title: Depressive symptoms and changes in physiological and social factors 1 week to 4 months postpartum in Japan.
abstract: BACKGROUND
  Postpartum depression (PPD) is a common condition and may be exacerbated unless treated. There is, however, a lack of longitudinal studies about the relationship between PPD and changes in physiological status and social role postpartum.
  
  
  METHODS
  We enrolled longitudinally 65 Japanese mothers (36 primiparas) and measured their psychological responses at 1 week, 1 month, and 4 months postpartum. The physiological indicators were three urine catecholamine fraction levels, cortisol levels, and heart-rate variability. We used the Edinburgh Postnatal Depression Scale (EPDS) and 28-item General Health Questionnaire (GHQ) for psychological evaluation.
  
  
  RESULTS
  Eleven participants had an EPDS score ≥9 (cutoff point) at 1 month and five at 4 months. With GHQ total score, 32 participants had ≥6 (cutoff point) at 1 month and 17 at 4 months. The psychological indicators underwent change from childbirth to 4 months postpartum. However, there was no correlation between the psychological and physiological indicators. We likewise found EPDS and GHQ scores were not influenced by parity or undertaking of social activities.
  
  
  CONCLUSIONS
  The mothers׳ high education level may mean that the results are not generalizable to Japan overall. We were unable to evaluate the status of 11 mothers who dropped out. The participants may have lacked sufficient time to complete questionnaires, resulting in diminished accuracy. We could not determine the prevalence of PPD.
  
  
  CONCLUSIONS
  Irrespective of parity status, postpartum mothers showed physiological and mental changes caused by childrearing-related stress. To prevent PPD, postnatal mothers need continuous screening with appropriate evaluating indicators and individualized advice.
authors.affiliation: Department of Nursing, Graduate School of Health Sciences, Kobe University, Hyogo, Japan. Electronic address: ashimizu@penguin.kobe-u.ac.jp.
authors.forename: Aya
authors.initials: A
authors.lastname: Shimizu
authors.affiliation: Department of Nursing, Graduate School of Health Sciences, Kobe University, Hyogo, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Nishiumi
authors.affiliation: Japanese Red Cross Hiroshima College of Nursing, Hiroshima, Japan.
authors.forename: Yukari
authors.initials: Y
authors.lastname: Okumura
authors.affiliation: The University of Shiga Prefecture, Shiga, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Watanabe
mesh_terms: D000328:Adult; D002395:Catecholamines / Q000652:urine; D019052:Depression, Postpartum / Q000503:physiopathology* / Q000523:psychology* / Q000652:urine; D005260:Female; D006304:Health Status; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D007564:Japan; D008137:Longitudinal Studies; D011247:Pregnancy; D012919:Social Behavior; D013997:Time Factors
chemical_list: D002395:Catecholamines; D006854:Hydrocortisone
keywords: Cortisol; Depression; Longitudinal study; Parity; Postpartum; Stress