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Postpartum Depression (PPD) exerts a substantial negative effect on maternal well-being post-delivery, particularly among Cesarean Section (C/S) recipients. In this study, we aimed to review the efficacy of perioperative esketamine, the S-enantiomer of ketamine, in preventing PPD incidence and depressive symptoms as measured with the Edinburgh Postnatal Depression Scale (EPDS) after C/S. A systematic search for relevant articles was conducted in Scopus, PubMed, Web of Sciences, and PsycINFO until April 6, 2024. Meta-analyses were conducted using random-effect models to compare the PPD incidence and EPDS scores via log odds ratio and Hedge's g, respectively, during the first week post-C/S and at 42 days post-C/S in the esketamine and control group. Fourteen studies, including 12 randomized controlled trials and 2 retrospective cohorts, were reviewed. Our meta-analyses found lower PPD incidence during the first week (log odds ratio: −0.956 [95 % confidence interval: −1.420, −0.491]) and at day 42 post-C/S (log odds ratio: −0.989 [95 % confidence interval: −1.707, −0.272]) among patients administered esketamine compared to controls. Additionally, EPDS scores for the esketamine group were significantly lower than controls during the first week (Hedge's g: −0.682 [95 % confidence interval: −1.088, −0.276]) and at day 42 post-C/S (Hedge's g: −0.614 [95 % confidence interval: −1.098, −0.129]). Presence of various concomitant medications and heterogeneous study designs. Our review highlights the potential impact of esketamine in PPD prevention, as well as in alleviating depressive symptoms post-C/S, regardless of PPD occurrence, therefore suggesting the benefits of adding esketamine to peri-C/S analgesic regimen. • Perioperative esketamine administration can reduce PPD incidence following C/S. • Esketamine can also reduce the severity of depressive symptoms post-C/S. • These favorable effects were observed at both short- and long-term assessments. • Limited number of analyzed studies may reduce our findings' generalizability. • More research on esketamine's preventive effects on PPD is essential. [ABSTRACT FROM AUTHOR]

Background: New mothers and fathers are at risk of developing postnatal depressive problems. To understand how postnatal depressive symptoms unfold over time, analyses at the within-person level are necessary. Inspecting postnatal depressive problems at the symptom level provides a novel perspective, ultimately offering insight into which symptoms contribute to the elevation of other symptoms over time. Methods: Panel graphical vector-autoregression (GVAR) models were applied to analyze the within-person temporal and contemporaneous relations between depressive symptoms across the postnatal period in new mothers and fathers (at T1; Nmothers = 869, Nfathers = 579). Depressive symptoms were assessed at 6-, 12-, and 18-months postpartum, using the Edinburgh Postnatal Depression Scale. Results: The results revealed that for mothers, sadness was a key symptom predicting symptom increases in multiple other depressive symptoms and itself (autoregressive effect) over time. Furthermore, anxiousness and feeling scared predicted each other across the postnatal period in mothers. For fathers, the most central predicting symptom in the overall network of symptoms was being anxious, while self-blame and being overwhelmed had strong self-maintaining roles in the fathers' symptomatology, indicating that these could be key features in fathers experiencing postnatal depressive problems. The pattern of symptoms that mothers and fathers experienced within the same time window (contemporaneous associations), shared many of the same characteristics compared to the temporal structure. Conclusions: This study suggests that across the postnatal period, from 6- to 18-months postpartum, depressive symptoms in mothers and fathers contribute differently to the pattern of depressive problems, highlighting sadness as a key feature in maternal symptomatology and anxiousness components in paternal symptomatology. [ABSTRACT FROM AUTHOR]

Attention deficit/hyperactivity behaviors in children are often unnoticed until they reach school age; however, evidence suggests that attention deficit hyperactivity disorder (ADHD) tends to develop at an earlier age. Recent studies also indicate that perinatal maternal mental health is associated with ADHD symptoms in offspring. This study examines the association between maternal postpartum depression, early hyperactive/aggressive behavior, and later ADHD symptoms. This longitudinal cohort study used data from health checkups and surveys. Mothers with a postpartum Edinburgh postnatal depression scale score ⩾ 9 were considered as having postpartum depression symptoms. The presence of early hyperactive/aggressive behavior was determined based on 3-year-old children's health checkup data. The ADHD rating scale (ADHD-RS) answered by the caregivers of 182 sixth-grade children was used for the analysis. ADHD-RS scores were significantly higher in children with early hyperactive and/or aggressive behavior (p =.002) and for children of mothers who had postpartum depression symptoms (p <.001). Early hyperactive/aggressive behavior did not mediate the predictive association of maternal postpartum depression symptoms with ADHD symptoms in sixth grade. ADHD symptoms in the sixth grade were independently associated with childhood hyperactive/aggressive behavior at age 3 and maternal postpartum depression symptoms. [ABSTRACT FROM AUTHOR]

Summary: There is conflicting evidence regarding the association between epidural labour analgesia and risk of postpartum depression. Most previous studies were observational trials with limited ability to account for confounders. We aimed to determine if epidural analgesia was associated with a significant change in the incidence of postpartum depression in this randomised controlled trial. We enrolled women aged 21–50 years old with a singleton fetus ≥ 36 weeks gestation. Patients were advised regarding available labour analgesic modalities during enrolment (epidural block; intramuscular pethidine; nitrous oxide; or intravenous remifentanil). On request for analgesia, patients were offered the modality that they had been allocated randomly to first. Blinded investigators recorded patient and obstetric characteristics within 24 h of delivery and assessed for postpartum depression at 6–10 weeks following delivery using the Edinburgh Postnatal Depression Scale (score ≥ 13 considered positive for postpartum depression). The modified intention‐to‐treat population consisted of all patients who received any form of labour analgesia, while per‐protocol consisted of patients who received their randomised modality as their first form of labour analgesia. Of 881 parturients allocated randomly (epidural n = 441, non‐epidural n = 440), we analysed 773 (epidural n = 389, non‐epidural n = 384); 62 (15.9%) of women allocated to epidural group developed postpartum depression compared with 65 (16.9%) women allocate to the non‐epidural group. There were no significant differences in the incidence of postpartum depression between the two groups (adjusted risk difference (95%CI) 1.6 (‐3.0–6.3%), p = 0.49). Similar results were obtained with per‐protocol analysis (adjusted risk difference (95%CI) ‐1.0 (‐8.3–6.3%), p = 0.79). We found no significant difference in the risk of postpartum depression between patients who received epidural labour analgesia and those who utilised non‐epidural analgesic modalities. [ABSTRACT FROM AUTHOR]

Background: In the case of preterm birth, the idealized postnatal period is replaced by an anxious and even traumatic experience for parents. Higher prevalence of parental anxiety, postnatal depression, and posttraumatic stress disorder has been observed in mothers of preterm infants up to 18 months after childbirth. There is increasing evidence that proprioceptive stimulation has a beneficial effect on preterms' short-term outcomes. Could this care also have an impact on parental anxiety and depressive symptoms? We reviewed recent publications on the impact on parents' anxiety and depressive symptoms of delivering tactile and/or kinesthetic stimulation to their premature newborn. Methods: We conducted a systematic review by searching the PubMed, PsycInfo, Scopus, ScienceDirect and Google Scholar databases for English-language publications from the past 10 years. We focused on the mothers or fathers of infants born preterm (before 37 weeks of gestation) who provided tactile and/or kinesthetic stimulation to their premature newborn in the neonatal intensive care unit. Relevant outcomes were the parents' anxiety, stress, depressive symptoms, and symptoms of posttraumatic stress disorder, assessed with reliable standardized inventories. Results: Eleven articles were included in the systematic review. Results suggested a beneficial effect of parents' early tactile and kinesthetic stimulation of their preterm infants. Conclusions: These interventions may act as protective factors against the occurrence of anxiety and depressive symptoms in parents and deserve to be studied further in this population. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your knowledge, recognition and management of perinatal mental health issues • To find advice and inspiration on how to discuss perinatal mental health with future or new parents • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Perinatal mental health is a major public health issue. Around 12% of women experience depression and 13% experience anxiety during pregnancy and up to one in five experience depression and/or anxiety in the first year after childbirth. Fathers, partners or co-parents can also develop perinatal mental health issues, while unrecognised or untreated parental mental health conditions can negatively affect early child development. Most women who experience perinatal mental health issues are managed in primary care, however some require referral to specialist services. This article outlines the role of primary care professionals, such as community nurses, midwives and health visitors, in the early recognition and management of perinatal mental health issues. It describes how symptoms of depression and anxiety may manifest in the perinatal period and the presenting symptoms of postpartum psychosis, and details assessment and referral processes. The author suggests explorative questions that can be incorporated into discussions about mental health with future and new parents and describes a simple mnemonic that may assist primary care professionals in providing emotional support to families. [ABSTRACT FROM AUTHOR]

The study aims to investigate risk factors of paternal perinatal depression during the COVID-19 pandemic. We conducted an online cross-sectional study of 473 prenatal fathers and 1246 postnatal fathers in August 2021. We applied a modified Poisson regression to estimate relative risk ratios of possible factors for paternal perinatal depression (measured by Edinburgh Postnatal Depression Scale), sequentially introducing the following factors into the model: individual factors, interpersonal factors, obstetric/pediatric factors, and service utilization factors. Prenatal fathers with the following risk factors were at an increased risk for having depressive symptoms: adverse childhood experiences (risk ratio; RR 1.61), past depression (RR 1.63), fear of COVID-19 (RR 2.09), lower social support (RR 1.91), low family resources (RR 1.95), and intimate partner violence (IPV) victimization (RR 1.29). Postnatal fathers having the following risk factors were at an increased risk for having depressive symptoms: past depression (RR 1.67), fear of COVID-19 (RR 1.26), low family resources (RR 1.85), IPV victimization. (RR 1.18), and preterm birth (RR 1.18). The study showed risk factors such as past history of depression, high fear of COVID-19, low family functionality, and IPV victimization were associated with perinatal depressive symptoms. The findings should contribute to future directions of interventions for paternal perinatal mental health. [ABSTRACT FROM AUTHOR]

Maternal depression and anxiety symptoms are common across the perinatal period and are associated with a raised risk for adverse child outcomes. While substantial evidence exists for child outcomes such as behaviour, language and cognition, infant sleep has been less studied. In this longitudinal study, we examined the association between maternal symptoms of depression and anxiety and mother-reported infant sleep at 6 and 12 months. Across the four infant sleep outcomes, total sleep time, sleep onset latency, number of awakenings and a maternal perception variable, we found modest effects for concomitant depression symptoms. There were almost no additional effects for anxiety symptoms beyond that already accounted for by depression. Using trajectory modelling of maternal symptoms at five time points, we found more robust effects for maternal groups with postnatally emerging symptoms over prenatally present symptoms across all four sleep outcomes. Our strongest finding was that mothers with postnatal depression symptoms were more likely to perceive their infant's sleep as problematic compared with all other mothers. Where we found effects on duration-based infant sleep outcomes overall, these were small and clearest for depressive symptoms over anxiety symptoms. For both nighttime awakenings and perception of sleep as a problem, effects were apparent only for mothers in the postnatal symptom groups, and not for prenatal symptoms, at both infant ages six and 12 months. Our sample was a relatively high-socioeconomic group with low symptoms overall, and findings may not generalize to more vulnerable populations. • Maternal depression symptoms have modest but certain effects on infant sleep. • Anxiety symptoms had minimal additional effects on infant sleep. • Postnatal depression symptoms were linked with perceiving infant sleep as a problem. • Prenatal depression was linked to 2 infant sleep outcomes. • Postnatal depression was linked to all 4 sleep outcomes. [ABSTRACT FROM AUTHOR]

To evaluate and compare the factor structure and reliability of EPDS and PHQ in antepartum and postpartum samples. Parallel analysis and exploratory factor analysis were conducted to determine the structure of both scales in the entire sample as well as in the antepartum and postpartum groups. McDonald's omega statistics examined the utility of treating items as a single scale versus multiple factors. Multigroup confirmatory factor analysis (MCFA) was utilized to test the measurement invariance between the antepartum and postpartum groups. Two-factor models fit best for the EPDS in both the antepartum and postpartum groups; however, the most reliable score variance was attributable to a general factor for each scale. MCFA provided evidence of weak invariance across groups regarding factor loadings and partial invariance regarding item thresholds. PHQ-9 showed a two-factor model in the antepartum group; however, the same model did not fit well in the postpartum group. EPDS should be preferred to PHQ-9 for measuring depressive symptoms in peripartum populations. Both scales should be used as a single-factor scale. Caution is required when comparing the antepartum and postpartum scores. [ABSTRACT FROM AUTHOR]

Prenatal and postnatal depression potentially have severe consequences, but we do not know to what extent they have the same etiological factors. Genetically informative designs yield insight into common etiology between pre- and postnatal depression and inform on potential prevention and intervention efforts. This study evaluates the overlap in genetic and environmental factors in pre- and postnatal depression symptoms. We conducted univariate and bivariate modeling, using a quantitative, extended twin study. The sample was a subsample of the MoBa prospective pregnancy cohort study in 6039 pairs of related women. Measurement was conducted at week 30 of pregnancy and 6 months following delivery, using a self-report scale. The heritability of depressive symptoms was 16.2 % (95 % CI = 10.7–22.1) prenatally and 25.7 % (95 % CI = 19.2–32.2) postnatally. The correlation between risk factors for prenatal and postnatal depressive symptoms was at unity (r = 1.00) for genetic effects, and at disunity (r = 0.36) for environmental effects. The genetic effects for postnatal depressive symptoms were 1.7 times larger compared to prenatal depressive symptoms. Although genes for depression become more influential postpartum, only future studies can inform on the mechanisms for such a socio-biological augmentation of effect. Genetic risk factors for prenatal and postnatal depressive symptoms are indistinguishable in kind, with greater impact after birth, whereas environmental risk factors for depression symptoms are mostly non-overlapping before and after birth. These findings indicate that interventions could be of different kind before and after birth. • Perinatal depression are common disorders with potentially severe consequences. • Pre- and postnatal depression - same kind of genes, but different environments. • Genes are of same kind, but are 1.7 times more important postnatally. • Environments were of different kinds, but of similar importance. • Fundamental biological mechanism for perinatal depressions are the same. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your ability at detecting risk factors and signs of paternal postnatal depression • To improve your knowledge and skills in supporting men who experience paternal postnatal depression • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) The prevalence of postnatal depression in fathers is likely to be close to the prevalence of postnatal depression in mothers. Beyond the detrimental consequences for the father, paternal postnatal depression negatively affects the well-being of the mother and the development of the child. Paternal postnatal depression is not commonly understood and there is a lack of assessment and support for new fathers experiencing mental health issues, but the importance of paternal mental health is increasingly recognised. Expertise around paternal postnatal depression is likely to be limited because research is scarce and healthcare professionals lack experience of it. However, mental health nurses can use their skills and competencies to identify expectant or new fathers at risk of postnatal depression, detect signs and symptoms of the condition, adopt an inclusive, sensitive and compassionate approach, encourage fathers to talk about their mental health issues, and refer or signpost them to further support as needed. [ABSTRACT FROM AUTHOR]

We aim to test the feasibility and effectiveness of Premature Triadic Music Therapy (PT-MT) in the premature baby unit. The design was a clinical pre-test-post-test trial with a convenience sample. Inclusion criteria were a gestational age higher than 28 weeks for preterm infants and the absence of shock or extreme distress for parents. Six preterm children (with a gestational age of 33 to 36 weeks) and their parents participated in the study. For the children, we measured heart rate, blood perfusion, and blood saturation at three different times (pre-PT-MT, during PT-MT, after PT-MT) as quantitative indicators of distress. Their parents completed the Edinburgh Postnatal Depression Scale (EPDS) before and after the PT-MT intervention. We found a statistically significant lower heart rate and a marginally statistically significant higher blood perfusion during PT-MT, as compared to the baseline. However, these changes were not present at the end of PT-MT. The parents' EPDS scores were not statistically significantly lower at the post-test, although, the Medians of the scores did decrease. PT-MT is a promising intervention for the reduction of distress in both parents and children. Further studies should include a higher number of sessions and participants. [ABSTRACT FROM AUTHOR]

Previous studies have demonstrated that oxytocin was a viable therapy option for postpartum depression. However, the role remains controversial. To evaluate the efficacy of oxytocin on women postpartum depression, we searched PubMed, Web of Science, Cochrane Library, and EmBase for literatures from inception of the database to April 18th, 2022. Randomized controlled trials (RCTs) that investigated the effects of oxytocin on postpartum depression were selected for this study. Six RCTs (195 women) were gathered. The effects of oxytocin were roughly divided into emotion and cognition. The modulation of oxytocin to women's emotion was demonstrated in four of the trials. The results were conflicting: One trial showed that oxytocin alleviated the depressive mood; two trials showed that oxytocin had no effect (but reduce negative thoughts in healthy mothers, or decrease the narcissistic trait); another trial showed that oxytocin aggravated depression. Women's cognition was shown to be regulated by oxytocin in four of the trials. In general, oxytocin enhanced postpartum depressive women's perception of their relationship with the infants. This systematic review showed that the effect of oxytocin on postpartum depression is still uncertain. We partly support that exogenous oxytocin might improve the cognition of women with postpartum depression to their infants, while the effect on emotion is still controversial. Further RCTs with larger samples and more diversified evaluation criteria are needed to better reveal its efficacy on postpartum depression. [ABSTRACT FROM AUTHOR]

Finding modifiable predictors of paternal depression symptoms is helpful for developing interventions. The aim is to assess the unidirectional and/or bidirectional associations between paternal postpartum depression symptoms and coparenting among fathers of infants and toddlers. Longitudinal data were collected prospectively from 429 fathers of infants aged 0–24 months (median = 8 months) in Sweden, with 6- and 18-month follow-ups. All fathers participated in at least two of three waves of data collection, and multiple imputation was used for missing values. The Edinburgh Postnatal Depression Scale was used to detect depression symptoms (≥10 points), while the Brief Coparenting Relationship Scale measured the coparenting relationship. A cross-lagged panel model was used to estimate the associations between paternal depression symptoms and coparenting relationship quality over time, controlling for several known covariates and COVID-19 exposure. Fathers with higher coparenting scores at Time 1 and 2 had less depression symptoms at Time 3, and fathers with more depression symptoms at Time 2 had lower coparenting scores at Time 3. Plotted probabilities of having at least mild depression symptoms revealed a multifold increase in the probability of depression symptoms at Time 3 for fathers with minimal coparenting scores at Times 1 and 2, respectively, compared to fathers with mean coparenting scores at Times 1 and 2, respectively. Causal links cannot be determined using the current non-experimental study design. Using the EPDS alone may have missed some fathers with depression symptoms. Clinicians seeking to reduce paternal depression symptoms should help strengthen the coparenting relationship. • Finding modifiable factors to help reduce paternal postpartum depression benefits the whole family • Cross-lagged panel models showed bidirectional associations between paternal depression symptoms and coparenting • Fathers reporting low coparenting levels are at significantly higher risk of reporting depression symptoms (and vice versa) • Clinicians should support the coparenting relationship to decrease paternal depression in fathers of infants and toddlers [ABSTRACT FROM AUTHOR]

Maternal antenatal depression experienced around conception or during pregnancy may adversely affect child development. This study explores three potential mechanisms of the effects of antenatal depression on children's developmental delays at 2–3 years: gestational age of the child, continued depressive symptoms postnatally, and interrupted breastfeeding practices. Mothers (N = 2888) of 3450 children, including 2303 singletons and 1147 multiples from the Upstate KIDS cohort provided data. Linked hospital discharge data was combined with mothers' reports to identify women with moderate to severe antenatal depression. Gestational age was extracted from birth certificates. Mothers completed a depression screener at 4 months postpartum, reported about their breastfeeding practices from 4 to 12 months postpartum, and completed a developmental delay screener when children were 24, 30, and 36 months. In unadjusted path analysis models, mothers with antenatal depression had more postnatal depressive symptoms and breastfed fewer months, which translated into children being more likely to have developmental delays. Gestational age was not a mediator. Effects were similar across girls and boys and singletons and twins, and largely held when adjusting for covariates. Main limitations were the relatively advantaged sample and reliance on maternal report. Maternal antenatal depression may impact child development through continued depressive symptoms in the postpartum period and through reduced breastfeeding duration suggesting additional targets for intervention. • This study explored 3 potential mechanisms of antenatal depression's effects on children's developmental delays at 2-3 years. • Associations were partially mediated by postnatal depression symptoms and breastfeeding duration, but not gestational age. • Models were similar across singletons and twins as well as girls and boys. • Beyond treating depression, this study suggests that breastfeeding may be a viable target for intervention. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: A significant proportion of fathers report experiencing depression after their baby is bornFathers are not offered regular support for their psychological well‐being in the transition to parenthood despite an acknowledged need for such support What does the paper add to existing knowledge?: Lived experience provides new insight into how one father experienced postnatal depression, including the role of his partner in help‐seekingIt explains the delayed presentation in help‐seeking as resulting from healthcare practitioner language and attitudes, and gendered expectations around mental health and help‐seeking in the context of fatherhood What are the implications for mental health nursing?: Mental health nurses should be aware that postnatal depression can affect fathers as well as mothers, and that it is necessary to support fathers in safe spaces and with appropriate languagePlanning care for depression in men should consider the recent birth of a child in order to provide effective careClearer guidance is needed for supporting new fathers with postnatal depression Introduction: Fathers are not universally supported with their perinatal mental health, but evidence shows that they suffer at a similar level to mothers. Aim: This paper examines the journey of one father through his PND experience, his help seeking, and encounters in healthcare, in order to highlight the needs of a depressed father. Method: The method is a father's lived experience narrative which has been written alongside a health visitor who highlights the relevance of the condition to healthcare practice. Results & Discussion: The needs of fathers are unmet. They require support which considers their gender role expectations. Partners are key to their help seeking. Implications for practice: The language and sensitivity used by nurses is key to encouraging fathers to share their depression and reduce stigma around the condition. [ABSTRACT FROM AUTHOR]

Aim: To test whether the implementation of the Close Collaboration with Parents intervention at a neonatal intensive care unit (NICU) decreases depression symptoms of mothers up to two years after the delivery of preterm infants. Methods: We used a non‐equivalent two‐group design, comparing mothers of very low birthweight infants in the same NICU before (2001–2006) and after (2011–215) the intervention. The unit carried out the educational intervention (2009–2012) that was targeted at its healthcare team and aimed to improve their skills to collaborate with parents. Maternal depression symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) six months and two years after the expected birth date of the infant. Results: We found a median difference of 2.56 (95% CI from 1.64 to 3.48) in EPDS at the two‐year follow‐up between the pre‐intervention and post‐intervention groups, p < 0.001. Furthermore, we found no interaction between measurement time‐points and group, implying that the intervention effect on maternal depression symptoms was similar at the six‐month and two‐year time‐points. Conclusion: The intervention seems to have long‐term preventive effects on maternal depressive symptoms. This effect is of clinical significance as prolonged maternal depression associates with adverse child outcomes. [ABSTRACT FROM AUTHOR]

This study explores whether young, low-income mothers' prenatal attachment to their infants is related to attachment and parenting behaviour postnatally. A small literature has documented continuity in maternal attachment from pregnancy to postpartum and shown that early maternal attachment is associated with positive parenting behaviour. Less is known about whether prenatal attachment has a unique impact on parenting behaviour, or if it is primarily a step in the development of postnatal attachment, which in turn influences parenting. Additionally, it is unclear whether associations between attachment and early parenting might be attributable to other factors such as depressive symptoms. This longitudinal study followed young primiparous mothers from pregnancy through 3-weeks postnatal. 240 ethnically/racially diverse low-income American women reported their attachment-related thoughts and feelings and their depressive symptoms during pregnancy and postnatally. At 3 weeks postpartum, mothers were observed interacting with their infant. There was stability in attachment and depressive symptoms from pregnancy to postpartum. In multivariate path models, prenatal attachment was directly associated with two types of parenting behaviour: positive engagement and encouragement of learning, even when accounting for depressive symptoms and postnatal attachment. There was an indirect effect of prenatal attachment on sensitivity through postnatal attachment. The foundation of a mother's emotional connection to her infant begins before birth. Parenting support programmes for young mothers should begin during pregnancy. Supporting the establishment of positive prenatal attachment may also have a positive influence on later parenting behaviour among mothers, including mothers experiencing depressive symptoms. [ABSTRACT FROM AUTHOR]

There is a lack of information on how maternal stress coping styles during admission of the newborn to the neonatal intensive care unit (NICU) influences the onset of the postpartum depression (PPD). We examined potential risk factors for the emergence of the PPD in mothers whose infants were admitted to the NICU. A cross-sectional study was conducted on 401 mothers, 125 were mothers whose infants were admitted to the NICU and 276 mothers without NICU care. Newborn illness severity information score was taken throughout NICU admission via the Clinical Risk Index for Babies (CRIB). Six weeks after giving birth, participants from both groups individually completed the Edinburg Postnatal Depression Scale (EPDS), the Postpartum Bonding Questionnaire (PBQ) and the Coping Strategies Inventory (CSI) using an online platform. No differences were found regarding PPD and bonding in either groups. Multivariate analysis provided a final model in which cognitive restructuring, problem avoidance, severity of neonatal health problems during the first 12 hours of life, and problem solving were the best predictors of postpartum depression explaining, 43.7% of the variance in the NICU group. It is necessary to obtain early detailed information on coping styles in the NICU environment to prevent the possible onset of PPD. [ABSTRACT FROM AUTHOR]

Ongoing disturbances in parental psychological functioning are proposed as one of the mechanisms linking maternal PPD and adverse child development. We examined the effect of maternal PPD on mothers' and fathers' parenting stress and depressive symptoms at child age five. Depressive symptoms and parenting stress were assessed using self-report questionnaires at child age five in a sample of nonclinical mothers (n = 31) and mothers previously diagnosed with PPD (n = 12) and their partners. Maternal PPD diagnosis was associated with mothers' but not fathers' depressive symptoms at child age five. Maternal PPD diagnosis was associated with more parental distress in mothers and fathers, although, for mothers, this relationship was better explained by own concurrent depressive symptoms. Finally, maternal PPD diagnosis was associated with mothers reporting more difficult parent–child interactions. Overall, the study shows that maternal PPD diagnosis has long-term negative effects on both mothers' and fathers' parenting resources. [ABSTRACT FROM AUTHOR]

Background and Aim: Maternal mental health difficulties during the perinatal period are prevalent and have a negative impact on both women and their infants. Universal perinatal mental health screening has focused primarily on symptoms of depression, with limited attention given to anxiety, despite its high prevalence. This is partly due to the lack of valid maternal anxiety symptom screening tools. The aim of this study was to assess the factor structure, validity, and reliability of the Spanish version of the Perinatal Anxiety Screening Scale. Participants and Method: 265 women participated in the study, 138 of them were assessed during their third trimester of pregnancy and 127 at 3 months postpartum. An Exploratory Factor Analysis was used to examine the factor structure of the PASS, the number of factors was determined using a Velicer MAP test. Results: A four-factor solution was obtained, which slightly differed from the original version of the instrument. High reliability for the subscales and the global score, as well as adequate validity, and test-retest reliability were observed. Conclusions: The Spanish version of the Perinatal Anxiety Screening Scale has good psychometric properties, which warrants its use in Chile. Future studies are needed to assess the validity of the instrument in other Latin-American contexts. [ABSTRACT FROM AUTHOR]

Background: Transitioning to motherhood is an important life event. Stress often arises due to feeding concerns, infant crying, and sleep problems. Neuroprotective Developmental Care (NDC) also known as the Possums programs provides an evidence-based, consistent and holistic approach to maternal and infant wellbeing. Objectives: To understand maternal characteristics at point of services access and an exploratory evaluation of effectiveness of NDC/Possums services. Methods: All mothers accessing NDC/Possums services via clinical services or self-paced online modules were invited to participate in a baseline survey. Follow up occurred when infants were 6 and 12 months of age. Participants who completed the 6-month survey were compared against their own baseline surveys. Those who completed the survey at 12-months were compared against their own baseline surveys. A pseudo-control group who had completed the baseline survey with infants 12 months of age was also compared to those who had accessed NDC/Possums services prior to 12 months of age (termed 'intervention' group). Results: Crying time, mothers' perceptions of infant sleep problems, mothers' own sleep, mothers' Acceptance and Action Questionnaire (AAQ) scores and the mothers' Edinburgh Postnatal Depression Scale (EPDS) scores showed statistically significant improvements from baseline to 12-month old follow-up. Significant differences were also found between the pseudo-control group and 'intervention' groups. Conclusions for Practice: This results indicate that accessing NDC/Possums services is efficacious in addressing infant's crying, the mother's perceptions of their baby's sleep problems, the mother's own sleep satisfaction, the mother's experiential avoidance, and the mother's risk of postnatal depression. NDC is relevant to public health, clinical service delivery and education for health professionals. [ABSTRACT FROM AUTHOR]

Background: Perinatal depression causes significant burden to women and their families during the perinatal period. However, there is no reliable national prevalence data on perinatal depression in Malawi. Aim: This systematic review aimed at establishing the pooled prevalence of perinatal depression. Setting: The study setting is Malawi. Methods: Two reviewers conducted the search, selection, quality evaluation and data abstraction. Appropriate terms were used to search the CINAHL, PsychINFO, PubMed and ScienceDirect databases. The relevance and the quality of the studies were assessed. The prevalence of prenatal depression was pooled using a random-effects model, which was used to synthesise the data. Results: The review included a total of eight articles of fair and good quality. This review found a pooled prevalence of antenatal depression of 17.1% (95.0% confidence interval [CI]: 12.5-22.2) and postnatal depression of 19.8% (95.0% CI: 4.6-42.1) with an overall pooled prevalence of perinatal depression of 18.9% (95.0% CI: 14.5-23.8). Conclusion: This systematic review provided a pooled prevalence of perinatal depression which may be used in the absence of national prevalence data on perinatal depression. Contribution: This systematic review found a high a pooled prevalence of perinatal depression in Malawi suggesting that mental health should be a key component of maternal health programmes, policies and activities in the local setting. [ABSTRACT FROM AUTHOR]

Background: The factors contributing to probable postnatal depression (PND), a type of clinical depression that can affect woman after childbirth, are socially derived. Therefore, variations among groups of women necessitate studies in different communities. Aim: This study compared the prevalence of PND and associated factors among women attending postnatal services facilities. Setting: The study setting included Tshwane Municipal district in Gauteng province (GP) and Fezile Dabi District (FS) in Free State province (FSP), South Africa. Methods: A total of 477 mothers within 12 weeks of giving birth were recruited by convenient sampling in health facilities. A self-developed questionnaire was used to obtain information on socio-demographics, obstetric history, and children's characteristics. The Edinburgh Postnatal Depression Scale (EPDS) was used to collect data on depression symptoms, with a score of ≥13 used as a cut-off for probable PND. Data were analysed using STATA 14. Multivariate logistic regression was used to determine association between probable PND and various covariates. Results: The overall mean age of women was 28 ± 6 years. The overall prevalence rate of PND was 22%, slightly higher in FS (23%) than in GP (21%). Most participants living in GP were married, had tertiary education, were employed and from the households with income of more than R8000.00. A chi-square test showed that planned pregnancy was significantly higher in GP compared with FS (p &8805; 0.001). Multivariate logistic regression showed that support from a partner or husband decreased the odds of a probable PND in GP (adjusted odd ratio [AOR] 0.37; 95% confidence interval [CI] [95%CI: 0.14-0.96; p = 0.041] and in the FS [AOR = 0.14, 95%CI: 0.05-0.40; p ≥ 0.001]). Significant associations of probable PND with several factors - planned pregnancy, baby age, support in difficult times, partner or husband drinking alcohol and stressful events - were more common in the FSP than in the GP. Conclusion: The prevalence of probable PND and its associated risk factors in the GP and the FS indicates the need for routine screening and targeted interventions in both urban and rural settings. [ABSTRACT FROM AUTHOR]

Background: Many perinatal mental health risk factor studies report that antenatal depression is a signifcant risk factor for women being depressed postnatally. They often describe the strength of the risk as being 'strong' or 'strongly predictive' (or similar phrases), though usually without explaining why these terms are used. It is possible that readers of such research may misunderstand these qualitative descriptors.Method: As part of routine teaching regarding risk analyses, we explored participants' understanding of the conclusion stated in one specific perinatal risk study, which was that antenatal depression "strongly predicts" postnatal depression. Participants were groups of mental health professionals and postgraduate students, in Italy (N = 56) and Australia (N = 34).They completed an Estimate Survey, in which they indicated the actual number of antenatally depressed women they expected would have been depressed postpartum, given the study's conclusion.Results: The majority of survey respondents (~80%) expected that "strongly predicts" meant that a much higher proportion of women with the risk then became depressed than was actually the case. Some participants expressed major concern at the study's conclusion.Limitation: Participants comprised two small convenience samples of health professionals and postgraduate students, and thus may not be representative of the population.Conclusion: Studies that rely on the statistical significance of their analyses to conclude whether antenatal depression is a strong predictor or risk for postnatal depression may not accord with how health professionals interpret the data, once the absolute risk information is clearly provided. Recommendations for improving the reporting of results in such studies are made. [ABSTRACT FROM AUTHOR]

Background: There is good evidence that female infants are particularly vulnerable to poor emotional outcomes following in utero glucocorticoid exposure. It is currently unclear whether such effects might persist into the postnatal period for breastfed infants, as maternal cortisol is expressed in breastmilk and is influenced by maternal psychological distress. We pre-registered hypotheses that maternal postnatal depression would be associated with infant negative emotionality, and that this effect would be moderated by breastfeeding status and infant sex. Methods: We analysed data from the Wirral Child Health and Development Study (WCHADS), a prospective epidemiological study starting in pregnancy. Nine weeks after birth mothers self-reported depressive symptoms and breastfeeding status, and reported infant negative emotionality using the distress to limits subscale of the infant behaviour questionnaire (IBQ-R) when their infant was aged 9 weeks and 14 months. Maximum likelihood estimations made use of data from 857 mother-infant pairs. Results: At 9 weeks of age, maternal postnatal depressive symptoms were positively associated with infant distress to limits; however, this effect was not moderated by infant sex or breastfeeding. At age 14 months, the association between postnatal depression symptoms and distress to limits was greatest in the breastfed females, whereas the association was smaller, but still significant, in the non-breastfed females. For males, the association was non-significant in both the breastfed and non-breastfed groups. A test of sex difference between breastfed males and females was significant. Conclusions: We provide evidence that effects of maternal postnatal depression on child emotional outcomes are moderated by breastfeeding status and differ by infant sex. Female vulnerability to elevated maternal breastmilk glucocorticoids may, at least in part, explain these effects. Highlights: Female infants breastfed by mothers with high depressive symptoms showed the highest levels of negative emotionality at age 14 months. Conversely, female infants breastfed by mothers with very low depressive symptoms showed the lowest negative emotionality. Negative emotionality of males was unrelated to maternal postnatal depression and breastfeeding at 14 months of age. We provide novel evidence that effects of maternal postnatal depression on infant emotional outcomes is moderated by breastfeeding status and differs by infant sex. [ABSTRACT FROM AUTHOR]

Background: There is a lack of studies that examine the complex relationship between parental mental health, parental sensitivity and responsiveness, and parent-infant bonding. This study aimed to test whether parental sensitivity and responsiveness were mediators between postpartum mental health (depression, anxiety, and stress) and parent-infant bonding in mothers and fathers. Method: Mothers (n = 427) and fathers (n = 170) of infants aged up to 1-year-old participated in an online study. The parents completed questionnaires on depression (Edinburgh Postnatal Depression Scale, EPDS), anxiety and stress (Depression, Anxiety, and Stress Scale, DASS-21). Parent-infant bonding was measured by Postpartum Bonding Questionnaire (PBQ) that has three components: Impaired bonding (PBQ1), Anxiety about care and parental distress (PBQ2), and Lack of enjoyment and affection with infant (PB3Q). Parental sensitivity was measured as the number of correct recognitions of infant facial expressions (City Infant Faces Database, CIFD). Responsiveness was measured as a self-report with two subscales of responsiveness and non-responsiveness (Maternal Infant Responsiveness Instrument, MIRI). Results: The path analysis showed that the model had a good fit to the data. Parental sex was a significant moderator, indicating different paths in mothers and fathers. In mothers, responsiveness and non-responsiveness were significant mediators between depression symptoms and three dimensions of bonding. In fathers, only non-responsiveness was a significant mediator between anxiety and PBQ3. Although recognizing infant facial expressions directly affected PBQ3 in mothers (but not in fathers), it was not a significant mediator between mental health and bonding. Conclusion: Higher levels of parental mental health problems (depression and anxiety) were associated with lower levels of parental responsiveness, which is, in turn, related to poor parent-infant bonding. Prevention and intervention programs should be offered for both mothers and fathers, focusing on postpartum mental health promotion and enhancing responsiveness in infant care. [ABSTRACT FROM AUTHOR]

Purpose: There is limited knowledge on the relationship between postnatal depression and childbirth pain characteristics associated with childbirth. We investigated whether the characteristics of childbirth pain, as assessed by Short-form-McGill Pain Questionnaire-2 (SF-MPQ-2), were associated with postnatal anxiety and depressive disorders. Patients and Methods: Nulliparous parturients who received labor epidural analgesia (LEA) and delivered in our institution were invited to have a Mini-International Neuropsychiatric Interview (MINI) assessment following their 5– 9 weeks post-delivery follow-up phone survey of a larger study. Parturients' demographics, pre-delivery questionnaires on pain and psychological vulnerabilities, LEA data, maternal and neonatal outcomes, postnatal follow-up survey on pain and psychological vulnerabilities, pain and breastfeeding were collected accordingly. The primary outcome was the binary variable (yes/no) of the presence of postnatal depression and/or anxiety disorders based on the post-delivery MINI assessment. Results: Among the 107 parturients who participated in the post-delivery MINI assessment, a total of 40 (42.5%) patients were found to have postnatal anxiety and depressive disorders. A greater pre-delivery SF-MPQ-2 neuropathic pain mean subscale score (adjusted odds ratio (OR) 1.32, 95% CI 1.00– 1.73, p=0.0482) and greater post-delivery Edinburgh Postnatal Depression Scale (EPDS) at 5– 9 weeks post-delivery (adjusted OR 1.30, 95% CI 1.13– 1.50, p=0.0002) were independently associated with the presence of postnatal anxiety and/or depressive disorders (receiver operating characteristic (ROC) = 0.7489). Conclusion: Patients with greater pre-delivery neuropathic pain and higher EPDS scores at 5– 9 weeks post-delivery are more likely to have postnatal depression and/or anxiety disorders, suggesting possible associations between pain and psychological vulnerability in the development of postnatal mental disorders. [ABSTRACT FROM AUTHOR]

Introduction: The transition to parenthood is a major life change that may affect the mental well‐being of both mothers and fathers and place them at an increased risk for depression. The objective of our study was to systematically review the literature and identify factors associated with postpartum depressive symptoms in fathers. Material and methods: Searches were conducted in PubMed, PsychInfo, Embase, and CINAHL to identify studies published until March 2020. Studies that reported factors associated with depression among fathers were included. The data from these studies were extracted independently by two authors with disagreements resolved by a third author and consensus. The odds ratio (OR) was used as a measure of association between the risk factor and the primary outcome: depression within the first 12 months following childbirth among fathers diagnosed using any method. Summary estimates were calculated using a random effects model. The associations between the risk factors and depressive symptoms were evaluated. Results: The search identified 1040 reports. After screening titles and abstracts, 62 full‐text articles were assessed for eligibility and 25 studies involving 13 972 fathers were included in the systematic review. Fathers with a prior mental health illness episode had higher odds of developing depressive symptoms than those with no mental health history (eight studies, n = 3515, pooled OR 6.77, 95% CI 5.07–9.04; I2 = 0%). Other significant risk factors included relationship dissatisfaction (eight studies, n = 6924, pooled OR 1.53, 95% CI 1.29–1.81; I2 = 93%), maternal depression (seven studies, n = 6661, pooled OR 1.66, 95% CI 1.27–2.17; I2 = 88%), financial instability (five studies, n = 3052, pooled OR 2.24, 95% CI 1.44–3.48; I2 = 74%), paternal unemployment (three studies, n = 1505, pooled OR 6.61, 95% CI 1.94–22.54; I2 = 59%), low education level (two studies, n = 1697, pooled OR 3.56, 95% CI 1.06–11.97; I2 = 88%), and perceived stress (two studies, n = 692, pooled OR 1.06, 95% CI 1.02–1.11; I2 = 5%). Lack of support and low parenting self‐efficacy were also associated with paternal postpartum depressive symptoms. Conclusions: A history of paternal mental illness, maternal depression, and diverse psychosocial factors were associated with depressive symptoms among fathers postnatally. These findings can guide the development of family‐level interventions for early identification and treatment and social media campaigns to promote help‐seeking behaviors and engagement in preventive strategies. [ABSTRACT FROM AUTHOR]

Postnatal depression (PND) is common and predicts a range of adverse maternal and offspring outcomes. PND rates are highest among women with persistent mental health problems before pregnancy, and antenatal healthcare provides ideal opportunity to intervene. We examined antenatal perceived social support as a potential intervention target in preventing PND symptoms among women with prior mental health problems. A total of 398 Australian women (600 pregnancies) were assessed repeatedly for mental health problems before pregnancy (ages 14-29 years, 1992-2006), and again during pregnancy, two months postpartum and one year postpartum (2006-2014). Causal mediation analysis found that intervention on perceived antenatal social support has the potential to reduce rates of PND symptoms by up to 3% (from 15 to 12%) in women with persistent preconception symptoms. Supplementary analyses found that the role of low antenatal social support was independent of concurrent antenatal depressive symptoms. Combined, these two factors mediated up to more than half of the association between preconception mental health problems and PND symptoms. Trialling dual interventions on antenatal depressive symptoms and perceived social support represents one promising strategy to prevent PND in women with persistent preconception symptoms. Interventions promoting mental health before pregnancy may yield an even greater reduction in PND symptoms by disrupting a developmental cascade of risks via these and other pathways. [ABSTRACT FROM AUTHOR]

Postnatal/postpartum depression (PND/PPD) had a pre-COVID-19 estimated prevalence ranging up to 23% in Europe, 33% in Australia, and 64% in America, and is detrimental to both mothers and their infants. Low social support is a key risk factor for developing PND. From an evolutionary perspective this is perhaps unsurprising, as humans evolved as cooperative childrearers, inherently reliant on social support to raise children. The coronavirus pandemic has created a situation in which support from social networks beyond the nuclear family is likely to be even more important to new mothers, as it poses risks and stresses for mothers to contend with; whilst at the same time, social distancing measures designed to limit transmission create unprecedented alterations to their access to such support. Using data from 162 mothers living in London with infants aged ≤6 months, we explore how communication with members of a mother's social network related to her experience of postnatal depressive symptoms during the first "lockdown" in England. Levels of depressive symptoms, as assessed via the Edinburgh Postnatal Depression Scale, were high, with 47.5% of the participants meeting a ≥11 cut-off for PND. Quasi-Poisson regression modelling found that the number of network members seen in-person, and remote communication with a higher proportion of those not seen, was negatively associated with depressive symptoms; however, contact with a higher proportion of relatives was positively associated with symptoms, suggesting kin risked seeing mothers in need. Thematic qualitative analysis of open text responses found that mothers experienced a burden of constant mothering, inadequacy of virtual contact, and sadness and worries about lost social opportunities, while support from partners facilitated family bonding. While Western childrearing norms focus on intensive parenting, and fathers are key caregivers, our results highlight that it still "takes a village" to raise children in high-income populations and mothers are struggling in its absence. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the association between mother–child bonding at 6–9 months after birth and suicidal ideation Methods: A cross-sectional study embedded in a clinical trial with 358 low-income postpartum women who had antenatal depression in São Paulo, Brazil. The Postpartum Bonding Questionnaire and the Patient Health Questionnaire-9 were used Results: The percentage of the main outcome, suicidal ideation (SI) was 10.3%. Using logistic regression models, bonding impairment (BI) was associated with SI even after controlling for postpartum depression and other covariates. Conclusions for Practice: SI affects 10% of vulnerable postpartum women. BI is independently associated with SI. Treating BI may prevent SI [ABSTRACT FROM AUTHOR]

Background: Child abuse and postnatal depression are two public health problems that often co-occur, with rates of childhood maltreatment highest during the first year of life. Internet-based behavioural activation (iBA) therapy has demonstrated its efficacy for improving postnatal depression. No study has examined whether the iBA program is also effective at preventing child abuse. This study aims to investigate whether iBA improves depressive symptoms among mothers and prevents abusive behaviours towards children in postpartum mothers in a randomized controlled trial, stratifying on depressive mood status. The study also evaluates the implementation aspects of the program, including how users, medical providers, and managers perceive the program in terms of acceptability, appropriateness, feasibility, and harm done.Methods: The study is a non-blinded, stratified randomized controlled trial. Based on cut-off scores validated on Japanese mothers, participants will be stratified to either a low Edinburgh Postnatal Depression Scale (EPDS) group, (EPDS 0-8 points) or a high EPDS group (EPDS ≥9 points). A total of 390 postnatal women, 20 years or older, who have given birth within 10 weeks and have regular internet-access will be recruited at two hospitals. Participants will be randomly assigned to either treatment, with treatment as usual (TAU) or through intervention groups. The TAU group receives 12 weekly iBA sessions with online assignments and feedback from trained therapists. Co-primary outcomes are maternal depressive symptoms (EPDS) and psychological aggression toward children (Conflict Tactic Scale 1) at the 24-week follow-up survey. Secondary outcomes include maternal depressive symptoms, parental stress, bonding relationship, quality of life, maternal health care use, and paediatric outcomes such as physical development, preventive care attendance, and health care use. The study will also investigate the implementation outcomes of the program.Discussion: The study investigates the effectiveness of the iBA program for maternal depressive symptoms and psychological aggression toward children, as well as implementation outcomes, in a randomized-controlled trial. The iBA may be a potential strategy for improving maternal postnatal depression and preventing child abuse.Trial Registration: The study protocol (issue date: 2019-Mar-01, original version 2019005NI-00) was registered at the UMIN Clinical Trial Registry (UMIN-CTR: ID UMIN 000036864 ). [ABSTRACT FROM AUTHOR]

Purpose: Maternal prenatal stress and postnatal depression are reported to increase the risk for early offspring psychological problems. We examined whether these two stressors predicted toddler emotional or behavioral problems based on the mother and teacher reports, respectively.Methods: A longitudinal study within the Odense Child Cohort (OCC). Prenatal stress was assessed (gestation week 28) using Cohen's Perceived Stress Scale (PSS). Depressive symptoms were assessed (3 months after birth) using the Edinburgh Postnatal Depression Scale (EPDS). Behavioral and emotional problems were assessed by mothers using the preschool version of Child Behaviour Checklist (CBCL) and by teachers using the caregiver-teacher report form (CTR-F).Results: N = 1302 mother-child dyads were included. CBCL (N = 1302) was collected at 29 months (SD 5.3) and C-TRF (N = 989) at 32.6 months (SD 6.9). N = 70 mothers (5.4%) were at high risk for postnatal depression (EPDS score > 12). Generalized additive models showed that prenatal stress (increase of + 1 on PSS-10 total score) predicted an increase in CBCL (+ 0.011) and C-TRF (+ 0.015) total scores. Postnatal depressive symptoms (increase of + 1 on EPDS total score) only predicted an increase in CBCL total score (+ 0.026).Conclusion: Prenatal maternal stress was a significant predictor of both mother and teacher reported toddler emotional and behavioral problems, although effect sizes were small. Postnatal depressive symptoms were associated with increased maternal (but not teacher) reporting of toddler problems. Mothers reported more toddler psychological problems than teachers, and the mother-teacher discrepancy was positively correlated to maternal postnatal depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: Maternal depression and other psychosocial factors have been shown to have adverse consequences on infant feeding practices. This study explored the longitudinal relationship of maternal depressive symptoms and other selected psychosocial factors with infant feeding practices (IFPs) in rural Ethiopia using summary IFP index. Methods: This study uses existing data from the ENGINE birth cohort study, conducted from March 2014 to March 2016 in three districts in the southwest of Ethiopia. A total of 4680 pregnant women were recruited and data were collected once during pregnancy (twice for those in the first trimester), at birth, and then every 3 months until the child was 12 months old. A standardized questionnaire was used to collect data on IFPs, maternal depressive symptoms, household food insecurity, intimate partner violence (IPV), maternal social support, active social participation, and other sociodemographic variables. A composite measure of IFP index was computed using 14 WHO recommended infant and young child feeding (IYCF) practice indicators. High IFP index indicated best practice. Prenatal and postnatal maternal depressive symptoms were assessed using the patient health questionnaire (PHQ-9). Linear multilevel mixed effects model was fitted to assess longitudinal relationship of IFPs with maternal depression and other psychosocial factors. Results: Reports of higher postnatal depressive symptoms (ß = − 1.03, P = 0.001) and IPV (ß = − 0.21, P = 0.001) were associated with lower scores on the IFP index. Whereas, reports of better maternal social support (ß = 0.11, P = 0.002) and active social participation (ß = 0.55, P < 0.001) were associated with higher scores on the IFP index. Contrary to expectations, moderate household food insecurity (ß = 0.84, P = 0.003), severe household food insecurity (ß = 1.03, P = 0.01) and infant morbidity episodes (ß = 0.63, P = 0.013) were associated with higher scores on the IFP index. Conclusions: Overall, a multitude of factors are related to IFPs and hence coordinated, multi-sectoral and multi-stakeholder interventions including maternal depressive symptoms screening and management are needed to improve infant feeding practices. [ABSTRACT FROM AUTHOR]

Maternal mental disorder and a negative family emotional climate are a great source of stress for many children, yet their role in the childhood development or expression of asthma and allergies remains poorly understood, particularly beyond the first 1–2 years of life. The current study tested whether childhood allergy onset and symptomatology would be predicted by (1) perinatal and any time exposure to maternal depression or anxiety and (2) current family emotional strain (whole family, mother-child). UK mothers of children aged 2–12 years (N = 328) living with them completed an online survey of measures. Children exposed to maternal depression were almost twice as likely to be diagnosed and almost five times as likely to screen positive for an allergic disorder. Perinatal depression was linked to childhood allergies, but more moderately. Any anxiety exposure, and not specific to the perinatal period, predicted allergy status. Family emotional strain contributed independently to variance in concurrent child allergic symptomatology. All results were independent of potential confounders and current mental distress. The findings highlight the importance of maternal mental health and family function in the child’s neuro-immune development, and that these factors need to be addressed in the treatment of childhood allergic disorders. [ABSTRACT FROM AUTHOR]

Background: Fathers want more professional and social support during the transition to fatherhood. It is unclear if these supports are associated with decreased depressive symptoms in fathers of infants.Aim: The aim of the current study was to assess if fathers' self-reported received professional and social support were related to changes in the odds for having depressive symptoms, with interaction terms focusing on differences of support based on the fathers' parity.Methods: In total, 612 fathers from Sweden completed a Facebook-advertised anonymous online survey. The Edinburgh Postnatal Depression Scale was used to detect depressive symptoms (≥10 points). Multiple imputation of missing data was performed. Logistic regressions were used, with interaction terms for fathers' parity.Results: Around 21% of fathers had depressive symptoms. There were no associations between depressive symptoms frequencies and paternal parity. Fathers reported fewer depressive symptoms when they received professional support from the prenatal midwife (OR = .39, p = .007), labor/birth midwife/nurse team (OR = .42, p = .021), and child health nurse (OR = .25, p = .001), as well as social support from their partner and if they had a higher income (odds ratios vary in different models). Multiparous fathers received significantly less professional and social support and were less frequently invited to child health visits than primiparous fathers.Limitations: The data collected was cross-sectional; therefore, causal links cannot be determined.Conclusions: Both primiparous and multiparous fathers should receive postnatal depression screenings and interventions to help reduce their depressive symptoms. [ABSTRACT FROM AUTHOR]

Peripartum depression is a common mental health condition among mothers, occurring between 4 and 6 weeks post-delivery. This study sought to evaluate the influence that mode of delivery and other related factors have on the development of peripartum depression. The study was carried out in Ixopo, in the KwaZulu-Natal province of South Africa. All women whose infants had been delivered within 4–6 weeks of the study were included until the sample size of 276 was reached. A demographic questionnaire and an Edinburgh postnatal depression scale were administered. Mothers with Edinburgh postnatal depression scale scores of ⩾10 were considered to be suffering from peripartum depression, and peripartum depression was ruled out in those with a score of <10. A total of 110 mothers had Edinburgh postnatal depression scale score ⩾10, thus presenting a prevalence of 39.9%. Of these, 51 (46.4%) had undergone normal vaginal delivery and 59 had a Caesarean section (53.6%). Of the latter group, 23 had elective Caesarean section and 36 had emergency Caesarean section. Logistic regression showed no significant association between peripartum depression and mode of delivery (p =.074); women who had delivered their child by emergency Caesarean section were three times more likely to develop peripartum depression compared to those who had delivered via normal vaginal delivery (odds ratio: 2.733, confidence interval: 1.002–7.452). Unemployment was found to have a statistically significant association with peripartum depression (p =.003) and single motherhood was not associated (p =.425). Emergency Caesarean sections and unemployment were shown to be risk factors for peripartum depression. [ABSTRACT FROM AUTHOR]

Objective: The postnatal period can be both a rewarding and challenging time. Research has found that experiences of motherhood that are less positive than expected are associated with depressive symptoms, however, no known study to date has examined expectations across the separate domains of motherhood and how they impact on attachment. The aim of this cross‐sectional study was to investigate whether discrepancies in a mother's expectations regarding their infant, levels of support, and sense of self and their actual experiences post birth impact on maternal feelings of attachment and depression in the postnatal period. Method: Two hundred and thirty‐eight mothers in Australia (aged 19–44) who had given birth in the last 12 months voluntarily completed an online survey. Results: As predicted, results revealed that postnatal experiences that were less positive than expected regarding support and sense of self were associated with higher levels of depression and lower levels of attachment. Regarding infant expectations, experiences that were less positive than expected were associated with lower levels of attachment; however, experiences that were more positive than expected were, unexpectedly, associated with higher levels of depression. Conclusion: These findings highlight the importance of providing realistic expectations of motherhood through prenatal education and media messages to promote greater wellbeing and bond between mothers and infants which may maximise the chances of positive infant development. [ABSTRACT FROM AUTHOR]

Postpartum depression (PPD) is a significant mental health issue in mothers and fathers alike; yet at-risk fathers often come to the attention of health care professionals late due to low awareness of symptoms and reluctance to seek help. This study aimed to examine whether passive social media markers are effective for identifying fathers at risk of PPD. We collected 67,796 Reddit posts from 365 fathers, spanning a 6-month period around the birth of their child. A list of "at-risk" words was developed in collaboration with a perinatal mental health expert. PPD was assessed by evaluating the change in fathers' use of words indicating depressive symptomatology after childbirth. Predictive models were developed as a series of support vector machine classifiers using behavior, emotion, linguistic style, and discussion topics as features. The performance of these classifiers indicates that fathers at risk of PPD can be predicted from their prepartum data alone. Overall, the best performing model used discussion topic features only with a recall score of 0.82. These findings could assist in the development of support and intervention tools for fathers during the prepartum period, with specific applicability to personalized and preventative support tools for at-risk fathers. [ABSTRACT FROM AUTHOR]

Background: There is some evidence posttraumatic stress disorder (PTSD) following childbirth may impact on the mother-infant bond. However, the evidence is inconsistent over whether PTSD or co-morbid depressive symptoms are primarily related to impaired bonding. This study therefore aimed to examine the relationship between PTSD symptoms, depressive symptoms and mother-infant bonding.Methods: A cross-sectional online study included 603 mothers of infants aged 1-12 months. Measures were taken of PTSD (City Birth Trauma Scale, Ayers et al., 2018) which has two subscales of birth-related PTSD symptoms and general PTSD symptoms; depression (Edinburgh Postnatal Depression Scale, Cox et al., 1987) and mother-infant bonding (Postpartum Bonding Questionnaire, Brockington et al., 2001).Results: Impaired bonding was related to both dimensions of PTSD symptoms and depressive symptoms in bivariate analysis. Path analysis testing the model of whether depressive symptoms mediated the effect of PTSD symptoms on mother-infant bonding found a differential role of birth-related and general PTSD symptoms. Birth-related PTSD symptoms did not have any effect on bonding or depressive symptoms. In contrast, general PTSD symptoms had a direct effect on bonding and an indirect effect on bonding via depressive symptoms.Limitations: Self-report measures of PTSD and depression symptoms were used.Conclusions: Further research regarding different aspects of postpartum PTSD, depression and other disorders in the context of mother-infant bonding are needed. Future preventive programs should focus on diminishing symptoms of postpartum PTSD and depression so that the mother-infant bonding remains optimal. [ABSTRACT FROM AUTHOR]

Objectives: This study examined (i) the demographic and illness profiles of mothers admitted to Werribee Mercy MBU in Victoria, Australia and (ii) the severity of maternal depressive symptoms over the course of admission.Method: A retrospective audit was conducted on consecutively admitted mother-baby dyads between January 2011 and June 2015. Routinely collected maternal Beck Depression Inventory, second edition (BDI-II) scores were analysed for severity and change.Results: A total of 307 mother-baby dyads were admitted during the study period. The majority of mothers was partnered and educated young adults. The average length of stay was 4.4 weeks. The mean age of babies was 3.3 months. One-third of mothers met International Classification of Diseases, 10th edition criteria for two or more psychiatric diagnoses. Unipolar major depression was the commonest diagnosis. Of the 307 mothers, 125 mothers completed BDI-II on admission and on discharge, which showed a mean reduction of 16 points (p < 0.001) on discharge.Conclusions: This study notes the similarities between the clinical profiles of the study population with mother-baby admissions to MBUs worldwide. Maternal depressive symptoms improved by 16 points on the BDI-II over the course of MBU admission, which shows the utility of MBU admission on maternal depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: Better community mental health literacy is associated with positive help-seeking behaviours and reduced stigma. There are relatively few published surveys of perinatal mental health literacy. Aims: To provide a profile of current awareness, knowledge and attitudes in relation to the mental health of women and men in the perinatal period. Method: A cross-sectional online survey (n = 1,201) of adults (⩾ 18 years) in each state and territory of Australia was conducted in early 2016. Survey questions were based on a previous 2009 survey, with the addition of several novel items designed to assess knowledge around both perinatal anxiety and men's perinatal mental health. Results: Depression (including postnatal depression) was the most frequently cited general health problem for women in the first postnatal year (52% of spontaneous first responses). Over 70% of adults believed that postnatal depression requires specialised treatment and checks for depressive symptoms should occur routinely in pregnancy and the first postnatal year. Women identified postnatal depression at a higher rate than men. Most commonly, postnatal depression was perceived as having a biological rather than psychosocial etiology (34.5%). Men and women differed in their knowledge about the symptoms of postnatal depression with more women correctly identifying core depressive symptoms. The specific term 'perinatal depression' was not well recognised. Although not well recognised as a general health issue, when prompted, 39% of respondents were aware of anxiety as a specific perinatal mental health issue. Most adult Australians (60%) were unaware that perinatal depression and anxiety could be experienced by men. Conclusion: Awareness of postnatal depression appeared high. However, areas including anxiety, antenatal mental health, and men's mental health were less well-understood. There remains considerable scope, and a need for, continued awareness-raising around anxiety, mental health in pregnancy and men's mental health. [ABSTRACT FROM AUTHOR]

Objective: This pilot study describes the adaptation of a parenting group intervention for social media, and examines the feasibility, acceptability and initial outcomes of the adapted intervention for mothers with postpartum depression symptoms. Background: Postpartum depression can negatively affect parenting and the parent–infant relationship. Mothers with postpartum depression symptoms experience barriers to access in-person parenting interventions. Methods: A small, randomised controlled trial was conducted with an adapted parenting intervention delivered via social media (Facebook) or in-person for mothers who screened positive for depression in paediatric clinics. Parenting sense of competence, depression symptoms and intervention attendance and satisfaction were assessed. Twenty-four mothers (mean age 26 years; predominantly African American with limited economic resources) participated in the study. Results: Linear regressions showed that the social media group had significantly improved parenting competence and decreased depression severity when compared to the in-person group. Attendance in the social media group was high (83%), but extremely poor in the in-person group (3%). The mothers rated the intervention positively and the majority of the mothers participated by posting comments on the group page on social media. Conclusion: The findings suggest the feasibility and benefit of delivering a parenting intervention through social media for postpartum mothers with high levels of depression symptoms. [ABSTRACT FROM AUTHOR]

Background: Perinatal mental health problems affect approximately 20% of women. The most common condition is postnatal depression; however, many women do not seek help. Aims: To identify and synthesise evidence on factors that enable or prevent help-seeking in women with depressive symptoms in the postnatal period. Methods: A qualitative systematic review was conducted using electronic databases and pre-determined eligibility criteria. Findings: Thematic synthesis of the included studies (n=4) identified the following themes: the influence of healthcare services, the influence of others and the influence of women themselves. Help-seeking was shaped by women's ability to recognise their symptoms, the reactions (experienced or anticipated) of others and the organisation of services. Conclusion: An improved interface between maternity and mental health services and enhanced health professional interactions are needed. However, meaningful change may require empowering women's self-assessment and public health messages to improve understanding of postnatal depression. [ABSTRACT FROM AUTHOR]

Abstract Rationale A growing body of literature links both depressive symptoms generally, and those specifically in the postnatal period, with an inflammatory immune response. Evolutionary medical approaches, such as the Pathogen Host Defence Theory of Depression (PATHOS-D), have likened depression to sickness behaviour in other mammals, and propose that the characteristics associated with depression are protective when an individual is experiencing pathogenic threat. Many known risk factors for depressive symptoms are associated with activation of inflammatory pathways, opening up the potential for identifying novel risk factors based on their inflammation causing effects. Objective Both the gestation of male foetuses and the experience of birth complications have documented associations with increased inflammation, yet their relationships with postnatal depression (PND) are currently unclear. Method Here we use the complete reproductive histories of 296 women from contemporary, low fertility populations gathered by retrospective survey to assess whether the odds of PND increased when mothers gave birth to male infants or experienced birth complications, using generalised estimating equation models controlling for individual effects of the mother and other known PND risk factors. Results We found the odds of PND increased by 71–79% when male infants were born compared to female infants. The occurrence of birth complications increased the odds of PND by 174% compared to having no complications. Testing for interaction effects found that, while always at increased risk of PND, women with a tendency towards symptoms of depression, anxiety, and stress at other points in the life course had reduced odds of PND when experiencing birth complications, suggesting such women may elicit greater support. Conclusions These results highlight two novel PND risk factors, male infants and birth complications, which can be easily assessed by health professionals. Highlights • Recent research indicates depression is linked to prolonged inflammation. • Factors triggering inflammation may highlight novel depressive risk factors. • Male foetuses and birth complications are likely to cause inflammation. • Giving birth to male infants increases the odds of postnatal depression. • The experience of birth complications increases postnatal depression odds. [ABSTRACT FROM AUTHOR]

Background: Disorganised attachment in childhood has been considered an important early marker for the development of socio‐emotional and mental health problems. This review critically examines the current evidence and methodology employed to assess the influence of perinatal maternal mental health on disorganised attachment in infancy. Methods: A search revealed 1 149 articles reporting studies examining predictors of disorganised attachment. An additional 564 grey literature articles were identified via bibliographic searches. After screening for inclusion of maternal mental health measures and use of the Strange Situation Procedure, 28 articles met inclusion criteria. Results: Few studies robustly examined clinical levels of maternal mental health over time and the potential effects on infant disorganised attachment. Still, the bulk of current evidence does not support a strong positive association between disorganised attachment and low to moderate levels of maternal depression. The relationship between disorganised attachment and chronic and/or severe maternal depression is unclear given the dearth of research into the area. Limited research has examined other mental health disorders, with one study suggesting borderline personality disorder is associated with disorganised attachment. A level of bias in the literature was evident, with many studies recruiting non‐clinical samples and excluding those with significant mental health concerns. Conclusions: Most non‐significant findings were reported in non‐clinical samples, while most positive findings were reported in clinical samples, suggesting that severity of mental disorder may be a critical factor. Further research on the relationship between disorganised attachment and chronic and severe maternal depression, psychotic, trauma, bipolar, and personality disorders is required. [ABSTRACT FROM AUTHOR]

This article explores the complex issue of breastfeeding and maternal mental health. Many women stop breastfeeding before they are ready, often leading to feelings of anxiety, guilt, and anger. Critics of breastfeeding promotion blame breastfeeding advocates for this impact, claiming that if the focus were merely on feeding the baby, with all methods equally valued and supported, maternal mental health would be protected. Established health impacts of infant feeding aside, this argument fails to account for the importance of maternal breastfeeding goals, or the physical and emotional rewards breastfeeding can bring. Although some women will take comfort in the message that what matters most is that the baby is fed, others view such suggestions as a lack of recognition of their wishes and the loss that they feel, exacerbating their grief and frustration. The purpose of this article is to highlight the importance of recognizing and valuing women's individual breastfeeding goals, and not dismissing or invalidating their experience if they do not meet these by telling them that they do not matter. To move forward, we must recognize the impact of all infant feeding experiences, consider the impact of public messaging, and work to support more women to meet their goals. [ABSTRACT FROM AUTHOR]

Purpose: Recalled experiences of parental bonding may be important in the aetiology of perinatal depression. We hypothesized that lower recalled parental bonding would be associated with perinatal depression.Method: In a cohort study of perinatal depression in Turkey, 677 women were recruited in their third trimester. Parental Bonding Inventory (PBI) scores at baseline were investigated as predictors of depression on the Edinburgh Postnatal Depression Scale (EPDS) at 4, 14 and 21 months after childbirth in mothers without depression at baseline.Results: Poor parental bonding scores, apart from paternal control and overprotection, were independently associated with antenatal depression. Incident postnatal depression at 4 months was predicted by parental overprotection, at 14 months by parental care and overprotection, and at 21 months by paternal control and overprotection.Conclusions: Less satisfactory parenting recalled in the antenatal period was an independent predictor of postnatal depression; however, the different bonding subscales varied as predictors according to the timing of the depression assessment after childbirth. [ABSTRACT FROM AUTHOR]

Approximately 20% of women in the UK experience perinatal mental health issues, making it a common problem. Islam is the second largest religion worldwide; however, there is little discussion surrounding the religion and perinatal mental health. This article aims to discuss the causes of perinatal mental illness in the context of Islam, which may offer some insight into the influence of religious beliefs on mental health. In turn, this may aid health professionals to have a deeper understanding and awareness when caring for Muslim women. [ABSTRACT FROM AUTHOR]