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15 pages, 715 KiB

Open AccessArticle

Association between Antidepressant Treatment during Pregnancy and Postpartum Self-Harm Ideation in Women with Psychiatric Disorders: A Cross-Sectional, Multinational Study

by Jennifer Vallee, Yih Wong, Eline Mannino, Hedvig Nordeng and Angela Lupattelli

Int. J. Environ. Res. Public Health 2021, 18(1), 46; https://doi.org/10.3390/ijerph18010046 - 23 Dec 2020

Cited by 2 | Viewed by 3554

Abstract

This study sought to estimate whether there is a preventative association between antidepressants during pregnancy and postpartum self-harm ideation (SHI), as this knowledge is to date unknown. Using the Multinational Medication Use in Pregnancy Study, we included a sample of mothers who were [...] Read more.

This study sought to estimate whether there is a preventative association between antidepressants during pregnancy and postpartum self-harm ideation (SHI), as this knowledge is to date unknown. Using the Multinational Medication Use in Pregnancy Study, we included a sample of mothers who were in the five weeks to one year postpartum period at the time of questionnaire completion, and reported preexisting or new onset depression and/or anxiety during pregnancy (n = 187). Frequency of postpartum SHI (‘often/sometimes’ = frequent, ‘hardly ever’ = sporadic, ‘never’) was measured via the Edinburgh Postnatal Depression Scale (EPDS) item 10, which reads “The thought of harming myself has occurred to me”. Mothers reported their antidepressant use in pregnancy retrospectively. Overall, 52.9% of women took an antidepressant during pregnancy. Frequent SHI postpartum was reported by 15.2% of non-medicated women and 22.0% of women on past antidepressant treatment in pregnancy; this proportion was higher following a single trimester treatment compared to three trimesters (36.3% versus 18.0%). There was no preventative association of antidepressant treatment in pregnancy on reporting frequent SHI postpartum (weighted RR: 1.90, 95% CI: 0.79, 4.56), relative to never/hardly ever SHI. In a population of women with antenatal depression/anxiety, there was no preventative association between past antidepressant treatment in pregnancy and reporting frequent SHI in the postpartum year. This analysis is only a first step in providing evidence to inform psychiatric disorder treatment decisions for pregnant women. Full article

(This article belongs to the Special Issue Perinatal Mood and Anxiety Disorders (PMADs): Correlates, Consequences, Screening Practices, Treatment Protocols, Interventions, Pharmacology and Public Health Impact)

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15 pages, 456 KiB

Open AccessArticle

Creating a Multisite Perinatal Psychiatry Databank: Purpose and Development

by Wid Kattan, Laura Avigan, Barbara Hayton, Jennifer L. Barkin, Martin St-André, Tuong-Vi Nguyen, Hannah Schwartz, Marie-Josée Poulin, Irena Stikarovska, Rahel Wolde-Giorghis, Maria Arafah and Phyllis Zelkowitz

Int. J. Environ. Res. Public Health 2020, 17(24), 9352; https://doi.org/10.3390/ijerph17249352 - 14 Dec 2020

Cited by 1 | Viewed by 2106

Abstract

Mental health issues during the perinatal period are common; up to 29% of pregnant and 15% of postpartum women meet psychiatric diagnostic criteria. Despite its ubiquity, little is known about the longitudinal trajectories of perinatal psychiatric illness. This paper describes a collaboration among [...] Read more.

Mental health issues during the perinatal period are common; up to 29% of pregnant and 15% of postpartum women meet psychiatric diagnostic criteria. Despite its ubiquity, little is known about the longitudinal trajectories of perinatal psychiatric illness. This paper describes a collaboration among six perinatal mental health services in Quebec, Canada, to create an electronic databank that captures longitudinal patient data over the course of the perinatal period. The collaborating sites met to identify research interests and to select a standardized set of variables to be collected during clinical appointments. Procedures were implemented for creating a databank that serves both research and clinical purposes. The resulting databank allows pregnant and postpartum patients to complete self-report questionnaires on medical and psychosocial variables during their intake appointment in conjunction with their clinicians who fill in relevant medical information. All participants are followed until 6 months postpartum. The databank represents an opportunity to examine illness trajectories and to study rare mental disorders and the relationship between biological and psychosocial variables. Full article

(This article belongs to the Special Issue Perinatal Mood and Anxiety Disorders (PMADs): Correlates, Consequences, Screening Practices, Treatment Protocols, Interventions, Pharmacology and Public Health Impact)

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13 pages, 342 KiB

Open AccessArticle

by Silvia Manso-Córdoba, Sarah Pickering, Miguel A. Ortega, Ángel Asúnsolo and Diana Romero

Int. J. Environ. Res. Public Health 2020, 17(24), 9328; https://doi.org/10.3390/ijerph17249328 - 13 Dec 2020

Cited by 22 | Viewed by 4980

Abstract

Postpartum depression (PPD) affects 13% of mothers and can have a major impact on their lives and those of their children. However, most cases go undiagnosed, and the risk factors for this underdiagnosis are not yet fully known. We intended to analyze the [...] Read more.

Postpartum depression (PPD) affects 13% of mothers and can have a major impact on their lives and those of their children. However, most cases go undiagnosed, and the risk factors for this underdiagnosis are not yet fully known. We intended to analyze the influence of different sociodemographic and health factors associated with symptoms of postpartum depression. Data from the New York City Pregnancy Risk Assessment Monitoring System (PRAMS) for 2016–2017 were analyzed. 618 women met the inclusion criterion of recurring depressive symptoms. Most women who experienced PPD symptoms did not seek help. Seeking help was a much better predictor of the diagnosis of PPD when compared to questions regarding symptoms. The most important factors related to a decreased risk of not asking for help were having a previous mental health history and having doctor visits for a chronic illness. The racial group most at risk of not asking for help were Asian/Pacific Islander (API) women. Interventions aimed at reducing the stigma and increasing knowledge of PPD should be incorporated into the antenatal education of expectant mothers, particularly among women who may not have previously sought care for mental or chronic illnesses. Full article

(This article belongs to the Special Issue Perinatal Mood and Anxiety Disorders (PMADs): Correlates, Consequences, Screening Practices, Treatment Protocols, Interventions, Pharmacology and Public Health Impact)

28 pages, 1315 KiB

Open AccessArticle

In Their Own Words: A Qualitative Investigation of the Factors Influencing Maternal Postpartum Functioning in the United States

by Ariana M. Albanese, Pamela A. Geller, Jackson M. Steinkamp and Jennifer L. Barkin

Int. J. Environ. Res. Public Health 2020, 17(17), 6021; https://doi.org/10.3390/ijerph17176021 - 19 Aug 2020

Cited by 15 | Viewed by 4152

Abstract

During the first twelve months postpartum, infants require intensive care and mothers are susceptible to physical and mental health concerns as they undergo a period of tremendous psychological and physiological adjustment. The mother’s level of postpartum functioning not only impacts her experience as [...] Read more.

During the first twelve months postpartum, infants require intensive care and mothers are susceptible to physical and mental health concerns as they undergo a period of tremendous psychological and physiological adjustment. The mother’s level of postpartum functioning not only impacts her experience as a mother but also the infant and family unit. However, efforts to bolster functioning are lacking, and previous literature has identified a gap between what experts recommend and what mothers desire during the postpartum period. To address this, we conducted structured interviews with a diverse sample of 30 postpartum mothers to identify factors that mothers report are most influential to their postpartum functioning. In total, we identified 23 clinically actionable factors, all of which are backed by existing literature. In addition to an in-depth presentation of the qualitative findings, we also present a heat map to visualize the relevance of these factors to each of seven established domains of maternal functioning. Lastly, based on our findings, we offer a taxonomy of interventional strategies that could bolster maternal functioning during this critical period. Full article

(This article belongs to the Special Issue Perinatal Mood and Anxiety Disorders (PMADs): Correlates, Consequences, Screening Practices, Treatment Protocols, Interventions, Pharmacology and Public Health Impact)

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20 pages, 861 KiB

Open AccessArticle

Perinatal Mental Illness in the Middle East and North Africa Region—A Systematic Overview

by Sathyanarayanan Doraiswamy, Anupama Jithesh, Sonia Chaabane, Amit Abraham, Karima Chaabna and Sohaila Cheema

Int. J. Environ. Res. Public Health 2020, 17(15), 5487; https://doi.org/10.3390/ijerph17155487 - 29 Jul 2020

Cited by 13 | Viewed by 3973

Abstract

Aims: Perinatal mental illness (PMI) is associated with a high risk of maternal and infant morbidity. Recently, several systematic reviews and primary studies have explored the prevalence and risk factors of PMI in the Middle East and North Africa (MENA) region. To our [...] Read more.

Aims: Perinatal mental illness (PMI) is associated with a high risk of maternal and infant morbidity. Recently, several systematic reviews and primary studies have explored the prevalence and risk factors of PMI in the Middle East and North Africa (MENA) region. To our knowledge, there has been no critical analysis of the existing systematic reviews (SRs) on this topic in the MENA region. Our systematic overview primarily aimed to synthesize evidence from the published SRs on PMI in the MENA countries focusing on a) the prevalence of PMI and b) the risk factors associated with PMI. Methods: We conducted a systematic overview of the epidemiology of PMI in the Middle East and North Africa region by searching the PubMed, Embase, and PsycInfo databases for relevant publications between January 2008 and July 2019. In addition to searching the reference lists of the identified SRs for other relevant SRs and additional primary studies of relevance (those which primarily discussed the prevalence of PMI and/or risk and protective factors), between August and October 2019, we also searched Google Scholar for relevant studies. Results: After applying our inclusion and exclusion criteria, 15 systematic reviews (SRs) and 79 primary studies were included in our overview. Studies utilizing validated diagnostic tools report a PMI prevalence range from 5.6% in Morocco to 28% in Pakistan. On the other hand, studies utilizing screening tools to detect PMI report a prevalence range of 9.2% in Sudan to 85.6% in the United Arab Emirates. Wide variations were observed in studies reporting PMI risk factors. We regrouped the risk factors applying an evidence-based categorization scheme. Our study indicates that risk factors in the relational, psychological, and sociodemographic categories are the most studied in the region. Conversely, lifestyle-related risk factors were less studied. Conclusions: Our systematic overview identifies perinatal mental illness as an important public health issue in the region. Standardizing approaches for estimating, preventing, screening, and treating perinatal mental illness would be a step in the right direction for the region. Full article

(This article belongs to the Special Issue Perinatal Mood and Anxiety Disorders (PMADs): Correlates, Consequences, Screening Practices, Treatment Protocols, Interventions, Pharmacology and Public Health Impact)

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14 pages, 395 KiB

Open AccessArticle

Personal and Family Resources Related to Depressive and Anxiety Symptoms in Women during Puerperium

by David Feligreras-Alcalá, Antonio Frías-Osuna and Rafael del-Pino-Casado

Int. J. Environ. Res. Public Health 2020, 17(14), 5230; https://doi.org/10.3390/ijerph17145230 - 20 Jul 2020

Cited by 14 | Viewed by 3881

Abstract

Introduction: This study investigated the relationship between personal and family resources (i.e., social support, family functioning, self-efficacy in care, sense of coherence and perceived burden of care) and depressive and anxiety symptoms in women during the puerperium, adjusting for stressors. Methods: [...] Read more.

Introduction: This study investigated the relationship between personal and family resources (i.e., social support, family functioning, self-efficacy in care, sense of coherence and perceived burden of care) and depressive and anxiety symptoms in women during the puerperium, adjusting for stressors. Methods: This is a quantitative research design, carried out through a descriptive, cross-sectional correlation study. 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). Women were selected during the immediate postpartum period. The variables analysed were postpartum depressive symptoms (Edinburgh scale), anxiety symptoms (STAI state anxiety questionnaire), perceived social support (Duke-UNC-11), family functioning (family APGAR), self-efficacy in care (Lawton), sense of coherence (SOC-13), perceived burden (Caregiver Strain Index) and stressful life events (Holmes and Rahe). The main analysis consisted of a multiple linear regression. Results: The regression model of depressive symptoms found a positive association with perceived burden (β = 0.230, p = 0.015) and negative associations with self-efficacy in care (β = −0.348, p < 0.001), social support (β = −0.161, p < 0.001) and sense of coherence (β = −0.081, p = 0.001). The regression model of anxiety symptoms obtained a positive association with perceived burden (β = 1.052, p < 0.001) and negative associations with self-efficacy in care (β = −0.329, p = 0.041), social support (β = −0.234, p = 0.001) and sense of coherence (β = −0.262, p < 0.001). Discussion: Firstly, depressive and anxiety symptoms in the puerperium period may be more prevalent than in other periods of a woman’s life. Secondly, perceived social support, self-efficacy in caring for the newborn and sense of coherence may be protective factors for depressive and anxiety symptoms in the puerperium period. Finally, perceived burden in caring for the newborn may be a risk factor for these symptoms. Full article

(This article belongs to the Special Issue Perinatal Mood and Anxiety Disorders (PMADs): Correlates, Consequences, Screening Practices, Treatment Protocols, Interventions, Pharmacology and Public Health Impact)

18 pages, 710 KiB

Open AccessArticle

Insecure Attachment and Other Help-Seeking Barriers among Women Depressed Postpartum

by Emily Cacciola and Elia Psouni

Int. J. Environ. Res. Public Health 2020, 17(11), 3887; https://doi.org/10.3390/ijerph17113887 - 30 May 2020

Cited by 14 | Viewed by 5496

Abstract

When untreated, postpartum depression (PPD) can severely, negatively affect maternal health, child development, and the wellbeing and functioning of the entire family. Yet, despite screening and treatment programs for PPD, many women who experience depression with onset in the postpartum year do not [...] Read more.

When untreated, postpartum depression (PPD) can severely, negatively affect maternal health, child development, and the wellbeing and functioning of the entire family. Yet, despite screening and treatment programs for PPD, many women who experience depression with onset in the postpartum year do not communicate their symptoms. Negative relational experiences early in life, such as not receiving sensitive help and support when needed, often result in so-called insecure attachment styles, and there is evidence that these may contribute to the development and maintenance of PPD. However, the role of insecure attachment styles in non-help-seeking is unknown for this group. Using mixed quantitative and qualitative methodology, we identified help-seeking barriers of women who experienced depression with onset in the postpartum year but who had not sought help for their depression (N = 37), and explored links to their attachment orientations as assessed through both self-reported attachment style and narrative based attachment script assessment. The sample was non-normative regarding attachment, with an over-representation of avoidant attachment styles. Help-seeking barriers varied systematically with the mother’s adult attachment style. Specifically, convictions of a strong self and lack of trust in healthcare professionals constituted a common barrier among women with avoidant attachment styles, while unrealistic expectations about motherhood constituted a barrier for women with secure attachment styles. This new knowledge on how barriers to communicating symptoms and seeking help when suffering from PPD vary systematically with attachment orientation can help formulate individualized, and therefore more efficient, approaches to addressing non-help-seeking behavior in women who suffer in silence. Full article

(This article belongs to the Special Issue Perinatal Mood and Anxiety Disorders (PMADs): Correlates, Consequences, Screening Practices, Treatment Protocols, Interventions, Pharmacology and Public Health Impact)

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11 pages, 464 KiB

Open AccessArticle

Comparison of Maternal Functioning between Iranian Mothers with and without Depressive Symptoms: A Case-Control Study

by Fatemeh Karami Chamgurdani, Jennifer L. Barkin, Carolann L. Curry and Mojgan Mirghafourvand

Int. J. Environ. Res. Public Health 2020, 17(10), 3350; https://doi.org/10.3390/ijerph17103350 - 12 May 2020

Cited by 7 | Viewed by 2576

Abstract

Postpartum depression (PPD) has adverse effects on the mother’s ability to work, her relationships, performance in other roles, and caregiving ability. The aim of this study was to compare levels of maternal functioning between mothers with depression symptoms and those without. The participants [...] Read more.

Postpartum depression (PPD) has adverse effects on the mother’s ability to work, her relationships, performance in other roles, and caregiving ability. The aim of this study was to compare levels of maternal functioning between mothers with depression symptoms and those without. The participants of this case-control study included 80 postpartum women (n = 40 with depressive symptoms and n = 40 with no depressive symptoms) referred to health centers in Tabriz, Iran, in 2018–2019. The case and control groups were matched for the number of deliveries (first or second deliveries) and the type of delivery (vaginal or cesarean section). A sociodemographic questionnaire, Edinburgh Postpartum Depression Scale (EPDS), and Barkin Index of Maternal Functioning (BIMF) were used for data collection. The relationship between maternal functioning and depression was assessed by conducting independent t-tests and Pearson correlation tests in bivariate analysis and applying the general linear model (GLM) in a multivariate analysis. There was no statistically significant difference between the two groups in terms of sociodemographic information. The mean (SD) total scores of maternal functioning in the case (depressed) and control (non-depressed) groups were 63.4 (12.2) and 93.3 (13.0), respectively. According to the independent t-test, this value in the control group was significantly higher than that of the case group (mean difference: −30.0; 95% confidence interval: −35.6 to −24.3; p < 0.001). In terms of the domains of the BIMF, based on the independent t-test, the mean score of all domains in the control group was significantly higher than that of the case group, except for the mother-child interaction dimension (p = 0.219). Based on the Pearson correlation test, there was significant negative correlation between the PPD score and total score of BIMF (r = −0.79, p < 0.001) and its domains (r = −0.81 to −0.54, p < 0.001). In addition, based on the GLM with adjusting the sociodemographic and obstetrics characteristics, the score of maternal functioning was significantly lower in the case group compared to the control group [β = −30.1; 95% CI: −36.8 to −23.4; p = 0.001]. The results of this study indicate that women with depressive symptoms have lower maternal functioning. Depressed women may find it difficult to perform their maternal duties and take care of themselves and other family members due to the burden of the depressive symptoms. Therefore, early diagnosis and treatment of postpartum depression can play an important role in improving daily maternal functioning. Full article

(This article belongs to the Special Issue Perinatal Mood and Anxiety Disorders (PMADs): Correlates, Consequences, Screening Practices, Treatment Protocols, Interventions, Pharmacology and Public Health Impact)

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11 pages, 327 KiB

Open AccessArticle

The Relationship between Maternal Functioning and Mental Health after Childbirth in Iranian Women

by Sevda Gholizadeh Shamasbi, Jennifer L. Barkin, Solmaz Ghanbari-Homayi, Ommlbanin Eyvazzadeh and Mojgan Mirghafourvand

Int. J. Environ. Res. Public Health 2020, 17(5), 1558; https://doi.org/10.3390/ijerph17051558 - 28 Feb 2020

Cited by 15 | Viewed by 3205

Abstract

The postpartum period is critical for new mothers, in terms of performing maternal functions, which can be affected by physical or psychological complications. The purpose of the present study is to determine the relationship between maternal functioning and mental health in the postpartum [...] Read more.

The postpartum period is critical for new mothers, in terms of performing maternal functions, which can be affected by physical or psychological complications. The purpose of the present study is to determine the relationship between maternal functioning and mental health in the postpartum period. This cross-sectional descriptive-analytic study was conducted on 530 eligible women who referred to health centers in Tabriz, Iran in 2018. The participants were selected through randomized cluster sampling, and data were collected by using a socio-demographic characteristics questionnaire, Mental Health Inventory (MHI), and the Barkin Index of Maternal Functioning (BIMF). These assessments were collected between 1 and 4 months postpartum. The relationship between maternal functioning and mental health was determined by conducting bivariate analysis via Pearson and Spearman correlation analysis and the general linear model (GLM) in a multivariate analysis. The mean (SD) mental health score in women was 79.1 (15.0) in the obtainable score range of 18 to 108, and the mean (SD) BIMF score in women was 97.4 (12.9) in the obtainable score range of 0 to 120. Based on Pearson or Spearman correlations, mental health and its sub-domains had positive, significant correlations with infant care, mother–child interaction, mental well-being, social support, management, adjustment, self-care, and maternal functioning (p < 0.001). Based on the GLM, increased maternal functioning was associated with higher total mental health score, having a moderate income, and receiving support for infant care (p < 0.05). High levels of postpartum mental health can have a positive impact on maternal functioning. Additionally, having support with infant care tasks can also improve functioning. Full article

(This article belongs to the Special Issue Perinatal Mood and Anxiety Disorders (PMADs): Correlates, Consequences, Screening Practices, Treatment Protocols, Interventions, Pharmacology and Public Health Impact)

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7 pages, 315 KiB

Open AccessBrief Report

The Association between Plasma ERVWE1 Concentrations and Affective Symptoms during Pregnancy: Is This a Friendly Alien?

by Marta Serati, Cecilia Maria Esposito, Silvia Grassi, Valentina Bollati, Jennifer Lynn Barkin and Massimiliano Buoli

Int. J. Environ. Res. Public Health 2020, 17(24), 9217; https://doi.org/10.3390/ijerph17249217 - 9 Dec 2020

Cited by 5 | Viewed by 1848

Abstract

Human endogenous retroviruses (HERVs) comprise 8% of the human genome, and HERV DNA was reported to be essential in human embryonic development. Specifically, HERV-W encodes a protein, syncytin-1, alternatively known as ERVWE1 (Human Endogenous Retrovirus W EnvC7-1 Envelope Protein), participating in human placental [...] Read more.

Human endogenous retroviruses (HERVs) comprise 8% of the human genome, and HERV DNA was reported to be essential in human embryonic development. Specifically, HERV-W encodes a protein, syncytin-1, alternatively known as ERVWE1 (Human Endogenous Retrovirus W EnvC7-1 Envelope Protein), participating in human placental morphogenesis and having a role in immune system regulation. Syncytin-1 activity is increased in neuropsychiatric disorders, autoimmune diseases, and cancer. In our study, forty-four women in the third trimester of pregnancy were tested for ERVWE1 plasma levels. In concomitance with blood samples the following rating scales were administered to women: the Edinburgh Postnatal Depression Scale (EPDS), State Anxiety Inventory (STAI-S), Trait Anxiety Inventory (STAI-T), and Prenatal Attachment Inventory (PAI). We found that higher ERVWE1 protein plasma levels were significantly associated with higher PAI scores (p = 0.02), an earlier gestational age at the time of blood collection (p = 0.01), a longer duration of symptoms (p = 0.03), and fewer lifetime attempted suicides (p = 0.02). Our results seem to support the role of ERVWE1 in maintaining clinical psychiatric symptoms as a result of potential prolonged inflammation. At the same time, this protein may have a protective role in pregnant women by a reduction of suicidal behavior and a better mother–fetus relationship. Full article

(This article belongs to the Special Issue Perinatal Mood and Anxiety Disorders (PMADs): Correlates, Consequences, Screening Practices, Treatment Protocols, Interventions, Pharmacology and Public Health Impact)

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