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Den Besten-Bertholee D, Touw DJ, Damer EA, Mian P, Ter Horst PGJ. Sertraline, citalopram and paroxetine in lactation: passage into breastmilk and infant exposure. Front Pharmacol 2024; 15:1414677. [PMID: 38841362 PMCID: PMC11150716 DOI: 10.3389/fphar.2024.1414677] [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: 04/09/2024] [Accepted: 04/30/2024] [Indexed: 06/07/2024] Open
Abstract
Objectives This study aimed to investigate the plasma and breastmilk concentrations for sertraline, citalopram and paroxetine for assessment of the Milk/Plasma (M/P) ratio and Absolute Infant Dose (AID), and to determine actual infant drug exposure through breastfeeding. Subsequently, informed recommendations will be formulated regarding the advisability of breastfeeding in women undergoing treatment with the three most widely used antidepressants. Methods A pharmacokinetic study in lactating women and their infants using sertraline, citalopram or paroxetine was performed. Paired breastmilk and plasma samples and single point infant plasma samples were collected to determine antidepressant concentrations. An Area Under the Curve (AUC) based approach with the trapezoidal rule was used to calculate M/P ratios and AID for all three antidepressants by combining all measured concentrations for the same dose. Results Thirty-seven lactating women and their infants participated in this study. 111 paired breastmilk and plasma samples and 37 single point infant plasma samples were collected. Detectable concentrations of sertraline, citalopram and paroxetine were present in all breastmilk samples. For sertraline and citalopram M/P ratio is above one, indicating higher breastmilk than plasma concentrations, however, drug exposure by breastmilk did not lead to detectable plasma drug levels in any of the 15 infants for sertraline, for nine (out of 13) infants for citalopram and for eight (out of nine) infants for paroxetine. Conclusion Given the well-known benefits of breastfeeding, our findings support breastfeeding of infants by mothers who are taking sertraline, citalopram or paroxetine is safe. Sertraline and paroxetine are the preferred antidepressants during breastfeeding, reaching mostly undetectable infant drug levels.
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Affiliation(s)
| | - Daan J. Touw
- Groningen Research Institute of Pharmacy, Section Pharmaceutical Analysis, University of Groningen, Groningen, Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | | | - Paola Mian
- Groningen Research Institute of Pharmacy, Section Pharmaceutical Analysis, University of Groningen, Groningen, Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
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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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Waqas A, Zafar SW, Meraj H, Tariq M, Naveed S, Fatima B, Chowdhary N, Dua T, Rahman A. Prevention of common mental disorders among women in the perinatal period: a critical mixed-methods review and meta-analysis. Glob Ment Health (Camb) 2022; 9:157-172. [PMID: 36618726 PMCID: PMC9806961 DOI: 10.1017/gmh.2022.17] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 01/11/2023] Open
Abstract
Perinatal depression and anxiety account for a high burden of perinatal morbidity and poor psychosocial functioning. There is a growing interest among mental health professionals, to devise interventions to prevent this condition. This review synthesizes evidence for the effectiveness of psychological and psychosocial interventions aimed at the prevention of perinatal depression and anxiety. We also explore qualitative evidence to understand the acceptability and feasibility of these interventions. Using a mixed-methods approach, data from a total of 21 studies were collated to inform the evidence for preventive interventions for perinatal depression and anxiety. Based on their theoretical orientations, these interventions were described by authors as cognitive-behavioral (n = 7); psychoeducational (n = 6); mindfulness (n = 2); and interpersonal psychotherapy (n = 2). These also included psychosocial approaches such as social support (n = 1) and multicomponent interventions (n = 3). For depressive symptoms, these interventions yielded moderate to strong effect sizes in favor of the intervention group [standardized mean difference (SMD) = -0.59; 95% confidence interval (CI) -0.95 to -0.23]. For anxiety symptoms, a strong effect size was estimated in favor of the intervention group (SMD = -1.43, 95% CI -2.22 to -0.65). Preventive interventions significantly reduce the severity of perinatal depressive and anxiety symptoms. These interventions are also acceptable and feasible in many settings.
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Affiliation(s)
- Ahmed Waqas
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Hafsa Meraj
- Human Development Research Foundation, Islamabad, Pakistan
| | | | | | - Batool Fatima
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Neerja Chowdhary
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, UK
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Sikka P, Behl T, Sharma S, Sehgal A, Bhatia S, Al-Harrasi A, Singh S, Sharma N, Aleya L. Exploring the therapeutic potential of omega-3 fatty acids in depression. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:43021-43034. [PMID: 34121162 DOI: 10.1007/s11356-021-14884-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/09/2021] [Indexed: 06/12/2023]
Abstract
Omega-3 fatty acids have been acknowledged for their number of holdings on an individual's health. Not only in physical valuation but also in managing psychiatric disorders, omega-3 fatty acids have been found to be a powerful formula. It is proclaimed that depressive patients suffer anomaly with the levels of omega-3 polyunsaturated fatty acids in the body, coupled with insignificant EPA and DHA. Enhancement in brain functioning, neuronal functions, and paying attention in interacting with the brain cells are some of the additional tasks, being performed by the supplementation of omega-3 fatty acids. The leading and primary source via dietary supplementation involves the involvement of fish and fish products. These are hypothesized to be the best and dominant source for omega-3 fatty acids. Consumption of omega-3 fatty acid is well safe, that physician highly favors intake of these supplements, remarkably in the case of pregnant women. However, treating this serious life-threatening mental disorder leads to many adverse effects when treated with antidepressants. The dose range includes 1g/d to 10g/d, which is to be incorporated by the patient. It is also tested that the combination of EPA and DHA is found to be more efficacious for a person in treating and preventing depressive symptoms. Some studies verify the supplementation of omega-3 fatty acids in diet was coequally productive and successful with minimal side effects when analyzed with antidepressants. Despite these facts, much research is still needed and presently in process for long-term safety and studying the role of omega-3 fatty acids in human health.
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Affiliation(s)
- Priyanshi Sikka
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
| | - Sanchay Sharma
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Aayush Sehgal
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Saurabh Bhatia
- Amity Institute of Pharmacy, Amity University, Gurugram, Haryana, India
- Natural & Medical Sciences Research Centre, University of Nizwa, Birkat Al Mauz, Nizwa, Oman
| | - Ahmed Al-Harrasi
- Natural & Medical Sciences Research Centre, University of Nizwa, Birkat Al Mauz, Nizwa, Oman
| | - Sukhbir Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Neelam Sharma
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Lotfi Aleya
- Chrono-Environment Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, Besançon, France
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Grippi C. Factors That Influence Women's Symptoms of Postpartum Depression After Discharge of Their Preterm Infants From the NICU. J Obstet Gynecol Neonatal Nurs 2021; 50:610-620. [PMID: 34343485 DOI: 10.1016/j.jogn.2021.05.003] [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: 05/01/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To examine resourcefulness, perception of child vulnerability, and stress in relation to symptoms of postpartum depression (PPD) in women after discharge of their preterm infants from the NICU. DESIGN Cross-sectional, descriptive, correlational study. SETTING An urban NICU follow-up clinic, a pediatric office in the northeastern United States, and an online NICU parent support group. PARTICIPANTS Seventy-four women who gave birth to preterm infants who were discharged home from the NICU. METHODS The participants completed a demographic data questionnaire, the Resourcefulness Scale, Child Vulnerability Scale, Perceived Stress Scale, and Edinburgh Postnatal Depression Scale. I examined the relationships among these data using correlational analysis and hierarchical multiple linear regression analysis. RESULTS Perception of child vulnerability and stress were predictors of symptoms of PPD; these variables accounted for 9% (p = .001) and 18% (p < .001) of the variation in symptoms of PPD, respectively. Although resourcefulness initially predicted PPD, it was no longer significant when controlling for demographic variables in the final regression analysis. CONCLUSIONS These results supported previously reported findings on the effects of women's perceptions of their child's vulnerability and stress on symptoms of PPD. However, the findings are not consistent with those of previous research regarding the inverse relationship between resourcefulness and symptoms of PPD. Nurses can implement interventions for women regarding perceptions of child vulnerability and stress to decrease symptoms of PPD after their preterm infant's discharge from the NICU.
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Singla DR, Lawson A, Kohrt BA, Jung JW, Meng Z, Ratjen C, Zahedi N, Dennis CL, Patel V. Implementation and Effectiveness of Nonspecialist-Delivered Interventions for Perinatal Mental Health in High-Income Countries: A Systematic Review and Meta-analysis. JAMA Psychiatry 2021; 78:498-509. [PMID: 33533904 PMCID: PMC7859878 DOI: 10.1001/jamapsychiatry.2020.4556] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Task sharing-or training of nonspecialist providers with no formal training in counseling-is an effective strategy to improve access to evidence-based counseling interventions and has the potential to address the burden of perinatal depression and anxiety. OBJECTIVES To identify the relevant implementation processes (who, what, where, and how) and to assess the effectiveness of counseling interventions delivered by nonspecialist providers for perinatal depression and anxiety in high-income countries. DATA SOURCES CINAHL, Ovid MEDLINE, Ovid MEDLINE In-Process, PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials, and Embase through December 31, 2019. Relevant systematic reviews were also considered. STUDY SELECTION Randomized clinical trials of counseling interventions that assessed depression or anxiety after intervention, delivered by a nonspecialist provider for adults, and that targeted perinatal populations in a high-income country were included. Self-help interventions that did not include a provider component were excluded. DATA EXTRACTION AND SYNTHESIS Four researchers independently reviewed abstracts and full-text articles, and 2 independently rated the quality of included studies. Random-effects meta-analysis was used to estimate the benefits of the interventions. The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed. MAIN OUTCOMES AND MEASURES For implementation processes, the frequencies represented by a total or percentage were estimated, where the denominator is the total number of eligible trials, unless otherwise indicated. For effectiveness, primary and secondary outcome data of depression, anxiety, or both symptoms were used, with separate analyses for prevention and treatment, stratified by depression or anxiety. Subgroup analyses compared outcome types (anxiety vs depression) and study objectives (treatment vs prevention). RESULTS In total, 46 trials (18 321 participants) were included in the systematic review; 44 trials (18 101 participants) were included in the meta-analysis. Interventions were implemented across 11 countries, with the majority in Australia, UK, and US. Two-thirds (65%) of counseling interventions were provided by nurses and midwives, lasted a mean of 11.2 weeks (95% CI, 6.4-16.0 weeks), and most were delivered face to face (31 [67.4%]). Only 2 interventions were delivered online. A dearth of information related to important implementation processes, such as supervision, fidelity, and participant sociodemographic characteristics, was observed in many articles. Compared with controls, counseling interventions were associated with lower depressive symptoms (standardized mean difference [SMD], 0.24 [95% CI, 0.14-0.34]; 43 trials; I2 = 81%) and anxiety scores (SMD, 0.30 [95% CI, 0.11-0.50]; 11 trials; I2 = 80%). Treatment interventions were reported to be effective for both depressive symptoms (SMD, 0.38 [95% CI, 0.17-0.59]; 15 trials; I2 = 69%) and anxiety symptoms (SMD, 0.34 [95% CI, 0.09-0.58]; 6 trials; I2 = 71%). However, heterogeneity was high among the trials included in this analysis. CONCLUSIONS AND RELEVANCE This study found evidence in high-income countries indicating that nonspecialist providers may be effective in delivering counseling interventions. Additional studies are needed to assess digital interventions and ensure the reporting of implementation processes to inform the optimal delivery and scale-up of these services.
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Affiliation(s)
- Daisy R. Singla
- Department of Psychiatry, Sinai Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Lunenfeld Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Andrea Lawson
- Women’s College Hospital, Canada, Toronto, Ontario, Canada
| | - Brandon A. Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC
| | - James W. Jung
- Lunenfeld Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Zifeng Meng
- Lunenfeld Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Clarissa Ratjen
- Lunenfeld Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Nika Zahedi
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, St Michael’s Hospital, Ontario, Canada
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts,Sangath, Alto Porvorim, Goa, India
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Atuhaire C, Brennaman L, Cumber SN, Rukundo GZ, Nambozi G. The magnitude of postpartum depression among mothers in Africa: a literature review. Pan Afr Med J 2020; 37:89. [PMID: 33244352 PMCID: PMC7680231 DOI: 10.11604/pamj.2020.37.89.23572] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/21/2020] [Indexed: 11/12/2022] Open
Abstract
Introduction postpartum depression (PPD) continues to become one of the major maternal health challenges across the globe but there is a paucity of recent data on its magnitude in Africa. This study was motivated by the need to update the current magnitude of PPD in Africa based on various assessment tools. Methods a total of 21 articles met the study criteria. Fifteen articles used the EPDS and six used other assessment tools. Postpartum depression among studies that used EPDS tool ranged from 6.9% in Morocco to 43% in Uganda and 6.1% in Uganda to 44% in Burkina Faso among studies that used other depression assessment tools. Sensitivity and specificity results of the EPDS ranged from 75%-100% and 87%-98% respectively. Results a total of 21 articles met the study criteria. Fifteen articles used the EPDS and six used other assessment tools. Postpartum depression among studies that used EPDS tool ranged from 6.9% in Morocco to 43% in Uganda and 6.1% in Uganda to 44% in Burkina Faso among studies that used other depression assessment tools. Sensitivity and specificity results of the EPDS ranged from 75%-100% and 87%-98% respectively. Conclusion despite the limited dearth of literature, the magnitude of PPD in Africa remains high which suggests that PPD is still a neglected illness and calls for immediate interventions. EPDS is an effective tool with high sensitivity and specify in varying study contexts.
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Affiliation(s)
- Catherine Atuhaire
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Laura Brennaman
- Nova Southeastern University College of Nursing, Fort Myers Campus, 3650 Colonial Court, Fort Myers, Florida, United State of America
| | - Samuel Nambile Cumber
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa.,Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.,School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Institute of Health and Care Sciences, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Godfrey Zari Rukundo
- Faculty of Medicine, Department of Psychiatry, Mbarara University of Science and Technology, Uganda
| | - Grace Nambozi
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
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Effects of a health education program targeted to Chinese women adhering to their cultural practice of doing the month: A randomized controlled trial. Midwifery 2020; 90:102796. [PMID: 32726727 DOI: 10.1016/j.midw.2020.102796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/05/2020] [Accepted: 07/17/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND "Doing the month" is a prevalent Chinese postpartum custom which is believed to restore health after delivery. However, some traditional practices are potentially harmful for women's health. OBJECTIVES To examine the effect of an evidence-based health education program on Chinese postpartum women's adherence to traditional practices of doing the month and the effect of adherence to doing the month on maternal physiological and psychological health. METHODS A randomized controlled trial was conducted. During December 2016-July 2017, we recruited postpartum women at a tertiary hospital. Women randomized to the intervention group received evidence-based health education within 1 week after returning home and received a second visit 1 month later. The control group received routine postpartum home visits. Adherence to doing the month was measured by the Adherence to Doing-the-Month Practices questionnaire (ADP). Maternal physical health was measured by the Chair Stand Test and Postpartum Symptom Checklist. Maternal psychological health was measured by the Edinburgh Postnatal Depression Scale (EPDS). Descriptive statistics, t-test, and chi-squared test were used to analyze the differences in scores and symptoms of the two groups. RESULTS We recruited 124 eligible postpartum women and 108 of them (54 intervention group, 54 control group) completed this study. The ADP score of the intervention group was significantly lower than that of the control group (p < 0.001). The number of participants in the experimental group with poor appetite and indigestion was significantly lower than that of control group. No significant differences were found in numbers of symptoms and average EPDS scores between the 2 study groups (p > 0.05). CONCLUSIONS Evidence-based health education can reduce postpartum women's adherence to some traditional practices of doing the month and improve women's physical health.
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Examining the Impact of Body Satisfaction and Physical Activity Change on Postpartum Depressive Symptoms. J Phys Act Health 2020; 17:141-148. [PMID: 31855851 DOI: 10.1123/jpah.2019-0340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/21/2019] [Accepted: 10/13/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Relationships among moderate to vigorous physical activity (MVPA), body satisfaction, and postpartum depressive symptoms are not well understood. The purpose of this study is to examine the (1) impact of postpartum body satisfaction and changes in MVPA on postpartum depressive symptoms and (2) moderating effect of changes in MVPA over time on the relationship between postpartum body satisfaction and depressive symptoms. METHODS Participants (N = 269) self-reported body satisfaction, MVPA (prepregnancy through postpartum), and postpartum depressive symptoms. Differences in MVPA at 3 time points (prepregnancy, third trimester, and postpartum) were calculated to create change scores. Main effects and interactions (body satisfaction × MVPA change) were examined using multiple regression. RESULTS A majority of the sample did not meet MVPA recommendations at all time points. All body satisfaction measures were inversely related to postpartum depressive symptoms (P = .01 to <.001). MVPA change did not predict postpartum depressive symptoms (P = .43-.90) or moderate the relationship between body satisfaction and postpartum depressive symptoms (P = .14-.94). CONCLUSIONS Given the relationship between postpartum body satisfaction and depressive symptoms, intervention research should include strategies that promote positive postpartum body image; clinicians should consider screening for body dissatisfaction. Although not a predictor or moderator, pregnancy and postpartum MVPA promotion should continue, as it has numerous other benefits.
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Mahdi A, Dembinsky M, Bristow K, Slade P. Approaches to the prevention of postnatal depression and anxiety - a review of the literature. J Psychosom Obstet Gynaecol 2019; 40:250-263. [PMID: 30204522 DOI: 10.1080/0167482x.2018.1512577] [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] [Indexed: 10/28/2022] Open
Abstract
Introduction: Poor maternal mental health during the perinatal period has been shown to have potentially long-lasting effects for mother and child. In recognition of this, maternal mental health is receiving increased attention from political and healthcare organizations, with a growing focus on preventing the onset of common mental health disorders. Objective: The objective for this review is to provide an update of randomized controlled trials examining the use of interventions targeted to prevent the onset of postnatal depression and anxiety in nondiagnostic populations with universal or selected samples. Methods: A total of four databases, EBSCO Host, Science Direct, Scopus, and Web of Science, incorporating PsychINFO were searched and papers selected according to clearly specified inclusion criteria. A large Health Technology review was published in 2016, for which the final search was conducted in December 2012. Therefore inclusion criteria were studies published from January 2013 onwards, available in English language, had a focus on prevention of postnatal maternal depression and anxiety, and used psychological interventions. Drug intervention trials were excluded. Findings: 12 studies were identified as examining antenatal or postnatal intervention trials with an aim of preventing maternal postnatal depression and/or anxiety. There continues to be limited evidence to recommend specific prevention strategies for universal samples without further testing. There is evidence to suggest the use of rational-emotive behavioral therapy in an antenatal sample may have some utility, and the use of psychotherapy-based interventions in a postnatal setting is also supported although both require further investigation. Additionally, there is a need to gather information on acceptability, as many trials were hindered by poor adherence to interventions and high attrition that were otherwise unexplained.
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Affiliation(s)
- Amy Mahdi
- NHS Foundation Trust, Liverpool Women's Hospital , Liverpool , UK
| | - Melanie Dembinsky
- Institute of Psychology Health and Society, University of Liverpool , Liverpool , UK
| | - Katie Bristow
- Institute of Psychology Health and Society, University of Liverpool , Liverpool , UK.,Improving Mental Health, NIHR CLAHRC North West Coast, University of Liverpool , Liverpool , UK
| | - Pauline Slade
- Institute of Psychology Health and Society, University of Liverpool , Liverpool , UK
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O'Connor E, Senger CA, Henninger ML, Coppola E, Gaynes BN. Interventions to Prevent Perinatal Depression: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2019; 321:588-601. [PMID: 30747970 DOI: 10.1001/jama.2018.20865] [Citation(s) in RCA: 176] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Depression during pregnancy and the postpartum period is relatively common and can have adverse effects on both mother and child. OBJECTIVE To systematically review benefits and harms of primary care-relevant interventions to prevent perinatal depression, a major or minor depressive episode during pregnancy or up to 1 year after childbirth, to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMED (for publisher-supplied records only), PsycINFO, and the Cochrane Central Register of Controlled Trials; surveillance through December 5, 2018. STUDY SELECTION Randomized clinical trials (RCTs) and nonrandomized controlled intervention studies of interventions (eg, behavior-based, antidepressants, dietary supplements) to prevent perinatal depression in general populations of pregnant and postpartum individuals or in those at increased risk of perinatal depression. Large cohort studies were considered for harms of antidepressant use only. DATA EXTRACTION AND SYNTHESIS Two investigators independently reviewed abstracts and full-text articles and quality rated included studies. Random-effects meta-analysis was used to estimate the benefits of the interventions. MAIN OUTCOMES AND MEASURES Depression status; depression symptoms; maternal, infant, and child health outcomes. RESULTS Fifty studies (N = 22 385) that met inclusion criteria were identified. Counseling interventions were the most widely studied interventions. Compared with controls, counseling interventions were associated with a lower likelihood of onset of perinatal depression (pooled risk ratio [RR], 0.61 [95% CI, 0.47-0.78]; 17 RCTs [n = 3094]; I2 = 39.0%). The absolute difference in the risk of perinatal depression ranged from 1.3% greater reduction in the control group to 31.8% greater reduction in the intervention group. Health system interventions showed a benefit in 3 studies (n = 5321) and had a pooled effect size similar to that of the counseling interventions, but the pooled effect was not statistically significant using a method appropriate for pooling a small number of studies (restricted maximum likelihood RR, 0.58 [95% CI, 0.22-1.53]; n = 4738; I2 = 66.3%; absolute risk reduction range, -3.1% to -13.1%). None of the behavior-based interventions reported on harms directly. A smaller percentage of participants prescribed sertraline had a depression recurrence compared with those prescribed placebo (7% vs 50%, P = .04) at 20 weeks postpartum in 1 very small RCT (n = 22 analyzed) but with an increased risk of adverse effects to the mother. CONCLUSIONS AND RELEVANCE Counseling interventions can be effective in preventing perinatal depression, although most evidence was limited to women at increased risk for perinatal depression. A variety of other intervention approaches provided some evidence of effectiveness but lacked a robust evidence base and need further research.
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Affiliation(s)
- Elizabeth O'Connor
- Kaiser Permanente Research Affiliates Evidence-Based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Caitlyn A Senger
- Kaiser Permanente Research Affiliates Evidence-Based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Michelle L Henninger
- Kaiser Permanente Research Affiliates Evidence-Based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Erin Coppola
- Kaiser Permanente Research Affiliates Evidence-Based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Tachibana Y, Koizumi N, Akanuma C, Tarui H, Ishii E, Hoshina T, Suzuki A, Asano A, Sekino S, Ito H. Integrated mental health care in a multidisciplinary maternal and child health service in the community: the findings from the Suzaka trial. BMC Pregnancy Childbirth 2019; 19:58. [PMID: 30727996 PMCID: PMC6364479 DOI: 10.1186/s12884-019-2179-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Perinatal mental health problems such as mood disorders are common. We propose a new multidisciplinary health service intervention program providing continuous support to women and their children from the start of pregnancy till after childbirth. The aim of this study was to examine the effects of the program with respect to making women’s mental health better in the postpartum period and improving the state of care for women and their children in the perinatal period. Methods We performed a controlled study to investigate the effectiveness of the program in Suzaka City, Japan. The women’s mental health status was assessed using the Edinburgh Postnatal Depression Scale (EPDS) 3 months postpartum. Of 349 women, 210 were allocated to the intervention group and 139 to the control group. From April 2014 to March 2015, the number of the pregnant women who were followed-up by the multidisciplinary meeting in the intervention and control groups were 60 and 4, respectively. In the same period, the number of the pregnant women who were identified as requiring intensive care were 21 and 2, respectively. Results The total EPDS score, which was the primary outcome of the present study, differed significantly between the intervention and control groups (Mean [SD] = 2.74 (2.89) and 4.58 [2.62], respectively; p < 0.001). The number of the women receiving counseling from a public health nurse (5.3% in intervention group, 0.7% in control group, p = 0.02), attending maternal seminars (attendant ratio: 46% whereas 16%, p = 0.01), and receiving home visits by public health nurses (home visit ratio: 93.8% whereas 82.6%, p < 0.001) was significantly higher in the intervention group compared to the control group. Conclusions The present study indicates that continuum support provided by integrated mental health care through a multidisciplinary maternal and child health service in the community can make women's mental health better in the postpartum period and help women and their children receive more health services from public health nurses. Trial registration Name of registry: Research for the effectiveness of a multi-professional health service intervention program of continuum supports for mother and child which starts for pregnancy periods to enhance maternal mental health. UMIN Clinical Trials Registry number: UMIN000032424. Registration date: April 29th, 2018. Registration timing: retrospective. Electronic supplementary material The online version of this article (10.1186/s12884-019-2179-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yoshiyuki Tachibana
- Division of Infant and Toddler Mental Health, Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan.
| | - Noriaki Koizumi
- Nagano Prefectural Public Health Center for Mental Health, Nagano, Japan
| | | | - Hiromi Tarui
- Suzaka City Public Health Center, Nagano, Japan.,Nagano Nursing Association, Nagano, Japan
| | - Eizaburo Ishii
- Department of Pediatrics, Nagano Prefectural Suzaka Hospital, Nagano, Japan.,Department of Pediatric Palliative Care, Shinsei Hospital, Nagano, Japan
| | | | | | - Akiko Asano
- Suzaka City Public Health Center, Nagano, Japan
| | | | - Hiroto Ito
- Research Center for Overwork-Related Disorders, National Institute of Occupational Safety and Health, Japan Organization of Occupational Health and Safety, Kanagawa, Japan
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Kim K, Lee Y. The effects of depressive symptom management interventions on low‐income mothers: A systematic review and meta‐analysis. J Adv Nurs 2019; 75:1173-1187. [DOI: 10.1111/jan.13912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 09/21/2018] [Accepted: 09/27/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Kisook Kim
- College of Nursing Chung‐Ang University Seoul South Korea
| | - Yoonyoung Lee
- Department of Nursing Science Sunchon National University Suncheon, Jeonnam South Korea
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den Besten-Bertholee D, van der Meer DH, Ter Horst PGJ. Quality of Lactation Studies Investigating Antidepressants. Breastfeed Med 2019; 14:359-365. [PMID: 31013435 DOI: 10.1089/bfm.2019.0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: The aim of this study was to determine the quality of lactation studies investigating antidepressants in breast milk according to the Food and Drug Administration (FDA) draft guidelines and the article by Begg et al., 2002, published in the official journal of the International Lactation Consultant Association (ILCA). Materials and Methods: We used PubMed and LactMed® for the literature search. Furthermore, cross references were searched for additional studies. Results: A total number of 60 articles were included for review. For selective serotonin reuptake inhibitors and venlafaxine, only two studies correctly assessed the absolute infant dose and milk to plasma ratio; one sertraline and one fluoxetine study. Of all tricyclic antidepressants, one study for amitriptyline and one for nortriptyline assessed these endpoints correctly. We found a lack of information on breast milk sampling methods in many studies. Concentrations needed for the calculations were based on single measurements instead of at least five measurements during one dose interval, and the relative infant dose was not normalized by maternal weight, or an average maternal weight of 70 kg was used as a standard. Discussion: We conclude that the quality of the current literature on this topic does not meet the standards of the FDA. Studies of higher quality are needed to determine the extent of drug transfer to breast milk for antidepressants, so an adequate recommendation about use of these drugs during lactation can be given.
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Stigma and Postpartum Depression Treatment Acceptability Among Black and White Women in the First Six-Months Postpartum. Matern Child Health J 2018; 21:1457-1468. [PMID: 28102504 DOI: 10.1007/s10995-017-2263-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective To measure stigma associated with four types of postpartum depression therapies and to estimate the association between stigma and the acceptance of these therapies for black and white postpartum mothers. Methods Using data from two postpartum depression randomized trials, this study included 481 black and white women who gave birth in a large urban hospital and answered a series of questions at 6-months postpartum. Survey items included socio demographic and clinical factors, attitudes about postpartum depression therapies and stigma. The associations between race, stigma, and treatment acceptability were examined using bivariate and multivariate analyses. Results Black postpartum mothers were less likely than whites to accept prescription medication (64 vs. 81%, p = 0.0001) and mental health counseling (87 vs. 93%, p = 0.001) and more likely to accept spiritual counseling (70 vs. 52%, p = 0.0002). Women who endorsed stigma about receipt of postpartum depression therapies versus those who did not were less likely to accept prescription medication, mental health and spiritual counseling for postpartum depression. Overall black mothers were less likely to report stigma associated with postpartum depression therapies. In adjusted models, black women versus white women remained less likely to accept prescription medication for postpartum depression (OR = 0.42, 95% CI 0.24-0.72) and stigma did not explain this difference. Conclusions Although treatment stigma is associated with lower postpartum depression treatment acceptance, stigma does not explain the lower levels of postpartum depression treatment acceptance among black women. More research is needed to understand treatment barriers for postpartum depression, especially among black women.
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Shi P, Ren H, Li H, Dai Q. Maternal depression and suicide at immediate prenatal and early postpartum periods and psychosocial risk factors. Psychiatry Res 2018; 261:298-306. [PMID: 29331710 DOI: 10.1016/j.psychres.2017.12.085] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 07/01/2017] [Accepted: 12/31/2017] [Indexed: 01/27/2023]
Abstract
Maternal depression has been intensively explored; however, less attention has been paid to maternal suicide. No studies to date have observed maternal depression and suicide at immediate prenatal and early postpartum stages. In total, 213 Chinese women were recruited in hospitals after they were admitted for childbirth. All completed a short-term longitudinal survey at perinatal stages. Women reported lower depression scores (6.65) and higher suicidal ideation incidence (11.74%) after childbirth. Prenatal depression raised the possibility of prenatal suicidal ideation, while prenatal depression and suicidal ideation increased postpartum depression and suicidal ideation. At immediate prenatal stage, marital satisfaction protected women from depression, while miscarriage experiences and self-esteem increased the risk. At early postpartum stage, in contrast, being first-time mother, marital satisfaction, and harmony with mother-in-law prevented them from depression. Our study is among the first to confirm that women have decreased depression but increased suicidal ideation at early postpartum, and a causal relationship between them, which are worthy of public attention. Potential protective (marital satisfaction, being first-time mother, and harmony with mother-in-law) or risk factors (miscarriage experiences and self-esteem) of maternal depression and suicidal ideation are identified at perinatal stages. This offers reliable guidance for clinical practice of health care.
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Affiliation(s)
- Peixia Shi
- Department of nursing psychology, the Third Military Medical University, Chong qing 400038, China
| | - Hui Ren
- Department of nursing, the Third Military Medical University, Chong qing 400038, China
| | - Hong Li
- Psychology & Social College, Shenzhen University, Shenzhen 518060, China
| | - Qin Dai
- Department of nursing psychology, the Third Military Medical University, Chong qing 400038, China; Psychology & Social College, Shenzhen University, Shenzhen 518060, China.
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Cunningham SD, Mokshagundam S, Chai H, Lewis JB, Levine J, Tobin JN, Ickovics JR. Postpartum Depressive Symptoms: Gestational Weight Gain as a Risk Factor for Adolescents Who Are Overweight or Obese. J Midwifery Womens Health 2018; 63:178-184. [PMID: 29569357 PMCID: PMC5878115 DOI: 10.1111/jmwh.12686] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 07/13/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Obesity is a risk factor for adverse physical health outcomes during pregnancy. Much less is known about the association between obesity and maternal mental health. Evidence suggests that prenatal depression is associated with excessive weight gain during pregnancy and that this relationship may vary according to pregravid body mass index (BMI). Young women may be particularly vulnerable to postpartum depression. The objective of this study is to examine the association between prepregnancy BMI, gestational weight gain, and postpartum depressive symptoms among adolescents. METHODS Participants were 505 pregnant adolescents aged 14 to 21 years followed during pregnancy and 6 months postpartum. Data were collected via interviews and medical record abstraction. Multilevel linear mixed models were used to test the association between excessive gestational weight gain as defined by National Academy of Medicine Guidelines and postpartum depressive symptoms measured via the validated Center for Epidemiologic Studies Depression (CES-D) scale. Analyses controlled for sociodemographic factors (maternal age, race, ethnicity, relationship status), health behaviors (nutrition, physical activity), prenatal depressive symptoms, and postpartum weight retention. RESULTS Prepregnancy BMI was classified as follows: 11% underweight, 53% healthy weight, 19% overweight, and 18% obese. One-half (50%) of participants exceeded recommended guidelines for gestational weight gain. Adolescents with excessive gestational weight gain who entered pregnancy overweight or obese had significantly higher postpartum depressive symptoms (β, 2.41; SE, 1.06 vs β, 2.58; SE, 1.08, respectively; both P < .05) compared with those with healthy prepregnancy BMI and appropriate gestational weight gain. Adolescents who gained gestational weight within clinically recommended guidelines were not at risk for increased depressive symptoms. DISCUSSION Adolescents who enter pregnancy overweight or obese and experience excessive weight gain may be at increased risk for postpartum depressive symptoms. Health care providers should offer preventive interventions during pregnancy and the interconceptional period to support healthy weight gain and safeguard women's mental health.
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Morrell CJ, Sutcliffe P, Booth A, Stevens J, Scope A, Stevenson M, Harvey R, Bessey A, Cantrell A, Dennis CL, Ren S, Ragonesi M, Barkham M, Churchill D, Henshaw C, Newstead J, Slade P, Spiby H, Stewart-Brown S. A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression. Health Technol Assess 2018; 20:1-414. [PMID: 27184772 DOI: 10.3310/hta20370] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Postnatal depression (PND) is a major depressive disorder in the year following childbirth, which impacts on women, their infants and their families. A range of interventions has been developed to prevent PND. OBJECTIVES To (1) evaluate the clinical effectiveness, cost-effectiveness, acceptability and safety of antenatal and postnatal interventions for pregnant and postnatal women to prevent PND; (2) apply rigorous methods of systematic reviewing of quantitative and qualitative studies, evidence synthesis and decision-analytic modelling to evaluate the preventive impact on women, their infants and their families; and (3) estimate cost-effectiveness. DATA SOURCES We searched MEDLINE, EMBASE, Science Citation Index and other databases (from inception to July 2013) in December 2012, and we were updated by electronic alerts until July 2013. REVIEW METHODS Two reviewers independently screened titles and abstracts with consensus agreement. We undertook quality assessment. All universal, selective and indicated preventive interventions for pregnant women and women in the first 6 postnatal weeks were included. All outcomes were included, focusing on the Edinburgh Postnatal Depression Scale (EPDS), diagnostic instruments and infant outcomes. The quantitative evidence was synthesised using network meta-analyses (NMAs). A mathematical model was constructed to explore the cost-effectiveness of interventions contained within the NMA for EPDS values. RESULTS From 3072 records identified, 122 papers (86 trials) were included in the quantitative review. From 2152 records, 56 papers (44 studies) were included in the qualitative review. The results were inconclusive. The most beneficial interventions appeared to be midwifery redesigned postnatal care [as shown by the mean 12-month EPDS score difference of -1.43 (95% credible interval -4.00 to 1.36)], person-centred approach (PCA)-based and cognitive-behavioural therapy (CBT)-based intervention (universal), interpersonal psychotherapy (IPT)-based intervention and education on preparing for parenting (selective), promoting parent-infant interaction, peer support, IPT-based intervention and PCA-based and CBT-based intervention (indicated). Women valued seeing the same health worker, the involvement of partners and access to several visits from a midwife or health visitor trained in person-centred or cognitive-behavioural approaches. The most cost-effective interventions were estimated to be midwifery redesigned postnatal care (universal), PCA-based intervention (indicated) and IPT-based intervention in the sensitivity analysis (indicated), although there was considerable uncertainty. Expected value of partial perfect information (EVPPI) for efficacy data was in excess of £150M for each population. Given the EVPPI values, future trials assessing the relative efficacies of promising interventions appears to represent value for money. LIMITATIONS In the NMAs, some trials were omitted because they could not be connected to the main network of evidence or did not provide EPDS scores. This may have introduced reporting or selection bias. No adjustment was made for the lack of quality of some trials. Although we appraised a very large number of studies, much of the evidence was inconclusive. CONCLUSIONS Interventions warrant replication within randomised controlled trials (RCTs). Several interventions appear to be cost-effective relative to usual care, but this is subject to considerable uncertainty. FUTURE WORK RECOMMENDATIONS Several interventions appear to be cost-effective relative to usual care, but this is subject to considerable uncertainty. Future research conducting RCTs to establish which interventions are most clinically effective and cost-effective should be considered. STUDY REGISTRATION This study is registered as PROSPERO CRD42012003273. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- C Jane Morrell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Sutcliffe
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Stevens
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alison Scope
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rebecca Harvey
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alice Bessey
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy-Lee Dennis
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Shijie Ren
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Margherita Ragonesi
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Michael Barkham
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Dick Churchill
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Carol Henshaw
- Division of Psychiatry, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Jo Newstead
- Nottingham Experts Patients Group, Clinical Reference Group for Perinatal Mental Health, Nottingham, UK
| | - Pauline Slade
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Stewart-Brown
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I. Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries. Front Psychiatry 2018; 8:248. [PMID: 29449816 PMCID: PMC5799244 DOI: 10.3389/fpsyt.2017.00248] [Citation(s) in RCA: 300] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/07/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) poses a major global public health challenge. PPD is the most common complication associated with childbirth and exerts harmful effects on children. Although hundreds of PPD studies have been published, we lack accurate global or national PPD prevalence estimates and have no clear account of why PPD appears to vary so dramatically between nations. Accordingly, we conducted a meta-analysis to estimate the global and national prevalence of PPD and a meta-regression to identify economic, health, social, or policy factors associated with national PPD prevalence. METHODS We conducted a systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To test for country level predictors, we drew on data from UNICEF, WHO, and the World Bank. Random effects meta-regression was used to test national predictors of PPD prevalence. FINDINGS 291 studies of 296284 women from 56 countries were identified. The global pooled prevalence of PPD was 17.7% (95% confidence interval: 16.6-18.8%), with significant heterogeneity across nations (Q = 16,823, p = 0.000, I2 = 98%), ranging from 3% (2-5%) in Singapore to 38% (35-41%) in Chile. Nations with significantly higher rates of income inequality (R2 = 41%), maternal mortality (R2 = 19%), infant mortality (R2 = 16%), or women of childbearing age working ≥40 h a week (R2 = 31%) have higher rates of PPD. Together, these factors explain 73% of the national variation in PPD prevalence. INTERPRETATION The global prevalence of PPD is greater than previously thought and varies dramatically by nation. Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.
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Affiliation(s)
- Jennifer Hahn-Holbrook
- Department of Psychology, University of California, Merced, Merced, CA, United States
- Center for Excellence in Biopsychosocial Approaches to Health, Chapman University, Orange, CA, United States
| | | | - Itzel Anaya
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
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Nguyen J. A Literature Review of Alternative Therapies for Postpartum Depression. Nurs Womens Health 2017; 21:348-359. [PMID: 28987208 DOI: 10.1016/j.nwh.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/07/2017] [Indexed: 06/07/2023]
Abstract
Postpartum depression is a debilitating disorder that requires greater awareness and treatment. Depending on severity of symptoms, standard treatment calls for individual psychotherapy and medication. Although postpartum depression can lead to negative health outcomes for women and their offspring, numerous barriers prevent women from receiving appropriate care. A review of the literature shows that nontraditional modes of psychotherapy dominate recent studies, whereas data for other complementary options are severely lacking. Further research is needed to help identify cost-effective alternative therapies for treating postpartum depression. Combined with prevention and screening, treatment options that suit women's varied situations and preferences must be explored to increase reception and adherence to treatment and, ultimately, to improve outcomes.
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Almalik MM. Understanding maternal postpartum needs: A descriptive survey of current maternal health services. J Clin Nurs 2017; 26:4654-4663. [PMID: 28329433 DOI: 10.1111/jocn.13812] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVE To assess mothers' learning needs and concerns after giving birth and to examine whether these needs were met at 6-8 weeks postpartum. BACKGROUND Women experience many physiologic and psychological changes during postpartum period, which is considered a vital transitional time. Exploring and meeting women's needs help woman to pass this period with little complications and enhance healthcare provider's ability to provide appropriate care following childbirth. DESIGN A prospective cohort design was employed in this study. METHODS A prospective cohort design was employed. A convenience sample of 150 postpartum women have completed perceived leaning needs scale prior to hospital discharge, at southern region of Jordan, and have completed perceived met learning needs scale at 6-8 weeks after giving birth. RESULTS Women reported a high level of concern across all eight learning needs subscales. The most common concerns were related to new baby care, episiotomy care and breastfeeding. At 6-8 weeks postpartum, the primary unmet learning needs postpartum were danger signs post-Caesarean section, physical changes, breastfeeding and new baby care. Attending postpartum check-up clinic was found as a significant predictor for postpartum meeting women's needs, particularly emotional changes and family planning-related information. CONCLUSIONS The current maternal health services are not at the optimum level to meet women's individual needs and concerns, which could increase the risk for postpartum complications. Some women's characteristics, such as employment status and educational level, have increased women's concerns and unmet needs in some of the learning needs. RELEVANCE TO CLINICAL PRACTICE Healthcare providers and policymakers should consider women's concerns and needs at early postpartum period to establish patient-centred postpartum care that is based on women's needs and concerns during this transitional period, with a focus on newborn baby care, episiotomy care and breastfeeding.
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Affiliation(s)
- Mona Ma Almalik
- Department of Maternal and Child Health Nursing, Faculty of Nursing, Mutah University, Karak, Jordan
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22
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Michiels Y. De quoi parlons-nous avec nos patients ? ACTUALITES PHARMACEUTIQUES 2017. [DOI: 10.1016/j.actpha.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Leventhal H, Phillips LA, Burns E. The Common-Sense Model of Self-Regulation (CSM): a dynamic framework for understanding illness self-management. J Behav Med 2016. [PMID: 27515801 DOI: 10.1007/10865-016-9782-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The Common-Sense Model of Self-Regulation (the "Common-Sense Model", CSM) is a widely used theoretical framework that explicates the processes by which patients become aware of a health threat, navigate affective responses to the threat, formulate perceptions of the threat and potential treatment actions, create action plans for addressing the threat, and integrate continuous feedback on action plan efficacy and threat-progression. A description of key aspects of the CSM's history-over 50 years of research and theoretical development-makes clear the model's dynamic underpinnings, characteristics, and assumptions. The current article provides this historical narrative and uses that narrative to highlight dynamic aspects of the model that are often not evaluated or utilized in contemporary CSM-based research. We provide suggestions for research advances that can more fully utilize these dynamic aspects of the CSM and have the potential to further advance the CSM's contribution to medical practice and patients' self-management of illness.
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Affiliation(s)
- Howard Leventhal
- Institute for Health and Department of Psychology, Rutgers University, 112 Paterson St, New Brunswick, NJ, 08901, USA
| | - L Alison Phillips
- Department of Psychology, Iowa State University, Ames, IA, 50011, USA.
| | - Edith Burns
- Division of Geriatrics, Medical College of Wisconsin, Milwaukee, WI, 53295, USA
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The Common-Sense Model of Self-Regulation (CSM): a dynamic framework for understanding illness self-management. J Behav Med 2016; 39:935-946. [DOI: 10.1007/s10865-016-9782-2] [Citation(s) in RCA: 364] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/02/2016] [Indexed: 12/15/2022]
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25
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Norhayati MN, Nik Hazlina NH, Aniza AA, Asrenee AR. Severe Maternal Morbidity and Postpartum Depressive Symptomatology: A Prospective Double Cohort Comparison Study. Res Nurs Health 2016; 39:415-425. [DOI: 10.1002/nur.21741] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Mohd Noor Norhayati
- Associate Professor; Department of Family Medicine; School of Medical Sciences; Universiti Sains Malaysia; 16150 Kota Bharu Kelantan Malaysia
| | - Nik Hussain Nik Hazlina
- Women's Health Development Unit; School of Medical Sciences; Universiti Sains Malaysia; Kota Bharu Kelantan Malaysia
| | - Abd Aziz Aniza
- Faculty of Medicine; Universiti Sultan Zainal Abidin; Kuala Terengganu Terengganu Malaysia
| | - Ab Razak Asrenee
- Department of Psychiatry; School of Medical Sciences; Universiti Sains Malaysia; Kota Bharu Kelantan Malaysia
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Bodnar-Deren S, Klipstein K, Fersh M, Shemesh E, Howell EA. Suicidal Ideation During the Postpartum Period. J Womens Health (Larchmt) 2016; 25:1219-1224. [PMID: 27227751 DOI: 10.1089/jwh.2015.5346] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the association between suicidal ideation (SI), 3 weeks, 3 months, and 6 months postpartum with demographic, psychosocial, clinical factors, and depressive/anxiety symptoms (measured 24-48 hours after delivery), among a cohort of postpartum women. METHODS This study included 1,073 mothers who gave birth in a large tertiary New York City hospital (2009-2010). Later, self-report SI was assessed using the suicide measure from the Edinburgh Postnatal Depression Scale and from the Patient Health Questionnaire. RESULTS Two percent of participants presented with SI during the first 6 months postpartum. In bivariate analyses, race/ethnicity, nativity, insurance, and language were significantly correlated with SI 3 weeks, 3 months, and 6 months postpartum. Screening positive for depression (p = 0.0245) and anxiety (0.0454), assessed 1-2 days postpartum, was significantly correlated with later SI in bivariate analyses, as were antepartum complications (p = 0.001), depressive history (0.001), and self-efficacy (0.045). In adjusted models, antepartum complications (OR = 4.681, 95% CI = 1.99-10.99) and depressive history (OR-3.780, 95% CI = 1.514-9.441) were significantly associated with later postpartum SI. Heightened self-efficacy reduced the odds of later SI (p = 0.050). CONCLUSION Findings suggest that SI among a relatively healthy group of new mothers occurs with some frequency. Mothers with a history of depression and antepartum complications may be at increased risk.
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Affiliation(s)
- Susan Bodnar-Deren
- 1 Department of Sociology and Institute of Women's Health, Virginia Commonwealth University , Richmond, Virginia
| | - Kimberly Klipstein
- 2 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Madeleine Fersh
- 2 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York.,3 Department of Psychiatry, North Shore LIJ, Zucker Hillside Hospital , Glen Oaks, New York
| | - Eyal Shemesh
- 2 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York.,4 Department of Pediatrics, Icahn School of Medicine at Mount Sinai , New York, New York.,5 Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Elizabeth A Howell
- 2 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York.,5 Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai , New York, New York.,6 Population Health Science and Policy, Icahn School of Medicine at Mount Sinai , New York, New York
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Abstract
Using data from two postpartum depression randomized trials, we examined the association between postpartum depressive symptoms and parenting practices among a diverse group of mothers. We examined the association between safety practices (back sleep position, car seat use, smoke alarm), feeding practices (breastfeeding, infant intake of cereal, juice, water), and health care practices (routine well child and Emergency Room (ER) visits) with 3-month postpartum depressive symptoms assessed using the Edinburgh Depression Scale (EPDS ≥10). Fifty-one percent of mothers were black or Latina, 33 % had Medicaid, and 30 % were foreign born. Depressed mothers were less likely to have their infant use back sleep position (60 vs. 79 %, p < .001), always use a car seat (67 vs. 84 %, p < .001), more likely to feed their infants water, juice, or cereal (36 vs. 25 %, p = .04 respectively), and to bring their babies for ER visits (26 vs. 16 %, p = .03) as compared with non-depressed mothers. In multivariable model, depressed mothers remained less likely to have their infant use the back sleep position, to use a car seat, and to have a working smoke alarm in the home. Findings suggest the need to intervene early among mothers with depressive symptoms and reinforce positive parenting practices.
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Postpartum depression among first-time mothers – results from a parallel randomised trial. SEXUAL & REPRODUCTIVE HEALTHCARE 2015; 6:95-100. [DOI: 10.1016/j.srhc.2015.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 01/04/2015] [Accepted: 01/07/2015] [Indexed: 11/21/2022]
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Norhayati MN, Hazlina NHN, Asrenee AR, Emilin WMAW. Magnitude and risk factors for postpartum symptoms: a literature review. J Affect Disord 2015; 175:34-52. [PMID: 25590764 DOI: 10.1016/j.jad.2014.12.041] [Citation(s) in RCA: 457] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND The prevalence of postpartum depression worldwide varies from 0.5% to 60.8% in the first 12 months postpartum using self-reported questionnaire. This review aims to update the current magnitude of postpartum depression based on self-reported questionnaire and clinical interview and explore its associated factors in developed and developing countries. METHODS A literature search conducted between 2005 and 2014 identified 203 studies, of which 191 used self-reported questionnaire in 42 countries and 21 used structured clinical interview in 15 countries. Nine studies used a combination of self-reported questionnaire and clinical interview. RESULT The prevalence of postpartum depression varies from 1.9% to 82.1% in developing countries and from 5.2% to 74.0% in developed countries using self-reported questionnaire. Structured clinical interview shows a much lower prevalence range from 0.1% in Finland to 26.3% in India. Antenatal depression and anxiety, previous psychiatric illness, poor marital relationship, stressful life events, negative attitude towards pregnancy, and lack of social support are significant contributors to postpartum depression. LIMITATION All studies are included irrespective of the methodological quality, such as small sample size and their inclusion could affect the generalizability of the results. CONCLUSION The current prevalence of postpartum depression is much higher than that previously reported, and similar risk factors are documented. A culturally sensitive cut-off score with adequate psychometric properties of the screening instruments should be available. In future studies, examining the physical, biological, and cultural factors in qualitative studies and in those with adequate methodological qualities is recommended.
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Affiliation(s)
- M N Norhayati
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia.
| | - N H Nik Hazlina
- Women Health Development Unit, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - A R Asrenee
- Department of Psychiatry, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - W M A Wan Emilin
- Perpustakaan Hamdan Tahir, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
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