Screening for Depression in Perinatal Settings

2009 ◽  
Author(s):  
Jodi Barton ◽  
Philip Boyce
Keyword(s):  
Depressive Symptoms ◽  
Postpartum Depression ◽  
Postpartum Period ◽  
Depressive Disorders ◽  
Early Recognition ◽  
Antenatal Depression ◽  
Maternal Morbidity And Mortality ◽  
Dsm Iv ◽  
Clinically Significant ◽  
Knowledge Of Depression

Implementing screening in perinatal settings poses a potentially complex set of issues, but screening is nonetheless increasingly being recommended and even mandated. When should screening occur—during pregnancy, postpartum, or both? What instrument should be used? How acceptable is screening to mothers? What difference does screening make to the management of postpartum depression? This chapter presents an evidence-based approach to all aspects of perinatal screening. Over the past 20 years there has been considerable interest in psychiatric disorders arising during the course of pregnancy and following childbirth. Most of the attention has been focused on depressive disorders arising within the first 3 months to 1 year after childbirth, commonly referred to as postnatal or postpartum depression. Pregnancy was once thought to be protective against depressive symptoms; however, women are just as likely to experience depressive symptoms while pregnant as they are during the postpartum period. The mean prevalence of antenatal depression is between 10.7% and 12%, with increasing prevalence and severity through the second and third trimesters. This is comparable with the 10% to 15% of women who develop postpartum depression. While the DSM-IV official recognition of postpartum depression arising after childbirth is confined to a postpartum specifier for those episodes of major depression that have an onset within 4 weeks after delivery, increasing knowledge of depression during the antenatal period has given rise to its equally important early recognition and treatment. Whatever the specifier of postpartum depression in the DSM-IV, depression at this time has been granted considerable importance because of its potential adverse impacts upon child development and maternal morbidity and mortality; and because of the treatment challenges inherent in pregnant and breastfeeding women. Even though the consequences of postpartum depression have been recognized, the illness itself is frequently not identified; it has been estimated that between 50% and 75% of the women suffering from postpartum depression will have it identified and potentially treated. More recent work has focused attention on depression during the course of pregnancy, so-called antenatal depression. However, the validity of measuring depression during pregnancy and in the postpartum period is not clear, especially the boundary between depressive symptoms and clinically significant depressive disorder.

Neural Dysfunction in Postpartum Depression: An fMRI Pilot Study

CNS Spectrums ◽  
2007 ◽  
Vol 12 (11) ◽  
pp. 853-862 ◽  
Author(s):  
Michael E. Silverman ◽  
Holly Loudon ◽  
Michal Safier ◽  
Xenia Protopopescu ◽  
Gila Leiter ◽  
...  
Keyword(s):  
Postpartum Depression ◽  
Postpartum Period ◽  
Emotional Processing ◽  
The United States ◽  
Depressive Illness ◽  
Critical Gap ◽  
Amygdala Activity ◽  
Clinically Significant ◽  
And Behavior ◽  
Striatal Function

ABSTRACTIntroduction:With ∼4 million births each year in the United States, an estimated 760,000 women annually suffer from a clinically significant postpartum depressive illness. Yet even though the relationship between psychiatric disorders and the postpartum period has been documented since the time of Hippocrates, fewer than half of all these cases are recognized.Objective:Because postpartum depression (PPD), the most common complication of childbearing, remains poorly characterized, and its etiology remains unclear, we attempted to address a critical gap in the mechanistic understanding of PPD by probing its systems-level neuropathophysiology, in the context of a specific neurobiological model of fronto-limbic-striatal function.Methods:Using emotionally valenced word probes, with linguistic semantic specificity within an integrated functional magnetic resonance imaging (fMRI) protocol, we investigated emotional processing, behavioral regulation, and their interaction (functions of clinical relevance to PPD), in the context of fronto-limbic-striatal function.Results:We observed attenuated activity in posterior orbitofrontal cortex for negative versus neutral stimuli with greater PPD symptomatology, increased amygdala activity in response to negative words in those without PPD symptomotology, and attenuated striatum activation to positive word conditions with greater PPD symptomotology.Conclusion:Identifying the functional neuroanatomical profile of brain systems involved in the regulation of emotion and behavior in the postpartum period will not only assist in determining whether the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric diagnostic specifier of PPD has an associated, unique, functional neuroanatomical profile, but a neurobiological characterization in relation to asymptomatic (postpartum nondepressed) control subjects, will also increase our understanding of the affective disorder spectrum, shed additional light on the possible mechanism(s) responsible for PPD and provide a necessary foundation for the development of more targeted, biologically based diagnostic and therapeutic strategies for PPD.

scholarly journals Pregnancy, perinatal and postpartum complications as determinants of postpartum depression: the Rhea mother–child cohort in Crete, Greece

2016 ◽  
Vol 27 (3) ◽  
pp. 244-255 ◽  
Author(s):  
K. Koutra ◽  
M. Vassilaki ◽  
V. Georgiou ◽  
A. Koutis ◽  
P. Bitsios ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Postpartum Depression ◽  
Postpartum Period ◽  
Depression Scale ◽  
Effective Prevention ◽  
Maternal Mood ◽  
Early Postpartum Period ◽  
Early Postpartum ◽  
Wide Range ◽  
Clinical Records

Aims.Few epidemiological studies evaluated associations between perinatal complications and maternal mood at the early postpartum period and the findings are inconsistent. We aimed at investigating a wide range of complications during pregnancy, at delivery, and at the early postpartum period as determinants of postpartum depression (PPD) at 8 weeks postpartum.Methods.A total of 1037 women who enrolled in the Rhea mother–child cohort in Crete, Greece participated in the present study. Information on pregnancy, perinatal and postpartum complications was obtained from clinical records or by questionnaires. Postpartum depressive symptoms were assessed at 8 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Multivariable linear and logistic regression models were fit to estimate the association between pregnancy, perinatal and postpartum complications and maternal depressive symptoms, adjusting also for potential confounders.Results.The prevalence of women with probable depression (EPDS score ≥ 13) was 13.6% at 8 weeks postpartum. Gestational hypertension and/or preeclampsia (β coefficient 1.86, 95% CI: 0.32, 3.41) and breastfeeding difficulties (β coefficient 0.77, 95% CI: 0.02, 1.53) were significantly associated with higher PPD symptoms. Sleep patterns during pregnancy, such as sleep deprivation (OR = 3.57, 95% CI: 1.91, 6.67) and snoring (OR = 1.81, 95% CI: 1.11, 2.93), and breastfeeding duration less than 2 months (OR = 1.77, 95% CI: 1.19, 2.64) were significantly associated with increase in the odds for PPD. Some other complications, such as unplanned pregnancy and hospitalisation during pregnancy were also associated with EPDS score, but these associations were explained by socio-demographic characteristics of the mother.Conclusions.We found that several pregnancy, perinatal and postpartum complications may have an adverse effect on maternal mood at the early postpartum period. These findings have considerable implications for developing effective prevention and early psychoeducational intervention strategies for women at risk of developing PPD.

Depressed patients with incurable cancer: Which depressive symptoms do they experience?

2013 ◽  
Vol 11 (6) ◽  
pp. 491-501 ◽  
Author(s):  
Elisabeth Brenne ◽  
Jon Håvard Loge ◽  
Stein Kaasa ◽  
Ellen Heitzer ◽  
Anne Kari Knudsen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Social Withdrawal ◽  
Incurable Cancer ◽  
Cancer Symptoms ◽  
Depressed Patients ◽  
Symptom Experiences ◽  
Dsm Iv ◽  
Symptom Criteria

AbstractObjective:Diagnosing depressive disorders in palliative care is challenging because of the overlap between some depressive symptoms and cancer-related symptoms, such as loss of appetite and fatigue. In order to improve future assessment of depression in palliative care, depressive symptoms experienced by patients receiving pharmacological treatment for depression were assessed and compared to the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for major depressive disorder.Method:Thirty Norwegian (n = 20) and Austrian (n = 10) patients with advanced cancer were included. Semistructured interviews on symptom experiences were conducted and transcribed verbatim. By the phenomenographic method, patients' symptom experiences were extracted and sorted by headings, first individually and then across patients. The patients subsequently rated 24 symptoms numerically including the DSM-IV depression criteria.Results:Lowered mood and a diminished motivational drive were prominent and reflected the two main DSM-IV symptom criteria. A relentless focus on their actual situation, restlessness, disrupted sleep, feelings of worthlessness, feelings of guilt, and thoughts of death as a solution were variably experienced. Appetite and weight changes, fatigue and psychomotor retardation were indistinguishable from cancer symptoms. All these symptoms reflected DSM-IV symptom criteria. Some major symptoms occurred that are not present in the DSM-IV symptom criteria: despair, anxiety, and social withdrawal. The numerical ratings of symptoms were mainly in accordance with the findings from the qualitative analysis.Significance of results:Despair, anxiety, and social withdrawal are common symptoms in depressed patients with incurable cancer, and, therefore, hypothesized as candidate symptom criteria. Other symptom criteria might need adjustment for improvement of relevance in this group of patients.

scholarly journals MOTERS DEPRESIŠKUMĄ LAIKOTARPIU PO GIMDYMO PROGNOZUOJANTYS VEIKSNIAI

Psichologija ◽  
2010 ◽  
Vol 42 ◽  
pp. 59-73
Author(s):  
O. Zamalijeva ◽  
R. Jusienė
Keyword(s):  
Depressive Symptoms ◽  
Postpartum Depression ◽  
Life Events ◽  
Postpartum Period ◽  
Structural Equation ◽  
Stressful Life Events ◽  
Well Being ◽  
Stressful Life ◽  
Equation Modeling

Vidutiniškai penktadalis moterų po gimdymo patiria įvairių psichologinių ir emocinių sunkumų, o tai savo ruožtu neigiamai veikia pačios moters savijautą, vaiko raidą bei santykius su vaiku ir šeima. Iki šiol nebuvo prieita prie vienodos nuomonės, kokie rizikos veiksniai reikšmingai nulemia moters depresiškumą laikotarpiu po gimdymo. Tyrėjų išvadose apie demografinių veiksnių, socialinės paramos, gimdymo ypatumų, patiriamo streso, emocinės ir fizinės būsenos bei kitų kintamųjų sąsajas su moters depresiškumu laikotarpiu po gimdymo yra prieštaravimų. Šio tyrimo tikslas – išsiaiškinti, kokie demografiniai, socialiniai, psichologiniai ir sveikatos veiksniai reikšmingai prognozuotų moters depresiškumą laikotarpiu po gimdymo. Tyrimas yra prospektyvus ir ilgalaikis – tiriamosios apklaustos nėštumo metu, pirmą mėnesį ir pusė metų po gimdymo. Tyrime analizuojami 66 savanoriškai sutikusių dalyvauti visuose trijuose tyrimo etapuose moterų duomenys. Tyrimo rezultatai, apskaičiuoti taikant struktūrinių lygčių modeliavimo metodą, leidžia teigti, kad vienintelis moters depresiškumą laikotarpiu po gimdymo prognozuojantis veiksnys, turintis tiesioginę reikšmę, yra moters depresiškumo vertinimas nėštumo metu. Taip pat daugiau depresijos simptomų laikotarpiu po gimdymo turi moterys, kurios prasčiau vertina savo pasiruošimą motinystei, jaučia stipresnį nerimą dėl gimdymo, mažiau patenkintos savo santykių su vyru kokybe, patyrė daugiau stresą keliančių gyvenimo įvykių ar laukiasi pirmo vaiko, tačiau prognostinis šių veiksnių ir moters depresiškumo laikotarpiu po gimdymo ryšys yra netiesioginis, o pasireiškia šių veiksnių įtaka depresiškumui nėštumo metu.Pagrindiniai žodžiai: depresiškumas po gimdymo, Edinburgo pogimdyminės depresijos skalė (EPDS), pasiruošimas motinystei.Predictors of women’s depression during postpartumperiod Zamalijeva O., Jusienė R. SummaryApproximately 20 percent of women suffer from postpartum depression after childbirth, which, in turn, negatively affects women’s well-being, child’s development and interactions with the child and family. Risk factors, which most significantly influence postpartum depression, have been analyzed by numerous researchers, seeking to make it possible to predict and identify women at risk before the onset of symptoms. Nevertheless, the data obtained is inconclusive and research results are contradictory. The most inconclusive results are those related to demographic and socioeconomic characteristics and their impact on depressive symptoms during postpartum period. Moreover, there are inconsistencies in conclusions concerning social support, pregnancy and delivery-related factors, stressful life events, emotional and physical health and their influence on postpartum depression. The goal of this research is to identify demographic, social, psychological and health related variables that could reliably predict women’s depression half year after delivery. This research is prospective and longitudinal, participants were interviewed at several assessment points – during pregnancy, the first month and half a year postpartum. The complete data about 66 women are analyzed in this article. The results of structural equation modeling (SEM), indicate that the only significant predictor of women’s depressive symptoms during postpartum period, having direct effect, is depression during pregnancy, i.e. women who report more depressive symptoms during pregnancy are significantly more likely to be depressed during postpartum period. Women who rated their subjective readiness for motherhood as lower, also with high anxiety concerning delivery, poor quality of relationship with a partner, and who reported more stressful life events, as well as primiparous women are at greater risk postpartum depression; however these variables and depressive symptoms during postpartum period are not directly related. The readiness for motherhood and anxiety concerning delivery predicts depression during pregnancy. The quality of relationships with partner, in turn, predicts both readiness for motherhood and anxiety concerning delivery. Finally, the readiness for motherhood could also be predicted by stressful life events and primiparity. The results of our study support the necessity of psychological interventions during the pregnancy in order to prevent postpartum depression.Keywords: perinatal depression, EPDS, readiness for motherhood.

scholarly journals Untreated Depressive Symptoms Significantly Worsen Quality of Life of the Elderly and may Lead to the Misdiagnosis of Dementia: A Cross-Sectional Study

2020 ◽  
Author(s):  
Viktor Voros ◽  
Sandor Fekete ◽  
Tamas Tenyi ◽  
Zoltan Rihmer ◽  
Ilona Szili ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Early Recognition ◽  
The Elderly ◽  
Screening Tools ◽  
Adequate Treatment

Abstract Background: Several studies demonstrated the role of depressive mood and cognitive impairment in the background of elevated mortality and decreased Quality of Life (QoL) of the elderly.Methods: In the framework of the ICT4Life project self-administered questionnaires and clinical screening tools were used to assess QoL, depressive symptoms and cognitive functions of 60 elderly over the age of 65.Results: Males found to be depressed and cognitively declined more frequently; and had higher scores on the depression and lower on the QoL scales. Depressed elderly had lower cognitive levels and their QoL was significantly poorer than that of the non-depressed subjects. Depressive disorders were detected in a quarter of the elderly, and the majority of them did not receive adequate antidepressant medication.Conclusions: Close correlation between depression and cognitive impairment was confirmed, as well as the key role of depression in the background of QoL decline. Results also highlighted the problems of recognition and adequate treatment of depression and cognitive decline in elderly, which can be further complicated by the common symptoms of depressive pseudo-dementia. Early recognition of depressive symptoms is important not only to treat the underlying mood disorder, but also to improve QoL of the elderly.

scholarly journals Postpartum depression and the scarcity of generalizable evidence: A mini-review of existing literature and the way forward

2021 ◽  
Vol 11 (2) ◽  
pp. 81-84
Author(s):  
Fidelis E Uwumiro ◽  
Victory O Okpujie ◽  
Kingsley O Anokwuru
Keyword(s):  
Postpartum Depression ◽  
Mental Health Professionals ◽  
Depressive Disorders ◽  
Early Recognition ◽  
Depression Scale ◽  
Diagnostic Tools ◽  
Diagnostic And Statistical Manual ◽  
The Bible ◽  
Patient Health ◽  
Distinct Disease

The first known reference to Postpartum Depression (PPD), was Hippocrates’ 4th century hypothesis that drainage of lochia, if suppressed, could flow to the brain resulting in agitation, delirium, and episodes of mania. This hypothesis became dogma and lasted over a millennium. Over the years, knowledge of PPD has evolved but researchers still struggle to establish it as a distinct disease entity. It was initially recognized as Major Depressive Disorder (MDD) with postpartum onset in the 1994 revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the “bible” of diagnostic criteria for mental health professionals and researchers. It is currently recognized as MDD with peripartum onset (DSM-V) and researchers have admitted that persuasive evidence to indicate that postpartum depression is distinct from other existing depressive disorders, has not been found. Several diagnostic tools such as the Edinburg Postpartum Depression Scale (EDPS), the Beck Depression Inventory (BDI-II), Patient Health Questionnaire (PHQ-9), and the Postpartum Depression Screening Scale (PDSS) are available for use but none of these is universally accepted. With much of the published literature plagued with bias and structural inconsistencies, the credibility of the evidence has been greatly diminished. The difficulty with disease designation, the absence of a universally accepted tool for diagnosis and the scarcity of generalizable evidence on the subject has impaired the early recognition and effective management of PPD. It is therefore expedient, to critically appraise some of the available literature and proffer solutions to navigating this conundrum.

scholarly journals Incidence and prevalence of postpartum depression in a rural community of India

2015 ◽  
Vol 5 (2) ◽  
pp. 11-19 ◽  
Author(s):  
N Shrestha ◽  
P Hazrah ◽  
R Sagar
Keyword(s):  
Depressive Symptoms ◽  
Postpartum Depression ◽  
Pregnant Women ◽  
Rural Community ◽  
Postpartum Period ◽  
Cutoff Score ◽  
Third Trimester ◽  
The Third ◽  
Maternal Suicide

Postpartum depression (PPD) is defined as presence of depressive symptoms in the postpartum period. A seemingly innocuous disorder, if untreated can lead to foeticide or maternal suicide. Unfortunately there are very few studies which have looked into the burden of the disease. The prevalence and incidence of postpartum depression vary across culture, region and communities, with very few studies having addressed the issue, thereby making it difficult to estimate the actual burden of the disease. The present study was undertaken to estimate the incidence and prevalence of postpartum depression in a rural community of India. A cohort of 200 pregnant women were interviewed in the third trimester of pregnancy and subsequently at 6 weeks postpartum to screen for presence and severity of depressive symptoms using BDI, ICD10 and EPDS scores. A cutoff score > 13 was considered as positive for depression in EPDS. The prevalence of PPD was 12% and incidence of PPD 4.4%.

Confirmatory Factor Analysis of the Postpartum Depression Screening Scale-21 in a Sample of Portuguese Women

2017 ◽  
Vol 41 (S1) ◽  
pp. s241-s241
Author(s):  
C. Marques ◽  
S. Xavier ◽  
J. Azevedo ◽  
M. Marques ◽  
M.J. Soares ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Depressive Symptoms ◽  
Confirmatory Factor Analysis ◽  
Postpartum Depression ◽  
Postpartum Period ◽  
Depression Screening ◽  
Short Version ◽  
Confirmatory Factor ◽  
Postpartum Depression Screening Scale ◽  
Screening Scale

IntroductionThe postpartum depression screening scale (PDSS; Beck & Gable, 2002) is a widely used measure to assess women's depressive symptoms after their children's birth. Pereira et al. adapted, validated and developed a short-version of PDSS for Portuguese women (PDSS-21).ObjectiveTo examine the factor structure of the PDSS–21, using confirmatory factor analysis (CFA) in a sample of Portuguese women in the postpartum period.MethodsThe sample was composed of 208 women (mean age = 32.72; SD = 4.49) who completed the PDSS–21 approximately at the 6th week postpartum. CFA was used to test the model suggested by prior exploratory factor analyses of PDSS–21. AMOS software was used.ResultsAfter two items were deleted and some errors were correlated, CFA indicated a good fit for the second-order factor (χ2/df = 1.793; CFI = 0.957; GFI = 0.889, rmsea = 0.062; P [rmsea ≤ 0.05] < 0.056). The 19–item PDSS showed excellent internal consistency (α = 0.92) and the four dimensions presented Cronbach's alphas ranging between good (α = 0.83) and excellent (α = 0.93).ConclusionsThese findings suggest that the 19–item PDSS obtained through CFA is a reliable and valid measure to assess depressive symptoms among women in the postpartum period.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Depression in elderly homecare patients: patient versus informant reports

2004 ◽  
Vol 34 (8) ◽  
pp. 1507-1517 ◽  
Author(s):  
GAIL J. McAVAY ◽  
MARTHA L. BRUCE ◽  
PATRICK J. RAUE ◽  
ELLEN L. BROWN
Keyword(s):  
Social Cognitive ◽  
Depressive Disorders ◽  
Community Sample ◽  
Patient Report ◽  
Late Life Depression ◽  
Short Term ◽  
Informant Report ◽  
Clinical Correlates ◽  
Dsm Iv ◽  
Clinically Significant

Background. This study compares patient and informant reports of depressive disorders in a community sample of elderly medical homecare patients. The associations between specific patterns of agreement/disagreement and other patient and informant characteristics are examined.Method. A random sample of 355 elderly medical homecare patients and their informants were interviewed using the current mood section of the Structured Clinical Interview for DSM-IV (SCID).Results. Thirty-seven patients (10·4%) reported a depressive disorder (major or subsyndromal) that was also identified by their informant while 27 (7·6%) patients self-reported depression that the informant did not identify. There were 250 patients (70·4%) who were not depressed according to both patient and informant report and 41 patients (11·5%) were identified as depressed by informant report alone. Patients identified as depressed by informant report alone were similar to patients who self-reported depression on a number of the sociodemographic and clinical correlates of depression, but had significantly poorer performance on items assessing orientation and short-term recall. These patients also had poorer functioning in a number of domains (social, cognitive, and functional) when compared with patients who were not depressed according to both the patient and informant. Finally, patients with younger informants were more likely to be identified as depressed by their informant.Conclusions. Obtaining informant reports of depression may be a useful method for detecting clinically significant cases of late-life depression that would otherwise be missed when relying only on patient report.

scholarly journals Postpartum depression — risk factors, clinical and treatment aspects

2021 ◽  
Vol 13 (4) ◽  
pp. 75-80
Author(s):  
M. A. Makarova ◽  
Yu. G. Tikhonova ◽  
T. I. Avdeeva ◽  
I. V. Ignatko ◽  
M. A. Kinkulkina
Keyword(s):  
Risk Factors ◽  
Postpartum Depression ◽  
Postpartum Period ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Behavioral Therapy ◽  
Unwanted Pregnancy ◽  
Mild Depression ◽  
Clinical Interviews ◽  
Pregnancy And Childbirth

Objective: to analyze the psychopathological structure, risk factors and tretment of depressive disorders in women in the postpartum period.Patients and methods. A prospective cohort study included 150 women in the postpartum period (0-3 days after birth), aged 18 to 41 years, with follow-up every two weeks for six months. The evaluation included clinical interviews, Montgomery-Asberg Depression Rating Scale, and the 17-item Hamilton Anxiety Rating Scale.Results and discussion. 11.3% of women developed depression within six weeks after childbirth. Among them, 94.2% presented with mild depression, and 5.8% - moderate. Risk factors associated with postpartum depression included: periods of low mood and anxiety before and during the current pregnancy, traumatic situations during pregnancy, unwanted pregnancy, pathology of pregnancy and childbirth, cesarean section, perinatal status, lack of breastfeeding. All women with postpartum depression were treated with rational-emotive and cognitive-behavioral therapy. A short course of pharmacotherapy was prescribed to 17.6% of them to correct insomnia and anxiety symptoms. Psychotherapy was highly efficient in the treatment of postpartum affective disorders.Conclusion. The postpartum depression prevalence was 11.3%. The severity of postpartum depression was predominantly mild, and the symptoms regressed during treatment within five months in all women.

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