Prevalence of postpartum major depression and depressive symptoms in Spanish women: A longitudinal study up to 1 year postpartum.

OBJECTIVE: Depression is a prevalent mental disorder in the postpartum period, with consequences for both the mother and her offspring. However, longitudinal studies determining the moments of greatest vulnerability and severity of depression during the postpartum period are scarce. The aims of this research were to determine the prevalence and trajectories of probable depression and major depression during the first year postpartum. DESIGN: Longitudinal study. SETTING: Interviews were conducted personally at three times: 2 months, 6 months and 1 year postpartum. PARTICIPANTS: 561 postpartum women. MEASUREMENTS AND FINDINGS: Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders (DSM). Descriptive and comparative analyses have been carried out. The prevalence of probable depression at 2 months, 6 months and 1 year postpartum, using a cut-off point ≥ 10, was 30.3%, 26.0% and 25.3%, respectively; and that of major depression using SCID was 10.3%, 10.9% and 14.8, respectively. The prevalence of probable depression was highest at 2 months postpartum and that of major depression at 1 year postpartum. Probable depression followed a downward trajectory and major depression followed an upward trajectory. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The clinical relevance of this research is that it has made it possible to demonstrate that depression is very prevalent in the first year postpartum and that, far from subsiding, the prevalence remains very high even at 1 year postpartum. Our findings highlight the importance of taking mental health care into account throughout at least the first year postpartum.

Risk factors for antenatal depression: A review.

Depression is the most prevalent mental disorder in pregnancy, and yet it is less studied than postpartum depression despite the consequences it may have on both the pregnant woman and her offspring. Therefore, it would be important to know which risk factors may favour the appearance of antenatal depression in order to carry out appropriate prevention interventions. The aim of the present review was to identify the main risk factors of antenatal depression. We searched in databases PubMed and PsycINFO for articles published about the factors associated with antenatal depression from January 2010 through December 2020. The literature review identified three main groups of antenatal depression risk factors: sociodemographic, obstetric, and psychological. First, among the sociodemographic variables, the low level of studies and the economic income clearly stood out from the rest. Then, not having planned the pregnancy was the main obstetric variable, and finally, the main psychological risk factors were having a history of psychological disorders and/or depression as well as presenting anxiety, stress, and/or low social support during pregnancy. This review shows that the antenatal depression is affected by multiple factors. Most can be identified at the beginning of the pregnancy, and some are risk factors potentially modifiable through appropriate interventions, such as psychological factors. For this reason, it is important to carry out a good screening for depression during pregnancy and consequently, be able to prevent its appearance or treat it if necessary.

Prevalence of Depression during Pregnancy in Spanish Women: Trajectory and Risk Factors in Each Trimester.

The aims of this research were to determine the trajectories of probable depression and major depression during pregnancy and to identify the associated and predictor variables (sociodemographic, pregnancy-related, and psychological) for both conditions in each trimester of pregnancy. A longitudinal study was carried out with 569 pregnant Spanish women who were assessed in the first, second, and third trimesters of pregnancy. Depression was assessed using the Edinburgh Postnatal Depression Scale and a clinical interview. Measures of anxiety and stress were also included. The prevalence of probable depression in the first, second, and third trimesters was 23.4%, 17.0%, and 21.4%, respectively, and that of major depression was 5.1%, 4.0%, and 4.7%. Thus, the prevalence of both conditions was the highest in the first and third trimesters. The trajectories of probable depression and major depression followed the same pattern throughout pregnancy. All of the psychological variables studied were associated with both conditions in all three trimesters, with perceived stress being a predictor at all times. The association between the other variables and both conditions of depression was similar. Two exceptions stand out: having had previous miscarriages, which was only associated with probable depression and was also a predictor, in the first trimester; and complications during pregnancy, which was only associated with probable and major depression in the third trimester. These findings should be taken into account in routine pregnancy follow-ups, and necessary interventions should be started in the first trimester.

Spanish Brief Version of the Pregnancy Related Anxiety Questionnaire: PRAQ-20 / Versión española abreviada del cuestionario de ansiedad relacionada con el embarazo

The aim of this study is to obtain a Spanish brief version of the Pregnancy Related Anxiety Questionnaire and analyse its psychometric properties. A longitudinal study was carried out on a sample of 569 Spanish pregnant women with normal risk status. Participants were assessed in the first, second, and third trimesters of pregnancy by using a socio-demographic and obstetric-gynaecological questionnaire, the PRAQ-55, the Edinburgh Postnatal Depression Scale, and the State-Trait Anxiety Inventory. PRAQ-55 items with factorial loads > .50 were selected resulting in a final scale of 20 items. A cut-off point ≥ 67 (85 th percentile) was used to identify women with high pregnancy-specific anxiety. The findings revealed that PRAQ-20 can be considered a useful screening tool in clinical practice to assess pregnancy-related anxiety in both nulliparous and multiparous pregnant women

El objetivo de este estudio es obtener una versión breve en español del Cuestionario de Ansiedad Relacionada con el Embarazo y analizar sus propiedades psicométricas. Se realizó un estudio longitudinal en una muestra de 569 mujeres embarazadas españolas con un embarazo de riesgo normal. Se evaluó a las participantes en el primer, segundo y tercer trimestre de embarazo utilizando un cuestionario sociodemográfico y obstétrico-ginecológico, el PRAQ-55, la Escala de Depresión Postparto de Edimburgo y el Inventario de Ansiedad de Estado-Rasgo. Se seleccionaron los ítems de la PRAQ-55 con cargas factoriales > .50, lo que dio como resultado una escala final de 20 ítems. Se utilizó como punto de corte 67 (percentil 85) para identificar a aquellas mujeres con elevada ansiedad específica del embarazo. Los resultados mostraron que el PRAQ-20 puede considerarse una herramienta de cribado útil en la práctica clínica para evaluar la ansiedad relacionada con el embarazo tanto en mujeres embarazadas nulíparas como multíparas

Validation of the Edinburgh postnatal depression scale as a screening tool for depression in Spanish pregnant women.

BACKGROUND: The Edinburgh Postnatal Depression Scale (EPDS) is a self-reported scale designed to detect postnatal depression, and also has been validated in multiple countries for its use during pregnancy, but not in Spain. The objective of this study was to validate the EPDS as a screening instrument to detect depression during different trimesters of pregnancy in Spanish women. METHODS: Longitudinal study of a large, unselected sample of 569 pregnant women who were assessed in the first, second and third trimesters of pregnancy by using the EPDS and the Structured Clinical Interview for DSM-IV (SCID). We evaluated the area under the ROC curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy (OA). RESULTS: The optimal cut-off point score of the EPDS for screening current SCID diagnosis of combined depression was 9 or more in the first trimester of pregnancy (AUC of 0.76, sensitivity of 67.5%, specificity of 70.9%, PPV of 14.9%, NPV of 96.7%; and OA of 70.7%) and 10 or more in the second and third trimesters of pregnancy (AUC of 0.89 and 0.89, respectively; sensitivity of 81.5% and 78.1%, respectively; specificity of 86.0% and 81.9, respectively; PPV of 23.4% and 21.6%, respectively; NPV of 98.9% and 98.3, respectively; and OA 85.8% and 81.7%, respectively). Likewise, the optimal cut-off point score during pregnancy was 10 or more (AUC of 0.76, sensitivity of 72.4%, specificity of 79.3%, PPV of 18.2%, NPV of 97.8%, and OA of 78.9%). LIMITATIONS: This study is limited due to the low rate of depression cases. CONCLUSIONS: EPDS is an adequate instrument for screening depression in Spanish pregnant women.

Psychometric Properties of the Spanish Version of the Pregnancy Related Anxiety Questionnaire (PRAQ).

Although pregnancy increases the vulnerability to anxiety, no specific assessment instruments are usually used to detect it. The objective of this study was to adapt the Pregnancy Related Anxiety Questionnaire (PRAQ) to Spanish population, as well as analyze its validity and reliability. A sample of 367 nulliparous pregnant women with a normal risk status filled in a socio-demographic and obstetric-gynaecological questionnaire, the PRAQ, the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). After performing a factorial analysis, a five-factor model that explains 53.1% of the variance was obtained. Estimates of internal consistency reliability were adequate (range = .78 to .93) for the five factors included in the final confirmatory factor analysis, and for the total scale (.97). Significant correlation among PRAQ, EPDS, and STAI was found (p < .001). The 85th percentile (score 234 or more) was used as a cut-off point to identify those women with high pregnancy-specific anxiety. In accordance with the results obtained, the PRAQ can be considered a useful screening tool to evaluate pregnancy-related anxiety among the Spanish population.

Psychometric properties of the Spanish version of the Pregnancy Related Anxiety Questionnaire (PRAQ)

Although pregnancy increases the vulnerability to anxiety, no specific assessment instruments are usually used to detect it. The objective of this study was to adapt the Pregnancy Related Anxiety Questionnaire (PRAQ) to Spanish population, as well as analyze its validity and reliability. A sample of 367 nulliparous pregnant women with a normal risk status filled in a socio-demographic and obstetric-gynaecological questionnaire, the PRAQ, the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). After performing a factorial analysis, a five-factor model that explains 53.1% of the variance was obtained. Estimates of internal consistency reliability were adequate (range = .78 to .93) for the five factors included in the final confirmatory factor analysis, and for the total scale (.97). Significant correlation among PRAQ, EPDS, and STAI was found (p < .001). The 85th percentile (score 234 or more) was used as a cut-off point to identify those women with high pregnancy-specific anxiety. In accordance with the results obtained, the PRAQ can be considered a useful screening tool to evaluate pregnancy-related anxiety among the Spanish population

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