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Uvod: Rojstvo otroka je za večino pozitiven dogodek v življenju, ki ga spremljajo sreča, veselje in ljubezen, kljub temu pa se kmalu po porodu pojavijo zahtevni in naporni dnevi. Psihična nestabilnost v tem obdobju je nekaj običajnega, kadar pa se pojavijo intenzivni simptomi, kot so jokavost, neprestana žalost, občutki krivde, jeze ter drugi neprijetni občutki, govorimo o poporodni depresiji. Obporodna depresija je velik javnozdravstveni problem, ki prizadene vsako šesto žensko v času nosečnosti ali po porodu. Samomor, kot posledica obporodne depresije, je en izmed najpogostejših vzrokov maternalne smrti. Namen: Namen preglednega diplomskega dela je pregledati strategije za odkrivanje obporodne depresije in preprečevanje njenih posledic, vključno s samomorom, ki se uporabljajo v Sloveniji. Metode dela: V diplomskem delu smo uporabili opisno oziroma deskriptivno metodo dela s pregledom literature. Varovalne dejavnike in dejavnike tveganja smo predstavili s sistematskim pregledom znanstvene literature. Viri so bili zbrani s pomočjo podatkovnih baz PubMed, Science Direct in mrežnika Google Učenjak. Strategije odkrivanja in preprečevanja obporodne depresije v Sloveniji smo predstavili na podlagi pregleda spletnih strani, strokovnih objav in dokumentov, povezanih z zdravjem žensk v nosečnosti in poporodnem obdobju. Rezultati: Depresija v osebni in družinski anamnezi ter predhodna obporodna depresija sta se izkazali za najpomembnejša dejavnika tveganja pojava obporodne depresije, depresija v času nosečnosti pa kot dodatni dejavnik tveganja za nastanek poporodne depresije. Prisotnost socialne podpore, predvsem s strani partnerja, pa se je izkazala kot ključen varovalni dejavnik obporodne depresije. Za preprečevanje, zgodnje odkrivanje ter zgodnje zdravljenje ima poleg upoštevanja varovalnih dejavnikov in dejavnikov tveganja velik pomen tudi izvajanje strategij preprečevanja obporodnih depresij. Promocija duševnega zdravja, dosledna uporaba presejalnih vprašalnikov za odkrivanje obporodnih depresij ter dostopna mreža služb za pomoč ob prisotnosti obporodne depresije so najpogostejše in najučinkovitejše strategije preprečevanja obporodnih depresij ter samomorov v Sloveniji. Razprava in zaključek: Dobro duševno zdravje nosečnice oziroma otročnice ima velik vpliv na žensko samo, otroka ter dobre medosebne odnose, zato je ob prisotnosti obporodne depresije ključno pravočasno diagnosticiranje ter takojšnje ukrepanje. V Sloveniji je še vedno premalo pozornosti namenjeno duševnemu zdravju nosečnic in otročnic, zato je nujno izvajanje in nadgrajevanje strategij preprečevanja obporodnih depresij ter upoštevanje in dosledno izvajanje priporočil projekta PODN glede izvajanja presejalnih testov s strani babic in ginekologov, saj bomo le tako pripomogli k preprečitvi in zgodnjemu odkrivanju obporodnih depresij. Introduction: For most people, a birth of a child is a positive experience accompanied by joy, happiness and love, but soon afterwards demanding and challenging days follow. Although emotional instability in this period is very common, the presence of intense symptoms, such as excessive crying, extreme sadness, guilt, anger, and other negative feelings, suggests a postpartum depression. Peripartum depression is a big public health issue, which on average affects one in six women during pregnancy and after giving birth. Suicide as a consequence of a peripartum depression is one of the leading causes of maternal deaths. Purpose: The purpose of this thesis is to review the strategies used in Slovenia, aiming diagnosis of peripartum depression and prevention of its negative consequences, including suicide. Methods: In this thesis, we used a descriptive method of literature review. Protective and risk factors were presented, based on a systematic overview of scientific literature. Publicly available databases,such as PubMed, Science Direct, and Google Scholar were used. The strategies of diagnosing and preventing peripartum depression in Slovenia are presented, based on the overview of websites, publications and documents related to women’s health during pregnancy and in the postpartum period. Results: Family and personal history of depression, as well as previous experience of peripartum depression have been proven to be the most important risk factors for peripartum depression, while depression during pregnancy is an additional risk factor for postpartum depression. On the other hand, the key protective factor against peripartum depression, is social support, especially from a partner. In addition to considering all the preventive and risk factors, early discovery and early treatment are crucial strategies for the prevention of peripartum depression. Mental-health promotion, consistent use of screening questionnaires in the process of peripartum-depression prevention, and an accessible combination of help services for coping with peripartum depression, are some of the most common and most efficient strategies used to prevent peripartum depressions and suicides in Slovenia. Discussion and conclusions: Good mental health of a pregnant woman or a neonatal mother has a significant effect on the woman herself, her child and her interpersonal relationships with others, therefore it is crucial to diagnose the presence of peripartum depression in time and to start treatment as soon as possible. In Slovenia, there is still not enough attention directed to the mental health of pregnant and neonatal women. Therefore, it is of extreme importance to use and further develop the strategies for peripartum-depression prevention and to abide by and consistently use the directions from the PODN project, recommending that midwives and gynaecologists perform screening tests with their patients, since this is the only way we can contribute to early detection and prevention of peripartum depression.

This is an editorial for the two newly published studies, Smythe et al. (2022) and Sultan et al (2022) which are systematic reviews dealing with the topic of perinatal mental health (i.e., mental health during the time of pregnancy up to 1 year after birth). Smythe et al. (2022) estimated prevalence rates of perinatal depression and anxiety in parental dyads and associated factors, while Sultan et al. (2022) examined the psychometric properties of 10 existing patient- reported outcome measures (PROM) for assessing maternal postpartum depression. They concluded that the Edinburgh Postnatal Depression Scale is the only receiving a class A recommendation or recommendation for use. Some implications and recommendations for future studies and clinical management of perinatal mental health difficulties are discussed and proposed.

Peripartum depression (PPD) is a severe illness that affects around 17% of pregnant and postpartum women worldwide. The repercussions of PPD are serious, with short-term and long-term adverse effects on both mother and child, including impaired maternal health, adverse pregnancy outcomes and difficulties in bonding and interacting with the newborn. Therefore, early detection of risk factors is of the utmost importance to develop targeted prevention and intervention programs that would reduce the symptom onset during the sensitive time of pregnancy and postpartum. Research has shown that PPD is a heterogeneous and multifaceted condition that derives from a combination of factors, including biological and psychosocial factors. Therefore, PPD should be explored within the biopsychosocial theoretical framework. However, although PPD research is increasingly turning towards a multidisciplinary approach, there is still a considerable paucity of integrative empirical studies. To better understand the precedents of PPD, we established an interdisciplinary longitudinal study aimed at investigating biological and psychosocial risk factors of peripartum depression symptoms. We aim to explore the interplay of indicators of serotonin system functioning (whole blood serotonin levels, polymorphisms and DNA methylation of 5-HTT gene, platelet serotonin uptake), indicators of metabolic functioning (pre- gestational body mass index, gestational weight gain, glucose tolerance status, blood metabolic parameters) and psychological factors (stress, general and pregnancy-specific anxiety, coping and social support) in predicting depression symptoms in late pregnancy, three, six, and twelve months postpartum. This presentation will outline the study design, describe the sample characteristics obtained to date, and discuss the implications for clinical practice.

Bakgrund: Föräldraskapet inkluderar fysiska och mentala utmaningar, vilket kan vara påfrestande för båda föräldrarna. Då peripartum depression (PPD) drabbar modern kan både föräldraskapet och upplevelsen av att vara förälder påverkas negativt. Faderns upplevelser av situationen då modern drabbas av PPD innebär ofta ett lidande även för honom, vilket är ett perspektiv som länge försummats. Syfte: Att beskriva fäders erfarenheter av föräldraskapet då modern drabbats av peripartum depression. Metod: En litteraturstudie innehållandes tio vetenskapliga artiklar av kvalitativ metod, utvalda genom systematiska sökningar i flera databaser. Analysen utfördes med en kvalitativ analysmodell, där jämförelser av likheter och skillnader genererade teman och subteman. Resultat: Fäderna påverkades främst av partnerns PPD genom att de upplevde utmaningar i faderskapet och behovet av stöd från samhället efterfrågades. Följande teman och subteman identifierades, (1) Utmaningar i faderskapet, subteman: Effekten av att inte vara förberedd, PPDs påverkan på familjelivet och Möjligheter till anknytning. (2) Samhällets inverkan, subteman: Stödbarriärer - Hinder att övervinna förnödvändigt stöd och Behovet av stöd och resurser. Konklusion: Ett begrepp genomsyrade studiens samtliga teman; barriärer. Fäder stötte på flera hinder som motverkade ambitionen att vara den fadersfigur de ville vara. Dessa barriärer har formats utifrån samhälleliga normer samtur ett vårdsystem som påvisar brister gällande kunskap och förståelse för PPDs inverkan på familjelivet, samt inkludering av fadern, den bortglömda föräldern. Background: Parenting includes physical and mental challenges, which can be stressful for both parents. As peripartum depression (PPD) affects the mother, both parenting and the experience of being a parent can be negatively affected. The fathers’ experiences of the situation when the mother suffers from PPD often mean suffering even for him, which is a perspective that has long been neglected. Aim: To describe fathers' experiences of parenthood when the mother suffered from peripartum depression. Method: A literature study involving ten scientific articles of qualitative method, selected through systematic searches in several databases. Analysis was carried out using a qualitative analysis model where comparisons of similarities and differences generated themes and sub themes. Result: Fathers were primarily affected by their partner’s PPD by experiencing challenges in paternity and the need for support from society was highlighted. Following themes and sub themes were identified, (1) Challenges in paternity, sub themes: The impact of not being prepared, PPD´s impact on family life and Opportunities for Attachment (2) Societal impact, sub themes: Support barriers – Obstacles to overcome for necessary support and The need for support and resources. Conclusion: A concept permeated all the themes of the study; Barriers. Fathers encountered several obstacles that thwarted the ambition to be the father figure they wanted to be. These barriers have been constructed by societal norms as well as from a care system that demonstrates a lack of knowledge and understanding of PPD's impact on family life and the inclusion of the father, the forgotten parent.

Background Peripartum depression in and after pregnancy are common, reported by 11.9% of women worldwide, and the proportion was even higher during the outbreak of coronavirus disease 2019 (COVID-19). We aimed to investigate the prevalence and risk factors of peripartum depression under the influence of COVID-19 in China. Methods Using a cross-sectional design, 2026 pregnant and postpartum women residing in Beijing, Wuhan, and Lanzhou of China were recruited from February 28 to April 9, 2020. The Patient Health Questionnaire-9 was used to assess their depressive symptoms. The women were divided into four subgroups based on pregnancy stage, and a binary logistic regression analysis was conducted on each subgroup. Results Under the influence of COVID-19, the prevalence rate of peripartum depression among Chinese women was 9.7%. It was 13.6, 10.8, 7.9 and 7.3% in the first, second, third trimester and puerperium, respectively. Regression analysis showed that the influence of current pregnancy status on movement (Mild vs. No, aORs were 3.89, P P = 0.003, 1.58, P = 0.150 in the three trimesters, respectively; Severe vs. No, aORs were 13.00, 20.45, 5.38 in the three trimesters, respectively, all P P Conclusions The prevalence rate of peripartum depression during the COVID-19 outbreak in China was not higher than usual. The influence of current pregnancy status on movement, as well as worries and fears about childbirth were independent risk factors for peripartum depression throughout pregnancy during COVID-19. The stage of pregnancy should be considered when implementing interventions.

Dissertação de Mestrado Integrado em Psicologia apresentada à Faculdade de Psicologia e de Ciências da Educação Background: A Depressão Periparto é a perturbação mental mais comum no período perinatal, traduzindo-se em consequências para mães e bebés. As técnicas de estimulação cerebral não invasivas e não convulsivas têm sido sugeridas como um tratamento eficaz na redução dos sintomas depressivos, durante este período. Objetivos: No presente estudo pretende-se rever estudos que aplicaram estas mesmas técnicas com o objetivo de reduzir a sintomatologia depressiva no período periparto. Métodos: Por forma a analisar a eficácia, segurança, aceitabilidade e o impacto nas funções neurocognitivas, foi conduzida uma pesquisa de literatura em quatro bases de dados (PUBMED, psycINFO, Web of Science e Lilacs), desde que há publicações até maio de 2020. Resultados: Vinte e cinco estudos foram incluídos e os dados de interesse extraídos de acordo com o protocolo previamente registado. Para além da análise qualitativa e avaliação do risco de enviesamento, seguiu-se uma síntese quantitativa focada no resultado primário, a eficácia. A análise qualitativa mostrou resultados promissores em relação à eficácia da estimulação magnética e elétrica transcraniana na redução dos sintomas depressivos e confirmou seu perfil seguro para mães e bebés e aceitabilidade. Em relação à avaliação neurocognitiva, o seu impacto é inconclusivo. Conclusões: O número reduzido de estudos controlados e o risco de enviesamento limitam a robustez da síntese quantitativa. Estudos futuros são necessários para confirmar estes resultados. Não obstante, as técnicas de estimulação cerebral não invasivas e não convulsivas parecem contornar algumas das limitações de outros tratamentos, podendo, no futuro complementar o conjunto de tratamentos para a Depressão Periparto. Background: Peripartum depression disorder is the most common mental health disorder in the peripartum, leading to adverse consequences for mothers and babies. Non-invasive and non-convulsive brain stimulation has been suggested as an efficacy treatment for depressive symptoms in the peripartum. Objectives: Here we aim to review studies that applied non-convulsive and non-invasive stimulation techniques in women during the peripartum. Methods: To analyze the efficacy, security, acceptability, and the impact in the neurocognitive functions we conducted the search literature in four data bases (PUBMED, psycINFO, Web of Science and Lilacs) from inception to May 2020. Results: Twenty-five studies were included, and data of interest was systematically extracted according to a preregistered protocol. We conducted a qualitative synthesis, completed by a risk of bias assessment, and followed by a quantitative analysis focused on the primary outcome of efficacy in reducing depressive symptoms. The qualitative analysis shows promising results regarding the efficacy of repetitive transcranial magnetic stimulation and transcranial electric stimulation and confirmed its safe profile both for mothers and infants, and the acceptability by women in the peripartum period. Regarding the impact on neurocognitive functions, results are inconclusive. Conclusions: The reduced number of controlled studies and risk of bias limit the robustness of the quantitative synthesis in what concerns efficacy. Future studies are needed to ascertain these results, nonetheless non-invasive and non-convulsive brain stimulation techniques seem to address some of the concerns and limitations of other treatments and may in the future complement the treatment algorithm for peripartum depression.

Peripartum depression, now called postpartum depression (PPD), is an adjustment disorder manifesting symptoms throughout pregnancy or after childbirth. Women suffering from PPD often experience feelings of depression and fatigue, making it difficult to carry out daily activities (American Psychological Association, 2013). This condition should not be confused with the “baby blues,” which affects up to 80% of mothers and naturally subsides within a couple of weeks after childbirth (National Institute of Mental Health, 2013). Research shows that one in seven women experience PPD (Wishner et al., 2013). This fact sheet reviews how to work through the process of identifying, supporting, and responding to this temporary adjustment disorder in a proper manner.

This report describes a case of major depressive disorder with peripartum onset in a 24-year-old African-American female who was admitted to the inpatient psychiatric facility after a suicide attempt. The patient demonstrated what we will describe as heralding symptoms during the birth of her second child, but her symptoms dramatically worsened one month prior to her admission with the birth of her third child. The patient presented with anxiety and depressive symptoms, including decreased energy, disrupted sleep patterns, and emotional lability. At the time of her admission, the patient had failed treatment with bupropion, which had been prescribed by her obstetrician. During her stay, the patient was treated with fluoxetine and participated in group therapy sessions. The patient gradually exhibited improvement in her depressive symptoms during the course of her six-day stay. At the time of discharge, the patient's depression was adequately managed with her medication regimen, and she was eager to be reunited with her newborn child. This case highlights the idiosyncratic nature of major depressive disorder with peripartum onset and the need for providers to tailor the treatment to the patient’s need.

Abnormalities related to peripartum depression (PPD) have been detected in several brain regions through tasking-state functional magnetic resonance imaging (fMRI). In this study, we used the two markers of resting-state fMRI (rs-fMRI) to investigate changes in spontaneous neural activity of PPD and their correlation with depression severity. A total of 16 individuals with PPD were compared with 16 age- and education-matched healthy controls (HCs) by using rs-fMRI. Two-sample t-test was used to compare the fractional amplitudes of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo) values between groups. Pearson correlation analysis was used to determine the correlation between the fALFF and ReHo of the abnormal brain region and the Hamilton Depression Scale (HAMD) and Edinburgh Postnatal Depression Scale scores. The spontaneous neural activity of the PPD group significantly increased mainly in the left middle frontal gyrus, left precuneus, left inferior parietal lobule, and left dorsolateral prefrontal cortex (DLPFC) and decreased mainly in the bilateral precentral gyrus and right inferior occipital gyrus compared with those of the HCs. The fALFF value of the left DLPFC was negatively correlated with the HAMD score in PPD. This rs-fMRI study suggests that changes in the spontaneous neural activity of these regions are related to emotional responses. PPD cases with low fALFF values in the left DLPFC have severe depression.

Peripartum depression (PPD) has been recognised as a significant public health problem, and has been widely studied. Nonetheless, study findings and clinical guidelines for PPD treatment differ among countries, and the condition is still underdiagnosed and underrated, suggesting the importance of a global understanding of PPD. The Riseup-PPD COST Action aims to establish a Pan- European and multidisciplinary network of researchers dedicated to the global understanding of PPD. This presentation will describe the first Action step, a consensus report comprised of a comprehensive narrative synthesis of the literature on PPD diagnosis, prevention, treatment and cost-effectiveness of its management and a critical overview of the current issues and questions that need to be addressed within the topic of PPD. Methods: A literature search was performed to identify relevant publications in the field of PPD, using various databases (e.g., Medline, PsychInfo) and a combination of broad search terms, including peripartum depression, diagnosis, prevention, treatment and cost-effectiveness. A representative sample of the existent literature was summarized in the form of a narrative synthesis. Results: Emerging issues include various challenges regarding: definition and timing of PPD ; heterogeneity in severity, timing of onset and assessment tools ; comparative effectiveness of preventive and treatment interventions ; help seeking for PPD ; improving health professional's awareness of PPD ; and cost-effectiveness of PPD management. Conclusion: The Riseup-PPD network will deal with these challenges through four lines of action ; (1)provide an updated and comprehensive synthesis of existing knowledge that can contribute to inform clinical recommendations and guidelines for PPD management ; (2)clarify inconsistent findings concerning diagnosis, prevention and treatment of PPD ; (3) develop new lines of research in the field of PPD ; and (4)develop international recommendation for PPD diagnosis, prevention and treatment. Ultimately these actions will raise awareness regarding PPD and play a key-role in influencing maternal mental health policymaking at global and local levels.

Objective Peripartum depression (PPD) pertaining to depression in pregnancy and postpartum is one of the most common complications around childbirth with enduring adverse effects on mother and child health. Although psychiatric symptoms may improve or worsen over time, relatively little is known about the course of PPD symptoms and possible fluctuations. Methods We applied a person-centered approach to examine PPD symptom patterns across pregnancy and childbirth. 824 women were assessed at three time points: first trimester (T1), third trimester (T2), and again at eight weeks (T3) postpartum. We assessed PPD symptoms, maternal mental health history, and childbirth variables. Results Growth mixture modeling (GMM) analysis revealed four discrete PPD symptom trajectory classes including chronic PPD (1.1%), delayed (10.2%), recovered (7.2%), and resilient (81.5%). Delivery complications were associated with chronic PPD but also with the recovered PPD trajectory class. History of mental health disorders was associated with chronic PPD and the delayed PPD class. Conclusion The findings underscore that significant changes in a woman's depression level can occur across pregnancy and childbirth. While a minority of women experience chronic PDD, for others depression symptoms appear to significantly alleviate over time, suggesting a form of recovery. Our findings support a personalized medicine approach based on the woman's symptom trajectory. Future research is warranted to identify the mechanisms underlying modifications in PPD symptoms severity and those implicated in recovery.

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Women have a lifetime risk of major depression double that of men but only during their reproductive years. This sex difference has been attributed partially to activational effects of female sex steroids and also to the burdens of pregnancy, childbirth, and parenting. Men, in contrast, have a reproductive period difficult to delineate, and research on the mental health of men has rarely considered the effects of fatherhood. However, the couple goes through a number of potentially stressing events during the reproductive period, and both mothers and fathers are at risk of developing peripartum depression. This Review discusses the literature on maternal and paternal depression and the endocrine changes that may predispose a person to depression at this stage of life, with specific focus on the hypothalamus-pituitary axis, oxytocin, and testosterone levels in men. Important findings on sex differences in the neural correlates of maternal and paternal behavior have emerged, highlighting the relevance of the emotional brain in mothers and the sociocognitive brain in fathers and pointing toward the presence of a common parents' brain. Additionally, sex differences in neurogenesis and brain plasticity are described in relation to peripartum depression.

Women have a lifetime risk of major depression double that of men but only during their reproductive years. This sex difference has been attributed partially to activational effects of female sex steroids and also to the burdens of pregnancy, childbirth, and parenting. Men, in contrast, have a reproductive period difficult to delineate, and research on the mental health of men has rarely considered the effects of fatherhood. However, the couple goes through a number of potentially stressing events during the reproductive period, and both mothers and fathers are at risk of developing peripartum depression. This Review discusses the literature on maternal and paternal depression and the endocrine changes that may predispose a person to depression at this stage of life, with specific focus on the hypothalamus–pituitary axis, oxytocin, and testosterone levels in men. Important findings on sex differences in the neural correlates of maternal and paternal behavior have emerged, highlighting the relevance of the emotional brain in mothers and the sociocognitive brain in fathers and pointing toward the presence of a common parents' brain. Additionally, sex differences in neurogenesis and brain plasticity are described in relation to peripartum depression. © 2016 The Authors. Journal of Neuroscience Research Published by Wiley Periodicals, Inc.

Postpartum depression is a psychiatric disorder affecting a substantial proportion of newly delivered women, and remains a significant cause of childbirth-related morbidity. The aim of the present thesis was to examine psychological, endocrine and genetic aspects of postpartum depression in a large, population-based sample of women in Uppsala, Sweden. All included studies were undertaken as parts of the BASIC-project, a longitudinal study on psychological wellbeing during pregnancy and the postpartum period. Study participants were screened for depressive symptoms in pregnancy week 17 and 32 as well as at six weeks and six months postpartum, mainly by use of the Swedish version of the Edinburgh Postnatal Depression Scale (EPDS). Furthermore, personality was assessed with the Swedish universities Scale of Personality (SSP) in pregnancy week 32. Evening cortisol levels in saliva were measured in pregnancy week 36 and at six weeks postpartum. Blood samples were obtained to measure corticotropin-releasing hormone levels (CRH) and to perform genetic analyses. The results of this thesis demonstrate that neuroticism is a strong and independent predictive factor of depressive symptoms at six weeks and six months postpartum, and has a significant mediatory role in the association between a single nucleotide polymorphism in the hydroxysteroid (11-beta) dehydrogenase 1 gene (HSD11B1) and postpartum depression. Furthermore, women with postpartum depressive symptoms present with a dysregulated hypothalamic-pituitary-adrenal axis activity in terms of elevated cortisol levels postpartum, as well as elevated CRH levels in mid-gestation. In conclusion, this thesis develops current knowledge on several attributes of postpartum depression. Further studies are required to replicate and expand on these results, which would further contribute to early identification of women at risk of postpartum depression and adoption of proper interventions that may moderate the short- and long-term consequences of the disorder.

Pregnancy and puerperium are crucial periods at both the biological and psychological levels. The aim of this longitudinal study was to investigate women's perceived health and illness during pregnancy and puerperium through the assessment of hedonic and eudaimonic components of well-being, symptoms of peripartum depression, and their relationship. Nineteen women recruited at the Unit of Obstetrics and Gy-necology of a university hospital in Northern Italy were enrolled and answered a set of questionnaires at two time points: 20-22 weeks of gestation and 6 months after childbirth. Results showed a substantial lack of correlation between the dimensions of mental illness and mental health. The analysis of the well- and ill-being components showed low levels of depression as well as good levels of mental health, especially concerning the eudaimonic components of well-being, both during and after pregnancy. Overall, findings attested to a general stability of well-being over pregnancy and puerperium.