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Peripartum depression (PPD) is a major depression disorder (MDD) episode with onset during pregnancy or within four weeks after childbirth, as defined in DSM-5. However, research suggests that PPD may be a distinct diagnosis. The goal of this study was to summarize the similarities and differences between PPD and MDD by synthesizing the current research on PPD diagnosis concerning different clinical features and give directions for improving diagnosis of PPD in clinical practice. To lay the groundwork for this narrative review, several databases were searched using general search phrases on PPD and its components of clinical diagnosis. When compared to MDD, peripartum depression exhibits several distinct characteristics. PPD manifests with a variety of symptoms, i.e., more anxiety, psychomotor symptoms, obsessive thoughts, impaired concentration, fatigue and loss of energy, but less sad mood and suicidal ideation, compared to MDD. Although PPD and MDD prevalence rates are comparable, there are greater cross-cultural variances for PPD. Additionally, PPD has some distinct risk factors and mechanisms such as distinct ovarian tissue expression, premenstrual syndrome, unintended pregnancy, and obstetric complications. There is a need for more in-depth research comparing MDD with depression during pregnancy and the entire postpartum year. The diagnostic criteria should be modified, particularly with (i) addition of specific symptoms (i.e., anxiety), (ii) onset specifier extending to the first year following childbirth, (iii) and change the peripartum onset specifier to either “pregnancy onset” or “postpartum onset”. Diagnostic criteria for PPD are further discussed. •Peripartum depression (PPD) is defined as a major depression disorder (MDD) episode.•PPD has some specific symptoms and risk factors in comparison to MDD.•PPD is a heterogeneous disorder with different subtypes according to the onset and severity.•Diagnostic criteria should change with time specifier until the first year postpartum.•Peripartum onset specifier should change to “pregnancy onset” or “postpartum onset”.

Background Anxiety is increasingly acknowledged as a common mental health issue during the perinatal period. Its prevalence as well as the associated adverse effects constitute screening imperative. This study evaluates the psychometric properties and underlying factor structures of a Greek version of GAD-7 among pregnant and postpartum women (up to 6 months) in Cyprus. Methods This study was conducted from June to December 2020. A total of 457 Cypriot women in the perinatal period (222 pregnant and 235 postpartum) were surveyed. The assessment included anxiety (GAD-7) and depression (EPDS), and psychosocial factors related with anxiety. The internal consistency and factor structure of GAD-7 were evaluated using reliability coefficients, Cronbach’s Alpha and McDonald's Omega, and factor analysis, both Exploratory as well as Confirmatory. Results GAD-7 demonstrated good internal consistency (α = 0.907; Ω = 0.909). Horn's parallel analysis indicated a single factor as the most appropriate. CFA using the standard ML method indicated a good model fit, χ 2  = 21.207, p  = 0.096; CFI = 0.999; SRMR = 0.027. More studies are needed to determinate the cut-off point and the maximisation of the scale’s sensitivity and specificity in pregnant and postpartum Greek Cypriot women. Conclusions GAD-7 is a valid and reliable measure and healthcare professionals should utilize GAD-7 as a standard instrument for the screening of anxiety symptoms in pregnant and postpartum Greek Cypriot women.

Empirical evidence has shown that cardiac rehabilitation programs are effective in reducing morbidity and mortality, improving quality of life in patients with cardiovascular disease. Despite the benefits, women have a high cardiac rehabilitation dropout rate. Our aim was to explore women's perceptions about the reasons they faced for dropout from these programs. Semi-structured interviews were conducted with women (n = 10) after dropping out from three different cardiac rehabilitation centers in Spain. In addition, a focus group and a semi-structured interview with cardiovascular professionals were conducted. From a grounded theory perspective, thematic analysis was used to derive themes from interview transcripts. The women were between 41 and 70 years. We identified five general themes that illustrated reasons for cardiac rehabilitation dropout: intrapersonal reasons (self-reported health, self-reported mental health, health beliefs); interpersonal reasons (family caregiver role, work conflicts); logistical reasons (transport, distance); cardiac rehabilitation program characteristics (perception of the objective of cardiac rehabilitation, exercise component, inconvenient timing, cardiac rehabilitation equipment); and health system reasons (financial assistance for transport, long waiting list). The cardiovascular professionals found barriers to cardiac rehabilitation completion similar to those found by the women. In order to prevent cardiac rehabilitation dropout in women, modular and flexible programs are needed. In addition, the inclusion of primary care centers or community resources could improve cardiac rehabilitation completion in women. Psychological assessment and counseling during cardiac rehabilitation should be included as an essential part of the programs and recommended for those women with depressive symptoms. Finally, improved financial assistance for transport from the health system is essential.

Background Coronavirus disease 2019 (COVID-19) has caused an increase in perinatal depression. The aim of this research was to identify which sociodemographic variables are related to the increase in perinatal depression due to the pandemic. In addition to estimating to what extent they predict perinatal depression, differentiating the prenatal and postnatal periods. Methods The sample consisted of 3,356 subjects, 1,402 in the prenatal period and 1,954 in the postnatal period. The Edinburgh Postnatal Depression Scale was used to assess depressive symptomatology. A subset of 14 questions was included to collect demographic data. Items from the Spanish version of the Coronavirus Perinatal Experiences Survey were also included. Results Experiencing the change of environment due to COVID-19 as negative and having a history of mental health predict perinatal depression, otherwise having higher education decreases the risk. In the prenatal stage having symptoms compatible with COVID-19 is a predictor of perinatal depression and having more than 3 years living together with the partner and being a housewife decreases the risk. In the postnatal stage being unemployed is a predictor of prenatal depression and being a first-time mother decreases the risk. Conclusions This study highlights the relevance of sociodemographic status. It is essential to be aware of the risk factors of perinatal depression, to make adequate prevention, and to create health policies to alleviate the consequences of the pandemic.

[...]the COVID-19 pandemic represents a particularly challenging circumstance for PPW with potential adverse outcomes on maternal mental health. [...]meta-analysis evidence makes it clear that the “objective and subjective social isolation” influences physical and mental health similar to that of well-known biomedical risk factors (e.g., tobacco consumption, lack of physical activity) (Holt-Lunstad et al., 2015). [...]the unpredictable situation of being unemployer with a reduced household income can be considered a very stressful event that can lead to psychologicaistress (Sareen et al., 2011). [...]a study carrieut in north-eastern Italy found higher levels of depressive symptomatology in the immediate postpartum period among women who gave birth during an active periof COVID-19 quarantine than in women whose delivery occurred in the same perione year earlier (Zanardo et al., 2020). [...]this issue constitutes another critical gap te addressed, specifically on how preventive measures involving confinement and sociaistancing may affect PPW and their newborns in terms of their mental well-being and their access to the adequate prenatal and postnatal care they need aneserve.

This study aimed to analyse the role of governmental responses to the coronavirus disease 2019 (COVID-19) outbreak, measured by the Containment and Health Index (CHI), on symptoms of anxiety and depression during pregnancy and postpartum, while considering the countries’ Inequality-adjusted Human Development Index (IHDI) and individual factors such as age, gravidity, and exposure to COVID-19. A cross-sectional study using baseline data from the Riseup-PPD-COVID-19 observational prospective international study (ClinicalTrials.gov: NCT04595123) was carried out between June and October 2020 in 12 countries (Albania, Brazil, Bulgaria, Chile, Cyprus, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom). Participants were 7645 pregnant women or mothers in the postpartum period—with an infant aged up to 6 months—who completed the Edinburgh Postnatal Depression Scale (EPDS) or the Generalised Anxiety Disorder Assessment (GAD-7) during pregnancy or the postpartum period. The overall prevalence of clinically significant depression symptoms (EPDS ≥ 13) was 30%, ranging from 20,5% in Cyprus to 44,3% in Brazil. The prevalence of clinically significant anxiety symptoms (GAD-7 ≥ 10) was 23,6% (ranging from 14,2% in Israel and Turkey to 39,5% in Brazil). Higher symptoms of anxiety or depression were observed in multigravida exposed to COVID-19 or living in countries with a higher number of deaths due to COVID-19. Furthermore, multigravida from countries with lower IHDI or CHI had higher symptoms of anxiety and depression. Perinatal mental health is context-dependent, with women from more disadvantaged countries at higher risk for poor mental health. Implementing more restrictive measures seems to be a protective factor for mental health, at least in the initial phase of the COVID-19.

Primary care (PC) patients have difficulties in committing to and incorporating primary prevention and health promotion (PP&HP) activities into their long-term care. We aimed to re-interpret, for the first time, qualitative findings regarding factors affecting PC patients' acceptance of PP&HP activities. A meta-ethnographic synthesis was generated following electronic and manual searches that retrieved 29 articles. Papers were reviewed and translated to produce a re-interpretation of the extracted concepts. The factors affecting PC patients' receptiveness to PP&HP activities were framed in a four-level ecological model (intrapersonal, interpersonal, institutional and environment and society). Intrapersonal factors (patients' beliefs/attitudes, knowledge, skills, self-concept, motivation and resources) were the most numerous, with almost 25 different factors. Public health education to modify erroneous beliefs and values regarding PP&HP could encourage a transition to healthier lifestyles. Health care professionals' abilities to communicate and involve patients in the decision-making process can act as facilitators. Biopsychosocial training (with emphasis on communication skills) for health professionals must start with undergraduates. Increased consultation time, the use of reminders, follow-up visits and tools for communicating risk and motivating patients could be applied at the intrapersonal level. Collaborative care involving other health professionals (nutritionists or psychotherapists) and family and community stakeholders (teachers or gym trainers) was important in developing healthier habits. Patients also cited barriers related to the built environment and socioeconomic difficulties that highlighted the need for policies promoting social justice and equity. Encouraging PP&HP using social marketing strategies and regulating media to control its impact on health were also cited. Only the perspectives of PC patients in the context of chronic conditions were considered thus limiting extrapolation to other contexts. Several factors affect PP&HP. This must be taken into account when designing PP&HP activities if they are to be successfully implemented and maintained in routine practice.

Background The current COVID-19 pandemic is a unique stressor with potentially challenging and negative consequences on the experiences of pregnant and postpartum women. International literature highlights the pandemic’s negative impact on women’s perinatal experiences. This is the first study in the scientific literature reporting on the impact of the COVID-19 pandemic, on the perinatal experiences of a large sample of women living in Cyprus. Aim To examine the impact of the COVID-19 pandemic on the experiences, concerns and needs of pregnant and postpartum women in Cyprus. Method The cross-sectional study was conducted from July 2020 to January 2021. A total of 695 women, 355 pregnant and 340 postpartum women (with infants up to 6 months of age), residing in Cyprus were surveyed. Results The great majority of the participants (80.9%) perceived the impact of the COVID-19 pandemic on their life as negative. The greatest sources of stress were identified and quantified for their impact on the participants. Our findings indicate that 74.1% of the pregnant women were concerned about changes due to COVID-19 measures impacting the presence of their family at the time of delivery, 57.2% about their newborn’s health, and 43.1% about changes related to perinatal care. Postpartum women’s concerns were mainly related to the welfare and health of their child (70.3%), whilst half of them (49.1%) expressed concerns about how they were going to care for their baby because of pandemic-related changes. Qualitative data revealed emerging themes as the basis of the pregnant and postpartum women’s concerns and needs. Conclusions The COVID-19 pandemic and the associated imposed measures and restrictions had adverse effects on pregnant and postpartum women’s perinatal experiences in Cyprus. The women’s concerns emphasized the need for the development of specialized, evidenced-based support systems which are essential particularly in pandemic-like situations, when pregnant and postpartum women are more vulnerable to isolation.