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

Background Approximately 13% of women experience postpartum depression. Early recognition is one of the most difficult challenges with this mood disorder because of how covertly it is suffered. Objectives The purpose of this meta-analysis was to update the findings of an earlier meta-analysis of postpartum depression predictors that had synthesized the results of studies conducted mostly in the 1980s. Method A meta-analysis of 84 studies published in the decade of the 1990s was conducted to determine the magnitude of the relationships between postpartum depression and various risk factors. Using the software system Advanced Basic Meta-Analysis, effect sizes were calculated three ways: unweighted, weighted by sample size, and weighted by quality index score. Results Thirteen significant predictors of postpartum depression were revealed. Ten of the 13 risk factors had moderate effect sizes while three predictors had small effect sizes. The mean effect size indicator ranges for each risk factor were as follows: prenatal depression (.44 to .46), self esteem (.45 to. 47), childcare stress (.45 to .46), prenatal anxiety (.41 to .45), life stress (.38 to .40), social support (.36 to .41), marital relationship (.38 to .39), history of previous depression (.38 to .39), infant temperament (.33 to .34), maternity blues (.25 to .31), marital status (.21 to .35), socioeconomic status (.19 to .22), and unplanned/unwanted pregnancy (.14 to .17). Conclusions Results confirmed findings of an earlier meta-analysis and in addition revealed four new predictors of postpartum depression: self-esteem, marital status, socioeconomic status, and unplanned/unwanted pregnancy.

Predictors of postpartum depression: an update.

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.

Context It is well established that maternal prenatal and postpartum depression is prevalent and has negative personal, family, and child developmental outcomes. Paternal depression during this period may have similar characteristics, but data are based on an emerging and currently inconsistent literature. Objective To describe point estimates and variability in rates of paternal prenatal and postpartum depression over time and its association with maternal depression. Data Sources Studies that documented depression in fathers between the first trimester and the first postpartum year were identified through MEDLINE, PsycINFO, EMBASE, Google Scholar, dissertation abstracts, and reference lists for the period between January 1980 and October 2009. Study Selection Studies that reported identified cases within the selected time frame were included, yielding a total of 43 studies involving 28 004 participants after duplicate reports and data were excluded. Data Extraction Information on rates of paternal and maternal depression, as well as reported paternal-maternal depressive correlations, was extracted independently by 2 raters. Effect sizes were calculated using logits, which were back-transformed and reported as proportions. Random-effects models of event rates were used because of significant heterogeneity. Moderator analyses included timing, measurement method, and study location. Study quality ratings were calculated and used for sensitivity analysis. Publication bias was evaluated with funnel plots and the Egger method. Data Synthesis Substantial heterogeneity was observed among rates of paternal depression, with a meta-estimate of 10.4% (95% confidence interval [CI], 8.5%-12.7%). Higher rates of depression were reported during the 3- to 6-month postpartum period (25.6%; 95% CI, 17.3%-36.1%). The correlation between paternal and maternal depression was positive and moderate in size (r = 0.308; 95% CI, 0.228-0.384). No evidence of significant publication bias was detected. Conclusions Prenatal and postpartum depression was evident in about 10% of men in the reviewed studies and was relatively higher in the 3- to 6-month postpartum period. Paternal depression also showed a moderate positive correlation with maternal depression.

https://jamanetwork.com/journals/jama/articlepdf/185905/jrv05003_1961_1969.pdf

Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression: A Meta-analysis

Background. Much attention has been paid to the problem of postpartum depression in women. However, there is some indication that men also experience depression after the birth of a child, and that paternal depression is linked to maternal depression.

Aims.  The purpose of this integrative review was to examine current knowledge about postpartum depression in fathers. Specific aims were (1) to examine the incidence of paternal depression in the first year after the birth of a child, (2) to identify the characteristics and predictors of paternal postpartum depression, (3) to describe the relationship between maternal and paternal postpartum depression, and (4) to discuss the influence of paternal depression on the family and infant.

Methods.  A literature search from 1980 to 2002 was carried out using the CINAHL, PsychInfo, and Medline electronic databases. Twenty research studies were identified that included incidence rates of paternal depression during the first year postpartum. These were further examined and synthesized regarding onset, severity, duration, and predictors of paternal depressive symptoms, and for information about the relationship between maternal and paternal depression.

Findings.  During the first postpartum year, the incidence of paternal depression ranged from 1·2% to 25·5% in community samples, and from 24% to 50% among men whose partners were experiencing postpartum depression. Maternal depression was identified as the strongest predictor of paternal depression during the postpartum period. The implications of parental depression for family health were discussed.

Conclusions.  Postpartum depression in men is a significant problem. The strong correlation of paternal postpartum depression with maternal postpartum depression has important implications for family health and well-being. Consideration of postpartum depression in fathers as well as mothers, and consideration of co-occurrence of depression in couples, is an important next step in research and practice involving childbearing families.

Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health

In the first study to systematically examine postnatal depression in fathers, we examined depression in 200 postnatal couples, using a two-stage design. The prevalence of depression ascertained by the 13-item Edinburgh Postnatal Depression Scale (EPDS), using a cut-off score for 'caseness' of 13 or more in an unselected postnatal sample, was 27.5% in mothers at six weeks postpartum, 25.7% in mothers at six months postpartum, 9.0% in fathers at six weeks postpartum, and 5.4% in fathers at six months postpartum. The prevalence did not differ significantly in either mothers or fathers from a control group of parents with children between three and five years of age. As expected, mothers had a significantly higher prevalence of psychiatric 'caseness' at both six weeks and six months postpartum than fathers. Fathers were significantly more likely to be cases if their partners were also cases. The hypothesis that different aetiological factors would be important in brief and persistent disorders in mothers was upheld.

Prevalence of postnatal psychiatric morbidity in mothers and fathers.

Objectives. To examine the prevalence and associations of altered eating patterns in dementia sufferers.

Design. Prospective cohort study.

Setting. Psychiatric services and a memory clinic.

Sample. 124 patients with DSM-III-R dementia.

Measures. The Geriatric Mental State Schedule, the History and Aetiology Schedule, the Cornell Depression Scale and the CAMCOG. Additional standardized questions were asked about eating patterns in the month prior to the study.

Results. Information concerning eating patterns was obtained from 105 of the 124 patients: 21% had increased food consumption, 22.1% had decreased food consumption, 2.9% tried to eat inedible substances, 11.4% had an increased preference for sweet things, 7.6% became more fussy about their food choices and 4.8% became less fussy. Decreased food consumption was significantly associated with less severe cognitive impairment and was related to RDC major depression in some patients. An increased preference for sweet things showed an association with a diagnosis of Alzheimer's disease. Increased food consumption was probably heterogeneous. Neither increased food consumption nor an increased preference for sweet foods was associated with the severity of cognitive impairment.

Conclusion. Altered eating patterns are common in dementia sufferers. © 1997 John Wiley & Sons, Ltd.

Eating disorders in dementia

Objectives. To determine the proportion of couples, one of whom suffers from dementia, continuing with a sexual relationship, their level of satisfaction with their sexual relationship and the associations of remaining sexually active.

Design. A survey of married couples enrolled in a prospective dementia study.

Setting. Psychiatric services and a memory clinic

Sample. The partners of 47 married patients with mild to moderate dementia.

Measures. The assessment included the GMS/HAS/SDS package, the Marital Intimacy Scale (with some additional questions regarding sexual relations), the CAMCOG, the Carers Stress Scale, the Cornell Depression Scale and the Burns Symptom Checklist. Dementia was diagnosed according to DSM-III-R, McKhann, McKeith, Hachinski and HAS AGECAT criteria.

Results. Forty partners completed the study. Nine (22.5%) continued to have a sexual relationship, all of whom were satisfied with the situation. Twelve (38.7%) of the carers who were not sexually active were dissatisfied with the absence of a sexual relationship. There was a trend for male carers to be more likely to be involved in a continuing sexual relationship. Dissatisfaction with the absence of a sexual relationship was significantly associated with a diagnosis of vascular dementia in the patient and showed a trend towards an association with younger patient age.

Conclusions. Nearly a quarter of married dementia sufferers are involved in a continuing sexual relationship, emphasizing the importance of further research in this area. © 1997 by John Wiley & Sons, Ltd.

Sexual relationships in married dementia sufferers

Nurses were questioned about the level of hearing impairment in the population (353) living in a hospital for people with learning disability. Systematic hearing assessments were then carried out on 324 individuals yielding a fourfold increase in identification. Methodological improvements over previous studies include specialised audiology facilities and equipment and staff experience in testing this special group. If hearing impairment is recognised and dealt with the potential for improvements in quality of life is considerable.

Paul Cullen

Papers

Prevalence of postnatal psychiatric morbidity in mothers and fathers.

Eating disorders in dementia

Sexual relationships in married dementia sufferers

Identification of Hearing Impairment in People with a Learning Disability: From Questioning to Testing

Vulnerability, coping and crisis