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Recent research has implicated allopregnanolone (ALLO), a neuroactive steroid and metabolite of progesterone, in perinatal mood and anxiety symptoms. We sought to add to the limited literature examining ALLO and mood and anxiety at multiple time points across the peripartum. We measured mood and anxiety symptoms and ALLO levels by ELISA at the second and third trimester (T2 and T3) and week 6 postpartum (W6) in N = 73 women with prior histories of mood and/or anxiety disorders and N = 38 healthy controls. Analytic methods included multivariate and logistic regressions with linear mixed effect models. Among all participants (N = 111), higher ALLO levels at W6 were associated with higher depression and anxiety scores: each one unit increase in log ALLO at W6 was associated with a 2.54 point increase on the Edinburgh Postnatal Depression Scale (EPDS) (95% CI: 0.73 to 4.33) and an 8.0 point increase on the Perinatal Anxiety Screening Scale (PASS) (95% CI: 3.82 to 12.6). In addition, the nature of the relationship between log ALLO level and psychological measures changed across time; from T2 to W6 for EPDS, β = 3.73 (95% CI:1.16, 6.30), p = 0.0045; for PASS β = 9.78 (95% CI:3.77, 15.79), p = 0.0014); from T3 to W6, for (EPDS, β = 2.52 (95% CI:0.08, 4.96), p = 0.043; for PASS β = 7.33 (95% CI:1.63, 13.02), p = 0.018). The relationship of log ALLO to mood and anxiety symptoms was the same among women with and without psychiatric histories. Our exploratory findings indicate that the relationship between ALLO and mood and anxiety symptoms may change across the peripartum.

Although prior research has examined associations between blood pressure (BP), depression, and suicidal ideation, few studies have examined this in high-risk populations such as pregnant women with HIV (WHIV). The current study examined the association of BP with depression and suicidal ideation among pregnant WHIV (n = 217) in rural South Africa. BP data (measured ≤ 1 month before the study visit) was extracted from medical records. Depressive symptomatology and suicidal ideation were assessed using the Edinburgh Postnatal Depression Scale. Diastolic BP was positively associated with both suicidal ideation and depressive symptomatology, even after controlling for demographic variables, gestational age, and intimate partner violence. These findings suggest that WHIV with elevated BP may be at greater risk for antenatal depression and suicidal ideation. Future research should utilize longitudinal designs to examine potential mechanisms and the directionality of the relationship, as well as other contributing factors.Aunque investigaciones anteriores han examinado las asociaciones entre la presión arterial (PA), depresión e ideación suicida, pocos estudios han examinado esto en poblaciones de alto riesgo, como las mujeres embarazadas con VIH. El estudio actual examinó la asociación de la PA con la depresión y la ideación suicida entre mujeres embarazadas con VIH (n = 217) en zonas rurales de Sudáfrica. Los datos de PA (medidos ≤ 1 mes antes de la visita del estudio) se extrajeron de los registros médicos. La sintomatología depresiva y la ideación suicida se evaluaron mediante la Escala de depresión posnatal de Edimburgo. La PA diastólica se asoció positivamente tanto con la ideación suicida como con la sintomatología depresiva, incluso después de controlar variables demográficas, edad gestacional y violencia de la pareja íntima. Estos hallazgos sugieren que mujeres embarazadas con VIH con PA elevada puede tener un mayor riesgo de depresión prenatal e ideación suicida. Las investigaciones futuras deberían aprovechar diseños longitudinales para examinar los posibles mecanismos y la direccionalidad de la relación, así como otros factores contribuyentes.

Transitioning to motherhood is an important life event. Stress often arises due to feeding concerns, infant crying, and sleep problems. Neuroprotective Developmental Care (NDC) also known as the Possums programs provides an evidence-based, consistent and holistic approach to maternal and infant wellbeing. To understand maternal characteristics at point of services access and an exploratory evaluation of effectiveness of NDC/Possums services. All mothers accessing NDC/Possums services via clinical services or self-paced online modules were invited to participate in a baseline survey. Follow up occurred when infants were 6 and 12 months of age. Participants who completed the 6-month survey were compared against their own baseline surveys. Those who completed the survey at 12-months were compared against their own baseline surveys. A pseudo-control group who had completed the baseline survey with infants 12 months of age was also compared to those who had accessed NDC/Possums services prior to 12 months of age (termed ‘intervention’ group). Crying time, mothers’ perceptions of infant sleep problems, mothers’ own sleep, mothers’ Acceptance and Action Questionnaire (AAQ) scores and the mothers’ Edinburgh Postnatal Depression Scale (EPDS) scores showed statistically significant improvements from baseline to 12-month old follow-up. Significant differences were also found between the pseudo-control group and ‘intervention’ groups. This results indicate that accessing NDC/Possums services is efficacious in addressing infant’s crying, the mother’s perceptions of their baby’s sleep problems, the mother’s own sleep satisfaction, the mother’s experiential avoidance, and the mother’s risk of postnatal depression. NDC is relevant to public health, clinical service delivery and education for health professionals.

Numerous studies report that some first-time parents experience a decline in relationship quality and an increase in conflict after the birth of a first baby. Inter-parental discord that is frequent, intense, and poorly resolved increases the likelihood of relationship breakdown and adversely impacts child development. We investigated the feasibility of a brief preventative couple-focused psychotherapeutic intervention in the perinatal period in a general population sample. Sixty couples expecting their first baby were recruited from the Royal Free Hospital, London. Thirty were randomly assigned to treatment (TMT, a newly developed five-session couple-focused intervention), and 30 to usual care (TAU). Outcomes were collected at 28 weeks into pregnancy, 6–8 weeks after birth, and when the baby was 6 months old. The intervention was feasible and acceptable, evidenced by 100% attendance. However, no change in relationship quality or inter-parental discord was detected in either TMT or TAU groups across the transition to parenthood. The intervention did not improve outcomes vs. TAU. Depression assessed by the Hospital Anxiety and Depression Scale increased across the cohort and mood symptoms assessed by the Edinburgh Postnatal Depression Scale decreased in mothers but not fathers. The absence of a decline in relationship quality could reflect sample attributes: couples were older than average UK first-time parents, had high levels of educational qualifications, and low discord. Even in this low-risk sample, only 20 out of 30 TAU couples completed all three assessments, vs. 29 out of 30 TMT couples. Larger-scale RCTs of perinatal couple-focused psychosocial interventions may be hampered by selection effects and attrition. They may benefit from co-design with stakeholders and active control conditions. Trial registration: ISRCTN12258825; 1st May 2020 (retrospectively registered).

The association between maternal depressive and anxiety symptoms and impaired bonding with infants were widely studied, but not in fathers and none in Malaysia. We investigated the impact of different trajectories of perinatal depressive and anxiety symptoms on parent-infant impaired bonding during 2–3 months postpartum in both mothers and fathers in two areas of Malaysia. This study originated from a psychiatric morbidity cohort study carried out in health clinics in east and west Malaysia. Edinburgh Postnatal Depression Scale and anxiety subscale of Depression, Anxiety, and Stress Scale at late pregnancy and 2–3 months postpartum and Postpartum Bonding Questionnaire were completed by 566 mothers and 457 fathers. About 11.7% mothers and 16.1% fathers reported depressive symptoms during pregnancy, 6.5% mothers and 10.5% fathers during 2–3 months postpartum, and 3–4% mothers and fathers both depressive and anxiety symptoms 2–3 months postpartum. The mean impaired bonding score was highest in mothers and fathers who had both depressive and anxiety symptoms 2–3 months postpartum. Impaired bonding is associated with higher EPDS and DASS (anxiety subscale) scores 2–3 months postpartum in both parents. Physical partner violence and deteriorated marital relationship were associated with increased risk of impaired bonding in mothers. The association between depressive, anxiety, and comorbidity of depressive and anxiety symptoms in both mothers and fathers and parent-infant impaired bonding during 2–3 months postpartum urges for screening and treatment of depressive and anxiety symptoms in both parents during early parenthood.

Prenatal depression is common and has been associated with risky maternal behavior, postpartum depression, and atypical child development. Still, its association with adverse perinatal outcomes is complex. The aim of our study was to look for this potential association in our region. The medical charts of women who were treated at our High-Risk Pregnancy Clinic and gave birth at our hospital were reviewed. The Edinburgh Postnatal Depression Scale (EPDS) was used to discover prenatal depression. Patients who reported past or current mental illness were excluded. We enrolled 202 women at a mean age of 32.81. Twin pregnancy was the most common reason for referral to the clinic (17.3%). The mean EPDS score was 4.63 (±4.66), with 15.3% scoring 10 or more. A significant correlation was found between the EPDS score and intrapartum fetal heart rate abnormalities, as well as with low birth weight. There were significant associations between the EPDS score and the maternal status of genetic disorder carrier, and the number of previous pregnancies, miscarriages, and elective termination of pregnancy. This study demonstrates a significant impact of the maternal psychological state on the obstetric outcome. In addition, we observed a significant association between maternal obstetric history, genetic data, and the risk of prenatal depression. Our study shows that completing the EPDS questionnaire is a very important part of the pregnancy follow-up, as it illuminates risk factors for prenatal depression and adverse perinatal outcomes.

Although maternal sense of competence is thought to be a multifaceted construct not enough is known about the factors predicting it. We aimed to measure the mediating role of postpartum psychopathology (depression and childbirth PTSD) on the association between insecure (anxious and avoidant) adult attachment styles and maternal sense of competence. Further, we measured the moderating effect of mother-infant rooming-in practices on these associations. The sample included 268 postpartum women (122 (45%) fully rooming-in) who gave birth at a large tertiary health center and were followed as part of a large longitudinal study. Participants responded to questionnaires at 1–4 days postpartum in-person (a demographic questionnaire and the Experiences in Close Relationships Scale [ECR]), at two months using online questionnaires (Edinburgh Postnatal Depression Scale [(EPDS], Birth Trauma Scale (BiTS) and Parental Sense of Competence [PSOC]). Obstetric data was obtained from medical files. Significant direct links were found between insecure adult attachment styles (anxious: B = −0.15, p = 0.0016, and avoidant: B = −0.14, p = 0.0085) and PSOC, while rooming-in mode did not moderate these links. However, for both insecure adult attachment styles (anxious and avoidant) the indirect links through childbirth PTSD general symptoms (anxious: B = −0.05, 95% CI = [−0.11, −0.01], avoidant: B = −0.10, 95% CI = [−0.18, −0.04]) and PPD (anxious: B = −0.10, 95% CI = [−0.17, −0.04], avoidant: B = −0.06, 95% CI = [−0.12, −0.01]) were significant only for women who were in partial rooming-in. Full rooming-in with the baby in the first days may be a promising practice in attenuating the impact of insecure attachment styles on parental sense of competence, among women with some postpartum psychopathology.

Literature has shown that hospitalized women with high-risk pregnancy tend to develop anxious and depressive symptoms. Research has used quantitative or qualitative methods. By integrating both quantitative and qualitative methods, this study aims to analyze: a) the level of depression, anxiety, and pregnancy-related anxiety in a group of women hospitalized with high-risk pregnancy (hospitalized high-risk) compared with a group of non-hospitalized women with low-risk pregnancy; b) the content of hospitalization-related emotions in a high-risk group. A cross-sectional study was conducted on 30 hospitalized high-risk pregnant women and 32 women with low-risk pregnancy. Participants completed the Edinburgh Postnatal Depression Scale, Hospital Anxiety and Depression Scale (Anxiety), and Pregnancy Related Anxiety Questionnaire. The hospitalized high-risk group also completed open-ended questions about emotions experienced during hospitalization. Univariate Analysis of Covariance showed that the hospitalized high-risk group reported higher general anxiety and depression than the low-risk pregnancy group. Low-risk group reported higher level of concerns about own appearance than high-risk group. Narratives showed that the anxious and depressive symptoms of hospitalized women are related to the loneliness of being away from family. Despite attempts to understand hospitalization, they express concerns about pregnancy. Psychological support for hospitalized pregnant women should be provided to facilitate the communication of emotions that leads women to elaborate the experience of hospitalization to better adapt and cope with the critical condition.

The study objective was to assess the reach and delivery of opportunistic postpartum depression (PPD) symptom screening at well-child clinic (WCC) immunization appointments in Alberta. The relationship between socio-demographic factors and PPD symptom screening status, and PPD symptom scores was explored.In this retrospective population-based cohort study, administrative health data from WCC immunization appointments were used to assess the PPD symptom screening delivery and scores from January 1, 2012 to December 31, 2016. The associations with maternal age and area-level material deprivation were determined by multivariable statistics.The number of births ranged from 51,537 to 55,787 annually. The percentage of mothers screened for PPD symptoms using the Edinburgh Postnatal Depression Scale decreased between 2012 and 2016, from 80.1% to 69.7%. Of those screened, 3-3.2% of the mothers were identified to be at high risk for PPD, annually. Screening status varied according to maternal age: mothers ≤29 years were more likely to be screened than mothers 30-34 years, while mothers ≥35 years were the least likely to be screened. Logistic regression analyses, adjusting for age, found the odds of not being screened increased with increases in area-level material deprivation. Language/cultural barriers were the most commonly reported reasons for not screening.Opportunistic PPD symptom screening at WCCs can be an efficient method to identify mothers who need postpartum support and to inform population-level public health surveillance. Additional work is needed to further understand barriers to PPD symptom screening, especially language, cultural, and socio-demographic factors.RéSUMé: OBJECTIFS: Évaluer la portée et l’exécution du dépistage opportuniste des symptômes de dépression du post-partum (DPP) lors des visites d’immunisation en clinique du bien-être de l’enfant (CBEE) en Alberta. Nous avons exploré la relation entre les facteurs sociodémographiques et la situation à l’égard du dépistage des symptômes de DPP, ainsi que les pointages des symptômes de DPP. MéTHODE: Pour cette étude de cohorte populationnelle rétrospective, nous avons utilisé les données administratives sur la santé des visites d’immunisation en CBEE pour évaluer l’exécution et les pointages du dépistage des symptômes de DPP entre le 1

Spending time in nature is associated with numerous mental health benefits, including reduced depression and improved well-being. However, few studies examine the most effective ways to nudge people to spend more time outside. Furthermore, the impact of spending time in nature has not been previously studied as a postpartum depression (PPD) prevention strategy. To fill these gaps, we developed and pilot tested Nurtured in Nature, a 4-week intervention leveraging a behavioral economics framework, and included a Nature Coach, digital nudges, and personalized goal feedback. We conducted a randomized controlled trial among postpartum women (n = 36) in Philadelphia, PA between 9/9/2019 and 3/27/2020. Nature visit frequency and duration was determined using GPS data. PPD was measured using the Edinburgh Postnatal Depression Scale (EPDS). Participants were from low-income, majority Black neighborhoods. Compared to control, the intervention arm had a strong trend toward longer duration and higher frequency of nature visits (IRR 2.6, 95%CI 0.96–2.75, p = 0.059). When analyzing women who completed the intervention (13 of 17 subjects), the intervention was associated with three times higher nature visits compared to control (IRR 3.1, 95%CI 1.16–3.14, p = 0.025). No significant differences were found in the EPDS scores, although we may have been limited by the study’s sample size. Nurture in Nature increased the amount of time postpartum women spent in nature, and may be a useful population health tool to leverage the health benefits of nature in majority Black, low-resourced communities. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11524-021-00544-z.

Studies in western cultures have proposed mechanisms by which adverse childhood experiences can affect mental health, including mediating variables such as social support and resilience. However, research replicating these findings in perinatal populations are sparse in Asia. This study assessed the association between lifetime trauma and postpartum depressive symptoms. Additionally, the study examined the mediating role that resilience and social support can play in this association. This study was conducted on 458 women participating in the PRAMMS cohort in urban Bangalore. Information on lifetime trauma was collected through a culturally appropriate trauma interview and postpartum depressive symptoms (8 weeks) were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Resilience was assessed using the Connor-Davidson Resilience Scale-10 and social support was assessed through the Zimet’s Multidimensional Scale of Perceived Social Support. A linear model was used to measure the association between lifetime trauma and postpartum depression and mediation analysis was used to assess the role of resilience and social support in the primary association. All analyses were conducted using SPSS. In this cohort, 254 women reported at least one trauma and 204 reported no trauma. A higher number of lifetime traumatic events was associated with higher EPDS scores (β = 0.487, 95%CI: 0.267–0.707). Social support was found to have a negative association between the predictor and the outcome; however, resilience was not a statistically significant mediator. Lifetime trauma was associated with postpartum depressive symptoms in our study and social support negatively mediated the association between lifetime trauma and postpartum depressive symptoms.

Group prenatal care provides an alternative model of prenatal care that allows for collaboration with peers, education, discussion, and self-management training in addition to standard prenatal care. Previous research on group prenatal care has demonstrated a decreased risk of preterm labor and of low birth weight babies, increased pregnancy knowledge, and decreased perceived stress in certain populations. CenteringPregnancy®, an evidence-based model of group prenatal care, has been the focus of group prenatal care research, which has demonstrated such improvements in health outcomes as well as positive health behaviors. Could CenteringPregnancy® also reduce rates or severity of depression through its potential to increase support and knowledge of pregnancy for patients? This study aims to assess factors that may reduce risk of depression as well as rates of depression in women enrolled in CenteringPregnancy® compared to women in traditional, individual care. This non-randomized study collected data from patients at their initial obstetric visit and again at their postpartum visit to compare psychosocial outcomes between those participants in CenteringPregnancy® versus individual prenatal care. The majority (64%) of primiparous women chose CenteringPregnancy® (×2 = 8.6399, df = 2, p = 0.003). A significant increase in Pregnancy Knowledge Scale (PKS) scores was observed in the CenteringPregnancy® group (p = 0.0278). Women in both groups revealed no significant difference in depression scores, as measured by the Edinburgh Postnatal Depression Scale (EPDS). Our research adds support to current literature suggesting group prenatal care is equivalent to, and perhaps more beneficial (in certain psychosocial arenas) than traditional prenatal care (Lathrop in Nurs Womens Health 17:118–130, 2013).

This study aims to explore association between maternal depressive symptoms and infant feeding practice at hospital discharge. Data were obtained from a birth cohort study based in Australia that linked to health administrative records. Maternal demographic data, mental health status derived from the Edinburgh Postnatal Depression Scale (EPDS), feeding practices of livebirths of at least 400 g or gestation periods of at least 20 weeks recorded during July–December 2015 were included (n = 14,658). Logistic regression models were performed to test association between presence of depressive symptoms and exclusive breast or formula feeding within 24 h prior to hospital discharge while adjusting for covariates known to be associated with breastfeeding. About 12% of women self-reported having depressive symptoms (EPDS score ≥ 10). Although only 7% of women (n = 1012) exclusively formula fed their babies, having depressive symptoms was associated with a 51% higher likelihood of exclusive formula feeding at hospital discharge. The association remains significant after adjustment for maternal age, gestational weeks, number of previous pregnancies, socioeconomic and partner status (p

A high proportion of women who quit smoking during pregnancy relapse during the postpartum period. However, research on smoking relapse in the early postpartum period is scarce. The aims of this study were to estimate rates of smoking relapse at 2 months postpartum and to analyze the factors (sociodemographic, psychological and pregnancy- and tobacco-related variables) involved in relapse and maintenance of abstinence. Eight hundred and fifty-three pregnant women in Spain were interviewed in the first and third trimesters of pregnancy and 2 months postpartum. Assessment included administration of an ad hoc questionnaire, to obtain socio-demographic and obstetric data and determine tobacco consumption status, the State Anxiety Inventory and the Edinburgh Postnatal Depression Scale. Biochemical tests were used to confirm smoking abstinence at each assessment. The study sample consisted of 125 women who smoked before becoming pregnant and who had spontaneously quit smoking during pregnancy. At 2 months postpartum, 17.6% of the sample had relapsed. Stepwise logistic regression analysis showed that the women significantly most likely to relapse in the early postpartum period were those who quit smoking later than the first month of pregnancy (OR = 18.51), those with high levels of anxiety (OR = 6.15) and those who smoked more cigarettes before pregnancy (OR = 4.91). The moment of smoking cessation during pregnancy, the level of consumption prior to pregnancy and anxiety levels should be considered in interventions aimed at maintaining smoking abstinence in pregnant women and preventing postpartum relapse.

To investigate adherence by Veterans Affairs (VA) providers to perinatal depression screening clinical practice guidelines (two prenatal and one postpartum screen). Women Veterans who enrolled in a multisite cohort study during pregnancy and delivered newborns between January 1, 2016 and December 31, 2019 were included. VA electronic health record (EHR) and claims data identified the start of pregnancy care, depression screens, and medical history. Prenatal and postpartum telephone surveys collected demographics, pregnancy characteristics, and Edinburgh Postnatal Depression Scale (EPDS) scores. Data from EHRs was combined with telephone survey data to create the analytic dataset (n = 663). Most (93%) Veterans had primary care at the VA during pregnancy; 41% saw a VA mental health provider. Perinatal depression screens were conducted with 43% of Veterans; 13% had both prenatal and postnatal screens. Screened Veterans were less likely to be diagnosed with depression by a VA provider in either the preconception or pregnancy time periods compared to those not screened (11% vs. 24% and 14% vs 23%, respectively). Among unscreened women, 18% scored positive for depression prenatally and 9% postnatally on the EPDS. Less than half of our sample had evidence of depression screening during the perinatal period, despite contact with VA providers. Perinatal Veterans sustaining VA mental health care may account for fewer screens. Lack of screening may hinder connection to VA mental health treatment and referral resources for symptomatic women. VA should ensure Veterans receive perinatal depression screening to mediate the risks of depression on Veterans and their children.

There is growing evidence that adolescent positive attributes and social aptitudes are associated with beneficial outcomes, including higher educational attainment and lower risk of later psychiatric disorder. Although maternal depression is a well-known risk factor for a variety of offspring adverse outcomes, less is known on its repercussion on children's positive behavioral traits. This study aimed to evaluate the impact of maternal depression trajectories on offspring positive attributes and social aptitudes, testing sex-moderated models for the studied association. The 2004 Pelotas Birth Cohort is an ongoing cohort originally comprised by 4231 live births from Brazil. We included 3465 11-year-old adolescents (48.6% female; maternal self-reported skin color: 27.0% non-white). Maternal depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS) at all follow-ups. Adolescent positive attributes and social aptitudes were ascertained by specific subscales of Development and Well-Being Assessment (DAWBA). Multivariate linear regression was used to examine the effect of maternal depression trajectories on offspring's outcomes, adjusting for potential confounding variables. Moderation was assessed with interaction terms. Adolescents from mothers who presented high-chronic levels of depressive symptoms during offspring's life have lower scores of positive attributes and social aptitudes. Boys exposed to maternal depression during their lifetime are more affected than girls regarding positive attributes, but this sex difference was not observed for social aptitudes. Interventions targeting the promotion of adaptive behavioral traits may represent an effective way to buffer the adverse impact of maternal depression on offspring development, especially for vulnerable groups such as male adolescents.

The objective of this study is to explore the associations between the patient-reported Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ)-9 and clinician-reported 17-item Hamilton Depression Rating Scale (HAMD-17) in order to facilitate clinical decision-making. An integrated efficacy dataset of three randomized placebo-controlled trials (NCT02614547, NCT02942004, and NCT02942017) evaluating brexanolone injection, a neuroactive steroid chemically identical to allopregnanolone, in women with postpartum depression was used for this post hoc analysis. Data were pooled across treatment arms. Associations were assessed at day 30 (end-of-trial follow-up). Pearson correlation assessed the relationship between EPDS and PHQ-9 item and total scores and HAMD-17 total score. Cohen’s kappa assessed agreement of EPDS remission (score r = 0.71, p < 0.001; HAMD-17/PHQ-9: r = 0.75, p < 0.001). Individual EPDS and PHQ-9 items significantly correlated (r= 0.35 to 0.67, all p < 0.001) with HAMD-17 total score. EPDS had 79% sensitivity and 67% specificity to detect HAMD-17 remission; corresponding estimates for PHQ-9 were 76% and 78%. OLS models yielded the following equations: HAMD-17 total = 2.66 + (EPDS total × 0.87) and HAMD-17 total = 3.99 + (PHQ-9 total × 0.97). There were large and statistically significant associations between patient-reported outcomes (EPDS, PHQ-9) and clinician-reported outcomes (HAMD-17) as clinical improvements were associated with patient-reported symptom improvement. These results provide tools to help translate clinical trial data to clinical practice, thus aiding shared decision-making for this critical population.

The notion that postnatal adjustment requires women’s selflessness is widely accepted but understudied. This study explored the utility of a combined (selflessness × differentiation of self) model in explaining postnatal adjustment. One hundred and seventy-eight women completed the following questionnaires: Differentiation of Self, The Selflessness Scale, The Selfishness Subscale of the Omnibus Self-Test, Maternal Attitudes Questionnaire, and Edinburgh Postnatal Depression Scale. The study findings partially support the suggested model. Both selflessness and differentiation were each found to have a significant direct effect on postnatal depression and mothers’ attitudes toward their baby. However, a quadratic effect of selflessness was found for maternal attitudes only, and interaction effect was not found. It is concluded that while these two variables may independently contribute to explaining postnatal adjustment, there is a need for an advanced multidimensional model to better understand their relationship in this context.

This study aims to examine postpartum Portuguese mothers’ emotional experiences, help-seeking behaviours, and perceived barriers to seeking help. It also intends to analyze mothers’ knowledge and acceptability of mindful parenting interventions and their preferences concerning the characteristics of these interventions. Differences between mothers with positive and negative screenings for depression were explored for all variables. Participants were recruited online and answered several questions aimed at assessing their emotional experience, help-seeking behaviours, perceived barriers to seeking help, knowledge about mindful parenting, acceptability of parenting and mindful parenting interventions during the postpartum period, and preferences concerning those interventions. They also completed the Edinburgh Postnatal Depression Scale. The sample comprises 599 mothers with a child aged 0–12 months (Mage = 5.28 months). Approximately 36% of mothers screened positively for depressive symptoms, and 24.2% thought about seeking help or actually sought help. Structural barriers were the most cited reasons for not seeking help. Approximately 95% of mothers felt that participating in a mindful parenting intervention during the postpartum period would be useful. Concerning mothers’ preferences, most mothers preferred a weekly frequency (85.0%) and an average of 10 sessions (48.6%) of 45–60 min in length (52.6%). Learning how to better understand the baby’s emotions and behaviours and learning new tools to better cope with parenting stress were among the intervention contents considered most useful. Our findings support postpartum mothers’ acceptability of mindful parenting interventions and provide important insights concerning specific features to consider and content to include in those interventions.

During the perinatal period, 10–20% of women experience anxiety and/or depression. Untreated perinatal depression has the potential for adverse effects on the family and infant resulting in long-term deleterious consequences. This study measured the association between self-reported depression using the Edinburgh Postnatal Depression Scale scores, self-reported anxiety and neonatal birth outcomes. A retrospective design was used with ObstetriX™ data retrieved from 16 metropolitan and rural hospitals in NSW, Australia during 2009–2014. Data were available for 53,646 singleton births. The Edinburgh Postnatal Depression Scale was used to identify self-reported depression while women self-reported pregnancy related anxiety. Regression modelling measured the effects of self-reported depression and self-reported pregnancy related anxiety on neonatal birth outcomes. Linear regression and logistic regression were used to model the effect on birth weight, gestational age, admission to NICU or the SCN, outcome (stillborn vs livebirth), and Apgar scores. Cox proportional hazards regression was used to estimate the effect on neonatal length of stay. Babies born to women self-reporting anxiety were more likely to have birth complications, be admitted to the nursery, had lower Apgar scores and longer hospital stays. Babies born to women self-identifying as experiencing a level of depression were more likely to have a lower birth weight, shorter gestational age, and, lower Apgar score. These babies were more likely to be admitted to the nursery with an increased length of stay. Perinatal anxiety and depression contribute to poor birth outcomes. Early detection of maternal perinatal anxiety and depression is an important step towards treatment interventions. More research is needed to identify models of care that are effective in identifying and managing perinatal depression and anxiety to improve birth outcomes for women and their babies.

Pregnant adolescents are at risk for micronutrient deficiency, psychological problems, and sexual dysfunction. We aimed to determine serum levels of vitamin D, calcium, magnesium, and copper, and also their relations with stress, anxiety, depression, and sexual function in pregnant adolescents. This cross-sectional study was conducted on two hundred 11-19-year-old healthy singleton pregnant women at gestational age of 26-32 weeks, who were covered by public health centers in Tabriz, Iran. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS), anxiety and stress using the Depression, Anxiety and Stress Scale-21 (DASS-21), and sexual function using the Female Sexual Function Index (FSFI). The independent t test was employed to determine the relations. Serum levels of vitamin D were found to be deficient ( 20 ng/ml) in 59% of the participants and insufficient (20-29 ng/ml) in 33%. Normal serum levels of calcium were observed in 67% of the participants, those of magnesium in 89.5%, and those of copper in 86%. Moreover, moderate-to-severe anxiety was observed in 38.5%, moderate-to-severe stress in 22.5%, depression in 30%, and sexual dysfunction in 68%. Mean serum level of copper was higher in women with depression compared with those with no depression (100.6 vs 93.0, P = 0.048). No other statistically significant associations were found between serum levels of any of the micronutrients and anxiety, stress, depression, and sexual dysfunction (P 0.05). The present study indicates high prevalence of micronutrient (especially vitamin D) deficiency, psychological problems, and sexual dysfunction among the pregnant adolescents. It also indicates an association between high serum copper level and depression.

PURPOSE: In India, antenatal anxiety prevalence estimates range from 6% to 48%. Social support is strongly associated with mental wellbeing, yet most studies have examined the impact of support from partners and family members rather than peers, community members, or health care providers. This study explores the supportive role of Accredited Social Health Activists (ASHA) contacts for antenatal anxiety. METHODS: Data were analyzed from the Saving Children, Improving Lives project, a quasi-experimental study conducted among rural, pregnant women in India. Regression models were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals for the relationship frequency of ASHA contacts and antenatal anxiety. Antenatal anxiety was measured using a subscale of the Edinburgh Postnatal Depression Scale. RESULTS: The sample consisted of 480 pregnant women. Reported antenatal anxiety prevalence was 27% (95% CI: 23%, 31%). Participants who were more frequently visited by ASHAs at home (aPR: 0.90; 95% CI: 0.76, 0.98) and more frequently accompanied by ASHAs to their antenatal care visits (aPR: 0.86, 95% CI: 0.78, 0.95) were less likely to report antenatal anxiety. ASHA home visits were protective for the most vulnerable women (primigravida and those experiencing domestic violence) and ASHA accompaniment to antenatal care visits was equally protective for all women. CONCLUSIONS: ASHAs are valued for their contribution towards maternal health education and linking women of reproductive age to healthcare services. Our findings additionally suggest the important role ASHAs play in providing social support to pregnant women, particularly those who are most vulnerable to experiencing antenatal anxiety.

Depression screening is recommended for all pregnant veterans; however, little is known on how often symptomatic women receive care, how depression treatment presents in practice, and whether women veterans are utilizing treatment during the appreciable perinatal period. Our sample included 142 pregnant veterans from 15 Veterans Health Administration (VA) medical facilities with Edinburgh Postnatal Depression Scale (EPDS) scores ≥10. Sociodemographic characteristics, military service, health utilization, and pregnancy related factors were collected as part of a telephone survey. A majority of our sample (70%) had 1 or more mental health visits or antidepressant prescriptions during pregnancy. Women with a history of depression had more mental health visits and a higher percentage of antidepressant use before and during pregnancy than women without a history of depression. Pregnant women veterans without a history of depression may be less likely to receive care for depression during pregnancy. However, the majority of our veterans showing depression symptoms prenatally had at least one mental health visit or an antidepressant medication fill during their pregnancy window, suggesting that mental health care is readily available for women veterans.

This study aimed to assess the association between suicidal ideation among mothers living with HIV in Zimbabwe and the cognitive development of their children. Participants were mother–child dyads recruited from two rural districts in Zimbabwe. Data were collected at baseline and 12 months follow-up. Suicidal ideation was assessed using item-10 from the Edinburgh postnatal depression scale. Mixed-effects linear regression was used to assess the association of child cognitive outcomes at follow-up (using the Mullen scales of early learning) with maternal suicidal ideation. Mothers with suicidal ideation at baseline (n = 171) tended to be younger, unmarried, experienced moderate to severe hunger, had elevated parental stress and depression symptoms compared with non-suicidal mothers (n = 391). At follow-up, emerging maternal suicidal ideation was associated with poorer child cognitive outcomes (adjusted mean difference − 6.1; 95% CI − 10.3 to − 1.8; p = 0.03). Suicidal ideation affects child cognitive development and should be addressed, particularly in HIV positive mothers.

Background Despite considerable policy actions at the national and hospital levels, rates of breastfeeding in the Middle East and North Africa (MENA) region remain below the global average. There is a need to explore the modifiable factors of breastfeeding such as maternal breastfeeding self-efficacy (BSE), support, and mental health among women in this region to guide interventions in the United Arab Emirates (UAE). The aim of this study was to examine the maternal predictors of any and exclusive breastfeeding in a cohort of Emirati and expatriate women residing in the UAE with a specific focus on modifiable factors. Methods Using a prospective cohort design, Emirati and expatriate women were recruited in the immediate postpartum period (N = 374) and followed at three and 6 months postpartum between February 2018 and July 2019. Questionnaires with validated tools were used to collect information on sociodemographic characteristics, breastfeeding practices, BSE, postnatal depression, and anxiety. The main outcomes in the study were Any Breastfeeding and exclusivity practices, which were assessed at three and 6 months postpartum by asking the mother about her breastfeeding behaviour during the past 7 days. Multilevel, multivariate logistic regression was used to estimate the association of different variables with breastfeeding outcomes. Results Almost all women reported initiating breastfeeding during their stay at the hospital (n = 357), while only 263 (70.3%) initiated breastfeeding within the first hour of delivery. At 6 months postpartum, 301 (81.5%) women continued to breastfeed of whom 100 (26.7%) were doing so exclusively. Older mothers who initiated breastfeeding within 1 h of birth and were satisfied with the breastfeeding support they received from family and friends had significantly greater odds of any breastfeeding at 6 months. Whereas a clinically significant Edinburgh Postnatal Depression Scale (EPDS) score, low BSE score as well as employment outside the home were associated with significantly lower odds of exclusive breastfeeding and any breastfeeding at 6 months postpartum. Conclusion This study highlights the need to develop effective education strategies and support programs targeting these modifiable variables to improve breastfeeding outcomes among women in the UAE.

Background Post-Traumatic Stress Disorder (PTSD) usually follows a catastrophic event. However, the experience of child birth can be severe enough to cause PTSD in some women. The aim of this study is to highlight the prevalence of Post Traumatic Stress Disorder among a cohort of postpartum mothers. Methods A cross-sectional study was conducted in field clinics of a semi-urban area in Sri Lanka. A pre-tested interviewer administered checklist was used to collect socio-demographic and pregnancy related data. Pre-existing self-administered, validated Sinhalese versions of the Edinburgh Postnatal Depression Scale (EPDS) and PTSD Symptom Scale-Self Report (PSS-SR) were used to assess the presence of Post-Partum Depression (PPD) and PTSD, respectively. Each participant was assessed for PTSD and PPD after one, two and six months following delivery. Scores of PPD > 9 and PSS-SR > 13 were taken as screening positive for the two conditions, respectively. Results Two hundred and twenty-five mothers at the end of postpartum one month were recruited for the study. The response rate at their follow-up visits at the second and sixth months were 95 % (n = 214) and 93 % (n = 211). The prevalence of postpartum PTSD was 2.7 % (n = 6), 0.9 % (n = 2) and 0.5 % (n = 1) after one, two and sixth months respectively. Prevalence of postpartum PTSD was 3.6 % over 6 months. Verbal abuse during labour (p = 0.04) and the presence of postpartum depression (P ≤ 0.001) were significantly associated with postpartum PTSD. There were no significant associations between PTSD and gestational age at delivery, index pregnancy being a planned pregnancy, a history of subfertility, family history of psychiatric disorders, intimate partner violence, receiving antenatal counseling, type and mode of delivery, duration of labour, presence of a labour companion, post-partum hemorrhage, manual removal of placenta, negative birth experience, low APGAR score of the baby at delivery, receiving neonatal and maternal intensive care, birth defects, problems with breast feeding or opportunity to discuss with a health care worker. Conclusions Prevalence of postpartum PTSD in this community-based study is 3.6 %; which is comparable with the overall global prevalence. PTSD was significantly associated with verbal abuse during labour and postpartum depression.

Background Anxiety in the ante- and postnatal period is prevalent, often co-occurs with depression, and can have adverse consequences for the infant. Therefore, perinatal mental health screening programs should not only focus on depression but also on detecting anxiety. However, in many already implemented perinatal screening programs, adding extra screening instruments is not feasible. We examine the utility of a subscale of the Edinburgh Postnatal Depression Scale (EPDS) consisting of items 3, 4, and 5 (EPDS-3A) for detecting anxiety in new mothers. Methods We used confirmatory factor analysis (CFA) to confirm the presence of the EPDS-3A found in a previous study (n = 320) where exploratory factor analysis (EFA) was used. For the CFA we used a sample of new mothers (n = 442) with children aged 2–11 months recruited from the same population from which mothers for the previous study was recruited. Three models were tested and compared. Receiver operating characteristics of the EPDS-3A were investigated in relation to anxiety caseness status on the combined sample (N = 762). Sample weighing was used to match the dataset to the target population. Cross tabulation was used to investigate the proportion of anxiety cases identified by the EPDS-3A above those identified with the total EPDS. Results The presence of the EPDS-3A was confirmed. An EFA-driven, two-dimensional 7-item model showed the best data fit with one factor representing the anxiety subscale consisting of items 3, 4, and 5. An EPDS-3A score of ≥ 5 was the most optimal for identifying cases of anxiety (sensitivity: 70.9; specificity: 92.2; AUC: 0.926). Further, we found that the EPDS-3A identifies an additional 2.5% of anxiety cases that would not have been identified with the total EPDS. Conclusions The EPDS-3A can be used as a time-efficient screening for possible anxiety in ante- and postnatal mothers. However, adding the EPDS-3A to routine screening with the total EPDS does not lead to a substantial increase in the number of women identified. In line with previous studies, this study confirms that the EPDS identifies anxiety in addition to depression. Therefore, assessment and treatment adjusted to the specific emotional difficulties is imperative.

Postpartum Depression (PPD) is the most common non-obstetric complications associated with childbearing, but currently has poor diagnostic regimes. Sensory symptoms of PPD are understudied, particularly with regard to the sense of olfaction. The present study addresses this research gap by assessing differences in olfactory abilities between 39 depressed mothers, who were within the perinatal period (i.e., during pregnancy and up to 1-year post pregnancy) and assessed with Edinburgh Postnatal Depression Scale, and their case-matched healthy volunteers. The assessments include two olfactory testing sessions conducted 4-weeks apart, each comprising a standard odour detection threshold test (i.e., Snap & Sniff Olfactory Test System), and intensity and valence ratings for 3 “pleasant” and 3 “unpleasant” odorants. The results revealed no difference between patients (M = 5.6; SE = 0.3) and control group (M = 5.7; SE = 0.4) in terms of olfactory detection threshold. However, the patients group perceived the 3 “unpleasant” odours as significantly less pleasant (p

BackgroundThe birth of a child entails major changes in a woman’s life. In the perinatal period, the woman is particularly susceptible to emotional problems. The objective of the present paper was to investigate the relationship between global orientation to life and its components on the one hand, and socio-demographic factors on the other, with regard to early postpartum emotional disorders.MethodsThe study included 643 patients hospitalized in obstetric departments in Lublin, Poland, who had had a spontaneous vaginal delivery. Research instruments included: the Edinburgh Postnatal Depression Scale (EPDS), the Orientation to Life Questionnaire (SOC-29), and the authors’ own survey questionnaire to record participants’ characteristics.ResultsThe study findings indicate an association between lower levels of postpartum blues and higher levels of global sense of coherence, as well as a stronger sense of meaningfulness, manageability, and comprehensibility. More severe emotional disorders were found in patients who were single. Postpartum blues symptoms were more intense in less educated respondents.ConclusionsPostpartum emotional disorders are associated with a global sense of coherence and its components. Higher levels of SOC reduce the risk of postpartum blues.

Background Depression is a serious mental health disorder that might affect women in the childbearing period. Incidences increase during pregnancy as well as after delivery. Its association with intimate partner violence (defined as physical, sexual, or psychological harm by a current or former partner) has been reported in many countries. Data about this sensitive issue are lacking in Egypt. The aim of the study was to determine the relation between intimate partner violence and depression during pregnancy. Methods This was a case control study conducted at the outpatient clinics in Suez Canal University hospital, from January 2019 to March 2020. The study included two groups, the study group included women exposed to violence during the current pregnancy and a control one included women with no history of violence. Both groups were recruited according to the predetermined inclusion criteria (women aged 18-45 years, continuous marital relationship, no history of depression in current or previous pregnancies, and singleton pregnancy). Women were asked to complete the Arabic validated NorVold Domestic Abuse Questionnaire (measuring four types of abuse: emotional, physical, sexual, and violence in the health care system, the last one being excluded). Depression was evaluated using the Arabic validated form of the Edinburgh Postnatal Depression Scale (comprises 10 questions that represent patients’ feelings in the last 7 days). The main outcome measure was to assess the association between intimate partner violence and depression. Results We recruited 158 women in each group. Both groups were matched in their demographic characters. Although emotional violence was reported prominently among women exposed to IPV 87.9% (139/158), it was not significantly reported in depressed women (P value 0.084). Physical and sexual violence were significantly reported among depressed women (P value 0.022 and 0.001, respectively). There was a significant difference between women exposed to violence and those who were not exposed to violence in the total depression scores (13.63 ± 5.47 and 10.65 ± 5.44, respectively with a p value p value Conclusion There was a strong association between intimate partner violence and depression during pregnancy.

The Parental Bonding Instrument (PBI) evaluates parental attitudes derived from an individual’s childhood experiences with their parents. The factor structure of the PBI differs depending on variables such as psychosocial factors including culture, race, sex, and psychological and social conditions of participants. Although previous studies of the relationship between perinatal depression and parenting experiences have used the factor structures of the PBI from the general population, it is unclear whether the same factor structures are appropriate in the highly variable perinatal period. In this study, complete responses to the PBI and the Edinburgh Postnatal Depression Scale (EPDS) were received from 932 primiparas at 25 weeks of gestation and at 1 month postpartum. An exploratory factor analysis was performed on half of the responses, and it was confirmed that the three factors were care, interference, and autonomy. Confirmatory factor analysis of the remaining half of the answers showed comprehensible fitness. Each factor showed a high degree of internal consistency, and each factor of the PBI correlated with the EPDS, indicating construct validity. The reliability and validity of the PBI in perinatal Japanese women were confirmed, and it was found that the PBI had a three-factor structure.

Infant and maternal mortality rates are among the highest in the world in low and middle-income countries where postpartum depression impacts at least one in five women. Currently, there is a dearth of data on maternal mood and infant health outcomes in small-scale non-industrial populations from such countries, particularly during the postnatal period. Here, we present the first investigation of postpartum maternal mood among a foraging population, the Hadza of Tanzania. We administered the Edinburgh Postnatal Depression Scale (EPDS) to twenty-three women, all with infants under the age of 12 months. Semi-structured interviews on happiness and unhappiness during the post-partum period served as a validity cross-check for the EPDS. The combined results of the EPDS surveys and the interview responses suggest that a high proportion of Hadza women experience significant mood disturbances following birth and that postpartum unhappiness is associated with self-reports of pain, anxiety, and disturbed sleep patterns. These findings suggest that many of the mothers in our sample are experiencing post-partum unhappiness at levels similar to or higher than those reported for low to middle income countries in general, including Tanzania. These data are critical for improving our understanding of the etiologies of postpartum mood disturbances cross-culturally.

The main objective of the present study was to report the incidence, recurrence, prevalence, and course of depressive symptoms during the transition from late pregnancy to the postpartum period in healthy women with and without a history of depression. The study also aimed to examine the predictive value of a history of premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) for peripartum depressive symptoms. A sample of 687 healthy women with (n = 192) and without (n = 495) a history of depression were included in the present analyses. Maternal depressive symptoms were assessed during late pregnancy, 1–2 weeks postpartum, and 4–6 weeks postpartum using the German version of the Edinburgh Postnatal Depression Scale. PMS/PMDD was assessed retrospectively using the German version of the Premenstrual Symptoms Screening Tool. Women with a history of depression were twice more likely to show peripartum depressive symptoms than women without a history of depression. A history of symptoms of PMS/PMDD prior to the current pregnancy was associated with increased odds of peripartum depressive symptoms (p values

Migration-related experiences can increase Latinas’ risk of perinatal depression and anxiety. Few studies have investigated these associations among Latinas due to a lack of survey instruments explicitly assessing migration experiences. This study assessed the feasibility and acceptability of the Migration Experiences Survey (MES), a newly-developed measure of migration and deportation fears and explored associations between those experiences and mental health in a sample of immigrant Latinas in the perinatal period. This cross-sectional study recruited women from community health clinics in Chapel Hill, NC between July 2013 and 2014. Twenty-five immigrant women were enrolled in the study during their third trimester of pregnancy. Women were interviewed in English or Spanish during pregnancy and at 8 weeks postpartum. The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms and the Spielberger State-Trait Anxiety Inventory was used to determine anxiety symptoms. The MES was administered at 8 weeks postpartum. Nonparametric tests were conducted to determine associations between deportation fears and maternal mood. Results show that the MES is acceptable for collecting data on migration experiences and assessing deportation fears among immigrant Latinas, regardless of depressive or anxiety symptoms. More than 40% had migration safety concerns and fears of deportation. Self or family-related fears of deportation were significantly associated with prenatal state anxiety and trait anxiety (p

We report on a successful quality improvement project designed to increase access to perinatal mental health services through universal screening for postpartum depression (PPD) and facilitating referrals for evaluation and treatment, at a multi-site, integrated system of pediatric and obstetric practices in Houston, Texas. Obstetric practices administered screenings twice during pregnancy and at 6 weeks postpartum. Pediatric practices screened women at the 2 week and 2, 4, and 6-month well-baby visit. Women with a score of 10 or higher on the Edinburgh Postnatal Depression Scale (EPDS) or women that reported thoughts of self-harm were offered a referral to a mental health provider. Data on screening and referrals were collected from the electronic medical record. A total of 102,906 screens for PPD were completed between May 2014 and July 2018. Of those, 6487 (6.3%) screened positive. The total number of women referred to treatment were 3893 (3.8%). Of referred women 2172 (55.8%) completed an appointment with a mental health provider within 60 days of referral. Rates of completed appointments varied by the level of integration of the mental health provider and referring physician: women referred by pediatrics in a Level 1 coordinated system completed 20.0% of referrals; obstetrics Level 4 co-located system, 76.6%; and obstetrics Level 5 integrated model, 82.7%. This project demonstrated that with planning, systems review and trained staff, PPD screening can be integrated into obstetric and pediatric practices and high screening and referral rates can be achieved.

Antenatal and postpartum depression has been associated with maternal, child and family-unit complications. Our aim was to assess the impact of a depression screening and intervention program on perinatal complications. This study included 2042 women. They were screened on the Edinburgh Postnatal Depression Scale (EPDS), three times during pregnancy and once after childbirth. If their EPDS score was above the cut-off score, psychological intervention was offered. Significant relationships were found between depression scores and perinatal complications, such as protracted cervical dilation, protracted descent, preeclampsia, intrauterine growth restriction, low birthweight and cesarean section. Depression scores were higher in the intervention group, compared to the non-intervention group, but decreased after the consultations. The cesarean section rate was significantly lower in the consultation group. A rapid screening process can provide an adequate tool to identify women who are more likely to have such complications due to depression.

During pregnancy, different mindfulness skills may reduce a mother’s depressive symptoms. This study investigated factors within the Self-Compassion Scale (SCS) and Five Facet Mindfulness Scale (FFMQ) that were significantly associated with the reduction of perinatal depression. The sample consisted of 77 pregnant women at risk of developing perinatal depression. Regression analysis, confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were used to analyze factors associated with reductions in perinatal depression. The CFA showed self-compassion scale had 6 factors and mindfulness scale had 5 factors. The regression analysis confirmed previous findings that self-compassion and mindfulness were significant change processes associated with the reduction of perinatal depression as measured by the Edinburgh Postnatal Depression Scale (EPDS). Model 1 (Pre-EPDS → Pre-SCS → Post-FFMQ → Post EPDS) fit the data with commendable goodness-of-fit indices (χ2 = 6.37, df = 5, p = .27, CFI = .98, TLI = .97, RMSEA = .06, LO 90 = .00, HI 90 = .16, PCLOSE = .38, GFI = .97, AGFI = .92, Bollen-Stine Bootstrap p = 1.00). A novel finding from the present study suggests self-kindness from SCS in addition to observing and acting with awareness from FFMQ were associated with significant reductions in perinatal depression. The reverse model (Pre-EPDS → Pre-FFMQ → Post-SCS → Post-EPDS) failed to fit the data. These findings indicate targeted skill development in self-kindness, observing and acting with awareness may have clinical utility for pregnant women at risk of developing perinatal depression. Future research with larger sample sizes, a control group and at least 3 measurement points is necessary to verify these findings.

Latent modelling was used to identify trajectories of depressive symptoms among low-income perinatal women in South Africa. Predictors of trajectories and the association of trajectories with child outcomes were assessed. This is a secondary analysis of data collected among women living in Cape Town settlements (N = 446). Participants were eligible if pregnant and 18 years or older, and included in the analysis if allocated to the control arm (routine perinatal care). Participants were excluded in case of non-singleton birth and baby death. Follow-up assessments were at 2 weeks, 6-, 18-, and 36-month postpartum. Trajectories of depressive symptoms were based on the Edinburgh Postnatal Depression Scale scores until 18-month postpartum, using latent class growth analysis. Child physical, cognitive, socio-emotional, and behavioural outcomes were assessed at 18 and/or 36 months. Univariate and multivariate regressions were used to identify predictors of trajectories and differences in child outcomes. Four trajectories were identified: chronic low (71.1%), late postpartum (10.1%), early postpartum (14.4%), and chronic high (4.5%). Low social support, unwanted pregnancy, and risky drinking were associated with the chronic high trajectory; unemployment and HIV-positive status with the early postpartum trajectory; and intimate partner violence with the late postpartum trajectory. Weight-to-length and weight-for-age z-scores at 18 months, and weight-for-age z-scores, length-for-age z-scores, emotional symptom, and peer problem scores at 36 months differed across trajectories. Severe depressive symptoms in postpartum period have a lasting effect on child physical and socio-emotional outcomes. Multiple screening throughout pregnancy and 1-year postpartum is essential.

Background Mothers of preterm infants are at increased risk for postpartum depression, which may disturb parenting and child development. Strategies for prevention are needed. Therefore, we evaluated how an educational intervention for neonatal staff affected depression symptoms among mothers of preterm infants. Methods The Close Collaboration with Parents intervention was implemented in the NICU at Turku University Hospital in Finland. Maternal depression was compared between the pre-intervention and post-intervention cohorts using the Edinburgh Postnatal Depression Scale. The eligible infants were born ≤1500 g without major anomalies and survived. Data were available from 145 and 93 mothers in the pre-intervention and post-intervention cohorts, respectively, at 4 and/or 6 months of corrected age. Results The depression scores were significantly lower in the post-intervention cohort than in the pre-intervention cohort; the estimated difference was 2.54 points (95% CI, 1.24–3.83), p

BackgroundGiven the prevalence of infertility and consequences of stress, anxiety, and depression during pregnancy and after childbirth, this study aimed to determine the effect of group cognitive behavioral therapy (CBT)-based counseling on perceived stress (primary outcome), anxiety, depression, and quality of life (QoL) of pregnant women with a history of primary infertility.MethodThis controlled randomized clinical trial was conducted on 56 pregnant women with a history of primary infertility referred to Infertility Clinic of Al-Zahra Teaching Hospital of Tabriz. The participants were divided into the intervention (n = 28) and control (n = 28) groups using block randomization. The intervention group received group CBT-based counseling after the 14th week of the pregnancy: six in-person sessions and two telephone sessions once per week. The control group received routine care. The Perceived Stress Scale (PSS), Edinburgh Postnatal Depression Scale (EPDS), Van den Bergh’s Pregnancy-Related Anxiety Questionnaire (PRAQ), and Quality of Life in Pregnancy (Gravidarum) (QOL-GRAV) were completed through interviews before and 4 weeks after the intervention by the researcher.ResultsThere was not any between-group difference in socio-demographic characteristics, except the gestational age and husband educational level (p > 0.05). Both of these variables were adjusted in ANCOVA. After the intervention, the mean scores of perceived stress (mean difference: − 7.3; confidence interval: 95%, from − 0.9 to − 5.6;p p = 0.052). The mean score of quality of life in pregnancy was significantly higher in the intervention group than the control (mean difference: − 5.4; confidence interval: 95% from 3.4 to 7.4;p ConclusionCBT counseling can affect the perceived stress, anxiety, and quality of life of pregnant women with a history of primary infertility. As a result, this counseling approach is recommended along with other counseling approaches to improve the mental health of pregnant women with a history of infertility.Trial registrationIRCT Registration Number:IRCT20111219008459N12, registered on 10/11/ 2018.

Background The influence of maternal temperament on child behavior, and whether maternal temperament impact boys and girls differently is not thoroughly studied. The aim was to investigate the impact of maternal temperament and character on child externalizing and internalizing problems at age 3. Methods A birth-cohort of 1723 mothers and their children were followed from birth to age 3. At the child’s age of 3 months, the mothers filled out standardized instruments on their temperament and character using the Temperament and Character Inventory (TCI) and depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). At the child’s age of 3 years, the mothers reported on child behavior using the Child Behaviour Checklist (CBCL). Results Maternal temperamental trait novelty seeking was positively associated with externalizing problems in the total population and in girls. Harm avoidance was positively associated with externalizing problems in the total population and in boys, and with internalizing problems in the total population and boys and girls respectively. Maternal character traits of self-directedness and cooperativeness were negatively associated with both externalizing and internalizing problems in the total population and in boys and girls respectively. Conclusions Maternal character traits were more influential on child behavior than were temperamental traits, and thus the opportunities for intervention targeted at parental support are good. Maternal mental health and socioeconomic aspects also increased the risk for child behavior problems, indicating the need for recognition and support in clinical settings.

Background Depression, stress, and poor-quality sleep are common during pregnancy and postpartum, but the relationship of these factors with reward-related eating is not well understood. This observational cohort study examines associations of depression, stress, and sleep quality with self-reported reward-related eating in pregnancy and postpartum. Methods Participants were enrolled at Results During pregnancy, greater depressive symptoms (β ± SE = 0.03 ± 0.01, p p p = 0.03) were associated with greater hedonic hunger. Similarly, greater depressive symptoms (OR = 1.08, 95% CI: 1.02, 1.14, p = .01), higher stress (OR = 1.09, 95% CI: 1.04, 1.14, p = p = .04) were associated with greater odds of addictive-like eating. These associations were also significant in postpartum except that sleep quality was not associated with hedonic hunger. Greater depressive symptoms (β ± SE = 0.06 ± 0.02, p p = p p p p p = 0.01) and addictive-like eating (0.88 ± 0.33, p = 0.01), and increased stress was associated with increased hedonic hunger (1.71 ± 0.76, p = 0.02). Change in stress was not associated with change in addictive-like eating and change in sleep quality was not associated with change in either hedonic hunger or addictive-like eating. Conclusions Greater depressive symptoms, perceived stress, and poorer sleep quality are associated with greater self-reported reward-related eating during pregnancy and postpartum, suggesting that efforts to improve diet during and after pregnancy may benefit from addressing mental health and sleep. Trial registration Clinicaltrials.gov Registration ID – NCT02217462. Date of registration – August 13, 2014

Background Child abuse and postnatal depression are two public health problems that often co-occur, with rates of childhood maltreatment highest during the first year of life. Internet-based behavioural activation (iBA) therapy has demonstrated its efficacy for improving postnatal depression. No study has examined whether the iBA program is also effective at preventing child abuse. This study aims to investigate whether iBA improves depressive symptoms among mothers and prevents abusive behaviours towards children in postpartum mothers in a randomized controlled trial, stratifying on depressive mood status. The study also evaluates the implementation aspects of the program, including how users, medical providers, and managers perceive the program in terms of acceptability, appropriateness, feasibility, and harm done. Methods The study is a non-blinded, stratified randomized controlled trial. Based on cut-off scores validated on Japanese mothers, participants will be stratified to either a low Edinburgh Postnatal Depression Scale (EPDS) group, (EPDS 0–8 points) or a high EPDS group (EPDS ≥9 points). A total of 390 postnatal women, 20 years or older, who have given birth within 10 weeks and have regular internet-access will be recruited at two hospitals. Participants will be randomly assigned to either treatment, with treatment as usual (TAU) or through intervention groups. The TAU group receives 12 weekly iBA sessions with online assignments and feedback from trained therapists. Co-primary outcomes are maternal depressive symptoms (EPDS) and psychological aggression toward children (Conflict Tactic Scale 1) at the 24-week follow-up survey. Secondary outcomes include maternal depressive symptoms, parental stress, bonding relationship, quality of life, maternal health care use, and paediatric outcomes such as physical development, preventive care attendance, and health care use. The study will also investigate the implementation outcomes of the program. Discussion The study investigates the effectiveness of the iBA program for maternal depressive symptoms and psychological aggression toward children, as well as implementation outcomes, in a randomized-controlled trial. The iBA may be a potential strategy for improving maternal postnatal depression and preventing child abuse. Trial registration The study protocol (issue date: 2019-Mar-01, original version 2019005NI-00) was registered at the UMIN Clinical Trial Registry (UMIN-CTR: ID UMIN 000036864).

BackgroundApproximately one-third of pregnant and postnatal women in Ethiopia experience depression posing a substantial health burden for these women and their families. Although associations between postnatal depression and worse infant health have been observed, there have been no studies to date assessing the causal effects of perinatal depression on infant health in Ethiopia. We applied longitudinal data and recently developed causal inference methods that reduce the risk of bias to estimate associations between perinatal depression and infant diarrhea, Acute Respiratory Infection (ARI), and malnutrition in Gondar Town, Ethiopia.MethodsA cohort of 866 mother-infant dyads were followed from infant birth for 6 months and the cumulative incidence of ARI, diarrhea, and malnutrition were assessed. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess the presence of maternal depression, the Integrated Management of Newborn and Childhood Illnesses (IMNCI) guidelines were used to identify infant ARI and diarrhea, and the mid upper arm circumference (MUAC) was used to identify infant malnutrition. The risk difference (RD) due to maternal depression for each outcome was estimated using targeted maximum likelihood estimation (TMLE), a doubly robust causal inference method used to reduce bias in observational studies.ResultsThe cumulative incidence of diarrhea, ARI and malnutrition during 6-month follow-up was 17.0% (95%CI: 14.5, 19.6), 21.6% (95%CI: 18.89, 24.49), and 14.4% (95%CI: 12.2, 16.9), respectively. There was no association between antenatal depression and ARI (RD = − 1.3%; 95%CI: − 21.0, 18.5), diarrhea (RD = 0.8%; 95%CI: − 9.2, 10.9), or malnutrition (RD = -7.3%; 95%CI: − 22.0, 21.8). Similarly, postnatal depression was not associated with diarrhea (RD = -2.4%; 95%CI: − 9.6, 4.9), ARI (RD = − 3.2%; 95%CI: − 12.4, 5.9), or malnutrition (RD = 0.9%; 95%CI: − 7.6, 9.5).ConclusionThere was no evidence for an association between perinatal depression and the risk of infant diarrhea, ARI, and malnutrition amongst women in Gondar Town. Previous reports suggesting increased risks resulting from maternal depression may be due to unobserved confounding.

Canonical transforming growth factor-beta (TGF-β) signaling exerts neuroprotection and influences memory formation and synaptic plasticity. It has been considered as a new target for the prevention and treatment of depression. This study aimed to examine its modulatory role in linking prenatal maternal depressive symptoms and the amygdala volumes from birth to 6 years of age. We included mother–child dyads (birth: n = 161; 4.5 years: n = 131; 6 years: n = 162) and acquired structural brain images of children at these three time points. Perinatal maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) questionnaire to mothers at 26 weeks of pregnancy and 3 months postpartum. Our findings showed that the genetic variants of TGF-β type I transmembrane receptor (TGF-βRI) modulated the association between prenatal maternal depressive symptoms and the amygdala volume consistently from birth to 6 years of age despite a trend of significance at 4.5 years of age. Children with a lower gene expression score (GES) of TGF-βRI exhibited larger amygdala volumes in relation to greater prenatal maternal depressive symptoms. Moreover, children with a lower GES of the TGF-β type II transmembrane receptor (TGF-βRII), Smad4, and Smad7 showed larger amygdala volumes at 6 years of age in relation to greater prenatal maternal depressive symptoms. These findings support the involvement of the canonical TGF-β signaling pathway in the brain development of children in the context of in utero maternal environment. Such involvement is age-dependent.

Background An unplanned pregnancy may be followed by increased depression and anxiety. The aim of the present study was to evaluate the mediating role of partner’s emotional reaction to pregnancy (PERP) on the relationship between pregnancy planning and prenatal mental health. Methods This cross-sectional study was conducted on 303 healthy Iranian pregnant women during their third trimester. The levels of depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory. The PERP score was also measured using a researcher-made questionnaire. The data were analyzed using the plug-in application PROCESS macro. Results The results showed that PERP score was reversely related to pregnancy planning and prenatal depression and anxiety. The direct effect of the pregnancy planning on depression (c = −.05) and anxiety levels (c = −.02) were not significant; but the indirect effect of pregnancy planning on depression (Point Estimate = −.379, CI: −.523 to −.250) and anxiety levels (Point Estimate = −.560, CI: −.741 to −.385) with the mediating role of PERP were significant. Conclusions The results indicated that the effect of pregnancy planning on prenatal mental health is mediated by PERP, and in unplanned pregnancy women need to receive positive reaction of their partners toward pregnancy so that they can preserve their mental health.

Background Mental disorders are common during the peripartum period and may have far-reaching consequences for both mother and child. Unfortunately, most antenatal care systems do not provide any structured screening for maternal mental health. As a consequence, mental illnesses are often overlooked and not treated adequately. If correctly diagnosed, cognitive behavioral therapy is currently the treatment of choice for mental illnesses. In addition, mindfulness-based interventions (MBIs) seem to represent a promising treatment option for anxiety and depression during the peripartum period. Considering the internet’s increasing omnipresence, MBIs can also be offered electronically via a (tablet) computer or smartphone (electronically based MBI = eMBI). Objective The current study aims to examine the clinical effectiveness and cost-effectiveness of an eMBI (the mindmom application) developed by an interdisciplinary team of gynecologists, psychologists, and midwives, teaching pregnant women how to deal with stress, pregnancy-related anxiety, and depressive symptoms. The study sample consists of pregnant women in their third trimester who screened positive for emotional distress. The mindmom study is a bicentric prospective randomized controlled trial (RCT), which is currently conducted at the University women’s hospitals of Heidelberg and Tübingen, Germany. Methods Within the scope of the routine prenatal care, pregnant women attending routine pregnancy care in Baden-Wuerttemberg, Germany, are invited to participate in a screening for mental distress based on the Edinburgh Postnatal Depression Scale (EPDS). Women with an EPDS screening result > 9 will be referred to one of the mindmom coordinating study centers and are offered counseling either face-to-face or via videotelephony. After an initial psychological counseling, women are invited to participate in an eMBI in their last pregnancy trimester. The study will enroll N = 280 study participants (N = 140 per group), who are randomized 1:1 into the intervention (IG) or control group (treatment as usual = TAU). All participants are requested to complete a total of 7 digital assessments (5 visits pre- and 2 follow-up visits postpartum), involving self-report questionnaires, sociodemographic and medical data, physiological measures, and morning cortisol profiles. The primary outcome will be depressive and anxiety symptoms, measured by the Edinburgh Postnatal Depression Scale, the State Trait Anxiety Questionnaire, and the Pregnancy-Related Anxiety Questionnaire. Secondary outcomes include mindfulness, satisfaction with birth, quality of life, fetal attachment, bonding, mode of delivery, and cost-effectiveness. Discussion This is the first German RCT to examine the (cost-)effectiveness of an eMBI on maternal mental health during pregnancy. If successful, the mindmom app represents a low-threshold and cost-effective help for psychologically distressed women during pregnancy, thereby reducing the negative impact on perinatal health outcome. Trial registration Deutsches Register Klinischer Studien, German Clinical Trials Register DRKS00017210. Registered on 13 January 2020. Retrospectively registered.

The aim of the current study was to assess the risk for post-partum depression among women delivering during the COVID-19 pandemic as compared to the risk among women delivering before the COVID-19 pandemic. A cohort study was performed among women delivering singletons at term which were recruited in the maternity wards of the Soroka University Medical Center. Recruitment was done during the COVID-19 strict isolation period (March 18 and April 29, 2020). Women delivering during the COVID-19 pandemic completed the Edinburgh Postnatal Depression Scale (EPDS), and the results were compared to women delivering at the same medical center before the COVID-19 pandemic. Multivariable logistic regression models were constructed to control for potential confounders. A total of 223 women who delivered during the COVID-19 strict isolation period were recruited. Women delivering during the COVID-19 pandemic had lower risk of having a high (> 10) or very high (≥ 13) EPDS score as compared with women delivering before the COVID-19 pandemic (16.7% vs 31.3%, p = 0.002, and 6.8% vs 15.2%, p = 0.014, for EPDS ≥ 10 and EPDS ≥ 13, respectively). These results remained similar in the multivariable logistic regression models, for both EPDS score ≥ 10 and EPDS score ≥ 13, while controlling for maternal age, ethnicity, marital status, and adverse pregnancy outcomes (adjusted OR 0.4, 95% CI 0.23–0.70, p = 0.001 and adjusted OR 0.3, 95% CI 0.15–0.74, p = 0.007 for EPDS score > 10 and > 13, respectively). In our population, delivering during the COVID-19 pandemic was independently associated with lower risk of post-partum depression.

Background During the perinatal period, suicides are more likely to occur in those with depression and who are not receiving active treatment at the time of death. Suicide is a common outcome in people with suicide ideation. We developed an intervention program taking care of comprehensive perinatal maternal mental healthcare to prevent suicide ideation. We hypothesized that our intervention program could reduce postnatal suicide ideation and improve maternal mental health. Methods We performed a controlled trial to examine the usual postnatal care plus a maternal suicide prevention program (the intervention group) compared with usual postnatal care alone, which comprised home visits by public health nurses without mental health screening (the control group) in Nagano city, Japan. In total, 464 women were included; 230 were allocated to the control group and 234 to the intervention group. The intervention had three components: 1) all the women received postnatal mental health screening by public health nurses who completed home visits during the neonatal period, 2) the intervention was administered by a multidisciplinary clinical network, and 3) systematic follow-up sheets were used to better understand bio–psycho–social characteristics of both the mothers and their infants and develop responsive care plans. We measured the participants’ mental health at 3–4 months postpartum (T1) and 7–8 months postpartum (T2) using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS). Results Suicidal ideation was significantly lower in the intervention group compared with the control group at T1 (p = 0.014); however, this significant between-group difference did not continue to T2 (p = 0.111). We measured the intervention effects on maternal mental health using the total score of the EPDS, which was significantly improved in the intervention group compared with the control group at T1. Here, the significant difference continued to T2 (p = 0.049). Conclusions Our results indicate that our program may reduce maternal suicidal ideation at 3–4 months postnatally and improve women’s mental health during the postnatal periods of 3–4 to 7–8 months. Postnatal maternal mental healthcare, including services to reduce suicide ideation, should be included as an important component of general postnatal care. Trial registration Name of registry: A multidisciplinary intervention program for maternal mental health in perinatal periods. UMIN Clinical Trials Registry number: UMIN000033396. Registration URL: https://upload.umin.ac.jp/cgibin/ctr/ctr_view_reg.cgi?recptno=R000038076 Registration date: July 15, 2018. Registration timing: retrospective.

Background Although there has been mounting research on postpartum depression (PPD), the impact of immigration on PPD has remained quite unexplored. The purpose of this study is to investigate the prevalence and associated factors of PPD among immigrant women living in Guangzhou at 6 weeks postpartum. Methods A cross-sectional study was conducted involving 1230 immigrant women in a tertiary hospital of Guangzhou from December 2016 to December 2017 at 6 weeks postpartum. The Chinese version of Edinburgh Postnatal Depression Scale and a structured questionnaire regarding associated factors were administered to all participants. Multivariate logistic regression was used to determine factors that were significantly associated with PPD. Results The prevalence of PPD among immigrant women at 6 weeks postpartum was 34.0%. A multivariate logistic regression model identified significant obstetric and social factors as: living in Guangzhou for less than 2 years, insufficient family income, poor social support and marital relationship. Conclusion Prevalence of PPD among immigrant women from Guangzhou at 6 weeks postpartum is high. The development of PPD among immigrant women is associated with individual and social factors. There’s an urgent need for healthcare providers to take a more active role in engaging immigrant women in their psychological needs.