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Perspective of Postpartum Depression Theories: A Narrative Literature Review

Abdollahi F, Lye MS, Zarghami M

N Am J Med Sci, 2016 Jun;8(6):232-6.
PMID: 27500126 DOI: 10.4103/1947-2714.185027

Postpartum depression is the most prevalent emotional problem during a women's lifespan. Untreated postpartum depression may lead to several consequences such as child, infant, fetal, and maternal effects. The main purpose of this article is to briefly describe different theoretical perspectives of postpartum depression. A literature search was conducted in Psych Info, PubMed, and Science Direct between 1950 and 2015. Additional articles and book chapters were referenced from these sources. Different theories were suggested for developing postpartum depression. Three theories, namely, biological, psychosocial, and evolutionary were discussed. One theory or combinations of psychosocial, biological, and evolutionary theories were considered for postpartum depression. The most important factor that makes clinicians' choice of intervention is their theoretical perspectives. Healthcare providers and physicians should help women to make informed choices regarding their treatment based on related theories.
Fulltext The World Health Organization Body Mass Index Curves for Iranian Children

Lye MS, Zarghami M, Abdollahi F

Oman Med J, 2023 Sep;38(5):e563.
PMID: 38192362 DOI: 10.5001/omj.2023.130
Stability of depressive symptoms over 3 months post-partum

Abdollahi F, Zarghami M, Sazlina SG, Lye MS

Early intervention in psychiatry, 2017 Feb;11(1):57-62.
PMID: 25582677 DOI: 10.1111/eip.12215

AIM: Prolonged depression during the post-partum period is associated with maternal and infant mortality and morbidity. Less attention has been given to factors that predict the persistence of depression beyond the first 3 months post-partum.
METHODS: From a longitudinal cohort of 2279 women who attended Mazandaran's primary health centres in 2009, 478 women with an Edinburgh Postnatal Depression Scale (EPDS) score of 12 or greater in the third trimester of pregnancy were recruited. Persistently depressed women (depressed at all three occasions: during pregnancy, and at 2 and 12 weeks post-partum) were compared with those without depression to determine demographic, cultural, obstetric and biopsychosocial predictors for persistence of depression. Data were analysed using chi-square test, t-test and logistic regression models.
RESULTS: The stability of depression was found in 193 (46.2 %) of 418 depressed cases who were followed up over the study period. Of those mothers who scored more than the threshold of 12 during the third trimester of pregnancy, 277 (66.3%) and 221 (52.9%) had high EPDS at 2 and 12 weeks post-partum. Psychological distress (based upon the General Health Questionnaire), low maternal parental self-efficacy (based upon the Parental Expectation Survey) and perceived social isolation (based upon the Network Orientation Scale) were independent predictors of persistent depression.
CONCLUSION: Fewer depressed mothers in this study were found to recover during the first 3 months after giving birth. Psychosocial factors predicted sustained depression from pregnancy to 3 months post-partum. The findings highlight the significance of support in enhancing maternal mental health.
Fulltext Postpartum Mental Health in First-Time Mothers: A Cohort Study

Abdollahi F, Agajani-Delavar M, Zarghami M, Lye MS

Iran J Psychiatry Behav Sci, 2016 Mar;10(1):e426.
PMID: 31168307 DOI: 10.17795/ijpbs-426

Background: Post-partum depression (PPD) can produce adverse symptoms that make motherhood one of the most tumultuous events in a female's life. First-time mothers who have problems adapting themselves to the mother's role are more vulnerable to PPD.

Objectives: The current study aimed to explore the extent of social support and parental self-efficacy on PPD, this study was conducted among the first-time pregnant women.

Patients and Methods: A prospective cohort study assessed the depressive symptoms and related factors among 838 first-time not depressed pregnant women from third trimester of pregnancy to 12 weeks postpartum who attended primary health centers (Jan to July 2009). The study employed Edinburgh postnatal depression scale, social support appraisals scale, network orientation scale, marital inventory, parental expectation survey and socio-demographic questionnaires. Logistic regression was used for data analysis.

Results: The incidence of depression was 10.7% at three months post-partum. The adjusted odds ratio showed the PPD was associated with perceived social isolation (OR = 1.06; 95% CI = 1.01 - 1.12), lack of marital satisfaction (OR = 0.91; 95% CI = 0.86 - 0.97) and low parental self-efficacy (OR = 0.74; 95% CI = 0.65 - 0.85).

Conclusions: A high incidence of PPD was identified among the first-time mothers which makes PPD one of the major health problems in females. The important effects of perceived social isolation, maternal parental self-efficacy, and marital satisfaction on reducing the risk of PPD should be considered.
Fulltext Impact of Intimate Partner Violence on Iranian Children's Growth and Development: A Descriptive-analytical Study

Lye MS, Zarghami M, Charati JY, Abdollahi F

Oman Med J, 2023 Jan;38(1):e464.
PMID: 36937772 DOI: 10.5001/omj.2023.51

OBJECTIVES: This study aimed to determine the prevalence of different types of intimate partner violence (IPV) experienced by married Iranian women and their impact on the growth and development of their children.
METHODS: For this descriptive-analytical study, we recruited the mothers of one-year-old children attending primary health centers in Gonbad-e-Kavoos city, Iran. The data was collected using a questionnaire comprising the World Health Organization Domestic Violence, Ages and Stages Questionnaire-12; and queries related to the participants' socio-economic, obstetrics, demographic, and anthropometric characteristics. The body mass index z (BMI z) scores of the children were divided into five categories based on the World Health Organization's classification: severely underweight (z < -3), underweight (-3 ≤ z < -2), normal (-2 ≤ z < 1), overweight (1 ≤ z ≤ 2), and obese (z > 2). The data were subjected to descriptive analysis, chi-square test, and regression.
RESULTS: A total of 596 of mother-child dyads were included in this study. The prevalence of psychological, physical, and sexual IPV was 29.5%, 7.4%, and 2.4%, respectively. Most children (91.7%) had normal weight while the rest were overweight or obese. Developmental problems were reported in 1.7% of children. The education level of the father was significantly related to IPV (p =0.001) while the type of his occupation was related to delay in child growth (p =0.020). There was no significant difference between BMI z-score and developmental disabilities in the children of women exposed and not exposed to any type of IPV.
CONCLUSIONS: The prevalence of psychological IPV was high while those of physical and sexual IPV were low. The rates of poor child growth and development were also low. The father's educational and socio-economic status influenced IPV and the children's growth deficits.
Depressive symptoms in men immediately after birth

Abdollahi F, Lye MS, Yazdani Cherati J, Zarghami M

J Psychosom Res, 2021 12;151:110650.
PMID: 34739946 DOI: 10.1016/j.jpsychores.2021.110650

OBJECTIVE: Depression is the second leading cause of morbidity worldwide. This study aimed to assess the prevalence and associated risk factors of paternal postpartum depressive symptoms (PPD).
METHODS: In a cross-sectional study, via a stratified random and convenience sampling method 591 couples who were referred to Mazandaran primary health centers between 2 and 8 weeks postpartum were recruited from March to October 2017. Couples were screened for depressive symptoms using Edinburgh Postnatal Depression Scale (EPDS). Fathers provided information on socio-demographic characteristics, life events, neonatal stressor, perceived stress (Perceived Stress Scale), social support (Multidimensional Scale of Perceived Social Support), and general health status using General Health Questionnaire (GHQ-12) as well. Data was analyzed using multiple logistic regression.
RESULTS: Overall, 93 fathers (15.7%) and 188 mothers (31.8%) reported depressive symptoms above the cut-off EPDS score of 12. In the multiple logistic regression model, older age, maternal depressive symptoms, higher GHQ-12 scores and increased recent life events were related to paternal PPD. A significant inverse association was found between number of children and paternal PPD.
CONCLUSION: Depressive symptoms especially in first-time fathers following the birth of a child are not uncommon. Creating opportunities for men to access special health care services, parental education to help adapting to parenthood, screening programs, and psychiatric/psychosocial interventions to decrease suffering of depression for both depressed parents are recommended.
Postnatal depression and its associated factors in women from different cultures

Abdollahi F, Lye MS, Md Zain A, Shariff Ghazali S, Zarghami M

Iran J Psychiatry Behav Sci, 2011;5(2):5-11.
PMID: 24644441

OBJECTIVE: Postpartum depression (PPD) is a common health problem which affects women in the postpartum period. This is a brief note on its associated factors in women from different cultures.
METHODS: A literature review was performed in MEDLINE and Pubmed from 1991 to 2008 and Magiran from 1991 to 2009. Additional articles and book chapters were referenced from these sources.
RESULTS: The prevalence of postpartum depression has been reported to be from 0.5% to 60% globally, and from 3.5% to 63.3% in Asian countries, in which Malaysia and Pakistan had respectively the lowest and highest rates. One of the factors contributing to PPD in Asian societies can be that women may not have the empowerment to reject traditional rituals that are imposed on them by their caregivers. Unsatisfactory pre-existing relationships between the mothers and their caregivers resulting in mothers experiencing difficulties during their confinement period may be another factor. Thirdly, some features of these traditional rituals may be the cause of tension, stress and emotional distress. Emotional conflicts caused by insistence on practice of traditional rituals during the postpartum period may lead to mental breakdown.
CONCLUSION: Health care professionals should be aware that the phenomenon in Asian cultures is as prevalent as European cultures. Moreover, further research needs to be conducted on the global prevalence of the experiences of childbearing women with depressive symptoms.
KEYWORDS: Cultures; Postpartum depression; Risk factors
Fulltext Prediction of incidence and bio-psycho-socio-cultural risk factors of post-partum depression immediately after birth in an Iranian population

Abdollahi F, Zarghami M, Sazlina SG, Zain AM, Mohammad AJ, Lye MS

Arch Med Sci, 2016 Oct 1;12(5):1043-1051.
PMID: 27695496

INTRODUCTION: Post-partum depression (PPD) is the most prevalent mental problem associated with childbirth. The purpose of the present study was to determine the incidence of early PPD and possible relevant risk factors among women attending primary health centers in Mazandaran province, Iran for the first time.
MATERIAL AND METHODS: A longitudinal cohort study was conducted among 2279 eligible women during weeks 32-42 of pregnancy to determine bio-psycho-socio-cultural risk factors of depression at 2 weeks post-partum using the Iranian version of the Edinburgh Postnatal Depression Scale (EPDS). Univariate and hierarchical multiple logistic regression models were used for data analysis.
RESULTS: Among 1,739 mothers whose EPDS scores were ≤ 12 during weeks 32-42 of gestation and at the follow-up study, the cumulative incidence rate of depression was 6.9% (120/1,739) at 2 weeks post-partum. In the multivariate model the factor that predicted depression symptomatology at 2 weeks post-partum was having psychiatric distress in pregnancy based on the General Health Questionnaire (GHQ) (OR = 1.06, (95% CI: 1.04-1.09), p = 0.001). The risk of PPD also lower in those with sufficient parenting skills (OR = 0.78 (95% CI: 0.69-0.88), p = 0.001), increased marital satisfaction (OR = 0.94 (95% CI: 0.9-0.99), p = 0.03), increased frequency of practicing rituals (OR = 0.94 (95% CI: 0.89-0.99), p = 0.004) and in those whose husbands had better education (OR = 0.03 (95% CI: 0.88-0.99), p = 0.04).
CONCLUSIONS: The findings indicated that a combination of demographic, sociological, psychological and cultural risk factors can make mothers vulnerable to PPD.
KEYWORDS: depression; incidence; post-partum
Fulltext Bio-psycho-socio-demographic and Obstetric Predictors of Postpartum Depression in Pregnancy: A prospective Cohort Study

Abdollahi F, Rohani S, Sazlina GS, Zarghami M, Azhar MZ, Lye MS, et al.

Iran J Psychiatry Behav Sci, 2014;8(2):11-21.
PMID: 25053953

OBJECTIVE:
There are various attempts to confirm variables that could predict postpartum depression in advance. This study determined antenatal risk factors for postpartum depression in women at risk of developing this disorder.

METHODS:
A prospective cohort study was conducted with 2279 eligible women who attended at Mazandaran province' primary health centers from 32-42 weeks of pregnancy to eighth postpartum weeks. The women were screened for symptoms of depression using the Iranian version of Edinburgh Postnatal Depression Scale. An Edinburgh Postnatal Depression Scale score of > 12 indicated possible postpartum depression. Univariate and multiple logistic regression models were used for data analysis.

RESULTS:
A total of 2083women during 32-42 weeks of gestation participated in this study and were followed up to 8-week postpartum. Four hundred and three (19.4%) mothers yielded scores above the threshold of 12. Depression and general health state in pregnancy based on Edinburgh Postnatal Depression Scale (OR = 1.35, CI = 1.3-1.4) and General Health Questionnaire-28 (OR = 1.03, CI = 1.01-1.04), respectively were significant independent antenatal risk factors of depression symptoms at 8-week postpartum. Mothers who lived in nuclear families (OR = 1.38, CI = 1.04-1.84), whose husbands had lower educational status (OR = 0.95, CI = 0.91-0.99), and with delayed prenatal care (OR = 1.01, CI = 1.001-1.03) were more susceptible to postpartum depression.

CONCLUSION:
A comprehensive antenatal assessment focused on psychiatric problems, environmental and obstetric factors would benefit pregnant women in the prevention of postpartum depression.

KEYWORDS:
Cohort Study; Postpartum Depression; Prediction; Risk Factors