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Lupattelli A, Branquinho M, Cardoso C, Tauqeer F, Bjørndal LD, Fonseca A. Psychometric properties of the Decisional Conflict Scale in a sample of perinatal women with depressive symptoms: A study in Portugal and Norway. PATIENT EDUCATION AND COUNSELING 2024; 127:108337. [PMID: 38820986 DOI: 10.1016/j.pec.2024.108337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/10/2024] [Accepted: 05/20/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE To assess the psychometric properties, i.e., reliability and construct validity of the 16-item Decisional Conflict Scale (DCS) and sub-scales in women with perinatal depressive symptoms in Norway and Portugal. METHODS We included 415 women in Portugal and 163 in Norway (≥18 years) who were pregnant or had given birth in the last 12 months and presenting with active depressive symptoms. Women replied to the original DCS items. We conducted confirmatory factor analysis, estimated internal consistency reliability, and examined factorial invariance across country, perinatal status, and treatment uptake. RESULTS The DCS factor model had good fit to the data, with all items loading significantly on their respective factor (.585 to .958). There was configural invariance of the DCS across countries, treatment, and perinatal status. The internal consistency of the total DCS (Cronbach's alpha) was .958, and for the subscales it ranged from .798 to .947. CONCLUSIONS The DCS is a valid and reliable measure of the decisional conflict in women with perinatal depressive symptoms in Portugal and Norway. PRACTICE IMPLICATIONS Measuring the extent of decisional conflict regarding treatment and the effect of multiple interventions towards its reduction, is critical to facilitate the decision-making process of women with perinatal mental illness.
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Affiliation(s)
- Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
| | - Mariana Branquinho
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
| | - Catarina Cardoso
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
| | - Fatima Tauqeer
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Ludvig D Bjørndal
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Ana Fonseca
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
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Ormsby SM, Dahlen HG, Smith CA. Investigation of Hypothalamic Pituitary Adrenal Axis and Oxytocinergic System Changes in a Pragmatic Randomized Controlled Feasibility Trial of Acupuncture for Antenatal Depression. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:173-184. [PMID: 37566543 DOI: 10.1089/jicm.2023.0012] [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: 08/13/2023]
Abstract
Background: Antenatal depression is common and associated with detrimental impacts on women and their families. Disrupted neuroendocrine functioning is reported in women experiencing perinatal mental health disturbances. Preliminary randomized controlled trial (RCT) evidence suggests acupuncture may provide a safe and effective adjunct treatment; however, underlying mechanisms of effect are unclear. We conducted an RCT examination of acupuncture for the management of antenatal depressive symptomologies, which included oxytocinergic and hypothalamic pituitary adrenal (HPA) axis system evaluations. This article reports postintervention changes to cortisol: dehydroepiandrosterone (DHEA) ratios, and oxytocin (OT) hormone concentrations. Methods: Fifty-seven women with Edinburgh Postnatal Depression Scale (EPDS) scores ≥13 were randomized to receive individually tailored depressed specific acupuncture, progressive muscle relaxation (PMR) attention comparator, or treatment as usual (TAU). Weekly 1-h sessions were conducted for 8 weeks (24-31 of pregnancy). Preintervention and postintervention saliva samples were collected. Results: Postintervention mean cortisol: DHEA ratio differences were not significantly predicted by group allocation (n = 46, p = 0.065). Two-group comparisons demonstrated cortisol: DHEA ratios were significantly increased and predicted by group allocation when acupuncture was compared to TAU (p = 0.039); however, not between acupuncture and PMR (p = 0.179), or PMR and TAU (p = 0.421). Postintervention OT concentrations were not significantly predicted by group allocation. Limitations: Small sample size and posthoc analysis Conclusion: Findings suggest positive regulation of the HPA axis may be an underlying mechanism by which acupuncture provided the significant improvements to antenatal depression, stress, and distress observed in this cohort. Trial Registration: Registered on March 19, 2015, with the Australian New Zealand Clinical Trials Registry (ACTRN12615000250538).
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Affiliation(s)
- Simone M Ormsby
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Caroline A Smith
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
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Sedlakova J, Westermair AL, Biller-Andorno N, Meier CA, Trachsel M. Comparison of analog and digital patient decision aids for the treatment of depression: a scoping review. Front Digit Health 2023; 5:1208889. [PMID: 37744684 PMCID: PMC10513051 DOI: 10.3389/fdgth.2023.1208889] [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: 04/19/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Patient decision aids (PDAs) are important tools to empower patients and integrate their preferences and values in the decision-making process. Even though patients with mental health problems have a strong interest in being more involved in decision making about their treatment, research has mainly focused on PDAs for somatic conditions. In this scoping review, we focus on patients suffering from depression and the role of PDAs for this patient group. The review offers an overview of digital and analog PDAs, their advantages and disadvantages as well as recommendations for further research and development. Methods A systematic search of the existing literature guided by the Cochrane Handbook for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - extension for scoping reviews (PRISMA-ScR) was conducted. Three electronic literature databases with the appropriate thematic focus were searched (PubMed, PsycInfo, and Web of Science). The search strategy used controlled and natural language to search for the key concepts decision aids and depression. The articles were selected in a two-step process guided by predefined inclusion and exclusion criteria. We narratively synthetized information extracted from 40 research articles. Results We included 40 articles in our review. Our review revealed that there is more focus on digital PDAs in research than in clinical practice. Digitalization can enhance the benefits of PDAs by developing tools that are more efficient, interactive, and personalized. The main disadvantages of both types of PDAs for the treatment of depression are related to time, dissemination, and capacity building for the health care providers. Digital PDAs need to be regularly updated, effective strategies for their dissemination and acceptance need to be identified, and clinicians need sufficient training on how to use digital PDAs. There is more research needed to study which forms of PDAs are most appropriate for various patient groups (e.g., older adults, or patients with comorbidities), and to identify the most effective ways of PDAs' integration in the clinical workflow. The findings from our review could be well aligned with the International Patient Decision Aids Standards. Discussion More research is needed regarding effective strategies for the implementation of digital PDAs into the clinical workflow, ethical issues raised by the digital format, and opportunities of tailoring PDAs for diverse patient groups.
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Affiliation(s)
- Jana Sedlakova
- Institute of Biomedical Ethics and History of Medicine, University of Zurich (UZH), Zürich, Switzerland
| | - Anna Lisa Westermair
- Institute of Biomedical Ethics and History of Medicine, University of Zurich (UZH), Zürich, Switzerland
- Clinical Ethics Unit, University Hospital of Basel (USB), Basel, Switzerland
- Clinical Ethics Unit, University Psychiatric Clinics Basel (UPK), Basel, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich (UZH), Zürich, Switzerland
| | - Christoph A. Meier
- Department of Internal Medicine, University Hospital Zurich (USZ), Zürich, Switzerland
- Medical Faculty, University of Geneva, Geneva, Switzerland
| | - Manuel Trachsel
- Clinical Ethics Unit, University Hospital of Basel (USB), Basel, Switzerland
- Clinical Ethics Unit, University Psychiatric Clinics Basel (UPK), Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
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Nanjundaswamy MH, Gowda SM, Ganjekar S, Thippeswamy H, Desai G, Chandra PS. Women with mental illness seeking conception counselling at a specialist perinatal psychiatry service in India. Asian J Psychiatr 2022; 78:103313. [PMID: 36356427 DOI: 10.1016/j.ajp.2022.103313] [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: 09/26/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022]
Abstract
AIMS To study the clinical and sociodemographic profile of women with mental illness seeking conception counselling at perinatal psychiatry service. To compare women seeking preconception counselling (PCC) to that of those who sought help after unplanned pregnancy with exposure (UPE) to psychotropics. MATERIAL AND METHODS Data was extracted from the clinical records of women between the year 2014-2017 who attended perinatal outpatient services. The details collected included sociodemographic details, illness details, contraception, infertility treatment and detailed treatment history. RESULTS Of the 766 women who consulted perinatal psychiatry services (2014-17), 179 (23.37%) had consulted for conception counselling. Out of that 104 (58.1%) sought PCC, and 75 (41.9%) had UPE to psychotropics. PCC was sought by women with higher education, those having a severe mental illness, and a longer duration of illness. Women with medical comorbidities and receiving infertility treatment also sought PCC. Also, women who had earlier undergone PCC been more likely to seek PCC for further pregnancies. CONCLUSIONS Women with mental illness should be counselled regarding planned pregnancies, contraception, and the impact of psychotropics on pregnancy and foetus. Also, liaison with other specialities like obstetricians, sonologist and paediatricians is essential.
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Affiliation(s)
- Madhuri H Nanjundaswamy
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | | | - Sundarnag Ganjekar
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India.
| | - Harish Thippeswamy
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Geetha Desai
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Prabha S Chandra
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
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Abousheishaa AA, Lazim NHM, Tang SL, Sulaiman AH, Huri HZ, Guan NC. Antidepressant decision aid for major depressive disorder patients (ADAM): Development and pilot testing. PATIENT EDUCATION AND COUNSELING 2022; 105:2466-2474. [PMID: 34844812 DOI: 10.1016/j.pec.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/25/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This study aimed to develop and assess the effectiveness of an encounter decision aid for Malaysian patients with MDD to support treatment decision-making during the consultation. METHODS The decision aid prototype was developed following a literature review and six focus groups. Alpha testing assessed its comprehensibility, acceptability, usability and desirability through user-centered cognitive interviews. Beta-testing evaluated preliminary evidence on its efficacy using the SDM Scale and PDMS. Feasibility was assessed by timing the consultation. RESULTS The alpha testing demonstrated that the decision aid was patient-oriented, comprehensible, comprehensive, concise and objective with an appealing design. Beta-testing indicated that PtDA significantly increased patients satisfaction with SDM from patients' [83.32 (13.92) vs 85.76 (13.80); p < 0.05] and physicians' [81.07 (10.09) vs 86.36 (10.10); p < 0.05] perspectives and prepared the patients for decision making from the patients' [PDMS patients: 84.10 (12.69)] and physicians' [PDMS physicians: 83.78 (16.62)] perspectives as well. There was no change in the consultation time between the control and the intervention groups. CONCLUSIONS We developed an antidepressant PtDA for Malaysian patients with MDD that increases patients' involvement in shared decision making and enhances their preparedness for decision making. PRACTICE IMPLICATIONS Using the PtDA can support collaborative decision-making in routine clinical practice without extending the consultation time.
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Affiliation(s)
- Aya Ahmed Abousheishaa
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Nor Hazila Mat Lazim
- Faculty of Languages and Linguistics, University of Malaya, Kuala Lumpur, Malaysia
| | - Song Ling Tang
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Hlongwane R, Phoswa WN. Effect of antidepressants in pregnancy outcomes: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27885. [PMID: 34918638 PMCID: PMC8677962 DOI: 10.1097/md.0000000000027885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Depression is much more common in women pre their pregnancies with antidepressants use less common which is caused by when many patients opt to discontinue with the use due to its side effects it causes. But whether depression is treated by antidepressants or not this has the same negative pregnancy outcomes on both the mother and the unborn and even born child from these mothers. METHODS Information will be retrieved for this systematic review and meta-analysis study on antidepressants use pregnancy outcomes from PubMed and Google scholar search engines using search medical subjects headings on PubMed and the PICOS framework as the determinant of the research question. All returned articles searched will be stored to Zotero.org and the software RevMan will be used to analyze data. ETHICS AND DISSEMINATION The review and meta-analysis will not require ethical approval and the findings will be published in peer-reviewed journals and presented at local and international conferences. In addition, findings from this study will assist in assessing health related risk outcomes of antidepressants during- and postpregnancy on both the fetal and mother either when used pre- and during-pregnancy. SYSTEMATIC REVIEW REGISTRATION International prospective Register of Systematic Reviews (PROSERO) number: CRD42021232111.
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Zisman-Ilani Y, Chmielowska M, Dixon LB, Ramon S. NICE shared decision making guidelines and mental health: challenges for research, practice and implementation. BJPsych Open 2021; 7:e154. [PMID: 34470688 PMCID: PMC8444056 DOI: 10.1192/bjo.2021.987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/07/2021] [Accepted: 07/27/2021] [Indexed: 01/19/2023] Open
Abstract
The National Institute for Health and Care Excellence (NICE) initiated an ambitious effort to develop the first shared decision making guidelines. The purpose of this commentary is to identify three main concerns pertaining to the new published guidelines for shared decision making research, practice, implementation and cultural differences in mental health.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, USA
| | - Marta Chmielowska
- Centre for Outcomes Research and Effectiveness, University College London, UK
| | - Lisa B. Dixon
- Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, USA
| | - Shulamit Ramon
- Department of Allied Health, Midwifery and Social Work, University of Hertfordshire, UK
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Schiller CE, Cohen MJ, O'Hara MW. Perinatal mental health around the world: priorities for research and service development in the USA. BJPsych Int 2020; 17:87-91. [PMID: 33196694 PMCID: PMC7609989 DOI: 10.1192/bji.2020.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The perinatal mental health field is growing rapidly, which has yielded innovations in both prevention and treatment. To realise the potential of these innovations to transform clinical practice, further investment in research and clinical service development is required. Clinical services must be expanded by providing increased access to specialty care and education for front-line clinicians. Research is needed to develop a personalised medicine approach to understanding the complex aetiologies of perinatal depression and optimising treatments to promote both remission and long-term recovery. Such initiatives will require policies to prioritise federal research funding and healthcare coverage for perinatal depression.
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Affiliation(s)
- Crystal Edler Schiller
- Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, USA
| | - Matthew J Cohen
- Postdoctoral Fellow, Department of Psychiatry, University of North Carolina at Chapel Hill, USA
| | - Michael W O'Hara
- Professor, Department of Psychological and Brain Sciences, University of Iowa, USA.
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Chen A, Tenhunen H, Torkki P, Heinonen S, Lillrank P, Stefanovic V. Women's decisional conflict in the pathway of prenatal screening and testing: an explorative study within Finnish public maternity care. J Perinat Med 2020; 48:527-537. [PMID: 32304311 DOI: 10.1515/jpm-2019-0450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/23/2020] [Indexed: 02/06/2023]
Abstract
Objectives To explore women's decisional conflict in the pathway of prenatal screening and testing (PreST) in Finland and to evaluate a counseling service. Methods Self-completion surveys were conducted at two medical settings (screening and further testing) of PreST. Decisional Conflict Scale (DCS) was the main measure. Different types of statistical tests were used to compare women's decisional conflict at different medical settings of PreST, and before-after pre-test counseling. Multivariable linear regressions analyzed the influences of the medical settings and other factors on women's decisional conflict. Results Compared to women in population-based screening, women in further testing (before pre-test counseling) were more likely to feel well informed (P < 0.001), had increased values clarity (P < 0.001), but more likely experienced uncertainty (P = 0.040). Besides medical settings, maternal age, gravidity and previous experience of fetal aneuploidy significantly influenced decisional conflict. After counseling, screen-positive women felt better informed (P < 0.001), had increased values clarity (P < 0.001), perceived more support (P < 0.001), and had better decision certainty (P < 0.001) than before counseling. Conclusions Medical settings influence women's decisional conflict during PreST. Individual counseling is effective in improving screen-positive women's decisional conflict. This research adds knowledge and experience on developing decision-making supports across the pathway of PreST.
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Affiliation(s)
- An Chen
- Institute of Healthcare Engineering, Management and Architecture (HEMA Institute), Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Henni Tenhunen
- Institute of Healthcare Engineering, Management and Architecture (HEMA Institute), Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Paulus Torkki
- Institute of Healthcare Engineering, Management and Architecture (HEMA Institute), Department of Industrial Engineering and Management, Aalto University, Espoo, Finland.,Department of Public Health, Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Seppo Heinonen
- Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Paul Lillrank
- Institute of Healthcare Engineering, Management and Architecture (HEMA Institute), Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Vedran Stefanovic
- Professor of Obstetrics, Gynecology and Fetal Medicine, Senior Consultant, Senior Lecturer, Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Rotem-Kohavi N, Williams LJ, Oberlander TF. Advanced neuroimaging: A window into the neural correlates of fetal programming related to prenatal exposure to maternal depression and SSRIs. Semin Perinatol 2020; 44:151223. [PMID: 32122645 DOI: 10.1016/j.semperi.2020.151223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Fetal programming is a conceptual framework whereby the in utero environment shapes the offspring's neurodevelopment. Maternal depression and treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants during pregnancy are common prenatal exposures that affect critical early life developmental programming processes. Prenatal depression and SSRIs both have been reported to increase the risks for preterm birth, low birth weight, and are associated with behavioral disturbances across the early life span. However, not all exposures lead to adverse developmental outcomes and distinguishing how each exposure contributes to variations in development remains challenging. Advances in neuroimaging, using MR and EEG, offer novel insights into central processes that might reveal the neural correlates of fetal programming. This review focuses on emerging findings from neuroimaging studies reflecting early brain functional and structural development associated with prenatal exposure to maternal depression and SSRI antidepressants. Suggestions for future research directions that use neuroimaging as a tool to advancing our understanding of the early origins of developmental plasticity are offered.
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Affiliation(s)
- Naama Rotem-Kohavi
- Graduate Program in Neuroscience, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | | | - Tim F Oberlander
- BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
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Decision-making about antidepressant medication use in pregnancy: a comparison between women making the decision in the preconception period versus in pregnancy. BMC Psychiatry 2020; 20:54. [PMID: 32033547 PMCID: PMC7007680 DOI: 10.1186/s12888-020-2478-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 01/31/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Decisions about antidepressant use in pregnancy are complex. Little is known about how pregnancy-planning and already pregnant women making these decisions differ. METHODS In 95 Canadian women having difficulty deciding whether to take antidepressants in pregnancy, we compared sociodemographic factors, clinical characteristics, and treatment intent between women planning pregnancy (preconception women) and currently-pregnant women. RESULTS About 90% of preconception women (n = 55) were married or cohabitating and university-educated, and over 60% had an annual income of > 80,000 CAD/year; this was not different from currently-pregnant women (n = 40). Almost all women had previously used antidepressants, but preconception women were more likely to report current use (85.5% vs. 45.0%). They were more likely to have high decisional conflict (83.6% vs. 60.0%) and less likely to be under the care of a psychiatrist (29.1% vs. 52.5%). Preconception women were more likely than pregnant women to report the intent to use antidepressants (60% vs. 32.5%, odds ratio 3.11, 95% confidence interval 1.33-7.32); this was partially explained by between-group differences in current antidepressant use. CONCLUSIONS Preconception women were more likely than pregnant women to intend to use antidepressants in pregnancy, in part because more of them were already using this treatment. Strategies to enhance support for decision-making about antidepressant medication use in pregnancy may need to be tailored differently for pregnancy-planning and already pregnant women.
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Patient Decision Aids to Facilitate Shared Decision Making in Obstetrics and Gynecology. Obstet Gynecol 2020; 135:444-451. [DOI: 10.1097/aog.0000000000003664] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Khalifeh H, Molyneaux E, Brauer R, Vigod S, Howard LM. Patient decision aids for antidepressant use in pregnancy: a pilot randomised controlled trial in the UK. BJGP Open 2019; 3:bjgpopen19X101666. [PMID: 31822489 PMCID: PMC6995861 DOI: 10.3399/bjgpopen19x101666] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Decision-making regarding antidepressant use in pregnancy is challenging, given the uncertain evidence base on the benefits and risks for women and their children. Patient decision aids (PDAs) can improve shared decision-making for complex health decisions but no evidence-based PDAs exist for antidepressant use in pregnancy. AIM To assess the feasibility of a full-scale randomised controlled trial (RCT) to evaluate the efficacy of an electronic PDA on antidepressant use in pregnancy. DESIGN & SETTING A UK-based pilot parallel-group RCT. METHOD The study recruited women whose clinicians recommended an antidepressant for depression in a current or planned pregnancy, and who were uncertain about antidepressant use while pregnant. Women were recruited via clinician or self-referral, and randomised to online access to the PDA or online access to standard resource list, with primary follow-up at 4 weeks and longer-term follow-up. The primary outcome was protocol feasibility (recruitment target of 50 women and follow-up rate of 80%). Outcome measures for a future full-scale RCT included the decisional conflict scale (DCS). RESULTS Fifty-one women were recruited with a follow-up rate of 90.2% at 4 weeks. The PDA received good overall satisfaction ratings (mean 4.2/5). Analysis of covariance (ANCOVA) indicated a small improvement in decisional conflict at 4 weeks, accounting for baseline scores (DCS regression coefficient = -3.5, 95% confidence intervals [CI = -12.6 to 5.6]). CONCLUSION This pilot RCT for an electronic PDA on antidepressant use in pregnancy showed that the study protocol was feasible, with high rates of participant satisfaction among those randomised to the PDA.
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Affiliation(s)
- Hind Khalifeh
- Senior Clinical Researcher and Consultant Perinatal Psychiatrist, Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College London, London, UK
| | - Emma Molyneaux
- Research Associate and Honorary Lecturer, Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College London, London, UK
| | - Ruth Brauer
- Lecturer Pharmacoepidemiology, School of Pharmacy, University College London, London, UK
| | - Simone Vigod
- Associate Professor and Psychiatrist-in-Chief, Women's College Hospital and Women's College Research Institute, and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Louise M Howard
- Professor of Women's Mental Health, Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College London, London, UK
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Rotem-Kohavi N, Williams LJ, Muller AM, Abdi H, Virji-Babul N, Bjornson BH, Brain U, Werker JF, Grunau RE, Miller SP, Oberlander TF. Hub distribution of the brain functional networks of newborns prenatally exposed to maternal depression and SSRI antidepressants. Depress Anxiety 2019; 36:753-765. [PMID: 31066992 DOI: 10.1002/da.22906] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/07/2019] [Accepted: 04/10/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Prenatal maternal depression (PMD) and selective serotonin reuptake inhibitor (SSRI) antidepressants are associated with increased developmental risk in infants. Reports suggest that PMD is associated with hyperconnectivity of the insula and the amygdala, while SSRI exposure is associated with hyperconnectivity of the auditory network in the infant brain. However, associations between functional brain organization and PMD and/or SSRI exposure are not well understood. METHODS We examined the relation between PMD or SSRI exposure and neonatal brain functional organization. Infants of control (n = 17), depressed SSRI-treated (n = 20) and depressed-only (HAM-D ≥ 8) (n = 16) women, underwent resting-state functional magnetic resonance imaging at postnatal Day 6. At 6 months, temperament was assessed using Infant Behavioral Questionnaire (IBQ). We applied GTA and partial least square regression (PLSR) to the resting-state time series to assess group differences in modularity, and connector and provincial hubs. RESULTS Modularity was similar across all groups. The depressed-only group showed higher connector hub values in the left anterior cingulate, insula, and caudate as well as higher provincial hub values in the amygdala compared to the control group. The SSRI group showed higher provincial hub values in Heschl's gyrus relative to the depressed-only group. PLSR showed that newborns' hub values predicted 10% of the variability in infant temperament at 6 months, suggesting different developmental patterns between groups. CONCLUSIONS Prenatal exposures to maternal depression and SSRIs have differential impacts on neonatal functional brain organization. Hub values at 6 days predict variance in temperament between infant groups at 6 months of age.
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Affiliation(s)
- Naama Rotem-Kohavi
- Graduate Program in Neuroscience, School of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lynne J Williams
- BC Children Hospital MRI Research Facility, Vancouver, BC, Canada
| | - Angela M Muller
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Hervé Abdi
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas
| | - Naznin Virji-Babul
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Bruce H Bjornson
- Brain Mapping, Neuroinformatics and Neurotechnology Laboratory, Division of Neurology, British Columbia Children's Hospital, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada.,BC Children Hospital MRI Research Facility, Vancouver, BC, Canada
| | - Ursula Brain
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Janet F Werker
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Ruth E Grunau
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Steven P Miller
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Canada
| | - Tim F Oberlander
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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15
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Vigod SN, Hussain-Shamsy N, Stewart DE, Grigoriadis S, Metcalfe K, Oberlander TF, Schram C, Taylor VH, Dennis CL. A patient decision aid for antidepressant use in pregnancy: Pilot randomized controlled trial. J Affect Disord 2019; 251:91-99. [PMID: 30913472 DOI: 10.1016/j.jad.2019.01.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/29/2018] [Accepted: 01/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Decisions about antidepressant use in pregnancy are complex. We performed a pilot randomized controlled trial assessing the feasibility of a trial protocol for an online patient decision aid (PDA) for women deciding about antidepressant use in pregnancy. METHODS 96 preconception and pregnant Canadian women recruited from specialist (n = 51) and non-specialist (n = 45) settings with Decisional Conflict Scale (DCS, range 0-100) score of ≥25 signifying moderate-to-high decisional conflict were randomly allocated to either the PDA or a control condition that guided participants to publicly available resources for advice around antidepressants and pregnancy. Follow-up data were collected at 4 weeks post-randomization. RESULTS About 88.9% of eligible participants consented to participate. Women's views of the tool were positive; 88.7% of participants provided follow-up data. At follow-up, mean DCS score had decreased by 19.9 points in the PDA group vs. 13.3 in controls (adjusted mean difference, MD, 7.01, 95% CI -14.3 to 0.30). In the non-specialist setting, DCS scores decreased more for PDA users (25.5 points) than controls (10.5 points; adjusted MD -15.1, 95% CI -25.6 to -4.55); the MD was negligible in the specialist setting. LIMITATIONS The main limitation is the highly educated, high-income nature of our sample. CONCLUSIONS Evaluation of an online PDA for antidepressant use in pregnancy with national recruitment is feasible. Pilot results suggest that the tool is acceptable and reduces decisional conflict more than clinical care alone in a non-specialist setting. Evaluation of the PDA's impact on longer-term maternal and child clinical outcomes is a key next step.
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Affiliation(s)
- Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Women's College Hospital and Research Institute, Toronto, ON, Canada.
| | | | - Donna E Stewart
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada
| | - Sophie Grigoriadis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kelly Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carrie Schram
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Cindy-Lee Dennis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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16
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Alterations in Resting-State Networks Following In Utero Selective Serotonin Reuptake Inhibitor Exposure in the Neonatal Brain. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 4:39-49. [PMID: 30292808 DOI: 10.1016/j.bpsc.2018.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat depression during pregnancy. SSRIs cross the placenta, inhibit serotonin reuptake, and thereby are thought to alter central fetal serotonin signaling. Both prenatal maternal mood disturbances and in utero SSRI exposure have been associated with altered fetal and infant behavior. Resting-state functional magnetic resonance imaging has identified resting-state networks (RSNs) in newborns, reflecting functional capacity of auditory and visual networks and providing opportunities to examine early experiences effects on neurodevelopment. We sought to examine the effect of in utero SSRI exposure on neonatal RSN functional organization. We hypothesized that prenatal SSRI exposure would be associated with alterations in neonatal RSNs compared with healthy control infants and infants exposed to mothers with depression. METHODS Clinician-rated Hamilton Depression Rating Scale and self-reported Pregnancy Experiences Scale were completed during the third trimester. Control (n = 17), maternal depression-exposed (Hamilton Depression Rating Scale ≥8 without SSRI exposure, n = 16), and SSRI-exposed (n = 20) 6-day-old neonates underwent resting-state functional magnetic resonance imaging. Independent component analysis was used as a data-driven approach to extract 22 RSNs. RESULTS SSRI-exposed neonates had higher connectivity in a putative auditory RSN compared with depressed-only (p = .01) and control (p = .02) infants (corrected for multiple comparisons), controlling for sex, age at the magnetic resonance imaging, and Pregnancy Experiences Scale score. CONCLUSIONS Hyperconnectivity in auditory RSN in neonates with in utero SSRI exposure relative to neonates of depressed but not pharmacologically treated mothers and control infants may offer an insight into the functional organization origins of shifts in language perception and altered language development, previously reported in infants and children with prenatal SSRI exposure.
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17
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Niethe M, Whitfield K. Psychotropic medication use during pregnancy. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Miranda Niethe
- School of Pharmacy; The University of Queensland; Woolloongabba Australia
| | - Karen Whitfield
- School of Pharmacy; The University of Queensland; Woolloongabba Australia
- Royal Brisbane and Women's Hospital; Brisbane Australia
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18
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Molenaar NM, Kamperman AM, Boyce P, Bergink V. Guidelines on treatment of perinatal depression with antidepressants: An international review. Aust N Z J Psychiatry 2018; 52:320-327. [PMID: 29506399 PMCID: PMC5871019 DOI: 10.1177/0004867418762057] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Several countries have developed Clinical Practice Guidelines regarding treatment of perinatal depressive symptoms and perinatal use of antidepressant. We aimed to compare guidelines to guide clinicians in best clinical practice. METHODS An extensive search in guideline databases, MEDLINE and PsycINFO was performed. When no guidelines were (publicly) available online, we contacted psychiatric-, obstetric-, perinatal- and mood disorder societies of all first world countries and the five largest second world countries. Only Clinical Practice Guidelines adhering to quality criteria of the Appraisal of Guidelines for Research and Evaluation instrument and including a systematic review of evidence were included. Data extraction focussed on recommendations regarding continuation or withdrawal of antidepressants and preferred treatment in newly depressed patients. RESULTS Our initial search resulted in 1094 articles. After first screening, 40 full-text articles were screened. Of these, 24 were excluded for not being an official Clinical Practice Guidelines. In total, 16 Clinical Practice Guidelines were included originating from 12 countries. Eight guidelines were perinatal specific and eight were general guidelines. CONCLUSION During pregnancy, four guidelines advise to continue antidepressants, while there is a lack of evidence supporting this recommendation. Five guidelines do not specifically advise or discourage continuation. For new episodes, guidelines agree on psychotherapy (especially cognitive behavioural therapy) as initial treatment for mild to moderate depression and antidepressants for severe depression, with a preference for sertraline. Paroxetine is not preferred treatment for new episodes but switching antidepressants for ongoing treatment is discouraged (three guidelines). If mothers use antidepressants, observation of the neonate is generally recommended and breastfeeding encouraged.
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Affiliation(s)
- Nina M Molenaar
- Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands,Nina M Molenaar, Department of Psychiatry, Erasmus MC, Antwoordnummer 55, 3000 WB Rotterdam, The Netherlands.
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital, Westmead, NSW, Australia
| | - Veerle Bergink
- Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands,Current affiliation: Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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19
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Rotem-Kohavi N, Oberlander TF. Variations in Neurodevelopmental Outcomes in Children with Prenatal SSRI Antidepressant Exposure. Birth Defects Res 2017; 109:909-923. [DOI: 10.1002/bdr2.1076] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/25/2017] [Accepted: 06/01/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Naama Rotem-Kohavi
- Graduate Program in Neuroscience; University of British Columbia; Vancouver BC
- BC Children's Hospital Research Institute; Vancouver BC
| | - Tim F. Oberlander
- BC Children's Hospital Research Institute; Vancouver BC
- Department of Pediatrics; University of British Columbia; Vancouver BC
- School of Population and Public Health; University of British Columbia; Vancouver BC
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