Mental Health Conditions in the Postpartum Period: A Scoping Study

doi:10.21203/rs.3.rs-2623747/v1

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Mental Health Conditions in the Postpartum Period: A Scoping Study

https://doi.org/10.21203/rs.3.rs-2623747/v1

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Background

Many women experience mental health disorders during the postpartum period, which can develop into chronic or recurrent conditions and might have negative consequences on the quality of parent-infant interactions, long-term mental health of the mother, the family, as well as child development. We aimed to Summarize the current literature on mental health disorders during the postpartum period; from 2 to 52 weeks after childbirth.

Methods

In this scoping study electronic databases were systematically searched for primary studies published in English between January 2016 and December 2022, and we performed an additional quality appraisal. Descriptive statistics for quantitative data and inductive content analysis for qualitative data were used.

Results

The final body of literature consisted of 34 articles. Three key categories were identified and used to summarize the literature: mental health screening instruments, postpartum mental health conditions, and associated factors with postpartum mental health. Seventeen different screenings instruments were identified, whereof the Edinburgh Postnatal Depression Scale (EPDS) was the most used. The periods during which the participant’s mental health screening evaluation was conducted varied from four to 52 weeks postpartum, and both single and multiple mental health screenings were common. Six mental health conditions were covered, whereof postpartum depression and postpartum anxiety were the most common. Family and partner support were identified as critical factors associated with development of postpartum menatal health conditions, as well as a history of previous mental health- or medical disorders prior to peripartum. Furhermore, the COVID-19 pandemic had impact on social support, resulting in increased levels of anxiety and depression symptoms, as well as postpartum anxiety.

Conclusion

Offering a spectrum of support services and care should be made available to all relevant subgroups of mothers throughout pregnancy and up to one year after birth, especially for mothers with pre-existing mental health conditions. Future studies are needed on postpartum psychosis, the effect of long-term postpartum mental health conditions on the child’s well-being, and the fathers’ mental health requires further attention.

Scoping review

Postpartum anxiety

Postpartum mental health

Postpartum depression

Postpartum mood disorders

Postpartum period

Post-Traumatic Stress Disorder

The authors acknowledge that all persons giving birth and going through the postpartum period, and as such constitute research subjects in the literature included in this scoping study, might not identify as women or mothers. For the ease of language, those persons are referred to as women and mothers in this manuscript.

Pregnancy, childbirth, and the postpartum period

Pregnancy, childbirth, and the postpartum period are some of the most important periods in the lives of women, where changes occur in both physical and mental well-being (1). The period is also recognized as a time of significant risk for development, relapse, or recurrence of mental health problems (2). Up to 20% of women experience mental health problems during this period (3), and most new mothers experience postpartum "baby blues" or "maternity blues" after childbirth, which commonly is a phase of emotional liability, characterized by frequent crying episodes, irritability, confusion, and anxiety (4) which in a report by the National Health Services (NHS) is so common that it is considered normal (5). Mental health is a major health issue worldwide and pregnancy is a unique maternal experience with significant psychological, physiological, and biochemical effects on women (6).

Mental health is a significant contributor to the global burden of disease and the World Health Organization (WHO) estimates that for women of reproductive age (15–49), mental and behavioral disorders accounted for approximately 64 million global disability-adjusted life years lost between 2000 and 2012 (7). The term postpartum mental health conditions encompass the full range of mental health disorders encountered by women after childbirth (period between 6 weeks and 1 year) (8). The disorders range from postpartum depression and anxiety to more serious postpartum mental health issues including severe depression, bipolar disorder, psychosis, and posttraumatic stress disorder (2). These mental health conditions are associated with adverse outcomes for both the mother and the child (9). The association between the postpartum period and mood disturbances has been identified and women are at increased risk of developing severe psychiatric illness during puerperium (4). To aid in detecting symptoms of ongoing mental health disorders and to assess individuals' mental health states, several mental health screening instruments can be used (10).

Untreated mental health disorders can have adverse long-term effects. For the mother, the episode can be the precursor of chronic or recurrent depression while for the newborn, a mother’s ongoing depression can contribute to emotional behavioral, cognitive, and interpersonal problems in later life (11). The consequences of unaddressed mental health needs in the postpartum period can negatively affect the quality of parent-infant interactions, the long-term mental health of the mother and the family, as well as the long-term child development. For this reason, maternal mental health needs to be considered a single target in the Sustainable Development Goals and determining the factors associated with maternal mental health is necessary to contribute to the achievement of Goals 3 and 5 (12). With this background we sought to what extent, focus, and nature the literature describes mental health conditions during the postpartum period. The aim of this scoping study is to summarize, through a systematic review, the current literature on issues related to postpartum mental health.

Study design

The current scoping study was guided by the framework outlined by Arksey & O’Malley (13) and Levac (14), following a five-stage method. The research question identified in the first stage was ‘what are the extent, focus, and nature of the literature on mental health conditions during the postpartum period?

Database Search and Selection Criteria

In the second stage, relevant studies were identified to select original articles associated with mental health conditions and the postpartum period. We systematically searched PubMed, PsycINFO, EMBASE and CINAHL for articles published between January 2016 and December 2022, the last round of article search was conducted in January 2023. Combinations of search terms related to the perinatal period (pregnancy, postpartum or postnatal period, antenatal and maternal), maternal mental health, postpartum depression and/or anxiety, maternal postpartum mental distress, and maternal emotional disorders were used. Considering the variation in the literature on the exact definition of the postpartum period (8), we included any articles referencing the postpartum period as within 12 months following childbirth. To ensure consistency, the same keywords and search terms were used across all the databases and reference lists from the full-text documents were manually reviewed until no new relevant documents were found.

In the third stage, a PICO table (Table 1) defining the inclusion and exclusion criteria were used to support the review process and the inclusion of articles. In addition to the criteria stated in the PICO table, publications were included if they were original research published in a peer-reviewed journal in English between 2016 and 2022, while excluded publications were literature reviews or case reports published before 2016 and gray literature.

Table 1

PICO Inclusion and Exclusion Criteria
PICO	Inclusion	Exclusion
Population	Women who had given birth (two weeks to 12 months after childbirth)	Women during childbirth or in the first two weeks of postpartum; because of unstable mood associated with physiological changes in the early days postpartum
Intervention	Reported mental health conditions in the postpartum period only	Mental health conditions in the antenatal period
Comparative Intervention	None
Outcome	Centered on outcome relating to the identified mental health conditions during the postpartum period	Centered on outcome relating to the fathers as participants and other pregnancy related conditions

Data charting, collation, summarizing, and reporting results

An analytical framework and recording standard to collate, summarize and report the findings were used (13, 14). In the fourth stage, a data extraction table using Microsoft Excel was created in an iterative process where discrepancies in decisions were resolved through discussion and consensus among the authors. The extraction table was piloted on six publications to determine the reliability of the tool and ensure all relevant information required of the study was captured and revised prior to the deployment of the study. The following data were finally extracted from the selected articles: author(s), year of publication, type of study, country of origin, study sample, target population, mental health, key findings or main results, ethical approval, and recommendation(s).

The extracted data were further analyzed using guidelines for qualitative inductive content analysis (15). The first step was to extract factors from the different publications where all fragments in which factors associated with mental health in the postpartum period were selected. Next was an iterative process of open coding, creating categories, and abstraction, and independently grouping the factors into main themes. Content validation was established with a dialogue among the authors to agree upon how the data were labelled (15). At last, all study team members revisited and discussed these main themes. Although quality appraisal does not form part of the scoping study remit (13, 14), we conducted quality appraisal using The Joanna Briggs Institute’s (JBI) Critical Appraisal Tools (CAT) Guideline (16).

In the fifth and final stage, the results were summarized and described. Reporting follows the PRISMA (17) and PRISMA-ScR (18) guidelines.

Search and selection of articles

The electronic database search yielded 443 articles, of which 118 duplicates were removed. From the remaining 325 articles, we conducted screening on the titles and abstracts in line with our inclusion criteria; this process further excluded 133 articles for not satisfying the inclusion criteria. A total of 192 articles that either appeared to satisfy all the inclusion and exclusion criteria or for which satisfaction of the criteria was not readily apparent, were retained for a full review, whereafter 156 articles were excluded. We performed a backwards citation chasing which yielded zero additional primary articles. Our quality appraisal using the Joanna Briggs Institute’s (JBI) Critical Appraisal Tools (CAT) Guideline further excluded one article because the postpartum period in that study was less than five days which did not meet our scoping study criteria. In total, we included 34 articles in the scoping study. The full details of the screening process are presented in Fig. 1, and a table of included articles are available in the Additional file 1.

Methodological characteristics of included articles

Of the 34 articles included in the scoping study, the most common study design was cross-sectional study (n = 18), followed by cohort studies (n = 15), and quasi-experimental study (n = 1). No qualitative studies were identified. Distribution of included articles, study designs and publication year are presented in Fig. 2.

Regional distribution

There was a high global representation among included articles (Fig. 3); Canada (n = 7), Iran and USA (n = 3), China, India, Poland, Portugal, Spain, Sweden, Turkey, and United Kingdom (n = 2), Brazil, Chile, Cote d'Ivoire, Cuba, Cyprus, Ethiopia, Germany, Ghana, Greece, Ireland, Israel, Kenya, Netherlands, and Nigeria (n = 1). Note that two articles (20, 21) had two and nine countries, respectively as study locations, hence the higher overall number.

One of the peer reviewed articles had a global focus with nine countries from different regions represented in the study. From the remaining 33 peer reviewed articles, 59% (n = 20) emerged from high-income countries (HICs), 12% (n = 4) from upper middle-income countries (UMICs), 26% (n = 9) from lower-and-middle income countries (LMICs) and only 3% (n = 1) emerged from low resource settings. A total of 11 (32%) of the peer-reviewed articles originated from the Northern America region, eight (24%) from the Asia region (East, South and West Asia), 10 (29%) from Europe, while five (15%) articles were from the Sub-Saharan Africa region.

Period of Postpartum Mental Health Evaluation

The periods during which the participant’s mental health screening evaluation was conducted varied in the included articles. Single time points (weeks) were used in nine articles: six (n = 4); four (n = 2); eight (n = 2); 24 (n = 1). A wider timespan (weeks) for the evaluations was used in 25 articles: 4 to 52 (n = 8); 4 to 24 (n = 5); 4 to 12 (n = 2); 4 to 8 (n = 2); 6 to 8 (n = 1), 6 to 10 (n = 1), 5 to 52 (n = 1); 6 to 14 (n = 1); 4 to 6 (n = 1); 4 to 16 (n = 1); 12 to 52 (n = 1), and 16 to 52 (n = 1).

Screening Instruments and Mental Health Conditions

Several mental health screening instruments are used to assess individuals' mental health states or identify signs or symptoms of psychological disorders or distress. These screening instruments assist healthcare providers or clinicians to understand the mental health condition of the individual and guide the appropriate treatment regimen. In the included articles, it was observed that the screening instruments are not designed for diagnostic purposes but only to flag areas of concern. A total of 17 different screening instruments were used to measure varying postpartum mental health conditions. Some of the articles utilized only one screening instrument and others combined multiple screening instruments based on the postpartum mental health conditions they covered. The instruments were well known for screening of mental health state, symptom severity, and anxiety in postpartum mothers and some of these instruments were adapted to different language versions.

Six different postpartum mental health conditions were covered; postpartum depression (PPD), postpartum anxiety (PPA), posttraumatic stress disorder (PTSD), generalized anxiety, bipolar disorder, and postpartum emotional disorder. The different articles covered one, two, or a maximum of three conditions, with the most common conditions beeing the PPD and the PPA, covered by 28/34 (82.4%) and 21/34 (61.8%) articles, respectively. A synthesis table with information on postpartum time point, screening instruments, and methal health conditions are available in Additional file 2.

Associated factors with postpartum mental health conditions

Theme 1: Support System

Support systems entail the kind of support received from networks, environments or communities that can directly or indirectly affect the new mother in the postpartum phase. It includes social support (the degree of support from the partner, society, and family members) and work support (the availability of support from the work environment or employers). Inadequate or lack of support systems increase the possibility of postpartum mental health issues, and stress-related workplace situations can also add to the burden.

Social support (Partner and Family) (n = 11)

Dennis et al., (21) reported that predicators of sustained postpartum anxiety were social support from the partner, mother-in-law, or other women with children at 1 week and 4 weeks, this is linked to the study by Liu et al., (22) which reported that pregnant women who received low support from family members were more likely to have PPD and PPA symptoms. Mothers with lower social support experienced higher levels of postpartum depression. In addition, mothers who received moderate social support were three times more likely to experience postpartum depression (23), in the same light, Toru et al., (24) reported that mothers prone to postpartum depression were likely to be those with poor social support, while Maliszewska et al., (25) reported that women at risk of postpartum depression had lower social support. The article from Barthel et al., (19) reported that less support from the partner and higher economic stress two years after birth were predictors of increasing anxiety. Similarly, the articles by Sylvén et al., (26); and van der Zee-van den Berg et al., (27) cited that inadequate partner support six weeks after delivery was significantly associated with anxiety and depressive symptoms. Maria et al., (28) cited that feelings of isolation from the rest of the family were possible contributing factors to PPA.

Work support (n = 3)

The article by Karl et al., (29) reported that work-related factors are associated with PPD and should be considered when screening for PPD. On the other hand, Dennis et al., (21) and Falah-Hassani et al., (30) found that work environments not supportive of the pregnancy, and women worrying about returning to work after pregnancy were significantly associated with a higher risk of postpartum mental health conditions.

Theme 2: Previous mental disorders and medical conditions

A pre-existing condition is typically a mental disorder or medical condition for which the woman has received treatment or diagnosis before the peripartum. This includes medical conditions like diabetes, sleep disorder, hypertension, and epilepsy, as well as mental health conditions like depression, anxiety, bipolar disorder, and post-traumatic stress disorder. A total of six articles presented that women at risk of postpartum depression, more often had a history of previous mental disorders (24, 25, 27, 30–32), whereas three articles identified various medical conditions to be associated with a higher risk of postpartum mental health conditions (21, 27, 30).

Theme 3: Other factors associated with postpartum mental health conditions

Other critical factors are associated with mental health conditions in the postpartum period, for example, socioeconomic issues (income, housing), violence (domestic violence and Intimate partner violence), mode of delivery (natural delivery, vaginal delivery, instrumental vaginal delivery, planned cesarean section, unplanned caesarean section), gender preference (male or female), and marital status (married, single, divorced, widowed), amidst others. These factors may occur in isolation or a combination with other factors.

Socioeconomic Issues (n = 3)

Socioeconomic issues such as financial difficulties (28), difficulties managing income and not having suitable housing (21, 30) were significantly associated with comorbid postpartum depressive symptomatology and anxiety.

Violence (n = 2)

Mothers prone to postpartum depression were likely to be those experiencing different forms of domestic violence (24). In addition, mental health conditions were 4.76 times more among mothers who reported intimate partner violence (IPV) as compared to those who did not experience IPV (33).

Mode of Delivery (n = 3)

Mothers who delivered their children through a caesarean section formed a higher proportion of those with PPD (n = 44, 18.3%) compared to those having a vaginal birth (n = 19, 7.9%, p = 0.053) (23). Similarly, women who selected cesarean section delivery were more likely to have PPA (34). Also, the mode of delivery was reported to account for 13% of the variance in symptoms severity (35).

Gender of the baby (n = 2)

The gender of the baby was reported to have a non-significant influence on the proportion of women experiencing mental health conditions as 15% of the women who had a male child and 11.3% of the women who had a female child experienced PPD (p = 0,311) (23). In another trial, when adding breastfeeding into a logistic model, those who delivered female infants were less likely to report depressive symptoms compared to male infants (adjusted odds ratio = 0.576, 95% Confidence Interval 0.431–0.770) (34).

Marital Status (n = 2)

Marital status was found to be significantly correlated with anxiety and/or depressive symptoms (36). More severe postpartum emotional disorders were associated with being single and with lower education levels (37).

Theme 4: COVID-19

There were five articles (20, 38–41) that mentioned the connection between the COVID-19 period and mental health during the postpartum period. Findings from (38–40) show a low level of social support leading to increased levels of both anxiety and depression symptoms during the postpartum period; the cases of postpartum anxiety was higher during the pandemic (38).

This scoping study which includes globally represented evidence from 34 peer-reviewed research articles, identifies different screening instruments for mental health conditions used during different timeframes and in a variety of ways during the postpartum period. Mental health conditions commonly reported among women in the postpartum period were general anxiety, postpartum anxiety (PPA), postpartum depression (PPD), post-traumatic stress disorder (PTSD), emotional disorders, and bipolar disorder. Factors identified to be associated with the experience of mental health conditions were levels of social support from the partner and family, work-related issues such as workload, environment and worries about returning to work. Other factors were previous mental disorders and medical conditions, financial difficulties, unsuitable housing, presence of domestic or intimate partner violence, mode of delivery, gender of the baby, and marital status. Also, low social support causes both postpartum anxiety and depression symptoms to worsen during the COVID-19 pandemic.

The result that a higher prevalence of PPD among mothers giving birth to male infants is considered confusing as a male preference among pregnant women and expecting families is common (42, 43). In addition, pregnant women in families with a male preference have been reported to develop antenatal depression (44), which suggest a correlation between gender preference and antenatal depression that might carry over to the postnatal period. Our study was not designed to discover this correlation and it merits further research.

The WHO-led international call for action titled “No health without mental health” (45) emphasized the importance of mental health issues and the major burden it has especially on resource-constrained countries with a limited health care budget. According to the WHO 2022 recommendations on maternal and newborn care for a positive postnatal experience, screening for postpartum depression and anxiety using a validated instrument is recommended and should be accompanied by diagnostic and management services for women who screen positive. (46).

The method of mental health screening used in postnatal care varied among the included studies. Using a screening instrument can help improve the detection of postpartum mental health conditions, screening frequency and responsiveness of health professionals (47). Although, screening instruments are not intended to make a formal diagnosis, depending on the validity of the specific instrument, the screening instruments are highly sensitive and specific, and positive screening is good enough indicator of the mental health condition (48). Also, having a well-defined cut-off point appropriate at the local setting is essential for accurate mental health detection and estimation. The timing for mental health screening also varied among the included studies, and there are only a few specific recommendations for screening timing. One study describes postpartum mental health conditions to have a natural history, with significant depression peaking at 6 weeks and moderate depressive symptoms peaking at 2–3 months and six months (49), and another study reports that postpartum screening for depression should be conducted within six to 12 weeks after birth and be repeated at least once in the first postnatal year (50). With all these mental health screening instruments, the screening competency of healthcare workers needs to be consistently updated to better understand the screening of postpartum mental health conditions especially postpartum depression and anxiety. More consistent use of screening instruments is needed to decrease the number of women with undetected postpartum mental health conditions as they might affect women’s general health, ability to fulfil their education, return to work and provide for themselves and their families. The use of screening instruments could hence be important assets in the strive to reach the United Nations' sustainable development goals number 1 (no poverty), 3 (good health and well-being), and 5 (gender equality), especially in low-resource settings.

Postpartum Mental Health Conditions including PPD are frequently comorbid with PPA amid PPA often proceed the onset of PPD (51), those are the most frequent maternal mental health conditions after childbirth (52). Our study affirms the link between PPA and PPD, as 17/34 (50%) of the included articles studied the combination of the two mental health conditions. Dennis et al., (2017) (21) suggests that the primary focus on depression in clinical practice means that mothers with anxiety are more likely to remain undetected. However, considering that symptoms of “baby blues” usually resolve by 2 weeks, earlier screening may result in over-identify postpartum anxiety in the early period following delivery. Our study identified PTSD as one of the postpartum mental health conditions encountered following an unplanned caesarean section. We also found that the mode of delivery appears to play an important role in maternal mental health three months following childbirth. This finding is supported by Cook et al., (2018) (53); and Liu et al., (2021) (54) who also reported that postpartum PTSD was significantly correlated with postpartum birth outcomes.

Some paramount risk factors associated with postpartum mental health conditions were identified in the scoping study; pre-existing mental health issues, history of violence, inadequate partner support, lack of social support, and low household income (51, 55). Our findings acknowledge the significance of WHO 2022 recommendations on maternal and newborn care for a positive postnatal experience that recommends screening for postpartum depression and anxiety using a validated instrument; and women who are screened positive should be accompanied by diagnostic and management services.

Strengths And Limitations

The scoping review methodology allows for a more general question and exploration of methodologically diverse studies and is considered the most appropriate methodology for assessing the breadth of the literature and identifying gaps and opportunities for further work in this field when compared with systematic review (56, 57). With the use of a rigorous and comprehensive scoping methodology by Arksey & O’Malley, (2005) (13) and Levac et al., (2010) (14), this study is systematic, replicable, and transparent to ensure trustworthiness. It also applied inclusion and exclusion criteria using PICO. Furthermore, the methodological quality of the included publications was assessed. However, it is likely that the use of English-only language articles, primary research, exclusion of gray literature, and a short time frame might have limited available data, thus, affecting credibility. Although included articles were globally representative, most studies were conducted in high-resource settings and unrepresentative of many less developed regions of the world, demonstrating limitations in the diversity in our publication sample and hence a limited perspective of postpartum mental health conditions. Perhaps one reason for an under-representation of research from certain regions is that we only assessed studies in English. The lack of diagnostic instruments makes it difficult to determine whether more formalized mental health services are required.

This study offer a view of mental health conditions during the postpartum period from a global perspective. It is imperative that a spectrum of support services and care are made available to all relevant subgroups of mothers throughout pregnancy, especially for mothers with pre-existing mental health conditions. The findings highlighted a need for more focused research in areas such as postpartum psychosis and the effects of maternal postpartum mental health conditions on the child. In addition, the fact that the gender of the baby seems to affect the risk of experiencing postpartum mental health conditions needs to be further explored as previous studies show an increase in antenatal depression among mothers in families reporting to have a male preference during pregnancy. The lack of information on fathers’ mental health requires further attention before more targeted interventions can be developed and tested.

ANCOVA Analysis of Covariance

ANOVA Analysis of Variance

BSI Brief Symptom Inventory

DASS 21 Depression, Anxiety and Stress Scale

DSM-5 Diagnostic and Statistical Manual of Mental Disorders

ECR-RS Experiences in Close Relationships – Relationship Structures

EPDS Edinburgh Postnatal Depression Scale

ERI Effort-Reward Imbalance

GAD-2 2-item Generalized anxiety disorder

GAD-7 7-item Generalized anxiety disorder

HADS Hospital Anxiety and Depression Scale

JBI CAT Joanna Briggs Institute’s Critical Appraisal Tools

K10 Kessler psychological distress scale

LMIC Low-and-Middle-Income Country

MANCOVA Multivariate Analysis of Covariate

MHI Mental Health Inventory

NICU Newborn Intensive Care Unit

PHQ-4 4-item Patient Health Questionnaire

PHQ-9 9-item Patient Health Questionnaire

PICO Population, Intervention, Comparative intervention, and Outcomes

PP Post-partum

PPA Postpartum Anxiety

PPD Postpartum Depression

PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PRISMA-ScR PRISMA Extension for Scoping Reviews

PSAS Postpartum Specific Anxiety Scale

PTSD Post-Traumatic Stress Disorder

SAS Self-rating Anxiety Scale

SIGH-ADS Structured Interview Guide for the Hamilton Depression Rating Scale-Atypical Depression Symptoms

SOC-29 Orientation to Life Questionnaire

SSAI Spielberger State Anxiety Index

STAI State Trait Anxiety Inventory

WHO World Health Organization

WPC Work-privacy conflict

Ethics approval and consent to participate

Not applicable. All included articles in the review had received ethical approval.

Consent for publication

Not applicable

Availability of data and materials

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

Competing interests

All authors have completed the ICMJE Disclosure form. NE reports honorariums for expert opinions on contraception from Medsphere Corporation and personal fees for educational activities from Bayer Sweden AB, outside the submitted work. All other authors declare that they have no competing interests.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Authors' contributions

OO, OAK and KÄ were responsible for the study concept and conduct. OO and OAK were responsible for designing the search strategy, the review of the literature and the interpretation of findings. All authors contributed to the drafting and revising of the manuscript under the leadership of NE and have read and approved the final version of the submitted manuscript.

Acknowledgements

The authors would like to thank Elin Ternström for her constructive review and contributions to the scoping study, and the university librarian, Johan Wernberg, for his support during the literature search. We also acknowledge Chukwuka Anene for his invaluable input on study conception and conduct.

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Competing interest reported. All authors have completed the ICMJE Disclosure form. NE reports honorariums for expert opinions on contraception from Medsphere Corporation and personal fees for educational activities from Bayer Sweden AB, outside the submitted work. All other authors declare that they have no competing interests.

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Mental Health Conditions in the Postpartum Period: A Scoping Study

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Abstract

Background

Methods

Results

Conclusion

Figures

Gender statement

Background

Pregnancy, childbirth, and the postpartum period

Methods

Study design

Database Search and Selection Criteria

Data charting, collation, summarizing, and reporting results

Results

Search and selection of articles

Methodological characteristics of included articles

Regional distribution

Period of Postpartum Mental Health Evaluation

Screening Instruments and Mental Health Conditions

Associated factors with postpartum mental health conditions

Theme 1: Support System

Social support (Partner and Family) (n = 11)

Work support (n = 3)

Theme 2: Previous mental disorders and medical conditions

Theme 3: Other factors associated with postpartum mental health conditions

Socioeconomic Issues (n = 3)

Violence (n = 2)

Mode of Delivery (n = 3)

Gender of the baby (n = 2)

Marital Status (n = 2)

Theme 4: COVID-19

Discussion

Strengths And Limitations

Conclusion And Further Research

List Of Abbreviations

Declarations

References

Additional Declarations

Supplementary Files

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