Magnitude and risk factors for postpartum symptoms: a literature review.

Background: Postpartum depression (PPD) poses a major global public health challenge. PPD is the most common complication associated with childbirth and exerts harmful effects on children. Although hundreds of PPD studies have been published, we lack accurate global or national PPD prevalence estimates, and have no clear account of why PPD appears to vary so dramatically between nations. Accordingly, we conducted a meta-analysis to estimate the global and national prevalence of PPD, and a meta-regression to identify economic, health, social or policy factors associated with national PPD prevalence. Methods: We conducted a systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To test for country level predictors, we drew on data from UNICEF, WHO, and the World Bank. Random effects meta-regression was used to test national predictors of PPD prevalence. Findings: 308 studies of 304,449 women from 56 countries were identified. The global pooled prevalence of PPD was 17.5% (95% CI: 16.4% - 18.6%), with significant heterogeneity across nations (Q = 17,192, p = .000, I2 = 98%), ranging from 3.10% (0.01% - 10.87%) in Singapore to 37.78% (30.95% - 44.83%) in Chile. Nations with significantly higher rates of income inequality (R2=42.78%), maternal mortality (R2=25.54%) infant mortality (R2=12.23%), total fertility rates (R2=17.14%), or women of childbearing age working > 40 hours a week (R2=24.14%) have higher rates of PPD. Together, these factors explain 77.26%% of the national variation in PPD prevalence. Interpretation: The global prevalence of PPD is greater than previously thought and varies dramatically by nation. Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.

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Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries.

Introduction or background It is well established that postnatal depression (PND) is prevalent in high-income countries and is associated with negative personal, family and child developmental outcomes. Sources of data Here, studies on the prevalence of maternal PND in low- and middle-income countries are reviewed and a geographical prevalence map is presented. The impact of PND upon child outcomes is also reviewed. Areas of agreement The available evidence suggests that rates of PND are substantial, and in many regions, are higher than those reported for high-income countries. An association between PND and adverse child developmental outcomes was identified in many of the countries examined. Areas of controversy Significant heterogeneity in prevalence rates and impact on child outcomes across studies means that the true extent of the disease burden is still unclear. Areas timely for developing research Nonetheless, there is a compelling case for the implementation of interventions to reduce the impact of PND on the quality of the mother-infant relationship and improve child outcomes.

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Postnatal depression and its effects on child development: a review of evidence from low- and middle-income countries

Handbook of Psychiatric Measures

One hundred-thirty-nine women participated in this longitudinal study from the third trimester of pregnancy through 8-months postpartum. Women completed depression scales at several time points and rated their infant’s characteristics and childcare stress at 2- and 6-months postpartum. Mothers’ reports of infant temperament were significantly different for depressed and non-depressed mothers, with depressed mothers reporting more difficult infants at both measurement points. These differences remained after controlling for histories of maternal abuse or prenatal anxiety, which occurred more often in the depressed mothers. There were no significant differences in childcare stress or perceived support between the groups. Infant temperament and childcare stress did not change over time. Recommendations for practice include consistent ongoing evaluations of the “goodness of fit” within the dyad and exploring interventions for depressed mothers that provide guidance about interactions with their infants and the appropriateness of the infant behaviors.

/pdf/maternal-depression-and-infant-temperament-characteristics-3e4jvw74ac.pdf

Maternal Depression and Infant Temperament Characteristics

The purpose of this study was to examine the screening of depression among pregnant and postpartum participants in a community-based program. This cross-sectional study used archival data from 98 women participating in a community-based visiting nurse program in a midwestern U.S. city. Depression screening was accomplished using the Center for Epidemiologic Studies Depression scale (CES-D) and Edinburgh Postnatal Depression scale (EPDS); both instruments ask respondents to answer questions regarding their mood during the past week. The CES-D identified more pregnant and postpartum women as depressed than did the EPDS. A standard regression analysis using previous pregnancies, history of depression, married versus nonmarried, presence of support, and breast-feeding as predictor variables did not produce statistically significant findings for predicting depression among the pregnant and postpartum women in this study. This finding underscores the value of brief depression screening instruments for nurses working with pregnant and postpartum women.

Elsie R. Shore

Papers

Screening for depression among pregnant and postpartum women