Modified Xiaoyao powder for postpartum depression:A systematic review and meta-analysis

Objective:To evaluate the effectiveness and safety of modified Xiaoyao powder for postpartum depression(PPD)by conducting a systematic review of randomized controlled trials(RCTs).Methods:The Chinese National Knowledge Infrastructure Databases(CNKI),the Chinese Scientific Journals Database(VIP),Wanfang,Google Scholar,the SinoMed,Embase,Cochrane Library,and PubMed databases were searched from their inception to April 25,2023.The Cochrane Risk of Bias tool was used to assess the quality of the trials.We applied the risk ratio to present dichotomous data and the mean difference to present continuous data.Data with similar characteristics were pooled for meta-analysis and heterogeneity was assessed using I2.Results:This review included 35 trials involving 2848 participants.The quality of the included studies was low(unclear randomization processes and insufficient reporting of blinding).Participants treated with modified Xiaoyao powder plus Western medicine showed lower Hamilton Depression Scale(HAMD)depression score than those who used Western medicine alone(mean difference=-2.15;95%confidence interval:-2.52 to 1.78;P<.00001),and higher effective rate(relative risk=1.19;95%confidence interval:1.15 to 1.24;P<.00001),When comparing modified Xiaoyao alone with Western medicine,the HAMD depression score remained low,however,the efficacy rate was higher in the modified Xiaoyao group.Regarding adverse events,the modified Xiaoyao group reported weight gain,nausea,and diarrhea,but no severe adverse events were reported.Conclusion:Modified Xiaoyao may help relieve depression in PPD when used alone or in combination with Western medicine,with minor side effects.Therefore,future high-quality,large-sample size RCTs are warranted.

Analysis of risk factors for postpartum depression after cesarean section in women with early-onset preeclampsia

BACKGROUND Early-onset preeclampsia significantly increases maternal and fetal morbidity and mortality.Many pregnant women with early onset preeclampsia choose cesarean section as their delivery method.Although extensive research has explored the association between postpartum depression(PPD)and cesarean section,few studies have investigated the risk factors after cesarean section in women with early-onset preeclampsia.AIM To examine these risk factors through a retrospective,observational analysis of 287 women who underwent a cesarean section for early preeclampsia between June 2014 and March 2024.METHODS Participants were assessed in person during the 32nd week of pregnancy,2 days post-cesarean,and 6 weeks postpartum.According to the Edinburgh Postnatal Depression Scale(EPDS),participants who underwent cesarean section were divided into PPD(n=60)and non-PPD groups(n=227).Furthermore,PPD was diagnosed at 6 weeks postpartum according to depressive symptoms(EPDS score≥11).The demographic and clinical features of PPD were screened.Multivariate logistic regression analysis was used to identify PPD risk factors.RESULTS The prevalence of PPD was 20.9%(60/287)among the 287 women who underwent cesarean section for early-onset preeclampsia.Multivariate logistic regression analyses revealed that advanced age(age>40 years)[odds ratio(OR)=1.93,95%CI:1.31-2.82],previous preeclampsia(OR=7.15,95%CI:5.81-8.85),pre-pregnancy obesity(OR=2.42,95%CI:1.62-3.63),gestational diabetes mellitus(OR=3.52,95%CI:2.51-4.92),preexisting hypertension(OR=1.35,95%CI:1.03-1.89),PPD symptoms(EPDS≥11)at 2 days postpartum(OR=6.15,95%CI:1.32-28.35),high prenatal self-rating anxiety scale score(OR=1.13,95%CI:1.06-1.18),and pain at 6 weeks postpartum(OR=2.16,95%CI:1.28-3.66)were independently associated with PPD.CONCLUSION Risk factors for PPD after cesarean section in women with early-onset preeclampsia include advanced age(age>40 years),pre-pregnancy obesity,previous preeclampsia,gestational diabetes mellitus,preexisting hypertension,PPD symptoms(EPDS≥11)at 2 days postpartum,prenatal anxiety,and pain at 6 weeks postpartum.The early identi-fication of these factors and interventions can mitigate the risk of PPD.

Therapeutic effect of manual massage on early postpartum rectus abdominis separation and postpartum depression

BACKGROUND Rectus abdominis separation(DRA)affects pelvic stability and body image.No studies have explored the effects of manual massage on early postpartum DRA and postpartum depression.AIM To analyze the curative effect of massage on early postpartum DRA and its impact on postpartum depression and thus its ability promote the overall psychosomatic rehabilitation of postpartum women.METHODS Data were retrospectively collected on 70 primiparous women with postpartum DRA who underwent rehabilitation at the Postpartum Rehabilitation Center of Huzhou Maternal and Child Health Hospital from October 2022 to September 2023.The patients were divided into the Group S(35 cases,biomimetic electrical stimulation treatment)and Group L(35 cases,biomimetic electrical stimulation combined with manual massage treatment).Baseline data,the edinburgh postpartum depression scale(EPDS)score,and the visual analog scale(VAS)scores for rectus abdominis distance,waist circumference,and lower back pain before and after treatment were compared.RESULTS No significant differences were found in the baseline data,rectus abdominis distance,waist circumference,and VAS and EPDS scores between the two groups before treatment(P>0.05).After treatment,the distance between rectus abdominis and waist circumference in Group L were significantly smaller than those in Group S(P<0.05).Furthermore,lower back pain(VAS score)and the EPDS score in Group L were significantly lower than those in Group S(P<0.05).CONCLUSION Manual massage can significantly reduce early postpartum DRA,waist circumference,and back pain and improve the patient’s mental state and postpartum depression.

Postpartum depression and partner support during the period of lactation:Correlation research and its influencing factors

BACKGROUND Postpartum depression(PPD)not only affects the psychological and physiological aspects of maternal health but can also affect neonatal growth and development.Partners who are in close contact with parturient women play a key role in communication and emotional support.This study explores the PPD support relationship with partners and its influencing factors,which is believed to establish psychological well-being and improve maternal partner support.AIM To explore the correlation between PPD and partner support during breastfeeding and its influencing factors.METHODS Convenience sampling was used to select lactating women(200 women)who underwent postpartum examinations at the Huzhou Maternity and Child Health Care Hospital from July 2022 to December 2022.A cross-sectional survey was conducted on the basic information(general information questionnaire),depression level[edinburgh postnatal depression scale(EPDS)],and partner support score[dyadic coping inventory(DCI)]of the selected subjects.Pearson’s correlation analysis was used to analyze the correlation between PPD and DCI in lactating women.Factors affecting PPD levels during lactation were analyzed using multiple linear regression.RESULTS The total average score of EPDS in 200 lactating women was(9.52±1.53),and the total average score of DCI was(115.78±14.90).Dividing the EPDS,the dimension scores were:emotional loss(1.91±0.52),anxiety(3.84±1.05),and depression(3.76±0.96).Each dimension of the DCI was subdivided into:Pressure communication(26.79±6.71),mutual support(39.76±9.63),negative support(24.97±6.68),agent support(6.87±1.92),and joint support(17.39±4.19).Pearson’s correlation analysis demonstrated that the total mean score and individual dimension scores of EPDS during breastfeeding were inversely correlated with the total score of partner support,stress communication,mutual support,and cosupport(P<0.05).The total mean score of the EPDS and its dimensions were positively correlated with negative support(P<0.05).Multiple linear regression analysis showed that the main factors affecting PPD during breastfeeding were marital harmony,newborn health,stress communication,mutual support,negative support,cosupport,and the total score of partner support(P<0.05).CONCLUSION PPD during breastfeeding was associated with marital harmony,newborn health,stress communication,mutual support,negative support,joint support,and the total DCI score.

Prevalence and Associated Factors of Postpartum Depression: A Study Conducted in Health Centres in Dakar (Senegal)

Introduction: Postpartum depression is the most common psychiatric disorder affecting women in the perinatal period. According to the WHO, it affects 10% - 15% of women who have just given birth. In Africa, and particularly in Senegal, epidemiological studies focusing exclusively on postpartum depression are rare or non-existent. For this reason, we conducted this screening study on postpartum depression to assess the socio-demographic characteristics and associated factors. Methods: This was a prospective cross- sectional study with descriptive and analytical aims. It was carried out in the twelve Dakar referral health centres during the period August 2021 to June 2022. Results: At the end of our survey we had recruited one hundred and twenty-two (122) participants with a PPD prevalence rate of 25.41%. The most common age group was 24 - 29 years. 40% of the participants were of Fulani ethnicity, followed by Wolof. Married women made up 93% of the sample. The school enrolment rate was 89%. Most participants were not in paid employment. Domestic violence was present in 14% of couples. 28% of mothers reported experiencing a stressful life event during their pregnancy. 22% of the women had a chronic medical condition, of which 55% had high blood pressure. 1% of the women reported a personal psychiatric history and 5% a family psychiatric history. Most women had between two and four healthy living children. The pregnancy was unwanted in 17% of cases and 12% of participants had a complication. 6% were dissatisfied with the quality of their antenatal care. The caesarean section rate was 18%. In terms of associated factors, eight factors were identified in a bivariate analysis: single marital status, lack of support from partner, domestic violence, conflict with in-laws, and the occurrence of a stressful life event during pregnancy, the presence of a personal medical history, lack of satisfaction with pregnancy follow-up, and mode of delivery by caesarean section. Conclusion: Our study showed the high prevalence of PPD (25.41%) and identified associated risk factors. Among these factors, two were strongly associated with postpartum depression: lack of satisfaction with pregnancy care and experiencing a stressful life event during pregnancy. Systematic screening or identification of risk factors during pregnancy is necessary for comprehensive treatment based on a biopsychosocial approach.

Endoplasmic reticulum stress,autophagy,neuroinflammation,and sigma 1 receptors as contributors to depression and its treatment

The etiological factors contributing to depression and other neuropsychiatric disorders are largely undefined. Endoplasmic reticulum stress pathways and autophagy are well-defined mechanisms that play critical functions in recognizing and resolving cellular stress and are possible targets for the pathophysiology and treatment of psychiatric and neurologic illnesses. An increasing number of studies indicate the involvement of endoplasmic reticulum stress and autophagy in the control of neuroinflammation, a contributing factor to multiple neuropsychiatric illnesses. Initial inflammatory triggers induce endoplasmic reticulum stress, leading to neuroinflammatory responses. Subsequently, induction of autophagy by neurosteroids and other signaling pathways that converge on autophagy induction are thought to participate in resolving neuroinflammation. The aim of this review is to summarize our current understanding of the molecular mechanisms governing the induction of endoplasmic reticulum stress, autophagy, and neuroinflammation in the central nervous system. Studies focused on innate immune factors, including neurosteroids with anti-inflammatory roles will be reviewed. In the context of depression, animal models that led to our current understanding of molecular mechanisms underlying depression will be highlighted, including the roles of sigma 1 receptors and pharmacological agents that dampen endoplasmic reticulum stress and associated neuroinflammation.

Mediating effect of mindfulness level on the relationship between marital quality and postpartum depression among primiparas

BACKGROUND Postpartum depression refers to a depressive episode or depressive symptoms up to 12 mo after delivery.Trait mindfulness has presented a protective factor for postpartum depressive symptoms and proved efficient in improving relationship satisfaction among couples.AIM To investigate the correlations among mindfulness,marital quality,anxiety,and depression in a large city in western China during the post-corona virus infectious disease-2019 era and determine whether trait mindfulness mediates the relationship between marital quality and postpartum anxiety and depression among primiparas.METHODS A cross-sectional study was conducted.The self-administered questionnaire was submitted online through smartphones.The levels of mindfulness,anxiety,depression,and marital quality were respectively investigated by the mindful attention awareness scale(MAAS),the self-rating anxiety scale(SAS),the selfrating depression scale(SDS),and the marriage perception scale(MPS)in these enrolled Han and Tujia primiparas.RESULTS No statistical significance was observed in the prevalence of postpartum anxiety and depression,nor scores of MAAS and MPS-Total in different regions or ethnicities(P>0.05).However,MPSMarital interaction(P<0.05),MPS-Family relationship(MPS-FR)(P<0.01),and MPS-Marital conflict(MPS-MC)(P<0.01)scores of urban primiparas were higher than those of rural primiparas.The MPS-MC score of Han primiparas was higher than that of Tujia primiparas(P<0.05).Negative correlations were observed between MAAS and SAS(r=-0.457,P<0.01),and MAAS and SDS(r=-0.439,P<0.01).SAS has revealed a highly positive correlation with SDS(r=0.720,P<0.01)and a weak negative correlation with MPS(r=-0.200,P<0.05).Besides,a weak negative correlation was observed between MAAS and MPS-MC(r=-0.184,P<0.05),and a weak positive correlation was noticed between SAS and MPS-MC(r=-0.225,P<0.01).Mediation analysis demonstrated a full mediation effect of mindfulness level on the relationship between MPS-FR and postpartum anxiety(P<0.05,95%CI:-0.384 to 0.033),MPS-MC and postpartum anxiety(P<0.01,95%CI:0.027-0.193),MPS-FR and postpartum depression(P<0.05,95%CI:-0.365 to 0.031),and MPS-MC and postpartum depression(P<0.01,95%CI:0.022-0.206).CONCLUSION Mindfulness demonstrates negative correlations with marital conflict,postpartum anxiety and depression,and it may have cross-ethnic and trans-regional characteristics.Although the mindfulness levels have revealed no significant mediating effect between the total score of marital quality and postpartum depression in this study,it demonstrates a full mediation effect on the relationships between family relationships,marital conflict,and postpartum anxiety and depression.

Analysis of influencing factors and the construction of predictive models for postpartum depression in older pregnant women

BACKGROUND Changes in China's fertility policy have led to a significant increase in older pregnant women.At present,there is a lack of analysis of influencing factors and research on predictive models for postpartum depression(PPD)in older pregnant women.AIM To analysis the influencing factors and the construction of predictive models for PPD in older pregnant women.METHODS By adopting a cross-sectional survey research design,239 older pregnant women(≥35 years old)who underwent obstetric examinations and gave birth at Suzhou Ninth People's Hospital from February 2022 to July 2023 were selected as the research subjects.When postpartum women of advanced maternal age came to the hospital for follow-up 42 d after birth,the Edinburgh PPD Scale(EPDS)was used to assess the presence of PPD symptoms.The women were divided into a PPD group and a no-PPD group.Two sets of data were collected for analysis,and a prediction model was constructed.The performance of the predictive model was evaluated using receiver operating characteristic(ROC)analysis and the Hosmer-Lemeshow goodness-of-fit test.RESULTS On the 42nd day after delivery,51 of 239 older pregnant women were evaluated with the EPDS scale and found to have depressive symptoms.The incidence rate was 21.34%(51/239).There were statistically significant differences between the PPD group and the no-PPD group in terms of education level(P=0.004),family relationships(P=0.001),pregnancy complications(P=0.019),and mother–infant separation after birth(P=0.002).Multivariate logistic regression analysis showed that a high school education and below,poor family relationships,pregnancy complications,and the separation of the mother and baby after birth were influencing factors for PPD in older pregnant women(P<0.05).Based on the influencing factors,the following model equation was developed:Logit(P)=0.729×education level+0.942×family relationship+1.137×pregnancy complications+1.285×separation of the mother and infant after birth-6.671.The area under the ROC curve of this prediction model was 0.873(95%CI:0.821-0.924),the sensitivity was 0.871,and the specificity was 0.815.The deviation between the value predicted by the model and the actual value through the Hosmer-Lemeshow goodness-of-fit test was not statistically significant(χ^(2)=2.749,P=0.638),indicating that the model did not show an overfitting phenomenon.CONCLUSION The risk of PPD among older pregnant women is influenced by educational level,family relationships,pregnancy complications,and the separation of the mother and baby after birth.A prediction model based on these factors can effectively predict the risk of PPD in older pregnant women.

Treatment of postpartum depression with integrated traditional Chinese and Western medicine nursing and electrical stimulation

BACKGROUND Postpartum depression(PPD)is a common psychological disease among puerperal women,and postpartum pelvic floor dysfunction is a common disease among pregnant women.The occurrence of postpartum pelvic floor dysfunction will increase the incidence of PPD.AIM To explore the therapeutic effect of integrated traditional Chinese and Western medicine nursing combined with electrical stimulation of pelvic floor muscles and the rectus abdominis on PPD.METHODS From April 2020 to January 2022,100 parturients with a rectus abdominis muscle separation distance>2.0 cm who underwent reexamination 6 wk after delivery at our hospital were selected as the research subjects.According to the random number table method,the patients were divided into either an observation group(n=50)or a control group(n=50).There was no significant difference in the general data between the two groups(P>0.05).Both groups were treated by electrical stimulation.The observation group was additionally treated by integrated traditional Chinese and Western medicine nursing.A self-designed Depression Knowledge Questionnaire was used to evaluate the awareness of knowledge on depression in all patients 3 wk after intervention.The Hamilton Depression Scale(HAMD)was used to evaluate the depression before intervention and 1 wk and 3 wk after intervention,and the Morisky Medication Adherence Scale(MMAS-8)was used to evaluate the medication compliance.SPSS19.0 was used for statistical analyses.RESULTS The rate of awareness of knowledge on depression in the observation group was significantly higher than that of the control group(P<0.05).The scores of MMAS-8 were comparable between the two groups before intervention(P>0.05),but were significantly higher in the observation group than in the control group at 1 wk and 3 wk after intervention(P<0.05).The HAMD scores were comparable between the two groups before intervention(P>0.05),but were significantly lower in the observation group than in the control group at 1 wk and 3 wk after intervention(P<0.05).CONCLUSION Integrated traditional Chinese and Western medicine nursing combined with electrical stimulation of pelvic floor muscles and the rectus abdominis is effective in the treatment of postpartum depression and worthy of clinical promotion.

Postpartum Depression: Overcoming Mental Health Challenges during Parenthood

Postpartum depression affects parents across all social, economic, and racial groups. While there are many factors that may contribute to depressive symptoms in the postpartum period, under-resourced populations and ethnic minorities are documented to experience higher rates. Traditional psychotherapeutic methods have shown success in mitigating depressive symptoms;however, these treatments are not always accessible and/or utilized, particularly in populations with the highest need. Mind-body interventions have become increasingly popular in addressing perinatal mental health, and new and innovative approaches are currently being evaluated to determine their efficacy with respect to treating postpartum depression. This scoping review highlights published clinical trials, interventions, meta-analyses, and reviews conducted in the last 20 years and examines how each method applies to meet the needs of postpartum parents, and particularly under-resourced populations.

Analysis of factors related to postpartum depression in pregnancyinduced hypertension syndrome patients and construction and evaluation of nomograms

BACKGROUND It is positive to integrate and evaluate the risk factors for postpartum depression in patients with pregnancy-induced hypertension syndrome and to detect highrisk patients as early as possible,which has application value for the clinical development of personalized prevention programs and prognosis of patients.AIM To analyze factors related to postpartum depression in patients with pregnancyinduced hypertension and construct and evaluate a nomogram model.METHODS The clinical data of 276 patients with pregnancy-induced hypertension admitted to Huzhou Maternity and Child Health Care Hospital between January 2017 and April 2022 were retrospectively analyzed.We evaluated the depression incidence at 6 wk postpartum.The depression group included patients with postpartum depression,and the remainder were in the non-depression group.Multivariate logistic regression analysis and the LASSO regression model were applied to analyze the factors related to postpartum depression in patients with pregnancyinduced hypertension.After that,a risk prediction model nomogram was constructed and evaluated.RESULTS Multivariate logistic regression analysis showed that vitamin A deficiency(VAD)during pregnancy and puerperium,family history of hypertension,maternal intestinal flora imbalance,eicosapentaenoic acid(EPA),and docosahexaenoic acid(DHA)were independent risk factors for postpartum depression in patients with pregnancy-induced hypertension(P<0.05).We constructed the nomogram model based on these five risk factors.The area under the curve,specificity,and sensitivity of the model in predicting postpartum depression in patients with pregnancy-induced hypertension was 0.867(95%confidence interval:0.828–0.935),0.676,and 0.889,respectively.The average absolute error was 0.037(Hosmer-Lemeshow testχ2=10.739,P=0.217).CONCLUSION VAD during pregnancy and puerperium,family history of hypertension,maternal intestinal flora imbalance,EPA,and DHA affect postpartum depression in patients with pregnancy-induced hypertension.

A Prospective Study on the Incidence and Predictors of Postpartum Depression among Pregnant Women Attending an Antenatal Clinic in Kano, Northern Nigeria

Depressive disorder is a major contributor to years lived with disability (YLD) globally. It is estimated that 13% of all women experience the disorder in the first year postpartum. Postpartum depression (PPD) has significant implications to the physical and mental wellbeing of both the mother and her baby. Only non-depressed pregnant women (score of ≤ 6 on Edinburgh Postnatal Depression Scale) were recruited into this study. Data collection was done at 2 different stages;at recruitment stage (during the third trimester of pregnancy) and at the follow up stage (4th - 6th week postpartum). During the recruitment stage, intimate partner violence (IPV) and level of social support perception, among the women, were assessed using Hurt Insult Threaten Scream (HITS) and Multidimensional Scale of Perceived Social Support (MSPSS) questionnaires respectively. While at the follow up stage, the Obstetric questionnaire and Mini International Neuropsychiatric Interview (MINI-7) were used respectively to obtain obstetric-related data and to diagnose for occurrence of depression. The incidence of PPD was found to be 16.34%. Several factors such as level of education, husband’s socioeconomic status, stressful life events, low perception of social support, obstetric instrumentation and not having a baby of preferred gender were significantly associated with PPD. Positive predictors of PPD included not practicing breast feeding (OR = 186.72, 95% CI = 8.32 - 4188.35), family history of mental illness (OR = 4.95, 95% CI = 1.04 - 23.81) and pregnancy lasting beyond 40 weeks (OR = 7.26, 95% CI = 1.51 - 34.88). High incidence of PPD with numerous associated but largely modifiable risk factors call for more proactive measures, such as PPD screening among pregnant women.

Effectiveness of an Educational Intervention for Postpartum Depression in a Pre-Parent Classroom

The global incidence of postpartum depression is estimated at approximately 10% - 20%. A lack of partner support is a key factor associated with perinatal depression. This study examined the effects of an educational intervention that provided information for the prevention and early detection of postpartum depression to first-time mothers and fathers who participated in a “First-Time Parent Class.” The study was utilized quasi-experimental research, conducted first with the control group and followed by an assessment of the intervention group. Mothers were assessed using the Edinburgh Postpartum Depression Scale and the Japan Child and Family Research Institute Child-Rearing Support Questionnaire. Fathers’ assessments were conducted using the Japan Child and Family Research Institute Child-Rearing Support Questionnaire for Fathers and were based on responses to questions regarding their coping strategies. Data were obtained from 158 data (72 interventions, 86 controls) couples analyzed. No significant difference was found between mothers’ child-rearing difficulty and depression score rates in the first month after childbirth. There was a difference among fathers in the control group and those in the intervention group regarding their responses to maternal depression: the “consult family” (p = 0.035), “consult friends” (p = 0.033), and “consult the city health center” (p = 0.047) variables were higher in the intervention group;however, the effect size was small. Providing first-time parents with information during pregnancy to prevent and detect postpartum depression will deepen parents’ understanding and help them cope with postpartum depression.

Prevalence and risk factors of postpartum depression in a populationbased sample of women in Tangxia Community,Guangzhou

Objective:To investigate the prevalence and analyze the risk factors of postpartum depression(PPD)in Tangxia Community.Guangzhou,a community representative of the process of urbanization in China.Methods:A total of 1 823 delivery women in Tangxia Community.Guangzhou were screened with the Chinese Version of Edinburgh Postnatal Depression Scale,Hamilton Depression Scale and Social Support Rating Scale.The risk factors were evaluated by self-made questionnaire based on literature interview combined with expert consultation.The data collected were analyzed using Student's t test and logistic regression in SPSS16.0.Results:The prevalence of PPD in Tangxia Community,Guangzhou was 27.37%.Mutivariant logistic regression analysis identified mode of delivery,puerperanl from one-child family,relationship between mother-in-law atul daughter-in-law and fetus gender as the risk factors of PPD while housing condition was negatively correlated with the incidence of PPD with OR value of 0.82.The the total score of social support rating scale,the score of objective support,subjective support and social utilization degree were significantly reduced in women with PPD in contrast with women without PPD.Conclusions:The incidence of PPD was slightly higher than other regions of China.It's of great importance to distinguish risk factors in regional culture context and develop health promotion program in order to enhance the well-being of delivery women.

Modeling postpartum depression in rats： theoretic and methodological issues

The postpartum period is when a host of changes occur at molecular, cellular, physiological and behavioral levels to prepare female humans for the challenge of maternity. Alteration or prevention of these normal adaptions is thought to contribute to disruptions of emotion regulation, motivation and cognitive abilities that underlie postpartum mental disorders, such as postpartum depression. Despite the high incidence of this disorder, and the detrimental consequences for both mother and child, its etiology and related neurobiological mechanisms remain poorly understood, partially due to the lack of appropriate animal models. In recent decades, there have been a number of attempts to model postpartum depression disorder in rats. In the present review, we first describe clinical symptoms of postpartum depression and discuss known risk factors, including both genetic and environmental factors. Thereafter, we discuss various rat models that have been developed to capture various aspects of this disorder and knowledge gained from such attempts. In doing so, we focus on the theories behind each attempt and the methods used to achieve their goals. Finally, we point out several understudied areas in this field and make suggestions for future directions.

A natural model of behavioral depression in postpartum adult female cynomolgus monkeys (Macaca fascicularis)

Postpartum depression （PPD） is a modified form of major depressive disorders （MDD） that can exert profound negative effects on both mothers and infants than MDD. Within the postpartum period, both mothers and infants are susceptible; but because PPD typically occurs for short durations and has moderate symptoms, there exists challenges in exploring and addressing the underlying cause of the depression. This fact highlights the need for relevant animal models. In the present study, postpartum adult female cynomolgus monkeys （Macaca fascicularis） living in breeding groups were observed for typical depressive behavior. The huddle posture behavior was utilized as an indicator of behavioral depression postpartum （BDP） as it has been established as the core depressive-like behavior in primates. Monkeys were divided into two groups： A t3DP group （n=6）, which were found to spend more time huddling over the first two weeks postpartum than other individuals that formed a non-depression control group （n=4）. The two groups were then further analyzed for locomotive activity, stressful events, hair cortisol levels and for maternal interactive behaviors. No differences were found between the BDP and control groups in locomotive activity, in the frequencies of stressful events experienced and in hair cortisol levels. These findings suggested that the postpartum depression witnessed in the monkeys was not related to external factors other than puerperium period. Interestingly, the BDP monkeys displayed an abnormal maternal relationship consisting of increased infant grooming. Taken together, these findings suggest that the adult female cynomolgus monkeys provide a natural model of behavioral postpartum depression that holds a number of advantages over commonly used rodent systems in PPD modeling. The cynomolgus monkeys have a highly-organized social hierarchy and reproductive characteristics without seasonal restriction--similar to humans--as well as much greater homology to humans than rodents. As such, this model may provide a greater translational efficiency and research platform for systematically investigating the etiology, treatment, prevention of PPD.

Postpartum depression:A systematic review of the genetics involved

Postpartum depression is one of the most prevalent psychopathologies. Its prevalence is estimated to be between 10% and 15%. Despite its multifactorial etiology, it is known that genetics play an important role in the genesis of this disorder. This paper reviews epidemiological evidence supporting the role of genetics in postpartum depression(PPD). The main objectives of this review are to determine which genes and polymorphisms are associated with PPD and discuss how this association may occur. In addition, this paper explores whether these genes are somehow related to or even the same as those linked to Major Depression(MD). To identify gaps in the current knowledge that require investigation, a systematic review was conducted in the electronic databases Pub Med, LILACS and Sci ELO using the index terms "postpartum depression" and "genetics". Literature searches for articles in peerreviewed journals were made until April 2014. PPD was indexed 56 times with genetics. The inclusion criteria were articles in Portuguese, Spanish or English that were available by institutional means or sent by authors upon request; this search resulted in 20 papers. Genes and polymorphisms traditionally related to MD, which are those involved in the serotonin, catecholamine, brain-derived neurotrophic factor and tryptophan metabolism, have been the most studied, and some have been related to PPD. The results are conflicting and some depend on epigenetics, which makes the data incipient. Further studies are required to determine the genes that are involved in PPD and establish the nature of the relationship between these genes and PPD.

Psychological Intervention for Postpartum Depression

Summary： The postpartum depression outcome and the effect of psychological intervention were studied in order to reduce the occurrence and development of the postpartum depression. A survey of 4000 women within 4-6 weeks postpartum in 80 communities in Shenzhen, China was performed using random cluster sampling method. By employing Edinburgh Postnatal Depression Scale （EPDS） as a screening tool, the positive women （defined as EPDS 〉10） were randomly divided into intervention group and control group at a ratio of 1：2. The women in the intervention group were treated by means of mailing postpartum depression prevention and treatment knowledge manual, face-to-face counseling, and telephone psychological counseling interventions aiming at individual risk factors, while those in the control group were treated with conventional methods. EPDS scores were assessed in these two groups again at 6th month postpartum. Totally, 3907 valid questionnaires were obtained. All the 771 positive women were divided into two groups： 257 in the intervention group, and 514 in the control group. At 6th month postpartum, the EPDS scores in the intervention group were decreased significantly, from baseline stage （12.84±3.02） to end stage （3.05±2.93）, while EPDS scores in the control group were reduced from 12.44±2.78 to 6.94±4.02. There were significant differences in the EPDS scores at end stage between the two groups （t=13.059, P〈0.001）. Psychological intervention can reduce postpartum depression, with better maternal compliance. It is feasible and necessary to establish postpartum depression screening and psychological intervention model in community-hospital and include the postpartum depression screening, intervention, and follow-up into the conventional healthcare.

Home-based nursing for improvement of quality of life and depression in patients with postpartum depression

BACKGROUND Postpartum depression is a common mental illness in puerpera,with an incidence of approximately 3.5%-33.0%abroad,and the incidence of postpartum depression in China is higher than the international level,reaching 10.0%-38.0%.Providing effective nursing care in clinical nursing activities is one of the key points of obstetrical care.However,little research has been designed to investigate the positive role of home-based nursing in the prevention of postpartum depression.AIM To study the effect of home-based nursing for postpartum depression patients on their quality of life and depression.METHODS The clinical data of 92 patients with postpartum depression treated at our hospital were retrospectively analyzed.The patients were grouped according to the nursing methods used;40 patients receiving basic nursing were included in a basic nursing group,and 52 receiving home-based nursing were included in a home-based nursing group.Depression and anxiety were evaluated and compared between the two groups.The estradiol(E2),serotonin(5-hydroxytryptamine,5-HT),and progesterone(PRGE)levels were measured.RESULTS The SAS and SDS scores of the home-based nursing group were significantly lower than those of the basic nursing group(P<0.05).The E2 and 5-HT levels of the home-based nursing group were significantly higher than those of the basic nursing group,but the PRGE level was significantly lower than that of the basic nursing group.The GQOLI-74 scores(material,social,somatic,and psychological)and nursing satisfaction were significantly higher in the home-based nursing group(P<0.05).CONCLUSION Postpartum depression through home-based nursing can effectively alleviate depression and improve the quality of life of patients,help modulate their serum E2,5-HT,and PRGE levels,and improve their satisfaction with nursing care.

Antenatal anxiety in the first trimester: Risk factors and effects on anxiety and depression in the third trimester and 6-week postpartum

Objective: Anxiety is common among pregnant women. However, research attention in the area of reproductive mental health has mainly focused on postpartum depression in past decades. Given adverse outcomes of antenatal anxiety, there is an urgent need to fill the research gaps. The objectives of the present study were to determine the prevalence of antenatal anxiety symptoms and examine the risk factors and effects of anxiety symptoms in early pregnancy on anxiety and depressive symptoms in later pregnancy and early postpartum period. Methodology: A prospective longitudinal design with quantitative approach was adopted. A consecutive sample of 1470 Chinese pregnant women from hospitals in Hong Kong was invited to participate in the study and was assessed using standardized instruments on 3 time points including first and third trimesters of pregnancy and 6-week postpartum. Results: The results showed that 17.7% of pregnant women manifested anxiety symptoms in the first trimester of pregnancy. Single mothers, younger mothers, mothers who smoked before pregnancy and mothers who received low education level reported significantly higher levels of anxiety symptoms in the first trimester. Unwanted pregnancy, low self esteem, low marital satisfaction and perceived low social support were significant psychosocial risk factors for anxiety symptoms in the first trimester. Anxiety symptoms in the first trimester were independent predictors for anxiety symptoms in the third trimester ( QUOTE β = 0.26, t = 5.74, p < 0.001), however anxiety symptoms in the first trimester no longer significantly predicted anxiety and depressive symptoms in 6 weeks postpartum after adjusting for the effects of potential confounders. Discussions: The present study points to the need for greater research and clinical attention to antenatal anxiety given that antenatal anxiety is a prevalent problem and has serious impacts on maternal well-being. Such findings also contribute to the understanding of maternal anxiety and have implications for the design of effective identification, prevention and treatment of these significant clinical