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Hölzle L, Schöch P, Hörtnagl C, Buchheim A, Lampe A, Zechmeister-Koss I, Paul JL. Identifying and synthesizing components of perinatal mental health peer support - a systematic review. Front Psychiatry 2024; 15:1389545. [PMID: 38966189 PMCID: PMC11223205 DOI: 10.3389/fpsyt.2024.1389545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/29/2024] [Indexed: 07/06/2024] Open
Abstract
Background Becoming a parent, while often perceived as a joyous event, can also be a vulnerable life transition, with approximately one in five mothers experiencing perinatal mental illness. Peer support is recommended for its preventive and therapeutic benefits. However, relevant program components of perinatal mental health peer support remain to be identified. Objectives This review aims to (1) identify peer support programs in perinatal mental health through existing reviews and to (2) synthesize the components of these programs. Methods A systematic literature review guided by PRISMA was conducted searching four databases, supplemented by hand searches. The Template for Intervention Description and Replication (TIDieR) checklist facilitated the systematic extraction and synthesis of program components. Results Eleven peer support programs were identified from three reviews, largely conducted in English-speaking countries. The identified reviews highlight the benefits of peer support in perinatal mental health. Key components of individual programs were contextual background, materials, provider training and support, delivery modes and locations, and evaluation. Sharing lived experience and providing flexible support were central to all programs. Conclusion Aspects of flexibility, authenticity and the challenges of program evaluation in peer support must be considered. Findings can now inform future planning and implementation efforts of peer support programs in periantal mental health.
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Affiliation(s)
- Laura Hölzle
- Department of Psychiatry, Medical University Innsbruck, Psychotherapy, Psychosomatics, and Medical Psychology, Division of Psychiatry I, Innsbruck, Austria
- University of Innsbruck, Institute of Psychology, Innsbruck, Austria
| | - Philipp Schöch
- Department of Psychiatry, Medical University Innsbruck, Psychotherapy, Psychosomatics, and Medical Psychology, Division of Psychiatry I, Innsbruck, Austria
- University of Innsbruck, Institute of Psychology, Innsbruck, Austria
| | - Christine Hörtnagl
- Department of Psychiatry, Medical University Innsbruck, Psychotherapy, Psychosomatics, and Medical Psychology, Division of Psychiatry I, Innsbruck, Austria
| | - Anna Buchheim
- University of Innsbruck, Institute of Psychology, Innsbruck, Austria
| | - Astrid Lampe
- Ludwig Boltzmann Gesellschaft Institute for Rehabilitation, Vienna, Austria
| | | | - Jean Lillian Paul
- Department of Psychiatry, Medical University Innsbruck, Psychotherapy, Psychosomatics, and Medical Psychology, Division of Psychiatry I, Innsbruck, Austria
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Kang HK, Bisht B, Kaur M, Alexis O, Worsley A, John D. Effectiveness of interpersonal psychotherapy in comparison to other psychological and pharmacological interventions for reducing depressive symptoms in women diagnosed with postpartum depression in low- and middle-income countries: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1399. [PMID: 38645302 PMCID: PMC11032640 DOI: 10.1002/cl2.1399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background Postpartum depression (PPD) is a condition that can affect any woman regardless of ethnicity, age, party, marital status, income, and type of delivery. This condition is highly prevalent worldwide. PPD, if not treated timely, can affect the maternal-child bond and can have a detrimental impact on the future cognitive, emotional, and behavioral development of the child. Interpersonal psychotherapy (IPT) has been reported as an effective treatment of PPD in previous studies as this focuses on relationship and social support issues. Previous reviews conducted in developed nations have reported the superior efficacy of IPT in comparison to other treatment options. There is no systematic review conducted in low to middle-income countries on the efficacy of IPT on PPD. Therefore it was necessary to undertake a systematic review to assess the effectiveness of IPT in reducing the depression among postpartum women in low and middle-income countries (LMICs). Objectives The main aim of this systematic review was to assess the effectiveness of IPT alone or in conjunction with pharmacological therapy and/or other psychological and psychosocial interventions, in reducing depressive symptoms among women diagnosed with PPD residing in LMICs. Search Methods The systematic search encompassed several prominent databases and grey literature. Furthermore, experts specializing in the field of IPT were consulted to identify any relevant studies conducted in LMICs that fulfilled the predetermined eligibility criteria. The most recent search update was performed in July 2022. Selection Criteria The PICOS criteria were meticulously defined for this review as described. Participants: Postpartum women diagnosed with PPD in LMICs were included. Intervention: IPT either as a standalone treatment or in conjunction with pharmacological therapy was included. Comparison: any form of psychological therapy or pharmacological therapy, whether administered individually or in combination, was considered for comparison. Study designs: experimental and quasi-experimental, factorial designs, and quantitative components (experimental, quasi-experimental, factorial designs) of mixed methods designs were eligible to be included. Studies with single-group study designs and qualitative studies were excluded from the review. Data Collection and Analysis Two reviewers from our team conducted a rigorous screening process to determine the eligibility of articles for inclusion. This involved an initial evaluation of titles and abstracts, followed by a comprehensive assessment of the full text of selected articles. In instances where discrepancies arose between the two reviewers, resolution was achieved through discussion or consultation with a third author to establish a consensus. Following the screening process, two team members independently extracted pertinent information and data from the studies that met the inclusion criteria. The treatment effect of the intervention, in comparison to the control group, was subsequently analyzed utilizing the fixed effects model taking into account the small number of studies. Main Results A total of 17,588 studies were identified from various databases, and 6493 duplicate studies were removed. Subsequently, 9380 studies underwent independent title and abstract screening resulting in the exclusion of 9040 studies. 345 full texts were thoroughly assessed leading to the exclusion of 341 studies, finally including 4 studies for review. The four included trials were randomized trials and comprised a total sample size of 188 women diagnosed with PPD residing in LMICs. Among these studies, three compared IPT with usual treatment, while one study compared IPT with antidepressant medications (ADMs). In terms of the providers of IPT, in one study, IPT was administered by nurses, while psychologists delivered IPT in another study. In one study, community health workers were responsible for providing IPT. However, in one study, information regarding the specific providers of IPT was not available or reported. The primary outcome measure reported in all four studies was depression, assessed using the Edinburgh Postnatal Depression Scale (EPDS). The geographical distribution of the studies included; one conducted in Zambia, one in Kenya, one in Pakistan, and one in Iran. Out of the four studies, three were included in the meta-analysis, as missing data from one study could not be obtained. Based on the overall treatment effect, it was found that depression scores decreased significantly more in the IPT group compared to other interventions (usual treatment or ADMs) (standardized mean difference [SMD] -0.62, 95% confidence interval [CI] (-1.01, -0.23), Z = 3.13 (p = 0.002), χ 2 = 49.49; df = 2; p < 0.00001; I 2 = 96%; 3 studies, n = 136). Out of the three studies, two studies compared the effectiveness of IPT in reducing depression scores specifically when compared to the usual treatment, and in both studies, depression scores were reduced significantly in the IPT group as compared to the usual treatment group. Only one study directly compared the effectiveness of IPT with ADM, reporting that IPT was more effective than ADM in reducing depression scores among postpartum women. Regarding adverse outcomes, only one study reported suicidal ideation with one participant in the IPT group and two in the ADM group (RR 0.50, 95% CI (0.05, 5.30), p = 0.56, n = 78). The same study reported seven participants in the ADM group had adverse drug reactions as compared to none in the IPT group (RR 15.0, 95% CI (0.89, 254), p = 0.06, n = 78). Authors' Conclusions Our comprehensive search yielded a limited number of four studies conducted in such settings. Despite the scarcity of available evidence, the findings collectively suggest that IPT is indeed an effective treatment for reducing PPD when compared to usual treatment and pharmacological therapy. However given the low certainty of evidence, there is a need for further research in the form of well-designed randomized controlled trials with larger sample sizes and a reduced risk of bias. Such studies would greatly contribute to enhancing the strength and reliability of the evidence base regarding the effectiveness of IPT in the context of PPD in LMICs. The knowledge generated from future research endeavors would be highly valuable in guiding the development of more affordable and cost-effective treatment approaches for PPD in resource-limited settings.
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Affiliation(s)
| | - Bandana Bisht
- Department of PsychiatryGovernment Medical College & HospitalChandigarhIndia
| | - Manmeet Kaur
- Shaheed Kartar Singh Sarabha College of NursingSarabhaLudhianaIndia
| | | | | | - Denny John
- Faculty of Life and Allied Health SciencesM S Ramaiah University of Applied SciencesBangaloreKarnatakaIndia
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Bourdeau AI, Harley KG, Nguyen AM. Association between maternity care practitioner type and postpartum depression screening. Birth 2023; 50:923-934. [PMID: 37435935 DOI: 10.1111/birt.12735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/27/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Postpartum depression (PPD) is increasingly common in the United States and poses a significant threat to maternal and neonatal health. Universal screening for postpartum depression is recommended by numerous organizations, including the American College of Obstetricians and Gynecologists, but is not achieved in practice. METHODS A cross-sectional, weighted, state-representative study of California residents who gave birth in 2016 using the Listening to Mothers in California 2018 data set. Primary exposure was type of maternity care professional providing care during pregnancy, and the primary outcome was PPD screening. The secondary exposure was self-reported depression or anxiety during pregnancy, and the secondary outcome was attending a postpartum office visit. Bivariate analyses were conducted using Rao-Scott chi-square tests, and multivariate analyses were conducted using logistic regression. RESULTS Compared to participants cared for by obstetricians, participants cared for by midwives had 2.6 times the odds of reporting being screened for PPD after controlling for covariates (95% CI = 1.5, 4.4). Receiving care from any other practitioner type compared with an obstetrician was not associated with a different rate of postpartum depression screening. Reporting depression or anxiety during pregnancy was associated with 0.7 times the odds (95% CI = 0.5, 1.0) of returning for postpartum care after controlling for covariates. CONCLUSIONS Being cared for by a midwife during pregnancy increases the likelihood of being screened for postpartum depression. In addition, even perfectly implemented universal screening will miss a vulnerable sector of the population that is at high risk for postpartum depression and is less likely to return for postpartum care.
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Affiliation(s)
- Althea I Bourdeau
- School of Public Health, University of California, Berkeley, California, USA
| | - Kim G Harley
- School of Public Health, University of California, Berkeley, California, USA
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Massoudi P, Strömwall LA, Åhlen J, Kärrman Fredriksson M, Dencker A, Andersson E. Women's experiences of psychological treatment and psychosocial interventions for postpartum depression: a qualitative systematic review and meta-synthesis. BMC Womens Health 2023; 23:604. [PMID: 37964250 PMCID: PMC10647124 DOI: 10.1186/s12905-023-02772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND To provide a comprehensive, systematic evaluation of the literature on experiences of psychological interventions for postpartum depression (PPD) in women. Depression is one of the most common postpartum mental disorders. Studies have identified that psychological interventions reduce depressive symptoms. However, less is known about the experiences of women who have received such treatments. METHODS A systematic review of the literature was conducted by searching five databases (CINAHL, Cochrane Library, EMBASE, Medline, PsycINFO), in August 2022. Studies with qualitative methodology examining women's experiences of professional treatment for PPD were included and checked for methodological quality. Eight studies (total N = 255) contributed to the findings, which were synthesized using thematic synthesis. Confidence in the synthesized evidence was assessed with GRADE CERQual. FINDINGS The women had received cognitive behavioral therapy (5 studies) or supportive home visits (3 studies). Treatments were individual or group-based. Two main themes were identified: Circumstances and expectations, and Experiences of treatment, with six descriptive themes. Establishing a good relationship to their health professional was important for the women, regardless of treatment model. They also expressed that they wanted to be able to choose the type and format of treatment. The women were satisfied with the support and treatment received and expressed that their emotional well-being had been improved as well as the relationship to their infant. CONCLUSION The findings can be helpful to develop and tailor patient-centered care for women who are experiencing postnatal depression.
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Affiliation(s)
- Pamela Massoudi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
- Department of Research and Development, Region Kronoberg, Växjö, Sweden.
| | - Leif A Strömwall
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Johan Åhlen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Maja Kärrman Fredriksson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Anna Dencker
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ewa Andersson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Singla DR, Savel KA, Magidson JF, Vigod SN, Dennis CL. The Role of Peer Providers to Scale Up Psychological Treatments for Perinatal Populations Worldwide. Curr Psychiatry Rep 2023; 25:735-740. [PMID: 37819490 DOI: 10.1007/s11920-023-01459-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW Psychological treatments remain largely inaccessible to perinatal populations despite their robust effectiveness. This gap is partly due to the limited number of available treatment providers. In this review, we critically evaluate recent literature on task-sharing to peer providers and propose future directions. RECENT FINDINGS There is a growing evidence base demonstrating that peer providers can effectively deliver psychological treatments for perinatal populations, as well as engage in processes critical to quality assurance, such as measurement-based peer supervision. Findings have also highlighted some benefits of peers over licensed healthcare providers, such as enhanced collaborative relationships, reduced stigma, provision of social comparisons, and increased accessibility. Peer providers may be one solution to improve access to psychological treatments for perinatal populations. However, there is a need to address clinical, professional, and health-system level barriers to effectively leverage this cadre of treatment providers.
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Affiliation(s)
- Daisy R Singla
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Katarina A Savel
- Department of Psychiatry, Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Jessica F Magidson
- Center for Substance Use, Addiction & Health Research, University of Maryland, College Park, MD, USA
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - 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
| | - Cindy-Lee Dennis
- Department of Psychiatry, Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Lawerence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Boisvert C, Talarico R, Gandhi J, Kaluzienski M, Dingwall-Harvey AL, White RR, Sampsel K, Wen SW, Walker M, Muldoon KA, El-Chaâr D. Screening for postpartum depression and risk of suicidality with obstetrical patients: a cross-sectional survey. BMC Pregnancy Childbirth 2023; 23:635. [PMID: 37667173 PMCID: PMC10478309 DOI: 10.1186/s12884-023-05903-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/07/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Pregnancy is a vulnerable time where the physical and social stress of the COVID-19 pandemic affects psychological health, including postpartum depression (PPD). This study is designed to estimate the prevalence and correlates of PPD and risk of suicidality among individuals who gave birth during the COVID-19 pandemic. METHODS We surveyed individuals who gave birth at The Ottawa Hospital and were ≥ 20 days postpartum, between March 17 and June 16, 2020. A PPD screen consisted of a score ≥ 13 using the Edinburgh Postnatal Depression Scale. A score of 1, 2, or 3 on item 10 ("The thought of harming myself has occurred to me") indicates risk of suicidality. If a participant scores greater than ≥ 13 or ≥ 1 on item 10 they were flagged for PPD, the Principal Investigator (DEC) was notified within 24 h of survey completion for a chart review and to assure follow-up. Modified Poisson multivariable regression models were used to identify factors associated with PPD and risk of suicidality using adjusted risk ratios (aRR) and 95% confidence intervals (CI). RESULTS Of the 216 respondents, 64 (30%) screened positive for PPD and 17 (8%) screened positive for risk of suicidality. The maternal median age of the total sample was 33 years (IQR: 30-36) and the infant median age at the time of the survey was 76 days (IQR: 66-90). Most participants reported some form of positive coping strategies during the pandemic (97%) (e.g. connecting with friends and family, exercising, getting professional help) and 139 (64%) reported negative coping patterns (e.g. over/under eating, sleep problems). In total, 47 (22%) had pre-pregnancy anxiety and/or depression. Negative coping (aRR:2.90, 95% CI: 1.56-5.37) and pre-existing anxiety/depression (aRR:2.03, 95% CI:1.32-3.11) were associated with PPD. Pre-existing anxiety/depression (aRR:3.16, 95% CI:1.28-7.81) was associated with risk of suicidality. CONCLUSIONS Almost a third of participants in this study screened positive for PPD and 8% for risk of suicidality. Mental health screening and techniques to foster positive coping skills/strategies are important areas to optimize postpartum mental health.
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Affiliation(s)
- Carlie Boisvert
- Faculty of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jasmine Gandhi
- Faculty of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Mark Kaluzienski
- Faculty of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | | | - Ruth Rennicks White
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
| | - Kari Sampsel
- Faculty of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Shi Wu Wen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Mark Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- International and Global Health Office, University of Ottawa, Ottawa, Canada
- Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, Ottawa, Canada
| | - Katherine A Muldoon
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
| | - Darine El-Chaâr
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
- Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, Ottawa, Canada.
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Johnson S, Kasparian NA, Cullum AS, Flanagan T, Ponting C, Kowalewski L, Main EK. Addressing Adverse Childhood and Adult Experiences During Prenatal Care. Obstet Gynecol 2023:00006250-990000000-00759. [PMID: 37141600 PMCID: PMC10184824 DOI: 10.1097/aog.0000000000005199] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/08/2022] [Indexed: 05/06/2023]
Abstract
Adverse childhood and adult experiences can affect health outcomes throughout life and across generations. The perinatal period offers a critical opportunity for obstetric clinicians to partner with patients to provide support and improve outcomes. This article draws on stakeholder input, expert opinion, and available evidence to provide recommendations for obstetric clinicians' inquiry about and response to pregnant patients' past and present adversity and trauma during prenatal care encounters. Trauma-informed care is a universal intervention that can proactively address adversity and trauma and support healing, even if a patient does not explicitly disclose past or present adversity. Inquiry about past and present adversity and trauma provides an avenue to offer support and to create individualized care plans. Preparatory steps to adopting a trauma-informed approach to prenatal care include initiating education and training for practice staff, prioritizing addressing racism and health disparities, and establishing patient safety and trust. Inquiry about adversity and trauma, as well as resilience factors, can be implemented gradually over time through open-ended questions, structured survey measures, or a combination of both techniques. A range of evidence-based educational resources, prevention and intervention programs, and community-based initiatives can be included within individualized care plans to improve perinatal health outcomes. These practices will be further developed and improved by increased clinical training and research, as well as through broad adoption of a trauma-informed approach and collaboration across specialty areas.
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Affiliation(s)
- Sara Johnson
- La Clinica de La Raza, Oakland, the California Maternal Quality Care Collaborative and the Departments of Pediatrics and Obstetrics and Gynecology, School of Medicine, Stanford University, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California; and the Department of Pediatrics, University of Cincinnati College of Medicine, Center for Heart Disease and Mental Health, Heart Institute, and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Kang D, Dong H, Shen Y, Ou J, Zhao J. The clinical application of Chinese herbal medication to depression: A narrative review. Front Public Health 2023; 11:1120683. [PMID: 36969689 PMCID: PMC10034025 DOI: 10.3389/fpubh.2023.1120683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
Depression severely impairs psychosocial functioning and quality of life, which places a huge burden on patients and their families. However, the physiological mechanism of depression remains unknown. Treatment with existing antidepressant medications is effective in around 50% of patients according to various studies, but is associated with severe side effects including nausea and headaches. Chinese herbal medicine (CHM) has been approved and widely used for depression as an alternative medicine in Chinese culture for decades. It has certain advantages and potential in the prevention and treatment of depression. In this review, we summarize the currently available evidence for the efficacy of CHM for the treatment of depression and physiological diseases comorbid with depression. We further discuss the possible mechanisms of action of CHM and the relationships to our current understanding of depression. The majority of current evidence has suggested that the combined treatment with CHM and mainstream antidepressants improves the response rate and reduces the side effects, while CHM alone could be more effective than placebo. However, the results should be carefully interpreted due to the shortcomings of existing clinical trials and a high risk of bias in meta-analyses. Our review provides a summary of the current applications and understanding of widely used CHMs for depression.
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Affiliation(s)
- Dongyu Kang
- Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, Hunan, China
| | - Huixi Dong
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yidong Shen
- Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, Hunan, China
- *Correspondence: Yidong Shen
| | - Jianjun Ou
- Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, Hunan, China
- Jianjun Ou
| | - Jingping Zhao
- Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, Hunan, China
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Steenland MW, Trivedi AN. Association of Medicaid Expansion With Postpartum Depression Treatment in Arkansas. JAMA HEALTH FORUM 2023; 4:e225603. [PMID: 36826827 PMCID: PMC9958523 DOI: 10.1001/jamahealthforum.2022.5603] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/26/2022] [Indexed: 02/25/2023] Open
Abstract
Importance Postpartum depression affects approximately 1 in every 8 postpartum individuals in the US. Antidepressant medication can effectively treat postpartum depression. However, gaps in postpartum insurance coverage after the end of Medicaid pregnancy coverage at 60 days postpartum may limit treatment uptake and decrease continuity of postpartum depression treatment. Objective To examine the association of Medicaid expansion in Arkansas with postpartum antidepressant prescription fills and antidepressant continuation and supply during the first 6 months postpartum. Design, Setting, and Participants Cohort study with a difference-in-differences analysis comparing persons with Medicaid and commercially financed childbirth using Arkansas' All-Payer Claims Database (2013-2016). Analysis was completed between July 2021 and June 2022. Exposures Medicaid-paid childbirth after January 1, 2014. Main Outcomes and Measures Antidepressant medication prescription fills and the number of days of antidepressant supply in the early (first 60 days after childbirth) and the late (61 days to 6 months after childbirth) postpartum periods. Results In this cohort study with a difference-in-differences analysis of 60 990 childbirths (mean [SD] birthing parent's age, 27 [5.3] years; 22% Black, 7% Hispanic, 67% White individuals), 72% of births were paid for by Medicaid and 28% were paid for by a commercial payer. Before expansion, 4.2% of people with a Medicaid-paid birth filled an antidepressant prescription in the later postpartum period. Medicaid expansion was associated with a 4.6 percentage point (95% CI, 2.9-6.3) increase in the likelihood, or a relative change of 110%, in this outcome. Before expansion, among people with postpartum depression in the early postpartum period with a Medicaid-paid birth, 32.7% filled an antidepressant prescription in the later postpartum period, and had an average of 23 days of antidepressant prescription supply during the later postpartum period. Among people with early postpartum depression, Medicaid expansion increased the continuity of antidepressant treatment by 20.5 percentage points (95% CI, 14.1-26.9) and the number of days with antidepressant supply in the later postpartum period by 14.1 days (95% CI, 7.2-20.9). Conclusions and Relevance Medicaid expansion in Arkansas was associated with an increase in postpartum antidepressant prescription fills, and an increase in antidepressant treatment continuity and medication supply in the period after Medicaid pregnancy-related eligibility ended.
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Affiliation(s)
- Maria W Steenland
- Population Studies and Training Center, Brown University, Providence, Rhode Island
| | - Amal N Trivedi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Providence VA Medical Center, Providence, Rhode Island
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Aylward P, Sved Williams A. Holistic community-based group parenting programs for mothers with maternal mental health issues help address a growing public health need for a diversity of vulnerable mothers, children and families: Findings from an action research study. Front Glob Womens Health 2023; 3:1039527. [PMID: 36733300 PMCID: PMC9887053 DOI: 10.3389/fgwh.2022.1039527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/20/2022] [Indexed: 01/18/2023] Open
Abstract
Background Maternal mental illness is a major growing global concern which can affect parenting with serious negative implications for offspring. Group-based parenting programs for mothers which both enhance the parent-child relationship and address mental health symptoms in a supportive social setting may optimise better outcomes for mothers and children. The Acorn program in South Australia draws on attachment theory to integrate dance play, reflective diary keeping and therapeutic letters in a holistic program for a diversity of vulnerable mothers and children aged 1-36 months. The program seeks to nurture and enhance parental wellbeing and the quality of the parent-child relationship for mothers experiencing identified mental health illnesses that impinge upon their parenting. This study presents the evaluation of the program and its effectiveness. Methods Action research approach for continuous monitoring and program improvement engaging Acorn program staff in evaluation data collection and interpretation of pre and post self-completion measures and standardized observations. Additional data was collected through a telephone interview of attending mothers 6-8 months after program completion to address sustainable impacts on parenting and wellbeing. Results The program engaged 353 diverse vulnerable mothers with their children. Many had profound overlapping mental health issues including borderline personality disorder (BPD) and depression. The quality of the parent-child interaction, parental confidence, competence and enjoyment were enhanced; mothers' wellbeing, ability to cope and lasting social supports were augmented. This occurred for a number of "most vulnerable" subgroups including single mothers, mothers with BPD, mothers from non-English speaking households and those with lower levels of education or household income. Mothers reported sustained improvements in their wellbeing, parenting, social and family lives, and feeling closer to their child as a result of participating in the program. Conclusions Given the high prevalence of maternal mental health issues and substantial potential negative consequences for mothers and offspring, the Acorn parenting program offers an effective means of addressing this pressing public health issue potentially helping large numbers of vulnerable mothers and their children. This has additional gravitas in the shadow of COVID-19 due to expanded numbers of those experiencing greater parental stress, isolation and mental illness.
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Affiliation(s)
- Paul Aylward
- Action Research Partnerships, Adelaide, SA, Australia
- Torrens University Australia, Public Health, Equity and Human Flourishing, Adelaide, SA, Australia
| | - Anne Sved Williams
- Department of Psychiatry, Women’s and Children’s Health Network, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia
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11
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Azarchi S, Ackerman M, Caravella R, Jones C, Kondas C, Madanes S, Rehim A, Deutch A. Psychiatric Considerations in Perinatal Mental Illness. Psychiatr Ann 2023. [DOI: 10.3928/00485713-20230103-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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12
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Kleiman K, Waller H. The Art of Holding Perinatal Women in Distress. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:111-117. [PMID: 36895821 PMCID: PMC9989510 DOI: 10.1089/whr.2022.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 03/06/2023]
Abstract
Therapies like cognitive behavioral therapy and interpersonal psychotherapy are regarded as highly effective treatments for perinatal mood and anxiety disorders. Therapists appreciate robust research supporting the efficacy of these evidenced-based treatments and the structure of the tools these therapies provide for effective intervention. Less has been written on supportive psychotherapeutic techniques and few of those writings provide instruction or tools for therapists who wish to strengthen their skills in this therapeutic approach. This article describes The Art of Holding Perinatal Women in Distress™, a model of perinatal treatment developed by Karen Kleiman, MSW, LCSW. Kleiman instructs therapists to incorporate six "Holding Points" into their approach to therapeutic assessment and intervention for the purpose of establishing a holding environment conducive to the release of authentic suffering. This article reviews the Holding Points and provides a case study that elucidates how the holding points function within the context of a therapy session.
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Affiliation(s)
- Karen Kleiman
- The Postpartum Stress Center, Rosemont, Pennsylvania, USA
| | - Hilary Waller
- The Postpartum Stress Center, Rosemont, Pennsylvania, USA
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13
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Chakravorty T. The role of specialist perinatal psychiatrists in modern medicine. J Perinat Med 2022; 50:1168-1173. [PMID: 35822707 DOI: 10.1515/jpm-2021-0512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 06/02/2022] [Indexed: 11/15/2022]
Abstract
The perinatal period, from the beginning of pregnancy to one year after birth, is a time of considerable physiological and emotional change, where women face a significant risk of development or relapse of mental health disorders. Mental health disorders are one of the most common conditions faced in the perinatal period, but often go unrecognised. There are several barriers to accessing and delivering care, such as instances of structural bias, cultural diversity, stigma, lack of resources and the additional challenge brought by the coronavirus pandemic. Perinatal psychiatry is a dynamic and evolving field, which spans gender, age, ethnicity, socioeconomic background and many other characteristics, to care for people at a vulnerable time in their lives. This article explores the role of perinatal psychiatrists in today's society, as well as the challenges faced in the field.
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14
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Nazir H, Rowther AA, Rauf N, Atiq M, Kazi AK, Malik A, Atif N, Surkan PJ. 'Those whom I have to talk to, I can't talk to': Perceived social isolation in the context of anxiety symptoms among pregnant women in Pakistan. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5885-e5896. [PMID: 36121172 PMCID: PMC11075807 DOI: 10.1111/hsc.14019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 07/26/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Anxiety during pregnancy is highly prevalent in low- and middle-income countries. The relative importance of different sources and types of perceived support in the Pakistani context is unknown. We explored social support during pregnancy and the role of social isolation in Pakistani women's experiences of antenatal anxiety. We conducted semi-structured interviews with 19 pregnant women with symptoms of anxiety and 10 female healthcare providers at a public urban hospital. We used inductive and deductive thematic coding to analyse the data. Many pregnant women reported feelings of physical and social isolation, even when living in joint families with larger social networks. Often fearing censure by their in-laws and peers for sharing or seeking help with pregnancy-related anxieties, women reported relying on husbands or natal family members. Normative expectations around pregnancy such as male gender preference, perceived immutability of wives' domestic responsibilities and expectations of accompanied travel by women may serve as sources of disconnectedness in the antenatal period. Providers viewed social isolation and deficits in social support during pregnancy as contributing to worse anxiety symptoms, reduced access to care and poorer health behaviours. One limitation is that the hospital setting for this study may have resulted in underreporting of abuse or neglect and limited inclusion of pregnant women who do not utilise facility-based antenatal care. In conclusion, husbands and natal families were key in reducing social isolation in pregnancy and mitigating anxiety, while in-laws did not always confer support. Targeted strategies should enhance existing support and strengthen in-law family relationships in pregnancy.
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Affiliation(s)
- Huma Nazir
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan
| | - Armaan A Rowther
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Nida Rauf
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan
| | - Maria Atiq
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan
| | - Asiya K Kazi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Abid Malik
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan
| | - Najia Atif
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan
| | - Pamela J. Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
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15
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Tang JJ, Malladi I, Covington MT, Ng E, Dixit S, Shankar S, Kachnowski S. Consumer acceptance of using a digital technology to manage postpartum depression. Front Glob Womens Health 2022; 3:844172. [PMID: 36090598 PMCID: PMC9453037 DOI: 10.3389/fgwh.2022.844172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/18/2022] [Indexed: 11/28/2022] Open
Abstract
The goal of the study was to evaluate the end user experience using the MamaLift Plus app for 2 weeks to support the treatment of their postpartum depression (PPD). A total of 14 participants completed the study and their experiences are reported in this publication. Participants reported that MamaLift Plus is an acceptable, highly usable, and practical mobile tool to use weekly for the management of their PPD. More research is warranted to evaluate the benefit of digital behavior health interventions, especially in patient populations where mental health care may be limited or harder to access by patients.
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Affiliation(s)
- Jian Jenny Tang
- The Mount Sinai Hospital, Obstetrics, Gynecology and Reproductive Science, New York, NY, United States
| | - Indira Malladi
- Curio Digital Therapeutics, Princeton, NJ, United States
- *Correspondence: Indira Malladi
| | | | - Eliza Ng
- Curio Digital Therapeutics, Princeton, NJ, United States
- Coalition for Asian-American Independent Physician Associations, New York, NY, United States
| | - Shailja Dixit
- Curio Digital Therapeutics, Princeton, NJ, United States
| | - Sid Shankar
- Curio Digital Therapeutics, Princeton, NJ, United States
| | - Stan Kachnowski
- Health Innovation and Technology Laboratory, New York, NY, United States
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Johnson JK, Diebold A, Yeh C, Ciolino JD, Tandon SD. Examining Participant Dosage and Skill Utilization Associated with Receipt of a Perinatal Depression Preventive Intervention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1241-1250. [DOI: 10.1007/s11121-022-01395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 11/28/2022]
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17
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Gemmill AW, Oliva JL, Ericksen J, Holt C, Holt CJ, Milgrom J. Web-based treatment for depression in pregnancy: a feasibility study of Mum2BMoodBooster. BMC Psychiatry 2022; 22:476. [PMID: 35842616 PMCID: PMC9287696 DOI: 10.1186/s12888-022-04111-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression in pregnancy is prevalent, under-treated, and has serious impacts on the wellbeing of women and on child development. Internet programs can reach women who may not access traditional treatments due to distance, stigma or concern about taking medication. We adapted our online postnatal depression program, MumMoodBooster, for antenatal use. We aimed to trial feasibility, acceptability, and potential efficacy of the new Mum2BMoodBooster intervention with depressed pregnant women. METHODS Twenty-seven pregnant women with Edinburgh Postnatal Depression Scale score > 11 used the program in a feasibility trial. Twenty-one had current diagnoses of major or minor depression on the Structured Clinical Interview for the DSM-IV. Assessment of symptoms occurred at screening/baseline, post-test (8 weeks post-enrollment), and at follow-up (3 months postpartum) using the Patient Health Questionnaire (PHQ-9) and the Depression Anxiety Stress Scales (DASS-21). RESULTS In this feasibility trial, depression scores on both the PHQ-9 and the DASS-21, showed significant reductions representing large effects, with average symptom scores reduced by > 50%, and maintained in the 'minimal or no depression' range at 3 month follow-up. Anxiety scores also decreased significantly. Program usage was high with 74% of women visiting all six sessions. Program acceptability ratings were moderate to high. CONCLUSIONS Findings paralleled the magnitude of symptom reductions seen in randomised trials of the postnatal MumMoodBooster program, suggesting that Mum2BMoodBooster is an effective treatment for depressed pregnant women. Effective internet therapies are likely to become increasingly important as the COVID-19 pandemic continues to make face-to-face access to health care problematic during 'lockdowns'.
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Affiliation(s)
- Alan W. Gemmill
- grid.413976.e0000 0004 0645 3457Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC 3081 Australia
| | - Jessica Lee Oliva
- grid.1011.10000 0004 0474 1797Department of Psychology, College of Health Care Science, James Cook University, Townsville, QLD Australia
| | - Jennifer Ericksen
- grid.413976.e0000 0004 0645 3457Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC 3081 Australia
| | - Charlene Holt
- grid.413976.e0000 0004 0645 3457Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC 3081 Australia
| | | | - Jeannette Milgrom
- grid.413976.e0000 0004 0645 3457Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC 3081 Australia ,grid.1008.90000 0001 2179 088XMelbourne School of Psychological Sciences, University of Melbourne, VIC, 3010 Australia
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18
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FINDIKLI E. PERINATAL MENTAL HEALTH,FREQUENCY, CAUSES AND RESULTS: A REVIEW. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1111035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
ABSTRACT
Perinatal mental illnesses occur during pregnancy and up to one year after birth. It is observed that diseases with a wide spectrum such a major depression, anxiety disorders, bipolar disorders and psychosis that are frequently recur in the early postnatal period. Although the underlying psychopatologies are not fully elucidated, multifaceted, multifactorial causes such as hormones during pregnancy, enviromental factors, social support of women and previous disease history, as well as genetic factors and the effects of all these on neurotransmitter levels in the brain are blamed. Clinically, exposure to prenatal depression and anxiety disorders has been associated with cognitive and behavioral problems in children, attention deficit/hyperactivity disorder, autism and emotional problems in early and middle childhood. Interventions for the treatment of mental ilnesses that occur in the perinatal period are in the form of pharmacological, psychotherapeutic and psychosocial interventions these aimed maternal and child health, development and finally healthy families should be planned and applied seriously in the long term by considering the benefit risk balance. Early detection and effective management of perinatal mental ilnesses are critical for the quality of life and welfare of women and their children.
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A Non-Randomized Controlled Trial for Reducing Postpartum Depression in Low-Income Minority Women at Community-Based Women's Health Clinics. Matern Child Health J 2022; 26:1689-1700. [PMID: 35445883 DOI: 10.1007/s10995-022-03434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To analyze an intervention that delivered tailored clinic staff training on postpartum depression (PPD) followed by awareness raising and social support aimed at lowering PPD among low-income Bedouin women in southern Israel. METHODS We conducted a non-randomized controlled trial at two women's health clinics. The study included 332 of the 384 eligible women recruited at baseline (intervention = 169, control = 163), who completed two face-to-face interviews, one at 26-38 weeks of pregnancy (Time 1) and one 2-4 months postpartum (Time 2). PPD was measured by the Edinburgh Postnatal Depression Scale (EPDS) and dichotomized using a ≥ 10 score cutoff. We calculated EPDS change (rate difference of dichotomous EPDS from Time 1 to Time 2) (no change, positive change, or negative change), and compared EPDS changes in a control clinic vs. an intervention clinic. RESULTS The intervention group showed a greater decrease in dichotomous EPDS ≥ 10 between times 1 and 2 (38.5% to 17.2%) than the control group (31.9% to 29.4%, PV = 0.008). Multinomial logistic regression showed that high PPD awareness significantly contributed to positive EPDS change in the intervention group (PV = 0.003) and high social support significantly protected against negative EPDS change in both groups, intervention (PV = 0.001) and control (PV = 0.003). CONCLUSIONS In low-income women, an intervention focusing on increasing PPD awareness and social support following staff training was associated with reduced EPDS and positive EPDS change following the intervention. Similar interventions should be implemented in women's clinics during pregnancy. CLINICAL TRIAL REGISTRY ClinicalTrials.gov NCT02862444.
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20
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Hildingsson I, Rubertsson C. Depressive symptoms during pregnancy and after birth in women living in Sweden who received treatments for fear of birth. Arch Womens Ment Health 2022; 25:473-484. [PMID: 35190877 PMCID: PMC8921011 DOI: 10.1007/s00737-022-01213-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 02/09/2022] [Indexed: 01/19/2023]
Abstract
The aim of this study was to investigate the prevalence of depressive symptoms and associated factors in women who underwent treatments for fear of birth; internet-based cognitive therapy, counseling with midwives, continuity with a known midwife or standard care. A secondary analysis was performed using data collected from four samples of women identified with fear of birth and receiving treatment with different methods. A questionnaire was used to collect data in mid-pregnancy and at follow-up 2 months after birth. Depressive symptoms were assessed using the Edinburgh Postnatal Depressive Scale. In mid-pregnancy, 32% of the 422 women with fear of birth also reported a co-morbidity with depressive symptoms. At postpartum follow-up, 19% reported depressive symptoms 2 months after birth, and 12% showed continued or recurrent depressive symptoms identified both during pregnancy and postpartum. A history of mental health problems was the strongest risk factor for presenting with depressive symptoms. None of the treatment options in this study was superior in reducing depressive symptoms. This study showed a significant co-morbidity and overlap between fear of birth and depressive symptoms. Screening for depressive symptoms and fear of birth during pregnancy is important to identify women at risk and offer specific treatment.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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21
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Pre-pregnancy sleep duration and postpartum depression: a multicenter study in Japan. Arch Womens Ment Health 2022; 25:181-189. [PMID: 34255202 DOI: 10.1007/s00737-021-01136-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/19/2021] [Indexed: 10/20/2022]
Abstract
Postpartum depression (PPD) is as a major public health issue and clinical priority worldwide. This study aimed to investigate the association between pre-pregnancy sleep duration and PPD. A multicenter retrospective study was conducted using clinical data of women who delivered at term between 2014 and 2018 at 12 maternity care hospitals in Japan. A total of 15,314 women were stratified into five groups according to their pre-pregnancy sleep duration: < 6, 6-7, 7-8, 8-9, and ≥ 9 h. Univariate and multivariate regression analyses were conducted to determine whether pre-pregnancy sleep duration affects the Edinburgh Postnatal Depression Scale (EPDS) scores at 1 month postpartum. We also evaluated whether the risk for PPD differs between primipara and multipara women classified according to pre-pregnancy sleep duration. The adjusted odds ratio for high EPDS scores (≥ 9) among women who slept for < 6 h and 6-7 h was 2.08 (95% confidence interval [CI]: 1.60-2.70) and 1.41 (95% CI: 1.18-1.68), respectively, relative to that in women with 7-8 h of sleep as the reference group. A 1-h increase in sleep duration was associated with an approximately 14% reduction in the risk for high EPDS scores. The association between short sleep duration and high EPDS scores was more remarkable in multipara women than in primipara women. Short pre-pregnancy sleep duration is associated with high EPDS scores, and this association is more significant in multipara women than in primipara women. Our findings emphasize the importance of collecting information on pre-pregnancy sleep duration to identify women at a high risk for PPD.
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Rodrigues AL, Ericksen J, Watson B, Gemmill AW, Milgrom J. Interventions for Perinatal Depression and Anxiety in Fathers: A Mini-Review. Front Psychol 2022; 12:744921. [PMID: 35126228 PMCID: PMC8810528 DOI: 10.3389/fpsyg.2021.744921] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives Up to 10% of fathers experience perinatal depression, often accompanied by anxiety, with a detrimental impact on the emotional and behavioural development of infants. Yet, few evidence-based interventions specifically for paternal perinatal depression or anxiety exist, and few depressed or anxious fathers engage with support. This mini-review aims to build on the evidence base set by other recent systematic reviews by synthesising more recently available studies on interventions for paternal perinatal depression and anxiety. Secondarily, we also aimed to identify useful information on key implementation strategies, if any, that increase the engagement of men. Methods We drew upon three major previous systematic reviews and performed an updated search of PubMed/Medline; Psycinfo; Cochrane Database; Embase and Cinahl. The search was limited to trials, feasibility studies or pilot studies of interventions published between 2015 and 2020 that reported on fathers' perinatal mental health. We included psychological, educational, psychosocial, paternal, couple-focused, or group therapies, delivered face-to-face, via telephone and/or online that reported on either paternal depression, anxiety or both. Results Eleven studies satisfied search criteria (5 of which were not included in previous reviews). The majority were randomised controlled trials. Most interventions incorporated counselling, therapy or psychoeducation and took an indirect approach to perinatal mental health through antenatal or postnatal education and were couple-focused. No studies reported a presence of diagnosed depression or anxiety at baseline, although five studies reported a positive effect on sub-threshold symptoms. Discussion There was some evidence that these approaches may be useful in the initial engagement of fathers with perinatal supports and improve depression and anxiety scores. No studies targeted the explicit treatment of clinically depressed or anxious men, and this remains the most substantial gap in the peer-reviewed evidence base. Our results highlight the need to deliver perinatal interventions specifically designed for men and evaluate them in populations with clinical levels of depressive and anxious symptomatology.
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Affiliation(s)
- Andre L. Rodrigues
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC, Australia
| | - Jennifer Ericksen
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC, Australia
| | - Brittany Watson
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC, Australia
| | - Alan W. Gemmill
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC, Australia
| | - Jeannette Milgrom
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC, Australia
- University of Melbourne School of Psychological Sciences, Parkville, VIC, Australia
- *Correspondence: Jeannette Milgrom
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Choi MH, Lee M. Psychosocial and psychological interventions' effectiveness among nurses in intensive care units caring for pediatric patients: A systematic review and meta-analysis. Front Pediatr 2022; 10:883230. [PMID: 36299695 PMCID: PMC9589089 DOI: 10.3389/fped.2022.883230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This review aimed to evaluate the effectiveness of psychosocial and psychological interventions in nurses among intensive care units caring for pediatric patients. METHODS A literature search was performed in PubMed, EMBASE, CINAHL databases, using preferred reporting items for systematic reviews and meta-analysis guidelines. Study design, population characteristics, contents of the programs, measured outcomes, and results were systematically reviewed from 8 selected studies. To estimate the effect size, a meta-analysis of the studies was performed using the RevMan 5.3 program. The effect size used was the standardized mean difference. RESULTS Of 1,630 studies identified, 4 met the inclusion criteria, and 3 studies were used to estimate the effect size of psychosocial and psychological interventions. The primary outcome variable of these studies was stress. The effect of the intervention program on stress was also found to have no effect in individual studies, and the overall effect size was not statistically significant (standardized mean difference = -0.06; 95% confidence interval: -0.33, 0.20; Z = 0.48, p = 0.630). However, according to the individual literature included in this study, after the stress management program was applied as a group, a significant stress reduction was shown in the experimental group (p = 0.021). CONCLUSIONS These results show that psychosocial and psychological interventions were effective in stress management by a group approach. Therefore, it is necessary to develop psychosocial support interventions for stress management of nurses among intensive care units caring for pediatric patients more diversely.
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Affiliation(s)
- Mi Hyang Choi
- College of Nursing, Changshin University, Changwon, South Korea
| | - Misoon Lee
- Department of Nursing, Youngsan University, Yangsan, South Korea
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Milgrom J, Danaher BG, Seeley JR, Holt CJ, Holt C, Ericksen J, Tyler MS, Gau JM, Gemmill AW. Internet and Face-to-face Cognitive Behavioral Therapy for Postnatal Depression Compared With Treatment as Usual: Randomized Controlled Trial of MumMoodBooster. J Med Internet Res 2021; 23:e17185. [PMID: 34889742 PMCID: PMC8701704 DOI: 10.2196/17185] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/10/2021] [Accepted: 09/28/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Previous research has confirmed that symptoms of postnatal depression (PND) can be ameliorated through internet-delivered psychological interventions. Advantages of internet-delivered treatment include anonymity, convenience, and catering to women who are unable to access face-to-face (FTF) treatments. To date, no research has examined the efficacy of such interventions compared directly with FTF treatments in women clinically diagnosed with PND. OBJECTIVE This study aims to compare the efficacy of one of the first web-based cognitive behavioral therapy (CBT) interventions (internet CBT+coach calls) for PND (MumMoodBooster [MMB]) with FTF-CBT in a randomized controlled trial (RCT). METHODS In this study, 116 postnatal women with a Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) diagnosis of major or minor depression were randomized to MMB (39/116, 33.6%), FTF-CBT (39/116, 33.6%), or a treatment-as-usual (TAU) control condition (38/116, 32.8%). Diagnostic status was determined at baseline and at 21-week follow-up using the Structured Clinical Interview for the DSM-IV. Severity of anxiety and depressive symptoms was evaluated using the Depression Anxiety Stress Scales and the revised Beck Depression Inventory at baseline, 12-week follow-up (after treatment), and 21-week follow-up. RESULTS Of the 116 participants, 107 (92.2%) had a diagnosis of major depression at baseline. Rates of remission from a major or minor depressive episode at 21 weeks in both the FTF-CBT and MMB groups were superior to that of the TAU group (56.6% and 47.7% less likely to be depressed, respectively) and they were not significantly different from each other. Although remission rates differed between TAU and FTF-CBT, growth models showed that, in terms of symptom reduction across time, the FTF-CBT treatment was not significantly better than TAU. By comparison, MMB was statistically superior to both TAU and FTF-CBT in reducing symptoms of depression, anxiety, and stress from baseline to the 21-week follow-up (large and moderate effect sizes). Thus, after 21 weeks, the average symptom scores for depression and anxiety of women receiving MMB were approximately half those of women in both the TAU and FTF-CBT groups. CONCLUSIONS In this RCT, MMB was at least as effective as FTF-CBT in achieving remission from a diagnosed PND episode. MMB was superior to TAU and FTF-CBT in encouraging and maintaining reduction of symptom severity over the 21-week follow-up for depressed postnatal women. These findings replicate results of prior studies on MMB that showed clinically significant improvements in depressive symptoms, and they provide direct empirical support that internet-delivered treatment for depressed postnatal women is a viable alternative to FTF treatment. The generalizability of the results needs to be examined in future research, as RCTs of internet-based versus FTF treatments necessarily involve a subset of people who are willing to undertake either modality of treatment. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000881730; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364683&isReview=true.
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Affiliation(s)
- Jeannette Milgrom
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | - Brian G Danaher
- University of Oregon, Eugene, OR, United States.,Influents Innovations, Eugene, OR, United States
| | - John R Seeley
- University of Oregon, Eugene, OR, United States.,Influents Innovations, Eugene, OR, United States
| | | | - Charlene Holt
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, Australia
| | - Jennifer Ericksen
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, Australia
| | - Milagra S Tyler
- University of Oregon, Eugene, OR, United States.,Influents Innovations, Eugene, OR, United States
| | - Jeff M Gau
- University of Oregon, Eugene, OR, United States.,Influents Innovations, Eugene, OR, United States
| | - Alan W Gemmill
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, Australia
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Maternal Mental Health following Ultrasonographic Detection of Fetal Structural Anomaly in the Midst of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412900. [PMID: 34948508 PMCID: PMC8701233 DOI: 10.3390/ijerph182412900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/16/2022]
Abstract
Prenatal ultrasonographic detection of fetal structural anomaly may adversely affect maternal mental health throughout pregnancy, particularly in the current COVID-19 pandemic. This study aims to prospectively assess maternal stress, anxiety, and depression following ultrasonographic detection of fetal structural anomaly from diagnosis until delivery during the COVID-19 pandemic. A total of 141 pregnant women at a tertiary hospital who underwent detailed scans between 16 and 24 gestational weeks were included and categorized into the study (anomaly finding, n = 65) and comparison (normal finding, n = 76) groups. Self-administered questionnaires of 10-item Perceived Stress Scale (PSS-10) and Hospital Anxiety and Depression Scale (HADS) were used to assess maternal stress, anxiety, and depression at prior detection (T1), two-to-four weeks post-detection (T2), one-to-two weeks prior to delivery (T3), and one-to-two weeks post-delivery (T4). Repeated measures of analysis of variance (ANOVA) were conducted to assess time-, between-group, and time-group interaction effect. In general, maternal stress improved, but anxiety worsened, while depression persisted, over the time from T1 to T4. The average maternal stress and anxiety levels were significantly higher among groups with fetal anomaly. The maternal stress and anxiety level were significantly affected within one-to-two weeks post-detection of fetal structural anomaly. In conclusion, maternal mental health parameters were affected differently during the COVID-19 pandemic, with higher vulnerability of stress and anxiety among pregnant women with fetal structural anomaly particularly within one-to-two weeks post-detection.
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Lewis BA, Schuver K, Dunsiger S, Samson L, Frayeh AL, Terrell CA, Ciccolo JT, Fischer J, Avery MD. Randomized trial examining the effect of exercise and wellness interventions on preventing postpartum depression and perceived stress. BMC Pregnancy Childbirth 2021; 21:785. [PMID: 34802425 PMCID: PMC8607568 DOI: 10.1186/s12884-021-04257-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 11/03/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Approximately 13-19% of postpartum women experience postpartum depression and a majority report at least some stress during the postpartum phase. Traditional interventions such as psychotherapy and antidepressant medications are often not feasible or desirable. The purpose of this study was to examine two low cost, brief, accessible interventions designed to prevent postpartum depression and perceived stress among women at high risk. METHODS Participants (n = 450) who were on average four weeks postpartum, had a history of depression before pregnancy, and exercised less than 60 min per week were randomly assigned to one of the following three conditions: (1) 6-month telephone-based exercise intervention; (2) 6-month telephone-based wellness/support intervention (e.g., healthy eating, sleep, and perceived stress); or (3) usual care. RESULTS Overall, 2.4% of participants met criteria for depression at 6 months and 3.6% at 9 months with no differences between groups. At 6 months following randomization, median symptoms of depression were significantly lower among wellness participants compared to usual care participants (b = - 1.00, SE = 0.46, p = .03). Perceived stress at 6 months post-randomization was significantly lower among exercise vs. usual care participants (b = - 2.00, SE = .98, p = .04) and exercise vs. wellness participants (b = - 2.20, SE = 1.11, p = .04). CONCLUSIONS The wellness intervention was efficacious for preventing symptoms of depression; however, postpartum depression that met the diagnostic criteria was surprisingly low in all conditions among this at risk sample of postpartum women. Exercise interventions may have a protective effect on perceived stress among women at risk for postpartum depression. Practitioners should consider integrating exercise and wellness interventions into postpartum care. TRIAL REGISTRATION Clinical Trials Number: NCT01883479 (06/21/2013).
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Affiliation(s)
- Beth A Lewis
- University of Minnesota, School of Kinesiology, 1900 University Ave SE, Minneapolis, MN, 55455, USA.
| | - Katie Schuver
- University of Minnesota, School of Kinesiology, 1900 University Ave SE, Minneapolis, MN, 55455, USA
| | - Shira Dunsiger
- Center for Health Promotion and Health Equity in the Department of Behavioral and Social Sciences, Brown University, Box G-S121-4, Providence, RI, 02912, USA
| | - Lauren Samson
- University of Minnesota, School of Kinesiology, 1900 University Ave SE, Minneapolis, MN, 55455, USA
| | - Amanda L Frayeh
- University of Minnesota, School of Kinesiology, 1900 University Ave SE, Minneapolis, MN, 55455, USA
| | - Carrie A Terrell
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, 604 24th Ave S, Ste 300, Minneapolis, MN, 55454, USA
| | - Joseph T Ciccolo
- Department of Biobehavioral Sciences, Teachers College Columbia University, 525 West 120th St., New York, NY, USA
| | - John Fischer
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, 604 24th Ave S, Ste 300, Minneapolis, MN, 55454, USA
| | - Melissa D Avery
- University of Minnesota, School of Nursing, 308 Harvard St. SE, Minneapolis, MN, 55455, USA
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Hasanzadeh R, Jafarabadi MA, Hasanpour S, Fallon V, Silverio SA, Montazeri R, Mirghafourvand M. Psychometric evaluation of the postpartum specific anxiety scale in an Iranian population (PSAS-IR). BMC Pregnancy Childbirth 2021; 21:597. [PMID: 34481468 PMCID: PMC8417620 DOI: 10.1186/s12884-021-04085-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety is one of the most prevalent mental health disorders among mothers during the postpartum period, which can lead to maternal and infant physical and psychological consequences. The Postpartum Specific Anxiety Scale (PSAS) predicts unique variance in postnatal outcomes over and above general anxiety tools. It has never been used in Iran and its validity and reliability have not been assessed either. Therefore, the present study aimed to translate and investigate the psychometric properties of the PSAS-IR. METHODS 510 women, from six weeks to six months postpartum, were selected through random sampling in 2020. After forward and back-translation, the face validity, content validity, and construct validity of PSAS (through confirmatory factor analysis) were examined. The reliability of the scale was assessed using both internal consistency (Cronbach's alpha) and test-retest stability methods. RESULTS CVI and CVR values of the PSAS tool were 0.89 and 0.88, respectively. The good fit indices confirmed the validity of four-factor structure. Cronbach's alpha coefficient and Intra Correlation Coefficient (ICC) equaled 0.93 and 0.92, respectively. CONCLUSION The Persian version of PSAS is a valid and reliable four-factor scale, it will improve the measurement of postpartum anxiety in an Iranian setting. This will improve the measurement of postpartum anxiety in an Iranian setting.
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Affiliation(s)
- Robab Hasanzadeh
- Department of Midwifery, Bonab Branch, Islamic Azad University, Bonab, Iran
| | - Mohammad Asghari Jafarabadi
- Department of Statistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.,Center for the Development of Interdisciplinary Research in Islamic Sciences and Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shirin Hasanpour
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Reyhane Montazeri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Hildingsson I, Nilsson J, Merio E, Larsson B. Anxiety and depressive symptoms in women with fear of birth: A longitudinal cohort study. Eur J Midwifery 2021; 5:32. [PMID: 34396062 PMCID: PMC8328228 DOI: 10.18332/ejm/138941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Anxiety and depression during pregnancy could imply difficulties in the attachment to the unborn baby. The objective of this study was to investigate the prevalence and change in anxiety and depressive symptoms in pregnant women with fear of birth. Another aim was to explore associations between symptoms of anxiety and depression on prenatal attachment. METHODS This is a longitudinal cohort study of 77 pregnant women with fear of birth in three hospitals in Sweden. Data were collected by three questionnaires in mid and late pregnancy and two months after birth. RESULTS Anxiety symptoms were more often reported than depressive symptoms, significantly decreasing over time in both conditions. Anxiety symptoms were associated with low education level, negative feelings towards the upcoming birth, and levels of fear of birth. Depressive symptoms were associated with levels of fear of birth. One in five women presented with fear of birth, anxiety, and depressive symptoms, suggesting that co-morbidity was quite common in this sample. Depressive symptoms and co-morbidity were negatively associated with prenatal attachment. CONCLUSIONS This study shows that symptoms of anxiety and depression in women with fear of birth vary over time and that co-morbidity is quite common. Lack of emotional well-being was related to prenatal attachment. Healthcare professionals must identify and support women with anxiety and depressive symptoms and fear of birth so that difficulties in the relationship between the mother and the newborn baby might be reduced.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Johanna Nilsson
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Elida Merio
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Birgitta Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden.,Department of Health Promoting Science, Sophiahemmet University College, Stockholm, Sweden
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Jain D, Jain AK, Metz GAS, Ballanyi N, Sood A, Linder R, Olson DM. A Strategic Program for Risk Assessment and Intervention to Mitigate Environmental Stressor-Related Adverse Pregnancy Outcomes in the Indian Population. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:673118. [PMID: 36304060 PMCID: PMC9580833 DOI: 10.3389/frph.2021.673118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
The Problem: Global environmental stressors of human health include, but are not limited to, conflict, migration, war, natural disasters, climate change, pollution, trauma, and pandemics. In combination with other factors, these stressors influence physical and mental as well as reproductive health. Maternal stress is a known factor for adverse pregnancy outcomes such as preterm birth (PTB); however, environmental stressors are less well-understood in this context and the problem is relatively under-researched. According to the WHO, major Indian cities including New Delhi are among the world's 20 most polluted cities. It is known that maternal exposure to environmental pollution increases the risk of premature births and other adverse pregnancy outcomes which is evident in this population. Response to the Problem: Considering the seriousness of this problem, an international and interdisciplinary group of researchers, physicians, and organizations dedicated to the welfare of women at risk of adverse pregnancy outcomes launched an international program named Optimal Pregnancy Environment Risk Assessment (OPERA). The program aims to discover and disseminate inexpensive, accessible tools to diagnose women at risk for PTB and other adverse pregnancy outcomes due to risky environmental factors as early as possible and to promote effective interventions to mitigate these risks. OPERA has been supported by the Worldwide Universities Network, World Health Organization (WHO) and March of Dimes USA. Addressing the Problem: This review article addresses the influence of environmental stressors on maternal-fetal health focusing on India as a model population and describes the role of OPERA in helping local practitioners by sharing with them the latest risk prediction and mitigation tools. The consequences of these environmental stressors can be partially mitigated by experience-based interventions that build resilience and break the cycle of inter- and-transgenerational transmission. The shared knowledge and experience from this collaboration are intended to guide and facilitate efforts at the local level in India and other LMIC to develop strategies appropriate for the jurisdiction for improving pregnancy outcomes in vulnerable populations.
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Affiliation(s)
- Divyanu Jain
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
- *Correspondence: Divyanu Jain
| | - Ajay K. Jain
- Department of Obstetrics & Gynecology and In-vitro Fertilization Center, Jaipur Golden Hospital, New Delhi, India
- IVF Center, Muzaffarnagar Medical College, Muzaffarnagar, India
| | - Gerlinde A. S. Metz
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB, Canada
| | - Nina Ballanyi
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Abha Sood
- Department of Obstetrics & Gynecology and In-vitro Fertilization Center, Jaipur Golden Hospital, New Delhi, India
| | - Rupert Linder
- Specialist for Gynecology, Obstetrics, Psychosomatics and Psychotherapy, Birkenfeld, Germany
| | - David M. Olson
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
- Departments of Pediatrics and Physiology, University of Alberta, Edmonton, AB, Canada
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Predicting women with depressive symptoms postpartum with machine learning methods. Sci Rep 2021; 11:7877. [PMID: 33846362 PMCID: PMC8041863 DOI: 10.1038/s41598-021-86368-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/15/2021] [Indexed: 11/09/2022] Open
Abstract
Postpartum depression (PPD) is a detrimental health condition that affects 12% of new mothers. Despite negative effects on mothers’ and children’s health, many women do not receive adequate care. Preventive interventions are cost-efficient among high-risk women, but our ability to identify these is poor. We leveraged the power of clinical, demographic, and psychometric data to assess if machine learning methods can make accurate predictions of postpartum depression. Data were obtained from a population-based prospective cohort study in Uppsala, Sweden, collected between 2009 and 2018 (BASIC study, n = 4313). Sub-analyses among women without previous depression were performed. The extremely randomized trees method provided robust performance with highest accuracy and well-balanced sensitivity and specificity (accuracy 73%, sensitivity 72%, specificity 75%, positive predictive value 33%, negative predictive value 94%, area under the curve 81%). Among women without earlier mental health issues, the accuracy was 64%. The variables setting women at most risk for PPD were depression and anxiety during pregnancy, as well as variables related to resilience and personality. Future clinical models that could be implemented directly after delivery might consider including these variables in order to identify women at high risk for postpartum depression to facilitate individualized follow-up and cost-effectiveness.
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31
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Brown JVE, Wilson CA, Ayre K, Robertson L, South E, Molyneaux E, Trevillion K, Howard LM, Khalifeh H. Antidepressant treatment for postnatal depression. Cochrane Database Syst Rev 2021; 2:CD013560. [PMID: 33580709 PMCID: PMC8094614 DOI: 10.1002/14651858.cd013560.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Depression is one of the most common morbidities of the postnatal period. It has been associated with adverse outcomes for women, children, the wider family and society as a whole. Treatment is with psychosocial interventions or antidepressant medication, or both. The aim of this review is to evaluate the effectiveness of different antidepressants and to compare their effectiveness with placebo, treatment as usual or other forms of treatment. This is an update of a review last published in 2014. OBJECTIVES To assess the effectiveness and safety of antidepressant drugs in comparison with any other treatment (psychological, psychosocial, or pharmacological), placebo, or treatment as usual for postnatal depression. SEARCH METHODS We searched Cochrane Common Mental Disorders's Specialized Register, CENTRAL, MEDLINE, Embase and PsycINFO in May 2020. We also searched international trials registries and contacted experts in the field. SELECTION CRITERIA We included randomised controlled trials (RCTs) of women with depression during the first 12 months postpartum that compared antidepressant treatment (alone or in combination with another treatment) with any other treatment, placebo or treatment as usual. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the study reports. We requested missing information from study authors wherever possible. We sought data to allow an intention-to-treat analysis. Where we identified sufficient comparable studies we pooled data and conducted random-effects meta-analyses. MAIN RESULTS We identified 11 RCTs (1016 women), the majority of which were from English-speaking, high-income countries; two were from middle-income countries. Women were recruited from a mix of community-based, primary care, maternity and outpatient settings. Most studies used selective serotonin reuptake inhibitors (SSRIs), with treatment duration ranging from 4 to 12 weeks. Meta-analysis showed that there may be a benefit of SSRIs over placebo in response (55% versus 43%; pooled risk ratio (RR) 1.27, 95% confidence interval (CI) 0.97 to 1.66); remission (42% versus 27%; RR 1.54, 95% CI 0.99 to 2.41); and reduced depressive symptoms (standardised mean difference (SMD) -0.30, 95% CI -0.55 to -0.05; 4 studies, 251 women), at 5 to 12 weeks' follow-up. We were unable to conduct meta-analysis for adverse events due to variation in the reporting of this between studies. There was no evidence of a difference between acceptability of SSRI and placebo (27% versus 27%; RR 1.10, 95% CI 0.74 to 1.64; 4 studies; 233 women). The certainty of all the evidence for SSRIs was low or very low due to the small number of included studies and a number of potential sources of bias, including high rates of attrition. There was insufficient evidence to assess the efficacy of SSRIs compared with other classes of antidepressants and of antidepressants compared with other pharmacological interventions, complementary medicines, psychological and psychosocial interventions or treatment as usual. A substantial proportion of women experienced adverse effects but there was no evidence of differences in the number of adverse effects between treatment groups in any of the studies. Data on effects on children, including breastfed infants, parenting, and the wider family were limited, although no adverse effects were noted. AUTHORS' CONCLUSIONS There remains limited evidence regarding the effectiveness and safety of antidepressants in the management of postnatal depression, particularly for those with more severe depression. We found low-certainty evidence that SSRI antidepressants may be more effective in treating postnatal depression than placebo as measured by response and remission rates. However, the low certainty of the evidence suggests that further research is very likely to have an important impact on our effect estimate. There is a continued imperative to better understand whether, and for whom, antidepressants or other treatments are more effective for postnatal depression, and whether some antidepressants are more effective or better tolerated than others. In clinical practice, the findings of this review need to be contextualised by the extensive broader literature on antidepressants in the general population and perinatal clinical guidance, to inform an individualised risk-benefit clinical decision. Future RCTs should focus on larger samples, longer follow-up, comparisons with alternative treatment modalities and inclusion of child and parenting outcomes.
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Affiliation(s)
- Jennifer Valeska Elli Brown
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Cochrane Common Mental Disorders, University of York, York, UK
| | - Claire A Wilson
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Karyn Ayre
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lindsay Robertson
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Emily South
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Emma Molyneaux
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kylee Trevillion
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hind Khalifeh
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Lilliecreutz C, Josefsson A, Mohammed H, Josefsson A, Sydsjö G. Mental disorders and risk factors among pregnant women with depressive symptoms in Sweden-A case-control study. Acta Obstet Gynecol Scand 2021; 100:1068-1074. [PMID: 33474752 PMCID: PMC8248054 DOI: 10.1111/aogs.14051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 11/05/2020] [Accepted: 11/14/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Identification of pregnant women suffering from depression or other mental disorders is a challenge for antenatal caregivers. The purpose of this case-control study was to describe mental disorders and the risk factors for mental disorders in women with depressive symptoms assessed with the Edinburgh Postnatal Depression Scale during the first trimester and to compare them with pregnant women without depressive symptoms. MATERIAL AND METHODS In total, 2271 women answered the Edinburgh Postnatal Depression Scale at the first antenatal visit with a midwife. An Edinburgh Postnatal Depression Scale score of 13 or higher was considered to be screen-positive and these women were further assessed. Screen-negative pregnant women, matched for age and parity, were chosen as controls. RESULTS In total, 149 (6.6%) women were found to be screen-positive. The majority (126, 85%) had at least one mental disorder or risk factor for mental disorder, such as depression (36.0%), anxiety (14.8%), or severe fear of childbirth (20.8%). The screen-positive women were more often smokers (16.1% vs 1.3%), unemployed (19.9% vs 1.3%), or on sick leave (25.3% vs 14.1%) during pregnancy and more often used selective serotonin reuptake inhibitor during pregnancy (14.2% vs 2.7%) compared with the screen-negative women (P<.001). Among the screen-negative women (n = 150) only three (2%) presented with symptoms of depression during pregnancy. CONCLUSIONS The Edinburgh Postnatal Depression Scale seems to be a valuable screening tool to detect depressive symptoms as well as other mental disorders during early pregnancy.
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Affiliation(s)
- Caroline Lilliecreutz
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ann Josefsson
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Hussein Mohammed
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Agnes Josefsson
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Chow R, Huang E, Li A, Li S, Fu SY, Son JS, Foster WG. Appraisal of systematic reviews on interventions for postpartum depression: systematic review. BMC Pregnancy Childbirth 2021; 21:18. [PMID: 33407226 PMCID: PMC7789727 DOI: 10.1186/s12884-020-03496-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/11/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) is a highly prevalent mental health problem that affects parental health with implications for child health in infancy, childhood, adolescence and beyond. The primary aim of this study was to critically appraise available systematic reviews describing interventions for PPD. The secondary aim was to evaluate the methodological quality of the included systematic reviews and their conclusions. METHODS An electronic database search of MEDLINE, Embase, and the Cochrane Library from 2000 to 2020 was conducted to identify systematic reviews that examined an intervention for PPD. A Measurement Tool to Assess Systematic Reviews was utilized to independently score each included systematic review which was then critically appraised to better define the most effective therapeutic options for PPD. RESULTS Of the 842 studies identified, 83 met the a priori criteria for inclusion. Based on the systematic reviews with the highest methodological quality, we found that use of antidepressants and telemedicine were the most effective treatments for PPD. Symptoms of PPD were also improved by traditional herbal medicine and aromatherapy. Current evidence for physical exercise and cognitive behavioural therapy in treating PPD remains equivocal. A significant, but weak relationship between AMSTAR score and journal impact factor was observed (p = 0.03, r = 0.24; 95% CI, 0.02 to 0.43) whilst no relationship was found between the number of total citations (p = 0.27, r = 0.12; 95% CI, - 0.09 to 0.34), or source of funding (p = 0.19). CONCLUSION Overall the systematic reviews on interventions for PPD are of low-moderate quality and are not improving over time. Antidepressants and telemedicine were the most effective therapeutic interventions for PPD treatment.
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Affiliation(s)
- Ryan Chow
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1N 6N5, Canada
- Department of Obstetrics and Gynecology, HSC-3N52D, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Eileen Huang
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1N 6N5, Canada
| | - Allen Li
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1N 6N5, Canada
| | - Sophie Li
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Sarah Y Fu
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1N 6N5, Canada
| | - Jin S Son
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Warren G Foster
- Department of Obstetrics and Gynecology, HSC-3N52D, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada.
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada.
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Lasater ME, Murray SM, Keita M, Souko F, Surkan PJ, Warren NE, Winch PJ, Ba A, Doumbia S, Bass JK. Integrating Mental Health into Maternal Health Care in Rural Mali: A Qualitative Study. J Midwifery Womens Health 2020; 66:233-239. [PMID: 33325644 DOI: 10.1111/jmwh.13184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Common perinatal mental disorders are prevalent in low- and middle-income countries. The gap between the need for and availability of mental health services, also known as the mental health treatment gap, is particularly acute for women during the perinatal period in rural Mali. This qualitative study aimed to identify a feasible and acceptable integrated care approach for the provision of maternal mental health care in rural Mali to help narrow the treatment gap and increase access to care. METHODS From April to June 2016, qualitative data were collected in the Sélingué health district and Bamako, Mali. In-depth interviews were conducted among women, community health workers, midwives, and mental health specialists. Focus group participants included community health workers, midwives, and an obstetric nurse. All data were inductively coded and analyzed using a thematic analysis approach. RESULTS Women described several coping strategies to manage their distress, including visiting their parents; confiding in a friend, relative, or community health worker; and participating in women's association groups. Mental health-related stigma was described as being widespread in the community and among health providers. In response to the lack of mental health services, midwives and community health workers supported the feasibility and acceptability of the integration of mental health services into maternal health services. Midwives were discussed as being key providers to conduct mental health screenings and provide initial psychosocial care for women. DISCUSSION Integrated maternal and mental health interventions are needed to narrow the gap between the need for and availability of mental health services in rural Mali. Findings from this study underscore the great need for mental health services for women in the perinatal period who reside in rural Mali and that it is both feasible and acceptable to integrate mental health screening and low-level psychosocial care into antenatal care, delivered by midwives.
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Affiliation(s)
- Molly E Lasater
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mariam Keita
- Department of Public Health, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Fatoumata Souko
- Department of Public Health, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Pamela J Surkan
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicole E Warren
- Department of Community Public Health Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Aissata Ba
- Department of Public Health, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Seydou Doumbia
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali.,University Clinical Research Center/ICER-Mali, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Gheorghe M, Varin M, Wong SL, Baker M, Grywacheski V, Orpana H. Symptoms of postpartum anxiety and depression among women in Canada: findings from a national cross-sectional survey. Canadian Journal of Public Health 2020; 112:244-252. [PMID: 33079328 PMCID: PMC7910326 DOI: 10.17269/s41997-020-00420-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study presents national estimates on symptoms consistent with postpartum anxiety (PPA) and postpartum depression (PPD) and the association between these conditions and possible risk and protective factors in women who gave birth in Canada. METHODS Data were collected through the Survey on Maternal Health, a cross-sectional survey administered in Canada's ten provinces between November 2018 and February 2019 among women who gave birth between January 1 and June 30, 2018. A total of 6558 respondents were included. Weighted prevalence estimates were calculated, and logistic regression was used to model the relationship between symptoms consistent with PPA, PPD, and potential risk factors. RESULTS Overall, 13.8% of women had symptoms consistent with PPA, while the prevalence of having symptoms consistent with PPD was 17.9%. Results of the logistic regression models indicated that women who had a history of depression were 3.4 times (95% CI 2.7-4.2) more likely to experience symptoms consistent with PPA and 2.6 times more likely to experience symptoms consistent with PPD (95% CI 2.2-3.2) compared with those who did not. Women who reported good, fair, or poor physical health were 2.4 times more likely to experience symptoms consistent with PPD (95% CI 2.0-2.9) and 2.0 times more likely to experience symptoms consistent with PPA (95% CI 1.7-2.4) compared with those who reported very good or excellent health. Maternal marital status, other postpartum maternal support, and sense of community belonging were also significant. CONCLUSION This study highlights that a history of depression and good, fair, or poor physical health are associated with an increased odds of symptoms consistent with PPA and PPD, while other maternal support and sense of community belonging are associated with a decreased odds of these conditions.
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Affiliation(s)
- Mihaela Gheorghe
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada.
| | - Mélanie Varin
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada
| | - Suzy L Wong
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada
| | - Melissa Baker
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada
| | - Vera Grywacheski
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada
| | - Heather Orpana
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada.,School of Epidemiology and Public Health, University of Ottawa, Alta Vista Campus, Room 101, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.,Royal Ottawa Institute for Mental Health Research, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
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Abstract
Perinatal mental health has become a significant focus of interest in recent years, with investment in new specialist mental health services in some high-income countries, and inpatient psychiatric mother and baby units in diverse settings. In this paper, we summarize and critically examine the epidemiology and impact of perinatal mental disorders, including emerging evidence of an increase of their prevalence in young pregnant women. Perinatal mental disorders are among the commonest morbidities of pregnancy, and make an important contribution to maternal mortality, as well as to adverse neonatal, infant and child outcomes. We then review the current evidence base on interventions, including individual level and public health ones, as well as service delivery models. Randomized controlled trials provide evidence on the effectiveness of psychological and psychosocial interventions at the individual level, though it is not yet clear which women with perinatal mental disorders also need additional support for parenting. The evidence base on psychotropic use in pregnancy is almost exclusively observational. There is little research on the full range of perinatal mental disorders, on how to improve access to treatment for women with psychosocial difficulties, and on the effectiveness of different service delivery models. We conclude with research and clinical implications, which, we argue, highlight the need for an extension of generic psychiatric services to include preconception care, and further investment into public health interventions, in addition to perinatal mental health services, potentially for women and men, to reduce maternal and child morbidity and mortality.
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Affiliation(s)
- Louise M. Howard
- Section of Women's Mental Health, Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Hind Khalifeh
- Section of Women's Mental Health, Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
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Brown JVE, Wilson CA, Ayre K, South E, Molyneaux E, Trevillion K, Howard LM, Khalifeh H. Antidepressant treatment for postnatal depression. Hippokratia 2020. [DOI: 10.1002/14651858.cd013560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Jennifer Valeska Elli Brown
- University of York; Mental Health and Addiction Research Group, Department of Health Sciences; York UK
- University of York; Cochrane Common Mental Disorders; York UK
| | - Claire A Wilson
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Karyn Ayre
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Emily South
- University of York; Centre for Reviews and Dissemination; York UK
| | - Emma Molyneaux
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Kylee Trevillion
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Louise M Howard
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Hind Khalifeh
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
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Ponting C, Mahrer NE, Zelcer H, Schetter CD, Chavira DA. Psychological interventions for depression and anxiety in pregnant Latina and Black women in the United States: A systematic review. Clin Psychol Psychother 2020; 27:249-265. [PMID: 31960525 PMCID: PMC7125032 DOI: 10.1002/cpp.2424] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/10/2020] [Indexed: 12/19/2022]
Abstract
Black women and Latinas have more symptoms of depression and anxiety during pregnancy than do their non-Latina White counterparts. Although effective interventions targeting internalizing disorders in pregnancy are available, they are primarily tested with White women. This article reviews randomized controlled trials and non-randomized studies to better understand the effectiveness of psychological interventions for anxiety and depression during pregnancy in Latinas and Black women. Additionally, this review summarizes important characteristics of interventions such as intervention format, treatment modality, and the use of cultural adaptations. Literature searches of relevant research citation databases produced 68 studies; 13 of which were included in the final review. Most studies were excluded because their samples were not majority Latina or Black women or because they did not test an intervention. Of the included studies, three interventions outperformed a control group condition and showed statistically significant reductions in depressive symptoms. An additional two studies showed reductions in depressive symptoms from pretreatment to post-treatment using non-controlled designs. The remaining eight studies (seven randomized and one non-randomized) did not show significant intervention effects. Cognitive behavioral therapy was the modality with most evidence for reducing depressive symptoms in pregnant Black and Latina women. No intervention was found to reduce anxiety symptoms, although only two of the 13 measured anxiety as an outcome. Five studies made cultural adaptations to their treatment protocols. Future studies should strive to better understand the importance of cultural modifications to improve engagement and clinical outcomes with pregnant women receiving treatment for anxiety and depression.
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Affiliation(s)
- Carolyn Ponting
- Department of Psychology, University of California, Los
Angeles. Los Angeles, CA
| | - Nicole E. Mahrer
- Department of Psychology, University of California, Los
Angeles. Los Angeles, CA
- Department of Psychology, University of La Verne, La Verne,
CA
| | - Hannah Zelcer
- Department of Psychology, University of California, Los
Angeles. Los Angeles, CA
| | | | - Denise A. Chavira
- Department of Psychology, University of California, Los
Angeles. Los Angeles, CA
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Pettman D, O'Mahen H, Skoog Svanberg A, von Essen L, Axfors C, Blomberg O, Woodford J. Effectiveness and acceptability of cognitive-behavioural therapy based interventions for maternal peripartum depression: a systematic review, meta-analysis and thematic synthesis protocol. BMJ Open 2019; 9:e032659. [PMID: 31871258 PMCID: PMC6937015 DOI: 10.1136/bmjopen-2019-032659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/30/2019] [Accepted: 11/26/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Peripartum depression is a common mental health difficulty associated with a range of negative impacts for the mother, infant and wider family. This review will examine the effectiveness of cognitive-behavioural therapy (CBT) based interventions for peripartum depression. Secondary aims are to explore the effect of CBT-based interventions targeted at peripartum depression on novel secondary outcomes and moderators potentially associated with effectiveness. To date, there has been little examination of effect on important secondary outcomes (eg, anxiety, stress and parenting), nor clinical and methodological moderators. Further, this review aims to explore the acceptability of CBT-based interventions for women with peripartum depression and examine important adaptations for this population. METHODS AND ANALYSIS Electronic databases (e.g., MEDLINE; ISI Web of Science; CINAHL; CENTRAL; Prospero; EMBASE; ASSIA; PsychINFO; SCOPUS; And Swemed+) will be systematically searched. Database searches will be supplemented by expert contact, reference and citation checking, and grey literature. Primary outcomes of interest will be validated measures of symptoms of depression. A proposed meta-analysis will examine: (1) the overall effectiveness of psychological interventions in improving symptoms of depression (both self-reported and diagnosed major depression) in the peripartum period; (2) the impact of interventions on secondary outcomes (eg, anxiety, stress and parenting); (3) clinical and methodological moderators associated with effectiveness. A thematic synthesis will be conducted on qualitative data exploring the acceptability of CBT-based intervention for postpartum depression including participants' experience and perspectives of the interventions, satisfaction, barriers and facilitators to intervention use, intervention relevance to mothers' situations and suggestions for improvements to tailor interventions to the peripartum client group. ETHICS AND DISSEMINATION Formal ethical approval is not required by the National Ethical Review Board in Sweden as primary data will not be collected. The results will be disseminated through a peer-reviewed publication and inform the development of a new psychological intervention for peripartum depression. This study including protocol development will run from March 2019 to March 2020.
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Affiliation(s)
- Danelle Pettman
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Heather O'Mahen
- Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, UK
| | - Agneta Skoog Svanberg
- Reproductive Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Cathrine Axfors
- Reproductive Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Oscar Blomberg
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanne Woodford
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Forde R, Peters S, Wittkowski A. Psychological interventions for managing postpartum psychosis: a qualitative analysis of women's and family members' experiences and preferences. BMC Psychiatry 2019; 19:411. [PMID: 31856785 PMCID: PMC6923990 DOI: 10.1186/s12888-019-2378-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/27/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Postpartum psychosis is a rare, yet severe disorder, in which early identification and immediate intervention are crucial. Despite recommendations for psychological input, little is known about the types of psychological intervention reported to be helpful. The aim of this study was to explore the experiences, needs and preferences for psychological intervention from the perspective of women with postpartum psychosis and from the perspective of family members. METHODS Thirteen women and eight family members, including partners were interviewed. The data from these semi-structured interviews were audio-recorded, transcribed and inductively analysed using thematic analysis. RESULTS Twelve subthemes were identified and then organised around three main themes: 1) Seeking safety and containment, 2) Recognising and responding to the psychological impact and 3) Planning for the future. These themes highlight the temporal element of recovery from postpartum psychosis, because women's psychological needs and preferences changed over time. Emphasis was initially placed on ensuring safety, followed by a need to connect, process and adjust to their experiences. Additional needs were reported by women and family when planning for the future, including managing the fear of relapse and help to reach a decision about future pregnancies. CONCLUSION The results illustrate a range of areas in which psychological intervention could be delivered to facilitate and enhance recovery. Further research is needed to develop meaningful and effective psychological interventions and to investigate the most appropriate timing for this to be offered.
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Affiliation(s)
- R Forde
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - S Peters
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
| | - A Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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Bischoff M, Howland V, Klinger-König J, Tomczyk S, Schmidt S, Zygmunt M, Heckmann M, van den Berg N, Bethke B, Corleis J, Günther S, Liutkus K, Stentzel U, Neumann A, Penndorf P, Ludwig T, Hammer E, Winter T, Grabe HJ. Save the children by treating their mothers (PriVileG-M-study) - study protocol: a sequentially randomized controlled trial of individualized psychotherapy and telemedicine to reduce mental stress in pregnant women and young mothers and to improve Child's health. BMC Psychiatry 2019; 19:371. [PMID: 31775668 PMCID: PMC6880484 DOI: 10.1186/s12888-019-2279-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/10/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND As early as pregnancy, maternal mental stress impinges on the child's development and health. Thus, this may cause enhanced risk for premature birth, lowered fetal growth, and lower fetal birth weight as well as enhanced levels of the stress hormone cortisol and lowered levels of the bonding hormone oxytocin. Maternal stress further reduces maternal sensitivity for the child's needs which impairs the mother-child-interaction and bonding. Therefore, prevention and intervention studies on mental stress are necessary, beginning prenatally and applying rigorous research methodology, such as randomized controlled trials, to ensure high validity. METHODS A randomized controlled trial is used to assess the impact of psychotherapy and telemedicine on maternal mental stress and the child's mental and physical health. Mentally stressed pregnant women are randomized to an intervention (IG) and a not intervened control group. The IG receives an individualized psychotherapy starting prenatal and lasting for 10 months. Afterwards, a second randomization is used to investigate whether the use of telemedicine can stabilize the therapeutic effects. Using ecological momentary assessments and video recordings, the transfer into daily life, maternal sensitivity and mother-child-bonding are assessed. Psycho-biologically, the synchronicity of cortisol and oxytocin levels between mother and child are assessed as well as the peptidome of the colostrum and breast milk, which are assumed to be essential for the adaptation to the extra-uterine environment. All assessments are compared to an additional control group of healthy women. Finally, the results of the study will lead to the development of a qualification measure for health professionals to detect mental stress, to treat it with low-level interventions and to refer those women with high stress levels to mental health professionals. DISCUSSION The study aims to prevent the transgenerational transfer of psychiatric and somatic disorders from the mother to her child. The effects of the psychotherapy will be stabilized through telemedicine and long-term impacts on the child's and mothers' mental health are enhanced. The combination of psychotherapy, telemedicine and methodologies of ecological momentary assessment, video recording and bio banking are new in content-related and methodological manner. TRIAL REGISTRATION German Clinical Trials Register: DRKS00017065. Registered 02 May 2019. World Health Organization, Universal Trial Number: U1111-1230-9826. Registered 01 April 2019.
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Affiliation(s)
- M. Bischoff
- Department of Health and Prevention, Institute of Psychology, University Greifswald, Greifswald, Germany
| | - V. Howland
- Department of Neonatology and Paediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - J. Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - S. Tomczyk
- Department of Health and Prevention, Institute of Psychology, University Greifswald, Greifswald, Germany
| | - S. Schmidt
- Department of Health and Prevention, Institute of Psychology, University Greifswald, Greifswald, Germany
| | - M. Zygmunt
- Clinic and Polyclinic for Obstetrics and Gynecology, University Medicine Greifswald, Greifswald, Germany
| | - M. Heckmann
- Department of Neonatology and Paediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - N. van den Berg
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - B. Bethke
- Department of Health, Nursing and Administration, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - J. Corleis
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - S. Günther
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - K. Liutkus
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - U. Stentzel
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - A. Neumann
- Department of Health, Nursing and Administration, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - P. Penndorf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - T. Ludwig
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - E. Hammer
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - T. Winter
- Integrated Research Biobank, University Medicine Greifswald, Greifswald, Germany
| | - H. J. Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
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Dennis CL, Brown JVE, Brown HK. Interventions (other than psychosocial, psychological and pharmacological) for treating postpartum depression. Hippokratia 2019. [DOI: 10.1002/14651858.cd013460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Cindy-Lee Dennis
- University of Toronto; Lawrence S. Bloomberg Faculty of Nursing; Toronto ON Canada
- St. Michael’s Hospital; Li Ka Shing Knowledge Institute; Toronto ON Canada
| | - Jennifer Valeska Elli Brown
- University of York; Centre for Reviews and Dissemination; York UK
- University of York; Cochrane Common Mental Disorders; York UK
| | - Hilary K Brown
- University of Toronto; Department of Psychiatry; Toronto ON Canada
- University of Toronto Scarborough; Interdisciplinary Centre for Health & Society; Toronto Canada
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Bright KS, Charrois EM, Mughal MK, Wajid A, McNeil D, Stuart S, Hayden KA, Kingston D. Interpersonal psychotherapy for perinatal women: a systematic review and meta-analysis protocol. Syst Rev 2019; 8:248. [PMID: 31665077 PMCID: PMC6819345 DOI: 10.1186/s13643-019-1158-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/13/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Interpersonal psychotherapy (IPT) is an intervention that has established efficacy in the prevention and treatment of depressive disorders. Previous systematic reviews have not evaluated the effectiveness of IPT on symptoms of stress, anxiety, depression, quality of life, relationship satisfaction/quality, social supports, and an improved psychological sense of well-being. There is limited data regarding factors that moderate and mediate the effectiveness of IPT including the timing of the intervention or the mode of delivery of IPT intervention. The objective of this systematic review and meta-analysis is to evaluate the effectiveness, feasibility, and acceptability of IPT interventions to treat perinatal psychological distress and to summarize the evidence on predictors, mediators, and moderators of IPT. METHODS We will include peer-reviewed studies that recruited perinatal women. The search strategy will involve the following databases: MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials (Ovid), CINAHL with Full Text (EBSCO), Social Work Abstracts (EBSCO), SocINDEX with Full Text (EBSCO), Academic Search Complete (EBSCO), Family & Society Studies Worldwide (EBSCO), Family Studies Abstracts (EBSCO), and Scopus. Study inclusion criteria include (1) randomized controlled trials, quasi-experimental studies, and pre-post studies that evaluated the effectiveness of IPT; (2) qualitative studies that evaluated feasibility and acceptability of IPT; (3) study sample included and analyzed perinatal women; and (4) publication language was English. Using pilot-tested screening and data extraction forms, two reviewers will independently review studies in three steps: (1) abstract/title screening, (2) full-text screening of potentially accepted studies, and (3) data extraction of accepted studies. Disagreements will be resolved by a third reviewer. Studies will be aggregated for meta-synthesis and meta-analysis should the data allow for this. Two independent reviewers will grade methodological quality. DISCUSSION Findings from this review will inform future development and implementation of IPT intervention research for perinatal women. Identifying key factors of successful IPT interventions will inform intervention design and adaptation of IPT interventions to increase the likelihood that perinatal women will engage in and benefit from IPT interventions. This review will also identify key considerations for increasing the effectiveness of IPT interventions during the perinatal period. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019114292.
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Affiliation(s)
- Katherine S. Bright
- Faculty of Nursing, University of Calgary, PF2226, 2500 University Drive NW, Calgary, Alberta T2N 1N4 Canada
- Alberta Children’s Hospital Research Institute (ACHRI), Calgary, Alberta Canada
| | - Elyse M. Charrois
- Faculty of Nursing, University of Calgary, PF2226, 2500 University Drive NW, Calgary, Alberta T2N 1N4 Canada
| | - Muhammad Kashif Mughal
- Faculty of Nursing, University of Calgary, PF2226, 2500 University Drive NW, Calgary, Alberta T2N 1N4 Canada
| | - Abdul Wajid
- Faculty of Nursing, University of Calgary, PF2226, 2500 University Drive NW, Calgary, Alberta T2N 1N4 Canada
| | - Deborah McNeil
- Faculty of Nursing, University of Calgary, PF2226, 2500 University Drive NW, Calgary, Alberta T2N 1N4 Canada
- Alberta Children’s Hospital Research Institute (ACHRI), Calgary, Alberta Canada
- Alberta Health Services, Southport Atrium #2237, 10101 Southport Road, S.W., Calgary, Alberta Canada
| | - Scott Stuart
- Psychiatry/Psychological & Brain Sciences, University of Iowa, 1-293 MEB, W311 Seashore Hall, Iowa City, IA 55241-1407 USA
| | - K. Alix Hayden
- Libraries and Cultural Resources, University of Calgary, 2500 University Dr. N.W., Calgary, Alberta T2N 1N4 Canada
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, PF2226, 2500 University Drive NW, Calgary, Alberta T2N 1N4 Canada
- Alberta Children’s Hospital Research Institute (ACHRI), Calgary, Alberta Canada
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Abstract
The birth of a child is one of the greatest moments in the life of a parent. It brings joy, bliss, and exhilaration. However, for a variety of reasons, childbirth may also promote fear and anxiety. In some cases, childbearing can even cause considerable emotional distress that can ruthlessly influence the dynamics of the family. Perinatal depressive disorders are mood disorders that can affect mothers, and are considered one of the most common complications during and after pregnancy. Perinatal depressive disorders can have profound negative effects on personal and family life. These disorders can also have serious childrearing consequences. The auricular acupuncture microsystem has been used for a long time to treat emotional problems in both animals and humans. This system offers a safe approach to treat depressive states without side-effects or complications.
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Affiliation(s)
- Nader Soliman
- Alternative Medicine Center/Soliman Wellness Center, Rockville, Maryland, USA
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Ekrami F, Mohammad-Alizadeh Charandabi S, Babapour Kheiroddin J, Mirghafourvand M. The Effect of Counselling on Depression and Anxiety of Women with Unplanned Pregnancy: A Randomized Controlled Trial. Community Ment Health J 2019; 55:1047-1056. [PMID: 31183585 DOI: 10.1007/s10597-019-00428-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/03/2019] [Indexed: 12/13/2022]
Abstract
This randomized controlled trial was conducted on 80 Iranian pregnant women with unplanned pregnancy. The participants were randomly assigned to two groups of intervention and control. The intervention group received one to three sessions of individual counseling and six sessions of group counseling each week in six consecutive weeks, and the control group received routine care. The Edinburgh Postnatal Depression Scale and the Spielberger State-Trait Anxiety Inventory were completed by the participants before and 4 weeks after the intervention. There was no significant difference between groups in terms of socio-demographic characteristics, and the baseline depression and anxiety scores (P > 0.05). The depression and anxiety scales were completed before and 4 weeks after the intervention. The mean scores of depression, state anxiety, and trait anxiety were significantly lower in the counseling group than in the control group 4 weeks after the end of intervention. It is recommended that counseling should be provided for women with unplanned pregnancy.
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Affiliation(s)
- Fatemeh Ekrami
- Students' Research Committee, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Jalil Babapour Kheiroddin
- Department of Psychology, Faculty of Psychology and Educational Sciences, University of Tabriz, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Associate Professor, Social Determinants of Health Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran. .,Midwifery Department, Tabriz University of Medical Sciences, Tabriz, Iran.
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Thomson G, Balaam MC. International insights into peer support in a neonatal context: A mixed-methods study. PLoS One 2019; 14:e0219743. [PMID: 31365559 PMCID: PMC6668779 DOI: 10.1371/journal.pone.0219743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/02/2019] [Indexed: 11/18/2022] Open
Abstract
Peer support is a widely used intervention that offers information and emotional support to parents during their infant's admission to the neonatal unit and/or post-discharge. Despite its widespread use, there are no comprehensive insights into the nature and types of neonatal-related peer support, or the training and support offered to peer supporters. We aimed to bridge these knowledge gaps via an international study into neonatal peer support provision. A mixed-methods study comprising an online survey was issued to peer support services/organisations, and follow-up interviews held with a purposive sample of survey respondents. Survey/interview questions explored the funding, types of peer support and the recruitment, training and support for peer supporters. Descriptive and thematic analysis was undertaken. Thirty-one managers/coordinators/trainers and 77 peer supporters completed the survey from 48 peer support organisations/services in 16 different countries; with 26 interviews undertaken with 27 survey respondents. We integrated survey and interview findings into five themes: 'background and infrastructure of peer support services', 'timing, location and nature of peer support', 'recruitment and suitability of peer supporters', 'training provision' and 'professional and emotional support'. Findings highlight variations in the types of peer support provided, training and development opportunities, supervisory and mentoring arrangements and the methods of recruitment and support for peer supporters; with these differences largely related to the size, funding, multidisciplinary involvement, and level of integration of peer support within healthcare pathways and contexts. Despite challenges, promising strategies were reported across the different services to inform macro (e.g. to facilitate management and leadership support), meso (e.g. to help embed peer support in practice) and micro (e.g. to improve training, supervision and support of peer supporters) recommendations to underpin the operationalisation and delivery of PS provision.
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Affiliation(s)
- Gill Thomson
- Maternal and Infant Nutrition & Nurture (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, Lancashire, United Kingdom
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Marie-Clare Balaam
- ReaCH, School of Community Health and Midwifery, University of Central Lancashire, Preston, Lancashire, United Kingdom
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Sebastianski M, Gates M, Gates A, Nuspl M, Bialy LM, Featherstone RM, Breault L, Mason-Lai P, Hartling L. Evidence available for patient-identified priorities in depression research: results of 11 rapid responses. BMJ Open 2019; 9:e026847. [PMID: 31256024 PMCID: PMC6609077 DOI: 10.1136/bmjopen-2018-026847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/07/2019] [Accepted: 06/11/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Patient priority setting projects (PPSPs) can reduce research agenda bias. A key element of PPSPs is a review of available literature to determine if the proposed research priorities have been addressed, identify research gaps, recognise opportunities for knowledge translation (KT) and avoid duplication of research efforts. We conducted rapid responses for 11 patient-identified priorities in depression to provide a map of the existing evidence. DESIGN Eleven rapid responses. DATA SOURCES Single electronic database (PubMed). ELIGIBILITY CRITERIA Each rapid response had unique eligibility criteria. For study designs, we used a stepwise inclusion process that started with systematic reviews (SRs) if available, then randomised controlled trials and observational studies as necessary. RESULTS For all but one of the rapid responses we identified existing SRs (median 7 SRs per rapid response, range 0-179). There were questions where extensive evidence exists (ie, hundreds of primary studies), yet uncertainties remain. For example, there is evidence supporting the effectiveness of many non-pharmacological interventions (including psychological interventions and exercise) to reduce depressive symptoms. However, targeted research is needed that addresses comparative effectiveness of promising interventions, specific populations of interest (eg, children, minority groups) and adverse effects. CONCLUSIONS We identified an extensive body of evidence addressing patient priorities in depression and mapped the results and limitations of existing evidence, areas of uncertainty and general directions for future research. This work can serve as a solid foundation to guide future research in depression and KT activities. Integrated knowledge syntheses bring value to the PPSP process; however, the role of knowledge synthesis in PPSPs and methodological approaches are not well defined at present.
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Affiliation(s)
- Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Gates
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Allison Gates
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Megan Nuspl
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Liza M Bialy
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Robin M Featherstone
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lorraine Breault
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Ping Mason-Lai
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Patient Engagement Platform, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Hartling
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Wang D, Gao X, Cai Y, Tu D. Development of a New Instrument for Depression With Cognitive Diagnosis Models. Front Psychol 2019; 10:1306. [PMID: 31214095 PMCID: PMC6558113 DOI: 10.3389/fpsyg.2019.01306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/20/2019] [Indexed: 11/22/2022] Open
Abstract
Most existing instruments for depression are developed based on classical test theory, factor analysis, or sometimes, item response theory, and focus on the accurate measurement of the severity of depressive disorder. Nevertheless, they tend to be less useful in supporting the decision based on ICD-10 or DSM-5 because of the lack of detailed information for symptoms. To gain rich and valid information at the symptom level, this article developed a depression test under the framework of cognitive diagnosis models (CDMs), referred to as CDMs-D. A total of 1,181 individuals were finally recruited and their responses were used to examine the psychometric properties of CDMs-D. After excluding poor items for statistical reasons (e.g., low discrimination, poor model-fit or having DIF), 56 items were included in the CDMs-D. The CDMs-D measures all ten symptom criteria for depression defined in ICD-10 and covers five domains of depression defined by Gibbons et al. (2012). Comparing with the existing self-report measures (such as PHQ-9, SDS, CES-D and so on), a distinguishing feature of the CDMs-D is that it can provide both overall information about the severity of depressive disorder and the assessment information about specific symptoms, which could be useful for diagnostic and interventional purposes.
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Affiliation(s)
| | - Xuliang Gao
- School of Psychology, Jiangxi Normal University, Nanchang, China
| | - Yan Cai
- School of Psychology, Jiangxi Normal University, Nanchang, China
| | - Dongbo Tu
- School of Psychology, Jiangxi Normal University, Nanchang, China
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Karkou V, Aithal S, Zubala A, Meekums B. Effectiveness of Dance Movement Therapy in the Treatment of Adults With Depression: A Systematic Review With Meta-Analyses. Front Psychol 2019; 10:936. [PMID: 31130889 PMCID: PMC6509172 DOI: 10.3389/fpsyg.2019.00936] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 04/08/2019] [Indexed: 01/10/2023] Open
Abstract
Background: Depression is the largest cause of mental ill health worldwide. Although interventions such as Dance Movement Therapy (DMT) may offer interesting and acceptable treatment options, current clinical guidelines do not include these interventions in their recommendations mainly because of what is perceived as insufficient research evidence. The 2015 Cochrane review on DMT for depression includes only three studies leading to inconclusive results. In a small and underfunded field such as DMT, expensive multi-centered Randomized Controlled Trials (RCTs) are as yet rare. It is therefore, necessary to not only capture evidence from RCTs, but to also look beyond such designs in order to identify and assess the range of current evidence. Methods: We therefore conducted a systematic review of studies that aimed to explore the effectiveness in the use of DMT with people with depression. This led to a qualitative narrative synthesis. We also performed meta-analyses that calculated the effect size for all included studies, studies with RCT designs only, followed by a subgroup analysis and a sensitivity analysis. In all meta-analyses a random effects model was used with Standardized Mean Differences (SMD) to accommodate for the heterogeneity of studies and outcome measures. Results: From the 817 studies reviewed, eight studies were identified as meeting our inclusion criteria. Three hundred and fifty one people with depression (mild to severe) participated, 192 of whom attended DMT groups while receiving treatment as usual (TAU) and 159 received TAU only. Qualitative findings suggest there was a decrease in depression scores in favor of DMT groups in all studies. Subgroup analysis performed on depression scores before and 3 months after the completion of DMT groups suggested changes in favor of the DMT groups. When sensitivity analysis was performed, RCTs at high risk of bias were excluded, leaving only studies with adult clients up to the age of 65. In these studies, the highest effect size was found favoring DMT plus TAU for adults with depression, when compared to TAU only. Conclusions: Based on studies with moderate to high quality, we concluded that DMT is an effective intervention in the treatment of adults with depression. Furthermore, by drawing on a wide range of designs with diverse quality, we were able to compile a comprehensive picture of relevant trends relating to the use of DMT in the treatment of depression. Despite the fact that there remains a paucity of high-quality studies, the results have relevance to both policy-making and clinical practice, and become a platform for further research.
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Affiliation(s)
- Vicky Karkou
- Faculty of Health and Social Care, Faculty of Arts and Sciences, Edge Hill University, Ormskirk, United Kingdom
| | - Supritha Aithal
- Department of Performing Arts, Faculty of Arts and Sciences, Edge Hill University, Ormskirk, United Kingdom
| | - Ania Zubala
- Division of Rural Health and Wellbeing, Institute for Health Research and Innovation, University of the Highlands and Islands, Inverness, United Kingdom
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Buston K, O’Brien R, Wight D, Henderson M. The reflective component of the Mellow Bumps parenting intervention: Implementation, engagement and mechanisms of change. PLoS One 2019; 14:e0215461. [PMID: 30990855 PMCID: PMC6467403 DOI: 10.1371/journal.pone.0215461] [Citation(s) in RCA: 4] [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: 10/30/2018] [Accepted: 04/02/2019] [Indexed: 12/18/2022] Open
Abstract
Understanding why parenting programmes work or do not work, and for whom, is crucial for development of more effective parenting interventions. In this paper we focus on a specific component of Mellow Bumps: reflection on one's own childhood/past/life. We explore how this component was implemented, how participants engaged with it, the facilitating and constraining factors shaping this, whether and how it appeared to work, or not, and for whom. The paper analyses data from the Process Evaluation of the Trial of Healthy Relationships Initiatives for the Very Early years, which is evaluating two antenatal interventions delivered to vulnerable women, one of which is Mellow Bumps. Data were collected from January 2014 to June 2018 for 28 groups, 108 participants and 24 facilitators in a comprehensive and rigorous Process Evaluation designed to complement the Outcome Evaluation. Data were gathered at various time points using multiple methods, and were synthesised to triangulate findings. The reflective component was implemented with fidelity and participants engaged with it to varying degrees, dependent largely on the coherence of the group. Patchy attendance compromised the coherence of some groups, with the development of rapport, which is key to delivering reflective exercises, more difficult when group composition varied from week to week. Where there was a coherent group, powerful mechanisms of change, leading to stress reduction, included: relief through unburdening, empowerment through support given and received, reduced isolation through sharing anxieties, and control through self-care advice. A minority of highly vulnerable mothers seemed not to benefit from the reflective exercises and were marginalised within their groups. In order to minimise potential harmful effects of such exercises, allocation of participants to groups should strive to maximise group homogeneity. More research is needed to explore how very vulnerable parents can be supported in attending parenting interventions from start to finish.
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Affiliation(s)
- Katie Buston
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Rosaleen O’Brien
- Glasgow Caledonian University, Psychology, Social Work and Allied Health Professionals, School of Health and Life Sciences, Glasgow, United Kingdom
| | - Daniel Wight
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Marion Henderson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
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