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Place JMS, Renbarger K, Van De Griend K, Guinn M, Wheatley C, Holmes O. Barriers to help-seeking for postpartum depression mapped onto the socio-ecological model and recommendations to address barriers. Front Glob Womens Health 2024; 5:1335437. [PMID: 38855482 PMCID: PMC11157017 DOI: 10.3389/fgwh.2024.1335437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Postpartum depression affects nearly a quarter of women up to a year after childbirth. Although it is treatable, significant barriers to help-seeking prevent women from being treated. This paper assesses key literature on the barriers for help-seeking among women with postpartum depression. The barriers identified have been mapped onto the socio-ecological model in addition to potential recommendations that professionals can use to address barriers on individual, interpersonal, organizational, community and societal levels. The recommendations provided are meant to serve as leverage points for professionals in efforts to create appropriate support and interventions. As such, this paper serves as a mapping tool for healthcare and public health professionals to assess obstacles to women's help-seeking and to guide multi-pronged interventions on various levels of the socio-ecological model that may increase help-seeking among women with postpartum depression. Holistically and comprehensively providing support to women will require significant effort throughout all sectors of society as opposed to isolated, siloed interventions.
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Affiliation(s)
- Jean Marie S. Place
- Department of Nutrition and Health Science, Ball State University, Muncie, IN, United States
| | - Kalyn Renbarger
- School of Nursing, Ball State University, Muncie, IN, United States
| | - Kristin Van De Griend
- Department of Community and Public Health, Idaho State University, Pocatello, ID, United States
| | - Maya Guinn
- Department of Biology, Ball State University, Muncie, IN, United States
| | - Chelsie Wheatley
- Medical Imaging, Idaho State University, Pocatello, ID, United States
| | - Olivia Holmes
- Department of Community and Public Health, Idaho State University, Pocatello, ID, United States
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Holicky A, Anderson-Reeves T, Bennett AC, Lightner S, McRae KD, Handler A. Child Care as a Barrier to Perinatal Health Care in Illinois. Matern Child Health J 2024; 28:221-228. [PMID: 37831338 PMCID: PMC10922574 DOI: 10.1007/s10995-023-03784-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Within a multi-state Collaborative Improvement and Innovation Network addressing the social determinants of health during 2017-2020, the Illinois Department of Public Health led an exploratory project to understand how the availability of child care affects maternal health care utilization. The project assessed whether lack of child care was a barrier to perinatal health care utilization and gathered information on health facility practices, resources, and policies related to child care DESCRIPTION: TWe surveyed (1) birthing hospitals (n = 98), (2) federally qualified health centers (FQHCs) (n = 40), and (3) a convenience sample of postpartum persons (n = 60). ASSESSMENT Each group reported that child care concerns negatively affect health care utilization (66% of birthing hospitals, 50% of FQHCs, and 32% of postpartum persons). Among postpartum persons, the most common reported reason for missing a visit due to child care issues was "not feeling comfortable leaving my child(ren) in the care of others" (22%). The most common child care resource reported by facilities was "staff watching children" (53% of birthing hospitals, 75% of FQHCs); however, most did not have formal child care policies or dedicated space for children. Fewer than half of FQHCs (43%) discussed child care at the first prenatal visit. CONCLUSION The project prompted the Illinois Title V program to add a child care-related strategy to their 2021-2025 Action Plan, providing opportunity for further examination of practices and policies that could be implemented to reduce child care barriers to perinatal care. Systematically addressing child care in health care settings may improve health care utilization among birthing/postpartum persons.
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Affiliation(s)
- Abigail Holicky
- Department of Medicine, Division of Academic Internal Medicine, Westside Research Office Building, University of Illinois at Chicago, 1747 W. Roosevelt Road, Room 274, Chicago, IL, 60612, USA.
- Illinois Department of Public Health (Formerly), Illinois, USA.
| | | | - Amanda C Bennett
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Field Support Branch, Maternal and Child Health Epidemiology Program, Atlanta, USA
- Illinois Department of Public Health, Office of Women's Health and Family Services, Title V Program, Illinois, USA
| | - Shannon Lightner
- Illinois Department of Public Health, Office of Women's Health and Family Services, Title V Program, Illinois, USA
| | - Kenya D McRae
- Illinois Department of Public Health (Formerly), Illinois, USA
| | - Arden Handler
- School of Public Health, University of Illinois at Chicago, Chicago, USA
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Webb R, Ford E, Shakespeare J, Easter A, Alderdice F, Holly J, Coates R, Hogg S, Cheyne H, McMullen S, Gilbody S, Salmon D, Ayers S. Conceptual framework on barriers and facilitators to implementing perinatal mental health care and treatment for women: the MATRIx evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-187. [PMID: 38317290 DOI: 10.3310/kqfe0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background Perinatal mental health difficulties can occur during pregnancy or after birth and mental illness is a leading cause of maternal death. It is therefore important to identify the barriers and facilitators to implementing and accessing perinatal mental health care. Objectives Our research objective was to develop a conceptual framework of barriers and facilitators to perinatal mental health care (defined as identification, assessment, care and treatment) to inform perinatal mental health services. Methods Two systematic reviews were conducted to synthesise the evidence on: Review 1 barriers and facilitators to implementing perinatal mental health care; and Review 2 barriers to women accessing perinatal mental health care. Results were used to develop a conceptual framework which was then refined through consultations with stakeholders. Data sources Pre-planned searches were conducted on MEDLINE, EMBASE, PsychInfo and CINAHL. Review 2 also included Scopus and the Cochrane Database of Systematic Reviews. Review methods In Review 1, studies were included if they examined barriers or facilitators to implementing perinatal mental health care. In Review 2, systematic reviews were included if they examined barriers and facilitators to women seeking help, accessing help and engaging in perinatal mental health care; and they used systematic search strategies. Only qualitative papers were identified from the searches. Results were analysed using thematic synthesis and themes were mapped on to a theoretically informed multi-level model then grouped to reflect different stages of the care pathway. Results Review 1 included 46 studies. Most were carried out in higher income countries and evaluated as good quality with low risk of bias. Review 2 included 32 systematic reviews. Most were carried out in higher income countries and evaluated as having low confidence in the results. Barriers and facilitators to perinatal mental health care were identified at seven levels: Individual (e.g. beliefs about mental illness); Health professional (e.g. confidence addressing perinatal mental illness); Interpersonal (e.g. relationship between women and health professionals); Organisational (e.g. continuity of carer); Commissioner (e.g. referral pathways); Political (e.g. women's economic status); and Societal (e.g. stigma). These factors impacted on perinatal mental health care at different stages of the care pathway. Results from reviews were synthesised to develop two MATRIx conceptual frameworks of the (1) barriers and (2) facilitators to perinatal mental health care. These provide pictorial representations of 66 barriers and 39 facilitators that intersect across the care pathway and at different levels. Limitations In Review 1 only 10% of abstracts were double screened and 10% of included papers methodologically appraised by two reviewers. The majority of reviews included in Review 2 were evaluated as having low (n = 14) or critically low (n = 5) confidence in their results. Both reviews only included papers published in academic journals and written in English. Conclusions The MATRIx frameworks highlight the complex interplay of individual and system level factors across different stages of the care pathway that influence women accessing perinatal mental health care and effective implementation of perinatal mental health services. Recommendations for health policy and practice These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to perinatal mental health care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services; and quality training for health professionals with protected time to do it. Future work Further research is needed to examine access to perinatal mental health care for specific groups, such as fathers, immigrants or those in lower income countries. Trial registration This trial is registered as PROSPERO: (R1) CRD42019142854; (R2) CRD42020193107. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR 128068) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Rebecca Webb
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton & Sussex Medical School, Falmer, UK
| | | | - Abigail Easter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Fiona Alderdice
- Oxford Population Health, National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Rose Coates
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Sally Hogg
- The Parent-Infant Foundation, London, UK
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | | | - Simon Gilbody
- Mental Health and Addictions Research Group, University of York, York, UK
| | - Debra Salmon
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
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Bhusal CK, Bhattarai S, Shrestha A, Sharma HR. Depression and Its Determinants among Postpartum Mothers Attending at Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Rupandehi, Nepal. Int J Pediatr 2023; 2023:1331641. [PMID: 37538262 PMCID: PMC10396550 DOI: 10.1155/2023/1331641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023] Open
Abstract
Background Postpartum depression is a serious mental health issue linked to maternal morbidity and negative effects for infant's normal growth, development, and well-being. This study is aimed at assessing the prevalence and factors associated with postpartum depression among mothers attending a tertiary hospital in Nepal. Methods A hospital-based cross-sectional study was conducted among 173 postpartum mothers (<6 weeks postdelivery) who were receiving care either at the postnatal ward or immunization clinic of Universal College of Medical Sciences and Teaching Hospital in Bhairahawa, Rupandehi district, Nepal. The study was carried out from October 2020 to February 2021 by using purposive sampling technique for selecting respondents. The variables that showed significant association with the dependent variable having p value < 0.05 in bivariate analysis were entered into multivariate logistic regression model to find the final associated factors. Results The prevalence of postpartum depression was 20.2% among mothers attending a tertiary hospital in Nepal. The mean age of the respondents was 24.77 ± 3.47. Factors such as mothers having female child (AOR = 6.39, CI = 1.54 - 26.46), unplanned pregnancy (AOR = 10.08, CI = 2.91 - 34.94), pregnancy-induced health problems (AOR = 9.68, CI: 3.51-26.64) were associated with an increased risk of postpartum depression. Similarly, mothers having formal education (AOR = 0.28, CI: 0.08-0.91), whose spouses have secondary and above education (AOR = 0.16, CI: 0.03-0.85), and who have ≥4 ANC visits (AOR = 0.15, CI = 0.05 - 0.40) were significantly associated but have a protective effect with postpartum depression. Conclusions Sex of newborn, mother's and spouse's education, intention of pregnancy, ANC visits, and pregnancy-induced health problems were found to be significantly associated with postpartum depression. Hence, specific health education program regarding maternal and child health integrating mental health should be provided to pregnant women, mothers, and their husbands, focusing on gender discrimination. Similarly specific orientation program should be provided to local health worker about the importance of planned pregnancy, in order to reduce pregnancy related health problems during ANC visits and to mothers after their delivery to reduce further chances of postpartum depression.
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Affiliation(s)
- Chet Kant Bhusal
- Department of Community Medicine, Universal College of Medical Sciences and Teaching Hospital Affiliated to Tribhuvan University, Bhairahawa, Rupandehi, Nepal
| | - Sigma Bhattarai
- Department of Nursing, Universal College of Medical Sciences and Teaching Hospital Affiliated to Tribhuvan University, Bhairahawa, Rupandehi, Nepal
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Le J, Alhusen J, Dreisbach C. Screening for Partner Postpartum Depression: A Systematic Review. MCN Am J Matern Child Nurs 2023; 48:142-150. [PMID: 36744867 DOI: 10.1097/nmc.0000000000000907] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postpartum depression is a significant mental health condition affecting an estimated 7% to 20% of women, with higher rates among individuals with increased risk factors. Most research on postpartum depression has focused on mothers, with less recognition of the mental health changes experienced by their partners. Research suggests almost 20% of partners may experience postpartum depression, yet our understanding is limited. An enhanced understanding of postpartum depression in a birthing person's partner is critical, given the mental and physical health sequelae associated with depression. PURPOSE The purpose of this review was to systematically examine the current tools available to assess partner postpartum depression. METHODS We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were identified using selected key terms in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Ovid MEDLINE. Studies were included if they assessed partner depressive symptoms and identified the specified use of a tool or screening measure. RESULTS Seventeen studies met inclusion criteria. Seven different measures were used to assess postpartum depression. The Edinburgh Postnatal Depression Scale (EPDS) was used in 16 out of the 17 studies for depression assessment. CLINICAL IMPLICATIONS Routine screening of partners for postpartum depression should be recommended as part of standard care. Nurses are critical liaisons for assessing risk and connecting relevant and timely resources to birthing people and their partners. Identifying the available screening tools may help to avoid adverse clinical outcomes associated with increased symptom severity and burden.
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Runkle JD, Risley K, Roy M, Sugg MM. Association Between Perinatal Mental Health and Pregnancy and Neonatal Complications: A Retrospective Birth Cohort Study. Womens Health Issues 2023; 33:289-299. [PMID: 36621340 PMCID: PMC10213085 DOI: 10.1016/j.whi.2022.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/30/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Maternal mental health as an important precursor to reproductive and neonatal complications remains understudied in the United States, particularly in the Southeastern region, despite high medical costs, maternal morbidity, and infant burden. This study sought to estimate the incidence of perinatal mental health disorders and the associated increased risk of leading pregnancy and infant complications. METHODS A population-based retrospective birth cohort of childbirth hospitalizations and readmissions was constructed for women in South Carolina, 1999 to 2017. Prevalence rates were calculated for perinatal mood and anxiety disorders (PMAD), severe mental illness, and mental disorders of pregnancy (MDP). Poisson regression models using generalized estimating equations were used to estimate adjusted relative risks for the association between mental health conditions and severe maternal morbidity, hypertensive disorders of pregnancy, gestational diabetes, cesarean section, preterm birth, and low birthweight. RESULTS The most prevalent maternal mental condition was MDP (3.9%), followed by PMAD (2.7%) and severe mental illness (0.13%). PMAD was associated with a higher risk of severe maternal morbidity, hypertensive disorders of pregnancy, and cesarean section, as well as a higher risk of preterm birth and low birthweight infants. Severe mental illness was associated with low birthweight, hypertensive disorders of pregnancy, and cesarean section. Pregnant populations with MDP were more at risk for severe maternal morbidity, preterm birth, hypertensive disorders of pregnancy, low birthweight, and cesarean section. Each maternal mental health outcome was associated with an increased risk for hospital readmissions up to 45 days after childbirth. CONCLUSIONS Results demonstrate the escalating burden of PMAD and MDP for pregnant populations over time, with important consequences related to maternal and infant morbidity.
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Affiliation(s)
- Jennifer D Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina.
| | - Kendra Risley
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina
| | - Manan Roy
- Department of Nutrition and Health Care Management, Appalachian State University, Boone, North Carolina
| | - Margaret M Sugg
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina
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Bright MA, Parrott M, Martin S, Thompson L, Roussos-Ross D, Montoya-Williams D. Streamlining Universal Prenatal Screening for Risk for Adverse Birth Outcomes. Matern Child Health J 2022; 26:1022-1029. [PMID: 35312912 DOI: 10.1007/s10995-022-03420-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Many of the medical risk factors for adverse birth outcomes (e.g., preeclampsia) are regularly monitored in prenatal care. However, many of the psychosocial risk factors associated with adverse birth outcomes (e.g., maternal stress, anxiety, depression, intimate partner violence) are not regularly addressed during routine prenatal care. Comprehensive prenatal screening for psychosocial risk factors for adverse birth outcomes can improve maternal and neonatal outcomes. In this study, we examine an existing tool for opportunities to streamline and improve screening. METHODS We reviewed medical records for 528 mother-infant dyads, recording maternal responses to a 21-item prenatal risk screening tool, and gestational age/birth weight of infants. Multiple approaches to scoring were used to predict likelihood of adverse birth outcome. RESULTS Women who answered yes to any of the top four interrelated items were 3.32 times more likely to have an adverse birth outcome. Sensitivity and specificity were 68% and 65%, respectively. CONCLUSION FOR PRACTICE We identified a short surveillance tool to identify women who are at highest risk and require more in-depth screening, and to rule out women who are at very low risk of an adverse birth outcome.
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Affiliation(s)
- Melissa A Bright
- Department of Obstetrics and Gynecology, University of Florida, PO Box 110070, Gainesville, USA. .,Center for Violence Prevention Research, Melrose, FL, USA. .,Department of Pediatrics, Division of General Pediatrics, University of Florida, PO Box 110070, Gainesville, USA.
| | - Melanie Parrott
- Medical Student, College of Medicine, University of Florida, Gainesville, USA
| | - Serena Martin
- Medical Student, College of Medicine, University of Florida, Gainesville, USA
| | - Lindsay Thompson
- Department of Pediatrics, Division of General Pediatrics, University of Florida, PO Box 110070, Gainesville, USA
| | - Dikea Roussos-Ross
- Department of Obstetrics and Gynecology, University of Florida, PO Box 110070, Gainesville, USA
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Declercq E, Feinberg E, Belanoff C. Racial inequities in the course of treating perinatal mental health challenges: Results from listening to mothers in California. Birth 2022; 49:132-140. [PMID: 34459012 PMCID: PMC9292331 DOI: 10.1111/birt.12584] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Concern with depression during the perinatal period has resulted in multiple states enacting legislation to require universal screening of mothers for postpartum depression. Despite this concern, rates of women receiving mental health counseling during pregnancy and postpartum remain low. This study examines factors, especially inequities in race/ethnicity, associated with receiving perinatal mental health counseling. METHODS This study draws on data from the Listening to Mothers in California survey of 2539 women, based on a representative sample of birth certificate files of women who gave birth in 2016. The survey included a series of mental health questions, based on the 4-item Patient Health Questionnaire (PHQ-4), and questions on the receipt of counseling, whether a practitioner asked respondents about their mental health, and whether the respondent was taking medications for anxiety or depression. RESULTS We found non-Latina Black women to experience both higher rates of prenatal depressive symptoms and significantly lower use of postpartum counseling services and medications than non-Latina White women. Among women with depressive symptoms, those asked by a practitioner about their mental health status reported a 46% rate of counseling compared with 20% who were not asked, and in a multivariable analysis, those asked were almost six times more likely (aOR 5.96; 95% CI 1.6-21.7) to report counseling. DISCUSSION These findings lend evidence to those advocating for state laws requiring universal screening for depressive symptoms to reduce inequities and help address the underuse of counseling services among all women with depressive symptoms, particularly women of color.
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Affiliation(s)
| | - Emily Feinberg
- Division of General PediatricsBoston University School of MedicineBostonMAUSA
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Fonseca A, Ganho-Ávila A, Lambregtse-van den Berg M, Lupattelli A, Rodriguez-Muñoz MDLF, Ferreira P, Radoš SN, Bina R. Emerging issues and questions on peripartum depression prevention, diagnosis and treatment: a consensus report from the cost action riseup-PPD. J Affect Disord 2020; 274:167-173. [PMID: 32469800 DOI: 10.1016/j.jad.2020.05.112] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/29/2020] [Accepted: 05/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Peripartum depression [PPD] is a public health problem which has been widely studied. Nonetheless, study findings and clinical guidelines for PPD treatment differ among countries and the condition is still underdiagnosed and undertreated, suggesting the importance of a global understanding of PPD. The Riseup-PPD Cost Action aims to establish a Pan-European and multidisciplinary network of researchers dedicated to the global understanding of PPD. METHODS A literature search was performed in different databases (e.g., Medline, PsychInfo) including a combination of terms related with PPD diagnosis, prevention, treatment and cost-effectiveness of its management. A narrative synthesis of the literature, together with a critical overview of the current issues/questions to be addressed within the topic of PPD were performed. RESULTS Emerging issues include challenges regarding definition and timing of PPD; heterogeneity in severity, timing of onset and assessment tools; comparative effectiveness of preventive and treatment interventions; help seeking for PPD; improving health professional's awareness of PPD; and cost-effectiveness of PPD management. LIMITATIONS The main limitation is the non-systematic nature of the literature search. CONCLUSIONS The Riseup-PPD network will deal with these challenges through four lines of action: (1)provide an updated and comprehensive synthesis of existing knowledge that can contribute to inform clinical recommendations and guidelines for PPD management; (2) clarify inconsistent findings concerning diagnosis, prevention and treatment of PPD; (3) develop new lines of research in the field of PPD; and (4) develop international recommendations for PPD diagnosis, prevention and treatment, ultimately influencing maternal mental health policymaking at global and local levels.
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Affiliation(s)
- Ana Fonseca
- Univ Coimbra, Center for Research in Neuropsychology and Cognitive-Behavior Interventions, Faculty of Psychology and Educational Sciences, Coimbra, Portugal.
| | - Ana Ganho-Ávila
- Univ Coimbra, Center for Research in Neuropsychology and Cognitive-Behavior Interventions, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
| | - Mijke Lambregtse-van den Berg
- Departments of Psychiatry and Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, & PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Norway
| | - Maria de la Fé Rodriguez-Muñoz
- Department of Personality Psychology, Evaluation and Psychological Treatment, National Distance Education University, Madrid, Spain
| | - Pedro Ferreira
- Center for Health Studies and Research (CEISUC), Faculty of Economy, University of Coimbra, Coimbra, Portugal
| | - Sandra Nakić Radoš
- Department of Psychology, Catholic University of Croatia, Zagreb, Croatia
| | - Rena Bina
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
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Zhang W, Liu H, Silenzio VMB, Qiu P, Gong W. Machine Learning Models for the Prediction of Postpartum Depression: Application and Comparison Based on a Cohort Study. JMIR Med Inform 2020; 8:e15516. [PMID: 32352387 PMCID: PMC7226048 DOI: 10.2196/15516] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/15/2019] [Accepted: 02/01/2020] [Indexed: 12/13/2022] Open
Abstract
Background Postpartum depression (PPD) is a serious public health problem. Building a predictive model for PPD using data during pregnancy can facilitate earlier identification and intervention. Objective The aims of this study are to compare the effects of four different machine learning models using data during pregnancy to predict PPD and explore which factors in the model are the most important for PPD prediction. Methods Information on the pregnancy period from a cohort of 508 women, including demographics, social environmental factors, and mental health, was used as predictors in the models. The Edinburgh Postnatal Depression Scale score within 42 days after delivery was used as the outcome indicator. Using two feature selection methods (expert consultation and random forest-based filter feature selection [FFS-RF]) and two algorithms (support vector machine [SVM] and random forest [RF]), we developed four different machine learning PPD prediction models and compared their prediction effects. Results There was no significant difference in the effectiveness of the two feature selection methods in terms of model prediction performance, but 10 fewer factors were selected with the FFS-RF than with the expert consultation method. The model based on SVM and FFS-RF had the best prediction effects (sensitivity=0.69, area under the curve=0.78). In the feature importance ranking output by the RF algorithm, psychological elasticity, depression during the third trimester, and income level were the most important predictors. Conclusions In contrast to the expert consultation method, FFS-RF was important in dimension reduction. When the sample size is small, the SVM algorithm is suitable for predicting PPD. In the prevention of PPD, more attention should be paid to the psychological resilience of mothers.
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Affiliation(s)
- Weina Zhang
- XiangYa School of Public Health, Central South University, Changsha, China
| | - Han Liu
- Sanofi Global Research and Design Operations Center, Chengdu, China
| | - Vincent Michael Bernard Silenzio
- Urban-Global Public Health, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Newark, NJ, United States
| | - Peiyuan Qiu
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Wenjie Gong
- XiangYa School of Public Health, Central South University, Changsha, China
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Predictors of postpartum depression service use: A theory-informed, integrative systematic review. Women Birth 2020; 33:e24-e32. [DOI: 10.1016/j.wombi.2019.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 12/14/2022]
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Boyd RC, Price J, Mogul M, Yates T, Guevara JP. Pilot RCT of a social media parenting intervention for postpartum mothers with depression symptoms. J Reprod Infant Psychol 2018; 37:290-301. [DOI: 10.1080/02646838.2018.1556788] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Rhonda C. Boyd
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jordan Price
- Policylab: Center to Bridge Research Practice, & Policy, The Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA, USA
| | - Marjie Mogul
- Research Department, Maternity Care Coalition, Philadelphia, PA, USA
| | - Tweety Yates
- Children’s Research Center, University of Illinois, Champaign, IL, USA
| | - James P. Guevara
- Policylab: Center to Bridge Research Practice, & Policy, The Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA, USA
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Boyd RC, Mogul M, O'Hara MW. A Pilot Investigation to Enhance Behavioral Health Referral for Perinatal, Low-Income Women With Mood Disorders. Prog Community Health Partnersh 2016; 9:583-9. [PMID: 26639384 DOI: 10.1353/cpr.2015.0085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Perinatal, low-income, ethnic minority women with mood disorders underutilize behavioral health treatment. A community-academic partnership was used to address behavioral health initiation among this population. OBJECTIVES We sought to examine the feasibility, acceptability, and preliminary outcomes of a behavioral health referral intervention with low-income, ethnic minority perinatal women diagnosed with mood disorders. METHODS An open trial pilot study was conducted with 38 perinatal women. The behavioral health referral intervention consisted of two sessions of manualized referral strategies to enhance access to care. The main outcome was attendance at a behavioral health appointment. RESULTS Approximately 55% of the perinatal women attended a behavioral health appointment within 2 months (i.e., initiated treatment). Intervention participation rates and ratings were high. Depression scores decreased from baseline to after the intervention. CONCLUSIONS The findings demonstrated favorable outcomes compared with other referral interventions. The behavioral health referral intervention shows promise for implementation in community settings.
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Keefe RH, Brownstein-Evans C, Rouland Polmanteer RS. Addressing access barriers to services for mothers at risk for perinatal mood disorders: A social work perspective. SOCIAL WORK IN HEALTH CARE 2016; 55:1-11. [PMID: 26821273 DOI: 10.1080/00981389.2015.1101045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article identifies variables at the micro/individual, mezzo/partner/spouse and family, and macro/health care-system levels that inhibit mothers at risk for perinatal mood disorders from accessing health and mental health care services. Specific recommendations are made for conducting thorough biopsychosocial assessments that address the mothers' micro-, mezzo-, and macro-level contexts. Finally, the authors provide suggestions for how to intervene at the various levels to remove access barriers for mothers living with perinatal mood disorders as well as their families.
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Affiliation(s)
- Robert H Keefe
- a School of Social Work , University at Buffalo, SUNY , Buffalo , New York , USA
| | - Carol Brownstein-Evans
- b Nazareth College and The Greater Rochester Collaborative MSW Program , Rochester , New York , USA
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Shamshiri Milani H, Azargashb E, Beyraghi N, Defaie S, Asbaghi T. Effect of Telephone-Based Support on Postpartum Depression: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:247-53. [PMID: 26246884 PMCID: PMC4518494 DOI: 10.22074/ijfs.2015.4246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/08/2014] [Indexed: 01/25/2023]
Abstract
Background Postpartum depression (PPD) is one public health issue that affects both
maternal and child health. This research studies the effect of health volunteers’ telephone-
based support on decreasing PPD. Materials and Methods This randomized controlled trial evaluated 203 women who
had uncomplicated deliveries. The women completed the Edinburg Postnatal Depres-
sion Scale (EPDS), 10 to 15 days after childbirth in order to be assessed for pre-trial
depression scores. The cut-off point for depression was considered to be a score of >10.
We randomly assigned 54 eligible mothers (n=27 per group) with mild and moderate de-
pression to the intervention and control groups. In both groups, mothers received routine
postpartum care. The intervention group additionally received telephone support from
health volunteers. A questionnaire was used to gather demographic and obstetric infor-
mation. By the end of the 6thweek, mothers completed the EPDS to be reassessed for
depression after intervention. Data were analyzed using the chi-square, Fisher’s exact,
t- and paired t tests. Results The mean depression scores before intervention (10 to 15 days after childbirth)
in the intervention and control groups did not significantly differ (P=0.682). Depres-
sion scores of the intervention and control groups showed a significant difference after
6 weeks (P=0.035). In addition, there was a significant decrease in depression for the
intervention and control groups (P=0.045). Conclusion Health volunteer telephone-based support effectively decreased PPD and
may be beneficial to women with symptoms of mild and moderate PPD (Registration
number: IRCT201202159027N1).
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Affiliation(s)
- Hourieh Shamshiri Milani
- Infertility and Reproductive Health Research Center (IRHRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran ; Department of Health and Social Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Eznollah Azargashb
- Department of Health and Social Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Beyraghi
- Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Defaie
- Department of Health and Social Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Taha Asbaghi
- Department of Health and Social Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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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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Wisner KL, Sit DKY, McShea MC, Rizzo DM, Zoretich RA, Hughes CL, Eng HF, Luther JF, Wisniewski SR, Costantino ML, Confer AL, Moses-Kolko EL, Famy CS, Hanusa BH. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 2013; 70:490-8. [PMID: 23487258 PMCID: PMC4440326 DOI: 10.1001/jamapsychiatry.2013.87] [Citation(s) in RCA: 632] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The period prevalence of depression among women is 21.9% during the first postpartum year; however, questions remain about the value of screening for depression. OBJECTIVES To screen for depression in postpartum women and evaluate positive screen findings to determine the timing of episode onset, rate and intensity of self-harm ideation, and primary and secondary DSM-IV disorders to inform treatment and policy decisions. DESIGN Sequential case series of women who recently gave birth. SETTING Urban academic women's hospital. PARTICIPANTS During the maternity hospitalization, women were offered screening at 4 to 6 weeks post partum by telephone. Screen-positive women were invited to undergo psychiatric evaluations in their homes. MAIN OUTCOMES AND MEASURES A positive screen finding was an Edinburgh Postnatal Depression Scale (EPDS) score of 10 or higher. Self-harm ideation was assessed on EPDS item 10: "The thought of harming myself has occurred to me" (yes, quite often; sometimes; hardly ever; never). Screen-positive women underwent evaluation with the Structured Clinical Interview for DSM-IV for Axis I primary and secondary diagnoses. RESULTS Ten thousand mothers underwent screening, with positive findings in 1396 (14.0%); of these, 826 (59.2%) completed the home visits and 147 (10.5%) completed a telephone diagnostic interview. Screen-positive women were more likely to be younger, African American, publicly insured, single, and less well educated. More episodes began post partum (40.1%), followed by during pregnancy (33.4%) and before pregnancy (26.5%). In this population, 19.3% had self-harm ideation. All mothers with the highest intensity of self-harm ideation were identified with the EPDS score of 10 or higher. The most common primary diagnoses were unipolar depressive disorders (68.5%), and almost two-thirds had comorbid anxiety disorders. A striking 22.6% had bipolar disorders. CONCLUSIONS AND RELEVANCE The most common diagnosis in screen-positive women was major depressive disorder with comorbid generalized anxiety disorder. Strategies to differentiate women with bipolar from unipolar disorders are needed. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00282776.
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Affiliation(s)
- Katherine L Wisner
- Department of Psychiatry and Behavioral Sciences, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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