Risk factors for sub-clinical and major postpartum depression among a community cohort of Canadian women.
ABSTRACT To identify prenatal and perinatal factors that predict women at risk of sub-clinical and major postpartum depression among a cohort of low medical risk pregnant women in Canada.
Data from 1,403 women who completed a randomized controlled trial of supplementary support during pregnancy was analyzed to identify risk factors for sub-clinical and major postpartum depression. The Edinburgh Postnatal Depression Scale (EPDS), completed at eight weeks postpartum, was used to classify each woman's depression symptom severity. Demographic, obstetric, behavioral risk, mental health and psychosocial factors were considered. Multiple logistic regression analyses were used to identify risk factors most predictive of sub-clinical and major postpartum depression.
After adjustment for other covariates, variables that increased the risk of sub-clinical postpartum depression included a history of depression (OR = 2.27, CI = 1.42-3.63), anxiety symptoms during pregnancy (OR = 2.12, CI = 1.09-4.11), being born outside Canada (OR = 1.87, CI = 1.17-3.00), and low parenting self-efficacy (OR = 1.65, CI = 1.06-2.55). Variables that increased the risk of major postpartum depression included a history of depression (OR = 2.78, CI = 1.56-4.97), being born outside Canada (OR = 2.97, CI = 1.70-5.17), depressive symptoms during pregnancy (OR = 2.83, CI = 1.29-6.19) and not breastfeeding at eight weeks postpartum (OR = 2.12, CI = 1.21-3.70).
A history of depression and being born outside Canada predicted women who were at an increased risk of sub-clinical and major postpartum depression. The remaining risk factors specific to sub-clinical and major postpartum depression suggest some differences between women vulnerable to sub-clinical compared to major depressive symptoms in the postpartum period, which may have implications for targeted screening and intervention strategies.
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ABSTRACT: The aim of this paper is to highlight the up-to-date knowledge on postpartum mood disorders: postpartum depression (PPD), postpartum psychosis (PP), postpar- tum hypomania (PH), and maternal blues (MB). Postpartum depression (characterized by the features of a moderate or severe major depressive episode) affects about 7-20% of postpartum women. Current evidence suggest that women are susceptible to developing PPD during the entire first year following delivery. The core clinical features of PPD are low self-esteem, tension, and hypochondria. The Edinburgh Postnatal Depression Scale is a standard tool used in screening for PPD. PPD has been included in the Ghaemi et al.’s diagnostic cri- teria for bipolar spectrum disorders. Postpartum psychosis is a psychiatric emergency condi- tion, characterized by high severity and rapid deterio- ration of symptoms, once described as ‘psychosis of delir- ium-like appearance’. It affects 0.1-0.2% of postpartum women. 72-80% of PP cases are due to bipolar disorder (BD) or schizoaffective disorder. The condition is an obligatory indication for hospitalization. Mood stabiliz- ers (usually in combination with atypical antipsychotics) are a mainstay of therapy for subjects with ‘bipolar’ PP. Typically PH develops on the first day postpartum. Its prevalence has been estimated at 10-20%. The disorder is a significant risk factor for developing PPD. The ‘Highs’ Questionnaire is a validated tool used in screening for PH. Maternal blues is a syndrome of mild, self-restricting mood disorders, usually developing in the early post- partum period. Although often considered to be a phys- iological phenomenon, it is an established risk factor for developing PPD or postpartum anxiety disorders.Neuropsychiatria i Neuropsychologia 09/2012; 7(3):113-121.
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ABSTRACT: The prevalence of postpartum depression worldwide varies from 0.5% to 60.8% in the first 12 months postpartum using self-reported questionnaire. This review aims to update the current magnitude of postpartum depression based on self-reported questionnaire and clinical interview and explore its associated factors in developed and developing countries. A literature search conducted between 2005 and 2014 identified 203 studies, of which 191 used self-reported questionnaire in 42 countries and 21 used structured clinical interview in 15 countries. Nine studies used a combination of self-reported questionnaire and clinical interview. The prevalence of postpartum depression varies from 1.9% to 82.1% in developing countries and from 5.2% to 74.0% in developed countries using self-reported questionnaire. Structured clinical interview shows a much lower prevalence range from 0.1% in Finland to 26.3% in India. Antenatal depression and anxiety, previous psychiatric illness, poor marital relationship, stressful life events, negative attitude towards pregnancy, and lack of social support are significant contributors to postpartum depression. All studies are included irrespective of the methodological quality, such as small sample size and their inclusion could affect the generalizability of the results. The current prevalence of postpartum depression is much higher than that previously reported, and similar risk factors are documented. A culturally sensitive cut-off score with adequate psychometric properties of the screening instruments should be available. In future studies, examining the physical, biological, and cultural factors in qualitative studies and in those with adequate methodological qualities is recommended. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.Journal of Affective Disorders 12/2014; 175C:34-52. DOI:10.1016/j.jad.2014.12.041 · 3.76 Impact Factor
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ABSTRACT: The broader autism phenotype (BAP), which refers to the expression of behavioral and cognitive propensities that are milder but qualitatively similar to those defining autism spectrum disorder, can play a crucial role in postpartum depression (PPD). We investigated whether pregnant women's BAP would increase the risk for PPD, using a representative birth cohort in Japan. Pregnant women were enrolled in the Hamamatsu Birth Cohort (HBC) Study during their mid-gestation (N = 841) and were followed up until 3 months after delivery. BAP was measured mainly during the 2nd trimester of the pregnancy by using the Broader Phenotype Autism Symptoms Scale. Participants scoring 9 points or higher on the Edinburgh Postnatal Depression Scale at least once during the first 3 months after childbirth were diagnosed with PPD. Among participants, 128 (15.2%) women were found to have PPD. Multiple logistic regression analyses showed that BAP were associated with PPD (OR = 1.19, 95% CI [1.07–1.31]), even after controlling for other potential confounders. In addition, the association was not moderated by history of depression and/or anxiety disorders, including concurrent depressive and anxiety symptoms during pregnancy. The findings suggest that pregnant women with BAP have an elevated risk for PPD.Research in Autism Spectrum Disorders 12/2014; 8(12):1672–1678. DOI:10.1016/j.rasd.2014.08.010 · 2.96 Impact Factor