Perinatal Depression and Beyond—Implications for Research Design and Clinical Management

Abstract

The 2 newly published studies, Smythe et al 1 and Sultan et al, 2 are systematic reviews (Smythe et al 1 also comprises a meta-analysis) dealing with the topic of perinatal mental health (ie, mental health during the time of pregnancy up to 1 year after birth). Smythe et al 1 estimated prevalence rates of perinatal depression and anxiety in parental dyads and associated factors. The pooled prevalence of depression was 1.72% (antenatally), 2.37% (0-12 weeks post partum), and 3.18% (3-12 months post partum). Given the paucity of dyadic studies, no prevalence estimate for anxiety could be determined. Sultan et al 2 examined the psychometric properties of 10 existing patient-reported outcome measures for assessing maternal postpartum depression. Although all included patientreported outcome measures demonstrated adequate content validity, only the Edinburgh Postnatal Depression Scale received a class A recommendation (recommended for use). All other patientreported outcome measures received a class B recommendation (further psychometric evaluation required before recommendation). The authors concluded that the Edinburgh Postnatal Depression Scale is currently the best available patient-reported screening measure for maternal postpartum depression.Perinatal mental health problems are very common: according to the World Health Organization, 3 approximately 10% of women in high income countries and approximately 30% in low-or middle-income countries are affected. The most common perinatal mental health problems are depression, anxiety disorders, and posttraumatic stress disorder (PTSD). 4 In the UK, the health care costs associated with maternal mental health problems are estimated at £8.1 billion, of which 72% are associated with health care costs related to the child. 5 Indeed, maternal depression, anxiety, or PTSD symptoms may negatively impact birth and breastfeeding outcomes and increase the risk for emotional or behavioral problems, symptoms of attention deficit hyperactivity disorder, or impaired cognitive development in the child. 6,7 Despite the large body of research on maternal perinatal mental health, most studies are conducted in samples of White, highly educated women, of middle to high socioeconomic background, and with planned or wanted singleton pregnancy. Hence, more studies on more diverse samples including teenage pregnancy, single motherhood, multiple pregnancies, adoption, and so forth, are needed. Moreover, paternal perinatal mental health has so far received fairly little attention from researchers and clinicians. A recent article 8 called for an inclusion of fathers' mental health in perinatal research. With the increasing involvement of fathers (or coparents) in family life in western societies, their mental health is also ever more important for maternal mental health, family relationships, and child development. 9 Similar to (expectant) mothers, (expectant) fathers also have an elevated risk of depression and anxiety disorders and PTSD during the perinatal period. Indeed, perinatal depression...

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