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Postpartum Depression: Is Mode of Delivery a Risk Factor?  [PDF]
Asli Goker,Emre Yanikkerem,M. Murat Demet,Serife Dikayak,Yasemin Yildirim,Faik M. Koyuncu
ISRN Obstetrics and Gynecology , 2012, DOI: 10.5402/2012/616759
Abstract: There are various factors related to postpartum depression. In this study we have aimed to determine the effect of mode of delivery on the risk of postpartum depression. A total of 318 women who applied for delivery were included in the study. Previously diagnosed fetal anomalies, preterm deliveries, stillbirths, and patients with need of intensive care unit were excluded from the study. Data about the patients were obtained during hospital stay. During the postpartum sixth week visit Edinburgh postnatal depression scale (EPDS) was applied. There was no significant difference between EPDS scores when compared according to age, education, gravidity, wanting the pregnancy, fear about birth, gender, family type, and income level ( ). Those who had experienced emesis during their pregnancy, had a history of depression, and were housewives had significantly higher EPDS scores ( ). Delivering by spontaneous vaginal birth, elective Cesarean section, or emergency Cesarean section had no effect on EPDS scores. In conclusion healthcare providers should be aware of postpartum depression risk in nonworking women with a history of emesis and depression and apply the EPDS to them for early detection of postpartum depression. 1. Introduction Postpartum depression (PPD) is considered as an important health problem in modern societies. The prevalence of PND ranges from 7.6% to 39% in various areas of the world and differs according to the population tested and screening tools used [1–4]. The Diagnostic and Statistical Manual of Mental Disorders defines PPD as having five or more of the following symptoms for at least two weeks: insomnia/hypersomnia, psychomotor agitation or retardation, fatigue, appetite changes, feelings of hopelessness or guilt, decreased concentration, and suicidality. These episodes begin within 4 weeks postpartum and may last one year [5]. Risk factors that have been identified are poor marital relationship, prenatal depression, illness of the child, low socioeconomic status, low educational level, unwanted pregnancy, obesity, previous history of postpartum depression, and physical symptoms [6–10]. Some risk factors are merely seen in eastern communities such as sex of the infant [11, 12] and grand multiparity [13]. The importance of PPD lies in the fact that it is associated with long-term effects on family and child. Marital relationships are frequently affected [14]. Women with PPD tend to discontinue breastfeeding and cognitive development of the child is also shown to be impaired due to insufficient maternal-infant interaction [15, 16].
The Experience of Postpartum Depression among Mothers with Withdrawn Attachment Style during Pregnancy and the First Postnatal Month  [PDF]
Mari Ikeda, Momoko Hayashi, Kiyoko Kamibeppu
Open Journal of Depression (OJD) , 2015, DOI: 10.4236/ojd.2015.44008
Abstract: Approximately 19% of women experience minor or major depression in the first three months following childbirth. Most research suggests that women with withdrawn attachment styles are less likely to be depressed. However, unlike mothers in Western culture, mothers in Japan with withdrawn attachment styles are reported to have greater potential to become depressed. Thus, the aim of this study was to describe the behaviors and situational awareness of Japanese mothers’ with withdrawn attachment styles during pregnancy in order to reveal the specific dynamics underlying the withdrawn style. Interview data were analyzed using qualitative thematic content analysis. Of the 84 women assessed, 12 were determined to have a withdrawn style, and based on the Mini-International Neuropsychiatric Interview, five demonstrated the onset of postpartum depression (PPD). Two themes regarding relationships with partners emerged including: 1) confiding behavior: the importance of what is shared; and 2) need to be heard: wanting sympathy rather than criticism. Additionally, three themes describing mothers’ experiences during the first postnatal month emerged: 1) overwhelming experiences: the childbirth experience; 2) seeking help: behavior changes altered relationships; and 3) experience with the baby. Withdrawn style mothers keep distance from crisis, avoid closeness with others, and opt to manage problems by themselves. However, childbirth and infant care are not easily managed in this style. Mothers who used childbirth to confide in their partners may have reduced the severity of insecurity or developed a more secure style. Healthcare professionals are in the best position to develop good relationships with new mothers and provide support that focuses more on emotional factors and self-esteem levels.
The Inter Relationship of Mental State between Antepartum and Postpartum Assessed by Depression and Bonding Scales in Mothers  [PDF]
Kafumi Sugishita, Kiyoko Kamibeppu, Hiroya Matsuo
Health (Health) , 2016, DOI: 10.4236/health.2016.812126
Abstract: The number of deaths caused by child abuse is increasing, which is one of social concerns. The mental health of mothers might be related to child abuse. The aim of this study was to examine and compare the mental state of mothers in both the antepartum and postpartum period assessed by the Edinburgh Postnatal Depression Scale (EPDS) and Mother-Infant-Bonding-Scale (MIBS), and compare the results. Participants (n = 134) were recruited twice in antepartum medical checkups (20 to 36 weeks of gestation) and postpartum medical checkups (1 month after birth). Information on characteristics of participants was collected from medical records in both periods. Family function and ante-postpartum mental health were assessed by Family APGAR, EPDS, and MIBS. Antepartum depressive state was related to postpartum depressive state (p = 0.015), antepartum bonding was related to bonding in postpartum bonding (p = 0.0001), and antepartum bonding disorder was related to postpartum depressive state (relative risk = 11.7). Worries about costs and poor of family function were related to the mental health of mothers in both the antepartum and postpartum periods. Antepartum depressive state is an indicator of postpartum depression. We suggested that health professionals conduct an evaluation of mother’s mental health and related factors in the antepartum period. The present findings emphasize the importance of antepartum mental health as a predictor of postpartum depression and bonding disorder.
Symptoms of postpartum depression and early interruption of exclusive breastfeeding in the first two months of life
Hasselmann, Maria Helena;Werneck, Guilherme L.;Silva, Claudia Valéria Cardim da;
Cadernos de Saúde Pública , 2008, DOI: 10.1590/S0102-311X2008001400019
Abstract: this study evaluates the association between postpartum depression and interruption of exclusive breastfeeding in the first two months of life. cohort study of 429 infants < 20 days of age to four primary health care units in rio de janeiro, brazil. interruption of exclusive breastfeeding (outcome) was defined as the introduction of water, other types of liquids, milk, or formulas or any food. postpartum depression was assessed using the edinburgh post-natal depression scale. associations between variables were expressed as prevalence ratios (baseline) and risk ratios (follow-up), with their respective 95% confidence intervals, estimated by poisson regression with robust variance. children of mothers with postpartum depressive symptoms were at higher risk of early interruption of exclusive breastfeeding in the first and second months of follow-up (rr = 1.46; 95%ci: 0.98-2.17 and rr = 1.21; 95%ci: 1.02-1.45, respectively). considering mothers that were exclusively breastfeeding at the first month, postpartum depression was not associated with interruption of exclusive breastfeeding in the second month (rr = 1.44; 95%ci: 0.68-3.06). the results indicate the importance of maternal mental health for the success of exclusive breastfeeding.
Anida Fazlagi？
Acta Medica Medianae , 2011,
Abstract: Manual of Mental Disorders (DSM-IV), postpartum depression may include any nonpsychotic depressive disorder during the first four weeks of postpartum, according to research criteria during the first year after birth. The exact cause of postpartum depression is not yet known, and most researchers believe that postpartum depression is a bio-psycho-social problem. So far, the biological aspect of the disease is explained by changing the levels of estrogen and progesterone during pregnancy, and by decrease of hormone levels after birth. Psychological correlates are often associated with low selfesteem, pessimism as a personality trait, bad strategies of coping with stress, mood swings and emotional reactions. The social aspect of the disease is associated with the existential conditions of pregnant woman, support of partners and education level. This paper will include issues like hereditary causes and possible psychological factors of postpartum depression prevention. Nowadays, it is estimated that on average 15% of women, regardless of the pregnancy outcome, are suffering from postpartum depression. However, this information includes only those women who were diagnosed with postpartum depression and who themselves reported about it. Almost every woman receives basic care during pregnancy to prevent complications in the physiological level. This paper has shown possible psychological factors of postpartum depression prevention, the impact of optimism, self-esteem and coping skills.
Impact of episiotomy on pelvic floor disorders and their influence on women's wellness after the sixth month postpartum: a retrospective study
Serena Bertozzi, Ambrogio P Londero, Arrigo Fruscalzo, Lorenza Driul, Cristina Delneri, Angelo Calcagno, Paolo Di Benedetto, Diego Marchesoni
BMC Women's Health , 2011, DOI: 10.1186/1472-6874-11-12
Abstract: A follow-up telephone interview was performed among 377 primiparous and secondiparous Caucasian women who had a child by spontaneous or operative vaginal delivery in 2006 using a self-created questionnaire and King's Health Questionnaire (KHQ).The mean age at delivery was 35.26 (±4.68) years and episiotomy was performed in 59.2% of women. Multivariate linear regression shows episiotomy associated to higher quality of life after the sixth month postpartum by correlating with inferior values of King's Health Questionnaire (p < 0.05).Episiotomy appears to be a protective factor for women's wellness. Women who had episiotomy and who experienced perineal symptoms have a better psycho-physical health status in the 12.79 months (±3.3) follow-up.Providing assistance in cases of spontaneous vaginal delivery presents a valuable opportunity to prevent perineal disorders such as urinary incontinence (UI), which, requiring surgical intervention in circa 400,000 women every year in the USA alone, has been compared to a hidden epidemic [1].UI prevalence rate in women is estimated at between 10% and 50% depending on age [2-5] - a study involving 1029 women with a mean age of 53 years in our region found a UI prevalence of around 44% [6]. UI in women is often assumed to be attributable to the effects of pregnancy and childbirth. In fact, among pregnant women, UI is a common occurrence compared with other groups of women, with reported prevalence rates ranging between 31% and 60% [7,8]. However, UI tends to be a self-limited condition postpartum, with persistent postpartum UI prevalence rates cited as variating between 0.7% and 44% [9-11].In addition to UI, many perineal disorders are commonly associated with vaginal delivery, such as anal incontinence, chronic pelvic pain, other lower urinary tract symptoms and dyspareunia, incidences of which are probably underestimated.Recent studies underline the importance of a better delivery management [12,13] in order to prevent perineal dama
Trends of Postpartum Depression in Iran: A Systematic Review and Meta-Analysis  [PDF]
Yousef Veisani,Ali Delpisheh,Kourosh Sayehmiri,Shahab Rezaeian
Depression Research and Treatment , 2013, DOI: 10.1155/2013/291029
Abstract: Background. Postpartum depression (PPD) is a serious mental health disorder affecting 13% of women in developed communities. The present study reviews available epidemiological publications on PPD-related aspects in Iranian women to help policy makers and health workers to design preventative strategies and further researches. Materials and Methods. A systematic review was constructed based on the computerized literature valid database. The 95% confidence intervals were calculated by random effects models. Metaregression was introduced to explore and explain heterogeneity between studies. Data manipulation and statistical analyses were performed using Stata 11. Results. Overall, 41 studies met the inclusion criteria. The pooled prevalence of PPD in Iran was 25.3% (95% CI: 22.7%–27.9%). Amongst subgroups of unwanted delivery, illiterate, housewives, and having history of depression the prevalence was 43.4% (35.6–51.1), 31.6% (18.1–45.0), 30.7% (25.2–36.3), and 45.2% (35.4–53.1), respectively. Conclusions. Interventions that would specifically target women with a prior history of depression, illiterates, housewives, or women with unwanted pregnancies could be helpful to decrease the prevalence of postpartum depression in Iran. 1. Introduction Postpartum depression (PPD) affects almost 13% of women in developed high income communities [1] and may be even more common in developing countries [2, 3]. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), PPD is a major depression when symptoms have onset within 5 weeks of childbirth [4]. PPD presents with the same symptoms as for a major depressive episode occurring outside of the prenatal period, including core symptoms of depressed mood and/or loss of pleasure, together with additional symptoms, including changes in weight or sleep, fatigue or loss of energy, feelings of worthlessness or guilt, concentration difficulties, and suicidal ideation [4]. Majority of PPD researches in Iran have not utilized diagnostic assessments to identify cases. Alternatively, they have used the validated self-report depression screening instruments, such as the Edinburgh Postnatal Depression Scale (EPDS) [5]. Although this approach has been criticized, the EPDS has showed good sensitivity and specificity, particularly when used to detect both major and minor depressions [5]. In terms of etiology, PPD is a multifactorial disorder with biological, psychological, and sociological aspects interacting with woman’s risk individually [6]. Sociological factors such as unwanted delivery,
Postpartum Blues and Postpartum Depression
Erdem ？ et al.
Konuralp Tip Dergisi , 2009,
Abstract: Postpartum blues which is seen during the postpartum period is a transient psychological state. Most of the mothers experience maternity blues in postpartum period. It remains usually unrecognized by the others. Some sensitive families can misattribute these feelings as depression. In this article, we tried to review the characteristics of maternity blues and its differences from depression. We defined depression and presented the incidence and diagnostic criteria, of major depression as well as the risk factors and clinic findings of postpartum depression. Thus, especially at primary care we aimed to prevent misdiagnosis of both maternity blues and depression
Retention rates and potential predictors in a longitudinal randomized control trial to prevent postpartum depression
Lara, Ma. Asunción;Navarro, Claudia;Navarrete, Laura;Le, Huynh-Nhu;
Salud mental , 2010,
Abstract: perinatal depression is increasingly recognized as a significant public mental health problem; consequently, there is a major interest in developing strategies to prevent postpartum depression that may help reduce its detrimental consequences. however, the unique experiences associated with the perinatal period make it more difficult to recruit participants at this stage and to retain them over time when assessing prevention interventions. the aim of the study is to examine retention rates and predictors of retention in a longitudinal, randomized controlled trial (rct) to prevent postnatal depression. method participants: pregnant women (n = 377) at risk of depression were randomized to intervention or usual care condition and assessed during pregnancy and at 6 weeks and 4-6 months postpartum. intervention: the intervention was designed by modifying a previously evaluated one and includes information on normal pregnancy and the postpartum period, from psychoanalytic and risk factors perspectives. it attempts to reduce depression levels by increasing positive thinking and pleasant activities, improving self-esteem, increasing self-care, learning skills to strengthen social support, and exploring unrealistic expectations about pregnancy and motherhood. it is delivered in eight two-hour weekly group sessions during pregnancy. measures: depressive symptoms were measured using the second edition of the beck depression inventory (bdi-ii); anxiety symptoms with the corresponding subscale of the hopkins symptoms checklist (scl-90) and social support with the social support apgar (ssa). a short form of 12 items representing potential stressors was used as a measurement of stressful life events and the abbreviated version of the dyadic adjustment scale (a-das) measured partner relationship. results retention rates -defined in three ways- were: (1) total retention (percentage of participants completing the 4-6 month postpartum interview) was 41.7% (31.2% intervention and 61.4%
Possible Predictive Factors for Low Back and Pelvic Pain at Three Months Postpartum Assessed in a Prospective Study from Early Pregnancy until the Postpartum Period  [PDF]
Yuko Uemura, Toshiyuki Yasui, Kimiyo Horike, Hirokazu Uemura, Mari Haku, Reiko Sakae, Keiko Matsumura
Open Journal of Nursing (OJN) , 2018, DOI: 10.4236/ojn.2018.88041
Abstract: Background: Low back and pelvic pain (LBPP) is an important issue related to mental health as well as to difficulty for daily life activity during early pregnancy and in the postpartum period. We examined the intensity of LBPP, difficulty for daily life activity and mental health and their associations from early pregnancy until 3 months postpartum in a prospective study. We also examined predictive factors for LBPP at 3 months postpartum. Methods: We recruited 55 pregnant women who responded to questionnaires in the first, second and third trimesters and at one week, one month and 3 months postpartum. We designed a self-administered questionnaire including a visual analog scale (VAS), pregnancy mobility index (PMI) of LBPP and Edinburgh postnatal depression scale (EPDS). Results: There were significant differences in the proportions of women with LBPP in the first trimester (63.6%), second trimester (78.2%) and third trimester (83.6%) and at one week postpartum (80.0%), one month postpartum (69.1%) and 3 months postpartum (56.4%). VAS score at 3 months postpartum was significantly correlated with VAS scores at the first trimester (r = 0.410, p = 0.002), second trimester (r = 0.298, p = 0.027) and one month postpartum (r = 0.476, p < 0.001). VAS score at 3 months postpartum was significantly correlated with PMI scores at the first trimester and one month postpartum. The presence of LBPP at 3 months postpartum was significantly associated with the proportion of women with LBPP at the first trimester. In multiparous women, predictive factor of LBPP at 3 months postpartum was a past history of LBPP in the previous pregnancy. Conclusion: The proportion of women with LBPP and the intensity of LBPP were increased at late pregnancy and gradually decreased until 3 months postpartum. LBPP at 3 months postpartum was associated with LBPP at the first trimester and a past history of LBPP in a previous pregnancy was an important factor for prediction of LBPP at 3 months postpartum. Provision of information regarding LBPP and confirmation of LBPP before pregnancy in addition to assessment of LBPP at early pregnancy are necessary for reduction of LBPP at 3 months postpartum.
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