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. 2018 Jun 6;10:655-669.
doi: 10.2147/CLEP.S156210. eCollection 2018.

Self-reported Perinatal Depressive Symptoms and Postnatal Symptom Severity After Treatment With Antidepressants in Pregnancy: A Cross-Sectional Study Across 12 European Countries Using the Edinburgh Postnatal Depression Scale

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Self-reported Perinatal Depressive Symptoms and Postnatal Symptom Severity After Treatment With Antidepressants in Pregnancy: A Cross-Sectional Study Across 12 European Countries Using the Edinburgh Postnatal Depression Scale

Angela Lupattelli et al. Clin Epidemiol. .
Free PMC article

Abstract

Purpose: This study aimed at exploring the prevalence of self-reported antenatal and postnatal depressive symptoms by severity across multiple countries and the association between antidepressant treatment in pregnancy and postnatal symptom severity.

Materials and methods: This was a multinational web-based study conducted across 12 European countries (n=8069). Uniform data collection was ensured via an electronic questionnaire. Pregnant women at any gestational week and mothers of children with <1 year of age could participate. We used the Edinburgh Postnatal Depression Scale (EPDS) to measure the prevalence of antenatal and postnatal depressive symptoms according to severity, which were corrected by survey weight adjustment (descriptive analysis). Within mothers with a psychiatric disorder (n=173), we estimated the association between antidepressant treatment in pregnancy and postnatal depressive symptom severity, as standardized EPDS mean scores, via the inverse probability of treatment weight (association analysis).

Results: In the descriptive analysis (n=8069), the period prevalence of moderate-to-very severe depressive symptoms was higher in the western and eastern regions relative to the northern region, both in the antenatal period (6.8%-7.5% vs 4.3%) and in the postnatal period (7.6% vs 4.7%). One in two mothers with psychiatric disorders used an antidepressant in pregnancy (86 of 173). In the association analysis, women medicated at any time during pregnancy (adjusted β=-0.34, 95% confidence interval [CI] =-0.66, -0.02) had a significant postnatal symptom severity reduction compared with the nonmedicated counterpart. This effect was larger (β=-0.74, 95% CI =-1.24, -0.24) when the analysis was restricted to mothers within 6 months after childbirth.

Conclusion: The prevalence of self-reported antenatal and postnatal depressive symptoms differs across European countries. Among women with psychiatric disorders, those who had been on treatment with antidepressants during pregnancy were less likely to report postnatal depressive symptoms, particularly within the 6-month period after childbirth, compared with the nonmedicated counterpart.

Keywords: antidepressants; anxiety; depression; pharmacotherapy; pregnancy and postpartum; web-based.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow chart to achieve the final antenatal and postnatal samples. Notes: aPsychiatric disorder refers to self-reported chronic depression, anxiety, bipolar, panic, or personality disorder. Western Europe included France, Italy, Switzerland, and the UK; Northern Europe included Finland, Norway, and Sweden; and Eastern Europe included Croatia, Poland, Russia, Serbia, and Slovenia. Abbreviation: EPDS, Edinburgh Postnatal Depression Scale.
Figure 2
Figure 2
Weighted proportions of women with antenatal depressive symptoms by severity and country of residence. Notes: Proportions and corresponding 95% CIs were corrected for survey weights based on educational level within age strata for each individual country among women of childbearing age. Population data for 2012 from: European Commission, Eurostat. Population by educational attainment level, sex and age (%) - main indicators; 2017 [updated February 28, 2018; cited November 8, 2017]. Available from: http://ec.europa.eu/eurostat/web/products-datasets/-/edat_lfse_03. Accessed August 17, 2017. Symptoms severity assessed as follows: “mild to moderate” (EPDS score=10–16), “moderate to severe” (EPDS score=17–21), and “very severe” (EPDS score=22–30). The proportion of women having no depressive symptoms (EPDS score=0–9) is not represented. In Slovenia, there were no women having moderate to severe or very severe depressive symptoms. The squares in red color indicate the proportion of women with mild to moderate depressive symptoms, the ones in green indicate moderate-to-severe symptoms, and the ones in black indicate very severe depressive symptoms. Abbreviations: CI, confidence interval; EPDS, Edinburgh Postnatal Depression Scale.
Figure 3
Figure 3
Weighted proportions of women with postnatal depressive symptoms by severity and country of residence. Notes: Proportions and corresponding 95% CIs were corrected for survey weights based on educational level within age strata for each individual country among women of childbearing age. Population data for 2012 from: European Commission, Eurostat. Population by educational attainment level, sex and age (%) - main indicators; 2017 [updated February 28, 2018; cited November 8, 2017]. Available from: http://ec.europa.eu/eurostat/web/products-datasets/-/edat_lfse_03. Accessed August 17, 2017. Symptoms severity assessed as follows: “mild to moderate” (EPDS score =10–16), “moderate to severe” (EPDS score =17–21), and ”very severe” (EPDS score =22–30). The proportion of women having no depressive symptoms (EPDS score =0–9) is not represented. The squares in red color indicate the proportion of women with mild-to-moderate depressive symptoms, the ones in green indicate moderate to severe symptoms, and the ones in black indicate very severe depressive symptoms. Abbreviations: CI, confidence interval; EPDS, Edinburgh Postnatal Depression Scale.

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