İsmet KIRKPINAR, Işık TEPELİ ÖZTÜRK, SEBAHAT GÖZÜM, TÜRKAN PASİNLİOĞLU

Doğum sonrası depresyon özgül bir tanı mıdır? İleriye dönük bir çalışma

Amaç: Doğum sonrası depresyonlarının (DSD) sıklık ve yaygınlığı ile tanısal durumunu inceleyen çalışmalar çelişkili sonuçlar bildirmektedir. Erzurum il merkezinde doğum sonrası depresyonlarının gelişimini inceleyen ileriye dönük, epidemiyolojik bir çalışmanın bir kısmını oluşturan bu yazı, doğum sonrası altıncı haftada depresyonların sıklık ve yaygınlığı ile DSM-IV’e göre tanısal dağılımını incelemeyi amaçlamaktadır. Yöntem: Üçüncü trimestrde saptanan 479 kadın, gebelikte ve doğumdan sonraki 7-10 gün ile altıncı haftada eğitimli ebeler tarafından evlerinde ziyaret edildi. Her ziyaret sırasında sosyodemografik ve sağlık değişkenlerine ilişkin sorguluklar ile doğum sonrası altıncı haftada Edinburgh Doğum Sonrası Depresyon Ölçeği (EDSDÖ) dolduruldu. EDSDÖ ile DSD saptanan anneler psikiyatrist tarafından ziyaret edilerek depresyonların zamansal durumları ve SCID ile tanı- ları belirlendi. Sonuçlar: Bu anne grubunda EDSDÖ ile altıncı haftada saptanan DSD yaygınlığı %14 olarak belirlendi. Klinik görüşme sonucu sıklık %6 olarak hesaplandı. SCID’le belirlenen DSM-IV tanı dağılımına göre depresif annelerin %74’ünde belirtiler majör depresif bozukluk tanı ölçütlerini karşılamakla birlikte, başka depreş- yon tanıları konan anneler de oldu. Tartışma: DSD için bu grupta saptanan sıklık ve yaygınlık oranları, başka dönemdeki kadınlardan anlamlı farklılıklar göstermemektedir. Tanısal dağılımı değerlendirildiğinde DSD özgül bir klinik tanı olarak görülmemektedir. (Anadolu Psikiyatri Derg 2012; 13:16-23)

Is postpartum depression a specific diagnosis? A prospective study

Objective: The studies investigating the prevalence and incidence of postpartum depression (PPD), as well as its nosologic status have controversial results. This article is part of a prospective, epidemiological study concerning postpartum depression in Erzurum City, Eastern Turkey. The present study focuses on the prevalence and incidence of PPD at sixth weeks after delivery and its diagnostic distribution according to DSM-IV. Methods: Four hundred and seventy-nine pregnant women in their third trimester were arranged to be visited by trained community midwives at 7-10 days and sixth weeks after delivery. Data were collected by use of the questionnaires on detailed sociodemographic and health information at each visit and the participitants filled out the Edinburgh Postpartum Depression Scale (EPDS) at six weeks after delivery. Finally, mothers who had PPD diagnosis according to EPDS were visited by a psychiatrist in their homes where the SCID was administered to make a DSM-IV diagnosis and determine whether the depression occurred before or after delivery. Results: The prevalence rate of PPD measured by EPDS was 14% in this population. The incidence of PPD was estimated as 6% with clinical interviews. Most of the depressed mothers (74.0%) were diagnosed as major depressive disorder according to DSM-IV, but there were some other depressive states too. Conclusion: The prevalence and incidence rates of PPD do not appear to be significantly different from those of non-childbearing women. PPD should not be seen as a specific clinical entity as far as its diagnostic distribution is concerned.

PDF

___

1. Pitt B. Atypical depression following childbirth. Br J Psychiatry 1968; 114:1325-1335.
2. Paykel ES, Emms EM, Fletcher J, Rassby ES. Life events and social support in puerperal depression. Br J Psychiatry 1980; 136:339-346.
3. O’Hara MW, Swain AM. Rates and risk of postpartum depression - a meta-analysis. Int Rev Psychiatry 1996; 8:37-54.
4. Gaynes B, Gavin N, Meltzer-Brody S, Lohr K, Swinson T, Gartlehner G, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes. A.P.N. 05- E006-2 (Ed.), Evidence Report/Technology Assessment (Vol. 119). Agency for Healthcare Research and Quality, Rockville, 2005, p.1-8.
5. Noorlander Y, Bergink V, Van den Berg MP. Perceived and observed mother-child interaction at time of hos- pitalization and release in postpartum depression and psychosis. Arch Women's Ment Health 2008; 11:49-56.
6. Gibson J, McKenzie-McHarg K, Shakespeare J, Price J, Gray R. A systematic review of studies validating the Edinburgh Post-natal Depression Scale in antepartum and postpartum women. Acta Psychiatr Scand 2009; 119:350-354.
7. Cooper PJ, Murray L. The course and recurrence of postnatal depression. Br J Psychiatry 1995; 166:191- 195.
8. Beck CT. Predictors of postpartum depression: An up- date. Nurs Res 2001; 50:275-285.
9. Nielson FD, Videbech P, Hedegaard M, Salvig JD, Se- cher NJ. Postpartum depression: Identification of women at risk. Br J Obstetr Gynecol 2000; 107:1210-1217.
10. Segre LS, Losch ME, O'Hara MW. Race/ethnicity and perinatal depressed mood. Journal of Reproductive and Infant Psychology 2006; 24:99-106.
11. Zelkowitz P, Saucier JF, Wang T, Katofsky L, Valenzuela M, Westreich R. Stability and change in depressive symptoms from pregnancy to two months postpartum in childbearing immigrant women. Arch Women's Ment Health 2008; 11:1-11.
12. Beeghly M, Olson KL, Weinberg M, Pierre SC, Downey N, Tronick EZ. Prevalence, stability, and socio-demo- graphic correlates of depressive symptoms in black mothers during the first 18 months postpartum. Matern Child Health 2003; 7:157-168.
13. Mayberry LJ, Horowitz JA, Declercq E. Depression symptom prevalence and demographic risk factors among U.S. women during the first 2 years postpartum. J Obstetr Gynecol Neonatal Nurs 2007; 36:542-548.
14. Amerikan Psikiyatri Birliği. Psikiyatride Hastalıkların Tanımlanması ve Sınıflandırılması Elkitabı. Yeniden gözden geçirilmiş dördüncü baskı (DSM-IV-TR), E Köroğlu (Çev.), Ankara, HYB, 2001.
15. Dünya Sağlık Örgütü. ICD-10 Ruhsal ve Davranışsal Bozukluklar Sınıflandırılması. MO Öztürk, B Uluğ (Çev. Eds.), Ankara, Türkiye Sinir ve Ruh Sağlığı Derneği Yayını, 1993.
16. Elliott SA. Report on the Satra Bruk workshop on classi- fication of postnatal mental disorders. Arch Women's Ment Health 2010; 3:27-33.
17. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Post- natal Depression Scale (EPDS). Br J Psychiatry 1987; 150:782-786.
18. Eberhard-Gran M, Eskild A, Tambs K, Opjordsmoen S, Samuelsen SO. Review of validation studies of the postpartum depression scale. Acta Psychiatr Scand 2001; 104:243-249.
19. Cox J. Postnatal mental disorder: towards ICD-11. World Psychiatry 2004; 3:96-97.
20. Kırpınar I, Gozum S, Pasinlioglu T. Prospective study of postpartum depression in eastern Turkey: prevalence, socio-demographic and obstetric correlates prenatal anxiety and early awareness. J Clin Nurs 2010; 19:422- 431.
21. Devlet İstatistik Enstitüsü. 2000 Nüfus Sayımı: Nüfusun Sosyal ve Ekonomik Özellikleri. Ankara, Devlet İstatistik Enstitüsü Yayın Bölümü, 2000.
22. Usta N. Ekonomi Ahlakı ve İnsan Kaynağı. Erzurum, Aktif Yayınevi, 2001.
23. Kirpinar İ, Coşkun İ, Çayköylü A, Anaç Ş, Özer H. First- case post-partum psychoses in Eastern Turkey: a clinical case and follow-up study. Acta Psychiatr Scand 1999; 100:199-204.
24. Erzurum Sağlık Müdürlüğü. 2001 Erzurum Sağlık İsta- tistikleri. Erzurum, Erzurum Sağlık Müdürlüğü Yayını, 2001.
25. Engindeniz AN, Küey L, Kültür S. Edinburgh doğum sonrası depresyon ölçeği Türkçe formu geçerlilik ve güvenilirlik çalışması. Bahar Sempozyumları 1 Kitabı, Ankara, Psikiyatri Derneği Yayınları, 1996, s.51-52.
26. First MB, Spitzer RL, Gibbon M, Williams JB. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID), Clinician Version. Washington DC, American Psychiatric Press, 1996.
27. Çorapçıoğlu A, Aydemir Ö, Yıldız M, Danacı AE, Köroğlu E. DSM-IV Eksen I Bozuklukları (SCID-I) için Yapılandı- rılmış Klinik Görüşme, Klinik Vers., Ankara, HYB, 1999.
28. Ghubash R, Abou-Saleh MT. Postpartum psychiatric illness in Arab culture: prevalence and psychosocial correlates. Br J Psychiatry 1997;171:65-68.
29. Glasser S, Barell V, Shoham A, Ziv A, Boyko V, Lusky A, et al. Prospective study of postpartum depression in an Israeli cohort: prevalence, incidence and demographic risk factors. J Psychosom Obstet Gynecol 1998; 19:155- 164.
30. Dominic TSL, Alexander SKY, Chiu HFK, Leung TYS, Chung TKY. A psychiatric epidemiological study of postpartum Chinese women. Am J Psychiatry 2001; 158:220-226.
31. Klainin P, Arthur DG. Postpartum depression in Asian cul-tures: a literature review. Int J Nurs Stud 2009; 46:1355-1373.
32. Danaci AE, Dinç G, Deveci A, Sen FS, Icelli I. Postnatal depres-sion in Turkey: epidemiological and cultural aspects. Soc Psychiatry Psychiatr Epidemiol 2002; 37:125-129.
33. Dindar I, Erdogan S. Screening of Turkish women for postpartum depression within the first postpartum year: the risk profile of a community sample. Public Health Nurs 2007; 24:176-183.
34. Phillips J, Sharpe L, Matthey S, Charles M. Subtypes of postnatal depression? A comparison of women with recurrent and de novo postnatal depression. J Affect Disord 2010; 120:67-75.
35. Cox JL, Murray D, Chapman G. A controlled study of the onset, duration and prevalence of postnatal depression. Br J Psychiatry 1993; 163:27-31.
36. Eberhard-Gran M, Tambs K, Opjordsmoen S, Samuel- sen SO, Opjordsmoen S. A comparison of anxiety and depressive symptomatology in postpartum and non- postpartum mothers. Soc Psychiatry Psychiatr Epidemiol 2003; 38:551-556.
37. Wickberg B, Hwang CP. Screening for postnatal depres- sion in a population-based Swedish sample. Acta Psychiatr Scan 1997; 95:62-66.
38. Chatillon O, Even C. Antepartum depression: preva- lence, diagnosis and treatment. Encephale 2010; 36:443-451.
39. Harris B, Othman S, Davies JA, Weppner GJ, Richards GJ, Newcombe R, et al. Association between post- partum thyroid dysfunction and thyroid antibodies and depression. Br Med J 1992; 305:152-156.
40. Prentice LM, Phillips DI, Sarsero D, Beever K, McLachlan SM, Smith BR. Geographical distribution of subclinical autoimmune thyroid disease in Britain: a study using highly sensitive direct assays for autoanti- bodies to thryoglobulin and thyroid peroxidase. Acta Endocrinol 1990; 123:493-498.
41. Bloch M, Schmidt PJ, Danaceau M, Murphy J, Nieman L, Rub-inow DR. Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatr 2000; 157:924-930.
42. Whiffen VE. Is postpartum depression a distinct diag- nosis? Clin Psychol Rev 1992; 12:485-508.
43. Whiffen VE, Gotlib IH. Comparison of postpartum and nonpostpartum depression: clinical presentation, psychi- atric history, and psychosocial functioning. J Consult Clin Psychol 1993; 61:485-494.
44. O'Hara MW, Zekoski EM, Philipps LH, Wright EJ. Cont- rolled prospective study of postpartum mood disorders: comparison of childbearing and nonchildbearing women. J Abnormal Psychol 1990; 99:3-15.
45. Riecher-Rossler A, Fallahpour MH. Postpartum depres- sion: do we still need this diagnostic term? Acta Psychiatr Scand 2003; 108:51-56.
46. Kendell RE, Chalmers JC, Platz C. Epidemiology of puerperal psychoses. Br J Psychiatry 1987;150:662-673.
47. Munk-Olsen T, Laursen T, Pederson C, Mors O, Morten- sen PB. New parents and mental disorders: a popula- tion-based register study. JAMA 2006; 296:2582-2588.
48. Marcus SM. Depression during pregnancy: rates, risks and consequences. Can J Clin Pharmacol 2009; 16:15- 22.