Risk Factors For Postpartum Depression Research Articles

Prevalence and risk factors of postpartum depression among preterm infant mothers

IntroductionThe birth of a preterm infant evokes considerable psychological distress in mothers and is associated with an increased risk for postpartum depression.ObjectivesThe aim of this study was to assess the prevalence of postnatal depression among preterm infant mothers and to identify highlighting associated factors.MethodsWe conducted a cross-sectional, descriptive and analytical study, including 97 mothers of premature infants who presented to the outpatient unit of neonatology at the UH Hedi Chaker of Sfax in Tunisia. For each mother, we collected sociodemographic and obstetric data. We used the Edinburgh Postnatal Depression Scale (EPDS) for screening postpartum depression.ResultsAverage age of mothers was 30.2 years. Average gestational age was 32.82 weeks. Almost all the mothers were married (99%), had a satisfactory couple relationship (93.7%), almost two thirds were multiparous (64.9%), and 77.3% gave birth by caesarean section. Prematurity was unexpected by 56.7% of women. Regarding newborns, digestive problems were noted in 25.8% of cases and sleep disturbances in 20.6% of them. Prevalence of depression in the population studied was 39.2%. It was significantly associated with unexpected prematurity (P < 0.001), impaired couple relationship (P = 0.001), digestive problems (P = 0.013) and sleep disturbances (P = 0.002).ConclusionMothers of preterm infants seem to be particularly vulnerable to postpartum depression. Systematic screening for depressive symptoms in this obstetric population can help to have an optimal psychological outcomes for mothers and infants during a crucial period of development of mother–infant coregulation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Preconception gynecological risk factors of postpartum depression among Japanese women: The Japan Environment and Children's Study (JECS)

BackgroundPostpartum depression is one of the major causes of disability among women who are on their childbearing years. Identifying people at risk of postpartum depression may improve its management. The objective of this study was to determine the probable association between postpartum depression and some preconception gynecological morbidities. MethodsData from a nationwide birth cohort study, the Japan Environment and Children's study (JECS), up to one month of postpartum were analyzed. To assess postpartum depression, the Edinburgh Postnatal Depression Scale (EPDS) was used; 11 preconception gynecological morbidities were considered as risk factors. Covariates included psychiatric illness history, psychosocial factors, some pregnancy adverse outcomes, birth outcomes, socio-demographic and health behavioral factors. ResultsExcept for the prevalence of previous miscarriage, leiomyoma and polycystic ovarian syndrome, depressive women had more gynecological morbidities compared to non-depressive ones.In logistic regression model, endometriosis (OR, 1.27; 95%CI: 1.15–1.41), dysmenorrhea (OR, 1.13; 95%CI: 1.06–1.21) and abnormal uterine bleeding (OR, 1.21; 95%CI: 1.15–1.29) were associated with postpartum depression. Limitations•We could not specify in detail which type of gynecological morbidity was associated with postpartum depression, because the current design was not exclusively oriented by the JECS research question.•A part of gynecological morbidities were self-reported. ConclusionWomen with endometriosis and menstrual problems were at risk of developing postpartum depression.This study suggests a perinatal mental health screening for predisposed women.

Postpartum depression risk factors among recent refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women: results from a prospective cohort study

The objective was to examine and compare risk factors for postpartum depression among: (1) recent (≤5 years) migrant and Canadian-born women, and (2) refugee, asylum-seeking, and non-refugee immigrant women. A sample of 1536 women (1024 migrant and 512 Canadian-born) were recruited from 12 hospitals. Women completed questionnaires at 1-2 and 16 weeks postpartum including questions on socio-demographics, biomedical history, health services, and migration and resettlement factors. Bivariate analyses and multivariate logistic regression were performed to examine and compare risk factors for postpartum depressive symptoms at 16 weeks postpartum. Recent migrant women had significantly higher rates (6%) of depressive symptoms at 16 weeks postpartum than Canadian-born women (2.9%). Asylum-seekers had the highest rate (14.3%), followed by refugee (11.5%) and non-refugee immigrant women (5.1%). Migrant women at greatest risk to develop depressive symptoms were those who experienced abuse, had pain post-birth, worried about family members left behind, had food insecurity, and had reduced access to healthcare (limited insurance and/or no regular care-provider). Conversely, those with higher levels of social support and who felt they belonged to a community had a lower risk of developing depressive symptoms. All childbearing recent migrant women should be considered at risk for postpartum depression. To prevent and support migrant women suffering postpartum depressive symptoms, barriers to healthcare need to be addressed and interventions should include assessments and support/programmes for abuse/violence, lack of social support, food insecurity, and stress/poor mental health. Treatment of pain during the postpartum period is also critical.

Is Perceived Discrimination in Pregnancy Prospectively Linked to Postpartum Depression? Exploring the Role of Education

Objectives The role of perceived discrimination in postpartum depression is largely unknown. We investigate whether perceived discrimination reported in pregnancy contributes to postpartum depression, and whether its impact varies by education level. Methods Prospective data are a part of European Longitudinal Study of Pregnancy and Childhood, the Czech Republic. Surveys were collected in mid-pregnancy and at 6 months after delivery. Depression was measured using Edinburgh Postnatal Depression Scale. Generalized linear models were estimated to test the effects of perceived discrimination on postpartum depression. Results Multivariate models revealed that among women with low education, discrimination in pregnancy was prospectively associated with 2.43 times higher odds of postpartum depression (p < .01), after adjusting for antenatal depression, history of earlier depression, and socio-demographic background. In contrast, perceived discrimination was not linked to postpartum depression among women with high education. Conclusions Perceived discrimination is a risk factor for postpartum depression among women with low education. Screening for discrimination and socio-economic disadvantage during pregnancy could benefit women who are at risk for mental health problems.

The risk factors for postpartum depression: A population-based study.

Postpartum depression (PPD) can result in negative personal and child developmental outcomes. Only a few large population-based studies of PPD have used clinical diagnoses of depression and no study has examined how a maternal depression history interacts with known risk factors. The objective of this study was to examine the impact of a depression history on PPD and pre- and perinatal risk factors. A nationwide prospective cohort study of all women with live singleton births in Sweden from 1997 through 2008 was conducted. Relative risk (RR) of clinical depression within the first year postpartum and two-sided 95% confidence intervals were estimated. The RR of PPD in women with a history of depression was estimated at 21.03 (confidence interval: 19.72-22.42), compared to those without. Among all women, PPD risk increased with advanced age (1.25 (1.13-1.37)) and gestational diabetes (1.70 (1.36-2.13)). Among women with a history of depression, pregestational diabetes (1.49 (1.01-2.21)) and mild preterm delivery also increased risk (1.20 (1.06-1.36)). Among women with no depression history, young age (2.14 (1.79-2.57)), undergoing instrument-assisted (1.23 (1.09-1.38)) or cesarean (1.64(1.07-2.50)) delivery, and moderate preterm delivery increased risk (1.36 (1.05-1.75)). Rates of PPD decreased considerably after the first postpartum month (RR = 0.27). In the largest population-based study to date, the risk of PPD was more than 20 times higher for women with a depression history, compared to women without. Gestational diabetes was independently associated with a modestly increased PPD risk. Maternal depression history also had a modifying effect on pre- and perinatal PPD risk factors.

Racial and ethnic differences in the relationship between antenatal stressful life events and postpartum depression among women in the United States: does provider communication on perinatal depression minimize the risk?

ABSTRACTObjective: Multi-state population-based studies exploring the racial/ethnic differences in the prevalence and correlates of postpartum depression (PPD), which affects 10–20% of women in the US, are rare. The aim of this study was to examine the racial/ethnic disparities in the relationship between antenatal stressful life events and PPD among US women and to explore whether antenatal health care provider communication on perinatal depression was associated with a lower risk.Methods: Data from the 2009–2011 Pregnancy Risk Assessment Monitoring System (PRAMS) were used. For each racial/ethnic group, the distribution of PPD was compared according to different levels of the stressors and socio-demographic, pre-pregnancy, antenatal, delivery, and neonatal characteristics. Multivariable logistic regression analyses were performed with PPD as the outcome and all variables that were significant in bivariate analyses as predictors.Results: Eleven percent of 87,565 women met the criteria for PPD with the prevalence ranging from 7.9% among Asian/Pacific Islanders to 14% among American Indian/Alaska Natives. Irrespective of race/ethnicity, having many bills to pay and having more than usual arguments with husband/partner were risk factors for PPD. Among non-Hispanic black (NHB) women, having a husband/partner who did not want the pregnancy was associated with PPD (adjusted odds ratio [aOR]: 1.47; 95% confidence interval [CI]: 1.14, 1.90), and among non-Hispanic whites (NHWs), drug/drinking problems of someone close was associated with PPD (aOR: 1.37; 95% CI: 1.21, 1.55). Provider communication was inversely associated with PPD among NHWs (aOR: 0.77; 95% CI: 0.69, 0.85) and NHBs (aOR: 0.74; 95% CI: 0.60, 0.93).Conclusion: The protective effect of provider communication on PPD suggests the benefit of a simple conversation about perinatal depression during antenatal care. Furthermore, risk factors for PPD varied by race/ethnicity suggesting that these vulnerabilities should be taken into consideration in identifying women at-risk for PPD.

Psychoeducational preventive treatment for women at risk of postpartum depression: study protocol for a randomized controlled trial, PROGEA

BackgroundPostpartum depression is a disease with a prevalence of 20% that has deleterious consequences not only for the mother but also for the baby and can cause delays in physical, social and cognitive development. In this context, the European Union Committee on Public Health has declared it essential that preventative measures are taken by centres providing care for women with a multidisciplinary approach. PROGEA is a multicentre, single-blind randomized, 3-year, longitudinal clinical trial aiming to evaluate the efficacy of a psychoeducational programme in preventing postpartum depression in at-risk women, based on a range of clinical variables, and explore prognostic factors. This paper describes the methods and rationale behind the study.MethodsWe will study women receiving treatment as usual plus a psychoeducation cognitive behavioural therapy (CBT)-based intervention and a control group receiving only treatment as usual. The sample will be recruited from an incidental sampling of pregnant women in two health regions. We will recruit 600 women in the third trimester of pregnancy who consent to take part in the study. Almost half of the women, about 280, would be expected to have some risk factors for postpartum depression. All those found to have risk factors will be evaluated, and we estimate that a quarter will be classified as at-risk of developing postpartum depression as measured with the Edinburgh Postnatal Depression Scale. This subset will be randomly allocated to receive treatment as usual with or without the CBT intervention. Six sessions of CBT (1 individual and 5 group) will be offered by a psychologist.DiscussionFindings from this study will be used to design a definitive study that will examine the clinical and cost-effectiveness of the CBT-based intervention in improving the mood of women in the postpartum period.Trial RegistrationClinicalTrials.gov Identifier: NCT02323152; Date: December 2014.

Postpartum depression risk factors: A narrative review

Postpartum depression is a debilitating mental disorder with a high prevalence. The aim of this study was review of the related studies. In this narrative review, we report studies that investigated risk factors of postpartum depression by searching the database, Scopus, PubMed, ScienceDirect, Uptodate, Proquest in the period 2000-2015 published articles about the factors associated with postpartum depression were assessed in Farsi and English. The search strategy included a combination of keywords include postpartum depression and risk factors or obstetrical history, social factors, or biological factors. Literature review showed that risk factors for postpartum depression in the area of economic and social factors, obstetrical history, and biological factors, lifestyle and history of mental illness detected. Data from this study can use for designing a screening tools for high-risk pregnant women and for designing a prevention programs.

The Rate and Risk Factors of Pospartum Depression in Sana’a Yemen

This cross – sectional study was done to assess the rate and risk factors of postpartum depression among women who had given birth between 4 – 6 weeks prior to interview in four public medical centers of Sana’a city over a period from February to July 2016. We administered the Edinburgh postnatal Depression Scale to 642 women. Among these, 97 women had scored ≥ 12, giving the rate of 15.1% of postpartum depression. Mothers with this condition were more likely to have unwanted pregnancy, recent conflict with husbands / family, financial hardship, anxiety and health problems during pregnancy, and difficulties in breastfeeding. The study revealed a high rate of postpartum depression. Although it is recognized that timing and ideal interval for screening is unknown such screening would increase detection, treatment and improve health outcomes of women and their children.

Postpartum Depression Effects, Risk Factors and Interventions: A Review

This review involved a literature search on postpartum depression effects, risk factors and interventions on Pubmed and PsycInfo. Empirical studies, systematic reviews and meta-analyses published in the years 2014-2016 are briefly summarized here. The approximate 10 - 20% postpartum depression prevalence rate and the effects on the mother such as altered connectivity in brain regions, effects on the father (17% depressed) and on the social, behavioural and cognitive problems of the offspring have led to screening mandates that have been effective. In this recent literature, risk factors for postpartum depression have included socio-demographic factors such as low income and social support, being an immigrant, and experiencing a deployment during delivery. Mothers’ early childhood experiences including disorganized attachment, maltreatment and childhood sexual abuse are also risk factors. The most frequently published risk factors in the 2014-16 time period have been prenatal depression, sleep disturbances, elevated cortisol and low levels of oxytocin. With respect to interventions, antidepressants have been rarely studied in contrast to cognitive behavioural therapy, interpersonal therapy, and mother-infant psychotherapy and biochemical interventions including oxytocin. Given the ethical problem of random assignment once treatments are known to be effective, very few randomized controlled trials appear in the literature, and the screening/diagnostic problems have limited the number of prospective longitudinal studies.

Postpartum Depression in Women: A Risk Factor Analysis.

Postpartum Depression (PPD) is a known entity affecting not only the women but the whole family. It affects women more harshly and chronically due to their increased stress sensitivity, maladaptive coping strategies and multiple social roles in the community. To estimate the commonly associated risk factors of PPD among the women coming to a tertiary hospital in New Delhi, India. It was a longitudinal study conducted at the antenatal clinic for a period of one year. Total 260 women were screened at > 36 weeks of gestation, of which 149 postnatal women completed the questionnaire for PPD at six weeks of their delivery. The inform consent, demographical data and obstetrical details from each participant was taken before commencing the screening. Various risk factors and their association were determined by odds-ratio and significant association was accepted at < 5% level of error. In order to identify the most important confounding variables, logistic regression analysis was used. PPD is a common mental health problem seen among the postnatal women as it was found in 12.75% (19 out of 149) of subjects at six weeks of their delivery. Moreover, it has significant association with the young maternal age (p-value=0.040), birth of the female child (p-value=0.015), previous stressful life events (p-value= 0.003), low self-esteem and feeling of loneliness (p-value=0.007). This study provides important information regarding the risk factors associated with development of PPD in this region of India. Female sex of the new born and the younger age play an important role in the development of PPD.

Stress induces equivalent remodeling of hippocampal spine synapses in a simulated postpartum environment and in a female rat model of major depression

Stress and withdrawal of female reproductive hormones are known risk factors of postpartum depression. Although both of these factors are capable of powerfully modulating neuronal plasticity, there is no direct electron microscopic evidence of hippocampal spine synapse remodeling in postpartum depression. To address this issue, hormonal conditions of pregnancy and postpartum period were simulated in ovariectomized adult female Sprague–Dawley rats (n=76). The number of hippocampal spine synapses and the depressive behavior of rats in an active escape task were investigated in untreated control, hormone-withdrawn ‘postpartum’, simulated proestrus, and hormone-treated ‘postpartum’ animals. After ‘postpartum’ withdrawal of gonadal steroids, inescapable stress caused a loss of hippocampal spine synapses, which was related to poor escape performance in hormone-withdrawn ‘postpartum’ females. These responses were equivalent with the changes observed in untreated controls that is an established animal model of major depression. Maintaining proestrus levels of ovarian hormones during ‘postpartum’ stress exposure did not affect synaptic and behavioral responses to inescapable stress in simulated proestrus animals. By contrast, maintaining pregnancy levels of estradiol and progesterone during ‘postpartum’ stress exposure completely prevented the stress-induced loss of hippocampal spine synapses, which was associated with improved escape performance in hormone-treated ‘postpartum’ females. This protective effect appears to be mediated by a muted stress response as measured by serum corticosterone concentrations. In line with our emerging ‘synaptogenic hypothesis’ of depression, the loss of hippocampal spine synapses may be a novel perspective both in the pathomechanism and in the clinical management of postpartum affective illness.

Positive screening and risk factors for postpartum depression

Positive screening and risk factors for postpartum depression

Postpartum depression in the Occupied Palestinian Territory: a longitudinal study in Bethlehem.

BackgroundPostpartum depression (PPD) affects women from different cultures around the world. No previous studies have investigated PPD among women in Palestine. Fertility rates in Palestine are among the highest in the world, hence even low rates of PPD could have considerable national impact. The aim of this study was to determine the prevalence of, and risk factors for, PPD among Palestinian mothers.Methods101 mothers were recruited during the registration of their child’s birth (within 1 week) at the Bethlehem branch of the Ministry of Interior. Participants were assessed via a face to face interview, and were followed up 1 week, 2 weeks, 6 weeks, 3 months, and 6 months later by telephone interview. Interviews included the Arabic Edinburgh Postnatal Depression Scale (EPDS), with PPD indicated by depressive symptoms (EPDS score ≥11) at ≥2 follow-up time points. Pearson’s correlation was calculated between repeated EPDS scores, and multivariable logistic regression was used to investigate risk factors for PPD.ResultsThe prevalence of depressive symptoms was fairly constant (14–19%) over the follow-up period. Most depressive symptoms developed within 1 month of delivery; mothers with depressive symptoms at 3 months postpartum were highly likely to still have symptoms at 6 months. 27.7% (28/101) of women met our criteria for PPD. High parity (odds ratio (OR) 4.52 (95% CI 0.90, 22.8) parity 3+ versus primiparous), unplanned pregnancy (OR 2.44 (0.99, 6.01)) and sex of child not being the one desired (OR 5.07 (1.12, 22.9)) were associated with PPD, but these associations were attenuated in multivariable analysis.ConclusionsThe prevalence of PPD in Palestine appears to be higher than in high income countries, but similar to the prevalence in other Middle Eastern countries. High parity and unplanned pregnancy were identified as risk factors for PPD, suggesting that fully meeting the need for family planning could reduce the incidence of PPD in the Palestinian population.

Stolen motherhood-case study of postpartum depression

Abstract Aim: The objective was to analyze the case of postpartum depression complicated with extended suicide attempt. Method: The analysis of clinical case and medical history. Results: In 25-year-old patient, two weeks after childbirth, postpartum depression episode occurred. In the further course of illness psychotic symptoms (delusions, mood disorders), suicidal and infanticide thoughts emerged. Four weeks after childbirth, the patient killed her baby and took an unsuccessful suicidal attempt. Based on medical records, several risk factors of postpartum depression were identified: 1. obstetric and child-related risk factors: Caesarean section, premature birth, obstetric complications during pregnancy, infant’s difficult temper, difficulties related to breastfeeding; 2. psychological risk factors: baby blues, high anxiety level during pregnancy, high level of stress related to child care. Conclusions: Psychoeducation of women during pregnancy, including their families, is an extremely crucial element of postpartum depression prevention. It is also necessary to raise awareness among healthcare professionals who have frequent contact with mothers after childbirth: midwives, gynaecologists and paediatricians.

Screening for maternal postpartum depression during infant hospitalizations.

Postpartum depression is common and adversely affects children of afflicted mothers; postpartum depression recognition and treatment may improve outcomes. Hospitalization represents a potential health encounter for expanding screening and intervention. We aimed to assess for postpartum depression at infant hospitalization and examine postpartum depression risk factors in this population. We conducted a prospective observational study of 310 English- or Spanish-speaking women with an infant aged 2 weeks to 1 year admitted to a pediatric hospitalist service at a large urban freestanding children's hospital. Mothers completed demographic questionnaires, a maternal-infant bonding scale, and the Edinburgh Postpartum Depression Scale (EPDS). Mothers with an EPDS score of 10 or higher (positive screen) received counseling and mental health referrals. Postenrollment calls followed trends in EPDS score and resource utilization. Multivariate logistic regression assessed relationships among risk factors and positive screens. Eighty-seven mothers (28%) were EPDS+. Only 14.6% reported appropriate prior depression screening. Maternal factors associated with EPDS+ were poor social support (4.40, interquartile range [IQR] = 2.27-8.53) and history of psychiatric diagnoses (5.02, IQR = 2.49-10.15). Having an infant with neurodevelopmental comorbidities was associated with EPDS+ screens (2.78, IQR = 1.03-7.52). Of 21 initially EPDS+ mothers reached by phone, 8 (38%) utilized their doctor or referral resource, resulting in lower EPDS scores (F(1,19) = 5.743, P < 0.05) compared to those not seeking help. Postpartum depression screening during infant hospitalizations captures women previously unscreened. Low social support, past psychiatric diagnoses, or having infants with neurodevelopmental problems may increase postpartum depression risk. Journal of Hospital Medicine 2015;11:840-846. © 2015 Society of Hospital Medicine.

Bipolar II disorder as a risk factor for postpartum depression

ObjectivesThere is evidence for a bipolar diathesis in postpartum depression (PPD) and women presenting with a first PPD frequently receive a diagnosis of bipolar type II disorder (BD-II). However formal evidence for an association between BD-II and PPD has not yet been reported. In the present study we tested a potential association between BD-II and PPD. MethodsParous women with a diagnosis of bipolar type I disorder (BD-I) (n=93), BD-II (n=36) or major depressive disorder (MDD) (n=444) were considered in the present study. All women were retrospectively evaluated for history of PPD (DSM-IV criteria) and other clinical and socio-demographic features. ResultsWomen with a history of PDD (n=139, 24%) were younger, younger at illness onset and had more family history for BD compared to women without history of PPD (n=436, 75.9%). Half of BD-II women reported PPD (50%), compared to less than one-third of BD-I and MDD women (respectively 27.5% and 21.6%) (p=0.004). LimitationsLimitations include the retrospective assessment of PPD and no available data about the timing of postpartum episodes, illness onset or psychiatric care before or after childbirth, and the number of postpartum episodes. ConclusionsBD-II may confer a remarkable risk for PPD, which may be even higher than that of women affected by BD-I disorder. Careful monitoring of BD-II women during the pregnancy and postpartum period, as well as assessment of bipolar features in women with a PPD without a current diagnosis of BD are recommended.

Comparison of the Use of the EPDS-3 vs. EPDS-10 to Identify Women at Risk for Peripartum Depression [3K

INTRODUCTION: Antepartum anxiety, affecting up to 45% of women, is a risk factor for postpartum depression, and antepartum depression has a strong anxiety component. The Edinburgh postnatal depression scale (EPDS-10) is a well-validated tool for identifying women who are at risk for peripartum depression. The EPDS-3, a shorter anxiety-focused subscale of the EPDS-10, has recently been examined. Our study evaluated if the EPDS-3 identifies a similar subset of women at risk for peripartum depression as the EPDS-10. METHODS: Study subjects (n=914) were evaluated with the EPDS-10 as part of the screening process for peripartum depression studies conducted at our academic medical center. The EPDS-3 for each subject was calculated and adjusted in order to use the same numerical cut-off for at-risk as is used for the EPDS-10. Each adjusted EPDS-3 score was compared to its EPDS-10. RESULTS: When using the adjusted EPDS-3 versus EPDS-10 score, the number of at-risk subjects increased by 40.1%. Of the subjects who were identified as at-risk using the EPDS-10, 100% maintained an at-risk adjusted EPDS-3 score (n=111). The remainder of at-risk subjects found using the adjusted EPDS-3 score (n=367) were newly identified. CONCLUSION: The use of the adjusted EPDS-3 anxiety subscale maintains all subjects' existing at-risk status in addition to identifying additional at-risk subjects. These findings confirm that women at risk for peripartum depression have significant comorbid anxiety symptoms. Future research should examine the accuracy of the anxiety-focused subscale in identifying depressive and anxiety disorders across the peripartum period.

Risk factors for postpartum depression in women living with HIV attending prevention of mother-to-child transmission clinic at Kenyatta National Hospital, Nairobi

ABSTRACTMothers with HIV are at high risk of a range of psychosocial issues that may impact HIV disease progression for themselves and their children. Stigma has also become a substantial barrier to accessing HIV/AIDS care and prevention services. The study objective was to determine the prevalence and severity of postpartum depression (PPD) among women living with HIV and to further understand the impact of stigma and other psychosocial factors in 123 women living with HIV attending prevention of mother-to-child transmission (PMTCT) clinic at Kenyatta National Hospital located in Nairobi, Kenya. We used the Edinburgh Postnatal Depression Scale and HIV/AIDS Stigma Instrument – PLWHA (HASI – P). Forty-eight percent (N = 59) of women screened positive for elevated depressive symptoms. Eleven (9%) of the participants reported high levels of stigma. Multivariate analyses showed that lower education (OR = 0.14, 95% CI [0.04–0.46], p = .001) and lack of family support (OR = 2.49, 95% CI [1.14–5.42], p = .02) were associated with the presence of elevated depressive symptoms. The presence of stigma implied more than ninefold risk of development of PPD (OR = 9.44, 95% CI [1.132–78.79], p = .04). Stigma was positively correlated with an increase in PPD. PMTCT is an ideal context to reach out to women to address mental health problems especially depression screening and offering psychosocial treatments bolstering quality of life of the mother–baby dyad.

A Biopsychosocial Conceptual Framework of Postpartum Depression Risk in Immigrant and U.S.-born Latina Mothers in the United States

ObjectiveIn this review, we offer a conceptual framework that identifies risk factors of postpartum depression (PPD) in immigrant and U.S.-born Latinas in the United States by focusing on psychosocial and neuroendocrine factors. Although the evidence of the impact psychosocial stressors have on the development of PPD has been well-documented, less is known about the biological etiology of PPD or how these complex stressors jointly increase the risk of PPD in immigrant and U.S.-born Latinas in the United States. MethodsUsing PubMed, CINAHL, and Embase, we reviewed the literature from 2000 to 2015 regarding psychosocial and physiological risk factors associated with PPD to develop a conceptual model for Latinas. ResultsOur search yielded 16 relevant studies. Based on our review of the literature, we developed a biopsychosocial conceptual model of PPD for Latinas in the United States. We make arguments for an integrated model designed to assess psychosocial and physiological risk factors and PPD in a high-risk population. Our framework describes the hypothesized associations between culturally and contextually relevant psychosocial stressors, neurobiological factors (e.g., hypothalamic-pituitary-adrenal [HPA] axis response system and oxytocin signaling), and PPD in Latinas in the United States. ConclusionsFuture studies should evaluate prospectively the impact psychosocial stressors identified here have on the development of PPD in both immigrant and U.S-born Latinas while examining neuroendocrine function, such as the HPA axis and oxytocin signaling. Our conceptual framework will allow for the reporting of main and indirect effects of psychosocial risk factors and biomarkers (e.g., HPA axis and oxytocin function) on PPD in foreign- and U.S.-born postpartum Latinas.