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Maternal Perinatal Mental Health

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Women's Health".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 50692

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editor

Prof. Dr. M. Carmen Míguez Varela

E-Mail Website
Guest Editor
Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Campus Vida, 15782 Santiago de Compostela, Spain
Interests: perinatal mental health; smoking and pregnancy; perinatal anxiety and depression; smoking
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue will focus on women's mental health at two important periods in their lives: pregnancy and postpartum. Therefore, we are seeking high-quality contributions on themes relating to perinatal mental health. Research on the topic includes prevalence, screening and diagnostic instruments, comorbidity, associated and/or risk factors, effects or consequences, and interventions.

An estimated one in five women will develop a mental disorder during pregnancy and/or postpartum up to one year after childbirth. Depression and anxiety are the most prevalent perinatal mental disorders and a major public health problem with adverse health consequences for mother and baby. Despite this, there is no standard protocol that healthcare professionals can follow to help them detect possible cases of mental health problems. As a result, many women are left unscreened, undiagnosed, and thus untreated for a treatable disorder. On the other hand, to design specific prevention and intervention programs, it is crucial to investigate the variables associated with an increased risk of perinatal mental-health problems. For example, substance abuse (tobacco and alcohol) is often associated with mental-health disorders.

This Special Issue will interest researchers and practitioners in mental health, maternal and child health, women´s health, obstetrics/gynecology, and pediatrics. I hope that this Special Issue will also encourage healthcare professionals to be more aware of the importance of this issue, screen for prenatal and postpartum depression or anxiety, and learn about mental-health resources available in their communities.

I invite those of you working in this area to submit articles on themes relating to mental health in pregnancy and postpartum. The keywords listed below provide an outline of some areas of potential interest.

Prof. Dr. María Carmen Míguez Varela
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Perinatal mental health
  • Perinatal depression
  • Perinatal anxiety
  • Assessment tools
  • Epidemiology
  • Perinatal mental health and tobacco consumption
  • Perinatal mental health and alcohol consumption
  • Risk factors
  • Effects
  • Prevention
  • Treatment

Published Papers (15 papers)

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11 pages, 823 KiB  
Article
States Transitions Inference of Postpartum Depression Based on Multi-State Markov Model
by Juan Xiong, Qiyu Fang, Jialing Chen, Yingxin Li, Huiyi Li, Wenjie Li and Xujuan Zheng
Int. J. Environ. Res. Public Health 2021, 18(14), 7449; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147449 - 13 Jul 2021
Cited by 5 | Viewed by 2526
Abstract
Background: Postpartum depression (PPD) has been recognized as a severe public health problem worldwide due to its high incidence and the detrimental consequences not only for the mother but for the infant and the family. However, the pattern of natural transition trajectories [...] Read more.
Background: Postpartum depression (PPD) has been recognized as a severe public health problem worldwide due to its high incidence and the detrimental consequences not only for the mother but for the infant and the family. However, the pattern of natural transition trajectories of PPD has rarely been explored. Methods: In this research, a quantitative longitudinal study was conducted to explore the PPD progression process, providing information on the transition probability, hazard ratio, and the mean sojourn time in the three postnatal mental states, namely normal state, mild PPD, and severe PPD. The multi-state Markov model was built based on 912 depression status assessments in 304 Chinese primiparous women over multiple time points of six weeks postpartum, three months postpartum, and six months postpartum. Results: Among the 608 PPD status transitions from one visit to the next visit, 6.2% (38/608) showed deterioration of mental status from the level at the previous visit; while 40.0% (243/608) showed improvement at the next visit. A subject in normal state who does transition then has a probability of 49.8% of worsening to mild PPD, and 50.2% to severe PPD. A subject with mild PPD who does transition has a 20.0% chance of worsening to severe PPD. A subject with severe PPD is more likely to improve to mild PPD than developing to the normal state. On average, the sojourn time in the normal state, mild PPD, and severe PPD was 64.12, 6.29, and 9.37 weeks, respectively. Women in normal state had 6.0%, 8.5%, 8.7%, and 8.8% chances of progress to severe PPD within three months, nine months, one year, and three years, respectively. Increased all kinds of supports were associated with decreased risk of deterioration from normal state to severe PPD (hazard ratio, HR: 0.42–0.65); and increased informational supports, evaluation of support, and maternal age were associated with alleviation from severe PPD to normal state (HR: 1.46–2.27). Conclusions: The PPD state transition probabilities caused more attention and awareness about the regular PPD screening for postnatal women and the timely intervention for women with mild or severe PPD. The preventive actions on PPD should be conducted at the early stages, and three yearly; at least one yearly screening is strongly recommended. Emotional support, material support, informational support, and evaluation of support had significant positive associations with the prevention of PPD progression transitions. The derived transition probabilities and sojourn time can serve as an importance reference for health professionals to make proactive plans and target interventions for PPD. Full article
(This article belongs to the Special Issue Maternal Perinatal Mental Health)
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17 pages, 851 KiB  
Article
Prevalence of Depression during Pregnancy in Spanish Women: Trajectory and Risk Factors in Each Trimester
by M. Carmen Míguez and M. Belén Vázquez
Int. J. Environ. Res. Public Health 2021, 18(13), 6789; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18136789 - 24 Jun 2021
Cited by 14 | Viewed by 2293
Abstract
The aims of this research were to determine the trajectories of probable depression and major depression during pregnancy and to identify the associated and predictor variables (sociodemographic, pregnancy-related, and psychological) for both conditions in each trimester of pregnancy. A longitudinal study was carried [...] Read more.
The aims of this research were to determine the trajectories of probable depression and major depression during pregnancy and to identify the associated and predictor variables (sociodemographic, pregnancy-related, and psychological) for both conditions in each trimester of pregnancy. A longitudinal study was carried out with 569 pregnant Spanish women who were assessed in the first, second, and third trimesters of pregnancy. Depression was assessed using the Edinburgh Postnatal Depression Scale and a clinical interview. Measures of anxiety and stress were also included. The prevalence of probable depression in the first, second, and third trimesters was 23.4%, 17.0%, and 21.4%, respectively, and that of major depression was 5.1%, 4.0%, and 4.7%. Thus, the prevalence of both conditions was the highest in the first and third trimesters. The trajectories of probable depression and major depression followed the same pattern throughout pregnancy. All of the psychological variables studied were associated with both conditions in all three trimesters, with perceived stress being a predictor at all times. The association between the other variables and both conditions of depression was similar. Two exceptions stand out: having had previous miscarriages, which was only associated with probable depression and was also a predictor, in the first trimester; and complications during pregnancy, which was only associated with probable and major depression in the third trimester. These findings should be taken into account in routine pregnancy follow-ups, and necessary interventions should be started in the first trimester. Full article
(This article belongs to the Special Issue Maternal Perinatal Mental Health)
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10 pages, 344 KiB  
Article
Perinatal Depression, Birth Experience, Marital Satisfaction and Childcare Sharing: A Study in Russian Mothers
by Vera Yakupova and Liudmila Liutsko
Int. J. Environ. Res. Public Health 2021, 18(11), 6086; https://doi.org/10.3390/ijerph18116086 - 04 Jun 2021
Cited by 10 | Viewed by 4230
Abstract
Background: Over 300,000 women in Russia face perinatal depressive disorders every year, according to the data for middle-income countries. This study is the first attempt to perform a two-phase study of perinatal depressive disorders in Russia. The paper examines risk factors for perinatal [...] Read more.
Background: Over 300,000 women in Russia face perinatal depressive disorders every year, according to the data for middle-income countries. This study is the first attempt to perform a two-phase study of perinatal depressive disorders in Russia. The paper examines risk factors for perinatal depressive symptoms, such as marital satisfaction, birth experience, and childcare sharing. Methods: At 15–40 gestational weeks (M = 30.7, SD = 6.6), 343 Russian-speaking women, with a mean age of 32 years (SD = 4.4), completed the Edinburgh Postnatal Depression Scale, Couples Satisfaction Index, Birth Satisfaction Scale, and provided socio-demographic data. Two months after childbirth, 190 of them participated in the follow-up. Results: The follow-up indicated that 36.4% of participants suffered from prenatal depression and 34.3% of participants had postnatal depression. Significant predictors of prenatal depression were physical well-being during pregnancy (β = −0.25; p = 0.002) and marital satisfaction during pregnancy (β = −0.01; p = 0.018). Birth satisfaction (β = −0.08; p = 0.001), physical well-being at two months after delivery (β = −0.36; p < 0.01), and marital satisfaction during pregnancy (β = 0.01; p = 0.016) and after delivery (β = −0.02; p < 0.01) significantly predicted postnatal depression at 2 months after delivery. Conclusion: Our study identified that physical well-being during pregnancy and marital satisfaction during pregnancy significantly predicted prenatal depression. Birth satisfaction, physical well-being at 2 months after delivery, and marital satisfaction during pregnancy and after delivery significantly predicted postnatal depression. To our knowledge, this is the first study of perinatal depressive disorders in the context of marital satisfaction and birth satisfaction in the Russian sample. The problem of unequal childcare sharing is widely spread in Russia. Adjusting spousal expectations and making arrangements for childcare may become the focus of psychological work with the family. The availability of psychological support during pregnancy and labor may be important in the context of reducing perinatal depression risks. Full article
(This article belongs to the Special Issue Maternal Perinatal Mental Health)
10 pages, 969 KiB  
Article
Effects of Internet-Based Support Program on Parenting Outcomes for Primiparous Women: A Pilot Study
by Lingling Huang, Qu Shen, Qiyu Fang and Xujuan Zheng
Int. J. Environ. Res. Public Health 2021, 18(9), 4402; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094402 - 21 Apr 2021
Cited by 8 | Viewed by 2759
Abstract
(1) Background: Some primiparous women are usually confronted with many parenting problems after childbirth, which can negatively influence the wellbeing of some mothers and infants. Evidence identified that internet interventions can include more tailored information, reach a larger research group, and supply more [...] Read more.
(1) Background: Some primiparous women are usually confronted with many parenting problems after childbirth, which can negatively influence the wellbeing of some mothers and infants. Evidence identified that internet interventions can include more tailored information, reach a larger research group, and supply more anonymity than face-to-face traditional interventions. Therefore, the internet-based support program (ISP) was designed to improve the parenting outcomes for Chinese first-time mothers. (2) Methods: A multicenter, single-blinded, pilot randomized controlled trial was conducted. From May to October 2020, a total of 44 participants were recruited in the obstetrical wards of two tertiary hospitals in China. Eighteen women in the control group received routine postnatal care; while eighteen women in the intervention group accessed to the ISP and routine postnatal care. The duration of intervention was not less than three months. Intervention outcomes were assessed through questionnaires before randomization (T0), immediately after intervention (T1), and three months after intervention (T2). The Self-efficacy in Infant Care Scale (SICS), Edinburgh Postnatal Depression Scale (EPDS), and Postpartum Social Support Scale (PSSS) were included to measure MSE, postpartum depression (PPD), and social support, respectively. (3) Results: No significant difference between the two groups were found in terms of the baseline social-demographic characteristics; and the scores of SICS, EPDS and PSSS at T0 (p > 0.05). Repeated measures multivariate analysis of covariance found that women in the intervention group had a higher MSE score at T1 (6.63, p = 0.007), and T2 (5.75, p = 0.020); a lower EPDS score at T1 (3.11, p = 0.003), and T2 (2.50, p = 0.005); and a higher PSSS score at T1 (4.30, p = 0.001); and no significant difference at T2 (0.35, p = 0.743), compared with women in the control group. (4) Conclusion: The effect of ISP was evaluated to significantly increase primiparous women’s MSE, social support, and to alleviate their PPD symptoms. However, the small sample in pilot study restricted the research results. Therefore, the ISP should be further investigated with a larger, diverse sample to confirm whether it should be adopted as routine postnatal care to support primiparous women on parenting outcomes and mental wellbeing in the early stage of motherhood. Full article
(This article belongs to the Special Issue Maternal Perinatal Mental Health)
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13 pages, 583 KiB  
Article
Women’s Depressive Symptoms during the COVID-19 Pandemic: The Role of Pregnancy
by Karen Yirmiya, Noa Yakirevich-Amir, Heidi Preis, Amit Lotan, Shir Atzil and Inbal Reuveni
Int. J. Environ. Res. Public Health 2021, 18(8), 4298; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084298 - 18 Apr 2021
Cited by 28 | Viewed by 4153
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has multiple ramifications for pregnant women. Untreated depression during pregnancy may have long-term effects on the mother and offspring. Therefore, delineating the effects of pregnancy on the mental health of reproductive-age women is crucial. This study aims [...] Read more.
The Coronavirus Disease 2019 (COVID-19) pandemic has multiple ramifications for pregnant women. Untreated depression during pregnancy may have long-term effects on the mother and offspring. Therefore, delineating the effects of pregnancy on the mental health of reproductive-age women is crucial. This study aims to determine the risk for depressive symptoms in pregnant and non-pregnant women during COVID-19, and to identify its bio-psycho-social contributors. A total of 1114 pregnant and 256 non-pregnant women were recruited via social media in May 2020 to complete an online survey that included depression and anxiety questionnaires, as well as demographic, obstetric and COVID-19-related questionnaires. Pregnant women also completed the Pandemic-Related Pregnancy Stress Scale (PREPS). Pregnant women reported fewer depressive symptoms and were less concerned that they had COVID-19 than non-pregnant women. Among pregnant women, risk factors for depression included lower income, fewer children, unemployment, thinking that one has COVID-19, high-risk pregnancy, earlier gestational age, and increased pregnancy-related stress. Protective factors included increased partner support, healthy behaviors, and positive appraisal of the pregnancy. Thus, being pregnant is associated with reduced risk for depressive symptoms during the pandemic. Increased social support, engaging in health behaviors and positive appraisal may enhance resilience. Future studies of pregnant versus non-pregnant women could clarify the role of pregnancy during stressful events, and clarify aspects of susceptibility and resilience during pregnancy. Full article
(This article belongs to the Special Issue Maternal Perinatal Mental Health)
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11 pages, 370 KiB  
Article
Validity and Reliability of the Caregiver Strain Index Scale in Women during the Puerperium in Spain
by David Feligreras-Alcalá, María del Pilar Cazalilla-López, Rafael del-Pino-Casado and Antonio Frías-Osuna
Int. J. Environ. Res. Public Health 2021, 18(7), 3602; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18073602 - 30 Mar 2021
Cited by 4 | Viewed by 3281
Abstract
Background: The objective of this study is to determine the validity and reliability of the Caregiver Strain Index (CSI) for women during the postpartum period. Methods: This is a validation study of a measurement instrument. This study includes 212 women over the age [...] Read more.
Background: The objective of this study is to determine the validity and reliability of the Caregiver Strain Index (CSI) for women during the postpartum period. Methods: This is a validation study of a measurement instrument. This study includes 212 women over the age of 19 who gave birth from March to September 2019 in Maternal and Child Hospital of Jaén (Spain). The items of the CSI were adapted for newborn care. Content validity was measured by five experts, calculating the index of agreement (Aiken’s V). Criterion validity was assessed by correlations with scores of other tools that measure constructs related to burden (Edinburgh Postpartum Depression Scale, State-Trait Anxiety Questionnaire, SOC-13 and Duke-UNC-11). Construct validity was determined by the known-groups method. Internal consistency was measured using Cronbach’s Alpha, and stability was analysed using the intraclass correlation coefficient (ICC). Results: Regarding content validity, an Aiken’s V of 1.00 (p = 0.032) was obtained. Regarding criterion validity, the correlation analyses showed statistically significant coefficients between the scores of the questionnaire and those of the sense of coherence (r = −0.447, p < 0.001), depressive symptoms (r = 0.429, p < 0.001), social support (rho = −0.379, p < 0.001) and anxiety symptoms (r = 0.532, p < 0.001). The known-groups method showed statistically significant differences in the mean of subjective burden between the groups (depressive symptoms, anxiety symptoms, sense of coherence and social support). The total scale obtained a Cronbach’s alpha value of 0.710. The ICC was 0.979. Conclusions: The adapted CSI is a valid and reliable screening tool for the subjective burden in women during the puerperium. The adapted CSI can play an important role as a guide to detect the subjective burden in women during the puerperium. Full article
(This article belongs to the Special Issue Maternal Perinatal Mental Health)
12 pages, 987 KiB  
Article
Exploring Maternal Self-Efficacy of First-Time Mothers among Rural-to-Urban Floating Women: A Quantitative Longitudinal Study in China
by Qun Wang, Yao Zhang, Xilin Li, Ziwen Ye, Lingling Huang, Yan Zhang and Xujuan Zheng
Int. J. Environ. Res. Public Health 2021, 18(6), 2793; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18062793 - 10 Mar 2021
Cited by 19 | Viewed by 2960
Abstract
(1) Background: China has the highest number of rural-to-urban floating women in the world, and the majority of them are of childbearing age. However, few studies have focused on maternal self-efficacy (MSE) for these women. This research aims to explore MSE and its [...] Read more.
(1) Background: China has the highest number of rural-to-urban floating women in the world, and the majority of them are of childbearing age. However, few studies have focused on maternal self-efficacy (MSE) for these women. This research aims to explore MSE and its influencing factors for primiparous women among the rural-to-urban floating population in China. (2) Methods: A quantitative longitudinal study was conducted, and primiparous women from the floating population were recruited in China. Face-to-face demographic questionnaires were collected from obstetric wards by the researchers, three days postpartum. The 6-week and 12-week questionnaires, including the Self-efficacy in Infant Care Scale (SICS), the Edinburgh Postnatal Depression Scale (EPDS), and the Postpartum Social Support Scale (PSSS), were sent to participants by wechat or email to measure MSE, postnatal depression, and social support, respectively. The completed 6-week and completed 12-week questionnaires were returned to the researchers. (3) Results: The mean MSE scores at 6 and 12 weeks postpartum were 67.16 (SD = 14.35) and 68.71 (SD = 15.00). The variables of social support, postnatal depression, whether women attended parenting training, baby fussiness, baby health, maternal educational level, occupation, and family income affected MSE at the two time points. (4) Conclusions: Primiparous women among the rural-to-urban floating population had a low MSE level. As a vulnerable and special group, more attention should be paid to the negative parenting status of floating women by health workers and family members. Effective measures must be taken to improve the floating women’s accessibility to parenting training from health services to strengthen their social support and alleviate postpartum depression. Health professionals should be more concerned with floating women with relatively low MSE levels, such as new mothers with lower education, poor working and living conditions, unhealthy babies, and babies with fussy temperaments. Full article
(This article belongs to the Special Issue Maternal Perinatal Mental Health)
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11 pages, 532 KiB  
Article
Effects of Pregnancy Loss on Subsequent Postpartum Mental Health: A Prospective Longitudinal Cohort Study
by David C. Reardon and Christopher Craver
Int. J. Environ. Res. Public Health 2021, 18(4), 2179; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18042179 - 23 Feb 2021
Cited by 12 | Viewed by 5417
Abstract
Pregnancy loss, natural or induced, is linked to higher rates of mental health problems, but little is known about its effects during the postpartum period. This study identifies the percentages of women receiving at least one postpartum psychiatric treatment (PPT), defined as any [...] Read more.
Pregnancy loss, natural or induced, is linked to higher rates of mental health problems, but little is known about its effects during the postpartum period. This study identifies the percentages of women receiving at least one postpartum psychiatric treatment (PPT), defined as any psychiatric treatment (ICD-9 290-316) within six months of their first live birth, relative to their history of pregnancy loss, history of prior mental health treatments, age, and race. The population consists of young women eligible for Medicaid in states that covered all reproductive services between 1999–2012. Of 1,939,078 Medicaid beneficiaries with a first live birth, 207,654 (10.7%) experienced at least one PPT, and 216,828 (11.2%) had at least one prior pregnancy loss. A history of prior mental health treatments (MHTs) was the strongest predictor of PPT, but a history of pregnancy loss is also another important risk factor. Overall, women with a prior pregnancy loss were 35% more likely to require a PPT. When the interactions of prior mental health and prior pregnancy loss are examined in greater detail, important effects of these combinations were revealed. About 58% of those whose first MHT was after a pregnancy loss required PPT. In addition, over 99% of women with a history of MHT one year prior to their first pregnancy loss required PPT after their first live births. These findings reveal that pregnancy loss (natural or induced) is a risk factor for PPT, and that the timing of events and the time span for considering prior mental health in research on pregnancy loss can significantly change observed effects. Clinicians should screen for a convergence of a history of MHT and prior pregnancy loss when evaluating pregnant women, in order to make appropriate referrals for counseling. Full article
(This article belongs to the Special Issue Maternal Perinatal Mental Health)
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14 pages, 1174 KiB  
Article
Is the Association between Postpartum Depression and Early Maternal–Infant Relationships Contextually Determined by Avoidant Coping in the Mother?
by Cecilia Peñacoba Puente, Carlos Suso-Ribera, Sheila Blanco Rico, Dolores Marín, Jesús San Román Montero and Patricia Catalá
Int. J. Environ. Res. Public Health 2021, 18(2), 562; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020562 - 11 Jan 2021
Cited by 6 | Viewed by 3240
Abstract
This study analyzes the moderating role of avoidant coping (in early pregnancy) in the relationship between postpartum depressive (PPD) symptoms and maternal perceptions about mother–baby relations and self-confidence. Participants were 116 low-risk obstetric mothers (mean age = 31.2 years, SD = 3.95, range [...] Read more.
This study analyzes the moderating role of avoidant coping (in early pregnancy) in the relationship between postpartum depressive (PPD) symptoms and maternal perceptions about mother–baby relations and self-confidence. Participants were 116 low-risk obstetric mothers (mean age = 31.2 years, SD = 3.95, range 23–42) who received care and gave birth at a Spanish public hospital. Measurements were made at two points in time: at first trimester of pregnancy (maternal avoidance coping) and four months after childbirth (PPD and maternal perceptions). Avoidant coping was associated with the perception of the baby as irritable and unstable (p = 0.003), including irritability during lactation (p = 0.041). Interaction effects of avoidant coping and postpartum depression were observed on the perception of the baby as irritable (p = 0.031) and with easy temperament (p = 0.002). Regarding the mother’s self-confidence, avoidant coping was related to a lack of security in caring for the baby (p < 0.001) and had a moderating effect between PPD and mother’s self-confidence (i.e., lack of security in caring for the baby, p =0.027; general security, p = 0.007). Interaction effects showed that the use of avoidant coping in the mother exacerbated the impact of PPD on the early mother–infant relationship. Full article
(This article belongs to the Special Issue Maternal Perinatal Mental Health)
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12 pages, 593 KiB  
Article
Perinatal Anxiety Symptoms: Rates and Risk Factors in Mexican Women
by Janeth Juarez Padilla, Sandraluz Lara-Cinisomo, Laura Navarrete and Ma. Asunción Lara
Int. J. Environ. Res. Public Health 2021, 18(1), 82; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18010082 - 24 Dec 2020
Cited by 6 | Viewed by 2836
Abstract
Anxiety during pregnancy and after childbirth can have negative consequences for a woman and her baby. Despite growing interest in the perinatal mental health of Mexican women living in the U.S., perinatal anxiety symptom (PAS) rates and risk factors have yet to be [...] Read more.
Anxiety during pregnancy and after childbirth can have negative consequences for a woman and her baby. Despite growing interest in the perinatal mental health of Mexican women living in the U.S., perinatal anxiety symptom (PAS) rates and risk factors have yet to be established for women in Mexico. We sought to determine PAS rates and identify risk factors, including the traditional female role (TFR) in a sample of Mexican women. This secondary data analysis is based on 234 Mexican women who participated in a longitudinal study on perinatal depression in Mexico. Anxiety symptoms were assessed in pregnancy and at six weeks postpartum. Rates were determined through frequencies, and multiple logistics regressions were conducted to identify risk factors in the sample. The PAS rate was 21% in pregnancy and 18% postpartum. Stressful life events and depressive symptoms were associated with a higher probability of PAS. Adherence to TFR increased the probability of prenatal anxiety; lower educational attainment and low social support during pregnancy increased the probability of postpartum anxiety. The PAS rates were within the range reported in the literature. The TFR was only associated with anxiety in gestation, highlighting the role of this culturally relevant risk factor. Culturally responsive early interventions are therefore required. Full article
(This article belongs to the Special Issue Maternal Perinatal Mental Health)
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11 pages, 1050 KiB  
Article
Chinese Women’s Acceptance and Uptake of Referral after Screening for Perinatal Depression
by Wenjie Gong, Xin Jin, Kar Keung Cheng, Eric D. Caine, Richard Lehman and Dong (Roman) Xu
Int. J. Environ. Res. Public Health 2020, 17(22), 8686; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17228686 - 23 Nov 2020
Cited by 18 | Viewed by 2645
Abstract
China recently issued a national plan on perinatal depression (PND) screening. Previous studies elsewhere suggested that uptake of referral after screening for PND is suboptimal, but little is known in China. In this cohort study including 1126 women in Hunan, we identified women [...] Read more.
China recently issued a national plan on perinatal depression (PND) screening. Previous studies elsewhere suggested that uptake of referral after screening for PND is suboptimal, but little is known in China. In this cohort study including 1126 women in Hunan, we identified women at a high risk of PND using the Edinburgh Postpartum Depression Scale (EPDS) over multiple time points. We texted them and offered free consultations with a psychiatrist/psychologist. Among 248 screen-positive women, only three expressed interest and one attended the appointment. We surveyed the women about their reasons for declining referrals and preferred means of care. Of the 161 respondents, 128 (79.5%) indicated that they could cope with the condition without professional assistance and 142 (88.2%) chose their families as the preferred source of help. Only 15 (9.3%) chose professionals as their first option. Implementing a referral policy for screen-positive women would mean approximately one-third of women who gave birth in China would be eligible. Our result argues against referring all screen-positive women for professional services at this time. Interventions should instead build upon the tradition of family support in a more engaged response. These considerations are relevant for the implementation of national screening for PND in China. Full article
(This article belongs to the Special Issue Maternal Perinatal Mental Health)
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15 pages, 811 KiB  
Article
Predicting Postpartum Depressive Symptoms from Pregnancy Biopsychosocial Factors: A Longitudinal Investigation Using Structural Equation Modeling
by Verónica Martínez-Borba, Carlos Suso-Ribera, Jorge Osma and Laura Andreu-Pejó
Int. J. Environ. Res. Public Health 2020, 17(22), 8445; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17228445 - 14 Nov 2020
Cited by 9 | Viewed by 3280
Abstract
The prediction of postpartum depression (PPD) should be conceptualized from a biopsychosocial perspective. This study aims at exploring the longitudinal contribution of a set of biopsychosocial factors for PPD in perinatal women. A longitudinal study was conducted, assessment was made with a website [...] Read more.
The prediction of postpartum depression (PPD) should be conceptualized from a biopsychosocial perspective. This study aims at exploring the longitudinal contribution of a set of biopsychosocial factors for PPD in perinatal women. A longitudinal study was conducted, assessment was made with a website and included biopsychosocial factors that were measured during pregnancy (n = 266, weeks 16–36), including age, affective ambivalence, personality characteristics, social support and depression. Depression was measured again at postpartum (n = 101, weeks 2–4). The analyses included bivariate associations and structural equation modeling (SEM). Age, affective ambivalence, neuroticism, positive, and negative affect at pregnancy were associated with concurrent depression during pregnancy (all p < 0.01). Age, affective ambivalence, positive affect, and depression at pregnancy correlated with PPD (all p < 0.05). Affective ambivalence (β = 1.97; p = 0.003) and positive (β = −0.29; p < 0.001) and negative affect (β = 0.22; p = 0.024) at pregnancy remained significant predictors of concurrent depression in the SEM, whereas only age (β = 0.27; p = 0.010) and depression (β = 0.37; p = 0.002) at pregnancy predicted PPD. Biopsychosocial factors are clearly associated with concurrent depression at pregnancy, but the stability of depression across time limits the prospective contribution of biopsychosocial factors. Depression should be screened early during pregnancy, as this is likely to persist after birth. The use of technology, as in the present investigation, might be a cost-effective option for this purpose. Full article
(This article belongs to the Special Issue Maternal Perinatal Mental Health)
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16 pages, 532 KiB  
Article
Effects of Tobacco Consumption and Anxiety or Depression during Pregnancy on Maternal and Neonatal Health
by Beatriz Pereira, Bárbara Figueiredo, Tiago Miguel Pinto and M. Carmen Míguez
Int. J. Environ. Res. Public Health 2020, 17(21), 8138; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17218138 - 04 Nov 2020
Cited by 6 | Viewed by 2087
Abstract
This study analyzed the possible interaction effects between tobacco consumption and anxiety or depression during pregnancy on maternal and neonatal health. We recruited a sample of 807 pregnant Spanish women from public healthcare services. Women completed a questionnaire on sociodemographic variables, health status [...] Read more.
This study analyzed the possible interaction effects between tobacco consumption and anxiety or depression during pregnancy on maternal and neonatal health. We recruited a sample of 807 pregnant Spanish women from public healthcare services. Women completed a questionnaire on sociodemographic variables, health status and tobacco consumption (continuous, quitting or no consumption) in the first and third trimester of pregnancy and at 2 months postpartum, and self-reported measures of anxiety and depression in the first trimester. Abstinence of tobacco consumption was verified through biochemical measurements. Interaction effects between tobacco consumption and anxiety were found for delivery (p < 0.001), neonatal health complications (p = 0.026) and gestational age at birth (p = 0.029). Interaction effects between tobacco consumption and depression were found for pregnancy (p = 0.032), delivery complications (p < 0.001) and weeks of gestation at birth (p = 0.031). This study suggests that there are different kinds of interaction effects between tobacco consumption and anxiety or depression. Smokers with high anxiety presented more delivery complications compared to quitters and non-smokers with high anxiety. There is a cumulative effect of anxiety on the effects of tobacco consumption on maternal health. The results highlighted the beneficial impact of quitting smoking during pregnancy to reduce the risk of suffering anxiety, depression and health complications. Full article
(This article belongs to the Special Issue Maternal Perinatal Mental Health)
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10 pages, 506 KiB  
Article
The Psychometric Properties of the Patient Health Questionnaire-4 for Pregnant Women
by María de la Fe Rodríguez-Muñoz, Natalia Ruiz-Segovia, Cristina Soto-Balbuena, Huynh-Nhu Le, María Eugenia Olivares-Crespo and Nuria Izquierdo-Méndez
Int. J. Environ. Res. Public Health 2020, 17(20), 7583; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17207583 - 19 Oct 2020
Cited by 14 | Viewed by 3291
Abstract
Background: Perinatal anxiety and depression are common complications during pregnancy. The purpose of this study was to examine the item characteristics, reliability, validity, and factorial structure of the four-item Patient Health Questionnaire-4 (PHQ-4) and to determine the associations between scale scores and sociodemographic [...] Read more.
Background: Perinatal anxiety and depression are common complications during pregnancy. The purpose of this study was to examine the item characteristics, reliability, validity, and factorial structure of the four-item Patient Health Questionnaire-4 (PHQ-4) and to determine the associations between scale scores and sociodemographic factors in a sample of pregnant women from Spain. Method: A total of 845 pregnant women were recruited from two public hospitals in Spain between 2014 and 2016. Participants completed a self-report questionnaire that included Patient Health Questionnaire-4, including the two-item Patient Health Questionnaire and the two-item Generalized Anxiety Disorder Screener. Results: Exploratory and confirmatory factor analysis and scale inter-correlations between the PHQ-4 and PHQ-9 revealed that the PHQ-4 has a bivariate structure and adequately assesses the dimensions of antenatal anxiety and depression. Conclusion: The PHQ-4 is a reliable and valid instrument to screen for depression and anxiety during pregnancy. The PHQ-4 is an ultra-brief measure that can be used to screen for antenatal depression and anxiety to prevent the negative consequences associated with these mental health conditions among mothers and infants. Full article
(This article belongs to the Special Issue Maternal Perinatal Mental Health)
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Review

Jump to: Research

23 pages, 943 KiB  
Review
Contemplating Help-Seeking in Perinatal Psychological Distress—A Meta-Ethnography
by Minna Anneli Sorsa, Jari Kylmä and Terese Elisabet Bondas
Int. J. Environ. Res. Public Health 2021, 18(10), 5226; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105226 - 14 May 2021
Cited by 8 | Viewed by 3386
Abstract
Perinatal psychological distress (PPD) may cause delays in help-seeking in the perinatal period, which is crucial for families with small children. Help-seeking theories focus on rational processes of behavior wherein ‘help-seeking’ is viewed as a decision-making process, in which action is preceded by [...] Read more.
Perinatal psychological distress (PPD) may cause delays in help-seeking in the perinatal period, which is crucial for families with small children. Help-seeking theories focus on rational processes of behavior wherein ‘help-seeking’ is viewed as a decision-making process, in which action is preceded by recognizing a problem. We identified the phase prior to actual help-seeking actions as a life situation and a phenomenon through which to gain a deeper understanding from women’s own perspectives. The aim of this study was to integrate and synthesize knowledge of women’s experiences of contemplating seeking help for PPD. We chose interpretative meta-ethnography by Noblit and Hare (1988) and implemented eMERGe guidelines in reporting. The search was performed systematically, and the 14 included studies were evaluated with Critical Appraisal Skills Programme checklist (CASP). We identified seven themes and a metaphor in a lines-of-argument synthesis, showing that contemplating help-seeking is a multidimensional phenomenon. We did not observe a straightforward and linear process (as previous research suggests) but instead a complex process of contemplating help-seeking. A clinical implication is that service providers should work with outreach and develop their tools to connect with mothers with PPD. Another suggestion is to improve training in mental health literacy prior to or during pregnancy. Full article
(This article belongs to the Special Issue Maternal Perinatal Mental Health)
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