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Acord transformatiu CRUE-CSIC Background: Certain personality traits increase vulnerability to depression, but the evidence linking personality and postpartum depression (PPD) is less robust. This systematic review aimed to identify personality traits that increase the risk of PPD. Methods: We systematically reviewed studies retrieved from PubMed/Medline, PsycINFO, Scopus, CINAHL, and Cochrane, following the PRISMA guidelines for reporting. We carried out a meta-analysis on the association between neuroticism and PPD. Results: A total of 34 studies were analyzed. Of these, 31 considered at least one trait associated with PPD; 10 studies considered at least one trait not associated with PPD. The meta-analysis included 13 studies, concluding that neuroticism was associated with PPD (OR: 1.37; 95%CI: 1.22-1.53; p

This review examines the association between the perinatal period and thoughts and behaviours of neonaticide, infanticide, and filicide, highlighting mothers' risk factors. A literature search was conducted on PubMed, PsycINFO, and ScienceDirect, with 2,957 articles screened and 13 determined as eligible for inclusion. Inclusion criteria were: 1) studies on neonaticide, infanticide and filicide; 2) studies conducted on women; 3) studies with perinatal population; 4) original, peer-reviewed studies; 5) studies written in English or Italian language. Single-case reports and qualitative studies were excluded, as were those studies written in any other language, and any studies for which the full-text version could not be obtained (i.e. conference abstracts). Two reviewers independently reviewed titles and abstracts, reviewed relevant articles' full text, and extracted the data. Several individuals and socio-environmental risk factors were identified for neonaticide, infanticide, and filicide during the perinatal period, highlighting the importance of paying particular attention to the mother's well-being in this critical phase. Women who committed neonaticide, infanticide, or filicide faced a variety of challenges in their lives. Such life events might prompt mental health professionals to address the possibility of harmful acts in their patients.

Objectives: Estimates of depression prevalence in pregnancy and postpartum are based on the Edinburgh Postnatal Depression Scale (EPDS) more than on any other method. We aimed to determine if any EPDS cutoff can accurately and consistently estimate depression prevalence in individual studies. Methods: We analyzed datasets that compared EPDS scores to Structured Clinical Interview for DSM (SCID) major depression status. Random‐effects meta‐analysis was used to compare prevalence with EPDS cutoffs versus the SCID. Results: Seven thousand three hundred and fifteen participants (1017 SCID major depression) from 29 primary studies were included. For EPDS cutoffs used to estimate prevalence in recent studies (≥9 to ≥14), pooled prevalence estimates ranged from 27.8% (95% CI: 22.0%–34.5%) for EPDS ≥ 9 to 9.0% (95% CI: 6.8%–11.9%) for EPDS ≥ 14; pooled SCID major depression prevalence was 9.0% (95% CI: 6.5%–12.3%). EPDS ≥14 provided pooled prevalence closest to SCID‐based prevalence but differed from SCID prevalence in individual studies by a mean absolute difference of 5.1% (95% prediction interval: 13.7%, 12.3%). Conclusion: EPDS ≥14 approximated SCID‐based prevalence overall, but considerable heterogeneity in individual studies is a barrier to using it for prevalence estimation., This study was funded by the Canadian Institutes of Health Research (CIHR, KRS‐140994). Ms. Lyubenova was supported by the Mitacs Globalink Research Internship Program. Ms. Neupane was supported by G.R. Caverhill Fellowship from the Faculty of Medicine, McGill University. Drs. Levis and Wu were supported by Fonds de recherche du Québec‐Santé (FRQS) Postdoctoral Training Fellowships. Mr. Bhandari was supported by a studentship from the Research Institute of the McGill University Health Centre. Ms. Rice was supported by a Vanier Canada Graduate Scholarship. Ms. Azar was supported by a FRQS Masters Training Award. 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 Chaudron et al. was supported by a grant from the National Institute of Mental Health (grant K23 MH64476). The primary study by Tissot et al. was supported by the Swiss National Science Foundation (grant 32003B 125493). 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 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 National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Numbers RP‐PG‐1210‐12002 and RP‐DG‐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 Nakić Radoš et al. was supported by the Croatian Ministry of Science, Education, and Sports (134‐0000000‐2421). 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 Pawlby et al. was supported by a Medical Research Council UK Project Grant (number G89292999N). The primary study by Quispel et al. was supported by Stichting Achmea Gezondheid (grant number z‐282). 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 the 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 Prenoveau et al. was supported by The Wellcome Trust (grant number 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 Tandon et al. was funded 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. Drs. Benedetti and Thombs were supported by FRQS researcher salary awards.

The aim of the present study was to validate the Spanish Postpartum Bonding Questionnaire (PBQ) against external criteria of bonding disorder, as well as to establish its test-retest reliability. One hundred fifty-six postpartum women consecutively recruited from a perinatal mental health outpatient unit completed the PBQ at 4–6 weeks postpartum. Four weeks later, all mothers completed again the PBQ and were interviewed using the Birmingham Interview for Maternal Mental Health to establish the presence of a bonding disorder. Receiver operating characteristic curve analysis revealed an area under the curve (AUC) value for the PBQ total score of 0.93, 95% CI [0.88, 0.98], with the optimal cut-off of 13 for detecting bonding disorders (sensitivity: 92%, specificity: 87%). Optimal cut-off scores for each scale were also obtained. The test-retest reliability coefficients were moderate to good. Our data confirm the validity of PBQ for detecting bonding disorders in Spanish population.

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.

Women with Bipolar Disorder (BD) during pregnancy present a negative impact on them and their babies' health. Caesarean Section (C-Section) is an intervention to reduce complications associated with childbirth, but it also has risks, including maternal infections, anaesthetic and psychological complications. There are few studies that analyse the C-Section rates in women with BD compared to the general population.A case-control study was conducted in a general university hospital. 100 pregnant women with BD matched with 100 controls without psychiatric illness who were attending the same hospital at delivery. We compared obstetrical outcomes during pregnancy, Pre/During Labour, onset of labour and mode of delivery specifying the type of C-Section.Rate of C-Section was significantly higher in BD group compared to the control group (OR=2, 95% CI 1,4-1,6). Case group had more somatic illness (SI) without treatment (P, 001). BD (P=,021), primiparity (P=, 003), obstetric complications during pregnancy (P, 001), obstetric complications during labour (P,001), and SI with and without treatment (P,001 and P=,007, respectively) were higher in women that required C- section.Women with Bipolar Disorder have near two-fold increased risk of C-section than women without Bipolar Disorder of similar age, gestational age and parity. Somatic illness was more prevalent in BD group that required C-section and this relation probably is related to high probability of having somatic comorbidities in patients with BD.

Background Survival methodology has not already been used in studies about postpartum depression (PPD) course. The aims of the present study were to estimate the duration of a Major Postpartum Depressive Episode (MPDE) during 2 years, as well as to explore factors associated with the course. Method This was a prospective, naturalistic, longitudinal study with a cohort of 165 women with a MPDE (DSM-IV criteria). Potential predictors of prognosis were recorded at baseline. Follow-up was conducted using the Longitudinal Interval Follow-up Evaluation (LIFE). Results Of the total sample, 110 (66.7%) completed the 2 years follow-up. The mean time to full remission was 49.4 weeks (95% CI: 44.0–59.8). The probability of recovering was 30.2% (95% CI: 22.1%–37.4%) at 6 months of follow-up, 66.3% (95% CI: 57.4%–73.4%) at 12 months of follow-up, and 90.3% (95% CI: 79.8%–95.4%) at 24 months of follow-up. Mothers with financial difficulties, onset of depressive episode previous to birth, and those with prior treated depressive episodes took longer in achieving full remission. Limitations Results are only generalizable to mothers with PPD treated in a psychiatric outpatient setting. Psychopharmacological treatment was uncontrolled and personality was not assessed. Conclusions Our findings suggest that PPD could become a chronic disorder, particularly in mothers with an onset of the episode previous to birth, with a history of depression or with financial problems. Knowledge of these factors may help to improve the guidelines of depression management and treatment during the perinatal period.

This article describes the development and testing of the psychometric properties of the Partner Violence Entrapment Scale (PVES), an instrument that evaluates the women’s perceived reasons for staying in violent partner relationships. After initial pilot testing, the scale was administered to 213 Spanish women who were victims of intimate partner violence (IPV). An exploratory factor analysis identified six factors: Socio-Economic Problems, Attachment and Fear of Loneliness, Blaming Oneself and Resignation, Impact on Children, Fear of Harm and Worry for the Partner, and Feelings of Confusion. Discriminant validity was established by demonstrating associations between PVES factors and socio-demographic, clinical and abuse variables. The scale appears to be a useful assessment tool for social and clinical settings. Its factor structure, reliability, and validity need to be replicated in other populations and samples.

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.

Resumen Fundamento y objetivo Estudio de la validacion externa y comparacion de la precision diagnostica y concordancia de cuatro instrumentos para la identificacion de la violencia de pareja (VP) en el ambito sanitario: Index of Spouse Abuse (ISA), Psychological Maltreatment of Women Inventory short form (PMWI-SF), Woman Abuse Screening Tool (WAST), Partner Violence Screen (PVS). Sujetos y metodo Estudio de casos y controles. La muestra se recluto en centros de asistencia primaria y centros especializados en VP. Completaron los cuestionarios ISA, PMWI-SF, WAST y PVS un total de 223 mujeres sin maltrato (controles) y 182 con maltrato de pareja (casos). Se evaluo la precision diagnostica mediante la estimacion por intervalo del area bajo la curva ROC, se compararon las areas bajo la curva (ABC) y se realizo un analisis de la concordancia entre ellos. Resultados Los valores de ABC fueron: ISA 0,99 (intervalo de confianza del 95% [IC 95%] 0,98-0,99), PMWI-SF 0,98 (IC 95% 0,97-0,99), WAST 0,95 (IC 95% 0,93-0,97), PVS 0,91 (IC 95% 0,87-0,94). La concordancia entre los cuatro cuestionarios fue excelente (Kappa de Fleiss = 0,82). Los valores del ABC del ISA y el PMWI-SF fueron significativamente mayores que el del WAST, y los tres obtuvieron un mejor funcionamiento que el PVS. El PVS fue el cuestionario que obtuvo menor concordancia con el resto. Conclusiones Todos los cuestionarios estudiados obtuvieron un buen funcionamiento global para la deteccion de la VP y una alta concordancia entre ellos. La sensibilidad puede estar sobreestimada debido a la distinta procedencia de los casos.

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.

In this study, the authors tested alternative factor models of the 12-item General Health Questionnaire (GHQ-12) in a sample of Spanish postpartum women, using confirmatory factor analysis. The authors report the results of modeling three different methods for scoring the GHQ-12 using estimation methods recommended for categorical and binary data. A discriminant function analysis was also performed to test the utility of a multiple factor model. A two-phase cross-sectional study was designed: (a) 1,453 women visiting at 6 weeks postpartum completed the GHQ-12 and the Edinburgh Postnatal Depression Scale questionnaire and (b) based on the Edinburgh Postnatal Depression Scale outcomes, participants were stratified and randomly selected within each stratum for clinical evaluation. Using the Likert-type scoring approach, Hankins’s one-factor model with “method effects” obtained the best fit. In addition, Graetz’s three-factor model provided little discrimination between diagnostic groups, the factors being highly correlated. These results support the presence of only one latent factor in the GHQ-12.

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.

Physiological changes during gestation and after delivery are associated with postpartum thyroid dysfunction, which is due to thyroid autoimmunity in some cases. Postpartum thyroid dysfunction, in turn, has been associated with postpartum depression (PPD). The aim of the present study was to evaluate whether thyroid function immediately after delivery can predict postpartum depression at 8 weeks and 32 weeks after delivery. This study examined 1053 postpartum Spanish women without a previous history of depression. We evaluated depressive symptoms at 48h, 8 weeks and 32 weeks postpartum and used a diagnostic interview to confirm major depression for all probable cases. Free thyroxin (fT4), thyroid-stimulating hormone (TSH), thyroid peroxidase antibodies (TPOAb) and C-reactive protein (CRP) were assayed at 48h postpartum. Binary and multivariate logistic regression analyses were performed to determine independent risk factors for PPD. Although 152 women (14.4%) had high TPOAb (>27IU/mL) and slightly elevated TSH concentrations with normal fT4, we did not find any association between thyroid function and PPD. This thyroid dysfunction was not associated with CRP concentrations that were outside of the normal range (>3mg/L). We conclude that thyroid function at 48h after delivery does not predict PPD susceptibility.

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

The aims of the study were to assess the psychometric properties of the Spanish version of the Index of Spouse Abuse (ISA), and to validate it against external criteria of intimate partner violence. The Spanish version of the ISA was administered to 223 non-abused women and 182 victims of intimate partner violence. Internal consistency coefficients oscillated between 0.88 and 0.98. The Confirmatory Factor Analysis failed to replicate the original two-factor structure. Using Exploratory Factor Analysis, a two-factor solution was found: physical (ISA-P) and non-physical (ISA-NP), but the items included in each factor were slightly different from the original two subscales. Receiver operating characteristic curve analysis revealed an AUC value for the ISA global score of 0.99 (95% CI: 0.98–0.99), with the optimal cut-off of 12 for detecting intimate partner violence. The Spanish version of the ISA is a valid instrument for detecting intimate partner violence in a female population.

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.

Fundamento y objetivo: Estimar la prevalencia de la depresion posparto (DPP) en una muestra poblacional mediante dos metodos de evaluacion: la entrevista clinica estructurada para el DSM-IV (SCID) y la medida de autoinforme de la Edinburgh Postnatal Depression Scale (EPDS), asi como identificar el punto de corte del EPDS que proporcione una estimacion sin sesgo de la prevalencia de DPP. Pacientes y metodo: Se incluyo en el estudio a todas las madres (n = 1.191) que, durante el periodo de un ano, acudieron al Servicio de Obstetricia y Ginecologia del Hospital Clinic de Barcelona para realizar la visita de control del puerperio (6 semanas posparto). Se utilizo un metodo en dos fases. En la primera etapa, todas las madres incluidas completaron el EPDS. En la segunda, todas aquellas con una puntuacion en la EPDS de 9 o superior (casos probables de DPP), y una muestra aleatoria del 16% de madres con puntuaciones de la EPDS inferior a 9 fueron evaluadas por una psiquiatra utilizando la entrevista SCID, para establecer el diagnostico de depresion mayor y menor. Se invito a realizar la entrevista SCID a un total de 402 mujeres, de las cuales 68 no quisieron participar. Resultados: La prevalencia de depresion segun la entrevista SCID fue del 10,15% (intervalo de confianza [IC] del 95%, 8,43-11,87). La prevalencia de depresion mayor fue del 3,6% (IC del 95%, 2,55-4,67) y la de depresion menor del 6,5% (IC del 95%, 5,14-7,95). El punto de corte 11/12 de la EPDS permite realizar una estimacion sin sesgo de la tasa de prevalencia de DPP. Conclusiones: El presente estudio justifica la necesidad de utilizar diferentes puntos de corte de la EPDS: el punto de corte 10/11 para identificar la poblacion de riesgo y el 11/12 para estimar la prevalencia en estudios epidemiologicos.

This study aims to examine whether a first-trimester strategy of secondary prevention for preeclampsia increases anxiety in pregnant women.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).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.A strategy of first-trimester screening for preeclampsia does not increase maternal anxiety.

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

Context Iron deficiency is the most common nutritional problem experienced by childbearing women, and postpartum depression (PPD) is the most common psychiatric disorder seen during the first year after delivery. The possible link between iron deficiency and PPD is not clear. Objective To evaluate whether iron status 48 h after delivery was associated with PPD. Our hypothesis was that iron deficiency would be associated with PPD. Design This was a prospective cohort study of depression-free women studied in the postpartum period. Setting Women who give birth at obstetric units in several general hospitals in Spain. Participants A subsample of 729 women was included in the present study after exclusion of women with high C-reactive protein (CRP) and other diseases known to interfere with iron metabolism. Main outcome measures We evaluated depressive symptoms at 48 h, 8 weeks and 32 weeks postpartum and used a diagnostic interview to confirm the diagnosis of major depression. A blood sample obtained 48 h after delivery was used to measure the following iron storage parameters: ferritin, transferrin (Tf), free iron and transferrin saturation (TfS) and the inflammatory marker CCRP. Results Overall, the women in the study had low iron concentrations (8.8 ± 6.9 μmol/L) and low TfS (12.6 ± 9.6%) but normal ferritin and Tf concentrations. A total of 65 women (9%) developed PPD during the 32 week postpartum period; these women also had a lower ferritin concentration (15.4 ± 12.7 μg/L vs. 21.6 ± 13.5 μg/L, P = 0.002). A strong association between ferritin and PPD was observed (odds ratio = 3.73, 95% CI: 1.84–7.56; P = 0.0001 for ferritin cutoff value of 7.26 μg/L). In our study, ferritin concentrations have a high specificity but low sensitivity in predicting PPD. Conclusions These findings support the role of iron in the etiology of PPD and the use of ferritin as a marker of iron deficiency in the postpartum period. We believe that this topic deserves further investigation.

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.

Our objectives were: To estimate the prevalence of postpartum depression (PD) by two evaluation methods: Structured Clinical Interview for DSM-IV (SCID), and self-report Edinburgh Postnatal Depression Scale (EPDS), and to identify the EPDS cut-off to provide an unbiased estimation of PD prevalence.We report data from all women (n = 1191) attending to postnatal routine checking visits at six weeks postpartum during one year in the Gynaecology and Obstetrics Department of the Hospital Clínic of Barcelona (Spain). A two-stage method was used. In the first stage, all women selected completed the EPDS. In the second stage, all women with an EPDS score= 9 (probable PD cases) and a randomized sample of 16% with a score9 were evaluated by a psychiatrist using the SCID interview to establish a psychiatric diagnosis of major and minor depression. 402 postpartum women were offered the SCID interview; 68 of them refused to participate.The prevalence of depression according to the SCID interview was 10.15% (CI 95%, 8.43-11.87). The prevalence of major depression was 3.6% (CI 95%, 2.55-4.67) and it was 6.5% (CI 95%, 5.14-7.95) for minor depression. An EPDS cut-off of 11/12 provided an unbiased estimation of the postpartum depression prevalence rate.Our results justify the need to use different EPDS cut-offs. A cut-off of 10/11 is effective for identifying the population at risk and a cut-off of 11/12 is useful to estimate the prevalence in epidemiological studies.

Introduction Insulin-dependent diabetes, obesity and gestational diabetes are factors associated with macrosomia. Some psychiatric medications have well established side effects of weight changes in exposed pregnants. However, very few studies have investigated about the effects of lithium in fetal and neonatal anthropometry. Aims To investigate the effects of maternal use of lithium during pregnancy on fetal and neonatal growth. Methods A case-control study was conducted at the PERINATAL PSYCHIATRY PROGRAM CLINIC-BARCELONA. Case group consisted of 18 pregnant women on maintenance treatment with lithium monotherapy (n=13) or polytherapy (n=5) during pregnancy; control group involves 49 healthy women selected from an initial sample of 309. We evaluated sociodemographic data, lithium plasma concentrations in maternal blood and umbilical cord, fetal and neonatal anthropometry. Results Women did not diabetes or obesity criteria pre-pregnancy and during pregnancy. Mean maternal age (SD) in lithium exposed cases was 33.5 (3.8) and 32.5 (4.1) in non-exposed pregnant. No statistically significant differences were found regarding sociodemographic variables and pre-pregnancy BMI. Caesarean section was required in 91.8% of lithium exposed mothers, whereas 8.2% of non-exposed women did not need it (p= 0.000). Fetuses exposed to lithium had greater abdominal circumference (p= 0.018) and femur length (p= 0.010) compared to non-exposed group. There were no differences in umbilical cord/maternal plasma lithium ratio between women treated with lithium monotherapy or polytherapy (1.11vs.1.03). Conclusions The fetuses exposed to lithium had a greater abdominal circumference, greater femur length and more caesarean section in comparison to non-exposed group. Fetal growth surveillance is recommended in pregnant treated with lithium.