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Nakamura N, Mitsuhashi T, Nakashima Y, Matsumoto N, Yorifuji T. Effect of 2-week postpartum check-ups on screening positive for postpartum depression: a population-based cohort study using instrumental variable estimation in Japan. Fam Pract 2025; 42:cmad074. [PMID: 37467366 PMCID: PMC12014903 DOI: 10.1093/fampra/cmad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Postpartum depression is experienced by approximately 10% of women and affects the health and development of their children. Although it is recommended that all mothers have the opportunity for early detection and intervention for postpartum depression, it is unclear whether early postpartum check-ups help to reduce postpartum depression. OBJECTIVE The aim of this study was to assess the effect of 2-week postpartum check-ups on screening positive for postpartum depression in Japan. METHODS This was a population-based cohort study that used the administrative database of Tsuyama, Japan. Participants were women who received postpartum home visits from a public health nurse in Tsuyama during the fiscal years 2017-2019. Data were obtained on participant's attendance at a 2-week postpartum check-up and their responses on the Edinburgh Postpartum Depression Scale. Owing to the initiation of a publicly funded postpartum check-up programme, participants were pseudo-randomly assigned to receive/not receive a 2-week postpartum check-up. We conducted instrumental variable estimation to assess the causal effects of the check-up on screening positive for postpartum depression. RESULTS The characteristics of the 1,382 participants did not differ by fiscal year of childbirth. We found a 6.7% (95% confidence interval 2.2-11.2) reduction in the prevalence of screening positive for postpartum depression as an effect of 2-week postpartum check-ups among women received 1-month postpartum home visits. CONCLUSION The results suggest that 2-week postpartum check-ups are effective in reducing the prevalence of screening positive for postpartum depression among 1-month postpartum women. Despite some limitations, early postpartum care could reduce postpartum depression.
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Affiliation(s)
- Naoko Nakamura
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Yasuko Nakashima
- Health Promotion Division, Tsuyama City Department of Children’s Health, Tsuyama, Japan
| | - Naomi Matsumoto
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Kubo T, Jikihara Y, Todo N, Aramaki M, Shiozaki N, Ando S. Ten-year trajectories of postpartum depression of Japanese mothers and fathers. J Affect Disord 2025; 369:276-287. [PMID: 39357676 DOI: 10.1016/j.jad.2024.09.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 09/19/2024] [Accepted: 09/22/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Perinatal depression is a significant concern affecting both women and men during pregnancy and postpartum periods. While maternal postpartum depression has been extensively studied, paternal depression remains under-researched despite its prevalence and impact on family well-being. This study aimed to estimate the trajectories of perinatal and postpartum depression in Japanese parents over ten years and to determine the details of the symptoms of postpartum depression for each trajectory group, considering reciprocal effects between maternal and paternal depression. METHODS A total of 789 couples used the Edinburgh Postnatal Depression Scale to rate their depressive symptoms prenatally; at 5 weeks, 3 months, 6 months, and 1 year postpartum; and then yearly thereafter until the 10th year. Parallel-process latent class growth analysis was used to group participants according to their longitudinal patterns of depressive symptoms. RESULTS For both mothers and fathers, four depressive symptom trajectories fit the data best and were most informative (escalating: 6.5 %; mothers low and fathers moderate: 17.2 %; mothers high and fathers low: 17.9 %; low: 58.4 %). A variance analysis showed significant class-parent interactions across anhedonia, anxiety, and depression subscales, indicating distinct patterns of depressive symptomatology. DISCUSSION Tailored mental health programs and universal screening using the Edinburgh Postnatal Depression Scale are recommended to address the specific needs of each trajectory class. This study contributes to the understanding of long-term depressive symptom trajectories in parents and emphasizes the necessity of comprehensive support strategies to enhance family well-being and resilience.
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Affiliation(s)
- Takahiro Kubo
- College of Education, Yokohama National University, 79-1 Tokiwadai, Hodogaya-ku, Yokohama, Kanagawa, Japan.
| | - Yasumitsu Jikihara
- Graduate School of Human Sciences, Osaka University, 1-2 Yamadaoka, Suita-shi, Osaka, Japan
| | - Naoya Todo
- Faculty of Humanities and Social Sciences, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji, Tokyo, Japan
| | - Misako Aramaki
- Early Childhood Education Research Center, National Institute For Educational Policy Research, 3-2-2 Kasumigaseki, Chiyoda-ku, Tokyo, Japan
| | - Naomi Shiozaki
- Faculty of Integrated Arts and Social Sciences, Japan Women's University, 2-8-1 Mejirodai, Bunkyo, Tokyo, Japan
| | - Satoko Ando
- Faculty of Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo, Tokyo, Japan
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Salehi A, Zhang M, Kithulegoda N, Vigod S, Ivers N. Validation of the culturally adapted Edinburgh postpartum depression scale among east Asian, southeast Asian and south Asian populations: A scoping review. Int J Ment Health Nurs 2023; 32:1616-1635. [PMID: 37574716 DOI: 10.1111/inm.13202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 07/20/2023] [Accepted: 07/29/2023] [Indexed: 08/15/2023]
Abstract
The Edinburgh Postnatal Depression Scale (EPDS) is a widely used self-report instrument to screen for postpartum depression (PPD). Assessing the relevance of the EPDS as a screening tool for minority ethnic populations is pertinent for ensuring culturally appropriate care. This scoping review aimed to explore what is known about the cultural adaptations of the EPDS in antepartum and postpartum mothers and fathers in East Asian, Southeast Asian and South Asian populations, and to what extent these adaptations are able to accurately screen for postpartum depression symptoms among these cultural groups. The scoping review was guided by the PRISMA-ScR checklist. The search strategy included databases of MEDLINE, PsycINFO, EMBASE, CINAHL and Grey literature. Included studies were primary articles published in English language peer-reviewed journals that investigated the validation or cultural adaptation of the EPDS in mothers who were pregnant and/or had recently given birth, or fathers who were new parents, and were limited to the following cultural groups, whether living locally or abroad in a foreign country: East Asian, Southeast Asian or South Asian populations. Thirty-six of 2469 studies met criteria for inclusion. Twenty-one of 36 studies utilizing a culturally validated EPDS demonstrated a cut-off score lower than the original recommended cut-off. Important themes identified included the Role of Culture, Somatization of PPD, Method of Interview, and contrasting performance compared to other scales used to assess depression and/or anxiety. Accessibility to translated and validated EPDS and mindfulness of ethnically relevant EPDS cut-off scores are critical when using this tool among minority ethnic populations.
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Affiliation(s)
- Ashkan Salehi
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Melody Zhang
- University Health Network, Toronto, Ontario, Canada
| | | | - Simone Vigod
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - Noah Ivers
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
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Shinohara S, Horiuchi S, Shinohara R, Otawa S, Kushima M, Miyake K, Yui H, Kojima R, Ooka T, Akiyama Y, Yokomichi H, Yamagata Z. Multiple pregnancy as a potential risk factor for postpartum depression: The Japan Environment and Children's Study. J Affect Disord 2023; 329:218-224. [PMID: 36849005 DOI: 10.1016/j.jad.2023.02.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/10/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Postpartum depression (PPD) results in adverse consequences for both mother and infant. However, the association between multiple pregnancy and PPD is unknown because of the difference in the estimated prevalence rate of PPD based on country, ethnicity, and study type. Thus, this study aimed to determine whether Japanese women with multiple pregnancy were at a high risk of developing PPD at 1 and 6 months postpartum. METHODS In this nationwide prospective cohort study (the Japan Environment and Children's Study), conducted between January 2011 and March 2014, 77,419 pregnant women were enrolled. PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS) 1 and 6 months postpartum. A score of ≥13 points implied "positive" for PPD. Multiple logistic regression analyses estimated the association between multiple pregnancy and PPD risk. RESULTS Overall, 77,419 pregnancies (singleton, n = 76,738; twins, n = 676; triplets, n = 5) were included; 3.6 % and 2.9 % of pregnant women had PPD at 1 and 6 months postpartum, respectively. Compared with singleton pregnancy, multiple pregnancy was not associated with PPD at 1 month, but at 6 months postpartum (adjusted odd ratios: 0.968 [95 % confidence interval {CI}, 0.633-1.481] and 1.554 [95 % CI, 1.046-2.308], respectively). LIMITATIONS 1) Some potential PPD risk factors could not be evaluated, 2) PPD was not diagnosed by psychiatrists, and 3) depressive symptoms at 6 months postpartum were considered PPD; however, definitions may vary. CONCLUSIONS Japanese women with multiple pregnancy may be regarded as a target group for follow-up and postpartum depression screening for at least 6 months during the initial postpartum period.
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Affiliation(s)
- Satoshi Shinohara
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506, Japan.
| | - Sayaka Horiuchi
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Sanae Otawa
- Center for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Megumi Kushima
- Center for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Kunio Miyake
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Hideki Yui
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Reiji Kojima
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Tadao Ooka
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Yuka Akiyama
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Hiroshi Yokomichi
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Zentaro Yamagata
- Center for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan; Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
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Li B, Tang X, Wang T. Neuraxial analgesia during labor and postpartum depression: Systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33039. [PMID: 36827052 PMCID: PMC11309598 DOI: 10.1097/md.0000000000033039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Severe pain has been linked to depression, which raises the question of whether neuraxial analgesia during childbirth is associated with a reduced risk of postpartum depression. This association has been explored, but previous studies did not control or analyze relevant confounders. We conducted a systematic review and meta-analysis to determine the association between neuraxial analgesia and postpartum depression. METHODS A systematic review was conducted using PubMed, Embase, and the Cochrane Central Register of Controlled Trials. Studies that tested the effect of neuraxial analgesia during labor on depression or depressive symptoms in the first year postpartum were included. Relevant articles were extracted independently by 2 authors. RESULTS In total, 14 studies (86,231 women) were included. The association between neuraxial analgesia and the long-term incidence of postpartum depression after childbirth was the risk ratio = 0.75, 95% confidence interval (CI): 0.56-1.00, P = .05; I2 = 79%, P < .00001. There was a significant association (pooled risk ratio = 0.55, 95% CI: 0.34-0.90, P = .02; I2 = 55%, P = .06) between neuraxial analgesia and the incidence of postpartum depression in the first week after delivery. The subgroup analysis showed a trend suggesting that in Asian populations, those who received neuraxial analgesia had lower postpartum depression rates than those who received non-neuraxial analgesia (risk ratio = 0.57, 95% CI: 0.38-0.86; P = .008; I2 = 82%) at ≥4 weeks after delivery. CONCLUSION Neuraxial analgesia may be beneficial for the short-term and long-term mental effects of parturient women, especially for short term after delivery. High-quality studies addressing the role of neuraxial analgesia during labor and its impact on postpartum depression remain necessary.
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Affiliation(s)
- Bin Li
- Department of Anesthesia, Changning Maternity and Infant Health Hospital, Shanghai, China
| | - Xiaohui Tang
- Department of Anesthesia, Changning Maternity and Infant Health Hospital, Shanghai, China
| | - Tingting Wang
- Department of Anesthesia, Changning Maternity and Infant Health Hospital, Shanghai, China
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Suenaga H. Comparison of response options and actual symptom frequency in the Japanese version of the Edinburgh Postnatal Depression Scale in women in early pregnancy and non-pregnant women. BMC Pregnancy Childbirth 2022; 22:937. [PMID: 36522699 PMCID: PMC9753857 DOI: 10.1186/s12884-022-05257-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/28/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The positive predictive rate of the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS) is lower than those of other versions. This study aimed to confirm whether the EPDS Japanese version reflects actual symptom frequency and to examine the possibility of improving the positive predictive rate. METHODS This is a methodological study aimed at improving the positive predictive value of EPDS. The participants were 63 non-pregnant and 382 pregnant women. They answered the 10 questions of the Japanese version of the EPDS and reported the specific number of days as the frequency. The EPDS score (EPDS-S) and the frequency score (FREQ-S) were calculated for three factors of emotion: anhedonia, anxiety, and depression. RESULTS The positive rates of the EPDS-S and FREQ-S in pregnant women were 6% and 8%, respectively, which were lower than those in non-pregnant women (17%). On comparing the EPDS-S with the FREQ-S, a significant underestimation of frequency was observed in approximately 3% of pregnant women. The FREQ-S showed better internal consistency than the EPDS-S. Among the factors of emotion, women tended to rate anhedonia lower in the EPDS-S than in the frequency scale. CONCLUSION Pregnant women tended to report a lower frequency on the Japanese version of the EPDS than their actual symptom frequency, which was especially true for those with a desire to self-harm. The combined use of the FREQ-S and EPDS-S can prevent underestimation and help improve the detection rate of depression.
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Affiliation(s)
- Hiromi Suenaga
- grid.268397.10000 0001 0660 7960Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
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Nassar EL, Levis B, Rice DB, Booij L, Benedetti A, Thombs BD. Inclusion of currently diagnosed or treated individuals in studies of depression screening tool accuracy: a meta-research review of studies published in 2018-2021. Gen Hosp Psychiatry 2022; 76:25-30. [PMID: 35334411 DOI: 10.1016/j.genhosppsych.2022.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/23/2022] [Accepted: 02/20/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Screening is done to improve health outcomes by identifying and effectively treating individuals with unrecognized conditions. Depression screening has been proposed to identify previously unrecognized depression cases. Including individuals already diagnosed or treated for depression in screening test accuracy studies could exaggerate accuracy and the yield of new cases from screening. The present study investigated (1) the proportion of depression screening tool accuracy primary studies published in 2018-2021 that excluded individuals with a confirmed depression diagnosis or who were already undergoing treatment; and (2) whether this has improved since the last review of studies published in 2013-2015, which found that five of 89 (5.6%) primary studies appropriately excluded such individuals. METHODS MEDLINE was searched from January 1, 2018 through May 21, 2021 for primary studies on depression screening tool accuracy. RESULTS Eighteen of 106 (17.0%; 95% Confidence Interval [CI], 11.0% to 25.3%) primary studies excluded currently diagnosed or treated individuals. This was 11.4% (95% CI, 2.8% to 20.0%) greater than in similar studies published in 2013-2015. CONCLUSION There has been an improvement since 2015, but the proportion of studies that exclude individuals already known to have depression remains low. This may bias research findings intended to inform clinical practice.
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Affiliation(s)
- Elsa-Lynn Nassar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Brooke Levis
- Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, UK
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Linda Booij
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Psychology, Concordia University, Montreal, Quebec, Canada; CHU Sainte-Justine Hospital Research Centre, Montreal, Quebec, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Psychology, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada; Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada.
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Predictive validity of the Edinburgh postnatal depression scale and other tools for screening depression in pregnant and postpartum women: a systematic review and meta-analysis. Arch Gynecol Obstet 2022; 307:1331-1345. [PMID: 35416478 DOI: 10.1007/s00404-022-06525-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/10/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE To compare the predictive validity of the Edinburgh Postnatal Depression Scale (EPDS) and other tools for screening depression in pregnant and postpartum women through a systematic review and meta-analysis. METHODS An electronic search of MEDLINE, EMBASE, CINAHL, and PsycArticles databases was conducted using the following keywords: depression, perinatal-related terms, and EPDS. Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess the risk of bias in diagnostic studies. RESULTS The search identified 823 articles, of which 17 studies met the inclusion criteria. In 1831 pregnant women from nine studies, pooled sensitivity and specificity of the EPDS were 0.81 and 0.87, respectively, with summary receiver operating characteristic (sROC) curve of 0.90. In 515 postpartum women from six studies, pooled sensitivity, specificity, and sROC were 0.79, 0.92, and 0.90, respectively. We then compared the EPDS with other tools using three or more studies. The sROC curve of the Patient Health Questionnaire-9 was 0.74, which was lower than that (0.86) of the EPDS. The sROC curve of the Beck Depression Inventory and the ten-item Kessler Psychological Distress Scale was 0.91, similar to that of the EPDS (0.90 and 0.87). However, in comparison with the Postpartum Depression Screening Scale (0.98), the sROC curve of the EPDS was 0.54. CONCLUSION As a tool specialized for screening depression in pregnant and postpartum women, the EPDS showed excellent performance. Thus, the EPDS can be used in preference to other tools to screen for depression in perinatal women at a primary care setting or a midwifery center.
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Yokoyama M, Tanaka K, Sugiyama T, Arakawa M, Miyake Y. Cesarean section is associated with increased risk of postpartum depressive symptoms in Japan: the Kyushu Okinawa Maternal and Child Health Study. J Affect Disord 2021; 278:497-501. [PMID: 33017676 DOI: 10.1016/j.jad.2020.09.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/27/2020] [Accepted: 09/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The association between cesarean section and the risk of postpartum depressive symptoms remains controversial. The present prebirth cohort study examined this issue in Japan. METHODS Study subjects were 1310 women. Information under study was obtained using a self-administered questionnaire. Postpartum depressive symptoms were defined as a total Edinburgh Postnatal Depression Scale score of nine or higher between three and four months postpartum. Multivariate logistic regression analysis was used to adjust for age, body mass index, gestational weeks at baseline, gestational weeks at delivery, number of children at baseline, previous miscarriage or stillbirth, previous abortion, history of depression, family history of depression, region of residence, employment status, educational level, household income, family structure, breastfeeding status, smoking during pregnancy, infant's birthweight, and infant's sex. RESULTS Postpartum depressive symptoms were identified in 8.2%. After adjustment for the confounding factors, compared with vaginal delivery, cesarean section was independently associated with an increased risk of postpartum depressive symptoms: the adjusted odds ratio (OR) was 1.95 (95% confidence interval [CI]: 1.16-3.23). This positive association was more apparent among those who had no other children at baseline than among those who already had one or more children: the adjusted ORs were 2.94 (95% CI: 1.35-6.26) and 1.45 (95% CI: 0.68-2.92), respectively; however, this interaction was not significant. LIMITATIONS Information on whether each cesarean section was emergency or elective and other obstetric complications was not available. CONCLUSIONS Cesarean section may be associated with an increased risk of postpartum depressive symptoms, especially among women without children at baseline.
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Affiliation(s)
- Maki Yokoyama
- Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Ehime, Japan.
| | - Keiko Tanaka
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Takashi Sugiyama
- Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Masashi Arakawa
- Health Tourism Research Fields, Graduate School of Tourism Sciences, University of the Ryukyus, Okinawa, Japan
| | - Yoshihiro Miyake
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
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Sasaki Y, Ito K, Fukumoto K, Kawamura H, Oyama R, Sasaki M, Baba T. Cerebral diffusion kurtosis imaging to assess the pathophysiology of postpartum depression. Sci Rep 2020; 10:15391. [PMID: 32958845 PMCID: PMC7505968 DOI: 10.1038/s41598-020-72310-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022] Open
Abstract
Postpartum depression (PPD), a main cause of maternal suicide, is an important issue in perinatal mental health. Recently, cerebral diffusion tensor imaging (DTI) studies have shown reduced fractional anisotropy (FA) in major depressive disorder (MDD) patients. There are, however, no reports using diffusion kurtosis imaging (DKI) for evaluation of PPD. This was a Japanese single-institutional prospective study from 2016 to 2019 to examine the pathophysiological changes in the brain of PPD patients using DKI. The DKI data from 3.0 T MRI of patients one month after delivery were analyzed; the patients were examined for PPD by a psychiatrist. The mean kurtosis (MK), FA and mean diffusivity (MD) were calculated from the DKI data and compared between PPD and non-PPD groups using tract-based spatial statistics analysis. Of the 75 patients analyzed, eight patients (10.7%) were diagnosed as having PPD. In the PPD group, FA values in the white matter and thalamus were significantly lower and MD values in the white matter and putamen were significantly higher. The area with significant differences in MD value was more extensive (40.8%) than the area with significant differences in FA value (6.5%). These findings may reflect pathophysiological differences of PPD compared with MDD.
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Affiliation(s)
- Yuri Sasaki
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3695, Japan.
| | - Kenji Ito
- Division of Ultrahigh Field MRI, Institute for Biomedical Science, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kentaro Fukumoto
- Department of Neuropsychiatry, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Hanae Kawamura
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3695, Japan
| | - Rie Oyama
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3695, Japan
| | - Makoto Sasaki
- Division of Ultrahigh Field MRI, Institute for Biomedical Science, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Tsukasa Baba
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3695, Japan
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Russell PSS, Chikkala SM, Earnest R, Viswanathan SA, Russell S, Mammen PM. Diagnostic accuracy and clinical utility of non-English versions of Edinburgh Post-Natal Depression Scale for screening post-natal depression in India: A meta-analysis. World J Psychiatry 2020; 10:71-80. [PMID: 32399400 PMCID: PMC7203085 DOI: 10.5498/wjp.v10.i4.71] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/03/2020] [Accepted: 03/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The prevalence of post-natal depression (PND) is high in India, as it is in many other low to middle income countries. There is an urgent need to identify PND and treat the mother as early as possible. Among the many paper and pencil tests available to identify PND, the Edinburgh Postnatal Depression Scale (EPDS) is a widely used and validated measure in India. However, the summary diagnostic accuracy and clinical utility data are not available for this measure.
AIM To establish summary data for the global diagnostic accuracy parameter as well as the clinical utility of the non-English versions of the EPDS in India.
METHODS Two researchers independently searched the PubMed, EMBASE, MEDKNOW and IndMED databases for published papers, governmental publications, conference proceedings and grey literature from 2000-2018. Seven studies that evaluated the diagnostic accuracy of EPDS in five Indian languages against DSM/ICD were included in the final analysis. Two other investigators extracted the Participants’ details, Index measures, Comparative reference measures, and Outcomes of diagnostic accuracy data, and appraised the study quality using QUADS-2. Deek’s plots were used to evaluate publication bias. We used the area under the curve of the hierarchical summary area under the receiver operating characteristic curve, with the random effect model, to summarize the global diagnostic accuracy of EPDS. Using the 2 × 2 table, we calculated positive and negative likelihood ratios. From the likelihood ratios, the Fagan’s nomogram was built for evaluating clinical utility using the Bayesian approach. We calculated the 95% confidence interval (95%CI) whenever indicated. STATA (version 15) with MIDAS and METANDI modules were used.
RESULTS There was no publication bias. The area under the curve for EPDS was 0.97 (95%CI: 0.95-0.98). The pre-test probability for the nomogram was 22%. For a positive likelihood ratio of 9, the positive post-test probability was 72% (95%CI: 68%, 76%) and for a negative LR of 0.08, the negative post-test probability was 2% (95%CI: 1%, 3%).
CONCLUSION In this meta-analysis, we established the summary global diagnostic parameter and clinical utility of the non-English versions of the EPDS in India. This work demonstrates that these non-English versions are accurate in their diagnosis of PND and can help clinicians in their diagnostic reasoning.
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Affiliation(s)
| | - Swetha Madhuri Chikkala
- Child and Adolescent Psychiatry Unit, Department of Psychiatry, Christian Medical College, Vellore 632 002, India
| | - Richa Earnest
- Child and Adolescent Psychiatry Unit, Department of Psychiatry, Christian Medical College, Vellore 632 002, India
| | | | - Sushila Russell
- Child and Adolescent Psychiatry Unit, Department of Psychiatry, Christian Medical College, Vellore 632 002, India
| | - Priya Mary Mammen
- Child and Adolescent Psychiatry Unit, Department of Psychiatry, Christian Medical College, Vellore 632 002, India
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