Background. Postpartum depression (PPD) is a serious mental health disorder affecting 13% of women in developed communities. The present study reviews available epidemiological publications on PPD-related aspects in Iranian women to help policy makers and health workers to design preventative strategies and further researches. Materials and Methods. A systematic review was constructed based on the computerized literature valid database. The 95% confidence intervals were calculated by random effects models. Metaregression was introduced to explore and explain heterogeneity between studies. Data manipulation and statistical analyses were performed using Stata 11. Results. Overall, 41 studies met the inclusion criteria. The pooled prevalence of PPD in Iran was 25.3% (95% CI: 22.7%–27.9%). Amongst subgroups of unwanted delivery, illiterate, housewives, and having history of depression the prevalence was 43.4% (35.6–51.1), 31.6% (18.1–45.0), 30.7% (25.2–36.3), and 45.2% (35.4–53.1), respectively. Conclusions. Interventions that would specifically target women with a prior history of depression, illiterates, housewives, or women with unwanted pregnancies could be helpful to decrease the prevalence of postpartum depression in Iran. 1. Introduction Postpartum depression (PPD) affects almost 13% of women in developed high income communities [1] and may be even more common in developing countries [2, 3]. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), PPD is a major depression when symptoms have onset within 5 weeks of childbirth [4]. PPD presents with the same symptoms as for a major depressive episode occurring outside of the prenatal period, including core symptoms of depressed mood and/or loss of pleasure, together with additional symptoms, including changes in weight or sleep, fatigue or loss of energy, feelings of worthlessness or guilt, concentration difficulties, and suicidal ideation [4]. Majority of PPD researches in Iran have not utilized diagnostic assessments to identify cases. Alternatively, they have used the validated self-report depression screening instruments, such as the Edinburgh Postnatal Depression Scale (EPDS) [5]. Although this approach has been criticized, the EPDS has showed good sensitivity and specificity, particularly when used to detect both major and minor depressions [5]. In terms of etiology, PPD is a multifactorial disorder with biological, psychological, and sociological aspects interacting with woman’s risk individually [6]. Sociological factors such as unwanted delivery,
References
[1]
B. N. Gaynes, N. Gavin, S. Meltzer-Brody et al., “Perinatal depression: prevalence, screening accuracy, and screening outcomes,” Evidence Report/Technology Assessment, no. 119, pp. 1–8, 2005.
[2]
H. M. Ahmed, S. K. Alalaf, and N. G. Al-Tawil, “Screening for postpartum depression using Kurdish version of Edinburgh postnatal depression scale,” Archives of Gynecology and Obstetrics, vol. 285, no. 5, pp. 1249–1255, 2011.
[3]
F. H. Al Dallal and I. N. Grant, “Postnatal depression among Bahraini women: prevalence of symptoms and psychosocial risk factors,” Eastern Mediterranean Health Journal, vol. 18, no. 5, pp. 439–445, 2012.
[4]
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Press, Washington, DC, USA, 1994.
[5]
A. Montazeri, B. Torkan, and S. Omidvari, “The edinburgh postnatal depression scale (EPDS): translation and validation study of the Iranian version,” BMC Psychiatry, vol. 7, no. 11, pp. 1–6, 2007.
[6]
P. Klainin and D. G. Arthur, “Postpartum depression in Asian cultures: a literature review,” International Journal of Nursing Studies, vol. 46, no. 10, pp. 1355–1373, 2009.
[7]
P. Bahadoran, S. S. Foroushani, S. Ehsanpour, and A. Abedi, “A meta-analysis on studies about obstetric risk factors of postpartum depression in Iran within 1995–2005,” Iranian Journal of Nursing and Midwifery Research, vol. 13, no. 4, pp. 129–133, 2008.
[8]
P. Grossman, L. Niemann, S. Schmidt, and H. Walach, “Mindfulness-based stress reduction and health benefits: a meta-analysis,” Journal of Psychosomatic Research, vol. 57, no. 1, pp. 35–43, 2004.
[9]
R. DerSimonian and N. Laird, “Meta-analysis in clinical trials,” Controlled Clinical Trials, vol. 7, no. 3, pp. 177–188, 1986.
[10]
A. E. Ades, G. Lu, and J. P. T. Higgins, “The interpretation of random-effects meta-analysis in decision models,” Medical Decision Making, vol. 25, no. 6, pp. 646–654, 2005.
[11]
M. Borenstein, L. V. Hedges, J. P. T. Higgins, and H. R. Rothstein, Introduction to Meta-Analysis, John Wiley & Sons, 2009.
[12]
G.-R. Kheirabadi, M.-R. Maracy, M. Barekatain et al., “Risk factors of postpartum depression in rural areas of Isfahan Province, Iran,” Archives of Iranian Medicine, vol. 12, no. 5, pp. 461–467, 2009.
[13]
I. Asadi Sadeghi Azar, Z. Hashemi, and F. Forghani, “Postpartum depression and its correlates among women living in zabol (Iran),” Iranian Journal of Psychiatry, vol. 1, no. 4, pp. 140–147, 2006.
[14]
S. Taavoni, P. Zarea, and H. Haghani, “P-532—postpartum depression: related factors in clients, whom had been visited in clinics of tehran university of medical sciences,” European Psychiatry, vol. 27, Supplement 1, article 1.
[15]
Z. Alipour, M. Lamyian, and E. Hajizadeh, “Anxiety and fear of childbirth as predictors of postnatal depression in nulliparous women,” Women and Birth, vol. 25, no. 3, pp. e37–e43, 2012.
[16]
G. R. Kheirabadia and M. R. Maracy, “Perinatal depression in a cohort study on Iranian women,” Journal of Research in Medical Sciences, vol. 15, no. 1, pp. 41–49, 2010.
[17]
S. Iranfar, J. Shakeri, M. Ranjbar, P. NazhadJafar, and M. Razaie, “Is unintended pregnancy a risk factor for depression in Iranian women?” Eastern Mediterranean Health Journal, vol. 11, no. 4, pp. 618–624, 2005.
[18]
A. Abbaszadeh, F. P. Kermani, H. Safizadeh, and N. Nakhee, “Violence during pregnancy and postpartum depression,” Pakistan Journal of Medical Sciences, vol. 27, no. 1, pp. 177–181, 2011.
[19]
A. Tashakori, A. Shanesaz, and A. Rezapour, “Assessment of some potential risk factors of postpartum depression,” Pakistan Journal of Medical Sciences, vol. 25, no. 2, pp. 261–264, 2009.
[20]
S. B. Kamranpour and M. Shakiba, “Cesarean section and post partum depression,” Iranian Journal of Obstetrics, Gynecology and Infertility, vol. 15, no. 1, part 41, pp. 56–62, 2012.
[21]
M. Aghapoor and A. Mohammadi, “Comparing postpartum depression of working women and housewives and its relationship with social support and marital adjustment,” Women & Study of Family, vol. 1, no. 4, pp. 9–32, 2009.
[22]
N. Ajh, M. Unesian, A. Fili, and A. Abasi Motejaded, “The study of supportive activities during pregnancy on postpartum depression,” Journal of Nursing and Midwifery, vol. 12, no. 3, pp. 73–80, 2006.
[23]
M. Akbarzadeh, F. Sharif, N. Zare, and F. Ghodrati, “Prevalence of symptoms post-partum anxiety and baby blues and factors effective uponit in women with high risk pregnancies,” Journal of Family Research, vol. 5, no. 1, pp. 57–71, 2009.
[24]
H. Azimi Lolati, M. M. Danesh, S. H. Hosseini, A. R. Khalilian, and M. Zarghami, “Postpartum depression in clients at health care centers in Sari,” Iranian Journal of Psychiatry and Psychology, vol. 111, no. 40, pp. 31–42, 2005.
[25]
R. Bagherzadeh, N. Zahmatkeshan, N. Moatamed, R. Khorramroudi, and M. Ganjoo, “Prevalence of maternal blues, postpartum depression and their correlation with premenstrual syndrome in women refferred to health centers affiliated to bushehr university of medical sciences,” Iranian Journal of Obstetric, Gynecology and Infertility, vol. 12, no. 3, pp. 9–15, 2009.
[26]
N. Bahrami, M. Araban, and S. Bahrami, “The Impact of antenatal education on postpartum,” Journal of Hormozgan University of Medical Sciences, vol. 13, no. 14, pp. 277–283, 2009.
[27]
M. Barekatain, M. Tavakkoli, G. Kheirabadi, and M. R. Maracy, “The relationship between life-time prevalence of bipolar spectrum disorders and incidence of postnatal depression,” Iranian Journal of Psychiatry and Clinical Psychology, vol. 15, no. 2, pp. 183–192, 2009.
[28]
M. Dolatian, K. Hesami, J. Shams, and H. A. Majd, “Relationship between violence during pregnancy and postpartum depression,” Iranian Red Crescent Medical Journal, vol. 12, no. 4, pp. 377–383, 2010.
[29]
M. Dolatian, P. Maziar, H. Alavi-Majd, and M. Yazdjerdi, “The relationship between mode of delivery and postpartum depression,” Journal of Reproduction and Infertility, vol. 7, no. 328, pp. 260–268, 2006.
[30]
N. Foruzandeh and B. Dashtebozorgi, “Prevalence and predisposing factors of post-partum depression among women referred to the health care centers of Shahrekord, 1996,” Journal of Shahrekord University of Medical Sciences, vol. 2, no. 1, pp. 43–51, 2000.
[31]
F. Ghaffari, T. Pourghaznain, and R. Mazlom, “A mental health of women and their husbands during pregnancy and postpatrum in health center of ramsar,” Journal of Gorgan University of Medical Sciences, vol. 5, no. 5, pp. 74–80, 2005.
[32]
A. R. Ghaffari Nejad, F. Khobyari, and F. F. P, “Prevalence of postpartum depression in Kerman,” Quarterly Journal of Mentality & Behavior, vol. 5, article 1, 1999.
[33]
H. Hosseini, A. H. Naghibi, and M. Khademloo, “Postpartum depression and relaship with some related factors,” Journal of Babol University of Medical Sciences, vol. 10, no. 2, pp. 76–81, 2008.
[34]
F. Hosseini Sazi, A. Poor Reza, M. Hosseini, and D. Shojaei Zadeh, “Depression during pregnancy,” Journal of Gorgan University of Medical Sciences, vol. 7, no. 1, pp. 60–65, 2005.
[35]
M. Jafarpour, M. Esfandyari, Mokhtarsahi sh, and F. Hoseini, “The effect of stressful life events on postpartum depression,” University of Medical Sciences, Kermanshah, vol. 10, no. 4, pp. 320–331, 2006.
[36]
N. Khodadadi, H. Mahmoudi, and N. Mir hagh jo, “Postpartum depression relationship with some psychosocial effects in mothers,” Journal of Ardabil University of Medical Sciences, vol. 8, no. 2, pp. 142–148, 2008.
[37]
G. Khooshemehry, A. Shariati Feizabady, V. Naserkhaki, and V. Naserkhak, “Prevalence of postpartum depression and the factors that decides in clinics in the North of Tehran,” Journal of Nursing and Midwifery, vol. 19, no. 1, pp. 59–64, 2011.
[38]
A. Khorramirad, M. Mousavi Lotfi, and A. Shoori Bidgol, “Prevalence of postpartum depression and related factors in qom,” Pejohandeh, vol. 15, no. 2, part 74, pp. 62–66, 2010.
[39]
F. Kiani, T. Khadivzadeh, M. R. Sargolzaee, and H. Behnam, “Relationship between marital satisfaction during Pregnancy and Postpartum Depression (PPD),” Iranian Journal of Obstetrics, Gynecology and Infertility, vol. 13, no. 5, pp. 37–44, 2010.
[40]
K. Lashkaripour, N. Bakhshani, S. Hokmabadi, A. R. SajjadiAmeneh, and A. Safarzadeh Sarasiyab, “Postpartum depression and related factors: a 4.5 months study,” Journal of Fundamentals of Mental Health, vol. 134, no. 52, pp. 404–412, 2012.
[41]
M. J. Modabernia, H. Shodjaei tehrani, and S. Heydari Nezhad, “Survey the frequency of depression in the last third months of pregnancy,” Journal of Guilan University of Medical Sciences, vol. 18, no. 71, pp. 19–25, 2009.
[42]
G. A. Mousavi, S. Sabahi Bidgoli, A. Omidi, et al., “Prevalence of postpartum depression and its relation to some psychosocial factors in mothers referred to health centers of Kashan during 2007-8,” Faiz, vol. 15, no. 3, pp. 247–253, 2011.
[43]
M. Nikpour, Z. Abedian, N. Mokhber, S. Ebrahimzadeh, and S. Khani, “Relationship between delivery method and postpartum depression,” Journal of Fundamentals of Mental Health, vol. 14, no. 1, part 53, pp. 46–53, 2012.
[44]
F. Pazande, J. Tominas, F. Valai, and N. Afshar, “Prevalence of depression and its associated factors in women's centers martyr Beheshti University of Medical Sciences, 1999,” Faiz, no. 28, pp. 66–70, 2002.
[45]
F. Rahmani, N. Seyedfatemi, M. Asadollahi, and A. Seyedrasooli, “Predisposing factors of postpartum depression,” Iran Journal of Nursing, vol. 24, no. 72, pp. 78–87, 2011.
[46]
S. S. Sadr, M. Dowlatian, and Z. Behboudi Moghadam, “Prevalence of postpartum depression and factors affecting it in Tehran,” Journal of Medical Council of IRI, vol. 22, no. 3, pp. 189–193, 2004.
[47]
P. Salary, E. Banafshe, P. Hebrani, and J. Jabbari Nooghabi, “On the relationship between maternal fatigue and postpartum depression,” Journal of Fundamentals of Mental Health, vol. 114, no. 14, pp. 302–311, 2010.
[48]
L. Salehi, “Postpartum depression prevalence in primiparous and multiparous women,” Journal of Hormozgan University of Medical Sciences, vol. 5, no. 2, pp. 22–25, 2001.
[49]
F. Sehhatie Shafaei, F. Ranjbar Koochaksariie, M. Ghojazadeh, and Zh. Mohamadrezaei, “Study of relationship between some predisposing factors and postpartum depression,” Journal of Ardabil University of Medical Sciences, vol. 81, no. 27, pp. 54–61, 2008.
[50]
F. Shobeiri, A. Farhadi Nasab, and M. Nazar, “Detecting postpartum depression in referents to medical and health centers in hamadan city,” Scientific Journal of Hamadan University of Medical Sciences and Health Services, vol. 14, no. 3, pp. 24–28, 2007.
[51]
M. Zangeneh, N. S. Alizadeh, M. Kaamrvamanesh, M. Rezaie, and S. Pormehr, “Postpartum depression and its relation to baby gender and unplanned pregnancy,” Scientific Journal of Kurdistan University of Medical Sciences, vol. 14, no. 2, pp. 65–71, 2009.
[52]
M. Tabrizi and K. H. Lorestani, “Eclectic effectiveness of interventions to reduce depression in pregnancy and prevention of Postpartum Depression,” Thought and Behavior in Clinical Psychology, vol. 5, no. 17, pp. 19–26, 2010.
[53]
S. Amir Ali Akbari, M. Toghiri, N. Karimian, and H. Alavi-Majd, “Association between anemia during pregnancy and postpartum depression,” Journal of Nursing and Midwifery, vol. 16, no. 54, pp. 19–26, 2007.
[54]
J. F. Paulson and S. D. Bazemore, “Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis,” Journal of the American Medical Association, vol. 303, no. 19, pp. 1961–1969, 2010.
[55]
J. Fisher, M. C. de Mello, V. Patel et al., “Prevalence and determinants of common perinatal mental disorders in women in low-and lower-middle-income countries: a systematic review,” Bulletin of the World Health Organization, vol. 90, no. 2, pp. 139–149, 2012.
[56]
L. S. Cohen, “Pharmacologic treatment of depression in women: PMS, pregnancy, and the postpartum period,” Depression and Anxiety, vol. 8, no. 1, pp. 18–26, 1998.
[57]
K. L. Wisner, J. M. Perel, and R. L. Findling, “Antidepressant treatment during breast-feeding,” American Journal of Psychiatry, vol. 153, no. 9, pp. 1132–1137, 1996.
