Virtual Platform Adaptation of Perinatal Depression Support Group: A Quality Improvement Study

INTRODUCTION: Group therapy interventions have shown to improve scores on postpartum depression and anxiety inventories. Our institution underwent transition from in-person (IP) to virtual platform (VP) over the course of the COVID-19 pandemic. The study's objective is to examine whether VP has similar participation rates and outcomes as IP. METHODS: This is a retrospective study of women who attended the perinatal mood disorders (PMD) support group. Between January 2019 and June 2021, the group transitioned from IP to VP sessions. Participants attending both IP and VP sessions were excluded. The participation rates and outcomes of IP and VP support groups were compared. Edinburgh Postnatal Depression Score (EPDS) and Mills Inventory (MI) were used to assess clinical improvement. P value of.05 is considered significant. RESULTS: One hundred thirty-seven women (85 [62%] IP and 52 [38%] VP) participated. Baseline characteristics were similar (P >.05). Most of the participants were 1–6 months postpartum (P =.38). The average number of sessions attended by IP was 3.86 versus 3.76 by VP (P =.41). The preintervention average EPDS scores were 15.56 in IP versus 14.76 in VP (P =.79), and MI scores were 52.48 (IP) versus 46.06 in VP (P =.07). The EPDS and MI mean scores decreased postintervention. The average decrease in EPDS score is 5.08 in IP versus 6 in VP (P =.36). The average decrease in MI score is 17.86 in IP versus 15.56 in VP (P =.25). CONCLUSION: The VP has similar participation and outcomes as IP format. The VP is a feasible and effective method of delivering support to women with PMD. [ FROM AUTHOR] Copyright of Obstetrics & Gynecology is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Benefits of Breastfeeding on Child and Postpartum Psychological Health of the Mother

Ab s t r ac t Aim: The aim of this study was to summarize different types of benefits that have been observed in the baby's development and the mother's psychological health during the postpartum period. Background(s): Breastfeeding is a natural process that plays a vital role in the physical as well as mental health of the mother and child. Breast milk is rich in contents such as proteins, fats, and vitamins, which are responsible for building the immune system of the baby. Lactation helps in decreasing the prevalence of infant mortality rate. It enhances the development of the physical health of the children. Breastfeeding protects the mother from many systemic conditions like endometrial cancer, ovarian cancer, breast cancer, etc. It has been observed that with an increase in healthy breastfeeding practices, there is a decline in the cases of maternal mental health issues reported mainly in the postpartum period. Review result: The authors have explained various types of advantages of breastfeeding on the child's and mother's health, their mechanism of action, effects on the baby, and mother-child relationship. Conclusion(s): The mother's mental health plays a crucial role in a healthy infant, and breastfeeding is key to it. The role of breastfeeding is therefore considered a boon for the mother because if there is a decrease in health issues in the child, the mother's mental condition improves automatically. Therefore, breastfeeding should be promoted at the national level. Clinical significance: Breastfeeding not only helps in reducing maternal stress and postpartum depression but also improves the physical health of the child and mother during the postpartum period. The clinicians should teach mothers about the importance and also the correct positions of breastfeeding. "Breastfeeding week" is celebrated every year from August 1 to August 7, as implemented by the Indian government.Copyright © The Author(s). 2023 Open Access.

The impact of postpartum social support on postpartum mental health outcomes during the COVID-19 pandemic.

Social support is an influential component of postpartum recovery, adjustment, and bonding, which was disrupted by social distancing recommendations related to the COVID-19 pandemic. This study reports on changes in the availability of social support for postpartum women during the pandemic, investigates how those changes may have contributed to postpartum mental health, and probes how specific types of social support buffered against poor postpartum mental health and maternal-infant bonding impairment. Participants were 833 pregnant patients receiving prenatal care in an urban USA setting and using an electronic patient portal to access self-report surveys at two time points, during pregnancy (April-July 2020) and at ~12 weeks postpartum (August 2020-March 2021). Measures included an assessment of COVID-19 pandemic-related change in social support, sources of social support, ratings of emotional and practical support, and postpartum outcomes including depression, anxiety, and maternal-infant bonding. Overall self-reported social support decreased during the pandemic. Decreased social support was associated with an increased risk of postpartum depression, postpartum anxiety, and impaired parent-infant bonding. Among women reporting low practical support, emotional support appeared to protect against clinically significant depressive symptoms and impaired bonding with the infant. Decreases in social support are associated with a risk for poor postpartum mental health outcomes and impaired maternal-infant bonding. Evaluation and promotion of social support are recommended for healthy adjustment and functioning of postpartum women and families.

Prevalence and Coping Strategies of Postnatal Depression among Women in Bayelsa State, Nigeria

This study examined the prevalence and coping strategies of Postnatal Depression (PND) among mothers in Bayelsa, the state of Nigeria. The general aim was to describe the level of PND experienced by women and the methods they adopt to cope with this syndrome. This study was a cross-sectional survey of 345 women with babies between 1-6 weeks old. The women were selected purposively at health and maternity centres and clinics in Bayelsa state. A structured questionnaire was used in data collection. The data gathered were analysed using univariate, bivariate and multivariate analyses at a p=0.05 level of significance. The prevalence rate of PND ranged from mild depression (37.7%), moderate depression (3.5%) to severe depression (3.2%). There is a statistically significant relationship between socio-demographic variables and PND among mothers (p=0.000). PND prevalent among the study population exerts adverse effects on the health and cognitive development of the mother and child. However, the strategies adopted by mothers to cope with PND ranged from social support to music therapy. This study recommended that counselling of mothers during and after childbirth should be carried out as part of the routine for mothers and childcare.

Health anxiety, death anxiety and coronaphobia: Predictors of postpartum depression symptomatology during the COVID-19 pandemic.

OBJECTIVE: To determine levels of postpartum depression symptoms and possible relevant predictors, such as death anxiety, health anxiety, and coronavirus-related anxiety. DESIGN: Cross-sectional web-based survey using quantitative methods. SETTING: Exclusively online recruiting via social media and unpaid cross-posting conducted during the third wave of the COVID-19 pandemic in Romania. PARTICIPANTS: Women were eligible to take part in the study if they were mothers over the age of 18 and had a baby aged between 4 weeks - 12 months of age; 1024 women were included in the final sample. MEASUREMENTS AND FINDINGS: Health anxiety, death anxiety, coronavirus-related anxiety, and postpartum depression symptoms were measured using validated instruments. Current depression symptomatology was 67.6%, 26.7% scored above the cut-off for high health anxiety, 1% for coronavirus-related anxiety, and 62.7% for death anxiety. Significant predictors for depressive symptomatology were breastfeeding, history of depression, family income, number of children, health anxiety, death anxiety, and coronavirus anxiety. Further, hierarchical multiple regression analysis indicated that death anxiety, health anxiety, and coronavirus anxiety predicted postpartum depression symptoms over and above socio-demographic factors. KEY CONCLUSIONS: Supported by previous studies, our results suggest that postpartum depression symptomatology levels during the COVID-19 pandemic are high and that they are predicted by health and death anxiety, which are also increased during the pandemic. IMPLICATION FOR PRACTICE: The findings provide information to identify the risk for depression symptoms in postpartum mothers during acute public health situations.

Understanding postpartum depression and social support

Within the field of maternal mental health, studies have demonstrated the connection between social support and postpartum depression (PPD). The purpose of this study was to further understand the experience of social support by women who have gone through PPD through the use of a qualitative phenomenological research design. In addition, this study will focus on the helpful and unhelpful aspects of social support received by participants and what types of social support participants found to be missing in their postpartum experience. Within this dissertation study, the researcher interviewed 15 women to understand their experience of social support in connection to PPD while utilizing the lens of Family Stress Theory and feminist theory. Six categories emerged from the interviews in this study: 1.) the experience of PPD, 2.) the concept of social support, 3.) the kind of social support mothers experienced, 4.) helpful forms of social support, 5.) helpful forms of social support, and 6.) missing social support for women. In this study, the researcher also addressed contextual factors and elements related to the global pandemic caused by COVID-19. The primary researcher also discussed clinical implications for mental health professionals, limitations of the study, and future research implications in the field of maternal mental health. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Prevalence of paternal postpartum depression in Anuradhapura district in Sri Lanka and its association with maternal postpartum depression as a risk factor

Objective: This study aimed to determine the prevalence of PPPD in Anuradhapura district, its association with maternal PPD, and relevant risk factors. Materials and methods: Cross sectional study was conducted among fathers in Anuradhapura district having infants 1-5 months by giving questionnaire specifically developed for the study with Edinburgh postnatal depression scale (EPDS) and self-constructed questions. Out of 6324 fathers, 435 fathers and their partners were randomly selected and proportionately allocated to 5 Medical Officer of Health (MOH) areas. R Program and SPSS have used for the data analysis. Results: Our results revealed that the PPPD prevalence is approximately 11% (95%CI: 8.08-14.67) based on cut off score of 7 points in the EPDS. PPPD was correlated with maternal PPD (OR 19.16, 95%CI 5.0473-85.1203), income decrement (OR 8.1571, 95%CI 2.4621-32.6289), increased time stayed at home in postpartum period (OR 3.7775, 95%CI 1.2365-13.8175). But other parameters such as infant's age, work time and number of children were not significantly influenced risk factors for PPPD. Conclusion: PPPD is prevalent in the Anuradhapura district and maternal postpartum depression has positively influenced. But currently, screening programmes for PPPD is lacking in Sri Lanka. Thus, these deficiencies urgently need to be addressed and should provide information and instructions to fathers regarding this new transition. However, these results need replication in more expanded case control study. Since the prevailing covid-19 pandemic at the time of data collection may have impacted the mental health of the fathers specially in countries like Sri Lanka, where mental health support is limited.

Mediating effect of mindfulness level on the relationship between marital quality and postpartum depression among primiparas.

BACKGROUND: Postpartum depression refers to a depressive episode or depressive symptoms up to 12 mo after delivery. Trait mindfulness has presented a protective factor for postpartum depressive symptoms and proved efficient in improving relationship satisfaction among couples. AIM: To investigate the correlations among mindfulness, marital quality, anxiety, and depression in a large city in western China during the post-corona virus infectious disease-2019 era and determine whether trait mindfulness mediates the relationship between marital quality and postpartum anxiety and depression among primiparas. METHODS: A cross-sectional study was conducted. The self-administered questionnaire was submitted online through smartphones. The levels of mindfulness, anxiety, depression, and marital quality were respectively investigated by the mindful attention awareness scale (MAAS), the self-rating anxiety scale (SAS), the self-rating depression scale (SDS), and the marriage perception scale (MPS) in these enrolled Han and Tujia primiparas. RESULTS: No statistical significance was observed in the prevalence of postpartum anxiety and depression, nor scores of MAAS and MPS-Total in different regions or ethnicities (P > 0.05). However, MPS-Marital interaction (P < 0.05), MPS-Family relationship (MPS-FR) (P < 0.01), and MPS-Marital conflict (MPS-MC) (P < 0.01) scores of urban primiparas were higher than those of rural primiparas. The MPS-MC score of Han primiparas was higher than that of Tujia primiparas (P < 0.05). Negative correlations were observed between MAAS and SAS (r = -0.457, P < 0.01), and MAAS and SDS (r = -0.439, P < 0.01). SAS has revealed a highly positive correlation with SDS (r = 0.720, P < 0.01) and a weak negative correlation with MPS (r = -0.200, P < 0.05). Besides, a weak negative correlation was observed between MAAS and MPS-MC (r = -0.184, P < 0.05), and a weak positive correlation was noticed between SAS and MPS-MC (r = -0.225, P < 0.01). Mediation analysis demonstrated a full mediation effect of mindfulness level on the relationship between MPS-FR and postpartum anxiety (P < 0.05, 95%CI: -0.384 to 0.033), MPS-MC and postpartum anxiety (P < 0.01, 95%CI: 0.027-0.193), MPS-FR and postpartum depression (P < 0.05, 95%CI: -0.365 to 0.031), and MPS-MC and postpartum depression (P < 0.01, 95%CI: 0.022-0.206). CONCLUSION: Mindfulness demonstrates negative correlations with marital conflict, postpartum anxiety and depression, and it may have cross-ethnic and trans-regional characteristics. Although the mindfulness levels have revealed no significant mediating effect between the total score of marital quality and postpartum depression in this study, it demonstrates a full mediation effect on the relationships between family relationships, marital conflict, and postpartum anxiety and depression.

Maternal Postpartum Depression Screening in a Federally Qualified Health Care Center: An Evidence-Based Pilot Project

Background: Postpartum depression (PPD) affects 10% to 40% of women bearing children, increasing in low-income women and adolescent mothers. Postpartum psychosis affects 1 to 2 per 1000 pregnant women, further magnifying the need for regular PPD screening. The American Academy of Pediatrics recommends screening of mothers during the first to 6-month infant well checkups. Screenings have been recommended since 2004, but studies show a gap of only half of pediatrician groups performing PPD screening. The purpose of this study was to implement an evidence-based PPD screening guide in a federally qualified health care facility (FQHC) to assess feasibility/sustainability and address the gap in practice. Methods: A blinded descriptive quantitative analysis using an implementation research design was used for the 3-month pilot project. Working with focus groups, provider/staff training for the two provider teams who see children was completed, and parents were notified of the study when given the Edinburgh Postpartum Depression Scale. Compliance with screening and feasibility of the referral protocol were assessed. Results: Mothers of patients aged 0 to 12 months in the study period were offered PPD screening 97% of the time. Providers and certified medical assistants agreed screening is important and generated a small increase in visit time. Screen scores identified one positive screen. Conclusion: PPD demands screening during the first year of the mother/infant relationship. Pediatric providers have the ideal scheduling of well visits in which to incorporate PPD screening. A barrier for some pediatric practices may be time to follow up after referring a mother to mental health for evaluation of compliance with outside appointments. Having mental health services as a part of the FQHC team allows immediate evaluation/treatment resources when needed.

A blended psychological intervention for postpartum depression: acceptability and preferences in women presenting depressive symptoms.

OBJECTIVES: To evaluate the acceptability of and preferences for a blended psychological intervention (combining face-to-face sessions and web-based interventions) for the treatment of postpartum depression among Portuguese women presenting depressive symptoms and to explore the factors associated with its acceptability. BACKGROUND: Despite its high prevalence and the existence of effective treatment, still few women seek professional help for postpartum depression, demanding for new treatment formats, such as blended interventions. METHODS: Women (n = 235) presenting postpartum depressive symptoms (EPDS>9) completed an internet survey assessing sociodemographic and clinical information, depressive symptoms, e-health literacy and the acceptability of and preferences for a blended intervention for postpartum depression. RESULTS: Most of the participants considered a blended intervention for postpartum depression to be useful and would be available to use it. Women reported significantly more advantages than disadvantages in regard to this treatment format. Married women, employed, with younger babies and with less severe depressive symptoms had a higher likelihood of finding a blended intervention useful. Higher educational levels increased the likelihood of being available to obtain a blended treatment. Most participants preferred an equal distribution of content across face-to-face and online sessions. Approximately one-third of the sample preferred a 75% face-to-face/ 25% online proportion. Most of the women preferred a duration of 45-60 minutes for face-to-face sessions and 30-45 minutes for online sessions. CONCLUSION: Our findings support and inform the development of blended psychological treatments for postpartum depression, according to women's preferences, and highlight the prioritisation of this format according to women's characteristics.

Trajectories of distress from pregnancy to 15-months post-partum during the COVID-19 pandemic.

Background: The COVID-19 pandemic has particularly burdened pregnant and postpartum women. It remains unclear how distress levels of pregnant and postpartum people have changed (or persisted) as the pandemic continues on and which factors may contribute to these trajectories of distress. Methods: This longitudinal study included 304 pregnant people, who were followed during pregnancy, 6-weeks, 6-months and 15-months postpartum. At each time point, a latent "distress" factor was estimated using self-reported depressive symptoms, anxiety symptoms, and stress. Reported negative impact of COVID-19 and social support were assessed during pregnancy as risk and protective factors related to distress. Second-order latent growth curve modeling with a piecewise growth function was used to estimate initial levels and changes in distress over time. Results: Mean distress was relatively stable from the pregnancy to 6-weeks postpartum and then declined from 6-weeks to 15-months postpartum. Higher education, greater social support, and lower negative impact of COVID-19 were associated with a lower distress during pregnancy. Unexpectedly, negative impact of COVID-19 was associated with a faster decrease in distress and more social support was associated with a greater increase in distress from pregnancy to 6-weeks postpartum. However, these effects became non-significant after controlling for distress during pregnancy. Conclusion: Findings indicate high but declining levels of distress from pregnancy to the postpartum period. Changes in distress are related to social support and the negative impact of the pandemic in pregnancy. Findings highlight the continued impact of COVID-19 on perinatal mental health and the need for support to limit the burden of this pandemic on pregnant people and families.

Impact of a postpartum care rehabilitation program to prevent postpartum depression at a secondary municipal hospital in Qingdao China: a cross-sectional study.

BACKGROUND: The emerging postpartum rehabilitation (PPR) program in Chinese hospitals characterized by applying ongoing medical care through traditional cultural practices shows a protective effect in early puerperium in China. This study explores the benefit of PPR program practices to postpartum depression (PPD) and the influencing factors for PPD among Chinese women during the first postnatal six weeks. METHODS: The cross-sectional study included 403 participants and was conducted in a Secondary Municipal Hospital in Qingdao, China, from 01 to 2018 to 31 December 2021. Information on this PPR program was collected during the six-weeks postpartum consultation, including the Edinburgh postnatal depression scale (EPDS) scores, the measurement results for diastasis recti abdominis, and the international physical activity questionnaire (long form) (IPAQ-L) scores. Logistic regression models were used to examine the effect of the PPR program on PPD among the local population. The secondary aim of this study was to investigate possible influencing factors for PPD, such as coronavirus disease 2019 (COVID-19), physical exercises, etc. RESULTS: PPR program has shown a positive effect in preventing PPD (p < 0.001) and diastasis recti prevalence (p < 0.001) during the six-weeks postnatal control in Qingdao, China. Better post-pregnancy weight reduction (p = 0.04) and higher metabolic equivalent of task (MET) value (p < 0.001) were noticed in the non-PPR group. Furthermore, lower PPD risk was associated with factors such as longer relationship duration years (2-5 years) (p = 0.04) and exercising one to three times a week (p = 0.01). A higher PPD risk was related to factors such as urinary incontinence during the postpartum period (p = 0.04) and subjective insomnia (p < 0.001). No significant effect was shown between COVID-19 and the EPDS score in this study (p = 0.50). CONCLUSION: Our results suggested that the PPR program provided protection against PPD and diastasis recti during the first six weeks after delivery. Urinary incontinence and subjective insomnia were the main risk factors for PPD, while longer relationship duration years and exercising one to three times a week gave protective effects to PPD. This study emphasized that a comprehensive ongoing medical care program, such as the PPR program, effectively improves women's mental and physical health in the early postpartum in China.

"I didn't get to have this experience with anyone”: experiences of becoming a mother during the pandemic

COVID-19 resulted in impacts across life experiences;this study focuses on impact on becoming a mother. People who were pregnant or gave birth in the US during the first year of the pandemic (April 2020-June 2021) were interviewed: six pregnant and 29 who had birthed. Interviews were analyzed using Interpretive Phenomenological Analysis. Themes included Missing Out Isolation, First-time Mom Experiences, Pervasive Uncertainty, and Depression. Subthemes were loss of celebration, missed events, somewhat helpful role of technology, less education and perinatal care, not having elder wisdom, COVID-specific anxiety, anxiety, and less postpartum support. Implications for research and practice are presented. © 2023 Taylor & Francis.

Validation of the French-Canadian version of the COVID-19 Peritraumatic Distress Index with parents of an infant

Parents of an infant may be particularly vulnerable to peritraumatic distress (e.g., psychological distress experienced during or immediately following a traumatic event) associated with events such as the COVID-19 pandemic. Since peritraumatic distress could affect both their psychological well-being and their couple relationship functioning, it is essential to measure and document these symptoms within parents. The COVID-19 Peritraumatic Distress Index (CPDI;Qiu et al., 2020) was the first validated instrument to measure COVID-19 peritraumatic distress, but it has not yet been validated in French. This study aimed to assess the psychometric properties of the French-Canadian version of the CPDI (F-CPDI) in a sample of 492 parents (58% of mothers) of an infant in Quebec Province (Canada). The factor structure, internal consistency, and convergent validity of the instrument were tested. Results indicate that the F-CPDI has good internal consistency and supports the four-factor structure proposed by the authors of the original instrument. Results of correlation analyses indicated that peritraumatic distress was related to increased psychological distress, postpartum depression, and lower life satisfaction. Results indicate satisfactory psychometric qualities for the F-CPDI, providing researchers and mental health professionals access to a COVID-19 peritraumatic distress measure. This questionnaire can be used to assess peritraumatic distress in parents of an infant during a pandemic period, which is a first step towards offering adapted intervention strategies. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (French) Les parents d'un nouveau-ne peuvent etre particulierement vulnerables a la detresse peritraumatique (c'est-a-dire la detresse psychologique vecue pendant ou immediatement apres un evenement traumatique) associee a des evenements tels que la pandemie de COVID-19. Puisque la detresse peritraumatique pourrait affecter a la fois leur bien-etre psychologique et le fonctionnement de leur relation de couple, il est essentiel de mesurer et de documenter ces symptomes chez les parents. L'indice de detresse peritraumatique reliee a la COVID-19 (IDPC;Qiu et al., 2020) a ete le premier instrument valide pour mesurer la detresse peritraumatique reliee a la COVID-19, mais il n'a pas encore ete valide en francais. Cette etude visait a evaluer les proprietes psychometriques de la version franco-canadienne du CPDI (l'IDPC en francais) aupres d'un echantillon de 492 parents (58 % de meres) d'un nouveau-ne dans la province de Quebec (Canada). La structure factorielle, la coherence interne et la validite convergente de l'instrument ont ete testees. Les resultats indiquent que l'IDPC a une bonne coherence interne et soutient la structure a quatre facteurs proposee par les auteurs de l'instrument original. Les resultats des analyses de correlation indiquent que la detresse peritraumatique est liee a une detresse psychologique accrue, a la depression post-partum et a une satisfaction de vie moindre. Les resultats indiquent des qualites psychometriques satisfaisantes pour l'IDPC, permettant aux chercheurs et aux professionnels de la sante mentale d'avoir acces a un indice de detresse peritraumatique reliee a la COVID-19. Ce questionnaire peut etre utilise pour evaluer la detresse peritraumatique des parents d'un nouveau-ne en periode de pandemie, ce qui constitue une premiere etape pour proposer des strategies d'intervention adaptees. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Impact Statement The COVID-19 pandemic is associated with an increase in mental health problems, including peritraumatic distress (Qiu et al., 2020). This study tested the validity of the French-Canadian COVID-19 Peritraumatic Distress Index (F-CPDI;Qiu et al., 2020), the first validated instrument to measure COVID-19 peritraumatic distress. Results revealed satisfactory psychometric qualities for the F-CPDI and prevalence rate of peritraumatic distress reaching 20.5% in Quebec parents of an infant. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Impact of the COVID-19-pandemic on mental health during peripartum period—a narrative review

Background: The impact of the coronavirus disease 2019 (COVID-19) pandemic and the subsequent measures by the government were associated with a drastic disruption of the lives of nearly everyone. Vulnerable groups were particularly affected, including pregnant women and mothers in the postpartum period. Objective: The aim of the review was to examine the impact of the COVID-19 pandemic on the mental health of pregnant women and mothers in the postpartum period based on stress, anxiety, depression and posttraumatic stress disorder (PTSD) symptoms. Furthermore, risk and protective factors that contributed to the development or prevention of postpartum mental illnesses during the pandemic were identified. Methods: A literature search was conducted via PsycArticles, PsycINFO, PSYNDEX, and Ovid Medline from April to June 2021. Data on anxiety, depression, stress, and PTSD symptoms, as well as potential risk and protective factors were extracted. Results: A total of 19 relevant studies with 44,709 participants were included. Nearly all studies recorded an increase in anxiety, depression, stress, and PTSD symptoms during the pandemic. Financial, intrafamilial stressors and concern for the child were identified as risk factors for the development of postpartum mental illnesses during the pandemic. Satisfaction with the couple relationship was apparently protective against stress and depression symptoms. Anxiety symptoms were reduced, for example, by increased levels of physical activity as well as perceived social support. Conclusion: Future studies are recommended to further investigate the risk factors for the development of postpartum mental illnesses. In addition, prevention programs for medical personnel as well as aftercare and therapy programs for affected mothers should be developed in order to prevent severe progression. © 2023, The Author(s).

The cooperative breeding model 2.0 - postpartum social support and maternal mental health in Ecatepec, Veracruz, Mexico

To deliver the level of care infants need for survival, the Homo genus evolved to engage in cooperative breeding. In fact, a large cross-cultural review found that most cultures have a set of structured postpartum practices to protect women and infants during the immediate postpartum - all requiring social support. Cooperative breeding researchers have focused on non-maternal support to older offspring and on infant outcomes, without regard for the vulnerable immediate postpartum or the reciprocal mother-infant impact. Considering the well-being of the infant without consideration for that of the mother, or vice versa, limits understanding of this integrated system. By including maternal mental health in the immediate postpartum, my project served to advance the cooperative breeding model, thereby providing a conceptual framework to further understand the development of postpartum depression. Finally, cooperative breeding models have examined social support primarily in terms of its presence or absence overlooking the fact that practices vary locally and recipients will thus expect and value different forms of support.Postpartum depression afflicts approximately 13% of women globally, with exceptionally high rates in Latin America. While it often resolves with only minor impact on subsequent quality of life, it does not always do so. In addition to creating serious mental health consequences for mothers, postpartum depression can result in serious and sometimes fatal results for infants. Despite our species' expectation of postpartum social support, very few studies have examined the relationship between mental health and postpartum practices, and among the few that have, there are methodological limitations that I addressed in this dissertation.My study objectives were: (1) describe the local cultural model of postpartum social support in Coatepec, Veracruz, Mexico;(2) determine the congruence of women's postpartum experiences with their cultural expectations;and (3) determine if there is a relationship between the degree of congruence and maternal depressive symptoms. I hypothesized that mothers whose postpartum experience was more closely aligned with their cultural expectations would experience fewer postpartum depressive symptoms than those whose experience was less aligned with expectations.Eighteen local women were interviewed to detail their postpartum practice, the cuarentena. Forty-eight additional women were interviewed during their third trimester, and approximately 40 days postpartum. The prenatal interview gathered demographics and baseline depression. The postpartum interview assessed depression, congruence of received with expected support, infant health, and birth experiences. Onset of COVID-19 allowed post hoc assessment of its impact on maternal mental health and cuarentena adherence.In Coatepec, the cuarentena is highly valued, widely practiced, and requires social support. Practice of the cuarentena made women feel comforted and good. There was no statistically significant association between adherence and depressive symptoms, yet postpartum depressive scores were higher for women who practiced the cuarentena ?a little? compared to those who practiced "a lot." Despite the pandemic, most followed the cuarentena with only minor modifications. The modification with the most salient impact was limiting visitors to adhere to public health recommendations. Maternal mood was reportedly negatively affected when women received fewer visitors than they would normally during the cuarentena. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Some concerns about imputation methods for missing data

Comments on an article by RJ Van Lieshout et al. (see record 2022-41504-002). Van Lieshout and colleagues1 conducted a randomized clinical trial of an online 1-day cognitive behavioral therapy workshop vs waiting list in a population at risk of postpartum depression and evaluated the effect using the Edinburgh Postnatal Depression Scale, a patient-reported outcome measure of depressive symptom severity. Second, although they used LMM, we have concerns about whether this method adequately imputed the missing outcomes. In general, repeated outcome measurements are required to correctly estimate the missing values using LMM. However, this study had only a single follow-up point, and in LMM the baseline measure must be used as a covariate and not as an outcome. We wonder how such a model could have accounted for missing outcomes. More details about the specific LMM methods used would be helpful. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The association between the COVID-19 pandemic and postpartum care provision.

BACKGROUND: The COVID-19 pandemic led to a rapid transformation in the healthcare system to mitigate viral exposure. In the perinatal context, one change included altering the prenatal visit cadence and increasing the utilization of telehealth methods. Whether this approach had inadvertent negative implications for postpartum care, including postpartum depression screening and contraceptive utilization, is unknown. OBJECTIVE: This study aimed to examine whether preventative health service utilization, including postpartum depression screening and contraceptive utilization, differed during the COVID-19 pandemic when compared with the prepandemic period. STUDY DESIGN: This retrospective cohort study included all pregnant patients who received prenatal care at 1 of 5 academic obstetrical practices and who delivered at Northwestern Memorial Hospital either before (delivery from September 1, 2018, to January 1, 2019) or during (delivery from February 1, 2020, to May 15, 2020) the COVID-19 pandemic. Completion of postpartum depression screening was assessed by reviewing standardized fields in the documentation associated with the screening in the electronic health record system. The method of contraception used was ascertained from the postpartum clinical documentation. Patients were classified as initiating long-acting reversible contraception use if they received NEXPLANON (etonogestrel implant) or an intrauterine device during the hospitalization for delivery or within 3 months following delivery. Bivariable and multivariable analyses were performed. RESULTS: Of the 2375 pregnant patients included in this study, 1120 (47%) delivered during the COVID-19 pandemic. Pregnant patients who delivered during the COVID-19 pandemic were significantly less likely to have undergone postpartum depression screening (45.5% vs 86.2%; P<.01); this association persisted after adjusting for potential confounders (adjusted odds ratio, 0.13; 95% confidence interval, 0.11-0.16). Pregnant patients who delivered during the COVID-19 pandemic also were significantly less likely to initiate long-acting reversible contraception use within 3 months of delivery (13.5% vs 19.6%; adjusted odds ratio, 0.67; 95% confidence interval, 0.53-0.84). CONCLUSION: The onset of the COVID-19 pandemic was associated with a decrease in the completion of postpartum depression screenings and fewer patients initiating long-acting reversible contraception use overall. These results can inform adaptations in healthcare delivery in the midst of the ongoing COVID-19 pandemic.

The effectiveness of an internet-based support program on maternal self-efficacy, postpartum depression and social support for primiparous women during the COVID-19 pandemic: Randomized controlled trial.

Background: Many primiparous women usually encounter various parenting and mental health issues after childbirth. The effects of intervention based on internet platform on parenting and mental health outcomes for Chinese first-time mothers remain unknown during the COVID-19 pandemic. Therefore, our research aimed to evaluate the effectiveness of an internet-based support program (ISP) on maternal self-efficacy (MSE), postpartum depression (PPD) and social support for primiparous women amid the pandemic. Methods: A multicenter randomized controlled trial (RCT) was conducted. From May 2020 to March 2021, 242 primiparous women were recruited in the maternity wards of two hospitals in Shenzhen City, China and randomly assigned to the intervention group and the control group. Women in control group (n = 118) received the routine postpartum care, and women in intervention group (n = 118) accessed to the ISP intervention (expert education and peer support) and routine postpartum care. Intervention outcomes were measured at baseline before randomization (T0), post-intervention (T1), and three-month follow up (T2) through questionnaires. The chi-square (χ2), the independent sample t-test and the repeated measures multivariate analysis of covariance were performed, and the two-tailed p-value <0.05 was regarded as statistically significant. Results: In comparison with women in the control group, women in the intervention group had a significantly higher score of MSE at T1 (mean: 73.53, standard deviation [SD]: 6.21) and at T2 (mean: 72.90, SD: 6.73); and a lower score of PPD at T1(mean: 6.03, SD: 2.50) and T2 (mean: 5.70, SD: 2.23); and a higher score of social support at T1 (mean: 45.70, SD: 3.73), but no significant difference at T2 (mean: 42.90, SD: 3.29). Conclusions: The effect of ISP was evaluated to significantly increase the levels of MSE, social support, and to alleviate PPD symptoms for Chinese first-time mothers. As an effective and easily accessible intervention, ISP could become a significant source for health professionals to support primiparous women on parenting and mental health during the COVID-19 pandemic. Trial registration: The trial is registered at the Chinese Clinical Trials Registry (ChiCTR2000033154).

Study characteristical and regional influences on postpartum depression before vs. during the COVID-19 pandemic: A systematic review and meta-analysis.

Background: While the public is under serious pressure from the coronavirus disease 2019 (COVID-19), the final impact and possible contributing factors to postpartum depression symptoms (PPDS) remain unknown. Therefore, a meta-analysis to investigate the association between PPDS and the COVID-19 pandemic was carried out by comparing the data between pre-pandemic and post-pandemic timeframes and exploring the influencing factors. Methods: This systematic review was prospectively registered and recorded in a study protocol (Prospero CRD42022336820, http://www.crd.york.ac.uk/PROSPERO). A comprehensive search of PubMed, Embase, Web of Science, CINALH, Cochrane and Scopus was cmpleted on June 6, 2022. Studies that compared the prevalence of PPD before and during the COVID-19 pandemic period were included. Results: Of 1766 citations identified, 22 studies were included with 15,098 participates before the COVID-19 pandemic and 11,836 participants during the COVID-19 pandemic. Overall, the analysis showed that the epidemic crisis was associated with an increased prevalence of PPDS (OR: 0.81 [0.68, 0.95], P = 0.009, I 2 = 59%). Subgroup analysis was conducted according to the study characteristics and regions. Within the study characteristics classification, results showed an obvious increase in the prevalence of PPDS during the COVID-19 pandemic if PPDS cutoff was defined as Edinburgh postpartum depression score (EPDS) ≥13 points (OR: 0.72 [0.52, 0.98], P = 0.03, I 2 = 67%) and an increased prevalence in follow-ups that happened after 2 weeks (≥ 2 weeks postpartum) (OR: 0.81 [0.68, 0.97], P = 0.02, I 2 = 43%). Selected studies that were high-quality (OR: 0.79 [0.64, 0.97], P = 0.02, I 2 = 56%) demonstrated an increased prevalence of PPDS during the COVID-19 pandemic period. Sorting by regional factors, studies conducted in Asia (OR: 0.81 [0.70, 0.93], P = 0.003, I 2 = 0%) showed an increase of PPDS prevalence rates during the COVID-19 period, while studies conducted in Europe (OR: 0.82 [0.59, 1.13], P = 0.23, I 2 = 71%) and North America (OR: 0.66 [0.42, 1.02], P = 0.06, I 2 = 65%) showed no significant difference. All studies conducted in the developed (OR: 0.79 [0.64, 0.98], P = 0.03, I 2 = 65%) and developing countries (OR: 0.81 [0.69, 0.94], P = 0.007, I 2 = 0%) showed an increase of PPDS during the COVID-19 period. Conclusions: The COVID-19 pandemic is associated with an increased prevalence of PPDS, especially after long-term follow-up and among the group with a high possibility of depression. The negative influence from the pandemic, causing more PPDS was significant in studies from Asia.