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Monteiro F, Pereira M, Canavarro MC, Fonseca A. Be a Mom, a Web-Based Intervention to Promote Positive Mental Health Among Postpartum Women With Low Risk for Postpartum Depression: Exploring Psychological Mechanisms of Change. Front Psychiatry 2021; 12:701107. [PMID: 34335336 PMCID: PMC8316830 DOI: 10.3389/fpsyt.2021.701107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background: This study explored whether Be a Mom, a brief and unguided cognitive behavioral web-based intervention, was effective in promoting psychological processes (self-compassion, psychological flexibility, emotion regulation) among low-risk postpartum women. Effects of Be a Mom in psychological processes compared with a control group were examined at post-intervention and at 4-months follow-up. Additionally, this work explored whether changes in psychological processes mediated improvements in positive mental health at postintervention. Methods: In total, 367 postpartum women presenting low risk for postpartum depression were randomly assigned to the intervention group (n = 191) or to a waiting-list control group (n = 176). Results: Compared with the control group, the intervention group reported significantly greater baseline to postintervention increases in self-compassion. No significant effects were found at the 4-month follow-up. Multilevel mediation showed that self-compassion improvements significantly mediated improvements in positive mental health among the intervention group. No significant results were found for psychological flexibility or emotion regulation. Conclusions: This study suggests that Be a Mom has the potential to cultivate self-compassion among low-risk postpartum women and that this may be a key mechanism for promoting positive mental health in this context. Clinical Trial Registration: www.clinicaltrials.gov, identifier: NCT04055974.
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Affiliation(s)
- Fabiana Monteiro
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
| | - Marco Pereira
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
| | - Maria Cristina Canavarro
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
| | - Ana Fonseca
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
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Postpartum Care. Fam Med 2021. [DOI: 10.1007/978-1-4939-0779-3_15-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Phoosuwan N, Lundberg PC. Knowledge, attitude and self-efficacy program intended to improve public health professionals' ability to identify and manage perinatal depressive symptoms: a quasi-experimental study. BMC Public Health 2020; 20:1926. [PMID: 33380321 PMCID: PMC7774237 DOI: 10.1186/s12889-020-10086-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During the perinatal period women lack screening and treatments for perinatal depressive symptoms, while public health professionals (PHPs) in primary care centres (PCCs) need training for identification and management of such symptoms. This quasi-experimental study was aimed at evaluating knowledge, attitudes and self-efficacy among PHPs after participating in a Knowledge, Attitude, and Self-efficacy (KAS) program for identification and management of perinatal depressive symptoms. METHOD The KAS-program, carried through in Sakonnakhon in north-eastern Thailand, comprised one day of theory and a four-week period of field practice. Thirty-three PHPs from PCCs participated in the program. Twenty-three of them participated in focus group discussions (FGDs). Chi-square for trend, paired-sample T-tests and content analysis were used. RESULTS Knowledge, attitude and self-efficacy scores increased after the PHPs had fully participated in the KAS-program. Four categories emerged from the FGDs: increased understanding and knowledge, being aware and having a positive attitude, having confidence and ability to work, and need of regular training and feedback. CONCLUSION The KAS-program may contribute to giving PHPs in PCCs the knowledge, positive attitude and self-efficacy they need to identify and manage perinatal depressive symptoms. Implementation of the KAS-program to other healthcare professionals such as nurses/midwives is great of interest.
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Affiliation(s)
- Nitikorn Phoosuwan
- Department of Public Health and Caring Sciences, Faculty of Medicine, Uppsala University, BMC, Husargatan 3, Box 564, 751 22, Uppsala, Sweden.
- Department of Community Health, Faculty of Public Health, Kasetsart University Chalermphrakiat Sakonnakhon Province Campus, Chiang Khruea sub-district, Muang Sakon Nakhon, Sakon Nakhon Province, Thailand.
| | - Pranee C Lundberg
- Department of Public Health and Caring Sciences, Faculty of Medicine, Uppsala University, BMC, Husargatan 3, Box 564, 751 22, Uppsala, Sweden
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Rosander M, Berlin A, Forslund Frykedal K, Barimani M. Maternal depression symptoms during the first 21 months after giving birth. Scand J Public Health 2020; 49:606-615. [PMID: 33308010 PMCID: PMC8512257 DOI: 10.1177/1403494820977969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aims: The first year after childbirth involves a major transition for women, which
can accentuate inadequacies and feelings of powerlessness, making them
vulnerable to depression. The aim of this study was to investigate the
prevalence and frequency of maternal postpartum depressive symptoms at
different times after giving birth (0–21 months). Methods: Data were collected cross-sectionally using a web questionnaire containing
the Edinburgh Postnatal Depression Scale (EPDS). A total of 888 mothers with
children in the age range 0–21 months responded. Results: The results showed different levels of depression over the range of months
included in the study. The overall prevalence using EPDS ⩾ 12 was 27.8%.
There were higher levels at 9–12 months and 17–21 months. The highest levels
of symptoms of depression were found at nine, 12, and 17 months after birth,
and the lowest levels at two and 16 months. Conclusions: Many mothers experience symptoms of depression after giving birth that
can continue well beyond the child’s first year. We have identified
different levels of depression at different points in time after giving
birth, with highs and lows throughout the first 21 months. This
highlights a need to screen for depression more than once during the
first years, as well as a closer cooperation between midwives and child
healthcare nurses in supporting mothers in the transition to motherhood.
This is an important aspect of public health, which not only involves
mothers with symptoms of depression, but also their ability to care for
their child and a possible negative impact on the child’s
development.
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Affiliation(s)
- Michael Rosander
- Department of Behavioural Sciences and
Learning, Linköping University, Linköping, Sweden
- Michael Rosander, Department of Behavioural
Sciences and Learning, Linköping University, 581 83 Linköping, Sweden. E-mail:
| | - Anita Berlin
- Department of Neurobiology, Care
Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Karin Forslund Frykedal
- Department of Behavioural Sciences and
Learning, Linköping University, Linköping, Sweden
- Department of Social and Behavioural
Studies, University West, Trollhättan, Sweden
| | - Mia Barimani
- Academic Primary Care Centre, Region
Stockholm, Stockholm, Sweden
- Division of Family Medicine and Primary
Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet,
Stockholm, Sweden
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Levels of n-3 and n-6 Fatty Acids in Maternal Erythrocytes during Pregnancy and in Human Milk and Its Association with Perinatal Mental Health. Nutrients 2020; 12:nu12092773. [PMID: 32932815 PMCID: PMC7551231 DOI: 10.3390/nu12092773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/03/2020] [Accepted: 09/09/2020] [Indexed: 12/27/2022] Open
Abstract
Omega-3 long-chain polyunsaturated fatty acid (n-3 FA) status may be associated with mood disorders. Here, we evaluated the potential association between antenatal depression/anxiety and n-3/n-6 FA in (a) maternal erythrocytes and (b) human milk. In addition, we explored associations between n-3/n-6 FA in erythrocytes and in human milk and postpartum depression, while controlling for antenatal depression. Twenty-seven pregnant women diagnosed with a current major depressive disorder (MDD; n = 9), anxiety disorder (AD; n = 10) or a mixed anxiety-depression disorder (MADD; n = 8), and 40 healthy controls were included. n-3/n-6 FA were determined in maternal erythrocytes in gestational week 32 and in human milk in postpartum week 1. In the first week postpartum, the Edinburgh-Postnatal-Depression-Questionnaire was used to assess postpartum depression. Results show that women with M(A)DD had significantly lower erythrocyte levels of total n-3 FA, EPA, DHA and DGLA, and significantly higher n-6 DPA, and n-6:n-3, AA:EPA and n-6 DPA:DHA ratios compared to healthy controls. No significant associations between antenatal depression or anxiety and n-3/n-6 FA in human milk were found. After controlling for antenatal mental health, n-3/n-6 FA in maternal erythrocytes or in human milk were not significantly associated with postpartum depression. In conclusion, antenatal depression, alone or with an anxiety disorder, was associated with lower n-3 FA levels and higher n-6:n-3 FA ratios in maternal erythrocytes during gestation. This study provides some insights into the associations between n-3/n-6 FA levels during pregnancy and lactation and perinatal mental health.
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Yin J, Nisar A, Waqas A, Guo Y, Qi WL, Wang D, Rahman A, Li X. Psychosocial interventions on perinatal depression in China: A systematic review and meta-analysis. J Affect Disord 2020; 271:310-327. [PMID: 32479331 DOI: 10.1016/j.jad.2020.03.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The prevalence of perinatal depression is 16.3% in China and has shown a rising trend in the last decade. However, few studies summarized psychosocial interventions for perinatal depression in this country. This study aimed at evaluating and characterizing psychosocial interventions for perinatal depression in Mainland China. METHODS Ten major English and Chinese language electronic bibliographic databases were searched for RCTs examining the effect of psychosocial interventions for perinatal depressed women in Mainland China. Studies meeting eligibility criteria and published before 25th February 2019 were included, while those focusing on a very specific sub-population or reporting non-psychosocial interventions were excluded. Data was extracted by a standard form. Meta-analysis was conducted to obtain a summary measure of the effectiveness of the interventions in reducing perinatal depressive symptoms. The theoretical underpinnings and implementation processes of the interventions were also characterised. RESULTS A total of 6857 articles were identified in the initial database searching, of which, 26 studies were eligible for data analysis, representing a sample size of 4673. Meta-analysis indicated that psychosocial interventions in China significantly reduced perinatal depressive symptoms (standard difference in means 0.81, 95% confidence intervals -1.03 to -0.58, P < 0.001). However, the overall evidence presented substantial heterogeneity (I2 = 91.12%). Most interventions were implemented in hospitals in urban areas by non-specialist health care providers. Few studies reported details of implementation procedures or scale-up strategies. LIMITATIONS The evidence in this review is of moderate to low quality and therefore, should be interpreted with caution. Some of the trials were inadequately powered and tended to overestimate effect sizes. CONCLUSIONS Current psychosocial interventions in China are somewhat effective in reducing perinatal depressive symptoms. High quality RCTs on scale-up interventions are required, especially in rural areas.
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Affiliation(s)
- Juan Yin
- School of nursing, Xi'an Jiaotong University, 76 West Yanta Road, 710061 Xi'an, China
| | - Anum Nisar
- School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Ahmed Waqas
- Human Development Research Foundation, Rawalpindi, Pakistan; University of Liverpool, Liverpool, UK
| | - Yan Guo
- School of nursing, Xi'an Jiaotong University, 76 West Yanta Road, 710061 Xi'an, China
| | - Wen Li Qi
- Department of obstetrics, Xi'an Aerospace general hospital, Xi'an, China
| | - Duolao Wang
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Atif Rahman
- Institute of Life and Human Sciences, University of Liverpool, Liverpool, UK
| | - Xiaomei Li
- School of nursing, Xi'an Jiaotong University, 76 West Yanta Road, 710061 Xi'an, China.
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Cacciola E, Psouni E. Insecure Attachment and Other Help-Seeking Barriers among Women Depressed Postpartum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3887. [PMID: 32486285 PMCID: PMC7313466 DOI: 10.3390/ijerph17113887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022]
Abstract
When untreated, postpartum depression (PPD) can severely, negatively affect maternal health, child development, and the wellbeing and functioning of the entire family. Yet, despite screening and treatment programs for PPD, many women who experience depression with onset in the postpartum year do not communicate their symptoms. Negative relational experiences early in life, such as not receiving sensitive help and support when needed, often result in so-called insecure attachment styles, and there is evidence that these may contribute to the development and maintenance of PPD. However, the role of insecure attachment styles in non-help-seeking is unknown for this group. Using mixed quantitative and qualitative methodology, we identified help-seeking barriers of women who experienced depression with onset in the postpartum year but who had not sought help for their depression (N = 37), and explored links to their attachment orientations as assessed through both self-reported attachment style and narrative based attachment script assessment. The sample was non-normative regarding attachment, with an over-representation of avoidant attachment styles. Help-seeking barriers varied systematically with the mother's adult attachment style. Specifically, convictions of a strong self and lack of trust in healthcare professionals constituted a common barrier among women with avoidant attachment styles, while unrealistic expectations about motherhood constituted a barrier for women with secure attachment styles. This new knowledge on how barriers to communicating symptoms and seeking help when suffering from PPD vary systematically with attachment orientation can help formulate individualized, and therefore more efficient, approaches to addressing non-help-seeking behavior in women who suffer in silence.
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Affiliation(s)
| | - Elia Psouni
- Department of Psychology, Lund University, P.O. Box 213, SE221-00 Lund, Sweden;
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Martín-Gómez C, Moreno-Peral P, Bellón JA, Conejo Cerón S, Campos-Paino H, Gómez-Gómez I, Rigabert A, Benítez I, Motrico E. Effectiveness of psychological, psychoeducational and psychosocial interventions to prevent postpartum depression in adolescent and adult mothers: study protocol for a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2020; 10:e034424. [PMID: 32423929 PMCID: PMC7239544 DOI: 10.1136/bmjopen-2019-034424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/27/2020] [Accepted: 04/09/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The prevalence of postpartum depression (PPD) is 17%, and the incidence is 12% worldwide. Adverse consequences for mothers and babies have been associated with this disease. To assess the effectiveness of psychological, psychoeducational and psychosocial interventions in preventing PPD, a systematic review and meta-analysis (SR/MA) will be conducted. METHODS AND ANALYSIS A SR/MA will be performed following the indications of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies will be identified through MEDLINE (Ovid and PubMed), PsycINFO, Web of Science, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, OpenGrey, Australian New Zealand Clinical Trial Registry, ClinicalTrials.gov and evidencebasedtherapy.org from inception until 31 January 2020. Bridging searches will be also conducted until the review is completed. The selection criteria will be as follows: (1) subjects will be pregnant females or females who have given birth in the last 12 months and who were non-depressive at baseline; (2) psychological, psychoeducational and psychosocial interventions; (3) comparator will be usual care, attention control, waiting list or no intervention; (4) outcomes will be specific results on PPD; and (5) the design of the studies will be randomised controlled trials. No restrictions regarding the year of publication, the setting of the intervention or the language of publication will be considered. Pooled standardised mean differences and 95% CIs will be calculated. The risk of bias of the studies will be assessed through the Cochrane Collaboration risk of bias tool. Heterogeneity between the studies will be determined by the I2 and Cochran's Q statistics. Sensitivity and subgroup analyses will also be performed. Publication bias will be checked with funnel plots and Egger's test. Heterogeneity will be explored by random-effects meta-regression analysis. ETHICS AND DISSEMINATION The ethical assessment was not required. The results will be presented at conferences and disseminated through publications. PROSPERO REGISTRATION NUMBER CRD42018109981.
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Affiliation(s)
- Carmen Martín-Gómez
- Department of Psychology, Universidad Loyola Andalucia, Dos Hermanas (Sevilla), Spain
| | - Patricia Moreno-Peral
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Juan A Bellón
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- El Palo Health Centre, Adalusian Health Service (SAS), Málaga, Spain
- Department of Public Health and Psychiatry, University of Málaga (UMA), Málaga, Spain
| | - Sonia Conejo Cerón
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Henar Campos-Paino
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Irene Gómez-Gómez
- Department of Psychology, Universidad Loyola Andalucia, Dos Hermanas (Sevilla), Spain
| | - Alina Rigabert
- Department of Psychology, Universidad Loyola Andalucia, Dos Hermanas (Sevilla), Spain
- Fundación Andaluza Beturia para la Investigación en Salud (FABIS), Huelva, Spain
| | - Isabel Benítez
- Department of Psychology, Universidad Loyola Andalucia, Dos Hermanas (Sevilla), Spain
| | - Emma Motrico
- Department of Psychology, Universidad Loyola Andalucia, Dos Hermanas (Sevilla), Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
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Heller HM, Hoogendoorn AW, Honig A, Broekman BFP, van Straten A. The Effectiveness of a Guided Internet-Based Tool for the Treatment of Depression and Anxiety in Pregnancy (MamaKits Online): Randomized Controlled Trial. J Med Internet Res 2020; 22:e15172. [PMID: 32202505 PMCID: PMC7136839 DOI: 10.2196/15172] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/26/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Pregnant women with symptoms of depression or anxiety often do not receive adequate treatment. In view of the high incidence of these symptoms in pregnancy and their impact on pregnancy outcomes, getting treatment is of the utmost importance. A guided internet self-help intervention may help to provide more women with appropriate treatment. OBJECTIVE This study aimed to examine the effectiveness of a guided internet intervention (MamaKits online) for pregnant women with moderate to severe symptoms of anxiety or depression. Assessments took place before randomization (T0), post intervention (T1), at 36 weeks of pregnancy (T2), and 6 weeks postpartum (T3). We also explored effects on perinatal child outcomes 6 weeks postpartum. METHODS This randomized controlled trial included pregnant women (<30 weeks) with depressive symptoms above threshold (ie, Center for Epidemiological Studies Depression scale [CES-D] >16) or anxiety above threshold (ie, Hospital Anxiety and Depression Scale-Anxiety subscale [HADS-A] >8) or both of them. Participants were recruited via general media and flyers in prenatal care waiting rooms or via obstetricians and midwives. After initial assessment, women were randomized to (1) MamaKits online in addition to treatment as usual or (2) treatment as usual (control condition). MamaKits online is a 5-week guided internet intervention based on problem solving treatment. Guidance was was provided by trained students pursuing a Master's in Psychology. Outcomes were based on a Web-based self-report. Women in the control condition were allowed to receive the intervention after the last assessment (6 weeks postpartum). RESULTS Of the 159 included women, 79 were randomized to MamaKits online, 47% (79/37) of whom completed the intervention. Both groups showed a substantial decrease in affective symptoms on the CES-D, HADS-A, and Edinburgh Postnatal Depression Scale over time. In the intervention group, affective symptoms decreased more than that in the control group, but between-group effect sizes were small to medium (Cohen d at T3=0.45, 0.21, and 0.23 for the 3 questionnaires, respectively) and statistically not significant. Negative perinatal child outcomes did not differ between the 2 groups (χ21=0.1; P=.78). Completer analysis revealed no differences in outcome between the treatment completers and the control group. The trial was terminated early for reasons of futility based on the results of an interim analysis, which we performed because of inclusion problems. CONCLUSIONS Our study did show a significant reduction in affective symptoms in both groups, but the differences in reduction of affective symptoms between the intervention and control groups were not significant. There were also no differences in perinatal child outcomes. Future research should examine for which women these interventions might be effective or if changes in the internet intervention might make the intervention more effective. TRIAL REGISTRATION Netherlands Trial Register NL4162; https://tinyurl.com/sdckjek.
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Affiliation(s)
- Hanna M Heller
- Department of Psychiatry, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Adriaan W Hoogendoorn
- Department of Psychiatry, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,GGZ inGeest, Amsterdam, Netherlands
| | - Adriaan Honig
- Department of Psychiatry, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Psychiatry, OLVG Hospital, Amsterdam, Netherlands
| | - Birit F P Broekman
- Department of Psychiatry, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Psychiatry, OLVG Hospital, Amsterdam, Netherlands
| | - Annemieke van Straten
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Hetherington E, McDonald S, Williamson T, Tough S. Trajectories of social support in pregnancy and early postpartum: findings from the All Our Families cohort. Soc Psychiatry Psychiatr Epidemiol 2020; 55:259-267. [PMID: 31256206 DOI: 10.1007/s00127-019-01740-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/24/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE Low social support during the perinatal period can increase the risk of postpartum depression and anxiety after giving birth but little is known about women's trajectories of social support during this time. This study will identify trajectories of social support among women from second trimester to 4-month postpartum, and the characteristics associated with different trajectories. METHODS Data from the All Our Families longitudinal birth cohort was used to assess women's perceived social support during their second trimester, third trimester, and at 4-month postpartum (n = 3387). Group-based trajectory modeling was used to determine the number of groups, shape of trajectories, and proportion of women with differing trajectories. Multinomial regression was used to compare probability of group membership. RESULTS Six distinct trajectory groups were identified, with the majority of participants belonging to groups with stable, high social support (60.6%). Only 2.7% of women had consistently low levels of social support, and 2.3% had rising levels. Membership in groups with lower levels of social support was associated with lower incomes and minority ethnicity. Women whose support improved over time may be more likely to be employed in pregnancy than those whose support remained low. CONCLUSION Trajectories of social support are relatively stable in pregnancy and early postpartum. Socio-demographic indicators of vulnerability predict initial levels of support, and participating in the workforce may help improve perception of support over time.
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Affiliation(s)
- Erin Hetherington
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada.
| | - Sheila McDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
| | - Suzanne Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
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Prevalence and risk factors for postpartum depression among women seen at Primary Health Care Centres in Damascus. BMC Pregnancy Childbirth 2019; 19:519. [PMID: 31870326 PMCID: PMC6929307 DOI: 10.1186/s12884-019-2685-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Syria, there are no previous studies on postpartum depression. The aim of this study is was identify the prevalence of postpartum depression and investigate its risk factors among Syrian women seen at the Primary Health Care Centres in Damascus. METHODS This descriptive cross-sectional study was carried out between January and December 2017 in Damascus, Syria. Postpartum women seen at a convenience sample of the largest and well-utilized primary health care centres in Damascus were invited to participate in the study. The Arabic version of the validated Edinburgh Postnatal Depression Scale questionnaire was used to measure postpartum depression. A cut-off score of 13 was considered to indicate probable depression. RESULTS Out of a total of 1105 women participated in this study, 28.2% had a score of 13 (probable Depression). The multivariate analysis showed that postpartum depression was significantly associated with a reported a health problem during last pregnancy (OR = 2.2; 95% confidence interval [CI]: 1.4-3.5); displacement (OR = 1.4; 95% confidence interval [CI]: 1.04-1.97); perceived exposure to a lot of life stressors (OR = 5.04; 95% confidence interval [CI]: 2.4-10.5); while antenatal care had a protective effect (OR = 0.52; 95% confidence interval [CI]: 0.36-0.75). CONCLUSIONS The prevalence of postpartum depression among Syrian women in this study was relatively high, as compared to other Arab and Non-Arab countries. Displacement due to the Syrian crisis among other factors was associated with postpartum depression. Obstetricians and other professionals should be sensitized about the importance of screening for the problem for better management.
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Pettman D, O'Mahen H, Skoog Svanberg A, von Essen L, Axfors C, Blomberg O, Woodford J. Effectiveness and acceptability of cognitive-behavioural therapy based interventions for maternal peripartum depression: a systematic review, meta-analysis and thematic synthesis protocol. BMJ Open 2019; 9:e032659. [PMID: 31871258 PMCID: PMC6937015 DOI: 10.1136/bmjopen-2019-032659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/30/2019] [Accepted: 11/26/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Peripartum depression is a common mental health difficulty associated with a range of negative impacts for the mother, infant and wider family. This review will examine the effectiveness of cognitive-behavioural therapy (CBT) based interventions for peripartum depression. Secondary aims are to explore the effect of CBT-based interventions targeted at peripartum depression on novel secondary outcomes and moderators potentially associated with effectiveness. To date, there has been little examination of effect on important secondary outcomes (eg, anxiety, stress and parenting), nor clinical and methodological moderators. Further, this review aims to explore the acceptability of CBT-based interventions for women with peripartum depression and examine important adaptations for this population. METHODS AND ANALYSIS Electronic databases (e.g., MEDLINE; ISI Web of Science; CINAHL; CENTRAL; Prospero; EMBASE; ASSIA; PsychINFO; SCOPUS; And Swemed+) will be systematically searched. Database searches will be supplemented by expert contact, reference and citation checking, and grey literature. Primary outcomes of interest will be validated measures of symptoms of depression. A proposed meta-analysis will examine: (1) the overall effectiveness of psychological interventions in improving symptoms of depression (both self-reported and diagnosed major depression) in the peripartum period; (2) the impact of interventions on secondary outcomes (eg, anxiety, stress and parenting); (3) clinical and methodological moderators associated with effectiveness. A thematic synthesis will be conducted on qualitative data exploring the acceptability of CBT-based intervention for postpartum depression including participants' experience and perspectives of the interventions, satisfaction, barriers and facilitators to intervention use, intervention relevance to mothers' situations and suggestions for improvements to tailor interventions to the peripartum client group. ETHICS AND DISSEMINATION Formal ethical approval is not required by the National Ethical Review Board in Sweden as primary data will not be collected. The results will be disseminated through a peer-reviewed publication and inform the development of a new psychological intervention for peripartum depression. This study including protocol development will run from March 2019 to March 2020.
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Affiliation(s)
- Danelle Pettman
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Heather O'Mahen
- Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, UK
| | - Agneta Skoog Svanberg
- Reproductive Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Cathrine Axfors
- Reproductive Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Oscar Blomberg
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanne Woodford
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Yasuma N, Narita Z, Sasaki N, Obikane E, Sekiya J, Inagawa T, Nakajima A, Yamada Y, Yamazaki R, Matsunaga A, Saito T, Watanabe K, Imamura K, Kawakami N, Nishi D. Psychological intervention for universal prevention of antenatal and postnatal depression among pregnant women: protocol for a systematic review and meta-analysis. Syst Rev 2019; 8:297. [PMID: 31787112 PMCID: PMC6886216 DOI: 10.1186/s13643-019-1238-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 11/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prevention of antenatal and postnatal depression is crucial, given its high prevalence and severe consequences. Although several systematic reviews and meta-analyses have examined the effects of psychological interventions on the population at risk for perinatal depression, few studies have focused on universal prevention and none have focused specifically on universal prevention in pregnancy. The aim of this study is to examine the effects of psychological interventions with a universal prevention focus on perinatal depression during pregnancy by performing a systematic review and meta-analysis based on both the latest articles and a broader literature search. METHODS The literature search will be conducted using the Cochrane Controlled Register of Trials (CENTRAL), Embase, PubMed and PsycINFO, from inception onwards. Randomized controlled trials that examined the association between psychological interventions and universal prevention of antenatal and postnatal depression among pregnant women will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted following a priori defined methods in the protocol. DISCUSSION The findings of this systematic review and meta-analysis will have both clinical and political importance in the context of perinatal mental health. In addition, this study will promote future studies and clarify the direction of research on universal prevention of perinatal depression. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019118041.
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Affiliation(s)
- Naonori Yasuma
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.,Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Zui Narita
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Natsu Sasaki
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
| | - Erika Obikane
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
| | - Junpei Sekiya
- Department of Psychiatry, Negishi Hospital, Fuchu, Tokyo, Japan
| | - Takuma Inagawa
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Kodaira, Tokyo, Japan
| | - Aiichiro Nakajima
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Kodaira, Tokyo, Japan
| | - Yuji Yamada
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Kodaira, Tokyo, Japan
| | - Ryuichi Yamazaki
- Department of Psychiatry, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Asami Matsunaga
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Tomomi Saito
- Department of Obstetrics and Gynecology, School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kazuhiro Watanabe
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
| | - Kotaro Imamura
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.
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Tay CT, Teede HJ, Boyle JA, Kulkarni J, Loxton D, Joham AE. Perinatal Mental Health in Women with Polycystic Ovary Syndrome: A Cross-Sectional Analysis of an Australian Population-Based Cohort. J Clin Med 2019; 8:jcm8122070. [PMID: 31775244 PMCID: PMC6947322 DOI: 10.3390/jcm8122070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/14/2019] [Accepted: 11/22/2019] [Indexed: 12/12/2022] Open
Abstract
Women with polycystic ovary syndrome (PCOS) have many risk factors associated with perinatal mental disorders, but research in this area is scarce. This study aims to compare the prevalence of common perinatal mental disorders in women with and without PCOS, and examine the relationship between PCOS and common perinatal mental disorders. We performed a cross-sectional study on self-reported data of 5239 women born between 1973 to 1978 in the Australian Longitudinal Study on Women’s Health. Compared with women not reporting PCOS, women reporting PCOS had higher prevalence of antenatal depression (8.9% vs. 4.4%, p < 0.001), antenatal anxiety (11.7% vs. 5.6%, p < 0.001), postnatal depression (26.8% vs. 18.6%, p < 0.001) and postnatal anxiety (18.4% vs. 12.0%, p < 0.001). PCOS was positively associated with antenatal depression and/or anxiety (adjusted odds ratio 1.8, 95% confidence interval 1.2–2.6) but not postnatal depression and/or anxiety after controlling for sociodemographic and lifestyle factors, reproductive history, obstetric complications and pre-existing depression and anxiety. General perinatal guidelines currently do not recognize PCOS as a risk factor and the international evidence based PCOS guideline noted inadequate evidence in this area. This paper addresses the gap in literature and highlights the need to screen for common perinatal mental disorders in women with PCOS.
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Affiliation(s)
- Chau Thien Tay
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton VIC 3168, Australia or (C.T.T.); (H.J.T.); (J.A.B.)
- Department of Diabetes and Vascular Medicine, Monash Health, Clayton VIC 3168, Australia
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton VIC 3168, Australia or (C.T.T.); (H.J.T.); (J.A.B.)
- Department of Diabetes and Vascular Medicine, Monash Health, Clayton VIC 3168, Australia
| | - Jacqueline A. Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton VIC 3168, Australia or (C.T.T.); (H.J.T.); (J.A.B.)
| | - Jayashri Kulkarni
- The Monash Alfred Psychiatry Research Centre, Monash University and the Alfred Hospital, Melbourne VIC 3004, Australia;
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Callaghan NSW 2308, Australia;
| | - Anju E. Joham
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton VIC 3168, Australia or (C.T.T.); (H.J.T.); (J.A.B.)
- Department of Diabetes and Vascular Medicine, Monash Health, Clayton VIC 3168, Australia
- Correspondence: ; Tel.: +613-8572-2661
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St James-Roberts I, Garratt R, Powell C, Bamber D, Long J, Brown J, Morris S, Dyson S, Morris T, Bhupendra Jaicim N. A support package for parents of excessively crying infants: development and feasibility study. Health Technol Assess 2019; 23:1-144. [PMID: 31597591 DOI: 10.3310/hta23560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Around 20% of 1- to 4-month-old infants cry for long periods without an apparent reason. Traditionally, this was attributed to gastrointestinal disorder ('colic'), but evidence shows that just 5% of infants cry a lot because of organic disturbances; in most cases, the crying is attributable to normal developmental processes. This has led to a focus on the impact of the crying on parents. Parental vulnerabilities influence how parents evaluate and respond to the crying and predict adverse outcomes. By developing evidence-based services that support parents, this study was designed to take the first steps towards national health services that enhance the coping and well-being of parents whose babies excessively cry. Related aims were to improve these infants' outcomes and how NHS money is spent. OBJECTIVES To develop a novel intervention package to support parents of excessively crying infants and to examine the feasibility of delivering and evaluating it in the NHS. DESIGN Stage 1 of this study aimed to (1) complete a literature review to identify example support materials, (2) obtain parents' guidance on the support needed when a baby cries excessively, together with their evaluation of the example materials, and (3) develop a support package based on the results. Stage 2 aimed to (1) recruit 60 parents whose babies were currently excessively crying, (2) assess parents' and NHS professionals' willingness to complete a study of the support package, (3) measure the use and evaluation of the package components, (4) estimate the package component costs and (5) provide evidence on the feasibility and methods for a large-scale trial. SETTING Primary health care. PARTICIPANTS Stage 1: 20 parents of previously excessively crying infants and 55 health visitors (HVs) or specialist community public health nurses (SCPHNs). Stage 2: 57 parents of currently excessively crying infants and 124 HVs/SCPHNs. INTERVENTIONS The support package included a website, a printed booklet and a programme of cognitive-behavioural therapy-based sessions delivered to parents by a qualified practitioner. MAIN OUTCOME MEASURES (1) Demographic data, (2) figures for parents' use of the package components and continuation in the study, (3) parents' and HVs'/SCPHNs' ratings of the package components and suitability for NHS use, (4) questionnaire measures of parental well-being and infant health and (5) costs. RESULTS Most parents (95%) accessed the website or printed materials and half (51%) attended the practitioner sessions. All 52 parents and 85% of HVs/SCPHNs providing data would support the inclusion of the package in the NHS. It was associated with reduced parental frustration, anxiety, depression, reported infant crying and contacts with health professionals and increased knowledge about crying. Methods for a full trial and figures for the cost of excessive infant crying for the NHS and each package element were identified. LIMITATIONS No control group was included. Most of the recruited parents were white, well educated and in stable relationships. CONCLUSIONS Parents and HVs/SCPHNs recognise the need for NHS provisions that support parents of excessively crying babies and consider the materials developed to meet that need. A full-scale randomised controlled trial is feasible and desirable. TRIAL REGISTRATION Current Controlled Trials ISRCTN84975637. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 56. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ian St James-Roberts
- Thomas Coram Research Unit, University College London Institute of Education, University College London, London, UK
| | - Rosemary Garratt
- The Leicester School of Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Charlotte Powell
- The Leicester School of Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Deborah Bamber
- The Leicester School of Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Jaqui Long
- The Leicester School of Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Jayne Brown
- The Leicester School of Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Sue Dyson
- School of Health and Education, Middlesex University, London, UK
| | - Tom Morris
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
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Contextual-relationship and stress-related factors of postpartum depression symptoms in nulliparas: a prospective study from Ljubljana, Slovenia. Reprod Health 2019; 16:145. [PMID: 31533847 PMCID: PMC6751738 DOI: 10.1186/s12978-019-0810-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 09/09/2019] [Indexed: 01/26/2023] Open
Abstract
Background For a significant proportion of women, postpartum depression (PPD) is the first mood episode in their lives, yet its aetiology still remains unclear. Insecure attachment in close adult relationships is considered to be a risk factor for depressive symptoms. This study aimed to gain further insight into the risk factors for postpartum depression symptoms (PPDS) of nulliparas in Slovenia and to examine vulnerability to developing depressive symptoms, with an emphasis on contextual and stress-related characteristics. Methods The sample consisted of 156 nulliparas in the third trimester of pregnancy enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Postpartum Depression Scale (EPDS), the Zung Anxiety Scale and a question battery designed by the research team including questions about emotional support and work-related stress. Logistic regression was used to test the association between demographic, social, environmental, personality and attachment variables and PPD of nulliparas (EPDS ≥10), controlling for baseline (prepartum) depression score. A multivariable linear regression model was built with the postpartum EPDS continuous score as a dependent variable. Results 28/156 (17,9%) were evaluated as being at risk for depression (EPDS≥10) in the last trimester and 25/156 (16%) at six weeks postpartum. The results of the logistic regression model controlled for prepartum depression score showed that increased risk for developing PPDS was associated with anxiety level postpartum, intimate-partner-attachment anxiety postpartum, and elevated stress due to loss of employment or an unsuccessful search for employment in the previous year. The results of the multivariable regression model, however, showed the association with education and postpartum anxiety with PPDS continuous score; EPDS after giving birth was higher for more educated and more anxious primiparas. Conclusions Our findings demonstrate the importance of anxiety symptoms and higher education level in assessments of nulliparas’ mental health. The results of our study show and confirm the results of previous research that anxiety symptoms in the immediate postpartum period are likely to be associated with depressive symptoms in nulliparas. The results also suggest that higher level of education of first-time mothers might not be a protective factor, especially for nulliparas with the university level of education. Further studies on larger samples should be considered.
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Riegel B, Hanlon AL, Coe NB, Hirschman KB, Thomas G, Stawnychy M, Wald JW, Bowles KH. Health coaching to improve self-care of informal caregivers of adults with chronic heart failure - iCare4Me: Study protocol for a randomized controlled trial. Contemp Clin Trials 2019; 85:105845. [PMID: 31499227 DOI: 10.1016/j.cct.2019.105845] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/23/2019] [Accepted: 09/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Persons with chronic heart failure are living longer. These patients typically live in the community and are cared for at home by informal caregivers. These caregivers are an understudied and stressed group. METHODS We are conducting a two-arm, randomized controlled trial of 250 caregivers of persons with chronic heart failure to evaluate the efficacy of a health coaching intervention. A consecutive sample of participants is being enrolled from both clinic and hospital settings at a single institution affiliated with a large medical center in the northeastern US. Both the intervention and control groups receive tablets programmed to provide standardized health information. In addition, the intervention group receives 10 live coaching sessions delivered virtually by health coaches using the tablets. The intervention is evaluated at 6-months, with self-care as the primary outcome. Cost-effectiveness of the intervention is evaluated at 12-months. We are also enrolling heart failure patients (dyads) whenever possible to explore the effect of caregiver outcomes (self-care, stress, coping, health status) on heart failure patient outcomes (number of hospitalizations and days in the hospital) at 12-months. DISCUSSION We expect the proposed study to require 5 years for completion. If shown to be efficacious and cost-effective, our virtual health coaching intervention can easily be scaled to. support millions of caregivers worldwide.
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Affiliation(s)
| | | | - Norma B Coe
- University of Pennsylvania, United States of America
| | | | - Gladys Thomas
- University of Pennsylvania, United States of America
| | | | - Joyce W Wald
- Hospital of the University of Pennsylvania, United States of America
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Takács L, Smolík F, Putnam S. Assessing longitudinal pathways between maternal depressive symptoms, parenting self-esteem and infant temperament. PLoS One 2019; 14:e0220633. [PMID: 31381596 PMCID: PMC6681961 DOI: 10.1371/journal.pone.0220633] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/19/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Previous studies of relations between parenting self-concepts, parental adjustment and child temperament have been ambiguous regarding the direction of influence; and have rarely followed families from pregnancy through the first year of life. The current study examines change and stability in maternal depressive symptoms, parenting competences and child temperament through the perinatal period until nine months postpartum. METHODS Czech mothers (N = 282) participated at three time points: the third trimester of pregnancy (Time 1), six weeks (Time 2) and nine months postpartum (Time 3). Questionnaire data concerned depressive symptoms (T1, T2, T3), maternal parenting self-esteem (T1, T2) and sense of competence (T3), and child temperament (T2, T3). A path model was used to examine concurrent and longitudinal relations between these variables. RESULTS The analyses indicated longitudinal stability of all constructs, as well as concurrent relations between them. Longitudinal relations supported child-to-parent, rather than parent-to-child, effects: child difficult temperament predicted decreases in perceived maternal parenting competences, but maternal variables did not predict change in infant temperament. In addition, we observed weak mutual relations between maternal depression levels and parenting competences, such that maternal depression diminished perceived parenting competences that in turn contributed to higher levels of depression. CONCLUSION Mothers' confidence in their ability to parent is influenced by their experience with a difficult infant and by their depressive symptoms during the child's first year of life. Depressive symptoms are, in turn, aggravated by mothers' low perceived competences in the parenting role.
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Affiliation(s)
- Lea Takács
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
- * E-mail:
| | - Filip Smolík
- Institute of Psychology, Czech Academy of Sciences, Prague, Czech Republic
| | - Samuel Putnam
- Department of Psychology, Bowdoin College, Brunswick, Maine, United States of America
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Ishii K, Goto A, Watanabe K, Tsutomi H, Sasaki M, Komiya H, Yasumura S. Characteristics and changes in the mental health indicators of expecting parents in a couple-based parenting support program in Japan. Health Care Women Int 2019; 41:330-344. [PMID: 31335256 DOI: 10.1080/07399332.2019.1643350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Postpartum depression is a serious problem not only for mothers, but also for their children and families. Evidence is scarce on the effectiveness of couple-targeted antenatal interventions aimed at preventing postpartum depression in Asia. Therefore, we implemented an antenatal parenting support program from Australia ("empathy program") at three sites in Japan, and assessed the characteristics of participating couples and changes in their mental health indicators before and after the program (during pregnancy and 6 weeks postpartum, respectively). In this program, participant couples discussed concerns during pregnancy and a "difficult day" scenario with other same-gender participants and then with their own partners. In total, 100 couples attended the program. Among 60 participating mothers, 20% screened positive for maternal depression symptoms (defined as an Edinburgh Postnatal Depression Scale greater than 9). Changes in paternal empathy and maternal antenatal Edinburgh Postnatal Depression Scale score were significantly associated with maternal postpartum Edinburgh Postnatal Depression Scale score in multivariable analyses. Our results indicate that a key in preventing postpartum depression is paternal involvement and long-term support from antenatal phase.
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Affiliation(s)
- Kayoko Ishii
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Aya Goto
- Center for Integrated Science and Humanities, Fukushima Medical University, Fukushima, Japan
| | - Kazuyo Watanabe
- Department of Midwifery and Maternal Nursing, Fukushima Medical University School of Nursing, Fukushima, Japan
| | - Hiroshi Tsutomi
- School of International Relations, University of Shizuoka, Shizuoka, Japan
| | - Mie Sasaki
- Faculty of Humanities, Saitama Gakuen University, Saitama, Japan
| | - Hiromi Komiya
- Center for Gender-Specific Medicine, Fukushima Medical University, Fukushima, Japan
| | - Seiji Yasumura
- Department of Public Health, Fukushima Medical University, Fukushima, Japan
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Ye J, Wang C, Xiao A, Xia Z, Yu L, Lin J, Liao Y, Xu Y, Zhang Y. Physical restraint in mental health nursing: A concept analysis. Int J Nurs Sci 2019; 6:343-348. [PMID: 31508457 PMCID: PMC6722410 DOI: 10.1016/j.ijnss.2019.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/04/2019] [Accepted: 04/18/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Physical restraint is frequently used in medical services, such as in mental health settings, intensive care units and nursing homes, but its nature varies in different institutions. By reviewing related literature, this study aims to clarify the concept of physical restraint in mental health nursing. METHOD Three databases (PubMed, PsycINFO and CINAHL) were retrieved, and Walker and Avant's concept analysis method was used to analyze the concept of physical restraint in mental health nursing. RESULTS Physical restraint is a coercive approach that enables the administration of necessary treatment by safely reducing the patient's physical movement. It should be the last option used by qualified personnel. Antecedents of physical restraint are improper behavior (violence and disturbance) of patients, medical assessment prior to implementation and legislation governing clinical usage. Consequences of physical restraint are alleviation of conflict, physical injury, mental trauma and invisible impact on the institution. DISCUSSION This study defined the characteristics of physical restraint in mental health nursing. The proposed concept analysis provided theoretical foundation for future studies.
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Affiliation(s)
- Junrong Ye
- Nursing Administration Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Chen Wang
- Early Intervention Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Aixiang Xiao
- Nursing Administration Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Zhichun Xia
- Nursing Administration Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Lin Yu
- Traditional Chinese Medicine Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Jiankui Lin
- Nursing Administration Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Yao Liao
- Cardiovascular Surgery Department, Jingzhou Central Hospital, China
| | - Yu Xu
- Intensive Care Unit Department, West China Hospital of Sichuan University, China
| | - Yunlei Zhang
- Cardiovascular Surgery Department, Jingzhou Central Hospital, China
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Khanlari S, Barnett AM B, Ogbo FA, Eastwood J. Re-examination of perinatal mental health policy frameworks for women signalling distress on the Edinburgh Postnatal Depression Scale (EPDS) completed during their antenatal booking-in consultation: a call for population health intervention. BMC Pregnancy Childbirth 2019; 19:221. [PMID: 31266468 PMCID: PMC6604146 DOI: 10.1186/s12884-019-2378-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/24/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Globally, anxiety and depression are the most common complications of the perinatal period (conception to 1 year postpartum). It is now recognised that anxiety and depression are more commonly found antenatally than postnatally and represent the greatest risk factor for developing postnatal depression. Research in this space has focused on treatment of postnatal depression, with limited attention paid to preventative strategies for women signalling distress, who are subthreshold for diagnosable illness. MAIN TEXT The Edinburgh Postnatal Depression Scale (EPDS) was introduced in 1987 and has since been validated as a depression screening tool in the Australian and international setting. The EPDS has been embedded as a depression screening tool within a broader psychosocial assessment for women who receive their maternity care in the public system in Australia. Owing to perceived service restrictions, an EPDS score must reach a threshold of 13 or more to warrant specific assessment or intervention. Current policy frameworks focus on tertiary prevention models, and those women scoring 10 to 12, who could reasonably be considered as signalling distress or early signs of illness, are not currently offered intervention. The consequences of undetected or untreated perinatal mood or anxiety disorder (often co-morbid) include maternal psychological, social, occupational and physical dysfunction, and extend to deleterious infant and child life-course effects. This provides a strong justification to explore the role of preventative programs for women who are distressed. A range of low-resource, population-based interventions are available and effective. We explore the evidence for a selection of these programs. Further research is needed to decipher their effectiveness as a secondary prevention approach in women who are currently signalling distress during antenatal assessment. CONCLUSION The burden of perinatal mood disorders, and their potential for prolonged impact, justify the exploration of preventatively-focused programs in women who signal distress during antenatal care.
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Affiliation(s)
- Sarah Khanlari
- Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Street, Croydon, NSW 2132 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW 2308 Australia
- Sydney Institute for Women Children and their Families, Sydney Local Health District, Camperdown, NSW 2050 Australia
| | - Bryanne Barnett AM
- Sydney Institute for Women Children and their Families, Sydney Local Health District, Camperdown, NSW 2050 Australia
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington Campus, Kensington, NSW 2052 Australia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, School of Medicine, University of Western Sydney, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - John Eastwood
- Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Street, Croydon, NSW 2132 Australia
- Sydney Institute for Women Children and their Families, Sydney Local Health District, Camperdown, NSW 2050 Australia
- Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW 2170 Australia
- School of Women’s and Children’s Health, Faculty of Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052 Australia
- Menzies Centre for Health Policy, Charles Perkins Centre, School of Public Health, Sydney University, Sydney, NSW 2006 Australia
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"…Society is, at the end of the day, still going to stigmatize you no matter which way": A qualitative study of the impact of stigma on social support during unintended pregnancy in early adulthood. PLoS One 2019; 14:e0217308. [PMID: 31120984 PMCID: PMC6532899 DOI: 10.1371/journal.pone.0217308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/08/2019] [Indexed: 11/19/2022] Open
Abstract
Unintended pregnancy in adolescence and early adulthood is stigmatized in the United States because it deviates from social norms that consider young people’s sexuality as a social problem. While limited, prior research has found that this stigma prevents young people from telling people in their lives about their pregnancies, for fear of judgment or negative reactions. We hypothesized that this selective disclosure of unintended pregnancy due to stigma would reduce the social support available to young pregnant people at a particularly vulnerable time—social support that we know is important for optimal physical and mental health of the young person, and the pregnancy (should they choose to carry to term). To explore this hypothesis, we conducted a qualitative study among young people to understand if and how they experienced stigma in relation to an unintended pregnancy, how this stigma shaped patterns of pregnancy disclosure, the implications for received social support, and participant thoughts on how to alleviate the influence of this stigma on their lives. In in-depth interviews with 25 young people in the San Francisco Bay area who had experienced at least one unintended pregnancy, using a thematic analysis approach, we found that the stigma of unintended pregnancy led participants to selectively disclose the pregnancy to limited people, which in turn cut them off from needed sources of social support. Black and Hispanic women disproportionately described this experience. Participants expressed a desire for programs that would connect young people who had experienced unplanned pregnancy to each other–either via the internet, organized groups through clinical care sites, college or high school campuses, or other forums—as a way to alleviate stigma, share perspectives and lessons learned, and otherwise build emotional and informational support networks for themselves where their usual support had fallen away.
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O'Connell MA, O'Neill SM, Dempsey E, Khashan AS, Leahy-Warren P, Smyth RMD, Kenny LC. Interventions for fear of childbirth (tocophobia). THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2019. [DOI: 10.1002/14651858.cd013321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Maeve Anne O'Connell
- P.O. Box 15503; RCSI Bahrain; Adliya Bahrain
- University College Cork; Irish Centre for Fetal and Neonatal Translational Research; Cork Ireland
| | - Sinéad M O'Neill
- Health Information and Quality Authority; Health Technology Assessment Directorate; Unit 1301, City Gate Mahon Cork Munster Ireland T12 Y2XT
| | - Eugene Dempsey
- Cork University Maternity Hospital; Neonatology; Wilton Cork Ireland
| | - Ali S Khashan
- University College Cork; School of Public Health; Cork Ireland
| | - Patricia Leahy-Warren
- University College Cork; School of Nursing and Midwifery; Brookfield Health Sciences Complex Cork Ireland
| | - Rebecca MD Smyth
- The University of Manchester; Division of Nursing Midwifery and Social Work; Jean McFarlane Building Oxford Road Manchester UK M13 9PL
| | - Louise C Kenny
- University of Liverpool; Faculty of Health and Life Sciences; Foundation Building, 765 Brownlow Hill Liverpool Merseyside UK
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Social Support-A Protective Factor for Depressed Perinatal Women? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081426. [PMID: 31010090 PMCID: PMC6518117 DOI: 10.3390/ijerph16081426] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 12/11/2022]
Abstract
Social support before and after childbirth is a possible protective factor for perinatal depression. Currently, there is a lack of longitudinal studies beyond the first year postpartum exploring the relationship of social support with depression and anxiety. Social support is also a possible protective factor for adverse child development, which is a known consequence of perinatal depression. The present study followed up a cohort of depressed women (n = 54) from a randomised controlled trial of psychological treatment for antenatal depression. We examined the trajectory of the relationships between perceived social support (Social Provisions Scale), depression (Beck Depression Inventory), and anxiety (Beck Anxiety Inventory) twice in pregnancy and twice postpartum up to two years. The influence of social support on child development and parenting-related stress was also explored. Two aspects of social support, Reassurance of Worth and Reliable Alliance, were strongly related to perinatal depression and anxiety, particularly when predicting symptoms in late pregnancy. However, the effect of postnatal depression on child development at 9 and 24 months post-birth was not mediated by social support. These results suggest the importance of adjusting current interventions for depressed perinatal women to focus on social support in late pregnancy and the first six months postpartum.
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Mokhele I, Nattey C, Jinga N, Mongwenyana C, Fox MP, Onoya D. Prevalence and predictors of postpartum depression by HIV status and timing of HIV diagnosis in Gauteng, South Africa. PLoS One 2019; 14:e0214849. [PMID: 30947293 PMCID: PMC6448929 DOI: 10.1371/journal.pone.0214849] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/17/2019] [Indexed: 12/03/2022] Open
Abstract
Background Postpartum depression (PPD) is a common mental health condition that can compromise the quality of life and functional capacity of mothers and cause health and developmental problems in children born to affected mothers. Objectives We set out to measure the prevalence of PPD comparing postpartum HIV-1 infected women with pre-pregnancy HIV care experience, newly diagnosed (in latest pregnancy) HIV-1 infected women and HIV negative women, and to identify predictors of major PPD among these women in a peri-urban clinic in South Africa. Methods We conducted a cross-sectional survey of 1151 adult (≥18 years) postpartum HIV-1 infected (690) and HIV negative (461) women who delivered up to 30 days before study enrolment, interviewed after their first post-natal visit (3–6 days post- delivery) at Midwife Obstetric Units in Gauteng, South Africa. PPD was categorised into no depression (CES-D 10 total score <5), low to medium depression (CES-D 10 total score ≥5 and <10) and major depressive symptoms (CES-D 10 total score≥10). We used ordered logistic regression to identify predictors of postpartum depression and report adjusted odds ratio (aOR) and 95% confidence intervals (CIs). Results Overall 288 (25.0%) women screened positive for postpartum depression, a total of 168 (14.6%) women had low to medium PPD and 120 (10.4%) had major PPD. A higher proportion of HIV negative women experienced PPD, 129/461 (28.0%) among HIV negative vs. 159/690 (23.0%) among HIV-1 infected. Among HIV positive women, there was no meaningful difference in PPD between newly HIV diagnosed and those diagnosed before the most recent pregnancy (aOR 1.3, 95% confidence interval (CI): 0.9–1.8). Predictors of PPD among HIV positive women were living with friends/in a house-share (aOR 0.5 for house-share vs. own home, 95% CI: 0.3–0.9), and attending antenatal care (ANC) for the most recent pregnancy (aOR 0.2 for ANC attendance vs. no ANC attendance, 95% CI: 0.0–0.5). Living with friends/in a house-share was also a predictor of PPD among HIV negative women (aOR 0.4 for house-share vs. own home, 95% CI: 0.2–0.8). Conclusions and recommendations Targeted symptom screening based on identified risk factors should be considered for postpartum women to increase PPD case-finding and referral to specialised social support services.
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Affiliation(s)
- Idah Mokhele
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cornelius Nattey
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nelly Jinga
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Constance Mongwenyana
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew P. Fox
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Dorina Onoya
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
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Chomat AM, Menchú AI, Andersson N, Ramirez-Zea M, Pedersen D, Bleile A, Letona P, Araya R. Women's circles as a culturally safe psychosocial intervention in Guatemalan indigenous communities: a community-led pilot randomised trial. BMC Womens Health 2019; 19:53. [PMID: 30943958 PMCID: PMC6448212 DOI: 10.1186/s12905-019-0744-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/14/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Indigenous Maya women in Guatemala show some of the worst maternal health indicators worldwide. Our objective was to test acceptability, feasibility and impact of a co-designed group psychosocial intervention (Women's Circles) in a population with significant need but no access to mental health services. METHODS A parallel group pilot randomised study was undertaken in five rural Mam and three periurban K'iche' communities. Participants included 84 women (12 per community, in seven of the communities) randomly allocated to intervention and 71 to control groups; all were pregnant and/or within 2 years postpartum. The intervention consisted of 10 sessions co-designed with and facilitated by 16 circle leaders. Main outcome measures were: maternal psychosocial distress (HSCL-25), wellbeing (MHC-SF), self-efficacy and engagement in early infant stimulation activities. In-depth interviews also assessed acceptability and feasibility. RESULTS The intervention proved feasible and well accepted by circle leaders and participating women. 1-month post-intervention, wellbeing scores (p-value 0.008) and self-care self-efficacy (0.049) scores were higher among intervention compared to control women. Those women who attended more sessions had higher wellbeing (0.007), self-care and infant-care self-efficacy (0.014 and 0.043, respectively), and early infant stimulation (0.019) scores. CONCLUSIONS The pilot demonstrated acceptability, feasibility and potential efficacy to justify a future definitive randomised controlled trial. Co-designed women's groups provide a safe space where indigenous women can collectively improve their functioning and wellbeing. TRIAL REGISTRATION ISRCTN13964819 . Registered 26 June 2018, retrospectively registered.
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Affiliation(s)
- Anne Marie Chomat
- Participatory Research at McGill (PRAM), Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges-3rd floor, Suite 300, Montréal, QC H3S 1Z1 Canada
- CIET International Guatemala, 5ª calle 14-35, apartamento 304, Edificio Las Tapias, zona 3, Quetzaltenango, Guatemala
| | - Aura Isabel Menchú
- CIET International Guatemala, 5ª calle 14-35, apartamento 304, Edificio Las Tapias, zona 3, Quetzaltenango, Guatemala
| | - Neil Andersson
- Participatory Research at McGill (PRAM), Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges-3rd floor, Suite 300, Montréal, QC H3S 1Z1 Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Manuel Ramirez-Zea
- Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Calzada Roosevelt 6-25 zona 11, Apartado Postal 1188, Guatemala City, Guatemala
| | - Duncan Pedersen
- Department of Psychiatry and Division of Social and Transcultural Psychiatry, McGill University, Montréal, Canada
| | - Alexandra Bleile
- Centre for Global Mental Health, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Paola Letona
- Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Calzada Roosevelt 6-25 zona 11, Apartado Postal 1188, Guatemala City, Guatemala
| | - Ricardo Araya
- Centre for Global Mental Health, King’s College London, De Crespigny Park, London, SE5 8AF UK
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Sangsawang B, Wacharasin C, Sangsawang N. Interventions for the prevention of postpartum depression in adolescent mothers: a systematic review. Arch Womens Ment Health 2019; 22:215-228. [PMID: 30116896 DOI: 10.1007/s00737-018-0901-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/08/2018] [Indexed: 01/08/2023]
Abstract
Postpartum depression (PPD) is a major public health problem affecting 10-57% of adolescent mothers which can affect not only adolescent mothers but also their infants. Thus, there is a need for interventions to prevent PPD in adolescent mothers. However, recent systematic reviews have been focused on effective interventions to prevent PPD in adult mothers. These interventions may not necessarily be applicable for adolescent mothers. Therefore, the purpose of this review was to examine the effectiveness of the existing interventions to prevent PPD in adolescent mothers. A systematic search was performed in MEDLINE, CINAHL, and SCOPUS databases between January 2000 and March 2017 with English language and studies involving human subjects. Studies reporting on the outcomes of intervention to prevent PPD particularly in adolescent mothers were selected. Non-comparative studies were excluded. From 2002 identified records, 13 studies were included, reporting on 2236 adolescent pregnant women. The evidence from this systematic review suggests that 6 of 13 studies from both psychological and psychosocial interventions including (1) home-visiting intervention, (2) prenatal antenatal and postnatal educational program, (3) CBT psycho-educational, (4) the REACH program based on interpersonal therapy, and (5) infant massage training is successful in reducing rates of PPD symptoms in adolescent mothers in the intervention group than those mothers in the control group. These interventions might be considered for incorporation in antenatal care interventions for adolescent pregnant women. However, this review did not find evidence identifying the most effective intervention for preventing postpartum depression symptoms in adolescent mothers.
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Affiliation(s)
- Bussara Sangsawang
- Department of Maternal-Child Nursing and Midwifery Nursing, Srinakharinwirot University, 63 M.7 Rangsit-Nakhonnayok Rd., Nakhonnayok, 26120, Thailand.
| | - Chintana Wacharasin
- Department of Pediatrics Nursing, Faculty of Nursing, Burapha University, Saen Suk, Chon Buri, Thailand
| | - Nucharee Sangsawang
- Department of Maternal-Child Nursing and Midwifery Nursing, Srinakharinwirot University, 63 M.7 Rangsit-Nakhonnayok Rd., Nakhonnayok, 26120, Thailand
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Abstract
OBJECTIVE To examine the evidence for the use of psychological and psychosocial interventions offered to forensic mental health inpatients. DESIGN CINAHL, MEDLINE, PsycINFO, ScienceDirect and Web of Science databases were searched for research published in English between 1 January 1990 and 31 May 2018. OUTCOME MEASURES Disturbance, mental well-being, quality of life, recovery, violence/risk, satisfaction, seclusion, symptoms, therapeutic relationship and ward environment. There were no limits on the length of follow-up. ELIGIBILITY CRITERIA We included randomised controlled trial (RCT) studies of any psychological or psychosocial intervention in an inpatient forensic setting. Pilot or feasibility studies were included if an RCT design was used.We restricted our search criteria to inpatients in low, medium and high secure units aged over 18. We focused on interventions considered applicable to most patients residing in forensic mental health settings. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias. RESULTS 17 232 citations were identified with 195 full manuscripts examined in detail. Nine papers were included in the review. The heterogeneity of the identified studies meant that meta-analysis was inappropriate. The results were presented in table form together with a narrative synthesis. Only 7 out of 91 comparisons revealed statistically significant results with no consistent significant findings. The most frequently reported outcomes were violence/risk and symptoms. 61% of the violence/risk comparisons and 79% of the symptom comparisons reported improvements in the intervention groups compared with the control groups. CONCLUSIONS Current practice is based on limited evidence with no consistent significant findings. This review suggests psychoeducational and psychosocial interventions did not reduce violence/risk, but there is tentative support they may improve symptoms. More RCTs are required with: larger sample sizes, representative populations, standardised outcomes and control group interventions similar in treatment intensity to the intervention. PROSPERO REGISTRATION NUMBER CRD42017067099.
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Affiliation(s)
- Douglas MacInnes
- Faculty of Health and Wellbeing, Canterbury Christ Church University, Canterbury, UK
| | - Serena Masino
- Department of Economics and Quantitative Methods, Westminster Business School, University of Westminster, London, UK
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Frieder A, Fersh M, Hainline R, Deligiannidis KM. Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development. CNS Drugs 2019; 33:265-282. [PMID: 30790145 PMCID: PMC6424603 DOI: 10.1007/s40263-019-00605-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Postpartum depression is one of the most common complications of childbirth. Untreated postpartum depression can have substantial adverse effects on the well-being of the mother and child, negatively impacting child cognitive, behavioral, and emotional development with lasting consequences. There are a number of therapeutic interventions for postpartum depression including pharmacotherapy, psychotherapy, neuromodulation, and hormonal therapy among others, most of which have been adapted from the treatment of major depressive disorder outside of the peripartum period. Current evidence of antidepressant treatment for postpartum depression is limited by the small number of randomized clinical trials, underpowered samples, and the lack of long-term follow-up. The peripartum period is characterized by rapid and significant physiological change in plasma levels of endocrine hormones, peptides, and neuroactive steroids. Evidence supporting the role of neuroactive steroids and γ-aminobutyric acid (GABA) in the pathophysiology of postpartum depression led to the investigation of synthetic neuroactive steroids and their analogs as potential treatment for postpartum depression. Brexanolone, a soluble proprietary intravenous preparation of synthetic allopregnanolone, has been developed. A recent series of open-label and placebo-controlled randomized clinical trials of brexanolone in postpartum depression demonstrated a rapid reduction in depressive symptoms, and has led to the submission for regulatory approval to the US Food and Drug Administration (decision due in March 2019). SAGE-217, an allopregnanolone analog, with oral bioavailability, was recently tested in a randomized, double-blind, placebo-controlled phase III study in severe postpartum depression, with reportedly positive results. Finally, a 3β-methylated synthetic analog of allopregnanolone, ganaxolone, is being tested in both intravenous and oral forms, in randomized, double-blind, placebo-controlled phase II studies in severe postpartum depression.
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Affiliation(s)
- Ariela Frieder
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA
| | - Madeleine Fersh
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA
| | - Rachel Hainline
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Kristina M Deligiannidis
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA.
- Departments of Psychiatry and Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Feinstein Institute for Medical Research, Manhasset, NY, USA.
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Tachibana Y, Koizumi N, Akanuma C, Tarui H, Ishii E, Hoshina T, Suzuki A, Asano A, Sekino S, Ito H. Integrated mental health care in a multidisciplinary maternal and child health service in the community: the findings from the Suzaka trial. BMC Pregnancy Childbirth 2019; 19:58. [PMID: 30727996 PMCID: PMC6364479 DOI: 10.1186/s12884-019-2179-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Perinatal mental health problems such as mood disorders are common. We propose a new multidisciplinary health service intervention program providing continuous support to women and their children from the start of pregnancy till after childbirth. The aim of this study was to examine the effects of the program with respect to making women’s mental health better in the postpartum period and improving the state of care for women and their children in the perinatal period. Methods We performed a controlled study to investigate the effectiveness of the program in Suzaka City, Japan. The women’s mental health status was assessed using the Edinburgh Postnatal Depression Scale (EPDS) 3 months postpartum. Of 349 women, 210 were allocated to the intervention group and 139 to the control group. From April 2014 to March 2015, the number of the pregnant women who were followed-up by the multidisciplinary meeting in the intervention and control groups were 60 and 4, respectively. In the same period, the number of the pregnant women who were identified as requiring intensive care were 21 and 2, respectively. Results The total EPDS score, which was the primary outcome of the present study, differed significantly between the intervention and control groups (Mean [SD] = 2.74 (2.89) and 4.58 [2.62], respectively; p < 0.001). The number of the women receiving counseling from a public health nurse (5.3% in intervention group, 0.7% in control group, p = 0.02), attending maternal seminars (attendant ratio: 46% whereas 16%, p = 0.01), and receiving home visits by public health nurses (home visit ratio: 93.8% whereas 82.6%, p < 0.001) was significantly higher in the intervention group compared to the control group. Conclusions The present study indicates that continuum support provided by integrated mental health care through a multidisciplinary maternal and child health service in the community can make women's mental health better in the postpartum period and help women and their children receive more health services from public health nurses. Trial registration Name of registry: Research for the effectiveness of a multi-professional health service intervention program of continuum supports for mother and child which starts for pregnancy periods to enhance maternal mental health. UMIN Clinical Trials Registry number: UMIN000032424. Registration date: April 29th, 2018. Registration timing: retrospective. Electronic supplementary material The online version of this article (10.1186/s12884-019-2179-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yoshiyuki Tachibana
- Division of Infant and Toddler Mental Health, Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan.
| | - Noriaki Koizumi
- Nagano Prefectural Public Health Center for Mental Health, Nagano, Japan
| | | | - Hiromi Tarui
- Suzaka City Public Health Center, Nagano, Japan.,Nagano Nursing Association, Nagano, Japan
| | - Eizaburo Ishii
- Department of Pediatrics, Nagano Prefectural Suzaka Hospital, Nagano, Japan.,Department of Pediatric Palliative Care, Shinsei Hospital, Nagano, Japan
| | | | | | - Akiko Asano
- Suzaka City Public Health Center, Nagano, Japan
| | | | - Hiroto Ito
- Research Center for Overwork-Related Disorders, National Institute of Occupational Safety and Health, Japan Organization of Occupational Health and Safety, Kanagawa, Japan
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Steardo L, Caivano V, Sampogna G, Di Cerbo A, Fico G, Zinno F, Del Vecchio V, Giallonardo V, Torella M, Luciano M, Fiorillo A. Psychoeducational Intervention for Perinatal Depression: Study Protocol of a Randomized Controlled Trial. Front Psychiatry 2019; 10:55. [PMID: 30814962 PMCID: PMC6381058 DOI: 10.3389/fpsyt.2019.00055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/24/2019] [Indexed: 12/12/2022] Open
Abstract
Perinatal depression (PD) is a severe and disabling condition impacting negatively on children in terms of adverse neonatal outcomes and on the well-being of women and their families. All pregnant women attending the unit of Gynecology and Obstetrics Service of the University of Campania "L. Vanvitelli" will be screened for PD using the Edinburgh Postpartum Depression Scale (EPDS). Women with a score ≥10 at the EPDS will be invited to receive a full psychiatric assessment. The required sample size is of 126 women with PD which will be randomly allocated to either an experimental group, receiving a uni-familiar psychoeducational intervention, or to a control group, receiving the Best Treatment Option (BTO). Patients will be evaluated through several assessment instruments: Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), Manchester Short Assessment of Quality of Life (MANSA), Family Assessment Device (FAD), Family Coping Questionnaire (FCQ), and Pattern of Care Schedule (PCS). Patients will be evaluated at baseline, 3, 6, 9, and 12 months post-randomization. The severity of depressive symptoms at the HAM-D scale has been selected as primary outcome. Other outcome measures include improvement in the severity of anxiety symptoms, of global and personal functioning, an improvement in family members' coping strategies and in the level of quality of life. It has been highlighted the importance of developing screening and treating programs for PD, and our study will use rigorous study design to evaluate the efficacy of the adaption of a well-known family psychoeducational model to the treatment of PD. The aims of present trial are to: (1) develop an informative package for pregnant women with PD; (2) promote a screening programme for PD; (3) identify those (socio-demographic and pregnancy-related environmental) factors associated with a higher risk to develop a perinatal or postnatal depression; (4) evaluate the efficacy of a new experimental psychoeducational intervention in reducing the depressive symptoms during pregnancy compared to the BTO.
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Affiliation(s)
- Luca Steardo
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vito Caivano
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Arcangelo Di Cerbo
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giovanna Fico
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Zinno
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Valeria Del Vecchio
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vincenzo Giallonardo
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marco Torella
- Department of Gynecology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
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Jensen JK, Ciolino JD, Diebold A, Segovia M, Degillio A, Solano-Martinez J, Tandon SD. Comparing the Effectiveness of Clinicians and Paraprofessionals to Reduce Disparities in Perinatal Depression via the Mothers and Babies Course: Protocol for a Cluster-Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e11624. [PMID: 30459138 PMCID: PMC6280028 DOI: 10.2196/11624] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 11/21/2022] Open
Abstract
Background Postpartum depression is highly prevalent in low-income women and has significant health and mental health effects on mother and child. Home visiting (HV) programs provide services to large numbers of perinatal women in the United States and are a logical setting for delivering mental health services. Although there are interventions that reduce the risk of developing postpartum depression among low-income women, none have used nonhealth or nonmental health professionals as interventionists. Objective This study aimed to outline the protocol of a cluster randomized trial funded by the Patient-Centered Outcomes Research Institute that evaluates whether the Mothers and Babies (MB) group intervention, when led by paraprofessional home visitors, is more efficacious than usual care. It will also examine if MB, when led by home visitors, is not inferior to MB delivered by mental health professionals (MHPs). MB has previously demonstrated efficacy when delivered by MHPs, and pilot work indicated promising results using home visitors to deliver the intervention. Methods A cluster randomized trial is being conducted with 38 HV programs. Sixteen HV programs will deliver MB using MHPs, 16 will deliver MB using paraprofessional home visitors, and 6 will deliver usual HV services. The study employs a modified covariate-constrained randomization design at the site level. We anticipate recruiting 933 women aged ≥16 years enrolled in HV programs, who are 33 or more weeks’ gestation and speak either English or Spanish. Women in the 2 intervention arms will receive the 6-session MB group intervention. Baseline, postintervention, 12-week postpartum, and 24-week postpartum assessments will be conducted to assess client outcomes. The primary outcome will be the change in Quick Inventory of Depressive Symptomatology Self-Report 16 scores from baseline to 24-week follow-up. Secondary outcomes associated with core MB content will also be examined. Semistructured interviews will be conducted with home visitors and MHPs who are group facilitators and 90 study participants to gain data on intervention successes and challenges. Analyses will proceed at the participant level. Primary analyses for depressive symptoms score at 24 weeks postpartum will involve a linear mixed model, controlling for baseline symptoms and other covariates, and random effects to account for clustering. Results We have recruited 838 women through the end of August 2018. Recruitment will be completed at the end of September 2018. Conclusions There is considerable potential to disseminate MB to HV programs throughout the United States. Should our results demonstrate home visitor efficacy when compared with usual care and/ noninferiority between home visitors and MHPs in improving mental health outcomes, no additional financial resources would be required for the existing HV staff to implement MB. Should this study determine that home visitors are less effective than MHPs, we will generate more wide-scale evidence on MB effectiveness when led by MHPs. Trial Registration ClinicalTrials.gov NCT02979444; https://clinicaltrials.gov/ct2/show/NCT02979444 (Archived by Webcite at http://www.webcitation.org/archive.php) International Registered Report Identifier (IRRID) PRR1-10.2196/11624
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Affiliation(s)
- Jessica K Jensen
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jody D Ciolino
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Alicia Diebold
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Melissa Segovia
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Aria Degillio
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jesus Solano-Martinez
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - S Darius Tandon
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Hans SL, Edwards RC, Zhang Y. Randomized Controlled Trial of Doula-Home-Visiting Services: Impact on Maternal and Infant Health. Matern Child Health J 2018; 22:105-113. [PMID: 29855838 PMCID: PMC6153776 DOI: 10.1007/s10995-018-2537-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Although home-visiting programs typically engage families during pregnancy, few studies have examined maternal and child health outcomes during the antenatal and newborn period and fewer have demonstrated intervention impacts. Illinois has developed an innovative model in which programs utilizing evidence-based home-visiting models incorporate community doulas who focus on childbirth education, breastfeeding, pregnancy health, and newborn care. This randomized controlled trial (RCT) examines the impact of doula-home-visiting on birth outcomes, postpartum maternal and infant health, and newborn care practices. Methods 312 young (M = 18.4 years), pregnant women across four communities were randomly assigned to receive doula-home-visiting services or case management. Women were African American (45%), Latina (38%), white (8%), and multiracial/other (9%). They were interviewed during pregnancy and at 3-weeks and 3-months postpartum. Results Intervention-group mothers were more likely to attend childbirth-preparation classes (50 vs. 10%, OR = 9.82, p < .01), but there were no differences on Caesarean delivery, birthweight, prematurity, or postpartum depression. Intervention-group mothers were less likely to use epidural/pain medication during labor (72 vs. 83%; OR = 0.49, p < .01) and more likely to initiate breastfeeding (81 vs. 74%; OR = 1.72, p < .05), although the breastfeeding impact was not sustained over time. Intervention-group mothers were more likely to put infants on their backs to sleep (70 vs. 61%; OR = 1.64, p < .05) and utilize car-seats at three weeks (97 vs. 93%; OR = 3.16, p < .05). Conclusions for practices The doula-home-visiting intervention was associated with positive infant-care behaviors. Since few evidence-based home-visiting programs have shown health impacts in the postpartum months after birth, incorporating doula services may confer additional health benefits to families.
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Affiliation(s)
- Sydney L Hans
- School of Social Service Administration, University of Chicago, 969 E 60th Street, Chicago, IL, 60637, USA.
| | - Renee C Edwards
- School of Social Service Administration, University of Chicago, 969 E 60th Street, Chicago, IL, 60637, USA
| | - Yudong Zhang
- School of Social Service Administration, University of Chicago, 969 E 60th Street, Chicago, IL, 60637, USA
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84
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Ahmed AH, Hui S, Crodian J, Plaut K, Haas D, Zhang L, Casey T. Relationship Between Sleep Quality, Depression Symptoms, and Blood Glucose in Pregnant Women. West J Nurs Res 2018; 41:1222-1240. [PMID: 30406728 DOI: 10.1177/0193945918809714] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sleep quality during pregnancy affects maternal/child health. We aimed to assess changes in sleep quality during pregnancy and determine its relationship to maternal mood, blood glucose, and work schedule among primiparous women. We conducted a prospective/longitudinal/observational study. Ninety-two pregnant women were recruited from Midwestern hospital. Mood and sleep quality data were collected using Edinburgh Postnatal Depression Scale/Pittsburgh Sleep Quality Index at Gestational Weeks 22 and 32. Forty-three women completed the study. Twenty-six women (63%) were African American and the mean age was 23.64 ( SD = 3.82) years. Rate of poor sleep quality increased during pregnancy with 25% of women had scores indicative of depression symptoms. Poor sleep quality score was related to mood scores ( p < .05) and work schedule. Blood glucose was not significantly related to sleep duration. In conclusion, poor sleep quality during pregnancy was associated with poor mood and work schedule, suggesting that interventions targeting mental health and lifestyles are needed.
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Affiliation(s)
| | - Sun Hui
- Purdue University, West Lafayette, IN, USA
| | | | | | - David Haas
- Indiana University School of Medicine, Indianapolis, USA
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85
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An experimental test of the fetal programming hypothesis: Can we reduce child ontogenetic vulnerability to psychopathology by decreasing maternal depression? Dev Psychopathol 2018; 30:787-806. [PMID: 30068416 DOI: 10.1017/s0954579418000470] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Maternal depression is one of the most common prenatal complications, and prenatal maternal depression predicts many child psychopathologies. Here, we apply the fetal programming hypothesis as an organizational framework to address the possibility that fetal exposure to maternal depressive symptoms during pregnancy affects fetal development of vulnerabilities and risk mechanisms, which enhance risk for subsequent psychopathology. We consider four candidate pathways through which maternal prenatal depression may affect the propensity of offspring to develop later psychopathology across the life span: brain development, physiological stress regulation (hypothalamic-pituitary-adrenocortical axis), negative emotionality, and cognitive (effortful) control. The majority of past research has been correlational, so potential causal conclusions have been limited. We describe an ongoing experimental test of the fetal programming influence of prenatal maternal depressive symptoms using a randomized controlled trial design. In this randomized controlled trial, interpersonal psychotherapy is compared to enhanced usual care among distressed pregnant women to evaluate whether reducing prenatal maternal depressive symptoms has a salutary impact on child ontogenetic vulnerabilities and thereby reduces offspring's risk for emergence of later psychopathology.
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86
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Song C, Li W, Leng J, Wang L, Li W, Shi F, Liu G, Zhou J, Yang X. Passive smoking and postpartum depression among Chinese women: A prospective cohort study in Tianjin, China. Women Health 2018; 59:281-293. [PMID: 29924720 DOI: 10.1080/03630242.2018.1478365] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Smoking has been associated with depression in the general population. Whether passive smoking is also associated with postpartum depression (PPD) is uncertain. From 2010 to 2012, we recruited 8,842 pregnant women in Tianjin, China. The mainland Chinese version of the Edinburgh Postnatal Depression Scale was used to evaluate postpartum depressive symptoms after birth, with a score of >9 defining PPD. Data were collected using specially designed questionnaires or data from the electronic database of Tianjin Maternal and Child Health Information System. Odds ratios (OR) and 95 percent confidence intervals (CI) were obtained for the association of smoking status with PPD using binary logistic regression. Passive smoke exposure rates before and during pregnancy were 40.9 percent and 52.1 percent, respectively. A total of 8.5% (n = 747) of participants had PPD. Compared with those not exposed, women passively exposed to smoke before and during pregnancy had higher odds of PPD (before pregnancy: OR: 1.24, 95 percent CI: 1.03-1.50; during pregnancy: OR: 1.43, 95 percent CI: 1.16-1.77) after adjustment for confounding factors. Passive smoking before and during pregnancy were associated with PPD in Chinese women. Reducing passive smoke exposure may reduce PPD in Chinese women; further longitudinal studies are warranted to replicate these findings.
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Affiliation(s)
- Chunhua Song
- a Department of Epidemiology and Biostatistics, School of Public Health , Tianjin Medical University , Tianjin , China.,b Center for Disease Control and Prevention of Tianjin Economic-Technological Development Area (TEDA) , Tianjin , China
| | - Wei Li
- c Tianjin Women and Children's Health Center , Tianjin , China
| | - Junhong Leng
- c Tianjin Women and Children's Health Center , Tianjin , China
| | - Leishen Wang
- c Tianjin Women and Children's Health Center , Tianjin , China
| | - Weiqin Li
- c Tianjin Women and Children's Health Center , Tianjin , China
| | - Fenglan Shi
- d Tianjin He Ping Women and Children's Health Centre , Tianjin , China
| | - Guifeng Liu
- e Tianjin Nan Kai Women and Children's Health Centre , Tianjin , China
| | - Juan Zhou
- f Tianjin Hong Qiao Disease Control and Prevention Center , Tianjin , China
| | - Xilin Yang
- a Department of Epidemiology and Biostatistics, School of Public Health , Tianjin Medical University , Tianjin , China
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87
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Perkins R, Yorke S, Fancourt D. How group singing facilitates recovery from the symptoms of postnatal depression: a comparative qualitative study. BMC Psychol 2018; 6:41. [PMID: 30119704 PMCID: PMC6098577 DOI: 10.1186/s40359-018-0253-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/24/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Previous research has demonstrated that making music can enhance positive emotions as well as support positive psychological functioning. However, studies tend to be limited by lack of comparison with other psychosocial interventions. This study builds on a three-arm randomised controlled trial (RCT) that demonstrated that group singing for mothers and babies, but not group creative play, can lead to faster recovery from moderate-severe symptoms of postnatal depression than usual care. The aim was to elucidate the mechanisms of the group singing intervention in order to account for its recovery properties. METHODS Qualitative research was conducted with 54 mothers who had experienced symptoms of postnatal depression. Mothers completed a 10-week programme of either group singing or group creative play as part of the wider RCT study. Data were collected via a series of 10 semi-structured focus groups conducted at the end of each 10-week programme. These were designed to elicit subjective and constructed experiences of the singing and play interventions and were analysed inductively for emergent themes. RESULTS Five distinctive features of the group singing emerged: (i) providing an authentic, social and multicultural creative experience, (ii) ability to calm babies; (iii) providing immersive 'me time' for mothers; (iv) facilitating a sense of achievement and identity; (v) enhancing mother-infant bond. CONCLUSIONS Community group singing interventions may reduce symptoms of postnatal depression through facilitating a functional emotional response rooted in the needs of new motherhood. These features are of relevance to others seeking to implement creative interventions for maternal mental health. TRIAL REGISTRATION NCT02526407 . Registered 18 August 2015.
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Affiliation(s)
- Rosie Perkins
- Centre for Performance Science, Royal College of Music, Prince Consort Road, London, SW7 2BS UK
- Faculty of Medicine, Imperial College London, London, SW7 2AZ UK
| | - Sarah Yorke
- Centre for Performance Science, Royal College of Music, Prince Consort Road, London, SW7 2BS UK
| | - Daisy Fancourt
- Centre for Performance Science, Royal College of Music, Prince Consort Road, London, SW7 2BS UK
- Present Address: Faculty of Medicine, Imperial College London, London, SW7 2AZ UK
- Present Address: Department of Behavioural Science and Health, University College London, London, WC1E 7HB UK
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88
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Clarry L, Carson J. Development and pilot of a positive measure of maternal mental health: The C-MEWS. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/johv.2018.6.8.394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Laura Clarry
- Graduate, Department of Psychology, University of Bolton
| | - Jerome Carson
- Professor of psychology, Department of Psychology, University of Bolton
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89
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Hetherington E, McDonald S, Williamson T, Patten SB, Tough SC. Social support and maternal mental health at 4 months and 1 year postpartum: analysis from the All Our Families cohort. J Epidemiol Community Health 2018; 72:933-939. [PMID: 29921649 DOI: 10.1136/jech-2017-210274] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/25/2018] [Accepted: 05/28/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Low social support is consistently associated with postpartum depression. Previous studies do not always control for previous mental health and do not consider what type of support (tangible, emotional, informational or positive social interaction) is most important. The objectives are: to examine if low social support contributes to subsequent risk of depressive or anxiety symptoms and to determine which type of support is most important. METHODS Data from the All Our Families longitudinal pregnancy cohort were used (n=3057). Outcomes were depressive or anxiety symptoms at 4 months and 1 year postpartum. Exposures were social support during pregnancy and at 4 months postpartum. Log binomial models were used to calculate risk ratios (RRs) and absolute risk differences, controlling for past mental health. RESULTS Low total social support during pregnancy was associated with an increased risk of depressive symptoms (RR 1.50, 95% CI 1.24 to 1.82) and anxiety symptoms (RR 1.63, 95% CI 1.38 to 1.93) at 4 months postpartum. Low total social support at 4 months was associated with an increased risk of anxiety symptoms (RR 1.65, 95% CI 1.31 to 2.09) at 1 year. Absolute risk differences were largest among women with previous mental health challenges resulting in a number needed to treat of 5 for some outcomes. Emotional/informational support was the most important type of support for postpartum anxiety. CONCLUSION Group prenatal care, prenatal education and peer support programmes have the potential to improve social support. Prenatal interventions studies are needed to confirm these findings in higher risk groups.
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Affiliation(s)
- Erin Hetherington
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sheila McDonald
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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90
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Clinical effectiveness of family therapeutic interventions in the prevention and treatment of perinatal depression: A systematic review and meta-analysis. PLoS One 2018; 13:e0198730. [PMID: 29902211 PMCID: PMC6002098 DOI: 10.1371/journal.pone.0198730] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 05/24/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Family therapy is a potential strategy to increase family support for those suffering from perinatal depression. Family therapeutic interventions for this population typically target depressed women and their adult family members to improve family functioning and reduce depressive symptoms. OBJECTIVE This systematic review and meta-analysis is a synthesis of the current evidence on the usefulness of family therapy interventions in the prevention and treatment of perinatal depression and impacts on maternal depressive symptoms and family functioning. METHODS This study used the Cochrane Collaboration guidelines for systematic reviews and meta-analyses. Six electronic databases were searched for randomized controlled trials and cluster randomized trials. The primary outcomes included maternal depressive symptoms and family functioning. RESULTS Seven studies were included in the qualitative and quantitative analyses. Fixed effects models showed statistically significant reductions in depressive symptoms at post-intervention in intervention group mothers. Intervention intensity and level of family involvement moderated intervention impacts on maternal depression. A fixed effects model showed a trend in improving family functioning at post-intervention in intervention group couples. CONCLUSION Although a limited number of controlled trials on family therapeutic interventions for this population exist, the findings show that these types of interventions are effective in both the prevention and treatment of perinatal depression. Recommendations for future research are addressed. SYSTEMATIC REVIEW AND META-ANALYSIS PROTOCOL REGISTRATION PROSPERO, CRD42017075150.
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91
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Improving postnatal care in Sweden - Midwives have a key role. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:78-79. [PMID: 29804780 DOI: 10.1016/j.srhc.2018.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 02/01/2018] [Indexed: 11/22/2022]
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92
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Gurung B, Jackson LJ, Monahan M, Butterworth R, Roberts TE. Identifying and assessing the benefits of interventions for postnatal depression: a systematic review of economic evaluations. BMC Pregnancy Childbirth 2018; 18:179. [PMID: 29783936 PMCID: PMC5963067 DOI: 10.1186/s12884-018-1738-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 04/10/2018] [Indexed: 01/30/2023] Open
Abstract
Background Economic evaluations of interventions for postnatal depression (PND) are essential to ensure optimal healthcare decision-making. Due to the wide-ranging effects of PND on the mother, baby and whole family, there is a need to include outcomes for all those affected and to include health and non-health outcomes for accurate estimates of cost-effectiveness. This study aimed to identify interventions to prevent or treat PND for which an economic evaluation had been conducted and to evaluate the health and non-health outcomes included. Methods A systematic review was conducted applying a comprehensive search strategy across eight electronic databases and other sources. Full or partial economic evaluations of interventions involving preventive strategies (including screening), and any treatments for women with or at-risk of PND, conducted in OECD countries were included. We excluded epidemiological studies and those focussing on costs only. The included studies underwent a quality appraisal to inform the analysis. Results Seventeen economic evaluations met the inclusion criteria, the majority focused on psychological /psychosocial interventions. The interventions ranged from additional support from health professionals, peer support, to combined screening and treatment strategies. Maternal health outcomes were measured in all studies; however child health outcomes were included in only four of them. Across studies, the maternal health outcomes included were quality-adjusted-life-years gained, improvement in depressive symptoms, PND cases detected or recovered, whereas the child health outcomes included were cognitive functioning, depression, sleep and temperament. Non-health outcomes such as couples’ relationships and parent-infant interaction were rarely included. Other methodological issues such as limitations in the time horizon and perspective(s) adopted were identified, that were likely to result in imprecise estimates of benefits. Conclusions The exclusion of relevant health and non-health outcomes may mean that only a partial assessment of cost-effectiveness is undertaken, leading to sub-optimal resource allocation decisions. Future research should seek ways to expand the evaluative space of economic evaluations and explore approaches to integrate health and non-health outcomes for all individuals affected by this condition. There is a need to ensure that the time horizon adopted in studies is appropriate to allow true estimation of the long-term benefits and costs of PND interventions. Electronic supplementary material The online version of this article (10.1186/s12884-018-1738-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Binu Gurung
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Louise J Jackson
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Mark Monahan
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Ruth Butterworth
- Cheshire and Mersey Specialist Perinatal Mental Health Service, Thorn Road Clinic, Thorn Road, Runcorn, WA7 5HQ, UK
| | - Tracy E Roberts
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Perinatal depression prevention through home visitation: a cluster randomized trial of mothers and babies 1-on-1. J Behav Med 2018; 41:641-652. [PMID: 29766470 DOI: 10.1007/s10865-018-9934-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
Abstract
Postpartum depression is highly prevalent in low-income women and has significant health effects on mother and child. This pilot study tested the effectiveness of the newly adapted Mothers and Babies (MB) 1-on-1 intervention. A cluster randomized trial was conducted with 8 programs using trained home visitors to deliver MB 1-on-1 and 6 delivering usual home visiting. One hundred twenty pregnant women not experiencing major depression were enrolled. Outcomes were assessed at baseline and 3- and 6-months postpartum. The rate of change in depressive and anxiety symptoms between groups was significant at 6 months, but not 3 months. No statistically significant differences between groups were found on secondary outcomes except perceptions of social support at 6 months. There was variability in use of MB skills, with fewer women using cognitive restructuring techniques. Although larger studies should be conducted, MB 1-on-1 appears promising in using home visitors to deliver a cognitive behavioral intervention to women at risk for postpartum depression.
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Firoz T, McCaw‐Binns A, Filippi V, Magee LA, Costa ML, Cecatti JG, Barreix M, Adanu R, Chou D, Say L. A framework for healthcare interventions to address maternal morbidity. Int J Gynaecol Obstet 2018; 141 Suppl 1:61-68. [PMID: 29851114 PMCID: PMC6001624 DOI: 10.1002/ijgo.12469] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The maternal health agenda is undergoing a paradigm shift from preventing maternal deaths to promoting women's health and wellness. A critical focus of this trajectory includes addressing maternal morbidity and the increasing burden of chronic and noncommunicable diseases (NCD) among pregnant women. The WHO convened the Maternal Morbidity Working Group (MMWG) to improve the scientific basis for defining, measuring, and monitoring maternal morbidity. Based on the MMWG's work, we propose paradigms for conceptualizing maternal health and related interventions, and call for greater integration between maternal health and NCD programs. This integration can be synergistic, given the links between chronic conditions, morbidity in pregnancy, and long-term health. Pregnancy should be viewed as a window of opportunity into the current and future health of women, and offers critical entry points for women who may otherwise not seek or have access to care for chronic conditions. Maternal health services should move beyond the focus on emergency obstetric care, to a broader approach that encompasses preventive and early interventions, and integration with existing services. Health systems need to respond by prioritizing funding for developing integrated health programs, and workforce strengthening. The MMWG's efforts have highlighted the changing landscape of maternal health, and the need to expand the narrow focus of maternal health, moving beyond surviving to thriving.
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Affiliation(s)
| | - Affette McCaw‐Binns
- Department of Community Health and PsychiatryUniversity of the West IndiesMona, KingstonJamaica
| | - Veronique Filippi
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Laura A. Magee
- Department of Women's HealthKing's College LondonLondonUK
| | - Maria L. Costa
- Department of Obstetrics and GynecologyUniversity of CampinasSão PauloBrazil
| | - Jose G. Cecatti
- Department of Obstetrics and GynecologyUniversity of CampinasSão PauloBrazil
| | - Maria Barreix
- UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of ResearchDevelopment and Research Training in Human Reproduction (HRP)Department of Reproductive Health and ResearchWHOGenevaSwitzerland
| | - Richard Adanu
- School of Public HealthDepartment of Population, Family and Reproductive HealthUniversity of GhanaAccraGhana
| | - Doris Chou
- UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of ResearchDevelopment and Research Training in Human Reproduction (HRP)Department of Reproductive Health and ResearchWHOGenevaSwitzerland
| | - Lale Say
- UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of ResearchDevelopment and Research Training in Human Reproduction (HRP)Department of Reproductive Health and ResearchWHOGenevaSwitzerland
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Schneider M, Baron E, Davies T, Munodawafa M, Lund C. Patterns of intimate partner violence among perinatal women with depression symptoms in Khayelitsha, South Africa: a longitudinal analysis. Glob Ment Health (Camb) 2018; 5:e13. [PMID: 29868233 PMCID: PMC5981657 DOI: 10.1017/gmh.2018.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 11/23/2017] [Accepted: 12/21/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A combination of intimate partner violence (IPV) and depression is a common feature of the perinatal period globally. Understanding this association can provide indications of how IPV can be addressed or prevented during pregnancy. This paper aims to determine the prevalence and correlates of IPV among pregnant low-income women with depressive symptoms in Khayelitsha, South Africa, and changes in IPV reports during the course of the perinatal period. METHODS This study is a secondary analysis of data collected as part of a randomised controlled trial testing a psychosocial intervention for antenatal depression. IPV, socio-demographic measures, depression and other mental health measures were collected at recruitment (first antenatal visit), 8 months gestation, and 3 and 12 months postpartum. IPV was defined as a sexual or physical violence perpetrated by the participant's partner in the past 3 months. Descriptive statistics are reported. RESULTS Of 425 recruited depressed participants, 59 (13.9%) reported IPV at baseline, with physical IPV being the most frequently reported (69.5%). Reported IPV was associated with greater emotional distress, potentially higher food insecurity and higher rates of alcohol abuse. There were clear longitudinal trends in reported IPV with the majority of women no longer reporting IPV postpartum. However, some women reported IPV at later assessment points after not reporting IPV at baseline. CONCLUSIONS There is a strong association between IPV and depression in pregnancy. IPV reports remit over time for the women in this study, although the reason for this reduction is not clear and requires further investigation.
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Affiliation(s)
- M. Schneider
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, South Africa
| | - E. Baron
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, South Africa
| | - T. Davies
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, South Africa
| | - M. Munodawafa
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, South Africa
| | - C. Lund
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, South Africa
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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96
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Darius Tandon S, Leis JA, Ward EA, Snyder H, Mendelson T, Perry DF, Carter M, Hamil J, Le HN. Adaptation of an evidence-based postpartum depression intervention: feasibility and acceptability of mothers and babies 1-on-1. BMC Pregnancy Childbirth 2018; 18:93. [PMID: 29642868 PMCID: PMC5896030 DOI: 10.1186/s12884-018-1726-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/29/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mothers and Babies (MB) is a cognitive-behavioral intervention with demonstrated efficacy in reducing depressive symptoms and preventing depressive episodes among perinatal women when delivered in a group format by mental health professionals. Study aims were to describe the adaptation of MB into a 1-on-1 modality (MB 1-on-1) and provide data on the adapted intervention's acceptability and feasibility. METHODS Seventy-five home visitors trained on MB 1-on-1 delivered the 15-session intervention to 1-2 clients. Client acceptability data assessed intervention enjoyment, comprehension, and usefulness. Home visitor feasibility and acceptability data measured amount of intervention material delivered, client comprehension, and client engagement. RESULTS Home visitors were all female with 8.8 years of experience on average. 117 clients completed acceptability surveys. Average client age was 21.9 years and 41% were pregnant. Home visitors completely covered 87.9% of sessions and reported clients totally understood MB material 82.5% of the time across sessions, although variability was found in comprehension across modules. 82.0% of clients found MB 1-on-1 enjoyable and 91.6% said they totally understood sessions, when averaged across sessions. Clients enjoyed content on noticing one's mood and pleasant activities. Implementation challenges were client engagement, facilitating completion of personal projects, and difficulty shifting between didactic and interactive activities. CONCLUSIONS Clients found MB 1-on-1 to be enjoyable, easily understood, and useful. Home visitors reported excellent implementation fidelity and felt clients understood MB material. A refined 12-session version of MB 1-on-1 should be examined for its effectiveness in reducing depressive symptoms, given encouraging feasibility and acceptability data.
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Affiliation(s)
- S. Darius Tandon
- Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 6th Floor, Chicago, IL 60614 USA
| | - Julie A. Leis
- James Bell Associates, 3033 Wilson Blvd, Suite 650, Arlington, VA 22201 USA
| | - Erin A. Ward
- Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 6th Floor, Chicago, IL 60614 USA
| | - Hannah Snyder
- Department of Psychology, George Washington University, 2125 G. St. NW, Washington, DC 20052 USA
| | - Tamar Mendelson
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Room 853, Baltimore, MD 21205 USA
| | - Deborah F. Perry
- Center for Child and Human Development, Georgetown University, 3300 Whitehaven St., Suite 3300, Box 571485, Washington, DC 20057 USA
| | - Mya Carter
- Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 6th Floor, Chicago, IL 60614 USA
| | - Jaime Hamil
- Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 6th Floor, Chicago, IL 60614 USA
| | - Huynh-Nhu Le
- Department of Psychology, George Washington University, 2125 G. St. NW, Washington, DC 20052 USA
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97
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Jones D, Feinberg M, Hostetler M, Roettger M, Paul IM, Ehrenthal DB. Family and Child Outcomes 2 Years After a Transition to Parenthood Intervention. FAMILY RELATIONS 2018; 67:270-286. [PMID: 30140113 PMCID: PMC6101046 DOI: 10.1111/fare.12309] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/19/2017] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To examine the impact from Family Foundations, a transition-to-parenting intervention, on parent and child outcomes 2 years after birth. BACKGROUND Couples transitioning to parenthood face many stressors and challenges that are not typically addressed through commonly available childbirth preparatory classes. The Family Foundations program was designed for couples expecting their first child and addresses family stressors related to coparenting, parenting, and mental health. METHOD The recruited sample of 399 couples expecting their first child were randomly assigned to intervention or control conditions. Data were obtained through home observation and parent surveys before and after intervention. RESULTS Intent-to-treat analyses indicated effects on several targeted domains including coparenting, parenting, and relationship quality, as well as on child sleep habits and internalizing behavior problems at 2 years of age. Effects for several outcomes were larger for those couples at greater risk based on pretest observed negative dyadic communication styles. CONCLUSION Longer term impact found here on parent and child outcomes provides new evidence of the effectiveness of this program for first-time parents. IMPLICATIONS Programs directed toward broader issues related to aspects of coparenting, parenting, and mental health have the potential to have longer term positive impact on the couples and the developing child.
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98
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Suzuki S, Takeda S, Okano T, Kinoshita K. Recent strategies in perinatal mental health care in Japan. HYPERTENSION RESEARCH IN PREGNANCY 2018. [DOI: 10.14390/jsshp.hrp2018-006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shunji Suzuki
- Japanese Red Cross Katsushika Maternity Hospital
- Japan Association of Obstetricians and Gynecologists
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99
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Faherty LJ, Hantsoo L, Appleby D, Sammel MD, Bennett IM, Wiebe DJ. Movement patterns in women at risk for perinatal depression: use of a mood-monitoring mobile application in pregnancy. J Am Med Inform Assoc 2018; 24:746-753. [PMID: 28339686 DOI: 10.1093/jamia/ocx005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 01/06/2017] [Indexed: 11/12/2022] Open
Abstract
Objectives To examine, using a smartphone application, whether mood is related to daily movement patterns in pregnant women at risk for perinatal depression. Materials and Methods Thirty-six women with elevated depression symptoms (PHQ-9 ≥ 5) in pregnancy used the application for 8 weeks. Mood was reported using application-administered surveys daily (2 questions) and weekly (PHQ-9 and GAD-7). The application measured daily mobility (distance travelled on foot) and travel radius. Generalized linear mixed-effects regression models estimated the association between mood and movement. Results Women with milder depression symptoms had a larger daily radius of travel (2.7 miles) than women with more severe symptoms (1.9 miles), P = .04. There was no difference in mobility. A worsening of mood from the prior day was associated with a contracted radius of travel, as was being in the group with more severe symptoms. No significant relationships were found between anxiety and either mobility or radius. Discussion We found that the association of mood with radius of travel was more pronounced than its association with mobility. Our study also demonstrated that a change in mood from the prior day was significantly associated with radius but not mood on the same day that mobility and radius were measured. Conclusion This study lays the groundwork for future research on how smartphone mood-monitoring applications can combine actively and passively collected data to better understand the relationship between the symptoms of perinatal depression and physical activity that could lead to improved monitoring and novel interventions.
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Affiliation(s)
- Laura J Faherty
- Robert Wood Johnson Foundation Clinical Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Liisa Hantsoo
- Department of Psychiatry, Penn Center for Women's Behavioral Wellness, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dina Appleby
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary D Sammel
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ian M Bennett
- Department of Family Medicine, University of Washington, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Douglas J Wiebe
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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100
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Raftery J, Hanney S, Greenhalgh T, Glover M, Blatch-Jones A. Models and applications for measuring the impact of health research: update of a systematic review for the Health Technology Assessment programme. Health Technol Assess 2018; 20:1-254. [PMID: 27767013 DOI: 10.3310/hta20760] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This report reviews approaches and tools for measuring the impact of research programmes, building on, and extending, a 2007 review. OBJECTIVES (1) To identify the range of theoretical models and empirical approaches for measuring the impact of health research programmes; (2) to develop a taxonomy of models and approaches; (3) to summarise the evidence on the application and use of these models; and (4) to evaluate the different options for the Health Technology Assessment (HTA) programme. DATA SOURCES We searched databases including Ovid MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and The Cochrane Library from January 2005 to August 2014. REVIEW METHODS This narrative systematic literature review comprised an update, extension and analysis/discussion. We systematically searched eight databases, supplemented by personal knowledge, in August 2014 through to March 2015. RESULTS The literature on impact assessment has much expanded. The Payback Framework, with adaptations, remains the most widely used approach. It draws on different philosophical traditions, enhancing an underlying logic model with an interpretative case study element and attention to context. Besides the logic model, other ideal type approaches included constructionist, realist, critical and performative. Most models in practice drew pragmatically on elements of several ideal types. Monetisation of impact, an increasingly popular approach, shows a high return from research but relies heavily on assumptions about the extent to which health gains depend on research. Despite usually requiring systematic reviews before funding trials, the HTA programme does not routinely examine the impact of those trials on subsequent systematic reviews. The York/Patient-Centered Outcomes Research Institute and the Grading of Recommendations Assessment, Development and Evaluation toolkits provide ways of assessing such impact, but need to be evaluated. The literature, as reviewed here, provides very few instances of a randomised trial playing a major role in stopping the use of a new technology. The few trials funded by the HTA programme that may have played such a role were outliers. DISCUSSION The findings of this review support the continued use of the Payback Framework by the HTA programme. Changes in the structure of the NHS, the development of NHS England and changes in the National Institute for Health and Care Excellence's remit pose new challenges for identifying and meeting current and future research needs. Future assessments of the impact of the HTA programme will have to take account of wider changes, especially as the Research Excellence Framework (REF), which assesses the quality of universities' research, seems likely to continue to rely on case studies to measure impact. The HTA programme should consider how the format and selection of case studies might be improved to aid more systematic assessment. The selection of case studies, such as in the REF, but also more generally, tends to be biased towards high-impact rather than low-impact stories. Experience for other industries indicate that much can be learnt from the latter. The adoption of researchfish® (researchfish Ltd, Cambridge, UK) by most major UK research funders has implications for future assessments of impact. Although the routine capture of indexed research publications has merit, the degree to which researchfish will succeed in collecting other, non-indexed outputs and activities remains to be established. LIMITATIONS There were limitations in how far we could address challenges that faced us as we extended the focus beyond that of the 2007 review, and well beyond a narrow focus just on the HTA programme. CONCLUSIONS Research funders can benefit from continuing to monitor and evaluate the impacts of the studies they fund. They should also review the contribution of case studies and expand work on linking trials to meta-analyses and to guidelines. FUNDING The National Institute for Health Research HTA programme.
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Affiliation(s)
- James Raftery
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Steve Hanney
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Trish Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Matthew Glover
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Amanda Blatch-Jones
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, UK
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