PERINATAL DEPRESSION: PREVALENCE, RISK FACTORS AND SCREENING TOOLS RESULTS FROM THE PERINATAL DEPRESSION - RESEARCH & SCREENING UNIT (PND-ReScU) STUDY

ABSTRACT Postpartum depression (PPD) is a mental disorder carrying substantial risk not only for the health of mother and child, but the whole family. Depression may emerge during pregnancy, carry over into the postpartum period or develop soon after delivery and even many months later. Several studies have been conducted for determining the etiology of PPD and identifying risk factors which may predict its occurrence during pregnancy. Several risk factors measured during pregnancy show a strong relation to PPD, including current and past history of depression and anxiety disorder, negative stressful life events, marital discord and poor social support. Most of this risk factors have been incorporated into scales and used for the screening and selection of high-risk women during pregnancy for prevention trials. In general, these instruments, used to identify a group of women with substantial increased risk for PPD over the base rate, can be useful as basis for conversation between woman and her healthcare provider. Despite its positive attribute, there is no single set of criteria for assessing the benefit of routine perinatal depression screening programs, and this lead to different approaches. Women were enrolled in two different groups (N=555) and they were the same likelihood of being part of group 1 (N=268) or group 2 (287). In the 1st group women enter the study at the beginning of pregnancy and prospectively followed up to 1 year after delivery; in the 2nd group women were recruited after the delivery and prospectively followed up to 1 year after childbirth. The setting for the study was based on an ongoing collaboration between the Department of Obstetrics and Gynecology and the Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies of the Azienda Ospedaliero-Universitaria Pisana (AOUP). Women were repeatedly administered a set of instruments that included the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI) and the Postpartum Depression Predictors Inventory-Revised (PDPI-R). The diagnostic assessment was conducted using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). The aim of this study was to assess the effectiveness of an early screening in reducing prevalence rate of postpartum distress. In particular We assessed anxiety and depressive symptoms. Overall We found that 48 women (18.8%) reported depressive symptoms throughout the 1 year after childbirth and 25 (11.8%) women reported state anxiety symptoms greater than 90° percentile. In particular we found that carry out an early screening during pregnancy significantly reduce the likelihood of having depressive (12.0% vs 23.6%; OR=2.26; 95%CI: 1.13-4.52) or anxiety (5.0% vs 18.0%; OR=4.18; 95%CI: 1.50-11.59) symptoms in the postpartum period. Antenatal screening of risk factors for postpartum distress is effective in reduce postpartum distress features