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BLE 1. Prevalence of self-reported postpartum depressive symptoms (PDS), by selected characteristics - Pregnancy Risk sessment Monitoring System, 17 states, 2004-2005
10.4$ 10.9$ 8.9$ 12.6$ 13.8$ 5.9$ 8.49 13.0$ 9.79 15.5$ 10.4$ 7.9$ 12.9$ 10.8$ (+2.0) (±1.8) (±2.0) (±1.2) (±2.4) (±1.4) (±1.6) (+2.4) (±1.6) (+2.4) (±2.0) (±1.8) (±1.6) (±2.7) 21.4 20.6 22.7 22.4 20.1 18.9 20.8 24.0 20.2 24.1 21.3 17.5 25.8 (±2.7) (±3.1) (±2.5) (±2.5) (±4.3) (±2.9) (13.3) (±2.9) (±2.2) (+2.4) (±3.9) (+2.7) (+5.9) (±3.5) (+2.2) (±2.7) AK = Alaska, CO = Colorado, GA Georgia, HI Hawaii, MD = Maryland, ME = Maine, MN Minnesota, NC North Carolina, NE = Nebraska, NM - New Mexico, NY New York (excluding New York City), OR = Oregon, RI Rhode Island, SC South Carolina, UT Utah, VT Vermont, and WA = Washington. 95% confidence interval. Confidence intervals are approximate because, when adjusting for the clustered survey design, the confidence intervals computed were close to but not equal to £1.96 × standard error.
9.9$ 7.3$ 8.89 (±1.4) (±1.4) 21.1 19.2
p<0.05 by chi-square test.
Insufficient sample size (based on fewer than 30 respondents).
Includes Asian/Pacific Islander, American Indian/Alaska Native, and other/multiple race/ethnicity.
edian percentage point differences in PDS prevalence for ɔmen with and without these risk factors were using bacco during the last 3 months of pregnancy (16 states; edian difference: 10.7), physical abuse before or during egnancy (17 states; median difference: 22.4), partnerlated stress during pregnancy (17 states; median differce: 16.4), traumatic stress during pregnancy (17 states; edian difference: 16.4), and financial stress during pregncy (17 states; median difference: 9.2). In 14 states, PDS
was significantly associated with delivering a low birth weight infant and experiencing emotional stress during pregnancy. NICU admission was associated with PDS in nine states. The state median percentage point differences in PDS prevalence were 5.7 by low birth weight delivery, 5.2 by emotional stress, and 6.2 by NICU admission. The effect of parity on PDS was unclear; the association was significant in only two states, and the results were inconsistent across all states regarding risk for developing PDS.
TABLE 2. Prevalence of self-reported postpartum depressive symptoms (PDS), by selected risk factors—Pregnancy Risk Assessmer Monitoring System, 17 states, 2004-2005
13.18 13.79 13.0$ 9.7$ 10.19 16.0$ 11.7$
15.6$ 10.8$ 9.18
8.7$ 11.49 (±1.2) (±1.4) (±1.8)
(16.7) (+4.7) (+4.9) (±5.5) (±3.9) (+4.1) (+6.7) (+4.7) (±5.1) (+6.5) (+3.9) (+4.9) (24.7)
AK = Alaska, CO Colorado, GA Georgia, HI Hawaii, MD = Maryland, ME = Maine, MN Minnesota, NC North Carolina, NE = Nebraska, NM - New Mexico, NY = New Yo (excluding New york City), OR = Oregon, RI Rhode Island, SC = South Carolina, UT - Utah, VT Vermont, and WA = Washington.
† 95% confidence interval. Confidence intervals are approximate because, when adjusting for the clustered survey design, the confidence intervals computed were close to bu not equal to +1.96 x standard error.
Stressors during pregnancy were categorized as 1) emotional (a very sick family member had to go into the hospital or someone close to the respondent died), 2) financial the respondent moved to a new address, her husband/partner lost his job, she lost her job, or she had a lot of bills she could not pay; 3) partner-related (the respondent separad or divorced from her husband/partner, she argued more than usual with her husband/partner, or her husband/partner said he did not want her to be pregnant); and 4) traumak (the respondent was homeless, she was involved in a physical fight, she or her husband/partner went to jail, or someone close to her had a problem with drinking/drugs!
ported by: K Brett, PhD, Office of Analysis and Epidemiology, National nter for Health Statistics; W Barfield, MD, Div of Reproductive Health, tional Center for Chronic Disease Prevention and Health Promotion; Williams, ScD, EIS Officer, CDC.
litorial Note: The continuum of depressive disorders. er delivery ranges from "baby blues" to PPD. Although aby blues" is more prevalent, the symptoms of this disder, which occur within the first few weeks after delivery, e less severe and do not require treatment. PPD can cur up to a year after delivery, is more severe, and quires treatment by a physician. PPD has important conquences for the well-being of mothers and their children. r example, in a 2006 study, mothers who reported pressive symptoms were less likely to engage in practices promote child development, such as playing with their ant (7). PPD also might also be associated with disconuation of breastfeeding (8).
The significant associations between PDS and young aternal age and experiencing partner-related stress or ysical abuse indicated in this report are consistent with evious research (2,3). The other significant risk factors · PDS described in this report (i.e., delivery of a low birth ight infant, tobacco use during pregnancy, and expericing traumatic or financial stress) have not been previsly identified as significant factors (3). The associations e not unexpected, given that these risk factors all can be nsidered either actual stressors or indicators of stress durg pregnancy. Further research is needed to examine the ationship between stressors during pregnancy and PDS. sociation of PDS with other potential postpartum stresrs, such as NICU admission and parity, were not consisnt across states and also warrant further study.
The findings in this report are subject to at least four nitations. First, data from the PRAMS survey are based 1 self-report and are not confirmed by physician diagno3. The screening questions used in the survey have a low ecificity (66%) which, although similar to that of other pression screening instruments, might produce a high te of false positives, leading to overestimates of PPD prevance (5). Second, mothers were asked about symptoms perienced since birth, so the duration of time about which mptoms are reported ranged from 2 to 6 months. Some ɔmen might have been misclassified as experiencing PDS cause of depressive symptoms that were not associated th being postpartum, whereas others might have been isclassified because they developed PDS after the interew. However, these possible misclassifications should not fferentially affect subgroups of women and, therefore, ould not affect the associations identified in this report.
Third, additional variables of interest, such as alcohol or illicit drug use, could not be analyzed because of limited sample sizes across all states. Finally, the analysis described in this report could not identify women with preexisting depression who might or might not also have reported PDS. These women might have been classified as experiencing PDS but might have required different interventions to address their condition than other women without history of depression. A study conducted by a health maintenance organization found that 54.2% of women with PPD also had been diagnosed with depression either before or during their most recent pregnancy (9).
The findings in this report can be used to estimate the number of women in each state requiring a more complete evaluation (and thus the potential burden on health-care services for those with suspected PPD). Although some states (e.g., Maryland) have already implemented methods for addressing PPD, more targeted screening and interventions for PPD could be directed at women at higher risk for developing PPD and incorporated into existing public health programs (e.g., those that address women who were physically abused). These women also could be more effectively targeted for public health interventions developed according to state and local needs and resources. Adolescent mothers or women who received Medicaid for their delivery are examples of subsets of the population at increased risk for developing PPD that could be easily identified at delivery for interventions in the postpartum period.
The American College of Obstetricians and Gynecologists includes screening for PPD among the essential parts of a women's 4-6 week postpartum visit. Postpartum women also can be screened for PPD by pediatricians at their infants' well-child visits (10). Women who are considered to have self-reported PDS based on these screenings should be administered a full diagnostic interview because they are most likely to develop PPD. State and local health departments and other health-care providers can use these screening results in their maternal and child health needs assessments and in planning for the provision of appropriate mental health services to new mothers. Additionally, the effectiveness of targeting services to mothers at higher risk for PPD should be evaluated.
The findings in this report are based on contributions by members of the PRAMS Working Group and the CDC PRAMS Team, Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.
1. O'Hara MW, Swain AM. Rates and risk of postpartum depression-A meta-analysis. Int Rev Psychiatry 1996;8:37-54.
2. Schmidt RM, Wiemann CM, Rickert VI, Smith EO. Moderate to severe depressive symptoms among adolescent mothers followed four years postpartum. J Adolesc Health 2006;38:712-8.
3. Gross KH, Wells CS, Radigan-Garcia A, Dietz PM. Correlates of selfreports of being very depressed in the months after delivery: results from the Pregnancy Risk Assessment Monitoring System. Matern Child Health J 2002;6:247–53.
4. Shulman HB, Gilbert BC, Lansky A. The Pregnancy Risk Assessment Monitoring System (PRAMS): current methods and evaluation of 2001 response rates. Public Health Rep 2006;121:74–83.
5. Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med 1997;12:439-45.
6. Berg AO. Screening for depression: recommendations and rationale. Am J Nurs 2002;102:77–80.
7. McLearn KT, Minkovitz CS, Strobino DM, Marks E, Hou W. Maternal depressive symptoms at 2 to 4 months post partum and early parenting practices. Arch Pediatr Adolesc Med 2006;160:279–84. 8. Taveras EM, Capra AM, Braveman PA, Jensvold NG, Escobar GJ, Lieu TA. Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics 2003;112:108–15. 9. Dietz PM, Williams SB, Callaghan WM, Bachman DJ, Whitlock EP, Hornbrook MC. Clinically identified maternal depression before, during, and after pregnancies ending in live births. Am J Psychiatry 2007; 164:1515-20.
10. Chaudron LH, Szilagyi PG, Campbell AT, Mounts KO, McInerny TK. Legal and ethical considerations: risks and benefits of postpartum depression screening at well-child visits. Pediatrics 2007;119:123-8.
Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food 10 States, 2007
The Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program collects data from 10 U.S. states* regarding diseases caused by pathogens commonly transmitted through food. FoodNet quantifies and monitors the incidence of these infections. by conducting active, population-based surveillance for laboratory-confirmed infections (1). This report describes preliminary surveillance data for 2007 and compares them with data for previous years. In 2007, the estimated incidence of infections caused by Campylobacter, Listeria, Shiga toxin-producing Escherichia coli O157 (STEC O157), Salmonella, Shigella, Vibrio, and Yersinia did not change significantly, and Cryptosporidium infections increased compared with 2004-2006. Progress toward the targets
*Connecticut, Georgia, Maryland, Minnesota, New Mexico, Oregon, Tennessee, and selected counties in California, Colorado, and New York.
for Healthy People 2010 national health objectives 2 targets (2) regarding the incidence of foodborne infectio... occurred before 2004; however, none of the targets wer reached in 2007. Salmonella incidence was the furthest fro its national health target, suggesting that reaching th target will require new approaches.
In 1996, FoodNet began active, population-based st veillance for laboratory-confirmed cases of infection cause by Campylobacter, Listeria, Salmonella, STEC O Shigella, Vibrio, and Yersinia. FoodNet added surveillanc for cases of Cryptosporidium and Cyclospora infection in 197 and STEC non-0157 infection in 2000. In 2004, FoodN began collecting data regarding which laboratory-confirme infections were associated with outbreaks.
Infection with STEC O157 can cause hemolytic urem syndrome (HUS), a complication in which the kidneys HUS surveillance, which began in 2000, is conducted nine states through a network of pediatric nephrologis and infection-control practitioners and validated throug review of hospital discharge data. Because of the tim required for review of hospital records, this report contain preliminary HUS data for 2006.
During 1996-2007, the FoodNet surveillance popula tion increased from 14.3 million persons (5% of the US population) in five states to 45.5 million persons (15% the U.S. population) in 10 states. The preliminary in dence for 2007 was calculated by dividing the number laboratory-confirmed infections by population estimates fer 2006. Final incidence will be reported when populatio estimates for 2007 are available from the U.S. CensBureau. In previous years, final incidence has bec comparable to preliminary incidence.
In 2007, a total of 17,883 laboratory-confirmed cases of infection in FoodNet surveillance areas were identified. T number of cases and incidence per 100,000 population were reported as follows: Salmonella (6,790; 14.924 Campylobacter (5,818; 12.79), Shigella (2,848; 6.20 Cryptosporidium (1,216; 2.67), STEC O157 (545; 1.20 STEC non-O157 (260; 0.57), Yersinia (163; 0.36 Listeria (122; 0.27), Vibrio (108; 0.24), and Cyclospora (!? 0.03). Substantial variation occurred across surveillance site (Table). The highest incidence per 100,000 population for Salmonella (62.11), Shigella (27.77), Campylobacter (24.01) and STEC O157 (3.66) infections was among children aged <5 years. In 2006, FoodNet identified 82 cases
BLE. Incidence* of laboratory-confirmed bacterial and parasitic infections in 2007 and postdiarrheal hemolytic uremic syndrome US) in 2006, by site and pathogen, compared with national health objectivest-Foodborne Diseases Active Surveillance Network, ited States
California Colorado Connecticut Georgia Maryland Minnesota Mexico New York Oregon Tennessee Overall objective
Healthy People 2010 objective 10 targets for incidence of Campylobacter, Salmonella, and Shiga toxin-producing Escherichia coli O157 infections and HUS for 2010 and for incidence of Listeria infections for 2005 and 2010, as revised by midcourse review.
No national health objective exists for these pathogens.
Shiga toxin-producing Escherichia coli.
ncidence of postdiarrheal HUS in children aged <5 years; denominator is surveillance population aged <5 years in sites that conduct hospital discharge data eview.
stdiarrheal HUS in persons aged <18 years (0.78 cases r 100,000 children); 58 (0.7%) cases occurred in chilen aged <5 years (2.01 cases per 100,000 children). Of the 6,299 (92.8%) Salmonella isolates serotyped, en serotypes accounted for 61.6% of infections: Enterdis, 1,062 (16.9%); Typhimurium, 1,006 (16.0%); ewport, 656 (10.4%); I 4,,12:i:-, 358 (5.7%); Javiana, i7 (5.5%); Heidelberg, 243 (3.9%); and Montevideo, 1 (3.4%). Among 102 (94.4%) Vibrio isolates for which be species was identified, 59 (57.8%) were paraemolyticus, 18 (17.7%) were alginolyticus, and 13 (12.8%) re vulnificus. Among 260 STEC non-0157 isolates tested r O antigen determination, 228 (87.7%) had an identible O antigen, primarily O26 (21.5%), O103 (20.6%), 0121 (19.3%).
omparison with Previous Years
A main-effects, log-linear Poisson regression model (negae binomial) was used to estimate statistically significant anges in incidence of infections in 2007 compared with evious years. This model accounts for the increase in the rveillance population and for variations in incidence. nong sites (1). The average annual incidence for 200406 and for 1996-1998 (1997-1998 for Cryptosporidium), e first years of surveillance, were used for comparison.
The estimated change in incidence (relative rate) between 2007 and the comparison periods was calculated, along with 95% confidence intervals (CIs). For HUS surveillance, 2000-2001, the first years of surveillance, was used as the comparison period. Changes over time have not been analyzed for non-0157 STEC, partly because changes in clinical laboratory practices might have affected incidence reporting (3).
The estimated incidence of Campylobacter, Listeria, Salmonella, Shigella, STEC O157, Vibrio, and Yersinia infections (Figure 1) did not change significantly in 2007 compared with 2004-2006, but the estimated incidence of Cryptosporidium infections increased 44% (CI = 8%91%). Among the seven most common Salmonella serotypes, the incidence of Typhimurium and Heidelberg decreased, I 4,, 12:i- and Newport increased, and the others did not change significantly.
In comparison with 1996-1998, relative rates of Yersinia decreased 49% (CI = 36%-59%), Listeria decreased 42% (CI = 28%-54%), Shigella decreased 36% (CI = 9%–55%), Campylobacter decreased 31% (CI = 25%-36%), STEC 0157 decreased 25% (CI = 9%-38%), and Salmonella decreased 8% (CI = 1%-14%) in 2007 (Figure 2). The estimated incidence of infection with Cryptosporidium and Vibrio did not change significantly. The incidence of