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Darcy A, Beaudette A, Chiauzzi E, Daniels J, Goodwin K, Mariano TY, Wicks P, Robinson A. Anatomy of a Woebot® (WB001): agent guided CBT for women with postpartum depression. Expert Rev Med Devices 2023; 20:1035-1049. [PMID: 37938145 DOI: 10.1080/17434440.2023.2280686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Postpartum depression (PPD) is common, persistent, and stigmatized. There are insufficient trained professionals to deliver appropriate screening, diagnosis, and treatment. AREAS COVERED WB001 is a Software as a Medical Device (SaMD) based Agent-Guided Cognitive-Behavioral Therapy (AGCBT) program for the treatment of PPD, for which Breakthrough Device Designation was recently granted by the US Food and Drug Administration. WB001 combines therapeutic alliance, human-centered design, machine learning techniques, and established principles from CBT and interpersonal therapy (IPT). We introduce AGCBT as a new model of service delivery, whilst describing Woebot, the agent technology that enables guidance through the replication of some elements of human relationships. The profile describes the device's design principles, enabling technology, risk handling, and efficacy data in PPD. EXPERT OPINION WB001 is a dynamic and personalized tool with which patients may establish a therapeutic bond. Woebot is designed to augment (rather than replace) human healthcare providers, unlocking the therapeutic potency associated with guidance, whilst retaining the scalability and agency that characterizes self-help approaches. WB001 has the potential to improve both the quality and the scalability of care through providing support to patients on waiting lists, in between clinical encounters, and enabling automation of measurement-based-care.
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Affiliation(s)
| | | | | | | | | | - Timothy Y Mariano
- Woebot Health, San Francisco, CA, USA
- RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Tandon SD, McGown M, Campbell L, Smith JD, Yeh C, Brady C. Results from an effectiveness-implementation evaluation of a postpartum depression prevention intervention delivered in home visiting programs. J Affect Disord 2022; 315:113-120. [PMID: 35878827 DOI: 10.1016/j.jad.2022.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/10/2022] [Accepted: 07/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Building on growing research examining lay health professionals delivering postpartum depression preventive interventions, we conducted a hybrid effectiveness-implementation Type 2 trial to examine implementation metrics and determine whether pregnant women receiving Mothers and Babies 1-on-1 delivered by lay home visitors exhibit greater reductions in depressive symptoms and perceived stress than women receiving usual home visiting. METHODS 1229 (672 control, 557 intervention) pregnant women were enrolled, with intervention participants receiving Mothers and Babies 1-on-1 delivered by a lay home visitor and control participants receiving usual home visiting services. Baseline and six-month follow-up assessments measured client mental health outcomes, with management information system data collected to assess intervention dosage. Surveys were administered nine months post-training to agency managers as well as home visitors who delivered any intervention content. RESULTS Intent-to-treat analyses indicated a significant reduction in perceived stress among intervention participants compared to controls, while as-treated analyses showed significant reductions in perceived stress and depressive symptoms. Although all study sites adopted the intervention, <50 % of eligible women received the intervention. Over two-thirds of home visitors made at least one fidelity-consistent adaptation, with client recruitment and retention in home visiting highlighted as challenges to delivery. LIMITATIONS Unmeasured historical events may have affected study outcomes and caution should be used generalizing to perinatal women from different racial/ethnic groups and home visiting models. CONCLUSION Mothers and Babies 1-on-1 delivered by lay home visitors leads to reductions in perceived stress and depressive symptoms, suggesting task shifting to non-mental health professionals is viable when appropriate training and supervision is provided.
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Affiliation(s)
- S Darius Tandon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States of America.
| | - Molly McGown
- Access Community Health Network, Chicago, IL 60609, United States of America
| | - Laura Campbell
- Oregon Health and Science University, Portland, OR 97239, United States of America
| | - Justin D Smith
- Department of Population Health Sciences, Division of Health Systems Innovation and Research, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84017, United States of America
| | - Chen Yeh
- Rush University Medical Center, Department of Family and Preventive Medicine, Chicago, IL 60611, United States of America
| | - Carol Brady
- Carol Brady & Associates, LLC, Atlantic Beach, FL 32233, United States of America
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Zeng M, Gong A, Wu Z. Paroxetine combined with traditional chinese medicine prescriptions in the treatment of postpartum depression: A systematic review of randomized controlled trials. Front Neuroendocrinol 2022; 67:101019. [PMID: 35926637 DOI: 10.1016/j.yfrne.2022.101019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/17/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Postpartum depression is a common mental disease in obstetric puerperium. Its etiology is not completely clear, and its clinical manifestations are complex. It has serious adverse effects on the body and mind of mothers and infants. Treatment should also follow the principle of individualization. Preliminary studies have shown that traditional chinese medicine prescriptions combined with paroxetine is effective in treating postpartum depression. In order to better determine the therapeutic effect, further exploration was carried out. HYPOTHESIS Does the study better evaluate the therapeutic effect and provide data support for clinical promotion? STUDY DESIGN The search comes from using the following electronic databases established until January 2022. STUDY RESULTS The meta analysis results show that paroxetine combined with traditional chinese medicine prescriptions can reduce the Hamilton Depression Scale (HAMD) score [WMD = -7.35, 95 % CI (-10.84, -3.87), P<0.001] and Edinburgh Postpartum Depression Scale (EPDS) score [WMD = -3.24, 95 % CI (-5.96, -0.53), P < 0.001].And better than paroxetine treatment alone in terms of improving clinical efficacy [RR = 1.22, 95 % CI (1.16, 1.30), P < 0.001]. CONCLUSIONS Based on the combination of paroxetine and traditional chinese medicine prescriptions in the treatment of postpartum depression, there is a certain clinical effect, and a strong research design and a certain number of RCTs are required at the same time. Future research should clarify the specific composition and composition of traditional Chinese medicine prescriptions.
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Affiliation(s)
- Mengjie Zeng
- Department of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Aimin Gong
- Department of Traditional Chinese Medicine, Hainan medical university, Haikou, China.
| | - Zhiquan Wu
- Department of rehabilitation medicine, Sanya Central Hospital, Sanya, China.
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Johnson JK, Diebold A, Yeh C, Ciolino JD, Tandon SD. Examining Participant Dosage and Skill Utilization Associated with Receipt of a Perinatal Depression Preventive Intervention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1241-1250. [DOI: 10.1007/s11121-022-01395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 11/28/2022]
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Darcy A, Beaudette A, Chiauzzi E, Daniels J, Goodwin K, Mariano TY, Wicks P, Robinson A. Anatomy of a Woebot® (WB001): agent guided CBT for women with postpartum depression. Expert Rev Med Devices 2022; 19:287-301. [PMID: 35748029 DOI: 10.1080/17434440.2022.2075726] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/05/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Postpartum Depression (PPD) is common, persistent, and stigmatized. There are insufficient trained professionals to deliver appropriate screening, diagnosis, and treatment. AREAS COVERED WB001 is a Software as a Medical Device (SaMD) based Agent-Guided Cognitive Behavioral Therapy (AGCBT) program for the treatment of PPD, for which Breakthrough Device Designation was recently granted by the US Food and Drug Administration. WB001 combines therapeutic alliance, human-centered design, machine learning techniques, and established principles from CBT and interpersonal therapy (IPT). We introduce AGCBT as a new model of service delivery, whilst describing Woebot, the agent technology that enables guidance through the replication of some elements of human relationships. The profile describes the device's design principles, enabling technology, risk handling, and efficacy data in PPD. EXPERT OPINION WB001 is a dynamic and personalized tool with which patients may establish a therapeutic bond. Woebot is designed to augment (rather than replace) human healthcare providers, unlocking the therapeutic potency associated with guidance, whilst retaining the scalability and agency that characterizes self-help approaches. WB001 has the potential to improve both the quality and the scalability of care through providing support to patients on waiting lists, in between clinical encounters, and enabling automation of measurement-based care.
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Ward EA, Iron Cloud-Two Dogs E, Gier EE, Littlefield L, Tandon SD. Cultural Adaptation of the Mothers and Babies Intervention for Use in Tribal Communities. Front Psychiatry 2022; 13:807432. [PMID: 35250665 PMCID: PMC8891558 DOI: 10.3389/fpsyt.2022.807432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE While one in five women may experience mood and anxiety disorders during pregnancy and postpartum, Indigenous identity increases that risk by 62%, especially among younger Indigenous women. The need for evidence-based perinatal mental health interventions that provide culturally relevant well-being perspectives and practices is critical to improving maternal, child, and community outcomes for Indigenous peoples, and reducing health inequities. METHODS Through a collaboration between community maternal and child health professionals, intervention researchers, and a cultural consultant, our workgroup developed cultural adaptations to Mothers and Babies, an evidence-based perinatal depression prevention intervention. Applying a cultural interface model, the workgroup identified existing intervention content for surface adaptations, as well as deep, conceptual adaptations to incorporate traditional teachings into this evidence-based intervention. RESULTS This collaboration developed a culturally adapted facilitator manual for intervention providers, including guidance for implementation and further adaptation to represent local tribal culture, and a culturally adapted participant workbook for Indigenous perinatal women that reflects cultural teachings and traditional practices to promote well-being for mother and baby. IMPLICATIONS Committing to a culturally respectful process to adapt Mothers and Babies is likely to increase the reach of the intervention into Indigenous communities, reengage communities with cultural practice, improve health outcomes among parents, children, and the next generation's elders, and reduce disparities among Indigenous groups. Replication of this community-engaged process can further the science and understanding of cultural adaptations to evidence-based interventions, while also further reducing health inequities. Future steps include evaluating implementation of the culturally adapted intervention among tribal home visiting organizations.
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Affiliation(s)
- Erin A Ward
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Emma E Gier
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Linda Littlefield
- Great Plains Healthy Start, Great Plains Tribal Leaders' Health Board, Rapid City, SD, United States
| | - S Darius Tandon
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Barrera AZ, Hamil J, Tandon D. Integrating SMS Text Messages Into a Preventive Intervention for Postpartum Depression Delivered via In-Home Visitation Programs: Feasibility and Acceptability Study. JMIR Form Res 2021; 5:e30995. [PMID: 34792478 PMCID: PMC8663697 DOI: 10.2196/30995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The Mothers and Babies (MB) Course is recognized by the US Preventive Services Task Force as an evidence-based preventive intervention for postpartum depression (PPD) that should be recommended to pregnant women at risk for PPD. OBJECTIVE This report examines the feasibility and acceptability of enhancing the MB 1-on-1 intervention by adding 36 SMS text messages that target 3 areas: reinforcement of skills, between-session homework reminders, and responding to self-monitoring texts (ie, MB Plus Text Messaging [MB-TXT]). METHODS In partnership with 9 home visiting programs, 28 ethnically and racially diverse pregnant women (mean 25.6, SD 9.0 weeks) received MB-TXT. Feasibility was defined by home visitors' adherence to logging into the HealthySMS platform to enter session data and trigger SMS text messages within 7 days of the in-person session. The acceptability of MB-TXT was measured by participants' usefulness and understanding ratings of the SMS text messages and responses to the self-monitoring SMS text messages. RESULTS On average, home visitors followed the study protocol and entered session-specific data between 5.50 and 61.17 days following the MB 1-on-1 sessions. A high proportion of participants responded to self-monitoring texts (25/28, 89%) and rated the text message content as very useful and understandable. CONCLUSIONS This report contributes to a growing body of research focusing on digital adaptations of the MB course. SMS is a low-cost, accessible digital tool that can be integrated into existing interventions. With appropriate resources to support staff, it can be implemented in community-based organizations and health care systems that serve women at risk for PPD. TRIAL REGISTRATION ClinicalTrials.gov NCT03420755; https://clinicaltrials.gov/ct2/show/NCT03420755.
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Affiliation(s)
- Alinne Z Barrera
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
| | - Jaime Hamil
- Institute for Public Health and Medicine, Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Darius Tandon
- Institute for Public Health and Medicine, Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Hamil J, Gier E, Garfield CF, Tandon D. The Development and Pilot of a Technology-Based Intervention in the United States for Father's Mental Health in the Perinatal Period. Am J Mens Health 2021; 15:15579883211044306. [PMID: 34587839 PMCID: PMC8488529 DOI: 10.1177/15579883211044306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Paternal mental health is increasingly recognized as an important public health issue, with about 10% of men experiencing depression perinatally. Paternal depression is associated with less responsive parenting, greater parenting stress, and suboptimal child development. In response to a lack of existing interventions that directly focus on fathers’ mental health in the United States, we developed and pilot tested the Fathers and Babies (FAB) intervention for use with partners of women enrolled in home visiting (HV) programs. After a review of the extant literature, FAB was developed with input from HV stakeholders and infant mental health consultants. FAB was subsequently pilot tested with 30 father-mother dyads, with mixed-method data collected from a subset of intervention participants to assess intervention feasibility and acceptability and guide intervention refinement. Five themes related to FAB content and delivery considerations emerged from the initial focus groups that were used to guide FAB development. Mixed-method data collected during the pilot study established that fathers receiving FAB reported its content appropriate and thought it was feasible to receive the intervention. Several recommendations for FAB revisions were also provided. FAB is an innovative intervention developed for fathers from contemporary family structures that was well-received during its pilot testing. Feasibility and acceptability data suggest that fathers have favorable opinions about intervention content and delivery, while also highlighting areas for future revisions of FAB.
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Affiliation(s)
- Jaime Hamil
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emma Gier
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Craig F Garfield
- Northwestern University Feinberg School of Medicine, Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Darius Tandon
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Gewali A, Lopez A, Dachelet K, Healy E, Jean-Baptiste M, Harridan H, Evans Y, Unger JA, Bhat A, Tandon D, Ronen K. A Social Media Group Cognitive Behavioral Therapy Intervention to Prevent Depression in Perinatal Youth: Stakeholder Interviews and Intervention Design. JMIR Ment Health 2021; 8:e26188. [PMID: 34524086 PMCID: PMC8482173 DOI: 10.2196/26188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Adolescents and young adults aged <25 years (youth) are at a higher risk of perinatal depression than older adults, and they experience elevated barriers to in-person care. Digital platforms such as social media offer an accessible avenue to deliver group cognitive behavioral therapy (CBT) to perinatal youth. OBJECTIVE We aim to develop the Interactive Maternal Group for Information and Emotional Support (IMAGINE) intervention, a facilitated social media group CBT intervention to prevent perinatal depression in youth in the United States, by adapting the Mothers and Babies (MB) course, an evidence-based in-person group CBT intervention. In this study, we report perspectives of youth and health care providers on perinatal youths' mental health needs and document how they informed IMAGINE design. METHODS We conducted 21 semistructured in-depth individual interviews with 10 pregnant or postpartum youths aged 14-24 years and 6 health care workers. All interviews were recorded, transcribed, and analyzed using deductive and inductive approaches to characterize perceptions of challenges and facilitators of youth perinatal mental health. Using a human-centered design approach, stakeholder perspectives were incorporated into the IMAGINE design. We classified MB adaptations to develop IMAGINE according to the Framework for Modification and Adaptation, reporting the nature, timing, reason, and goal of the adaptations. RESULTS Youth and health care workers described stigma associated with young pregnancy and parenting, social isolation, and lack of material resources as significant challenges to youth mental wellness. They identified nonjudgmental support, peer companionship, and access to step-by-step guidance as facilitators of youth mental wellness. They endorsed the use of a social media group to prevent perinatal depression and recommended that IMAGINE facilitate peer support, deliver content asynchronously to accommodate varied schedules, use a confidential platform, and facilitate the discussion of topics beyond the MB curriculum, such as navigating support resources or asking medical questions. IMAGINE was adapted from MB to accommodate stakeholder recommendations and facilitate the transition to web-based delivery. Content was tailored to be multimodal (text, images, and video), and the language was shortened and simplified. All content was designed for asynchronous engagement, and redundancy was added to accommodate intermittent access. The structure was loosened to allow the intervention facilitator to respond in real time to topics of interest for youth. A social media platform was selected that allows multiple conversation channels and conceals group member identity. All adaptations sought to preserve the fidelity of the MB core components. CONCLUSIONS Our findings highlight the effect of stigmatization of young pregnancy and social determinants of health on youth perinatal mental health. Stakeholders supported the use of a social media group to create a supportive community and improve access to evidence-based depression prevention. This study demonstrates how a validated intervention can be tailored to this unique group.
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Affiliation(s)
- Anupa Gewali
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Alana Lopez
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kristin Dachelet
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Elise Healy
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Holly Harridan
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Yolanda Evans
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Jennifer A Unger
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Darius Tandon
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
- Center for Community Health, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, United States
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Mackness J, Gallis JA, Owusu RK, Ali M, Abubakr-Bibilazu S, Adam H, Aborigo R, Awoonor-Williams JK, Lillie M, McEwan E, Hembling J, Vasudevan L, Baumgartner JN. Prevalence and correlates of maternal early stimulation behaviors during pregnancy in northern Ghana: a cross-sectional survey. BMC Pregnancy Childbirth 2021; 21:4. [PMID: 33397319 PMCID: PMC7784360 DOI: 10.1186/s12884-020-03476-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/03/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Per UNICEF's Nurturing Care Framework, early childhood development (ECD) begins during pregnancy and many lower-resource settings need data to inform their programs for optimal child development. The maternal-fetal relationship can be partly examined via a series of bonding activities called early stimulation behaviors (ESB). This study describes early stimulation behaviors and the associated correlates among pregnant women in Ghana. METHODS This cross-sectional study used data from a cluster-randomized trial in two districts of Northern Ghana. A total of 374 pregnant women were enrolled at baseline and administered a pre-intervention survey. Communication-related early stimulation behaviors was the primary outcome which was evaluated using three maternal-fetal bonding activities; did the woman self-report touching and/or talking, singing, and/or talking about family to her belly. A generalized estimating equation modified Poisson model was used for the bivariate and multivariable analysis. RESULTS About half of the participants reported performing communication-related ESB during pregnancy frequently or sometimes. Bivariate analysis revealed that negative life experiences including higher rates of emotional, physical and sexual intimate partner violence (IPV) and having moderate to severe depressive symptoms were associated with women performing early stimulation behaviors more often. In the multivariable model, physical intimate partner violence remained significantly associated with early stimulation behaviors. CONCLUSION Research on early stimulation behaviors is still in a nascent phase. It is unclear why our results revealed an association between intimate partner violence and early stimulation behaviors; this could reflect a coping mechanism for the expectant mother. Further research is needed to better understand this association and explore potential long-term impacts of early stimulation behaviors during pregnancy on child development. TRIAL REGISTRATION Clinical Trials # NCT03665246 , August 29, 2018.
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Affiliation(s)
| | - John A Gallis
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | | | - Mohammed Ali
- Catholic Relief Services Country Office, Tamale, Ghana
| | | | - Haliq Adam
- Catholic Relief Services Country Office, Tamale, Ghana
| | | | | | - Margaret Lillie
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Elena McEwan
- Catholic Relief Services Head Quarters, Baltimore, MD, USA
| | - John Hembling
- Catholic Relief Services Head Quarters, Baltimore, MD, USA
| | - Lavanya Vasudevan
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Family Medicine & Community Health, Duke University, Durham, North Carolina, USA
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Winstone LK, Luecken LJ, Crnic KA, Gonzales NA. Patterns of family negativity in the perinatal period: Implications for mental health among Mexican-origin women. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2020; 34:642-651. [PMID: 32162941 PMCID: PMC7373671 DOI: 10.1037/fam0000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Negativity in the family environment during the perinatal period is likely to have detrimental effects on maternal well-being, especially among low-income ethnic minority mothers who are at increased risk for experiencing postpartum depressive symptoms. With a sample of 322 Mexican and Mexican American families, this study used latent class growth analysis to identify meaningful subgroups of women based on their perceived family negativity reported prenatally and at 6, 12, 18, and 24 weeks postpartum. A 4-trajectory model of family negativity fit the data well: low-stable (58%), moderate-increasing (26%), high-decreasing (8%), and high-increasing (8%). Higher prenatal depressive symptomatology predicted membership in the moderate-increasing, high-decreasing, and high-increasing trajectories, relative to the low-stable trajectory. Findings suggest substantial heterogeneity in family negativity, identifying three significant growth patterns during the perinatal period with differential implications for maternal depressive symptomatology at 24 weeks and 12 months after delivery. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Asif S, Mulic‐Lutvica A, Axfors C, Eckerdal P, Iliadis SI, Fransson E, Skalkidou A. Severe obstetric lacerations associated with postpartum depression among women with low resilience – a Swedish birth cohort study. BJOG 2020; 127:1382-1390. [DOI: 10.1111/1471-0528.16271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 12/13/2022]
Affiliation(s)
- S Asif
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - A Mulic‐Lutvica
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - C Axfors
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - P Eckerdal
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - SI Iliadis
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - E Fransson
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
- Department of Microbiology, Tumour and Cell Biology Karolinska Institutet Stockholm Sweden
| | - A Skalkidou
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
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Addressing Maternal Depression, Substance Use, and Intimate Partner Violence in Home Visiting: a Quasi-Experimental Pilot Test of a Screen-and-Refer Approach. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 20:1233-1243. [PMID: 31432378 DOI: 10.1007/s11121-019-01045-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This quasi-experimental pilot study describes preliminary impacts of the "Home Visitation Enhancing Linkages Project (HELP)," a pragmatic screen-and-refer approach for promoting identification of and linkage to treatment for maternal depression (MD), substance use (SU), and intimate partner violence (IPV) within early childhood home visiting. HELP includes screening for MD, SU, and IPV followed by a menu of motivational interviewing and case management interventions aimed at linking clients to treatment, designed for delivery within routine home visiting. HELP was piloted within four counties of a statewide home visiting system that were implementing Healthy Families America. HELP clients (N = 394) were compared to clients in five demographically matched counties that received usual Healthy Families services (N = 771) on whether their home visitors (1) identified MD, SU, and IPV risk; (2) discussed MD, SU, and IPV during home visits; and (3) made referrals for MD, SU, and IPV. All data were extracted from the program's management information system. A significant impact of HELP was found on discussion of risk in home visits for all three risk domains with large effect sizes (MD OR = 4.08; SU OR = 15.94; IPV OR = 9.35). HELP had no impact on risk identification and minimal impact on referral. Findings provide preliminary support for HELP as a way of improving discussion of client behavioral health risks during home visits, an important first step toward better meeting these needs within home visiting. However, more intensive intervention is likely needed to impact risk identification and referral outcomes.
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Perinatal depression prevention through home visitation: a cluster randomized trial of mothers and babies 1-on-1. J Behav Med 2018; 41:641-652. [PMID: 29766470 DOI: 10.1007/s10865-018-9934-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
Abstract
Postpartum depression is highly prevalent in low-income women and has significant health effects on mother and child. This pilot study tested the effectiveness of the newly adapted Mothers and Babies (MB) 1-on-1 intervention. A cluster randomized trial was conducted with 8 programs using trained home visitors to deliver MB 1-on-1 and 6 delivering usual home visiting. One hundred twenty pregnant women not experiencing major depression were enrolled. Outcomes were assessed at baseline and 3- and 6-months postpartum. The rate of change in depressive and anxiety symptoms between groups was significant at 6 months, but not 3 months. No statistically significant differences between groups were found on secondary outcomes except perceptions of social support at 6 months. There was variability in use of MB skills, with fewer women using cognitive restructuring techniques. Although larger studies should be conducted, MB 1-on-1 appears promising in using home visitors to deliver a cognitive behavioral intervention to women at risk for postpartum depression.
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