Question

Please put this in APA style 6th edition and provide and in text citation as well.

Wisner KL, Sit DKY, McShea MC, et al. Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings. JAMA Psychiatry. 2013;70(5):490–498. doi:10.1001/jamapsychiatry.2013.87

Answer 1

Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings

Katherine L. Wisner, MD, MS, Dorothy K. Y. Sit, MD, [...], and Barbara H. Hanusa, PhD.

Importance

The period prevalence of depression among women is 21.9% during the first postpartum year; however, questions remain about the value of screening for depression.

Objectives

To screen for depression in postpartum women and evaluate positive screen findings to determine the timing of episode onset, rate and intensity of self-harm ideation, and primary and secondary DSM-IV disorders to inform treatment and policy decisions.

Design

Sequential case series of women who recently gave birth.

Setting

Urban academic women’s hospital.

Participants

During the maternity hospitalization, women were offered screening at 4 to 6 weeks post parturn by telephone. Screen-positive women were invited to undergo psychiatric evaluations in their homes.

Main Outcomes and Measures

A positive screen finding was an Edinburgh Postnatal Depression Scale (EPDS) score of 10 or higher. Self-harm ideation was assessed on EPDS item 10: “The thought of harming myself has occurred to me” (yes, quite often; sometimes; hardly ever; never). Screen-positive women underwent evaluation with the Structured Clinical Interview for DSM-IV for Axis I primary and secondary diagnoses.

Results

Ten thousand mothers underwent screening, with positive findings in 1396 (14.0%); of these, 826 (59.2%) completed the home visits and 147 (10.5%) completed a telephone diagnostic interview. Screen-positive women were more likely to be younger, African American, publicly insured, single, and less well educated. More episodes began post partum (40.1%), followed by during pregnancy (33.4%) and before pregnancy (26.5%). In this population, 19.3% had self-harm ideation. All mothers with the highest intensity of self-harm ideation were identified with the EPDS score of 10 or higher. The most common primary diagnoses were unipolar depressive disorders (68.5%), and almost two-thirds had co-morbid anxiety disorders. A striking 22.6% had bipolar disorders.

Conclusions and Relevance

The most common diagnosis in screen-positive women was major depressive disorder with comorbid generalized anxiety disorder. Strategies to differentiate women with bipolar from unipolar disorders are needed.

Trial Registration

With a period prevalence of 21.9% the year after birth, depression is a frequent complication of childbearing. However, recognition and treatment rates are even lower in pregnant and postpartum women (14%) than in the general population (26%),Low treatment rates are juxtaposed against mounting evidence that antenatal and postpartum depression (PPD) increase the risk for multiple adverse outcomes among women and their offspring. Maternal depression interferes with child development and increases the rates of insecure attachment and poor cognitive performance. Suicide accounts for about 20% of postpartum deaths and is the second most common cause of mortality in postpartum women.

Childbearing is an opportune time for intervention because women have contact with health care professionals, have access to health insurance, and are motivated toward positive behaviors to invest in their offspring’s welfare.Identification of PPD through universal screening has been recommended (and is mandated in several states); however, screening without system enhancements, such as diagnostic evaluation with intervention implementation, is not currently justifiable o cost-effective. an may incur ethical and liability concerns.

SELF-HARM IDEATION

In the sample of 10 000 women who underwent screening, 319 (3.2%) had thoughts of self-harm, including 8 who endorsed “yes, quite often”; 65, “sometimes”; and 246, “hardly ever.” Most women who endorsed self-harm ideation also had screen-positive findings on the EPDS (270 of 319 [84.6%]). The rates of self-harm ideation for women with EPDS scores of 10 or higher (n = 1396) and 13 or higher (n = 703) are shown in Figure 3. At an EPDS score of 10 or higher, the percentage of subjects within each category of response was 80.7% for never and 19.3% for yes, divided as 14.3% for 1 (hardly ever), 4.5% for 2 (sometimes), and 0.6% for 3 (yes, quite often). Women with higher EPDS scores (≥13) had a higher proportion within each category who endorsed thoughts of self-harm, with 70.0% for never and 30.0% for yes, divided as 20.3% for 1, 8.6% for 2, and 11.1% for 3.A small number of women endorsing thoughts of self-harm (n = 49) had screen-negative findings. None of these women gave the response of “yes, quite often,” whereas “sometimes” was endorsed by 2 and “hardly ever” by 47. Notably, all the mothers who had the highest level of self-harm ideation were captured with an EPDS of 10 or higher.