Antonella Gigantesco

Although the three anxiety‐related items of the Edinburgh Postnatal Depression Scale (EPDS‐3A) are widely used to flag anxiety‐related distress, their psychometric performance across perinatal phases remains insufficiently established. We evaluated factor structure, measurement invariance, differential item functioning (DIF), score precision and convergence with Generalized Anxiety Disorder–7 (GAD‐7) thresholds in a nationwide Italian sample of 10,100 individuals (4,410 pregnant; 5,690 postpartum). Participants completed the EPDS and GAD‐7. Analyses included exploratory graph analysis, tau‐equivalent ordered‐categorical confirmatory factor analysis, multi‐group invariance testing, DIF analysis, graded‐response item response theory and receiver‐operating characteristic curves. The three anxiety‐related items formed a distinct community, with stronger clustering postpartum. Tau‐equivalent one‐factor fit was stronger postpartum and modest during pregnancy; scalar invariance was supported. DIF was negligible, and item response theory analyses indicated ordered thresholds and meaningful item discrimination. The EPDS‐3A showed moderate convergence with GAD‐7 generalized anxiety symptom thresholds. A score of 5 was the Youden‐selected EPDS‐3A threshold for distinguishing participants above versus below moderate or severe GAD‐7 thresholds in both phases. The EPDS‐3A yields a brief, psychometrically coherent anxiety‐related score across pregnancy and postpartum, but convergence with worry‐related GAD‐7 symptoms does not establish diagnostic or broad perinatal anxiety screening accuracy.

Background: Network analysis was employed to test whether the overall pattern of depressive–anxious symptom connections remains stable or whether specific symptom-to-symptom links shift from pregnancy to postpartum. Methods: In a perinatal sample (n = 4,461 pregnant women, n = 5,711 postpartum women), depressive and anxiety symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder-7 (GAD-7). Phase-specific polychoric Gaussian graphical models were estimated with EBICglass. We examined strength and bridge centrality, community structure, and nodewise predictability, and compared networks using the network comparison test. Results: Depression and anxiety formed four reproducible communities (one GAD-7 worry/arousal and three EPDS affective/anhedonic, anxious–cognitive distress, and depressed affect/sleep–suicidality modules) with identical partitions across phases. Global strength was similar, but postpartum networks showed higher edge density and more negative partial correlations, suggesting localized changes in which symptom pairs were directly linked—and how strongly—across phases. Across phases, Sadness, Crying, Uncontrollable worrying, and Trouble relaxing were most central and predictable. Worry-, arousal-, and sleep-related symptoms (e.g., hard to sleep) showed the strongest bridge centrality postpartum, and Self-harm was a prominent bridge during pregnancy; several edges shifted between phases, including stronger Enjoyment–Self-harm and weaker Hard to sleep–Self-harm postpartum. Conclusions: Perinatal depression and anxiety organize into cohesive yet partially distinct symptom networks that remain globally stable but show localized shifts in direct symptom-to-symptom connections from pregnancy to postpartum. Central affective and arousal nodes, particularly sadness, pathological worry, and sleep disturbance, may be high-yield targets for phase-tailored screening and intervention.

There is no doubt that the Internet has such an important and relevant role in life that we cannot reasonably believe that we want and can live without it (Unicef, 2017). Researchers working in the psychoeducational field ask schools and educators to use such technology in ways that could be productive (Thompson, 2013). Learning digital activities such as online videos and serious games can be particularly useful, for example, to improve emotional, social, and decision-making skills (Campbell et al., 2010; Albert and Steinberg, 2011). The authors of this paper have developed a program for middle school students aimed at the prevention of Internet abuse. The program based on serious games has been developed within a multi-regional project funded by the Ministry of Health under the CCM Call (National Centre for Disease Prevention and Control) in 2018. Here we will briefly describe the program and present the main results of its implementation that involved schools from different Regions and provinces of Italy, such as the Autonomous Province of Trento, Lombardy, Lazio, Marche and Molise.

The paper evaluates a digitally-supported pedagogical tool for promoting well-being from the perspective of students (N=428) and teachers (N=43) from nine secondary schools in five European countries (Poland, Italy, Great Britain, Lithuania, Bulgaria). Each of the eight thematic modules (decision making, coping with anger and aggressiveness, conflict resolution, stress management, self-esteem and self-awareness, collaboration and teamwork skills, empathy, communication skills) included in the online educational training was evaluated. Students demonstrated high satisfaction with the tool; however, there were differences between modules (Self-esteem and Stress management were the most appreciated, Communication the least). The students’ assessment was influenced by age, gender and national differences, while the teachers’ evaluation of usefulness and sustainability was influenced by nationality. Digitally-supported school-based programs can promote well-being among adolescents; however, the interventions need to address differences between boys, girls and nationalities in order to be effective. Teachers, as an immanent part of school life, should be engaged in promoting health programs.

Introduction. This review aims to synthesise the studies that have estimated the preva-lence of perinatal depression in Italy, summarising the results of the existing literature based on their quality.Materials and metbods. 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 & GE;9 and 11.1% (CI 95% 6.0-16.2) for an EPDS cut-off score & GE;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.

Increasing evidence suggests that during the COVID-19 pandemic, anxiety and depression during the perinatal period increased. The aim of the study is to estimate the prevalence of risk for both maternal depression and anxiety among women attending 18 healthcare centres in Italy during the SARS-COV-2 pandemic and to investigate the psychosocial risks and protective factors associated. It was divided into a retrospective phase (2019, 2020, and the first nine months of 2021) and a prospective phase (which began in November 2021 and it is still ongoing), which screened 12,479 and 2349 women, respectively, for a total of 14,828 women in the perinatal period. To evaluate the risk of anxiety and depression, the General Anxiety Disorder-7 (GAD-7), the Edinburgh Postnatal Depression Scale (EPDS), and an ad hoc form were used to collect sociodemographic variables. In the prospective study, the average age of the women is 31 (range 18–52) years. Results showed that the percentage of women who had EPDS score ≥9 increased from 11.6% in 2019 to 25.5% in the period ranging from November 2021 to April 2022. In logistic regression models, the variables associated with the risk of depression at a level ≤0.01 include having economic problems (OR 2.16) and not being able to rely on support from relatives or friends (OR 2.36). Having the professional status of the housewife is a lower risk (OR 0.52). Those associated with the risk of anxiety include being Italian (OR 2.97), having an education below secondary school level (OR 0.47), having some or many economic problems (OR 2.87), being unable to rely on support from relatives or friends (OR 2.48), and not having attended an antenatal course (OR 1.41). The data from this survey could be useful to determine the impact of the SARS-COV-2 pandemic on women and to establish a screening program with common and uniformly applied criteria which are consistent with national and international women’s mental health programs.

Introduction: There is ongoing interest in using brief screening instruments to identify perinatal depression in clinical practice. One ultra‐brief screening instrument for depression is the Patient Health Questionnaire‐2 (PHQ‐2), but thus far its accuracy in perinatal clinical practice has been barely researched. In the present study, we aimed to assess the screening accuracy of the PHQ‐2 against the Patient Health Questionnaire‐9 (PHQ‐9) in a large sample of perinatal women.Methods: A total of 1155 consecutive women attending 11 health care centers throughout Italy completed the PHQ‐9 (which includes the PHQ‐2) during pregnancy (27‐40 weeks) or postpartum (1‐13 weeks). Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio positive, likelihood ratio negative, and overall accuracy were calculated using cut points 3 or greater and 2 or greater.Results: During pregnancy, PHQ‐2 greater than or equal to 3 revealed low sensitivity (38.4%‐44.7%) but high specificity (97.8%‐99.3%). In postpartum, it revealed moderate sensitivity (56.9%‐70.6%), high specificity (95.8%‐99.8%), and fair overall accuracy in pregnancy (70%). The alternative threshold greater than or equal to 2 revealed very high sensitivity (pregnancy: 92.1%‐95.2%; postpartum: 87.1%‐95.2%), moderate specificity (pregnancy: 78.1%‐83.2%; postpartum: 68.8%‐81.1%) and good overall accuracy, both during pregnancy (87%) and postpartum (84%).Discussion: The PHQ‐2 provided acceptable accuracy for screening for depression compared with the PHQ‐9. In perinatal screening practice, a threshold of 2 or greater should be preferred as this ensures high sensitivity, missing only approximately 6% to 8% of cases, and a false‐positive rate (percentage of women classified as affected with depressive symptoms when they are not) of 19% to 25%.

Article: Poor social support is associated with preterm birth rather than maternal prenatal anxiety and depression: a retrospective case-control study - Minerva Pediatrics 2021 Oct 14 - Minerva Medica - Journals