Postpartum Depression Prevalence and Risk Factors in Turkey: A Systematic Review and Meta-Analysis

Accepted Manuscript Postpartum Depression Prevalence and Risk Factors in Turkey: A Systematic Review and Meta-analysis

Neslihan Keser Özcan, Nur Elçin Boyacıoğlu, Hüsniye Dinç PII: DOI: Reference:

S0883-9417(16)30291-6 doi: 10.1016/j.apnu.2017.04.006 YAPNU 50941

To appear in:

Archives of Psychiatric Nursing

Received date: Accepted date:

10 October 2016 9 April 2017

Please cite this article as: Neslihan Keser Özcan, Nur Elçin Boyacıoğlu, Hüsniye Dinç , Postpartum Depression Prevalence and Risk Factors in Turkey: A Systematic Review and Meta-analysis. The address for the corresponding author was captured as affiliation for all authors. Please check if appropriate. Yapnu(2017), doi: 10.1016/j.apnu.2017.04.006

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT Postpartum Depression Prevalence and Risk Factors in Turkey: A Systematic Review and Meta-Analysis

Running Title: Postpartum Depression Name/Surname:

PT

* Neslihan Keser Özcan (Corresponding Author) ** Nur Elçin Boyacıoğlu

Title:

**Research Assistant, PhD in Psychiatric Nursing

NU

*Assistant Professor, PhD, Msc in Psychiatric Nursing

SC

RI

***Hüsniye Dinç

MA

*** Research Assistant, PhD in Obstetrics and Gynecology Nursing

D

Workplace:

PT E

*/**/***Istanbul University Faculty of Health Sciences Department of Midwifery

CE

Mailing address:

[email protected]

AC

[email protected]

[email protected]

*/**Istanbul University Faculty of Health Sciences Department of Midwifery Demirkapı Cad. Karabal Sk. Bakırköy Ruh ve Sinir Hastalıkları Hastanesi Bahçesi içi 34740 Bakırkoy/Istanbul/Turkey Phone:+90 212 6601125/ 40136

Word count: 3935

ACCEPTED MANUSCRIPT

Role of funding source This research received no specific grant from any funding agency in the public, commercial, or notfor-profit sectors.

PT

Conflict of interest


RI

The authors declare no conflict of interest.

SC

Acknowledgements

We have received help in statistical and editing service (English Language Editing Services). We

NU

would like to thank both service for improving our papers’ quality.

Study Design: NKÖ, NEB, HD

MA

Contributors

Data Collection and Analysis: NKÖ, HD

PT E

D

Manuscript Writing: NKÖ, NEB, HD

CE

Abstract

Postpartum depression (PPD) is a common problem with adverse consequences for the mother and

AC

the infant. This study was performed to determine the prevalence of and risk factors for PPD in Turkey. In this study, 52 primary studies that were published between January 1999 and January 2015 were examined. The prevalence of PPD was determined through a meta-analysis, and the risk factors were determined through a systematic review. The prevalence of PPD in Turkey was found to be 23.8%. Developed cities had a prevalence of 21.2%, and developing cities had a prevalence of 25%. Just as throughout the world, PPD is a common problem in Turkey. It is more prevalent in developing cities. The following factors were the strongest predictors of postpartum depression: economic status and the employment status of the spouse, planned pregnancy and having a

ACCEPTED MANUSCRIPT stressor/illness during pregnancy, health problems in the newborn, previous psychiatric illness, problems with family and spouse, reduced social support, and a history of psychiatric illness in the family. Keywords Frequency, Meta-analysis, Mothers, Postnatal depression, Postpartum depression, Risk

AC

CE

PT E

D

MA

NU

SC

RI

PT

factors

ACCEPTED MANUSCRIPT INTRODUCTION

Postpartum depression (PPD) is a well-known postpartum psychological disorder characterized by a non-psychotic depressive episode of mild to moderate severity beginning in or extending into the first year after delivery. PPD is distinguished from the postpartum

PT

blues and postpartum psychosis. Postpartum blues is a prevalent (40-80%) mood disorder that presents 3 to 5 days after giving birth. It requires no treatment, and its symptoms recess within

RI

two weeks at most. Postpartum psychosis, on the other hand, differs from PPD in being

SC

infrequent (0.1-0.5%), acute, and accompanied by psychotic episodes, requiring treatment

NU

(O’Hara & McCabe, 2013).

PPD prevalence rates also differ according to the postpartum period studied, the sample size,

MA

the study population, and the diagnostic tools (Erdem & Bucaktepe, 2012; O’Hara & McCabe, 2013). The first meta-analysis, based on 59 studies reported the prevalence of PPD

D

as 13% (O’Hara & Swain, 1996). The systematic review of Gavin et al. (2005), which

months postpartum.

PT E

included 16 primary studies, found the prevalence of depression to be 12.9% in the first three

CE

Several meta-analyses of risk factors for PPD have been conducted. Family history of

AC

depression, anxiety and depression during pregnancy, neurosis, low self-esteem, stressful life events, poor marital relationship and poor social support are among the psychosocial factors. Low socio-economic status and being unmarried are among the socio-demographic factors. Unwanted pregnancy, obstetrical stressors, the health of the newborn and difficult infant temperament are among the pregnancy and newborn factors that have been found to be related to PPD (O’Hara & Swain, 1996; Beck, 2001; Robertson et al., 2004). In the literature, PPD has been reported to be successfully prevented through the use of various psychosocial interventions, such as hypnosis, cognitive-behavioral therapy and non-directive counseling,

ACCEPTED MANUSCRIPT individualized postpartum home visits provided by nurses or midwives, peer support, and interpersonal psychotherapy (Dennis & Dowswell, 2013). Nurses and midwives play key roles in applying these interventions through regular home visits. In Turkey, nurses/midwives follow up with mothers in the postpartum period 6 times. An innitial monitoring is first performed in the hospital within 24 hours after birth; and another three monitoring visits are

PT

generally performed in health care institutions (Turkey Public Health Agency, 2014). Home

RI

visits are important in evaluating both the mother and the baby. However, house visits are not

SC

desirable in our country. One of the biggest obstacles to these visits is an insufficient number of nurses and midwives.

NU

The results of a meta-analysis, where studies from countries with different cultural and

MA

developmental statuses are brought together, have to be interpreted carefully. While these studies may help bring out the common points on the subject, they may also diminish the differences. For this reason, each country needs systematic review and meta-analysis studies

PT E

D

formed from studies within that country alongside cross-country meta-analysis studies. Although there are many studies on PPD in Turkey, a systematic review and meta-analysis

CE

study determining prevalence and risk factors is lacking. This study is thought to fill this gap.

Aim

AC

AIMS AND METHOD

In this meta-analysis, studies that were published between January 1999 and January 2015 that conformed to the inclusion criteria were examined. The prevalence of PPD was determined through meta-analysis, and risk factors were determined through a systematic review. The research questions for this study were as follows:

ACCEPTED MANUSCRIPT 1. What is the prevalence of PPD? Are there differences in the prevalence of PPD in developed and developing cities? 2. What are the risk factors for PPD? Information sources and search

PT

The study was conducted as a retrospective scan of existing studies. A search using Pubmed,

RI

Science Direct, Medline, PsycINFO, Ovid, Ebsco CINAHL Plus, Cochrane Library databases

SC

was conducted with keywords such as postpartum, puerperal, postnatal, depression, and Turkey, in Turkish and English, using the internet access of Istanbul University. A total of

NU

892 national and international studies were published between January 1999 and January 2015, and they were reviewed independently by three researchers. Identical studies were

MA

omitted, and 52 studies meeting the inclusion criteria were subsequently evaluated (Figure 1).

D

Inclusion criteria

PT E

1. It was a quantitative study published in a national or international journal with referees.

CE

2. It included women living in Turkey between the ages of 18 and 45.

AC

3. It was conducted within the first 24 months postpartum. 4. It reported the prevalence of PPD based on a standardized depression scale. Exclusion criteria 1. The study was not performed with a sample with a specific limitation (women with physical or mental health problems, inmates, infertility treatments, women with anomalous babies etc.)

ACCEPTED MANUSCRIPT Conducting the study To evaluate the quality of the studies, 12 of the evaluation criteria suggested by Polit and Beck (2009) were used. The criteria were as follows: 1. Were the aim and research questions of the study stated appropriately?

PT

2. Were the research questions answered appropriately? 3. Were the terms used in the study identified?

RI

4. Were the characteristics of the sample identified?

SC

5. Was the sample size sufficient? 6. Were the tools and methods used appropriate?

NU

7. Were the tools used reliable?

MA

8. Were the findings open and organized? 9. Were important results discussed?

10. Did the findings match the discussion?

PT E

D

11. Were the results summarized? 12. Were limitations stated?

CE

Each study was evaluated according to all of the criteria by two separate researchers, and

AC

studies meeting the criteria were given a score of 1 while those that did not meet the criteria were given a score of 0. Data analysis

As a result of the evaluations, the highest score was 12, and the lowest included score was 8. For reliability among scorers, the kappa values were subjected to compliance analysis using SPSS-11. The kappa score for the sum of all criteria was .773, and reliability among scorers

ACCEPTED MANUSCRIPT was high (p=. 000). The average scores given by each researcher for the quality control of each study is shown in Table 1. For PPD prevalence, a meta-analysis was performed using Comprehensive Meta-Analysis software (Version 3.3.070). The prevalence of PPD was calculated using a random effects

PT

model. This method gives a stronger estimate of effect sizes. The random effects model weighs each study by the inverse of its internal variance and also accounts for variance

RI

between studies. For this reason, a random effects model is more suited for meta-analysis in

SC

the presence of heterogeneity. Heterogeneity was calculated using Cochran Q and I2 statistics. The Q statistic is reported as χ2 and p values, and the I2 statistic is reported as percentages. A

NU

higher value of I2 shows more heterogeneity between statistics (For I2, 25, 50, and 75%

MA

correspond to low, medium and high heterogeneity, respectively). In comparing two groups for frequency, the Q statistic was used (Borenstein et al., 2013).

D

The risk factors for PPD were examined through a systematic review. Many risk factors (108)

PT E

were found to be evaluated in the studies, but only the 36 most commonly repeated risk factors were evaluated. The PRISMA check list protocol was used when writing this

AC

RESULTS

CE

manuscript.

The results of the review will be evaluated in two sections. Under “Study method characteristics”, the publishing date and study design, the sample characteristics, the characteristics of the location of the study, the characteristics of the questionnaires and scales used and the period when PPD was evaluated were examined.

Under the second section titled “PPD and related characteristics”, the prevalence of PPD and PPD risk factors were examined.

ACCEPTED MANUSCRIPT

Characteristics regarding study methods The publishing date and study design Most studies on PPD were published in 2014 (7), with 6 published in 2006, 2010 and 2012, 5 published in 2007, 4 published in 2004, 3 published in 2002, 2008, 2009, 2011 and 2013, 2

PT

published in 2005 and 1 published in 1999. Fourteen studies were of cohort quality, and 38 of

SC

RI

the studies were descriptive and cross sectional (Table 1).

It is evident that there are many studies on the subject with increasing attention throughout the

NU

years. Most of the studies were descriptive and cross sectional. Repeated measurements across different periods were found in 14 of the studies, which is important because they

MA

provided more scientific data on PPD. Randomized, controlled studies on PPD were not found.

PT E

D

Characteristics of the sample

The sample of one of the studies consisted of primiparous women (Vural and Akkuzu, 1999),

CE

and the samples of all other studies consisted of women in the postpartum period (1 to 24 months) without any other criteria. Nearly half of the studies (24) had a sample size ≤200.

2002).

AC

The lowest sample size was 41 (Selcuk et al., 2012) and the highest was 2514 (İnandi et al.,

Characteristics of the location of the study

According to data from the “Socio-economic development ranking among cities and regions 2013” study by the Ministry of Development of the Republic of Turkey, 17 of the 52 studies

ACCEPTED MANUSCRIPT were conducted in developed cities (Ankara, İstanbul, İzmir and Eskişehir), and the rest were conducted in developing cities (Dincer et al., 2013) (Table 1).

Twenty-three studies were conducted in primary health care services, 18 in obstetrics clinics, 8 in pediatrics clinics, one in both primary health care services and pediatrics centers, and one

PT

in both primary health care services and obstetrics centers. One study gave no information on

RI

the location of the study. Most of the studies were thus determined to be conducted in primary

SC

health care services followed by obstetrics clinics.

NU

PPD and related characteristics

MA

The prevalence of PPD

As a result of heterogeneity of evaluations for the 52 studies, the Q statistic was found to be

D

566.225 (sd=51) (p<0.001). (I2 statistic = 90.993). Both statistics showed the studies to be

PT E

heterogeneous. As a result of the meta-analysis performed with the results of the 52 studies, PPD prevalence was found to be 23.8% (95% CI, 21.6%-26.1%). The prevalence values in the

CE

studies varied between 5% and 61.8%.

AC

In the 17 studies conducted in developed cities (Ankara, İstanbul, İzmir and Eskişehir), the Q statistic was 113.976 (sd=16) p<0.001, and the I2 statistic was 85.962. The prevalence of PPD was 21.2% (95% CI, 17.2%-25.9%). In the 35 studies conducted in developing cities, the Q statistic was 411.320 (sd=34) p<0.001, and the I2 statistic was 91.734. The prevalence of PPD was 25% (95% CI, 22.4%-27.8%). Although the prevalence of PPD in developing cities was relatively higher, the difference was not statistically meaningful (p=0.156). In fourteen studies using repeated measurements, the measurements were made in different periods (Table 1). One study split the sample into two groups and reported an prevelance of

ACCEPTED MANUSCRIPT 5% PPD in normal births in comparison to a 15% prevalence in those who had a C-section. In another study, the prevalence of PPD was 42.9% when the baby was born at <1500 gr, 14.3% when the baby was born at 1500-2500 gr, and 5.7% when the baby was born at >2500 gr. Risk factors for PPD

PT

Even though the factors examined in each of the studies were similar, homogeneity is impossible to mention because of the differences in methods. Additionally, while some

RI

factors were examined in many studies, some were mentioned only in a few. Despite different

SC

methods, a total of 36 risk factors were found to be examined in all of the studies, and these

NU

were summarized into four groups: socio-demographic characteristics, pregnancy-related characteristics, newborn-related characteristics, and psychosocial characteristics. It is

MA

important to note that socio-demographic characteristics were the most commonly examined group in nearly all of the studies.

D

The most prevalent risk factors were determined to be economic status and the employment

PT E

status of the spouse among socio-demographic characteristics; unplanned pregnancy and going through a stressor/illness during pregnancy among pregnancy-related characteristics;

CE

health problems in the newborn among newborn-related characteristics; and past psychiatric illness, problems with the family and spouse, reduced social support, and a history of

AC

psychiatric illness in the family among psychosocial characteristics (Figure 2). DISCUSSION

In this systematic review and meta-analysis, the prevalence of PPD in Turkey was found to be high, especially in rural areas. In many studies, PPD has been reported to have a greater prevalence in the rural areas of countries or in developing countries. In a meta-analysis study where 59 studies were evaluated (n=12.810), the prevalence of PPD was found to be 12.8% (O’Hara & Swain, 1996). Villegas et al. (2011), in a systematic review in which they

ACCEPTED MANUSCRIPT evaluated studies from 10 developed and 7 developing countries, found the prevalence of PPD to be greater (31.3%) in developing countries than in developed (21.5%) countries. In a systematic review by Gavin et al. (2005), the prevalence of PPD was found to be 19.8% (19.5–20.0%) in developed countries and 12.9% (10.6-15.8%) in developing countries. In another study conducted in Africa, the prevalence values in sub-Saharan African countries

PT

were found to be higher than those in developed countries (18.3%, 12.9%). While the ratios

RI

vary on a larger scale when comparisons are made between countries with different socio-

SC

economic structures, the difference between cities in our study is not so evident. In a systematic review by Norhayati et al. (2015), the prevalence of PPD in developed countries

NU

was found be between 1.9% and 82.1%, and the prevalence was between 5.2% and 74% in developing countries. Halbreich and Karkun (2006), in a meta-analysis in which they

MA

evaluated PPD studies from across 40 countries, reported the prevalence of PPD to be 10-15% and found this prevalence to vary between 0% and 60%. Various PPD prevalences have thus

D

been reported from around the world. The sample size, socio-demographic and cultural

PT E

characteristics, the period postpartum when the study was conducted, and the differences in measurement methods are thought to contribute to this variability. While the most accurate

CE

information on the subject is thus expected from systematic reviews and meta-analyses, Mann et al. (2010) provided a warning in their overview study, in which they evaluated five

AC

systematic reviews that methodological mistakes in the primary studies included in such reviews may effect prevalence and that caution should be taken when generalizing findings. Turkey is a developing, conservative country. During the postpartum period, social changes abound alongside the biological changes that women go through. Traditional support comes about through intervention from other family members (grandparents, relatives), often leading to a loss of privacy and meddling in the lives of women. The woman, who wants the comforts of a modern family life, accepts traditional support unwillingly. Accordingly, a high

ACCEPTED MANUSCRIPT prevalence of PPD is an expected outcome and is not surprising, especially in rural areas. The fact that the prevalence of PPD is also high in Iran, India, and Latin countries, which are culturally similar with their relatively conservative structures, support this model. In a study performed in Australia, Vietnamese, Filipino, and Turkish immigrants were evaluated with regard to PPD, and the highest rate of PPD was found in Turkish people (44.2%), with the

PT

most evident risk factor being familial issues (Small et al., 2003). The difficulties brought

RI

about by a traditional family structure are seen to be an important risk factor for Turkish

SC

women, even when living in another country as an immigrant. The systematic reviews and meta-analyses on this subject have discussed the effectiveness of professional help in the

NU

postpartum period (Dennis, 2005; Dennis & Dowswell, 2013). Under these circumstances, it is thought that that interventions to prevent PPD should encompass regular house visits by

MA

midwives and nurses, who may regulate interpersonal relationships. The risk factors rising from among socio demographic characteristics are seen to come about

PT E

D

from casual relationships. While poverty may lead to insufficient education, insufficient education may support marriage at an early age, which contributes additional risk factors for

CE

mental health to worsen. This may considered as a type of “rich get richer” effect. Low socio-economic status, which is connected to many psychological problems, also arose

AC

as a major risk factor for PPD, and this finding is in agreement with the literature (Beydoun et al., 2010; Lanes et al. 2011; Eastwood et al., 2012). O’Hara and Mc Cabe (2013) have defined characteristics regarding socio economic status as “buffering resources” for PPD. A higher socio economic status can be a both easing factor as well as an obstacle for other PPD risk factors. In this context, nurses and midwives support the mother who benefits from various material resources that remove various risk factors in this important intervention.

ACCEPTED MANUSCRIPT Unplanned pregnancy is one of the most important risk factors for PPD reported in studies (Beck, 2001; Beydoun et al., 2010; Hayes et al., 2010; Lanes et al., 2011; Martini et al., 2015). Another factor is stressful events that occur during pregnancy. This risk factor has been identified as an important risk factor for PPD in three meta-analyses (O’Hara & Swain, 1996; Beck, 2001; Robertson et al., 2004) and in many descriptive studies (Robertson et al.,

PT

2004; Milgrom et al., 2008; Beydoun et al., 2010; Lanes et al., 2011; Eastwood et al., 2012;

RI

Wittkowski et al., 2014; Norhayati et al., 2015). A pregnancy period without complications is

SC

very important for both the physical health of the mother and the child and for postpartum mental health. In this context, interventions to prevent PPD should start in the antenatal

NU

period. Every intervention by midwives and nurses for the woman to have a better pregnancy

MA

may protect her from potential problems in the postpartum period. Health problems in the newborn were found to affect PPD the most. While some studies report that the mother’s depression affects the health of the newborn (Parsons et al., 2011;

D

Apter-Levy et al., 2013), other studies report that the newborn being born disabled or ill can

PT E

cause the mother’s depression (Vigod et al., 2010; Helle et al., 2015). In this study, history of psychiatric illness in the family or the mother, relations with spouse and family, and social

CE

support were found to be the most important psychosocial factors. Risk factors for PPD have

AC

been examined in three meta-analyses, indicating that the strongest predictors of PPD include depression or anxiety during pregnancy, personal and family history of depression and lack of social support (O’Hara & Swain, 1996; Beck, 2001; Robertson et al., 2004). In later studies not included in these meta-analyses, the presence of pre-pregnancy and antenatal depression and lack of social support were important risk factors (Robertson et al., 2004; Milgrom et al., 2008; Ramchandi et al., 2009; Ludermir et al., 2010; Vigod et al., 2010; Lanes et al., 2011; Valantine et al., 2011; Villegas et al., 2011; Gjerdingen et al., 2014, Martini et al., 2015, Norhayati et al., 2015). Nurses and midwives should take a careful approach when they first

ACCEPTED MANUSCRIPT meet a pregnant woman and evaluate both the woman and her family for a history of psychiatric illnesses. For pregnant women with a history of mental illness and less social support, more frequent interactions and peer support groups can be useful. Strengths and Limitations

PT

The facts that the 52 studies included in this systematic review and meta-analysis were performed on different samples, that they evaluated different risk factors, and that some

RI

studies did not take into consideration certain factors made reporting and interpreting the

SC

studies more difficult. The fact that we did not use any risk of bias tools to reduce the study

NU

bias is a major limitation of this study. Despite all systematic review and meta-analysis enable valuable information on general trends about the primary studies, the details should also be

MA

considered that could become indistinct.

In addition, the different scales used to evaluate PPD in the studies (EPDS, BDS, SCID-I,

D

BSE), the different postpartum periods during which the study was conducted (1st month, first

PT E

6 months, first year, etc.), the scales being dependent on self-reporting, the low sample sizes in the studies, and the lack of countrywide studies are other methodological limitations.

CE

Although the heterogeneity of the primary studies is a limitation, the high number of studies is

AC

viewed as strength.

Despite all limitations, this systematic review and meta-analysis evaluated a relatively high number of studies for a single country and has filled a gap in determining the size of the problem and risk factors in Turkey. Additionally, this study provides data to compare to national meta-analyses from other countries in the literature. Implication for Practice While the majority of women and infants exhibit a normal prognosis during the postpartum period, some may experience serious morbidity. Effective postpartum care facilitates the

ACCEPTED MANUSCRIPT solution of short, medium, and long-term problems. Use of evidence based guidelines, which are carefully developed, have the potential of enhancing patient care and of affecting policies; which, in turn, can provide consistency of care between health sectors. Systematic reviews and meta-analytic studies on the topic may provide solid data for developing evidence based guidelines. In addition, determining the prevalence rates and risk factors regarding postpartum

PT

depression can guide health professionals in taking protective precautions and in making early

RI

interventions. Modifying health policies (pregnancy and postpartum follow ups) for women at

SC

risk may lead to increasing the importance placed on postpartum depression. It may also lead to focusing on this topic in the education of health professionals. Providing that women at risk

NU

more extensively receive professional help on the topic of postpartum depression will positively affect mother-infant health. This study will help women who are facing the risk of

MA

PPD to receive professional help and therefore will help enhance the health of both the mother

D

and the baby.

PT E

CONCLUSION

In this systematic review and meta-analysis, the prevalence of PPD in Turkey was determined

CE

to be 23.8%. The prevalence of PPD in developed cities was 21.2%, and the prevalence of PPD was 25% in developing cities. The most prevalent risk factors were determined to be

AC

economic status and the employment status of the spouse among socio-demographic characteristics; unplanned pregnancy and going through a stressor/illness during pregnancy among pregnancy-related characteristics; health problems in the newborn among newbornrelated characteristics; and past psychiatric illness, problems with the family and spouse, reduced social support, and a history of psychiatric illness in the family among psychosocial characteristics. In this study, the prevalence of PPD in Turkey was determined to be high. This evidence may

ACCEPTED MANUSCRIPT be used to guide future studies and health policies. From now on, rather than determining prevalence and risk factors, randomized controlled studies evaluating the effectiveness of interventions are needed, as such studies are currently insufficient. Studies on theory-based preventive and treatment methods suggest that midwives and nurses should operate in a manner congruent with local cultures and take into account how determined risk factors

PT

should be dealt with. Additionally, the policies of a specific country regarding monitoring

RI

women under risk of PPD in both the antenatal and postpartum periods, through house visits

SC

for depression screening and supplying professional help should be considered. Acknowledgment

MA

services forimproving ourpapers' quality.

NU

We have received help in statisticaland editing services. We would like to thank both the

Data Collection and Analysis: NKÖ, HD

PT E

Study Design: NKÖ, NEB, HD

D

Contributors

AC

REFERENCES

CE

Manuscript Writing: NKÖ, NEB, HD

Apter-Levy Y, Feldman M, Vakart A, Ebstein RP, Feldman R. Impact of maternal depression across the first 6 years of life on the child’s mental health, social engagement, and empathy: the moderating role of oxytocin. Am J Psychiatry. 2013; 170: 1161-1168. Beck CT. Predictors of postpartum depression: an update. Nurs Res. 2001; 50: 275–85. Beydoun HA, Al-Sahab B, Beydoun MA, Tamim H. Intimate partner violence as a risk factor for postpartum depression among Canadian women in the Maternity Experience Survey.

ACCEPTED MANUSCRIPT Ann Epidemiol. 2010; 20: 75–583. Borenstein M, Hedges LV, Higgins JPT & Rothstein HR Introduction to meta-analysis (Trans. Serkan Dinçer), Anı Yayıncılık, Ankara, 2013. Dennis CL. Psychosocial and psychological interventions for prevention of postnatal depression: systematic review. BMJ. 2005; 331: 1-8.

PT

Dennis CL & Dowswell T. Psychosocial and psychological interventions for preventing

RI

postpartum depression (Review). Cochrane Database Systematic Review 2013; 2: 1-

SC

206.

Eastwood JG, Jalaludin BB, Kemp LA, Phung HN, Barnett BE. Relationship of postnatal

NU

depressive symptoms to infant temperament, maternal expectations, social support and other potential risk factors: findings from a large Australian cross-sectional study. BMC

MA

Pregnancy and Childbirth. 2012; 12: 1-11.

Erdem O, Bucaktepe PGE. The prevalence and screening methods of postpartum depression.

D

Dicle Medical Journal 2012; 39: 458-461.

PT E

Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;

CE

106: 1071–83.

Gjerdingen D, McGovern P, Attanasio L, Johnson PJ, Kozhimannil KB. Maternal depressive

AC

symptoms, employment, and social support. J Am Board Fam Med. 2014; 27: 87-96. Halbreich U, Karkun S. Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms. J Affect Disord. 2006; 91: 97–111. Hayes, DK, Ta VM, Hurwitz EL, Mitchell-Box KM, Fuddy LJ. Disparities in self-reported postpartum depression among Asian, Hawaiian, and Pacific Islander Women in Hawaii: Pregnancy Risk Assessment Monitoring System (PRAMS) 2004–2007. Matern Child Health J. 2010; 14: 765– 773.

ACCEPTED MANUSCRIPT Helle N, Barkmann C, Bartz-Seel J, et al. Very low birth-weight as a risk factor for postpartum depression four to six weeks postbirth in mothers and fathers: Crosssectional results from a controlled multicentre cohort study. J Affect Disord. 2015; 180: 154-161. Lanes A, Kuk JL, Tamim H. Prevalence and characteristics of postpartum depression

PT

symptomatology among Canadian women: a cross-sectional study. BMC Public Health

RI

2011; 11: 302-311.

SC

Ludermir AB, Lewis G, Valongueiro SA, Araujo TV, Araya R. Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort

NU

study. Lancet 2010; 376: 903–910.

Mann R, Gilbody S, Adamson J. Prevalence and incidence of postnatal depression: what can

MA

systematic reviews tell us? Arch Womens Ment Health. 2010; 13: 295-305. Martini J, Petzoldt J, Einsle F, Beesdo-Baum K, Höfler M, Wittchen HU. Risk factors and

D

course patterns of anxiety and depressive disorders during pregnancy and after delivery:

PT E

A prospective-longitudinal study. J Affect Disord. 2015; 175: 385-395. Milgrom J, Gemmill AW, Bilszta JL, et al. Antenatal risk factors for postnatal depression: a

CE

large prospective study. J Affect Disord. 2008; 108: 147-157. Norhayati MN, Hazlina NN, Asrenee AR, Emilin WW. Magnitude and risk factors for

AC

postpartum symptoms: A literature review. J Affect Disord. 2015; 175: 34-52. O’Hara MW, Swain AM. Rates and risks of postpartum depression: a meta-analysis. Int Rev Psychiatry. 1996; 8: 37–54. O'Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol. 2013; 9: 379-407. Parsons CE, Young KS, Rochat TJ, Kringelbach ML, Stein A. Postnatal depression and its effects on child development: a review of evidence from low-and middle-income

ACCEPTED MANUSCRIPT countries. Br Med Bull. 2011; 101: 57-79. Polit DF, Beck CT. Literature reviews: finding and reviewing research evidence. In: Polit DF, Tatano BC, eds. Essentails of Nursing Research: Appraising Evidence for Nursing Practice. 7thed. Philadelphia: Lippincott Williams & Wilkins, p.169-93. 2009. Ramchandani P, Richter L, Stein A, Norris SA. Predictors of postnatal depression in an urban

PT

South African cohort. J Affect Disord. 2009; 113: 279–284.

RI

Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum

SC

depression: a synthesis of recent literature. Gen Hosp Psychiatry. 2004; 26: 289–95. Small R, Lumley J, Yelland J Cross-cultural experiences of maternal depression: associations

NU

and contributing factors for Vietnamese, Turkish and Filipino immigrant women in Victoria, Australia. Ethnicity & Health. 2003; 8: 189-206.

MA

Turkey Public Health Agency. Postpartum care management guide. Ministry of Health Publications, Ankara, 2014.

D

Valentine JM, Rodriguez MA, Lapeyrouse LM, Zhang M. Recent intimate partner violence as

PT E

a prenatal predictor of maternal depression in the first year postpartum among Latinas. Arch Womens Ment Health. 2011; 14: 135-143.

CE

Vigod SN, Villegas L, Dennis CL, Ross LE. Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: a systematic

AC

review. BJOG. 2010; 117: 540-550. Villegas L, McKay K, Dennis CL, Ross LE. Postpartum depression among rural women from developed and developing countries: a systematic review. J Rural Health. 2011; 27: 278-288. Wittkowski A, Gardner PL, Bunton P, Edge D. Culturally determined risk factors for postnatal depression in Sub-Saharan Africa: A mixed method systematic review. J Affect Disord. 2014; 163: 115-124.

ACCEPTED MANUSCRIPT

Records identified through database searches (n= 892)

AC

CE

PT E

D

MA

NU

SC

Records after duplicates and irrelevant removed (n=92)

RI

PT

Titles/abstracts excluded (because article did notincluded depression prevalence and duplicated) (n= 800)

Studies were included in review (n=52)

Figure 1. Flow chart to illustrate results of search strategy

Titles/abstracts excluded, with reasons (n=40)  25 Ineligible publication type (21 review, 3 gray literature and 1 case report),  12 studies only conducted in pregnancy period,  1 study conducted with infertile woman,  1 study conducted with mothers of babies with infantile colic,  1 study conducted with mothers of infants in intensive care

ACCEPTED MANUSCRIPT

Socio-demographic Characteristics

Education 27 (√); 12(-) Economic 11 (√); 15 (-)

 

Employment 18 (√); 12(+); 2(-) People number in family 12 (√); 5(+)

 

Spouse education 8 (√); 7 (-) Spouse employment 5 (√); 9 (-)



Marriage duration 5 (√); 1 (+); 1(-)



Marriage age 7 (√); 4 (-); 1(+)



Gestational age 3 (√)

 

Pregnancy number 11 (√); 3 (+) Miscarriage/Stillbirth history 9 (√); 6 (+)



Planned pregnancy 15 (√); 17 (-)

 

Stressful events during pregnancy 11 (√); 11 (+) Delivery mode 16 (√); 6 (+)NSD

  

PT

Age 29 (√); 2 (+);3 (-)

 

Antenatal care 5 (√); 3 (-) Parity 5 (√); 2 (-) Blood values 2(+)

MA

NU

SC

RI



Pregnancy-related Characteristics

PT E

D

PPD

Newborn-related Characteristics

 

Child number 13 (√); 7 (+) Infant weight 13 (√); 1 (-)



Health problems in infant 6 (√); 14 (+)



Breastfeeding 13 (√); 6 (-)

AC

CE



Gender 17 (√); o Female 2 (+) o Male 1 (+) Gender satisfaction 1 (-); 1 (√)



Psychological Characteristics  

Relationship problems with spouse and family 1 (√); 19 (+) Social support 7 (√); 12 (-)

 

Psychiatric illness history 9 (√); 24 (+) Psychiatric illness in family 6 (√); 7 (+)

     

Premenstrual complaints 3 (√); 4 (+) Personality disorder 1(+) Anxiety 1 (√); 3 (+) Attachment 3 (+) Quality of life 1(+) Violence history 1 (√); 4(+)

 

Smoking 3 (√); 4 (+) Sports 1(+)

Figure 2: PPD risk factors identified in primary studies *(√) Relation questioned but not determined statistical significance *(+) Positive correlation/significance *(-) Negative correlation/significance

ACCEPTED MANUSCRIPT Table 1. Summary of Primary Studies Examining Postpartum Depression (PPD) in Turkey Author (Year)

1.

Vural and Akkuzu (1999)

Setting

Sample (Time of recruitment)

Ankara

Design

Data Collection Tool

Prevelance

Quality

(%)

score

- BDS

21,2

8

- BDS - SPSS - STAI

12

8

- EPDS

14

8.5

Descriptive/ Cross sectional

- EPDS

27,2

10

Cohort

- EPDS

19,5

7

Descriptive/ Cross sectional

- EPDS

40,4

8

1477 (Postpartum 24 month)

Descriptive/ Cross sectional

- EPDS

29

9

750 (Postpartum 12 month)

Descriptive/ Cross sectional

- EPDS

28

8

728 (Postpartum 12 month)

Descriptive/ Cross sectional

- EPDS

34,6

10

90 (Postpartum 10. day)

Descriptive/ Cross sectional

100 (Postpartum 1-2 day)

Descriptive/ Cross sectional

257 (Postpartum 1-6 month)

Descriptive/ Cross sectional

Obstetrics clinic 2.

Cebeci et al. (2002)

Ankara

T P

I R

Obstetrics clinic 3.

Danaci et al. (2002)

Manisa

C S U

Primary health care services (10) 4

Inandi et al. (2002)

Erzurum, Elâzıg, Malatya, Konya, Kayseri

2514 ( Postpartum 12 month)

N A

Primary health care services 5.

Atasoy et al. (2004)

Zonguldak

97 ( Postpartum 1 and 6 week)

Obstetrics clinic 6.

Ekuklu et al. (2004)

Edirne Primary health care services

7.

Bugdayci et al. (2004)

Nur et al. (2004)

PT

Mersin

E C

Primary health care services 8.

Sivas

D E

M

178 ( Postpartum 6 week)

C A

Primary health care services (7) 9.

Aydin et al. (2005)

Erzurum

Primary health care services (7)

ACCEPTED MANUSCRIPT Table 1. (continued) Author (Year)

Setting

Sample (Time of recruitment)

Design

Data Collection Tool

Prevelance (%)

10.

Inandi et al. (2005)

Mersin, Sivas, Manisa

Sabuncuoglu and Berkem (2006)

İstanbul

31

9

I R

- EPDS

30

8

Descriptive/ Cross sectional

- EPDS

23,1

8

Descriptive/ Cross sectional

- BDS

21,8

7.5

Cohort

-

EPDS BDS GHQ BAI

28,1

9

66 (3 interview: in pregnancy, Postpartum 2. week and 6 month)

Cohort

- EPDS

22,7

8

125 (4 interview: 36- 38 week in pregnancy,

Cohort

- EPDS

16,8

9

Descriptive/ Cross sectional

80 (Postpartum 2-18 month)

Descriptive/ Cross sectional

T P

Pediatric clinics (3) and Primary health care services 12.

Sunter et al. (2006)

Samsun

Tasdemir et al. (2006)

Gaziantep

101 (Postpartum 1 month)

Obstetrics clinic 14.

Ayvaz et al. (2006)

Trabzon

U N

D E

T P E

Obstetrics clinic Ocaktan et al. (2006)

Ankara Primary health care services

16.

17.

Gulseren et al. (2006)

Bingol and Tel (2007)

A M

192 (3 interview: 6 month in pregnancy, Postpartum 6- 8 week and 6 month)

Primary health care services (6)

15.

SC

380 (Postpartum 8. week)

Primary health care services (20) 13.

C C

Erzurum

A

score

- EPDS

1350 (Postpartum 12 month)

Primary health care servicess 11.

Quality

Primary health care services

Postpartum 5-8 week, 10-14 week and 20-26 week

Aksaray

328 (Postpartum 2. week)

Descriptive/ Cross sectional

- EPDS - SPSS

29,9

8

679 (Postpartum 12 month)

Descriptive/ Cross sectional

- EPDS

25,6

11

Obstetrics clinic 18.

Dindar and Erdogan (2007)

Edirne Primary health care services (9)

ACCEPTED MANUSCRIPT Table 1. (continued) Author (Year)

19.

Alkar and Gencoz (2007)

Setting

Sample (Time of recruitment)

Ankara

Design

Data Collection Tool

Akman et al. (2007)

Konya

score

- EPDS - PDLL - MSI

12,96

7

I R

- SCID-I

6,3

10

- EPDS

19

8

Descriptive/ Cross sectional

- EPDS

19,4

9

Descriptive/ Cross sectional

- EPDS

27,2

9

364 (Postpartum 12 month)

Descriptive/ Cross sectional

- EPDS - SPSS

33,2

10

248 (Postpartum 6- 8. week)

Descriptive/ Cross sectional

- EPDS - PSS-Fa, PSS-Fr - GHQ

12,5

9

214 (Postpartum 4. week)

Descriptive/ Cross sectional

- EPDS

23,4

8

302 (Postpartum 4- 36. Hour and 1- 1.5 month)

Cohort

- BSI

11,5

8

78 (Postpartum 0-6 month)

Descriptive/ Cross sectional

- EPDS

39,7

6.5

151 (Postpartum 12 month)

Descriptive/ Cross sectional

302 (Postpartum 1 day and 6. week)

Cohort

Pediatric clinic 21.

Salgin et al. (2007)

İstanbul

T P

C S U

100 (Postpartum 1, 3 and 6 month

Pediatric clinic 22.

Ozdemir et al. (2008)

Konya

242 (Postpartum 2- 6 month)

N A

Primary health care services (2) 23.

Orhon et al. (2008)

Ankara

Ege et al. (2008)

Malatya

D E

T P E

Primary health care services 25.

Arslantas et al. (2009)

M

103 (Postpartum 1 month)

Pediatric clinics 24

Aydın

C C

Cohort

Primary health care services (9) 26.

Efe et al. (2009)

Ankara

A

Quality

(%)

Obstetrics clinic 20.

Prevelance

Obstetrics clinic 27.

Orun et al. (2009)

Ankara Obstetrics clinic

28.

Ak 2010

Malatya Primary health care services

ACCEPTED MANUSCRIPT Table 1. (continued) Author (Year)

Setting

Sample (Time of recruitment)

Design

Data Collection Tool

Prevelance (%)

29.

30.

Kirpinar et al. (2010)

Durat and Kutlu (2010)

Erzurum

479 (3 interview: 3 month in pregnancy,

Primary health care services (10)

Postpartum 1. week and 6 week)

Sakarya

126 (Postpartum 4. week)

Cohort

T P

Descriptive/ Cross sectional

I R

Unspecified 31.

Gulnar et al. (2010 )

Ankara

C S U

33.

Erdem et al. (2010)

Yagmur, Ulukoca (2010)

Durukan et al. (2011)

35.

Yildirim et al. (2011)

7

Descriptive/ Cross sectional

- EPDS - SPSS

21

10

708 (Postpartum 18 month)

Descriptive/ Cross sectional

- EPDS - WHOQOLBREF QL

15

9

197 (Postpartum 12 month)

Descriptive/ Cross sectional

- EPDS - SPSS

51,3

9

123 (Postpartum 8. week)

Descriptive/ Cross sectional

- EPDS

30,1

8

183 (Postpartum 12 month)

Descriptive/ Cross sectional

- EPDS

30,6

6

110 (Postpartum 12 month)

Descriptive/ Cross sectional

- EPDS

9,1

9

785 (Postpartum 12 month)

Yucesoy et al. (2011)

Kocaeli

D E

37.

Battaloglu et al. (2012)

İstanbul

A

N A

M

T P E

C C

10

28,6

Malatya

36.

24

- BDS - STAI

Postpartum 3 month)

Obstetrics clinic

- EPDS - BDS - SCL-90-R

Cohort

Obstetrics clinic

Erzincan

11

9

49 (2 interviews: last 3months in pregnancy,

Primary health care services (6)

14

35,5

Diyarbakır

Ankara

- EPDS - STAI - MSPSS

- EPDS

Primary health care services (5) 34.

score

Descriptive/ Cross sectional

141 (Postpartum 0- 24. week)

Obstetrics clinic 32.

Quality

Pediatric clinic 38.

Serhan et al. (2012)

Eskişehir Primary health care services

ACCEPTED MANUSCRIPT Table 1. (continued) Author (Year)

39.

Gumuş et al. (2012)

Setting

Sample (Time of recruitment)

Çanakkale

Data Collection Tool

Design

Goker et al. (2012)

Manisa

score

- EPDS

26,2

9

- EPDS

31,4

10

Descriptive/ Cross sectional

- EPDS

26

6

Cohort

- EPDS

11,2

10

Descriptive/ Cross sectional

- EPDS - SPSS

5,7

9

98 (2 interview: Postpartum 3. day, 2. month)

Cohort

8.5

Descriptive/ Cross sectional

EPDS BSI MIBS PBQ EPDS

16,9

187 (Postpartum 4- 6. week)

-

28,9

8

125 (Postpartum 1. week, 1 month and 2. month)

Cohort

- EPDS - Anthropometic measurements

40,9

8

80 (Postpartum 5. month)

Descriptive/ Cross sectional

- EPDS - MAI - SPSS

5

9

221 (Postpartum 12 month)

Descriptive/ Cross sectional

318 (Postpartum 6. week)

Descriptive/ Cross sectional

T P

I R

Obstetrics clinic 41.

Selcuk et al. (2012)

Ankara

C S U

41 (Postpartum 6 month)

Obstetrics clinic 42.

Annagur et al. (2012)

Konya

197 (2 interview: Postpartum 2 day, 6. week)

N A

Obstetrics clinic 43.

Herguner et al. (2013)

Konya

Orun et al. (2013)

Ankara

D E

T P E

Pediatric clinics 45.

Pocan et al. (2013)

Adana

C C

Obstetrics clinic 46.

Beyca et al. (2014)

M

105 (Postpartum 5 month)

Pediatric clinic 44.

İstanbul

A

Obstetrics clinic 47.

Herguner et al. (2014)

Konya Pediatric clinic

Quality

(%)

Primary health care servicess (3) 40.

Prevelance

ACCEPTED MANUSCRIPT Table 1. (continued) Author (Year)

48.

Karakas et al. (2014)

Setting

Sample (Time of recruitment)

Malatya

Design

Data Collection Tool

Kucukoglu et al. (2014)

Elazığ

score

- EPDS

18,4

9.5

- EPDS - BSE

61,8

9.5

Descriptive/ Cross sectional

- EPDS - BAT

25

10

Cohort

- EPDS

35

9

23.2

11

272 (Postpartum 12 month)

Descriptive/ Cross sectional

110 (Postpartum 0- 12 month)

Descriptive/ Cross sectional

T P

I R

Pediatric clinic 50.

Ozkan et al. (2014)

Erzurum

C S U

200 (Postpartum 1 month)

Obstetrics clinic 51.

52.

Kirkhan et al. (2014)

Gur et al. (2014)

Erzurum

360 (2 interview: in pregnancy and

Primary health care services

Postpartum 6 week)

İzmir

208 (3 interview: Postpartum 1., 6 week and 6 month)

D E

Obstetrics clinic

N A

M

EPDS: Edinburg Postpartum Depression Scale BDS: Beck Depression Scale SPSS: Scale of Perceived Social Support MSPSS: Multidimensional Scale of Perceived Social Support SCDI-I: Structured Clinical Interview for DSM-IV Axis I Disorders STAI: The State-Trait Anxiety Inventory MAI: Maternal Attachment Inventory BAT: Breastfeeding Assessment Tool BSE: Breastfeeding Self- Efficacy PBQ: Postpartum Bonding Questionnaire PSS-Fa, PSS-Fr: Perceived Social Support from Family and Perceived Social Support from Friend

T P E

A

C C

Quality

(%)

Primary health care servicess 49.

Prevelance

Cohort

- SCID-I - EPDS - D vitamine

BAI: Beck Anxiety Inventory SCL-90-R: Symptom Distress Check List BSI: Brief Symptom Inventory GHQ: General Health Questionnaire PDLL: Perceived Difficulty Level of Labor MSI: Marital Satisfaction Inventory WHOQOLBREF QL: WHOQOLBREF Quality of Life MIBS: Mother-Infant Bonding Scale

ACCEPTED MANUSCRIPT Table 2. Primary studies which included in systematic review and meta-analysis Ak M. Prevalence and risk factors of postpartum maternal depression in the first six months. Harran Univ Medical Journal. 2010; 7: 39-42. Akman C, Uguz F, Kaya N. Postpartum-onset major depression is associated with personality disorders. Compr Psychiatry. 2007; 48: 343-347. Alkar OY, Gencoz T. Early postpartum depression symptoms among Turkish women: influence of marital satisfaction and perceived difficulty level of the labor. Journal of Crisis. 2007; 15: 1-8.

PT

Annagur A, Annagur BB, Sahin A, Ors R, Kara F. Is maternal depressive symptomatology effective on success of exclusive breastfeeding during postpartum 6 weeks? Breastfeed Med. 2012; 8: 53-57.

SC

RI

Arslantas A, Ergin F, Balkaya NA. Postpartum depression prevalence and related risk factors in Aydin Province. Journal of ADU Medical Faculty. 2009; 10: 13-22.

NU

Atasoy N, Bayar U, Sade H et al. Clinical and sociodemographic risk factors effecting level of postpartum depressive symptoms during postpartum period. Turkiye Klinikleri J Gynecol Obst. 2004; 14: 252-257. Aydin N, Inandi T, Karabulut N. Depression and associated factors among women within their first postnatal year in Erzurum province in eastern Turkey. Women & Health. 2005; 41: 1-12.

MA

Ayvaz S, Hocaoglu C, Tiryaki A, Ak I. Incidence of postpartum depression in Trabzon province and risk factors at gestation. Turk Psikiyatri Derg. 2006; 17: 243-251.

PT E

D

Battaloglu B, Aydemir N, Hatipoglu S. Depression screening and risk factors for depression in mothers with 0-1 year old babies who admitted to the healthy baby outpatient clinic. Medical Journal of Bakirkoy. 2012; 8: 12-21. Beyca HH, Mutlu HH, Ozdamar O. Effect of breastfeeding on depression levels of mothers, weight and height measurements
of babies in the postpartum first two months. Medical Bulletin of Zeynep Kamil. 2014; 45: 124-130.

CE

Bingol TY, Tel H. Perceived Social Support, Postpartum Depression and the Effecting Factors in Women in the Postpartum Period. Journal of Anatolia Nursing and Health Sciences. 2007; 10: 1-6.

AC

Bugdayci R, Sasmaz T, Tezcan H, Kurt AO, Oner S. A cross-sectional prevalence study of depression at various times after delivery in Mersin Province in Turkey. J Women’s Health (Larchmt). 2004; 13: 63-68. Cebeci SA, Aydemir C, Goka E. The prevalance of depressive symptom levels in puerperal period: relationship with obstetric risk factors, anxiety levels and social support. Journal of Crisis. 2002; 10: 11-18. Danaci AE, Dinc G, Deveci A, Sen FS, Icelli I. Postnatal depression in Turkey: epidemiological and cultural aspects. Soc Psychiatry Psychiatr Epidemiol. 2002; 37: 125-9. Dindar I, Erdogan S. Screening of Turkish women for postpartum depression within the first postpartum year: The risk profile of a community sample. Public Health Nurs. 2007; 24: 176-183. Durat G, Kutlu Y. The prevalance of postpartum depression and related factors in Sakarya. New Symposium. 2010; 48: 63-8.

ACCEPTED MANUSCRIPT Durukan E, Ilhan MN, Bumin MA, Aycan S. Postpartum depression frequency and quality of life among a group of mothers having a child aged 2 weeks-18 months. Balkan Med J. 2011; 28: 385393. Efe SY, Taskın L, Eroglu K. Postnatal depression and effecting factors in Turkey. J Turk Ger Gynecol Assoc. 2009; 10: 14-20. Ege E, Timur S, Zincir H, Geckil E, Sunar- Reeder B. Social support and symptoms of postpartum depression among new mothers in Eastern Turkey. J Obstet Gynaecol Res. 2008; 34: 585-593.

PT

Ekuklu G, Tokuc B, Eskiocak M, Berberoglu U, Saltik A. Prevalence of postpartum depression in Edirne, Turkey, and related factors. J Reprod Med. 2004; 49: 908-14.

RI

Erdem O, Bucaktepe PG, Ozen S, Kara IH. Evaluation of anxiety and depression levels of mothers during prepartum and postpartum periods. Duzce Medical Journal. 2010; 12: 24-31.

SC

Goker A, Yanikkerem E, Demet MM, Dikayak S, Yildirim Y, Koyuncu FM. Postpartum depression: is mode of delivery a risk factor?. Int Sch Res Notices. 2012; 616759: 1-6.

NU

Gulseren L, Erol A, Gulseren S, Kuey L, Kilic B, Ergor G. From antepartum to postpartum: a prospective study on the prevalence of peripartum depression in a semiurban Turkish community. J Reprod Med. 2006; 51: 955-960.

MA

Gur EB, Gokduman A, Turan GA et al. Mid-pregnancy vitamin D levels and postpartum depression. Eur J Obstet Gynecol Reprod Biol. 2014; 179: 110-116. Gulnar D, Sunay D, Ceylan A. Risk factors related with postpartum depression. Turkiye Klinikleri J Gynecol Obst. 2010; 20: 141-148.

D

Gumus AB, Keskin G, Alp N, Ozyar S, Karsak A. The prevalence of postpartum depression and associated variables. New Symposium Journal. 2012; 50: 145-154.

PT E

Herguner S, Annagur A, Cicek E, Altunhan H, Ors R. Postpartum depression in mothers of ınfants with very low birth weight. Archieves of Neuropsychiatry. 2013; 50: 30-33.

CE

Herguner S, Annagur A, Cicek E, Altunhan H, Ors R. Association of delivery type with postpartum depression, perceived social support and maternal attachment. Düşünen Adam The Journal of Psychiatry and Neurological Sciences. 2014; 27: 15-20.

AC

Inandi T, Bugdayci R, Dundar P, Sumer H, Sasmaz T. Risk factor for depression in the first postnatal year. Soc Psychiatry Psychiatr Epidemiol. 2005; 40: 725-730. Inandi T, Elci OC, Ozturk A, Egri M, Polat A, Sahin TK. Risk factors for depression in postnatal first year, in eastern Turkey. Int J Epidemiol. 2002; 31: 1201-1207. Karakas NM, Gunes G, Saribiyik M. Risk of postpartum depression and affecting factors in Battalgazi Town. Journal of Inönü University Health Services Vocational School. 2014; 4: 3-15. Kirkan TS, Aydin N, Yazici E, Aslan PA, Acemoglu H, Daloglu AG.The depression in women in pregnancy and postpartum period: A follow-up study. Int J Soc Psychiatry. 2014; 61: 343-349. Kirpinar I, Gozum S, Pasinlioglu T. Prospective study of postpartum depression in eastern Turkey prevalence, socio‐demographic and obstetric correlates, prenatal anxiety and early awareness. J Clin Nurs. 2010; 19: 422-431. Kucukoglu S, Celebioglu A, Coskun D. Determination of the postpartum depression symptoms and

ACCEPTED MANUSCRIPT breastfeeding self-efficacy of the mothers who have their babies hospitalized in newborn clinic. Gumushane University Journal of Health Sciences. 2014; 3: 921-932. Nur N, Cetinkaya S, Bakir DA, Demirel Y. Prevalance of postnatal depression and risk factors in women in Sivas city. CMJ. 2004; 26: 55-59. Ocaktan ME, Calıskan D, Oncu B, Ozdemir O, Kose K. Antepartum and postpartum depression in a primary health care center area. Journal of Ankara University Faculty of Medicine. 2006; 59: 151-157.

PT

Orhon FS, Ulukol B, Soykan A. Risk factors for postpartum depression in a well-child clinic: maternal and infant characteristics. Journal of Ankara University Faculty of Medicine. 2008; 61: 712.

RI

Orun E, Yalcın S, Madendag Y et al. The effects of mothers’ psychopathologies and sociodemographic characteristics on exclusive breastfeeding during postpartum 1-1.5 month. Turkish Pediatric Journal. 2009; 52: 167-175.

NU

SC

Orun E, Yalcın SS, Mutlu B. Relations of maternal psychopathologies, social-obstetrical factors and mother-infant bonding at 2-month postpartum: a sample of Turkish mothers. World J Pediatr. 2013; 9: 350-355. Ozdemir S, Marakoglu K, Civi S. Risk of postpartum depression and affecting factors in Konya center. TAF Prev Med Bull. 2008; 7: 391-398.

MA

Ozkan H, Ust ZD, Gundogdu G, Capik A, Sahin SA. Risk of postpartum depression and affecting factors in Konya center. The Medical Bulletin of Sisli Etfal Hospital. 2014; 48: 125-132.

PT E

D

Pocan AG, Aki OE, Parlakgumus AH, Gereklioglu C, Dolgun AB. The incidence of and risk factors for postpartum depression at an urban maternity clinic in Turkey. Int J Psychiatry Med. 2013; 46: 179-194. Sabuncuoglu O, Berkem M.Relationship between attachment style and depressive symptoms in postpartum women: Findings from Turkey. Turk Psikiyatri Derg. 2006; 17: 252-258.

CE

Salgin A, Gokcay G, Yucel B et al. Effects of postpartum depression on breastfeeding and child development. J Ist Faculty Med. 2007; 70: 70-73.

AC

Selcuk MY, Usman MG, Oktay M, Istanbullu A, Ozdemir O, Saracoglu F. The relationship of Postpartum depression with weight gain during pregnancy and sociodemographic factors. J Turgut Ozal Med Cent. 2012; 19: 256-263. Serhan N, Ege E, Ayranci U, Kosgeroglu N. Prevalence of postpartum depression in mothers and fathers and its correlates. J Clin Nurs. 2013; 22: 279–284. Sunter AT, Guz H, Canbaz S, Dundar C. Postpartum depression in Turkey: Prevalence and related factors. TJOD. 2006; 3: 26-31. Tasdemir B, Kaplan S, Bahar A. Determination of the affecting factors of postpartum depression. Fırat University Medical Journal of Health Sciences. 2006; 1:106. Vural G, Akkuzu G. Determined the depression prevalence of the mothers given normal vaginal birth on the tenth day of their postpartum period. Journal of Cumhuriyet University School of Nursing. 1999; 3: 33-38. Yagmur Y, Ulukoca N. Social support and postpartum depression in low-socioeconomic level

ACCEPTED MANUSCRIPT postpartum women in Eastern Turkey. Int J Public Health. 2010; 55: 543-549. Yildirim A, Hacihasanoglu R, Karakurt P. The relationship between postpartum depression and social support and affecting factors. International Journal of Human Sciences. 2011; 8: 31-46.

AC

CE

PT E

D

MA

NU

SC

RI

PT

Yucesoy G, Ozkan S, Yildiz M, Cakiroglu Y, Bodur H. Postpartum depression: prevalence and contributing risk factors. Turkiye Klinikleri J Gynecol Obst. 2011; 21: 6-12.

ACCEPTED MANUSCRIPT Highlights

-

These results give data on PPD prevalence and risk factors in Turkey.

-

The prevalence of PPD in Turkey is affected by the level of development of the cities.

-

Most of the studies on PPD in our country are descriptive and cross-sectional, and

RI

The EPDS was widely used in evaluating PPD, and PPD was mostly questioned within

CE

PT E

D

MA

NU

SC

the first 12 months postpartum.

AC

-

PT

most of them were performed in developing cities in primary health care services.