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Bipolar Disorder (BD) is a chronic psychiatric condition with somatic morbidity that requires continuous mood stabilizing treatment to prevent relapses. Pregnant women with BD have shown an increased rate of caesarean section (C-Section) in comparison with women without BD. Because specific differentiated profiles between mothers with BD that require C-Section and those that do not require C-Section have not been largely discussed, we aim to explore the risk factors associated with the type of delivery in pregnant women with BD. A prospective cohort study was conducted at the Perinatal Mental Health Unit. 100 pregnant women with BD were followed throughout their pregnancy by obstetric and psychiatric services at the same hospital. The cohort was developed in order to compare psychiatric and obstetric outcomes between women with BD that required C-Section (N = 40) versus women that did not require C-Section (N = 60). Final regression models showed an increased risk for obstetric complications during labour (OR 4,52, 95% CI 1,66–12,29), higher rates of hypothyroidism (OR 3,73, 95% CI 1,04–13,73) and treatment with lithium + antidepressant (OR 4,24, 95% CI 1,34–13,40) amongst the C-Section group when compared to the non-C-Section group. In our sample, women with BD treated with lithium plus antidepressant, with hypothyroidism and without obstetric complications have a 70,5% probability of C-Section. In conclusion, psychopharmacology and thyroid function might help understanding which women with BD will have more probability of C-Section. The implementation of more targeted interventions in selected patients might be useful to avoid complications during delivery.

Objectives: A previous individual participant data meta-analysis (IPDMA) identified differences in major depression classification rates between different diagnostic interviews, controlling for depressive symptoms on the basis of the Patient Health Questionnaire-9. We aimed to determine whether similar results would be seen in a different population, using studies that administered the Edinburgh Postnatal Depression Scale (EPDS) in pregnancy or postpartum. Methods: Data accrued for an EPDS diagnostic accuracy IPDMA were analysed. Binomial generalised linear mixed models were fit to compare depression classification odds for the Mini International Neuropsychiatric Interview (MINI), Composite International Diagnostic Interview (CIDI), and Structured Clinical Interview for DSM (SCID), controlling for EPDS scores and participant characteristics. Results: Among fully structured interviews, the MINI (15 studies, 2,532 participants, 342 major depression cases) classified depression more often than the CIDI (3 studies, 2,948 participants, 194 major depression cases; adjusted odds ratio [aOR] = 3.72, 95% confidence interval [CI] [1.21, 11.43]). Compared with the semistructured SCID (28 studies, 7,403 participants, 1,027 major depression cases), odds with the CIDI (interaction aOR = 0.88, 95% CI [0.85, 0.92]) and MINI (interaction aOR = 0.95, 95% CI [0.92, 0.99]) increased less as EPDS scores increased. Conclusion: Different interviews may not classify major depression equivalently., This study was funded by the Canadian Institutes of Health Research (CIHR, KRS-140994). Ms. Levis was supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship Doctoral Awards. Ms. Rice was supported by a Vanier Canada Graduate Scholarship. Dr. Wu was supported by an Utting Postdoctoral Fellowship from the Jewish General Hospital, Montreal, Quebec, Canada. Ms. Azar was supported by a Fonds de recherche du Québec - Santé (FRQS) Masters Training Award. Mr. Bhandari was supported by a studentship from the Research Institute of the McGill University Health Centre. The primary study by Alvarado et al. was supported by the Ministry of Health of Chile. The primary study by Barnes et al. was supported by a grant from the Health Foundation (1665/608). The primary study by Beck et al. was supported by the Patrick and Catherine Weldon Donaghue Medical Research Foundation and the University of Connecticut Research Foundation. The primary study by Helle et al. was supported by the Werner Otto Foundation, the Kroschke Foundation, and the Feindt Foundation. Prof. Robertas Bunevicius, MD, PhD (1958–2016) was principal investigator of the primary study by Bunevicius et al. but passed away and was unable to participate in this project. The primary study by Couto et al. was supported by the National Counsel of Technological and Scientific Development (CNPq; Grant 444254/2014-5) and the Minas Gerais State Research Foundation (FAPEMIG; Grant APQ-01954-14). The primary study by Chaudron et al. was supported by a grant from the National Institute of Mental Health (Grant K23 MH64476). The primary study by Figueira et al. was supported by the Brazilian Ministry of Health and by the National Counsel of Technological and Scientific Development (CNPq; Grant 403433/2004-5). The primary study by de Figueiredo et al. was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo. The primary study by Tissot et al. was supported by the Swiss National Science Foundation (Grant 32003B 125493). The primary study by Fernandes et al. was supported by grants from the Child: Care Health and Development Trust and the Department of Psychiatry, University of Oxford, Oxford, UK, and by the Ashok Ranganathan Bursary from Exeter College, University of Oxford. Dr. Fernandes was supported by a National Institute for Health Research (NIHR) academic clinical fellowship. The primary study by Tendais et al. was supported under the project POCI/SAU-ESP/56397/2004 by the Operational Program Science and Innovation 2010 (POCI 2010) of the Community Support Board III and by the European Community Fund FEDER. The primary study by Fisher et al. was supported by a grant under the Invest to Grow Scheme from the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs. The primary study by Garcia-Esteve et al. was supported by Grant 7/98 from the Ministerio de Trabajo y Asuntos Sociales, Women's Institute, Spain. The primary study by Howard et al. was supported by the NIHR under its Programme Grants for Applied Research Programme (Grants RP-PG-1210-12002 and RPDG-1108-10012) and by the South London Clinical Research Network. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The primary study by Phillips et al. was supported by a scholarship from the National Health and Medical and Research Council (NHMRC). The primary study by Roomruangwong et al. was supported by the Ratchadaphiseksomphot Endowment Fund 2013 of Chulalongkorn University (CU-56-457-HR). The primary study by Naki c Radoš et al. was supported by the Croatian Ministry of Science, Education, and Sports. The primary study by Navarro et al. was supported by Grant 13/00 from the Ministry of Work and Social Affairs, Institute of Women, Spain. The primary study by Usuda et al. was supported by Grants-in-Aid for Young Scientists (A) from the Japan Society for the Promotion of Science (primary investigator: Daisuke Nishi, MD, PhD) and by an Intramural Research Grant for Neurological and Psychiatric Disorders from the National Center of Neurology and Psychiatry, Japan. Dr. Robertson-Blackmore was supported by a Young Investigator Award from the Brain and Behavior Research Foundation and NIMH Grant K23MH080290. The primary study by Rochat et al. was supported by grants from University of Oxford (HQ5035), the Tuixen Foundation (9940), the Wellcome Trust (082384/Z/07/Z and 071571), and the American Psychological Association. Dr. Rochat receives salary support from a Wellcome Trust Intermediate Fellowship (211374/Z/18/Z). The primary study by Rowe et al. was supported by the diamond Consortium, beyondblue Victorian Centre of Excellence in Depression and Related Disorders. The primary study by Comasco et al. was supported by funds from the Swedish Research Council (VR: 521-2013-2339, VR: 523-2014-2342), the Swedish Council for Working Life and Social Research (FAS: 2011-0627), the Marta Lundqvist Foundation (2013, 2014), and the Swedish Society of Medicine (SLS-331991). The primary study by Prenoveau et al. was supported by the Wellcome Trust (Grant 071571). The primary study by Stewart et al. was supported by Professor Francis Creed's Journal of Psychosomatic Research Editorship fund (BA00457) administered through University of Manchester. The primary study by Su et al. was supported by grants from the Department of Health (DOH94F044 and DOH95F022) and the China Medical University and Hospital (CMU94-105, DMR-92-92, and DMR94-46). The primary study by Tandon et al. was supported by the Thomas Wilson Sanitarium. The primary study by Tran et al. was supported by the Myer Foundation who funded the study under its Beyond Australia scheme. Dr. Tran was supported by an early career fellowship from the Australian National Health and Medical Research Council. The primary study by Vega-Dienstmaier et al. was supported by Tejada Family Foundation, Inc. and Peruvian-American Endowment, Inc. The primary study by Yonkers et al. was supported by a National Institute of Child Health and Human Development grant (5 R01HD045735). Drs. Benedetti and Thombs were supported by FRQS researcher salary awards.

This article describes an interview exploring the social, psychological and psychiatric events in a single pregnancy and puerperium. It has been in development since 1992 and is now in its 6th edition. It takes approximately 2 h to administer and has 130 compulsory probes and 185 ratings. It is suitable for clinical practice, teaching and research.

The Postpartum Bonding Questionnaire (PBQ) was developed to assess mother-infant bonding disturbances in the postpartum period. The aim of this study was to examine the psychometric properties of the Spanish version of the PBQ in a sample of Spanish postpartum women. Eight hundred forty mothers were recruited in the postpartum visit (4-6 weeks after delivery): 513 from a gynecology unit (forming the general population sample) and 327 mothers from a perinatal psychiatry program (forming the clinical sample). All women were assessed by means of the Edinburgh Postnatal Depression Scale (EPDS) and the PBQ. Neither the original four-factor structure nor alternative structures (Reck et al. 2006; Wittkowski et al. 2010) were replicated by the confirmatory factor analyses. An exploratory factor analysis showed a four-factor solution. The Schmid-Leiman transformation found a general factor that accounted for 61% of the variance of the PBQ. Bonding impairment showed higher associations with depressive symptomatology in both samples. The Spanish version of the PBQ showed adequate psychometric properties for use with clinical and general populations of Spanish postpartum women. The results suggest that the PBQ could be summarized by a general factor and confirm the utility of the use of the total score for detecting bonding impairment.

Background Long-acting injectable (LAI) antipsychotics provide some advantages in treatment compliance of psychotic disorders. However, information about their effects during pregnancy is still very limited. We expose a clinical case of aripiprazole LAI use in a pregnant woman diagnosed of schizophrenia. Methods A non-systematic review using Pubmed was conducted using the following terms: schizophrenia, pregnancy, aripiprazole and aripiprazole LAI. A clinical record review was performed for the clinical case report. Results We report the case of a 30-year-old woman diagnosed of schizophrenia. She required several hospital admissions in the past because of the mental disorder and the lack of treatment adherence, what was the consequence of having no insight of illness and her pregnancy desires. She was initially treated with risperidone, suffering from some adverse effects like prolactine elevation and amenorrhea. In the last hospital admission, she started treatment with aripiprazol 20mg, having a good tolerability and being finally changed into aripiprazole LAI 400mg/28days. No incidences were reported and stability was achieved. After five months, she became pregnant and started being followed up in the Perinatal Mental Health Unit that belongs to the same hospital. The severity of the mental disorder and her stability at that moment made psychiatrists; obstetricians and patient decide to keep the antipsychotic treatment with subsequent appointments. The goal was to supervise psychopathology and blood tests during pregnancy. Prolactine was in physiologic levels and there were no obstetric complications. She finally delivered at 41 gestational weeks to a 3465g baby girl (Apgar 1’: 9 Apgar 5’: 10). No neonatal complications were reported. The Stafford interview was also administered in order to explore her social, obstetric and psychological background as well as possible psychiatric complications due to pregnancy and puerperium. No psychiatric complications were reported. Postpartum Bounding Questionnaire was also administered. No bounding disorder was detected. Discussion Pregnancy and postpartum are periods that carry a high risk of illness onset or recurrence in women with severe mental disorders, such as schizophrenia. Having a good control of the symptoms may prevent from risks to both patient and child, due to the important influence that exists on the development of the baby and the mother-infant relationship.

This study aims to examine the extent to which a variety of pre-delivery factors (demographic, reproductive, psychological, psychiatric, and psychopathological) predict disturbances in mother–infant bonding (MIB) in the postpartum period. Two hundred fifty-one pregnant women enrolled at a public perinatal psychiatric service were assessed between the first and second trimester of pregnancy and at 6–7 weeks after delivery. During pregnancy, the psychological risk factors were assessed with the Vulnerable Personality Style Questionnaire, the Marital Adjustment Scale, the Early Trauma Inventory, and the General Health Questionnaire. To detect psychopathology, the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory were used. At the postpartum evaluation, MIB was measured by the Postpartum Bonding Questionnaire. The results of the final regression model showed that emotional abuse in childhood, family psychiatric history, previous psychiatric hospitalization, and anxiety during pregnancy were significant predictors of MIB disturbances in postpartum, explaining 10.7% of the variance. The evaluation of women’s risk factors in pregnancy is important in order to prevent MIB disturbances and thus to ensure the welfare of mothers and their babies.

Objective This study aims to examine whether a first-trimester strategy of secondary prevention for preeclampsia increases anxiety in pregnant women. Methods The anxiety levels of a cohort of women screened for preeclampsia at first trimester were measured by the Spielberg State–Trait Anxiety Inventory (STAI-S) and compared between women screened as low and high risk. In a subgroup of women, the anxiety levels were additionally measured at second and third trimester. A General Linear Model (GLM) for repeated measurements was performed to adjust for potential confounders (age, nulliparity and socio-economic level). Results A total of 255 women (135 low-risk and 120 high-risk) were evaluated. No differences were found in the mean STAI-S scores between low-risk and high-risk women: 35 (SD 9.9) and 34.6 (SD 10.1); p = 0.77. The proportion of women with high anxiety was not significantly different between groups (28/134 [20.7%] vs 24/120 [20%]; p = 0.88). No differences were found in the subgroups (51 low-risk and 50 high-risk) in which the anxiety levels were also measured at second and third trimester: 35.8 (SD 8.8) vs 35.2 (SD 9.7), p = 0.74, and 37.2 (SD 9.4) vs 35.3 (SD 8.6), p = 0.3. These differences remained non-significant after adjustment for potential confounders. Conclusion A strategy of first-trimester screening for preeclampsia does not increase maternal anxiety. © 2014 John Wiley & Sons, Ltd.

The aim of this study was to examine the relationship between intimate partner violence (IPV) and personality disorder symptoms controlling for depressive state. Victims of IPV (n = 176) and non-abused women (n = 193) completed the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ), Index of Spouse Abuse (ISA), and Beck Depression Inventory-II (BDI-II). IPV victims scored higher than non-abused women on Intimacy Problems, and scored lower on Rejection traits, after adjustment for depressive symptoms. Severity of the IPV was related to Cognitive Distortion, Suspiciousness, Restricted Expression, and Intimacy Problems, and the length of the IPV was negatively associated with Rejection. The current study suggests only modest differences in personality traits between IPV and non-abused women. The DAPP-BQ traits associated with severity of IPV, in a dose-response manner, would partially reflect the symptoms of complex post-traumatic stress disorder (CPTSD), although this possibility deserves further study.

Childhood abuse is a powerful risk factor for developing postpartum depression in adulthood, and recently it has been associated to thyroid dysfunction in postpartum depressive women. The purpose of this study was to investigated the effects of childhood abuse on thyroid status and depressive symptomatology in two hundred and thirty-six (n=236) postpartum women 24-48h after delivery. The Early-Trauma-Inventory Self-Report was used to assess the presence of childhood abuse and the Edinburgh Postpartum Depression Scale (EPDS) to evaluate depressive symptomatology (EPDS≥11). Free thyroxin (fT4) and thyroid-stimulating hormone (TSH) were measured. Thyroid dysfunction (TD) was defined as altered TSH or TSH and fT4. Socio-demographic, reproductive, and psychopathological variables were also collected. Multivariate analysis shows that childhood physical abuse increases by four times the risk for TD (OR: 3.95, 95% CI: 1.23-12.71) and five times the risk for depressive symptomatology (OR: 5.45, 95% CI: 2.17-13.66) in the earlier postpartum. Our findings suggest that women with history of childhood physical abuse are particularly at-risk for thyroid dysfunction and depressive symptomatology 24-48h after delivery. The assessment of childhood abuse in the perinatal period is important to identify women at-risk for physical and mental health problems in this period.

PURPOSE: To carry out a systematic review of the association between maternal and school-age children depression and covariate factors. DESIGN AND METHODS: The key words maternal depression, depressed children, and school-age key words were searched in Medline, Lilacs, Scielo, IndexPsi, and PsycInfo (2004–2010). Clinical and community cross-sectional and longitudinal studies were included. A qualitative checklist was used. FINDINGS: Thirty studies were included (21.926 dyads). The results supported the association, showing several modulators: family environment, marital adjustment, social support, depression symptoms, and children-related variables. Limitations were nonrandom samples, single informants, and nondepression diagnosis. PRACTICE IMPLICATIONS: Identifying mothers with depression may be useful for prevention and early detection of school-age children's depression.

The aims were to study the validity and test-retest reliability of the Early Trauma Inventory—Self Report (ETI-SR) and its short-form (ETI-SF), which retrospectively assess different childhood trauma, in a sample of Spanish postpartum women. A total of 227 healthy postpartum women completed the ETI-SR and ETI-SF. The longitudinal, expert, all data procedure was used as the external criterion for the assessment of childhood trauma. The ETI-SR and ETI-SF were also administered to a sample of 102 postpartum depressive women (DSM-IV) and the results were compared with those of the healthy postpartum sample. The area under the curve values of the ETI-SR and ETI-SF were 0.77 (95% confidence interval [CI], 0.71–0.84) and 0.78 (95% CI, 0.72–0.85), the internal consistencies of the 2 scales were 0.79 and 0.72, and the intraclass correlation coefficients were 0.92 (95% CI, 0.80–0.97) and 0.91 (95% CI, 0.78–0.96), all respectively. The ETI-SR and ETI-SF had higher test-retest reliability on all subscales. The ETI-SR and ETI-SF are shown to be valid and reliable instruments for assessing childhood trauma in postpartum women.

The Vulnerable Personality Style Questionnaire (VPSQ) is a nine-item self-report scale developed to asses personality traits which increase the risk of postpartum depression. The aim of the present study was to examine the psychometric properties of the Spanish version of the VPSQ in a sample of postpartum women. A cohort of 309 postpartum women was followed up for 32 weeks after delivery. All women were assessed with the Spanish version of the VPSQ, the Eysenck Personality Questionnaire-R Short Scale, the Frost Multidimensional Perfectionism Scale and the harm avoidance dimension of the Temperament and Character Inventory at 2-3 days postpartum. Depressive symptoms were evaluated at 8 and 32 weeks after delivery by the Edinburgh Postnatal Depression Scale, and a diagnostic interview was used to confirm the presence of major depression disorder. Factor analysis results revealed the unidimensionality of the Spanish version of the VPSQ. Cronbach's alpha coefficient for the VPSQ total score was 0.63. The test-retest reliability indicated a good temporal stability (ICC = 0.88; 95% confidence interval (CI) = 0.82-0.91). A moderate association between the VPSQ and other personality measures provided evidence for its construct validity. Logistic regression analyses showed that women with higher scores on the VPSQ had a higher risk of developing depressive symptoms (OR = 1.20; 95% CI = 1.11-1.29) and major depression (OR = 1.16; 95% CI = 1.07-1.26) throughout the 32 weeks after delivery. Overall, our results suggest adequate psychometric properties of the Spanish version of the VPSQ and its usefulness in identifying women with a personality style that increases the risk of developing postpartum depression.

OBJECTIVE: The aim of this study was to investigate the association between early life events in women with postpartum major depression and concomitant hypothalamus-pituitary-thyroid axis disturbances (HPTD), thyroid dysfunction or presence of thyroid antibodies. METHODS: Serum total tri-iodothyronine (TT3), free thyroxin (FT4), Thyroid-stimulating hormone (TSH), Thyroperoxidasa (TPOAb) and Thyroglobulin (TGAb) autoantibodies was measured in 103 major postpartum depressive women. HPTD was defined as TSH and/or T4 abnormal, presence of thyroid autoantibodies and alterations of TT3. All women were assessed with a psychiatry structured interview for DSM-IV. Early Trauma Inventory Self Report, sociodemographic, reproductive, psychosocial and psychopathological variables were also assessed. RESULTS: Sixty three percent of women had suffered childhood trauma, which was childhood sexual abuse in 27.2%. Childhood sexual abuse in postpartum major depression women increased the risk for thyroid dysfunction (OR=5.018, 95%CI=1.128-22.327), presence of thyroid autoantibodies (OR=2.528; 95%CI=1.00-6.39) and HPTD (OR=2.955; 95%CI=1.191-7.32). Moreover, age over 34 (OR=12.394; 95%CI=1.424-107.910) and previous postpartum depression (OR=8.470; 95%CI=1.20-59.43) increased the risk for thyroid dysfunction in postpartum depression. LIMITATIONS: The study design does not allow us to know the direction of the association and there is a lack of previous assessment of current posttraumatic stress disorder. CONCLUSIONS: According to the present findings, childhood sexual abuse may represent an important risk factor for the presence of thyroid autoantibodies and HPTD in women with postpartum depression. Language: en

Background Postnatal psychiatric morbidity is a frequent and serious complication of childbirth. The aim of the present study was to determine the prevalence and co-occurrence of DSM-IV psychiatric disorders in a community sample of postpartum Spanish mothers. Methods A two-phase cross-sectional study was conducted in which all consecutive women attending the routine 6-week postnatal control visit at the Department of Obstetric and Gynecology of a university-affiliated hospital over a one year period were included. In the first phase, 1453 women were screened with the Edinburgh Postnatal Depression Scale (EPDS). In the second phase, 428 participants stratified according to employment status and EPDS outcomes were randomly selected within each stratum for clinical psychiatric evaluation using the Structured Clinical Interview for DSM-IV. Weighted prevalence estimates were obtained for DSM-IV disorders with or without comorbidity. Results The overall 6-week prevalence rate for postpartum psychiatric disorders was 18.1% (95% CI 15.0–21.8) and 2.0% (95% CI 1.2–2.9) of postpartum women met criteria for more than one disorder. Mood disorders was the most prevalent group (9.8%; 95% CI 7.9–12.1) followed by adjustment disorders (4.3%; 95% CI 3.0–6.3), and anxiety disorders (4%; 95% CI 3.0–6.3). Comorbidity was associated to major depressive disorder. Limitations Underestimation of some disorders due to the cross-sectional design and the use of a screening instrument with good psychometric characteristics restricted to depression, anxiety, and adjustment disorders. Conclusions In the context of a 6-week postnatal visit, a high prevalence and heterogeneity of postnatal psychiatric morbidity in a community sample of Spanish women was found.

The goal of this study was to identify sociodemographic, psychopathological, and obstetric risk factors associated with postnatal depression (PND) and their relative weight. A cross-sectional two-stage design was used. All consecutive women receiving a routine check-up 6 weeks postpartum at Obstetric Services during a 1-year period were included. In the first stage, women completed the Edinburgh Post-natal Depression Scale (EPDS). In the second stage, mothers with EPDS scoresor =9 and a randomized sample of 16% with EPDS9 were explored through a structured clinical interview to diagnose DSM-IV PND (major and minor depression). Variables were entered into stepwise regression models. A total of 1,201 women were recruited and did the EPDS; 261 women with EPDS scoresor =9 and 151 with EPDS scores9 were selected. Three hundred and thirty-four women agreed to be interviewed and 100 were diagnosed with PND. Family caregiver role (defined as women who have to take care of handicapped or ill relatives) was associated with a 4.4-fold increase in risk for major PND (OR: 4.39, 95%CI: 1.10-17.38). Premenstrual syndrome was identified as an independent risk factor for major and minor PND (OR: 1.81, 95%CI: 1.03-3.18). Moreover, previous depression, poor partner relationship, and lower social support were also confirmed as risk factors for PND. Both family caregiver role and premenstrual syndrome should be considered for inclusion in the rating scales of pregnant women at risk for PND.

Objective To assess the validity of the 12-Item General Health Questionnaire (GHQ-12) and the Edinburgh Postnatal Depression Scale (EPDS) in screening for the most common postnatal psychiatric morbidities (mood, anxiety and adjustment disorders). Method A two-phase cross-sectional study was designed. First, a sample of 1453 women visiting at 6 weeks postpartum completed the GHQ-12 and the EPDS questionnaires. Second, based upon EPDS outcomes, participants were stratified and randomly selected within each stratum for clinical evaluation [Structured Clinical Interview for DSM-IV (SCID)]. Receiver operating characteristic (ROC) analysis was used. Results The concurrent validity was satisfactory (0.80). At optimum cut-off scores, both GHQ-12 and EPDS yielded very good sensitivity (80; 85.5) and specificity (80.4; 85.3), respectively. ROC curves showed that the performance of the EPDS (AUC=0.933) is slightly superior to that of GHQ-12 (AUC=0.904). Conclusion Both GHQ-12 and EPDS are valid instruments to detect postnatal depression as well as postnatal anxiety and adjustment disorders.

This study aims to examine the prevalence and characteristics of physical, emotional and sexual childhood abuse. It also examines whether other non-abuse types of childhood adversities related to maladaptive family functioning and separations during childhood can be used as markers for the presence of childhood abuse. Participants (N = 237) were women at 2–3 days after delivery that completed the Spanish-validated version of the Early Trauma Inventory Self Report (ETI-SR; Bremner, Bolus, & Mayer, 2007; Plaza et al., 2011), designed to assess the presence of childhood adversities. Results show that 29% of the women had experienced some type of childhood abuse, and 10% more than one type. Logistic regression analyses indicate that childhood parental death is a risk marker for childhood emotional abuse (OR: 3.77; 95% CI: 1.327–10.755; p OR: 3.72; 95% CI: 1.480–9.303; p < .005) and physical abuse (OR: 2.610; 95% CI: 1.000–6.812; p < .05) and that childhood family mental illness is a risk marker for childhood emotional (OR: 2.95; 95% CI: 1.175–7.441; p < .021) and sexual abuse (OR: 2.55; 95% CI: 1.168–5.580; p < .019). The high prevalence of childhood abuse indicates a need for assessment during the perinatal period. Screening for childhood family mental illness, parental substance abuse, and parental death - all identified risk factors for reporting childhood abuse - can help to identify women that should be assessed specifically regarding abuse.

This chapter has two objectives. First, it provides an overview of the state of the art of the assistance of postpartum depression (PPD) in the context of the Spanish Health System. Second, it describes a study aimed to explore the differences between Spanish and Spanish-speaking Latin American immigrant (LAI) mothers in terms of rates of PPD and health behaviors. LAI mothers are socioeconomically disadvantaged; they are younger, have less support from their partner, and have more economic problems than Spanish mothers. Seventeen percent of the LAI mothers will develop PPD, and 11 % a major depressive episode in the postpartum period. They have an increased risk of PPD and poorer reproductive health habits (unplanned pregnancies and induced abortions) than Spanish mothers, with the exception of the preference for breast-feeding. Given the vulnerability of LAI mothers living in Spain, efforts to address their psychosocial and perinatal mental health needs should be addressed by healthcare providers at all levels.

Postpartum depression (PPD), a disorder that has severe consequences for mother and child (Pearlstein, Howard, Salisbury, & Zlotnick, 2009), is the most common psychiatric disorder experienced by women after childbirth (McGarry, Kim, Sheng, Egger, & Baksh, 2009), with a prevalence of ~7% during the first three postpartum months (O'Hara, 2009). While different biological (Albacar et al., 2011; Brummelte & Galea, 2010; Leung & Kaplan, 2009) and genetic (Costas et al., 2010; Mahon et al., 2009; Sanjuan et al., 2008; Treloar, Martin, Bucholz, Madden, & Heath, 1999) factors have been associated with PPD, most researchers have identified a history of affective disorder, depressive episodes and anxiety during pregnancy as the principal risk factors for PPD (O'Hara, 2009; Oppo et al., 2009). Social and psychological factors such as marital discord, low social support, stressful life events and lack of marital support have been strongly associated with PPD in several studies (Beck, 2001; Chen, 2001; O'Hara, 2009), and unemployment, which has been associated with depression in the general population (Stankunas, Kalediene, Starkuviene, & Kapustinskiene, 2006), has been specifically associated with PPD (Chen, 2001; Inandi et al., 2002; Jardri et al., 2006; Lane et al., 1997; Miyake, Tanaka, Sasaki, & Hirota, 2011; Posmontier, 2008; Rubertsson, Wickberg, Gustavsson, & Radestad, 2005; Warner, Appleby, Whitton, & Faragher, 1996). However, the results of studies on the impacts of other social variables such as income (Miyake et al., 2011) and the mother’s level of education (Beck, 2001; Josefsson et al., 2002; Kozinszky et al., 2011; Miyake et al., 2011) are controversial. A recent study in Japan found that full-time employment and professional or technical employment significantly reduced the risk of PPD, leading researchers to claim that it is likely that a

Although perfectionism from a multidimensional perspective has generally been associated with depressive illness, there are not many studies on its role in major depression in the postnatal period. The aim of the present study was to explore the relationship between perfectionism dimensions using the Frost Multidimensional Perfectionism Scale (FMPS) and major postpartum depression.One-hundred-twenty-two women with major postpartum depression (SCID-I; DSM-IV) and 115 healthy postpartum women were evaluated using the FMPS, an instrument for the assessment of six perfectionism dimensions: concern over mistakes, personal standards, parental expectations, parental criticism, doubt about actions and organisation. Other variables were also considered: neuroticism, psychiatric history, social support, life events and genotype combinations according to serotonin transporter expression (5-HTTLPR and Stin2 VNTR polymorphisms).The prevalence of high-perfectionism was higher in major postpartum depression group than in control group (34% vs. 11%; p0.001). Multivariate models confirmed high-perfectionism as an independent factor associated with major postpartum depression. Specifically, the high-concern over mistakes dimension increased over four-fold the odds of major depression in postpartum period. (OR=4.14; 95% CI=1.24-13.81) Neuroticism, personal psychiatric history and 5-HTT low-expressing genotypes at one of the loci were also identified as independent factors.High-perfectionism, and particularly high-concern over mistakes is a personality dimension associated with major postpartum depression. The inclusion of perfectionism assessment, together with others factors, may be considered in order to improve the detection of women at risk of postpartum depression, in whom early intervention may be of benefit.

The EPDS is a 10-items self-report scale designed as a specific instrument to detect postnatal depression. It was validated in the UK and in other countries, but not in Spain.We report data from all women (n=1201) attending in a routine postnatal check-up at 6 weeks postpartum during 1 year. A two-stage method was used: for the first stage, all individuals selected completed the EPDS; in the second one, 'probable cases' (n=261) with EPDS score/=9, and a randomised sample of 10% with EPDS score less than 9 (n=126) were interviewed by a psychiatrist using the Structured Clinical Interview for DSM-IV, non-patient (SCID-NP), to establish psychiatric diagnosis of major and minor depression.The best cut-off of the Spanish validation of the EPDS was 10/11 for combined major and minor depression, the sensitivity was 79%, and specificity was 95.5%, with a positive predictive value of 63.2% and a negative predictive value of 97.7%. At this cut-off all cases of major depression were detected. The area under the ROC curve was 0.976 (P0.0001) with an asymptotic interval of confidence of 95% between 0.968 and 0.984.Our data confirm the validity of the EPDS to identify postnatal depression in its Spanish version. The cut-off 10/11 for major and minor combined depression is useful to screen for a posterior psychiatric evaluation in Spanish sample.