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

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.

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Monica C Myers ◽  
Mark K Santillan ◽  
Debra S Brandt ◽  
Amy K Stroud ◽  
Julie A Vignato ◽  
...  

Hypertensive diseases are associated with adverse experiences in childhood as well as depression. In order to determine if these associations were present in women with preeclampsia (PreE), a particularly devastating hypertensive disease in pregnancy, the scores from three questionnaires: Adverse Childhood Experiences (ACE), Edinburgh Postnatal Depression Scale (EPDS), and the Patient Health Questionnaire-9 (PHQ-9) were compared between women with PreE (n=32) and women without PreE (n=46) between 9 and 48 months postpartum (IRB# 201808705). ACE scores are calculated by summing an individual’s affirmative responses to specific adverse experiences during childhood. In our study, the average ACE score of individuals with PreE was higher than that of women without PreE (1.69 vs. 1.02, P=.04). We also divided women into groups based on whether their ACE score was ≤3 or ≥4 due to evidence that individuals who have experienced ≥4 ACEs are at greatest risk for physical and mental health conditions. Among our participants, 80% of women with an ACE score ≥4 (n=10) had PreE while only 35.3% of women with a score ≤3 (n=68) developed the condition (P=0.01). As well, the odds of having PreE were higher in those with ACE scores ≥4, compared with those with scores ≤3 (OR= 7.34; 95% CI = 1.44, 37.33). In a subset of participants, scores were available from EPDS, survey that identifies women who have postpartum depression 6 weeks after birth, and from the PHQ-9, another assessment for depression. Among our participants, the average EPDS score was higher in women with PreE than women without PreE (6.38, n=21 vs. 3.71, n=42 P=0.01), indicating more severe symptoms of postpartum depression in women who also had PreE. In addition, the average PHQ-9 score among women with PreE was higher than that of women without PreE (3.71, n=15 vs 1.86, n=37 P=.02) with a higher score indicating more severe depression. The average PHQ-9 score was also higher in women who had ACE scores ≥4 than women with scores ≤3 (4.00, n=4 vs. 2.27, n=48 P=.01) indicating that women with more adverse childhood events were more likely to experience depression. Together, these findings indicate that PreE may be associated with adverse events during childhood as well as depression in late pregnancy and/or postpartum.


2017 ◽  
Vol 39 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Gustavo Paranhos de Albuquerque Moraes ◽  
Laura Lorenzo ◽  
Gabriela Arruda Reinaux Pontes ◽  
Maria Cristina Montenegro ◽  
Amaury Cantilino

Abstract Introduction: Prevalence rates of postpartum depression (PPD) vary widely, depending on the methodological parameters used in studies: differences in study populations, diagnostic methods, and postpartum time frame. There is also no consensus on the ideal time to perform screening, on whether PPD can only be diagnosed in the early postnatal period, or on how soon after a delivery depression may be related to it. Objective: To review which instruments have been used over recent years to screen and diagnose PPD and the prevailing periods of diagnosis. Methods: Only articles published within 5 years and related exclusively to screening and diagnosis were selected. The sample comprised 22 articles. Results: The Edinburgh Posnatal Depression Scale (EPDS) was the most common screening tool, used in 68% of the sample (15 articles), followed by the Beck Depression Inventory (BDI-II) (27%, 6 articles), and the Patient Health Questionnaire-9 (PHQ-9) (18%, 4 articles). Screening time frame was reported in 21/22 articles: 0 to 3 months postpartum in 9 (43%), up to 6 months in 4 (19%), and up to 12 months or more in 8 (38%). In short, 13 articles screened during the first 6 months (59%) while only 8 (36%) screened up to 1 year. Conclusion: The most frequent PPD diagnosis tool was the EPDS, but other scales were also used. The most common period for diagnosis was up to 3 months postpartum. However, some researchers diagnosed PPD 12 months or more postpartum. Greater standardization of parameters for investigation of this disease is needed.


Author(s):  
Jodi Barton ◽  
Philip Boyce

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.


2016 ◽  
Vol 33 (S1) ◽  
pp. S417-S418 ◽  
Author(s):  
V. Medvedev

IntroductionThe urgency of depression treatment in patients with cardiovascular diseases (CVD) is determined by the increasing prevalence of affective disorders. For these patients, tolerance and safety of antidepressants are of great importance.ObjectiveTo obtain additional data on therapeutic efficacy and tolerance of agomelatine in the treatment of mild to moderate depressive disorders in cardiologic practice in Russia.MethodsEight hundred and ninety-six adult patients with CVD (86.5% arterial hypertension, 29.5% stable angina, 16% myocardial infarction, 23.6% conduction disturbances, 17.6% chronic heartfailure) were treated with agomelatine 25-50 mg for 12 weeks. Depression and anxiety symptoms were evaluated via Hospital Anxiety and Depression Scale (HADS), Clinical Global Impression (CGI-S and CGI-I), Visual Analog Scale (VAS), Spielberger Anxiety Scale (SAS), Whitely Hypochondria Index (WHI) and quality of life questionnaire (SF-36). Safety and tolerance were also monitored according to the summary of product characteristics recommendations.ResultsHADS scores decreased throughout the study and severe anxiety rate decreased from 95.9% to 15%. After 12 weeks of treatment, remission (HADS < 7) rate was 84.6%. Subjective assessment of patient health significantly improved (P < 0.00001). WHI decreased significantly (P < 0.00001). Physical and mental health significantly improved (P < 0.00001). Heart rate and blood pressure decreased. Treatment acceptability was considered “excellent” by 82% of doctors and 75% of patients.ConclusionAgomelatine significantly improved depressive symptoms, anxiety and hypochondria in depressed patients with CVD and demonstrated good tolerance. This suggests the possibility of wide and safe use of agomelatine for treatment of depression in patients with CVD.Disclosure of interestThe authors have not supplied their declaration of competing interest.


2018 ◽  
Vol 14 (1) ◽  
pp. 109-119 ◽  
Author(s):  
Addishiwet Fantahun Adamu ◽  
Yohannes Mehretie Adinew

Background:Mental illness in women leads to an increased maternal morbidity and mortality. Postpartum depression accommodates various groups of depressive disorders and syndromes that occur within the first immediate year after delivery. Thus, this study aimed to assess the prevalence of postpartum depression symptoms and correlates among mothers attending public health centers of Addis Ababa, Ethiopia.Methods:Facility-based cross-sectional study was conducted on 618 women in their postpartum period. Simple random sampling technique was used to select three out of ten sub cities in Addis Ababa. Then, nine health centers were selected by lottery method from the three sub-cities. The number of women included from each health center was determined by proportional allocation. Study participants were enrolled by systematic random sampling. The Edinburgh Postnatal Depression Scale was used at a cutoff point>13 to detect depression. Descriptive statistics were done. The bivariate and multivariate analysis was also carried out to identify predictors of postpartum depression.Results:Significant proportion 144 (23.3%) of the women had the symptom of postpartum depression. Respondents who were the victims of domestic violence [AOR 3.1; 95% CI: 1.6-5.9], reported to have diagnosed with postpartum depression [AOR 4.41; 95% CI: 2.4-8.3], and dissatisfied with their marriage [AOR 2.9; 95% CI: 1.5-5.6] had higher odds of reporting postpartum depression symptoms.Conclusion:Postpartum depression is a common mental health problem during the postnatal period. Domestic violence was positively and significantly associated with the symptom of postpartum depression. Maternity services shall consider a sector that provides health care for women who encounter violence and develop symptoms of postpartum depression.


2019 ◽  
Vol 6 (4) ◽  
pp. 226-231
Author(s):  
N. Scherbina ◽  
L. Potapova ◽  
I. Scherbina ◽  
O. Lipko ◽  
O. Mertsalova

THE CURRENT STATE OF THE PROBLEM OF PERINATAL PSYCHOSOMATIC DISORDERS IN PREGNANT WOMEN Scherbina N., Potapova L., Scherbina I., Lipko O., Mertsalova O. Objective: to study the characteristics of the psychosomatic state of women during pregnancy using the Edinburgh Postpartum Depression Scale (EPDS). Materials and Methods: sixty pregnant women in the III trimester of pregnancy were tested using the EPDS questionnaire, a 10-point self-assessment scale that covers the general symptoms of depression. To determine the internal consistency and reliability of this scale, the Cronbach alpha indicator, a statistical indicator that allows evaluation of whether the features included in the questionnaire measure the same thing (high internal agreement), or different things (low internal agreement), was calculated. Results: Subjectively, all pregnant women noted  simplicity, unambiguity and clear wording of the questions, which indicated good acceptability of this questionnaire for the use in the complex of standard monitoring of pregnant women in an antenatal clinic. The Cronbach alpha coefficient was 0.775, which corresponds to a sufficient degree of consistency of the internal elements of the scale. Screening for depressive disorders using EPDS during pregnancy revealed psychosomatic problems of the perinatal period. Data obtained using this scale demonstrate high rates of depressive manifestations in pregnant women. Psychopathological disorders were detected in 40% of women, while in 23% the symptoms of the current "major" depression were identified. The frequency of development of depressive symptoms increases significantly in the presence of a high obstetric risk, characteristic of the current pregnancy (threat of premature birth, hypertensive disorders during pregnancy, intrauterine infection of the fetus, retardation of the fetus development), as well as compromised obstetric and gynecological history. EPDS can be used as a reliable diagnostic tool to prevent pregnancy-related adverse outcomes. Conclusions: identifying the risk factors of pregnancy, screening and examining psychosomatic symptoms with EPDS, and timely referral for psychiatric care are key issues for reducing the risk among women with psychosomatic disorders during pregnancy and the postpartum period. Keywords: pregnancy, psychosomatic disorders, Edinburgh postpartum depression scale.   Абстракт. СУЧАСНИЙ СТАН ПРОБЛЕМИ ПЕРИНАТАЛЬНИХ ПСИХОСОМАТИЧНИХ РОЗЛАДІВ У ВАГІТНИХ. Щербина М., Потапова Л., Щербина I., Ліпко О., Мерцалова О. Мета дослідження: вивчити особливості психосоматичного стану жінок під час вагітності з використанням Единбурзької шкали післяпологової депресії (EPDS). Матеріали і методи: проведено тестування за опитувальником EPDS 60 вагітних жінок в III триместрі вагітності. EPDS є шкалою самооцінки, складається з 10 пунктів охоплює загальну симптоматику депресії. Для визначення внутрішньої узгодженості і надійності зазначеної шкали розраховувався показник альфа Кронбаха, статистичний показник, що дозволяє оцінити вимірюють чи ознаки, що входять в опитувальник одне і те ж (висока внутрішня згода, або різні речі (низький внутрішній згоду). Результати дослідження: суб'єктивно все вагітні відзначали простоту, однозначність і зрозумілу формулювання питань, що свідчило про хорошу прийнятності даного опитувальника для застосування в комплексі стандартного спостереження за вагітними в жіночій консультації. Значення коефіцієнта альфа Кронбаха склало 0,775, що відповідає достатньому ступені узгодженості внутрішніх елементів шкали. Проведений скринінг на наявність депресивних розладів за допомогою EPDS під час вагітності дозволив виявити психосоматичні проблеми перинатального періоду. Дані, отримані на основі застосування цієї шкали демонструють високі показники присутності депресивних проявів у вагітних жінок. Психопатологічні розлади виявлено у 40% жінок, при цьому у 23% визначені симптоми поточної «великої» депресії. Частота розвитку депресивних симптомів значно підвищується при наявності високого акушерського ризику, характерного для поточної вагітності (загроза передчасних пологів, гіпертензивні порушення під час вагітності, внутрішньоутробне інфікування плода, ретардація плода), а також обтяженого акушерського і гінекологічного анамнезів. EPDS може бути використана як надійний діагностичний інструмент для попередження несприятливих наслідків, пов'язаних з вагітністю. Висновок: виявлення факторів ризику  вагітності, скринінг і вивчення психосоматичних симптомів у вагітних із використанням  EPDS, а також своєчасне направлення для надання психіатричної допомоги, є ключовими питаннями зниження ризику серед жінок з психосоматичними розладами під час вагітності та в післяпологовому періоді. Ключові слова: вагітність, психосоматичні розлади, Единбурзька шкала післяродової депресії.    Абстракт СОВРЕМЕННОЕ СОСТОЯНИЕ ПРОБЛЕМЫ ПЕРИНАТАЛЬНЫХ ПСИХОСОМАТИЧЕСКИХ  РАССТРОЙСТВ У БЕРЕМЕННЫХ. Щербина Н., Потапова Л., Щербина И., Липко О., Мерцалова О. Цель исследования: изучить особенности психосоматического состояния женщин во время беременности с использованием Эдинбургской шкалы послеродовой депрессии (EPDS).Материалы и методы: проведено тестирование по опроснику EPDS 60 беременных женщин в III триместре беременности. EPDS является шкалой самооценки, состоит из 10 пунктов и охватывает общую симптоматику депрессии. Для определения внутренней согласованности и надежности указанной шкалы рассчитывался показатель альфы Кронбаха, статистический показатель, позволяющий оценить измеряют ли признаки, входящие в опросник одно и то же (высокое внутреннее согласие, или разные вещи (низкое внутреннее согласие). Результаты исследования: Субьективно все беременные отмечали простоту, однозначность и понятную формулировку вопросов, что свидетельствовало о хорошей приемлемости данного опросника для применения в комплексе стандартного наблюдения за беременными в женской консультации. Значение коэффициента альфа Кронбаха составило 0,775, что соответствует достаточной степени согласованности внутренних элементов шкалы. Проведенный скрининг на наличие депрессивных расстройств с помощью EPDS во время беременности позволил выявить психосоматические проблемы перинатального периода. Данные, полученныена основе применения этой шкалы демонстрируют высокие показатели присутствия депрессивных проявлений у беременных женщин. Психопатологические расстройства выявлены у 40% женщин, при этом у 23% определены симптомы текущей «большой» депрессии. Частота развитии депрессивных симптомов значительно повышается при наличии высокого акушерского риска, характерного для текущей беременности (угроза преждевременных родов, гипертензивные нарушения во время беременности, внутриутробное инфицирование плода, ретардация плода), а также отягощенного акушерского и гинекологического анамнезов. EPDSможет быть использована как надежный диагностический инструмент для предотвращения неблагоприятных исходов, связанных с беременностью. Заключение: выявление факторов риска беременности и родов, скрининг и изучение психосоматических симптомов cиспользованием EPDS, а также своевременное направление для оказания психиатрической помощи, являются ключевыми вопросами снижения риска среди женщин с психосоматическими расстройствами во время беременности и в послеродовом периоде. Ключевые слова: беременность, психосоматические расстройства, Эдинбургская шкала послеродовой депрессии.


2016 ◽  
Vol 33 (S1) ◽  
pp. s279-s280
Author(s):  
A. Ugarte ◽  
P. López ◽  
C. Serrulla ◽  
M.T. Zabalza ◽  
J.G. Torregaray ◽  
...  

IntroductionPostpartum depression has a prevalence of 15% and has consequences for mother and baby (delayed physical, social and cognitive development). It's essential to prevent the illness with an early identification of Risk Factors (RF).MethodsFive hundred and seventy-two women in 3rd trimester of pregnancy were evaluated and selected those with ≥ 1 RF (n = 290). We re-evaluated in the postpartum with Edinburgh Depression Scale and selected those with subsyndromal depressive symptoms (≥ 7.5) (n = 57). Clinical, demographic and functional data were collected.ResultsA total of 50.7% had RF. A percentage of 48.6 had family history of mental illness (MI), 34.1%had personal history of (MI) and 34.1% had some pregnancy associated illness. Twenty percent had needed some assisted reproductive technique, 14.1% had little family support and 15.2% had little couple support, 3.8% showed anxiety-depressive disorders during pregnancy, 19.7% had depressive symptoms after delivery. The mean age was 33.67. No significant differences between patients with and without RF (T-1858, P 0.064). Among women with RF, 59.6% were married, 35.1% single and 3.0% had other situation. 89.5% live with their own family, 8.8% with their family of origin, 1.8% alone. 50.8% had university studies.ConclusionsAssessing RF during pregnancy can help these women, since we see that the 19.7% will have serious risk of developing postpartum depression. The RF to take more into account are not those related to social-academic development, neither the presence of anxiety-depressive symptoms during pregnancy, but the family or personal history of (MI) and the presence of a pregnancy associated illness. Early detection and treatment may prevent the development of this disease improving the quality of life of mother and babies’ development.Disclosure of interestThe authors have not supplied their declaration of competing interest.


Postpartum depression (PPD) is a common psychiatric disorder in the peripartum period affecting approximately 8% of European women without prior psychiatric history [1] and even more with pre-existing depressive disorders. Up to 70% of new mothers develop mild depressive symptoms called “baby-blues” which include weepiness, sadness and mood lability. Those symptoms usually peak between 2 and 5 days post-delivery and abate spontaneously within days up to 2 weeks [2]. In contrast to “baby blues” postpartum depression can have a serious impact on functioning and even lead to suicidality rendering it highly important to detect the disorder as early as possible. The Edinburgh Postnatal Depression Scale (EPDS) [3] is widely used to screen for postpartum depression and should be applied to all new mothers who develop depressive symptoms such as loss of interest, hopelessness and depressive feelings. Several risk factors for postpartum depression have been identified: Prenatal depression poses the highest risk, followed by low self-esteem, childcare stress, prenatal anxiety, life stress and lack of social support [4]. Postpartum depression is a treatable condition, however, it has to be distinguished from bipolar disorder and postpartum psychosis, which require different treatment strategies [2].


2021 ◽  
Vol 11 (5) ◽  
pp. 285-296
Author(s):  
Nwosu Netochi Georgiana ◽  

Background: The reproductive years come with their own share of mental health issues with childbirth and the postpartum period being a particularly vulnerable time for mothers leading to an increase in the risk of depressive disorders. Postpartum depression has a huge public health effect on the mother with long-term consequences on the child and family. Research has shown that physical activity is beneficial; however, such studies are lacking in Nigeria. Therefore, this study sought to look at the association between postpartum depression and physical activity and determine its prevalence among women in a tertiary hospital in Nigeria. Methods: This cross-sectional study was conducted among 401 women attending immunization and postnatal clinics at the University College Hospital Ibadan. The data were collected using a self-administered questionnaire containing a self-developed socio-demographic section, Edinburgh postnatal depression scale to measure postpartum depression, and an International physical activity questionnaire (short type) to as sess physical activity. Analysis was done using the Chi-square test and multivariate analysis to determine independent factors. Significance was set at 0.05. Results: More than a third of the respondents (37.8%) had postpartum depression. Physical activity level was high (72.1%). High levels of physical activity increased the odds of postpartum depression compared to lower levels (95% CI= 0.797-0.97). Gender of the child, marital relationship satisfaction, and age of the child were independently associated with postpartum depression. Conclusion: This study showed that the prevalence of postpartum depression is greater than previously reported in past studies in southwest Nigeria and high levels of physical activity may increase the risk of postpartum depression.


2021 ◽  
Author(s):  
Netochi Nwosu

Abstract Background Depressive disorders are listed as one important public health issue among women of reproductive age. Postpartum depression is a mental health disorder occurring after childbirth and has disabling effect on mother and child. Amongst other alternative treatment methods, physical activity has been proposed as beneficial especially for mild postpartum depression. Therefore, this study sought to determine the prevalence of postpartum depression, and the association between postpartum depression and physical activity among women in a tertiary hospital in Ibadan. Methods The cross-sectional study was conducted among 401 women attending immunisation and postnatal clinics at the University College Hospital Ibadan. The data was collected using a self-administered questionnaire containing; a self-developed socio-demographic section, Edinburgh postnatal depression scale to measure postpartum depression and International physical activity questionnaire (short type) to assess physical activity. Analysis was done using chi square and a multivariate analysis to determine independent factors. Significance was set at 0.05. Results More than a third of the respondents (37.8%) had postpartum depression. Physical activity level was high (72.1%). High levels of physical activity had 1.25 the odds of postpartum depression as compared to lower levels (95% CI = 0.797–0.97). Gender of child, relationship satisfaction, age of child, were independently associated with postpartum depression. Conclusion This study shows that prevalence of postpartum depression is greater than previously reported in past studies in southwest Nigeria and high levels of physical activity may increase the risk of postpartum depression.


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