Different patterns of depressive symptoms during pregnancy
TL;DR: A depression screening strategy in pregnant women should take into account the potential chronicity of depressive symptoms by repeated assessments in order to offer an intervention to the most vulnerable women.
Abstract: Recently, the US Preventive Services Task Force has advocated to screen pregnant and postpartum women for depression. However, we questioned the meaning of a single elevated depression score: does it represent just one episode of depression or do these symptoms persist throughout the entire pregnancy? This study assessed depressive symptoms at each trimester in a cohort of 1813 pregnant women and evaluated whether women with different patterns of depressive symptoms showed other characteristics. Depending on the trimester, elevated depression scores were prevalent in 10–15% of the pregnant women. Up to 4% reported persistent symptoms of depression throughout pregnancy. Different patterns of depressive symptoms were observed, for which persistent symptoms were related to other characteristics than incidentally elevated symptoms. Besides a previous history of mental health problems as best overall predictor, incidentally elevated depression scores were related to major life events. Furthermore, persistently depressive symptoms were related to unplanned pregnancy and multiparity. An EDS assessment at 12 weeks of gestation including three additional items (history of mental health problems, unplanned pregnancy and multiparity) enabled us to identify 83% of the women with persistent depressive symptoms. A depression screening strategy in pregnant women should take into account the potential chronicity of depressive symptoms by repeated assessments in order to offer an intervention to the most vulnerable women.
Citations
More filters
Icahn School of Medicine at Mount Sinai1, Veterans Health Administration2, University of California, San Francisco3, Group Health Cooperative4, University of Wisconsin-Madison5, Columbia University6, University of Georgia7, Harvard University8, Duke University9, Virginia Commonwealth University10, New York University11, Stanford University12, United States Department of Veterans Affairs13, University of Washington14, Brown University15, University of North Carolina at Chapel Hill16
TL;DR: The overall magnitude of harms to the fetus is small to moderate and the USPSTF recommends diagnosis and treatment as a grade B definition, and that treatment of pregnant and postpartum women with depression using CBT improves clinical outcomes.
Abstract: Description Update of the 2009 US Preventive Services Task Force (USPSTF) recommendation on screening for depression in adults. Methods The USPSTF reviewed the evidence on the benefits and harms of screening for depression in adult populations, including older adults and pregnant and postpartum women; the accuracy of depression screening instruments; and the benefits and harms of depression treatment in these populations. Population This recommendation applies to adults 18 years and older. Recommendation The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. (B recommendation)
287 citations
TL;DR: Antenatal depression was higher in low- Income countries than in middle-income countries and was found to be a risk factor for low birth weight and preterm births.
Abstract: Background Depression in pregnancy (antenatal depression) in many low and middle-income countries is not well documented and has not been given priority for intervention due to competing urgencies and the belief that it does not immediately cause fatalities, which mainly emanated from lack of comprehensive research on the area. To fill this research gap, this systematic review was conducted to investigate the burden of antenatal depression and its consequences on birth outcomes in low- and middle-income countries. Methods We systematically searched the databases: CINHAL, MEDLINE, EMCare, PubMed, PSyc Info, Psychiatry online, and Scopus for studies conducted in low and middle-income countries about antenatal depression and its association with adverse birth outcomes. We have included observational studies (case control, cross-sectional and cohort studies), written in English-language, scored in the range of "good quality" on the Newcastle Ottawa Scale (NOS), and were published between January 1, 2007 and December 31, 2017. Studies were excluded if a standardized approach was not used to measure main outcomes, they were conducted on restricted (high risk) populations, or had fair to poor quality score on NOS. We used Higgins and Egger's to test for heterogeneity and publication bias. Primary estimates were pooled using a random effect meta-analysis. The study protocol was registered in PROSPERO with protocol number CRD42017082624. Result We included 64 studies (with 44, 035 women) on antenatal depression and nine studies (with 5,540 women) on adverse birth outcomes. Antenatal depression was higher in the lower-income countries (Pooled Prevalence (PP) = 34.0%; 95%CI: 33.1%-34.9%) compared to the middle-income countries (PP = 22.7%, 95%CI: 20.1%-25.2%) and increased over the three trimesters. Pregnant women with a history of economic difficulties, poor marital relationships, common mental disorders, poor social support, bad obstetric history, and exposure to violence were more likely to report antenatal depression. The risk of having preterm birth (2.41; 1.47-3.56) and low birth weight (1.66; 1.06-2.61) was higher in depressed mothers compared to mothers without depression. Conclusions Antenatal depression was higher in low-income countries than in middle-income countries and was found to be a risk factor for low birth weight and preterm births. The economic, maternal, and psychosocial risk factors were responsible for the occurrence of antenatal depression. While there could be competing priority agenda to juggle for health policymakers in low-income countries, interventions for antenatal depression should be reprioritized as vitally important in order to prevent the poor maternal and perinatal outcomes identified in this review.
97 citations
TL;DR: This narrative review provides an updated synthesis of research examining the association of inflammation with depression and CVD, and their comorbidity in women and provides evidence of pro-inflammatory states and sex differences associated with alterations in the hypothalamic–pituitary–adrenal axis.
Abstract: Women are at increased risk for developing depression and cardiovascular disease (CVD) across the lifespan and their comorbidity is associated with adverse outcomes that contribute significantly to rates of morbidity and mortality in women worldwide. Immune-system activity has been implicated in the etiology of both depression and CVD, but it is unclear how inflammation contributes to sex differences in this comorbidity. This narrative review provides an updated synthesis of research examining the association of inflammation with depression and CVD, and their comorbidity in women. Recent research provides evidence of pro-inflammatory states and sex differences associated with alterations in the hypothalamic-pituitary-adrenal axis, the renin-angiotensin-aldosterone system and the serotonin/kynurenine pathway, that likely contribute to the development of depression and CVD. Changes to inflammatory cytokines in relation to reproductive periods of hormonal fluctuation (i.e. the menstrual cycle, perinatal period and menopause) are highlighted and provide a greater understanding of the unique vulnerability women experience in developing both depressed mood and adverse cardiovascular events. Inflammatory biomarkers hold substantial promise when combined with a patient's reproductive and mental health history to aid in the prediction, identification and treatment of the women most at risk for CVD and depression. However, more research is needed to improve our understanding of the mechanisms underlying inflammation in relation to their comorbidity, and how these findings can be translated to improve women's health.
54 citations
TL;DR: The pharmacogenetic testing with concomitant application of TDM seems to be the best way for implementing personalized dosing of current state-of-the-art antidepressants metabolized by polymorphic CYPs, especially when co-administered with strong inhibitors or other substrates of CYP2D6 or CYP 2C19.
Abstract: Introduction: Nowadays, the first-line medications in depression include SSRIs, SNRIs, NDRIs, NaSSAs, SMSs, or a melatonin (M1/M2) receptor agonist and a 5-HT2C receptor antagonist. These drugs hav...
28 citations
TL;DR: Intolerance of uncertainty, depressive symptom severity, and obsessive-compulsive disorder symptoms present in pregnancy were significant predictors of anxiety worsening in the postpartum.
22 citations
References
More filters
Book•
01 Dec 1969TL;DR: The concepts of power analysis are discussed in this paper, where Chi-square Tests for Goodness of Fit and Contingency Tables, t-Test for Means, and Sign Test are used.
Abstract: Contents: Prefaces. The Concepts of Power Analysis. The t-Test for Means. The Significance of a Product Moment rs (subscript s). Differences Between Correlation Coefficients. The Test That a Proportion is .50 and the Sign Test. Differences Between Proportions. Chi-Square Tests for Goodness of Fit and Contingency Tables. The Analysis of Variance and Covariance. Multiple Regression and Correlation Analysis. Set Correlation and Multivariate Methods. Some Issues in Power Analysis. Computational Procedures.
115,069 citations
"Different patterns of depressive sy..." refers background in this paper
...…EDS scores compared to the other three groups at all trimesters: F (3; 1, 809) = 529.0 at 12 weeks, F (3; 1, 809) = 684.7 at 22 weeks, F (3; 1, 809) = 637.1 at 32 weeks, respectively (p < .001 after Bonferroni correction, η2 all >0.46 which indicates a large effect size according to Cohen (1988))....
[...]
[...]
TL;DR: A convenient, although not comprehensive, presentation of required sample sizes is providedHere the sample sizes necessary for .80 power to detect effects at these levels are tabled for eight standard statistical tests.
Abstract: One possible reason for the continued neglect of statistical power analysis in research in the behavioral sciences is the inaccessibility of or difficulty with the standard material. A convenient, although not comprehensive, presentation of required sample sizes is provided here. Effect-size indexes and conventional values for these are given for operationally defined small, medium, and large effects. The sample sizes necessary for .80 power to detect effects at these levels are tabled for eight standard statistical tests: (a) the difference between independent means, (b) the significance of a product-moment correlation, (c) the difference between independent rs, (d) the sign test, (e) the difference between independent proportions, (f) chi-square tests for goodness of fit and contingency tables, (g) one-way analysis of variance, and (h) the significance of a multiple or multiple partial correlation.
38,291 citations
Additional excerpts
...…compared to controls (group 0): t(1626) = 15.2 at 12 weeks, t(1626) = 19.9 at 22 weeks, t(1626) = 19.6 at 32 weeks, respectively (p 0.001 after Bonferroni correction, Cohen’s d effect size of 1.13, 1.46 and 1.43, respectively, which all indicate a very large effect size (d > .80) (Cohen 1992)....
[...]
TL;DR: The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community was found to have satisfactory sensitivity and specficity, and was also sensitive to change in the severity of depression over time.
Abstract: The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.
10,857 citations
"Different patterns of depressive sy..." refers methods in this paper
...The Dutch version of the Edinburgh Depression Scale (EDS) (Cox et al. 1987; Pop et al. 1992) was used to measure symptoms of depression at all trimesters....
[...]
01 Jan 1992
TL;DR: In this article, the authors present the sample sizes necessary for.80 power to detect effects at these levels are tabled for eight standard statistical tests: (a) the difference between independent means, (b) the significance of a product-moment correlation, (c) the sign test, (d) the different between independent proportions, (f) chi-square tests for goodness of fit and contingency tables, (g) one-way analysis of variance, and (h) significance o f a multiple or multiple partial correlation.
Abstract: One possible reason for the continued neglect of statistical power analysis in research in the behavioral sciences is the inaccessibility of or difficulty with the standard material. A convenient, although not comprehensive, presentation of required sample sizes is provided here. Effect-size indexes and conventional values for these are given for operationally defined small, medium, and large effects. The sample sizes necessary for .80 power to detect effects at these levels are tabled for eight standard statistical tests: (a) the difference between independent means, (b) the significance of a product-moment correlation, (c) the difference between independent rs, (d) the sign test, (e) the difference between independent proportions, (f) chi-square tests for goodness of fit and contingency tables, (g) one-way analysis of variance, and (h) the significance o f a multiple or multiple partial correlation. The preface to the first edition of my power handbook (Cohen, 1969) begins: During my first dozen years o f teaching and consulting o n applied statistics with behavioral scientists, 1 became increasingly impressed with the importance of statistical power analysis, an importance which was increased an order of magnitude by its neglect in our textbooks and curricula. The case for its importance is easily made: What behavioral scientist would view with equanimity the question of the probability that his investigation would lead to statistically significant results, i.e., its power? (p. vii) This neglect was obvious through casual observation and had been confirmed by a power review of the 1960 volume of the Journal of Abnormal and Social Psychology, which found the mean power to detect medium effect sizes to be .48 (Cohen, 1962). Thus, the chance of obtaining a significant result was about that of tossing a head with a fair coin. I attributed this disregard of power to the inaccessibility of a meager and mathematically difficult literature, beginning with its origin in the work of Neyman and Pearson (1928,1933). The power handbook was supposed to solve the problem. It required no more background than an introductory psychological statistics course that included significance testing. The exposition was verbal-intuitive and carried largely by many worked examples drawn from across the spectrum of behavioral science. In the ensuing two decades, the book has been through revised (1977) and second (1988) editions and has inspired dozens of power and effect-size surveys i n many areas of the social and life sciences (Cohen, 1988, pp. xi-xii). During this period, there has been a spate of articles on power analysis in the social science literature, a baker's dozen of computer programs (re
1,272 citations
Additional excerpts
...…compared to controls (group 0): t(1626) = 15.2 at 12 weeks, t(1626) = 19.9 at 22 weeks, t(1626) = 19.6 at 32 weeks, respectively (p 0.001 after Bonferroni correction, Cohen’s d effect size of 1.13, 1.46 and 1.43, respectively, which all indicate a very large effect size (d > .80) (Cohen 1992)....
[...]
Icahn School of Medicine at Mount Sinai1, Veterans Health Administration2, University of California, San Francisco3, Group Health Research Institute4, University of Wisconsin-Madison5, Columbia University6, University of Georgia7, Harvard University8, Duke University9, Virginia Commonwealth University10, New York University11, Stanford University12, University of Washington13, Brown University14, University of North Carolina at Chapel Hill15
TL;DR: Screening for depression in the general adult population, including pregnant and postpartum women, should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.
Abstract: Description Update of the 2009 US Preventive Services Task Force (USPSTF) recommendation on screening for depression in adults. Methods The USPSTF reviewed the evidence on the benefits and harms of screening for depression in adult populations, including older adults and pregnant and postpartum women; the accuracy of depression screening instruments; and the benefits and harms of depression treatment in these populations. Population This recommendation applies to adults 18 years and older. Recommendation The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. (B recommendation)
1,040 citations