Psychological distress in pregnancy and postpartum

PurposeDepression, stress, and anxiety, termed ‘psychological distress,’ are common in pregnancy and postpartum periods. However, it is unclear whether prenatal psychological distress predicts postpartum psychological distress. We studied the prevalence, comorbidity and associations of maternal depression, stress, and anxiety in the prenatal period in relation to the occurrence of these same measures in the postpartum period.MethodsData originated from the MotherToBaby study of pregnant women residing in the U.S or Canada (2016–2018). Risk ratios and 95% Confidence Intervals using modified-Poisson regression models were used to investigate associations between prenatal psychological distress and postpartum psychological distress.ResultsOf the 288 women in the analysis, 21.2% and 26.7% of women had evidence of prenatal and postnatal psychological distress, respectively. Among those with prenatal psychological distress, 43 (70.5%) also had postpartum psychological distress. Twenty-five (41%) of those with prenatal and 46 (60%) of those with postpartum psychological distress had comorbidity of at least two of the measures. Prenatal measures independently predicted the same postnatal measures; prenatal anxiety also independently predicted postpartum stress. Participants who experienced more types of prenatal psychological distress were at higher risk for postpartum depression, stress, and anxiety.ConclusionDepression, stress, and anxiety are common in pregnant women and often occur together. Prenatal psychological distress measures are associated with postnatal psychological distress measures, with stronger associations among women with more than one type of psychological distress in pregnancy. Interventions during pregnancy may reduce the risk of postpartum psychological distress.     

The EPDS and Australian Indigenous women: A systematic review of the literature

ProblemThe Edinburgh Postnatal Depression Scale (EPDS) is considered the gold standard in perinatal mental health screening and the Australian Clinical Practice Guidelines recommend universal use. However, screening rates are four times lower with Indigenous Australian women compared to non-Indigenous women. Difficulties have been reported using the EPDS in this context.BackgroundEvidence demonstrates the link between perinatal mental health and maternal and child outcomes. Indigenous Australian maternal and child health and wellbeing outcomes remain unacceptably poor across all measured parameters and reported psychological distress and child removal rates are increasing.MethodsA systematic literature review was conducted to assess the effectiveness, validity, reliability, and cultural safety of the EPDS in the Indigenous Australian context and identify the availability and suitability of any adaptations.FindingsThe EPDS has not been validated for use with Indigenous Australian women.DiscussionThe findings and limitations identified in this review are consistent with concerns in other countries about the cross-cultural use of the EPDS and its sensitivity in predicting risk for postnatal depression amongst Indigenous women. Where adaptations of the EPDS have been used there has been no psychometric and cultural validation beyond the remote communities in which they were developed.ConclusionsThere is no evidence to demonstrate that the EPDS in its current form and application is suitable for screening with Indigenous Australian women. Urgent work is required to evaluate and/or develop culturally meaningful screening tools that are predictive of risk for social and emotional wellbeing and perinatal mental distress in this context.     

Relationship Transitions and the Risk for Child Maltreatment

Family structure as a risk for child maltreatment has long been viewed as a static state in the child maltreatment literature. Drawing on data from the Fragile Families and Child Wellbeing Study, the author uses a series of individual fixed-effects models to investigate whether particular types of relationship transitions over children’s first decade of life are associated with increased risk for maternal and paternal child abuse and maternal neglect. Findings question and confirm a number of long-standing theoretical and empirical findings from the child maltreatment literature. Results indicate that transitions to being single are associated with increased risk for maternal child abuse and neglect. In addition, the frequency and severity of paternal harsh parenting may be closely linked with the nature of fathers’ relationship transitions. Last, results largely do not provide support for the theory that the presence of social (nonbiological) fathers increases mothers’ risk for engaging in child abuse or neglect.     

Social support,parental role competence and satisfaction among Chinese mothers and fathers in the early postpartum period: A cross-sectional study

BackgroundA sense of parental competence and satisfaction during the transition to parenthood can have a tremendous impact on the quality of parenting behaviors, with social support being an important facilitator.AimTo examine parental role competence and satisfaction of Chinese mothers and fathers in the early postpartum period with regard to social support.MethodsA cross-sectional study was conducted in a regional teaching hospital in Guangzhou, China. The study was conducted between June 5 and November 16, 2015. One hundred and eighty parental pairs at 6–8 weeks after birth completed the Parenting Sense of Competence Scale, Perceived Social Support Scale, and socio-demographic questionnaires.ResultsParental role competence and satisfaction of Chinese mothers and fathers were at a moderate level, affected each other and there were no significant differences between the mothers and the fathers. The Competence Scale scores had a significant positive correlation with social support. Multiple regression analysis revealed two variables that predicted maternal Competence Scale scores: maternal social support and the paternal Competence Scale scores. Paternal social support and maternal Competence Scale scores contributed significantly to paternal Competence Scale scores.ConclusionParental role competence and satisfaction of mothers and fathers were at a moderate level and affected by the parenting partner. To improve parental role competence and satisfaction, health care professionals should develop strategies that impact the whole family and not just a single individual. Supportive parenting programs should be implemented for both mothers and fathers.     

Informational interventions on paternal outcomes during the perinatal period: A systematic review

Problem

The perinatal period is a stressful transition for new parents.

Prevalence and risk factors for postnatal depression in Sabah,Malaysia: A cohort study

BackgroundPostnatal depression can have serious consequences for both the mother and infant. However, epidemiological data required to implement appropriate early prevention are still lacking in Malaysia.AimTo investigate the prevalence of postnatal depression within six months postpartum and associated risk factors among women in Sabah, Malaysia.MethodsA prospective cohort study of 2072 women was conducted in Sabah during 2009–2010. Participants were recruited at 36–38 weeks of gestation and followed up at 1, 3 and 6 months postpartum. The presence of depressive symptoms was assessed using the validated Malay version of the Edinburgh Postnatal Depression Scale. Logistic regression analyses were performed to ascertain risk factors associated with postnatal depression.FindingsOverall, 14.3% of mothers (95% confidence interval (CI) 12.5–16.2%) had experienced depression within the first six months postpartum. Women depressed during pregnancy (odds ratio (OR) 3.71, 95% CI 2.46–5.60) and those with consistent worries about the newborn (OR 1.68, 95% CI 1.16–2.42) were more likely to suffer from depression after childbirth. Women whose husband assisted with infant care (OR 0.43, 95% CI 0.20–0.97) and mothers who were satisfied with their marital relationship (OR 0.27, 95% CI 0.09–0.81) appeared to incur a reduced risk of postnatal depression.ConclusionA substantial proportion of mothers suffered from postnatal depression in Sabah, Malaysia. Screening and intervention programmes targeting vulnerable subgroups of women during antenatal and early postpartum periods are recommended to deal with the problem.     

Family Life Quality and Emotional Quality of Life in Chinese Adolescents with and Without Economic Disadvantage

Chinese secondary school students (N = 2758) responded to measures of perceived family life quality (parenting quality and parent–child relational quality) and emotional quality of life (hopelessness, mastery, life satisfaction and self-esteem). Parenting quality included different aspects of parental behavioral control (parental knowledge, expectation, monitoring, discipline and demandingness as well as parental control defined in terms of indigenous Chinese concepts), parental psychological control, and parental responsiveness whereas parent–child relational quality included satisfaction with parental control, child’s readiness to communicate with the parents, parental trust of the child, and child’s trust of the parent. Results showed that parenting quality and parent–child relational quality in poor families were generally poorer than those of non-poor families and the differences were more pronounced in paternal parenting quality and father–child relational quality than in maternal parenting quality and mother–child relational quality. Emotional quality of life of adolescents experiencing economic disadvantage was also found to be poorer than that of adolescents not experiencing economic disadvantage. The present findings replicate the previous research findings in the literature and generate a pioneering dataset based on Chinese adolescents at Secondary 2 level in Hong Kong.     

An Evolutionary Psychological Investigation of Parental Distress and Reproductive Coercion During the “Coming Out” of Gay Sons

The lack of success of the “coming out” studies over the last three decades to explain and predict parental responses has motivated an evolutionary psychological reconceptualization. According to this reconceptualization, it was predicted that (a) biological mothers would experience more distress and apply more pressure on gay sons to change than would biological fathers and; (b) obligate investment for fathers on dependent sons would cause fathers to experience more distress and apply more pressure on gay sons to change than it would fathers without this obligate investment. In contrast, a cultural-norm hypothesis predicted that fathers would experience more distress and apply more pressure on gay sons to change than mothers. The majority of predictions were tested using 787 participants from two-biological parent families, who were drawn from a total sample of 891 participants from various family backgrounds. As predicted by the evolutionary hypothesis, biological mothers were reported to have been more distressed and coercive than biological fathers, in spite of a strong, societal expectation to the contrary. Furthermore, the results supported the obligate investment argument for paternal reactions. The model not only correctly explained and predicted parental behavior during coming out, but also was shown to unify within its theoretical framework discrepant results from the literature previously considered inconsistent.     

Pattern and Determinants of Paternal Involvement in Childcare: An Empirical Investigation in a Metropolis of India

An analysis of various aspects of paternal involvement among Indian fathers is presented in this article. The pattern of involvement in terms of the activities participated in, and their frequency of participation have been examined. Overall level of involvement of fathers in childcare has also been determined. A number of hypotheses regarding predictors of paternal involvement have been formulated and examined with the use of empirical data. The study is based on interviews conducted with Indian couples (N = 350) having at least one child aged 10 years or younger. To understand the determinants of paternal involvement, regression has been conducted wherein paternal involvement has been regressed with 14 predictors. Results indicate that paternal involvement in childcare is mainly determined by the perception of individuals towards fatherhood—be it gender role expectations, or perception of the peer group, or fathering received by the individual fathers. Other socio-economic factors affecting paternal involvement have also been examined. As the importance of paternal involvement in childcare is increasingly being recognised, these findings have implications for programmers and policy makers. Interventions to bring about a positive change in the attitude of fathers may improve paternal participation.     

Effects of the COVID-19 pandemic on perinatal mental health in Spain: Positive and negative outcomes

BackgroundPrevious studies have shown that perinatal distress has a negative influence on pregnancy outcome and the physiological development of the baby.ObjectiveThe aim of this study was to describe the effects of the COVID-19 pandemic on maternal perinatal mental health in Spain.MethodsSeven hundred and twenty-four women (N = 450 pregnancy, N = 274 postpartum) were recruited online during the pandemic. The Edinburgh Postnatal Depression Scale, the Positive and Negative Affect Schedule, and the Satisfaction With Life Scale were administered. Variables related to sociodemographic information, the COVID-19 pandemic, and perinatal care were also assessed.FindingsThe results showed that 58% of women reported depressive symptoms. Moreover, 51% of women reported anxiety symptoms. On the other hand, a regression analysis for life satisfaction showed that besides the perception about their own health, marital status or being a health practitioner were also significant predictors during pregnancy. However, perception about baby’s health and sleep, perception about their own health, and marital status were significant predictors of life satisfaction during the postpartum stage.DiscussionWomen assessed during the COVID-19 pandemic reported high rates of psychological distress.ConclusionThese results highlight the need of clinical support during this period. Knowing the routes to both distress and well-being may help maternity services to effectively cope with the pandemic.     

The effects of kin on child mortality in rural gambia

We analyzed data that were collected continuously between 1950 and 1974 from a rural area of the Gambia to determine the effects of kin on child mortality. Multilevel event-history models were used to demonstrate that having a living mother, maternal grandmother, or elder sisters had a significant positive effect on the survival probabilities of children, whereas having a living father, paternal grandmother, grandfather, or elder brothers had no effect. The mother's remarriage to a new husband had a detrimental effect on child survival, but there was little difference in the mortality rates of children who were born to monogamous or polygynous fathers. The implications of these results for understanding the evolution of human life-history are discussed.     

Aids mortality and the mobility of children in Kwazulu Natal,South Africa

This paper examines the effect of parental death on the mobility of 39,163 children aged 0-17 in rural KwaZulu Natal, South Africa, in 2000 and 2001. Parental mortality from all causes prior to and during follow-up increased the risk of a child moving by nearly two times after we controlled for the age and gender of the child and household characteristics. However, in the follow-up period, child mobility following maternal deaths from AIDS was lower than child mobility following maternal deaths from other causes. Younger children, boys, and children whose mothers or fathers were resident members of the children's households were also less likely to move.     

The impact of routine assessment of past or current mental health on help-seeking in the perinatal period

BackgroundClinical practice guidelines now recommend that women be asked about their past or current mental health as a routine component of maternity care. However, the value of this line of enquiry in increasing engagement with support services, as required, remains controversial.AimThe current study aimed to examine whether assessment of past or current mental health, received with or without referral for additional support, is associated with help-seeking during pregnancy and the postpartum.MethodsA subsample of women drawn from the Australian Longitudinal Study on Women's Health (young cohort) who reported experiencing significant emotional distress during pregnancy (N = 398) or in the 12 months following birth (N = 380) participated in the study.ResultsMultivariate analysis showed that women who were not asked about their emotional health were less likely to seek any formal help during both pregnancy (adjOR = 0.09, 95%CI: 0.04–0.24) and the postpartum (adjOR = 0.07, 95%CI: 0.02–0.13), as were women who were asked about these issues but who were not referred for additional support (antenatal: adjOR = 0.26, 95%CI: 0.15–0.45; postnatal: adjOR = 0.14, 95%CI: 0.07–0.27). However, considerable levels of consultation with general practitioners, midwives and child health nurses, even in the absence of referral, were evident.ConclusionThis study demonstrates that enquiry by a health professional about women's past or current mental health is associated with help-seeking throughout the perinatal period. The clinical and resource implications of these findings for the primary health care sector should be considered prior to the implementation of future routine perinatal depression screening or psychosocial assessment programmes.     

“Doing the month” and postpartum depression among Chinese women: A Shanghai prospective cohort study

BackgroundThe Chinese postpartum custom of “doing the month” characterized by generous social support available through the traditional cultural practices was considered to protect women from postpartum depression in early puerperium.MethodsThis study used data from the Shanghai Birth Cohort, a study of 2615 postpartum women from Shanghai, China, that was conducted between 2013 and 2016. Detailed information on the traditional “doing the month” practices and the on the Edinburgh Postnatal Depression Scale scores was collected from questionnaires administered on the 42nd day after childbirth. Logistic regression models were used to examine the association between the adopting traditional puerperium practices and postpartum depression.ResultsThe estimated prevalence of postpartum depression in women from the Shanghai area in China was 11.8% (n = 308) at six weeks postpartum. Women who went outside their homes during the first month postpartum showed higher risks of postpartum depression compared with those who never left the house (1–2 times: OR = 1.9, 95% CI = 1.4–2.4; 3–5 times: OR = 2.3, 95% CI = 1.5–3.5; ≥6 times: OR = 2.5, 95% CI = 1.2–5.1). Women with average sleep of 6 h or less per night were more likely to suffer from postpartum depression compared with those who slept 8 h (6 h: OR = 1.7, 95% CI = 1.2–2.4; less than 6 h : OR = 3.3, 95% CI = 2.2–5.0). Women who opened the house windows most of the time exhibited decreased risks of postpartum depression compared to those who never or rarely opened the windows (often: OR = 0.6, 95% CI = 0.4–0.9; always: OR = 0.4, 95% CI = 0.3–0.7).ConclusionsOur results suggested that not all the activities of “doing the month” provided protection against developing PPD. This study emphasized the need for flexibility to fit and adjust the ritual into the modern life to enhance the positive effects of traditional practices on maternal health.     

The transition to motherhood: Towards a broader understanding of perinatal distress

BackgroundA substantial body of research has focused on maternal perinatal mood and wellbeing, with the focus predominantly being on depression, and to a lesser extent, anxiety. Perinatal maternal stress has also been investigated recently, but to a far lesser extent. The present paper questions whether the term ‘perinatal distress’ accurately captures the range of challenges experienced by women during the perinatal period, when the scope of ‘distress’ is limited to the experience of depression and anxiety alone.MethodA review of the perinatal literature was conducted using several databases, to identify studies that have focused on the experience of stress as a distinct affective state in the perinatal period.FindingsThe findings of two recent studies which have employed a broader conceptualisation of perinatal distress to encompass the experience of stress as well as depression and anxiety are outlined. These recent studies have identified the experience of stress both in conjunction with and independent of depression and anxiety.ConclusionIt is argued that future studies should investigate the concept of stress as a separate affective state throughout the perinatal period, in order to further assess how it differs from depression and/or anxiety. A more comprehensive understanding of women's experiences during their transition to motherhood, and whether ‘stress’ plays a critical role in the development and maintenance of perinatal anxiety and/or depression is needed.     

Beyond Absenteeism: Father Incarceration and Child Development

High rates of incarceration among American men, coupled with high rates of fatherhood among men in prison, have motivated recent research on the effects of parental imprisonment on children’s development. We use data from the Fragile Families and Child Wellbeing Study to examine the relationship between paternal incarceration and developmental outcomes for approximately 3,000 urban children. We estimate cross-sectional and longitudinal regression models that control not only for fathers’ basic demographic characteristics and a rich set of potential confounders, but also for several measures of pre-incarceration child development and family fixed effects. We find significant increases in aggressive behaviors and some evidence of increased attention problems among children whose fathers are incarcerated. The estimated effects of paternal incarceration are stronger than those of other forms of father absence, suggesting that children with incarcerated fathers may require specialized support from caretakers, teachers, and social service providers. The estimated effects are stronger for children who lived with their fathers prior to incarceration but are also significant for children of nonresident fathers, suggesting that incarceration places children at risk through family hardships including and beyond parent-child separation.     

A narrative review of studies addressing the clinical effectiveness of perinatal depression screening programs

BackgroundClinical practice guidelines recommend that women be screened for depression as a routine component of maternity care however there is ongoing debate about the benefits of depression screening programs in this context.AimThis narrative review identifies and describes the clinical effectiveness of perinatal depression screening programs in relation to one or more of the following interrelated domains: referral for additional mental health support or treatment; engagement with mental health support or treatment options; and, maternal mental health or parenting outcomes.MethodsEnglish-language studies, published up to July 2017, were identified and their methodological quality was assessed. RCTs and non-RCTs were included.ResultsOverall, the majority of the fourteen studies identified showed that participation in a perinatal depression screening program increases referral rates and service use, and is associated with more optimal emotional health outcomes. One of four available studies demonstrated an improvement in parenting outcomes as a result of participation in an integrated postnatal depression screening program.ConclusionThis small but important body of work is integral to the continuing debate over the merits of screening for depression in the perinatal period. Current evidence favours the overall benefits of perinatal depression screening programs across the three focus areas of this review. Future research should consider a woman’s broader psychosocial context and should address the economic as well as clinical outcomes of these programs. Rigorous evaluation of emerging digital approaches to perinatal depression screening is also required.     

Positive,Negative, or Null? The Effects of Maternal Incarceration on Children’s Behavioral Problems

We use data from the Fragile Families and Child Wellbeing Study to consider the effects of maternal incarceration on 21 caregiver- and teacher-reported behavioral problems among 9-year-old children. The results suggest three primary conclusions. First, children of incarcerated mothers are a disadvantaged group that exhibit high levels of caregiver- and teacher-reported behavioral problems. Second, after we adjust for selection, the effects of maternal incarceration on children’s behavioral problems are consistently null (for 19 of 21 outcomes) and rarely positive (1 of 21) or negative (1 of 21), suggesting that the poor outcomes of these children are driven by disadvantages preceding maternal incarceration rather than incarceration. These effects, however, vary across race/ethnicity, with maternal incarceration diminishing caregiver-reported behavioral problems among non-Hispanic whites. Finally, in models considering both maternal and paternal incarceration, paternal incarceration is associated with more behavioral problems, which is consistent with previous research and suggests that the null effects of maternal incarceration are not artifacts of our sample or analytic decisions.     

Sexual dysfunction predicts depressive symptoms during the first 2 years postpartum

Background

The association between sexual function and depression has yet to be examined in a prospective cohort study with prolonged postpartum follow-up.