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Roy A, Patten S, Thurston W, Beran T, Crowshoe LL, Tough S. Race as a determinant of prenatal depressive symptoms: analysis of data from the 'All Our Families' study. ETHNICITY & HEALTH 2024; 29:395-422. [PMID: 38332731 DOI: 10.1080/13557858.2024.2312420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Prenatal depression is a serious maternal-child health concern. Risk factors and health consequences appear more prevalent in Indigenous communities and ethnic minority groups; however, research on these populations is limited. We examined the following questions: (A) How do pregnant Indigenous women, ethnic minority women, and White women compare on levels of depressive symptoms and possible clinical depression, and on major risk and protective factors? (B) Is non-dominant (non-White) race associated with higher depressive symptoms and possible clinical depression? (C) What factors mediate and moderate the relationship between race and depression? DESIGN Data were from the All Our Families study (n = 3354 pregnant women from Alberta, Canada). Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS). Descriptive statistics and multivariable regression methods were used to assess the hypotheses that Indigenous and ethnic minority women would have significantly higher mean EPDS score estimates and higher proportions scoring above cut-offs for possible clinical depression, relative to White women. The association between race and depressive symptoms was hypothesised to be partially mediated by risk factors of socioeconomics, health background, discrimination, domestic violence, and psychosocial stress. Potential confounders were age, marital status, and parity. Diet and social support were hypothesised as protective buffers between stress and depressive symptoms. RESULTS A higher proportion of White women were married, had family income over $80,000, were employed, and had adequate social support, relative to other women. They had significantly lower mean depressive symptom score, and a smaller proportion scored above cut-offs for possible clinical depression. The positive association between race and depressive symptoms appeared to be partially mediated by socioeconomic factors and psychosocial stress. Social support appeared to moderate the association between stress and depressive symptoms. CONCLUSIONS Strategies to address socioeconomic status, stress, and social support among racialized minority women may reduce the risk for prenatal depression.
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Affiliation(s)
- Amrita Roy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Wilfreda Thurston
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Tanya Beran
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Lynden Lindsay Crowshoe
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Suzanne Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Quiray J, Richards E, Navarro-Aguirre Y, Glazer D, Adachi J, Trujillo E, Perera D, Garcia EP, Bhat A. The role of doulas in supporting perinatal mental health - a qualitative study. Front Psychiatry 2024; 15:1272513. [PMID: 38487585 PMCID: PMC10937562 DOI: 10.3389/fpsyt.2024.1272513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Abstract
Objective The perinatal period presents several opportunities to identify and treat perinatal mental health and substance use disorders by integrating into existing care pathways. We aimed to examine the role of birth doulas in supporting their clients' perinatal mental health. Methods Thematic content analysis of focus groups with doulas, and interviews with doula clients was used to characterize the doula-client relationship, investigate whether and how doulas provide mental health and substance use support, and identify barriers and recommendations for doulas to support their clients' mental health. Participants were doula clients from communities underserved due to race, income, language and culture. Results Doulas and clients reported positive relationships, supported by congruence in culture, language, and lived experiences. Doulas varied in their confidence in identifying perinatal mental health problems, though most agreed that doulas could support their clients' mental health to different degrees. Barriers to engaging in perinatal mental health treatments included low perceived need and socio-economic burden. Conclusions With adequate support and training, doulas can play an important role in supporting their client's emotional well-being.
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Affiliation(s)
- Joanne Quiray
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Elizabeth Richards
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Yesenia Navarro-Aguirre
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Debra Glazer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Jamie Adachi
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Emily Trujillo
- Open Arms Perinatal Services, Seattle, WA, United States
| | - Dila Perera
- Open Arms Perinatal Services, Seattle, WA, United States
| | | | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Tembo C, Portsmouth L, Burns S. Postnatal depression and its social-cultural influences among adolescent mothers: A cross sectional study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002025. [PMID: 37352145 DOI: 10.1371/journal.pgph.0002025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/15/2023] [Indexed: 06/25/2023]
Abstract
In rural Malawi, adolescent mothers represent 31% of pregnancies. While some adolescent mothers experience motherhood as an exciting, positive, and affirming experience, for others, it may increase their risk of postnatal depression (PND). Social norms and culture contribute to adolescent mothers' experiences and may influence their mental health. However, there is limited research around the prevalence of PND and its cultural influences among adolescent mothers. A cross-sectional survey was administered from 7th September 2021 to 31st March 2022. Three hundred and ninety-five adolescent postnatal mothers aged ≤19 were conveniently recruited at Mitundu hospital in Lilongwe, Malawi. The Edinburgh Postnatal Depression Scale was used to assess depression. A cutoff point of ≥ 10 was employed to categorize probable PND. Binary logistic regression was used to determine the predictors of depression. The mean age of participants was 17 (SD 1.157). and 43.6% (n = 172) presented with PND (EPDS scores ≥10). When all factors were considered in a binary logistic model, adolescents who had ever experienced intimate partner violence (IPV) were 13.6 times more likely to report PND after controlling for age and other predictors compared to those without an experience of IPV (aOR 13.6, p = 0.01, 95% CI 2.10-88.9). Participants whose families did not decide for them (regarding their care) were 2.3 times more likely to present with PND than those whose families decided for them (aOR 2.3 p = 0.03, 95% CI 1.04-5.2). Adolescent mothers who had interacted with their health worker were less likely to report PND than those who had no interaction with the health worker (aOR 0.4 P0.02, CI 0.17-0.67). Social and cultural factors can impact mental health of adolescent mothers. It is recommended that targeted and integrated interventions are developed, implemented. and evaluated. There is a need to improve policy and practice to better support adolescent mothers postnatally.
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Affiliation(s)
- Chimwemwe Tembo
- Saint John of God Hospitaller Services Malawi, Mzuzu, Malawi
| | - Linda Portsmouth
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Sharyn Burns
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
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Deichen Hansen ME, Londoño Tobón A, Kamal Haider U, Moore Simas TA, Newsome M, Finelli J, Boama-Nyarko E, Mittal L, Tabb KM, Nápoles AM, Schaefer AJ, Davis WN, Mackie TI, Flynn HA, Byatt N. The role of perinatal psychiatry access programs in advancing mental health equity. Gen Hosp Psychiatry 2023; 82:75-85. [PMID: 36989766 DOI: 10.1016/j.genhosppsych.2023.03.001] [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: 01/23/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
This editorial presents: 1) a review of Perinatal Psychiatry Access Programs as an integrated care model with potential for promoting perinatal mental health equity; and 2) a summary of how the model has been and can be further adapted to help achieve perinatal mental health equity in geographically diverse settings. Within the editorial, we highlight Access Programs as a promising model for promoting perinatal mental health equity. This editorial is supported by original descriptive data on the Lifeline for Moms National Network of Perinatal Psychiatric Access Programs. Descriptive data is additionally provided on three statewide Access Programs. The Access Program model, and the accompanying Network of Access Programs, is a multi-level approach demonstrating promise in reducing perinatal mental health inequities. Access Programs demonstrate potential to implement interventions to address well-documented inequities in perinatal mental healthcare access at the patient-, clinician-, practice-, community-, and policy-levels. For Access Programs to leverage their potential to advance perinatal mental health equity, systematic efforts are needed that include partnership with impacted communities and implementation teams.
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Affiliation(s)
- Megan E Deichen Hansen
- Florida State University College of Medicine, Department of Behavioral Sciences & Social Medicine, 1115 W Call St., Tallahassee, FL 32304, United States of America.
| | - Amalia Londoño Tobón
- Department of Psychiatry, MedStar Georgetown University Hospital, Washington, DC 20007, United States of America
| | - Uruj Kamal Haider
- Department of Psychiatry, UMass Chan Medical School/UMass Memorial Health, 55 Lake Avenue North, Worcester, MA 01655, United States of America
| | - Tiffany A Moore Simas
- Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry, and Population & Quantitative Health Sciences, UMass Chan Medical School/UMass Memorial Health, Memorial Campus,119 Belmont Street, Jaquith Building Room 2.060, Worcester, MA 01605, United States of America
| | - Melissa Newsome
- Florida State University College of Medicine, Department of Behavioral Sciences & Social Medicine, 1115 W Call St., Tallahassee, FL 32304, United States of America
| | - Julianna Finelli
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 131 S Robertson St, New Orleans, LA 70112, United States of America
| | - Esther Boama-Nyarko
- Departments of Psychiatry, UMass Chan Medical School/UMass Memorial Health, 55 Lake Avenue North, Worcester, MA 01655, United States of America
| | - Leena Mittal
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United States of America
| | - Karen M Tabb
- Beckman Institute, University of Illinois at Urbana-Champaign, Champaign, IL 61820, United States of America; Social of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States of America
| | - Anna M Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD 20892, United States of America
| | - Ana J Schaefer
- School of Public Health, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY 11203, United States of America
| | - Wendy N Davis
- Postpartum Support International, 6706 SW 54th Avenue, Portland, OR 97219, United States of America
| | - Thomas I Mackie
- Department of Health Policy and Management, School of Public Health, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY 11203, United States of America
| | - Heather A Flynn
- Florida State University College of Medicine, Department of Behavioral Sciences & Social Medicine, 1115 W Call St., Tallahassee, FL 32304, United States of America
| | - Nancy Byatt
- Departments of Psychiatry, Obstetrics & Gynecology, and Population & Quantitative Health Sciences, UMass Chan Medical School/UMass Memorial Health, 222 Maple Ave - Chang Building, Shrewsbury, MA 01545, United States of America
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5
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Medical Mistrust in Perinatal Mental Health. Harv Rev Psychiatry 2022; 30:238-247. [PMID: 35849741 DOI: 10.1097/hrp.0000000000000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Despite the advancement of telemedicine and recent innovations in treatment, minoritized women continue to bear a disproportionate burden of pregnancy-related psychiatric conditions and complications, which the pandemic has further exacerbated. Research demonstrates that medical mistrust and systemic racism play central roles in the underutilization of services by racially and ethnically diverse women during pregnancy and postpartum. To effectively address these disparities, it is imperative to understand the drivers of medical mistrust in perinatal health care systems. This Perspectives article describes the historical context of medical mistrust in psychiatric and obstetric health systems and offers solutions to mitigate mistrust and the impact of systemic racism on perinatal care.
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Khalil D, Giurgescu C, Misra DP, Javanbakht A, Templin T, Jenuwine E. Acculturative Stress and Postpartum Depressive Symptoms among Immigrant Arab American Couples. MCN Am J Matern Child Nurs 2022; 47:92-99. [PMID: 35202011 DOI: 10.1097/nmc.0000000000000804] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to examine the relationships between acculturative stress, perceived stress, social support, and postpartum depression (PPD) symptoms among immigrant Arab American couples. METHODS Using a cross-sectional design, 30 Arab American immigrant couples were enrolled. During home visits, couples completed the demographic information, the Multi-Dimensional Acculturative Stress Inventory, Perceived Stress, the Multidimensional Scale of Perceived Social Support among Arab Women, and the Edinburgh Postnatal Depression Scale. Data were analyzed using bivariate linear regression and Pearson correlation. RESULTS In bivariate regressions, paternal and maternal acculturative stress was moderately associated with maternal PPD symptoms (r = .39, and .46, respectively; p < .05). Maternal perceived stress (r = .70, P < .01) was strongly associated with PPD and maternal perceived social support was moderately associated with PPD (r = -.42, p < .05). Maternal and paternal acculturative stress was strongly correlated (r = .61, p < .001). CONCLUSION Couple's acculturative stress and mother's perceived stress were positively associated with mother's PPD symptoms. Our findings suggest the need to develop a culturally appropriate procedure to assess couple's stress that may affect immigrant women at high risk for PPD.
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Niyonsenga J, Mutabaruka J. Factors of postpartum depression among teen mothers in Rwanda: a cross- sectional study. J Psychosom Obstet Gynaecol 2021; 42:356-360. [PMID: 32131669 DOI: 10.1080/0167482x.2020.1735340] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To identify the factors of postpartum depression among teen mothers. METHOD A convenient sample of 120 teen mothers who were aged 15 to 19 years (M = 18.02, SD = 1.16) were recruited. Depression and its related factors were assessed with Edinburgh Postnatal Depression Scale, Eating Disorder Inventory (Body Dissatisfaction and Drive for Thinness subscales), Parental stress index (Parental distress and Parental-child dysfunctional interaction subscales), Frost Multidimensional Perfectionism Scale (parental criticism of parenting subscale) and Multidimensional Scale of Perceived Social Support. Both descriptive and analytical analyses were performed using Statistical Package for the Social Sciences (SPSS version 22). RESULTS Results showed that 48% of sample had clinically high levels of depressive symptoms. Its associated factors were parental distress (β = .297, t = 3.378, p = .001), weight/shape disturbances (β = .217, t = 2.42, p = .017), economic income (β = -.210, t = -2.32, p = .022) and parental-child dysfunctional interaction (β = .20, t = 2.08, p = .03) among seven factors considered. CONCLUSION Regression analyses showed that parental distress, weight/shape disturbances, economic income and parental-child dysfunctional interaction predicted unique variance associated with depression level. These findings are discussed in light of future work and the persistent need to inform prevention and treatment programs for teen mothers.
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Affiliation(s)
- Japhet Niyonsenga
- Department of Clinical Psychology, University of Rwanda, Kigali, Rwanda
| | - Jean Mutabaruka
- Department of Clinical Psychology, University of Rwanda, Kigali, Rwanda
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8
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Yang ZC, Wang LX, Yu Y, Lin HY, Shih LC. Increased Risk of Postpartum Depression in Women With Allergic Rhinitis During Pregnancy: A Population-Based Case-Control Study. Ann Otol Rhinol Laryngol 2021; 131:1137-1143. [PMID: 34779274 DOI: 10.1177/00034894211058135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Allergic rhinitis (AR) is associated with increased risk of major depression in the general population, however, no previous study has evaluated its role among pregnant women. We aimed to investigate the potential impact of AR during pregnancy on the development of postpartum depression (PPD). METHODS This is a population-based case-control study. Data were retrieved from the National Health Insurance Research Database (NHIRD). Medical records of a total of 199 470 deliveries during 2000 and 2010 were identified. Among which, 1416 women with PPD within 12 months after delivery were classified as the case group, while 198 054 women without PPD after delivery formed the control group. Univariate and multivariate regression analyses were conducted to determine the associations between AR during pregnancies and other study variables with PPD. RESULTS AR during pregnancy was found in 9.53% women who developed PPD and 5.44% in women without PPD. After adjusting for age at delivery, income level, various pregnancy and delivery-related conditions, asthma, atopic dermatitis and other medical comorbidities in the multivariate analysis, AR was significantly associated with increased odds of PPD (aOR: 1.498, 95% CI: 1.222-1.836). CONCLUSION AR during pregnancy was independently and significantly associated with an approximately 50% increased risk of PPD among women giving birth. Closely monitoring of AR is warranted in the future in order to optimize mother and child outcomes after delivery.
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Affiliation(s)
- Zhi-Chao Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Li-Xin Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yang Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Huan-Yu Lin
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung
| | - Liang-Chun Shih
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung
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9
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Nannini S, Tung I, Northrup JB, Stepp SD, Keenan K, Hipwell AE. Changes in severity of depression and borderline personality disorder symptoms from pregnancy to three years postpartum in adolescent mothers. J Affect Disord 2021; 294:459-463. [PMID: 34325165 PMCID: PMC8410668 DOI: 10.1016/j.jad.2021.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/30/2021] [Accepted: 07/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The transition to motherhood is associated with the emergence or exacerbation of symptoms of emotional distress disorders for many women. Although adolescence is a developmental period of increased risk for mood disorders and emotion dysregulation among women, little is known about changes in emotional distress across the early postpartum years among adolescent mothers. We tested the hypothesis that symptoms of depression and borderline personality disorder (BPD) would differ between pregnant and non-pregnant adolescents, and that these differences would be maintained in the three years following delivery. METHODS Data were drawn from the longitudinal Pittsburgh Girls Study: 307 adolescent mothers (14-18 years) and 307 never-pregnant adolescents, matched on age, race and household receipt of public assistance, self-reported severity of depression and BPD across four years. RESULTS There were no group differences on depression severity during or after pregnancy. However, compared with their non-pregnant peers, pregnant adolescents reported more severe BPD symptoms even after comorbid depression symptoms were accounted for, and this group difference was sustained during the following three years. LIMITATIONS Findings are based on a community sample rather than a clinical sample, which may have limited the severity of symptoms captured. CONCLUSIONS Findings suggest that adolescent mothers are a high-risk group for BPD symptoms during and after pregnancy, highlighting pregnancy as a critical window of opportunity to reduce morbidity among young mothers and potential negative effects on the next generation.
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Affiliation(s)
- Sierra Nannini
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Irene Tung
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | | | - Stephanie D. Stepp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, Corresponding author: Alison E. Hipwell PhD, ClinPsyD. Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213.
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10
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Anderson CA, Ruiz J. Depressive Symptoms Among Hispanic Adolescents and Effect on Neonatal Outcomes. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:25-32. [PMID: 33813920 DOI: 10.1177/15404153211003223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Hispanics have the highest birth rate among adolescents and may be vulnerable to experience depression. The purpose of this study was to explore the prevalence of perinatal depression and effects upon neonatal outcomes among Hispanic adolescents 13-19 years old. METHODS Available data from a previously conducted study examining the prevalence of adolescent depression and post-traumatic stress were used for the current secondary analysis. Perinatal data reflected a rating of prenatal depression and scores from the Edinburgh Postpartum Depression Scale (EPDS). Adverse infant outcomes included preterm birth, low birth weight, and neonatal complications. RESULTS Over 20% of adolescents reported an adverse infant outcome. About one third of adolescents reported perinatal depression: prenatally (14%) and postnatally (14% minor depression/12.7% major depression). Significant associations were found between EPDS scores, gestational age, and feelings during pregnancy; however, perinatal depression was not found to predict adverse infant outcomes. CONCLUSION Prenatally depressed adolescents are vulnerable to postpartum depression and if experience an adverse infant outcome, postpartum depression may be more likely reported. Therefore, prenatal- and afterbirth-focused assessments and care, including plans for follow-up, are essential.
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Affiliation(s)
- Cheryl Ann Anderson
- College of Nursing and Health Innovation, 12329The University of Texas at Arlington, TX, USA
| | - Jocelyn Ruiz
- The 12329TUniversity of Texas at Arlington, TX, USA
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Davidson H, Gubrium AC. 'A Way to Know' Your Stress: Acceptability and Meaning of Hair Sample Collection for Cortisol Analysis From African-American and Latina Women in a Digital Storytelling Study. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 42:115-121. [PMID: 33593179 DOI: 10.1177/0272684x21996908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obtaining biological samples for research purposes from members of marginalized communities demands careful social and ethical consideration. This paper aims to discuss how feasibility and acceptability translate into methodological and ethical considerations for collecting hair samples in a study comprised of young, pregnant Latinx and African-American women participating in a digital storytelling intervention (DST). Transcripts from two focus groups with Healthy Families home visitor staff (N =10) and follow-up interviews with DST participants (N = 8) were analyzed through qualitative content analysis for hair sampling acceptability. Responses regarding the feasibility of obtaining a hair sample were generally positive amongst Healthy Families home visitor staff participating in the two focus groups, though responses overall were more favorable with the pregnant women participants who were interviewed post-DST intervention. Home visitors emphasized clear communication to participants around the reasoning for obtaining biological samples. Social and ethical considerations for communication of biomarker data to participants, as well as the intersection of lay knowledge of stress and participants' perspectives on providing a hair sample for cortisol analysis, is discussed.
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Affiliation(s)
- Hannah Davidson
- School of Critical Social Inquiry, Hampshire College, Amherst, Massachusetts, United States
| | - A C Gubrium
- School of Public Health and Health Sciences, University of Massachusetts-Amherst, Amherst, United States
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12
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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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Sha T, Gao X, Chen C, Li L, Cheng G, Wu X, Tian Q, Yang F, He Q, Yan Y. A prospective study of maternal postnatal depressive symptoms with infant-feeding practices in a Chinese birth cohort. BMC Pregnancy Childbirth 2019; 19:388. [PMID: 31660900 PMCID: PMC6819524 DOI: 10.1186/s12884-019-2559-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 10/14/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The first few weeks after childbirth are critical, as women may encounter lactation problems and postpartum depression during this period. However, it is still unclear whether early breastfeeding behaviours are related to the symptoms of postnatal depression (PND) in Chinese populations. Therefore, the current study aimed to investigate the association between symptoms of PND and infant feeding practices based on a large-scale Chinese cohort. METHODS A prospective study of the community-based cohort was conducted from January 2015 to December 2016. Infant feeding outcomes, including exclusive/partial breastfeeding and formula feeding, were assessed according to the WHO guidelines. Symptoms of PND were assessed by the Edinburgh Postnatal Depression Scale at 4 weeks postpartum. Multivariate generalized estimating equation models were applied to investigate the associations between depressive symptoms and infant feeding behaviours. RESULTS A total of 956 mother-infant pairs were included. Fifty-six mothers presented screen-positive symptoms of PND with a cut-off ≥10. The percentage of early breastfeeding initiation was 75.8%, while the average duration of exclusive breastfeeding was 3.90 ± 2.33 months. Postnatal depressive symptoms were associated with a shorter breastfeeding duration (8.02 vs. 6.32 months, P < 0.05) and earlier formula introduction (4.98 vs. 3.60 months, P < 0.05). After adjustments were made for covariates, postnatal depressive symptoms were associated with an increased risk of the discontinuation of exclusive and partial breastfeeding (β = - 0.049, P = 0.047 and β = - 0.082, P = 0.006, respectively). Compared to mothers without symptoms of PND, mothers with depressive symptoms were more likely to supplement formula for their infants in the first year of life (β =0.074, P = 0.016). These associations were still significant in the sensitivity analyses, using an EPDS cut-off of ≥13. CONCLUSIONS Our findings indicate that depressive symptoms at 4 weeks postpartum are associated with the cessation of exclusive and partial breastfeeding duration and the introduction of formula in the 12 months of delivery. Early psychosocial assessment and social support should be offered to mothers in the early postpartum period to indirectly prevent adverse breastfeeding outcomes.
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Affiliation(s)
- Tingting Sha
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Xiao Gao
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Cheng Chen
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Ling Li
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Gang Cheng
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Xialing Wu
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Qianling Tian
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Fan Yang
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Qiong He
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Yan Yan
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
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Self- screening using the Edinburgh post natal depression scale for mothers and fathers to initiate early help seeking behaviours. Arch Psychiatr Nurs 2019; 33:421-427. [PMID: 31280789 DOI: 10.1016/j.apnu.2019.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 05/24/2019] [Indexed: 11/23/2022]
Abstract
The forthcoming birth of a new baby and the life changes that occur can present parents with a range of challenges. While recognised in mothers, postnatal depression is not well researched in fathers; especially considering that up to 25% of men report experiencing depression in the ante and postnatal periods. The aim of this study was to test a self-screening tool and referral pathway pamphlet for expectant women and their partners. We used a single blinded randomised controlled study design. The sample, comprised 70 dyads, was randomised to either care as usual or to the self-screening tool and referral pathway pamphlet intervention. The self-screening tool included the Edinburgh Postnatal Depression Scale (EPDS). Other questionnaires used to survey the dyads were the Kessler Psychological Distress (Kessler-10) and the Maternity Social Support Scale (MSSS). The gender differences in the EPDS, Kessler-10 and MSSS scales are represented by differences of 1.0 points on EPDS, 1.0 points on Kessler-10, fathers were reporting less psychological distress than mothers in all cases. No difference was observed in perceived social support. The attrition between time-points was mostly men. Cultural and socio-demographic factors may affect generalisability of the findings. The self-screening tool and referral pathway pamphlet provided to dyads may have some benefit in assisting couples in the perinatal period to detect and seek help for early symptoms of distress.
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Daoud N, O'Brien K, O'Campo P, Harney S, Harney E, Bebee K, Bourgeois C, Smylie J. Postpartum depression prevalence and risk factors among Indigenous, non-Indigenous and immigrant women in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:440-452. [PMID: 30767191 PMCID: PMC6964473 DOI: 10.17269/s41997-019-00182-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/16/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The social position of different minority groups in contemporary societies suggests different risk factors for postpartum depression (PPD). In this study, we used two cut-offs of the Edinburgh Postpartum Depression Scale (EPDS) to examine prevalence and risk factors for PPD among mothers participating in the Canadian Maternity Experiences Survey (MES), and to compare Indigenous, Canadian-born non-Indigenous and immigrant mothers. METHODS We used cross-sectional nationwide data from the 2006 MES (unweighted N = 6237, weighted N = 74,231) and conducted multivariate logistic regression models for EPDS ≥ 10 and EPDS ≥ 13 to explore risk factors for the total sample of mothers and in each study group. RESULTS Prevalence (%, 95 % CI) of EPDS ≥ 10 and EPDS ≥ 13 was significantly higher among immigrant (12.2 %, 10.2-14.2 and 24.1 %, 21.5-26.7) and Indigenous (11.1 %, 7.5-14.7 and 21.2 %, 16.5-25.9) compared to Canadian-born non-Indigenous mothers (5.6 %, 4.9-6.3 and 12.9 %, 11.9-13.9). Multivariate analysis of the total sample showed similar risk factors for EPDS ≥ 10 and EPDS ≥ 13 (ethnicity, low education, ≥ low income cut-off, taking antidepressants, experiencing abuse, low social support). Stratification by study group revealed differing risk factors in each group for EPDS ≥ 10 and EPDS ≥ 13. Indigenous mothers had the most distinct risk factors, followed by immigrant mothers. Non-indigenous Canadian-born mothers had risk factors most similar to the total sample. CONCLUSION Differing prevalence and risk factors for PPD within and across study groups suggest that instead of a universal approach, tailored programs and services to prevent PPD in Indigenous, immigrant and non-Indigenous Canadian-born groups could better protect the mental health of Canadian mothers.
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Affiliation(s)
- Nihaya Daoud
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84015, Beer Sheva, Israel.
| | - Kristen O'Brien
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
| | - Patricia O'Campo
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Dalla Lana School of Public Health, Toronto, Canada
| | - Sarah Harney
- Native Women's Association of Canada (NWAC), Ottawa, Canada
| | - Evelyn Harney
- National Aboriginal Council of Midwives (NACM), Montréal, Canada
| | - Kerry Bebee
- National Aboriginal Council of Midwives (NACM), Montréal, Canada
| | | | - Janet Smylie
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Dalla Lana School of Public Health, Toronto, Canada
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Anderson CA, Connolly JP. Predicting posttraumatic stress and depression symptoms among adolescents in the extended postpartum period. Heliyon 2018; 4:e00965. [PMID: 30519659 PMCID: PMC6260239 DOI: 10.1016/j.heliyon.2018.e00965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 11/09/2018] [Accepted: 11/20/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Adolescent childbirth continues as a public health concern, and investigation of postpartum posttraumatic stress symptoms (PTSS) and depression is important to inform future research and practice. Longitudinal studies exploring PTSS alone or in combination with depression are non-existent for postpartum adolescent populations. This study aimed to identify stress/PTSS and depression symptoms at 72 hours and three, six, and nine months postpartum, and determine if symptoms at each time point predicted later symptoms. METHODS A convenience sample of 303 adolescents 13-19 years of age were recruited from two postpartum units of one, large, public hospital. The Impact of Event Scale and the Edinburgh Postpartum Depression Inventory provided a screen of symptoms for stress/PTSS and depression at all time points. A lagged autoregressive model was developed to assess the predictive power of symptoms at each time point to the next across the extended postpartum period. RESULTS About 30% of adolescents displayed early symptoms; 20% showed symptoms at the final time point. Early symptoms did not predict symptoms at 3 months; yet, symptoms at 3 months predicted symptoms at 6-9 months. LIMITATIONS Attrition at final time points necessitated pooled data. Adolescents were primarily older, Hispanics, and recruited from one public hospital decreasing demographic representation. Use of screening tools prevented diagnostic outcomes. Unknown stressors occurring before and after pregnancy or birth may have influenced final outcomes. CONCLUSIONS Early symptoms were common and 3 month symptoms predicted later symptoms. For at risk adolescents, a plan for follow-up beyond hospital discharge is recommended.
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Affiliation(s)
- Cheryl A. Anderson
- College of Nursing and Health Innovation, University of Texas at Arlington, P.O.B 19407, Arlington, Texas, 76019, USA
| | - John P. Connolly
- Office of Information Technology, University of Texas at Arlington, P.O.B 19407, Arlington, Texas, 76019, USA
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Sipsma HL, Ruiz E, Jones K, Magriples U, Kersahw T. Effect of breastfeeding on postpartum depressive symptoms among adolescent and young adult mothers. J Matern Fetal Neonatal Med 2018; 31:1442-1447. [PMID: 28412876 PMCID: PMC8094923 DOI: 10.1080/14767058.2017.1319351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe the association between breastfeeding and postpartum depressive symptoms among a sample of adolescent and young adult mothers and to determine whether breastfeeding difficulty moderates this association. MATERIALS AND METHODS Data were derived from a prospective cohort of pregnant adolescent and young adult females (ages 14-21) as they transitioned to parenthood. This analysis uses data collected during pregnancy and at 6 months postpartum among mothers (n = 137) who initiated breastfeeding. Multivariable linear regression was used to adjust for prenatal depressive symptoms and other potential confounders. RESULTS Postpartum depressive symptoms were not significantly associated with breastfeeding duration or breastfeeding at 6 months. Early breastfeeding difficulty moderated the association between depressive symptoms and breastfeeding at 6 months. Among young mothers who were still breastfeeding at 6 months, those who reported no early breastfeeding difficulties had the lowest depressive scores and those who reported much early breastfeeding difficulty had the highest depressive scores at 6 months. CONCLUSIONS Minimizing challenges with breastfeeding may help improve postpartum mental health among adolescent and young adult mothers. Health care providers should help young pregnant women manage expectations about breastfeeding and ensure that they are linked to appropriate professional breastfeeding support during the early postpartum period.
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Affiliation(s)
- Heather L. Sipsma
- Department of Women, Children and Family Health Science, University of Illinois at Chicago College of Nursing, Chicago, IL
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health University of Chicago, Chicago, IL
| | - Elizabeth Ruiz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Krista Jones
- Department of Health System Science, University of Illinois at Chicago College of Nursing, Urbana, IL
| | - Urania Magriples
- Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Trace Kersahw
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
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Ukatu N, Clare CA, Brulja M. Postpartum Depression Screening Tools: A Review. PSYCHOSOMATICS 2017; 59:211-219. [PMID: 29396166 DOI: 10.1016/j.psym.2017.11.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the accuracy of screening tools in detecting postpartum depression (PPD). METHODS A review of the literature was conducted using PubMed, Clinical Key, and Google Scholar from the years 2001-2016 with a modified PRISMA method. The keywords, "postnatal depression screening," "antenatal depression screening," and "maternal depression" were used in the search. Sixty-eight articles were reviewed, and 36 further analyzed. RESULTS The accuracy of screening tools was dependent upon a number of factors. The studies reviewed differed in the types of screening tools tested, the combination of screening tools administered, the timing in which screening tools were administered, the geographic location of patients screened, and the reference standard(s) used. CONCLUSIONS No tool could be deemed best at accurately detecting PPD on the basis of sensitivity and specificity. Additionally, there was no recommended time duration in which screening should be done. Thus, further research is needed to elucidate the accuracy of PPD screening tools, and the best criteria to determine this.
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Affiliation(s)
- Nneamaka Ukatu
- School of Medicine, New York Medical College, Valhalla, NY
| | - Camille A Clare
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY.
| | - Mary Brulja
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY
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Hughes LP, Austin-Ketch T, Volpe EM, Campbell-Heider N. Identification and Treatment of Adolescents With Perinatal Anxiety and Depression. J Psychosoc Nurs Ment Health Serv 2017; 55:23-29. [PMID: 28585664 DOI: 10.3928/02793695-20170519-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/04/2017] [Indexed: 11/20/2022]
Abstract
Perinatal mood and anxiety disorders (PMAD) are the most common, yet under-diagnosed and undertreated complication of pregnancy, affecting up to 50% of pregnant and parenting teens. PMAD are a global health issue that can have devastating effects on the mental, physical, emotional, developmental health, and social life of the mother, infant, and family. Adolescents present with similar symptoms of PMAD as their adult counterparts, but also experience isolation from their peer group and lack of resources and coping strategies, as well as difficulty sleeping and lack of concentration and ability to focus. Nurses and nurse practitioners are in an ideal position to assess preexisting risk factors for PMAD. The current applied evidence-based article addresses the diagnosis of PMAD, provides a conceptual framework for understanding the intra- and interpersonal dynamics affecting teens with PMAD, and suggests a new screening tool to guide diagnosis. An easy to recall mnemonic for diagnosis and referral (SAIL AHEAD) is proposed. By using the SAIL AHEAD mnemonic, providers will impact adolescents' parenting success and resiliency, thereby enhancing their future success in life. [Journal of Psychosocial Nursing and Mental Health Services, 55(6), 23-29.].
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SmithBattle L, Chantamit-o-pas C, Freed P, McLaughlin D, Schneider JK. Moms growing together: Piloting action methods and expressive arts in a therapeutic group for teen mothers. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2017; 30:72-79. [DOI: 10.1111/jcap.12172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 05/03/2017] [Accepted: 05/05/2017] [Indexed: 01/18/2023]
Affiliation(s)
| | | | - Patricia Freed
- School of Nursing; Saint Louis University; St. Louis MO USA
| | - Dorcas McLaughlin
- School of Nursing; Saint Louis University; St. Louis MO USA
- Nursing Department; Webster University; Webster Groves MO USA
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Liu S, Yan Y, Gao X, Xiang S, Sha T, Zeng G, He Q. Risk factors for postpartum depression among Chinese women: path model analysis. BMC Pregnancy Childbirth 2017; 17:133. [PMID: 28464884 PMCID: PMC5414210 DOI: 10.1186/s12884-017-1320-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/26/2017] [Indexed: 12/01/2022] Open
Abstract
Background Postpartum depression causes harm to both mothers and infants. The purpose of this study was to find out several potential risk factors, and to identify the intrinsic interrelationships between factors and postpartum depression by constructing a path model. The results of this study may help to control the increasing incidence of maternal postpartum depression. Methods The study was based on a sample of mothers from a cross-sectional study which was set up at 4 weeks after a mother had childbirth and was conducted in three streets at Kaifu District of Changsha in Hunan province from January to December 2015. Questionnaires were distributed to subjects who responded to questions concerning factors related to pregnancy, delivery and infants within 4 weeks after childbirth. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure postpartum depression. Chi-square test was used to detect significant differences between non-postpartum depression group and postpartum depression group. A path model was constructed to explore the interrelationships between variables, and to verify the relationships between variables and postpartum depression. Results The proportion of maternal postpartum depression was 6.7%. Univariate analysis showed that there were significant differences between non-postpartum depression group and postpartum depression group (all P-values <0.05) on the part of maternal age, parity, frequent exposure to mobile phone during pregnancy, gestational hypertensive disorders, fetus number, premature delivery, birth weight, initiation of breastfeeding, mode of feeding, infant illness within 4 weeks after delivery and infant weight at 4 weeks. Path analysis results showed that the final model could be fitted well with sample data (P = 0.687, CMIN/DF = 0.824, NFI = 0.992, RFI = 0.982, IFI = 1.002, TLI =1.004, CFI = 1.000 and RMSEA < 0.001). Frequent exposure to mobile phone during pregnancy, maternal age and gestational hypertensive disorders had both direct and indirect effects on postpartum depression. Mode of feeding and infant weight at 4 weeks, which was the most total effect on postpartum depression, had only a direct impact on postpartum depression. Fetus number, premature delivery, initiation of breastfeeding and birth weight had only an indirect influence on postpartum depression. Conclusion The findings of this study suggest that constructing a path analysis model could identify potential factors and explore the potential interrelations between factors and postpartum depression. It is an effective way to prevent maternal postpartum depression by taking appropriate intervention measures and carrying out health education for pregnant women. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1320-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shiping Liu
- Department of Epidemiology and Health Statistics, Central South University Xiangya School of Public Health, Changsha, Hunan, China
| | - Yan Yan
- Department of Epidemiology and Health Statistics, Central South University Xiangya School of Public Health, Changsha, Hunan, China.
| | - Xiao Gao
- Department of Epidemiology and Health Statistics, Central South University Xiangya School of Public Health, Changsha, Hunan, China
| | - Shiting Xiang
- Department of Epidemiology and Health Statistics, Central South University Xiangya School of Public Health, Changsha, Hunan, China
| | - Tingting Sha
- Department of Epidemiology and Health Statistics, Central South University Xiangya School of Public Health, Changsha, Hunan, China
| | - Guangyu Zeng
- Department of Epidemiology and Health Statistics, Central South University Xiangya School of Public Health, Changsha, Hunan, China
| | - Qiong He
- Department of Epidemiology and Health Statistics, Central South University Xiangya School of Public Health, Changsha, Hunan, China
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Freitas CJ, Williams-Reade J, Distelberg B, Fox CA, Lister Z. Paternal depression during pregnancy and postpartum: An international Delphi study. J Affect Disord 2016; 202:128-36. [PMID: 27262634 DOI: 10.1016/j.jad.2016.05.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/21/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Fathers are at risk for depression during a mother's gestation and postpartum. Assessment, detection, and treatment are hampered by the lack of consensus on this issue. The purpose of this study was to reach expert consensus through the Delphi method on the defining factors of depression in peripartum fathers. METHODS Purposive sampling resulted in the surveying of 14 international expert panelists. The study used a modified Delphi approach in which experts participated in two rounds of open-ended and scale questionnaires, followed by two rounds of opportunities to adjust their responses and/or comment on evolving data until consensus was achieved. RESULTS Experts responded to 10 questions on terminology, diagnostics, symptomology, risk/protective factors, biological factors, assessment tools/protocol, cost implications, and key stakeholders. Of these 10 questions presented for discussion, the analysis resulted in 197 coded themes. Consensus was met for 119 of the 197 coded responses (60.41%). LIMITATIONS Diversity of opinion within this Delphi Study was excluded for the sake of consensus. Regression to the mean may have occurred after continuous surveying and when evolving results were shared with panelists. Critics of Delphi methodologies have pointed to the issue of small expert samples typically used and the subjectivity of "expert." CONCLUSION Consensus identified diagnostic criteria and symptomology that differentiates the paternal experience of peripartum depression. Experts indicated the importance of a father's social context, biological risk factors, limitations of current assessment tools, key stakeholders, and potential financial costs. Stakeholders on this issue would benefit from translating consensus into assessment and treatment.
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Affiliation(s)
- Cassidy J Freitas
- School of Leadership and Education Sciences, Department of Counseling and Marital and Family Therapy, University of San Diego, 4540 Kearny Villa Road Suite 210, San Diego, CA 92123, United States.
| | - Jacqueline Williams-Reade
- School of Behavioral Health, Department of Counseling and Family Sciences, Loma Linda University, United States
| | - Brian Distelberg
- School of Behavioral Health, Department of Counseling and Family Sciences, Loma Linda University, United States
| | - Curtis A Fox
- School of Behavioral Health, Department of Counseling and Family Sciences, Loma Linda University, United States
| | - Zephon Lister
- Collaborative Care Program, Department of Family Medicine, University of California, San Diego, United States
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Exploring Trajectories and Predictors of Depressive Symptoms Among Young Couples During Their Transition to Parenthood. Matern Child Health J 2016; 20:2372-2381. [DOI: 10.1007/s10995-016-2064-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Aitken Z, Hewitt B, Keogh L, LaMontagne AD, Bentley R, Kavanagh AM. Young maternal age at first birth and mental health later in life: Does the association vary by birth cohort? Soc Sci Med 2016; 157:9-17. [DOI: 10.1016/j.socscimed.2016.03.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/23/2016] [Accepted: 03/28/2016] [Indexed: 11/30/2022]
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Ashby B, Ranadive N, Alaniz V, St. John-Larkin C, Scott S. Implications of Comprehensive Mental Health Services Embedded in an Adolescent Obstetric Medical Home. Matern Child Health J 2016; 20:1258-65. [DOI: 10.1007/s10995-016-1927-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Glasser S, Hadad L, Bina R, Boyko V, Magnezi R. Rate, risk factors and assessment of a counselling intervention for antenatal depression by public health nurses in an Israeli ultra-orthodox community. J Adv Nurs 2016; 72:1602-15. [DOI: 10.1111/jan.12938] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 01/13/2023]
Affiliation(s)
- Saralee Glasser
- Women and Children's Health Research Unit; Gertner Institute for Epidemiology and Health Policy Research; Sheba Medical Center; Tel Hashomer Israel
| | - Lea Hadad
- Women Health Clinic; Maccabi Health Services; Elad Israel
| | - Rena Bina
- School of Social Work; Bar Ilan University; Ramat Gan Israel
| | - Valentina Boyko
- Women and Children's Health Research Unit; Gertner Institute for Epidemiology and Health Policy Research; Sheba Medical Center; Tel Hashomer Israel
| | - Racheli Magnezi
- Public Health and Health Systems Management Program; Department of Management; Bar Ilan University; Ramat Gan Israel
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Winders Davis D, Myers J, Logsdon MC, Bauer NS. The Relationship Among Caregiver Depressive Symptoms, Parenting Behavior, and Family-Centered Care. J Pediatr Health Care 2016; 30:121-32. [PMID: 26189603 DOI: 10.1016/j.pedhc.2015.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/01/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Parental depression has been associated with adverse child outcomes. However, the specific parenting behaviors that may result in such child outcomes and the effect of family-centered care (FCC) on positive parenting behavior of depressed parents has not previously been examined. METHODS Data from the National Survey of Early Childhood Health was used (n = 2,068). Groups were stratified by the presence of parental depression and compared with regard to demographics and the mean number of specific positive parenting behaviors. Generalized linear models were developed based on testing whether individuals performed more or less than the median number of positive behaviors. Lastly, we tested whether depression independently predicted each outcome after adjustment for FCC, coping, social support, and ethnicity to evaluate if depression independently predicted each outcome after adjustment. RESULTS No difference was found in demographic variables between parents who were depressed and not depressed. Parents who were not depressed performed significantly more routines (p = .036); reported coping better with parenting (p < .001); performed significantly less punitive behaviors (p = .022); and needed/had less social support (p = .002) compared with parents who were depressed. Individual items and scale scores were associated in the expected directions. FCC was independently associated with study variables but did not moderate the effect of depression. CONCLUSIONS These data identify specific parenting behaviors that differ between parents who report depressive symptoms compared with parents who do not have depressive symptoms. More targeted interventions coordinated through a medical home are needed for parents with depressive symptoms to reduce the child health disparities often associated with parental depression.
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Abstract
OBJECTIVE To carry out a systematic review exploring the interconnections between oxytocin, postnatal depression (PND), and parenting. Questions include: (1) How does PND affect parenting? (2) How does oxytocin affect parenting? (3) How does oxytocin affect PND? METHODOLOGY To review English articles in major medical databases. RESULTS Compared to nondepressed controls, mothers with PND interact with their infants less sensitively, report feeling less competent, and less often choose recommended practical-parenting strategies. Psychological interventions for mothers with PND generally have positive effects on mother-infant interactions. The administration of oxytocin in community samples tends to improve parental behaviors. Findings exploring the association between oxytocin and PND were inconsistent, with some evidence that oxytocin has a negative impact on mood. CONCLUSIONS Oxytocin is potentially useful in improving parental behaviors of mothers with PND, but more research is needed to establish its safety because of the uncertain impact of OT on maternal mood.
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Figueiredo FPD, Parada AP, Cardoso VC, Batista RFL, Silva AAMD, Barbieri MA, Cavalli RDC, Bettiol H, Del-Ben CM. Postpartum depression screening by telephone: a good alternative for public health and research. Arch Womens Ment Health 2015; 18:547-53. [PMID: 25380783 DOI: 10.1007/s00737-014-0480-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 10/18/2014] [Indexed: 11/24/2022]
Abstract
This study verified the reliability and validity of the Edinburg Postpartum Depression Scale (EPDS) administered by telephone interviews. In a cross-sectional study of a cohort from Brazil (BRISA), the EPDS was administered by telephone to 1,083 women within 12 months postpartum, and 257 (23.7 %) participants had an EPDS score ≥10. At 67 ± 48 days after their telephone interview, 199 (EPDS ≥10 = 96; EPDS <10 = 103) participants were interviewed face-to-face using the Structured Clinical Interview for DSM-IV (SCID) and completed the EPDS again by self-report. In 90 participants, the diagnosis of major depressive episode was confirmed by the SCID (EPDS ≥10 = 65; EPDS <10 = 25). The Cronbach's alpha coefficient was 0.861. The Spearman's correlation between the EPDS administered by telephone and the self-reported EPDS was 0.69 (p < 0.001). The receiver-operating characteristic (ROC) curve for the EPDS administered by telephone was 0.78 (95 % confidence interval (CI) = 0.72 to 0.84). Scores ≥10 showed a sensitivity of 72.2 %, a specificity of 71.6 %, and a positive predictive value of 67.7 %. The application of the EPDS by telephone is a suitable alternative for clinical practice and research and represents a method to optimize the diagnosis of postpartum depression.
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Affiliation(s)
- Felipe Pinheiro de Figueiredo
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, Av. dos Bandeirantes 3900, Ribeirao Preto, SP, 14048-900, Brazil,
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Sipsma HL, Jones KL, Cole-Lewis H. Breastfeeding among adolescent mothers: a systematic review of interventions from high-income countries. J Hum Lact 2015; 31:221-9; quiz 321-2. [PMID: 25480018 DOI: 10.1177/0890334414561264] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 11/03/2014] [Indexed: 11/17/2022]
Abstract
Despite growing evidence of the benefits of breastfeeding, rates of breastfeeding remain disproportionately low among adolescent mothers compared with older mothers in the United States. Current interventions primarily target adult women, and little evidence is available for breastfeeding promotion among young women. Accordingly, we aim to review interventions designed to improve breastfeeding rates among adolescents to make recommendations for future research and practice. We searched MEDLINE and PsycINFO for articles that evaluated interventions aiming to improve rates of breastfeeding initiation, duration, or exclusivity among adolescents. Inclusion criteria included interventions targeting pregnant or postpartum adolescents (mean/median age <22 years) that were conducted in high-income settings. Six interventions met our inclusion criteria; of these, 4 interventions aimed to increase breastfeeding initiation, 5 aimed to increase breastfeeding duration, and 4 aimed to increase breastfeeding exclusivity. Interventions included school-based programs, home visits, and telephone support that were implemented by a combination of peer counselors, nurse clinicians, doulas, and lactation consultants. Only 1 intervention, a combination of education and counseling provided by a lactation consultant-peer counselor team, significantly improved both breastfeeding initiation and duration. Other results were mixed, and studies were subject to several methodological limitations. We recommend that more interventions should be developed and evaluated. In addition, interventions should be less resource intensive, be more theoretically driven, and specifically include mothers and partners of adolescents to successfully promote breastfeeding among adolescent mothers.
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Affiliation(s)
- Heather L Sipsma
- Department of Women, Children and Family Health Science, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Krista L Jones
- Department of Health Systems Sciences, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Heather Cole-Lewis
- Department of Biomedical Informatics, Columbia University Medical Center, New York, NY, USA ICF International, Rockville, MD, USA
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Mitra M, Iezzoni LI, Zhang J, Long-Bellil LM, Smeltzer SC, Barton BA. Prevalence and risk factors for postpartum depression symptoms among women with disabilities. Matern Child Health J 2015; 19:362-72. [PMID: 24889114 PMCID: PMC4254905 DOI: 10.1007/s10995-014-1518-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The adverse consequences of postpartum depression on the health of the mother and her child are well documented. However, there is little information on postpartum depression among mothers with disabilities. This study examines the patterns of depression and depressive symptoms before, during and after pregnancy and the association between depression before and during pregnancy and postpartum depression symptomatology (PPD) among women with and without disabilities. Data from the 2009-2011 Rhode Island Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed in 2013. Almost 30% (28.9%; 95% CI 22.8-35.8) of mothers with disabilities reported often or always feeling down, depressed or sad after childbirth compared to 10% of those without disabilities (95% CI 8.9-11.3). Compared to other women in the study, women with disabilities had a greater likelihood for PPD symptoms (RR 1.6, 95% CI 1.1-2.2) after accounting for sociodemographics, maternal characteristics related to PPD, and depression before and during pregnancy. Adjusting for other covariates, self-reported prenatal diagnosis of depression was not associated with symptoms of PPD and depression during pregnancy was marginally associated with PPD symptomatology for women with disabilities. Women with disabilities are at a greater risk of experiencing symptoms of postpartum depression than other women. Screening for PPD among new mothers with disabilities and timely referral of those with PPD diagnosis are vital to the health of mothers with disabilities and their children.
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Affiliation(s)
- Monika Mitra
- Center for Health Policy and Research, University of Massachusetts Medical School, 333 South Street, Shrewsbury MA 01545, 508-856-8548 voice, 508-856-8543 fax,
| | - Lisa I. Iezzoni
- The Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford Street, Room 901B, Boston, MA 02114, 617-643-0657,
| | - Jianying Zhang
- Center for Health Policy and Research, University of Massachusetts Medical School, 333 South Street, Shrewsbury MA 01545, 508-856-8221,
| | - Linda M. Long-Bellil
- Center for Health Policy and Research, University of Massachusetts Medical School, 333 South Street, Shrewsbury MA 01545, 508-856-8417,
| | - Suzanne C. Smeltzer
- Center for Nursing Research, Villanova University, 800 Lancaster Avenue, Villanova, PA 19085, 610-519-6828,
| | - Bruce A. Barton
- Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester MA 01655, 508-856-8191,
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Bobo WV, Yawn BP. Concise review for physicians and other clinicians: postpartum depression. Mayo Clin Proc 2014; 89:835-44. [PMID: 24943697 PMCID: PMC4113321 DOI: 10.1016/j.mayocp.2014.01.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 01/21/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
Postpartum depression (PPD) is a common, potentially disabling, and, in some cases, life-threatening condition. Fortunately, PPD is also readily detectable in routine practice and is amenable to treatment by a wide variety of modalities that are effective for treating nonpuerperal major depression. Postpartum depression screening can improve case identification (an Edinburgh Postnatal Depression Scale score of ≥ 13 indicates a high risk of PPD) and, when associated with a diagnostic and follow-up program, leads to improved clinical outcomes. Symptom severity, patient preference, past response to treatment, availability of local mental health care resources, and patient decisions about breast-feeding will drive management decisions. In general, cognitive-behavioral therapy and interpersonal therapy are preferred psychotherapies for women with mild to moderate PPD, whereas antidepressants are appropriate in more severe cases. Many patients will require other types of assistance, such as parenting support, case management, or care coordination because many barriers to receiving adequate PPD treatment must still be overcome.
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Affiliation(s)
- William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
| | - Barbara P Yawn
- Department of Research, Olmsted Medical Center, Rochester, MN
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Deng AW, Xiong RB, Jiang TT, Luo YP, Chen WZ. Prevalence and risk factors of postpartum depression in a population-based sample of women in Tangxia Community, Guangzhou. ASIAN PAC J TROP MED 2014; 7:244-9. [DOI: 10.1016/s1995-7645(14)60030-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/15/2014] [Accepted: 02/15/2014] [Indexed: 11/29/2022] Open
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Pregnancy in the severely mentally ill patient as an opportunity for global coordination of care. Am J Obstet Gynecol 2014; 210:32-7. [PMID: 23911382 DOI: 10.1016/j.ajog.2013.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 07/24/2013] [Accepted: 07/29/2013] [Indexed: 11/24/2022]
Abstract
Although obstetricians commonly care for pregnant patients with psychiatric disorders, little has been written about the implications of managing a pregnancy during a prolonged psychiatric hospitalization for severe mental illness. Multidisciplinary care may optimize obstetric and psychiatric outcomes. We describe a severely mentally ill patient at 27 weeks' gestation (G1P0) who was admitted after a suicide attempt. She exhibited intermittently worsening depression and anxiety throughout a 2-month inpatient psychiatric hospitalization, during which her psychiatric and obstetric providers collaborated regarding her care. We review recommendations for antepartum and intrapartum treatment of the acutely suicidal and severely mentally ill patient and, in particular, the evidence that a multidisciplinary coordinated approach to planning can maximize patient physical and mental health and facilitate preparedness for delivery.
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Higginbottom GMA, Morgan M, O'Mahony J, Chiu Y, Kocay D, Alexandre M, Forgeron J, Young M. Immigrant women's experiences of postpartum depression in Canada: a protocol for systematic review using a narrative synthesis. Syst Rev 2013; 2:65. [PMID: 23965183 PMCID: PMC3765819 DOI: 10.1186/2046-4053-2-65] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Literature documents that immigrant women in Canada have a higher prevalence of postpartum depression symptomatology than Canadian-born women. There exists a need to synthesize information on the contextual factors and social determinants of health that influence immigrant women's reception of and behavior in accessing existing mental health services. Our research question is: what are the ethnoculturally defined patterns of help-seeking behaviors and decision-making and other predictive factors for therapeutic mental health care access and outcomes with respect to postpartum depression for immigrant women in Canada? METHODS/DESIGN Our synthesis incorporates a systematic review using narrative synthesis of reports (peer- and non-peer reviewed) of empirical research and aims to provide stakeholders with perspectives on postpartum mental health care services as experienced by immigrant women. To reach this goal we are using integrated knowledge translation, thus partnering with key stakeholders throughout the planning, implementation and dissemination stages to ensure topic relevancy and impact on future practice and policy. The search and selection strategies draw upon established systematic review methodologies as outlined by the Centre for Reviews and Dissemination and also incorporate guidelines for selection and appraisal of gray literature. Two search phases (a database and a gray literature phase) will identify literature for screening and final selection based on an inclusion/exclusion checklist. Quality appraisal will be performed using the tools produced by the Centre for Evidence Based Management. The narrative synthesis will be informed by Popay et al. (2006) framework using identified tools for each of its four elements. The integrated knowledge translation plan will ensure key messages are delivered in an audience-specific manner to optimize their impact on policy and practice change throughout health service, public health, immigration and community sectors. DISCUSSION The narrative synthesis methodology will facilitate understandings and acknowledgement of the broader influences of theoretical and contextual variables, such as race, gender, socio-economic status, pre-migration history and geographical location. Our review aims to have a substantive and sustainable impact on health outcomes, practice, programs and/or policy in the context of postpartum mental health of immigrant women. PROSPERO registration number CRD42012003020.
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Affiliation(s)
- Gina M A Higginbottom
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton AB T6G 1C9, Canada.
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McGuinness TM, Medrano B, Hodges A. Update on Adolescent Motherhood and Postpartum Depression. J Psychosoc Nurs Ment Health Serv 2013; 51:15-8. [DOI: 10.3928/02793695-20130109-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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37
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Gilchrist G, Cameron J, Nicolson S, Galbally M, Moore P. Reducing depression among perinatal drug users – what is needed? A triangulated study. ADVANCES IN DUAL DIAGNOSIS 2012. [DOI: 10.1108/17570971211281666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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