title: Rate, risk factors and assessment of a counselling intervention for antenatal depression by public health nurses in an Israeli ultra-orthodox community.
abstract: OBJECTIVE
  To investigate the rate of and risk factors for perinatal depression in an Israeli ultra-orthodox Jewish community and assess the contribution of antenatal nursing intervention to reducing symptoms of postpartum depression.
  
  
  BACKGROUND
  Perinatal depression is recognized globally as a common complication of pregnancy and childbirth, with negative effects on the mother, infant and family. Among Jewish ultra-orthodox women both religion and childbearing play major roles.
  
  
  METHODS
  Single-group pretest-posttest intervention study.
  
  
  METHODS
  Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale. One-hundred-sixty women attending a mother-child healthcare clinic during December 2011-January 2013 completed the Edinburgh Postnatal Depression Scale prenatally and 148 (92·5%) repeated the survey 6 weeks postpartum. Nurses were trained to screen and offer non-directive supportive counselling intervention. Risk factors for antenatal depressive symptoms were analysed using multivariable logistic regression and analysis of changes in score was performed by 2-way analysis of variance.
  
  
  RESULTS
  Nineteen participants (11·9%) scored ≥10 on the Edinburgh Postnatal Depression Scale antenatally. Nurses provided intervention for 40 women. Postpartum, only one participant scored ≥10. The decrease in Edinburgh score was greater for those whose antenatal score was ≥10.
  
  
  CONCLUSIONS
  Although the rate of antenatal depressive symptoms was similar to that in other studies, postpartum symptoms may have been underreported, possible due to culturally-related reticence. This underscores the importance of understanding the context in which the service is offered and the sensitivities of particular groups. The findings indicate that antenatal nursing intervention is a potentially protective measure for perinatal emotional well-being.
authors.affiliation: Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Saralee
authors.initials: S
authors.lastname: Glasser
authors.affiliation: Women Health Clinic, Maccabi Health Services, Elad, Israel.
authors.forename: Lea
authors.initials: L
authors.lastname: Hadad
authors.affiliation: School of Social Work, Bar Ilan University, Ramat Gan, Israel.
authors.forename: Rena
authors.initials: R
authors.lastname: Bina
authors.affiliation: Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Valentina
authors.initials: V
authors.lastname: Boyko
authors.affiliation: Public Health and Health Systems Management Program, Department of Management, Bar Ilan University, Ramat Gan, Israel.
authors.forename: Racheli
authors.initials: R
authors.lastname: Magnezi
mesh_terms: D000328:Adult; D003376:Counseling; D019052:Depression, Postpartum / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007557:Israel; D007599:Judaism; D064689:Nurses, Public Health; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D012307:Risk Factors
keywords: Edinburgh Postnatal Depression Scale; antenatal depression; culture; nurses; perinatal depression; postpartum depression; public health nurse; supportive counselling