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Background: Primary health care (PHC) professionals may play a crucial role in improving early diagnosis of depressive disorders. However, only 50% of cases are detected in PHC. The most widely used screening instrument for major depression is the Patient Health Questionnaire (PHQ), including the two-, eight- and nine-item versions. Surprisingly, there is neither enough evidence about the validity of PHQ in PHC patients in Spain nor indications about how to interpret the total scores. This study aimed to gather validity evidence to support the use of the three PHQ versions to screen for major depression in PHC in Spain. Additionally, the present study provided information for helping professionals to choose the best PHQ version according to the context. Methods: The sample was composed of 2579 participants from 22 Spanish PHC centers participating in the EIRA-3 study. The reliability and validity of the three PHQ versions for Spanish PHC patients were assessed based on responses to the questionnaire. Results: The PHQ-8 and PHQ-9 showed high internal consistency. The results obtained confirm the theoretically expected relationship between PHQ results and anxiety, social support and health-related QoL. A single-factor solution was confirmed. Regarding to the level of agreement with the CIDI interview (used as the criterion), our results indicate that the PHQ has a good discrimination power. The optimal cut-off values were: ⩾2 for PHQ-2, ⩾7 for PHQ-8 and ⩾8 for PHQ-9. Conclusions: PHQ is a good and valuable tool for detecting major depression in PHC patients in Spain. [ABSTRACT FROM AUTHOR]

Background: Evidence of post-traumatic stress disorder (PTSD) symptoms related to the COVID-19 pandemic during the perinatal period and the associated risk factors are still limited. Thus, we aimed to investigate the PTSD symptoms associated with the COVID-19 pandemic in a large sample of both pregnant and postpartum women. Methods: A cross-sectional study was conducted on 3319 pregnant and up to 6-month postpartum women from Spain. An online survey was completed between June 2020 and January 2021. The assessment included measures of PTSD symptoms associated with COVID-19 (evaluated with 10 questions from the PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), pandemic-related concerns and health background (assessed by the Coronavirus Perinatal Experiences—Impact Survey), and demographic characteristics. Results: We found that >40% of women suffered from symptoms of PTSD associated with the COVID-19 pandemic. Difficulty concentrating and irritability were the most common symptoms, showing marked alterations in arousal and reactivity associated with the traumatic event. Being younger, suffering from pandemic concerns and distress, changes due to the pandemic and previous mental health problems were risk factors associated with PTSD symptoms in perinatal women. In addition, whereas being an immigrant (non-Spanish) was a risk factor for pregnant women, having other children and financial problems were risk factors for postpartum women. COVID-19 infection did not appear to be a risk factor for symptoms of PTSD in perinatal women. Conclusions: The increased risk of PTSD in pregnant and postpartum women highlights the importance of early detection and treatment of PTSD for pregnant and postnatal women, both during and beyond the pandemic. Trial Registration: ClinicalTrials.gov Identifier (NCT04595123). [ABSTRACT FROM AUTHOR]

Background: The use of online questionnaires to assess common mental disorders such as perinatal anxiety has spread due to the proliferation of Internet-based psychological interventions and research. This study analyses the validity and reliability of the online version of the Generalized Anxiety Disorder-7 (GAD-7) in a sample of pregnant and postpartum Spanish women., Method: A total of 3082 pregnant (n = 1260) and postpartum (n = 1822) women were recruited via the Internet and underwent three follow-up evaluations during a six-month period., Results: A one-factor solution was assigned by Exploratory Factor Analysis and confirmed by Confirmatory Factor Analysis for both pregnant (CFI = 0.998; RMSEA = 0.035) and postpartum (CFI = 0.998; RMSEA = 0.038) women. The one-factor model showed strict invariance across groups. Validity was confirmed by assessing correlations between GAD-7, the Edinburgh Postnatal Depression Scale, and the 10-item Posttraumatic Stress Disorder checklist at three time points. The reliability coefficient was .92 for the two groups., Conclusions: This study shows that the Spanish online GAD-7 version has good psychometric properties and can be used to assess anxiety symptoms during the perinatal period.

Background: The current COVID-19 pandemic is a unique stressor with potentially negative consequences for pregnant and postpartum women. We investigated the impact of the COVID-19 pandemic on perinatal depression and anxiety in Spain., Method: This cross-sectional study was conducted from June to December 2020. A total of 3,356 adult pregnant and postpartum women (with infants up to 6 months of age) from all Spanish regions were surveyed. The assessment included measures of Coronavirus Perinatal Experiences (COPE-IS questionnaire) and Generalized Anxiety Disorder Screener (GAD-7=10) and Edinburgh Postnatal Depression Scale (EPDS=10)., Results: The prevalence of perinatal anxiety and depression (above established cut-offs) was 33.3% and 47.2%, respectively; 29.2% of women screened positive for both conditions. Higher rates of perinatal depression and anxiety were associated with increased concern about threats of COVID-19, especially employment and the financial impact, along with increased overall levels of distress. Exposure to COVID-19 and its symptoms did not appear to be a relevant risk factor. More COVID-19-related predictors and a higher rate of depression were found in postpartum women., Conclusions: The current study highlights the substantial increase in symptoms of perinatal depression and anxiety, especially in postpartum women. Interventions for perinatal mental health should be a priority.

Though many studies have explored the association between single-risk lifestyle interventions and depression, unhealthy lifestyle factors often co-occur, with adults engaging in two or more risk behaviours. To date, little is known about the effectiveness of universal multiple-risk lifestyle interventions to reduce depressive symptoms. We conducted a SR/MA to assess the effectiveness of universal multiple-risk lifestyle interventions (by promoting a healthy diet, physical activity and/or smoking cessation) to reduce depressive symptoms in adults. We searched MEDLINE, Scopus, CENTRAL, PsycINFO, WOS, OpenGrey, the ICTRP and other sources from inception to 16 September 2019. We selected only randomized controlled trials, with no restrictions on language or setting. Our outcome was the reduction of depressive symptoms. We calculated the standardized mean difference using random-effect models. Sensitivity, sub-group and meta-regression analyses were performed. Of the 9386 abstracts reviewed, 311 were selected for full-text review. Of these, 23 RCTs met the inclusion criteria, including 7558 patients from four continents. Twenty RCTs provided valid data for inclusion in the meta-analysis. The pooled SMD was -0.184 (95% CI, -0.311 to -0.057; p = 0.005). We found no publication bias, but heterogeneity was substantial (I 2  = 72%; 95% CI: 56% to 82%). The effectiveness disappeared when only studies with a low risk of bias were included. The quality of evidence according GRADE was low. Although a small preventive effect was found, the substantial heterogeneity and RCTs with lower risk of bias suggested no effectiveness of universal multiple-risk lifestyle interventions in reducing depressive symptoms in a varied adult population. Further evidence is required., Competing Interests: Declaration of competing interest The authors declare they have no conflicts of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)