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Daehn D, Meyer C, Loew V, Wabiszczewicz J, Pohl S, Böttche M, Pawils S, Renneberg B. Smartphone-based intervention for postpartum depressive symptoms (Smart-e-Moms): study protocol for a randomized controlled trial. Trials 2024; 25:469. [PMID: 38987846 PMCID: PMC11234544 DOI: 10.1186/s13063-024-08304-5] [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: 04/02/2024] [Accepted: 06/28/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Postpartum depression constitutes a significant public health issue, with prevalence rates ranging between 8 and 19% in high-income nations. Nevertheless, numerous barriers, including time constraints, societal stigmatization, and feelings of shame, contribute to the limited utilization of healthcare services during the postpartum period. Digital interventions offer an opportunity to enhance care for women experiencing postpartum depressive symptoms. METHODS We will conduct a two-arm randomized controlled trial to assess the effectiveness of a smartphone-based intervention in comparison to a treatment-as-usual control group in Germany. Our aim is to randomize 556 participants in a 1:1 ratio. Participants in the intervention group will be provided access to a preventive smartphone-based intervention called "Smart-e-Moms," which incorporates therapeutic support and comprises 10 concise modules rooted in cognitive-behavioral therapy. For the intervention group, evaluations will take place at baseline (t0), prior to sessions 4 and 8 (intermediate assessments), and upon completing the intervention 6 weeks after baseline (t1). The control group's assessments will be at baseline (t0) and 6 weeks after baseline. Follow-up assessments are scheduled at 12 and 24 weeks from baseline to examine the short-term stability of any observed effects. We anticipate that participants in the intervention group will exhibit improvements in their postpartum depressive symptoms (as measured with the Edinburgh Postnatal Depression Scale). Additionally, we will analyze secondary outcomes, including maternal bonding, stress levels, self-efficacy, satisfaction with the intervention, and healthcare utilization. DISCUSSION If Smart-e-Moms proves to be effective, it has the potential to play a significant role in postpartum depression care within German-speaking regions. Ideally, this intervention could not only benefit maternal well-being but also improve the prospects for healthy child development. TRIAL REGISTRATION German clinical trials registry DRKS00032324. Registered on January 26, 2024.
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Affiliation(s)
- Daria Daehn
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
| | - Caroline Meyer
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Viola Loew
- Department of Medical Psychology, University Medical Center Hamburg‑Eppendorf, Hamburg, Germany
| | | | - Steffi Pohl
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Maria Böttche
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Silke Pawils
- Department of Medical Psychology, University Medical Center Hamburg‑Eppendorf, Hamburg, Germany
| | - Babette Renneberg
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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Bhadelia A, Barr KR, John JR, Jalaludin B, Dissanyake C, Williams K, Woolfenden S, Eapen V. Difficult Toddler Temperament - Prevalence and Associated Factors at 18-Month Follow-Up of a Birth Cohort. Neuropsychiatr Dis Treat 2024; 20:967-977. [PMID: 38741582 PMCID: PMC11090188 DOI: 10.2147/ndt.s454949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/03/2024] [Indexed: 05/16/2024] Open
Abstract
Purpose Difficult temperament coupled with other risk factors may lead to mental health problems in childhood and have long-lasting effects in adolescence and adulthood. This study aimed to investigate the prevalence of parental perception of difficult temperament in toddlers and identify significant factors associated with individual and family-level sociodemographic risk factors. Patients and Methods The prevalence of parental perception of difficult temperament was derived from items in the 18-month follow-up questionnaire within the Watch Me Grow (WMG) longitudinal birth cohort study in a multicultural and socioeconomically disadvantaged community in Sydney, Australia. Data was available for 500 children and their parents. Descriptive analysis was used to calculate the participant characteristics and the prevalence of parental perception of difficult temperament, whereas multivariable logistic regression analysis was used to assess significant risk factors associated with a difficult temperament. Results Parental perception of difficult temperament in the cohort was 7.3% (n = 492). Findings of the multivariable logistic regression showed that screen time >2 hours a day (AOR 2.43, 95% CI: 1.2, 4.9), child not being read to (AOR 3.92, 95% CI: 1.8, 8.5), and family history of mental health problems (AOR 2.69, 95% CI: 1.1, 6.5) significantly increased the odds of having a difficult temperament. Conclusion Toddlers with difficult temperament were less likely to have received stimulatory experiences, and their families were more likely to be under greater stress. The findings emphasize the importance of parental support and anticipatory guidance in promoting nurturing care to facilitate child health and development, particularly in disadvantaged communities.
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Affiliation(s)
- A’ishah Bhadelia
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Karlen R Barr
- South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - James Rufus John
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- South Western Sydney Local Health District, Liverpool, NSW, Australia
- Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Bin Jalaludin
- Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Cheryl Dissanyake
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Susan Woolfenden
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Valsamma Eapen
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- South Western Sydney Local Health District, Liverpool, NSW, Australia
- Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
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Ansaari N, Rajan SK, Kuruveettissery S. Efficacy of in-person versus digital mental health interventions for postpartum depression: meta-analysis of randomized controlled trials. J Reprod Infant Psychol 2024:1-21. [PMID: 38221725 DOI: 10.1080/02646838.2024.2303470] [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: 10/23/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
AIM This meta-analysis aimed to compare the efficacy of in-person and digital mental health interventions in addressing Postpartum Depression. METHODS Following PRISMA guidelines, the protocol for this meta-analysis was registered at the Open Science Framework (Retrieved from osf.io/wy3s4). This meta analysis included Randomized Controlled Trials (RCTs) conducted between 2013 and 2023. A comprehensive literature search identified 35 eligible RCTs from various electronic databases. Inclusion criteria focused on pregnant women over 18 years old, encompassing antenatal depression and up to two years postpartum. Diagnostic interviews or Edinburgh Postnatal Depression Scale (EPDS) were used to establish PPD. Digital interventions included telephonic, app-based, or internet-based approaches, while in-person interventions involved face-to-face sessions. RESULTS The meta-analysis revealed a moderate overall effect size of -0.69, indicating that psychological interventions are effective for PPD. Digital interventions (g = -0.86) exhibited a higher mean effect size than in-person interventions (g = -0.55). Both types of interventions displayed substantial heterogeneity (digital: I2 = 99%, in-person: I2 = 92%), suggesting variability in intervention content, delivery methods, and participant characteristics. CONCLUSION Digital mental health interventions show promise in addressing PPD symptoms, with a potentially greater effect size compared to in-person interventions. However, the high heterogeneity observed in both modalities underscores the need for further research to identify key drivers of success and tailor interventions to diverse populations. Additionally, the choice between digital and in-person interventions should consider individual needs and preferences. Ongoing research should further investigate and optimise intervention modalities to better serve pregnant women at risk of PPD.
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Affiliation(s)
- Neda Ansaari
- Department of Psychology, CHRIST (Deemed to be University), Bangalore, India
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Lewkowitz AK, Whelan AR, Ayala NK, Hardi A, Stoll C, Battle CL, Tuuli MG, Ranney ML, Miller ES. The effect of digital health interventions on postpartum depression or anxiety: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol 2024; 230:12-43. [PMID: 37330123 PMCID: PMC10721728 DOI: 10.1016/j.ajog.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE This study aimed to examine the effect of digital health interventions compared with treatment as usual on preventing and treating postpartum depression and postpartum anxiety. DATA SOURCES Searches were conducted in Ovid MEDLINE, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. STUDY ELIGIBILITY REQUIREMENTS The systematic review included full-text randomized controlled trials comparing digital health interventions with treatment as usual for preventing or treating postpartum depression and postpartum anxiety. STUDY APPRAISAL AND SYNTHESIS METHODS Two authors independently screened all abstracts for eligibility and independently reviewed all potentially eligible full-text articles for inclusion. A third author screened abstracts and full-text articles as needed to determine eligibility in cases of discrepancy. The primary outcome was the score on the first ascertainment of postpartum depression or postpartum anxiety symptoms after the intervention. Secondary outcomes included screening positive for postpartum depression or postpartum anxiety --as defined in the primary study --and loss to follow-up, defined as the proportion of participants who completed the final study assessment compared with the number of initially randomized participants. For continuous outcomes, the Hedges method was used to obtain standardized mean differences when the studies used different psychometric scales, and weighted mean differences were calculated when studies used the same psychometric scales. For categorical outcomes, pooled relative risks were estimated. RESULTS Of 921 studies originally identified, 31 randomized controlled trials-corresponding to 5532 participants randomized to digital health intervention and 5492 participants randomized to treatment as usual-were included. Compared with treatment as usual, digital health interventions significantly reduced mean scores ascertaining postpartum depression symptoms (29 studies: standardized mean difference, -0.64 [95% confidence interval, -0.88 to -0.40]; I2=94.4%) and postpartum anxiety symptoms (17 studies: standardized mean difference, -0.49 [95% confidence interval, -0.72 to -0.25]; I2=84.6%). In the few studies that assessed screen-positive rates for postpartum depression (n=4) or postpartum anxiety (n=1), there were no significant differences between those randomized to digital health intervention and treatment as usual. Overall, those randomized to digital health intervention had 38% increased risk of not completing the final study assessment compared with those randomized to treatment as usual (pooled relative risk, 1.38 [95% confidence interval, 1.18-1.62]), but those randomized to app-based digital health intervention had similar loss-to-follow-up rates as those randomized to treatment as usual (relative risk, 1.04 [95% confidence interval, 0.91-1.19]). CONCLUSION Digital health interventions modestly, but significantly, reduced scores assessing postpartum depression and postpartum anxiety symptoms. More research is needed to identify digital health interventions that effectively prevent or treat postpartum depression and postpartum anxiety but encourage ongoing engagement throughout the study period.
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Affiliation(s)
- Adam K Lewkowitz
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI; Center for Digital Health, Brown University School of Public Health, Providence, RI.
| | - Anna R Whelan
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI
| | - Nina K Ayala
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI
| | - Angela Hardi
- Becker Medical Library, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Carrie Stoll
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Cynthia L Battle
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | - Methodius G Tuuli
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI
| | - Megan L Ranney
- Center for Digital Health, Brown University School of Public Health, Providence, RI; Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI
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Miura Y, Ogawa Y, Shibata A, Kamijo K, Joko K, Aoki T. App-based interventions for the prevention of postpartum depression: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:441. [PMID: 37316768 DOI: 10.1186/s12884-023-05749-5] [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: 12/31/2022] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND This study explored whether psychosocial intervention applications (apps) are effective in preventing postpartum depression. METHODS We conducted an initial article search on 26 March 2020, and the updated search on 17 March 2023 on the electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, Scopus, PsycINFO, CINAHL, and ProQuest Dissertations & Theses A&I. Furthermore, we searched the International Clinical Trials Platform Search Portal (ICTRP), and Clinical Trials. RESULTS We identified 2515 references, and sixteen studies were ultimately included in this review. We conducted a meta-analysis of two studies on the onset of postpartum depression. There were no significant differences between the intervention and control groups (RR 0.80; 95% CI 0.62 to 1.04; P = 0.570). We performed a meta-analysis of the Edinburgh Postnatal Depression Scale (EPDS). The intervention group had significantly lower EPDS scores than the control group (mean difference -0.96; 95% CI -1.44 to -0.48; P < 0.001, I2 = 82%, Chi2 = 62.75, P < 0.001; high heterogeneity). CONCLUSION This study presents the results of current RCTs on interventions with apps, including an app with an automated psychosocial component for preventing postpartum depression that has been conducted. These apps improved the EPDS score; furthermore, they may prevent postpartum depression.
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Affiliation(s)
- Yumika Miura
- Hamamatsu Satocho Clinic, 1-22-22 Sato, Naka-Ku, Hamamatsu-Shi, Shizuoka, 430-0807, Japan
| | - Yusuke Ogawa
- Department of Healthcare Epidemiology, School of Public Health, Kyoto University, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Ayako Shibata
- Department of Obstetrics and Gynecology, Yodogawa Christian Hospital, 1-7-50, Kunijima, Higashiyodogawa-Ku, Osaka, 533-0024, Japan
| | - Kyosuke Kamijo
- Department of Gynecology, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano, 381-8551, Japan
| | - Ken Joko
- Department of Obstetrics and Gynecology, Kikugawa General Hospital, 1632 Higashiyokochi, Kikugawa, Shizuoka, 439-0022, Japan
| | - Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Syogoin, Sakyo-Ku, Kyoto, 606-8507, Japan.
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Han A, Kim TH. Effects of Self-Compassion Interventions on Reducing Depressive Symptoms, Anxiety, and Stress: A Meta-Analysis. Mindfulness (N Y) 2023; 14:1-29. [PMID: 37362192 PMCID: PMC10239723 DOI: 10.1007/s12671-023-02148-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/28/2023]
Abstract
Objectives A growing body of evidence shows self-compassion can play a key role in alleviating depressive symptoms, anxiety, and stress in various populations. Interventions fostering self-compassion have recently received increased attention. This meta-analysis aimed to identify studies that measured effects of self-compassion focused interventions on reducing depressive symptoms, anxiety, and stress. Methods A comprehensive search was conducted within four databases to identify relevant randomized controlled trials (RCTs). The quality of the included RCTs was assessed using the Cochrane Collaboration risk-of-bias tool. Either a random-effects model or fixed-effects model was used. Subgroup analyses were conducted according to types of control groups, intervention delivery modes, and the involvement of directly targeted populations with psychological distress symptoms. Results Fifty-six RCTs met the eligibility criteria. Meta-analyses showed self-compassion focused interventions had small to medium effects on reducing depressive symptoms, anxiety, and stress at the immediate posttest and small effects on reducing depressive symptoms and stress at follow-up compared to control conditions. The overall risk of bias across included RCTs was high. Conclusions Fewer studies were conducted to compare effects of self-compassion interventions to active control conditions. Also, fewer studies involved online self-compassion interventions than in-person interventions and directly targeted people with distress symptoms. Further high-quality studies are needed to verify effects of self-compassion interventions on depressive symptoms, anxiety, and stress. As more studies are implemented, future meta-analyses of self-compassion interventions may consider conducting subgroup analyses according to intervention doses, specific self-compassion intervention techniques involved, and specific comparison or control groups. Preregistration This study is not preregistered. Supplementary Information The online version contains supplementary material available at 10.1007/s12671-023-02148-x.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, SHPB 339, 1720 2Nd Ave South, Birmingham, AL 35294 USA
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-RoGangwon Province, Wonju, 26426 South Korea
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