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Abstract Background Depression ranks as the foremost mental health concern among childbearing women. Within low- and middle-income countries (LMICs), between 20 and 25% of women encounter depression during pregnancy or soon after delivery. This condition impacts not only the mothers but also their offspring. Offspring of women suffering from postnatal depression (PND) exhibit suboptimal cognitive development and increased emotional and behavioural issues throughout their growth. This scenario becomes more pronounced in LMICs, where numerous adversities further jeopardise children’s developmental progress. Despite antenatal services providing a pivotal platform to address women’s mental health needs, PND treatment remains inaccessible in many LMICs. The World Health Organization advocates interpersonal psychotherapy (IPT) for treating depression. While research from high-income countries has established the efficacy of IPT and group-IPT (g-IPT) for PND, its effectiveness within the LMIC context and its potential benefits for child development remain uncharted. This study seeks to gauge the potency of g-IPT for women with PND in two LMICs. Methods This multi-site randomised controlled trial is a continuation of two preceding phases—conceptual mapping and a feasibility study executed in Lebanon and Kenya. Insights gleaned from these phases underpin this comprehensive RCT, which contrasts the efficacy and cost-effectiveness of high-quality standard care (HQ-SC) augmented with g-IPT against HQ-SC in isolation. The trial, characterised as an individually randomised superiority assessment, targets women with postnatal depression in Beirut, Lebanon, and Nairobi, Kenya. It aims to determine if culturally tailored g-IPT, administered within community settings in both countries, outperforms HQ-SC in influencing child developmental outcomes, maternal depression, and the quality of the mother–child bond. Discussion The SUMMIT trial, designed with pragmatism, possesses the magnitude to evaluate g-IPT within two LMIC frameworks. It seeks to enlighten policymakers, service commissioners, professionals, and users about g-IPT’s potential to alleviate maternal PND and bolster child developmental outcomes in LMICs. Additionally, the trial will generate valuable data on the clinical and economic merits of high-quality standard care. Trial registration ISRCTN, ISRCTN15154316. Registered on 27 September 2023, https://doi.org/10.1186/ISRCTN15154316

Background: Depression ranks as the foremost mental health concern among childbearing women. Within low- and middle-income countries (LMICs), between 20 and 25% of women encounter depression during pregnancy or soon after delivery. This condition impacts not only the mothers but also their offspring. Offspring of women suffering from postnatal depression (PND) exhibit suboptimal cognitive development and increased emotional and behavioural issues throughout their growth. This scenario becomes more pronounced in LMICs, where numerous adversities further jeopardise children's developmental progress. Despite antenatal services providing a pivotal platform to address women's mental health needs, PND treatment remains inaccessible in many LMICs. The World Health Organization advocates interpersonal psychotherapy (IPT) for treating depression. While research from high-income countries has established the efficacy of IPT and group-IPT (g-IPT) for PND, its effectiveness within the LMIC context and its potential benefits for child development remain uncharted. This study seeks to gauge the potency of g-IPT for women with PND in two LMICs. Methods: This multi-site randomised controlled trial is a continuation of two preceding phases—conceptual mapping and a feasibility study executed in Lebanon and Kenya. Insights gleaned from these phases underpin this comprehensive RCT, which contrasts the efficacy and cost-effectiveness of high-quality standard care (HQ-SC) augmented with g-IPT against HQ-SC in isolation. The trial, characterised as an individually randomised superiority assessment, targets women with postnatal depression in Beirut, Lebanon, and Nairobi, Kenya. It aims to determine if culturally tailored g-IPT, administered within community settings in both countries, outperforms HQ-SC in influencing child developmental outcomes, maternal depression, and the quality of the mother–child bond. Discussion: The SUMMIT trial, designed with pragmatism, possesses the magnitude to evaluate g-IPT within two LMIC frameworks. It seeks to enlighten policymakers, service commissioners, professionals, and users about g-IPT's potential to alleviate maternal PND and bolster child developmental outcomes in LMICs. Additionally, the trial will generate valuable data on the clinical and economic merits of high-quality standard care. Trial registration: ISRCTN, ISRCTN15154316. Registered on 27 September 2023, https://doi.org/10.1186/ISRCTN15154316 [ABSTRACT FROM AUTHOR]

Background: The pilgrimage of this Doctor of Nursing Practice project was to bring postpartum depression (PPD) out of the shadows and into the light. A gap existed in a postpartum ambulatory setting with the screening, detection, and treatment of PPD. Objective: A quality improvement project with an evidence-based standard of care for PPD screening was implemented with every postpartum patient. Methods: The Edinburgh Postnatal Depression Scale-10 (EPDS-10; Cox et al., 1987) was used as a reliable and valid screening instrument to screen 46 postpartum women. Results: Screening for PPD increased from 10.9% to 95.8% after the implementation of the EPDS. Referral and treatment of PPD increased from 1.8% to 19.6%. Conclusion: This project established an evidence-based standard of care that can be implemented with every postpartum patient and brought nine women out of the shadows with the hope that they can find the light to recover from PPD. Implications for Nursing: Screening for PPD is recommended by experts and is a Healthy People 2030 goal (ACOG, 2018; USPSTF, 2018). Universal screening with a validated tool may lead to improved compliance with screening, detection, and treatment of PPD. The outcomes of this project inform and prepare clinicians for the predicted mandate of national screening for PPD. [ABSTRACT FROM AUTHOR]

Background: Maternal health is essential for the growth and development of the child. Mothers’ depression can cause great harm to their children. Many studies have investigated stunting in children and its relationship with maternal depression. However, these studies have yielded different results. This systematic review aims to answer the question of “what is the relationship between maternal depression and stunting in children” in published articles. Methods: This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The databases used included ScienceDirect, PubMed, ProQuest, and Cochrane Library setting the publication period between 2010 and 2021. The studies with observational designs, measuring maternal depression at any stage after childbirth, and examining child (under five) stunting status, using z-score or percentile were included. The quality of the studies was assessed using the Downs and Black tool, and the risk of bias was evaluated by the Cochrane Collaboration’s Risk of Bias Tool. Two authors extracted the data independently and the findings were synthesized qualitatively. Results: The literature search yielded 611 articles, and only 14 articles were found to meet the inclusion criteria after removing duplicates, dissertations, editorials, comments, not full texts, and case reports. A total of eight articles showed a significant relationship between maternal depression and stunting. In contrast, the remaining six studies did not show an association between these variables. It seems that the tools for measuring depression and the age difference of children participating in the studies were important factors that affected the outcome of the relationship between maternal depression and children’s stunting. Also, episodic maternal depression does not appear to be associated with stunting. Conclusion: The findings suggest that to prevent childhood stunting, initiatives may be needed to identify and support mothers with chronic depression. Future systematic reviews are suggested to investigate the relationship between maternal depression and children’s stunting in urban and rural communities or in high- and low-income countries in a broader time frame.

Associations between breastfeeding intention, duration and post‐natal depression (PND) have been shown in pre‐COVID‐19 studies. However, studies during COVID‐19 have not examined the associations between breastfeeding intention, breastfeeding practices, and PND in an international sample of post‐natal women, taking into consideration COVID‐19 related factors. This is the first study to address this gap as both PND and breastfeeding may be affected by COVID‐19, and have important long‐term effects on women's and infant's health. A cross‐sectional internet‐based survey was conducted with 3253 post‐natal women from five countries: Brazil, South Korea, Taiwan, Thailand, and the United Kingdom from July to November 2021. The results showed that women who intended to breastfeed during pregnancy had lower odds of having PND than women who did not intend to. Women who had no breastfeeding intention but actually breastfed had greater odds (AOR 1.75) of having PND than women who intended to breastfeed and actually breastfed. While there was no statistical significance in expressed breast milk feeding in multivariable logistic regression models, women who had shorter duration of breastfeeding directly on breast than they planned had greater odds (AOR 1.58) of having PND than those who breastfed longer than they planned even after adjusting for covariates including COVID‐19‐related variables. These findings suggested the importance of working with women on their breastfeeding intention. Tailored support is required to ensure women's breastfeeding needs are met and at the same time care for maternal mental health during and beyond the pandemic. Key messages: This study identified independent associations of breastfeeding intention and actual breastfeeding practices with PND after adjustment for COVID‐19‐related covariates.Although women who intended to breastfeed during pregnancy were less likely to have PND, those who did not intend to breastfeed but did breastfeed were more likely to have PND than those who intended to breastfeed and breastfed.Women with shorter (vs. longer) than planned duration of breastfeeding on breast were more likely to have PND.Health care providers and policymakers should ensure tailored support is available for women's infant feeding plans and mental health. [ABSTRACT FROM AUTHOR]

Back in 2015 I gave birth to my first child and had a complicated birth and postnatal experience. I suffered birth trauma and I was diagnosed with post-traumatic stress disorder (PTSD) when my baby was eight months old. Whilst I mostly dealt with the mental and physical difficulties of PTSD with therapy, what I was not prepared for nor do I think I'll fully get over, was the effect the investigation report into my birth had on my mental well-being. Writing became part of my therapy. In fact, my therapist prescribed it as 'homework' at the time. I had not written creatively prior to this and I didn't understand how writing would benefit my well-being positively. What I learned along the course of my therapy was the power the written word has in healing a hurt and damaged soul. I maintained a blog and could see my healing progress as time moved on. Therapy for me has since finished but I still try to write when I can. I do this often around my child's birthday as I struggle most with memories from the time of birth. I write when I feel emotionally overwhelmed and I feel a release in this process. Whilst I do not think my pieces are award winning, each holds a period of time when my emotions ran high and to me, they have become precious notes capturing the rawness unique to my experiences and where others may also find some comfort in that they're not alone. I will share some of these pieces with you. Dedicated to anyone who has suffered birth trauma or from the effects of poor communication and lack of acknowledgement around psychological harm, this is for you. [ABSTRACT FROM AUTHOR]

Abstract Associations between breastfeeding intention, duration and post‐natal depression (PND) have been shown in pre‐COVID‐19 studies. However, studies during COVID‐19 have not examined the associations between breastfeeding intention, breastfeeding practices, and PND in an international sample of post‐natal women, taking into consideration COVID‐19 related factors. This is the first study to address this gap as both PND and breastfeeding may be affected by COVID‐19, and have important long‐term effects on women's and infant's health. A cross‐sectional internet‐based survey was conducted with 3253 post‐natal women from five countries: Brazil, South Korea, Taiwan, Thailand, and the United Kingdom from July to November 2021. The results showed that women who intended to breastfeed during pregnancy had lower odds of having PND than women who did not intend to. Women who had no breastfeeding intention but actually breastfed had greater odds (AOR 1.75) of having PND than women who intended to breastfeed and actually breastfed. While there was no statistical significance in expressed breast milk feeding in multivariable logistic regression models, women who had shorter duration of breastfeeding directly on breast than they planned had greater odds (AOR 1.58) of having PND than those who breastfed longer than they planned even after adjusting for covariates including COVID‐19‐related variables. These findings suggested the importance of working with women on their breastfeeding intention. Tailored support is required to ensure women's breastfeeding needs are met and at the same time care for maternal mental health during and beyond the pandemic.

In this article the author considers the symptom of the post-natal depression as a crisis which bears a meaning and has a direction, and which can represent an opportunity to start up a process of awareness about the complexes that have emerged. Through a detailed description of a clinical case she shows, moreover, the usefulness of dream exploration and the crucial importance of the relation between the analyst and the patient. [ABSTRACT FROM AUTHOR]

Background: Maternal health is essential for the growth and development of the child. Mothers' depression can cause great harm to their children. Many studies have investigated stunting in children and its relationship with maternal depression. However, these studies have yielded different results. This systematic review aims to answer the question of "what is the relationship between maternal depression and stunting in children" in published articles. Methods: This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The databases used included ScienceDirect, PubMed, ProQuest, and Cochrane Library setting the publication period between 2010 and 2021. The studies with observational designs, measuring maternal depression at any stage after childbirth, and examining child (under five) stunting status, using z-score or percentile were included. The quality of the studies was assessed using the Downs and Black tool, and the risk of bias was evaluated by the Cochrane Collaboration's Risk of Bias Tool. Two authors extracted the data independently and the findings were synthesized qualitatively. Results: The literature search yielded 611 articles, and only 14 articles were found to meet the inclusion criteria after removing duplicates, dissertations, editorials, comments, not full texts, and case reports. A total of eight articles showed a significant relationship between maternal depression and stunting. In contrast, the remaining six studies did not show an association between these variables. It seems that the tools for measuring depression and the age difference of children participating in the studies were important factors that affected the outcome of the relationship between maternal depression and children's stunting. Also, episodic maternal depression does not appear to be associated with stunting. Conclusion: The findings suggest that to prevent childhood stunting, initiatives may be needed to identify and support mothers with chronic depression. Future systematic reviews are suggested to investigate the relationship between maternal depression and children's stunting in urban and rural communities or in high- and low-income countries in a broader time frame. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of a supportive educational intervention on the psychological wellbeing of mothers whose babies were admitted to Neonatal Care Unit (NCU) in Nigeria.Methods: Controlled trial involving 41 mothers whose babies were consecutively admitted into two NCUs (21 in the intervention group and 19 controls). The intervention group received two group-based sessions which included psychological coping strategies, and familiarity with NCU environment, equipment, personnel and procedures. The control group received usual care. Outcome measures were depressive symptoms (Edinburg Postnatal Depression Scale-EPDS), stress-related to NCU (Parental Stressor Scale: Neonatal Intensive Care Unit-PSS: NICU) and post-traumatic symptoms (Impact Event Scale-Revised-IES-R).Results: Difference-in-Differences (DiD) analysis showed a difference of -4.70 in PSS: NICU score in favour of the intervention group which was statistically significant [F(3, 75) = 9.47, p < 0.0001, R2 = 0.28]. The differences in EPDS (0.91) and IES-R (2.55) were not statistically significant [F(3, 75) = 10.10, p = 0.74] and [F(3, 75) = 10.13, p = 0.73], respectively. All the mothers in the treatment group expressed satisfaction with the intervention.Conclusion: This brief group-based supportive educational intervention for mothers with babies in NCU was feasible, acceptable and helpful in reducing stress related to NCU. Larger controlled trials are recommended to establish the generalizability of these findings in this region.Lay Summary: Babies born too early and or with complications require admission to special hospital called Neonatal Care Unit (NCU) to help them to survive. However, parents whose babies are admitted to NCU can find the experience frightening. We examined how to reduce the fear and stress mothers in Nigeria experience when their babies are admitted to NCU.We had two groups of mothers. The first group made up of 21 mothers was taught how to cope with the stress of having a baby in NCU. They were also shown how the various equipment in the NCU work, what the staff in NCU do and what types of things need to be done to help their babies. The second group of 19 mothers received usual care but did not have the extra teaching the first group received. After 2 weeks, we checked the level of depression and stress the mothers in both groups had compared with the level before the first group received the extra teaching.We found that mothers in the first group who received the extra teaching were less stressed about having their babies in the NCU compared with the mothers that did not receive the teaching. [ABSTRACT FROM AUTHOR]

Background:Post-natal depression, aserious mental health problem experienced by mothers 4 to 6 weeks after delivery. Patients suffering from post-natal depression are at higher risk of developing major depressive illness in future life. Objectives: To assess the prevalence of post-natal depression and its associates among women in a rural community in Hooghly district, West Bengal. Methodology: A crosssectional study was conducted among 83 post-natal mothers (period of 6th to 10th week after delivery) in a rural community in Hooghly district, West Bengal, selected by simple random sampling technique from the list of mothers attending the immunization clinic in a health centreduring the period of April 2019 to September 2019. Data was collected by face-to-face interview and review of records by house to house visits. Depression was assessed by Edinburgh post-natal depression scale (EPDS). Statistical analysis was done using Microsoft Excel and SPSS version 16. Results: Prevalence of post-natal depression among study participants came out to be 28.9%. Poor socio-economic status (p=0.000). Unplanned pregnancy (p=0.025), Pre-term delivery (p=0.011) and increase in number of parity (p=0.025) were found to be statistically significantly associated with post-natal depression. Conclusion: Post-natal depression is a major public health problem which should be dealt with great concern while making policy for betterment of maternal and child health especially in low income countries like India. This can be detected early by health care providers in primary health care set up using simple screening tools. Special care and counselling should be provided to them. [ABSTRACT FROM AUTHOR]

Objective: To examine qualitatively changes occurring in discussions within a time-limited psychotherapy group for mothers with post-natal depression. Method: Discussions occurring in a group that comprised five mothers and a therapist were recorded over the course of six one-hour therapeutic sessions. Participants had been referred or had self-referred to the group on the basis of having post-natal depression. The recorded discussions were transcribed and then analysed in accordance with principles of conversation analysis. Results: Analysis of early and later group discussions showed changes in group members' alignment with the topics that were introduced, in turn-allocation and turn-taking, and in the co-construction of accounts of experience. In contrast to early discussions, in later discussions participants aligned with topics relating to personal emotions, self-selected as next speakers in the discussions, and collaboratively worked up accounts that made sense of their experiences of childbirth and of being diagnosed as having post-natal depression. Conclusions: Interactional changes over the duration of the group point to the benefits for mothers with post-natal depression of participating in a time-limited psychotherapy group. Fine-grained analysis of group discussions potentially offers a way of examining changes over time in psychotherapeutic groups more generally. [ABSTRACT FROM AUTHOR]

Purpose: This pilot study was designed to inform a larger effectiveness trial by: (1) assessing the feasibility of the PRogram In Support of Moms (PRISM) and our study procedures; and, (2) determining the extent to which PRISM as compared to an active comparison group, the Massachusetts Child Access Psychiatry Program (MCPAP) for Moms alone, improves depression among perinatal women. Methods: Four practices were randomized to either PRISM or MCPAP for Moms alone, a state-wide telephonic perinatal psychiatry program. PRISM includes MCPAP for Moms plus implementation assistance with local champions, training, and implementation of office prompts and procedures to enhance depression screening, assessment and treatment. Patients with Edinburgh Postnatal Depression Scales (EPDS) ≥ 10 were recruited during pregnancy, and completed the EPDS and a structured interview at baseline and 3–12 weeks’ postpartum. Results: Among MCPAP for Moms alone practices, patients’ (n = 9) EPDS scores improved from 15.22 to 10.11 (p = 0.010), whereas in PRISM practices patients’ (n = 21) EPDS scores improved from 13.57 to 6.19 (p = 0.001); the between groups difference-of-differences was 2.27 (p = 0.341). Conclusions: PRISM was beneficial for patients, clinicians, and support staff. Both PRISM and MCPAP for Moms alone improve depression symptom severity and the percentage of women with an EPDS >10. The improvement difference between groups was not statistically significant due to limited power associated with small sample size.

Abstract Background Post-natal Depression (PND) is a depressive disorder that causes significant distress or impairment on different levels in the individual’s life and their families. There is already evidence of the efficacy of psychological treatments for PND. We conducted a narrative review and researched the literature for identifying systematic reviews and studies for the best psychological treatments of PND, and examined what parameters made those treatments successful. Methods We searched 4 electronic databases. We included reviews and randomised controlled clinical trials for our research. We excluded other types of studies such as case studies and cohort studies. We followed a specific search strategy with specific terms and a selection process. We identified risk of bias in reviews and studies, and identified their limitations. We synthesized the data based on particular information, including: name of the authors, location, research type, target, population, delivery, outcome measures, participants, control groups, types of intervention, components of treatments, providers, experimental conditions amongst others. Results We found 6 reviews and 15 studies which met our inclusion criteria focusing on Cognitive Behavioural Therapy (CBT) for PND. Among the main findings we found that CBT can be delivered on an individual basis or within a group. It can be effective in the short-term, or up to six months post-intervention. CBT can be delivered by professionals or experts, but can also be practiced by non-experts. We found 7 components of CBT, including psychoeducation, cognitive restructuring, and goal setting. We also researched whether virtual reality (VR) has ever been used for the treatment of PND, and found that it has not. Conclusion From our review, we have concluded that CBT is an effective treatment for PND. We have explored the utility of VR as a possible therapeutic modality for PND and have decided to run a pilot feasibility study as a next step, which will act as the foundational guide for a clinical trial at a later stage.

Purpose: This pilot study was designed to inform a larger effectiveness trial by: (1) assessing the feasibility of the PRogram In Support of Moms (PRISM) and our study procedures; and, (2) determining the extent to which PRISM as compared to an active comparison group, the Massachusetts Child Access Psychiatry Program (MCPAP) for Moms alone, improves depression among perinatal women.Methods: Four practices were randomized to either PRISM or MCPAP for Moms alone, a state-wide telephonic perinatal psychiatry program. PRISM includes MCPAP for Moms plus implementation assistance with local champions, training, and implementation of office prompts and procedures to enhance depression screening, assessment and treatment. Patients with Edinburgh Postnatal Depression Scales (EPDS) ≥ 10 were recruited during pregnancy, and completed the EPDS and a structured interview at baseline and 3-12 weeks' postpartum.Results: Among MCPAP for Moms alone practices, patients' (n = 9) EPDS scores improved from 15.22 to 10.11 (p = 0.010), whereas in PRISM practices patients' (n = 21) EPDS scores improved from 13.57 to 6.19 (p = 0.001); the between groups difference-of-differences was 2.27 (p = 0.341).Conclusions: PRISM was beneficial for patients, clinicians, and support staff. Both PRISM and MCPAP for Moms alone improve depression symptom severity and the percentage of women with an EPDS >10. The improvement difference between groups was not statistically significant due to limited power associated with small sample size. [ABSTRACT FROM AUTHOR]

Both men and women are known to suffer from post-natal depression. However, there has been little attention paid to the psychodynamic genesis of post-natal depression in fathers. In this paper, I describe case histories of post-natal depression in two first time fathers and offer a formulation for understanding post-natal depression in such cases. I suggest a range of reasons for the failure to recognize this condition; and possible therapeutic interventions. [ABSTRACT FROM AUTHOR]

Background: Difficulty of maternal bonding towards a baby is widely recognised. It is unclear whether this phenomenon is dimensional or categorical. If categorical, an optimal cut-off score of a screening instrument is needed in clinical settings.Aims: In this study, we investigated whether maternal bonding is dimensional or categorical phenomenon and try to set optimal cut-off score of screening instruments.Methods: Self-report questionnaire studies were conducted in a general hospital and four antenatal clinics. Two-step cluster analysis was conducted for the Mother-to-Infant Bonding Scale (MIBS) subscale scores in 723 mothers of neonates. ROC curves and optimal cut-off points of the MIBS scores were calculated based on cluster-analysis derived groups.Results: A 2-cluster structure appeared: "normal" (n=619) vs. "pathological maternal bonding" (n=104). Mothers of the latter category scored significantly higher in terms of postnatal depression and neonatal abuse than those of the former category. AUC of the ROC curve by the total MIBS scores both 5days and 1month after childbirth were >0.9. The optimal cut off scores were 3/4 at 5days, and 4/5 at 1month, after childbirth.Conclusions: There was a group of mothers with high MIBS scores discretely different from those with low MIBS scores. MIBS may be a useful tool to identify mothers with a severe bonding disorder that needs clinical intervention. [ABSTRACT FROM AUTHOR]

Background: Perinatal anxiety and depression are widespread, with up to 20% of women affected during pregnancy and after birth. In the UK, management of perinatal mental health falls under the remit of general practitioners (GPs). We reviewed the literature on GPs' routine recognition, diagnosis and management of anxiety and depression in the perinatal period.Method: A systematic search of Embase, Medline, PsycInfo, Pubmed, Scopus and Web of Science was conducted. Studies were eligible if they reported quantitative measures of GPs' or Family Physicians' assessment, recognition and management of anxiety or depression in pregnancy or post-partum.Results: Thirteen papers, reporting 10 studies, were identified from the United States, Australia, UK, Netherlands and Canada. All reported on depression; two included anxiety disorders. Reported awareness and ability to diagnose perinatal depression among GPs was high. GPs knew about and used screening tools in the UK but less so in US settings. Antidepressants were the first line of treatment, with various SSRIs considered safest. Counseling by GPs and referrals to specialists were common in the post-natal period, less so in pregnancy. Treatment choices were determined by resources, attitudes, knowledge and training.Conclusions: Data on GPs' awareness and management of perinatal depression were sparse and unlikely to be generalizable. Future directions for research are proposed; such as exploring the management of anxiety disorders which are largely missing from the literature, and understanding more about barriers to disclosure and recognition in primary care. More standardized training could help to improve recognition and management practices. [ABSTRACT FROM AUTHOR]

Maternal depression is a known risk factor for poor outcomes for children. Pathways to these poor outcomes relate to reduced maternal responsiveness or sensitivity to the child. Impaired responsiveness potentially impacts the feeding relationship and thus may be a risk factor for inappropriate feeding practices. The aim of this study was to examine the longitudinal relationships between self‐reported maternal post‐natal depressive symptoms at child age 4 months and feeding practices at child age 2 years in a community sample. Participants were Australian first‐time mothers allocated to the control group of the NOURISH randomized controlled trial when infants were 4 months old. Complete data from 211 mothers (of 346 allocated) followed up when their children were 2 years of age (51% girls) were available for analysis. The relationship between Edinburgh Postnatal Depression Scale (EPDS) score (child age 4 months) and child feeding practices (child age 2 years) was tested using hierarchical linear regression analysis adjusted for maternal and child characteristics. Higher EPDS score was associated with less responsive feeding practices at child age 2 years: greater pressure [β = 0.18, 95% confidence interval (CI): 0.04–0.32, P = 0.01], restriction (β = 0.14, 95% CI: 0.001–0.28, P = 0.05), instrumental (β = 0.14, 95% CI: 0.005–0.27, P = 0.04) and emotional (β = 0.15, 95% CI: 0.01–0.29, P = 0.03) feeding practices (ΔR2 values: 0.02–0.03, P < 0.05). This study provides evidence for the proposed link between maternal post‐natal depressive symptoms and lower responsiveness in child feeding. These findings suggest that the provision of support to mothers experiencing some levels of depressive symptomatology in the early post‐natal period may improve responsiveness in the child feeding relationship. [ABSTRACT FROM AUTHOR]

Background Many variables have been proposed as predictive of post-natal depression (PND). Aims To investigate and refine PND risk variables. Method We recruited a large sample and employed two measures of PND (the dimensional Edinburgh Postnatal Depression Scale or EPDS, and DSM-defined major depression). Results High levels of stress in the post-natal period, previous depression and higher depression scores during pregnancy were the only consistent predictors across measures. Those exceeding the EPDS cut-off had additional psychosocial risk factors while those meeting criteria for major depression were strongly predicted by a past history of depression as well as higher pre-natal state depression scores. Limitations The EPDS has been used with variable cut off scores across multiple studies. We used only nine of the 10 EPDS items, electing to exclude the self-harm related question, but preserving the recommended EPDS cut-off score, and which might have impacted on predictions. Conclusions Study results generated a refined set of predictors of PND but, more importantly, identified that predictors of PND status are distinctly influenced by the measure of PND. Such inconsistencies are intrinsically noteworthy and of potential key importance in shaping intervention strategies. [ABSTRACT FROM AUTHOR]

Objective: Several predictors of postpartum mood have been identified in the literature, but the role of maternal expectations in postpartum mental health remains unclear. The aim of this study was to identify whether maternal expectations during the postpartum hospital stay predict adjustment and depressive symptoms at 6 weeks postpartum. Methods: The sample included 233 first-time mothers recruited from the postpartum unit of a Midwestern hospital. Participants completed measures of maternal expectations and depressive symptoms (EPDS) at Time 1 (2 d postpartum) and completed EPDS and an Emotional Adjustment Scale (BaM-13) at Time 2 (6 weeks postpartum). Results: A conditional relationship between the expectation that an infant's behavior will reflect maternal skill and Time 2 outcomes (BaM-13 and EPDS) was found, such that endorsing this belief predicted increased depression and poorer adjustment in those with higher (but not lower) Time 1 EPDS scores. Time 2 BaM-13 scores were also negatively predicted by expectations of self-sacrifice and positively predicted by expectations that parenthood would be naturally fulfilling. Conclusions: The expectations that new mothers hold about parenting soon after delivery are predictive of emotional adjustment in the early postpartum period, suggesting a role for discussion of expectations in future preventive strategies. [ABSTRACT FROM AUTHOR]

We investigated the impact of pre-existing mental ill health on postpartum maternal outcomes. Women reporting childbirth trauma received counselling (Promoting Resilience in Mothers' Emotions; n = 137) or parenting support ( n = 125) at birth and 6 weeks. The EuroQol Five dimensional (EQ-5D)-measured health-related quality of life at 6 weeks, 6 and 12 months. At 12 months, EQ-5D was better for women without mental health problems receiving PRIME (mean difference (MD) 0.06; 95 % confidence interval (CI) 0.02 to 0.10) or parenting support (MD 0.08; 95 % CI 0.01 to 0.14). Pre-existing mental health conditions influence quality of life in women with childbirth trauma. [ABSTRACT FROM AUTHOR]

Background Low socio-economic status ( SES), post-natal mental distress and parenting impact child mental health and future well-being. There are unexplained differences in child mental health between South Asian ethnic minority groups living in the UK that may be due to variation in, and differential mediation of, these factors. Methods We used multivariate multiple regression analysis of the effect of symptoms of mental distress, socio-demographic variables and warmth of parenting on child internalizing and externalizing scores at age seven (measured in 2010) in a population cohort of English children whose mothers were of Indian ( n = 211) and Pakistani ( n = 260) origin. Results In the fully adjusted models the legacy of mental distress was visible for both internalizing (β coefficient 1.52, P = 0.04) and externalizing (1.68, P = 0.01) behaviour in the Pakistani children, and on the Indian children's internalizing (2.08, P = 0.008) but not externalizing (0.84, P = 0.204) behaviour. Lower SES was associated with worse behavioural scores for the Pakistani children, and warmth of parenting on Indian children's externalizing scores. Conclusions Symptoms of post-natal mental distress are associated with Indian and Pakistani child outcomes at age seven. The finding that warmth of parenting had a stronger association on Indian children's externalizing scores than mental distress might be explained by differences in the expression of SES on family characteristics and functioning between the two ethnic groups. [ABSTRACT FROM AUTHOR]

High-risk families exposed to toxic stressors such as family violence, depression, addiction, and poverty, have shown greater difficulty in parenting young children. In this study, we examined the effectiveness of ATTACHTM, a 10−12 session manualized one-on-one parental Reflective Function (RF)-based parenting program designed for high-risk families. Outcomes of parent-child attachment and parental RF were assessed via the Strange Situation Procedure (SSP) and Reflective Function Scale (RFS), respectively. The protective role of ATTACHTM on parental depression was also assessed. Data were available from caregivers and their children < 6 years of age who participated in five pilot randomized control trials (RCTs) and quasi-experimental studies (QES; n = 40). Compared with the control group, caregivers who received the ATTACHTM-program demonstrated a greater likelihood of secure attachment with their children (p = 0.004) and higher parental RF [self (p = 0.004), child (p = 0.001), overall (p = 0.002)] in RCTs. A significant improvement in parental RF (p = 0.000) was also observed in the QES within ATTACHTM group analysis. As attachment security increased, receiving the ATTACHTM program may be protective for depressed caregivers. Results demonstrated the promise of ATTACHTM for high-risk parents and their young children.

This paper aims to provide a critical analysis of key concepts associated with post-natal depression (PND) to facilitate healthcare professionals with improving standards of care. Post-natal depression is often inadequately understood by healthcare professionals. The objective was to clarify and present understandings of PND. Post-natal depression may result in referral to Community Mental Health Teams and although initial contact and management is usually through Primary Care, increasingly there is involvement of liaison mental health nurses. A literature review and synthesis of research papers on PND was conducted. Using the keywords post-natal depression, post-partum, puerperium, perinatal, therapy, trial, review, systematic, 135 articles were yielded and limited to 57, which were critically reviewed and categorized into key concepts and themes. Synthesis of literature in relation to PND has facilitated construction of an evidence-based contemporary picture of clinical manifestation, aetiology, methods of screening, preventing, treating and managing PND. The veracity of the evidence surrounding the aetiology and treatment of PND is variable. Interventions are often ineffective and a vacuum in the evidence base exists leaving a dynamic environment for researchers to identify more successful ways of predicting, detecting, treating and managing PND. [ABSTRACT FROM AUTHOR]

Objective. To estimate the association between common mental disorders (CMD) during pregnancy and risk of low birth weight (LBW) or preterm birth (PTB). Methods. A prospective cohort study was conducted with 831 pregnant women from antenatal clinics in primary healthcare in São Paulo, Brazil. The clinical interview schedule-revised and demographic questionnaires were administered between the 20th and 30th weeks of gestation. Information on infant weight and gestational age at birth were obtained from hospital records. Univariate analyses were used to examine the association between the main exposure and main outcomes. Statistical associations were examined with χ2 tests. Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the main outcomes were obtained using a multivariable logistic regression model. Results. The prevalence of CMD during gestation was 33.6 (95% CI: 30.4-36.9). The follow-up rate was 99.5%. Sixty three (7.6%) newborns were classified as LBW and 56 (6.9%) were classified as PTB. CMD during pregnancy was not associated with risk of PTB (adjusted OR:1.03, 95% CI: 0.57-1.88) or LBW (adjusted OR:1.09, 95% CI: 0.62-1.91). Conclusions. CMD prevalence is high among low-income and low-risk pregnant women attended by public health services in a middle-income country, but not confer an increased risk for adverse obstetric outcome. [ABSTRACT FROM AUTHOR]

The aim of the present study was to analyse whether the Portuguese version of the Postpartum Depression Screening Scale (PDSS) was a valid instrument for screening postpartum depression. For this purpose the following objectives were delineated: (1) to analyse PDSS psychometric properties; (2) to determine PDSS cut-off points and associated conditional probabilities for screening depression according to DSM-IV and ICD-10 criteria; and (3) to compare the performance of PDSS with the Beck Depression Inventory-II (BDI-II) in screening for postpartum depression. Four hundred eighty-six 3-months-postpartum women completed both questionnaires and were interviewed with the Portuguese version of Diagnostic Interview for Genetic Studies (DIGS). The Portuguese version of the operational criteria checklist for psychotic illness (OPCRIT) was used to obtain DSM-IV and ICD-10 diagnoses of depression, our gold standards for caseness. PDSS reliability and validity were very good and equivalent to those reported in other versions, including the original. PDSS was an accurate screening instrument for postpartum depression, showing satisfactory combination of sensitivity and specificity (>80%). Compared to BDI-II it has the advantage of being more specific for the motherhood context. PDSS could be very useful for clinical and epidemiological purposes. [ABSTRACT FROM AUTHOR]

Objectives. To investigate which methods to identify post-natal depression are the most extensively validated, in what setting and in what language. Methods. A systematic search of the literature was undertaken to retrieve English and non-English language articles available until February 2007. This included searching 16 electronic databases, forward citation searching, personal communication with authors and inspection of reference lists. Results. A total of 60 studies (published in 64 articles) met the inclusion criteria. Four PND specific measures and nine generic depression (and sometimes anxiety) measures were found to have been validated against a diagnostic reference standard in pregnant or post-natal populations. The Edinburgh Post-natal Depression Scale (EPDS) was the most frequently validated method to identify women with PND. The EPDS has been translated and validated in 20 different languages. The majority of studies were undertaken at ante-natal clinics ( n=15), after the birth in post-natal wards ( n=12) or during post-natal visits or follow-up clinics ( n=16). Conclusions. The EPDS is the most frequently researched method to identify PND and has been translated and validated in multiple different languages. [ABSTRACT FROM AUTHOR]

Objectives: Research has shown that between 1 and 3% of women may suffer from post-traumatic stress disorder (PTSD) following childbirth. However, the potential effect of childbirth on fathers, and the implications of post-natal symptoms of PTSD for family relationships, have received little attention. The current study therefore examined the potential effects of PTSD symptoms on the couple's relationship and parent-baby bond. Design: Internet-based questionnaire study. Methods: One hundred and fifty-two parents (126 women and 26 men) completed questionnaire measures of PTSD, depression, quality of the couple's relationship, and the parent-baby bond. Results: Symptoms of PTSD and depression were significantly correlated with the couples' relationship and parent-baby bond. Structural equation modelling found the model that best fitted the data was one where PTSD symptoms had a direct effect on the parent-baby bond, but the effect of PTSD on the couples' relationship was mediated by depression. Conclusions: The results indicate the importance of examining the psychological reactions of men and women after birth; and suggest that symptoms of PTSD have an effect on the parent-baby bond. However, methodological considerations mean further research is needed to replicate and extend this study before firm conclusions can be drawn. [ABSTRACT FROM AUTHOR]

Background Post-natal depression is common and has been associated with adverse effects on children's later emotional and behavioural development. The evidence for effects on children's cognitive development is unclear but this could potentially be a major public health issue. The aim was to examine whether maternal depression and maternal caregiving during the first year of life are associated with children's subsequent language development. Methods One thousand two hundred and one women were recruited from antenatal and post-natal baby clinics in two areas in England, and followed up until their babies were 3 years. Mothers and children were assessed by questionnaire, interview and home observation; 999 children's language was assessed at 36 months, although 55 were excluded principally because they had been exposed to insufficient English. Results In bivariate analyses maternal depressive symptomatology in the post-natal year but not at 36 months was associated with poorer child language at 36 months; maternal caregiving, was positively associated with language. Structural Equation Modelling revealed that depression was associated with poorer caregiving but was not independently associated with language. Higher quality caregiving at 10 months was associated with better language. When the sample was split by socioeconomic factors the effects of depression on caregiving were stronger in the less advantaged group. In both groups poorer quality early caregiving predicted lower language outcome. Conclusions Post-natal depression had a negative effect on caregiving, which in turn affected language; post-natal depression did not have an additional direct effect on language. Socioeconomic factors moderated the effects of depression on caregiving. When targeting interventions at mothers with post-natal depression, it may be strategic to focus on lower socioeconomic groups at higher risk. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the relationship between postnatal depression and adult attachment style; maternal attachment style; and infant social-emotional behaviour. The sample comprised 139 mothers and 139 infants aged between three and twenty-four months. All respondents completed the ages and Stages Questionnaire, adult attachment Scale and Maternal attachment Scale as part of a battery of questionnaires. Results supported a relationship between a mother's adult attachment style, maternal attachment style, certain infant behaviours and postnatal depression. Along with major adjustments following childbirth and consequent hormonal fluctuations, women need to adapt to their new role as mothers, and reorganise marital and family relationships. These changes are generally positive, but they can predispose women to psychiatric disorders. although many women experience feelings of sadness after giving birth, an estimated 10-20% experience postnatal depression, a major depressive episode with the onset in the postnatal phase. Epidemiological studies define the postnatal phase as ranging from birth to six months after delivery 7. [ABSTRACT FROM AUTHOR]

Aim To examine the association between maternal post-natal depression and infant growth. Background Infant growth has recently been shown, in two studies from South Asia, to be adversely affected by maternal depression in the early post-partum period. It is uncertain whether a similar association obtains in developing countries outside Asia. Method A sample of 147 mother–infant dyads was recruited from a peri-urban settlement outside Cape Town and seen at 2 and 18 months post partum. Results No clear effect of post-partum depression on infant growth was found. Although maternal depression at 2 months was found to be associated with lower infant weight at 18 months, when birthweight was considered this effect disappeared. Conclusions Possible explanations for the non-replication of the South Asian findings are considered. [ABSTRACT FROM AUTHOR]

Background Epidemiological studies in Pakistan show high rates of depression in women, while rates of malnutrition in children are also high. This study aimed to determine whether poor maternal mental health is associated with an increased risk of infant undernutrition. Methods Clinic-based case-control study. A total of 172 consecutive infants and their mothers attending for 9-month measles immunization were recruited over a 3-month period. Eighty-two undernourished infants [weight for age below the National Centre for Health Statistics (NCHS)/World Health Organization (WHO) third centile] were matched to 90 controls (weight for age above 10th centile), and their mothers interviewed for mental distress using the Self-Reporting Questionnaire (WHO SRQ-20, a psychiatric screening instrument). Infants' exposure to maternal distress (score ≥ 10 on SRQ-20) and other potential risk or protective biological, social, socio-economic and family factors were measured. Results Mental distress determined by WHO SRQ-20 was associated with increased risk of undernutrition in infants (odds ratio 3.91, 95% confidence interval 1.95-7.86). This association remained significant after controlling for birthweight and social factors. Conclusion Exposure to maternal mental distress is associated with undernutrition in 9-month infants in urban Pakistan. These mothers may represent a group whose children are at higher risk of ill health, and potentially be a specific target for advice on infant care. Early recognition and treatment of mental health problems in mothers may help reduce morbidity and mortality rates in children. [ABSTRACT FROM AUTHOR]

There is little qualitative research on depression in motherhood from non-Western societies. The objective of the study described in this paper was to use qualitative methods to investigate the cultural validity of the construct of post-natal depression (PND) and its social and cultural contexts. The study was nested in a cohort of mothers recruited to study the risk factors and outcome of PND in Goa, India. In-depth interviews were carried out with 39 mothers (19 of whom were found to be suffering from PND as defined by a cut-off score on the Edinburgh PND scale) and their husbands purposively recruited from the cohort. An illness narrative was conducted with mothers who were categorized as suffering from PND and their husbands to elicit their explanatory models. The two groups (PND and non-PND) of mothers were comparable in terms of socio-demographic characteristics. PND mothers had lower levels of practical help and emotional support. The symptoms reported by PND mothers were similar to those recorded in studies with women in other cultures suggesting a universal clinical presentation of PND. Causal attributions for the experience of depression focused on economic difficulties and poor marital relationship. All mothers expressed the need for more practical help and support during the period after childbirth; husbands in both groups were often disengaged from baby care or supporting the mother. The study provides validity for the construct of PND in an Indian setting, but also shows that the emotional distress is interpreted from the context of social adversity, poor marital relationships and cultural attitudes towards gender rather than a biomedical psychiatric category. Contrary to the assumption that socio-cultural contexts associated with childbirth in non-Western societies protect mothers from depression, factors unique to the culture such as gender preference and the low involvement of husbands in child-care are major causes of stress to mothers. [Copyright &y& Elsevier]

Objective: The aims were (1) to establish whether Early Childhood Nurses (ECNs) can be trained in a modified Cognitive Behavioural Therapy (CBT) for Post-natal Depression (PND), and (2) to compare the outcome of women treated with this therapy with ‘ideal standard care’ using non-specific counselling by ECNs with no additional training. Method: Five ECNs were trained in CBT and supervised weekly. Women were screened post-natally using the Edinburgh PND Scale (EPDS) and diagnostically assessed by a research registrar. Women with DSM-IV major or minor depression (n=37) were then randomized into either ‘ideal standard care’ (n=20) or CBT (n=17) for six weekly sessions. Two stages of follow-up were undertaken: research registrar interview immediately post-treatment and a postal follow-up at six months. Results: The training package was evaluated both by ECN completed questionnaires and analysis of taped therapy sessions. These evaluations indicated that ECNs could deliver modified CBT. There was a very high rate of recovery at initial follow-up with 70–80% recovered (EPDS < 10) in both groups. Six month follow-up showed a trend towards CBT being more effective in the longer term. Conclusions: ECNs can effectively provide a modified CBT intervention in the treatment of PND. For the majority of this sample with mild-moderate depression, perceived support from their ECN (forming an integral part of both the baseline assessment interview and control condition) appeared to be as effective as modified CBT. [ABSTRACT FROM AUTHOR]

This paper illustrates how my work has developed over the years and informed my thinking about, and work with, depressed mothers. It also describes the work of the Parent Infant Foundation in Sydney where pregnant women and mothers with infants and toddlers are seen in groups and individually through home visits. The relevance of the support of a peer group when doing such difficult work is described. The paper draws on a central theme: the depressed mother, returning to her own infant beginnings through pregnancy and birth, confronts a dead mother-dead infant dyad. Trauma from the mother's own infancy is seen to have created an internal, autistic, deadened, psychic space. It is argued that behind this deadness lies the primeval pain of abandonment and loss. The associated rage, previously repressed but now awakened by her alive infant and his powerful primitive demands, invade the mother's psyche. The internal deadness freezes her alive processes as mother to her baby. Unbearable pain is awakened - and she may be in terror and unable to move, or she may experience herself as drowning in something catastrophic. SUMMARY This paper illustrates how my work has developed over the. [ABSTRACT FROM AUTHOR]