Expectant fathers' knowledge and attitudes towards postpartum depression and the associated factors: a cross-sectional study in a rural community, Sri Lanka.

Postpartum depression is easily managed when detected early. Since mothers' and newborns' health is influenced by fathers, good knowledge and positive attitudes toward postpartum depression among fathers would help in early detection and early intervention. To describe the knowledge and attitudes of expectant fathers about postpartum depression and factors associated with their knowledge and attitudes about postpartum depression in a rural community in Sri Lanka. A descriptive cross-sectional study was conducted among 440 expectant fathers selected using cluster sampling. A pretested self-administered questionnaire was used with 30 knowledge statements with a maximum score of 30 points and 15 Likert scale attitude statements with a maximum score of 60 points. Good knowledge was defined as ≥ 50% of the total knowledge score. Positive attitudes were defined as ≥ 50% of the total attitude score. The chi-square test was applied to identify the significance of the associations between sociodemographic factors and knowledge and attitude levels. Multiple logistic regression was performed, and the results were expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI). The response rate was 93.6%. Most of the expectant fathers (58.2%, n = 256) had never heard about postpartum depression. The median knowledge score was 10 (IQR 4-16), and 33.6% (n = 148) of participants had good knowledge. Good knowledge was significantly associated with a higher educational level (p < 0.001), having a close relative/friend with postpartum depression (p < 0.001), and having heard about postpartum depression before (p < 0.001). Logistic regression revealed significant associations only with higher educational level (aOR = 2.53; 95% CI = 1.54-4.15) and having heard about postpartum depression before (aOR = 5.46; 95% CI = 3.47-8.59). The median attitude score was 36 (IQR 31-40.75), and 83.4% (n = 367) had positive attitudes. Although the bivariate analysis showed that working in the private sector (p = 0.04) and expecting their first child (p = 0.04) were significantly associated with positive attitudes, logistic regression did not reveal any significant association. The majority of fathers had positive attitudes toward postpartum depression, but their knowledge was limited. Since their attitudes are favorable, the knowledge gap should be minimized by imparting knowledge to facilitate the early detection of postpartum depression among mothers in the area.

Jayamanna K ，Abeysena C 《Reproductive Health》

Examining the associations between social support and postpartum depression symptoms among adolescent mothers in Nairobi, Kenya.

Globally, adolescent mothers are at increased risk for postpartum depression (PPD). In Kenya, 15% of adolescent girls become mothers before the age of 18. While social support can buffer a mother's risk of PPD, there are gaps in knowledge as to whether-and which types-of social support are protective for adolescent mothers in Kenya. Understanding the associations between support and postpartum depression symptoms among adolescent mothers can inform mental health interventions. Cross-sectional data of adolescent mothers ≤ 1 year postpartum (aged 14-19 years old) in an informal settlement in Nairobi, Kenya (N = 193) were used in analyses. Participants with scores ≥ 10 on the Patient Health Questionnaire-9 were classified as having postpartum depressive symptoms. To fully examine the different ways that social support might matter for adolescent mothers, we examined several domains of social support: child's father support during pregnancy, parental support during pregnancy, parental support of girl's education, membership in a social club, having a good female friend and having a supportive female adult one can turn to for help. We used bivariate and adjusted modified Poisson regression with robust standard errors to examine the associations between support measures and depressive symptoms, controlling for relevant covariates. One-quarter of participants experienced postpartum depressive symptoms (24.9%). Adolescent mothers who reported their mothers or their fathers as being very supportive of girls' education had a lower risk of depressive symptoms (ARR 0.35, 95% CI 0.20-0.61; ARR:0.34, 95% CI 0.13-0.90, respectively) than those whose mothers or fathers were less supportive. Adolescent mothers who had a good female friend to confide in had decreased risk of depressive symptoms (ARR 0.61; 95% CI 0.37-0.99). Having a mother or father being very supportive of girls' education and having a good female friend reduced risk of depressive symptoms. With the unique challenges of early childbearing and high adolescent birth rates in Kenya, interventions which increase parental and peer support during pregnancy and the postpartum period could improve adolescent mothers' mental health.

Gebrekristos LT ，Ajayi AI ，Groves AK ，Kabiru CW ... -  《-》

The Effect of Labeling During Simulated Contact on Attitudes Toward Autistic Adults.

Autistic adults are perceived more negatively than neurotypical (NT) adults by NT individuals. These negative perceptions can contribute to discrimination toward and social exclusion of autistic adults, which is detrimental to their mental and physical well-being. This study examined whether reading a vignette and imagining an interaction with a peer labeled as autistic would improve implicit and explicit attitudes toward autistic people. NT adults (n = 120) read a vignette and were asked to imagine an interaction with an unfamiliar person who was either labeled as autistic or not and displayed perseverative behavior, limited eye contact, or no described behavior. Overall, participants associated autistic terms with negative attributes rather than positive attributes, but those who imagined interacting with an individual labeled as autistic had less negative implicit bias toward autistic people than those who imagined interacting with a person without a label of autism. Explicit bias was not affected by the simulated scenario. When assessing some of the factors that are associated with implicit and explicit attitudes, we found that implicit attitudes and prior contact with autistic individuals were significantly related while controlling for Societal Attitudes towards Autism (SATA), while explicit attitudes were associated with SATA controlling for prior contact. These findings suggest that a brief exercise in which participants imagine a positive encounter with a person labeled as autistic can reduce implicit bias toward autistic people.

Allen AM ，Burk JA ，Dickter CL 《-》

Breastfeeding interventions for preventing postpartum depression.

Postpartum depression is a debilitating mental health disorder, which occurs in approximately 6% to 13% of women who give birth in high-income countries. It is a cause of great suffering for women and can have long-term consequences for child development. Postpartum depression can also negatively influence breastfeeding duration and breastfeeding exclusivity (i.e. feeding the infant only breast milk). However, a positive early, and continued, breastfeeding experience may reduce the risk of having postpartum depression. Breastfeeding interventions that increase the duration and exclusivity of breastfeeding may help prevent or reduce postpartum depressive symptoms. The primary objective of this review was to assess the effect (benefits and harms) of breastfeeding support interventions, in comparison to standard perinatal care, on maternal postpartum depression. The secondary objective was to assess whether breastfeeding support interventions had an effect on depression symptoms, and whether the effect was dependent on the duration and exclusivity of breastfeeding. We searched CENTRAL (Wiley), MEDLINE ALL (Ovid), Embase (Ovid), PsycINFO (Ovid), CINAHL Complete (Ebsco) and several other bibliographic databases and trial registers. The most recent search was conducted in June 2024. Randomised controlled trials (RCTs) that evaluated educational, psychosocial, pharmacological, alternative (any breastfeeding support intervention that promotes relaxation and stress) or herbal breastfeeding support interventions targeting the prevention or reduction of postpartum depression were eligible for inclusion. Each title and abstract we identified was screened by two authors independently. Two review authors then independently examined full-text manuscripts to decide if the study met the inclusion criteria. If so, they extracted data from included studies using Covidence software. Two review authors also independently conducted a risk of bias assessment of each study using the RoB 2 tool. We contacted study authors when necessary for more information. We conducted meta-analyses using a random-effects model. We included 10 RCTs with 1573 participants in this review. Depression was measured using the Edinburgh Postnatal Depression Scale (EPDS) in all studies, where scores range between 0 and 30 (higher scores indicating more depressive symptoms). The studies used a score of over 10 as the cut-off for a diagnosis of depression. Primary outcome It is very uncertain whether psychosocial breastfeeding interventions had any effect on the incidence of postpartum depression immediately post-intervention (RR 0.78, 95% CI 0.23 to 2.70; 1 study, 30 participants), but we found low-certainty evidence that psychosocial breastfeeding interventions may prevent the incidence of postpartum depression in the short term (one to three months) post-intervention (risk ratio (RR) 0.37, 95% confidence interval (CI) 0.14 to 0.93; 1 study, 82 participants). It is very uncertain whether alternative breastfeeding interventions had any effect in preventing the incidence of postpartum depression immediately post-intervention (RR 0.64, 95% CI 0.27 to 1.54; 1 study, 60 participants). The short-term time point was not measured. Secondary outcomes It is very uncertain whether psychosocial breastfeeding interventions had any effect on reducing depressive symptoms immediately post-intervention (mean difference (MD) -0.67, 95% CI -1.63 to 0.28; 4 studies, 512 participants). There is very low-certainty evidence that psychosocial breastfeeding interventions could reduce symptoms of anxiety immediately post-intervention as measured with the Zung Self-rating Anxiety Scale (SAS), where scores between 45 and 59 out of 80 on the SAS indicate mild to moderate anxiety, scores between 60 and 74 marked severe anxiety levels and > 75 extreme anxiety levels (MD -2.30, 95% CI -4.36 to -0.24; 1 study, 100 participants). There was no difference in rates of exclusive breastfeeding immediately post-intervention between those offered a psychosocial breastfeeding intervention and those receiving standard care, but the evidence is very uncertain (RR 1.20, 95% CI 0.96 to 1.51; I2 = 29%; 571 participants; very low-certainty evidence). We found low-certainty evidence that a psychosocial breastfeeding intervention may increase the duration of breastfeeding in the long term (RR 1.64, 95% CI 1.08 to 2.50; 129 participants; low-certainty evidence). For the comparison of alternative breastfeeding intervention versus standard care (which was evaluated in only one study), there was no difference between groups immediately post-intervention in anxiety measured with the State-Trait Anxiety Inventory (STAI); range 20 to 80; higher scores indicate more severe anxiety symptoms (MD 1.80, 95% CI -9.41 to 13.01; 60 participants; very low-certainty evidence), or in stress measured with the Perceived Stress Scale (PSS)-NICE; range 1 to 230, higher scores indicate higher levels of stress (MD 1.90, 95% CI -10.28 to 14.08; 60 participants; very low-certainty evidence), but the evidence is very uncertain. No adverse events connected to the intervention itself were stated in any of the trials, but for most studies, we do not know if this is because there were none or because they were not measured or reported. There is low-certainty evidence that psychosocial breastfeeding interventions may prevent postpartum depression in the short term and increase the duration of breastfeeding in the long-term. The evidence is very uncertain about the effect of psychosocial breastfeeding interventions on other outcomes. The evidence is very uncertain about the effect of alternative breastfeeding interventions on postpartum depression or other outcomes. The included studies did not report any adverse events directly related to the interventions, but it is not clear if this outcome was measured in most studies. Future trials of breastfeeding interventions should be conducted carefully to reduce their risk of bias, and they should be large enough to detect differences between mothers in their mental health.

Lenells M ，Uphoff E ，Marshall D ，Wilson E ，Gustafsson A ，Wells MB ，Andersson E ，Dennis CL ... -  《Cochrane Database of Systematic Reviews》

Menstrual hygiene management practices among schoolgirls in resource-limited settings of Bahir Dar City administration, Northwestern Ethiopia.

Adane Y ，Ambelu A ，Azage Yenesew M ，Mekonnen Y ... -  《-》