RSU and Riga Maternity Hospital study reveals that nearly one in five new mothers experience postpartum depression

The most extensive study to date on improving the detection, care, and treatment of postpartum depression in Latvia has been completed. The study determined how widespread postpartum depression is in Latvia, identified its risk factors, validated two screening tools, and surveyed women’s opinions about the proposed new care model. The research was conducted by the Rīga Stradiņš University (RSU) Department of Psychiatry and Narcology in collaboration with the Riga Maternity Hospital. 

Over the past year, all women, who visited a gynaecologist at the Riga Maternity Hospital on an outpatient basis during the 4th-6th week after childbirth, were surveyed.

It was found that nearly one in five new mothers (18%) suffer from postpartum depression, a rate that is 50% higher than in Western Europe (12.9%) and slightly above the average for Eastern Europe (16.6%).

Researchers are concerned that 30% of women who initially showed symptoms of depression or anxiety declined further consultations or could not be reached for an in-depth psychiatric assessment. At least 40% of the women involved in the study exhibited depressive symptoms at a clinical level. 

Risk and protective factors 

Women are at greater risk of developing postpartum depression if they experience factors such as complications during childbirth or sleep disturbances after delivery. Those who simultaneously suffer from other mental health disorders and experience significant stress during pregnancy are also part of the risk group. Also, lack of emotional support from a partner or close relatives during pregnancy and the postpartum period; insufficient recognition of the mother’s role; low self-confidence about being a good mother; dissatisfaction with childbirth and postnatal care and having a newborn with a lower birth weight (<2500 g) are identified as risk factors for postpartum depression.

Meanwhile, one of the protective mechanisms is receiving practical support from a partner or relatives, both during pregnancy and after childbirth. Many of these factors align with findings from studies conducted in other countries; however, some point to factors specific to Latvia (e.g., mother’s age, first pregnancy, etc.).

 Validation of screening tools in Latvia 

The study involved the validation of two postpartum depression screening tools in Latvia. Until now, there had been no screening instrument in the country specifically tailored to assess the severity of postpartum depression symptoms. According to the literature, one of the most widely used tools worldwide is the Edinburgh Postnatal Depression Scale (EPDS), indicating major depression when the scale is between 8 and 15 points. The researchers determined that the Latvia-specific EPDS cut-off score is 11 points or higher. Another widely used screening tool, the Patient Health Questionnaire-9 (PHQ-9), was also validated for identifying postpartum depression. A score of eight points or higher on the PHQ-9 scale indicates a risk of major depression.

Women’s views on the new care model 

Another part of the study examined women’s opinions on one of the possible solutions to the problem - a model designed to help identify those in need of assistance in a timely manner and to ensure it systematically. This model has proven effective across the world, involving cooperation between family doctors, gynaecologists, midwives, and psychiatrists ensuring that each woman receives the care she needs in due time. In Latvia, such an integrated care system has never been. The women surveyed in the study welcomed the proposed model and offered valuable recommendations for its adaptation in Latvia. 

Further use of research results

‘We are planning to present the detailed research results to the Ministry of Health, professional associations of family doctors and other specialists, the academic community, non-governmental organisations, and the wider public. Scientific publications are also in preparation. 

The validated depression screening tools - the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-9 - will be made accessible for free to healthcare professionals, researchers, and the general public,’ said Prof. Elmārs Rancāns, Head of Department of Psychiatry and Narcology.