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Alfayumi-Zeadna S, Ghalion HA, O'Rourke N, Azbarga Z, Daoud N. Direct and indirect predictors of postpartum depression symptoms among indigenous Bedouin mothers in Israel. Res Nurs Health 2024; 47:114-124. [PMID: 38073270 DOI: 10.1002/nur.22361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/27/2023] [Accepted: 11/24/2023] [Indexed: 03/25/2024]
Abstract
Postpartum depression (PPD) is a common and complex phenomenon with negative outcomes for children, women and their families. This study set out to identify both direct and indirect predictors of PPD symptoms among indigenous Bedouin mothers in Israel. The study included 305 women, 18 to 45 years of age, who were interviewed while pregnant and again, 2 to 4 months postpartum. Interviews were conducted in Arabic and included the Edinburgh Postnatal Depression Scale, administered at both points of measurement. Using path analyses, we identified four significant, direct predictors of PPD symptoms. The strongest was depressive symptoms when pregnant, followed by low relative income, low hemoglobin, and number of prior miscarriages. The latter was significantly associated with consanguinity, meaning that women married to a first cousin experienced more miscarriages which, in turn, increased PPD risk. Low relative income was the only variable that had both a direct and indirect effect upon PPD symptoms (via symptoms of depression when pregnant and hemoglobin). Education and polygamy also emerged as indirect predictors of PPD via depressive symptoms reported during pregnancy. Results suggest a high rate of PPD in this perinatal sample of indigenous women. Our findings underscore the need for tailored interventions to reduce PPD, especially for low-income Bedouin women, faced with many barriers and insufficient access to healthcare services.
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Affiliation(s)
- Samira Alfayumi-Zeadna
- Nursing Department, School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
| | - Huda Abu Ghalion
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion, University of the Negev, Be'er Sheva, Israel
- Clalit Health Services, Be'er Sheva, Israel
| | - Norm O'Rourke
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion, University of the Negev, Be'er Sheva, Israel
- Department of Psychology, Faculty of Humanities and Social Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | | | - Nihaya Daoud
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion, University of the Negev, Be'er Sheva, Israel
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2
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Lee K, Hough K. Racial Disparity of Mental Health Service Utilization Among Low-Income Head Start Eligible Parents. J Racial Ethn Health Disparities 2024; 11:611-620. [PMID: 36959391 DOI: 10.1007/s40615-023-01545-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/25/2023]
Abstract
Based on the Head Start Impact Study, 1706 parents who had mild, moderate, and severe depressive symptoms were selected to examine the following questions: (1) Are there racial disparities in mental health service utilization among low-income parents? (2) Does Head Start have an impact on mental health service utilization across white, African American, and Hispanic parents? The present research found that, compared to white parents, African American and Hispanic parents are significantly less likely to utilize mental health services. Head Start impact was found for white parents but not for African American and Hispanic parents. Furthermore, parents who spoke a language other than English had higher household risk factors, and reside in rural areas are less likely to utilize mental health services. Mental health providers should deliver patient-centered services that consider cultural and linguistic competency as well as the personal life context of their patients to remove any barriers to accessing mental health services.
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Affiliation(s)
- Kyunghee Lee
- School of Social Work, Michigan State University, 226 Baker Hall, East Lansing, MI, 48824, USA.
| | - Kerri Hough
- School of Social Work, Michigan State University, 226 Baker Hall, East Lansing, MI, 48824, USA
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3
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Goldstein E, Merrick JS, Edwards RC, Zhang Y, Sinche B, Raven J, Krislov S, Robledo D, Brown RL, Moskowitz JT, Tandon SD, Wakschlag LS. Personalized Mobile Health-Enhanced Cognitive Behavioral Intervention for Maternal Distress: Examining the Moderating Role of Adverse Childhood Experiences. Perm J 2024; 28:111-123. [PMID: 38263868 PMCID: PMC10940253 DOI: 10.7812/tpp/23.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Maternal history of trauma is a risk factor for distress during pregnancy. The purpose of this paper was to examine the theorized differential impact of a cognitive behavioral intervention (Mothers and Babies Personalized; MB-P) on maternal distress and emotional regulation for those with ≥ 1 adverse childhood experiences (ACEs; vs no ACEs) from pregnancy to 3 months postpartum. METHODS Between August 2019 and August 2021, eligible pregnant individuals aged ≥ 18 years, < 22 weeks' gestation, and English-speaking were recruited from 6 university-affiliated prenatal clinics. Participants (N = 100) were randomized to MB-P (n = 49) or control (n = 51). Analyzable data were collected for 95 participants. Analyses tested progression of change (slope) and at individual timepoints (panel analysis) for perinatal mental health outcomes. RESULTS The majority of participants (n = 68, 71%) reported experiencing > 1 ACE (median = 1, range: 0-11). Participants demonstrated significant differential effects for depressive symptoms in absence of ACEs (standardized mean differences [SMD] = 0.82; 95% confidence interval [CI] = [0.13-1.51]) vs in presence of ACEs (SMD = 0.39; 95% CI = [-0.20 to 0.97]) and perceived stress in absence of ACEs (SMD = 0.92; 95% CI = [0.23-1.62]) vs in presence of ACEs (SMD = -0.05; 95% CI = [-0.63 to 0.53]). A panel analysis showed significantly reduced depressive symptoms postintervention and increased negative mood regulation at 3 months postpartum for individuals with ACEs. CONCLUSIONS Findings support effectiveness of the MB-P intervention to reduce prenatal distress for all pregnant individuals. Preliminary exploration suggests the possibility that individuals with ACEs may benefit from enhanced trauma-informed content to optimize the effects of a perinatal intervention.
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Affiliation(s)
- Ellen Goldstein
- Department of Population Health Nursing Science, University of Illinois Chicago College of Nursing, Chicago, IL, USA
| | - Jillian S Merrick
- Department of Psychiatry and Behavioral Health, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Renee C Edwards
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yudong Zhang
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brianna Sinche
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Julia Raven
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephanie Krislov
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniela Robledo
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Roger L Brown
- University of Wisconsin Schools of Nursing, Medicine and Public Health, Madison, WI, USA
| | - Judith T Moskowitz
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Darius Tandon
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lauren S Wakschlag
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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4
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Bell K, Ashby BD, Scott SM, Poleshuck E. Integrating Mental Health Care in Ambulatory Obstetrical Practices: Strategies and Models. Clin Obstet Gynecol 2024; 67:154-168. [PMID: 38174556 DOI: 10.1097/grf.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Perinatal mental health is recognized as a priority component of obstetrical care. Perinatal patients often turn to their obstetrician for help with mental health concerns as they view them as their primary health care provider. Unfortunately, obstetricians face challenges in providing adequate support due to time constraints and limited expertise. Integrated behavioral health care offers a collaborative and cost-effective solution to enhance patient care and clinician satisfaction. Integrated behavioral health clinicians possess fundamental skills to care for patients throughout the reproductive lifespan and assist obstetricians in identifying and managing common mood concerns.
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Affiliation(s)
- Keisha Bell
- Departments of Psychiatry and Ob/Gyn, University of Rochester Medical Center, Rochester, New York
| | - Bethany D Ashby
- Department of Psychiatry and Ob/Gyn, University of Colorado, School of Medicine, Aurora, Colorado
| | - Stephen M Scott
- Department of Ob/Gyn and Pediatrics, University of Colorado, School of Medicine, Aurora, Colorado
| | - Ellen Poleshuck
- Departments of Psychiatry and Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
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5
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Ronen K, Gewali A, Dachelet K, White E, Jean-Baptiste M, Evans YN, Unger JA, Tandon SD, Bhat A. Acceptability and Utility of a Digital Group Intervention to Prevent Perinatal Depression in Youths via Interactive Maternal Group for Information and Emotional Support (IMAGINE): Pilot Cohort Study. JMIR Form Res 2024; 8:e51066. [PMID: 38306159 PMCID: PMC10873795 DOI: 10.2196/51066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Perinatal depression (depression during pregnancy or the first year postpartum) affects 10%-25% of perinatal individuals, with a higher risk among youths aged <25 years. The Mothers and Babies Course (MB) is an evidence-based intervention for the prevention of perinatal depression, grounded in cognitive behavioral therapy, attachment theory, and psychoeducation. OBJECTIVE We developed a digital adaptation of MB (Interactive Maternal Group for Information and Emotional Support [IMAGINE]) and evaluated it in a pre-post mixed methods pilot among young perinatal people in the United States. METHODS IMAGINE was a structured digital group of up to 7 participants, with scheduled MB content and open discussion for 12 weeks, facilitated by a social worker. Scheduled content included asynchronous SMS text messages, graphics, prerecorded videos, mood polls, and optional weekly synchronous video calls. Eligible participants were pregnant or ≤80 days postpartum, aged 16 to 24 years, had access to a smartphone, spoke English, and had a Patient Health Questionnaire score <10. Participants were recruited throughout the United States from August 2020 to January 2021 through paid social media ads, in-person outreach at clinics, and respondent-driven sampling. Participants completed quantitative questionnaires at enrollment and 3 months, and qualitative interviews at 3 months. We determined uptake, acceptability (by Acceptability of Intervention Measure score), and utility (by use of cognitive behavioral therapy skills). We compared depression symptoms (by Patient Health Questionnaire score), social support (by abbreviated Social Support Behavior score), and perceived stress (by Perceived Stress Score) between enrollment and follow-up by paired 2-tailed t test. RESULTS Among 68 individuals who contacted this study, 22 were screened, 13 were eligible, and 10 enrolled, for an uptake of 76.9%. Furthermore, 4 (40%) participants were pregnant at enrollment. Participants had a median age of 17.9 (IQR 17.4-21.7) years, 6 (67%) identified as Black, 5 (56%) Latinx, and 6 (67%) using Medicaid health insurance. Further, 9 (90%) participants completed follow-up. Among these, the mean acceptability score was 4.3 out of 5 (SD 0.6) and all participants said they would recommend IMAGINE to a friend. Participants reported using a median of 7 of 11 skills (IQR 5-7 skills) at least half the days. We found no significant changes in depression symptoms, perceived stress, or social support. Qualitatively, participants reported one-to-one support from the facilitator, connection with other parents, and regular mood reflection were especially helpful aspects of the intervention. Additionally, participants reported that the intervention normalized their mental health challenges, improved their ability to manage their mood, and increased their openness to mental health care. CONCLUSIONS This pilot study provides promising evidence of the acceptability and utility of IMAGINE among perinatal youths. Our study's small sample size did not detect changes in clinical outcomes; our findings suggest IMAGINE warrants larger-scale evaluation.
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Affiliation(s)
- Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anupa Gewali
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kristin Dachelet
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Erica White
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Yolanda N Evans
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Jennifer A Unger
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, RI, United States
| | - S Darius Tandon
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
- Center for Community Health, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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6
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Hartinger Pena SM, Mäusezahl D, Jäggi L, Aguilar L, Alvarado Llatance M, Castellanos A, Huaylinos Bustamante ML, Hinckley K, Charles McCoy D, Zhang C, Fink G. Digital Support Systems to Improve Child Health and Development in Peru: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e50371. [PMID: 38096020 PMCID: PMC10755649 DOI: 10.2196/50371] [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: 06/29/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Children living in low and middle-income countries (LMICs) are at greater risk for experiencing adversities that can undermine their health and early development. Recently launched digital early childhood development (ECD) programs attempt to support families with young children in their home environments using digital technologies. However, relatively little is known regarding the effectiveness of these new technologies. OBJECTIVE The goal of this study is to rigorously assess the reach, effectiveness, and cost-effectiveness of a newly developed digital ECD platform called Afini. The Afini platform was designed to support parents of young children in low-resource settings to improve ECD and interact with caregivers through messenger services and a chatbot. METHODS This is a 3-arm cluster randomized controlled trial. In total, 2471 caregivers and their 3- to 9-month-old children were enrolled in the study across 164 study clusters in the San Marcos, Cajabamba, and Cajamarca provinces of Peru. Clusters of participants were randomly assigned to 1 of 3 groups: a control group (72 community clusters and 980 caregiver-child dyads), a home visit intervention group (20 community clusters and 316 caregiver-child dyads), and an Afini intervention group (72 community clusters and 1175 caregiver-child dyads). Families in the control group receive no focused ECD intervention. The home visit group is receiving biweekly home visits by a trained field staff following the national ECD program (Programa Nacional Cuna Más) curriculum and training guidelines. Caregivers in the Afini group are receiving ECD activities and advice through the digital platform. The primary study outcome is children's overall development at the age of 2.5 years, using the internationally validated long form of the Global Scales for Early Development. Secondary outcomes include caregiver engagement; caregiver mental health; screen time; as well as caregiver reports of children's motor, cognitive, language, and socioemotional development measured through locally piloted and validated tools. RESULTS Enrollment started in September 2021 and ended in March 2023. Endline assessments will take place between August 2023 and September 2024. CONCLUSIONS This study is, to our knowledge, the first to rigorously assess the effectiveness and cost-effectiveness of digital ECD technologies in LMICs. Given the large number of children in LMICs currently receiving only limited external support, the evaluated platform has the potential to improve the short- and long-term well-being of millions of children and their parents globally. TRIAL REGISTRATION ClinicalTrials.gov NCT05202106; https://clinicaltrials.gov/ct2/show/NCT05202106. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50371.
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Affiliation(s)
- Stella Maria Hartinger Pena
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daniel Mäusezahl
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Lena Jäggi
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Leonel Aguilar
- Institute for Computing Platforms, Federal Institute of Technology Zurich, Zürich, Switzerland
| | | | | | | | - Kristen Hinckley
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Ce Zhang
- Institute for Computing Platforms, Federal Institute of Technology Zurich, Zürich, Switzerland
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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7
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Zimmermann M, Peacock-Chambers E, Merton C, Pasciak K, Thompson A, Mackie T, Clare CA, Lemon SC, Byatt N. Equitable reach: Patient and professional recommendations for interventions to prevent perinatal depression and anxiety. Gen Hosp Psychiatry 2023; 85:95-103. [PMID: 37862962 PMCID: PMC11056209 DOI: 10.1016/j.genhosppsych.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/14/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Perinatal depression and anxiety are the most common complications in the perinatal period and disproportionately affect those experiencing economic marginalization. Fewer than 15% of individuals at risk for perinatal depression are referred for preventative counseling. The goal of this study was to elicit patient and perinatal care professionals' perspectives on how to increase the reach of interventions to prevent perinatal depression and anxiety among economically marginalized individuals. METHODS We conducted qualitative interviews with perinatal individuals with lived experience of perinatal depression and/or anxiety who were experiencing economic marginalization (n = 12) and perinatal care professionals and paraprofessionals (e.g., obstetrician/gynecologists, midwives, doulas; n = 12) serving this population. Three study team members engaged a "a coding consensus, co-occurrence, and comparison," approach to code interviews. RESULTS Perinatal individuals and professionals identified prevention intervention delivery approaches and content to facilitate equitable reach for individuals who are economically marginalized. Factors influential included availability of mental health counselors, facilitation of prevention interventions by a trusted professional, digital health options, and options for mental health intervention delivery approaches. Content that was perceived as increasing equitable intervention reach included emphasizing stigma reduction, using cultural humility and inclusive materials, and content personalization. CONCLUSIONS Leveraging varied options for mental health intervention delivery approaches and content could reach perinatal individuals experiencing economic marginalization and address resource considerations associated with preventative interventions.
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Affiliation(s)
- Martha Zimmermann
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America.
| | - Elizabeth Peacock-Chambers
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Catherine Merton
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Katarzyna Pasciak
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Azure Thompson
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Thomas Mackie
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Camille A Clare
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Stephenie C Lemon
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Nancy Byatt
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
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8
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Platt R, Martin CP, Perry O, Cooper L, Tandon D, Richman R, Bettencourt AF, Polk S. A Mixed-Methods Evaluation of Virtually Delivered Group-Based Mothers and Babies for Latina Immigrant Mothers. Womens Health Issues 2023; 33:465-473. [PMID: 37330398 DOI: 10.1016/j.whi.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/27/2023] [Accepted: 05/10/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Immigrant Latinas are at higher risk for postpartum depression (PPD) than the general perinatal population, yet face numerous barriers to accessing mental health services. The goal of this study was to pilot an enhanced virtual group delivery of a PPD prevention program, Mothers and Babies (MB), among immigrant Latinas engaged in early childhood programming. METHODS Forty-nine Spanish-speaking mothers participated in one of four MB virtual groups, facilitated by trained bilingual staff at affiliated early learning centers. MB was enhanced to also target social determinants of health. A mixed-methods design was used to evaluate MB using participant interviews and pre-post surveys measuring depressive symptoms, parenting distress, and self-efficacy to manage emotions. RESULTS On average, participants attended 69% of MB virtual sessions and rated group cohesiveness at a 4.6 on a 5-point scale. Paired-samples t tests showed significant reductions in depressive symptoms (Cohen's d = 0.29; p = .03) and parenting distress (Cohen's d = 0.31; p = .02), and improved self-efficacy to manage emotions (Cohen's d = -0.58; p < .001). Participants reported both benefits and drawbacks of the virtual format and provided largely favorable feedback on program enhancements. CONCLUSIONS Results provide initial evidence for the acceptability, feasibility, and effectiveness of an enhanced virtual group PPD prevention program for immigrant Latinas, delivered in partnership with local early learning centers. These findings have important implications for extending the reach of preventive interventions among a population that faces many structural and linguistic barriers to traditional forms of mental health service delivery.
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Affiliation(s)
- Rheanna Platt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Caroline P Martin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Olivia Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Darius Tandon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rebecca Richman
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Amie F Bettencourt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sarah Polk
- Centro SOL at Johns Hopkins, Baltimore, Maryland
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9
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Johnson JE, Loree AM, Sikorskii A, Miller TR, Carravallah L, Taylor B, Zlotnick C. Study protocol for the ROSE Scale-Up Study: Informing a decision about ROSE as universal postpartum depression prevention. Contemp Clin Trials 2023; 132:107297. [PMID: 37473848 PMCID: PMC10528027 DOI: 10.1016/j.cct.2023.107297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/10/2023] [Accepted: 07/15/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE To examine the effectiveness, cost-outcome, equity, scalability, and mechanisms of the Reach Out, Stay strong, Essentials for mothers of newborns (ROSE) postpartum depression prevention (PPD) program as universal versus selective or indicated prevention. BACKGROUND The United States Preventive Services Task Force (USPSTF) currently recommends PPD prevention for pregnant people at risk of PPD (i.e., selective/indicated prevention). However, universal prevention may be more scalable, equitable, and cost-beneficial. DESIGN Effectiveness of ROSE for preventing PPD among people at risk is known. To assess ROSE as universal prevention, we need to determine the effectiveness of ROSE among all pregnant people, including those screening negative for PPD risk. We will enroll 2320 pregnant people, assess them with commonly available PPD risk prediction tools, randomize everyone to ROSE or enhanced care as usual, and assess ROSE as universal, selective, and indicated prevention in terms of: (1) effectiveness (PPD prevention and functioning), (2) cost-benefit, (3) equity (PPD cases prevented by universal prevention that would not be prevented under selective/indicated for minority vs. non-Hispanic white people), (4) quantitative and qualitative measures of scalability (from 98 agencies previously implementing ROSE), (5) ROSE mechanisms across risk levels. We will integrate results to outline pros and cons of the three prevention approaches (i.e., universal, selective, indicated). CONCLUSION This will be the first trial to assess universal vs. selective/indicated PPD prevention. Trial design illustrates a novel, efficient way to make these comparisons. This trial, the largest PPD prevention trial to date, will examine scalability, an understudied area of implementation science.
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Affiliation(s)
- Jennifer E Johnson
- Charles Stewart Mott Department of Public Health, Michigan State University College of Human Medicine, 200 East 1(st) St Room 366, Flint, MI 48502, United States of America.
| | - Amy M Loree
- Center for Health Policy & Health Services Research, Henry Ford Health, 1 Ford Place, Suite 5E, Detroit, MI 48220, United States of America.
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University College of Osteopathic Medicine, 909 Wilson Rd, East Lansing, MI 48824, United States of America.
| | - Ted R Miller
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive Suite 900, Calverton, MD 20705, United States of America.
| | - Laura Carravallah
- Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, 200 East 1(st) St, Flint, MI 48502, United States of America.
| | - Brandon Taylor
- Charles Stewart Mott Department of Public Health, Michigan State University College of Human Medicine, 200 East 1(st) St Room 366, Flint, MI 48502, United States of America.
| | - Caron Zlotnick
- Butler Hospital and Women and Infants Hospital, 345 Blackstone Blvd, Providence, RI 02906, United States of America; University of Cape Town, Cape Town, South Africa.
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10
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Ahmed SR, Watt F, Mahfoud ZR, Korayem M, Buhmaid S, Alberry M, Ibrahim IM, Tandon SD. Examining Feasibility, Acceptability, and Preliminary Outcomes of a Culturally Adapted Evidence-Based Postpartum Depression Preventive Intervention for Women in Doha, Qatar: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e11623. [PMID: 37566449 PMCID: PMC10457694 DOI: 10.2196/11623] [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: 05/17/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Postpartum depression and anxiety are the 2 most common perinatal mental health disorders, with prevalence rates higher among women living in the Middle East than in most Western countries. The negative outcomes associated with postpartum depression and anxiety are profound and include less responsive parenting and compromised infant and young child development. Although interventions exist to prevent postpartum depression and anxiety, to date, there have been no studies that have attempted to prevent postpartum depression or anxiety among Arabic-speaking women in the Middle East, including Qatar. OBJECTIVE The purpose of this study is to conduct a randomized controlled trial (RCT) of an evidence-based postpartum depression preventive intervention-Mothers and Babies (MB)-culturally adapted for use with Arabic-speaking women in Doha, Qatar. MB is guided by a cognitive behavioral therapy framework that focuses on increasing pleasant activities, promoting healthy thought patterns, and increasing the type and frequency of personal contacts. MB is tailored to specific needs and issues related to pregnancy and the postpartum period. METHODS A multidisciplinary and multiethnic investigator team adapted MB to promote cultural and contextual fit for Arabic-speaking women. Intervention concepts were reviewed to ensure core content would be understood by Arabic-speaking women in Qatar. Subsequently, images, activities, and examples in the intervention manuals were adapted, as needed, to make the content more relevant to Arab culture. To deliver the adapted intervention, 30 Arabic-speaking individuals with mental health backgrounds were trained. The adapted intervention was subsequently pilot-tested with 10 pregnant women receiving prenatal care at Sidra Hospital in Doha. We are now conducting an RCT to examine the effectiveness of the adapted intervention. We plan to enroll 210 pregnant individuals who are Arabic-speaking, with 1:1 randomization to the MB intervention or usual prenatal care. Among the enrolled participants, a stratified subsample of 40 pregnant women with diabetes is being recruited. Data collection will take place at baseline and a 6-month follow-up. The primary outcomes are depressive and anxiety symptoms and perceived stress. Diabetes self-care is the exploratory outcome for the subsample of individuals with diabetes. Intervention implementation will be assessed via client and provider surveys during and after intervention delivery. Power and sample size were calculated using a 2-sided 5% effort rate and assumed analyses on the individual level, accounting for attrition of 20%. RESULTS The cultural adaptation and pilot study of the adapted MB intervention are completed. A total of 157 women have been enrolled in the RCT as of March 31, 2023. CONCLUSIONS This study is highly innovative, as it is the first study to our knowledge to examine the effectiveness of an evidence-based postpartum depression preventive intervention in the Middle East. Limitations include a single follow-up time point and a small subsample of individuals with diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT04442529; https://www.clinicaltrials.gov/study/NCT04442529. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/11623.
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Affiliation(s)
- Sawssan R Ahmed
- Department of Psychology, California State University-Fullerton, Fullerton, CA, United States
| | | | | | | | | | | | | | - S Darius Tandon
- Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Darcy A, Beaudette A, Chiauzzi E, Daniels J, Goodwin K, Mariano TY, Wicks P, Robinson A. Anatomy of a Woebot® (WB001): agent guided CBT for women with postpartum depression. Expert Rev Med Devices 2023; 20:1035-1049. [PMID: 37938145 DOI: 10.1080/17434440.2023.2280686] [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: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Postpartum depression (PPD) is common, persistent, and stigmatized. There are insufficient trained professionals to deliver appropriate screening, diagnosis, and treatment. AREAS COVERED WB001 is a Software as a Medical Device (SaMD) based Agent-Guided Cognitive-Behavioral Therapy (AGCBT) program for the treatment of PPD, for which Breakthrough Device Designation was recently granted by the US Food and Drug Administration. WB001 combines therapeutic alliance, human-centered design, machine learning techniques, and established principles from CBT and interpersonal therapy (IPT). We introduce AGCBT as a new model of service delivery, whilst describing Woebot, the agent technology that enables guidance through the replication of some elements of human relationships. The profile describes the device's design principles, enabling technology, risk handling, and efficacy data in PPD. EXPERT OPINION WB001 is a dynamic and personalized tool with which patients may establish a therapeutic bond. Woebot is designed to augment (rather than replace) human healthcare providers, unlocking the therapeutic potency associated with guidance, whilst retaining the scalability and agency that characterizes self-help approaches. WB001 has the potential to improve both the quality and the scalability of care through providing support to patients on waiting lists, in between clinical encounters, and enabling automation of measurement-based-care.
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Affiliation(s)
| | | | | | | | | | - Timothy Y Mariano
- Woebot Health, San Francisco, CA, USA
- RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 5. Obstet Gynecol 2023; 141:1262-1288. [PMID: 37486661 DOI: 10.1097/aog.0000000000005202] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
PURPOSE To assess the evidence regarding safety and efficacy of psychiatric medications to treat mental health conditions during pregnancy and lactation. The conditions reviewed include depression, anxiety and anxiety-related disorders, bipolar disorder, and acute psychosis. For information on screening and diagnosis, refer to American College of Obstetricians and Gynecologists (ACOG) Clinical Practice Guideline Number 4, "Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum" (1). TARGET POPULATION Pregnant or postpartum individuals with mental health conditions with onset that may have predated the perinatal period or may have occurred for the first time in pregnancy or the first year postpartum or may have been exacerbated in that time. METHODS This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one specialist in obstetrics and gynecology and one maternal-fetal medicine subspecialist appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics and two external subject matter experts. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS This Clinical Practice Guideline includes recommendations on treatment and management of perinatal mental health conditions including depression, anxiety, bipolar disorders, and acute postpartum psychosis, with a focus on psychopharmacotherapy. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.
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Waqas A, Zafar SW, Akhtar P, Naveed S, Rahman A. Optimizing cognitive and behavioral approaches for perinatal depression: A systematic review and meta-regression analysis. Glob Ment Health (Camb) 2023; 10:e22. [PMID: 37854411 PMCID: PMC10579678 DOI: 10.1017/gmh.2023.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/20/2023] [Accepted: 03/03/2023] [Indexed: 03/15/2023] Open
Abstract
Cognitive behavioral therapies (CBT) have been demonstrated efficacious in treating perinatal depression (PND). This has been demonstrated in several meta-analyses of randomized controlled trials and quasi-experimental studies. However, there is a need for up-to-date meta-analytical evidence providing reliable estimates for CBT's effectiveness in treating and preventing PND. Furthermore, with the world moving toward precision medicine, approaches require a critical synthesis of psychotherapies, especially to unpack their mechanisms of action and to understand what approaches work best for whom. Therefore, the present systematic review and meta-regression analyses aim to answer these research questions. We searched six academic databases through February 2022 and identified 56 studies for an in-depth review. Using pretested data extraction sheets, we extracted patient-level and intervention-level characteristics and effect size data from each study. Random-effects meta-analyses and mixed-effect subgroup analyses were run to delineate the effectiveness and moderators of CBT interventions for PND, respectively. CBT-based interventions yielded a strong effect size (SMD = -0.74, 95% confidence interval [CI]: -0.91 to -0.56, n = 9,722) in alleviating depressive symptoms. These interventions were effective across different delivery formats (individual, group, and electronic) and could be delivered effectively by specialists and nonspecialists. Longer duration CBT interventions may not necessarily be more effective than shorter ones. Moreover, CBT-based interventions should consider including various behavioral ingredients to maximize intervention benefits.
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Affiliation(s)
- Ahmed Waqas
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Syeda Wajeeha Zafar
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Parveen Akhtar
- Department of Psychology, Capital University of Science and Technology, Islamabad, Pakistan
| | - Sadiq Naveed
- Department of Psychiatry, Eastern Connecticut Health Network, Manchester, CT, USA
| | - Atif Rahman
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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Naja S, Elyamani R, Chehab M, Ali Siddig Ahmed M, Babeker G, Lawand G, Singh R, Adli N, Mohamad T, Bougmiza I. The impact of telemental health interventions on maternal mental health outcomes: a pilot randomized controlled trial during the COVID-19 pandemic. Health Psychol Behav Med 2022; 11:1-21. [PMID: 36606005 PMCID: PMC9809366 DOI: 10.1080/21642850.2022.2155167] [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] [Indexed: 12/29/2022] Open
Abstract
Background The lethal potential of COVID-19 was often emphasized and repeatedly brought to the attention of pregnant women, leading to a higher level of anxiety, depression, and COVID-19-specific phobia among this population. Furthermore, legislation forced social distancing and isolation to interrupt the infection cycle. Together these factors resulted in higher maternal mental health distress requiring intervention. Nevertheless, there is a lack of evidence regarding the impact of low-intensity psychosocial telemental interventions on maternal mental health outcomes. Therefore, the objective of this pilot study is to assess the efficacy of video low-intensity psychosocial telemental maternal intervention on COVID-19-specific phobia, antenatal depression, and anxiety among pregnant women. We hypothesized that the intervention arm would be superior to the control arm. A parallel design randomized interventional controlled trial with 1:1 randomization was conducted at the Women Wellness and Research Center. We enrolled fifty-eight pregnant women in their second trimester who spoke English or Arabic. We assessed antenatal anxiety, depression, and Covid-19-specific phobia at baseline (T0), and thirty-three pregnant women completed the follow-up after four weeks (T1). Pregnant women receiving psychotropic medications and follow up in mental health services were excluded. Results A low-intensity psychosocial telemental maternal session helps reduce antenatal anxiety. We found statistically significant differences in antenatal anxiety scores between the intervention (2.4 ± 2.2) and control (4.2 ± 1.6) groups (p = 0.013) with a large effect size of Hedges' g value (0.96, 0.22-1.74). The absolute risk reduction was 27.27 percent. However, the intervention had no statistically significant effect on reducing antenatal depression or COVID-19-specific phobia. Conclusions Low-intensity psychosocial telemental maternal sessions effectively reduce antenatal anxiety. While our findings are promising, further RCTs are needed to replicate these findings. Trial registration 2a-ClinicalTrials.gov identifier: NCT04594525.. Registered on 20/October/2020; updated 9/March/ 2022. Available from: Maternal Telemental Health Interventions in Response to Covid-19* - Full Text View - ClinicalTrials.gov.
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Affiliation(s)
- Sarah Naja
- Community Medicine Department, Hamad Medical Corporation, Doha, Qatar, Sarah Naja Community Medicine Residency Program, Department of Medical Education, Hamad Medical Corporation, DohaPO Box 3050, Qatar
| | - Rowaida Elyamani
- Community Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohamad Chehab
- Community Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Ghidaa Babeker
- Community Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Ghinwa Lawand
- Obstetrics and Gynecology Department, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiology Research Department, Hamad Medical Corporation, Doha, Qatar
| | - Nada Adli
- Community Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Tagreed Mohamad
- Obstetrics and Gynecology Department, Hamad Medical Corporation, Doha, Qatar
| | - Iheb Bougmiza
- Community Medicine Department, Primary Health Care Corporation, Doha, Qatar
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Tandon SD, McGown M, Campbell L, Smith JD, Yeh C, Brady C. Results from an effectiveness-implementation evaluation of a postpartum depression prevention intervention delivered in home visiting programs. J Affect Disord 2022; 315:113-120. [PMID: 35878827 DOI: 10.1016/j.jad.2022.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/10/2022] [Accepted: 07/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Building on growing research examining lay health professionals delivering postpartum depression preventive interventions, we conducted a hybrid effectiveness-implementation Type 2 trial to examine implementation metrics and determine whether pregnant women receiving Mothers and Babies 1-on-1 delivered by lay home visitors exhibit greater reductions in depressive symptoms and perceived stress than women receiving usual home visiting. METHODS 1229 (672 control, 557 intervention) pregnant women were enrolled, with intervention participants receiving Mothers and Babies 1-on-1 delivered by a lay home visitor and control participants receiving usual home visiting services. Baseline and six-month follow-up assessments measured client mental health outcomes, with management information system data collected to assess intervention dosage. Surveys were administered nine months post-training to agency managers as well as home visitors who delivered any intervention content. RESULTS Intent-to-treat analyses indicated a significant reduction in perceived stress among intervention participants compared to controls, while as-treated analyses showed significant reductions in perceived stress and depressive symptoms. Although all study sites adopted the intervention, <50 % of eligible women received the intervention. Over two-thirds of home visitors made at least one fidelity-consistent adaptation, with client recruitment and retention in home visiting highlighted as challenges to delivery. LIMITATIONS Unmeasured historical events may have affected study outcomes and caution should be used generalizing to perinatal women from different racial/ethnic groups and home visiting models. CONCLUSION Mothers and Babies 1-on-1 delivered by lay home visitors leads to reductions in perceived stress and depressive symptoms, suggesting task shifting to non-mental health professionals is viable when appropriate training and supervision is provided.
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Affiliation(s)
- S Darius Tandon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States of America.
| | - Molly McGown
- Access Community Health Network, Chicago, IL 60609, United States of America
| | - Laura Campbell
- Oregon Health and Science University, Portland, OR 97239, United States of America
| | - Justin D Smith
- Department of Population Health Sciences, Division of Health Systems Innovation and Research, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84017, United States of America
| | - Chen Yeh
- Rush University Medical Center, Department of Family and Preventive Medicine, Chicago, IL 60611, United States of America
| | - Carol Brady
- Carol Brady & Associates, LLC, Atlantic Beach, FL 32233, United States of America
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Six SG, Byrne KA, Aly H, Harris MW. The Effect of Mental Health App Customization on Depressive Symptoms in College Students: Randomized Controlled Trial. JMIR Ment Health 2022; 9:e39516. [PMID: 35943788 PMCID: PMC9399839 DOI: 10.2196/39516] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Mental health apps have shown promise in improving mental health symptoms, including depressive symptoms. However, limited research has been aimed at understanding how specific app features and designs can optimize the therapeutic benefits and adherence to such mental health apps. OBJECTIVE The primary purpose of this study is to investigate the effect of avatar customization on depressive symptoms and adherence to use a novel cognitive behavioral therapy (CBT)-based mental health app. The secondary aim is to examine whether specific app features, including journaling, mood tracking, and reminders, affect the usability of the mental health app. METHODS College students were recruited from a university study recruitment pool website and via flyer advertisements throughout campus. A total of 94 participants completed a randomized controlled trial in which they were randomized to either customization or no customization version of the app. Customization involved personalizing a virtual avatar and a travel vehicle to one's own preferences and use of one's name throughout the app. Participants completed a 14-day trial using a novel CBT-based mental health app called AirHeart. Self-report scores for depressive symptoms, anxiety, and stress were measured at baseline and after the intervention. Postintervention survey measures also included usability and avatar identification questionnaires. RESULTS Of the 94 enrolled participants, 83 (88%) completed the intervention and postintervention assessments. AirHeart app use significantly reduced symptoms of depression (P=.006) from baseline to the end of the 2-week intervention period for all participants, regardless of the customization condition. However, no differences in depressive symptoms (P=.17) or adherence (P=.80) were observed between the customization (39/83, 47%) and no customization (44/83, 53%) conditions. The frequency of journaling, usefulness of mood tracking, and helpfulness of reminders were not associated with changes in depressive symptoms or adherence (P>.05). Exploratory analyses showed that there were 3 moderate positive correlations between avatar identification and depressive symptoms (identification: r=-0.312, P=.02; connection: r=-0.305, P=.02; and lack of relatability: r=0.338, P=.01). CONCLUSIONS These results indicate that CBT mental health apps, such as AirHeart, have the potential to reduce depressive symptoms over a short intervention period. The randomized controlled trial results demonstrated that customization of app features, such as avatars, does not further reduce depressive symptoms over and above the CBT modules and standard app features, including journal, reminders, and mood tracking. However, further research elucidating the relationship between virtual avatar identification and mental health systems is needed as society becomes increasingly more digitized. These findings have potential implications for improving the optimization of mental health app designs. TRIAL REGISTRATION Open Science Framework t28gm; https://osf.io/t28gm.
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Affiliation(s)
- Stephanie G Six
- Department of Psychology, Clemson University, Clemson, SC, United States
| | - Kaileigh A Byrne
- Department of Psychology, Clemson University, Clemson, SC, United States
| | - Heba Aly
- Department of Computer Science, Clemson University, Clemson, SC, United States
| | - Maggie W Harris
- Department of Psychology, Clemson University, Clemson, SC, United States
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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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Martín-Gómez C, Moreno-Peral P, Bellón JA, Conejo-Cerón S, Campos-Paino H, Gómez-Gómez I, Rigabert A, Benítez I, Motrico E. Effectiveness of psychological interventions in preventing postpartum depression in non-depressed women: a systematic review and meta-analysis of randomized controlled trials. Psychol Med 2022; 52:1001-1013. [PMID: 35257650 DOI: 10.1017/s0033291722000071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Postpartum depression (PPD) is one of the most common disorders following childbirth. This systematic review and meta-analysis (SR/MA) aimed to assess the effectiveness of psychological interventions in preventing PPD in non-depressed women. PRISMA guidelines were followed. MEDLINE (Ovid and PubMed), PsycINFO, Web of Science, Scopus, CINAHL, CENTRAL, OpenGrey, Australian New Zealand Clinical Trial Registry and clinicaltrial.gov were searched. Randomized controlled trials (RCTs) conducted with pregnant or postpartum (up to 12 months) women who were non-depressed at baseline were selected. The outcomes were the incidence of PPD and/or the reduction of postpartum depressive symptoms. The standardized mean difference (SMD) using random-effect models was calculated. Sensitivity, sub-group and meta-regression analyses were performed. 17 RCTs were included in the SR and 15 in the MA, representing 4958 participants from four continents. The pooled SMD was -0.175 [95% confidence interval (CI) -0.266 to -0.083; p < 0.001] and sensitivity analyses confirmed the robustness of this result. Heterogeneity was low (I2 = 21.20%) and was fully explained by a meta-regression model including one variable (previous deliveries). The meta-regression model and MA stratified by previous deliveries indicated that interventions focused on primiparous women are more effective. There was no evidence of publication bias. Few RCTs had an overall low risk of bias. According to GRADE, the quality of evidence was moderate. Psychological interventions have very little effectiveness in preventing PPD in non-depressed women, although this effectiveness is greater in interventions focused on primiparous women. Further RCTs with a low risk of bias and more effective interventions are needed.
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Affiliation(s)
- Carmen Martín-Gómez
- Fundación Pública Andaluza Progreso y Salud, Área de Evaluación de Tecnologías Sanitarias, Sevilla, Spain
- Grupo de Investigación (HUM604). Desarrollo de estilos de vida en el ciclo vital y promoción de la salud. Universidad de Huelva, Huelva, Spain
| | - Patricia Moreno-Peral
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Juan A Bellón
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
- El Palo Health Centre, Andalusian Health Service (SAS), Málaga, Spain
- Department of Public Health and Psychiatry, University of Málaga (UMA), Málaga, Spain
| | - Sonia Conejo-Cerón
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Henar Campos-Paino
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Irene Gómez-Gómez
- Department of Psychology, Universidad Loyola Andalucía, Sevilla, Spain
| | - Alina Rigabert
- Department of Psychology, Universidad Loyola Andalucía, Sevilla, Spain
- Fundación Andaluza Beturia para la Investigación en Salud (FABIS), Huelva, Spain
| | - Isabel Benítez
- Department of Methodology of Behavioural Sciences, University of Granada, Granada, Spain
| | - Emma Motrico
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Department of Psychology, Universidad Loyola Andalucía, Sevilla, Spain
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Darcy A, Beaudette A, Chiauzzi E, Daniels J, Goodwin K, Mariano TY, Wicks P, Robinson A. Anatomy of a Woebot® (WB001): agent guided CBT for women with postpartum depression. Expert Rev Med Devices 2022; 19:287-301. [PMID: 35748029 DOI: 10.1080/17434440.2022.2075726] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/05/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Postpartum Depression (PPD) is common, persistent, and stigmatized. There are insufficient trained professionals to deliver appropriate screening, diagnosis, and treatment. AREAS COVERED WB001 is a Software as a Medical Device (SaMD) based Agent-Guided Cognitive Behavioral Therapy (AGCBT) program for the treatment of PPD, for which Breakthrough Device Designation was recently granted by the US Food and Drug Administration. WB001 combines therapeutic alliance, human-centered design, machine learning techniques, and established principles from CBT and interpersonal therapy (IPT). We introduce AGCBT as a new model of service delivery, whilst describing Woebot, the agent technology that enables guidance through the replication of some elements of human relationships. The profile describes the device's design principles, enabling technology, risk handling, and efficacy data in PPD. EXPERT OPINION WB001 is a dynamic and personalized tool with which patients may establish a therapeutic bond. Woebot is designed to augment (rather than replace) human healthcare providers, unlocking the therapeutic potency associated with guidance, whilst retaining the scalability and agency that characterizes self-help approaches. WB001 has the potential to improve both the quality and the scalability of care through providing support to patients on waiting lists, in between clinical encounters, and enabling automation of measurement-based care.
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Tabb KM, Bentley B, Pineros Leano M, Simonovich SD, Nidey N, Ross K, Huang WHD, Huang H. Home Visiting as an Equitable Intervention for Perinatal Depression: A Scoping Review. Front Psychiatry 2022; 13:826673. [PMID: 35370817 PMCID: PMC8971366 DOI: 10.3389/fpsyt.2022.826673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/11/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Maternal mental health disorders are a leading complication of childbirth. While few systems are adequately able to identify and treat depression, people experiencing perinatal depression may benefit from the intervention of home visiting. The intent of home visiting interventions is to alleviate stressors of parenthood for people facing additional risk factors. The aim of this scoping review is to investigate the effect of home visiting on perinatal depression grounded in published studies. Methods We conducted a scoping review of the existing literature of studies relevant to perinatal depression and home visiting. We entered keywords in five search databases: MEDLINE, PsycInfo, CINAHL, Social Work Abstracts, and Google Scholar. All relevant literature published between January 1999-December 2019 was reviewed. Duplicates, books, and errata were excluded from the study. As a scoping review, we included all studies published in English describing the inclusion of maternal depression in home visits. We hypothesize birthing people with perinatal depression will benefit from home visiting interventions. Results The results from the scoping review and describe the use of home visiting to improve perinatal mental health. An initial 12,652 records were identified in the search. After duplicates were removed, the titles of 2,140 articles were assessed for applicability, however 29 identified for full-text eligibility and were included in this analysis. The majority of the studies included in this review were quantitative (n = 23), followed by qualitative (n = 3), and mixed methods (n = 3). Nearly all studies (n = 28) using validated instruments such as the Edinburgh Postnatal Depression Scale to determine depressive symptoms. Discussion This review offers preliminary qualitative insights on the efficacy of home visiting for administrating perinatal depression care. Studies show that home visiting programs can provide treatment for perinatal depression and reduce the effects of depression for birthing people. Our review suggests that the efficacy of home visiting programs beginning in the postpartum period are less predictable than prenatal home visiting intervention among various populations, including people experiencing both high-risk and low-risk situations.
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Affiliation(s)
- Karen M. Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Brandie Bentley
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | | | | | - Nichole Nidey
- Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Kate Ross
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Wen-hao David Huang
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Hsiang Huang
- Cambridge Health Alliance (CHA), Cambridge, MA, United States
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21
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Ponting C, Chavira DA, Schetter CD, Urizar GG. Cognitive behavioral stress management effects on prenatal anxiety among low-income women. J Consult Clin Psychol 2022; 90:148-160. [PMID: 34914418 PMCID: PMC10037536 DOI: 10.1037/ccp0000699] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Few studies have tested cognitive behavioral therapy to reduce prenatal anxiety despite substantial empirical support among individuals seeking treatment for anxiety symptoms. We examined whether a brief cognitive behavioral intervention delivered to low-income pregnant women would be efficacious for reducing prenatal anxiety. METHOD A sample of 100 primarily ethnic and racial minority pregnant women with subclinical anxiety (74% Latina, 18% Black; Mage = 26.5) were randomized to an 8-week cognitive behavioral stress management (CBSM) intervention (n = 55), or to an attentional control condition (n = 45). Two forms of anxiety (state and pregnancy-specific) were measured at baseline, post-treatment, and at follow-up in the postpartum using the State-Trait Personality Inventory-State and the Pregnancy Related Anxiety scale, respectively. Intent-to-treat (ITT) and completer analyses were conducted using linear mixed models to test mean differences in both forms of anxiety by group assignment and by intervention completion (< 7 vs. ≥ 7 sessions) at post-treatment and follow-up timepoints. RESULTS ITT results revealed no intervention Group × Time interactions for state, F(3, 356) = .51, p = .68, or pregnancy-specific anxiety, F(2, 184.39) = .75, p = .47, indicating no intervention effect post-treatment or at follow-up. Completer analyses showed that women who received all intervention content (34.5%) had significantly less state anxiety at post-treatment compared to women who had not completed the intervention, (65.5%; Msessions = 3.62); F(6, 270.67) = 2.35, p = .03, and those in the control condition. CONCLUSIONS While we did not find support for the use of CBSM to treat prenatal anxiety among low-income women, those who received a full dose benefited in state anxiety immediately postintervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Carolyn Ponting
- Department of Psychology, University of California, Los Angeles
| | | | | | - Guido G. Urizar
- Department of Psychology, California State University, Long Beach
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22
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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: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [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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23
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Barrera AZ, Hamil J, Tandon D. Integrating SMS Text Messages Into a Preventive Intervention for Postpartum Depression Delivered via In-Home Visitation Programs: Feasibility and Acceptability Study. JMIR Form Res 2021; 5:e30995. [PMID: 34792478 PMCID: PMC8663697 DOI: 10.2196/30995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The Mothers and Babies (MB) Course is recognized by the US Preventive Services Task Force as an evidence-based preventive intervention for postpartum depression (PPD) that should be recommended to pregnant women at risk for PPD. OBJECTIVE This report examines the feasibility and acceptability of enhancing the MB 1-on-1 intervention by adding 36 SMS text messages that target 3 areas: reinforcement of skills, between-session homework reminders, and responding to self-monitoring texts (ie, MB Plus Text Messaging [MB-TXT]). METHODS In partnership with 9 home visiting programs, 28 ethnically and racially diverse pregnant women (mean 25.6, SD 9.0 weeks) received MB-TXT. Feasibility was defined by home visitors' adherence to logging into the HealthySMS platform to enter session data and trigger SMS text messages within 7 days of the in-person session. The acceptability of MB-TXT was measured by participants' usefulness and understanding ratings of the SMS text messages and responses to the self-monitoring SMS text messages. RESULTS On average, home visitors followed the study protocol and entered session-specific data between 5.50 and 61.17 days following the MB 1-on-1 sessions. A high proportion of participants responded to self-monitoring texts (25/28, 89%) and rated the text message content as very useful and understandable. CONCLUSIONS This report contributes to a growing body of research focusing on digital adaptations of the MB course. SMS is a low-cost, accessible digital tool that can be integrated into existing interventions. With appropriate resources to support staff, it can be implemented in community-based organizations and health care systems that serve women at risk for PPD. TRIAL REGISTRATION ClinicalTrials.gov NCT03420755; https://clinicaltrials.gov/ct2/show/NCT03420755.
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Affiliation(s)
- Alinne Z Barrera
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
| | - Jaime Hamil
- Institute for Public Health and Medicine, Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Darius Tandon
- Institute for Public Health and Medicine, Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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24
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Arbour MC, Floyd B, Morton S, Hampton P, Sims JM, Doyle S, Atwood S, Sege R. Cross-Sector Approach Expands Screening and Addresses Health-Related Social Needs in Primary Care. Pediatrics 2021; 148:peds.2021-050152. [PMID: 34706903 DOI: 10.1542/peds.2021-050152] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES During infancy, the American Academy of Pediatrics Bright Futures fourth edition health supervision guidelines recommend frequent well-child visits (WCVs) in which providers are expected to screen for and address maternal depression, intimate partner violence (IPV), and health-related social needs (HRSN). We spread an evidence-based approach that implements these recommendations (Developmental Understanding and Legal Collaboration for Everyone; DULCE) with 3 aims for 6-month-old infants and their families: 75% receive all WCVs on time, 95% are screened for 7 HRSNs, and 90% of families with concrete supports needs and 75% of families with maternal depression or IPV receive support. METHODS Between January 2017 and July 2018, five DULCE teams (including a community health worker, early childhood system representative, legal partner, clinic administrator, pediatric and behavioral health clinicians) from 3 communities in 2 states participated in a learning collaborative. Teams adapted DULCE using Plan-Do-Study-Act cycles, reported data, and shared learning monthly. Run charts were used to study measures. The main outcome was the percent of infants that received all WCVs on time. RESULTS The percentage of families who completed all WCVs on time increased from 46% to 65%. More than 95% of families were screened for HRSNs, 70% had ≥1 positive screen, and 86% and 71% of those received resource information for concrete supports and maternal depression and IPV, respectively. CONCLUSIONS Quality improvement-supported DULCE expansion increased by 50% the proportion of infants receiving all WCVs on time and reliably identified and addressed families' HRSNs, via integration of existing resources.
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Affiliation(s)
| | - Baraka Floyd
- Stanford School of Medicine, Stanford, California
| | | | - Patsy Hampton
- Center for the Study of Social Policy, Washington, DC
| | | | | | | | - Robert Sege
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
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25
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Hamil J, Gier E, Garfield CF, Tandon D. The Development and Pilot of a Technology-Based Intervention in the United States for Father's Mental Health in the Perinatal Period. Am J Mens Health 2021; 15:15579883211044306. [PMID: 34587839 PMCID: PMC8488529 DOI: 10.1177/15579883211044306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Paternal mental health is increasingly recognized as an important public health issue, with about 10% of men experiencing depression perinatally. Paternal depression is associated with less responsive parenting, greater parenting stress, and suboptimal child development. In response to a lack of existing interventions that directly focus on fathers’ mental health in the United States, we developed and pilot tested the Fathers and Babies (FAB) intervention for use with partners of women enrolled in home visiting (HV) programs. After a review of the extant literature, FAB was developed with input from HV stakeholders and infant mental health consultants. FAB was subsequently pilot tested with 30 father-mother dyads, with mixed-method data collected from a subset of intervention participants to assess intervention feasibility and acceptability and guide intervention refinement. Five themes related to FAB content and delivery considerations emerged from the initial focus groups that were used to guide FAB development. Mixed-method data collected during the pilot study established that fathers receiving FAB reported its content appropriate and thought it was feasible to receive the intervention. Several recommendations for FAB revisions were also provided. FAB is an innovative intervention developed for fathers from contemporary family structures that was well-received during its pilot testing. Feasibility and acceptability data suggest that fathers have favorable opinions about intervention content and delivery, while also highlighting areas for future revisions of FAB.
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Affiliation(s)
- Jaime Hamil
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emma Gier
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Craig F Garfield
- Northwestern University Feinberg School of Medicine, Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Darius Tandon
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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26
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Izett E, Rooney R, Prescott SL, De Palma M, McDevitt M. Prevention of Mental Health Difficulties for Children Aged 0-3 Years: A Review. Front Psychol 2021; 11:500361. [PMID: 34777074 PMCID: PMC8579481 DOI: 10.3389/fpsyg.2020.500361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/24/2020] [Indexed: 12/05/2022] Open
Abstract
The period of infancy and early childhood is a critical time for interventions to prevent future mental health problems. The first signs of mental health difficulties can be manifest in infancy, emphasizing the importance of understanding and identifying both protective and risk factors in pregnancy and the early postnatal period. Parents are at a higher risk of developing mental health problems during the perinatal period. An understanding of the evidence around prevention and intervention for parental anxiety and depression is vital to the process of prevention of early mental health disorders in infants and young children. Here we review the existing prevention and treatment interventions in the early years focusing on the period from conception to 3 years - the majority targeting parents in order to improve their mental health, and that of their infants. Elements of successful programs for parents include psychoeducation and practical skills training, as well as work on the co-parenting relationship, developing secure attachment, and enhancing parental reflective functioning. While both targeted and universal programs have produced strong effect sizes, universal programs have the added benefit of reaching people who may otherwise not have sought treatment. In synthesizing this information, our goal is to inform the development of integrated models for prevention and novel early intervention programs as early in life as possible.
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Affiliation(s)
- Elizabeth Izett
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Rosanna Rooney
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Susan L. Prescott
- The ORIGINS Project, Telethon Kids Institute and the Division of Paediatrics, School of Medicine, University of Western Australia, Nedlands, WA, Australia
| | - Mia De Palma
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Maryanne McDevitt
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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27
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Gewali A, Lopez A, Dachelet K, Healy E, Jean-Baptiste M, Harridan H, Evans Y, Unger JA, Bhat A, Tandon D, Ronen K. A Social Media Group Cognitive Behavioral Therapy Intervention to Prevent Depression in Perinatal Youth: Stakeholder Interviews and Intervention Design. JMIR Ment Health 2021; 8:e26188. [PMID: 34524086 PMCID: PMC8482173 DOI: 10.2196/26188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Adolescents and young adults aged <25 years (youth) are at a higher risk of perinatal depression than older adults, and they experience elevated barriers to in-person care. Digital platforms such as social media offer an accessible avenue to deliver group cognitive behavioral therapy (CBT) to perinatal youth. OBJECTIVE We aim to develop the Interactive Maternal Group for Information and Emotional Support (IMAGINE) intervention, a facilitated social media group CBT intervention to prevent perinatal depression in youth in the United States, by adapting the Mothers and Babies (MB) course, an evidence-based in-person group CBT intervention. In this study, we report perspectives of youth and health care providers on perinatal youths' mental health needs and document how they informed IMAGINE design. METHODS We conducted 21 semistructured in-depth individual interviews with 10 pregnant or postpartum youths aged 14-24 years and 6 health care workers. All interviews were recorded, transcribed, and analyzed using deductive and inductive approaches to characterize perceptions of challenges and facilitators of youth perinatal mental health. Using a human-centered design approach, stakeholder perspectives were incorporated into the IMAGINE design. We classified MB adaptations to develop IMAGINE according to the Framework for Modification and Adaptation, reporting the nature, timing, reason, and goal of the adaptations. RESULTS Youth and health care workers described stigma associated with young pregnancy and parenting, social isolation, and lack of material resources as significant challenges to youth mental wellness. They identified nonjudgmental support, peer companionship, and access to step-by-step guidance as facilitators of youth mental wellness. They endorsed the use of a social media group to prevent perinatal depression and recommended that IMAGINE facilitate peer support, deliver content asynchronously to accommodate varied schedules, use a confidential platform, and facilitate the discussion of topics beyond the MB curriculum, such as navigating support resources or asking medical questions. IMAGINE was adapted from MB to accommodate stakeholder recommendations and facilitate the transition to web-based delivery. Content was tailored to be multimodal (text, images, and video), and the language was shortened and simplified. All content was designed for asynchronous engagement, and redundancy was added to accommodate intermittent access. The structure was loosened to allow the intervention facilitator to respond in real time to topics of interest for youth. A social media platform was selected that allows multiple conversation channels and conceals group member identity. All adaptations sought to preserve the fidelity of the MB core components. CONCLUSIONS Our findings highlight the effect of stigmatization of young pregnancy and social determinants of health on youth perinatal mental health. Stakeholders supported the use of a social media group to create a supportive community and improve access to evidence-based depression prevention. This study demonstrates how a validated intervention can be tailored to this unique group.
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Affiliation(s)
- Anupa Gewali
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Alana Lopez
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kristin Dachelet
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Elise Healy
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Holly Harridan
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Yolanda Evans
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Jennifer A Unger
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Darius Tandon
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
- Center for Community Health, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, United States
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28
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Comparing the effectiveness of home visiting paraprofessionals and mental health professionals delivering a postpartum depression preventive intervention: a cluster-randomized non-inferiority clinical trial. Arch Womens Ment Health 2021; 24:629-640. [PMID: 33655429 DOI: 10.1007/s00737-021-01112-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/27/2021] [Indexed: 12/18/2022]
Abstract
To determine whether pregnant women receiving the Mothers and Babies group-based intervention exhibited greater depressive symptom reductions and fewer new cases of major depression than women receiving usual community-based services, and to examine whether groups run by paraprofessional home visitors and mental health professionals yielded similar depressive symptom reductions and prevention of major depression. Using a cluster-randomized design, 37 home visiting programs were randomized to usual home visiting, Mothers and Babies delivered via home visiting paraprofessionals, or Mothers and Babies delivered via mental health professionals. Baseline assessments were conducted prenatally with follow-up extending to 24 weeks postpartum. Eligibility criteria were ≥ 16 years old, ≤ 33 gestation upon referral, and Spanish/English speaking. Depressive symptoms at 24 weeks postpartum was the primary outcome. Eight hundred seventy-four women were enrolled. Neither intervention arm was superior to usual care in decreasing depressive symptoms across the sample (p = 0.401 home visiting paraprofessional vs. control; p = 0.430 mental health professional vs. control). Post hoc analyses suggest a positive intervention effect for women exhibiting mild depressive symptoms at baseline. We have evidence of non-inferiority, as the model-estimated mean difference in depressive symptoms between intervention arms (0.01 points, 95% CI: -0.79, 0.78) did not surpass our pre-specified margin of non-inferiority of two points. Although we did not find statistically significant differences between intervention and control arms, non-inferiority analyses found paraprofessional home visitors generated similar reductions in depressive symptoms as mental health professionals. Additionally, Mothers and Babies appears to reduce depressive symptoms among women with mild depressive symptoms when delivered by mental health professionals. This trial is registered on ClinicalTrials.gov (initial post: December 1, 2016; identifier: NCT02979444).
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29
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Tandon SD, Hamil J, Gier EE, Garfield CF. Examining the Effectiveness of the Fathers and Babies Intervention: A Pilot Study. Front Psychol 2021; 12:668284. [PMID: 34335380 PMCID: PMC8319568 DOI: 10.3389/fpsyg.2021.668284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/21/2021] [Indexed: 01/21/2023] Open
Abstract
There is increasing recognition of the importance of addressing the mental health of fathers, including during the perinatal period. Fathers exhibiting mental health concerns during the perinatal period are at heightened risk for future negative mental health outcomes and are less likely to engage in nurturing relationships with their children, leading to a sequalae of negative child outcomes during infancy and into adolescence. Although interventions have been developed for perinatal fathers, they typically do not focus directly on addressing paternal mental health. To fill this gap, we developed the Fathers and Babies intervention to be delivered to perinatal fathers whose partners (mothers) were enrolled in home visiting programs. A pre-post longitudinal study was conducted in which 30 father-mother dyads were recruited from home visiting programs. Fathers received the 12-session Fathers and Babies intervention while the mother concurrently received the Mothers and Babies intervention delivered to her by a home visitor. Baseline, 3- and 6-month self-report surveys were conducted with both fathers and mothers. Fathers and mothers had statistically significant decreases in perceived stress between baseline and both follow-up time points, with moderate effect sizes generated for both sexes. No statistically significant differences were found for depressive symptoms, anxiety symptoms, or perceived partner support, although we found small effects for reductions in depressive symptoms among fathers, as well as increases in the percentage of fathers and mothers who reported high levels of emotional and instrumental support post-intervention. While preliminary, these findings suggest the potential for Fathers and Babies to positively impact the mental health of fathers in the perinatal period, and also signal the viability of home visiting as a setting for delivering this intervention. Future research should employ a comparison group to generate stronger evidence of intervention effectiveness and include measurement of dyadic relationships and paternal parenting practices.
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Affiliation(s)
- S Darius Tandon
- Center for Community Health, Northwestern Feinberg School of Medicine, Institute of Public Health and Medicine, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Jaime Hamil
- Center for Community Health, Northwestern Feinberg School of Medicine, Institute of Public Health and Medicine, Chicago, IL, United States
| | - Emma E Gier
- Center for Community Health, Northwestern Feinberg School of Medicine, Institute of Public Health and Medicine, Chicago, IL, United States
| | - Craig F Garfield
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States.,Family and Child Health Innovations Program, Department of Pediatrics, Lurie Children's Hospital of Chicago, Chicago, IL, United States
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30
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Diebold A, Ciolino JD, Johnson JK, Yeh C, Gollan JK, Tandon SD. Comparing Fidelity Outcomes of Paraprofessional and Professional Delivery of a Perinatal Depression Preventive Intervention. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:597-605. [PMID: 32086657 PMCID: PMC7253394 DOI: 10.1007/s10488-020-01022-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Mothers and Babies (MB), a perinatal depression preventive intervention, has proven effective in decreasing depressive symptoms and preventing onset of major depression. An ongoing cluster-randomized trial is comparing the effectiveness of the six-session MB group intervention led by paraprofessionals versus mental health professionals. Twenty percent of all audio-recorded intervention sessions were randomly selected for fidelity checks. Analyses assessed mean facilitator adherence and competency overall, by study arm, and by session; and, examined site, facilitator, and client-specific effects. There were no significant differences found between study arms. Findings show paraprofessionals can deliver MB with similar fidelity as mental health professionals.
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Affiliation(s)
- Alicia Diebold
- Institute for Public Health and Medicine, Center for Community Health, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Suite 643, Chicago, IL, 60611, USA.
| | - Jody D Ciolino
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jessica K Johnson
- Institute for Public Health and Medicine, Center for Community Health, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Suite 643, Chicago, IL, 60611, USA
| | - Chen Yeh
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jackie K Gollan
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - S Darius Tandon
- Department of Medical Social Sciences, Institute for Public Health and Medicine, Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
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31
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Yu M, Sampson M, Liu Y, Rubin A. A longitudinal study of the stress-buffering effect of social support on postpartum depression: a structural equation modeling approach. ANXIETY STRESS AND COPING 2021; 34:751-765. [PMID: 33938786 DOI: 10.1080/10615806.2021.1921160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Postpartum depression (PPD) impacts about one out of eight new mothers. Research has demonstrated that social support is a protector of PPD. Nevertheless, there has been disagreement on how social support influences depression. The objective is to test two theories - main-effect theory and stress-buffering theory of social support on PPD with different definitions of stress and two types of social support. METHODS Secondary longitudinal data from the National Data Archive on Child Abuse and Neglect were used. Parenting stress and difficult life circumstances (DLC) measured at six-month postpartum was used to predict the changes in depression from six- to 12-month postpartum; social support at six-month postpartum was conceptualized as a moderator between stress and PPD. Structural Equation Modeling was adopted for the longitudinal analyses. RESULTS DLC and parental distress both showed long-lasting impacts on PPD. Social support was not found to have a direct or indirect effect on PPD. Neither the stress-buffering theory nor the main-effect model was endorsed by this study. CONCLUSION Interventions that are accessible to new mothers and aim to improve self-efficacy are recommended. Measures with higher psychometric quality should be used in moderation research. More longitudinal studies with shorter lags between measurement occasions are warranted.
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Affiliation(s)
- Miao Yu
- School of Social Work, Social Work Complex, University of Texas at Arlington, Arlington, TX, USA
| | - McClain Sampson
- Graduate College of Social Work, University of Houston, Houston, Texas, USA
| | - Yu Liu
- Department of Psychological, Health and Learning Sciences, College of Education, University of Houston, Houston, Texas, USA
| | - Allen Rubin
- Graduate College of Social Work, University of Houston, Houston, Texas, USA
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32
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Consensus Bundle on Postpartum Care Basics: From Birth to the Comprehensive Postpartum Visit. Obstet Gynecol 2021; 137:33-40. [PMID: 33278281 DOI: 10.1097/aog.0000000000004206] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/09/2020] [Indexed: 01/31/2023]
Abstract
In the weeks after childbirth, a woman navigates multiple challenges. She must recover from birth, learn to care for herself and her newborn, and cope with fatigue and postpartum mood changes as well as chronic health conditions. Alongside these common morbidities, the number of maternal deaths in the United States continues to increase, and unacceptable racial inequities persist. One third of pregnancy-related deaths occur between 1 week and 1 year after delivery, with a growing proportion of these deaths due to cardiovascular disease; one fifth occur between 7 and 42 days postpartum. In addition, pregnancy-associated deaths due to self-harm or substance misuse are increasing at an alarming rate. Rising maternal mortality and morbidity rates, coupled with significant disparities in outcomes, highlight the need for tailored interventions to improve safety and well-being of families during the fourth trimester of pregnancy, which includes the period from birth to the comprehensive postpartum visit. Targeted support for growing families during this transition can improve health and well-being across generations.
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Organ M, Tandon SD, Diebold A, Johnson JK, Yeh C, Ciolino JD. Evaluating performance of covariate-constrained randomization (CCR) techniques under misspecification of cluster-level variables in cluster-randomized trials. Contemp Clin Trials Commun 2021; 22:100754. [PMID: 33732943 PMCID: PMC7941091 DOI: 10.1016/j.conctc.2021.100754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/12/2020] [Accepted: 02/09/2021] [Indexed: 11/27/2022] Open
Abstract
Covariate constrained randomization (CCR) is a method of controlling imbalance in important baseline covariates in cluster-randomized trials (CRT). We use simulated CRTs to investigate the performance (control of imbalance) of CCR relative to simple randomization (SR) under conditions of misspecification of the cluster-level variable used in the CCR algorithm. We use data from a Patient-Centered Outcomes Research Institute (PCORI)-funded CRT evaluating the Mothers and Babies (MB) intervention (AD-1507-31,473). CCR methodology was used in the MB study to control imbalance in, among other baseline variables, the percent minority (i.e., non-White) participants at each study site. Simulation schemes explored variation in degree of misspecification in the baseline covariate of interest, and include correct report, observed misspecification, and a range of simulated misspecification for intervals within and beyond that observed in the MB study. We also consider three within-site sample size scenarios: that observed in the MB study, small (mean 10) and large (mean 50). Simulations at every level of baseline covariate misspecification suggest that use of the CCR strategy provides between-arm imbalance that is simultaneously lower and less variable, on average, than that produced from the SR strategy. We find that the gains to using CCR over SR are nearly twice as high with accurate reporting (Δ = -5.33) compared to the observed study-level misspecification (Δ = -3.03). Although CCR still outperforms SR as the level of misspecification increases, the gains to using CCR over SR decrease; thus, every effort should still be made to obtain high-quality baseline data.
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Affiliation(s)
- Madeleine Organ
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, USA.,Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S Darius Tandon
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alicia Diebold
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jessica K Johnson
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Chen Yeh
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jody D Ciolino
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Lowe K, Cartagena D, Gudger K. Evaluation of a Home Visiting Program: Perspectives of Mothers. Home Healthc Now 2021; 39:91-98. [PMID: 33662967 DOI: 10.1097/nhh.0000000000000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Home visiting programs provide families with an array of services that contribute to decreased infant and maternal morbidity and mortality. However, little is known as to how mothers perceive participation in home visiting programs, and questions remain regarding what improvements can be made to better serve these families. The purpose of this program evaluation was to assess mothers' perceived benefits and barriers to participation in established home visiting and outreach programs at Child Developmental Resources (CDR) in Williamsburg, Virginia. The program evaluation was a descriptive project consisting of 30-minute telephone interviews. Participants included 23 English-speaking mothers enrolled in CDR programs. Maternal demographics and perception of benefits/barriers were measured. Descriptive statistics were performed to describe sample demographics and outcome variables. Overall, most mothers perceived CDR programs as beneficial and were very satisfied with the services; however, a few changes could be made to improve programs and combat barriers to participation. Potential alternatives to supplement programs were suggested including the use of mobile technology in the participant's home.
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Bass M, Rosen KD, Gerend MA, Wakschlag LS, Madkins K, Crosby ST, Alshurafa N, King ZD, Ghaffari R, Smith JD. Development and feasibility of a Configurable Assessment Messaging Platform for Interventions (CAMPI). FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2021; 39:19-28. [PMID: 34014727 PMCID: PMC8345008 DOI: 10.1037/fsh0000592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Short message service (SMS) is a widely accepted telecommunications approach used to support health informatics, including behavioral interventions, data collection, and patient-provider communication. However, SMS delivery platforms are not standardized and platforms are typically commercial "off-the-shelf" or developed "in-house." As a consequence of platform variability, implementing SMS-based interventions may be challenging for both providers and patients. Off-the-shelf SMS delivery platforms may require minimal development or technical resources from providers, but users are often limited in their functionality. Conversely, platforms that are developed in-house are often specified for individual projects, requiring specialized development and technical expertise. Patients are on the receiving end of programming and technical specification challenges; message delays or lagged data affect quality of SMS communications. To date, little work has been done to develop a generalizable SMS platform that can be scaled across health initiatives. OBJECTIVE We propose the Configurable Assessment Messaging Platform for Interventions (CAMPI) to mitigate challenges associated with SMS intervention implementation (e.g., programming, data collection, message delivery). METHOD CAMPI aims to optimize health data captured from a multitude of sources and enhance patient-provider communication through a technology that is simple and familiar to patients. Using representative examples from three behavioral intervention case studies implemented among diverse populations (pregnant women, young sexual minority men, and parents with young children), we describe CAMPI capabilities and feasibility. CONCLUSION As a generalizable SMS platform, CAMPI can be scaled to meet the priorities of various health initiatives, while reducing unnecessary resource utilization and burden on providers and patients. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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A pilot study of a group-based perinatal depression intervention on reducing depressive symptoms and improving maternal-fetal attachment and maternal sensitivity. Arch Womens Ment Health 2021; 24:145-154. [PMID: 32409986 PMCID: PMC7666645 DOI: 10.1007/s00737-020-01032-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/07/2020] [Indexed: 12/30/2022]
Abstract
To conduct a pilot study of a group-based perinatal depression intervention, the Mothers and Babies Course, on depressive symptomatology, maternal-fetal attachment, and maternal sensitivity, 60 pregnant women with moderate to severe depressive symptomatology were randomized to a 6-week intervention or usual care group at their initial prenatal care visit. Measures of depressive symptomatology and maternal-fetal attachment were collected at baseline and 36 weeks gestation. At 12 weeks postpartum, participants completed a measure of depressive symptomatology, and an objective measure of maternal sensitivity was collected. Participants randomized to the intervention group completed an average of 5.2 sessions, and 70% of women completed all six sessions. Exploratory analyses showed that at 12 weeks postpartum, participants randomized to the intervention group had an 8.32-point decrease from baseline on the Edinburgh Postnatal Depression Scale (EPDS) as compared to a 4.59-point decrease among participants randomized to usual care. Participants randomized to the intervention group had a mean change score of 12.60 in maternal-fetal attachment via the Maternal Fetal Attachment Scale (MFAS) as compared to 4.60 among participants in usual care. Maternal sensitivity scores, assessed via the Nursing Child Assessment Satellite Training-Feeding Scale (NCAST-Feeding), were higher at 12 weeks postpartum for women in the intervention group as compared to women in usual care (59.2 and 51.8, respectively). Our pilot study findings provide preliminary support for the benefits of a perinatal depression intervention, delivered in a group setting, on reducing depressive symptomatology, and improving maternal-fetal attachment and maternal sensitivity. Further research, conducted with larger samples, is necessary to determine the effect of this intervention on indicators of maternal attachment.
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Batra K, Pharr J, Olawepo JO, Cruz P. Understanding the multidimensional trajectory of psychosocial maternal risk factors causing preterm birth: A systematic review. Asian J Psychiatr 2020; 54:102436. [PMID: 33271716 DOI: 10.1016/j.ajp.2020.102436] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/23/2020] [Accepted: 10/03/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Among all known risk factors of preterm birth, psychosocial factors form an intricate collection, which includes a multidimensional spectrum of interrelated mediating mechanisms. The understanding of these interconnected mechanisms is vital for designing targeted interventions to reduce preterm births. The objective of this systematic review was to investigate potential psychosocial maternal factors and their interactions to cause preterm birth. METHODS PubMed, CINAHL, Scopus, Medline, and Cochrane Database of Systematic Reviews were searched for U.S.-based English language studies published between 1989 and 2019. Titles, abstracts, and full-texts were screened to determine eligibility for inclusion. Data were extracted from eligible studies using a customized data collection form. The National Institutes of Health assessment tool was utilized for quality assessment. RESULTS Among the 76 full texts that were reviewed, 9 records met the eligibility criteria, and were included in the final review. The included publications addressed psychosocial factors including racial disparity, lifetime racism, neighborhood disadvantage, lack of partner support, childhood maltreatment and life-course variations, including homelessness and marital status. Antenatal stress was identified as a common mechanism through which psychosocial mediators may act to cause preterm birth. CONCLUSIONS This review highlights the need for controlling potential risk factors of maternal stress by improving prenatal care, providing proper housing, and establishing conducive social environments for pregnant women. The review also suggests the importance of maternal psychological counselling and extensive maternal health monitoring among minority groups during the pregnancy period.
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Affiliation(s)
- Kavita Batra
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, Nevada, USA; Office of Research, School of Medicine, University of Nevada, Las Vegas, Nevada, USA.
| | - Jennifer Pharr
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, Nevada, USA
| | - John O Olawepo
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, Nevada, USA; Department of Health Sciences, Bouve College of Health Sciences, North Eastern University, Boston, Massachusetts, USA
| | - Patricia Cruz
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, Nevada, USA
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Wakschlag LS, Tandon D, Krogh-Jespersen S, Petitclerc A, Nielsen A, Ghaffari R, Mithal L, Bass M, Ward E, Berken J, Fareedi E, Cummings P, Mestan K, Norton ES, Grobman W, Rogers J, Moskowitz J, Alshurafa N. Moving the dial on prenatal stress mechanisms of neurodevelopmental vulnerability to mental health problems: A personalized prevention proof of concept. Dev Psychobiol 2020; 63:622-640. [PMID: 33225463 DOI: 10.1002/dev.22057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 12/31/2022]
Abstract
Prenatal stress exposure increases vulnerability to virtually all forms of psychopathology. Based on this robust evidence base, we propose a "Mental Health, Earlier" paradigm shift for prenatal stress research, which moves from the documentation of stress-related outcomes to their prevention, with a focus on infant neurodevelopmental indicators of vulnerability to subsequent mental health problems. Achieving this requires an expansive team science approach. As an exemplar, we introduce the Promoting Healthy Brain Project (PHBP), a randomized trial testing the impact of the Wellness-4-2 personalized prenatal stress-reduction intervention on stress-related alterations in infant neurodevelopmental trajectories in the first year of life. Wellness-4-2 utilizes bio-integrated stress monitoring for just-in-time adaptive intervention. We highlight unique challenges and opportunities this novel team science approach presents in synergizing expertise across predictive analytics, bioengineering, health information technology, prevention science, maternal-fetal medicine, neonatology, pediatrics, and neurodevelopmental science. We discuss how innovations across many areas of study facilitate this personalized preventive approach, using developmentally sensitive brain and behavioral methods to investigate whether altering children's adverse gestational exposures, i.e., maternal stress in the womb, can improve their mental health outlooks. In so doing, we seek to propel developmental SEED research towards preventive applications with the potential to reduce the pernicious effect of prenatal stress on neurodevelopment, mental health, and wellbeing.
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Affiliation(s)
- Lauren S Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Darius Tandon
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA.,Institute for Public Health & Medicine Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sheila Krogh-Jespersen
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Amelie Petitclerc
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Ashley Nielsen
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Rhoozbeh Ghaffari
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA.,Department of Materials Science & Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA
| | - Leena Mithal
- Department of Materials Science & Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA.,Department of Pediatrics (Infectious Diseases), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Bass
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Erin Ward
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA.,Institute for Public Health & Medicine Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jonathan Berken
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Feinberg School of Medicine, Chicago, IL, USA
| | - Elveena Fareedi
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Peter Cummings
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Karen Mestan
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics (Neonatology), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elizabeth S Norton
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA.,Department of Communication Sciences & Disorders, School of Communication, Northwestern University, Chicago, IL, USA
| | - William Grobman
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA.,Department of Obstetrics & Gynecology (Maternal-Fetal Medicine), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - John Rogers
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA.,Department of Materials Science & Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA
| | - Judith Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Nabil Alshurafa
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA.,Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Computer Science, McCormick School of Engineering, Northwestern University, Chicago, IL, USA
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Lewis Johnson TE, Clare CA, Johnson JE, Simon MA. Preventing Perinatal Depression Now: A Call to Action. J Womens Health (Larchmt) 2020; 29:1143-1147. [PMID: 32749917 PMCID: PMC7520910 DOI: 10.1089/jwh.2020.8646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the United States, perinatal depression (PD) affects an estimated 11.5% of pregnant and postpartum individuals annually and is one of the most common complications of pregnancy and the postpartum period. Alarmingly, up to 51% of people with PD are undiagnosed. Despite the availability of tools to screen for PD, there is no consensus on which tool is most accurate, nor is there a universal policy on when and how to best screen patients with PD. Screening to identify PD is essential, but prevention of depression is even more critical, yet traditionally not well addressed until recently with the US Preventive Services Task Force (USPSTF) recommendation in 2019. When the USPSTF recommended implementing programs to prevent PD in at-risk individuals, the recommendation cited two evidence-based PD prevention programs by name. One of these, ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns), is a four-session class taught in prenatal settings. The second program mentioned is the Mothers and Babies program, which has been shown to be effective in using a cognitive behavioral therapy approach to prevent PD. Although scientists develop effective mental health interventions to prevent PD, community-based advocacy groups are engaged in grassroots efforts to provide support and encouragement to racially and ethnically diverse pregnant and postpartum women. To increase the number of pregnant and postpartum women who are screened and supported so that they do not develop PD, research supports three key strategies: (1) Establish a standard combination of multicultural PD screening tools with evidence-based timepoints for screening administration. (2) Introduce an evidence-based definition of PD that accurately captures the prevalence and incidence of this mental health condition. (3) Improve our understanding of PD by incorporating the psychosocial context in which mental health complications occur into routine clinical practice for pregnant and postpartum women.
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Affiliation(s)
- Tamara E. Lewis Johnson
- National Institutes of Health, National Institute of Mental Health, Office of Disparities Research and Workforce Diversity, Rockville, Maryland, USA
- Address correspondence to: Tamara E. Lewis Johnson, MPH, MBA, Office of Disparities Research and Workforce Diversity, National Institutes of Health, National Institute of Mental Health, 6001 Executive Boulevard, Room 7209, MSC 9659, Rockville, MD 20892-7963, USA
| | - Camille A. Clare
- Department of Obstetrics and Gynecology, New York Medical College, New York, New York, USA
| | - Jennifer E. Johnson
- Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Melissa A. Simon
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Li Z, Liu Y, Wang J, Liu J, Zhang C, Liu Y. Effectiveness of cognitive behavioural therapy for perinatal depression: A systematic review and meta-analysis. J Clin Nurs 2020; 29:3170-3182. [PMID: 32563204 DOI: 10.1111/jocn.15378] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/24/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To systematically review the efficacy of cognitive behavioural therapy for improving mood in perinatal depression. BACKGROUND The impact of cognitive behavioural therapy on perinatal depression has been evaluated in various studies, but there is uncertainty about their impact. DESIGN Systematic review and meta-analysis. METHODS Nine electronic literature databases were searched to retrieve eligible randomised controlled trials: CNKI, VIP digital database, Chinese Wanfang database, the Cochrane library, PubMed, Web of science, EMBASE, PsycINFO, CINAHL from the inception of the databases up to 15 November 2019. The eligible studies were screened and extracted, and then, the methodological quality was evaluated independently by two researchers. The meta-analyst software (Rev Man 5.3) was used to conduct the meta-analysis. Checklist of Preferred Reporting Items for Systematic Reviews and Meta-analyses has been followed. RESULTS Thirteen RCTs with 966 participants were included. The results showed that the CBT group was superior to the usual care group in reducing depression symptoms of pregnant women after treatment immediately, and the difference was statistically significant. Similarly, at postpartum (<4 months), the results showed that the CBT group was superior to the usual care group in improving depression symptoms of pregnant women. However, there was no statistical difference at postpartum (>4 months). CONCLUSIONS Cognitive behavioural therapy can effectively relieve the symptoms of depression at short-term effect. However, its long-term effect need to be verified by further clinical studies. RELEVANCE TO CLINICAL PRACTICE This meta-analysis suggested that cognitive behavioural therapy should be considered as a complementary programme for patients with perinatal depression. Medical workers could apply cognitive behavioural therapy into daily routine cares for perinatal depression.
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Affiliation(s)
- Zimeng Li
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ying Liu
- Department of Cardiology, Wuxi people's Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Jiayao Wang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jia Liu
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chunmei Zhang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yanhui Liu
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Variation of Behavioral Health Care by Behavioral Health Symptom Profile Among a Diverse Group of Pregnant and Parenting Mothers. J Behav Health Serv Res 2020; 48:36-49. [PMID: 32333363 DOI: 10.1007/s11414-020-09701-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examines the association between behavioral health symptoms and use of behavioral health care (BHC; i.e., past year counseling and/or regular use of psychiatric medication) among a diverse group of mothers of toddlers. Data were from the Fragile Families and Child Wellbeing study (N = 4205 mothers). The association between symptom profiles (i.e., depressive, anxiety, and alcohol and drug dependence) and use of BHC was estimated with logistic regression models. Potential moderation by race/ethnicity was examined. Complex symptom profiles, older age, functional limitations, prior behavioral health symptoms, and having Medicaid were associated with increased BHC use. While BHC use varied by symptom profile (but not by race/ethnicity), BHC use was low across profiles. Pregnant women and women of color were most likely to have unmet needs, underscoring the need to improve screening and management systems for these populations.
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Tandon D, Mackrain M, Beeber L, Topping-Tailby N, Raska M, Arbour M. Addressing maternal depression in home visiting: Findings from the home visiting collaborative improvement and innovation network. PLoS One 2020; 15:e0230211. [PMID: 32298289 PMCID: PMC7161976 DOI: 10.1371/journal.pone.0230211] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/24/2020] [Indexed: 11/22/2022] Open
Abstract
Background Maternal depression is common among low-income women enrolled in home visiting programs, yet there is considerable variability in the extent to which it is identified and addressed. This study examines outcomes related to postpartum depression screening, receipt of evidence-based services, and reductions in depressive symptoms among clients of home visiting programs in the Health Resources and Services Administration’s Maternal, Infant, and Early Childhood Home Visiting Program Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN), the first U.S. national application of the Institute for Healthcare Improvement’s Breakthrough Series (BTS) Model in home visiting programs. Methods and findings Fourteen home visiting programs in eight states, serving a geographically and racially diverse caseload of pregnant women and new mothers, took part in the HV CoIIN. Women in participating home visiting programs received the intervention strategies implemented by their program during participation in the collaborative. HV CoIIN strategies included specific policies and protocols for depression screening and home visitor response to screening results; home visitor training and supervision; delivery of prevention and treatment interventions; and tracking systems for screening, referral, and follow-up. HV CoIIN’s proposed primary outcome was that 85% of women who accessed evidence-based services would experience a 25% reduction in depressive symptoms three months after accessing services. Secondary outcomes included an increased percentage of women who were screened for depression within three months of enrollment or birth, who verbally accepted a referral to evidence-based services, and who received one or more evidence-based service contacts. HV CoIIN resulted in improved symptoms among women who accessed services, from 51.1% to 59.9%. HV CoIIN also improved the percent of women screened for depression, from 83.6% to 96.3%, and those with positive depression screens who accessed evidence-based services, from 41.6% to 65.5%. Home visiting programs in this study were early adopters of quality improvement activities, which may limit the generalizability of these results to other home visiting programs. Conclusions Home visiting programs can play an important role in closing gaps in maternal depression identification, referrals, service access, and symptom alleviation. Continuous quality improvement and BTS collaborative methods can be used to improve home visiting services in ways that advance national public health priorities and improve population health outcomes.
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Affiliation(s)
- Darius Tandon
- Institute for Public Health and Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, United States of America
- * E-mail:
| | - Mary Mackrain
- Education Development Center, Inc., Waltham, MA, United States of America
| | - Linda Beeber
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | | | - Marcy Raska
- Education Development Center, Inc., Waltham, MA, United States of America
| | - MaryCatherine Arbour
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, United States of America
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Diebold A, Segovia M, Johnson JK, Degillio A, Zakieh D, Park HJ, Lim K, Tandon SD. Acceptability and appropriateness of a perinatal depression preventive group intervention: a qualitative analysis. BMC Health Serv Res 2020; 20:189. [PMID: 32143644 PMCID: PMC7060621 DOI: 10.1186/s12913-020-5031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 02/24/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Perinatal depression is a prevalent public health concern. Although preventive interventions exist, there is limited literature on the acceptability and appropriateness of these interventions, especially those delivered by paraprofessionals. The Mothers and Babies Program (MB) is a group-based perinatal depression preventive intervention delivered prenatally. A cluster-randomized controlled trial examined the acceptability, appropriateness, and effectiveness of MB delivered by mental health professionals compared to paraprofessional staff from home visiting programs. METHODS The full study enrolled 874 pregnant women. Fifty-three facilitators were trained and delivered the MB intervention to women in one of seven states in the United States. Semi-structured interviews were attempted with a randomly-selected subset of the full sample of pregnant women who received the MB intervention and with all facilitators. Specifically, interviews were conducted with 88 women who received the MB group intervention (45 in the paraprofessional-led arm and 43 in the mental health professional-led arm) and 46 women who facilitated the groups (27 home visiting staff and 19 mental health professionals). Interviews were conducted over the phone in English or Spanish and audio recorded. The recordings were translated into English, as needed, and transcribed. Thematic analysis was conducted using NVIVO to identify key themes related to intervention acceptability and appropriateness. Similarities and differences between study arms were explored. RESULTS Clients and facilitators found the MB content and group format acceptable. Challenges included maintaining group attendance, transportation issues, and managing group discussion. Overall, facilitators found the intervention appropriate for pregnant clients with some challenges presented for clients in crisis situations, experiencing housing instability, and with literacy and learning challenges. Participants provided suggestions for improvement, both for the course content and implementation. There were no significant differences found between study arms. CONCLUSIONS Overall, clients and facilitators enjoyed MB irrespective of study arm, and facilitators found the intervention appropriate for the population. These findings add to the qualitative literature on perinatal depression preventive interventions, specifically those delivered by paraprofessionals. TRIAL REGISTRATION This trial is registered on ClinicalTrials.gov (Initial post: December 1, 2016; identifier: NCT02979444).
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Affiliation(s)
- Alicia Diebold
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 643, Chicago, IL, 60611, USA.
| | - Melissa Segovia
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Jessica K Johnson
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Aria Degillio
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Dana Zakieh
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Hee Jin Park
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Kenneth Lim
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - S Darius Tandon
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
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Effectiveness of a group intervention led by lay health workers in reducing the incidence of postpartum depression in South India. Asian J Psychiatr 2020; 47:101864. [PMID: 31759286 DOI: 10.1016/j.ajp.2019.101864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Postnatal depression is a highly prevalent disorder with serious implications on maternal and child outcomes. There are few studies examining feasible interventions in low-middle-income community settings. AIMS To assess the effectiveness of a low intensity group intervention led by lay workers during the antenatal period in reducing postnatal depression at 6-2 weeks postpartum. METHODS A parallel group design with both positive and negative controls was employed. 1 community site was allocated to each of the 3 arms. The active intervention consisted of problem based sessions with cognitive behavioural components. The primary outcome was the presence of depression on CIS-R and secondary outcome measures where Global Assessment of Functioning (GAF) scores, EPNDS scores and participant perceptions. RESULTS 69, 75 and 70 women received active, positive control and negative control interventions respectively. Post partum depression diagnosed with the CIS-R was present in 14.06% (C.I.- 5.55%-22.57%) and 22.62% (C.I.15.62%-29.63%) in the active arm and two control (combined) arms respectively. There was a 1/3 lower proportion of postpartum depression and impaired functioning in the intervention group, though statistical significance was not reached (p = 0.30). There were high levels of satisfaction reported for the active intervention. CONCLUSION There were trends for the possible effectiveness for this low intensity intervention and conclusions regarding its effectiveness can't be made as the sample size was small. There is a need to explore and develop locally relevant, innovative and feasible strategies for prevention of postnatal depression in resource constrained enviroments.
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Baker CE, Brooks‐Gunn J, Gouskova N. Reciprocal Relations Between Maternal Depression and Child Behavior Problems in Families Served by Head Start. Child Dev 2019; 91:1563-1576. [DOI: 10.1111/cdev.13344] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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46
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Molewyk Doornbos M, Zandee GL, Timmermans B, Moes J, Heitsch E, Quist M, Heetderks E, Houskamp C, VanWolde A. Factors impacting attrition of vulnerable women from a longitudinal mental health intervention study. Public Health Nurs 2019; 37:73-80. [PMID: 31736164 DOI: 10.1111/phn.12687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 10/26/2019] [Accepted: 10/29/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study explored factors associated with attrition of vulnerable women from a community-based, longitudinal mental health intervention study. DESIGN The study employed a quasi-experimental, nonequivalent comparison group pretest-posttest design. The intervention consisted of six, 90-min meetings featuring education and support. SAMPLE One hundred and eighteen women aged 18-88 years enrolled from four urban neighborhoods. MEASUREMENTS The team used the Generalized Anxiety Disorder-7, the Primary Health Questionnaire-9, a self-care knowledge for anxiety and depression instrument, and demographics to measure variables. INTERVENTION Sessions occurred at trusted neighborhood sites. The team provided transportation, child care, and reminder calls or texts. Community health workers actively encouraged participants to continue in the study. The researchers did not offer financial incentives. Completion of the intervention involved attending four of six sessions. RESULTS The study had a 39% attrition rate. Results, using a Chi-square test for independence, indicated significant associations between attrition, neighborhood/homelessness, and family income. Additionally, there were significant associations between attrition, a past diagnosis of anxiety, and a lack of concurrent therapy for anxiety/depression. CONCLUSIONS This study identified social determinants and mental health factors linked to the attrition of urban, ethnically diverse, and impoverished women from longitudinal intervention studies.
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Affiliation(s)
| | | | | | - Jesse Moes
- Department of Nursing, Calvin College, Grand Rapids, MI, USA
| | - Emily Heitsch
- Department of Nursing, Calvin College, Grand Rapids, MI, USA
| | - Morgan Quist
- Department of Nursing, Calvin College, Grand Rapids, MI, USA
| | - Erica Heetderks
- Department of Nursing, Calvin College, Grand Rapids, MI, USA
| | | | - Anna VanWolde
- Department of Nursing, Calvin College, Grand Rapids, MI, USA
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Ciolino JD, Diebold A, Jensen JK, Rouleau GW, Koloms KK, Tandon D. Choosing an imbalance metric for covariate-constrained randomization in multiple-arm cluster-randomized trials. Trials 2019; 20:293. [PMID: 31138319 PMCID: PMC6537428 DOI: 10.1186/s13063-019-3324-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/25/2019] [Indexed: 11/16/2022] Open
Abstract
Background In cluster-randomized controlled trials (C-RCTs), covariate-constrained randomization (CCR) methods efficiently control imbalance in multiple baseline cluster-level variables, but the choice of imbalance metric to define the subset of “adequately balanced” possible allocation schemes for C-RCTs involving more than two arms and continuous variables is unclear. In an ongoing three-armed C-RCT, we chose the min(three Kruskal–Wallis [KW] test P values) > 0.30 as our metric. We use simulation studies to explore the performance of this and other metrics of baseline variable imbalance in CCR. Methods We simulated three continuous variables across three arms under varying allocation ratios and assumptions. We compared the performance of min(analysis of variance [ANOVA] P value) > 0.30, min(KW P value) > 0.30, multivariate analysis of variance (MANOVA) P value > 0.30, min(nine possible t test P values) > 0.30, and min(Wilcoxon rank-sum [WRS] P values) > 0.30. Results Pairwise comparison metrics (t test and WRS) tended to be the most conservative, providing the smallest subset of allocation schemes (10%–13%) meeting criteria for acceptable balance. Sensitivity of the min(t test P values) > 0.30 for detecting non-trivial imbalance was 100% for both hypothetical and resampled simulation scenarios. The KW criterion maintained higher sensitivity than both the MANOVA and ANOVA criteria (89% to over 99%) but was not as sensitive as pairwise criteria. Conclusions Our criterion, the KW P value > 0.30, to signify “acceptable” balance was not the most conservative, but it appropriately identified imbalance in the majority of simulations. Since all are related, CCR algorithms involving any of these imbalance metrics for continuous baseline variables will ensure robust simultaneous control over multiple continuous baseline variables, but we recommend care in determining the threshold of “acceptable” levels of (im)balance. Trial registration This trial is registered on ClinicalTrials.gov (initial post: December 1, 2016; identifier: NCT02979444). Electronic supplementary material The online version of this article (10.1186/s13063-019-3324-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jody D Ciolino
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Alicia Diebold
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jessica K Jensen
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gerald W Rouleau
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | - Darius Tandon
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Developing and Pretesting a Survey About Immigrant Women’s Experiences With Postpartum Depression Screening. J Obstet Gynecol Neonatal Nurs 2019; 48:216-226. [DOI: 10.1016/j.jogn.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2019] [Indexed: 11/17/2022] Open
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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: 169] [Impact Index Per Article: 33.8] [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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50
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Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW, Grossman DC, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB. Interventions to Prevent Perinatal Depression: US Preventive Services Task Force Recommendation Statement. JAMA 2019; 321:580-587. [PMID: 30747971 DOI: 10.1001/jama.2019.0007] [Citation(s) in RCA: 276] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Perinatal depression, which is the occurrence of a depressive disorder during pregnancy or following childbirth, affects as many as 1 in 7 women and is one of the most common complications of pregnancy and the postpartum period. It is well established that perinatal depression can result in adverse short- and long-term effects on both the woman and child. OBJECTIVE To issue a new US Preventive Services Task Force (USPSTF) recommendation on interventions to prevent perinatal depression. EVIDENCE REVIEW The USPSTF reviewed the evidence on the benefits and harms of preventive interventions for perinatal depression in pregnant or postpartum women or their children. The USPSTF reviewed contextual information on the accuracy of tools used to identify women at increased risk of perinatal depression and the most effective timing for preventive interventions. Interventions reviewed included counseling, health system interventions, physical activity, education, supportive interventions, and other behavioral interventions, such as infant sleep training and expressive writing. Pharmacological approaches included the use of nortriptyline, sertraline, and omega-3 fatty acids. FINDINGS The USPSTF found convincing evidence that counseling interventions, such as cognitive behavioral therapy and interpersonal therapy, are effective in preventing perinatal depression. Women with a history of depression, current depressive symptoms, or certain socioeconomic risk factors (eg, low income or young or single parenthood) would benefit from counseling interventions and could be considered at increased risk. The USPSTF found adequate evidence to bound the potential harms of counseling interventions as no greater than small, based on the nature of the intervention and the low likelihood of serious harms. The USPSTF found inadequate evidence to assess the benefits and harms of other noncounseling interventions. The USPSTF concludes with moderate certainty that providing or referring pregnant or postpartum women at increased risk to counseling interventions has a moderate net benefit in preventing perinatal depression. CONCLUSIONS AND RECOMMENDATION The USPSTF recommends that clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions. (B recommendation).
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Affiliation(s)
| | | | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | - Douglas K Owens
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Stanford University, Stanford, California
| | | | | | - Karina W Davidson
- Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | | | | | | | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
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