressive Episode during pregnancy (antenatal depression) and within 3 months after delivery (postnatal depression) were 5.6% and 5.0%, respectively. Women with antenatal depression were characterised by young age and negative attitude towards the current pregnancy, whereas women with postnatal depression were characterised by poor accommodation, dissatisfaction with sex of the newborn baby and with the emotional undermining. Antenatal depression was a major risk factor for postnatal depression.

Prospective Testing of the Brisbane Postnatal Depression Index

Over 50 percent of women have one or more risk factors for postnatal depression during pregnancy or in the perinatal period, but only 10 to 15 percent become clinically depressed. The objective of this study was to prospectively test the Brisbane Postnatal Depression Index (referred to here as Index), to validate a theoretical index that was developed earlier, and to establish whether the index could be introduced as a clinically useful method to detect women who may be at risk for developing postnatal depression. Antenatally, women were asked about social support and about personal and family history of mental illness, including postnatal depression. Responses were scored according to predefined ratings on the Index. In the postnatal wards, 353 women were recruited and their scores for "blues," social support, feelings about the baby, and satisfaction with the birth process were added. Sixteen weeks after hospital discharge, women were asked to complete the Edinburgh Postnatal Depression Scale. The Brisbane Index was validated by the number of women scoring more than 12 on the Edinburgh Postnatal Depression Scale at 16 weeks postpartum who were correctly predicted by a score of more than 6 on the Index. Sensitivity, specificity, positive predictive value, and negative predictive value for the Index, using >6 as a cutoff point, were calculated. "Ease of use" was assessed informally with participants and staff responsible for administration and scoring the instrument. Compared with results from the derivation study, prospective testing of the index showed an improvement in sensitivity from 36.3 to 47.5 percent and a small decrease in specificity, but no improvement on the positive predictive value from 39.8 to 39.6 percent. The Brisbane Postnatal Depression Index was validated in a prospective sample, but its sensitivity and specificity require improvement before introduction as a measure of prediction.

Confinement and other psychosocial factors in perinatal depression: A transcultural study in Singapore

Background To investigate the prevalence, socio-cultural and psychosocial risk factors for perinatal depression in Singaporean women. Method A prospective cohort of 559 women was interviewed antenatally and at six weeks' postpartum at a tertiary hospital. Women were interviewed for diagnosis of depression using a two-stage design, with a screening questionnaire and diagnostic interview. Results Postnatally, a negative confinement experience was associated with depression. Other independent factors included poor emotional support, a past history of depression, unplanned pregnancy and perceived potential conflicts with relatives over childcare antenatally and dissatisfaction, poor instrumental support postnatally. The prevalence of depression antenatally and postnatally was 12.2% and 6.8%, respectively. Limitations Measures of satisfaction with social support were based on self-report; there were high dropout rates at six weeks' postpartum; and other modulating social factors such as pre-existing interpersonal conflicts were not studied. Conclusions Perinatal depression in Singaporean women is common. Contrary to expectations, a negative ‘confinement’ experience is a significant risk factor for postnatal depression, and is not universally welcomed by women. Depression is modulated by dissimilar sets of psychosocial factors antenatally and postnatally.

Prevention of postnatal depression

Postnatal depression is the most frequent psychiatric disorder seen after childbirth, with a prevalence rate of 10% to 15%. The women at risk need to be identified by a valid and reliable method, either using a screening instrument or an interview schedule. The preventive strategies need to have enough power to detect a clinically worthwhile effect to be considered useful in clinical practice. Many of the risk factors for developing postnatal depression are present during the pregnancy and immediate post-partum period. The risk factors for postnatal depression include depression or anxiety during pregnancy, experiencing stressful life events during pregnancy or the early puerperium, maternity blues, low levels of social support, past history of depression and poor marital adjustment. The antenatal and postnatal period provides an ideal opportunity to screen women for these risk factors. The women identified to be at risk can be identified, and preventive interventions can be implemented. Routine clinical practice can be improved to identify some of the women at risk by better communication between health professionals. There are no antenatal screening tools that have been shown to be of benefit in predicting postnatal depression. Edinburgh Postnatal Depression Scale is widely used in the postnatal period to screen for depression. The psychosocial interventions to prevent postnatal depression have not been shown to be beneficial and there is a dearth of psychopharmacological trials to make firm conclusions about their efficacy in preventing postnatal depression. Individualised psychosocial interventions aimed at the at-risk populations and initiated in the postnatal period appear to have some benefit in preventing postnatal depression. The focus of this article will be the risk factors associated with postnatal depression, screening methods and tools to identify those at risk of developing the disorder and the psychosocial, psychological and psychopharmacological interventions to prevent postnatal depression.

Postnatal depressive mood in Turkish women

The aim of this study was measure the prevalence and influencing factors of depressive mood after delivery. We performed this study on 912 women who gave birth at Maternity Hospital in Bursa/Turkey. We used Zung's Self-Rating Depression Scale (ZSDS) and a questionnaire in order to obtain the women's backgrounds and the possible risk factor characteristics. The ZSDS and questionnaire were filled out within 1 week after the delivery, by means of face-to-face interviews at the hospital, and 1 month after delivery all the women were visited at their homes and the ZSDS was performed again. In our study, 18% of the mothers (164/912) scored 60 and over in the ZSDS 1 week after childbirth. This percentage had fallen to 9.8% (89/912) 1 month after childbirth. The prevalence of maternity blues in our study was 13.1%. In terms of depression, we found no significant differences regarding age, fertility characteristics, length of labor, residence after childbirth, help after childbirth, breast-feeding practices and the health of the baby. Low educational and economic levels were found to be effective factors in postnatal mood for our population. They may also be risk factors for postnatal depression.

Commentary on Chan S & Levy V (2004) Postnatal depression: a qualitative study of the experiences of a group of Hong Kong Chinese women. Journal of Clinical Nursing 13, 120–123

Commentary on Chan S &amp; Levy V (2004) Postnatal depression: a qualitative study of the experiences of a group of Hong Kong Chinese women. <i>Journal of Clinical Nursing</i> 13, 120–123

Perinatal psychiatry

Psychiatric disorders contribute significantly to maternal morbidity; 10–15% of pregnant and post-partum women are depressed or anxious, and suicide is the most common cause of maternal death. Mild disorders in early pregnancy often relate to psychosocial factors and are treated with psychosocial interventions. Depression later in pregnancy is likely to continue after delivery, and 3–5% of these cases are severe illnesses. Pregnancy can also be complicated by recurrent or chronic psychiatric disorders. Most post-partum illnesses are affective disorders. The risk factors for postnatal depression differ from those of puerperal psychosis, which is a severe illness with a high risk of recurrence after subsequent deliveries. Mild-to-moderate illness can be managed in primary care with counselling or antidepressants. More severe disorders may require referral to secondary mental health care and, if the woman is suicidal or psychotic, admission preferably to a specialist mother and baby unit.

Risk factors for postnatal depression

A prospective longitudinal study of 620 women investigated the association between a range of risk factors and postnatal depression (PND). Univariate analyses of results demonstrated seven antenatal and three perinatal variables significantly associated with PND. Antenatal risk factors included relationship problems, antenatal depression and limited supports. These factors had previously been reported in the literature. Additionally this study highlighted the significance of domestic violence as a risk factor. Perinatal factors significantly associated with PND were severe blues/highs, no partner or support person at birth and dissatisfaction with care in labour. Logistic regression analysis of the 10 combined antenatal and perinatal risk factors demonstrated that only three factors were found to be significant predictors of depression in the final model. These were antenatal depression, severe blues/highs and dissatisfaction with care in labour. With these variables in the regression equation, none of the other risk factors were contributing significantly to the prediction of PND.

Ethnoepidemiology of postnatal depression. Prospective multivariate study of sociocultural risk factors in a Chinese population in Hong Kong.

Although there have been many studies of the biological and psychosocial causations of postnatal depression, studies of sociocultural risk factors are rare. To investigate the sociocultural risk factors of postnatal depression using ethnographically informed epidemiological methods. A total of 959 women were assessed at their first ante-partum visit (baseline), in the third trimester, immediately after delivery, and 3 months postpartum. Six domains of risk factors were examined. The dependent variable was postnatal depression (as defined by the Edinburgh Postnatal Depression Scale) at 3 months post-partum. Conflict with mother-in-law, marital dissatisfaction, past depression and antenatal depression independently predicted the occurrence of postnatal depression. The cultural practice of peiyue - a Chinese post-partum custom of mandated family support - was associated with better social support and a slightly lower risk of postnatal depression. Sociocultural aspects of the immediate puerperium shape maternal emotional well-being. In-law conflict is an important source of household distress in many Asian societies. The findings have implications for clinical practice and future studies.

Does pain relief during delivery decrease the risk of postnatal depression?

Background. To test the hypothesis that sufficient pain relief during delivery decreases the risk of postnatal depression. Methods. As part of a prospective follow-up study of the risk factors for postnatal depression and its impact on the mother–infant interaction and child development, 185 parturients filled in the Edinburgh Postnatal Depression Scale (EPDS), first during the first postpartum week and again (n = 162) 4 months later. The incidence and the risk of high EPDS scores was calculated according to the mode of delivery and the mode of pain relief during vaginal delivery, also after adjusting for the length of labor. Results. Mothers who received epidural/paracervical blockade during their delivery spent less time in the delivery room than mothers in the nitrous oxide/acupuncture group (p = 0.033) or mothers with no pain relief (p = 0.026) and had shorter length of labor than mothers without pain relief (p = 0.04). The adjusted risk of depressive scores at the first postnatal week was decreased in the epidural/paracervical group when compared with no analgesia group (OR: 0.25, 95% CI: 0.09–0.72). This difference was not shown at 4 months postpartum. Elective or emergency cesarean section did not increase the risk of high EPDS scores at the first week or at 4 months postpartum. Conclusion. The mode of pain relief during vaginal delivery seems to be associated with the incidence of postpartum depression, especially immediately after delivery.

Newborn Behavior and Risk of Postnatal Depression in the Mother

The aim of this study was to assess which behavioral characteristics of the newborn infant are associated with an increased risk of postnatal depression (PND) in the mother. A total of 497 mothers from a prospective cohort study were recruited during the last trimester of pregnancy. Infants were evaluated at 3 days with the Brazelton Neonatal Behavioral Scale. Maternal PND was assessed at 6 weeks postpartum with the Edinburgh Postnatal Depression Scale. Behavioral characteristics of the infant predicted the occurrence of PND, independent of other risk factors for PND: The lower the infants' orientation performance, the higher the risk that the mother would present with PND 6 weeks after delivery. As orientation capacities play a key role in the interactional skills developed between mothers and their infants, an infant who is difficult to engage in interaction may contribute to the risk of PND.

IDentify, Educate and Alert (IDEA) trial: an intervention to reduce postnatal depression

Objective To test the effectiveness of a prenatal intervention in reducing the incidence of postnatal depression. Design A randomized controlled trial. Setting A large metropolitan obstetric hospital. Population or sample Pregnant women with risk factors for postnatal depression. Methods Women attending their first prenatal visit at the Royal Women's Hospital, Brisbane, were screened for risk factors for postnatal depression ( IDentify). Positively screened women were randomly allocated to the intervention group or the control group. The intervention consisted of a booklet about postnatal depression, which included contact numbers; prenatal screening using the Edinburgh Postnatal Depression Scale; a discussion with the woman about her risk of developing postnatal depression ( Educate); and a letter to the woman's referring general practitioner and local Child Health Nurse, alerting them of the woman's risk for postnatal depression ( Alert). Main outcome measure Edinburgh Postnatal Depression Scale Score > 12 at 16 weeks postpartum. Results Of the 509 women who were sent a follow up questionnaire, 371 (72.9%) responded. The proportion of women who reported an Edinburgh Postnatal Depression Scale score of >12 was 26%. There were no significant differences between intervention (46/192, 24%) and control groups (50/177, 28.2%) on this primary outcome measure (OR 0.80; 95% CI 0.50–1.28). Conclusion Over one-quarter of women with risk factors will develop postnatal depression. It is a treatable disorder but under-diagnosis is common. Efforts to reduce postnatal depression by implementing interventions in the prenatal period have been unsuccessful.

IDentify, Educate and Alert (IDEA) trial: an intervention to reduce postnatal depression

To test the effectiveness of a prenatal intervention in reducing the incidence of postnatal depression. A randomized controlled trial. A large metropolitan obstetric hospital. Pregnant women with risk factors for postnatal depression. Women attending their first prenatal visit at the Royal Women's Hospital, Brisbane, were screened for risk factors for postnatal depression (IDentify). Positively screened women were randomly allocated to the intervention group or the control group. The intervention consisted of a booklet about postnatal depression, which included contact numbers; prenatal screening using the Edinburgh Postnatal Depression Scale; a discussion with the woman about her risk of developing postnatal depression (Educate); and a letter to the woman's referring general practitioner and local Child Health Nurse, alerting them of the woman's risk for postnatal depression (Alert). Edinburgh Postnatal Depression Scale Score > 12 at 16 weeks postpartum. Of the 509 women who were sent a follow-up questionnaire, 371 (72.9%) responded. The proportion of women who reported an Edinburgh Postnatal Depression Scale score of >12 was 26%. There were no significant differences between intervention (46/192, 24%) and control groups (50/177, 28.2%) on this primary outcome measure (OR 0.80; 95% CI 0.50-1.28). Over one-quarter of women with risk factors will develop postnatal depression. It is a treatable disorder but under-diagnosis is common. Efforts to reduce postnatal depression by implementing interventions in the prenatal period have been unsuccessful.

Risk factors for postnatal depression: a review and risk factors in Australian populations.

Postnatal depression affects up to 15% of women in the six months following childbirth. Risk factors for this disorder are predominantly psychosocial. An overview of sociodemographic, early life experiences, external environment, internal environment and obstetric and infant variables are presented in the introduction. Two studies that recruited women shortly after they had given birth and followed up to six months postpartum are used to demonstrate the salience of such risk factors. The importance of clarifying risk factors to postnatal depression are discussed especially in relation to improving our understanding of the mechanisms of postnatal depression, how they may assist in developing preventative strategies and how they can help in planning treatment.

Predicting postnatal depression

Background: The contribution that recently identified risk factors for Postnatal Depression (PND) made to an existing prenatal screening tool (‘Predictive Index’ of PND; Cooper et al., 1996) was assessed in an attempt to improve the performance of this measure. Method: The Predictive Index and measures of appraisal and coping were administered during the final trimester of pregnancy ( n=306). The Edinburgh Postnatal Depression Scale (EPDS) and Childcare Stress Inventory were completed at 6-weeks postpartum ( n=223). Results: The predictive index identified 23% of PND cases. The addition of specific appraisal and coping factors increased predictive performance by 26%. Inclusion of maternal reports of childcare stress in the early postpartum period resulted in a further 15% of PND cases being identified. Limitations: Diagnostic criteria were not used to assess the incidence of PND; instead PND case status was assessed using an established cut-off criterion on the EPDS. In addition, the contribution that women’s prenatal appraisal and coping processes made to improving the predictive index was not assessed on a second independent sample. Conclusions: The inclusion of prenatal appraisal, coping and maternal reports of childcare stress in a screening tool for PND substantially increased predictive performance, resulting in 64% of PND cases being identified. These findings highlight the importance of negative prenatal appraisal and coping processes in the development of PND and have important implications for the prevention and treatment of this disorder.

Screening for postnatal depression: Validation of the Norwegian version of the Edinburgh Postnatal Depression Scale, and assessment of risk factors for postnatal depression

Objective: The Edinburgh Postnatal Depression Scale (EPDS) is a self-rating scale developed to screen for postnatal depression. The aim of this study was to validate a Norwegian translation of the EPDS, study its psychometric properties, and identify risk factors for postnatal depression. Method: EPDS was filled in by 411 women at 6–12 weeks postpartum. Of these, 100 were interviewed using the Mini International Neuropsychiatric Interview for DSM-IV major and minor depressive disorders. Results: When using a cut-off of 11 on the EPDS, 26 of 27 women with major depression were identified (sensitivity 96%, specificity 78%). An aggregate point prevalence of 10.0% of major and minor depression was found. A one-factor model accounted for 46.6% of the variance. Strongest risk factors for postpartum depression were previous depression, depression in current pregnancy, and current somatic illness. Limitations: Women screened using the EPDS who had a score above threshold, yet did not attend the diagnostic interview could cause the point prevalence of depression to be higher than indicated here. Conclusion: The Norwegian translation of EPDS functions equally well as other translations as a screening tool for postnatal depression. The risk factors that were found are compatible with other studies.

Postnatal depression in turkey: epidemiological and cultural aspects.

In some periods of a woman's life the risk of depression increases and the postnatal period is one of these. The prevalence and the risk factors of postnatal depression are not systematically studied in Turkey. The aim of this study is to investigate the epidemiological aspects and the cultural factors that may affect postnatal depression in our country. According to the records of ten primary health care centres in Manisa, a city in western Turkey, there were 1,337 women who had given birth in the previous 6 months. A sample group of 317 mothers were randomised among these women and 257 (81.7%) of the sample group could be reached. Data were collected by use of the Edinburgh Postnatal Depression Scale and a questionnaire on sociodemographic variables designed for this study. The mean depression score was found to be 7.54 +/- 4.66. When the cut-off point was taken into consideration, 14% of mothers had a syndromal depression. The factors which affected the prevalence of depression were the number of living children, living in a shanty, being an immigrant, serious health problems in the baby, previous psychiatric history, psychiatric disorder in the spouse, and having bad relations with the spouse and his parents. These findings revealed that the prevalence of postnatal depression in the Manisa province and the factors affecting it were very similar to other studies; but the negative impact of bad relations of the mother with her family-in-law on postnatal depression seems to be a distinguishing aspect of Turkish culture.

Obstetric risk factors for postnatal depression in urban and rural community samples.

The objective of this study was to examine obstetric risk factors for postnatal depression in an urban and rural community sample, with concurrent consideration of personality, psychiatric history and recent life events. This was a prospective study with women planning to give birth in one of the four participating hospitals recruited antenatally. Obstetric information was obtained from the New South Wales Midwives Data Collection, completed shortly after delivery. Personality, psychiatric history and life-events information were obtained from a questionnaire, administered within 1 week postpartum. Depression status was assessed at 8 weeks postpartum using the Edinburgh Postnatal Depression Scale. Complete data were obtained from 490 women. Several non-obstetric risk factors for the development of postnatal depression at 8 weeks postpartum were reported including: sociodemographic (up to technical college level education, rented housing, receiving a pension/benefit), personality (those who described themselves as either nervy, shy/selfconscious, obsessional, angry or a worrier), psychiatric history (familial history of mental illness, personal history of depression or anxiety or a history of depression in the participant's mother) and recent life-events (major health problem, arguments with partner and friends/relatives). None of the obstetric variables were significantly associated with increased risk for postnatal depression, but several showed marginally significant increases (multiparous women, antepartum haemorrhage, forceps and caesarean section deliveries). The results emphasize the importance of psychosocial risk factors for postnatal depression and suggest that most obstetric factors during pregnancy and birth do not significantly increase risk for this depression. Early identification of potential risk for postnatal depression should include assessment of sociodemography, personality, psychiatric history and recent life events, as well as past and present obstetric factors.

Improving antenatal recognition of women at risk for postnatal depression.

The purpose of this study was to assess the effectiveness of a practical antenatal screen used at the Royal Women's Hospital, Brisbane, to identify women at risk for postnatal depression. It was a prospective, hospital-based, cohort study of 901 women (600 with and 301 without prenatal risk factors for postnatal depression). Depression was measured 16 weeks after the birth using the Edinburgh Postnatal Depression Scale. More of the women with a prenatal risk factor for depression (25.9%) scored above 12 on the Edinburgh Postnatal Depression Scale than those without any risk (10.9%) (p < or = 0.001). Low social support (p < or = 0.001), a personal history of mood disorder (p < or = 0.001) and a past history of postnatal depression ( p = 0.002) were all strongly associated with postnatal depression in this sample. Results indicate that an objective, psychosocial assessment during pregnancy improves recognition of women at risk for postnatal depression.

Screening women for high risk of postnatal depression

A ten-item screening questionnaire was constructed from previous reports on risk factors for postnatal depression, and its ability to predict antenatally the development of postnatal depression was tested. Women attending an antenatal clinic at 36 wk gestation completed the questionnaire and, at 8 wk postpartum, were assessed for the presence of depression using the Edinburgh Postnatal depression Scale (EPDS). Although antenatal questionnaire scores correlated significantly with postnatal EPDS scores, this was largely because the questionnaire was able to identify correctly those would not become depressed. Neither the questionnaire as a whole, nor groups of items, was able to discriminate well between women who later did or did not become depressed. However, women who reported previous or current treatment for depression were at a threefold greater risk of becoming or remaining depressed postnatally. Possible reasons for the negative results are discussed, including the heterogeneity of depression occurring in the postnatal period.