Perinatal Depression Screening Research Articles

The Impact of COVID-19 on Anxious and Depressive Symptomatology in the Postpartum Period.

Background: Women in the postpartum period may be particularly vulnerable to the psychological effects of the COVID-19 pandemic. The aim of our study was to evaluate the impact of the coronavirus pandemic on postpartum depression and anxiety levels and the role of the fear of COVID-19 in its development. Methods: Women who delivered at the Bissaya Barreto Maternity Hospital, between 16 March and 16 June 2020 (Group 1: Birth in COVID-19 period, n = 207), recruited in the postpartum period, filled in a set of self-reported validated questionnaires: Perinatal Depression Screening Scale, Perinatal Anxiety Screening Scale, Profile of Mood States, Perseverative Thinking Questionnaire, Dysfunctional Beliefs Towards Maternity Scale, and the Fear of COVID-19 Scale. Levels of depressive and anxious symptomatology, negative affect, negative repetitive thinking, and the dysfunctional beliefs towards motherhood of these women were compared with data from samples of previous studies that included women whose delivery had occurred at the same Maternity Hospital before the COVID-19 pandemic period (Group 2: Birth before the COVID-19 period, n = 212). Results: Based on the cutoff points of the screening scales, the prevalence of clinically relevant depressive and anxious symptoms in Group 1 was 40.1% and 36.2%, respectively. Women in Group 1 had significantly higher levels of anxious and depressive symptoms, negative affect, negative repetitive thinking, and dysfunctional beliefs towards motherhood than women in Group 2 (p < 0.05). Fear of COVID-19 in the postpartum period was a predictor of depressive (ß = 0.262) and anxious (ß = 0.371) symptoms, explaining 6.9% and 13.7% of their variability, respectively (p < 0.001). Conclusion: During the COVID-19 pandemic, women in the postpartum period present greater depressive and anxious symptomatology, as well as increased risk factors.

Further validation of the European and Brazilian Portuguese short version of the Postpartum Depression Screening Scale-7

IntroductionWe have recently validated the Portuguese shortest version of the Perinatal Depression Screening Scale-PDSS-7 (items selected from the PDSS-21; each one representing a dimension evaluated by the PDSS-35), for the assessment of depression severity in pregnancy, both in Portugal and Brazil.ObjectivesTo analyze the validity and reliability of the PDSS-7 Portuguese version to evaluate postpartum women both from Portugal and Brazil.MethodsThe Portuguese sample was composed of 304 women between the 2nd-6th postpartum months (Mean=20.09±7.21 weeks postpartum). These participants were not the same who participated in the psychometric study that led to the selection of the seven items. The Brazilian sample was composed of 121 women (Mean=10.51±4.53 weeks postpartum). All the participants completed the European/Brazilian Portuguese versions of PDSS-21, which was composed of the same items and included the seven items of PDSS-7. Participants also filled in the validated versions of Perinatal Anxiety Screening Scale and Profile of Mood States.ResultsConfirmatory Factor Analysis revealed that the unidimensional model of PDSS-7 presented acceptable/good fit indexes in both samples (Portuguese/Brazilian: χ2/d.f.=2.6598/1.7897; RMSEA=.0740/.0807, CFI=.8289/.7934, TLI=.7901/.8434, GFI=.9298/.9496; p&lt;.001). The PDSS-7 Cronbach’s alphas were of .841/.856 and all the items contributed to the internal consistency. Pearson correlations with postpartum anxiety (.646/.763) and negative affect (.666/.676) were significantly (p&lt;.01) high. PDSS-7 mean scores were higher in the Brazilian sample (16.06±7.39 versus 11.37±4.37, p&lt;.01).ConclusionsPDSS-7 presented validity (construct and convergent), reliability and utility in clinical and research settings, including in transcultural studies, in Portugal and Brazil, namely in the postpartum.DisclosureNo significant relationships.

Screening Accuracy of the Portuguese version of the Postpartum Depression Screening Scale-7 according to DSM-5 criteria

IntroductionThe Portuguese shortest version of the Perinatal Depression Screening Scale/PDSS-7 proved to be valid and reliable, in Portugal and Brazil, but it is essential to analyze its operational characteristics before using it for screening purposes.ObjectivesTo determine PDSS-7 cut-off points and associated conditional probabilities to screen for major depression, according to the DSM-5.Methodshe pregnancy sample was composed of 259 women in the second trimester (Mean gestation weeks=17.83±4.750). The postpartum sample consisted of 241 women assessed between the 2nd-6thmonths postpartum(M=17.99±4.689 weeks postpartum). All women completed the PDSS-7 and were interviewed with the Diagnostic Interview for Psychological Distress(Pereira et al., 2017), a semi-structured clinical interview to assess the most prevalent psychiatric disorders in the perinatal period according to the DSM-5 criteria. MedCalc was used to perform ROC analysis.ResultsDuring pregnancy, the major depression prevalence was of 4.6%(n=12). The cut-off point that maximizes the Youden Index(J=.98, 95%CI: .97-.99; AUC=.99; se=.004; p&lt;.001) was of 18(95%CI:17-19), which resulted in a sensitivity of 100%(71.5%-100%), a specificity of 97.98%(95.3%-99.3%), a positive predictive value/+PP of 68.8%(48.0%-84.0%) and a negative predictive value/-PP of 100%. In the postpartum, the major depression prevalence was of 10.4%(n=25). The cut-off point(J=.79, 95%CI: .63-.82; AUC=.89; se=.036; p&lt;.001) was of 14(95%CI: 12-16), with a sensitivity of 85.0%(69.3%-93.2%), a specificity of 85.0%(69.3%-93.2%), a +PP of 56.5%(46.1%-67.3%) and a -PP of 97.5%(94.6%-98.8%).ConclusionsThe Portuguese version of PDSS-7 presents good combinations of sensitivity and specificity, being accurate and usable to screen for depression during pregnancy and in the postpartum both in research and primary health care.DisclosureNo significant relationships.

The Portuguese adapted version of the fear of covid-19 scale for the postpartum period

IntroductionThe Portuguese version of the Fear of COVID-19 Scale (FCV-19S; Cabaços et al. 2021), composed of seven items, presented good validity and reliability to be used in general population. To be used within perinatal context, specifically in the postpartum period, we have added an item related to the baby (item 8 – “I’m afraid my baby will be infected with coronavirus-19”).ObjectivesTo analyze the psychometric properties of Portuguese adapted version of the Fear of COVID-19 Scale for the postpartum period (FCV-19SP), namely construct validity, internal consistency, and convergent validity.Methods207 women (mean age= 33.51 ± 5.23 years) recruited in the postpartum period (9,06 ± 8,52 months after delivery) fill in a set of self-reported validated questionnaires: Perinatal Depression Screening Scale (PDSS), Perinatal Anxiety Screening Scale (PASS) and Coronavirus-19 Fear Scale for the postpartum period (FCV-19SP).ResultsCFA revealed that the unifactorial model composed of eight items presented good fit indexes (X2/df=1.508; CFI=.991; GFI=.974; TLI=.983; p[RMSEA≤.01] = .049), better than those of the seven items version (X2/df=3.963; CFI=.957; GFI=.909; TLI=.905; p[RMSEA≤.01] =.219). Cronbach alpha for the FCV-19SPP was α=.880. The total score significantly (p&lt;.01) and moderately correlated with PDSS (r=.262) and PASS (r=.371).ConclusionsThe FCV-19SP is a valid and reliable questionnaire to assess fear of COVID-19 in women in the postpartum period.DisclosureNo significant relationships.

Validity of the Edinburgh Postnatal Depression Scale for screening pregnant and postpartum adolescents: a systematic review

Objective: To examine the validity of the Edinburgh Postnatal Depression Scale (EPDS) for screening depression in pregnant and postpartum adolescents. Background: The incidence of postpartum depression (PPD) in 15 to 19-year olds is double the rate reported among mothers older than 25 years. EPDS threshold scores that indicate possible depression among adolescents have not been established and may differ from those validated for adults. Study design and methods: A systematic review of the literature between 1987 and 2020 was conducted using five databases: CINAHL, EMBASE, MEDLINE, MIDIRS and PsycInfo. Studies that sampled adolescent mothers in the perinatal period, that screened for depressive symptoms using the EPDS, and which assessed the validity of the tool were included. The studies were grouped according to their methodology with results presented as a narrative synthesis. Two researchers independently reviewed search results, study selection and data extraction, and undertook quality appraisals using the Quality Assessment of Diagnostic Accuracy Studies checklist. Results: Five studies that sampled a total of 1,241 participants were included in the review: four validated the EPDS against diagnostic reference standards and one against other depression screening tools. The EPDS demonstrated high levels of sensitivity and specificity although optimal cut-off scores for possible depression were between 2 and 7 points lower than that recommended for adult samples. Overall performance of the EPDS was equivalent or better when compared to other screening tools. Discussion: The standard EPDS cut-off score (≥12) does not identify all adolescents at high risk of depression during the perinatal period. Scores of ≥9 may be more appropriate. However, different reference standards and sampling methods used in the studies compromise the review’s strength of evidence. Conclusion: Despite development of the EPDS more than 30 years ago, research into its validity among adolescents is still in its infancy. This review makes an important contribution to that body of evidence by revealing its limitations and highlighting trends upon which further research can build. Implications for research, policy and practice: Although Australian guidelines for perinatal depression screening are some of the most detailed in the world, limited guidance is offered for EPDS use among adolescents. The findings of this review raise important points for that guidance and for practitioners. Concerns for possible depression in adolescents should be triggered at an advisory EPDS cut-off score of ≥9. Further research is needed to confirm or refute these findings. What is already known about the topic? Postpartum depression (PPD) among adolescents is prevalent and a recognised public health concern due to its significant association with morbidity. Perinatal screening for depression using validated instruments, including the Edinburgh Postnatal Depression Scale (EPDS), is recommended in national and international guidance. There is no validated version of the EPDS for adolescents although there is evidence to suggest that cut-off scores indicative of possible depression may need to be lower than those recommended for adults. What this paper adds: The paper synthesises evidence that demonstrates the EPDS is a valid scale for perinatal screening of depression in adolescents. It identifies lower cut-off scores for suspected depression among adolescents compared to adults, and also highlights score differences in the pre and postnatal periods. The paper provides advisory screening guidance for practitioners and emphasises the importance of monitoring for depressive symptoms in perinatal adolescents at every healthcare encounter.

Introducing and integrating perinatal mental health screening: Development of an equity-informed evidence-based approach.

Pregnancy is a time of increased risk for developing or re-experiencing mental illness. Perinatal mental health screening for all women is recommended in many national guidelines, but a number of systems-level and individual barriers often hinder policy implementation. These barriers result in missed opportunities for detection and early intervention and are likely to be experienced disproportionately by women from culturally and linguistically diverse backgrounds, including women of refugee backgrounds. The objectives of this study were to develop a theory-informed, evidence-based guide for introducing and integrating perinatal mental health screening across health settings and to synthesize the learnings from an implementation initiative and multisectoral partnership between the Centre of Perinatal Excellence (COPE), and a university-based research centre. COPE is a nongovernmental organization (NGO) commissioned to update the Australian perinatal mental health guidelines, train health professionals and implement digital screening. In this case study, barriers to implementation were prospectively identified and strategies to overcome them were developed. A pilot perinatal screening programme for depression and anxiety with a strong health equity focus was implemented and evaluated at a large public maternity service delivering care to a culturally diverse population of women in metropolitan Melbourne, Australia, including women of refugee background. Strategies that were identified preimplementation and postevaluation were mapped to theoretical frameworks. An implementation guide was developed to support future policy, planning and decision-making by healthcare organizations. Using a behavioural change framework (Capability, Opportunity, Motivation-Behaviour Model), the key barriers, processes and outcomes are described for a real-world example designed to maximize accessibility, feasibility and acceptability. A Programme Logic Model was developed to demonstrate the relationships of the inputs, which included stakeholder consultation, resource development and a digital screening platform, with the outcomes of the programme. A seven-stage implementation guide is presented for use in a range of healthcare settings. These findings describe an equity-informed, evidence-based approach that can be used by healthcare organizations to address common systems and individual-level barriers to implement perinatal depression and anxiety screening guidelines. These results present strategies that were informed by prior research involving patients and staff from a large public antenatal clinic in Melbourne, Australia. This involved interviews with health professionals from the clinic such as midwives, obstetricians, perinatal mental health and refugee health experts and interpreters. Interviews were also conducted with women of refugee background who were attending the clinic for antenatal care. A steering committee was formed to facilitate the implementation of the perinatal mental health screening programme comprising staff from key hospital departments, GP liaison, refugee health and well-being, the NGOCOPE and academic experts in psychology, midwifery, obstetrics and public health. This committee met fortnightly for 2 years to devise strategies to address the barriers, implement and evaluate the programme. A community advisory group was also formed that involved women from eight different countries, some of refugee background, who had recently given birth at the health service. This committee met bimonthly and was instrumental in planning the implementation and evaluation such as recruitment strategies, resources and facilitating an understanding of the cultural complexity of the women participating in the study.

Does interactive ultrasound intervention relieve minor depressive symptoms and increase maternal attachment in pregnancy? A protocol for a randomized controlled trial

BackgroundPerinatal depression, especially minor depression, is common during pregnancy and is likely to continue into the postpartum period. It may impair the mother’s health, the infant’s neurodevelopment, and the mother-infant relationship. Screening for perinatal depression is recommended; however, there is no consensus on how to treat depressive symptoms while simultaneously supporting the mother-infant relationship. Ultrasound examination has been shown to improve maternal-fetal attachment among pregnant women. Our aim is to develop a four-dimensional (4D) based interactive ultrasound intervention and test whether it relieves minor depressive symptoms and improves maternal-fetal attachment. Previous studies show that supporting the mother-infant relationship aids in relieving maternal depression. Until now, few studies have combined pregnancy ultrasound and psychological support.MethodsA controlled randomized setting was designed to assess whether interactive 4D-ultrasound intervention would decrease maternal depressive symptoms, strengthen maternal-fetal attachment, and mother-infant relationship. An obstetrician and a psychologist specialized in infant mental health conduct the interventions. The focus is to jointly observe the behavior of the fetus according to the mothers’ wishes. Altogether, 100 women scoring 10–15 on Edinburgh Pre-/Postnatal Depression Scale (EPDS) and with singleton pregnancy are recruited using a web-based questionnaire. Half of the participants will be randomized to the intervention group and will undergo three interactive ultrasound examinations. The primary outcomes are a decrease in perinatal depressive symptoms assessed with EPDS and an increase in maternal attachment. The maternal attachment was assessed using the Working Model of the Child Interview (WMCI), the Maternal Antenatal Attachment Scale (MAAS), and the Maternal Postnatal Attachment Scale (MPAS). Secondly, we hypothesize that if the intervention decreases prenatal depressive symptoms and improves prenatal attachment, the decrease in depressive symptoms and improvement in mother-infant relationship is seen postnatally.DiscussionUltrasound is widely used during pregnancy. The interactive approach is unique and may be feasible as part of routine screenings and maternity clinic visits. Intervention that decreases depression and simultaneously supports maternal-fetal attachment would be a valuable addition to the treatment of minor depression among pregnant women.Trial registrationClinicalTrials.gov NCT03424642. Registered on January 5 2018.

Perinatal Depression

Key Points Perinatal mood and anxiety disorders affect 15% to 20% of mothers from conception to 1 year postpartum and 4% to 25% of fathers.Infants of affected mothers are at risk for impaired social interaction, delays in language and cognitive development, failure to thrive, reactive attachment disorder of infancy, early discontinuation of breastfeeding, and neglect and abuse; longer-term adverse effects can be seen in the child’s learning, memory, behavioral, and emotional adaptation.Formal screening for perinatal depression at infant preventive visits, consistent with the peaks of occurrence, is recommended by Bright Futures, 4th Edition; US Preventive Services Taskforce (2016); and Centers for Medicare &amp; Medicaid Services (2016).Caregivers with a positive screen result and/or symptoms of depression should be triaged for a psychiatric or social emergency and their infants should be screened and followed for potential social-emotional problems.Management is 2-generational.For the parents, demystification, brief interventions to promote the mother-infant relationship and encourage social connections, and referral for evidence-based therapy (individual or couple), emergency medical services, or hospitalizationFor the child, regular monitoring of social-emotional development and Early Intervention Part C servicesFor the mother-infant dyad, evidence-based therapy by a pediatric mental health specialist with expertise in treating infants and young children (0–5 years of age).

Screening programs for common maternal mental health disorders among perinatal women: report of the systematic review of evidence

Postpartum depression and anxiety are highly prevalent worldwide. Fisher et al., estimated the prevalence of depression and anxiety at 15.6% during the antenatal and 19.8% during the postpartum period. Their impact on maternal and child health is well-recognized among the public health community, accounting for high societal costs. The public health impact of these conditions has highlighted the need to focus on the development and provision of effective prevention and treatment strategies.In recent decades, some advances have been made in the development of effective universal and targeted screening programmes for perinatal depression and anxiety disorders. Recent research has shown potential benefits of universal and targeted screening for perinatal depression, to identify and treat undiagnosed cases, and help thwart its deleterious consequences. Ethical implications, however, for these screening programmes, without the provision of treatment have often been emphasized.The present mixed-methods systematic review and meta-analysis was conducted to collate evidence for screening programmes for perinatal depression and anxiety. It aims to answer the following questions, in a global context: For women in the perinatal period, do screening programmes for perinatal depression and anxiety compared with no screening improve maternal mental health and infant outcomes?A series of meta-analyses reveal a reduction in perinatal depression and anxiety among perinatal women undergoing screening programmes. For the outcome of depressive disorder, meta-analysis indicates a positive impact in favour of the intervention group (OR = 0.55, 95% CI: 0.45 to 0.66, n = 9009), with moderate quality of evidence. A significant improvement (high quality) was also observed in symptoms of anxiety among perinatal women (SMD = − 0.18, 95% CI: − 0.25 to − 0.12, n = 3654).

Reliability and validity of a perinatal depression screening instrument in rural Mali

BackgroundIn order to reduce the burden of perinatal depression in low- and middle-income countries, health systems must be able to identify and treat women suffering from depression. The objective of our study was to develop a locally valid and reliable screening instrument for use in identifying pregnant women and mothers of young children with a local depression syndrome, dusukasi, in rural Mali. MethodsWe administered a locally adapted screening instrument containing items from the Edinburgh Postpartum Depression Scale (EPDS) and Hopkins Symptom Checklist (HSCL-25) to 180 pregnant women and mothers of children under age 2 in Sélingué, Mali to assess the instrument's psychometric properties and validity. Item Response Theory was used to develop an abbreviated version of the measure and the validity and psychometric properties of this shortened version were compared with the full-length scale. ResultsThe full 28-item scale exhibited a single factor structure with good internal consistency (Cronbach's alpha ​= ​0.92). Women who self-identified as suffering from dusukasi (n ​= ​87) in a known groups analysis to assess construct validity had significantly higher depression and anxiety symptom scores (p ​< ​0.0001) and functional impairment scores (p ​< ​0.0001) compared to women not reporting dusukasi (n ​= ​93). The shortened 16-item scale performed as well as the full scale in identifying women with dusukasi. ConclusionsConstruct validity of our adapted screening instrument was supported for identifying dusukasi in rural Malian women. Our methodology can be applied in other settings to develop similarly valid screening instruments for perinatal depression.

Does implementation of collaborative care mitigate racial disparities in screening and treatment of perinatal depression?

Collaborative care (CC) is an evidence-based health services intervention that improves health outcomes for individuals with depression. Our objective was to evaluate whether implementation of CC was associated with a reduction in racial disparities in perinatal depression care.

Effect of mode of administration on Edinburgh Postnatal Depression Scale in the South Indian population: A comparative study on self-administered and interviewer-administered scores.

Edinburgh Postnatal Depression Scale (EPDS) is a validated screening tool widely used to assess perinatal depression (PND). However, due to stigma associated with PND, respondents could answer sensitive questions differently depending on the mode of administration, especially in culturally and linguistically diverse country like India. The present study explored longitudinal differences in EPDS scores between self-administered and interviewer-administered modes. 177 women from rural South India were administered EPDS, self-administration followed by interviewer-administered for four visits, twice each during prenatal and postnatal visits. EPDS scores were compared between the two modes descriptively, graphically and by repeated mixed measure models. Classification of antenatal depression (AD), postnatal depression (PD) and PND based on the two modes were compared by McNemar Chi-square test. Clinical and psychosocial characteristics were examined to identify factors associated with differences in the scoring modes. Concordance rates and Goodman Kruskal's Gamma coefficients were measured for individual EPDS items. Longitudinal EPDS scores and rates of AD, PD and PND were significantly higher in self-administered mode. Recent adverse life events were the only factor observed to be significantly associated with the differences between the two modes. Rank correlation and concordance rates suggested stronger association for EPDS items relating to anhedonia subscale and moderate/weaker association for EPDS items relating to anxiety/depression subscales. Our study findings suggest that the effect of mode of administration should be taken into account while using PND screening tools such as EPDS, especially in countries such as India with higher levels of illiteracy.

Patients’ Perceptions Of Perinatal Depression Screening: A Qualitative Study

Screening for perinatal depression is a clinical approach to identifying women in need of mental health diagnoses, referral, and treatment. Many states mandate screening for perinatal depression, but it remains unclear whether screening leads to increased access to treatment and better health outcomes. The aim of this qualitative study was to identify how women from diverse backgrounds perceive the quality of perinatal depression screening and whether the perceived quality affected their decisions about mental health care. During 2019 a sample of twenty-nine participants who had been screened for perinatal depression completed semistructured in-depth interviews in which they were asked for their impressions of the screening process. Common themes were that the screening was ineffective because providers didn't explain the purpose or uses of the screening tool, didn't tell patients anything about the results, and failed to provide any follow-up relating to patient depression scores. The results suggest the need for health care facilities to engage patients in a dialogue about screening results and for health care delivery systems to refine the screening process. These findings offer a foundation to design more comprehensive, patient-centered screening protocols that might result in improved mental health outcomes.

Evidence summary on the timing and frequency of screening for perinatal depression.

This study sought to search, evaluate, and summarize the best evidence about the time and frequency of screening for perinatal depression (PND). The UpToDate, Scottish Intercollegiate Network, National Institute for Health and Care Excellence, National Guideline Clearinghouse, Guidelines International Network, BMJ Best Practice, Cochrane Library, Embase, Campbell Collaboration, CINAHL, Joanna Briggs Institute Library, Medline, CNKI, Wanfang, VIP, and CBM databases were searched to retrieve relevant articles. A total of 9 articles were included in the meta-analysis, comprising 2 guidelines, 1 expert consensus, 1 evidence summary, 3 systematic reviews, and 2 clinical decisions. A total of 11 articles of best evidence were collected. The evidence was mainly related to the two aspects of screening time and frequency. There is abundant evidence on the best screening time for and frequency of PND; however, some evidence was from foreign evidence-based resources. Local clinical conditions need to be considered at the time of application.

Perinatal depression screening: Improving outcomes during COVID-19.

:Recommendations for social distancing and avoidance of mass gatherings during the COVID-19 pandemic have correlated with increased depressive symptoms in some individuals, such as loss of interest in daily activities, sleeplessness, or sadness. Perinatal depression screening using established, validated tools can aid with early diagnosis, guide management strategies, and optimize outcomes for pregnant women and their families. Identifying at-risk patients early in pregnancy and implementing a plan of care with appropriate mental health resources such as counseling or therapy have been shown to decrease clinical depression by more than 40%.

Using computerised adaptive tests to screen for perinatal depression in underserved women of colour

BackgroundCompared with traditional screening questionnaires, computerised adaptive tests for severity of depression (CAT-DI) and computerised adaptive diagnostic modules for depression (CAD-MDD) show improved precision in screening for major depressive disorder....

Experts consensus on screening and diagnosis of perinatal depression

围产期抑郁症是导致孕产妇心理健康不良事件的重要原因，可能导致孕产妇及其子代的不良结局。随着对围产期抑郁症的不断重视，中华医学会妇产科学分会产科学组结合国内外相关领域最新的循证医学证据及精神卫生专家的意见，制定了本专家共识，旨在指导妇产科医师尽早筛查、合理评估及临床观察，并及时转诊至精神专科。.

Experiences and perceptions of perinatal depression among new immigrant Chinese parents: a qualitative study

BackgroundImmigrant status, acculturation level, race and ethnicity have been found to contribute to the utilization of mental health services in the perinatal period. This study explored perinatal experiences and perceptions among Chinese immigrant mothers and their spouses, as well as the possible barriers and facilitators that affect their health care utilization.MethodsWe recruited 13 women ages 18–35 years born in mainland China, living in Rochester, New York, and residing less than 5 years in the United States. Participants primary language was Mandarin Chinese and all had given birth to at least one live infant within the past 7 years. Participants’ age was at least 18 years old at the time of delivery. Five spouses also participated. We divided women in two focus groups and held one focus group for men, with data collection including demographic questionnaires and semi-structured focus group questions conducted in December 2014. Data were analyzed following thematic analysis.ResultsFour themes emerged: experiences of perinatal depression; perceptions of perinatal depression; general preventive and coping strategies; and attitudes toward the supportive use social media applications (apps) and text messaging during the perinatal period. Participants had limited knowledge of perinatal depression and had difficulty distinguishing between normal perinatal mood fluctuations and more severe symptoms of depression. They discussed immigrant-related stress, conflicts with parents/in-laws while “doing the month”, the perceived gap between the ideal of “perfect moms” and reality, and challenges with parenting as the causes of perinatal depression. Women approved of screening for the condition but were conservative about follow-up interventions. As for the management of perinatal depression, participants preferred to deal with the problem within the family before seeking external help, due to potential stigma as well as Chinese traditional culture. They were receptive to obtaining pertinent health information from anonymous social media apps, preferring these to personal text messages.ConclusionThe recent immigrant Chinese parents to the United States in the study had limited knowledge of perinatal depression and did not make full use of mental health services for support due to language and cultural barriers. Screening for perinatal depression is only the first step. Future research should explore what interventions may serve as an acceptable approach to overcoming these gaps.

A systematic review of screening for perinatal depression and anxiety in community-based settings.

Screening for perinatal depression and anxiety in community-based maternal and child health settings may help close the detection and treatment gap among women at higher risk for these conditions. We aim to review perinatal depression and anxiety screening tools, timing, and follow-up processes for positive screens in community-based settings. We conducted a systematic review of the literature to identify papers describing screening and interventions for perinatal depression and anxiety in community-based settings. We identified 49 papers describing 47 studies of perinatal depression or anxiety screening in community-based settings. The Edinburgh Postnatal Depression Scale (EPDS) was the most frequently used screening tool. Referral and referral tracking for those who screened positive for symptoms were inadequately described. Types of training and technical assistance provided for screening varied widely. It is feasible and acceptable to screen for perinatal depression in community settings, but there is a need for systematic research examining which screening tools to use, the ideal frequency of screening, and referral completion rates. There is a lack of information regarding perinatal anxiety screening and a lack of uniformity in training regarding screening in community-based settings. Future studies should compare the efficacy of screening in community-based settings to screening in healthcare settings.

Scalable Screening and Treatment Response Monitoring for Perinatal Depression in Low- and Middle-Income Countries.

Common perinatal mental disorders such as anxiety and depression are a public health concern in low- and middle-income countries. Several tools exist for screening and monitoring treatment responses, which have frequently been tested globally in clinical and research settings. However, these tools are relatively long and not practical for integration into routine data systems in most settings. This study aims to address this gap by considering three short tools: The Community Informant Detection Tool (CIDT) for the identification of women at risk, the 4-item Patient Health Questionnaire (PHQ-4) for screening women at high-risk, and the 4-item Hamilton Depression Rating Scale (HAMD-4) for measuring treatment responses. Studies in rural Pakistan showed that the CIDT offered a valid and reliable key-informant approach for the detection of perinatal depression by utilizing a network of peers and local health workers, yielding a sensitivity of 97.5% and specificity of 82.4%. The PHQ-4 had excellent psychometric properties to screen women with perinatal depression through trained community health workers, with a sensitivity of 93.4% and specificity of 91.70%. The HAMD-4 provided a good model fit and unidimensional construct for assessing intervention responses. These short, reliable, and valid tools are scalable and expected to reduce training, administrative and human resource costs to health systems.