Interventions for the prevention of postpartum depression in adolescent mothers: a systematic review

The Effectiveness of Preventative Interventions to Reduce Mental Health Problems in at-risk Children and Young People: A Systematic Review of Reviews

Mental health problems are the leading cause of childhood disability worldwide, resulting in poor outcomes for children and young people that persist into adulthood. It is essential that those young people most at risk of developing mental health problems receive effective preventative interventions. Whilst there have been a number of systematic reviews which have examined the effectiveness of secondary prevention interventions for specific groups of children and young people, or to address identified mental health concerns, no review has engaged with the breadth of this literature. We conducted a systematic review of systematic reviews to map this complex field of secondary preventative interventions and identify effective interventions to prevent mental health problems in children and adolescents aged 3-17 years. The review protocol was registered on PROSPERO. We searched five electronic databases from inception to February 2023. The certainty of the evidence was appraised using the AMSTAR 2. We included 49 unique systematic reviews each including between 2 and 249 (mean 34) unique studies; the majority of which were reviews which included only or mostly randomised controlled trials (70%). The reviews examined selective interventions (defined as interventions which are delivered to sub-group populations of young people at increased risk of mental health problems) (n = 22), indicated interventions (defined as interventions which target young people who are found to have pre-clinical symptoms) (n = 15) or a synthesis of both (n = 12). The certainty of the evidence in the reviews was rated as high, (n = 12) moderate (n = 5), low (n = 9) and critically low (n = 23). We found evidence to support both selective and indicated interventions in a range of populations and settings, with most of this evidence available for children and young people in their mid-years (6-10 years) and early adolescence (11-13 years). There was a large body of evidence suggesting that resilience enhancing, cognitive behaviour therapy-based and psychoeducational interventions for children who experience adversity, or those with subclinical externalising problems may offer promise. Early selective interventions for a subpopulation of children and young people who have experienced adversity which combines risk reduction and resilience enhancing approaches directed at children and their families may be effective at reducing mental health problems.

Interventions to reduce inequalities for pregnant women living with disadvantage in high-income countries: an umbrella review protocol

BACKGROUND

Women who live with disadvantages such as socioeconomic deprivation, substance misuse, poor mental health, or domestic abuse face inequalities in health before, during, and after pregnancy and for their infants through to childhood. Women do not experience these factors alone; they accumulate and interact. Therefore, there is a need for an overview of interventions that work across health and social care and target women at risk of inequalities in maternal or child health.

METHODS

Systematic review methodology will be used to identify systematic reviews from high-income countries that describe interventions aiming to reduce inequalities for women who experience social disadvantage during pregnancy. We will describe the range of interventions and their effectiveness in reducing inequalities in maternal or child health. Any individual, hospital, or community-level activity specific to women during the pre-conception, antenatal, or postpartum period up to 1 year after birth will be included, regardless of the setting in which they are delivered. We will search eight electronic databases with the pre-determined search strategy and supplement them with extensive grey literature searches. We will present a narrative synthesis, taking into account the quality assessment and coverage of included studies.

DISCUSSION

Inequalities in maternal and child health are a key priority area for national policymakers. Understanding the range and effectiveness of interventions across the perinatal period will inform policy and practice. Identifying gaps in the evidence will inform future research.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42023455502.

Long-term effects on depressive symptoms among Ugandan mothers - Findings from a follow-up of a cluster-randomized education trial in a rural low-resource setting

INTRODUCTION

Depression is increasingly affecting mothers in poor countries such as Uganda. Various interventions have been implemented to tackle this problem, but their sustainability is under-researched. Here we present follow-up data on maternal depression six years after a cluster-randomized controlled maternal education trial in rural Uganda.

METHODS

The intervention lasted six months and consisted of nutrition, hygiene, sanitation and child stimulation education, delivered to 511 mothers of 6 to 8 months' old children. Six years later we assessed maternal depressive symptoms using two psychometric tools; the Beck Depression Inventory II (BDI-II) and Center for Epidemiologic Studies Depression scale (CESD).

RESULTS

For this follow-up study, data was available from 307/511 (60 %) mothers. Intention-to-treat analyses adjusting for clustering showed that the intervention mothers had non-significantly less depression symptoms (absolute score difference - 2; 95 % CI -5 to 0; p = 0.07) on BDI-II, and borderline significantly less depression symptoms (absolute score difference - 3; 95 % CI -5 to 0; p = 0.05) on CES-D compared to the controls. For categorized depression scores, the control mothers had significantly higher proportion of women classified in the worse depression categories for both BDI-II and CESD. We did not find any baseline characteristics associated with maternal depression.

LIMITATIONS

The BDI-II and CES-D tools are both self-reported and we cannot rule out the possibility of social desirability bias in reporting of depression symptoms.

CONCLUSION

Six years after the maternal education trial, some benefits on maternal mental health were sustained. More studies are warranted on sustainability and scale-up of such interventions.

A qualitative analysis of adolescent motherhood within the broader family context in Peru

Objective

The purpose of this study was to characterize the impact of adolescent pregnancy on families and describe the needs of adolescent mothers and their infants in order to assess the need for intervention and identify potential intervention targets.

Background

Adolescent mothers and their offspring face an increased risk of mental health problems. Adolescent mothers and their families also face significant resource constraints; 95% live in low- and middle-income countries (LMICs). Cost-effective interventions are needed to improve outcomes for this vulnerable group.

Method

This qualitative study conducted in Lima, Peru, consisted of four clinician focus groups and 18 in-depth interviews with adolescent mothers and their family members. Data were coded thematically, and direct content analysis was employed.

Results

The study identified the following issues facing adolescent parents: the transition to parenthood, the need for family support, difficulty accessing support, the difficulty for family members of providing support, and ideas about responsibility and adolescent autonomy.

Conclusion

Overall, these findings demonstrate the need for interventions that engage families and address barriers to accessing support, including relationship conflict and differing beliefs about responsibility and autonomy.

Implications

Interventions are needed for adolescent mothers in LMICs that mobilize family support. Clinicians who care for these patients need to be aware of the family context and the resources available where they practice.

Timing theory integrated nursing combined behavior change integrated theory of nursing on primiparous influence

BACKGROUND

The comprehension and utilization of timing theory and behavior change can offer a more extensive and individualized provision of support and treatment alternatives for primipara. This has the potential to enhance the psychological well-being and overall quality of life for primipara, while also furnishing healthcare providers with efficacious interventions to tackle the psychological and physiological obstacles encountered during the stages of pregnancy and postpartum.

AIM

To explore the effect of timing theory combined with behavior change on self-efficacy, negative emotions and quality of life in patients with primipara.

METHODS

A total of 80 primipara cases were selected and admitted to our hospital between August 2020 and May 2022. These cases were divided into two groups, namely the observation group and the control group, with 40 cases in each group. The nursing interventions differed between the two groups, with the control group receiving routine nursing and the observation group receiving integrated nursing based on the timing theory and behavior change. The study aimed to compare the pre- and post-nursing scores of Chinese Perceived Stress Scale (CPSS), Edinburgh Postpartum Depression Scale (EPDS), Self-rating Anxiety Scale (SAS), breast milk knowledge, self-efficacy, and SF-36 quality of life in both groups.

RESULTS

After nursing, the CPSS, EPDS, and SAS scores of the two groups was significantly lower than that before nursing, and the CPSS, EPDS, and SAS scores of the observation group was significantly lower than that of the control group (P = 0.002, P = 0.011, and P = 0.001 respectively). After nursing, the breastfeeding knowledge mastery, self-efficacy, and SF-36 quality of life scores was significantly higher than that before nursing, and the breastfeeding knowledge mastery (P = 0.013), self-efficacy (P = 0.008), and SF-36 quality of life (P = 0.011) scores of the observation group was significantly higher than that of the control group.

CONCLUSION

The integration of timing theory and behavior change integrated theory has been found to be an effective approach in alleviating negative mood and stress experienced by primipara individuals, while also enhancing their self-efficacy and overall quality of life. This study focuses on the key concepts of timing theory, behavior change, primipara individuals, negative mood, and quality of life.

Psychoeducation as an active ingredient for interventions for perinatal depression and anxiety in youth: a mixed-method systematic literature review and lived experience synthesis

BACKGROUND

Psychoeducation is a common element in psychological interventions for youth depression and anxiety, but evidence about its use with youth perinatally is limited.

AIMS

This review aims to understand outcomes and mechanisms of psychoeducation for the indicated prevention and treatment of perinatal depression and anxiety in youth.

METHOD

For this review, we synthesised published quantitative and qualitative evidence. Seven databases (ASSIA, Medline, PubMed, PsycINFO, PsycArticles, Scopus and Web of Science) were searched for studies published before 10 August 2021. We also had consultations with a youth advisory group (N = 12).

RESULTS

In total, 20 studies met the inclusion criteria. Seven quantitative studies examined multicomponent interventions that included psychoeducation, and one study evaluated psychoeducation as a standalone intervention for postnatal depression. Multicomponent interventions showed significant effects on postnatal depression in two out of six studies, as well as being effective at reducing prenatal anxiety in one study. Standalone psychoeducation for postnatal depression was also effective in one study. Evidence from 12 qualitative studies, corroborated by commentaries from the youth advisory group, suggested that psychoeducation could increase knowledge about symptoms, generate awareness of relevant services and enhance coping.

CONCLUSIONS

Psychoeducation may be an important foundational ingredient of interventions for perinatal depression and, potentially, anxiety in adolescents and young adults through stimulating help-seeking and self-care.

Perinatal Depression: A Review and an Update

Perinatal depression is a common psychiatric condition that has negative effects on pregnancy and infant outcomes. Screening for the condition is relatively easy and should be done routinely in all medical care of the pregnant and postpartum woman and her infant. The risk-benefit analysis favors the use of antidepressant medications during pregnancy and lactation compared with the risk of untreated maternal depression. Other, nonpharmacological treatments will be discussed as well as new treatments, including a new class of medications that act on the inhibitory GABAergic neurotransmitter system.

Risk factors for the development of postpartum depression in individuals who screened positive for antenatal depression

BACKGROUND

Women with antenatal depression often have a higher risk of developing postpartum depression (PPD) after delivery. A number of factors associated with the PDD in those previously reporting antenatal depression have been suggested, but further research is needed. This study aimed to investigate factors associated with developing subsequent postnatal depression in women who had screened positive for antenatal depression.

METHODS

This study was carried out in Hangzhou women's Hospital. 578 women who experienced antenatal depression from this cohort were enrolled in this study. The sociodemographic and clinical characteristics of the participants were collected and tabulated against the incidence of postnatal depression. Binary logistic regression was used to estimate the effects of the principal underlying variables. The Chinese-version Edinburgh Postnatal Depression Scale (EPDS) was used to screen for PPD. Antenatal screening for depression was conducted at 28-34 weeks during pregnancy and postpartum depressive symptoms were assessed at 6 weeks after childbirth in the women. Path Analysis of Structural Equation Model (SEM) was employed to explore the direct, indirect, and total effects of risk factors of PPD.

RESULTS

57.6% (n = 333) of the participants subsequently developed PPD in our study. The results of the logistic analysis indicated that ages ≤ 35 years old (OR = 1.852; 95%CI: 1.002-3.423), non-one-child families (OR = 1.518; 95%CI: 1.047-2.200), and rare care from partner during pregnancy (OR = 2.801; 95%CI: 1.038-7.562), the antenatal EPDS score (OR = 1.128; 95%CI: 1.052-1.209), pyrexia during pregnancy (OR = 2.43; 95%CI: 1.358-4.345), fairly good (OR = 1.836; 95%CI: 1.009-3.340), fairly bad (OR = 3.919; 95%CI:2.072-7.414) and very bad postpartum sleep quality (OR = 9.18; 95%CI: 2.335-36.241) were associated with increased risk of PPD (compared to very good postpartum sleep quality). In path analysis model, antenatal EPDS score (standardized total β = 0.173) and pyrexia during pregnancy (standardized total β = 0.132) had both direct and indirect effects (the impact on outcome variables needs to be determined through other variables) on PPD. Sleep quality after delivery (standardized β = 0.226) and one-child family (standardized β = 0.088) had direct effects only on PPD.

CONCLUSION

The results from our study indicated that more than 50% of the women who experienced antepartum depression would subsequently develop PPD. Depressive symptoms and pyrexia during pregnancy increase PPD scores, and these effects were in part mediated via poor sleep quality during the postpartum period.

Effectiveness of digital psychological interventions in reducing perinatal depression: a systematic review of meta-analyses

Digital psychological interventions have been widely used clinically in recent years, but the methodological quality and quality of evidence of related studies are unclear, thus interfering with the translation of practice outcomes and the application of clinical decisions. We searched for meta-analyses of randomized controlled trials in the PubMed, Web of Science, Embase, Cochrane Library, JBI Database, CINAHL, and PsycINFO databases as well as some databases containing gray literature up to 27 April 2022 using a combination of keywords. After two researchers independently screened and extracted data from the literature, the methodological quality of the included literature was evaluated by the AMSTAR 2 scale, and the evidence quality of the outcome index was graded by the Grading of Recommendations, Assessment, Development, and Evaluation system. A total of 12 meta-analyses reporting the positive impact of digital psychological interventions in the prevention and/or treatment of depressive symptoms in perinatal women were included, but the methodological quality and evidence level of the included studies were low. Digital psychological interventions are effective in reducing perinatal depression, but the methodological quality and reliability of outcome indicators are mostly low. Improving study designs, using higher-quality clinical evidence, conducting systematic evaluation studies strictly following the procedures, and standardizing the reporting of study results are recommended.

Factors that influence the uptake of postnatal care among adolescent girls: a qualitative evidence synthesis

BACKGROUND

Adolescent pregnancy is associated with increased risk of maternal and child morbidity and mortality globally. Access to safe, appropriate and affordable antenatal, childbirth and postnatal care (PNC) is essential in mitigating this risk. PNC is an often undervalued, underused, and understudied component of the continuum of maternal health services; however, it provides an important opportunity for adolescent girls to have access to health information and resources as they navigate the transition to motherhood and/or recovery from childbirth. This qualitative evidence synthesis seeks to highlight the experiences and perspectives of adolescent girls and their partners in accessing and using routine PNC.

METHODS

Papers were selected from a primary review on PNC where a global search of databases was conducted to identify studies with qualitative data focused on PNC utilisation. Within this primary review, a subset of studies focused on adolescents was tagged for subanalysis. A data extraction form drawing on an a priori framework was used to extract data from each study. Review findings were grouped across studies and mapped onto relevant themes, which were then adapted, as appropriate, to best reflect emergent themes from included studies.

RESULTS

Of 662 papers identified for full text review, 15 were included in this review on adolescents' experiences. Fourteen review findings were mapped onto four themes including: resources and access, social norms, experiences of care, and tailored support needs.

CONCLUSION

Improving uptake of PNC by adolescent girls requires multipronged approaches in improving availability of and access to adolescent-sensitive maternal health services and reducing feelings of shame and stigma in the postpartum period. Much should be done to address structural barriers to access, but tangible steps to improving the quality and responsiveness of available services can be taken immediately.

PROSPERO REGISTRATION NUMBER

CRD42019139183.

Effectiveness of interventions to prevent perinatal depression: An umbrella review of systematic reviews and meta-analysis

BACKGROUND

To date, dozens of systematic reviews (SRs) and meta-analyses (MAs) summarize the effectiveness of preventive interventions for perinatal depression. However, the results are inconclusive, making an urgent need to step up to higher levels of evidence synthesis.

AIMS

To summarize and compare the evidence from the SR&MA examining the effectiveness of all types of interventions for preventing perinatal depression.

METHOD

PubMed, PsycINFO, Cochrane Database of Systematic Reviews and OpenGrey were searched from inception to December 2022. We selected SR&MA of randomized controlled trials (RCTs) that compared all types of preventive interventions for perinatal depression with control groups whose outcome was the reduction of depressive symptoms and/or incidence of new cases of perinatal depression (PROSPERO: CRD42020173125).

RESULTS

A total of 19 SRs and MAs evaluated 152 unique RCTs that included 83,408 women from 26 countries and five continents. The median effect size for any intervention was SMD = 0.29 (95% CI: 0.20 to 0.38). Exercise/physical activity-based, psychological, and any type of intervention showed median effect sizes of 0.43, 0.28 and 0.36, respectively. The degree of overlap among RCTs was slight. According to AMSTAR-2, 79% of them were rated as low or critically low-quality. The strength of evidence, according to GRADE, was poorly reported and, in most cases, was low.

CONCLUSIONS

Exercise/physical activity-based and psychological interventions have a small-to-medium effect on reducing perinatal depressive symptoms. There is insufficient evidence to conclude that dietary supplements and pharmacological interventions are effective in preventing perinatal depression. There is a need for high-quality SR&MA of RCTs, mainly focusing on universal preventive interventions.

Parent-Performed Infant Massage for Improving Parental Mental State Within 18 Months Postpartum: A Systematic Review

The aim of the current review was to assess whether parent-performed infant massage (PPIM) could effectively improve the mental state of parents during the postpartum period. Several international electronic databases were thoroughly searched for relevant articles. Included studies observed the influence of PPIM on the mental state of parents of healthy full-term infants within 18 months postpartum or medically stable preterm infants during hospitalization after birth. Nine studies were included, which observed one or more aspects of parental mental state, including depression, anxiety, parental stress, or general mood state. Characteristics of participants, massage protocols, and outcome measures were heterogenous; hence, results regarding the influence of PPIM on parental mental state were inconsistent. Upon further investigation, 10-minute, home-based PPIM for at least 4 weeks is advisable for maternal depression within 5 months postpartum. Moreover, PPIM in a neonatal intensive care unit is advisable for improving the general mood of mothers of preterm infants. Additional methodologically rigorous studies are needed to provide stronger evidence. [Journal of Psychosocial Nursing and Mental Health Services, 61(4), 52-59.].

Acceptability and impact of group interpersonal therapy (IPT-G) on Kenyan adolescent mothers living with human immunodeficiency virus (HIV): a qualitative analysis

Background

Task shifting is a well-tested implementation strategy within low- and middle-income countries that addresses the shortage of trained mental health personnel. Task shifting can increase access to care for patients with mental illnesses. In Kenya, community health workers (CHWs) are a combination of community health assistants and community health volunteers and have played a crucial role on this front. In our study, we seek to assess the acceptability and feasibility of Group Interpersonal Psychotherapy (IPT-G) delivered by CHWs among depressed postpartum adolescents (PPAs) living with human immunodeficiency virus (HIV).

Method

The study used theoretical framework of behaviour change including: Capability, Opportunity and Motivation (COM-B model) to help understand behavioural changes due to IPT-G intervention delivered by the CHWs. 24 PPAs were administered IPT-G by trained CHWs from two health centres. A two-arm study design (IPT-G intervention and treatment as usual) with an intent to treat was used to assess the acceptability and feasibility of IPT-G. With purposeful sampling, participants who scored > 10 on the Edinburgh postnatal depression scale and who were 6–12 weeks postpartum were eligible for the study. Participants were equally distributed into two groups: one group for intervention and another as a wait-listed group. This was achieved by randomly allocating numerical numbers and separating those with odd numbers (intervention group) and even numbers (wait-listed group). Focus group discussions and in-depth interviews ascertained the experiences and perceptions of the PPAs and the CHWs during IP-G delivery process. In addition to weekly face-to-face continuous supportive supervision for the CHWs, the researchers also utilized phone calls, short messages services and WhatsApp instant messaging services.

Results

The CHWs found the intervention useful for their own knowledge and skill-set. With regards to participation, 21 out of the 24 adolescents attended all sessions. Most of the adolescents reported an improvement in their interpersonal relationships with reduced distress and lessening of HIV-related stigma. Primary healthcare workers embraced the intervention by accommodating the sessions in their routine clinic activities.

Conclusion

Our study demonstrates the possible benefits of task shifting in addressing mental health problems within low-resource settings in Kenya, and IPT-G is demonstrated to be both acceptable and feasible by health workers and adolescents receiving care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01807-w.

Is Sedentary Behavior Associated With Executive Function in Children and Adolescents? A Systematic Review

Background

Prolonged time on sedentary behavior, especially screen-based sitting time, is associated with unfavorable health indicators in children and adolescents. However, the effects of sedentary behavior on cognitive function remain to be elucidated.

Objective

The purpose of this systematic review was to synthesize the evidence on the associations of sedentary behavior with executive function in children and adolescents.

Methods

Four electronic databases (i.e., PubMed, Web of Science, PsycINFO, and SPORTDiscus) were searched for studies examining the associations between sedentary behavior and executive function in children and adolescents. Study quality was assessed by the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results

A total of 1,151 records were initially identified through database searches and other searches. Twelve cross-sectional and four longitudinal studies met the inclusion criteria. Of the 16 studies, seven studies found significant negative associations between sedentary behavior and executive function, and two studies presented positive associations. Eight studies measured sedentary time using accelerometers and showed varied associations between objectively measured sedentary time and executive function. Nine studies measured screen-based sedentary behavior, of which five studies found negative associations of sedentary time with executive function.

Conclusion

The available evidence on the associations between sedentary behavior and executive function is not conclusive in children and adolescents. However, screen-based sedentary behavior may be negatively associated with executive function.

The effectiveness of telemedicine interventions on women with postpartum depression: A systematic review and meta-analysis

BACKGROUND

Postpartum depression (PPD) is a public health problem that has significant adverse effects on mothers, couple's relationships, newborn neurodevelopment, and child emotional and cognitive development. This study reviewed the effectiveness of telemedicine interventions in postparturient women with postpartum depression.

AIMS

To evaluate the effectiveness of telemedicine intervention in women with postpartum depression.

METHODS

Cochrane Library, PubMed, EMBASE, Web of Science, CINAHL, and PsycINFO were searched for relevant articles published between 2003 and March 2021. We also manually reviewed the reference lists of the retrieved articles. The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias for individual studies was evaluated according to the Cochrane Handbook. RevMan 5.4 software was used to carry out the meta-analysis.

RESULTS

The meta-analysis included 20 randomized controlled trials with a total of 3252 patients. The results demonstrated that telemedicine was an effective intervention for treating PPD and anxiety and for improving functional impairment in women during their postpartum period.

LINKING EVIDENCE TO ACTION

This meta-analysis provided evidence that telemedicine was an effective intervention for treating PPD in women. Telemedicine also has significant effects on anxiety and improved functional impairment in women during their postpartum period. Our findings may provide accurate evidence-based guidance for postpartum women's mental health management. In the future, more high-quality studies are required for verifying these results.

Postnatal depression: identification of risk factors in the short-stay maternity program in Belgium. A cross-sectional study

Background

Postnatal depression (PND) is one of the most frequent complications in women of childbearing age in the developed world. The onset of PND is influenced by several risk factors. In an attempt to avoid unnecessary long maternity stays, the Short Stay Maternity programme was launched, shifting care from the hospital environment to the outpatient setting.

Aim

In order to develop an efficient programme to trace vulnerable women after childbirth and to provide support within primary care, the aim was to create an inventory of the risk factors for PND within the population of women participating in the short-stay programme.

Design & setting

This study is a cross-sectional study without follow-up. Women in Belgium were invited by email to participate in the Short Stay Maternity programme within 3 months of delivery.

Method

The questionnaire addressed background features and feelings during the maternity period, supplemented with the validated Dutch version of the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome measure of the questionnaire was the score on the EPDS.

Results

A total of 131 (27.46%) of the invited women participated. Sixteen participants (12.21%) presented with a positive score on the EPDS. The odds ratio (OR) for a positive score on the EPDS when experiencing negative feelings was 13.5 (95% confidence interval [CI] = 4.14 to 44.01). If only material support was provided, the OR for a positive EPDS score was OR 11.2 (95% CI = 2.72 to 55.5).

Conclusion

In this study, two risk factors were identified for PND: negative feelings during pregnancy and the provision of only material support by the partner.

Intervention Studies on the Enhancement of Self-Concept Among Adolescent Mothers: A Systematic Review

Self-concept affects the overall process of pregnancy, childbirth, and parenting among adolescent mothers. The current systematic review explores intervention studies on the enhancement of self-concept among adolescent mothers, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English and Korean literature published within the past 10 years was searched and five articles met the inclusion criteria. To improve self-concept among adolescent mothers, especially self-esteem, it was deemed necessary to strengthen a balanced capacity of physiological, psychological, sociocultural, and developmental aspects, based on a comprehensive assessment. To provide effective intervention, it was essential to reflect the cultural characteristics of adolescent mothers' native countries. Lectures were confirmed as a representative method of enhancing self-concept and participatory learning methods, such as group discussions, group activities, practical skills training, and supervision, were considered effective for enhancing self-esteem by strengthening not only knowledge but also the motivation of adolescent mothers. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Effectiveness of psychosocial support provided by midwives and family on preventing postpartum depression among first-time adolescent mothers at 3-month follow-up: A randomised controlled trial

AIMS AND OBJECTIVES

To evaluate the effectiveness of a midwife-family provided social support programme (MFPSS programme) for first-time adolescent mothers on preventing postpartum depression (PPD) at 3-month postpartum.

BACKGROUND

Adolescent mothers with lack of social support are a high-risk group for increasing the development of PPD. Interventions designed to promote social support and provided to mothers following childbirth have a more effective role in preventing PPD.

DESIGN

The Consolidated Standards of Reporting Trials (CONSORT) guidelines for a single-blinded randomised controlled trial were conducted.

METHODS

Forty-two adolescent mothers were randomly assigned to 4-week MFPSS programme plus routine care (n = 21) and routine care only (n = 21). PPD was measured using the Edinburgh Postnatal Depression Scale (EPDS), rates and severity at baseline, post-test, 6-week and 3-month postpartum follow-ups. Repeated measures ANOVA and Cohen's d were used to analyse the data.

RESULTS

At the last follow-up, 20 (95.24%) participants remained in each group. Data were analysed based on 40 adolescent mothers. After the intervention, the mean EPDS scores in the intervention group were significantly lower than the same scores in the control group at post-test, 6-week and 3-month postpartum follow-ups. Similarly, the rates and severity of PPD in the intervention group were also lower than the control group at post-test, 6-week and 3-month postpartum follow-ups.

CONCLUSION

Psychosocial support interventions designed to incorporate support from midwives and family members is an effective intervention for preventing PPD in first-time adolescent mothers and the preventive effect is sustained for up to 3-month postpartum.

RELEVANCE TO CLINICAL PRACTICE

Midwives or nurses could apply the MFPSS programme to nursing care for adolescent mothers and family members by adding health information about PPD and promoting social support.

CLINICAL TRIAL REGISTRATION

The trial was registered with Thai Clinical Trials Registry (TCTR). The trial registration number is TCTR 20190206004.

[Questionnaires for the Assessment of Peripartum Depression, Anxiety and Stress (Part 1 of a series on psychological assessment during the peripartum period)]

During pregnancy and after birth, women and men may experience symptoms of psychological distress. The most common symptoms comprise pregnancy-related anxiety and fear of childbirth as well as elevated levels of depression throughout the peripartum period. Particularly burdened populations, such as parents of premature infants, are also likely to experience greatly increased stress levels. Adequate questionnaires are needed to provide a standardized and time-efficient assessment of the aforementioned symptoms. However, only few questionnaires have been validated in the German language, and with the exception of the Edinburgh Postnatal Depression Scale, most of them are not very common in research and clinical practice. Furthermore, men are widely underrepresented in these questionnaires. Nevertheless, suitable screening tools are a prerequisite for the prevention and treatment of mental health problems in the peripartum period. Thus, symptoms of acute distress can be alleviated and the manifestation of chronic mental disorders with adverse consequences for the child or the couple relationship can be prevented. Therefore a standardization of the instruments used might be needed for future research and clinical practice.

Effectiveness of the CenteringPregnancy program on maternal and birth outcomes: A systematic review and meta-analysis

BACKGROUND

The World Health Organization has emphasized the critical role of prenatal care in achieving the Millennium Development Goals to reduce child and maternal mortality. The CenteringPregnancy program is a widely recognized model of prenatal care. Several countries have attempted to implement the program in prenatal care practice; however, its effectiveness on maternal and birth outcomes has not been systematically evaluated and analyzed.

OBJECTIVES

To determine the effect of the CenteringPregnancy program on improving maternal and birth outcomes, including low birth weight, preterm birth, and postpartum depression.

DESIGN

This study evaluated and analyzed randomized controlled trials by comparing the CenteringPregnancy program with o0bstetric led prenatal care. Maternal and birth outcomes of interest included low birthweight, preterm birth, and postpartum depressive symptoms.

DATA SOURCES

Embase, PubMed, CINAHL, Web of Science, and The Cochrane Library were utilized in this systematic review. Additionally, a supplemental Google Scholar search was performed to capture all relevant articles.

METHODS

All data were extracted independently by two trained researchers, who evaluated the quality of the study by examining the risk of bias. The biases of selection, allocation, measurement, reporting, and loss of follow-up were assessed using the Cochrane risk of bias for these included randomized controlled trials. A meta-analysis of eligible randomized controlled trials was conducted using Review Manager. Heterogeneity of studies was assessed using the I² statistic.

RESULTS

Out of 591 articles reviewed, seven randomized controlled trials were included in this study. Findings showed that the CenteringPregnancy program was not associated with lower rates of preterm birth (0.88 [0.71-1.07], p = 0.20, I² = 0%), low birth weight (0.87 [0.68-1.12], p =0.29, I² = 0%), or 12-month postpartum depressive symptoms (0.07 [-0.12-0.26], p =0.46, I² = 69%). However, the CenteringPregnancy program was associated with reduced rates of 6-month postpartum depressive symptoms (0.49 [0.40-0.59], p < 0.01, I² = 40%).

CONCLUSIONS

Existing evidence suggests that the CenteringPregnancy program and obstetric led care have similar effects on reducing the rates of preterm birth and low birth weight but different effects on postpartum depressive symptoms. More studies are needed to examine the effect of the CenteringPregnancy program on the improvement of postpartum depressive symptoms. PROSPERO Registration number: CRD42020171831. Tweetable abstract: We conducted a systematic review and meta-analysis of randomized controlled trials to determine the effects of the CenteringPregnancy program on improving maternal and birth outcomes, including low birth weight, preterm birth, and postpartum depressive symptoms. Seven randomized controlled trials were included in this study. The findings suggested that the CenteringPregnancy program and obstetric led care had similar effects in reducing the rates of preterm birth and low birth weight. More studies are needed to examine the effect of the CenteringPregnancy program on the improvement of postpartum depressive symptoms.

Informative title: Effects of social support, parenting stress and self-efficacy on postpartum depression among adolescent mothers in Jordan

AIM AND OBJECTIVE

This study investigated the effects of social support, parenting stress and maternal self-efficacy on postpartum depression among adolescent mothers in Jordan.

BACKGROUND

Adolescent pregnancy may have serious health, social and economic consequences for young women, families and communities. In Jordan, the incidence of adolescent pregnancy has increased from 5% in 2012 to 15% in 2018. Little attention has been given to postpartum depression among adolescent mothers in Arab and Middle Eastern countries.

METHOD

In a cross-sectional design using convenience sampling, 200 women aged less than 20 years, six to eight weeks postpartum and who could speak and read Arabic were interviewed in a participating health clinic. The interview occurred before or after a woman's scheduled clinic appointment and included socio-demographic data, Edinburgh Postnatal Depression Scale (EPDS), Maternity Social Support Scale (MSSS), Parenting Stress Scale (PSS) and Perceived Self-efficacy Scale (PSES). Data collection took place between December of 2018 and April of 2019. Reporting followed the STROBE guidelines.

RESULTS

Results revealed that 28.5% of adolescent mothers had probable postpartum depression. Mothers who reported high social support, high parenting stress, low self-efficacy, financial stress and marital conflict had significantly higher EPDS scores than those who did not report these stressors.

CONCLUSION

Prevalence of postpartum depression reported in this study warrants immediate action on early assessment, detection and intervention. High levels of social support may feel overwhelming for young mothers and contribute to high parenting stress, low maternal self-efficacy and marital conflict.

RELEVANCE TO CLINICAL PRACTICE

Adolescent mothers are at increased risk of PPD compared to mothers over 20 years of age. Perceived quality rather than availability of social support needs to be considered. Young mothers require education and early intervention prevention strategies to better prepared them for motherhood and manage stressors associated with their changing social role.

Associations between sleep and academic performance in US adolescents: a systematic review and meta-analysis

This systematic review and meta-analysis aim to investigate the relationship between sleep and academic performance in students enrolled in secondary education programs in the United States. The study team conducted a literature search of 4 databases-PubMed, Embase, CINAHL, and ERIC-on September 19 and repeated December 17, 2020. Studies were included if they were observational, published in a peer-reviewed, non-predatory journal, available in full-text, written in English, included adolescents enrolled in an organized academic program, took place in the US, and evaluated the effect of sleep duration and/or sleep quality on academic performance. After excluding reviews, editorials, interventions, and those targeting diagnostic groups, 14 studies met inclusion criteria. Risk of bias was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies; 12 studies were found to be good or high quality, 2 were adequate/fair or poor quality. A meta-analysis of 11 of the included studies revealed that sleep duration (r = 0.03; 95%CI -0.027, 0.087; p = 0.087) and sleep quality (r = 0.089; 95%CI 0.027, 0.151; p = 0.005) had negligible correlations with academic performance (non-significant and significant, respectively). Inconsistencies in definitions, methods, and measures utilized to assess sleep duration, sleep quality, and academic performance constructs may offer insight into seemingly conflicting findings. Given the pivotal role sleep plays in development, future investigations utilizing validated and objective sleep and academic performance measures are needed in adolescents.

MAternal Mental Health in the WORKplace (MAMH@WORK): A Protocol for Promoting Perinatal Maternal Mental Health and Wellbeing

Women are exposed to increased burden of mental disorders during the perinatal period: 13–19% experience postpartum depression. Perinatal psychological suffering affects early mother-child relationship, impacting child’s emotional and cognitive development. Return-to-work brings additional vulnerability given the required balance between parenting and job demands. The MAternal Mental Health in the WORKplace (MAMH@WORK) project aims to develop and evaluate the effectiveness of a brief and sustainable intervention, promoting (a) maternal mental health throughout pregnancy and first 12 months after delivery, and (b) quality of mother–child interactions, child emotional self-regulation, and cognitive self-control, while (c) reducing perinatal absenteeism and presenteeism. MAMH@WORK is a three-arm randomized controlled trial. A short-term cognitive-behavioral therapy-based (CBT-based) psychoeducation plus biofeedback intervention will be implemented by psychiatrists and psychologists, following a standardized procedure manual developed after consensus (Delphi method). Participants (n = 225, primiparous, singleton pregnant women at 28–30 weeks gestational age, aged 18–40 years, employed) will be randomly allocated to arms: CBT-based psychoeducation intervention (including mindfulness); psychoeducation plus biofeedback intervention; and control. Assessments will take place before and after delivery. Main outcomes (and main tools): mental health literacy (MHLS), psychological wellbeing (HADS, EPDS, KBS, CD-RISC, BRIEF COPE), quality of mother–child interaction, child–mother attachment, child emotional self-regulation and cognitive self-control (including PBQ, Strange Situation Procedure, QDIBRB, SGS-II, CARE-Index), job engagement (UWES), and presenteeism. Intention-to-treat and per-protocol analyses will be conducted; Cohen’s d coefficient, Cramer’s V and odds ratio will be used to assess the effect size of the intervention. MAMH@WORK is expected to contribute to mental health promotion during the perinatal period and beyond. Its results have the potential to inform health policies regarding work–life balance and maternal mental health and wellbeing promotion in the workplace.

Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis

BACKGROUND

Cognitive-behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive-behavioural therapy systematic reviews suggested that cognitive-behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials.

OBJECTIVES

This project was undertaken to map the quality and gaps in the cognitive-behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive-behavioural therapy.

DATA SOURCES

The overview was designed with cognitive-behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019.

REVIEW METHODS

Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive-behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive-behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality.

RESULTS

A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive-behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive-behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.05 to 0.50, I2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval -0.28 to 0.88, I2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.28 to 0.74, I2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions.

LIMITATIONS

Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them.

CONCLUSION

Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive-behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes.

FUTURE WORK

Future research should focus on how the modest effect sizes seen with cognitive-behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42017078690.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.

Are "Superwomen" without social support at risk for postpartum depression and anxiety?

Postpartum depression and anxiety are common among women. Previous research has found perfectionism and the lack of social support to be associated with psychological distress. This study examined (1) social support as a protective factor against postpartum depressive and anxiety symptoms and perfectionism as a risk factor; (2) associations between different types of social support and postpartum depressive and anxiety symptoms; and (3) social support as a moderator between the relationship of perfectionism and postpartum depressive and anxiety symptoms. A total of 596 postpartum participants were included. Participants completed measures on postpartum depression, anxiety, social support, and perfectionism. Multivariate regressions revealed perfectionism was not significantly associated with depressive symptoms but predicted anxiety symptoms. Social support was a significant protective factor against depressive and anxiety symptoms. All support subscales were significantly associated with depressive and anxiety symptoms, with support from friends having the largest effect size (partial η²  = .061). High levels of support significantly moderated the relationship between perfectionism and depressive symptoms, β = .003, 95% CI [.0006, .005], t (592) = 2.53, p = .012, and average and high levels of support significantly moderated the relationship between perfectionism and anxiety symptoms, β = .0023, 95% CI [.0002, .004], t (592) = 2.13, p = .03. These results emphasize the importance of social support for postpartum women's mental health, especially for "Superwomen" with perfectionistic tendencies. Implications for healthcare and policies are discussed.

Emerging issues and questions on peripartum depression prevention, diagnosis and treatment: a consensus report from the cost action riseup-PPD

BACKGROUND

Peripartum depression [PPD] is a public health problem which has been widely studied. Nonetheless, study findings and clinical guidelines for PPD treatment differ among countries and the condition is still underdiagnosed and undertreated, suggesting the importance of a global understanding of PPD. The Riseup-PPD Cost Action aims to establish a Pan-European and multidisciplinary network of researchers dedicated to the global understanding of PPD.

METHODS

A literature search was performed in different databases (e.g., Medline, PsychInfo) including a combination of terms related with PPD diagnosis, prevention, treatment and cost-effectiveness of its management. A narrative synthesis of the literature, together with a critical overview of the current issues/questions to be addressed within the topic of PPD were performed.

RESULTS

Emerging issues include challenges regarding definition and timing of PPD; heterogeneity in severity, timing of onset and assessment tools; comparative effectiveness of preventive and treatment interventions; help seeking for PPD; improving health professional's awareness of PPD; and cost-effectiveness of PPD management.

LIMITATIONS

The main limitation is the non-systematic nature of the literature search.

CONCLUSIONS

The Riseup-PPD network will deal with these challenges through four lines of action: (1)provide an updated and comprehensive synthesis of existing knowledge that can contribute to inform clinical recommendations and guidelines for PPD management; (2) clarify inconsistent findings concerning diagnosis, prevention and treatment of PPD; (3) develop new lines of research in the field of PPD; and (4) develop international recommendations for PPD diagnosis, prevention and treatment, ultimately influencing maternal mental health policymaking at global and local levels.

The efficacy of cognitive behavioral therapy for the treatment of antenatal depression: A systematic review

BACKGROUND

Antenatal depression affects 7-20% of pregnant women globally yet less than a fifth of such women receive adequate treatment. Cognitive behavioral therapy (CBT) is known to be effective in the treatment of depression. However, the research is more limited with regard to the antenatal period suggesting a need for clearer evidence within this field.

OBJECTIVE

To determine if CBT is effective in the treatment of antenatal depression.

METHODS

Medline, Embase, PsychINFO, CINAHL and CENTRAL were searched for studies that quantified the effectiveness of CBT in women with a confirmed diagnosis of antenatal depression. Randomised controlled trials that measured the effectiveness of CBT delivered during the antenatal period, compared to another intervention or usual care, measured using a validated depression score pre and post intervention were included.

RESULTS

Five RCTs were eligible for inclusion, all of which found a significant decrease in depression scores following CBT interventions, greater than that observed in control groups. Improvements in depressive scores were maintained long-term for participants who received CBT. Participant satisfaction with the interventions received was high.

LIMITATIONS

Studies included displayed major performance biases, and language bias is present due to exclusion of an Iranian paper.

CONCLUSION

CBT, tailored to pregnant women, is effective in the treatment of antenatal depression, with little difference in efficacy between CBT sub-types. Further large-scale RCTs are needed to confirm these hypotheses and determine the most cost-effective way of delivering CBT to pregnant women. There is also need for a specific, validated tool for assessing antenatal depression.

The association between breastfeeding and attachment: A systematic review

OBJECTIVE

In the popular and scientific literature an association between breastfeeding and attachment is often supposed although this has not been systematically investigated. This is the first review that provides a systematic overview of the current state of research on the association between breastfeeding and attachment. The objective is to determine whether breastfeeding is associated with child attachment as well as if maternal attachment is associated with breastfeeding behaviour.

DESIGN

A systematic electronic literature search for English language articles published from 1963 to 2019 using the databases Web of Science, PubMed, PsycInfo, and PsycArticles was conducted. Studies were included if (1) the association between breastfeeding and attachment of the child or maternal attachment style and breastfeeding was investigated, (2) participants were mothers or mother-child dyads, and (3) quantitative measures of breastfeeding and attachment were used. Study quality was rated using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

PARTICIPANTS

Studies examining mothers or mother-child dyads were reviewed. Sample sizes varied between N = 60 and N = 8900 participants. On average, mothers were between 27.56 and 32.50 years old.

FINDINGS

Eleven studies were eligible for inclusion. Of seven studies examining breastfeeding and child attachment, four found that a longer duration of breastfeeding was significantly associated with higher levels of attachment security after controlling for various covariates. No significant differences in attachment security between breastfeeding and bottle-feeding were reported, but one study found higher levels of attachment disorganization for bottle-feeding, although mean levels were below a clinically relevant level. The initiation of breastfeeding directly after childbirth was not related to child attachment. Of four studies examining maternal attachment and breastfeeding, three found a significant association between secure attachment of the mother and breastfeeding behaviour. Secure attached mothers initiated breastfeeding more often and preferred breast- over bottle-feeding than insecure attached mothers. Mixed results were found for breastfeeding duration. Most studies had limitations regarding adequate sample size, and valid and reliable measurement of breastfeeding.

KEY CONCLUSIONS

The findings provide some evidence that breastfeeding might contribute to child attachment security. Furthermore, maternal attachment style might play a role in breastfeeding behaviour. However, more prospective studies are needed to draw a solid conclusion.

IMPLICATIONS FOR PRACTICE

With regard to breastfeeding recommendations, health professionals should be aware of and communicate towards clients that the effect of breastfeeding on child attachment might be rather small. Screening of maternal attachment style as a part of maternity practice could be useful to support insecure attached mothers experiencing breastfeeding difficulties.

Traditional Chinese acupuncture and postpartum depression: A systematic review and meta-analysis

BACKGROUND

Acupuncture, a key component of traditional Chinese medicine, is a form of alternative medicine in which thin needles are inserted into the body commonly for pain relief. To date, the role of traditional Chinese acupuncture in mood disorders in the postpartum period is unclear. Thus, this study aimed to review the effectiveness of acupuncture in patients with postpartum depression (PPD).

METHODS

We searched databases such as PUBMED, EMBASE, and Cochrane Controlled Trials Register until September 2018. Meta-analysis was performed using Comprehensive Meta-Analysis 2.0 software. The mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) were calculated to evaluate the results of each comparison.

RESULTS

A total of 887 PPD patients from 12 randomised controlled trials were included in the quantitative meta-analysis, with 443 patients in the treatment group and 444 patients in the control group. Patients in the acupuncture group had significantly better performances assessed by the Hamilton Depression Scale than those in the control group, and the pooled MD was -1.27 (95% CI: -2.55 to 0.01; p = 0.05, I = 83%) in the random-effect model. In addition, significantly better performance in the effective rate was observed in the acupuncture group than in the control group, and the pooled RR was 1.20 (95% CI: 1.09 to 1.33; p < 0.0001, I = 46%). However, in subgroup analysis for the acupuncture therapy alone, only effective rate showed a significantly better performance.

CONCLUSION

Traditional Chinese acupuncture seems to be effective in improving some symptoms of PPD, although the evidence is uncertain. Therefore, further studies following standardized guidelines with a low risk of bias are needed to confirm the effectiveness of acupuncture in the treatment of PPD.