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Dhaurali S, Dugat V, Whittler T, Shrestha S, Kiani M, Ruiz MG, Ali I, Enge C, Amutah-Onukagha N. Investigating Maternal Stress, Depression, and Breastfeeding: A Pregnancy Risk Assessment Monitoring System (2016-2019) Analysis. Healthcare (Basel) 2023; 11:1691. [PMID: 37372809 DOI: 10.3390/healthcare11121691] [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: 04/26/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Breastfeeding is invaluable for postpartum physical healing and mental wellbeing, but psychosocial stress and depression impede such recovery processes. To inform future interventions and policies, associations between breastfeeding, maternal stress, and depression were examined. Data from the Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed (2016-2019). Logistic regression models were used to calculate adjusted odds ratios with 95% confidence intervals. Of the total sample (n = 95,820), approximately 88% of participants attempted breastfeeding. Our findings indicate that participants who experienced any form of stress had a slightly higher likelihood of breastfeeding compared to those without stress. Specifically, partner-related and financial-related stressors were significantly associated with increased odds of breastfeeding. However, no significant associations were observed trauma-related or emotional-related stressors and breastfeeding. Additionally, no significant association was found between depression at different stages (preconception, prenatal, and postpartum) and breastfeeding. A significant interaction effect was noted between having experienced any of the 13 stressors and Black race/ethnicity on breastfeeding odds. Similarly, significant interaction effects were observed between partner-related, trauma, financial, or emotional stressors and Black race/ethnicity. These findings emphasize the importance of considering various factors when promoting breastfeeding in diverse populations, and screening for psychosocial stress during postpartum visits. Our study recommends tailoring breastfeeding interventions to address the needs of Black mothers which could significantly improve maternal health and breastfeeding outcomes.
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Affiliation(s)
- Shubhecchha Dhaurali
- Department of Community Health, Tufts University, 419 Boston Avenue, Medford, MA 02155, USA
- Maternal Outcomes for Translational Health Equity Research (MOTHER) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
- Maternal Health Epidemiology and Data Synthesis Unit, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Vickie Dugat
- Maternal Outcomes for Translational Health Equity Research (MOTHER) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Tayler Whittler
- Maternal Outcomes for Translational Health Equity Research (MOTHER) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Shikhar Shrestha
- Maternal Health Epidemiology and Data Synthesis Unit, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Marwah Kiani
- Maternal Outcomes for Translational Health Equity Research (MOTHER) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Maria Gabriela Ruiz
- Maternal Outcomes for Translational Health Equity Research (MOTHER) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Iman Ali
- Maternal Outcomes for Translational Health Equity Research (MOTHER) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Courtney Enge
- Maternal Outcomes for Translational Health Equity Research (MOTHER) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Ndidiamaka Amutah-Onukagha
- Maternal Outcomes for Translational Health Equity Research (MOTHER) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
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Yang ST, Yang SQ, Duan KM, Tang YZ, Ping AQ, Bai ZH, Gao K, Shen Y, Chen MH, Yu RL, Wang SY. The development and application of a prediction model for postpartum depression: optimizing risk assessment and prevention in the clinic. J Affect Disord 2022; 296:434-442. [PMID: 34606808 DOI: 10.1016/j.jad.2021.09.099] [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: 05/21/2021] [Revised: 09/10/2021] [Accepted: 09/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Preventive intervention can significantly reduce the human and economic costs of postpartum depression (PPD) compared with treatment post-diagnosis. However, identifying women with a high PPD risk and making a judgement as to the benefits of preventive intervention is a major challenge. METHODS This is a retrospective study of parturients that underwent a cesarean delivery. Control group was used as development cohort and validation cohort to construct the risk prediction model of PPD and determine a risk threshold. Ketamine group and development cohort were used to verify the risk classification of parturients by evaluating whether the incidence of PPD decreased significantly after ketamine treatment in high-risk for PPD population. RESULTS The AUC for the development cohort and validation cohort of the PPD prediction model were 0.751 (95%CI:0.700-0.802) and 0.748 (95%CI:0.680-0.816), respectively. A threshold of 19% PPD risk probability was determined, with a specificity and sensitivity in the validation cohort are 0.766 and 0.604, respectively. After matching the high-risk group and the low-risk group by propensity score, the results demonstrated that PPD incidence significantly reduced in the high-risk group following ketamine, versus non-ketamine, intervention (p < 0.01). In contrast, intervention in the low-risk group showed no significant difference in PPD outcomes (p > 0.01). LIMITATION Randomized trials are needed to further verify the feasibility of the model and the thresholds proposed. CONCLUSION This prediction model developed in this study shows utility in predicting PPD risk. Ketamine intervention significantly lowers PPD incidence in parturients with a risk classification threshold greater than 19%.
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Affiliation(s)
- Shu-Ting Yang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Si-Qi Yang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Kai-Ming Duan
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Yong-Zhong Tang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China; Hunan Key Laboratory of Brain Homeostasis, China
| | - An-Qi Ping
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Zhi-Hong Bai
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Kai Gao
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Yang Shen
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Ming-Hua Chen
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Ri-Li Yu
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Sai-Ying Wang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China.
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McFarland MJ, McFarland CAS, Hill TD, D'Oria R. Postpartum Depressive Symptoms during the Beginning of the COVID-19 Pandemic: An Examination of Population Birth Data from Central New Jersey. Matern Child Health J 2021; 25:353-359. [PMID: 33492587 PMCID: PMC7829096 DOI: 10.1007/s10995-020-03116-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 11/21/2022]
Abstract
Objectives To examine the mental health of women in the perinatal period prior to and during the COVID-19 pandemic. Methods We use provisional vital statistics data for births occurring in the central region of New Jersey. The Edinburgh Postnatal Depression Scale is employed to assess depressive symptoms. Our focal analysis uses linear regression models to test whether giving birth during the pandemic is associated with elevated depressive symptoms. All analyses are performed using time-matched (September 2019-April 2020; n = 18,531) and month-matched (January 2019-April 2019 and January 2020- April 2020; n = 18,346) samples. Results Women who gave birth in March and not in April reported higher levels of depressive symptoms than those who gave birth prior to the pandemic in our time-matched (b = 0.09) and month-matched (b = 0.09) samples. The magnitude of this association is approximately one-third the magnitude of the association between preterm birth and depressive symptoms. Conclusion These findings suggest that researchers and practitioners should pay special attention to signs of postpartum depression and women’s adaptive coping responses in the early stages of pandemics. Supplementary Information
The online version contains supplementary material available at
10.1007/s10995-020-03116-w.
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Affiliation(s)
- Michael J McFarland
- Department of Sociology and Center for Demography and Population Health, Florida State University, 113 Collegiate Loop, P.O. Box 3062270, Tallahassee, FL, 32306-2270, USA.
| | | | - Terrence D Hill
- Department of Sociology, University of Texas, San Antonio, USA
| | - Robyn D'Oria
- Central Jersey Family Health Consortium, North Brunswick Township, USA
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Perinatal Food Insecurity and Postpartum Psychosocial Stress are Positively Associated Among Kenyan Women of Mixed HIV Status. AIDS Behav 2020; 24:1632-1642. [PMID: 31538283 DOI: 10.1007/s10461-019-02676-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Stress and food insecurity (FI) are associated with poor perinatal and HIV outcomes. We hypothesized that FI would increase postpartum stress among women in Kenya, and that the impact would be greater in women with HIV. Among 371 pregnant women, we identified latent FI trajectories across the perinatal period, and estimated their association with postpartum stress. Stress metrics included the Perceived Stress Scale (PSS) and hair cortisol concentrations (HCC). We identified two FI trajectories: persistent moderate FI and persistent mild FI. Moderate FI (vs. mild) was associated with higher PSS; this association was stronger among HIV-negative women. We observed a trend towards higher HCC associated with moderate FI, which did not differ by HIV status. HCC and PSS were not correlated. In summary, moderate FI (vs. mild) was associated with increased stress. The lack of PSS-HCC correlation could reflect different physiological pathways. Interventions to mitigate FI could alleviate postpartum stress.
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Germeroth LJ, Benno MT, Kolko Conlon RP, Emery RL, Cheng Y, Grace J, Salk RH, Levine MD. Trial design and methodology for a non-restricted sequential multiple assignment randomized trial to evaluate combinations of perinatal interventions to optimize women's health. Contemp Clin Trials 2019; 79:111-121. [PMID: 30851434 PMCID: PMC6436999 DOI: 10.1016/j.cct.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 02/01/2023]
Abstract
Pre-pregnancy overweight/obesity and excessive gestational weight gain (GWG) independently predict negative maternal and child health outcomes. To date, however, interventions that target GWG have not produced lasting improvements in maternal weight or health at 12-months postpartum. Given that interventions solely aimed at addressing GWG may not equip women with the skills needed for postpartum weight management, interventions that address health behaviors over the perinatal period might maximize maternal health in the first postpartum year. Thus, the current study leveraged a sequential multiple assignment randomized trial (SMART) design to evaluate sequences of prenatal (i.e., during pregnancy) and postpartum lifestyle interventions that optimize maternal weight, cardiometabolic health, and psychosocial outcomes at 12-months postpartum. Pregnant women (N = 300; ≤16 weeks pregnant) with overweight/obesity (BMI ≥ 25 kg/m2) are being recruited. Women are randomized to intervention or treatment as usual on two occasions: (1) early in pregnancy, and (2) prior to delivery, resulting in four intervention sequences. Intervention during pregnancy is designed to moderate GWG and introduce skills for management of weight as a chronic condition, while intervention in the postpartum period addresses weight loss. The primary outcome is weight at 12-months postpartum and secondary outcomes include variables of cardiometabolic health and psychosocial well-being. Analyses will evaluate the combination of prenatal and postpartum lifestyle interventions that optimizes maternal weight and secondary outcomes at 12-months postpartum. Optimizing the sequence of behavioral interventions to address specific needs during pregnancy and the first postpartum year can maximize intervention potency and mitigate longer-term cardiometabolic health risks for women.
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Affiliation(s)
- Lisa J Germeroth
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Maria T Benno
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Rachel P Kolko Conlon
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Rebecca L Emery
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Yu Cheng
- Department of Statistics, University of Pittsburgh, 1800 Wesley W. Posvar Hall, 230 South Bouquet Street, Pittsburgh, PA 15260, USA
| | - Jennifer Grace
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Rachel H Salk
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Michele D Levine
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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Maguire J. Neuroactive Steroids and GABAergic Involvement in the Neuroendocrine Dysfunction Associated With Major Depressive Disorder and Postpartum Depression. Front Cell Neurosci 2019; 13:83. [PMID: 30906252 PMCID: PMC6418819 DOI: 10.3389/fncel.2019.00083] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/19/2019] [Indexed: 12/21/2022] Open
Abstract
Stress and previous adverse life events are well-established risk factors for depression. Further, neuroendocrine disruptions are associated with both major depressive disorder (MDD) and postpartum depression (PPD). However, the mechanisms whereby stress contributes to the underlying neurobiology of depression remains poorly understood. The hypothalamic-pituitary-adrenal (HPA) axis, which mediates the body's neuroendocrine response to stress, is tightly controlled by GABAergic signaling and there is accumulating evidence that GABAergic dysfunction contributes to the impact of stress on depression. GABAergic signaling plays a critical role in the neurobiological effects of stress, not only by tightly controlling the activity of the HPA axis, but also mediating stress effects in stress-related brain regions. Deficits in neuroactive steroids and neurosteroids, some of which are positive allosteric modulators of GABAA receptors (GABAARs), such as allopregnanolone and THDOC, have also been implicated in MDD and PPD, further supporting a role for GABAergic signaling in depression. Alterations in neurosteroid levels and GABAergic signaling are implicated as potential contributing factors to neuroendocrine dysfunction and vulnerability to MDD and PPD. Further, potential novel treatment strategies targeting these proposed underlying neurobiological mechanisms are discussed. The evidence summarized in the current review supports the notion that MDD and PPD are stress-related psychiatric disorders involving neurosteroids and GABAergic dysfunction.
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Affiliation(s)
- Jamie Maguire
- Neuroscience Department, Tufts University School of Medicine, Boston, MA, United States
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Kose S, Cetin M. Brexanolone: an allosteric modulator of GABA-A receptors in the rapid treatment of postpartum depression. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1380352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - Mesut Cetin
- Psychiatry &Clinical Psychopharmacology and Journal of Mood Disorders, Istanbul, Turkey
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Seymour-Smith M, Cruwys T, Haslam SA, Brodribb W. Loss of group memberships predicts depression in postpartum mothers. Soc Psychiatry Psychiatr Epidemiol 2017; 52:201-210. [PMID: 27896374 DOI: 10.1007/s00127-016-1315-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 11/13/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The postpartum period presents the highest risk for women's mental health throughout the lifespan. We aimed to examine the Social Identity Model of Identity Change in this context. More specifically, we investigated changes in social identity during this life transition and their consequences for women's postpartum mental health. METHODS Women who had given birth within the last 12 months (N = 387) reported on measures of depression, social group memberships, and motherhood identification. RESULTS Analyses indicated that a decrease in group memberships after having a baby, controlling for group memberships prior to birth, was associated with an increase in depressive symptomology. However, maintaining pre-existing group memberships was predictive of better mental health. New group memberships were not associated with depressive symptomology. Identification as a mother was a strong positive predictor of mental health in the postpartum period. CONCLUSIONS The social identity model of identity change provides a useful framework for understanding postpartum depression. Interventions to prevent and treat postpartum depression might aim to support women in maintaining important social group networks throughout pregnancy and the postpartum period.
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Affiliation(s)
- Magen Seymour-Smith
- School of Psychology, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Tegan Cruwys
- School of Psychology, The University of Queensland, St Lucia, QLD, 4072, Australia.
| | - S Alexander Haslam
- School of Psychology, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Wendy Brodribb
- Discipline of General Practice, School of Medicine, The University of Queensland, Herston, QLD, 4029, Australia
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Wright N, Hill J, Pickles A, Sharp H. The Specific Role of Relationship Life Events in the Onset of Depression during Pregnancy and the Postpartum. PLoS One 2015; 10:e0144131. [PMID: 26645963 PMCID: PMC4672906 DOI: 10.1371/journal.pone.0144131] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/14/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The precipitating role of life events in the onset of depression is well-established. The present study sought to examine whether life events hypothesised to be personally salient would be more strongly associated with depression than other life events. In a sample of women making the first transition to parenthood, we hypothesised that negative events related to the partner relationship would be particularly salient and thus more strongly predictive of depression than other events. METHODS A community-based sample of 316 first-time mothers stratified by psychosocial risk completed interviews at 32 weeks gestation and 29 weeks postpartum to assess dated occurrence of life events and depression onsets from conception to 29 weeks postpartum. Complete data was available from 273 (86.4%). Cox proportional hazards regression was used to examine risk for onset of depression in the 6 months following a relationship event versus other events, after accounting for past history of depression and other potential confounders. RESULTS 52 women (19.0%) experienced an onset of depression between conception and 6 months postpartum. Both relationship events (Hazard Ratio = 2.1, p = .001) and other life events (Hazard Ratio = 1.3, p = .020) were associated with increased risk for depression onset; however, relationship events showed a significantly greater risk for depression than did other life events (p = .044). CONCLUSIONS The results are consistent with the hypothesis that personally salient events are more predictive of depression onset than other events. Further, they indicate the clinical significance of events related to the partner relationship during pregnancy and the postpartum.
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Affiliation(s)
- Nicola Wright
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Jonathan Hill
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Andrew Pickles
- Biostatistics Department, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Helen Sharp
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
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Goodman JH, Prager J, Goldstein R, Freeman M. Perinatal Dyadic Psychotherapy for postpartum depression: a randomized controlled pilot trial. Arch Womens Ment Health 2015; 18:493-506. [PMID: 25522664 PMCID: PMC4439372 DOI: 10.1007/s00737-014-0483-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 12/03/2014] [Indexed: 01/16/2023]
Abstract
An integrated approach addressing maternal depression and associated mother-infant relationship dysfunction may improve outcomes. This study tested Perinatal Dyadic Psychotherapy (PDP), a dual-focused mother-infant intervention to prevent/decrease maternal postpartum depression and improve aspects of the mother-infant relationship related to child development. Women recruited from hospital postpartum units were screened using a three-stage process. Forty-two depressed first-time mothers and their 6-week-old infants were enrolled and randomized to receive the PDP intervention or usual care plus depression monitoring by phone. The intervention consisted of eight home-based, nurse-delivered mother-infant sessions consisting of (a) supportive, relationship-based, mother-infant psychotherapy, and (b) a developmentally based infant-oriented component focused on promoting positive mother-infant interactions. Data collected at baseline, post-intervention, and three-month follow-up included measures of maternal depression, anxiety, maternal self-esteem, parenting stress, and mother-infant interaction. Depression and anxiety symptoms and diagnoses decreased significantly, and maternal self-esteem increased significantly across the study time frame with no between-group differences. There were no significant differences between groups on parenting stress or mother-infant interaction at post-intervention and follow-up. No participants developed onset of postpartum depression during the course of the study. PDP holds potential for treating depression in the context of the mother-infant relationship; however, usual care plus depression monitoring showed equal benefit. Further research is needed to explore using low-intensity interventions as a first step in a stepped care approach and to determine what subset of at-risk or depressed postpartum mothers might benefit most from the PDP intervention.
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Affiliation(s)
- Janice H. Goodman
- MGH Institute of Health Professions, School of Nursing, 36 1 Ave, Boston, MA 02129, Phone: 617-726-0862, Fax: 617-724-6321
| | - Joanna Prager
- MGH Institute of Health Professions, School of Nursing, Boston, MA
| | - Richard Goldstein
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Boston, MA
| | - Marlene Freeman
- Massachusetts General Hospital Harvard Medical School Boston, MA
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Stress and Maternal Postpartum Depression: The Importance of Stress Type and Timing. POPULATION RESEARCH AND POLICY REVIEW 2015. [DOI: 10.1007/s11113-015-9368-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Turkcapar AF, Kadıoğlu N, Aslan E, Tunc S, Zayıfoğlu M, Mollamahmutoğlu L. Sociodemographic and clinical features of postpartum depression among Turkish women: a prospective study. BMC Pregnancy Childbirth 2015; 15:108. [PMID: 25935726 PMCID: PMC4491203 DOI: 10.1186/s12884-015-0532-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 04/16/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) is moderate to severe depression in a woman after she has given birth. Findings from several well-designed studies reflect great variability in rates, from 10 to 22%, and also in risk factors for PPD. This variability may reflect geographical location. The incidence and risk factors for PPD among Turkish women are not well documented. It is, however, important to understand the risk factors to develop preventive intervention strategies. This study aims to examine the prevalence of PPD and associated risk factors among a sample of women receiving services at a tertiary obstetrics hospital in Ankara, Turkey. METHODS A sample of 671 women, between 36 and 40 gestational weeks, were enrolled and screened for depressive symptomatology using the Hospital Depression Inventory. Sociodemographic and clinical data were also collected. At a subsequent postpartum evaluation, 6-8 weeks post-delivery, 540 of the 671 were screened using the Edinburgh Postnatal Depression Scale (EPDS) for PPD. RESULTS Eighty-three (15.4%) of the 540 women had scores above the cutoff point (>13) on the EPDS. Statistically significant correlations were found between antenatal, prenatal and postpartum depression scores (r = 0.24). Women reporting suicidal thoughts during pregnancy (OR: 6.99), history of past PPD (OR: 6.64), physical violence during pregnancy (OR: 6.20) or during the postpartum period (OR: 5.87), previous psychiatric history (OR: 4.16), depressive symptoms during pregnancy (OR: 1.70), subjectively lower level of satisfaction with the pregnancy (OR:0. 69), a history of premenstrual syndrome (PMS) (OR: 2.05), and unplanned pregnancy (OR: 1.69) had higher odds for developing PPD. CONCLUSION One in six mothers screened as positive for PPD. Women who had previously been diagnosed with PPD, reported suicidal thoughts during pregnancy, or had been exposed to physical violence were at especially high risk for postpartum depression. To prevent and treat postpartum depression, special attention should be paid to women reporting these characteristics.
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Affiliation(s)
| | - Nezaket Kadıoğlu
- Zekai Tahir Burak (ZTB) Women's Health Research and Education Hospital, Ankara, Turkey
| | - Ebru Aslan
- Zekai Tahir Burak (ZTB) Women's Health Research and Education Hospital, Ankara, Turkey.
| | - Suphi Tunc
- Zekai Tahir Burak (ZTB) Women's Health Research and Education Hospital, Ankara, Turkey.
| | - Müjdegül Zayıfoğlu
- Zekai Tahir Burak (ZTB) Women's Health Research and Education Hospital, Ankara, Turkey.
| | - Leyla Mollamahmutoğlu
- Zekai Tahir Burak (ZTB) Women's Health Research and Education Hospital, Ankara, Turkey.
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13
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Lynch CD, Prasad MR. Association between infertility treatment and symptoms of postpartum depression. Fertil Steril 2014; 102:1416-21. [DOI: 10.1016/j.fertnstert.2014.07.1247] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/20/2014] [Accepted: 07/22/2014] [Indexed: 11/29/2022]
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Rosenquist SE. When the bough breaks: rethinking treatment strategies for perinatal depression. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2013; 55:291-323. [PMID: 23488254 DOI: 10.1080/00029157.2012.723284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Awareness of depression among OB-GYN physicians has increased with the result that more than 13% of pregnant women in the United States receive prescriptions for antidepressant medications. But the safety and effectiveness of these compounds has been exaggerated while the effectiveness of psychotherapy has been overlooked and distorted and various medical guidelines for treatment of perinatal depression have been downplayed or ignored. This article addresses the common fears and misconceptions surrounding treatment of depression during pregnancy and after childbirth. The effectiveness of strategic cognitive-behavioral therapy enhanced with hypnosis offers excellent results without the risks associated with these medications. Targets for focused intervention are identified and discussed.
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Levine MD, Marcus MD, Kalarchian MA, Houck PR, Cheng Y. Weight concerns, mood, and postpartum smoking relapse. Am J Prev Med 2010; 39:345-51. [PMID: 20837285 PMCID: PMC2939865 DOI: 10.1016/j.amepre.2010.05.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 04/19/2010] [Accepted: 05/29/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND The majority of women who quit smoking as a result of pregnancy will resume smoking during the first 6 months postpartum. Evidence suggests that changes in depressive symptoms, perceived stress, and concerns about weight may relate to postpartum smoking relapse. PURPOSE This study was designed to prospectively evaluate the relationship of mood and weight concerns to postpartum smoking among women who quit smoking during pregnancy. METHODS Pregnant women who had quit smoking (N=183) were recruited between February 2003 and November 2006. Women completed assessments of mood (depressive symptoms, perceived stress, positive and negative affect) and weight concerns during the third trimester of pregnancy and at 6, 12, and 24 weeks postpartum. Self-reported smoking status was verified by expired-air carbon monoxide and salivary cotinine at each assessment. Cox regression analyses in which mood and weight concerns were treated as time-dependent covariates were conducted in 2007 and 2009. RESULTS By 24 weeks postpartum, 65% of women had resumed smoking. Smoking-related weight concerns increased risk of relapse, and positive affect and self-efficacy for weight management without smoking decreased risk of relapse postpartum. Moreover, after controlling for variables previously related to postpartum relapse, weight concerns remained significantly related to smoking relapse. CONCLUSIONS Smoking-related weight concerns and positive affect increase the likelihood that a woman will resume smoking postpartum. Moreover, weight concerns appear to be salient even in the context of other factors shown to affect postpartum smoking. This study suggests that interventions may need to address women's weight concerns and mood to help sustain smoking abstinence after childbirth.
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Affiliation(s)
- Michele D Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Senecky Y, Agassi H, Inbar D, Horesh N, Diamond G, Bergman YS, Apter A. Post-adoption depression among adoptive mothers. J Affect Disord 2009; 115:62-8. [PMID: 18950870 DOI: 10.1016/j.jad.2008.09.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 09/06/2008] [Accepted: 09/06/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the rate of depressive symptomatology and possible underlying factors in adoptive mothers during the transition to motherhood. DESIGN Cohort survey. SETTING General Community. PARTICIPANTS Thirty-nine adoptive mothers of reproductive age registered with international adoption agencies. INTERVENTIONS All women completed the Edinburgh Postnatal Depression Scale (EPDS), the Beck Depression Inventory (BDI), and the Brief Symptom Inventory (BSI) before and 6 weeks after the adoption. MAIN OUTCOME MEASURES Responses were compared between the study group and published findings for biological mothers in the general population, and within the study group, before and after adoption. RESULTS Symptoms of depression were found in 15.4% of the study group. This rate was similar to that for postpartum depression in the general population, and lower than the rate recorded in the study group before adoption (25.6%). All women with symptoms of depression after the adoption had also shown evidence of depressive features before the adoption. Similar findings were noted for other psychopathologies as well. CONCLUSION Adopting a child does not cause new-onset, reactive depression among adoptive mothers. It may even lead to a decrease in depressive features, perhaps in response to relief from other adjustment difficulties.
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Affiliation(s)
- Yehuda Senecky
- Child Development and Rehabilitation Institute, Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel.
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Wisner KL, Logsdon MC, Shanahan BR. Web-based education for postpartum depression: conceptual development and impact. Arch Womens Ment Health 2008; 11:377-85. [PMID: 18784975 DOI: 10.1007/s00737-008-0030-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 08/17/2008] [Indexed: 11/30/2022]
Abstract
Postpartum depression (PPD) is a major public health problem that occurs in one of every seven women in the first 3 months after birth. Left untreated, PPD can persist for months to years and lead to adverse consequences for both mother and child. Primary care providers have the most medical contact with postpartum women and are well positioned to screen for and identify PPD. However, PPD recognition and treatment is generally not included in physician training, and few continuing education programs on PPD are available. Developed with support from NIMH SBIR contract (# HHSN278200554096C), the Web site MedEdPPD was designed to provide professionals with the tools to successfully engage, screen, diagnose, treat, and refer women with PPD. Resources on the site include CME/CE modules; interactive case studies; classic papers and current literature; provider tools; a comprehensive slide library; events calendar; and resources. MedEdPPD also contains materials for women with PPD, their friends and family members. As of March 2008, the site had over 17,000 visitors who represented both consumers and a broad distribution of health care professional disciplines. The nine CME/CE learning modules on MedEdPPD have been particularly heavily utilized by nurses. The number of repeat and new visitors has increased steadily since the site's launch. User feedback has been consistently positive. Based upon theories of adult education, MedEdPPD offers diverse strategies to facilitate learning. The site promotes education and training in PPD treatment that is flexible, cost-effective, and meets the needs of health care professionals.
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Affiliation(s)
- Katherine L Wisner
- Epidemiology and Women's Studies, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Reich WA, Silbert-Mazzarella BA, Spence JA, Siegel HI. Self-Structure and Postpartum Dejection in First-Time Mothers. THE JOURNAL OF PSYCHOLOGY 2005; 139:426-38. [PMID: 16285213 DOI: 10.3200/jrlp.139.5.426-438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Twenty-nine first-time mothers completed the Beck Depression Inventory (A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) at Time 1 (3rd trimester) and at Time 2 (3-6 months after delivery). At Time 1, women described each of 20 self-aspects by repeatedly selecting from a list of 36 traits; they also reported the size of their social support network in a structured interview. At Time 2, the new mothers completed a short measure of mother role stress and described postpartum difficulties to an interviewer. The authors used HIerarchical CLASses (HICLAS; P. De Boeck & S. Rosenberg, 1988) to idiographically model each woman's self-descriptive data and to identify the class that contained each woman's most superordinate (cardinal) traits, which were then coded either as agentic or social-emotional. Postpartum difficulty predicted Time 2 dejection, but mother role stress and social network size did not. However, the content of the most superordinate trait class moderated the latter two effects. New mothers coded as agentic were more dejected than were new mothers coded as social-emotional when there was high mother role stress and when there was a large social support network.
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Affiliation(s)
- Warren A Reich
- Rutgers, The State University of New Jersey-Newark, USA.
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Affiliation(s)
- Dorothy K Y Sit
- Psychiatry, Women's Behavioral HealthCARE, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Katherine L Wisner
- Psychiatry, obstetrics and gynecology, and reproductive sciences, epidemiology, and women's studies, Women's Behavioral HealthCARE, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center
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