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Xue W, Cheng KK, Liu L, Li Q, Jin X, Yi J, Gong W. Barriers and facilitators for referring women with positive perinatal depression screening results in China: a qualitative study. BMC Pregnancy Childbirth 2023; 23:230. [PMID: 37020285 PMCID: PMC10074342 DOI: 10.1186/s12884-023-05532-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Timely screening and referral can improve the outcomes of perinatal depression (PND). However, uptake rates of referral after PND screening are low in China and the reasons are unclear. The aim of this article is to explore the barriers and facilitators for referring women with positive results of PND screening in the Chinese primary maternal health care system. METHODS Qualitative data were collected from four primary health centers located in four different provinces of China. Each of the four investigators conducted 30 days of participant observations in the primary health centers from May to August 2020. Data were collected via participant observations and semi-structured in-depth interviews with new mothers who had positive results of PND screening, their family members, and primary health providers. Two investigators analyzed qualitative data independently. A thematic analysis was conducted, and data were framed using the social ecological model. RESULTS A total of 870 hours of observation and 46 interviews were carried out. Five themes were identified: individual (new mothers' knowledge of PND, perceived need to seek help), interpersonal (new mothers' attitudes towards providers, family support), institutional (providers' perception of PND, lack of training, time constraints), community (accessibility to mental health services, practical factors), and public policy (policy requirements, stigma). CONCLUSIONS The likelihood of new mothers accepting PND referral is related to factors in five areas. Intervention strategies can be developed around these themes and may include educating new mothers and their families about PND, training primary health providers to improve their awareness of condition and indication for referral, building mental health support in routine postpartum home visits, and providing support through mobile technology.
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Affiliation(s)
- Wenqing Xue
- Xiangya School of Public Health, Central South University, 110 Xiangya Road, 410078, Changsha, Hunan, China
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK
| | - Lu Liu
- Xiangya School of Public Health, Central South University, 110 Xiangya Road, 410078, Changsha, Hunan, China
| | - Qiao Li
- Xiangya School of Public Health, Central South University, 110 Xiangya Road, 410078, Changsha, Hunan, China
| | - Xin Jin
- Xiangya School of Public Health, Central South University, 110 Xiangya Road, 410078, Changsha, Hunan, China
| | - Jingmin Yi
- Xiangya School of Public Health, Central South University, 110 Xiangya Road, 410078, Changsha, Hunan, China
| | - Wenjie Gong
- Xiangya School of Public Health, Central South University, 110 Xiangya Road, 410078, Changsha, Hunan, China.
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK.
- Department of Psychiatry, University of Rochester, 14642, Rochester, USA.
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Zhu Y, Yin X, Qiu L, Sun N, An R, Gong Y. Association between breastfeeding and perinatal depressive symptoms: A 13-months cross-lagged analysis in China. Asian J Psychiatr 2023; 82:103474. [PMID: 36709612 DOI: 10.1016/j.ajp.2023.103474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023]
Abstract
Breastfeeding is associated with perinatal depressive symptoms, the directionality of this relationship, however, remains unclear. Therefore, the present study aimed to evaluate the longitudinal relationship between breastfeeding and perinatal depressive symptoms. A longitudinal study was conducted from September 2018 to August 2020 in two cities of China. Depressive symptoms and breastfeeding behaviors were investigated during the third trimester and at 1, 3, 6, and 12 months postpartum. A total of 856 women participated in the present study. The cross-lagged model revealed that after adjustments were made for covariates, depressive symptoms at 3 and 6 months postpartum predicted breastfeeding at 6 and 12 months postpartum, respectively. Additionally, prenatal and 1-month postpartum depressive symptoms were not found to predict breastfeeding. Nor was found that breastfeeding, in turn, predicted depressive symptoms. These results indicated that women who experienced depressive symptoms at 3 months postpartum were more likely to discontinue breastfeeding. The first 3-months postpartum period seems to be the optimal time to identify and treat depressive symptoms to maintain and increase breastfeeding rates. Early intervention of perinatal depressive symptoms is warranted.
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Affiliation(s)
- Yi Zhu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China.
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China.
| | - Lei Qiu
- Department of Epidemiology, School of Public Health, Hainan Medical University, Xue Yuan Road 3, Haikou 571199, Hainan, PR China.
| | - Na Sun
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China.
| | - Rongrong An
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China.
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China.
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Guma E, Andrýsková L, Brázdil M, Chakravarty MM, Marečková K. Perinatal maternal mental health and amygdala morphology in young adulthood. Prog Neuropsychopharmacol Biol Psychiatry 2023; 122:110676. [PMID: 36372293 DOI: 10.1016/j.pnpbp.2022.110676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/11/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
The pre- and perinatal environment is thought to play a critical role in shaping brain development. Specifically, maternal mental health and maternal care have been shown to influence offspring brain development in regions implicated in emotional regulation such as the amygdala. In this study, we used data from a neuroimaging follow-up of a prenatal birth-cohort, the European Longitudinal Study of Pregnancy and Childhood, to investigate the impact of early postnatal maternal anxiety/co-dependence, and prenatal and early-postnatal depression and dysregulated mood on amygdala volume and morphology in young adulthood (n = 103). We observed that in typically developing young adults, greater maternal anxiety/co-dependence after birth was significantly associated with lower volume (right: t = -2.913, p = 0.0045, β = -0.523; left: t = -1.471, p = 0.144, β = -0.248) and non-significantly associated with surface area (right: t = -3.502, q = 0.069, <10%FDR, β = -0.090, left: t = -3.137, q = 0.117, <10%FDR, = -0.088) of the amygdala in young adulthood. Conversely, prenatal maternal depression and mood dysregulation in the early postnatal period was not associated with any volumetric or morphological changes in the amygdala in young adulthood. Our findings provide evidence for subtle but long-lasting alterations to amygdala morphology associated with differences in maternal anxiety/co-dependence in early development.
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Affiliation(s)
- Elisa Guma
- Computational Brain Anatomy Laboratory, Cerebral Imaging Center, Douglas Mental Health University Institute, Montreal, Quebec, Canada; Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
| | - Lenka Andrýsková
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Milan Brázdil
- Brain and Mind Research, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - M Mallar Chakravarty
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada.
| | - Klára Marečková
- Brain and Mind Research, Central European Institute of Technology, Masaryk University, Brno, Czech Republic.
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Osuna E, Symington EA, Malan L, Ricci C, Zandberg L, Smuts CM, Baumgartner J. Higher n-3 polyunsaturated fatty acid status during early pregnancy is associated with lower risk for depression at 12 months postpartum: The NuPED study. Prostaglandins Leukot Essent Fatty Acids 2023; 190:102528. [PMID: 36716632 DOI: 10.1016/j.plefa.2022.102528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/30/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023]
Abstract
Perinatal depression can negatively affect the health of the mother and her offspring. N-3 polyunsaturated fatty acids (PUFA) may play a role in the aetiology of depression. Therefore, we investigated the association of n-3 PUFA status during early pregnancy with perinatal depression among women living in urban Johannesburg, South Africa. For this prospective analysis, we analysed red blood cell (RBC) total phospholipid fatty acid (FA) composition (% of total FA) of 242 pregnant women at <18 weeks' gestation. We used the Edinburgh Postnatal Depression Scale (EPDS) to identify women at risk for depression (EPDS score ≥9) at <18, 22 and 36 weeks' gestation, and at 6 and 12 months postpartum. RBC EPA status was negatively (β=-0.22, p<0.05), and the AA/EPA ratio positively (β=0.24, p<0.05) associated with EPDS scores at 12 months postpartum. Higher RBC DHA and n-3 index were further associated with lower odds (OR=0.56 [95% CI: 0.32-0.91]; OR=0.63 [95% CI: 0.39-0.94]), while higher n-6/n-3 PUFA and AA/EPA ratios early in pregnancy were associated with higher odds for depression at 12 months postpartum ((OR=2.34 [95% CI: 1.12-4.97]; OR=1.02 [95% CI: 1.00-1.05]). Our results suggest that women with a higher RBC n-3 PUFA status during early pregnancy may be at lower risk for depression at 12 months postpartum.
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Affiliation(s)
- Ester Osuna
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland
| | - Elizabeth A Symington
- Department of Life and Consumer Sciences, University of South Africa, Johannesburg, South Africa
| | - Linda Malan
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research (AUTHER), North-West University, Potchefstroom, South Africa
| | - Lizelle Zandberg
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Jeannine Baumgartner
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland; Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa; Department of Nutritional Sciences, King's College London, London, United Kingdom.
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Adlington K, Vasquez C, Pearce E, Wilson CA, Nowland R, Taylor BL, Spring S, Johnson S. 'Just snap out of it' - the experience of loneliness in women with perinatal depression: a Meta-synthesis of qualitative studies. BMC Psychiatry 2023; 23:110. [PMID: 36849948 PMCID: PMC9970854 DOI: 10.1186/s12888-023-04532-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 01/06/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Pregnancy and the arrival of a new baby is a time of great transition and upheaval. Women often experience social isolation and loneliness at this time and may develop depression, particularly in the postnatal period. Qualitative studies have reported that loneliness is also a feature of perinatal depression. However, until now there has been no attempt to synthesise research exploring the links between loneliness and perinatal depression. This study's aim was to explore existing qualitative evidence to answer two research questions: What are the experiences of loneliness for women with perinatal depression? What helps and what makes loneliness worse for women with perinatal depression? METHODS A qualitative meta-synthesis retrieved primary qualitative studies relevant to the research questions. Four electronic databases were systematically searched (Ovid MEDLINE®; PsycINFO; Embase; Web of Science). Papers were screened according to pre-defined inclusion criteria and assigned a quality score. Thematic analysis was used to identify major overarching themes in the literature. RESULTS Twenty-seven relevant qualitative studies were included. Themes relating to the interaction between perinatal depression and loneliness included self-isolation and hiding symptoms due to stigma of perinatal depression and fear of judgement as a 'bad mother'; a sudden sense of emotional disconnection after birth; and a mismatch between expected and actual support provided by partner, family and community. There was also a double burden of loneliness for women from disadvantaged communities, due to increased stigma and decreased social support. Validation and understanding from healthcare professionals, peer support from other mothers with experience of perinatal depression, and practical and emotional family support were all important factors that could ameliorate loneliness. CONCLUSIONS Loneliness appears to play a central role in the experience of perinatal depression based on the frequency with which it emerged in women's accounts. The findings provide a foundation for the development of further theories about the role of loneliness in perinatal depression and evidence in which future psychological and social intervention design processes can be rooted. Addressing stigma and offering culturally appropriate professional and peer support are potential targets for interventions that could help women with perinatal depression, particularly in disadvantaged communities, feel less lonely. TRIAL REGISTRATION Prospero registration: https://www.crd.york.ac.uk/prospero/display_record.php? RecordID = 251,936.
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Affiliation(s)
- Katherine Adlington
- Division of Psychiatry, University College London, London, UK. .,Section of Women's Mental Health, King's College London, London, UK. .,East London NHS Foundation Trust, London, UK.
| | | | - Eiluned Pearce
- Division of Psychiatry, University College London, London, UK
| | - Claire A Wilson
- Section of Women's Mental Health, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Rebecca Nowland
- School of Health and Midwifery, University of Central Lancashire, Preston, UK
| | | | | | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
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Keynejad RC, Bitew T, Mulushoa A, Howard LM, Hanlon C. Pregnant women and health workers' perspectives on perinatal mental health and intimate partner violence in rural Ethiopia: a qualitative interview study. BMC Pregnancy Childbirth 2023; 23:78. [PMID: 36709257 PMCID: PMC9883891 DOI: 10.1186/s12884-023-05352-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/05/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Mental health conditions are common during the perinatal period and associated with maternal, foetal, and neonatal morbidity and mortality. There is an established bidirectional relationship between mental health conditions and intimate partner violence (IPV), including during and after pregnancy. Mean lifetime prevalence of physical, sexual or emotional IPV exposure among women in rural Ethiopia is estimated to be 61% and may be even higher during the perinatal period. We aimed to explore the perspectives of women and antenatal care (ANC) health workers on the relationship between all types of IPV and perinatal mental health, to inform the adaptation of a psychological intervention for pregnant women experiencing IPV in rural Ethiopia. METHODS We conducted in-depth qualitative interviews with 16 pregnant women and 12 health workers in the Gurage zone of the Southern Nations, Nationalities and People's Region of Ethiopia, between December 2018 and December 2019. We conducted thematic analysis of English-translated transcripts of audio-recorded Amharic-language interviews. RESULTS Participants contextualised IPV as the primary form of abusive treatment women experienced, connected by multiple pathways to emotional and bodily distress. Patriarchal norms explained how the actions of neighbours, family, community leaders, law enforcement, and government agents in response to IPV often reinforced women's experiences of abuse. This created a sense of powerlessness, exacerbated by the tension between high cultural expectations of reciprocal generosity and severe deprivation. Women and health workers advocated a psychological intervention to address women's powerlessness over the range of difficulties they faced in their daily lives. CONCLUSIONS Women and health workers in rural Ethiopia perceive multiple, interconnected pathways between IPV and perinatal emotional difficulties. Contrary to expectations of sensitivity, women and health workers were comfortable discussing the impact of IPV on perinatal mental health, and supported the need for brief mental health interventions integrated into ANC.
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Affiliation(s)
- Roxanne C. Keynejad
- grid.13097.3c0000 0001 2322 6764Section of Women’s Mental Health, Health Service and Population Research Department, PO31 David Goldberg Building, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London, SE5 8AF UK
| | - Tesera Bitew
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adiyam Mulushoa
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Louise M. Howard
- grid.13097.3c0000 0001 2322 6764Section of Women’s Mental Health, Health Service and Population Research Department, PO31 David Goldberg Building, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London, SE5 8AF UK
| | - Charlotte Hanlon
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ,grid.7123.70000 0001 1250 5688Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ,grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, PO31 David Goldberg Building, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London, SE5 8AF UK
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Boran P, Dönmez M, Barış E, Us MC, Altaş ZM, Nisar A, Atif N, Sikander S, Hıdıroğlu S, Save D, Rahman A. Delivering the Thinking Healthy Programme as a universal group intervention integrated into routine antenatal care: a randomized-controlled pilot study. BMC Psychiatry 2023; 23:14. [PMID: 36604685 PMCID: PMC9816542 DOI: 10.1186/s12888-022-04499-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/26/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Women with perinatal depression and their children are at increased risk of poor health outcomes. There is a need to implement non-stigmatizing interventions into existing health systems which reduce psychosocial distress during pregnancy and prevent perinatal depression. We adapted the WHO-endorsed Thinking Healthy Programme (THP) to be delivered universally to all women attending routine online pregnancy schools in Istanbul, Turkey. This study aimed to evaluate the feasibility and acceptability of this intervention. METHODS This mixed-methods study incorporated a two-arm pilot randomized controlled trial and qualitative evaluation of the feasibility and acceptability of the adapted THP - Brief Group version (THP-BGV) to a range of stakeholders. We recruited pregnant women at 12-30 weeks' gestation through pregnancy schools within the University Hospital's catchment area. Women in the intervention arm received five online sessions of the THP-BGV delivered by antenatal nurses. The intervention employed principles of cognitive behaviour therapy to provide psychoeducation, behaviour activation, problem-solving strategies and group support to participants. In the control arm, women received usual care consisting of routine online educational pregnancy classes aided by the antenatal nurses. The women were assessed for depressive symptoms with the Edinburgh Postnatal Depression Scale at baseline and 4-6 weeks post-intervention and also evaluated for anxiety, perceived social support, partner relationship, level of disability and sleep quality. In-depth interviews were conducted with women and other key stakeholders. RESULTS Of the 99 consecutive women referred to the pregnancy schools, 91 (91.9%) were eligible and 88 (88.8%) consented to participate in the study and were randomized. Eighty-two (83%) completed the final assessments. Our main findings were that this preventive group intervention was feasible to be integrated into routine antenatal educational classes and it was valued by the women and delivery-agents. While the study was not powered to detect differences between intervention and control conditions, we found small trends towards reduction in anxiety and depressive symptoms favoring the intervention arm. No serious adverse events were reported. CONCLUSIONS Given the paucity of preventive interventions for perinatal depression in low and middle-income countries, a fully powered definitive randomized controlled trial of this feasible and acceptable intervention should be conducted. TRIAL REGISTRATION The study was registered at Clinical Trails.gov ( NCT04819711 ) (Registration Date: 29/03/2021).
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Affiliation(s)
- Perran Boran
- grid.16477.330000 0001 0668 8422Marmara University, School of Medicine, Division of Social Pediatrics, Istanbul, Turkey
| | - Melike Dönmez
- grid.16477.330000 0001 0668 8422Marmara University, School of Medicine, Department of Psychiatry, Istanbul, Turkey
| | - Ezgi Barış
- grid.16477.330000 0001 0668 8422Marmara University, School of Medicine, Division of Social Pediatrics, Istanbul, Turkey ,grid.16477.330000 0001 0668 8422Marmara University, Institute of Health Sciences, Social Pediatrics Doctorate Program, Istanbul, Turkey
| | - Mahmut Caner Us
- grid.16477.330000 0001 0668 8422Marmara University, Institute of Health Sciences, Social Pediatrics Doctorate Program, Istanbul, Turkey
| | - Zeynep Meva Altaş
- grid.16477.330000 0001 0668 8422Marmara University, School of Medicine, Department of Public Health, Istanbul, Turkey
| | - Anum Nisar
- grid.43169.390000 0001 0599 1243School of Public Health, Xi’an Jiaotong University, Xi’an, China
| | - Najia Atif
- grid.490844.5Human Development Research Foundation, Islamabad, Pakistan
| | - Siham Sikander
- grid.490844.5Human Development Research Foundation, Islamabad, Pakistan
| | - Seyhan Hıdıroğlu
- grid.16477.330000 0001 0668 8422Marmara University, School of Medicine, Department of Public Health, Istanbul, Turkey
| | - Dilşad Save
- grid.16477.330000 0001 0668 8422Marmara University, School of Medicine, Department of Public Health, Istanbul, Turkey
| | - Atif Rahman
- University of Liverpool, Department of Primary Care and Mental Health, Waterhouse Buildings Block B, Liverpool, L69 3LH, UK.
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Airaksinen V, Ruohomäki A, Hantunen S, Keski-Nisula L, Luojus MK, Pekkanen J, Tuomainen TP, Heinonen S, Pasanen M, Lehto SM. Longitudinal Analyses of Diet Quality and Maternal Depressive Symptoms During Pregnancy: The Kuopio Birth Cohort Study. J Acad Nutr Diet 2023; 123:77-86.e4. [PMID: 35605960 DOI: 10.1016/j.jand.2022.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 05/09/2022] [Accepted: 05/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Depression and diet quality appear to be associated in the general population. Nevertheless, little is known about their relationship among pregnant females. OBJECTIVE The aims of this study were first, to investigate longitudinally whether or not diet quality is associated with depressive symptoms during pregnancy; second, to examine whether or not variation in diet quality during pregnancy predicts variation in depressive symptoms; and third, to explore how individual dietary components are associated with depressive symptoms. DESIGN A longitudinal secondary analysis of the Kuopio Birth Cohort Study in eastern Finland was conducted. Data were collected from pregnant females during the first and third trimesters of pregnancy. PARTICIPANTS/SETTING The participants were 1,362 pregnant females who entered the study between 2012 and 2017. MAIN OUTCOME MEASURES Depressive symptoms, as measured with the Edinburgh Postnatal Depressive Scale during the first and third trimesters of pregnancy were used as continuous variables. STATISTICAL ANALYSES PERFORMED The main analyses consisted of linear mixed model analyses adjusted for potential confounders to longitudinally assess the association between diet quality as measured by the Healthy Eating Index-2015, calculated using data from a food frequency questionnaire completed during the first trimester and third trimester, and depressive symptoms during the study period. An exploratory set of linear mixed models was also used to longitudinally assess the associations between selected individual food frequency questionnaire food groups and depressive symptoms. RESULTS Descriptive analyses revealed that 12.3% of the participants had clinically relevant levels of depressive symptoms (ie, Edinburgh Postnatal Depressive Scale score ≥10) during either the first or third trimester. Longitudinal modeling suggested that depressive symptoms in pregnant females tend to remain stable throughout pregnancy. Females with a poorer quality diet already displayed higher levels of depressive symptoms during the first trimester of pregnancy (β = -.038 ± .016; P = 0.022). Variation in diet quality did not predict variation in depressive symptoms over the course of pregnancy (β = -9.741 × 10-5 ± .001; P = 0.869). CONCLUSIONS Females entering pregnancy with a poorer quality diet also displayed higher levels of depressive symptoms compared with females with a higher quality diet at the beginning of pregnancy, and this association remained constant throughout pregnancy. Further research is needed to assess the direction and the potential causality of the observed associations between diet quality and depressive symptoms.
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Affiliation(s)
- Ville Airaksinen
- Department of Psychiatry, University of Helsinki, Helsinki, Finland; Institute of Clinical Medicine, Department of Psychiatry, University of Eastern Finland, Kuopio, Finland.
| | - Aleksi Ruohomäki
- Institute of Clinical Medicine, Department of Psychiatry, University of Eastern Finland, Kuopio, Finland
| | - Sari Hantunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Leea Keski-Nisula
- Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Maria Katariina Luojus
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Juha Pekkanen
- Environment Health Unit, National Institute for Health and Welfare, Kuopio, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki, Finland; Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
| | - Markku Pasanen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Soili Marianne Lehto
- Department of Psychiatry, University of Helsinki, Helsinki, Finland; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health Services, R&D Department, Akershus University Hospital, Lørenskog, Norway
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Felder JN, Roubinov D, Zhang L, Gray M, Beck A. Endorsement of a single-item measure of sleep disturbance during pregnancy and risk for postpartum depression: a retrospective cohort study. Arch Womens Ment Health 2023; 26:67-74. [PMID: 36633715 PMCID: PMC9908713 DOI: 10.1007/s00737-022-01287-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023]
Abstract
Poor prenatal sleep quality is associated with increased risk for depressive symptoms but may go undetected in brief, busy prenatal care visits. Among non-depressed pregnant participants, we evaluated whether 1) the endorsement of sleep disturbance on a depression questionnaire predicted postpartum depressive symptoms, 2) the strength of these associations was higher than other somatic symptoms of pregnancy and depression (i.e., fatigue, appetite disturbance), and 3) the endorsement of prenatal sleep disturbance varied by participant characteristics. In this retrospective cohort study, participants had a live birth and completed Patient Health Questionnaire (PHQ-9) during pregnancy and within 8 weeks postpartum between 2012 and 2017. Participants who were non-depressed during pregnancy (PHQ-9 < 10) were included (n = 3619). We operationalized sleep disturbance, fatigue, and appetite disturbance as endorsement of item 3, 4, and 5 on the PHQ-9, respectively, and postpartum depressive symptoms as PHQ-9 total score ≥ 10. Participant characteristic variables included age, race, ethnicity, parity, gestational age at delivery, and preterm birth. Prenatal sleep disturbance was associated with higher odds of postpartum depressive symptoms (aORs 1.9, 95% CI 1.2-3.1 for first trimester; 3.7, 95% CI 1.5-11.5 for second trimester; 3.4, 95% CI 1.9-6.8 for third trimester). Fatigue and appetite disturbance in the first and third trimesters were associated with higher odds of postpartum depressive symptoms. Sleep disturbance varied by race during the first and second trimesters (p < 0.05) and was highest among Black or African American participants (61.8-65.1%). A routinely administered single-item measure of sleep disturbance could identify otherwise lower-risk pregnant individuals who may benefit from depression prevention efforts.
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Affiliation(s)
- Jennifer N. Felder
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA USA ,Osher Center for Integrative Health, University of California, San Francisco, CA USA
| | - Danielle Roubinov
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA USA
| | - Li Zhang
- Department of Medicine, University of California, San Francisco, CA USA ,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
| | - Mark Gray
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO USA
| | - Arne Beck
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO USA
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Kulisewa K, Dussault JM, Gaynes BN, Hosseinipour MC, Go VF, Kutengule A, LeMasters K, Meltzer-Brody S, Midiani D, Mphonda SM, Udedi M, Pence BW, Bengtson AM. The feasibility and acceptability of a task-shifted intervention for perinatal depression among women living with HIV in Malawi: a qualitative analysis. BMC Psychiatry 2022; 22:833. [PMID: 36581849 PMCID: PMC9798611 DOI: 10.1186/s12888-022-04476-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 12/15/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Perinatal depression (PND) is prevalent and negatively impacts HIV care among women living with HIV (WLHIV), yet PND remains under-identified in Malawian WLHIV. Accordingly, this formative study explored perceptions of the feasibility and acceptability of an integrated, task-shifted approach to PND screening and treatment in maternity clinics. METHODS We completed consecutive PND screenings of HIV+ women attending pre- or post-natal appointments at 5 clinics in Lilongwe district, Malawi. We conducted in-depth interviews with the first 4-5 women presenting with PND per site (n = 24 total) from July to August 2018. PND classification was based on a score ≥ 10 on the Edinburgh Postnatal Depression Scale (EPDS). We conducted 10 additional in-depth interviews with HIV and mental health providers at the 5 clinics. RESULTS Most participants endorsed the feasibility of integrated PND screening, as they believed that PND had potential for significant morbidity. Among providers, identified barriers to screening were negative staff attitudes toward additional work, inadequate staffing numbers and time constraints. Suggested solutions to barriers were health worker training, supervision, and a brief screening tool. Patient-centered counselling strategies were favored over medication by WLHIV as the acceptable treatment of choice, with providers supporting the role of medication to be restricted to severe depression. Providers identified nurses as the most suitable health workers to deliver task-shifted interventions and emphasized further training as a requirement to ensure successful task shifting. CONCLUSION Improving PND in a simple, task-shifted intervention is essential for supporting mental health among women with PND and HIV. Our results suggest that an effective PND intervention for this population should include a brief, streamlined PND screening questionnaire and individualized counselling for those who have PND, with supplemental support groups and depression medication readily available. These study results support the development of a PND intervention to address the gap in treatment of PND and HIV among WLHIV in Malawi.
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Affiliation(s)
- Kazione Kulisewa
- Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Faculty of Medicine, Private Bag 360, Blantyre, Malawi
| | - Josée M Dussault
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Bradley N Gaynes
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mina C Hosseinipour
- UNC-Project Malawi, Lilongwe, Malawi
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Katherine LeMasters
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Angela M Bengtson
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, Rhode Island, USA
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Schwartz H, McCusker J, Da Costa D, Singh S, Baskaran S, Belzile E, Van Roost K. A pilot randomized controlled trial of a lay telephone coaching and web-based intervention for postpartum depression and anxiety: The MPOWER study. Internet Interv 2022; 31:100597. [PMID: 36698424 PMCID: PMC9867972 DOI: 10.1016/j.invent.2022.100597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Mental health problems are frequent in the postpartum period, but accessible treatment options are lacking. The MPOWER study investigated whether the use of trained lay coaches could increase the uptake and effectiveness of a web-based intervention (WBI) for women with postpartum depression and/or anxiety. OBJECTIVES First, to compare the feasibility and acceptability of a WBI for women with postpartum depression and anxiety, with and without the addition of telephone coaching calls. Second, to estimate the effectiveness of the WBI at decreasing symptoms of depression and anxiety at 6 months, with and without coaching calls. METHODS We conducted a pilot randomized controlled trial (RCT) that enrolled women who had recently given birth and had mild to moderate postpartum depression and/or anxiety. Study participants were provided access to the WBI. Women randomized to the intervention group also received up to 7 telephone coaching calls during the 6 months of follow up. We evaluated the feasibility of the intervention through participants' usage of the WBI, as well as the completion and fidelity of planned coach calls. We measured acceptability via two questionnaires on the usability of the WBI and participant satisfaction with the intervention. To determine the potential effectiveness of the intervention, the primary outcomes were defined as symptoms of depression and anxiety at 6 months and adjusted mean differences between groups for these outcomes were estimated using linear regression models. RESULTS We recruited 52 participants (25 intervention; 27 control). At 6 months, 88 % (22/25) of participants randomized to the intervention arm and 59 % (16/27) of participants randomized to the control arm remained in the study. The intervention group had an average of 11 (95 % CI: [5, 18]) more website logins than the control group. Intervention group participants completed a mean of 6.2 coaching calls with high fidelity. The estimates of the effect of the intervention on mental health outcomes at 6-months were imprecise but point estimates and confidence intervals were consistent with a moderate beneficial effect of the intervention on both symptoms of depression and anxiety (fully adjusted effects sizes: 0.51 (95 % CI: [-0.14, 1.17]) and 0.56 (95 % CI: [-0.09, 1.22]), respectively). CONCLUSIONS WBIs with coaching are feasible, acceptable, and potentially effective treatment options for women with mild to moderate postpartum depression and/or anxiety. The addition of coaching calls markedly increased engagement with the WBI, but a larger RCT is needed to determine the effectiveness of such an intervention.
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Affiliation(s)
- Hannah Schwartz
- St. Mary's Hospital Center, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada,Corresponding author at: St. Mary's Hospital Center, Department of Psychiatry, 3830 Avenue Lacombe, Montreal, Quebec H3T 1M5, Canada.
| | - Jane McCusker
- St. Mary's Research Centre, Montréal, QC, Canada,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
| | | | - Santokh Singh
- St. Mary's Hospital Center, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | | | - Eric Belzile
- St. Mary's Research Centre, Montréal, QC, Canada
| | - Kaya Van Roost
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
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Bauer A, Knapp M, Matijasevich A, Osório A, de Paula CS. The lifetime costs of perinatal depression and anxiety in Brazil. J Affect Disord 2022; 319:361-369. [PMID: 36162663 DOI: 10.1016/j.jad.2022.09.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Each year, an estimated 860,000 Brazilian women experience depression and anxiety perinatally. Despite well-known devastating impacts of these conditions on mothers and children, they remain neglected in low- and middle-income countries. Knowing the costs of untreated perinatal depression and anxiety can inform decision-making. METHODS Simulation modelling is used to examine lifetime costs of perinatal depression and anxiety for a hypothetical cohort of women and their children, followed until children are aged 40 years. Costs are measured from a societal perspective, including healthcare expenditure, productivity and health-related quality of life losses; 2017 data are taken from country-specific sources. Present values are calculated using a discount rate of 3 %. RESULTS Lifetime cost of perinatal depression and anxiety in Brazil are USD 4.86 billion or R$ 26.16 billion, including costs linked to poorer quality of life (USD 2.65 billion), productivity loss (USD 2.16 billion) and hospital care (USD 0.05 billion). When the costs associated with maternal suicide are included, total costs increase to USD 4.93 billion. LIMITATIONS Several costs could not be included in the analysis because of a lack of data. The study is reliant of longitudinal data on associations between perinatal depression and anxiety and impacts on mothers and children. Therefore, no causality can be inferred. CONCLUSION Our findings illustrate the economic rationale for investment in this area. This is the first study that estimates the costs of perinatal mental health problems in a low- or middle-income country setting.
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Affiliation(s)
- Annette Bauer
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Martin Knapp
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, SP, Brazil.
| | - Ana Osório
- Developmental Disorders Program and Mackenzie Center for Research in Childhood and Adolescence, Universidade Presbiteriana Mackenzie, São Paulo, SP, Brazil.
| | - Cristiane Silvestre de Paula
- Developmental Disorders Program and Mackenzie Center for Research in Childhood and Adolescence, Universidade Presbiteriana Mackenzie, São Paulo, SP, Brazil.
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Suenaga H. Comparison of response options and actual symptom frequency in the Japanese version of the Edinburgh Postnatal Depression Scale in women in early pregnancy and non-pregnant women. BMC Pregnancy Childbirth 2022; 22:937. [PMID: 36522699 PMCID: PMC9753857 DOI: 10.1186/s12884-022-05257-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/28/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The positive predictive rate of the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS) is lower than those of other versions. This study aimed to confirm whether the EPDS Japanese version reflects actual symptom frequency and to examine the possibility of improving the positive predictive rate. METHODS This is a methodological study aimed at improving the positive predictive value of EPDS. The participants were 63 non-pregnant and 382 pregnant women. They answered the 10 questions of the Japanese version of the EPDS and reported the specific number of days as the frequency. The EPDS score (EPDS-S) and the frequency score (FREQ-S) were calculated for three factors of emotion: anhedonia, anxiety, and depression. RESULTS The positive rates of the EPDS-S and FREQ-S in pregnant women were 6% and 8%, respectively, which were lower than those in non-pregnant women (17%). On comparing the EPDS-S with the FREQ-S, a significant underestimation of frequency was observed in approximately 3% of pregnant women. The FREQ-S showed better internal consistency than the EPDS-S. Among the factors of emotion, women tended to rate anhedonia lower in the EPDS-S than in the frequency scale. CONCLUSION Pregnant women tended to report a lower frequency on the Japanese version of the EPDS than their actual symptom frequency, which was especially true for those with a desire to self-harm. The combined use of the FREQ-S and EPDS-S can prevent underestimation and help improve the detection rate of depression.
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Affiliation(s)
- Hiromi Suenaga
- grid.268397.10000 0001 0660 7960Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
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64
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Davies T, Lund C, Schneider M. Implementation of a task-shared psychosocial intervention for perinatal depression in South Africa: A grounded theory process evaluation. SSM Ment Health 2022; 2:100056. [PMID: 36776724 PMCID: PMC9912697 DOI: 10.1016/j.ssmmh.2021.100056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Perinatal depression carries significant levels of disability for both women and their infants, but there is a large treatment gap for this condition in low and middle-income countries (LMICs). To address this gap, task-sharing using community health workers (CHWs) to provide psychosocial interventions for perinatal depression is increasingly common. Many of these interventions have shown significant positive effects on maternal mood, however not all have done so. This study used data from a task-shared psychosocial intervention for perinatal depression in Cape Town, South Africa, the 'Africa Focus on Intervention Research for Mental Health' (AFFIRM-SA) randomised controlled trial (RCT). It aimed to examine the processes that occurred within the delivery of the counselling intervention, and to use these findings to provide recommendations for psychosocial task sharing in LMICs. A grounded theory analysis was conducted of 234 counselling session transcripts from 39 randomly selected participants from the RCT. This revealed that the effectiveness of the intervention was compromised by the negative influence of participants' socio-economic context, and by counselling strategies that did not align with what was intended in the counselling manual. Despite this, participants provided spontaneous accounts of improvement in mood and cognition, and reasons for these improvements, interpreted as elements that were therapeutically effective for them. Most of these elements aligned with previously identified 'common elements' of therapy. Recommendations for future research and practice include conducting participatory formative research, using an iterative and responsive research design informed by implementation science, incorporating contextually appropriate strategies in interventions such as addressing social determinants of mental health, conducting intensive training and supervision, adopting a staged approach to managing depression, and using common elements of therapy as the basis for psychosocial interventions.
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Affiliation(s)
- Thandi Davies
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa,Corresponding author: (T. Davies)
| | - Crick Lund
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa,King’s Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF, United Kingdom
| | - Marguerite Schneider
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa
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Lasater ME, Beebe M, Warren NE, Winch PJ, Soucko F, Keita M, Doumbia S, Murray SM. Reliability and validity of a perinatal depression screening instrument in rural Mali. SSM Ment Health 2022; 2:100059. [PMID: 36644110 PMCID: PMC9835090 DOI: 10.1016/j.ssmmh.2021.100059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background In order to reduce the burden of perinatal depression in low- and middle-income countries, health systems must be able to identify and treat women suffering from depression. The objective of our study was to develop a locally valid and reliable screening instrument for use in identifying pregnant women and mothers of young children with a local depression syndrome, dusukasi, in rural Mali. Methods We administered a locally adapted screening instrument containing items from the Edinburgh Postpartum Depression Scale (EPDS) and Hopkins Symptom Checklist (HSCL-25) to 180 pregnant women and mothers of children under age 2 in Sélingué, Mali to assess the instrument's psychometric properties and validity. Item Response Theory was used to develop an abbreviated version of the measure and the validity and psychometric properties of this shortened version were compared with the full-length scale. Results The full 28-item scale exhibited a single factor structure with good internal consistency (Cronbach's alpha = 0.92). Women who self-identified as suffering from dusukasi (n = 87) in a known groups analysis to assess construct validity had significantly higher depression and anxiety symptom scores (p < 0.0001) and functional impairment scores (p < 0.0001) compared to women not reporting dusukasi (n = 93). The shortened 16-item scale performed as well as the full scale in identifying women with dusukasi. Conclusions Construct validity of our adapted screening instrument was supported for identifying dusukasi in rural Malian women. Our methodology can be applied in other settings to develop similarly valid screening instruments for perinatal depression.
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Affiliation(s)
- Molly E. Lasater
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA,Corresponding author. 615 N. Wolfe St, Baltimore, MD, USA, 21205. (M.E. Lasater)
| | - Madeleine Beebe
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Nicole E. Warren
- School of Nursing, Johns Hopkins University, 525 N Wolfe St, Baltimore, MD, 21205, USA
| | - Peter J. Winch
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Fatoumata Soucko
- Department of Public Health, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Mali
| | - Mariam Keita
- Department of Public Health, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Mali
| | - Seydou Doumbia
- Department of Public Health, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Mali
| | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
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Sasaki N, Ikeda M, Nishi D. Long-term influence of unintended pregnancy on psychological distress: a large sample retrospective cross-sectional study. Arch Womens Ment Health 2022; 25:1119-1127. [PMID: 36306037 DOI: 10.1007/s00737-022-01273-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/13/2022] [Indexed: 12/25/2022]
Abstract
This study examined the associations between childbirth decisions in women with unintended pregnancies and long-term psychological distress. An online survey of women selected from a representative research panel was conducted in July 2021. Among participants who experienced an unintended pregnancy, the childbirth decision was categorized: (i) wanted birth, (ii) abortion, (iii) adoption, and (iv) unwanted birth. Participants who made childbirth decisions more than 1 year ago were included. ANCOVA was conducted with psychological distress (Kessler 6) as the dependent variable and education, marital status, years from the decision, age of the first pregnancy, economic situation at the unintended pregnancy, and the number of persons consulted at the unintended pregnancy as covariates. Logistic regression analysis was conducted for high distress (K6 ≥ 13) by adjusting the same covariates. A total of 47,401 respondents participated in the study. Women with an experience of unintended pregnancy experienced more than 1 year before the study were analyzed (n = 7162). Psychological distress was the lowest for wanted birth and increased for abortion, adoption, and unwanted birth. In the adjusted model, abortion was associated with lower distress scores than both adoption and unwanted birth. Compared to the wanted birth, adoption and unwanted birth showed significantly higher levels of distress (adjusted odds ratio [aOR] = 2.03 [95% CI 1.36-3.04], aOR = 1.64 [95% CI 1.04-2.58], respectively). Long-term effects on psychological distress differed according to the childbirth decisions in unintended pregnancy. Healthcare professionals should be aware of this hidden effect of unintended pregnancy experience on women's mental health.
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Affiliation(s)
- Natsu Sasaki
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1Bunkyo-ku, HongoTokyo, 113-0033, Japan
| | - Mari Ikeda
- Department of Family Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1Bunkyo-ku, HongoTokyo, 113-0033, Japan.
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Mulligan EM, Simon J, Lowe M, Santopetro N, Flynn H, Hajcak G. The P300 and late positive potential in pregnancy prospectively predict increases in depressive and anxious symptoms in the early postpartum period. J Affect Disord 2022; 317:193-203. [PMID: 36028012 PMCID: PMC10450819 DOI: 10.1016/j.jad.2022.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 10/31/2022]
Abstract
Postnatal depression and anxiety disorders pose a major burden on maternal mental health. While psychosocial risk factors for perinatal depression and anxiety are well-researched, there is a dearth of research examining neural biomarkers of risk for postnatal increases in depression and anxiety. Previous studies suggest two different event-related potentials, the P300 and the late positive potential (LPP), may predict the course of depressive and anxious symptoms in non-perinatal populations. In a sample of 221 perinatal women, the present study utilized an emotional interrupt task administered in pregnancy to examine whether antenatal P300 and LPP amplitudes may predict change in depressive and anxious symptoms from pregnancy to the early postpartum period. Zero-order correlations and linear regressions revealed that a reduced antenatal P300 to target stimuli and an enhanced LPP to positive infant images were uniquely associated with postnatal depressive and anxiety symptoms, respectively, and that these ERPs were independent predictors beyond antenatal self-report measures of psychological symptoms. Furthermore, individuals with increased depressive symptoms in pregnancy exhibited a stronger negative association between antenatal P300 amplitude and postnatal depressive symptoms. The present findings underscore the possibility that the measurement of ERPs during pregnancy could serve as a screening tool for risk for perinatal depression and anxiety, and thereby assist with identifying at-risk individuals who might benefit from prevention efforts.
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Affiliation(s)
- Elizabeth M Mulligan
- Florida State University, Department of Psychology, Tallahassee, FL 32304, United States of America.
| | - Jessica Simon
- Florida State University, Department of Psychology, Tallahassee, FL 32304, United States of America
| | - Magen Lowe
- Washington State University, Department of Psychology, Pullman, WA 99164, United States of America
| | - Nicholas Santopetro
- Florida State University, Department of Psychology, Tallahassee, FL 32304, United States of America
| | - Heather Flynn
- Florida State University, Department of Behavioral Sciences and Social Medicine, Tallahassee, FL 32306, United States of America
| | - Greg Hajcak
- Florida State University, Department of Psychology, Tallahassee, FL 32304, United States of America; Florida State University, Department of Biomedical Sciences, Tallahassee, FL 32306, United States of America
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Garbazza C, Hackethal S, Migliore E, D'Agostino A, Serrati C, Fanti V, Riccardi S, Baiardi S, Cicolin A, Borgwardt S, Mondini S, Cirignotta F, Cajochen C, Manconi M. Influence of chronotype on the incidence and severity of perinatal depression in the "Life-ON" study. J Affect Disord 2022; 317:245-255. [PMID: 36055526 DOI: 10.1016/j.jad.2022.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/10/2022] [Accepted: 08/21/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Perinatal depression (PND) is a severe complication of pregnancy, but there are no established risk factors predicting the disease. Evening chronotype has been associated with unhealthy lifestyle habits and adverse outcomes during pregnancy. In this study, we aimed to clarify whether chronotype can predict symptoms and/or occurrence of PND. METHODS Two hundred ninety-nine women were followed-up from the first trimester of pregnancy until 6 months postpartum. Chronotype was assessed at baseline using the MEQ, while mood was repeatedly assessed by depression rating scales (EPDS, HDRS, MADRS). The influence of time and chronotype on EPDS, HDRS and MADRS, was estimated by constructing multilevel linear mixed regression models. A Cox proportional-hazard regression model was built to evaluate the association between chronotype and incidence of depression. RESULTS Chronotype modulated PND symptom severity depending on time of assessment, with evening chronotypes having a higher risk for developing PND symptoms, as assessed by EPDS, at postpartum visits V4 (5-12 days) and V5 (19-26 days). These also had less healthy lifestyle habits and were more likely to suffer from gestational diabetes mellitus and undergo cesarean delivery as compared to other chronotypes. LIMITATIONS Only a minority of women were classified as evening chronotypes. The long follow-up phase of the study led to missing data. CONCLUSIONS Pregnant evening chronotypes show unhealthy lifestyle habits and sociodemographic characteristics commonly associated with a higher risk for PND. They also have a higher risk of developing PND symptoms in the first month after delivery. Chronotype should therefore be routinely assessed during pregnancy to identify women potentially at risk for developing PND.
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Affiliation(s)
- Corrado Garbazza
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland; Centre for Chronobiology, University of Basel, Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland.
| | - Sandra Hackethal
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Enrica Migliore
- Clinical Epidemiology Unit, University Hospital Città Della Salute e Della Scienza di Torino, Turin, Italy; Cancer Epidemiology Unit, University Hospital Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Armando D'Agostino
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Chiara Serrati
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Valentina Fanti
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Silvia Riccardi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Simone Baiardi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Experimental, Diagnostics, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alessandro Cicolin
- Sleep Medicine Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland; Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Susanna Mondini
- Neurology Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Christian Cajochen
- Centre for Chronobiology, University of Basel, Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
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Monks DT, Palanisamy A, Jaffer D, Singh PM, Carter E, Lenze S. A randomized feasibility pilot-study of intravenous and subcutaneous administration of ketamine to prevent postpartum depression after planned cesarean delivery under neuraxial anesthesia. BMC Pregnancy Childbirth 2022; 22:786. [PMID: 36271352 PMCID: PMC9587550 DOI: 10.1186/s12884-022-05118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Evidence suggests ketamine may prevent postpartum depression (PPD) after cesarean delivery (CD) although intolerability and inconvenience of administration are problematic. We assessed the feasibility of studying ketamine (0.5 mg/kg, via subcutaneous injection or 40-min intravenous infusion) to prevent PPD after CD. Methods Twenty-three women scheduled for cesarean delivery under neuraxial anesthesia were randomized to one of three groups: subcutaneous ketamine (SC Group, n = 8), intravenous ketamine (IV Group, n = 8) or placebo (n = 7). We measured depression (Edinburgh Postpartum Depression Scale [EPDS]) scores pre-operatively and at 1, 2, 21 and 42 days postoperatively. Anxiety, adverse effects, surgical site pain and analgesic consumption were also assessed. Feasibility was assessed based on acceptability, burden of disease, ability to collect study data and, tolerability of interventions. Results Baseline characteristics of groups were similar, however, more women in the placebo group had pre-existing anxiety disorder (p = 0.03). 20.7% (25/121) of those approached consented to participate and 34.8% (8/23), of those assessed, screened positive for depression in the postpartum (EPDS > 12). PPD screening data was complete in 78.3% (18/23). No differences were observed for any adverse effect outcomes except for fewer incidences of intraoperative shivering with ketamine (SC: 25%, IV: 0% and Placebo: 85.7%, p = 0.01). No statistically significant difference in positive screening for PPD was observed (SC: 14.3%, IV: 50% and Placebo: 42.9%, p = 0.58). Conclusion An RCT was judged to be feasible and there was no evidence of intolerability of either route of ketamine administration. Dispensing with the need for intravenous access makes the subcutaneous route a particularly attractive option for use in the postpartum population. Further examination of these interventions to prevent, and possibly treat, postpartum depression is warranted. Trial registration NCT04227704, January 14th, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05118-8.
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Affiliation(s)
- David Thomas Monks
- Department of Anesthesiology, Washington University School of Medicine, 660 S Euclid Avenue, St. Louis, MO, 63110, USA.
| | - Arvind Palanisamy
- Department of Anesthesiology, Washington University School of Medicine, 660 S Euclid Avenue, St. Louis, MO, 63110, USA.,Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, USA
| | - Danish Jaffer
- Department of Anesthesiology, Washington University School of Medicine, 660 S Euclid Avenue, St. Louis, MO, 63110, USA
| | - Preet Mohinder Singh
- Department of Anesthesiology, Washington University School of Medicine, 660 S Euclid Avenue, St. Louis, MO, 63110, USA
| | - Ebony Carter
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, USA
| | - Shannon Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, USA
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Vanwetswinkel F, Bruffaerts R, Arif U, Hompes T. The longitudinal course of depressive symptoms during the perinatal period: A systematic review. J Affect Disord 2022; 315:213-223. [PMID: 35803394 DOI: 10.1016/j.jad.2022.06.087] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Perinatal Depression (PND) is one of the most common complications (10-20 %) during the perinatal period and its clinical course and phenotypes are still an area of research. It is becoming increasingly clear that pregnant women and mothers with depression are not a homogeneous clinical group. METHODS A systematic literature search in 4 databases revealed 359 studies, 33 relevant studies met the inclusion criteria. We only included studies with at least three assessment points in total. RESULTS Two to six trajectory classes were identified. A three trajectories solution was most observed. All the included studies reported a low symptom trajectory but ranged from 6.5 % to 92 %. The high-symptom group was in most of the studies the smallest subgroup (1.1 % - 14.6 %). Most of the studies described episodic trajectories of depressive symptoms during the peripartum. The most common risk factor associated with a high-symptom trajectory of depressive symptoms in our study was a history of depression. Important socio-demographic predictors were: young age, ethnicity, low maternal education, low income, single relationship status or relationship problems, unplanned or unintended pregnancy and experiencing high stress levels. LIMITATIONS The methodology and the observed PND trajectories of the included studies differed, which makes generalizability difficult in this review. CONCLUSIONS PND is a frequent but heterogeneous disorder. Globally, four major groups could be distinguished: low, medium, high and episodic trajectories. There is a need for consensus regarding which assessment instruments to use, validated cutoff scores and similar time points of assessment.
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Affiliation(s)
- Femke Vanwetswinkel
- Adult Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium; Department of Neurosciences, Faculty of Medicine, Research Group Psychiatry, University of Leuven, Leuven, Belgium.
| | - Ronny Bruffaerts
- Adult Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium; Department of Neurosciences, Faculty of Medicine, Research Group Psychiatry, University of Leuven, Leuven, Belgium
| | - Umesa Arif
- Biomedical Sciences, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Titia Hompes
- Adult Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium; Department of Neurosciences, Faculty of Medicine, Research Group Psychiatry, University of Leuven, Leuven, Belgium
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Smith RD, Shing JSY, Lin J, Bosanquet K, Fong DYT, Lok KYW. Meta-analysis of diagnostic properties of the Whooley questions to identify depression in perinatal women. J Affect Disord 2022; 315:148-155. [PMID: 35931230 DOI: 10.1016/j.jad.2022.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/16/2022] [Accepted: 07/17/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND This study's objective was to assess the diagnostic properties of the Whooley questions in identifying depression among perinatal women according to previously published studies. We conducted a systematic review and meta-analysis of studies investigating the diagnostic accuracy of the Whooley questions in perinatal women. METHODS Nine databases were searched in October 2021. All primary studies evaluated the diagnostic properties of the Whooley questions compared with a diagnostic gold standard in women during the perinatal period or, if not identified as being in the perinatal stage within the study, women between 20 weeks' gestation to 4 weeks post-delivery. A bivariate mixed-effects meta-analysis was performed to estimate pooled diagnostic properties and measure heterogeneity. Meta-regression was conducted to evaluate factors contributing to heterogeneity. RESULTS Six studies were included in the review; five were used in the meta-analysis. The pooled sensitivity (95 % confidence interval) was 0.95 (0.81-0.99), pooled specificity was 0.60 (0.44-0.74), pooled positive likelihood ratio was 2.4 (1.6-3.4), pooled negative likelihood ratio was 0.09 (0.02-0.32), and pooled diagnostic odds ratio was 27 (7-106); heterogeneity was substantial (I2 = 0.90, 0.81-1.00). Participant age and setting (community vs. hospital) significantly contributed to heterogeneity. CONCLUSIONS The Whooley questions have high sensitivity but moderate specificity for perinatal women. The Whooley questions are a short and acceptable tool for identifying depression in perinatal women. However, a potential risk exists of incorrectly identifying a high proportion of women as positive. Using the Whooley questions followed by a secondary case-finding tool could reduce the misdiagnosis risk.
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Affiliation(s)
- Robert D Smith
- School of Nursing, the University of Hong Kong, Hong Kong, China
| | | | - Jessie Lin
- Department of Rehabilitation Sciences, the Hong Kong Polytechnic University, Hong Kong, China
| | - Kate Bosanquet
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Daniel Y T Fong
- School of Nursing, the University of Hong Kong, Hong Kong, China
| | - Kris Y W Lok
- School of Nursing, the University of Hong Kong, Hong Kong, China.
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Shuffrey LC, Lucchini M, Morales S, Sania A, Hockett C, Barrett E, Carroll KN, Cioffi CC, Dabelea D, Deoni S, Dunlop AL, Deutsch A, Fifer WP, Firestein MR, Hedderson MM, Jacobson M, Kelly RS, Kerver JM, Mason WA, Mirzakhani H, O'Connor TG, Trasande L, Weiss S, Wright R, Zhu Y, Crum RM, Lee S, Elliott AJ, Monk C. Gestational diabetes mellitus, prenatal maternal depression, and risk for postpartum depression: an Environmental influences on Child Health Outcomes (ECHO) Study. BMC Pregnancy Childbirth 2022; 22:758. [PMID: 36209070 PMCID: PMC9548153 DOI: 10.1186/s12884-022-05049-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/14/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Prior research has demonstrated bidirectional associations between gestational diabetes mellitus (GDM) and perinatal maternal depression. However, the association between GDM, prenatal depression, and postpartum depression (PPD) has not been examined in a prospective cohort longitudinally. METHODS Participants in the current analysis included 5,822 women from the National Institutes of Health's Environmental influences on Child Health Outcomes (ECHO) Research Program: N = 4,606 with Neither GDM nor Prenatal Maternal Depression (Reference Category); N = 416 with GDM only; N = 689 with Prenatal Maternal Depression only; and N = 111 with Comorbid GDM and Prenatal Maternal Depression. The PROMIS-D scale was used to measure prenatal and postnatal maternal depressive symptoms. Primary analyses consisted of linear regression models to estimate the independent and joint effects of GDM and prenatal maternal depression on maternal postpartum depressive symptoms. RESULTS A higher proportion of women with GDM were classified as having prenatal depression (N = 111; 21%) compared to the proportion of women without GDM who were classified as having prenatal depression (N = 689; 13%), however this finding was not significant after adjustment for covariates. Women with Comorbid GDM and Prenatal Maternal Depression had significantly increased postpartum depressive symptoms measured by PROMIS-D T-scores compared to women with Neither GDM nor Prenatal Maternal Depression (mean difference 7.02, 95% CI 5.00, 9.05). Comorbid GDM and Prenatal Maternal Depression was associated with an increased likelihood of PPD (OR 7.38, 95% CI 4.05, 12.94). However, women with GDM only did not have increased postpartum PROMIS-D T-scores or increased rates of PPD. CONCLUSIONS Our findings underscore the importance of universal depression screening during pregnancy and in the first postpartum year. Due to the joint association of GDM and prenatal maternal depression on risk of PPD, future studies should examine potential mechanisms underlying this relation.
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Affiliation(s)
- Lauren C Shuffrey
- Department of Psychiatry, Division of Developmental Neuroscience, Columbia University Irving Medical Center, NYSPI, Pardes Rm 4932, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Maristella Lucchini
- Department of Psychiatry, Division of Developmental Neuroscience, Columbia University Irving Medical Center, NYSPI, Pardes Rm 4932, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Santiago Morales
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Ayesha Sania
- Department of Psychiatry, Division of Developmental Neuroscience, Columbia University Irving Medical Center, NYSPI, Pardes Rm 4932, 1051 Riverside Drive, New York, NY, 10032, USA
| | | | - Emily Barrett
- Rutgers School of Public Health, Environmental and Occupational Health Sciences Institute, Piscataway, NJ, USA
| | | | - Camille C Cioffi
- Prevention Science Institute, University of Oregon, Eugene, OR, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sean Deoni
- Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Anne L Dunlop
- Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | | | - William P Fifer
- Department of Psychiatry, Division of Developmental Neuroscience, Columbia University Irving Medical Center, NYSPI, Pardes Rm 4932, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Morgan R Firestein
- Department of Psychiatry, Division of Developmental Neuroscience, Columbia University Irving Medical Center, NYSPI, Pardes Rm 4932, 1051 Riverside Drive, New York, NY, 10032, USA
| | | | - Melanie Jacobson
- Department of Pediatrics, Division of Environmental Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Rachel S Kelly
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jean M Kerver
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - W Alex Mason
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Thomas G O'Connor
- Department of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Leonardo Trasande
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Scott Weiss
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Yeyi Zhu
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Rosa M Crum
- Johns Hopkins University, Baltimore, MD, USA
| | - Seonjoo Lee
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, NY, New York, USA
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA
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Buultjens M, Gill J, Fielding J, Lambert KA, Vondeling K, Mastwyk SE, Sloane S, Fedele W, Karimi L, Milgrom J, von Treuer K, Erbas B. Maternity care during a pandemic: Can a hybrid telehealth model comprising group interdisciplinary education support maternal psychological health? Women Birth 2022; 36:305-313. [PMID: 36184532 PMCID: PMC9551992 DOI: 10.1016/j.wombi.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/21/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022]
Abstract
Background The transition to parenthood is one of the most challenging across the life course, with profound changes that can impact psychological health. In response to the coronavirus disease 2019 (COVID-19), came the rapid implementation of remote antenatal care, i.e., telehealth, with fewer in-person consultations. A change in service delivery in addition to the cancellation of antenatal education represented a potential threat to a woman’s experience – with likely adverse effects on mental health and wellbeing. Aim To explore a hybrid model of pregnancy care, i.e., telehealth and fewer in-person health assessments, coupled with concurrent small group interdisciplinary education delivered via video conferencing, extending into the postnatal period. Methods Using a quasi-experimental design with an interrupted time series and a control group, this population-based study recruited low-risk women booking for maternity care at one community health site affiliated with a large public hospital in Victoria, Australia. Findings Whilst there was no difference in stress and anxiety scores, a significant interactive effect of the hybrid model of care with time was seen in the DASS depression score (−1.17, 95% CI: −1.81, −0.53) and the EPDS (−0.83, 95% CI: −1.5, −0.15). Discussion The analyses provide important exploratory findings regarding the positive effects of a hybrid model of care with interdisciplinary education in supporting mental health of first-time mothers. Conclusion This study demonstrates that small group online education scheduled in conjunction with individual pregnancy health assessments can be executed within a busy antenatal clinic with promising results and modest but dedicated staff support.
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Affiliation(s)
- Melissa Buultjens
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Jessica Gill
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Jennifer Fielding
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Katrina A Lambert
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kirsty Vondeling
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Sally E Mastwyk
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Sarita Sloane
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Wendy Fedele
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Leila Karimi
- School of Applied Health, Psychology Department, RMIT University, Melbourne, Australia.
| | - Jeannette Milgrom
- Parent-Infant Research Institute (PIRI), Australia and Melbourne School of Psychological Science, University of Melbourne, Australia
| | | | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Hummel AD, Ronen K, Bhat A, Wandika B, Choo EM, Osborn L, Batra M, Kinuthia J, Kumar M, Unger JA. Perinatal depression and its impact on infant outcomes and maternal-nurse SMS communication in a cohort of Kenyan women. BMC Pregnancy Childbirth 2022; 22:723. [PMID: 36138357 DOI: 10.1186/s12884-022-05039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Perinatal depression is broadly defined as depressive symptoms during pregnancy or within the 12 months following delivery, affecting approximately 20-25% of pregnant and postpartum women in low- and middle-income countries. The wide accessibility of mobile phones allows mobile health (mHealth) interventions to be considered a solution to identify perinatal depression and provide appropriate referrals for treatment. This study, nested in a larger SMS communication project, examined the prevalence and correlates of perinatal depression, determined the association between antenatal depression and infant morbidity and mortality, and compared SMS communication patterns between women with and without perinatal depression. METHODS This was a prospective longitudinal cohort study of pregnant women seeking antenatal services at two public sector health clinics in Kenya. SMS messages were sent to participants with educational content related to their pregnancy and infant health and two-way SMS communication occurred with a nurse. Sociodemographic and obstetric characteristics, SMS messaging behaviors, infant health status, and depressive symptoms were assessed by a standardized questionnaire administered at enrollment (30-36 weeks gestation) and follow-up (14 weeks postpartum). Generalized estimating equation (GEE) with Poisson link was used to evaluate correlates of perinatal depressive symptoms, infant outcomes, and frequency of SMS messaging. RESULTS Of the 572 women with complete follow-up information, 188 (32.9%) screened positive for elevated depressive symptoms (≥10 by EPDS scale) at some time point during pregnancy or postpartum. The strongest predictors of any depressive symptoms included interpersonal abuse during pregnancy, fewer years of schooling, and maternal unemployment. Antenatal depressive symptoms were associated with an increased risk of infant illness or hospitalization (RR = 1.12, 95% CI: 1.11, 1.13). Women with antenatal or persistent perinatal depressive symptoms sent fewer SMS messages during the study period than their counterparts without depression. CONCLUSIONS Prevalence of elevated perinatal depressive symptoms was high in this cohort of Kenyan women. Our findings highlight the importance of screening perinatal women for experiences of symptoms of depression as well as abuse. Differences in messaging frequency between women with vs. without depressive symptoms presents an opportunity to provide more tailored support for those perinatal depression.
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Gureje O, Oladeji BD, Kola L, Bello T, Ayinde O, Faregh N, Bennett I, Zelkowitz P. Effect of intervention delivered by frontline maternal care providers to improve outcome and parenting skills among adolescents with perinatal depression in Nigeria (the RAPiD study): A cluster randomized controlled trial. J Affect Disord 2022; 312:169-176. [PMID: 35752215 DOI: 10.1016/j.jad.2022.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/12/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Perinatal depression is more common and is associated with greater negative consequences among adolescents than adults. Psychosocial interventions designed for adults may be inadequate at addressing the unique features of adolescent perinatal depression. METHODS In a two-arm parallel cluster randomized trial conducted in thirty primary maternal care clinics in Ibadan, Nigeria (15-intervention and 15-control) we compared age-appropriate intervention consisting of problem-solving therapy, behavioral activation, parenting skills training, and parenting support from a self-identified adult to care as usual. Pregnant adolescents (aged <20 years) at fetal gestational age16-36 weeks with moderate to severe depression were recruited. Primary outcomes were depression symptoms (Edinburgh Postnatal Depression Scale, EPDS) and parenting practices (Infant-Toddler version of the Home Inventory for Measurement of the Environment, HOME-IT) at six-months postnatal. RESULTS There were 242 participants (intervention arm: 141; Control arm: 101), with a mean age of 18∙0 (SD-1∙2). Baseline mean EPDS score was 14∙2 (SD-2.1); 80∙1 % completed the six-month postnatal follow-up. The intervention group had lower level of depressive symptoms than the control group, mean EPDS scores: 5∙5 (SD-3∙6) versus 7∙2 (SD-4∙0) (adjusted mean difference -1∙84 (95%CI- 3∙06 to -0∙62; p = 0∙003) and better parenting practices, mean total HOME-IT scores: 29∙8 (SD-4∙4) versus 26∙4 (SD-4∙2) (adjusted mean difference 3∙4 (95%Cl- 2∙12 to 4∙69, p = 0∙001). LIMITATIONS This study explored the effect of complex interventions making it difficult to know precisely what aspects produced the outcomes. CONCLUSIONS An age-appropriate psychosocial intervention package holds promise for scaling up care for adolescents with perinatal depression especially in resource-constrained settings. TRIAL REGISTRATION ISRCTN16775958. Registered on 30 April 2019.
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Affiliation(s)
- Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria.
| | - Bibilola D Oladeji
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Lola Kola
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Toyin Bello
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Olatunde Ayinde
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Neda Faregh
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - Ian Bennett
- Department of Family Medicine, Psychiatry and Behavioral Sciences, and Global Health, University of Washington, Seattle, USA
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Parameswaran UD, Pentecost R, Williams M, Smid M, Latendresse G. Experiences with use of technology and telehealth among women with perinatal depression. BMC Pregnancy Childbirth 2022; 22:571. [PMID: 35850663 PMCID: PMC9289084 DOI: 10.1186/s12884-022-04889-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 05/05/2022] [Indexed: 11/28/2022] Open
Abstract
Background Perinatal depression (PD) affects 10–20% of childbearing women. Telehealth is increasingly utilized for mental health services to increase access to care and overcome COVID-19 pandemic barriers. Women’s perspectives on telehealth services for PD is unknown, however. This study’s primary objective was to obtain the perspectives of women who participated in an 8-week group videoconference intervention for PD symptoms, including how technology impacted their experience. Methods We utilized theoretical sampling and included perinatal women who had completed the 8-week mindfulness-based cognitive-behavioral intervention group. Semi-structured focus groups with four to six women were conducted on a videoconference platform. Primary analysis used grounded theory and a secondary analysis used qualitative description and was conducted by two coding teams. The teams collaborated on the final themes across the analyses. Results Three groups, with a total of 17 participants were conducted. Composition consisted of seven postpartum and ten pregnant women from the 47 total participants. Identified core themes regarding their experiences of the videoconference intervention were: positive experiences, negative experiences, suggestions and ideas, and screening and communication. Conclusion This study provides growing evidence informed by perinatal women of positive experiences with engagement in a videoconference intervention for PD. Telehealth may be a reasonable and acceptable platform to increase access and retention for mental health services in childbearing women. Further, this pilot work showcases videoconferencing delivery for a wide range of effective and affordable mental health services in low-resource communities.
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Affiliation(s)
- Uma D Parameswaran
- Department of Psychology, University of Utah, Salt Lake City, USA. .,Department of Applied Psychology, New York University, New York, USA.
| | | | | | - Marcela Smid
- Maternal Fetal Medicine, University of Utah Hospital, Salt Lake City, USA
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Jones K, Harrison V, Moulds ML, Lazard L. A qualitative analysis of feelings and experiences associated with perinatal distress during the COVID-19 pandemic. BMC Pregnancy Childbirth 2022; 22:572. [PMID: 35850668 PMCID: PMC9294838 DOI: 10.1186/s12884-022-04876-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Rates of perinatal mental health difficulties (experienced during pregnancy and the 12-months postpartum) increased worldwide during the COVID-19 pandemic. In the UK, anxiety and depression were estimated to affect more than half of perinatal women during the first national lockdown. However, little is known about women’s qualitative experiences of distress. This study aimed to extend published quantitative findings resulting from the same data set (Harrison et al., Women Birth xxxx, 2021; Harrison et al., J Reprod Infant Psychol 1–16, 2021) to qualitatively explore: 1) the feelings and symptoms associated with maternal perinatal distress during the COVID-19 pandemic; and 2) the associated sources of distress. Methods As part of an online survey during May 2020, 424 perinatal women responded to an open-ended question regarding a recent experience of distress. Qualitative data were analysed using an initial content analysis, followed by an inductive thematic analysis adopting a realist approach. Data were explored in the context of self-reported perinatal anxiety and depression symptoms. Results Initial content analysis of the data identified twelve distinct categories depicting participants’ feelings and symptoms associated with psychological distress. Despite the high rates of probable depression in the sample, women’s descriptions were more indicative of anxiety and general distress, than of symptoms traditionally related to depression. In terms of the associated psychosocial stressors, a thematic analysis identified five themes: Family wellbeing; Lack of support; Mothering challenges; Loss of control due to COVID-19; and Work and finances. Unsurprisingly given the context, isolation was a common challenge. Additionally, psychological conflict between maternal expectations and the reality of pregnancy and motherhood, loss of autonomy and control, and fears surrounding family health, safety, and wellbeing underlay many of the themes. Conclusions This study presents an array of feelings and symptoms expressed by perinatal mothers which may be useful to consider in relation to perinatal wellbeing. Furthermore, our data highlights several common sources of distress, including multiple COVID-19 specific factors. However, many were related to more general perinatal/maternal experiences. Our findings also point to considerations that may be useful in alleviating distress in pregnancy and early motherhood, including social support, realistic perinatal/maternal expectations, and support for those with perceived perinatal trauma.
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Affiliation(s)
- Katie Jones
- School of Psychology and Counselling, The Open University, Milton Keynes, UK.
| | - Virginia Harrison
- School of Psychology and Counselling, The Open University, Milton Keynes, UK
| | | | - Lisa Lazard
- School of Psychology and Counselling, The Open University, Milton Keynes, UK
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Atif N, Nazir H, Sultan ZH, Rauf R, Waqas A, Malik A, Sikander S, Rahman A. Technology-assisted peer therapy: a new way of delivering evidence-based psychological interventions. BMC Health Serv Res 2022; 22:842. [PMID: 35773677 PMCID: PMC9245257 DOI: 10.1186/s12913-022-08233-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/16/2022] [Indexed: 11/20/2022] Open
Abstract
In low-income settings, ninety percent of individuals with clinical depression have no access to evidence-based psychological interventions. Reasons include lack of funds for specialist services, scarcity of trained mental health professionals, and the stigma attached to mental illness. In recent years there have been many studies demonstrating effective delivery of psychological interventions through a variety of non-specialists. While these interventions are cost-effective and less stigmatising, efforts to scale-up are hampered by issues of quality-control, and what has been described by implementation scientists as ‘voltage-drop’ and ‘programme-drift.’ Using principles of Human Centred Design in a rural setting in Pakistan, we worked with potential users to co-design a Tablet or Smartphone-based App that can assist a lay-person deliver the Thinking Healthy Programme, a World Health Organization-endorsed evidence-based intervention for perinatal depression. The active ingredients of this cognitive-therapy based intervention are delivered by a virtual ‘avatar’ therapist incorporated into the App which is operated by a ‘peer’ (a woman from the neighbourhood with no prior experience of healthcare delivery). Using automated cues from the App, the peer reinforces key therapeutic messages, helps with problem-solving and provides the non-specific but essential therapeutic elements of empathy and support. The peer and App therefore act as co-therapists in delivery of the intervention. The peer can deliver the intervention with good fidelity after brief automated in-built training. This approach has the potential to be applied to other areas of mental health and help bridge the treatment gap, especially in resource-poor settings. This paper describes the process of co-development with end-users and key features of the App.
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Affiliation(s)
- Najia Atif
- Human Development Research Foundation, Rawalpindi, Pakistan
| | - Huma Nazir
- Human Development Research Foundation, Rawalpindi, Pakistan
| | | | - Rabia Rauf
- Human Development Research Foundation, Rawalpindi, Pakistan
| | - Ahmed Waqas
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Abid Malik
- Human Development Research Foundation, Rawalpindi, Pakistan.,Health Services Academy, Chak Shahzad, Islamabad, Pakistan
| | - Siham Sikander
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK.,Global Institute of Human Development, Shifa Tameer-E-Millat University, Islamabad, Pakistan
| | - Atif Rahman
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK.
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Bhushan NL, Stockton MA, Harrington BJ, DiPrete BL, Maliwichi M, Jumbe AN, Kulisewa K, Chagomerana MB, Pence BW, Gaynes BN, Hosseinipour MC. Probable perinatal depression and social support among women enrolled in Malawi's Option B+ Program: A longitudinal analysis. J Affect Disord 2022; 306:200-207. [PMID: 35314248 PMCID: PMC9681029 DOI: 10.1016/j.jad.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 11/19/2021] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Malawi's PMTCT Option B+ program has expanded the reach of ART services among pregnant and breastfeeding women, but retention in lifelong HIV care remains challenging. Given that depression can undermine retention, it is important to understand how depression changes over the perinatal period, varies across treatment and retention groups, and could be buffered by social support. METHODS Data are from an observational study conducted among women enrolled in Malawi's PMTCT Option B+ program. We used multilevel generalized linear models to estimate the odds of probable depression by time, treatment and retention group, and social support. Probable depression was assessed with the Edinburgh Postnatal Depression Scale and Patient Health Questionnaire-9. RESULTS Of 468 women, 15% reported probable depression at antenatal enrollment and prevalence differed across newly diagnosed individuals, second line therapy users, and previous defaulters (18%, 21%, 5%, p = 0.001). Odds of probable perinatal depression decreased over time (OR per month: 0.87, 95% CI: 0.82-0.92) but were higher among those newly diagnosed (OR: 3.25, 95% CI: 1.59-6.65) and on second line therapy (OR: 3.39, 95% CI: 1.44-7.99) as compared to previous defaulters. Odds of probable postpartum depression were lower for participants with high social support (OR: 0.19, 95% CI: 0.09-0.39). LIMITATIONS Lack of diagnostic psychiatric evaluation precludes actual diagnosis of depression. CONCLUSIONS Probable depression varied across the perinatal period and across treatment and retention groups. Social support was protective for postpartum depression among all participants. Depression screening and provision of social support should be considered in PMTCT programs.
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Affiliation(s)
- Nivedita L. Bhushan
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Bethany L. DiPrete
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | | | | | - Brian W. Pence
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bradley N. Gaynes
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Mina C. Hosseinipour
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,UNC Project, Lilongwe, Malawi
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80
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Ng'oma M, Atif N, Meltzer-Brody S, Stewart RC, Chirwa E. Exploring the cultural appropriateness of a psychosocial intervention, the Thinking Healthy Programme-Peer delivered (THPP), for perinatal depression in Lilongwe, Malawi. Malawi Med J 2022; 34:87-94. [PMID: 35991818 PMCID: PMC9356516 DOI: 10.4314/mmj.v34i2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Perinatal depression is a common and disabling mental health problem in Malawi and other Low- and middle-income countries. There is evidence for effective psychosocial interventions for perinatal depression, but no such intervention has been developed for use in Malawi. The broad aim of this study was to explore the cultural appropriateness of a psychosocial intervention for perinatal depression called the Thinking Healthy Programme-Peer delivered for adaptation and use in Lilongwe, Malawi. Methods A qualitative exploratory design was used. Data were collected through conducting five Focus Group Discussions, involving thirty-eight purposefully selected participants including pregnant women, community volunteers and their supervisors, the Health Surveillance Assistants and maternal health care workers at implementation and policy level following observations of video recorded role plays of the Thinking Healthy Programme-Peer delivered sessions in theatre testing. A content analysis approach was used to analyse data. Results Six main themes were generated regarding the appropriateness of the content and delivery of the Thinking Healthy Programme-Peer delivered intervention, including: 1) Focus of the intervention; 2) Cultural appropriateness of the content; 3) Language used; 4) Context; 5) Provider of the intervention; and 6) Flexibility in the delivery of the intervention. The Thinking Healthy Programme-Peer delivered intervention was deemed appropriate for the target population, though with recommendations to: review illustrations to enhance clarity, use culturally appropriate stories and idioms, use daily spoken language, and adapt the number and duration of sessions to meet the needs of individual clients. Conclusions These findings highlight important areas to inform adaptation of the Thinking Healthy Programme-Peer delivered and add to the growing evidence of cultural adaptation of psychosocial interventions for perinatal depression.
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Affiliation(s)
- Mwawi Ng'oma
- Department of Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi, St John of God Hospitaller Services, Lilongwe, Malawi
| | - Najia Atif
- Human Development Research Foundation, Islamabad, Pakistan
| | | | - Robert C Stewart
- Department of Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi, Division of Psychiatry, University of Edinburgh, United Kingdom
| | - Ellen Chirwa
- Department of Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
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Reps JM, Wilcox M, McGee BA, Leonte M, LaCross L, Wildenhaus K. Development of multivariable models to predict perinatal depression before and after delivery using patient reported survey responses at weeks 4-10 of pregnancy. BMC Pregnancy Childbirth 2022; 22:442. [PMID: 35619056 PMCID: PMC9137134 DOI: 10.1186/s12884-022-04741-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 05/09/2022] [Indexed: 11/22/2022] Open
Abstract
Background Perinatal depression is estimated to affect ~ 12% of pregnancies and is linked to numerous negative outcomes. There is currently no model to predict perinatal depression at multiple time-points during and after pregnancy using variables ascertained early into pregnancy. Methods A prospective cohort design where 858 participants filled in a baseline self-reported survey at week 4–10 of pregnancy (that included social economics, health history, various psychiatric measures), with follow-up until 3 months after delivery. Our primary outcome was an Edinburgh Postnatal Depression Score (EPDS) score of 12 or more (a proxy for perinatal depression) assessed during each trimester and again at two time periods after delivery. Five gradient boosting machines were trained to predict the risk of having EPDS score > = 12 at each of the five follow-up periods. The predictors consisted of 21 variables from 3 validated psychometric scales. As a sensitivity analysis, we also investigated different predictor sets that contained: i) 17 of the 21 variables predictors by only including two of the psychometric scales and ii) including 143 additional social economics and health history predictors, resulting in 164 predictors. Results We developed five prognostic models: PND-T1 (trimester 1), PND-T2 (trimester 2), PND-T3 (trimester 3), PND-A1 (after delivery 1) and PND-A2 (delayed onset after delivery) that calculate personalised risks while only requiring that women be asked 21 questions from 3 validated psychometric scales at weeks 4–10 of pregnancy. C-statistics (also known as AUC) ranged between 0.69 (95% CI 0.65–0.73) and 0.77 (95% CI 0.74–0.80). At 50% sensitivity the positive predictive value ranged between 30%-50% across the models, generally identifying groups of patients with double the average risk. Models trained using the 17 predictors and 164 predictors did not improve model performance compared to the models trained using 21 predictors. Conclusions The five models can predict risk of perinatal depression within each trimester and in two post-natal periods using survey responses as early as week 4 of pregnancy with modest performance. The models need to be externally validated and prospectively tested to ensure generalizability to any pregnant patient. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04741-9.
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Affiliation(s)
- Jenna M Reps
- Janssen Research & Development, Titusville, NJ, USA.
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Donmez M, Yorguner N, Kora K, Topcuoglu V. Efficacy of bright light therapy in perinatal depression: A randomized, double-blind, placebo-controlled study. J Psychiatr Res 2022; 149:315-322. [PMID: 35339911 DOI: 10.1016/j.jpsychires.2022.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/29/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Uncertainties and difficulties associated with the current treatment modalities for perinatal depression (PND) may cause some mothers to avoid treatment. Raising awareness about the effectiveness and safety of bright light therapy (BLT) may help to alleviate the challenges of PND. The main goal of this study was to evaluate the efficacy and safety of BLT versus placebo in PND. METHOD A total of 30 women who were either pregnant or in first year postpartum and diagnosed with major depressive disorder were enrolled; 23 completed the study. Patients were randomly assigned to either the BLT (10,000 lux) or placebo (<500 lux) group. BLT and placebo light were applied for 45 min in the morning every day for a 3-week period. The Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Depression Rating Scale (HAM-D), and Edinburgh Postnatal Depression Scale (EPDS) were administered weekly to evaluate response and remission rates and depression scores. RESULTS There was no significant difference between the two groups in terms of baseline depression scores. At the end of the study, the response rates assessed according to MADRS were 75% for BLT and 18.2% for placebo (p = .006), and remission rates were 41.7% vs. 0% (p = .016), respectively. There was no significant difference between the groups (p > .05) in terms of treatment-related side effects. The main limitation of this study is its small sample size, which limits the generalizability of the study's findings. CONCLUSION The results indicate that BLT is more effective than placebo and is reliable in terms of side effects in PND patients. In order to expand the use of BLT in PND, new studies with larger sample sizes are needed.
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Affiliation(s)
- Melike Donmez
- Department of Psychiatry, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey.
| | - Nese Yorguner
- Department of Psychiatry, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey.
| | | | - Volkan Topcuoglu
- Department of Psychiatry, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey.
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Lodha P, Jahangir T, Karia S, DeSousa A, Appasani R, Withers M. Perceptions of perinatal depression among low-income mothers and families in Mumbai, India. Asian J Psychiatr 2022; 71:103048. [PMID: 35272254 DOI: 10.1016/j.ajp.2022.103048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/11/2022] [Accepted: 02/19/2022] [Indexed: 11/23/2022]
Abstract
Perinatal depression yields long-term adverse effects on maternal mental health, maternal-child interactions, and child development. Research conducted in India suggests that the risk of perinatal depression may be associated with socio-cultural factors. This warrants an assessment of cultural attitudes towards perinatal depression. Our study examined the perceptions of perinatal depression among pregnant mothers (n = 46) admitted to antenatal and postnatal care wards, as well as their accompanying relatives (n = 60), at a government hospital in Mumbai, India. We administered structured interviews to understand the awareness levels of and attitudes towards perinatal depression. We found that a strong majority of the respondents (93%) were unfamiliar with the concept of perinatal depression. Roughly half of the respondents did not believe that women could experience mental health problems during and after delivery (45% and 50% respectively). A majority of the respondents (77%) believed that a mother does not love her baby if she is depressed after delivery. We additionally report qualitative findings from our open-ended questions on perceived symptomatology, post-delivery priorities, perceived treatment needs, and attitudes towards spousal or familial support. Findings highlight an exigency for researchers, clinicians, and mental health advocates to foster increased awareness of perinatal depression among expectant mothers and their family members. Accordingly, interventions to address perinatal depression should factor in the target population's awareness levels and sociocultural perceptions. Findings helped inform the development of psychoeducation and informational materials to target this need.
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Falek I, Acri M, Dominguez J, Havens J, McCord M, Sisco S, Wilcox W, Hoagwood K. Management of depression during the perinatal period: state of the evidence. Int J Ment Health Syst 2022; 16:21. [PMID: 35468808 PMCID: PMC9036756 DOI: 10.1186/s13033-022-00531-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perinatal depression (PND) is a prevalent ailment that affects both the woman and her family. Addressing PND in primary health care, such as pediatrics and obstetric care settings, has been proposed as an effective way to identify and treat women. OBJECTIVE The purpose of this study is to examine best practices for management of PND in obstetric and pediatric settings, as well as investigate the evidence that supports the guidelines. METHODS Guidelines were identified through a literature search and discussion with experts in the field of perinatal depression, while evidence was examined through a literature search of reviews and thereafter experimental studies. RESULTS Twenty-five guidelines, across 17 organizations were retained for analysis. Findings suggest that there is little or varied guidance on the management of PND, as well as a lack of specificity. Treatment was the topic most frequently reported, followed by screening. However best practices vary greatly and often contradict one another. Across all areas, there is inadequate or contrasting evidence to support these guidelines. CONCLUSIONS Although there was consensus on the key steps in the pathway to care, the review revealed lack of consensus across guidelines on specific issues relating to identification and management of depression during the perinatal period. Clinicians may use these recommendations to guide their practice, but they should be aware of the limitations of the evidence supporting these guidelines and remain alert to new evidence. There is a clear need for researchers and policymakers to prioritize this area in order to develop evidence-based guidelines for managing perinatal depression.
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Affiliation(s)
- Idan Falek
- Department of Child & Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA.
| | - Mary Acri
- Department of Child & Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Joanna Dominguez
- Department of Child & Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Jennifer Havens
- Department of Child & Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Mary McCord
- New York City Health and Hospitals Corporation, 55 Water St., New York, NY, 10041, USA
| | - Sarah Sisco
- New York City Health and Hospitals Corporation, 55 Water St., New York, NY, 10041, USA
| | - Wendy Wilcox
- New York City Health and Hospitals Corporation, 55 Water St., New York, NY, 10041, USA
| | - Kimberly Hoagwood
- Department of Child & Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
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Li H, Yu X, Qiang W, Lu M, Jiang M, Hou Y, Gu Y, Tao F, Zhu B. A longitudinal cohort study of gestational diabetes mellitus and perinatal depression. BMC Pregnancy Childbirth 2022; 22:337. [PMID: 35440070 PMCID: PMC9017412 DOI: 10.1186/s12884-022-04667-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/08/2022] [Indexed: 11/26/2022] Open
Abstract
Background The association between gestational diabetes mellitus (GDM) and perinatal depression (PND) remains controversial. Our study aimed to comprehensively assess this association in a longitudinal cohort study with repeated measurements of depression. Methods Our cohort study was nested in a pilot study of an implementation study aiming to screen and manage perinatal depression within the primary health system in China. Women were recruited in the first trimester from May–September 2019 and followed four times up to 1 year postpartum. Data on sociodemographic characteristics and depression were collected using self-developed questionnaires incorporating the Edinburgh Postnatal Depression Scale (EPDS). Oral glucose tolerance test at 24 ~ 28 weeks and fasting plasma glucose (FPG) data were extracted from medical records. Depression throughout the whole period was divided into different trajectories. Associations of GDM with PND at different time periods and PND of different trajectories were determined by logistic regression. The path of association between blood glucose and depression over time was estimated with an autoregressive cross-lagged model. Results In total, 1043 women were included in this analysis and 313 (30.0%) were diagnosed with GDM. The prevalence of depression in the first, second, and third trimesters and postpartum period were 17.2, 6.9, 6.8 and 9.0%, respectively. GDM was neither significantly associated with PND at any time point nor with any specific trajectory of depression. Except for autoregressive paths, no cross-lagged path of FPG and scores of EPDS was significant. Conclusions Our study indicates no association between GDM/blood glucose and PND. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04667-2.
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Affiliation(s)
- Haiyan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xiayan Yu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Wenjing Qiang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Mengjuan Lu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Minmin Jiang
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Department of Occupational Health and Environmental Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yanyan Hou
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yue Gu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Beibei Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China.
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Jin X, Cheng Z, Yu X, Tao Q, Huang R, Wang S. Continuous supplementation of folic acid in pregnancy and the risk of perinatal depression-A meta-analysis. J Affect Disord 2022; 302:258-272. [PMID: 35066009 DOI: 10.1016/j.jad.2022.01.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/25/2021] [Accepted: 01/19/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND The blood folic acid1(FA) level of depressed patients seems to be lower than that of normal, and pregnant women are at greater risk of FA deficiency. The relationship between FA and perinatal depression has not been well described. METHODS We conducted a meta-analysis of the evidence for the association between the two, using current FA supplementation behavior during pregnancy and blood FA levels as exposures, and the incidence of perinatal depressive symptoms and mean Edinburgh Postnatal Depression Scale2 (EPDS) scores as outcomes. The present study was recorded in PROSPERO (2019 CRD: 42,020,211,509). RESULTS Fifteen studies were identified, covering a total of 26,275 women from eleven observational studies and four randomized controlled trials. For the primary outcome of folic acid supplementation behavior and risk of perinatal depression, the overall odds ratio was 0.742 (95% CI: (0.647-0.852)), with a combined effect value of 0.84 (95% CI: (0.76, 0.93)) for studies in which an OR could be extracted. A negative association was observed between blood folate levels and depressive symptoms (Standardized mean difference (SMD) =-0.127, 95% CI:(-0.183,-0.071)). No association was observed between folic acid intervention and EPDS score. Continuous supplementation of folic acid during pregnancy may reduce the incidence of perinatal depressive symptoms (R = 0.017, (95 CI%:(0.014, 0.021)). LIMITATIONS Lack of rigorous randomized controlled trials due to ethical issues, and the research is heterogeneous and does not consider the influence of genetic factors. CONCLUSIONS Continuous use of FA during pregnancy may reduce the incidence of perinatal depressive symptoms.
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Affiliation(s)
- Xingyi Jin
- Department of Nutrition and Food Hygiene, Anhui Medical University, 81 Meishan Road, Hefei City, Anhui Province, China
| | - Zi Cheng
- Department of Nutrition and Food Hygiene, Anhui Medical University, 81 Meishan Road, Hefei City, Anhui Province, China
| | - Xuemin Yu
- Department of Nutrition and Food Hygiene, Anhui Medical University, 81 Meishan Road, Hefei City, Anhui Province, China
| | - Qi Tao
- Department of Nutrition and Food Hygiene, Anhui Medical University, 81 Meishan Road, Hefei City, Anhui Province, China
| | - Rui Huang
- Department of Nutrition and Food Hygiene, Anhui Medical University, 81 Meishan Road, Hefei City, Anhui Province, China
| | - Sufang Wang
- Department of Nutrition and Food Hygiene, Anhui Medical University, 81 Meishan Road, Hefei City, Anhui Province, China.
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87
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Oladeji BD, Bello T, Ayinde O, Idowu P, Gureje O. Prevalence and correlates of depression among pregnant adolescents in primary maternal care in Nigeria. Arch Womens Ment Health 2022; 25:441-50. [PMID: 35089429 DOI: 10.1007/s00737-021-01198-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/02/2022]
Abstract
To examine the prevalence as well as the clinical and psychosocial factors associated with depression and depression severity in pregnant adolescents. Participants were consecutively registered pregnant adolescents presenting to 30 selected primary maternal and child healthcare centers in Ibadan, Nigeria, who were screened for enrolment into an intervention trial for perinatal depression (depression defined as a score of ≥ 12 on the Edinburg Postnatal Depression Scale [EPDS] and met the DSM-IV diagnostic criteria for depression). Of the 1359 pregnant adolescents screened, 246 (18.1%) had depression. Mean age was 18.4 (sd 1.00), 58.9% were either married or cohabiting, 91.4% were primipara, and the mean gestational age was 23.8 weeks (sd 5.4 weeks). Food insecurity (going to bed hungry at least once in the previous week because there was no food to eat) was reported by 13.3%. In bivariate analysis, younger age, not living with a partner, unemployment, and food insecurity were associated with depression. In bivariate analysis, younger age, not living with a partner, unemployment and food insecurity were associated with depression, while younger age, being single and food insecurity were independently associated with being depressed in multivariate analysis. Severity of depression was related to age, higher anxiety and disability scores, lower quality of life scores across all domains and poorer attitudes towards pregnancy. Depression was associated with indices of higher social disadvantage among adolescents. Delaying childbearing and measures aimed at alleviating poverty may be important in preventing depression in this vulnerable group.
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88
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Schmidt PMDS, Longoni A, Pinheiro RT, Assis AMD. Postpartum depression in maternal thyroidal changes. Thyroid Res 2022; 15:6. [PMID: 35351167 PMCID: PMC8966368 DOI: 10.1186/s13044-022-00124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 03/18/2022] [Indexed: 11/17/2022] Open
Abstract
Evidence in the literature has suggested that there may be an association between thyroid antibodies and depression during pregnancy and in the postpartum period. Thus, this study aims to conduct a systematic review on the prevalence of postpartum depression (PPD) in women with thyroid abnormalities during pregnancy or in the postpartum period. For this review, we used four databases (PubMed, Lilacs, Scielo, and Scopus). Fifteen studies were selected; one study used a case–control design, four used a cross-sectional design and ten utilized prospective cohort designs. All studies were restricted to up to 1 year postpartum, and 46.7% focused on a period between immediate postpartum and 6 months postpartum. Estimates of the prevalence of PPD in pregnant women with thyroid disorders ranged between 8.3% and 36.0%. For follow-up studies, the cumulative incidence of self-reported depression from the primary episode in the first postpartum year was 6.3% in a high-city survey. Although some authors consider the status of positive anti-TPO antibodies to be a possible marker of vulnerability to depression , it is not yet possible to conclude whether thyroid function in the pregnancy-puerperal cycle is involved with the development of PPD.
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Affiliation(s)
- Paula Michele da Silva Schmidt
- Center of Health Science, Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas - UCPel, Pelotas, RS, 96015-560, Brazil
| | - Aline Longoni
- Center of Health Science, Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas - UCPel, Pelotas, RS, 96015-560, Brazil
| | - Ricardo Tavares Pinheiro
- Center of Health Science, Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas - UCPel, Pelotas, RS, 96015-560, Brazil
| | - Adriano Martimbianco de Assis
- Center of Health Science, Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas - UCPel, Pelotas, RS, 96015-560, Brazil.
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89
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Hardman MP, Reynolds KA, Petty SK, Pryor TAM, Pierce SK, Bernstein MT, Furer P. An evaluation of the quality of online perinatal depression information. BMC Pregnancy Childbirth 2022; 22:209. [PMID: 35291974 PMCID: PMC8923100 DOI: 10.1186/s12884-021-04320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During the perinatal period (including pregnancy and up to 12 months after childbirth), expectant and new mothers are at an elevated risk of developing depression. Inadequate knowledge about perinatal depression and treatment options may contribute to the low help-seeking rates exhibited by perinatal people. The Internet can be an accessible source of information about perinatal depression; however, the quality of this information remains to be evaluated. The purpose of this study was to assess the quality of perinatal depression information websites. METHODS After review, 37 websites were included in our sample. To assess overall website quality, we rated websites based on their reading level (Simple Measure of Gobbledegook; SMOG), information quality (DISCERN), usability (Patient Education Materials Assessment Tool; PEMAT), and visual design (Visual Aesthetics of Website Inventory; VisAWI). RESULTS Websites often exceeded the National Institute of Health's recommended reading level of grades 6-8, with scores ranging from 6.8 to 13.5. Website information quality ratings ranged from 1.8 to 4.3 out of 5, with websites often containing insufficient information about treatment choices. Website usability ratings were negatively impacted by the lack of information summaries, visual aids, and tangible tools. Visual design ratings ranged from 3.2 to 6.6 out of 7, with a need for more creative design elements to enhance user engagement. CONCLUSIONS This study outlines the characteristics of high-quality perinatal depression information websites. Our findings illustrate that perinatal depression websites are not meeting the needs of users in terms of reading level, information quality, usability, and visual design. Our results may be helpful in guiding healthcare providers to reliable, evidence-based online resources for their perinatal patients.
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Affiliation(s)
- Madison P Hardman
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada
| | - Kristin A Reynolds
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada.
| | - Sarah K Petty
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada
| | - Teaghan A M Pryor
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada
| | - Shayna K Pierce
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada
| | - Matthew T Bernstein
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada
| | - Patricia Furer
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
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90
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Choi C, Mersky JP, Janczewski CE, Goyal D. Advancing research on perinatal depression trajectories: Evidence from a longitudinal study of low-income women. J Affect Disord 2022; 301:44-51. [PMID: 34995707 DOI: 10.1016/j.jad.2022.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/02/2021] [Accepted: 01/02/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The current study aimed to describe and predict perinatal depression trajectories in a sample of low-income women from the first trimester of pregnancy to six months postpartum. METHODS The study sample consisted of 899 women in Wisconsin who received home visiting services. Eligible participants were screened for depressive symptoms by home visitors using the Edinburgh Postnatal Depression Scale at least three times across four time periods from the first trimester of pregnancy to six months postpartum. Growth Mixture Modeling was applied to identify distinct trajectory classes, and multinomial logistic regressions were performed to analyze predictors of class membership. RESULTS Mean depressive symptom scores in this racially/ethnically diverse sample of low-income women decreased significantly over time from a high of 8.1 at time1 to a low of 6.8 at time4. Four classes were identified, including a low-stable group (78.2% of sample), a high-stable group (10.6%) along with decreasing (7.1%) and increasing (4.1%) trajectories. Women with a history of abuse and mental health difficulties were more likely to be classified in the high-stable and decreasing depression groups than the low-stable group. Low social support was linked to an increasing trajectory that resulted in high levels of postpartum depression. CONCLUSIONS AND IMPLICATIONS Although most women exhibited stable and positive trajectories, more than one out of five presented with either persistently or intermittently high depression scores. Taken together, the findings underscore the importance of depression screening throughout the perinatal period and identifying factors that may be used to target resources to at-risk populations.
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91
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Zhu Y, Ma J, Wang Q, Xu Y, Xu G, Du S. Factors affecting the implementation of task-sharing interventions for perinatal depression in low- and middle-income countries: A systematic review and qualitative metasynthesis. J Affect Disord 2022; 300:400-409. [PMID: 34990629 DOI: 10.1016/j.jad.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/24/2021] [Accepted: 01/01/2022] [Indexed: 10/19/2022]
Abstract
Background The vast majority of women with perinatal depression (PND) live in low- and middle-income countries (LMICs). Task sharing is an alternative delivery strategy to implement PND services. However, the exploration of influencing factors for task sharing in PND services is poor. Therefore, this study aimed to identify factors affecting LMICs to implement PND task-sharing interventions from the perspective of stakeholders and weigh their levels of evidence. Methods A comprehensive literature search was carried out through six English and Chinese databases on qualitative data. We used Critical Appraisal Skills Programme (CASP)/Meta Quality Appraisal Tool (MetaQAT) to appraise included studies, extracted data according to the Consolidated Framework for Implementation Research (CFIR), and assigned levels of confidence in the factors through Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual). Results 17 studies met the eligibility criteria, factors identified with high levels of evidence were coded to the CFIR constructs, including "Knowledge and Attitudes of Those Served by the Organization", "Available Resources", "Compatibility", "Access to knowledge and information", "Resources of Those Served by the Organization" and "Alignment". Conclusion This metasynthesis highlights task sharing in PND interventions is influenced by multiple factors. We synthesized and developed implementation recommendations for practice. Strategies must be actively developed to enable women and their families to enjoy the benefits of good perinatal mental health.
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Affiliation(s)
- Yuan Zhu
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing Jiangsu Province, China
| | - Jiayuan Ma
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing Jiangsu Province, China
| | - Qing Wang
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing Jiangsu Province, China
| | - Yue Xu
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing Jiangsu Province, China
| | - Guihua Xu
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing Jiangsu Province, China.
| | - Shizheng Du
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing Jiangsu Province, China.
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92
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Matsumura K, Hamazaki K, Tsuchida A, Kasamatsu H, Inadera H. Causal model of the association of social support during pregnancy with a perinatal and postpartum depressive state: A nationwide birth cohort - the Japan Environment and Children's Study. J Affect Disord 2022; 300:540-550. [PMID: 34979183 DOI: 10.1016/j.jad.2021.12.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/03/2021] [Accepted: 12/30/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite many epidemiological studies on the relationship between social support during pregnancy and perinatal/postpartum depression, its impact remains unclear. Therefore, this study examined this association using a causal model of risk based on various levels of social support. METHODS Participants were 88,711 mothers in an ongoing nationwide birth cohort study in Japan. Social support during pregnancy was set at four treatment levels. Depressive state was identified twice, with the Kessler Psychological Distress Scale (K6; score ≥ 5) and the Edinburgh Postnatal Depression Scale (EPDS; score ≥ 9). With the highest level of social support set as reference, marginal structural models were fitted to derive counterfactual risk ratios (cRRs). RESULTS cRRs (95% CIs) for EPDS cases increased as the level of social support decreased, with values of 1.06 (0.99-1.13) for upper-middle, 1.30 (1.23-1.39) for lower-middle, and 1.61 (1.52-1.71) for low. Also, cRRs (95% CIs) at the second measurement (interaction) tended to increase as social support decreased, with values of 1.05 (0.97-1.13) for upper-middle, 1.05 (0.98-1.13) for lower-middle, and 1.10 (1.03-1.18) for low. The same tendency was observed in K6 cases. LIMITATION Depressive state was identified by self-administered questionnaire. CONCLUSIONS Lower social support during pregnancy is associated with increased counterfactual risk of perinatal/postpartum depressive state and worsened counterfactual spontaneous recovery over time. These findings highlight the importance of sufficient social support for preventing perinatal/postpartum depression and promoting recovery. TRIAL REGISTRATION UMIN000030786.
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Affiliation(s)
- Kenta Matsumura
- Department of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Japan; Toyama Regional Center for JECS, University of Toyama, Toyama, Japan.
| | - Kei Hamazaki
- Department of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Japan; Toyama Regional Center for JECS, University of Toyama, Toyama, Japan; Department of Public Health, Gunma University Graduate school of Medicine, Gunma, Japan
| | - Akiko Tsuchida
- Department of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Japan; Toyama Regional Center for JECS, University of Toyama, Toyama, Japan
| | - Haruka Kasamatsu
- Toyama Regional Center for JECS, University of Toyama, Toyama, Japan
| | - Hidekuni Inadera
- Department of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Japan; Toyama Regional Center for JECS, University of Toyama, Toyama, Japan
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93
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Singla DR, Hossain S, Ravitz P, Schiller CE, Andrejek N, Kim J, La Porte L, Meltzer-Brody SE, Silver R, Vigod SN, Jung JW, Dimidjian S. Adapting behavioral activation for perinatal depression and anxiety in response to the COVID-19 pandemic and racial injustice. J Affect Disord 2022; 299:180-187. [PMID: 34875282 PMCID: PMC8645290 DOI: 10.1016/j.jad.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 11/06/2021] [Accepted: 12/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND We examined the implementation of a brief, behavioural activation (BA) model, via telemedicine, for perinatal populations during a confluence of significant global events in 2020. We conducted a rigorous qualitative study to identify relevant barriers and facilitators from the perspectives of both perinatal participants and treatment providers. We also present two case studies where BA was used and adapted to provide patient-centered care. METHODS Within the ongoing SUMMIT non-inferiority randomized controlled trial in Canada and USA, we interviewed a random selection of perinatal participants (n = 23) and all treatment providers (n = 28). A content analysis framework was developed to identify relevant barriers and facilitators and frequencies were calculated for each emergent theme within and across respondent groups. RESULTS Key facilitators reported by participants receiving BA were that BA helped with support and social connection (73.9%), creative problem solving (26.1%) and attending to pandemic-related symptoms (21.7%). Key facilitators endorsed by providers delivering BA were the use of telemedicine (35.7%) and loosening of government restrictions (21.4%). Both participant groups reported similar barriers to BA during the pandemic such as a lack of privacy and limited activities due to pandemic restrictions. However, providers were more likely to endorse pandemic-related life stressors as a barrier to treatment delivery compared to participants (64.3% vs. 34.8%). Both participant groups experienced explicit discussion of race and the racial justice movements during sessions as beneficial and reported harms of not doing so to the therapeutic alliance. CONCLUSIONS BA offers a person-centered model to facilitate social connection through creative problem-solving for women with perinatal depressive and anxiety symptoms within the context of the COVID-19 pandemic. Explicit discussion of race and racial injustice during sessions is an important and helpful aspect in psychological treatments.
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Affiliation(s)
- Daisy R. Singla
- Campbell Family Mental Health Research Institute, Center of Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada,Lunenfeld Tanenbaum Research Institute, Toronto, Canada,Corresponding author at: 60 White Squirrel Way, Rm313, Toronto, ON M6J 1H4, Canada
| | | | - Paula Ravitz
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada,Lunenfeld Tanenbaum Research Institute, Toronto, Canada,Department of Psychiatry, Sinai Health, Toronto, Canada
| | - Crystal E. Schiller
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, United States
| | | | - Jo Kim
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Chicago, IL, United States
| | - Laura La Porte
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Chicago, IL, United States
| | - Samantha E. Meltzer-Brody
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, United States
| | - Richard Silver
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Chicago, IL, United States
| | - Simone N. Vigod
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada,Department of Psychiatry, Women's College Hospital, Toronto, Canada
| | - James W. Jung
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Sona Dimidjian
- Renee Crown Wellness Institute and Department of Psychology and Neuroscience, University of Colorado, Boulder, United States
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94
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Abstract
Perinatal depression is a commonly underdiagnosed problem which not only severely affects maternal mental and physical health, but also affects the newborn on a physical, mental and cognitive level with serious repercussions on adult life. Despite efforts to obtain useful information to dimension the problem, most experts in the field agree that this disorder is more frequent than estimated. Thus, the improvement in obtaining information on perinatal mental health will not only allow for a better dimensioning of the problem, but will also allow for better decision making in public mental health to reduce morbidity and mortality and the burden of disease associated with perinatal depression.
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Affiliation(s)
- Nilson A Contreras-Carreto
- Dirección de Mejora de Procesos, Dirección General de Calidad y Educación en Salud (DGES), Secretaría de Salud, Ciudad de México
| | - Luis Villalobos-Gallegos
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Campus Tijuana, Tijuana, Baja California
| | - Javier Mancilla-Ramírez
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México. México
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95
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Bhat A, Nanda A, Murphy L, Ball AL, Fortney J, Katon J. A systematic review of screening for perinatal depression and anxiety in community-based settings. Arch Womens Ment Health 2022; 25:33-49. [PMID: 34247269 DOI: 10.1007/s00737-021-01151-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/24/2021] [Indexed: 02/02/2023]
Abstract
Screening for perinatal depression and anxiety in community-based maternal and child health settings may help close the detection and treatment gap among women at higher risk for these conditions. We aim to review perinatal depression and anxiety screening tools, timing, and follow-up processes for positive screens in community-based settings. We conducted a systematic review of the literature to identify papers describing screening and interventions for perinatal depression and anxiety in community-based settings. We identified 49 papers describing 47 studies of perinatal depression or anxiety screening in community-based settings. The Edinburgh Postnatal Depression Scale (EPDS) was the most frequently used screening tool. Referral and referral tracking for those who screened positive for symptoms were inadequately described. Types of training and technical assistance provided for screening varied widely. It is feasible and acceptable to screen for perinatal depression in community settings, but there is a need for systematic research examining which screening tools to use, the ideal frequency of screening, and referral completion rates. There is a lack of information regarding perinatal anxiety screening and a lack of uniformity in training regarding screening in community-based settings. Future studies should compare the efficacy of screening in community-based settings to screening in healthcare settings.
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Affiliation(s)
- Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Arjun Nanda
- Department of Child and Adolescent Psychiatry, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | - Lauren Murphy
- College of Medicine - Tucson, The University of Arizona, Tucson, AZ, USA
| | - Andrea L Ball
- MultiCare Institute for Research and Innovation, Tacoma, WA, USA
| | - John Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Jodie Katon
- VA Puget Sound Health Care System, WA, Seattle, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
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96
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Pereira D, Pessoa AR, Madeira N, Macedo A, Pereira AT. Association between premenstrual dysphoric disorder and perinatal depression: a systematic review. Arch Womens Ment Health 2022; 25:61-70. [PMID: 34436653 DOI: 10.1007/s00737-021-01177-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
Premenstrual dysphoric disorder (PMDD) affects 1.2 to 5% of women of reproductive age. Besides significant suffering and social, occupational, and interpersonal impairment, it has been suggested that this syndrome is associated with other affective disorders, in different reproductive phases, such as pregnancy and the postpartum period. However, the literature on this association is scarce and presents great variability in terms of adopted methodology and mixed results. To analyze the relationship between PMDD and other affective disorders, aiming to contribute to the clarification of whether PMDD can be considered a risk factor for perinatal depression (PND). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive literature search in PubMed, EMBASE, CINAHL, PsycINFO databases. Seven original studies were included. Only one study linked PMDD with depression during pregnancy, with evidence of a positive association between PMDD and PND. This and five other studies show a positive relationship between PMDD and postpartum depression (PPD), assessed in periods ranging from 2 to 4 days to 1 year after birth. Only one study found no significant association between PMDD and PPD, assessed at 4 weeks postpartum. There seems to be a positive and significant association between PMDD and the development of perinatal depression, particularly postpartum depression. This review supports the relevance of health professionals systematically evaluating the presence of premenstrual dysphoric disorder, when monitoring women throughout the perinatal period.
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97
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Abstract
BACKGROUND Perinatal depression in women is associated with high morbidity and mortality, and has attracted increasing attention. The investigation of risk factors of perinatal depression in women may contribute to the early identification of depressed or depression-prone women in clinical practice. MATERIAL AND METHODS A computerized systematic literature search was made in Cochrane Library, PubMed, Web of Science, and EMBASE from January 2009 to October 2021. All included articles were published in English, which evaluated factors influencing perinatal depression in women. Based on the recommendations of the Cochrane Collaboration protocols, Review Manager 5.3 was used as a statistical platform. RESULTS Thirty-one studies with an overall sample size of 79,043 women were included in the review. Educational level (P = 0.0001, odds ratio [OR]: 1.40, 95% CI: [1.18,1.67]), economic status of families (P = 0.0001, OR: 1.69, 95%CI: [1.29,2.22]), history of mental illness (P < 0.00001, OR: 0.29, 95% CI: [0.18, 0.47]), domestic violence (P < 0.00001, OR: 0.24, 95% CI: [0.17,0.34]), perinatal smoking or drinking (P = 0.005, OR: 0.63; 95% CI [0.45, 0.87]; P = 0.008, OR: 0.43, 95% CI, [0.23 to 0.80]; respectively), and multiparity(P = 0.0003, OR: 0.74, 95% CI: [0.63, 0.87]) were correlated with perinatal depression in women. The stability of our pooled results was verified by sensitivity analysis and publication bias was not observed based on funnel plot results. CONCLUSION Lower educational level, poor economic status of families, history of mental illness, domestic violence, perinatal smoking or drinking, and multiparity serve as risk factors of perinatal depression in women.
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Affiliation(s)
- Kai Yang
- grid.33199.310000 0004 0368 7223Department of Anesthesiology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Jing Wu
- grid.33199.310000 0004 0368 7223Department of Anesthesiology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, 430022, China.
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98
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Hong L, Le T, Lu Y, Shi X, Xiang L, Liu M, Zhang W, Zhou M, Wang J, Xu D, Yu X, Zhao K. Distinct trajectories of perinatal depression in Chinese women: application of latent growth mixture modelling. BMC Pregnancy Childbirth 2022; 22:24. [PMID: 35012496 PMCID: PMC8751241 DOI: 10.1186/s12884-021-04316-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 12/03/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Current research on perinatal depression rarely pays attention to the continuity and volatility of depression symptoms over time, which is very important for the early prediction and prognostic evaluation of perinatal depression. This study investigated the trajectories of perinatal depression symptoms and aimed to explore the factors related to these trajectories. METHODS The study recruited 550 women during late pregnancy (32 ± 4 weeks of gestation) and followed them up 1 and 6 weeks postpartum. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). Latent growth mixture modelling (LGMM) was used to identify trajectories of depressive symptoms during pregnancy. RESULTS Two trajectories of perinatal depressive symptoms were identified: "decreasing" (n = 524, 95.3%) and "increasing" (n = 26, 4.7%). History of smoking, alcohol use and gestational hypertension increased the chance of belonging to the increasing trajectories, and a high level of social support was a protective factor for maintaining a decreasing trajectory. CONCLUSIONS This study identified two trajectories of perinatal depression and the factors associated with each trajectory. Paying attention to these factors and providing necessary psychological support services during pregnancy would effectively reduce the incidence of perinatal depression and improve patient prognosis.
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Affiliation(s)
- Lan Hong
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Tao Le
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Yinping Lu
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Xiang Shi
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Ludan Xiang
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Meng Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Wenmiao Zhang
- Department of Obstetrics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Meixi Zhou
- Department of Obstetrics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiangling Wang
- Department of Obstetrics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dongwu Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China.
| | - Xin Yu
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China.
| | - Ke Zhao
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China.
- The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, 325035, China.
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99
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Gopalan P, Spada ML, Shenai N, Brockman I, Keil M, Livingston S, Moses-Kolko E, Nichols N, O'Toole K, Quinn B, Glance JB. Postpartum Depression-Identifying Risk and Access to Intervention. Curr Psychiatry Rep 2022; 24:889-96. [PMID: 36422834 DOI: 10.1007/s11920-022-01392-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW As maternal mortality climbs in the USA with mental health conditions driving these preventable deaths, the field of reproductive psychiatry must shift towards identification of women and other birthing individuals at risk and facilitating access. This review brings together recent studies regarding risk of perinatal depression and highlights important comorbidities that place individuals at higher vulnerability to poor perinatal outcomes. RECENT FINDINGS Recent research suggests that identifying risk for perinatal depression including historical diagnoses of depression, anxiety, trauma, and comorbid substance use and intimate partner violence may move the field to focus on preventive care in peripartum populations. Emerging data shows stark health inequities in racial and ethnic minority populations historically marginalized by the health system and in other vulnerable groups such as LGBTQ+ individuals and those with severe mental illness. Innovative models of care using systems-level approaches can provide opportunities for identification and risk analyses of vulnerable peripartum patients and facilitate access to therapeutic or preventive interventions. Utilizing intergenerational approaches and leveraging multidisciplinary teams that thoughtfully target high-risk women and other birthing individuals could promote significant changes to population-level care in maternal health.
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100
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Felder JN, Mirchandaney R, Dimidjian S. Uptake of USPSTF recommendation to refer pregnant individuals for therapy or counseling to prevent perinatal depression. Arch Womens Ment Health 2022; 25:1149-1153. [PMID: 36152085 PMCID: PMC9734199 DOI: 10.1007/s00737-022-01267-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Perinatal depression is the most common complication of pregnancy and childbirth, and it is associated with adverse consequences. The United States Preventive Services Task Force (USPSTF) recommends that pregnant and postpartum (i.e., perinatal) individuals at risk for depression be referred for therapy or counseling interventions; however, it is unclear to what extent this recommendation has been implemented. METHODS Pregnant individuals were recruited via advertisements on a pregnancy app and a separate study on sleep. Respondents completed the initial screening questions to determine their risk for perinatal depression, defined as self-reported history of depression; recent stressors; history of emotional, sexual, or physical abuse; mild depressive symptoms; anxiety symptoms; single; diabetes diagnosis; or unwanted pregnancy. Eligible respondents reported their providers' recommendations for preventing depression, and their utilization of interventions to prevent depression (n = 303). RESULTS Fewer than 15% of participants reported that a provider referred them for therapy or counseling to prevent depression; recommendations included cognitive behavioral therapy (4%), interpersonal psychotherapy (2.3%), mindfulness-based cognitive therapy (4.3%), or other/unknown (6.6%). Approximately 12% reported that a provider recommended medication to prevent depression. Provider referral rates varied by risk factor, but not by patient demographics. Nearly 20% of participants reported using therapy or counseling to prevent depression, and nearly 13% reported using medication to prevent depression. CONCLUSIONS We explore potential factors affecting the uptake of the USPSTF recommendation and underscore the importance of preventing perinatal depression.
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Affiliation(s)
- Jennifer N. Felder
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA ,Osher Center for Integrative Health, University of California, San Francisco, UCSF, Box 1726, San Francisco, CA 94143 USA ,Crown Institute and Department of Psychiatry and Neuroscience, University of Colorado Boulder, Boulder, USA
| | - Riya Mirchandaney
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA ,Crown Institute and Department of Psychiatry and Neuroscience, University of Colorado Boulder, Boulder, USA
| | - Sona Dimidjian
- Osher Center for Integrative Health, University of California, San Francisco, UCSF, Box 1726, San Francisco, CA 94143 USA ,Crown Institute and Department of Psychiatry and Neuroscience, University of Colorado Boulder, Boulder, USA
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