Depression is the leading cause of disease-related disability among women. Postpartal depression (PPD) can produce substantial clinical, economic, and psychosocial impairment, not only for the women experiencing it but also for the women's children and family. Therefore, a comprehensive understanding the accurate detection and appropriate treatment of depression is mandatory in women of childbearing age. This review focused on the current knowledge of PPD.
Child ; Depression ; Depression, Postpartum* ; Diagnosis* ; Female ; Humans ; Postpartum Period*

OBJECTIVES: Primary health workers are the first fine to identify postpartum depression, which is important for patients with this disease to get early specialist diagnosis and treatment. The smartphone-based virtual patient is economical, convenient and effective, and has been applied extensively to evaluate the competency to detect postpartum depression, but there is no relevant application in China. This study aims to use virtual patient to assess the current status on the competency of detecting postpartum depression among primary maternal and child health workers in Hunan Province, and to explore potential influencing factors. METHODS: A total of 222 primary maternal and child health workers from 3 regions with low, medium, and high economic levels in Hunan Province were enrolled, and smartphone-based virtual patients with postpartum depression were used for the assessment from May to July in 2018, and a self-designed questionnaire was used to investigate their demographic characteristics. The competency to detect postpartum depression was measured by 2 indicators: diagnostic accuracy and treatment accuracy. Descriptive statistical methods were used to describe the competency to detect postpartum depression among them and their demographic characteristics. A logistic regression analysis was used to explore the possible influencing factors for the diagnostic accuracy and treatment accuracy. RESULTS: The diagnostic accuracy rate was 64.0%. There was no significant difference between the demographic characteristics and diagnostic accuracy rate ( CONCLUSIONS About half of the primary maternal and child health workers in Hunan Province, China have basic competency to detect postpartum depression, but the overall results are not satisfactory. The regional economic level is correlated with the competency of detecting postpartum depression, and the competency of detecting postpartum depression is stronger in more developed areas. Moreover, for the patients who have been identified as postpartum depression, the rate of correct treatment is low, which warrants particular attention in the follow-up training.
Child ; China ; Cross-Sectional Studies ; Depression, Postpartum/diagnosis* ; Female ; Health Personnel ; Humans ; Surveys and Questionnaires

PURPOSE: This study was designed to determine the predictors of postpartum depression. METHOD: One hundred- sixty one women within one year after delivery from one public health center located in the northern area of Seoul were used in this study. The instruments were a survey of general characteristics, the Edinburgh Postnatal Depression Scale, recent life events index, perceived social support from family, Quality of marriage index, parenting stress index, and Rosenberg's self-esteem inventory. Data was analysed using descriptive statistics, Pearson correlation coefficients, and logistic regression. RESULT: The average item score of the EPDS was 6.67. 12.4% of respondents, who scored above a threshold 12, were likely to be suffering from a depression of varying severity. The fitness of the model for explaining postpartum depression from six variables, plan for pregnancy, family support, quality of marital relation, perceived social support, life events, childcare stress, and self-esteem, was statistically significant and the predictive power of these variables was 90.9%. The significant predictors of postpartum depression were family support and child care stress. CONCLUSION: Further research is needed to identify the prevalence rate of postpartum depression using more reliable sampling methods from a large general population. Nursing interventions need to be developed for promoting family support and reducing childcare stress.
Adult ; Child ; Child Care ; Depression, Postpartum/*diagnosis/psychology ; Female ; Humans ; Marriage ; Pregnancy ; Questionnaires ; Risk Factors ; Social Support ; Stress, Psychological

The prevalence of postnatal depression (PND) was reported to be 6.8% in an obstetric setting in Singapore. Since primary care physicians are the healthcare clinicians most likely to interact with postnatal mothers in Singapore, they are in the best position to screen for PND and help new mothers. PND affects the well-being of the mother, her baby and those around her. If left untreated, depression can result in lasting adverse outcomes such as unfavourable parenting practices, impaired mother-infant bonding, impaired intellectual and emotional development of the infant, maternal suicide, and even infanticide. The Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-2 are effective screening tools that can be easily used in primary care settings for screening at-risk mothers. Herein, we discuss the management options available in primary care settings, as well as share some local resources available to mothers and the benefits of timely intervention.
Depression, Postpartum ; diagnosis ; epidemiology ; psychology ; Family Practice ; Female ; Global Health ; Humans ; Incidence ; Mothers ; psychology ; Physician's Role ; Prevalence ; Psychometrics ; methods

PURPOSE: Mothers' postpartum depression is a worldwide health concern that produces compromising effects on their infants. This study was conducted to compare the infants' temperament and health problems according to the presence of maternal postpartum depression. METHODS: Data were collected from May to October in 2009. The sample was 137 mothers at one month postpartum. The Edinburgh Postpartum Depression Scale (EPDS) was used to assess depressive symptoms. RESULTS: At one month postpartum, 22.6% of mothers were classified as having postpartum depression. Infants of depressed mothers were more frequently classified as difficult temperament infants. They showed lower scores on the amenability, rhythmicity and persistency and higher scores on activity in temperament. Also, infants of depressed mothers reported more infant health problems at one months. Maternal depression showed significant negative correlations with family functioning, social support and marital satisfaction. CONCLUSION: Study findings show that postpartum maternal depression is associated with infants' temperament and health, and thus screening and early interventions for postpartum depression would promote the health of both the mother and infant.
Adult ; Depression, Postpartum/diagnosis/*psychology ; Family Relations ; Female ; Humans ; Infant ; Infant Behavior/*psychology ; Infant Welfare ; Male ; Maternal Behavior/psychology ; Mother-Child Relations ; Mothers/*psychology ; Postpartum Period ; Psychiatric Status Rating Scales ; Questionnaires ; Social Support ; *Temperament ; Time Factors

OBJECTIVE: To explore the association between postpartum depression (PPD) and transforming growth factor-β (TGF-β) concentrations in human colostrum. METHODS: Participants were recruited from a maternal and infant cohort established in a tertiary general hospital in Guangdong Province between December, 2020 and September, 2021. In the afternoon of the second postpartum day, the women were evaluated with Edinburgh Postnatal Depression Scale (EPDS) for screening PPD (defined as a score of 10 or higher). The women with PPD were matched at a 1:1 ratio with women without PPD with maternal age difference within 5 years and the same mode of delivery. Colostrum samples were collected in morning on the third postpartum day for measurement of TGF-β concentrations using enzyme-linked immunosorbent assay (ELISA), and the association between EPDS scores and TGF-β concentrations was analyzed in the two groups. RESULTS: A total of 90 women were included in the final analysis. The mean concentrations of TGF-β1, TGF-β2 and TGF-β3 in the colostrum were 684.03 (321.22-859.25) pg/mL, 5116.50±1747.04 pg/mL and 147.84±48.68 pg/mL in women with PPD, respectively, as compared with 745.67 (596.00-964.22) pg/mL, 4912.40±1516.80 pg/mL, and 168.21±48.15 pg/mL in women without PPD, respectively. Compared with women without PPD, the women with PPD had significantly lower concentrations of TGF-β1 (P=0.026) and TGF-β3 (P=0.049) in the colostrum. Spearman correlation analysis revealed that the EPDS scores were negatively associated with the concentrations of TGF-β1 (r=-0.23, P=0.03) and TGF-β3 (r=-0.25, P=0.02) in the colostrum. CONCLUSION PPD is associated with decreased concentrations of TGF-β1 and TGF-β3 in human colostrum, suggesting the need of early PPD screening and interventions during pregnancy and the perinatal period to minimize the impact of PPD on human milk compositions.
Child, Preschool ; Cohort Studies ; Colostrum ; Depression, Postpartum/diagnosis* ; Female ; Humans ; Infant ; Postpartum Period ; Pregnancy ; Transforming Growth Factor beta1 ; Transforming Growth Factor beta2 ; Transforming Growth Factor beta3 ; Transforming Growth Factors

The postpartum depression outcome and the effect of psychological intervention were studied in order to reduce the occurrence and development of the postpartum depression. A survey of 4000 women within 4-6 weeks postpartum in 80 communities in Shenzhen, China was performed using random cluster sampling method. By employing Edinburgh Postnatal Depression Scale (EPDS) as a screening tool, the positive women (defined as EPDS ≥10) were randomly divided into intervention group and control group at a ratio of 1:2. The women in the intervention group were treated by means of mailing postpartum depression prevention and treatment knowledge manual, face-to-face counseling, and telephone psychological counseling interventions aiming at individual risk factors, while those in the control group were treated with conventional methods. EPDS scores were assessed in these two groups again at 6th month postpartum. Totally, 3907 valid questionnaires were obtained. All the 771 positive women were divided into two groups: 257 in the intervention group, and 514 in the control group. At 6th month postpartum, the EPDS scores in the intervention group were decreased significantly, from baseline stage (12.84±3.02) to end stage (3.05±2.93), while EPDS scores in the control group were reduced from 12.44±2.78 to 6.94±4.02. There were significant differences in the EPDS scores at end stage between the two groups (t=13.059, P<0.001). Psychological intervention can reduce postpartum depression, with better maternal compliance. It is feasible and necessary to establish postpartum depression screening and psychological intervention model in community-hospital and include the postpartum depression screening, intervention, and follow-up into the conventional healthcare.
Adolescent ; Adult ; Depression, Postpartum ; diagnosis ; psychology ; therapy ; Female ; Follow-Up Studies ; Humans ; Interview, Psychological ; Mass Screening ; Psychotherapy ; methods ; Risk Factors ; Surveys and Questionnaires ; Treatment Outcome ; Young Adult

Postnatal depression is a major public health problem with clearly established adverse effects in child outcomes. This study examines the 4-year outcomes of a screening and early intervention programme, in relation to improvement in symptoms, functioning and health quality of life. Women were prospectively recruited up to 6 months postdelivery, using the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool. High-scorers (EPDS >13), were offered psychiatric consultation, and those with borderline scores (EPDS 10-12) were provided counselling, and offered follow-up phone counselling by the assigned case manager. Outcome measures were obtained at baseline, and at 6 months or discharge if earlier, for levels of symptoms, functioning, and health quality of life. From 2008 to 2012, 5245 women were screened, with 307 (5.9%) women with EPDS >13 receiving intervention. Of these, 70.0% had depression, 4.6% anxiety and 3.4% psychosis. In the depression subgroup, the net change was improvement of 93.4% EPDS symptom scores, 92.2% Global Assessment of Functioning (GAF) scores, and 88.3% visual analogue scale (EQ VAS) health quality of life scores. Outcome scores across diagnostic categories demonstrated median changes of 10 points on EPDS, 20 points on GAF, and 25 points on EQ VAS, reflecting 73.9%, 36.4% and 41.7% change from baseline scores. Women with psychosis showed the biggest (80.0%) relative change in GAF functioning scores from baseline to discharge but had the lowest median change in EPDS symptom scores. A screening and intervention programme rightly-sited within an obstetric setting can improve clinical outcomes because of early detection and intervention.
Adult ; Anxiety Disorders ; diagnosis ; therapy ; Case Management ; Counselors ; Delivery of Health Care ; Depression, Postpartum ; diagnosis ; therapy ; Early Medical Intervention ; Female ; Health Status ; Humans ; Mass Screening ; Obstetrics ; Outcome Assessment (Health Care) ; Prospective Studies ; Psychiatry ; Psychotic Disorders ; diagnosis ; therapy ; Puerperal Disorders ; diagnosis ; therapy ; Quality of Life ; Referral and Consultation ; Singapore

OBJECTIVE: To investigate the association of genetic polymorphisms of norepinephrine metabolizing enzymes with postpartum depression and analyze the risk factors for postpartum depression in women following cesarean section. METHODS: A total of 591 Chinese woman of Han Nationality undergoing caesarean section were enrolled in this study. The diagnosis of postpartum depression was established for an Edinburgh Postnatal Depression Scale (EPDS) score ≥9. For all the women without antepartum depression, the genotypes of catechol-O-methyltransferase (COMT; at 5 sites including rs2020917 and rs737865) and monoamine oxidase A (rs6323) were determined using Sequenom Mass Array single nucleotide polymorphism (SNP) analysis. We analyzed the contribution of the genetic factors (SNPs, linkage disequilibrium and haplotype) to postpartum depression and performed logistic regression analysis to identify all the potential risk factors for postpartum depression and define the interactions between the genetic and environmental factors. RESULTS: The incidence of postpartum depression was 18.1% in this cohort. Univariate analysis suggested that COMT polymorphism at rs2020917 (TT genotype) and rs737865 (GG genotype) were significantly correlated with the occurrence of postpartum depression ( < 0.05). Logistic regression analysis showed that COMT polymorphism at rs2020917 (TT genotype) and rs737865 (GG genotype), severe stress during pregnancy, and domestic violence were the risk factors for postpartum depression ( < 0.05); no obvious interaction was found between the genetic polymorphisms and the environmental factors in the occurrence of postpartum depression. CONCLUSIONS The rs2020917TT and rs737865GG genotypes of COMT, stress in pregnancy, and domestic violence are the risk factors for postpartum depression.
Catechol O-Methyltransferase ; genetics ; Cesarean Section ; adverse effects ; Depression, Postpartum ; diagnosis ; enzymology ; genetics ; Domestic Violence ; psychology ; Female ; Gene-Environment Interaction ; Genotype ; Haplotypes ; Humans ; Linkage Disequilibrium ; Monoamine Oxidase ; genetics ; Norepinephrine ; metabolism ; Polymorphism, Single Nucleotide ; Postoperative Complications ; diagnosis ; enzymology ; genetics ; Pregnancy ; Pregnancy Complications ; etiology ; psychology ; Risk Factors ; Stress, Psychological

PURPOSE: A quasi-experimental study was performed to investigate the effects of a home visiting discharge education program on the maternal self-esteem, attachment, postpartum depression and family function in 35 mothers of neonatal intensive care unit (NICU) infants. METHODS: Twenty-three mothers in the intervention group received the home visiting discharge education while 12 mothers in the control group received the routine, hospital discharge education. Baseline data was collected in both groups one day after delivery. The intervention group received the home visiting discharge education while the control group did the routine hospital-based discharge education. The questionnaire including the data on maternal self-esteem, attachment, postpartum depression and family function were collected within 1week after the discharge by mail. RESULTS: The scores of maternal self-esteem, and attachment were significantly increased, and the postpartum depression and the family function score were decreased after the home visiting discharge education in intervention group. There were no changes in these variables before and after the routine hospital-based discharge education in control group. CONCLUSION: These results support the beneficial effects of home visiting discharge education on the maternal role adaptation and family function of the mothers of NICU infants.
Adaptation, Psychological ; Adult ; Aftercare/organization & administration ; Attitude to Health ; Depression, Postpartum/diagnosis/etiology/*prevention & control ; *Family Health ; Female ; Home Care Services/*organization & administration ; Humans ; Infant, Newborn ; *Intensive Care Units, Neonatal ; Korea ; Male ; *Mother-Child Relations ; *Mothers/education/psychology ; Nursing Evaluation Research ; Patient Discharge ; Postnatal Care/organization & administration ; Program Evaluation ; Public Health Nursing/*organization & administration ; Questionnaires ; *Self Concept