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Postpartum depressive mood (PDM) among Chinese women: a meta-analysis

  • Ting-Yu Mu
  • Yu-Hong Li
  • Hai-Feng Pan
  • Liu Zhang
  • Da-Hui Zha
  • Cheng-Lu Zhang
  • Ri-Xiang Xu
Original Article
  • 61 Downloads

Abstract

Postpartum depression is a common complication of childbearing and up to 12 months postpartum. This study aimed to determine the prevalence of postpartum depressive mood (PDM) in China by performing a meta-analysis of published studies. Studies that reported the prevalence of PDM in China were identified by searching the PubMed, Embase, CNKI, and CQVIP databases. Three thousand, one hundred, and two articles were obtained, and after careful evaluation, 26 studies were finally included in the meta-analysis. The combined studies included a total of 7618 cases with 1621 cases of PDM. The studies were assessed on the basis of heterogeneity testing and the potential for publication bias. Stata software 11.0 was used to perform the meta-analysis. The random-effect model showed that the prevalence of PDM was 21% with a 95% confidence interval (CI) of 17–25%. PDM was the highest 0 to 1.5 months after delivery. PDM levels decreased to 10.4% (95% CI 9.7–11.1%, P < 0.001) after publication bias were corrected. Sensitivity analyses evaluated the stability of our results and showed no significant change when any single study was excluded. Subgroup analyses showed that region, instruments used, cut-off score, and time points for depression assessment were positively associated with PDM prevalence. The prevalence of PDM differed among regions, with South Central China and East China exhibiting the lowest prevalence. The prevalence was higher in regions with poor economic development, suggesting that more attention should be devoted to Southwest and North China and that the prevalence of PDM should be evaluated 0 to 1.5 months after delivery.

Keywords

Postpartum Depression Mood Meta-analysis EPDS SDS 

Notes

Funding information

This research was funded by the Natural Science Research Key Project of Education Department of Anhui Provincial Government, China (Project number: KJ2017A191).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

References

  1. Adouard F, Glangeaud-Freudenthal N-M-C, Golse B (2005) Validation of the Edinburgh postnatal depression scale (EPDS) in a sample of women with high-risk pregnancies in France. Arch Womens Ment Health 8:89–95CrossRefPubMedGoogle Scholar
  2. Alligood M-R (2013) Nursing theorists and their work, 8th edn. Elsevier Medicine, Amsterdam, pp 743–761Google Scholar
  3. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5thedition. American Psychiatric Association, Washington, DCCrossRefGoogle Scholar
  4. Beck CT (1993) Teetering on the edge: a substantive theory of postpartum depression. Nurs Res 42:42–48CrossRefPubMedGoogle Scholar
  5. Beck CT (2002) Postpartum depression: a metasynthesis. Qual Health Res 12:453–472.  https://doi.org/10.1177/104973202129120016 CrossRefPubMedGoogle Scholar
  6. Bina R, Harrington D (2017) Differential predictors of postpartum depression and anxiety: the Edinburgh postnatal depression scale Hebrew version two factor structure construct validity. Matern Child Health J 21:2237–2244.  https://doi.org/10.1007/s10995-017-2345-5 CrossRefPubMedGoogle Scholar
  7. Cameron EE, Sedov ID, Tomfohr-Madsen LM (2016) Prevalence of paternal depression in pregnancy and the postpartum: an updated meta-analysis. J Affect Disord 206:189–203CrossRefPubMedGoogle Scholar
  8. Cox J-L, Sagovsky R (1987) Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 50:782–786CrossRefGoogle Scholar
  9. Egger M, Schneider M et al (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–633CrossRefPubMedPubMedCentralGoogle Scholar
  10. Gavin N-I, Gaynes B-N, Lohr K-N, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106:1071–1083CrossRefPubMedGoogle Scholar
  11. Gaynes B-N, Gavin N, Meltzer-Brody S et al (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess 119:1–8Google Scholar
  12. Higgins J-P, Thompson S-G (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558.  https://doi.org/10.1002/sim.1186 CrossRefPubMedGoogle Scholar
  13. Higgins J-P, Deeks J-J et al (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560CrossRefPubMedPubMedCentralGoogle Scholar
  14. Klainin P, Arthur D-G (2009) Postpartum depression in Asian cultures: a literature review. Int J Nurs Stud 46:1355–1373CrossRefPubMedGoogle Scholar
  15. Lai B-P, Tang A-K, Lee D-T et al (2010) Detecting postnatal depression in Chinese men: a comparison of three instruments. Psychiatry Res 180:80–85.  https://doi.org/10.1016/j.psychres.2009.07.015 CrossRefPubMedGoogle Scholar
  16. Lee D-T-S, Yip SK, Chiu H-F-K, Leung TYS, Chan KPM, Chau IOL, Leung HCM, Chung TKH (1998) Detecting postnatal depression in Chinese women validation of Chinese version of the Edinburgh postnatal depression scale. Br J Psychiatry 172:433–437CrossRefPubMedGoogle Scholar
  17. Lee D-T, Chiu H et al (2006) A psychiatric epidemiological study of postpartum Chinese women. Am J Psychiatry 158:220–226CrossRefGoogle Scholar
  18. Li Y-H, Fu S-L et al (2009) Survey on the status of depression in puerpera and her spouse during the puerperium [in Chinese]. Acta Univ Med Anhui 44:506–508Google Scholar
  19. Lin Y, Xu J, Huang J, Jia Y, Zhang J, Yan C, Zhang J (2017) Effects of prenatal and postnatal maternal emotional stress on toddlers’ cognitive and temperamental development. J Affect Disord 207:9–17.  https://doi.org/10.1016/j.jad.2016.09.010 CrossRefPubMedGoogle Scholar
  20. Luo Y, He G-P (2007) Correlative analysis of postpartum depression[in Chinese]. J Cent South Univ 32:460–464Google Scholar
  21. Ma X-H, Song F-L et al (2017) Study of the Edinburgh postnatal depression scale in the screening of postpartum depression [in Chinese]. Chinese J Med 2:52–57Google Scholar
  22. Mandelli L, Souery D, Bartova L (2016) Bipolar II disorder as a risk factor for postpartum depression. J Affect Disord 204:54–58CrossRefPubMedGoogle Scholar
  23. Matthey S, Barnett B, Kavanagh DJ, Howie P (2001) Validation of the Edinburgh postnatal depression scale for men, and comparison of item endorsement with their partners. J Affect Disord 64:175–184CrossRefPubMedGoogle Scholar
  24. Nakken B, Szodoray P (2010) Accelerated atherosclerosis in rheumatoid arthritis: rationale for mannose-binding lectins? J Rheumatol 37:482–484.  https://doi.org/10.3899/jrheum.091364 CrossRefPubMedGoogle Scholar
  25. Navarro P, Ascaso C, Garcia-Esteve L, Aguado J, Torres A, Martín-Santos R (2007) Postnatal psychiatric morbidity: a validation study of the GHQ-12 and the EPDS as screening tools. Gen Hosp Psychiatry 29(1):1–7.  https://doi.org/10.1016/j.genhosppsych.2006.10.004 CrossRefPubMedGoogle Scholar
  26. O’Hara M, Swain A (1996) Rates and risk of postpartum depression: a meta-analysis. Int Rev Psychiatry 8:37–54CrossRefGoogle Scholar
  27. Palma S, Delgado-Rodriguez M (2005) Assessment of publication bias in meta-analyses of cardiovascular diseases. J Epidemiol Community Health 59:864–869CrossRefPubMedPubMedCentralGoogle Scholar
  28. Qian Y-R, Yan X (2013) Prevalence of postpartum depression in China: a systematic analysis [in Chinese]. Chinese J Pract Nurs 29:1–3Google Scholar
  29. Robert K, Pages C, Ledru A et al (2005) Regulation of extracellular signal-regulated kinase by homocysteine in hippocampus. Neuroscience 133:925–935CrossRefPubMedGoogle Scholar
  30. Tao P, Lian W et al (1994) EPDS in postpartum depression screening [in Chinese]. Chin Ment Health J 8:18–19Google Scholar
  31. Tian L-J, Li C-X, Man D-M (2014) The effect of sopfrology childbirth method training, Kegel training and Lamaze respiratory training on depression and sexual life of perinatal pregnant woman [in Chinese]. Chin J Behav Med Brain Sci 23:344–347Google Scholar
  32. Villegas L-K-M, Lee D et al (2011) Postpartum depression among rural women from developed and developing countries: a systematic review. J Rural Health 27:278–288.  https://doi.org/10.1111/j.1748-0361.2010.00339.x CrossRefPubMedGoogle Scholar
  33. Wang T-T, Xu Y, Li Z-Z et al (2016) Prevalence of paternal postpartum depression in China and its association with maternal postpartum depression [in Chinese]. J Cent South Univ 10:1082–1089Google Scholar
  34. Zhong Q, Gelaye B, Rondon M, E. Sánchez S, J. García P, Sánchez E, V. Barrios Y, E. Simon G, C. Henderson D, May Cripe S, A. Williams M (2014) Comparative performance of patient health questionnaire-9 and Edinburgh postnatal depression scale for screening antepartum depression. J Affect Disord 162:1–7.  https://doi.org/10.1016/j.jad.2014.03.028 CrossRefPubMedPubMedCentralGoogle Scholar

Studies included in the meta-analysis

  1. Gao L-L, Chan S-W, Mao Q (2009) Depression, perceived stress, and social support among first-time Chinese mothers and fathers in the postpartum period. Res Nurs Health 32:50–58CrossRefPubMedGoogle Scholar
  2. Guo X-J, Liu Y, Wang Y-Q et al (2013) The association between postnatal depression symptoms and parent-in-law conflicts. Pract J Clin Med 10:36–38 [In Chinese]Google Scholar
  3. He Y (2008) The study of the risk factors and cognition function lesion of postpartum depression in parturient women in Changsha City. Dissertation, Central South University of China. [In Chinese]Google Scholar
  4. He J, Shang-guan J-X, Wang H-P (2000) Clinical study on postpartum depression and its related factors. Chin J Obstet Gynecol 35:660–663 [In Chinese]Google Scholar
  5. He P, Huang Y, Lu M et al (2014) Analysis on gestational and postpartum psychological statuses and influencing factors in 419 pregnant women. Matern Child Health Care China 23:3731–3735 [In Chinese]Google Scholar
  6. Hu S-J, Gu R-J, Xu G-H (2001) Investigation on depression, anxiety situation before and after childbirth of 76 first lying—in women. Health Psychol J 9:464–465 [In Chinese]Google Scholar
  7. Jin J-Z (2008) Investigation and analysis of postpartum depression status and its influence factors in YanBian Area. Dissertation, Yanbian University of China. [In Chinese]Google Scholar
  8. Li Z-M, Liu X-Q, Chen Y-P et al (2010) Research of mothers and their spouses depression condition. J Pract Med 26:3244–3246 [In Chinese]Google Scholar
  9. Liang X-H, Hu D-G, Yang B-F (2007) Analysis of logistic regression of anxiety and depression for postpartum. Chin J Behav Med Brain Sci 16:511–512 [In Chinese]Google Scholar
  10. Liu L-F, Zhao G-F, Hou R-H et al (2002) Links between early maternity blues and post-natal depression. Chin J Behav Med Brain Sci 11:167–169 [In Chinese]Google Scholar
  11. Liu Y-Q, Judith A, Marcia A et al (2014) Effect of postpartum practices of doing the month on Chinese women’s physical and psychological health. Biol Res Nurs 16:55–63CrossRefPubMedGoogle Scholar
  12. Mao Q, Zhu L-X, Su X-Y (2011) A comparison of postnatal depression and related factors between Chinese new mothers and fathers. J Clin Nurs 20:645–652CrossRefPubMedGoogle Scholar
  13. Ngai F-W, Chan S-W (2012) Learned resourcefulness, social support, and perinatal depression in Chinese mothers. Nurs Res 61:78–85CrossRefPubMedGoogle Scholar
  14. Ngai F-W, Ngu S-F (2015) Predictors of maternal and paternal depressive symptoms at postpartum. J Psychosom Res 78:156–161CrossRefPubMedGoogle Scholar
  15. Nv L-J, Zou X-R, Chen X-Y (2006) Investigation to factors related to post-parturition depression. J Huaihai Med 24:273–275 [In Chinese]Google Scholar
  16. Qiu J-Y, Wang Z-C, Xie B et al (2001) A prospective study of postpartum depression: biological and psychosocial factors. Chin J Nerv Ment Dis 27:26–28 [In Chinese]Google Scholar
  17. Sun H-L, Su H, Zhang J, Fan W (2015) Analysis of correlation factors of postpartum depression. J Kunming Med Univ 36:60–64 [In Chinese]Google Scholar
  18. Wang X-N, Wu H-N (2014) Correlation analysis of perceived stress and postpartum depression of delivery women in a hospital in Taizhou, Zhejiang. Med Soc 27:77–79 [In Chinese]Google Scholar
  19. Wang X, Yuan Y, Liu J-A (2009) An explore of postpartum depression level and risk factors. China J Health Psychol 17:89–91 [In Chinese]Google Scholar
  20. Yang H-A, Song G-L, Li R-P et al (2009) Study on influence of social support and family function on postpartum depression feeling. Chin Nurs Res 23:3126–3128 [In Chinese]Google Scholar
  21. Yu J (2010) The study of postpartum depression in shanghai. Dissertation, Fudan University of China. [In Chinese]Google Scholar
  22. Zhang H-W, Zhou P, Liu L-Q et al (2014) Analysis of relevant factors of postpartum depression in rural primiparas. Med J Chin People’s Health 26:1–5 [In Chinese]Google Scholar
  23. Zhang L, Li Y-H, Bu Y-G et al (2015) Dynamic observation of female perinatal depression and study on the related factors. Matern Child Health Care China 15:2393–2397 [In Chinese]Google Scholar
  24. Zhao B-L, Zhao Y, Fang J (2008) A survey of antepartum and postpartum women with depression and anxiety. J Clin Psychiatry 18:105–106 [In Chinese]Google Scholar
  25. Zhao Y, Zhao B-L, Ying X, Fang M et al (2011) Investigation of mental states of 201 women in pregnant and postpartum periods. J Clin Psychiatry 21:18–20 [In Chinese]Google Scholar
  26. Zhong H, Wei X-F (2009) Maternal anxiety and depression condition investigation before and after childbirth. Physicians association psychiatrist branch of ZheJiang province second annual meeting 236–239. [In Chinese]Google Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Ting-Yu Mu
    • 1
  • Yu-Hong Li
    • 1
  • Hai-Feng Pan
    • 2
  • Liu Zhang
    • 1
  • Da-Hui Zha
    • 1
  • Cheng-Lu Zhang
    • 1
  • Ri-Xiang Xu
    • 3
  1. 1.Nursing College of Anhui Medical UniversityHefeiPeople’s Republic of China
  2. 2.Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiPeople’s Republic of China
  3. 3.School of PharmacyAnhui Medical UniversityHefeiPeople’s Republic of China

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