Antenatal Depression Screening Research Articles

Prevalence of anxiety and depression and their associated risk factors throughout pregnancy and postpartum: a prospective cross-sectional descriptive multicentred study

ObjectiveTo assess the prevalence of anxiety and depression and their associated risk factors throughout the pregnancy and postpartum process using a new screening for the early detection of mental health problems.DesignA prospective cross-sectional descriptive multicentred study. Participants were consecutively enrolled at ≥ 12 weeks’ gestation and followed at three different time points: at 12–14 weeks of pregnancy, at 29–30 weeks of pregnancy, and 4–6 weeks postpartum. All women completed a mental screening at week 12–14 of pregnancy consisting of two questions from the Generalised Anxiety Disorder Scale (GAD-2) and the two Whooley questions. If this screening was positive, the woman completed the Edinburgh Postnatal Depression Scale (EPDS).SettingSeven primary care centres coordinated by a Gynaecology and Obstetrics Department in the city of Terrassa (Barcelona) in northern Spain.ParticipantsPregnant women (N = 335, age 18–45 years), in their first trimester of pregnancy, and receiving prenatal care in the public health system between July 2018 and July 2020.FindingsThe most relevant factors associated with positive screening for antenatal depression or anxiety during pregnancy, that appear after the first trimester of pregnancy, are systematically repeated throughout the pregnancy, and are maintained in the postpartum period were: a history of previous depression, previous anxiety, abuse, and marital problems. In weeks 12–14 early risk factors for positive depression and anxiety screening and positive EPDS were: age, smoking, educational level, employment status, previous psychological/psychiatric history and treatment, suicide in the family environment, voluntary termination of pregnancy and current planned pregnancy, living with a partner and partner’s income. In weeks 29–30 risk factors were: being a skilled worker, a history of previous depression or anxiety, and marital problems. In weeks 4–6 postpartum, risk factors were: age, a history of previous depression or anxiety or psychological/psychiatric treatment, type of treatment, having been mistreated, and marital problems.ConclusionsEarly screening for anxiety and depression in pregnancy may enable the creation of more effective healthcare pathways, by acting long before mental health problems in pregnant women worsen or by preventing their onset. Assessment of anxiety and depression symptoms before and after childbirth and emotional support needs to be incorporated into routine practice.

Antenatal depressive symptoms and adverse birth outcomes in healthy start participants: The modifying role of utilization of mental health services

ObjectiveWe examined the association between antenatal depressive symptoms and adverse birth outcomes in Midland Healthy Start (MHS) participants and determined whether receiving mental health services reduced the odds of adverse outcomes among those with elevated antenatal depressive symptoms. MethodData from a retrospective cohort of participants (N = 1,733) served by the MHS in South Carolina (2010–2019) were linked with their birth certificates. A score of ≥16 on the Center for Epidemiologic Studies Depression Scale was defined as elevated antenatal depressive symptoms. Services provided by MHS were categorized into: (1) receiving mental health services, (2) receiving other services, and (3) not receiving any services. Adverse birth outcomes included preterm birth, low birth weight, and small for gestational age. ResultsAround 31 % had elevated antenatal depressive symptoms. The prevalences of preterm birth, low birthweight, and small for gestational age were 9.5 %, 9.1 %, and 14.6 %, respectively. No significant associations were observed between elevated depressive symptoms and adverse outcomes. Among women with elevated antenatal depressive symptoms, the odds for small for gestational age were lower in those who received mental health services (AOR 0.33, 95 % CI 0.15–0.72) or other services (AOR 0.34, 95 % CI 0.16–0.74) compared to those who did not receive any services. The odds for low birth weight (AOR 0.34, 95 % CI 0.13–0.93) were also lower in those who received mental health services. ConclusionsReceiving screening and referral services for antenatal depression reduced the risks of having small for gestational age or low birth weight babies among MHS participants.

Factors associated with antenatal depression among women attending antenatal care at Mubende Regional Referral Hospital: a cross-sectional study

IntroductionThis study aimed to investigate the prevalence, severity, and factors associated with antenatal depression among women receiving antenatal care at Mubende Regional Referral Hospital (MRRH) in Uganda. Antenatal depression is a critical concern for maternal and child well-being, as it is associated with adverse outcomes such as preterm birth, abortion, low birth weight, and impaired maternal-infant bonding. Despite several international guidelines recommending routine screening for antenatal depression, local Ugandan guidelines often overlook this essential aspect of maternal care.MethodsA cross-sectional study involving 353 pregnant women utilized the Patient Health Questionnaire 9 (PHQ-9) to assess antenatal depression. Participants were categorized as having antenatal depression if their total PHQ-9 score was ≥ 5 and met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for either major or minor depression. Psychosocial demographic and obstetric characteristics were recorded. Logistic regression analysis identified factors linked to antenatal depression.ResultsThe burden of antenatal depression was notably high, affecting 37.68% of the participants. Among those with antenatal depression, the majority exhibited mild symptoms 94 (70.68%). The significant factors associated with antenatal depression, revealed by multivariate analysis, included younger age (≤ 20 years), older age (≥ 35 years), history of domestic violence, alcohol use, gestational age, history of abortion, history of preeclampsia, and unplanned pregnancies.ConclusionThis study revealed a significantly high prevalence of antenatal depression, emphasizing its public health importance. Most cases were classified as mild, emphasizing the importance of timely interventions to prevent escalation. The identified risk factors included age, history of domestic violence, alcohol use, first-trimester pregnancy, abortion history, previous preeclampsia, and unplanned pregnancy.

Antenatal Depression Screening During The COVID-19 Pandemic In A German Perinatal Center

Antenatal Depression Screening During The COVID-19 Pandemic In A German Perinatal Center

Concordance of the Thai versions of the Patient Health Questionnaire and Edinburgh Post-natal Depression Scale for antenatal depression

Objective: To compare the Thai versions of the Patient Health Questionnaire (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS) and examine the associated factors with the degree of concordance for assessing depression in pregnant Thai women. Material and Methods: This was a cross-sectional study conducted in November-December 2022. The Thai versions of both the PHQ-9 and EPDS were completed by pregnant women at the Antenatal Care Clinic, Songklanagarind Hospital, Thailand. Descriptive data analysis and multivariate logistic regression were performed using The R Program to categorize “normal” and “increased risk of antenatal depression” and examine the statistical agreement, associated factors, and concordance between the two tools.Results: Of the 135 pregnant Thai women enrolled in the study, most lived in non-restive areas of southern Thailand (80.7%) with a mean age of 31.7 years. Most participants were found “normal” for antenatal depression screening by the Thai versions of both the PHQ-9 and the EPDS (89.6% and 88.9%, respectively). Complete concordance between the PHQ-9 and EPDS tests was found in 122 of the women, with 84.4% of all women found ‘normal’ and 5.9% found to have “increased risk of antenatal depression” with both questionnaires. The overall agreement between the 2 questionnaires was statistically significant (Kappa=0.4979, p-value<0.0001, Z=5.79). The statistical analysis identified no demographic factors associated with the concordance.Conclusion: The Thai versions of the PHQ-9 and the EPDS for antenatal depression screening had significantly moderate agreement. The statistical analysis found no factors associated with the concordance.

The difference of depression level in pregnant women based on the acceptance of pregnancy during the COVID-19 pandemic: a study on pregnant women in Bontang, East Kalimantan

Background: Antenatal depression in pregnant women becomes less of a concern, leading to the worse condition of developing postpartum blues, ranging from moderate to severe degrees. In this study, antenatal depression was detected as a psychosocial impact on pregnant women, and their perspective on accepting pregnancy may alter due to the COVID-19 pandemic. Methods: This study used a cross-sectional study design. A total of 257 pregnant women were enrolled in this study with a purposive sampling technique. Inclusion criteria: healthy pregnant women (over 18 years) from trimester I until trimester III. Antenatal depression was measured using a PHQ-9 scale questionnaire. Data were analyzed using SPSS version 20.0 for Windows. Results: The prevalence of antenatal depression of 257 pregnant women was: 80.95% had mild depression, 14.12% had moderate depression, 4.69% had moderate or severe depression, and 0.79% had severe depression. The factor analysis results indicated that refusal of pregnancy had the highest correlation coefficient (coef. 0.586; p=0.000) on the incidence of antenatal depression compared to the history of abortion, parity, financial deficits, and conflicts with partners. During the assessment, pregnant women who reported refusal of their pregnancy felt that their pregnancy was a burden because it occurred at a challenging time. Conclusion: Changes in psychosocial status through determinants of antenatal depression in pregnant women in East Kalimantan during the COVID-19 pandemic are expected to be the initiation of policy and antenatal depression screening formulation for each pregnant woman and mental health improvement during pregnancy.

Association between antenatal depression and adverse perinatal outcomes: a prospective cohort study

BackgroundAntenatal depression might cause adverse pregnancy outcomes. However, previous study results were inconsistent, especially in the low- and middle- income countries. We aimed to study the association between antenatal depression and adverse perinatal outcomes in a Chinese population. MethodsWe performed a prospective cohort study and enrolled pregnant women from January 2020 to January 2021. Antenatal depressive symptoms in the third trimester of pregnancy were evaluated by the Edinburgh Postpartum Depression Scale (EPDS). Baseline characteristics and pregnancy outcomes were recorded. After adjusting for confounding factors (age, occupation, education level, and annual income), multivariate logistic regression analysis was applied to evaluate the associations between antenatal depression and pregnancy outcomes. ResultsAmong the 5209 participants, 1448 (27.7 %) pregnant women were positive for depression. After adjusting for potential confounders, women with antenatal depressive symptoms were significantly more likely to deliver prematurely [Odds ratio (OR) = 1.404, 95 % confidence interval (CI) = 1.020–1.933, P = 0.037] and receive cesarean section (OR = 1.154, 95 % CI = 1.002–1.331, P = 0.048). LimitationsEPDS, not a structured diagnostic interview, was used for psychological assessment. In addition, we only screened the women in their third trimester in a single research center. The association between the duration of antenatal depression and perinatal outcomes was not evaluated. ConclusionsDepressive symptoms were common among Chinese women in their third trimester of pregnancy. Women with antenatal depressive symptoms had increased cesarean section and preterm delivery risks. Screening and treatment for antenatal depression are needed during the prenatal care.

Associations Between Implementation of the Collaborative Care Model and Disparities in Perinatal Depression Care.

To evaluate whether perinatal collaborative care model implementation was associated with a reduction in racial disparities in depression care. This retrospective cohort study included pregnant and postpartum people who self-identified as either Black or White, and received prenatal care at academic faculty offices affiliated with an urban quaternary medical center. Individuals were divided into two cohorts to reflect the epochs of implementation. The primary outcome was the frequency of depression screening. The secondary outcome was the frequency of provision of a treatment recommendation for those with a positive depression screen. Antenatal and postpartum care were analyzed separately. A propensity score was used in multivariable models to control for confounders chosen a priori across implementation epoch. Interaction terms were created between race and implementation epoch to identify whether effect modification was present. Subgroup analyses were performed for outcomes with significant race-by-epoch interaction terms. Of the 4,710 individuals included in these analyses, 4,135 (87.8%) self-identified as White and 575 (12.2%) self-identified as Black. Before implementation, Black individuals were more likely to receive screening (adjusted odds ratio [aOR] 2.44) but less likely to have a treatment recommended when a positive screen was identified (aOR 0.05). In multivariable models, race-by-epoch interaction terms were significant for both antenatal screening (P<.001) and antenatal treatment recommendation (P=.045), demonstrating that implementation of the perinatal collaborative care model was associated with reductions in extant racial disparities. After implementation, there were no significant differences by race (referent=White) in screening for antenatal depression (aOR 1.22, 95% CI 0.89-1.68) or treatment recommendations for those who screened positive (aOR 0.64, 95% CI 0.27-1.53). Race-by-epoch interaction terms were not significant in multivariable models for either postpartum screening or treatment recommendation. Implementation of the perinatal collaborative care model is associated with a mitigation of racial disparities in antenatal depression care and may be an equity-promoting intervention for maternal health.

Antenatal depression screening and psychosocial assessment in an Australian private hospital: An evaluation.

Universal mental health screening and psychosocial assessment during pregnancy have been recommended as best practice, but uptake of universal programs in the private hospital system has been slow. The aim of this study was to evaluate the Pre-admission Midwife Appointment Program (PMAP), an antenatal mental health screening program at the Mater Hospital, Sydney. In this mixed-methods design study, PMAP interview data were collected for a consecutive series of 485 women who attended the PMAP during a 10-month period. Women also completed two postnatal telephone interviews (10 weeks and 9months postpartum). The interviews involved depression screening and questions about the program. Of the 485 participants, 4.1% screened positive for depression on the Edinburgh Postnatal Depression Scale. In total, 19% were identified as currently suffering from, or at risk of developing, perinatal mental health issues; referrals to support services were provided for the 13% who were not already linked in with appropriate supports. All women displayed a decrease in depressive symptom severity from pregnancy to 10 weeks and 9months postpartum. The PMAP was viewed positively by consumers, with >93% viewing the program as helpful and >98% saying that they would recommend the program to others. Additional program benefits identified included opportunities to gain practical information and prepare for motherhood and to think/reflect on their emotional well-being. Given the observed rates of psychosocial risk among this sample, related referral opportunities and positive consumer feedback, we recommend other Australian private hospitals consider implementing PMAP or similar programs.

Effect of antenatal depression on the initiation of breastfeeding in South Gondar zone, Northwest Ethiopia: A population-based prospective cohort study

BackgroundDelayed initiation of breastfeeding has been found to increase early neonatal morbidity, mortality, and impaired mother-infant bonding. However, there is no study that revealed the effect of antenatal depression on breastfeeding initiation in Ethiopia. This study aimed to see the effect of antenatal depression on the practice of initiation of breastfeeding among women in urban Ethiopia. MethodsThe Edinburgh Postnatal Depression Scale (EPDS) was administered to 970 women in the second and third trimesters of pregnancy to screen for antenatal depression. Information was collected on initiation of breastfeeding of newborns and mother's socio-demographic, obstetric, clinical, psychosocial, and behavioral factors. A logistic regression model was used to adjust for the confounders and determine association between antenatal depression and initiation of breastfeeding. ResultsThe cumulative incidence of late initiation of breastfeeding (LIBF) was found to be 166 (18.34%). The cumulative incidence of LIBF in those born from depressed pregnant women was 37% as compared to 8.4% in nondepressed. Antenatal depression at the second and third trimester of pregnancy remained a potential predictor of late initiation of breastfeeding after adjusting for potential confounders (AOR = 6.42: (95% CI 3.72, 11.05)). A significant association was also seen between infants who were born by cesarean section, a complication of current pregnancy, inadequate ANC follow-up, lack of advice about the importance of early initiation of breastfeeding (EIBF), home delivery, and low quartile of wealth index and late initiation of breastfeeding. ConclusionsThese findings suggest that screening for antenatal depression can help to identify women at risk for late initiation of breastfeeding. Health care providers shall have to give emphasis on the treatment of antenatal depression to benefit both the mother and the physical health, growth, and development of the fetus.

Predictors and occurrence of antenatal depressive symptoms in Galle, Sri Lanka: a mixed-methods cross-sectional study

BackgroundThere is a high prevalence of antenatal depression in low-or-middle-income countries, but information about risk factors in these settings is still lacking. The purpose of this study is to measure the prevalence of and explore risk factors associated with antenatal depressive symptoms in Galle, Sri Lanka.MethodsThis study used a mixed-method approach. The quantitative portion included 505 pregnant women from Galle, Sri Lanka, with health record data, responses to psychometric questionnaires (MSPSS and PRAQ-R2), and antenatal depression screening (EPDS). The qualitative portion included interviews with public health midwives about their experiences and routine clinical practices with women with antenatal depressive symptoms.ResultsPrevalence of antenatal depressive symptoms was 7.5%, highest in women over the age of 30 (13.0%, OR = 3.88, 95%CI = 1.71 – 9.97), with diabetes (21.9%, OR = 3.99, 95%CI = 1.50 – 9.56), or pre-eclampsia in a previous pregnancy (19.4%, OR = 3.32, 95%CI = 1.17 – 8.21). Lower prevalence was observed in the primiparous (3.3%, OR = 0.29, 95%CI = 0.12 – 0.64) employed outside the home (3.6%, OR = 0.33, 95%CI = 0.13 – 0.72), or upper-middle class (2.3%, OR = 0.17, 95%CI = 0.04 – 0.56). Anxiety levels were elevated in depressed women (OR = 1.13, 95%CI = 1.07 – 1.20), while perceived social support was lower (OR = 0.91, 95%CI = 0.89 – 0.93). After multivariable adjustment, only parity (OR = 0.20, 95%CI 0.05 – 0.74) and social support from a “special person” (OR = 0.94, 95%CI = 0.77 – 0.95) remained significantly associated with depressive symptoms. Qualitative findings also identified antenatal health problems and poor social support as risk factors for depressive symptoms. They also identified different contributing factors to poor mental health based on ethnicity, higher stress levels among women working outside the home, and misinformation about health conditions as a cause of poor mental health.ConclusionsPrevalence of antenatal depressive symptoms in Galle is lower than the recorded prevalence in other regions of Sri Lanka. Risk factors for antenatal depressive symptoms were identified on biological, psychological, and social axes. These variables should be considered when developing future guidelines for mental health and obstetric treatment in this context.

Prevalence of Antenatal Depression in a Teaching Hospital South/South Nigeria.

Background: Over 30 million people living in Africa suffer from depression which also contributes to global burden of diseases with a steady rise in prevalence, affecting all groups, including pregnant women. Factors which account for the psychological effects of pregnancy on mothers include; maternal age, planned pregnancy, previous experiences, spouse support, and partner violence. These risk factors may lead to antenatal depression which endangers the mother and the pregnancy. To safeguard mothers from depression during pregnancy, these factors need to be determined.&#x0D; Objective: To determine the prevalence, risk factors and predictors of antenatal depression.&#x0D; Methods: Pregnant women attending antenatal care, who met the study inclusion criteria were interviewed and screened for depression using the risk factor and socio-demographic questionnaire and Edinburgh Postnatal Depression Scale (EPDS). Data obtained was fed into the statistical package for social sciences (SPSS) version 23.0 and cross-tabulation of the relevant variables obtained using chi-squared and t-test. P values &lt;0.05 were statistically significant.&#x0D; Results: Of 500 respondents, 158 (31.6%) had depression. Risk factors of cohabiting with spouse, lack of financial support from spouse, fight with spouse, threat to life, history of still birth and child health challenges were determined, four of which turned out to be predictors of antenatal depression (AD).&#x0D; Conclusion: The high prevalence of 31.6% of antenatal depression calls for a review of obstetrics practice to include screening and diagnosis for antenatal depression.&#x0D; Keywords: Antenatal depression, socio-demographic factors, EPDS, Obstetrics risk factors, social support, predictors.

Antenatal psychosocial assessment and depression screening in an Australian Private Hospital setting: A qualitative examination of women's perspectives

BackgroundIn Australia, clinical practice guidelines have been developed to support the implementation of antenatal psychosocial assessment and depression screening in routine clinical obstetric care. While there has been widespread uptake of such programs in Australian public hospitals, implementation in private hospitals has been slower. However, the situation in this regard may be changing, with the emergence of examples of midwife delivered screening programs in a number of private hospital settings. At present, patient experiences of these programs are largely unknown. AimThe aim of this study was to gain feedback from women who participated in the ‘Pre-admission midwife appointment’ program at an Australian private hospital about their experiences of, and perspectives about, the program. MethodsSemi-structured interviews were conducted with 20 women (Mage 36.04 years, range 30-48) who had given birth to a child between 9 and 14 months prior to the interview (M = 11.87 months, SD = 1.76) and who had attended the Pre-admission midwife appointment program during the pregnancy. Interviews were transcribed and analysed using an inductive thematic analysis approach with an essentialist-realistic theoretical framework. FindingsData analysis revealed five major themes: ‘increased awareness and support for perinatal mental health issues’, ‘enhanced quality of care provided at the hospital’, ‘experience with the midwife impacts perceptions of the program’; ‘partners’, and ‘preparation for the program’. DiscussionThis study provides useful information from the perspective of consumers, about a psychosocial assessment and depression screening program at an Australian private hospital. It highlights a number of program benefits for pregnant women, their partners, and the hospital, as well as factors facilitating program success.

Screening for antenatal depression and its determinants among pregnant women in Qatar: revisiting the biopsychosocial model

BackgroundScreening for antenatal depression and its determinants is highly recommended. However, there is no consensus on a standard conceptual framework to approach pregnant women in a primary health care setting. The prevalence of antenatal depression and significant determinants are unknown in Qatar, a gap that we propose to fill.MethodsAn analytical cross-sectional study with a probability sampling technique was employed. Enrolling eight-hundred participants from primary health care centers. The screening was performed through a valid and reliable screening instrument ‘Edinburgh Postpartum Depression Scale.’ In addition to the proposed Comprehensive Biopsychosocial Model, participants were asked about their predisposing profile, biological risk, and other suggested modifiable variables.ResultsTwenty-one percent reported minor depressive episodes (n = 167, 20.9%) at a 95% confidence interval [18.2–23.8]. Previous use of mental health medications, fear of giving birth, concern about appearance, low perceived social support, and low resilience level showed to be associated with antenatal depression. The logistic regression analyses revealed that the Comprehensive Biopsychosocial model forecast 89% of antenatal depression predictors provided Area Under the Receiver Operating Characteristic Curve of 0.89 at a 95% confidence interval [0.85 to 0.92].ConclusionsAntenatal depression is common among pregnant women in Qatar, and preventive interventions must target the determinants revealed. From a clinical perspective, the use of the proposed model may aid in the standardization of the screening process.

Protocol for assessing feasibility, acceptability and fidelity of screening for antenatal depression (FAFSAD) by midwives in Blantyre District, Malawi

BackgroundDepression is often underdiagnosed by treating health professionals. This is a situation in Malawi where there is no routine screening of depression at antenatal clinics. Recently, a Screening Protocol for Antenatal Depression (SPADe) that can be used by midwives to screen for antenatal depression was developed in Blantyre District. SPADe proposes multistage screening of antenatal depression by midwives which may enable early detection and treatment of pregnant women with depression. Proper treatment of antenatal depression can assist in achieving Sustainable Development Goals (SDGs). However, utilisation of SPADe in clinical practice to screening for depression in antenatal clinics has not been established yet. Therefore, the primary aim of this study is to assess feasibility of screening for depression by midwives using SPADe in antenatal clinics in Blantyre District. The secondary aim was to assess acceptability and fidelity of screening for depression by midwives using SPADe in antenatal clinics in Blantyre District.MethodsThis will be a feasibility study which will consist of scientific investigations that will support movement of evidence-based, effective health care approach, SPADe, from the clinical knowledge base into routine use. This study will consist three phases: phase 1 will introduce SPADe in antenatal clinics in Blantyre District where screening of depression is almost none existent; phase 2 will implement screening of depression using SPADe in antenatal clinics in Blantyre District; and phase 3 will evaluate the screening of antenatal depression using SPADe to establish its feasibility, acceptability and fidelity in antenatal clinics in Blantyre District.DiscussionThis study will establish and document feasibility, acceptability and fidelity of screening for depression by midwives using SPADe in antenatal clinics in Blantyre District. It is expected that midwives will develop more confidence in detecting and dealing with antenatal depression. Consequently, there will be increased numbers of pregnant women detected with depression by midwives and increased accessibility to mental health care by pregnant women in antenatal clinics.

Association between antenatal screening for depressive symptoms and postpartum psychiatric admissions

Antenatal depression is the strongest predictor for postpartum depression including psychiatric admission. Universal screening for depressive symptoms during pregnancy may increase the detection of clinical depression and reduce consequent morbidity. We therefore hypothesised that antenatal screening for depressive symptoms could reduce the risk of postpartum psychiatric admissions. We explored the association between antenatal depression screening and postpartum psychiatric admissions using cross-sectional retrospective analysis of state-wide population-based health services administrative data. The analysis included all pregnant women who gave birth to a singleton in Queensland in the second half of 2015 and had information in variables of interest (28,255 women; 95.6% of 29,543 women who gave birth to a singleton during the study period). Women who did not complete antenatal depression screening had increased odds of being admitted to hospital for psychiatric disorders during the first three months after birth (aOR, 2.57; 95% CI, 1.69–3.92), which extended to six months postpartum (aOR, 1.74; 95% CI, 1.10–2.76). We found similar effects for specific psychiatric disorder groups such as mood disorders; schizophrenia, schizotypal and delusional disorders; and mental disorders associated with the puerperium (aOR, 2.65; 95% CI, 1.55–4.54) and mood disorders and puerperal mental disorders (aOR, 3.00; 95% CI, 1.70–5.30). Completion of antenatal depression screening appears to be associated with a decreased risk of psychiatric admission in the first postnatal months. This finding suggests that screening, and associated follow-up interventions, might decrease the severity of depressive symptoms during the perinatal period.

Use of an educational intervention to increase screening for antenatal depression in an obstetrics and gynecology practice.

Depression affects approximately 12% of pregnant women and increases maternal and fetal risk during pregnancy and the postpartum period. The United States Preventative Services Task Force and the American College of Obstetricians and Gynecologists recommend that all prenatal care include depression screening. This study assessed the effectiveness of an educational intervention to increase screening for depression during prenatal care. The clinical site serves a socioeconomically and culturally high-risk population. Prior to the intervention, prenatal depression screening was not incorporated into prenatal care. Health records of patients presenting for prenatal care to an obstetrics and gynecology clinic were analyzed before an educational intervention on prenatal depression was delivered to providers at the practice site. Data for prenatal depression screening rates, treatment plans, and patient demographic information were extracted and compared to determine compliance with antenatal depression screening guidelines. The primary intervention of this initiative is the provision of education on the importance of and techniques for prenatal depression screening, diagnosis, and treatment. Prenatal depression screening increased from 0% to 27% of patients following the intervention. No significant correlation was found between factors of age, gestational age, gravidity, parity, or marital status. A total of 2.8% of screened patients scored positive for severe depression, 5.7% indicated moderate depression, and 51% indicated mild depression. Education and training improves provision of prenatal depression screening, but further work is needed to improve the accurate and timely identification of depression, as well as its appropriate treatment, referral, and follow-up.

Midwives' role in screening for antenatal depression and postnatal depression

This is an educational paper which aims to inform midwives of tools available to help them make appropriate provisional diagnosis of perinatal depression. A second aim of the paper is to increase midwives' awareness of the relatively newer diagnosis of antenatal depression (AND). Of additional clinical importance, midwives need to recognise that postnatal depression (PND) may be a continuation of AND. To date, screening for AND has received relatively little attention compared with PND, with the evidence-base supporting that the impact can be as severe. It is important for midwives to know that screening for AND can be undertaken using valid and reliable psychometric self-report depression screening questionnaires which have known validity characteristics and threshold cut-off scores. There are several of these tools available to help midwives make the decision about whether or not to refer the women to the mental health team. Current practice in the UK involves the midwife asking an initial short two-item ‘Whooley Question’ screen which, if indicates depression, can be followed up by the women completing a self-report depression screening questionnaire. To highlight their availability, a selection of valid and reliable psychometric self-report depression screening questionnaires are discussed herein, with it being important for midwives to develop a toolkit that can be given to women at clinics, in pamphlets, online or embedded into mobile applications.

The effect of antenatal screening for depression on neonatal birthweight and gestation

BackgroundAntenatal depression has been associated with poor perinatal outcomes such as preterm birth and low birth weight. Universal screening of perinatal depression has been recommended to improve maternal and pregnancy outcomes. Hypothesis and aimWe hypothesise that screening for antenatal depressive symptoms may reduce the risk of preterm birth and low birth weight. To assess the hypothesis, we explore the association between antenatal depression screening using the Edinburgh Postnatal Depression Scale and neonatal outcomes. MethodsA retrospective analysis of state-wide population-based health administrative data. Inclusion criteria were pregnant women who gave birth to a singleton in Queensland in the second half of 2015 (29,543 women). Logistic regression analyses were run in 27,817 women with information in all variables. Main outcomes were preterm birth (<37 weeks of gestation) and low birth weight (<2500 grs). ResultsWomen who did not complete the screening had increased odds of preterm birth (AOR, 1.56; 95% CI, 1.39–1.74; p < 0.001) and low birth weight (AOR, 1.48; 95% CI, 1.30–1.68; p < 0.001) before and after adjustments for relevant confounders when compared to women who completed the screening. Sensitivity analyses performed in women with spontaneous labour and in women without a diagnosis of depression showed similar results. Conclusion(s)We found an association between screening for depressive symptoms during pregnancy and better neonatal outcomes. However, this result does not necessarily infer causality. Any association may represent a previously unknown benefit to screening, which could support the case for universal antenatal depression screening.

Sociodemographic and Obstetric Determinants of Antenatal Depression in Jimma Medical Center, Southwest Ethiopia: Facility Based Case-Control Study.

BackgroundWorldwide, 10–20% of women experience depression during pregnancy. In sub-Saharan countries, depression during pregnancy is estimated to be 15–57%. Even though there is a high burden of depression during pregnancy, little attention has been given to identify sociodemographic and obstetric determinants in diverse populations like Ethiopia.ObjectiveTo identify sociodemographic and obstetric determinants of antenatal depression among women attending an antenatal clinic at Jimma Medical Center, southwest Ethiopia.Patients and MethodsA case–control study was conducted among 246 pregnant mothers (82 cases and 164 controls) attending an antenatal clinic in Jimma Medical Center from June 1 to August 30, 2019. Antenatal depression was assessed using the Beck Depression Inventory-II. Epidata 3.1 and SPSS v24 were used for data entry and analysis, respectively. Adjusted odds ratios (AOR) and 95%CIs were estimated using logistic regression models. Statistical significance was set at P<0.05.ResultsMarried mothers were 67% (AOR=0.33, 95%CI: 0.15–0.75), housewives were 97% (AOR=0.03, 95%CI: 0.01–0.14), private workers were 87% (AOR=0.13, 95%CI: 0.04–0.44), and government employees were 84% (AOR=0.16, 95%CI: 0.05–0.46), less likely to develop antenatal depression. Multigravida were 88% (AOR=0.12, 95%CI: 0.04–0.37) less likely to develop antenatal depression. Third trimester pregnancy was four times (AOR=4.04, 95%CI: 1.51–10.81) more likely to have depression. Mothers who having wanted pregnancy were 83% (AOR=0.17, 95%CI: 0.04–0.81) less likely to develop antenatal depression compared with mothers having unwanted pregnancy.Conclusion and RecommendationBeing married, multigravida, having wanted pregnancy and occupation status (housewives, private workers and government employees) can protect mothers from developing antenatal depression. Mothers with third trimester pregnancy were four times more likely to have depression. Designing a screening and intervention strategy for antenatal depression must consider the aforementioned protective and risk factors.