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Background: The postpartum period is critical for maternal health status after childbirth. The traditional Chinese postpartum confinement practice, "doing-the-month", is considered especially effective in helping mothers recover during the postpartum period. However, research has not provided evidence to confirm its benefits. Postpartum depression is a common postpartum disease that seriously threatens maternal health. The systematic review aims to explore the association between "doing-the-month" and postpartum depression in the Chinese female population and to provide a scientific foundation for evidence-based postpartum maternal care., Methods: Five databases (PubMed, Embase, Web of Science, Scopus, Cochrane, PsycINFO, and Web of Science) were searched according to the protocol (INPALSY202320102). The JBI assessment tool was used to assess the quality of the included studies., Results: Sixteen quantitative studies from China and Chinese female immigrants in other countries, including 15 cross-sectional studies and 1 randomized controlled study, were identified. Four studies indicated that "doing-the-month" rituals reduced postpartum depression risk while 2 studies showed opposite results; 10 studies did not show a significant association between "doing-the-month" practices and postpartum depression., Conclusion: There is conflicting evidence regarding the association between "doing-the-month" and the likelihood of developing postpartum depression. Some studies have explored the impact of family ties, particular rituals, and specific stressors during the postpartum period on the occurrence of postpartum depression in Chinese women. According to current research, "doing-the-month" practice failed to show a significant protective effect on postpartum depression in the Chinese maternal population. Evidence-based medical health education for the Chinese postpartum female community is urgently needed., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Yang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Postpartum depression explains various groups of depressive symptoms and syndromes that can take place during the first 6 weeks following birth. The postpartum period is a critical time where both mild and severe mood disorders can occur. The familiar forms are baby blues and postpartum depression. Understanding the prevalence and associated factors of postpartum depression is mandatory for early detection and treatment., Methods: Institution based cross-sectional study was conducted from 1st May to June 30, 2018. The study participants were eligible women who came to Debre Berhan referral hospital and health centers for postnatal care and vaccination service. The Edinburgh postnatal depression scale was used to assess postpartum depression. A systematic random sampling technique was used to collect the data after determining the skip fraction (k = 2). The collected data were coded and entered into Epi-info version 7 and transported to SPSS version 20 for analysis. Both bivariate and multivariate binary logistic regression were done to identify associated factors. During bivariate analysis, variables with p-value < 0.05 were included in multivariate analysis. Odds ratios and their 95% confidence intervals were computed and variables with p-value less than 0.05 were considered to declare significantly associated factors (multivariate analysis)., Results: A total of 308 mothers who attended postpartum care we're included, which was a 100% response rate. The prevalence of postpartum depression was found to be 15.6% (95%CI = 11.7, 19.8). Being widowed/widower, having poor social support, having a current hospitalized child, and experienced a death of family member or close relative were significantly associated with postpartum depression., Conclusions: The prevalence of postpartum depression was lower than most studies done in different areas. Major life events and traumas are associated with an increased risk of postpartum depression. Health professionals should be aware of the mother's circumstances during the puerperium, they should initiate support to reduce the risk of depression in the postpartum period. Health care professionals working postpartum care clinics should give special attention to mothers who are widowed/widower, have poor social support, have a current hospitalized children, and experienced a death of family member or close relative.

Postpartum depression (PPD) is a major public health problem affecting 10-57% of adolescent mothers which can affect not only adolescent mothers but also their infants. Thus, there is a need for interventions to prevent PPD in adolescent mothers. However, recent systematic reviews have been focused on effective interventions to prevent PPD in adult mothers. These interventions may not necessarily be applicable for adolescent mothers. Therefore, the purpose of this review was to examine the effectiveness of the existing interventions to prevent PPD in adolescent mothers. A systematic search was performed in MEDLINE, CINAHL, and SCOPUS databases between January 2000 and March 2017 with English language and studies involving human subjects. Studies reporting on the outcomes of intervention to prevent PPD particularly in adolescent mothers were selected. Non-comparative studies were excluded. From 2002 identified records, 13 studies were included, reporting on 2236 adolescent pregnant women. The evidence from this systematic review suggests that 6 of 13 studies from both psychological and psychosocial interventions including (1) home-visiting intervention, (2) prenatal antenatal and postnatal educational program, (3) CBT psycho-educational, (4) the REACH program based on interpersonal therapy, and (5) infant massage training is successful in reducing rates of PPD symptoms in adolescent mothers in the intervention group than those mothers in the control group. These interventions might be considered for incorporation in antenatal care interventions for adolescent pregnant women. However, this review did not find evidence identifying the most effective intervention for preventing postpartum depression symptoms in adolescent mothers.

Aims and Objectives: To describe experienced child and family health nurses' clinical decision-making during a postnatal psychosocial assessment., Background: Maternal emotional well-being in the postnatal year optimises parenting and promotes infant development. Psychosocial assessment potentially enables early intervention and reduces the risk of a mental disorder occurring during this time of change. Assessment accuracy and the interventions used are determined by the standard of nursing decision-making., Design: A qualitative methodology was employed to explore decision-making behaviour when conducting a postnatal psychosocial assessment., Methods: This study was conducted in an Australian early parenting organisation. Twelve experienced child and family health nurses were interviewed. A detailed description of a postnatal psychosocial assessment process was obtained using a critical incident technique. Template analysis was used to determine the information domains the nurses accessed, and content analysis was used to determine the nurses' thinking strategies, to make clinical decisions from this assessment., Results: The nurses described 24 domains of information and used 17 thinking strategies, in a variety of combinations. The four information domains most commonly used were parenting, assessment tools, women-determined issues and sleep. The seven thinking strategies most commonly used were searching for information, forming relationships between the information, recognising a pattern, drawing a conclusion, setting priorities, providing explanations for the information and judging the value of the information., Conclusion: The variety and complexity of the clinical decision-making involved in postnatal psychosocial assessment confirm that the nurses use information appropriately and within their scope of nursing practice. The standard of clinical decision-making determines the results of the assessment and the optimal access to care., Relevance to Clinical Practice: Knowledge of the information domains and the decision-making strategies that experienced nurses use for psychosocial assessment potentially improves practice by providing a framework for education and mentoring., (© 2018 John Wiley & Sons Ltd.)

Background: Previous research has demonstrated that making music can enhance positive emotions as well as support positive psychological functioning. However, studies tend to be limited by lack of comparison with other psychosocial interventions. This study builds on a three-arm randomised controlled trial (RCT) that demonstrated that group singing for mothers and babies, but not group creative play, can lead to faster recovery from moderate-severe symptoms of postnatal depression than usual care. The aim was to elucidate the mechanisms of the group singing intervention in order to account for its recovery properties., Methods: Qualitative research was conducted with 54 mothers who had experienced symptoms of postnatal depression. Mothers completed a 10-week programme of either group singing or group creative play as part of the wider RCT study. Data were collected via a series of 10 semi-structured focus groups conducted at the end of each 10-week programme. These were designed to elicit subjective and constructed experiences of the singing and play interventions and were analysed inductively for emergent themes., Results: Five distinctive features of the group singing emerged: (i) providing an authentic, social and multicultural creative experience, (ii) ability to calm babies; (iii) providing immersive 'me time' for mothers; (iv) facilitating a sense of achievement and identity; (v) enhancing mother-infant bond., Conclusions: Community group singing interventions may reduce symptoms of postnatal depression through facilitating a functional emotional response rooted in the needs of new motherhood. These features are of relevance to others seeking to implement creative interventions for maternal mental health., Trial Registration: NCT02526407 . Registered 18 August 2015.

Purpose: to estimate the prevalence of depression at 4-week postpartum using the Edinburgh postpartum Depression Scale (EPDS) in women who delivered in a public maternity hospital in Argentina., Methods: This prospective cohort study was carried out from March to August 2016 in northwest Argentina. Eligibility included delivering a singleton live birth 28 weeks of gestational age or over, 18 years or older and resided within 1h from the maternity hospital. Women were excluded if they or their newborn were in the intensive care unit. We defined a positive screening as an EPDS score of 10 or higher or a positive response to item 10, which indicates thoughts of self-harm., Results: A total of 587 women were enrolled and 539 women completed the home visit interview and the EPDS. A total of 167 (31.0%, 95% CI 27.1-35.1) mothers screened positive in the EPDS using a score ≥ 10 and 99 (18.4%, 95% CI 15.1-21.6%) using a score ≥ 13, which indicate increased severity of depressive symptoms. In both cases, the 23 (4.3%) women that responded as having thoughts of self-harm were included., Conclusion: Nearly a third of women who participated had depressive symptoms at four weeks postpartum in a public hospital in Tucumán, Argentina. Socio-demographic, particularly personal psychiatric history, factors and social and cultural influences can impact results. Our results highlight the need for improved screening and better diagnostic tool for women with postpartum depression in Argentina and to investigate the impact of postpartum depressive symptoms on women's health and their families., (Copyright © 2017 Elsevier B.V. All rights reserved.)

This article summarizes the specific treatment options in the combined mother-child treatment for women with postpartum psychiatric disorders. The incidence of postpartum mental illness is high, especially for postpartum depression that probably occurs in10-15 % of cases. Mental disorders not only have a negative impact on the mental health of the women affected, such as chronification and suicidal tendencies but can also adversely affect the mother-child relationship as well as the emotional and cognitive development of the child. For these reasons it is important, also under the aspects of a primary prevention with respect to the children of mentally ill mothers, to provide a needs-oriented, timely and disorder-specific interactional therapy, which also considers the long-term aspects of treatment. At the Celenus Klinik Carolabad in Chemnitz an integrated treatment model, the "Carola PLUS", could be established that caters for the particularly high demands of combined care and treatment for both mother and child.

This article explores expositions of subjectivity in accounts of postnatal depression (PND). It examines the public narratives of 19 Australian women contributing to a health information website (healthtalkaustralia.org), collected across two Australian qualitative research studies conducted between 2011 and 2014. For the first part of the paper we analysed narrative data using a combination of phenomenological and psychoanalytic techniques. We found that postnatal distress was described in embodied, relational terms and that women depicted their distress as a pre-verbal intrusion into 'known' selves. We interpreted this intrusion as a doubly relational phenomenon - informed at once by a woman's encounter with her infant and her 'body memory' of earlier relational experiences. For the second part we examined how and why women classified this relational distress as PND. We drew on illness narrative literature and recent work on narrative identity to explore why women would want to 'narrate PND' - an apparently antithetical act in an environment where there is a duty to be a good (healthy) mother. We highlight the dual purpose of the public PND narration - as a means of re-establishing a socially sanctioned known self and as a relational act prompted by the heightened relationality of early maternity. Our focus on the salutary aspects of narrating PND, and its links to relational maternal subjectivities, offers a novel contribution to the current literature and a timely analysis of a largely uninterrogated sociocultural phenomenon., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Most interventions to prevent postpartum depression (PPD) focus on the mother rather than the mother-infant dyad. As strong relationships between infant sleep and cry behavior and maternal postpartum mood have been demonstrated by previous research, interventions targeted at the dyad may reduce symptoms of PPD. The goal of the current study was to examine the effectiveness of Practical Resources for Effective Postpartum Parenting (PREPP). PREPP is a new PPD prevention protocol that aims to treat women at risk for PPD by promoting maternally mediated behavioral changes in their infants, while also including mother-focused skills. Results of this randomized control trial (RCT) (n = 54) indicate that this novel, brief intervention was well tolerated and effective in reducing maternal symptoms of anxiety and depression, particularly at 6 weeks postpartum. Additionally, this study found that infants of mothers enrolled in PREPP had fewer bouts of fussing and crying at 6 weeks postpartum than those infants whose mothers were in the Enhanced TAU group. These preliminary results indicate that PREPP has the potential to reduce the incidence of PPD in women at risk and to directly impact the developing mother-child relationship, the mother's view of her child, and child outcomes.

Aims: To examine the relationship between specific reasons for stopping breastfeeding and depressive symptoms in the postnatal period., Background: Difficulty breastfeeding has been connected to postnatal depression although it is unclear whether difficulty breastfeeding precedes or succeeds a diagnosis. However, the concept of 'breastfeeding difficulty' is wide and includes biological, psychological and social factors., Design: A cross-sectional self-report survey., Methods: Data were collected between December 2012 and February 2013. 217 women with an infant aged 0-6 months who had started breastfeeding at birth but had stopped before 6 months old completed a questionnaire examining breastfeeding duration and reasons for stopping breastfeeding. They further completed a copy of the Edinburgh Postnatal Depression Scale., Results: A short breastfeeding duration and multiple reasons for stopping breastfeeding were associated with higher depression score. However, in a regression analysis only the specific reasons of stopping breastfeeding for physical difficulty and pain remained predictive of depression score., Conclusions: Understanding women's specific reasons for stopping breastfeeding rather than breastfeeding duration is critical in understanding women's breastfeeding experience and providing women with emotional support. Issues with pain and physical breastfeeding were most indicative of postnatal depression in comparison to psychosocial reasons highlighting the importance of spending time with new mothers to help them with issues such as latch., (© 2015 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: Psychosocial assessment and depression screening are recommended for all pregnant and postnatal women in Australia. However, women who give birth in private maternity settings remain less likely to participate in psychosocial assessment programs, making it difficult to comment on the potential resource implications., Aims: To describe the psychosocial profile of a sample of women who had recently given birth in a private hospital and to examine the acceptability and feasibility of introducing psychosocial assessment as a routine component of maternity care., Materials and Methods: Two hundred and twenty participants were recruited in a four-month period from a private tertiary hospital located in Murdoch, Western Australia. All participants completed the Edinburgh Depression Scale (EDS) and a Antenatal Risk Questionnaire (ANRQ) prior to discharge via an iPad., Results: The mean total score for the EDS was 4.77 (SD = 3.93), with 5% of women scoring above the recommended cut-off of 13 or more. The mean total score for the ANRQ was 17.73 (SD = 10.72). 45.0% of all women endorsed no significant risk factors. The proportion of women scoring above the recommended ANRQ cut-off of 23 or more was 32.3%. Approximately 11% of women were referred for additional support or treatment. Acceptability of the ANRQ was high at 97.3%., Conclusions: This study describes the psychosocial profile of a sample of women who recently gave birth in an Australian private maternity hospital and demonstrates that with additional resources, the implementation of psychosocial assessment as a routine component of maternity care was feasible and highly acceptable in this setting., (© 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Aim: The purpose of the study was to investigate whether an intervention which focused on enhancing the quality of the mother-infant relationship would prevent the development of postnatal depression (PND) and the associated impairments in parenting and adverse effects on child development., Background: Recent meta-analyses indicate modest preventive effects of psychological treatments for women vulnerable to the development of PND. However, given the strong evidence for an impact of PND on the quality of the mother-infant relationship and child development, it is notable that there are limited data on the impact of preventive interventions on these outcomes. This is clearly a question that requires research attention. Accordingly, a randomised controlled trial (RCT) was conducted of such a preventive intervention., Methods: A large sample of pregnant women was screened to identify those at risk of PND. In an RCT 91 were randomly assigned to receive the index intervention from research health visitors, and 99 were assigned to a control group who received normal care. In an adjacent area 76 women at risk of PND received the index intervention from trained National Health Service (NHS) health visitors. The index intervention involved 11 home visits, two antenatally and nine postnatally. They were supportive in nature, with specific measures to enhance maternal sensitivity to infant communicative signals, including items from the Neonatal Behavioral Assessment Scale. Independent assessments were made at 8 weeks, 18 weeks, and 12 and 18 months postpartum. Assessments were made of maternal mood, maternal sensitivity in mother-infant engagement, and infant behaviour problems, attachment and cognition., Findings: The RCT revealed that the index intervention had no impact on maternal mood, the quality of the maternal parenting behaviours, or infant outcome, although there were suggestions, on some self-report measures, that those with a lower level of antenatal risk experienced benefit. This was also the case for the intervention delivered by trained NHS health visitors. The findings indicate that the approach investigated to preventing PND and its associated problems cannot be recommended.

Pregnancy and new motherhood may be crisis and vulnerability periods and therefore increase the risk of psychiatric disorders. Liaison psychiatry plays a major role in the first psychiatric evaluation of mothers in order to specify a diagnosis and to initiate a treatment when necessary. This article describes the care of mothers suffering from peripartum psychiatric disorders by the liaison psychiatry in the maternity ward, an outpatient practice, as well as an in-patient care unit where mother and baby can stay together. The multidisciplinary approach and its constellation around the mother-baby dyad are detailed and two clinical cases are reported.

In the western world, most women deliver their infants in a hospital setting. The purposes of this article are to provide guidelines and suggest best practices related to hospital-based care for postpartum depression by perinatal nurses; with this information, policies, procedures, and educational programs can be implemented to improve nursing care of new mothers. Hospital-based perinatal nurses need to "launch" new mothers from the hospital into the community so that the new mothers are prepared for self-monitoring for symptoms of depression, and know what steps to take if they do experience depressive symptoms.

Background: Maternal, neonatal and child health outcomes are worse in families from black and ethnic minority groups and disadvantaged backgrounds. There is little evidence on whether lay support improves maternal and infant outcomes among women with complex social needs within a disadvantaged multi-ethnic population in the United Kingdom (UK)., Method/design: The aim of this study is to evaluate a lay Pregnancy Outreach Worker (POW) service for nulliparous women identified as having social risk within a maternity service that is systematically assessing social risks alongside the usual obstetric and medical risks. The study design is a randomised controlled trial (RCT) in nulliparous women assessed as having social risk comparing standard maternity care with the addition of referral to the POW support service. The POWs work alongside community midwifery teams and offer individualised support to women to encourage engagement with services (health and social care) from randomisation (before 28 weeks gestation) until 6 weeks after birth. The primary outcomes have been chosen on the basis that they are linked to maternal and infant health. The two primary outcomes are engagement with antenatal care, assessed by the number of antenatal visits; and maternal depression, assessed using the Edinburgh Postnatal Depression Scale at 8-12 weeks after birth. Secondary outcomes include maternal and neonatal morbidity and mortality, routine child health assessments, including immunisation uptake and breastfeeding at 6 weeks. Other psychological outcomes (self efficacy) and mother-to-infant bonding will also be collected using validated tools.A sample size of 1316 will provide 90% power (at the 5% significance level) to detect increased engagement with antenatal services of 1.5 visits and a reduction of 1.5 in the average EPDS score for women with two or more social risk factors, with power in excess of this for women with any social risk factor. Analysis will be by intention to treat. Qualitative research will explore the POWs' daily work in context. This will complement the findings of the RCT through a triangulation of quantitative and qualitative data on the process of the intervention, and identify other contextual factors that affect the implementation of the intervention., Discussion: The trial will provide high quality evidence as to whether or not lay support (POW) offered to women identified with social risk factors improves engagement with maternity services and reduces numbers of women with depression. MREC NUMBER: 10/H1207/23, Trial Registration Number: ISRCTN: ISRCTN35027323.

Emotional processing and cortisol were investigated in non-depressed young adults whose mothers experienced PND. PND-exposed participants (n=11) had higher waking salivary cortisol and slower performance on an emotional categorization task than controls (n=15). This supports the hypothesis that early exposure to maternal depression is associated with characteristics reminiscent of vulnerability to depression., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Purpose: Postpartum depression (PPD) is a significant public health problem, with significant consequences for the mother, infant, and family. Available research has not adequately examined the potential impact of sociodemographic characteristics, such as place of residence, on risk for PPD. Therefore, this systematic review and meta-analysis examines the prevalence of and risk factors for PPD in rural communities within developed and developing countries, and where possible, compares rates to those among urban women., Methods: Five databases were searched, from start dates through early May 2010, using key words relevant to PPD and rural residence. Peer-reviewed articles were eligible if a standardized assessment of depression was administered to rural mothers within the first year postpartum. Data on PPD were extracted from 19 articles, of which 17 provided data for meta-analyses., Findings: The overall prevalence of PPD among rural women was 27.0% (95% CI, 18.8%-37.2%). Prevalence was somewhat higher among women in developing countries (31.3%; 95% CI, 21.3%-43.5%) than among women in developed countries (21.5%; 95% CI, 10.9%-38.0%), although there was significant heterogeneity among both groups of studies. Comparisons between rural and urban women yielded conflicting results. Although established PPD risk factors were associated with depression in rural women, additional risk factors were reported for rural women from developing countries, such as having 2 or more young children., Conclusions: Longitudinal studies with clearly defined "rural" and "comparison" groups are needed to determine whether rural residence is associated with increased risk for PPD. The results can inform prevention and treatment programs tailored to serve rural women., (© 2010 National Rural Health Association.)

Background: Maternal depression can be detrimental to infant development. Structured home visiting initiated either in pregnancy or soon after the birth by a professional has led to better outcomes for mothers and their children but some vulnerable families may respond more favourably to a local volunteer. The value of volunteer support provided in the UK by Home-Start for maternal well-being is noted in qualitative studies, but there is no evidence of its impact from trials. The support is not structured and both the frequency and content of visits may vary., Methods: A cluster randomized study allocated Home-Start local schemes to intervention or control conditions. Mothers in all areas were screened at routine health checks in late pregnancy. In intervention areas names of those scoring 9+ on the Social Disadvantage Screening Index were passed to Home-Start to be offered a volunteer. Not all those offered the support accepted the offer. In control areas no support was offered. Research assessments were conducted at 2 and 12 months. The outcomes were major or minor depression occurring between 2 and 12 months (Structured Clinical Interview for Diagnostic and Statistical Manual - Third Edition - Revised) and depression symptoms at 12 months (Edinburgh Postnatal Depression Scale). Three groups were compared: supported, case-matched controls and those offered but not receiving support., Results: Almost one-third experienced depression during the time period. Volunteer support had no identifiable impact on the emergence of maternal depression from 2 to 12 months or on depression symptoms when infants were 12 months. The major predictor of both was depression identified at 2 months., Conclusions: It was not found that informal support initiated following screening for disadvantage in pregnancy reduced the likelihood of depression for mothers with infants.

Objectives: Postpartum depression (PPD), a major health concern, produces insidious effects on new mothers, their infant, and family. This literature review aims to explore risk factors for postpartum depression among women in Asian cultures, which has not been fully elaborated., Data Sources: A literature search was undertaken by using various electronic research databases. Studies were eligible for this review if they (a) examined risk factors for PPD, (b) were conducted in Asian countries using quantitative or qualitative methodologies, and (c) were published in English in peer-reviewed journals between 1998 and 2008. A total of 64 studies from 17 countries were reviewed, summarised, and synthesised., Results: The prevalence of postpartum depression in Asian countries ranged from 3.5% to 63.3% where Malaysia and Pakistan had the lowest and highest, respectively. Risk factors for postpartum depression were clustered into five major groups: biological/physical (e.g., riboflavin consumption), psychological (e.g., antenatal depression), obstetric/paediatric (e.g., unwanted pregnancy), socio-demographic (e.g., poverty), and cultural factors (e.g., preference of infants' gender). Traditional postpartum rituals were not found to provide substantial psychological benefits for the new mothers., Conclusions: This review informs a current state of knowledge regarding risk factors for postpartum depression and has implications for clinical practice. Health care professionals should be aware that the phenomenon is as prevalent in Asian cultures as in European cultures. Women should be screened for potential risk factors and depressive symptoms during pregnancy and postpartum periods so that appropriate interventions, if needed, can be initiated in a timely fashion.

Sociocultural patterning of the postnatal period in non-Western settings has been hypothesised to protect against postnatal depression. In 2004, in a predominantly rural area of Ethiopia, we conducted 25 in-depth interviews and five focus group discussions with purposively selected participants including perinatal women, fathers, grandmothers, traditional and religious leaders, birth attendants and community leaders. Our main objectives were (1) to examine societal recognition of problematic distress states in the postnatal period and relate this to Western conceptualisations of postnatal depression and (2) to relate the occurrence of distress states to sociocultural patterning of the postnatal period. Inductive analysis was employed to identify salient themes. Participants spontaneously described culturally problematic distress states occurring in the postnatal period, although did not consider them to be illness. Vulnerability and danger of the postnatal period was emphasised, with risk of supernatural attack and physical harm leading to distress states. Participants also spoke of how gender disadvantage and economic strain intersect with cultural patterning of the postnatal period, threatening mental health due to the resulting disappointed expectations and exclusion, as well as exacerbation of pre-existing problems. Cultural dissonance, where a person's beliefs or actions are out of kilter with strong prevailing cultural norms, may be an important risk factor for postnatal distress in rural Ethiopia, where the postnatal period is extensively culturally elaborated.

Objective: To explore awareness of postpartum depression and its symptoms and available community resources for women with postpartum depression., Design: Cross-sectional surveillance research, using population-based data., Setting: Eight communities in southern and eastern Ontario, Canada., Participants: A random selection of adults 18 years of age and older with telephones., Method: Logistic regression and chi-square test were used to analyze awareness of postpartum depression and its symptoms, the baby blues, and sources of assistance for women with postpartum depression., Results: The vast majority of respondents were aware of postpartum depression (90.1% +/- 0.6% confidence interval) (n=8,750) as compared with the baby blues (62.5% +/- 1.1%). Awareness of postpartum depression, its symptoms, the baby blues, and sources of assistance varied according to the demographic profiles of the respondents (family structure, education, and language spoken at home)., Conclusion: Awareness of the term postpartum depression does not necessarily imply awareness of its symptoms or sources of assistance. Public education is needed to address this fact in order to provide social support and encourage treatment for symptomatic women and their families. Education should target individuals with lower levels of education and non-English-speaking groups.

Objective: To determine the relationship between the traditional Chinese practice of postpartum care, known as zuoyuezi, and postpartum depression (PPD) in China., Methods: A total of 342 Chinese women were surveyed 6- to 8-weeks post partum using the Edinburgh Postnatal Depression Scale (EPDS) and items assessing sociodemographics, health history, peripartum experiences, zuoyuezi, and social support., Results: Prevalence of PPD was 15.5% (EPDS cutoff >or=13). PPD was associated with lower income, difficult pregnancy experience, poor infant health status, not attending childbirth classes, and low spousal involvement before and after delivery. Among the 96% of women who practiced zuoyuezi, those for whom the caregiver was her mother-in-law or who perceived zuoyuezi as unhelpful had twice the odds of PPD., Conclusion: These data highlight the importance of the peripartum experience in assessing PPD risk. Zuoyuezi is still commonly practiced in urban China, and further research is needed to explore its role in the potential prevention of PPD.

Utilizing an ethnographic narrative approach, we explored in the Canadian context the experiences of three groups of first-generation Punjabi-speaking, Cantonese-speaking, and Mandarin-speaking immigrant women with depression after childbirth. The information emerging from women's narratives of their experiences reveals the critical importance of the sociocultural context of childbirth in understanding postpartum depression. We suggest that an examination of women's narratives about their experiences of postpartum depression can broaden the understanding of the kinds of perinatal supports women need beyond health care provision and yet can also usefully inform the practice of health care professionals.

Postpartum depression is a serious disorder that affects many women globally. Studies have shown that cultural factors play a significant role in postpartum depression; they may trigger postpartum depression as well as contribute to the alleviation of its depressive symptomatology. The cultural aspects of the postpartum period have been described in the literature; however, the impact of cultural factors upon postpartum depression has been less investigated, and studies that looked at this association have yielded oppositional conclusions. In addition, the literature is inconclusive as to whether there are significant differences among various cultures in the prevalence of postpartum depression. The purpose of this literature review is to identify and critically review published and unpublished studies regarding the effect of cultural factors on the alleviation or deterioration of postpartum depression. Results show that cultures have different rituals and beliefs that may affect the severity of postpartum depression.

Our objective in this qualitative study was to investigate the acceptance and experience of treatment for postnatal depression (PND). Fifteen women who had received treatment and support from the community mental health service for PND were interviewed. Interviews were transcribed verbatim and then analyzed using the modified analytic induction method. The majority of women interviewed had reached "crisis point" before they sought and received treatment. The stigma attached to an inability to cope and being a "bad mother" emerged as the main barrier to seeking help earlier. In addition, women were unable to differentiate between "normal" levels of postpartum distress and depressive symptoms that might require intervention. Talking about their distress and experiences, both with health professionals and other mothers, was regarded as of primary importance in the recovery process.

This article presents a case study of a new mother experiencing postpartum depression and altered attachment with her newborn. Theories related to postpartum depression and maternal-newborn attachment are reviewed, and evidenced-based strategies for care are discussed in the context of the case.

Purpose of Review: The postpartum period is a time of significant emotional, social, and physical change for most women. This review focuses on recent evidence supported by systematic reviews and randomized, controlled trials to guide the care of postpartum women who are otherwise healthy., Recent Findings: Mental health outcomes are improved with postpartum support in at-risk women. Postpartum depression can be treated either pharmacologically or with counseling; however, exercise and omega-3 fatty acids are emerging as potentially effective alternatives. Intrauterine devices are safe and effective methods of contraception in the postpartum period. There has yet to be an effective, postpartum, smoking-cessation program developed, although intensive motivational counseling shows some promising early results. Bladder dysfunction continues to be a significant problem for women even at 10 years postpartum. Pelvic floor muscle exercises can help prevent and treat incontinence at 12 months, but longer-term follow-up studies are needed. Prevalence studies suggest that bowel dysfunction is common in the postpartum period, but randomized, controlled trials are limited to treatment in women with third-degree perineal damage., Summary: Although some recommendations can be made for evidence-based postpartum care, many important questions related to the postpartum period have not been examined by rigorous methodologies.

Objective: To assess the support needs, support resources, barriers to support, and preferences for support intervention for women with postpartum depression., Design: Multisite, exploratory, descriptive study in which qualitative data were collected on support needs, the availability of resources, perceived barriers to support, and preferences for support of women who have experienced symptoms of postpartum depression., Participants and Setting: Conducted in Alberta and New Brunswick; mothers were interviewed individually (Alberta, n= 24; New Brunswick, n= 17) and in groups (Alberta, n= 5; New Brunswick, n= 6)., Results: For most mothers, one-on-one support was preferred when postpartum depression is recognized. Group support should be available once the mothers start to feel better and are able to comfortably interact with other mothers in a group format. This suite of alternatives needs to be underpinned by concerted public education efforts.

Background: To reach the Millennium Development Goals, maternal health-promoting behaviours need to be encouraged after childbirth; little is known about the health-promoting behaviour among first-time mothers during their postpartum period., Aim: To examine levels of engagement in health-promoting behaviours and related factors among postpartum women in Taiwan., Methods: This cross-sectional study was conducted through a convenience sample of 122 qualified women. Participants self-completed a questionnaire and mailed it back using a stamped, self-addressed envelope from July to September 2003. Instruments of this study included a demographic questionnaire as well as three Likert-type scales: the Health Promotion Lifestyle Profile scale, the Edinburgh Postnatal Depression scale and a self-developed social support scale., Results: The average overall Health Promotion Lifestyle Profile score was low (mean, 2.83 SD 1.35), with exercise rated lowest among the six subscales. Postpartum women perceived that they had high levels of social support from their mothers-in-law, mothers and husbands. An astonishing 42.6% of women experienced postnatal depression. Based on results of multiple regressions, 25% of the variance in health-promoting lifestyle practices was explained by postpartum depression and social support. Social support was found to predict all subscales significantly except exercise. Postpartum depression can significantly predict self-actualization, interpersonal relationships, nutrition and stress management. All modifying factors were excluded from the regression model., Conclusions: This study validates the theoretical relationships among concepts in the Health Promotion Model. Nursing interventions are recommended which are tailored to enhance women's social support and decrease their depression to promote their pursuit of healthy lifestyles., Relevance to Clinical Practice: This study highlights the implications of social support to nursing practice, especially in Chinese culture which has a strict ritual during a women's postpartum period. Findings of this study provide information and data for service planning and community care to support postpartum care in the communities.

Due to the high incidence of postpartum mental illness [postpartum depression (PPD): 10-15%], joint mother-baby treatment is the state-of-the-art, especially in Anglo-Saxon countries. The joint treatment furthermore allows the unique possibility of primary prevention for the high risk group, the children of the postpartum affected mothers, to be used. Compared to other European countries the development of German mother-baby units (MBUs) is delayed due to the higher uncovered costs of treatment, which result from treatment of the mother-baby relationship and the instructions in baby care for the mother. The committee "Qualitätssicherung in der Mutter-Kind-Behandlung" of the German section of the international Marcé-Society contacted all 470 psychiatric institutions in Germany with the goal of achieving an overview concerning the MBUs. A total of 173 institutions answered of which 83 gave an affirmative answer as far as mother-child treatment is concerned. All in all 157 treatment possibilities (134 inpatient and 24 day clinic) were recorded. From the number of treatment possibilities in England and assuming that all MBUs in Germany were recorded, only 21% of the necessary mother-child therapy places are covered.

There have been significant studies commenting on the postnatal experience and the emotional well-being of mothers following the birth of their child. This paper focuses on the emotional well-being and health beliefs of Bangladeshi mothers during this period. An attempt was made to understand if postnatal depression was recognised, how it was interpreted and to explore the effect it has on the well-being of the mother, her family and the wider community. A qualitative approach was used to explore the values and views of the mothers by means of a focus group interview. Ten mothers who resided in Wales and were brought up within a Muslim community participated in the study. Findings suggest that when mothers experienced emotional issues they sought the support of their family, friends and religious leaders, and, although familiar with some primary care services, they were not always their first point of contact. It is proposed that health visitors could discuss their role, particularly in relation to perinatal mental health, with the Bangladeshi mothers. This may help the mothers to access support and services. It is important for health visitors to understand the significance of cultural diversity and the competing interpretations of postnatal depression and also to recognise why mothers might seek alternative methods to manage their health during the ante and postnatal period.

There is now evidence to support the antidepressant effects of exercise in general and in clinical populations. This article reviews the evidence regarding the potential role of exercise, particularly pram walking, as an adjunctive treatment for postpartum depression. Database searches revealed two small randomised controlled trials conducted in Australia which support exercise as a useful treatment for women with postpartum depression. In addition, uncontrolled studies and observational evidence suggest that postpartum women, some of whom were depressed, report benefit from participation in exercise programmes. There are plausible mechanisms by which exercise could have such an effect. Limited evidence supports a relationship between participation in exercise and reduction in postpartum depression. Given the reluctance by some women to use antidepressant medication postpartum and the limited availability of psychological therapies, exercise as a therapeutic possibility deserves further exploration. Further research using well-designed randomised controlled trial methodologies are warranted.

Objective: The aim of this study was to compare the effect of nursing intervention to the effect of problem solving training on the level of postpartum depressive symptom., Methods: We utilized a pretest-posttest mutual controlled semi experimental model for this study. The study consisted of 62 women (30 in care group and 32 in training group), all of who were at risk for postpartum depression, but without major depressive symptoms. These women were not undergoing pharmacologic or psychotherapeutic treatment, were all literate and consented to join the study in Erzurum, Turkey. Participants (N=62), recruited over a 9 month, were randomly assigned to one of two groups. Women in care group (average age=21, 33.3% primaparus) were given nursing care for her depressive symptoms. Women in training group (average age=25, 33.9% primaparus) were taught problem solving skills., Results: Depressive symptoms were assessed before and after nursing interventions. We found that nursing care was effective women for with depressive symptoms (McNemar test, p<0.001), and problem-solving training was also effective (McNemar test, p<0.05). When the effectiveness of nursing care and the problem solving education was compared utilizing the BDI, it was found out that the nursing care was more effective than education alone (t=4.529, p<0.05)., Conclusion: Results from this study suggest that nursing care and problem solving training may be use confidently in the primary care setting by nurses for women with postpartum depressive symptoms., Practice Implication: Nurses play on important role in its detection and can reduce depressive symptoms. Public health nurses are equipped with care paths addressing specific health needs of depressed women in the primary care setting. Our finding indicate that these two programs of study can converge with meaningful results, and perhaps future research could address these points in a theoretical framework.

As a rule, mothers are the primary caregivers of infants regardless of employment or marital status. Thus, any factors that impact mothering affect the infant and have public health significance. National attention is now focused on postpartum depression, a major variable affecting mothering. The impact of postpartum depression on the various components of the maternal role is described. Recommendations for health care practice include screening for depression across the first postpartum year and developing a strong network for mental health referrals., ((c) 2006, AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses)

The role of grassroots organizations in supporting new mothers is reviewed. Postpartum Support International is an organization that links pregnant and new families with mental health resources and is a key advocate for mental health services for childbearing women., ((c) 2006, AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses)

Postpartum depression (PPD) strikes about 1 in 10 Western women. Studies of Western women have demonstrated that this emotional experience can occur during pregnancy and/or after delivery, and even in women who adopt an infant. Is PPD a universal experience or a morbid condition that is culture specific to Western/industrialized countries? The purpose of this literature review was to examine other cultures to ascertain whether PPD is a universal experience. The literature describes women throughout the world experiencing degrees of sadness postnatally, which persist up to 1 year. The risk factors for PPD also share similar themes cross-culturally, with one notable exception--the impact that the sex of the infant had on PPD, for a higher value for male children over female offspring was reported in literature from China, Turkey, and India. This literature review demonstrated that, although PPD is an experience that women in all cultures experience, the underlying cause for this malady in non-Western cultures is not attributed to biologic causes, and treatment is not generally based on a Western medical model.

Objective: To determine the incidence of postpartum depressive symptomatology in a sample of immigrant Asian Indian women and to establish whether cultural factors such as arranged marriage or gender of the newborn are associated with differences in depression scores., Design: Quantitative, descriptive study., Setting: Ten private obstetric and pediatric offices in Northern California., Participants: A convenience sample of 58 self-selected immigrant Asian Indian women between 2 weeks and 12 months postpartum., Main Outcome Measure: Depressive symptomatology as measured by the 35-item self-report Postpartum Depression Screening Scale., Results: There was a minor depressive symptomatology rate of 28% and an additional major depressive symptomatology rate of 24%. No differences in depression scores were found with regard to arranged marriage or the gender of the newborn., Conclusions: Findings suggest that Asian Indian women living in the United States are just as likely to experience postpartum depressive symptomatology as White women. Therefore, it is critical to identify and refer women at risk for postpartum depression to ensure they do not become part of the 50% who remain undiagnosed. Health care providers need to become cognizant of the potential for postpartum depression and become skilled in the detection of this mood disorder.

The purpose of the study was to explore the association between depressive symptoms and social support in Taiwanese women doing the month. A correlational survey design using the Postpartum Social Support Questionnaire (PSSQ) and the Edinburgh Postnatal Depression Scale (EPDS) to measure social support and postnatal depressive symptomatology was employed. Two hundred and forty postpartum women receiving care in two teaching hospitals in Taipei, Taiwan, aged between 20 and 35, with no peri-natal complications or previous psychiatric history, experiencing a normal spontaneous delivery of one full term healthy baby, were selected. Each was mailed the PSSQ and the EPDS as well as a short, semi-structured self-report questionnaire requesting demographic details and subjective data relating to the experience of doing the month and depressive symptoms during the fourth week following birth. One hundred and eighty six women (78%) returned questionnaires. Taiwanese postpartum women were less depressed when they stayed in their parents' home and had their own mothers take care of them. It was found that the greater the level of postpartum social support received by the women doing the month, the lower the risk of postnatal depressive symptoms experienced. Almost a quarter (24%) of the variance of the symptoms was attributed to dissatisfaction with parents' instrumental support and unwanted emotional support from parents-in-law. It is concluded that the ritual of doing the month provides valuable social support and may help to prevent postnatal depression in Taiwanese women.

Reports of non-Western prevalence of postpartum depression (PPD) are highly variable. This variation may indicate that the label of PPD may be unacceptable in some groups or not used, that manifestations may vary by culture, or that cross-cultural diagnostic standards do not match Western clinical criteria. These factors complicate efforts to explore the relationship of postpartum traditional practices to PPD between Western and non-Western cultures. Although Stern and Kruckman viewed PPD as a culture-bound phenomenon of Western culture, an expanding international literature has demonstrated that PPD occurs in a variety of countries. To address these issues, the authors examined the literature to describe cultural postpartum traditions, to explore possible relationships among practices and PPD prevalence, to critique the culture-bound theory, and to discuss clinical practice implications.

Objectives: To investigate in an Australian study of immigrant women conducted 6-9 months following childbirth (a) the associations of a range of demographic, obstetric, health and social context variables with maternal depression, and (b) women's views of contributing factors in their experiences of depression., Design: Three hundred and eighteen Vietnamese, Turkish and Filipino women participated in personal interviews conducted by three bicultural interviewers in the language of the women's choice. Utilising three approaches to the assessment of maternal depression, the consistency of associations on the different measures is examined. Women's views of contributing factors are compared with previous research with largely English-speaking Australian-born women., Results: Analysis of the associations of maternal depression revealed considerable consistency in associations among the three approaches to assessing depression. Significant associations with depression on at least two of the measures were seen for: mothers under 25 years, shorter residence in Australia, speaking little or no English, migrating for marriage, having no relatives in Melbourne, or no friends to confide in, physical health problems, or a baby with feeding problems. There were no consistent associations found with family income or maternal education, method of delivery and a range of other birth events, or women's views about maternity care. The issues most commonly identified by women in this study as contributing to depression are similar to those found previously for Australian-born women: isolation (in this study, including being homesick)--29%; lack of support and marital issues--25%; physical ill-health and exhaustion--23%; family problems--19%, and baby-related issues--17%. There were some differences in the importance of these among the three country-of-birth groups, but all except family issues were in the top four contributing factors mentioned by women in all groups., Conclusions: These findings support the evidence for quite marked cross-cultural similarity in the associations of maternal depression and in women's views about their experiences.