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Dennis CL, Singla DR, Brown HK, Savel K, Clark CT, Grigoriadis S, Vigod SN. Postpartum Depression: A Clinical Review of Impact and Current Treatment Solutions. Drugs 2024; 84:645-659. [PMID: 38811474 DOI: 10.1007/s40265-024-02038-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/31/2024]
Abstract
Depression during the first year postpartum (postpartum depression) impacts millions of women and their families worldwide. In this narrative review, we provide a summary of postpartum depression, examining the etiology and consequences, pharmacological and psychological treatments, and potential mechanisms of change and current barriers to care. Psychological treatments are effective and preferred by many perinatal patients over medications, but they often remain inaccessible. Key potential mechanisms underlying their effectiveness include treatment variables (e.g., dosage and therapeutic alliance) and patient behaviors (e.g., activation and avoidance and emotional regulation). Among pharmacological treatments, the selective serotonin reuptake inhibitor (SSRI) sertraline is generally the first-line antidepressant medication recommended to women in the postpartum period due to its minimal passage into breastmilk and the corresponding decades of safety data. Importantly, most antidepressant drugs are considered compatible with breastfeeding. Neurosteroids are emerging as an effective treatment for postpartum depression, although currently this treatment is not widely available. Barriers to widespread access to treatment include those that are systematic (e.g., lack of specialist providers), provider-driven (e.g., lack of flexibility in treatment delivery), and patient-driven (e.g., stigma and lack of time for treatment engagement). We propose virtual care, task-sharing to non-specialist treatment providers, and collaborative care models as potential solutions to enhance the reach and scalability of effective treatments to address the growing burden of postpartum depression worldwide and its negative impact on families and society.
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Affiliation(s)
- Cindy-Lee Dennis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada.
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Rm 280, Toronto, ON, M6J 1H4, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Daisy R Singla
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Hilary K Brown
- Department of Health and Society, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
- Women's College Research Institute, Toronto, Canada
| | - Katarina Savel
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Crystal T Clark
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
- Women's College Research Institute, Toronto, Canada
| | - Sophie Grigoriadis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Simone N Vigod
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
- Women's College Research Institute, Toronto, Canada
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2
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Zhai WH, Wang MJ, Zhao YJ, Hu SL, Zhou JM. Treatment of postpartum depression with integrated traditional Chinese and Western medicine nursing and electrical stimulation. World J Clin Cases 2023; 11:7980-7986. [DOI: 10.12998/wjcc.v11.i33.7980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/09/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Postpartum depression (PPD) is a common psychological disease among puerperal women, and postpartum pelvic floor dysfunction is a common disease among pregnant women. The occurrence of postpartum pelvic floor dysfunction will increase the incidence of PPD.
AIM To explore the therapeutic effect of integrated traditional Chinese and Western medicine nursing combined with electrical stimulation of pelvic floor muscles and the rectus abdominis on PPD.
METHODS From April 2020 to January 2022, 100 parturients with a rectus abdominis muscle separation distance > 2.0 cm who underwent reexamination 6 wk after delivery at our hospital were selected as the research subjects. According to the random number table method, the patients were divided into either an observation group (n = 50) or a control group (n = 50). There was no significant difference in the general data between the two groups (P > 0.05). Both groups were treated by electrical stimulation. The observation group was additionally treated by integrated traditional Chinese and Western medicine nursing. A self-designed Depression Knowledge Questionnaire was used to evaluate the awareness of knowledge on depression in all patients 3 wk after intervention. The Hamilton Depression Scale (HAMD) was used to evaluate the depression before intervention and 1 wk and 3 wk after intervention, and the Morisky Medication Adherence Scale (MMAS-8) was used to evaluate the medication compliance. SPSS19.0 was used for statistical analyses.
RESULTS The rate of awareness of knowledge on depression in the observation group was significantly higher than that of the control group (P < 0.05). The scores of MMAS-8 were comparable between the two groups before intervention (P > 0.05), but were significantly higher in the observation group than in the control group at 1 wk and 3 wk after intervention (P < 0.05). The HAMD scores were comparable between the two groups before intervention (P > 0.05), but were significantly lower in the observation group than in the control group at 1 wk and 3 wk after intervention (P < 0.05).
CONCLUSION Integrated traditional Chinese and Western medicine nursing combined with electrical stimulation of pelvic floor muscles and the rectus abdominis is effective in the treatment of postpartum depression and worthy of clinical promotion.
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Affiliation(s)
- Wen-Hui Zhai
- Psychiatric Intensive Care Unit 2, Wudong Hospital, Wuhan 430084, Hubei Province, China
| | - Mei-Jiao Wang
- Psychiatric Intensive Care Unit 2, Wudong Hospital, Wuhan 430084, Hubei Province, China
| | - Yi-Jing Zhao
- Psychiatric Intensive Care Unit 2, Wudong Hospital, Wuhan 430084, Hubei Province, China
| | - Shuang-Ling Hu
- Psychiatric Intensive Care Unit 2, Wudong Hospital, Wuhan 430084, Hubei Province, China
| | - Jin-Man Zhou
- Department of Nursing, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430063, Hubei Province, China
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Almarri SS, Alzahrani YA, Alsudais MS, Bamehrez M, Alotaibi RK, Almalki BS, Almukhles AS, Al-Wassia H. The Effects of Booking Status on the Outcome of Infants of ≥32 Weeks Gestational Age Admitted to the Neonatal Intensive Care Unit in a Tertiary Academic Center. Cureus 2022; 14:e31020. [DOI: 10.7759/cureus.31020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 11/05/2022] Open
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Shorey S, Tan TC, Mathews J, Yu CY, Lim SH, Shi L, Ng ED, Chan YH, Law E, Chee C, Chong YS. Development of a Supportive Parenting App to Improve Parent and Infant Outcomes in the Perinatal Period: Development Study. J Med Internet Res 2021; 23:e27033. [PMID: 36260376 PMCID: PMC8785955 DOI: 10.2196/27033] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/05/2021] [Accepted: 11/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background The transition to parenthood can be challenging, and parents are vulnerable to psychological disorders during the perinatal period. This may have adverse long-term consequences on a child’s development. Given the rise in technology and parents’ preferences for mobile health apps, a supportive mobile health intervention is optimal. However, there is a lack of a theoretical framework and technology-based perinatal educational intervention for couples with healthy infants. Objective The aim of this study is to describe the Supportive Parenting App (SPA) development procedure and highlight the challenges and lessons learned. Methods The SPA development procedure was guided by the information systems research framework, which emphasizes a nonlinear, iterative, and user-centered process involving 3 research cycles—the relevance cycle, design cycle, and rigor cycle. Treatment fidelity was ensured, and team cohesiveness was maintained using strategies from the Tuckman model of team development. Results In the relevance cycle, end-user requirements were identified through focus groups and interviews. In the rigor cycle, the user engagement pyramid and well-established theories (social cognitive theory proposed by Bandura and attachment theory proposed by Bowlby) were used to inform and justify the features of the artifact. In the design cycle, the admin portal was developed using Microsoft Visual Studio 2017, whereas the SPA, which ran on both iOS and Android, was developed using hybrid development tools. The SPA featured knowledge-based content, informational videos and audio clips, a discussion forum, chat groups, and a frequently asked questions and expert advice section. The intervention underwent iterative testing by a small group of new parents and research team members. Qualitative feedback was obtained for further app enhancements before official implementation. Testing revealed user and technological issues, such as web browser and app incompatibility, a lack of notifications for both administrators and users, and limited search engine capability. Conclusions The information systems research framework documented the technical details of the SPA but did not take into consideration the interpersonal and real-life challenges. Ineffective communication between the health care research team and the app developers, limited resources, and the COVID-19 pandemic were the main challenges faced during content development. Quick adaptability, team cohesion, and hindsight budgeting are crucial for intervention development. Although the effectiveness of the SPA in improving parental and infant outcomes is currently unknown, this detailed intervention development study highlights the key aspects that need to be considered for future app development.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Thiam Chye Tan
- Mount Elizabeth Novena Specialist Centre, Singapore, Singapore
| | - Jancy Mathews
- National University Polyclinics, Singapore, Singapore
| | | | | | - Luming Shi
- Singapore Clinical Research Institute, Singapore, Singapore
| | - Esperanza Debby Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Evelyn Law
- National University Hospital, Singapore, Singapore
| | | | - Yap Seng Chong
- National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Darling EV, Byatt N, Maher EL, Gray TD, Simas TAM, Cordova JV. The Before Baby Relationship Checkup: A Couples-Based Intervention to Reduce Relationship Risk Factors for Perinatal Mood and Anxiety Disorders. J Clin Psychol Med Settings 2021; 29:295-309. [PMID: 34617155 DOI: 10.1007/s10880-021-09819-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/27/2022]
Abstract
Relationship conflict and lack of partner support are risk factors for perinatal mood and anxiety disorders. An intervention to strengthen couples' relationships before birth may reduce relationship risk factors for perinatal mood and anxiety disorders, though no research has explored this to date. The aims of this Stage 1 open-series non-experimental proof of concept study were to adapt the 'Marriage Checkup', an evidence-based intervention for relationship distress, as a preventative intervention for perinatal mood and anxiety disorders and to assess its feasibility and acceptability. Pregnant women receiving care at a university-based obstetric practice, and their partners, were recruited. Ten couples participated in the Before Baby Relationship Checkup, a personalized relationship health service offered in the obstetric clinic. Quantitative and qualitative data gathered suggests the intervention is feasible to implement in an obstetric setting, and acceptable to perinatal couples. Specific adaptations to the Marriage Checkup for perinatal couples are warranted and further testing is needed to evaluate efficacy.
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Affiliation(s)
- Ellen V Darling
- Department of Psychology, Clark University, Worcester, MA, USA.
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Emily L Maher
- Department of Psychology, Clark University, Worcester, MA, USA
| | - Tatiana D Gray
- Department of Psychology, Clark University, Worcester, MA, USA
| | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
| | - James V Cordova
- Department of Psychology, Clark University, Worcester, MA, USA
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6
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Monteiro F, Pereira M, Canavarro MC, Fonseca A. Be a Mom's Efficacy in Enhancing Positive Mental Health among Postpartum Women Presenting Low Risk for Postpartum Depression: Results from a Pilot Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134679. [PMID: 32610640 PMCID: PMC7370106 DOI: 10.3390/ijerph17134679] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/25/2020] [Accepted: 06/28/2020] [Indexed: 01/02/2023]
Abstract
In this study, we conducted a preliminary investigation of the efficacy of Be a Mom, a web-based self-guided intervention, in enhancing positive mental health among postpartum women at low risk for postpartum depression. Additionally, we examined Be a Mom’s efficacy regarding secondary outcomes as well as its acceptability and adherence. A total of 367 participants were randomly assigned to the Be a Mom group (n = 191) or to the waiting-list control group (n = 176) and completed baseline (T1) and postintervention (T2) assessments. The intervention group reported significant increases in positive mental health between T1 and T2 compared to the control group. Additionally, group effects were found for depressive and anxiety symptoms. A significantly higher proportion of participants in the Be a Mom group had an improvement trajectory (from not flourishing at T1 to flourishing at T2). A total of 62 (32.5%) women completed Be a Mom, and most would use it again if needed (n = 82/113; 72.6%). This study provides preliminary evidence of Be a Mom’s efficacy in increasing positive mental health among low-risk postpartum women. Our findings support mental health promotion strategies in the postpartum period and highlight the important role of web-based CBT interventions.
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Sudhanthar S, Sheikh ZEH, Thakur K. Postpartum depression screening: are we doing a competent job? BMJ Open Qual 2019; 8:e000616. [PMID: 31673639 PMCID: PMC6797414 DOI: 10.1136/bmjoq-2018-000616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 09/06/2019] [Accepted: 09/30/2019] [Indexed: 11/16/2022] Open
Abstract
Postpartum depression (PPD) is one of the most common and severe postpartum morbidity, affecting 10%–20% of mothers within the first year of childbirth. The adverse effects of PPD, namely, prevention of mother-baby bonding and early cessation of breastfeeding, adversely affects infant growth and brain development. Studies have found that up to 50% of women with PPD go undiagnosed. Despite the American Academy of Pediatrics (AAP) recommendations, only a small percentage of paediatricians are currently screening for PPD. This project aimed to improve PPD screening using a validated tool to 75% in a primary care inner-city clinic serving a predominantly underserved population as per AAP recommendations. Baseline data for 40 charts of 2-month-old and 4-month-old well-child visits showed no documentation of PPD screening. The screening tool used for this project was the Edinburgh Postpartum Depression Scale (EPDS), which is a validated 10-item screening questionnaire for PPD. Three Plan-Do-Study-Act (PDSA) cycles were implemented involving educational strategies, system-based practice improvement and stakeholder participation. Improvement seen after PDSA cycle 1 was minimal. At the end of cycle 2, 16/50 (33%) charts had documentation of screening using EPDS. At the end of cycle 3, 33/40 (82%) charts had EPDS documentation, an increase of 49% from cycle 2. There were eight in total positive PPD screenings between cycles 2 and 3. These patients were provided counselling support through a social worker and referral services through the local community mental health organisation. We achieved more than our 75% target goal for PPD screening implementation at the residency clinic, thereby increasing residents’ awareness of PPD and the importance of PPD screening. Poststudy follow-up shows that screening was maintained at a higher rate but never reached 100%.
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Affiliation(s)
- Sathyanarayan Sudhanthar
- Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Zile-E-Huma Sheikh
- Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Kripa Thakur
- Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
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8
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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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9
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Morrell CJ, Sutcliffe P, Booth A, Stevens J, Scope A, Stevenson M, Harvey R, Bessey A, Cantrell A, Dennis CL, Ren S, Ragonesi M, Barkham M, Churchill D, Henshaw C, Newstead J, Slade P, Spiby H, Stewart-Brown S. A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression. Health Technol Assess 2018; 20:1-414. [PMID: 27184772 DOI: 10.3310/hta20370] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Postnatal depression (PND) is a major depressive disorder in the year following childbirth, which impacts on women, their infants and their families. A range of interventions has been developed to prevent PND. OBJECTIVES To (1) evaluate the clinical effectiveness, cost-effectiveness, acceptability and safety of antenatal and postnatal interventions for pregnant and postnatal women to prevent PND; (2) apply rigorous methods of systematic reviewing of quantitative and qualitative studies, evidence synthesis and decision-analytic modelling to evaluate the preventive impact on women, their infants and their families; and (3) estimate cost-effectiveness. DATA SOURCES We searched MEDLINE, EMBASE, Science Citation Index and other databases (from inception to July 2013) in December 2012, and we were updated by electronic alerts until July 2013. REVIEW METHODS Two reviewers independently screened titles and abstracts with consensus agreement. We undertook quality assessment. All universal, selective and indicated preventive interventions for pregnant women and women in the first 6 postnatal weeks were included. All outcomes were included, focusing on the Edinburgh Postnatal Depression Scale (EPDS), diagnostic instruments and infant outcomes. The quantitative evidence was synthesised using network meta-analyses (NMAs). A mathematical model was constructed to explore the cost-effectiveness of interventions contained within the NMA for EPDS values. RESULTS From 3072 records identified, 122 papers (86 trials) were included in the quantitative review. From 2152 records, 56 papers (44 studies) were included in the qualitative review. The results were inconclusive. The most beneficial interventions appeared to be midwifery redesigned postnatal care [as shown by the mean 12-month EPDS score difference of -1.43 (95% credible interval -4.00 to 1.36)], person-centred approach (PCA)-based and cognitive-behavioural therapy (CBT)-based intervention (universal), interpersonal psychotherapy (IPT)-based intervention and education on preparing for parenting (selective), promoting parent-infant interaction, peer support, IPT-based intervention and PCA-based and CBT-based intervention (indicated). Women valued seeing the same health worker, the involvement of partners and access to several visits from a midwife or health visitor trained in person-centred or cognitive-behavioural approaches. The most cost-effective interventions were estimated to be midwifery redesigned postnatal care (universal), PCA-based intervention (indicated) and IPT-based intervention in the sensitivity analysis (indicated), although there was considerable uncertainty. Expected value of partial perfect information (EVPPI) for efficacy data was in excess of £150M for each population. Given the EVPPI values, future trials assessing the relative efficacies of promising interventions appears to represent value for money. LIMITATIONS In the NMAs, some trials were omitted because they could not be connected to the main network of evidence or did not provide EPDS scores. This may have introduced reporting or selection bias. No adjustment was made for the lack of quality of some trials. Although we appraised a very large number of studies, much of the evidence was inconclusive. CONCLUSIONS Interventions warrant replication within randomised controlled trials (RCTs). Several interventions appear to be cost-effective relative to usual care, but this is subject to considerable uncertainty. FUTURE WORK RECOMMENDATIONS Several interventions appear to be cost-effective relative to usual care, but this is subject to considerable uncertainty. Future research conducting RCTs to establish which interventions are most clinically effective and cost-effective should be considered. STUDY REGISTRATION This study is registered as PROSPERO CRD42012003273. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- C Jane Morrell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Sutcliffe
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Stevens
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alison Scope
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rebecca Harvey
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alice Bessey
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy-Lee Dennis
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Shijie Ren
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Margherita Ragonesi
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Michael Barkham
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Dick Churchill
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Carol Henshaw
- Division of Psychiatry, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Jo Newstead
- Nottingham Experts Patients Group, Clinical Reference Group for Perinatal Mental Health, Nottingham, UK
| | - Pauline Slade
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Stewart-Brown
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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10
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Horibe M, Hane Y, Abe J, Matsui T, Kato Y, Ueda N, Sasaoka S, Motooka Y, Hatahira H, Hasegawa S, Kinosada Y, Hara H, Nakamura M. Contraceptives as possible risk factors for postpartum depression: A retrospective study of the food and drug administration adverse event reporting system, 2004-2015. Nurs Open 2018; 5:131-138. [PMID: 29599988 PMCID: PMC5867283 DOI: 10.1002/nop2.121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022] Open
Abstract
Aim Postpartum depression is a mood disorder that commonly affects women during the early postpartum period. The objective of this study was to analyse the association of postpartum depression with drugs (including contraceptive devices and implants) with spontaneously reported adverse events reported in the US Food and Drug Administration Adverse Event Reporting System database. Design Retrospective study. Method Reports of postpartum depression events between 2004–2015 were analysed with a reporting odds ratio (ROR) algorithm. The Medical Dictionary for Regulatory Activities was used to identify postpartum depression. Results The reporting odds ratios (95% confidence intervals, CI) of levonorgestrel (an intrauterine device with progestogen), etonogestrel (a hormonal contraceptive implant), sertraline and drospirenone (an oral contraceptive) were 12.5 (8.7–18.0), 14.0 (8.5–22.8), 12.2 (6.5–23.1) and 5.4 (2.7–10.9) respectively. Among the drugs in the US Food and Drug Administration Adverse Event Reporting System database, the use of contraceptives or an intrauterine device with progestogen might convey risk for postpartum depression.
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Affiliation(s)
- Megumi Horibe
- Department of Nursing School of Health Sciences Asahi University Gifu Japan.,Molecular Pharmacology Department of Biofunctional Evaluation Gifu Pharmaceutical University Gifu Japan
| | - Yuuki Hane
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan
| | - Junko Abe
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan.,Medical Database Co., LTD Tokyo Japan
| | - Toshinobu Matsui
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan
| | - Yamato Kato
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan.,Present address: Department of Environmental Affairs and Citizen Support Gifu Prefectural Government Gifu Japan
| | - Natsumi Ueda
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan.,Present address: Division of Pharmacy Ehime University Hospital Shitsukawa, Toon Ehime Japan
| | - Sayaka Sasaoka
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan
| | - Yumi Motooka
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan
| | - Haruna Hatahira
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan
| | - Shiori Hasegawa
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan
| | - Yasutomi Kinosada
- United Graduate School of Drug Discovery and Medical Information Sciences Gifu University Graduate School of Medicine Gifu Japan
| | - Hideaki Hara
- Molecular Pharmacology Department of Biofunctional Evaluation Gifu Pharmaceutical University Gifu Japan
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11
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Letourneau NL, Dennis CL, Cosic N, Linder J. The effect of perinatal depression treatment for mothers on parenting and child development: A systematic review. Depress Anxiety 2017; 34:928-966. [PMID: 28962068 DOI: 10.1002/da.22687] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/05/2017] [Accepted: 08/28/2017] [Indexed: 11/10/2022] Open
Abstract
Antenatal and postpartum depression are very common and have significant consequences for mothers and their children. This review examines which antenatal depression (AD) and postpartum depression (PPD) treatment interventions are most efficacious in improving parenting and/or child development. CINAHL, Scopus, Cochrane Systematic Reviews, Cochrane Controlled Trials, Medline (OVID), Embase (OVID), PsychINFO, PsycARTICLES, AMED, and reference lists were searched. Randomized controlled trials (RCTs) and quasi-experimental studies assessing the effect of AD, PPD, or both treatment interventions on parenting and/or child development were included. Meta-analysis was conducted using random effects when possible. Thirty-six trials (within 40 articles) met criteria for review. Interventions include interpersonal psychotherapy (IPT), cognitive behavioural therapy (CBT), peer support, maternal-child interaction guidance, and other interventions, such as massage. For AD, IPT, CBT, and massage produced large effects on parenting (e.g. adjustment and attention toward infant) and child development (e.g. behaviour). For PPD, maternal-child interaction guidance and psychotherapeutic group support produced large effects on parenting (e.g. sense of competence) and child development (e.g. cortisol). However, meta-analysis revealed nonsignificant effects of IPT on maternal-child attachment and CBT on parenting stress. Promising findings exist for IPT, CBT, maternal-child interaction guidance, massage, and psychotherapeutic group support for specific parenting and/or child development outcomes. Additional RCTs using measures already employed in the literature are required to conduct necessary meta-analysis and fully elucidate treatment effects.
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Affiliation(s)
- Nicole L Letourneau
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Cindy-Lee Dennis
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Nela Cosic
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Jordana Linder
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB, Canada
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12
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Kotz J, Munns A, Marriott R, Marley JV. Perinatal depression and screening among Aboriginal Australians in the Kimberley. Contemp Nurse 2017; 52:42-58. [PMID: 27294330 DOI: 10.1080/10376178.2016.1198710] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PROBLEM Adhoc culturally questionable perinatal mental-health screening among Aboriginal women in the Kimberley. BACKGROUND Mental-health issues, substance abuse and suicide attempts are high among young Aboriginal women in Australia. There is no evidence that the Edinburgh Postnatal Depression Scale (EPDS) is effective or culturally safe. Screening practices are complicated by limited understanding of the complex cultural interface between Western and Aboriginal beliefs and notions about health and mental-health. QUESTION What is the current context of perinatal mental-health screening practices among Aboriginal women in the Kimberley and what might be considered a culturally safe approach? METHODS A review of the literature and exploration of current screening practices preceded community participatory action research (CPAR) of perinatal mental-health screening. RESULTS More than 100 Kimberley women and 72 health practitioners contributed to this joint strategic body of work. Recommendations for practice include one single culturally appropriate Kimberley version of the EPDS.
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Affiliation(s)
- Jayne Kotz
- a School of Psychology and Exercise Science , Murdoch University , South Street, Murdoch , WA , Australia
| | - Ailsa Munns
- b School of Nursing, Midwifery & Paramedicine , Curtin University , Bentley , Australia
| | - Rhonda Marriott
- a School of Psychology and Exercise Science , Murdoch University , South Street, Murdoch , WA , Australia
| | - Julia V Marley
- c The Rural Clinical School of Western Australia , The University of Western Australia , Broome , Australia.,d Kimberley Aboriginal Medical Services , Broome , Australia
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13
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Pawils S, Metzner F, Wendt C, Raus S, Shedden-Mora M, Wlodarczyk O, Härter M. Patients with Postpartum Depression in Gynaecological Practices in Germany - Results of a Representative Survey of Local Gynaecologists about Diagnosis and Management. Geburtshilfe Frauenheilkd 2016; 76:888-894. [PMID: 27582583 DOI: 10.1055/s-0042-103326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
THEORETICAL BACKGROUND AND CURRENT ISSUES For the sake of pre-emptive child protection it is necessary to recognise signs of postpartum depression (PPD) in pregnant women and young mothers as early as possible and to initiate adequate assistance. Because of their high acceptance, especially in the phases of pregnancy and birth, the local gynaecologists offer ideal prerequisites for access to the parents. This study evaluates the current status of diagnosis and management of PPD in gynaecological practices. MATERIAL AND METHODS In a representative German nation-wide questionnaire survey taking the regional distribution into account n = 3000 local gynaecologists were selected at random and contacted by post. The questionnaire addressed their approaches to the diagnosis and management of PPD as well as the encountered barriers. RESULTS Among the n = 1034 participating gynaecologists (response rate: 35 %) half of them dealt actively with PPD; 16 % used a questionnaire for this purpose. Consultation by the gynaecologist (84 %) or referral to therapists or hospitals (86 %) were among the most common interventions in the management of PPD. A need for improvement in the management of women with PPD was recognised equally often. As barriers the gynaecologists mentioned above all the lack of time, the low reimbursements for consultations and the lack of effective treatment options. Predictors for an active anamnesis were found to be female gender of the gynaecologist, possession of an additional psychosomatic qualification and practice located in an urban catchment area or state of the former West Germany. CONCLUSION The results clearly demonstrate a high acceptance for the management of PPD by gynaecologists as well as the need for further action to improve the care of patients with PPD in gynaecological practices.
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Affiliation(s)
- S Pawils
- Universitätsklinikum Hamburg-Eppendorf, Institut für Medizinische Psychologie, Hamburg
| | - F Metzner
- Universitätsklinikum Hamburg-Eppendorf, Institut für Medizinische Psychologie, Hamburg
| | - C Wendt
- Universitätsklinikum Hamburg-Eppendorf, Institut für Medizinische Psychologie, Hamburg
| | - S Raus
- Universitätsklinikum Hamburg-Eppendorf, Institut für Medizinische Psychologie, Hamburg
| | - M Shedden-Mora
- Universitätsklinikum Hamburg-Eppendorf, Poliklinik für Psychosomatische Medizin und Psychotherapie, Hamburg
| | - O Wlodarczyk
- Universitätsklinikum Hamburg-Eppendorf, Institut für Medizinische Psychologie, Hamburg
| | - M Härter
- Universitätsklinikum Hamburg-Eppendorf, Institut für Medizinische Psychologie, Hamburg
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A systematic review of the relationship factor between women and health professionals within the multivariant analysis of maternal satisfaction. Midwifery 2016; 41:68-78. [PMID: 27551856 DOI: 10.1016/j.midw.2016.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 07/17/2016] [Accepted: 08/05/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION personalised support provided to women by health professionals is one of the prime factors attaining women's satisfaction during pregnancy and childbirth. However the multifactorial nature of 'satisfaction' makes difficult to assess it. Statistical multivariate analysis may be an effective technique to obtain in depth quantitative evidence of the importance of this factor and its interaction with the other factors involved. This technique allows us to estimate the importance of overall satisfaction in its context and suggest actions for healthcare services. METHODS systematic review of studies that quantitatively measure the personal relationship between women and healthcare professionals (gynecologists, obstetricians, nurse, midwifes, etc.) regarding maternity care satisfaction. The literature search focused on studies carried out between 1970 and 2014 that used multivariate analyses and included the woman-caregiver relationship as a factor of their analysis. RESULTS twenty-four studies which applied various multivariate analysis tools to different periods of maternity care (antenatal, perinatal, post partum) were selected. The studies included discrete scale scores and questionnaires from women with low-risk pregnancies. The "personal relationship" factor appeared under various names: care received, personalised treatment, professional support, amongst others. The most common multivariate techniques used to assess the percentage of variance explained and the odds ratio of each factor were principal component analysis and logistic regression. DISCUSSION the data, variables and factor analysis suggest that continuous, personalised care provided by the usual midwife and delivered within a family or a specialised setting, generates the highest level of satisfaction. In addition, these factors foster the woman's psychological and physiological recovery, often surpassing clinical action (e.g. medicalization and hospital organization) and/or physiological determinants (e.g. pain, pathologies, etc.).
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15
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Meaney S, Lutomski JE, O' Connor L, O' Donoghue K, Greene RA. Women's experience of maternal morbidity: a qualitative analysis. BMC Pregnancy Childbirth 2016; 16:184. [PMID: 27457248 PMCID: PMC4960829 DOI: 10.1186/s12884-016-0974-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 07/14/2016] [Indexed: 11/24/2022] Open
Abstract
Background Maternal morbidity refers to pregnancy-related complications, ranging in severity from acute to chronic. In Ireland one in 210 maternities will experience a severe morbidity. Yet, how women internalize their experience of morbidity has gone largely unexplored. This study aimed to explore women’s experiences of maternal morbidity. Methods A qualitative semi-structured interview format was utilized. Purposive sampling was used to recruit 14 women with a maternal morbidity before, during or after birth; nine women were diagnosed with one morbidity including hypertensive disorders, haemorrhage, placenta praevia and gestational diabetes whereas five women were diagnosed with two or more morbidities. Thematic analysis was employed as the analytic strategy. Results Four superordinate themes were identified: powerlessness, morbidity management, morbidity treatment and socio-behavioural responses to morbidities. Women were accepting of the uncontrollable nature of the adverse outcome experienced. While being treated for trauma, women were satisfied to relinquish their autonomy to ensure the safety of themselves and their babies. However, these events were debilitating. Women’s inability to control their own bodies, as a result of the morbidity, contributed to high levels of frustration and anxiety. Morbidities impacted greatly on women’s quality of life and sometimes these effects persisted for a prolonged period after delivery. Women felt that they were provided very little information on the practicalities of living with their condition; many were uncertain how to manage their morbidities in the home setting. Conclusion Healthcare providers should ensure that women who experience a maternal morbidity are fully debriefed and have sufficient information on the morbidity including ongoing care and expectations prior to discharge.
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Affiliation(s)
- S Meaney
- National Perintal Epidemiology Centre, University College Cork, 5th floor, Cork University Maternity Hospital, Cork, Ireland.
| | - J E Lutomski
- National Perintal Epidemiology Centre, University College Cork, 5th floor, Cork University Maternity Hospital, Cork, Ireland.,Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - L O' Connor
- National Perintal Epidemiology Centre, University College Cork, 5th floor, Cork University Maternity Hospital, Cork, Ireland
| | - K O' Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - R A Greene
- National Perintal Epidemiology Centre, University College Cork, 5th floor, Cork University Maternity Hospital, Cork, Ireland
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O'Connor TG, Monk C, Burke AS. Maternal Affective Illness in the Perinatal Period and Child Development: Findings on Developmental Timing, Mechanisms, and Intervention. Curr Psychiatry Rep 2016; 18:24. [PMID: 26830882 DOI: 10.1007/s11920-016-0660-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Maternal mental illness is one of the most reliable risks for clinically significant child adjustment difficulties. The research literature in this area is very large and broad and dates back decades. In this review, we consider recent research findings on maternal mental illness and child development by focusing particularly on affective illness the perinatal period. We do this because maternal affective illness in the perinatal period is common; recent evidence suggests that pre- and postpartum maternal depression may have lasting effects on child behavioral and somatic health; research in the perinatal period raises acute and compelling questions about mechanisms of transmission and effect; and perinatal-focused interventions may offer distinct advantages for benefitting mother and child and gaining insights into developmental mechanisms. Throughout the review, we attend to the increasing integration of psychological and biological models and the trans-disciplinary approach now required for clinical investigation.
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Affiliation(s)
- Thomas G O'Connor
- Department of Psychiatry, Wynne Center for Family Research, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY, 14642, USA.
| | - Catherine Monk
- Department of Psychiatry, Columbia University Medical Center, 622 West 168th Street, Suite 1540, New York, NY, 10032, USA.
- Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th Street, Suite 1540, New York, NY, 10032, USA.
| | - Anne S Burke
- Department of Psychology, University of Rochester, Meliora Hall, Rochester, NY, 14642, USA.
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17
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Abstract
This study examines the direct and moderating effects of emotional intelligence on postpartum depression (PPD), while taking into account social support and stressful life events. Using a prospective cohort design, 165 women were surveyed in their third trimester and again at 9 weeks postpartum. Results support the direct effects of emotional intelligence (β = -.20, p = .01), social support (β = -.17, p = .04), and stressful life events (β = .17, p = .04) on PPD. Moderating effects are also supported with significant effects on PPD: stressful life events × emotional intelligence (β = -.17, p = .04) and stressful life events × social support (β = -.21, p = .01).
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18
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Closing the gap in maternal and child health: a qualitative study examining health needs of migrant mothers in Dandenong, Victoria, Australia. Matern Child Health J 2015; 18:1391-402. [PMID: 24158505 DOI: 10.1007/s10995-013-1378-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We conducted a qualitative study that explored the views and perceptions of migrant women in, Dandenong, Victoria, Australia about sociocultural barriers and health needs during pregnancy and in the postnatal period. The study was informed by the Social Identity Theory and the Acculturation Theory. It involved five focus group discussions with 35 migrant mothers from Afghanistan, Africa, China, Palestine, Lebanon, Syria, Iran and Jordan. Five themes emerged from the analysis: (1) the need for family support and complex social environments; (2) dealing with two cultural identities; (3) the health of mother and offspring; (4) access to the health system; and (5) life-skills for better health. Pregnancy and motherhood are challenges that are made more difficult by migration. The findings point towards the need for policies and interventions: (1) to reduce the negative impact of social isolation and lack of support during pregnancy and postnatally; (2) to support greater fathers' involvement in childcare; and (3) to reconcile different practices and expectations between traditional cultures and Australian norms. They also suggest a need to test culturally competent interventions that address health and lifestyle needs in migrant women and education programs for mothers that effectively address their concerns about maternal and child health.
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Ride J, Rowe H, Wynter K, Fisher J, Lorgelly P. Protocol for economic evaluation alongside a cluster-randomised controlled trial of a psychoeducational intervention for the primary prevention of postnatal mental health problems in first-time mothers. BMJ Open 2014; 4:e006226. [PMID: 25280810 PMCID: PMC4187457 DOI: 10.1136/bmjopen-2014-006226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Postnatal mental health problems, which are an international public health priority, are a suitable target for preventive approaches. The financial burden of these disorders is borne across sectors in society, including health, early childhood, education, justice and the workforce. This paper describes the planned economic evaluation of What Were We Thinking, a psychoeducational intervention for the prevention of postnatal mental health problems in first-time mothers. METHODS AND ANALYSIS The evaluation will be conducted alongside a cluster-randomised controlled trial of its clinical effectiveness. Cost-effectiveness and costs-utility analyses will be conducted, resulting in estimates of cost per percentage point reduction in combined 30-day prevalence of depression, anxiety and adjustment disorders and cost per quality-adjusted life year gained. Uncertainty surrounding these estimates will be addressed using non-parametric bootstrapping and represented using cost-effectiveness acceptability curves. Additional cost analyses relevant for implementation will also be conducted. Modelling will be employed to estimate longer term cost-effectiveness if the intervention is found to be clinically effective during the period of the trial. ETHICS AND DISSEMINATION Approval to conduct the study was granted by the Southern Health (now Monash Health) Human Research Ethics Committee (24 April 2013; 11388B). The study was registered with the Monash University Human Research Ethics Committee (30 April 2013; CF12/1022-2012000474). The Education and Policy Research Committee, Victorian Government Department of Education and Early Childhood Development approved the study (22 March 2012; 2012_001472). Use of the EuroQol was registered with the EuroQol Group; 16 August 2012. TRIAL REGISTRATION NUMBER The trial was registered with the Australian New Zealand Clinical Trials Registry on 7 May 2012 (registration number ACTRN12613000506796).
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Affiliation(s)
- Jemimah Ride
- Centre for Health Economics, Monash University, Clayton, Victoria, Australia
| | - Heather Rowe
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Wynter
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paula Lorgelly
- Centre for Health Economics, Monash University, Clayton, Victoria, Australia
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20
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Cultural background and socioeconomic influence of immigrant and refugee women coping with postpartum depression. J Immigr Minor Health 2014; 15:300-14. [PMID: 22711219 DOI: 10.1007/s10903-012-9663-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Postpartum depression is a serious condition that can have long lasting traumatic effects on women and their families. Until recently postpartum depression research has focused more on the population as a whole rather than refugee and immigrant women. Informed by Kleinman's explanatory model and the postcolonial feminist perspective, 30 immigrant and refugee women were interviewed to find out what factors influenced them in seeking postpartum care and what strategies would be helpful in prevention and treatment of postpartum depression. We found that the immigrant and refugee women in our sample: (a) were influenced by both cultural background and socioeconomic factors in seeking support and treatment; (b) were influenced by cultural differences and social stigma when making decisions about health care practices; and (c) employed numerous coping strategies to deal with postpartum depression. Recommendations are provided for more culturally appropriate and equitable mental health care services for immigrant and refugee women living in Canada.
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Miller BJ, Murray L, Beckmann MM, Kent T, Macfarlane B. Dietary supplements for preventing postnatal depression. Cochrane Database Syst Rev 2013:CD009104. [PMID: 24158923 PMCID: PMC10166593 DOI: 10.1002/14651858.cd009104.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Postnatal depression is a medical condition that affects many women and the development of their infants. There is a lack of evidence for treatment and prevention strategies that are safe for mothers and infants. Certain dietary deficiencies in a pregnant or postnatal woman's diet may cause postnatal depression. By correcting these deficiencies postnatal depression could be prevented in some women. Specific examples of dietary supplements aimed at preventing postnatal depression include: omega-3 fatty acids, iron, folate, s-adenosyl-L-methionine, cobalamin, pyridoxine, riboflavin, vitamin D and calcium. OBJECTIVES To assess the benefits of dietary supplements for preventing postnatal depression either in the antenatal period, postnatal period, or both. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2013). SELECTION CRITERIA Randomised controlled trials, involving women who were pregnant or who had given birth in the previous six weeks, who were not depressed or taking antidepressants at the commencement of the trials. The trials could use as intervention any dietary supplementation alone or in combination with another treatment compared with any other preventive treatment, or placebo, or standard clinical care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and assessed the risk of bias for the two included studies. Two review authors extracted data and the data were checked for accuracy. MAIN RESULTS We included two randomised controlled trials.One trial compared oral 100 microgram (µg) selenium yeast tablets with placebo, taken from the first trimester until birth. The trial randomised 179 women but outcome data were only provided for 85 women. Eighty-three women were randomised to each arm of the trial. Sixty-one women completed the selenium arm, 44 of whom completed an Edinburgh Postnatal Depression Scale (EPDS). In the placebo arm, 64 women completed the trial, 41 of whom completed an EPDS. This included study (n = 85) found selenium had an effect on EPDS scores but did not reach statistical significance (P = 0.07). There was a mean difference (MD) of -1.90 (95% confidence interval (CI) -3.92 to 0.12) of the self-reported EPDS completed by participants within eight weeks of delivery. There was a high risk of attrition bias due to a large proportion of women withdrawing from the study or not completing an EPDS. This included study did not report on any of the secondary outcomes of this review.The other trial compared docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA) with placebo. The trial randomised 126 women at risk of postpartum depression to three arms: 42 were allocated to EPA, 42 to DHA, and 42 to placebo. Three women in the EPA arm, four in the DHA arm, and one woman in the placebo arm were lost to follow-up. Women who were found to have major depressive disorder, bipolar disorder, current substance abuse or dependence, suicidal ideation or schizophrenia at recruitment were excluded from the study. The women who discontinued the intervention (five in the EPA arm, four in the DHA arm and seven in the placebo arm) were included in the intention-to-treat analysis, while those who were lost to follow-up were not. Women received supplements or placebo from recruitment at a gestational age of 12 to 20 weeks until their final review visit six to eight weeks postpartum. The primary outcome measure was the Beck Depression Inventory (BDI) score at the fifth visit (six to eight weeks postpartum). No benefit was found for EPA-rich fish oil (MD 0.70, 95% CI -1.78 to 3.18) or DHA-rich fish oil supplementation (MD 0.90, 95% CI -1.33 to 3.13) in preventing postpartum depression. No difference was found in the effect on postnatal depression comparing EPA with DHA (MD -0.20, 95% CI -2.61 to 2.21). No benefit or significant effect was found in terms of the secondary outcomes of the presence of major depressive disorder at six to eight weeks postpartum, the number of women who commenced antidepressants, maternal estimated blood loss at delivery or admission of neonates to the neonatal intensive care unit. AUTHORS' CONCLUSIONS There is insufficient evidence to conclude that selenium, DHA or EPA prevent postnatal depression. There is currently no evidence to recommend any other dietary supplement for prevention of postnatal depression.
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Affiliation(s)
- Brendan J Miller
- Department of Obstetrics and Gynaecology, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia, 5042
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22
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Jones BA, Griffiths KM, Christensen H, Ellwood D, Bennett K, Bennett A. Online cognitive behaviour training for the prevention of postnatal depression in at-risk mothers: a randomised controlled trial protocol. BMC Psychiatry 2013; 13:265. [PMID: 24131528 PMCID: PMC3853016 DOI: 10.1186/1471-244x-13-265] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 09/30/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Postnatal depression (PND) is the most common disorder of the puerperium with serious consequences for both mother and child if left untreated. While there are effective treatments, there are many barriers for new mothers needing to access them. Prevention strategies may offer a more acceptable means of addressing the problem. Internet interventions can help overcome some barriers to reducing the impact of PND. However, to date there are no published studies that investigate the efficacy of internet interventions for the prevention of PND. METHODS/DESIGN The proposed study is a two-arm double blind randomised controlled trial. 175 participants will be recruited in the immediate postnatal period at an Australian community hospital. Women who meet inclusion criteria (internet access, email address, telephone number, over 18, live birth, fluent English) will complete the Edinburgh Postnatal Depression Scale (EPDS). Those with a score above 9 will undertake the Structured Clinical Interview for DSM Disorders (SCID). Those with a clinical diagnosis of depression, or a lifetime diagnosis of bipolar disorder or psychosis on the SCID will be excluded. Following completion of the baseline battery women will be randomised using a computer-generated algorithm to either the intervention or control condition. The intervention will consist of 5 modules of automated, interactive cognitive behaviour training (CB training), completed weekly with email reminders. The control will replicate the level of contact participants experience with the intervention, but the content will be of a general health nature. Participants will complete questionnaires immediately post-intervention (6 weeks) and 3-, 6- and 12 months follow-up. There will also be a second SCID delivered via telephone at 6 months. We hypothesise that relative to the control group, the intervention group will show a greater reduction in postnatal distress on the EPDS (primary outcome measure). We also hypothesise that the intervention group will demonstrate lower levels of anxiety and stress and higher levels of parenting confidence than the control group following intervention and/or follow-up. DISCUSSION The proposed study addresses a number of limitations of earlier trials. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registers, ACTRN12609001032246.
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Affiliation(s)
- Bethany A Jones
- Centre for Mental Health Research, The Australian National University, Building 63 Eggleston Road, Acton ACT 0200, Australia.
| | - Kathleen M Griffiths
- Centre for Mental Health Research, The Australian National University, Building 63 Eggleston Road, Acton ACT 0200, Australia
| | - Helen Christensen
- The Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, NSW 2031, Australia
| | - David Ellwood
- School of Medicine, Gold Coast campus, Griffith University, QLD 4222, Australia
| | - Kylie Bennett
- Centre for Mental Health Research, The Australian National University, Building 63 Eggleston Road, Acton ACT 0200, Australia
| | - Anthony Bennett
- Centre for Mental Health Research, The Australian National University, Building 63 Eggleston Road, Acton ACT 0200, Australia
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Clarke K, King M, Prost A. Psychosocial interventions for perinatal common mental disorders delivered by providers who are not mental health specialists in low- and middle-income countries: a systematic review and meta-analysis. PLoS Med 2013; 10:e1001541. [PMID: 24204215 PMCID: PMC3812075 DOI: 10.1371/journal.pmed.1001541] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 09/11/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Perinatal common mental disorders (PCMDs) are a major cause of disability among women. Psychosocial interventions are one approach to reduce the burden of PCMDs. Working with care providers who are not mental health specialists, in the community or in antenatal health care facilities, can expand access to these interventions in low-resource settings. We assessed effects of such interventions compared to usual perinatal care, as well as effects of interventions based on intervention type, delivery method, and timing. METHODS AND FINDINGS We conducted a systematic review, meta-analysis, and meta-regression. We searched databases including Embase and the Global Health Library (up to 7 July 2013) for randomized and non-randomized trials of psychosocial interventions delivered by non-specialist mental health care providers in community settings and antenatal health care facilities in low- and middle-income countries. We pooled outcomes from ten trials for 18,738 participants. Interventions led to an overall reduction in PCMDs compared to usual care when using continuous data for PCMD symptomatology (effect size [ES] -0.34; 95% CI -0.53, -0.16) but not binary categorizations for presence or absence of PCMDs (OR 0.62, 95% CI 0.35, 1.080 [corrected]. We found a significantly larger ES for psychological interventions (three studies; ES -0.46; 95% CI -0.58, -0.33) than for health promotion interventions (seven studies; ES -0.15; 95% CI -0.27, -0.02). Both individual (five studies; ES -0.18; 95% CI -0.34, -0.01) and group (three studies; ES -0.48; 95% CI -0.85, -0.11) interventions were effective compared to usual care, though delivery method was not associated with ES (meta-regression β coefficient -0.11; 95% CI -0.36, 0.14). Combined group and individual interventions (based on two studies) had no benefit compared to usual care, nor did interventions restricted to pregnancy (three studies). Intervention timing was not associated with ES (β 0.16; 95% CI -0.16, 0.49). The small number of trials and heterogeneity of interventions limit our findings. CONCLUSIONS Psychosocial interventions delivered by non-specialists are beneficial for PCMDs, especially psychological interventions. Research is needed on interventions in low-income countries, treatment versus preventive approaches, and cost-effectiveness. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Kelly Clarke
- UCL Institute for Global Health, University College London, London, United Kingdom
- * E-mail:
| | - Michael King
- Mental Health Sciences Unit, University College London, London, United Kingdom
| | - Audrey Prost
- UCL Institute for Global Health, University College London, London, United Kingdom
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Glavin K, Leahy-Warren P. Postnatal depression is a public health nursing issue: perspectives from norway and ireland. Nurs Res Pract 2013; 2013:813409. [PMID: 24089636 PMCID: PMC3780656 DOI: 10.1155/2013/813409] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 07/16/2013] [Accepted: 08/01/2013] [Indexed: 11/17/2022] Open
Abstract
The framework provided by the Millennium Development Goals includes maternal health as an area of priority. Postnatal depression (PND) is a serious public health issue because it occurs at a crucial time in a mothers' life, can persist for long periods, and can have adverse effects on partners and the emotional, behavioural, and cognitive development of infants and children. Internationally, public health nurses (PHNs) are key professionals in the delivery of health care to mothers in the postpartum period, and international research collaborations are encouraged. Two researchers from the European Academy of Nursing Science (EANS) identified a need to collaborate and strengthen research capacity and discussion on postnatal depression, a public health nursing issue in both countries. Within the context of public health and public health nursing in Ireland and Norway, the aim of this paper is to present a discussion on the concept of PND, prevalence, and outcomes; screening issues for PHNs; and the research evidence of the benefits of social support in facilitating recovery for new mothers.
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Affiliation(s)
- Kari Glavin
- Department of Nursing, Diakonova University College, Fredensborgveien 24 Q, 0177 Oslo, Norway
| | - Patricia Leahy-Warren
- School of Nursing & Midwifery, Brookfield Health Sciences Complex, University College Cork, Ireland
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Mortazavi F, Chaman R, Mousavi SA, Khosravi A, Ajami ME. Maternal psychological state during the transition to motherhood: a longitudinal study. Asia Pac Psychiatry 2013; 5:E49-57. [PMID: 23857812 DOI: 10.1111/appy.12075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 02/26/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the psychological state of women and its associated factors in the third trimester of pregnancy and at 8 weeks postpartum and to explore the changes in psychological state between these two time points. METHODS This survey study was carried out on 358 pregnant women visiting urban health centers in Shahroud, northeast Iran, in 2011. The women were followed at 8 weeks postpartum. In the third trimester of pregnancy, the participants completed the 28-item General Health Questionnaire (GHQ-28) and two other questionnaires on sociodemographic characteristics and frequent psychosocial stressors. They also completed the GHQ-28 and an obstetric information form at 8 weeks postpartum. The cutoff score for GHQ-28 in Iran has been calculated as 24, which denotes probable psychological health problems. RESULTS The mean total GHQ score decreased from 23.7 in the third trimester of pregnancy to 18.8 postpartum (P < 0.001). The proportion of women with a GHQ-28 score of 24 or higher in the third trimester of pregnancy and postpartum were 42% and 26%, respectively. Multiparity, caring for other family members, financial problems, and anxiety about personal and fetal health were the predictors of psychological health problems in the third trimester of pregnancy. The two predictors for postpartum psychological health problems were psychological health problems in the third trimester of pregnancy and the method of infant feeding at 8 weeks postpartum. DISCUSSION The prevalence of psychological symptoms was high among women in the third trimester of pregnancy. Psychological state of women improved after childbirth.
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Affiliation(s)
- Forough Mortazavi
- Student Research Committee, Shahroud University of Medical Sciences, Shahroud, Iran
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Elder W, Glickman-Simon R. Acupuncture and Migraine Prophylaxis, Probiotics and C. Difficile-Associated Diarrhea, Preventive Group Counseling and Postpartum Depression, Black Cohosh and Menopausal Symptoms, Deep Needling Electroacupuncture and Trigeminal Neuralgia. Explore (NY) 2013; 9:188-91. [DOI: 10.1016/j.explore.2013.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
OBJECTIVE To be used in conjunction with 'Pharmacological management of unipolar depression' [Malhi et al. Acta Psychiatr Scand 2013;127(Suppl. 443):6-23] and 'Lifestyle management of unipolar depression' [Berk et al. Acta Psychiatr Scand 2013;127(Suppl. 443):38-54]. To provide clinically relevant recommendations for the use of psychological treatments in depression derived from a literature review. METHOD Medical databases including MEDLINE and PubMed were searched for pertinent literature, with an emphasis on recent publications. RESULTS Structured psychological treatments such as cognitive behaviour therapy and interpersonal therapy (IPT) have a robust evidence base for efficacy in treating depression, even in severe cases of depression. However, they may not offer benefit as quickly as antidepressants, and maximal efficacy requires well-trained and experienced therapists. These therapies are effective across the lifespan and may be preferred where it is desired to avoid pharmacotherapy. In some instances, combination with pharmacotherapy may enhance outcome. Psychological therapy may have more enduring protective effects than medication and be effective in relapse prevention. Newer structured psychological therapies such as mindfulness-based cognitive therapy and acceptance and commitment therapy lack an extensive outcome literature, but the few published studies yielding positive outcomes suggest they should be considered options for treatment. CONCLUSION Cognitive behaviour therapy and IPT can be effective in alleviating acute depression for all levels of severity and in maintaining improvement. Psychological treatments for depression have demonstrated efficacy across the lifespan and may present a preferred treatment option in some groups, for example, children and adolescents and women who are pregnant or postnatal.
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Affiliation(s)
- L Lampe
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia.
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Abstract
BACKGROUND Epidemiological studies and meta-analyses of predictive studies have consistently demonstrated the importance of psychosocial and psychological variables as postpartum depression risk factors. While interventions based on these variables may be effective treatment strategies, theoretically they may also be used in pregnancy and the early postpartum period to prevent postpartum depression. OBJECTIVES Primary: to assess the effect of diverse psychosocial and psychological interventions compared with usual antepartum, intrapartum, or postpartum care to reduce the risk of developing postpartum depression. Secondary: to examine (1) the effectiveness of specific types of psychosocial and psychological interventions, (2) the effectiveness of professionally-based versus lay-based interventions, (3) the effectiveness of individually-based versus group-based interventions, (4) the effects of intervention onset and duration, and (5) whether interventions are more effective in women selected with specific risk factors. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2011), scanned secondary references and contacted experts in the field. We updated the search on 31 December 2012 and added the results to the awaiting classification section of the review for assessment at the next update. SELECTION CRITERIA All published and unpublished randomised controlled trials of acceptable quality comparing a psychosocial or psychological intervention with usual antenatal, intrapartum, or postpartum care. DATA COLLECTION AND ANALYSIS Review authors and a research co-ordinator with Cochrane review experience participated in the evaluation of methodological quality and data extraction. Additional information was sought from several trial researchers. Results are presented using risk ratio (RR) for categorical data and mean difference (MD) for continuous data. MAIN RESULTS Twenty-eight trials, involving almost 17,000 women, contributed data to the review. Overall, women who received a psychosocial or psychological intervention were significantly less likely to develop postpartum depression compared with those receiving standard care (average RR 0.78, 95% confidence interval (CI) 0.66 to 0.93; 20 trials, 14,727 women). Several promising interventions include: (1) the provision of intensive, individualised postpartum home visits provided by public health nurses or midwives (RR 0.56, 95% CI 0.43 to 0.73; two trials, 1262 women); (2) lay (peer)-based telephone support (RR 0.54, 95% CI 0.38 to 0.77; one trial, 612 women); and (3) interpersonal psychotherapy (standardised mean difference -0.27, 95% CI -0.52 to -0.01; five trials, 366 women). Professional- and lay-based interventions were both effective in reducing the risk to develop depressive symptomatology. Individually-based interventions reduced depressive symptomatology at final assessment (RR 0.75, 95% CI 0.61 to 0.92; 14 trials, 12,914 women) as did multiple-contact interventions (RR 0.78, 95% CI 0.66 to 0.93; 16 trials, 11,850 women). Interventions that were initiated in the postpartum period also significantly reduced the risk to develop depressive symptomatology (RR 0.73, 95% CI 0.59 to 0.90; 12 trials, 12,786 women). Identifying mothers 'at-risk' assisted the prevention of postpartum depression (RR 0.66, 95% CI 0.50 to 0.88; eight trials, 1853 women). AUTHORS' CONCLUSIONS Overall, psychosocial and psychological interventions significantly reduce the number of women who develop postpartum depression. Promising interventions include the provision of intensive, professionally-based postpartum home visits, telephone-based peer support, and interpersonal psychotherapy.
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Affiliation(s)
- Cindy-Lee Dennis
- University of Toronto and Women’s College Research Institute, Toronto, Canada.
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Leung SSK, Lee AM, Chiang VCL, Lam SK, Kuen YW, Wong DFK. Culturally sensitive, preventive antenatal group cognitive-behavioural therapy for Chinese women with depression. Int J Nurs Pract 2013; 19 Suppl 1:28-37. [DOI: 10.1111/ijn.12021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Antoinette M Lee
- Department of Psychiatry; The University of Hong Kong; Hong Kong
| | - Vico CL Chiang
- School of Nursing; Hong Kong Polytechnic University; Hong Kong
| | - SK Lam
- Department of Obstetrics and Gynaecology; The University of Hong Kong; Hong Kong
| | - Yung Wai Kuen
- Department of Obstetrics and Gynaecology; Kwong Wah Hospital; Hong Kong
| | - Daniel FK Wong
- Department of Applied Social Studies; City University of Hong Kong; Hong Kong
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McNeill J, Lynn F, Alderdice F. Public health interventions in midwifery: a systematic review of systematic reviews. BMC Public Health 2012; 12:955. [PMID: 23134701 PMCID: PMC3544621 DOI: 10.1186/1471-2458-12-955] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 10/29/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Maternity care providers, particularly midwives, have a window of opportunity to influence pregnant women about positive health choices. This aim of this paper is to identify evidence of effective public health interventions from good quality systematic reviews that could be conducted by midwives. METHODS Relevant databases including MEDLINE, Pubmed, EBSCO, CRD, MIDIRS, Web of Science, The Cochrane Library and Econlit were searched to identify systematic reviews in October 2010. Quality assessment of all reviews was conducted. RESULTS Thirty-six good quality systematic reviews were identified which reported on effective interventions. The reviews were conducted on a diverse range of interventions across the reproductive continuum and were categorised under: screening; supplementation; support; education; mental health; birthing environment; clinical care in labour and breast feeding. The scope and strength of the review findings are discussed in relation to current practice. A logic model was developed to provide an overarching framework of midwifery public health roles to inform research policy and practice. CONCLUSIONS This review provides a broad scope of high quality systematic review evidence and definitively highlights the challenge of knowledge transfer from research into practice. The review also identified gaps in knowledge around the impact of core midwifery practice on public health outcomes and the value of this contribution. This review provides evidence for researchers and funders as to the gaps in current knowledge and should be used to inform the strategic direction of the role of midwifery in public health in policy and practice.
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Affiliation(s)
- Jenny McNeill
- School of Nursing & Midwifery, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland
| | - Fiona Lynn
- School of Nursing & Midwifery, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland
| | - Fiona Alderdice
- School of Nursing & Midwifery, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland
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Lewis BA, Gjerdingen DK, Avery MD, Guo H, Sirard JR, Bonikowske AR, Marcus BH. Examination of a telephone-based exercise intervention for the prevention of postpartum depression: design, methodology, and baseline data from The Healthy Mom study. Contemp Clin Trials 2012; 33:1150-8. [PMID: 22890220 DOI: 10.1016/j.cct.2012.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 07/17/2012] [Accepted: 07/23/2012] [Indexed: 11/19/2022]
Abstract
Research indicates that exercise is an efficacious intervention for depression among adults; however, little is known regarding its efficacy for preventing postpartum depression. The Healthy Mom study was a randomized controlled trial examining the efficacy of an exercise intervention for the prevention of postpartum depression. Specifically, postpartum women with a history of depression or a maternal family history of depression (n=130) were randomly assigned to a telephone-based exercise intervention or a wellness/support contact control condition each lasting six months. The exercise intervention was designed to motivate postpartum women to exercise based on Social Cognitive Theory and the Transtheoretical Model. The primary dependent variable was depression based on the Structured Clinical Diagnostic Interview (SCID). Secondary dependent variables included scores on the Edinburgh Postnatal Depression Scale, the PHQ-9, and the Perceived Stress Scale. The purpose of this paper is to describe the study design, methodology, and baseline data for this trial. Upon completion of the trial, the results will yield important information about the efficacy of exercise in preventing postpartum depression.
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Affiliation(s)
- Beth A Lewis
- School of Kinesiology, University of Minnesota, Minneapolis, MN 55455, USA.
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Gjerdingen DK, McGovern P, Pratt R, Johnson L, Crow S. Postpartum Doula and Peer Telephone Support for Postpartum Depression. J Prim Care Community Health 2012; 4:36-43. [DOI: 10.1177/2150131912451598] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: This research provides the first test of feasibility of recruiting postpartum doulas and depressed mothers for a peer support intervention study and begins to evaluate the benefit of postpartum doula support and peer telephone support for at-risk mothers. Methods: The authors recruited postpartum doulas from national doula organizations, peer telephone supporters from nursing referrals, and mothers with depressive symptoms from 3 local hospitals, local medical practices, Web sites, and community organizations. Participating mothers were randomized to 3 groups—postpartum doula, peer telephone support, and control group. Surveys were completed at 0, 3, and 6 months postenrollment. Results: Thirty-nine mothers with depressive symptoms, 6 postpartum doulas, and 6 peer telephone supporters participated. The postpartum doula group, compared with the other 2 groups, had a higher proportion of women with a previous history of depression, and similarly, a higher proportion of women who were depressed and receiving depression treatment at the 6-month follow-up. Satisfaction with study-sponsored support was greater in the postpartum doula group than in the telephone support group. Conclusions: It is feasible to recruit postpartum doulas, peer telephone supporters, and mothers with depressive symptoms for a peer support intervention trial. Mothers were more satisfied with postpartum doulas than peer telephone support. The authors recommend further research to assess the benefit of postpartum doula support for postpartum depression as adjunctive or alternative therapy.
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Affiliation(s)
| | | | | | | | - Scott Crow
- University of Minnesota, Minneapolis, MN, USA
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Hübner-Liebermann B, Hausner H, Wittmann M. Recognizing and treating peripartum depression. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:419-24. [PMID: 22787503 DOI: 10.3238/arztebl.2012.0419] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 03/19/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND In this article, we review current data on the prevalence of, risk factors for, and treatment of peripartum depression. METHOD Pertinent publications were retrieved by searches in Medline and the Cochrane Library using the key words "peri/pre/post", "partum/partal/natal", "maternal/motherhood/pregnancy", and "depression/affective disorder". RESULTS Depression is the most common peripartal disease: The prevalence of depressive disorders is 18.4% during pregnancy and 19.2% in the puerperium. Prepartum depression is associated with preterm birth, low birth weight, and an abnormal fetal heart rate. In the long run, children of depressed mothers have been found to have impaired cognitive and emotional abilities. Risk factors for peripartal depression include prior depression, poor social support, poor quality of intimate relationship, and negative live events. Peripartum depression can be treated effectively with psychotherapy or drug therapy. Current data support the use of antidepressants during pregnancy and breastfeeding. In many places, pregnancy counseling centers offer low-threshold psychosocial assistance. Nonetheless, no more than 20% of the affected women are identified, even though rapid screening would be possible with instruments such as the Edinburgh Postnatal Depression Scale (EPDS) and the two Whooley questions. CONCLUSION Peripartum depression is both common and treatable. Screening for depression should become a routine part of both prepartum care by gynecologists and postpartum care by midwives. This will only be possible, however, with expanded availability of ambulatory and inpatient psychotherapy and psychiatric care for the affected women and their children.
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Howell EA, Balbierz A, Wang J, Parides M, Zlotnick C, Leventhal H. Reducing postpartum depressive symptoms among black and Latina mothers: a randomized controlled trial. Obstet Gynecol 2012; 119:942-9. [PMID: 22488220 PMCID: PMC3336015 DOI: 10.1097/aog.0b013e318250ba48] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate the effectiveness of a behavioral educational intervention to reduce postpartum depressive symptoms among minority mothers. METHODS We recruited 540 self-identified black and Latina mothers during their postpartum hospital stay and randomized them to receive a behavioral educational intervention or enhanced usual care. Those in the intervention arm received a two-step behavioral educational intervention that prepares and educates mothers about modifiable factors associated with symptoms of postpartum depression (physical symptoms, low social support, low self-efficacy, and infant factors), bolsters social support, enhances management skills, and increases participants' access to resources. Enhanced usual care participants received a list of community resources and received a 2-week control call. Participants were surveyed before randomization and, 3 weeks, 3 months, and 6 months later to assess depressive symptoms. The primary outcome, depression, was assessed using the Edinburgh Postnatal Depression Scale (score of 10 or greater). RESULTS Positive depression screens were less common among intervention compared with enhanced usual care posthospitalization: 3 weeks (8.8% compared with 15.3%, P=.03), 3 months (8.4% compared with 13.24%, P=.09), and 6 months (8.9% compared with 13.7%, P=.11). An intention-to-treat repeated-measures analysis for up to 6 months of follow-up demonstrated that mothers in the intervention group were less likely to screen positive for depression compared with enhanced usual care (odds ratio 0.67, 95% confidence interval [CI] 0.47-0.97; number needed to treat 16, 95% CI 9-112). CONCLUSION An action-oriented behavioral educational intervention reduced positive depression screens among black and Latina postpartum mothers. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, www.clinicaltrials.gov, NCT01312883. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Elizabeth A Howell
- Department of Health Evidence & Policy, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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Dennis CL, Ravitz P, Grigoriadis S, Jovellanos M, Hodnett E, Ross L, Zupancic J. The effect of telephone-based interpersonal psychotherapy for the treatment of postpartum depression: study protocol for a randomized controlled trial. Trials 2012; 13:38. [PMID: 22515528 PMCID: PMC3404910 DOI: 10.1186/1745-6215-13-38] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 04/19/2012] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Substantial data indicate potential health consequences of untreated postpartum depression (PPD) on the mother, infant, and family. Studies have evaluated interpersonal psychotherapy (IPT) as treatment for PPD; however, the results are questionable due to methodological limitations. A comprehensive review of maternal treatment preferences suggests that mothers favor 'talking therapy' as a form of PPD treatment. Unfortunately, IPT is not widely available, especially in rural and remote areas. To improve access to care, telepsychiatry has been introduced, including the provision of therapy via the telephone. METHODS/DESIGN The purpose of this randomized controlled trial is to evaluate the effect of telephone-based IPT on the treatment of PPD. Stratification is based on self-reported history of depression and province. The target sample is 240 women. Currently, women from across Canada between 2 and 24 weeks postpartum are able to either self-identify as depressed and refer themselves to the trial or they may be referred by a health professional based on a score >12 on the Edinburgh Postnatal Depression Scale (EPDS). Following contact by the trial coordinator, a detailed study explanation is provided. Women who fulfill the eligibility criteria (including a positive diagnostic assessment for major depression) and consent to participate are randomized to either the control group (standard postpartum care) or intervention group (standard postpartum care plus 12 telephone-based IPT sessions within 12 to 16 weeks, provided by trained nurses). Blinded research nurses telephone participants at 12, 24, and 36 weeks post-randomization to assess for PPD and other outcomes including depressive symptomatology, anxiety, couple adjustment, attachment, and health service utilization. Results from this ongoing trial will: (1) develop the body of knowledge concerning the effect of telephone-based IPT as a treatment option for PPD; (2) advance our understanding of training nurses to deliver IPT; (3) provide an economic evaluation of an IPT intervention; (4) investigate the utility of the EPDS in general clinical practice to identify depressed mothers; and (5) present valuable information regarding PPD, along with associated couple adjustment, co-morbid anxiety and self-reported attachment among a mixed rural and urban Canadian population. TRIAL REGISTRATION Current Controlled Trials Ltd. ISRCTN88987377.
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Affiliation(s)
- Cindy-Lee Dennis
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada
- Women’s College Hospital, Women’s College Research Institute, 790 Bay Street, Toronto, ON, Canada
| | - Paula Ravitz
- Department of Psychiatry, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Sophie Grigoriadis
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Melissa Jovellanos
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada
| | - Ellen Hodnett
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada
| | - Lori Ross
- Centre for Addiction and Mental Health, 455 Spadina Avenue, Suite 302, Toronto, ON, M5S 2G8, Canada
| | - John Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Rose 318, 330 Brookline Avenue, Boston, MA, 02115, USA
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Kenyon S, Jolly K, Hemming K, Ingram L, Gale N, Dann SA, Chambers J, MacArthur C. Evaluation of Lay Support in Pregnant women with Social risk (ELSIPS): a randomised controlled trial. BMC Pregnancy Childbirth 2012; 12:11. [PMID: 22375895 PMCID: PMC3349581 DOI: 10.1186/1471-2393-12-11] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 02/29/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal, neonatal and child health outcomes are worse in families from black and ethnic minority groups and disadvantaged backgrounds. There is little evidence on whether lay support improves maternal and infant outcomes among women with complex social needs within a disadvantaged multi-ethnic population in the United Kingdom (UK). METHOD/DESIGN The aim of this study is to evaluate a lay Pregnancy Outreach Worker (POW) service for nulliparous women identified as having social risk within a maternity service that is systematically assessing social risks alongside the usual obstetric and medical risks. The study design is a randomised controlled trial (RCT) in nulliparous women assessed as having social risk comparing standard maternity care with the addition of referral to the POW support service. The POWs work alongside community midwifery teams and offer individualised support to women to encourage engagement with services (health and social care) from randomisation (before 28 weeks gestation) until 6 weeks after birth. The primary outcomes have been chosen on the basis that they are linked to maternal and infant health. The two primary outcomes are engagement with antenatal care, assessed by the number of antenatal visits; and maternal depression, assessed using the Edinburgh Postnatal Depression Scale at 8-12 weeks after birth. Secondary outcomes include maternal and neonatal morbidity and mortality, routine child health assessments, including immunisation uptake and breastfeeding at 6 weeks. Other psychological outcomes (self efficacy) and mother-to-infant bonding will also be collected using validated tools.A sample size of 1316 will provide 90% power (at the 5% significance level) to detect increased engagement with antenatal services of 1.5 visits and a reduction of 1.5 in the average EPDS score for women with two or more social risk factors, with power in excess of this for women with any social risk factor. Analysis will be by intention to treat. Qualitative research will explore the POWs' daily work in context. This will complement the findings of the RCT through a triangulation of quantitative and qualitative data on the process of the intervention, and identify other contextual factors that affect the implementation of the intervention. DISCUSSION The trial will provide high quality evidence as to whether or not lay support (POW) offered to women identified with social risk factors improves engagement with maternity services and reduces numbers of women with depression. MREC NUMBER: 10/H1207/23 TRIAL REGISTRATION NUMBER ISRCTN: ISRCTN35027323.
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Affiliation(s)
- Sara Kenyon
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Kate Jolly
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Karla Hemming
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Lucy Ingram
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Nicola Gale
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Sophie-Anna Dann
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Jacky Chambers
- Heart of Birmingham Teaching PCT, Bartholomew House, 142 Hagley Road, Edgbaston, Birmingham B16 9PA, UK
| | - Christine MacArthur
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Mundell JP, Visser MJ, Makin JD, Kershaw TS, Forsyth BWC, Jeffery B, Sikkema KJ. The impact of structured support groups for pregnant South African women recently diagnosed HIV positive. Women Health 2012; 51:546-65. [PMID: 21973110 DOI: 10.1080/03630242.2011.606356] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The authors of this study evaluated a structured 10-session psychosocial support group intervention for newly HIV-diagnosed pregnant South African women. Participants were expected to display increases in HIV disclosure, self-esteem, active coping and positive social support, and decreases in depression, avoidant coping, and negative social support. Three hundred sixty-one pregnant HIV-infected women were recruited from four antenatal clinics in Tshwane townships from April 2005 to September 2006. Using a quasi-experimental design, assessments were conducted at baseline and two and eight months post-intervention. A series of random effects regression analyses were conducted, with the three assessment points treated as a random effect of time. At both follow-ups, the rate of disclosure in the intervention group was significantly higher than that of the comparison group (p<0.001). Compared to the comparison group at the first follow-up, the intervention group displayed higher levels of active coping (t=2.68, p<0.05) and lower levels of avoidant coping (t=-2.02, p<0.05), and those who attended at least half of the intervention sessions exhibited improved self-esteem (t=2.11, p<0.05). Group interventions tailored for newly HIV positive pregnant women, implemented in resource-limited settings, may accelerate the process of adjusting to one's HIV status, but may not have sustainable benefits over time.
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Affiliation(s)
- Jonathan P Mundell
- MRC Unit for Maternal and Infant Health Care Strategies, Department of Psychology, University of Pretoria, Pretoria, South Africa.
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Miller BJ, Murray L, Beckmann MM, Kent T, Macfarlane B. Dietary supplements for preventing postnatal depression. Cochrane Database Syst Rev 2011. [DOI: 10.1002/14651858.cd009104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Milgrom J, Schembri C, Ericksen J, Ross J, Gemmill AW. Towards parenthood: an antenatal intervention to reduce depression, anxiety and parenting difficulties. J Affect Disord 2011; 130:385-94. [PMID: 21112641 DOI: 10.1016/j.jad.2010.10.045] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 10/25/2010] [Accepted: 10/25/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND There have been few antenatal interventions aimed at preparing women for the transition to parenthood and previous attempts to intervene antenatally to prevent postnatal depression and anxiety have had limited impact. METHODS We evaluated the effectiveness of an antenatal intervention which targeted risk factors for poor postnatal adjustment, with the dual aim of reducing both postnatal symptoms of depression/anxiety and parenting difficulties (a nine-unit self-guided workbook with weekly telephone support). Based on an initial feasibility study (n=200) which confirmed a low level of help-seeking among distressed women during pregnancy, an additional community networking component was developed aimed at increasing social support and access to health professionals to facilitate treatment of current antenatal depression/anxiety, if present. In the evaluation of a second version of the intervention, pregnant women (n=143) were randomly allocated to receive either the intervention or routine care. RESULTS Following the antenatal intervention there were significantly fewer cases scoring above threshold for mild-to-severe depression/anxiety symptoms postnatally compared to routine care, along with a trend towards reduced parenting stress. The community networking component appeared helpful and women with higher baseline depression scores showed higher levels of help-seeking in both intervention and routine care groups. LIMITATIONS It was not possible to evaluate the efficacy of individual program components separately. CONCLUSIONS The findings provide support for the effectiveness of the Towards Parenthood intervention both as a preparation for parenthood program and in reducing symptoms of postnatal depression/anxiety.
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Abstract
Major depression is a frequent complication of the postpartum period. Untreated postpartum depression increases the risk of maternal suicide and can impair parenting capability with resultant adverse effects on offspring development. A number of factors influence a woman's vulnerability to postpartum depressive episodes. This article summarizes processes for assessing these risk factors and implementing primary preventive interventions, and summarizes methods of early detection to promote secondary and tertiary prevention.
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Affiliation(s)
- Laura J Miller
- Department of Psychiatry, Brigham and Women's/Faulkner Hospitals, Harvard Medical School, 75 Francis Street, Boston, MA 02115,
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Barlow J, McMillan AS, Kirkpatrick S, Ghate D, Barnes J, Smith M. Health-Led Interventions in the Early Years to Enhance Infant and Maternal Mental Health: A Review of Reviews. Child Adolesc Ment Health 2010; 15:178-185. [PMID: 32847203 DOI: 10.1111/j.1475-3588.2010.00570.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Increasing recognition of the importance of maternal mental health and early parenting in optimising the later mental health of the child has given rise to new ways of working during the perinatal period. AIMS The objective of this review is to identify effective health-led interventions to support parents, parenting and the parent-infant relationship during the perinatal period,1 and beyond. METHOD A systematic search of key electronic databases was undertaken to identify secondary and primary sources of data addressing the research question. Twenty-four reviews addressed the effectiveness of interventions delivered during the postnatal period in promoting closeness and sensitive parenting, infant sensory and perceptual capabilities, and positive parenting, and in addressing infant regulatory problems, maternal mental health problems, and parent-infant relationship problems. CONCLUSIONS A number of methods of working are recommended as part of a model of progressive-universalism beginning ante-natally and continuing through the first two post-natal years, and beyond. The implications for universal, targeted and specialist healthcare services are explored, alongside the role and contribution of CAMHS practitioners.
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Affiliation(s)
- Jane Barlow
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. E-mail:
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Rowe HJ, Fisher JRW. Development of a universal psycho-educational intervention to prevent common postpartum mental disorders in primiparous women: a multiple method approach. BMC Public Health 2010; 10:499. [PMID: 20718991 PMCID: PMC2931475 DOI: 10.1186/1471-2458-10-499] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 08/18/2010] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Prevention of postnatal mental disorders in women is an important component of comprehensive health service delivery because of the substantial potential benefits for population health. However, diverse approaches to prevention of postnatal depression have had limited success, possibly because anxiety and adjustment disorders are also problematic, mental health problems are multifactorially determined, and because relationships amongst psychosocial risk factors are complex and difficult to modify. The aim of this paper is to describe the development of a novel psycho-educational intervention to prevent postnatal mental disorders in mothers of firstborn infants. METHODS Data from a variety of sources were synthesised: a literature review summarised epidemiological evidence about neglected modifiable risk factors; clinical research evidence identified successful psychosocial treatments for postnatal mental health problems; consultations with clinicians, health professionals, policy makers and consumers informed the proposed program and psychological and health promotion theories underpinned the proposed mechanisms of effect. The intervention was pilot-tested with small groups of mothers and fathers and their first newborn infants. RESULTS What Were We Thinking! is a psycho-educational intervention, designed for universal implementation, that addresses heightened learning needs of parents of first newborns. It re-conceptualises mental health problems in mothers of infants as reflecting unmet needs for adaptations in the intimate partner relationship after the birth of a baby, and skills to promote settled infant behaviour. It addresses these two risk factors in half-day seminars, facilitated by trained maternal and child health nurses using non-psychiatric language, in groups of up to five couples and their four-week old infants in primary care. It is designed to promote confidence and reduce mental disorders by providing skills in sustainable sleep and settling strategies, and the re-negotiation of the unpaid household workload in non-confrontational ways. Materials include a Facilitators' Handbook, creatively designed worksheets for use in seminars, and a book for couples to take home for reference. A website provides an alternative means of access to the intervention. CONCLUSIONS What Were We Thinking! is a postnatal mental health intervention which has the potential to contribute to psychologically-informed routine primary postnatal health care and prevent common mental disorders in women.
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Affiliation(s)
- Heather J Rowe
- Centre for Women's Health Gender and Society, Melbourne School of Population Health, University of Melbourne, Victoria 3010 Australia
| | - Jane RW Fisher
- Centre for Women's Health Gender and Society, Melbourne School of Population Health, University of Melbourne, Victoria 3010 Australia
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Fisher JRW, Wynter KH, Rowe HJ. Innovative psycho-educational program to prevent common postpartum mental disorders in primiparous women: a before and after controlled study. BMC Public Health 2010; 10:432. [PMID: 20653934 PMCID: PMC2920889 DOI: 10.1186/1471-2458-10-432] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Accepted: 07/23/2010] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Universal interventions to prevent postnatal mental disorders in women have had limited success, perhaps because they were insufficiently theorized, not gender-informed and overlooked relevant risk factors. This study aimed to determine whether an innovative brief psycho-educational program for mothers, fathers and first newborns, which addressed salient learning needs about infant behaviour management and adjustment tasks in the intimate partner relationship, prevented postpartum mental health problems in primiparous women. METHODS A before and after controlled study was conducted in primary care in seven local government areas in Victoria, Australia. English-speaking couples with one-week old infants were invited consecutively to participate by the maternal and child health nurse at the universal first home visit. Two groups were recruited and followed sequentially: both completed telephone interviews at four weeks and six months postpartum and received standard health care. Intervention group participants were also invited to attend a half-day program with up to five couples and one month old infants, facilitated by trained, supervised nurses. The main outcome was any Composite International Diagnostic Interview (CIDI) diagnosis of Depression or Anxiety or Adjustment Disorder with Depressed Mood, Anxiety, or Mixed Anxiety and Depressed Mood in the first six months postpartum. Factors associated with the outcome were established by logistic regression controlling for potential confounders and analysis was by intention to treat. RESULTS In total 399/646 (62%) women were recruited; 210 received only standard care and 189 were also offered the intervention; 364 (91%) were retained at follow up six months postpartum. In women without a psychiatric history (232/364; 64%), 36/125 (29%) were diagnosed with Depression or Anxiety or Adjustment Disorder with Depressed Mood, Anxiety, or Mixed Anxiety and Depressed Mood in the control group, compared with 16/107 (15%) in the intervention group. In those without a psychiatric history, the adjusted odds ratio for diagnosis of a common postpartum mental disorder was 0.43 (95% CI 0.21, 0.89) in the intervention group compared to the control group. CONCLUSIONS A universal, brief psycho-educational group program for English-speaking first time parents and babies in primary care reduces de novo postpartum mental disorders in women. A universal approach supplemented by an additional program may improve effectiveness for women with a psychiatric history. TRIAL REGISTRATION ACTRN 12605000567628.
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Affiliation(s)
- Jane RW Fisher
- Centre for Women's Health, Gender and Society, Melbourne School of Population Health, University of Melbourne, Victoria 3010, Australia
| | - Karen H Wynter
- Centre for Women's Health, Gender and Society, Melbourne School of Population Health, University of Melbourne, Victoria 3010, Australia
| | - Heather J Rowe
- Centre for Women's Health, Gender and Society, Melbourne School of Population Health, University of Melbourne, Victoria 3010, Australia
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Glavin K, Ellefsen B, Erdal B. Norwegian Public Health Nurses' Experience Using a Screening Protocol for Postpartum Depression. Public Health Nurs 2010; 27:255-62. [DOI: 10.1111/j.1525-1446.2010.00851.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Field T. Postpartum depression effects on early interactions, parenting, and safety practices: a review. Infant Behav Dev 2010; 33:1-6. [PMID: 19962196 PMCID: PMC2819576 DOI: 10.1016/j.infbeh.2009.10.005] [Citation(s) in RCA: 816] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 02/06/2009] [Accepted: 10/23/2009] [Indexed: 10/20/2022]
Abstract
In this paper studies are reviewed from the last decade on postpartum depression effects on early interactions, parenting, safety practices and on early interventions. The interaction disturbances of depressed mothers and their infants appear to be universal, across different cultures and socioeconomic status groups and, include less sensitivity of the mothers and responsivity of the infants. Several caregiving activities also appear to be compromised by postpartum depression including feeding practices, most especially breastfeeding, sleep routines and well-child visits, vaccinations and safety practices. These data highlight the need for universal screening of maternal and paternal depression during the postpartum period. Early interventions reviewed here include psychotherapy and interaction coaching for the mothers, and infant massage for their infants.
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Affiliation(s)
- Tiffany Field
- Touch Research Institute, University of Miami School of Medicine, Miami, FL 33101, United States.
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Bryanton J, Beck CT. Postnatal parental education for optimizing infant general health and parent-infant relationships. Cochrane Database Syst Rev 2010:CD004068. [PMID: 20091558 DOI: 10.1002/14651858.cd004068.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Many learning needs arise in the early postpartum period, and it is important to examine interventions used to educate new parents about caring for their newborns during this time. OBJECTIVES The primary objective was to assess the effects of structured postnatal education delivered by an educator to an individual or group on infant general health and parent-infant relationships. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2009), CINAHL (1982 to July 2009), ERIC (1966 to July 2009), HealthSTAR (1966 to July 2009), PsycINFO (1806 to July 2009), Sociological Abstracts (1974 to July 2009), ClinicalTrials.gov (August 2009), Current Controlled Trials (August 2009), and Trialscentral.org (August 2009). SELECTION CRITERIA We included randomized controlled trials of any structured postnatal education provided by an educator to individual parents or groups of parents within the first two months post birth related to the care of an infant or parent-infant relationships. We excluded studies of educational interventions for parents of infants in neonatal intensive care units. DATA COLLECTION AND ANALYSIS Both authors assessed trial quality and extracted data from published reports. MAIN RESULTS Of the 25 trials (3689 mothers and 793 fathers) that met the inclusion criteria, only 15 (2868 mothers and 613 fathers) reported useable data. Educational interventions included: four on infant sleep enhancement, 13 on infant behaviour, two on general post-birth health, two on infant care, three on infant safety, and one on father involvement/skills with infants. Details of the randomization procedures, allocation concealment, blinding, and participant loss were often not reported. Of the outcomes analyzed, only six were measured similarly enough by more than one study to be combined in meta-analyses. Of these six meta-analyses, only two were found to have a low enough level of heterogeneity to provide an overall estimate of effect. Education on sleep enhancement resulted in a mean difference of 29 more minutes of infant sleep in 24 hours (95% confidence interval (CI) 18.53 to 39.73) than usual care. Education on infant behaviour increased maternal knowledge of infant behaviour by a mean difference of 2.85 points (95% CI 1.78 to 3.91). AUTHORS' CONCLUSIONS The benefits of educational programs to participants and their newborns remain unclear. Education on sleep enhancement appears to increase infant sleep and education about infant behaviour potentially enhances mothers' knowledge; however more and larger, well-designed studies are needed to confirm this.
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Affiliation(s)
- Janet Bryanton
- School of Nursing, University of Prince Edward Island, 550 University Avenue, Charlottetown, Canada, C1A 4P3
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Hughes A, Williams M, Bardacke N, Duncan LG, Dimidjian S, Goodman SH. Mindfulness approaches to childbirth and parenting. BRITISH JOURNAL OF MIDWIFERY 2009; 17:630-635. [PMID: 24307764 PMCID: PMC3846392 DOI: 10.12968/bjom.2009.17.10.44470] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Mindfulness meditation is increasingly being used as a way of managing pain, reducing stress and anxiety and, in the form of mindfulness-based cognitive therapy (MBCT), as a way of reducing the risk of recurrence in depression (NICE, 2004). This article considers its potential for parents preparing for childbirth focusing on three areas: managing pain during pregnancy and labour; reducing risk of perinatal depression; and increasing 'availability' of attention for the infant. The encouraging evidence to date suggests the possibility that mindfulness has an important contribution to make, both for reducing vulnerability in high-risk groups and as a universal intervention.
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Affiliation(s)
| | | | - Nancy Bardacke
- Osher Center for Integrative Medicine and Department of Family Healthcare Nursing, University of California, San Francisco
| | - Larissa G. Duncan
- Osher Center for Integrative Medicine, University of California, San Francisco
| | - Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado
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Glavin K, Smith L, Sørum R. Prevalence of postpartum depression in two municipalities in Norway. Scand J Caring Sci 2009; 23:705-10. [PMID: 19490523 DOI: 10.1111/j.1471-6712.2008.00667.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objectives of this study were (i) to describe the prevalence of postpartum depression (PPD) in two Norwegian municipalities and (ii) to investigate whether mothers' age and parity are related to the development of PPD. A total of 2227 women, 437 from M1 and 1790 from M2 participated in the study. Mothers who had given birth between 1 May, 2005 and 31 December, 2006 completed The Edinburgh Postnatal Depression Scale (EPDS) at well baby clinics 6 weeks after delivery. The prevalence of PPD (EPDS >or= 10) was 10.1%. However, there was a significant difference between the municipalities, with a prevalence of 14.4% in M1 and 9% in M2. Primiparous mothers showed a higher prevalence than multiparous mothers did, and the oldest mothers (36 years and over) showed the highest prevalence. PPD is an issue of importance in Norway, as in many other countries. Public health services should be aware of the higher risk of PPD among primiparous mothers and especially among older primiparous mothers. A small difference in the information provided by nurses to the mothers in the two groups at the home visit 2 weeks postpartum may have produced a significant difference in the prevalence of PPD. The findings may have implications for service delivery in public health.
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Affiliation(s)
- Kari Glavin
- Department of Nursing Research, Diakonova University College, Oslo N-0166, Norway.
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Hewitt CE, Gilbody SM. Is it clinically and cost effective to screen for postnatal depression: a systematic review of controlled clinical trials and economic evidence. BJOG 2009; 116:1019-27. [DOI: 10.1111/j.1471-0528.2009.02148.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wachs TD, Black MM, Engle PL. Maternal Depression: A Global Threat to Children’s Health, Development, and Behavior and to Human Rights. CHILD DEVELOPMENT PERSPECTIVES 2009. [DOI: 10.1111/j.1750-8606.2008.00077.x] [Citation(s) in RCA: 265] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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