Postpartum mental health of immigrant mothers by region of origin, time since immigration, and refugee status: a population-based study.

Immigrant women are at high risk for postpartum mental disorders. The purpose of this study was to understand how rates of postpartum mental health contact differ among immigrant women by region of origin, time since immigration, and refugee status. We conducted a population-based cohort study of immigrant mothers in Ontario, Canada, with children born from 2008 to 2012 (N = 123,231). We compared risk for mental health contact (outpatient, emergency department, inpatient hospitalization) in the first postpartum year by region of origin, time since immigration, and refugee status, generating adjusted odds ratios (aOR) and 95% confidence intervals (CI). Immigrants from North Africa and the Middle East were more likely to have outpatient mental health contact than a referent group of immigrants from North America or Europe (aOR 1.07, 95% CI 1.01-1.14); those from East Asia and the Pacific, Southern Asia, and Sub-Saharan Africa were less likely (0.64, 0.61-0.68; 0.78, 0.74-0.83; 0.88, 0.81-0.94). Refugees were more likely to have contact than non-refugees (1.10, 1.04-1.15); those in Canada <5 years were less likely than longer-term immigrants (0.83, 0.79-0.87). Refugees were more likely to have an emergency department visit (1.81, 1.50-2.17) and a psychiatric hospitalization than non-refugees (1.78, 1.31-2.42). These findings have implications for targeted postpartum mental health service delivery targeting certain immigrant groups and particularly refugees.

The Association Between Antenatal Exposure to Selective Serotonin Reuptake Inhibitors and Autism: A Systematic Review and Meta-Analysis.

OBJECTIVE: This systematic review and meta-analysis examines the relationship between antenatal selective serotonin reuptake inhibitor (SSRI) exposure and child autism, with specific attention to maternal mental illness (MMI) as a potential confounding factor. DATA SOURCES: We searched MEDLINE, Embase, PsycINFO, and CINAHL from database inception to January 28, 2016. STUDY SELECTION: Keywords included terms for SSRIs, pregnancy, and autism. We included published, peer-reviewed articles written in English. DATA EXTRACTION: Two reviewers used standardized instruments for data extraction and quality assessment. We generated pooled estimates for studies of the same design for SSRI exposure at any time during pregnancy and exposure during the first trimester. Subanalyses were conducted among studies with analyses (1) adjusted for MMI and (2) restricted to MMI. RESULTS: We included in the meta-analysis 4 case-control studies and 2 cohort studies. In the case-control studies, the adjusted pooled odds ratio (aPOR) values were 1.4 (95% CI, 1.0-2.0) (any) and 1.7 (95% CI, 1.1-2.6) (first trimester). In MMI-adjusted analyses, only first trimester exposure remained statistically significant (aPOR = 1.8; 95% CI, 1.1-3.1). In MMI-restricted analyses, neither exposure period was statistically significant. In the cohort studies, MMI-adjusted relative risk values were 1.5 (95% CI, 0.9-2.7) (any) and 1.4 (95% CI, 1.0-1.9) (first trimester). In MMI-restricted analyses, SSRI exposure at any time during pregnancy was nonsignificant. CONCLUSIONS: It remains unclear whether the association between first trimester SSRI exposure and child autism that was present in the case-control studies even after adjustment for MMI is a true association or a product of residual confounding. Future studies require robust measurement of MMI prior to and during pregnancy.

Identifying predictors of breastfeeding self-efficacy in the immediate postpartum period.

Researchers have found evidence that breastfeeding self-efficacy is an important variable that significantly influences initiation and duration rates. The purpose of this study was to develop a multi-factorial predictive model of breastfeeding self-efficacy in the first week postpartum. As part of a longitudinal study, a population-based sample of 522 breastfeeding mothers in a health region near Vancouver, British Columbia completed mailed questionnaires at 1-week postpartum. Bivariate correlations were used to select variables for the multiple regression analysis. The best-fit regression model revealed eight variables that explained 54% of the variance in Breastfeeding Self Efficacy Scale (BSES) scores at 1-week postpartum: maternal education, support from other women with children, type of delivery, satisfaction with labor pain relief, satisfaction with postpartum care, perceptions of breastfeeding progress, infant feeding method as planned, and maternal anxiety. The BSES may be used to identify risk factors, enabling health professionals to improve quality of care for new breastfeeding mothers.

Treatment of postpartum depression, part 1: a critical review of biological interventions.

BACKGROUND: While postpartum depression is a major health issue for many women from diverse cultures, this affective condition often remains undiagnosed and untreated. The objective of this article is to critically review the literature to determine the current state of scientific knowledge related to the treatment of postpartum depression from a biological perspective. METHOD: Databases searched for this review included MEDLINE, PubMed, CINAHL, PsycINFO, EMBASE, ProQuest, the Cochrane Library, and the WHO Reproductive Health Library from 1966 to 2003. The search terms used were postpartum/ postnatal depression and randomized controlled/ clinical trials in various combinations. Published peer-reviewed articles in English from 1990 to 2003 were chosen for review, although select earlier studies were also included based on good methodological quality and/or the absence of more recent work. The criteria used to evaluate the interventions were based on the standardized methodology developed by the U.S. Preventive Services Task Force and the Canadian Task Force on Preventive Health Care. RESULTS: Nine studies that met study criteria were examined. The interventions studied included antidepressant medication, estrogen therapy, critically timed sleep deprivation, and bright light therapy. Although some of these interventions have been better studied for depression unrelated to childbirth, methodological limitations render their efficacy equivocal for postpartum depression with limited strong evidence available to guide practice or policy recommendations. CONCLUSIONS: Despite the recent upsurge of interest in this area, many questions remain unanswered, resulting in diverse research implications. In view of the lack of randomized controlled trials, psychiatrists who are experts in the treatment of postpartum mood disorders have developed consensus guidelines. These guidelines will require regular updating as better and stronger evidence emerges.

Treatment of postpartum depression, part 2: a critical review of nonbiological interventions.

BACKGROUND: While postpartum depression is a common mental condition with significant burden, it often remains undiagnosed and untreated. The objective of this article is to critically review the literature to determine the current state of scientific knowledge related to the treatment of postpartum depression from a nonbiological perspective. DATA SOURCES: Databases searched for this review included MEDLINE, PubMed, CINAHL, PsycINFO, EMBASE, ProQuest, the Cochrane Library, and the WHO Reproductive Health Library from 1966 to 2003. The search terms used were postpartum/postnatal depression and randomized controlled/clinical trials. Published peer-reviewed articles in English from 1990 to 2003 were included in the review, although select earlier studies were also included based on good methodological quality and/or the absence of more recent work. METHOD: The criteria used to evaluate the interventions were based on the standardized methodology developed by the U.S. Preventive Services Task Force and the Canadian Task Force on Preventive Health Care. RESULTS: Twenty-one studies that met inclusion criteria were examined. These studies included interpersonal psychotherapy, cognitive-behavioral therapy, peer and partner support, nondirective counseling, relaxation/massage therapy, infant sleep interventions, infant-mother relationship therapy, and maternal exercise. Although some of these interventions have been better studied for depression unrelated to childbirth, methodological limitations render their efficacy equivocal for postpartum depression. CONCLUSIONS: Definite conclusions cannot be reached about the relative effectiveness of most of the nonbiological treatment approaches due to the lack of well-designed investigations. Randomized controlled trials are needed to compare different treatment modalities, examine the effectiveness of individual treatment components, and determine which treatments are most useful for women with different risk factors or clinical presentations of postpartum depression.

Preventing postpartum depression part I: a review of biological interventions.

OBJECTIVE: This paper critically reviews the literature to determine the current state of scientific knowledge concerning the prevention of postpartum depression (PPD) from a biological perspective. METHODS: The criteria used to evaluate the interventions were derived from the standardized methodology developed by the Canadian Task Force on Preventive Health Care. Databases searched for this review include Medline, PubMed, Cinahl, PsycINFO, Embase, ProQuest, the Cochrane Library, and the World Health Organization Reproductive Health Library. Studies selected were peer-reviewed English-language articles published between January 1, 1966, and December 31, 2003. RESULTS: Seven studies that met criteria were examined. These studies focused on evaluating the preventive effect of antidepressant medication, estrogen and progesterone therapy, thyroid therapy, docosahexanoic acid, and calcium supplementation. Although some of these interventions have been examined rigorously for depression unrelated to childbirth, methodological study limitations render intervention efficacy equivocal for PPD; thus, there is limited strong evidence to guide practice or policy recommendations. CONCLUSIONS: Despite the recent upsurge of interest in this area, many questions remain unanswered, which has several implications for research.

Preventing postpartum depression part II: A critical review of nonbiological interventions.

OBJECTIVE: To critically review the literature to determine the current state of scientific knowledge concerning the prevention of postpartum depression (PPD) from a nonbiological perspective. METHODS: Databases searched for this review include Medline, PubMed, Cinahl, PsycINFO, Embase, ProQuest, the Cochrane Library, and the World Health Organization Reproductive Health Library. Studies selected were peer-reviewed English-language articles published between January 1, 1966, and December 31, 2003. Criteria used to evaluate the interventions were derived from the standardized methodology developed by the Canadian Task Force on Preventive Health Care. RESULTS: Twenty-nine studies that met criteria were examined. These included studies evaluating interpersonal psychotherapy, cognitive-behavioural therapy, psychological debriefing, antenatal classes, intrapartum support, supportive interactions, continuity of care, antenatal identification and notification, early postpartum follow-up, flexible postpartum care, educational strategies, and relaxation with guided imagery. CONCLUSIONS: While this review demonstrates that no specific approach can be strongly recommended for clinical practice, many explicit research implications have been highlighted. To further address PPD as a public health problem, it is critical to include ethnically and socioeconomically diverse women in research efforts examining the differences among depression symptoms, intervention response rates, and health service use.