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Segre G, Clavenna A, Cartabia M, Bonati M. Postpartum depression screening in mothers and fathers at well-child visits: a feasibility study within the NASCITA cohort. BMJ Open 2023; 13:e069797. [PMID: 37355274 PMCID: PMC10314581 DOI: 10.1136/bmjopen-2022-069797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/23/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVE To assess the feasibility of the family paediatrician's (FP) role in identifying the signs of postpartum depression in parents in time to guarantee child well-being. DESIGN, SETTING AND PARTICIPANTS Data for this observational prospective study were collected within the NASCITA (NAscere e creSCere in ITAlia) cohort. During the first visit, paediatricians collected sociodemographic data regarding the parents and information about their health status, the pregnancy and the delivery. Whooley questions were administered during the first and second visits (scheduled 60-90 days after childbirth). Moreover, on the third visit (5-7 months after childbirth) the FP was asked to answer 'yes' or 'no' to a question on the parental postpartum depression, based on his knowledge and on the acquired information. RESULTS In 2203 couples who completed the assessment, 529 mothers (19.9%), 141 fathers (6.3%) and 110 (5%) couples reported any depressive symptomatology. Of these, 141 mothers (5.3% of the total sample) and 18 fathers (0.8% of the total sample) were classified as 'likely depressed'. An association was found between maternal postnatal depressive symptoms and having a diagnosed psychiatric disorder during pregnancy (OR 9.49, 95% CI: 3.20 to 28.17), not exclusively breastfeeding at hospital discharge (OR 1.76, 95% CI: 1.19 to 2.61) and the presence of child sleeping disorders at 3 (OR 2.46, 95% CI: 1.41 to 4.28) and 6 months (OR 2.18, 95% CI: 1.37 to 3.47). Another significant predictor of postpartum depression was being primiparous (OR 1.99, 95% CI: 1.31 to 3.02). Concerning the fathers, a significant association was reported only between likely depressed fathers and child sleeping disorders at 3 months (OR 7.64, 95% CI: 2.92 to 19.97). Moreover, having a likely depressed partner was strongly associated with depressive symptoms in fathers (OR 85.53, 95% CI 26.83 to 272.69). CONCLUSIONS The findings of this study support the feasibility of an active screening programme for parental postnatal depression during well-child visits as an integral part of postpartum care. TRIAL REGISTRATION NUMBER NCT03894566; Pre-results.
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Affiliation(s)
- Giulia Segre
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Antonio Clavenna
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Massimo Cartabia
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Maurizio Bonati
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Johnson J, Hope L, Jones L, Bradley E. A mixed methods study to understand perinatal mental healthcare referral decisions among midwives and health visitors in the UK. Front Psychiatry 2023; 14:1056987. [PMID: 37377475 PMCID: PMC10291319 DOI: 10.3389/fpsyt.2023.1056987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 05/15/2023] [Indexed: 06/29/2023] Open
Abstract
Background In the UK approximately half of women requiring perinatal mental health (PNMH) care do not receive treatment despite having routine contact with midwives (MWs) and health visitors (HVs). Limited research has been undertaken regarding MWs'/HVs' decision-making around referring women for secondary PNMH care. In particular, the impact that the level of local secondary PNMH services may have on MWs'/HVs' referral decisions is unexplored. Aim To understand MWs'/HVs' decision-making in relation to referring women with identified PNMH problems, to identify barriers and facilitators to effective and timely referrals including any impact of the local secondary PNMH service provision. Methods Participants were recruited from four National Health Service (NHS) Trusts in England, located across two geographical areas, that provided different types of PNMH services. One area had PNMH services that met National Institute for Health and Care Excellence (NICE) guidelines; the other area had no secondary PNMH services. A sequential mixed methods design was used: In-depth semi-structured interviews with practising MWs/HVs (n = 24) to explore their approach to PNMH referral decision-making, analysed using thematic analysis; Questionnaire offered to all practising MWs/HVs in the two geographical areas to measure factors that may impact on PNMH referral decision-making allowing for statistical comparisons to be made between the professional groups/geographical areas. Findings Three themes were identified from the interviews that impacted on MWs'/HVs' PNMH referral decision-making: identifying need; education, skills and experience; and referral pathways.Questionnaire response rate 13.1% (n = 99). The most reported facilitators to referral decision-making were a trusted relationship between MWs/HVs and women and routine enquiry about women's mental health; the most reported barriers were stigma associated with mental ill-health and women's perceived fear of child removal. Conclusion Fundamental to MWs'/HVs' decision-making was their perceived relationship between themselves and women. Although PNMH service provision is important for women to ensure they receive appropriate PNMH care, service provision appeared less important to MWs'/HVs' referral decision-making than how maternity/health visiting services were delivered. Further important factors to MWs/HVs were to the ability to provide continuity of carer with women allowing MWs/HVs to identify women who would benefit from referral for secondary PNMH care.
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Affiliation(s)
- Joanne Johnson
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcestershire, United Kingdom
| | - Lucy Hope
- College of Health, Life and Environmental Sciences, University of Worcester, Worcester, United Kingdom
| | - Lisa Jones
- Department of Psychological Medicine, University of Worcester, Worcester, United Kingdom
| | - Eleanor Bradley
- College of Health, Life and Environmental Sciences, University of Worcester, Worcester, United Kingdom
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3
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Effects of maternal depression on maternal responsiveness and infants' expressive language abilities. PLoS One 2023; 18:e0277762. [PMID: 36630343 PMCID: PMC9833548 DOI: 10.1371/journal.pone.0277762] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 11/02/2022] [Indexed: 01/12/2023] Open
Abstract
High levels of maternal responsiveness are associated with healthy cognitive and emotional development in infants. However, depression and anxiety can negatively impact individual mothers' responsiveness levels and infants' expressive language abilities. Australian mother-infant dyads (N = 48) participated in a longitudinal study examining the effect of maternal responsiveness (when infants were 9- and 12-months), and maternal depression and anxiety symptoms on infant vocabulary size at 18-months. Global maternal responsiveness ratings were stronger predictors of infants' vocabulary size than levels of depression and anxiety symptoms. However, depression levels moderated the effect of maternal responsiveness on vocabulary size. These results highlight the importance of screening for maternal responsiveness-in addition to depression-to identify infants who may be at developmental risk. Also, mothers with elevated depression need support to first reduce their symptoms so that improvements in their responsiveness have the potential to be protective for their infant's language acquisition.
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The role of body dissatisfaction and self-compassion in pregnancy-related anxiety. J Affect Disord 2022; 313:84-91. [PMID: 35772628 DOI: 10.1016/j.jad.2022.06.068] [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: 02/24/2022] [Revised: 05/28/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Women undergo significant physical, physiological, and psychological changes during pregnancy. They are also exposed to sociocultural pressure to meet appearance-related ideals. These pregnancy-related changes and sociocultural appearance-related pressures may place pregnant women at greater vulnerability to developing body dissatisfaction and psychological distress. To date, however, little is known about how sociocultural pressure may influence pregnancy-related anxiety, or factors that may protect against such distress during pregnancy. This study examined whether body dissatisfaction mediated the relationship between appearance-related sociocultural pressure and pregnancy-related anxiety, and whether this relationship was moderated by self-compassion and/or self-criticism. METHOD A cross-sectional sample of 253 pregnant women (Mage = 26.28, SDage = 4.43) completed an online questionnaire measuring sociocultural pressure, body dissatisfaction, pregnancy-related anxiety, and self-compassion. RESULTS Moderated mediation analyses revealed body dissatisfaction fully mediated the relationship between sociocultural pressure and pregnancy-related anxiety. Analyses confirmed the moderating role of self-compassion and self-criticism on the relationship between sociocultural pressure and body dissatisfaction, but not on the relationship between body dissatisfaction and pregnancy-related anxiety. LIMITATIONS The cross-sectional nature of this study limits confirmation of the direction of relationships between sociocultural pressure, body dissatisfaction and pregnancy-related anxiety. CONCLUSIONS While the findings of this study need to be replicated in prospective and longitudinal studies, they suggest that sociocultural pressure to meet appearance-related standards contribute to body dissatisfaction, which in turn may facilitate pregnancy-related anxiety. Self-compassion may protect the body image of pregnant women against negative effects of appearance-related sociocultural pressure.
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Glenn Fowler M, Boivin MJ, Familiar I, Nyangoma B. Central Nervous System and Neurodevelopmental Outcomes of HIV+ and HIV exposed children: A Mini Review of Recent Findings and Lessons Learned from the Field. Neurosci Lett 2022; 775:136501. [PMID: 35122932 DOI: 10.1016/j.neulet.2022.136501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 01/11/2022] [Accepted: 01/28/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Mary Glenn Fowler
- Dept of Pathology, Johns Hopkins U. School of Medicine Baltimore MD, USA; Dept of PsychiatryMichigan State U. East Lansing, MI, USA; Makerere U. Johns Hopkins U. Research Collaboration, USA; Kampala Uganda
| | - Michael J Boivin
- Dept of Pathology, Johns Hopkins U. School of Medicine Baltimore MD, USA; Dept of PsychiatryMichigan State U. East Lansing, MI, USA; Makerere U. Johns Hopkins U. Research Collaboration, USA; Kampala Uganda
| | - Itziar Familiar
- Dept of Pathology, Johns Hopkins U. School of Medicine Baltimore MD, USA; Dept of PsychiatryMichigan State U. East Lansing, MI, USA; Makerere U. Johns Hopkins U. Research Collaboration, USA; Kampala Uganda
| | - Betty Nyangoma
- Dept of Pathology, Johns Hopkins U. School of Medicine Baltimore MD, USA; Dept of PsychiatryMichigan State U. East Lansing, MI, USA; Makerere U. Johns Hopkins U. Research Collaboration, USA; Kampala Uganda
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Agako A, Donegan E, McCabe RE, Frey BN, Streiner D, Green S. The role of emotion dysregulation in cognitive behavioural group therapy for perinatal anxiety: Results from a randomized controlled trial and routine clinical care. J Affect Disord 2021; 292:517-525. [PMID: 34147963 DOI: 10.1016/j.jad.2021.05.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/11/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emotion dysregulation (ED) has been implicated in anxiety disorders and may play an important role in Cognitive Behavioural Therapy (CBT) treatment for perinatal anxiety outcomes although there is a dearth of research in this area. The current study investigated the role of ED in perinatal anxiety treatment outcome to determine whether it impacts CBT treatment outcomes and whether CBT reduces ED. METHODS Secondary analyses were run on a sample of N = 75 women participating in a CBT for perinatal anxiety randomized controlled trial (RCT), and N = 47 women who received the treatment as part of routine clinical care. Participants completed measures of anxiety, depression and ED at baseline, post-CBT/post-waitlist and 3-month follow-up (CBT-RCT group only). MANOVAs were conducted to determine if level of ED moderates treatment outcomes and whether CBT reduces ED. Reliable and clinically meaningful change was calculated. RESULTS Baseline level of ED did not moderate treatment outcomes. There were significant changes in some ED subscales over time in the CBT group compared to waitlist. Changes were reliable and clinically meaningful in 28.6% (RCT) and 16% (routine clinical care) of participants. Participants with high ED at baseline remained in the high range at post-treatment. LIMITATIONS Limitations include low sample size; homogeneity of sample, use of measures not validated in perinatal populations. CONCLUSIONS These findings suggest that ED during the perinatal period may be a stand-alone factor that will need to be separately addressed in psychological treatment.
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Affiliation(s)
- Arela Agako
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada.
| | - Eleanor Donegan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Randi E McCabe
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - David Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Sheryl Green
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
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7
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Brookman R, Kalashnikova M, Conti J, Xu Rattanasone N, Grant KA, Demuth K, Burnham D. Maternal Depression Affects Infants' Lexical Processing Abilities in the Second Year of Life. Brain Sci 2020; 10:E977. [PMID: 33322798 PMCID: PMC7763905 DOI: 10.3390/brainsci10120977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/23/2020] [Accepted: 12/09/2020] [Indexed: 11/16/2022] Open
Abstract
Maternal depression and anxiety have been proposed to increase the risk of adverse outcomes of language development in the early years of life. This study investigated the effects of maternal depression and anxiety on language development using two approaches: (i) a categorical approach that compared lexical abilities in two groups of children, a risk group (mothers with clinical-level symptomatology) and a control non-risk group, and (ii) a continuous approach that assessed the relation between individual mothers' clinical and subclinical symptomatology and their infants' lexical abilities. Infants' lexical abilities were assessed at 18 months of age using an objective lexical processing measure and a parental report of expressive vocabulary. Infants in the risk group exhibited lower lexical processing abilities compared to controls, and maternal depression scores were negatively correlated to infants' lexical processing and vocabulary measures. Furthermore, maternal depression (not anxiety) explained the variance in infants' individual lexical processing performance above the variance explained by their individual expressive vocabulary size. These results suggest that significant differences are emerging in 18-month-old infants' lexical processing abilities, and this appears to be related, in part, to their mothers' depression and anxiety symptomatology during the postnatal period.
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Affiliation(s)
- Ruth Brookman
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1957, Penrith, NSW 2750, Australia; (M.K.); (D.B.)
- School of Psychology, Western Sydney University, Locked Bag 1957, Penrith, NSW 2750, Australia;
| | - Marina Kalashnikova
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1957, Penrith, NSW 2750, Australia; (M.K.); (D.B.)
- Basque Centre for Cognition, Brain and Language, Paseo Mikeletegi 69, 2º, 20009 Donostia-San Sebastián, Spain
- IKERBASQUE, Basque Foundation for Science, Plaza Euskadi 5, 48009 Bilbao, Spain
| | - Janet Conti
- School of Psychology, Western Sydney University, Locked Bag 1957, Penrith, NSW 2750, Australia;
| | - Nan Xu Rattanasone
- Department of Linguistics, Macquarie University, Balaclava Road, North Ryde, NSW 2109, Australia; (N.X.R.); (K.D.)
| | - Kerry-Ann Grant
- Health Education and Training Institute, Locked Bag 7118, Parramatta Bc, NSW 2124, Australia;
| | - Katherine Demuth
- Department of Linguistics, Macquarie University, Balaclava Road, North Ryde, NSW 2109, Australia; (N.X.R.); (K.D.)
| | - Denis Burnham
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1957, Penrith, NSW 2750, Australia; (M.K.); (D.B.)
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Brookman R, Kalashnikova M, Conti J, Xu Rattanasone N, Grant KA, Demuth K, Burnham D. Depression and Anxiety in the Postnatal Period: An Examination of Infants' Home Language Environment, Vocalizations, and Expressive Language Abilities. Child Dev 2020; 91:e1211-e1230. [PMID: 32745250 DOI: 10.1111/cdev.13421] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This longitudinal study investigated the effects of maternal emotional health concerns, on infants' home language environment, vocalization quantity, and expressive language skills. Mothers and their infants (at 6 and 12 months; 21 mothers with depression and or anxiety and 21 controls) provided day-long home-language recordings. Compared with controls, risk group recordings contained fewer mother-infant conversational turns and infant vocalizations, but daily number of adult word counts showed no group difference. Furthermore, conversational turns and infant vocalizations were stronger predictors of infants' 18-month vocabulary size than depression and anxiety measures. However, anxiety levels moderated the effect of conversational turns on vocabulary size. These results suggest that variability in mothers' emotional health influences infants' language environment and later language ability.
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Affiliation(s)
| | - Marina Kalashnikova
- Western Sydney University.,BCBL-Basque Center for Cognition, Brain and Language
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Dryer R, Graefin von der Schulenburg I, Brunton R. Body dissatisfaction and Fat Talk during pregnancy: Predictors of distress. J Affect Disord 2020; 267:289-296. [PMID: 32217229 DOI: 10.1016/j.jad.2020.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 01/14/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND During pregnancy, women are vulnerable to mood and anxiety disorders due to the significant physical and emotional changes that occur during this period. For some women, pregnancy can also present as a period of immense body dissatisfaction due to the substantial changes in body shape and size. OBJECTIVES This study examined the mediating role of Fat Talk (i.e., engaging in disparaging comments about one's body shape and size with others) in the relationship between (a) body dissatisfaction and distress in pregnant women (i.e., pregnancy-related anxiety, depression and eating disorder symptomatology), and (b) sociocultural pressure to meet the thin ideal and distress. METHOD A nonclinical sample of 408 pregnant women (Mage = 28.24 years, SDage = 5.04, range 18-44 years) completed measures of body dissatisfaction, sociocultural pressure, pregnancy-related anxiety, depression and eating disorder symptomatology. FINDINGS Analyses confirmed the partial mediating role of Fat Talk between body dissatisfaction and all three measures of distress, when examined individually. Fat Talk also mediated the relationship between sociocultural pressure (i.e., peers/family and media) and the three measures of distress. Age also partially mediated the relationship between body dissatisfaction and a composite measure of pregnancy distress. CONCLUSIONS The results suggest that women face sociocultural pressures for thinness and body dissatisfaction even when pregnant, and that engaging in Fat Talk contribute to greater levels of pregnancy-related anxiety, depression and eating disorder symptomatology. The role of Fat Talk in regard to pregnancy distress may be more pertinent to younger women.
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Affiliation(s)
- Rachel Dryer
- School of Behavioural & Health Sciences, Australian Catholic University, Strathfield, New South Wales 2135, Australia.
| | | | - Robyn Brunton
- School of Psychology, Charles Sturt University, Bathurst, New South Wales 2795, Australia
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Maternal Satisfaction with Healthcare after Perinatal Loss in Monochorionic Twin Pregnancy. J Clin Med 2019; 8:jcm8081213. [PMID: 31416177 PMCID: PMC6723400 DOI: 10.3390/jcm8081213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/30/2019] [Accepted: 08/13/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The analysis of patients' satisfaction with healthcare is recognised as being useful in the evaluation of health outcomes and perceived quality of care. Little is known, however, about how the psychological status of women who experience perinatal complications may affect their perceived satisfaction with care. METHODS We assessed healthcare satisfaction in 52 women who had undergone intrauterine surgery during a complicated monochorionic twin pregnancy and examined the influence that fetal loss and sociodemographic, clinical, and psychological factors had on the degree of satisfaction. Data were gathered in an individual interview and through the administration of the Medical Patient Satisfaction Questionnaire, Beck Depression Inventory, and State-Trait Anxiety Inventory. Relationships between variables were analysed using a chi-square test, Spearman's rho, Student's t test, and the Mann-Whitney U test, in accordance with the metric nature of the variables and the assumptions fulfilled. RESULTS Age and level of education were not associated with the degree of healthcare satisfaction. Negative but non-significant correlations were observed between the level of satisfaction and symptoms of anxiety and depression. Satisfaction with healthcare was high in the sample as a whole, although it was significantly higher among women who had not experienced fetal loss. There were no differences in satisfaction with services involving direct contact with medical staff, whereas satisfaction with indirect services was lower among women who had experienced perinatal loss. CONCLUSIONS Due to the unique characteristics of this population, specialised care teams of both professional healthcare and indirect services are needed. Although administrative aspects of healthcare are regarded as being of secondary importance, this may not be the case with more vulnerable populations.
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Sims DJ, Fowler C. Postnatal psychosocial assessment and clinical decision-making, a descriptive study. J Clin Nurs 2018; 27:3739-3749. [PMID: 29775993 DOI: 10.1111/jocn.14530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To describe experienced child and family health nurses' clinical decision-making during a postnatal psychosocial assessment. BACKGROUND Maternal emotional well-being in the postnatal year optimises parenting and promotes infant development. Psychosocial assessment potentially enables early intervention and reduces the risk of a mental disorder occurring during this time of change. Assessment accuracy and the interventions used are determined by the standard of nursing decision-making. DESIGN A qualitative methodology was employed to explore decision-making behaviour when conducting a postnatal psychosocial assessment. METHODS This study was conducted in an Australian early parenting organisation. Twelve experienced child and family health nurses were interviewed. A detailed description of a postnatal psychosocial assessment process was obtained using a critical incident technique. Template analysis was used to determine the information domains the nurses accessed, and content analysis was used to determine the nurses' thinking strategies, to make clinical decisions from this assessment. RESULTS The nurses described 24 domains of information and used 17 thinking strategies, in a variety of combinations. The four information domains most commonly used were parenting, assessment tools, women-determined issues and sleep. The seven thinking strategies most commonly used were searching for information, forming relationships between the information, recognising a pattern, drawing a conclusion, setting priorities, providing explanations for the information and judging the value of the information. CONCLUSION The variety and complexity of the clinical decision-making involved in postnatal psychosocial assessment confirm that the nurses use information appropriately and within their scope of nursing practice. The standard of clinical decision-making determines the results of the assessment and the optimal access to care. RELEVANCE TO CLINICAL PRACTICE Knowledge of the information domains and the decision-making strategies that experienced nurses use for psychosocial assessment potentially improves practice by providing a framework for education and mentoring.
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Affiliation(s)
- Deborah Jane Sims
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Cathrine Fowler
- Faculty of Health, Tresillian Chair in Child and Family Health, University of Technology Sydney, Ultimo, NSW, Australia
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12
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Antenatal depressive symptoms in Jamaica associated with limited perceived partner and other social support: A cross-sectional study. PLoS One 2018; 13:e0194338. [PMID: 29554107 PMCID: PMC5858785 DOI: 10.1371/journal.pone.0194338] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 03/01/2018] [Indexed: 11/30/2022] Open
Abstract
Background Antenatal depression is associated with adverse maternal and infant well-being. However, compared to postpartum depression, it has been less frequently explored globally or in Jamaica. This study aimed to determine the prevalence of, and factors associated with, antenatal depressive symptoms among Jamaican women in order to inform policy and build interventions that could improve their management and reduce their negative consequences. Methods This secondary analysis of data from the second Jamaican Birth Cohort Study (JA-Kids Birth Cohort) included 3,517 women enrolled during pregnancy. Information was extracted from interviewer-administered questionnaires which recorded social, demographic, medical and obstetric information during pregnancy. The Edinburgh Postnatal Depression scale (EPDS) was used to screen for depression, with scores ≥13 considered indicative of a high likelihood of depression. Bivariate analysis examined associations between depressive symptoms and: age, income, financial difficulties, perceived social support, perceived partner infidelity, previous child-bearing unions and children with the current partner. Obstetric factors were also explored and included gravidity, prior adverse pregnancy outcome and complications from previous pregnancies. Variables that predicted the likelihood of depression based on an EPDS cut score of 13 were evaluated using logistic regression. Results One in five participants (19.6%; 95% CI 18.3–20.9%) had a high likelihood of antenatal depression (EPDS ≥13). Significant predictors of high depressive symptom severity included four indicators of poor perceived social and partner support [ORs (95% CI) ranged from: 1.61 (1.07–2.43); p = 0.024 to 3.14(1.69–5.84); p< 0.001], perceived partner infidelity [1.86 (1.36, 2.54); p<0.001], exposure to violence [2.36 (1.66–3.38); p<0.001] and financial difficulties [1.39 (1.07, 1.80); p = 0.013]. Conclusions Women’s perceived social and partner support were strongly associated with depressive symptom severity. Within the Jamaican cultural context of unstable reproductive unions, efforts are needed to involve fathers in the antenatal care process to strategically improve the psychological well-being of new mothers which may positively influence long term developmental outcomes for their babies.
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Fatmawati A, Nur Rachmawati I, Budiati T. The influence of adolescent postpartum women’s psychosocial condition on mother-infant bonding. ENFERMERIA CLINICA 2018. [DOI: 10.1016/s1130-8621(18)30068-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kurtz S, Levine J, Safyer M. Ask the Question: Screening for Postpartum Mood and Anxiety Disorders in Pediatric Primary Care. Curr Probl Pediatr Adolesc Health Care 2017; 47:241-253. [PMID: 28935390 DOI: 10.1016/j.cppeds.2017.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Postpartum mood and anxiety disorders (PMADs) are a significant source of toxic stress for young children and can disrupt developing brain architecture resulting in long-lasting deleterious effects. Thus, screening for PMADs must be considered as an essential task of a pediatric primary care provider (PCP) and the pediatric medical home. Problems in parenting capacity in mothers with PMADs can lead to disorders in attachment and a range of other emotional and developmental challenges for a young child. Therefore, all PCP office visits with mothers should include surveillance as well as formal screening at regular, pre-determined intervals. During surveillance, identification of psychosocial, maternal, infant, and maternal/infant risk factors is critical. There are a number of well researched, standardized, reliable, free and valid screening tools including the Patient Health Questionnaires (PHQ-2 and PHQ-9) and the Edinburgh Postnatal Depression Scale (EDPS). Office implementation includes availability of educational materials, resource information, and referrals so families can get appropriate treatment. Screening for PMADs is highly effective and helps to identify a common, underdiagnosed disorder in parents that without identification and appropriate treatment can lead to significant negative outcomes for a young child.
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Affiliation(s)
- Stacy Kurtz
- Institute for Parenting, Adelphi University, Garden City, NY.
| | - Jack Levine
- Hofstra University School of Medicine, Department of Pediatrics, Hempstead, NY
| | - Marcy Safyer
- Institute for Parenting, Adelphi University, Garden City, NY
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Nyatsanza M, Schneider M, Davies T, Lund C. Filling the treatment gap: developing a task sharing counselling intervention for perinatal depression in Khayelitsha, South Africa. BMC Psychiatry 2016; 16:164. [PMID: 27228979 PMCID: PMC4881204 DOI: 10.1186/s12888-016-0873-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 05/16/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Perinatal depression is a major public health issue especially in low income settings in South Africa, where there is a shortage of mental health professionals. New psychological interventions delivered by non-specialists are needed to fill the treatment gap. This paper describes the process of developing a manual based task sharing counselling intervention for perinatal depression in Khayelitsha, Cape Town. METHODS Qualitative semi-structured interviews were conducted with 26 participants, including service providers and service users at a clinic in Khayelitsha in order to explore the feasibility, acceptability and content of a task sharing counselling intervention. The interviews were recorded, translated and transcribed. Themes were identified using the framework analysis approach and were coded and analysed using NVivo v10. After the semi-structured interviews, a workshop was conducted with mental health experts on evidence-based psychological interventions for depression, together with a document review of counselling manuals for community health workers in South Africa. RESULTS The findings indicate that a task sharing counselling intervention was acceptable and feasible for depressed women in Khayelitsha, under the following conditions: (1) respondents preferred a female counsellor and felt that clinic based individual sessions should be provided at least once a month by an experienced Xhosa speaking counsellor from the community; and (2) the content of a counselling intervention should include psycho-education on cognitive and behavioural effects of depression, how to cope with interpersonal problems, and financial stressors. Based on these conditions, the review of manuals and expert consultation, key components of the counselling intervention were identified as: psycho-education, problem solving, healthy thinking and behaviour activation. These were included in the final counselling manual. CONCLUSION The development of task sharing counselling interventions for perinatal depression should be informed by the views and needs of local service users and service providers. The study illustrates the manner in which these views can be incorporated for the development of evidence-based psychological interventions, within a task sharing framework in low and middle-income countries.
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Affiliation(s)
- Memory Nyatsanza
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, South Africa.
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, South Africa
| | - Thandi Davies
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, South Africa
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, South Africa ,Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neurosciences, King’s College London, London, UK
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Cunningham NK, Brown PM, Page AC. The structure of negative emotional states in a postpartum inpatient sample. J Affect Disord 2016; 192:11-21. [PMID: 26706827 DOI: 10.1016/j.jad.2015.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 11/18/2015] [Accepted: 12/07/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Depression and anxiety disorders exhibit comorbidity, and the same relationships have been observed in postpartum samples. The tripartite model posits that anxiety and depression overlap due to shared and unique symptom components. The present study tested whether a one-factor model, or a three-factor model consistent with the tripartite model, provided a better fit to anxiety and depression symptoms in a postpartum sample. METHODS The sample consisted of 663 postpartum psychiatric inpatients who completed self-reported questionnaires assessing symptoms of anxiety and depression. RESULTS Confirmatory factor analysis revealed that a three-factor model consistent with the tripartite model provided a good fit to anxiety/depression data. This model consisted of three factors: positive affect, negative affect, and autonomic arousal. Positive affect was related to depressive diagnoses and negatively related to anxiety diagnoses; autonomic arousal was related to anxiety diagnoses; and negative affect was uniquely related to mixed anxiety-depressive diagnoses. LIMITATIONS The sample consisted of postpartum psychiatric inpatients and the generalisability of results to other postpartum samples is not known. CONCLUSIONS Postpartum anxiety and depression appear to be characterised by three differentiable symptom clusters. Postpartum anxiety, depression, and mixed anxiety-depressive diagnoses are differentially associated with these symptom clusters. These findings suggest that the tripartite model may be useful in guiding assessment, differentiation, and treatment of postpartum emotional disorders.
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Affiliation(s)
- Nadia K Cunningham
- School of Psychology, The University of Western Australia, 35 Stirling Highway, Crawley 6009, Australia.
| | - Philippa M Brown
- Mother and Baby Unit, King Edward Memorial Hospital, Western Australia, Australia
| | - Andrew C Page
- School of Psychology, The University of Western Australia, 35 Stirling Highway, Crawley 6009, Australia
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Claridge AM. Pregnancy Plans of First-time Mothers and Their Children's Outcomes: An Examination of Mechanisms. INFANT AND CHILD DEVELOPMENT 2016. [DOI: 10.1002/icd.1962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Amy M. Claridge
- Department of Family and Consumer Sciences, College of Education and Professional Studies; Central Washington University; Ellensburg WA USA
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Sikander S, Lazarus A, Bangash O, Fuhr DC, Weobong B, Krishna RN, Ahmad I, Weiss HA, Price L, Rahman A, Patel V. The effectiveness and cost-effectiveness of the peer-delivered Thinking Healthy Programme for perinatal depression in Pakistan and India: the SHARE study protocol for randomised controlled trials. Trials 2015; 16:534. [PMID: 26604001 PMCID: PMC4659202 DOI: 10.1186/s13063-015-1063-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/17/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Rates of perinatal depression (antenatal and postnatal depression) in South Asia are among the highest in the world. The delivery of effective psychological treatments for perinatal depression through existing health systems is a challenge due to a lack of human resources. This paper reports on a trial protocol that aims to evaluate the effectiveness and cost-effectiveness of the Thinking Healthy Programme delivered by peers (Thinking Healthy Programme Peer-delivered; THPP), for women with moderate to severe perinatal depression in rural and urban settings in Pakistan and India. METHODS/DESIGN THPP is evaluated with two randomised controlled trials: a cluster trial in Rawalpindi, Pakistan, and an individually randomised trial in Goa, India. Trial participants are pregnant women who are registered with the lady health workers in the study area in Pakistan and pregnant women attending outpatient antenatal clinics in India. They will be screened using the patient health questionnaire-9 (PHQ-9) for depression symptoms and will be eligible if their PHQ-9 is equal to or greater than 10 (PHQ-9 ≥ 10). The sample size will be 560 and 280 women in Pakistan and India, respectively. Women in the intervention arm (THPP) will be offered ten individual and four group sessions (Pakistan) or 6-14 individual sessions (India) delivered by a peer (defined as a mother from the same community who is trained and supervised in delivering the intervention). Women in the control arm (enhanced usual care) will receive health care as usual, enhanced by providing the gynaecologist or primary-health facilities with adapted WHO mhGAP guidelines for depression treatment, and providing the woman with her diagnosis and information on how to seek help for herself. The primary outcomes are remission and severity of depression symptoms at the 6-month postnatal follow-up. Secondary outcomes include remission and severity of depression symptoms at the 3-month postnatal follow-up, functional disability, perceived social support, breastfeeding rates, infant height and weight, and costs of health care at the 3- and 6-month postnatal follow-ups. The primary analysis will be intention-to-treat. DISCUSSION The trials have the potential to strengthen the evidence on the effectiveness and cost-effectiveness of an evidence-based psychological treatment recommended by the World Health Organisation and delivered by peers for perinatal depression. The trials have the unique opportunity to overcome the shortage of human resources in global mental health and may advance our understanding about the use of peers who work in partnership with the existing health systems in low-resource settings. TRIAL REGISTRATION Pakistan Trial: ClinicalTrials.gov Identifier: NCT02111915 (9 April 2014) India Trial: ClinicalTrials.gov Identifier: NCT02104232 (1 April 2014).
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Affiliation(s)
- Siham Sikander
- Human Development Research Foundation, Islamabad, Pakistan.
| | | | - Omer Bangash
- Human Development Research Foundation, Islamabad, Pakistan.
| | - Daniela C Fuhr
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Benedict Weobong
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Ikhlaq Ahmad
- Human Development Research Foundation, Islamabad, Pakistan.
| | - Helen A Weiss
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - LeShawndra Price
- Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA.
| | - Atif Rahman
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
| | - Vikram Patel
- Sangath, , Goa, India.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Delhi NCR, India.
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Claridge AM, Wojciak AS, Lettenberger-Klein CG, Pettigrew HV, McWey LM, Chaviano CL. Reciprocal Associations Among Maternal and Child Characteristics of At-Risk Families: A Longitudinal Actor-Partner Interdependence Model. JOURNAL OF MARITAL AND FAMILY THERAPY 2015; 41:308-323. [PMID: 25039501 DOI: 10.1111/jmft.12084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Researchers have found linear associations among maternal and child characteristics. However, family systems theorists suggest that relationships are more complex and family members are interdependent. We used actor-partner interdependence modeling to unravel associations among maternal and child characteristics to predict outcomes in adolescence. We used data from 361 mother-child dyads from the Longitudinal Studies of Child Abuse and Neglect and found both actor and partner effects. Maternal depression and history of victimization were associated with children's later reports of lower mother-adolescent relationship quality. Children's perceptions of relationship quality were also associated with mothers' later depressive symptoms and perceptions of relationship quality. Overall, results highlighted interdependence among mothers and their children over time. We discuss implications for marriage and family therapists.
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Public health care nurses’ views of mothers’ mental health in paediatric healthcare services: a qualitative study. Prim Health Care Res Dev 2015; 16:470-80. [DOI: 10.1017/s1463423615000055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AimTo investigate public health nurses’ perceptions and experiences of mental health and of the prevention of mental ill health among women postpartum, within paediatric healthcare services.BackgroundAlthough maternal health following childbirth should be a priority within primary care, it is known that women postpartum do not always receive the support they need to adapt to and cope with motherhood. Research implies that postnatal problems lack recognition and are not always acknowledged in routine practice. Few studies have been presented on this topic or from the perspective of nurses.MethodsFor this study, eight semi-structured interviews were conducted with public health nurses, and the transcribed texts were analysed through a process inspired by Burnard’s description of the four-step qualitative content analysis.FindingsThree categories – external influences on postpartum mental health, screening for and preventing postpartum mental ill health and paediatric healthcare services as a platform for support – were interpreted to reflect the nurses’ perceptions and experiences of mental health among women postpartum and of the prevention of mental ill health among women postpartum.ConclusionWe found that public health nurses can have an important role in supporting mothers’ mental health postpartum. Although caution is warranted in interpreting our results, the findings concur with those of other studies, highlighting that an equal care emphasis on both the mother and child can be an important aspect of successful support. Implementing person-centred care might be one strategy to create such an emphasis, while also promoting the mental health of new mothers. Public health nurses have a unique opportunity to support mothers’ transition into healthy motherhood, especially because they are likely to meet both mothers and children on a regular basis during the first year after birth.
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Räisänen S, Lehto SM, Nielsen HS, Gissler M, Kramer MR, Heinonen S. Risk factors for and perinatal outcomes of major depression during pregnancy: a population-based analysis during 2002-2010 in Finland. BMJ Open 2014; 4:e004883. [PMID: 25398675 PMCID: PMC4244456 DOI: 10.1136/bmjopen-2014-004883] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To identify risk factors for and the consequences (several adverse perinatal outcomes) of physician-diagnosed major depression during pregnancy treated in specialised healthcare. DESIGN A population-based cross-sectional study. SETTING Data were gathered from Finnish health registers for 1996-2010. PARTICIPANTS All singleton births (n=511,938) for 2002-2010 in Finland. PRIMARY OUTCOME MEASURES Prevalence, risk factors and consequences of major depression during pregnancy. RESULTS Among 511,938 women, 0.8% experienced major depression during pregnancy, of which 46.9% had a history of depression prior to pregnancy. After history of depression, the second strongest associated factor for major depression was fear of childbirth, with a 2.6-fold (adjusted OR (aOR=2.63, 95% CI 2.39 to 2.89) increased prevalence. The risk profile of major depression also included adolescent or advanced maternal age, low or unspecified socioeconomic status (SES), single marital status, smoking, prior pregnancy terminations, anaemia and gestational diabetes regardless of a history of depression. Outcomes of pregnancies were worse among women with major depression than without. The contribution of smoking was substantial to modest for small-for-gestational age newborn (<-2 SD below mean birth), low birth weight (<2500 g), preterm birth (<37 weeks) and admission to neonatal intensive care associated with major depression, whereas SES made only a minor contribution. CONCLUSIONS Physician-diagnosed major depression during pregnancy was found to be rare. The strongest risk factor was history of depression prior to pregnancy. Other associated factors were fear of childbirth, low SES, lack of social support and unhealthy reproductive behaviour such as smoking. Outcomes of pregnancies were worse among women with major depression than without. Smoking during pregnancy made a substantial to modest contribution to adverse outcomes associated with depression during pregnancy.
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Affiliation(s)
- Sari Räisänen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland
| | - Soili M Lehto
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
- Department of Psychiatry, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Mika Gissler
- National Institute for Health and Welfare (THL), Helsinki, Finland
- Nordic School of Public Health, Gothenburg, Sweden
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Seppo Heinonen
- Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, University of Eastern Finland, Kuopio, Finland
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Goutaudier N, Séjourné N, Bui É, Cazenave N, Chabrol H. [Premature delivery: a traumatic birth? Posttraumatic stress symptoms and associated features]. ACTA ACUST UNITED AC 2014; 42:749-54. [PMID: 24931321 DOI: 10.1016/j.gyobfe.2014.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 03/20/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES While researches focusing on posttraumatic stress disorder (PTSD) symptoms following childbirth tend to develop, few studies have been conducted on French samples. The aim of the current study was to explore the prevalence rate of women developing postpartum PTSD following preterm birth and highlighting associated features. PATIENTS AND METHOD In the 4weeks following the preterm infant's hospital discharge, a sample of 110 French women (mean age [SD]=29.5 [4.3]years) who delivered prematurely completed questionnaires assessing PTSD symptoms (Impact of Event Scale-Revised) postpartum depressive symptomatology (Edinburgh Postnatal Depression Scale), quality of marital relationship (Dyadic Adjustment Scale) and partner support (Multidimensional Scale of Perceived Social Support). Sociodemographic and gynecologic data were also gathered. RESULTS Thirty percent of our sample reported a score on the IES-R highlighting a probable posttraumatic stress disorder. Increased postpartum depressive symptoms (β=0.47, P<0.05), having undergone a caesarian section (β=0.24, P<0.05), and prior traumatic event (β=0.20, P<0.05), were independently associated with the intensity of PTSD symptoms. DISCUSSION AND CONCLUSION Given the traumatic impact of preterm birth on mothers, further studies focusing on the trauma of premature delivery are warranted.
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Affiliation(s)
- N Goutaudier
- Centre d'études et de recherches en psychopathologie, URI Octogone, université Toulouse II-Le Mirail, 5, allées Antonio-Machado, 31058 Toulouse cedex 9, France.
| | - N Séjourné
- Centre d'études et de recherches en psychopathologie, URI Octogone, université Toulouse II-Le Mirail, 5, allées Antonio-Machado, 31058 Toulouse cedex 9, France
| | - É Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, États-Unis; Harvard Medical School, Boston, Massachusetts, États-Unis
| | - N Cazenave
- Centre d'études et de recherches en psychopathologie, URI Octogone, université Toulouse II-Le Mirail, 5, allées Antonio-Machado, 31058 Toulouse cedex 9, France
| | - H Chabrol
- Centre d'études et de recherches en psychopathologie, URI Octogone, université Toulouse II-Le Mirail, 5, allées Antonio-Machado, 31058 Toulouse cedex 9, France
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Efficacy of systemically oriented psychotherapies in the treatment of perinatal depression: a meta-analysis. Arch Womens Ment Health 2014; 17:3-15. [PMID: 24240636 DOI: 10.1007/s00737-013-0391-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 10/20/2013] [Indexed: 10/26/2022]
Abstract
The objective of this meta-analysis was to examine the efficacy of systemically oriented psychotherapy treatments for depression in pregnancy and the postpartum. Specifically, this synthesis examined standardized mean differences between pre- and posttest and treatment-control conditions in depression symptom reduction among 24 individual interpersonal psychotherapy or relational psychotherapy studies completed between 1997 and 2013. Analyses assessed heterogeneity, potential moderators, and publication bias. Random-effects analyses revealed a large, positive average effect size [Formula: see text] for psychotherapy treatments among one-group, pre-post-studies and a medium, positive average effect [Formula: see text] when treatments were compared with control groups. Mixed-effects meta-ANOVAs indicated that treatment type, participant depression severity, and method of depression assessment were significant moderators such that effect sizes were larger among individual interpersonal psychotherapy studies, clinical samples, and studies that included an independent evaluation of depression. However, relational treatments and studies with nonclinical samples were less represented in the literature, and still demonstrated small to medium positive effects. Meta-regressions revealed that effects were largest when treatments were delivered with adherence fidelity checks and over more sessions. Based on funnel plots and Egger tests, there was evidence of publication bias in this analysis; however, the effects were distributed fairly symmetrically about the mean given the relatively small number of available studies. Findings have implications for continued examination of systemically oriented psychotherapy treatments for depression in pregnancy and the postpartum.
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Weikum WM, Mayes LC, Grunau RE, Brain U, Oberlander TF. The impact of prenatal serotonin reuptake inhibitor (SRI) antidepressant exposure and maternal mood on mother–infant interactions at 3 months of age. Infant Behav Dev 2013; 36:485-93. [DOI: 10.1016/j.infbeh.2013.04.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/28/2013] [Accepted: 04/30/2013] [Indexed: 01/30/2023]
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Christl B, Reilly N, Smith M, Sims D, Chavasse F, Austin MP. The mental health of mothers of unsettled infants: is there value in routine psychosocial assessment in this context? Arch Womens Ment Health 2013; 16:391-9. [PMID: 23775393 DOI: 10.1007/s00737-013-0360-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
Abstract
This study aims to investigate the (1) pattern of psychosocial risk factors among mothers of unsettled infants, (2) the relationship between these risk factors and current mental health status and (3) acceptability of psychosocial risk assessment in the parentcraft setting. Women with unsettled infants aged up to 12 months were assessed using the Edinburgh Postnatal Depression Scale, a diagnostic interview (Mini-International Neuropsychiatric Interview (MINI)) and a psychosocial assessment tool, the Postnatal Risk Questionnaire (PNRQ). Of the women, 27.5 % met the MINI diagnostic criteria for a current (predominantly) anxiety disorder, and 43.1 %, for a past psychiatric diagnosis. On the Edinburgh Postnatal Depression Scale, 29.9 % of women scored above 12 (mean 9.8; SD 5.1). The most common psychosocial risk factors were high trait anxiety (40.9 %), past mental health problems (40.7 %), perfectionistic traits (38.1 %) and 'abuse trauma' of any kind (31.6 %). The likelihood of meeting diagnostic criteria for a current mental illness was significantly increased for women who experienced emotional abuse during childhood (adj. odds ratio (OR) 3.386; p = 0.006), had high trait anxiety (adj. OR = 2.63, p = 0.003) or had a negative birth experience (adj. OR 2.78; p = 0.015). The majority of women (78 %) felt moderately to very comfortable completing the PNRQ. The results showed high rates of current anxiety disorders (almost twice that of the general postnatal population) and multiple significant psychosocial risk factors among mothers with unsettled infants. Identification of specific psychosocial risk factors in mothers of unsettled infants can help to address issues beyond infant settling difficulties such as mother-infant interaction, especially for mothers with unresolved issues around their own parenting or trauma history.
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Affiliation(s)
- Bettina Christl
- Perinatal and Women's Mental Health Unit, St John of God Health Care and School of Psychiatry, University of New South Wales, 13 Grantham St., Burwood, NSW, 2134, Australia,
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Browne J, O'Brien M, Taylor J, Bowman R, Davis D. 'You've got it within you': the political act of keeping a wellness focus in the antenatal time. Midwifery 2013; 30:420-6. [PMID: 23747292 DOI: 10.1016/j.midw.2013.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/18/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE by exploring midwives' communication techniques intended to promote a wellness focus in the antenatal period, this study identified strategies midwives use to amplify women's own resources and capacities, with the aim of reducing antenatal anxiety. DESIGN a qualitative design utilising focus groups as a means of generating data. SETTING two Australian cities: Canberra, ACT and Sydney NSW. PARTICIPANTS 14 experienced, practising midwives across two states/territories, employed in multiple hospitals and community settings. FINDINGS three themes emerged from the analysis: calm unhurriedness, speaking in wellness and reassuring bodies. Midwives in these focus groups used strategies in antenatal care that could be co-ordinated into a planned process for wellness focussed care. KEY CONCLUSIONS individually midwives used a variety of strategies specifically intended to facilitate women's capabilities, to employ worry usefully and to reduce anxiety. Midwives in the study clearly viewed this kind of wellness focussed care as their responsibility and their right. IMPLICATIONS FOR PRACTICE the midwives' collective wisdom could be shared and developed further into an overall salutogenic antenatal strategy to be used for the good of pregnant women and their infants.
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Affiliation(s)
- Jenny Browne
- Disciplines of Nursing and Midwifery, Faculty of Health, University of Canberra, ACT 2601, Australia.
| | - Maureen O'Brien
- Disciplines of Nursing and Midwifery, Faculty of Health, University of Canberra, ACT 2601, Australia
| | - Jan Taylor
- Disciplines of Nursing and Midwifery, Faculty of Health, University of Canberra, ACT 2601, Australia
| | - Rebekah Bowman
- Canberra Midwifery Program, The Canberra Hospital, ACT Health, Canberra, Australia
| | - Deborah Davis
- Disciplines of Nursing and Midwifery, Faculty of Health, University of Canberra, ACT 2601, Australia; ACT Health Directorate, Canberra, Australia
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A systematic review of systematic reviews of interventions to improve maternal mental health and well-being. Midwifery 2013; 29:389-99. [DOI: 10.1016/j.midw.2012.05.010] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 05/24/2012] [Accepted: 05/27/2012] [Indexed: 11/22/2022]
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Goodman JH, Tyer-Viola L. Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers. J Womens Health (Larchmt) 2013; 19:477-90. [PMID: 20156110 DOI: 10.1089/jwh.2008.1352] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS This study aimed to assess the rates of detection, treatment, and referral of maternal depression and anxiety by obstetrical providers during pregnancy and at 6 weeks postpartum. METHODS A convenience sample of women receiving obstetrical care at a large urban teaching hospital (n = 491) was screened for depression and anxiety during the third trimester of pregnancy and again at 6 weeks postpartum using the Edinburgh Postnatal Depression Scale and the anxiety portions of the Patient Health Questionnaire. Participants were also asked if they thought they needed help for depression, anxiety, or stress at the two time points. Obstetrical providers were blind to screening results. Two months postdelivery, each woman's obstetrical electronic medical record (EMR) was reviewed for documentation of psychiatric symptoms, diagnoses, psychiatric treatment, and mental health referrals at the two time points. Data were analyzed using descriptive statistics. RESULTS Twenty-three percent of participants screened positive for an anxiety disorder or high levels of depressive symptoms or both prenatally, and 17% screened positive at 6 weeks postpartum. The majority of women who screened positive were not identified by their providers during pregnancy or postpartum. Only 15% of positively screened participants had evidence of any mental health treatment in their EMR during pregnancy, with equally low rates of referral to mental health or social services. In the postpartum period, only 25% of positively screened postpartum women received treatment, and an additional 2.5% were referred. A low proportion of women who reported they felt a need for help with depression, anxiety, or stress prenatally or postpartum received treatment or referral. CONCLUSIONS These findings indicate that detection, treatment, and referral of perinatal depression by obstetrical providers are seriously lacking and need to be addressed.
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Affiliation(s)
- Janice H Goodman
- MGH Institute of Health Professions and The Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Eastwood J, Jalaludin B, Kemp L, Phung H, Barnett B, Tobin J. Social exclusion, infant behavior, social isolation, and maternal expectations independently predict maternal depressive symptoms. Brain Behav 2013; 3:14-23. [PMID: 23408743 PMCID: PMC3568785 DOI: 10.1002/brb3.107] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 10/15/2012] [Accepted: 10/23/2012] [Indexed: 11/22/2022] Open
Abstract
The objective of the study was to identify latent variables that can be used to inform theoretical models of perinatal influences on postnatal depressed mood and maternal-infant attachment. A routine survey of mothers with newborn infants was commenced in South Western Sydney in 2000. The survey included the Edinburgh Postnatal Depression Scale (EPDS) and 46 psychosocial and health-related variables. Mothers (n = 15,389) delivering in 2002 and 2003 were surveyed at 2-3 weeks for depressive symptoms. Nonlinear principal components analysis was undertaken to identify dimensions that might represent latent variables. Correlations between latent variables and EPDS >12 were assessed by logistic regression. A five-dimension solution was identified, which accounted for 51% of the variance among the items studied. The five dimensions identified were maternal responsiveness, social exclusion, infant behavior, migrant social isolation, and family size. In addition, the variable maternal expectation contributed significantly to total variance and was included in the regression analysis. Regression on EPDS >12 was predictive for all variables except for maternal responsiveness, which was considered an outcome variable. The findings are consistent with the proposition that social exclusion, infant behavior, social isolation among migrant mothers, and maternal expectations are determinants of maternal mood.
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Affiliation(s)
- John Eastwood
- School of Women's and Children's Health, University of New South Wales Sydney, New South Wales, Australia ; School of Public Health and Community Medicine, University of New South Wales Australia
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Makregiorgos H, Joubert L, Epstein I. Maternal mental health: pathways of care for women experiencing mental health issues during pregnancy. SOCIAL WORK IN HEALTH CARE 2013; 52:258-279. [PMID: 23521388 DOI: 10.1080/00981389.2012.737899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Perinatal mental health has become the focus for policymakers, government, research, the acute health sector, and health practitioners. The aim of this clinical data-mining study ( Epstein, 2010 ) was to undertake a retrospective exploration into the primary mental health and psychosocial issues experienced by women who were pregnant and accessing obstetric care at one of the largest maternity hospitals in Australia. The study also investigated service pathways and gaps. Aboriginal women were overrepresented, demonstrating their ongoing disadvantage, whereas other linguistically and culturally diverse women were underrepresented, suggesting the existence of barriers to service. Although psychosocial factors tend to be underreported ( Buist et al., 2002 ), the findings highlighted the integral rather than peripheral nature of these factors during pregnancy ( Vilder, 2006 ) and suggest the need for change to systems that work to support women's perinatal mental health.
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Affiliation(s)
- Helen Makregiorgos
- Department of Social Work, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
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Xu F, Austin MP, Reilly N, Hilder L, Sullivan EA. Major depressive disorder in the perinatal period: using data linkage to inform perinatal mental health policy. Arch Womens Ment Health 2012; 15:333-41. [PMID: 22643848 DOI: 10.1007/s00737-012-0289-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 05/15/2012] [Indexed: 01/03/2023]
Abstract
This study aims to investigate hospital admission of major depressive disorders (MDD) before and after birth. Population data for all primiparous women admitted to the hospital with depressive disorders before and after birth were used. The comparison group consisted of 10 % of primiparous women not admitted to the hospital with a diagnosis of a psychiatric disorder or substance use. A total of 728 women had a first admission with depressive disorders (501 in the first postpartum year). The rate of first hospital admission for depressive disorders decreased during pregnancy and increased markedly in the first three months after birth (peaking in the second month with a rate of 10.74/1,000 person year and rate ratio of 12.56) compared with the 6 months prior to pregnancy. Admission remained elevated in the second postpartum year. Older maternal age, smoking, elective caesarian section and admission to a neonatal intensive care unit or special care nursery were associated with a higher rate of admission. Women born outside Australia and those most socioeconomically disadvantaged were less likely to be admitted to the hospital in the first postpartum year. Overall risk of hospital admission with depressive disorders rose significantly across the entire first postpartum year. This has significant implications for policy and service planning for women with mood disorders in the perinatal period.
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Affiliation(s)
- Fenglian Xu
- Perinatal and Reproductive Epidemiology Research Unit, School of Women's and Children's Health, University of New South Wales, Randwick Hospitals Campus, Randwick, Sydney, Australia.
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Bilszta JLC, Buist AE, Wang F, Zulkefli NR. Use of video feedback intervention in an inpatient perinatal psychiatric setting to improve maternal parenting. Arch Womens Ment Health 2012; 15:249-57. [PMID: 22588508 DOI: 10.1007/s00737-012-0283-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 04/18/2012] [Indexed: 12/24/2022]
Abstract
This study utilizes video feedback to improve maternal parenting behavior in clinically depressed mothers admitted to a perinatal inpatient psychiatric unit. Depressed mothers (n = 74) were randomized to "video" (n = 25), "verbal" (n = 26), or "standard care" (n = 23). "Video" mothers were taped playing with their infant; interaction was reviewed with a mental health specialist. "Verbal" mothers only discussed interaction with their infant. "Standard care" mothers received only routine inpatient care. Mothers were assessed for mental health status, perceptions of baby behavior, and parenting competence. There was significant improvement in mental health status of all participants, regardless of intervention. Neither intervention had an advantage, compared to standard care, in improving parenting confidence or perceptions of infant behavior. Video mothers were more likely to report no change in their parenting confidence the more feedback sessions completed. The number of intervention sessions for each participant was limited by the duration of their inpatient admission. Most participants were on simultaneous pharmacotherapy and psychotherapy, as well as receiving intensive mothercraft assistance; this may have influenced intervention effectiveness. Results suggest that this type of intervention may be beneficial, but in the current format does not add sufficiently to standard care to be detected by the measures used.
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Affiliation(s)
- Justin L C Bilszta
- Department of Psychiatry, University of Melbourne and Austin Health, West Heidelberg, Australia.
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Abstract
Maternal mental health is an important public health issue because of its effects not only on the mother's well-being and functional status, but also her relationship with her partner and the development of her children. There is accumulating evidence of the adverse sequelae of maternal anxiety on fetal development, obstetrical complications, pregnancy outcomes such as low birth weight, and subsequent child development. Evaluation of maternal anxiety and intervention to reduce these symptoms, may ensure optimal developmental outcomes, particularly in high-risk infants such as those born at very low birth weights. This article will outline recent advances in our understanding of the etiology, assessment and impact of maternal anxiety, and describe intervention strategies to promote maternal well-being.
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Affiliation(s)
- Phyllis Zelkowitz
- Department of Psychiatry, Jewish General Hospital & McGill University, Lady Davis Institute, Jewish General Hospital, QC, Canada
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Choi SK, Kim JJ, Park YG, Ko HS, Park IY, Shin JC. The simplified Edinburgh Postnatal Depression Scale (EPDS) for antenatal depression: is it a valid measure for pre-screening? Int J Med Sci 2012; 9:40-6. [PMID: 22211088 PMCID: PMC3222089 DOI: 10.7150/ijms.9.40] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 11/07/2011] [Indexed: 11/05/2022] Open
Abstract
The identification of antenatal depression is critical but poorly conducted. The aim of this study was to construct a simplified depression survey scale and to verify its efficacy as a pre-screening for antenatal depression. A total of 494 pregnant women in the third trimester of gestation who had received antenatal care at Seoul St. Mary's Hospital from July 2009 to June 2010 were included. The Edinburgh Postnatal Depression Scale (EPDS) questionnaire was completed by them. The subjects were randomly divided into two groups: 250 of training set and 244 of validation set. We designed a simplified questionnaire comprising two items of EPDS using the training set. We then validated its efficacy with the training set and reaffirmed the results with the validation set. The sum of item 5 (scare or panic) and item 8 (sadness or misery) explained 75.5% of the total score of the EPDS (AUC = 0.947). Using a score of 3 as a cut-off value of the simplified scale, sensitivity was 92.4% and specificity was 86.3%. The positive and negative predictive values were 56.2% and 98.4%, retrospectively. This study suggests that the simplified EPDS can be an efficient instrument to rule out depression during pregnancy.
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Affiliation(s)
- Sea Kyung Choi
- Department of Obstetrics and Gynecology, College of Medicine, Catholic University of Korea, Seoul 137-040, Korea
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Eastwood JG, Phung H, Barnett B. Postnatal depression and socio-demographic risk: factors associated with Edinburgh Depression Scale scores in a metropolitan area of New South Wales, Australia. Aust N Z J Psychiatry 2011; 45:1040-6. [PMID: 22017687 DOI: 10.3109/00048674.2011.619160] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of this study was to determine the prevalence and risk factors for postnatal depressive symptoms in women living in metropolitan Sydney, Australia. METHOD A population-based cross-sectional study of mothers of newborn infants was undertaken during home and community clinic visits in South West Sydney from 2000 to 2004. A comprehensive 45 item survey questionnaire was completed by 29 405 mothers. A self-report Edinburgh Postnatal Depression Scale (EPDS) of depressive symptoms was completed by 25 455 mothers at the first child and family nurse visit. The primary study outcome measures were EPDS scores greater than 9 and greater than 12. RESULTS At a mean infant age of 2.16 weeks the prevalence of EPDS >9 was 12% and EPDS >12 was 6.2%. Results from multiple logistic regression revealed that EPDS >9 and EPDS > 2 were associated with a maternal country of birth other than Australia, difficult financial situation, living in the suburb one year or less, 'no regret leaving the suburb', unplanned pregnancy, not breastfeeding, and poor rating of mother's own health. Other social demographic factors such as marital status, maternal age, education of mother, or being Aboriginal or a Torres Strait Islander show no significant association with postnatal depressive symptoms. CONCLUSIONS The results confirm prevalence rates and maternal individual-level risk factors from previous studies. The study contributes to the limited number of studies of postnatal depression and socio-demographic factors. Neighbourhood and community group-level factors may be important and should be studied further.
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Affiliation(s)
- John G Eastwood
- Community Paediatrics, South Western Sydney Local Health District, Hugh Jardine Building, Eastern Campus, Locked Mail Bag 7017, Liverpool BC, New South Wales 1871, Australia.
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Wangel AM, Molin J, Moghaddassi M, Stman M. Prior psychiatric inpatient care and risk of cesarean sections: a registry study. J Psychosom Obstet Gynaecol 2011; 32:189-97. [PMID: 22040006 DOI: 10.3109/0167482x.2011.626940] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study of 17,443 childbearing women, investigated the relationship between hospital admissions 5 years prior to index birth, type of mental disorders and risk factors for mode of delivery. Hospital based electronic perinatal medical records between 2001 and 2006, were linked with the Swedish National Inpatient Care Registry 1996-2006. Of all the women, 39.3% had had inpatient care prior to index birth (27.3% had had obstetric, 10.1% somatic, and 1.9% psychiatric inpatient care). Diagnoses of mental disorders at psychiatric admission (n=333) were categorized into five groups: personality/behavioral/unspecified disorder (30.9%), affective disorders and 'suicide attempt' (28.9%), neurotic/somatoform disorders (18.9%), substance use (17.1%) and schizophrenia (4.2%). Women with history of psychiatric care were more often smokers, below age 24 and single (p<0.001, respectively), had more markers of mental ill-health in pregnancy records (p≤0.001), compared to women without such previous care, and fewer were nulliparous (p<0.001). The results show that women with prior psychiatric inpatient care and those with identified mental ill-health in pregnancy records, were associated with increased adjusted risks of cesarean sections. Identifying a woman?s mental health status in pregnancy may predict and prevent emergency cesarean section.
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The antenatal risk questionnaire (ANRQ): acceptability and use for psychosocial risk assessment in the maternity setting. Women Birth 2011; 26:17-25. [PMID: 21764399 DOI: 10.1016/j.wombi.2011.06.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 05/30/2011] [Accepted: 06/23/2011] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To assess the value of the antenatal risk questionnaire (ANRQ) as a predictor of postnatal depression, to evaluate its acceptability to pregnant women and midwives, and to consider its use as part of a model for integrated psychosocial risk assessment in the antenatal setting. METHOD This paper further analysed published data from the pregnancy risk questionnaire in a sample of 1196 women. We extracted 12 items from the original 23 item pregnancy risk questionnaire to assess how the shorter ANRQ would perform, and undertook the analysis in the subset who were administered the composite international diagnostic interview (CIDI) at 2 or 4 months postpartum to assess for major depression (N=276). We also sampled a subset of pregnant participants (N=378) and midwives (N=44) to assess the tool's acceptability to these groups respectively. FINDINGS ROC curve analysis for the ANRQ yielded an acceptable area under the curve of 0.69. The most 'clinically' useful cut off on the ANRQ was a score of 23 or more, yielding a sensitivity of 0.62 and specificity of 0.64 with positive predictive value of 0.3. The odds that a woman scoring 23 or more on the ANRQ is also a case was 6.3 times greater than for a woman scoring less than 23. Acceptability of the ANRQ was high among both women and midwives. CONCLUSION The ANRQ is a highly acceptable self-report psychosocial assessment tool which aids in the prediction of women who go on to develop postnatal depression. In combination with a symptom based screening measure (e.g., the Edinburgh postnatal depression scale) and routine questions relating to drug and alcohol use and domestic violence, the ANRQ becomes most useful as a key element of a "screening intervention" aimed at the early identification of mental health risk and morbidity across the perinatal period. Evaluation of this model in terms of clinical outcomes remains to be undertaken.
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Pereira AT, Bos SC, Marques M, Maia BR, Soares MJ, Valente J, Gomes AA, Macedo A, de Azevedo MHP. The postpartum depression screening scale: is it valid to screen for antenatal depression? Arch Womens Ment Health 2011; 14:227-38. [PMID: 20645114 DOI: 10.1007/s00737-010-0178-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 06/28/2010] [Indexed: 01/29/2023]
Abstract
The purpose of the study was to analyse for the first time the validity of a slightly modified version of the Portuguese Postpartum Depression Screening Scale (PDSS), to be used as a screening instrument for antenatal depression. Specifically, the aims were to analyse its psychometric properties, to determine PDSS cutoff points and associated conditional probabilities to screen for depression according to DSM-IV and ICD-10 criteria and to compare its screening performance with that of the Beck Depression Inventory-II (BDI-II). Five hundred and three pregnant women in the third trimester of pregnancy completed both questionnaires and were interviewed face-to-face with the Portuguese version of the Diagnostic Interview for Genetic Studies. The Portuguese version of the Operational Criteria Checklist for Psychotic Illness was used to obtain DSM-IV and ICD-10 diagnoses of depression, our gold standards for caseness. PDSS reliability and validity were very good and comparable to those obtained in the postpartum validation studies developed in Portugal and in other countries, showing satisfactory sensitivity and specificity combinations (≅80%). Compared with BDI-II, it has the advantage of being more specific for the motherhood context. Although developed for postpartum depression, PDSS is accurate to screen for antenatal depression, and it could be very useful for clinical and epidemiologic purposes.
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Affiliation(s)
- Ana Telma Pereira
- Instituto de Psicologia Médica, Faculdade de Medicina, Universidade de Coimbra, Rua Larga, 3004-504 Coimbra, Portugal.
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Mauri M, Oppo A, Montagnani MS, Borri C, Banti S, Camilleri V, Cortopassi S, Ramacciotti D, Rambelli C, Cassano GB. Beyond "postpartum depressions": specific anxiety diagnoses during pregnancy predict different outcomes: results from PND-ReScU. J Affect Disord 2010; 127:177-84. [PMID: 20554326 DOI: 10.1016/j.jad.2010.05.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 05/17/2010] [Accepted: 05/17/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Literature underlines that the Edinburgh Postnatal Depression Scale (EPDS) is the most common measure to assess postpartum depression (PPD) worldwide and suggests that the rate of false positives is high. Furthermore, the EPDS does not distinguish between depression and anxiety. This study describes different definitions of PPD and whether pregnancy anxiety disorders are risk factors for different PPDs at both 1month and 1year postpartum. METHOD 1066 women were recruited during pregnancy and followed until the 12th month postpartum (N=500). Women were administered the SCID and completed the PDPI-R during pregnancy. During the postpartum women who had an EPDS score of 13 or more were administered the SCID to distinguish minor or major depressive episodes (mMD) from false positives. RESULTS 41.5% and 44.9% of the PPD assessed with the EPDS were false positives at the 1st month and during the 1st year postpartum respectively. The difference observed in prevalence rates estimated with EPDS and SCID was statistically significant both at the 1st month and during the 1st year postpartum. Overall the effect of anxiety diagnoses in predicting PPD was stronger at the 1st month than during the 1st year postpartum. The role of panic disorder is associated both with probable depression (ES=0.82) and with mMD (ES=0.87) at the 1st month postpartum, and predicted mMD during the 1st year postpartum (ES=0.71). OCD predicted false positives at the 1st month postpartum (ES=0.89). CONCLUSION An antenatal screening of specific anxiety diagnoses could be extremely useful for the prevention of possible postpartum distress outcomes.
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Affiliation(s)
- Mauro Mauri
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa, Pisa, Italy.
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Oei JL, Abdel-Latif ME, Craig F, Kee A, Austin MP, Lui K. Short-term outcomes of mothers and newborn infants with comorbid psychiatric disorders and drug dependency. Aust N Z J Psychiatry 2009; 43:323-31. [PMID: 19296287 DOI: 10.1080/00048670902721087] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of the present study was to determine the characteristics and short-term outcomes of mother-infant pairs with comorbid drug dependency and psychiatric disorders. METHODS A population-based retrospective chart review was carried out of 879 drug-dependent mother and infant pairs in New South Wales (NSW) and the Australian Capital Territory (ACT) who delivered between 1 January and 31 December 2004. RESULTS Psychiatric comorbidity (dual diagnosis, DD) was identified in 396 (45%) of the 879 drug-dependent women. DSM-IV depression (79%), followed by anxiety (20%), was most prevalent. DD women were more likely to use amphetamines (29% vs 18%, p < 0.05), less likely to use opiates (42% vs 51%, p < 0.05) and to have had no antenatal care (24% vs 8%, p < 0.05). They also had more previous pregnancies (4, range = 2-5 vs 3, range = 2-5, p < 0.05) and domestic violence (29% vs 14%, p < 0.05) was more common. DD infants were less likely to be admitted to a nursery (47% vs 55%, p < 0.05). Withdrawal scores were similar (maximum median Finnegan scores = 4 (interquartile range = 3-8) vs 10 (interquartile range = 7-12, p = 0.30) but fewer needed withdrawal medication (19% vs 27%, p < 0.05). Maternal psychotropic agents did not worsen the severity of neonatal withdrawal. CONCLUSIONS Psychiatric comorbidity, especially depression, is common and affects almost half of drug-using mothers. Antenatal care, drug use and social outcomes are worse for DD mothers and their infants. It is recommended that all drug-using women be assessed antenatally for psychosocial disorders so that timely mental health intervention can be offered, if required.
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Affiliation(s)
- Ju Lee Oei
- Department of Newborn Care, Royal Hospital for Women, NSW, Australia.
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McConachie S, Whitford H. Mental health nurses’ attitudes towards severe perinatal mental illness. J Adv Nurs 2009; 65:867-76. [DOI: 10.1111/j.1365-2648.2008.04952.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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A psychosocial risk assessment model (PRAM) for use with pregnant and postpartum women in primary care settings. Arch Womens Ment Health 2008; 11:307-17. [PMID: 18726142 DOI: 10.1007/s00737-008-0028-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Accepted: 08/04/2008] [Indexed: 01/09/2023]
Abstract
Recognition of high rates of mental health morbidity and mortality that affect women during the perinatal period has prompted the development of psychosocial risk assessment programs. Designed to identify women, at risk, during routine health checks and delivered by primary care health service providers, these fit within a primary prevention and early intervention strategic approach to the reduction of perinatal mental illness and reflect an integrated approach to perinatal health services delivery. This paper describes the development and use of the psychosocial risk assessment model (PRAM) at the Royal Hospital for Women in Sydney, Australia. Data is presented on 2,142 women who attended the Antenatal Midwives Clinic between 2002 and 2005. The PRAM guides primary care staff to quickly identify women experiencing emotional distress and/or psychosocial problems during pregnancy or postnatal checks. Measures used in pregnancy are the symptom-based Edinburgh Depression Scale and the psychosocial risk-based Antenatal Risk Questionnaire. In postnatal setting the Postnatal Risk Questionnaire is used. Scores can be used to compute a Psychosocial Risk Index (PRI) to guide individualized care planning, define needs for referral and classify groups for clinical and research purposes. Based on the PRI, among 2,142 women assessed in pregnancy 70.6% were classified as low/no risk (no interventions indicated currently), 24.1% as medium risk (in need of monitoring), and 5.3% as high risk (complex). The PRAM offers a conceptual framework, methods and measures for brief psychosocial assessment with clinical and research applications. Postpartum follow up studies of women assessed during pregnancy have commenced. Randomized controlled trials and cross-cultural studies are now indicated to strengthen the evidence base for the model.
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Newport DJ, Brennan PA, Green P, Ilardi D, Whitfield TH, Morris N, Knight BT, Stowe ZN. Maternal depression and medication exposure during pregnancy: comparison of maternal retrospective recall to prospective documentation. BJOG 2008; 115:681-8. [PMID: 18410650 DOI: 10.1111/j.1471-0528.2008.01701.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Outcome investigations of prenatal maternal depression and psychotropic exposure rely extensively on maternal retrospective recall. This study compared postnatal recall to prospective documentation of illness and medication exposures. DESIGN Prospective cohort and retrospective case-control studies. SETTING Emory Women's Mental Health Program (prospective study) and Emory University Department of Psychology (retrospective study). SAMPLE A total of 164 women who participated in both the prospective and retrospective studies. METHODS Women with a history of mental illness were followed during pregnancy for prospective prenatal assessments of depression and medication exposures. At 6 months postpartum, some of these women also participated in a retrospective study during which they were asked to recall prenatal depression and medication use. Agreement between prospective and retrospective documentation of exposures was analysed. MAIN OUTCOME MEASURES Occurrence of maternal depression during pregnancy and maternal use of pharmacological agents during pregnancy. RESULTS There was only moderate agreement (k = 0.42) in prospective versus retrospective reporting of prenatal depression. Positive predictive value for recalling depression was 90.4%; however, negative predictive value for denying depression was only 53.8%. Participants accurately recalled psychotropic use but significantly underreported use of nonpsychotropic medications. CONCLUSIONS Studies using retrospective data collection may be susceptible to systematic recall bias with underreporting of maternal depression and use of nonpsychotropic agents during pregnancy.
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Affiliation(s)
- D J Newport
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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Rowe HJ, Fisher JRW, Loh WM. The Edinburgh Postnatal Depression Scale detects but does not distinguish anxiety disorders from depression in mothers of infants. Arch Womens Ment Health 2008; 11:103-8. [PMID: 18463939 DOI: 10.1007/s00737-008-0003-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Accepted: 01/20/2008] [Indexed: 11/30/2022]
Abstract
Specific screening tests to detect postpartum anxiety are as yet unavailable. The aim of this study was to test the ability of the Edinburgh Postnatal Depression Scale (EPDS) to detect anxiety disorders in women admitted to residential early parenting centres. Consecutive cohorts of English speaking women admitted with their infants to two centres in Melbourne, Australia completed the Composite International Diagnostic Interview and the Edinburgh Postnatal Depression Scale (EPDS). Anxiety and depression diagnoses were compared with EPDS scores. Of the 145 women (78% recruitment rate), 138 (95%) provided complete data of whom 35 (25%) had at least one anxiety disorder. EPDS scores over 12 correctly identified 28 women (44%) as having major depression, either alone or co-morbid with an anxiety disorder but 10 (16%) had only an anxiety disorder and were not depressed. All of the 26 (41%) women with EPDS scores over 12 with neither diagnosis met diagnostic criteria for minor depression or an adjustment disorder. EPDS scores were unable to distinguish between these diagnostic groups. The presumption that EPDS scores over 12 indicate only probable depression is an oversimplification. Current national initiatives recommend that EPDS scores over 12 warrant treatment for depression, which may lead to inappropriate labeling and therapy.
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Affiliation(s)
- Heather J Rowe
- Key Centre for Women's Health in Society, School of Population Health, University of Melbourne, Victoria, Australia.
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McQueen K, Montgomery P, Lappan-Gracon S, Evans M, Hunter J. Evidence-based recommendations for depressive symptoms in postpartum women. J Obstet Gynecol Neonatal Nurs 2008; 37:127-36. [PMID: 18336436 DOI: 10.1111/j.1552-6909.2008.00215.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Postpartum depression is a serious health issue affecting 13% of women from diverse cultures. Despite the well-documented consequences of postpartum depression, it remains difficult to identify, and diverse practices relate to its prevention and treatment. Evidence-based interventions are essential to improve both maternal and infant health outcomes associated with pregnancy. This article describes the development process of an evidence-based practice guideline for postpartum depression and highlights the practice recommendations related to the confirmation, prevention, and treatment of depressive symptoms in postpartum mothers.
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Affiliation(s)
- Karen McQueen
- School of Nursing, Lakehead University, Thunder Bay, Ontario, Canada.
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Abstract
OBJECTIVE Given the importance of depression as a world health problem, depression assessment should be standard practice in large-scale health surveys. The aim of the study was to construct a short matrix-version of the Edinburgh Depression Scale (EDS) that can be used in questionnaire studies. METHOD On the basis of the complete EDS scale of ten items, answered by 2730 women, stepwise multiple regression analysis was used to find the combination of items that explains the maximum proportion of the variance of the full scale sum score. The selected EDS items were thereafter correlated with the Hopkins Symptom Check List (SCL-25) for external validation. RESULTS The sum of five selected items from the EDS correlated at r = 0.96 with the full version. The EDS-5 scores correlated strongly with the SCL-25 (r = 0.75). CONCLUSION The EDS-5 version shows good psychometric properties and may, for some scientific purposes, substitute the full EDS scale.
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Affiliation(s)
- M Eberhard-Gran
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
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48
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Rahman A. Challenges and opportunities in developing a psychological intervention for perinatal depression in rural Pakistan--a multi-method study. Arch Womens Ment Health 2007; 10:211-9. [PMID: 17676431 PMCID: PMC2424205 DOI: 10.1007/s00737-007-0193-9] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Accepted: 06/30/2007] [Indexed: 01/29/2023]
Abstract
Perinatal depression, due to its high prevalence and associations with disability, poor infant development and family disruption, is a major public health problem in developing countries. In non-literate and poor communities where depression is not recognised and where there are no specialists, developing a culturally acceptable, deliverable psychological intervention that community members find useful, presents special challenges but also opportunities. We describe lessons learned from a multi-method formative study to develop and deliver a psychological intervention to depressed mothers and their infants through non-specialist village based health workers.
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Affiliation(s)
- A Rahman
- Division of Psychiatry, University of Manchester, Manchester, U.K.
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Rahman A, Bunn J, Lovel H, Creed F. Association between antenatal depression and low birthweight in a developing country. Acta Psychiatr Scand 2007; 115:481-6. [PMID: 17498160 PMCID: PMC1974771 DOI: 10.1111/j.1600-0447.2006.00950.x] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE There is a high prevalence of depression in south Asian women. We aimed to examine the association between antenatal depression and low birthweight (LBW) in infants in a rural community in Rawalpindi, Pakistan. METHOD A total of 143 physically healthy mothers with ICD-10 depression in the third trimester of pregnancy and 147 non-depressed mothers of similar gestation were followed from birth. Infant weight was measured and information collected on socioeconomic status, maternal body-mass index and sociodemographic factors. RESULTS Infants of depressed mothers had lower birthweight (mean 2910 g) than infants of non-depressed mothers (mean 3022 g). The relative risk for LBW (< or =2500 g) in infants of depressed mothers was 1.9 (95% CI 1.3-2.9). The association remained significant after adjustment for confounders by multivariate analyses. CONCLUSION Low birthweight is a major public health problem in developing countries. Maternal depression during pregnancy predicts LBW. Interventions aimed at maternal depression may help improve infant outcomes.
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Affiliation(s)
- A Rahman
- Department of Psychological Medicine, University of Manchester, Manchester, UK
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50
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Sheikh L, Johnston S, Thangaratinam S, Kilby MD, Khan KS. A review of the methodological features of systematic reviews in maternal medicine. BMC Med 2007; 5:10. [PMID: 17524137 PMCID: PMC1910604 DOI: 10.1186/1741-7015-5-10] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 05/24/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In maternal medicine, research evidence is scattered making it difficult to access information for clinical decision making. Systematic reviews of good methodological quality are essential to provide valid inferences and to produce usable evidence summaries to guide management. This review assesses the methodological features of existing systematic reviews in maternal medicine, comparing Cochrane and non-Cochrane reviews in maternal medicine. METHODS Medline, Embase, Database of Reviews of Effectiveness (DARE) and Cochrane Database of Systematic Reviews (CDSR) were searched for relevant reviews published between 2001 and 2006. We selected those reviews in which a minimum of two databases were searched and the primary outcome was related to the maternal condition. The selected reviews were assessed for information on framing of question, literature search and methods of review. RESULTS Out of 2846 citations, 68 reviews were selected. Among these, 39 (57%) were Cochrane reviews. Most of the reviews (50/68, 74%) evaluated therapeutic interventions. Overall, 54/68 (79%) addressed a focussed question. Although 64/68 (94%) reviews had a detailed search description, only 17/68 (25%) searched without language restriction. 32/68 (47%) attempted to include unpublished data and 11/68 (16%) assessed for the risk of missing studies quantitatively. The reviews had deficiencies in the assessment of validity of studies and exploration for heterogeneity. When compared to Cochrane reviews, other reviews were significantly inferior in specifying questions (OR 20.3, 95% CI 1.1-381.3, p = 0.04), framing focussed questions (OR 30.9, 95% CI 3.7- 256.2, p = 0.001), use of unpublished data (OR 5.6, 95% CI 1.9-16.4, p = 0.002), assessment for heterogeneity (OR 38.1, 95%CI 2.1, 688.2, p = 0.01) and use of meta-analyses (OR 3.7, 95% CI 1.3-10.8, p = 0.02). CONCLUSION This study identifies areas which have a strong influence on maternal morbidity and mortality but lack good quality systematic reviews. Overall quality of the existing systematic reviews was variable. Cochrane reviews were of better quality as compared to other reviews. There is a need for good quality systematic reviews to inform practice in maternal medicine.
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Affiliation(s)
- Lumaan Sheikh
- Academic Unit, Birmingham Women's Hospital, University of Birmingham, Birmingham B15 2 TG, UK
| | - Shelley Johnston
- Academic Unit, Birmingham Women's Hospital, University of Birmingham, Birmingham B15 2 TG, UK
| | - Shakila Thangaratinam
- Academic Unit, Birmingham Women's Hospital, University of Birmingham, Birmingham B15 2 TG, UK
- Clinical Lecturer in Obstetrics and Gynaecology and Clinical Epidemiology, Academic Unit, 3rd floor, Birmingham Women's Hospital, Birmingham B15 2TG, UK
| | - Mark D Kilby
- Academic Unit, Birmingham Women's Hospital, University of Birmingham, Birmingham B15 2 TG, UK
| | - Khalid S Khan
- Academic Unit, Birmingham Women's Hospital, University of Birmingham, Birmingham B15 2 TG, UK
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