The role of early screening in perinatal psychopathology

For some women, pregnancy and arrival of a new baby can be overshadowed by mental illness, aggravated by widespread stigma. Notably, Perinatal Depression (PND) may emerge during pregnancy and carry over into the postpartum period, or develop soon after delivery or even many months later. Depression during childbearing years is common, but up to 50% of the PND cases go undetected: the majority of women do not seek help and even when women consult a healthcare professional, half of them remain untreated. Unfortunately, untreated depression impacts mothers’ physical and psychological wellbeing as well as the infants’ development. Indeed, new mothers may experience some mental health conditions that may affect their quality of life, and the health of their children. Yet, the mental health of postpartum mothers is relatively neglected in both research and clinical practice. For these reasons, early detection of perinatal psychopathology represents one of the major challenges, and constitutes the first critical step in reducing the damages of PND. There is increasing evidence that an appropriate screening could identify women at risk, allowing performing an earlier diagnosis and leading to a more accurate management. Several studies have been conducted to determine the aetiology of PND and to identify its risk factors. Current and past history of depression and anxiety disorder, family history of mood disorders, negative stressful life events, marital discord and poor social support seem to be the strongest risk factors for PND. The aim of this dissertation is to evaluate the role of the early screening of the PND in reducing prevalence rate of postpartum distress and to describe the health related-quality of life (HRQOL) in perinatal period. A total of 1363 women were assessed for eligibility, and 946 (69.4%) signed an informed consent. A total of 417 (30.6%) immediately refused to participate for various reasons (e.g. lack of time, lack of interest, the convictions that they would never become depressed, or resistance of the partner). Women were enrolled in two different groups: group 1 (N=456), included in the study from the 1st month of pregnancy; group 2 (N=490), assessed in the 1st month postpartum for the first time; both group were followed up to 1 year postpartum. However, 188 women (41.2%) in the group 1 and 203 (41.4%) in the in the group 2 dropped out before complete the first assessment. Participants included 268 pregnant women recruited at the 1st month of pregnancy (group 1), and 287 puerperal women recruited at 1st month of postpartum (group 2). To assess psychopathology, we administered the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI), and the Short Form Health Survey-36 (SF-36) at different time points during perinatal period. These scales evaluated anxiety and depressive symptoms, and HRQOL. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was used as diagnostic tool. In the recruited population, 48 women (18.8%) reported depressive symptoms throughout the 1-year follow-up after childbirth and 25 (11.8%) women reported state anxiety symptoms greater than 90° percentile. In particular, we found that carrying out an early screening during pregnancy significantly reduce the likelihood of having depressive (group 1 vs. group 2: 12.0% vs. 23.6%; OR=2.26; 95%CI: 1.13-4.52) or anxiety (group 1 vs. group 2: 5.0% vs. 18.0%; OR=4.18; 95%CI: 1.50-11.59) symptoms in the postpartum period. In the 1st month postpartum, we found a Mental Component Summary (MCS) statistically higher in group 1 respect to group 2 (p=.011), but we did not find any Physical Component Summary (PCS) difference. In the 1st month women of group 1 were significantly more impaired in 3 out of the 4 SF-36 mental dimensions including Vitality (p<.001), Social Functioning (p=.007) and Mental Health (p=.048). Therefore, we assessed mean values of MCS and PCS over the 1st year postpartum, compared to age- and sex-appropriate normative means: women of group 2 were significantly more impaired in PCS score at 6th month (p=.021), and the mean of PCS score of group 1 were higher than group 2 in the 1st year postpartum. Interestingly, in the 12th month assessment, General Health perceptions appear to be statistically significant better in the group 1 (p=.036). These analyses suggest that antenatal screening of risk factors for postpartum distress might be effective to reduce postpartum distress features. Depression and anxiety symptoms are higher and the perceived mental health is worse in women followed from the 1st postpartum month. According to our data, screening for PND seems to be appropriate and useful in order to reduce the rates of perinatal psychopathology and to detect women at risk to develop PND, allowing an earlier diagnosis and a better treatment management. However, more longitudinal research is needed that focuses on predictors, instruments, and management of the perinatal psychopathology