The average prevalence rate of non-psychotic postpartum depression based on the results of a large number of studies is 13%. Prevalence estimates are affected by the nature of the assessment method...

Rates and risk of postpartum depression—a meta-analysis

Perinatal depression: a systematic review of prevalence and incidence.

This report builds on a highly valued predecessor, the 1994 Institute of Medicine (IOM) report entitled Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. That report provided the basis for understanding prevention science, elucidating its then-existing research base, and contemplating where it should go in the future. This report documents that an increasing number of mental, emotional, and behavioral problems in young people are in fact preventable. The proverbial ounce of prevention will indeed be worth a pound of cure: effectively applying the evidence-based prevention interventions at hand could potentially save billions of dollars in associated costs by avoiding or tempering these disorders in many individuals. Furthermore, devoting significantly greater resources to research on even more effective prevention and promotion efforts, and then reliably implementing the findings of such research, could substantially diminish the human and economic toll.

Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities

https://yorkspace.library.yorku.ca/xmlui/bitstream/handle/10315/2553/Antenatal%20risk%20factors%20for%20postpartum%20depression.pdf

Antenatal risk factors for postpartum depression: a synthesis of recent literature

Depression is the leading cause of diseaserelated disability among women. In particular, women of childbearing age are at high risk for major depression. Pregnancy and new motherhood may increase the risk of depressive episodes. Depression during the perinatal period can have devastating consequences, not only for the women experiencing it but also for the women’s children and family. Perinatal depression encompasses major and minor depressive episodes that occur either during pregnancy or within the first 12 months following delivery. When referring to depression in this population, researchers and clinicians frequently have not been clear about whether they are referring to major depression alone or to both major and minor depression. Major depression is a distinct clinical syndrome for which treatment is clearly indicated, whereas the definition and management of minor depression are less clear. In this report, we refer to major depression alone by identifying it discretely as major depression. Minor depression is an impairing, yet less severe, constellation of depressive symptoms for which controlled trials have not consistently indicated whether or not particular interventions are more effective than placebo. In this report, we refer to this grouping as major or minor depression or by the more general terms “depression” or “depressive illness.” Perinatal depression, whether one is referring to major depression alone or to either major or minor depression, often goes unrecognized because many of the discomforts of pregnancy and the puerperium are similar to symptoms of depression. Another mental disorder that can occur in the perinatal period is postpartum psychosis. Unlike postpartum depression, postpartum psychosis is a relatively rare event with a range of estimated incidence of 1.1 to 4.0 cases per 1,000 deliveries. The onset of postpartum psychosis is usually acute, within the first 2 weeks of delivery, and appears to be more common in women with a strong family history of bipolar or schizoaffective disorder. Postpartum psychosis is an important disorder in its own right, but it is not addressed specifically in this report. The precise level of the prevalence and incidence of perinatal depression is uncertain. Published estimates of the rate of major and minor depression in the postpartum period range widely—from 5 percent to more than 25 percent of new mothers, depending on the assessment method, the timing of the assessment, and population characteristics. In addition, although many screening instruments have been developed or modified to detect major and minor depression in pregnant and newly delivered women, the evidence on their screening accuracy relative to a reference standard has yet to be systematically reviewed and assessed. Evidence on the effectiveness of screening all pregnant women and providing a preventive intervention to those scoring at high risk has not been systematically investigated and evaluated either. To address these gaps, the Agency for Healthcare Research and Quality (AHRQ), in collaboration with the Safe Motherhood Group (SMG), commissioned this evidence report from the RTI International-University of North Carolina’s (RTI-UNC’s) Evidence-based Practice Center (EPC) for a systematic review of the evidence on three questions related to perinatal depression. These questions address the prevalence and incidence of perinatal depression, the accuracy of screening instruments for Evidence Report/Technology Assessment Number 119

Perinatal depression: prevalence, screening accuracy, and screening outcomes.

A controlled prospective study was undertaken to determine the extent to which pregnancy and the puerperium are associated with increased risk for minor and major depression, depressive symptom-atology, and poor social adjustment. A large sample of childbearing (CB) women were recruited during the second trimester of pregnancy along with an equal sized, matched sample of nonchild-bearing (NCB) women. Ss were assessed multiple times during pregnancy and after delivery by questionnaire and through personal interview on measures of depression and other mood states and marital and social adjustment. There were no differences between CB and NCB Ss with respect to rates of minor and major depression during pregnancy or after delivery. However, CB women experienced significantly higher levels of depressive symptomatology and poor social adjustment than NCB women during late pregnancy and the early puerperium.

Controlled prospective study of postpartum mood disorders: comparison of childbearing and nonchildbearing women.

Objective. Depression in parents is a prevalent and impairing illness that is encountered frequently in medical practice. Children of depressed parents are at risk for psychopathology and other difficulties. A series of recent national reports have recommended the development of prevention efforts targeting children of depressed parents. Yet, to date, few controlled prevention studies of depression in children and adolescents have been conducted. In this study, we report the evaluation of 2 preventive intervention strategies that target children living in homes with depressed parents. Both are public health approaches that were designed to be used by a wide range of practitioners from a variety of disciplines, including pediatricians, internists, school counselors, nurses, and mental health practitioners. We adopted a developmental perspective and intervened with families when children were entering the age of highest risk for depression onset (ie, adolescence). We chose a family-based approach to prevention and sought to reduce risk factors and enhance protective factors for early adolescents by increasing positive interactions between parents and children, and by increasing understanding of the illness for everyone in the family. Our prevention approaches were designed to provide information about mood disorders to parents, to equip parents with the skills they need to communicate information to their children, and to open a dialogue with their children about the effects of parental depression. We hypothesized that participation in these prevention programs would result in parental change in child-related behaviors and attitudes about depression and its impact on the family. In addition, we hypothesized that this parental change would produce change in children’s self-understanding, and in children’s depressive symptomatology. Methods. We conducted a large-scale efficacy trial of 2 manual-based preventive intervention programs that were designed to be used widely in public health settings. These interventions target the relatively healthy children (ages 8–15) of parents with mood disorder. Ninety-three families (88.5% of our initial sample), including 121 children, participated in this study through the fourth assessment point. These families were assigned randomly to either a lecture or a clinician-facilitated intervention. Both interventions were specified in manuals. The lecture condition consisted of 2 separate meetings delivered in a group format without children present. The clinician-facilitated condition consisted of 6 to 11 sessions, including separate meetings with parents and children, and a family meeting in which the parents led a discussion of the illness and of positive steps that can be taken to promote healthy functioning in the children. In addition, telephone contacts or refresher meetings were conducted at 6- to 9-month intervals. In both conditions, psychoeducational material about mood disorders, risk, and resilience was presented and efforts were made to decrease feelings of guilt and blame in children. Parents were helped to build resilience in their children through encouraging their friendships, their success outside of the home, and their understanding of parental illness and of themselves. In addition, in the clinician-facilitated condition, efforts were made to link the psychoeducational material presented to the family’s own unique illness experience. To address directly how their lives had changed, all family members in both conditions were assessed for psychopathology and for overall functioning at intake, and for psychopathology, functioning, and response to intervention immediately postintervention, ∼1 year postintervention, and again ∼2.5 years postintervention. Results. We examined the outcomes of child understanding and internalizing symptomatology, and a number of predictor variables, using repeated measures analyses with generalized estimating equations. We found that parents in both conditions reported significant change in child-related behaviors and attitudes, and that the amount of change reported increased over time from time 3 to time 4 (χ 2 1 = 18.1). Moreover, relative to parents in the lecture program (mean number of changes = 6.3), parents in the clinician-facilitated program reported more change in child-related behaviors and attitudes (mean number of changes = 9.8). Children in both conditions reported increased understanding of parental illness attributable to participation in our intervention programs. There was a positive association between the amount of change children reported in their understanding of parental illness and the number of changes couples reported in child-related behaviors/attitudes (χ 2 1 = 37.3; ie, parents who had changed the most in response to intervention had children who also changed the most). Finally, internalizing scores for all children decreased with increased time since intervention (χ 2 1 = 7.3). In addition, females had higher internalizing scores than males (χ 2 1 = 5.3). There was no significant effect of group on children’s change in internalizing symptomatology (χ 2 1 = 0.2). Conclusions. We enrolled families with relatively healthy children, administered carefully designed preventive interventions that are manual-based and relatively brief, and found that these programs do have long-standing positive effects in how families problem solve around parental illness. Our results show significant benefits from both interventions. Moreover, changes in parents’ perceptions translated directly into changes in children’s own understanding of parental illness. Parental behavior and attitude changes and their connection to child changes in understanding identify an important mediating variable: family change. By increasing children’s understanding of parental mood disorder, our interventions were found to promote resilience-related qualities in these children at risk. This presentation represents the first and only longitudinal primary prevention study of relatively healthy children at risk for psychopathology attributable to parental mood disorder and demonstrates a significant reduction in risk factors and increase in protective factors in these families over a long time interval—2½ years. Our results provide support for a family-based approach to preventive intervention.

A family-based approach to the prevention of depressive symptoms in children at risk: evidence of parental and child change.

Potential biologic and psychosocial causative factors for the postpartum blues were tested in a prospective study of 182 women followed up from the second trimester of pregnancy until postpartum week 9. Personal and family history of depression, depressive symptoms, stressful life events, and social adjustment were all assessed during the second trimester. Levels of progesterone, prolactin, estradiol, free and total estriol, and free and total cortisol were measured on several occasions during late pregnancy and early puerperium. Obstetric and child-care stressors and the postpartum blues were assessed after delivery. Predictors of the postpartum blues were personal and family history of depression, social adjustment, stressful life events, and levels of free and total estriol. Our results support the hypothesis that the postpartum blues is within the spectrum of affective disorders.

Prospective Study of Postpartum Blues: Biologic and Psychosocial Factors

This article presents long-term effects of a randomized trial evaluating 2 standardized, manual-based prevention strategies for families with parental mood disorder: informational lectures and a brief, clinician-based approach including child assessment and a family meeting. A sample of 105 families, in which at least 1 parent suffered from a mood disorder and at least 1 nondepressed child was within the 8- to 15-year age range, was recruited. Parents and children were assessed separately at baseline and every 9 to 12 months thereafter on behavioral functioning, psychopathology, and response to intervention. Both interventions produced sustained effects through the 6th assessment point, approximately 4.5 years after enrollment, with relatively small sample loss of families (<14%). Clinician-based families had significantly more gains in parental child-related behaviors and attitudes and in child-reported understanding of parental disorder. Child and parent family functioning increased for both groups and internalizing symptoms decreased for both groups, with no significant group differences. These findings demonstrate that brief, family-centered preventive interventions for parental depression may contribute to long-term, sustained improvements in family functioning.

Long-term effects from a randomized trial of two public health preventive interventions for parental depression.

Objective To examine long-term effects of two forms of preventive intervention designed to increase families' understanding of parental affective disorder and to prevent depression in children. Method Thirty-six families who had a nondepressed child between ages 8 and 15 years and a parent who had experienced affective disorder were enrolled and randomly assigned to either a clinician-facilitated intervention or a lecture discussion group. Each parent and child were assessed prior to randomization, after intervention, and approximately 1 1/2 years after enrollment. Assessments included standard diagnostic interviews, measures of child and family functioning, and interviews about experience of parental affective disorder and intervention effects. Results Children in the clinician-facilitated group reported greater understanding of parental affective disorder, as rated by self-report, rater-generated scales, and parent report, and had better adaptive functioning after intervention. Parents in the clinician-facilitated intervention group reported significantly more change. Conclusion Findings from both interventions support the value of a future-oriented resiliency-based approach. The greater effects of the clinician-facilitated intervention support the need for linking cognitive information to families' life experience and involving children directly in order to achieve long-term effects.

Ellen J. Wright

Papers

Controlled prospective study of postpartum mood disorders: comparison of childbearing and nonchildbearing women.

A family-based approach to the prevention of depressive symptoms in children at risk: evidence of parental and child change.

Prospective Study of Postpartum Blues: Biologic and Psychosocial Factors

Long-term effects from a randomized trial of two public health preventive interventions for parental depression.

Examination of Children's Responses to Two Preventive Intervention Strategies Over Time