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The optimum way to improve the recognition and treatment of postnatal depression in developing countries is uncertain. We compared the effectiveness of a multicomponent intervention with usual care to treat postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile. 230 mothers with major depression attending postnatal clinics were randomly allocated to either a multicomponent intervention (n=114) or usual care (n=116). The multicomponent intervention involved a psychoeducational group, treatment adherence support, and pharmacotherapy if needed. Usual care included all services normally available in the clinics, including antidepressant drugs, brief psychotherapeutic interventions, medical consultations, or external referral for specialty treatment. The primary outcome measure was the Edinburgh postnatal depression scale (EPDS) score at 3 and 6 months after randomisation. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00518830. 208 (90%) of women randomly assigned to treatment groups completed assessments. The crude mean EPDS score was lower for the multicomponent intervention group than for the usual care group at 3 months (8·5 [95% CI 7·2–9·7] vs 12·8 [11·3–14·1]). Although these differences between groups decreased by 6 months, EPDS score remained better in multicomponent intervention group than in usual care group (10·9 [9·6–12·2] vs 12·5 [11·1–13·8]). The adjusted difference in mean EPDS between the two groups at 3 months was −4·5 (95% CI −6·3 to −2·7; p<0·0001). The decrease in the number of women taking antidepressants after 3 months was greater in the intervention group than in the usual care group (multicomponent intervention from 60/101 [59%; 95% CI 49–69%] to 38/106 [36%; 27–46%]; usual care from 18/108 [17%; 10–25%] to 11/102 [11%; 6–19%]). Our findings suggest that low-income mothers with depression and who have newly born children could be effectively helped, even in low-income settings, through multicomponent interventions. Further refinements to this intervention are needed to ensure treatment compliance after the acute phase.

Background The Edinburgh Postnatal Depression Scale (EPDS) has been proposed as a one-dimensional instrument and used as a single 10-item scale. This might be considered questionable since repeated psychometric studies have shown multi-dimensionality, which would entail using separate component subscales. This study reappraised the dimensional structure of the EPDS, with a focus on the extent of factor correlations and related factor-based discriminant validity as a foundation for deciding how to effectively scale the component items. Methods The sample comprised 811 randomly selected mothers of children up to 5 months attending primary health services of Rio de Janeiro, Brazil. Strict Confirmatory Factor Analysis (CFA) and Exploratory Factor Analysis modeled within a CFA framework (E/CFA) were sequentially used to identify best fitting and parsimonious model(s), including a bifactor analysis to evaluate the existence of a general factor. Properties concerning the related 10-item raw-score scale were also investigated using non-parametric items response theory methods (scalability and monotonicity). Results An initial CFA rejected the one-dimensional structure, while an E/CFA subscribed a three-dimensional solution. Yet, factors were highly correlated (0.66, 0.75 and 0.82). The ensuing CFA showed poor discriminant validity (some square-roots of average variance extracted below the factor correlations). A general bifactor CFA was then fit. Results suggested that, although still weakly encompassing three specific factors, the EPDS might be better described by a model encompassing a general factor (loadings ranging from 0.51 to 0.81). The related 10-item raw score showed adequate scalability (Loevinger's H coefficient = 0.4208), monotonicity e partial double monotonicity (nonintersections of Item Step Response Functions). Conclusion Although the EPDS indicated the presence of specific factors, they do not qualify as independent dimensions if used separately and should therefore not be used empirically as sub-scales (raw scores). An all-encompassing scale seems better suited and continuing its use in clinical practice and applied research should be encouraged.

Background Perinatal (antenatal and postpartum) depression impacts approximately 12% of mothers. Perinatal depression can impact everyday functioning for mothers, and the relationship with, and development of, their children. The purpose of this study was to investigate depression trajectories from the antenatal period through 54-months postpartum and associations with child body mass index at 54-months postpartum. Methods This study applied latent growth modeling to the Growing Up in New Zealand study, which is a longitudinal pregnancy cohort study that provides nationally representative-level data, to investigate associations between depression at three time points (antenatal, 9-months postpartum, 54-months postpartum) and child body mass index at 54-months ( n =4897). Results The average slope of depression for this sample is low and decreases over time. When child BMI was added to the model as an outcome variable, both antenatal depression (B=.25, p <.01), and the rate of change of depression across the perinatal and postpartum periods (B=.09, p <.01) were associated with child BMI at 54-months postpartum. After controlling for sociodemographic characteristics, antenatal depression, but not the slope of depression, remained significantly associated with child BMI (B=.05, p <.05). When controlling for maternal pre-pregnancy BMI the effect of antenatal depression on child BMI at 54-months was entirely attenuated ( χ 2 (9) = 39.60, p < .05, SRMR = 0.01, CFI = .99, RMSEA = 0.03, BIC=53213). Conclusions Our findings align with the Developmental Origins of Health and Disease theory and imply that both the physical and mental health of mothers during pregnancy may be important indicators of child growth and development outcomes. Early intervention directed towards women who have even mild depression scores during pregnancy may promote healthy child development outcomes. Additionally, given the heterogeneity of depressive symptoms over time seen in this study, multiple assessment periods across the postpartum period may be valuable to adequately address and support maternal mental health.

While contemporary diagnostic nosology characterizes postpartum depression (PPD) as a specifier of a major depressive disorder (MDD), this classification continues to be questioned. Functional magnetic resonance imaging (fMRI) holds the promise of helping to characterize the neuroanatomical dysfunction associated with dysregulated emotion after childbirth. Twenty postpartum women underwent fMRI in the presence of emotionally valenced stimuli. The observation of relative amygdala non-responsivity in subjects demonstrating greater depression symptomotology stands in contrast to imaging studies of MDD and provides insight into possible phenotypic differences of PPD.

Objectives The objective of this study is to validate three mental health scales in a targeted sample of pregnant Arab women living in Qatar: the Kuwait University Anxiety Scale, the Perceived Stress Scale, and the Edinburgh Postnatal Depression Scale. Methods Random split-half exploratory factor analysis and confirmatory factor analyses ( n =  336; n  = 331), conducted separately, were used to evaluate scale dimensionality, factor loadings, and factor structure of the KUAS, the PSS, and the EPDS. Results Fit statistics for the three scales suggested adequate fit to the data and estimated factor loadings were positive, similar in magnitude, and were significant. The final CFA model for the KUAS supported a 19-item, two factor structure. CFA models also confirmed 8- and 10-item, single-factor structures for the PSS and EPDS, respectively. Conclusions The validation of scales for these aspects of mental health in Arab pregnant women is critical to ensure appropriate screening, identification, and treatment to reduce the risk of sequelae in women and their children. Findings offer a useful comparison to mental-health scale validations in other Arab contexts.

Data were collected on postpartum depression from 151 women, ages 16-40 years who received postpartum health services from a rural obstetrical clinic in North Carolina between September 2002 and May 2003. Reflective of the racial and socio-economic makeup of the county, 60.9% of the sample were American Indian (Lumbee tribe) 25.8% were African American and 13.3% were Caucasian or other. The Postpartum Depression Screening Scale (PDSS) was utilized to explore the prevalence of postpartum depression requiring clinical intervention in a largely unexplored population, minority women. The incidence of postpartum depression symptoms was over 23%, which is significantly higher than even the most liberal estimates in other populations. As with previous literature on risk factors, the sample demonstrates a strong association between symptoms of depression, history of depression and receiving treatment for depression. The PDSS proved to be a clinically useful tool in this setting. Findings support the importance of implementing routine screening protocols to guide practice and implement support services.

Fatigue is both a symptom and a predictor of depression in women after childbirth. At the same time, postpartum fatigue is experienced by most non-depressed women. Health care providers experientially know that not all women who experience postpartum fatigue will manifest depression. However, while researchers agree that fatigue and depression are distinct concepts, they have not yet identified a means for describing or measuring this distinctness. A new model proposing how fatigue may be differentiated from depression after childbirth is presented. The Depressive Symptoms Responsiveness Model proposes that depression-related postpartum fatigue may potentially be differentiated from non-depression-related postpartum fatigue on the basis of whether depressive symptoms abate when fatigue is relieved. The ability to differentiate between fatigue and depression in postpartum women has the potential to improve women's health through improvements in practice and resource utilization. Furthermore, differentiation may lead to a better understanding of the role of fatigue in postpartum depression.

Examining the process undertaken to name and codify psychiatric illnesses provides important insights into how everyday healthcare practices are shaped by knowledge production processes. However, studies of illness classification often rely on an overly simplified distinction between the production of diagnostic categories and the application of those categories in practice. Drawing insight from science and technology studies, I argue that psychiatric diagnostic categories are iteratively generated through production and practice, even during the development of those categories. Through a discursive analysis of interviews, archival documents, and psychiatric literature, I identify the practical politics that enabled the creation of the postpartum depression (PPD) modifier in the Diagnostic and Statistical Manual of Mental Disorders , version four ( DSM - IV ). In addition, I demonstrate how the overarching discourses of evidence-based decision-making and biomedicine shaped the development of the postpartum modifier, and draw together comments made by interview participants regarding the administrative value of a PPD-related category in the DSM . These remarks suggest that, in their practice, researchers and clinicians also take into consideration their own knowledge about DSM production processes, providing further support for the argument that diagnostic categories are iteratively generated.

For the purpose of this study, a consecutive sample of 95 postpartum women were assessed at 1 week postpartum with the (EPDS) and at 8 +/- 2 weeks postpartum using the Present State Examination (PSE). A moderate correlation between PSE total score and EPDS score was found (r = 0.57). A moderate agreement between EPDS and Catego diagnosis of depression was also found (Kappa = 0.52). Using a cut-off score of 12 on EPDS and Catego diagnosis as a criterion variable, the sensitivity and specificity of the scale were 73% and 90%, respectively. However, using a cut-off score of 10, the sensitivity of the scale rose to 91% without much fall in its specificity (84%). The internal reliability of the scale was 0.84 (alpha Cronbach). We conclude that the Arabic version of the EPDS is a reliable and valid screening tool for depression in postpartum women.

This paper reviews the importance Emil Kraepelin put on disease course as a classificatory principle. It then outlines the academic reception of Kraepelin’s disease entities outside Germany, charts the uptake of his diagnostic concepts within clinical practice in Britain, and compares data on admissions for bipolar disorders, involutional melancholia and postpartum psychoses to the North Wales asylum during the period Kraepelin was working to data on contemporary admissions in an effort to shed further light on the validity of his diagnostic concepts.