Depression during pregnancy

In recent years much more attention has been paid to postnatal mental illness and to its possible effects on the baby than to antenatal mental disorder and its effects on fetal development. It is now generally accepted that most women do not conform to the stereotype of the woman who blooms with health in pregnancy. Observers have commented on the apparent high prevalence of psychiatric symptoms in pregnancy. Studies of antenatal depression offer certain advantages. The time perimeter is limited to the pregnancy, easing comparisons between studies. Furthermore women can easily be recruited since pregnancy is a time of high medical contact.peer-reviewe

Perinatal mental health screening trial

Background: Pregnancy is a time of great joy and happiness but is also a time of great change, where the woman is at increased risk of onset and relapse of mental health disorders. However, unfortunately many patients go undiagnosed. --- Method: A trial for perinatal mental health screening was set up at Mater Dei Hospital. Mothers under the care of four consultant obstetricians were included in the study. All were asked a series of screening questions to assess necessity of referral to mental health services. If positive for one of the questions, a telephone consultation was carried out by one of the perinatal mental health midwives, giving them the necessary information about the mental health services available. The services offer a multidisciplinary approach with perinatal midwives, a specialised psychiatric team, social worker and psychologists. --- Results: A total of 283 mothers were screened. 105 of which were positive for a screening question, requiring mental health services. 8 accepted an office session with the perinatal midwives, and 12 were followed-up up by psychiatric team in the perinatal mental health clinic. --- Conclusion: Previous data at Mater Dei Hospital stated that 3% of all mothers delivering in labour ward were being referred to the perinatal mental health clinic. During this trial 6% of the mothers screened were making use of the service. This points towards ⁓3% of mothers who would otherwise have been suffering in the dark, proving the necessity of a screening program.peer-reviewe

Factors invoved in onset and recovery from postnatal depression

Background: A wide variety of psychosocial variables have been implicated in the onset and recovery from postnatal depression. A number of these factors were examined on a representative sample of pregnant Maltese women attending St Luke's Hospital. Method: A random sample of 239 pregnant women were interviewed at booking using a detailed sociodemographic history, the Revised Version of the Clinical Interview Schedule (CIS-R) and Maltese translation of the Edinburgh Postnatal Depression Scale (EPDS). The CIS-R was again administered over the phone at 36 weeks and the EPDS sent by post. At eight weeks postpartum, the CIS-R, modified version of the Social Maladjustment Schedule and the EPDS were again administered to 95.8% of women. Results: Onset of depression in the postpartum was not predicted by depressive symptomatology during pregnancy, marital status, level of education, planning of pregnancy, woman's, partner's or family's reaction to pregnancy and marital adjustment. However being primiparous and employed during pregnancy were significantly associated with postnatal depression. In contrast, depressed women who remained depressed postnatally had a past personal psychiatry history and significantly higher scores on the CISR recorded at 36 weeks gestation. Limitation: The number of women examined in the study yielded a small number of depressed women, for which the results are limited in value. The sample is that of Maltese women booking in at the antenatal clinic, thus excluding women who present late, close to delivery date. The follow up period was limited to eight weeks postpartum only, excluding those who develop depressive episodes after 8 weeks. Conclusions: Some cases of postpartum depression may be traced back to pregnancy while others do not seem to be predictable during pregnancy further contributing evidence to the view that the prenatal period may be a separate entity from the postnatal period with regards to depressive illness.peer-reviewe

Impact of the Covid-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19): protocol for an international prospective cohort study

Corona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study

Good Practices in Perinatal Mental Health during the COVID-19 Pandemic: A Report from Task-Force RISEUP-PPD COVID-19

Due to the changes that occur to the immunity and physiological state of women during pregnancy, they are at increased risk of suffering issues with both their physical and mental health (Liu et al., 2020). It is estimated that 1 in 5 women develop a mental health problem in the perinatal period (Hahn-Holbrook et al., 2018; World Health Organization, 2015), with depression and anxiety among the most prevalent conditions (Shorey et al., 2018). Importantly, these conditions have long lasting adverse effects on women and their babies, and place a heavy burden on families and society as a whole (Bauer et al., 2014; Gavin et al., 2005). Conditions such as extreme stress, conflict situations, emergencies, and natural disasters can increase the risk of developing specific mental illnesses (World Health Organization, 2016)

Treatment of peripartum depression with antidepressant and other psychotropic medications: a synthesis of clinical practice guidelines in Europe

This study examined (1) the availability and content of national CPGs for treatment of peripartum depression, including comorbid anxiety, with antidepressants and other psychotropics across Europe and (2) antidepressant and other psychotropic utilization data as an indicator of prescribers’ compliance to the guidelines. We conducted a search using Medline and the Guidelines International Network database, combined with direct e-mail contact with national Riseup-PPD COST ACTION members and researchers within psychiatry. Of the 48 European countries examined, we screened 41 records and included 14 of them for full-text evaluation. After exclusion of ineligible and duplicate records, we included 12 CPGs. Multiple CPGs recommend antidepressant initiation or continuation based on maternal disease severity, non-response to first-line non-pharmacological interventions, and after risk-benefit assessment. Advice on treatment of comorbid anxiety is largely missing or unspecific. Antidepressant dispensing data suggest general prescribers’ compliance with the preferred substances of the CPG, although country-specific differences were noted. To conclude, there is an urgent need for harmonized, up-to-date CPGs for pharmacological management of peripartum depression and comorbid anxiety in Europe. The recommendations need to be informed by the latest available evidence so that healthcare providers and women can make informed, evidence-based decisions about treatment choices

The Mental Health of Women with Gestational Diabetes During the COVID-19 Pandemic:An International Cross-Sectional Survey

Background: There is evidence that women with gestational diabetes are at increased risk of the common mental disorders of anxiety and depression. The COVID-19 pandemic may have exerted an additional burden on the mental health of this population. The aim of this analysis was to compare levels of symptoms of common mental disorders and experiences during the COVID-19 pandemic between pregnant and postnatal women exposed and unexposed to gestational diabetes. Methods: Cross-sectional study utilizing quantitative data from an online survey administered across 10 countries to women who were pregnant or up to 6 months postpartum from 15 June to October 31, 2020. Women self-reported gestational diabetes and completed the Edinburgh Postnatal Depression Scale and GAD-7 (Generalized Anxiety Disorder 7 items) measures. The COPE-IS (Coronavirus Perinatal Experiences-Impact Survey) tool was also administered. Complete case analyses were conducted on a sample of 7,371 women. Results: There was evidence of an association between gestational diabetes and increased levels of depression symptoms, which was robust to adjustment for age, education, and employment status. There was only evidence of an association with anxiety in postnatal women. There was also evidence that women with gestational diabetes, particularly those in the postnatal period, experienced higher levels of pandemic-related distress, although they did not experience higher levels of COVID-19 infection in this sample. Conclusions: The increased risk of common mental disorders in women with gestational diabetes underscores the importance of integrated physical and mental health care for pregnant and postnatal women both during and beyond the pandemic. Clinical Trial Registration no. NCT04595123. © Claire A. Wilson et al. 2022; Published by Mary Ann Liebert, Inc. 2022.This paper is part of the European Cooperation in Science and Technology (COST) Action Riseup-PPD CA18138 and was supported by COST under COST Action Riseup-PPD CA18138. R.C. is supported by the FSE and FCT under an individual Post-Doctoral Grant SFRH/BPD/117597/2016. D.L. received funding from the Bar-Ilan Dangoor Centre for Personalized Medicine, Israel. C.A.W is supported by the UK's National Institute for Health and Care Research (NIHR). Open access fees from an NIHR senior investigator grant (NIHR200241)

Changes to women’s childbirth plans during the COVID-19 pandemic and posttraumatic stress symptoms: a cross-national study

A considerable number of women giving birth during COVID-19 pandemic reported being concerned about changes to their childbirth plans and experiences due to imposed restrictions. Research prior to the pandemic suggests that women may be more at risk of post-traumatic stress symptoms (PTSS) due to unmet expectations of their childbirth plans. Therefore, this study aimed to examine if the mismatch between women’s planned birth and actual birth experiences during COVID-19 was associated with women’s postpartum PTSS. Women in the postpartum period (up to 6 months after birth) across 11 countries reported on childbirth experiences, mental health, COVID-19-related factors, and PTSS (PTSD checklist DSM-5 version) using self-report questionnaires (ClinicalTrials.gov: NCT04595123). More than half (64%) of the 3532 postpartum women included in the analysis reported changes to their childbirth plans. All changes were significantly associated with PTSS scores. Participants with one and two changes to their childbirth plans had a 12% and 38% increase, respectively, in PTSS scores compared to those with no changes (Exp(β) = 1.12; 95% CI [1.06–1.19]; p < 0.001 and Exp(β) = 1.38; 95% CI [1.29–1.48]; p < 0.001). In addition, the effect of having one change in the childbirth plan on PTSS scores was stronger in primigravida than in multigravida (Exp(β) = 0.86; 95% CI [0.77–0.97]; p = 0.014). Changes to women’s childbirth plans during the COVID-19 pandemic were common and associated with women’s postpartum PTSS score. Developing health policies that protect women from the negative consequences of unexpected or unintended birth experiences is important for perinatal mental health.Open access funding provided by FCT|FCCN (b-on). This publication is based upon work from COST Action Research Innovation and Sustainable Pan-European Network in Peripartum Depression Disorder (Riseup-PPD), CA18138 and DEVoTION: Perinatal Mental Health and Birth-Related Trauma: Maximising best practice and optimal outcomes, CA18211 both supported by COST (European Cooperation in Science and Technology). EPIUnit – UIDB/04750/2020, ITR – LA/P/0064/2020, and HEILab – UIDB/05380/2020 are supported by Portuguese fundings through FCT – Fundação para a Ciência e a Tecnologia, IP. RC has a postdoctoral grant supported by the European Social Fund (ESF) and FCT (SFRH/BPD/117597/2016; RC postdoctoral fellowship). The work developed by ProChild CoLAB was supported by (i) NORTE-06-3559-FSE-000044, integrated in the invitation NORTE59-2018-41, aiming to hire Highly Qualified Human Resources, cofinanced by the Regional Operational Programme of the North 2020, thematic area of Competitiveness and Employment, through the European Social Fund (ESF) and (ii) Mission Interface Program from the Resilience and Recuperation Plan, notice nº 01/C05-i02 /2022, aiming to guarantee public core funding to strengthen the network of interface institutions, as defined in the legal regime in force, approved by DecreeLaw no. 63/2019, of May 16th, as well as in its 1st review on “Technology and Innovation Centres – CTI” and “Collaborative Laboratories – CoLABs,” approved by Decree-Law no. 126-B/2021, of December 31st. The Psychology Research Centre - CIPsi (PSI/01662), School of Psychology, University of Minho, was supported by the Foundation for Science and Technology (FCT) through the Portuguese State Budget (Ref.: UIDB/PSI/01662/2020). Bulgarian national data collection supported by national co-funding of COST Actions, № KP-06-KOST/14 from 16.12.2020, FNI. CAW is funded by the UK’s National Institute for Health and Care Research (NIHR) as an Academic Clinical Lecturer

A cross-country study on the impact of governmental responses to the COVID-19 pandemic on perinatal mental health

This study aimed to analyse the role of governmental responses to the coronavirus disease 2019 (COVID-19) outbreak, measured by the Containment and Health Index (CHI), on symptoms of anxiety and depression during pregnancy and postpartum, while considering the countries' Inequality-adjusted Human Development Index (IHDI) and individual factors such as age, gravidity, and exposure to COVID-19. A cross-sectional study using baseline data from the Riseup-PPD-COVID-19 observational prospective international study (ClinicalTrials.gov: NCT04595123) was carried out between June and October 2020 in 12 countries (Albania, Brazil, Bulgaria, Chile, Cyprus, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom). Participants were 7645 pregnant women or mothers in the postpartum period-with an infant aged up to 6 months-who completed the Edinburgh Postnatal Depression Scale (EPDS) or the Generalised Anxiety Disorder Assessment (GAD-7) during pregnancy or the postpartum period. The overall prevalence of clinically significant depression symptoms (EPDS ≥ 13) was 30%, ranging from 20,5% in Cyprus to 44,3% in Brazil. The prevalence of clinically significant anxiety symptoms (GAD-7 ≥ 10) was 23,6% (ranging from 14,2% in Israel and Turkey to 39,5% in Brazil). Higher symptoms of anxiety or depression were observed in multigravida exposed to COVID-19 or living in countries with a higher number of deaths due to COVID-19. Furthermore, multigravida from countries with lower IHDI or CHI had higher symptoms of anxiety and depression. Perinatal mental health is context-dependent, with women from more disadvantaged countries at higher risk for poor mental health. Implementing more restrictive measures seems to be a protective factor for mental health, at least in the initial phase of the COVID-19

A cross‑country study on the impact of governmental responses to the COVID‑19 pandemic on perinatal mental health

This study aimed to analyse the role of governmental responses to the coronavirus disease 2019 (COVID-19) outbreak, measured by the Containment and Health Index (CHI), on symptoms of anxiety and depression during pregnancy and postpartum, while considering the countries’ Inequalityadjusted Human Development Index (IHDI) and individual factors such as age, gravidity, and exposure to COVID-19. A cross-sectional study using baseline data from the Riseup-PPD-COVID-19 observational prospective international study (ClinicalTrials.gov: NCT04595123) was carried out between June and October 2020 in 12 countries (Albania, Brazil, Bulgaria, Chile, Cyprus, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom). Participants were 7645 pregnant women or mothers in the postpartum period—with an infant aged up to 6 months—who completed the Edinburgh Postnatal Depression Scale (EPDS) or the Generalised Anxiety Disorder Assessment (GAD-7) during pregnancy or the postpartum period. The overall prevalence of clinically signifcant depression symptoms (EPDS≥ 13) was 30%, ranging from 20,5% in Cyprus to 44,3% in Brazil. The prevalence of clinically signifcant anxiety symptoms (GAD-7≥ 10) was 23,6% (ranging from 14,2% in Israel and Turkey to 39,5% in Brazil). Higher symptoms of anxiety or depression were observed in multigravida exposed to COVID-19 or living in countries with a higher number of deaths due to COVID19. Furthermore, multigravida from countries with lower IHDI or CHI had higher symptoms of anxiety and depression. Perinatal mental health is context-dependent, with women from more disadvantaged countries at higher risk for poor mental health. Implementing more restrictive measures seems to be a protective factor for mental health, at least in the initial phase of the COVID-19