Depression and anxiety disorders.

Depressive and anxiety disorders are common problems facing obstetrician-gynecologists. Although psychiatric disorders are equally common in men and women, women are at least twice as likely to present with depressive disorders and most anxiety disorders. The depressive disorders include major depression, dysthymia, seasonal affective disorder, and premenstrual dysphoric disorder. The anxiety disorders are panic disorder (with and without agoraphobia), generalized anxiety disorder, social phobia, obsessive compulsive disorder, and PTSD. One must diagnose and manage depressive and anxiety disorders during pregnancy, the purpureum, and while breastfeeding. General treatment principles include assessing suicide risk, psychotherapy, pharmacologic treatment, and an appropriate medical work-up for depressive and anxiety disorders. The SSRIs are the first-line treatment for most depressive and anxiety disorders because of data supporting their efficacy, the minimal need for dosage titration, the overall favorable side-effect profile, and the length of available clinical experience. Newer antidepressants, such as venlafaxine, bupropion, nefazodone, and mirtazapine, are options for patients unresponsive to, or intolerant of, the SSRIs. Treatment considerations include acute, maintenance, and continuation therapy, dosage regimens, adverse effects, and drug interactions. Specific guidelines are available for referring patients to a mental health specialist.     

Relationships of premenstrual dysphoric disorder to major depression and anxiety disorders: a re-examination

Clarifying the relationships of premenstrual dysphoric disorder (PMDD) to depressive and anxiety disorders may contribute to the understanding of risk factors and etiologies associated with the disorders. A current belief is that women with PMDD have a higher percentage of past psychiatric disorders than women without the disorder, an assumption that may be premature. This review carefully examines existing literature on the nature of the relationships between PMDD and major depression and anxiety disorders. A re-evaluation of the literature and the resulting implications for risk factors and etiology, as well as for obstetric and gynecological practice, are provided.     

Prevalence of depressive disorders in early puerperium]

OBJECTIVE: The aims of this investigation were to detect the prevalence and influencing factors of early postpartal depressive disorders in a large hospital sample. METHODS: By means of an interview we acquired information on sociodemographic data, physical and psychiatric anamnesis, obstetric and psychological variables. The German version of the Edinburgh Postnatal Depression Scale (EPDS) served to determine the depressive disorder of our patients. The interview was carried out on 1,250 women at the maternity ward 5 days after delivery. RESULTS: According to the results of the German validation of the EPDS, 254 (20.3%) women at the maternity ward had an at least mild depressive disorder. A comparison between nondepressed women (n = 996, 79.7%) and depressed women (n = 254, 20.3%) revealed the following risk factors for the development of an early postpartal depressive disorder: higher subjective burden of childbirth, higher trait anxiety, poorer couple compatibility, lower job satisfaction and lower social status. Of all the obstetric variables previous abortions, elevated pregnancy risks, low weight of the newborn at delivery and cesarean section were of significant influence. CONCLUSIONS: Early postpartal depressive disorder appears in 20% of all women 5 days after delivery. According to previous studies this group seems to be at highest risk for developing a later postpartum depression. Considering the psychosocial and obstetric risk factors, preventive psychotherapeutic interventions at the maternity ward are indicated.     

Sexual Dysfunction in Male Iraq and Afghanistan War Veterans: Association with Posttraumatic Stress Disorder and Other Combat-Related Mental Health Disorders: A Population-Based Cohort Study

IntroductionMental health disorders are prevalent in the United States, Iraq, and Afghanistan war veterans. Mental illness, including posttraumatic stress disorder (PTSD) with or without psychiatric medications, can increase the risk for male sexual dysfunction, threatening quality of life.AimsWe sought to determine the prevalence and correlates of sexual dysfunction among male Iraq and Afghanistan veterans.MethodsWe performed a retrospective cohort study of 405,275 male Iraq and Afghanistan veterans who were new users of U.S. Department of Veterans Affairs healthcare from October 7, 2001 to September 30, 2009 and had 2-year follow-up.Main Outcome MeasuresWe determined the independent association of mental health diagnoses and sexual dysfunction after adjusting for sociodemographic and military service characteristics, comorbidities, and medications.ResultsVeterans with PTSD were more likely to have a sexual dysfunction diagnosis, be prescribed medications for sexual dysfunction, or both (10.6%), compared with veterans having a mental diagnosis other than PTSD (7.2%), or no mental health diagnosis (2.3%). In a fully adjusted model, PTSD increased the risk of sexual dysfunction by more than threefold (adjusted risk ratio = 3.61, 95% CI = 3.48–3.75). Veterans with mental health disorders, particularly PTSD, were at the highest risk of sexual dysfunction when prescribed psychiatric medications (adjusted risk ratio = 4.59, 95% CI = 4.41–4.77).ConclusionsAmong U.S. combat veterans, mental health disorders, particularly PTSD, increased the risk of sexual dysfunction independent of the use of psychiatric medications. Breyer BN, Cohen BE, Bertenthal D, Rosen RC, Neylan TC, and Seal KH. Sexual dysfunction in male Iraq and Afghanistan war veterans: Association with posttraumatic stress disorder and other combat-related mental health disorders: A population-based cohort study. J Sex Med 2014;11:75–83.     

Risk of psychiatric disorders following pelvic inflammatory disease: a nationwide population-based retrospective cohort study

Pelvic inflammatory disease (PID) a common infection in women that is associated with significant morbidity and is a major cause of infertility. A clear temporal causal relationship between PID and psychiatric disorders has not been well established. We used a nationwide population-based retrospective cohort study to explore the relationship between PID and the subsequent development of psychiatric disorders. We identified subjects who were newly diagnosed with PID between 1 January 2000 and 31 December 2002 in the Taiwan National Health Insurance Research Database. A comparison cohort was constructed for patients without PID. A total of 21 930 PID and 21 930 matched control patients were observed until diagnosed with psychiatric disorders, or until death, withdrawal from the NHI system, or until 31 December 2009. Adjusted hazard ratio (HR) of bipolar disorder, depressive disorder, anxiety disorder and sleep disorder in subjects with PID were significantly higher (HR: 2.671, 2.173, 2.006 and 2.251, respectively) than that of the controls during the follow-up. PID may increase the risk of subsequent newly diagnosed bipolar disorder, depressive disorder, anxiety disorder and sleep disorder, which will impair life quality. Our findings highlight that clinicians should pay particular attention to psychiatric comorbidities in PID patients.     

The relationships between perceived levels of control, psychological distress, and legal system variables in a sample of sexual assault survivors

Information regarding psychological distress, perceived levels of temporal control, and legal system success and satisfaction ratings were collected from 41 survivors of sexual assault. Results suggest that self-blame and offender blame may differentially impact posttraumatic stress disorder (PTSD) and depressive symptom severity. In addition, participants who perceived a greater risk of future assault reported higher levels of depressive and PTSD symptoms. Furthermore, perceptions of present control over the recovery process were related to lower levels of psychological distress. For those who reported the assault to police, lower levels of legal system success and satisfaction were linked to higher levels of perceived control over present recovery.     

Patients with psychiatric disorders in gynecologic practice--a three year follow-up

OBJECTIVE: Patients with depressive disorders are commonly encountered in gynecologic practice. The prevalence rates for depressive disorders have been reported to vary between 10 and 40% among patients consulting their gynecologist. The purpose of the current study was to study health care utilization by patients with a psychiatric disorder in the gynecologic setting during a three-year period after the initial diagnosis of depression and/or anxiety. STUDY DESIGN: In 1998 all scheduled and walk-in patients, at two gynecologic centers in northern Sweden during one month, were screened for prevalence of depression and anxiety disorders using the PRIME-MD system. Medical records for the period 16 December 1998 to 31 December 2001 have been reviewed. RESULTS: Patients diagnosed with any anxiety disorder made significantly more appointments to the gynecologist and were acutely hospitalized more often than control subjects. Both patients with any depressive or any anxiety diagnosis made significantly more visits to health care personnel other than the gynecologist and they received counseling by phone and/or letter significantly more often than patients in the control group. Furthermore, patients with depressive and/or anxiety diagnosis were also referred to other medical specialists more often than controls. CONCLUSION: The present study has indicated that gynecologic patients with depression and anxiety over a three-year follow-up period have an increased health care utilization with more frequent consultations and more frequent referrals.     

Association of psychological distress with psychological factors in rescue workers within two months after a major earthquake.

BACKGROUND AND PURPOSE: Studies of the health of rescue workers after a major disaster have frequently focused on posttraumatic stress disorder. This study aimed to determine the characteristics of psychological distress and its psychosocial predictors in rescue workers within a 2-month period after an earthquake that struck central Taiwan on September 21, 1999. METHODS: A total of 1,104 rescue workers serving in the earthquake were enrolled in the study. Psychological distress was measured using the Brief Symptom Rating Scale (BSRS), personality traits using the Maudsley Personality Inventory (MPI), and family function using APGAR (adaptability, partnership, growth, affection, and resolve) indexes. These measurements were performed within 2 months of the earthquake. Univariate and multivariate analyses were applied to examine the association between psychological distress and various psychosocial factors. RESULTS: BSRS assessment revealed severe psychological distress in 137 (16.4%) subjects. The most common symptom dimension was phobic-anxiety (18.7%), followed by hostility (17.6%), obsessive-compulsive symptoms (16.2%), depression (14.9%), paranoid ideation (14.2%), interpersonal sensitivity (13.3%), psychoticism (11.9%), anxiety (10.8%), additional symptoms (8.5%), and somatization (6.2%). Pre-disaster major life events (R2 = 0.03) and most of the factor scores of the MPI (including moodiness, anxiety-prone, outgoing, conscientiousness, activity, and sociability factors; R2 = 0.25) predicted the severity of psychological distress. Time of arrival at the scene, previous exposure, age, and family function had no or trivial predictive power. CONCLUSION: The results of this study indicated that prevalence of general psychological distress is high among rescue workers in the first 2 months after a major earthquake. Personality traits and pre-disaster life adjustment had a dominant predictive power for psychological distress. Immediate psychosocial intervention should be considered to ameliorate the distress related to disaster rescue work.     

Severe Antenatal Depressive Symptoms Before and After the 2008 Wenchuan Earthquake in Chengdu,China

ObjectiveTo investigate the prevalence and correlates of severe antenatal depressive symptoms among pregnant women in Chengdu before and after the Wenchuan earthquake.DesignAn exploratory and comparative cross‐sectional study.SettingsFour regional public hospitals in Chengdu located 90 km from the epicenter of the Wenchuan earthquake.ParticipantsThe convenience sample was composed of 1,156 pregnant women at 12 to 24 weeks' gestation.MethodsThe women were identified as having depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS).Marital conflict and parent‐in‐law conflict were assessed using the Dyadic Adjustment Scale (DAS) and the Stryker Adjustment Checklist (SAC), respectively.The Interpersonal Support Evaluation List (ISEL) was used to measure the functional aspects of the perceived availability of social support.ResultsUsing the EPDS with a cutoff score of 14/15 for severe symptoms of depression, 9.2% and 7.1% of the women screened positive before and after the earthquake.Women who had been married for a shorter time were more likely to have depressive symptoms before the earthquake; those who had lived in Chengdu for a shorter period and who had more infants were more likely to suffer after it.Marital conflict and lack of social support were consistent risk factors before and after the earthquake.ConclusionAdditional research is needed to investigate the long‐term, earthquake‐related psychopathology.Nurses should receive more education about disaster‐related psychological health skills to provide more effective prenatal screening and intervene successfully to assist women to optimize their psychological health status after a disaster.     

Psychiatric Disorders,Self-Esteem,and Quality of Life in Adolescents with Polycystic Ovary Syndrome

Study ObjectiveTo assess psychiatric disorders in adolescents with polycystic ovary syndrome (PCOS) and evaluate health-related quality of life and self-esteem in this group.DesignCross-sectional design. The survey was composed of validated measures and a semistructured interview.SettingUniversity School of Medicine, Turkey.ParticipantsFemale adolescents aged 13-18 years.Interventions and Main Outcome MeasuresAssessment of psychiatric disorders through a semistructured interview (Schedule for Affective Disorders and Schizophrenia for School Age Children) conducted by a child and adolescent psychiatrist. Health-related quality of life was measured using the Pediatric Quality of Life Inventory (PedsQL) and self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES).ResultsA total of 28 adolescent with PCOS and 31 age- and sex-matched healthy peers were recruited. The psychiatric diagnosis rate was higher in the PCOS group than in the control group (P < .5). In the patient group, 6 of 28 patients (21%) were diagnosed with depressive disorder and the most common single diagnosis was major depressive disorder. There were no significant differences in the PCOS and control groups in terms of RSES and PedsQL scores. There was no significant relationship between RSES scores and body image related to hirsutism, acne, and body mass index. Also, there was no significant relationship between PedsQL scores and hirsutism, acne, and body mass index.ConclusionAdolescents with PCOS frequently experience psychiatric disorders. Physicians should be aware that adolescents with PCOS are at a high risk for major depression and anxiety disorders.     

Patients with psychiatric disorders in gynecologic practice—a three year follow-up

Objective.?Patients with depressive disorders are commonly encountered in gynecologic practice. The prevalence rates for depressive disorders have been reported to vary between 10 and 40% among patients consulting their gynecologist. The purpose of the current study was to study health care utilization by patients with a psychiatric disorder in the gynecologic setting during a three-year period after the initial diagnosis of depression and/or anxiety.

Study design.?In 1998 all scheduled and walk-in patients, at two gynecologic centers in northern Sweden during one month, were screened for prevalence of depression and anxiety disorders using the PRIME-MD system. Medical records for the period 16 December 1998 to 31 December 2001 have been reviewed.

Results.?Patients diagnosed with any anxiety disorder made significantly more appointments to the gynecologist and were acutely hospitalized more often than control subjects. Both patients with any depressive or any anxiety diagnosis made significantly more visits to health care personnel other than the gynecologist and they received counseling by phone and/or letter significantly more often than patients in the control group. Furthermore, patients with depressive and/or anxiety diagnosis were also referred to other medical specialists more often than controls.

Conclusion.?The present study has indicated that gynecologic patients with depression and anxiety over a three-year follow-up period have an increased health care utilization with more frequent consultations and more frequent referrals.     

Erectile Dysfunction is a Modifiable Risk Factor for Major Depressive Disorder: Analysis of a Federated Research Network

BackgroundErectile dysfunction is one of many conditions associated with depression, but few studies exist to establish the risk of major depressive disorder (MDD) in the large population of men with erectile dysfunction, and it is unclear whether erectile dysfunction (ED) treatment is associated with decreased rates of MDD.AimWe determined the risk of major depressive disorder in men with erectile dysfunction and evaluated whether treatment of ED with phosphodiesterase-5 inhibitor or penile prosthesis is associated with a lower risk of developing major depressive disorder.MethodsWe reviewed a large, retrospective, cohort that utilized electronic health record data collected by the TriNetX Research Network, a global federated database that provides healthcare data for analysis. We performed multiple comparisons: men with ED against men without ED; men with ED treated with phosphodiesterase-5 inhibitors against untreated ED patients, and of men with ED who received penile prosthesis against those who did not. We assessed major depressive disorder (ICD-10-CM F32-F33) as a primary outcome and used propensity score matching to control for ethnicity, race, type 2 diabetes mellitus (E11), essential hypertension (I10), acute myocardial infarction (I21), chronic ischemic heart disease (I25), cerebral infarction (I63), overweight and obesity (E66), personal history of nicotine (Z87.891), hypogonadism (E29.1), and alcohol related disorders (F10).OutcomesWe assessed new diagnosis of major depressive disorder (F32-F33) within a 3-year time window following index event of ED diagnosis, visit to healthcare organization, or ED treatment with phosphodiesterase-5 inhibitor or penile prosthesis as the primary outcome.ResultsED was associated with major depressive disorder both before and after (OR 2.00, 95% CI 1.94–2.06) controlling for confounding variables through propensity score matching. Men who received ED therapies had lower rates of depression compared to those who did not, whether they were treated with phosphodiesterase-5 inhibitor (0.80, 0.77–0.83) or penile prosthesis (0.73, 0.60–0.89).Strengths and LimitationsStrengths include a large sample size and robust statistical techniques. Limitations include lack of detailed information regarding clinical severity and socioeconomic factors.Clinical ImplicationsOur findings indicate that clinicians should consider evaluating depressive symptoms among men with erectile dysfunction and counsel them regarding the risk of developing major depressive disorder.ConclusionsErectile dysfunction is associated with major depressive disorder, but treatment is associated with decreased rates of MDD.S Nackeeran, A Havanur, J Ory, et al. Erectile Dysfunction is a Modifiable Risk Factor for Major Depressive Disorder: Analysis of a Federated Research Network. J Sex Med 2021;18:2005–2011.     

Post-traumatic stress disorder after childbirth in Nigerian women: prevalence and risk factors

OBJECTIVE: To estimate the prevalence of post-traumatic stress disorder (PTSD) after childbirth in a group of postpartum Nigerian women and to examine any associated factors. DESIGN: A cross-sectional survey. SETTING: Postnatal clinics and infant immunisation clinics of the five health centres in Ilesa Township, Nigeria. POPULATION: A total of 876 women at 6 weeks postpartum. METHODS: The postpartum women were assessed for PTSD at 6 weeks. Other data collected were demographic characteristics, details of pregnancy and delivery and neonatal outcome. Additionally, the following measures were used: the MINI International Neuropsychiatric Interview to assess PTSD, the Index of Marital Satisfaction to measure the degree of problem a spouse encounters in the marital relationship, the Medical Outcome Study Social Support Survey to measure social support, the Life Events Scale to measure the life stress covering the preceding 12 months and the Labour Agentry Scale that measures the maternal experiences of control during childbirth. MAIN OUTCOME MEASURES: Prevalence of PTSD in this population of postpartum Nigerian women, and how this prevalence related to other maternal and neonatal characteristics. RESULTS: The prevalence of PTSD was 5.9%. The factors independently associated with PTSD after childbirth include hospital admission due to pregnancy complications (OR 11.86, 95% CI 6.36-22.10), instrumental delivery (OR 7.94, 95% CI 3.91-16.15), emergency caesarean section (OR 7.31, 95% CI 3.53-15.10), manual removal of placenta (OR 4.96, 95% CI 2.43-10.14) and poor maternal experience of control during childbirth (OR 5.05, 95% CI 2.69-9.48). CONCLUSIONS: The prevalence of PTSD after childbirth in Nigerian women is slightly higher than those found in western culture. An effective model for the prediction of the development of PTSD after childbirth needs to be developed and evaluated, and interventions aimed at reducing the incidence of PTSD after childbirth need further research.     

Co-occurring psychiatric disorders in women with addictions

There is clinically important comorbidity between psychiatric and substance use disorders, particularly in women. Women with affective and anxiety disorders are more likely to present with alcohol or drug abuse/dependence. In turn, substance-abusing women are more likely to experience clinically significant depression and anxiety. Emerging evidence is pointing to an etiological role for anxiety disorders in the development of substance abuse/dependence; however, etiologic evidence is not as clear-cut for major depressive disorder. PTSD appears to be a particularly important factor for alcohol and drug dependence in women who have experienced childhood or adult sexual and or physical abuse. Although pharmacotherapy for affective or anxiety disorders is useful for ameliorating psychiatric symptoms, research is mixed on the effectiveness for improving alcohol- and drug-related outcomes. There is some limited evidence that women-specific services can improve treatment retention, substance use outcomes, and possibly psychosocial functioning compared with traditional mixed-gender programs. However, it is clear that women with co-occurring psychiatric and substance use problems are challenging to engage and retain in care. Physicians providing women's reproductive health services can serve a vital role in the identification and referral of substance-abusing women. Particular attention should be focused on screening and assessment of alcohol and drug use and problem severity among women who have identified psychiatric disorders or who are receiving antidepressant or anxiolytic medications. Recognition and referral for both psychiatric and substance use disorders are critical for long-term health and psychosocial improvement.     

Anxiety and prevalence of psychiatric disorders among patients awaiting surgery for suspected ovarian cancer

Aim:  The goal of the current study was to determine the anxiety level and prevalence of psychiatric disorders among patients awaiting surgery for ovarian tumors. Also analyzed were the predictive factors for psychiatric disorders and changes after surgical diagnosis.
Methods:  Patients who underwent surgery for ovarian tumors were examined before and after surgery with the MINI International Neuropsychiatric Interview, the Spielberger State-Trait Anxiety Inventory (STAI) and the Mausley Personality Inventory (MPI). Participants diagnosed with cancer were examined a third time after being given an explanation about whether or not adjuvant chemotherapy was required.
Results:  Twenty-seven participants completed the study and were analyzed. Nine (33.3%) of these 27 participants were diagnosed as having adjustment disorder. There were no differences in the demographic data, STAI trait anxiety score and MPI score between the participants with or without adjustment disorder. At the pre-surgical interview, the STAI state anxiety score of the participants was high (49.5 ± 10.30). After pathological examination of the tumors, it was found that 12 patients had cancer (malignant group) and 15 patients had a benign tumor (benign group). At pre-surgery, the prevalence of adjustment disorder and the level of anxiety in the benign group were similar to those in the malignant group. There was a second surge of anxiety in patients who needed chemotherapy.
Conclusion:  The above findings demonstrate that patients with suspected ovarian cancer experience a high level of anxiety. Physicians should be aware of the risk of adjustment disorder in these patients. Additionally, ovarian cancer patients need psychological assessment during the course of treatment.     

Psychologic effects of traumatic live deliveries

OBJECTIVES: Traumatically experienced childbirth can lead to serious psychological disturbances postpartum. Dependent upon objective and subjective factors, some women may even develop the symptomatology of a posttraumatic stress disorder (PTSD). The aim of a pilot study was the evaluation of the frequency of traumatically experienced childbirth, of the effects of these traumatic experiences and possible risk factors for the development of PTSD. STUDY DESIGN: 976 women, who had given birth at the Bonn University Women's Hospital during 1997/1998, were retrospectively questioned regarding their experiences with pregnancy, childbirth and postpartum. 46 women, who described relevant psychological symptoms after childbirth, were personally interviewed. RESULTS: 424 women returned the completed questionnaire. 17.2% of the women reported anxiety postpartum, 9.4% depressive symptoms, 12% a mental re-experience of delivery within the first weeks postpartum, 3.8% were still suffering from these intrusions at the time of the study. In the first weeks after labor, nightmares were reported in 3.1%. In 4 cases, the full criteria for a PTSD were met. In 10 further cases, a subsyndromal form of this disorder was found. The case analysis showed that the development of PTSD symptoms was influenced by factors such as expectations, need for control, sense of shame and previous traumatic experiences. CONCLUSIONS: Psychological symptoms postpartum were reported frequently. Traumatically experienced childbirth can be responsible for specific short-term or long-term symptoms. In individual cases, a PTSD can develop after a traumatic delivery with long-term negative consequences for the health and mental condition of the mother, the mother-child-relationship and the desire for further pregnancy. In such cases, a specific psychotherapeutic treatment is always necessary.     

Adolescent sexual assault: an update of the literature

PURPOSE OF REVIEW: In this review, we examine the most recent literature on adolescent sexual assault, and summarize new findings regarding prevalence, risk factors, sequelae, cultural factors, genital injury, legal issues and practice implications. RECENT FINDINGS: Child and adolescent sexual-assault victims are at risk for a range of negative outcomes, including comorbid post-traumatic stress disorder and major depressive episode, comorbid post-traumatic stress disorder and substance abuse, eating disorders, delinquency, and revictimization. Cultural factors and severity levels of trauma may serve as risk factors to such outcomes in adolescent sexual-assault victims. Compared with adults, adolescent sexual-assault victims have a greater frequency of rape-related anogenital injuries, but data on healing of injuries in this population are lacking. Factors related to a child sexual-assault victim's demeanor and intelligence can influence the perceived credibility of the child as a witness to the abuse. SUMMARY: Recent studies investigating prevalence, risk factors, and sequelae of child and adolescent sexual assault highlight the need for educational programs and primary prevention interventions to educate pre-pubescent children and adolescents about sexuality, including sexual assault. In addition, further research is warranted in the area of statutory rape reporting to determine its effects on adolescent health-service-seeking behaviors and outcomes. Although most adolescent sexual assault victims do not seek acute post-rape medical care, forensic nurse examiners are often the first clinicians to encounter the adolescent sexual assault victim. Nursing protocols that standardize evidence collection as well as psychological support are important in the comprehensive care of these traumatized teens.     

Depressive symptoms and symptoms of post-traumatic stress disorder in women after childbirth

This study examined the course of psychological problems in women from late pregnancy to six months postpartum, the rates of psychiatric, especially depressive and post-traumatic stress symptoms and possible related antecedent variables. During late pregnancy, one to three days postpartum, six weeks and six months postpartum, 47 of the 60 participating women completed a battery of questionnaires including the General Health Questionnaire, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale, and the PTSD Symptom Scale. In general, most women recovered from psychiatric and somatic problems over the period of investigation. However, depressive and post-traumatic stress symptoms in particular were not found to decline significantly. Six weeks postpartum, 22% of the women had depressive symptoms, with this figure remaining at 21.3% six months postpartum. In addition, 6% of the women studied reported clinically significant PTSD symptoms at six weeks postpartum with 14.9% reporting such symptoms at six months postpartum. The most important predictor for depressive and post-traumatic stress symptoms was the block variable "anxiety in late pregnancy". Other predictors were the variables "psychiatric symptoms in late pregnancy", "critical life events" and the "experience of delivery". The results of our study show a high prevalence rate of psychiatric symptoms in women after childbirth and suggest, besides the experience of the delivery itself, a vulnerability or predisposing history that makes the development of psychiatric symptoms after childbirth more probable.     

The Origin of the World: Science and Fiction of the Vagina

This study examined the course of psychological problems in women from late pregnancy to six months postpartum, the rates of psychiatric, especially depressive and post-traumatic stress symptoms and possible related antecedent variables. During late pregnancy, one to three days postpartum, six weeks and six months postpartum, 47 of the 60 participating women completed a battery of questionnaires including the General Health Questionnaire, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale, and the PTSD Symptom Scale. In general, most women recovered from psychiatric and somatic problems over the period of investigation. However, depressive and post-traumatic stress symptoms in particular were not found to decline significantly. Six weeks postpartum, 22% of the women had depressive symptoms, with this figure remaining at 21.3% six months postpartum. In addition, 6% of the women studied reported clinically significant PTSD symptoms at six weeks postpartum with 14.9% reporting such symptoms at six months postpartum. The most important predictor for depressive and post-traumatic stress symptoms was the block variable “anxiety in late pregnancy”. Other predictors were the variables “psychiatric symptoms in late pregnancy”, “critical life events” and the “experience of delivery”. The results of our study show a high prevalence rate of psychiatric symptoms in women after childbirth and suggest, besides the experience of the delivery itself, a vulnerability or predisposing history that makes the development of psychiatric symptoms after childbirth more probable.