Validacijsko istraživanje hrvatske verzije Edinburškog upitnika poslijeporođajne depresivnosti (EPDS)

Validation studies established different cut-off points for the Edinburgh Postnatal Depression Scale (EPDS) in different countries. The aim of this paper was to validate the Croatian EPDS against DSM-IV-TR for major and minor depression. A community sample of 272 women was followed from pregnancy to six weeks postpartum. They filled out the EPDS and STAI and were diagnosed using the SCID-I-RV. At the 8/9 cut-off score the sensitivity of the EPDS was 77.3% and its specificity was 82.4%. The principal component analysis with oblique rotation resulted in two correlated oblique factors, reflecting depressive and anxiety symptoms. Since the scree plot indicated that a one-factor solution would be appropriate, it is advised to treat the scale as one-dimensional. The Croatian version of the EPDS is a valid screening instrument and can be used by health practitioners for PPD screening.Istraživanja koja su se bavila validacijom Edinburškog upitnika poslijeporođajne depresivnosti (EPDS) utvrdila su različite kritične rezultate u različitim zemljama. Cilj ovog istraživanja bio je validirati hrvatsku verziju EPDS-a s obzirom na dijagnozu velike i male depresivne epizode prema DSM-IV-TR. U istraživanju su sudjelovale 272 žene koje su praćene od trudnoće do 6 tjedana nakon porođaja, kad su ispunile EPDS i Spielbergerov upitnik anksioznosti (STAI) te je proveden strukturirani klinički intervju (SCID-I-RV) s ciljem postavljanja dijagnoze depresije. Pri kritičnom rezultatu 8/9 osjetljivost EPDS-a je 77,3%, a specifičnost 82,4%. Metodom glavnih komponenti s kosokutnom rotacijom utvrđena su dva kosokutna faktora koji odražavaju depresivnost i anksioznost, a za koje se pokazalo da su u međusobnoj korelaciji. S obzirom na to da scree plot upućuje na postojanje jednog faktora, preporuča se koristiti upitnik kao jednodimenzionalni. Zaključno se može reći da se hrvatska verzija EPDS-a pokazala valjanim upitnikom za trijažu poslijeporođajne depresije te se preporuča za korištenje u kliničke i zdravstvene svrhe

Usporedba odnosa između značajki ličnosti i načina suočavanja sa stresom u trudnica i studenata

Previous studies showed that personality predicted coping with stress, especially in young samples and samples under stress. The goal of the study was to relate personality traits and ways of coping in a normal population, in two different samples in specific stressful situations: students and pregnant women, and to compare the patterns of these relations. Undergraduate and graduate students (N = 186) and pregnant women (N = 51) anonymously filled out the Revised NEO Personality Inventory (NEO-FFI; measuring neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness) and Ways of Coping Questionnaire (WOC; consisting of 8 subscales: Confrontive Coping, Distancing, Self-Controlling, Seeking Social Support, Accepting Responsibility, Escape-Avoidance, Planful Problem Solving, Positive Reappraisal). Correlational and regression analyses were performed. The results showed that personality traits were related to ways of coping in the sample of both students and pregnant women, with somewhat different patterns. The consistent finding in both samples was that neuroticism was positively associated with Accepting Responsibility and Escape-Avoidance, while consciousness was positively associated with Planful Problem Solving and negatively associated with Escape-Avoidance. Extraversion had a different role in coping in the sample of students and pregnant women, while openness to experience and agreeableness were not related to ways of coping. To conclude, neuroticism was more related to disengagement coping styles, while consciousness and extraversion were more related to engagement coping styles.Prethodne studije su pokazale da ličnost može predvidjeti način suočavanja sa stresom, pogotovo u mladih ispitanika i ispitanika izloženih stresu. Cilj studije bio je povezati značajke ličnosti i načine suočavanja sa stresom u prosječnom pučanstvu, u dva različita uzorka ispitanika: studentima i trudnicama, te u specifičnim stresnim situacijama usporediti obrasce tih odnosa. Studenti preddiplomskog i diplomskog studija (N = 186) i trudnice (N = 51) anonimno su ispunili Revidirani NEO inventar ličnosti (Revised NEO Personality Inventory, NEO-FFI; kojim se mjeri neuroticizam, ekstraverzija, otvorenost, ugodnost i savjesnost) i Upitnik o načini suočavanja sa stresom (Ways of Coping Questionnaire - WOC), koji se sastoji od 8 podskupina: konfrontirajuće suočavanje, distanciranje, samokontrola, traženje socijalne podrške, prihvaćanje odgovornosti, izbjegavanje, plansko rješavanje problema, pozitivna ponovna procjena). Provedene su korelacijske i regresijske analize. Rezultati su pokazali da su značajke ličnosti povezane s načinima suočavanja sa stresom u skupini studenata i skupini trudnica, s donekle različitim obrascima ponašanja. Dosljedan nalaz u oba uzorka bio je da je neuroticizam pozitivno povezan s prihvaćanjem odgovornosti i izbjegavanjem, dok je savjesnost pozitivno povezana s planskim rješavanjem problema i negativno povezana s izbjegavanjem. Ekstraverzija je imala drugačiju ulogu u suočavanju sa stresom u uzorku studenata i trudnica, dok otvorenost i ugodnost nisu bili povezani s načinima suočavanja sa stresom. U konačnici, neuroticizam je bio više povezan s izbjegavajućim pristupom suočavanja sa stresom, dok su savjesnost i ektraverzija više povezani s angažiranim pristupom suočavanja sa stresom

Development and validation of Pregnancy Concerns Scale

Anksioznost kao stanje i anksioznost specifična za trudnoću su povezani, ali ponešto različiti konstrukti, što zahtijeva da se anksioznost vezana uz trudnoću mjeri zasebnim instrumentima. Cilj ovog istraživanja bio je razviti i validirati novu mjeru - Ljestvicu zabrinutosti u trudnoći (LJZT), koja će mjeriti specifičnu zabrinutost, strahove i brige u trudnoći. U istraživanju su sudjelovale 384 trudnice u trećem tromjesečju trudnoće, koje su ispunile Ljestvicu zabrinutosti u trudnoći, Upitnik anksioznosti kao stanja i osobine (STAI), Ljestvicu intenziteta doživljenog stresa (PSS), Edinburšku ljestvicu poslijeporođajne depresivnosti (EPDS) te upitnik demografskih i opstetričkih podataka. Analizirana je pouzdanost, faktorska struktura, konvergentna i diskriminantna valjanost te osjetljivost i specifičnost Ljestvice. Konačna Ljestvica sastoji se od 16 čestica i 4 podljestvice: Zabrinutost za zdravlje ploda, Zabrinutost za vlastito zdravlje i porođaj, Zabrinutost za financije i bliske odnose te Zabrinutost za vlastiti izgled. Pouzdanost ukupne ljestvice je 0,80, a pri kritičnom rezultatu 5/6 osjetljivost Ljestvice je 80,8%, a specifičnost 50,4%. Analiza konvergentne valjanosti je pokazala da je Ljestvica neovisna mjera anksioznosti u trudnoći te da dobro razlikuje trudnice koje imaju i koje nemaju komplikacija u trudnoći. Zaključno, ljestvica ima visoku pouzdanost i konstruktnu valjanost sa zadovoljavajućim psihometrijskim karakteristikama.State anxiety and pregnancy-specific anxiety are related albeit distinct constructs. Therefore, pregnancy-specific anxiety should be assessed with pregnancy-specific measures. The aim of the study was to construct and validate a new scale, Pregnancy Concerns Scale (PCS) that measures specific worries, fears and concerns during pregnancy. Pregnant women in the third trimester of pregnancy (N = 384) completed the PCS, the State-Trait Anxiety Inventory (STAI), the Perceived Stress Scale (PSS), and the Edinburgh Postnatal Depression Scale (EPDS). Reliability, factor structure, convergent and discriminant validity, and scale sensitivity and specificity were analyzed. The final scale comprised 16 items and four subscales measuring Concerns about fetal health, Concerns about own health and childbirth, Concerns about financial issues and close relations, and Concerns about appearance. Reliability of the PCS total scale is 0.80. At a cut-off score of 5/6, sensitivity was 80.8% and specificity 50.4%. Convergent validity analysis showed the PCS to be an independent measure of pregnancyspecific anxiety that can discriminate between pregnant women with and without pregnancy complications. To conclude, the PCS has high reliability and construct validity, and satisfactory psychometric characteristics

Anksioznost u trudnoći i nakon porođaja: tijek, prediktori i komorbiditet s poslijeporođajnom depresijom

Previous findings on peripartum anxiety are inconsistent in respect to the prevalence and course of peripartum anxiety with comorbidity of depression. Our aim was threefold: (1) to examine the course of elevated anxiety during pregnancy, immediately after childbirth, and six weeks postpartum; (2) to establish comorbidity of postpartum anxiety and postpartum depression (PPD); and (3) to examine predictors of anxiety 6 weeks postpartum. A sample of women (N=272) who were below the cut-off score for clinical depression during pregnancy were assessed in the third trimester of pregnancy, then 2 days and 6 weeks postpartum. Questionnaires on anxiety, pregnancy specific distress, stress, coping styles, social support, and depression were administered at each assessment. Obstetric data were collected from the participants’ medical records. The estimated rate of high anxiety was 35% during pregnancy, 17% immediately after childbirth, and 20% six weeks postpartum, showing a decrease in anxiety levels after childbirth. Comorbidity of anxiety and PPD was 75%. Trait anxiety and early postpartum state anxiety are significant predictors of postpartum anxiety. Anxiety is a common peripartum psychological disturbance. Anxiety symptoms overlap with PPD, but not completely, indicating that screening for postpartum mental difficulties should include both depression and anxiety.Prethodna istraživanja o peripartalnoj anksioznosti nisu dosljedna s obzirom na učestalost, tijek anksioznosti i komorbiditet s depresijom. Cilj ovoga istraživanja bio je: 1) ispitati tijek povišene anksioznosti u trudnoći, neposredno nakon porođaja i 6 tjedana nakon porođaja; 2) utvrditi komorbiditet anksioznosti i poslijeporođajne depresije (PD); 3) ispitati prediktore anksioznosti 6 tjedana nakon porođaja. Uzorak žena (N=272) s rezultatom nižim od kritičnog za kliničku depresiju u trudnoći praćen je u trećem tromjesečju trudnoće te 2 dana i 6 tjedana nakon porođaja. U svakoj točki mjerenja primijenjeni su upitnici anksioznosti, stresa, stresa specifičnog za trudnoću, načina suočavanja, socijalne potpore i depresivnosti. Opstetrički podaci prikupljeni su iz medicinske dokumentacije. Utvrđena je učestalost povišene anksioznosti od 35% u trudnoći, 17% neposredno nakon porođaja i 20% šest tjedana nakon porođaja, pri čemu je utvrđeno smanjenje razine anksioznosti nakon porođaja. Komorbiditet anksioznosti i PD-a je bio 75%. Anksioznost kao osobina i anksioznost kao stanje neposredno nakon porođaja značajni su prediktori anksioznosti šest tjedana nakon porođaja. Anksioznost je česta psihološka smetnja u peripartalnom razdoblju. Anksiozni simptomi se preklapaju s PD-om, ali ne u potpunosti, što upućuje na to da trijaža za poslijeporođajne mentalne teškoće mora uključivati i depresiju i anksioznost

Klinička vrijednost transvaginalne ultrasonografije u usporedbi s histeroskopijom i histopatološkom analizom kod dijagnoze endometralnih abnormalnosti

The aim of our retrospective study was to compare the performance of transvaginal sonography in relation to histologic diagnosis of samples obtained by hysteroscopy through analysis of data collected over 16 years. Data on suspected formation of endometrial polyp or submucosal fibroid found on ultrasound examination were extracted. The study included a total of 3679 women examined during the 2000-2015 period. All women underwent ultrasound examination preoperatively for better planning the type and scope of operation to be performed. The study included only women with samples for histopathologic analysis collected during the operation. Ultrasound diagnosis of polyps compared with histology showed 89.6% sensitivity and 39.1% specificity. For submucosal myomas, sensitivity was 69.2% and specificity 91.3%. In conclusion, ultrasound is not reliable method for definitive diagnosis but it is an excellent orientation method.Cilj ovog retrospektivnog istraživanja je bila usporedba pouzdanosti transvaginalnog ultrazvuka u odnosu na histološki nalaz dobiven histeroskopijom kroz analizu podataka skupljenih tijekom 16 godina. Podatci o suspektnim endometralnim polipima i submukoznim miomima primijećenim na ultrazvučnom pregledu su izdvojeni. U istraživanje je uključeno 3679 žena pregledanih u razdoblju od 2000. do 2015. godine. Svim ženama je učinjen prijeoperacijski ultrazvučni pregled radi planiranja tipa i opsega zahvata. U istraživanje su uključene samo žene kojima je uzet histološki uzorak tijekom operacije. Ultrazvučno utvrđeni polipi u usporedbi s histološkim nalazom pokazali su osjetljivost od 89,6% i specifičnost od 39,1%. Za submukozne miome utvrđena je osjetljivost od 69,2% i specifičnost od 91,3%. Može se zaključiti kako je ultrazvuk nepouzdana metoda pri donošenju konačne dijagnoze, ali odlična orijentacijska metoda

Diagnosis of peripartum depression disorder:A state-of-the-art approach from the COST Action Riseup-PPD

Background: Peripartum depression (PPD) is a major depression disorder (MDD) episode with onset during pregnancy or within four weeks after childbirth, as defined in DSM-5. However, research suggests that PPD may be a distinct diagnosis. The goal of this study was to summarize the similarities and differences between PPD and MDD by synthesizing the current research on PPD diagnosis concerning different clinical features and give directions for improving diagnosis of PPD in clinical practice. Methods: To lay the groundwork for this narrative review, several databases were searched using general search phrases on PPD and its components of clinical diagnosis. Results: When compared to MDD, peripartum depression exhibits several distinct characteristics. PPD manifests with a variety of symptoms, i.e., more anxiety, psychomotor symptoms, obsessive thoughts, impaired concentration, fatigue and loss of energy, but less sad mood and suicidal ideation, compared to MDD. Although PPD and MDD prevalence rates are comparable, there are greater cross-cultural variances for PPD. Additionally, PPD has some distinct risk factors and mechanisms such as distinct ovarian tissue expression, premenstrual syndrome, unintended pregnancy, and obstetric complications. Conclusion: There is a need for more in-depth research comparing MDD with depression during pregnancy and the entire postpartum year. The diagnostic criteria should be modified, particularly with (i) addition of specific symptoms (i.e., anxiety), (ii) onset specifier extending to the first year following childbirth, (iii) and change the peripartum onset specifier to either “pregnancy onset” or “postpartum onset”. Diagnostic criteria for PPD are further discussed.</p

Diagnosis of peripartum depression disorder:A state-of-the-art approach from the COST Action Riseup-PPD

Background: Peripartum depression (PPD) is a major depression disorder (MDD) episode with onset during pregnancy or within four weeks after childbirth, as defined in DSM-5. However, research suggests that PPD may be a distinct diagnosis. The goal of this study was to summarize the similarities and differences between PPD and MDD by synthesizing the current research on PPD diagnosis concerning different clinical features and give directions for improving diagnosis of PPD in clinical practice. Methods: To lay the groundwork for this narrative review, several databases were searched using general search phrases on PPD and its components of clinical diagnosis. Results: When compared to MDD, peripartum depression exhibits several distinct characteristics. PPD manifests with a variety of symptoms, i.e., more anxiety, psychomotor symptoms, obsessive thoughts, impaired concentration, fatigue and loss of energy, but less sad mood and suicidal ideation, compared to MDD. Although PPD and MDD prevalence rates are comparable, there are greater cross-cultural variances for PPD. Additionally, PPD has some distinct risk factors and mechanisms such as distinct ovarian tissue expression, premenstrual syndrome, unintended pregnancy, and obstetric complications. Conclusion: There is a need for more in-depth research comparing MDD with depression during pregnancy and the entire postpartum year. The diagnostic criteria should be modified, particularly with (i) addition of specific symptoms (i.e., anxiety), (ii) onset specifier extending to the first year following childbirth, (iii) and change the peripartum onset specifier to either “pregnancy onset” or “postpartum onset”. Diagnostic criteria for PPD are further discussed.</p

Maternal Metabolic State and Fetal Sex and Genotype Modulate Methylation of the Serotonin Receptor Type 2A Gene (HTR2A) in the Human Placenta

The serotonin receptor 2A gene (HTR2A) is a strong candidate for the fetal programming of future behavior and metabolism. Maternal obesity and gestational diabetes mellitus (GDM) have been associated with an increased risk of metabolic and psychological problems in offspring. We tested the hypothesis that maternal metabolic status affects methylation of HTR2A in the placenta. The prospective study included 199 pairs of mothers and healthy full-term newborns. Genomic DNA was extracted from feto-placental samples and analyzed for genotypes of two polymorphisms (rs6311, rs6306) and methylation of four cytosine residues (−1665, −1439, −1421, −1224) in the HTR2A promoter region. Placental HTR2A promoter methylation was higher in male than female placentas and depended on both rs6311 and rs6306 genotypes. A higher maternal pre-gestational body mass index (pBMI) and, to a lesser extent, diagnosis of GDM were associated with reduced HTR2A promoter methylation in female but not male placentas. Higher pBMI was associated with reduced methylation both directly and indirectly through increased GDM incidence. Tobacco use during pregnancy was associated with reduced HTR2A promoter methylation in male but not female placentas. The obtained results suggest that HTR2A is a sexually dimorphic epigenetic target of intrauterine exposures. The findings may contribute to a better understanding of the early developmental origins of neurobehavioral and metabolic disorders associated with altered HTR2A function

Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS:Systematic Review and Individual Participant Data Meta-analysis

Objective:The Maternal Mental Health in Canada, 2018/2019, survey reported that 18% of 7,085 mothers who recently gave birth reported "feelings consistent with postpartum depression" based on scores >= 7 on a 5-item version of the Edinburgh Postpartum Depression Scale (EPDS-5). The EPDS-5 was designed as a screening questionnaire, not to classify disorders or estimate prevalence; the extent to which EPDS-5 results reflect depression prevalence is unknown. We investigated EPDS-5 >= 7 performance relative to major depression prevalence based on a validated diagnostic interview, the Structured Clinical Interview for DSM (SCID).Methods:We searched Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and the Web of Science Core Collection through June 2016 for studies with data sets with item response data to calculate EPDS-5 scores and that used the SCID to ascertain depression status. We conducted an individual participant data meta-analysis to estimate pooled percentage of EPDS-5 >= 7, pooled SCID major depression prevalence, and the pooled difference in prevalence.Results:A total of 3,958 participants from 19 primary studies were included. Pooled prevalence of SCID major depression was 9.2% (95% confidence interval [CI] 6.0% to 13.7%), pooled percentage of participants with EPDS-5 >= 7 was 16.2% (95% CI 10.7% to 23.8%), and pooled difference was 8.0% (95% CI 2.9% to 13.2%). In the 19 included studies, mean and median ratios of EPDS-5 to SCID prevalence were 2.1 and 1.4 times.Conclusions:Prevalence estimated based on EPDS-5 >= 7 appears to be substantially higher than the prevalence of major depression. Validated diagnostic interviews should be used to establish prevalence

Comparison of major depression diagnostic classification probability using the SCID, CIDI, and MINI diagnostic interviews among women in pregnancy or postpartum: An individual participant data meta‐analysis

OBJECTIVES: A previous individual participant data meta-analysis (IPDMA) identified differences in major depression classification rates between different diagnostic interviews, controlling for depressive symptoms on the basis of the Patient Health Questionnaire-9. We aimed to determine whether similar results would be seen in a different population, using studies that administered the Edinburgh Postnatal Depression Scale (EPDS) in pregnancy or postpartum. METHODS: Data accrued for an EPDS diagnostic accuracy IPDMA were analysed. Binomial generalised linear mixed models were fit to compare depression classification odds for the Mini International Neuropsychiatric Interview (MINI), Composite International Diagnostic Interview (CIDI), and Structured Clinical Interview for DSM (SCID), controlling for EPDS scores and participant characteristics. RESULTS: Among fully structured interviews, the MINI (15 studies, 2,532 participants, 342 major depression cases) classified depression more often than the CIDI (3 studies, 2,948 participants, 194 major depression cases; adjusted odds ratio [aOR] = 3.72, 95% confidence interval [CI] [1.21, 11.43]). Compared with the semistructured SCID (28 studies, 7,403 participants, 1,027 major depression cases), odds with the CIDI (interaction aOR = 0.88, 95% CI [0.85, 0.92]) and MINI (interaction aOR = 0.95, 95% CI [0.92, 0.99]) increased less as EPDS scores increased. CONCLUSION: Different interviews may not classify major depression equivalently