Tadaharu Okano

Multicentre prospective study of perinatal depression in Japan: incidence and correlates of antenatal and postnatal depression

SummaryA multicentre study on the epidemiology of perinatal depression was conducted among Japanese women expecting the first baby (N = 290). The incidence rate of the onset of the DSM-III-R Major Depressive Episode during pregnancy (antenatal depression) and within 3 months after delivery (postnatal depression) were 5.6% and 5.0%, respectively. Women with antenatal depression were characterised by young age and negative attitude towards the current pregnancy, whereas women with postnatal depression were characterised by poor accommodation, dissatisfaction with sex of the newborn baby and with the emotional undermining. Antenatal depression was a major risk factor for postnatal depression.

Endocrine study of the maternity blues.

The relationship between several psychological variables and adrenocortical function of the blues is examined in a prospective study of 47 Japanese women. Psychological measures, including the psychiatric interview and assessment of the Schedule for Affective Disorders and Schizophrenia (SASD), the Research Diagnostic Criteria (RDC) and self-rating scales, were administered at the 36th week of pregnancy, on the 3rd or 4th day postnatal and one month after delivery. Twelve subjects (25.5%) were diagnosed as having the blues on the Steins scale. Women who developed the blues had significantly higher serum bound cortisol than the non-blues group. No significant correlation was obtained between the incidence of the blues and obstetric variables. At one month after delivery, four women (8.5%) were diagnosed as postpartum depression according to the RDC. Our finding that there was no consistent obstetric factor which predisposes women to develop the blues support the hypothesis that hyperadrenocorticalism is important in the genesis of this syndrome.

Risk factors for postpartum depression in Japan

Abstract We conducted a longitudinal study to identify risk factors for postpartum depression. At the late phase of pregnancy, 627 pregnant women agreed to take the State‐Trait Anxiety Inventory Trait (STAIT) test and to remain in the study until 4 months postpartum. At 1, 3 and 4 months postpartum, they took the Edinburgh Postnatal Depression Scale (EPDS) test and the State‐Trait Anxiety Inventory State (STAIS) test. At 3 months postpartum, they were asked about socio‐psychological and obstetric factors. High scores in the EPDS and STAIS tests were correlated with primiparity, premature delivery, difficult labor, experience of life events and worries about baby care. Furthermore, high scores in the STAIT test in late pregnancy were strongly correlated with high scores in the EPDS and STAIS tests in the postpartum period.

Effectiveness of antenatal education about postnatal depression: A comparison of two groups of Japanese mothers

The effectiveness of information and practical advice provided during pregnancy about postnatal depression has not been adequately demonstrated. We examined the occurrence of postnatal depression in two groups of childbearing women (attenders v. non-attenders at antenatal informational support groups). Assessments of outcome were made by a three-stage procedure, using the Edinburgh Postnatal Depression Scale (EPDS) and a clinical interview at the first consultation, 6 weeks and 12 weeks later. Forty patients were identified as suffering from postnatal depression; 18 of the patients belonged to the attenders and 22 to the non-attenders. The attenders were referred to psychiatrists more quickly after the onset of depression in comparison with the non-attenders (p <0.001). The mean score on the EPDS of the attenders was significantly lower at the first consultation (p <0.001) and still at 6 weeks later (p <0.01) when compared with that of non-attenders. Antenatal information and advice about services for pos...

Translation and validation of the Japanese version of the Wijma Delivery Expectancy/Experience Questionnaire version A.

Severe antenatal fear of childbirth causes adverse effects on emotional well-being during the postpartum period. The Wijma Delivery Expectancy/Experience Questionnaire is widely used to measure fear of childbirth among women before (version A) and after (version B) delivery. In this study, the original Swedish version was translated into Japanese, and its validity and reliability were examined among healthy, pregnant Japanese women. The Japanese-translated version presented a multidimensional structure with four factors: fear, lack of positive anticipation, isolation, and riskiness. Exhibiting concurrent/convergent validity, the Japanese version correlated with other psychological measures at expected levels. The Cronbachs α (0.90) and the intraclass correlation coefficient (0.86, P < 0.001) were high. In conclusion, the results provide support for the Japanese version to be considered a valid and reliable measure of prenatal fear of childbirth among pregnant Japanese women.

Aetiological relationships between factors associated with postnatal traumatic symptoms among Japanese primiparas and multiparas: A longitudinal study

OBJECTIVE this study aims to identify the aetiological relationships of psychosocial factors in postnatal traumatic symptoms among Japanese primiparas and multiparas. DESIGN a longitudinal, observational survey. SETTING participants were recruited at three institutions in Tokyo, Japan between April 2013 and May 2014. Questionnaires were distributed to 464 Japanese women in late pregnancy (> 32 gestational weeks, Time 1), on the third day (Time 2) and one month (Time 3) postpartum. MEASUREMENTS The Japanese Wijma Delivery Expectancy/Experience Questionnaire (JW-DEQ) version A was used to measure antenatal fear of childbirth and social support, while the Impact of Event Scale Revised (IES-R) measured traumatic stress symptoms due to childbirth. FINDINGS of the 464 recruited, 427 (92%) completed questionnaires at Time 1, 358 (77%) completed at Time 2, and 248 (53%) completed at Time 3. Total 238 (51%) were analysed. A higher educational level has been identified in analysed group (p=0.021) Structural equation modelling was conducted separately for primiparas and multiparas and exhibited a good fit. In both groups antenatal fear of childbirth predicted Time 2 postnatal traumatic symptoms (β=0.33-0.54, p=0.002-0.007). Antenatal fear of childbirth was associated with a history of mental illness (β=0.23, p=0.026) and lower annual income (β =-0.24, p=0.018). Among multiparas, lower satisfaction with a previous delivery was related to antenatal fear of childbirth (β =-0.28, p < 0.001). KEY CONCLUSIONS antenatal fear of childbirth was a significant predictor of traumatic stress symptoms after childbirth among both primiparous and multiparous women. Fear of childbirth was predicted by a history of mental illness and lower annual income for primiparous women, whereas previous birth experiences were central to multiparous women. IMPLICATION FOR PRACTICE the association between antenatal fear of childbirth and postnatal traumatic symptoms indicates the necessity of antenatal care. It may be important to take account of the background of primiparous women, such as a history of mental illness and their attitude towards the upcoming birth. For multiparous women, focusing on and helping them to view their previous birth experiences in a more positive light are vital tasks for midwives.

Thyroid function and postpartum psychiatric disorders

Summary It is well known that pregnancy and the postpartum period are associated in some women with pathological changes in thyroid function. On the other hand, the relationship of psychiatric disorders with thyroid dysfunction is also well accepted. However, the diagnosis and treatment of thyroid dysfunction in postpartum psychiatric disorders is complex and still controversial. Autoimmune thyroiditis, which develops to various grades of hypothyroidism, sometimes seemed to be a clue for postpartum psychiatric disorder. These issues, however, should be strictly differentiated from the point of specific endocrinological pathogenesis. Making an appropriate diagnosis for women with concurrent psychiatric and/or endocrinological dysfunction will lead to special applications of hormone treatment.

Problems of Perinatal Mental Health Care in Tokyo, Japan

Recently, a dramatic increase in pregnancies complicated by mental disorders has been observed in Tokyo, Japan [1, 2]. In 2014, the estimated number of deliveries complicated by mental disorders was 1,800 [2]. The rate of general hospital with psychiatric inpatient beds is only about 16% of the delivery facilities in Tokyo; however, about 36% of the deliveries with mental disorders were managed by these general hospitals. These rates are feared to lead to the tremendous burden of both obstetrics and psychiatric staffs of the general hospitals in Tokyo. To know the reason why many deliveries with mild mental disorders are managed in a small number of general hospitals, we requested 85 private obstetric clinics to provide the reason why they introduced even deliveries with mild mental disorders to the general hospitals. Because many of the deliveries with mental disorders managed at the general hospital seemed to be not severe as necessary to be managed at the higher-order facilities. A total of 57 (67%) of them responded. The most common reason (26/57, 46%) was “We cannot examine the severity of mental disorders” and the second common reason was “It is difficult to take reservation of psychiatric clinics for pregnant women”. Therefore, they seemed to introduce all pregnant women suspected having mental disorders to the general hospitals. On the other hand, about 60% of the staffs of the psychiatric clinics in Tokyo seemed to be worried excessively about the influence of medications on both fetuses and pregnant women (Takeuchi and Okano, unpublished data). Therefore, some psychiatrists also seemed to introduce all pregnant women with mental disorders to the general hospitals. For the proper management of perinatal psychosis, it is necessary to build a smooth cooperation system of obstetricians and psychiatrists. As the first step of the cooperation, the guidelines for the determination of severity of mental disorders by obstetricians those obtained a consensus between the obstetricians and psychiatrists are needed.