S. Banti

From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the Perinatal Depression―Research & Screening Unit study

OBJECTIVE Perinatal depression is a particular challenge to clinicians, and its prevalence estimates are difficult to compare across studies. Furthermore, to our knowledge, there are no studies that systematically assessed the incidence of perinatal depression. The aim of this study is to estimate the prevalence, incidence, recurrence, and new onset of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, minor and major depression (mMD) in an unselected population of women recruited at the third month of pregnancy and followed up until the 12th month postpartum. METHOD One thousand sixty-six pregnant women were recruited. Minor and major depression was assessed in a naturalistic, longitudinal study. The Edinburgh Postnatal Depression Scale and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Disorders were administered at different time points during pregnancy and in the postpartum period. RESULTS The period prevalence of mMD was 12.4% in pregnancy and 9.6% in the postpartum period. The cumulative incidence of mMD in pregnancy and in the postpartum period was 2.2% and 6.8%, respectively. Thirty-two (7.3%) women had their first episode in the perinatal period: 1.6% had a new onset of depression during pregnancy, 5.7% in the postpartum period. CONCLUSIONS Our postpartum prevalence figures, which are lower than those reported in the literature, may reflect treatment during the study, suggesting that casting a multiprofessional network around women in need of support may be potentially useful for reducing the effects of this disorder on the mother and the newborn child. Furthermore, our results indicate that women with a history of depression have a 2-fold risk of developing mMD in the perinatal period.

Panic-agoraphobic spectrum: reliability and validity of assessment instruments

DSM IV is a simple, reliable diagnostic system with many advantages. However, DSM diagnostic criteria may not provide sufficient characterization of clinically significant symptoms. We have undertaken a project to assess an array (spectrum) of clinical features associated with different DSM Disorders. The purpose of this paper is to report on reliability of assessment instruments for Panic-Agoraphobic Spectrum (PAS), to document convergent validity of PAS symptom groupings, and to confirm the relationship between PAS and DSM IV Panic Disorder (PD). We studied 22 normal controls and 95 outpatients who met criteria for Panic Disorder with and without lifetime Major Depression, and Major Depression or Obsessive Compulsive Disorder without lifetime Panic Disorder. Assessment instruments had excellent reliability and there was good concordance between interview and self-report formats. PAS scores were highest in subjects with PD, followed by outpatients without PD, and were lowest in normal controls. PAS scores varied among PD patients, and a subgroup of patients without PD scored high on PAS. We conclude that PAS can be reliably assessed, and that it describes a valid, coherent constellation of features associated with DSM IV Panic Disorder, but providing additional important clinical information.

Adult separation anxiety: psychometric properties of a new structured clinical interview

Separation anxiety has traditionally been characterized and assessed as a disorder that is unique to childhood. Yet the core symptoms of separation anxiety, i.e. excessive and often disabling distress when faced with actual or perceived separation from major attachment figures, may persist or even arise during adulthood. We report on the psychometric properties of a new structured clinical interview designed to assess symptoms of separation anxiety as experienced both during childhood and adulthood. This instrument, called the Structured Clinical Interview for Separation Anxiety Symptoms (or SCI-SAS), was administered as part of an assessment battery to 91 adult psychiatric outpatients and 20 non-psychiatric controls. Results indicate that this instrument displays excellent psychometric properties, including good internal consistency, a clear factor structure, and exceptional levels of convergent and discriminate validity. These results highlight the feasibility and potential clinical utility of assessing age-appropriate symptoms of separation anxiety experienced during adulthood.

Beyond “postpartum depressions”: Specific anxiety diagnoses during pregnancy predict different outcomes: Results from PND-ReScU

OBJECTIVE Literature underlines that the Edinburgh Postnatal Depression Scale (EPDS) is the most common measure to assess postpartum depression (PPD) worldwide and suggests that the rate of false positives is high. Furthermore, the EPDS does not distinguish between depression and anxiety. This study describes different definitions of PPD and whether pregnancy anxiety disorders are risk factors for different PPDs at both 1month and 1year postpartum. METHOD 1066 women were recruited during pregnancy and followed until the 12th month postpartum (N=500). Women were administered the SCID and completed the PDPI-R during pregnancy. During the postpartum women who had an EPDS score of 13 or more were administered the SCID to distinguish minor or major depressive episodes (mMD) from false positives. RESULTS 41.5% and 44.9% of the PPD assessed with the EPDS were false positives at the 1st month and during the 1st year postpartum respectively. The difference observed in prevalence rates estimated with EPDS and SCID was statistically significant both at the 1st month and during the 1st year postpartum. Overall the effect of anxiety diagnoses in predicting PPD was stronger at the 1st month than during the 1st year postpartum. The role of panic disorder is associated both with probable depression (ES=0.82) and with mMD (ES=0.87) at the 1st month postpartum, and predicted mMD during the 1st year postpartum (ES=0.71). OCD predicted false positives at the 1st month postpartum (ES=0.89). CONCLUSION An antenatal screening of specific anxiety diagnoses could be extremely useful for the prevention of possible postpartum distress outcomes.

SUICIDALITY in the perinatal period: comparison of two self-report instruments. Results from PND-ReScU

The aim of this study was to assess suicidality in a non-clinical sample during the perinatal period and to report suicidality rates in women with major or minor depressive episode (MmD), assessed with the SCID, during the perinatal period. Women (1,066) were recruited at the third month of pregnancy and followed until the 12th month postpartum (N = 500). Suicidality was assessed with the MOODS-SR and with item 10 of the EPDS at different time-points during the perinatal period. The period prevalence of suicidality was 6.9% (95% CI: 6.0–7.8) during pregnancy and 4.3% (95% CI: 3.4–5.2) during postpartum, assessed with the MOODS-SR, and was 12.0% (95% CI: 10.8–13.2) during pregnancy and 8.6% (95% CI: 7.4–9.8) during the postpartum period, assessed with the EPDS. The prevalence of suicidality in women who had MmD during pregnancy was 26.4% and 34.1%, assessed with the MOODS-SR and the EPDS, respectively, while it was 18.4% (MOODS-SR) and 30.6% (EPDS) during the postpartum period. Clinicians should assess suicidality in women presenting with MmD during the whole perinatal period. Furthermore, suicidality should be assessed in women with a previous history of psychiatric disorder that reported a lifetime suicidal ideation.

Panic disorder as a risk factor for post-partum depression Results from the Perinatal Depression-Research & Screening Unit (PND-ReScU) study

BACKGROUND Although the role of anxiety disorders on the development of Post-partum Depression (PPD) have already been studied in literature, that of individual anxiety disorders has not received specific attention. The aim of this study is to investigate the role of Panic Disorder (PD) and family history for PD as risk factors for PPD. METHODS Six hundred women were recruited in a prospective, observational study at the 3rd month of pregnancy and followed up until the 6th month after delivery. At baseline, risk factors for PPD, Axis-I disorders and family history for psychiatric disorders were assessed. We investigated minor and major depression (mMD) occurred at 1st, 3rd and 6th months post-partum. Logistic regression models were used to estimate the association between PD, family history for PD and PPD. RESULTS Forty women had mMD in the post-partum. PD during pregnancy (RR=4.25; 95%CI:1.48-12.19), a history of PD (RR 2.47; 95%CI:1.11-5.49) and family history for PD (RR=2.1; 95%CI:1.06-4.4) predicted PPD after adjusting for lifetime depression and risk factors for PPD. LIMITATIONS The response rate is moderately low, but it is similar to other studies. The drop out rate is slightly high, however the 600 women who completed the 6th month follow-up did not differ from the presence of PD at baseline. CONCLUSIONS PD is an independent risk factor for PPD, underscoring need to assess PD symptoms during pregnancy. Furthermore, PD represents an important risk factor for the development of PPD and should be routinely screened in order to develop specific preventive interventions.

CROSS-CULTURAL VALIDITY OF THE STRUCTURED CLINICAL INTERVIEW FOR PANIC-AGORAPHOBIC SPECTRUM

BackgroundWe sought to develop a series of assessment measures of psychiatric spectrum conditions associated with major DSM-IV mood and anxiety disorders that might capture the true phenotypes underlying these disorders. The specific objective of this report was to describe the methods we employed to create instruments that could cross linguistic and national boundaries and to evaluate the comparability of results obtained when one of these instruments, the Structured Clinical Interview for Panic-Agoraphobic Spectrum (SCI-PAS), was administered in the United States and in Italy.MethodAfter developing, in parallel, the English and the Italian versions of the SCI-PAS, identical protocols were conducted in patients and control samples at the University of Pittsburgh and the University of Pisa to examine the reliability and validity of the interview.ResultsTotal and domain scores on the SCI-PAS were strikingly similar in the US and Italian patient groups and in controls. In addition, similarly high levels of inter-rater and test-retest reliability were found at the two sites. Finally, virtually identical patterns of relationships were found between the domains of the SCI-PAS and established measures of the same constructs.ConclusionsThe SCI-PAS displays similar reliability and validity properties in the two versions. This suggests that the instrument taps a phenotype that is consistent in American and Italian patient and control populations.

P02-373 - Prevalence, incidence, recurrence and new onset of depression durin pregnancy. results from the perinatal depression-research & screening unit (PND-RESCU) study

Objectives Perinatal depression is a particolar challenge to clinicians, and its prevalence estimates are difficult to compare across studies. Furthermore,there are no studies that systematically assessed the incidence of perinatal depression. The aim of this study is to estimate prevalence, incidence, recurrence and new onset of DSM IV minor and major depression (mMD) in an unselected population of pregnant women. Method 1066 pregnant women were recruited at third month of pregnancy (T0), and minor/major depression (mMD) was assessed by the Structured Clinical Interview for DSM IV disorders (SCID I). The SCID I was administered at baseline evaluation (T0), the Edimburgh Postnatal Depression Scale (EPDS) was administered at third, 6th (T1), 8th (T2) month of pregnancy, and the SCID I Mood module was administered to confirme an eventual DSM-IV minor or major depression diagnosis when the EPDS score was≥13. Result The pregnancy period prevalence of mMD was 12,4%.The point prevalence of mMD decreased from 8,6% at the 3rd month of pregnancy to 1,7% at the 8th month of pregnancy.The cumulative incidence of mMD was 2,2%. The weighted incidence of new onsets during pregnancy was 1,6%. The weighted percentage of recurrences during pregnancy was 3,7%. Conclusion The decline in the point prevalence during the second and third trimester of pregnancy found in our study may be attributed to psychological counselling and/or pharmacological treatment.Further studies about new onsets of depression during pregnancy are highly important in order to improve clinical prediction of risk in any individual woman.

Maternal–foetal attachment independently predicts the quality of maternal–infant bonding and post-partum psychopathology

Abstract Purpose: The aim of this study was to evaluate the association of maternal antenatal attachment and post-partum psychopathology, maternal–infant bonding, while checking for antenatal psychopathology, for lifetime psychiatric diagnosis and for the known risk factors for peripartum depression. Methods: One hundred and six women recruited at the first month of pregnancy (T0) were evaluated with the structured interview for DSM-IV TR (SCID-I) to assess the presence of lifetime psychiatric diagnosis and with the Perinatal Depression Predictor Inventory-Revised (PDPI-R), the Edinburgh Postnatal Depression Scale (EPDS), and the State–Trait Anxiety Inventory (STAI). At the sixth month of pregnancy (T1) and at the first month post-partum (T2), all patients were evaluated with the PDPI-R, the EPDS, the STAI, at T1, with the Maternal Antenatal Attachment Scale (MAAS), and at T2 with the Maternal Postnatal Attachment Scale (MPAS). Results: Multivariate regression analyses showed that maternal–foetal attachment was the variable most significantly associated with postnatal symptoms of depression and anxiety and with quality of maternal-infant attachment. The logistic regression analyses showed that antenatal attachment may predict postnatal depressive and anxiety symptoms (respectively, OR: 0.83 – IC [0.74 − 0.95], p = .005, OR: 0.88 – IC [0.79 − 0.98], p = .02), and the quality of maternal postnatal attachment (OR: 1.17 – IC [1.08 − 1.27], p < .001), also after taking into account the known risk factors for perinatal depression, the sociodemographic variables and lifetime psychiatric diagnosis. Conclusion: The quality of maternal–foetal bonding may independently predict the quality of maternal–infant attachment and post-partum depressive and anxiety symptoms. A comprehensive assessment of maternal risk factors for perinatal psychopathology during pregnancy should include the evaluation of antenatal attachment that could be modifiable by specific interventions promoting the quality of maternal bonding.

PW01-260 - Depression during pregnancy: comparison between pregnant depressed women and non pregnant depressed women

Object Depression during pregnancy is associated to physical symptoms that can impair the functioning of women; furthermore some of the depression somatic symptoms (i.e., sleep disturbance, fatigue, weight change and appetite) are also features of pregnancy. The overlap of symptomatology can interfere with the identification and the diagnosis of the mood episode. Aim of this study is to compare the the depressive phenomenology and the presence of Axis I comorbidity between pregnant and non pregnant depressed women. Method We diagnosed Major Depression (MD) using the Structured Clinical Interview for Axis I Diagnosis DSM IV (SCID I) in 32 pregnant women at third month of pregnancy and 87 non pregnant women and we compared the depressive phenomenology in the two groups. Then we administered the Mood Spectrum Self Repost Last Month (MOOD SR-LM) in the two group in order to study the mood spectrum symptomatology. Result Pregnant depressed women have higher psychomotor retardation, higher levels of concentration and lower agitation than non pregnant depressed women. The severity of depression symptoms was similar in the two depressed groups. Conclusion Our results agree with current litterature about the presence of psychomotor retardation in depressed pregnant women. The higher level of concentration in pregnant women could be explained by the high comorbidity with Generalized Anxiety Disorder (GAD). In the pregnant depressed women the Obsessive-Compulsive Disorder (OCD) and Panic Disorder (PD) comorbidity are more rappresentated.