A pilot study on identification of perinatal depressive symptoms in mother-child health clinics: Community nurses can make a difference

Glasser, Saralee; Appel, Dorit; Meiraz, Hannah; Kaplan, Giora

doi:10.5430/jnep.v3n11p1

Cited by 5 publications

(11 citation statements)

References 47 publications

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“…From the available Israeli published reports [ 30 – 35 ] and the as-yet unpublished data from the MOH and Maccabi Health Services databases, the rates of postpartum suicidal ideation, as reflected by any score other than zero on Question 10 of the EPDS screening questionnaire (thoughts-of-self-harm), are considerably lower than those reported in other countries. In a study of over 1000 women in New York, Bodnar-Deran [ 37 ] found that 6% of the participants presented with suicidal ideation during the first six months postpartum.…”

Section: Discussionmentioning

confidence: 99%

“…That rate, 8.7%, is somewhat higher than the 6.2% of suicidal ideation reported by adult females in the Israel National Health Survey, conducted in 2003–2004 [ 40 ]. The study was conducted before 2001, when the first systematic effort in Israel by the MOH was begun, raising awareness among primary care nurses and the public regarding PPD and its early detection [ 24 , 30 ]. In the ensuing years, even before 2013 when the MOH mandated EPDS screening [ 25 ], attention was increasingly paid to early identification, screening and supportive intervention of maternal emotional distress by public health nurses during pregnancy and in the first two months postpartum [ 31 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Reported here are data from various sources that offer an estimation of the rate of suicidal ideation among Israeli women in the postpartum period (Table 1 ) [ 30 – 35 ]. The most current and broad data, albeit as yet unpublished, were communicated from the MOH Tipat Chalav database (Rubin, L., personal communication, 2017) and Maccabi Health Services database (Fish, R., personal communication, 2017).…”

Section: Methodsmentioning

confidence: 99%

“…The EPDS is a 10-item screening instrument that includes a question regarding thoughts of self-harm (Question 10) that states: “In the past week the thought of harming myself has occurred to me: quite often/sometimes/hardly ever/never.” Any response other than ‘never’ is considered suicidal ideation, and guidelines instruct immediate consultation in the event of this response [ 25 ]. After its successful use in Israel in a pilot project in MOH Mother-Child Healthcare clinics [ 30 ], its implementation for universal screening of depressive symptoms during pregnancy and within the first postpartum months was gradually expanded, and since 2013 has been mandatory.…”

Section: Methodsmentioning

confidence: 99%

“…After its successful use in Israel in a pilot project in MOH Mother-Child Healthcare clinics [ 30 ], its implementation for universal screening of depressive symptoms during pregnancy and within the first postpartum months was gradually expanded, and since 2013 has been mandatory.…”

Section: Methodsmentioning

confidence: 99%

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The tip of the iceberg: postpartum suicidality in Israel

Glasser

Levinson

Gordon

et al. 2018

Isr J Health Policy Res

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BackgroundPostpartum suicidality, a result of extreme distress or depression, is a tragedy for the woman, infant, and family. Screening for postpartum depression (PPD) is mandatory in Israel, including a question on suicidal ideation. This study presents and analyzes data regarding rates, trends and characteristics of postpartum women who considered, attempted, or completed suicide, to help direct services aimed at preventing these occurrences.MethodsSuicidal ideation data based on PPD screening was drawn from various publications and databases. Suicide attempt data was obtained from the Emergency Department database for 2006–2015 and matched with the National Birth Registry. Cause of death from the national database for those years were similarly linked to births to identify postpartum suicides and deaths. Postpartum and non-postpartum suicide attempt rates were computed by year, and by age and ethnic/immigrant group. A multivariate logistic model was used to estimate relative risk for postpartum attempts, controlling for age and ethnic group.ResultsSuicidal ideation in recent years has been reported as 1% or less, with higher rates found in studies of Arab women. Suicide attempt rates for non-postpartum women were 3–5 times that of postpartum women, rising over the years, while remaining relatively stable for postpartum women. Adjusted risk of suicide attempt for non-postpartum women was significantly higher; adjusted odds ratio was 4.08 (95% CI 3.75–4.44). It was also significantly higher for Arabs and immigrants from the Former Soviet Union, compared to Israeli-born Jews/veteran immigrants, and for younger women compared to those aged 35–44. Seven postpartum suicides were recorded during 2006–2015, a rate of 0.43 per 100,000 births.ConclusionPostpartum suicidality in Israel is low relative to other countries. Although relatively rare and lower than among non-postpartum women, health professionals should be attentive to risk factors, such as past psychiatric disorders, suicide attempts and current emotional distress, particularly among higher-risk populations. The universal screening program for PPD is a valuable opportunity for this, but increased resources should be allotted to implement and utilize it optimally. Prenatal screening should be added as an Israeli Quality Indicator, and postpartum completed suicides should be thoroughly investigated to guide prevention efforts.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The tip of the iceberg: postpartum suicidality in Israel

Glasser

Levinson

Gordon

et al. 2018

Isr J Health Policy Res

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Development and validation of a machine learning‐based postpartum depression prediction model: A nationwide cohort study

Hochman

Feldman

Weizman

et al. 2020

Depression and Anxiety

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Background Currently, postpartum depression (PPD) screening is mainly based on self‐report symptom‐based assessment, with lack of an objective, integrative tool which identifies women at increased risk, before the emergent of PPD. We developed and validated a machine learning‐based PPD prediction model utilizing electronic health record (EHR) data, and identified novel PPD predictors. Methods A nationwide longitudinal cohort that included 214,359 births between January 2008 and December 2015, divided into model training and validation sets, was constructed utilizing Israel largest health maintenance organization's EHR‐database. PPD was defined as new diagnosis of a depressive episode or antidepressant prescription within the first year postpartum. A gradient‐boosted decision tree algorithm was applied to EHR‐derived sociodemographic, clinical, and obstetric features. Results Among the birth cohort, 1.9% (n = 4104) met the case definition of new‐onset PPD. In the validation set, the prediction model achieved an area under the curve (AUC) of 0.712 (95% confidence interval, 0.690–0.733), with a sensitivity of 0.349 and a specificity of 0.905 at the 90th percentile risk threshold, identifying PPDs at a rate more than three times higher than the overall set (positive and negative predictive values were 0.074 and 0.985, respectively). The model's strongest predictors included both well‐recognized (e.g., past depression) and less‐recognized (differing patterns of blood tests) PPD risk factors. Conclusions Machine learning‐based models incorporating EHR‐derived predictors, could augment symptom‐based screening practice by identifying the high‐risk population at greatest need for preventive intervention, before development of PPD.

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Rate, risk factors and assessment of a counselling intervention for antenatal depression by public health nurses in an Israeli ultra‐orthodox community

Glasser

Hadad

Bina

et al. 2016

Journal of Advanced Nursing

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Although the rate of antenatal depressive symptoms was similar to that in other studies, postpartum symptoms may have been underreported, possible due to culturally-related reticence. This underscores the importance of understanding the context in which the service is offered and the sensitivities of particular groups. The findings indicate that antenatal nursing intervention is a potentially protective measure for perinatal emotional well-being.

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A pilot study on identification of perinatal depressive symptoms in mother-child health clinics: Community nurses can make a difference

Cited by 5 publications

References 47 publications

The tip of the iceberg: postpartum suicidality in Israel

The tip of the iceberg: postpartum suicidality in Israel

Development and validation of a machine learning‐based postpartum depression prediction model: A nationwide cohort study

Rate, risk factors and assessment of a counselling intervention for antenatal depression by public health nurses in an Israeli ultra‐orthodox community

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