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Background: There is a lack of evidence on the effectiveness of postnatal depression (PND) screening programmes in reducing morbidity. The aim of this study was to evaluate the effectiveness of a PND screening programme using Edinburgh Postnatal Depression Scale (EPDS) in improving maternal mental health., Methods: The randomized controlled trial design was used. Participants were 462 Chinese mothers with 2-month-old babies visiting Maternal and Child Health Centres in Hong Kong. Participants in the intervention group were screened for PND using the EPDS, whereas those in the control group were screened by clinical assessment. In both groups, participants identified with PND were offered follow-up management according to protocol., Results: Participants in the intervention group had better maternal mental health outcome as assessed by EPDS at 6 months (risk ratio: 0.59; 95% confidence interval: 0.39-0.89). The number needed to screen was 25., Conclusions: A PND screening programme comprising the use of EPDS as the screening tool and the provision of follow-up care had resulted in an improvement in maternal mental health at 6 months.

Postnatal depression affects both men and women. The detection of postnatal depression is important, yet there are few validated screening tools on Chinese men. The goals of the present study were to compare the psychometric properties of the Edinburgh Postnatal Depression Scale (EPDS), the Beck Depression Inventory (BDI), and the Patient Health Questionnaire - Depression Module (PHQ-9) in screening for postnatal depression among Chinese fathers in Hong Kong. The prevalence of depression at 8 weeks postpartum was also estimated. A prospective cohort of 551 men completed the EPDS, BDI, and PHQ-9 at 8 weeks postpartum. Clinical diagnosis of depression was established with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), non-patient version (SCID-NP). The criterion validity of the instruments was evaluated against this clinical diagnosis. The EPDS was significantly more accurate than the BDI and PHQ-9 in detecting postnatal depression among Chinese men. With a cut-off score of 10 or more, the EPDS has a sensitivity of 91%, specificity of 97%, positive predictive value of 57%, and negative predictive value of 99%. Approximately 3.1% men met the DSM-IV criteria for depression at 8 weeks postpartum. The prevalence rate of postnatal depression in Chinese men is comparable to their Western counterparts. The Chinese EPDS is a valid instrument for detecting postnatal depression in men. It could be applied as a supplementary assessment tool in Chinese fathers who may be reluctant to disclose their depressive symptoms in face-to-face interviews., (Copyright © 2009 Elsevier Ltd. All rights reserved.)

Background: Perinatal depression is common, but women typically do not seek help for it. We studied its association with frequent non-routine physician visits, which may be a form of help-seeking behaviour., Methods: A prospective cohort study of women in their 34th to 38th week of pregnancy at the outpatient obstetrics clinic at a Singapore tertiary hospital was done. Screening was done using the Edinburgh Postnatal Depression Scale and diagnosis of major or minor depressive disorder was made using the SCID-IV. At 6 to 12 months' post-partum, women were screened and interviewed again for depression and asked to report the frequencies with which they had brought their infants to the doctor on non-routine visits in the preceding 6 weeks. Four hundred and seventy-one of the 559 patients recruited before delivery were re-interviewed., Results: After adjusting for confounders, women who had brought their infants for three or more non-routine visits to the infant's doctor had a significantly higher prevalence of depression (32.6%) than those with fewer visits (13.6%) (OR 2.87, 95% CI 1.41 to 5.85, p=0.004). The relative risk reduction for women who did not bring their infants for frequent non-routine visits was 0.583 (95% CI 0.44 to 0.73, p=0.002). They were also more likely to have poorer perceived emotional support from their families., Limitations: These included use of self-reported doctor visits, and relatively high educational levels of the participants., Conclusions: Doctors should have a high index of suspicion for enquiring about depression and emotional support in mothers who bring their infants for frequent non-routine visits.

Apart from causing emotional suffering, postnatal depression strains marriage, undermines the mother's confidence, impairs her social functioning and quality of life, and in serious cases contributes to infant abuses, infanticides and suicidal behaviour. Recent studies also show that postnatal depression adversely affects emotional, behavioural and cognitive development of the newborn. In addition, there is growing awareness that depression can occur during pregnancy, and antenatal depression can adversely affect obstetric and neonatal outcomes. Antenatal depressive symptoms are also the strongest predictor of postnatal depression. This paper reviews the epidemiology, clinical presentation, risk factors, prevention and treatment of perinatal depression. The latest development in research and practice related to this condition are also highlighted.

Background: To investigate the prevalence, socio-cultural and psychosocial risk factors for perinatal depression in Singaporean women., Method: A prospective cohort of 559 women was interviewed antenatally and at six weeks' postpartum at a tertiary hospital. Women were interviewed for diagnosis of depression using a two-stage design, with a screening questionnaire and diagnostic interview., Results: Postnatally, a negative confinement experience was associated with depression. Other independent factors included poor emotional support, a past history of depression, unplanned pregnancy and perceived potential conflicts with relatives over childcare antenatally and dissatisfaction, poor instrumental support postnatally. The prevalence of depression antenatally and postnatally was 12.2% and 6.8%, respectively., Limitations: Measures of satisfaction with social support were based on self-report; there were high dropout rates at six weeks' postpartum; and other modulating social factors such as pre-existing interpersonal conflicts were not studied., Conclusions: Perinatal depression in Singaporean women is common. Contrary to expectations, a negative 'confinement' experience is a significant risk factor for postnatal depression, and is not universally welcomed by women. Depression is modulated by dissimilar sets of psychosocial factors antenatally and postnatally.

Background: Although there have been many studies of the biological and psychosocial causations of postnatal depression, studies of sociocultural risk factors are rare., Aims: To investigate the sociocultural risk factors of postnatal depression using ethnographically informed epidemiological methods., Method: A total of 959 women were assessed at their first ante-partum visit (baseline), in the third trimester, immediately after delivery, and 3 months postpartum. Six domains of risk factors were examined. The dependent variable was postnatal depression (as defined by the Edinburgh Postnatal Depression Scale) at 3 months post-partum., Results: Conflict with mother-in-law, marital dissatisfaction, past depression and antenatal depression independently predicted the occurrence of postnatal depression. The cultural practice of peiyue - a Chinese post-partum custom of mandated family support - was associated with better social support and a slightly lower risk of postnatal depression., Conclusions: Sociocultural aspects of the immediate puerperium shape maternal emotional well-being. In-law conflict is an important source of household distress in many Asian societies. The findings have implications for clinical practice and future studies.

Background: Few studies have examined the utility of rating scales developed in non-puerperal context in detecting postnatal depression. This study evaluated the utility of the General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI) in screening for depression among recently delivered women in Hong Kong., Methods: A prospective cohort of 145 Chinese women completed the GHQ, BDI and Edinburgh Postnatal Depression Scale (EPDS) 6 weeks after delivery. They were then assessed using the non-patient version of the Structured Clinical Interview for DSM-III-R (SCID-NP) to establish psychiatric diagnosis, against which the criterion validity of the GHQ and BDI was evaluated against this clinical diagnosis. The psychometric performance of the GHQ, BDI and EPDS in detecting postnatal depression was assessed using the receiver operating characteristic (ROC) curves., Results: Both Chinese GHQ and BDI had satisfactory sensitivity and positive predictive value in detecting postnatal depression. Their receiver operating characteristic (ROC) curves were comparable to that of the EPDS., Limitation: The study was conducted in Chinese women using translated version of the rating scales., Conclusions: The GHQ and BDI are useful for detecting postnatal depression among recently delivered Chinese women. The results of this study suggest that rating scales developed in non-puerperal context may also be applicable for postnatal depression.

Objective: To identify psychosocial risk factors for postnatal depression among Hong Kong Chinese women., Design: Prospective longitudinal study involving self-report questionnaires and face-to-face interviews., Setting: University teaching hospital, Hong Kong., Participants: Two hundred and twenty consecutive Chinese women who were admitted to the postnatal ward of the Department of Obstetrics and Gynaecology from 6 November 1996 to 18 January 1997., Main Outcome Measures: Psychiatric diagnoses were established using the clinician-administered Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. Psychosocial risk factors were ascertained by conducting face-to-face interviews and using psychometric rating scales., Results: Of the 330 women who delivered during the study period, 220 (66.7%) agreed to participate in the study. The 220 participants had a mean age of 29 years (range, 16-42 years). Postnatal depression was associated with depression during pregnancy, elevated depression score at delivery, and prolonged postnatal 'blues'. Other correlates of postnatal depression were temporary housing accommodation, financial difficulties, two or more induced abortions, past psychiatric disorders (including depression), and an elevated neuroticism score. Postnatal depression was more likely if the spouse was disappointed with the gender of the newborn., Conclusion: Some risk factors are similar to those found in the West, whereas others (spouse disappointment and history of abortion) may be unique to the local population. To help identify women who are at particularly high risk of developing postnatal depression, obstetricians and midwives in Hong Kong should consider codifying the identified risk factors into a check-list.

Objective: Postnatal depression affects 10% to 15% of women after childbirth. Self-report rating instruments, such as the Edinburgh Postnatal Depression Scale (EPDS), have been developed and administered to postpartum women to facilitate early detection. Most postnatal depression screening scales, however, focus solely on depressive symptomatology. We hypothesized that applying two complementary rating scales of symptoms and functioning as a double test would significantly enhance the positive predictive value of screening., Methods: A prospective cohort study was conducted at the postnatal clinic of a university teaching hospital. One hundred forty-five Chinese women completed the EPDS and 12-item General Health Questionnaire (GHQ) 6 weeks after delivery. They were then interviewed by a psychiatrist, who used the Structured Clinical Interview for third revised edition of the Diagnostic and Statistical Manual of Mental Disorders, nonpatient version (SCID-NP), to validate the diagnoses., Results: The positive predictive value of the EPDS and GHQ, when administered independently, was 44% and 52%, respectively, at their respective optimal cutoff scores. When the EPDS-GHQ double test was administered, the positive predictive value was significantly increased to 78%., Conclusions: Simultaneous administration of the EPDS and GHQ can substantially improve identification of women with postnatal depression. This can potentially reduce unnecessary referrals to general practitioners and psychiatrists and may enhance the overall cost-effectiveness of population-wide screening.

Background: We evaluated the utility of the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS) and measured the prevalence of major depression six weeks after confinement among Chinese women in Hong Kong., Method: A prospective cohort of 145 women completed the EPDS, the 12-item General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI) six weeks after giving birth. They were then assessed with the Structured Clinical Interview for DSM-III-R, non-patient version (SCID-NP) to establish psychiatric diagnosis. The criterion validity of EPDS was tested against this clinical diagnosis, and the concurrent validity against the GHQ and BDI scores was also evaluated. The internal consistency of the scales was measured by Cronbach's alpha coefficient., Results: The Chinese EPDS had satisfactory psychometric properties and a cut-off score of 9/10 is recommended for screening depressive illness in a general postnatal population. At six weeks postpartum, 5.5% of the study population suffered from major depression., Conclusions: The Chinese EPDS will be useful for screening for postnatal depression.

Objective: Psychiatric morbidity affects 48% to 51% of women who have miscarried. This study evaluated the utility of two sample and brief self-report questionnaires in screening psychiatric morbidity after miscarriage., Method: One hundred fifty-six subjects completed the 30-item General Health Questionnaire (GHQ), the Edinburgh Postnatal Depression Scale (EPDS), and the Beck Depression Inventory (BDI) 6 weeks after miscarriage. Then there was a blind assessment using the Structured Clinical Interview for DSM-III-R (SCID) to establish psychiatric diagnosis. The criterion validity of GHQ and EPDS were tested against this yardstick diagnosis and the concurrent validity against the BDI scores. The internal consistency of the scales was measured by Cronbach's alpha-coefficient., Results: Both GHQ and EPDS had good sensitivity and specificity in screening for psychiatric morbidity after miscarriage. The concurrent validity and the internal consistency of both scales were satisfactory. The EPDS could only identify those subjects with major depression. The GHQ was longer to perform, but was able to detect both anxiety and depressive disorders. Furthermore, the GHQ had better psychometric properties when compared with the EPDS., Conclusions: These scales will be particularly useful for nonpsychiatric medical personnel. We recommend routine application of the GHQ 6 to 8 weeks after miscarriage to identify women who may require psychiatric management.