Maria Dritsa

Health-related quality of life in postpartum depressed women

SummaryThe objectives of this study were a) to evaluate health-related quality of life (HRQoL) among women with postpartum depression, b) examine the association between severity of depressive symptoms and level of impairment in physical and mental HRQoL and c) to identify contributors to physical and mental HRQoL. Seventy-eight women scoring ≥10 on the Edinburgh Postnatal Depression Scale completed the questionnaires measuring: HRQoL (Medical Outcomes Study 36-item short form SF-36), sleep quality, life stress, and social support. All women underwent a cardiovascular stress test to determine aerobic capacity. Compared to Canadian normative data, women experiencing postpartum depressed mood scored significantly lower on all SF-36 domains, as well as on the SF-36 physical and mental component summary score. Severity of depressed mood was not associated to worse physical health status, while poorer aerobic capacity emerged as a significant independent contributor of physical health status. Severity of depressed mood contributed to worse mental health status. After controlling for severity of depressed mood, the occurrence of pregnancy complications, cesarean delivery, poorer sleep quality, life stress, and less social support predicted poorer mental health status.

Self-reported leisure-time physical activity during pregnancy and relationship to psychological well-being

The psychological benefits of physical exercise have been reported in numerous populations. While studies have found elevated stress and depressed mood during pregnancy and no adverse birth effects associated with low to moderate intensity exercise, few have examined exercise in relation to psychosocial outcomes during pregnancy. The present study examined leisure-time physical activity (LTPA) patterns during pregnancy and its association to psychological well-being. In each trimester of pregnancy 180 women self-reported on frequency, form and duration of LTPA through structured interviews. Beginning in the third month of pregnancy, data was collected monthly on depressed mood (Lubin depression adjective checklist), state-anxiety, pregnancy-specific stress (pregnancy experiences questionnaire) and Hassles Scale. Independent samples t-tests comparing exercisers and non-exercisers in each trimester showed exercisers reported significantly less depressed mood, daily hassles, state-anxiety and pregnancy-specific stress in the first and second trimester. Women who exercised in the third trimester reported less state-anxiety in that trimester compared to non-exercisers. The results indicate a consistent association between enhanced psychological well-being, as measured by a variety of psychosocial inventories, and LTPA participation particularly during the first and second trimesters of pregnancy. In healthy pregnant women, even low-intensity regular exercise may be a potentially effective low-cost method of enhancing psychological well-being.

Sleep problems and depressed mood negatively impact health-related quality of life during pregnancy

The objectives of this study were to evaluate and identify determinants of health related quality of life (HRQoL) during pregnancy. Pregnant women (n = 245) completed questionnaires measuring: HRQoL (Short Form Health Survey SF-36), life stress, social support, sleep, and depressed mood in the third trimester. Demographics and medical variables were also collected. Compared to Canadian normative data, our sample scored significantly poorer on the following HRQoL domains: physical functioning, role limitations due to physical health problems, bodily pain, vitality, and social functioning. Multivariate linear regressions were used to model each of the SF-36 subscales. Experiencing sleep problems emerged as a significant determinant of poorer HRQoL in all domains, with the exception of emotional role. Higher depressed mood scores was independently associated with lower HRQoL in six of the eight domains, including bodily pain, general health, vitality, social functioning, emotional role, and mental health. Greater pregnancy-related anxiety was independently associated with lower scores on physical functioning and role limitations due to physical health problems. Women experience lower HRQoL during pregnancy, particularly in the physical domains. The importance of identifying and managing modifiable determinants early in pregnancy to enhance maternal health status is discussed.

PTSD following childbirth: a prospective study of incidence and risk factors in Canadian women.

OBJECTIVE The goals of the present study were to estimate the incidence and course of full and partial Post-Traumatic Stress Disorder (PTSD) following childbirth and to prospectively identify factors associated with the development of PTSD symptoms at 1month following childbirth. METHODS The sample comprised 308 women, with assessments at four time points: 25-40weeks gestation, 4-6weeks postpartum, 3 and 6months postpartum. Current and prior PTSD were assessed by the Structured Clinical Interview for DSM-IV (SCID-I) and the Modified PTSD Symptom Scale Self-Report (MPSS-SR). RESULTS Incidence rates of PTSD varied according to time of measurement and instrument used, with higher rates of full and partial PTSD using the MPSS-SR at 1month postpartum (7.6% and 16.6%, respectively). Multivariate logistic regression showed that higher anxiety sensitivity (OR=1.75; 95% CI=1.19‒2.57, p=.005), history of sexual trauma (OR=2.81; 95% CI=1.07‒7.37, p=.036), a more negative childbirth experience than expected (OR=0.96; 95% CI=0.94‒0.98, p=.001), and less available social support at 1month postpartum (OR=0.40; 95% CI=0.17‒0.96, p=.041) independently predicted full or partial PTSD at 1month following childbirth. CONCLUSION Our results indicate that a history of sexual trauma and anxiety sensitivity can increase the probability of developing PTSD after childbirth. The findings highlight the importance of screening and providing more tailored services for women at high risk.

Rates and risk factors associated with depressive symptoms during pregnancy and with postpartum onset

Abstract The objectives of this study were to evaluate the prevalence of depressive symptoms in the third trimester of pregnancy and at 3 months postpartum and to prospectively identify risk factors associated with elevated depressive symptoms during pregnancy and with postpartum onset. About 364 women attending antenatal clinics or at the time of their ultrasound were recruited and completed questionnaires in pregnancy and 226 returned their questionnaires at 3 months postpartum. Depressed mood was assessed by the Edinburgh Postnatal Depression Scale (EPDS; score of ≥ 10). The rate of depressed mood during pregnancy was 28.3% and 16.4% at 3 months postpartum. Among women with postpartum depressed mood, 6.6% were new postpartum cases. In the present study, belonging to a non-Caucasian ethnic group, a history of emotional problems (e.g. anxiety and depression) or of sexual abuse, comorbid anxiety, higher anxiety sensitivity and having experienced stressful events were associated with elevated depressed mood during pregnancy. Four risk factors emerged as predictors of new onset elevated depressed mood at 3 months postpartum: higher depressive symptomatology during pregnancy, a history of emotional problems, lower social support during pregnancy and a delivery that was more difficult than expected. The importance of identifying women at risk of depressed mood early in pregnancy and clinical implications are discussed.

Effects of home-based exercise on fatigue in postpartum depressed women: Who is more likely to benefit and why?

OBJECTIVES (1) To explore moderators of the effects of home-based exercise on reductions in physical and mental fatigue scores in postpartum depressed women and (2) to explore mediators of the intervention on changes in physical fatigue. METHOD Eighty-eight women in the postpartum period (4-38 weeks) obtaining a score >or=10 on the Edinburgh Postnatal Depression Scale were randomly assigned to a 12-week individualized home-based exercise intervention (n=46) or a no-treatment control group (n=42). The present analyses include the 35 women who adhered to the intervention and the no-treatment control group. Participants completed a cardiovascular fitness test, and a battery of questionnaires assessing the outcomes (Physical and Mental Fatigue) as well as potential moderators and mediators at baseline and posttreatment. RESULTS Hierarchical linear regressions evaluating moderators of changes in mental fatigue with exercise showed that the intervention was effective for women entering the study later in the postpartum period (P=.001) and women with higher depression scores (P=.014). Reductions in physical fatigue with exercise were partially mediated by reductions in perceived stress and increased exercise-related energy expenditure. CONCLUSION Identification of moderators allows for the tailoring of exercise interventions to particular subgroups of women that are most likely to benefit. The identified mediators may be enhanced and directly tested in future trials.

The relationship between exercise participation and depressed mood in women with fibromyalgia

Fibromyalgia (FM) is a chronic, widespread musculoskeletal pain disorder, with unknown organic etiology and no known pharmacologic treatment shown to be consistently effective. The present study examined the relationship between regular weekly exercise participation and depressed mood among women with FM. Seventy women with a diagnosis of FM were evaluated at baseline and at the three-year follow-up. At each assessment participants were interviewed, underwent a medical examination, and completed questionnaires assessing depressed mood, health status and daily functioning. Thirteen per cent of the women at baseline and 18% at follow-up reported doing no leisure physical activity. Depressed mood was significantly lower at follow-up compared to baseline. Engaging in more weekly leisure physical activity was associated with better functional ability at both assessments. A hierarchical multiple regression analysis revealed that after controlling for baseline depression, higher depressed mood scores at the three-year follow-up was associated with younger age, lower household income, less improvement in daily functioning and less participation in weekly leisure physical activity. These results support the claims that exercise can improve mental as well as physical health, underlining the importance of its integration into the comprehensive treatment of fibromyalgia.