The aim of this study was to conduct a nationwide survey in Japan of prefectural health centers, which were responsible for providing guidance to municipalities. The survey was performed in order to clarify the following issues: 1) the current level of support provided by prefectural centers for pre-and post-natal mental health; 2) the structures in place for providing consultation services for an "unwanted pregnancy" and the support available for high-risk cases; and 3) the advice available on postpartum maternal psychological screening, and interpretation of results of such screening. Questionnaires were sent by post to 394 prefectural health centers, of which 277 (70.3%) responded. A total of 32% of prefectural health centers confirmed that they had offered support to high-risk cases during pregnancy, and 72% had offered support post-partum. Regarding offering support to high-risk mothers, those prefectural health centers that did provide consultation services (n = 59) reported providing introductions and information about available facilities (P < 0.001) and conducting case conferences (P < 0.002). This was significantly different than prefectural health centers that did not provide consultation services (n = 198). At the prefectural health centers that "follow up on" the results of the mental health screening, psychiatry consultations were reported twice as often as the prefectural health centers that did "not follow up on" the results of mental health screening. These findings indicate that childcare support systems for postpartum mental health and the prevention of child abuse were established. However, the lack of prenatal health and support systems for the prenatal period remains an issue.

The number of deaths caused by child abuse is increasing, which is one of social concerns. The mental health of mothers might be related to child abuse. The aim of this study was to examine and compare the mental state of mothers in both the antepartum and postpartum period assessed by the Edinburgh Postnatal Depression Scale (EPDS) and Mother-Infant-Bonding-Scale (MIBS), and compare the results. Participants (n = 134) were recruited twice in antepartum medical checkups (20 to 36 weeks of gestation) and postpartum medical checkups (1 month after birth). Information on characteristics of participants was collected from medical records in both periods. Family function and ante-postpartum mental health were assessed by Family APGAR, EPDS, and MIBS. Antepartum depressive state was related to postpartum depressive state (p = 0.015), antepartum bonding was related to bonding in postpartum bonding (p = 0.0001), and antepartum bonding disorder was related to postpartum depressive state (relative risk = 11.7). Worries about costs and poor of family function were related to the mental health of mothers in both the antepartum and postpartum periods. Antepartum depressive state is an indicator of postpartum depression. We suggested that health professionals conduct an evaluation of mother's mental health and related factors in the antepartum period. The present findings emphasize the importance of antepartum mental health as a predictor of postpartum depression and bonding disorder.

Weak attachment to the fetus during pregnancy has been linked to postpartum depression and child abuse. A longitudinal study was conducted to verify the hypothesis that postpartum depression decreases when bonding between the mothers to fetus is promoted during pregnancy. This study aimed to verify the hypothesis that postpartum depression decreases when bonding is promoted during pregnancy. Methods One hundred and fifty-seven pregnant women were enrolled in a mothers' class and were divided into either a control or intervention group. The intervention group listened to music and maintained a "fetal diary". The control group received no additional instructions beyond the mothers' class. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen pregnancy and postpartum depression. The Mother-to-Infant Bonding Scale (MIBS) and the Prenatal Attachment Inventory/Maternal Attachment Inventory were used to evaluate mothers' attachment to the fetus/neonate. The paired t-test and Fisher's exact test were used to compare scores within and between the two groups in the antepartum and postpartum periods. The level of statistical significance was set to p<0.05. Results Data were obtained for 85 (54.1%) women (control group: n=47, intervention group: n=38). Approximately 19% and 20.4% of participants were in a depressive state in the antepartum and postpartum periods, respectively. There was no difference in depressive state between the antepartum and postpartum periods in the intervention group. However, EPDS scores were increased in the period of postpartum than antepartum in the control group (p=0.05). There were no significant differences in MIBS scores between the control and intervention groups in the antepartum period. However, MIBS scores were significantly higher in the control group in the postpartum period (p=0.001). The intervention group showed a reduction in mothers' negative feelings towards the baby between the antepartum and postpartum periods than the control group. Conclusion The results supported the hypothesis that postpartum depression decreased when bonding between the mothers to fetus is promoted during pregnancy.