Perinatal depression

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  • We are delighted to present Integrative Women’s Health—the fi rst such text created for health professionals. It is our hope that you will fi nd it of great value as you care for your patients. As the largest group of health care consumers, women have made it abundantly clear that they desire a broader, more integrative approach to their care. In response to this need, we have elected to cover both women’s reproductive health and those conditions that manifest diff erently in wome

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  • In the Western world, the arrival in the 20th century of the Welfare State meant that the basic needs of citizens in terms of health, hygiene and socio-economic considerations were met to a greater extent than ever before. It soon however became apparent that, as Maslow’s hierarchy of need predicts (Maslow, 1943), people continued to want more, they needed choices, and they sought opportunities to fulfil ambitions and goals.

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  • Gaynes et al. (109) did a meta-analysis of screening instruments (i.e., EPDS, Beck Depression Inventory (BDI), Postpartum Depression Screening Scale (PDSS), and the Center for Epidemiological Studies Depression Scale (CES-D)) for depression and concluded that, "various screening instruments can identify perinatal depression". They concluded that these instruments have high specificity and low sensitivity for depressive states, and this acquires a greater importance when deciding on whether false-positives or false-negatives are preferred.

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  • Since the recognition of the importance of antenatal as well as postnatal depression, a number of studies have looked at the prevalence of depression among pregnant women in the developed and developing world. Prevalence rates vary because of a variety of methodological factors.

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  • The line between depressive and anxiety disorders in perinatal as well as general populations is often blurred; when the EPDS has been factor-analyzed, although there are separate factors corresponding to depression and anxiety, several items have moderate loadings on both factors (Swalm, et al., 2010). Some services refer to antenatal or postnatal “distress” rather than attempt to differentiate depression from anxiety, and often women report a mix of anxious and depressed symptoms.

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  • The impact of perinatal mental health problems on infants has been studied in HIC, mostly in terms of neuro-psycho-behavioural variables, which are likely to apply in LMICs as well. Infants of depressed mothers show dysregulations affecting their behavior and physiology, thought to be derived from a prenatal exposure to a biochemical imbalance in their mothers (48, 70). Newborns of depressed mothers also have neurotransmitter imbalances (e.g., higher cortisol and lower dopamine and serotonin levels), are described as physiologically less mature (e.g.

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  • Various hypotheses have been advanced to explain the high prevalence of mental health problems during the perinatal period, ranging from biological (e.g., hormones and neurochemical modifications) to psychological (e.g., personality types and ways of thinking) and social determinants (e.g., gender disparities in access to education and income-generating opportunities, social roles, disproportionate burden of unpaid work, exposure to family violence, low autonomy, poverty and coincidental adversity) explanations.

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  • Studies conducted in HICs indicate a prevalence of 10-15% of perinatal mental disorders (11, 12). It has been suggested that rates of first onset and severe depression are three times higher in the postnatal period than in other periods of women's lives (13). More recently, Gavin et al. (14) confirmed those findings, suggesting that the rates are particularly high during the first trimester following childbirth.

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