Submit an Article > Register > Login >

Annali

dell'Istituto Superiore di Sanità

Search
Vol. 59 No. 2 (2023)
DOI: 10.4415/ANN_23_02_07
Original Articles
2023-06-14
Share on

Epidemiology of perinatal depression in Italy: systematic review and meta-analysis

Authors

Laura Camoni , Antonella Gigantesco , Giulia Guzzini , Elisa Pellegrini , Fiorino Mirabella

Abstract

Introduction. This review aims to synthesise the studies that have estimated the prevalence
of perinatal depression in Italy, summarising the results of the existing literature based on their quality.
Materials and methods. Systematic searches were conducted in four major databases, and a random effect meta-analysis was performed to achieve the pooled variance of perinatal depression.
Results. The pooled prepartum risk of depression prevalence was 20.2% (CI 95% 15.3- 24.5) while the postpartum risk of depression prevalence was 27.5% (CI 95% 17.8-37.3) for an Edinburgh Postnatal Depression Scale (EPDS) cut-off score ≥9 and 11.1% (CI 95% 6.0-16.2) for an EPDS cut-off score ≥12. Significant publication bias was found and was determined by the presence of a small study with a low prevalence and a large study with a high prevalence.
Conclusion. The prevalence of perinatal risk of depression is similar to that reported in other countries. The high prevalence of prepartum risk suggests the need to activate specific prevention actions during this period.

INTRODUCTION

Depression is one of the most frequent complications for women in the perinatal period, defined as the period from pregnancy to the first year after childbirth [1]. It is a moment characterised by greater vulnerability, often associated with anxiety, and an impoverishment of the quality of personal and family life, which can lead to compromise in the child’s emotional, intellectual, and cognitive development. Several reasons may explain women’s increased vulnerability to depression during and after pregnancy, including the physical, emotional, and hormonal changes associated with pregnancy and childbirth, as well as the life-changing and family redefinition that having a child brings [2]. Based on current research, the strongest predictors of depression during the perinatal period are maternity blues, previous depression, family psychiatric history, unplanned pregnancy, partner relationship difficulties, stressful life events, and poor social support [3-6].

Recent systematic reviews highlight a prevalence of depressive disorder of 15-20% in the prenatal period and 16-18% in the postpartum period, with higher proportions in low- and middle-income countries [7, 8].

In Italy, several studies have investigated the diffusion of depression in the perinatal period, reporting highly variable prevalence estimates. Most of the studies were conducted locally on small samples, making results difficult to compare because of the period in which the screening was performed (in pregnancy, at delivery, and 1, 3, 6, and 12 months after delivery), the various instruments used, and the chosen cut-off values. The most commonly used screening tools are the Whooley questions [9], the Edinburgh Postnatal Depression Scale (EPDS) [10], the Beck Depression Inventory (BDI) [11, 12], the Center for Epidemiological Studies-Depression Scale (CES-D) [13], the Patient Health Questionnaire-9 (PHQ-9) [14, 15]. Among the tools mentioned, the most communly used for assessing the risk of depression in women during pregnancy and after childbirth [16, 3] is the EPDS. As indicated in the validation study of the Italian version [17], the choice of the cut-off value to use depends on the objectives of the evaluation: a cut-off of 9/10 seems to be the most suitable in screening programmes or population surveys, while a cut-off of 12/13 is usually recommended in clinical assessment and research, particularly in effectiveness studies in practise (effectiveness), in which it is intended to treat only people with a higher probability of developing depression in the perinatal period. Different cut-offs result in different values of sensitivity, specificity, and positive and negative predictive values. A recent Italian study showed high internal consistency with a Cronbach’s alpha of 0.80 during pregnancy and 0.87 following delivery [18].

The present systematic review aims to revise the studies that have estimated the prevalence of perinatal depression in Italy, summarizing the results of the existing literature based on their quality.

METHOD

This systematic review adheres to the PRISMA guidelines [19-21].

The Web of Science, Pubmed, PsycoInfo and Scopus electronic databases were systematically queried, considering papers published from January 1, 2000, to May 20, 2022. The following MESH terms and free words were combined to construct the search string: “depression” “maternal depression” “postpartum”, “perinatal”, “prenatal”, “postnatal”, “pregnancy”, “prevalence”, “incidence”, “mother”, “maternal”, “Italian study”, “Italian women”. Finally, the bibliographies of the included studies were evaluated to identify additional relevant studies, including grey literature.

The inclusion criteria were: 1) studies reporting prevalence estimates of depression in the perinatal period; 2) studies using the EPDS as a screening tool for assessing the risk of depression; and 3) studies conducted in Italy.

Studies reporting prevalence estimates of depression in association with anxiety and studies using screening tools other than the EPDS were excluded.

After the exclusion of the duplicates through the titles, the abstracts were analysed to select the studies pertinent to the topic based on the exclusion/inclusion criteria.

The complete text of the studies considered eligible for this review was acquired.

Two reviewers independently assessed the methodological quality of the extracted studies. For the quality assessment, the “checklist for prevalence studies” developed by the working group of the Joanna Briggs Institute, Australia [22] was used (Figure 1).

The checklist questionnaire contains 9 items with a four-level response method: “yes/no/unclear/not applicable”. The items investigate the representativeness and size of the sample, recruitment methods, setting, validity of the tools used, appropriateness of the statistical methods, reproducibility of the study, and adherence to the study by the people recruited.

Disagreements regarding the qualitative evaluation of the studies were resolved with the help of a third reviewer. Studies reporting a score ≥5 out of a maximum possible score of 9 were considered to be of good quality.

Prevalence estimates of pre- and postpartum depression were extracted from studies rated as having good methodological quality, and 95% confidence intervals were calculated where they were not available.

Three meta-analyses were conducted, one referring to prepartum and two to postpartum, one of which including studies with an EPDS cut-off score ≥9 and the other included studies with an EPDS cut-off score ≥12. Studies that were screened after the first three months of delivery were considered. This last distinction was necessary due to the great heterogeneity of the sample in terms of the cut-off and sample size. Where studies reported prevalence estimates relating to different cut-off scores, the number of events to consider was obtained by summing the relevant data.

The Statistical Package for Social Science (SPSS) version 28 was used for the analyses. Heterogeneity between included studies and overall estimates was calculated with the random effects model, and the test for heterogeneity was applied using the Chi2 and the I2 statistics. The I2 represents the percentage of the total study variation due to heterogeneity rather than chance. An I2 value below 25% indicates a low degree of heterogeneity, 25-75% indicates moderate heterogeneity, and a value above 75% indicates high heterogeneity [23].

RESULTS

A total of 801 studies were extracted. Of these, 551 were eliminated because they were duplicates, and of the remaining 250, after careful examination of the abstracts, 225 studies were excluded because they did not meet the inclusion criteria. The remaining 25 studies were evaluated for methodological quality, and 17 were found to be of good quality and therefore included in the final evaluation. Of these, 2 studies reported data relating to the antepartum period, 13 to the postpartum period, and 2 studies to both the antepartum and postpartum periods (Figure 1).

Most of the included studies were carried out in the Departments of Gynaecology and Obstetrics of various Italian Hospitals and Paediatric Clinics. Two studies were conducted at local Maternal-Child Health Centres and one at vaccination centres (Table 1) [24-48].

Most of the studies included in this review were conducted in northern and central Italy. In particular, eight studies recruited participants in northern regions, six in central Italy and only one in southern Italy. Finally, two studies enrolled women from northern, central and southern Italy.

Most of the screenings took place during prenatal checks at the health facilities to which the women regularly belonged and during childbirth preparation courses.

The prevalence values observed in the 4 prenatal studies and the 15 studies relating to the postpartum period are highly variable and depend, as already mentioned, on the type of centre that carried out the screening, and consequently on the women who refer to it, on the cut-off used, and on the sample size (Tables 2, 3, 4).

As Figure 2 shows, the pooled prevalence estimate was 20.2% (95% CI 15.3-24.5) for the 4 prepartum studies with cut-off scores ≥10. Significant heterogeneity was observed between studies (I2=0.97; p<0.001). Observation of the funnel plot shows the presence of a significant publication bias, determined by the presence of a small study with a low prevalence and a large study with a high prevalence. The small number of studies included in this meta-analysis does not allow for a sensitivity analysis.

Regarding the studies relating to postpartum, after a preliminary analysis that showed significant heterogeneity, a sensitivity analysis was conducted, distinguishing the studies that used a cut-off ≥9 from those with a cut-off ≥12.

Figure 3 of postpartum studies using cut-off scores ≥9 shows an overall prevalence estimate of 27.5% (95% CI 17.8-37.3). However, significant heterogeneity was observed between the studies (I2=0.98; p<0.001).

Figure 4 of postpartum studies using cut-off scores ≥12 shows an overall prevalence estimate of 11.1% (95% CI 6.0-16.2). In addition, in this case, significant heterogeneity is observed (I2=0.95; p<0.001).

DISCUSSION

To our knowledge, this is the first systematic review that intends to summarise prevalence estimates of depression in the perinatal period in Italy, taking into consideration the studies that used the same screening tool.

The different cut-off scores used help to explain the variability of prevalence estimates: lower cut-off scores correspond to higher prevalence estimates, and vice versa.

The results of the meta-analysis show that in the prepartum period, about one in five women shows a risk of depression, while in the postpartum period, more than one in four women shows a risk of depression if we consider the EPDS with a cut-off ≥9, and about one in ten when a cut-off ≥12 is considered.

Our estimates of the risk of prepartum depression are similar to those observed in other systematic reviews. In particular, the review of Nisar [49] which includes only studies conducted in China, shows prenatal depression values of 19.7%. While the review by Gavin [50] which also included studies conducted in Western countries, reports an estimate of prenatal depression prevalence of 18.4%.

Furthermore, our data are in line with the review by Underwood [51] which found a prevalence of depression of 17.2% during pregnancy for EPDS cut-off values ≥10 and ≥12.

Regarding the postpartum period, other systematic reviews show an overall estimate ranging from 14 to 17% [49, 52, 53]. It should be noted, however, that the studies included in these reviews also used other screening tools (CES-D, BDI, PHQ-9) in addition to the EPDS to calculate overall prevalence. Also, where EPDS was used, no differentiation was made for the cut-off scores used or for the periods in which screening was performed.

The estimates found in our country are consistent with those of another recent Italian study in which the EPDS was used (11-24%) during the perinatal period [54].

Concerning the general population, the only epidemiological study conducted in Italy on the prevalence of common mental disorders in a representative sample of the adult population and performed with a highly reliable diagnostic tool (Composite International Diagnostic Interview, CIDI) is the European Study of the Epidemiology of Mental Disorders (ESEMeD) study [55] which showed estimates of lifetime major depression in the female population equal to 13.4% (95% CI 11.0-15.0). Importantly, the sample of this survey suffers from depression, not the risk of depression that our systematic review refers to. Our overall estimate is therefore consequently higher because it refers to a more vulnerable population and to a probability of depression that, if confirmed with an appropriate diagnostic tool, would probably have lower values.

Finally, this systematic review shows that the risk of depression is also high during pregnancy and underlines the need to monitor women during this period, given that prenatal depression has always been recognised as one of the major risk predictors for depression during pregnancy and the postpartum period [56, 57]. Very often, prenatal depression is not recognised as such, partly due to its insidious onset and partly because many women do not recognise the disorder as such or are afraid to seek help from a specialist. A timely diagnosis is instead essential because it allows effective treatments to be undertaken, not only to reduce women’s suffering but also to limit the consequences for children and family relationships in general [58, 59].

CONCLUSION

This review and meta-analysis attempted to summarise the principal screening studies on the risk of depression for women in the perinatal period. The studies analysed are methodologically very different from each other and not always comparable. The reported prevalences are not always clearly referable to a clear cut-off score used, the screening periods are highly variable, and the centres where screening is performed have, by their very nature, a very different reference population as regards the risk of depression.

However, the data appear to tend towards values that are not too far apart when considering cut-off scores and uniform screening periods.

Monitoring the frequency of depression in the perinatal period is essential from a public health point of view to identify early women to be referred to a treatment that is easy to implement and of proven efficacy to reduce major complications for the woman and for the child.

Figures and tables

Figure 1. Flowchart of the systematic review literature search illustrating the identification of included studies.

Figure 2. Forest plot of prevalence studies during the prepartum period.

Figure 3. Forest plot of prevalence studies (with EPDS ≥9) during the post-partum period. EPDS: Edinburgh Postnatal Depression Scale.

Figure 4. Forest plot of prevalence studies (with EPDS ≥12) during the post-partum period. EPDS: Edinburgh Postnatal Depression Scale.

Before childbirth After childbirth
Author (year) Healthcare centre Region/city N. of women participants N. of women at risk of depression % prevalence (CI 95%) Screening time % prevalence (CI 95%) Screening time Cut-off EPDS
§ Monti et al. (2008) [24] 6 Obstetrics and Gynaecology Unit Emilia-Romagna 234 31 13.2±4.7 3 months ≥13
217 12 5.5±3.2 9 months
167 8 4.8±3.3 18 months
§ Currò et al. (2009) [25] Pediatric Unit. A. Gemelli Hospital Rome 1,122 298 26.6±2.5 15-20 days ≥10
§ Piacentini et al. (2009) [26] 3 Hospitals Bergamo 509 38 7.5±2.3 8-12 weeks ≥12
De Magistris et al. (2010) [27] Neonatal Intensive Care Unit Cagliari 113 26 23.0±8.9 >4 weeks ≥10
100 8 8.0±5.5 4-8 weeks
Aceti et al. (2011) [28] Obstetrics and Gynaecology Unit Umberto I Hospital Rome 453 92 20.3±4.2 3° trimester ≥12
§ Gremigni et al. (2011) [29] Obstetrics and Gynaecology Unit Ancona 70 39 55.7±17.5 3 months >9
§ Aceti et al. (2012) [30] Obstetrics and Gynaecology Unit Umberto I Hospital Rome 253 49 19.3±5.1 3° trimester ≥12
§ Balestrieri et al. (2012) [31] 4 Obstetrics and Gynaecology Unit Ascoli, Bari, Verona, Udine 1,608 175 10.9±1.6 12-15 weeks 10-12
133 8.3±1.4 ≥13
75 4.7±1.1 ≥15
§ Giardinelli et al. (2012) [32] Obstetrics and Gynaecology Unit, Careggi Hospitals Florence 590 129 21.9±3.2 28-32 weeks ≥10
70 11.9±2.7 10-12
60 10.2±2.6 ≥13
78 13.2±2.48 12 weeks ≥10
45 7.6%±2.2 10-12
33 5.6±1.9 ≥13
§ Elisei et al. (2013) [33] Prenatal Clinic, Hospital Santa Maria della Misericordia Perugia 85 5 5.5±5.1 72 hours ≥12
5 5.5±5.1 13-14
26 30±11.7 9-12
6 7.4±5.6 3 months ≥15
8 9.3±6.5 13-14
20 24.1±10.3 9-12
§ Mirabella et al. (2014) [34] Local maternal-child health centres Bergamo, Treviso 567 42 7.4±1.87 6-12 weeks ≥12
Cattaneo et al. (2015) [35] Maggiore Hospital Milan 122 29 23.8±8.6 2-5 days ≥10
19 15.6±7.0 2 months
11 9.0±5.3 6 months
Vismara et al. (2016) [36] Hospitals and local maternal-child health centres Cagliari. Turin. Cesena, Rome 181 36 19.9±6.5 3 months 9-12
31 17.1±6.1 >13
21 11.6±5.0 6 months 9-12
17 9.4±4.5 >13
§ Clavenna et al.(2017) [37] Local maternal-child health centres Milan 2,706 126 4.7±0.8 60-90 days ≥12
Lucarini et al. (2017) [38] Prenatal clinic, Hospital Santa Maria della Misericordia Perugia 54 3 5.5±6.3 1 week 13-14
3 5.5±6.3 ≥15
16 30±14.5 9-12
5 9.3±8.1 3 months 13-14
4 7.4±7.3 ≥15
13 24.1±13.1 9-12
§ Della Vedova et al. (2020) [39] Vaccination centres Brescia 416 48 11.5±3.3 2-4 months ≥10
§ Ferrari et al. (2020) [40] Local Psychiatry Department Camposampiero Padova 3,102 454 14.6±1.2 6-8 weeks ≥9
Molgora et al. (2020) [41] Online survey 389 133 34.2±5.8 pregnancy ≥13
186 49 26.3±7.4 0-6 months
Spinola et al. (2020) [42] Online survey 243 108 44.4±8.4 1 year >12
§ Zanardo et al. (2020) [43] Abano Terme Hospital Padova 192 38 19.79% 2 days >12
§ Cena et al. (2021) [44] 11 centres (local maternal-child health centres, Obstetrics and Gynaecology Unit) Bergamo, Bologna, Brescia, Enna, Florence, Mantova, Milan, Novara, Rome, Turin 2 0 0 1-13 weeks ≥12
129 16 12.4±6.1 14-26 weeks
1,029 58 5.6±1.5 27-40 weeks
1,160 74 6.4±1.4 1-40 weeks
220 40 18.2±5.6 1-13 weeks
66 14 21.2±11.1 14-26 weeks
16 6 37.5±30.0 27-40 weeks
1,462 133 9.2±1.5 1-40 weeks
Della Corte et al. (2021) [45] Local maternal-child health centres Naples 80 9 11.3±7.3 3 months >10
§ Luciano et al. (2021) [46] Obstetrics and Gynaecology Unit Naples 178 31 17.4±6.1 1 months ≥10
161 31 19.2±6.7 3 months
109 18 16.5±7.6 6 months
106 19 17.9±8.1 12 months
§ Molgora et al. (2022) [47] Maggiore Hospital Milan 137 28 20.3±7.6 3 months ≥12
29 21.3±7.7 6 months
30 21.9±7.8 12 months
56 40.9±10.7 3 months ≥9
49 36.0±10.0 6 months
56 40.9±10.7 12 months
Smorti et al. (2022) [48] Santa Chiara Hospital Pisa 80 22 27.5±11.5 23-32 weeks ≥10
75 40 53.3±16.6
§ Studies included in the metanalysis.
CI: confidence interval. EPDS: Edinburgh Postnatal Depression Scale.
Table 1. Characteristics of the studies included in the systematic reviews (Italy)
Authors (year) N. of women participants N. of women at risk of depression % prevalence (CI 95%) Screening time Cut-off
Aceti et al. (2012) [30] 253 49 19.3±5.1 3 months ≥12
Balestrieri et al. [31] 1,608 383 23.8±2.4 12-15 weeks ≥10
Giardinelli et al. [32] 590 129 21.9±3.8 28-32 weeks ≥10
Cena et al. [44] 129 16 12.4±6.1 14-26 weeks ≥12
Table 2. Prevalence studies during the prepartum period included in the meta-analysis
Authors (year) N. of women participants N. of women at risk of depression % prevalence (CI 95%) Screening time Cut-off
Currò et al. (2009) [25] 1,122 298 26.6±2.5 15-20 days ≥10
Gremigni et al. (2011) [29] 70 39 55.7±17.5 3 months ≥9
Giardinelli et al. (2012) [32] 590 78 13.2±2.48 12 weeks ≥10
Elisei et al. (2013) [33] 85 34 40.0±13.4 3 months ≥9
Lucarini et al. (2017) [38] 54 22 40.7±17.0 3 months ≥9
Della Vedova et al. (2020) [39] 416 48 11.5±3.3 2-4 months ≥10
Ferrari et al. (2020) [40] 3,102 454 14.6±1.2 6-8 weeks ≥9
Luciano et al. (2021) [46] 161 31 19.2±6.7 3 months ≥10
Molgora et al. (2022) [47] 137 56 40.9±10.7 3 months ≥9
EPDS: Edinburgh Postnatal Depression Scale.
Table 3. Prevalence studies (with EPDS ≥9) during the post-partum period included in the meta-analysis
Authors (year) N. of women participants N. of women at risk of depression % prevalence (CI 95%) Screening time Cut-off
Monti et al. (2008) [24] 234 31 13.2±4.7 3 months ≥13
Piacentini et al. (2009) [26] 509 38 7.5±2.3 8-12 weeks ≥12
Mirabella et al. (2014) [34] 567 42 7.4±1.87 6-12 weeks ≥12
Clavenna et al. (2017) [37] 2,706 126 4.7±0.8 60-90 days ≥12
Cena et al. (2021) [44] 66 14 21.2±11.1 14-26 weeks ≥12
Molgora et al. (2022) [47] 137 28 20.3±7.6 3 months ≥12
EPDS: Edinburgh Postnatal Depression Scale.
Table 4. Prevalence studies (with EPDS ≥12) during the post-partum period included in the meta-analysis

References

  1. WHO-Mental Health Action Plan 2013-2020.
  2. Rallis S, Skouteris H, McCabe M, Milgrom J. The transition to motherhood: towards a broader understanding of perinatal distress. Women Birth. 2014;27(1):68-71.
  3. Howard L, Piot P, Stein A. No health without perinatal mental health. Lancet. 2014;384(9956):1723-4.
  4. Norhayati M, Hazlina N, Asrenee A, Emilin W. Magnitude and risk factors for postpartum symptoms: a literature review. J Affect Disord. 2015;175:34-52.
  5. Robertson E, Grace S, Wallington T, Stewart D. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry. 2004;26(4):289-95.
  6. Mirabella F, Michielin P, Piacentini D, Veltro F, Barbano G, Cattaneo M, Cascavilla I, Palumbo G, Gigantesco A. Positività allo screening e fattori di rischio della depressione post partum in donne che hanno partecipato a corsi preparto. Riv Psichiatr. 2014;49(6):253-64.
  7. Howard L, Khalifeh H. Perinatal mental health: a review of progress and challenges. World Psychiatry. 2020;19(3):313-27.
  8. Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I. Economic and health predictors of national postpartum depression prevalence: A systematic review, meta-analysis, and meta-regression of 291 studies from 56 Countries. Front Psychiatry. 2018;8.
  9. Whooley M, Avins A, Miranda J, Browner W. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med. 1997;12(7):439-45.
  10. Cox J, Holden J, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-6.
  11. Beck A, Ward C, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-71.
  12. Beck A, Steer R, Brown G. Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation; 1996.
  13. Radloff L. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385-401.
  14. Kroenke K, Spitzer R, Williams J. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-13.
  15. Wang L, Kroenke K, Stump T, Monahan P. Screening for perinatal depression with the patient health questionnaire depression scale (PHQ-9): a systematic review and meta-analysis. Gen Hosp Psychiatry. 2021;68:74-82.
  16. Hewitt C, Gilbody S, Brealey S, Paulden M, Palmer S, Mann R, Green J, Morrell J, Barkham M, Light K, Richards D. Methods to identify postnatal depression in primary care: an integrated evidence synthesis and value of information analysis. Health Technol Assess. 2009;13(36):1-145.
  17. Benvenuti P, Ferrara M, Niccolai C, Valoriani V, Cox J. The Edinburgh Postnatal Depression Scale: validation for an Italian sample. J Affect Disord. 1999;53(2):137-41.
  18. Gigantesco A, Palumbo G, Cena L, Camoni L, Trainini A, Stefana A, Mirabella F. The limited screening accuracy of the Patient Health Questionnaire-2 in detecting depression among perinatal women in Italy. PLoS One. 2021;16(11).
  19. Liberati A, Altman D, Tetzlaff J, Mulrow C, Gøtzsche P, Ioannidis J, Clarke M, Devereaux P, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339.
  20. Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C, Shamseer L, Tetzlaff J, Akl E, Brennan S, Chou R, Glanville J, Grimshaw J, Hróbjartsson A, Lalu M, Li T, Loder E, Mayo-Wilson E, McDonald S, McGuinness L, Stewart L, Thomas J, Tricco A, Welch V, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372.
  21. Moher D, Liberati A, Tetzlaff J, Altman D. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7).
  22. Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc. 2015;13(3):147-53.
  23. Higgins J, Thompson S, Deeks J, Altman D. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-60.
  24. Monti F, Agostini F, Marano G, Lupi F. The course of maternal depressive symptomatology during the first 18 months postpartum in an Italian sample. Arch Womens Ment Health. 2008;11(3):231-8.
  25. Currò V, De Rosa E, Maulucci S, Maulucci M, Silvestri M, Zambrano A, Regine V. The use of Edinburgh Postnatal Depression Scale to identify postnatal depression symptoms at well child visit. Ital J Pediatr. 2009;35(1).
  26. Piacentini D, Leveni D, Primerano G, Cattaneo M, Volpi L, Biffi G, Mirabella F. Prevalence and risk factors of postnatal depression among women attending antenatal courses. Epidemiol Psichiatr Soc. 2009;18(3):214-20.
  27. De Magistris A, Coni E, Puddu M, Zonza M, Fanos V. Screening of postpartum depression: comparison between mothers in the neonatal intensive care unit and in the neonatal section. J Matern Fetal Neonatal Med. 2010;23:101-3.
  28. Aceti F, Baglioni V, Ciolli P, De Bei F, Di Lorenzo F, Ferracuti S, Giacchetti N, Marini I, Meuti V, Motta P, Roma P, Zaccagni M, Williams R. [Maternal attachment patterns and personality in post partum depression]. Riv Psichiatr. 2012;47(3):214-20.
  29. Gremigni P, Mariani L, Marracino V, Tranquilli A, Turi A. Partner support and postpartum depressive symptoms. J Psychosom Obstet Gynaecol. 2011;32(3):135-40.
  30. Aceti F, Aveni F, Baglioni V, Carluccio G, Colosimo D, Giacchetti N, Marini I, Meuti V, Motta P, Zaccagni M, Biondi M. Perinatal and postpartum depression: from attachment to personality. A pilot study. J Psychopathol. 2012;18:328-34.
  31. Balestrieri M, Isola M, Bisoffi G, Calò S, Conforti A, Driul L, Marchesoni D, Petrosemolo P, Rossi M, Zito A, Zorzenone S, Di Sciascio G, Leone R, Bellantuono C. Determinants of ante-partum depression: a multicenter study. Soc Psychiatry Psychiatr Epidemiol. 2012;47(12):1959-65.
  32. Giardinelli L, Innocenti A, Benni L, Stefanini M, Lino G, Lunardi C, Svelto V, Afshar S, Bovani R, Castellini G, Faravelli C. Depression and anxiety in perinatal period: prevalence and risk factors in an Italian sample. Arch Womens Ment Health. 2012;15(1):21-30.
  33. Elisei S, Lucarini E, Murgia N, Ferranti L, Attademo L. Perinatal depression: a study of prevalence and of risk and protective factors. Psychiatr Danub. 2013;25:S258-62.
  34. Mirabella F, Michielin P, Piacentini D, Veltro F, Barbano G, Cattaneo M, Cascavilla I, Palumbo G, Gigantesco A. Positività allo screening e fattori di rischio della depressione post partum in donne che hanno partecipato a corsi preparto [Positive screening and risk factors of postpartum depression in women who attended antenatal courses]. Riv Psichiatr. 2014;49(6):253-64.
  35. Cattaneo M, Roveraro S, Chiorino V, Macchi E, Salerno R, Gatti M, Arcaro L, Barretta F, Fontana C, Colombo L, Rossi P, Mosca F. The behavior over time of postnatal depression symptomatology and its early detection via the Edinburgh Postnatal Depression Scale: An Italian longitudinal study. Int J Adv Nurs Studies. 2015;4(1):23-9.
  36. Vismara L, Rollè L, Agostini F, Sechi C, Fenaroli V, Molgora S, Neri E, Prino L, Odorisio F, Trovato A, Polizzi C, Brustia P, Lucarelli L, Monti F, Saita E, Tambelli R. Perinatal parenting stress, anxiety, and depression outcomes in first-time mothers and fathers: a 3- to 6-months postpartum follow-up study. Front. Psychol. 2016;7.
  37. Clavenna A, Seletti E, Cartabia M, Didoni A, Fortinguerra F, Sciascia T, Brivio L, Malnis D, Bonati M. Postnatal depression screening in a paediatric primary care setting in Italy. BMC Psychiatry. 2017;17(1).
  38. Lucarini E, Attademo L, Moretti P, Spollon G, Elisei S, Quartesan R, Tortorella A. Personality disorders features in a sample of women with perinatal depression in Perugia, Italy. Psychiatr Danub. 2017;29:323-32.
  39. Della Vedova A. Maternity and migration: psychosocial risk and depressive symptoms in the postpartum period. Ricerche di psicologia online. 2020;43(1).
  40. Ferrari B, Mesiano L, Benacchio L, Ciulli B, Donolato A, Riolo R. Prevalence and risk factors of postpartum depression and adjustment disorder during puerperium: a retrospective research. J Reprod Infant Psychol. 2021;39(5):486-98.
  41. Molgora S, Accordini M. Motherhood in the time of coronavirus: the impact of the pandemic emergency on expectant and postpartum women’s psychological well-being. Front Psychol. 2020;11.
  42. Spinola O, Liotti M, Speranza A, Tambelli R. Effects of COVID-19 epidemic lockdown on postpartum depressive symptoms in a sample of Italian mothers. Front Psychiatry. 2020;11.
  43. Zanardo V, Manghina V, Giliberti L, Vettore M, Severino L, Straface G. Psychological impact of COVID-19 quarantine measures in northeastern Italy on mothers in the immediate postpartum period. Int J Gynaecol Obstet. 2020;150(2):184-8.
  44. Cena L, Gigantesco A, Mirabella F, Palumbo G, Camoni L, Trainini A, Stefana A. Prevalence of comorbid anxiety and depressive symptomatology in the third trimester of pregnancy: analysing its association with sociodemographic, obstetric, and mental health features. J Affect Disord. 2021;295:1398-406.
  45. Della Corte L. Prevalence and associated psychological risk factors of postpartum depression: a cross-sectional study. Journal Obstet Gynaecol Online. 2021;:1-5.
  46. Luciano M, Sampogna G, Del Vecchio V, Giallonardo V, Perris F, Carfagno M, Raia M, Di Vincenzo M, La Verde M, Torella M, Fiorillo A. The transition from maternity blues to full-blown perinatal depression: results from a longitudinal study. Front Psychiatry. 2021;12.
  47. Molgora S, Saita E, Barbieri Carones M, Ferrazzi E, Facchin F. Predictors of postpartum depression among Italian women: a longitudinal study. Int J Environ Res Public Health. 2022;19(3).
  48. Smorti M, Gemignani A, Bonassi L, Mauri G, Carducci A, Ionio C. The impact of Covid-19 restrictions on depressive symptoms in low-risk and high-risk pregnant women: a cross-sectional study before and during pandemic. BMC Pregnancy Childbirth. 2022;22(1).
  49. Nisar A, Yin J, Waqas A, Bai X, Wang D, Rahman A, Li X. Prevalence of perinatal depression and its determinants in Mainland China: a systematic review and meta-analysis. J Affect Disord. 2020;277:1022-37.
  50. Gavin N, Gaynes B, Lohr K, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106(5 Pt 1):1071-83.
  51. Underwood L, Waldie K, D’Souza S, Peterson E, Morton S. A review of longitudinal studies on antenatal and postnatal depression. Arch Womens Ment Health. 2016;19(5):711-20.
  52. Liu X, Wang S, Wang G. Prevalence and risk factors of postpartum depression in women: a systematic review and meta-analysis. J Clin Nurs. 2022;31(19-20):2665-77.
  53. Shorey S, Chee C, Ng E, Chan Y, Tam W, Chong Y. Prevalence and incidence of postpartum depression among healthy mothers: a systematic review and meta-analysis. J Psychiatr Res. 2018;104:235-48.
  54. Camoni L, Mirabella F, Gigantesco A, Brescianini S, Ferri M, Palumbo G, Calamandrei G. The impact of the COVID-19 pandemic on women’s perinatal mental health: preliminary data on the risk of perinatal depression/anxiety from a National Survey in Italy. Int J Environ Res Public Health. 2022;19(22).
  55. de Girolamo G, Polidori G, Morosini P, Mazzi F, Serra G, Visonà G, Falsirollo F, Rossi A, Scarpino V, Reda V. La prevalenza dei disturbi mentali in Italia: il progetto ESEMED-WMH. Una sintesi.
  56. Beck C. Predictors of postpartum depression: an update. Nurs Res. 2001;50(5):275-85.
  57. Hutchens B, Kearney J. Risk factors for postpartum depression: an umbrella review. J Midwifery Womens Health. 2020;65(1):96-108.
  58. Biaggi A, Conroy S, Pawlby S, Pariante C. Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord. 2016;191:62-77.
  59. MacMillan K, Lewis A, Watson S, Bourke D, Galbally M. Maternal social support, depression and emotional availability in early mother-infant interaction: findings from a pregnancy cohort. J Affect Disord. 2021;292:757-65.

Downloads

PDF
Authors

Laura Camoni - SCIC - Centro di riferimento scienze comportamentali e salute mentale - ISS

Antonella Gigantesco - Centro per le Scienze Comportamentali e la Salute mentale-ISS

Giulia Guzzini - Centro per le Scienze Comportamentali e la Salute mentale-ISS

Elisa Pellegrini - Centro per le Scienze Comportamentali e la Salute mentale-ISS

Fiorino Mirabella - Centro per le Scienze Comportamentali e la Salute mentale-ISS

License

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Copyright

Copyright (c) 2023 Istituto Superiore di Sanità

How to Cite
Camoni, L., Gigantesco, A., Guzzini, G., Pellegrini, E., & Mirabella, F. (2023). Epidemiology of perinatal depression in Italy: systematic review and meta-analysis. Annali dell’Istituto Superiore Di Sanità, 59(2), 139–148. https://doi.org/10.4415/ANN_23_02_07
  • Abstract viewed - 314 times
  • PDF downloaded - 130 times