Explore the vast range of titles available.

The Edinburgh Postnatal Depression Scale (EPDS) and the State Anxiety Inventory (STAI-S) are widely used self-report measures that still need to be further validated for the perinatal period. The aim of this study was to examine the screening performance of the EPDS and the STAI-S in detecting depressive and anxiety disorders at pregnancy and postpartum. Women screening positive on EPDS (EPDS ≥ 9) or STAI-S (STAI-S ≥ 45) during pregnancy (n = 90), as well as matched controls (n = 58) were selected from a larger study. At 3 months postpartum, 99 of these women were reassessed. At a second stage, women were administered a clinical interview to establish a DSM-IV-TR diagnosis. Receiver operator characteristics (ROC) analysis yielded areas under the curve higher than .80 and .70 for EPDS and STAI-S, respectively. EPDS and STAI-S optimal cut-offs were found to be lower at postpartum (EDPS = 7; STAI-S = 34) than during pregnancy (EPDS = 9; STAI-S = 40). EPDS and STAI-S are reasonably valid screening tools during pregnancy and the postpartum.

Child and youth victimization is a universal phenomenon, common to all the different social groups, regardless of their condition (UNICEF 2014). Even though it has a lot of characteristics in common with adult victimization, child and youth victimization each have their own specificities (Martins 2016). In fact, child victimization rates are known to be greater than those of adults (Finkelhor 2008, 2011), and this cannot be explained only by the relative size of the child population. On the other hand, children are subject to a greater diversity of violence, insofar as, in addition to being victims of the same types of adult victimization, they are victimized by specific forms of violence (e.g., child abuse, bullying) and in different contexts: at home, school, and in the community, they are exposed to violence perpetrated by relatives and strangers, whether peers or adults (Cater et al. 2016). Also, childhood violence has a high developmental impact, as well as an effect on the present and future functioning of the child, with potentially dramatic consequences (Herrenkohl et al. 2013; Mrug and Windle 2010; Wright et al. 2013) that will influence children’s future paths, as it may interfere in their psychophysiological processes and compromise the child’s health and well-being. In addition to being victim of a single traumatic event or a chronic form of violence or abuse, the co-occurrence of various forms of victimization during childhood is frequent, particularly intra-family and extra-family types of violence, as well as direct and indirect forms of exposure. This corresponds to patterns or combinations of different kinds of abuse, violence, and other complex adversities (Finkelhor et al. 2007). Polyvictimization, combining multiple stressors, leads to more detrimental outcomes than single or repeated victimizations (Finkelhor et al. 2011). Additionally, it impacts several domains of functioning, with a wide range of short- and long-term negative results. The impact of violence on children and young people depends on multiple factors: the age at which the violent condition is experienced, its type, severity, frequency, complexity (single or polyvictimization), the relationship between the people involved (Gilad 2017; Jackson and Deye 2015), and children’s characteristics (gender, socioeconomic status, and emotional skills, amongst others). The quality of the child’s environment and an early and effective intervention also play a protective role, helping to reduce the negative impact of victimization and build resilience (Jackson and Deye 2015). Generally speaking, an empirical body of literature on the impact of violence and abuse on children and youth documents symptoms, such as: 1) developmental and behavioral problems, attention disorders, attachment disorders, developmental delays, poor social behavior, mental health problems, more criminal activity and victimization; 2) risk behaviors, such as drug and alcohol abuse, suicidal behavior, and promiscuous behavior; and 3) finally, serious health conditions, such as cancer, lung, heart, liver and skeletal diseases, and sexually transmitted diseases (Gilad 2017). Moreover, in addition to being a critical phenomenon from a clinical, social, and political perspective, the victimization of children and young people is, as Enzmann et al. (2010) claim, an indirect way of measuring crime. Therefore, as a critical social problem, child victimization is a relevant topic of research (Finkelhor 2008; Hartjen and Priyadarsini 2012). Our knowledge of victimization during childhood is, however, dispersed and fragmented (Finkelhor and Wells 2003). This paper addresses current victimization among Portuguese youth in urban areas, based on ISRD-3 results, conducted in 2015–2016. Specifically, the purpose of this study is to determine lifetime prevalence of juvenile victimization, considering overall and specific types of victimization and gender, age, and city size, and their demographic and socioeconomic correlates.

AimTo examine whether mode of conception and gender are associated with parents' psychological adjustment across the transition to twin parenthood. There is limited knowledge on the psychological adjustment of couples to twin parenthood during pregnancy and early postpartum, especially for fathers. The available research suggests that first-time mothers of twins conceived by assisted reproduction techniques (ART) may experience lower psychosocial well-being than mothers of spontaneously conceived (SC) twins. A total of 41 couples expecting twins, 25 of whom conceived spontaneously and 16 conceived by assisted reproduction techniques, completed measures of depressive and anxiety symptoms, marital relationship, attitudes to sex, and attitudes to pregnancy and the baby.FindingsART parents showed a decline in marital relationship quality, no changes in attitudes to pregnancy and the baby and no changes in attitudes to sex over the postpartum. In contrast, SC parents did not change their perception of the marital relationship, reported more positive attitudes to pregnancy and the baby, and more positive attitudes to sex over the postpartum. Compared with the other groups (SC mothers and fathers, ART fathers), ART mothers exhibited a higher increase in depressive and anxiety symptoms from pregnancy to postpartum and only anxiety symptoms exhibited a decline trend over the postpartum. These findings suggest that ART parents may experience more psychological difficulties during the transition to twin parenthood than SC parents. ART mothers, in particular, appear to be more at risk of high levels of postpartum depressive symptoms.

AbstractObjectiveTo evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression in pregnant and postpartum women.DesignIndividual participant data meta-analysis.Data sourcesMedline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (from inception to 3 October 2018).Eligibility criteria for selecting studiesEligible datasets included EPDS scores and major depression classification based on validated diagnostic interviews. Bivariate random effects meta-analysis was used to estimate EPDS sensitivity and specificity compared with semi-structured, fully structured (Mini International Neuropsychiatric Interview (MINI) excluded), and MINI diagnostic interviews separately using individual participant data. One stage meta-regression was used to examine accuracy by reference standard categories and participant characteristics.ResultsIndividual participant data were obtained from 58 of 83 eligible studies (70%; 15 557 of 22 788 eligible participants (68%), 2069 with major depression). Combined sensitivity and specificity was maximised at a cut-off value of 11 or higher across reference standards. Among studies with a semi-structured interview (36 studies, 9066 participants, 1330 with major depression), sensitivity and specificity were 0.85 (95% confidence interval 0.79 to 0.90) and 0.84 (0.79 to 0.88) for a cut-off value of 10 or higher, 0.81 (0.75 to 0.87) and 0.88 (0.85 to 0.91) for a cut-off value of 11 or higher, and 0.66 (0.58 to 0.74) and 0.95 (0.92 to 0.96) for a cut-off value of 13 or higher, respectively. Accuracy was similar across reference standards and subgroups, including for pregnant and postpartum women.ConclusionsAn EPDS cut-off value of 11 or higher maximised combined sensitivity and specificity; a cut-off value of 13 or higher was less sensitive but more specific. To identify pregnant and postpartum women with higher symptom levels, a cut-off of 13 or higher could be used. Lower cut-off values could be used if the intention is to avoid false negatives and identify most patients who meet diagnostic criteria.RegistrationPROSPERO (CRD42015024785).

Item 10 of the Edinburgh Postnatal Depression Scale (EPDS) is intended to assess thoughts of intentional self-harm but may also elicit concerns about accidental self-harm. It does not specifically address suicide ideation but, nonetheless, is sometimes used as an indicator of suicidality. The 9-item version of the EPDS (EPDS-9), which omits item 10, is sometimes used in research due to concern about positive endorsements of item 10 and necessary follow-up. We assessed the equivalence of total score correlations and screening accuracy to detect major depression using the EPDS-9 versus full EPDS among pregnant and postpartum women. We searched Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science from database inception to October 3, 2018 for studies that administered the EPDS and conducted diagnostic classification for major depression based on a validated semi-structured or fully structured interview among women aged 18 or older during pregnancy or within 12 months of giving birth. We conducted an individual participant data meta-analysis. We calculated Pearson correlations with 95% prediction interval (PI) between EPDS-9 and full EPDS total scores using a random effects model. Bivariate random-effects models were fitted to assess screening accuracy. Equivalence tests were done by comparing the confidence intervals (CIs) around the pooled sensitivity and specificity differences to the equivalence margin of δ = 0.05. Individual participant data were obtained from 41 eligible studies (10,906 participants, 1407 major depression cases). The correlation between EPDS-9 and full EPDS scores was 0.998 (95% PI 0.991, 0.999). For sensitivity, the EPDS-9 and full EPDS were equivalent for cut-offs 7–12 (difference range − 0.02, 0.01) and the equivalence was indeterminate for cut-offs 13–15 (all differences − 0.04). For specificity, the EPDS-9 and full EPDS were equivalent for all cut-offs (difference range 0.00, 0.01). The EPDS-9 performs similarly to the full EPDS and can be used when there are concerns about the implications of administering EPDS item 10. Trial registration: The original IPDMA was registered in PROSPERO (CRD42015024785).

•We evaluated using real patient data, across multiple sample sizes, the degree that data-driven methods result in selection of inaccurate optimal cutoffs and bias in accuracy estimates.•We found that the optimal EPDS cutoffs identified in samples of different sizes varied widely, ranging from ≥ 5 to ≥ 17 for studies with n = 100 and ≥ 8 to ≥ 13 for n = 1,000.•We also found that the accuracy estimates were often overstated with mean overestimation of sensitivity and underestimation of specificity, respectively, of 6.5 percentage point (pp) and −1.3pp for n = 100 and 1.4pp and −1.0pp for n = 1000.•Researchers should avoid making recommendations about cutoffs to use in practice and accuracy when reporting results from small studies.•Clinicians should only select cutoffs generated from well-conducted meta-analyses or those that are identified consistently across multiple studies. To evaluate, across multiple sample sizes, the degree that data-driven methods result in (1) optimal cutoffs different from population optimal cutoff and (2) bias in accuracy estimates. A total of 1,000 samples of sample size 100, 200, 500 and 1,000 each were randomly drawn to simulate studies of different sample sizes from a database (n = 13,255) synthesized to assess Edinburgh Postnatal Depression Scale (EPDS) screening accuracy. Optimal cutoffs were selected by maximizing Youden's J (sensitivity+specificity–1). Optimal cutoffs and accuracy estimates in simulated samples were compared to population values. Optimal cutoffs in simulated samples ranged from ≥ 5 to ≥ 17 for n = 100, ≥ 6 to ≥ 16 for n = 200, ≥ 6 to ≥ 14 for n = 500, and ≥ 8 to ≥ 13 for n = 1,000. Percentage of simulated samples identifying the population optimal cutoff (≥ 11) was 30% for n = 100, 35% for n = 200, 53% for n = 500, and 71% for n = 1,000. Mean overestimation of sensitivity and underestimation of specificity were 6.5 percentage point (pp) and -1.3 pp for n = 100, 4.2 pp and -1.1 pp for n = 200, 1.8 pp and -1.0 pp for n = 500, and 1.4 pp and -1.0 pp for n = 1,000. Small accuracy studies may identify inaccurate optimal cutoff and overstate accuracy estimates with data-driven methods.

Background: Twin birth rates have increased worldwide in the last decades. Compared with the well-known health risks associated with twin pregnancy, relatively little is known about the psychological adjustment of couples during the transition to twin parenthood and twins’ early development. Aims: 1) To describe the trajectories of parents’ psychological adjustment during the transition to twin parenthood; 2) to determine whether parents of twins and parents of singletons differ on psychological adjustment trajectories; 3) to investigate whether psychological adjustment trajectories vary as a function of mode of conception and parent gender; 4) to examine twins’ fetal development (fetal movements and heart rate) and to investigate factors associated with it. Method: This prospective longitudinal study assessed 41 parent-twi-n pairs conceived spontaneously (n = 25) and after infertility treatment (n = 16) at multiple time points from the first trimester of pregnancy up to 3 months postpartum. A control sample of parents of singletons was derived from a larger longitudinal study. Parents’ psychological adjustment was assessed with self-report measures. Fetal movements were assessed from ultrasound recordings and fetal heart rate variability was assessed by computerized cardiotocography. Results: Using dyadic growth curve analyses, we found that parents of twins reported increasingly positive attitudes to pregnancy and the baby over time, a decrease in marital relationship and increasingly positive attitudes to sex from pregnancy to the postpartum period and over the postpartum period. Anxiety and depression trajectories varied as a function of type of pregnancy and mode of conception. While parents of singletons exhibited a significant decrease in anxiety levels during the postpartum period, parents of twins showed no significant decrease in anxiety during this period. Parents of twins conceived after infertility treatment showed no significant decrease in depression during pregnancy and a significant increase in anxiety from pregnancy to the postpartum period, whereas parents of twins conceived spontaneously showed a decline in depression during pregnancy and no significant increase in anxiety from pregnancy to the postpartum period. In addition, parents of twins conceived after infertility treatment showed a higher risk for clinically significant depression symptoms than parents of twins conceived spontaneously and parents of singletons conceived after infertility treatment during the postpartum period. No systematic gender differences were found in anxiety and depression trajectories over time. Dyadic growth curve analyses also demonstrated age-dependent changes in fetal general movements and breathing movements. While the developmental course of fetal movement patterns was found to be largely independent of a number of factors (co-twin, fetal sex, gestational age at delivery and birthweight), fetal sex differences were found in one fetal movement pattern at mid-pregnancy and heart rate parameters at late pregnancy. Conclusion: This study provides new data on the psychological adjustment to twin parenthood and on twins’ fetal development.