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Evidence regarding the accuracy of existing anxiety screeners used in pregnancy is limited. This study compares the psychometric characteristics of the Generalized Anxiety Disorder 2- and 7-item Scales (GAD-2 and GAD-7), the anxiety subscale of the Edinburgh Postnatal Depression Scale (EPDS-3A) and the two anxiety items of the Antenatal Risk Questionnaire (ANRQ-2A). Nine hundred fifty-four women completed the screening measures and anxiety modules of a diagnostic reference standard (SAGE-SR) in the third trimester. Test performance characteristics of each measure was assessed using Receiver Operator Characteristic (ROC) analysis. We applied four previously recommended criteria to ascertain the value of each measure for widespread clinical use: area under the curve (AUC ≥ 0.8, Youden's index ≥ 0.5, negative predictive value (NPV) ≥ 0.8 and positive likelihood ratio (LR +) ≥ 4.0). Prevalence for any SAGE-SR anxiety disorder was 3%. All measures yielded an acceptable AUC of ≥ 0.8, Youden's index of ≥ 0.5 and NPV of ≥ 0.8. Only the EPDS-3A, at a cut-point ≥ 5, also achieved a LR + of ≥ 4.0 (4.35) but at this cut-point sensitivity was less than 0.75. The ANRQ-2A, at its optimal cut-point of ≥ 6, was the only measure to additionally attain both a sensitivity and specificity of ≥.75. This study expands the evidence base for brief anxiety screening measures in the maternity setting and provides empirical support for the use of the EPDS-3A and ANRQ-2A in routine screening programmes. Studies assessing the performance of these measures in samples with higher disease prevalence and broader socio-economic status are warranted. [ABSTRACT FROM AUTHOR]

Purpose: The early postnatal period is a time of increased risk for psychiatric admission. However, there is scope to further examine if this increase in risk extends to the entire perinatal period (pregnancy and first postnatal year), and how it compares to admission outside of the perinatal period. Methods: Data were linked across birth and hospital admission registers from July 2000 to December 2009. The study cohort, consisting of all pregnant and childbearing women with a psychiatric history, was divided into two groups: case women (at least one perinatal principal psychiatric admission in the study period) (38%) and comparison women (no perinatal principal psychiatric admissions) (62%). Outcomes were admission rate and length of stay adjusted for diagnosis, socio-demographic factors and timing of admission. Results: Antenatal and postnatal admissions rates were both higher than non-perinatal admission rates for case women for all diagnoses. There was little evidence that women with perinatal admissions were at an increased risk of admissions at other times. Socially disadvantaged women had significantly fewer and shorter admissions than their respective counterparts. Conclusions: The entire perinatal period is a time of increased risk for admission across the range of psychiatric disorders, compared to other times in a woman's childbearing years. Reduced admission rate and length of stay for socially disadvantaged women suggest lack of equity of access highlighting the importance of national perinatal mental health policy initiatives inclusive of disadvantaged groups. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) have been found to be associated with various health conditions; however, there is dearth of evidence on the relationship between ACEs and prenatal depression. This study was conducted to determine the association between overall ACE score and prenatal depression symptoms, assess the moderating effect of social support and partner support on this relationship, and determine the association between individual ACE scores and prenatal depression. A secondary analysis was conducted of data from an RCT that assessed the feasibility of e-screening for maternal mental health among 636 pregnant women recruited from antenatal clinics. Two logistic regression models were built to reach our objectives. Over 80% of the participants were older than 25 years and had education beyond high school. Eighteen percent of the women had an ACE score of four or more. Univariable analysis found a 2.5-fold increase in the odds of prenatal depression for women with an ACEs score of ≥ 4. When examining the overall ACE score, lack of social support during pregnancy [AOR = 4.16; 95%CI (2.10–10.35)] and partner's relationship [AOR = 2.23; 95%CI (1.12–4.44)] were associated with prenatal depression while among the individual ACE scores, living with a person who went to prison was found to be associated with prenatal depression even when controlled for all variables. No moderating effect was found. These findings suggest for the improvement of partner's relationship and provision of social support before women conceive, in order to mitigate the effect of these adversities. [ABSTRACT FROM AUTHOR]

This paper helps to quantify the impact of the Australian National Perinatal Depression Initiative (NPDI) on postnatal inpatient psychiatric hospitalisation. Based on individual hospital admissions data from New South Wales and Western Australia, we found that the NPDI reduced inpatient psychiatric hospital admission by up to 50% [0.9% point reduction (95% CI 0.70–1.22)] in the first postnatal year. The greatest reduction was observed for adjustment disorders. The NPDI appears to be associated with fewer post-birth psychiatric disorders hospital admissions; this suggests earlier detection of psychiatric disorders resulting in early care of women at risk during their perinatal period. [ABSTRACT FROM AUTHOR]

This paper reports on the acceptability, experience of participation and the immediate impact on maternal mood state of group singing sessions, introduced as a routine component of a mother-baby unit (MBU) treatment programme. Data was collected from 27 women who participated in the pilot programme. Results showed that implementation of a singing intervention in this setting is positively appraised by women and is associated with positive changes in self-reported mood state from pre- to post-session. Key facilitators and barriers to the success of the programme and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Poor postnatal mental health is a major public health issue, and risk factors include experiencing adverse life events during pregnancy. We assessed whether midwifery group practice, compared to standard hospital care, would protect women from the negative impact of a sudden-onset flood on postnatal depression and anxiety. Women either received midwifery group practice care in pregnancy, in which they were allocated a primary midwife who provided continuity of care, or they received standard hospital care provided by various on-call and rostered medical staff. Women were pregnant when a sudden-onset flood severely affected Queensland, Australia, in January 2011. Women completed questionnaires on their flood-related hardship (objective stress), emotional reactions (subjective stress), and cognitive appraisal of the impact of the flood. Self-report assessments of the women’s depression and anxiety were obtained during pregnancy, at 6 weeks and 6 months postnatally. Controlling for all main effects, regression analyses at 6 weeks postpartum showed a significant interaction between maternity care type and objective flood-related hardship and subjective stress, such that depression scores increased with increasing objective and subjective stress with standard care, but not with midwifery group practice (continuity), indicating a buffering effect of continuity of midwifery carer. Similar results were found for anxiety scores at 6 weeks, but only with subjective stress. The benefits of midwifery continuity of carer in pregnancy extend beyond a more positive birth experience and better birthing and infant outcomes, to mitigating the effects of high levels of stress experienced by women in the context of a natural disaster on postnatal mental health. [ABSTRACT FROM AUTHOR]

This study examines the clinical profile of women admitted to a psychiatric mother-baby unit as well as change in their clinical, parenting, attachment and quality of life outcomes. Data was collected from 191 mothers through self-report measures at admission and discharge. Change was analysed in terms of Edinburgh Postnatal Depression Scale (EPDS) score, parenting confidence, maternal attachment to the infant and overall functioning. Psychosocial factors impacting on symptom severity and recovery were examined. Most women (64.8 %) were admitted in the first 3 months after birth with an ICD-10 unipolar depressive episode (52.3 %) or anxiety disorder (25.7 %), and 47.6 % had comorbid diagnoses. Improvement from admission to discharge was seen with large effect sizes (≥one standard deviation, i.e. μ) in terms of clinical symptoms (EPDS, μ = 1.7), parenting confidence (Karitane Parenting Confidence Scale (KPCS), μ = 1.1) and attachment to their infant (Maternal Postpartum Attachment Scale (MPAS), μ = 0.9) as well as overall level of functioning (SF-14, μ = 1.9). The majority (73.3 %) recovered symptomatically, and this was associated with increasing maternal age (odds ratio (OR) = 1.129, p = 0.002) and lower levels of psychosocial risk at admission (OR = 0.963, p = 0.008). Improvement in parenting confidence was associated with increasing maternal age (OR = 1.17, p = 0.003). No predictive factors were found for improvement in maternal attachment after controlling for admission scores. In the short term, joint admission of mothers with their infants is highly beneficial in terms of clinical, functional and parenting outcomes, but follow up studies are needed to assess the longer term benefits for mother-infant dyads. The use of an observational tool to enhance our assessment of maternal-infant interaction and some measure of maternal emotional dysregulation-both important mediators of development of secure infant attachment-would also enhance our ability to tailor therapeutic interventions. [ABSTRACT FROM AUTHOR]

This study aims to investigate the (1) pattern of psychosocial risk factors among mothers of unsettled infants, (2) the relationship between these risk factors and current mental health status and (3) acceptability of psychosocial risk assessment in the parentcraft setting. Women with unsettled infants aged up to 12 months were assessed using the Edinburgh Postnatal Depression Scale, a diagnostic interview (Mini-International Neuropsychiatric Interview (MINI)) and a psychosocial assessment tool, the Postnatal Risk Questionnaire (PNRQ). Of the women, 27.5 % met the MINI diagnostic criteria for a current (predominantly) anxiety disorder, and 43.1 %, for a past psychiatric diagnosis. On the Edinburgh Postnatal Depression Scale, 29.9 % of women scored above 12 (mean 9.8; SD 5.1). The most common psychosocial risk factors were high trait anxiety (40.9 %), past mental health problems (40.7 %), perfectionistic traits (38.1 %) and 'abuse trauma' of any kind (31.6 %). The likelihood of meeting diagnostic criteria for a current mental illness was significantly increased for women who experienced emotional abuse during childhood (adj. odds ratio (OR) 3.386; p = 0.006), had high trait anxiety (adj. OR = 2.63, p = 0.003) or had a negative birth experience (adj. OR 2.78; p = 0.015). The majority of women (78 %) felt moderately to very comfortable completing the PNRQ. The results showed high rates of current anxiety disorders (almost twice that of the general postnatal population) and multiple significant psychosocial risk factors among mothers with unsettled infants. Identification of specific psychosocial risk factors in mothers of unsettled infants can help to address issues beyond infant settling difficulties such as mother-infant interaction, especially for mothers with unresolved issues around their own parenting or trauma history. [ABSTRACT FROM AUTHOR]

This study aims to investigate hospital admission of major depressive disorders (MDD) before and after birth. Population data for all primiparous women admitted to the hospital with depressive disorders before and after birth were used. The comparison group consisted of 10 % of primiparous women not admitted to the hospital with a diagnosis of a psychiatric disorder or substance use. A total of 728 women had a first admission with depressive disorders (501 in the first postpartum year). The rate of first hospital admission for depressive disorders decreased during pregnancy and increased markedly in the first three months after birth (peaking in the second month with a rate of 10.74/1,000 person year and rate ratio of 12.56) compared with the 6 months prior to pregnancy. Admission remained elevated in the second postpartum year. Older maternal age, smoking, elective caesarian section and admission to a neonatal intensive care unit or special care nursery were associated with a higher rate of admission. Women born outside Australia and those most socioeconomically disadvantaged were less likely to be admitted to the hospital in the first postpartum year. Overall risk of hospital admission with depressive disorders rose significantly across the entire first postpartum year. This has significant implications for policy and service planning for women with mood disorders in the perinatal period. [ABSTRACT FROM AUTHOR]

This study examined the associations between perceived parental care and control in childhood and maternal anxiety, depression and parenting stress during the transition to parenthood. Eighty-eight women completed the Parental Bonding Instrument, self-report measures of anxiety and depression and a structured diagnostic interview (Mini-plus International Neuropsychiatric Interview) during the third trimester of pregnancy. The MINI-Plus and anxiety and depression measures were re-administered at 7 months postpartum. The Parenting Stress Index was also administered at this time. Significant associations were found between maternal 'affectionless control' and prenatal and postnatal symptom measures of anxiety and depression, p values <0.005. Compared to women who reported optimal parenting, women who recalled maternal 'affectionless control' were also six times more likely to be diagnosed with an anxiety disorder during pregnancy (OR = 6.1, 95 % CI = 2.17-30.11) and seven times more likely to be diagnosed with postnatal major depression (OR = 6.8, 95 % CI = 1.80-25.37). Paternal 'affectionless control' was associated with significantly higher scores on symptom measures of prenatal and postnatal anxiety, p values <0.005. This study suggests that assessing a woman's own parenting history is important in identifying and managing the risk of prenatal and postnatal affective disorders and parenting stress. [ABSTRACT FROM AUTHOR]

The objectives of this study were: (1) to examine Composite International Diagnostic Interview (CIDI) period prevalence and comorbidity for depression and anxiety disorder in a cohort of women assessed during the first 6-8 months postpartum and (2) to examine the benefits of combining the Edinburgh Postnatal Depression Scale (EPDS) with a simple 'interval symptom' question to optimize screening postpartum. Women aged over 18 ( N = 1,549) were assessed during late pregnancy and reviewed at approximately 2, 4, and 6-8 months postpartum using the EPDS and an 'interval symptom' question. The latter asked about any depressive symptoms in the interval since the last EPDS. Women who scored >12 on the EPDS and/or positive on the 'interval symptom' question were then administered the CIDI. A further 65 randomly selected women that screened negative were also administered the CIDI. Loss to postnatal follow-up was very significant, and returns rates were inconsistent across the three postnatal time points. Almost 25% of those who screened positive did not complete a CIDI. For screen-positive status, a total of 314 (24.4%) of those that returned questionnaires ( N = 1,289) screened positive at least once across the 6- to 8-month interval. Of these, 79 were lost to follow-up; thus, 235 (74.8%) completed a CIDI. In this group, 34.7% had been positive both on the EPDS and the 'interval' question, 15.9% on the EPDS alone, and 49.4% on the 'interval' question alone. For the CIDI diagnosis and estimated 6- to 8-month period CIDI prevalence, among those 235 women who screened positive and completed a CIDI, 67.2% met the criteria for a CIDI diagnosis, as did 16.9% of those who screened negative. The breakdown in CIDI diagnoses in the 235 women was 32.8% major depression (± anxiety disorder); 26.4% minor depression alone; and 8.1% with a primary anxiety disorder (approximately half with minor depression). Put another way, 20.4% of these women had an anxiety disorder (approximately two thirds with comorbid depression) and 37.7% of women with a major depressive episode (MDE) had a comorbid anxiety disorder. The estimated 6- to 8-month prevalence rate for a CIDI diagnosis of anxiety or depression (major or minor) was 29.2% (95% CI 26.7%-31.7%). The use of the 'interval symptom' question alone was 1.7 times more likely to identify positive CIDI cases than the EPDS alone. Almost 40% of postnatal women with a diagnosis of MDE have a comorbid diagnosis of anxiety disorder. The estimated 6- to 8-month period prevalence for CIDI cases of anxiety and depression was 29.2%. Screening for anxiety and depression using the EPDS alone was associated with a lesser capacity to identify CIDI caseness than a simple 'interval symptom' question (for the 2 months prior) which almost doubled the yield. This paper demonstrates that combining the EPDS with the 'interval symptom' question improves detection of CIDI caseness. [ABSTRACT FROM AUTHOR]

The author discusses the classification of mental health disorders in the perinatal period, which provide future directions for the fifth edition of "Diagnostic and Statistical Manual of Mental Disorders" (DSM)-V and 11th edition of International Classification of Diseases (ICD)-11 publication. She believes that the DSM system has progressed over the last 20 years. She comments on issues affecting the nosology of postpartum disorders. She suggests several factors to consider to extend the classificatory approach to the postpartum disorders.

Summary Recent developments in the study of mental health issues surrounding childbirth, have brought about a shift from the narrow concept of “postnatal depression” (PND) to a consideration of the spectrum of depressive and anxiety disorders arising in the “perinatal” period – which in the mental health context is defined as encompassing pregnancy and the first year postpartum. This shift has been associated with a growing recognition of the potential for prevention and early intervention in the perinatal period. In this article, the difficulties of antenatal screening with the aim of predicting PND are highlighted and contrasted with the potential benefits of antenatal screening aimed at identifying psychological morbidity – whether pre-existing risk factors and/or current symptoms – which may have bearing across the entire perinatal period. The literature on randomized controlled trials of “targeted” antenatal interventions to reduce PND and “indicated” interventions in postnatally depressed women are also reviewed. Future clinical and research directions in the field of early intervention for perinatal mood and anxiety disorders are identified. [ABSTRACT FROM AUTHOR]